Canadian Study Research Articles

Heuristics Identified in Health Data-Sharing Preferences of Patients With Cancer: Qualitative Focus Group Study.

Evaluating precision oncology outcomes requires access to real-world and clinical trial data. Access is based on consent, and consent is based on patients' informed preferences when deciding to share their data. Decision-making is often modeled using utility theory, but a complex decision context calls for a consideration of how heuristic, intuitive thought processes interact with rational utility maximization. Data-sharing decision-making has been studied using heuristic theory, but almost no heuristic research exists in the health data context. This study explores this evidence gap, applying a qualitative approach to probe for evidence of heuristic mechanisms behind the health data-sharing preferences of those who have experienced cancer. Exploring qualitative decision-making reveals the types of heuristics used and how they are related to the process of decision-making to better understand whether consent mechanisms should consider nonrational processes to better serve patient decision-making. This study aimed to explore how patients with cancer use heuristics when deciding whether to share their data for research. The researchers conducted a focus group study of Canadians who have experienced cancer. We recruited participants through an online advertisement, screening individuals based on their ability to increase demographic diversity in the sample. We reviewed the literature on data-sharing platforms to develop a semistructured topic guide on concerns about data sharing, incentives to share, and consent and control. Focus group facilitators led the open-ended discussions about data-sharing preferences that revealed underlying heuristics. Two qualitative analysts coded transcripts using a heuristic framework developed from a review of the literature. Transcripts were analyzed for heuristic instances which were grouped according to sociocultural categories. Using thematic analysis, the analysts generated reflexive themes through norming sessions and consultations. A total of 3 focus groups were held with 19 participants in total. The analysis identified 12 heuristics underlying intentions to share data. From the thematic analysis, we identified how the heuristics of social norms and community building were expressed through altruism; the recognition, reputation, and authority heuristics led to (dis)trust in certain institutions; the need for security prompted the illusion of control and transparency heuristics; and the availability and affect heuristics influenced attitudes around risk and benefit. These thematic relationships all had impacts on the participants' intentions to share their health data. The findings provide a novel qualitative understanding of how health data-sharing decisions and preferences may be based on heuristic processing. As patients consider the extent of risks and benefits, heuristic processes influence their assessment of anticipated outcomes, which may not result in rational, truly informed consent. This study shows how considering heuristic processing when designing current consent mechanisms opens up the opportunity for more meaningful and realistic interactions with the complex decision-making context.

Comparing How Three Frailty Scales Predict Negative Outcomes in Trauma Patients with Rib Fractures

Frailty is a risk factor for adverse outcomes after injury. Herein, we compared three frailty scales: the Canadian Study of Health and Aging clinical frailty scale, the rib fracture frailty index (RFFI) and the modified frailty index-5, to assess which scale is most applicable in predicting risk for negative outcomes in older patients with rib fractures. Patients ≥65 admitted for rib fractures were retrospectively scored for frailty using the RFFI, Canadian Study of Health and Aging clinical frailty scale, and modified frailty index-5. Outcomes examined were in-hospital mortality, pneumonia, in-hospital intubation, hospital length of stay, and discharge to skilled nursing facilities. Areas under the curve, sensitivity, specificity, negative predictive value, and positive predictive value were determined for each frailty scale with each outcome. Agreement was determined using Fleiss' Kappa. P<0.05 was considered significant. Three hundred forty-one patients were included. All three scales demonstrated similar predictive abilities for the measured outcomes. RFFI predicted mortality and pneumonia 70% of the time. All three scales predicted discharge to skilled nursing facilities 60% of the time. The concordance for all three frailty scales was 241/341 (70.7%). Fleiss Kappa was 0.40 [0.34-0.46] (P<0.001), indicating a fair to moderate agreement. The predictive ability of all three scales was higher in patients 65-74y old than in patients ≥75. Overall, no scale appeared to significantly outperform the others by areas under the curve estimation. Interrater reliability was higher in the 65 to 74-y-old population compared to the 75 and older population.

