Lead exposure from honey: meta-analysis and risk assessment for the Arab region.

The Codex Alimentarius Commission has adopted a maximum level for lead in honey (0.1 mg/kg). Despite representing a population of more than half a billion, exposure and risk assessments for lead specific to the Arab region are lacking. The aim of this work was to collect analytical data for lead in honey available in Arab countries and to assess the risk caused by exposure to lead from these samples for local consumers. A regional mean lead concentration in honey, obtained through a meta-analysis of 57 studies, was used in deterministic risk assessments for adults (nephrotoxicity and cardiovascular effects) and young children (developmental neurotoxicity). A regional pooled mean concentration of 0.12 mg/kg [95%CI: 0.07-0.21] (0.13 mg/kg, if non-detects are considered at their highest possible value) was obtained. Margins of exposure of 363 [71-17182] and 865 [168-40909] were calculated for adults, and of 48 [9-2273] for children, indicating potential concern for the latter population subset. These values were produced using GEMS consumption data, and considering the same intake for both children and adults, potentially overestimating the risk for children. Nevertheless, food competent authorities should consider measures to reduce lead concentration in honey available for sale in the region to prevent trade constraints and to better protect vulnerable populations.

[Emotional overload of health personnel of the Navarra Health Service during the SARS-CoV-2 pandemic]. / Sobrecarga emocional del personal sanitario del Servicio Navarro de Salud durante la pandemia del SARS-CoV-2.

INTRODUCTION: Health care workers faced unprecedented levels of emotional burden related to the COVID-19 pandemic.. This study aims to find out the self-perception of the state of emotional overload of the professionals of the Navarre Osasunbidea Health Service (SNS-O) at two moments during the pandemic and its associated factors. METHOD: Cross-sectional study using a questionnaire that includes the Emotional Overload Self-Assessment Scale sent by email to all SNS-O health professionals at two moments of the pandemic, in October 2020 and October 2021. Results of the global scale and of the subscales '"fear-anxiety"' and ""affective response"' were compared between the two moments of measurement according to position, field, area and service using ANCOVA models. RESULTS: The number of responding participants in the 2020 survey was 1 485 (11,3%) and 950 in the 2021 survey (7,3%). The mean difference for overall score between 2020 and 2021 was -1.87 (95% CI: -2.38, -1.35), indicating less worrying results with the passage of time since the start of the pandemic, with some differences accross occupational categories. CONCLUSIONS: The year 2020 had a great impact on the emotional overload that decreased the following year. One of the greatest fears of health personnel during their occupational exposure to epidemic infectious diseases continues to be the fear of contracting the disease and transmitting it to their family members and social environment. As the proximity to the patient and their environment increases, the probability of psycho-emotional affectation increases.

OBJETIVO: Los trabajadores de la salud se enfrentaron a niveles sin precedentes de carga emocional relacionada con la pandemia de la COVID-19. Este estudio pretende conocer la autopercepción del estado de sobrecarga emocional de los profesionales del Servicio Navarro de Salud-Osasunbidea (SNS-O) en dos momentos durante la pandemia y sus factores asociados. Método: Estudio transversal mediante el uso de un cuestionario que incluye la Escala de Autoevaluación de Sobrecarga Emocional, enviado por correo electrónico a todos los profesionales sanitarios del SNS-O en dos momentos de la pandemia, en octubre de 2020 y octubre de 2021. Los resultados de la escala global y de las subescalas '"miedos-ansiedad"' y '"respuesta afectiva"' se compararon entre los dos momentos de medición según puesto de trabajo, ámbito, área y servicio, mediante modelos ANCOVA?.  Resultados: Participaron en la encuesta de 2020 1.485 (11,3%) sanitarios y 950 (7,3%) en la encuesta de 2021 de. La diferencia media para el score global entre 2020 y 2021 fue -1.87 (95% IC: -2.38, -1.35), indicando una reducción de la sobrecarga emocional con la evolución de la pandemia, con algunas diferencias entre categorías profesionales. CONCLUSIONES: El año 2020 tuvo gran impacto en la sobrecarga emocional que disminuyó al año siguiente. Uno de los mayores temores del personal sanitario durante su exposición laboral a enfermedades infecciosas epidémicas sigue siendo el miedo a contraer la enfermedad y transmitirla a sus familiares y entorno social. Conforme aumenta la proximidad con el paciente y su entorno, incrementa la probabilidad de afectación psicoemocional.

