“They Wait until the Disease Has Taking over You and the Doctors Cannot Do Anything about It”: Qualitative Insights from Harambee! 2.0

African immigrants make up a large subgroup of Black/African-Americans in the US. However, because African immigrant groups are typically categorized as “Black,” little is known about their preventative healthcare needs. Differences in culture, life and healthcare experiences between African immigrant populations and US-born people may influence preventive health care uptake. Thus, policymakers and healthcare providers lack information needed to make informed decisions around preventive care for African immigrants. This formative study was conducted among the largest East African immigrant communities in King County, WA. We recruited religious leaders, community leaders, health professionals, and lay community members to participate in thirty key informant interviews and five focus group discussions (n = 72 total), to better understand preventative healthcare attitudes in these communities. Through inductive coding and thematic analysis, we identified factors that impact preventative healthcare attitudes of the Somali, Ethiopian and Eritrean immigrant communities and deter them from accessing and utilizing healthcare. Cultural beliefs and attitudes around preventative healthcare, mistrust of westernized healthcare, religious beliefs/views, intersecting identities and shared immigrant experiences all influence how participants view preventative healthcare. Our results suggest that interventions that address these factors are needed to most effectively increase uptake of preventative healthcare in African immigrant communities.

Perceptions on Preventative Care During the Covid-19 Pandemic: A Survey Using Clinical Scenarios

One significant side effect of the Covid-19 pandemic is the decline in preventative healthcare services. The reduction in inpatient and outpatient visits has been attributed to fears of contracting the virus. Our study utilized a cross sectional survey of adults to determine patient risk assessment for receiving preventative care during the pandemic, specifically mammography, colonoscopy, and immunizations, through clinical scenarios (ranked high, medium, or low risk). Based on the scenario, the respondent indicated whether they would schedule their appointment for the relevant procedure within the next month. We hypothesized that more people would choose to seek care as their symptomatic severity and risk factors increased including increased age, outweighing their Covid-19 fears against the urgency of their clinical presentation. Consistent with the hypothesis, there were statistically significant differences to increasing scenario intensity for all procedures (mammography, immunization, colonoscopy). Regarding age, low risk immunization respondents 65 years and older were more likely to get their flu shot than those in the 18-49 or 50-64 age brackets, whereas no significant differences were found for colonoscopy and mammography among eligible age groups. These empirical results epidemiologically support proposed projection models stating there will likely be an increased incidence in late-stage cancers and immunization preventable disease due to missed/unscheduled appointments attributed to the pandemic. Thus, physicians should strongly encourage their patients to receive missed preventative care.

Whole Genome Interpretation for a Family of Five

Although best practices have emerged on how to analyse and interpret personal genomes, the utility of whole genome screening remains underdeveloped. A large amount of information can be gathered from various types of analyses via whole genome sequencing including pathogenicity screening, genetic risk scoring, fitness, nutrition, and pharmacogenomic analysis. We recognize different levels of confidence when assessing the validity of genetic markers and apply rigorous standards for evaluation of phenotype associations. We illustrate the application of this approach on a family of five. By applying analyses of whole genomes from different methodological perspectives, we are able to build a more comprehensive picture to assist decision making in preventative healthcare and well-being management. Our interpretation and reporting outputs provide input for a clinician to develop a healthcare plan for the individual, based on genetic and other healthcare data.

Bioactive peptides in preventative healthcare: An overview of bioactivities and suggested methods to assess potential applications.

: Food derived bioactive peptides can be generated from various protein sources and usually consist of between 2-30 amino acids with bulky, side-chain aromatic amino acids preferred in the ultimate and penultimate positions at the Cterminal end of the amino acid chain. They are reported to impart a myriad of preventative health beneficial effects to the consumer once ingested and these include heart health benefits through inhibition of enzymes including renin (EC 3.4.23.15) and angiotensin-I-converting enzyme (ACE-I; EC 3.4.15.1) within the renin angiotensin aldosterone system (RAAS); anti-inflammatory (due to inhibition of ACE-I and other enzymes) and anti-cancer benefits; prevention of type-2 diabetes through inhibition of dipeptidyl peptidase IV (DPP-IV), bone and dental strength, antimicrobial and immunomodulatory effects and several others. Peptides have also reported health benefits in the treatment of asthma, neuropathic pain, HIV and wound healing. However, the structure, amino acid composition and length of these peptides along with the quantity of peptide that can pass through the gastrointestinal tract and often the blood brain barrier (BBB) intact and reach the target organ is important for the realisation of these health effects in an in vivo setting. This paper aims to collate recent important research concerning the generation and detection of peptides in the laboratory. It discusses products currently available as preventative healthcare peptide options and relevant legislation barriers to place a food peptide product on the market. The review also highlights useful in silico computer based methods and analysis that may be used to generate specific peptide sequences from proteins whose amino acid sequences are known and also to determine if the peptides generated are unique and bioactive. The topic of food-derived bioactive peptides for health is of great interest to scientific research and industry due to evolving drivers in food product innovation including health and wellness for the elderly, infant nutrition and optimum nutrition for sports athletes as well as the humanisation of pets. This paper provides an overview of what is required to generate bioactive peptide containing hydrolysates; what methods should be used in order to characterise the health beneficial effects of these hydrolysates and the active peptide sequences, potential applications of bioactive peptides and legislative requirements in Europe and the United States. It also highlights success stories and barriers to the development of peptide containing food products that currently exist.

An Exploration of the Value of Elective Health Checks in UK Zoo-Housed Gibbons

Elective health checks form an important part of the preventative healthcare of many zoo-housed animals. These procedures are not without risk or financial expenditure, meaning careful cost–benefit analysis is required when determining the frequency and intensity with which they are implemented. This study evaluated the value of elective health checks (n = 74) carried out on 33 gibbons at a single UK zoological collection from 2011 to 2018. Data were categorised by health check type, animal age, clinical findings and outcome. Univariable binary logistic regression and multivariable modelling were used to identify factors associated with the likelihood of actionable (clinically significant) outcomes. In total, 51.35% of all elective health checks resulted in an actionable outcome. Elderly heath checks had 13.64 times greater odds of an actionable outcome and 34 times greater odds of a significant radiographic finding, when compared to routine (non-elderly) health checks. Our findings suggest that 75% wild longevity is a suitable threshold for identifying elderly captive gibbons and increasing health check frequency. Whilst further work is needed to ascertain whether these findings can be extrapolated to other collections and/or species, this study demonstrates how the analysis of clinical data can aid in the implementation of an effective and evidence-based preventative healthcare plan.

Healthscaping a Medieval City: Lucca’s Curia viarum and the Future of Public Health History,” Urban History 40: 395-415

In early fourteenth-century Lucca, one government organ began expanding its activities beyond the maintenance of public works to promoting public hygiene and safety, and in ways that suggest both a concern for and an appreciation of population-level preventative healthcare. Evidence for this shift (which is traceable in and beyond the Italian peninsula) is mostly found in documents of practice such as court and financial records, which augment and complicate the traditional view afforded by urban statutes and medical treatises. The revised if still nebulous picture emerging from this preliminary study challenges a lingering tendency among urban and public health historians to see pre-modern European cities as ignorant and apathetic demographic black holes.