To see that which cannot be seen: ontological differences and public health policies in Southern Chile

In this article, I explore different visual practices performed by Pehuenche Indigenous healers and state public health professionals in Southern Chile. While non‐Indigenous health workers seek to make ‘traditional’ Pehuenche healing visible within or alongside their own ‘modern’ practices, Pehuenche people are concerned with making visible the evil spirits whose ‘eating’ of persons produces illness. Focusing in particular on different healing practices triggered by the existence of Pehuenche spiritual illnesses that are ‘seen’ by both Indigenous healers and state professionals, this article discusses how different ontologies ground differences between the Indigenous healers and what they ‘see’; as well as how a broader and substantive binary between Pehuenche and non‐Pehuenche realities goes above and beyond these multiplicities. By exploring and discussing the endurance of Pehuenche cosmo‐political relations in a world inhabited by visible and invisible eaters, I hope to create awareness about how a failure to recognize these different realities limits current multicultural policies in Southern Chile, and Indigenous health policies more broadly. At a more theoretical level, the following ethnographic account sheds light on unresolved tensions between the ways ontological difference has been conceptualized within the so‐called ‘ontological turn’ in anthropology and within the field of Science and Technology Studies (STS).     

The elephant in the room - healthy brains in later life, epidemiology and public health

The increasing age of the population around the world has meant that greater attention is being paid to disorders that mainly affect older people. In particular, work is focusing on ways to preserve the healthy brain and prevent dementia. Preventive studies are complex and must take into account not only simple approaches such as those used in risk and outcome studies, but also stage of life, survival and mortality, and population context before their effect can be assessed. This paper presents questions and areas which must be explored if the potential for prevention of dementia during brain ageing is to be properly understood.     

What should the standard of proof be in scientific misconduct proceedings relating to public health service-funded research?

This article discusses the nature and purposes behind the three standards of proof commonly used in the United States. It summarizes the analytical constructs or standards of review courts commonly use to determine the constitutional validity of standards of proof (as well as other procedural protections) in physician disciplinary proceedings. It applies these constructs to the context of scientific misconduct and an illustrative case, and shows that sound policy and morals as well as procedural due process and equal protection provisions of the United States and some state constitutions require the use of the clear and convincing evidence standard of proof in scientific misconduct proceedings. That standard is necessary to protect scientists from misuse of scientific misconduct charges and proceedings, entailing, as they do, vast discretion in bureaucratic officials as well as staggering costs. The imminent rule making proceedings at the federal level will provide a special opportunity to right a wrong that long has been long visited upon academic scientists throughout the United States.     

Barriers to partnership working in public health: a qualitative study

Background

Public health provision in England is undergoing dramatic changes. Currently established partnerships are thus likely to be significantly disrupted by the radical reforms outlined in the Public Health White Paper. We therefore explored the process of partnership working in public health, in order to better understand the potential opportunities and threats associated with the proposed changes.

Methodology/Principal Findings

70 participants took part in an in-depth qualitative study involving 40 semi-structured interviews and three focus group discussions. Participants were senior and middle grade public health decision makers working in Primary Care Trusts, Local Authorities, Department of Health, academia, General Practice and Hospital Trusts and the third sector in England. Despite mature arrangements for partnership working in many areas, and much support for joint working in principle, many important barriers exist. These include cultural issues such as a lack of shared values and language, the inherent complexity of intersectoral collaboration for public health, and macro issues including political and resource constraints. There is particular uncertainty and anxiety about the future of joint working relating to the availability and distribution of scarce and diminishing financial resources. There is also the concern that existing effective collaborative networks may be completely disrupted as the proposed changes unfold. The extent to which the proposed reforms might mitigate or potentiate these issues remains unclear. However the threats currently remain more salient than opportunities.

Conclusions

The current re-organisation of public health offers real opportunity to address some of the barriers to partnership working identified in this study. However, significant threats exist. These include the breakup of established networks, and the risk of cost cutting on effective public health interventions.     

Hepatitis C virus infection among First Nation and non-First Nation people in Manitoba, Canada: a public health laboratory study

Demographic information and laboratory test results on 136 169 clinical serum specimens submitted to the public health laboratory in Manitoba, Canada, for hepatitis C virus (HCV) testing between January 1995 and December 2003 were analyzed. The difference in the clearance rates of HCV infection, without therapeutic intervention, and the HCV genotypes infecting First Nation and non-First Nation people were studied. The rates of co-infection of HCV-positive individuals with other hepatitis viruses were also compared between the two study groups. The results of the analyses of the data indicated that there was a 4.4-fold increase in the number of specimens tested and a 4.9-fold decrease in HCV antibody (anti-HCV) positive cases during the study period. The proportion of specimens submitted for testing from First Nation individuals was lower than their proportion in the Manitoba population. Our study also indicated that there was a significantly higher proportion of First Nation patients who had self-limiting infection (patients cleared the infection and became HCV RNA negative without anti-HCV treatment) in comparison to non-First Nation patients. The proportion of First Nation females who had self-limiting infection was significantly higher than non-First Nation females. HCV genotype 1 infection represented more than 60% of HCV infection in Manitoba. The rate of individuals positive for the hepatitis A virus antibody in the HCV-positive population was higher among First Nation than non-First Nation individuals. On the other hand, there were more HCV-infected First Nation patients than non-First Nation patients who were not immune to the hepatitis B virus. The data indicate that fewer First Nation patients seek anti-HCV therapy in comparison to non-First Nation. In conclusion, the differences in the rates of HCV self-limiting infection between First Nation and non-First Nation individuals in Manitoba may reflect the genetic differences between the two cohorts, which may consequently affect the immune response to the HCV infection.     

Molecular diagnostics in infectious diseases and public health microbiology: cottage industry to postgenomics

Molecular methods have been used increasingly over the past ten years to improve the sensitivity and speed of diagnosis in infectious diseases. Although their routine use is still limited to the detection of pathogens that are difficult to culture in vitro,'real-time' methods, commercial kits, quantification and automation will increase potential applications. Molecular methods are now widely used for epidemiological fingerprinting of isolates of public health importance. Sequence-based identification and strain typing, together with the development of tools that can probe for thousands of markers, will allow detailed strain fingerprinting to assist in disease management and control.