Canadian Participants Research Articles

Access and models of obstructive sleep apnea care: a cross-national comparison of Canadian and Australian patient survey data.

To describe similarities and differences in OSA care pathways and their impact on patients in Australia and Canada, including among urban versus rural participants. In this secondary data analysis of patient surveys exploring OSA care in Australia and Canada, we recruited adults with a prior diagnosis of OSA from market research companies, social media, and patient-facing medical associations. Residential postal codes were used to classify participants as urban or rural. Survey domains included wait times and travel distances for care, providers, and treatments. Data from 589 Canadians (21% rural; 42% female, mean [SD] age = 57 [13] years) and 412 Australians (38% rural; 45% female, mean [SD] age = 58 [14] years) with OSA were included. Participants in both countries most commonly sought initial care for suspected OSA from a primary care practitioner. Canadian participants waited longer to seek care than Australian participants (37% vs 51% within 12 months of symptom onset). Wait times for diagnostic testing were longer in Canada (59% vs 76% within 3 months of initial assessment), especially in urban settings (58% vs 78%). In both countries, >80% of participants were offered positive airway pressure (PAP) therapy. Overall, a greater variety of treatments were offered and used by Australian participants. Greater access to diagnostic testing and a greater variety of treatments were found in Australia compared to Canada. Further research is needed to determine if reduced diagnostic wait times and presentation of increased therapy options found in Australia translate into better patient outcomes.

The relationship of childhood maltreatment, adult sexual victimization, depressed mood and symptoms of trauma with fear of childbirth

Background: Fear of childbirth (FoB) is experienced to some degree by most pregnant people and can be intense enough to merit treatment. Despite significant research on the topic of FoB, studies investigating various forms of maltreatment and mental health symptoms in relation to FoB are very limited. In particular, studies including multiple forms of maltreatment along with mental health symptoms as predictors of FoB are extremely limited. We sought to fill this gap and clarify the relative contributions of these variables to the prediction of FoB. Methods: This was a secondary analysis of data from pregnant people in Canada. Participants (N = 881) provided demographic and reproductive history information, completed self-report measures of FoB, childhood maltreatment (multiple forms), adult sexual victimization, depressed mood and symptoms of posttraumatic stress disorder (PTSD). They were also administered a diagnostic interview to assess for specific phobia, FoB. Analyses included descriptive information, Wilcoxon rank sum tests, linear and logistic regression, and path analysis. Results: Most forms of maltreatment showed some association with increased FoB. However, when assessed together, only emotional maltreatment remained a significant predictor of FoB. Both depressed mood and symptoms of PTSD contributed more to FoB than maltreatment, and mediated the relationship of emotional maltreatment with FoB. The only direct effects of childhood emotional maltreatment on FoB were for fears of medical interventions and feelings of embarrassment during labour and delivery. Limitations: Study findings fill significant gaps in our understanding of the relationship between maltreatment, mental health symptoms and FoB. However, the study sample was limited to Canadian participants, most of whom were socio-economically advantaged, cis-gender women of European descent, thus limiting the generalizability of the findings. Further, as childhood maltreatment and sexual assault experiences in adulthood were reported retrospectively, study findings are also vulnerable to recall bias. Conclusions: Findings contribute to our understanding of the relationship between childhood maltreatment, adult sexual victimization, mental health and FoB. These findings can facilitate future research and improved care via a focus on depressed mood, symptoms of PTSD, emotional maltreatment and specific fears of medical interventions and social discomfort as significant contributors to one's experience of FoB.

