143 research outputs found

    Employing Community-based Participatory Research Approaches to Improve Local Influenza Pandemic Preparedness in Remote and Isolated Canadian First Nations Communities

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    Background: Public health emergencies, such as influenza pandemics, continue to disproportionately impact Aboriginal Canadians (First Nations, Inuit, and Métis), especially those populations residing in geographically remote areas. Previous influenza pandemic plans reflected inadequacies with regards to addressing the pre-existing inequalities and special needs of Aboriginal Canadians during an influenza pandemic, and this may be attributed to their limited participation during preparedness efforts. Significant barriers hinder the ability of Aboriginal Canadians to effectively participate in preparedness efforts and there is a limited amount of information of how to operationalize their participation. By addressing the identified barriers to participation, community-based participatory research (CBPR) offers a promising framework and strategy to facilitate the effective participation of Aboriginal Canadians in influenza pandemic preparedness efforts. Objectives: The overall objective of this dissertation was to explore the use of CBPR approaches to engage community members in directing how to improve local influenza pandemic preparedness in remote and isolated Canadian First Nations communities. This dissertation consisted of five manuscripts grouped into three overarching studies; all of which employed a CBPR approach. The objectives for Study I were to qualitatively identify the needs and explore the potential of using a collaborative health informatics system (CHIS) to improve the delivery of health care services during an influenza pandemic response while also identifying any perceived barriers of implementing such a system. Study II used a qualitative questionnaire to examine the experiences, perceptions, and recommendations regarding implementing measures to mitigate the effects of an influenza pandemic. Study III was a cross-sectional survey conducted to gain an understanding of the bird harvesting practices and knowledge, risk perceptions, and attitudes regarding avian influenza among subsistence hunters and discussed related implications to future influenza pandemic plans. Methods: The initial needs assessment of Study I involved conducting semi-directed interviews with community-based health care professionals (n=9) residing in three remote and isolated Canadian First Nations communities to explore the use of the CHIS. The second needs assessment of Study I was conducted with one of the initial three study communities and involved semi-directed interviews and focus groups with community-based health care professionals (n=16). Questions were specifically developed to further explore issues that emerged from the initial needs assessment. Interviews were transcribed verbatim and open, axial, and selective coding were used to create the emerging concepts and categories. Study II involved conducting interviewer-administered questionnaires with community-based health care professionals (n=9) residing in three remote and isolated Canadian First Nations communities to explore the experiences, perceptions, and recommendations regarding forty-one mitigation measures. The collected qualitative data were transcribed verbatim and deductively analyzed following a template organizing approach. The cross-sectional survey of Study III was conducted with subsistence hunters (n=106) residing in a remote and isolated First Nations community. The survey employed twenty closed-ended questions related to bird harvesting practices, knowledge, risk perceptions, and attitudes about hunting influenza-infected birds. Two open-ended questions allowed for participants to describe their risk perceptions of avian influenza as well as any additional concerns. Simple descriptive statistics, cross-tabulations, and analysis of variance (ANOVA) were used to examine the distributions and relationships between variables. Written responses were transcribed verbatim and deductively analyzed following a template organizing approach. Results: For the initial needs assessment of Study I, the fifty-five emerging concepts were organized into five categories, including: general issues, potential benefits, potential uses, useful technical functions and suggested technical modifications, and concerns. Participants stated that the CHIS could improve the delivery of health care services by tracking and mapping the occurrence of disease outbreaks, along with facilitating communication and health information sharing between the involved health care organizations. Some concerns of the CHIS were noted, namely the concern of accessibility safeguards considering that confidential health information would be inputted, stored, and presented. For the second needs assessment of Study I, one hundred and thirty eight emerging concepts were organized into four overarching categories, including: level of intra- and inter-government agency communication and collaboration, health information sharing within and between government agencies, patient charting and reporting, and solutions. It was noted that having different jurisdictions responsible for providing health care services hindered the ability to share patient’s health information and provide quality health care. Participants stated that the CHIS could potentially be utilized to help manage a response by facilitating inter-agency communication, collaboration, and health information sharing. For Study II, participants reported that thirty mitigation measures were used during their response to the 2009 H1N1 influenza pandemic (A(H1N1)pdm09). Although participants reported that most measures were modified or altered when being implemented to address the unique characteristics of their communities. All of the mitigation measures implemented during A(H1N1)pdm09 were considered to be effective, along with three measures that were not used and one additional measure suggested by a participant. Measures were considered to be effective particularly if the measure aided in decreasing virus transmission, protecting their high-risk population, and increasing community awareness about influenza pandemics. Participants reported that lack of resources, minimal community awareness, overcrowding in homes, and inadequate health care infrastructure hindered the implementation of some mitigation measures. The list of community-informed recommended mitigation measures created from the collected data revealed many discrepancies when compared to national recommendations and existing literature. For Study III, the findings indicated that subsistence hunters partook in some practices while harvesting wild birds that could potentially expose them to avian influenza, although appropriate levels of compliance with some protective measures were reported. More than half of the respondents were generally aware of avian influenza, with fewer being aware of key signs and symptoms, and almost one third perceived a risk of becoming infected with avian influenza while harvesting birds. Participants aware of avian influenza were more likely to perceive a risk of being infected with avian influenza while harvesting birds. The results suggested that knowledge of avian influenza positively influenced the use of a recommended protective measure. Regarding attitudes about hunting influenza-infected birds, the results revealed that the percentage of hunters who would cease harvesting birds increased as avian influenza was detected in birds in more nearby geographic areas. Conclusions: Study I highlighted that the CHIS was viewed as being a useful and valuable tool to improve the delivery of health care, among other potential functions, during an influenza pandemic response. Study II highlighted the perceived barriers to implementing nationally recommended mitigation measures and supports the notion of recommending pandemic control strategies in remote and isolated Canadian First Nations communities that may not be supported in other communities. And Study III revealed a need for more education that is culturally-appropriate about avian influenza and precautions First Nations subsistence hunters can take to reduce the possibility of being exposed to avian influenza while harvesting wild birds. Moreover, the inclusion of First Nations subsistence hunters as an avian influenza risk group with associated special considerations in future influenza pandemic plans seems warranted. In general, the three overarching studies of this dissertation display the importance and value of employing CBPR approaches to engage locally impacted populations in improving influenza pandemic preparedness. The CBPR processes used and findings revealed throughout this dissertation can be used to inform future influenza pandemic preparedness efforts to improve the response capacity and health outcomes of Canadian First Nations residing in remote and isolated communities during the next influenza pandemic

