A qualitative enquiry of hypoglycemia and the social determinants of health: The InHypo-DM study, Canada

INTRODUCTION

A significant body of research exists on the impact of the social determinants of health (SDoHs) on diabetes care and general health outcomes. However, less is known about health care practitioners' (HCPs') perspectives and experiences regarding the impact of the SDoHs on their patients with Type I and Type 2 diabetes mellitus and how this affects the prevention and treatment of hypoglycemia.

METHOD

A descriptive qualitative study, derived from the InHypo-DM (Canada) research program. A purposive sampling technique was used to recruit participants residing in southwestern Ontario, Canada, for a 30- to 45-min semistructured interview. Individual and team analysis of interviews was conducted to identify overarching and subthemes. Twenty HCP participants, including endocrinologists, family physicians, and allied health care practitioners, were recruited. Seven were Certified Diabetes Educators.

RESULTS

Participants articulated 2 overarching components of the SDoHs: patients' socioeconomic issues and psychosocial issues. They highlighted two socioeconomic issues: occupation type and poverty. Participants also emphasized 3 areas pertaining to patients' psychosocial issues: stage in the life cycle (e.g., elderly), social isolation, and mental health.

DISCUSSION

This study emphasizes the need for conducting detailed and comprehensive social histories during clinical diabetes assessments, as well as the necessity of adequate clinical time and resources for HCPs and patients to address these issues in the context of hypoglycemia management. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Fundamental Bioinformatic and Chemoinformatic Data Processing

In order to execute more advanced computational chemogenomic workflows, it is essential to understand the basic data formats and options for processing them. In this chapter, de facto standards for compound and protein representation are explained, with procedures for processing them given. A walkthrough demonstrates the step-by-step processes of downloading a ligand-target database, parsing the bioactivity in the database, automatically retrieving its chemical structures and protein sequences from a command line, and finally converting the structures and sequences into representative machine-ready formats. A basic protocol to visualize the parsed database and look for patterns is also given.

Processes that influence the evolution of family health teams

OBJECTIVE

To identify the processes that influence the evolution of family health teams (FHTs).

DESIGN

Qualitative study using grounded theory methodology.

SETTING

Family health teams in Ontario.

PARTICIPANTS

A total of 110 team members from 20 FHT sites in Ontario.

METHODS

Individual semistructured interviews were conducted and data were analyzed using initial coding, focused coding, and a constant comparison analysis.

MAIN FINDINGS

The analysis illuminated the complex and diverse nature of the FHTs' evolutionary trajectories, which were influenced by 7 discrete but interrelated processes: sharing a common philosophy about teamwork; having effective leadership; respecting each other's scopes of practice; sharing the physical environment; including team activities; supporting conflict resolution; and managing change. The status of each site's evolution was categorized as evolving, progressing, or stalled.

CONCLUSION

The concept of evolution by its very definition does not imply stasis, and as the data revealed, change is always on the horizon. This study revealed 7 processes that influenced team evolution, and these processes were observed to be either optimally applied or noticeably limited in their execution, irrespective of team composition or configuration. These processes can be extrapolated to other primary health care teams to facilitate team evolution.

The Emerging Role of Social Work in Primary Health Care: A Survey of Social Workers in Ontario Family Health Teams

Primary health care systems are increasingly integrating interprofessional team-based approaches to care delivery. As members of these interprofessional primary health care teams, it is important for social workers to explore our experiences of integration into these newly emerging teams to help strengthen patient care. Despite the expansion of social work within primary health care settings, few studies have examined the integration of social work's role into this expanding area of the health care system. A survey was conducted with Canadian social work practitioners who were employed within Family Health Teams (FHTs), an interprofessional model of primary health care in Ontario emerging from a period of health care reform. One hundred and twenty-eight (N = 128) respondents completed the online survey. Key barriers to social work integration in FHTs included difficulties associated with a medical model environment, confusion about social work role, and organizational barriers. Facilitators for integration of social work in FHTs included adequate education and competencies, collaborative engagement, and organizational structures.

"I Think He Will Have It Throughout His Whole Life": Parent and Youth Perspectives About Childhood Mental Health Problems

Children's mental health (CMH) problems can be long-lasting. Even among children and youth who receive specialized CMH treatment, recurrence of problems is common. It is unknown whether youth and their parents view the possibility of future mental health problems. This has important implications for how CMH services should be delivered. This grounded theory study gained perspectives from youth (aged 12-15 years) who received CMH treatment ( n = 10) and their parents ( n = 10) about the expected course of CMH problems. Three disorder trajectories emerged: (a) not chronic, (b) chronic and persistent, and (c) chronic and remitting, with the majority of youth falling in the third trajectory. A gap in available services between CMH and adult care was perceived by parents, leaving them either help hopeful or help hungry about their child's future care. Improving care for youth with ongoing mental health problems is needed to minimize costs to families and the system.

