Communication and Perspectives About COVID-19 and Vaccinations Among Native Americans.

The COVID-19 pandemic disproportionately affected Native American people and communities across the United States. Despite unequal losses during the pandemic, Native Americans have high vaccination rates. We provide insight into perspectives of COVID-19 and vaccinations through in-depth interviews with Native Americans. Through this research, we provide a holistic view of how Native Americans perceive vaccines by pairing Indigenous perspectives of risk and the Health Belief Model. We discuss the importance of tribal sovereignty in developing health communication strategies, and the need for messaging that is trusted and culturally appropriate.

Factors That Influence Risk Perceptions and Successful COVID-19 Vaccination Communication Campaigns With American Indians.

COVID-19 vaccinations are the primary tool to end the pandemic. However, vaccine hesitancy continues to be a barrier to herd-immunity in the United States. American Indians (AI) often have higher levels of distrust in western medicine and lower levels of satisfaction with health care when compared to non-Hispanic Whites. Yet AIs have high COVID-19 vaccination rates. We discuss factors that influence AI risk perceptions of COVID-19 vaccinations including the impact of COVID-19 on AI Elders, community, and culture. We conclude with future research needs on vaccination communication and how culturally congruent communication campaigns may have contributed to high COVID-19 vaccination rates.

A Systematic Literature Review of Cancer Communication with Indigenous Populations in Canada and the United States.

Cancer is one of the leading causes of death among Indigenous populations. Communication campaigns are an important component of cancer prevention and treatment. However, communication about cancer with Indigenous populations has yet to be fully explored and understood. In this systematic literature review, we examine peer-reviewed research to gain insight into the factors that contribute to effective communication about cancer with Indigenous populations. The review yielded a total of 7313 potential articles and a total of 25 of these manuscripts met the inclusion criteria. Results indicate five primary factors that may increase the effectiveness of communication about cancer with Indigenous populations. Factors include the need to (1) respect traditional knowledge, (2) use appropriate language, (3) involve community members in the communication process, (4) include people from different generations in message design, and (5) engender trust in health communicators. Results also provide insight into communication methods that contribute to effective cancer communication. We identify gaps in the literature and provide recommendations for future cancer communication strategies and research with Indigenous populations.

The formation of paranodal spirals at the ends of CNS myelin sheaths requires the planar polarity protein Vangl2.

During axonal ensheathment, noncompact myelin channels formed at lateral edges of the myelinating process become arranged into tight paranodal spirals that resemble loops when cut in cross section. These adhere to the axon, concentrating voltage-dependent sodium channels at nodes of Ranvier and patterning the surrounding axon into distinct molecular domains. The signals responsible for forming and maintaining the complex structure of paranodal myelin are poorly understood. Here, we test the hypothesis that the planar cell polarity determinant Vangl2 organizes paranodal myelin. We show that Vangl2 is concentrated at paranodes and that, following conditional knockout of Vangl2 in oligodendrocytes, the paranodal spiral loosens, accompanied by disruption to the microtubule cytoskeleton and mislocalization of autotypic adhesion molecules between loops within the spiral. Adhesion of the spiral to the axon is unaffected. This results in disruptions to axonal patterning at nodes of Ranvier, paranodal axon diameter and conduction velocity. When taken together with our previous work showing that loss of the apico-basal polarity protein Scribble has the opposite phenotype-loss of axonal adhesion but no effect on loop-loop autotypic adhesion-our results identify a novel mechanism by which polarity proteins control the shape of nodes of Ranvier and regulate conduction in the CNS.

Communication With American Indians and Alaska Natives About Cardiovascular Disease.

