This study aimed to assess health literacy and medication awareness in outpatient neurology patients. The study found that over 85% of patients had adequate health literacy based on the S-TOFHLA test. Preliminary results found that a single question could predict inadequate literacy with 80% sensitivity and 97.1% specificity. Limitations included a low participation rate of 53.5% and need for altered recruitment strategies. Next steps include expanding to other hospitals, adding control groups, and improving organization as a single researcher.
3 forette prevention of alzheimer ifa 2012] 2ifa2012
The document discusses potential approaches for preventing Alzheimer's disease and dementia. It notes that while some observational studies have found associations between certain factors and reduced dementia risk, large randomized controlled trials have not shown that anti-inflammatory agents, antioxidants, or estrogen therapy can prevent Alzheimer's disease. The document does provide evidence from randomized trials that treating hypertension through blood pressure lowering agents can reduce incidence of dementia. It summarizes trials showing reduced dementia risk when treating hypertension with calcium channel blockers, ACE inhibitors, and diuretics.
Diabetes and Cardiovascular Risk in Driftpile First Nation: Longitudinal ResultsKelli Buckreus
This study examined diabetes and cardiovascular risk factors longitudinally among adults and children in Driftpile First Nation who returned for at least one follow-up visit. Among adults, BMI, cholesterol, and blood pressure did not change significantly over time, while waist circumference increased. A1c also tended to increase. Among children, BMI, blood pressure, cholesterol, and A1c all increased over time, though only the increase in BMI was statistically significant. The results suggest that risk factors for diabetes are not decreasing despite prevention and health initiatives in the community over seven years.
Standing Strong Against Diabetes: Maskwacis Health Services Diabetes Conferen...Kelli Buckreus
Dr. Ellen Toth gave a presentation on diabetes at the Maskwacis Health Services Diabetes Conference in November 2012. She discussed her work with the University of Alberta doing diabetes clinics in Hobbema for 10 years. She then provided an overview of diabetes, explaining the different types and how diabetes can be managed through lifestyle changes and medication. Finally, she discussed how communities can stand strong against diabetes through prevention, treatment, living well, and assessing and treating diabetes during pregnancy.
Increasing incidence and prevalence of diabetes among the Status Aboriginal P...Kelli Buckreus
1) The study examined increasing rates of diabetes among Status Aboriginal people in rural and urban Alberta between 1995-2006.
2) Age-adjusted diabetes incidence rates increased by 34% for those with urban residences and 13% for rural residents over this period. Incidence rates were higher for rural residents after adjusting for age and sex.
3) Age-adjusted diabetes prevalence rates among Status Aboriginal people increased 22% for urban and 35% for rural residents from 1995-2006. Prevalence was higher for women than men in both locations.
Diabetes care and patient understanding of type 2 diabetes in remote, rural A...Kelli Buckreus
Most respondents saw their family doctor as their main diabetes care provider and saw them at least 3 times in the previous year. However, few clients received appropriate testing and screening. Only 26% had an A1c test and 25% had a retinal exam in the past year, below recommended guidelines. While 60% felt they understood diabetes well, few attended formal education. Despite opportunities to receive care, few clients are getting appropriate testing, screening and specialist referrals like podiatry. The mobile diabetes program aims to empower clients to request appropriate care and works to improve access.
Health outcomes of Aboriginal individuals with early onset diabetesKelli Buckreus
The study examined the health outcomes of 116 Aboriginal individuals in Alberta diagnosed with diabetes in youth (≤20 years old). The majority (86.2%) were Aboriginal, with an average current age of 30.5 years and average diabetes duration of 14.5 years. High rates of comorbidities were found, including obesity (82%), abnormal waist circumference (64.1%), metabolic syndrome (43.1%), hypertension (48.4%), and poor blood glucose control (61.1% had A1c >7%). Many also showed signs of diabetes complications like microalbuminuria (33%) and being at high risk for foot issues (11.4%). The results suggest diabetes takes a significant toll on health early in
Improved Outcomes from Diabetes Outreach Programs in Rural and Remote Aborigi...Kelli Buckreus
For returning subjects with diabetes (N=1415), improvements were observed over time in BMI, blood pressure, total cholesterol, and A1c concentrations (p<0.05). Waist circumferences were unchanged. For subjects without diabetes (N=1398), improvements were seen in blood pressure and total cholesterol only (p<0.05), while BMI and waist circumference increased (p<0.05) and A1c was unaffected. While diabetes outcomes are improving with outreach programs, more intense strategies may be needed to modify risk factors in those with pre-diabetes.
This study aimed to assess health literacy and medication awareness in outpatient neurology patients. The study found that over 85% of patients had adequate health literacy based on the S-TOFHLA test. Preliminary results found that a single question could predict inadequate literacy with 80% sensitivity and 97.1% specificity. Limitations included a low participation rate of 53.5% and need for altered recruitment strategies. Next steps include expanding to other hospitals, adding control groups, and improving organization as a single researcher.
3 forette prevention of alzheimer ifa 2012] 2ifa2012
The document discusses potential approaches for preventing Alzheimer's disease and dementia. It notes that while some observational studies have found associations between certain factors and reduced dementia risk, large randomized controlled trials have not shown that anti-inflammatory agents, antioxidants, or estrogen therapy can prevent Alzheimer's disease. The document does provide evidence from randomized trials that treating hypertension through blood pressure lowering agents can reduce incidence of dementia. It summarizes trials showing reduced dementia risk when treating hypertension with calcium channel blockers, ACE inhibitors, and diuretics.