Sobrecarga emocional del personal sanitario del Servicio Navarro de Salud durante la pandemia del SARS-CoV-2 / Emotional overload of health personnel of the Navarra Health Service during the SARS-CoV-2 pandemic

Objetivo: Los trabajadores de la salud se enfrentaron a niveles sin precedentes de carga emocional relacionada con la pandemia de la COVID-19. Este estudio pretende conocer la autopercepción del estado de sobrecarga emocional de los profesionales del Servicio Na-varro de Salud-Osasunbidea (SNS-O) en dos momentos durante la pandemia y sus factores asociados.Método: Estudio transversal mediante el uso de un cuestionario que incluye la Escala de Autoevaluación de Sobrecarga Emocional, enviado por correo electrónico a todos los pro-fesionales sanitarios del SNS-O en dos momentos de la pandemia, en octubre de 2020 y octubre de 2021. Los resultados de la escala global y de las subescalas ‘“miedos-ansiedad”’ y ‘“respuesta afectiva”’ se compararon entre los dos momentos de medición según puesto de trabajo, ámbito, área y servicio, mediante modelos ANCOVA?. Resultados: Participaron en la encuesta de 2020 1.485 (11,3%) sanitarios y 950 (7,3%) en la encuesta de 2021 de. La diferencia media para el score global entre 2020 y 2021 fue -1.87 (95% IC: -2.38, -1.35), indicando una reducción de la sobrecarga emocional con la evolución de la pandemia, con algunas diferencias entre categorías profesionales.Conclusiones: El año 2020 tuvo gran impacto en la sobrecarga emocional que disminuyó al año siguiente. Uno de los mayores temores del personal sanitario durante su exposición laboral a enfermedades infecciosas epidémicas sigue siendo el miedo a contraer la enfer-medad y transmitirla a sus familiares y entorno social. Conforme aumenta la proximidad con el paciente y su entorno, incrementa la probabilidad de afectación psicoemocional (AU)

Introduction: Health care workers faced unprecedented levels of emotional burden related to the COVID-19 pandemic.. This study aims to find out the self-perception of the state of emotional overload of the professionals of the Navarre Osasunbidea Health Service (SNS-O) at two moments during the pandemic and its associated factors.Method: Cross-sectional study using a questionnaire that includes the Emotional Overload Self-Assessment Scale sent by email to all SNS-O health professionals at two moments of the pandemic, in October 2020 and October 2021. Results of the global scale and of the sub-scales '“fear-anxiety”' and ““affective response”' were compared between the two moments of measurement according to position, field, area and service using ANCOVA models.Results: The number of responding participants in the 2020 survey was 1 485 (11,3%) and 950 in the 2021 survey (7,3%). The mean difference for overall score between 2020 and 2021 was -1.87 (95% CI: -2.38, -1.35), indicating less worrying results with the passage of time since the start of the pandemic, with some differences accross occupational categories.Conclusions: The year 2020 had a great impact on the emotional overload that decreased the following year. One of the greatest fears of health personnel during their occupational exposure to epidemic infectious diseases continues to be the fear of contracting the dis-ease and transmitting it to their family members and social environment. As the proximity to the patient and their environment increases, the probability of psycho-emotional affectation increases (AU)

"Vegan" and "plant-based" claims: risk implications for milk- and egg-allergic consumers in Canada.

