Introduction: The rural and remote nature of many First Nations communities in Northwestern Ontario, Canada poses unique obstacles to physically accessing health care, in addition to other barriers. ...Indigenous peoples face similar challenges globally. First Nations communities experience significant health inequities, including cancer burden, which can be attributed to complex factors associated with colonization and Westernization. One potentially promising intervention to decrease the burden of advanced cancers is the provision of accessible, convenient and culturally sensitive cancer screening services, leading to early detection and treatment. The Wequedong Lodge Cancer Screening Program (WLCSP) was a pilot project aiming to provide cancer screening education and opportunistic cancer screening to residents from rural and remote First Nations communities while accessing health services in the urban center of Thunder Bay, Ontario, Canada.
Methods: Cancer screening education and opportunistic breast, cervical and colorectal cancer screening appointments were offered to individuals and their travel escorts already staying at Wequedong Lodge. Program uptake was determined primarily by education participation, and secondarily by client participation in screening.
Results: In total, the WLCSP booked 1033 appointments, with 841 being attended. Over the program's 3 years there was an increase in clients each year. Specifically, 22% (60/275) of age-eligible women completed a mammogram. Pap tests were provided to 8% (45/554) of age-eligible females. Finally, 32% (106/333) of all age-eligible service participants were given a fecal occult blood test kit. An evaluation survey (n=396) demonstrated overall client satisfaction with the program.
Conclusion: The WLCSP aimed to provide education about, access to and uptake of cancer screening services for First Nations people from rural and remote communities in Northwestern Ontario by targeting inequalities in accessing cancer screening opportunities. Therefore, program uptake may provide helpful numerical comparisons for similar future programs globally. Other entities working to improve cancer screening rates in remote and/or rural populations and/or amongst Indigenous peoples may find consideration of the WLCSP processes, successes and challenges helpful to their efforts.
Introduction: The rural and remote nature of many First Nations communities in Northwestern Ontario, Canada poses unique obstacles to physically accessing health care, in addition to other barriers. ...Indigenous peoples face similar challenges globally. First Nations communities experience significant health inequities, including cancer burden, which can be attributed to complex factors associated with colonization and Westernization. One potentially promising intervention to decrease the burden of advanced cancers is the provision of accessible, convenient and culturally sensitive cancer screening services, leading to early detection and treatment. The Wequedong Lodge Cancer Screening Program (WLCSP) was a pilot project aiming to provide cancer screening education and opportunistic cancer screening to residents from rural and remote First Nations communities while accessing health services in the urban center of Thunder Bay, Ontario, Canada.
Methods: Cancer screening education and opportunistic breast, cervical and colorectal cancer screening appointments were offered to individuals and their travel escorts already staying at Wequedong Lodge. Program uptake was determined primarily by education participation, and secondarily by client participation in screening.
Results: In total, the WLCSP booked 1033 appointments, with 841 being attended. Over the program's 3 years there was an increase in clients each year. Specifically, 22% (60/275) of age-eligible women completed a mammogram. Pap tests were provided to 8% (45/554) of age-eligible females. Finally, 32% (106/333) of all age-eligible service participants were given a fecal occult blood test kit. An evaluation survey (n=396) demonstrated overall client satisfaction with the program.
Conclusion: The WLCSP aimed to provide education about, access to and uptake of cancer screening services for First Nations people from rural and remote communities in Northwestern Ontario by targeting inequalities in accessing cancer screening opportunities. Therefore, program uptake may provide helpful numerical comparisons for similar future programs globally. Other entities working to improve cancer screening rates in remote and/or rural populations and/or amongst Indigenous peoples may find consideration of the WLCSP processes, successes and challenges helpful to their efforts.
Avian host life history traits have been hypothesized to predict rates of infection by haemosporidian parasites. Using molecular techniques, we tested this hypothesis for parasites from three ...haemosporidian genera (Plasmodium, Haemoproteus, and Leucocytozoon) collected from a diverse sampling of birds in northern Malawi. We found that host life history traits were significantly associated with parasitism rates by all three parasite genera. Nest type and nest location predicted infection probability for all three parasite genera, whereas flocking behavior is an important predictor of Plasmodium and Haemoproteus infection and habitat is an important predictor of Leucocytozoon infection. Parasite prevalence was 79.1% across all individuals sampled, higher than that reported for comparable studies from any other region of the world. Parasite diversity was also exceptionally high, with 248 parasite cytochrome b lineages identified from 152 host species. A large proportion of Plasmodium, Haemoproteus, and Leucocytozoon parasite DNA sequences identified in this study represent new, previously undocumented lineages (n = 201; 81% of total identified) based on BLAST queries against the avian malaria database, MalAvi.
Substantial increases in pediatric and adult obesity in the US have prompted a major revision to the current UF/NCI (University of Florida/National Cancer Institute) family of hybrid computational ...phantoms to more accurately reflect current trends in larger body morphometry. A decision was made to construct the new library in a gridded fashion by height/weight without further reference to age-dependent weight/height percentiles as these become quickly outdated. At each height/weight combination, circumferential parameters were defined and used for phantom construction. All morphometric data for the new library were taken from the CDC NHANES survey data over the time period 1999-2006, the most recent reported survey period. A subset of the phantom library was then used in a CT organ dose sensitivity study to examine the degree to which body morphometry influences the magnitude of organ doses for patients that are underweight to morbidly obese in body size. Using primary and secondary morphometric parameters, grids containing 100 adult male height/weight bins, 93 adult female height/weight bins, 85 pediatric male height/weight bins and 73 pediatric female height/weight bins were constructed. These grids served as the blueprints for construction of a comprehensive library of patient-dependent phantoms containing 351 computational phantoms. At a given phantom standing height, normalized CT organ doses were shown to linearly decrease with increasing phantom BMI for pediatric males, while curvilinear decreases in organ dose were shown with increasing phantom BMI for adult females. These results suggest that one very useful application of the phantom library would be the construction of a pre-computed dose library for CT imaging as needed for patient dose-tracking.