INTRODUCTION: Cardiovascular disease (CVD) is the leading cause of death among American Indians and Alaska Natives. Reducing CVD risk requires effective communication about risk factors and preventive behaviors. Messages should be designed with an understanding of where people seek health information, their perceptions of a hazard, and their perception of information sufficiency. We examined these components of message design to inform strategies to effectively communicate information about CVD to American Indians and Alaska Natives. METHODS: We surveyed 220 adults who self-identified as American Indians or Alaska Natives at 2 Native-focused events in urban areas. Our survey included items on demographic characteristics, place of residence, sources of information used to learn about CVD, perceived information sufficiency, and perceptions about the importance of CVD as a health problem. RESULTS: Respondents used the internet (67%), their doctors (66%), friends and relatives (63%), brochures (62%), and television (61%) to learn about CVD. Participants aged 60 or older and those living on a reservation were more likely to use their doctor to learn about CVD than their younger (≤30 y) or urban peers. CVD was viewed as a major problem for American Indians and Alaska Natives (84%) and for Americans in general (86%). Most respondents felt moderately (54%) or well informed (37%) about CVD. CONCLUSION: Various information sources should be used to increase awareness about CVD. Special attention may be needed to optimize communication to American Indians and Alaska Natives aged 60 or older and people living on reservations. Further study is needed to determine how our findings can best inform effective interventions to reduce CVD morbidity and mortality among these populations.

Communicating Environmental Health Risks with Indigenous Populations: A Systematic Literature Review of Current Research and Recommendations for Future Studies.

Indigenous populations are recognized as a group who are potentially vulnerable to environmental health hazards due to their intimate relationship with and reliance on local environments for aspects of culture, health, and well-being. In many circumstances barriers to effective communication and health risk management are linked to cultural, economic, and geographic factors. A systematic literature review was conducted to consolidate peer-reviewed research on the communication of environmental health risks with Indigenous populations. The comprehensive literature review procedures included searching databases and key journals that represented various fields in communication, environmental health, and Indigenous studies. The review yielded a total of 4,469 potential articles and a total of 13 of these manuscripts met the inclusion criteria. The 13 articles were analyzed to identify lessons learned for effective risk communication. Factors that influence successful risk communication strategies with Indigenous populations on this topic include: (1) developing messages that are congruent with the populations' cultural beliefs and understanding of the environment; (2) including Indigenous populations in message design and delivery; (3) using credible and trustworthy spokespeople in message delivery; (4) identifying and utilizing effective communication materials and channels; and (5) ensuring that messages are understandable to the target audience. Gaps in the literature include the lack of longitudinal studies that empirically measure changes in perception, awareness and behavior, as well as a general lack of theory-based research. Results from this review provide directions for future work to help guide the development of more effective health risk communication research and strategies with Indigenous populations.

The polarity protein Scribble regulates myelination and remyelination in the central nervous system.

The development and regeneration of myelin by oligodendrocytes, the myelin-forming cells of the central nervous system (CNS), requires profound changes in cell shape that lead to myelin sheath initiation and formation. Here, we demonstrate a requirement for the basal polarity complex protein Scribble in CNS myelination and remyelination. Scribble is expressed throughout oligodendroglial development and is up-regulated in mature oligodendrocytes where it is localised to both developing and mature CNS myelin sheaths. Knockdown of Scribble expression in cultured oligodendroglia results in disrupted morphology and myelination initiation. When Scribble expression is conditionally eliminated in the myelinating glia of transgenic mice, myelin initiation in CNS is disrupted, both during development and following focal demyelination, and longitudinal extension of the myelin sheath is disrupted. At later stages of myelination, Scribble acts to negatively regulate myelin thickness whilst suppressing the extracellular signal-related kinase (ERK)/mitogen-activated protein kinase (MAP) kinase pathway, and localises to non-compact myelin flanking the node of Ranvier where it is required for paranodal axo-glial adhesion. These findings demonstrate an essential role for the evolutionarily-conserved regulators of intracellular polarity in myelination and remyelination.

Bolus Administration of Fentanyl and Midazolam for Colonoscopy Increases Endoscopy Unit Efficiency and Safety Compared With Titrated Sedation.

BACKGROUND & AIMS: Guidelines recommend slow titration of sedatives for moderate sedation. Bolus sedation, in which a larger weight-based dose of medication is given upfront, has been shown in a single trial to be beneficial. We evaluated the effects of bolus sedation on procedural safety, efficiency, and patient experience. METHODS: We performed a retrospective analysis of colonoscopies performed between April 2010 and April 2011 at Duke Medical Center. Colonoscopies before October 2010 were performed with nurse-directed titration of sedative (n = 966); colonoscopies performed after October 2010 were performed with physician-directed administration of bolus sedative (n = 699). We compared sedation and recovery times, medication doses, and adverse events between groups. We also compared patient satisfaction in a subset of patients from each group. Data were compared using the chi-square test for categorical variables and Wilcoxon rank sum test for continuous and ordinal categorical variables. RESULTS: Patients in the bolus group had a shorter sedation time (6.0 min) than patients in the titration group (13.0 min; P < .01) and a slightly longer colonoscopy time (25.0 min vs 24.0 min in the titration group; P < .01). Recovery time did not differ significantly between groups (53.0 min in the bolus group vs 52.1 min in the titration group; P = .07). Patients in the bolus group received lower weight-adjusted doses of fentanyl (1.71 µg/kg vs 1.89 µg/kg in the titration group) and midazolam (0.065 mg/kg vs 0.075 mg/kg in the titration group). A smaller proportion of patients in the bolus sedative group developed hypotension (12.7% vs 17.9% in the titration group; P < .01). These findings persisted even after adjustment for baseline patient age, race, sex, smoking status, alcohol use, body mass index, and American Society of Anesthesiologists' classification. CONCLUSIONS: In a retrospective study of patients undergoing colonoscopy, we found that compared with titrated administration of sedative, bolus dosing improves endoscopy unit efficiency and safety and decreases the amount of sedative required. This benefit does not come at the expense of the patient experience.

Front page or "buried" beneath the fold? Media coverage of carbon capture and storage.

Media can affect public views and opinions on science, policy and risk issues. This is especially true of a controversial emerging technology that is relatively unknown. The study presented here employs a media content analysis of carbon capture and storage (CCS), one potential strategy to reduce greenhouse gas emissions. The authors analyzed all mentions of CCS in two leading Canadian national newspapers and two major western regional newspapers from the first article that discussed CCS in 2004 to the end of 2009 (825 articles). An in-depth content analysis was conducted to examine factors relating to risk from CCS, how the technology was portrayed and if coverage was negatively or positively biased. We conclude by discussing the possible impact of media coverage on support or opposition to CCS adoption.

Insufficient OPC migration into demyelinated lesions is a cause of poor remyelination in MS and mouse models.

Failure of remyelination of multiple sclerosis (MS) lesions contributes to neurodegeneration that correlates with chronic disability in patients. Currently, there are no available treatments to reduce neurodegeneration, but one therapeutic approach to fill this unmet need is to promote remyelination. As many demyelinated MS lesions contain plentiful oligodendrocyte precursor cells (OPCs), but no mature myelinating oligodendrocytes, research has previously concentrated on promoting OPC maturation. However, some MS lesions contain few OPCs, and therefore, remyelination failure may also be secondary to OPC recruitment failure. Here, in a series of MS samples, we determined how many lesions contained few OPCs, and correlated this to pathological subtype and expression of the chemotactic molecules Semaphorin (Sema) 3A and 3F. 37 % of MS lesions contained low numbers of OPCs, and these were mostly chronic active lesions, in which cells expressed Sema3A (chemorepellent). To test the hypothesis that differential Sema3 expression in demyelinated lesions alters OPC recruitment and the efficiency of subsequent remyelination, we used a focal myelinotoxic mouse model of demyelination. Adding recombinant (r)Sema3A (chemorepellent) to demyelinated lesions reduced OPC recruitment and remyelination, whereas the addition of rSema3F (chemoattractant), or use of transgenic mice with reduced Sema3A expression increased OPC recruitment and remyelination. We conclude that some MS lesions fail to remyelinate secondary to reduced OPC recruitment, and that chemotactic molecules are involved in the mechanism, providing a new group of drug targets to improve remyelination, with a specific target in the Sema3A receptor neuropilin-1.

Risk communication and perceptions about lead ammunition and Inuit health in Nunavik, Canada.

Lead ammunition is commonly used to hunt waterfowl and other wildlife in the Arctic. Hunting with lead is problematic because the toxicant can be transferred to the consumer. Therefore, it is critical to evaluate perceptions and awareness of the risks associated with using lead ammunition among Arctic populations. Results of the Nunavik Child Development Study (a longitudinal health study gathering information on health and well-being among Inuit in Nunavik, Canada) included advice to eliminate the use of lead ammunition in hunting practices. We surveyed 112 Nunavik residents (93 women; 18 men) about their awareness of lead related messages, use of lead ammunition and risk perceptions about contaminants. Sixty-seven participants (59.8%) reported there was an active hunter in their household. We found that only 27% of participants had heard or seen the messages about reducing lead ammunition. After participants viewed the Nunavik Child Development Study messages about lead, 44% stated they would stop using lead ammunition. However, 28% indicated that they would continue using lead ammunition. We conclude that, while messages had an overall positive effect, further study is required to understand why people continue to use lead ammunition.