The market share of foods carrying labels suggesting absence of animal ingredients has significantly increased in recent years. The purpose of this study was to document the purchasing behaviour of egg- or milk-allergic consumers vis-à-vis food marketed as "vegan" and "plant-based", and to evaluate the associated allergenic risk. A survey was conducted among egg- and milk-allergic consumers and revealed that 86% (margin of error 5.4%; confidence level 95%) would buy "vegan" products, indicating this label may be perceived as a substitute for "free from milk and eggs". To assess the risk posed by these products, 87 prepackaged foods with "vegan" and/or "plant-based" claims purchased in Quebec were tested for milk proteins, and 64 for egg proteins. Overall, 5.7% and 0% occurrence of milk and egg proteins, respectively, were observed, suggesting that the analysed prepackaged foods carrying "vegan" and/or "plant-based" labels pose little risk to egg- or milk-allergic consumers. However, this is likely due to allergen management practices applied by the Canadian manufacturers of the products tested, and should not be attributed to the use of "vegan" or similar labels. Enhanced regulatory requirements for the use of these labels, and an education campaign on their meaning with respect to allergy-related risks, are necessary to better inform and protect egg- and milk-allergic consumers.

Differential effects of high dose omega-3 fatty acids on metabolism and inflammation in patients with obesity: eicosapentaenoic and docosahexaenoic acid supplementation.

Background: Obesity is complicated by low-grade chronic inflammation characterised by increases in inflammatory proteins and cells in peripheral blood. It has been known that omega-3 fatty acids (FA) like eicosapentaenoic (EPA) and docosahexaenoic (DHA) could modulate the inflammatory process and improve metabolic markers. Objective: This study aimed to determine the effect of high-dose omega-3 FA on metabolic and inflammatory markers among patients with obesity and healthy volunteers. Methods: This prospective study included 12 women with obesity (body mass index [BMI] ≥ 35.0 kg/m2) and 12 healthy women (BMI < 24.0 kg/m2) who were supplemented with a dose of 4.8 g/day (3.2 g EPA plus 1.6 g DHA) for 3 months followed by no treatment for 1 month. Plasma metabolic and inflammatory markers and levels of mRNA transcripts of CD4+ T lymphocyte subsets were determined monthly. Results: None of the participants exhibited changes in weight or body composition after study completion. EPA and DHA supplementation improved metabolic (insulin, Homeostatic Model Assessment of Insulin Resistance [HOMA-IR], triglyceride [TG]/ high-density lipoprotein [HDL] ratio, TG, and arachidonic acid [AA]/EPA ratio) and tumor necrosis factor-alpha (TNF-α). Moreover, the levels of mRNA transcripts of T CD4+ lymphocyte subsets (TBX21, IFNG, GATA-3, interleukin [IL]-4, FOXP3, IL-10 IL-6, and TNF-α), were down-regulated during the intervention phase. After 1 month without supplementation, only insulin, HOMA-IR and the mRNA transcripts remained low, whereas all other markers returned to their levels before supplementation. Conclusion: Supplementation with high-dose omega-3 FAs could modulate metabolism and inflammation in patients with obesity without weight loss or changes in body composition. However, these modulatory effects were ephemeral and with clear differential effects: short-duration on metabolism and long-lasting on inflammation.

Risk assessment supporting the establishment of a maximum residue limit for ractopamine in beef liver, applicable in the Arab Republic of Egypt.

