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INTRODUCTION: Food prescription programs are part of the broader social prescribing movement as an approach to address food insecurity and suboptimal diet in health care settings. These programs exist amid other social services, including income-based supports and food assistance programs; however, evaluations of the interactions between these programs and pre-existing services and supports are limited. This study was embedded within a larger evaluation of the 52-week Fresh Food Prescription (FFRx) program (April 2021-October 2022); the objective of this study was to examine how program participation influenced individuals' interactions with existing income-based supports and food assistance programs. METHODS: This study was conducted in Guelph, Ontario, Canada. One-to-one (n = 23) and follow-up (n = 10) interviews were conducted to explore participants' experiences with the program. Qualitative data were analyzed thematically using a constant comparative analysis. RESULTS: Participants described their experience with FFRx in relation to existing income-based supports and food assistance programs. FFRx reportedly extended income support further to cover living expenses, allowed participants to divert income to other necessities, and reduced the sacrifices required to meet basic needs. FFRx lessened the frequency of accessing other food assistance programs. Aspects of FFRx's design (e.g. food delivery) shaped participant preferences in favour of FFRx over other food supports. CONCLUSION: As food prescribing and other social prescribing programs continue to expand, there is a need to evaluate how these initiatives interact with pre-existing services and supports and shape the broader social service landscape.
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Asistencia Alimentaria , Inseguridad Alimentaria , Investigación Cualitativa , Servicio Social , Humanos , Ontario , Femenino , Masculino , Servicio Social/organización & administración , Persona de Mediana Edad , Adulto , Asistencia Alimentaria/organización & administración , Asistencia Alimentaria/estadística & datos numéricosRESUMEN
INTRODUCTION: There is growing interest in food prescriptions, which leverage health care settings to provide patients access to healthy foods through vouchers or food boxes. In this commentary, we draw on our experiences and interest in food prescribing to provide a summary of the current evidence on this intervention model and critically assess its limitations and opportunities. RATIONALE: Food insecurity is an important determinant of health and is associated with compromised dietary adequacy, higher rates of chronic diseases, and higher health service utilization and costs. Aligning with recent discourse on social prescribing and "food is medicine" approaches, food prescribing can empower health care providers to link patients with supports to improve food access and limit barriers to healthy diets. Food prescribing has been shown to improve fruit and vegetable intake and household food insecurity, although impacts on health outcomes are inconclusive. Research on food prescribing in the Canadian context is limited and there is a need to establish evidence of effectiveness and best practices. CONCLUSION: As food prescribing continues to gain traction in Canada, there is a need to assess the effectiveness, cost-efficiency, limitations and potential paternalism of this intervention model. Further, it is necessary to assess how food prescribing fits into broader social welfare systems that aim to address the underlying determinants of food insecurity.
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Inseguridad Alimentaria , Humanos , Canadá/epidemiología , Promoción de la Salud/métodos , Dieta Saludable , Abastecimiento de AlimentosRESUMEN
Background: Community-based nutrition interventions have been established as the standard of care for identifying and treating acute malnutrition among children 6-59 months in low- and lower-middle-income countries. However, limited research has examined the factors that influence the implementation of the community-based component of interventions that address severe acute malnutrition and moderate acute malnutrition among children. Aim: The objective of this review was to identify and describe the facilitators and barriers in implementing complex community-based nutrition interventions to address acute malnutrition among children in low- and lower-middle-income countries. Methods: This review used a systematic search strategy to identify existing peer-reviewed literature from three databases on complex community-based interventions (defined as including active surveillance, treatment, and education in community settings) to address severe acute malnutrition and moderate acute malnutrition in children. Results: In total, 1771 sources were retrieved from peer-reviewed databases, with 38 sources included in the review, covering 26 different interventions. Through an iterative deductive and inductive analysis approach, three main domains (household and interpersonal, sociocultural and geographical; operational and administrative) and eight mechanisms were classified, which were central to the successful implementation of complex community-based interventions to address acute child malnutrition. Conclusion: Overall, this review highlights the importance of addressing contextual and geographical challenges to support participant access and program operations. There is a need to critically examine program design and structure to promote intervention adherence and effectiveness. In addition, there is an opportunity to direct resources towards community health workers to facilitate long-term community trust and engagement.
