Intersecting Inequities in COVID-19 Vaccination: A Discourse Analysis of Information Use and Decision-Making Among Ethnically Diverse Parents in Canada.

BACKGROUND: Little is known about how intersecting social privilege and disadvantage contribute to inequities in COVID-19 information use and vaccine access. This study explored how social inequities intersect to shape access to and use of COVID-19 information and vaccines among parents in Canada. METHODS: We conducted semi-structured interviews on COVID-19 vaccination information use with ethnically diverse parents of children ages 11 to 18 years from April to August 2022. We purposefully invited parents from respondents to a national online survey to ensure representation across diverse intersecting social identities. Five researchers coded transcripts in NVivo using a discourse analysis approach informed by intersectionality. Our analysis focused on use of vaccine information and intersecting privileges and oppressions, including identifying with equity-denied group(s). RESULTS: Interview participants (N = 48) identified as ethnically diverse non-Indigenous (n = 40) and Indigenous (n = 8) Peoples from seven Canadian provinces. Racialized minority or Indigenous participants reflected on historical and contemporary events of racism from government and medical institutions as barriers to trust and access to COVID-19 information, vaccines, and the Canadian healthcare system. Participants with privileged social locations showed greater comfort in resisting public health measures. Despite the urgency to receive COVID-19 vaccines, information gaps and transportation barriers delayed vaccination among some participants living with chronic medical conditions. CONCLUSION: Historicization of colonialism and ongoing events of racism are a major barrier to trusting public health information. Fostering partnerships with trusted leaders and/or healthcare workers from racialized communities may help rebuild trust. Healthcare systems need to continuously implement strategies to restore trust with Indigenous and racialized populations.

"It's not that I don't trust vaccines, I just don't think I need them": Perspectives on COVID-19 vaccination.

In Quebec (Canada), the roll-out of the vaccination started slowly in December 2020 due to limited vaccine supply. While the first and second doses were well-accepted among adults and vaccine uptake was above 90%, in late 2021 and 2022, vaccine acceptance decreased for children vaccination and receipt of a 3rd or a 4th dose. In the autumn of 2022, four focus groups were conducted with vaccine-hesitant parents of children aged 0-4 and adults who expressed little intention to receive a booster dose. The objective of this study was to gather participants' perspectives on vaccination in general, on the COVID-19 vaccination campaign and the information available, and to gain insights into the underlying reasons for their low intention of either having their child(ren) vaccinated, or receiving an additional dose of vaccine. A total of 35 participants took part in the focus groups. While participants expressed a certain level of trust and confidence in public health and government authorities regarding pandemic management and the vaccination campaign, they were also concerned that transparent information was lacking to support an informed decision on booster doses and children's vaccination. Many participants felt adequately protected against the infection during the focus groups, citing a lack of perceived benefits as the primary reason for refusing a booster dose. Parents who refused to administer the COVID-19 vaccine to their young children felt that the vaccine was not useful for children and were concerned about potential side effects. The majority reported that their opinions regarding other recommended vaccines had not changed since the beginning of the pandemic. While these results are reassuring, our findings highlight the importance of transparency in public health communications about vaccines to increase confidence and to develop strategies to address vaccine fatigue and complacency toward COVID-19 vaccines.

"The needle is already ready to go": communities' and health care professionals' perceptions of routine vaccination in Nunavik, Canada.

Inuit living in the northern region of Nunavik continue to experience significant health inequalities, which are rooted in colonialism that still have repercussions on their health-related perceptions and practices, including vaccination. This study aimed to explore the perceptions and determinants of routine vaccination among the Inuit of Nunavik by describing factors influencing vaccination decisions from the perspective of community members and health professionals. Semi-structured interviews focusing on the perception of vaccination and experience with vaccination and health services were conducted with 18 Inuit and 11 non-Inuit health professionals. Using the socio-ecological model, factors acting at the community and public policy (e.g. rumours and misinformation about vaccination, language barrier), organisational (e.g. complexity of the vaccination process, staff turnover, lack of specialised vaccination workers and interpreters), and intrapersonal and interpersonal (e.g. past experiences with vaccination, vaccine attitudes, social norms) levels were identified as having an impact on vaccination decisions. Improving vaccination coverage in Nunavik requires a more global reflection on how to improve and culturally adapt the health care and services offered to the Inuit population.

