Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 26.345
Filtrar
1.
Can J Surg ; 63(1): E46-E51, 2020 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-31995336

RESUMEN

Background: Oncoplastic surgery (OPS) is becoming the new standard of care for breast-conserving surgery (BCS). It has become increasingly popular in Europe; however, it has not yet been widely accepted in North America. This study aims to describe the experience with OPS at a Canadian tertiary care centre. Methods: This study is a retrospective case series consisting of consecutive OPS cases at a single Canadian centre, the Royal Victoria Regional Health Centre in Barrie, Ontario, between 2009 and 2015. Results: A total of 275 women who consecutively underwent OPS were included. The average size of the tumour was 17 mm (standard deviation [SD] 13 mm; range 0­110 mm). The average specimen weight was 155 g (SD 146 g; range 15­1132 g). Invasive ductal carcinoma was the most common diagnosis (237 patients, 86.2%), followed by ductal carcinoma in situ (18 patients, 6.6%) and then invasive lobular carcinoma (15 patients, 5.5%). A positive margin was recorded in 37 (13.5%) patients. Immediate postoperative complications included seroma and edema (32.7%), wound infection (13.1%), hematoma (8.7%) and delayed wound healing (6.5%). A delay to adjuvant therapy due to postoperative complications occurred in 7 of 217 (3.2%) patients. The median follow-up was 18 months. There were local and distant recurrences in 9 (3.3%) and 2 (0.7%) patients, respectively. Overall survival was 99.3%. Conclusion: The findings of this study are comparable to results in the literature on OPS and demonstrate that OPS is an attractive alternative to standard lumpectomy for Canadian general surgeons who treat breast cancer.


Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Mastectomía Segmentaria/métodos , Neoplasias de la Mama/terapia , Femenino , Humanos , Márgenes de Escisión , Mastectomía Segmentaria/normas , Ontario , Estudios Retrospectivos , Centros de Atención Terciaria
2.
Waste Manag ; 102: 743-750, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-31805447

RESUMEN

In this study, multi-criteria assessment technique is used to predict the methane generation from large municipal solid waste landfills in Ontario, Canada. Although a number of properties determine the gas generation from landfills, these parameters are linked with empirical relationships making it difficult to generate precise information concerning gas production. Moreover, available landfill data involve sources of uncertainty and are mostly insufficient. To fully characterize the chemistry of reaction and predict gas generation volumes from landfills, a fuzzy-based model is proposed having seven input parameters. Parameters were identified in a linguistic form and linked by 19 IF-THEN statements. When compared to measured values, results of the fuzzy based model showed good prediction of landfill gas generation rates. Also, when compared to other first order decay and second order decay models like LandGEM, the fuzzy based model showed better results. When plotting the LandGEM and Fuzzy model values to the actual measured data, the fuzzy model resulted in a better fit to actual data than the LandGEM model with a coefficient of determination R2 of 0.951 for fuzzy model versus 0.804 for LandGEM model. The results show how multi-criteria assessment technique can be used in modelling of complicated processes that take place within the landfills and somehow accurately predicting the landfill gas generation rate under different operating conditions.


Asunto(s)
Contaminantes Atmosféricos , Gases de Efecto Invernadero , Eliminación de Residuos , Lógica Difusa , Metano , Ontario , Residuos Sólidos , Instalaciones de Eliminación de Residuos
3.
Gut ; 69(2): 274-282, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31196874

RESUMEN

OBJECTIVES: To better understand the real-world impact of biologic therapy in persons with Crohn's disease (CD) and ulcerative colitis (UC), we evaluated the effect of marketplace introduction of infliximab on the population rates of hospitalisations and surgeries and public payer drug costs. DESIGN: We used health administrative data to study adult persons with CD and UC living in Ontario, Canada between 1995 and 2012. We used an interrupted time series design with segmented regression analysis to evaluate the impact of infliximab introduction on the rates of IBD-related hospitalisations, intestinal resections and public payer drug costs over 10 years among patients with CD and 5 years among patients with UC, allowing for a 1-year transition. RESULTS: Relative to what would have been expected in the absence of infliximab, marketplace introduction of infliximab did not produce significant declines in the rates of CD-related hospitalisations (OR at the last observation quarter 1.06, 95% CI 0.811 to 1.39) or intestinal resections (OR 1.10, 95% CI 0.810 to 1.50), or in the rates of UC-related hospitalisations (OR 1.22, 95% CI 1.07 to 1.39) or colectomies (OR 0.933, 95% CI 0.54 to 1.61). The findings were similar among infliximab users, except that hospitalisation rates declined substantially among UC patients following marketplace introduction of infliximab (OR 0.515, 95% CI 0.342 to 0.777). There was a threefold rise over expected trends in public payer drug cost among patients with CD following infliximab introduction (OR 2.98,95% CI 2.29 to 3.86), suggesting robust market penetration in this group, but no significant change among patients with UC (OR 1.06, 95% CI 0.955 to 1.18). CONCLUSIONS: Marketplace introduction of infliximab has not yielded anticipated reductions in the population rates of IBD-related hospitalisations or intestinal resections, despite robust market penetration among patients with CD. Misguided use of infliximab in CD patients and underuse of infliximab in UC patients may largely explain our study findings.


