Australian and New Zealand Living Guideline cholesterol-lowering therapy for people with chronic kidney disease (CARI Guidelines): Reducing the evidence-practice gap.

AIM: People with chronic kidney disease experience high rates of cardiovascular disease. Cholesterol-lowering therapy is a mainstay in the management but there is uncertainty in the treatment effects on patient-important outcomes, such as fatigue and rhabdomyolysis. Here, we summarise the updated CARI Australian and New Zealand Living Guidelines on cholesterol-lowering therapy in chronic kidney disease. METHODS: We updated a Cochrane review and monitored newly published studies weekly to inform guideline development according to international standards. The Working Group included expertise from nephrology, cardiology, Indigenous Health, guideline development and people with lived experience of chronic kidney disease. RESULTS: The guideline recommends people with chronic kidney disease (eGFR ≥15 mL/min/1.73 m2) and an absolute cardiovascular risk of 10% or higher should receive statin therapy (with or without ezetimibe) to reduce the risk of cardiovascular events and death (strong recommendation, moderate certainty evidence). The guidelines also recommends a lower absolute cardiovascular risk threshold (≥5%) for Aboriginal and Torres Strait Islander Peoples and Maori with chronic kidney disease to receive statin therapy (with or without ezetimibe) (strong recommendation, low certainty evidence). The evidence was actively surveyed from 2020-2023 and updated as required. No changes to guideline recommendations were made, with no new data on the balance and benefits of harms. CONCLUSIONS: The development of living guidelines was feasible and provided the opportunity to update recommendations to improve clinical decision-making in real-time. Living guidelines provide the opportunity to transform chronic kidney disease guidelines.

Cape York Kidney Care: service description and baseline characteristics of a client-centred multidisciplinary specialist kidney health service in remote Australia.

BACKGROUND: Chronic Kidney disease (CKD) is over-represented amongst First Nation people with more than triple the rate of CKD in those aged 15 years and over. The impact of colonisation, including harmful experiences of health practices and research, has contributed to these health inequities. Cape York Kidney Care (CYKC) has been created as an unique service which provides specialist care that aims to centre the client within a multidisciplinary team that is integrated within the primary care setting of the remote health clinics in six communities in western Cape York, Australia. This research aims to describe the Cape York Kidney Care service delivery model, and baseline service data, including aggregated client health measures. METHODS: The model of care is described in detail. Review of the first 12 months of service provision has been undertaken with client demographic and clinical profile baseline data collected including kidney health measures. Participants are adults (> 18 years if age) with CKD grades 1-5. This data has been de-identified and aggregated. RESULTS: CYKC reviewed 204 individuals, with 182 not previously been reviewed by specialist kidney health services. Three quarters of clients identified as Aboriginal. The average age was 55 with a high level of comorbidity, with majority having a history of hypertension and Type 2 diabetes (average Hba1c 8.2%). Just under one third had cardiovascular disease. A large proportion of people had either Grade 2 CKD (32%) or Grade 3 CKD (~ 30%), and over half had severely increased albuminuria (A3), with Type 2 diabetes being the predominant presumed cause of CKD. Most clients did not meet evidence-based targets for diabetes, blood pressure or lipids and half were self-reported smokers. The proportion of clients reviewed represents 6.2% of the adult population in the participating First Nation communities. CONCLUSION: The CYKC model was able to target those clients at high risk of progression and increase the number of people with chronic kidney disease reviewed by specialist kidney services within community. Baseline data demonstrated a high burden of chronic disease that subsequently will increase risk of CKD progression and cardiovascular disease. People were seen to have more severe disease at younger ages, with a substantial number demonstrating risk factors for rapid progression of kidney disease including poorly controlled Type 2 diabetes and severely increased albuminuria. Further evaluation concerning implementation challenges, consumer and community satisfaction, and health outcomes is required.

Analysis of medical tourism at the Andrade port of entry.

