Early-life origins of disparities in chronic diseases among Indigenous youth: pathways to recovering health disparities from intergenerational trauma.

Indigenous women and children experience some of the most profound health disparities globally. These disparities are grounded in historical and contemporary trauma secondary to colonial atrocities perpetuated by settler society. The health disparities that exist for chronic diseases may have their origins in early-life exposures that Indigenous women and children face. Mechanistically, there is evidence that these adverse exposures epigenetically modify genes associated with cardiometabolic disease risk. Interventions designed to support a resilient pregnancy and first 1000 days of life should abrogate disparities in early-life socioeconomic status. Breastfeeding, prenatal care and early child education are key targets for governments and health care providers to start addressing current health disparities in cardiometabolic diseases among Indigenous youth. Programmes grounded in cultural safety and co-developed with communities have successfully reduced health disparities. More works of this kind are needed to reduce inequities in cardiometabolic diseases among Indigenous women and children worldwide.

Epidemiology and cost of ventral hernia repair: making the case for hernia research.

PURPOSE: Ventral hernia repair (VHR) lacks standardization of care and exhibits variation in delivery. Complications of VHR, notably recurrence and infection, increase costs. Efforts at obtaining federal funding for VHR research are frequently unsuccessful, in part due to misperceptions that VHR is not a clinical challenge and has minimal impact on healthcare resources. We analyzed national trends for VHR performance and associated costs to demonstrate potential savings resulting from an improvement in outcomes. METHODS: Inpatient non-federal discharges for VHR were identified from the 2001-2006 Healthcare Cost and Utilization Project, supplemented by the Center for Disease Control 2006 National Survey of Ambulatory Surgery for outpatient estimates. The total number of VHRs performed in the US was estimated along with associated costs. Costs were standardized to 2010 US dollars using the Consumer Price Index and reported as mean with 95% confidence intervals (95% CI). RESULTS: The number of inpatient VHRs increased from 126,548 in 2001 to 154,278 in 2006. Including 193,543 outpatient operations, an estimated 348,000 VHRs were performed for 2006. Inpatient costs consistently rose with 2006 costs estimated at US $15,899 (95% CI $15,394-$16,404) per operation. Estimated cost for outpatient VHR was US $3,873 (95% CI $2,788-$4,958). The total cost of VHR for 2006 was US $3.2 billion. CONCLUSIONS: VHRs continue to rise in incidence and cost. By reducing recurrence rate alone, a cost saving of US $32 million dollars for each 1% reduction in operations would result. Further research is necessary for improved understanding of ventral hernia etiology and treatment and is critical to cost effective healthcare.

The assessment and selection of patients for heterotopic heart transplantation.

In the 2-year period 1979-1980, 34 patients were assessed at Groote Schuur Hospital as candidates for heterotopic heart transplantation. Ischaemic heart disease was the most common underlying cause (19 patients), with cardiomyopathy (9), rheumatic heart disease (2), failed transplants (3), and endomyocardial fibrosis (1) as the other causes of myocardial disease. Five patients were not accepted into the transplant programme, 2 declined after being accepted, and in 3 the initial decision of acceptance was later reversed. Nine patients died while awaiting suitable donors, the mean survival time from the date of acceptance being only 26 days. Fifteen patients underwent heterotopic heart transplantation, 11 remaining alive at the end of the period of study; 8 had normally functioning donor hearts but 3 had suffered irreversible rejection and awaited a second transplant.

The clinical assessment and management of patients with prosthetic cardiac valves: A review of current practice at the Cardiac Clinic, Groote Schuur Hospital.

This review deals with the clinical assessment and management of patients with prosthetic cardiac valves. The types of prosthesis available are considered, with special reference to those which have been used frequently at Groot Schuur Hospital. The common complications encountered are described, as well as the clinical features of normally and abnormally functioning prostheses. The management of anticoagulant medication, pregnancy, infective endocarditis, systemic embolism and haemolysis in these patients is discussed. Particular emphasis is placed on the urgent referral to a cardiac department of patients with posthetic malfunction or conditions in which there is a potential for the development of malfunction.

Hemodynamic assessment of Lillehei-Kaster tilting disc aortic and mitral prostheses.

Twenty-six patients with Lillehei-Kaster prosthetic heart valves, 15 with aortic and 11 with mitral valves, were catheterized to assess their hemodynamic performance. The calculated effective orifice areas were linearly related to but always less than their actual orifice areas. There was no significant difference in the effective orifice area of the mitral or aortic prostheses of similar size. The aortic prosthesis with an annulus diameter of 21 mm. was found to have a mean effective orifice area of 0.77 sq. cm. Our catheter studies have demonstrated no hemodynamic advantages of the Lillehei-Kaster aortic and mitral prosthetic valves over prosthetic valves.

Cost-benefit analysis of two decision criteria for spondee threshold measurements.

Normal-hearing subjects were tested and retested using two spondee threshold criteria: a strict 50 percent correct rule and a 50 percent or 75 percent correct (or both) rule. The 50 percent criterion produced lower thresholds at the cost of poorer test-retest reliability and longer test durations. Both decision rules gave lower threshold SPL values and required less testing time during the second trial. A proposed benefit-cost ratio model indicated that the 50 percent or 75 percent (or both) decision rule gives a better return on the investment of clinical effort.