Vadim Koleneko Memorial Conference on Canadian Studies at the Russian State University of Humanities

The article provides information about the Vadim Koleneko Memorial Conference on Canadian Studies at the Russian State University of Humanities (RSUH) on April 4, 2024. This conference was organized by the Research and Educational Centre “Moscow-Quebec” and the Department of American Studies of RSUH with the assistance of the Centre for Canadian Studies of Saint-Petersburg State University. It was dedicated to Memory of Vadim Koleneko (1943–2011) – Soviet and than Russian Academic who was the leading Russian-speaking expert on the Canadian and Quebec History and Politics. It is noted that the conference was attended by 30 scholars from different educational and research institutions. Their papers were devoted to the Scientific Heritage of Vadim Koleneko as well as to the important issues of Canadian history, politics and culture.

9th Conference on Canadian Studies at Saint Petersburg State University

The article provides information about the IX Canadian Studies Conference held at St. Petersburg State University within the framework of the Second St. Petersburg Congress of Researchers of International Relations on April 25-27, 2024. This conference was organized by the Centre for Canadian Studies at SPbSU and was timed to coincide with three anniversaries: the 300th anniversary of SPbSU, the 30th anniversary of the Faculty of International Relations at SPbSU, and the 25th anniversary of the St. Petersburg branch of the Russian Association for Canadian Studies. It is noted that the conference was attended by a significant number of Canadianists from various scientific and educational institutions. Their presentations, dedicated to various aspects of Canadian history, politics, culture, and the social sphere, were delivered at an extremely high level.

From 2015 to now: The impact of the Robarts Centre for Canadian Studies

From 2015 to now: The impact of the Robarts Centre for Canadian Studies

“At Robarts, where knowledge takes flight”: A limerick about the Robarts Centre for Canadian Studies

“At Robarts, where knowledge takes flight”: A limerick about the Robarts Centre for Canadian Studies

Childhood obesity, sugar, and Early Childhood Caries: the sweet trap.

What drives our irresistible attraction to foods like chocolate, fries, or a warm apple pie? Sugar intake triggers the brain's dopamine system, creating a sense of reward that unconsciously conditions a preference for foods that satisfy cravings. Over time, this weakens attraction to healthier, low-fat and low-sugar foods. This response shares characteristics with addiction, sparking the concept of "food addiction." For early humans, this reward-driven behaviour was advantageous, motivating them to seek high-calorie foods essential for survival when food was scarce. Today, however, it fuels a global surge in obesity and diabetes the real "killer" of our times. Additionally, a study on fruit flies (Drosophila melanogaster) found that a sugar-heavy diet reduces sensitivity to sweetness, leading to increased consumption. This phenomenon, like "desensitisation" in humans, suggests that high sugar intake may promote obesity by altering taste perception and reward circuits [May et al., 2019]. The link between sugar-rich diets, obesity, and public health is a critical concern for healthcare professionals, policymakers, and the sustainability of the western healthcare system. A 2024 study published in BMJ [Lara-Castor et al., 2024] revealed that from 1990 to 2018, the consumption of sugar-sweetened beverages (SSBs) in children and adolescents (aged 3-19) from 185 countries rose by 23%, paralleling a global rise in obesity rates in this age group (Fig. 1). The findings highlighted a range of consumption levels influenced by factors like age, parental education, and urban living; however, the overall increase calls for national and targeted approaches to reduce SSB intake. Exactly like the prevalence of overweight (including obesity) among children and adolescents aged 5-19 has risen dramatically from just 8% in 1990 to 20% in 2022. While just 2% of children and adolescents aged 5-19 was obese in 1990 (31 million young people), by 2022, 8% of children and adolescents were living with obesity (160 million young people) [GBD 2019 Risk Factors Collaborators 2020; Okunogbe et al., 2022] (Fig. 2) [Ritchie and Roser, 2017]. Establishing good habits early is vital, as children are highly receptive to new behaviours. Notably, paediatric prevention begins even in the womb [Paglia 2017; Paglia, 2019]: a 2021 Canadian study [Laforest-Lapointeet al, 2021] linked maternal consumption of artificial sweeteners during pregnancy to an increased risk of infant obesity. By examining the gut microbiomes of 100 infants, researchers found that artificial sweetener intake could influence infant gut health and body mass index in the first year of life. The effects of sugar thus begin before birth and extend into early childhood. In Italy, added sugars are often introduced into infants' diets before 12 months, and delayed oral hygiene practices worsen the risks. Parental obesity further correlates with a higher incidence of Early Childhood Caries (ECC), emphasizing the need to address sugar consumption and health habits from prenatal to early childhood stages [D'oria, Bettocchi et al., 2024] Addressing the roots of obesity and diet-related diseases in young populations is therefore crucial and early intervention is key. In Italy, the government is attempting to curb sugar consumption through the so-called "sugar tax," introduced in the 2020 Budget Law. The tax was initially set to take effect on January 1st, 2021; but was postponed to January 1st, 2022. Then to January 1st, 2023; again to January 1st, 2024, and recently postponed once more to January 1st, 2025…Hoping next year will finally be the one!

