Canadian patient experiences of lupus nephritis: a qualitative analysis.

OBJECTIVE: Lupus nephritis (LN) is one of the most severe manifestations of SLE; however, we know little about the lived experience of LN. This research investigates patient experiences and perspectives of (1) LN diagnosis; (2) living with LN; and (3) LN healthcare and treatment. METHODS: Patients aged ≥18 years with biopsy-proven pure or mixed International Society of Nephrology/Renal Pathology Society class III, IV or V LN were purposefully recruited from a Canadian lupus cohort to participate in semistructured in-depth interviews. RESULTS: Thirty patients with LN completed the interviews. The mean (SD) age was 42.1 (16.4) years, and 86.7% were female. Participants described challenges seeking, receiving and adjusting to a LN diagnosis, and some reported that their diagnosis process took weeks to years. While 16 participants were provided resources by healthcare providers to help them through the process of diagnosis, the need for accessible LN-specific information at diagnosis was highlighted (n=18). Participants also described the unpredictability of living with LN, particularly related to impacts on physical and mental health, relationships, leisure activities, employment and education, and family planning. While most (n=26) participants reported a positive impression of their care, the side effects of LN medications and the need to increase patient and societal awareness/understanding of LN were highlighted in the context of healthcare and treatment. CONCLUSIONS: The unpredictability of living with LN, the heavy treatment burden and a lack of patient/societal awareness substantially affect the lived experience of LN. These findings will inform the development of LN-specific patient resources to increase understanding of LN and improve well-being for patients.

The use of non-pharmaceutical interventions for the prevention and control of schistosomiasis in sub-Saharan Africa: A systematic review.

Schistosomiasis remains a major cause of global parasitic morbidity. Current control strategies focus on pharmaceutical approaches using Mass Drug Administration (MDA) to distribute praziquantel in endemic areas of sub-Saharan Africa. Our paper systematically reviewed the literature on non-pharmaceutical interventions for enhanced schistosomiasis control. We conducted a systematic review of peer-reviewed English language literature using PubMed, Embase and Web of Science. Our search terms were limited to the year 2000 to March 2019 to reflect the period of the Millennium and Sustainable Development Goals. We initially identified 1733 publications, which were reduced to 1324 after screening by title and abstract. After the inclusion and exclusion criteria, a total of 1312 studies were excluded. Following this, we had a total of 12 articles, which we later screened by full text. Out of the twelve articles, seven were excluded for being systematic reviews or examining clinical and nutritional aspects of schistosomiasis control. We finally remained with five studies that met our inclusion criteria. Our paper indicates a gap in non-pharmaceutical based interventions for schistosomiasis control. We propose that future research addresses this gap by engaging communities in participatory approaches such as environmental sanitation, Water, Sanitation and Hygiene (WASH), health education and economic empowerment.

"What the mind does not know, the eyes do not see". Placing food allergy risk in sub-Saharan Africa.

Policy makers and health geographers are increasingly intrigued by the global rise of chronic disease. While current engagement coalesce around cardiovascular disease, cancers, chronic respiratory disease, and diabetes, very little attention has been given to other important chronic conditions: e.g., allergic disease. Concerns about how health is shaped by context and experienced in place can provide important insights to understand the trajectory of allergic disease and inform policy especially in developing countries experiencing an epidemiologic transition. Using Ghana as a case study. this paper draw on theories of political ecology of health to enhance our understanding of how individual (e.g. care seeking behaviours), sociocultural (e.g. lack of education and awareness), health system (e.g. absence of logistics) and policy environments (e.g. absence of policy) influence the ways in which food allergy is perceived, diagnosed and managed. These findings highlight the need for decision makers to target structural factors that impede access to and utilization of healthcare, diagnostic practices, as well as food allergy coping and management strategies. Moreover, the findings highlight the need for a global health agenda that pays critical attention to place-based factors in the construction of emerging health risks.

The next Sub Saharan African epidemic? A case study of the determinants of cervical cancer knowledge and screening in Kenya.

Early cervical cancer screening has been shown to be beneficial in reducing cervical cancer related deaths. Despite the benefits of early cervical cancer screening, uptake remains limited, with wide disparities in access and uptake in most developing countries. As part of a larger study, this paper uses a socio-ecological framework to explain the determinants of cervical cancer knowledge and screening among women of reproductive age (15-49 years) in Kenya. We conducted a multilevel analysis of cervical cancer knowledge (n = 11,138) and screening (n = 10,333) using the 2014 Kenya Demographic and Health Survey (KDHS). Results show regional disparities in cancer knowledge and the utilization of cervical cancer screening services; regions with high wealth inequality (OR = 0.70, 95% CI [0.56-0.87]) emerged as vulnerable regions where women were less likely to screen for cervical cancer. Gender equity, health insurance coverage and education level significantly predicted cervical cancer screening rates. Results further revealed regional as well as rural-urban wealth inequalities in cervical cancer screening. We argue that given that Kenyan women are highly exposed to human papilloma virus (HPV) due to the legacy of human immunodeficiency virus (HIV) in the country, cervical cancer may be the next epidemic if integrated measures are not adopted to increase cervical cancer knowledge and overcome the barriers to utilizing early screening services. The paper concludes with policy recommendations and directions for future research.

