A long-term process for decolonizing and democratizing community-focused research: the case for MicroResearch in East Africa and in Canada.

Academics and multinational pharmaceutical companies from high-income countries (HIC) are major drivers of health research in many low- and low-middle-income countries (LMIC) but have neglected investing in and growing local research capacity. Community-focused health research in LMICs needs to be more locally driven and benefiting. The MicroResearch (MR) workshop program supports teams of local healthcare workers and community experts to identify local healthcare problems. Once a problem is clearly identified, the team then develops a research proposal and is empowered to conduct this research to find solutions to address the problem that fit the local context, culture and resources. Knowledge translation of the findings is a key element in MR. By placing the drivers of change in the hands of locals, the decolonization of the local health research has begun. MR also democratizes health research by extending community health research training beyond local academics and by fostering gender equity. More than half of the local MR research project team leaders, as selected by team members, are women. The success of MR in LMIC has led to its adaptation for use in HIC such as Canada. Decolonization and democratization of community-focused research is practical and achievable and should be seen as best practice in global health research capacity building.

RéSUMé: Les universitaires et les compagnies pharmaceutiques multinationales des pays à revenu élevé (PRÉ) sont les principaux moteurs de la recherche en santé dans bien des pays à faible revenu et à revenu faible/intermédiaire (PFRRI), mais ils ont négligé d'investir dans le renforcement des capacités de recherche locales. La recherche de proximité en santé dans les PFRRI devrait être plus axée sur les besoins locaux. Un programme d'ateliers de « microrecherche ¼ (MR) aide des équipes de personnels de santé et d'experts locaux à cerner les problèmes de soins de santé sur le terrain. Lorsqu'un problème est clairement défini, l'équipe élabore un plan de recherche, et on lui donne les moyens d'effectuer cette recherche afin de trouver des solutions en harmonie avec la culture et les ressources locales. L'application des connaissances sur les constats de la recherche est un élément clé en MR. Lorsque les facteurs de changement sont entre les mains des résidents, la décolonisation de la recherche locale en santé peut commencer. La MR démocratise aussi la recherche en santé en offrant de la formation en recherche sur la santé communautaire à d'autres que les universitaires locaux et en favorisant l'équité entre les sexes. Plus de la moitié des responsables des équipes de MR locales, sélectionnés par les membres de ces équipes, sont des femmes. En raison de son succès dans les PFRRI, la MR est maintenant adaptée pour être utilisée dans les PRÉ comme le Canada. Il est pratique et réalisable de décoloniser et de démocratiser la recherche de proximité, et cela devrait être considéré comme une pratique exemplaire de renforcement des capacités de recherche en santé mondiale.

Improved maternal-fetal outcomes among emergency obstetric referrals following phone call communication at a teaching hospital in south western Uganda: a quasi-experimental study.

BACKGROUND: Emergency obstetric referrals develop adverse maternal-fetal outcomes partly due to delays in offering appropriate care at referral hospitals especially in resource limited settings. Referral hospitals do not get prior communication of incoming referrals leading to inadequate preparedness and delays of care. Phone based innovations may bridge such communication challenges. We investigated effect of a phone call communication prior to referral of mothers in labour as intervention to reduce preparation delays and improve maternal-fetal outcome at a referral hospital in a resource limited setting. METHODS: This was a quasi-experimental study with non-equivalent control group conducted at Mbarara Regional Referral Hospital (MRRH) in South Western Uganda from September 2020 to March 2021. Adverse maternal-fetal outcomes included: early neonatal death, fresh still birth, obstructed labour, ruptured uterus, maternal sepsis, low Apgar score, admission to neonatal ICU and hysterectomy. Exposure variable for intervention group was a phone call prior maternal referral from a lower health facility. We compared distribution of clinical characteristics and adverse maternal-fetal outcomes between intervention and control groups using Chi square or Fisher's exact test. We performed logistic regression to assess association between independent variables and adverse maternal-fetal outcomes. RESULTS: We enrolled 177 participants: 75 in intervention group and 102 in control group. Participants had similar demographic characteristics. Three quarters (75.0%) of participants in control group delayed on admission waiting bench of MRRH compared to (40.0%) in intervention group [p = < 0.001]. There were significantly more adverse maternal-fetal outcomes in control group than intervention group (obstructed labour [p = 0.026], low Apgar score [p = 0.013] and admission to neonatal high dependency unit [p = < 0.001]). The phone call intervention was protective against adverse maternal-fetal outcome [aOR = 0.22; 95%CI: 0.09-0.44, p = 0.001]. CONCLUSION: The phone call intervention resulted in reduced delay to patient admission at a tertiary referral hospital in a resource limited setting, and is protective against adverse maternal-fetal outcomes. Incorporating the phone call communication intervention in the routine practice of emergency obstetric referrals from lower health facilities to regional referral hospitals may reduce both maternal and fetal morbidities. TRIAL REGISTRATION: Pan African Clinical Trial Registry PACTR20200686885039.

