Exploration of Work and Health Disparities among Black Women Employed in Poultry Processing in the Rural South

We describe an ongoing collaboration that developed as academic investigators responded to a specific request from community members to document health effects on black women of employment in poultry-processing plants in rural North Carolina. Primary outcomes of interest are upper extremity musculoskeletal disorders and function as well as quality of life. Because of concerns of community women and the history of poor labor relations, we decided to conduct this longitudinal study in a manner that did not require involvement of the employer. To provide more detailed insights into the effects of this type of employment, the epidemiologic analyses are supplemented by ethnographic interviews. The resulting approach requires community collaboration. Community-based staff, as paid members of the research team, manage the local project office, recruit and retain participants, conduct interviews, coordinate physical assessments, and participate in outreach. Other community members assisted in the design of the data collection tools and the recruitment of longitudinal study participants and took part in the ethnographic component of the study. This presentation provides an example of one model through which academic researchers and community members can work together productively under challenging circumstances. Notable accomplishments include the recruitment and retention of a cohort of low-income rural black women, often considered hard to reach in research studies. This community-based project includes a number of elements associated with community-based participatory research

Robbins, Moore County : a community diagnosis including secondary data analysis and qualitative data collection

This document is the product of a community diagnosis of Robbins, North Carolina. A community diagnosis is a process that aims to understand the strengths, challenges, and issues of importance for a community, through a review of existing data and interviews with community members and service providers. The document is intended to serve as a comprehensive resource for Robbins residents to use in order to achieve community goals. It was created by six graduate students in the Department of Health Behavior and Health Education at the School of Public Health, at the University of North Carolina at Chapel Hill, with the support of FirstHealth of the Carolinas. The community diagnosis of Robbins began in September of 1999 and lasted through April of 2000. The process included three phases. The first phase, secondary data collection, began in the fall of 1999. This phase included the collection of existing data, such as U.S. Census data, economic data, health statistics, and other indicators from local, county, and state sources. To gain an understanding of the town's history and current issues, local newspapers and town documents were also utilized. When possible, information was collected from Robbins, Moore County, and North Carolina for comparison purposes. The second phase of the community diagnosis was the primary data collection, which began in November of 1999 and continued through the spring of 2000. The primary data collection included interviewing community members and service providers highlighting the strengths and challenges of the community. The final phase of the community diagnosis was a community forum (the Northern Moore Community Forum), held in Robbins. This included a presentation to Robbins residents, of the primary and secondary data collected, a discussion among the residents of the findings, and a consideration by the residents of possible solutions to issues presented. EXECUTIVE SUMMARY It was clear that residents have a clear comprehension of issues in the community. Salient issues that emerged from the qualitative data from the interviews almost exactly mirrored the quantitative data collected earlier. Some residents felt that the health issues that the secondary data described were not representative of the same health problems Robbins residents faced, but health problems were not considered a pertinent issue to the town much, if at all. Overall, the secondary and primary data were reflective of each other. Robbins, North Carolina is located in northwest Moore County. The incorporated town of Robbins is one square mile; the Robbins zip code encompasses this area, and several other rural areas surrounding the town. As we began to work in Robbins, we learned that many people define the Robbins area differently. To some, Robbins represents northern Moore County, and includes neighboring communities such as High Falls and Westmoore. Others felt that those communities had their own sense of identity and were separate from Robbins. For the purposes of this document, we chose to define Robbins by its zip code, and include some of the neighboring rural areas. Additionally, we chose to interview people that identified themselves as Robbins residents or service providers in the area. Because of the size of the town, many of the service providers were also residents. There were limitations in the data collection process that are important to consider. Most of the secondary data was only available at the county level; therefore, the secondary data found may not be representative of the town of Robbins. The only source that provided community-level information was the 1990 U.S. Census. However, because the Census is ten years old, the information presented may not be completely descriptive of the community. In an effort to describe changes in the demographics of the community, we utilized current hospital birth records and school enrollment figures. Limitations in the primary data collection include population sample, “social desirability” bias (the tendency to report answers to interview questions that are considered socially desirable), and sample size. Although attempts were made to interview people of all age, racial, and socioeconomic groups in Robbins, it is apparent that the interviews we conducted may not be representative of the entire Robbins community. We were aware of the population growth of Hispanics, but due to language barriers, we were only able to interview four Hispanic individuals. Due to time constraints, we did not conduct a random selection of the community, and so we cannot be assured of representativeness. Additionally, as with any type of social research about delicate issues, it is possible that the answers we were given to certain interview questions were not as accurate as possible; some participants may have tried to give “socially desirable” answers, and some may not have answered to the best of their knowledge due to the fear of being labeled in such a small town (note: confidentiality was assured in all interviews). Finally, our sample size was smaller than we would have liked due to inclement weather in January and time constraints. Because a larger sample size is more likely to be generalized to the whole population of Robbins, this is a considerable limitation. During our interviews, we learned of many of the issues most pertinent to Robbins residents. Community members and service providers enjoyed talking about their town, and described Robbins as a community of many strengths. Residents of Robbins are proud to live in a small, safe, close-knit community, and they feel strong ties to their neighbors. We were repeatedly told that the strength of Robbins is its people. This feeling of community connectedness among the townspeople is illustrated in the community projects that the town has undertaken together. In recent years, Robbins has experienced an influx of Hispanics, and this change has presented a significant challenge to the town. The biggest obstacle posed is the language barrier, and Robbins is working towards solutions to this issue. The schools employ bilingual teachers in an effort to meet this need, and many residents expressed that they would like the opportunity to take Spanish classes. Many community members feel that the Hispanic community is separated from the larger town, and although this division is partially due to language barriers, understanding cultural differences is also a problem the town is trying to address. In the past decade, Robbins has experienced a shift in the town industry. Traditionally a mill town, Robbins is now experiencing growth in the poultry and furniture industries. Still, many residents are leaving Robbins to work elsewhere. Some residents expressed concern that the community will not grow unless more industry and jobs are available in the town. It is possible that Robbins’ children may not return to their hometown to work and raise their families if the lack of employment opportunities continues. Other issues that emerged during our interviews with community members and service providers include housing, education, and health care. Residents remarked about the need for improvements in the quantity and quality of adequate housing in the town. Education was a concern, especially regarding the debate over the consolidation of the middle school and the need to address the issues related to the rise in the Hispanic population within the Robbins school system. The need for more health care providers in Robbins was an issue expressed numerous times by residents, and is a topic that needs further attention in order to offer Robbins more options for convenient health care. At the community forum residents enthusiastically discussed these issues, and many expressed a desire to address the challenges that each poses. Recommendations concerning these issues are highlighted as a means to assist future decisions and solutions for the Robbins community. We hope that the information presented in the following chapters will be a tool to assist with decision making for the present and the future. Robbins is a strong community, built on a foundation of committed citizens dedicated to ensuring a bright future for their town.Master of Public Healt

