Indigenous Identity and Household Food Insecurity are Associated with Poor Health Outcomes in Canada

Purpose: To examine whether Indigenous identity and food insecurity combined were associated with self-reported poor health.Methods: Data from the 2015-2016 Canadian Community Health Survey and multiple logistic regression were employed to evaluate the association between Indigenous identity, household food insecurity, and health outcomes, adjusted for individual and household covariates. The Alexander Research Committee in Alexander First Nation (Treaty 6) reviewed the manuscript and commented on the interpretation of study findings.Results: Data were from 59082 adults (3756 Indigenous). The prevalence of household food insecurity was 26.3% for Indigenous adults and 9.8% for non-Indigenous adults (weighted to the Canadian population). Food-secure Indigenous adults, food-insecure non-Indigenous adults, and food-insecure Indigenous adults had significantly (p < 0.001) greater odds of poor health outcomes than food-secure non-Indigenous adults (referent group). Food-insecure Indigenous adults had 1.96 [95% CI:1.53,2.52], 3.73 [95% CI: 2.95,4.72], 3.00 [95% CI:2.37,3.79], and 3.94 [95% CI:3.02,5.14] greater odds of a chronic health condition, a chronic mental health disorder, poor general health, and poor mental health, respectively, compared to food-secure non-Indigenous adults.Conclusions: Health policy decisions and programs should focus on food security initiatives for all Canadians, including addressing the unique challenges of Indigenous communities, irrespective of their food security status.

[From hospital architecture to hospitality]

This article on architecture, care and hospitality is part of a reflection shared by several researchers at the Chair of Philosophy in Hospitals. It follows on from previously published texts by Marie Tesson, Éric de Thoisy and Hugo Martin, which explore in different ways the spaces in which care can be deployed, and how the ethics of care are likely to guide our decisions about our cities and our architectures.

Older Adults' Quality of Life in Long-Term Care: A Cross-Sectional Comparison Before and During the COVID-19 Pandemic

This study aims to assess changes in long-term care (LTC) residents' quality of life (QoL) before and during the COVID-19 pandemic. A pre-test post-test study of 49 QoL measures, across four dimensions from the interRAI self-reported QoL survey, was conducted. Secondary data from 2019 (n = 116) and 2020 (n = 128) were analysed to assess the change in QoL. A significant decline in 12 measures was observed, indicating a change in QoL of LTC residents during the pandemic. Social life was the dimension mostly affected with residents reporting less opportunities to spend time with like-minded residents, explore new skills and interests, participate in meaningful religious activities, and have enjoyable things to do in the evenings. Several measures of personal control, staff responsiveness and care, and safety also demonstrated a significant change. The results can inform future strategies for pandemic and outbreak preparedness. Balancing the safety of residents with attention to their QoL should be a priority moving forward.

[The transition preparation consultation: What for?]

The transition from pediatrics to adult services represents one of the many changes experienced by adolescents with chronic illnesses between childhood and adulthood. It needs to be structured and personalized to support the young person's development and empowerment, as well as the construction of his or her overall life project. With this in mind, AD'venir offers transition preparation consultations, the details and benefits of which are described in this article.

[Changes in autonomy and attachment to parents and caregivers during transition to adult services]

The transition from pediatric to adult care is a risky period in the care of a child or adolescent with a chronic illness. This pivotal stage is also part of an evolutionary process of individuation and empowerment that is both global and specific. The security felt, both in relationships with parents and caregivers, is fundamental to these processes. It is this security that will enable the young person to develop nuanced, flexible strategies for adjusting to the different kinds of changes he will have to face in his situation as a patient and, more broadly, in his daily life. Enrolled in multiple networks of relationships, yet autonomous, he or she will become an agent of his or her own life, of which medical care is one aspect.

[History and challenges of the transition from pediatrics to adult care]

Transition from pediatrics to adult care involves a growing number of young people living with chronic health conditions. Now a field of study and practice, transition has been built up in successive stages, the nature of which informs us about its evolution and current issues.

Association of health literacy with physical and mental health in people with chronic diseases

OBJECTIVE

to explore the association of health literacy domains with physical and mental quality of life in people with selected chronic diseases.