263 Public perspectives of calf handling: A survey of Canadians

Abstract In North American beef production handling and restraint of young calves is integral to animal welfare and management practices. This study used a mixed method approach to gather public perceptions of three handling and restraint methods common on beef operations in western Canada (RW - Roping and Wrestling, NF – roping and NordForks, and TT – Tilt Table). Canadian participants (n = 551) recruited by CloudResearch to represent the national demographics participated in an online survey that included videos of each handling method to ascertain preferences and acceptability. Prior to watching the videos, participants were given industry information about handling and restraint or generic information regarding hay as a control information statement within the topic of agriculture. The survey also collected information about knowledge of the beef industry, animal welfare, and empathy toward animals. The reasons for preferences were described as presence of a perceived positive attribute and absence of a perceived negative for most preferred methods, and inversely when explaining least preferred method. The findings focused on calf’s experience, perception of handler actions, and pragmatic balancing of handler needs and a good life for the calf. Methods were rated as more acceptable for participants that ate meat consistently, knew more about the beef industry, and, to a lesser extent, if the individual had a lower animal empathy score (Table 1). Acceptability was not affected by providing information about the practices; however, information about handling and restraint did elicit more pragmatic reasoning. Most participants preferred TT over NF and RW (P < 0.001) and found TT more acceptable as well (P < 0.001). The TT was the most preferred method due to calf experience and human handling, notably the absence of dragging a calf, which was predominant in why participants selected NF or RW as their least preferred method. Consistency of themes highlights that the Canadian public has a fundamental expectation of value for the quality of life of the calf, humane handling, and pragmatism which aligns with beef sustainability initiatives and represent points of connection for building trust between industry and the public.

Understanding health data social licence: An international comparison of community attitudes towards health data use across Canada and Australia

ObjectiveResearch has found general but conditional support for health data being used for public benefit. The term “social licence” describes which uses of health data the public supports and under what conditions. Here, we aim to compare two approaches to understanding community attitudes towards health data use, and how social licence may differ, between Canadian and Australian populations. ApproachFactors that affect community support for health data use include the specific population, the type(s) of data, and the engagement approach used. In Canada, facilitated dialogues were held to explore whether (i) there were uses of health data that diverse members of the public all supported and (ii) there was consensus on essential requirements for health data social licence. In Australia, national surveys and citizens’ juries were conducted to better understand (i) attitudes towards private sector data use and (ii) the ethical, legal and social implications of using general practice data in research. ResultsDespite the different approaches taken, many conditions for social licence were similar across Canadian and Australian participants. Both groups agreed on conditions for health data social licence related to equity, governance, privacy and transparency. However, there was a stark contrast between levels of support for private sector data use, personal control and consent. ConclusionThis comparative exercise contributes valuable insights into the ongoing dialogue surrounding community attitudes towards health data use. Continued research monitoring health data social licence across populations is imperative for public trust while gaining full benefits from health data use in research.

Patient preferences for preventive migraine treatments among Canadian adults: A discrete choice experiment.

To evaluate preferences for key attributes of injected or infused preventive migraine treatments and assess heterogeneity in preferences among Canadian participants with migraine. Current treatment options for migraine prevention differ in their attributes, including mode of administration, efficacy, and dosing frequency; preferences for such attributes can vary among patients. With the advent of new therapies, evidence demonstrating patient preferences for injected or infused preventive migraine treatments is necessary. Canadian adults self-reporting a diagnosis of migraine completed a cross-sectional, internet-based survey that included a discrete choice experiment. Participants were presented with attributes of preventive migraine treatments, including speed of onset, durability of efficacy, mode of administration, administration setting, and dosing frequency. Latent class analysis (LCA) was used to identify subgroups of patients who differed in their treatment preferences. In total, 200 participants completed the survey. Participants' treatment preferences were most sensitive to improvements in the durability of effectiveness from "wears off 2 weeks before next dose" to "does not wear off before the next dose" (absolute difference in weights = |-0.95 to 1.07| = 2.02) and improvements from "cranial injections" to "intravenous infusions" (|-1.04 to 0.58| = 1.62); participants equally preferred self-injection and intravenous infusion from a health-care provider (mean weight = 0.58 and 0.47, respectively) as a route of administration over cranial injections (mean weight = -1.04). Three subgroups were identified with LCA: group one (n = 103) prioritized fast-acting and durable therapies, group two (n = 54) expressed aversion to cranial injections, and group three (n = 43) favored treatments administered in a health-care provider setting. In this sample of Canadian adults with migraine, we showed that durability of effectiveness and mode of administration are key attributes influencing patient preferences for preventive migraine treatments; however, certain groups of patients may differ in their treatment priorities. Our results highlight the need for patient-provider discussions regarding treatment attributes and consideration of patients' preferences when selecting a preventive migraine treatment.