A literature review of health literacy competency for health professionals

Purpose: This study aimed to provide a descriptive review of health literacy competency questionnaires and to identify their attributes for developing a health literacy competency measurement tool to be used by Korean health professionals.Methods: A literature review was conducted through a search in international and Korean databases (PubMed, CINAHL, RISS, and KISS) for articles published between 2010 and 2024. A total of 2,200 articles were explored, out of which 6 studies met the inclusion criteria.Results: In Canada, an initial set of health literacy competency questionnaires was developed; subsequently, two questionnaires were developed in China and Brazil. Another study was translated using the initial Canadian study questionnaires, and two studies were modified. All six studies meeting the inclusion criteria employed a Delphi process involving 20~41 expert panels. Among the six studies, only one reported the psychometric properties of the questionnaires used. The reviewed questionnaires comprised knowledge, attitude, skills, and practice domains based on Bloom’s taxonomy. Knowledge and skills were commonly included factors in the questionnaires.Conclusion: There were 17 knowledge, 10 attitude, 13 skills, and 13 practice attributes for each area of the reviewed questionnaires. “Easy-to-read materials,” “plain language,” and “teach-back” were identified as appropriate attributes for measuring health literacy competencies. Among the questionnaires, there were many items and many overlapping items between the domains. Further studies are required to refine their essential attributes and to verify the instruments’ psychometric properties in order to increase their feasibility.

Exploring the relevance of Universal Design for Learning implementation in the post-secondary landscape from the perspective of sustainability

This presentation showcases findings from a Canadian study which was carried out through 2023-24. This project explores an innovative facet of the momentum around sustainability within higher education, one that goes beyond the focus on environmental and operational preoccupations and concentrates on social and pedagogical sustainability. It examines the way the introduction of Universal Design for Learning (UDL) to a campus, through the creation of a cross-discipline community of practice, can (i) empower faculty to develop sustainable accessible practices within their own classroom, (ii) significantly reduce the reliance of the campus on accessibility services and reduce the pressure felt by these services, (iii) successfully integrate accessibility and inclusion within institutional strategic thinking around sustainability. The presentation synthesizes findings from a qualitative action-research project which examined perceptions and experiences of 14 stakeholders with different status and toles across the campus. The study adopted a phenomenological approach to data collection and analysis (Holland, 2014) and explored the participants’ own constructs in relation to the overlap between UDL and sustainability. Accessibility in the higher education has thus far been addressed through a medical model approach focused on retrofitting. In a nutshell, teaching and learning is designed for the ‘traditional learner’ and support services take on the task of supporting students who experience barriers in this design, with remedial, targeted services outside the classroom. The demographics of higher education, however, have changed widely over the last two decades, and retrofitting approaches are no longer sustainable. The volume of demand is growing exponentially, wait times increase, and the cost of Accessibility Services increases in a way that becomes unmanageable within most post-secondary campuses (NEADS, 2018). Universal Design for Learning (UDL) can address many of these strains on resources. Indeed, UDL is an emerging model for the management of diversity in the classroom which equips instructors to remove the majority of barriers to access to learning and support the needs of most diverse learners within the classroom itself (Al-Azawei et al., 2016). The literature highlights that most of the needs of diverse learners can be addressed with ease within the classroom itself once inclusive design and UDL are adopted and integrated as a mindset, across institutions (Baumann &amp; Melle, 2019; Dalton et al., 2019). UDL can therefore address some of the concerns over the sustainability of current disability service provision models. The need for a sustainable lens in this area is therefore tangible and pressing. Accessibility services, student services personnel, and faculty are all painfully feeling first-hand the inability of the current structure to meet the needs of diverse learners and to address the volume of service requests. UDL has the potential to address this strain on support services and to re-empower faculty to create inclusive provisions within the classroom space. A practical example of this would be the considerable pressure placed on accessibility services to digitalize printed material or to seek alternate versions of PDFs that are shared in class but are not accessible with reading software. This is an example of costly, repetitive use of resources that can be solved sustainably by empowering instructors to use the UDL principles in their class design and not rely on print only or on non-accessible digital documents. This has immediate resource and funding implications. UDL integration represents a clear example of sustainable transformation: an initial focus on professional development with faculty leads to a reduction in spending and resources that are non-renewable (Fovet, 2017). The presentation showcases the wider implications for UDL development across the sector.

