Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 26.962
Filtrar
3.
J Prim Care Community Health ; 11: 2150132720962871, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32985333

RESUMO

As COVID-19 cases began to rise in Ontario, Canada, in March 2020, increasing surge capacity in hospitals and intensive care units became a large focus of preparations. As part of these preparations, primary care physicians were ready to be redeployed to the hospitals. However, due to the effective implementation of community-wide public health measures, the hospital system was not overwhelmed. As Ontario prepares now for a potential second wave of COVID-19, primary care physicians have an opportunity to consider the full breadth and depth of scope for primary care during a pandemic. From planning to surveillance to vaccination, primary care physicians are positioned to play a unique and vital role in a pandemic. Nevertheless, there are specific barriers that will need to be overcome.


Assuntos
Infecções por Coronavirus/terapia , Pandemias , Papel do Médico , Médicos de Atenção Primária , Pneumonia Viral/terapia , Atenção Primária à Saúde , Infecções por Coronavirus/epidemiologia , Humanos , Ontário/epidemiologia , Pneumonia Viral/epidemiologia
4.
Proc Natl Acad Sci U S A ; 117(39): 24575-24580, 2020 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-32887803

RESUMO

In the late stages of an epidemic, infections are often sporadic and geographically distributed. Spatially structured stochastic models can capture these important features of disease dynamics, thereby allowing a broader exploration of interventions. Here we develop a stochastic model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission among an interconnected group of population centers representing counties, municipalities, and districts (collectively, "counties"). The model is parameterized with demographic, epidemiological, testing, and travel data from Ontario, Canada. We explore the effects of different control strategies after the epidemic curve has been flattened. We compare a local strategy of reopening (and reclosing, as needed) schools and workplaces county by county, according to triggers for county-specific infection prevalence, to a global strategy of province-wide reopening and reclosing, according to triggers for province-wide infection prevalence. For trigger levels that result in the same number of COVID-19 cases between the two strategies, the local strategy causes significantly fewer person-days of closure, even under high intercounty travel scenarios. However, both cases and person-days lost to closure rise when county triggers are not coordinated and when testing rates vary among counties. Finally, we show that local strategies can also do better in the early epidemic stage, but only if testing rates are high and the trigger prevalence is low. Our results suggest that pandemic planning for the far side of the COVID-19 epidemic curve should consider local strategies for reopening and reclosing.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Betacoronavirus , Cidades/epidemiologia , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Modelos Estatísticos , Ontário/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Prevalência , Processos Estocásticos , Viagem
5.
Water Res ; 183: 116121, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32877809

RESUMO

About 25 golf courses in Ontario, Canada have environmental compliance approvals to use reclaimed water for irrigation, where disinfection is confirmed through E. coli limits. A previous study at five Ontario municipal wastewater treatment plants (WWTPs) confirmed that enteric viruses are less susceptible to disinfection than E. coli, when plants provided conventional (secondary or tertiary) treatment and routine (chlorine or UV) disinfection. Here we query whether these four treatment-disinfection scenarios plus 60-day lagoon storage of disinfected effluent would be sufficient to reduce norovirus genogroups I and II (NoV GI and GII) risk of infection to tolerable levels for a golfer who incidentally ingests NoV after handling wet golf balls at a golf course irrigated with reclaimed water. We used our RT-qPCR NoV enumeration datasets from the four treatment-disinfection scenarios above and modeled detected and non-detected NoV by Bayesian inference in 'R'. Monte Carlo simulation included pre-disinfection NoV GI and GII gene copy densities; Ontario WWTP-derived chlorine and UV log10 reductions; literature-derived effluent storage decay parameters and golfer ingested volumes, followed by six different NoV dose-response (DR) models. Quantitative Microbial Risk Assessment (QMRA) results suggest that there is an unacceptable NoV infection risk when using the conservative assumption that all detected NoV particles (RT-qPCR gene copies) are infectious, in both aggregated or disaggregated form. However, after adjusting for PCR target sequences and for infectiousness using data from recently published studies on cultivation of human NoV in human intestinal enteroids, we noted a significant reduction of infection risk. However, this less conservative (i.e., less protective) assumption for water reuse applications such as golf course irrigation may not be corroborated until human NoV are efficiently and routinely grown in cell cultures. In addition, further studies on drivers of NoV risk estimation by DR models are needed, e.g., the extent of NoV particle aggregation resulting from wastewater treatment, as well as the role of immunity. Meantime, regulatory agencies could consider more stringent treatment-disinfection requirements that target enteric viruses rather than E. coli and testing of actual reclaimed irrigation waters.


