Prevalence of Unmet Rehabilitation Needs Among Canadians Living With Long-term Conditions or Disabilities During the First Wave of the COVID-19 Pandemic.

OBJECTIVE: We aimed to describe the prevalence of unmet rehabilitation needs among a sample of Canadians living with long-term conditions or disabilities during the first wave of the COVID-19 pandemic. DESIGN: Cross-sectional survey. SETTING: Individuals residing in Canada during the first wave of the COVID-19 pandemic. PARTICIPANTS: Eligible participants were Canadians living with long-term conditions or disabilities, 15 years or older living in 1 of the 10 provinces or 3 territories (n=13,487). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: We defined unmet rehabilitation needs as those who reported needing rehabilitation (ie, physiotherapy/massage therapy/chiropractic, speech, or occupational therapy, counseling services, support groups) but did not receive it because of the COVID-19 pandemic. We calculated the national, age, gender, and province/territory-specific prevalence and 95% confidence interval of unmet rehabilitation needs. RESULTS: During the first wave of the pandemic, the prevalence of unmet rehabilitation needs among Canadians with long-term conditions or disabilities was 49.3% (95% confidence interval [CI]; 48.3, 50.3]). The age-specific prevalence was higher among individuals 15-49 years old (55.6%; 95% CI [54.2, 57.1]) than those 50 years and older (46.0%; 95% CI [44.5, 47.4]). Females (53.7%; 95% CI [52.6, 54.9]) had higher unmet needs than males (44.1%; 95% CI [42.3, 45.9]). Unmet rehabilitation needs varied across provinces and territories. CONCLUSIONS: In this sample, almost 50% of Canadians living with long-term conditions or disabilities had unmet rehabilitation needs during the first wave of the COVID-19 pandemic. This suggests that a significant gap between the needs for and delivery of rehabilitation care existed during the early phase of the pandemic.

Characteristics of Canadians living with long-term health conditions or disabilities who had unmet rehabilitation needs during the first wave of the COVID-19 pandemic: A cross-sectional study.

OBJECTIVE: To describe the characteristics associated with unmet rehabilitation needs in a sample of Canadians with long-term health conditions or disabilities during the first wave of the COVID-19 pandemic. DESIGN: Data from the Impacts of COVID-19 on Canadians - Living with Long-Term Conditions and Disabilities, a national cross-sectional survey with 13,487 respondents. Unmet needs were defined as needing rehabilitation (i.e., physiotherapy/massage/chiropractic, speech therapy, occupational therapy, counselling services, or support groups) but not receiving due to the pandemic. We used multivariable modified Poisson regression to examine the association between demographic, socioeconomic, and health-related characteristics, and unmet rehabilitation needs. RESULTS: More than half of the sample were ≥ 50 years (52.3%), female (53.8%), and 49.3% reported unmet rehabilitation needs. Those more likely to report unmet needs were females, those with lower socio-economic status (receiving disability benefits or social assistance, job loss, increased work hours, decreased household income or earnings), and those with lower perceived general health or mental health status. CONCLUSIONS: Among Canadians with disabilities or chronic health conditions, marginalized groups are more likely to report unmet rehabilitation needs. Understanding the systemic and upstream determinants is necessary to develop strategies to minimize unmet rehabilitation needs and facilitate the delivery of equitable rehabilitation services.

Assessing cultural competency among Canadian chiropractors: a cross-sectional survey of Canadian Chiropractic Association members.

BACKGROUND: There is a paucity of research assessing cultural competency among Canadian chiropractors. Therefore, the aims of this study were to (1) measure cultural competency among Canadian chiropractors, (2) understand chiropractors' perspectives of challenges and attitudes regarding the delivery of chiropractic services to equity-seeking communities, and (3) assess contextual factors associated with cultural competency. METHODS: We conducted a cross-sectional survey of members of the Canadian Chiropractic Association (CCA) (May-July 2021). The survey instrument consisted of 57 questions related to demographics, cultural competency, perceptions about health disparities, and challenges in delivery of rehabilitation. Cultural competency was measured using the Cultural Awareness and Sensitivity and Cultural Competence Behaviours subscales of the Cultural Competence Assessment Instrument. We conducted a multivariate linear regression to assess factors that may be associated with cultural competency. RESULTS: A total of 3143 CCA members responded (response rate of 41%). Mean scores for the Cultural Awareness and Sensitivity subscale were 5.8/7 (95% CI 5.7; 5.8) and 4.2/7 (95% CI 4.1; 4.2) for the Cultural Competence Behaviour subscale. Most chiropractors (72-78%) reported observing important cultural health disparities across various care-related outcomes. Cost of services and language were identified as barriers to providing care to equity-seeking communities. Cultural Awareness and Sensitivity scores were weakly associated with gender (men), years of clinical practice, cultural health disparities, the statement "I think some people have an agenda to look for discrimination even where it does not exist (DEI attitudes)," race (Caucasian), and prior DEI training, (R2 = 0.15, p < 0.0001). Cultural Competence Behaviour scores were weakly associated with race (Caucasian), cultural health disparities, prior DEI training, increased years of clinical experience, and higher Cultural Awareness and Sensitivity scores (R2 = 0.19, p < 0.0001). CONCLUSION: This study provides the first description of cultural competency within the chiropractic profession in Canada. Findings suggest a gap between knowledge and behaviour and uncover several barriers and challenges that may inform the development of profession-specific training in cultural competence.

