The Changing Contexts of Family Care in Canada

Over the past 20 to 30 years, the importance of families as providers of assistance to older Canadians has been well documented through research. However, over these decades, the contexts within which families exist and provide support have changed considerably. This paper examines changes over this time period which affect family support to older adults. Specific areas examined include: likelihood of having a parent alive; living arrangements; divorce and single-parenthood; women's labour force participation, and combining employment and care of older relatives. The paper concludes with an assessment of policy changes in health and long-term care as these affect older Canadians and their families.family care; older population; policy change

The Consequences of Caregiving: Does Employment Make a Difference?

While a number of studies have examined the consequences of caregiving among employed women, surprisingly little research has explicitly compared how consequences differ between employed and not employed women. Moreover, very little research in this area has distinguished between part-time and full- time employment. This paper examines these issues drawing on the 1996 General Social Survey of Canada. The sample for this study consists of women aged 25 to 64 who reported providing care to one or more people aged 65+ because of a long-term physical disability (n=426). Three employment status groups (full-time, part-time and not employed) are compared on positive consequences, burden, guilt, job adjustment, postponed opportunities, and social and economic consequences. Results reveal significant differences between the three employment categories indicating that employment, both full and part-time, is associated with higher burden, guilt and social and economic consequences.caregiving; employment status; GSS

Families as Care-Providers versus Care-Managers? Gender and Type of Care in a Sample of Employed Canadians

This article extends previous research by examining care management as a distinct type of informal care. Using data drawn from a large Canadian study of work and family, the research is based on a study of a sub-sample of women (1068) and men (805) who were employed full-time and who had provided help to an elderly relative during the six month period preceding the interview. Results indicate that managerial care is a meaningful construct that denotes a distinct type of care. Most commonly, individuals combine managerial care with other types of assistance. Managerial care is a very common activity among caregivers and usually involves aspects of care other than arranging for formal services. Managerial care has an adverse impact on job costs and personal costs, and, among women, is associated with greater stress.elderly; caregiving

How Much Help Is Exchanged in Families? Towards an Understanding of Discrepant Research Findings

Responding to claims that contemporary families had abandoned their elderly members, gerontologists over the past 30 years have provided extensive documentation of intergenerational familial support. These studies have been lodged within conceptual frameworks of the modified extended family, intergenerational solidarity, and, more recently, intergenerational equity. By and large, studies claim to have found extensive levels of support. Closer examination of findings from various studies, however, reveals widely discrepant findings in terms of amounts of help given to and received by older family members. This paper examines the findings from four representative Canadian and American studies spanning four decades. Factors contributing to discrepant findings are identified at both methodological and conceptual levels, and implications for future research are discussed.intergenerational support

Caught in the Middle? Occupancy in Multiple Roles and Help to Parents in a National Probability Sample of Canadian Adults

This paper considers for a Canadian national probability sample of middle-aged women and men the question of how typical is the experience of being "caught in the middle" between being the adult child of elderly parents and other roles. Three roles are examined: adult child, employed worker, and parent (and a refinement of the parent role, being a parent of a co-resident child). Occupancy in multiple roles is examined, followed by an investigation of the extent to which adults in various role combinations actually assist older parents and whether those who provide frequent help are also those "sandwiched" by competing ommitments. The majority of middle-aged children do not provide frequent help to parents. Notably, the highest proportion of daughters who assist elderly parents are those in their fifties whose children are no longer co-resident. For both sons and daughters, being "caught in the middle" is far from a typical experience in this cross-sectional analysis.multiple roles

Age-Gapped and Age-Condensed Lineages: Patterns of Intergenerational Age Structure among Canadian Families

This paper examines intergenerational connections within Canadian families. Its focus is on intergenerational age structure, the interval or 'gap' in years that separates one generation from the next. Intergenerational age structure is measured in terms of the age of a mother at the birth of her first child. Using data from the 1995 General Social Survey of Canada, the study examines the socio-demographic characteristics of women (n=404) in three- and four-generation families (lineages) that are age-condensed (small age distances between generations that are the result of early fertility) and those that are age- gapped (with large age distances between generations that are the result of late fertility patterns). Across two generations of women, there is a striking similarity in the distributions of age at first birth with just under one-third of the sample having early fertility, just over one-half falling into a normative or "on-time" category, and one-seventh having delayed fertility. However, when matched pairs of mothers and daughters are compared across generations, age-condensed and age-gapped lineage patterns show considerable variability. Although just under one-half of mother-daughter dyads show lineage consistency in family age structure across three generations (most typically in age-condensed/age-condensed or normative/normative age structures), low percentages of women whose family of origin was age-gapped repeat that age structure pattern in their own families of procreation. Socio-demographic factors such as mother's and daughter's age, family size, age at first marriage, and level of education are associated with lineage continuity and discontinuity in family age structure.intergenerational age structure; GSS

