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BACKGROUND: The intersection of race and older age compounds existing health disparities experienced by historically marginalised communities. Therefore, racialised older adults with cancer are more disadvantaged in their access to cancer clinical trials compared with age-matched counterparts. To determine what has already been published in this area, the rapid scoping review question are: what are the barriers, facilitators and potential solutions for enhancing access to cancer clinical trials among racialised older adults? METHODS: We will use a rapid scoping review methodology in which we follow the six-step framework of Arksey and O'Malley, including a systematic search of the literature with abstract and full-text screening to be conducted by two independent reviewers, data abstraction by one reviewer and verification by a second reviewer using an Excel data abstraction sheet. Articles focusing on persons aged 18 and over who identify as a racialised person with cancer, that describe therapies/therapeutic interventions/prevention/outcomes related to barriers, facilitators and solutions to enhancing access to and equity in cancer clinical trials will be eligible for inclusion in this rapid scoping review. ETHICS AND DISSEMINATION: All data will be extracted from published literature. Hence, ethical approval and patient informed consent are not required. The findings of the scoping review will be submitted for publication in a peer-reviewed journal and presentation at international conferences.
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Neoplasias , Humanos , Adolescente , Adulto , Idoso , Neoplasias/terapia , Projetos de Pesquisa , Revisão por Pares , Literatura de Revisão como AssuntoRESUMO
Background: Recovery from substance use disorder requires sustained effort and perseverance. Hence, the resilience factor of grit may be important for people in recovery. Little research has been conducted on grit in patients with substance use disorder (SUD), especially in a large and varied sample.Objectives: To analyze the psychometric properties of the Short Grit Scale (Grit-S) in patients with SUD and to use demographic and clinical characteristics to predict variance in Grit-S scores.Methods: Participants completed the Grit-S and other self-report measures. Psychometric properties of the Grit-S were assessed in outpatients (N = 94, 77.7% male) and a hierarchical regression predicted Grit-S variance in inpatients (N = 1238, 65.0% male).Results: The Grit-S demonstrated good internal consistency (α=.75) and strong test-retest reliability (adjusted r = .79, p < .001). Mean Grit-S score was 3.15, lower than other clinical samples reported in the literature. Regression modeling indicated a moderate, statistically significant association between demographic and clinical characteristics and Grit-S scores (R2 = 15.5%, p < .001). Of particular interest, the positive factor of recovery protection showed the strongest association with Grit-S of all variables assessed (ß=.185 vs. ß = .052-.175 for the remaining significant independent variables).Conclusion: The psychometric properties of the Grit-S in patients with SUD support its use in this population. Moreover, the particularly low grit scores among inpatients with SUDs and the association of grit scores with substance use risk and recovery factors suggest that grit could be useful as a treatment target in this population.
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Satisfação Pessoal , Transtornos Relacionados ao Uso de Substâncias , Humanos , Masculino , Feminino , Psicometria , Reprodutibilidade dos Testes , Pacientes InternadosRESUMO
BACKGROUND: Children with cancer and childhood cancer survivors (CCS) are at risk for developing chemotherapy-induced cardiomyopathy. Myocardial deformation imaging has shown potential in the early detection of subclinical myocardial damage with implications on therapeutic interventions and improvement of outcomes. The aim of this study was to perform a systemic review and meta-analysis of literature on the assessment of left ventricular and right ventricular myocardial deformation by speckle-tracking echocardiography at rest and during stress in children with cancer during and in survivors after chemotherapy. METHODS: A systematic review was performed through searching MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Central Register of Controlled Trials, and Scopus. Search hedges were created to cover the concepts of childhood cancer, chemotherapy, radiotherapy, anthracycline, cardiotoxicity, speckle-tracking, myocardial strain, and myocardial deformation. Two independent investigators reviewed the eligibility of articles for inclusion. The weighted mean difference in ventricular strain between pre- and postchemotherapy treatment and that between long-term CCS and healthy subjects were estimated using random-effect models with 95% CIs. Heterogeneity and publication bias were assessed using I2 statistics and the Egger test, respectively. RESULTS: Of the total of 8,703 records initially identified, 42 studies with a total of 5,430 children with cancer were included. Of these 42 studies that showed heterogeneities, nine assessed early myocardial injury during chemotherapy, 30 assessed late myocardial injury after chemotherapy with no publication bias, and three studied myocardial mechanics during stress. The main findings were as follows: (1) left ventricular systolic deformation is impaired in children with cancer during the initial treatment phase and among long-term CCS, while data on changes in right ventricular deformation are limited and inconclusive; (2) the predictive value of early reduction of myocardial strain imaging in forecasting subsequent development of cardiotoxicity is unknown, as it has not been studied; (3) limited data suggest the possibility of impaired left ventricular contractile mechanics during stress in CCS; and (4) cumulative anthracycline dose and chest-directed radiotherapy are consistently identified as factors associated with impaired myocardial deformation. CONCLUSIONS: Myocardial strain imaging by speckle-tracking echocardiography unveils early evidence of myocardial injury in children with cancer and long-term CCS. To support its adoption for clinical use, more data are required for the better understating of myocardial deformation parameters in the risk stratification of children with cancer and prediction of development of cardiomyopathy among CCS.
