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Stopping the Gender Paradox: Male-Specific Interventions for Suicide
No full textIntroduction: The “gender paradox” describes the phenomenon in which men are more likely to die by suicide, despite women being more likely to experience suicidal ideation and attempt suicide. Men experience unique social pressures associated with masculinity which affects their ability to seek and benefit from suicide interventions. Despite this, the Canadian public health strategy does not specifically account for the male experience when developing suicide interventions.
Objective: This literature review sought to determine the efficacy of male-specific interventions on male suicidality and compare the efficacy of these interventions to one another. It also aimed to identify what male-specific interventions are available in Canada and the feasibility of introducing or reinforcing these interventions nationally.
Methods: The literature review used PubMed and Semantic Scholar to find articles relating to male-tailored suicide interventions. A search using three national suicide prevention websites produced a list of male-specific interventions available in Canada.
Results: The literature search produced five articles, three of which discussed informational, internet-based interventions and two of which discussed community-based interventions. There were no studies which compared male-specific interventions to each other. Of the five male-specific interventions available in Canada, three were internet-based and two were community-based.
Conclusion: Male-specific interventions, regardless of modality, appealed to men and increased help-seeking behaviour. These interventions were generally accessible and cost-effective to the user. No conclusions can be drawn regarding which male-specific intervention is most effective in decreasing male suicide
Investigation of functional near-infrared spectroscopy as a monitoring tool for measuring the effect of transcranial alternating current stimulation on dementia patients’ cognitive function
No full textFunctional near-infrared spectroscopy (fNIRS) is used as a non-invasive neuroimaging
technique for studying the neural dynamics within the human brain. This study uses fNIRS to
explore how transcranial alternating current stimulation (tACS) affects cognitive function in
people with dementia including Alzheimer’s disease (AD). By measuring changes in blood
oxygenation levels, fNIRS provides a valuable means to capture plausible post-treatment
alterations in cerebral hemodynamics. Previous studies have shown individuals with dementia
exhibit increased oxygen consumption during verbal fluency tasks. This suggested that they might
require greater effort to compensate for cognitive deficits. Therefore, it is hypothesized that tACS
intervention will potentially alleviate this increased oxygen consumption by enhancing cognitive
function, resulting in reduced oxyhemoglobin level post-treatment amongst those who respond
positively to tACS treatment. To investigate this hypothesis, this research involved a
comprehensive examination of 29 individuals with dementia, who received both real (40 Hz) and
sham tACS treatment in a double-blind cross-over randomized trial. Each tACS intervention was
paired with cognitive exercises (CE) on a daily basis in two 30-minute sessions for four
consecutive weeks (excluding weekends) (tACS+CE). To reduce treatment effects between
intervention, each participant had a 2-5 month wash-out period between treatments. Study
participants were assigned into two groups using their age and cognitive level as the stratification
parameters. One group received real tACS first and sham second (R1S2), and the other group’s
real/sham assignment was the opposite (S1R2). An eight-channel fNIRS device was utilized to
measure blood oxygenation levels in the prefrontal cortex (PFC) before and after each treatment
block, during a mental task (word production and subtraction tasks). The results of this work are
in support of our hypothesis that patients with dementia showed a decrease in oxyhemoglobin level
after real tACS+CE by a mean difference of 0.06µM for word production task, and a significant
decrease of 0.10µM for subtraction task (p=0.04). Notably, real tACS treatment showed a higher
decrease in oxyhemoglobin levels compared to the sham treatment, suggesting that real stimulation
has a more significant impact on hemodynamic responses than only cognitive exercises. Analyzing
changes in blood oxygenation separately for group R1S2 and group S1R2 showed a significant
decrease in oxyhemoglobin levels in group R1S2 during real tACS intervention in the subtraction
task (p=0.03) but not significant for the word production task. This may be attributed to the fact
that dementia participants usually have a ceiling effect in word production task.October 202
Nonlinear association between atherogenic index of plasma and type 2 diabetes mellitus in overweight and obesity patients: evidence from Chinese medical examination data
No full textAbstract
Background
The atherogenic index of plasma (AIP) is closely associated with the onset of diabetes, with obesity being a significant risk factor for type 2 diabetes mellitus (T2DM). However, the association between the AIP and T2DM in overweight and obese populations has been infrequently studied. Therefore, this study aimed to explore this association in overweight and obese individuals with T2DM.