Diversity of the chiropractic profession in Canada: a cross-sectional survey of Canadian Chiropractic Association members.

BACKGROUND: Little is known about the diversity of the chiropractic profession with respect to gender, sexual orientation, race, ethnicity and community of practice. This knowledge is important as profession representation of key equity seeking groups may impact quality of care and access for vulnerable communities. The aim of this cross-sectional survey was to explore the diversity of the chiropractic profession in Canada. METHODS: All registered members of the Canadian Chiropractic Association (N = 7721) were invited to participate in a web-based survey between May and June 2021. Survey questions explored diversity with respect to personal demographics (age, sex, gender, sexual orientation, race, ethnicity, language) and practice characteristics (community setting, practice type). Where possible, survey data was compared to data from the 2016 Census of the Canadian population. RESULTS: We received a total of 3143 survey responses (response rate-41%). The average age of our sample was 44.7 years (standard deviation 12.7). Forty-five percent were female with the same proportion (45.2%) self-identifying as women. Ninety-one percent of the sample self-identified as heterosexual. With respect to race, 80% of respondents were Caucasian. Seventy percent of chiropractors in our sample identified with Canadian ancestry and 29% with European ancestry. In comparison to the Canadian population, some visible minorities were underrepresented. The greatest discrepancy between the Canadian population and our sample was in the proportion of Black and Indigenous chiropractors. With respect to ethnicity, chiropractors identifying themselves with Canadian ancestry were overrepresented in our sample compared to others, specifically those with North American Indigenous and South, Central and Latin American ancestry. Sixty-one percent of chiropractors practiced in major cities and most work in interdisciplinary clinics (42% Complementary and Alternative Medicine and 33% rehabilitation). CONCLUSIONS: This study provides an initial description of diversity within the chiropractic profession in Canada. Women represent less than 50% of the profession nationally. Overall, there is little racial and ethnic diversity in the chiropractic profession compared to the Canadian population, with Black and Indigenous peoples being underrepresented. Future work should focus strategies to foster the development of a more diverse chiropractic workforce.

The effect of ultrasound or phonophoresis as an adjuvant treatment for non-specific neck pain: systematic review of randomised controlled trials.

OBJECTIVE: To determine the effectiveness of ultrasound/phonophoresis as an adjuvant to exercise or manual therapy for the improvement of patient-centred outcomes in adults with non-specific neck pain (NSNP). METHODS: Seven electronic databases were systematically searched up to September 2020. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to judge the Quality of Evidence (QoE). RESULTS: Six studies involving 249 participants were included. The QoE was very low GRADE. Phonophoresis with capsaicin plus exercise improved pain at immediate post-treatment (MD: -3.30 [-4.05, -2.55]) but not with diclofenac sodium plus exercise as compared to exercise. Continuous ultrasound (CUS) plus exercise improved pain and pressure pain threshold (PPT) at immediate post-treatment (pain: MD: -3.42 [-4.08, -2.7]); (PPT: MD: 0.91 [0.68, 1.14]) and at intermediate-term as compared to exercise. CUS or high power pain threshold (HPPT) ultrasound plus manual therapy and exercise showed no benefit for pain reduction (MD: -0.75 [-2.08, 0.58]) did not improve function/disability (MD: -1.05 [-4.27, 2.17]) at immediate or short-term as compared to manual therapy and exercise. CONCLUSIONS: Due to high risk of bias, inconsistency, and indirectness the QoE is very low in support of benefit of ultrasound/phonophoresis as an adjuvant treatment for NSNP.Implication for rehabilitationDue to high risk of bias, inconsistency, and indirectness the quality of evidence (QoE) is very low in support of benefit of adding ultrasound or phonophoresis to exercise or manual therapy for pain reduction or improvement in function/disability for those with sub-acute and chronic myofascial associated neck pain. However, our confidence in the findings is very low and conclusions are likely to change as more evidences emerges.Clinicians using ultrasound therapy as an adjuvant intervention for management of chronic myofascial associated neck pain should carefully consider the available evidence on ultrasound, including the benefits and costs involved.