BACKGROUND: Medical tourism, a term used to describe the practice of traveling to obtain medical services or products, is known to occur along the U.S.-Mexico border and has for some time. Despite the ever-increasing number of local border crossings, there is little research or monitoring done on the prevalence of medical tourism or to show the products and services sought. OBJECTIVES: To identify which medications and services are most frequently obtained, the reasons for these instances of medical tourism, perceived efficacy or satisfaction of the medications and services, and the likelihood of continuing to receive health care in Mexico. METHODS: Using a cross-sectional survey design, participants were recruited to participate in an anonymous electronic 12-question survey at or near the U.S.-Mexico border at the Andrade port of entry. All participants were waiting to cross or had just crossed the border through this port. Data were analyzed using descriptive statistics. RESULTS: A total of 427 surveys were collected for analysis. The respondents reported traveling from 29 states within the United States, as well as from 3 other countries. The average age of the participants was 64.5 years, with a range of 19-93 years. Cost was reported by 92% (n = 394) as the major factor to participate in medical tourism, and the most common income bracket reported was between $25,001 and $50,000 annually (n = 103). Dental (n = 124) was the most common medical service, and antibiotics (n = 225) were the most common class of medications sought. Most of the participants expressed the intent to continue to participate in medical tourism (n = 404). CONCLUSION: Most survey respondents felt that Mexican health care services are of the same or better quality compared with those in the United States, for a lower cost, and plan to participate in medical tourism moving forward. Many opportunities for future research exist on this topic, including follow-up surveys and laboratory analyses to compare medication samples.

Views on aging among undergraduates, faculty, and staff: Domain-specific measurement invariance and comparisons.

Views on aging have been shown to reliably predict various psychological and physical health outcomes. To our knowledge, this is the first study exploring domain-specific views on aging using a university sample including students, faculty, and staff (N = 646). Specifically, we assessed how one's age stereotypes (AS), current self-views on aging (CS), and future self-views on aging (FS) vary among students, faculty, and staff by age and by eight everyday functioning domains using an existing domain-specific scale. In general, the older one becomes, the more positive one's views on aging are in various domains with a few exceptions. No single group (e.g., students, faculty, or staff) consistently had more positive views across domains than the other groups. Moreover, faculty and staff tended to share similar views on aging compared to students. The most salient difference between students and faculty/staff was in the finance domain; students had more positive age stereotypes and future self-views than faculty and staff but not for current self-views. The results highlight the importance of examining the domain-specific age stereotypes, current and future self-views on aging to understand the differences among university populations and provide implications for future educational programs on ageism.

Supporting holistic care for patients with tuberculosis in a remote Indigenous community: a case report.

CONTEXT: Tuberculosis (TB) is a serious infectious disease with high rates of morbidity and mortality if left untreated. In Australia, TB has been virtually eradicated in non-Indigenous Australian-born populations but in remote Aboriginal and/or Torres Strait Islander communities TB presents a rare but significant public health issue. Remote health services are most likely to encounter patients with suspected and confirmed TB diagnosis but may be unprepared for supporting someone with this disease and the complexities of balancing public health risk with patient autonomy. ISSUE: This case study will outline the process for diagnosis and treatment of a TB patient in a remote Cape York community. This case involved significant delay in diagnosis and required several strategies to achieve successful disease eradication. The process of treatment, however, had a significant effect on the patient's physical health, and social and emotional wellbeing. LESSONS LEARNED: This case highlights the importance of early collaboration between medical, nursing, Indigenous health worker and allied health services and the importance of technology such as electronic information records to support opportunistic access to diagnostic services and treatment. The enactment of the TB protocol should include discussions about the consequences of any restrictions of movement, employment or social/community roles. Identifying alternative opportunities to engage in meaningful roles may reduce the impact the disease has on a patient's quality of life.

An academic perspective of participation in healthcare redesign.