OBJECTIVE:To demonstrate the feasibility of a placebo-controlled trial of antipsychotics for delirium in the intensive care unit and to test the hypothesis that antipsychotics would improve days ...alive without delirium or coma.
DESIGN:Randomized, double-blind, placebo-controlled trial.
SETTING:Six tertiary care medical centers in the US.
PATIENTS:One hundred one mechanically ventilated medical and surgical intensive care unit patients.
INTERVENTION:Patients were randomly assigned to receive haloperidol or ziprasidone or placebo every 6 hrs for up to 14 days. Twice each day, frequency of study drug administration was adjusted according to delirium status, level of sedation, and side effects.
MEASUREMENTS AND MAIN OUTCOMES:The primary end point was the number of days patients were alive without delirium or coma. During the 21-day study period, patients in the haloperidol group spent a similar number days alive without delirium or coma (median interquartile range, 14.0 6.0–18.0 days) as did patients in the ziprasidone (15.0 9.1–18.0 days) and placebo groups (12.5 1.2–17.2 days; p = 0.66). No differences were found in secondary clinical outcomes, including ventilator-free days (p = .25), hospital length of stay (p = .68), and mortality (p = .81). Ten (29%) patients in the haloperidol group reported symptoms consistent with akathisia, compared with six (20%) patients in the ziprasidone group and seven (19%) patients in the placebo group (p = .60), and a global measure of extrapyramidal symptoms was similar between treatment groups (p = .46).
CONCLUSIONS:A randomized, placebo-controlled trial of antipsychotics for delirium in mechanically ventilated intensive care unit patients is feasible. Treatment with antipsychotics in this limited pilot trial did not improve the number of days alive without delirium or coma, nor did it increase adverse outcomes. Thus, a large trial is needed to determine whether use of antipsychotics for intensive care unit delirium is appropriate.
TRIAL REGISTRATION:ClinicalTrials.gov, number NCT00096863.
Problem, research strategy, and findings: Disaster impacts result from interactions between hazard exposure, physical vulnerability, and social vulnerability. We report empirical work from 1992′s ...Hurricane Andrew in Miami-Dade (FL) and 2008′s Hurricane Ike in Galveston (TX) to assess long-term trends in housing recovery. Longitudinal, parcel-level data on housing units along with neighborhood sociodemographic data permit analysis of the pace of recovery for different neighborhoods, populations, and housing types. Housing recovery is highly uneven for different population groups. Unsurprisingly, damage has major consequences; even after four years, the effects of damage are evident in the rebuilding process. Social vulnerability factors play differently in different settings. In Miami, income and race and ethnicity were critical determinants of higher losses and slower recovery rates, while in Galveston income was the more critical factor, with housing in lower-income areas suffering more damage and lagging significantly in the recovery process.
Takeaway for practice: Effective land use policy and building codes can reduce physical vulnerability and ultimately damage, thus enhancing resilience for all. Differentials in impact and recovery trajectories suggest that assessment and the monitoring of recovery is critical to target resources to areas that are lagging. Perhaps most important is having an effective plan in place that addresses housing recovery issues to help reduce long-term consequences. Pre-event planning for housing and social change can help support community vision and overcome inequities.
OBJECTIVE:Decades-old, common ICU practices including deep sedation, immobilization, and limited family access are being challenged. We endeavoured to evaluate the relationship between ABCDEF bundle ...performance and patient-centered outcomes in critical care.
DESIGN:Prospective, multicenter, cohort study from a national quality improvement collaborative.
SETTING:68 academic, community, and federal ICUs collected data during a 20-month period.
PATIENTS:15,226 adults with at least one ICU day.
INTERVENTIONS:We defined ABCDEF bundle performance (our main exposure) in two ways1) complete performance (patient received every eligible bundle element on any given day) and 2) proportional performance (percentage of eligible bundle elements performed on any given day). We explored the association between complete and proportional ABCDEF bundle performance and three sets of outcomespatient-related (mortality, ICU and hospital discharge), symptom-related (mechanical ventilation, coma, delirium, pain, restraint use), and system-related (ICU readmission, discharge destination). All models were adjusted for a minimum of 18 a priori determined potential confounders.
MEASUREMENTS AND RESULTS:Complete ABCDEF bundle performance was associated with lower likelihood of seven outcomeshospital death within 7 days (adjusted hazard ratio, 0.32; CI, 0.17–0.62), next-day mechanical ventilation (adjusted odds ratio AOR, 0.28; CI, 0.22–0.36), coma (AOR, 0.35; CI, 0.22–0.56), delirium (AOR, 0.60; CI, 0.49–0.72), physical restraint use (AOR, 0.37; CI, 0.30–0.46), ICU readmission (AOR, 0.54; CI, 0.37–0.79), and discharge to a facility other than home (AOR, 0.64; CI, 0.51–0.80). There was a consistent dose-response relationship between higher proportional bundle performance and improvements in each of the above-mentioned clinical outcomes (all p < 0.002). Significant pain was more frequently reported as bundle performance proportionally increased (p = 0.0001).
CONCLUSIONS:ABCDEF bundle performance showed significant and clinically meaningful improvements in outcomes including survival, mechanical ventilation use, coma, delirium, restraint-free care, ICU readmissions, and post-ICU discharge disposition.
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