RESUMEN
Setting: The Prairie provinces of Canada. Objective: To understand how Indigenous peoples with infectious pulmonary tuberculosis living in different community settings in the Prairie provinces of Canada experience respiratory isolation. Design: Using an exploratory qualitative approach, we interviewed participants living in urban centres, non-remote reserve settings and remote and isolated reserve settings. Results: Through qualitative content analysis of 48 interviews, we determined that participants experienced feelings of confinement regardless of the community setting in which they lived. Participants also experienced family and social disconnect, but the experience was more potent for the remote and isolated reserve participants, who were required to be flown out of their home communities to receive treatment, and for those urban centre and non-remote reserve participants who lacked social connections. The roles of past experiences with sanitoria and of family in providing social support are discussed. Conclusions: The conclusions of this study focus on examining isolation policies and improving the hospital isolation experience.
Contexte : Les provinces de la Prairie au Canada.Objectif : Comprendre comment les populations indigènes atteintes de tuberculose pulmonaire contagieuse, vivant dans différents contextes communautaires dans les provinces de la Prairie au Canada, ressentent l'isolement.Schéma : En utilisant une approche exploratoire qualitative, nous nous sommes entretenus avec les participants vivant dans des centres urbains, ou dans des réserves éloignées non isolées et dans des réserves éloignées et isolées.Résultat : Une analyse qualitative du contenu des 48 entretiens nous a permis de déterminer que les participants ont eu des sentiments de confinement quel que soit le contexte communautaire dans lequel ils vivaient. Les participants ont également vécu une coupure familiale et sociale, mais l'expérience a été plus dure pour les participants des réserves éloignées et isolées qui ont été obligés de quitter leurs communautés pour recevoir leur traitement, et pour les patients des centres urbains et des réserves non éloignées qui manquaient de connections sociales. Le rôle des expériences passées avec les services de santé et avec le soutien social de la famille est discuté.Conclusions: Les conclusions se concentrent sur l'examen des politiques d'isolement et l'amélioration des expériences d'isolement à l'hôpital.
Marco de referencia: Las provincias de las Praderas del Canadá.Objetivo: Comprender de qué manera perciben el aislamiento respiratorio las poblaciones indígenas con tuberculosis pulmonar contagiosa, de diferentes entornos comunitarios en las provincias de las Praderas canadienses.Método: Mediante una estrategia exploratoria cualitativa, se entrevistaron los participantes que residían en centros urbanos, en reservas no distantes y en reservas aisladas y distantes.Resultados: Tras el análisis cualitativo de contenido de 48 entrevistas, se determinó que los participantes percibían una sensación de confinamiento, con independencia en su entorno comunitario. Asimismo, los participantes percibían desconexión familiar y social, pero la experiencia fue más intensa en los participantes de ámbitos distantes y aislados que tenían que salir de sus comunidades por vía aérea con el fin de recibir el tratamiento y en los participantes de centros urbanos y reservas no distantes que carecían de conexiones sociales. En el artículo se analiza la influencia de las experiencias pasadas con sanatorios y la función de la familia en la prestación del apoyo social.Conclusión: Las conclusiones se centran en el análisis de las políticas de aislamiento y las iniciativas de mejoramiento de la experiencia hospitalaria del aislamiento respiratorio.
RESUMEN
We have previously shown, using a gastric chamber model, that both sucralfate and luminal stasis protected the rat gastric mucosa against the development of hemorrhagic erosions produced by subsequent exposure for 10 minutes to acidified (50 mM HCl) 80 mM sodium taurocholate (NaT). The protection afforded by sucralfate was abolished by inhibition of cyclooxygenase activity but restored by sucralfate. In this study we demonstrate that indomethacin pretreatment decreases both the depth (in microns) and magnitude (in pH units) of the juxtamucosal pH gradient, but that sucralfate restores these parameters to levels characteristic of normal mucosae. The cytoprotective effect of sucralfate is thus prostaglandin-independent and, at least in part, a consequence of sucralfate-induced increases in the thickness of the juxtamucosal pH gradient/unstirred layer. We have also examined the ability of sucralfate to prevent the otherwise inevitable development of hemorrhagic erosions when it was applied after the gastric mucosa was exposed to NaT. When 100 mg sucralfate in 50 mM HCl was applied for 10 minutes, without stirring, subsequent to a 10-minute exposure of the mucosa to NaT, the average lesion area was reduced from about 15% to less than 3%. Unlike its cytoprotective property, the ability of sucralfate to accelerate the recovery process after damage was abolished by indomethacin pretreatment. Studies using antimony microelectrodes revealed that indomethacin pretreatment resulted in reductions in both the depth and magnitude of the pH gradient that resulted from plasma efflux from the mucosa after exposure to the acidified bile salt. These studies demonstrate that sucralfate is capable not only of prevention or attenuation of acute damage when administered prior to damaging agents, but is also capable of arresting the sequence of events that produces hemorrhage in the previously inflamed or damaged stomach.