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Social isolation can have long-term effects on brain development and behavior and increases the risk of developing clinical conditions, including anxiety disorders. One modulator of the stress response is gamma-aminobutyric acid, an inhibitory neurotransmitter synthesized by glutamic acid decarboxylase (GAD). This study examined sex differences in behavior and GAD expression following prolonged social isolation beginning in adolescence in Long Evans rats. Males and females were equally divided into group-housed (GH) and socially isolated conditions on Postnatal Day 28 (n = 8 per group). Beginning 5 weeks later, tests were conducted for anxietylike behaviors (open-field test and elevated plus maze), social interactions (sociability test), and spatial memory (novel object location). Sex differences in behavior were observed, with GH females showing fewer anxietylike behaviors in the open-field test and elevated plus maze and spending more time with objects (sociability task) compared to GH males. Isolation had no effect on males but increased anxiety and reduced neophilic measures in females, removing sex differences. On the sociability task, all groups spent more time with novel rats compared to objects, suggesting social interest was retained after isolation. In the hippocampus, isolation reduced GAD in both sexes, and sex differences were seen (F > M). However, no group differences in behavior were observed in the hippocampal-dependent novel object location task. Our findings suggest that prolonged social isolation beginning in adolescence is anxiogenic for female Long Evans rats. Furthermore, sex and housing impact hippocampal GABA-ergic activity, which may have important implications in the treatment of anxiety disorders. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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OBJECTIVE: To measure vitamin D status and estimate factors associated with serum 25-hydroxyvitamin D (25(OH)D) in Nunavimmiut (Inuit living in Nunavik) adults in 2017. DESIGN: Data were from Qanuilirpitaa? 2017 Nunavik Inuit Health Survey, a cross-sectional study conducted in August-October 2017. Participants underwent a questionnaire, including an FFQ, and blood samples were analysed for total serum 25(OH)D. SETTING: Nunavik, northern Québec, Canada. PARTICIPANTS: A stratified proportional model was used to select respondents, including 1,155 who identified as Inuit and had complete data. RESULTS: Geometric mean serum vitamin D levels were 65·2 nmol/l (95 % CI 62·9-67·6 nmol/l) among women and 65·4 nmol/l (95 % CI 62·3-68·7 nmol/l) among men. The weighted prevalence of serum 25(OH)D < 75 nmol/l, <50 nmol/l <30 nmol/l was 61·2 %, 30·3 % and 7·0 %, respectively. Individuals who were older, female, lived in smaller and/or more southerly communities and/or consumed more country (traditional) foods were at a reduced risk of low vitamin D status. Higher consumption of wild fish was specifically associated with increased serum 25(OH)D concentration. CONCLUSION: It is important that national, regional and local policies and programs are in place to secure harvest, sharing and consumption of nutritious and culturally important country foods like Arctic char and other wild fish species, particularly considering ongoing climate change in the Arctic which impacts the availability, access and quality of fish as food.
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Dieta , Inuk , Masculino , Adulto , Animales , Humanos , Femenino , Quebec/epidemiología , Estudios Transversales , Vitamina D , VitaminasRESUMEN
Selenium is an essential mineral yet both deficiency and excess are associated with adverse health effects. Dietary intake of Se in humans varies greatly between populations due to food availability, dietary preferences, and local geological and ecosystem processes impacting Se accumulation into agricultural products and animal populations. We argue there is a need to evaluate and reconsider the relevance of public health recommendations on Se given recent evidence, including the metabolic pathways and health implications of Se. This argument is particularly pertinent for Inuit populations in Northern Canada, who often exceed dietary tolerable upper intake levels and exhibit very high whole blood Se concentrations due to their dependence on local country foods high in the newly discovered Se compound, selenoneine. Since selenoneine appears to have lower toxicity compared to other Se species and does not contribute to the circulating pools of Se for selenoprotein synthesis, we argue that total dietary Se or total Se in plasma or whole blood are poor indicators of Se adequacy for human health in these populations. Overall, this review provides an overview of the current evidence of Se speciation, deficiency, adequacy, and excess and implications for human health and dietary recommendations, with particular reference to Inuit populations in the Canadian Arctic and other coastal populations consuming marine foods.
