Pub Date : 2021-09-27DOI: 10.33137/utjph.v2i2.36835
Claire Carnegie
Fred Victor is an organization that supports those experiencing poverty and homelessness in Toronto. As a practicum student in the Health Promotions department at Fred Victor, I gained experience working on health promotion projects and was able to work directly with the community. Throughout the practicum, I worked on several projects to adapt Fred Victor’s services during COVID-19. First, I worked to develop a resilience toolkit for Fred Victor staff. COVID-19 has led to higher levels of stress. This prompted Fred Victor to develop tools to support their staff. I designed a toolkit that instructs managers on how to promote resilience in their supervision sessions and team meetings. This toolkit provided information on what resilience is, as well as practical actions that managers can take to promote resilience in staff. This project involved knowledge translation to convey the research on resilience to Fred Victor staff in an accessible way. Additionally, I worked to support the development of online peer support groups. Typically, Fred Victor runs weekly in-person peer support groups for community members. However, due to COVID-19, these groups had to move to an online format. I helped facilitate this transition by developing a guide for facilitating online group programming. This guide included information on the best platforms to run online programming, how to create a safety agreement, and best practices for facilitating the group. I then conducted outreach to community members to ask for their input on the format and content of the groups. These projects are important to public health as they work to meet the public health goal to improve quality of life by promoting and encouraging healthy behaviours. These projects played an important role in promoting the health of Fred Victor staff and clients during COVID-19 by providing them with support and tools to manage their mental health.
Fred Victor是一个支持多伦多贫困和无家可归者的组织。作为Fred Victor健康促进部门的实习学生，我获得了从事健康促进项目的经验，并能够直接与社区合作。在整个实习期间，我参与了几个项目，以适应弗雷德·维克多在COVID-19期间的服务。首先，我为弗雷德·维克多的员工开发了一个弹性工具包。COVID-19导致了更大的压力。这促使Fred Victor开发工具来支持他们的员工。我设计了一个工具包，指导经理们如何在监督会议和团队会议上提高弹性。这个工具包提供了关于什么是弹性的信息，以及管理者可以采取的实际行动，以促进员工的弹性。该项目涉及知识翻译，以一种易于理解的方式向弗雷德维克多的员工传达对弹性的研究。此外，我还致力于支持在线同伴支持小组的发展。通常，弗雷德·维克多每周都会为社区成员举办面对面的同伴支持小组。然而，由于2019冠状病毒病，这些团体不得不转向在线形式。我通过开发一个促进在线小组编程的指南来帮助促进这种转变。该指南包括运行在线节目的最佳平台，如何创建安全协议以及促进小组的最佳实践等信息。然后，我向社区成员征求他们对小组形式和内容的意见。这些项目对公共卫生很重要，因为它们致力于通过促进和鼓励健康行为来实现改善生活质量的公共卫生目标。在2019冠状病毒病疫情期间，这些项目为Fred Victor员工和客户提供了管理心理健康的支持和工具，在促进他们的健康方面发挥了重要作用。
{"title":"Developing Resources for Staff and Adapting Programing During COVID-19 at Fred Victor","authors":"Claire Carnegie","doi":"10.33137/utjph.v2i2.36835","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.36835","url":null,"abstract":"Fred Victor is an organization that supports those experiencing poverty and homelessness in Toronto. As a practicum student in the Health Promotions department at Fred Victor, I gained experience working on health promotion projects and was able to work directly with the community. Throughout the practicum, I worked on several projects to adapt Fred Victor’s services during COVID-19. First, I worked to develop a resilience toolkit for Fred Victor staff. COVID-19 has led to higher levels of stress. This prompted Fred Victor to develop tools to support their staff. I designed a toolkit that instructs managers on how to promote resilience in their supervision sessions and team meetings. This toolkit provided information on what resilience is, as well as practical actions that managers can take to promote resilience in staff. This project involved knowledge translation to convey the research on resilience to Fred Victor staff in an accessible way. Additionally, I worked to support the development of online peer support groups. Typically, Fred Victor runs weekly in-person peer support groups for community members. However, due to COVID-19, these groups had to move to an online format. I helped facilitate this transition by developing a guide for facilitating online group programming. This guide included information on the best platforms to run online programming, how to create a safety agreement, and best practices for facilitating the group. I then conducted outreach to community members to ask for their input on the format and content of the groups. These projects are important to public health as they work to meet the public health goal to improve quality of life by promoting and encouraging healthy behaviours. These projects played an important role in promoting the health of Fred Victor staff and clients during COVID-19 by providing them with support and tools to manage their mental health.