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Garcia C, Holbrook A, Djiadeu P, Alvarez E, Matos Silva J, Mbuagbaw L. Developing a reporting item checklist for studies of HIV drug resistance prevalence or incidence: a mixed methods study. BMJ Open 2024; 14:e080014. [PMID: 38548361 PMCID: PMC10982790 DOI: 10.1136/bmjopen-2023-080014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/18/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Adequate surveillance of HIV drug resistance prevalence is challenged by heterogenous and inadequate data reporting. To address this issue, we recently published reporting guidance documentation for studies of HIV drug resistance prevalence and incidence. OBJECTIVES In this study, we describe the methods used to develop this reporting guidance. DESIGN We used a mixed-methods sequential explanatory design involving authors and users of studies of HIV drug resistance prevalence. In the quantitative phase, we conducted a cross-sectional electronic survey (n=51). Survey participants rated various reporting items on whether they are essential to report. Validity ratios were computed to determine the items to discuss in the qualitative phase. In the qualitative phase, two focus group discussions (n=9 in total) discussed this draft item checklist, providing a justification and examples for each item. We conducted a descriptive qualitative analysis of the group discussions to identify emergent themes regarding the qualities of an essential reporting item. RESULTS We identified 38 potential reporting items that better characterise the study participants, improve the interpretability of study results and clarify the methods used for HIV resistance testing. These items were synthesised to create the reporting item checklist. Qualitative insights formed the basis of the explanation, elaboration, and rationale components of the guidance document. CONCLUSIONS We generated a list of reporting items for studies on the incidence or prevalence of HIV drug resistance along with an explanation of why researchers believe these items are important. Mixed methods allowed for the simultaneous generation and integration of the item list and qualitative insights. The integrated findings were then further developed to become the subsequently published reporting guidance.
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Affiliation(s)
- Cristian Garcia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anne Holbrook
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Clinical Pharmacology & Toxicology Research, Research Institute of St Joes Hamilton, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Pascal Djiadeu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Jéssyca Matos Silva
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Chen Y, Ingram C, Downey V, Roe M, Sripaiboonkij P, Buckley CM, Alvarez E, Perrotta C, Buggy C. Pandemic preparedness from the perspective of Occupational Health professionals. Occup Med (Lond) 2024; 74:93-98. [PMID: 38085666 PMCID: PMC10875927 DOI: 10.1093/occmed/kqad119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Prior to any infectious disease emergence as a public health concern, early occupational preparedness is crucial for protecting employees from novel pathogens- coronavirus disease 2019 (COVID-19) is no different. AIMS This study ascertains how occupational safety and health (OSH)/Human Resource (HR) professionals in the Republic of Ireland had managed to prepare their workplaces prior to the advent of COVID-19. METHODS As part of a larger COVID-19 workplace study, online focus groups were conducted with OSH/HR professionals. Collected data were transcribed verbatim and entered into NVivo for thematic analysis incorporating intercoder reliability testing. RESULTS Fifteen focus groups were conducted with OSH/HR professionals (n = 60) from various occupational settings. Three levels of organizational preparedness were identified: 'early awareness and preparation'; 'unaware and not ready' and 'aware, but not ready'. Most organizations were aware of the COVID-19 severity, but not fully prepared for the pandemic, especially stand-alone enterprises that may not have sufficient resources to cope with an unanticipated crisis. The experiences shared by OSH professionals illustrate their agility in applying risk management and control skills to unanticipated public/occupational health crises that arise. CONCLUSIONS General pandemic preparedness such as the availability of work-from-home policies, emergency scenario planning and prior experience in workplace outbreaks of infectious diseases were helpful for workplace-associated COVID-19 prevention. This is the first study conducted with OSH/HR professionals in Ireland regarding COVID-19 preparedness in workplaces, which provides valuable insights into research literature, as well as empirical experience for the preparation of future public health emergencies.
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Affiliation(s)
- Y Chen
- Applied Aviation Science Department, Embry-Riddle Aeronautical University, Daytona Beach, FL 32114, USA
| | - C Ingram
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - V Downey
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - M Roe
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - P Sripaiboonkij
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Centre for Safety and Health at Work, University College Dublin, Dublin, Ireland
| | - C M Buckley
- Health Service Executive, Dublin, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - E Alvarez
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - C Perrotta
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - C Buggy
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Centre for Safety and Health at Work, University College Dublin, Dublin, Ireland
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Cummings H, Ul Haq MZ, Dargham A, Shakeel N, Busse JW, Darzi AJ, Alvarez E. Individuals' Values and Preferences Regarding Medical Cannabis for Chronic Pain: A Descriptive Qualitative Study. J Pain Res 2024; 17:21-34. [PMID: 38192366 PMCID: PMC10771731 DOI: 10.2147/jpr.s432823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Background Cannabis for medical purposes has been legal in Canada since 2001; however, physicians receive no formal training in this modality, and clinical use of cannabis remains controversial. This study aims to explore the values and preferences of people living with chronic pain (PLwCP) in using medical cannabis for chronic pain to inform guideline development and shared decision-making in clinical practice. Methods We conducted a descriptive qualitative study using in-depth interviews with PLwCP. Using a deductive/inductive approach, we developed concepts and themes related to values and preferences of PLwCP on their use (or avoidance) of medical cannabis for chronic pain. Results We interviewed 52 PLwCP, including current medical cannabis users (40), previous users (10) and non-users (2). Most PLwCP who used cannabis therapeutically reported the need for experimentation to determine what cannabis products, routes, and doses worked for them. Perceived benefits of medical cannabis among current users included relief from pain, better sleep, and improved mental health. Reasons for discontinuing use of medical cannabis included lack of improvement in pain or sleep or undesirable side effects. Cannabidiol (CBD) dominant products were reported to result in minimal adverse effects (eg, physical or mental impairment) compared to tetrahydrocannabinol (THC) dominant products. Perceived barriers or facilitators to use included social acceptability, availability or access, cost, and attitudes and knowledge among healthcare providers. Participants noted different routes of cannabis use including oral routes that provided longer-lasting pain relief with a slower onset and inhaled routes with a more rapid onset with shorter-lived effects. Conclusion Participants' decisions to use medical cannabis for chronic pain were varied, which suggests these decisions are likely to be sensitive to individuals' values and preferences. There is a call for further research and information-sharing to help PLwCP understand the complexities of cannabis use for medical purposes, including ideal dosing and timing.
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Affiliation(s)
- Hanson Cummings
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Moizza Zia Ul Haq
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Amne Dargham
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nauman Shakeel
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Andrea J Darzi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
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Singh J, Poon DEO, Alvarez E, Anderson L, Verschoor CP, Sutton A, Zendo Z, Piggott T, Apatu E, Churipuy D, Culbert I, Hopkins JP. Burnout among public health workers in Canada: a cross-sectional study. BMC Public Health 2024; 24:48. [PMID: 38166742 PMCID: PMC10763416 DOI: 10.1186/s12889-023-17572-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND This study presents the prevalence of burnout among the Canadian public health workforce after three years of the COVID-19 pandemic and its association with work-related factors. METHODS Data were collected using an online survey distributed through Canadian public health associations and professional networks between November 2022 and January 2023. Burnout was measured using a modified version of the Oldenburg Burnout Inventory (OLBI). Logistic regressions were used to model the relationship between burnout and work-related factors including years of work experience, redeployment to pandemic response, workplace safety and supports, and harassment. Burnout and the intention to leave or retire as a result of the COVID-19 pandemic was explored using multinomial logistic regressions. RESULTS In 2,079 participants who completed the OLBI, the prevalence of burnout was 78.7%. Additionally, 49.1% of participants reported being harassed because of their work during the pandemic. Burnout was positively associated with years of work experience, redeployment to the pandemic response, being harassed during the pandemic, feeling unsafe in the workplace and not being offered workplace supports. Furthermore, burnout was associated with greater odds of intending to leave public health or retire earlier than anticipated. CONCLUSION The high levels of burnout among our large sample of Canadian public health workers and its association with work-related factors suggest that public health organizations should consider interventions that mitigate burnout and promote recovery.
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Affiliation(s)
- Japteg Singh
- Niagara Region Public Health, Thorold, ON, Canada
| | - David E-O Poon
- Public Health and Preventive Medicine Residency Program, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Laura Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Chris P Verschoor
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Health Sciences North Research Institute, Sudbury, ON, Canada
| | - Arielle Sutton
- MD Program, Faculty of Medicine and Dentistry, Schulich School of Medicine, Western University, London, ON, Canada
| | - Zayya Zendo
- MD Program, Faculty of Medicine and Dentistry, Schulich School of Medicine, Western University, London, ON, Canada
| | - Thomas Piggott
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Peterborough Public Health, Peterborough, ON, Canada
| | - Emma Apatu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Ian Culbert
- Canadian Public Health Association, Ottawa, ON, Canada
| | - Jessica P Hopkins
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
- Public Health Ontario, Toronto, ON, Canada.
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Pavalagantharajah S, Negrin AR, Bouzanis K, Joan Lee TS, Miller P, Jones R, Sinnott W, Alvarez E. Facility-Based Maternal Quality of Care Frameworks: A Systematic Review and Best Fit Framework Analysis. Matern Child Health J 2023; 27:1742-1753. [PMID: 37418097 DOI: 10.1007/s10995-023-03702-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES The World Health Organization has adopted two main strategies to improve the quality of maternal health: increasing the number of deliveries by skilled birth attendants and increasing access to emergency obstetric care. Despite increased access to care, there continue to be high rates of maternal morbidity and mortality in part due to quality of care. This study aims to identify and summarize existing frameworks for measuring quality of maternal care at a facility-level. METHODS PubMed, Health Systems Evidence, Embase, Global Health, OVID Healthstar, OVID Medline, PsycINFO, and Web of Science were searched for frameworks, tools, theories, or components of frameworks relevant to maternal quality of care in facility-level settings. Title/abstract and full-text screening were completed by two independent reviewers and conflicts resolved through consensus or a third reviewer. RESULTS An initial search resulted in 3182 studies. Fifty-four studies were included in the qualitative analysis. A best fit framework analysis was done using the updated Hulton framework as the conceptual framework. A facility-based maternal quality of care framework is proposed including the following components, separated into provision and experience of care: (1) human resources; (2) infrastructure; (3) equipment, supplies and medicine; (4) evidence and information; (5) referral and networks of care; (6) cultural competence; (7) clinical practice; (8) financing; (9) leadership and governance; (10) cognition; and 11) respect, dignity, equity, and emotional support.
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Affiliation(s)
| | | | - Katrina Bouzanis
- Department of Global Health, McMaster University, Hamilton, ON, Canada
| | - Tin-Suet Joan Lee
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Peter Miller
- Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Rebecca Jones
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Will Sinnott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
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Anderson LN, Alvarez E, Incze T, Tarride JE, Kwan M, Mbuagbaw L. Motivational interviewing to promote healthy behaviors for obesity prevention in young adults (MOTIVATE): a pilot randomized controlled trial protocol. Pilot Feasibility Stud 2023; 9:156. [PMID: 37679845 PMCID: PMC10483727 DOI: 10.1186/s40814-023-01385-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Obesity is a chronic disease and is an established risk factor for other chronic diseases and mortality. Young adulthood is a period when people may be highly amenable to healthy behavior change, develop lifelong healthy behaviors, and when primary prevention of obesity may be feasible. Interventions in early adulthood have the potential for primary or primordial prevention (i.e., preventing risk factors before disease onset). The primary objective of this study is to determine the feasibility of a 6-month behavioral and educational intervention to promote healthy behaviors for obesity prevention among young adults. METHODS This is the study protocol for a pilot randomized controlled trial. Young adults (age 18-29) attending McMaster University, Hamilton, Canada, will be recruited and randomized to either the intervention or control. The intervention will include individual motivational interviewing sessions (online or in-person) with a trained interviewer plus educational materials (based on Canada's food guide and physical activity recommendations). The control group will receive educational materials only. The primary feasibility outcomes that will be evaluated as part of this pilot study include enrollment, retention (≥ 80%), data completion (≥ 80% of weights measured, and surveys completed), and participant satisfaction. Secondary clinical outcomes will include body mass index (BMI) change from baseline to 6 months, physical activity, nutrition risk, health-related quality of life mental health, and economic outcomes. Outcomes will be measured remotely using activity trackers, and online questionnaires at baseline and every 2 months. Risk stratification will be applied at baseline to identify participants at high risk of obesity (e.g., due to family or personal history). Exit questionnaires will collect data on how participants felt about the study and cost analysis will be conducted. DISCUSSION Our pilot randomized controlled trial will evaluate the feasibility of an obesity prevention intervention in early adulthood and will inform future larger studies for obesity prevention. The results of this study have the potential to directly contribute to the primary prevention of several types of cancer by testing an intervention that could be scalable to public health, post-secondary education, or primary care settings. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT05264740 . Registered on March 3, 2022.
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Affiliation(s)
- Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada.
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, ON, Canada.
- Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada.
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
- Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
| | - Taylor Incze
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
- Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare, Hamilton, Canada
| | - Matthew Kwan
- Department of Child and Youth Studies, Brock University, St. Catharines, ON, Canada
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Department of Anaesthesia, McMaster University, Hamilton, ON, Canada
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Alvarez E, Nichelason A, Lygo-Baker S, Olin S, Whittemore J, Ng Z. Virtual Clinics: A Student-Led, Problem-Based Learning Approach to Supplement Veterinary Clinical Experiences. J Vet Med Educ 2023; 50:147-161. [PMID: 35500194 DOI: 10.3138/jvme-2021-0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The COVID-19 pandemic created an abrupt need for effective remote clinical experiences for senior clinical veterinary students. Subsequently, the authors created virtual clinics. This activity was derived from a problem-based learning (PBL) model wherein students designed clinical cases and participated through virtual role play as clients and clinicians. The purpose of this article is to describe virtual clinics and to report data from focus groups of participating students and faculty facilitators from two institutions regarding the positive and negative aspects of the shift in practice. A few common emerging themes included that case rounds were fun and engaging, students could learn at their own pace, and peer-to-peer learning opportunities had perceived value. Themes are reflected against the pedagogical literature to draw out areas that resonated. Students felt this activity was more engaging than listening to a discussion of a case they had no ownership of, and facilitators agreed that the peer-to-peer interactions added to student engagement. Additionally, students developed deeper knowledge about the underlying disease process and clinical presentation of their case, which required independent and self-directed learning, enabling students to think about a case from a client's perspective. By participating in these activities, students developed skills of classroom-to-clinic transitional value. While virtual clinics should not replace in-person clinical experiences, this activity might be useful to facilitate students' transition from a structured classroom setting to a less-structured clinical experience.
