Incident Functional Limitations Among Older Adults With Diabetes During the COVID-19 Pandemic: An Analysis of Prospective Data From the Canadian Longitudinal Study on Aging.

OBJECTIVES: The objectives of this study were: 1) to examine and compare changes in functional limitations during the COVID-19 pandemic among older adults with and without diabetes; and 2): to identify key risk factors associated with developing functional limitations among older adults with and without diabetes during the pandemic. METHODS: We analyzed data collected from the Canadian Longitudinal Study on Aging. The analysis was restricted to those with no functional limitations in the follow-up 1 wave (2015 to 2018) (final sample N=6,045). Regression models were used to describe associations between diabetic status and functional limitation outcomes. We conducted stratified analyses to evaluate whether these associations varied by sociodemographic indicators. We also predicted the probability of the development of ≥1 functional limitation among those with and without diabetes for various patient profiles. RESULTS: Older adults with diabetes were 1.28-fold (95% confidence interval 1.02 to 1.60) more likely to develop ≥1 functional limitation than older adults without diabetes after controlling for relevant sociodemographic and health covariates. Risk factors for incident functional limitations among older adults, both with and without diabetes, include increasing age, low socioeconomic status, obesity, multimorbidity, and physical inactivity. CONCLUSIONS: Our findings indicate that older adults with diabetes were at an increased risk of developing functional limitations during the pandemic when compared with older adults without diabetes, even when controlling for several key risk factors. Targetting modifiable risk factors, such as physical activity, may help to reduce the risk of functional limitations among older adults with diabetes.

Are school-based measures of walkability and greenness associated with modes of commuting to school? Findings from a student survey in Ontario, Canada.

OBJECTIVES: In Canada, students are increasingly reliant on motorized vehicles to commute to school, and few meet the recommended overall physical activity guidelines. Infrastructure and built environments around schools may promote active commuting to and from school, thereby increasing physical activity. To date, few Canadian studies have examined this research question. METHODS: This study is a cross-sectional analysis of 11,006 students, aged 11-20, who participated in the 2016/2017 Ontario Student Drug Use and Health Survey. The remote sensing-derived Normalized Difference Vegetation Index (NDVI), at a buffer of 500 m from the schools' locations, was used to characterize greenness, while the 2016 Canadian Active Living Environments (Can-ALE) measure was used for walkability. Students were asked about their mode of regular commuting to school, and to provide information on several socio-demographic variables. Multivariable logistic regression models were used to quantify associations between active commuting and greenness and the Can-ALE. The resulting odds ratios, and their 95% confidence intervals, were adjusted for a series of risk factors that were collected from the survey. RESULTS: Overall, 21% of students reported active commuting (biking or walking) to school, and this prevalence decreased with increasing age. Students whose schools had higher Can-ALE scores were more likely to be active commuters. Specifically, the adjusted odds ratio (OR) of being an active commuter for schools in the highest quartile of the Can-ALE was 2.11 (95% CI = 1.64, 2.72) when compared with those in the lowest. For children, aged 11-14 years, who attended schools in high dwelling density areas, a higher odds of active commuting was observed among those in the upper quartile of greenness relative to the lowest (OR = 1.41; 95% CI = 0.92, 2.15). In contrast, for lower dwelling density areas, greenness was inversely associated with active commuting across all ages. CONCLUSION: Our findings suggest that students attending schools with higher Can-ALE scores are more likely to actively commute to school, and that positive impacts of greenness on active commuting are evident only in younger children in more densely populated areas. Future studies should collect more detailed data on residential measures of the built environment, safety, distance between home and school, and mixed modes of commuting behaviours.

