Spring Migration and Subsistence Hunting of King and Common Eiders at Holman, Northwest Territories, 1996-98

A subsistence hunt for eiders by Innuvialuit of Holman, Northwest Territories, was observed over three spring harvest seasons from 1966 to 1998 to determine rates of crippling loss and to assess the sustainability of the harvest. King eiders (Somateria spectabilis) are the dominant waterfowl species harvested. The number of king eiders estimated to migrate past Holman in spring varied from 40 696 ± 4461 (95% confidence interval) in 1996 to 70 018 ± 14 356 in 1998, averaging 53 000 per year. Common eiders (Somateria mollissima v-nigra) were much less abundant, varying from 2728 ± 631 to 6017 ± 770 birds, averaging 4400 annually. Peak numbers of king eiders moved through the study area in 1-8 days during the second to third week of June in all years, and common eiders peaked in 1-8 days during the first to second week of June. Strong winds may have hindered migration for a few days. Crippling loss rates during the hunt were low (3-9%) in the first two years of the study, but increased to 13-20% in the early open-water spring of 1998, when hunters were forced to shoot over open water rather than shorefast ice. On the basis of these estimates and harvest data from the Inuvialuit Harvest Study, we determined that Holman hunters removed 3.7-6.9% of the king eider subpopulation and less than 1% of the common eiders over the three-year study period. The present level of harvest of eiders available to Holman hunters is likely sustainable. However, more information on natural mortality and recruitment rates, particularly for king eiders, is needed to confirm this.La chasse de subsistance à l'eider menée par les Inuvialuit de Holman (Territoires du Nord-Ouest) a fait l'objet d'un étude sur les trois saisons de récoltes printanières allant de 1996 à 1998, afin de déterminer les taux de pertes dues aux blessures et d'évaluer la viabilité de la récolte. L'eider à tête grise (Somateria spectabilis) représente la plus importante espèce de sauvagine récoltée. L'estimation du nombre d'eiders à tête grise passant près d'Holman durant la migration printanière variait de 40 696 ± 4461 (intervalle de confiance de 95 p.cent) en 1996 à 70 018 ± 14356 en 1998, soit une moyenne annuelle de 53 000. L'eider à duvet (Somateria mollissima v-nigra) était beaucoup moins abondant, variant de 2728 ± 631 à 6017 ± 770 individus, soit une moyenne annuelle de 4400. Le nombre d'eiders à tête grise passant dans la zone d'étude atteignait chaque année son apogée durant 1 à 8 jours pendant la deuxième et la troisième semaine de juin, et celui des eiders à duvet durant 1 à 8 jours pendant la première quinzaine de juin. Il se peut que des vents forts aient entravé la migration pendant quelques jours. Le taux de pertes dues aux blessures survenues au cours de la chasse était faible (de 3 à 9 p.cent) durant les deux premières années de l'étude, mais a augmenté jusqu'á 13 à 20 p.cent au début de la période d'eau libre printanière de 1998, quand les chasseurs devaient tirer au-dessus de l'eau libre plutôt qu'au-dessus de la glace de rive. En s'appuyant sur ces estimations et sur les données de prélèvements renfermées dans l'étude sur la récolte des Inuvialuit, on a établi que les chasseurs d'Holman avaient prélevé de 3,7 à 6,9 p.cent de la sous-population, de l'eider à tête grise et moins de 1 p.cent de l'eider à duvet au cours des trois années constituant la période d'étude. Il semble que le niveau de récolte actuel de l'eider s'offrant aux chasseurs d'Holman soit viable, mais pour le confirmer, on a besoin d'un supplément d'information sur la mortalité naturelle et les taux de recrutement, en particulier dans le cas de l'eider à tête grise.eider à tête grise; Somateria spectabilis; eider à duvet; Somateria mollissima v-nigra; récolte; pertes dues aux blessures; migratio

The Effect of Two Church-based Interventions on Breast Cancer Screening Rates Among Medicaid-Insured Latinas

INTRODUCTION: Latinas face disparities in cancer screening rates compared with non-Latina whites. The Tepeyac Project aims to reduce these disparities by using a church-based approach to increase breast cancer screening among Latinas in Colorado. The objective of this study was to compare the effect of two Tepeyac Project interventions on the mammogram rates of Latinas and non-Latina whites enrolled in the Medicaid fee-for-service program. METHODS: Two intervention groups were compared: 209 churches in Colorado that received educational printed materials in Spanish and English (the printed statewide intervention) and four churches in the Denver area that received personalized education from promotoras, or peer counselors (the promotora intervention), in addition to the printed statewide intervention. Biennial Medicaid mammogram claim rates in Colorado before the interventions (1998–1999) and after (2000–2001) were used to compare the effect of the interventions on mammogram use among Latinas and non-Latina whites aged 50 to 64 years who were enrolled in the Medicaid fee-for-service program. Adjusted rates were computed using generalized estimating equations. RESULTS: Small, nonsignificant increases in screening were observed among Latinas exposed to the promotora intervention (from 25% at baseline to 30% at follow-up [P = .30]) as compared with 45% at baseline and 43% at follow-up for the printed statewide intervention (P = .27). Screening among non-Latina whites increased by 6% in the promotora intervention area (from 32% at baseline to 38% at follow-up [P = .40]) and by 3% in the printed statewide intervention (from 41% at baseline to 44% at follow-up [P = .02]). No significant disparities in breast cancer screening were detected between Latinas and non-Latina whites. After adjustment for the confounders by generalized estimating equations, the promotora intervention had a marginally greater impact than the printed statewide intervention in increasing mammogram use among Latinas (generalized estimating equation, P = .07). CONCLUSION: A personalized community-based education was only modestly effective in increasing breast cancer screening among Medicaid-insured Latinas. Education alone may not be the answer for this population. The barriers for these Medicaid enrollees must be investigated so that interventions can be tailored to address their needs

Church-Based Breast Cancer Screening Education: Impact of Two Approaches on Latinas Enrolled in Public and Private Health Insurance Plans

Introduction The Tepeyac Project is a church-based health promotion project that was conducted from 1999 through 2005 to increase breast cancer screening rates among Latinas in Colorado. Previous reports evaluated the project among Medicare and Medicaid enrollees in the state. In this report, we evaluate the program among enrollees in the state's five major insurance plans. Methods We compared the Tepeyac Project's two interventions: the Printed Intervention and the Promotora Intervention. In the first, we mailed culturally tailored education packages to 209 Colorado Catholic churches for their use. In the second, promotoras (peer counselors) in four Catholic churches delivered breast-health education messages personally. We compared biennial mammogram claims from the five insurance plans in the analysis at baseline (1998–1999) and during follow-up (2000–2001) for Latinas who had received the interventions. We used generalized estimating equations (GEE) analysis to adjust rates for confounders. Results The mammogram rate for Latinas in the Printed Intervention remained the same from baseline to follow-up (58% [2979/5130] vs 58% [3338/5708]). In the Promotora Intervention, the rate was 59% (316/536) at baseline and 61% (359/590) at follow-up. Rates increased modestly over time and varied widely by insurance type. After adjusting for age, income, urban versus rural location, disability, and insurance type, we found that women exposed to the Promotora Intervention had a significantly higher increase in biennial mammograms than did women exposed to the Printed Intervention (GEE parameter estimate = .24 [±.11], P = .03). Conclusion For insured Latinas, personally delivering church-based education through peer counselors appears to be a better breast-health promotion method than mailing printed educational materials to churches

Integrating the Totality of Food and Nutrition Evidence for Public Health Decision Making and Communication