Methods
This cross-sectional analysis utilized data from 40,633 participants with a body mass index (BMI) ≥ 24 kg/m2 who were screened from January 2018 to December 2023 at Henan Provincial People’s Hospital. Participants were categorized into groups of overweight and obese individuals with and without diabetes according to the T2DM criteria. The AIP, our dependent variable, was calculated using the formula log10 [(TG mol/L)/HDL-C (mol/L)]. We investigated the association between the AIP and T2DM in overweight and obese individuals using multivariate logistic regression, subgroup analysis, generalized additive models, smoothed curve fitting, and threshold effect analysis. Additionally, mediation analysis evaluated the role of inflammatory cells in AIP-related T2DM.
Results
Overweight and obese patients with T2DM exhibited higher AIP levels than those without diabetes. After adjusting for confounders, our results indicated a significant association between the AIP and the risk of T2DM in overweight and obese individuals (odds ratio (OR) = 5.17, 95% confidence interval (CI) 4.69–5.69). Notably, participants with a high baseline AIP (Q4 group) had a significantly greater risk of T2DM than those in the Q1 group, with an OR of 3.18 (95% CI 2.94–3.45). Subgroup analysis revealed that the association between the AIP and T2DM decreased with increasing age (interaction P – 0.07 indicating a significant increase in T2DM risk. Various inflammatory cells, including neutrophils, leukocytes, and monocytes, mediated 4.66%, 4.16%, and 1.93% of the associations, respectively.
Conclusion
In overweight and obese individuals, the AIP was independently associated with T2DM, exhibiting a nonlinear association. Additionally, the association between the AIP and T2DM decreased with advancing age. Multiple types of inflammatory cells mediate this association
High circulating MIF levels indicate the association with atypical antipsychotic-induced adverse metabolic effects
No full textAtypical antipsychotics (AAPs) are primary medications for schizophrenia (SZ). However, their use is frequently associated with the development of adverse metabolic effects, and the mechanisms behind these negative effects remain inadequately elucidated. To investigate the role of macrophage migration inhibitory factor (MIF) in regulating antipsychotic-induced metabolic abnormalities, between 2017 and 2020, a cross-sectional study was conducted, involving 142 healthy individuals and 388 SZ patients undergoing treatment with either typical antipsychotic (TAP) or AAP medications. Symptoms of SZ patients were evaluated using the Positive and Negative Syndrome Scale (PANSS), and measurements of metabolic indices and plasma MIF levels were performed on all individuals. A significant increase in plasma MIF levels was observed in groups receiving five major AAP monotherapies in comparison to healthy controls (all p 0.05). Elevated plasma MIF levels displayed a notable correlation with insulin resistance (β = 0.024, p = 0.020), as well as with the levels of triglycerides (β = 0.019, p = 0.001) and total cholesterol (β = 0.012, p = 0.038) in the groups receiving AAPs. However, while the TAP group also displayed certain metabolic dysfunction compared to healthy controls, no significant association was evident with plasma MIF levels (all p > 0.05). In conclusion, plasma MIF levels exhibit a distinctive correlation with metabolic abnormalities triggered by AAPs. Hence, there is potential for further development of MIF as a distinctive marker for monitoring adverse metabolic effects induced by AAPs in clinical settings.N/AOctober 202
Fatigue in children with cancer: a systematic review and meta-analysis and a North American survey of pediatric hematology-oncology professionals
No full textBackground: Children with cancer experience fatigue related to cancer and its treatment. Fatigue can be debilitating and distressing, resulting in poor health-related quality of life. The prevalence of fatigue reported in literature among children with cancer is variable, and it is uncertain which children with cancer are at increased risk of experiencing fatigue during their cancer treatment. Despite being a common symptom, there is a limited understanding of current practices of screening and management of fatigue among pediatric oncology patients.
