148 research outputs found
sj-docx-1-cjk-10.1177_20543581221140633 – Supplemental material for Dietary Patterns and Perceptions in Older Adults With Chronic Kidney Disease in the Canadian Frailty Observation and Interventions Trial (CanFIT)
No full textSupplemental material, sj-docx-1-cjk-10.1177_20543581221140633 for Dietary Patterns and Perceptions in Older Adults With Chronic Kidney Disease in the Canadian Frailty Observation and Interventions Trial (CanFIT) by Derek Sin, Oksana Harasemiw, Sarah Curtis, Yasmin Iman, Jeann Buenafe, Julia DaCosta, Rebecca C. Mollard, Navdeep Tangri, Jennifer L. P. Protudjer and Dylan Mackay in Canadian Journal of Kidney Health and Disease</p
Mothers’ Experiences of Breastfeeding Their Infants with Cow’s Milk Protein Allergies
No full textBackground: Breastfeeding is widely recognized as the optimal form of infant feeding, and provides physiological, emotional, and public health benefits. However, breastfeeding can be significantly disrupted by cow’s milk protein allergy (CMPA), the most common allergy in infancy. CMPA management requires strict maternal elimination diets or specialized formulas, which impose additional medical, emotional, and logistical burdens. While clinical literature on CMPA and research on maternal mental health in breastfeeding each exist independently, little scholarship addresses the intersection thereof. Purpose: The purpose of this study was to explore the lived experiences of mothers who were breastfeeding infants diagnosed with CMPA. This research aimed to identify the challenges, coping strategies, and support needs of mothers, with the goal of informing more effective support systems. Methods: A qualitative interpretive descriptive design, guided by a feminist theoretical framework, was employed. Semi-structured interviews were conducted with ten mothers recruited from a pediatric tertiary care hospital (Children’s Hospital of Eastern Ontario; CHEO). Reflexive thematic analysis (RTA) was used to analyze the data, with an emphasis on reflexivity, transparency, and co-construction of meaning between researcher and participants. Results: Five interconnected themes were identified: (1) Carrying the Weight Alone, wherein mothers experienced disproportionate responsibility for decision-making and advocacy amid fragmented medical support; (2) The Breaking Point, capturing the moments of cumulative strain, vulnerability, and emotional overwhelm; (3) Navigating Emotional Extremes, oscillating between pride, guilt, hope, despair, confidence and doubt; (4) Emerging from the Fog, gaining iii resilience and agency through validation, clearer information, and practical problem-solving; and (5) Reflective Wisdom, retrospectively making sense and desiring to support others. This theme highlighted breakdowns in communication, identity disruption, and the interplay of emotional, cultural, and relational dimensions of breastfeeding with CMPA. Conclusion: Mothers breastfeeding infants with CMPA navigate a complex trajectory marked by uncertainty, emotional burden, and systemic gaps in support. While breastfeeding offered resilience and meaning-making, unmet expectations and inadequate guidance amplified maternal stress. These findings underscore the need for multidisciplinary, inclusive, and compassionate support systems that address both the clinical and psychosocial dimensions of CMPA. By integrating maternal voices into CMPA management, healthcare providers can better sustain breastfeeding, enhance maternal well-being, and improve outcomes for affected families
Asthma and Epinephrine Administration Prior to Emergency Department Presentation for Suspected Anaphylaxis in Pediatric Patients
No full textAnaphylaxis is a potentially life-threatening systemic allergic reaction that involves at least two organs or systems and may result in hypotension. The mainstay of anaphylaxis treatment is epinephrine, and as such, individuals with severe allergies are recommended to carry epinephrine auto-injectors (EAIs). However, there is a substantial underutilization of EAIs for the management of anaphylaxis. One of the challenges that hinders early anaphylaxis diagnosis and management is its similarity to asthma with respect to immunopathology, clinical presentation, response to therapies, and natural history. While asthma and anaphylaxis frequently coexist and mimic each other, the exact influence of the two conditions on each other has yet to be fully explained. In the current study using data from the Cross-Canada Anaphylaxis registry (C-CARE), univariable and multivariable logistic regressions were performed to examine the association between comorbid asthma and both pre-hospital and overall epinephrine treatment. It was identified that the presence of comorbid asthma asthma was not associated with the use of pre-hospital epinephrine in the treatment of anaphylaxis and is associated with a decreased likelihood of receiving epinephrine overall. Given this finding, and the current substantial underutilization of EAIs, it is more important than ever to improve EAI prescribing practices and educate patients with allergies and relevant caregivers on prompt and safe EAI use
Winnipeg-based elementary school teachers’ perspectives on food allergy management and practices: a qualitative investigation
No full textIntroduction
Food allergy affects approximately 7.0% of children worldwide. Children spend most of their
waking hours at school, yet, teachers, who have the majority of contact with children during all
school day, have variable food allergy-related knowledge.
