Indian Health Service

Nutrition insecurity is a major driver of poor cardiovascular health in Indigenous communities. Medically tailored meals may improve heart failure outcomes and quality of life. There is growing momentum among Indigenous communities to reclaim traditional precontact foods to improve cardiovascular health. In this context, utilizing community-based-participatory methods, we designed MUTTON-HF (Medically Utilized Tailored Traditional Foods to Optimize Nutrition in Heart Failure)-an Indigenous culturally and medically tailored meals program that locally sources Native produce and meat and incorporates traditional Diné (Navajo) foods and recipes. The MUTTON-HF trial is a 2-center, pragmatic, open-label randomized controlled trial to determine the efficacy and safety of MUTTON-HF among Diné patients with heart failure and hospitalization, or emergency room visit in the last 12 months. Two hundred and four subjects at 2 Indian Health Service sites will be randomized in a 1:1 stratified fashion by sex, age (<65 versus ≥65 years), and left ventricular ejection fraction (<50% versus ≥50%). Study subjects will receive either culturally and medically tailored meals that incorporate traditional Diné recipes and foods or usual dietary advice for 8 weeks. Data analysts will be blinded to group assignment until study completion. The primary efficacy end point is the proportion of patients with a hospitalization or emergency room visit (all-cause) within 90 days. Secondary outcomes will include hospitalizations or emergency room visits for heart failure specifically; Kansas City Cardiomyopathy Questionnaire scores for health-related quality of life; measures of food insecurity; Indigenous nourishment; diet quality; financial strain; and clinical biomarkers from study enrollment to 8 weeks. Community-based interventions that leverage the protective assets of Indigenous communities are needed to improve cardiovascular health among Native populations. This pragmatic randomized controlled trial will target a rural tribal population and be the first to evaluate the efficacy of an Indigenous food is medicine intervention to improve Indigenous cardiovascular health outcomes for patients with heart failure. URL: https://www.clinicaltrials.gov; Unique identifier: NCT06549699.

The Medical College Admissions Test (MCAT) remains a significant barrier for students from low socioeconomic status (SES) backgrounds, with performance disparities driven by unequal access to resources rather than by differences in aptitude. Holistic admissions practices seek to contextualize exam performance alongside other essential pre-medical competencies such as resilience, empathy, and scientific inquiry. Evidence shows that students with middle-tercile MCAT scores who demonstrate these qualities will succeed in medical school and beyond. However, only those who apply can benefit from such holistic review. Little is known about application behaviors at this pivotal stage, when examinees must decide whether to apply with their achieved MCAT score. This study examines the relationship between socioeconomic status, MCAT performance, and application probability. This study analyzed de-identified Association of American Medical Colleges (AAMC) data for all MCAT examinees between 2017 and 2019, including sociodemographic characteristics and total MCAT score. The outcome was allopathic (M.D.) medical school application status through the 2021 application cycle, allowing examinees at least two full years to apply. The AAMC parental education and occupation (EO) indicator stood as a proxy for SES – ranging from EO-1 (less than college degree, any occupation) to EO-5 (doctoral degree; executive, managerial or professional occupations). Socioeconomic disadvantage (SED) was defined as EO-1 and EO-2. Middle- or top-tercile MCAT scores were achieved by 51.8% of examinees with SED (middle, 33.2%; top, 18.6%) compared with 73.1% of examines without SED (middle, 34.4%; top, 38.7%). The probability of applying to medical school was closely tied to MCAT performance, and regardless of SES, the probability of application with any given MCAT score was similar. While most top-tercile performers (92 to 94%) applied, a much lower proportion of middle-tercile performers (78 to 80%) applied. Socioeconomically disadvantaged MCAT examinees infrequently score in the top tercile where application rates are uniformly high. Those with acceptable, middle-tercile performance may under-appreciate their academic achievements through economic adversity, as over 20% do not apply to medical school. Targeted interventions are needed to promote application and maximize the impact of holistic review.

Tribal communities face barriers to care. This is especially true for American Indian Alaskan Native children needing pediatric-subspecialty care. We created a new pediatric rheumatology hybrid clinic using telemedicine to enhance access. A combination of telemedicine clinics and face-to-face clinics onsite at the Northern Navajo Medical Center was offered. The new clinic reduced the wait time for care for pediatric rheumatology conditions by 95%.

