Marked variation in newborn resuscitation practice: a national survey in the UK

Abstract Background Although international newborn resuscitation guidance has been in force for some time, there are no UK data on current newborn resuscitation practices. Objective Establish delivery room (DR) resuscitation practices in the UK, and identify any differences between neonatal intensive care units (NICU), and other local neonatal services. Methods We conducted a structured two-stage survey of DR management, among UK neonatal units during 2009–2010 (n = 192). Differences between NICU services (tertiary level) and other local neonatal services (non-tertiary) were analysed using Fisher's exact and Student's t-tests. Results There was an 89% response rate (n = 171). More tertiary NICUs institute DR CPAP than non-tertiary units (43% vs. 16%, P = 0.0001) though there was no significant difference in frequency of elective intubation and surfactant administration for preterm babies. More tertiary units commence DR resuscitation in air (62% vs. 29%, P < 0.0001) and fewer in 100% oxygen (11% vs. 41%, P < 0.0001). Resuscitation of preterm babies in particular, commences with air in 56% of tertiary units. Significantly more tertiary units use DR pulse oximeters (58% vs. 29%, P < 0.01) and titrate oxygen based on saturations. Almost all services use occlusive wrapping to maintain temperature for preterm infants. Conclusions In the UK, there are many areas of good evidence based DR practice. However, there is marked variation in management, including between units of different designation, suggesting a need to review practice to fulfil new resuscitation guidance, which will have training and resource implications

Aboriginal Food Security in Northern Canada: An Assessment of the State of Knowledge

As the world’s population increases, as global markets become more interconnected, and as the effects of climate change become clearer, the issue of food insecurity is gaining traction at local, national, and international levels. The recent global economic crisis and increased food prices have drawn attention to the urgent situation of the world’s 870 million chronically undernourished people who face the number one worldwide risk to health: hunger and malnutrition. Although about 75% of the world’s undernourished people live in low-income, rural regions of developing countries, hunger is also an issue in Canada. In 2011, 1.6 million Canadian households, or slightly more than 12%, experienced some level of food insecurity. About one in eight households are affected, including 3.9 million individuals. Of these, 1.1 million are children. Food insecurity presents a particularly serious and growing challenge in Canada’s northern and remote Aboriginal communities (see Figure 1). Evidence from a variety of sources concludes that food insecurity among northern Aboriginal peoples is a problem that requires urgent attention to address and mitigate the serious impacts it has on health and well-being. Results from the 2007–2008 International Polar Year Inuit Health Survey indicate that Nunavut has the highest documented rate of food insecurity for any Indigenous population living in a developed country. According to estimates from the 2011 Canadian Community Health Survey (CCHS), off-reserve Aboriginal households across Canada experience food insecurity at a rate that is more than double that of all Canadian households (27%). Recent data indicate that Canadian households with children have a higher prevalence of food insecurity than households without children, and preliminary evidence indicates that more women than men are affected

Safety, immunogenicity, and reactogenicity of BNT162b2 and mRNA-1273 COVID-19 vaccines given as fourth-dose boosters following two doses of ChAdOx1 nCoV-19 or BNT162b2 and a third dose of BNT162b2 (COV-BOOST): a multicentre, blinded, phase 2, randomised trial

