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Racial disparities in healthcare have been well documented in the United States. We hypothesise that there will be a racial variance in different clinical variables in single-ventricle patients through stages of palliation.
Materials and Methods:
Retrospective single-centre study stratified all single-ventricle patients who reached stage 2 palliation by race: Black and White. Other races were excluded. Demographic and clinical characteristics were compared, alongside follow-up survival data. Primary outcomes were progression to Fontan and overall survival.
Results:
Among 526 patients, 325 (61.8%) were White, and 201 (38.2%) were Black. Median age at stage 2 palliation was 150 days for White and 165 for Black patients (p = 0.005), with similar weights. Black patients exhibited higher median cardiopulmonary bypass times (87 vs. 74 minutes, p = 0.001) and a greater frequency of genetic syndromes (30.1% vs. 22.1%, p = 0.044). No significant differences were observed in outcomes between groups from stage 2 to stage 3, pre-stage 3 cardiac catheterisation variables, or perioperative outcomes. Multivariable regression analysis identified hypoplastic pulmonary arteries as the risk factor for mortality after stage 2. Survival analysis showed no difference in survival by race; however, occurrence of combined cardiovascular event was significantly higher in Black race.
Conclusions:
Significant racial disparities exist among single-ventricle patients regarding the timing of stage 2 palliation, cardiopulmonary bypass duration, and frequency of genetic syndromes. Black race was a risk factor for sub-optimal long-term outcome, although perioperative mortality was similar. These race-related factors warrant further studies to improve our understanding of the impact of race on outcomes.
Effective regulation is essential for preventing the establishment of new invasive plants and managing the environmental, social, and economic impacts of those already established. Invasive plants are regulated by jurisdictions at a mix of local, regional, national, and international levels. Enhanced coordination of policy and regulations has been identified as a key strategy for addressing the impacts of invasive species; however, coordination between jurisdictions, and even within jurisdictions, is not always considered. To review regulatory coordination in Australia, we compiled a comprehensive dataset of noxious weeds (defined as invasive plants and potentially invasive plants with controls specified in regulation) in each Australian jurisdiction (i.e., state or territory). We found that jurisdictions on average shared ca. 67% (SD = 15%) of noxious weed listings. Neighboring jurisdictions were not more similar than separated jurisdictions in their noxious weed listings. There were significant differences in the biogeographic native ranges of noxious weeds between jurisdictions, with species native to temperate Asia being most frequently listed overall. The predominant likely entry pathway for noxious weeds in Australia was the ornamental trade. Listings were primarily dedicated to proactive control, prohibiting the cultivation of noxious weeds to avoid their naturalization. There were 415 noxious weeds regulated in a harmonious manner across jurisdictions. However, there were 327 noxious weeds regulated by jurisdictions in a discordant manner, potentially leaving neighboring jurisdictions vulnerable to invasion. We suggest jurisdictions reassess the regulation of these 327 discordant noxious weeds in Australia and utilize a national taxonomic standard to avoid problematic synonyms. Improved cohesion of policies could be achieved through wider adoption of existing regulatory systems and codevelopment of regulations between government and industry.
In 2015, the Canadian Supreme Court declared that an absolute Criminal Code prohibition on assisted suicide and euthanasia was unconstitutional. In response, the Canadian parliament enacted Bill C-14 in 2016 permitting assisted suicide and euthanasia for the end-of-life context, which it termed “Medical Assistance in Dying” (MAiD). In 2021, Bill C-7 expanded eligibility for MAiD to those with disabilities not approaching their natural death. By 2021, MAiD accounted for 3.3% of all deaths in Canada with some areas of Canada presently reporting MAiD death rates upward of 7%. In 2021, Canada had 10,064 deaths by MAiD, surpassing all jurisdictions for yearly reported assisted deaths.
Objectives
To examine the impact of the Canadian MAiD program and analyze its safeguards.
Methods
A working group of physicians from diverse practice backgrounds and a legal expert, several with bioethics expertise, reviewed Canadian MAiD data and case reports. Grey literature was also considered, including fact-checked and reliable Canadian mainstream newspapers and parliamentary committee hearings considering the expansion of MAiD.
Results
Several scientific studies and reviews, provincial and correctional system authorities have identified issues with MAiD practice. As well, there is a growing accumulation of narrative accounts detailing people getting MAiD due to suffering associated with a lack of access to medical, disability, and social support.
Significance of results
The Canadian MAiD regime is lacking the safeguards, data collection, and oversight necessary to protect Canadians against premature death. The authors have identified these policy gaps and used MAiD cases to illustrate these findings.
Inspired by notions of interest of humankind and intergenerational equity, we explored Antarctic perceptions of a subset of future generations—university students. Students at three universities in Canada, the Netherlands, and the USA were surveyed to determine the relationships between nationality, academic major, opinions on values of Antarctica, and support for a range of human activities in Antarctica (n = 618). Logistic regression was used to model the relationship of these variables with support for designation of Antarctica as a wilderness reserve, construction of new research stations, and mining. Compared with business and economics majors, biological sciences and natural resources/conservation majors were more likely to support wilderness designation and less likely to support mineral resource development. Nationality was not significantly associated with support for construction of new research stations and mineral resource development. Opinions on the value of Antarctica and support for activities also exhibited significant influences on dependent variables. Consistent with earlier studies of Antarctic scientists, personnel, tourists, and other members of the general public, university students valued Antarctica as one of the world’s last great wildernesses (66%), an important component of the Earth’s climate system (66%), and a science laboratory for the benefit of mankind (62%).
Low back pain (LBP) is a major health problem globally, but approaches to prevention are not yet clearly identified because modifiable risk factors are not well established. Although physical activity is one promising modifiable risk factor, it is still not known what types and doses of physical activity are protective or harmful for LBP. The aim of this study is to establish the feasibility of a definitive cohort study that will investigate the effects of different types and doses of physical activity on the risk of developing recurrent LBP while accounting for genetic factors. This will be a pilot longitudinal twin study and twins will be recruited from the Australian Twin Registry, and will be followed over 1 year. Thirty adult complete twin pairs with a history of LBP, but symptom free at recruitment, will be included. Data on physical activity (predictor) will be collected using four questionnaires and an objective measure (accelerometer) at baseline and at 6-month follow-up. Twins will also complete an additional physical activity questionnaire monthly. Data on LBP (outcome) will be collected at baseline and weekly. Data will be collected using short message service (SMS) and email. We will keep records of the recruitment rate, follow-up rate, and completeness of data. Barriers to completing the study will be investigated. The results of this study will inform the design and implementation of a future definitive study, which will help to clarify the effects of different types and doses of physical activity on the risk of developing recurrent LBP.
Poor sleep quality is highly prevalent in patients with low back pain (LBP) and is associated with high levels of pain, psychological distress, and physical disability. Studies have reported a bidirectional relationship between sleep problems and intensity of LBP. Accordingly, effective management of LBP should address sleep quality. In addition, genetics has been found to significantly affect the prevalence of both LBP and insomnia. Our study aims to establish the feasibility of a trial exploring the efficacy of a web-based sleep quality intervention in people with LBP, with the genetic influences being controlled for. 30 twins (15 complete pairs) with subacute or chronic LBP (>6 weeks) will be recruited from the Australian Twin Registry. Participants will be randomly assigned to one of the two groups with each twin within a pair receiving either an interactive web-based sleep intervention based on cognitive behavioral therapy principles (intervention) or a web-based education program (control) for 6 weeks. The feasibility of the trial will be investigated with regard to recruitment rate, feasibility of data collection and outcome measure completion, contamination of intervention, acceptability and experience of intervention, and sample size requirement for the full trial. Patient outcomes will be collected electronically at baseline, immediately post-treatment, and at 3-months’ follow-up post-randomization. This trial employs a robust design that will effectively control for the influence of genetics on treatment effect. Additionally, this study addresses sleep quality, a significant but under-explored issue in LBP. Results will inform the design and implementation of the definitive trial.
The favourable impact of surgery for intractable epilepsy on seizures is well documented. However, few studies have determined what changes in antiepileptic drug (AED) therapy occur following surgery. Alterations in AED blood levels in the immediate postoperative period can result in breakthrough seizures. In long term follow-up, one-third to one-half of seizure-free patients after temporal lobectomy, the most common type of epilepsy surgery, still require AED treatment which usually has been reduced from polytherapy to monotherapy. In our study of 93 patients followed two years after temporal lobectomy, polytherapy decreased from 78% before surgery to 14% postoperatively, while medication was discontinued in 44%. Early reduction from polytherapy to monotherapy can often be carried out in the immediate postoperative period but the most appropriate timing of cessation of AED treatment has yet to be determined. Patients undergoing extratemporal resections and other forms of epilepsy surgery associated with less favourable postoperative seizure control may achieve comparatively less reduction in antiepileptic medication. We generally do not recommend stopping AEDs prior to one year after surgery.
To explore public health nutritionists’ perceptions of nutrition and its place in community pharmacy (CP) presently and into the future; and to explore perceived opportunities, feasibility and scope of public health nutrition (PHN) interventions in CP, with a focus on maternal and infant nutrition.
Design
Qualitative data were gathered through semi-structured interviews and drew on hermeneutics as the theoretical framework for analysis and interpretation.
Setting
Queensland, Australia.
Subjects
Public health nutritionists, identified through purposive, criterion sampling, were chosen due to (i) their role as potential stakeholders, (ii) their knowledge and emphasis on nutrition and (iii) their practice experience.
Results
Opportunities for PHN action focused primarily on actions relating to early nutrient supplementation in pregnancy and breast-feeding protection and promotion. Opportunities in CP were constrained by practitioners’ perception of (i) conflict between health care and commercial interests in CP, (ii) problematic practices in CP and (iii) values and motivations of practitioners and other stakeholders in the CP sector. Strategies were suggested to improve practices and enhance the setting from a PHN perspective. Participants suggested both collaborative and regulatory approaches to achieve settings-based changes, identifying the need for these to coexist for effective outcomes.
Conclusions
Public health nutritionists suggest that opportunities for PHN action are constrained by perceived conflicted interests and that consumers need to be adequately protected from the influence of commercial interests. PHN action in this setting needs adequate reflection on evidence as well as ethics ensuring that practices are ‘for the good’ of mothers and infants.