Healthcare redesign, based on building collaborative capacity between academic and clinical partners, should create a method to facilitate flow between the key elements of health service improvement. However, utilising the skills and resources of an organisation outside of the health facility may not always have the desired effect. Accountability and mutually respectful relationships are fundamental for collaborative, sustainable and successful completion of clinical research projects. This paper provides an academic perspective of both the benefits of academic involvement in facilitating healthcare redesign processes as well as the potential pitfalls of involving external partner institutions in internal healthcare redesign projects.

A diaper bank and home visiting partnership: Initial exploration of research and policy questions.

OBJECTIVES: The cost of diapering an infant can place a significant financial strain on families living in poverty. Partnerships between diaper banks and home visiting programs for young families may offer an innovative solution to expanding the reach and impact of diaper banks in low-income communities. The purpose of this pilot study was to uncover preliminary information about the functions of diaper distribution through home visiting programs, and to inform future research and policy questions regarding diaper distribution to families in need. DESIGN AND SAMPLE: In this descriptive qualitative pilot study, semi-structured interviews were conducted with 6 home visitors from Minding the Baby® (MTB), a home visiting intervention for young parents. MTB clinicians routinely distribute diapers in partnership with The Diaper Bank in Connecticut. We used directed content analysis to code and analyze interview transcripts. RESULTS/CONCLUSION: These preliminary findings indicate that partnerships between home visiting programs and diaper banks may benefit families by improving diaper access, reducing stigma, and fostering trusting relationships with home visitors. Home visiting program benefits including engagement or re-engagement with families may need to be balanced with potential effects on clinical and therapeutic relationships. Recommendations for next steps in research and related policy questions are discussed.

Transmission ecology of taeniid larval cestodes in rodents in Sweden, a low endemic area for Echinococcus multilocularis.

Although local prevalence of Echinococcus multilocularis may be high, this zoonotic parasite has an overall low prevalence in foxes and rodents in Sweden. To better understand opportunities for E. multilocularis transmission in the Swedish environment, the aim of this study was to investigate other taeniid cestodes and to relate observed patterns to E. multilocularis. Cestode parasites were examined in fox feces and rodents caught in different habitats from four regions of Sweden. Arvicola amphibius and Microtus agrestis were parasitized with Versteria mustelae, Hydatigera taeniaeformis s. l., and E. multilocularis, whereas Myodes glareolus and Apodemus spp. were parasitized with V. mustelae, Taenia polyacantha, H. taeniaeformis s.l., and Mesocestoides spp. Rodents caught in field habitat (Ar. amphibius, Mi. agrestis) were more likely (OR 10, 95% CI 5-19) to be parasitized than rodents caught in forest habitat (My. glareolus, Apodemus spp.). The parasite preference for each rodent species was present regardless of the type of background contamination from fox feces. These results further support the importance of both ecological barriers and individual species susceptibility in parasite transmission, and indicate that future monitoring for E. multilocularis in the Swedish environment should focus in field habitats where Mi. agrestis and Ar. amphibius are abundant.

A Qualitative Study of Health Care Experiences Among International Students.

The purpose of this qualitative study was to explore the health care experiences of international students at a college in Indiana. The study answered the following research question: What are the lived experiences of international students while seeking health care? This research question was identified after a literature review, which showed a lack of research regarding international students' health care experiences. The data in this study were collected through in-depth interviews with 5 participants who resided at the college. After the interviews, the identification of themes and the analysis of results revealed the international students' lived experiences and perceptions of health care in the United States.

Moral typecasting underlies punitive responses to crime.

We examine the role of moral typecasting in lay individuals' punitive responses to crime. Individuals perceive criminal offenders and victims in ways that are biased by their perceptions of the actors' moral roles in prior simulated criminal incidents. We find that this psychological process of moral typecasting has important implications for punitive responses to criminal offenders, and these findings make 2 major contributions to the literature. First, we show that moral agency is distinct from moral deservingness, which is 1 of the dominant explanations for punitive behavior in social psychology. Second, the role of moral typecasting in punitive responses means that these responses can occur regardless of the valence of moral character. We argue that theories of lay punitive responding that do not take moral typecasting processes into account are incomplete. (PsycINFO Database Record

Forgiveness-reconciliation and communication-conflict-resolution interventions versus retested controls in early married couples.