METHODS

Community-dwelling people with selected chronic diseases planned for immunization against influenza in 2017/2018 were included in the study. All non-vaccinated people and the corresponding number of randomly selected vaccinated people matched on town of residence were included. Data were collected by means of socio-demographic questionnaire, Health Literacy Questionnaire (HLQ) and Short Form-36 (SF-36). The Physical and Mental Composite Scores as well as their domains were observed as the study outcomes.

RESULTS

A total of 295 people were studied. The adjusted logistic regression showed that Physical and Mental composite scores were associated with all HLQ domains except 5) Appraisal of health information. Better Physical Functioning was associated with higher scores on 1) Feeling understood and supported by healthcare providers, 6) Ability to actively engage with healthcare providers, 7) Navigating the healthcare system and 8) Ability to find good health information. Better scores on Vitality, Social Functioning, Role Emotional and Mental Health were associated with higher scores on all HLQ domains except 5) Appraisal of health information.

CONCLUSION

Health literacy is important for physical and mental quality of life among people with chronic diseases. Health care providers and other stakeholders should continuously work to improve health literacy of their patients.

[Deployment of cross-functional patient education units in healthcare institutions in Île-de-France]

Therapeutic patient education (TPE) has proven its value and is a real challenge in the health care system. In order to coordinate the various TPE programs existing within health care institutions, transverse units for patient education have begun to be deployed. Although they have encountered some obstacles in their development, the teams, like the people being cared for, find them a real advantage. Research conducted in the Île-de-France region offers some ideas for strengthening their implementation.

[Risks and opportunities of reproduction with HIV]

As the human immunodeficiency virus (HIV) infection has become a chronic disease, the question of becoming a parent arises for HIV-positive people. There are several answers to this question, depending on the situation. Here is an overview of the risks and possibilities of procreation with HIV.

[Care and information for an HIV-positive patient]

Since the year 2000, AIDS has become a chronic disease that can be treated and monitored. The two specific and necessary parameters for monitoring patients are the CD4 lymphocyte rate, which indicates the state of the immune system, and the viral load, which makes it possible to monitor the effectiveness of the antiretroviral treatments prescribed; in addition, blood antiretroviral drugs can be measured in certain cases. Today, it is clear that a patient who is effectively treated with an undetectable viral load is no longer a contaminant and that he or she will live with the disease, while facing the health issues common to everyone: emotional life, aging, other pathologies. Each caregiver, whether in the city or in a health care facility, will have a role to play in the care process.

[The place of therapeutic education in the care of an HIV-positive patient]

Since the advent of triple therapy, HIV has become a chronic disease. Therapeutic patient education (TPE) seems to have a place in this accompaniment, which has sometimes lasted several decades. The role of a nurse in TPE is still essential for the accompaniment of an HIV positive patient.

[Advanced practice nursing as a complement to primary care physician practice]

Two advanced practice nurses (APNs) who graduated in France propose a feasibility perspective on their future multiprofessional practice in primary care. A retrospective exploratory study of 9 physicians was carried out on 396 consultations according to reasons and patient profiles. Slightly more than 22% of the consultations could be oriented strictly towards IPA. Approximately 60% of IPA consultations would fall under the heading of parallel therapeutic education.

Appel à l'action : des recommandations pour améliorer la transition des jeunes ayant des besoins de santé complexes vers les soins aux adultes