From high hopes to disenchantment: A qualitative analysis of editorial cartoons on COVID-19 vaccines in Canadian newspapers.

In Canada, the first COVID-19 vaccine was approved for use in December 2020, marking the beginning of a large vaccination campaign. The campaign was not only unprecedented in terms of reach, but also with regards to the amount of information about vaccines that circulated in traditional and social media. This study's aim was to describe COVID-19 vaccine related discourses in Canada through an analysis of editorial cartoons. We collected 2172 cartoons about COVID-19 published between January 2020 and August 2022 in Canadian newspapers. These cartoons were downloaded and a first thematic analysis was conducted using the WHO-EPIWIN taxonomy (cause, illness, treatment, interventions, and information). From this, 389 cartoons related to COVID-19 vaccines were identified under the treatment category. These were subjected to a second thematic analysis to assess main themes (e.g., vaccine development, campaign progress, etc.), characters featured (e.g., politicians, public figures, public) and position with respect to vaccine (favorable, unfavorable, neutral). Six main themes emerged: Research and development of vaccines; Management of the vaccination campaign; Perceptions of and experiences with vaccination services; Measures and incentives to increase COVID-19 vaccine uptake; Criticism of the unvaccinated; and Effectiveness of vaccination. Our analysis revealed a shift in attitudes toward COVID-19 vaccination from high hopes to disenchantment, which may reflect some vaccine fatigue. In the future, public health authorities could face some challenges in maintaining confidence and high COVID-19 vaccine uptake.

The Prevalence of Idiopathic or Inherited Isolated Dystonia: A Systematic Review and Meta-Analysis.

Background: A systematic review of epidemiological studies of primary dystonia from 1985 and 2010 found an overall prevalence of 16.43 per 100,000 (95% CI = 12.09-22.32). Methods: We performed a systematic review of studies from 2010 and 2022 to determine if there are important differences in epidemiology between these time periods. Results: Nineteen studies were included. Incidence of cervical dystonia, blepharospasm, and oromandibular dystonia were each reported in one study; one study reported incidence for all adult onset idiopathic focal dystonias combined. Using data from 11 studies, we performed random effects meta-analyses of the prevalence of cervical dystonia (9.95 per 100,000; 95% CI = 3.51-28.17), blepharospasm (2.82 per 100,000; 95% CI = 1.12-7.12), laryngeal dystonia (0.40 per 100,000; 95% CI = 0.09-1.83), upper limb dystonia (1.27 per 100,000; 95% CI = 0.36-4.52), oromandibular dystonia (0.57 per 100,000; 95% CI = 0.15-2.15), and idiopathic or inherited isolated dystonia all subtypes combined (30.85 per 100,000; 95% CI = 5.06-187.74). All studies reported more cases of dystonia in females. There was no significant difference in prevalence by subgroup analysis based on time of study publication (1985-2010 vs. 2010-2022). Subgroup analysis of differences in prevalence by dystonia subtype by continent using all studies published (1985-2022) revealed significant regional differences in the prevalence of cervical and laryngeal dystonia. Conclusion: The incidence and prevalence of idiopathic or inherited isolated dystonia in the last decade was not significantly different from earlier reports. Population-based studies across multiple geographic areas are needed to obtain a clearer understanding of the epidemiology of this condition.

Public health communication during the COVID-19 pandemic: perspectives of communication specialists, healthcare professionals, and community members in Quebec, Canada.