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Cardiomiopatias , Neoplasias , Disfunção Ventricular Esquerda , Antraciclinas/efeitos adversos , Cardiotoxicidade , Criança , Detecção Precoce de Câncer , Ecocardiografia/métodos , Humanos , Neoplasias/tratamento farmacológico , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/diagnóstico por imagemRESUMO
BACKGROUND: The Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE) is a nationally recognized standardized protocol that goes beyond medical acuity to account for patients' social determinants of health (SDH). AIMS: We described the magnitude of patient SDH barriers at health centers. METHODS: Health centers across three PRAPARE implementation cohorts collected and submitted PRAPARE data using a standardized data reporting template. We analyzed the scope and intensity of SDH barriers across the cohorts. RESULTS: Nationally, patients faced an average of 7.2 out of 22 social risks. The most common SDH risks among all three cohorts were limited English proficiency, less than high school education, lack of insurance, experiencing high to medium-high stress, and unemployment. CONCLUSIONS: Findings demonstrated a high prevalence of SDH risks among health center patients that can be critical for informing social interventions and upstream transformation to improve health equity for underserved populations.
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Equidade em Saúde , Determinantes Sociais da Saúde , HumanosRESUMO
In the determination of the net impact of liquefied natural gas (LNG) on greenhouse gas emissions, life cycle assessments (LCA) of electricity generation have yet to combine the effects of transport distances between exporting and importing countries, country-level infrastructure in importing countries, and the fuel sources displaced in importing countries. To address this, we conduct a LCA of electricity generated from LNG export from British Columbia, Canada with a three-step approach: (1) a review of viable electricity generation markets for LNG, (2) the development of results for greenhouse gas emissions that account for transport to importing nations as well as the infrastructure required for power generation and delivery, and (3) emissions displacement scenarios to test assumptions about what electricity is being displaced in the importing nation. Results show that while the ultimate magnitude of the greenhouse gas emissions associated with natural gas production systems is still unknown, life cycle greenhouse gas emissions depend on country-level infrastructure (specifically, the efficiency of the generation fleet, transmission and distribution losses and LNG ocean transport distances) as well as the assumptions on what is displaced in the domestic electricity generation mix. Exogenous events such as the Fukushima nuclear disaster have unanticipated effects on the emissions displacement results. We highlight national regulations, environmental policies, and multilateral agreements that could play a role in mitigating emissions.
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Gases de Efeito Estufa , Gás Natural , Colúmbia Britânica , Eletricidade , Efeito EstufaRESUMO
OBJECTIVE: Recent research demonstrates an increased need to understand the contribution of social determinants of health (SDHs) in shaping an individual's health status and outcomes. We studied patients with diabetes in safety-net centers and evaluated associations of their disease complexity, demographic characteristics, comorbidities, insurance status, and primary language with their HbA1c level over time. METHODS: Adult patients with diabetes with at least 3 distinct primary care visits between January 1, 2006, and December 31, 2013, were identified in the CHARN data warehouse. These patients were categorized into 4 groups: those without a diagnosis of cardiovascular disease (CVD) or depression; those with CVD but not depression; those with depression but not CVD; and those with CVD and depression. Charlson score; demographic characteristics such as age, sex, and race/ethnicity; and SDHs such as primary language and insurance status were used as predictors. The outcome measure was HbA1c. Hypothesis testing was conducted using 3-level hierarchical linear models. RESULTS: Baseline HbA1c differed significantly across the 4 diabetes groups and by race/ethnicity. The amount of HbA1c change over time differed by insurance status. Patients who were continuously insured tended to have lower baseline HbA1c and a smaller increase. Chinese-speaking patients tended to have lower baseline HbA1c but a larger increase over time compared with English speakers. There were various unexpected associations: compared with the diabetes-only group, mean HbA1c tended to be lower among the other more complex groups at baseline; women tended to have lower measures at baseline; older age and higher Charlson scores were associated with lower HbA1c. CONCLUSIONS: There is still unexplained variability relating to both baseline HbA1c values and change over time in the model. SDHs, such as insurance status and primary language, are associated with HbA1c, and results suggest that these relationships vary with disease status among patients with diabetes in safety-net centers. It is important to recognize that there are complex relationships among demographic and SDH measures in complex patients, and there is work to be done in correctly modeling and understanding these relationships. We also recommend prioritizing the collection of SDH and enabling services data for safety-net patients that would be instrumental in conducting a more comprehensive study.
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Doenças Cardiovasculares/epidemiologia , Depressão/epidemiologia , Diabetes Mellitus/epidemiologia , Hemoglobinas Glicadas/análise , Nível de Saúde , Determinantes Sociais da Saúde , Adulto , Idoso , Comorbidade , Diabetes Mellitus/sangue , Humanos , Cobertura do Seguro , Idioma , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Estudos Retrospectivos , Provedores de Redes de SegurançaRESUMO
Inequalities are everywhere, yet little is known about how children respond to people affected by inequalities. This article explores two responses-minimizing inequalities and favoring those who are advantaged by them. In Studies 1a (N = 37) and 1b (N = 38), 4- and 5-year-olds allocated a resource to a disadvantaged recipient, but judged advantaged recipients more positively. In Studies (N = 38) and (N = 74), a delay occurred between seeing the inequality and allocating resources, or stating a preference, during which time participants forgot who was initially more advantaged. Children then favored advantaged recipients on the preference and resource allocation measures, suggesting an implicit "affective tagging" mechanism drives the tendency to favor the advantaged. In contrast, reducing inequalities through resource allocation appears to require explicit reasoning.