Food budget ratio as an equitable metric for food affordability and insecurity: a population-based cohort study of 121 remote Indigenous communities in Canada.

BACKGROUND: Food insecurity is a public health issue for many regions globally, and especially Indigenous communities. We propose food budget ratio (FBR)-the ratio of food spending to after-tax income-as an affordability metric that better aligns with health equity over traditional price-focused metrics. Existing census and inflation monitoring programs render FBR an accessible tool for future affordability research. METHODS: Public census and food pricing datasets from 2011 to 2021 were analyzed to evaluate food affordability for a cohort of 121 remote Indigenous communities in Canada (n = 80,354 persons as of March 2021). Trends in population-weighted versus community-weighted averages, inflation-adjusted mean price of the Revised Northern Food Basket (RNFB), and distributions of FBR, per-capita price of food, and per-capita after-tax income were calculated and compared to Canada at large. RESULTS: Population-weighted versus community-weighted mean price of the RNFB differed by < 5% for most points in time, peaking at 17%. Mean raw price of the RNFB was relatively stable, while mean inflation-adjusted price of the RNFB decreased 19%. Mean and standard deviation in FBR trended downwards from (0.40; 0.21) in 2011 to (0.25; 0.10) in 2021, while the mean for Canada held stable at 0.10 ± 0.01. Mean and standard deviation in inflation-adjusted per-capita price of food fell from ($5,621; $493) to ($4,510; $243), while the Canada-wide mean rose from $2,189 to $2,567; values for per-capita after-tax income increased from ($17,384; $7,816) to ($21,661; $9,707), while the Canada-wide mean remained between $24,443 and $26,006. Current Nutrition North Canada (NNC) subsidy rates correlate closely with distance to nearest transportation hub (σXY = 0.68 to 0.70) whereas food pricing, after-tax income, and FBR correlate poorly with distance (σXY = -0.22 to 0.03). CONCLUSIONS: The FBR approach yields greater insights on food affordability compared to price-based results, while using readily available public datasets. Whereas 19% reductions in RNFB per-capita food price were observed, FBR decreased 63% yet remained 2.5 times the Canada-wide FBR. The reduction in FBR was driven both by the reduced price of food and a 25% increase in after-tax income. It is recommended that NNC consider FBR for performance measurement and setting subsidy rates.

Medical Mistrust Mediates the Relationship Between Nonconsensual Intersex Surgery and Healthcare Avoidance Among Intersex Adults.

BACKGROUND: Intersex individuals experience poor health due, in part, to healthcare avoidance. Nonconsensual intersex surgery may contribute to medical mistrust and avoidance among intersex populations. PURPOSE: The purpose of this study was to explore the relationship between nonconsensual surgery and healthcare avoidance among intersex populations and to examine if medical mistrust mediates this relationship. METHODS: Data for this cross-sectional study were collected in 2018 and analyzed in 2022. Participants completed a survey collecting information on demographics, medical mistrust, history of nonconsensual surgery, and history of postponing healthcare. One hundred nine participants with valid responses to all regression model variables were included in the study. Multivariable logistic regression models controlling for age, race, and income, examined the relationship between nonconsensual surgery and postponing preventive and emergency healthcare. Mediation analyses of cross-sectional data examined whether medical mistrust mediated the relationship between nonconsensual surgery and postponing preventive and emergency healthcare. RESULTS: Mean medical mistrust score was 2.8 (range = 1-4; standard deviation = 0.8), 49.7% of participants had nonconsensual surgery in their lifetime, 45.9% postponed emergency healthcare, and 61.5% postponed preventive healthcare in their lifetime. Nonconsensual surgery was associated with increased odds of delaying preventive (adjusted odds ratio [AOR] = 4.17; confidence interval [CI] = 1.76-9.88; p = .016) and emergency healthcare (AOR = 4.26; CI = 1.71-10.59; p = .002). Medical mistrust mediated the relationship between nonconsensual surgery and delaying preventive (indirect effect = 1.78; CI = 1.16-3.67) and emergency healthcare (indirect effect = 1.66; CI = 1.04-3.30). CONCLUSIONS: Nonconsensual surgery contributed to healthcare avoidance in this intersex population by increasing medical mistrust. To decrease healthcare avoidance, intersex health promotion interventions should restrict nonconsensual surgery and build trust through trauma-informed care.

