Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

La carte conceptuelle du transport actif urbain

La carte conceptuelle du transport actif en milieu urbain expose l’ensemble des déterminants qui influencent les déplacements actifs. L’environnement bâti, composé de l’aménagement du territoire et des infrastructures de la voirie, constitue un des déterminants majeurs du transport actif en milieu urbain. Cependant, une série de concepts caractérisant les systèmes de transport, les politiques publiques et les individus sont à considérer pour comprendre le phénomène. La carte conceptuelle montre aussi les impacts du transport actif et du transport motorisé sur la santé ainsi que l’effet de levier possible sur les politiques publiques visant l’aménagement du territoire et la mobilité. Le transport actif en milieu urbain constitue une thématique remarquable pour établir des passerelles de pratiques et de recherches entre la géographie, l’aménagement, le transport et la santé.The concept map of active transportation in urban areas illustrates the determinants influencing the choice of walking. This kind of map is an innovative method that uses available scientific knowledge to represent urban active transportation in the urban environment. The built environment (land use and transportation infrastructures) is a major determinant of active urban travel. However, a series of concepts that characterize transport systems, public policy and the choices made by individuals need to be taken into consideration to fully understand the subject. The concept map also shows the impact of active and motorized transport on health which in turn can exert leverage effects on public policies for improving land use and mobility. Active transportation is a remarkable topic that provides opportunities to bridge the divide between research and practical applications in fields such as geography, urban planning, transportation and public health.El plan conceptual del transporte activo en medio urbano expone el conjunto de determinantes que influencian la locomoción activa. El medio ambiente construido, compuesto por el planeamiento del territorio y por las infraestructuras públicas, constituye uno de los mayores determinantes del transporte activo en medio urbano. Sin embargo, es necesario tener en cuenta una serie de conceptos que caracterizan los sistemas de transporte, las políticas públicas y los individuos para comprender ese fenómeno. El plan conceptual muestra también los impactos del transporte activo y del motorizado sobre la salud, así como el posible efecto de palanca sobre las políticas públicas que enfocan el planeamiento territorial y la movilidad. El transporte activo en medio urbano constituye un tema importante para establecer un puente entre la práctica y la investigación en Geografía, planeamiento, transporte y salud

Vieillissement et accessibilité à la rue commerçante : le cas de la Promenade Masson

Si les espaces publics constituent des lieux privilégiés de socialisation, il n’en demeure pas moins que leur accessibilité peut être difficile pour les personnes vieillissantes, notamment lorsque les capacités physiques et cognitives de celles-ci diminuent. Pourtant, la fréquentation de ces espaces peut contribuer au bien-être des individus en favorisant l’activité physique, l’autonomie, le contact social et la participation à la vie de quartier. Le présent article porte sur les enjeux que les personnes âgées perçoivent dans leur utilisation d’un type particulier d’espace public, soit la rue commerçante de quartier. L’article prend appui sur une étude qualitative menée en 2010 auprès de huit personnes âgées entre 65 et 87 ans à Montréal. Sous la forme d’une étude de cas, la démarche comportait deux volets : d’une part, l’analyse spatiale d’une rue commerçante, soit la rue Masson, dans l’arrondissement Rosemont─La Petite-Patrie (Montréal); d’autre part, l’analyse du discours d’un groupe de personnes âgées à l’égard de cette rue. Pour ce deuxième volet, nous avons mené deux activités de cueillette de données, soit un groupe de discussion et une marche exploratoire. L’analyse qualitative des données recueillies permet d’identifier plusieurs difficultés rencontrées par les personnes âgées sur la rue commerçante. L’analyse permet également de saisir l’importance de cet espace au plan de la mobilité quotidienne des personnes âgées, essentielle à leur socialisation et à leur participation à la vie de quartier, ainsi que les caractéristiques qui rendent cette rue attractive aux yeux des participants.If public spaces are places of socialization, the fact remains that accessibility to these spaces can be difficult for the elderly, especially when their physical and cognitive capabilities decrease. Yet, these areas may contribute to the welfare of seniors by promoting physical activity, independence, social contact and participation in community life. This paper focuses on the issues that seniors perceive regarding the use of a particular kind of public space: the local commercial street. The paper builds on a research conducted in 2010 among eight people aged between 65 and 87 years in Montreal. As a case study, the research included two dimensions: firstly, a spatial analysis of a local commercial street (Promenade Masson, Montreal); secondly, an analysis of the discourse of a group of seniors about this street. For this second dimension, we conducted two data collection activities: a focus group and an exploratory walk. The qualitative analysis of data identifies several challenges faced by older people on the local commercial street. The analysis also helps to understand the importance of this place in terms of daily mobility of seniors, essential to their socialization and participation in community life, as well as the characteristics that make the street attractive to participants

Evaluating the impact of implementing public bicycle share programs on cycling: the International Bikeshare Impacts on Cycling and Collisions Study (IBICCS)

Background: Despite rapid expansion of public bicycle share programs (PBSP), there are limited evaluations of the population-level impacts of these programs on cycling, leaving uncertainty as to whether these programs lead to net health gains at a population level or attract those that already cycle and are sufficiently physically active. Our objective was to determine whether the implementation of PBSPs increased population-level cycling in cities across the US and Canada. Methods: We conducted repeat cross-sectional surveys with 23,901 residents in cities with newly implemented PBSPs (Chicago, New York), existing PBSPs (Boston, Montreal, Toronto) and no PBSPs (Detroit, Philadelphia, Vancouver) at three time points (Fall 2012, 2013, 2014). We used a triple difference in differences analysis to assess whether there were increases in cycling over time amongst those living in closer proximity (< 500 m) to bicycle share docking stations in cities with newly implemented and existing PBSPs, relative to those in cities with no PBSPs. Results: Living in closer proximity to bicycle share predicted increases in cycling over time for those living in cities with newly implemented PBSPs at 2-year follow-up. No change was seen over time for those living in closer proximity to bicycle share in cities with existing PBSPs relative to those in cities with no PBSP. Conclusion: These findings indicate that PBSPs are associated with increases in population-level cycling for those who live near to a docking station in the second year of program implementation.Other UBCNon UBCReviewedFacult

Evaluating the impact of environmental interventions across 2 countries: the International Bikeshare Impacts on Cycling and Collisions Study (IBICCS) Study protocol

Abstract Background Few international studies examine public bicycle share programs (PBSP) health impacts. We describe the protocol for the International Bikeshare Impacts on Cycling and Collisions Study (IBICCS). Methods A quasi-experimental non-equivalent groups design was used. Intervention cities (Montreal, Toronto, Boston, New York and Vancouver) were matched to control cities (Chicago, Detroit, and Philadelphia) on total population, population density, cycling rates, and average yearly temperature. The study used three repeated, cross-sectional surveys in intervention and control cities in Fall 2012 (baseline), 2013 (year 1), and 2014 (year 2). A non-probabilistic online panel survey with a sampling frame of individuals residing in and around areas where PBSP are/would be implemented was used. A total of 12,000 respondents will be sampled. In each of the 8 cities 1000 respondents will be sampled with an additional 4000 respondents sampled based on the total population of the city. Survey questions include measures of self-rated health, and self-reported height and weight, knowledge and experience using PBSP, physical activity, bicycle helmet use and history of collisions and injuries while cycling, socio-demographic questions, and home/workplace locations. Respondents could complete questionnaires in English, French, and Spanish. Two weights will be applied to the data: inverse probability of selection and post-stratification on age and sex. A triple difference analysis will be used. This approach includes in the models, time, exposure, and treatment group, and interaction terms between these variables to estimate changes across time, between exposure groups and between cities. Discussion There are scientific and practical challenges in evaluating PBSP. Methodological challenges included: appropriate sample recruitment, exchangeability of treatment and control groups, controlling unmeasured confounding, and specifying exposure. Practical challenges arise in the evaluation of environmental interventions such as a PBSP: one of the companies involved filed for bankruptcy, a Hurricane devastated New York City, and one PBSP was not implemented. Overall, this protocol provides methodological and practical guidance for researchers wanting to study PBSP impacts on health

Evaluating the impact of environmental interventions across 2 countries: the International Bikeshare Impacts on Cycling and Collisions Study (IBICCS) Study protocol

Background: Few international studies examine public bicycle share programs (PBSP) health impacts. We describe the protocol for the International Bikeshare Impacts on Cycling and Collisions Study (IBICCS). Methods: A quasi-experimental non-equivalent groups design was used. Intervention cities (Montreal, Toronto, Boston, New York and Vancouver) were matched to control cities (Chicago, Detroit, and Philadelphia) on total population, population density, cycling rates, and average yearly temperature. The study used three repeated, cross-sectional surveys in intervention and control cities in Fall 2012 (baseline), 2013 (year 1), and 2014 (year 2). A non-probabilistic online panel survey with a sampling frame of individuals residing in and around areas where PBSP are/would be implemented was used. A total of 12,000 respondents will be sampled. In each of the 8 cities 1000 respondents will be sampled with an additional 4000 respondents sampled based on the total population of the city. Survey questions include measures of self-rated health, and self-reported height and weight, knowledge and experience using PBSP, physical activity, bicycle helmet use and history of collisions and injuries while cycling, socio-demographic questions, and home/workplace locations. Respondents could complete questionnaires in English, French, and Spanish. Two weights will be applied to the data: inverse probability of selection and post-stratification on age and sex. A triple difference analysis will be used. This approach includes in the models, time, exposure, and treatment group, and interaction terms between these variables to estimate changes across time, between exposure groups and between cities. Discussion: There are scientific and practical challenges in evaluating PBSP. Methodological challenges included: appropriate sample recruitment, exchangeability of treatment and control groups, controlling unmeasured confounding, and specifying exposure. Practical challenges arise in the evaluation of environmental interventions such as a PBSP: one of the companies involved filed for bankruptcy, a Hurricane devastated New York City, and one PBSP was not implemented. Overall, this protocol provides methodological and practical guidance for researchers wanting to study PBSP impacts on health.Population and Public Health (SPPH), School ofNon UBCMedicine, Faculty ofReviewedFacult

Motivation to participate and attrition factors in a COVID-19 biobank: A qualitative study

Background: The Biobanque québécoise de la COVID-19 (Quebec Biobank for COVID-19, or BQC19) is a provincial initiative that aims to manage the longitudinal collection, storage, and sharing of biological samples and clinical data related to COVID-19. During the study, BQC19 investigators reported a high loss-to-follow-up rate. The current study aimed to explore motivational and attrition factors from the perspective of BQC19 participants and health care and research professionals. Methods: This was an inductive exploratory qualitative study. Using a theoretical sampling approach, a sample of BQC19 participants and professionals were invited to participate via semi-structured interviews. Topics included motivations to participate; participants’ fears, doubts, and barriers to participation; and professionals’ experiences with biobanking during the COVID-19 pandemic. Results: Interviews were conducted with BQC19 participants (n = 23) and professionals (n = 17) from 8 clinical data collection sites. Motivations included the contribution to science and society in crisis, self-worth, and interactions with medical professionals. Reasons for attrition included logistical barriers, negative attitudes about public health measures or genomic studies, fear of clinical settings, and a desire to move on from COVID-19. Motivations and barriers seemed to evolve over time and with COVID-19 trends and surges. Certain situations were associated with attrition, such as when patients experienced indirect verbal consent during hospitalization. Barriers related to human and material resources and containment/prevention measures limited the ability of research teams to recruit and retain participants, especially in the ever-evolving context of crisis. Conclusion: The pandemic setting impacted participation and attrition, either by influencing participants’ motivations and barriers or by affecting research teams’ ability to recruit and retain participants. Longitudinal and/or biobanking studies in a public health crisis setting should consider these factors to limit attrition

Expériences de la stigmatisation en lien avec la santé mentale chez des jeunes de trois communautés au Nouveau-Brunswick

Cette étude vise à comprendre comment les jeunes recourant à des services en santé mentale (SM) perçoivent la stigmatisation en SM et comment cela a été vécu durant leur parcours de soins et de rétablissement. Des groupes de discussion avec 25 jeunes ont été réalisés dans trois communautés (autochtone dans une région isolée, francophone rurale et anglophone urbaine). L’analyse thématique révèle que leurs expériences de la stigmatisation sont marquées par diverses formes de discrédit et par le traitement différentiel déshumanisant qui les conduit à rechercher des alternatives non stigmatisantes et comblant mieux leurs besoins. Ainsi, ces jeunes orientent activement leurs parcours de soins en SM selon la stigmatisation perçue. D’importantes nuances socioculturelles ont également été identifiées quant aux expériences et stratégies des jeunes et éléments favorisant ou atténuant la stigmatisation. Leurs perspectives sont riches d’enseignements pour déstigmatiser les services de SM pour les jeunes de différents groupes culturels.This study aims to understand how youth who receive mental health (MH) services perceive stigma related to mental illness and how this was experienced during their trajectory toward care and recovery. Discussion groups were carried out with 25 youths in three New Brunswick communities (remote Indigenous, rural Francophone and urban Anglophone). Thematic analysis reveals that youth’s experiences of stigma reflect various forms of discrediting as well as differential, dehumanising treatment, which lead them to look for stigma-free alternatives that better meet their needs. This shows that youth actively select their options for MH support depending on the stigma they perceive. Results also show important socio-cultural nuances with regards to youth’s experiences and to the strategies and factors that enable or mitigate stigma. Their accounts hold valuable lessons for destigmatizing mental illness and the access to youth MH services for different cultural groups