Primary Health care and Disasters—The Current State of the Literature: What We Know, Gaps and Next Steps

Introduction: The 2009 Global Platform for Disaster Risk Reduction/Emergency Preparedness (DRR/EP) and the Hyogo Framework for Action 2005-2015 demonstrate increased international commitment to DRR/EP in addition to response and recovery. In addition, the World Health Report 2008 has re-focused the world's attention on the renewal of Primary Health Care (PHC) as a set of values/principles for all sectors. Evidence suggests that access to comprehensive PHC improves health outcomes and an integrated PHC approach may improve health in low income countries (LICs). Strong PHC health systems can provide stronger health emergency management, which reinforce each other for healthier communities. Problem: The global re-emphasis of PHC recently necessitates the health sector and the broader disaster community to consider health emergency management from the perspective of PHC. How PHC is being described in the literature related to disasters and the quality of this literature is reviewed. Identifying which topics/lessons learned are being published helps to identify key lessons learned, gaps and future directions. Methods: Fourteen major scientific and grey literature databases searched. Primary Health Care or Primary Care coupled with the term disaster was searched (title or abstract). The 2009 ISDR definition of disaster and the 1978 World Health Organization definition of Primary Health Care were used. 119 articles resulted. Results: Literature characteristics; 16% research papers, only 29% target LICs, 8% of authors were from LICs, 7% clearly defined PHC, 50% used PHC to denote care provided by clinicians and 4% cited PHC values and principles. Most topics related to disaster response. Key topics; true need for PHC, mental health, chronic disease, models of PHC, importance of PHC soon after a natural disaster relative to acute care, methods of surge capacity, utilization patterns in recovery, access to vulnerable populations, rebuilding with the PHC approach and using current PHC infrastructure to build capacity for disasters. Conclusions: Primary Health Care is very important for effective health emergency management during response and recovery, but also for risk reduction, including preparedness. There is need to; increase the quality of this research, clarify terminology, encourage paper authorship from LICs, develop and validate PHC- specific disaster indicators and to encourage organizations involved in PHC disaster activities to publish data. Lessons learned from high-income countries need contextual analysis about applicability in low-income countrie

Translational use of homing peptides: Tumor and placental targeting

HypothesisTissue-specific homing peptides have been shown to improve chemotherapeutic efficacy due to their trophism for tumor cells. Other sequences that selectively home to the placenta are providing new and safer therapeutics to treat complications in pregnancy. Our hypothesis is that the placental homing peptide RSGVAKS (RSG) may have binding affinity to cancer cells, and that insight can be gained into the binding mechanisms of RSG and the tumor homing peptide CGKRK to model membranes that mimic the primary lipid compositions of the respective cells.ExperimentsFollowing cell culture studies on the binding efficacy of the peptides on a breast cancer cell line, a systematic translational characterization is delivered using ellipsometry, Brewster angle microscopy and neutron reflectometry of the extents, structures, and dynamics of the interactions of the peptides with the model membranes on a Langmuir trough.FindingsWe start by revealing that RSG does indeed have binding affinity to breast cancer cells. The peptide is then shown to exhibit stronger interactions and greater penetration than CGKRK into both model membranes, combined with greater disruption to the lipid component. RSG also forms aggregates bound to the model membranes, yet both peptides bind to a greater extent to the placental than cancer model membranes. The results demonstrate the potential for varying local reservoirs of peptide within cell membranes that may influence receptor binding. The innovative nature of our findings motivates the urgent need for more studies involving multifaceted experimental platforms to explore the use of specific peptide sequences to home to different cellular targets

The Role of Dietary Advanced Glycation End Products in Metabolic Dysfunction

Open Access via the Wiley Jisc Deal Funded by: Rural and Environment Science and Analytical Services Division Commonwealth Scientific and Industrial Research Organisation (CSIRO; Australia)Peer reviewedPublisher PD

Stroke Quality Measures in Mexican Americans and Non-Hispanic Whites

Mexican Americans (MAs) have been shown to have worse outcomes after stroke than non-Hispanic Whites (NHWs), but it is unknown if ethnic differences in stroke quality of care may contribute to these worse outcomes. We investigated ethnic differences in the quality of inpatient stroke care between MAs and NHWs within the population-based prospective Brain Attack Surveillance in Corpus Christi (BASIC) Project (February 2009- June 2012). Quality measures for inpatient stroke care, based on the 2008 Joint Commission Primary Stroke Center definitions were assessed from the medical record by a trained abstractor. Two summary measure of overall quality were also created (binary measure of defect-free care and the proportion of measures achieved for which the patient was eligible). 757 individuals were included (480 MAs and 277 NHWs). MAs were younger, more likely to have hypertension and diabetes, and less likely to have atrial fibrillation than NHWs. MAs were less likely than NHWs to receive tPA (RR: 0.72, 95% confidence interval (CI) 0.52, 0.98), and MAs with atrial fibrillation were less likely to receive anticoagulant medications at discharge than NHWs (RR 0.73, 95% CI 0.58, 0.94). There were no ethnic differences in the other individual quality measures, or in the two summary measures assessing overall quality. In conclusion, there were no ethnic differences in the overall quality of stroke care between MAs and NHWs, though ethnic differences were seen in the proportion of patients who received tPA and anticoagulant at discharge for atrial fibrillation