Is Frailty Discouraging Surgeons from Performing Thoracolumbar Fusion? A Retrospective Study.

Retrospective cohort study. To evaluate whether frailty scoring is associated with adverse outcomes and management of thoracolumbar fractures (TLF) patients. Trauma patients with TLF often face longer recovery. The Canadian Study of Health and Aging clinical frailty scale (CSHA-CFS) predicts outcomes in older trauma patients. Adult trauma patients admitted from 2017 to 2021 who presented with TLF were included. Frailty was scored using CSHA-CFS. Endpoints were in-hospital mortality, hospital length of stay, surgery, complications, and discharge disposition. Multivariate analyses adjusting for baseline characteristics were performed. P<0.05 was considered significant. Overall, 1456 patients were included; 1013 fit, 240 pre-frail, and 203 frail. Frail patients underwent fewer surgeries (OR=0.5 [0.32-0.77], P=0.002). TL fusion was associated with lower mortality (OR=0.31 [0.11-0.85], P=0.024). Pre-frailty and frailty were associated with increased risk of pneumonia (OR=2.522 [1.428-4.456], P=0.001; OR=2.93 [1.32-6.54], P=0.008, respectively) and death (OR=3.581 [1.853-6.921], P<0.001; OR=2.46 [1.07-5.67], P=0.035). Pre-frail and frail patients were more likely to discharge to skilled nursing facilities (OR=1.687 [1.024-2.780], P=0.04; OR=4.89 [2.66-9.0]), P<0.001). Pre-frailty and frailty were associated with poor outcomes and higher level of care at discharge. Frail patients were less likely to undergo TL fusion, despite its association with improved survival. This suggests frailty should not discourage surgeons from performing thoracolumbar fusion. Frailty scoring upon admission may help guide management and set realistic expectations for patients and their families.

Treatment patterns for advanced therapies in Canadians with moderate-to-severe inflammatory bowel disease: a retrospective cohort analysis

Abstract Many patients with inflammatory bowel disease (IBD) show an inadequate response or experience a loss of response to advanced therapies. Guidelines recommend dose optimization and switching among therapies until an optimal treatment response is attained. With several advanced treatments available, we aimed to evaluate the persistence of different therapeutic sequences in IBD. The RECORDED study was a retrospective cohort study of Canadians with moderate-to-severely active ulcerative colitis (UC) or Crohn’s disease (CD) who had been exposed to more than 1 advanced therapy between May 2015 and April 2021 for UC, and May 2016 and April 2021 for CD. The primary endpoint was time to permanent discontinuation of the first advanced treatment. Overall, 330 patients had CD and 344 had UC. The most common first-line treatments for CD and UC were adalimumab and infliximab, respectively. The median (95% CI) time to permanent discontinuation of first-line treatment was 12.3 (10.9, 13.6) months in patients with CD and 9.2 (8.2, 10.8) months for those with UC. The most common reason for treatment change across both diseases was lack of efficacy. First-line advanced treatments were optimized in 191 (58.1%) CD patients and 202 (59.1%) UC patients prior to permanent discontinuation. Second-line therapy was typically from a different class compared with the first-line treatment choice. The RECORDED study provides insights into the real-world sequencing and optimization patterns of advanced treatments in patients with moderate-to-severe IBD in Canada. Lack of efficacy was the most cited reason for switching to a different therapy.

Experiences with discrimination during pregnancy in Canada and associations with depression and anxiety symptoms.

Experiences of discrimination reported during pregnancy are common and are associated with poor mental health and adverse birth outcomes. No Canadian studies have investigated interpersonal discrimination during pregnancy. This study aimed to quantify and identify lived-experiences of discrimination in a Canadian cohort of pregnant individuals, and examine associations with concurrent prenatal anxiety and depression symptoms. Pregnant individuals from the pan-Canadian Pregnancy During the Pandemic (PdP) study (n = 1943) completed the Everyday Discrimination Scale (EDS), demographic measures and self-report measures of depression and anxiety symptoms. Descriptive statistics and ANCOVA were used to assess prevalence of discrimination and associated mental health outcomes. Open-text responses (n = 189) to a question investigating reasons for discrimination were analyzed using conventional content analysis. Approximately three quarters (72%) of pregnant individuals experienced at least one instance of discrimination during their pregnancy or within the year prior. Pregnant individuals experiencing more frequent and/or more types of discrimination were more likely to identify as non-white, not be partnered, have lower socioeconomic status, and have a pre-pregnancy history of anxiety and depression. The most common attributions for interpersonal discrimination were gender, age, and education/income level. Pregnant individuals who experienced more frequent discrimination and/or more types of discrimination were more likely to report clinically significant symptoms of depression and anxiety (n = 623; 35.2% and 49.1%, respectively) compared to those who reported no discrimination (n = 539; 11.5% and 19.1%, respectively). Conventional content analysis of open-text responses generated the following main themes: (1) personal attributes and sociodemographic characteristics, (2) occupation, (3) the COVID-19 pandemic, (4) pregnancy and parenting, and (5) causes outside the self. Frequent discrimination was associated with more adverse concurrent mental health symptoms. Understanding experiences of discrimination can inform interventions that better address the needs of pregnant individuals and their infants.

47 Association between unmet social needs and parental stress in a paediatric asthma clinic

Abstract Background There are well documented associations between unmet social needs and undesirable health outcomes, but little data exist on the association between unmet social needs and stress in families of children with asthma. Objectives To document the relationship between unmet social needs and parental stress in a Canadian paediatric asthma clinic. Design/Methods Ongoing prospective observational study to determine the association between unmet social needs and parental stress was conducted in a tertiary care paediatric asthma clinic, between September 2022 and September 2023. Participants were parents of children with a diagnosis of asthma, treated with at least one controller medication. Unmet social needs were collected by parental self-report using a questionnaire assessing 8 domains: employment, housing, ability to pay for utilities, financial resources, food security, transportation, childcare, and education. The four-item Perceived Stress Scale was used to assess how parents perceived stress and how they felt they were able to manage situations in their lives. Chi-square tests compared our independent variable, the presence vs. absence of unmet social needs, to our dependent variables; each measure of stress (control over important aspects of ones’ life, confidence in ability to overcome problems, feeling that everything was going well, ability to overcome too many accumulated difficulties). Results Of 162 participants, seventy-seven (48%) reported at least one unmet social need. Compared to participants without unmet social needs, those with unmet needs were more likely to report having no control over important aspect of their work or main activity (p&amp;lt; 0.001); less likely to report having confidence in their ability to overcome problems (p&amp;lt; 0.001); less likely to report having the feeling that everything was going well (p&amp;lt; 0.001); and less likely to report having the ability to overcome too many accumulated difficulties (p&amp;lt; 0.001). Conclusion Findings suggest significant association between unmet social needs and parental stress of asthmatic children. Parental stress and unmet needs may concomitantly increase the burden of adhering to asthma controller medication, making adherence more challenging through pathways related to the interactions between cognitive burden and precarious living situations. This ongoing Canadian study seeks to elucidate the mechanisms by which these factors make adherence to asthma medication more challenging for families, so these challenges can be addressed.

Severe maternal morbidity in high income countries

IntroductionWith declining maternal mortality rates in high income countries (HICs), severe maternal morbidity (SMM) is becoming an important quality measure of maternal care. However, there is no international consensus on the definition and types of SMM. This study aims to critically analyze published literature on SMM in HICs. ObjectivesTo compare definitions and criteria used to identify SMM, and to identify the main types and risk factors contributing to SMM in eight HICs. MethodsThree databases were searched, results were filtered, and ten studies were critically appraised. ResultsSix of the articles discussed SMM identification criteria and proposed definition modifications. Longer hospital stay and admission to intensive care unit were suggested as additional criteria. Disease-based criteria was shown to be superior to organ dysfunction criteria. Seven articles detailed common types of SMM as severe haemorrhage, hypertensive disorders, and pre-eclampsia/eclampsia. Six articles described SMM risk factors, of which advanced maternal age and caesarean delivery were most common. DiscussionThis literature review identified disease-based criteria and Canadian study criteria as promising measures of SMM. It also identified several types and risk factors of SMM common between HICs. These findings can help physicians identify women at risk of SMM. The study is however limited to eight HICs and ten studies. Further research should aim to investigate how the measures compare with previous sources of criteria, and to discern the association of weight and race risk factors with SMM.