Les jeunes qui ont des besoins de santé complexes, définis comme ceux qui nécessitent des soins et services spécialisés en raison d'affections physiques, développementales ou mentales, sont souvent traités par des pédiatres et autres spécialistes en pédiatrie. Au Canada, l'âge auquel les bailleurs de fonds provinciaux et territoriaux exigent le transfert des soins pédiatriques aux soins pour adultes varie entre 16 et 19 ans. La délimitation actuelle entre les services de santé pédiatriques et aux adultes est fragmentaire, ce qui entrave la continuité des soins pendant une période déjà vulnérable du développement. Le peu d'intégration des soins entre les domaines peut nuire à l'engagement des jeunes en matière de santé et compromettre leur santé à l'âge adulte. Pour renverser ces obstacles et améliorer les résultats de la transition, les dispensateurs de soins pédiatriques et de soins aux adultes, de même que les médecins de famille et d'autres partenaires communautaires, doivent collaborer de manière satisfaisante à l'élaboration de stratégies systémiques qui rationalisent et préservent les soins aux jeunes en transition vers des soins aux adultes en milieu tertiaire, communautaire et primaire. Il est recommandé de privilégier des limites d'âge flexibles pour effectuer cette transition vers les soins aux adultes et de tenir compte de la phase de développement et de l'aptitude de chaque jeune, ainsi que des besoins et de la situation de chaque patient et de chaque famille. Une formation et un enseignement spécialisés sur les enjeux liés aux soins de transition s'imposent pour renforcer les capacités et s'assurer que les professionnels de la santé des diverses disciplines et des divers milieux soient mieux outillés pour accepter et traiter les jeunes qui ont des besoins de santé complexes.

[Therapeutic patient education in the city by private nurses]

Therapeutic patient education (TPE) is part of the nurse's role, but a minimum of 40hours of training is required to practice in a national or regional program. Offering TPE requires a good command of the pathologies concerned, finding the time to proceed in a way that is comfortable for everyone, identifying the health professionals who intervene in the home. But also showing adaptability to accompany the patient towards autonomy.

[Long-term nursing care of the adult sickle cell patient]

Sickle cell disease is a genetic and chronic disease that requires multidisciplinary care. This requires investment on the part of both the patient and the entire health care team. In most cases, the sickle cell patient is diagnosed about two months after birth. The care pathway for adults is a continuation of the work done in paediatrics. The chronic nature of the disease means that patients are regularly admitted to hospital, which has an impact on their personal and professional lives. Appropriate nursing support helps to improve their daily lives.

[Psychology and culture in sickle cell disease]

Sickle cell disease is a chronic pathology which can be expressed as early as the first few months of life. There are many psychological repercussions, linked to the effects of the disease itself, to its impact on the patients' relational life and, for some, to exile and cultural differences. Psychological support is useful for both the patient and his or her family, particularly at key moments in the treatment process.

[The health benefits of physical activity]

Five million deaths per year worldwide could be prevented if physical activity (PA) recommendations were followed. Scientific studies have shown with a high level of evidence that PA prevents and treats most chronic diseases. It also contributes to the prevention of the main risk factors for these diseases. In France, whatever the age group, physical activity is considered insufficient in relation to the recommendations of the World Health Organisation. However, over the last ten years, public policies have been moving in the direction of promoting physical activity.

[Physical activity upon prescription]

The concept of adapted physical activity (APA) was born in the 1980s in French universities, and more particularly in the Sciences and techniques of physical and athletic activities degree. Today, it is an integral part of the caregivers' therapeutic arsenal. However, if everything seems to be done to ensure that the practice of APA is prescribed to as many people as possible, for doctors, this new therapeutic opportunity to improve the health of their patients is not so easy to put in place in the field.

[Physical activity and quality of life with chronic disease]

After the diagnosis of a genetic disease, Fabrice Huré underwent dialysis and a kidney transplant, followed by graft rejection. Thanks to regular physical activity and night-time care, his living conditions, physical and mental capacities improved. Passionate about mountains and wide open spaces, he participated in the Grand Raid, on the island of Reunion. Testimonial.

[Geriatric and social assessment by the heart failure patients' nurse in the FIL-EAS ic]

The use of geriatric and social assessment grids by dedicated nurses for patients hospitalised for acute heart failure allows for an early and safe return home in home hospitalisation. These grids isolate a sub-group of older patients with a high risk of re-hospitalisation for whom specific actions can be envisaged.

Initial stay times for uncompensable occupational heat stress in young and older men: a preliminary assessment

During uncompensable occupational heat stress, heat-mitigation controls are required to prevent core temperature exceeding recommended limits (≥38 °C). However, the initial stay time before employing controls remained unknown. We estimated these times for moderate-intensity work at 26, 28, 30, and 32 °C wet-bulb globe temperatures (WBGT) in 50 young (18-30 years) and older (50-70 years), non-heat acclimatized men. Initial stay time was 111 min at 26 °C WBGT and declined exponentially to 44 min at 32 °C WBGT. Novelty: We provide estimates of the moderate-intensity work duration before heat-mitigation is required in wet-bulb globe temperatures between 26-32 °C for young and older, non-heat acclimatized men.