Healthier choices in an Australian health service : a pre-post audit of an intervention to improve the nutritional value of foods and drinks in vending machines and food outlets

Background: Vending machines and shops located within health care facilities are a source of food and drinks for staff, visitors and outpatients and they have the potential to promote healthy food and drink choices. This paper describes perceptions of parents and managers of health-service located food outlets towards the availability and labelling of healthier food options and the food and drinks offered for sale in health care facilities in Australia. It also describes the impact of an intervention to improve availability and labelling of healthier foods and drinks for sale. Methods: Parents (n = 168) and food outlet managers (n = 17) were surveyed. Food and drinks for sale in health-service operated food outlets (n = 5) and vending machines (n = 90) in health care facilities in the Hunter New England region of NSW were audited pre (2007) and post (2010/11) the introduction of policy and associated support to increase the availability of healthier choices. A traffic light system was used to classify foods from least (red) to most healthy choices (green). Results: Almost all (95%) parents and most (65%) food outlet managers thought food outlets on health service sites should have signs clearly showing healthy choices. Parents (90%) also thought all food outlets on health service sites should provide mostly healthy items compared to 47% of managers. The proportion of healthier beverage slots in vending machines increased from 29% to 51% at follow-up and the proportion of machines that labelled healthier drinks increased from 0 to 26%. No outlets labelled healthier items at baseline compared to 4 out of 5 after the intervention. No changes were observed in the availability or labelling of healthier food in vending machines or the availability of healthier food or drinks in food outlets. Conclusions: Baseline availability and labelling of healthier food and beverage choices for sale in health care facilities was poor in spite of the support of parents and outlet managers for such initiatives. The intervention encouraged improvements in the availability and labelling of healthier drinks but not foods in vending machines

CGH and SNP array using DNA extracted from fixed cytogenetic preparations and long-term refrigerated bone marrow specimens

<p>Abstract</p> <p>Background</p> <p>The analysis of nucleic acids is limited by the availability of archival specimens and the quality and amount of the extracted material. Archived cytogenetic preparations are stored in many laboratories and are a potential source of total genomic DNA for array karyotyping and other applications. Array CGH using DNA from fixed cytogenetic preparations has been described, but it is not known whether it can be used for SNP arrays. Diagnostic bone marrow specimens taken during the assessment of hematological malignancies are also a potential source of DNA, but it is generally assumed that DNA must be extracted, or the specimen frozen, within a day or two of collection, to obtain DNA suitable for further analysis. We have assessed DNA extracted from these materials for both SNP array and array CGH.</p> <p>Results</p> <p>We show that both SNP array and array CGH can be performed on genomic DNA extracted from cytogenetic specimens stored in Carnoy's fixative, and from bone marrow which has been stored unfrozen, at 4°C, for at least 36 days. We describe a procedure for extracting a usable concentration of total genomic DNA from cytogenetic suspensions of low cellularity.</p> <p>Conclusions</p> <p>The ability to use these archival specimens for DNA-based analysis increases the potential for retrospective genetic analysis of clinical specimens. Fixed cytogenetic preparations and long-term refrigerated bone marrow both provide DNA suitable for array karyotyping, and may be suitable for a wider range of analytical procedures.</p

Impact of Canadian tobacco packaging policy on quitline reach and reach equity

AbstractObjectiveTo examine the impact of the new Canadian tobacco package warning labels with a quitline toll-free phone number for seven provincial quitlines, focusing on treatment reach and reach equity in selected vulnerable groups.MethodsA quasi-experimental design assessed changes in new incoming caller characteristics, treatment reach for selected vulnerable sub-populations and the extent to which this reach is equitable, before and after the introduction of the labels in June, 2012. Administrative call data on smokers were collected at intake. Pre- and post-label treatment reach and reach equity differences were analysed by comparing the natural logarithms of the reach and reach equity statistics.ResultsDuring the six months following the introduction of the new warning labels, 86.4% of incoming new callers indicated seeing the quitline number on the labels. Treatment reach for the six-month period significantly improved compared to the same six-month period the year before from .042% to .114% (p<.0001) and reach equity significantly improved for young males (p<.0001) and those with high school education or less (p=.004).ConclusionsThe introduction of the new tobacco warning labels with a quitline toll-free number in Canada was associated with an increase in treatment reach. The toll-free number on tobacco warning labels aided in reducing tobacco related inequalities, such as improved reach equity for young males and those with high school or less education

Evidence Collection for the Unconscious and Unconsented Patient

Forensic nurses are faced with making an ethical decision when an unconscious patient presents with signs of sexual assault. If the patient is unable to consent, the nurses need to decide whether or not to perform a forensic exam. Hospitals have policies in place regarding consent for emergency care, but not all of them consider the collection of forensic evidence. The window of opportunity for forensic collection may disappear before contacts are made or proper consent is established.\ud Ethical, legal, and policy considerations that complicate this scenario are discussed