Hypothesis: We hypothesized that fatigue will be prevalent among children with cancer during cancer treatment, and various patient-, disease- and treatment-related factors will influence the prevalence of fatigue during treatment. We also hypothesized that pediatric hematology oncology healthcare professionals (HCPs) will have limited knowledge about the screening and management of fatigue, along with underutilization of fatigue management guidelines in North America.
Objectives: The aims of my thesis were to (1) determine the prevalence of fatigue among children undergoing cancer treatment; (2) identify the factors associated with fatigue among children undergoing cancer treatment; (3) understand the knowledge of pediatric hematology oncology HCPs about fatigue; (4) explore the perspectives of HCPs on screening and management of fatigue;(5) identify barriers to the screening and management of fatigue, and; (6) understand HCPs perspectives regarding future clinical trials on fatigue in pediatric oncology.
Methods: We conducted a systematic review and meta-analysis of observational studies to determine the prevalence of, and factors associated with, fatigue among children during cancer treatment. Systematic searches of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and SCOPUS were conducted from inception to May 22, 2023, to identify relevant citations. Pooled prevalence estimates were calculated using an inverse variance, random-effects model. We used the Joanna Briggs critical appraisal checklist to assess study quality. To accomplish objectives (3-6), we conducted a web-based American cross-sectional survey of pediatric hematologist oncologists, nurses and nurse practitioners utilizing evidence-based survey methods. We used descriptive statistics to summarize the quantitative data. We used univariable and multivariable logistic regression analyses to assess the HCPs- and treatment center-related factors associated with fatigue knowledge, screening, and management strategies. Framework analysis was used to analyze the open-ended responses to the survey questions.
Results: We included 47 studies in our systematic review; 26 contributed to the prevalence outcome, whereas 29 contributed to the secondary outcome of factors associated with fatigue. Substantial heterogeneity in the patient characteristics, cancer diagnoses, treatment modalities, fatigue assessment tools, study designs and sample size was observed. The pooled prevalence of fatigue among 2699 children undergoing cancer treatment was 73% (95% CI,66%-79%; I2 96%). Considerable heterogeneity was observed in the patient-, disease- and treatment-related factors associated with fatigue in the included studies.
In our survey of 528 pediatric hematology oncology HCPs, 35% of the HCPs attended fatigue educational events in the previous five years. Only 32% of the HCPs reported fatigue screening in their centers during outpatient visits; 91% of fatigue screening was reported to be conducted verbally without utilizing a validated fatigue screening tool. Most HCPs responded that assessing patients for fatigue during cancer treatment is very important. Although 18% of HCPs reported being familiar with fatigue management guidelines, only 1% reported that these guidelines were implemented at their oncology centers. Common themes believed to improve fatigue screening and management included enhancing the education of HCPs and patients, routine fatigue screening throughout the cancer continuum, and developing and implementing fatigue assessment tools, guidelines, interventions and resources for treating fatigue. The barriers to fatigue screening and management included a lack of education, routine screening and fatigue screening tools. Most HCPs (94%) considered clinical trials for fatigue management necessary and favoured clinical trials of non-pharmacological interventions compared to pharmacological interventions.
Conclusions: The prevalence of fatigue among children with cancer during treatment is variable but high. Several factors have been heterogeneously reported to be associated with fatigue. Most North American pediatric hematology-oncology HCPs consider it essential to address fatigue among children with cancer. The utilization of fatigue screening tools and implementation of fatigue management guidelines is low in routine clinical practice. Future studies should address the implementation of fatigue screening tools and fatigue management pathways in clinical practice. Clinical trials are required to determine the efficacy of developmentally appropriate non-pharmacological interventions for fatigue management in this population.February 202
Engaging patient and community stakeholders in the optimization of the Compassionate And Loving Mindset towards heart health risk (CALM Hearts) physical activity intervention: a description of initial work and protocol for future engagement activities
No full textBackground
Participatory research approaches systematically integrate the perspectives of individuals, organizations, or communities that have a direct interest in a study’s processes and outcomes (i.e., stakeholders) in research design and implementation. This supports interventions that are developed “by, not for” end-users, thereby increasing acceptability, uptake, and adherence. However, participatory approaches are relatively under-utilized in intervention development and behavioral change intervention research, in part, due to inadequate reporting of methodology. Therefore, to improve transparency in planning and reporting, we (a) describe how we engaged patients and community organizations (i.e., patient and community partners) in grant development for a self-compassion and physical activity behaviour change intervention for women with cardiovascular risk factors and (b) present a protocol for engaging patient and community partners in the optimization and implementation of the intervention moving forward.
Methods
Our participatory research approach was guided by the Strategy for Patient-Oriented Research patient engagement framework and our prior stakeholder engagement work. Four patients and three community partners were engaged at the level of Involve, meaning their perspectives informed directions, processes, and decisions at major project milestones. Specifically, patient and community partners engaged in three separate meetings during grant development wherein they: (a) established a Terms of Reference to guide engagement activities and expectations; (b) shaped the grant through guided conversations about research priorities, outcomes, and intervention delivery components that could be targeted for optimization and (c) co-developed a protocol that specifies how relationships will be initiated with future patient partners, proposes engagement activities across the research cycle, and includes plans for formal evaluation of engagement processes.
Conclusions
Participatory research approaches provide valuable insights into the development of behavioural interventions, especially when stakeholders can partner early and have a meaningful impact. By detailing our engagement activities to date, we hope to model an approach to engaging stakeholders in behavioral intervention development and demonstrate the impacts of doing so.Plain English summary
Background
Participatory research engages individuals, organizations, or communities affected by a study’s outcomes (“stakeholders”), in its design and conduct. Participatory research approaches are not commonly used in intervention development and behavioral intervention research, in part due to a lack of studies describing ways to engage stakeholders in this work. Therefore, our study aimed to (a) describe how we engaged patients and community organizations (“patient and community partners”) in developing a grant application for a behaviour intervention for women with cardiovascular risk factors and (b) present a protocol for engaging patient and community partners in the future intervention.
Methods
Our approach was guided by the Strategy for Patient-Oriented Research patient engagement framework and our prior engagement work. Four patient and three community partners were engaged at the level of Involve, meaning their perspectives informed directions, processes, and decisions at project milestones. Across three sets of meetings, patient and community partners: (a) established a Terms of Reference to guide engagement activities and expectations; (b) shaped the grant through guided conversations about research priorities, outcomes, and intervention design; and (c) co-developed a protocol that described how relationships will be initiated with future patient partners, potential engagement activities across the research cycle, and evaluation plans.
Conclusions
Participatory research approaches provide valuable insights into the development of behavioural interventions, especially when stakeholders can partner early and have a meaningful impact. By detailing our engagement activities, we hope to model an approach to engaging stakeholders in behavioral intervention development and demonstrate the impacts of doing so
Perspectives on HIV care and support services for African, Caribbean, and Black women living with HIV in Winnipeg, Manitoba
No full textAbstract:
Introduction: African, Caribbean, and Black (ACB) women in Manitoba are overrepresented in HIV infections relative to other racial groups. Yet, there are no community-based or participatory studies that have explored the stories of these women. The goal of this study was to explore how ACB women living with HIV in Winnipeg experience care and support to call attention to their lived realities, including highlighting the historical and cultural oppressions.
Methods: Study participants were ACB women living with HIV (n=10) in Winnipeg, as well as healthcare staff (n=12). The qualitative research design was informed by critical race and feminist theoretical frameworks, incorporating intersectionality and constructivist grounded theory methodology for data generation, organization, and analysis. This study was also community-based and collaborated with several HIV-focused clinics in Winnipeg. The study focused on providing insight and developing a theoretical lens into the experiences of HIV care and support by HIV-positive ACB women through in-depth, semi-structured face-to-face and phone interviews.
Results: Study findings revealed the specific life histories and themes of ACB women in Winnipeg, particularly highlighting trauma that informs and shapes their experiences. ACB women with HIV in Winnipeg and their care staff also expressed a lack of cultural care and support, how ACB women bear multiple loads, face language problems, experience long waiting times, and do not feel welcomed, including dealing with the cost of HIV medication. Findings show that the difficulties ACB women face involve multiple intersecting forms of oppression within social and health services and are at various levels. At the same time, ACB women commit to using HIV care, self-accepting their HIV-positive identity, connecting with religion and spirituality, and creating a stronger sense of themselves in order to live well with their condition.
Implications: This study generates new knowledge and understanding of the experiences of ACB women living with HIV in Winnipeg, Manitoba. Study participants indicated a demand for consideration of the holistic needs of ACB women, which may include their cultural, linguistic, religious, and racial or ethnic characteristics. Stories from these women can inform future public health practices and interventions regarding HIV care and support in Winnipeg and across Canada.October 202
Values and attitudes toward canada geese (branta canadensis) and population management on the university of manitoba fort garry campus
No full textCanada geese populations have increased across North America and have now been declared overabundant in some jurisdictions. Human-geese conflicts may rise, making a case to better understand peoples’ views toward this highly adaptable species. This study’s goal was to gain a better understanding of a university campus community’s values and attitudes as well as acceptance of lethal management techniques toward Canada geese found on the campus. A self-administered online questionnaire, using a modified Tailored Design Method was applied to University of Manitoba students, staff and faculty. Findings showed a significant difference between campus users in both general wildlife and Canada geese value orientations. General wildlife value orientations predicted Canada geese value orientations, while Canada geese value orientations significantly predicted acceptance of lethal population management options. Using the Potential for Conflict Index 2 demonstrated that as the severity of conflict scenarios increased, the level of consensus about lethal management decreased and varied among users. All lethal management options were rejected in favour of public education. This study showed how human dimensions can help management authorities better understand interest groups that may have a relationship with wildlife species. In this case, it also confirmed support for increased public education to minimize human-geese conflicts on campus.October 202
Redesigning car-centric neighbourhood streets to reduce park inequities in Winnipeg, Manitoba
No full textTrees and green space seldom exist in historically low-income neighbourhoods. Yet, neighbourhoods with higher socio-economic levels do not experience the same issue. Winnipeg’s car prioritization demands seas of hard surfaces that facilitate these problematic conditions. Little parkland exists after the City prioritizes expansive right-of-ways that access the land it sold to developers. When park space inequities are acknowledged, expensive land acquisition is the scapegoat for adding more park space. Winnipeg’s failure to prioritize equal access to its outdoor services perpetuates inequities and poverty. However, specific public streets created at the onset of car-centrism have been redundant and idle for years. The practicum will explore where these redundant streets exist within Winnipeg, and by examining low-income neighbourhood trees, parks, and pedestrian spatial experiences, it will propose a parkway network that addresses park space inequities in neighbourhoods of the highest need.May 202
Life history of an endangered prairie butterfly: insights from an ex situ population of Poweshiek skipperling in Manitoba, Canada
No full textSpecies recovery plans benefit from a complete understanding of an organism’s biology. The Poweshiek skipperling, Oarisma poweshiek (Parker) (Lepidoptera: Hesperiidae), is an endangered butterfly native to tallgrass prairies in North America. Following rapid, range-wide population crashes, Poweshiek are now reared ex situ in Manitoba, Canada to augment the remaining wild population. Although this species has been the focus of research since their “Endangered” listing in 2014, there are knowledge gaps regarding Poweshiek skipperling life history. I measured head capsule widths of larvae of two Poweshiek cohorts to determine the overwintering instar. I analysed six years of ex situ data to assess trends in the timing of flight period, degree day accumulations, and protandry. I estimated this species’ lower developmental threshold using dates for developmental milestones. Head capsule measurements showed that Poweshiek typically overwinter in the fourth instar. Peak flight period varied among years by up to three weeks, while degree day accumulations were similar between years. I found evidence that this species is protandrous. An information theoretical approach using Akaike Information Criterion was used to assess lower developmental thresholds. This approach indicated different lower developmental thresholds for larvae and pupae; the AICc scores also demonstrated that larvae enter winter dormancy at different stages of development. These findings will inform conservation decision-making and may allow for greater accuracy in predicting the adult flight period.May 202