Exploration of inter-jurisdictional TB programming and mobility in a Canadian First Nation community.

BACKGROUND: Colonially imposed jurisdictional boundaries that have little meaning to Indigenous peoples in Canada may confound tuberculosis (TB) prevention and care activities. This study explores how inter-jurisdictional mobility and the current accommodation of mobility through policies and programming sustain a regional TB epidemic in northwestern Saskatchewan, and northeastern Alberta. METHODS: A qualitative instrumental case study was performed using a community based participatory approach. Semi-structured interviews were conducted with First Nations peoples from a high-incidence community in Canada including community-based healthcare workers. These interview data are presented in the context of a multi-level document analysis of TB program guidelines. RESULTS: The location of the community, and related lack of access to employment, services and care, necessitates mobility across jurisdictional boundaries. There are currently no formal federal or provincial guidelines in place to accommodate highly mobile patients and clients within and across provincial TB prevention and care programs. As a result, locally developed community-based protocols, and related ad-hoc strategies ensure continuity of care. CONCLUSION: Indigenous peoples living in remote communities face unique push/pull factors that motivate mobility. When these motivations exist in communities with increased risk of contagion by communicable infectious diseases such as TB, public health risks extend into increasingly large areas with competing jurisdictional authority. Such mobility poses several threats to TB elimination. We have identified a gap in TB services to systematically accommodate mobility, with specific implications for Indigenous peoples and reconciliation. We recommend clearly defined communication paths and inter-jurisdictional coordination to ensure maintenance of care for mobile populations.

The Contribution of Project Environmental Assessment to Assessing and Managing Cumulative Effects: Individually and Collectively Insignificant?

This paper explores the opportunities and constraints to project-based environmental assessment as a means to support the assessment and management of cumulative environmental effects. A case study of the hydroelectric sector is used to determine whether sufficient information is available over time through project-by-project assessments to support an adequate understanding of cumulative change. Results show inconsistency from one project to the next in terms of the components and indicators assessed, limited transfer of baseline information between project assessments over time, and the same issues and concerns being raised by review panels-even though the projects reviewed are operating in the same watershed and operated by the same proponent. Project environmental assessments must be managed, and coordinated, as part of a larger system of impact assessment, if project-by-project assessments are to provide a meaningful forum for learning and understanding cumulative change. The paper concludes with recommendations for improved project-based assessment practice in support of cumulative effects assessment and management.

Stigma Reduction Interventions of Dementia: A Scoping Review.

Despite its global importance and the recognition of dementia as an international public health priority, interventions to reduce stigma of dementia are a relatively new and emerging field. The purpose of this review was to synthesize the existing literature and identify key components of interventions to reduce stigma of dementia. We followed Arksey and O'Malley's scoping review process to examine peer-reviewed literature of interventions to reduce dementia-related stigma. A stigma-reduction framework was used for classifying the interventions: education (dispel myths with facts), contact (interact with people with dementia), mixed (education and contact), and protest (challenge negative attitudes). From the initial 732 references, 21 studies were identified for inclusion. We found a variety of education, contact, and mixed interventions ranging from culturally tailored films to intergenerational choirs. Findings from our review can inform the development of interventions to support policies, programs, and practices to reduce stigma and improve the quality of life for people with dementia.

Addressing the needs of rural and remote people in a national dementia strategy for Canada.

A number of organizations such as the Canadian Academy of Health Sciences have identified the growing need for a National Dementia Strategy in Canada to improve the quality of life for people with dementia. This commentary highlights the necessity of addressing stigma, social inclusion, and supports for people affected by dementia, specifically those living in rural and remote communities. Drawing on Saskatchewan-based examples, we discuss the importance of recognizing the unique needs of rural and remote communities in developing a National Dementia Strategy for Canada. We believe that a national strategy needs to be built from the ground up and not imposed from the top down. Only through the development of evidence-informed research and collaborative partnerships can we ensure that there is equitable access to services and supports for people with dementia in rural and remote communities.

Serum proteomic patterns for detection of prostate cancer.

