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1.
Curr Oncol ; 30(1): 641-652, 2023 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-36661698

RESUMO

Oncology programs across Canada are reaching capacity as more Canadians are diagnosed with and treated for cancer each year. There is an increasing need to share care with family doctors, however it is unclear how this type of care impacts patient experiences, particularly while receiving active treatment. Retrospective data from the 2021 Ambulatory Oncology Patient Satisfaction Survey (AOPSS) in Alberta, Canada was used in this study. A unique question on the Alberta survey asks patients about their family doctor's involvement during their cancer care. Patient satisfaction across the six domains of person-centred care on the AOPSS was analyzed based on how involved a patient's family doctor was. Compared to patients who indicated their family doctor was "Not involved", patients with "Very involved" family doctors had significantly higher satisfaction scores in all six domains of care. The three domains which showed the largest positive impact of family doctor involvement were: Coordination & Integration of Care, Emotional Concerns, and Information, Communication & Education. The results demonstrate that involving family doctors in cancer care can be beneficial for patients. Based on the observed satisfaction increases in this study, shared care models may be preferred by many patients. These models of care can also help alleviate strain and capacity issues within cancer programs. The results could be used to support recommendations for cancer care teams to regularly involve and communicate with family doctors, to ensure that patients receive comprehensive and tailored care from all their health care providers.


Assuntos
Neoplasias , Satisfação do Paciente , Humanos , Alberta , Estudos Retrospectivos , Pacientes , Neoplasias/terapia , Neoplasias/psicologia
2.
BMJ Open ; 13(1): e067606, 2023 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-36697045

RESUMO

INTRODUCTION: Vaginal pain during intercourse and urinary incontinence are common complaints after gynaecological cancer treatments. Pelvic health physiotherapy treatments aim at optimising function through education on the use of vaginal moisturisers, dilation therapy programme and pelvic floor muscle training. Given that barriers such as time, travel, and costs are known to limit access to physiotherapy services, a virtual pelvic health physiotherapy programme may help to facilitate access. The primary objective of this study is to identify preferences, barriers and facilitators from individuals with gynaecological cancer regarding virtual pelvic healthcare survivorship care. METHODS AND ANALYSIS: This patient-oriented, mixed-methods study will involve an online cross-sectional survey data (phase I) and qualitative data from a series of virtual focus groups (phase II). PHASE I: an anonymous survey will be used to assess the demographics, health status, prevalence of urogenital symptoms, as well as knowledge, barriers and facilitators to pelvic health services of people with gynaecological cancer. A total of N=50 participants from Canada will be recruited through convenience and self-selection sampling. PHASE II: a series of virtual semi-structured focus groups will be conducted with 10-15 participants on key topics related to virtual pelvic healthcare. Interviews will be audio-recorded and transcribed, from which key themes and quotes will be identified. An interpretive description qualitative method will guide analysis and implementation of results. ETHICS AND DISSEMINATION: Approval from the Health Research Ethics Board of Alberta-Cancer Committee (HREBA.CC-21-0498) and of the CISSS Bas-Saint-Laurent (CISSSBSL-2021-10) have been obtained. Informed, electronically signed consent will be required from all participants. Results from this work will be published in a peer-reviewed journal and will be used to inform the development and implementation of a new Pelvic eHealth Module for individuals treated for gynaecological cancers. This module will be incorporated into a comprehensive educational and exercise programme offered by a web-based application.


Assuntos
Atenção à Saúde , Neoplasias , Feminino , Humanos , Pesquisa Qualitativa , Estudos Transversais , Diafragma da Pelve , Alberta
3.
BMC Health Serv Res ; 23(1): 58, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36658565

RESUMO

BACKGROUND: Post-stroke visual impairment (VI) is a common but under-recognized care challenge. Common manifestations of post-stroke VI include: diplopia, homonymous hemianopia, oscillopsia secondary to nystagmus, and visual inattention or neglect. In acute care settings, post-stroke VI recognition and treatment are often sub-optimal as emphasis is placed on survival. Stroke survivors with VI often face inconsistencies when accessing care out of hospital because variable availability and subsidization of visual rehabilitation. We sought to identify gaps in care experienced by stroke survivors with VI from stroke survivors' and care providers' perspectives. METHODS: We conducted a qualitative description study across 12 care sites in Alberta, Canada, using semi-structured interviews. Survivor interviews focused on the health system experience. Provider interviews discussed approaches to care, perceived gaps, and current resources. Interviews were audio-recorded and transcribed. Iterative content analysis was completed using NVivo 12. We promoted rigour through an audit trail, open-ended questions, thick description, and collaborative coding. RESULTS: We completed 50 interviews: 19 survivor interviews and 31 provider interviews. The majority of survivors were male (n = 14) and recruited from community settings (n = 16). Providers varied in profession and location within the care continuum. Two key themes emerged from the provider and survivor interviews pertaining to (a) facets of visual rehabilitation (sub-themes: access, resources, and multidisciplinary professional interaction); and (b) functioning with post-stroke VI (sub-themes: early experiences post-stroke and living with VI in the real world). CONCLUSIONS: The visual rehabilitation model needs to be optimized to ensure transparent inter-disciplinary communication and efficient referral pathways. Future research will focus on evaluating the effectiveness of post-stroke care from multiple perspectives in Alberta.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Masculino , Feminino , Alberta , Acidente Vascular Cerebral/complicações , Sobreviventes , Pesquisa Qualitativa , Transtornos da Visão/etiologia
4.
BMC Prim Care ; 24(1): 27, 2023 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-36690937