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OBJECTIVE: Cardiovascular disease (CVD) is the leading cause of death across Europe. We estimated lost earnings (productivity losses) associated with premature mortality due to CVD, and separately for its main sub-categories of coronary heart disease and cerebrovascular disease, across 54 country members of the European Society of Cardiology (ESC). METHODS AND RESULTS: We used a standardized approach to estimate working years and earnings lost due to premature death resulting from CVD across the 54 ESC member countries in 2018. Our population-based approach was based on national data on the number of deaths, employment rates, and earnings by age group and sex. We discounted future working years and earnings lost to present values using a 3.5% annual rate. In 2018, there were 4.4 million deaths due to CVD across the 54 countries, with 7.1 million working years lost. This represented productivity losses due to premature death of 62 billion in 2018. Deaths due to coronary heart disease accounted for 47% (29 billion) of all CVD costs, and cerebrovascular disease accounted for 18% (11 billion). Approximately 60% (37 billion) of all productivity losses occurred in the 28 European Union member states, despite accounting for only 42% (1.8 million) of deaths and 21% (1.5 million) of working years lost across the 54 countries. CONCLUSION: Our study provides a snapshot of the economic consequences posed by premature mortality due to CVD across 54 countries in 2018. The considerable variation across countries highlights the potential gains from policies targeting prevention and care of cardiovascular diseases.
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Cardiología , Enfermedades Cardiovasculares , Trastornos Cerebrovasculares , Enfermedad Coronaria , Humanos , Enfermedades Cardiovasculares/epidemiología , Europa (Continente)/epidemiologíaRESUMEN
The purpose of this systematic review was to report on the vaccine efficacy (VE) of three SARS-CoV-2 vaccines approved by Health Canada: Pfizer BioNTech, Moderna, and AstraZeneca. Four databases were searched for primary publications on population-level VE. Ninety-two publications matched the inclusion criteria, and the extracted data were separated by vaccine type: mRNA vaccines (Pfizer and Moderna) and the AstraZeneca vaccine. The median VE for PCR-positive patients and various levels of clinical disease was determined for the first and second doses of both vaccine types against multiple SARS-CoV-2 variants. The median VE for PCR-positive infections against unidentified variants from an mRNA vaccine was 64.5 and 89%, respectively, after one or two doses. The median VE for PCR-positive infections against unidentified variants from the AstraZeneca vaccine was 53.4 and 69.6%, respectively, after one or two doses. The median VE for two doses of mRNA for asymptomatic, symptomatic, and severe infection against unidentified variants was 85.5, 93.2, and 92.2%, respectively. The median VE for two doses of AstraZeneca for asymptomatic, symptomatic, and severe infection against unidentified variants was 69.7, 71, and 90.2%, respectively. Vaccine efficacy numerically increased from the first to the second dose, increased from the first 2 weeks to the second 2 weeks post-vaccination for both doses, but decreased after 4 months from the second dose. Vaccine efficacy did not differ by person's age.
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COVID-19 , Vacunas , Humanos , Vacunas contra la COVID-19 , SARS-CoV-2 , Eficacia de las Vacunas , COVID-19/prevención & controlRESUMEN
BACKGROUND: In the Philippines, the rising prevalence of obesity and related chronic diseases alongside persistent undernutrition presents a complex public health challenge. Understanding the patterns and dynamics of this 'double burden of malnutrition' (DBM) is crucial for developing effective intervention strategies. However, evidence of the occurrence of undernutrition and overnutrition within the same household is currently lacking. METHODS: Using cross-sectional data from the 2013 Philippines National Nutrition Survey this study examined the prevalence of different typologies of household-level DBM from an analytical sample of 5,837 households and 25,417 individuals. Multivariable logistic regression was performed to identify factors associated with overall occurrence of intrahousehold DBM. RESULTS: The overall prevalence of double burden households was 56% based on a comprehensive definition. The most common typology of intrahousehold DBM characterized in this study (% of all households) comprised households with at least one adult with overnutrition and at least one separate adult with undernutrition. Household size, wealth quintile, food insecurity, and household dietary diversity were all associated with household-level DBM. Double burden households were also influenced by head of household characteristics, including sex, level of education, employment status, and age. CONCLUSIONS: The findings from this study reveal that the coexistence of overnutrition and undernutrition at the household level is a major public health concern in the Philippines. Further comprehensive assessments of household-level manifestations of the DBM are needed to improve our understanding of the trends and drivers of this phenomenon in order to develop better targeted interventions.