OBJECTIVES: Communication during a pandemic is key in ensuring adoption of preventive behaviours and limiting disease transmission. The aim of the study was to explore how communication specialists working in health and governmental institutions and healthcare professionals have communicated about COVID-19, and how different groups of the public have perceived official communications on COVID-19. METHODS: We conducted an exploratory qualitative study. Data were collected via individual semi-structured interviews and focus-group discussions. The Crisis and Emergency Risk Communication (CERC) model was used as a theoretical framework to guide data interpretation. RESULTS: We interviewed 6 communication specialists and 5 healthcare professionals. Three focus groups were held with 23 participants (8 young adults, 9 Quebecers of Asian ethnicity, and 6 Quebecers who suffered harshly from economic consequences of the pandemic and measures). Although daily press conferences were rapidly implemented in Quebec, participants highlighted several communication challenges, including accuracy and credibility of information in a context of uncertainties and rapidly evolving knowledge. Participants also identified paternalism, stigmatization of some communities, and issues with promoting action and mobilization of some subpopulations as communication challenges. CONCLUSION: Our study showed that the six core CERC principles have not all been applied systematically in communication interventions in Quebec. Despite some limitations, messages about COVID-19 risk were clearly and consistently communicated and were generally well understood by most Quebecers.

RéSUMé: OBJECTIFS: La communication en temps de pandémie joue un rôle clé dans l'adoption des comportements préventifs et le contrôle de la transmission de la maladie. Cette étude visait à explorer comment les spécialistes de la communication travaillant dans les institutions gouvernementales et de santé et les professionnels de la santé ont communiqué sur la COVID-19 et comment les différents groupes du public ont perçu les communications officielles sur la COVID-19. MéTHODE: Les données de cette étude qualitative exploratoire ont été recueillies à l'aide d'entretiens individuels semi-structurés et de groupes de discussion. Le modèle de la communication des risques en situation de crise et d'urgence (CERC) a été utilisé comme cadre théorique pour guider l'interprétation des données. RéSULTATS: Nous avons rencontré 6 experts en communication et 5 professionnels de la santé. Trois groupes de discussion ont eu lieu avec 23 participants (8 jeunes adultes, 9 Québécois d'origine asiatique et 6 Québécois ayant subi des conséquences financières importantes à cause de la pandémie et des mesures sanitaires). Bien que des conférences de presse quotidiennes aient été rapidement mises en place au Québec, les participants ont souligné plusieurs défis de communication, notamment en ce qui concerne l'exactitude et la crédibilité de l'information dans un contexte d'incertitudes et d'évolution rapide des connaissances. Les participants ont également identifié le paternalisme, la stigmatisation de certaines communautés et les problèmes de promotion de l'action et de mobilisation au sein de certaines sous-populations comme des défis de communication. CONCLUSION: Notre étude a démontré que les six principes fondamentaux du CERC n'ont pas tous été appliqués systématiquement dans les interventions de communication au Québec. Malgré certaines limites, les messages sur le risque lié à la COVID-19 ont été communiqués de manière claire et cohérente et ont été généralement bien compris par la plupart des Québécois.

COVID-19 vaccination in 5-11 years old children: Drivers of vaccine hesitancy among parents in Quebec.

The Pfizer-BioNTech COVID-19 vaccine was recently authorized for Canadian children aged 5 to 11 years old. Previous studies have indicated that low parental vaccination intention can be anticipated. To better understand drivers of vaccine hesitancy among parents of 5-11 years old children, four focus group discussions were conducted. Interviewed parents generally showed little concern about the risk of COVID-19 for their child(ren) and many mentioned that children are at low risk of complications from COVID-19. Out of 28 participants, seven intended to vaccinate their child(ren) while the remaining were unsure or unwilling. Even if parents were themselves vaccinated, many hesitated for their child(ren). These parents perceived that it was unnecessary (due to low risk of complications) and were concerned about risks of side effects. Clear communication on vaccine safety and usefulness will be critical to reassure parents and foster vaccine acceptance.

Stigma and blame related to COVID-19 pandemic: A case-study of editorial cartoons in Canada.

The COVID-19 pandemic represents not only the spread of a highly contagious and potentially fatal virus, but also an outbreak of theories, rumors, discourses and representations trying to make sense of a crisis. In this article, we explore the issue of blame and stigma in the context of the COVID-19 pandemic in Canada. We do so by studying editorial cartoons published about COVID-19 in ten mainstream Canadian newspapers between January 2020 and March 2021. We identified 203 editorial cartoons that highlight common discourses which blame or stigmatize specific groups of people for the origin or transmission of COVID-19, or for their behavior during the pandemic. The cartoons focused on four groups: 1) people of Chinese origin or descent and of other national/geographic provenance (Americans, Canadians from specific provinces, urban residents); 2) international travelers; 3) people who do not respect the preventive measures to contain the pandemic; and 4) people who question or criticize the scientific discourses about COVID-19. Our analysis revealed an "othering process" common in times of pandemic. Our analysis of editorial cartoons in Canada also uncovered a moralization around the respect of the counter measures against COVID-19. These editorial cartoons largely divide the population into two groups: 1) "virtuous" people who are "selfless" and "smart" and who respect the public health preventive measures; 2) those who are "immoral", "self-centered", "silly" and even "stupid", who do not respect the recommended measures to prevent the transmission of COVID-19. While negatively portraying these individuals may help promote adherence to the recommended measures, it also can exacerbate polarization. Analyzing editorial cartoons can be a useful approach to rapidly gather information on attitudes and feelings in the public at a specific time and place.

CARDEA study protocol: investigating early markers of cardiovascular disease and their association with lifestyle habits, inflammation and oxidative stress in adolescence using a cross-sectional comparison of adolescents with type 1 diabetes and healthy controls.

INTRODUCTION: Little is known regarding associations between potentially modifiable lifestyle habits and early markers of cardiovascular disease (CVD) in pediatric type 1 diabetes (T1D), hindering early prevention efforts. Specific objectives are: (1) compare established risk factors (dyslipidemia, hypertension) with novel early markers for CVD (cardiac phenotype, aortic distensibility, endothelial function) in adolescents with T1D and healthy age-matched and sex-matched controls; (2) examine associations between these novel early markers with: (i) lifestyle habits; (ii) adipokines and measures of inflammation; and (iii) markers of oxidative stress among adolescents with T1D and controls, and determine group differences in these associations; (3) explore, across both groups, associations between CVD markers and residential neighbourhood features. METHODS AND ANALYSES: Using a cross-sectional design, we will compare 100 participants aged 14-18 years with T1D to 100 healthy controls. Measures include: anthropometrics; stage of sexual maturity (Tanner stages); physical activity (7-day accelerometry); sleep and sedentary behaviour (self-report and accelerometry); fitness (peak oxygen consumption); and dietary intake (three non-consecutive 24- hour dietary recalls). Repeated measures of blood pressure will be obtained. Lipid profiles will be determined after a 12- hour fast. Cardiac structure/function: non-contrast cardiac magnetic resonance imaging (CMR) images will evaluate volume, mass, systolic and diastolic function and myocardial fibrosis. Aortic distensibility will be determined by pulse wave velocity with elasticity and resistance studies at the central aorta. Endothelial function will be determined by flow-mediated dilation. Inflammatory markers include plasma leptin, adiponectin, tumour necrosis factor alpha (TNF-α), type I and type II TNF-α soluble receptors and interleukin-6 concentrations. Measures of endogenous antioxidants include manganese superoxide dismutase, glutathione peroxidase and glutathione in blood. Neighbourhood features include built and social environment indicators and air quality. ETHICS AND DISSEMINATION: This study was approved by the Sainte-Justine Hospital Research Ethics Board. Written informed assent and consent will be obtained from participants and their parents. TRIAL REGISTRATION NUMBER: NCT04304729.

COVID-19 vaccination attitudes and intention among Quebecers during the first and second waves of the pandemic: findings from repeated cross-sectional surveys.

The availability of safe and effective vaccines is a major breakthrough in controlling the COVID-19 pandemic. However, the success of the COVID-19 vaccination campaign relies on high uptake by the public. We monitored Quebecers' attitudes and intention toward COVID-19 vaccination during the first and second waves of the pandemic. Since March 2020, online surveys are conducted every week in Quebec (Canada) to assess Quebecers' adherence to recommended public health measures (3,300 respondents are surveyed every week through an online panel; respondents are not invited to answer the survey for 21 days after responding). Ten items measured respondents' attitudes and intentions regarding COVID-19 vaccination. Logistic regression models were used to identify determinants of intention to be vaccinated against COVID-19. Intention to be vaccinated against COVID-19 ranged from 76%-66% between the first and second waves. The proportion of undecided adults remained stable (12%). Being a man; being 60 years of age and over; having a university education level; having or living with someone with chronic medical conditions and increased risk perceptions of COVID-19 were the strongest predictors of COVID-19 vaccine acceptance in multivariate analysis. During data collection, COVID-19 vaccine supply was very limited. It was reassuring to note that intention to be vaccinated is the highest among older age groups that are prioritized to be vaccinated first. As more doses and vaccines will be available it will be important to enhance vaccine acceptance and uptake, especially among adults younger than 60 years of age and Quebecers with lower risk perceptions of COVID-19.

Trends in the incidence of diagnosed diabetes: a multicountry analysis of aggregate data from 22 million diagnoses in high-income and middle-income settings.

BACKGROUND: Diabetes prevalence is increasing in most places in the world, but prevalence is affected by both risk of developing diabetes and survival of those with diabetes. Diabetes incidence is a better metric to understand the trends in population risk of diabetes. Using a multicountry analysis, we aimed to ascertain whether the incidence of clinically diagnosed diabetes has changed over time. METHODS: In this multicountry data analysis, we assembled aggregated data describing trends in diagnosed total or type 2 diabetes incidence from 24 population-based data sources in 21 countries or jurisdictions. Data were from administrative sources, health insurance records, registries, and a health survey. We modelled incidence rates with Poisson regression, using age and calendar time (1995-2018) as variables, describing the effects with restricted cubic splines with six knots for age and calendar time. FINDINGS: Our data included about 22 million diabetes diagnoses from 5 billion person-years of follow-up. Data were from 19 high-income and two middle-income countries or jurisdictions. 23 data sources had data from 2010 onwards, among which 19 had a downward or stable trend, with an annual estimated change in incidence ranging from -1·1% to -10·8%. Among the four data sources with an increasing trend from 2010 onwards, the annual estimated change ranged from 0·9% to 5·6%. The findings were robust to sensitivity analyses excluding data sources in which the data quality was lower and were consistent in analyses stratified by different diabetes definitions. INTERPRETATION: The incidence of diagnosed diabetes is stabilising or declining in many high-income countries. The reasons for the declines in the incidence of diagnosed diabetes warrant further investigation with appropriate data sources. FUNDING: US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.

Zoo soundscape: Daily variation of low-to-high-frequency sounds.

Most studies assessing the impact of noises on zoo animal welfare did not measure sound frequencies outside of the human-hearing range (infrasounds and ultrasounds). Many nonhuman mammals can hear these frequencies, and because loud and variable soundscapes are potentially detrimental for animal welfare, this overlooked aspect of their acoustic environment could have important consequences. This study evaluated the soundscape of an urban zoo in a large frequency range (17.5-90,510 Hz) by measuring its average sound levels (Leq ) and variability (the difference between highest and lowest peaks). Sound data were collected for 24 hr in 25 locations (e.g., indoor, outdoor, near the amusement park). The soundscape was not considered problematic for animal welfare when looking at the average sound levels in most locations (<77-dB sound pressure level [SPL]), except for a few indoor areas and near the water park. Ultrasounds were rare, had low average sound levels, and were less variable in time. Infrasounds were always present and were the loudest and most variable sound frequencies. The soundscape was louder and more variable during the day and when visitors were present, suggesting that human-related activities were the sources of these augmentations. Indoor environments were generally louder than outdoor environments and touristic features; however, the water park was near 85-dB SPL during the day. On the basis of results, we suggest a series of mitigation actions to minimize noise-related stress in captive animals.

At-a-glance - Twenty years of diabetes surveillance using the Canadian Chronic Disease Surveillance System. / Aperçu - Vingt ans de surveillance du diabète grâce au Système canadien de surveillance des maladies chroniques.

In 1999, the Government of Canada, along with the provinces and territories, established the National Diabetes Surveillance System (NDSS) to track rates of diabetes in Canada. The NDSS used a novel method to systematically collect and report national diabetes data using linked administrative health databases. The NDSS has since evolved to become the Canadian Chronic Disease Surveillance System (CCDSS) and provides information on over 20 chronic conditions. This At-a-glance report provides the most up-to-date CCDSS information on diabetes rates in Canada. Currently, 8.8% of Canadians (9.4% male, 8.1% female, aged one year and older) live with diabetes, and approximately 549 new cases are diagnosed each day. Since 2000, the age-standardized prevalence rate has increased by an average of 3.3% per year. The age-standardized incidence rate has remained relatively stable, and all-cause mortality rates among those with diabetes have decreased by an average of 2.1% per year. This suggests that people are living longer with a diabetes diagnosis.

The Canadian Chronic Disease Surveillance System has provided important information on diabetes rates in Canada since 2000. Currently, 8.8% of Canadians (9.4% male, 8.1% female, aged one year and older) live with diabetes. The age-standardized prevalence rate of diabetes has increased over time, whereas the age-standardized incidence rate has remained stable. The all-cause mortality rate among those with diabetes has decreased, suggesting people are living longer with a diabetes diagnosis.

Le Système canadien de surveillance des maladies chroniques fournit des renseignements importants sur les taux de diabète au Canada depuis 2000. Actuellement, 8,8 % des Canadiens (9,4 % des hommes et 8,1 % des femmes d'un an et plus) sont atteints de diabète. Le taux de prévalence du diabète normalisé selon l'âge a augmenté avec le temps, tandis que le taux d'incidence normalisé selon l'âge est demeuré stable. Le taux de mortalité toutes causes confondues chez les personnes atteintes de diabète a diminué, ce qui donne à penser que l'on vit plus longtemps avec un diagnostic de diabète.

The Canadian Chronic Disease Surveillance System: A model for collaborative surveillance.

Chronic diseases have a major impact on populations and healthcare systems worldwide. Administrative health data are an ideal resource for chronic disease surveillance because they are population-based and routinely collected. For multi-jurisdictional surveillance, a distributed model is advantageous because it does not require individual-level data to be shared across jurisdictional boundaries. Our objective is to describe the process, structure, benefits, and challenges of a distributed model for chronic disease surveillance across all Canadian provinces and territories (P/Ts) using linked administrative data. The Public Health Agency of Canada (PHAC) established the Canadian Chronic Disease Surveillance System (CCDSS) in 2009 to facilitate standardized, national estimates of chronic disease prevalence, incidence, and outcomes. The CCDSS primarily relies on linked health insurance registration files, physician billing claims, and hospital discharge abstracts. Standardized case definitions and common analytic protocols are applied to the data for each P/T; aggregate data are shared with PHAC and summarized for reports and open access data initiatives. Advantages of this distributed model include: it uses the rich data resources available in all P/Ts; it supports chronic disease surveillance capacity building in all P/Ts; and changes in surveillance methodology can be easily developed by PHAC and implemented by the P/Ts. However, there are challenges: heterogeneity in administrative databases across jurisdictions and changes in data quality over time threaten the production of standardized disease estimates; a limited set of databases are common to all P/Ts, which hinders potential CCDSS expansion; and there is a need to balance comprehensive reporting with P/T disclosure requirements to protect privacy. The CCDSS distributed model for chronic disease surveillance has been successfully implemented and sustained by PHAC and its P/T partners. Many lessons have been learned about national surveillance involving jurisdictions that are heterogeneous with respect to healthcare databases, expertise and analytical capacity, population characteristics, and priorities.

Childhood maltreatment as a risk factor for diabetes: findings from a population-based survey of Canadian adults.

BACKGROUND: It is well established that childhood maltreatment (CM) is a risk factor for various mental and substance use disorders. To date, however, little research has focused on the possible long-term physical consequences of CM. Diabetes is a chronic disease, for which an association with CM has been postulated. METHODS: Based on data from a sample of 21,878 men and women from the 2012 Canadian Community Health Survey - Mental Health (CCHS - MH), this study examines associations between three types of CM (childhood physical abuse (CPA), childhood sexual abuse (CSA), and childhood exposure to intimate partner violence (CEIPV)) and diabetes in adulthood. Multiple logistic regression models were used to examine associations between CM and diabetes controlling for the effects of socio-demographic characteristics and risk factors for type 2 diabetes. RESULTS: When controlling socio-demographic characteristics, diabetes was significantly associated with reports of severe and frequent CPA (OR = 1.8) and severe and frequent CSA (OR = 2.2). A dose-response relationship was observed when co-occurrence of CSA and CPA was considered with the strongest association with diabetes being observed when both severe and frequent CSA and CPA were reported (OR = 2.6). Controlling for type 2 diabetes risk factors attenuated associations particularly for CPA. CEIPV was not significantly associated with having diabetes in adulthood. CONCLUSION: CPA and CSA are risk factors for diabetes. For the most part, associations between CPA and diabetes are mediated via risk factors for type 2 diabetes. Failure to consider severity and frequency of abuse may limit our understanding of the importance of CM as a risk factor for diabetes.

Wavelet-based algorithm for auto-detection of daily living activities of older adults captured by multiple inertial measurement units (IMUs).

A recent trend in human motion capture is the use of inertial measurement units (IMUs) for monitoring and performance evaluation of mobility in the natural living environment. Although the use of such systems have grown significantly, the development of methods and algorithms to process IMU data for clinical purposes is still limited. The aim of this work is to develop algorithms based on wavelet transform and discrete-time detection of events for the automatic segmentation of tasks related activities of daily living (ADL) from body worn IMUs. Seven healthy older adults (73 ± 4 years old) performed 10 ADL tasks in a simulated apartment during trials of different durations (3, 4, and 5 min). They wore a suit (Synertial UK Ltd IGS-180) comprised of 17 IMUs positioned strategically on body segments to capture full body motion. The proposed method automatically detected the number of template waveforms (representing each movement separately) using discrete wavelet transform (DWT) and discrete-time detection of events based on angular velocity, linear acceleration and 3D orientation data of pertinent IMUs. The sensitivity (Se.) and specificity (Sp.) of detection for the proposed method was established using time stamps of10tasks obtained from visual segmentation of each trial using the video records and the avatar provided by the system's software. At first, we identified six pertinent sensors that were strongly associated to different activities (at most two sensors/task) that allowed detection of tasks with high accuracy. The proposed algorithm exhibited significant global accuracy (N events = 1999, Se. = 97.5%, Sp. = 94%), despite the variation in the occurrences of the performed tasks (free living). The Se. varied from 94% to 100% for all the detected ADL tasks and Sp. ranged from 90% to 100% with the worst Sp. = 85 and 87% for Release_mid (reaching for object held just beyond reach at chest height) and Turning_Left tasks, respectively. This study demonstrated that DWT in conjunction with a nonlinear transform and auto-adaptive thresholding process for decision rules are highly efficient in detecting and segmenting tasks performed during free-living activities. This study also helped to determine the optimal number of sensors, and their location to detect such activities. This work lays the foundation for the automatic assessment of mobility performance within the segmented signals, as well as potentially helps differentiate populations based on their mobility patterns and symptomatology.

Auto detection and segmentation of physical activities during a Timed-Up-and-Go (TUG) task in healthy older adults using multiple inertial sensors.

BACKGROUND: Recently, much attention has been given to the use of inertial sensors for remote monitoring of individuals with limited mobility. However, the focus has been mostly on the detection of symptoms, not specific activities. The objective of the present study was to develop an automated recognition and segmentation algorithm based on inertial sensor data to identify common gross motor patterns during activity of daily living. METHOD: A modified Time-Up-And-Go (TUG) task was used since it is comprised of four common daily living activities; Standing, Walking, Turning, and Sitting, all performed in a continuous fashion resulting in six different segments during the task. Sixteen healthy older adults performed two trials of a 5 and 10 meter TUG task. They were outfitted with 17 inertial motion sensors covering each body segment. Data from the 10 meter TUG were used to identify pertinent sensors on the trunk, head, hip, knee, and thigh that provided suitable data for detecting and segmenting activities associated with the TUG. Raw data from sensors were detrended to remove sensor drift, normalized, and band pass filtered with optimal frequencies to reveal kinematic peaks that corresponded to different activities. Segmentation was accomplished by identifying the time stamps of the first minimum or maximum to the right and the left of these peaks. Segmentation time stamps were compared to results from two examiners visually segmenting the activities of the TUG. RESULTS: We were able to detect these activities in a TUG with 100% sensitivity and specificity (n = 192) during the 10 meter TUG. The rate of success was subsequently confirmed in the 5 meter TUG (n = 192) without altering the parameters of the algorithm. When applying the segmentation algorithms to the 10 meter TUG, we were able to parse 100% of the transition points (n = 224) between different segments that were as reliable and less variable than visual segmentation performed by two independent examiners. CONCLUSIONS: The present study lays the foundation for the development of a comprehensive algorithm to detect and segment naturalistic activities using inertial sensors, in hope of evaluating automatically motor performance within the detected tasks.

Profile of adults with type 2 diabetes and uptake of clinical care best practices: results from the 2011 Survey on Living with Chronic Diseases in Canada - Diabetes component.

AIMS: This study aimed to (1) describe the profile of adults with type 2 diabetes (T2D) in Canada and (2) assess the uptake of clinical care best practices, as defined by the Canadian Diabetes Association (CDA) Clinical Practice Guidelines (CPGs). METHODS: We used data from the 2011 Survey on Living with Chronic Diseases in Canada - Diabetes component. Participants were aged 20 years and older, living in the 10 Canadian provinces, with self-reported T2D. Descriptive analyses present the prevalence of complications and comorbidities, as well as the level of clinical monitoring and self-monitoring/lifestyle management recommendations participants received. RESULTS: We included 2335 participants with T2D, a mean age of 62.9 years, and high prevalence of complications/comorbidities and prescription medication use. Most participants reported being monitored as recommended for eye disease (73.9%), weight (81.0%), blood pressure (89.0%) and blood cholesterol levels (94.3%), but only 65.5% reported having at least two HbA1c tests during the last year and 46.5% reported an annual foot examination by a health professional. About two-thirds of the participants reported having received recommendations on weight management (59.9%) and physical activity (64.7%) from a health professional in the previous year; only 47.8% of the participants reported having received diet counseling to improve diabetes control. CONCLUSION: Although the uptake of CDA CPGs for clinical and self-monitoring was high, with the majority of the participants reporting meeting most indicators, it was lower for HbA1c measurement and foot examination. Uptake of lifestyle management recommendations provided by health professionals was also significantly lower.

Self-monitoring of blood glucose in type 2 diabetes: Results of the 2011 Survey on Living with Chronic Diseases in Canada.

BACKGROUND: For insulin-treated patients with type 2 diabetes mellitus (T2DM), self-monitoring of blood glucose (SMBG) may be vital in adjusting insulin dosages. For patients who do not use insulin, evidence supporting the use of SMBG is inconclusive. METHODS: The prevalence, frequency and correlates of SMBG are examined. Data pertain to 2,682 individuals aged 20 or older with T2DM who responded to the 2011 Survey on Living with Chronic Diseases in Canada. Multivariate prevalence rate ratios for associations between respondents' characteristics and their use of SMBG were derived using binomial regression models. RESULTS: A large majority of the study population (87.8%) reported SMBG. No difference in the prevalence of SMBG was observed between oral medication users compared with insulin users; however, the frequency of SMBG was lower for those taking oral medication only. Significant determinants of SMBG were a health professional's recommendation, having insurance coverage, and receiving an A1C test from a health professional. INTERPRETATION: The use of SMBG by adults with T2DM is common, and does not differ between those taking oral medication only and those treated with insulin.