RESUMO

BACKGROUND: The COVID-19 pandemic challenged healthcare systems worldwide and disrupted primary care, particularly prevention, screening, and lifestyle counselling. BETTER WISE is a comprehensive and structured approach that proactively addresses cancer and chronic disease prevention and screening (CCDPS), including cancer survivorship and screening for poverty and lifestyle risks for patients aged 40 to 65. Patients from 13 primary care clinics (urban, rural, and remote) in Alberta, Ontario, and Newfoundland & Labrador, Canada were invited for a 1-hour visit with a prevention practitioner (PP), a member of the primary care team with specialized training in CCDPS to provide patients an overview of eligible screening and assist with lifestyle counselling. This qualitative sub-study describes how the COVID-19 pandemic impacted BETTER WISE in a constantly changing medical landscape. METHODS: We conducted 17 focus groups and 48 key informant interviews with a total of 132 primary care providers (PPs, physicians, allied health professionals, and clinic staff) over three different time points to better understand their perspectives on the BETTER WISE project. We also received 585 patient feedback forms of the 1005 patients who agreed to participate in the study. We also collected field notes and memos and employed thematic analysis using a constant comparative method focused on the impact of the pandemic on BETTER WISE. RESULTS: We identified four themes related to how the COVID-19 pandemic impacted the BETTER WISE study: 1) Switch of in-person visits to visits over the phone; 2) Lack of access to preventive care and delays of screening tests; 3) Changes in primary care providers' availability and priorities; 4) Mental health impacts of the pandemic on patients and primary care providers. CONCLUSIONS: The COVID-19 pandemic had and, at the time of writing, continues to have an impact on primary care, particularly on prevention, screening, and lifestyle counselling. Despite structural, procedural, and personal challenges throughout different waves of the pandemic, the primary care clinics participating in BETTER WISE were able to complete the study. Our results underscore the importance of the role of primary care providers in adapting to changing circumstances and support of patients in these challenging times. TRIAL REGISTRATION: This qualitative study is a sub-component of the BETTER WISE pragmatic, cRCT, trial registration ISRCTN21333761 (date of registration 19/12/2016).


Assuntos
COVID-19 , Humanos , Pandemias , Pesquisa Qualitativa , Grupos Focais , Doença Crônica , Alberta
5.
BMC Health Serv Res ; 23(1): 51, 2023 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-36653820

RESUMO

BACKGROUND: Directly-funded home care (DF) provides government funds to people who need assistance with the activities of daily living, allowing them to arrange their own services. As programs expand globally, many allow DF clients to hire home care agencies to organize their services rather than finding their own workers. In Canada, half of the DF home care programs allow users to purchase agency services. The goal of this research is to describe the role of agency providers in DF home care in Canada and consider potential equity implications for service access from the perspectives of clients and families. METHODS: Framed with intersectionality, the study included online focus groups with families and clients (n = 56) in the two Canadian provinces of Alberta and Manitoba between June 2021-April 2022. All transcripts underwent qualitative thematic analysis using open and axial coding techniques. Each transcript was analyzed by two of three possible independent coders using Dedoose qualitative analysis software. RESULTS: The article presents five thematic findings. First, the focus groups document high rates of satisfaction with the care regardless of whether the client uses agency providers. Second, agency providers mediate some of the administrative barriers and emotional strain of using DF home care, and this is especially important for family caregivers who are working or have additional care responsibilities. Third, there are out-of-pocket expenses reported by most participants, with agency clients describing administrative fees despite lower pay for the frontline care workers. Fourth, agencies are not generally effective for linguistic and/or cultural matching between workers and families. Finally, we find that DF care programs cannot compensate for a limited informal support network. CONCLUSIONS: Clients and families often intentionally choose DF home care after negative experiences with other public service options, yet the results suggest that in some Canadian contexts, DF home care is a privilege only afforded to some. Given the growing inequalities that exist in Canadian society, all public home care options must be open to all who need it, irrespective of ability to pay, degree of social support, or competence in the English language.