Asunto(s)
Fármacos Gastrointestinales/uso terapéutico , Hospitalización/estadística & datos numéricos , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , /uso terapéutico , Adulto , Colectomía/estadística & datos numéricos , Colectomía/tendencias , Colitis Ulcerosa/tratamiento farmacológico , Colitis Ulcerosa/epidemiología , Colitis Ulcerosa/cirugía , Enfermedad de Crohn/tratamiento farmacológico , Enfermedad de Crohn/epidemiología , Enfermedad de Crohn/cirugía , Costos de los Medicamentos/estadística & datos numéricos , Costos de los Medicamentos/tendencias , Femenino , Hospitalización/tendencias , Humanos , Enfermedades Inflamatorias del Intestino/epidemiología , Enfermedades Inflamatorias del Intestino/cirugía , Análisis de Series de Tiempo Interrumpido , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Factores Socioeconómicos
4.
BJOG ; 127(1): 116-122, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31553136

RESUMEN

OBJECTIVE: To estimate the risk for adverse perinatal outcomes for women who met the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria but not the two-step criteria for gestational diabetes mellitus (GDM). DESIGN: Population-level cross-sectional study. SETTING: Ontario, Canada. POPULATION: A total of 90 140 women who underwent a 75-g oral glucose tolerance test. METHODS: Women were divided into those who met the diagnostic thresholds for GDM by two-step criteria and were therefore treated, those who met only the IADPSG criteria for GDM and so were not treated, and those who did not have GDM by either criteria. MAIN OUTCOME MEASURES: Hypertensive disorders of pregnancy, preterm delivery, primary caesarean section, large-for-gestational-age, shoulder dystocia and neonatal intensive care unit admission. RESULTS: Women who met the IADPSG criteria had an increased risk for all adverse perinatal outcomes compared with women who did not have GDM. Women with GDM by two-step criteria also had an increased risk of most outcomes. However, their risk for large-for-gestational-age neonates and for shoulder dystocia was actually lower than that of women who met IADPSG criteria. CONCLUSION: Women who met IADPSG criteria but who were not diagnosed with GDM based on the current two-step diagnostic strategy, and were therefore not treated, had an increased risk for adverse perinatal outcomes compared with women who do not have GDM. The current strategy for diagnosing GDM may be leaving women who are at risk for adverse events without the dietary and pharmacological treatments that could improve their pregnancy outcomes. TWEETABLE ABSTRACT: Women who meet IADPSG criteria for GDM have an increased risk for adverse perinatal outcomes compared with women without GDM.


Asunto(s)
Diabetes Gestacional/epidemiología , Resultado del Embarazo/epidemiología , Cesárea/estadística & datos numéricos , Estudios Transversales , Femenino , Macrosomía Fetal/epidemiología , Prueba de Tolerancia a la Glucosa/estadística & datos numéricos , Humanos , Hipertensión Inducida en el Embarazo/epidemiología , Cuidado Intensivo Neonatal/estadística & datos numéricos , Ontario/epidemiología , Embarazo , Factores de Riesgo , Salud Rural , Salud Urbana
5.
Chemosphere ; 239: 124797, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31521930

RESUMEN

F2-isoprostanes (F2-isoPs) are a reliable biomarker class for oxidative stress in vivo in animals. These compounds are traditionally measured in matrices like liver and plasma, however social and environmental pressures warrant the development of non-lethal and non-invasive methods to assess animal health. Therefore, this study aimed to develop a high-performance liquid chromatography tandem mass spectrometry (HPLC-ESI-MS/MS) method to separate and detect F2-isoPs in fish mucus. The method was developed and validated for four native F2-isoP isomers using Northern pike mucus (Esox lucius). Linearity was observed between 5 and 1000 pg/µL. The limits of detection of the four F2-IsoP isomers ranged from 0.63 to 2.0 ng/g. Recoveries ranged from 78 to 95%, and matrix effects were small (<10%). The between-day and within-day repeatability for all target analytes was lower than 20% RSD. Endogenous F2-isoPs were measured in the pike mucus (5.3-28.8 ng/g). A preliminary study of baseline F2-isoP concentrations in lake trout (Salvelinus namaycush) captured from five lakes at the IISD-Experimental Lakes Area in Northwestern Ontario, Canada, was also conducted to test the interspecies applicability of the method. Endogenous F2-isoPs were quantified in lake trout (6.3-132 ng/g). Lake trout samples displayed large variability within and between the different lakes, which suggests sampling methods may require adjustment for this species. This work developed a sensitive analytical method for measuring F2-isoPs in fish mucus, however several further studies are required to determine its ability to accurately measure oxidative stress in fish species.


