Factors Associated with COVID-19 Vaccination Uptake in Great Plains American Indian Communities.

With the development of the COVID-19 vaccine in late 2020, the importance of understanding the drivers of vaccine acceptance and vaccine hesitancy is important for the health of American Indian and Alaska Native communities. We conducted a cross-sectional, anonymous survey in October 2021 using established quantitative methods of virtual surveys to reach tribal members living on three reservations in the Great Plains (N = 679). We conducted multivariate analyses using logistic regression to assess the association between independent variables and COVID-19 vaccination status after adjusting for confounding. Respondents were more likely to have received a COVID-19 vaccine if they were older, had a full-time job, had previously received a flu vaccination, reported a higher level of trust in the health care system, had increased access to vaccinations, were able to isolate, or if they held a desire to keep their family safe. This study is one of the first to offer insights into the associations and possible determinants of COVID-19 vaccine uptake among American Indians in the Great Plains and was completed as part of the National Institutes of Health Rapid Acceleration of Diagnostics of Underserved Populations consortium. We identified a set of demographic, socioeconomic, and motivational factors that are associated with COVID-19 vaccination uptake among Great Plains American Indians and Alaska Natives. It is possible that future vaccine uptake may be enhanced through economic development, strengthening health care operations and care quality, and focusing vaccination messaging on family and community impact.

Great Plains American Indians' Perspectives on Patient and Family Needs Throughout the Cancer Journey.

PURPOSE: To explore the perspectives on patient and family needs during cancer treatment and survivorship of American Indian (AI) cancer survivors, caregivers, Tribal leaders, and healers. PARTICIPANTS & SETTING: 36 AI cancer survivors from three reservations in the Great Plains region. METHODOLOGIC APPROACH: A community-based participatory research design was employed. Postcolonial Indigenous research techniques of talking circles and semistructured interviews were used to gather qualitative data. Data were analyzed using content analysis to identify themes. FINDINGS: The overarching theme of accompaniment was identified. The following themes were intertwined with this theme: (a) the need for home health care, with the subthemes of family support and symptom management; and (b) patient and family education. IMPLICATIONS FOR NURSING: To provide high-quality cancer care to AI patients in their home communities, oncology clinicians should collaborate with local care providers, relevant organizations, and the Indian Health Service to identify and develop essential services. Future efforts must emphasize culturally responsive interventions in which Tribal community health workers serve as navigators to accompany patients and families during treatment and in survivorship.

COVID-19 Testing Factors Among Great Plains American Indians.

BACKGROUND: COVID-19 created unparalleled challenges for vulnerable communities, especially among American Indians and Alaska Natives. An effective COVID-19 response requires a tribally driven effort to understand the perspectives of Tribal members on testing and to ensure that delivery strategies are grounded in the cultural values, traditions, and experiences of the Tribes. METHODS: We conducted a cross-sectional, anonymous survey in October 2021 using established methods to reach Tribal members residing in three Reservations in the Great Plains (N = 679). Multivariate analyses were conducted using logistic regression to assess the association between independent variables and COVID-19 testing uptake after adjusting for confounding. RESULTS: After multivariate adjustment, a respondent's employment status, ability to isolate if diagnosed with COVID-19, and endorsing that COVID-19 testing is only needed if one has symptoms were significantly correlated with having been previously tested for COVID-19. Participants without a full-time job were about half as likely to have been tested for COVID-19 compared to those with full-time jobs. Participants who reported not being able to isolate if they tested positive for COVID-19 and participants who did not think testing was needed if asymptomatic were also half as likely to be tested. CONCLUSIONS: Ensuring that everyone has the ability to isolate, that people who are not working have easy access to testing, and that everyone understands the value of testing after exposure are key steps to maximizing testing uptake. Efforts will only be successful if there is continued investment in programs that provide free testing access for everyone on Reservations.

Factors Influencing Palliative Care Access and Delivery for Great Plains American Indians.

CONTEXT: Despite the known importance of culturally tailored palliative care (PC), American Indian people (AIs) in the Great Plains lack access to such services. While clinicians caring for AIs in the Great Plains have long acknowledged major barriers to serious illness care, there is a paucity of literature describing specific factors influencing PC access and delivery for AI patients living on reservation land. OBJECTIVES: This study aimed to explore factors influencing PC access and delivery on reservation land in the Great Plains to inform the development culturally tailored PC services for AIs. METHODS: Three authors recorded and transcribed interviews with 21 specialty and 17 primary clinicians. A data analysis team of seven authors analyzed transcripts using conventional content analysis. The analysis team met over Zoom to engage in code negotiation, classify codes, and develop themes. RESULTS: Qualitative analysis of interview data revealed four themes encompassing factors influencing palliative care delivery and access for Great Plains American Indians: health care system operations (e.g., hospice and home health availability, fragmented services), geography (e.g., weather, travel distances), workforce elements (e.g., care continuity, inadequate staffing, cultural familiarity), and historical trauma and racism. CONCLUSION: Our findings emphasize the importance of addressing the time and cost of travel for seriously ill patients, increasing home health and hospice availability on reservations, and improving trust in the medical system. Strengthening the AI medical workforce, increasing funding for the Indian Health Service, and transitioning the governance of reservation health care to Tribal entities may improve the trustworthiness of the medical system.

Quantitative and qualitative evaluation of spirometry for COPD screening in general practice.

INTRODUCTION: Proper diagnosis of COPD remains a challenge. Spirometry testing in primary care may help to reduce misdiagnosis, but its reliability as a diagnostic instrument needs to be assessed. OBJECTIVES: To investigate (1) the validity of spirometry testing performed in primary care and (2) the accuracy of the diagnostic of airflow limitation obtained by these tests. METHODS: Subjects attending a COPD screening programme had screening spirometry performed either by general practitioners (GPs) or by trained nurses or technicians, who had all received two 3-hour training sessions. Subjects with airflow limitation and a subset of subjects with normal spirometry at screening were invited to undergo confirmatory spirometry performed by trained nurses in a pulmonary function laboratory. RESULTS: Of the 4610 subjects who attended the screening sessions, 96.5% had a valid screening spirometry test. A total of 392 subjects attended the confirmatory sessions. Values measured by screening spirometry were satisfactory compared with those of confirmatory spirometry (rc=0.83). Taking confirmatory spirometry as reference, the positive predictive value of screening spirometry for the diagnosis of persistent airflow limitation was 93% with a specificity of 95%. Agreement for the diagnosis of persistent airflow limitation was substantial (k=0.80). CONCLUSION: Spirometry performed in primary care by trained personnel reliably identifies persistent airflow limitation. This may encourage pulmonologists to collaborate with primary care providers with the aim of improving appropriate diagnosis of COPD.

Standardizing the influenza neuraminidase inhibition assay among United States public health laboratories conducting virological surveillance.

BACKGROUND: Monitoring influenza virus susceptibility to neuraminidase (NA) inhibitors (NAIs) is vital for detecting drug-resistant variants, and is primarily assessed using NA inhibition (NI) assays, supplemented by NA sequence analysis. However, differences in NI testing methodologies between surveillance laboratories results in variability of 50% inhibitory concentration (IC50) values, which impacts data sharing, reporting and interpretation. In 2011, the Centers for Disease Control and Prevention (CDC), in collaboration with the Association for Public Health Laboratories (APHL) spearheaded efforts to standardize fluorescence-based NI assay testing in the United States (U.S.), with the goal of achieving consistency of IC50 data. METHODS: For the standardization process, three participating state public health laboratories (PHLs), designated as National Surveillance Reference Centers for Influenza (NSRC-Is), assessed the NAI susceptibility of the 2011-12 CDC reference virus panel using stepwise procedures, with support from the CDC reference laboratory. Next, the NSRC-Is assessed the NAI susceptibility of season 2011-12 U.S. influenza surveillance isolates (n = 940), with a large subset (n = 742) tested in parallel by CDC. Subsequently, U.S. influenza surveillance isolates (n = 9629) circulating during the next three influenza seasons (2012-15), were independently tested by the three NSRC-Is (n = 7331) and CDC (n = 2298). RESULTS: The NI assay IC50s generated by respective NSRC-Is using viruses and drugs prepared by CDC were similar to those obtained with viruses and drugs prepared in-house, and were uniform between laboratories. IC50s for U.S. surveillance isolates tested during four consecutive influenza seasons (2011-15) were consistent from season to season, within and between laboratories. CONCLUSION: These results show that the NI assay is robust enough to be standardized, marking the first time IC50 data have been normalized across multiple laboratories, and used for U.S. national NAI susceptibility surveillance.

[COPD in dairy farmers: screening, characterization and constitution of a cohort. The BALISTIC study]. / BPCO des producteurs laitiers : dépistage, caractérisation et constitution d'une cohorte. Étude BALISTIC.

BACKGROUND: A pilot study from our group suggests that the prevalence of chronic obstructive pulmonary disease (COPD) among dairy farmers is higher than in the general population although dairy workers are less frequently smokers. OBJECTIVES AND METHODS: The study presented here aims at (i) determining the prevalence of COPD in a large and representative population of dairy farmers; (ii) characterizing these patients in terms of smoking habits, dyspnoea, quality of life, lung function, bronchial exhaled nitric oxide, systemic inflammation, arterial stiffness and exercise capacity; (iii) comparing characteristics of dairy farmers' COPD with the characteristics of COPD in patients without any occupational exposure; (iv) identifying the etiological factors of COPD in dairy farmers; and (v) constituting a cohort of COPD patients and control subjects for further longitudinal studies. Two groups of COPD patients (dairy farmers or not) and two groups of controls subjects will be selected among a representative panel of 2000 dairy workers and 2000 subjects without any occupational exposure, all aged 40 to 75 years. EXPECTED RESULTS: A better knowledge of the epidemiology and pathophysiology of COPD in dairy farmers should guide a specific strategy of prevention. The knowledge of the characteristics of COPD occurring in dairy farmers will help to define the therapeutic modalities that might be different compared with the therapeutic recommendations for COPD secondary to tobacco smoking.

Influence of hay and animal feed exposure on respiratory status: a longitudinal study.

Our aim was to study respiratory symptoms and lung function decline in farmers, with particular attention to the influence of handling hay, straw and animal feed. From a cohort recruited in 1993-1994, 219 (82.6%) dairy farmers, 130 (62.5%) nondairy agricultural workers and 99 (66.4%) controls were re-evaluated in 2006. They answered medical and occupational questionnaires, underwent spirometric tests at both evaluations and pulse oximetry in 2006. Dairy and nondairy agricultural workers showed an increased risk for usual morning phlegm (adjusted OR 4.27 (95% CI 1.41-12.95) and 3.59 (95% CI 1.16-11.10), respectively). Animal feed handling was associated with increased risks of wheezing (p = 0.01) and usual morning phlegm (p = 0.04); hay or straw handling was associated with increased risk of wheezing (p = 0.008). Adjusting for smoking, age, height, sex and altitude, dairy farmers had greater declines in forced expiratory volume in 1 s (FEV(1))/forced vital capacity ratio (p = 0.01) than controls. An increased decline in FEV(1) for all agricultural workers was associated with animal feed handling, both measured as a categorical (currently versus never handling; p = 0.05) or quantitative value (years of exposure during the survey period; p = 0.03). Hay, straw or animal feed handling represents a risk factor of bronchial symptoms and, for animal feed only, of accelerated decline in expiratory flows.

Twelve-year longitudinal study of respiratory status in dairy farmers.

To evaluate respiratory risk in dairy farmers, the present authors conducted a longitudinal study in the Doubs region of France. From a cohort constituted in 1986 (T1), 157 (62.8%) dairy farmers and 159 (63.6%) controls were re-evaluated in 1998 (T3). The study protocol comprised a medical and occupational questionnaire, spirometric tests at both evaluations, and noninvasive measure of blood oxygen saturation with pulse oximetry (S(p,O(2))) at T3. In 1998, the prevalence of chronic bronchitis was higher in dairy farmers. In cross-sectional analyses, all respiratory function parameters and S(p,O(2)) were significantly lower in dairy farmers. In a multiple linear regression model, farming, age, male sex and smoking were significantly and negatively correlated with S(p,O(2)). However, the mean annual decline in respiratory function parameters did not differ significantly between groups. After adjustment of covariables, accelerated decline in vital capacity and forced expiratory volume in one second was associated with age, smoking and male sex. Decline in vital capacity was accelerated in dairy farmers working in traditional farms and those currently foddering. The current study demonstrates that dairy farming is associated with an increased risk of lung disorders and a decrease in blood oxygen saturation and suggests that respiratory function impairment is correlated with cumulated exposure to organic dusts.