    The 2009 H1N1 Health Sector Pandemic Response in Remote and Isolated First Nation Communities of Sub-Arctic Ontario, Canada

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    On June 11, 2009, the World Health Organization declared a global influenza pandemic due to a novel influenza A virus subtype of H1N1. Public health emergencies, such as an influenza pandemic, can potentially impact disadvantaged populations disproportionately due to underlying social factors. Canada’s First Nation population was severely impacted by the 2009 H1N1 influenza pandemic. Most First Nation communities suffer from poor living conditions, impoverished lifestyles, lack of access to adequate health care, and uncoordinated health care delivery. Also, there are vulnerable populations who suffer from co-morbidities who are at a greater risk of falling ill. Moreover, First Nation communities that are geographically remote (nearest service center with year-round road access is located over 350 kilometers away) and isolated (only accessible by planes year-round) face additional challenges. For example, transportation of supplies and resources may be limited, especially during extreme weather conditions. Therefore, remote and isolated First Nation communities face unique challenges which must be addressed by policy planners in order to mitigate the injustice that may occur during a public health emergency. The Assembly of First Nations noted that there has been very little inclusion of First Nations’ input into current federal and provincial pandemic plans. Disadvantaged groups know best how they will be affected by a public health emergency and are able to identify barriers and solutions. Therefore, the objective of my research was to gain retrospective insight into the barriers faced by three remote and isolated First Nation communities of sub-arctic Ontario (i.e., Fort Albany, Attawapiskat, and Kashechewan) during their 2009 H1N1 pandemic response. Culturally-appropriate community-based suggestions for improvement of existing community-level pandemic plans were also elicited. Collected data informed modifications to community-level pandemic plans, thereby directly applying research findings. Being a qualitative community-based participatory study, First Nation community members were involved in many aspects of this research. Semi-directed interviews were conducted with adult key informants (n=13) using purposive sampling of participants representing the three main sectors responsible for health care services (i.e., federal health centers, provincial hospitals, and Band Councils). Data were manually transcribed and coded using deductive and inductive thematic analysis to reveal similarities and differences experienced within and between each community (and government body) regarding their respective pandemic response. Another round of semi-directed interviews (n=4) and community pandemic committee meetings were conducted to collect additional information to guide the modifications to the community-level pandemic plans. Reported barriers due to being geographically remote and isolated included the following: overcrowding in houses, insufficient human resources, and inadequate community awareness. Primary barriers faced by government bodies responsible for health care delivery were reported as follows: receiving contradicting governmental guidelines and direction from many sources, lack of health information sharing, and insufficient details in community-level pandemic plans. Suggested areas for improvement included increasing human resources (i.e., nurses and trained health care professionals), funding for supplies, and community awareness. Additionally, participants recommended that complementary communication plans should be developed. As suggested by participants, community-specific information was added to update community-level pandemic plans. Remote and isolated First Nation communities faced some barriers during their 2009 H1N1 health sector pandemic response. Government bodies should focus efforts to provide more support in terms of human resources, monies, and education. In addition, various government organizations should collaborate to improve housing conditions, timely access to resources, and the level of coordination regarding health care delivery. Furthermore, as pandemic plans are dynamic, government bodies should continue to aide First Nation communities with updating their community-level pandemic plans to satisfy their evolving needs. These recommendations should be addressed so that remote and isolated western James Bay First Nation communities and other similar communities can be better prepared for the next public health emergency.1 yea