Background Some high-income countries have deployed fourth doses of COVID-19 vaccines, but the clinical need, effectiveness, timing, and dose of a fourth dose remain uncertain. We aimed to investigate the safety, reactogenicity, and immunogenicity of fourth-dose boosters against COVID-19.Methods The COV-BOOST trial is a multicentre, blinded, phase 2, randomised controlled trial of seven COVID-19 vaccines given as third-dose boosters at 18 sites in the UK. This sub-study enrolled participants who had received BNT162b2 (Pfizer-BioNTech) as their third dose in COV-BOOST and randomly assigned them (1:1) to receive a fourth dose of either BNT162b2 (30 µg in 0·30 mL; full dose) or mRNA-1273 (Moderna; 50 µg in 0·25 mL; half dose) via intramuscular injection into the upper arm. The computer-generated randomisation list was created by the study statisticians with random block sizes of two or four. Participants and all study staff not delivering the vaccines were masked to treatment allocation. The coprimary outcomes were safety and reactogenicity, and immunogenicity (antispike protein IgG titres by ELISA and cellular immune response by ELISpot). We compared immunogenicity at 28 days after the third dose versus 14 days after the fourth dose and at day 0 versus day 14 relative to the fourth dose. Safety and reactogenicity were assessed in the per-protocol population, which comprised all participants who received a fourth-dose booster regardless of their SARS-CoV-2 serostatus. Immunogenicity was primarily analysed in a modified intention-to-treat population comprising seronegative participants who had received a fourth-dose booster and had available endpoint data. This trial is registered with ISRCTN, 73765130, and is ongoing.Findings Between Jan 11 and Jan 25, 2022, 166 participants were screened, randomly assigned, and received either full-dose BNT162b2 (n=83) or half-dose mRNA-1273 (n=83) as a fourth dose. The median age of these participants was 70·1 years (IQR 51·6–77·5) and 86 (52%) of 166 participants were female and 80 (48%) were male. The median interval between the third and fourth doses was 208·5 days (IQR 203·3–214·8). Pain was the most common local solicited adverse event and fatigue was the most common systemic solicited adverse event after BNT162b2 or mRNA-1273 booster doses. None of three serious adverse events reported after a fourth dose with BNT162b2 were related to the study vaccine. In the BNT162b2 group, geometric mean anti-spike protein IgG concentration at day 28 after the third dose was 23 325 ELISA laboratory units (ELU)/mL (95% CI 20 030–27 162), which increased to 37 460 ELU/mL (31 996–43 857) at day 14 after the fourth dose, representing a significant fold change (geometric mean 1·59, 95% CI 1·41–1·78). There was a significant increase in geometric mean anti-spike protein IgG concentration from 28 days after the third dose (25 317 ELU/mL, 95% CI 20 996–30 528) to 14 days after a fourth dose of mRNA-1273 (54 936 ELU/mL, 46 826–64 452), with a geometric mean fold change of 2·19 (1·90–2·52). The fold changes in anti-spike protein IgG titres from before (day 0) to after (day 14) the fourth dose were 12·19 (95% CI 10·37–14·32) and 15·90 (12·92–19·58) in the BNT162b2 and mRNA-1273 groups, respectively. T-cell responses were also boosted after the fourth dose (eg, the fold changes for the wild-type variant from before to after the fourth dose were 7·32 [95% CI 3·24–16·54] in the BNT162b2 group and 6·22 [3·90–9·92] in the mRNA-1273 group).Interpretation Fourth-dose COVID-19 mRNA booster vaccines are well tolerated and boost cellular and humoral immunity. Peak responses after the fourth dose were similar to, and possibly better than, peak responses after the third dose

The Social Determinants of Inuit Health: A Focus on Social Support in the Canadian Arctic

Objectives. Societies that foster socially supportive networks produce healthier populations. Social support is a significant determinant of health among Canada’s Inuit population; however, little is known about the characteristics that provide access to social support among Inuit. This exploratory analysis describes how 4 types of social support (namely, positive social interaction, emotional support, tangible support and affection and intimacy) differ in relation to various determinants of health. Study design. Micro-data from the Arctic Supplement of the 2001 Aboriginal Peoples Survey (n=26,290) was used. Methods. Cross-tabulations and multivariate logistic regression analyses were used to examine levels (high/low) of the 4 types of social support among the full Inuit sample (n=26,290) as they relate to age, gender, geographic region, marital status, Aboriginal language use and participation in traditional harvesting activities. Results. Certain subsegments of the Inuit population were less likely to report high levels of social support, including men, the elderly (aged 55+) and the unmarried. Some Inuit-relevant determinants were also found to decrease the odds of reporting high levels of social support, including being unable to speak or understand an Aboriginal language, not participating in traditional harvesting activities and living in Nunavik. Conclusions. Research that frames Inuit health within the social determinants of health is in its relative infancy; however, evidence from the social epidemiological literature indicates that those with diminished access to social support also suffer poorer health outcomes. Future research should build on the findings of this study to examine how the relationship between various health outcomes (e.g., respiratory disease, suicide attempts, self-rated health) and social support may respond along a social gradient. Such analysis will build on the paucity of literature specific to Inuit health and social conditions and set priorities for policy and programming efforts that will improve the social determinants of Inuit health

“We Make It Work Because We Must”: Narrating the Creation of an Urban Indigenous Food Bank in London, Ontario, Canada

This research draws from a community-engaged methodology and qualitative interviews to narrate the creation and daily operations of an Indigenous food bank in London, Ontario, Canada. In-depth interviews (n = 10) with program leaders, volunteers, and recipients detailed the day-to-day operations, including where and how foods were collected and distributed, and a preliminary analysis of the meanings and challenges of the food bank. The key strengths of the food bank are its focus on cultural safety, provision of traditional foods, and its community-led approach. The limitations of the food bank relate to the structure of the workload and sustainability of program funding. Community-led research with Indigenous non-profit organizations, such as that presented here, offer approaches that are critically important for creating culturally relevant and inclusive data that can both explain and address Indigenous health inequities, and provide the evidence needed to advocate for change