Many intersex people experience nonconsensual surgery during childhood to alter their genitalia and other anatomy. Some intersex people who have experienced nonconsensual surgery develop subsequent mistrust in medical providers and avoidance of healthcare. The purpose of this study was to understand the relationship between nonconsensual surgery and delay in emergency and preventive healthcare among intersex adults. Additionally, this study aimed to understand whether mistrust in medical providers mediates the relationship between nonconsensual surgery and delaying emergency and preventive healthcare. This study found that ever having nonconsensual surgery was positively associated with delaying both emergency and preventive healthcare among intersex adults. Additionally, this study found that increased mistrust in medical providers mediated the relationship between nonconsensual surgery and delaying emergency and preventive healthcare. Interventions aimed at improving the healthcare engagement of intersex adults may focus on building trust between intersex patients and healthcare providers and restricting nonconsensual intersex surgeries.

The association between religiosity and resilience among young trans women.

INTRODUCTION: Young transgender women (trans women) experience poor health in part due to discrimination. Factors that promote resilience may help young trans women positively adapt to discrimination, resulting in attenuation of poor health outcomes. While religion is sometimes a source of stigma and transphobia, qualitative studies have identified religiosity as an important resilience resource for young trans women. The goals of this study were to quantitatively measure religiosity and resilience among young trans women and to assess whether they are associated. METHODS: From 2012-2013, 300 young trans women between the ages of 16-24 years were enrolled in a longitudinal study; we examined the cross-sectional baseline data on demographics, religiosity, and resilience. Bivariate and multivariable logistic regression analysis examined the correlation between demographics (age, gender, race/ethnicity, education, income) and religiosity among young trans women. Additionally, bivariate and multivariable logistic regression analysis examined the association between religiosity and resilience among young trans women, controlling for age, gender, race/ethnicity, education, and income. RESULTS: Participants who reported high religiosity had significantly greater odds (aOR 1.78, 95% CI 1.05-3.01, p = .03) of reporting high resilience compared to those reporting low religiosity. Black/African American participants had significantly higher odds (aOR 6.16, 95% CI 2.34-16.20, p = < .001) of reporting high religiosity compared to those who identified as White. CONCLUSION: Religiosity may be an important resilience resource for young trans women. Gender affirming religious and spiritual interventions may promote resilience among some young trans women.

Factors Associated with Unsatisfactory Pap Tests Among Sexually Active Trans Masculine Adults.

Purpose: Unsatisfactory collection of cells during Papanicolaou (Pap) tests prevents the detection of cervical cancer and dysplasia. Prior research found that trans masculine (TM) individuals are significantly more likely than cisgender women to have an unsatisfactory Pap test. The purpose of this study was to identify factors that place some TM individuals at greater risk for an unsatisfactory Pap test than others. Methods: Between 2015 and 2016, 150 TM adults were enrolled in a cross-sectional survey assessing demographics, health characteristics, health care experiences, trauma history, and unsatisfactory Pap test history. Bivariate and multivariable logistic regression analyses conducted in 2020 examined associations between age, length of time on testosterone, smoking history, having to educate a provider about transgender people to receive appropriate care, anticipated health care stigma, post-traumatic stress disorder (PTSD) symptoms, and lifetime history of unsatisfactory Pap tests. Results: Of all participants, 20.2% had an unsatisfactory test in their lifetime, age ranged from 21 to 50 years, 55.1% used testosterone for 1 year or more, and 41.3% had PTSD symptoms. In the multivariable model, older age (adjusted odds ratio [AOR] = 1.15; 95% confidence interval (CI) = 1.04-1.27; p < 0.01), 1 year or more lifetime testosterone use (AOR = 3.51; 95% CI = 1.02-12.08; p = 0.046), and PTSD symptoms (AOR = 3.48; 95% CI = 1.10-11.00, p = 0.03) were significantly associated with increased odds of having an unsatisfactory Pap test. Conclusions: Older age, testosterone use, and PTSD symptoms are associated with lifetime unsatisfactory Pap tests among TM adults. Clinicians should assess TM patients' trauma and testosterone use history before Pap tests and utilize trauma-informed practices that facilitate the collection of adequate Pap samples.

Posterior stabilization strategies following resection of cervicothoracic junction tumors: review of 90 consecutive cases.

OBJECT: In this retrospective analysis the authors describe the assessment and outcomes of 90 patients who underwent placement of posterior instrumentation at the cervicothoracic junction following the resection of a primary or metastatic tumor during a 10-year period. METHODS: All patients underwent a posterolateral laminectomy including uni- or bilateral facetectomy, and 44 patients additionally required vertebral body resection and reconstruction. In patients who underwent C-6 or C-7 decompression, the posterior instrumentation strategies changed from the use of lateral mass plate systems (LMPSs) to lateral mass screw/rod systems (LMSRSs). Similarly, for T1-3 tumor decompression, the strategy shifted from sublaminar hook/rod systems (SHRSs) to the use of pedicle screw systems (PSSs) in which the surgeon used either a 6.25-mm rod or dual-diameter rods with or without a connector. RESULTS: The overall surgical complication rate was 19% including fixation failure in 11 patients (12%), 6 of whom required reoperation. Fixation failure rates for cervical decompression decreased from 2 (29%) of 7 patients in the LMPS group to 0 (0%) of 8 in the LMSRS group (p = 0.2). The fixation failure rates for thoracic decompression were 7 (15%) of 48 patients in the SHRS group, and there was a decrease to 2 (7%) of 27 in the PSS group (p = 0.48). Neurological and functional outcomes including American Spinal Injury Association, Eastern Cooperative Oncology Group, and Medical Research Council muscle strength and pain scores remained stable or improved in 94, 96, 100, and 96% of patients, respectively. CONCLUSIONS: Current posterior instrumentation strategies involving LMSRSs and PSSs provide excellent and safe stabilization of the cervicothoracic junction following resection of primary or metastatic tumors.