    Designing Assignments to Establish a Foundation for Evidenceâ Based Practice in an Undergraduate Clinical Nursing Course

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    Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142903/1/wvn12198.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142903/2/wvn12198_am.pd

    Colonic miRNA Expression/Secretion, Regulated by Intestinal Epithelial PepT1, Plays an Important Role in Cell-to-Cell Communication during Colitis

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    PepT1 is a member of the proton-oligopeptide cotransporter family SLC15, which mediates the transport of di/tripeptides from intestinal lumen into epithelial cells. MicroRNAs (miRNAs), a small noncoding RNAs (21–23 nucleotides), posttranscriptionally regulate gene expression by binding to the 39-untranslated regions (UTRs) of their target mRNAs. Although the role of most miRNAs remains elusive, they have been implicated in vital cellular functions such as intestinal epithelial cells differentiation, proliferation, and apoptosis. In the present study, we investigated the effect of intestinal epithelial PepT1 expression on microRNA (miRNA) expression/secretion in the colons of control mice and in mice with experimentally induced colonic inflammation (colitis). The colonic miRNA expression was deregulated in both colitis and control mice but the deregulation of miRNA expression/secretion was specific to colonic tissue and did not affect other tissues such as spleen and liver. Intestinal epithelial PepT1-dependent deregulation of colonic miRNA expression not only affects epithelial cells but also other cell types, such as intestinal macrophages. Importantly, we found the miRNA 23b which was known to be involved in inflammatory bowel disease was secreted and transported between cells to impose a gene-silencing effect on recipient intestinal macrophages. Based on our data, we may conclude that the expression of a specific protein, PepT1, in the intestine affects local miRNA expression/secretion in the colon on a tissue specific manner and may play an important role during the induction and progression of colitis. Colonic miRNA expression/secretion, regulated by intestinal epithelial PepT1, could play a crucial role in cell-to-cell communication during colitis

    Efficacy of HIV/STI behavioral interventions for heterosexual African American men in the United States: a meta-analysis

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    This meta-analysis estimates the overall efficacy of HIV prevention interventions to reduce HIV sexual risk behaviors and sexually transmitted infections (STIs) among heterosexual African American men. A comprehensive search of the literature published during 1988–2008 yielded 44 relevant studies. Interventions significantly reduced HIV sexual risk behaviors and STIs. The stratified analysis for HIV sexual risk behaviors indicated that interventions were efficacious for studies specifically targeting African American men and men with incarceration history. In addition, interventions that had provision/referral of medical services, male facilitators, shorter follow-up periods, or emphasized the importance of protecting family and significant others were associated with reductions in HIV sexual risk behaviors. Meta-regression analyses indicated that the most robust intervention component is the provision/referral of medical services. Findings indicate that HIV interventions for heterosexual African American men might be more efficacious if they incorporated a range of health care services rather than HIV/STI-related services alone