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Desnutrición , Hipernutrición , Adulto , Humanos , Filipinas/epidemiología , Estudios Transversales , Desnutrición/epidemiología , Estado Nutricional , Composición Familiar , Hipernutrición/epidemiología , Encuestas Nutricionales , Prevalencia , Factores Socioeconómicos , Sobrepeso/epidemiologíaRESUMEN
PURPOSE: To report a challenging case of tuberculous chorioretinitis. METHODS: Case report of a 51-year-old woman from the Middle East, who was referred from an optometrist with a suspicious retinal lesion in her right eye. RESULTS: Clinical examination showed multifocal, pale, elevated lesions temporal to the right macula with no vasculitis or hemorrhages. Infective and inflammatory workup showed unremarkable results. B-scan ultrasound confirmed an 8 mm × 3 mm × 10 mm right focal chorioretinal thickening. Computed tomography scanning showed calcified lung hilar nodes supporting a prior granulomatous process, along with an enhancing nodule in the right globe. Magnetic resonance imaging of the brain and obits showed retinal thickening of the temporal surface of the right globe with subtle enhancement without retrobulbar extension or evidence for cerebral vasculitis. Subretinal lesion biopsy showed mononuclear inflammatory cells with granulomatous inflammation, including multinucleated giant cells but no neoplastic features. Interferon-gamma release assay testing for tuberculosis showed negative result, but a high index of suspicion lead to tuberculin skin testing and subsequent treatment for tuberculous chorioretinitis. CONCLUSION: Ocular tuberculosis presents in a variety of ways, making it a challenging diagnosis. Herein, we describe such case of tuberculous chorioretinitis.
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Coriorretinitis , Oftalmopatías , Tuberculosis Ocular , Femenino , Humanos , Persona de Mediana Edad , Tuberculosis Ocular/tratamiento farmacológico , Coriorretinitis/tratamiento farmacológico , Biopsia , Prueba de Tuberculina/efectos adversosRESUMEN
LASSBio-1920 was synthesized due to the poor solubility of its natural precursor, combretastatin A4 (CA4). The cytotoxic potential of the compound against human colorectal cancer cells (HCT-116) and non-small cell lung cancer cells (PC-9) was evaluated, yielding IC50 values of 0.06 and 0.07 µM, respectively. Its mechanism of action was analyzed by microscopy and flow cytometry, where LASSBio-1920 was found to induce apoptosis. Molecular docking simulations and the enzymatic inhibition study with wild-type (wt) EGFR indicated enzyme-substrate interactions similar to other tyrosine kinase inhibitors. We suggest that LASSBio-1920 is metabolized by O-demethylation and NADPH generation. LASSBio-1920 demonstrated excellent absorption in the gastrointestinal tract and high central nervous system (CNS) permeability. The pharmacokinetic parameters obtained by predictions indicated that the compound presents zero-order kinetics and, in a human module simulation, accumulates in the liver, heart, gut, and spleen. The pharmacokinetic parameters obtained will serve as the basis to initiate in vivo studies regarding LASSBio-1920's antitumor potential.
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BACKGROUND: Fish and seafood play an important role in improving food security in Inuit Nunangat. Therefore, this scoping review aims to explore (1) what topics and/or themes have been widely explored in the literature related to barriers and pathways linking fish and seafood to food security; (2) where research, policy, and action gaps exist; and (3) how fisheries currently contribute to food security. METHODS: A systematic search of peer-reviewed articles was conducted using six databases. Articles were screened by two independent reviewers. Eligible studies included primary research conducted in Inuit Nunangat that explored the roles of fish and seafood in food security. RESULTS: Thirty-one articles were included for review. Overall, we found that fisheries can influence food security through direct pathways (e.g., consuming fish for nutrition), and through indirect pathways such as increasing household purchasing power (e.g., through employment). Research indicated that policies relating to wildlife and fisheries management need to be integrated with food and health policies to better address food insecurity in Inuit Nunangat. CONCLUSION: Future research is needed to establish a more robust understanding of the explicit mechanisms that fish and seafood harvest and/or the participation in commercial fisheries alleviates household food insecurity.