(Dis)Connecting Through COVID-19: Experiences of Older Persons in the Context of a Volunteer-Client Relationship

The coronavirus (COVID-19) pandemic and mandated physical distancing requirements significantly impacted volunteer programs for older persons with many long-standing programs either ceasing altogether or pivoting to connecting through virtual technologies. In this study, we collected qualitative interview data from 23 clients and 33 volunteers to investigate their experiences during the COVID-19 pandemic and the effects on the volunteer-client relationship. Three themes were identified: pandemic emotions, negotiating social interactions, and growing through the COVID-19 pandemic. These findings provide important insights into the experiences of hospice organizations and their volunteers and clients during the COVID 19 pandemic, further highlighting the importance of acknowledging both older persons' vulnerability and their resilience, of building in compassionate community approaches to care, and of finding innovative ways to foster volunteer-client relationships during times when physical visiting is not possible.

Age and Sex-Specific Associations in Health Risk Factors for Chronic Disease: Evidence from the Atlantic Partnership for Tomorrow's Health (PATH) Cohort

The objective of this study was to discern health risk factors for chronic disease by age and sex in a Canadian cohort. Participants of the Atlantic Partnership for Tomorrow's Health (PATH) cohort with health risk factor data (physical activity, smoking, alcohol consumption, diet, body mass index [BMI]) were included (n = 16,165). Multivariable logistic regression models were used to evaluate the relationship among health risk factors, age, and sex. Regression analysis revealed that the odds of engaging in high levels of physical activity and having a BMI ≥ 25 was lower for females than males across all age groups, whereas the odds of abdominal obesity was substantially higher for females of all ages than for males. The odds of habitually consuming alcohol was lower for females of all ages than for males, and the odds of being a former/current smoker was lower for older (57-74 years of age) females than for males. The odds of consuming five or more servings of fruit and vegetables per day was higher for females of all ages than for males. There are evident differences in health risk factors for males and for females, as well as across age groups, and public health efforts need to account for the role played by sex and age in addressing chronic disease burden in Canadian adults.

Dietary Reference Intakes based on chronic disease endpoints: outcomes from a case study workshop for omega 3's EPA and DHA

Given the focus on developing Dietary Reference Intakes (DRIs) based on chronic disease risk reduction and recent research for omega-3 long chain PUFA since the last DRI review, the Canadian Nutrition Society convened a panel of stakeholders for a 1-day workshop in late 2019. Attendees discussed the new NASEM guidelines for establishing DRI values based on chronic disease risk endpoints and the strength of current evidence for EPA and DHA as it relates to the new guidelines. Novelty: Summarizes evidence and expert opinions regarding the potential for reviewing DRI values for EPA and DHA and cardiovascular disease risk and early development.

A Canadian perspective on severe acute respiratory syndrome coronavirus 2 infection and treatment: how prevalent underlying inflammatory disease contributes to pathogenesis

The coronavirus disease 2019 (COVID-19), a serious respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emerged as a global pandemic. Canada reported its first case of COVID-19 on the 25th January 2020. By March 2020, the virus had spread within Canadian communities reaching the most frail and vulnerable elderly population in long-term care facilities. The majority of cases were reported in the provinces of Quebec, Ontario, Alberta, and British Columbia, and the highest mortality was seen among individuals aged 65 years or older. Canada has the highest prevalence and incidence rates of several chronic inflammatory diseases, such as multiple sclerosis, inflammatory bowel disease, and Parkinson's disease. Many elderly Canadians also live with comorbid medical illnesses, such as hypertension, diabetes, cardiovascular disease, and chronic lung disease, and are more likely to suffer from severe COVID-19 with a poor prognosis. It is becoming increasingly evident that underlying inflammatory disease contributes to the pathogenesis of SARS-CoV-2. Here, we review the mechanisms behind SARS-CoV-2 infection, and the host inflammatory responses that lead to resolution or progression to severe COVID-19 disease. Furthermore, we discuss the landscape of COVID-19 therapeutics that are currently in development in Canada.