The interpretation and integration of epidemiological studies detecting weak associations (RR < 2) with data from other study designs (e.g., animal models and human intervention trials) is both challenging and vital for making science-based dietary recommendations in the nutrition and food safety communities. The 2008 ILSI North America “Decision-Making for Recommendations and Communication Based on Totality of Food-Related Research” workshop provided an overview of epidemiological methods, and case-study examples of how weak associations have been incorporated into decision making for nutritional recommendations. Based on the workshop presentations and dialogue among the participants, three clear strategies were provided for the use of weak associations in informing nutritional recommendations for optimal health. First, enable more effective integration of data from all sources through the use of genetic and nutritional biomarkers; second, minimize the risk of bias and confounding through the adoption of rigorous quality-control standards, greater emphasis on the replication of study results, and better integration of results from independent studies, perhaps using adaptive study designs and Bayesian meta-analysis methods; and third, emphasize more effective and truthful communication to the public about the evolving understanding of the often complex relationship between nutrition, lifestyle, and optimal health

Body fatness and cancer - viewpoint of the IARC working group

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Effects of social approval bias on self-reported fruit and vegetable consumption: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Self-reports of dietary intake in the context of nutrition intervention research can be biased by the tendency of respondents to answer consistent with expected norms (social approval bias). The objective of this study was to assess the potential influence of social approval bias on self-reports of fruit and vegetable intake obtained using both food frequency questionnaire (FFQ) and 24-hour recall methods.</p> <p>Methods</p> <p>A randomized blinded trial compared reported fruit and vegetable intake among subjects exposed to a potentially biasing prompt to that from control subjects. Subjects included 163 women residing in Colorado between 35 and 65 years of age who were randomly selected and recruited by telephone to complete what they were told would be a future telephone survey about health. Randomly half of the subjects then received a letter prior to the interview describing this as a study of fruit and vegetable intake. The letter included a brief statement of the benefits of fruits and vegetables, a 5-A-Day sticker, and a 5-a-Day refrigerator magnet. The remainder received the same letter, but describing the study purpose only as a more general nutrition survey, with neither the fruit and vegetable message nor the 5-A-Day materials. Subjects were then interviewed on the telephone within 10 days following the letters using an eight-item FFQ and a limited 24-hour recall to estimate fruit and vegetable intake. All interviewers were blinded to the treatment condition.</p> <p>Results</p> <p>By the FFQ method, subjects who viewed the potentially biasing prompts reported consuming more fruits and vegetables than did control subjects (5.2 vs. 3.7 servings per day, p < 0.001). By the 24-hour recall method, 61% of the intervention group but only 32% of the control reported eating fruits and vegetables on 3 or more occasions the prior day (p = 0.002). These associations were independent of age, race/ethnicity, education level, self-perceived health status, and time since last medical check-up.</p> <p>Conclusion</p> <p>Self-reports of fruit and vegetable intake using either a food frequency questionnaire or a limited 24-hour recall are both susceptible to substantial social approval bias. Valid assessments of intervention effects in nutritional intervention trials may require objective measures of dietary change.</p

Colorectal Adenomas in a Randomized Folate Trial: The Role of Baseline Dietary and Circulating Folate Levels

The Aspirin/Folate Polyp Prevention Study is a randomized, placebo-controlled trial of aspirin use and folic acid supplementation and incidence of colorectal adenomas in individuals with a history of these lesions. The trial showed that folic acid supplementation does not prevent the occurrence of new adenomas and may increase risk. We extend these results by investigating whether the effect of folic acid treatment differed by baseline dietary and circulating folate levels. Diet and supplement use were ascertained at baseline through a food-frequency questionnaire; a blood sample was used to determine plasma and red blood cell (RBC) folate levels. Individuals were followed for 3 years (1st follow up) and subsequently for an additional 3-5 years (2nd follow up). We used generalized linear regression to estimate risk ratios and 95% confidence limits as measures of association. There was little evidence that baseline dietary and total folate intake, and plasma and RBC folate modified the association between folic acid treatment and risk of any adenomas or advanced lesions. However, there was a protective association of the highest tertile of dietary and total intake as well as circulating folate with risk of any adenomas among those in the placebo group, but no association among individuals in the folic acid group. Our findings support the idea that while moderate doses of folate may be protective compared to deficiency, at some point of sufficiency supplementation provides no additional benefit