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Abastecimiento de Alimentos , Inuk , Humanos , Animales , Estado Nutricional , Peces , Seguridad Alimentaria , Alimentos MarinosRESUMEN
BACKGROUND: Academic research on food security in Inuit Nunangat and Alaska frequently adopts the Food and Agriculture Organization of the United Nations' working definition of food security and Western conceptualisations of what it means to be 'food secure'. However, in 2014, the Alaskan branch of the Inuit Circumpolar Council (ICC) stated that academic and intergovernmental definitions and understandings 'are important, but not what we are talking about when we say food security'. The organisation subsequently developed its own conceptualisation and definition: the Alaskan Inuit Food Security Conceptual Framework (AIFSCF), which in 2020 received informal assent by ICC-Canada. AIM: This protocol establishes a review strategy to examine how well academic research reflects Inuit conceptualisations and understandings of food security, as outlined in the AIFSCF. METHODS: Review structure and reporting will be completed according to adapted RepOrting standards for Systematic Evidence Syntheses (ROSES) guidelines. A comprehensive search strategy will be used to locate peer-reviewed research from Medline, Scopus, Web of Science and the Arctic and Antarctic Regions (EBSCO) databases. Dual reviewer screening will take place at the abstract, title, and full-text stages. Different study methodologies (qualitative, quantitative, and mixed methods) will be included for review, on the proviso that articles identify drivers of food security. An a priori coding framework will be applied by a single reviewer to extract data on publication characteristics, methods and article aims. Deductive thematic content analysis will then identify the frequency and precedence afforded within literature to the drivers and dimensions of food security identified by the AIFSCF.
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Seguridad Alimentaria , Inuk , Humanos , Alaska , Canadá , Regiones Árticas , Literatura de Revisión como AsuntoRESUMEN
Background: Food environments are crucial spaces within the food system for understanding and addressing many of the shared drivers of malnutrition. In recent years, food environment research has grown rapidly, however, definitions, measures, and methods remain highly inconsistent, leading to a body of literature that is notably heterogeneous and poorly understood, particularly within regions of the Asia-Pacific. Aim: This scoping review aims to synthesize the nature, extent, and range of published literature surrounding the role of the food environment on influencing dietary behaviour and nutrition in Southeast Asia. Methods: A systematic search of 5 databases was conducted following PRISMA guidelines for scoping reviews. Eligible studies included peer-reviewed research with adult participants living in Southeast Asia that examined the food environment as a determinant of dietary behaviour or nutrition. Results: A total of 45 articles were included. Overall, studies indicated that dietary behaviours in Southeast Asia were primarily driven by social, cultural, and economic factors rather than physical (e.g. geographical) features of food environments. Food price and affordability were most consistently identified as key barriers to achieving healthy diets. Conclusion: This work contributes to the establishment of more robust conceptualizations of food environments within diverse settings which may aid future policymakers and researchers identify and address the barriers or obstacles impacting nutrition and food security in their communities. Further research is needed to strengthen this knowledge, particularly research that explicitly explores the macro-level mechanisms and pathways that influence diet and nutrition outcomes.
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Desnutrición , Estado Nutricional , Adulto , Humanos , Dieta , Alimentos , Dieta SaludableRESUMEN
PURPOSE: To report a case of severe, recurrent bilateral panuveitis secondary to primary progressive multiple sclerosis responsive to ocrelizumab infusions. OBSERVATION: We describe the clinical progression of a 40 year old female who presented with a 3-week history of insidious bilateral visual loss that was clinically consistent with panuveitis. A diagnosis of multiple sclerosis was established with serial magnetic resonance imaging (MRI) that coincided with focal neurological events separated by time. There was initially good response to high dose oral prednisolone; however, the patient would have recurrent uveitis each time the dose was weaned. Under guidance of neurology, we had initiated treatment with ocrelizumab with stability of ocular inflammation for the past 24 months. CONCLUSION: Six-monthly 600mg ocrelizumab infusions may be effective as a steroid sparing option for patients with severe, recurrent bilateral panuveitis secondary to primary progressive multiple sclerosis.