In 2012, the Codex Alimentarius Commission adopted maximum residue limits (MRLs) for ractopamine in pig and cattle tissues. Egypt, a country that records a high consumption of beef liver, conducted a health risk assessment to estimate the risks associated with the adoption of Codex MRLs and the possible adoption of alternative values that may offer higher protection. Ractopamine was characterized based on previous assessments performed by international regulatory agencies, and an acceptable daily intake was set at 1 µg/kg bw for both chronic and acute ractopamine exposure. Beef liver consumption data for the Egyptian population were collected through a field survey (529 households, 1929 individuals). The standard body weight of 60 kg was used, as well as 70 kg, as a potentially more representative weight for the Egyptian population. Simulations showed that when the MRL for ractopamine in beef liver is set to 40 µg/kg (Codex MRL) or 20 µg/kg, the health-based guidance value of 1 µg/kg bw was not exceeded, as a result of chronic or acute exposure. An MRL of 20 µg/kg of ractopamine in beef liver was shown to provide optimum protection of Egyptian consumers, considering other potential sources of ractopamine intake and abnormally high consumption patterns, and was therefore recommended for adoption in Egypt. This study presents the inputs, model, and results of the probabilistic risk assessment that supported such recommendation. PRACTICAL APPLICATION: Residues of veterinary drugs, such as ractopamine, accumulate in animal tissues and may pose a risk to consumers. Establishing maximum residue limits (MRLs) will help importers by giving them the necessary visibility for commercial trade. It will also benefit Egyptian consumers, large consumers of beef liver, who will be better protected with a lower MRL than the internationally recommended one.

Allergen management under a voluntary PAL regulatory framework - A survey of Canadian food processors.

Canadian regulations require food business operators (FBOs) to implement preventive controls to manage allergens and ensure their accurate declaration. However, the use of precautionary allergen labelling (PAL) is voluntary and competent authorities provide limited guidance on its use. The objective of this study was to present an overview of Canadian FBOs' current allergen management practices, including the mechanisms used to evaluate the need for PAL in finished products, and to investigate potential areas for improvement. Canadian FBOs were invited to answer an online survey of 48 questions covering allergen management practices and perceptions. Eighty-four full survey responses (margin of error of 9% at a 90% confidence level) were obtained. Differences in responses to multiple choice questions per company size were determined using chi-square and Fisher's exact tests. Kruskal-Wallis tests were used to analyse responses to rating or forced ranking questions. Survey respondents' allergen management practices were based on a combination of recognized best practices, third-party quality systems' standards, and regulatory requirements. Concerning practices related to the criteria used to reach PAL decisions were noted, which could be addressed with increased awareness and use of risk-based approaches and a clearer regulatory policy. Analytical testing applicability and interpretation, access to information on unintentional allergen presence in raw materials, and clarity on the expectations related to the current regulatory framework on food allergens and its enforcement, were identified as challenges faced by Canadian FBOs. The results of this survey and its analysis could be used by regulators - to inform potential policy changes, by FBOs - to map industry practices, and by allergic consumers - to better understand how manufacturers manage allergens in their operations.

Giant Squid (Dosidicus gigas) Meal in Chicken Diets to Enrich Meat with n-3 Fatty Acids.

The main marketed parts of squid are the mantle, the head with tentacles, and fins. However, when the whole squid does not meet quality standards for human consumption it can be used for broiler feed. The objective of the study was to include giant squid (Dosidicus gigas) meal (GSM) in broiler rations to increase the content of the n-3 fatty acids eicosapentaenoic (EPA), docosapentaenoic (DPA), and docosahexaenoic (DHA) in chicken meat. Two hundred Ross 380 chickens, half male, half female, and one day old, were randomly distributed in a 4x2x2 factorial arrangement. The factors were the treatment (0%, 1.67%, 3.34%, and 5.01% of GSM in the diet), sex, and content of n-3 in the legs with thighs and the breasts. Each treatment had five repetitions with 10 birds each. There were no differences (p > 0.05) in the production parameters for both sexes. The contents of EPA, DPA, and DHA increased in the females and in the legs with thighs (p < 0.05) with GSM. Acceptance for the flavor and texture of meat was higher in the treatment with 1.67% GSM than in the other treatments. It is concluded that GSM is an alternative for increasing the amount of n-3 in chicken meat.

Spent fowl as a source of unintentional egg proteins exposure in Canadian food products.

