Awareness of the prevalence of osteoporosis and fractures across jurisdictions can guide the development of local preventive programs and healthcare policies. We observed geographical variations in total hip bone mineral density and in the prevalence of major osteoporotic fractures across Canadian provinces, which persisted after adjusting for important covariates. We aimed to describe sex-specific total hip bone mineral density (aBMD) and prevalent major osteoporotic fractures (MOF) variation between Canadian provinces. We used baseline data from 21,227 Canadians (10,716 women, 10,511 men) aged 50–85 years in the Canadian Longitudinal Study on Aging (CLSA; baseline: 2012–2015). Linear and logistic regression models were used to examine associations between province of residence and total hip aBMD and self-reported MOF, stratified by sex. CLSA sampling weights were used to generate the prevalence and regression estimates. The mean (SD) age of participants was 63.9 (9.1) years. The mean body mass index (kg/m2) was lowest in British Columbia (27.4 [5.0]) and highest in Newfoundland and Labrador (28.8 [5.3]). Women and men from British Columbia had the lowest mean total hip aBMD and the lowest prevalence of MOF. Alberta had the highest proportion of participants reporting recent falls (12.0%), and Manitoba (8.4%) the fewest (p-value=0.002). Linear regression analyses demonstrated significant differences in total hip aBMD: women and men from British Columbia and Alberta, and women from Manitoba and Nova Scotia had lower adjusted total hip aBMD than Ontario (p-values<0.02). Adjusted odds ratios (95% confidence intervals, CI) for prevalent MOF were significantly lower in women from British Columbia (0.47 [95% CI: 0.32; 0.69]) and Quebec (0.68 [95% CI: 0.48; 0.97]) and in men from British Columbia (0.40 [95% CI:0.22; 0.71]) compared to Ontario (p-values<0.03). Results were similar when adjusting for physical performance measures and when restricting the analyses to participants who reported White race/ethnicity. Geographical variations in total hip aBMD and in the prevalence of MOF between provinces persisted after adjusting for important covariates which suggests an association with unmeasured individual and environmental factors.
During the summer of 2022, Hockey Canada faced a reckoning regarding its outright denial of the ways in which gender-based violence is a part of hockey culture. This paper shares data from a study that involved qualitative interviews with semi/professional men’s ice hockey players regarding their resistance to the expectations of hypermasculinity in hockey culture. Hypermasculinity is the elevated status of traits that promote violence, stoicism, and aggression and that privileges the locker-room code of silence. Participants spoke about the dangers of playing through pain as well as the precarity of their roles on their teams due to policing strategies that put the team before anything else. The participants were less direct about the ways sexism and misogyny are used as a means to improve team bonding and performance, yet stories of sexism and misogyny were riddled throughout the data. Our analysis brings together Bourdieu’s concept of misrecognition to gain understanding as to why sexism remains/ed silent and Freire’s conscientization to promote more dialogic encounters to clear the air of sexism in men’s ice hockey.
Prions are misfolded proteins that accumulate within the brain in association with a rare group of fatal and infectious neurological disorders in humans and animals. A current challenge to research is a lack of in vitro model systems that are compatible with a wide range of prion strains, reproduce prion toxicity, and are amenable to genetic manipulations. In an attempt to address this need, here we produced stable cell lines that overexpress different versions of PrPC through lentiviral transduction of immortalized human neural progenitor cells (ReN VM). Differentiated cultures made from the neural progenitor cell lines overexpressed PrPC within 3D spheroid-like structures of TUBB3+ neurons and we observed evidence that PrPC modulates formation of these structures, consistent with PrPC's role in neurogenesis. However, through repeated measurements of amyloid seeding activity in 6-week time course experiments, we failed to observe any evidence of prion replication within the differentiated ReN cultures following challenge with four prion isolates (human sCJD subtypes MM1 and VV2, and rodent adapted scrapie strains RML and 263K). We attributed amyloid seeding activity detected within the cultures to residual inoculum and concluded that PrPC overexpression was insufficient to confer permissiveness of ReN cultures to prion infection. While our ReN cell prion infection model was unsuccessful, additional efforts to develop cellular models of human prion disease are highly warranted.