Asunto(s)
Biomarcadores/análisis , F2-Isoprostanos/análisis , Peces/fisiología , Moco/química , Estrés Oxidativo , Animales , Cromatografía Líquida de Alta Presión , Femenino , Lagos , Hígado/química , Masculino , Moco/metabolismo , Ontario , Reproducibilidad de los Resultados , Espectrometría de Masa por Ionización de Electrospray , Espectrometría de Masas en Tándem , Trucha/fisiología
6.
J Environ Sci (China) ; 86: 195-202, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31787184

RESUMEN

The presence of municipal wastewater at the intake of a major drinking water treatment facility located on Lake Ontario was examined using fluorescence data collected during a period of continuous monitoring. In addition, controlled mixing of lake water and wastewater sampled from a local treatment facility were conducted using a bench-scale fluorescence system to quantify observed changes in natural organic matter. Multivariate linear regression was applied to components derived from parallel factors analysis. The resulting mean absolute error for predicted wastewater level was 0.22% (V/V, wastewater/lake water), indicating that wastewater detection at below 1.0% (V/V) was possible. Analyses of sucralose, a wastewater indicator, were conducted for treated wastewater as well as surface water collected at two intake locations on Lake Ontario. Results suggested minimal wastewater contribution at the drinking water intake. A wastewater detection model using a moving baseline was developed and applied to continuous fluorescence data collected at one of the drinking water intakes, which agreed well with sucralose results. Furthermore, the simulated addition of 1.0% (V/V) of wastewater/wastewater was detectable in 89% of samples analyzed, demonstrating the utility of fluorescence-based wastewater monitoring.


Asunto(s)
Monitoreo del Ambiente , Aguas Residuales/análisis , Contaminantes Químicos del Agua/análisis , Ontario
7.
Environ Monit Assess ; 192(1): 52, 2019 Dec 17.
Artículo en Inglés | MEDLINE | ID: mdl-31848773

RESUMEN

Elevated concentrations of heavy metals in water caused by mining activities create significant risks to the environment. Traditional biological methods used to assess heavy metal-related toxicity in aquatic environments are lengthy and labor intensive. Real-time biomonitoring approaches eliminate some of these limitations and provide a more accurate indication of toxicity. This study describes the performance of a flow-through and floating design microbial fuel cell (MFC) biosensors for real-time detection of copper (Cu) and other heavy metal-related toxicity in aquatic environments. Several biomonitoring tests were carried out using Cu and mining effluents as toxicants. The biosensors were able to detect, in real-time, Cu-related toxicity at concentrations as low as 35 - 40 µg L-1, as confirmed by a Daphnia assay. A comparison of the floating biosensor's outputs with Daphnia magna survival rates showed a linear correlation with a coefficient of determination (R2) higher than 0.9. In addition, the flow-through biosensor was shown to be able to detect  differences in the quality of two mining effluents with different compositions of heavy metals. Finally, the biosensor's real-time field performance was investigated in two aquatic environments in the Sudbury, Ontario region of Canada.


Asunto(s)
Fuentes de Energía Bioeléctrica , Técnicas Biosensibles , Monitoreo del Ambiente/métodos , Metales Pesados/toxicidad , Contaminantes Químicos del Agua/toxicidad , Animales , Cobre , Daphnia , Metales Pesados/análisis , Minería , Ontario , Contaminantes Químicos del Agua/análisis
8.
J Water Health ; 17(6): 944-956, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31850901

RESUMEN

The incidence of infectious waterborne disease in Canada continues to be a public health issue and can be associated with the source of drinking water. Millions of Canadians relying on unregulated private well water are at increased risk of disease. This study examined relationships between well and owner characteristics and the frequency of microbial testing of private wells in two southern-Ontario counties. Using multi-level logistic regression models, testing frequency (i.e., at least once per year vs. less) was modeled, as both self-reported and laboratory-validated, for associations with owner and well characteristics. For the self-reported outcome, a previous adverse test result significantly increased the odds of being classified as a frequent tester, and owners with a well-head more than 16 inches (40.6 cm) above the ground were at significantly higher odds of being classified as frequent testers compared to those with well-heads less than 16 inches above the ground and those below ground level. For the model based on the laboratory-validated outcome, the odds of an owner being a frequent tester significantly varied with the length of occupancy and the occurrence of a previous adverse result. The absence of associations between other well characteristics and testing frequency suggests that well safety education could benefit these communities.