Assuntos
Golfe , Norovirus , Teorema de Bayes , Escherichia coli , Humanos , Ontário , Medição de Risco , Águas Residuárias , Água
6.
Can J Public Health ; 111(5): 636-640, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32875520

RESUMO

The objective of social distancing is to slow the rate of viral transmission and thereby spread out the incidence of coronavirus disease 2019 (COVID-19) cases over time (i.e., flattening the curve) so that a surge of patients will not overwhelm the capacity of the healthcare system. Given this objective, the specific curve that requires flattening is that of COVID-19-associated hospitalizations. In this context, we evaluated the rates of COVID-19-associated hospitalization in British Columbia (BC) and Ontario to see if either province shows evidence of flattening the relevant curve. From late March to mid-June 2020, the cumulative rate of COVID-19-associated hospitalization in BC has indeed shown evidence of flattening, whereas that in Ontario has increased linearly. The cumulative hospitalization rate in Ontario first surpassed that of BC on April 14. By June 18, the respective hospitalization rates per 100,000 population were 27.86 for Ontario and 9.96 for BC. In both provinces, the cumulative hospitalization rate has remained lower than that of comparator US states. In conclusion, there is evidence of flattening the relevant curve in BC but not yet in Ontario. The comparison with BC underscores the need for continued caution with the relaxation of social distancing efforts in Ontario.


Assuntos
Infecções por Coronavirus/terapia , Hospitalização/estatística & dados numéricos , Pneumonia Viral/terapia , Colúmbia Britânica/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Incidência , Ontário/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Distância Social
7.
Sci Total Environ ; 738: 140382, 2020 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-32806349

RESUMO

Approximately 1.5 million individuals in Ontario are supplied by private water wells (private groundwater supplies). Unlike municipal supplies, private well water quality remains unregulated, with owners responsible for testing, treating, and maintaining their own water supplies. The primary goal of this study was to assess the effect of repeat sampling of private well water in Ontario and investigate the efficacy of geographically- and/or temporally specific testing recommendations and health risk assessments. The current study combines the Well Water Information System Dataset and the Well Water Testing Dataset from 2010 to 2017, inclusive. These two large existing province-wide datasets collated over an eight-year period were merged using an integrated spatial fuzzy logic and (next)- nearest neighbour approach. Provincial sampling data from 239,244 wells (702,861 samples) were analyzed for Escherichia coli to study the relationship between sampling frequency and Escherichia coli detection. Dataset variables were delineated based on hydrogeological setting (e.g. aquifer type, overburden depth, well depth, bedrock type) and seasonality to provide an in-depth understanding of Escherichia coli detection in private well water. Findings reveal differences between detection rates in consolidated and unconsolidated aquifers (p = 0.0191), and across seasons (p < 0.0001). The variability associated with Escherichia coli detection rates was explored by estimating sentinel sampling rates for private wells sampled three times, twelve times and twenty-four times per year. As sample size increases on an annual basis, so too does detection rate, highlighting the need to address current testing frequency guidelines. Future health risk assessments for private well water should consider the impact of spatial and temporal factors on the susceptibility of this drinking water source, leading to an increasingly accurate depiction of private well water contamination and the estimated effects on human health.