Vitamin B12, bone mineral density and fracture risk in adults: A systematic review / Vitamina B12, densidade mineral óssea e risco de fraturas em adultos: uma revisão sistemática

Summary Objective: To consolidate information available on the effect of vitamin B12 on bone mineral density and fracture risk, with emphasis on clinical trials, observational and longitudinal data conducted in humans. Method: A systematic review of the literature of the past decade on the role of vitamin B12 in bone mineral density and fracture risk in subjects of all ages and both sexes was performed by means of a PubMed, Science Direct, Medline and SciELO database search. Articles included in this review were identified using the search terms: B12 Vitamin and Bone Mineral Density and Vitamin B12 and Risk of Fractures. Evidence quality of the included articles was evaluated by GRADE system. Results: A total of 25 original studies were identified. After reviewing the titles and abstracts of articles, only 17 articles met the inclusion criteria. The present review provides evidence that the role of vitamin B12 on bone mineral density or fracture risk should be further elucidated. Controversies are explained by heterogeneity of methodologies used for the diagnosis of vitamin B12 and also by differences among populations investigated on the studies. Conclusion: A real effect of vitamin B12 deficiency in bone health and the mechanisms associated with bone metabolism is not well established yet. It is extremely important to carry out more clarifying studies about this theme, especially with vulnerable groups such as postmenopausal and elderly women, as is well-known that they are greatly affected by deficiency of this vitamin.

Resumo Objetivo: Consolidar as informações disponíveis acerca dos efeitos da vitamina B12 sobre a densidade mineral óssea e o risco de fraturas, com destaque para ensaios clínicos, dados observacionais e longitudinais realizados com humanos. Método: Foi realizada uma revisão sistemática da literatura dos últimos dez anos sobre o papel da vitamina B12 na densidade mineral óssea e no risco de fraturas em populações de todas as idades e para ambos os sexos, com busca de artigos nos bancos de dados eletrônicos: PubMed, Science Direct, Medline e SciELO. Como estratégia de busca de dados incluíram-se os descritores: B12 Vitamin and Bone Mineral Density e B12 Vitamin and Risk of Fractures. A qualidade das evidências dos artigos incluídos foi avaliada pelo sistema GRADE. Resultados: Após a análise dos títulos e dos resumos dos artigos, a estratégia de busca resultou em 25 referências, das quais 17 artigos preencheram os critérios de elegibilidade. Esta revisão fornece evidências de que o papel da vitamina B12 sobre a densidade mineral óssea ou o risco de fraturas ainda precisa ser mais bem elucidado. As controvérsias encontram respaldo na heterogeneidade das metodologias utilizadas para o diagnóstico da vitamina B12 e também na variedade de populações presentes entre os estudos. Conclusão: Ainda não está bem estabelecido o real impacto da deficiência de vitamina B12 na saúde dos ossos e sobre os mecanismos associados ao metabolismo ósseo. É de suma importância a realização de mais estudos esclarecedores, principalmente em grupos vulneráveis como as mulheres pós-menopausa e os idosos, grupos estes bastante afetados pela deficiência dessa vitamina.

Vitamin B12, bone mineral density and fracture risk in adults: A systematic review.

OBJECTIVE: To consolidate information available on the effect of vitamin B12 on bone mineral density and fracture risk, with emphasis on clinical trials, observational and longitudinal data conducted in humans. METHOD: A systematic review of the literature of the past decade on the role of vitamin B12 in bone mineral density and fracture risk in subjects of all ages and both sexes was performed by means of a PubMed, Science Direct, Medline and SciELO database search. Articles included in this review were identified using the search terms: B12 Vitamin and Bone Mineral Density and Vitamin B12 and Risk of Fractures. Evidence quality of the included articles was evaluated by GRADE system. RESULTS: A total of 25 original studies were identified. After reviewing the titles and abstracts of articles, only 17 articles met the inclusion criteria. The present review provides evidence that the role of vitamin B12 on bone mineral density or fracture risk should be further elucidated. Controversies are explained by heterogeneity of methodologies used for the diagnosis of vitamin B12 and also by differences among populations investigated on the studies. CONCLUSION: A real effect of vitamin B12 deficiency in bone health and the mechanisms associated with bone metabolism is not well established yet. It is extremely important to carry out more clarifying studies about this theme, especially with vulnerable groups such as postmenopausal and elderly women, as is well-known that they are greatly affected by deficiency of this vitamin.