Pathologic states within the prostate may be reflected by changes in serum proteomic patterns. To test this hypothesis, we analyzed serum proteomic mass spectra with a bioinformatics tool to reveal the most fit pattern that discriminated the training set of sera of men with a histopathologic diagnosis of prostate cancer (serum prostate-specific antigen [PSA] > or =4 ng/mL) from those men without prostate cancer (serum PSA level <1 ng/mL). Mass spectra of blinded sera (N = 266) from a test set derived from men with prostate cancer or men without prostate cancer were matched against the discriminating pattern revealed by the training set. A predicted diagnosis of benign disease or cancer was rendered based on similarity to the discriminating pattern discovered from the training set. The proteomic pattern correctly predicted 36 (95%, 95% confidence interval [CI] = 82% to 99%) of 38 patients with prostate cancer, while 177 (78%, 95% CI = 72% to 83%) of 228 patients were correctly classified as having benign conditions. For men with marginally elevated PSA levels (4-10 ng/mL; n = 137), the specificity was 71%. If validated in future series, serum proteomic pattern diagnostics may be of value in deciding whether to perform a biopsy on a man with an elevated PSA level.

Treaties and tuberculosis: First Nations people in late 19th-century western Canada, a political and economic transformation.

This paper examines the explosion of tuberculosis infections among First Nations communities of western Canada during the critical period from Canada's acquisition of the Northwest to the early 1880s. In the early 1870s, the disease was relatively rare among the indigenous population of the plains. Within a few years, the situation changed dramatically. By the early 1880s, TB was widely recognized to be the primary cause of morbidity and mortality among First Nations populations. Rather than direct infection from the burgeoning European population in the region, the explosion of the disease was caused by sudden ecological, economic, and political changes in the west that were primarily the result of the imposition of Canadian hegemony.

Facet Theory and the Mapping Sentence As Hermeneutically Consistent Structured Meta-Ontology and Structured Meta-Mereology.

When behavior is interpreted in a reliable manner (i.e., robustly across different situations and times) its explained meaning may be seen to possess hermeneutic consistency. In this essay I present an evaluation of the hermeneutic consistency that I propose may be present when the research tool known as the mapping sentence is used to create generic structural ontologies. I also claim that theoretical and empirical validity is a likely result of employing the mapping sentence in research design and interpretation. These claims are non-contentious within the realm of quantitative psychological and behavioral research. However, I extend the scope of both facet theory based research and claims for its structural utility, reliability and validity to philosophical and qualitative investigations. I assert that the hermeneutic consistency of a structural ontology is a product of a structural representation's ontological components and the mereological relationships between these ontological sub-units: the mapping sentence seminally allows for the depiction of such structure.

From past to present: understanding First Nations health patterns in a historical context.

By many measures of health, Canada's First Nations compare very poorly to the non-Native population as a whole. The need to explain, and to correct, this disparity has led public health researchers to consider a wide variety of community characteristics. One area that is as yet under-utilized, but may yield important insights into the complex question of First Nations health, is history. This paper presents an overview of the potential uses of historical methods in the study of the health of First Nations communities in Manitoba. It also introduces the major historical data sources available to public health researchers involved in such research. There are three main benefits to the inclusion of history in public health research. First, we may learn about the impact of health changes on Aboriginal groups in the past. Second, we may better understand the origins of present-day health concerns, many of which emerged out of the events of the recent or not so recent past. Finally, we may gain important insights into the nature of the disease process, and the diseases themselves, by employing the past as a laboratory. The addition of an historical approach can enhance health research directed towards First Nations communities in Manitoba.

Radio-frequency ablation of large, nonresectable hepatic tumors.

Patients with nonresectable hepatic metastases who are not treated survive an average of 6 months. We report our experience with radio-frequency ablation (RFA) of nonresectable hepatic tumors 4 cm or greater in size. A retrospective chart review of all patients undergoing RFA of hepatic tumors 4 cm or greater from October 1, 1999, through August 31, 2002, was performed. Thirty-six patients were identified who underwent RFA of tumors 4 cm or greater. There were a total of 81 tumors ablated in the 36 patients. Twenty patients underwent RFA only; seven patients received RFA plus a wedge resection. Five patients were treated with RFA followed by chemoembolization. Two patients underwent RFA plus placement of a hepatic artery infusion pump. The median tumor size was 5 cm (range, 4-14 cm). Median patient follow-up was 26 months (range, 1-54 months). Patients with metastatic colon cancer had the longest median survival of 28 months (range, 1 and 48 months). The survival of primary hepatocellular carcinoma was worse with a median survival of 20 months (range, 1-36 months). At last follow-up, 11 (30%) of the patients remain alive and disease free. There were no perioperative deaths and one intraoperative complication. In our experience, RFA of larger tumors is effective and safe. Tumor size should not be an absolute contraindication to RFA of nonresectable hepatic tumors.