Influence of occupational factors on lung function in French dairy farmers. A 5-year longitudinal study.

BACKGROUND: Dairy farming is associated with a high prevalence of respiratory disorders but the respective influence of occupational exposures, environmental, and individual factors on lung function remain unclear. METHODS: In 1994 and 1999, dairy farmers were examined in the Doubs province, France. Spirometric measures and allergological tests were performed. Medical and professional data were obtained by questionnaires. A multiple linear regression analysis was performed. RESULTS: An accelerated decline in lung function parameters was associated with age, male sex, traditional farm (as opposed to modern farms), and a high rate of total IgE (P < 10(-2)). Blood oxygen saturation (SpO2) was significantly positively linked with the modernization of the farm and negatively with age, smoking status, and log IgE (P < 10(-2)). Geographical factors (altitude and climatic conditions) had no significant effect. CONCLUSIONS: The modernization of the farm has an important and beneficial impact on lung functiony.

Respiratory status in dairy farmers in France; cross sectional and longitudinal analyses.

AIMS: To compare respiratory status in dairy farmers with that of non-farming controls. METHODS: Longitudinal study in the Doubs (France). From a cohort constituted in 1994 (T1), 215 (81.1%) dairy farmers and 110 (73.8%) controls were reevaluated in 1999 (T2). The protocol comprised a medical and occupational questionnaire, spirometric tests at both evaluations, allergological tests at T1, and a non-invasive measure of blood oxygen saturation (SpO2) at T2. RESULTS: In 1999 analyses, the prevalence of chronic bronchitis was higher (p = 0.013), and FEV1/VC (p < 0.025) and SpO2 (-0.7%, p < 0.01) lower in dairy farmers than in controls. In a multiple linear regression model, farming, age, and smoking were significantly and inversely correlated with SpO2. In the whole population, the mean annual decline in FEV1 and FEV1/VC was -13.4 ml and -0.30%, respectively. Farming was associated with an accelerated decline in FEV1/VC (p < 0.025) after adjustment for covariates. No relation between allergy and respiratory function changes was observed, except for FEF25-75. CONCLUSIONS: This prospective study shows that dairy farming is associated with an excess of chronic bronchitis, with a moderate degree of bronchial obstruction and a mild decrease in SpO2.

Detection of delirium using the confusion assessment method.

Delirium in hospitalized elderly patients is a phenomenon requiring a lot of nursing attention. It is also a disorder contributing to poor health outcomes in this population. Because of their 24-hour work schedule, nurses are frequently the first to observe acute changes in patients' mental health status and to initiate early interventions. However, delirium is not always easily identified. Therefore, the goal of this article is to increase nurses' knowledge and awareness of early signs of delirium using the Confusion Assessment Method (CAM) routinely and systematically.

Cloning of human Ca2+ homoeostasis endoplasmic reticulum protein (CHERP): regulated expression of antisense cDNA depletes CHERP, inhibits intracellular Ca2+ mobilization and decreases cell proliferation.

A monoclonal antibody which blocks InsP(3)-induced Ca(2+) release from isolated endoplasmic reticulum was used to isolate a novel 4.0 kb cDNA from a human erythroleukaemia (HEL) cell cDNA expression library. A corresponding mRNA transcript of approx. 4.2 kb was present in all human cell lines and tissues examined, but cardiac and skeletal muscle had an additional transcript of 6.4 kb. The identification in GenBank(R) of homologous expressed sequence tags from many tissues and organisms suggests that the gene is ubiquitously expressed in higher eukaryotes. The gene was mapped to human chromosome 19p13.1. The cDNA predicts a 100 kDa protein, designated Ca(2+) homoeostasis endoplasmic reticulum protein (CHERP), with two putative transmembrane domains, multiple consensus phosphorylation sites, a polyglutamine tract of 12 repeats and regions of imperfect tryptophan and histadine octa- and nona-peptide repeats. In vitro translation of the full-length cDNA produced proteins of M(r) 128000 and 100000, corresponding to protein bands detected by Western blotting of many cell types. CHERP was co-localized in HEL cells with the InsP(3) receptor by two-colour immunofluorescence. Transfection of HEL cells with antisense cDNA led to an 80% decline in CHERP within 5 days of antisense induction, with markedly decreased intracellular Ca(2+) mobilization by thrombin, decreased DNA synthesis and growth arrest, indicating that the protein has an important function in Ca(2+) homoeostasis, growth and proliferation.

