Objective: Schizophrenia is a severe and persistent mental illness with profound effects on patients, families, and communities. It causes immense suffering on personal, emotional, and socioeconomic levels. Individuals with schizophrenia have poorer health outcomes and die 10–20 years younger than the general population. Economic costs associated with schizophrenia are substantial and comprise 2.5% of healthcare expenditures worldwide. Despite psychosocioeconomic impacts, individuals with schizophrenia are subject to inequitable care, particularly at end of life. A systematic review was conducted to examine disparities in end-of-life care in schizophrenia and identify factors that can be targeted to enhance end-of-life care in this vulnerable population. Design: A comprehensive search was conducted using the databases Ovid MEDLINE(R), Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus from 2008–2018. Keywords included schizophrenia, palliative, end-of-life, and hospice. Two authors independently reviewed titles and abstracts; disagreements were resolved by consensus. Results: The search identified 123 articles; 33 met criteria: 13 case reports, 12 retrospective studies, 5 literature reviews, and 3 prospective studies. Articles were divided into major themes including healthcare disparities, ethics, and palliative care. Palliative care was the most frequent theme comprising >50% of the articles, and there was considerable thematic overlap with ethics and palliative care. Almost half the articles (45%) were related to schizophrenia and comorbid cancer. Conclusions: Increased awareness of potential healthcare disparities in this population, creative approaches in multidisciplinary care, and provision of adequate palliative services and resources can enhance end-of-life care in schizophrenia.

Objective This report describes findings from a randomized controlled trial of an intervention to increase colorectal cancer (CRC) screening in primary care practices in Appalachian Kentucky. Methods Sixty-six primary care practices were randomized to early or delayed intervention groups. The intervention was provided at practices using academic detailing, a method of education where providers receive information on a specific topic through personal contact. Data were collected in cross-sectional surveys of medical records at baseline and six months post-intervention. Results A total of 3844 medical records were reviewed at baseline and 3751 at the six-month follow-up. At baselines, colonoscopy was recommended more frequently (43.4%) than any other screening modality, followed by fecal occult blood testing (18.0%), flexible sigmoidoscopy (0.4%), and double-contrast barium enema (0.3%). Rates of documented screening results were higher for all practices at the six-month follow-up for colonoscopy (31.8% vs 29.6%) and fecal occult blood testing (12.2% vs 11.2%). For early intervention practices that recommended screening, colonoscopy rates increased by 15.7% at six months compared to an increase of 2.4% in the delayed intervention practices (p=.01). Conclusions Using academic detailing to reach rural primary care providers with a CRC screening intervention was associated with an increase in colonoscopy.

Introduction:Wildfires are life threatening incessant fires in thickly vegetated areas that spread extremely rapidly to human habitat and are difficult to control by human force. The impact of wildfires is enormous on population health and causes tremendous financial burden to individuals and communities.Aim:The aim is to understand the potential disease burden secondary to wildfires both at an individual and population level and reflect upon the immediate and delayed neuropsychiatric manifestations of smoke exposure.Methods:Data on wildfires associated direct and indirect costs on individual health and health care delivery appears to be scant. The effort of this presentation is to present the federal data from 2012 to 2016 on nationwide wildfires, estimated acreage consumed in wildfires, the population exposed, and deaths. Information was extracted from the National Interagency Fire Center, the United States Fire Administration, and the Federal Emergency Management Agency. Through literature review on neuropsychological sequelae of wildfires smoke inhalation and associated trauma, the goal is to reflect upon potential healthcare burden secondary to neuropsychiatric manifestations.Results:Per National Center for Health Statistics, the national fire death rates from 2012 to 2016 ranged 10 to 11 per million population each year, and the property loss both residential and non-residential was estimated at 9 to 10 billion dollars each year. We know healthcare cost is expensive in the United States, and with the stated estimates, one can only envision the health care and public health system burden.Discussion:The characteristic neuropathology of carbon monoxide toxicity is bilateral Globus pallidus necrosis and the common neuropsychological symptoms include fatigue, affective conditions, emotional distress, memory deficits, sleep disturbance, vertigo, dementia, and psychosis. The health effects and associated disability demand policymakers to allocate resources for wildfire prevention/ containment and primary health care providers education, research, and building effective healthcare delivery systems.