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127005406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-27DOI: 10.33137/utjph.v2i2.36843
Jiamin Guo, Andrew Paterson, D. Roshandel
Introduction & Objective: Cumulated advanced glycation end products (AGEs) in the bloodstream and tissues contribute to the pathogenesis of diabetes complications. The skin intrinsic fluorescence (SIF) is a non-invasive measurement of dermal AGEs level using spectrometer, and it can be used as a biomarker in AGEs-related diseases. Previously, specific epigenomic factor has been found to be associated with haemoglobin A1c (HbA1c). HbA1c is a type of glycated haemoglobin – the HbA1c test measures the average glycemic control over the period of 3 months. However, the effect of epigenetic factors on the level of AGEs in the skin remains unknown. We hypothesize that some cytosine-guanine dinucleotides (CpGs) are associated with SIF. An epigenome-wide associations study (EWAS) was performed to identify CpG sites associated with SIF in people with type 1 diabetes. Methods: 499 people with type 1 diabetes that have both methylation and SIF from the Diabetes Control Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study were included. We fit linear regression models for SIF with each CpG site one at a time. The epigenome-wide significance level (p=5e-8) was applied. Then the result is compared with the null hypothesis where CpGs are not associated with SIF to check the inflation. In order to check the assumptions of the multiple linear models at a single CpG, we use diagnostic plots. Results: We did not identify a specific CpG that is significantly associated with neither skin intrinsic fluorescence 1 (SIF1) nor skin intrinsic fluorescence 12 (SIF 12).The CpG site with strongest effect is cg06538183 ([SE] -2.73 [0.61], p = 8.72e-6) on SIF1 and cg12871967 ([SE] 2.52, 0.53, p = 2.71e-6) on SIF12. Conclusion: We did not find any specific CpG that was significantly associated with either SIF 1 or SIF12. In general, the result suggests that DNA methylation does not impact the accumulation of AGEs in skin cells. DNA methylation data has a unique pattern of distribution that drives the non-uniform distribution of the p-values. The group of 275,301 CpGs that have means above the median and standard deviations below the median has the expected uniform p-value distribution.
简介与目的:血液和组织中累积的晚期糖基化终产物(AGEs)有助于糖尿病并发症的发病。皮肤本征荧光(SIF)是一种利用分光计无创测量皮肤AGEs水平的方法，可作为AGEs相关疾病的生物标志物。以前，已经发现特定的表观基因组因子与血红蛋白A1c (HbA1c)相关。糖化血红蛋白是一种糖化血红蛋白——糖化血红蛋白测试测量的是3个月的平均血糖控制水平。然而，表观遗传因素对皮肤中AGEs水平的影响尚不清楚。我们假设一些胞嘧啶-鸟嘌呤二核苷酸(CpGs)与SIF有关。进行了一项全表观基因组关联研究(EWAS)，以确定与1型糖尿病患者SIF相关的CpG位点。方法:纳入糖尿病控制并发症试验/糖尿病干预和并发症流行病学(DCCT/EDIC)研究中同时存在甲基化和SIF的499例1型糖尿病患者。我们将SIF的线性回归模型与每个CpG位点一次拟合一个。采用全表观基因组显著性水平(p=5e-8)。然后将结果与零假设进行比较，其中CpGs与SIF无关，以检查通货膨胀。为了检验多个线性模型在单个CpG下的假设，我们使用诊断图。结果:我们没有发现特异性CpG与皮肤固有荧光1 (SIF1)和皮肤固有荧光12 (sif12)都没有显著相关。影响最强的CpG位点为SIF1上的cg06538183 ([SE] -2.73 [0.61]， p = 8.72e-6)和SIF12上的cg12871967 ([SE] 2.52, 0.53, p = 2.71e-6)。结论:我们没有发现任何特定的CpG与sif1或SIF12显著相关。总的来说，结果表明DNA甲基化不会影响皮肤细胞中AGEs的积累。DNA甲基化数据具有独特的分布模式，驱动p值的非均匀分布。均值高于中位数且标准差低于中位数的275,301个cpg组具有期望的均匀p值分布。