Progress Tracker Breast Cancer Registry: A Breast Cancer Canada initiative.

e23018 Background: Significant gaps exist in the collection of real-world evidence and validated patient-reported outcome measures (PROMs) data from individuals with breast cancer. Variations in treatment and surveillance care across regional jurisdictions present knowledge gaps across diverse populations which remain difficult to study. The PROgress Tracker Breast Cancer Registry, a large, prospective Canadian PROMs cohort study aims to identify care gaps through the lived patient experience to inform patient-centered care and new research directions. Methods: PROgress Tracker is a real-world, longitudinal, non-interventional PROMs registry directed by Breast Cancer Canada, a registered non-profit patient-led organization, and data managed by University of Calgary’s POET program. Launched in October 2023, this registry aims to enroll up to 50,000 adult Canadian participants with a histologic diagnosis of in-situ or invasive breast cancer (stage 0 through IV) within 10 years. A volunteer-led peer-to-peer support model, based in regional and provincial hubs across Canada, facilitates participant recruitment, engagement, and retention. Individuals who self-identify for study inclusion provide informed consent, demographic and socioeconomic profile, and clinical information on their breast cancer diagnosis. Every three months (and up to 10 years) a bilingual digital platform to reduce barriers to access is used to provide all PROgress Tracker participants 8 validated PROMs to capture evolving measures of self-efficacy for wellbeing, symptoms and overall global functioning. Based on treatment, up to 10 additional PROMs to assess the immediate adverse effects and long-term impacts of treatment are collected. PROgress Tracker has the additional capacity to link to external ethics-approved studies to investigate clinical outcome and healthcare utilization metrics for participants consenting to additional studies. Results: In progress. Conclusions: PROgress Tracker represents Canada’s first national PROMs breast cancer registry. Its unique design and implementation by a patient-led research organization helps fill gaps in current knowledge through longitudinal follow up of patients prior to, during, and after cancer care, and from the time from diagnosis through active treatment, long-term survivorship, and/or palliative care. The PROgress Tracker Registry will comprehensively gather the validated real-world data information rarely collected in in the traditional clinical or trial-based research setting using a novel self-enroll design and digital process. Such information is crucial to support evidence-based decision making to inform patient-centered healthcare change. This allows comparison across Canadian jurisdictions, is scalable to other jurisdictions around the world and further explores the utility of electronic PROMs data capture within a diverse patient population.

P.006 Barriers and risk factors for emergency room visits vs smartphone app use for migraine in Canada and the United States

Background: Migraine affects more than 1 billion people, with attacks triggered by a variety of factors. Knowledge of environmental triggers for migraine attacks is limited, and has mostly been studied via emergency room (ER) visits. There are significant barriers and delays for attending ER for migraine treatment, which create challenges for estimating causal links to environmental exposures. We assessed whether smartphone app records may have fewer barriers and reduced lags. Methods: American and Canadian participants completed an online survey about their migraine attacks, smartphone app use, and ER visits. Results: Among 308 participants, barriers to visiting ER were similar in both countries, except for financial concerns in the US. About half of participants who attended ER also recorded the attack in a diary or app. Whereas migraine patients often present to ER 7+ days after onset, records in a smartphone app dataset were created within 2 days of onset. Conclusions: Although not all severe migraine attacks are recorded by smartphone users, smartphone app records may have fewer barriers to creation and shorter time lags compared to ER visit records, making them a rich source of data for research on transient neurologic health outcomes and environmental exposures.

