Cohort profile: Impact of Maternal and Paternal Mental Health - Assessing Concurrent Depression, Anxiety and Comorbidity in the Canadian Family (IMPACT study).

PURPOSE: This paper describes a prospective cohort, Impact of Maternal and Paternal Mental Health: Assessing Concurrent Depression, Anxiety and Comorbidity in The Canadian Family (IMPACT) study, which followed maternal-paternal dyads and their children across the first 2 years post partum. PARTICIPANTS: A total of 3217 cohabitating maternal-paternal dyads were recruited into the study from 2014 to 2018. Each dyad member separately completed online questionnaires at baseline (<3 weeks post partum) and again at 3, 6, 9, 12, 18 and 24 months on a variety of measures, including mental health, parenting environment, family functioning and child health and development. FINDINGS TO DATE: At baseline, the mean maternal age was 31.9±4.2 years and 33.8±5.0 years for fathers. Overall, 12.8% of families had a household income below the poverty line of $C50 000, and 1 in 5 mothers and 1 in 4 fathers were not born in Canada. One in 10 women experienced depressive symptoms during pregnancy (9.7%) and 1 in 6 had markedly anxious symptoms (15.4%) while 1 in 20 men reported feeling depression during their partner's pregnancy and 1 in 10 had marked anxiety (10.1%). Approximately 91% of mothers and 82% of fathers completed the 12-month questionnaire as did 88% of mothers and 78% of fathers at 24 months postpartum. FUTURE PLANS: The IMPACT study will examine the influence of parental mental illness in the first 2 years of a child's life with a focus on understanding the mechanisms by which single (maternal or paternal) versus dual (maternal and paternal) parental depression, anxiety and comorbidity symptoms affect family and infant outcomes. Future analyses planned to address the research objectives of IMPACT will consider the longitudinal design and dyadic interparental relationship.

Protocol for a randomised trial evaluating a preconception-early childhood telephone-based intervention with tailored e-health resources for women and their partners to optimise growth and development among children in Canada: a Healthy Life Trajectory Initiative (HeLTI Canada).

INTRODUCTION: The 'Developmental Origins of Health and Disease' hypothesis suggests that a healthy trajectory of growth and development in pregnancy and early childhood is necessary for optimal health, development and lifetime well-being. The purpose of this paper is to present the protocol for a randomised controlled trial evaluating a preconception-early childhood telephone-based intervention with tailored e-health resources for women and their partners to optimise growth and development among children in Canada: a Healthy Life Trajectory Initiative (HeLTI Canada). The primary objective of HeLTI Canada is to determine whether a 4-phase 'preconception to early childhood' lifecourse intervention can reduce the rate of child overweight and obesity. Secondary objectives include improved child: (1) growth trajectories; (2) cardiometabolic risk factors; (3) health behaviours, including nutrition, physical activity, sedentary behaviour and sleep; and (4) development and school readiness at age 5 years. METHOD AND ANALYSIS: A randomised controlled multicentre trial will be conducted in two of Canada's highly populous provinces-Alberta and Ontario-with 786 nulliparous (15%) and 4444 primiparous (85%) women, their partners and, when possible, the first 'sibling child.' The intervention is telephone-based collaborative care delivered by experienced public health nurses trained in healthy conversation skills that includes detailed risk assessments, individualised structured management plans, scheduled follow-up calls, and access to a web-based app with individualised, evidence-based resources. An 'index child' conceived after randomisation will be followed until age 5 years and assessed for the primary and secondary outcomes. Pregnancy, infancy (age 2 years) and parental outcomes across time will also be assessed. ETHICS AND DISSEMINATION: The study has received approval from Clinical Trials Ontario (CTO 1776). The findings will be published in peer-reviewed journals and disseminated to policymakers at local, national and international agencies. Findings will also be shared with study participants and their communities. TRIAL REGISTRATION NUMBER: ISRCTN13308752; Pre-results.

Police officer competence in handling Alzheimer's cases: The roles of AD knowledge, beliefs, and exposure.