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Affiliation(s)
- Elizabeth Alvarez
- Department of Medical Sciences, University of Wisconsin-Madison, 2015 Linden Dr., Madison, WI 53706 USA
| | - Amy Nichelason
- Department of Medical Sciences, University of Wisconsin-Madison, 2015 Linden Dr., Madison, WI 53706 USA
| | - Simon Lygo-Baker
- Surrey Institute of Education, University of Surrey, Guildford, Surrey GU2 7XH UK
| | - Shelly Olin
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, 2407 River Dr., Knoxville, TN 37996 USA
| | - Jacqueline Whittemore
- Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, 2407 River Dr., Knoxville, Knoxville TN 37996 USA
| | - Zenithson Ng
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, 2407 River Dr., Knoxville, TN 37996 USA
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Newbold KB, Valaitis R, Phillips S, Alvarez E, Neil-Sztramko S, Sihota D, Tandon M, Nadarajah A, Wang A, Moore C, Orr E, Ganann R. Enhancing Physical and Community MoBility in OLDEr Adults with Health Inequities Using CommuNity Co-Design (EMBOLDEN): Results of an Environmental Scan. Can Geriatr J 2023; 26:23-30. [PMID: 36865406 PMCID: PMC9953504 DOI: 10.5770/cgj.26.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Background Using the comparatively new environmental scan methodology, a protocol was developed and conducted to inform the co-design and implementation of a novel intervention to promote mobility among older adults in Hamilton, Ontario, Canada. The EMBOLDEN program seeks to promote physical and community mobility in adults 55 years and older who face barriers accessing community programs and who reside in areas of high inequity in Hamilton, and to address the following areas of focus: physical activity, nutrition, social participation, and system navigation supports. Methods The environmental scan protocol was developed using existing models and drew insights from census data, a review of existing services, organizational representative interviews, windshield surveys of selected high-priority neighbourhoods, and Geographic Information System (GIS) mapping. Results A total of 98 programs for older adults from 50 different organizations were identified, with the majority (92) supporting mobility, physical activity, nutrition, social participation, and system navigation. The analysis of census tract data identified eight high-priority neighbourhoods characterized by large shares of older adults, high material deprivation, low income, and high proportion of immigrants. These populations can be hard to reach and face multiple barriers to participation in community-based activities. The scan also revealed the nature and types of services geared toward older adults in each neighbourhood, with each priority neighbourhood having at least one school and park. Most areas had a range of services and supports (i.e., health care, housing, stores, religious options), although there was a lack of diverse ethnic community centres and income-diverse activities specific to older adults in most neighbourhoods. Neighbourhoods also differed in the geographic distribution number of services, along with the number of recreational services specific to older adults. Barriers included financial and physical accessibility, lack of ethnically diverse community centres, and food deserts. Conclusions Scan results will inform the co-design and implementation of the Enhancing physical and community MoBility in OLDEr adults with health inequities using commuNity co-design intervention-EMBOLDEN.
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Affiliation(s)
- K. Bruce Newbold
- School of Earth, Environment & Society, McMaster University, Hamilton, ON
| | - Ruta Valaitis
- School of Nursing, McMaster University, Hamilton, ON
| | - Stuart Phillips
- Department of Kinesiology, McMaster University, Hamilton, ON
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON
| | - Sarah Neil-Sztramko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON
| | - Davneet Sihota
- Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - Mainka Tandon
- School of Nursing, McMaster University, Hamilton, ON
| | | | - Amy Wang
- Faculty of Health Sciences, McMaster University, Hamilton, ON
| | | | - Elizabeth Orr
- Nursing, Brock University, St. Catharines, ON, Canada
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Alvarez E, Bielska IA, Hopkins S, Belal AA, Goldstein DM, Slick J, Pavalagantharajah S, Wynfield A, Dakey S, Gedeon MC, Alam E, Bouzanis K. Limitations of COVID-19 testing and case data for evidence-informed health policy and practice. Health Res Policy Syst 2023; 21:11. [PMID: 36698202 PMCID: PMC9876649 DOI: 10.1186/s12961-023-00963-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 01/15/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) became a pandemic within a matter of months. Analysing the first year of the pandemic, data and surveillance gaps have subsequently surfaced. Yet, policy decisions and public trust in their country's strategies in combating COVID-19 rely on case numbers, death numbers and other unfamiliar metrics. There are many limitations on COVID-19 case counts internationally, which make cross-country comparisons of raw data and policy responses difficult. PURPOSE AND CONCLUSIONS This paper presents and describes steps in the testing and reporting process, with examples from a number of countries of barriers encountered in each step, all of which create an undercount of COVID-19 cases. This work raises factors to consider in COVID-19 data and provides recommendations to inform the current situation with COVID-19 as well as issues to be aware of in future pandemics.
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Affiliation(s)
- Elizabeth Alvarez
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence and Impact, McMaster University, CRL 2nd Floor, 1280 Main Street West, Hamilton, ON L8S4K1 Canada
| | - Iwona A. Bielska
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence and Impact, McMaster University, CRL 2nd Floor, 1280 Main Street West, Hamilton, ON L8S4K1 Canada
| | - Stephanie Hopkins
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence and Impact, McMaster University, CRL 2nd Floor, 1280 Main Street West, Hamilton, ON L8S4K1 Canada
| | - Ahmed A. Belal
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence and Impact, McMaster University, CRL 2nd Floor, 1280 Main Street West, Hamilton, ON L8S4K1 Canada
| | - Donna M. Goldstein
- grid.266190.a0000000096214564Department of Anthropology, University of Colorado Boulder, Boulder, CO USA
| | - Jean Slick
- grid.262714.40000 0001 2180 0902Disaster and Emergency Management, Royal Roads University, British Columbia, Canada
| | | | - Anna Wynfield
- grid.266190.a0000000096214564Department of Anthropology, University of Colorado Boulder, Boulder, CO USA
| | - Shruthi Dakey
- grid.433837.80000 0001 2301 2002Department of Architecture and Planning, Visvesvaraya National Institute of Technology, Nagpur, India
| | - Marie-Carmel Gedeon
- grid.459278.50000 0004 4910 4652University Integrated Health Center of the Nord-de-l’île de Montréal (CIUSSS NIM), Montréal, QC Canada
| | - Edris Alam
- Faculty of Resilience, Rabdan Academy, Abu Dhabi, United Arab Emirates
| | - Katrina Bouzanis
- grid.25073.330000 0004 1936 8227Department of Global Health, McMaster University, Hamilton, ON Canada
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Martín Lozano R, Roche-Molina M, Alvarez E, Del Monte-Millan M, Jerez Gilarranz Y, Moreno Anton F, García Saenz J, Echavarria Diaz-Guardamino I, Massarrah T, Cebollero M, Ballesteros Garcia A, Bohn Sarmiento U, Gomez Moreno H, Fuentes H, Herrero Lopez B, Gamez Casado S, Bueno Muiño C, Bueno O, Lopez-Tarruella Cobo S, Martin Jimenez M. 216P Relationship between regulatory T lymphocytes (Treg): Related genes and pathological response to neoadjuvant docetaxel-carboplatin in early-stage triple-negative breast cancer (TNBC). Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Alvarez E, Lygo-Baker S, Schultz K, Gilles W, Chun R. Veterinary and Pharmacy Students' Expectations Before and Experiences After Participating in an Interdisciplinary Access to Care Veterinary Clinic, WisCARES. J Vet Med Educ 2022; 49:610-617. [PMID: 34351831 DOI: 10.3138/jvme-2021-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This pilot survey study describes student expectations and experiences at WisCARES, a low-cost veterinary medical teaching clinic where students from multiple disciplines collaborate. We hypothesized that prior to the workday, students would describe different expectations of working in an interdisciplinary access to care clinic than what they ultimately experienced. We surveyed 62 students from the School of Veterinary Medicine (46) and pharmacy (16) who spent a clinic day at WisCARES. Before introductory rounds, students completed a short survey consisting of four open-ended questions about their learning expectations; at the end of the day, they reviewed their initial responses and added what they actually learned. Qualitative information was categorized and analyzed using descriptive statistics. Thirteen major themes emerged: diversity, confidence, communication, case lead/case management, financial experience, helping people, teamwork, technical skills, inter-professional experience, mentoring, non-specific positive regard, appreciation for resources, and rounds. Students reported improved confidence in managing and leading cases with specific positive outcomes in communicating with clients, particularly regarding leading financial conversations. Developing greater insight into diversity was a common theme expressed in students' expectations but was less frequently noted as an end-of-day outcome. Veterinary students less frequently described the value of the inter-professional environment and collaboration, but this was a major theme noted among pharmacy students. Student feedback was positive overall. The current study is useful in identifying areas for improving collaborative instruction and access to care professional student learning opportunities.
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Ramia JM, Cabello A, Garijo J, Hernandez-Salvan J, Herrero B, Jover JM, Vaquero MA, Unda A, Jimenez A, Martinez-Meco L, Nicolas S, Sanchez-Cabezudo F, Alvarez E, Torres J. Benefica chirurgia. A global surgery project focusing on hernia surgery. Surgeon 2022; 20:309-313. [PMID: 34483056 DOI: 10.1016/j.surge.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/19/2021] [Accepted: 08/04/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of international health cooperation projects is to alleviate the deficiencies in the area of health in low resource settings. Hernia surgery is a procedure that is well suited to these missions, due to its low morbidity, the fact that it can be performed on an outpatient basis, and the improvement in quality of life that it provides. OBJECTIVE To describe the results of Benefica Chirurgia (BC), a Spanish non-profit humanitarian association in hernia pathology. METHODS Five one-week surgical campaigns were carried out in Ecuador between 2015 and 2019, involving anesthetists, general and pediatric surgeons. Surgical and medical equipment was provided and transported by BC. ASA I/II patients underwent surgery. RESULTS Surgery was performed on 240 patients with hernia pathology on 27 days. Sixty-three per cent of patients were male and the mean age was 48.2 years (range: 1-83). Hernia location was inguinal in 113 patients, umbilical in 101, and other in 26. The anesthetic technique used was spinal in 185 patients (77.1%), local plus intravenous sedation in 31 (12.9%), and general in 24 (10%). The surgical technique used was hernioplasty in 191 patients, herniorrhaphy in 31, incisional hernia repair in 15 and herniotomy in three. Surgery was performed on an outpatient basis in 98.4% of cases. Morbidity was 2%. Long-term postoperative evaluation is very complex. CONCLUSION These campaigns make a significant contribution to health in low resource settings and provide great personal satisfaction for those involved. Standards achieved in the immediate postoperative period were similar to those obtained at the surgeons' centers in Europe. However, it is difficult to establish the rates of recurrence and chronic pain.
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Affiliation(s)
- J M Ramia
- Department of Surgery, Hospital Universitario de Alicante, ISABIAL, Alicante, Spain.
| | - A Cabello
- Department of Surgery, Hospital Regional Carlos Haya, Malaga, Spain
| | - J Garijo
- Department of Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - J Hernandez-Salvan
- Department of Anesthesia, Hospital Universitario Principes de Asturias, Alcalá de Henares, Spain
| | - B Herrero
- Department of Anesthesia, Hospital Universitario Principes de Asturias, Alcalá de Henares, Spain
| | - J M Jover
- Department of Surgery, Hospital Universitario de Getafe, Getafe, Spain
| | - M A Vaquero
- Department of Anesthesia, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - A Unda
- Department of Surgery, Hospital Regional Carlos Haya, Malaga, Spain
| | - A Jimenez
- Department of Anesthesia, Hospital Universitario Principes de Asturias, Alcalá de Henares, Spain
| | - Laura Martinez-Meco
- Department of Anesthesia, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - S Nicolas
- Department of Surgery, Hospital Regional Carlos Haya, Malaga, Spain
| | - F Sanchez-Cabezudo
- Department of Surgery, Hospital Infanta Sofía, San Sebastian de Los Reyes, Madrid, Spain
| | - E Alvarez
- Department of Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - J Torres
- Department of Surgery, Hospital Infanta Sofía, San Sebastian de Los Reyes, Madrid, Spain; President of Benefica Chirugia, Spain
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Echavarria Diaz-Guardamino I, Lopez-Tarruella Cobo S, Del Monte-Millan M, Alvarez E, Jerez Y, Moreno Anton F, García Saenz J, Massarrah T, Ocaña I, Cebollero M, Ballesteros Garcia A, Bohn Sarmiento U, Gomez H, Fuentes H, Herrero Lopez B, Gamez Casado S, Bueno O, Jiménez-Santos M, Roche-Molina M, Martin Jimenez M. 141MO Pathological response and early survival data according to TNBCtype4 classifier in operable triple-negative breast cancer (TNBC) treated with neoadjuvant carboplatin and docetaxel. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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Chen Y, Ingram C, Downey V, Roe M, Drummond A, Sripaiboonkij P, Buckley C, Alvarez E, Perrotta C, Buggy C. Employee Mental Health During COVID-19 Adaptation: Observations of Occupational Safety and Health/Human Resource Professionals in Ireland. Int J Public Health 2022; 67:1604720. [PMID: 36016962 PMCID: PMC9396539 DOI: 10.3389/ijph.2022.1604720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 07/04/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives: This study aims to understand mental health issues among Irish employees arising from COVID-19 adaptation from the perspective of Occupational Safety and Health (OSH) and/or Human Resource (HR) professionals. Methods: Fifteen focus groups including 60 OSH/HR professionals from various sectors were conducted covering four predetermined themes. The data were transcribed verbatim, with transcripts entered into Nvivo for thematic analysis incorporating intercoder reliability testing. Results: The mental health impacts among employees are identified from three stages: pre-adaptation, during adaptation, and post-adaptation. Most issues were reported during the second stage when working conditions dramatically changed to follow emerging COVID-19 policies. The identified mental health support from participating organizations included providing timely and reliable information, Employee Assistance Programme (EAP), informal communication channels, hybrid work schedules and reinforcement of control measures. Conclusion: This study explores the challenges facing employees during the different stages of COVID-19 adaptation and the associated mental health impacts. Gender’s influence on mental health consultations should be considered when planning for public health emergencies, and further research conducted in male dominated industries.