Assuntos
Água Potável , Água Subterrânea , Humanos , Ontário , Medição de Risco , Poços de Água
8.
J Otolaryngol Head Neck Surg ; 49(1): 59, 2020 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-32778168

RESUMO

With the COVID-19 pandemic, there has been significant changes and challenges in the management of oncology patients. One of the major strategies to reduce transmission of the virus between patients and healthcare workers is deferral of follow-up visits. However, deferral may not be possible in total laryngectomy patients. Urgent procedures may be necessary to prevent complications related to ill-fitting tracheoesophageal puncture (TEP) voice prostheses, such as aspiration or loss of voicing. In this paper, we describe the Princess Margaret Cancer Center's approach to managing this unique patient population.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Neoplasias Laríngeas/cirurgia , Laringectomia/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Neoplasias Laríngeas/diagnóstico , Laringectomia/métodos , Laringe Artificial , Masculino , Ontário , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Implantação de Prótese/métodos , Implantação de Prótese/estatística & dados numéricos , Medição de Risco
9.
Healthc Q ; 23(2): 9-15, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32762813

RESUMO

Setting: Primary care is the first line of defence in healthcare, particularly during the coronavirus disease 2019 (COVID-19) pandemic. In the London-Middlesex region of Ontario, a critical shortage of personal protective equipment (PPE) was identified among primary care physicians (PCPs). Intervention: With the help of the London-Middlesex Primary Care Alliance, volunteer administrators, physicians and medical students coordinated the acquisition and redistribution of community-donated PPE to PCPs across London-Middlesex. Our scope evolved to include PPE reusability and stewardship and PCP wellness. Outcome: Beginning on March 16, 2020, our initial four-week operation provided PPE to over 200 PCPs. We received 60 donations, including over 118,000 gloves, 13,700 masks, 700 wellness kits and reusable cloth masks and gowns. Each delivery included educational pamphlets, and our online PPE stewardship session was attended by over 30 physicians. Implications: In response to the PPE shortage in COVID-19, our efforts evolved into a complex adaptive system, supported by an organizational body with a pre-existing communication infrastructure, to great success. Our scope extended beyond simple PPE provision to PCPs. Furthermore, our initiative established a framework for a centralized response to PPE shortage in Ontario Health West.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual/provisão & distribução , Médicos de Atenção Primária , Pneumonia Viral/prevenção & controle , Betacoronavirus , Humanos , Ontário , Equipamento de Proteção Individual/normas , Estudantes de Medicina , Voluntários
10.
J Environ Manage ; 272: 111106, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-32854896

RESUMO

Phreatophytic trees such as willows and poplars have a large capacity for extracting shallow groundwater, as evidenced by diurnal water table fluctuations corresponding to intensified transpiration during the day. As a result, they have been employed for phytoremediation of shallow contaminated groundwater. In this study, the water extraction (i.e. pumping) capacity of mature willows (Salix nigra) to capture shallow polluted groundwater in Belle Park, the site of a former landfill in Kingston, Ontario (Canada), was assessed using continuous field measurements of sap flow and water table levels associated with a single willow tree, combined with a transient numerical model (FEFLOW). On an annual basis, the sapflow averaged 2.3 m3d-1, with 70% of the cumulative sap flow occurring during the active growing season (May to September). The calibration showed a good fit (0.91 < R2<0.97) between measured groundwater levels from three shallow wells installed near the willow and the calculated water table level fluctuations, thus confirming that the water extraction rate based on sap flow data for the willow was appropriate. At stand level, additional modelling suggests that 3.4-4.7 ha of mature willows (i.e. between 7.8% and 10.6% of the Park area), could compensate for the current water volumes extracted by the municipality using a conventional pump and treat system. The results of this study indicate that willows can play a significant role in capturing contaminated groundwater underlying Belle Park, and potentially at other sites where removal of contaminants from shallow aquifers is desired.