The first 6 months of marriage are optimal for marriage enrichment interventions. The Hope-Focused Approach to couple enrichment was presented as two 9-hr interventions--(a) Handling Our Problems Effectively (HOPE), which emphasized communication and conflict resolution, and (b) Forgiveness and Reconciliation through Experiencing Empathy (FREE). HOPE and FREE were compared with repeated assessment controls. Couples were randomly assigned and were assessed at pretreatment (t1); 1 month posttreatment (t2) and at 3- (t3), 6- (t4), and 12-month (t5) follow-ups using self-reports. In addition to self-report measures, couples were assessed at t1, t2, and t5 using salivary cortisol, and behavioral coding of decision making. Of 179 couples who began the study, 145 cases were analyzed. Both FREE and HOPE produced lasting positive changes on self-reports. For cortisol reactivity, HOPE and FREE reduced reactivity at t2, but only HOPE at t5. For coded behaviors, control couples deteriorated; FREE and HOPE did not change. Enrichment training was effective regardless of the focus of the training.

Parasite Spillover from Domestic Sheep to Wild Reindeer-The Role of Salt Licks.

Attraction sites are important for environmental pathogen transmission and spillover. Yet, their role in wildlife disease dynamics is often poorly substantiated. Herein, we study the role of salt licks as potential attraction sites for the spillover of gastrointestinal parasites from domestic sheep to wild reindeer. Eggs from the introduced sheep nematode Nematodirus battus were found in faecal samples of both species, suggestive of spillover. DNA metabarcoding of soil, collected at salt licks, revealed that N. battus, in addition to Teladorsagia circumcincta, were the most frequently occurring parasitic nematodes, with a significantly higher prevalence of nematodal DNA in salt lick soil compared to soil from control sites nearby. The finding of similar DNA haplotypes of N. battus in sheep, reindeer, and salt lick soil supports the hypothesis of spillover to reindeer via salt licks. More detailed investigation of the genetic diversity of N. battus across these hosts is needed to draw firm conclusions. Infection with these sheep nematodes could potentially explain a recently observed decline in the calf recruitment rate of the Knutshø reindeer herd. This study also supports the hypothesized role of artificial salt licks as hot spots for the transmission of environmentally persistent pathogens and illustrates the importance of knowledge about such attraction points in the study of disease in free-roaming animals.

Predation of endangered Arctic foxes by Golden eagles: What do we know?

Dedicated conservation efforts spanning the past two decades have saved the Fennoscandian Arctic fox (Vulpes lagopus) population from local extinction, and extensive resources continue to be invested in the species' conservation and management. Although increasing, populations remain isolated, small and are not yet viable in the longer term. An understanding of causes of mortality are consequently important to optimize ongoing conservation actions. Golden eagles (Aquila chrysaetos) are a predator of Arctic foxes, yet little information on this interaction is available in the literature. We document and detail six confirmed cases of Golden eagle depredation of Arctic foxes at the Norwegian captive breeding facility (2019-2022), where foxes are housed in large open-air enclosures in the species' natural habitat. Here, timely detection of missing/dead foxes was challenging, and new insights have been gained following recently improved enclosure monitoring. Golden eagle predation peaked during the winter months, with no cases reported from June to November. This finding contrasts with that which is reported from the field, both for Arctic and other fox species, where eagle depredation peaked at dens with young (summer). While the seasonality of depredation may be ecosystem specific, documented cases from the field may be biased by higher survey efforts associated with the monitoring of reproductive success during the summer. Both white and blue color morphs were housed at the breeding station, yet only white foxes were preyed upon, and mortality was male biased. Mitigation measures and their effectiveness implemented at the facility are presented. Findings are discussed in the broader Arctic fox population ecology and conservation context.