Relationships of immunoglobulins E and G sensitization to respiratory function in dairy farmers.

An impairment of respiratory function has been demonstrated in dairy farmers. The objective of this study was to evaluate the relationship of allergy to respiratory function in dairy farmers in a longitudinal study conducted in the Doubs (France). A cohort of male dairy farmers constituted in 1990 was re-evalued in 1995. Subjects completed a medical and occupational questionnaire, and a spirometry test in both 1990 and 1995, in 1995 they were also subjected to immunological tests. Relationships between immunological variables and respiratory function were studied by a multiple linear regression model adjusted for age, smoking status, respiratory symptoms, altitude and occupational exposure. Amongst the 394 subjects of the initial cohort, 330 were included in the longitudinal study and 320 had immunological tests. Log immunoglobulin (Ig) E was negatively correlated with the 1995 respiratory function parameters (p<0.05 for forced expiratory volume in one second (FEV1) and FEV1/vital capacity (VC). Immunoglobulin (Ig) G response to Aspergillus fumigatus detected by enzyme-linked immunosorbent assay (ELISA) was negatively correlated to 1995 respiratory function parameters (VC: p<0.01; FEV1: p<0.001; FEV1/VC: p<0.01). There was a positive relationship between IgG antibodies against Aspergillus fumigatus and the mean annual decline in FEV1 (p<0.01) and FEV1/VC (p<0.01). To conclude, allergy may play a role in the impairment of respiratory function in dairy farmers of the Doubs and sensitization to Aspergillus fumigatus seems to constitute an independent risk factor for the development of airflow obstruction in this occupational setting.

Prevalence of asthma and respiratory symptoms in dairy farmers in the French province of the Doubs.

With the aim of determining whether dairy farming is associated with an excess of asthma and respiratory symptoms, we compared the respiratory status in a sample of dairy farmers (n = 265) and a control group of nonexposed subjects (n = 149). The study protocol comprised a questionnaire, spirometry, and a bronchodilatation test (400 micrograms salbutamol powder), and an allergological evaluation: serum total IgE level, Phadiatop test, and skin prick tests (SPT) for seven inhalant allergens. Cumulative prevalences of self-reported asthma and of current asthma were respectively 5.3% and 1.5% in farmers, and respectively 3.4% and 1.3% in control subjects (both NS). Prevalences of all the respiratory symptoms studied were higher in farmers, with statistically significant differences after adjusting for age, sex, and smoking, for wheezing ever (OR: 2.7, p < 0.05), wheezing within the last year (OR: 5.2, p < 0.025), usual morning cough (OR: 5, p < 10(-)3), usual morning phlegm (OR: 11.3, p < 10(-)4), and chronic bronchitis (OR: 11.8, p < 0.01). The effect of exposure on these symptoms was more pronounced than, or of the same magnitude as that of smoking. Smoking and exposure had an additive effect except for chronic cough for which a positive interaction was observed (p = 0.05). Mean FEV1/VC (percentage of predicted) was statistically negatively correlated to dairy farming (p < 0.025) after adjusting for confounders. Bronchial obstruction was reversible in about 10% of subjects in both groups. In conclusion, this study mainly demonstrated an excess of respiratory symptoms in dairy farmers which is weak and nonsignificant for asthma, and high for cough, phlegm, and chronic bronchitis. It also suggested that the combined effect of farming and smoking was synergistic on chronic cough.

Detection and diagnosis of delirium in the elderly: psychiatrist diagnosis, confusion assessment method, or consensus diagnosis?

