Sleep health inequities in vulnerable populations: Beyond sleep deserts.

Despite the importance of sleep to overall health and well-being, there is a high prevalence of undiagnosed sleep disorders and adverse sleep health, particularly among vulnerable populations. Such vulnerable populations include people experiencing homelessness (PEH), refugees, and incarcerated individuals. In this narrative review, we provide an overview of the literature on sleep health and disorders among key and vulnerable populations (e.g., PEH, refugees, and incarcerated individuals). The limited research among these populations indicated a high prevalence of sleep disorders, mainly insomnia, short sleep duration, and fatigue. Substance abuse and PTSD were commonly found among PEH and refugee populations, respectively, which were was related to poor sleep. Similar across the included vulnerable populations, the individuals reside in environments/facilities with inopportune light exposure, noise disruption, inadequate bedding, and forced sleep schedules. Studies also found a high prevalence of psychosocial stress and reports of threats to safety, which were associated with poor sleep health outcomes. Additionally, several studies reported environmental barriers to adherence to sleep disorder treatment. This paper highlighted the conditions in which these vulnerable populations reside, which may inform interventions within these various facilities (homeless shelters, refugee camps, prisons/jails). The improvement of these facilities with a sleep equity focus may in turn improve quality of life and daily functioning.

Addressing sleep deserts: A proposed call for action.

Sleep deserts are a major cause of health inequity. They occur primarily in disadvantaged neighborhoods because of structural racism, social and environmental factors, and dearth of medical services. We describe several strategies that can serve as a feasible action plan to target structural racism, environmental pollution, and impact of climate change. We also suggest ways healthcare providers in these underserved areas can incorporate sleep medicine into their practice. Lastly, we highlight strategies to increase community awareness of sleep health in a culturally sensitive manner. There are several ways, from a policy level to healthcare that we can begin to eliminate sleep deserts, which is urgently needed.

Stents for benign and malignant esophageal strictures.

This paper presents commentaries on endotherapy for esophageal perforation/leaks; treatment of esophageal perforation; whether esophageal stents should be used for treating benign esophageal strictures; what determines the optimal stenting period in benign esophageal strictures/leaks; how to choose an esophageal stent; how a new fistula secondary to an esophageal stent should be treated; which strategy should be adopted when a fistula of a cervical anastomosis occurs; intralesional steroids for refractory esophageal strictures; balloon and bougie dilators for esophageal strictures and predictors of response to dilation; whether refractory strictures from different etiologies respond differently to endotherapy; surgical therapy of benign esophageal strictures; and whether stenoses following severe esophageal burns should be treated by esophageal resection or esophageal bypass.

Factors influencing quality of bowel preparation for colonoscopy.

Recent technological advances in colonoscopy have led to improvements in both image enhancement and procedural performance. However, the utility of these technological advancements remain dependent on the quality of bowel preparation during colonoscopy. Poor bowel preparation has been shown to be associated with lower quality indicators of colonoscopy performance, such as reduced cecal intubation rates, increased patient discomfort and lower adenoma detection. The most popular bowel preparation regimes currently used are based on either Polyethylene glycol-electrolyte, a non-absorbable solution, or aqueous sodium phosphate, a low-volume hyperosmotic solution. Statements from various international societies and several reviews have suggested that the efficacy of bowel preparation regimes based on both purgatives are similar, although patients' compliance with these regimes may differ somewhat. Many studies have now shown that factors other than the type of bowel preparation regime used, can influence the quality of bowel preparation among adult patients undergoing colonoscopy. These factors can be broadly categorized as either patient-related or procedure-related. Studies from both Asia and the West have identified patient-related factors such as an increased age, male gender, presence of co-morbidity and socio-economic status of patients to be associated with poor bowel preparation among adults undergoing routine out-patient colonoscopy. Additionally, procedure-related factors such as adherence to bowel preparation instructions, timing of bowel purgative administration and appointment waiting times for colonoscopy are recognized to influence the quality of colon cleansing. Knowledge of these factors should aid clinicians in modifying bowel preparation regimes accordingly, such that the quality of colonoscopy performance and delivery of service to patients can be optimised.