Goal setting in people with low back pain attending an education and exercise program (GLA:D Back) and the impact of demographic factors

BackgroundIndividual goal setting is a fundamental element in self-management supportive interventions, serving to guide actions and enhance motivation for engagement. Despite this, little is known about the goals people with back pain have and to what extent these differ across genders, age groups and geographical location. This study aimed to elucidate this by first describing individual goals set by Danish and Canadian participants in a self-management intervention for people with back pain using the ICF framework; then, determining what proportion of these goals met criteria for being specific, measurable, acceptable, and time bound, and finally, by investigating differences between countries, sexes, and age groups.MethodsIn a cross-sectional study conducted August 2018 to June 2020, 394 Danish and 133 Canadian (Alberta Province) participants defined their individual goals of participating in a self-management programme involving patient education and supervised exercises. The goals were linked to the ICF framework. Distribution of goals was compared between countries, sexes, and age groups.ResultsGoals most often related to the ICF component of ‘Activity and Participation’. The most prevalent goals were “Walking” (DK: 20%; CA: 15%) and “Maintaining a body position” (DK: 17%; CA: 22%). Only few goals differed between populations, age and sex. All elements of SMART goal setting were recorded for 88% of Danish and 94% of Alberta participants.ConclusionsPeople with low back pain attending a self-management programme established goals according to the SMART criteria and focused primarily on activity. Goals were similar across countries and showed few differences across sex and age groups. The high number of different goals points to the need for individualised person-centred care.

Racial microaggressions in U.S. and Canadian contexts: Identity, perceptions of severity and the use of mindset signalling to repair harm

AbstractMicroaggressions are behaviours constituting indirect or unintentional discrimination, but little is known about how group identity affects perceptions of their harm. Canada and the United States have similar socio‐cultural backgrounds, but different socio‐political climates, with greater political polarisation and arguably stronger ties between politics and race in the United States (Pew research, 2020). Thus, the interplay between ethnic/racial identity (ERI), political identity, and perceived harm of microaggressions may differ across these countries. In a recent study of Canadians, perceived microaggression harm was associated with leftward political orientation rather than ERI. Here, we extend this work to a U.S. sample. In two experiments (N = 99; N = 210), White participants and Participants of Colour rated the severity of microaggressions and reported their political orientation and the strength of their ERI. Microaggression severity ratings were associated with left‐leaning political orientation, regardless of ERI. In Experiment 2, vignettes in which the perpetrator of a microaggression sought reparation by signalling a “reparatory open‐mindedness” reduced severity ratings compared to instances in which the source doubled down on the microaggression. Interestingly, the size of this reduction in perceived severity was smaller than for Canadian participants. Thus, perceived microaggression harm is governed by similar forces in Canada and the United States, but signalling mindset, while still effective, leads to smaller reductions in perceived harm in the United States. This could indicate differences in intergroup trust and polarization between these nations. This work underscores the role of political orientation in perceptions of microaggressions and highlights the efficacy of mindset signalling in mitigating their harm.

Disparities in public awareness, practitioner availability, and institutional support contribute to differential rates of MAiD utilization: a natural experiment comparing California and Canada

ABSTRACT Even though California and Canada both legalised medical aid in dying (MAiD) in 2016 and have similarly sized populations, only 853 medically assisted deaths occurred in California versus 13,241 in Canada in 2022, the most recently reported year. Ten testable hypotheses were proposed to explain this 15-fold differential in MAiD utilisation. A demographically representative online survey of adults 60 and older in both jurisdictions (N = 556) revealed no differences in moral acceptance of MAiD or willingness to use it. However, only 25% of Californian participants were aware that MAiD was legally available versus 67% of Canadian participants. Evidence in the public domain revealed that there were 6.0 times more MAiD practitioners per capita in Canada than in California, and there was far greater support for MAiD by Canadian healthcare institutions. The evidence did not support hypotheses presuming more restrictive laws in California or greater access to palliative care/hospice. While other reasons may contribute to the difference in MAiD utilisation, limited public awareness, fewer MAiD practitioners per capita, and sparse support by healthcare institutions may significantly reduce California residents’ ability to exercise their autonomy when making end of life choices.

Evaluating past emotions in changing facial expressions: The role of current emotions and culture.

