Policy Brief No. 5 - The Social and Health Consequences of Family/Friend Caregiving

The retrenchment of health care and other public support services coupled with economic and demographic changes have increased demands on family/friend caregivers. Family/friend caregivers are expected to do more with less. Yet the social and health consequences of providing family/friend care can undermine caregivers’ own wellbeing. A better understanding of these non-economic costs is important to preserving this vital resource. Using Statistics Canada’s 2007 General Social Survey (GSS), we describe the impact caregiving has on the health and social well-being of family/friend caregivers aged 45 and older in Canada

Population Change and Lifecourse Strategic Knowledge Cluster Reports of Thematic Committees

Contains the following reports: Aging and paid work – Ellie Berger Caregiving and social participation – Janet Fast Health over the lifecourse – Amélie Quesnel-Vallée Families – Zheng Wu Immigrants and migrants – Barry Edmonston Aging, lifelong learning and lifecourse flexibility – Paul Bélange

Policy Brief No. 2 - Gender differences in family/friend caregiving in Canada

Family/friend caregivers comprise the backbone of the Canadian health care system. They provide 70-80% of care to individuals with a chronic health problem or disability at an estimated value of $25-26 billion annually. For those who develop policies and programs to support the family/friend care sector, it is critical to understand the characteristics of current family/friend caregivers. Using data from Statistics Canada’s 2007 General Social Survey (GSS) on family, social support, and retirement, we describe the characteristics of family/friend caregivers age 45 and older in Canada

Policy Brief No. 3 - Employment consequences of family/friend caregiving in Canada

There are more than 2.3M employed family/friend caregivers in Canada. Their multiple competing demands come with the risk of such negative employment consequences as missing work days, reducing work hours or foregoing job opportunities. These carerelated employment consequences have economic costs for caregivers, their families and their employers. Using Statistics Canada’s 2007 General Social Survey (GSS), we describe the characteristics of employed family/friend caregivers age 45 and older in Canada and the impact caregiving has on their employment

Understanding mobility and sexual risk behaviour among women in fishing communities of Lake Victoria in East Africa: a qualitative study.

BACKGROUND: HIV-prevalence and incidence is high in many fishing communities around Lake Victoria in East Africa. In these settings, mobility among women is high and may contribute to increased risk of HIV infection and poor access to effective prevention and treatment services. Understanding the nature and patterns of this mobility is important for the design of interventions. We conducted an exploratory study to understand the nature and patterns of women's mobility to inform the design of HIV intervention trials in fishing communities of Lake Victoria. METHODS: This was a cross-sectional formative qualitative study conducted in six purposively selected fishing communities in Kenya, Tanzania and Uganda. Potential participants were screened for eligibility on age (18+ years) and having stayed in the fishing community for more than 6 months. We collected data using introductory and focus group discussions, and in-depth interviews with key informants. Data focused on: history and patterns of mobility, migration in and out of fishing communities and the relationship between mobility and HIV infection. Since the interviews and discussions were not audio-recorded, detailed notes were taken and written up into full scripts for analysis. We conducted a thematic analysis using constant comparison analysis. RESULTS: Participants reported that women in fishing communities were highly mobile for work-related activities. Overall, we categorized mobility as travels over long and short distances or periods depending on the kind of livelihood activity women were involved in. Participants reported that women often travelled to new places, away from familiar contacts and far from healthcare access. Some women were reported to engage in high risk sexual behaviour and disengaging from HIV care. However, participants reported that women often returned to the fishing communities they considered home, or followed a seasonal pattern of work, which would facilitate contact with service providers. CONCLUSION: Women exhibited circular and seasonal mobility patterns over varying distances and duration away from their home communities. These mobility patterns may limit women's access to trial/health services and put them at risk of HIV-infection. Interventions should be tailored to take into account mobility patterns of seasonal work observed in this study

Cuantificación del calcio mineral en la ateromatosis carotídea mediante angiografía por tomografía computarizada: perfil evolutivo y relación con la progresión del grado de estenosis volumétrica