{"title":"Epigenetics of skin intrinsic florescence","authors":"Jiamin Guo, Andrew Paterson, D. Roshandel","doi":"10.33137/utjph.v2i2.36843","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.36843","url":null,"abstract":"Introduction & Objective: Cumulated advanced glycation end products (AGEs) in the bloodstream and tissues contribute to the pathogenesis of diabetes complications. The skin intrinsic fluorescence (SIF) is a non-invasive measurement of dermal AGEs level using spectrometer, and it can be used as a biomarker in AGEs-related diseases. Previously, specific epigenomic factor has been found to be associated with haemoglobin A1c (HbA1c). HbA1c is a type of glycated haemoglobin – the HbA1c test measures the average glycemic control over the period of 3 months. However, the effect of epigenetic factors on the level of AGEs in the skin remains unknown. We hypothesize that some cytosine-guanine dinucleotides (CpGs) are associated with SIF. An epigenome-wide associations study (EWAS) was performed to identify CpG sites associated with SIF in people with type 1 diabetes. \u0000Methods: 499 people with type 1 diabetes that have both methylation and SIF from the Diabetes Control Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study were included. We fit linear regression models for SIF with each CpG site one at a time. The epigenome-wide significance level (p=5e-8) was applied. Then the result is compared with the null hypothesis where CpGs are not associated with SIF to check the inflation. In order to check the assumptions of the multiple linear models at a single CpG, we use diagnostic plots. \u0000Results: We did not identify a specific CpG that is significantly associated with neither skin intrinsic fluorescence 1 (SIF1) nor skin intrinsic fluorescence 12 (SIF 12).The CpG site with strongest effect is cg06538183 ([SE] -2.73 [0.61], p = 8.72e-6) on SIF1 and cg12871967 ([SE] 2.52, 0.53, p = 2.71e-6) on SIF12. \u0000Conclusion: We did not find any specific CpG that was significantly associated with either SIF 1 or SIF12. In general, the result suggests that DNA methylation does not impact the accumulation of AGEs in skin cells. DNA methylation data has a unique pattern of distribution that drives the non-uniform distribution of the p-values. The group of 275,301 CpGs that have means above the median and standard deviations below the median has the expected uniform p-value distribution.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120894703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-27DOI: 10.33137/utjph.v2i2.36897
Thilaxcy Yohathasan, Sterling Stutz
Purpose: The availability of culturally safe and plain-language resources is necessary to reduce the spread of COVID-19 for Indigenous communities around the world. Translations For Our Nations is an initiative addressing these resource gaps, making available COVID-19 health resources in Indigenous languages on the web. The project began in April 2020 as a result of the Indigenous COVID-19 Health Partnership launched by Victor A. Lopez-Carmen, a Dakota and Yaqui medical student, Harvard Medical School) and co-founded by Sterling Stutz and Thilaxcy Yohathasan, (MPH-Indigenous Health at the University of Toronto), and Sukhmeet Singh Sachal (medical student, University of British Columbia). Methods: Translators from Indigenous communities around the world signed up to participate in the project via a GoogleForm in April 2020. Over 100 Indigenous translators and community members in regions (South America, Asia, Africa, Europe, North America, and the Pacific) were provided the 5 English language source materials reviewed by physicians and Indigenous youth leaders. Translators submitted their translated documents via email and on September 1, 2020 the website Translations4OurNations.org was launched where the translated documents can be accessed and downloaded with more translations accepted on a rolling basis. Results: Translations for our Nations has published COVID-19 health resources in 40+ Indigenous languages from around the world. The website also includes photos and text submissions from community members speaking to the importance of culturally-specific COVID-19 health information disseminated directly to communities in local languages and dialects. Implications: Indigenous Nations have the right to access vital health information in their mother tongue. This project is led by and designed for Indigenous youth and Indigenous community members to empower individuals and communities to make informed choices regarding their health and exposure risks, and decrease the risk of COVID-19 transmission in Indigenous communities around the world.