An assessment of technology-based service encounters & network security on the e-health care systems of medical centers in Taiwan

<p>Abstract</p> <p>Background</p> <p>Enhancing service efficiency and quality has always been one of the most important factors to heighten competitiveness in the health care service industry. Thus, how to utilize information technology to reduce work load for staff and expeditiously improve work efficiency and healthcare service quality is presently the top priority for every healthcare institution. In this fast changing modern society, e-health care systems are currently the best possible way to achieve enhanced service efficiency and quality under the restraint of healthcare cost control. The electronic medical record system and the online appointment system are the core features in employing e-health care systems in the technology-based service encounters.</p> <p>Methods</p> <p>This study implemented the Service Encounters Evaluation Model, the European Customer Satisfaction Index, the Attribute Model and the Overall Affect Model for model inference. A total of 700 copies of questionnaires from two authoritative southern Taiwan medical centers providing the electronic medical record system and the online appointment system service were distributed, among which 590 valid copies were retrieved with a response rate of 84.3%. We then used SPSS 11.0 and the Linear Structural Relationship Model (LISREL 8.54) to analyze and evaluate the data.</p> <p>Results</p> <p>The findings are as follows: (1) Technology-based service encounters have a positive impact on service quality, but not patient satisfaction; (2) After experiencing technology-based service encounters, the cognition of the service quality has a positive effect on patient satisfaction; and (3) Network security contributes a positive moderating effect on service quality and patient satisfaction.</p> <p>Conclusion</p> <p>It revealed that the impact of electronic workflow (online appointment system service) on service quality was greater than electronic facilities (electronic medical record systems) in technology-based service encounters. Convenience and credibility are the most important factors of service quality in technology-based service encounters that patients demand. Due to the openness of networks, patients worry that transaction information could be intercepted; also, the credibility of the hospital involved is even a bigger concern, as patients have a strong sense of distrust. Therefore, in the operation of technology-based service encounters, along with providing network security, it is essential to build an atmosphere of psychological trust.</p

Colorectal Cancer in Patients Under Close Colonoscopic Surveillance

BACKGROUND & AIMS: Colonoscopic polypectomy is considered effective for preventing colorectal cancer (CRC), but the incidence of cancer in patients under colonoscopic surveillance has rarely been investigated. We determined the incidence of CRC in patients under colonoscopic surveillance and examined the circumstances and risk factors for CRC and adenoma with high-grade dysplasia. METHODS: Patients were drawn from 3 adenoma chemoprevention trials. All underwent baseline colonoscopy with removal of at least one adenoma and were deemed free of remaining lesions. We identified patients subsequently diagnosed with invasive cancer or adenoma with high-grade dysplasia. The timing, location, and outcome of all cases of cancer and high-grade dysplasia identified are described and risks associated with their development explored. RESULTS: CRC was diagnosed in 19 of the 2915 patients over a mean follow-up of 3.7 years (incidence, 1.74 cancers/1000 person-years). The cancers were located in all regions of the colon; 10 were at or proximal to the hepatic flexure. Although most of the cancers (84%) were of early stage, 2 participants died of CRC. Seven patients were diagnosed with adenoma with high-grade dysplasia during follow-up. Older patients and those with a history of more adenomas were at higher risk of being diagnosed with invasive cancer or adenoma with high-grade dysplasia. CONCLUSIONS: CRC is diagnosed in a clinically important proportion of patients following complete colonoscopy and polypectomy. More precise and representative estimates of CRC incidence and death among patients undergoing surveillance examinations are needed