Obstetrician-Gynecologists’ Knowledge of Health Disparities and Barriers among American Indian/Alaska Native Women in Washington State

Background: Health disparities between American Indian/Alaska Native (AI/AN) women and other races/ethnicities have long been noted. Obstetricians-Gynecologists (Ob-Gyn) play a significant role in well-woman care and are often the first and most frequent point of medical contact for women, particularly among minority and low-income women. Objective: This study aimed to assess Ob-Gyns’ knowledge, beliefs, and practices related to health disparities among AI/AN women. Method: A self-administered questionnaire, consisting of questions about knowledge, beliefs, and practices of health disparities among AI/AN women, was mailed to 722 members of The American College of Obstetricians and Gynecologists (ACOG) practicing in the state of Washington in September 2013-February 2014. Results: The majority of respondents were knowledgeable about numerous health care disparities among non-pregnant AI/AN women, while slightly fewer were aware of disparities among pregnant AI/AN patients. Ob-Gyns reported low confidence in their training and knowledge of AI/AN culture and health disparities, but high confidence in their ability to treat AI/AN patients. Participants reported dissatisfaction with their AI/AN patients’ breastfeeding rates. Conclusion: Ob-Gyn knowledge of health disparities among AI/AN women is adequate. In spite of this, barriers to quality care are still present and increased identification and implementation of effective resources is needed

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The Aboriginal and Torres Strait Islander smoking epidemic:What stage are we at, and what does it mean?

Smoking is the leading contributor to the burden of disease among Aboriginal and Torres Strait Islander Australians, and there is considerable potential for change. Understanding the epidemic stage may provide insight into probable trends in smoking-attributable mortality, and inform program and policy development. Tobacco use among Aboriginal and Torres Strait Islander Australians has declined substantially, accompanied by declining tobacco-related cardiovascular mortality. Based on the available evidence, we expect tobacco-related cancer mortality to remain high, but peak within the next decade; however, there is a critical need for improved evidence to make an accurate assessment. The continuation and expansion of comprehensive tobacco reduction measures is expected to further decrease tobacco use. Health gains will be observed over both the short and long term

The Aboriginal and Torres Strait Islander smoking epidemic: what stage are we at, and what does it mean?

Smoking is the leading contributor to the burden of disease among Aboriginal and Torres Strait Islander Australians, and there is considerable potential for change. Understanding the epidemic stage may provide insight into probable trends in smoking-attributable mortality, and inform program and policy development. Tobacco use among Aboriginal and Torres Strait Islander Australians has declined substantially, accompanied by declining tobacco-related cardiovascular mortality. Based on the available evidence, we expect tobacco-related cancer mortality to remain high, but peak within the next decade; however, there is a critical need for improved evidence to make an accurate assessment. The continuation and expansion of comprehensive tobacco reduction measures is expected to further decrease tobacco use. Health gains will be observed over both the short and long term.RL is supported by a National Health and Medical Research Council Fellowship

Obstetrician/Gynecologist Care Considerations Practice Changes in Disease Management With an Aging Patient Population

Abstract and Introduction Abstract Demographic changes across the country are leading to an increased proportion of older Americans. This shift will likely lead to changes in the patient population seen by obstetrician/gynecologists, and practices may need to adapt to the needs of older women. This article looks at mental health, sexual health, bone loss, cardiovascular disease and cancer as areas in which obstetrician/gynecologists may experience changes with the increasing age of patients. While this is by no means a comprehensive list of changing areas of practice, it offers a guide for reflecting on the future of obstetrician/gynecologists training, and the importance of considering the needs of older patients in practice

Commercial tobacco and indigenous peoples: a stock take on Framework Convention on Tobacco Control progress

Background The health status and needs of indigenous populations of Australia, Canada and New Zealand are often compared because of the shared experience of colonisation. One enduring impact has been a disproportionately high rate of commercial tobacco use compared with non-indigenous populations. All three countries have ratified the WHO Framework Convention on Tobacco Control (FCTC), which acknowledges the harm caused to indigenous peoples by tobacco. Aim and objectives We evaluated and compared reporting on FCTC progress related to indigenous peoples by Australia, Canada and New Zealand as States Parties. The critiqued data included disparities in smoking prevalence between indigenous and non-indigenous peoples; extent of indigenous participation in tobacco control development, implementation and evaluation; and what indigenous commercial tobacco reduction interventions were delivered and evaluated. Data sources We searched FCTC: (1) Global Progress Reports for information regarding indigenous peoples in Australia, Canada and New Zealand; and (2) country-specific reports from Australia, Canada and New Zealand between 2007 and 2016. Study selection Two of the authors independently reviewed the FCTC Global and respective Country Reports, identifying where indigenous search terms appeared. Data extraction All data associated with the identified search terms were extracted, and content analysis was applied. Results It is difficult to determine if or what progress has been made to reduce commercial tobacco use by the three States Parties as part of their commitments under FCTC reporting systems. There is some evidence that progress is being made towards reducing indigenous commercial tobacco use, including the implementation of indigenous-focused initiatives. However, there are significant gaps and inconsistencies in reporting. Strengthening FCTC reporting instruments to include standardised indigenous-specific data will help to realise the FCTC Guiding Principles by holding States Parties to account and building momentum for reducing the high prevalence of commercial tobacco use among indigenous peoples.This research is funded in part by the National Cancer Institute, National Institutes of Health (Grant Number R01-CA091021) and the Canadian Institutes for Health Research (Grant Number 379337)

Deadly news: the downward trend continues in Aboriginal and Torres Strait Islander smoking 2004-2019

Smoking is the leading contributor to the burden of disease among Aboriginal and Torres Strait Islander Australians, and one of the largest causes of preventable morbidity and mortality. Reducing exposure to tobacco provides substantial opportunity for improving the health outcomes of Aboriginal and Torres Strait Islander peoples and is reflected in the Framework Convention on Tobacco Control (FCTC). The FCTC acknowledges concern "about the high levels of smoking and other forms of tobacco consumption by indigenous peoples"(FCTC, Preamble). It is important to continue the focus on reducing tobacco use and promoting smoke-]free environments, consequently improving Aboriginal and Torres Strait Islander health outcomes

Total ankle replacement: comparison of the outcomes of STAR and Mobility

Total Ankle Replacement is a recognised treatment for end-stage ankle arthritis and an alternative to arthrodesis. This study reviews a single centre series of prospectively collected outcome measures to determine whether the Mobility performs better than the Scandinavian ankle replacement. The primary outcome measure was the survivorship. Secondary outcome measures consisted of complications and international scoring systems. 147 Scandinavian and 162 Mobility ankle replacements were reviewed at a mean follow up of 12.4 and 7.7 years respectively. The revision rate, which included liner exchange, component exchange or removal of implant was at 7 years 12.3% (18) for Scandinavian and 5.2% (8) for Mobility. The complication rate was 16.5% (22) for Scandinavian compared to 9.9 % (15) for Mobility. The results of our unit compare favourably with previous published studies. In this study the Mobility has been shown to have more favourable results at 7 years compared to the Scandinavian