Facial expressions in daily life typically change from one emotional state to another. To understand how people process emotions, it is important to know not only how current facial expressions are interpreted but also recent past expressions. While researchers have recently focused on perceptions of current expressions, little is known about how past expressions are gauged and about cultural differences in this process. The present research investigated whether and how evaluations of past facial expressions are influenced by subsequent expressions, and whether this process varies across East Asian and Western cultures. Specifically, Chinese and Canadian participants judged the degree of positivity/negativity of past expressions after viewing expressions that changed from past emotions-low-intensity smiles (Experiment 1), high-intensity smiles (Experiment 2), and anger (Experiment 3)-to current positive or negative emotions (collected between 2019 and 2020). All three experiments consistently found an assimilation effect, whereby past expressions were rated more positively when the current expression was positive than when the current expression was negative. Moreover, this assimilation effect was consistently greater in Chinese than in Canadian participants. Together, these findings suggest that the interpretation of past facial expressions assimilates toward the valence of subsequent expressions and that the impact of this temporal emotional context is more pronounced in Eastern relative to Western cultures. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Bowel and Bladder Dysfunction after SCI: A Comparison between India and Canada.

The inclusion of people living with spinal cord injury (SCI) in research has allowed for an informed understanding of priorities of recovery of which bowel dysfunction and bladder dysfunction have been continuously identified. Research has also demonstrated the global disparities in SCI outcomes particularly when comparing high- and low-income countries. Currently, there is a lack of direct comparison between countries when assessing SCI outcomes. This is an exploratory study to better understand bowel and bladder dysfunction amongst individuals with SCI in India and Canada. Data from 33 participants were analyzed. Participants completed an online questionnaire assessing demographic information and the Neurogenic Bowel Dysfunction (NBD) score, Wexner score, Neurogenic Bladder Symptom Score (NBSS), and the Incontinence Quality of Life Instrument (I-QOL). Continuous data were compared using t tests. For not normally distributed data, the independent Mann-Whitney U test was used. Categorical variables were evaluated for association using Fisher's exact or chi-square test, depending on the sample size. Independent Mann-Whitney U test demonstrated that the Canadian participants had poorer bowel function with higher total NBD scores (p = .007) and less frequent bowel movements (p = .036), and they were more likely to experience uneasiness, headaches, and perspiration during bowel movements (p < .001). NBSS results indicated a small but significantly higher proportion of the Indian participants were unsatisfied or unhappy with their bladder function (p = .049). The distribution of Wexner and I-QOL scores were the same across countries. Potential explanations for differences include lifestyle, management, financial resources, patient and caregiver education, and societal pressures, which are all heavily influenced by cultural, geographical, and economic circumstances.

Moral identity goal characteristics: Age-related trends from early adolescence to old age.

The study investigated age-related trends in moral identity goal characteristics, as proposed in previous research (Krettenauer, 2022a), by modifying the Self-Importance of Moral Identity Questionnaire (Aquino & Reed, 2002). Internally and externally motivated moral identity was assessed on varying levels of abstractness for promotion orientation as well as prevention orientation in Canadian participants from three different age groups: early adolescence (13-14 years, n = 248, 119 female), late adolescence to early adulthood (17-20 years, n = 251, 160 female), and mid to old age (50-76 years, n = 129, 76 female). Findings demonstrate that the self-importance of abstract moral identity characteristics increased with age relative to concrete identity characteristics, while the relationship between the two characteristics weakened. The same trend was found for internal moral identity motivation in comparison to external motivation. The study demonstrates that moral identity does not only reflect stable individual differences but is also an important developmental construct. Merging developmental and individual difference perspectives on moral identity opens new and promising avenues for future research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Patient and family experiences of lysosomal storage diseases in Canada: A qualitative interview study.