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Affiliation(s)
- Yanbing Chen
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- *Correspondence: Yanbing Chen,
| | - Carolyn Ingram
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Vicky Downey
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Mark Roe
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Anne Drummond
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Penpatra Sripaiboonkij
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Claire Buckley
- Health Service Executive, Dublin, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Carla Perrotta
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Conor Buggy
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Roe M, Buggy C, Ingram C, Codd M, Buckley C, Archibald M, Rachwal N, Downey V, Chen Y, Sripaiboonkij P, Drummond A, Alvarez E, Perrotta C. 'Communication, that is the key': a qualitative investigation of how essential workers with COVID-19 responded to public health information. BMJ Open 2022; 12:e061583. [PMID: 35798515 PMCID: PMC9263375 DOI: 10.1136/bmjopen-2022-061583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To understand how essential workers with confirmed infections responded to information on COVID-19. DESIGN Qualitative analysis of semistructured interviews conducted in collaboration with the national contact tracing management programme in Ireland. SETTING Semistructured interviews conducted via telephone and Zoom Meetings. PARTICIPANTS 18 people in Ireland with laboratory confirmed SARS-CoV-2 infections using real-time PCR testing of oropharyngeal and nasopharyngeal swabs. All individuals were identified as part of workplace outbreaks defined as ≥2 individuals with epidemiologically linked infections. RESULTS A total of four high-order themes were identified: (1) accessing essential information early, (2) responses to emerging 'infodemic', (3) barriers to ongoing engagement and (4) communication strategies. Thirteen lower order or subthemes were identified and agreed on by the researchers. CONCLUSIONS Our findings provide insights into how people infected with COVID-19 sought and processed related health information throughout the pandemic. We describe strategies used to navigate excessive and incomplete information and how perceptions of information providers evolve overtime. These results can inform future communication strategies on COVID-19.
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Affiliation(s)
- Mark Roe
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Conor Buggy
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Carolyn Ingram
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Mary Codd
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Claire Buckley
- Health Service Executive Contact Management Programme, Health Service Executive, Dublin, Ireland
| | - Mary Archibald
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Natalie Rachwal
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Vicky Downey
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Yanbing Chen
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Penpatra Sripaiboonkij
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Anne Drummond
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Elizabeth Alvarez
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Carla Perrotta
- School of Public Health, Physiotherapy and Sport Sciences, University College Dublin, Dublin, Ireland
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Neil-Sztramko SE, Teggart K, Moore C, Sherifali D, Fitzpatrick-Lewis D, Coletta G, Phillips SM, Newbold KB, Alvarez E, Kuspinar A, Kennedy CC, Santaguida PL, Ganann R. Community-based group physical activity and/or nutrition interventions to promote mobility in older adults: an umbrella review. BMC Geriatr 2022; 22:539. [PMID: 35768770 PMCID: PMC9241281 DOI: 10.1186/s12877-022-03170-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity and a healthy diet are important in helping to maintain mobility with aging. This umbrella review aims to identify group-based physical activity and/or nutrition interventions for community-dwelling older adults that improve mobility-related outcomes. METHODS Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Sociological Abstracts) were searched from inception to December 2021. Eligibility criteria included systematic reviews exploring the effectiveness of physical activity or structured exercise, alone or combined with nutrition interventions on mobility-related outcomes (aerobic capacity, physical function, balance, falls/safety, muscle strength, health-related quality of life/wellbeing). Interventions must have been delivered in a group setting to community-dwelling older adults aged 55+. Two reviewers independently performed eligibility screening, critical appraisal (using AMSTAR 2) and data extraction. The GRADE approach was used to reflect the certainty of evidence based on the size of the effect within each mobility-related outcome category. Older adult/provider research partners informed data synthesis and results presentation. RESULTS In total, 62 systematic reviews (1 high, 21 moderate, 40 low/critically low quality) were identified; 53 included physical activity only, and nine included both physical activity and nutritional supplements. No reviews included nutrition interventions alone. Combined aerobic/resistance, general physical activity, and mind-body exercise all improved physical function and balance (moderate-high certainty). Aerobic/resistance training improved aerobic capacity (high certainty). Resistance training and general physical activity improved muscle strength (moderate certainty). Aerobic/resistance training and general physical activity are likely to reduce falls among older adults (moderate certainty). There was no evidence of benefit for nutritional supplementation with physical activity. CONCLUSIONS Group-based physical activity interventions that combine aerobic and resistance, general PA and mind-body exercise can improve measures of mobility in community-dwelling older adults. We found no reviews focused on nutrition only, highlighting a gap in the literature.
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Affiliation(s)
- Sarah E Neil-Sztramko
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8S 4K1, Canada.
| | - Kylie Teggart
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Caroline Moore
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Donna Fitzpatrick-Lewis
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Giulia Coletta
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Stuart M Phillips
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - K Bruce Newbold
- School of Earth, Environment & Society, Faculty of Science, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8S 4K1, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Courtney C Kennedy
- Department of Medicine, Division of Geriatrics, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Pasqualina L Santaguida
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8S 4K1, Canada
| | - Rebecca Ganann
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, L8S 4K1, Canada
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Gallagher E, Alvarez E, Jin L, Guenter D, Hatcher L, Furlan A. Patient contracts for chronic medical conditions: Scoping review. Can Fam Physician 2022; 68:e169-e177. [PMID: 35552216 PMCID: PMC9097748 DOI: 10.46747/cfp.6805e169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To describe how and why patient contracts are used for the management of chronic medical conditions. DATA SOURCES A scoping review was conducted in the following databases: MEDLINE, Embase, AMED, PsycInfo, Cochrane Library, CINAHL, and Nursing & Allied Health. Literature from 1997 to 2017 was included. STUDY SELECTION Articles were included if they were written in English and described the implementation of a patient contract by a health care provider for the management of a chronic condition. Articles had to present an outcome as a result of using the contract or an intervention that included the contract. SYNTHESIS Of the 7528 articles found in the original search, 76 met the inclusion criteria for the final review. Multiple study types were included. Extensive variety in contract elements, target populations, clinical settings, and cointerventions was found. Purposes for initiating contracts included behaviour change and skill development, including goal development and problem solving; altering beliefs and knowledge, including motivation and perceived self-efficacy; improving interpersonal relationships and role clarification; improving quality and process of chronic care; and altering objective and subjective health indices. How contracts were developed, implemented, and assessed was inconsistently described. CONCLUSION More research is required to determine whether the use of contracts is accomplishing their intended purposes. Questions remain regarding their rationale, development, and implementation.
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Affiliation(s)
- Erin Gallagher
- Assistant Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont.
| | - Elizabeth Alvarez
- Assistant Professor in the Department of Health Research Methods, Evidence and Impact at McMaster University
| | - Lin Jin
- Master of public health candidate at McMaster University
| | - Dale Guenter
- Associate Professor in the Department of Family Medicine and the Department of Health Research Methods, Evidence and Impact at McMaster University
| | - Lydia Hatcher
- Associate Clinical Professor in the Department of Family Medicine at McMaster University
| | - Andrea Furlan
- Associate Professor in the Department of Medicine at the University of Toronto in Ontario
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Martín M, Del Monte-Millán M, Jerez Y, Echavarria Diaz-Guardamino I, Herrero Lopez B, Gamez Casado S, Roche-Molina M, Marquez-Rodas I, Cebollero M, Alvarez E, Massarrah T, Ocaña I, Arias A, García Saenz J, Moreno Anton F, Olier Garate C, Moreno Muñoz D, Marrupe Gonzalez D, Merina T, Lopez-Tarruella Cobo S. 85P Correlation between nCOUNTER PAM-50 assay and three IHC-based surrogate intrinsic breast cancer subtype classifiers: A real-world study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Lim J, Pavalagantharajah S, Verschoor CP, Lentz E, Loeb M, Levine M, Smieja M, Mbuagbaw L, Kalina D, Tarride JE, O’Shea T, Cvetkovic A, van Gaalen S, Findlater AR, Lennox R, Bassim C, Lokker C, Alvarez E. Infectious diseases, comorbidities and outcomes in hospitalized people who inject drugs (PWID). PLoS One 2022; 17:e0266663. [PMID: 35443003 PMCID: PMC9020696 DOI: 10.1371/journal.pone.0266663] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 03/24/2022] [Indexed: 11/19/2022] Open
Abstract
Injection drug use poses a public health challenge. Clinical experience indicates that people who inject drugs (PWID) are hospitalized frequently for infectious diseases, but little is known about outcomes when admitted. Charts were identified from local hospitals between 2013-2018 using consultation lists and hospital record searches. Included individuals injected drugs in the past six months and presented with infection. Charts were accessed using the hospital information system, undergoing primary and secondary reviews using Research Electronic Data Capture (REDCap). The Wilcoxon rank-sum test was used for comparisons between outcome categories. Categorical data were summarized as count and frequency, and compared using Fisher's exact test. Of 240 individuals, 33% were admitted to the intensive care unit, 36% underwent surgery, 12% left against medical advice (AMA), and 9% died. Infectious diagnoses included bacteremia (31%), abscess (29%), endocarditis (29%), cellulitis (20%), sepsis (10%), osteomyelitis (9%), septic arthritis (8%), pneumonia (7%), discitis (2%), meningitis/encephalitis (2%), or other (7%). Sixty-six percent had stable housing and 60% had a family physician. Fifty-four percent of patient-initiated discharges were seen in the emergency department within 30 days and 29% were readmitted. PWID are at risk for infections. Understanding their healthcare trajectory is essential to improve their care.
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Affiliation(s)
- Jacqueline Lim
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Eric Lentz
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mark Loeb
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mitchell Levine
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Marek Smieja
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dale Kalina
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Tim O’Shea
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Anna Cvetkovic
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarah van Gaalen
- Department of Family Medicine, Queen’s University, Kingston, Ontario, Canada
| | | | - Robin Lennox
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Carol Bassim
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
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Ganann R, Phillips S, Moore C, Newbold B, MacNeil M, Orr E, Neil-Sztramko S, Kuspinar A, Kennedy C, Alvarez E. The EMBOLDEN Co-design study: Partnering with older adults and communities to develop a community program to enhance mobility. Ann Fam Med 2022; 20:2945. [PMID: 38270810 PMCID: PMC10549125 DOI: 10.1370/afm.20.s1.2945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Context: Physical mobility and social participation are requisite for independence and quality of life as one ages. Barriers to mobility lead to social isolation, poor physical and mental health, all of which are precursors to frailty. To date, most mobility-enhancing interventions in older adults have been designed by researchers without citizen input and delivered in controlled settings; their translation to real-world contexts is often impractical and rarely occurs. Objectives: i) To engage older adults and community service providers to qualitatively explore priorities, needs, enablers and barriers to mobility and community participation faced by older adults, and ii) To co-design an evidence-informed, feasible, acceptable group intervention to support mobility and promote health among older adults facing health inequities. Study Design: Adapted experience-based co-design, conducted in collaboration with a Strategic Guiding Council comprised of older adults and service providers. Setting: Community-based. Population studied: Community-dwelling older adults (55+) and local health and social service providers. Outcome Measures: EMBOLDEN's Strategic Guiding Council and the research team collectively interpreted qualitative study findings, together with results of completed systematic reviews and an environmental scan, to determine priority design features of a community-based mobility-enhancing intervention to enable health and well-being in older adults in Hamilton, ON. Results: Eighteen diverse older adults and 16 service providers completed persona scenario interviews. These lived experience perspectives were analyzed, interpreted, and integrated with research and local evidence in the intervention co-design process. Priority design features for the intervention included duration, intensity, mode of delivery, characteristics of interventionists, and implementation strategies. Findings highlighted key strategies related to participant motivation, recruitment, and engagement, as well as important equity, diversity, and inclusion considerations. Conclusions: Partnering with diverse stakeholders is critical to identifying optimal design features of a community-based intervention to promote mobility. Ultimately, we aim to implement and evaluate a health promoting intervention that is sustainable, scalable, addresses health inequities, and effectively improves the lives of older adults.
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Neil-Sztramko S, Coletta G, Teggart K, Ganann R, Kuspinar A, Fitzpatrick-Lewis D, Newbold B, Phillips S, Moore C, Kennedy C, Sherifali D, Alvarez E. Community-based physical activity and/or nutrition interventions to promote mobility in older adults: An umbrella review. Ann Fam Med 2022; 20:2937. [PMID: 36944044 PMCID: PMC10549072 DOI: 10.1370/afm.20.s1.2937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Physical activity and a healthy diet are important in helping to maintain mobility and quality of life with aging. Delivery of physical activity and nutrition interventions in a group setting adds the benefits of social participation. Several published systematic reviews have explored a broad range of PA and/or nutrition interventions for older adults, making it challenging to bring together the best scientific evidence to inform program design and to inform multicomponent intervention development. This umbrella review aims to identify group-based physical activity and nutrition interventions for community-dwelling older adults that improve mobility. Methods: Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Sociological Abstracts) were searched from inception to April 28, 2020. Eligibility criteria included systematic reviews exploring the effectiveness of physical activity and/or nutrition interventions, delivered in a group setting for community-dwelling older adults. Two reviewers independently performed eligibility screening, critical appraisal (using AMSTAR 2) and data extraction. The GRADE approach was used to assess the overall certainty of the evidence. Older adult/provider research partners informed data synthesis and results presentation. Results: In total, 54 systematic reviews (1 high, 21 moderate, 32 low/critically low quality) were identified; 46 included physical activity only, and eight included both physical activity and nutritional supplements. No reviews included nutrition interventions alone. Combined aerobic/resistance, general physical activity, and mind-body exercise all improved physical function and balance (moderate-high certainty). Aerobic/resistance training improved aerobic capacity (high certainty). Resistance training and general physical activity improved muscle strength (moderate certainty). Aerobic/resistance training and general physical activity are likely to reduce falls among older adults (moderate certainty). There was no evidence of benefit for nutritional supplementation with physical activity. Conclusions: Multicomponent group-based physical activity interventions can improve measures of mobility in community-dwelling older adults. We found no reviews focused on nutrition only, highlighting a gap in the literature.