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Esclerosis Múltiple Crónica Progresiva , Esclerosis Múltiple , Panuveítis , Uveítis , Femenino , Humanos , Adulto , Esclerosis Múltiple/tratamiento farmacológico , Esclerosis Múltiple Crónica Progresiva/complicaciones , Esclerosis Múltiple Crónica Progresiva/diagnóstico , Esclerosis Múltiple Crónica Progresiva/tratamiento farmacológico , Panuveítis/diagnóstico , Panuveítis/tratamiento farmacológico , Panuveítis/etiologíaRESUMEN
OBJECTIVES: Country (traditional) foods are integral to Inuit culture, but market food consumption is increasing. The Qanuilirpitaa? 2017 Nunavik Health Survey (Q2017) reported similar country food consumption frequency compared to that in 2004; however, examining food items individually does not account for diet patterns, food accessibility, and correlations between food items. Our objective was to identify underlying dietary profiles and compare them across sex, age, ecological region, and food insecurity markers, given the links among diet, health, and sociocultural determinants. METHODS: Food frequency and sociodemographic data were derived from the Q2017 survey (N = 1176). Latent profile analysis identified dietary profiles using variables for the relative frequencies of country and market food consumption first, followed by an analysis with those for country food variables only. Multinomial logistic regression examined the associations among dietary profiles, sociodemographic factors, and food insecurity markers (to disassociate between food preferences and food access). RESULTS: Four overall dietary profiles and four country food dietary profiles were identified characterized by the relative frequency of country and market food in the diet. The patterns were stable across several sensitivity analyses and in line with our Inuit partners' local knowledge. For the overall profiles, women and adults aged 30-49 years were more likely to have a market food-dominant profile, whereas men and individuals aged 16-29 and 50+ years more often consumed a country food-dominant profile. In the country food profiles, Inuit aged 16-29 years were more likely to have a moderate country food profile whereas Inuit aged 50+ were more likely to have a high country food-consumption profile. A low country and market food-consumption profile was linked to higher prevalence of food insecurity markers. CONCLUSION: We were able to identify distinct dietary profiles with strong social patterning. The profiles elucidated in this study are aligned with the impact of colonial influence on diet and subsequent country food promotion programs for Inuit youth. These profiles will be used for further study of nutritional status, contaminant exposure, and health to provide context for future public health programs.
RéSUMé: OBJECTIFS: Les aliments traditionnels font partie intégrante de la culture inuite, mais la consommation d'aliments du marché est en augmentation. L'enquête de santé des Inuit Qanuilirpitaa? réalisée en 2017 (Q2017) a mis en évidence que la fréquence de consommation d'aliments traditionnels était similaire à celle rapportée en 2004. Or, les fréquences de consommation des aliments pris individuellement ne tiennent pas compte des habitudes alimentaires, de l'accessibilité des aliments et des corrélations entre les aliments consommés. Notre objectif était d'identifier les profils alimentaires sous-jacents et de les comparer selon le sexe, l'âge, la région écologique et les marqueurs d'insécurité alimentaire, étant donné le lien entre l'alimentation, la santé et les déterminants socioculturels. MéTHODES: Les données sur les fréquences alimentaires et sociodémographiques sont issues de l'enquête Q2017 (N=1176). L'analyse des profils latents a permis d'identifier des profils alimentaires en utilisant les variables pour les fréquences relatives de la consommation d'aliments traditionnels et du marché et uniquement celles pour les aliments traditionnels. Des régressions logistiques multinomiales ont été utilisées pour examiner les associations entre les profils alimentaires, les facteurs sociodémographiques et les marqueurs d'insécurité alimentaire (pour dissocier les préférences alimentaires de l'accès aux aliments). RéSULTATS: Quatre profils alimentaires globaux et quatre profils alimentaires spécifiques à la consommation d'aliments traditionnels ont été identifiés en fonction de la fréquence relative des aliments traditionnels et des aliments du marché dans l'alimentation. Les profils étaient en accord avec les connaissances locales de nos partenaires Inuit. Pour les profils alimentaires globaux, les femmes et les adultes âgés de 30 à 49 ans étaient plus susceptibles d'avoir un profil dominé par les aliments du marché, tandis