Canadian patients and families affected by rare genetic lysosomal storage diseases (LSDs) suffer from numerous challenges related to disease management, including issues navigating healthcare and social support services, access to orphan drugs, and intensive treatment regimens. These challenges significantly impact people's quality of life, yet they remain obscure and have not been the subject of comprehensive analysis. Thus, we conducted qualitative interviews with Canadian patients and caregivers living with LSDs to advance current understanding of their experiences with rare-disease (RD) management and health systems navigation to support patient-focused RD policies and programs and improve the health outcomes of the 2.8 million Canadians affected by RDs. This study employed a qualitative descriptive research design with inductive thematic analysis. The study data were collected using semi-structured interviews. Thirty Canadian participants were interviewed in person or remotely via video chat to allow for an interactive discussion and the acquisition of rich data related to the insights and perceptions of people with LSDs. Between April and November 2019, 30 participants (16 patients and 14 caregivers) with experiences with nine types of LSDs and living in seven Canadian provinces were interviewed. Five themes were identified using comprehensive thematic analysis. These themes were the complexity of the diagnosis process; navigation of healthcare systems; psychological, social, and financial implications of LSDs; access to social support services; and access to orphan drugs. Our findings reveal that patients' access to appropriate healthcare and social services is subject to significant delays and lacks care coordination. The process of accessing orphan drugs in Canada is extremely complex and convoluted. The study results also illuminate experiences of RD stigma when navigating healthcare and social support systems. Our study offers new insights into the complex nature and extensive needs of Canadians with LSDs that are currently unmet. The management of these complex diseases requires holistic patient care and support beyond having access to orphan drugs. Our findings highlight the importance of bridging existing gaps between health and social care for RD patients. Policymakers should utilize these results when developing the forthcoming national RD strategy.

Ambient air pollution and rate of spontaneous abortion

Spontaneous abortion (SAB), defined as a pregnancy loss before 20 weeks of gestation, affects up to 30% of conceptions, yet few modifiable risk factors have been identified. We estimated the effect of ambient air pollution exposure on SAB incidence in Pregnancy Study Online (PRESTO), a preconception cohort study of North American couples who were trying to conceive. Participants completed questionnaires at baseline, every 8 weeks during preconception follow-up, and in early and late pregnancy. We analyzed data on 4643 United States (U.S.) participants and 851 Canadian participants who enrolled during 2013–2019 and conceived during 12 months of follow-up. We used country-specific national spatiotemporal models to estimate concentrations of particulate matter <2.5 μm (PM2.5), nitrogen dioxide (NO2), and ozone (O3) during the preconception and prenatal periods at each participant's residential address. On follow-up and pregnancy questionnaires, participants reported information on pregnancy status, including SAB incidence and timing. We fit Cox proportional hazards regression models with gestational weeks as the time scale to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of time-varying prenatal concentrations of PM2.5, NO2, and O3 with rate of SAB, adjusting for individual- and neighborhood-level factors. Nineteen percent of pregnancies ended in SAB. Greater PM2.5 concentrations were associated with a higher incidence of SAB in Canada, but not in the U.S. (HRs for a 5 μg/m3 increase = 1.29, 95% CI: 0.99, 1.68 and 0.94, 95% CI: 0.83, 1.08, respectively). NO2 and O3 concentrations were not appreciably associated with SAB incidence. Results did not vary substantially by gestational weeks or season at risk. In summary, we found little evidence for an effect of residential ambient PM2.5, NO2, and O3 concentrations on SAB incidence in the U.S., but a moderate positive association of PM2.5 with SAB incidence in Canada.

Differences in eye movements for face recognition between Canadian and Chinese participants are not modulated by social orientation.

Face recognition strategies do not generalize across individuals. Many studies have reported robust cultural differences between West Europeans/North Americans and East Asians in eye movement strategies during face recognition. The social orientation hypothesis posits that individualistic vs. collectivistic (IND/COL) value systems, respectively defining West European/North American and East Asian societies, would be at the root of many cultural differences in visual perception. Whether social orientation is also responsible for such cultural contrast in face recognition remains to be clarified. To this aim, we conducted two experiments with West European/North American and Chinese observers. In Experiment 1, we probed the existence of a link between IND/COL social values and eye movements during face recognition, by using an IND/COL priming paradigm. In Experiment 2, we dissected the latter relationship in greater depth, by using two IND/COL questionnaires, including subdimensions to those concepts. In both studies, cultural differences in fixation patterns were revealed between West European/North American and East Asian observers. Priming IND/COL values did not modulate eye movement visual sampling strategies, and only specific subdimensions of the IND/COL questionnaires were associated with distinct eye-movement patterns. Altogether, we show that the typical contrast between IND/COL cannot fully account for cultural differences in eye movement strategies for face recognition. Cultural differences in eye movements for faces might originate from mechanisms distinct from social orientation.

Digital Tool-Assisted Hospitalization Detection in the Tailored Antiplatelet Initiation to Lessen Outcomes due to Decreased Clopidogrel Response After Percutaneous Coronary Intervention Study Compared to Traditional Site-Coordinator Ascertainment: Intervention Study.

Accurate, timely ascertainment of clinical end points, particularly hospitalizations, is crucial for clinical trials. The Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response after Percutaneous Coronary Intervention (TAILOR-PCI) Digital Study extended the main TAILOR-PCI trial's follow-up to 2 years, using a smartphone-based research app featuring geofencing-triggered surveys and routine monthly mobile phone surveys to detect cardiovascular (CV) hospitalizations. This pilot study compared these digital tools to conventional site-coordinator ascertainment of CV hospitalizations. The objectives were to evaluate geofencing-triggered notifications and routine monthly mobile phone surveys' performance in detecting CV hospitalizations compared to telephone visits and health record reviews by study coordinators at each site. US and Canadian participants from the TAILOR-PCI Digital Follow-Up Study were invited to download the Eureka Research Platform mobile app, opting in for location tracking using geofencing, triggering a smartphone-based survey if near a hospital for ≥4 hours. Participants were sent monthly notifications for CV hospitalization surveys. From 85 participants who consented to the Digital Study, downloaded the mobile app, and had not previously completed their final follow-up visit, 73 (85.8%) initially opted in and consented to geofencing. There were 9 CV hospitalizations ascertained by study coordinators among 5 patients, whereas 8 out of 9 (88.9%) were detected by routine monthly hospitalization surveys. One CV hospitalization went undetected by the survey as it occurred within two weeks of the previous event, and the survey only allowed reporting of a single hospitalization. Among these, 3 were also detected by the geofencing algorithm, but 6 out of 9 (66.7%) were missed by geofencing: 1 occurred in a participant who never consented to geofencing, while 5 hospitalizations occurred among participants who had subsequently turned off geofencing prior to their hospitalization. Geofencing-detected hospitalizations were ascertained within a median of 2 (IQR 1-3) days, monthly surveys within 11 (IQR 6.5-25) days, and site coordinator methods within 38 (IQR 9-105) days. The geofencing algorithm triggered 245 notifications among 39 participants, with 128 (52.2%) from true hospital presence and 117 (47.8%) from nonhospital health care facility visits. Additional geofencing iterative improvements to reduce hospital misidentification were made to the algorithm at months 7 and 12, elevating the rate of true alerts from 35.4% (55 true alerts/155 total alerts before month 7) to 78.7% (59 true alerts/75 total alerts in months 7-12) and ultimately to 93.3% (14 true alerts/5 total alerts in months 13-21), respectively. The monthly digital survey detected most CV hospitalizations, while the geofencing survey enabled earlier detection but did not offer incremental value beyond traditional tools. Digital tools could potentially reduce the burden on study coordinators in ascertaining CV hospitalizations. The advantages of timely reporting via geofencing should be weighed against the issue of false notifications, which can be mitigated through algorithmic refinements.

Fifteen-year mortality outcomes in the APEX-AMI trial compared to the general ST-elevation myocardial infarction population in Canada: Exploring lessons from numerators and denominators

Abstract Background It is well established that patients enrolled in clinical trials tend to be younger, more likely male, and have fewer comorbidities. Moreover, sites that enroll patients in randomized trials (RT) are often tertiary care centres in urban areas especially in the setting of STEMI. The impact of these potential selection biases on clinical outcomes both within and well beyond the proscribed RT follow-up window have not been adequately explored. Objective To compare 15-year mortality of ST elevation myocardial infarction of Canadian (STEMI) patients with high-risk electrocardiographic findings enrolled within 6 hours of symptom onset undergoing primary PCI in the APEX-AMI clinical trial of Pexelizumab (APEX-AMI group) with STEMI patients presenting to 25 APEX-AMI enrolling sites (APEX-AMI sites group); and STEMI patients presenting to 400 other sites (non-APEX-AMI site group). Methods APEX-AMI enrolled patients between 07/13/2004 – 05/11/2006. We conducted a probabilistic linkage (based on admission date, discharge date, age, sex, province, diagnosis of MI, presence of comorbidities) between APEX-AMI and the Canadian national Discharge Abstract Database (DAD), excluding Quebec, for the same time period. These data were further linked to tax files (for socio-economic data) and vital statistics data to obtain mortality status as of 2020. Results Of the 335 Canadian participants in APEX-AMI, 143 were from Quebec and were excluded. Of the remaining 192 patients, 188 (97.9%) were linked with the DAD. There were 8,470 patients in the APEX-AMI sites and 10,940 in the non-APEX-AMI sites groups, respectively (Table 1). Patients enrolled in APEX-AMI were less likely to be female, more affluent, have a lower comorbidity burden as measured by the Charlson Comorbidity Index, and higher PCI rates. Ninety-day all-cause mortality in the three groups was 4.3%, 8.5%, 12.7% in the APEX-AMI, APEX-AMI site, and non-APEX-AMI site groups, respectively. At 15-years, mortality rates were 34.0%, 45.8%, and 52.2% in the three groups (p&amp;lt;0.01, Figure). Enrollment in APEX-AMI was associated with an unadjusted 45% reduction in risk of 15-year mortality (HR 0.55, 95% CI: 0.43-0.70). However, this association was attenuated after adjusting for demographic and clinical factors (adjusted HR (aHR), 0.69, 95% CI: 0.54-0.88), and completely nullified after adjusting for PCI (aHR, 0.82, 95% CI: 0.64-1.05). Conclusions Our study demonstrates the feasibility and value of extending clinical trial follow-up via linkage with routinely collected administrative data. While enrollment in clinical trials appears to be associated with better long-term outcomes, our findings highlight the need to be vigilant to the potential for selection bias, the generalizability of trial findings and the potential to more broadly enhance long-term STEMI outcomes.

Culture shapes spontaneous brain dynamics – Shared versus idiosyncratic neural features among Chinese versus Canadian subjects

ABSTRACTEnvironmental factors, such as culture, are known to shape individual variation in brain activity including spontaneous activity, but less is known about their population-level effects. Eastern and Western cultures differ strongly in their cultural norms about relationships between individuals. For example, the collectivism, interdependence and tightness of Eastern cultures relative to the individualism, independence and looseness of Western cultures, promote interpersonal connectedness and coordination. Do such cultural contexts therefore influence the group-level variability of their cultural members’ spontaneous brain activity? Using novel methods adapted from studies of inter-subject neural synchrony, we compare the group-level variability of resting state EEG dynamics in Chinese and Canadian samples. We observe that Chinese subjects show significantly higher inter-subject correlation and lower inter-subject distance in their EEG power spectra than Canadian subjects, as well as lower variability in theta power and alpha peak frequency. We demonstrate, for the first time, different relationships among subjects’ resting state brain dynamics in Chinese and Canadian samples. These results point to more idiosyncratic neural dynamics among Canadian participants, compared with more shared neural features in Chinese participants.

Emotion perception from vocal cues: Testing the influence of emotion intensity and sex on in-group advantage.

The present study examined individuals' ability to identify emotions being expressed in vocal cues depending on the accent of the speaker as well as the intensity of the emotion being expressed. Australian and Canadian participants listened to Australian and Canadian speakers express pairs of emotions that fall within the same emotion family but vary in intensity (e.g., anger vs. irritation). Accent of listener was unrelated to emotion recognition. Instead, performance varied more based on emotion intensity and sex; Australian and Canadian participants generally found high intensity emotions easier to recognize compared to low intensity emotions as well as emotion conveyed by females compared to males. Participants found it particularly difficult to recognize the expressed emotion of Australian males. The results suggest the importance of considering the context in which emotion recognition is embedded. (PsycInfo Database Record (c) 2023 APA, all rights reserved).