The Effect of Virtual Civic Engagement on Crime: SeeClickFix in New Haven

Mobile virtual communities are an emerging space for improving social cohesiveness and promoting collective efficacy. The application SeeClickFix is a smartphone and web application developed in New Haven, Connecticut, where users report issues in their communities including non-violent crimes. These posts can be supported and commented on by other users and local government agencies acknowledge and address issues. The data are publicly available, providing a data-rich and transparent venue for monitoring the interaction of individuals with each other and city representatives. The purpose of our study is to look for correlations between SeeClickFix use and crime. We hypothesize that SeeClickFix activity reduces crime by increasing social cohesion and promoting collective efficacy. Preliminary analyses show that within each neighborhood, months with more SeeClickFix posts tend to have fewer crimes. In addition, the crime rate is lower after the creation of SeeClickFix relative to before. These data suggest that SeeClickFix use is correlated with reduced crime in New Haven. Further efforts are needed to establish if there is a causal relationship and if so by what mechanism. This work has the potential to suggest a method by which communities can increase transparency and reduce crime through an open data platform

The effects of combination canagliflozin and glucagon-like peptide-1 receptor agonist therapy on intermediate markers of cardiovascular risk in the CANVAS program

Background: Sodium glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP1-RA) reduce cardiovascular events, and improve intermediate markers of cardiometabolic health, in those with type 2 diabetes. We investigated these effects in the CANVAS Program. Methods and results: The CANVAS Program comprised 2 double-blind, randomized, placebo-controlled trials (CANVAS and CANVAS-R) done in patients with type 2 diabetes and elevated cardiovascular risk. Effects were estimated using mixed-effects models for continuous measures and Cox regression models for other outcomes. Randomized treatment by subgroup interaction terms were used to compare effects of canagliflozin versus placebo across subgroups defined by baseline use of GLP1-RA. There were 10,142 participants, of whom 407 (4%) were using GLP1-RA therapy at baseline. Those using GLP1-RA at baseline were less likely to have a history of cardiovascular disease (60.4% vs 65.8%), had a longer duration of diabetes (152 vs 13.5 years) and a higher body mass index (BMI; 35.6 vs 31.8 kg/m(2)) but were otherwise similar. There were greater reductions with canagliflozin versus placebo for HbA1c (-0.75% versus -0.58%; P = .0091), SBP (-6.26 versus -3.83 mmHg; P = .0018), and body weight (-3.79 versus -2.18 kg; P <.0001) in those on baseline GLP1-RA therapy. Effects across subgroups were similar for UACR (P = .21), eGFR slope (A - .72), major adverse cardiac events (P = .94) and total serious adverse events (P = .74). Conclusions: There may be a synergistic effect of SGLT2 inhibition when used on a background of GLP1-RA for intermediate cardiometabolic markers. (C) 2020 Elsevier B.V. All rights reserved

Identifying priorities in methodological research using ICD-9-CM and ICD-10 administrative data: report from an international consortium

BACKGROUND: Health administrative data are frequently used for health services and population health research. Comparative research using these data has been facilitated by the use of a standard system for coding diagnoses, the International Classification of Diseases (ICD). Research using the data must deal with data quality and validity limitations which arise because the data are not created for research purposes. This paper presents a list of high-priority methodological areas for researchers using health administrative data. METHODS: A group of researchers and users of health administrative data from Canada, the United States, Switzerland, Australia, China and the United Kingdom came together in June 2005 in Banff, Canada to discuss and identify high-priority methodological research areas. The generation of ideas for research focussed not only on matters relating to the use of administrative data in health services and population health research, but also on the challenges created in transitioning from ICD-9 to ICD-10. After the brain-storming session, voting took place to rank-order the suggested projects. Participants were asked to rate the importance of each project from 1 (low priority) to 10 (high priority). Average ranks were computed to prioritise the projects. RESULTS: Thirteen potential areas of research were identified, some of which represented preparatory work rather than research per se. The three most highly ranked priorities were the documentation of data fields in each country's hospital administrative data (average score 8.4), the translation of patient safety indicators from ICD-9 to ICD-10 (average score 8.0), and the development and validation of algorithms to verify the logic and internal consistency of coding in hospital abstract data (average score 7.0). CONCLUSION: The group discussions resulted in a list of expert views on critical international priorities for future methodological research relating to health administrative data. The consortium's members welcome contacts from investigators involved in research using health administrative data, especially in cross-jurisdictional collaborative studies or in studies that illustrate the application of ICD-10

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts