Tribal Group

The Opioid Use Disorder (OUD) Cascade of Care is a public health model that has been used to measure population-level OUD risk, treatment engagement, retention, service and outcome indicators. However, no studies have examined its relevance for American Indian and Alaska Native (AI/AN) communities. Thus, we aimed to understand (1) the utility of existing stages and (2) the relative 'fit' of the OUD Cascade of Care from a tribal perspective. Qualitative analysis of in-depth interviews with 20 individuals who were knowledgeable regarding the treatment of OUD in an Anishinaabe tribal setting in Minnesota, USA. Community member roles included clinicians, peer support specialists and cultural practitioners, among others. Thematic analysis was used to analyze the data. Participants identified the key transition points of prevention, assessment, inpatient/outpatient pathways and recovery as relevant to their community. They re-imagined an Aanji'bide (Changing our Paths) model of opioid recovery and change that was non-linear; included developmental stage and individual pathways; and demonstrated resilience through connection to culture/spirituality, community and others. Community members living/working in a rural tribal nation in Minnesota, USA identified non-linearity and cultural connection as key elements to include in an Anishinaabe-centered model of opioid recovery and change.

Abstract BackgroundHealth-care workers are at high risk of facing violence all over the world. The sanctity, respect and protection of health care is threatened by violence in health-care settings. The study aims to explore the perception of health-care personnel about violence in health-care settings in district Peshawar.MethodsThis qualitative multiple case study uses a participatory approach to develop an understanding of the processes and themes that explain the health-care personnel`s experience of violence. Ten focus group discussions and three individual in-depth interviews were conducted with eighty-three participants recruited through purposive sampling.ResultsThree distinct recurrent themes emerged from the responses of the different stakeholders and consensus was reached on seven broad categories. The themes were: (a) Not all the wounds are visible: the theme describes the nature, frequency, and characteristics of violence and explores that violence is not merely any physical action taken against men or women to cause visible physical wounds, but also includes verbal or emotional abuse that attempts to hurt the feelings or affects the health of an individual. (b) But violence is never the answer: different categories including the perpetrators of violence, causes, and contributing factors, and the consequences and effects of violence on individuals and institutions were explored and summarized that there could be many causes to provoke violence but still violence cannot be justified. (c) Vaccine for violence: described the various strategies for the prevention of violence and suggests various measures at the public and institutional levels to be incorporated for a future without violence. ConclusionThe study concluded that violence against health care is a frequently occurring phenomenon in health-care settings. Most of the incidents are not highlighted as they are verbal/emotional but have far more impact on the health-care personnel. A holistic approach was suggested for ending violence in the health-care settings and the need to involve all relevant stakeholders was emphasized. The recommended measures include policy formulation, promoting awareness and education, capacity building of health-care personnel on communication strategies/consultation skills, improved security of the health-care settings, and positive role of media in promoting the respect of health-care personnel. Further research should then focus on evaluating the effectiveness of these measures.

The mayfly family Neoephemeridae was discovered in Wisconsin for the first time and is represented by the species Neoephemera bicolor. Nymphs were collected from three sites in two rivers in northern Wisconsin. Adults were reared from nymphs. Some physical and chemical characteristics of the sample locations are discussed.