Interest in bringing Traditional Ecological Knowledge (TEK) and Western Science together to enhance climate and landscape resilience is growing rapidly, particularly for engagement with pyrogenic communities around the world. For these systems, Indigenous Knowledge offers unique insights that reflect millennia of intimate engagement with local landscapes, while Western Science can offer additional understanding of the emergence of climates and ecological conditions that are novel at evolutionary timescales. Here, we weave Indigenous Knowledge together with a multicentury history of fire, landuse, and forest development derived from tree rings to retell a more complete history of human engagement with the places commonly referred to as Wisconsin and Minnesota Points at the head of Lake Superior in the Laurentian Great Lakes. Our aim in this work is to create mutual reciprocal benefits for those involved in this work to disrupt a long history of extractive research and to honor the knowledge shared with us by reducing barriers to the revitalization of traditional cultural and landuse practices. This intensely local study, contextualized by substantial bodies of Indigenous Knowledge and Western Science, illustrates the importance of place-based and community-based research for understanding the role of Indigenous fire stewardship in shaping pine barrens sites and demonstrates how these fine-scale relationships are linked to regional landscape diversity yet may be invisible to other proxy-based studies. These results help (re)center Indigenous Knowledge and traditional fire-use practices in the process of ecocultural fire restoration for the creation of diverse, resilient, and just socioecological systems that continue to transition toward a warmer future.

This cross-sectional study compares characteristics of Indian Health Services hospitals and rural hospitals with Graduate Medical Education programs.

Abstract We conduct a randomized controlled trial to evaluate the impact of an innovative police patrol program on sexual harassment in public spaces in Hyderabad, India. In collaboration with the Hyderabad City Police, we randomize exposure to police patrols and the visibility of officers by deploying both uniformed and undercover officers across 350 hotspots. To assess the effect, we implement a novel, high-frequency observation exercise to measure sexual harassment at these hotspots, where enumerators recorded all observed instances of sexual harassment and women’s responses in real time. We find that although police patrols had no impact on overall street harassment, uniformed police patrols reduced severe forms of harassment (forceful touching, intimidation) by 27 percent and reduced the likelihood of women leaving the hotspot due to sexual harassment. We uncovered the underlying mechanisms and found that both police visibility and officers’ attitudes toward sexual harassment are key to understanding its incidence.

American Indian (AI) communities in the Southwest have a high burden of invasive pneumococcal disease (IPD) and COVID-19. Through laboratory-based surveillance, the impact of the pandemic on IPD incidence and serotype distribution was evaluated in two AI communities. IPD rates were lower during the pandemic (21.8 vs. 39.0/100 000 pre-pandemic). Rates increased in 2021 compared to 2020 but not to pre-pandemic levels. Cases with SARS-CoV-2 co-infection had a higher case fatality rate (45.2% vs. 17.6% without co-infection). No significant change in serotype distribution was observed. Continued surveillance in these communities is critical to understand the changing IPD burden as the pandemic evolves.

The primary focus of disaster-related literature historically has been on natural disasters due to their severity. There is less than sufficient focus in the academic world regarding man-made disasters despite their high magnitude. While the world is exposed to the hazards of natural disasters often, the frequency of man-made disasters is also very high. Seventy-five million people died in World War II due to deliberate genocides, massacres and bombings. Millions of people were displaced or made refugees from 1990 to 2003 during fifty-nine armed conflicts in forty-eight separate locations. The recent casualties in the ongoing wars between Russia and Ukraine and Israel and Palestine further strengthen the overall narrative of man-made disasters. Road traffic deaths is another critical area where lots of human lives are lost every year. The world loses 1.3 million people every year due to road traffic crashes. 1,54,732 people lost their lives in road accidents in India in the year 2019. Road traffic accidents fall in the category of man-made disasters. The present article examines road traffic accidents and deaths in Delhi. It also analyses the role of various proactive measures taken by the Delhi Traffic Police in curbing the increasing trend of fatalities on roads. These measures were implemented after proper analyses of the accident sites. These measures broadly fall in the domain of road engineering, law enforcement and education of road users, technically known as triple E (engineering, enforcement and education). Installation of over-speeding violation detection cameras and red-light violation detection cameras on affected roads has substantially reduced the number of accidents and has also acted as psychological deterrents for road users. The analysis tries to use the theoretical construct of triple T (targeting, testing and tracking) used by Prof. Sherman in the context of evidence-based policing for preventing crime.

We assessed the impact of pneumococcal conjugate vaccines on pneumococcal otitis media (OM) among children living in Navajo and White Mountain Apache Tribal lands. During the PCV7 era (2000-2009), the proportion of vaccine-type OM declined. However, vaccine-type OM (predominantly 3, 19A, and 19F) persisted in the PCV13 era (2010-2019).