Asunto(s)
Agua Potable/microbiología , Microbiología del Agua/normas , Pozos de Agua , Agua Potable/normas , Humanos , Modelos Logísticos , Ontario , Salud Pública , Política Pública , Abastecimiento de Agua/normas
9.
J Opioid Manag ; 15(6): 507-520, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31850513

RESUMEN

OBJECTIVE: To identify key characteristics and habits of recreational opioid users. DESIGN: The data were compiled from volunteers who participated in clinical studies at a contract research organization in Toronto, Ontario, Canada. INTERVENTIONS: Data were collected from 5,018 male and female recreational opioid users via telephone and face-to-face screening interviews. Five recreational opioid users participated in a live interview broadcast on the internet. MAIN OUTCOME MEASURES: Demographic data, recreational drug use history, routes of recreational drug administration, alcohol use, and smoking status. A subset of the demographic information and recreational drug use history was summarized separately using data collected between 2013 and 2016 from 114 recreational opioid users who were not dependent on opioids. Interview excerpts were included from five recreational opioid users who described their real-world experiences with drug abuse, including the impact of abuse-deterrent opioid formulations on their drug abuse behavior. RESULTS: The preferred route of administration of opioids was oral (52 percent), followed by intranasal (36 percent), intravenous (10 percent), and buccal (chewing on a patch; 2 percent). Other substances used included nicotine, alcohol, and non-opioid psychoactive drugs (primarily cannabis). Oxycodone was the most frequently reported opioid of abuse. CONCLUSIONS: Recreational opioid users have distinct drug-related behaviors and preferences. Monitoring current trends and examining these behaviors is an important component to understand the potential safety risks associated with recreational opioid use.


Asunto(s)
Analgésicos Opioides , Consumidores de Drogas/psicología , Hábitos , Trastornos Relacionados con Opioides , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Masculino , Ontario , Trastornos Relacionados con Opioides/psicología , Oxicodona
10.
BMC Infect Dis ; 19(1): 982, 2019 Nov 21.
Artículo en Inglés | MEDLINE | ID: mdl-31752729

RESUMEN

BACKGROUND: Hepatitis B (HBV) and Human Immunodeficiency Virus (HIV) share common risk factors for exposure. Co-infected patients have an increased liver-related mortality risk and may have accelerated HIV progression. The epidemiology and demographic characteristics of HIV-HBV co-infection in Canada remain poorly defined. We compared the demographic and clinical characteristics and factors associated with advanced hepatic fibrosis between HIV and HIV-HBV co-infected patients. METHODS: A retrospective cohort analysis was conducted using data from the Canadian Observational Cohort (CANOC) Collaboration, including eight sites from British Columbia, Quebec, and Ontario. Eligible participants were HIV-infected patients who initiated combination ARV between January 1, 2000 and December 14, 2014. Demographic and clinical characteristics were compared between HIV-HBV co-infected and HIV-infected groups using chi-square or Fisher exact tests for categorical variables, and Wilcoxon's Rank Sum test for continuous variables. Liver fibrosis was estimated by the AST to Platelet Ratio Index (APRI). RESULTS: HBV status and APRI values were available for 2419 cohort participants. 199 (8%) were HBV co-infected. Compared to HIV-infected participants, HIV-HBV co-infected participants were more likely to use injection drugs (28% vs. 21%, p = 0.03) and be HCV-positive (31%, vs. 23%, p = 0.02). HIV-HBV co-infected participants had lower baseline CD4 T cell counts (188 cells/mm3, IQR: 120-360) compared to 235 cells/mm3 in HIV-infected participants (IQR: 85-294) (p = 0.0002) and higher baseline median APRI scores (0.50 vs. 0.37, p < 0.0001). This difference in APRI was no longer clinically significant at follow-up (0.32 vs. 0.30, p = 0.03). HIV-HBV co-infected participants had a higher mortality rate compared to HIV-infected participants (11% vs. 7%, p = 0.02). CONCLUSION: The prevalence, demographic and clinical characteristics of the HIV-HBV co-infected population in Canada is described. HIV-HBV co-infected patients have higher mortality, more advanced CD4 T cell depletion, and liver fibrosis that improves in conjunction with ARV therapy. The high prevalence of unknown HBV status demonstrates a need for increased screening among HIV-infected patients in Canada.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Antivirales/administración & dosificación , Coinfección/tratamiento farmacológico , Infecciones por VIH/tratamiento farmacológico , Hepatitis B/tratamiento farmacológico , Adulto , Colombia Británica/epidemiología , Coinfección/epidemiología , Coinfección/virología , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , Hepatitis B/epidemiología , Hepatitis B/virología , Virus de la Hepatitis B/efectos de los fármacos , Virus de la Hepatitis B/genética , Virus de la Hepatitis B/fisiología , Humanos , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Prevalencia , Quebec/epidemiología , Estudios Retrospectivos , Factores de Riesgo
11.
Medicine (Baltimore) ; 98(44): e17541, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31689755