Diabetes and Cardiovascular Risk in Driftpile First Nation: Longitudinal ResultsKelli Buckreus
This study examined diabetes and cardiovascular risk factors longitudinally among adults and children in Driftpile First Nation who returned for at least one follow-up visit. Among adults, BMI, cholesterol, and blood pressure did not change significantly over time, while waist circumference increased. A1c also tended to increase. Among children, BMI, blood pressure, cholesterol, and A1c all increased over time, though only the increase in BMI was statistically significant. The results suggest that risk factors for diabetes are not decreasing despite prevention and health initiatives in the community over seven years.
Standing Strong Against Diabetes: Maskwacis Health Services Diabetes Conferen...Kelli Buckreus
Dr. Ellen Toth gave a presentation on diabetes at the Maskwacis Health Services Diabetes Conference in November 2012. She discussed her work with the University of Alberta doing diabetes clinics in Hobbema for 10 years. She then provided an overview of diabetes, explaining the different types and how diabetes can be managed through lifestyle changes and medication. Finally, she discussed how communities can stand strong against diabetes through prevention, treatment, living well, and assessing and treating diabetes during pregnancy.
Increasing incidence and prevalence of diabetes among the Status Aboriginal P...Kelli Buckreus
1) The study examined increasing rates of diabetes among Status Aboriginal people in rural and urban Alberta between 1995-2006.
2) Age-adjusted diabetes incidence rates increased by 34% for those with urban residences and 13% for rural residents over this period. Incidence rates were higher for rural residents after adjusting for age and sex.
3) Age-adjusted diabetes prevalence rates among Status Aboriginal people increased 22% for urban and 35% for rural residents from 1995-2006. Prevalence was higher for women than men in both locations.
Diabetes care and patient understanding of type 2 diabetes in remote, rural A...Kelli Buckreus
Most respondents saw their family doctor as their main diabetes care provider and saw them at least 3 times in the previous year. However, few clients received appropriate testing and screening. Only 26% had an A1c test and 25% had a retinal exam in the past year, below recommended guidelines. While 60% felt they understood diabetes well, few attended formal education. Despite opportunities to receive care, few clients are getting appropriate testing, screening and specialist referrals like podiatry. The mobile diabetes program aims to empower clients to request appropriate care and works to improve access.
Health outcomes of Aboriginal individuals with early onset diabetesKelli Buckreus
The study examined the health outcomes of 116 Aboriginal individuals in Alberta diagnosed with diabetes in youth (≤20 years old). The majority (86.2%) were Aboriginal, with an average current age of 30.5 years and average diabetes duration of 14.5 years. High rates of comorbidities were found, including obesity (82%), abnormal waist circumference (64.1%), metabolic syndrome (43.1%), hypertension (48.4%), and poor blood glucose control (61.1% had A1c >7%). Many also showed signs of diabetes complications like microalbuminuria (33%) and being at high risk for foot issues (11.4%). The results suggest diabetes takes a significant toll on health early in
Improved Outcomes from Diabetes Outreach Programs in Rural and Remote Aborigi...Kelli Buckreus
For returning subjects with diabetes (N=1415), improvements were observed over time in BMI, blood pressure, total cholesterol, and A1c concentrations (p<0.05). Waist circumferences were unchanged. For subjects without diabetes (N=1398), improvements were seen in blood pressure and total cholesterol only (p<0.05), while BMI and waist circumference increased (p<0.05) and A1c was unaffected. While diabetes outcomes are improving with outreach programs, more intense strategies may be needed to modify risk factors in those with pre-diabetes.
Partnerships to address the diabetes epidemic in Aboriginal Communities in Al...Kelli Buckreus
This document summarizes an Aboriginal diabetes program in Alberta, Canada. It describes the high rates of diabetes among Aboriginal populations and the cultural and socioeconomic barriers to care. The program was developed in partnership with Elders and takes a holistic, culturally-relevant approach. It provides on-site and outreach services, education, and promotes healthy living. Research shows the program is helping improve health outcomes and further partnership is needed to fully address the diabetes epidemic in Aboriginal communities.
Screening Métis clients in Alberta for undiagnosed diabetes and cardiovascula...Kelli Buckreus
The document summarizes screening results from the Mobile Diabetes Screening Initiative (MDSi) that screened 624 Métis participants in Alberta, Canada between 2003-2005. Key findings include:
1) High rates of pre-diabetes (50% of adults, 13% of children), undiagnosed diabetes (4% of adults, 5% of children), overweight/obesity (32%/50% of adults, 10%/50% of children), and metabolic syndrome (50% of both adults and children) were found.
2) Risk factors for diabetes and cardiovascular disease were very high, consistent with screening in other First Nation communities.
3) Continued screening
Cardiovascular and diabetes risk profiles of children and adolescents attendi...Kelli Buckreus
This study examined cardiovascular and diabetes risk profiles in First Nations, Métis, and non-Aboriginal children and adolescents in rural Alberta. Mobile clinics screened 456 youth aged 6-17, measuring BMI, waist circumference, blood pressure, lipids, glucose, and hemoglobin A1c. Results showed higher rates of obesity, high waist circumference, hypercholesterolemia, low HDL, and high cholesterol-HDL ratio in First Nations and Métis youth compared to non-Aboriginal youth. No differences were found between First Nations and Métis youth. The study provides novel community-based data on differences in risk factors between Aboriginal and non-Aboriginal youth.
Alberta Diabetes Surveillance System (ADSS) - Diabetes Atlas: Diabetes in Fir...Kelli Buckreus
The document summarizes findings from a study comparing rates of diabetes among First Nations and non-First Nations populations in Alberta from 1995 to 2005. The key findings are:
1) The incidence and prevalence of diabetes was more than twice as high among First Nations people compared to non-First Nations, for both males and females.
2) The increased rates of diabetes have remained constant over the 10-year study period for First Nations relative to non-First Nations.