Researchers Supporting Schools to Improve Health: Influential Factors and Outcomes of Knowledge Brokering in the COMPASS Study.

BACKGROUND: Although schools are considered opportune settings for youth health interventions, a gap between school health research and practice exists. COMPASS, a longitudinal study of Ontario and Alberta secondary students and schools (2012-2021), used integrated knowledge translation to enhance schools' uptake of research findings. Schools received annual summaries of their students' health behaviors and suggestions for action, and were linked with COMPASS knowledge brokers to support them in making changes to improve student health. This research examines the factors that influenced schools' participation in knowledge brokering and associated outcomes. METHODS: School- and student-level data from the first 3 years of the COMPASS study (2012-2013; 2013-2014; 2014-2015) were used to examine factors that influenced knowledge brokering participation, school-level changes, and school-aggregated student health behaviors. RESULTS: Both school characteristics and study-related factors influenced schools' participation in knowledge brokering. Knowledge brokering participation was significantly associated with school-level changes related to healthy eating, physical activity, and tobacco programming, but the impact of those changes was not evident at the aggregate student level. CONCLUSIONS: Knowledge brokering provided a platform for collaboration between researchers and school practitioners, and led to school-level changes. These findings can inform future researcher-school practitioner partnerships to ultimately enhance student health.

Health impacts of air pollution: a life course approach for examining predictors of respiratory health in adulthood.

PURPOSE: This research applies a life course health development framework to examine the impacts of childhood exposure to air pollution on respiratory health in adulthood. METHODS: This prospective cohort study uses data collected from children originally studied in the 1970/1980s, including exposure to air pollution, indoor exposures, sociodemographic variables, and health outcomes data. Thirty years later, a self-administered questionnaire was used to collect data from adulthood on health status, occupational and residential histories, socioeconomic status, and lifestyle. RESULTS: Overall, 29% of respondents were diagnosed with at least one respiratory condition and 24% have persistent respiratory symptoms in adulthood. Significant neighborhood differences in exposure variables and adulthood health outcomes were found. Predictors of adulthood respiratory health include asthma diagnosis or chest illness in childhood, parental record of respiratory symptoms, other medical diagnosis in adulthood, fair/poor self-perceived health, smoking/exposure to smoking, and residing in a property built before 1950. Results suggest that exposure to ambient total suspended particulates in childhood is preventative for diagnosis with at least one respiratory condition in adulthood. CONCLUSION: Findings suggest that long-term childhood exposure to air pollution does not predict respiratory conditions and symptoms in adulthood. However, respiratory health in childhood predicts adulthood respiratory health, thus suggesting that the health impacts of any exposures that impact respiratory health during critical or sensitive times in childhood are long term.

Predictors of locating children participants in epidemiological studies 20 years after last contact: Internet resources and longitudinal research.

This study examines predictors of locating participants that were last contacted 20 years ago using public web-search directories, in order to facilitate longitudinal environmental health research. Participants (n = 3,202) resided in four distinct geographical neighborhoods in Hamilton, Ontario during childhood; they were between 15 and 17 years old when they were last contacted in 1986. Data used for tracing included available addresses, telephone numbers, given names, and parental names. Reverse and forward search strategies were used to retrieve updated contact details. 43% of the sample was traced using online directories. Following ethical approval, participants were contacted using traced data and 29% of the original cohort was located. Predictors of locating participants were: availability of paternal names, being traced to original addresses or telephone numbers, gender (male), relatively higher socioeconomic status in childhood, and not being exposed to smoking in childhood. Where participants resided in childhood was not a significant predictor of locating participants. Although 13% of the sample was traced using forward search by name, only 4% were located. For participants traced to available addresses or telephone numbers, the difference between the proportions of traced and located participants was <3%. Prospective studies on children may benefit from including the listed names that pertain to each child's telephone number and full parental names at recruitment, thereby increasing the likelihood of locating participants using Internet resources. Integrating the use of Internet-based public directories for cohort reconstruction can reduce financial costs related to follow-up for longitudinal research.