目的:提供文化上安全和语言简单的资源对于减少COVID-19在世界各地土著社区的传播是必要的。“为我们的国家翻译”是一项解决这些资源缺口的倡议，在网络上提供土著语言的COVID-19卫生资源。该项目于2020年4月启动，是由哈佛医学院达科他和雅基医科学生Victor a . Lopez-Carmen发起的土著COVID-19卫生伙伴关系的结果，该伙伴关系由Sterling Stutz和Thilaxcy Yohathasan(多伦多大学土著卫生硕士)和Sukhmeet Singh Sachal(不列颠哥伦比亚大学医科学生)共同创立。方法:来自世界各地土著社区的翻译人员于2020年4月通过GoogleForm报名参加该项目。来自各地区(南美、亚洲、非洲、欧洲、北美和太平洋)的100多名土著翻译人员和社区成员获得了由医生和土著青年领袖审查的5种英语源材料。翻译人员通过电子邮件提交翻译文件，并于2020年9月1日启动了Translations4OurNations.org网站，可以访问和下载翻译文件，并以滚动方式接受更多翻译。结果:翻译为我们的国家出版了来自世界各地的40多种土著语言的COVID-19卫生资源。该网站还包括社区成员提交的照片和文字，说明以当地语言和方言直接向社区传播具有文化特殊性的COVID-19卫生信息的重要性。影响:土著民族有权以其母语获取重要的卫生信息。该项目由土著青年和土著社区成员领导，旨在使个人和社区能够就其健康和暴露风险做出知情选择，并降低COVID-19在世界各地土著社区传播的风险。
{"title":"Translations for Our Nations: Addressing the Indigenous Language Gap in COVID-19 Health Communication","authors":"Thilaxcy Yohathasan, Sterling Stutz","doi":"10.33137/utjph.v2i2.36897","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.36897","url":null,"abstract":"Purpose: The availability of culturally safe and plain-language resources is necessary to reduce the spread of COVID-19 for Indigenous communities around the world. Translations For Our Nations is an initiative addressing these resource gaps, making available COVID-19 health resources in Indigenous languages on the web. The project began in April 2020 as a result of the Indigenous COVID-19 Health Partnership launched by Victor A. Lopez-Carmen, a Dakota and Yaqui medical student, Harvard Medical School) and co-founded by Sterling Stutz and Thilaxcy Yohathasan, (MPH-Indigenous Health at the University of Toronto), and Sukhmeet Singh Sachal (medical student, University of British Columbia). \u0000Methods: Translators from Indigenous communities around the world signed up to participate in the project via a GoogleForm in April 2020. Over 100 Indigenous translators and community members in regions (South America, Asia, Africa, Europe, North America, and the Pacific) were provided the 5 English language source materials reviewed by physicians and Indigenous youth leaders. Translators submitted their translated documents via email and on September 1, 2020 the website Translations4OurNations.org was launched where the translated documents can be accessed and downloaded with more translations accepted on a rolling basis. \u0000Results: Translations for our Nations has published COVID-19 health resources in 40+ Indigenous languages from around the world. The website also includes photos and text submissions from community members speaking to the importance of culturally-specific COVID-19 health information disseminated directly to communities in local languages and dialects. \u0000Implications: Indigenous Nations have the right to access vital health information in their mother tongue. This project is led by and designed for Indigenous youth and Indigenous community members to empower individuals and communities to make informed choices regarding their health and exposure risks, and decrease the risk of COVID-19 transmission in Indigenous communities around the world.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128997400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-27DOI: 10.33137/utjph.v2i2.36827
Xinyang Feng, Huan Jiang
Introduction & Objective: Given that the impact of regulatory and public policy initiatives cannot usually be tested through traditional randomized controlled trial designs, well-selected, -designed, and -analyzed natural experiments are the method of choice when examining the effects of such enactments on a variety of outcomes. The classic methodology for such evaluations is interrupted time-series (ITS) analysis, which is considered as one of the quasi-experimental designs that use both pre- and post-policy data without randomization. This study tests the impact of alcohol control interventions implemented in different period of times on suicide mortality rates among people 25-74 years of age using ITS. Methods: We mainly use the generalized additive mixed model (GAMM) to capture trend and seasonality in suicide mortality rates while controlling for unemployment rates, financial crisis during 2007-2008, and legal alcohol consumption records. Given the notable differences in alcohol consumption and suicide mortality between males and females, all analyses are conducted gender-specifically. Results: The ITS shows that the intervention introduced in 2017 has a significant effect on reducing suicide mortality rates for males between 25 and 74. Following the implementation of the intervention, suicide mortality rates decreased by 23.8% (95% CI: 10.2% - 35.4%) on average. Conclusion: The alcohol control intervention that strictly increased the excise tax on alcohol products has been shown to have a strong impact on reducing suicide mortality rates among male adults 25-74 years of age. ITS analyses are one of the strongest evaluative designs and allow a more detailed assessment of the longitudinal impact of an intervention than may be possible with a randomized control trial.