Communication about Alzheimer's disease and research among American Indians and Alaska Natives.

Introduction: American Indian and Alaska Native (AI/AN) people infrequently participate in Alzheimer's disease (AD) research, despite the rapidly increasing population of AI/AN people aged 65 and older. Methods: We surveyed 320 adults who identified as AI/AN at two Native-focused events and used ordinary least squares regression and logistic regression models to test associations between demographic factors and perceived risk of AD, knowledge about AD, and willingness to participate in research, along with preferred source of AD information. Results: Willingness to participate in research was highest among those living in a city versus reservation and associated with perceived personal risk for AD. Health professionals and the internet were preferred sources of information about AD. Discussion: These hypothesis-generating results provide insight into perceptions of AD and willingness to participate in research. Conclusions could inform development of AD recruitment strategies for AI/ANs and influence participation in AD research.

Improving documentation of anticoagulation and antiplatelet recommendations after outpatientendoscopy.

Clear documentation of instructions for resuming anticoagulant and antiplatelet (AC/AP) medications after gastrointestinal endoscopy is essential for high-quality postprocedure care. Yet, these recommendations are frequently absent, which may impact patient safety. We aimed to improve documentation of postprocedural AC/AP instructions through targeted interventions during outpatient endoscopy at a Veterans Affairs Medical Center using validated Quality Improvement methodology. We identified patients on AC/AP agents presenting for outpatient oesophagogastroduodenoscopy or colonoscopy and found restart recommendations were documented in only 59.4% of procedures at baseline. After two intervention cycles, which included provider education, nursing prompts and alterations to endoscopic documentation software, postprocedure documentation increased by 26.7%-86.1% when compared with baseline (p<0.001). These interventions, which require low-resource utilisation, could be part of standardised processes readily implemented at other institutions to help potentially reduce postprocedure patient confusion, medication errors and complications.

Phosphorylation of the epidermal growth factor receptor (EGFR) is essential for interleukin-8 release from intestinal epithelial cells in response to challenge with Escherichia coli O157 : H7 flagellin.

Enterohaemorrhagic Escherichia coli O157 : H7 is a major foodborne and environmental pathogen responsible for both sporadic cases and outbreaks of food poisoning, which can lead to serious sequelae, such as haemolytic uraemic syndrome. The structural subunit of E. coli O157 : H7 flagella is flagellin, which is both the antigenic determinant of the H7 serotype, an important factor in colonization, and an immunomodulatory protein that has been determined to be a major pro-inflammatory component through the instigation of host cell signalling pathways. Flagellin has highly conserved N- and C-terminal regions that are recognized by the host cell pattern recognition receptor Toll-like receptor (TLR) 5. Activation of this receptor triggers cell signalling cascades, which are known to activate host cell kinases and transcription factors that respond with the production of inflammatory mediators such as the chemokine interleukin-8 (IL-8), although the exact components of this pathway are not yet fully characterized. We demonstrate that E. coli O157 : H7-derived flagellin induces rapid phosphorylation of the epidermal growth factor receptor (EGFR), as an early event in intestinal epithelial cell signalling, and that this is required for the release of the pro-inflammatory cytokine IL-8.

No Microscope Needed: A Macroscopic Presentation of Collagenous Colitis.

Microscopic colitis (MC) is a common cause of chronic secretory diarrhea with variable etiologies, including nonsteroidal anti-inflammatory drugs. As its name implies, the diagnosis requires consistent histopathologic findings that typically accompany normal-appearing mucosa. However, accumulating evidence suggests that the presence of distinct endoscopic features is associated with MC. We present a case of MC that highlights the importance of recognizing these macroscopic findings because they can aid in diagnosis and have significant management implications.

Seasonal variations in exposure to methylmercury and its dietary sources among pregnant Inuit women in Nunavik, Canada.

Among populations living in close connection with the sea, rivers and lakes for subsistence, diet varies according to local monthly wildlife species availability and food preferences. This may lead to variations in methylmercury (MeHg) exposure over a year, although no biomonitoring studies have documented this issue in Circumpolar populations, the most exposed to international Hg emissions. Our aim was to characterize seasonal variations in MeHg exposure among pregnant Inuit women from Nunavik and to identify country foods responsible for these variations. Between October 2016 and March 2017, 97 participants were recruited. Blood mercury (Hg) was tested and hair Hg was measured by centimeter as a surrogate for monthly MeHg exposure over the past year. Latent class growth analysis was conducted to identify groups of pregnant women with similar hair Hg monthly trajectories. Country foods consumption was documented by season. Seasonal daily intakes of MeHg were estimated based on concentrations in country foods. Retrospective monthly hair Hg analyses revealed that MeHg exposure was lowest in winter, and highest in summer and early fall months. Three latent classes (groups) of pregnant women with similar trajectories of monthly hair Hg variations were identified: high (n = 20, 21%), moderate (n = 38, 41%) and low variation (n = 35, 38%). Beluga meat was the country food contributing to most of daily MeHg intake, primarily during summer and fall, and was the only one associated with the odds of being classified into moderate and high variation groups (OR 95% CI: 1.19 [1.01-1.39] and 1.25 [1.04-1.50]). These findings underscore the importance of monthly variations in exposure to MeHg due to the seasonality of local foods consumed and responsible for elevated MeHg exposure. Further studies critically need to understand local diet fluctuations over a year to adequately assess MeHg exposure, adopt timely preventive interventions and evaluate the effectiveness of the Minamata Convention.

Alzheimer's disease knowledge among American Indians and Alaska Natives.

INTRODUCTION: The population of American Indians and Alaska Natives (AI/ANs) aged 65 and older is growing rapidly, raising concerns about Alzheimer's disease (AD) in their communities. METHODS: We distributed a survey incorporating the Alzheimer's Disease Knowledge Scale to 341 AI/AN community members attending cultural events. We computed average adjusted predictions and 95% confidence intervals from a linear regression model, used joint F tests to examine differences in scores according to demographic variables, calculated the percentage of correct items for each participant, and computed domain-specific averages across the sample. RESULTS: The average score was 19.0 (maximum 30); the average percentage of correct responses was 63%. Higher scores were associated with education but not with age, sex, or rural versus urban residence. Low scores were observed for items on caregiving and disease risk. DISCUSSION: Participants were moderately well informed about AD, but specific knowledge domains call for community outreach and education.

US Pediatrician Practices on Early Nutrition, Feeding, and Growth.

OBJECTIVE: Assess pediatrician practices around growth and nutrition for children under 2 years. DESIGN: 2017 cross-sectional survey of a national random sample of the American Academy of Pediatrics members. SETTING: US. PARTICIPANTS: Practicing primary care pediatricians and residents (n = 698). MAIN OUTCOME MEASURES: World Health Organization growth chart use, solid food introduction recommendations, healthy behaviors discussion. ANALYSIS: Descriptive statistics were calculated for nutrition-related questions. McNemar tests compared recommendations on the introduction of different solid foods at <6 months; chi-square tests of independence examined outcomes by pediatrician and practice characteristics. RESULTS: Most respondents (82.2%) reported using the World Health Organization growth charts at all well visits. Nearly half (45.3%) recommended solid food introduction at 6 months; 48.2% recommended <6 months. Cereals were more frequently recommended at <6 months than fruits/vegetables or meats (P <.001). Topics most frequently discussed were limiting juice (92.3%), and sugar-sweetened beverages (92.0%), avoiding restrictive and permissive food practices (30.7%), and avoiding food as a reward (29.1%) were least discussed. Pediatricians in hospital/clinic settings discussed healthy behaviors less than group or solo/2-physician practices. CONCLUSIONS AND IMPLICATIONS: For children under 2 years, most pediatricians reported using recommended growth charts and discussing healthy behaviors. Fewer discussed responsive feeding topics. Results for guiding solid food introduction were mixed. Continued efforts to support pediatricians' work could improve the implementation of recommended practices.