Mixed success for carbon payments and subsidies in support of forest restoration in the neotropics.

Restoration of forests in low- and middle-income countries (LMICs) has the potential to contribute to international carbon mitigation targets. However, high upfront costs and variable cashflows are obstacles for many landholders. Carbon payments have been promoted as a mechanism to incentivize restoration and economists have suggested cost-sharing by third parties to reduce financial burdens of restoration. Yet empirical evidence to support this theory, based on robust, dynamic field sampling is lacking. Here we use large, long-term datasets from Panama to evaluate the financial prospects of three forest restoration methods under different cost-sharing and carbon payment designs where income is generated through timber harvests. We show some, but not all options are economically viable. Further work combining growth and survival data from field trials with more sophisticated financial analyses is essential to understanding barriers and realizing the potential of forest restoration in LMICs to help meet global carbon mitigation commitments.

A Participatory Framework for Plain Language Clinical Management Guideline Development.

BACKGROUND: Clinical management guidelines (CMGs) are decision support tools for patient care used by professionals, patients, and family caregivers. Since clinical experts develop numerous CMGs, their technical language hinders comprehension and access by nonmedical stakeholders. Additionally, the views of affected individuals and their families are often not incorporated into treatment guidelines. We developed an adequate methodology for addressing the needs and preferences of family and professional stakeholders regarding CMGs, a recently developed protocol for managing congenital disorders of glycosylation (CDG), a family of rare metabolic diseases. We used the CDG community and phosphomannomutase 2 (PMM2)-CDG CMGs as a pilot to test and implement our methodology. RESULTS: We listened to 89 PMM2-CDG families and 35 professional stakeholders and quantified their CMG-related needs and preferences through an electronic questionnaire. Most families and professionals rated CMGs as relevant (86.5% and 94.3%, respectively), and valuable (84.3% and 94.3%, respectively) in CDG management. The most identified challenges were the lack of CMG awareness (50.6% of families) and the lack of plain language CMG (39.3% of professionals). Concordantly, among families, the most suggested solution was involving them in CMG development (55.1%), while professionals proposed adapting CMGs to include plain language (71.4%). Based on these results, a participatory framework built upon health literacy principles was created to improve CMG comprehension and accessibility. The outputs are six complementary CMG-related resources differentially adapted to the CDG community's needs and preferences, with a plain language PMM2-CDG CMG as the primary outcome. Additionally, the participants established a distribution plan to ensure wider access to all resources. CONCLUSIONS: This empowering, people-centric methodology accelerates CMG development and accessibility to all stakeholders, ultimately improving the quality of life of individuals living with a specific condition and raising the possibility of application to other clinical guidelines.

Object movement in preschool children's word learning.

Two studies examined whether preschool children preferred to select a moving object over stationary objects when determining the referent of a novel word. In both studies three- and four-year-olds observed three novel objects, one moving object and two stationary objects. In Study 1, children (n=44) were asked to select the object that best matched a novel word. In Study 2, children (n=45) were asked to select the object that best matched a novel fact. Results across the two studies indicated that three- and four-year-olds showed a preference for selecting the moving object and that this preference was similar for both words and facts. These results suggest that preschool children are able to use movement to determine the referent of a novel word, especially when other cues are unavailable or unhelpful, but that movement may not be uniquely helpful for word learning.

Echinococcus granulosus sensu lato and Echinococcus multilocularis: A review.

