Estimating the Economic Cost of Obesity in Canadian Populations

This study aims to provide a more complete description of who suffers most severely from obesity in terms of both the prevalence of the disease and its associated costs. Literature estimating the cost of obesity is often highly aggregated and combines data on all age groups, genders, and ethnicities. I disaggregate across relevant variables to identify the most troublesome obese populations in Canada in terms of economic cost. The second goal of my research is to consider how these specific Canadian populations (age groups, genders, and ethnicities) are expected to grow to gain a more accurate prediction of how the total economic cost of obesity will change in the near future and whether those costs should be deemed an epidemic for our economy

Impacts of the initial 2020 COVID-19 lockdown on volunteers aged 70+ years at New Zealand Red Cross : a thesis presented in partial fulfilment of the requirements for the degree of Master of Emergency Management at Massey University, Wellington, New Zealand

In addition to widespread economic implications, and impacts on physical health globally, epidemics can significantly negatively impact on people’s mental health and sense of wellbeing. The current COVID-19 pandemic is expected to have disproportionately negative impacts on vulnerable communities by compounding pre-existing social and economic. To add to this body of knowledge, the research question for this study is “What were the experiences of New Zealand Red Cross’ Meals on Wheels Volunteers, during aged 70 years and older, the initial 2020 response to COVID-19?”. This question was addressed by conducting an online survey, which ultimately received 81 respondents from around the country. Thematic analysis was undertaken within NVivo, to identify four key themes. The analysis revealed there were several volunteer motivations for choosing to join MoW including wanting to give back to their community, to connect with others, with the level of connection to family and friends being of primary importance in order to feel socially connected. Participants based in Auckland reported being more conscientious about adhering to COVID-19 protocols, and the majority of respondents reported increased use of technology, such as Zoom and FaceTime. Following a disaster NZRC typically help with evacuations, deliver essential supplies such as food and water, and provide emotional and social support to people in their homes and in the community. The findings of the research suggest that additional commitment is needed by NZRC in considering options for social support and recovery assistance for older adults in the wake of a disaster is needed

Continuity of care for carers of people with severe mental illness: Results of a longitudinal study

Background: Continuity of care is considered by patients and clinicians an essential feature of good quality care in long-term disorders, yet there is general agreement that it is a complex concept. Most policies emphasise it and encourage systems to promote it. Despite this there is no accepted definition or measure against which to test policies or interventions designed to improve continuity. We aimed to operationalise a multi-axial model of continuity of care and to use factor analysis to determine its validity for severe mental illness. Methods: A multi-axial model of continuity of care comprising eight facets was operationalised for quantitative data collection from mental health service users using 32 variables. Of these variables, 22 were subsequently entered into a factor analysis as independent components, using data from a clinical population considered to require long-term consistent care. Results: Factor analysis produced seven independent continuity factors accounting for 62.5% of the Total variance. These factors, Experience & Relationship, Regularity, Meeting Needs, Consolidation, Managed Transitions, Care Coordination and Supported Living, were close though not identical to the original theoretical model. Conclusions: We confirmed that continuity of care is multi-factorial. Our even factors are intuitively meaningful and appear to work in mental health. These factors should be used as a starting-point in research into the determinants and outcomes of continuity of care in long-term disorders

Cryogenic carbon cycling at an Icelandic glacier

Glaciers and ice caps are recognised as an important component of the global carbon cycle. Carbon within glacial systems exists in organic and inorganic forms, across supraglacial, englacial and subglacial realms. It is often difficult to detach cryospheric carbon cycling from hydrology, with the transfer of carbon between glacial inventories relying upon meltwater flows. Classical glacial hydrology consists of distributed drainage delivering delayed flow meltwaters, throughout the accumulation season, superseded by quick flow, aerated channelized drainage during increased ablation. It is upon this template that most existing studies have addressed the dynamics of carbon within glaciated catchments. However, Icelandic glacial systems provide an opportunity to investigate the role of subglacial volcanism in driving carbon dynamics. Hydrochemical properties of Sόlheimajökull bulk meltwaters indicate untraditional redox conditions, with discharge of reduced, anoxic meltwaters in Summer, when expansion of subglacial drainage intersects the Katla geothermal zone. This unique hydrological regime generates profound effects upon the solute flux from the glacier, particularly with regard to the carbon budget. Dissolved inorganic carbon dynamics are dominated by weathering of basaltic bedrocks and accessory hydrothermal calcites, fuelled by subglacial geothermal proton supply. Widespread basal anoxia during summer facilitates methanogenesis resulting in large quantities of methane being discharged from beneath the glacier (flux range between 9,179 to 22,551 tonnes per year). Evidence suggests subglacial microbial acetoclastic methanogenesis is responsible with δ13C and δD CH4 values of ~60‰ and -320‰ respectively, supported by laboratory identification of methanogenesis in Sόlheimajökull subglacial sediments. The organic counterpart to the carbon cycle is invoked to serve as the energy source for microbial metabolism. Such direct measurements of subglacial methane have rarely been achieved at contemporary ice margins. This study therefore provides an exciting opportunity to identify methane sources and carbon cycling in areas subjected to subglacial volcanism and to consider these within the broader context of global carbon dynamics