7236 Long Term Extension of Osilodrostat Therapy in Canadian Patients with Cushing’s Disease Benefiting from the LINC 3 and LINC 4 Studies

Abstract Disclosure: L.M. Martel: Other; Self; LMD receives partial fellowship salary support though educational grants from Recordati Rare Disease Canada Inc and Pfizer Canada. G. Houde: Other; Self; GH served as a consultant for Novartis. C. Chik: Other; Self; grants and/or consulting fees from Pfizer, Ipsen, Novartis and Novo Nordisk Canada. S.A. Imran: Other; Self; consulting fees from Pfizer, Recordati and Novartis. E. Paron: Other; Self; employees of Recordati Rare Disease Canada Inc. F. Lebel: Other; Self; employees of Recordati Rare Disease Canada Inc. A. Lacroix: Other; Self; reports grants and personal consulting fees from Novartis, Recordati and Pfizer. Introduction: Osilodrostat, a potent oral 11β-hydroxylase inhibitor, provided rapid, sustained cortisol normalization in Cushing’s disease (CD) patients in two Phase III trials (LINC 3, NCT02180217; LINC 4, NCT02697734); persistent biochemical and clinical improvement of CD were reported after 72 and 96 weeks of therapy, respectively (10.1530/EJE-22-0317; 10.3389/fendo.2023.1236465). After study completion and continued clinical benefit with osilodrostat, patients could transition in a roll-over study (CLCI699C2X01B , NCT03606408). As osilodrostat is now approved for therapy of CS in Europe and CD in USA, but not in Canada, seven Canadian patients who had benefited from osilodrostat were transitioned to an investigator initiated study ((ISS-CA-2023, NCT06131580). Objective: To analyze the course of therapy with osilodrostat which allowed long-term biochemical and clinical control of CD since initiation of LINC 3 and LINC 4 core studies for up to 105 months. Methods: Retrospective review of clinical, biochemical and imaging data were collected through chart review of 11patients enrolled in four Canadian centers in LINC 3 and 4 in LINC 4 parent studies. Seven patients remained in the roll-over study until termination and initiation of the Canadian study on October 24 2023. Data from initiation of therapy until October 24 2023 were analyzed. Results: Of the eleven enrolled patients, four discontinued treatment due to muscle cramps, repeat transsphenoidal surgery (TSS) for corticotroph adenoma progression in 2 cases, and hyperandrogenism and opting for bilateral adrenalectomy in one case. Seven cases (5 LINC 3 and 2 LINC 4) pursued therapy in the extension study: 2 men and 5 women, mean age 46 y.o. (range 28-72). All but one had previous TSS, one Gamma Knife and 4 received previous medical therapy. The median 24 hour urinary free cortisol (UFC) before starting osilodrostat was 334 nnmol/d (2.4 x ULN; range 133-414). The median treatment duration was 82 months (range 67-105) and median time to normalize UFC was 36 days. The median maximal dose required to normalize UFC was 10 mg/day (4-60); dose was frequently reduced because of symptoms of relative cortisol withdrawal or adrenal insufficiency (n: 5) to 6.5 mg/day (range: 1 mg every 6 days to 30 mg/d) currently. Last median UFC was 60 nmol/d (range 22-154; 6/7 in normal range &amp;lt; 138nmol/d). Tumor growth occurred in 1 patient (2mm). All patients presented partial to complete improvement of CD features, whereas one patient developed moderate clinical hyperandrogenism, hypertension and borderline prolongation of QTc that normalized after a dose reduction. Conclusions: Osilodrostat can provide sustained biochemical and clinical control of hypercortisolism in patients with CD for up to 9 years; however drug efficacy and dose requirement varies greatly between patients and must be adjusted carefully and regularly during course of therapy. Presentation: 6/3/2024

The relationship between fragility scores and intraoperative body temperature changes in geriatric patients: Prospective observational research.