RESUMEN

BACKGROUND: Previous clinical trials indicated that duloxetine may be effective in the treatment of osteoarthritis (OA) pain. This meta-analysis is conducted to evaluate short term analgesic effect and safety of duloxetine in the treatment of OA. METHODS: Electronic databases were searched in February 2019, including PUBMED, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science. All eligible studies should be randomized controlled trials (RCTs) comparing duloxetine treatment group to placebo about OA pain relief and safety outcomes. RESULTS: Five RCTs with 2059 patients were involved in this systematic review and meta-analysis. Compared to placebo, duloxetine treatment showed significant better result, with higher reduction pain intensity (mean difference [MD] = -0.77, P < .00001), higher rates of both 30% and 50% reduction in pain severity (risk ratio [RR] = 1.42, P < .00001; RR = 1.62, P < .00001), lower mean Patient Global Improvement-Inventory (PGI-I) score (MD = -0.48, P < .00001). The results of the Western Ontario and McMaster Universities (WOMAC) score change from baseline to endpoint also favored duloxetine treatment group in all four categories, including total (MD = -5.43, P < .00001), pain (MD = -1.63, P = .001), physical function (MD = -4.22, P < .00001), and stiffness score (MD = -0.58, P < .00001). There were higher rates of treatment-emergent adverse events (TEAEs) (RR = 1.32, P < .00001) and discontinuation (RR = 1.88, P < .00001) in duloxetine group. However, there was no significant difference in the incidence of severe adverse events (SAEs) between these 2 groups (RR = 0.84, P = .68). CONCLUSION: Duloxetine was an effective and safe choice to improve pain and functional outcome in OA patients. However, further studies are still needed to find out the optimal dosage for OA and examine its long-term efficacy and safety. TRIAL REGISTRATION NUMBER: CRD42019128862.


Asunto(s)
Analgésicos/uso terapéutico , Clorhidrato de Duloxetina/uso terapéutico , Osteoartritis/tratamiento farmacológico , Analgésicos/efectos adversos , Clorhidrato de Duloxetina/efectos adversos , Humanos , Ontario , Dimensión del Dolor , Gravedad del Paciente , Rendimiento Físico Funcional , Ensayos Clínicos Controlados Aleatorios como Asunto
12.
Environ Sci Technol ; 53(23): 14020-14028, 2019 Dec 03.
Artículo en Inglés | MEDLINE | ID: mdl-31743010

RESUMEN

Selenium (Se) is one of the trace elements that is enriched in bitumen. To assess the importance of atmospheric Se deposition from mining and upgrading of bituminous sands in northern Alberta, Canada, Sphagnum moss was obtained from 25 bogs near industrial operations. The average Se concentration in moss near industries (58 ± 13 µg/kg; n = 75) was greater than in remote sites in Alberta (29-50 µg/kg), but comparable to bogs in central regions of the province and lower than bogs in southern Ontario (121-244 µg/kg) or the west and east coasts (230-285 µg/kg). In bog vegetation and peat, arsenic (As) concentrations and accumulation rates are 10 times greater at the industrial site (MIL) compared to the control site (UTK), but this is proportional to the differences in scandium (a surrogate for mineral matter concentrations), which points to dust as the predominant As source. An age-dated peat core collected near industries revealed that both Se and As deposition have declined in recent years. A peat core from UTK provided a record of atmospheric deposition dating back over 2700 years, indicating that As and Se deposition in northern Alberta increased considerably in the early 19th century and then went into decline during ∼1950-1970.


Asunto(s)
Arsénico , Selenio , Alberta , Monitoreo del Ambiente , Ontario , Arena , Suelo
13.
Cancer Invest ; 37(10): 513-523, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31617759

RESUMEN

The epidemiology of prostate cancer (PC) continues to change. We evaluated the changes in incidence, in average age at diagnosis, and in survival from 1992 to 2015 in Ontario. We compared the cumulative incidence of PC-specific and non PC-specific mortality using two algorithms for cause of death: Method 1 assigned deaths from "other cancers" to non PC-specific causes, and Method 2 assigned these cases to PC-specific mortality. There were 188,714 cases diagnosed with PC between 1992 and 2015 in Ontario. The average age at diagnosis declined from 1992 to 2008 by 0.26 year (3.1 months) annually (p < 0.001) and increased by 0.15 year (1.8 months) thereafter (p > 0.05). Between 2010 and 2015, the proportion of patients diagnosed at stage IV increased, and the proportion diagnosed at stage I decreased (p-values for trends <0.001). Overall survival significantly improved over the years. The cumulative incidence of PC-specific mortality at 5 and 10 years was 6.8 and 9.8% using Method 1, and 10.2 and 16.8% using Method 2. We observed trends toward older age and more advanced stage at PC diagnosis in Ontario. Further studies are needed to validate algorithms for estimating PC-specific mortality from administrative databases.