Comparison of CD HORIZON SPIRE spinous process plate stabilization and pedicle screw fixation after anterior lumbar interbody fusion. Invited submission from the Joint Section Meeting On Disorders of the Spine and Peripheral Nerves, March 2005.

OBJECT: The authors present the early clinical results obtained in patients who underwent SPIRE spinous process plate fixation following anterior lumbar interbody fusion (ALIF). METHODS: Between May 2003 and January 2005, 32 patients underwent titanium cage and bone morphogenetic protein-augmented ALIF and subsequent SPIRE (21 cases) or bilateral pedicle screw (BPS; 11 cases) fixation. Pedicle screws were implanted using either the open approach (three cases) or using a tubular retractor (eight cases). Patients' charts were reviewed for operative time, estimated blood loss (EBL), hospital length of stay (LOS), and evidence of pseudarthrosis or hardware failure. In SPIRE plate-treated patients, the median EBL (75 ml) was lower than in BPS-treated patients (open BPS [150 ml]; tubular BPS [125 ml]). The median operative time in SPIRE plate-treated patients was also shorter (164 minutes compared with 239 and 250 minutes in the open and tubular BPS, respectively). The median LOS was 3 days for both the SPIRE and tubular BPS groups, but 4 days in the open BPS group. There were no instances of major surgery-induced complication, pseudarthrosis, or hardware failure during mean follow-up periods of 5.5, 7.2, and 4.9 months in the SPIRE, open PS, and tubular BPS groups, respectively. CONCLUSIONS: The SPIRE plate is easy to implant and is associated with minimal operative risk. Compared with BPS/rod constructs, SPIRE plate fixation leads to less EBL and shorter operative time, without an increase in the rate of pseudarthrosis. Hospital LOS was also shorter in SPIRE plate-treated patients, which is consistent with the goals of minimal access spinal technologies.

SPIRE spinous process stabilization plate: biomechanical evaluation of a novel technology. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2005.

OBJECT: The authors studied the biomechanical properties of a novel spinous process stabilization plate (CD HORIZON SPIRE Spinal System) and present the results in comparison with those of other posterior fixation methods. METHODS: Ten functional cadaveric lumbar segments were subjected to nondestructive quasistatic loading forces in 10 different conditions: intact, destabilized (discectomy), fitted with spinous process plate (SPP) alone, with anterior-column support (ACS) alone, ACS with SPP, ACS with posterior translaminar facet screw (PTFS) fixation, ACS with unilateral pedicle screw and rod (UPSR) fixation, ACS with bilateral pedicle screw and rod (BPSR) fixation, UPSR alone, or BPSR alone. Stiffness and range of motion (ROM) data were compared using a repeated-measures, one-way analysis of variance. The construct with greatest mean limitation of flexion-extension ROM was ACS/SPP at 4.14 degrees whereas it was 5.75 degrees for ACS/UPSR fixation, 5.03 degrees for ACS/BPSR fixation, and 10.13 degrees for the intact spine. The SPIRE plate alone also provided greater flexion and extension stiffness, with less ROM than other posterior stabilization options. Fixation with BPSR with or without ACS resulted in the stiffest construct in lateral bending and axial rotation. The SPP and UPSR fixation groups were equivalent in resisting lateral bending and axial rotation forces with or without ACS. CONCLUSIONS: The SPIRE plate effectively stabilized the spine, and the test results compare favorably with other fixation techniques that are more time consuming to perform and have greater inherent risks.

Current treatment strategies for the painful lumbar motion segment: posterolateral fusion versus interbody fusion.

STUDY DESIGN: Review of the literature. OBJECTIVES: We discuss the indications and contraindications for posterolateral lumbar fusion and posterior approaches to lumbar interbody fusion. We also review the advances in minimal access surgical techniques, graft materials, and osteobiologics. SUMMARY OF BACKGROUND DATA: Previously published data and our own surgical experience form the basis of this report. METHODS: A Pub Med online internet search for the keywords was performed. The pertinent articles were then cited. RESULTS: Posterior interbody fusion techniques have theoretical and demonstrable advantages over posterolateral fusion, but the former is also associated with greater morbidity. There are several approaches one may use to perform posterior interbody fusion, as well as multiple minimally invasive techniques and interbody spacer graft options. Bone morphogenetic protein offers an attractive alternative for achieving fusion. CONCLUSION: Fusion of painful motion segments is widely used to treat patients with degenerative low back pain. Successful arthrodesis may be achieved using either posterolateral fusion with pedicle screw fixation or posterior interbody fusion, depending on the patient's situation. These techniques may be accomplished with a variety of minimal access strategies and various graft and spacer technologies. The modern spine surgeon should be proficient in using all these options to treat the painful lumbar motion segment.

Single-stage posterolateral transpedicular approach for resection of epidural metastatic spine tumors involving the vertebral body with circumferential reconstruction: results in 140 patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004.

OBJECT: Patients with metastatic spine tumors often have multicolumn involvement and high-grade epidural compression, requiring circumferential decompression and instrumentation. Secondary medical and oncological issues add morbidity to combined approaches. The authors present their experience in using the single-stage posterolateral transpedicular approach (PTA) to decompress the spine circumferentially and to place instrumentation. METHODS: From September 1997 to February 2004, 140 patients with spine metastases underwent the PTA. Magnetic resonance imaging revealed high-grade spinal cord compression in 120 patients (86%) and lytic vertebral body destruction in all patients. Preoperatively 84 patients (60%) received radiotherapy directed to the involved level and 42 (30%) underwent tumor embolization. Following circumferential decompression, all patients underwent anterior reconstruction with polymethylmethacrylate and Steinmann pins, and posterior segmental fixation. The median operative time was 5.1 hours, the median blood loss was 1500 ml, and the median hospital stay was 9 days. Ninety-six percent of the patients experienced postoperative pain improvement and improvement in or stabilization of neurological status. In 51 nonambulatory patients with poor Eastern Cooperative Oncology Group grades, 75% regained the ability to walk. One month postoperatively 90% of patients achieved good-to-excellent performance scores. The overall median patient survival time was 7.7 months. Patients with colon and lung carcinomas had significantly shorter survival times. Major operative complications occurred in 20 patients (14.3%). Wound complications occurred in 16 patients (11.4%), but this was not correlated with preoperative radiation treatment. CONCLUSIONS: The PTA allows circumferential epidural tumor decompression and the placement of anterior and posterior spinal column instrumention. Immediate spinal stability is achieved without the use of brace therapy. This technique achieved a high success rate for pain palliation, neurological preservation, and functional improvement, while avoiding the morbidity associated with combined approaches.

Advances in the endoscopic management of suprasellar arachnoid cysts in children.

OBJECT: Suprasellar arachnoid cysts present unique management problems. The authors retrospectively reviewed six cases, in which endoscopic ventriculocystocisternotomy was performed, to identify specific neuroimaging features that aid both the accurate diagnosis of this entity and the postoperative assessment of fenestration patency. METHODS: Six consecutive children underwent treatment for suprasellar arachnoid cysts. Consistent radiographic features in all cases were identified. Through a single entry site, endoscopic fenestration was performed at both the apical and basal cyst membranes. Outcome was assessed using clinical examination, quantitative changes in cyst size, and triplanar magnetic resonance (MR) imaging with flow-sensitive (long TR) sequences. In every case, the suprasellar cysts displayed three diagnostic MR imaging features: 1) vertical displacement of the optic chiasm/tracts; 2) upward deflection of the rostral mesencephalon and mammillary bodies; and 3) effacement of the ventral pons. Two patients initially underwent placement of a ventriculoperitoneal shunt before the cysts were recognized, but MR images obtained after shunt placement revealed the cysts. In a mean follow-up period of 26.2 months, all patients improved clinically. Postoperative imaging revealed a mean cyst volume decrease of 52.7% and a return to more normal suprasellar and prepontine anatomy. Flow-sensitive MR imaging confirmed pulsation artifact at all 12 fenestration sites. There was no surgery-related death and no additional cerebrospinal fluid diversion procedure was required. CONCLUSIONS: To aid in the accurate diagnosis of prepontine arachnoid cysts, the authors identified several pathognomonic features on sagittal MR images: vertical deflection of the optic chiasm and mammillary bodies, as well as pontine effacement. Dual endoscopic fenestration into the intraventricular compartment and basal cistern is safe, and it effectively provides symptomatic relief by decreasing the cyst size. Triplanar flow-sensitive MR imaging sequences can confirm fenestration patency without the need for cine-mode MR imaging.