Today, to evaluate morbidity and mortality in elderly surgical patients, fragility scores, which reflect the patient's current condition rather than increasing age, are used as a basis. Our research examines the association between fragility groups, body temperature changes, and inadvertent perioperative hypothermia (IPH) in major orthopedic surgery patients. Patients over the age of 65 who underwent major orthopedic surgery were evaluated. Body temperature measurements were taken tympanically preoperatively and every 5 minutes during surgery. Temperature changes (Δn) were calculated. Patients whose body temperature was below 36 °C were recorded as IPH. The Canadian Study of Health and Aging-Clinical Frailty Scale scoring system, consisting of 9 categories, was used for fragility scores. As the category number increases, the level of fragility increases. These categories are classified into 3 subgroups: Group F1 (Level 1-3), Group F2 (Level 4-7), and Group F3 (Level 8-9). Age groups: it is defined as Group A1 (66-74 years), Group A2 (75-84 years), and Group A3 (85<). The median (min-max) of surgery time was determined as 75 (35-131). For Δ35 (ºC), the differences between both fragility groups (P = .054) and the age groups (P = .145) were not significant. IPH frequency is 44.0% (n = 149). No difference was detected between hypothermia frequencies in the fragility groups (P = .546) and the age groups (P = .065). Nearly half of major surgery patients developed IPH. We did not find a relationship between both fragility groups and age groups and the frequency of IPH.

Effects of Progesterone on Vasomotor Symptoms in Postmenopausal Women (PROGEST) - a Prospective Multi-Center Randomized Double-Blind Placebo-Controlled Trial (RDPCT).

Introduction Monotherapy with progesterone for treatment of vasomotor symptoms (VMS) was more effective than placebo treatment of postmenopausal healthy women in a Canadian trial. The PROGEST-trial was initiated to fulfill FDA-approval criteria for the indication of treatment of postmenopausal VMS. Methods This prospective randomized, double-blind placebo-controlled clinical trial studied three doses of oral micronized progesterone (200 mg, 300 mg, 400 mg) and placebo for 12 weeks. Postmenopausal women with moderate to severe VMS (> 50 per week) were screened for one week for VMS frequency, then randomized to 200, 300 or 400 mg progesterone daily or placebo for a double-blinded trial of 12 weeks duration. Results 74 women were recruited in 12 study centers. 44 terminated the study as per protocol (PP). Moderate to severe hot flushes decreased by 7.4/d in the placebo arm, 7.7 VMS/d with 200 mg/d progesterone (P4), 8.3 VMS/d on 300 mg/d and 9.0 VMS/d on 400 mg/d P4, respectively by week 12. 32treatment emergent adverse events were documented in 18 participants, mostly minor AEs. The only SAE was a syncope requiring hospitalization on the day after treatment initiation, leading to discontinuation of the drug. Discussion Baseline VMS frequency was much higher in the German than in the Canadian study and the course of the placebo group had a markedly stronger decrease in VMS-frequency during the PROGEST study (-7.4/d) than in the Canadian trial (-1.4/d). Trial populations differed by age, BMI, the number of women with natural menopause, and comorbidities, mainly hypertension. Conclusion Premature discontinuation of the trial due to insufficient subject accrual rate led to only 55 randomized participants for analysis, therefore the study results lack statistical power. Still, a slight dose-dependent improvement in VMS was seen for all doses, while AE frequency did not increase with progesterone dose.

Assessing the impact of the COVID-19 pandemic on the mental health–related hospitalization rate of youth in Canada: an interrupted time series analysis

Introduction This study evaluated the effect of the COVID-19 pandemic on temporal trends in mental health and addiction–related inpatient hospitalization rates among youth (aged 10–17 years) in Canadian provinces and territories (excluding Quebec) from 1 April 2018 to 5 March 2022. Methods We conducted an interrupted time series analysis across three periods: T0 (pre-pandemic: 1 April 2018 to 15 March 2020); T1 (early pandemic: 15 March 2020 to 5 July 2020); and T2 (later pandemic: 6 July 2020 to 5 March 2022). Results Pre-pandemic mental health and addiction–related hospitalization rates had significant regional variability, with weekly rates from 6.27 to 85.59 events per 100 000 persons in Manitoba and the territories combined, respectively. During T1, the national (excluding Quebec) weekly hospitalization rate decreased from a pre-pandemic level of 12.82 (95% CI: 12.14 to 13.50) to 5.11 (95% CI: 3.80 to 6.41) events per 100 000 persons. There was no statistically significant change in the mental health and addiction– related hospitalization rate across provinces and territories in T2 compared to T0. However, there was a significant increase in the rate of self-harm–related hospitalizations among females Canada-wide and in most provinces during this period. Conclusion Although several Canadian studies have reported increases in mental health and addiction–related outpatient and emergency department visits among youth during the COVID-19 pandemic, this did not correspond to an increase in the inpatient hospital burden, with the notable exception of self-harm among young females.