Atividade antifúngica de produtos naturais indicados por raizeiros para tratamento de candidíase oral / Actividad antifúngica de productos naturales indicados por vendedores de hierbas (raizeiros) para el tratamiento de la candidiasis oral / Antifungal activity of natural products indicated by herb sellers (raizeiros) for the treatment of oral candidiasis

A crescente resistência das leveduras pertencentes ao gênero Candida frente aos antifúngicos sintéticos, atualmente disponíveis no comércio, impulsiona a busca por novos compostos antifúngicos de origem vegetal. Assim, o propósito do presente estudo foi avaliar in vitro a atividade antifúngica dos decoctos de Schinus terebenthifolius Raddi (aroeira) Cinnamomum zeylanicum Breym (canela) e Punica granatum Linn (romã), vendidos por raizeiros em três feiras livres distintas (A, B e C), frente a três espécies de microorganismos do gênero Candida (C. albicans, C. tropicalis e C. krusei). O ensaio para determinação da atividade antifúngica dos produtos naturais foi realizado pelo método da difusão em meio sólido, em triplicata, onde discos de papel de filtro estéreis embebidos em 50 µL dos extratos foram colocados sobre o meio de cultura. Os resultados foram avaliados a partir da mensuração dos diâmetros dos halos de inibição de crescimento fúngico em milímetros (mm), sendo considerada a moda dos valores obtidos. Foi observada atividade antifúngica de S. terebenthifolius Raddi e de C. zeylanicum Breym sobre C. krusei. No entanto, diferenças foram identificadas entre os produtos obtidos nos diferentes locais. O decocto de Punica granatum Linn apresentou atividade antifúngica sobre as três cepas fúngicas utilizadas no estudo. Também foram verificadas diferenças entres os produtos obtidos nas feiras livres, sendo que apenas as amostras de Punica granatum Linn provenientes da feira A foram capazes de inibir o crescimento fúngico de todas as cepas analisadas. Desta forma, conclui-se que todos os produtos avaliados apresentam atividade antifúngica, havendo diferenças relacionadas aos locais de sua obtenção e sensibilidade das cepas ensaiadas(AU)

La resistencia cada vez mayor de levaduras del género candida a los antifúngicos sintéticos disponibles en la actualidad ha llevado a la búsqueda de nuevos compuestos antifúngicos de origen vegetal. El propósito de este estudio fue evaluar la actividad antifúngica in vitro de decocciones de Schinus terebenthifolius Raddi (pimentero brasileño),Cinnamomum zeylanicum Breym (canela) y Punica granatum Linn (granada) sobre tres especies del género Candida (C. albicans, C . tropicalis y C. krusei). Este material vegetal fue vendido por vendedores de hierbas (raizeiros) en tres ferias callejeras distintas (A, B y C). El ensayo para determinar la actividad antifúngica de los productos se realizó por triplicado. Se empleó el método de difusión en medio sólido, en el que discos de papel de filtro estériles fueron empapados en 50 µL de los extractos y colocados en medio de cultivo. Los datos fueron evaluados mediante la medición de los diámetros de los halos de inhibición del crecimiento fúngico, en milímetros, y se consideró la moda de los valores encontrados. Se observó actividad antifúngica de S. terebinthifolius Raddi y C. zeylanicum Breym contra C. krusei, pero fueron identificadas diferencias entre los productos obtenidos en diferentes lugares. La decocción de Punica granatum Linn presentó actividad antifúngica sobre las tres levaduras en estudio. Además, se encontraron diferencias entre los productos adquiridos en las ferias callejeras, pero sólo las muestras de Punica granatum Linn de la feria A fueron capaces de inhibir el crecimiento de hongos de todas las levaduras analizadas. Todos los productos evaluados mostraron actividad antifúngica, pero hubo diferencias en función de la localidad donde los productos fueron obtenidos y de la sensibilidad a las cepas ensayadas(AU)

