30921 research outputs found
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Impact of the medical fitness model on long term health outcomes in older adults
No full textBackground
Physical inactivity is common among older adults and is associated with poor health outcomes. Medical fitness facilities provide a medically focused approach to physical fitness and can improve physical activity in their communities. This study aimed to assess the relationship between membership in the medical fitness model and all-cause mortality, health care utilization, and major adverse cardiac events in older adults.
Methods
A propensity weighted retrospective cohort study linked individuals that attended medical fitness facilities to provincial health administrative databases. Older adults who had at least 1 year of health coverage from their index date between January 1st, 2005 to December 31st 2015 were included. Controls were assigned a pseudo-index date at random based on the frequency distribution of index dates in members. Members were stratified into low frequency attenders ( 1 Weekly Visits). Time to event models estimated the hazard ratios (HRs) for risk of all-cause mortality and major adverse cardiac event. Negative binomial models estimated the risk ratios (RRs) for risk of hospitalizations, outpatient primary care visits and emergency department visits.
Results
Among 3,029 older adult members and 91,734 controls, members had a 45% lower risk of all-cause mortality (HR: 0.55, 95% CI: 0.50 – 0.61), 20% lower risk of hospitalizations (RR: 0.80, 95% CI: 0.75 – 0.84), and a 27% (HR: 0.72, 95% CI: 0.66 – 0.77), lower risk of a major adverse cardiovascular event. A dose–response effect with larger risk reductions was associated with more frequent attendance as regular frequency attenders were 4% more likely to visit a general practitioner for a routine healthcare visit (RR: 1.04, 95% CI: 1.01 – 1.07), but 23% less likely to visit the emergency department (RR: 0.87, 95% CI: 0.82 – 0.92).
Conclusions
Membership at a medical fitness facility was associated with a decreased risk of mortality, health care utilization and cardiovascular events. The medical fitness model may be an alternative approach for public health strategies to promote positive health behaviors in older adult populations
Exploratory analysis of the potential impact of violence on HIV among female sex workers in Mombasa, Kenya: a mathematical modelling study
No full textBackground Understanding the frequency of violence experienced by female sex workers (FSWs) and how violence contributes to HIV transmission can help improve HIV programs. Methods Using recent recommendations for modelling structural factors and associated causal pathways, we developed a HIV transmission dynamic model for FSWs and their clients in Mombasa, Kenya, mechanistically representing three types of violence (sexual violence, SV; physical violence, PV; police assault and arrest, PAA). Each type of violence affects HIV transmission through key mediators (condom non-use, HIV testing). We parameterized the model using data from a cross-sectional study of FSWs aged 15–24 recruited from a systematic geographical mapping sampling frame in Mombasa, Kenya (Cheuk E et al., Frontiers in Reproductive Health 2(7), 2020). Using this model, calibrated (and cross-validated) to HIV epidemiological and violence outcomes, we estimated the incidence of violence episodes, the contribution of violence to the HIV epidemic measured by the transmission population-attributable fraction, and the potential impact of possible violence interventions. Results The median estimated incidence of PAA in 2023 among FSWs who had not previously experienced that type of violence was 0.20 (95% credible interval: 0.17–0.22) per person-year (ppy), about double the incidence of SV and PV (0.10 (0.09–0.11), 0.11 (0.09–0.12), respectively). The incidence of violence was higher among FSWs who had previously experienced violence: the incidence of recurrent PV was 2.65 (1.82–3.37) ppy, while the incidence of recurrent SV and PAA were 1.26 (0.80–1.67) and 1.37 (0.94–1.74 ppy, respectively. In this setting, we estimated that a median of 35.3% (3.4–55.8%) infections in FSWs and clients combined over the next 10 years may be due to all types of violence (and mediators), mainly through reduced condom use in FSWs who have ever experienced SV (34.6% (2.4–55.5%)). Interventions that prevent future violence without mitigating the effects of past violence may only prevent 8.8% (0.8–14.0%) infections over 10 years. Conclusions FSWs in Mombasa experience violence frequently. In this population, we find that addressing sexual violence, including mitigating the effects of past violence, is potentially important in reducing HIV transmission in this population. However, the wide uncertainty range shows longitudinal studies are needed to strengthen the evidence of the influence of violence on HIV risk behavior. We find that the recommendations for modelling structural factors provide a useful framework for describing the model
Redefining the design of car dealerships: creating experiential retail environments that bridge the gap between brick-and-mortar and e-commerce to minimize ecological footprint
No full textThis interior design practicum aims to create a sustainable car dealership showroom that responds to global climate change challenges while increasing functionality and resilience for future use. The automobile industry is the largest contributor to environmental pollution, and the transportation sector is Canada's second-largest source of greenhouse gas emissions. This practicum explores the concepts of the lean dealership approach and omnichannel system in automotive retail. The proposed site is chosen to showcase the opportunity of a smaller-scale footprint, connectivity and its potential to integrate e-commerce into the interior design of traditional brick-and-mortar settings. Additionally, the study highlights the importance of experiential retail space theories in enhancing the buying experience for consumers and visitors.February 202
The effectiveness of sodium-glucose co-transporter 2 inhibitors on cardiorenal outcomes: an updated systematic review and meta-analysis
No full textBackground
The 2022 Canadian Cardiovascular Society (CCS) cardiorenal guideline provided clinical recommendations on sodium-glucose co-transport 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) use. Since then, additional trials of relevance for SGLT2i have been published. This update re-evaluates the clinical recommendations for using SGLTi and their indirect comparison with existing evidence on GLP-1RA as compared to the standard of care to reduce cardiorenal morbidity and mortality.