que les hommes et les personnes âgées de 16 à 29 ans et celles de 50 ans et plus avaient plus fréquemment un profil dominé par les aliments traditionnels. En ce qui concerne les profils de consommation d'aliments traditionnels, les Inuit âgés de 16 à 29 ans étaient plus susceptibles d'avoir un profil modéré de consommation d'aliments traditionnels, tandis que les Inuit âgés de 50 ans et plus étaient plus susceptibles d'avoir un profil élevé de consommation d'aliments traditionnels. Un profil bas de consommation d'aliments traditionnels et de marché était associé à une prévalence plus élevée de marqueurs d'insécurité alimentaire. CONCLUSION: Nous avons identifié différents profils alimentaires et ces derniers étaient associés à des caractéristiques socio-démographiques distinctes. Les profils alimentaires mis en lumière dans cette étude concordent avec l'impact du colonialisme sur l'alimentation au Nunavik et aux programmes subséquents de promotion des aliments traditionnels auprès des jeunes Inuit. Ces profils seront utilisés pour une étude plus approfondie du statut nutritionnel, de l'exposition aux contaminants et des issues de santé afin d'identifier des pistes de solutions pour les futurs programmes de santé publique.
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In order to provide meaningful and effective support to refugees in Canada during the COVID-19 pandemic, as well as during post-pandemic recovery efforts, it is critical to explore the experiences of refugee mothers and families during the pandemic, and to identify sources of resilience that can be leveraged to promote individual and household wellbeing. From November 2020 to June 2021, we conducted in-depth interviews with mothers from refugee backgrounds (n = 28) who resettled in Calgary, Alberta and are currently participating in the Multicultural Home Instruction for Parents of Preschool Youngsters (HIPPY) program. Interviews were conducted virtually using Microsoft Teams; we sought to better understand the pathways and barriers to wellbeing experienced by refugee mothers during the pandemic. The results indicate that the refugee mothers and families in our study experienced widespread disruptions to education and employment and increased motherhood burden, contributing to diminished wellbeing. Mental health was further impacted by heightened levels of worry, stress and social isolation, as well as intense fear pertaining to the spread of SARS-CoV-2. Some mothers reported experiencing barriers to accessing healthcare services and reliable health information during the pandemic. In the face of these challenges, the mothers demonstrated great resilience and identified tangible individual, household and extra-household factors and resources that supported them in coping with the impact of the COVID-19 pandemic. Additionally, our findings suggest that participation in HIPPY played a significant role in fostering the resilience of the participating mothers and families during the pandemic, speaking to the potential of home visiting intervention models in mitigating household hardship during current and future public health crises.
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BACKGROUND: Colonoscopy surveillance is recommended for some patients post polypectomy. The 2002 UK surveillance guidelines classify post-polypectomy patients into low, intermediate and high risk, and recommend different strategies for each classification. Limited evidence supports these guidelines. OBJECTIVES: To examine, for each risk group, long-term colorectal cancer incidence by baseline characteristics and the number of surveillance visits; the effects of interval length on detection rates of advanced adenomas and colorectal cancer at first surveillance; and the cost-effectiveness of surveillance compared with no surveillance. DESIGN: A retrospective cohort study and economic evaluation. SETTING: Seventeen NHS hospitals. PARTICIPANTS: Patients with a colonoscopy and at least one adenoma at baseline. MAIN OUTCOME MEASURES: Long-term colorectal cancer incidence after baseline and detection rates of advanced adenomas and colorectal cancer at first surveillance. DATA SOURCES: Hospital databases, NHS Digital, the Office for National Statistics, National Services Scotland and Public Health England. METHODS: Cox regression was used to compare colorectal cancer incidence in the presence and absence of surveillance and to identify colorectal cancer risk factors. Risk factors were used to stratify risk groups into higher- and lower-risk subgroups. We examined detection rates of advanced adenomas and colorectal cancer at first surveillance by interval length. Cost-effectiveness of surveillance compared with no surveillance was evaluated