RéSUMé: OBJECTIFS: Au Canada, les élèves comptent de plus en plus sur les véhicules à moteur pour faire le trajet entre la maison et l'école, et ils sont peu nombreux à avoir des niveaux d'activité physique globaux conformes aux recommandations des lignes directrices. Les infrastructures et les milieux bâtis autour des écoles pourraient promouvoir les déplacements actifs entre la maison et l'école, faisant ainsi augmenter l'activité physique. Jusqu'à maintenant toutefois, très peu d'études canadiennes ont examiné cette question de recherche. MéTHODE: La présente étude est une analyse transversale de 11 006 élèves de 11 à 20 ans ayant participé au Sondage sur la consommation de drogues et la santé des élèves de l'Ontario en 2016-2017. L'indice de végétation par différence normalisée (IVDN) dérivé par télédétection, utilisé dans un rayon de 500 m des établissements scolaires, a servi à caractériser la verdure, et l'indice d'accessibilité à la vie active dans les milieux de vie au Canada (AVA-Can) a servi à caractériser la marchabilité. Les élèves ont répondu à une question sur leur mode de transport habituel pour se rendre à l'école et donné des informations sur plusieurs variables sociodémographiques. Des modèles de régression logistique multivariée ont servi à chiffrer les associations entre les déplacements actifs, la verdure et l'AVA-Can. Les rapports de cotes ainsi obtenus, et leurs intervalles de confiance de 95 %, ont été ajustés en fonction d'une série de facteurs de risque retracés dans l'enquête. RéSULTATS: Dans l'ensemble, 21 % des élèves ont dit utiliser un mode de déplacement actif (vélo ou marche) pour se rendre à l'école, et cette prévalence était inversement liée à l'âge. Les élèves dont les écoles avaient un indice Can-ALE élevé étaient plus susceptibles d'employer un mode de transport actif. Spécifiquement, le rapport de cotes (RC) ajusté pour le fait de se rendre à l'école par un mode de transport actif dans le quartile supérieur de l'indice Can-ALE était de 2,11 (IC de 95 % = 1,64, 2,72) comparativement au quartile inférieur. Pour les enfants (11 à 14 ans) fréquentant des écoles dans des zones à forte densité d'habitation, des probabilités plus élevées de déplacements actifs ont été observées chez ceux du quartile de verdure supérieur que chez ceux du quartile inférieur (RC = 1,41; IC de 95 % = 0,92, 2,15). Par contre, dans les zones à faible densité d'habitation, la verdure étaient inversement associée aux déplacements actifs, à tout âge. CONCLUSION: Nos constatations indiquent que les élèves fréquentant des écoles dont l'indice Can-ALE est élevé sont plus susceptibles d'utiliser un mode de déplacement actif pour se rendre à l'école, et que l'effet positif de la verdure n'est manifeste que chez les jeunes enfants, dans les zones urbaines densément peuplées. Les études futures devraient obtenir des données plus détaillées sur les indicateurs résidentiels du milieu bâti, la sécurité, la distance entre la maison et l'école et les modes de déplacement mixtes.

Antimicrobial Resistance Surveillance in Typhoidal Salmonella in Ahmedabad in an Era of Global Antimicrobial Resistance Surveillance Systems.

INTRODUCTION: India possibly carries the highest burden of antimicrobial resistant typhoidal salmonellae in the world. We report on the health-care ecosystem that produces data on antimicrobial resistance (AMR) testing and the resistance patterns of typhoidal Salmonella isolates in the city of Ahmedabad. MATERIALS AND METHODS: Through municipality records and internet searches, we identified 1696 private and 83 public laboratories in the city; 4 medical colleges, 4 health-care institution attached laboratories, and 4 corporate laboratories (CLs) were performing culture and antibiotic sensitivity testing (AST), but only 2 medical colleges and 1 CL shared their data with us. There was considerable variation in culturing and sensitivity testing methodology across laboratories. RESULTS: Out of 51,260 blood cultures, Salmonella isolates were detected in only 146 (0.28%). AST was conducted on 124 isolates, of which 67 (54%) were found resistant. Multidrug resistance was absent. Concurrent resistance to more than one antibiotic was very high, 88%, among the 67 resistant isolates. Ciprofloxacin resistance varied widely between the private and public sector laboratories. Notably, isolates from the private sector laboratory showed complete resistance to azithromycin. CONCLUSIONS: High resistance to ciprofloxacin and azithromycin observed in Ahmedabad may be due to the increased use of these two antibiotics in the public and private sectors, respectively. The need of the hour is to identify a representative sample of laboratories from both the public and the private sectors and encourage them to participate in the national AMR surveillance network.