Methods
We updated our existing search and screening of the literature from September 2021 to April 2023 for randomized controlled trials of SGLT2i and GLP-1RA with placebo control. We conducted risk of bias assessment, data extraction and updated our meta-analysis of studies with similar interventions and components. The certainty of the evidence was determined using GRADE.
Results
Evidence from three new trials and additional results from an updated existing trial on SGLT2i met our inclusion criteria after an updated search. Across all the included studies, the total sample size was 151,023 adults, with 90,943 in SGLT2i trials and 60,080 in GLP-1 RA trials. The mean age ranged from 59.9 to 68.4 years. Compared with standard care, the use of SGLT2i and GLP-1 RA showed significant reductions in the outcomes of cardiovascular (CV) mortality (14% & 13%), any-cause mortality (12% & 12%), major adverse CV events (MACE) (11% & 14%), heart failure (HF) hospitalization (30% & 9%), CV death or HF hospitalization (23% & 11%), and kidney composite outcome (32% & 22%). In participants with T2D, both classes demonstrated significant cardiorenal protection. But, only GLP-1RA showed a reduction in non-fatal stroke (16%) and only SGLT2i showed a reduction in HF hospitalization (30%) in this population of people living with T2D.
Conclusions
This updated and comprehensive meta-analysis substantiates and strengthens the clinical recommendations of the CCS cardiorenal guidelines
A comprehensive metabolomic-assisted investigation of bioactive phenolic and lipophilic compounds in underutilized Canadian wild berries
No full textPrairie berries are cold hardy fruits consumed by Canadians for their perceived health benefits. Phenolic compounds, fatty acids, phytosterols and terpenes are important bioactive molecules in berries. Assessment of the bioactive compounds is essential to identify their potential as a functional food. The objective of this study was to comprehensively examine the contents of phenolic compounds, fatty acids, phytosterols and terpenes content of fourteen different berries grown in prairies. The ultra-high performance liquid chromatography-high resolution mass spectrometry (UHPLC-HRMS) method was developed and used for the comprehensive and simultaneous analysis of 66 phenolic compounds in fourteen different types of Canadian wild berries. Gas chromatography-mass spectrometry (GC-MS) was used to analyze the fatty acids, phytosterols and terpenes in the aforementioned berries. In vitro, lipid peroxidation was tested in all the selected wild berry types. Principal component analysis and analysis of variance were performed to identify the significance of the results. Wild grapes were rich in phenolic compounds such as resveratrol, while gooseberries were rich in isoquercetin and p-coumaric acid. Saskatoon berries were rich in chlorogenic acid. Rutin and chlorogenic acid were the most abundant phenolic compounds in chokecherry. Essential fatty acids such as linoleic and α-linolenic acids were found in wild grapes, buckthorn and Saskatoon berries. Predominant phytosterols and terpenes identified in Canadian wild berries included β-sitosterol, isofucosterol, phytol, and α-amyrin. The novel UHPLC-HRMS method for phenolic compounds and a GC-MS method for lipophilic compounds proved that the underutilized wild berries consist of unique and beneficial phenolic compounds, essential fatty acids, phytosterols and terpenes. As a source of these important bioactive compounds, these berries have the potential to function as antioxidants and antihypertensive agents. The information from this study will help in finding applications for underutilized prairie berries as potential sources of functional food in the neutraceutical and pharmaceutical industries.Natural Sciences and Engineering Research Council [RGPIN 2020-07136]May 202
Unlocking the value of Canadian oats: evaluating oat starch by-product through starch noodle production
No full textThe growing plant protein industry necessitates innovative approaches to valorize starch by-products. Oats are garnering attention for protein extraction, which raises concerns about the sustainability of the industry as the majority of the oat kernel's starch remains underutilized. While oat starch demonstrates desirable properties for various applications, genetic and environmental variations pose challenges to its consistent utilization. Chemically modifying starch offers a potential solution to tailor its properties for specific end uses. The objective of the first study was to screen thirty oat cultivars and identify suitable genotypes for starch extraction. The objective of the second study was to analyze native oat starch and produce modified oat starch using citric acid cross-linking, elucidating physiochemical, pasting, and morphological differences. The objective of the last study was to optimize a method for oat starch noodle preparation and compare the quality characteristics of noodles made with native oat starch (NOS) to those substituted with varying levels of citrate-modified oat starch (COS). Subsequently, the digestibility implications of COS addition would be studied. The first study revealed significant effects of genotype, environment, and their interaction on protein, total starch, and amylose content. Cultivar CDC Morrison was selected for further analysis based on these findings. Study two identified significant differences in NOS and COS, particularly in resistant starch content and pasting properties. Notably, COS exhibited an inability to form a paste, while NOS displayed higher pasting temperature and final viscosity. Chemical modification altered crystalline peaks and morphology, providing insights into their potential application in noodle production. Study three optimized a method for oat starch noodle production and observed that the addition of COS altered cooking time, texture, and colour compared to NOS noodles. NOS noodles exhibited similarities to commercial rice noodles. In vitro digestibility results revealed that substituting 25% of NOS with COS reduced glucose release, indicating beneficial in slowing starch digestibility. The studies collectively offer valuable insights into the valorization of oat starch by-products in the plant protein industry. The successful production of oat starch noodles, including those with modified starch, underscores the potential of oat starch by-products for human consumption.May 202
Connecting farmer well-being with cattle health and perceptions of wildlife on dairy and beef farms in Western Canada and Ontario
No full textThis study surveyed 88 dairy and 17 beef farmers in Western Canada and Ontario to assess farmer well-being, and how it is connected to cattle health and perceptions of wildlife. Well-being was assessed using validated psychometric scales for mental health, sleep and injuries for physical health, and questions about social well-being. The survey additionally assessed farm management, animal health (including mastitis, and calf mortality), and perceptions and management of wildlife. Dairy farm visits (n=66) were conducted to assess lameness, body condition, and knee, neck, and hock lesions on a representative sample of each herd’s lactating cows (30% to a maximum of 69 cows). Dairy farmer responses were analyzed statistically, and beef farmer data are presented using descriptive statistics due to a low response rate. For dairy farmers, clinical lameness tended to be negatively associated with stress scores (P=0.07) and anxiety scores (P=0.06), and mastitis incidence was positively associated with stress scores (P=0.02). Beef farmers reported stress related to weather, pasture condition, and finances, but were generally satisfied with their personal relationships at home. Associations between beef farmers’ well-being and cattle health could not be drawn in this study. Overall, there was a connection between farmer well-being and animal health on dairy farms, but more research is needed to determine the factors that influence these associations. Regarding wildlife perceptions, both dairy and beef farmers viewed mice and rats, raccoons, and corvids negatively. Beef farmers additionally had negative perceptions of small mammals and large predatory mammals. Dairy farmers with negative perceptions of mice tended to have higher depression scores (P=0.0002), as well as lower resilience scores (P=0.07), even when considering region. The majority of dairy and beef farmers reported using wildlife control for mice, raccoons, and corvids and reported choosing these methods based on effectiveness, ease of use, and cost.Dairy Farmers of Ontario, Dairy Farmers of Mantioba, Alberta Milk, Sask Milk, BC Dairy, Mental Health Research Canada, University of Manitoba University Collaborative Research ProgramOctober 202
Correction: Role and promise of health policy and systems research in integrating rehabilitation into the health systems
No full text“But when it's there, like, more mouths [...] that's like ‘Oh, I'm actually kind of low key sad’”: an investigation into the pragmatics of emoticon lengthening
No full textEmoticons are text-based graphicons built from characters and are frequently used in computer-mediated communication. Emoticons serve multiple functions ranging from expressing emotions (Kaye et al., 2016; Vidal et al., 2016; Yus, 2014) to signaling the intended meaning behind a message (Dresner & Herring, 2010; Yus, 2014). While the repetition of characters within emoticons, such as the mouth, is a common practice for achieving various pragmatic effects, there is a notable absence of dedicated analyses exploring these effects. Previous studies (Yus, 2005; Park et al., 2013) have briefly noted that lengthened emoticons indicate heightened intensity and emphasis, but further detailed research is needed.
This thesis investigates the contexts in which lengthened :) smile and :( frown emoticons occur and their functions, compared to their unlengthened counterparts. A corpus of texts was collected from Twitter, consisting of 1,831 emoticon tokens in order to identify the contexts in which unlengthened and lengthened emoticons appear. Additionally, seven focus groups involving 24 participants discussed some of these tokens, and their interpretations were qualitatively analyzed. Corpus analysis revealed that unlengthened smiles are more common in expressions of gratitude, and lengthened smiles in expressions of friendliness and closeness. And while unlengthened frowns are frequently used in questions, lengthened frowns appear more often in expressions of solidarity and support. Results from the focus groups confirmed that intensification is a major use of emoticon lengthening and identified additional functions. First, a lengthened emoticon can signal a higher degree of closeness between the user and the recipient than an unlengthened one. Furthermore, emoticons are known to enhance and modify tone and emotion, and lengthening can further modify these effects. Lengthening can also mitigate certain aspects of a message and influence its overall prosody. These findings illustrate that emoticon lengthening serves functions beyond intensification. Moreover, they suggest that the increasingly visual role of character repetition observed in written words (Brody & Diakopoulos, 2011; Kalman & Gergle, 2014; Lamontagne & McCulloch, 2017; Myslín & Gries, 2010) extends to emoticons as well.February 202
Real-world outcomes of patients with hereditary angioedema with normal C1-inhibitor function and patients with idiopathic angioedema of unknown etiology in Canada
No full textBackground
Hereditary angioedema with normal C1-inhibitor function (HAE nC1-INH) and idiopathic angioedema of unknown etiology (AE-UNK) are rare conditions that cause recurrent subcutaneous and submucosal swelling. The characteristics and clinical outcomes of patients with these conditions in Canada have not been studied.
Methods
The aim of this study was to extract real-world evidence from the electronic health records of patients with HAE nC1-INH or AE-UNK who were managed in selected practices of Canadian HAE-treating specialist physicians between 01-Jan-2012 and 01-Jan-2022, to examine case numbers, treatment, clinical outcomes, and healthcare utilization.
Results
Of 60 patients (37 with HAE nC1-INH, 23 with AE-UNK), median (range) age at symptom onset was 21.5 (5.0–57.0) and 23.0 (10.0–54.0) years, respectively. Time to diagnosis from onset of symptoms was 7.0 (0.0–43.0) and 2.0 (− 10.0 to 50.0) years. Significant differences were observed in terms of the predominant triggers for angioedema attacks between patients with HAE nC1-INH and AE-UNK: stress (65% vs. 26%, p = 0.007) and estrogen therapy (35% vs. 9%, p = 0.031). Before diagnosis, most patients received antihistamines (50% of HAE nC1-INH and 61% of AE-UNK patients). Post-diagnosis, 73% and 74% of HAE nC1-INH and AE-UNK patients received long-term prophylaxis (LTP), with the most common LTP treatments being subcutaneous pdC1-INH (43% of HAE nC1-INH patients and 39% of AE-UNK patients) and tranexamic acid (41% of HAE nC1-INH patients and 35% of AE-UNK patients). Of patients with HAE nC1-INH, and patients with AE-UNK, 22% and 13%, respectively, were taking more than one LTP treatment concurrently. Before HAE treatment initiation, significantly fewer patients with AE-UNK compared to patients with HAE nC1-INH had angioedema attacks affecting their extremities (13% vs. 38%, p = 0.045) and GI system (22% vs. 57%, p = 0.015). In the three months following treatment initiation, patients with AE-UNK experienced significantly fewer angioedema attacks compared to patients with HAE nC1-INH (median 2.0 attacks [0.0–48.0] vs. 6.0 attacks [0.0–60.0], p = 0.044). Additionally, fewer patients with AE-UNK compared to HAE nC1-INH experienced attacks affecting their GI system (26% vs. 57%, p = 0.032). Attack duration and frequency significantly decreased for patients with HAE nC1-INH from a median of 1.00 day (range: 0.00–7.00) to 0.29 day (range: 0.02–4.00; p = 0.001) and from 10.50 attacks (range: 0.00–90.00) to 6.00 attacks (range: 0.00–60.00; p = 0.004) in the three months following HAE treatment initiation.
Conclusions
Using Canadian real-world evidence, these data demonstrate differing clinical trajectories between patients with HAE nC1-INH and AE-UNK, including diagnostic delays, varied attack characteristics, treatment responses and healthcare utilization. Despite treatment response, many patients still experienced frequent angioedema attacks. These results suggest an unmet need for treatment guidelines and therapies specifically for patients with HAE nC1-INH and AE-UNK and better understanding of the pathophysiology accounting for the reported differences between the two