Antecedentes: La cuantificación y caracterización del calcio (Ca) mineral (hidroxiapatita) en la bifurcación carotídea con AngioTC, y su relación con la sintomatología neurológica, en un estudio preliminar de casos y controles (Miralles y cols. Eur J Vasc Endovasc Surg 2006), constituye la base conceptual del presente estudio. Sus resultados, al igual que los de otras publicaciones, sugerían un posible papel protector del calcio en el desarrollo de eventos neurológicos. Sin embargo, su relación con la progresión de la ateromatosis carotídea ha sido escasamente analizado. Objetivos: Principales: 1. Diseñar un método de medición volumétrica de la ateromatosis (AE) carotídea y contenido de Ca mediante AngioTC. 2. Analizar el grado de calcificación arterial y su relación con la progresión de la ateromatosis carotídea. Secundarios: 3. Evaluar la relación entre calcificación arterial carotídea y descalcificación ósea, así como su posible conexión a través de los factores humorales implicados en la regulación del metabolismo Ca-P. 4. Estudiar un posible mecanismo genético común: relación entre los polimorfismos del gen de la OPG y la progresión de la calcificación en la placa de ateroma. Pacientes y método: Diseño: Cohortes, medidas repetidas. Pacientes: 54 pacientes, neurológicamente asintomáticos con estenosis de la arteria carótida interna (ECI) >50% (eco-Doppler). Determinaciones: Medición del grado de ECI mediante eco-Doppler y proyecciones MIP 2D de AngioTC. Medición del Volumen del molde de contraste y contenido de Ca (AngioTC cuantitativa: Agatston score modificado: volumen de Ca (mm3) x densidad radiológica (unidades Hounsfield, UH) en reconstrucción volumétrica (volume rendering) de la bifurcación carotídea (volumen de contraste entre 2 cm por debajo y 1 cm por encima de la bifurcación [VBif] y su cociente con un segmento de 1 cm en carótida primitiva [VCP]) (n=45). En todos los pacientes se repitió la exploración a los 122 meses para valorar la variación en el contenido de Ca y en el grado de estenosis volumétrica de la bifurcación, como medición indirecta de la progresión/regresión de la AE carotídea. Densitometría ósea de columna y fémur (n=32), (basal y a los 122 meses). Bioquímica y metabolismo Ca-P (Ca, P, vit D, PTH). Determinación de osteopontina (OPN) y osteoprotegerina (OPG) sérica y distribución de 7 SNPs del gen de la OPG seleccionados sobre bases bibiliométricas (n=48). Análisis estadístico: descriptivo (media [DE]); concordancia intra e interobservador (gráficos de Bland-Altman) y coeficiente de correlación intraclase (CCI), precisión eco-Doppler/AngioTC y Volumetría 3D/MIP 2D: sensibilidad (Sens), especificidad (Esp), índice kappa, curvas operador receptor (COR), comparación de medias (prueba T), análisis de regresión uni y multivariable. Resultados: 1. La medición volumétrica de la bifurcación carotídea mostró una concordancia intra e interobservador con un CCI de 0,96 (IC 95%: 0,904-0,985) y 0,94 (IC 95%: 0,822-0,977), respectivamente. El VBif/VCP del grupo de ECI50% (p=0,001). El punto de corte óptimo de la relación VBif/VCP se identificó a partir de la curva COR en 4,1 (Sens=0,75; Esp=0,75, kappa=0,46). 2. La medición mediante AngioTC demostró, a los 12 meses, un aumento del volumen promedio de pared arterial (disminución del volumen de la columna de contraste), respecto al valor basal (475,45 [155,6] mm3xUH vs 501,3 [171,9] mm3xUH, p=0,04), así como un aumento del Ca intraplaca (56,8 [52,3] vs 64,58 [57,8] mm3xUH, p=0,002). El análisis univariable demostró una correlación inversa entre el contenido basal de Ca y progresión de estenosis volumétrica de la bifurcación (r=-0,481; p<0,001). El análisis de regresión múltiple permitió ajustar un modelo de regresión lineal entre la reducción del volumen de la bifurcación (progresión de AE carotídea) y el contenido basal de Ca intraplaca, ajustado por el índice de masa corporal (IMC). 3. Se observó una disminución estadísticamente significativa de la densidad ósea respecto a la determinación basal (2,08 [0,22] vs 2,06 [0,23] g/cm2; p=0,013), así como un aumento del Ca intraplaca respecto a los valores basales (79,2 [55] vs 64,58 [49,2] mm3xUH, p=0,12). Sin embargo, se identificó una correlación positiva entre la variación relativa del contenido de Ca y la variación relativa de la densidad ósea (r=0,574, p=0,003). En otras palabras, una mayor tendencia a la osteoporosis se asoció con una menor tendencia a la progresión del calcio intraplaca. Así mismo, se observó una relación entre los niveles plasmáticos de Vit D y la densitometría basal (r=-0,459, p=0,036) y entre los niveles plasmáticos de HDL-colesterol y la variación relativa, respecto a los valores basales, de la densidad ósea (r=-0,579, p=0,009). El análisis univariable demostró una correlación inversa entre el incremento del contenido de calcio intraplaca y los niveles plasmáticos de vit D (r=0,4; p=0,025) y score Z en fémur (r=0,378; p=0,047). Sólo la concentración de P en orina presentó una correlación positiva moderada con el aumento de Ca intraplaca (r=0,488, p=0,015). Ninguna otra variable, entre los parámetros del metabolismo Ca-P, mostró relación con la calcificación arterial. 4. No se observaron diferencias entre la distribución de los SNPs en los pacientes de la muestra del estudio y el grupo control. Tampoco se observó relación entre el genotipo (SNPs) y la concentración de OPG sérica. Conclusiones: 1. La medición volumétrica de la bifurcación carotídea supone un nuevo concepto basado en la valoración de la carga de placa más que en su efecto hemodinámico o estenosis máxima. Dada su precisión en la detección de variaciones pequeñas de la luz arterial, este método puede ser de especial utilidad en estudios de progresión de placa. 2. Los resultados de este estudio sugieren que un mayor contenido de Ca confiere mayor estabilidad frente a la progresión de la AE carotídea y, eventualmente, a su capacidad para generar sintomatología tromboembólica. 3. Encontramos una tendencia independiente a la progresiva calcificación arterial y descalcificación ósea. Sin embargo, los resultados sugieren una relación temporal directa en la evolución del depósito de calcio en ambas localizaciones, por lo que no es posible descartar que su modulación se rija por mecanismos similares. 