Asthma Prevention and Management for Aboriginal People: Lessons From Mi'kmaq Communities, Unama'ki, Canada, 2012.

BACKGROUND: Asthma affects at least 10% of Aboriginal children (aged 11 or younger) in Canada, making it the second most common chronic disease suffered by this demographic group; yet asthma support strategies specific to Aboriginal peoples have only begun to be identified. COMMUNITY CONTEXT: This research builds on earlier phases of a recent study focused on identifying the support needs and intervention preferences of Aboriginal children with asthma and their parents or caregivers. Here, we seek to identify the implications of our initial findings for asthma programs, policies, and practices in an Aboriginal context and to determine strategies for implementing prevention programs in Aboriginal communities. METHODS: Five focus groups were conducted with 22 recruited community health care professionals and school personnel in 5 Mi'kmaq communities in Unama'ki (Cape Breton), Nova Scotia, Canada, through a community-based participatory research design. Each focus group was first introduced to findings from a local "social support for asthma" intervention, and then the groups explored issues associated with implementing social support from their respective professional positions. OUTCOME: Thematic analysis revealed 3 key areas of opportunity and challenges for implementing asthma prevention and management initiatives in Mi'kmaq communities in terms of 1) professional awareness, 2) local school issues, and 3) community health centers. INTERPRETATION: Culturally relevant support initiatives are feasible and effective community-driven ways of improving asthma support in Mi'kmaq communities; however, ongoing assistance from the local leadership (ie, chief and council), community health directors, and school administrators, in addition to partnerships with respiratory health service organizations, is needed.

Adherence to published guidelines for perioperative care of the elderly: a survey of Scottish anaesthetic departments.

BACKGROUND: In 2010, a national enquiry into elderly patient outcomes after surgery identified that only 36% received 'good' care. Guidance was subsequently published by the Association of Anaesthetists of Great Britain and Ireland regarding perioperative care of the elderly and those with dementia; this study aims to assess current adherence to these guidelines in anaesthetic departments across Scotland. METHODS: A web-based survey was sent to all Scottish departments. The questions assessed department patient demographic, access to specialist pre-assessment services, availability of multidisciplinary input, perioperative care of patients with cognitive impairment and departmental training on geriatric perioperative care. RESULTS: Responses were collected from November-December 2020 with a 92.6% response rate. A total of 64% of departments stated that > 50% of their workload involved patients over 75. One department had a lead clinician for geriatric anaesthesia, whilst 20% could access a geriatric specialist when coordinating perioperative care. Specialist geriatric pre-assessment services operate in 20% of centres. A total of 60% of respondents used a clinical frailty score when pre-assessing patients over 75, with 48% specifically screening for cognitive impairment. The vast majority of centres, 76%, did not routinely provide information regarding post-operative delirium and 24% 'never or very rarely' invite caregivers to accompany patients with dementia into the department. Education sessions regarding perioperative elderly care had occurred in 56% of departments. CONCLUSIONS: Elderly patients represent a significant proportion of anaesthetic workload in Scotland. Despite this, adherence to recommended practice is low. The vast majority of centres lack access to specialist multidisciplinary input or specialist pre-assessment services which are essential to providing good care. Reported screening for frailty and cognitive impairment is variable, with opportunities for improvement in communication and education (patient and clinician) surrounding these conditions.

Acute intermittent renal replacement therapy in a rural Scottish intensive care unit - a review of patient and renal outcomes.

In this study we report 5-year outcomes for patients who received intermittent haemodiafiltration for Acute Kidney Injury (AKI) between 2010 and 2014 in a small Scottish Intensive Care Unit (ICU). Dialysis independence and mortality at ICU discharge, 30 and 90 days, one and five years were determined. There were 1496 admissions to ICU during the study period. 12% of patient admissions required Renal Replacement Therapy (RRT). 56.3% of patients survived to ICU discharge and all were RRT independent at ICU discharge. 30 day, 90 day, 1 year and 5 year survival was 52.3%, 50.6%, 46.6% and 30.7% respectively. By 5 years, 2 patients had developed end stage kidney disease.

"Put It Near the Indians": Indigenous Perspectives on Pulp Mill Contaminants in Their Traditional Territories (Pictou Landing First Nation, Canada).

BACKGROUND: Pictou Landing First Nation (PLFN), a small Mi'kmaw community on the Canadian east coast, has had a relationship with a tidal estuary known as A'se'k for millennia. In the 1960s, it became the site of effluent disposal from a nearby pulp mill. Almost immediately, health concerns regularly and consistently reverberated throughout the community. OBJECTIVES: The Pictou Landing Native Women's Group (PLNWG) formed a community-based participatory research (CBPR) partnership with an academic team to conceptualize community well-being in the context of environment and human health connections. This paper documents Mi'kmaw Elders' stories of A'se'k before it became contaminated. METHODS: Using narrative inquiry vis-à-vis oral histories, we carried out conversational interviews with 10 Elders from PLFN. These interviews were thematically analyzed and 're-storied' through a process of (w)holistic content analysis. RESULTS: Our findings present four broad story layers, recounting the themes that emerged through analysis and presenting a broad Mi'kmaw narrative of A'se'k. These story layers share: what A'se'k originally provided, the historical/cultural context of PLFN, changes to land and health after the mill was put in, and reflections on the past and future of A'se'k. CONCLUSIONS: Our research offers a novel contribution to the literature by showing how Mi'kmaw perspectives on the pollution at A'se'k reveal the close connection between Mi'kmaw livelihood, local ecologies, and health and well-being. Our research also provides insights into the way the research relationship developed between the PLNWG and the academic team, providing a pathway for others seeking to decolonize the research landscape.