The occurrence of egg proteins in products containing spent fowl manufactured under current practices was studied to assess the risk these food products may pose to egg-allergic consumers and to determine if Precautionary Allergen Labelling (PAL) was recommended. Spent fowl slaughtering and processing operations in 2 Canadian facilities were observed. Raw hen pieces (n = 134), coming from 2 facilities, and intermediate and processed products containing spent fowl (n = 57), coming from one facility, were analyzed using ELISA. All samples tested positive for egg proteins. Raw pieces were tested using a qualitative method (i.e., swabbing); estimated egg proteins concentrations suggest the presence of highly contaminated samples (>600 mg/kg in 2 hen wing samples). Swabbing was found to be efficient for rapid detection of eggs in raw hen pieces, but not for quantification. A comparison between swab and grind results showed that egg proteins concentration is underestimated by at least a factor 2 for whole carcasses and a factor 10 for breast, wings and drumsticks, when using the swab protocol. For intermediate and processed products, quantitative measurements indicate that egg protein levels were below 16 mg/kg. Additionally, 88 water samples from chiller tanks were analyzed and indicate that this step could be the cause of the global contamination observed with an increase in egg protein concentrations overtime during the production schedule. As egg contamination is not adequately controlled under the current good production practices, the use of PAL would be recommended for raw spent fowl products.

Characterizing Elder Abuse in the UK: A Description of Cases Reported to a National Helpline.

The abuse of older adults by someone in a position of trust-also known as elder abuse (EA)-has a severe impact on victims and society. However, knowledge about EA in the UK is limited in comparison to other types of interpersonal violence and international knowledge. The present study utilized secondary data from a UK national EA helpline to investigate the characteristics of reported cases. Over a one-year period between 2017 and 2018, 1,623 records met inclusion criteria. Descriptive statistics are provided to describe this sample. Most cases reported to the helpline pertained to female victims, suffering from financial or psychological abuse. Co-occurrence of different abuse types was common. Findings provide updated knowledge about the phenomenology of EA cases in the UK. Recommendations are provided for advancing research in this area, including the need for examining cases across longer periods of time with a view to informing practice and policy.

Elder Abuse Vulnerability and Risk Factors: Is Financial Abuse Different From Other Subtypes?

Elder abuse (EA) affects one in six older adults, and financial EA, a common subtype, severely impacts victims and society. Understanding victim vulnerability and perpetrator risk factors is essential to EA prevention and management. The limited existing evidence about these factors in relation to EA types suggests that financial EA is different. In a cross-sectional quantitative analysis of secondary data (N = 1,238), we investigated EA vulnerability and risk factors, and victim-perpetrator family relationship, with respect to different EA types (financial only, financial co-occurring with other types, and nonfinancial abuse). Financial abuse-only cases had the lowest prevalence of vulnerability and risk factors. Most of these factors, and a familial relationship, were significantly more common in cases involving other EA types. Findings indicate that financial abuse, occurring in isolation, is distinct from other EA types. Risk assessment and future research should consider financial abuse separately to other EA forms.

Validation of the RIDASCREEN® Peanut for Determination of Peanut Protein in Cookies, Milk Chocolate, Ice Cream, Trail Mix, Puffed Rice Cereals, and Granola Bar: AOAC Performance Tested MethodSM 112102.

BACKGROUND: Regulations in many countries worldwide prescribe that peanut must be listed on food labels as a cause of food allergies. Re-evaluated voluntary incidental trace allergen labelling (VITAL) values for peanut revealed the eliciting dose (ED01) value-at which 99% of all peanut-allergic individuals will not react-is 0.2 mg peanut protein. OBJECTIVE: Validation of a sandwich ELISA based on monoclonal antibodies to detect peanut proteins. METHODS: Non-processed and processed samples are extracted by an easy procedure at 60°C within 10 min. The measurement range is between 0.75 and 6 mg/kg peanut using a national institute of standards and technology (NIST) reference material as calibrator. RESULTS: The system shows no cross-reactivity against 91 different food commodities. The LOD was 0.15 mg/kg for food matrixes such as cookies, milk chocolate, ice cream, trail mix, puffed rice cereal, and granola bar. LOQ was verified at a level of 0.75 mg/kg. Recovery studies with incurred milk chocolate and ice cream revealed consistent recoveries between 67 and 85%. Mean recoveries for incurred cookies depend on the baking temperature and time and ranged from 60 to 109%. Repeatability was between 5.2 and 12.3%, whereas relative intermediate precision was between 6.4 and 13.0%. The results for incurred cookies and milk chocolate in the independent laboratory study showed mean recoveries between 99 and 104% with RSDs between 3.56 and 19.5% under repeatability conditions. CONCLUSION: The results from the in-house validation study and the independent lab confirmed that the method is accurate and in accordance with requirements laid down in Standard Method Performance Requirement 2017.020. HIGHLIGHTS: RIDASCREEN® Peanut quantifies proteins from peanut in a wide range of food categories.

Sesame as an allergen in Lebanese food products: Occurrence, consumption and quantitative risk assessment.

Despite the intensive use of sesame in the Middle Eastern diet, studies on this allergen in this region are lacking. A survey on the occurrence of sesame in Lebanese food products that did not contain this allergen as an ingredient, a food consumption survey conducted in Beirut schools, and the most recent sesame eliciting dose estimates were used to build a probabilistic risk assessment model providing estimates of sesame-induced allergic reactions per eating occasion and per week in Lebanese children and adolescents. Of 1270 food samples analysed, 34% contained sesame proteins (0.44-3392 mg kg-1). Sesame was detected in 47% of unlabeled bulk samples, 43% of samples with PAL, and 27% of samples without PAL. "Sfouf" had the highest concentration of sesame proteins (mean 549 mg kg-1), highest mean exposure per eating occasion (78 mg sesame proteins for children and 103 mg sesame proteins for adolescents), and posed the highest predicted risk per eating occasion (>20%) and per week (>13% individuals predicted in simulation experience at least 1 reaction). Bakery products (notably "sfouf") may pose a serious risk to sesame-allergic children and adolescents in Lebanon. Enhanced guidance on the use of PAL is needed to better protect allergic consumers.

Effectiveness of two procedures for deploying a facilitated collaborative modeling implementation strategy-the PVS-PREDIAPS strategy-to optimize type 2 diabetes prevention in primary care: the PREDIAPS cluster randomized hybrid type II implementation trial.

BACKGROUND: The most efficient procedures to engage and guide healthcare professionals in collaborative processes that seek to optimize practice are unknown. The PREDIAPS project aims to assess the effectiveness and feasibility of different procedures to perform a facilitated interprofessional collaborative process to optimize type 2 diabetes prevention in routine primary care. METHODS: A type II hybrid cluster randomized implementation trial was conducted in nine primary care centers of the Basque Health Service. All centers received training on effective healthy lifestyle promotion. Headed by a local leader and an external facilitator, centers conducted a collaborative structured process-the PVS-PREDIAPS implementation strategy-to adapt the intervention and its implementation to their specific context. The centers were randomly allocated to one of two groups: one group applied the implementation strategy globally, promoting the cooperation of all health professionals from the beginning, and the other performed it sequentially, centered first on nurses, who later sought the pragmatic cooperation of physicians. The following patients were eligible for inclusion: all those aged ≥ 30 years old with at least one known cardiovascular risk factor and an impaired fasting glucose level (≥ 110-125 mg/dl) but without diabetes who attended centers during the study period. The main outcome measures concerned changes in type 2 diabetes prevention practice indicators after 12 months. RESULTS: After 12 months, 3273 eligible patients at risk of type 2 diabetes had attended their family physician at least once, and of these, 490 (15%) have been addressed by assessing their healthy lifestyles in both comparison groups. The proportion of at-risk patients receiving a personalized prescription of lifestyle change was slightly higher (8.6%; range 13.5-5.9% vs 6.8%; range 7.2-5.8%) and 2.3 times more likely (95% CI for adjusted hazard ratio, 1.38-3.94) in the sequential than in the global centers, after 8 months of the intervention program implementation period. The probability of meeting the recommended levels of physical activity and fruit and vegetable intake were four- and threefold higher after the prescription of lifestyle change than only assessment and provision of advice. The procedure of engagement in and execution of the implementation strategy does not modify the effect of prescribing healthy habits (p interaction component of intervention by group, p > 0.05). DISCUSSION: Our results show that the PVS-PREDIAPS implementation strategy manages to integrate interventions with proven efficacy in the prevention of type 2 diabetes in clinical practice in primary care. Further, they suggest that implementation outcomes were somewhat better with a sequential facilitated collaborative process focused on enhancing the autonomy and responsibility of nurses who subsequently seek a pragmatic cooperation of GPs. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03254979 . Registered 16 August 2017-retrospectively registered.