Asunto(s)
Neoplasias de la Próstata/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Antígeno Prostático Específico/metabolismo , Neoplasias de la Próstata/metabolismo , Sistema de Registros
14.
J Water Health ; 17(5): 670-682, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31638019

RESUMEN

In Ontario, Canada, information is lacking on chlorine and ultraviolet (UV) light disinfection performance against enteric viruses in wastewater. We enumerated enteroviruses and noroviruses, coliphages, and Escherichia coli per USEPA methods 1615, 1602, and membrane filtration, respectively, in pre- and post-disinfection effluent at five wastewater treatment plants (WWTPs), with full-year monthly sampling, and calculated log10 reductions (LRs) while WWTPs complied with their monthly geometric mean limit of 200 E. coli/100 mL. Modeling of densities by left-censored estimation and Bayesian inference gave very similar results. Polymerase chain reaction (PCR)-detected enteroviruses and noroviruses were abundant in post-disinfection effluent (mean concentrations of 2.1 × 10+4-7.2 × 10+5 and 2.7 × 10+4-3.6 × 10+5 gene copies (GC)/L, respectively). Chlorine or UV disinfection produced modest LRs for culture- (0.3-0.9) and PCR-detected enteroviruses (0.3-1.3), as well as noroviruses GI + GII (0.5-0.8). Coliphages and E. coli were more susceptible, with LRs of 0.8-3.0 and 2.5, respectively. Sand-filtered effluent produced significantly higher enteric virus LRs (except cultured enteroviruses). Coliphage and human enteric virus densities gave significantly positive correlations using Kendall's Tau test. Enteric viruses are abundant in wastewater effluent following routine chlorine or UV disinfection processes that target E. coli. Coliphages appear to be good indicators for evaluating wastewater disinfection of enteric viruses.


Asunto(s)
Desinfección , Eliminación de Residuos Líquidos/métodos , Aguas Residuales/virología , Teorema de Bayes , Cloro , Escherichia coli , Humanos , Ontario , Rayos Ultravioleta
16.
BMC Public Health ; 19(1): 1345, 2019 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-31640664

RESUMEN

BACKGROUND: Slapping/spanking is related to a number of poor health outcomes. Understanding what factors are related to the increased or decreased use of spanking/slapping is necessary to inform prevention. This study used a population-based sample to determine the prevalence of slapping/spanking reported by youth; the relationship between sociodemographic factors and slapping/spanking; and the extent to which parental exposures to victimization and maltreatment in childhood and current parental mental health, substance use and family circumstances, are associated with youth reports of slapping/spanking. METHODS: Data were from the 2014 Ontario Child Health Study, a provincially representative sample of households with children and youth aged 4-17 years. Self-reported lifetime slapping/spanking prevalence was determined using a sub-sample of youth aged 14-17 years (n = 1883). Parents/primary caregivers (i.e., person most knowledgeable (PMK) of the youth) self-reported their own childhood experiences including bullying victimization, slapping/spanking and child maltreatment, and current mental health, substance use and family circumstances including mental health functioning and emotional well-being, alcohol use, smoking, marital conflict and family functioning. Analyses were conducted in 2018. RESULTS: Living in urban compared to rural residence and family poverty were associated with decreased odds of slapping/spanking. PMK childhood experiences of physical and verbal bullying victimization, spanking, sexual abuse, emotional abuse, and exposure to physical intimate partner violence were associated with increased odds of youth reported slapping/spanking (adjusted odds ratio [AOR] ranged from 1.33-1.77). PMK experiences of physical abuse and exposure to emotional/verbal intimate partner violence in childhood was associated with decreased odds of youth reported slapping/spanking (AOR = 0.72 and 0.88, respectively). PMK's higher levels of marital conflict, languishing to moderate mental health functioning and emotional well-being, and moderate or greater alcohol use were associated with increased odds of youth reported slapping/spanking (AOR ranged from 1.36-1.61). CONCLUSIONS: It may be important to consider parent/primary caregiver's childhood experiences with victimization and maltreatment along with their current parental mental health, substance use and family circumstances when developing and testing strategies to prevent slapping/spanking.