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Alvarez E, Spannowsky M, Szewc M. Unsupervised Quark/Gluon Jet Tagging With Poissonian Mixture Models. Front Artif Intell 2022; 5:852970. [PMID: 35372834 PMCID: PMC8969742 DOI: 10.3389/frai.2022.852970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/18/2022] [Indexed: 11/23/2022] Open
Abstract
The classification of jets induced by quarks or gluons is important for New Physics searches at high-energy colliders. However, available taggers usually rely on modeling the data through Monte Carlo simulations, which could veil intractable theoretical and systematical uncertainties. To significantly reduce biases, we propose an unsupervised learning algorithm that, given a sample of jets, can learn the SoftDrop Poissonian rates for quark- and gluon-initiated jets and their fractions. We extract the Maximum Likelihood Estimates for the mixture parameters and the posterior probability over them. We then construct a quark-gluon tagger and estimate its accuracy in actual data to be in the 0.65-0.7 range, below supervised algorithms but nevertheless competitive. We also show how relevant unsupervised metrics perform well, allowing for an unsupervised hyperparameter selection. Further, we find that this result is not affected by an angular smearing introduced to simulate detector effects for central jets. The presented unsupervised learning algorithm is simple; its result is interpretable and depends on very few assumptions.
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Affiliation(s)
- E. Alvarez
- International Center for Advanced Studies (ICAS) and CONICET, UNSAM, San Martin, Argentina
| | - M. Spannowsky
- Institute for Particle Physics Phenomenology, Durham University, Durham, United Kingdom
- Department of Physics, Durham University, Durham, United Kingdom
| | - M. Szewc
- International Center for Advanced Studies (ICAS) and CONICET, UNSAM, San Martin, Argentina
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Alvarez E, Garvin A, Germaine N, Guidoni L, Schnurr M. Use of Mental Health Interventions by Physiotherapists to Treat Individuals with Chronic Conditions: A Systematic Scoping Review. Physiother Can 2022; 74:35-43. [PMID: 35185246 PMCID: PMC8816365 DOI: 10.3138/ptc-2020-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 01/03/2023]
Abstract
Purpose: Physiotherapists work with people with chronic conditions and can act as catalysts for behavioural change. Physiotherapy has also seen a shift to a bio-psychosocial model of health management and interdisciplinary care, which is important in the context of chronic conditions. This scoping review addressed the research question "How do physiotherapists use mental health-based interventions in their treatment of individuals with chronic conditions?" Method: The Embase, MEDLINE, PsycINFO, and CINAHL databases were searched, and a variety of study designs were included. Data were categorized and descriptively analyzed. Results: Data were extracted from 103 articles. Low back pain (43; 41.7%) and non-specified pain (16; 15.5%) were the most commonly researched chronic conditions, but other chronic conditions were also represented. Outpatient facilities were the most common setting for intervention (68; 73.1%). A total of 73 (70.9%) of the articles involved cognitive-behavioural therapy, and 41 (40.0%) included graded exercise or graded activity as a mental health intervention. Conclusions: Physiotherapists can use a variety of mental health interventions in the treatment of chronic conditions. More detailed descriptions of treatment and training protocols would be helpful for incorporating these techniques into clinical practice.
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Affiliation(s)
- Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Amanda Garvin
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Germaine
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Guidoni
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Meghan Schnurr
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Jezrawi R, Balakumar S, Masud R, Gabizon I, Bhagirath V, Varughese J, Brown M, Trottier D, Schwalm JD, McGillion M, Alvarez E, Lokker C. Patient and physician perspectives on the use and outcome measures of mHealth apps: Exploratory survey and focus group study. Digit Health 2022; 8:20552076221102773. [PMID: 35646382 PMCID: PMC9136450 DOI: 10.1177/20552076221102773] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Factors that physicians and patients consider when making decisions about
using or recommending health apps are not well understood. We explored these
factors to better assess how to support such decision making. Methods We conducted an exploratory cross-sectional study in Ontario using
qualitative focus groups and quantitative surveys. 133 physicians and 94
community dwelling adults completed online surveys and we held two focus
groups of nine community dwelling participants who had cardiovascular risk
factors and an interest in using mHealth apps. Quantitative survey data was
analyzed descriptively. Focus groups were audio-recorded and transcribed
verbatim prior to inductive thematic content analysis. We integrated the
results from the surveys and focus groups to understand factors that
influence physicians' and patients' selection and use of such apps. Results Physicians recommend apps to patients but the level of evidence they prefer
to use to guide selection did not align with what they were currently using.
Patients trusted recommendations and reviews from medical organizations and
healthcare professionals when selecting apps and were motivated to continue
using apps when they supported goal setting and tracking, data sharing,
decision making, and empowerment. Conclusions The findings highlight the significance of evaluating mHealth apps based on
metrics that patients and physicians value beyond usage and clinical outcome
data. Patients engage with apps that support them in confidently managing
their health. Increased training and awareness of apps and creating a more
rigorous evidence base showing the value of apps to supporting health goals
will support greater adoption and acceptance of mHealth apps.
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Affiliation(s)
- Rita Jezrawi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Sarmini Balakumar
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Rafia Masud
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Itzhak Gabizon
- Department of Cardiology, Soroka University Medical Center, University of the Negev, Beer-Sheva, Israel
| | - Vinai Bhagirath
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Jobin Varughese
- Department of Family Medicine, McMaster University, Hamilton, Canada.,Queen Square Family Health Team, Brampton, Canada
| | - Michael Brown
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Dan Trottier
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - J D Schwalm
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | | | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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Bouzanis K, Joshi S, Lokker C, Pavalagantharajah S, Qiu Y, Sidhu H, Mbuagbaw L, Qutob M, Henedi A, Levine MAH, Lennox R, Tarride JE, Kalina D, Alvarez E. Health programmes and services addressing the prevention and management of infectious diseases in people who inject drugs in Canada: a systematic integrative review. BMJ Open 2021; 11:e047511. [PMID: 34556508 PMCID: PMC8461723 DOI: 10.1136/bmjopen-2020-047511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES People who inject drugs (PWID) experience a high burden of injection drug use-related infectious disease and challenges in accessing adequate care. This study sought to identify programmes and services in Canada addressing the prevention and management of infectious disease in PWID. DESIGN This study employed a systematic integrative review methodology. Electronic databases (PubMed, CINAHL and Web of Science Core Collection) and relevant websites were searched for literature published between 2008 and 2019 (last search date was 6 June 2019). Eligible articles and documents were required to address injection or intravenous drug use and health programmes or services relating to the prevention or management of infectious diseases in Canada. RESULTS This study identified 1607 unique articles and 97 were included in this study. The health programmes and services identified included testing and management of HIV and hepatitis C virus (n=27), supervised injection facilities (n=19), medication treatment for opioid use disorder (n=12), integrated infectious disease and addiction programmes (n=10), needle exchange programmes (n=9), harm reduction strategies broadly (n=6), mobile care initiatives (n=5), peer-delivered services (n=3), management of IDU-related bacterial infections (n=2) and others (n=4). Key implications for policy, practice and future research were identified based on the results of the included studies, which include addressing individual and systemic factors that impede care, furthering evaluation of programmes and the need to provide comprehensive care to PWID, involving medical care, social support and harm reduction. CONCLUSIONS These results demonstrate the need for expanded services across a variety of settings and populations. Our study emphasises the importance of addressing social and structural factors that impede infectious disease care for PWID. Further research is needed to improve evaluation of health programmes and services and contextual factors surrounding accessing services or returning to care. PROSPERO REGISTRATION NUMBER CRD42020142947.
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Affiliation(s)
- Katrina Bouzanis
- Department of Global Health, McMaster University, Hamilton, Ontario, Canada
| | - Siddharth Joshi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Yun Qiu
- School of Health Sciences, Jiangsu Institute of Commerce, Nanjing, Jiangsu, China
| | - Hargun Sidhu
- Department of Undergraduate Medical Education, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Majdi Qutob
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Alia Henedi
- Faculty of Pharmacy, Eastern Mediterranean University, Famagusta, North Cyprus, Cyprus
| | - Mitchell A H Levine
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Robin Lennox
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Center for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Dale Kalina
- Department of Infectious Diseases, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
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Ontaneda D, Sati P, Raza P, Kilbane M, Gombos E, Alvarez E, Azevedo C, Calabresi P, Cohen JA, Freeman L, Henry RG, Longbrake EE, Mitra N, Illenberger N, Schindler M, Moreno-Dominguez D, Ramos M, Mowry E, Oh J, Rodrigues P, Chahin S, Kaisey M, Waubant E, Cutter G, Shinohara R, Reich DS, Solomon A, Sicotte NL. Central vein sign: A diagnostic biomarker in multiple sclerosis (CAVS-MS) study protocol for a prospective multicenter trial. Neuroimage Clin 2021; 32:102834. [PMID: 34592690 PMCID: PMC8482479 DOI: 10.1016/j.nicl.2021.102834] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 01/06/2023]
Abstract
The specificity and implementation of current MRI-based diagnostic criteria for multiple sclerosis (MS) are imperfect. Approximately 1 in 5 of individuals diagnosed with MS are eventually determined not to have the disease, with overreliance on MRI findings a major cause of MS misdiagnosis. The central vein sign (CVS), a proposed MRI biomarker for MS lesions, has been extensively studied in numerous cross sectional studies and may increase diagnostic specificity for MS. CVS has desirable analytical, measurement, and scalability properties. "Central Vein Sign: A Diagnostic Biomarker in Multiple Sclerosis (CAVS-MS)" is an NIH-supported, 2-year, prospective, international, multicenter study conducted by the North American Imaging in MS Cooperative (NAIMS) to evaluate CVS as a diagnostic biomarker for immediate translation into clinical care. Study objectives include determining the concordance of CVS and McDonald Criteria to diagnose MS, the sensitivity of CVS to detect MS in those with typical presentations, and the specificity of CVS among those with atypical presentations. The study will recruit a total of 400 participants (200 with typical and 200 with atypical presentations) across 11 sites. T2*-weighted, high-isotropic-resolution, segmented echo-planar MRI will be acquired at baseline and 24 months on 3-tesla scanners, and FLAIR* images (combination of FLAIR and T2*) will be generated for evaluating CVS. Data will be processed on a cloud-based platform that contains clinical and CVS rating modules. Imaging quality control will be conducted by automated methods and neuroradiologist review. CVS will be determined by Select6* and Select3* lesion methods following published criteria at each site and by central readers, including neurologists and neuroradiologists. Automated CVS detection and algorithms for incorporation of CVS into McDonald Criteria will be tested. Diagnosis will be adjudicated by three neurologists who served on the 2017 International Panel on the Diagnosis of MS. The CAVS-MS study aims to definitively establish CVS as a diagnostic biomarker that can be applied broadly to individuals presenting for evaluation of the diagnosis of MS.
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Affiliation(s)
- D Ontaneda
- Cleveland Clinic Foundation, Cleveland, OH, United States.
| | - P Sati
- Cedars Sinai, Los Angeles, CA, United States; NINDS, NIH, Bethesda, MD, United States
| | - P Raza
- Cleveland Clinic Foundation, Cleveland, OH, United States
| | - M Kilbane
- Cleveland Clinic Foundation, Cleveland, OH, United States
| | - E Gombos
- Cedars Sinai, Los Angeles, CA, United States
| | - E Alvarez
- Neurology, U of Colorado, Denver, CO, United States
| | | | - P Calabresi
- Neurology, Johns Hopkins, Baltimore, MD, United States
| | - J A Cohen
- Cleveland Clinic Foundation, Cleveland, OH, United States
| | - L Freeman
- Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - R G Henry
- University of California San Francisco, San Francisco, CA, United States
| | | | - N Mitra
- University of Pennsylvania, Philadelphia, PA, United States
| | - N Illenberger
- University of Pennsylvania, Philadelphia, PA, United States
| | - M Schindler
- University of Pennsylvania, Philadelphia, PA, United States
| | | | - M Ramos
- QMENTA Inc, Boston, MA, United States
| | - E Mowry
- Neurology, Johns Hopkins, Baltimore, MD, United States
| | - J Oh
- University of Toronto, Toronto, ON, Canada
| | | | - S Chahin
- Washington University, St. Louis, MO, United States
| | - M Kaisey
- Cedars Sinai, Los Angeles, CA, United States
| | - E Waubant
- University of California San Francisco, San Francisco, CA, United States
| | - G Cutter
- UAB School of Public Health, Birmingham, AL, United States
| | - R Shinohara
- University of Pennsylvania, Philadelphia, PA, United States
| | - D S Reich
- NINDS, NIH, Bethesda, MD, United States
| | - A Solomon
- The University of Vermont, Burlington, VT, United States
| | - N L Sicotte
- Cedars Sinai, Los Angeles, CA, United States
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27
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De Rubeis V, Lee J, Anwer MS, Yoshida-Montezuma Y, Andreacchi AT, Stone E, Iftikhar S, Morgenstern JD, Rebinsky R, Neil-Sztramko SE, Alvarez E, Apatu E, Anderson LN. Impact of disasters, including pandemics, on cardiometabolic outcomes across the life-course: a systematic review. BMJ Open 2021; 11:e047152. [PMID: 33941635 PMCID: PMC8098961 DOI: 10.1136/bmjopen-2020-047152] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Disasters are events that disrupt the daily functioning of a community or society, and may increase long-term risk of adverse cardiometabolic outcomes, including cardiovascular disease, obesity and diabetes. The objective of this study was to conduct a systematic review to determine the impact of disasters, including pandemics, on cardiometabolic outcomes across the life-course. DESIGN A systematic search was conducted in May 2020 using two electronic databases, EMBASE and Medline. All studies were screened in duplicate at title and abstract, and full-text level. Studies were eligible for inclusion if they assessed the association between a population-level or community disaster and cardiometabolic outcomes ≥1 month following the disaster. There were no restrictions on age, year of publication, country or population. Data were extracted on study characteristics, exposure (eg, type of disaster, region, year), cardiometabolic outcomes and measures of effect. Study quality was evaluated using the Joanna Briggs Institute critical appraisal tools. RESULTS A total of 58 studies were included, with 24 studies reporting the effects of exposure to disaster during pregnancy/childhood and 34 studies reporting the effects of exposure during adulthood. Studies included exposure to natural (n=35; 60%) and human-made (n=23; 40%) disasters, with only three (5%) of these studies evaluating previous pandemics. Most studies reported increased cardiometabolic risk, including increased cardiovascular disease incidence or mortality, diabetes and obesity, but not all. Few studies evaluated the biological mechanisms or high-risk subgroups that may be at a greater risk of negative health outcomes following disasters. CONCLUSIONS The findings from this study suggest that the burden of disasters extend beyond the known direct harm, and attention is needed on the detrimental indirect long-term effects on cardiometabolic health. Given the current COVID-19 pandemic, these findings may inform public health prevention strategies to mitigate the impact of future cardiometabolic risk. PROSPERO REGISTRATION NUMBER CRD42020186074.