Advanced driver assistance systems (ADAS) are transforming the modern driving experience. Today’s vehicles seem better equipped than ever to augment safety by automating routine driving activities. The assumption appears straightforward: automation will necessarily improve road safety because automation replaces the human driver, thereby reducing human driving errors. But is this truly a straightforward assumption? In our contention, this assumption has potentially dangerous limits. This paper explores how well-understood and well-researched psychological and cognitive phenomena pertaining to human interaction with automation should not be properly labelled as misuse. Framing the problem through an automation bias lens, we argue that such so-called instances of misuse can instead be seen as predictable by-products of specific engineering design choices. We engage empirical data to problematize the assumption that automating driving functions directly leads to increased safety. Our conclusion calls for more transparent testing and safety data on the part of manufacturers, for updated notions of misuse in legal contexts, and for updated driver training regimes.
Measles virus genotype B3 coding-complete genome sequence from a 2019 case showed a novel mutation in the phosphoprotein (P) gene that abrogates the established stop codon. A downstream stop codon has been identified, resulting in a putative P that would be 19 amino acids longer than wild type.
Background and Aims Communicating information about the risks and benefits of benzodiazepines so that it is meaningful to the patient has not been previously described. This study aims to determine patient preferences regarding information received before initiating a benzodiazepine. Methods An online survey was distributed through social media and advertisements to Canadians ≥18 years old over a 6‐month period (May–Oct 2022) to collect participant's rating of importance of statements and factors about the risk and benefits of benzodiazepines before initiating treatment using a 10‐point Likert‐type scale. Treatment preferences based on efficacy and risk information were also elicited. The survey was developed and pilot‐tested in collaboration with an advisory committee of individuals with lived and living experience with benzodiazepine use. Results Thirty‐seven participants responded to the survey (mean age 30 years old, 81.1% identified as female). The majority of respondents had a history of anxiety (83.8%) or insomnia (32.4%), and 10 (27.0%) respondents had used a benzodiazepine. Patient counseling related to withdrawal symptoms of benzodiazepines, risk of harm in combination with other sedating agents, risk of physical and psychological dependence, and risk of effects on cognition were rated high in the importance of receiving this information before starting a benzodiazepine relative to efficacy endpoints, such as improvement in sleep parameters. When provided with information about the chance of efficacy and risk of harm, 100% would have selected cognitive behavioral therapy as the best treatment option. The most frequently reported source of medication information where patients have sought information was from the internet (25.0%), followed by doctors (21.9%) and pharmacists (18.8%). Conclusions This study identified patient important factors and statements viewed as important to communicate before initiating a benzodiazepine. The findings of this survey study will help inform decision‐making when considering treatment options for managing anxiety or insomnia.
This study aimed to assess the physical properties of pea‐based texturised vegetable proteins (TVPs) and TVP function as a meat extender (20‐ 40% w/w) in beef burgers. TVPs were produced with varying protein blend formulas (PBF) (70, 76, 82% protein on a dry basis), extrusion screw speeds (350‐ 450 rpm) and feed moisture contents (FMC) (38 and 42%, db). Increasing PBF raised TVP hydration time and integrity index, while FMC and screw speed had no discernable trend on these properties. A select group of TVPs were applied as extenders in beef burgers which were tested for their cooking properties and textural quality. Higher FMC lowered total cooking loss for some burgers, but overall did not impact burger cooking properties or texture. Increasing extension level reduced total cooking loss and change in burger diameter. TVPs produced at the lowest PBF and higher FMC studied had the greatest potential in meat extender applications, as they decreased total cooking loss and change in burger diameter, while maintaining comparable texture to burgers without TVP addition. These lower protein TVPs with enhanced cooking quality can be economically advantageous for the vegetarian and flexitarian applications of plant‐based extenders.