Objective
We aimed to identify how Winnipeg-based elementary school teachers manage food allergic
reactions in their classrooms and schools.
Methods
Winnipeg-based public and private school teachers who taught Kindergarten to Grade 6 were
recruited via social media and word-of-mouth, and were interviewed virtually consent.
Interviews were recorded and transcribed verbatim. The study followed a pragmatic framework.
Data were analysed via thematic analysis. Member checking was done to enhance study rigour.
Results
We interviewed 16 teachers, who taught primarily public school and between Kindergarten Grade 3.
The manuscript presents four identified themes. Theme 1 (“Each classroom is a case-by-case
basis”) describes the minimal standardization and inconsistent policies and education between
and within schools. Theme 2 (Food allergy-related knowledge, experience and supports shape
teachers’ confidence) reflected teachers’ variable confidence/perceived food allergy knowledge.
Theme 3 (Food allergy could be a more prominent conversation for teachers to “debunk the
myths”) captured the lack of standardized food allergy education for teachers. Theme 4
(Communication between all parties is essential) described how teachers’ reliance on school
staff, families and students to effectively communicate.
The published paper presents two identified themes. Theme 1 (COVID-19 restrictions made
mealtimes more manageable) depicted how pandemic-related restrictions, such as enhanced
cleaning, handwashing, and emphasis on no food sharing, were deemed positively influencing
food allergy management. Theme 2 (Food allergy management was indirectly adapted to fit
changing COVID-19 restrictions) captured how food allergy management had to be adapted to
pandemic restrictions. Teachers also had less nursing supports and virtual training.
Conclusions
Teachers’ food allergy management was informed by their knowledge and lived experience,
guided by school policies, and students’ needs. Continuation of pandemic-related restrictions
may enhance food allergy management in the classroom. Teachers unanimously wanted further
food allergy education and training, and resources to improve communication gaps and language
barriers. More training throughout the school year and multimedia resources may be beneficial.Mae Santos receives funding for her MSc studies from a grant held by Dr Protudjer from
Canadian Institutes of Health Research MRC 422574, matched with University of Manitoba
Graduate Enhancement of Tri-Agency Stipends (GETS) Program.February 202
Weight, related lifestyle behaviours and asthma in Manitoba children
No full textBackground and Rationale: Asthma and overweight are public health concerns. Lifestyle, including dietary and activity patterns, is associated with overweight and asthma. Moreover, an association between these two diseases has been described. Yet, few studies have considered these associations longitudinally in youth. Methods: Based on data from the 1995 Manitoba Birth Prospective Cohort (n=723, 404 [55.9%] boys), we designed a series of studies to address the question: “Do obesity and related lifestyle behaviours influence asthma and airway hyperresponsivess (AHR) outcomes in children?” Following protocol for a mixed methods sequential explanatory design study, we first considered this research question using quantitative methods. Exposure variables included weight status (body mass index (BMI); BMI z-scores; normal weight vs. overweight), diet, physical activity and screen time. Outcome variables included asthma and AHR at 8-10 years old and at 12-13 years old. Quantitative findings provided direction for the qualitative investigations. That is, we sought to further explain some of the quantitative findings using qualitative methods. For the qualitative portion of this dissertation, 15-16 year old youth were purposively selected (Winnipeg residency, asthma status, gender) from the 1995 Manitoba Prospective Birth Cohort. Due to recruitment challenges, participation was supplemented with youth from the Canadian Asthma Primary Prevention Study, using the same purposive selection criteria. Quantitative Results: Overweight at 12-13 years old was associated with a two-fold increased odds of persistent asthma in girls. In contrast, boys within the highest BMI quartile at 8-10 years old were nearly twice as likely to have remittent asthma at 12-13 years old. High vegetable intake was protective against allergic asthma and moderate-to-severe AHR by 50% and 