Listeriosis in infants: Prospective surveillance studies in Canada and Switzerland.

OBJECTIVES: International data on listeriosis during infancy from large populations are essential to guide evidence-based empiric antibiotic guidelines for sepsis in infancy. We aimed to determine the incidence, clinical manifestations, and outcome of listeriosis in infants <6 months of age in Canada and Switzerland. METHODS: Prospective, active surveillance of listeriosis in infants <6 months of age was conducted through the Canadian Paediatric Surveillance Program (May 2015 to April 2017) and the Swiss Paediatric Surveillance Unit (April 2017 to March 2018). Confirmed and probable cases were included. RESULTS: In Canada, eight sporadic listeriosis cases were reported (incidence, 1.1/100,000 live births/year). In Switzerland, four cases were reported (incidence, 4.5/100,000 live births/year) of which three were part of a confirmed outbreak with an unclear source. In the two countries, eight of the 12 cases (66.6%) presented as early-onset disease (within the first 7 days of life) and none presented after 28 days life. CONCLUSIONS: Neonatal listeriosis is rare. Infants presenting with sepsis, especially after 4 weeks of life, may not routinely require empiric antibiotic coverage for listeriosis. Outbreak-related cases still occur. Continued surveillance is important.

Hats Off to the CIM Reviewers of 2021.

For over 40 years the journal of Clinical and Investigative Medicine (CIM) has published articles of interest to clinician investigators in Canada and elsewhere. We strive for the highest standards and to remain relevant to our readers, but we cannot achieve this goal without the help of our reviewers, all of whom play a vital role in maintaining the integrity of the scientific process. Without their efforts, academic excellence would falter.

Challenges and opportunities for future Canadian physician-scientists: Perspectives of four experts.

In this series of interviews, the Clinical and Investigative Medicine editorial team gathered expert opinions on the future of physician-scientist training and career prospects in Canada. This was inspired by recent publications that voiced concerns over the diminishing support for the physician-scientist in Canada and the United States. For this editorial, the term physician-scientist was intentionally broad and inclusive; referring to individuals who identify both clinical work and biomedical or healthcare research as major components of their career. The following leaders in medical research or research funding shared their perspectives: Roderick R. McInnes; Michel G. Bergeron; Thomas J. Marrie; and Bev J. Holmes.

COVID-19 in sub-Saharan Africa: impacts on vulnerable populations and sustaining home-grown solutions.

This commentary draws on sub-Saharan African health researchers' accounts of their countries' responses to control the spread of COVID-19, including social and health impacts, home-grown solutions, and gaps in knowledge. Limited human and material resources for infection control and lack of understanding or appreciation by the government of the realities of vulnerable populations have contributed to failed interventions to curb transmission, and further deepened inequalities. Some governments have adapted or limited lockdowns due to the negative impacts on livelihoods and taken specific measures to minimize the impact on the most vulnerable citizens. However, these measures may not reach the majority of the poor. Yet, African countries' responses to COVID-19 have also included a range of innovations, including diversification of local businesses to produce personal protective equipment, disinfectants, test kits, etc., which may expand domestic manufacturing capabilities and deepen self-reliance. African and high-income governments, donors, non-governmental organizations, and businesses should work to strengthen existing health system capacity and back African-led business. Social scientific understandings of public perceptions, their interactions with COVID-19 control measures, and studies on promising clinical interventions are needed. However, a decolonizing response to COVID-19 must include explicit and meaningful commitments to sharing the power-the authority and resources-to study and endorse solutions.

Supporting breastfeeding: Tanzanian men's knowledge and attitude towards exclusive breastfeeding.