Operationalizing the Disablement Process for Research on Older Adults: A Critical Review

Self-care disability is difficulty with or dependence on others to perform activities of daily living, such as eating and dressing. Disablement is worsening self-care disability measured over time. The disablement process model (DPM) is often used to conceptualize gerontology research on self-care disability and disablement; however, no summary of variables that align with person-level DPM constructs exists. This review summarizes the results of 88 studies to identify the nature and role of variables associated with disability and disablement in older adults according to the person-level constructs (e.g., demographic characteristics, chronic pathologies) in the DPM. It also examines the evidence for cross-sectional applications of the DPM and identifies common limitations in extant literature to address in future research. Researchers can apply these results to guide theory-driven disability and disablement research using routinely collected health data from older adults.

[Nursing student, expert patient, knowledge broker]

Therapeutic education plays an important role in nursing education in terms of knowledge and skills. Indeed, the support of the chronic patient represents a new challenge for the caregiver and requires a change in his or her posture. Thus, he may have to collaborate with the expert patient, who is now fully recognised as a care partner. Sharing experience with a student from a Parisian nursing training institute, himself an expert patient.

[A multidisciplinary collaboration for the benefit of patients]

A study focusing on therapeutic education sessions for patients with psoriasis receiving subcutaneous biotherapy was carried out in a dermatology department of a university hospital. To meet the needs identified by the research, multi-professional collaboration around a therapeutic patient education approach resulted in the creation and implementation of specific information tools and the organisation of training sessions for the nurses. A subsequent survey showed a 100% satisfaction rate among patients and nurses.

[The benefits of the "patient experience"]

The doctor-patient relationship tends to reconfigure. The chronic patient is recognised for the ability to perform certain healthcare activities, but also for a type of expertise related to his or her personal experience with illness. However, what are the individual and collective benefits of this expertise? How is it enhanced by connected medical systems?

[The motivational interview in a context of palliative care]

Palliative care remains a practice at the crossroads between several theoretical approaches. The palliative approach in terms of support requires a certain amount of diversity in order to reflect the plurality of the sources of anxiety. This anxiety causes ambivalence, a source of existential difficulties. This study analyses the motivational interview as a potential approach in the process to support patients suffering from progressive chronic diseases in order to improve their quality of life.

[Therapeutic education in children, progress and perspectives]

Therapeutic education in paediatrics forms part of the child's care pathway, from the discovery of the chronic disease, through to adulthood. Around fifteen years ago, this specific healthcare activity resulted in the creation of a multiple pathology therapeutic education centre at Robert-Debré university hospital in Paris. The centre has continued to develop over the years and further improved its interventions.

[Living with HIV/AIDS today, impacts on mental health]

The human immunodeficiency virus (HIV)/AIDS, at one time fatal, has now become a chronic disease. Physically, patients are generally in good health. However, 35 years after the discovery of the virus, mental suffering is still very much present. Morbid representations, understandable given the history of the disease, are still active on an individual level as well as on a broader level within society. Adapted information campaigns are essential in order to change behaviour.

[The place of the subject in prevention, the example of chronic diseases]

The place of the patient and their expertise are essential in the success of prevention actions, as shown by the situations of people facing AIDS, cardiovascular disease and the post-cancer period. Promotional campaigns can help to improve the prevention of risks around chronic diseases. It is also necessary to transform the patient's experience into expertise and ensure it is acknowledged by caregivers and the healthcare system.

[Therapeutic education, a source of inspiration for students]

Therapeutic education contributes to improving the health of patients suffering from chronic diseases, their quality of life and that of their loved ones. It is complementary and inseparable from treatment and care, symptom relief and prevention of complications. Inspired by the modalities of this approach towards children suffering from cystic fibrosis, students from a nursing training institute in Ile-de-France share their work on this theme.