Bariatric surgery decreases prescription drug costs for metabolic syndrome: a Canadian population-based cohort study.

Obesity is a chronic disease that is significantly linked to metabolic syndrome. Bariatric surgery is considered the most effective treatment for obesity resulting in long-term weight loss and comorbidity resolution. Prior studies have demonstrated the overall cost effectiveness of bariatric surgery; however, there is little data regarding direct pharmaceutical costs. The objective of this population-based study is to compare the cost of dispensed common prescription medications for metabolic syndrome before and after bariatric surgery. All patients that were enrolled in the Center for Metabolic and Bariatric Surgery who underwent gastric bypass or sleeve gastrectomy between 2013 and 2019 in Manitoba were included. Basic demographic information and outpatient prescription dispensation data were obtained from the Manitoba Population Research Data Repository, which is housed at the Manitoba Centre for Health Policy. Specific drug categories that were reviewed for costs 5years before and after surgery included Antihypertensives, Lipid Lowering Agents, Insulin and Non-insulin Diabetic Drugs. One thousand one hundred and eighty four patients were included in this review. Comparing the 5-yearpre- and post-surgery, there was a decrease in the overall amount of drug dispensed and the overall cost for all drug categories in the 5years following surgery. These categories included Antihypertensives ($506,268.8), Lipid Lowering Agents ($173,866.48), Insulin ($549,305.92), and Other Diabetes Drugs ($513,371.1). Additionally, older patients experienced a larger proportion of cost savings compared to younger patients, with the exception of non-insulin diabetic medications which trended to have more cost savings in the 30-49year old grouping. This is the first Canadian study to use accurate dispensing data from a provincial administrative prescription database to capture long-term cost savings for metabolic prescriptions after bariatric surgery. The results are consistent with the existing literature for prescriptions post-bariatric surgery. Future study will include subgroup analysis by patient age, gender, income quintile, and geography.

Association of preoperative frailty with suboptimal weight loss response among patients undergoing metabolic and bariatric surgery.

Preoperative patient frailty (i.e., aging-related functional decline across multiple physiological systems) has been linked to greater perioperative complications following metabolic bariatric surgery (MBS). This study evaluated whether preoperative patient frailty predicts 1-year suboptimal weight loss response after primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). The Bariatric Frailty Score (BFS), an adapted version of the Canadian Study of Health and Aging-Frailty Index based on 10 variables from MBSAQIP, assessed degree of frailty based on number of deficits (i.e., 0-10). Suboptimal response to MBS was defined as < 20% and < 30% percentage total weight loss (%TWL) at 1year following SG and RYGB, respectively. Multiple linear and logistic regression models evaluated associations of preoperative BFS score with %TWL and %TWL response thresholds, respectively. Patients (n = 1574; 78.9% female, 28.3% non-white, mean age 45 ± 12year; 67% SG) had a mean BFS of 1.6 ± 1.3 (range = 0-7). Overall, higher BFS related to lower %TWL after SG and RYGB (ß = - 0.12 and ß = - 0.17, respectively, p = 0.001). Compared to patients with 0-1 deficits (BFS score ≤ 1; n = 785, 49.9%), those with multiple deficits (BFS score ≥ 2; n = 789, 50.1%) had higher odds of suboptimal weight loss response after SG (OR 1.88, 95% CI 1.40-2.52, p < 0.001) and RYGB (OR 2.18, 95% CI 1.43-3.32, p < 0.001). Having multiple preoperative frailty deficits is associated with higher odds of suboptimal weight loss response after MBS. These findings point to the need for increased frailty screening and appropriate adjunctive interventions (i.e., exercise, nutrition, and cognitive), as these interventions may improve frailty status and MBS outcomes.