Asunto(s)
Relaciones Padres-Hijo , Padres/psicología , Castigo , Adolescente , Adulto , Maltrato a los Niños/psicología , Maltrato a los Niños/estadística & datos numéricos , Víctimas de Crimen/psicología , Víctimas de Crimen/estadística & datos numéricos , Estudios Transversales , Composición Familiar , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Ontario/epidemiología , Factores de Riesgo , Autoinforme , Factores Socioeconómicos , Trastornos Relacionados con Sustancias/epidemiología
17.
J Nurs Adm ; 49(11): 549-555, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31651615

RESUMEN

OBJECTIVE: This study aims to investigate the role of nurse managers in supporting point-of-care nurses' health information technology (IT) use and identify strategies employed by nurse managers to improve adoption, while also gathering point-of-care nurses' perceptions of these strategies. BACKGROUND: Nurse managers are essential in facilitating point-of-care nurses' use of health IT; however, the underlying phenomenon for this facilitation remains unreported. METHODS: A qualitative descriptive study was conducted with 10 nurse managers and 14 point-of-care nurses recruited from a mental health hospital environment in Ontario, Canada. Inductive and deductive content analyses were used to analyze the semistructured interviews. RESULTS: Nurse managers adopt the role of advocate, educator, and connector, using the following strategies: communicating system updates, demonstrating use of health IT, linking staff to resources, facilitating education, and providing IT oversight. CONCLUSIONS: Nurse managers use a variety of strategies to support nurses' use of health IT. Future research should focus on the effectiveness of these strategies.


Asunto(s)
Actitud del Personal de Salud , Liderazgo , Informática Médica/organización & administración , Enfermeras Administradoras/psicología , Rol de la Enfermera/psicología , Personal de Enfermería en Hospital/psicología , Rol Profesional , Femenino , Humanos , Ontario , Investigación Cualitativa
18.
BMC Health Serv Res ; 19(1): 761, 2019 Oct 28.
Artículo en Inglés | MEDLINE | ID: mdl-31660976

RESUMEN

BACKGROUND: Accessing HIV-related care is challenging for formerly incarcerated people with HIV. Interventions informed by the perspectives of these individuals could facilitate engagement with care and address competing priorities that may act as barriers to this process. METHODS: We used concept mapping to identify and prioritize the main obstacles to engaging with HIV-related care following prison release. In brainstorming sessions, formerly incarcerated people with HIV generated responses to a focused prompt regarding the main barriers to reengaging with care. These were consolidated in 35 statements. Next, participants sorted the consolidated list of responses into groups and rated each from lowest to highest in terms of its importance and feasibility of being addressed. We used cluster analysis to generate concept maps that were interpreted with participants. RESULTS: Overall, 39 participants participated in brainstorming sessions, among whom 18 returned for rating and sorting. Following analysis, a seven-cluster map was generated, with participants rating the 'Practical Considerations' (e.g. lack of transportation from prison) and 'Survival Needs' (e.g. securing housing and food) clusters as most important. Although ratings were generally similar between women and men, women assigned greater importance to barriers related to reconnecting with children. CONCLUSIONS: Using concept mapping, we worked with formerly incarcerated people with HIV to identify and prioritize key challenges related to accessing health and social services following prison release. Transitional intervention programs should include programs and processes that address meeting basic subsistence needs and overcoming logistical barriers related to community re-entry.


Asunto(s)
Formación de Concepto , Infecciones por VIH/terapia , Prisioneros/estadística & datos numéricos , Cuidado de Transición/organización & administración , Adulto , Análisis por Conglomerados , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Ontario
19.
Lancet Psychiatry ; 6(11): 915-925, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31601530