This study seeks to understand the level of police officer competence for providing assistance during interactions with patients of Alzheimer's disease (AD), and to reveal the roles their knowledge of AD, beliefs of AD, and previous exposure to patients with AD play in influencing these competence levels. Data were collected from police officers in two Phoenix metropolitan-area police departments through focus group discussions and survey. Four focus groups comprised of 27 police officers discussed their perceptions of AD and challenges of dealing with individuals with AD. Building on the findings from the focus groups, an online survey ( n = 228) examined police officer AD knowledge, as well as their experience and competence in the handling of AD cases. Police participants had fair knowledge of AD with an average 71.8% accuracy rate. More AD knowledge ( B = 0.29) and higher levels of education ( B = 0.85) were associated with higher levels of competence of recognizing AD-related behaviors. Low levels of discomfort interacting with AD patients ( B = -0.75) and having a family member of dementia ( B = 1.32) were related to higher levels of competence of reacting appropriately to an AD patient. The findings suggest that information about the best practices for dealing with community residents with AD needs to be made available to police officers. To ensure a dementia-friendly environment, aging service providers need to reach out to local law enforcement departments and provide training that promotes AD knowledge, decreases AD-related stigma, and increases competence of handing dementia cases in a way that fits the policing culture.

Clinical outcomes of 5358 patients undergoing direct open bypass or endovascular treatment for aortoiliac occlusive disease: a systematic review and meta-analysis.

PURPOSE: To examine clinical outcomes of endovascular and open bypass treatment for aortoiliac occlusive disease (AIOD). METHODS: Multiple databases were systematically searched to identify studies on open and endovascular treatment for AIOD published from 1989 to 2010. Studies were independently reviewed for eligibility criteria. Study selection and assessment of methodological quality were performed by two independent reviewers. Assuming between-study heterogeneity due to biases inherent to observational studies, a random effects model (DerSimonian-Laird method) was used for calculation of weighted proportions. Pooled weighted proportions or weighted means are reported. Twenty-nine open bypass studies (3733 patients) and 28 endovascular treatment studies (1625 patients) were analyzed. RESULTS: Weighted mean patient age was 60.4 years for open bypass and 60.8 years for endovascular treatment. Poor preoperative runoff was greater in the open bypass group (50.0% vs. 24.6%, p<0.001). Mean length of hospital stay (LOS) was 13 days for open bypass vs. 4 days for endovascular treatment procedures (p<0.001). The open bypass group experienced more complications (18.0% vs. 13.4%, p<0.001) and greater 30-day mortality (2.6% vs. 0.7%, p<0.001). At 1, 3, and 5 years, pooled primary patency rates were greater in the open bypass group vs. the endovascular cohort (94.8% vs. 86.0%, 86.0% vs. 80.0%, 82.7% vs. 71.4%, respectively; all p<0.001); the same was true for secondary patency [95.7% vs. 90.0% (p=0.002), 91.5 vs. 86.5% (p<0.001), and 91.0% vs. 82.5% (p<0.001), respectively]. CONCLUSION: Although this study was limited by a paucity of randomized control trials, these results demonstrate superior durability for open bypass, although with longer LOS and increased risk for complications and mortality, when compared to the endovascular approach.

Variation in styles of rifting in the Gulf of California.

Constraints on the structure of rifted continental margins and the magmatism resulting from such rifting can help refine our understanding of the strength of the lithosphere, the state of the underlying mantle and the transition from rifting to seafloor spreading. An important structural classification of rifts is by width, with narrow rifts thought to form as necking instabilities (where extension rates outpace thermal diffusion) and wide rifts thought to require a mechanism to inhibit localization, such as lower-crustal flow in high heat-flow settings. Observations of the magmatism that results from rifting range from volcanic margins with two to three times the magmatism predicted from melting models to non-volcanic margins with almost no rift or post-rift magmatism. Such variations in magmatic activity are commonly attributed to variations in mantle temperature. Here we describe results from the PESCADOR seismic experiment in the southern Gulf of California and present crustal-scale images across three rift segments. Over short lateral distances, we observe large differences in rifting style and magmatism--from wide rifting with minor synchronous magmatism to narrow rifting in magmatically robust segments. But many of the factors believed to control structural evolution and magmatism during rifting (extension rate, mantle potential temperature and heat flow) tend to vary over larger length scales. We conclude instead that mantle depletion, rather than low mantle temperature, accounts for the observed wide, magma-poor margins, and that mantle fertility and possibly sedimentary insulation, rather than high mantle temperature, account for the observed robust rift and post-rift magmatism.