The Changing Face of Little Italy: The Miss Colombo Pageant and the Making of Ethnicity in Trail, British Columbia, 1970–1977

This article examines gender and ethnicity as part of the same social experience. It argues that the annual contest to crown Miss Colombo in Trail, British Columbia, during the first half of the 1970s, together with the campaign to preserve the beauty pageant after 1973, offers a unique gendered context to understand the making of ethnicity in a small city. Broadly speaking, the pageant reflected specific social, economic, spatial, and cultural changes within the local Italian experience: a strong sense of place, occupational success, movement to ethnically mixed neighbourhoods, and positive relations with non-Italians. These processes played out in a paradoxical forum of the Colombo pageant—a paternal institution that celebrated and evaluated young Italian women’s bodies. Never contesting the institution itself, which carried a gendered power imbalance, Italian women—both as volunteers and contestants—worked through the pageant to promote their own interpretation of Italian belonging and to endorse a range of new possibilities for themselves. The women dramatically recast, but did not overturn, the gendered structures through which these changes took place—a pattern that points to the resiliency of paternalism in discourses of ethnic belonging.Cet article examine genre et ethnicité comme faisant partie de la même expérience sociale. Il fait valoir que le concours annuel “Miss Colombo” à Trail en Colombie-Britannique au début des années 70, de pair avec une campagne visant sa préservation à partir de 1973, offre un cadre genré unique pour comprendre la construction de l’ethnicité dans une petite municipalité. D’une manière générale, le concours reflète des changements spécifiques sociaux, économiques, spatiaux et culturels au sein de l’expérience locale italienne : un fort sentiment d’appartenance, la réussite professionnelle, le déplacement vers des quartiers ethniquement mixtes, et des relations positives avec les non Italiens. Ces processus se sont déroulés dans le forum paradoxal du concours de beauté, une institution paternelle qui célèbre et évalue le corps de jeunes femmes italiennes. N’ayant jamais contesté l’institution en soi, porteuse d’un déséquilibre de pouvoir entre les sexes, les femmes italiennes – tant bénévoles que candidates – ont travaillé dans le cadre du spectacle afin de promouvoir leur propre interprétation de l’appartenance italienne et de souscrire à une gamme de nouvelles possibilités pour elles-mêmes. Les femmes ont refait de façon spectaculaire, sans toutefois renverser, les structures genrées à travers lequel ces changements ont eu lieu, fait qui souligne la résilience du paternalisme dans le discours de l’appartenance ethnique

Training Indiana's Family Medicine Residents to Address the Problem of Prescription Drug Abuse

Prescription drug abuse has been a growing problem in Indiana and around the nation for almost two decades. In recent years, prescription drug overdoses have pushed drug poisonings ahead of motor vehicle crashes as the leading cause of injury death. However, deaths due to overdoses of prescription drugs are only the tip of the iceberg when it comes to the much larger problem of abuse. This study has characterized prescription drug abuse in Indiana and taken an in-depth look at how it is and can be addressed both through organizational policies and state legislation. Opioid painkillers such as hydrocodone, oxycodone, and methadone are the most commonly abused prescription drugs, and most of these prescriptions are written by primary care physicians. Because more than 70% of Indiana’s family medicine residents will remain in the state to practice medicine following the conclusion of their residencies, it is worthwhile to take a look at how these residents are being educated during their training. St. Vincent’s Family Medicine Residency program in Indianapolis is one of several residency programs in Indiana training their residents on best practices of prescribing controlled substances. A review of residents’ prescribing patterns before and after training on the subject went into effect showed significant reductions in the number of opioid painkillers being prescribed, and showed the same reductions for alprazolam, a benzodiazepine anxiolytic

Commercial Insurance Coverage Decline Associated with Affordable Care Act: What's Next?

BACKGROUND: A key feature of the Affordable Care Act was the establishment of insurance exchanges and subsidies to assist Americans in obtaining affordable commercial insurance. This study was undertaken to determine whether this effort has met its goal. METHODS: A review of all patients requiring surgery for maxillofacial trauma at a level 1 trauma center was undertaken for time periods before the Affordable Care Act was passed (2008 and 2009), while partially in effect (2012), and after the establishment exchanges and subsidies (2014). Insurance statuses were recorded and rates of commercial insurance coverage during each period were compared. RESULTS: A total of 1,123 patients were included. Of these, 511 were treated before passage of the Affordable Care Act, 288 were treated in 2012, and 324 were treated in 2014. Before passage, 50.5% of patients had commercial insurance. This number was virtually unchanged in 2012. However, after the insurance exchanges and subsidies were established, the percentage of patients with commercial insurance fell to 36.73% (p = 0.004). CONCLUSIONS: Surprisingly, the establishment of insurance exchanges and subsidies through the Affordable Care Act was associated with a decline in rates of commercial insurance coverage. Trends in reimbursement patterns will need to be followed if the law is repealed and replaced

Prevalence of tuberculosis in post-mortem studies of HIV-infected adults and children in resource-limited settings: a systematic review and meta-analysis.

OBJECTIVES: Tuberculosis (TB) is estimated to be the leading cause of HIV-related deaths globally. However, since HIV-associated TB frequently remains unascertained, we systematically reviewed autopsy studies to determine the true burden of TB at death. METHODS: We systematically searched Medline and Embase databases (to end 2013) for literature reporting on health facility-based autopsy studies of HIV-infected adults and/or children in resource-limited settings. Using forest plots and random-effects meta-analysis, we summarized the TB prevalence found at autopsy and used meta-regression to explore variables associated with autopsy TB prevalence. RESULTS: We included 36 eligible studies, reporting on 3237 autopsies. Autopsy TB prevalence was extremely heterogeneous (range 0-64.4%), but was markedly higher in adults [pooled prevalence 39.7%, 95% confidence interval (CI) 32.4-47.0%] compared to children (pooled prevalence 4.5%, 95% CI 1.7-7.4%). Post-mortem TB prevalence varied by world region, with pooled estimates in adults of 63.2% (95% CI 57.7-68.7%) in South Asia (n = 2 studies); 43.2% (95% CI 38.0-48.3) in sub-Saharan Africa (n = 9 studies); and 27.1% (95% CI 16.0-38.1%) in the Americas (n = 5 studies). Autopsy prevalence positively correlated with contemporary estimates of national TB prevalence. TB in adults was disseminated in 87.9% (82.2-93.7%) of cases and was considered the cause of death in 91.4% (95% CI 85.8-97.0%) of TB cases. Overall, TB was the cause of death in 37.2% (95% CI 25.7-48.7%) of adult HIV/AIDS-related deaths. TB remained undiagnosed at death in 45.8% (95% CI 32.6-59.1%) of TB cases. CONCLUSIONS: In resource-limited settings, TB accounts for approximately 40% of facility-based HIV/AIDS-related adult deaths. Almost half of this disease remains undiagnosed at the time of death. These findings highlight the critical need to improve the prevention, diagnosis and treatment of HIV-associated TB globally

Outcomes of Childhood Asthma and Wheezy Bronchitis. A 50-Year Cohort Study

Rationale: Cohort studies suggest that airflow obstruction is established early in life, manifests as childhood asthma and wheezy bronchitis, and continues into early adulthood. Although an association between childhood asthma and chronic obstructive pulmonary disease (COPD) in later life has been demonstrated, it is unclear if childhood wheezy bronchitis is associated with COPD. Objectives: To investigate whether childhood wheezy bronchitis increases the risk of COPD in the seventh decade. Methods: A cohort of children recruited in 1964 at age 10 to 15 years, which was followed up in 1989, 1995, and 2001, was followed up again in 2014 when at age 60 to 65 years. Discrete time-to-event and linear mixed effects models were used. Measurements and Main Results: FEV1 and FVC were measured. COPD was defined as post-bronchodilator FEV1/FVC <0.7. Childhood wheezing phenotype was related to 1989, 1995, 2001, and 2014 spirometry data. Three hundred thirty subjects, mean age 61 years, were followed up: 38 with childhood asthma; 53 with childhood wheezy bronchitis; and 239 control subjects (of whom 57 developed adulthood-onset wheeze between ages 16 and 46 yr). In adjusted multivariate analyses, childhood asthma was associated with an increased risk of COPD (odds ratio, 6.37; 95% confidence interval, 3.73–10.94), as was childhood wheezy bronchitis (odd ratio 1.81; 95% confidence interval, 1.12–2.91). The COPD risk increased with childhood asthma, and wheezy bronchitis was associated with reduced FEV1 that was evident by the fifth decade and not an accelerated rate of FEV1 decline. In contrast, adulthood-onset wheeze was associated with accelerated FEV1 decline. Conclusions: Childhood wheezy bronchitis and asthma are associated with an increased risk of COPD and reduced ventilatory function

Xpert MTB/RIF - why the lack of morbidity and mortality impact in intervention trials?

Compared with smear microscopy, the Xpert MTB/RIF assay (Xpert), with superior accuracy and capacity to diagnose rifampicin resistance, has advanced TB diagnostic capability. However, recent trials of Xpert impact have not demonstrated reductions in patient morbidity and mortality. We conducted a narrative review of Xpert impact trials to summarize which patient-relevant outcomes Xpert has improved and explore reasons for no observed morbidity or mortality reductions. We searched PubMed, Google Scholar, Cochrane Library and Embase and identified eight trials meeting inclusion criteria: three individually randomized, three cluster-randomized, and two pre-post trials. In six trials Xpert increased diagnostic yield of bacteriologically-confirmed TB from sputa and in four trials Xpert shortened time to TB treatment. However, all-cause mortality was similar between arms in all six trials reporting this outcome, and the only trial to assess Xpert impact on morbidity reported no impact. Trial characteristics that might explain lack of observed impact on morbidity and mortality include: higher rates of empiric TB treatment in microscopy compared with Xpert arms, enrollment of study populations not comprised exclusively of populations most likely to benefit from Xpert, and health system weaknesses. So far as equipoise exists, future trials that address past limitations are needed to inform Xpert use in resource-limited settings

In Search of Competitive Givers

Much of the theoretical and experimental research on charitable giving allows for three main types of donor: pure altruists, impure altruists, and pure warm-glow givers. For none of these types should donations be increasing in the amount donated by others, and the fact that some experimental subjects do behave in this way suggests a fourth type, the "competitive giver". Our experimental results provide evidence for the existence of competitive givers. The results also suggest that most (but not all) competitive giving is a result of uncertainty about the social norm: when information about the norm is revealed, the incidence of competitive giving is much lower