3) Among First Nations, prevalence and incidence of diabetes were higher among females than males and increased with older age groups.
Rationale and design of the Mobile Diabetes Screening Initiative (MDSI) for A...Kelli Buckreus
The Mobile Diabetes Screening Initiative (MDSi) provides diabetes screening and education services to remote and off-reserve Aboriginal communities in Northern Alberta. MDSi screens for diabetes, cardiovascular risk factors, and diabetes complications using portable equipment. They have screened over 1700 people total, finding high rates of pre-diabetes, diabetes, obesity, high cholesterol, and elevated blood pressure. The screening helps reduce barriers to healthcare access for these communities and provides diabetes education.
Outsmarting Diabetes: Presentation to the Metis Settlements, March 2012Kelli Buckreus
This document summarizes a presentation by Dr. Ellen Toth on outsmarting diabetes. It discusses the Mobile Diabetes Screening Initiative which screens for diabetes and complications in remote Alberta communities. The presentation covers trends seen in screening results including a small rise in BMI and weight in adults without diabetes. It also notes a significant improvement in HbA1c and cholesterol levels in adults with diabetes. The document raises questions about determinants of health and stopping the diabetes epidemic in Aboriginal communities.
This document summarizes a conference on diabetes management and complications. It discusses the initial shock of a diabetes diagnosis and stages of acceptance. Proper management requires controlling blood sugar, lifestyle balance, and potential medication. Complications can impact organs like the heart, blood vessels, nerves, eyes and kidneys if blood sugar is not well controlled. The document provides tips on monitoring ABCs (A1C, Blood Pressure, Cholesterol), diet, activity, and medical team support to help prevent complications.
Fitness improvements amongst children in one Alberta First Nation after eight...Kelli Buckreus
2012 (Feb 8-10) Integrated Chronic Disease Prevention: It Works! CDPAC Fourth Pan-Canadian Conference, presentation by BRAID Research and Driftpile First Nation
Diabetes Complicating Pregnancies: Presentation to Maskwacis Health Services,...Kelli Buckreus
Dr. Ellen Toth gave a presentation on diabetes and pregnancy to a group in Maskwacis. She discussed how diabetes, both pre-existing and gestational, can complicate pregnancies by increasing risks for complications like miscarriages, large babies, and birth defects. Babies exposed to high glucose levels in the womb may develop lifelong health consequences like obesity and diabetes themselves. Screening before and during pregnancy is important to detect diabetes early and manage it properly to avoid poor outcomes for both mother and baby.
• Undiagnosed diabetes, pre-diabetes and cardiovascular risk in Alberta Métis...Kelli Buckreus
The Mobile Diabetes Screening Initiative screened over 800 Métis clients in Alberta settlements to assess undiagnosed diabetes and cardiovascular risk. They found that 5% of adult clients had undiagnosed diabetes, 51% had pre-diabetes, and high rates of overweight/obesity and family history of diabetes. No children screened had diabetes but 21% had pre-diabetes. High rates of metabolic syndrome were also found among both adults and children screened. These results suggest Métis people in Alberta have similar high rates of diabetes and related conditions as other First Nations groups in Canada.
Results of a survey to assess patient memory of diagnosis and compliance with...Kelli Buckreus
1) The document reports on a survey assessing patients' memory of their diabetes diagnosis from a mobile screening initiative (MDSi) and compliance with physician follow-up recommendations.
2) The survey found that 42% of patients correctly remembered their MDSi diagnosis, while 21% incorrectly but still seriously remembered a diagnosis like "impaired."
3) 76% of patients saw their family physician after screening, and the MDSi diagnosis was confirmed for 77% of these patients. The high follow-up and confirmation rates support the efficacy of MDSi's community-based screening methodology.
Screening for diabetes in Indigenous communities in Alberta, Canada: reframin...Kelli Buckreus
This document discusses screening for diabetes in Indigenous communities in Alberta, Canada. It provides background information on the high prevalence of diabetes and risk factors in Indigenous populations. It also reviews different community-based screening programs that have been implemented in Indigenous communities in Canada and their findings. The document discusses debates around population-based screening and considerations for conducting research and screening in Indigenous communities. It profiles some initiatives in Alberta to conduct mobile diabetes screening and monitoring of complications in Indigenous communities.
Stillbirth epidemiology, diabetes, and other risk factors among all pregnanci...Kelli Buckreus
This study analyzed pregnancy data from 2000-2009 in Alberta to examine stillbirth rates and risk factors among First Nations and non-First Nations women. The key findings were:
1) Stillbirth rates were significantly higher among First Nations women compared to non-First Nations women, with age-adjusted antepartum and intrapartum stillbirth rates 2.86 and 1.80 times higher respectively.
2) Stillbirth rates remained stable over the study period for both groups.
3) Risk factors for stillbirth identified for both groups included advanced maternal age, history of abortion/stillbirth, pregestational diabetes, and preexisting hypertension. First Nations ethnicity was also an independent risk factor.
The Next Generation of Diabetes: Children at Risk in Driftpile First Nation, ...Kelli Buckreus
The BRAID-Kids project began in 2009 in response to screening data from an earlier BRAID study that showed high rates of obesity, overweight, and pre-diabetes among children in Driftpile First Nation, Alberta. BRAID-Kids is researching whether working with families to address the effects of colonization can improve the ability to live healthy lifestyles. Clinical measurements and fitness tests of children ages 5-15 are conducted every six months. BRAID-Kids aims to improve diet and physical activity through school curriculum and a tradition-based "Cree Pride" family program. Initial results after six months showed no improvements, and challenges implementing the family program and getting teacher support for curriculum.