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Affiliation(s)
- Vanessa De Rubeis
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jinhee Lee
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Muhammad Saqib Anwer
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yulika Yoshida-Montezuma
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alessandra T Andreacchi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Erica Stone
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Saman Iftikhar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jason D Morgenstern
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Reid Rebinsky
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarah E Neil-Sztramko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Emma Apatu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
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28
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Apatu E, Stallings-Smith S, Alvarez E, Anderson L, Spaulding A. Does community engaged Carnegie status matter for county health rankings in the United States? J Public Health (Oxf) 2021; 43:164-171. [PMID: 31211380 DOI: 10.1093/pubmed/fdz066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/23/2019] [Accepted: 05/21/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Community engagement is commonly used to address social inequities. The Carnegie Foundation offers an optional designation for which U.S. colleges and universities may apply to facilitate better educational outcomes through the institutionalization of community engagement. This study is the first to examine the relationship between Carnegie community engaged status and community health outcomes. METHODS Ordinal logistic regression was conducted to investigate the association between the presence of a community engaged institution and county health outcomes, including health behaviors, clinical care relating to access and quality, social and economic factors, and physical environment from the 2016 Robert Wood Johnson County Health Rankings and 2015 New England Resource Center for Higher Education Community engaged list. We examined 820 U.S. counties containing a university or college, 240 of which had a community engaged designation. RESULTS Findings indicated that the presence of a community-engaged institution was positively associated with Clinical Care (OR = 1.99; 95% CI: 1.09, 3.64). Other county health factors were not similarly associated. CONCLUSIONS Our findings suggest that community engagement status may be most relevant for achieving better access and quality of clinical care. More research is needed to explore this association in the U.S. and internationally.
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Affiliation(s)
- Emma Apatu
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, USA
| | - Sericea Stallings-Smith
- Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, FL, USA
| | - Elizabeth Alvarez
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, USA
| | - Laura Anderson
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, USA
| | - Aaron Spaulding
- Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic Robert D. and Patricia E. Kern, Center for the Science of Health Care Delivery, 4500 San Pablo Rd., Jacksonville, FL, USA
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29
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Apatu E, Sinnott W, Piggott T, Butler-Jones D, Anderson LN, Alvarez E, Dobbins M, Harrison L, Neil-Sztramko SE. Where Are We Now? A Content Analysis of Canadian Master of Public Health Course Descriptions and the Public Health Agency of Canada's Core Competencies. J Public Health Manag Pract 2021; 27:201-207. [PMID: 32371629 PMCID: PMC7837747 DOI: 10.1097/phh.0000000000001173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the degree to which Master of Public Health (MPH) programs' course descriptions align with the Public Health Agency of Canada's (PHAC's) core competency categories in order to identify strengths and training gaps in such programs across Canada. METHODS A content analysis of MPH programs in Canada was conducted from July 2019 to November 2019. A sampling frame of programs was obtained from a list from the PHAC Web site. Program information, including mandatory and elective course descriptions, was extracted from each program's Web site and analyzed in NVivo 12. Course descriptions were independently categorized by 2 researchers into 1 or more of the 7 categories of the core competencies outlined by the PHAC. RESULTS We identified 18 universities with MPH programs with 267 courses across Canada. Thematic analysis revealed that 100% of programs had coursework that addressed the "Public Health Sciences" and "Assessment and Analysis" categories; 93% addressed "Policy and Program Planning, Implementation, and Evaluation"; 67% addressed each of "Communication," "Leadership," and "Partnerships, Collaboration, and Advocacy"; and only 56% had course descriptions addressing "Diversity and Inclusiveness." CONCLUSIONS We find that Canadian MPH programs may lack course offerings addressing core competency categories relating to diversity and inclusiveness, communication, and leadership. Our findings were limited in scope as we relied on program Web sites; thus, further research should explore course content in more depth than this course description analysis allowed and identify ways to close the MPH curricular gaps we identified.
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Affiliation(s)
- Emma Apatu
- Department of Health Research Methods, Evidence, and Impact (Drs Apatu, Piggott, Anderson, Alvarez, Dobbins, and Neil-Sztramko, Mr Sinnott, and Ms Harrison) and School of Nursing (Drs Dobbins and Neil-Sztramko), McMaster University, Hamilton, Ontario, Canada; University of Saskatchewan, Saskatoon, Saskatchewan, Canada (Dr Butler-Jones); and National Collaborating Centre for Methods and Tools, Canada, Hamilton, Ontario, Canada (Dr Dobbins)
| | - Will Sinnott
- Department of Health Research Methods, Evidence, and Impact (Drs Apatu, Piggott, Anderson, Alvarez, Dobbins, and Neil-Sztramko, Mr Sinnott, and Ms Harrison) and School of Nursing (Drs Dobbins and Neil-Sztramko), McMaster University, Hamilton, Ontario, Canada; University of Saskatchewan, Saskatoon, Saskatchewan, Canada (Dr Butler-Jones); and National Collaborating Centre for Methods and Tools, Canada, Hamilton, Ontario, Canada (Dr Dobbins)
| | - Thomas Piggott
- Department of Health Research Methods, Evidence, and Impact (Drs Apatu, Piggott, Anderson, Alvarez, Dobbins, and Neil-Sztramko, Mr Sinnott, and Ms Harrison) and School of Nursing (Drs Dobbins and Neil-Sztramko), McMaster University, Hamilton, Ontario, Canada; University of Saskatchewan, Saskatoon, Saskatchewan, Canada (Dr Butler-Jones); and National Collaborating Centre for Methods and Tools, Canada, Hamilton, Ontario, Canada (Dr Dobbins)
| | - David Butler-Jones
- Department of Health Research Methods, Evidence, and Impact (Drs Apatu, Piggott, Anderson, Alvarez, Dobbins, and Neil-Sztramko, Mr Sinnott, and Ms Harrison) and School of Nursing (Drs Dobbins and Neil-Sztramko), McMaster University, Hamilton, Ontario, Canada; University of Saskatchewan, Saskatoon, Saskatchewan, Canada (Dr Butler-Jones); and National Collaborating Centre for Methods and Tools, Canada, Hamilton, Ontario, Canada (Dr Dobbins)
| | - Laura N. Anderson
- Department of Health Research Methods, Evidence, and Impact (Drs Apatu, Piggott, Anderson, Alvarez, Dobbins, and Neil-Sztramko, Mr Sinnott, and Ms Harrison) and School of Nursing (Drs Dobbins and Neil-Sztramko), McMaster University, Hamilton, Ontario, Canada; University of Saskatchewan, Saskatoon, Saskatchewan, Canada (Dr Butler-Jones); and National Collaborating Centre for Methods and Tools, Canada, Hamilton, Ontario, Canada (Dr Dobbins)
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence, and Impact (Drs Apatu, Piggott, Anderson, Alvarez, Dobbins, and Neil-Sztramko, Mr Sinnott, and Ms Harrison) and School of Nursing (Drs Dobbins and Neil-Sztramko), McMaster University, Hamilton, Ontario, Canada; University of Saskatchewan, Saskatoon, Saskatchewan, Canada (Dr Butler-Jones); and National Collaborating Centre for Methods and Tools, Canada, Hamilton, Ontario, Canada (Dr Dobbins)
| | - Maureen Dobbins
- Department of Health Research Methods, Evidence, and Impact (Drs Apatu, Piggott, Anderson, Alvarez, Dobbins, and Neil-Sztramko, Mr Sinnott, and Ms Harrison) and School of Nursing (Drs Dobbins and Neil-Sztramko), McMaster University, Hamilton, Ontario, Canada; University of Saskatchewan, Saskatoon, Saskatchewan, Canada (Dr Butler-Jones); and National Collaborating Centre for Methods and Tools, Canada, Hamilton, Ontario, Canada (Dr Dobbins)
| | - Leila Harrison
- Department of Health Research Methods, Evidence, and Impact (Drs Apatu, Piggott, Anderson, Alvarez, Dobbins, and Neil-Sztramko, Mr Sinnott, and Ms Harrison) and School of Nursing (Drs Dobbins and Neil-Sztramko), McMaster University, Hamilton, Ontario, Canada; University of Saskatchewan, Saskatoon, Saskatchewan, Canada (Dr Butler-Jones); and National Collaborating Centre for Methods and Tools, Canada, Hamilton, Ontario, Canada (Dr Dobbins)
| | - Sarah E. Neil-Sztramko
- Department of Health Research Methods, Evidence, and Impact (Drs Apatu, Piggott, Anderson, Alvarez, Dobbins, and Neil-Sztramko, Mr Sinnott, and Ms Harrison) and School of Nursing (Drs Dobbins and Neil-Sztramko), McMaster University, Hamilton, Ontario, Canada; University of Saskatchewan, Saskatoon, Saskatchewan, Canada (Dr Butler-Jones); and National Collaborating Centre for Methods and Tools, Canada, Hamilton, Ontario, Canada (Dr Dobbins)
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Alvarez E, Nair KV, Gorritz M, Bartolome L, Maloney H, Ding Y, Golan T, Wade RL, Kumar R, Su W, Shah R, Russo P. Identification and diagnosis of Secondary Progressive Multiple Sclerosis during the clinical encounter: Results from a physician survey. Mult Scler Relat Disord 2021; 50:102858. [PMID: 33799068 DOI: 10.1016/j.msard.2021.102858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/09/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND It is difficult to characterize the transition from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive MS (SPMS), due to symptomatic variability across patients. Diagnosis of SPMS is prolonged and often established retrospectively, as it is based on patient clinical history and symptoms. This cross-sectional study aimed to identify MS neurologist reported clinical indicators deemed important in diagnosing SPMS in clinical practice. METHODS A web-based quantitative survey was conducted among MS-treating neurologists across the United States in January 2019. The questionnaire comprised of 17 questions evaluating primary clinical indicators used by neurologists in assessing patient progression to SPMS. Treatment approach and factors influencing treatment decision-making following SPMS diagnosis were also analyzed in the survey. RESULTS Overall, 300 neurologists completed the survey; most of the respondents were general MS-treating neurologists (63%) and from private care setting (58%). The overall respondents as well as MS-focused neurologists ranked patient history (45% and 42%, respectively) and patients' neurological exam (39% and 44%, respectively) as -primary clinical indicators of SPMS diagnosis. 57% of neurologists always or mostly switched disease modifying therapies after progression to SPMS, and mostly considered 3-6 months' assessment interval to diagnose SPMS. CONCLUSION The survey indicated that neurologists are able to recognize signs of SPMS within six months of symptomatic assessment. The diagnosis is primarily based on patient history among MS-treating neurologists. Therefore, continued education to neurologists may facilitate early diagnosis and timely introduction of effective treatment to manage the progression of SPMS.
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Affiliation(s)
- E Alvarez
- Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, USA
| | - K V Nair
- Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, USA
| | - M Gorritz
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - L Bartolome
- Thomas Jefferson University, Philadelphia, PA, USA
| | - H Maloney
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - Y Ding
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - T Golan
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - R L Wade
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - R Kumar
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - W Su
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - R Shah
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - P Russo
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Lokker C, Jezrawi R, Gabizon I, Varughese J, Brown M, Trottier D, Alvarez E, Schwalm JD, McGillion M, Ma J, Bhagirath V. Feasibility of a Web-Based Platform (Trial My App) to Efficiently Conduct Randomized Controlled Trials of mHealth Apps For Patients With Cardiovascular Risk Factors: Protocol For Evaluating an mHealth App for Hypertension. JMIR Res Protoc 2021; 10:e26155. [PMID: 33522978 PMCID: PMC7884212 DOI: 10.2196/26155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 12/17/2022] Open
Abstract
Background Mobile health (mHealth) interventions can improve health by improving cardiovascular risk factors, but their adoption in care by physicians and patients is untapped. Few mHealth apps have been evaluated in clinical trials, and due to the fast pace of technological development, those previously evaluated are often outdated by the time trial results are available. Given the rapid pace of change in this field, it is not feasible to rigorously evaluate mHealth apps with current methodologies. Objective The overall aim of this pilot study was to test the feasibility of using a web research platform called Trial My App to conduct efficient and rigorous web-based randomized controlled trials (RCTs) of mHealth apps relevant to patients with cardiovascular risk factors by evaluating an app that targets hypertension. Methods For this study, 200 participants with suboptimally controlled hypertension will be recruited through advertisements in newsletters, media, and the internet, as well as through referrals from their health care providers. Screening, consent, randomization, and collection of patient-important health confidence and self-management ability outcomes will be conducted online through the Trial My App research platform. Participants will be randomized into 2 groups: 100 that will use an mHealth app for tracking hypertension and 100 that will be considered as an educational control. All participants will complete questionnaires at 0, 1, 3 and 6 months after enrolment. A substudy to validate the method of blood pressure readings and the consistency of data entered through Trial My App will be conducted with 40 participants. Results The development of the Trial My App web platform has been completed. The creation of survey instruments has been completed in collaboration with our patient partners and advisory board. Recruitment is expected to begin in the first quarter of 2021; data collection and analysis are expected to be completed approximately 1 year after study commencement. Results will be disseminated through conferences and publications. The primary outcomes of this study include the feasibility of conducting an RCT using the Trial My App platform by reporting recruitment, retention, and completion statistics. We will validate app-entered data with a standard 7-day home blood pressure measurement method. Lastly, the pilot, nonblinded RCT will assess the effectiveness of the mHealth app in improving the control of hypertension compared with the control of hypertension in the educational control group. Conclusions This study will determine if it is feasible to use the Trial My App web-based platform to evaluate the effectiveness of mHealth apps for patients with cardiovascular risk factors. As more mHealth apps are evaluated in RCTs, patients will be able to select apps that meet their needs and physicians will be able to make evidence-based recommendations to their patients for apps aimed at improving cardiovascular health. Trial Registration ClinicalTrials.gov NCT04528654; https://clinicaltrials.gov/ct2/show/NCT04528654 International Registered Report Identifier (IRRID) PRR1-10.2196/26155
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Affiliation(s)
- Cynthia Lokker
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Rita Jezrawi
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Itzhak Gabizon
- Department of Cardiology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Jobin Varughese
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Queen Square Family Health Team, Brampton, ON, Canada
| | - Michael Brown
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Dan Trottier
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Jon-David Schwalm
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Michael McGillion
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.,School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Vinai Bhagirath
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Mbuagbaw L, Hajizadeh A, Wang A, Mertz D, Lawson DO, Smieja M, Benoit AC, Alvarez E, Puchalski Ritchie L, Rachlis B, Logie C, Husbands W, Margolese S, Zani B, Thabane L. Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1. BMJ Open 2020; 10:e034793. [PMID: 32967868 PMCID: PMC7513605 DOI: 10.1136/bmjopen-2019-034793] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 07/01/2020] [Accepted: 08/07/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES We sought to map the evidence and identify interventions that increase initiation of antiretroviral therapy, adherence to antiretroviral therapy and retention in care for people living with HIV at high risk for poor engagement in care. METHODS We conducted an overview of systematic reviews and sought for evidence on vulnerable populations (men who have sex with men (MSM), African, Caribbean and Black (ACB) people, sex workers (SWs), people who inject drugs (PWID) and indigenous people). We searched PubMed, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and the Cochrane Library in November 2018. We screened, extracted data and assessed methodological quality in duplicate and present a narrative synthesis. RESULTS We identified 2420 records of which only 98 systematic reviews were eligible. Overall, 65/98 (66.3%) were at low risk of bias. Systematic reviews focused on ACB (66/98; 67.3%), MSM (32/98; 32.7%), PWID (6/98; 6.1%), SWs and prisoners (both 4/98; 4.1%). Interventions were: mixed (37/98; 37.8%), digital (22/98; 22.4%), behavioural or educational (9/98; 9.2%), peer or community based (8/98; 8.2%), health system (7/98; 7.1%), medication modification (6/98; 6.1%), economic (4/98; 4.1%), pharmacy based (3/98; 3.1%) or task-shifting (2/98; 2.0%). Most of the reviews concluded that the interventions effective (69/98; 70.4%), 17.3% (17/98) were neutral or were indeterminate 12.2% (12/98). Knowledge gaps were the types of participants included in primary studies (vulnerable populations not included), poor research quality of primary studies and poorly tailored interventions (not designed for vulnerable populations). Digital, mixed and peer/community-based interventions were reported to be effective across the continuum of care. CONCLUSIONS Interventions along the care cascade are mostly focused on adherence and do not sufficiently address all vulnerable populations.
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Affiliation(s)
- Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Centre for the Develoment of Best Practices in Health, Yaounde Central Hospital, Yaounde, Cameroon
| | - Anisa Hajizadeh
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Annie Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dominik Mertz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Rheumatology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Marek Smieja
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anita C Benoit
- Women's College Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Lisa Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Beth Rachlis
- Division of Clinical Public Health, Dalla Lana School of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Carmen Logie
- Women's College Research Institute, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Shari Margolese
- Canadian HIV Trials Network Community Advisory Committee, Vancouver, British Columbia, Canada
| | - Babalwa Zani
- Knowledge Translation Unit, University of Cape Town Lung Institute, Rondebosch, Western Cape, South Africa
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Pediatrics and Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicine, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
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Alvarez E, Joshi S, Lokker C, Wang A, Pavalagantharajah S, Qiu Y, Sidhu H, Mbuagbaw L, Qutob M, Henedi A, Levine M, Lennox R, Tarride JE, Kalina D. Health programmes and services addressing the prevention and management of infectious diseases in persons who inject drugs in Canada: a systematic integrative review protocol. BMJ Open 2020; 10:e035188. [PMID: 32792428 PMCID: PMC7430337 DOI: 10.1136/bmjopen-2019-035188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/29/2020] [Accepted: 06/29/2020] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Injection drug use (IDU) and intravenous drug use (IVDU) are of concern to the people using drugs, their families and health systems. One of the complications of IDU/IVDU is the risk of infection. Clinical experience has shown that persons who inject drugs (PWID) are hospitalised and re-hospitalised frequently. In Canada there are sparse data about the reasons for which PWID are admitted to hospital and their health trajectories, especially for infectious diseases. There are special concerns regarding PWID with infections who leave the hospital against medical advice and those who leave with a peripherally inserted central catheter line in place for administration of long-term antibiotics or other therapies. Improving our understanding of current programmes and services addressing the prevention and management of infectious diseases and their complications in PWID could lead to focused interventions to enhance care in this population. METHODS AND ANALYSIS An integrative systematic review allows for inclusion of a variety of methodologies to understand a health issue from different viewpoints. PubMed, CINAHL, Web of Science Databases and websites of the Public Health Agency of Canada, Canadian Institute for Substance Use Research, and Canadian Centre on Substance Use and Addiction will be searched using terms for infectious diseases, drug use and geography (Canada) and limited to the last 10 years (2009-2019). The Quality Appraisal Tool in Studies with Diverse Designs will be used to appraise the quality of identified studies and documents. Quantitative, qualitative or mixed methods data synthesis will be used as needed. ETHICS AND DISSEMINATION This study is a secondary analysis of publicly available documents; therefore, no ethics approval is required. This information will inform a research agenda to further investigate interventions that aim to address these issues. PROSPERO REGISTRATION NUMBER CRD42020142947.
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Affiliation(s)
- Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Siddharth Joshi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Annie Wang
- Department of Life Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Yun Qiu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- School of Health Sciences, Jiangsu Vocational Institute of Commerce, Nanjing City, Jiangsu, China
| | - Hargun Sidhu
- Department of Undergraduate Medical Education, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Majdi Qutob
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Alia Henedi
- Eastern Mediterranean University, Cyprus, Turkey
| | - Mitchell Levine
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Robin Lennox
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Dale Kalina
- Infectious Diseases, Joseph Brant Hospital, Burlington, Ontario, Canada
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Jarvis T, Scott F, El-Jardali F, Alvarez E. Defining and classifying public health systems: a critical interpretive synthesis. Health Res Policy Syst 2020; 18:68. [PMID: 32546163 PMCID: PMC7296190 DOI: 10.1186/s12961-020-00583-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background The introduction of the determinants of health has caused a shift towards understanding health from a holistic perspective as well as increased recognition of public health’s contributions to the health of the population. Several frameworks exist to conceptualise healthcare systems, highlighting the stark contrast of frameworks unique to public health systems. The objectives of this study were to define public health systems and assess differences between healthcare systems and public health systems within established health systems frameworks. Methods A critical interpretive synthesis was conducted. Databases searched included EBSCOhost, OVID, Scholars Portal, Web of Science, Cochrane Library and Health Systems Evidence. Data extraction, coding and analysis followed a best-fit framework analysis method. Initial codes were based on a current leading health systems and policy classification scheme – health systems arrangements (governance, financial and delivery arrangements). Results A total of 5933 unique documents were identified and 67 were included in the analysis. Definitions of public health and public health systems varied significantly as did their roles and functions across jurisdictions. Public health systems arrangements generally followed those of health systems, with the addition of partnerships (community and inter-sectoral) and communication playing a larger role in public health. A public health systems framework and conceptualisation of how public health currently fits within health systems are presented. Conclusions Public health systems are unique and vital entities within health systems. In addition to examining how public health and public health systems have been defined within the literature, this review suggests that establishing the scope of public health is crucial to understanding its role within the larger health system and adds to the discourse around the relationship between public health, healthcare and population health. More broadly, this study addresses an important gap in understanding public health systems and provides conceptual and practical contributions as well as areas for future research.
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Affiliation(s)
- Tamika Jarvis
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Fran Scott
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Fadi El-Jardali
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.,Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
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Mañago MM, Kline PW, Alvarez E, Christiansen CL. Trunk and pelvis movement compensation in people with multiple sclerosis: Relationships to muscle function and gait performance outcomes. Gait Posture 2020; 78:48-53. [PMID: 32200163 DOI: 10.1016/j.gaitpost.2020.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 02/21/2020] [Accepted: 03/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Problems with gait are common in people with multiple sclerosis (MS), but little is known about pelvis and trunk kinematics, especially in the frontal plane. RESEARCH QUESTION Are pelvis and trunk kinematics in people with MS related to muscle function, spatiotemporal parameters, and gait performance? METHODS In this cross-sectional study, 20 people with MS (Expanded Disability Status Scale 1.5-5.5) and 10 people with comparable age and sex (CTL) underwent threedimensional gait analysis, muscle function assessments (hip and trunk strength and endurance), and gait performance measures (Timed 25-Foot Walk - T25FW, 2-Minute Walk Test - 2MWT). Frontal and sagittal plane pelvis and trunk excursion during the stance period of walking were compared between groups; and in the MS group, associations were determined between kinematic variables, muscle function, spatiotemporal parameters, and gait performance. RESULTS Compared to the CTL group, the MS group had significantly greater sagittal plane trunk and pelvis excursion for both the stronger (p = 0.031) and weaker (p = 0.042) sides; less frontal plane trunk and pelvis excursion for both the stronger (p = 0.008) and weaker (p = 0.024) sides; and more sagittal plane trunk excursion for the stronger side (p = 0.047) during stance phase. There were low-to-moderate correlations in the MS group for sagittal plane pelvis excursion with muscle function (p = 0.019 to 0.030), spatiotemporal parameters (p < 0.001 to 0.005), and gait performance (p = < 0.001 to 0.001). Using linear regression, frontal and sagittal plane pelvis excursion were significant predictors of both T25FW and 2MWT, explaining 34 % and 46 % of the variance of each gait performance measure, respectively. SIGNIFICANCE Rehabilitation interventions may consider addressing pelvis movement compensations in order to improve spatiotemporal parameters and gait performance in people with MS.
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Affiliation(s)
- M M Mañago
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Mail Stop C244, 13121 E 17th Ave., Room 3108, Aurora, CO, 80045, United States; Department of Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Mail Stop B182, Research Complex 2, 12700 East 19th Ave., Aurora, CO, 80045, United States.
| | - P W Kline
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Mail Stop C244, 13121 E 17th Ave., Room 3108, Aurora, CO, 80045, United States; Geriatric, Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, 1700 N Wheeling St., Aurora, CO, 80045, United States
| | - E Alvarez
- Department of Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Mail Stop B182, Research Complex 2, 12700 East 19th Ave., Aurora, CO, 80045, United States
| | - C L Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Mail Stop C244, 13121 E 17th Ave., Room 3108, Aurora, CO, 80045, United States; Geriatric, Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, 1700 N Wheeling St., Aurora, CO, 80045, United States
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Abstract
INTRODUCTION Rates of mental health illnesses and burnout are increasing internationally. Therapeutic yoga is increasingly used to improve and maintain physical, mental and emotional well-being and general health. This protocol describes a study to evaluate the effectiveness of an existing primary care group-based therapeutic yoga programme, the Yoga of Stress Resilience programme, which combines yoga and psychotherapeutic techniques, in improving mental health and decreasing burnout. Implementation factors will also be evaluated for potential scale-up. METHODS AND ANALYSIS A pragmatic before-after interventional trial design will be used to study changes in occupational participation and mental health outcomes, including anxiety, depression, burnout, functional impairment, insomnia, perceived stress, loneliness, self-compassion and readiness for change in adults experiencing anxiety and burnout. Repeated measures analysis of variance will be used to determine changes in outcome measures over time. Regression and multivariate analyses will be conducted to examine relationships between participant characteristics and outcomes and among various outcomes. The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework will be used to guide the analyses. ETHICS AND DISSEMINATION Approval from the Hamilton Integrated Research Ethics Board has been waived: project number 7082 (full review waived). Informed consent will be obtained prior to enrolling any participant into the study. All data will be kept confidential. Peer-reviewed publications and presentations will target researchers and health professionals. TRIAL REGISTRATION NUMBER The ClinicalTrials.gov registry (NCT03973216).