42%, respectively. High screen time at 8-10 years old, particularly amongst overweight youth, was associated with an increased odds of asthma, but not AHR at 8-10 years and 12-13 years; there were no associations between physical activity, asthma and AHR. Qualitative Results: Youth spoke of asthma as a condition that neither limits physical activity, nor is an excuse for refraining from physical activity. Conclusions: Modest evidence that some quantitatively-measured weight and related lifestyle behaviours during the pubertal years is associated with asthma. Yet, qualitative data suggest that youth with asthma believe that physical activity is achievable despite their condition, although some describe that asthma interferes with physical activity.February 201
Talking to children about lifestyle, weight and asthma : a substudy of the Gender-Related Evolution of Asthma Team: Interdisciplinary Capacity Enhancement (GREATice)
No full textAssignment or Selection: Evaluation of Two Different Methods Used During Scientific Research Skill Development for First-Semester Medical Students
No full textAbstract Introduction As part of the scientific research skill development for first-semester medical students, we evaluated two different methods employed during a novel activity based on Medical Subject Heading (MeSH) terms. This module (called the Miniproject) was developed with student-centered study in mind, as this method provides the opportunity for students to be responsible for their own learning and allows instructors to design and engage students in learning activities that stimulate deep learning that align with the intended learning outcomes. Methods Learners were assigned a unique triad of MeSH terms (they were allowed to select their own from a pre-determined list starting in 2015). The learners were required to independently read about their terms, construct a hypothesis based on the terms, prepare a short written summary, and deliver a 5-minute presentation on their readings and hypothesis. Immediately following their presentations, they were orally assessed by peers and the instructor. Following each student seminar, learners and instructors provided anonymous feedback on the Miniproject. Results The Miniproject has been run for the past 3 years (six semesters). During this time, we have made ongoing attempts to refine it based on our own experiences as course leaders and as teachers, as well as discussions and evaluations from students and teachers. The majority of learners found the terms to be “just right.” This was true whether students were part of the cohort assigned MeSH terms or the cohort who could select their own MeSH terms. Discussion This resource is constantly evolving. Although we make every effort to ensure that these files are as comprehensive and concise as possible, we actively seek feedback from teachers and students. This feedback is then used to further clarify and improve the resource files and how the Miniproject is delivered
Remission of type 2 diabetes: a mixed-method analysis of lived experience perspectives on barriers and facilitators
No full textType 2 Diabetes (T2D) affects approximately 3.8 million Canadians and is a leading cause of many health complications. T2D remission refers to an HbA1c level 15 kg weight reduction through lifestyle changes and/or bariatric surgery is associated with the greatest likelihood of remission. Although remission rates vary by intervention and individual factors, clinical trials reported estimated remission rates ranging from 30% to 60% of participants. However, few studies explored the lived experiences of those who achieve remission, and the barriers they might experience.
To address this gap, a two-phase explanatory sequential mixed methods study was conducted to explore barriers and facilitators of achieving and sustaining remission through lifestyle interventions. Quantitative data from 21 adult (57±8 years; T2D duration: 4±3 years) with lived experiences of T2D remission were collected to assess clinical outcomes; including health surveys, HbA1c, continuous glucose monitoring (CGM) metrics, and dietary records. From this cohort, a purposive sub-sample of 7 participants took part in a one-on-one semi-structured interviews. An inductive thematic analysis of interview data identified key factors influencing the remission process. Findings were integrated using joint display methodology to explore points of convergence and divergence between clinical indicators and lived experiences.
Analysis revealed that adapting lifestyle behaviors with ongoing self-monitoring and tailoring strategies to individual needs were central to sustaining remission. Quantitative results showed strong glycemic outcomes (mean glucose: 5.0 mmol/L; >92.2% time in range), regular physical activity (Godin Leisure-Time Exercise score ≥ 24), and good perceived health. These aligned with seven overreaching qualitative themes: 1. “flexibility as freedom”, 2. self-reliance, 3. accountability, 4. “one size doesn’t fit all”, 5. “healthcare, not medical care”, 6. barriers inside and out and 7. “I’d rather be healthy”.
Participants reported enhanced physical and mental well-being, crediting self-motivation, accountability, and self-directed education. However, they also reported barriers, including limited healthcare and individualized support, social stigma and mental health challenges, highlighting divergence in mixed findings.
This research contributes to a growing body of evidence supporting lifestyle-based T2D remission and centering lived experience as essential for rethinking and improving T2D care.Research Manitoba Master's Studentship Awards, 2024
University of Manitoba Graduate Fellowship, 2024-25October 202
The Indirect Costs of Avoidance in Food Allergy Management: A Scoping Review
No full textBackground: Food allergy management requires avoidance of allergenic food. While the direct costs of food allergy management have been described, avoidance may also contribute to time and opportunity costs. We aimed to conduct a scoping review of the peer-reviewed literature on the indirect costs of food allergy, and to characterise these costs through a series of fictitious case studies. Methods: We performed a scoping review, guided by Arskey and O’Malley’s methodological framework, and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews. Eligible studies included original, peer-reviewed, English language literature with no lower limits to publication dates, which addressed the indirect costs of food allergy, including time and opportunity costs. A search strategy was developed by content experts with experience performing multi-database scoping reviews. The search was performed on 10 July 2023, managed using Rayyan (Cambridge, USA), and screened for eligibility. Results: Searches yielded 104 articles. After deduplication, 96 articles were screened at the title and abstract level; 12 articles were included following full-text screening. Of these, three studies were performed on adults with food allergy, eight studies were based on data collected from caregivers of children with food allergy, and one study made use of data reflecting adults and caregivers of children with food allergy. Collectively, indirect costs were identified as higher amongst those with vs. without food allergy. The few studies on age and food allergy differences (e.g., type and number of food allergies, history of reaction) are equivocal. Conclusions: The limited body of peer-reviewed literature supports that food allergy commonly carries substantial indirect costs across diverse measurement tools, albeit with age-group differences
Veganism and paediatric food allergy: two increasingly prevalent dietary issues that are challenging when co-occurring
No full textVegan diets - defined as the exclusion of all foods of animal origin from the diet- are becoming popular. In recent years, the prevalence of food allergy has also increased, and disproportionately affects children. When vegan diets and food allergy co-occur, this combination can be challenging and pose risks of nutritional deficiencies, particularly during childhood. In this paper, we aim to summarise the major concerns regarding vegan diets and food allergy, review the literature on this topic, and provide some suggestions for healthcare providers, particularly dietitians and nutritionists, who work with food allergic, vegan patients and their family. When working with this patient population, a regular and complete medical nutrition history, including screening for any possible nutritional deficiencies, is warranted. Likewise, the routine tracking of serum markers (especially iodine, iron, zinc, calcium, Vitamins B12, D, B2, and A, selected n-3 fatty acids and protein, which are more abundant in animal vs. plant foods) and symptoms of co-morbid diseases, including asthma, is important, as comorbid diseases may increase energy and nutrient requirements. For infants and children, anthropometry ought to be tracked longitudinally at regular intervals to identify any deviations from the child's previous growth pattern, and to accommodate any increased requirements for growth and development. Correct diagnoses, education and allergy management must be disseminated to the family in a clear and appropriate manner. Children with allergy may have increased nutritional needs due to comorbidity. This is complicated by coincident food allergy and vegan diet as both impose diet restrictions (limiting sources of important nutrients, need for dietary variety and/or increased consumption due to reduced bioavaliability)
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