Evaluation of the International Consultation on Incontinence Questionnaire Short-Form : evidence from a surgical population

The International Consultation on Incontinence Questionnaire Short-Form (ICIQ-UI-SF) is a four-item patient-reported outcome (PRO) measure. Its intended use is screening for incontinence, assessing impact of incontinence on quality of life, and facilitating patient-clinician discussions. Evaluations of this instrument to date have relied on a simple set of analytical tools—limiting user’s confidence of the instrument’s validity and reliability. The purpose of this thesis was to conduct a comprehensive evaluation of the ICIQ-UI-SF. The analyses were conducted on 177 completed ICIQ-UI-SF instruments by men with chronic urinary incontinence waitlisted for urological surgery for treatment of their condition. This comprehensive evaluation included application of the following methods: confirmatory factor analysis (CFA), principal component analysis, measures of reliability (classical test theory (CTT) and McDonald’s coefficient), item response theory (IRT), and differential item functioning (DIF). A supplemental investigation examined previously constructed ICIQ-UI-SF severity categories. Specific goals included assessing: instrument characteristics (dimensionality, ceiling effects), reliability, performance of individual items, whether socioeconomic status influences patients’ ICIQ-UI-SF scores, and concordance with other commonly collected PROs (EQ-5D-3L, Visual Analogue Scale). Responses to all items were left skewed and ceiling effects were identified. Model fit could not be assessed through the CFA, however the factor loadings of items one and two differed significantly (p < 0.0002) from item three indicating possible multidimensionality. The PCA contrastingly provided some, albeit limited evidence that the ICIQ-UI-SF is unidimensional. Reliability was low/moderate as measured by Cronbach’s alpha (0.63) and McDonald’s coefficient (0.65). The IRT revealed the third item’s reliability may be improved by collapsing response levels. The instrument does not discriminate between individuals with high incontinence burden. There was no DIF by socioeconomic status. Supplemental investigations demonstrated the ICIQ-UI-SF discriminates between surgical patients with mild/moderate incontinence versus severe/very severe—but not beyond these dichotomies. Directly comparing ICIQ-UI-SF scores of urological surgery patients with high incontinence burden is not recommended. If unchanged, the ICIQ-UI-SF can be used as a complement to other data, such as reporting aggregated surgical outcomes, or as a starting point for patient-clinician discussions when applied to a surgical population. For application to surgical triage, this analysis recommends amendments to the ICIQ-UI-SF.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat

Wait lists and adult general surgery: is there a socioeconomic dimension in Canada?

Background: Little is known about whether patients’ socioeconomic status influences their access to elective general surgery in Canada. The purpose of this study was to assess the association between socioeconomic status and wait times for elective general surgery. Methods: Analysis of prospectively recruited participants’ data. The setting was six hospitals in the Vancouver Coastal Health Authority, a geographically defined region that includes Vancouver, British Columbia, Canada. Participants had elective general surgery between October 2013 and April 2017, community dwelling, aged 19 years or older and could complete survey forms. The outcome measure was wait time, defined as the number of weeks between being registered for elective general surgery and surgery date. Results: One thousand three hundred twenty elective general surgery participants were included in the study. The response rate among eligible patients was 53%. Regression analyses found no statistically significant association between patients’ wait time with SES, adjusting for health status, cancer status, surgical priority level, comorbidity burden and demographic characteristics. Participants with proven or suspected cancer status had shorter waits relative to participants waiting for surgery for benign conditions. Participants with at least one comorbidity tended to experience shorter waits of approximately 5 weeks (p < 0.01). Pre-operative pain or depression/anxiety were not associated with shorter wait times. Conclusions: Although this study found no relationship between SES and surgical wait time for elective general surgeries in the study hospitals, patients in lower SES categories reported worse health when assigned to the surgical queue.Medicine, Faculty ofOther UBCNon UBCPopulation and Public Health (SPPH), School ofSurgery, Department ofReviewedFacult

Simple and Effective Derivatization of Amino Acids with 1-Fluoro-2-nitro-4-(trifluoromethyl)benzene in a Microwave Reactor for Determination of Free Amino Acids in Kombucha Beverages

Kombucha is a fermentation product of sweetened tea with a symbiotic culture of acetic acid and yeast bacteria, consumed worldwide for its health-promoting properties. Few reports can be found about free amino acids among the health-promoting compounds found and determined in kombucha. These compounds influence the sensory properties of kombucha, and they are precursors of bioactive compounds, which have a significant role as neurotransmitters and are involved in biological functions. The presented studies proposed a convenient, simple, and “more green” procedure of the synthesis of amino acid derivatives, assisted by microwave energy, followed by chromatographic determination. The structure of 1-Fluoro-2-nitro-4-(trifluoromethyl)benzene was used as a suitable reagent for the derivatization of free amino acids in fermented kombucha beverages prepared from selected dry fruit such as Crataegus L., Morus alba L., Sorbus aucuparia L., Berberis vulgaris L., Rosa canina L., and black tea. The obtained results were discussed regarding the tested beverages’ application as a source of amino acids in one’s daily diet. The obtained results point out that the proposed microwave-assisted derivatization procedure prior to HPLC analyses allows for a significant time reduction and the limitation of using organic reagents

Multiple micronutrient supplementation cost–benefit tool for informing maternal nutrition policy and investment decisions

Abstract Antenatal multiple micronutrient supplementation (MMS) is an intervention that can help reach three of the six global nutrition targets, either directly or indirectly: a reduction in low birth weight, stunting, and anaemia in women of reproductive age. To support global guideline development and national decision‐making on investments into maternal nutrition, Nutrition International developed a modelling tool called the MMS cost–benefit tool to help users understand whether antenatal MMS is better value for money than iron and folic acid supplementation (IFAS) during pregnancy. The MMS cost–benefit tool can generate estimates on the potential health impact, budget impact, economic value, cost‐effectiveness and benefit–cost ratio of investing in MMS compared to IFAS in LMICs. In the 33 countries with data included in the tool, the MMS cost–benefit tool shows that transitioning is expected to generate substantial health benefits in terms of morbidity and mortality averted and can be very cost‐effective in multiple scenarios for these countries. The cost per DALY averted averages at US$23.61 and benefit–cost ratio ranges from US$ 41–US$1304:$1.0, which suggest MMS is good value for money compared with IFAS. With its user‐friendly design, open access availability, and online data‐driven analytics, the MMS cost–benefit tool can be a powerful resource for governments and nutrition partners seeking timely and evidence‐based analyses to inform policy‐decision and investments towards the scale‐up of MMS for pregnant women globally