TRAUMA-RELATED NIGHTMARES AMONG AMERICAN INDIAN VETERANS: VIEWS FROM THE DREAM CATCHER

Abstract: Dreams hold particular relevance in mental health work with American Indians (AI

Moving Towards a New Vision: Implementation of a Public Health Policy Intervention

Background Public health systems in Canada have undergone significant policy renewal over the last decade in response to threats to the public’s health, such as severe acute respiratory syndrome. There is limited research on how public health policies have been implemented or what has influenced their implementation. This paper explores policy implementation in two exemplar public health programs -chronic disease prevention and sexually-transmitted infection prevention - in Ontario, Canada. It examines public health service providers’, managers’ and senior managements’ perspectives on the process of implementation of the Ontario Public Health Standards 2008 and factors influencing implementation. Methods Public health staff from six health units representing rural, remote, large and small urban settings were included. We conducted 21 focus groups and 18 interviews between 2010 (manager and staff focus groups) and 2011 (senior management interviews) involving 133 participants. Research assistants coded transcripts and researchers reviewed these; the research team discussed and resolved discrepancies. To facilitate a breadth of perspectives, several team members helped interpret the findings. An integrated knowledge translation approach was used, reflected by the inclusion of academics as well as decision-makers on the team and as co-authors. Results Front line service providers often were unaware of the new policies but managers and senior management incorporated them in operational and program planning. Some participants were involved in policy development or provided feedback prior to their launch. Implementation was influenced by many factors that aligned with Greenhalgh and colleagues’ empirically-based Diffusion of Innovations in Service Organizations Framework. Factors and related components that were most clearly linked to the OPHS policy implementation were: attributes of the innovation itself; adoption by individuals; diffusion and dissemination; the outer context – interorganizational networks and collaboration; the inner setting – implementation processes and routinization; and, linkage at the design and implementation stage. Conclusions Multiple factors influenced public health policy implementation. Results provide empirical support for components of Greenhalgh et al’s framework and suggest two additional components – the role of external organizational collaborations and partnerships as well as planning processes in influencing implementation. These are important to consider by government and public health organizations when promoting new or revised public health policies as they evolve over time. A successful policy implementation process in Ontario has helped to move public health towards the new vision

Migraine and risk of cardiovascular disease in women: Prospective cohort study

Objective To evaluate the association between migraine and incident cardiovascular disease and cardiovascular mortality in women. Design Prospective cohort study among Nurses’ Health Study II participants, with follow-up from 1989 and through June 2011. Setting Cohort of female nurses in United States. Participants 115 541 women aged 25-42 years at baseline and free of angina and cardiovascular disease. Cumulative follow-up rates were more than 90%. Main outcome measures The primary outcome of the study was major cardiovascular disease, a combined endpoint of myocardial infarction, stroke, or fatal cardiovascular disease. Secondary outcome measures included individual endpoints of myocardial infarction, stroke, angina/coronary revascularization procedures, and cardiovascular mortality. Results 17 531 (15.2%) women reported a physician’s diagnosis of migraine. Over 20 years of follow-up, 1329 major cardiovascular disease events occurred and 223 women died from cardiovascular disease. After adjustment for potential confounding factors, migraine was associated with an increased risk for major cardiovascular disease (hazard ratio 1.50, 95% confidence interval 1.33 to 1.69), myocardial infarction (1.39, 1.18 to 1.64), stroke (1.62, 1.37 to 1.92), and angina/coronary revascularization procedures (1.73, 1.29 to 2.32), compared with women without migraine. Furthermore, migraine was associated with a significantly increased risk for cardiovascular disease mortality (hazard ratio 1.37, 1.02 to 1.83). Associations were similar across subgroups of women, including by age (<50/≥50), smoking status (current/past/never), hypertension (yes/no), postmenopausal hormone therapy (current/not current), and oral contraceptive use (current/not current). Conclusions Results of this large, prospective cohort study in women with more than 20 years of follow-up indicate a consistent link between migraine and cardiovascular disease events, including cardiovascular mortality. Women with migraine should be evaluated for their vascular risk. Future targeted research is warranted to identify preventive strategies to reduce the risk of future cardiovascular disease among patients with migraine

Trends in Socioeconomic Inequalities in Ischemic Heart Disease, 2000-2012

Introduction Low socioeconomic position (SEP) is an important risk factor for ischemic heart disease (IHD). Current surveillance methods use area-based SEP measures to monitor trends in socioeconomic inequalities in IHD. The extent to which these methods underestimate individual-level socioeconomic inequalities in IHD is unclear. Objectives and Approach The study objective was to estimate socioeconomic trends in IHD by household income and material deprivation in Ontario from 2000 to 2012. A pooled cross-sectional study was conducted using data from 6 Canadian Community Health Survey (CCHS) cycles (2000-2012) linked to the Discharge Abstract Database (n= 119,529 over 35 years of age, 55% female). Relative-weighted Poisson regression models were used to estimate IHD prevalence rates (adjusted for age, sex, ethnicity and immigration) across quintiles of equivalized household income and area-level material deprivation. Socioeconomic inequalities were estimated using the slope index of inequality (SII) and relative index of inequality (RII). Results Socioeconomic inequalities in IHD were observed across income and material deprivation quintiles. Measured using the SII, adjusted IHD rates were 345 per 10,000 (95%CI: 207,483) higher at the bottom of the income distribution than the top in 2000, decreasing to 167 per 10,000 (95%CI: 40,293) by 2012. These differences represented 2.52 (95%CI: 1.58,3.46) times higher IHD rates in 2000, an increased risk that remained in 2012 (RII: 1.80, 95%CI: 0.97,2.63). A similar pattern was observed across material deprivation quintiles, however with smaller absolute and relative inequalities observed in 2000 (SII:195 per 10,000, 95%CI:79,312; RII:1.64, 95%CI:1.16,2.11) and 2012 (SII:142 per 10,000, 95%CI:16,268; RII:1.54, 95%CI:0.94,2.14). Conclusion/Implications Consistent socioeconomic inequalities in IHD were observed in Ontario, with an absolute reduction between 2000 and 2012. Area-level material deprivation underestimated individual-level socioeconomic inequalities in IHD