Background: Exclusive breastfeeding (EBF) is one of the key strategies to ensure infants and young children survive and grow. However, a 2010 study showed that it was only practiced by 50% of Tanzanian women. That study also found that men were rarely supportive; either at home or in the health facilities, due to their personal beliefs or to traditional beliefs and culture of the community. In a report six years later the rate of EBF has decreased to 30%, in one region. Methods: In this qualitative study, we used focus groups to assess the knowledge and attitudes of 35 men from three villages on the benefits of EBF, the disadvantages of not breastfeeding, and how they can support their partners' breastfeeding. In addition, we assessed how they felt about spending time at home, if they considered handling the infant to be rewarding and whether they helped the mother with home chores. Differences in village infrastructure and characteristics were noted. Results: Five themes were identified, including traditional roles, and feelings of exclusion/inclusion and resistance. Men felt they needed better information on EBF. They wished that their partners could breastfeed for a longer time, since they realized it improved infant growth and prevented disease; however, they did not have time to remain with the infant at home. Poverty required the men to work for long periods outside the home. As well, the men were not involved with the Reproductive Child Health Clinic (RCHC) except at the time of delivery or for mandatory HIV testing, however, they wanted to be educated together with their partners at the RCHC. Conclusion: Most men in this study understood that the EBF period was important, and that it broadened their relationship with their partner. EBF, however, could be a challenge for couples because of poverty. Nevertheless, many men wanted to help and to become more involved.

1978: Forty years later.

Think back; think wayyy back: before laptops, internet and smartphones. Bank machines didn't exist, tele-phones were permanently plugged into the wall, airport security meant only checking that you paid for your ticket and medical journals came in the mail (as did the bills for the journals). As it turned out, the 1970s was not a kind decade for medical journals, and several were struggling financially. Even the New England Journal of Medicine (NEJM), desperate for cash, was forced to offer a lifetime subscription to anyone who could pay the princely sum of $350! (A colleague of ours, now retired, still receives the weekly NEJM by mail, 45 years later!).

My brief but spectacular career in hockey: A life lesson.

Bob is a pediatric infectious disease specialist at Dalhousie University, where he did research on the ontogeny of the immune system in neonates. He was VP Research at the IWK Health Centre (1992-2007). He developed the curriculum for a CIHR train-ing program and edited "Handbook for Clinician Scientists". In 2008, he cofounded MicroResearch, which helps clinicians in Africa do research that will improve health programs there. He is also a Professor Emeritus at Dalhousie University and current Editor-in-Chief of CIM.

Newsletter 2018: Clinician Investigator Trainee Association of Canada (CITAC).

A decade of CITAC Annual General Meetings: 2007-2017 In 2007, the Clinician Investigator Trainee Association of Canada (CITAC) launched its inaugural Annual General Meeting (AGM). The AGM has since become a major annual event, jointly organized by CITAC and leaders from the Canadian Society for Clinical Investigation (CSCI), and continues to provide a forum for clinician investigator (CI) trainees to exchange ideas, advance career prospects and engage with the broader community. Indeed, since its inception, all Canadian institutions with medical doctor and clinician investigator (MD+CI) training programs have participated in the AGM, while more than 1,000 trainees have registered as CITAC members. The 10th CITAC-CSCI AGM was recently held in Toronto (November 20-22, 2017). There were nearly 200 attendees, including CI trainees, faculty member and physician leaders from across Canada (Figure 1A, 1B). Trainees spanning diverse career stages had opportunities to participate in interactive poster sessions, workshops and lectures by leading physician-scientists. These exercises were designed to encourage and enhance networking, career development and mentorship for prospective physician-scientists.

Editor's Comment and Announcement.

It is hard to believe but Clinical and Investigative Medicine (CIM), the official journal of Canadian Society for Clinical Investigation (CSCI), will soon celebrate its 40th birthday!  Over these past four decades, CIM has been the premier journal for Canadian clinician scientists; publishing over 1,000 articles on breakthroughs and major advances from Canada and around the world.  We are listed on Medline, PubMed and the Library of Science. We have been, and will continue to be, an independent journal. To celebrate this auspicious occasion, we have plans to become an even bigger showpiece for national and international clinical advances. We want to connect more closely with Canadian clinician scientists and trainees and we particularly want to encourage more Canadian publications. Changes will soon be coming to CIM with several new features: Newsletter with announcements and news on activities of interest to clinician scientists and trainees; Focused Reviews on specific areas of research; Reflections on work and life experiences of trainees and senior clinician scientists; Methods Papers describing novel methods anticipated to be useful for others; and  Guidelines or Recommendations on clinical care that are endorsed by a Canadian Medical or Surgical Society. Starting in 2018, we will be publishing on a quarterly basis. This will help to ensure we will focus on important breakthroughs and commentaries. However, we are also planning a special edition in the autumn to commemorate the 40th birthday. Stay tuned! Of course CIM will continue to publish original papers on discoveries in pathophysiology, prevention, management, treatment and outcome of clinical problems confronting clinicians in Canada and around the world.  Please join us as we embark on these changes and a new era for CIM, Robert Bortolussi Clinical and Investigative Medicine (CIM) Editor in Chief.