Assuntos
Água Subterrânea , Salix , Biodegradação Ambiental , Ontário , Instalações de Eliminação de Resíduos
11.
Pediatrics ; 146(Suppl 1): S66-S69, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737235

RESUMO

In all of medicine, there is perhaps nothing so distressing as bearing witness to a patient's suffering, especially if that patient is a child. We want to do everything that we can to avoid or alleviate a child's suffering, yet what do clinicians, ethicists, lawyers, or family members mean when they use the term "suffering," and how should these claims of suffering factor into pediatric decision-making? This question of suffering and what to do about it has played a key role in several prominent pediatric cases over the past decade, including the cases of Charlie Gard, Alfie Evans, and Baby Joseph. These cases have become seminal cases precisely because there is no clear resolution, and the "suffering child" continues to challenge our moral ideals of what it means to live a good life. In this article, I explore the various ways in which the concept of suffering is used in these cases, and I offer new ways in which parents, providers, and all those who work with sick children can approach the suffering child.


Assuntos
Tomada de Decisão Clínica/ética , Doença de Leigh , Encefalomiopatias Mitocondriais , Doenças Neurodegenerativas , Terminologia como Assunto , Suspensão de Tratamento/ética , História do Século XXI , Humanos , Lactente , Doença de Leigh/diagnóstico , Doença de Leigh/psicologia , Doença de Leigh/terapia , Masculino , Encefalomiopatias Mitocondriais/terapia , Doenças Neurodegenerativas/diagnóstico , Doenças Neurodegenerativas/psicologia , Doenças Neurodegenerativas/terapia , Ontário , Pais/psicologia , Estado Vegetativo Persistente/psicologia , Estado Vegetativo Persistente/terapia , Qualidade de Vida , Respiração Artificial/ética , Estresse Psicológico/diagnóstico , Estresse Psicológico/psicologia , Estresse Psicológico/terapia , Traqueostomia/psicologia , Reino Unido , Suspensão de Tratamento/legislação & jurisprudência
12.
Can J Public Health ; 111(4): 473-476, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32767269

RESUMO

The fear, grief, social isolation, and financial and occupational losses from COVID-19 have created a mental health crisis. Ontario's response highlights the shortcomings of its physician-only public healthcare system that limits public access to appropriate and sustainable mental healthcare. Specifically, Ontario's attempt to rapidly expand mental healthcare access in response to COVID-19 includes new Ontario Health Insurance Program (OHIP) billing codes that enable physicians to provide telephonic trauma counselling and patient self-serve online tools while psychologist and other registered mental health provider services have been largely left out of the provincial response. Why? Non-physician mental health providers operate outside of the provincial healthcare infrastructure, including the provincial payer (i.e., OHIP) that facilitated the provincial physician response. A physician-centric mental healthcare system limits public access to quality, sustainable, evidence-based mental health services because most physicians do not have the capacity, training, or desire to provide mental health services. To improve public access to needed mental health services, provinces should integrate psychologists and other registered mental health providers directly into their public health insurance systems. Integrated providers can be strategically and sustainably mobilized to respond to COVID-19 and future mental health crises.


Assuntos
Infecções por Coronavirus/psicologia , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Programas Nacionais de Saúde/organização & administração , Pneumonia Viral/psicologia , Infecções por Coronavirus/epidemiologia , Humanos , Ontário/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia
13.
PLoS One ; 15(8): e0237723, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857771

RESUMO

PURPOSE: This study investigated nicotine dependence as an independent risk factor for upper aerodigestive tract (UADT) cancers, including lung and head and neck cancers (HNC). The study aimed to isolate the direct effect of nicotine dependence, independent of tobacco smoking. METHODS: A case-control study with a total of 4957 participants was conducted in Ontario, Canada, of which 2964 categorized as either current or former smokers were used in the analysis. Nicotine dependence of ever-smokers (2360 UADT cases and 604 controls) was measured using the Fagerström Test for Nicotine Dependence. Using mediation analyses and adjusted logistic regression models, we decomposed the direct effect of nicotine dependence and the mediated effect of smoking duration to quantify the risks of lung and HNC. The role of human papillomavirus (HPV) and cancer subtypes were assessed. RESULTS: Most individual nicotine dependence behaviours showed positive associations with lung cancer with approximately 1.8 to 3.5-fold risk increase, and to lesser extent with 1.4 to 2.3-fold risk for HNC. Nicotine dependence is partially accountable for increased risks of lung cancer (OR = 1.20, 95%CI = 1.13-1.28) and HNC (1.12, 95%CI = 1.04-1.19). Nicotine dependence had a greater effect on the risk of HPV-negative oropharyngeal cancer (OR = 3.06, 95%CI = 1.65-5.66) in comparison to HPV-positive oropharyngeal cancer (OR = 1.05, 95%CI = 0.67-1.65). The direct effects of nicotine dependence remained significant after accounting for cumulative tobacco exposures. CONCLUSION: Nicotine dependence increases the risks of lung and HNC cancers after accounting for tobacco smoking, suggesting potential toxic effects of nicotine. These results are informative for the safety consideration of nicotine exposures.


Assuntos
Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias Pulmonares/epidemiologia , Nicotina/efeitos adversos , Tabagismo/epidemiologia , Idoso , Estudos de Casos e Controles , Feminino , Neoplasias de Cabeça e Pescoço/etiologia , Humanos , Neoplasias Pulmonares/etiologia , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Tabagismo/complicações
14.
PLoS One ; 15(8): e0236480, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32813687

RESUMO

BACKGROUND: The Government of Ontario, Canada, announced hospital funding reforms in 2011, including Quality-based Procedures (QBPs) involving pre-set funds for managing patients with specific diagnoses/procedures. A key goal was to improve quality of care across the jurisdiction. METHODS: Interrupted time series evaluated the policy change, focusing on four QBPs (congestive heart failure, hip fracture surgery, pneumonia, prostate cancer surgery), on patients hospitalized 2010-2017. Outcomes included return to hospital or death within 30 days, acute length of stay (LOS), volume of admissions, and patient characteristics. RESULTS: At 2 years post-QBPs, the percentage of hip fracture patients who returned to hospital or died was 3.13% higher in absolute terms (95% CI: 0.37% to 5.89%) than if QBPs had not been introduced. There were no other statistically significant changes for return to hospital or death. For LOS, the only statistically significant change was an increase for prostate cancer surgery of 0.33 days (95% CI: 0.07 to 0.59). Volume increased for congestive heart failure admissions by 80 patients (95% CI: 2 to 159) and decreased for hip fracture surgery by 138 patients (95% CI: -183 to -93) but did not change for pneumonia or prostate cancer surgery. The percentage of patients who lived in the lowest neighborhood income quintile increased slightly for those diagnosed with congestive heart failure (1.89%; 95% CI: 0.51% to 3.27%) and decreased for those who underwent prostate cancer surgery (-2.08%; 95% CI: -3.74% to -0.43%). INTERPRETATION: This policy initiative involving a change to hospital funding for certain conditions was not associated with substantial, jurisdictional-level changes in access or quality.


Assuntos
Administração Financeira/economia , Hospitalização/economia , Hospitais , Análise de Séries Temporais Interrompida/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Economia Hospitalar , Feminino , Insuficiência Cardíaca/economia , Fraturas do Quadril/economia , Fraturas do Quadril/cirurgia , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Pneumonia/economia , Neoplasias da Próstata/economia , Neoplasias da Próstata/cirurgia
15.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32817396

RESUMO

BACKGROUND: Severe maternal morbidity (SMM) comprises an array of conditions and procedures denoting an acutely life-threatening pregnancy-related condition. SMM may further compromise fetal well-being. Empirical data are lacking about the relation between SMM and infant mortality. METHODS: This population-based cohort study included 1 892 857 singleton births between 2002 and 2017 in Ontario, Canada, within a universal health care system. The exposure was SMM as an overall construct arising from 23 weeks' gestation up to 42 days after the index delivery. The primary outcome was infant mortality from birth to 365 days. Multivariable modified Poisson regression generated relative risks and 95% confidence intervals (CIs), adjusted for maternal age, income, rurality, world region of origin, diabetes mellitus, and chronic hypertension. RESULTS: Infant mortality occurred among 174 of 19 587 live births with SMM (8.9 per 1000) vs 5289 of 1 865 791 live births without SMM (2.8 per 1000) (an adjusted relative risk of 2.93 [95% CI 2.51-3.41]). Of 19 587 pregnancies with SMM, 4523 (23.1%) had sepsis. Relative to births without SMM, the adjusted odds ratio for infant death from sepsis was 1.95 (95% CI 1.10-3.45) if SMM occurred without maternal sepsis and 6.36 (95% CI 3.50-11.55) if SMM included sepsis. CONCLUSIONS: SMM confers a higher risk of infant death. There is also coupling tendency (concurrent event of interest) between SMM with sepsis and infant death from sepsis. Identification of preventable SMM indicators, as well as the development of strategies to limit their onset or progression, may reduce infant mortality.


Assuntos
Mortalidade Infantil/tendências , Saúde Materna/tendências , Complicações na Gravidez/epidemiologia , Índice de Gravidade de Doença , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Morbidade , Ontário/epidemiologia , Gravidez , Complicações na Gravidez/diagnóstico , Adulto Jovem
16.
PLoS One ; 15(8): e0235787, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817615

RESUMO

Maple syrup, made by boiling the sap of Acer saccharum, is an important agriculture commodity in eastern Canada and New England. Although the collection season is relatively short, a rich progression in the sensory qualities of maple syrup can occur throughout the season. A risk associated with maple syrup production at the end of a season is the development of off-flavors that result in syrup with little to no commercial value. Maple syrup producers in Canada and the USA call this 'buddy syrup'. In this study, sugar maple (Acer saccharum) sap was collected in sequential samples through the harvest season from stands across Ontario. Metabolomics analysis of the sap samples was performed by high-resolution mass spectrometry. This revealed an evolution of the chemical composition, mainly occurring 30 days prior to leaf emergence. The major chemical constituent of maple syrup, sucrose, decreased sharply in late season sap, driven by microbial activity. The alditol mannitol increased in late season sap to concentrations ≥2 mg/mL and is likely an indicator of the start of photosynthesis. Amino acids, notably methionine and asparagine were present in higher amounts in late season sap. Non-targeted analysis revealed a series of related compounds that contained quaternary ammonium moieties including choline, hercynine, trigonelline, glycine betaine and carnitine increased in late season sap. These classes of compounds could act as methyl donors during the heating/evaporation of sap into syrup, affecting taste. Based on descriptions of the nature of buddy syrup and an extensive literature on flavors in foods, the amino acids methionine and asparagine were found as likely precursors to the compounds responsible for buddy syrup.


Assuntos
Acer/metabolismo , Exsudatos de Plantas/metabolismo , Acer/química , Aromatizantes/química , Aromatizantes/metabolismo , Alimentos , Metabolômica , Ontário , Exsudatos de Plantas/química , Estações do Ano
17.
Parasitol Res ; 119(9): 2917-2925, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32734308

RESUMO

Trematode-induced castration of snails is widespread and can lead to other life history changes of snails such as changes in trajectories of size and growth or survival. The changes produced likely depend on whether the parasite or host controls allocation of host resources remaining after partial or complete cessation of host current reproduction by castrating trematodes. Documenting host life history changes, like changes in host size in response to castration, is a first step in assessing whether these changes are beneficial to the parasite (increasing transmission success) or to the host (outliving the infection) or to neither. Herein, we test for differences in size and survival among individuals of two snail species in relation to infection by Echinostoma spp. trematodes. Active shedding of Echinostoma spp. was associated with castration of all Stagnicola elodes snails from a site in Eastern Ontario. Snails actively shedding cercariae were not different in size from non-shedding, egg-laying snails but had a higher mortality than egg-laying snails. Active shedding of Echinostoma spp. cercariae was also associated with castration of nearly all Helisoma trivolvis monitored, from a site in Southwestern Ontario. Actively shedding, non-laying H. trivolvis hosts were smaller on average than non-shedding egg-laying hosts, but both non-laying and egg-laying snails survived equally well. We discuss these results in light of what is known about effects of castration on snail hosts in terms of growth and survival for these and other trematode species and speculate on whether changes in size or survival benefits parasite or host.


Assuntos
Castração , Cercárias/crescimento & desenvolvimento , Echinostoma/crescimento & desenvolvimento , Lymnaea/parasitologia , Oviposição/fisiologia , Animais , Alimentos , Água Doce , Interações Hospedeiro-Parasita , Ontário , Reprodução
18.
PLoS One ; 15(8): e0236559, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817636

RESUMO

Chronic obstructive pulmonary disease (COPD) poses a significant but heterogeneous burden to individuals and healthcare systems. Policymakers develop targeted policies to minimize this burden but need personalized tools to evaluate novel interventions and target them to subpopulations most likely to benefit. We developed a platform to identify subgroups that are at increased risk of emergency department visits, hospitalizations and mortality and to provide stratified patient input in economic evaluations of COPD interventions. We relied on administrative and survey data from Ontario, Canada and applied a combination of microsimulation and multi-state modeling methods. We illustrated the functionality of the platform by quantifying outcomes across smoking status (current, former, never smokers) and by estimating the effect of smoking cessation on resource use and survival, by comparing outcomes of hypothetical cohorts of smokers who quit at diagnosis and smokers that continued to smoke post diagnosis. The cumulative incidence of all-cause mortality was 37.9% (95% CI: 34.9, 41.4) for never smokers, 34.7% (95% CI: 32.1, 36.9) for current smokers, and 46.4% (95% CI: 43.6, 49.0) for former smokers, at 14 years. Over 14 years, smokers who did not quit at diagnosis had 16.3% (95% CI: 9.6, 38.4%) more COPD-related emergency department visits than smokers who quit at diagnosis. In summary, we combined methods from clinical and economic modeling to create a novel tool that policymakers and health economists can use to inform future COPD policy decisions and quantify the effect of modifying COPD risk factors on resource utilization and morality.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Formulação de Políticas , Doença Pulmonar Obstrutiva Crônica/mortalidade , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar Tabaco/efeitos adversos , Idoso , Análise Custo-Benefício , Feminino , Recursos em Saúde/economia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , não Fumantes/estatística & dados numéricos , Ontário , Estudos Retrospectivos , Fatores de Risco , Fumantes/estatística & dados numéricos
19.
BMJ ; 370: m2257, 2020 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631907

RESUMO

OBJECTIVE: To measure the associations between newly initiated palliative care in the last six months of life, healthcare use, and location of death in adults dying from non-cancer illness, and to compare these associations with those in adults who die from cancer at a population level. DESIGN: Population based matched cohort study. SETTING: Ontario, Canada between 2010 and 2015. PARTICIPANTS: 113 540 adults dying from cancer and non-cancer illness who were given newly initiated physician delivered palliative care in the last six months of life administered across all healthcare settings. Linked health administrative data were used to directly match patients on cause of death, hospital frailty risk score, presence of metastatic cancer, residential location (according to 1 of 14 local health integration networks that organise all healthcare services in Ontario), and a propensity score to receive palliative care that was derived by using age and sex. MAIN OUTCOME MEASURES: Rates of emergency department visits, admissions to hospital, and admissions to the intensive care unit, and odds of death at home versus in hospital after first palliative care visit, adjusted for patient characteristics (such as age, sex, and comorbidities). RESULTS: In patients dying from non-cancer illness related to chronic organ failure (such as heart failure, cirrhosis, and stroke), palliative care was associated with reduced rates of emergency department visits (crude rate 1.9 (standard deviation 6.2) v 2.9 (8.7) per person year; adjusted rate ratio 0.88, 95% confidence interval 0.85 to 0.91), admissions to hospital (crude rate 6.1 (standard deviation 10.2) v 8.7 (12.6) per person year; adjusted rate ratio 0.88, 95% confidence interval 0.86 to 0.91), and admissions to the intensive care unit (crude rate 1.4 (standard deviation 5.9) v 2.9 (8.7) per person year; adjusted rate ratio 0.59, 95% confidence interval 0.56 to 0.62) compared with those who did not receive palliative care. Additionally increased odds of dying at home or in a nursing home compared with dying in hospital were found in these patients (n=6936 (49.5%) v n=9526 (39.6%); adjusted odds ratio 1.67, 95% confidence interval 1.60 to 1.74). Overall, in patients dying from dementia, palliative care was associated with increased rates of emergency department visits (crude rate 1.2 (standard deviation 4.9) v 1.3 (5.5) per person year; adjusted rate ratio 1.06, 95% confidence interval 1.01 to 1.12) and admissions to hospital (crude rate 3.6 (standard deviation 8.2) v 2.8 (7.8) per person year; adjusted rate ratio 1.33, 95% confidence interval 1.27 to 1.39), and reduced odds of dying at home or in a nursing home (n=6667 (72.1%) v n=13 384 (83.5%); adjusted odds ratio 0.68, 95% confidence interval 0.64 to 0.73). However, these rates differed depending on whether patients dying with dementia lived in the community or in a nursing home. No association was found between healthcare use and palliative care for patients dying from dementia who lived in the community, and these patients had increased odds of dying at home. CONCLUSIONS: These findings highlight the potential benefits of palliative care in some non-cancer illnesses. Increasing access to palliative care through sustained investment in physician training and current models of collaborative palliative care could improve end-of-life care, which might have important implications for health policy.


Assuntos
Doença Crônica/mortalidade , Cuidados Paliativos/estatística & dados numéricos , Doente Terminal/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Neoplasias/mortalidade , Ontário
20.
Environ Monit Assess ; 192(8): 530, 2020 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-32681456

RESUMO

Ecological risk assessment (ERA) is used to determine potential effect of human activities and industries on the natural environment. Numerous ERA management approaches exist and vary based on jurisdiction or ecological media. This ERA focused on contaminants within an aquatic ecosystem in sediments and surface water at South Baymouth port facility in Ontario, Canada. Contaminants were evaluated using the Canada-Ontario Decision-Making Framework for Assessment of Great Lakes Contaminated Sediments (COA). Following COA, this study (1) examined historical data from South Baymouth to determine contaminants of potential concern, (2) delineated potential contamination by comparing sediment and surface water concentration data to sediment quality guidelines and water quality guidelines from Canada and from different jurisdictions if Canadian guidelines were unavailable, (3) compared sediment concentrations to reference concentrations, and (4) developed an ERA decision matrix (used to inform management decisions at this aquatic site). Although sediments exhibited negligible potential for ecological risk and required no remedial management action, this case study highlights strengths of using COA for this ERA which included use of iterative and consistent approaches, but also highlights weaknesses which included unclear linkages between cause and effects of aquatic contaminants. Recommendations for future ERAs at contaminated aquatic sites include use of passive samplers and incorporating recent macroecology techniques.


Assuntos
Sedimentos Geológicos , Poluentes Químicos da Água/análise , Ecossistema , Monitoramento Ambiental , Humanos , Ontário , Medição de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA