Modelling changes in healthcare demand through geographic data extrapolation.

Stay Well Plans are a new programme of care offered to frail and elderly people in Newport. In 2016 a roll out the programme to be offered in all five counties serviced by Aneurin Bevan University Health Board was planned. This paper presents the data analysis and modelling used to determine the programme's effects on the demand of the wider system, and the effects of a Gwent-wide roll out. We extrapolate information from data from a geographical subset of the model domain to a larger geographical area, adjusting for population sizes, deprivation, and distances to healthcare facilities. These parametrise a Markov model and Monte Carlo simulation to predict changes in demand due to different levels of roll out. We conclude that a programme roll out may result in a large reduction on demand at residential care, however at the expense of an increase in demand at community care services.

Role of social, cultural and symbolic capital for youth and community wellbeing in a rural Alaska Native community.

Health promotion programs by and for Indigenous Peoples increasingly use strength-based Indigenous approaches aimed at reinforcing protective factors rooted in their cultures and traditions. These protective factors can counteract the deleterious effects induced by the rapid social changes related to colonization. Western social scientists defined cultural, social and symbolic capital as assets akin to social strengths that can promote health. It is important to understand Indigenous perspectives on these social and cultural capitals, and the ways their interplay can promote wellness. Using the qualitative methods photovoice and digital storytelling, we elicited the perspectives of Athabascan middle and high school students participating in the Frank Attla Youth and Sled Dog Care-Mushing Program in their home community of Huslia in Interior Alaska. Subsequently, we disseminated the stories and preliminary findings in Huslia, and conducted focus groups with adults to triangulate with the youth perspectives. Deductive and inductive thematic content analysis of youth stories and photos revealed the impacts of the program on them and their community. Youth reported gains in cultural, social and symbolic capital and shared what these forms of capital mean in their cultural context. Cultural capital gains were mostly in its embodied form, e.g. in work ethics, perseverance and the value of cultural traditions; social capital gains revolved around relations with peers, adults and Elders, nature and animals, as well as social cohesion and sense of belonging in Huslia; Symbolic capital was reflected through pride and spirituality. The students' stories also illustrated their perspectives on how the program affected their wellbeing, through physical activity, healing relations with dogs, increased self-esteem and visions of a bright future. Adults corroborated youth perspectives and shared their observations of program impacts on discipline, academic and life skills and resilience. These findings could be used to guide development and assessment of culturally-based wellbeing promoting interventions.

Indigenous Knowledge: Revitalizing Everlasting Relationships between Alaska Natives and Sled Dogs to Promote Holistic Wellbeing.

INTRODUCTION: Indigenous peoples have documented their culture's history in oral stories, revealing lessons about holistic relationships fostering perseverance. Despite vast differences in time, relationships and stories are equally important today. Athabascans retain their values, life skills, and wellness through cultural practices. Creating opportunities for youths to learn through reciprocal relationships increases wellness in Indigenous communities, highlighting the significance of community-developed programs that connect youths to their place and culture. METHOD: Athabascan youths in rural Alaska get hands-on experience and Elder mentorship working with sled dogs in the Frank Attla Youth and Sled Dog Care-Mushing Program (FAYSDP). Through a community-based participatory research partnership with the community of Huslia and Jimmy Huntington School, we examined how FAYSDP affects youths, and how relationships within culture and land promote wellbeing. Fifteen middle and high-school youths shared their perspectives on how FAYSDP impacts them and their community using photovoice and digital storytelling. Nineteen adults contributed their perspectives in focus groups. We used emerging themes (inductive) and Athabascan cultural values and elements of social capital (deductive approaches) to analyze the qualitative data. RESULTS: Findings illustrate how FAYSDP promotes wellbeing by empowering youths to apply what they learn to generate their own knowledge, while centering communities around culturally significant practices such as dog mushing. It connects youths to their home and their cultural values, using dogs as the driving force to bridge generations and foster youth wellness. DISCUSSION: We discuss implications for community-based programs that engage Elders as teachers and the land as their classroom to promote youth holistic wellness.

Serological test performance for bovine tuberculosis in cattle from herds with evidence of on-going infection in Northern Ireland.

The ability to accurately identify infected hosts is the cornerstone of effective disease control and eradication programs. In the case of bovine tuberculosis, accurately identifying infected individual animals has been challenging as all available tests exhibit limited discriminatory ability. Here we assess the utility of two serological tests (IDEXX Mycobacterium bovis Ab test and Enfer multiplex antibody assay) and assess their performance relative to skin test (Single Intradermal Comparative Cervical Tuberculin; SICCT), gamma-interferon (IFNγ) and post-mortem results in a Northern Ireland setting. Furthermore, we describe a case-study where one test was used in conjunction with statutory testing. Serological tests using samples taken prior to SICCT disclosed low proportions of animals as test positive (mean 3% positive), despite the cohort having high proportions with positive SICCT test under standard interpretation (121/921; 13%) or IFNγ (365/922; 40%) results. Furthermore, for animals with a post-mortem record (n = 286), there was a high proportion with TB visible lesions (27%) or with laboratory confirmed infection (25%). As a result, apparent sensitivities within this cohort was very low (≤15%), however the tests succeeded in achieving very high specificities (96-100%). During the case-study, 7/670 (1.04%) samples from SICCT negative animals from a large chronically infected herd were serology positive, with a further 17 animals being borderline positive (17/670; 2.54%). Nine of the borderline animals were voluntarily removed, none of which were found to be infected post-mortem (no lesions/bacteriology negative). One serology test negative animal was subsequently found to have lesions at slaughter with M. bovis confirmed in the laboratory.