    Assessing Impact of COVID-19 Pandemic on Receipt and Timeliness of Newborn Hearing Screening and Diagnostic Services Among Infants Born in Four States

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    The study compares receipt and timeliness of newborn hearing screening and follow-up diagnostic services between the pre-pandemic birth cohort and the pandemic birth cohort in four participating states. Findings from this study will help inform state Early Hearing Detection and Intervention (EHDI) programs in the future should major public health event occur again

    Dextran Sodium Sulfate (DSS) Induces Colitis in Mice by Forming Nano-Lipocomplexes with Medium-Chain-Length Fatty Acids in the Colon

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    Inflammatory bowel diseases (IBDs), primarily ulcerative colitis and Crohn's disease, are inflammatory disorders caused by multiple factors. Research on IBD has often used the dextran sodium sulfate (DSS)-induced colitis mouse model. DSS induces in vivo but not in vitro intestinal inflammation. In addition, no DSS-associated molecule (free glucose, sodium sulfate solution, free dextran) induces in vitro or in vivo intestinal inflammation. We find that DSS but not dextran associated molecules established linkages with medium-chain-length fatty acids (MCFAs), such as dodecanoate, that are present in the colonic lumen. DSS complexed to MCFAs forms nanometer-sized vesicles ∼200 nm in diameter that can fuse with colonocyte membranes. The arrival of nanometer-sized DSS/MCFA vesicles in the cytoplasm may activate intestinal inflammatory signaling pathways. We also show that the inflammatory activity of DSS is mediated by the dextran moieties. The deleterious effect of DSS is localized principally in the distal colon, therefore it will be important to chemically modify DSS to develop materials beneficial to the colon without affecting colon-targeting specificity

    Smart Partnerships to Increase Equity in Education

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    This exploratory analysis of smart partnerships identifies the risk of increasing the digital divide with the deployment of data analytics. Smart partnerships in education appear to include a process of evolution into a synergy of strategic and holistic approaches that enhance the quality of education with digital technologies, harnessing ICT “smartly” both in relation to learning and support of the partnership itself. To guide strategic development as data analytics start to emerge in the schooling sector, two cases of large multi-stakeholder partnership initiatives aiming to increase access to education with ICT nationwide in India and Malaysia are analyzed. Mapping the partners’ collaborative activities in Davis’ Arena of change with digital technologies enabled the identification of both local and global influences in that ecological framework, which inform the choice of partners and their roles to increase equitable access to education. Research and development is recommended so that multi-stakeholder partnerships leverage data analytics alongside technology enhanced learning in the schooling sector with strategies that proactively increase equity

    Microbiota Modulate Host Gene Expression via MicroRNAs

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    Microbiota are known to modulate host gene expression, yet the underlying molecular mechanisms remain elusive. MicroRNAs (miRNAs) are importantly implicated in many cellular functions by post-transcriptionally regulating gene expression via binding to the 3′-untranslated regions (3′-UTRs) of the target mRNAs. However, a role for miRNAs in microbiota-host interactions remains unknown. Here we investigated if miRNAs are involved in microbiota-mediated regulation of host gene expression. Germ-free mice were colonized with the microbiota from pathogen-free mice. Comparative profiling of miRNA expression using miRNA arrays revealed one and eight miRNAs that were differently expressed in the ileum and the colon, respectively, of colonized mice relative to germ-free mice. A computational approach was then employed to predict genes that were potentially targeted by the dysregulated miRNAs during colonization. Overlapping the miRNA potential targets with the microbiota-induced dysregulated genes detected by a DNA microarray performed in parallel revealed several host genes that were regulated by miRNAs in response to colonization. Among them, Abcc3 was identified as a highly potential miRNA target during colonization. Using the murine macrophage RAW 264.7 cell line, we demonstrated that mmu-miR-665, which was dysregulated during colonization, down-regulated Abcc3 expression by directly targeting the Abcc3 3′-UTR. In conclusion, our study demonstrates that microbiota modulate host microRNA expression, which could in turn regulate host gene expression
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