The origins and persistence of Homo floresiensis on Flores: biogeographical and ecological perspectives

The finding of archaeological evidence predating 1 Ma and a small hominin species (Homo floresiensis) on Flores, Indonesia, has stimulated much research on its origins and ancestry. Here we take a different approach and examine two key questions – 1) how did the ancestors of H. floresiensis reach Flores and 2) what are the prospects and difficulties of estimating the likelihood of hominin persistence for over 1 million years on a small island? With regard to the first question, on the basis of the biogeography we conclude that the mammalian, avian, and reptilian fauna on Flores arrived from a number of sources including Java, Sulawesi and Sahul. Many of the terrestrial taxa were able to float or swim (e.g. stegodons, giant tortoises and the Komodo dragon), while the rodents and hominins probably accidentally rafted from Sulawesi, following the prevailing currents. The precise route by which hominins arrived on Flores cannot at present be determined, although a route from South Asia through Indochina, Sulawesi and hence Flores is tentatively supported on the basis of zoogeography. With regards to the second question, we find the archaeological record equivocal. A basic energetics model shows that a greater number of small-bodied hominins could persist on Flores than larger-bodied hominins (whether H. floresiensis is a dwarfed species or a descendent of an early small-bodied ancestor is immaterial here), which may in part explain their apparent long-term success. Yet the frequent tsunamis and volcanic eruptions in the region would certainly have affected all the taxa on the island, and at least one turnover event is recorded, when Stegodon sondaari became extinct. The question of the likelihood of persistence may be unanswerable until we know much more about the biology of H. floresiensis

Version 2 of the HIPPARCOS Input Catalogue

International audienc

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London