Assuntos
Atividades Cotidianas , Serviços de Assistência Domiciliar , Humanos , Canadá , Cuidadores , Manitoba , Alberta
6.
BMC Health Serv Res ; 23(1): 2, 2023 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-36593502

RESUMO

BACKGROUND: Transition-age youth (TAY) with chronic health conditions frequently experience co-occurring mental health conditions. However, little is known about the perspectives of TAY with co-occurring diagnoses preparing to exit pediatric health and mental health services. Research is needed to understand the impact of a mental health condition on transition readiness and self-management in TAY with chronic health conditions. METHODS: TAY (aged 16-20 years) with co-occurring chronic health and mental health conditions were recruited in Alberta, Canada. Nine semi-structured individual interviews were completed by phone or videoconference, and transcribed verbatim. Guided by qualitative description, we analyzed the data using thematic analysis in partnership with five young adults with lived experience in the health/mental health systems. RESULTS: Participants shared their experiences living with simultaneous physical and mental health concerns and preparing for transition to adult care. Our analysis revealed three overarching themes: 1) "they're intertwined": connections between chronic health and mental health conditions in TAY, 2) impact of mental health on transition readiness and self-management, and 3) recommendations for service provision from the perspectives of TAY. CONCLUSIONS: Our findings highlighted the myriad ways in which physical and mental health are connected as TAY prepare for service transitions using specific examples and powerful metaphors. TAY endorsed the importance of providers discussing these connections in routine clinical care. Future research should involve co-designing and evaluating educational material addressing this topic with diverse TAY, caregivers, and service providers.


Assuntos
Transtornos Mentais , Saúde Mental , Adulto Jovem , Humanos , Adolescente , Criança , Transtornos Mentais/terapia , Transtornos Mentais/psicologia , Pesquisa Qualitativa , Cuidadores/psicologia , Doença Crônica , Alberta
7.
Vet Parasitol Reg Stud Reports ; 37: 100811, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36623894

RESUMO

Brugia is a vector-transmitted nematode that is commonly known for its zoonotic significance of causing lymphatic filariasis in Asia and Oceanic regions of the world. In addition to public health concerns, Brugia species have been known to infect domestic animals, including dogs and cats. However, information is scarce regarding genus Brugia in North America, and rare infections have been noted in domestic cats, humans, and other wild mammals. Herein, we document the first reported case of a Brugia species infection in a dog from North America and the first molecular characterization of the species in question. A three-year-old German Shepard from Alberta, Canada presented to a local veterinary clinic with a facial subcutaneous nodule that was surgically excised. Histopathology identified an enlarged buccal lymph node containing small foci of eosinophilic and granulomatous inflammation within the cortex and capsule. This inflammation was associated with adult filarioid nematodes localized within lymphatic vessels or adjacent connective tissue. Genomic DNA was extracted from formalin-fixed paraffin-embedded tissue, and PCR targeting the Hha1 repeat and the partial cytochrome oxidase c subunit 1 (cox1) of the mitochondrial DNA confirmed parasite identity as Brugia sp. While we can rule out B. beaveri being the causative agent, we cannot exclude B. lepori infection or a third uncharacterized Brugia species. Veterinarians and physicians should be made aware of North American Brugia infections and their possible health concerns.


Assuntos
Doenças do Cão , Filariose , Animais , Cães , Alberta , Brugia/genética , Doenças do Cão/diagnóstico , Doenças do Cão/parasitologia , Filariose/diagnóstico , Filariose/veterinária , Filariose/parasitologia , Inflamação/veterinária
8.
JAMA Health Forum ; 4(1): e225041, 2023 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-36637814

RESUMO

Importance: Canada legalized cannabis in October 2018 but initially prohibited the sale of edibles (eg, prepackaged candies). Starting in January 2020, some provinces permitted the sale of commercial cannabis edibles. The association of legalizing cannabis edibles with unintentional pediatric poisonings is uncertain. Objective: To evaluate changes in proportions of all-cause hospitalizations for poisoning due to cannabis in children during 3 legalization policy periods in Canada's 4 most populous provinces (including 3.4 million children aged 0-9 years). Design, Setting, and Participants: This repeated cross-sectional study included all hospitalizations in children aged 0 to 9 years in Ontario, Alberta, British Columbia, and Quebec between January 1, 2015, and September 30, 2021. Exposures: Prelegalization (January 2015 to September 2018); period 1, in which dried flower only was legalized in all provinces (October 2018 to December 2019); and period 2, in which edibles were legalized in 3 provinces (exposed provinces) and restricted in 1 province (control province) (January 2020 to September 2021). Main Outcomes and Measures: The primary outcome was the proportion of hospitalizations due to cannabis poisoning out of all-cause poisoning hospitalizations. Data analysis was performed using descriptive statistics and Poisson regression models. Results: During the 7-year study period, there were 581 pediatric hospitalizations for cannabis poisoning (313 [53.9%] boys; 268 [46.1%] girls; mean [SD] age, 3.6 [2.5] years) and 4406 hospitalizations for all-cause poisonings. Of all-cause poisoning hospitalizations, the rate per 1000 due to cannabis poisoning before legalization was 57.42 in the exposed provinces and 38.50 in the control province. During period 1, the rate per 1000 poisoning hospitalizations increased to 149.71 in the exposed provinces (incidence rate ratio [IRR], 2.55; 95% CI, 1.88-3.46) and to 117.52 in the control province (IRR, 3.05; 95% CI, 1.82-5.11). During period 2, the rate per 1000 poisoning hospitalizations due to cannabis more than doubled to 318.04 in the exposed provinces (IRR, 2.16; 95% CI, 1.68-2.80) but remained similar at 137.93 in the control province (IRR, 1.18; 95% CI, 0.71-1.97). Conclusions and Relevance: This cross-sectional study found that following cannabis legalization, provinces that permitted edible cannabis sales experienced much larger increases in hospitalizations for unintentional pediatric poisonings than the province that prohibited cannabis edibles. In provinces with legal edibles, approximately one-third of pediatric hospitalizations for poisonings were due to cannabis. These findings suggest that restricting the sale of legal commercial edibles may be key to preventing pediatric poisonings after recreational cannabis legalization.


Assuntos
Cannabis , Alucinógenos , Feminino , Masculino , Criança , Humanos , Pré-Escolar , Cannabis/efeitos adversos , Estudos Transversais , Alberta , Analgésicos , Hospitalização
9.
Health Promot Chronic Dis Prev Can ; 43(1): 40-48, 2023 Jan.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-36651885

RESUMO

INTRODUCTION: Current published long-term provincial or territorial congenital anomaly data are lacking for Canada. We report on prevalence (per 1000 total births) and trends in 1997-2019, in Alberta, Canada, for selected congenital anomalies. Associated risk factors are also discussed. METHODS: We used data from the Alberta Congenital Anomalies Surveillance System (ACASS) to calculate the prevalence and perform chi-square linear trend analyses. RESULTS: From 1997 to 2019, the overall prevalence of neural tube defects was stable, at 0.74 per 1000 total births. The same was true for spina bifida (0.38), orofacial clefts (1.99), more severe CHDs (transposition of the great arteries, 0.38; tetralogy of Fallot, 0.33; and hypoplastic left heart syndrome, 0.32); and gastroschisis (0.38). Anencephaly, cleft palate and anorectal malformation significantly decreased with a prevalence of 0.23, 0.75 and 0.54 per 1000 total births, respectively. Significantly increasing trends were reported for anotia/microtia (0.24), limb reduction anomalies (0.73), omphalocele (0.36) and Down syndrome (2.21) and for hypospadias and undescended testes (4.68 and 5.29, respectively, per 1000 male births). CONCLUSION: Congenital anomalies are an important public health concern with significant social and societal costs. Surveillance data gathered by ACASS for over 40 years can be used for planning and policy decisions and the evaluation of prevention strategies. Contributing genetic and environmental factors are discussed as is the need for continued surveillance and research.


Assuntos
Fenda Labial , Fissura Palatina , Anormalidades Congênitas , Transposição dos Grandes Vasos , Masculino , Humanos , Alberta/epidemiologia , Prevalência , Anormalidades Congênitas/epidemiologia
10.
Virus Res ; 324: 199032, 2023 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-36584760

RESUMO

This triennial International dsRNA Virus Symposium covered original data which have accrued during the most recent five years. In detail, the genomic diversity of these viruses continued to be explored; various structure-function studies were carried out using reverse genetics and biophysical techniques; intestinal organoids proved to be very suitable for special pathogenesis studies; and the potential of next generation rotavirus vaccines including use of rotavirus recombinants as vectored vaccine candidates was explored. 'Non-lytic release of enteric viruses in cloaked vesicles' was the topic of the keynote lecture by Nihal Altan-Bonnet, NIH, Bethesda, USA. The Jean Cohen lecturer of this meeting was Polly Roy, London School of Hygiene and Tropical Medicine, who spoke on aspects of the replication cycle of bluetongue viruses, and how some of the data are similar to details of rotavirus replication.


Assuntos
Infecções por Rotavirus , Rotavirus , Vírus , Animais , Humanos , Alberta , Vírus de RNA de Cadeia Dupla , Rotavirus/genética , Replicação Viral/genética
11.
J Environ Sci (China) ; 125: 843-850, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36375966

RESUMO

With a unique and large size of testing results of 1,842 samples collected from 12 wastewater treatment plants (WWTP) for 14 months through from low to high prevalence of COVID-19, the sensitivity of RT-qPCR detection of SARS-CoV-2 RNA in wastewater that correspond to the communities was computed by using Probit analysis. This study determined the number of new COVID-19 cases per 100,000 population required to detect SARS-CoV-2 RNA in wastewater at defined probabilities and provided an evidence-based framework of wastewater-based epidemiology surveillance (WBE). Input data were positive and negative test results of SARS-CoV-2 RNA in wastewater samples and the corresponding new COVID-19 case rates per 100,000 population served by each WWTP. The analyses determined that RT-qPCR-based SARS-CoV-2 RNA detection threshold at 50%, 80% and 99% probability required a median of 8 (range: 4-19), 18 (9-43), and 38 (17-97) of new COVID-19 cases /100,000, respectively. Namely, the positive detection rate at 50%, 80% and 99% probability were 0.01%, 0.02%, and 0.04% averagely for new cases in the population. This study improves understanding of the performance of WBE SARS-CoV-2 RNA detection using the large datasets and prolonged study period. Estimated COVID-19 burden at a community level that would result in a positive detection of SARS-CoV-2 in wastewater is critical to support WBE application as a supplementary warning/monitoring system for COVID-19 prevention and control.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , SARS-CoV-2/genética , RNA Viral/genética , RNA Viral/análise , Alberta/epidemiologia
12.
Sci Total Environ ; 856(Pt 1): 158964, 2023 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-36167131

RESUMO

Wastewater-based surveillance (WBS) data normalization is an analyte measurement correction that addresses variations resulting from dilution of fecal discharge by non-sanitary sewage, stormwater or groundwater infiltration. No consensus exists on what WBS normalization parameters result in the strongest correlations and lead time between SARS-CoV-2 WBS data and COVID-19 cases. This study compared flow, population size and biomarker normalization impacts on the correlations and lead times for ten communities in twelve sewersheds in Alberta (Canada) between September 2020 and October 2021 (n = 1024) to determine if normalization by Pepper Mild Mottle Virus (PMMoV) provides any advantages compared to other normalization parameters (e.g., flow, reported and dynamic population sizes, BOD, TSS, NH3, TP). PMMoV concentrations (GC/mL) corresponded with plant influent flows and were highest in the urban centres. SARS-CoV-2 target genes E, N1 and N2 were all negatively associated with wastewater influent pH, while PMMoV was positively associated with temperature. Pooled data analysis showed that normalization increased ρ-values by almost 0.1 and was highest for ammonia, TKN and TP followed by PMMoV. Normalization by other parameters weakened associations. None of the differences were statistically significant. Site-specific correlations showed that normalization of SARS-CoV-2 data by PMMoV only improved correlations significantly in two of the twelve systems; neither were large sewersheds or combined sewer systems. In five systems, normalization by traditional wastewater strength parameters and dynamic population estimates improved correlations. Lead time ranged between 1 and 4 days in both pooled and site-specific comparisons. We recommend that WBS researchers and health departments: a) Investigate WWTP influent properties (e.g., pH) in the WBS planning phase and use at least two parallel approaches for normalization only if shown to provide value; b) Explore normalization by wastewater strength parameters and dynamic population size estimates further; and c) Evaluate purchasing an influent flow meter in small communities to support long-term WBS efforts and WWTP management.


Assuntos
COVID-19 , Humanos , SARS-CoV-2 , Alberta , Chumbo , Vigilância Epidemiológica Baseada em Águas Residuárias
13.
Environ Res ; 219: 114999, 2023 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-36565843

RESUMO

OBJECTIVE: Ambient extreme temperatures have been associated with mental and behavior disorders (MBDs). However, few studies have assesed whether vulnerability factors such as ambient air pollution, pre-existing mental health conditions and residential environmental factors increase susceptibility. This study aims to evaluate the associations between short-term variations in outdoor ambient extreme temperatures and MBD-related emergency department (ED) visits and how these associations are modified by vulnerability factors. METHODS: We conducted a case-crossover study of 9,958,759 MBD ED visits in Alberta and Ontario, Canada made between March 1st, 2004 and December 31st, 2020. Daily average temperature was assigned to individual cases with ED visits for MBD using gridded data at a 1 km × 1 km spatial resolution. Conditional logistic regression was used to estimate associations between extreme temperatures (i.e., risk of ED visit at the 2.5th percentile temperature for cold and 97.5th percentile temperature for heat for each health region compared to the minimal temperature risk) and MBD ED visits. Age, sex, pre-existing mental health conditions, ambient air pollution (i.e. PM2.5, NO2 and O3) and residential environmental factors (neighborhood deprivation, residential green space exposure and urbanization) were evaluated as potential effect modifiers. RESULTS: Cumulative exposure to extreme heat over 0-5 days (odds ratio [OR] = 1.145; 95% CI: 1.121-1.171) was associated with ED visits for any MBD. However, cumulative exposure to extreme cold was associated with lower risk of ED visits for any MBD (OR = 0.981; 95% CI: 0.976-0.987). We also found heat to be associated with ED visits for specific MBDs such as substance use disorders, dementia, neurotic disorders, schizophrenia and personality behavior disorder. Individuals with pre-existing mental health conditions, those exposed to higher daily concentrations of NO2 and O3 and those residing in neighborhoods with greater material and social deprivation were at higher risk of heat-related MBD ED visits. Increasing tree canopy coverage appeared to mitigate risks of the effect of heat on MBD ED visits. CONCLUSIONS: Findings provide evidence that the impacts of heat on MBD ED visits may vary across different vulnerability factors.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Transtornos Mentais , Humanos , Poluentes Atmosféricos/análise , Temperatura , Temperatura Alta , Estudos Cross-Over , Dióxido de Nitrogênio/análise , Transtornos Mentais/epidemiologia , Alberta/epidemiologia , Fatores de Risco , Serviço Hospitalar de Emergência
14.
J Environ Sci (China) ; 127: 169-186, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36522051

RESUMO

The oil sands in Northern Alberta are the largest oil sands in the world, providing an important economic resource for the Canadian energy industry. The extraction of petroleum in the oil sands begins with the addition of hot water to the bituminous sediment, generating oil sands process-affected water (OSPW), which is acutely toxic to organisms. Trillions of litres of OSPW are stored on oil sands mining leased sites in man-made reservoirs called tailings ponds. As the volume of OSPW increases, concerns arise regarding the reclamation and eventual release of this water back into the environment. OSPW is composed of a complex and heterogeneous mix of components that vary based on factors such as company extraction techniques, age of the water, location, and bitumen ore quality. Therefore, the effective remediation of OSPW requires the consideration of abiotic and biotic constituents within it to understand short and long term effects of treatments used. This review summarizes selected chemicals and organisms in these waters and their interactions to provide a holistic perspective on the physiochemical and microbial dynamics underpinning OSPW .


Assuntos
Campos de Petróleo e Gás , Poluentes Químicos da Água , Humanos , Poluentes Químicos da Água/análise , Ácidos Carboxílicos , Água/química , Alberta
15.
Nurs Adm Q ; 47(1): 72-83, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36469375

RESUMO

The COVID-19 pandemic impacted nursing education and health care systems alike. Increases in staff absenteeism along with increased hospitalizations have strained health systems across the globe. Postsecondary institutions (PSIs) were required to remove students from clinical placements, thus delaying nursing students' ability to complete their programs, and in turn, contributing to the nursing workforce challenges. Health care organizations and PSIs had to collaborate innovatively to support the health care response to the pandemic while continuing to educate and graduate students to expand the nursing workforce. In Alberta, the collaboration between the health system and PSIs led to the creation of an undergraduate nursing employee/student hybrid (UNE/Hybrid) role. This role was not only a response to the nursing workforce challenges created by the pandemic, but it provided nursing students with positive learning clinical placements ensuring that they completed their program in a timely manner. This role was designed to assist with the fourth wave of the pandemic (omicron variant), which was expected to be the most severe wave in terms of hospitalizations and increased staff absences. The UNE/Hybrid role allowed nursing students to complete the required learning for their final preceptorships and/or complete leadership placements in a paid role while being integrated into the unit culture and becoming part of the team. The initiative's results, including its successes, challenges, and lessons, are discussed.


Assuntos
COVID-19 , Bacharelado em Enfermagem , Estudantes de Enfermagem , Humanos , Bacharelado em Enfermagem/métodos , COVID-19/epidemiologia , Alberta , Pandemias , SARS-CoV-2
16.
Nurs Adm Q ; 47(1): 20-30, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36469371

RESUMO

Design, implementation, and evaluation of effective multicomponent interventions typically take decades before value is realized even when value can be measured. Value-based health care, an approach to improving patient and health system outcomes, is a way of organizing health systems to transform outcomes and achieve the highest quality of care and the best possible outcomes with the lowest cost. We describe 2 case studies of value-based health care optimized through a learning health system framework that includes Strategic Clinical Networks. Both cases demonstrate the acceleration of evidence to practice through scientific, financial, structural administrative supports and partnerships. Clinical practice interventions in both cases, one in perioperative services and the other in neonatal intensive care, were implemented across multiple hospital sites. The practical application of using an innovation pipeline as a structural process is described and applied to these cases. A value for money improvement calculator using a benefits realization approach is presented as a mechanism/tool for attributing value to improvement initiatives that takes advantage of available system data, customizing and making the data usable for frontline managers and decision makers. Health care leaders will find value in the descriptions and practical information provided.


Assuntos
Sistema de Aprendizagem em Saúde , Recém-Nascido , Humanos , Alberta , Atenção à Saúde , Hospitais
17.
AIDS Patient Care STDS ; 37(1): 1-10, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36576421

RESUMO

Unsuppressed HIV viremia damages immunity and increases the risk for secondary HIV transmission. Successful engagement of persons with HIV (PWH) into care resulting in viral suppression is vital. PWH already engaged in care, who, after achieving viral suppression, experience viral breakthrough episodes (VBEs) with a sequence of suppressed/unsuppressed/suppressed viral loads remain problematic. We examined the frequency and outcomes of PWH experiencing VBE. HIV care is provided at no cost to all patients under Alberta's universal health program. All PWH followed at Southern Alberta Clinic, Canada, with two or more viral load tests between January 1, 2010, and January 1, 2020, were evaluated. Sociodemographic, clinical, and lifestyle variables were determined along with health outcomes (CD4 levels, HIV-related hospitalizations, and HIV/AIDS-related mortality). Descriptive and multi-variable analyses were performed comparing PWH with and without VBEs. Of 2096 PWH, 386 (18%) experienced one or more VBEs. A higher risk of VBEs was seen in adjusted analyses in those diagnosed age ≤40 years. Increased risk of VBE was seen with injection drug use (46%) and in heterosexuals (56%) compared with MSM. Experience of intimate partner violence, unstable housing, homelessness, and past incarceration also increased risks by 36%, 44% 79%, and 51%, respectively. PWH with VBEs experienced lower CD4 counts (median -417/mm3 vs. 576/mm3), higher rates of HIV-related hospitalizations (16% vs. 5%), and a 67% increased risk of death (95% confidence interval 1.17-2.39) over the study period. Nearly 20% of all PWH, after achieving viral suppression, experienced VBEs. Distinct clinical, lifestyle, and life experiences predict PWH at greatest risk for more than one VBEs. Serious negative health outcomes of VBEs were identified, suggesting that novel customized care programming is required for PWH at greatest risk.


Assuntos
Síndrome de Imunodeficiência Adquirida , Infecções por HIV , Humanos , Adulto , Alberta/epidemiologia , Infecções por HIV/complicações , Saúde Pública , Síndrome de Imunodeficiência Adquirida/complicações , Contagem de Linfócito CD4
18.
Sci Rep ; 12(1): 20885, 2022 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-36463245

RESUMO

Children with unhealthy eating behaviours are more likely to experience poor physical and mental health. Few studies have investigated the importance of eating patterns for health-related quality of life (HRQoL) among children. This study aimed to identify common eating patterns, and their associations with HRQoL among Canadian children. Data were collected from 9150 grade five students (aged 10-11 years) in repeat cross-sectional population-based surveys in Alberta, Canada. Students' eating behaviours were analyzed using latent class analysis to identify the eating patterns. We applied multilevel multivariable logistic regression to examine the association of the eating patterns with HRQoL. We identified three groups of children with distinct eating patterns: eating healthy (52%), less healthy (31%) and unhealthy (17%). The first group had a higher proportion of students engaged in healthy eating behaviours. The unhealthy pattern group (third group) included a higher proportion of students with poor eating behaviours. Students' eating behaviours in the second group were healthier than the third group but less healthy than the first group. Children with unhealthy and less healthy patterns were more likely to experience lower HRQoL than children with the healthy pattern. Health promotion programs effective in improving healthy eating patterns may not only reduce the risk for chronic diseases in the long term, but also improve the HRQoL in the short term.


Assuntos
Nível de Saúde , Qualidade de Vida , Criança , Humanos , Alberta , Estudos Transversais , Comportamento Alimentar
19.
Can Vet J ; 63(12): 1247-1251, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36467383

RESUMO

Objective: To determine the prevalence of Mycobacterium avium spp. paratuberculosis (MAP) in cow-calf herds located in the prairie provinces of Alberta, Saskatchewan, and Manitoba using a serum ELISA test. Animals: Study herds were recruited from the Western Canadian Cow-calf Surveillance Network (WC3SN) designed to monitor factors related to the health and productivity of cow-calf herds. Overall, 1791 cows from 92 herds were included in the study. Procedure: Blood samples were collected from 20 cows per herd in a systematic random fashion by private veterinarians in the fall of 2014. A serum ELISA (IDEXX, Westbrook, Maine, USA) test was used for the detection of MAP antibodies in the blood samples. Results: The cow level seroprevalence across all 3 provinces was 1.5%. Alberta had the lowest cow seroprevalence (1.3%) followed by Saskatchewan (1.7%), and Manitoba (2.1%). Herd level data showed that 24% of herds had at least 1 positive animal and 5% had at least 2 positive animals. Seroprevalence estimates varied between geographical regions within each province and with herd size. Conclusions: The apparent prevalence of MAP in prairie cow-calf herds remains low and similar to past estimates for the region. However, controlling the spread of Johne's disease in the western Canadian cow-calf herd should be considered an important discussion point in the beef industry. Clinical relevance: Ongoing surveillance of Johne's disease in western Canadian beef herds is necessary for mitigating disease spread before it becomes a disease of major concern within the industry.


Séroprévalence de Mycobacterium avium spp. paratuberculosis dans les troupeaux de vaches-veaux situés dans les provinces des Prairies du Canada. Objectif: Pour déterminer la prévalence de Mycobacterium avium spp. paratuberculosis (MAP) dans des troupeaux de vachesveaux situés dans les provinces des Prairies de l'Alberta, de la Saskatchewan et du Manitoba à l'aide d'un test ELISA sérique. Animaux: Les troupeaux à l'étude ont été recrutés à partir du Réseau de surveillance des vaches-veaux de l'Ouest canadien (WC3SN) conçu pour surveiller les facteurs liés à la santé et à la productivité des troupeaux de vaches-veaux. Au total, 1791 vaches de 92 troupeaux ont été incluses dans l'étude. Procédure: Des échantillons de sang ont été prélevés de 20 vaches par troupeau de façon aléatoire systématique par des vétérinaires en pratique privée à l'automne 2014. Un test ELISA sérique (IDEXX, Westbrook, Maine, États-Unis) a été utilisé pour la détection des anticorps MAP dans les échantillons de sang. Résultats: La séroprévalence chez les vaches dans les trois provinces était de 1,5 %. L'Alberta avait la plus faible séroprévalence chez les vaches (1,3 %), suivie de la Saskatchewan (1,7 %) et du Manitoba (2,1 %). Les données au niveau du troupeau ont montré que 24 % des troupeaux avaient au moins un animal positif et 5 % avaient au moins deux animaux positifs. Les estimations de la séroprévalence variaient entre les régions géographiques de chaque province et selon la taille du troupeau. Conclusions: La prévalence apparente de la MAP dans les troupeaux de vaches-veaux des Prairies demeure faible et semblable aux estimations antérieures pour la région. Cependant, la maitrise de la propagation de la maladie de Johne dans le troupeau vache-veau de l'Ouest canadien devrait être considérée comme un point de discussion important dans l'industrie bovine. Pertinence clinique: La surveillance continue de la maladie de Johne dans les troupeaux de bovins de boucherie de l'Ouest canadien est nécessaire pour atténuer la propagation de la maladie avant qu'elle ne devienne une maladie préoccupante au sein de l'industrie.(Traduit par Dr Serge Messier).


Assuntos
Doenças dos Bovinos , Mycobacterium avium subsp. paratuberculosis , Paratuberculose , Feminino , Bovinos , Animais , Paratuberculose/epidemiologia , Estudos Soroepidemiológicos , Pradaria , Alberta/epidemiologia , Doenças dos Bovinos/epidemiologia
20.
PLoS One ; 17(12): e0278472, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36454791

RESUMO

More than 1,300 Canadians are diagnosed with cervical cancer annually, which is nearly preventable through human papillomavirus (HPV) immunization. Across Canada, coverage rates remain below the 90% target set out by the Action Plan for the Elimination of Cervical Cancer in Canada (2020-2030). To support this Plan, the Canadian Partnership Against Cancer has commissioned the Urban Public Health Network (UPHN) to coordinate a quality improvement project with Canada's school-based HPV immunization programs. In Alberta, the UPHN partnered with Alberta Health Services (AHS) for this work. This study has one overarching research question: what are parent/guardian and program stakeholder perceived barriers, enablers and opportunities to immunization for youth as part of the school-based HPV immunization program in Alberta? This study uses a mixed-methods sequential explanatory design. A survey will be emailed to a sample of Albertans with children aged 11-17 years. Questions will be based on a Conceptual Framework of Access to Health Care. Subsequent qualitative work will explore the survey's findings. Parents/guardians identifying as vaccine hesitant in the survey will be invited to participate in virtual, semi-structured, in-depth interviews. Stakeholders of the school-based immunization program will be purposively sampled from AHS' five health zones for virtual focus groups. Quantitative data will be analyzed using SAS Studio 3.6 to carry out descriptive statistics and, using logistic regression, investigate if Framework constructs are associated with parents'/guardians' decision to immunize their children. Qualitative data will be analyzed using NVivo 12 to conduct template thematic analysis guided by the Framework. Study results will provide insights for Alberta's public health practitioners to make evidence-informed decisions when tailoring the school-based HPV immunization program to increase uptake in vaccine hesitant populations. Findings will contribute to the national study, which will culminate in recommendations to increase HPV immunization uptake nationally and progress towards the 90% coverage target.


Assuntos
Alphapapillomavirus , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Neoplasias do Colo do Útero , Criança , Adolescente , Feminino , Humanos , Alberta , Infecções por Papillomavirus/prevenção & controle , Imunização
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