Background The kidney failure risk equation (KFRE) can be used to predict progression to end-stage kidney disease in a clinical setting. Objective Evaluate implementation of a formalized risk-based approach in nephrologists’ outpatient clinics and multidisciplinary chronic kidney disease (CKD) clinics to determine candidacy for multidisciplinary care, and the impact of CKD care selection on clinical outcomes. Design Population-based descriptive cohort study. Setting Alberta Kidney Care South. Patients Adults attending or considered for a multidisciplinary CKD clinic between April 1, 2017, and March 31, 2019. Measurements Exposure—The course of CKD care assigned by the nephrologist: management at multidisciplinary CKD clinic; management by a nephrologist or primary care physician. Primary Outcome—CKD progression, defined as commencement of kidney replacement therapy (KRT). Secondary Outcomes—Death, emergency department visits, and hospitalizations. Methods We linked operational data from the clinics (available until March 31, 2019) with administrative health and laboratory data (available until March 31, 2020). Comparisons among patient groups, courses of care, and clinical settings with negative binomial regression count models and calculated unadjusted and fully adjusted incidence rate ratios. For the all-cause death outcome, we used Cox survival models to calculate unadjusted and fully adjusted hazard ratios. Results Of the 1748 patients for whom a KFRE was completed, 1347 (77%) remained in or were admitted to a multidisciplinary CKD clinic, 310 (18%) were managed by a nephrologist only, and 91 (5%) were referred back for management by their primary care physician. There was a much higher kidney failure risk among patients who remained at or were admitted to a multidisciplinary CKD clinic (median 2-year risk of 34.7% compared with 3.6% and 0.8% who remained with a nephrologist or primary care physician, respectively). None of the people managed by their primary care physician alone commenced KRT, while only 2 (0.6%) managed by a nephrologist without multidisciplinary CKD care commenced KRT. The rates of emergency department visits, hospitalizations, and death were lower in those assigned to management outside the multidisciplinary CKD clinics when compared with those managed in the multidisciplinary care setting. Limitations The follow-up period may not have been long enough to determine outcomes, and potentially limited generalizability given variability of care in multidisciplinary clinics. Conclusions Our findings indicate that a portion of patients can be directed to less resource-intensive care without a higher risk of adverse events. Trial registration Not applicable.
Background Given the distress associated with cancer experiences, there is a growing interest in mindfulness-based expressive arts interventions (MBAIs) for promoting patients' well-being. Our research objective was to develop a theoretical understanding of how patients with cancer experience, use, and draw meaning from an MBAI. Methods We used a constructivist grounded theory research design and gathered narrative descriptions of participants' (N = 32) MBAI experiences through semistructured interviews and field notes. Participants brought the artwork they had created in the group, facilitating art elicitation. Data were analyzed with grounded theory methods. Results Participants described how the dynamic interplay of mindfulness, the arts, group sharing, and bearing witness facilitated the processing and sharing of hidden thoughts, experiences, and emotions. The group facilitated several unique meaning-making processes, including re-envisioning personal identity within disruption and loss, creating a fitting container for the exploration of diverse emotions, revisiting difficult experiences within the sensitivity of art, and visualizing hope and healing. This process resulted in important learnings and benefits for living in the here and now: relational connections, facing cancer through artistic play, discovering intuition and personal resources, learning an emotional language and a new mindset to move forward, understanding what one needs to heal, and fostering gratitude and hope. Conclusions MBAIs allowed for a multimodal form of meaning making which facilitated coping, adjustment, and living well with cancer. These findings will enable practitioners to design and implement more effective health services and inform future research about this therapeutically promising approach to psychosocial oncology care.
Little is known about disease-modifying drug (DMD) initiation by immigrants with multiple sclerosis (MS) in countries with universal health coverage. We assessed the association between immigration status and DMD use within 5-years after the first MS-related healthcare encounter. Using health administrative data, we identified MS cases in British Columbia (BC), Canada. The index date was the first MS-related healthcare encounter (MS/demyelinating disease-related diagnosis or DMD prescription filled), and ranged from 01/January/1996 to 31/December/2012. Those included were ≥ 18 years old, BC residents for ≥ 1-year pre- and ≥ 5-years post-index date. Persons becoming permanent residents 1985–2012 were defined as immigrants, all others were long-term residents. The association between immigration status and any DMD prescription filled within 5-years post-index date (with the latest study end date being 31/December/2017) was assessed using logistic regression, reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). We identified 8762 MS cases (522 were immigrants). Among immigrants of lower SES, odds of filling any DMD prescription were reduced, whereas they did not differ between immigrants and long-term residents across SES quintiles (aOR 0.96; 95%CI 0.78–1.19). Overall use (odds) of a first DMD within 5 years after the first MS-related encounter was associated with immigration status.
Although genetic (counseling) assistants (GAs) have been implemented in many institutions, their roles vary widely. Therefore, this study aimed to refine our knowledge of GA tasks across work settings and specialties. Tasks performed by GAs were extracted from peer‐reviewed articles, publicly available theses, and job postings, then analyzed using directed content analysis. Briefly, task statements were coded using broad categories from previous studies, with new categories added as emergent. Coded tasks were combined and condensed to produce a final task list, which was reviewed by subject matter experts. Sixty‐one task statements were extracted from previous studies and 335 task statements were extracted from job descriptions. Directed content analysis produced a list of 40 unique tasks under 10 categories (8 from original research and 2 from the data). This study design resulted in a refined list of GA tasks that may be applicable across work settings and specialties, which is an essential step towards defining the scope of GA work. Beyond the human resource applications of the refined task list, this work may also benefit genetics services by reducing role overlap, improving efficiencies, improving employee satisfaction, and informing the development/improvement of training and other educational materials.
Blends of poly(lactic acid) (PLA) and poly(butylene adipate-co-terephthalate) (PBAT) are biodegradable polymers with opposite, yet complementary, physical and thermal properties. However, PLA and PBAT are immiscible and additives must be introduced to overcome their incompatibility and achieve their full potential as blended polymers. In this work, we describe the use of epoxidized canola oil (ECO) as a novel compatibilizer for PLA and PBAT. ECO was produced and characterized using Attenuated Total Reflectance Fourier-Transform Infrared spectroscopy (ATR-FTIR) and proton nuclear magnetic resonance (¹H NMR). ATR-FTIR confirmed the epoxidation reaction, while ¹H NMR was used to quantify the alkene-to-epoxy conversion rate. Polymer blends were prepared using a batch mixer and were characterized using ATR-FTIR, ¹H NMR, scanning electron microscopy, differential scanning calorimetry, and mechanical analyses. The polymer blends containing ECO demonstrated a significant reduction in the PBAT dispersed phase size and thermal transitions of PLA (glass transition, cold crystallization, and melt temperatures), as well as a significant increase in elongation-at-break while maintaining the same tensile strength and Young’s Modulus. Graphical abstract
Objectives In response to COVID-19’s first wave, provincial governments rapidly implemented several public health directives, including isolation measures and care facility visitor restrictions, which profoundly affected healthcare delivery at the end of life and dying experiences and perceptions. The objective of this study was to identify implications of early policy changes for dying at home. Methods Analysis of interviews with 29 key informants with expertise in the policy and practice context of dying at home and care for those dying at home was conducted as part of a larger mixed-methods study on dying at home in Canada. Results Initial pandemic policy responses, especially visitor restrictions and limitations to home care services, shaped dying at home in relation to three themes: (1) increasing preferences and demand for, yet constrained system ability to support dying at home; (2) reinforcing and illuminating systemic reliance on and need for family/friend caregivers and community organizations, while constraining their abilities to help people die at home; and (3) illuminating challenges in developing and implementing policy changes during a pandemic, including equity-related implications. Conclusion This study contributes to broader understanding of the multifaceted impacts of COVID-19 policy responses in various areas within Canadian healthcare systems. Implications for healthcare delivery and policy development include (1) recognizing the role of family/friend caregivers and community organizations in end-of-life care, (2) recognizing health inequities at the end of life, and (3) considering possible changes in future end-of-life preferences and public attitudes about dying at home and responsibility for end-of-life care.
Background The pandemic Era has forced palliative care professionals to use a dignity-in-care approach in different settings from the classic ones of palliative care: acute and intensive care. We explored the meanings of dignity for patients, their family members, and clinicians who have experienced COVID-19 in the acute and intensive care setting. Methods A qualitative, prospective study by means of semi-structured interviews with patients hospitalized for COVID-19, family members, and clinicians who care for them. Findings Between March 2021 and October 2021, we interviewed 16 participants: five physicians, three nurses, and eight patients. None of the patients interviewed consented for family members to participate: they considered it important to protect them from bringing the painful memory back to the period of their hospitalization. Several concepts and themes arose from the interviews: humanity, reciprocity, connectedness, and relationship, as confirmed by the literature. Interestingly, both healthcare professionals and patients expressed the value of informing and being informed about clinical conditions and uncertainties to protect dignity. Conclusions Dignity should be enhanced by all healthcare professionals, not only those in palliative care or end-of-life but also in emergency departments.
Objective Growing evidence suggests that inner-city residents actively navigate their food landscape to meet a wide range of socio-economic needs. Given the increasing focus of health policies on sugar-sweetened beverages (SSB) through price-based strategies, it is critical to understand purchasing habits of populations with higher SSB intake. This study examined urban Indigenous adults’ SSB shopping behaviour and experiences. Methods We conducted a community-based participatory research study using semi-structured interviews with a purposive sample of Indigenous adults (≥ 18 years old) from the North End neighbourhood of Winnipeg. Interviews were audio recorded, transcribed verbatim, and thematically analyzed. Results All 20 participants (women = 10; men = 8; two-spirit = 2) consumed SSB on a regular, daily basis either at the time of the interview or at a prior period in their lives. Themes defining residents’ SSB shopping behaviour and experiences of shopping for SSB included balancing on the redline , specifically (1) balancing SSB purchasing constraints and facilitators with savvy shopping approaches and (2) balancing (stereo)typical reactions with resilient coping approaches . Residents procured SSB in various stores within and beyond the boundaries of the North End neighbourhood. SSB is a considerable, reoccurring expense, requiring savvy price-shopping strategies in order to access. Indigenous adults experience judgement and stereotyping when purchasing SSB, including intersecting racial, class, and weight stigma. Conclusion Purchasing SSB is perceived as a source of judgement when outside of inner-city neighbourhoods. Policymakers should consider how policies directed at SSB, which are consumed by Indigenous and food-insecure populations in greater quantities, may magnify existing racial, class, and weight-based discrimination.
Background Childhood atopic dermatitis can have a negative effect on caregivers’ quality of life and stress levels due to the burdensome nature of its treatment. Given that the condition often emerges in infancy, atopic dermatitis-related stress also carries the potential to negatively affect the developing mother-infant bond. While it is plausible that atopic dermatitis has a negative impact on maternal-infant bonding, these relationships have not been studied directly. In light of this gap, the current study investigated the association between infantile atopic dermatitis and the maternal-infant bond using a mixed-method design. Methods Mothers of infants (< 19 months) with atopic dermatitis were recruited from social media and medical clinics between October 2021 and May 2022. Mothers with infants unaffected by inflammatory skin conditions were also recruited to serve as a control group. Participants were asked to complete questionnaires related to their demographics, child’s health, and mother-infant bond. Multiple linear regression analyses were used to assess bonding quality among cases and controls. A subset of cases were also asked to participate in semi-structured interviews focused on infantile atopic dermatitis and the maternal-infant bond. Results The final sample consisted of 32 cases and 65 controls. Scores on the impaired bonding and risk of abuse subscales did not significantly differ between cases and controls. However, mothers of infants with atopic dermatitis did report lower levels of caregiving anxiety ( b = − 1.47, p < 0.01) and pathological anger/rejection ( b = − 1.74, p = 0.02) relative to controls. Qualitative findings suggest that the topical therapies required to manage atopic dermatitis may strengthen the bond between some mothers and infants. Conclusion Findings suggest that atopic dermatitis does not have a negative impact on maternal-infant bonding and may actually improve bonds in some cases. In light of this finding, clinicians may leverage the potentially positive impact of atopic dermatitis-related caregiving on the maternal-infant bond to encourage caregivers to remain adherent to their child’s topical treatments.
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