RESUMEN

BACKGROUND: Housing First is increasingly implemented for homeless adults with mental illness in large urban centres, but little is known about its long-term effectiveness. The At Home/Chez Soi randomised controlled trial done in five cities in Canada showed that Housing First improved housing stability and other select health outcomes. We extended the At Home/Chez Soi trial at the Toronto site to evaluate the long-term effects of the Housing First intervention on housing and health outcomes of homeless adults with mental illness over 6 years. METHODS: The At Home/Chez Soi Toronto study was a randomised, controlled trial done in Toronto (ON, Canada). Here, we present the results of an extension study done at the same site. Participants were homeless adults (aged ≥18 years) with a serious mental disorder with or without co-occurring substance use disorder. In phase 1, participants were stratified by level of need for mental health support services (high vs moderate), and randomly assigned (1:1) using adaptive randomisation procedures to Housing First with assertive community treatment (HF-ACT), Housing First with intensive case management (HF-ICM), or to treatment as usual (TAU). Participants with moderate support needs were further stratified by ethnoracial status. Considering the nature of the Housing First intervention, study participants and study personnel were not masked to group assignment. Phase 1 participants could choose to enrol in the extension study (phase 2). The primary outcome was the rate of days stably housed per year analysed in the modified intention-to-treat population, which included all randomly assigned participants who had at least one assessment for the primary outcome. Participants contributed data to the study up to the point of their last interview. Multilevel multiple imputation was used to handle missing data. The trial was registered with ISRCTN, ISRCTN42520374. FINDINGS: Between Oct 1, 2009, and March 31, 2013, 575 individuals participated in phase 1 of the Toronto Site At Home/Chez Soi study (197 [34%] participants with high support needs and 378 [66%] with moderate support needs). Of the 378 participants with moderate support needs, 204 were randomly assigned to receive the HF intervention with ICM or with ethnoracial-specific ICM services (HF-ER-ICM; HF-ICM or HF-ER-ICM groups) and 174 were randomly assigned to TAU. Of the 197 participants with high support needs, 97 were randomly assigned to receive the HF intervention with ACT (HF-ACT treatment group) and 100 were randomly assigned to TAU group. Between Jan 1, 2014, and March 31, 2017, 414 (81%) of 575 phase 1 participants participated in the extended phase 2 study. The median duration of follow-up was 5·4 years (IQR 2·1-5·9). Among phase 2 participants, 141 had high support needs (79 participants in the HF-ACT group; 62 participants in the TAU group), and 273 had moderate support needs (160 participants in the HF-ICM or HF-ER-ICM group; 113 participants in the TAU group). 187 high support needs participants (93 participants in the HF-ACT group, 94 participants in the TAU group), and 361 moderate support needs participants (201 participants in the HF-ICM or HF-ER-ICM group, 160 participants in the TAU group) were included in the modified intention-to-treat analysis for the primary outcome. The number of days spent stably housed was significantly higher among participants in the HF-ACT and HR-ICM or HF-ER-ICM groups than participants in the TAU groups at all timepoints. For participants with moderate support needs, the rate ratio (RR) of days stably housed in the Housing First group, compared with TAU, was 2·40 (95% CI 2·03-2·83) in year 1, which decreased to 1·13 (1·01-1·26) in year 6. The RR of days stably housed for participants with high support needs, compared with TAU, was 3·02 (2·43-3·75) in year 1 and 1·42 (1·19-1·69) in year 6. In year 6, high support needs participants in the Housing First group spent 85·51% of days stably housed compared with 60·33% for the TAU group, and moderate needs participants in the Housing First group spent 88·16% of days stably housed compared with 78·22% for the TAU group. INTERPRETATION: Rent supplements and mental health support services had an enduring positive effect on housing stability for homeless adults with mental illness in a large, resource-rich urban centre, with a larger impact on individuals with high support needs than moderate support needs. FUNDING: Mental Health Commission of Canada, Ontario Ministry of Health and Long-Term Care, and the Canadian Institute of Health Research.


Asunto(s)
Servicios Comunitarios de Salud Mental/métodos , Personas sin Hogar/psicología , Personas sin Hogar/estadística & datos numéricos , Trastornos Mentales/terapia , Evaluación de Programas y Proyectos de Salud/métodos , Vivienda Popular/estadística & datos numéricos , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Trastornos Mentales/psicología , Ontario , Tiempo , Población Urbana/estadística & datos numéricos
20.
Clin Exp Rheumatol ; 37 Suppl 120(5): 100-111, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31621565

RESUMEN

A patient history generally provides the most important information in diagnosis and management of patients with most rheumatic diseases, including osteoarthritis (OA). Patient history components can be expressed as quantitative, structured, "scientific" data, rather than "subjective" narrative descriptions, using patient self-report questionnaires. The Western Ontario McMaster (WOMAC) questionnaire is used in all OA clinical trials, and the health assessment questionnaire (HAQ) in all rheumatoid arthritis (RA) clinical trials, as "disease-specific" questionnaires. However, both questionnaires include scores for physical function function and pain; physical function scores are correlated highly significantly at r=0.78 in both RA and OA patients, while WOMAC pain scores are correlated with HAQ visual analogue scale (VAS) pain scores at r=0.73 in OA and r=0.71 in RA. Therefore, the WOMAC and HAQ may be regarded as largely "generic" questionnaires, at least for people with arthritis. Since it is not feasible to ask patients with different diagnoses to complete different care questionnaires in busy clinical settings, a single multidimensional HAQ (MDHAQ), derived from the HAQ and largely similar and informative in all rheumatic diseases, has been used in all rheumatology patients in several settings. The MDHAQ also has been incorporated into two OA clinical trials, with virtually identical results to the WOMAC. In routine clinical care, MDHAQ scores have documented that the disease burden of OA is comparable to RA in terms of scores for pain, physical function, and RAPID3 (routine assessment of patient index data) an index of pain, function and patient global assessment. Further observations indicate capacity of the MDHAQ to recognise fibromyalgia similarly to formal fibromyalgia criteria, as well as the ineffectiveness of opioids in OA, and similar prevalence of depression and other psychological issues in OA to RA. These findings also illustrate the value of a database of MDHAQ data for retrospective analysis of serendipitous observations from routine clinical care.


Asunto(s)
Osteoartritis , Encuestas y Cuestionarios , Humanos , Ontario , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA