Public health crisis in the refugee community: little change in social determinants of health preserve health disparities.

Structural inequities and lack of resources put vulnerable refugee communities at great risk. Refugees flee their country of origin to escape persecution and flee from war, famine and torture. Resettled refugee communities become particularly vulnerable during times of crisis due to limited English proficiency and poor social determinants of health (SDOH), which create barriers to attaining and sustaining health and wellbeing for themselves and their families. The purpose of this case study was to evaluate SDOH among a refugee community in the Southeastern United States. We surveyed the community twice during a 1-year period to assess various elements of SDOH. Among a primarily African and Southeast Asian refugee community, 76% reported difficulty paying for food, housing and healthcare during the first round of surveys. During the second round of surveys at the beginning of the Coronavirus pandemic, 70% reported lost income; 58% indicated concern about paying bills. There was little change during the 12-month study period, showing that SDOH are an enduring measure of poor health and wellbeing for this vulnerable refugee community.

Assessment of insulin action on carbohydrate metabolism: physiological and non-physiological methods.

Carbohydrate metabolism in humans is regulated by insulin secretion from pancreatic ß-cells and glucose disposal by insulin-sensitive tissues. Insulin facilitates glucose utilization in peripheral tissues and suppresses hepatic glucose production. Any defects in insulin action predispose an individual to glucose intolerance and Type 2 diabetes mellitus. Early detection of defects in insulin action could provide opportunities to prevent or delay progression of the disease state. There are different approaches to assess insulin action. Initial methods, such as peripheral insulin concentration and simple indices, have several limitations. Subsequently, researchers developed methodologies using intravenous glucose infusion to determine glucose fluxes. However, these methodologies are limited by being non-physiological. Newer, innovative techniques that have been developed are more sophisticated and physiological. By modelling glucose kinetics using isotope dilution techniques, several robust parameters can be obtained that are physiologically relevant and sound. This brief review summarizes most of the non-physiological and physiological methodologies used to measure the variables of insulin action.

Estimating the resources required in the roll-out of universal access to antiretroviral treatment in Zimbabwe.

OBJECTIVES: To develop projections of the resources required (person-years of drug supply and healthcare worker time) for universal access to antiretroviral treatment (ART) in Zimbabwe. METHODS: A stochastic mathematical model of disease progression, diagnosis, clinical monitoring and survival in HIV infected individuals. FINDINGS: The number of patients receiving ART is determined by many factors, including the strategy of the ART programme (method of initiation, frequency of patient monitoring, ability to include patients diagnosed before ART became available), other healthcare services (referral rates from antenatal clinics, uptake of HIV testing), demographic and epidemiological conditions (past and future trends in incidence rates and population growth) as well as the medical impact of ART (average survival and the relationship with CD4 count when initiated). The variations in these factors lead to substantial differences in long-term projections; with universal access by 2010 and no further prevention interventions, between 370 000 and almost 2 million patients could be receiving treatment in 2030-a fivefold difference. Under universal access, by 2010 each doctor will initiate ART for up to two patients every day and the case-load for nurses will at least triple as more patients enter care and start treatment. CONCLUSIONS: The resources required by ART programmes are great and depend on the healthcare systems and the demographic/epidemiological context. This leads to considerable uncertainty in long-term projections and large variation in the resources required in different countries and over time. Understanding how current practices relate to future resource requirements can help optimise ART programmes and inform long-term public health planning.

The Quebec Association of Gastroenterology position paper on colorectal cancer screening - 2003.

Colorectal cancer is a leading cause of death and the third most common cancer in Canada. Evidence suggests that screening can reduce mortality rates and the cost effectiveness of a program compares favourably with initiatives for breast and cervical cancer. The objectives of the Association des gastro-entérologues du Québec Task Force were to determine the need for a policy on screening for colorectal cancer in Quebec, to evaluate the testing methods available and to propose one or more of these alternatives as part of a formal screening program, if indicated. Fecal occult blood testing (FOBT), endoscopy (including sigmoidoscopy and colonoscopy), barium enema and virtual colonoscopy were considered. Although most clinical efficacy data are available for FOBT and sigmoidoscopy, there are limitations to programs based on these strategies. FOBT has a high false positive rate and a low detection yield, and even a combination of these strategies will miss 24% of cancers. Colonoscopy is the best strategy to both detect and remove polyps and to diagnose colorectal cancer, with double contrast barium enema also being a sensitive detection method. The Task Force recommended the establishment, in Quebec, of a screening program with five- to 10-yearly double contrast barium enema or 10-yearly colonoscopy for individuals aged 50 years or older at low risk. The program should include outcome monitoring, public and professional education to increase awareness and promote compliance, and central coordination with other provincial programs. The program should be evaluated; specific billing codes for screening for colorectal cancer would help facilitate this. Formal feasibility, effectiveness and cost-effectiveness studies in Quebec are now warranted.

Growing up with parental alcohol abuse: exposure to childhood abuse, neglect, and household dysfunction.

OBJECTIVE: This study is a detailed examination of the association between parental alcohol abuse (mother only, father only, or both parents) and multiple forms of childhood abuse, neglect, and other household dysfunction, known as adverse childhood experiences (ACEs). METHOD: A questionnaire about ACEs including child abuse, neglect, household dysfunction, and exposure to parental alcohol abuse was completed by 8629 adult HMO members to retrospectively assess the relationship of growing up with parental alcohol abuse to 10 ACEs and multiple ACEs (ACE score). RESULTS: Compared to persons who grew up with no parental alcohol abuse, the adjusted odds ratio for each category of ACE was approximately 2 to 13 times higher if either the mother, father, or both parents abused alcohol (p < 0.05). For example, the likelihood of having a battered mother was increased 13-fold for men who grew up with both parents who abused alcohol (OR, 12.7; 95% CI: 8.4-19.1). For almost every ACE, those who grew up with both an alcohol-abusing mother and father had the highest likelihood of ACEs. The mean number of ACEs for persons with no parental alcohol abuse, father only, mother only, or both parents was 1.4, 2.6, 3.2, and 3.8, respectively (p < .001). CONCLUSION: Although the retrospective reporting of these experiences cannot establish a causal association with certainty, exposure to parental alcohol abuse is highly associated with experiencing adverse childhood experiences. Improved coordination of adult and pediatric health care along with related social and substance abuse services may lead to earlier recognition, treatment, and prevention of both adult alcohol abuse and adverse childhood experiences, reducing the negative sequelae of ACEs in adolescents and adults.

[Assessment of the quality of life during adjuvant chemotherapy of colorectal cancer]. / Mesure de la qualité de vie durant une chimiothérapie adjuvante du cancer colorectal.

Enhanced 5 year survival rates with adjuvant chemotherapy for colon and rectal cancers are 5% and 9% respectively, according to recent meta-analysis. Despite the NIH consensus statement endorsing adjuvant chemotherapy, many clinicians regard such a seemingly small benefit not justworthy of the expense, inconvenience, discomfort and risk of treatment for their individual patient with colorectal carcinoma. The aim of this study is to evaluate these quality of life issues. The seven criteria considered most important were determined by interviews of treated patients, who emphasized the following quality of life parameters: nausea and vomiting, diarrhea, perineal dermatitis, asthenia, impairment of daily activity, family support, and difficulties of daily transportation to hospital. A numeric scale (1-5) was used to measure their answers (0 = hospitalization, 5 = no modification), and the nonparametric rank coefficient of Kendall was used to compare them. Twenty patients with colon cancer treated with Moertel's protocol and 5 patients with rectal cancer treated with Krook's protocol were evaluated. The study revealed a diminished quality of life for both patients with colon cancer (7 on a scale of 10) and those with rectal cancer (6 on the same scale). By using the same questionnaire at one week interval, the responses remained unchanged (p < 0.001). The effect of radiotherapy seems to be responsible for this difference. This study is one of the first to approach the quality of life from the real interested party's point of view: the patient.

The effect of disparity on motion coherence.

Many moving plaid stimuli are ambiguous, and perception switches between a coherent plaid pattern and two transparent gratings. Here, experiments are reported that examined the effect of stereodepth between the two gratings of the moving plaid stimulus on the perception of coherence or motion transparency. Increasing disparity increased the percentage of time that two independently drifting transparent gratings were perceived. This was studied for plaids with various levels of intersection luminance. Using intersection luminances beyond conditions of physical transparency increased the percentage of time that one coherent plaid was seen. These two opposing influences could be pitted against each other to achieve constant levels of coherence. An adaptation paradigm was also used in which observers adapted to a stationary stimulus with either zero, crossed or uncrossed disparity between the gratings, and then indicated the occurrence of coherence and motion transparency in test stimuli of drifting plaids with zero, crossed or uncrossed disparity. Adaptation to crossed and uncrossed stereo-depth increased relative perceived coherence equally, especially for zero test disparity. An analysis of the length of the episodes of coherence and motion transparency indicated that the effect of adaptation was to decrease the length of motion transparency episodes, while the length of coherence episodes did not change. It is concluded that mechanisms involved in the processing of stereo-depth must have an input to the integration stage of the motion channel and that pattern and component motion mechanisms can operate quite independently.

Influence of age on caloric expenditure during exercise.

Young (147 +/- 2 g) and adult (322 +/- 7 g) male Sprague Dawley rats were subjected to an incremental treadmill protocol and assessed via the Oxyscan Metabolic System in order to determine if differences exist relative to oxygen consumption (VO2, expressed in ml/kg/min), respiratory exchange ratio (RER) and caloric expenditure of two different age groups. The young rats attained a higher VO2 (81.55 +/- 1.22) compared to adult rats (68.97 +/- 2.05) at a maximal level of exercise. The adult rats became dependent upon carbohydrates as the primary source of energy until reaching 52% VO2 max, whereas the young rats did not resort to carbohydrate utilization as a primary fuel source until reaching 87% VO2max. At peak exercise, the adult animals burned only 15% less kcal/kg/h than the young rats, but the adult rats burned 37% more carbohydrate than the young animals. These data suggest that as exercise intensity increases, younger rats can more readily maintain a higher level of oxygen consumption accompanied by a more efficient use of fat as an energy source compared to adult rats. The clinical implication of this finding suggests that during the growth and development years of life, fat plays a significant role in energy expenditure needs and may therefore be more important than currently believed in young children's nutritional intake.

Quantitative assessment of pelvic ileal reservoir emptying with a semisolid radionuclide enema. A correlation with clinical outcome.

Fecal stasis in an ileal reservoir may lead to overgrowth of bacteria and changes in mucosal morphology that are of future concern. Moreover, improper evacuation may lead to increased stool frequency and reduced continence. The aims of this study were: to compare the functional results of two types of ileal reservoirs constructed with an ileoanal anastomosis, to compare their emptying to a normal rectum as assessed by a radionuclide enema, and to correlate functional results with emptying. The reservoirs were made of two (J) or three (S) limbs of terminal ileum. Thirty-three patients (16 with J-pouch and 17 with S-pouch) and ten healthy controls were included in the study. There was no difference in the mean age of patients or interval following diverting ileostomy closure. Functional results were obtained by written questionnaire assessing stool frequency, and soiling, use of medication, need for intubation, and episodes of pouchitis. Emptying was measured with instillation per anus of a semisolid medium labeled with 1.0 mCi of Tc-99. Ileal pouch counts were measured using a scintillation camera and computer before and after spontaneous evacuation. The emptying was defined as the difference in counts divided by preevacuation counts. The functional results were similar in the two groups. Nocturnal soiling occurred more frequently in the S-pouch group. Pouchitis occurred in seven patients. Emptying of the two types of reservoir was similar (J: 72 +/- 4%, S: 67 +/- 5%), but it was less efficient than a normal rectum (90 +/- 3%, P less than 0.004). No correlation was established between age, sex, number of stools, pouchitis, and the efficacy of emptying. The clinical outcome of two patients who emptied less than 30%, however, was greatly improved by intermittent intubation. In conclusion, a semisolid radionuclide enema can be useful to identify patients who would benefit from intubation. No persistent defect in emptying was detected in patients with pouchitis.

Cytohormonal assessment of ovarian function following tubal ligation.

One hundred fifty postligation and 54 random cases matched for age and parity were studied. Vaginal cytologic samples and endometrial histologic samples were used for cytohormonal assessment of ovarian function. There was no indication of ovarian insufficiency following tubal ligation. The menstrual cycles were ovulatory. Menstrual disturbances were seen in 40.6% of the cases following tubal ligation. Cytohormonal comparison of these cases with that of dysfunctional uterine bleeding cases (who did not undergo tubal ligation) showed either similar or high maturation value. This may be due either to psychological stimulation or to low-grade infection following tubal ligation. There was complete cytomorphologic correlation.