The prevalence and correlates of texting while driving among a population-based sample of Ontario students

Objective: Texting while driving (TWD) has a deleterious impact on driving performance and may pose a significant challenge to traffic safety. This challenge may be particularly relevant for young and inexperienced drivers. This study examined the prevalence and risk factors of writing text messages or emails while driving during the past 12 months. Method: This study analyzed a subpopulation of 1,133 licensed students 16 years of age or older from the 2013 Ontario Student Drug Use Survey (OSDUHS), a population-based survey of students in Ontario, Canada. Results: Our results indicate that 36% of licensed drivers reported writing a text message while driving during the past 12 months; of those who did, 56% reported doing so 4 or more times. Graduated licensing was the strongest factor predicting TWD. Compared to students with the more restrictive G1 license, students with a G2 or full license were 9.4 times more likely to report TWD after controlling for the effect of all other factors. Older students, white students, and students attending school in urban centers were more likely to report TWD, and the amount of time spent on social media sites, being a passenger with a driver using substances, and past-year collisions were also significantly associated with TWD. Gender differences and participation in driver education training were not associated with TWD. Conclusions: This research demonstrates that TWD is an extremely common behavior among licensed student drivers in Ontario, particularly among those who have passed the first stage of graduated licensing. TWD is associated with other risky driving behaviors and outcomes, and the findings from this study underscore the need to better understand the harms associated with this behavior

Elevated urinary CRELD2 is associated with endoplasmic reticulum stress-mediated kidney disease

ER stress has emerged as a signaling platform underlying the pathogenesis of various kidney diseases. Thus, there is an urgent need to develop ER stress biomarkers in the incipient stages of ER stress-mediated kidney disease, when a kidney biopsy is not yet clinically indicated, for early therapeutic intervention. Cysteine-rich with EGF-like domains 2 (CRELD2) is a newly identified protein that is induced and secreted under ER stress. For the first time to our knowledge, we demonstrate that CRELD2 can serve as a sensitive urinary biomarker for detecting ER stress in podocytes or renal tubular cells in murine models of podocyte ER stress-induced nephrotic syndrome and tunicamycin- or ischemia-reperfusion-induced acute kidney injury (AKI), respectively. Most importantly, urinary CRELD2 elevation occurs in patients with autosomal dominant tubulointerstitial kidney disease caused by UMOD mutations, a prototypical tubular ER stress disease. In addition, in pediatric patients undergoing cardiac surgery, detectable urine levels of CRELD2 within postoperative 6 hours strongly associate with severe AKI after surgery. In conclusion, our study has identified CRELD2 as a potentially novel urinary ER stress biomarker with potential utility in early diagnosis, risk stratification, treatment response monitoring, and directing of ER-targeted therapies in selected patient subgroups in the emerging era of precision nephrology

The ethics of biobanking: key issues and controversies

The ethics of biobanking is one of the most controversial issues in current bioethics and public health debates. For some, biobanks offer the possibility of unprecedented advances which will revolutionise research and improve the health of future generations. For others they are worrying repositories of personal information and tissue which will be used without sufficient respect for those from whom they came. Wherever one stands on this spectrum, from an ethics perspective biobanks are revolutionary. Traditional ethical safeguards of informed consent and confidentiality, for example, simply don’t work for the governance of biobanks and as a result new ethical structures are required. Thus it is not too great a claim to say that biobanks require a rethinking of our ethical assumptions and frameworks which we have applied generally to other issues in ethics. This paper maps the key challenges and controversies of biobanking ethics; it considers; informed consent (its problems in biobanking and possibilities of participants’ withdrawal), broad consent, the problems of confidentiality, ownership, property and comercialisation issues, feedback to participants and the ethics of re-contact

A computational framework for modelling infectious disease policy based on age and household structure with applications to the COVID-19 pandemic

The widespread, and in many countries unprecedented, use of non-pharmaceutical interventions (NPIs) during the COVID-19 pandemic has highlighted the need for mathematical models which can estimate the impact of these measures while accounting for the highly heterogeneous risk profile of COVID-19. Models accounting either for age structure or the household structure necessary to explicitly model many NPIs are commonly used in infectious disease modelling, but models incorporating both levels of structure present substantial computational and mathematical challenges due to their high dimensionality. Here we present a modelling framework for the spread of an epidemic that includes explicit representation of age structure and household structure. Our model is formulated in terms of tractable systems of ordinary differential equations for which we provide an open-source Python implementation. Such tractability leads to significant benefits for model calibration, exhaustive evaluation of possible parameter values, and interpretability of results. We demonstrate the flexibility of our model through four policy case studies, where we quantify the likely benefits of the following measures which were either considered or implemented in the UK during the current COVID-19 pandemic: control of within- and between-household mixing through NPIs; formation of support bubbles during lockdown periods; out-of-household isolation (OOHI); and temporary relaxation of NPIs during holiday periods. Our ordinary differential equation formulation and associated analysis demonstrate that multiple dimensions of risk stratification and social structure can be incorporated into infectious disease models without sacrificing mathematical tractability. This model and its software implementation expand the range of tools available to infectious disease policy analysts