Assessing the health impacts of air pollution: a re-analysis of the Hamilton children's cohort data using a spatial analytic approach.

The objective of this paper was to reassess children's exposure to air pollution as well as investigate the importance of other covariates of respiratory health. We re-examined the Hamilton Children's Cohort (HCC) dataset with enhanced spatial analysis methods, refined in the approximately two decades since the original study was undertaken. Children's exposure to air pollution was first re-estimated using kriging and land-use regression. The land-use regression model performed better, compared to kriging, in capturing local variation of air pollution. Multivariate linear and logistic regression analysis was then applied for the study of potential risk factors for respiratory health. Findings agree with the HCC study-results, confirming that children's respiratory health was associated with maternal smoking, hospitalization in infancy and air pollution. However, results from this study reveal a stronger association between children's respiratory health and air pollution. Additionally, this study demonstrated associations with low-income, household crowding and chest illness in siblings.

Factors affecting change over time in self-reported health.

BACKGROUND: Self-reported health status has become a conventional measure of health status at the population level. Further, the literature supports its use as a valid indicator of morbidity and mortality. However, relatively little attention has been paid to how self-reported health status changes over time or the factors affecting change. This paper explores the factors affecting health status change over time using data from a neighbourhood health survey. METHODS: Two rounds (2001; 2003) of health survey data (n=671) were collected across 4 distinct neighbourhoods in Hamilton, Ontario. Logistic regression analysis is used to predict change in self-reported health status between the two time periods as well as determinants of change using a range of compositional, contextual and collective characteristics of individuals as potential explanatory variables. RESULTS: Results reveal that approximately one third of participants experienced a change in health status between the two survey years. Interestingly, the key factors affecting change in health status are compositional characteristics of individuals (e.g., smoking, health care use) as opposed to contextual (e.g., neighbourhood of residence) or collective (e.g., marital status). Contrary to published literature, the current study does not reveal any significant links between a change in health status and either gender or age. CONCLUSION: These results inform our understanding of both the stability of health ratings over time and the determinants of health status change. Further research should be undertaken to enhance this understanding; in particular, studies with larger sample sizes, longer time frames and more sensitive indicators of composition, context and collective are needed.

A spatial analysis of the determinants of pneumonia and influenza hospitalizations in Ontario (1992-2001).

Previous research on the determinants of pneumonia and influenza has focused primarily on the role of individual level biological and behavioural risk factors resulting in partial explanations and largely curative approaches to reducing the disease burden. This study examines the geographic patterns of pneumonia and influenza hospitalizations and the role that broad ecologic-level factors may have in determining them. We conducted a county level, retrospective, ecologic study of pneumonia and influenza hospitalizations in the province of Ontario, Canada, between 1992 and 2001 (N=241,803), controlling for spatial dependence in the data. Non-spatial and spatial regression models were estimated using a range of environmental, social, economic, behavioural, and health care predictors. Results revealed low education to be positively associated with hospitalization rates over all age groups and both genders. The Aboriginal population variable was also positively associated in most models except for the 65+-year age group. Behavioural factors (daily smoking and heavy drinking), environmental factors (passive smoking, poor housing, temperature), and health care factors (influenza vaccination) were all significantly associated in different age and gender-specific models. The use of spatial error regression models allowed for unbiased estimation of regression parameters and their significance levels. These findings demonstrate the importance of broad age and gender-specific population-level factors in determining pneumonia and influenza hospitalizations, and illustrate the need for place and population-specific policies that take these factors into consideration.

Using linking systems to build capacity and enhance dissemination in heart health promotion: a Canadian multiple-case study.

The purpose of this paper is to examine the utility of linking systems between public health resource and user organizations for health promotion dissemination and capacity building, and to identify factors related to the success of linking systems. The design is a parallel-case study using key informant interviews and content analysis of project reports (synthesized qualitative and quantitative data) of three provincial dissemination projects of the Canadian Heart Health Initiative-Dissemination Phase. Each provincial project used linking activities with public health user groups including meetings, skill building, resources, collaboration, networking and research feedback to facilitate capacity building for and implementation of heart health promotion activities. This paper presents empirical examples of linking system designs, activities, and qualitative and quantitative changes in the public health user groups' health promotion capacity, program delivery and sustainability. The findings indicate enhanced health promotion skills, partnerships, resources, infrastructure, and increased programming and sustainability in the targeted public health organizations of all three provincial projects. Identified barriers to the success of linking systems included lack of appropriately skilled personnel, funds, buy-in and leadership. We conclude that linking systems can be flexibly used to build capacity and disseminate health promotion innovations, and suggest conditions for success.