Probabilistic risk assessment for milk in dark chocolate, cookies and other baked goods with PAL sold in Canada.

The risk of having an allergic reaction in milk-allergic individuals consuming products with precautionary allergen labelling (PAL) for milk has been rarely studied in products such as dark chocolate, cookies, and other baked goods. A probabilistic risk assessment model was developed to estimate potential risks. Milk occurrence and contamination levels were reported in a previous article from our group. Dose-response curves for milk were constructed using values (n = 1078) from published double-blind placebo-controlled food challenges. Canadian consumption data was extracted from a national survey, and a homemade survey involving food-allergic Canadians. Milk eliciting doses (ED) were 0.23 (ED01), 1.34 (ED05), 3.42 (ED10), and 16.3 (ED25) mg of milk protein (Log-Normal distribution). Average exposures, per eating occasion, were 24 mg (dark chocolate), 3.9 mg (baked goods), and 0.20 mg (cookies) of milk proteins. The estimated risk of having a milk-induced allergic reaction by consuming foods with PAL for milk was higher for dark chocolate (16%; 15,881/100,000) than baked goods (3.8%; 3802/100,000) or cookies (0.6%; 646/100,000) in milk-allergic Canadians. Dark chocolate, cookies, and baked goods with PAL for milk, should be avoided by milk-allergic Canadians (consuming or not products with PAL) to prevent allergic reactions.

Occurrence and risk assessment of sesame as an allergen in selected Middle Eastern foods available in Montreal, Canada.

Sesame allergy is a public health problem in many countries around the world. The purpose of this study is to determine the occurrence of sesame allergen in unlabelled or labelled free-sesame Middle Eastern foods with or without Precautionary Allergen Labelling (PAL) 'may contain' and estimate the risk incurred by the Canadian population allergic to sesame with a focus on products purchased in Middle Eastern grocery stores and bakeries in Montreal, Canada. A total of 571 samples were analysed to determine the level of sesame protein. Of the 571 samples analysed, 19% (109/571) contained sesame (results >LOQ) with concentrations of sesame proteins varying between 0.5 and 1,875 mg kg-1 and 35% (199/571) contained traces (a value between LOD and LOQ). Unpackaged products were found to present the highest proportion of sesame containing samples (36%). For packaged products, 16% (27/173) of samples with PAL and 3% (5/173) without PAL were found to contain sesame. A probabilistic approach was used to estimate the risk incurred by the Canadian consumers allergic to sesame. Our evaluation estimated that 33 to 308 allergic reactions may occur out of 10 000 individuals ingesting one type of bakery product contaminated at a level of 0.6-74 mg kg-1 sesame proteins. The incidence and level of sesame cross-contact reported in this study demonstrate that sesame allergic consumers could react if they ignore the precautionary allergen statements on product labels. Attention to sesame as a potential cross-contact agent and as a priority allergen calls for better management, given the growing interest in this ingredient to be included in food formulations. Enhanced risk management efforts must be coupled with targeted risk communication covering both producers and consumers as to the need to adopt and an approach for the application of precautionary allergen labelling based on risk.

Help-Seeking Behavior in Victims of Elder Abuse: A Systematic Review.

Elder abuse has become increasingly relevant for intervention and study in the context of an aging population. One of the major barriers to progress in the field is underreporting of elder abuse by victims. This systematic literature review aimed to synthesize the available findings regarding victims' help-seeking behavior to inform practice, understand the limits of the evidence, and identify research gaps. A comprehensive search of published and unpublished literature was undertaken, and studies were included if they addressed help-seeking behavior from the perspective of elder abuse victims aged 60 and older. A total of 19 studies met inclusion criteria for review. Findings are presented as a narrative synthesis organized according to help-seeking barriers, facilitators, sources of help, the responses of others, and the characteristics of victims more likely to seek help. Although barriers and sources of help received detailed attention across all studies, findings regarding victim characteristics and facilitators for and responses to help-seeking were limited. The results suggest that there are many barriers to help-seeking and that some victims only seek help when the abuse is perceived as unbearable or they fear for their safety. Results are discussed in relation to implications for intervention, including suggestions to enhance help-seeking behavior. Future research should identify facilitators of help-seeking among victims of elder abuse and victim characteristics associated with early disclosure. Research efforts should frame help-seeking as a continuing process and study ways in which the responses of others may impact future help-seeking or service engagement.

Effectiveness of physical exercise for people with chronic diseases: the EFIKRONIK study protocol for a hybrid, clinical and implementation randomized trial.

BACKGROUND: Chronic illnesses are the leading cause of morbidity and mortality and threaten the sustainability of healthcare systems worldwide. There is limited evidence in terms of the best modality and intensity of physical activity for improving cardiorespiratory capacity and quality of life in patients with chronic conditions. The objective of the EfiKroniK study is to estimate the common effect of innovative, individualized and supervised physical exercise, on cardiorespiratory functional capacity and quality of life across people with different chronic conditions. METHODS/DESIGN: This is a multicentre clinical trial with a type I hybrid effectiveness-implementation design, including 370 patients each with one of four different chronic illnesses: solid cancer, blood cancer, chronic obstructive pulmonary disease or schizophrenia. Patients will be randomly divided into two parallel groups, stratified by illness type. Patients in both groups will receive a standard healthy life prescription (PVS, from the Spanish "Prescribe Vida Saludable") and additionally, the EfiKroniK group will be prescribed a physical exercise programme tailored to each patient in terms of intensity in each session. The primary outcome variables will be cardiorespiratory functional capacity and quality of life. The secondary outcome variables will be signs and symptoms, psychological and social factors and specific laboratory parameters. We will also analyse the dose-response effect of the physical exercise programme. Qualitative variables will describe patients' perception of the utility and suitability of the EfiKroniK programme, as well as their expectations and satisfaction, identifying barriers to and facilitators of the EfiKroniK implementation process through discussion groups. The study will be carried out on an intention-to-treat basis, comparing changes throughout the 1-year follow-up between groups, adjusting for baseline, by performing mixed-effect analysis of covariance. We will estimate the effect of time on repeated measures in each subject and changes in the EfiKroniK and PVS groups over time. DISCUSSION: The study will provide the data necessary to allow us to prescribe physical exercise in a similar way to a drug and as a key part of the treatment of chronic illnesses within our healthcare system. TRIAL REGISTRATION: NCT03810755 . Date and version identifier: October 9, 2020. Version2.0.

Elder Abuse Detection and Intervention: Challenges for Professionals and Strategies for Engagement From a Canadian Specialist Service.

Elder abuse (EA) is of increasing relevance in the context of an aging society, and this has implications for detection and intervention for several types of healthcare providers, including forensic nurses. Knowledge related to EA is important as victims are likely to interact with providers, because of either existing health problems or the consequences of abuse. This article provides a brief overview of EA, followed by an outline of current detection and intervention efforts used by healthcare providers in community and hospital settings. In addition, knowledge about help-seeking and barriers to disclosure are discussed to inform healthcare provider interactions with older adults where EA is suspected or disclosed. To illustrate challenges faced by healthcare providers in this area, two cases of EA involving case management by a forensic nurse in a specialist service in Canada are presented.