A survey study to determine health disparities among men who have sex with men in Eastern Ontario: looking beyond sexual risk and the gay, urban core

To create health promotion programs and clinical guidelines inclusive of gay, bisexual and other men who have sex with men (gbMSM), a better understanding of the health and social determinants that influence health outcomes for these men is required. Health research on gbMSM, however, has focused primarily on sexual health and HIV (human immunodeficiency virus) with most information coming from men living in large urban centers. To address this limitation and better characterize the overall health of this population, we conducted a survey of gbMSM living in Eastern Ontario, Canada. The survey, completed anonymously, was available from June to October 2015. A total of 674 gbMSM completed the survey; 61% were urban, 23% suburban and 16% lived in small towns or rural settings. The average age was 44.2 years, ranging from 18 to 83 years. Healthcare engagement was high for all groups of gbMSM, though disclosure of sexual orientation to healthcare providers varied based on the gender of sexual partners. Urban men tended to be younger, sexually active only with men, open about their sexual orientation, and more likely to use recreational drugs while men living in small towns and rural settings tended to be older, bisexual and more likely to conceal their sexual orientation. While the physical health of respondents was on par with national averages for men, we found younger men were more likely to suffer from anxiety and use recreational drugs while older men were more likely to develop problem alcohol use. Depressive symptoms were high across all demographic groups. Our data demonstrate that while gbMSM in Eastern Ontario have a high degree of contact with the healthcare system, considerable health inequities remain unaddressed. We also find significant health differences among gbMSM depending on age, area of residence, and degree of disclosure of sexual orientation

Language and geographical location influence the incidence of chronic cough in the Canadian Longitudinal Study on Aging

French speakers have a 4% lower incidence of chronic cough than English speakers in the CLSA, but English speakers from Quebec, Newfoundland and Labrador, and Nova Scotia also have a lower risk of developing chronic cough https://bit.ly/3qAd3M

Effects of Asm-024, A Modulator of Acetylcholine Receptor Function, On Airway Responsiveness and Allergen-Induced Responses in Patients with Mild Asthma

OBJECTIVES: To evaluate the safety, tolerability and clinical activity of ASM-024, a new cholinergic compound with dual nicotinic and muscarinic activity, in mild allergic asthma

A new scale to assess health-facility level management: the development and validation of the facility management scale in Ghana, Uganda, and Malawi

Background: The increased recognition of governance, leadership, and management as determinants of health system performance has prompted calls for research focusing on the nature, quality, and measurement of this key health system building block. In low- or middle-income contexts (LMIC), where facility-level management and performance remain a challenge, valid tools to measure management have the potential to boost performance and accelerate improvements. We, therefore, sought to develop a Facility-level Management Scale (FMS) and test its reliability in the psychometric properties in three African contexts. Methods: The FMS was administered to 881 health workers in; Ghana (n = 287; 32.6%), Malawi (n = 66; 7.5%) and Uganda (n = 528; 59.9%). Half of the sample data was randomly subjected to exploratory factor analysis (EFA) and Monte Carlo Parallel Component Analysis to explore the FMS’ latent structure. The construct validity of this structure was then tested on the remaining half of the sample using confirmatory factor analysis (CFA). The FMS’ convergent and divergent validity, as well as internal consistency, were also tested. Results: Findings from the EFA and Monte Carlo PCA suggested the retention of three factors (labelled ‘Supportive Management’, ‘Resource Management’ and ‘Time management’). The 3-factor solution explained 51% of the variance in perceived facility management. These results were supported by the results of the CFA (N = 381; χ2 = 256.8, df = 61, p < 0.001; CFI = 0.94; TLI = 0.92; RMSEA [95% CI] = 0.065 [0.057–0.074]; SRMR = 0.047). Conclusion: The FMS is an open-access, short, easy-to-administer scale that can be used to assess how health workers perceive facility-level management in LMICs. When used as a regular monitoring tool, the FMS can identify key strengths or challenges pertaining to time, resources, and supportive management functions at the health facility level

Efficacy and safety of once-daily fluticasone furoate 50 mcg in adults with persistent asthma: a 12-week randomized trial

Abstract Background Fluticasone furoate (FF) is a novel, once-daily inhaled corticosteroid (ICS) that has been shown to improve lung function vs. placebo in asthma patients. This study evaluated the efficacy and safety of FF 50 mcg compared with placebo in asthma patients uncontrolled by non-ICS therapy. Methods This 12-week, multicentre, randomized, double-blind, placebo-controlled, parallel-group, phase III study randomized 248 patients (aged ≥12 years) to once-daily FF 50 mcg administered via the ELLIPTA™a dry powder inhaler or placebo. The primary endpoint was change from baseline in pre-dose evening trough forced expiratory volume in one second (FEV1). Secondary endpoints were change from baseline in percentage of rescue-free 24-h periods (powered), evening and morning peak expiratory flow, symptom-free 24-h periods and withdrawals due to lack of efficacy. Other endpoints included Asthma Control Test™, Asthma Quality of Life Questionnaire and ELLIPTA ease of use questions. Safety was assessed throughout the study. Results There was a significant difference in evening trough FEV1 between FF 50 mcg and placebo (treatment difference: 120 mL; p = 0.012). There was also a significant difference in rescue-free 24-h periods (11.6%; p = 0.004) vs. placebo. There were numerically greater improvements with FF vs. placebo for all remaining secondary endpoints. The incidence of adverse events was lower with FF (31%) than with placebo (38%); few were treatment-related (FF 50 mcg: n = 1, <1%; placebo: n = 4, 3%). Conclusion FF 50 mcg once daily significantly improved FEV1 and percentage of rescue-free 24-h periods experienced over 12 weeks vs. placebo, and was well tolerated. Trial registration www.clinicaltrials.gov , registration number: NCT0143607

Eff ects of bidi smoking on all-cause mortality and cardiorespiratory outcomes in men from south Asia: an observational community-based substudy of the Prospective Urban Rural Epidemiology Study (PURE)

Background Bidis are minimally regulated, inexpensive, hand-rolled tobacco products smoked in south Asia. We examined the eff ects of bidi smoking on baseline respiratory impairment, and prospectively collected data for all-cause mortality and cardiorespiratory events in men from this region. Methods This substudy of the international, community-based Prospective Urban Rural Epidemiology (PURE) study was done in seven centres in India, Pakistan, and Bangladesh. Men aged 35–70 years completed spirometry testing and standardised questionnaires at baseline and were followed up yearly. We used multilevel regression to compare cross-sectional baseline cardiorespiratory symptoms, spirometry measurements, and follow-up events (all-cause mortality, cardiovascular events, respiratory events) adjusted for socioeconomic status and baseline risk factors between non-smokers, light smokers of bidis or cigarettes (≤10 pack-years), heavy smokers of cigarettes only (>10 packyears), and heavy smokers of bidis (>10 pack-years). Findings 14 919 men from 158 communities were included in this substudy (8438 non-smokers, 3321 light smokers, 959 heavy cigarette smokers, and 2201 heavy bidi smokers). Mean duration of follow-up was 5·6 years (range 1–13). The adjusted prevalence of self-reported chronic wheeze, cough or sputum, dyspnoea, and chest pain at baseline increased across the categories of non-smokers, light smokers, heavy cigarette smokers, and heavy bidi smokers (p<0·0001 for association). Adjusted cross-sectional age-related changes in forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity (FVC) ratio were larger for heavy bidi smokers than for the other smoking categories. Hazard ratios (relative to non-smokers) showed increasing hazards for all-cause mortality (light smokers 1·28 [95% CI 1·02–1·62], heavy cigarette smokers 1·59 [1·13–2·24], heavy bidi smokers 1·56 [1·22–1·98]), cardiovascular events (1·45 [1·13–1·84], 1·47 [1·05–2·06], 1·55 [1·17–2·06], respectively) and respiratory events (1·30 [0·91–1·85], 1·21 [0·70–2·07], 1·73 [1·23–2·45], respectively) across the smoking categories. Interpretation Bidi smoking is associated with severe baseline respiratory impairment, all-cause mortality, and cardiorespiratory outcomes. Stricter controls and regulation of bidis are needed to reduce the tobacco-related disease burden in south Asia

Process account of curiosity and interest: a reward-learning perspective

Previous studies suggested roles for curiosity and interest in knowledge acquisition and exploration, but there has been a long-standing debate about how to define these concepts and whether they are related or different. In this paper, we address the definition issue by arguing that there is inherent difficulty in defining curiosity and interest, because both curiosity and interest are naïve concepts, which are not supposed to have a priori scientific definitions. We present a reward-learning framework of autonomous knowledge acquisition and use this framework to illustrate the importance of process account as an alternative to advance our understanding of curiosity and interest without being troubled by their definitions. The framework centers on the role of rewarding experience associated with knowledge acquisition and learning and posits that the acquisition of new knowledge strengthens the value of further information. Critically, we argue that curiosity and interest are the concepts that they subjectively construe through this knowledge-acquisition process. Finally, we discuss the implications of the reward-learning framework for education and empirical research in educational psychology