Physical activity among Canadian adults with obstructive respiratory diseases

The objective of this study was to investigate the amount and modes of physical activity in which adults with obstructive respiratory disease engage. Data from respondents with self-reported asthma (n = 4293), chronic obstructive pulmonary disease (COPD) (n = 3118), both diseases (n = 1569), and neither obstructive respiratory disease (n = 64 175); these data are from the Canadian Community Health Survey (2011-2012). Logistic regressions were used to assess associations between modes of physical activity and type of respiratory disease. Linear regressions were used to investigate the association between daily energy expenditure and respiratory disease. Adults with COPD and both diseases had the lowest participation in all modes of physical activity. Those with both diseases were less likely to report walking (odds ratio (OR) = 0.74, 95% confidence interval (CI) = 0.63-0.88), while those with COPD were less likely to report participation in endurance activities (OR = 0.79, 95% CI = 0.68-0.92), compared with those with neither obstructive respiratory disease. Those with asthma had similar daily energy expenditure levels and physical activity preferences compared with those with neither obstructive respiratory disease. In conclusion, adults with COPD and both asthma and COPD were less likely to engage in common activities such as walking, while physical activity levels among adults with asthma did not differ from the general population.

[The challenges of time in therapeutic education]

The notion of temporality is particularly important in the management of a chronic disease. Therapeutic education of the patient represents a holistic care approach in which his life history plays a role. Establishing a context favourable to personalised support requires one to consider one's cultural interactions. Adapted communication will favour an adjustment of behaviour and the improvement of one's quality of life.

[Beating cancer, living with it: success and ethical dilemmas]

Cancers are serious conditions which affect numerous families. The advances made in treatments thanks to research enable a growing number of cancers to be cured. Some cancers which are treated evolve towards a form of chronicity whereby patients have to live with the condition. These varied situations, always sensitive, mobilise and bring together patients, their families, caregivers, researchers and associations. There are many ethical dilemmas facing all those involved in this fight.

[Health literacy and therapeutic education, converging objectives]

As part of the support provided to people with chronic diseases, nurses contribute to therapeutic patient education. This approach, drawing in particular on health literacy, aims to give people the skills needed for greater autonomy.

Les enjeux de la transition de la pédiatrie vers la médecine d’adultes

THE ISSUES IN THE TRANSITION FROM PAEDIATRICS TO ADULT MEDICINE

The transfer or transition from paediatric care to adult medicine is, for a large number of adolescents and young adults being monitored for a rare and/or chronic pathology, as well as for the care teams, a critical period in their medical journey and in their life. It is both an individual and a public health issue, with medical-economic consequences. At the hôpital Necker-Enfants malades in Paris, a specific programme has been implemented aimed at the patients and carers.

[Psychological support for patients with a ventricular assist device]

In the case of end-stage heart failure, the medical-surgical team can suggest the use of an external circulatory assist device as a definitive therapy. Living with this assistance requires a certain amount of adaptation on the part of the patients and their family, but can significantly improve quality of life. Support groups give them the opportunity to talk about their new life and receive psychological support.

The Prevalence and Risk for Herpes Zoster Infection in Adult Patients With Diabetes Mellitus in the Canadian Primary Care Sentinel Surveillance Network

OBJECTIVES

Herpes zoster (HZ) is a common infection in Canada that can result in serious and long-term complications. People with diabetes may be at an increased risk for HZ. The objectives of this study were to develop and validate a case definition of HZ diagnosis based on electronic medical records; determine a prevalence estimate for HZ in adult patients in the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) and assess the association between HZ and diabetes.

METHODS

This was a retrospective cross-sectional study. Patients 18 years of age or older who had made at least 1 visit to their primary health-care providers within the past 2 years in the CPCSSN were included. These data came from a 2015 extract of CPCSSN data, and a subsample of 289 patients was used to validate our case definition. Prevalences were estimated for the overall population and for people with diabetes, chronic obstructive pulmonary disease, cancer or HIV. Risk ratios were modelled for these conditions.

RESULTS

The sensitivity, specificity, positive predictive value and negative predictive values for HZ were 100%, 73.8%, 83.9% and 100%, respectively. The 1-year prevalence of HZ in the CPCSSN data was 0.32%. The prevalence of HZ was higher in females (0.35%) than in males (0.28%). People with diabetes have an increased risk for HZ infection (RR 2.64, 95% CI 2.34, 2.99).