Echinococcus spp. have a global distribution and are found on every continent except Antarctica. Infections with these parasites are considered extremely serious, contributing to significant morbidity and mortality in addition to substantial economic losses to the livestock industry. Echinococcus granulosus sensu lato (s.l.) and Echinococcus multilocularis, causing cystic echinococcosis (CE) and alveolar echinococcosis (AE) respectively, are the two main species of interest from a human and veterinary perspective. This review collates the current state-of-the-art understanding of these two parasites within four key areas of relevance to human and veterinary professionals: transmission and epidemiology, clinical signs and pathogenesis, diagnosis, and treatment and prevention. This review should serve as a broad introduction to the most important Echinococcus spp. The reader is advised to seek out specific literature on individual diseases and their causative parasites for a deeper understanding.

LOUPING-ILL VIRUS SEROSURVEY OF WILLOW PTARMIGAN (LAGOPUS LAGOPUS LAGOPUS) IN NORWAY.

In Norway, the Willow Ptarmigan (Lagopus lagopus lagopus) is experiencing population declines and is nationally Red Listed as Near Threatened. Although disease has not generally been regarded as an important factor behind population fluctuations for Willow Ptarmigan in Norway, disease occurrence has been poorly investigated. Both louping-ill virus (LIV) and the closely related tick-borne encephalitis virus are found along the southern part of the Norwegian coast. We assessed whether and where Norwegian Willow Ptarmigan populations have been infected with LIV. We expected to find infected individuals in populations in the southernmost part of the country. We did not expect to find infected individuals in populations further north and at higher altitudes because of the absence of the main vector, the sheep tick (Ixodes ricinus). We collected serum samples on Nobuto filter paper and used a hemagglutination inhibition assay for antibodies against LIV. We collected data at both local and country-wide levels. For local sampling, we collected and analyzed 87 hunter-collected samples from one of the southernmost Willow Ptarmigan populations in Norway. Of these birds, only three positives (3.4%) were found. For the country-wide sampling, we collected serum samples from 163 Willow Ptarmigan carcasses submitted from selected locations all over the country. Of these birds, 32% (53) were seropositive for LIV or a cross-reacting virus. Surprisingly, we found seropositive individuals from locations across the whole country, including outside the known distribution of the sheep tick. These results suggest that either LIV or a cross-reacting virus infects ptarmigan in large parts of Norway, including at high altitudes and latitudes.

Distribution, prevalence and intensity of moose nose bot fly (Cephenemyia ulrichii) larvae in moose (Alces alces) from Norway.

High host density combined with climate change may lead to invasion of harmful parasites in cervid (host) populations. Bot flies (Diptera: Oestridae) are a group of ectoparasites that may have strong impact on their hosts, but data on the current distribution, prevalence and intensity of the moose nose bot fly (Cephenemyia ulrichii) in Scandinavia are lacking. We estimated prevalence and intensity of nose bot fly larvae in 30 moose from southern and 79 moose from central Norway. All larvae detected were identified as the moose nose bot fly. We found surprisingly high prevalence in these areas, which are up to 1300 km south-southwest of the first published location in Norway and west of the distribution in Sweden. Prevalence (0.44-1.00) was higher in areas with higher moose density. Parasite intensity in hunter killed moose was higher in central Norway (mean 5.7) than southern Norway (mean 2.9), and in both regions higher in calves and yearlings than adults. Fallen moose had higher parasite intensity (mean 9.8) compared to hunter killed moose in the subsample from central Norway, suggesting a link to host condition or behavior. Our study provides evidence of parasite range expansion, and establishing monitoring appears urgent to better understand impact on host populations.

Emerging insights in weight management and prevention: implications for practice and research.

Recent advances in foundational research on energy balance and weight loss shed new light on earlier findings. Emerging evidence and insights around mental illness and client-centred, weight-inclusive approaches have implications for practitioners. This paper provides an overview of opinions from invited experts who presented at the Canadian Nutrition Society Thematic Conference in January 2019. Novelty: Weight loss involves an interplay of multiple factors, not diet alone. There is no "best diet" or treatment approach for weight loss. Future research should involve minimizing weight loss countermeasures and new health system-based approaches aimed at improving health.