4. No se observó una relación estadísticamente significativa entre la distribución de los SNPs analizados y los niveles de la OPG o la calcificación intraplaca en los pacientes estudiados.Background: Quantification and characterization of mineral calcium (Ca) (hydroxyapatite) in the carotid bifurcation with AngioCT, and its relation with neurological symptomatology, in a preliminary case-control study (Miralles et al., Eur J Vasc Endovasc Surg 2006) Constitutes the conceptual basis of the present study. Their results, like those of other publications, suggested a possible protective role for calcium in the development of neurological events. However, its relationship with the progression of carotid atheromatosis has been scarcely analyzed. Objectives: Primary: 1. To design a method of volumetric measurement of carotid atheromatosis (AE) and Ca content by AngioCT. 2. To analyze the degree of arterial calcification and its relation with the progression of carotid atheromatosis. Secondary: 3. To evaluate the relationship between carotid artery calcification and bone decalcification, as well as its possible connection through humoral factors involved in the regulation of Ca-P metabolism. 4 To study a possible common genetic mechanism: relationship between polymorphisms of osteoprotegerin (OPG) gene and the progression of calcification in the atherosclerotic plaque. Patients and method: Design: Cohorts, repeated measures. Patients: 54 asymptomatic patients with internal carotid artery stenosis CAS>50% (duplex scanning). Determinations: Measurement of CAS grade with duplex scanning and MIP 2D projections of AngioCT. Volume measurement of contrast medium and Ca content (quantitative AngioCT: Agatston score: Ca volume (mm3) x radiological density (Hounsfield units, HU) in volume reconstruction of the carotid bifurcation [contrast volume between 2 cm below and 1 cm above the bifurcation (BifV) and its ratio with that from 1 cm segment in common carotid artery (CCV)] (n=45). In all patients, the scans was repeated at 12±2 months to assess the variation in Ca content and the degree of bifurcation volumetric stenosis as an indirect measure of carotid AE progression / regression. Bone and spine densitometry (n=32), where obtained at baseline and after 12±2 months, as well as Biochemistry and Ca-P metabolism parameters (Ca, P, vit D, PTH). Determination of plasma levels of osteopontin (OPN) and osteoprotegerin (OPG) where compared with the distribution of 7 SNPs of the OPG gene selected on bibiliometrics bases (n=48). Statistical analysis: descriptive [mean (SD)]; Intra and interobserver agreement (Bland-Altman plots and intraclass correlation coefficient (ICC), duplex scanning / AngioCT precision and 3D Volumetry / MIP 2D: Sensitivity (S), specificity (E), kappa index, ROC curves, means comparison (T test), univariate and multivariate regression analysis. Results: 1.The volumetric measurement of the carotid bifurcation showed intra and interobserver agreement with a ICC of 0.96 (95% CI: 0.904-0.985) and 0.94 (95% CI: 0.822-0.977), respectively. The BifV/CCV of the CAS > 50% group was 5.2±1.8 vs 3.8 ±1.3 in the CAS >50% group (p=0.001). The optimum cutoff point for the BifV/CCV relation was identified from the ROC curve at 4,1 (S=0.75, E=0.75, kappa=0.46). 2. AngioCT measurement showed, at 12 months, an increase in mean arterial wall volume (decrease in contrast column volume), compared to baseline (475.45 [155.6] mm3xHU vs 501.3 [171.9] mm3xHU, p=0.04), as well as an increase in intraplaque Ca (56.8 [52.3] vs 64.58 [57.8] mm3xHU, p=0.002). Univariate analysis showed an inverse correlation between basal Ca content and progression of bifurcation volumetric stenosis (r=-0.481; p<0.001). The multiple regression analysis allowed to fit a linear regression model between the reduction of bifurcation volume (carotid AE progression) and the baseline intraplaque content of Ca, adjusted for body mass index (BMI). 3. A statistically significant decrease in bone density was observed with respect to the baseline determination (2.08 [0.22] vs 2.06 [0.23] g/cm2, p=0.013), as well as increased intraplaque Ca as compared with baseline values (79.2 [55] vs 64.58 [49.2] mm3xHU, p=0.12). However, a positive correlation was identified between the relative variation of Ca content and the relative variation of bone density (r=0.574, p=0.003). In other words, a greater tendency to osteoporosis was associated with a lower tendency to progression of intraplaque calcium. Likewise, a relationship between Vit D plasma levels and baseline densitometry (r=-0.459, p=0.036) and between plasma HDL-cholesterol levels and the relative variation, relative to baseline values, were observed. Bone density (r=-0.579, p=0.009). The univariate analysis showed an inverse correlation between the basal Ca content and the progression of bifurcation volumetric stenosis (r=-0.481; p<0.001), as well as between the increase in the intra-plaque calcium content and plasma levels of vit D (R=0.4, p=0.025) and femur Z score (r=0.378, p=0.047). Only the urine P concentration presented a moderate positive correlation with the increase of intra-plaque Ca (r=0.488, p=0.015). No other variable, among Ca-P metabolism parameters, was related to arterial calcification. 4. There were no differences between the distribution of SNPs in patients and control group. There was also no relationship between genotype and serum OPG concentration. Conclusions: 1. The volumetric measurement of the carotid bifurcation is a new concept based on the assessment of the plaque load rather than on its hemodynamic effect or maximal stenosis. Given its accuracy in detecting small variations in arterial lumen, this method may be especially useful in plaque progression studies. 2. The results of this study suggest that a higher content of Ca confers greater stability against the progression of carotid AE and, eventually, its capacity to generate symptomatology. 3. We found an independent tendency to progressive arterial calcification and bone decalcification. However, the results suggest a direct temporal relationship in the evolution of the calcium deposit in both locations, so it is not possible to rule out that its modulation is controlled by similar mechanisms. 4. The results are inconclusive with regard to the role of OPG in AE plaque calcification. No significant relationship between the distribution of SNPs analyzed and OPG levels in the studied patients was observed

Finding women in fishing communities around Lake Victoria: "Feasibility and acceptability of using phones and tracking devices".

INTRODUCTION: Women in fishing communities have both high HIV prevalence and incidence, hence they are a priority population for HIV prevention and treatment interventions. However, their mobility is likely to compromise the effectiveness of interventions. We assessed the acceptability, feasibility and of using phones and global positioning system (GPS) devices for tracking mobility, to inform future health research innovations. METHODS: A mult-site formative qualitative study was conducted in six purposively selected Fishing Communities on the shores of Lake Victoria in Kenya, Tanzania, and Uganda. Participants were selected based on duration of stay in the community and frequency of movement. Sixty-four (64) women participated in the study (16 per fishing community). Twenty-four (24) participants were given a study phone; 24 were asked to use their own phones and 16 were provided with a portable GPS device to understand what is most preferred. Women were interviewed about their experiences and recommendations on carrying GPS devices or phones. Twenty four (24) Focus Group Discussions with 8-12 participants were conducted with community members to generate data on community perceptions regarding GPS devices and phones acceptability among women. Data were analyzed thematically and compared across sites/countries. RESULTS: Women reported being willing to use tracking devices (both phones and GPS) because they are easy to carry. Their own phone was preferred compared to a study phone and GPS device because they were not required to carry an additional device, worry about losing it or be questioned about the extra device by their sexual partner. Women who carried GPS devices suggested more sensitization in communities to avoid domestic conflicts and public concern. Women suggested changing the GPS colour from white to a darker colour and, design to look like a commonly used object such as a telephone Subscriber Identity Module (SIM) card, a rosary/necklace or a ring for easy and safe storage. CONCLUSION: Women in the study communities were willing to have their movements tracked, embraced the use of phones and GPS devices for mobility tracking. Devices need to be redesigned to be more discrete, but they could be valuable tools to understanding movement patterns and inform design of interventions for these mobile populations

Factors Associated with Short and Long Term Mobility and HIV Risk of Women Living in Fishing Communities Around Lake Victoria in Kenya, Tanzania, and Uganda: A Cross Sectional Survey.

Mobility is linked to negative HIV care continuum outcomes. We sought to understand factors associated with short and long term mobility among women in fishing communities in Kenya, Tanzania, and Uganda. From 2018 through 2019 we conducted a cross-sectional survey of women aged 15 years and above, randomly selected from a census of six fishing villages, around Lake Victoria. Data collected included: demographics, risky sexual behaviour on the most recent trip, and travel behaviour in the previous 4 months. Mobility was recorded as any overnight trip outside the participant's village. A two-level multinomial logistic regression model was used to determine the associated factors. A total of 901 participants were enrolled, of whom 645 (71.6%) reported travelling (53.4%; short and 18.2% long term trips). Five factors were associated with long term travel: age, travel purpose, frequency of travel, sexual behaviour while travelling, and destination. Trips made by women aged 46-75 years were less likely to be long term. Long term trips were more common if the trip was to visit, rather than to trade, and more common for women who reported one or two trips rather than three or more trips. Women who made long term trips were more likely to engage in unprotected sex while on a trip. Women who travelled to a regional town/district or another town/district were more likely to take long term trips. The factors associated with travel duration among women living in fishing communities could inform planning of future health care interventions in these communities

CLSI-Derived Hematology and Biochemistry Reference Intervals for Healthy Adults in Eastern and Southern Africa

BACKGROUND: Clinical laboratory reference intervals have not been established in many African countries, and non-local intervals are commonly used in clinical trials to screen and monitor adverse events (AEs) among African participants. Using laboratory reference intervals derived from other populations excludes potential trial volunteers in Africa and makes AE assessment challenging. The objective of this study was to establish clinical laboratory reference intervals for 25 hematology, immunology and biochemistry values among healthy African adults typical of those who might join a clinical trial. METHODS AND FINDINGS: Equal proportions of men and women were invited to participate in a cross sectional study at seven clinical centers (Kigali, Rwanda; Masaka and Entebbe, Uganda; two in Nairobi and one in Kilifi, Kenya; and Lusaka, Zambia). All laboratories used hematology, immunology and biochemistry analyzers validated by an independent clinical laboratory. Clinical and Laboratory Standards Institute guidelines were followed to create study consensus intervals. For comparison, AE grading criteria published by the U.S. National Institute of Allergy and Infectious Diseases Division of AIDS (DAIDS) and other U.S. reference intervals were used. 2,990 potential volunteers were screened, and 2,105 (1,083 men and 1,022 women) were included in the analysis. While some significant gender and regional differences were observed, creating consensus African study intervals from the complete data was possible for 18 of the 25 analytes. Compared to reference intervals from the U.S., we found lower hematocrit and hemoglobin levels, particularly among women, lower white blood cell and neutrophil counts, and lower amylase. Both genders had elevated eosinophil counts, immunoglobulin G, total and direct bilirubin, lactate dehydrogenase and creatine phosphokinase, the latter being more pronounced among women. When graded against U.S. -derived DAIDS AE grading criteria, we observed 774 (35.3%) volunteers with grade one or higher results; 314 (14.9%) had elevated total bilirubin, and 201 (9.6%) had low neutrophil counts. These otherwise healthy volunteers would be excluded or would require special exemption to participate in many clinical trials. CONCLUSIONS: To accelerate clinical trials in Africa, and to improve their scientific validity, locally appropriate reference ranges should be used. This study provides ranges that will inform inclusion criteria and evaluation of adverse events for studies in these regions of Africa