Caribbean Heat Threatens Health, Well-Being, and the Future of Humanity

Climate change has substantial impacts on public health and safety, disease risks and the provision of health care, with the poor being particularly disadvantaged. Management of the associated health risks and changing health service requirements requires adequate responses at local levels. Health-care providers are central to these responses. While climate change raises ethical questions about its causes, impacts and social justice, medicine and bioethics typically focus on individual patients and research participants rather than these broader issues. We broaden this focus by examining awareness among health-care providers in the Caribbean region, where geographic and socioeconomic features pose particular vulnerabilities to climate change. In focus groups, Caribbean providers described rises in mosquito-borne, flood-related, heat-related, respiratory and mental illnesses, and attributed these to local impacts of climate change. Their discussions showed that the significance of these impacts differs in different Caribbean nations, raising policy and social justice questions. Bioethics and public health ethics are situated to frame, inform and initiate public and policy dialog about values and scientific evidence associated with climate change. We urge readers to initiate such dialog within their own institutions about the context-dependent nature of the burdens of climate change, and values and policies that permit it to worsen

United Airways Disease Among Florists

Previously we observed an excess risk for occupational asthma among florists with rhinitis. To further evaluate the link between upper and lower airways, we investigated united airways disease in the same occupational group. Occupational history, symptoms and atopy were investigated among 128 florists. Age-, smoking-, and gender-adjusted risks were calculated using logistic regression models comparing symptomatic and asymptomatic individuals. The prevalence of work-related rhinitis symptoms was 13.3%, conjunctivitis symptoms and asthma-like symptoms were 14.1%. We observed an excess risk of work-related asthma symptoms among florists with work-related conjunctivitis (OR: 8.5, 95% CI: 2.4-29.9) and rhinitis (OR: 13.1, 95% CI: 3.0- 58.0). Florists with positive allergen skin test for flower mix were 13.0 times more likely to have work-related rhinitis and 12.5 times more likely to have work-related conjunctivitis. The observed relationship between work-related asthma and rhinoconjunctivitis is supportive of the concept of the united airways disease

Nursing, Physical Therapy, and Cytotechnology Graduate and Undergraduate Students\u27 Attitudes Toward Teamwork Before and After Participation in an Interprofessional Education Experience

BACKGROUND Educating health professional (HP) students in environments wherein they can learn about, from, and with each other can prepare them for interprofessional collaborative practice (IPCP), which may positively impact patient safety and satisfaction (Brashers et al., 2015; Health Professions Accreditors Collaborative [HPAC], 2019). IPCP is characterized by effective communication, shared values, respect for diverse disciplines and teamwork among health professionals (IOM, 2015). However, professional silos in practice can foster competition rather than collaboration. Knowledge of HP roles and responsibilities is a primary tenet of IPCP (Interprofessional Educational Collaborative [IPEC], 2011). PURPOSE An interprofessional education (IPE) approach that combined book reading, a presentation by the author of the book, and small group discussion of a case study focused on patient safety was used to introduce students to HP roles and responsibilities and to highlight the benefits of IPCP. Patient safety is an effective platform for engaging students in IPE learning and exposing them to the benefits of teamwork and interprofessional collaboration as demonstrated in this study. METHOD Block randomization was used to assign graduate and undergraduate students (N=167) to interprofessional groups for the IPE learning, including case discussions. There were 20 groups of 8 students and one group with the remaining 7 students. The group compositions were reviewed and it was verified prior to data collection that each group had interprofessional representation of students based on their programs of study. Most students in our sample had two or more prior IPE experiences. Pre- and post-participation attitudes about teamwork were assessed using the Teamwork, Roles, and Responsibilities (TRR) subscale of the Interprofessional Attitudes Scale (IPAS). RESULTS There were significant changes in student attitudes toward teamwork (p \u3c .05) and significant differences in scores based on discipline, prior IPE learning and level (graduate or undergraduate) with moderate to large effect sizes. CONCLUSION This study demonstrates how IPE can be implemented through co-curricular learning to build upon prior IPE learning to improve both graduate and undergraduate students’ attitudes toward teamwork

Mental Health and Drivers of Need in Emergent and Non-Emergent Emergency Department (ED) Use: Do Living Location and Non-Emergent Care Sources Matter?

Emergency department (ED) utilization has increased due to factors such as admissions for mental health conditions, including suicide and self-harm. We investigate direct and moderating influences on non-emergent ED utilization through the Behavioral Model of Health Services Use. Through logistic regression, we examined correlates of ED use via 2014 New York State Department of Health Statewide Planning and Research Cooperative System outpatient data. Consistent with the primary hypothesis, mental health admissions were associated with emergent use across models, with only a slight decrease in effect size in rural living locations. Concerning moderating effects, Spanish/Hispanic origin was associated with increased likelihood for emergent ED use in the rural living location model, and non-emergent ED use for the no non-emergent source model. \u27Other\u27 ethnic origin increased the likelihood of emergent ED use for rural living location and no non-emergent source models. The findings reveal \u27need\u27, including mental health admissions, as the largest driver for ED use. This may be due to mental healthcare access, or patients with mental health emergencies being transported via first responders to the ED, as in the case of suicide, self-harm, manic episodes or psychotic episodes. Further educating ED staff on this patient population through gatekeeper training may ensure patients receive the best treatment and aid in driving access to mental healthcare delivery changes

Demansı Olan Bireyde Davranışsal Problemleri Azaltmada Kanıta Dayalı Bir Model: Azalmış Stres Eşiği Modeli

Demans, toplumun yaşlanması ile birlikte görülme sıklığı giderek artan bir sendromdur. Demansın evresi ilerledikçe, her bireyde tipi veşiddeti değişen oranlarda davranışsal sorunlar gözlenmektedir. Bu davranışsal sorunlar, hem hastalara bakım veren sağlık personelinin hemde aile üyelerinin, bakım sürecini devam ettirmelerini güçleştirmekte ve yaşam kalitelerini düşürmektedir. Bunun sonucu olarak da demanslıbireylerin kurumlara yatırılma oranları artmaktadır. Azalmış Stres Eşiği Modeli, demansı olan bireylerde görülen davranışsal sorunlarıazaltmak için geliştirilmiş nonfarmakolojik bir modeldir. Bu model, demanslı bireylerin yaşadıkları çevrenin, bilişsel yetilerdeki kayıplarauygun bir şekilde düzenlenmesi ile daha az stresli ortam yaratılması temeline odaklanmaktadır. Hemşirelerin azalmış stres eşiği modelinedayandırarak yapacakları girişimler ile davranışsal sorunları olan demanslı bireylerin bakımları hem hemşireler hem de bakım verenlertarafından en iyi şekilde yönetilebilecektir. Bu makalede demanslı bireye sunulacak hemşirelik uygulamalarına ışık tutacak bir model olanazalmış stres eşiği modelinin teorik çerçevesi açıklanacaktır. Dementia is a syndrome of increasing prevalence with aging of society. Stage of dementia progresses, the type and severity of the behavioralproblems observed in varying proportions for each people with dementia. These behavioral problems, both medical staff who are caring forpeople with dementia and their caregivers makes it difficult to continue the process of care and reduces the quality of life. As a result of this,people with dementia is increasing rates of admission institutions. Progressively Lowered Stress Threshold Model (PLST) is anonpharmacologic model and developed to reduce behavioral problems seen in people with dementia. PLST, focus on the patientsenvironment, in accordance with the regulation of cognitive losses, creation of less stressful environment. When the nursing interventionsbased on the PLST, the behavioral problems of people with dementia to be managed in the best way from nurses and caregivers. In thisarticle, PLST model will be described in a theoretical framework, which is shed light on the nursing interventions for people with dementi

Interaction Between Climatic, Environmental, and Demographic Factors on Cholera Outbreaks in Kenya

Background: Cholera remains an important public health concern in developing countries including Kenya where 11,769 cases and 274 deaths were reported in 2009 according to the World Health Organization (WHO). This ecological study investigates the impact of various climatic, environmental, and demographic variables on the spatial distribution of cholera cases in Kenya. Methods: District-level data was gathered from Kenya’s Division of Disease Surveillance and Response, the Meteorological Department, and the National Bureau of Statistics. The data included the entire population of Kenya from 1999 to 2009. Results: Multivariate analyses showed that districts had an increased risk of cholera outbreaks when a greater proportion of the population lived more than five kilometers from a health facility (RR: 1.025 per 1% increase; 95% CI: 1.010, 1.039), bordered a body of water (RR: 5.5; 95% CI: 2.472, 12.404), experienced increased rainfall from October to December (RR: 1.003 per 1 mm increase; 95% CI: 1.001, 1.005), and experienced decreased rainfall from April to June (RR: 0.996 per 1 mm increase; 95% CI: 0.992, 0.999). There was no detectable association between cholera and population density, poverty, availability of piped water, waste disposal methods, rainfall from January to March, or rainfall from July to September. Conclusion: Bordering a large body of water, lack of health facilities nearby, and changes in rainfall were significantly associated with an increased risk of cholera in Kenya

Spine deformities in patients with Ehlers-Danlos syndrome, type IV - late results of surgical treatment

<p>Abstract</p> <p>Background</p> <p>Spinal deformities in Ehlers-Danlos syndrome are usually progressive and may require operative treatment. There is limited number of studies describing late results of surgery in this disease.</p> <p>Methods</p> <p>This is a retrospective study of the records of 11 patients with Ehlers-Danlos syndrome type IV, treated surgically between 1990 and 2007. All patients underwent surgical treatment for spinal deformity. Duration of operation, type of instrumentation, intraoperative blood loss, complications and number of additional surgeries were noted. Radiographic measurement was performed on standing AP and lateral radiographs acquired before surgery, just after and at final follow up.</p> <p>Results</p> <p>The mean follow up period was 5.5 ± 2.9 years (range 1-10 years). The mean preoperative thoracic and lumbar curve were 109.5 ± 19.9° (range 83° - 142°) and 75.6 ± 26.7° (range 40° - 108°) respectively. Posterior spine fusion alone was performed on 6 patients and combined anterior and posterior fusion (one- or two stage) on 5 cases. Posterior segmental spinal instrumentation was applied with use of hooks, screws and wires. The mean postoperative thoracic and lumbar curve improved to 79.3 ± 16.1° (range 56° - 105°) and 58.5 ± 27.7° (range 10° - 95°) respectively, with a slight loss of correction during follow up. The average thoracic and lumbar correction was 26.4 ± 14.9% (range 5.3 - 50.4%) and 26.3 ± 21.2% (range 7.9 - 75%). Postoperatively, the mean kyphosis was 79.5 ± 40.3° (range 21° -170°), and lordosis was 50.8 ± 18.6° (range 20° -79°). Hyperkyphosis increased during follow up while lordosis remained stable. Mean Th12-L2 angle was -3.5 ±9.9° (range -19° - 15°) postoperatively and did not change significantly during follow up.</p> <p>Conclusions</p> <p>Huge spinal deformities in patients with Ehlers-Danlos syndrome require complex and extensive surgery. There is a big risk of sagittal imbalance in this group.</p

Quantification of Biomolecular Dynamics Inside Real and Synthetic Nuclear Pore Complexes Using Time-Resolved Atomic Force Microscopy

Over the past decades, atomic force microscopy (AFM) has emerged as an increasingly powerful tool to study the dynamics of biomolecules at nanometer length scales. However, the more stochastic the nature of such biomolecular dynamics, the harder it becomes to distinguish them from AFM measurement noise. Rapid, stochastic dynamics are inherent to biological systems comprising intrinsically disordered proteins. One role of such proteins is in the formation of the transport barrier of the nuclear pore complex (NPC): the selective gateway for macromolecular traffic entering or exiting the nucleus. Here, we use AFM to observe the dynamics of intrinsically disordered proteins from two systems: the transport barrier of native NPCs and the transport barrier of a mimetic NPC made using a DNA origami scaffold. Analyzing data recorded with 50-200 ms temporal resolution, we highlight the importance of drift correction and appropriate baseline measurements in such experiments. In addition, we describe an autocorrelation analysis to quantify time scales of observed dynamics and to assess their veracity-an analysis protocol that lends itself to the quantification of stochastic fluctuations in other biomolecular systems. The results reveal the surprisingly slow rate of stochastic, collective transitions inside mimetic NPCs, highlighting the importance of FG-nup cohesive interactions