An increasing resistance of Candida yeasts to the synthetic antifungals currently available has driven the search for new plant-derived antifungal compounds. In this respect, the present study aimed to evaluate the in vitro antifungal activity of decoctions from Schinus terebenthifolius Raddi (Brazilian pepper tree), Cinnamomum zeylanicum Breym (cinnamon) and Punica granatum Linn (pomegranate) against three species of Candida genus (C. albicans, C. tropicalis and C. krusei). Such plant material was sold by herb sellers in three distinct street fairs (A, B and C). The test to determine the products antifungal activity was performed in triplicate by means of the diffusion method on solid medium, in which sterile filter paper discs were soaked in 50 µL of the extracts and then placed on culture medium. Data were assessed by measuring the diameters of halos of fungal growth inhibition, in millimeters (mm), and it was considered the mode of the values found. Antifungal activity of S. terebinthifolius Raddi and C. zeylanicum Breym was observed against C. krusei, but were identified differences among the products obtained in different locations. Punica granatum Linn decoction presented antifungal activity on the three yeasts under study. Also, were found differences among the products acquired in the street fairs, but only the samples of Punica granatum Linn from fair A were able to inhibit fungal growth of all yeasts analyzed. Thus, it is concluded that all the products assessed showed antifungal activity, but differences were found depending on the location where these were obtained and on the sensitivity to the strains assayed(AU)

Compliance with clinical guidelines for whiplash improved with a targeted implementation strategy: a prospective cohort study.

BACKGROUND: Implementation strategies for clinical guidelines have shown modest effects in changing health professional's knowledge and practice, however, targeted implementations are suggested to achieve greater improvements. This study aimed to examine the effect of a targeted implementation strategy of the Australian whiplash guidelines on health professionals' knowledge, beliefs and practice and to identify predictors of improved knowledge. METHODS: 94 health professionals (Physiotherapists, Chiropractors and Osteopaths) who manage whiplash participated in this study. Prior to their inclusion in the study, health professionals were classified as compliant with clinical guidelines for whiplash (n = 52) or non-compliant (n = 42), according to a record of clinical practice. All participants completed a 2- day interactive workshop with outcomes measured at baseline and 3 months following the workshop. The workshop was delivered by opinion leaders, with the educational content focused on the pre-identified knowledge and practice gaps in relation to clinical guidelines for whiplash. Knowledge and health professional beliefs were assessed by a questionnaire and professional practice by record of clinical practice. RESULTS: Participants significantly increased knowledge (p < 0.0001) and were more likely to be compliant with the guidelines at follow-up (compliant at baseline 58%, follow-up 79%, p = 0.002). Health professional belief systems significantly changed to be more behavioural (p = 0.02) and less biomedical (p = 0.000). Predictors of improved knowledge were baseline knowledge (parameter estimate = -0.6, p = 0.000) and profession (parameter estimate = -3.8, p = 0.003) (adj R2 = 35%). CONCLUSIONS: A targeted implementation strategy improved health professional's knowledge and clinical practice so that they became more compliant with clinical guidelines for whiplash. In addition health professionals' belief systems significantly changed to be more behavioural in orientation. Baseline knowledge and profession predicted 35% of the variance in improved knowledge.

Differences in range of motion between dominant and nondominant sides of upper and lower extremities.

OBJECTIVE: The objective of this study was to compare ranges of motion (ROM) between dominant and nondominant sides for the joints of the upper and lower extremities. METHODS: Ninety healthy white women from 18 to 59 years of age were measured in this study. Active and passive ROM were measured for the ankle, knee, hip, shoulder, elbow, and wrist using a standard goniometer. The order of the joints, motion, sides, and active or passive motion testing was randomly selected. A paired t test was used for the comparison between sides. RESULTS: The results of this study showed a statistically significant difference between dominant and nondominant sides for 34 of the 60 ROM measured. The maximum mean difference between sides for all ROM measured was 7.5 degrees . CONCLUSION: The results of this show that some ROM are different between body sides and that when these differences exist they are minimal and may not be clinically insignificant. These results support the practice of using the opposite side of the body as an indicator of preinjury or normal extremity ROM.

Synthesis and preliminary pharmacological evaluation of new (+/-) 1,4-naphthoquinones structurally related to lapachol.

Seven new 1,4-naphthoquinones structurally related to lapachol were synthesized from lawsone and oxygenated arylmercurials. These compounds can also be seen as pterocarpan derivatives where the A-ring was substituted by the 1,4-naphthoquinone nucleus. Pharmacological screening provided evidence of significant biological activities, including effects against proliferation of the MCF-7 human breast cancer cell line, against Herpes Simplex Virus type 2 infection, and against snake poison-induced myotoxicity. One derivative displaced flunitrazepam binding and showed benzodiazepine-like activity, suggesting novel neuroactive structural motifs.