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Affiliation(s)
- Elizabeth Alvarez
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Arielle Sutton
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Bria Barton
- Ontario Network of Sexual Assault /Domestic Violence Treatment Centres, Women's College Hospital, Toronto, Ontario, Canada
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Agra RM, Gago-Dominguez M, Paradela-Dobarro B, Torres-Español M, Alvarez L, Fernandez-Trasancos A, Varela-Roman A, Calaza M, Eiras S, Alvarez E, Carracedo A, Gonzalez-Juanatey JR. Obesity-Related Genetic Determinants of Heart Failure Prognosis. Cardiovasc Drugs Ther 2020; 33:415-424. [PMID: 31209632 DOI: 10.1007/s10557-019-06888-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Recent advances in genomics offer a smart option for predicting future risk of disease and prognosis. The objective of this study was to examine the prognostic value in heart failure (HF) patients, of a series of single nucleotide polymorphisms (SNPs). METHODS A selection of 192 SNPs found to be related with obesity, body mass index, circulating lipids or cardiovascular diseases were genotyped in 191 patients with HF. Anthropometrical and clinical variables were collected for each patient, and death and readmission by HF were registered as the primary endpoint. RESULTS A total of 53 events were registered during a follow-up period of 438 (263-1077) days (median (IQR)). Eight SNPs strongly related to obesity and HF prognosis were selected as possible prognostic variables. From these, rs10189761 and rs737337 variants were independently associated with HF prognosis (HR 2.295 (1.287-4.089, 95% CI); p = 0.005), whereas rs10423928, rs1800437, rs737337 and rs9351814 were related with bad prognosis only in obese patients (HR 2.142 (1.438-3.192, 95% CI); p = 0.00018). Combined scores of the genomic variants were highly predictive of poor prognosis. CONCLUSIONS SNPs rs10189761 and rs737337 were identified, for the first time, as independent predictors of major clinical outcomes in patients with HF. The data suggests an additive predictive value of these SNPs for a HF prognosis. In particular for obese patients, SNPs rs10423928, rs1800437, rs737337 and rs9351814 were related with a bad prognosis. Combined scores weighting the risk of each genomic variant could effect interesting new tools to stratify the prognostic risk of HF patients.
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Affiliation(s)
- R M Agra
- Laboratorio no. 6. Edif. Consultas externas (planta -2), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Servicio de Cardiología y Unidad de Hemodinámica, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Travesía da Choupana s/n, Santiago de Compostela, 15706, A Coruña, Spain
- CIBERCV, Madrid, Spain
| | - M Gago-Dominguez
- Fundación Pública Galega de Medicina Xenómica, SERGAS, Santiago de Compostela, Spain
| | - B Paradela-Dobarro
- Laboratorio no. 6. Edif. Consultas externas (planta -2), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Servicio de Cardiología y Unidad de Hemodinámica, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Travesía da Choupana s/n, Santiago de Compostela, 15706, A Coruña, Spain
- CIBERCV, Madrid, Spain
| | - M Torres-Español
- Grupo de Medicina Xenómica, CeGen-PRB2, Instituto de Investigación Sanitaria de Santiago, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - L Alvarez
- Laboratorio no. 6. Edif. Consultas externas (planta -2), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Servicio de Cardiología y Unidad de Hemodinámica, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Travesía da Choupana s/n, Santiago de Compostela, 15706, A Coruña, Spain
- CIBERCV, Madrid, Spain
| | - A Fernandez-Trasancos
- Laboratorio no. 6. Edif. Consultas externas (planta -2), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Servicio de Cardiología y Unidad de Hemodinámica, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Travesía da Choupana s/n, Santiago de Compostela, 15706, A Coruña, Spain
- CIBERCV, Madrid, Spain
| | - A Varela-Roman
- Laboratorio no. 6. Edif. Consultas externas (planta -2), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Servicio de Cardiología y Unidad de Hemodinámica, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Travesía da Choupana s/n, Santiago de Compostela, 15706, A Coruña, Spain
- CIBERCV, Madrid, Spain
| | - M Calaza
- Centro de Investigación en Medicina Molecular y Enfermedades Crónicas, CIMUS, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - S Eiras
- Laboratorio no. 6. Edif. Consultas externas (planta -2), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Servicio de Cardiología y Unidad de Hemodinámica, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Travesía da Choupana s/n, Santiago de Compostela, 15706, A Coruña, Spain
- CIBERCV, Madrid, Spain
| | - E Alvarez
- Laboratorio no. 6. Edif. Consultas externas (planta -2), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Servicio de Cardiología y Unidad de Hemodinámica, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Travesía da Choupana s/n, Santiago de Compostela, 15706, A Coruña, Spain.
- CIBERCV, Madrid, Spain.
| | - A Carracedo
- Fundación Pública Galega de Medicina Xenómica, SERGAS, Santiago de Compostela, Spain
| | - J R Gonzalez-Juanatey
- Laboratorio no. 6. Edif. Consultas externas (planta -2), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Servicio de Cardiología y Unidad de Hemodinámica, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Travesía da Choupana s/n, Santiago de Compostela, 15706, A Coruña, Spain
- CIBERCV, Madrid, Spain
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Guerra R, Freeman A, Swanson M, Chapman J, Ueda S, Alvarez E, Chen L. Enhancing Gastrointestinal Recovery Among Women Undergoing Surgery for Ovarian Cancer: A Quality Improvement Analysis of Alvimopan Administration in Gynecologic Oncology. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2019.11.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Alvarez E, Lavis JN, Brouwers M, Carmona Clavijo G, Sewankambo N, Solari L, Schwartz L. Developing evidence briefs for policy: a qualitative case study comparing the process of using a guidance-contextualization workbook in Peru and Uganda. Health Res Policy Syst 2019; 17:89. [PMID: 31752888 PMCID: PMC6868683 DOI: 10.1186/s12961-019-0488-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Translating research evidence from global guidance into policy can help strengthen health systems. A workbook was developed to support the contextualization of the WHO's 'Optimizing health worker roles to improve maternal and newborn health' (OptimizeMNH) guidance. This study evaluated the use of the workbook for the development of evidence briefs in two countries - Peru and Uganda. Findings surrounding contextual factors, steps in the process and evaluation of the workbook are presented. METHODS A qualitative embedded case study was used. The case was the process of using the workbook to support the contextualization of global health systems guidance, with local evidence, to develop evidence briefs. Criterion sampling was used to select the countries, participants for interviews and documents included in the study. A template-organizing style and constant comparison were used for data analysis. RESULTS A total of 19 participant-observation sessions and 8 interviews were conducted, and 50 documents were reviewed. Contextual factors, including the cadres, or groups, of health workers available in each country, the way the problem and its causes were framed, potential policy options to address the problem, and implementation considerations for these policy options, varied substantially between Peru and Uganda. However, many similarities were found in the process of using the workbook. Overall, the workbook was viewed positively and participants in both countries would use it again for other topics. CONCLUSIONS Organizations that produce global guidance, such as WHO, need to consider institutionalizing the application of the workbook into their guidance development processes to help users at the national/subnational level create actionable and context-relevant policies. Feedback mechanisms also need to be established so that the evidence briefs and health policies arising from global guidance are tracked and the findings coming out of such guideline contextualization processes can be taken into consideration during future guidance development and research priority-setting.
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Affiliation(s)
- Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact (HEI), Faculty of Health Sciences, McMaster University, CRL 2nd Floor, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. .,Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada.
| | - John N Lavis
- Department of Health Research Methods, Evidence and Impact (HEI), Faculty of Health Sciences, McMaster University, CRL 2nd Floor, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.,Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada.,McMaster Health Forum, McMaster University, Hamilton, ON, Canada
| | - Melissa Brouwers
- Department of Health Research Methods, Evidence and Impact (HEI), Faculty of Health Sciences, McMaster University, CRL 2nd Floor, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Lely Solari
- Instituto Nacional de Salud (INS), Ministry of Health, Lima, Peru
| | - Lisa Schwartz
- Department of Health Research Methods, Evidence and Impact (HEI), Faculty of Health Sciences, McMaster University, CRL 2nd Floor, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.,Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
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Zink DN, Kuwabara H, Reyes E, Gomez-Batista S, Reyes A, Alvarez E, Strauss GP, Allen DN. Influence of Acculturation on Emotional Learning and Memory in Spanish and English Speakers. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz029.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
The Emotional Verbal Learning Test-Spanish (EVLT-S) is a novel list learning test similar in structure to traditional verbal memory tests but contains words from 4 discrete emotional categories. Influence of acculturation on emotional learning was examined on EVLT-S learning trials 1 to 5.
Participants and Method
Participants included 50 bilingual healthy individuals in the Spanish-dominant group (Age M = 20.3years; 72% female) and 27 in the English-dominant group (Age M = 23.4years, 51.9% female). They were administered a battery of tests including the EVLT, a non-emotional verbal list learning test (LLT), Vocabulary (VC), Digit Span (DS), and The Short Acculturation Scale for Hispanics (SASH) in their dominant language. To examine learning curves a mixed model ANOVA was conducted with test (EVLT-S/EVLT, LLT-S/LLT) and trial as within-subjects variables and group (Spanish, English) as a between-subjects variable.
Results
There were significant main effects (p < .005) for test, trial, and group. The Spanish-dominant group had the lowest overall performance on the EVLT-S (main effect for group). Post hoc comparisons of the Spanish-dominant group’s LLT-S and EVLT-S performance indicated significant differences at each trail (p < .01), with the EVLT-S scores being lower than the LLT-S scores. The ANOVA was repeated with VC, DS, and SASH included as covariates. When controlling for these variables, the main effect for group was no longer significant. A significant trial by acculturation interaction effect emerged (p<.05), with the English-dominant group generally performing better than the Spanish-dominant group.
Conclusions
Results suggest that Spanish and English language group differences were largely accounted for by word knowledge (VC), working memory (DS), and acculturation differences (SASH) between the groups. The role of these variables is discussed further in the context of acculturation.
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Alvarez E, Qutob M, Mbuagbaw L, Lavis J, Lokker C, Walli-Attaei M, Samaan Z, Sutton A, Singh J, Feeny D, Fortuna J. Feasibility and implementation of a healthy lifestyles program in a community setting in Ontario, Canada: protocol for a pragmatic mixed methods pilot study. BMJ Open 2019; 9:e031298. [PMID: 31619429 PMCID: PMC6797346 DOI: 10.1136/bmjopen-2019-031298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Rates of chronic conditions, such as diabetes, cardiovascular disease and obesity are increasing in Canada and internationally. There are effective lifestyle interventions that are known to improve chronic conditions. However, there is often a gap in 'how to' make lifestyle changes. Mental health and other determinants of health play a role in the development and progression of chronic conditions. Changing habits takes time and requires the use of multiple techniques, including mental health and behavioural change strategies, based on a person's needs. A new, multidisciplinary, person-centred and evidence-based and practice-based programme has been created to address these needs. This proposal aims to evaluate the feasibility and implementation of this programme and to determine changes in participant-directed and clinical outcomes through a pilot study. METHODS AND ANALYSIS A pragmatic mixed methods design will be used to study multiple dimensions of the year-long healthy lifestyles programme. The pilot study includes a randomised controlled trial, with 30 participants randomised to either the programme or to a comparator arm, and qualitative components to determine the feasibility of the programme, including recruitment and retention, data missing rates and resources needed to run this programme. Changes in participant-directed and clinical outcomes will be measured. Descriptive statistics, t-tests and repeated measures analysis of variance (ANOVA) for within group comparisons and generalised estimating equations for between group analyses will be used. Qualitative interviews of programme staff and healthcare providers and family focus groups will be used to further enhance the findings and improve the programme. ETHICS AND DISSEMINATION Approval from the Hamilton Integrated Research Ethics Board (HiREB) has been obtained. Informed consent will be obtained prior to enrolling any participant into the study. Participant IDs will be used during data collection and entry. Peer-reviewed publications and presentations will target researchers, health professionals and stakeholders. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT03258138.HiREB project number: 3793.