Classifiers and their Metrics Quantified

Molecular modeling frequently constructs classification models for the prediction of two‐class entities, such as compound bio(in)activity, chemical property (non)existence, protein (non)interaction, and so forth. The models are evaluated using well known metrics such as accuracy or true positive rates. However, these frequently used metrics applied to retrospective and/or artificially generated prediction datasets can potentially overestimate true performance in actual prospective experiments. Here, we systematically consider metric value surface generation as a consequence of data balance, and propose the computation of an inverse cumulative distribution function taken over a metric surface. The proposed distribution analysis can aid in the selection of metrics when formulating study design. In addition to theoretical analyses, a practical example in chemogenomic virtual screening highlights the care required in metric selection and interpretation.

The Future of Computational Chemogenomics

Following the elucidation of the human genome, chemogenomics emerged in the beginning of the twenty-first century as an interdisciplinary research field with the aim to accelerate target and drug discovery by making best usage of the genomic data and the data linkable to it. What started as a systematization approach within protein target families now encompasses all types of chemical compounds and gene products. A key objective of chemogenomics is the establishment, extension, analysis, and prediction of a comprehensive SAR matrix which by application will enable further systematization in drug discovery. Herein we outline future perspectives of chemogenomics including the extension to new molecular modalities, or the potential extension beyond the pharma to the agro and nutrition sectors, and the importance for environmental protection. The focus is on computational sciences with potential applications for compound library design, virtual screening, hit assessment, analysis of phenotypic screens, lead finding and optimization, and systems biology-based prediction of toxicology and translational research.

Real-world crude incidence of hypoglycemia in adults with diabetes: Results of the InHypo-DM Study, Canada

OBJECTIVE

Very few real-world studies have been conducted to assess the incidence of diabetes-related hypoglycemia. Moreover, there is a paucity of studies that have investigated hypoglycemia among people taking secretagogues as a monotherapy or in combination with insulin. Accordingly, our research team developed and validated the InHypo-DM Person with Diabetes Mellitus Questionnaire (InHypo-DMPQ) with the aim of capturing the real-world incidence of self-reported, symptomatic hypoglycemia. The questionnaire was administered online to a national sample of Canadians (≥18 years old) with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) treated with insulin and/or insulin secretagogues.

RESEARCH DESIGN AND METHODS

Self-report data obtained from the InHypo-DMPQ were descriptively analyzed to ascertain the crude incidence proportions and annualized incidence densities (rates) of 30-day retrospective non-severe and 1-year retrospective severe hypoglycemia, including daytime and nocturnal events.

RESULTS

A total of 552 people (T2DM: 83%; T1DM: 17%) completed the questionnaire. Over half (65.2%) of the total respondents reported experiencing at least one event (non-severe or severe) at an annualized crude incidence density of 35.1 events per person-year. The incidence proportion and rate of non-severe events were higher among people with T1DM versus T2DM (77% and 55.7 events per person-year vs 54% and 28.0 events per person-year). Severe hypoglycemia was reported by 41.8% of all respondents, at an average rate of 2.5 events per person-year.

CONCLUSIONS

The results of the InHypo-DMPQ, the largest real-world investigation of hypoglycemia epidemiology in Canada, suggest that the incidence of hypoglycemia among adults with diabetes taking insulin and/or insulin secretagogues is higher than previously thought.

Selection of Informative Examples in Chemogenomic Datasets

High-throughput and high-content screening campaigns have resulted in the creation of large chemogenomic matrices. These matrices form the training data which is used to build ligand-target interaction models for pharmacological and chemical biology research. While academic, government, and industrial efforts continuously add to the ligand-target data pairs available for modeling, major research efforts are devoted to improving machine learning techniques to cope with the sparseness, heterogeneity, and size of available datasets as well as inherent noise and bias. This "race of arms" has led to the creation of algorithms to generate highly complex models with high prediction performance at the cost of training efficiency as well as interpretability.In contrast, recent studies have challenged the necessity for "big data" in chemogenomic modeling and found that models built on larger numbers of examples do not necessarily result in better predictive abilities. Automated adaptive selection of the training data (ligand-target instances) used for model creation can result in considerably smaller training sets that retain prediction performance on par with training using hundreds of thousands of data points. In this chapter, we describe the protocols used for one such iterative chemogenomic selection technique, including model construction and update as well as possible techniques for evaluations of constructed models and analysis of the iterative model construction.

Social work's scope of practice in the provision of primary mental health care: protocol for a scoping review

INTRODUCTION

Social work is a key member of interprofessional primary healthcare teams and foundational to primary healthcare reforms that aim to improve the provision of mental healthcare. Little is known, however, about social work's scope of practice within primary healthcare settings, particularly in the provision of mental healthcare. The objective of this study is to identify and describe social work's scope of practice as it relates to mental healthcare in primary healthcare settings.