World Kidney Day was established to raise awareness of chronic kidney disease (CKD) and encourage detection and prevention programs. CKD affects over 20 million Americans and is a major cause of death worldwide. While kidney failure requiring dialysis has increased, CKD is often preventable or treatable through control of diabetes, hypertension, and obesity. World Kidney Day aims to educate the public and healthcare professionals about CKD risks and signs through collaborative events around the world each March.
This document discusses epidemiology and risk factors for aging and dementia in individuals with Down syndrome. It notes that those with Down syndrome experience accelerated aging processes and highlights factors associated with this, such as shorter telomere length and earlier menopause. It also discusses how having an extra copy of chromosome 21, and therefore an extra copy of the APP gene, increases risk of Alzheimer's disease in Down syndrome due to overproduction of amyloid beta. The cumulative incidence of dementia in Down syndrome is shown to be highly age-dependent, with risk increasing substantially after age 50. Certain genetic and medical factors can further influence this risk.
Powerpoint presentation of a talk I gave in World Congress of Nephrology 2009 in Milan about subdistribution hazard regression models as a method of analyzing ESRD clinical trials in the setting of informative censoring (due to transplantation or drop-out).
Partnerships to address the diabetes epidemic in Aboriginal Communities in Al...Kelli Buckreus
This document summarizes an Aboriginal diabetes program in Alberta, Canada. It describes the high rates of diabetes among Aboriginal populations and the cultural and socioeconomic barriers to care. The program was developed in partnership with Elders and takes a holistic, culturally-relevant approach. It provides on-site and outreach services, education, and promotes healthy living. Research shows the program is helping improve health outcomes and further partnership is needed to fully address the diabetes epidemic in Aboriginal communities.
Screening Métis clients in Alberta for undiagnosed diabetes and cardiovascula...Kelli Buckreus
The document summarizes screening results from the Mobile Diabetes Screening Initiative (MDSi) that screened 624 Métis participants in Alberta, Canada between 2003-2005. Key findings include:
1) High rates of pre-diabetes (50% of adults, 13% of children), undiagnosed diabetes (4% of adults, 5% of children), overweight/obesity (32%/50% of adults, 10%/50% of children), and metabolic syndrome (50% of both adults and children) were found.
2) Risk factors for diabetes and cardiovascular disease were very high, consistent with screening in other First Nation communities.
3) Continued screening
Cardiovascular and diabetes risk profiles of children and adolescents attendi...Kelli Buckreus
This study examined cardiovascular and diabetes risk profiles in First Nations, Métis, and non-Aboriginal children and adolescents in rural Alberta. Mobile clinics screened 456 youth aged 6-17, measuring BMI, waist circumference, blood pressure, lipids, glucose, and hemoglobin A1c. Results showed higher rates of obesity, high waist circumference, hypercholesterolemia, low HDL, and high cholesterol-HDL ratio in First Nations and Métis youth compared to non-Aboriginal youth. No differences were found between First Nations and Métis youth. The study provides novel community-based data on differences in risk factors between Aboriginal and non-Aboriginal youth.
Alberta Diabetes Surveillance System (ADSS) - Diabetes Atlas: Diabetes in Fir...Kelli Buckreus
The document summarizes findings from a study comparing rates of diabetes among First Nations and non-First Nations populations in Alberta from 1995 to 2005. The key findings are:
1) The incidence and prevalence of diabetes was more than twice as high among First Nations people compared to non-First Nations, for both males and females.
2) The increased rates of diabetes have remained constant over the 10-year study period for First Nations relative to non-First Nations.
3) Among First Nations, prevalence and incidence of diabetes were higher among females than males and increased with older age groups.
Rationale and design of the Mobile Diabetes Screening Initiative (MDSI) for A...Kelli Buckreus
The Mobile Diabetes Screening Initiative (MDSi) provides diabetes screening and education services to remote and off-reserve Aboriginal communities in Northern Alberta. MDSi screens for diabetes, cardiovascular risk factors, and diabetes complications using portable equipment. They have screened over 1700 people total, finding high rates of pre-diabetes, diabetes, obesity, high cholesterol, and elevated blood pressure. The screening helps reduce barriers to healthcare access for these communities and provides diabetes education.
Outsmarting Diabetes: Presentation to the Metis Settlements, March 2012Kelli Buckreus
This document summarizes a presentation by Dr. Ellen Toth on outsmarting diabetes. It discusses the Mobile Diabetes Screening Initiative which screens for diabetes and complications in remote Alberta communities. The presentation covers trends seen in screening results including a small rise in BMI and weight in adults without diabetes. It also notes a significant improvement in HbA1c and cholesterol levels in adults with diabetes. The document raises questions about determinants of health and stopping the diabetes epidemic in Aboriginal communities.
This document summarizes a conference on diabetes management and complications. It discusses the initial shock of a diabetes diagnosis and stages of acceptance. Proper management requires controlling blood sugar, lifestyle balance, and potential medication. Complications can impact organs like the heart, blood vessels, nerves, eyes and kidneys if blood sugar is not well controlled. The document provides tips on monitoring ABCs (A1C, Blood Pressure, Cholesterol), diet, activity, and medical team support to help prevent complications.
Fitness improvements amongst children in one Alberta First Nation after eight...Kelli Buckreus
2012 (Feb 8-10) Integrated Chronic Disease Prevention: It Works! CDPAC Fourth Pan-Canadian Conference, presentation by BRAID Research and Driftpile First Nation
Diabetes Complicating Pregnancies: Presentation to Maskwacis Health Services,...Kelli Buckreus
Dr. Ellen Toth gave a presentation on diabetes and pregnancy to a group in Maskwacis. She discussed how diabetes, both pre-existing and gestational, can complicate pregnancies by increasing risks for complications like miscarriages, large babies, and birth defects. Babies exposed to high glucose levels in the womb may develop lifelong health consequences like obesity and diabetes themselves. Screening before and during pregnancy is important to detect diabetes early and manage it properly to avoid poor outcomes for both mother and baby.
• Undiagnosed diabetes, pre-diabetes and cardiovascular risk in Alberta Métis...Kelli Buckreus
The Mobile Diabetes Screening Initiative screened over 800 Métis clients in Alberta settlements to assess undiagnosed diabetes and cardiovascular risk. They found that 5% of adult clients had undiagnosed diabetes, 51% had pre-diabetes, and high rates of overweight/obesity and family history of diabetes. No children screened had diabetes but 21% had pre-diabetes. High rates of metabolic syndrome were also found among both adults and children screened. These results suggest Métis people in Alberta have similar high rates of diabetes and related conditions as other First Nations groups in Canada.
Results of a survey to assess patient memory of diagnosis and compliance with...Kelli Buckreus
1) The document reports on a survey assessing patients' memory of their diabetes diagnosis from a mobile screening initiative (MDSi) and compliance with physician follow-up recommendations.
2) The survey found that 42% of patients correctly remembered their MDSi diagnosis, while 21% incorrectly but still seriously remembered a diagnosis like "impaired."
3) 76% of patients saw their family physician after screening, and the MDSi diagnosis was confirmed for 77% of these patients. The high follow-up and confirmation rates support the efficacy of MDSi's community-based screening methodology.
Screening for diabetes in Indigenous communities in Alberta, Canada: reframin...Kelli Buckreus
This document discusses screening for diabetes in Indigenous communities in Alberta, Canada. It provides background information on the high prevalence of diabetes and risk factors in Indigenous populations. It also reviews different community-based screening programs that have been implemented in Indigenous communities in Canada and their findings. The document discusses debates around population-based screening and considerations for conducting research and screening in Indigenous communities. It profiles some initiatives in Alberta to conduct mobile diabetes screening and monitoring of complications in Indigenous communities.
Stillbirth epidemiology, diabetes, and other risk factors among all pregnanci...Kelli Buckreus
This study analyzed pregnancy data from 2000-2009 in Alberta to examine stillbirth rates and risk factors among First Nations and non-First Nations women. The key findings were:
1) Stillbirth rates were significantly higher among First Nations women compared to non-First Nations women, with age-adjusted antepartum and intrapartum stillbirth rates 2.86 and 1.80 times higher respectively.
2) Stillbirth rates remained stable over the study period for both groups.
3) Risk factors for stillbirth identified for both groups included advanced maternal age, history of abortion/stillbirth, pregestational diabetes, and preexisting hypertension. First Nations ethnicity was also an independent risk factor.
The Next Generation of Diabetes: Children at Risk in Driftpile First Nation, ...Kelli Buckreus
The BRAID-Kids project began in 2009 in response to screening data from an earlier BRAID study that showed high rates of obesity, overweight, and pre-diabetes among children in Driftpile First Nation, Alberta. BRAID-Kids is researching whether working with families to address the effects of colonization can improve the ability to live healthy lifestyles. Clinical measurements and fitness tests of children ages 5-15 are conducted every six months. BRAID-Kids aims to improve diet and physical activity through school curriculum and a tradition-based "Cree Pride" family program. Initial results after six months showed no improvements, and challenges implementing the family program and getting teacher support for curriculum.
World Kidney Day was established to raise awareness of chronic kidney disease (CKD) and encourage detection and prevention programs. CKD affects over 20 million Americans and is a major cause of death worldwide. While kidney failure requiring dialysis has increased, CKD is often preventable or treatable through control of diabetes, hypertension, and obesity. World Kidney Day aims to educate the public and healthcare professionals about CKD risks and signs through collaborative events around the world each March.
This document discusses epidemiology and risk factors for aging and dementia in individuals with Down syndrome. It notes that those with Down syndrome experience accelerated aging processes and highlights factors associated with this, such as shorter telomere length and earlier menopause. It also discusses how having an extra copy of chromosome 21, and therefore an extra copy of the APP gene, increases risk of Alzheimer's disease in Down syndrome due to overproduction of amyloid beta. The cumulative incidence of dementia in Down syndrome is shown to be highly age-dependent, with risk increasing substantially after age 50. Certain genetic and medical factors can further influence this risk.
Powerpoint presentation of a talk I gave in World Congress of Nephrology 2009 in Milan about subdistribution hazard regression models as a method of analyzing ESRD clinical trials in the setting of informative censoring (due to transplantation or drop-out).
01 merlin wilcox_research as a route in to global health_personal reflectionsjintc
Presentation given by Dr Merlin Wilcon on Friday 13th April 2012 to the 4th RCGP Junior International Committee Annual General Meeting in Croydon, London
Prevalence of metabolic syndrome amongst Canadian Aboriginals attending a scr...Kelli Buckreus
The prevalence of metabolic syndrome among Canadian Aboriginals attending a screening program was found to be 31% in both men and women. Increased waist circumference contributed to the diagnosis in 96% of cases. A family history of diabetes was common, with 43% reporting a parent with diabetes, 27% a sibling, and 26% of women reporting a history of gestational diabetes. Screening of a larger, population-based Aboriginal sample is underway.
Myocardial infarction and sudden cardiac death in olmsted 10 19_11Global Bridges
This study examined the effects of two smoke-free workplace laws passed in Olmsted County, Minnesota on the rates of myocardial infarction (MI) and sudden cardiac death (SCD). The authors found that after the first law banning smoking in restaurants was implemented in 2002, the rates of SCD decreased by 28% but the rates of MI did not change significantly. After the second law banning smoking in all workplaces was implemented in 2007, the rates of both MI and SCD decreased, with MI rates declining by 21% and SCD rates remaining unchanged. Comparing rates before any law to after the second law, MI rates decreased by 46% and SCD rates decreased by 50%, indicating the population impact of comprehensive smoke-
The document discusses the importance of health to business and the economy. It notes that a nation's health indicators provide a key measure of its wealth, and changes in the health and disease patterns of citizens will be reflected in the economy. The document then highlights Nigeria's poor health indices and infrastructure compared to global standards, and identifies factors contributing to poor health outcomes, such as poverty, corruption, and underfunding of the health sector. It argues that improving health is crucial for reducing poverty and driving economic growth.
This document summarizes a randomized controlled trial called ADVANCE that studied the effects of intensive blood pressure lowering and glucose control on vascular outcomes in patients with type 2 diabetes. Over 11,000 patients aged 55 and older from 21 countries with elevated vascular risk were enrolled and randomized to different treatment groups. The primary outcomes were macrovascular and microvascular events. Substudies also examined effects on heart function and eye disease.
The document discusses the importance of health to business and the economy. It notes that a nation's health indicators reflect the state of its wealth and economy. Poor health leads to a less productive workforce and economic drain. The document then provides an overview of Nigeria's poor health indices and underfunding of the health sector compared to global standards. It also discusses the social determinants of health issues in Nigeria like poverty, cultural beliefs, and brain drain of health professionals.
The document discusses hypertension in Malaysia, including:
1) The prevalence of hypertension in Malaysia is 25.7% overall, affecting 1 in 4 adults aged 25-64, with known hypertensives numbering 1.4 million and newly diagnosed at 1.7 million.
2) Control rates remain low with only 8% of hypertensives in Malaysia achieving blood pressure control, compared to over 30% in the United States.
3) Recommendations are made to improve management of hypertension through risk stratification, emphasis on first-line therapies such as ACE inhibitors, ARBs, diuretics and calcium channel blockers, and addressing concomitant conditions through appropriate drug selections.
The Motherisk Program in Canada provides drug and alcohol counseling to the public and performs research studies. It is led by Dr. Gideon Koren and has a clinic, call center, and laboratory. The program studies the transfer of drugs from mother to fetus using placental perfusion and analyzes hair samples to detect drug and alcohol use. Studies by the program found no increase in adverse fetal outcomes for babies exposed to domperidone and no association between isotretinoin therapy and congenital defects.
ueda2012 reducing risk of cardiovascular diseases-d.nabilueda2015
1) The document discusses several studies and trials related to the relationship between glucose control and cardiovascular disease risk in diabetics.
2) Subgroup analyses from some trials suggested that more intensive glucose control may benefit some patient subgroups but not others, depending on factors like age, disease duration, and presence of vascular complications.
3) Recent evidence emphasizes the need for personalized treatment targets and management based on individual patient characteristics and risk factors rather than a "one size fits all" approach to glucose control.
This study analyzed data on childhood malnutrition cases from Kilifi District Hospital in Kenya between 1999-2011. It found that the prevalence of severe acute malnutrition, including kwashiorkor, was highest in children under 2 years old and declined with increasing age. Kwashiorkor was more common in females and children living outside the demographic surveillance system area. Factors like mid-upper arm circumference, residence, age, year of admission, and presence of edema were found to significantly predict mortality among malnourished children ages 6-60 months. The study concluded that Kilifi is representative of other developing areas in terms of severe acute malnutrition prevalence and trends over time.
This document discusses the importance of access to safe water for people living with HIV/AIDS, especially in developing countries. It notes that people with HIV have higher risks of opportunistic infections transmitted through contaminated water, including diarrhea. Lack of access to clean water negatively impacts HIV treatment and outcomes. Interventions to provide clean water can reduce diarrhea and improve health for those with HIV. Overall, the document emphasizes that access to safe water is critical for HIV care, treatment, and management of opportunistic infections in developing countries.
Examples from HIV Prevention and Treatment: HIV Prevention among Men Who Have...Paul Pietquin
This document summarizes information presented on HIV prevention among men who have sex with men (MSM). It discusses challenges to prevention including greater biological efficiency of HIV transmission during anal sex compared to vaginal sex. Risk reduction strategies practiced by some MSM can significantly reduce but not eliminate risk. Combination prevention approaches including increasing HIV testing, linkage to care, antiretroviral therapy coverage and adherence may be needed to reach national goals of reducing new HIV infections by 25% among MSM. However, many MSM still face barriers to accessing condoms and lubricants. Criminalization of homosexuality in some regions is also associated with higher HIV prevalence and less funding for MSM-focused prevention programs.
The document summarizes a study that examined whether waist circumference (WC) predicts risk of diabetes and cardiovascular disease (CVD) beyond what is explained by body mass index (BMI) and other metabolic risk factors. The study found that higher WC was associated with greater odds of diabetes even after accounting for BMI and metabolic risk factors. However, WC was not associated with increased odds of CVD after accounting for these other factors. Thus, the study concludes that WC predicts diabetes risk beyond other measures but not CVD risk.
Study I examined associations between promoter methylation of 10 tumor suppressor genes (e.g. RASSF1A, GSTP1) in breast tumor tissue and prognosis in a population-based cohort of breast cancer patients followed for 8 years. Methylation of certain genes like GSTP1 and TWIST1 were associated with increased breast cancer mortality. Patients with more methylated genes had higher mortality, with a 41% increased risk of breast cancer death for each additional methylated gene. Overall, DNA methylation shows potential as a prognostic biomarker for breast cancer outcomes.
This document provides an overview of multiple sclerosis (MS) and experimental autoimmune encephalomyelitis (EAE), an animal model of MS. It discusses the importance of understanding the biology and clinical course of both MS and EAE to effectively model and translate findings from animals to humans. It highlights challenges with failure to translate preclinical findings, including using models and studies that do not accurately reflect human disease. The document emphasizes the need for rigorous experimental design, reporting, and application of the 3Rs to improve modelling of MS and outcomes of drug development efforts.
Similar to Tracking rates of diabetes amongst Status Aboriginal and general population youth in Alberta, Canada (20)
The document summarizes initiatives to address diabetes in Aboriginal communities in Canada. It discusses the continuation of funding for the Aboriginal Diabetes Initiative (ADI) with $110 million over two years. It outlines ADI's focus on initiatives for at-risk groups and community-led prevention programs. The Mobile Diabetes Screening Initiative (MDSI) works with Métis settlements on prevention and is planning a health promoter program and community visits.
This document is a newsletter from the BRAID-Kids project that introduces the project team members and announces upcoming community events related to health, nutrition, and diabetes prevention. It profiles the BRAID-Kids research assistant and coordinator, community research consultant, dietitian consultant, and doctor involved in the project. It also advertises a fitness testing event and walk/luncheon taking place in June and shares two healthy recipes from the project's dietitian.
The newsletter provides information about recent and upcoming events related to diabetes prevention and healthy living in the community. It summarizes a diabetes walk that 118 people participated in with prize winners. It also describes a BRAID-Kids forum to discuss supporting families' health and wellness. Upcoming events are listed such as a family fitness challenge, Four Fires ceremony, handgame tournaments, and a community garden contest. Tips for healthy breakfast options are provided to help with concentration and learning.
Driftpile Diabetes News (newsletter) - Vol 1 No 3Kelli Buckreus
The document is a newsletter from the BRAID diabetes research group and Driftpile First Nation about their diabetes prevention work. It provides the following information:
- BRAID-Kids diabetes prevention lessons will be taught in the Driftpile school starting in October to teach children about healthy lifestyles.
- Results from a youth questionnaire about physical activity and eating habits administered in May/July.
- Upcoming BRAID-Kids testing dates in October include running tests and blood sugar measurements.
- Information about a moose preserving event that involved processing and preparing moose meat traditionally.
- A story about the Hobbema Cadets program visiting poor neighborhoods in Jamaica and seeing cultural pride has helped
The document summarizes the BRAID-Kids project in Driftpile First Nation which aims to prevent obesity and diabetes among children. 16 children participated in the initial running tests to measure fitness levels and provide health assessments. The project will continue testing children in the fall of 2009 and spring of 2010. It also describes the Cree Pride program which addresses spiritual/emotional health using traditional Cree teachings and aims to prevent diabetes risk. A dietitian named Karie Quinn provides nutrition support to the program. Children can still sign up for BRAID-Kids by contacting the local health center.
The document summarizes a study that tested two approaches to preventing diabetes risk in children from Driftpile First Nation: a usual counseling approach and a new approach adding a "Cree Pride" program addressing spiritual and emotional aspects. Screening of 102 children found high rates of obesity and pre-diabetes. The new approach will be tested through the upcoming BRAID-Kids project to see if it can better prevent diabetes risk.
Driftpile Diabetes News (newsletter) - Vol 1 No 4Kelli Buckreus
The BRAID-Kids program has found that children in Driftpile First Nation are generally less healthy than Cree children in James Bay, Quebec based on initial testing. Children in Driftpile had higher rates of overweight, obesity, and central adiposity. They also had unhealthier fitness levels on average based on shuttle run times. Further testing over time found that the health of children in Driftpile did not improve on average. The results suggest kids in Driftpile are at greater risk for diabetes and related health issues compared to the Cree children in James Bay.
Presentation to the ACCFCR Showcase, May 22, 2013Kelli Buckreus
The document describes a study conducted in Driftpile First Nation called BRAID-Kids that aimed to prevent obesity and diabetes in children through improved fitness and nutrition. Baseline results found high rates of overweight, obesity and low fitness levels among participating children. After about 1 year, children who were re-tested showed significant improvements in aerobic fitness levels but no changes in other health measures. The improvements are likely due to a new physical education program and increased focus on fitness rather than BRAID-Kids interventions alone, which faced challenges in implementation.
Screening for diabetes and its complications as part of the Alberta Diabetes ...Kelli Buckreus
2004 (Jan) 3rd National Conference on Diabetes and Aboriginal Peoples, National Aboriginal Diabetes Association (NADA), poster presentation by BRAID Research
Association of birth weight and risk factors for renal disease in a rural Can...Kelli Buckreus
This study examined the relationship between birth weight and risk factors for renal disease in 1160 Canadians from rural and Aboriginal communities. The results showed:
1) Low birth weight (LBW) and high birth weight (HBW) were both associated with hypertension in the overall cohort.
2) LBW, but not HBW, was significantly associated with later life diabetes, particularly in the Aboriginal subgroup.
3) As expected, diabetes, hypertension and metabolic syndrome were interrelated and likely confounded the relationships with birth weight, though each may be independently programmed during fetal development.
The results were consistent with prior research linking LBW and HBW to increased risk of cardiovascular and renal diseases later in life.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
4. Introduction
Background
Methods
Results CANADA’S ABORIGINAL PEOPLES
Summary
First Nations and Canada Alberta
Inuit (‘status’ and
‘non‐status’), as well
First 696 310 97 130
as Métis Nations
3.8% of total
Inuit 50 340 1 600
population
The contemporary
Métis 388 465 85 240
Aboriginal
population is young,
growing and Total 1 135 115 183 970
urbanizing Adapted from Statistics Canada, 2006
5. Introduction
Background
Methods
Results DIABETES IN STATUS ABORIGINALS
Summary
Rapid emergence of type 2 diabetes
Prevalence 2‐5 times higher
Females have higher prevalence, but gap
may be closing
6. Introduction
Background Prevalence and incidence of diabetes among
Methods
people aged 20 years or more in Alberta
Results
Summary
Oster et al, 2011
7. Introduction
Background
Methods
Results DIABETES IN STATUS ABORIGINALS
Summary
Perhaps more alarming are reports of
increasing obesity and emerging type 2
diabetes in Aboriginal youth
Those with early‐onset type 2 diabetes
experience a longer duration of disease and
thus have an increased risk of developing
complications
8. Introduction
Background Age‐specific diabetes incident case counts and
Methods incidence by period in Saskatchewan
Results
Summary
Dyck et al, 2010
10. Introduction
Background
Methods
Results
Summary
Clinical, metabolic, behavioral, and sociodemographic
risk factors for chronic complications among Navajo
youth with type 2 diabetes
Variable Clinical type 2 diabetes
N 66
% with A1c > 9.5 43.3%
% with waist circumference > 90th 82.5%
percentile
% with hypertension 35.5%
% with hypertriglyceridemia 74.1%
% with low HDL 41.1%
% with microalbuminuria 31.5%
Adapted from Dabelea et al, 2009
11. Introduction
Background
Methods
Results IN ALBERTA?
Summary
The epidemiology of diabetes
in Aboriginal youth has not
been explored in Alberta
The Alberta Diabetes
Surveillance System (ADSS)
includes administrative data on
youth
OBJECTIVE: To track and compare
trends in diabetes rates from 1995 to
2007 for Status Aboriginal and general
population youth
13. Introduction
Background
Methods
Results DATA SOURCE
Summary
Data from 1995‐2007 for youth (< 20 years)
was obtained: physician claims, vital
statistics, hospital discharge data
Diabetes cases were identified using the
National Diabetes Surveillance System
algorithm
Does not differentiate between type 1 and type
2 diabetes
The Status Aboriginal identifier captures
First Nations and Inuit peoples both on‐ and
off‐reserve with Treaty status
14. Introduction
Background
Methods
Results DATA ANALYSES
Summary
Crude annual diabetes prevalence and
incidence rates by ethnicity
Odds ratios (OR) were calculated to
compare the likelihood of being a prevalent
case and incident case of diabetes for the
two populations in 2007
Average Annual Percent Changes (AAPC) in
prevalence and incidence from 1995 to 2007
were determined and compared
16. Introduction
Background
Methods
Results CRUDE DIABETES RATES, 2007
Summary
Crude diabetes prevalence and incidence among Status Aboriginal and general
population youth, 2007
Odds ratio
Status Aboriginal General population (95% CI)
Prevalence rate (per
100)
Combined 0.27 0.31 0.90 (0.76, 1.07)
Females 0.31 0.30 1.02 (0.81, 1.29)
Males 0.25 0.31 0.79 (0.61, 1.01)
Incidence rate (per
1000)
Combined 0.59 0.49 1.21 (0.83, 1.75)
Female 0.56 0.49 1.15 (0.67, 1.98)
Males 0.61 0.49 1.26 (0.76, 2.10)
17. Introduction
Background
Methods
Results CRUDE PREVALENCE OVER TIME
Summary
0.35
Status Aboriginal
0.3 General population
0.25
Rate per 100
0.2
0.15
0.1
0.05
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
18. Introduction
Background
Methods
Results CRUDE INCIDENCE OVER TIME
Summary
0.9
0.8 Status Aboriginal
General population
0.7
0.6
Rate per 1000
0.5
0.4
0.3
0.2
0.1
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
19. Introduction
Background
Methods
Results ETHNICITY COMPARISONS OVER TIME
Summary
Ethnicity comparisons of AAPC (Average annual percent change) in diabetes
prevalence and incidence among Status Aboriginal and general population
youth, 1995- 2007
AAPC Status Aboriginal AAPC General population
Prevalence
Combined 6.98*† 3.93*
Female 5.70*†§ 3.70*§
Male 9.18*† 4.15*
Incidence
Combined 8.92* 4.01*
Female 6.18*§ 3.36*§
Male 11.65*† 4.62*
* p < 0.05 for AAPC
† p < 0.05 for AAPC ethnicity comparison
§ p < 0.05 for AAPC sex comparison
21. Introduction
Background
Methods
Results TAKE HOME MESSAGES
Summary
Diabetes prevalence and incidence has
increased among all Alberta youth
Status Aboriginal youth, males in particular,
experienced a disproportionate growth in
diabetes
If unabated, increasing diabetes in youth
will likely only further perpetuate the
diabetes epidemic in the Status Aboriginal
population
22. Introduction
Background
Methods
Results ACKNOWLEDGEMENTS
Summary
Dr. Ellen Toth
Sheri Pohar
ADSS
Dr. Jeff Johnson
Stephanie Balko
Greg Hugel
Alberta Health and Wellness
Larry Svenson
23. Introduction
Background
Methods
Results REFERENCES
Summary
Dean HJ et al. Can J Diabetes. 2003;27(4):449‐54.
Dabelea D et al. Diabetes Care. 2009;32(Suppl
2):S141‐7.
Dyck R et al. CMAJ. 2010;182(3):249‐56.
Oster RT et a l. CMAJ. 2011;183(12):E803‐8.
Statistics Canada. 2006. Available online at:
http://www12.statcan.gc.ca/census‐
recensement/2006/as‐sa/97‐558/index‐eng.cfm