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Affiliation(s)
- Elizabeth Alvarez
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Majdi Qutob
- Innovation Science and Medicine (ISM), Burlington, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - John Lavis
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Zainab Samaan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Arielle Sutton
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Japteg Singh
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - David Feeny
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
- Department of Economics, McMaster University, Hamilton, Ontario, Canada
| | - John Fortuna
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- City of Hamilton Public Health Services, Hamilton, Ontario, Canada
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Picornell AC, Echavarria I, Alvarez E, López-Tarruella S, Jerez Y, Hoadley K, Parker JS, Del Monte-Millán M, Ramos-Medina R, Gayarre J, Ocaña I, Cebollero M, Massarrah T, Moreno F, García Saenz JA, Gómez Moreno H, Ballesteros A, Ruiz Borrego M, Perou CM, Martin M. Breast cancer PAM50 signature: correlation and concordance between RNA-Seq and digital multiplexed gene expression technologies in a triple negative breast cancer series. BMC Genomics 2019; 20:452. [PMID: 31159741 PMCID: PMC6547580 DOI: 10.1186/s12864-019-5849-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 05/27/2019] [Indexed: 01/18/2023] Open
Abstract
Background Full RNA-Seq is a fundamental research tool for whole transcriptome analysis. However, it is too costly and time consuming to be used in routine clinical practice. We evaluated the transcript quantification agreement between RNA-Seq and a digital multiplexed gene expression platform, and the subtype call after running the PAM50 assay in a series of breast cancer patients classified as triple negative by IHC/FISH. The goal of this study is to analyze the concordance between both expression platforms overall, and for calling PAM50 triple negative breast cancer intrinsic subtypes in particular. Results The analyses were performed in paraffin-embedded tissues from 96 patients recruited in a multicenter, prospective, non-randomized neoadjuvant triple negative breast cancer trial (NCT01560663). Pre-treatment core biopsies were obtained following clinical practice guidelines and conserved as FFPE for further RNA extraction. PAM50 was performed on both digital multiplexed gene expression and RNA-Seq platforms. Subtype assignment was based on the nearest centroid classification following this procedure for both platforms and it was concordant on 96% of the cases (N = 96). In four cases, digital multiplexed gene expression analysis and RNA-Seq were discordant. The Spearman correlation to each of the centroids and the risk of recurrence were above 0.89 in both platforms while the agreement on Proliferation Score reached up to 0.97. In addition, 82% of the individual PAM50 genes showed a correlation coefficient > 0.80. Conclusions In our analysis, the subtype calling in most of the samples was concordant in both platforms and the potential discordances had reduced clinical implications in terms of prognosis. If speed and cost are the main driving forces then the preferred technique is the digital multiplexed platform, while if whole genome patterns and subtype are the driving forces, then RNA-Seq is the preferred method. Electronic supplementary material The online version of this article (10.1186/s12864-019-5849-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A C Picornell
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo 46, 28007, Madrid, Spain.
| | - I Echavarria
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - E Alvarez
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Doctor Esquerdo 46, 28007, Madrid, Spain
| | - S López-Tarruella
- Medical Oncology Service, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). CiberOnc, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Y Jerez
- Medical Oncology Service, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). CiberOnc, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - K Hoadley
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J S Parker
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Del Monte-Millán
- Medical Oncology Service, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). CiberOnc, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R Ramos-Medina
- Medical Oncology Service, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). CiberOnc, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Gayarre
- Medical Oncology Service, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). CiberOnc, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - I Ocaña
- Medical Oncology Service, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). CiberOnc, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Cebollero
- Anatomical Pathology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - T Massarrah
- Medical Oncology Service, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM). CiberOnc, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F Moreno
- Medical Oncology Service, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - J A García Saenz
- Medical Oncology Service, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - H Gómez Moreno
- Medicina Oncológic, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
| | - A Ballesteros
- Medical Oncology Service, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - C M Perou
- Department of Genetics, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - M Martin
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, CiberOnc, GEICAM, Madrid, Spain
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Vizcardo M, Jiménez J, Alvarez E, Moleiro F, Rodríguez A, Octavio A. Nonlinear characterization of ECGs in patients with Chagas’ disease. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab03f7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Richardson E, Alvarez E, Ifafore-Calfee T. Lessons From Zika Policies to Improve Gender Equity. Int J Travel Med Glob Health 2018. [DOI: 10.15171/ijtmgh.2018.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Gender equity is easily supported in theory but harder to pursue in practice. In this article, the case of Zika travel policies is used to illustrate some glaring gaps related to gender, for both men and women, at both international and national levels. Zika travel policies have not considered new evidence on biological or social determinants of health, putting babies at risk of exposure. The authors suggest best practices at the international level, such as developing pre-organized gender committees to provide actionable and swift advice for international infectious disease policies; at the national level, such as promoting holistic policies addressing mosquito control and sex and gender considerations, including access to reproductive health services; and at the local level, such as education on local infectious diseases. These deliberations are especially important with emerging infectious diseases (EIDs), as little may be known about them. New knowledge needs to be translated in a timely fashion in order to shape effective and equitable policies.
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Affiliation(s)
- Emma Richardson
- Centre for Ethical, Social and Cultural Risk, St. Michael’s Hospital, Toronto, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada
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Tewari K, Vergote I, Oaknin A, Alvarez E, Gaillard S, Lheureux S, Rischin D, Santin A, Feng M, Mathias M, Fury M, Lowy I, Monk B. GOG 3016/ENGOT-cx9: An open-label, multi-national, randomized, phase III trial of cemiplimab, an anti-PD-1, versus investigator's choice (IC) chemotherapy in ≥ second-line recurrent or metastatic cervical cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy436.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mbuagbaw L, Mertz D, Lawson DO, Smieja M, Benoit AC, Alvarez E, Puchalski Ritchie L, Rachlis B, Logie C, Husbands W, Margolese S, Thabane L. Strategies to improve adherence to antiretroviral therapy and retention in care for people living with HIV in high-income countries: a protocol for an overview of systematic reviews. BMJ Open 2018; 8:e022982. [PMID: 30206089 PMCID: PMC6144485 DOI: 10.1136/bmjopen-2018-022982] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION While access to antiretroviral therapy (ART) for people living with HIV has expanded in recent years, additional efforts are required to support adherence to medication and retention in care. Interventions should be applicable in real-world settings and amenable to widespread use. The objectives of this overview are to identify effective pragmatic interventions that increase adherence to ART and retention in care for people living with HIV at high risk for suboptimal adherence and retention in high-income countries. METHODS AND ANALYSIS We will conduct an overview of systematic reviews of studies on interventions which target improved adherence to medication and retention in care among high-risk people living with HIV in high-income countries (men who have sex with men, African, Caribbean and black people, sex workers, people who inject drugs, indigenous people and other socially marginalised groups). We will search the following databases: PubMed, EMBASE (Exerpta Medica Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycINFO, Web of Science and the Cochrane Library. We will conduct screening, data extraction and assessment of methodological quality of the systematic reviews. Analysis will be narrative. Our findings will be interpreted in light of the certainty of the evidence, level of pragmatism, setting and population of interest. ETHICS AND DISSEMINATION Only published secondary data will be used in this study, and therefore ethics approval is not required. Our findings will be disseminated as peer-reviewed manuscripts, conference abstracts and through community activities. The findings from this overview will inform a mixed-methods study among people living with HIV and health workers in Ontario, Canada.
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Affiliation(s)
- Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Centre, St Joseph’s Healthcare, Hamilton, Ontario, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Dominik Mertz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Marek Smieja
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anita C Benoit
- Women’s College Research, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Lisa Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, Ontario, Canada
| | - Beth Rachlis
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Dignitas International, Toronto, Ontario, Canada
- Division of Clinical Public Health, Dalla Lana School of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Carmen Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Shari Margolese
- Canadian HIV Trials Network Community Advisory Committee, Toronto, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Centre, St Joseph’s Healthcare, Hamilton, Ontario, Canada
- Departments of Paediatrics and Anaesthesia, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicine, St Joseph’s Healthcare, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
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47
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Domen C, Nair K, Hoyt B, Alvarez E, Medina L. C - 14Worsening Fatigue Predicts Increased Cognitive Complaints and Declines in Cognitive Test Performance Among Individuals with Multiple Sclerosis. Arch Clin Neuropsychol 2018. [DOI: 10.1093/arclin/acy061.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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48
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Pérez-García A, Dongil P, Hurtado-Carneiro V, Blazquez E, Sanz C, Alvarez E. PAS Kinase deficiency alters the glucokinase function and hepatic metabolism. Sci Rep 2018; 8:11091. [PMID: 30038292 PMCID: PMC6056484 DOI: 10.1038/s41598-018-29234-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 07/03/2018] [Indexed: 12/15/2022] Open
Abstract
The liver controls metabolic homeostasis in response to fasting and refeeding periods. Glucokinase (GCK) adjusts hepatic glucose phosphorylation to blood glucose levels, acting as a glucose sensor. Our objective was to determine whether PAS kinase (PASK), a nutrient sensor, could be affecting the expression or activity of liver GCK and the response to fasting and refeeding states of key hepatic metabolic pathways. PASK-deficient mice have impaired insulin signaling (AKT overactivation). Furthermore, PASK deficiency modified the expression of several transcription factors involved in the adjustment to fasting and refeeding. Foxo1 decreased under fasting conditions, while Ppara and Pparg were overexpressed in PASK-deficient mice. However, PEPCK protein levels were similar or higher, while the expression of Cpt1a decreased in PASK-deficient mice. By contrast, Lxra and Chrebp were overexpressed after refeeding, while the expression of Acc and Fas decreased in PASK-deficient mice. Likewise, with a decreased expression of Gck and increased nuclear location of the complex GCK-GCKR, GCK activity decreased in PASK-deficient mice. Therefore, PASK regulated some of the genes and proteins responsible for glucose sensing, such as glucokinase, and for insulin signalling, affecting glucose and lipid metabolism and consequently certain critical hepatic functions.
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Affiliation(s)
- A Pérez-García
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Complutense University of Madrid, Institute of Medical Research at the Hospital Clínico San Carlos (IdISSC), Ciudad Universitaria, s/n, 28040, Madrid, Spain.,Department of Cell Biology, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - P Dongil
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Complutense University of Madrid, Institute of Medical Research at the Hospital Clínico San Carlos (IdISSC), Ciudad Universitaria, s/n, 28040, Madrid, Spain.,Department of Cell Biology, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - V Hurtado-Carneiro
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Complutense University of Madrid, Institute of Medical Research at the Hospital Clínico San Carlos (IdISSC), Ciudad Universitaria, s/n, 28040, Madrid, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - E Blazquez
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Complutense University of Madrid, Institute of Medical Research at the Hospital Clínico San Carlos (IdISSC), Ciudad Universitaria, s/n, 28040, Madrid, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - C Sanz
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain. .,Department of Cell Biology, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain.
| | - E Alvarez
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Complutense University of Madrid, Institute of Medical Research at the Hospital Clínico San Carlos (IdISSC), Ciudad Universitaria, s/n, 28040, Madrid, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
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49
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Abstract
SummaryThe in vitro antiplatelet aggregating activity of magnesium and magnesium associated with soluble citroflavomJids (hesperidin and eriodictin, 1:1) is well-established.The degree of inhibition of in vitro platelet aggregation activity produced by different concentrations of magnesium halogenates was determined. ADP (4 μM) was used to induce aggregation following Cardinal and Flowers’ (1) technique.Antithtombotic activity was studied in vivo. The differencein duration. of ADP-induced respiratory dysfunction was compared between animals fed 25 mg/kg magnesium halogenates for 10 days before testing and controls.An increase in circulating platelets was observed in rats treated with magnesium halogenates.
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Affiliation(s)
- R Cantón
- The Departamento de Farmacologia, Facultad de Farmacia, Universidad Complutense de Madrid, Spain
| | - J Manzanares
- The Departamento de Farmacologia, Facultad de Farmacia, Universidad Complutense de Madrid, Spain
| | - E Alvarez
- The Departamento de Farmacologia, Facultad de Farmacia, Universidad Complutense de Madrid, Spain
| | - F Zaragozá
- The Departamento de Farmacologia, Facultad de Farmacia, Universidad Complutense de Madrid, Spain
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50
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Vicent-Gil M, Keymer-Gausset A, Serra-Blasco M, Carceller-Sindreu M, de Diego-Adeliño J, Trujols J, Mur M, Pérez V, Alvarez E, Cardoner N, Portella MJ. Cognitive predictors of illness course at 12 months after first-episode of depression. Eur Neuropsychopharmacol 2018; 28:529-537. [PMID: 29482974 DOI: 10.1016/j.euroneuro.2018.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 02/01/2018] [Accepted: 02/07/2018] [Indexed: 10/17/2022]
Abstract
Major Depressive Disorder (MDD) entails cognitive dysfunction in many cognitive domains, but it is still uncertain whether such deficits are present in the early stages. The purpose of the study is to determine the cognitive performance in first episode depression (FED) exploring the presence of different cognitive profiles, and the role of cognition in FED at baseline and long-term. Ninety subjects (18-50 years) were included, 50 patients with a FED and 40 healthy controls. Participants were assessed with a neuropsychological battery, covering language, attention, verbal memory, processing speed and executive domains. Neuropsychological group comparisons were performed with MANOVAs. A hierarchical cluster analysis was run to identify clusters of patients with similar neuropsychological performance. Two generalized linear models were built to predict baseline HDRS-17 and changes at 12 months. Patients performed significantly worse than healthy controls in language, attention/working memory, verbal memory, processing speed and executive functioning, with moderate to large effect sizes (0.5 - 1). Two clusters were found: cognitively preserved patients (n=37) and cognitively impaired patients (n=13). Large effect sizes of cognitive impairment in FED were observed between the two cognitive clusters (preserved and impaired). Depressive symptoms at baseline were predicted by verbal memory (p=0.003), while 12-month changes were predicted by executive function (p=0.041) and language (p=0.037). Cognitive performance predicted depressive symptoms at baseline and at follow-up, pointing to the usefulness of cognitive assessment even at the commencement of the illness.
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Affiliation(s)
- M Vicent-Gil
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau)- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), CIBERSAM, Biomedical Research Networking Center Consortium on Mental Health, Sant Antoni Mª Claret 167, 08025 Barcelona, Spain; Mental Health, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), CIBERSAM, Biomedical Research Networking Center Consortium on Mental Health, Sabadell, Spain
| | - A Keymer-Gausset
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau)- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), CIBERSAM, Biomedical Research Networking Center Consortium on Mental Health, Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
| | - M Serra-Blasco
- Mental Health, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), CIBERSAM, Biomedical Research Networking Center Consortium on Mental Health, Sabadell, Spain
| | - M Carceller-Sindreu
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau)- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), CIBERSAM, Biomedical Research Networking Center Consortium on Mental Health, Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
| | - J de Diego-Adeliño
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau)- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), CIBERSAM, Biomedical Research Networking Center Consortium on Mental Health, Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
| | - J Trujols
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau)- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), CIBERSAM, Biomedical Research Networking Center Consortium on Mental Health, Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
| | - M Mur
- Psychiatric Service, Hospital Universitari Santa Maria, University of Lleida, IRB Lleida (Biomedicine Research Institute), Lleida, Catalonia, Spain
| | - V Pérez
- Hospital del Mar, Institut Hospital del Mar d'Investigacions Biomèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CIBERSAM, Biomedical Research Networking Center Consortium on Mental Health, Barcelona, Spain
| | - E Alvarez
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau)- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), CIBERSAM, Biomedical Research Networking Center Consortium on Mental Health, Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
| | - N Cardoner
- Mental Health, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), CIBERSAM, Biomedical Research Networking Center Consortium on Mental Health, Sabadell, Spain
| | - M J Portella
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau)- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), CIBERSAM, Biomedical Research Networking Center Consortium on Mental Health, Sant Antoni Mª Claret 167, 08025 Barcelona, Spain.
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