METHODS AND ANALYSIS

A scoping review will be conducted using the methodology established by Arksey and O'Malley. We will search electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, Social Services Abstracts and Social Work Abstracts) to identify studies appropriate for inclusion. One reviewer will independently screen all abstracts and full-text studies for inclusion, with supervision by lead investigator. We will include any study that focuses on social work and mental healthcare within primary healthcare settings. All bibliographic data, study characteristics and range of social work practice activities will be collected and analysed using a tool developed by the research team.

ETHICS AND DISSEMINATION

The scoping review will synthesise social work's scope of practice in the provision of mental healthcare within primary healthcare settings. This review will be the first step to formally develop guidelines for social work practice in primary healthcare. The results will be disseminated through a peer-reviewed publication and conference presentations.

Using the Woman Abuse Screening Tool to Screen for and Assess Dating Violence in College Students

The study aimed to evaluate the measurement properties of the Woman Abuse Screening Tool (WAST) in Chinese college students. A cross-sectional survey was conducted in Hong Kong. A cutoff score of 10 was found to be able to discriminate between abused and nonabused Chinese young adults. The total score was significantly correlated with total scores for anxiety and depression on the Chinese version of the Hospital Anxiety and Depression Scale. Two-factor structure of the WAST was supported by exploratory and confirmatory factor analyses. The Chinese WAST was found to be valid in screening for and assessing intimate partner violence.

Association between UGT1A1*28*28 genotype and lung cancer in the Japanese population

BACKGROUND

Lung cancer is the leading cause of cancer death and is closely linked to tobacco smoking. Genetic polymorphisms in genes that encode enzymes involved in metabolizing tobacco carcinogens could affect an individual's risk for lung cancer. While polymorphism of UDP-glucuronosyltransferase1A1 (UGT1A1) is involved in detoxification of benzo(a)pyrene-7,8-dihydrodiol(-), a major tobacco carcinogen, the association between UGT1A1 genotype and lung cancer has not been examined.

METHODS

We retrieved the clinical data of 5,285 patients who underwent systemic chemotherapy at Kyoto University Hospital. A total of 765 patients (194 lung cancer patients and 671 patients with other malignancies) with UGT1A1 genotyping data were included in this analysis. We used logistic regression with recessive, dominant, and additive models to identify differences in genotype frequencies between lung cancer and other malignancies.

RESULTS

In the recessive model, UGT1A1*28*28 genotype was significantly associated with lung cancer compared to other malignancies (odds ratio 5.3, P = 0.0083). Among lung cancer patients with a smoking history, squamous cell carcinoma was significantly predominant in patients with UGT1A1*28*28 compared to those with other UGT1A1 genotypes (P = 0.024).

CONCLUSION

This is the first study to demonstrate a significant association between the homozygous UGT1A1*28 genotype and lung cancer.

Asking patients about their religious and spiritual beliefs: Cross-sectional study of family physicians

OBJECTIVE

To examine family physicians' practices in and opinions on asking patients about their religious and spiritual beliefs, as well as physicians' comfort levels in asking.

DESIGN

Cross-sectional study using self-administered questionnaires.

SETTING

Kitchener-Waterloo, Ont.

PARTICIPANTS

A total of 155 family physicians with office practices.

MAIN OUTCOME MEASURES

Frequency of asking patients about their religious and spiritual beliefs and physicians' comfort levels in asking. Separate multiple linear regression analyses were conducted for each of these outcomes.

RESULTS

A total of 139 questionnaires were returned for a response rate of 89.7 %. Of the respondents, 51.8 % stated that they asked patients about their religious and spiritual beliefs sometimes. Physician opinion that it was important to ask patients about religious and spiritual beliefs (P = .001) and physician comfort level with asking (P < .001) were significantly associated with physicians' frequency of asking patients about their religious and spiritual beliefs. Comfort level with asking patients about their religious and spiritual beliefs was significantly associated with the opinions that it was important to ask (P = .004) and that it was their business to ask (P = .003), as well as with lack of training as the reason for not asking (P = .007).

CONCLUSION

This study found that family physicians were more likely to ask patients about their religious and spiritual beliefs if they had higher comfort levels in asking or if they believed that asking was important. Further, this study found that family physicians' comfort level with asking was higher if they believed that it was important to ask and that it was their business to ask about religious and spiritual beliefs. Physician comfort levels with asking patients about religious and spiritual beliefs can be addressed through adequate training and education.

Implementing and Using a Patient Portal: A qualitative exploration of patient and provider perspectives on engaging patients

BACKGROUND

The use of portals might be expected to rise; however, adoption has been slow. Development of portals has occurred with limited patient involvement. This paper fills a need for literature concerning perspectives regarding the value of portals, how best to organize and provide portals, and critically how to seek patient involvement in implementation.ObjectiveThe objective was to explore the feelings, ideas, and expectations of patients and primary care providers concerning the implementation and use of patient portals.

METHOD

The study employed a descriptive qualitative design interviewing seven patients and four providers from an interdisciplinary primary health care clinic in Ontario, Canada. Patients were older with at least one chronic condition. Interviews were analysed independently by three coders who then met to synthesize the findings.

RESULTS

There was limited experience of portals and substantial convergence between patients and providers regarding concerns and potential benefits with an overall positive view. Four themes emerged: 1) the Context in which patient portal use takes place; 2) the Necessary conditions for use of a patient portal; 3) the Implementation of a patient portal; and 4) the Use of a patient portal for care.

CONCLUSIONS

Findings highlight that it is not sufficient to engage patients in the use of a portal; it is critical that patients be engaged in the early stages of implementation. With many health and fitness electronic tools available (e.g. Fitbit©), this study remind us that tools are not enough. Patient engagement requires patient-centred partnerships between patients and health care providers.

Men with Prostate Cancer: Making Decisions about Complementary/Alternative Medicine

Purpose. The purpose ofthis study was to explore prostate cancer patients’ perceptions, feelings, ideas, and experiences regarding making decisions to use (or not use) complementary/alternative medicine (CAM). Methods. Five focus groups were conducted with 29 men diagnosed with prostate cancer. Content analysis ofthe verbatim transcripts was used to identify key themes in the data. Findings. Decision making about CAM treatments appears to depend on both fixed (e.g., disease characteristics, demographic characteristics, and medical history) and flexible (e.g., perceptions of CAM and conventional-medicine, experiences with the health care system and health care practitioners, and perceptions about the need for control or action) decision factors. Conclusions. The participants in this study appeared more likely to be “pushed” toward using CAM by negative experiences with the health care system than to be “pulled” toward CAM by perceptions about its safety or congruence with their beliefs about health and illness.

Processes of patient-centred care in Family Health Teams: a qualitative study

BACKGROUND

Patient-centred care, access to care, and continuity of and coordination of care are core processes in primary health care delivery. Our objective was to evaluate how these processes are enacted by 1 primary care model, Family Health Teams, in Ontario.

METHODS

Our study used grounded theory methodology to examine these 4 processes of care from the perspective of health care providers. Twenty Family Health Team practice sites in Ontario were selected to represent maximum variation (e.g., location, year of Family Health Team approval). Semi-structured interviews were conducted with each participant. A constant comparative approach was used to analyze the data.

RESULTS

Our final sample population involved 110 participants from 20 Family Health Teams. Participants described how their Family Health Team strived to provide patient-centred care, to ensure access, and to pursue continuity and coordination in their delivery of care. Patient-centred care was provided through a variety of means forging the links among the other processes of care. Participants from all teams articulated a commitment to timely access, spontaneously expressing the importance of access to mental health services. Continuity of care was linked to both access and patient-centred care. Coordination of care by the team was perceived to reduce unnecessary walk-in clinic and emergency department visits, and facilitated a smoother transition from hospital to home.

INTERPRETATION

These 4 processes of patient care were inextricably linked. Patient-centred care was the focal point, and these processes in turn served to enhance the delivery of patient-centred care.

Influence of a quality improvement learning collaborative program on team functioning in primary healthcare

Quality improvement (QI) programs are frequently implemented to support primary healthcare (PHC) team development and to improve care outcomes. In Ontario, Canada, the Quality Improvement and Innovation Partnership (QIIP) offered a learning collaborative (LC) program to support the development of interdisciplinary team function and improve chronic disease management, disease prevention, and access to care. A qualitative study using a phenomenological approach was conducted as part of a mixed-method evaluation to explore the influence of the program on team functioning in participating PHC teams. A purposive sampling strategy was used to identify PHC teams (n = 10), from which participants of different professional roles were selected through a purposeful recruitment process to reflect maximum variation of team roles. Additionally, QI coaches working with the interview participants and the LC administrators were also interviewed. Data were collected through semistructured telephone interviews that were audiotaped and transcribed verbatim. Thematic analysis was conducted through an iterative and interpretive approach. The shared experience of participating in the program appeared to improve team functioning. Participants described increased trust and respect for each other's clinical and administrative roles and were inspired by learning about different approaches to interdisciplinary care. This appeared to enhance collegial relationships, collapse professional silos, improve communication, and increase interdisciplinary collaboration. Teamwork involves more than just physically grouping healthcare providers from multiple disciplines and mandating them to work together. The LC program provided opportunities for participants to learn how to work collaboratively, and participation in the LC program appeared to enhance team functioning.