We Ask Because We Care: Feasibility and acceptability of sociodemographic data collection in Saskatoon

The study assessed the feasibility and acceptability of sociodemographic data collection in one western Canadian urban centre. It also explored local facilitators and barriers to implementation in order to gain insight about how to support change and foster adoption of similar equity interventions across health regions in the province of Saskatchewan. A multiple case study was used to evaluate the process of implementation of sociodemographic data collection across three acute and ambulatory care sites. The study draws on multiple qualitative and quantitative methods including individual and group interviews, chart reviews and surveys to understand the diverse participant perspectives and experiences. Cases were studied sequentially. Within cases an integrated approach to data collection and analysis was applied. Cross case synthesis was done to identify similarities and differences across health contexts. Analysis revealed that it was feasible to collect selected sociodemographic information although there was a gradient of comfort depending on the question and context in which it was asked. High item non responses were observed for questions related to annual household income and year of arrival to Canada. Perceived importance of sociodemographic data collection varied by participant characteristics including age, race/ethnicity and gender identity. Patient participants who felt that data collection was important appreciated how it could be used to improve care, trusted institutional motives for collection and had positive experiences with the health care system. Common reasons for reservations about data collection included perceptions that it was inappropriate to ask or irrelevant to the provision of care, and concerns about the potential for misuse of the information. Preferences for mode of administration of questions varied depending on the participant characteristics. Structural, organizational, provider and patient factors influenced implementation across sites. There is growing interest in upstream approaches to the delivery of care. The study demonstrated feasibility and acceptability for sociodemographic data collection, however more work is needed to support wider implementation of some determinants across local health care settings

What older adults want from their health care providers

Changing demographic trends and population needs have increased demand for chronic complex care and contributed to rising health care costs. The study sought to identify unmet health care needs of older adults and opportunities for service improvement in a high need suburban neighborhood of a prairie province. The insights provided by older adults informed the service design for a new model of integrated care in community settings. Narrative inquiry methodology was used to understand care experiences through stories. Stories of older adults’ health care journeys were elicited with semi-structured interviews. A paradigmatic approach to analysis was applied with holistic coding, mapping of story elements followed by comparison and theming across participants’ stories. Older adults perceived that relationship and informational continuity fostered effective communication and supported coordination of care. Timely access to care was valued and flexibility in types of medical encounters was suggested as an option to improve provider responsiveness. Access to information about community resources was limited and older adults required support with navigation. Structural (e.g. availability of services and transportation), financial and personal barriers exist for older adults to access and use community health services. Health care transitions were inadequately supported by comprehensive discharge planning, timely communication and follow up post discharge. New models of care need to embrace person-centred and goal directed approaches to the delivery of care to improve patient experience. Older adults offer valuable perspectives as community partners and co-designers of systems change in efforts to re-engineer health services

The effect of seasonal host birth rates on disease persistence

In this paper, we add seasonality to the birth rate of an SIR model with density dependence in the death rate. We find that disease persistence can be explained by considering the average value of the seasonal term. If the basic reproductive ratio with this average value then the disease will persist and if with this average value then the disease will die out. However, if the underlying non-seasonal model displays oscillations towards the equilibrium then the dynamics of the seasonal model can become more complex. In this case the seasonality can interact with the underlying oscillations, resonate and the population can display a range of complex behaviours including chaos. We discuss these results in terms of two examples, Cowpox in bank voles and Rabbit Haemorrhagic Disease in rabbits

Human SNP links differential outcomes in inflammatory and infectious disease to a FOXO3-regulated pathway

The clinical course and eventual outcome, or prognosis, of complex diseases varies enormously between affected individuals. This variability critically determines the impact a disease has on a patient’s life but is very poorly understood. Here, we exploit existing genome-wide association study data to gain insight into the role of genetics in prognosis. We identify a noncoding polymorphism in FOXO3A (rs12212067: T > G) at which the minor (G) allele, despite not being associated with disease susceptibility, is associated with a milder course of Crohn’s disease and rheumatoid arthritis and with increased risk of severe malaria. Minor allele carriage is shown to limit inflammatory responses in monocytes via a FOXO3-driven pathway, which through TGFβ1 reduces production of proinflammatory cytokines, including TNFα, and increases production of anti-inflammatory cytokines, including IL-10. Thus, we uncover a shared genetic contribution to prognosis in distinct diseases that operates via a FOXO3-driven pathway modulating inflammatory responses. PAPERCLIP

CIHR Health System Impact Fellows: Reflections on “Driving Change” Within the Health System

Learning health systems necessitate interdependence between health and academic sectors and are critical to address the present and future needs of our health systems. This concept is being supported through the new Canadian Institutes of Health Research (CIHR) Health System Impact (HSI) Fellowship, through which postdoctoral fellows are situated within a health system-related organization to help propel evidence-informed organizational transformation and change. A voluntary working group of fellows from the inaugural cohort representing diversity in geography, host setting and personal background, collectively organized a panel at the 2018 Canadian Association for Health Services and Policy Research Conference with the purpose of describing this shared scholarship experience. Here, we present a summary of this panel reflecting on our experiential learning in a practice environment and its ability for impact

Brand Ownership As a Central Component of Adolescent Self-esteem: The Development of a New Self-esteem Scale

This article outlines the development of a new scale to measure adolescent self-esteem. The new scale addresses weaknesses in existing measures that have failed to consider the growth of the consumer society in the Western world and the impact of this on the formation of adolescent self-esteem. The development of this scale includes extensive qualitative research with over 100 high school pupils, which led to a series of quantitative data collection and analysis processes to develop the scale. In the final stage, data were collected from 889 pupils and analyzed to confirm the validity and reliability of the new measure. The result of this work is a 21-item self-esteem scale comprising of four distinct, yet interrelated factors: self-evaluation, social ability, social comparison effects, and notably, brand ownership. The findings provide an updated and upgraded measure of self-esteem that takes into consideration the specific audience of adolescents living in a consumer culture. The scale development process demonstrates that when considering the formation of self-esteem, the influence of the use and possession of commercial brands is as relevant as the traditional factors/components such as academic achievement or sporting prowess

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

On the mechanisms governing gas penetration into a tokamak plasma during a massive gas injection

A new 1D radial fluid code, IMAGINE, is used to simulate the penetration of gas into a tokamak plasma during a massive gas injection (MGI). The main result is that the gas is in general strongly braked as it reaches the plasma, due to mechanisms related to charge exchange and (to a smaller extent) recombination. As a result, only a fraction of the gas penetrates into the plasma. Also, a shock wave is created in the gas which propagates away from the plasma, braking and compressing the incoming gas. Simulation results are quantitatively consistent, at least in terms of orders of magnitude, with experimental data for a D 2 MGI into a JET Ohmic plasma. Simulations of MGI into the background plasma surrounding a runaway electron beam show that if the background electron density is too high, the gas may not penetrate, suggesting a possible explanation for the recent results of Reux et al in JET (2015 Nucl. Fusion 55 093013)