CONCLUSIONS

People with diabetes have an increased risk for the diagnosis of HZ infection in the primary care setting in Canada. Women over the age of 65 years with diabetes and/or other chronic conditions are at greatest risk for developing HZ.

Policy recommendations for front-of-package, shelf, and menu labelling in Canada: Moving towards consensus

Greater availability of low nutritional quality foods and decreased consumption of nutrient-dense foods have negatively impacted the nutrient profile of the Canadian diet. Poor diet is now the leading risk factor for chronic disease and premature death in Canada. To help consumers choose healthful foods, nutrition labelling is one policy tool for communicating relevant nutrition information. However, there are notable shortcomings with current nutrition labelling systems, which make it difficult for Canadians to navigate the complex food environment. Government action on nutrition labelling systems, including front-of-package (FOP), shelf, and menu labelling, is required. In May 2016, we hosted a consensus conference with experts from research, policy and practice to review available evidence, share experiences and come to consensus regarding the next best steps for action on nutrition labelling in Canada. In this paper, we examine the evidence, opportunities and challenges surrounding FOP, shelf, and menu labelling. We outline recommendations, emphasizing FOP, shelf, and menu labelling as part of a standardized, coordinated and multi-pronged strategy supported by a robust, evidence-based nutrition profiling system. Recommendations for monitoring adherence to regulations and participation of stakeholders to avoid conflict of interest in policy development, implementation and evaluation are included. Within a comprehensive strategy, these recommendations can help to improve the nutrition information environment for Canadians.

[Social inequalities, chronic diseases and therapeutic patient education]

A study was carried out of patients with type 2 diabetes following a hospital therapeutic education programme. The results show that the transfer of self-management and adaptation competencies must take into consideration patients' social differentiation. They bring into question the assumption of the individual's autonomy. In this context, the professional position of the caregivers is essential in order to provide patients with the best support possible.

Nutra-ergonomics: influence of nutrition on physical employment standards and the health of workers

The importance of ergonomics across several scientific domains, including biomechanics, psychology, sociology, and physiology, have been extensively explored. However, the role of other factors that may influence the health and productivity of workers, such as nutrition, is generally overlooked. Nutra-ergonomics describes the interface between workers, their work environment, and performance in relation to their nutritional status. It considers nutrition to be an integral part of a safe and productive workplace that encompasses physical and mental health as well as the long-term wellbeing of workers. This review explores the knowledge, awareness, and common practices of nutrition, hydration, stimulants, and fortified product use employed prior to physical employment standards testing and within the workplace. The influence of these nutra-ergonomic strategies on physical employment standards, worker safety, and performance will be examined. Further, the roles, responsibilities, and implications for the applicant, worker, and the employer will be discussed within the context of nutra-ergonomics, with reference to the provision and sustainability of an environment conducive to optimize worker health and wellbeing. Beyond physical employment standards, workplace productivity, and performance, the influence of extended or chronic desynchronization (irregular or shift work) in the work schedule on metabolism and long-term health, including risk of developing chronic and complex diseases, is discussed. Finally, practical nutra-ergonomic strategies and recommendations for the applicant, worker, and employer alike will be provided to enhance the short- and long-term safety, performance, health, and wellbeing of workers.

[Towards the active participation of users in quality approaches]

Since the 1990s, the quality approach has been developing in hospitals in accordance with an assessment strategy, based on reference guidelines, or with a continuous quality improvement strategy, more favourable to the participation of players. The increase in chronic diseases encourages the participation of patients, with their own particular expertise on the disease and the associated care. Patients can also be involved in a collective mission, favourable to the improvement of the care provision.

Strategies used by Patients with Type 1 Diabetes to Avoid Hypoglycemia in a 24×1-Hour Marathon: Comparison with the Amounts of Carbohydrates Estimated by a Customizable Algorithm

OBJECTIVES

The preferred countermeasure to avoid exercise-related hypoglycemia was investigated in a group of patients with type 1 diabetes participating in a stressful event, a 24×1-hour relay marathon. The carbohydrates actually consumed were compared to those estimated for each patient by applying a customizable algorithm, Exercise Carbohydrates Requirement Estimating Software (ECRES), based on patient's usual therapy and diet and on the exercise characteristics.

METHODS

Glycemia was tested at the start, middle and end of the races. Usual therapies and diets and the adopted countermeasures were recorded in detail.

RESULTS

We studied 19 patients who walked/ran 10.4±2.8 km with a heart rate of 167±11 beats per minute. Of the 19 patients, 7 patients reduced the administered insulin (premeal bolus or basal infusion rate). Glycemia fell by the end of the races (p=0.006; median -1.8 mmol⋅L^-1; interquartile range -0.4 mmol⋅L^-1 to -5.3 mmol⋅L^-1), despite 9 patients being hyperglycemic at the start. Of the patients, 14 concluded the race with glycemia on target, and 4 patients were hyperglycemic. Amounts of carbohydrates actually consumed (median 30 g; interquartile range 0 g to 71 g) were not significantly different from those estimated by ECRES (median 38 g; interquartile range 24 g to 68 g), the 2 quantities being significantly related (R=0.64; p=0.003). ECRES estimated lower carbohydrate levels (-13 g) than the amounts actually consumed by the 4 patients who concluded their exercises with hyperglycemia.

CONCLUSIONS

Patients preferred to consume extra carbohydrates to avoid the possible exercise-induced hypoglycemia. ECRES would provide satisfactory estimates of the carbohydrate requirements, even for a stressful condition, and almost equal to the quantities consumed following medical advice.

[Summary]

Obesity is a frequent disease, due to complex causes. Importantly, its related medical and psychosocial comorbidities are linked to its severity. Thus, the first thorough evaluation is mandatory in order to build a personalized care program, which needs to be in agreement with all the health professionals involved. This care program also needs to be reevaluated and possibly modified during the follow-up. The care objectives need to be realistic and in agreement with what the patients is expecting.

[Doctor-nurse cooperation in a therapeutic education pathway at home]

A therapeutic education programme comprising individual sessions in the patient's home has been tried out with patients with diabetes. It enables them to gain a better understanding of the disease and become players in their own health care. This initiative strengthens the doctor-nurse partnership within a coordinated care pathway.

Scoping review: strategies of providing care for children with chronic health conditions in low- and middle-income countries

OBJECTIVES

To identify and review strategies of providing care for children living with chronic health conditions in low- and middle-income countries.

METHODS

We searched MEDLINE and Cochrane EPOC databases for papers evaluating strategies of providing care for children with chronic health conditions in low- or middle-income countries. Data were systematically extracted using a standardised data charting form, and analysed according to Arksey and O'Malley's 'descriptive analytical method' for scoping reviews.

RESULTS

Our search identified 71 papers addressing eight chronic conditions; two chronic communicable diseases (HIV and TB) accounted for the majority of papers (n = 37, 52%). Nine (13%) papers reported the use of a package of care provision strategies (mostly related to HIV and/or TB in sub-Saharan Africa). Most papers addressed a narrow aspect of clinical care provision, such as patient education (n = 23) or task-shifting (n = 15). Few papers addressed the strategies for providing care at the community (n = 10, 15%) or policy (n = 6, 9%) level. Low-income countries were under-represented (n = 24, 34%), almost exclusively involving HIV interventions in sub-Saharan Africa (n = 21). Strategies and summary findings are described and components of future models of care proposed.

CONCLUSIONS

Strategies that have been effective in reducing child mortality globally are unlikely to adequately address the needs of children with chronic health conditions in low- and middle-income settings. Current evidence mostly relates to disease-specific, narrow strategies, and more research is required to develop and evaluate the integrated models of care, which may be effective in improving the outcomes for these children.

[Chronic disease and sexuality, a taboo for caregivers]

Chronic disease impacts on patients' quality of life and in particular their sexuality. The consequences on their sexual quality of life are both physical and psychological and also affect their relationship as a couple. The issue is still taboo with too few caregivers prepared to address it.