HIV-associated lymphoma—advances in clinical management

The association between human immunodeficiency virus (HIV) and lymphoma was observed early in the HIV epidemic in the 1980s. Lymphoma incidence remains significantly higher than in the general population. Previously people living with HIV (PLWH) had advanced immune suppression, organ dysfunction and consequently poor performance status (PS). The advent of combination antiretroviral therapy (ART) has led to improved immune reconstitution and significantly enhanced the outlook of PLWH, influenced the incidence of lymphoma subtypes and improved tolerability of treatment. However lymphoma still remains the most common cause of cancer related death. We describe the multidisciplinary management of HIV-associated lymphomas and outline recent advances. Challenges include the advanced stage at presentation, propensity for extranodal sites including the central nervous system (CNS), potential drug interactions and increased incidence of opportunistic infections (OIs). Overall management now focusses less on HIV-related factors and more on lymphoma characteristics, with favourable outcomes. Representation in lymphoma clinical trials however is lacking, as a positive serostatus is an exclusion criterion for the majority. Data is scant for the rarer subtypes. A number of small phase I/II trials have successfully recruited patients living with HIV. Immunotherapy trial and safety data will be essential in understanding toxicity and efficacy of this promising targeted treatment. We welcome the recent more permissive inclusion criteria for clinical trials and support the expansion of understudied targeted therapies particularly for rarer subtypes. Broadening access will provide better equity for those living with HIV

Identifying features associated with higher-quality hospital care and shorter length of admission for people with dementia : a mixed-methods study

Background: Concerns have repeatedly been expressed about the quality of inpatient care that people with dementia receive. Policies and practices have been introduced that aim to improve this, but their impact is unclear. Aims: To identify which aspects of the organisation and delivery of acute inpatient services for people with dementia are associated with higher-quality care and shorter length of stay. Design: Mixed-methods study combining a secondary analysis of data from the third National Audit of Dementia (2016/17) and a nested qualitative exploration of the context, mechanism and outcomes of acute care for people with dementia. Setting: Quantitative data from 200 general hospitals in England and Wales and qualitative data from six general hospitals in England that were purposively selected based on their performance in the audit. Participants: Quantitative data from clinical records of 10,106 people with dementia who had an admission to hospital lasting ≥ 72 hours and 4688 carers who took part in a cross-sectional survey of carer experience. Qualitative data from interviews with 56 hospital staff and seven carers of people with dementia. Main outcome measures: Length of stay, quality of assessment and carer-rated experience. Results: People with dementia spent less time in hospital when discharge planning was initiated within 24 hours of admission. This is a challenging task when patients have complex needs, and requires named staff to take responsibility for co-ordinating the discharge and effective systems for escalating concerns when obstacles arise. When trust boards review delayed discharges, they can identify recurring problems and work with local stakeholders to try to resolve them. Carers of people with dementia play an important role in helping to ensure that hospital staff are aware of patient needs. When carers are present on the ward, they can reassure patients and help make sure that they eat and drink well, and adhere to treatment and care plans. Clear communication between staff and family carers can help ensure that they have realistic expectations about what the hospital staff can and cannot provide. Dementia-specific training can promote the delivery of person-centred care when it is made available to a wide range of staff and accompanied by ‘hands-on’ support from senior staff. Limitations: The quantitative component of this research relied on audit data of variable quality. We relied on carers of people with dementia to explore aspects of service quality, rather than directly interviewing people with dementia. Conclusions: If effective support is provided by senior managers, appropriately trained staff can work with carers of people with dementia to help ensure that patients receive timely and person-centred treatment, and that the amount of time they spend in hospital is minimised. Future work: Future research could examine new ways to work with carers to co-produce aspects of inpatient care, and to explore the relationship between ethnicity and quality of care in patients with dementia. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 22. See the NIHR Journals Library website for further project information