The clinical diagnosis of delirium has traditionally been based on an assessment by one or more physicians. Because of the transient, ubiquitous, and fluctuating nature of the symptoms of delirium, however, this approach may be flawed. Therefore, we decided to compare diagnosis based on one assessment by a psychiatrist, diagnosis by a nurse clinician (using the Confusion Assessment Method [CAM] and multiple observation points), and diagnosis by consensus. The study subjects were 87 patients aged 65 and over who were admitted consecutively from the emergency department to the medical wards, and who scored 3 or more on the Short Portable Mental Status Questionnaire. All subjects were assessed independently by one of three psychiatrists (a chart review and clinical examination) and a nurse clinician (using the CAM and multiple observation points). A consensus conference, attended by the three psychiatrists and the nurse clinician, used all available information to reach a consensus diagnosis. Compared to the consensus diagnosis, the clinical diagnosis by a psychiatrist had a sensitivity of .73 (95% confidence interval [CI]: .61-.85), a specificity of .93 (95% CI: .79-1.0), and an agreement kappa coefficient of .58 (95% CI: .41-.74). The nurse clinician diagnosis had a sensitivity of .89 (95% CI: .81-.97), a specificity of 1.00, and an agreement kappa coefficient of .86 (95% CI: .75-.97). These results suggest that one clinical assessment by a psychiatrist may not be the best method for detecting and diagnosing delirium in the elderly. A consensus diagnosis or diagnosis by a trained rater (using the CAM and multiple observation points) may be more sensitive approaches.

Six year longitudinal study of respiratory function in dairy farmers in the Doubs province.

A previous study, carried out in 1986 in France, showed the prevalence of respiratory symptoms and of respiratory function impairment to be higher in dairy farmers than in a control group of nonexposed subjects living in a rural zone. In order to confirm the harmful effect of dairy farming, the two groups were re-studied 6 yrs later at the same period of the year. One hundred and ninety-four (77.6%) farmers and 155 (62%) control subjects were available for re-examination. Non-re-evaluated subjects were comparable to re-evaluated subjects for age, sex, smoking and respiratory symptoms and function at initial evaluation. Dairy farmers consistently had more respiratory symptoms and lower levels of respiratory function than did control subjects. In the study populations as a whole, the mean annual decline in vital capacity (VC) and forced expiratory volume in one second (FEV1) was slightly, but nonsignificantly, higher in farmers than in control subjects: in mL x yr(-1) (SD), -43.1 (68.2) versus -37.9 (60.2) for VC and -32.8 (56.7) versus -30 (47.2) for FEV1. There was a positive interaction between farming and age (i.e. duration of exposure in this cohort) on respiratory function decline, and in male subjects aged > or = 45 yrs, dairy farming was associated with an accelerated loss in VC (p<0.05) and FEV1 (p<0.05) after controlling for age, smoking, height and geographic location in a multiple linear regression model. Initial values of respiratory function, age and pack-years smoked (only for VC) were the other variables found to be significant determinants of decline in lung function. In conclusion, this study mainly suggests that dairy farming is associated to a very moderate accelerated loss in respiratory function that increases with duration of exposure and is significant in older male subjects.

[Respective influence of occupational and personal factors on respiratory function in dairy farmers]. / Influence respective des facteurs professionnels et personnels sur la fonction respiratoire en milieu agricole de production laitière.

Occupational and individual factors influencing respiratory function were analysed in a sample of dairy farmers. The study protocol included a medical questionnaire, an occupational questionnaire, spirometry and allergological tests (skin prick tests for a panel of inhalant allergens, serum total IgE level and Phadiatop (CAP System). Two hundred and forty-five farmers were studied (140 men, 105 women with an average age of 45.9 (11.3) years, 35 were smokers, 27 ex-smokers and 183 non-smokers). A multiple linear regression model was used to analyse the correlations between respiratory function and the different independent variables. There was a statistically significant negative correlations between smoking (expressed in pack-years) and all the respiratory function parameters (p < 0.01). Respiratory function was significantly impaired in farmers working on traditional farms (p < 0.05 for VC and for FEV1), and the respiratory function values increased proportionally with the modernisation of the farms (notably using an artificial barn drying system for hay and a ventilation system for the cow byres). No significant relationship between respiratory function and quantitative indicators of exposure (size of farm, amount of livestock, quantity of hay handled during professional lifetime) or indicators of IgE-mediated allergy was observed. In conclusion, this study suggests that traditional work conditions in farms which have little mechanisation are, along with tobacco, the determining factors for the respiratory function impairment in dairy farmers.