in terms of incremental costs per colorectal cancer prevented and per quality-adjusted life-year gained. RESULTS: Our study included 28,972 patients, of whom 14,401 (50%), 11,852 (41%) and 2719 (9%) were classed as low, intermediate and high risk, respectively. The median follow-up time was 9.3 years. Colorectal cancer incidence was 140, 221 and 366 per 100,000 person-years among low-, intermediate- and high-risk patients, respectively. Attendance at one surveillance visit was associated with reduced colorectal cancer incidence among low-, intermediate- and high-risk patients [hazard ratios were 0.56 (95% confidence interval 0.39 to 0.80), 0.59 (95% confidence interval 0.43 to 0.81) and 0.49 (95% confidence interval 0.29 to 0.82), respectively]. Compared with the general population, colorectal cancer incidence without surveillance was similar among low-risk patients and higher among high-risk patients [standardised incidence ratios were 0.86 (95% confidence interval 0.73 to 1.02) and 1.91 (95% confidence interval 1.39 to 2.56), respectively]. For intermediate-risk patients, standardised incidence ratios differed for the lower- (0.70, 95% confidence interval 0.48 to 0.99) and higher-risk (1.46, 95% confidence interval 1.19 to 1.78) subgroups. In each risk group, incremental costs per colorectal cancer prevented and per quality-adjusted life-year gained with surveillance were lower for the higher-risk subgroup than for the lower-risk subgroup. Incremental costs per quality-adjusted life-year gained were lowest for the higher-risk subgroup of high-risk patients at £7821. LIMITATIONS: The observational design means that we cannot assume that surveillance caused the reductions in cancer incidence. The fact that some cancer staging data were missing places uncertainty on our cost-effectiveness estimates. CONCLUSIONS: Surveillance was associated with reduced colorectal cancer incidence in all risk groups. However, in low-risk patients and the lower-risk subgroup of intermediate-risk patients, colorectal cancer incidence was no higher than in the general population without surveillance, indicating that surveillance might not be necessary. Surveillance was most cost-effective for the higher-risk subgroup of high-risk patients. FUTURE WORK: Studies should examine the clinical effectiveness and cost-effectiveness of post-polypectomy surveillance without prior classification of patients into risk groups. TRIAL REGISTRATION: This trial is registered as ISRCTN15213649. FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 26. See the NIHR Journals Library website for further project information.
Bowel cancers develop from polyps, also called adenomas, which are growths on the lining of the bowel. Removal of adenomas, therefore, helps prevent bowel cancer. Adenomas can be detected and removed during colonoscopy, when a thin tube with a camera on one end is used to examine the bowel lining. In the UK, patients with adenomas are divided into three risk groups. Low-risk patients (i.e. those with one or two adenomas that are < 10 mm in size) are thought to be unlikely to develop bowel cancer after adenoma removal and follow-up colonoscopy is not recommended in this group. Intermediate-risk patients (i.e. those with three or four adenomas that are < 10 mm in size, or one or two adenomas with at least one ≥ 10 mm in size) are recommended to have another colonoscopy 3 years after adenoma removal. High-risk patients (i.e. those with five or more adenomas that are < 10 mm in size, or three or more adenomas with at least one ≥ 10 mm in size) are recommended to have another colonoscopy after 1 year and then usually again after 3 years. The number of follow-up colonoscopies carried out is stretching health-care resources and each procedure carries a small risk of complications for patients. It is possible that too many follow-up colonoscopies are being carried out. This study aimed to determine which patients require follow-up colonoscopies and how many are required to detect adenomas and prevent bowel cancer, while also being resource-efficient, cost-effective and not exposing patients to unnecessary risks. The study used data from 17 hospitals and cancer registries in the UK. In each risk group, one follow-up colonoscopy after adenoma removal was associated with a 4050% reduction in bowel cancer risk. However, even without any follow-up, bowel cancer risk was no higher in some low- and intermediate-risk patients than in the general population. These patients may not need as many follow-up colonoscopies as recommended. In the case of higher-risk patients, who even after adenoma removal have a higher bowel cancer risk than the general population, follow-up colonoscopies are necessary and cost-effective.