Evidence that banana (Musa spp.), a tropical monocotyledon, has a facultative long-day response to photoperiod.

Bananas and plantains (Musa spp.) may flower at any time of the year but they show seasonal variation in flowering. To determine whether photoperiod contributed to this seasonal variation, we calculated the thermal development units (DT) from planting to bunch appearance (flowering) using data from published planting date experiments in the tropics and subtropics. Minimising the coefficient of variation in DT across planting dates was used to evaluate the contribution of photoperiod and soil water balance to time of flowering. Coefficients evaluating sensitivity to photoperiod were estimated in some datasets and validated on independent datasets. Data on the rate of bunch appearance from four locations over several years were analysed to establish correlations between this, photoperiod and temperature. The time of bunch initiation was matched against photoperiod to determine whether short photoperiods delayed bunch initiation. Long photoperiods in the mid-vegetative phase hastened flowering while soil water deficits delayed it. Cultivars of the Cavendish subgroup (AAA) were more sensitive to photoperiod than the Maricongo cultivar (False Horn-type plantain, AAB). Long photoperiods during the reproductive phase were correlated with an increased rate of bunch appearance some 8 to 11 weeks later. Musa spp. show a facultative long-day response to photoperiod.

Characterization of Benomyl Resistance in Mycosphaerella fijiensis, Cause of Black Sigatoka of Banana, in Costa Rica.

Sixty-eight and eighty-six percent of monoascosporic isolates of Mycosphaerella fijiensis from two banana plantations in Costa Rica, in which benomyl was used for ≈10 years to control black Sigatoka, were resistant to benomyl in February and November 1994, respectively. No resistance to benomyl was detected in isolates collected during February 1994 from farms with no history of benomyl use that were located ≈50 km from the nearest banana plantations. Only 1% of isolates was resistant to benomyl in a sample taken during November 1994. In three additional banana farms where benomyl had not been used for 3 to 5 years before sampling, ben-omyl resistance persisted at a high frequency. Benomyl-resistant and -sensitive isolates were distributed equally throughout the range of isolate sensitivity to propiconazole, indicating no relationship between resistance to benomyl and lower sensitivity to propiconazole but double resistance to these two compounds. Five benomyl-resistant and five benomyl-sensitive isolates of M. fijiensis were inoculated to banana plants under greenhouse conditions. Benomyl-resistant isolates were more aggressive than benomyl-sensitive isolates, as determined by measures of disease severity, incubation time, and number of lesions at 40 days after inoculation.

Reaction of Four Musa Genotypes at Three Temperatures to Isolates of Mycosphaerella fijiensis from Different Geographical Regions.

Two tetraploid banana hybrids, FHIA1 and FHIA2, with resistance to black Sigatoka, and two highly susceptible, naturally occurring triploids, Grand Naine and False Horn, were evaluated at three temperatures for their resistance to isolates of Mycosphaerella fijiensis from five geographical regions. The youngest open leaf of young plants was inoculated, and plants were incubated at 22, 26, and 30°C in growth chambers. Duration of the incubation period and disease severity were used to evaluate the reactions of the genotypes. The incubation period was the shortest at 26°C. Disease severity was greatest at 26°C on Grand Naine and False Horn, but there was no clear temperature effect for the FHIA genotypes. The incubation period was longer on both FHIA genotypes than on Grand Naine and False Horn. With few exceptions, isolates with the shortest incubation periods caused greater disease severity than those with longer incubation periods. The level of resistance between the two FHIA genotypes was similar, and both expressed high resistance across temperatures and isolates of M. fijiensis, indicating that no physiological races of the pathogen were detected. There were differences in durations of the incubation periods and disease severities associated with the geographical origin of the isolates. Isolates that originated in Honduras, Colombia, and Costa Rica produced more disease on Grand Naine and False Horn than did isolates from Cameroon and Asia. However, no differences associated with the geographical origin of the isolates were observed for both FHIA genotypes. Also, there were no differences in disease severities within isolates that originated from Honduras, Colombia, and Costa Rica.