{"title":"Evaluating the Impact of Alcohol Control Interventions on Suicide Mortality Rates","authors":"Xinyang Feng, Huan Jiang","doi":"10.33137/utjph.v2i2.36827","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.36827","url":null,"abstract":"Introduction & Objective: Given that the impact of regulatory and public policy initiatives cannot usually be tested through traditional randomized controlled trial designs, well-selected, -designed, and -analyzed natural experiments are the method of choice when examining the effects of such enactments on a variety of outcomes. The classic methodology for such evaluations is interrupted time-series (ITS) analysis, which is considered as one of the quasi-experimental designs that use both pre- and post-policy data without randomization. This study tests the impact of alcohol control interventions implemented in different period of times on suicide mortality rates among people 25-74 years of age using ITS. \u0000Methods: We mainly use the generalized additive mixed model (GAMM) to capture trend and seasonality in suicide mortality rates while controlling for unemployment rates, financial crisis during 2007-2008, and legal alcohol consumption records. Given the notable differences in alcohol consumption and suicide mortality between males and females, all analyses are conducted gender-specifically. \u0000Results: The ITS shows that the intervention introduced in 2017 has a significant effect on reducing suicide mortality rates for males between 25 and 74. Following the implementation of the intervention, suicide mortality rates decreased by 23.8% (95% CI: 10.2% - 35.4%) on average. \u0000Conclusion: The alcohol control intervention that strictly increased the excise tax on alcohol products has been shown to have a strong impact on reducing suicide mortality rates among male adults 25-74 years of age. ITS analyses are one of the strongest evaluative designs and allow a more detailed assessment of the longitudinal impact of an intervention than may be possible with a randomized control trial.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125249684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-27DOI: 10.33137/utjph.v2i2.36896
Alifa Siddiqui
My practicum placement was completed with the Dalla Lana School of Public Health Centre for Global Health. I have contributed to the work of a team of student and faculty members developing a review of the literature and environmental scan to explore the impact of the COVID-19 pandemic on migrant populations. I worked with colleagues to design and run a search strategy on the Medline (OVID) and Scopus bibliographic databases. The findings showed that crises including the COVID-19 pandemic act as magnifying lens and expose existing inequities within society as the impact of the pandemic is not equally felt by all population groups. Migrant populations are particularly impacted due to their intersectional identities that marginalize and disempower them and severely impact their health outcomes. Even though migration is the engine of the globalized economy and migrant workers make significant contribution to agricultural and economic prosperity, their precarious living conditions have worsened during the pandemic and they are being excluded from relief packages and income support. Furthermore, racism and xenophobia are fuelling hostility and prejudice towards migrants as governments are controlling the movement of migrants by closing their borders to asylum seekers and existing refugee camps are having outbreaks due to cramped and overcrowded living conditions and limited healthcare access. It is evident that migrant populations are very diverse groups that are facing unique challenges and thus, require distinct forms of protection particularly during this pandemic. The results of this work are currently being summarized in a manuscript that recognizes how determinants of health impact the health and well-being of migrants, the need to develop a road map for recovery using a health equity lens, and inform health policies. To eradicate COVID-19, it is imperative to leave no one behind including migrant populations and re-evaluate how inequities are addressed globally.
{"title":"Impact of COVID-19 on displaced populations and migrants around the world","authors":"Alifa Siddiqui","doi":"10.33137/utjph.v2i2.36896","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.36896","url":null,"abstract":"My practicum placement was completed with the Dalla Lana School of Public Health Centre for Global Health. I have contributed to the work of a team of student and faculty members developing a review of the literature and environmental scan to explore the impact of the COVID-19 pandemic on migrant populations. I worked with colleagues to design and run a search strategy on the Medline (OVID) and Scopus bibliographic databases. The findings showed that crises including the COVID-19 pandemic act as magnifying lens and expose existing inequities within society as the impact of the pandemic is not equally felt by all population groups. Migrant populations are particularly impacted due to their intersectional identities that marginalize and disempower them and severely impact their health outcomes. Even though migration is the engine of the globalized economy and migrant workers make significant contribution to agricultural and economic prosperity, their precarious living conditions have worsened during the pandemic and they are being excluded from relief packages and income support. Furthermore, racism and xenophobia are fuelling hostility and prejudice towards migrants as governments are controlling the movement of migrants by closing their borders to asylum seekers and existing refugee camps are having outbreaks due to cramped and overcrowded living conditions and limited healthcare access. It is evident that migrant populations are very diverse groups that are facing unique challenges and thus, require distinct forms of protection particularly during this pandemic. The results of this work are currently being summarized in a manuscript that recognizes how determinants of health impact the health and well-being of migrants, the need to develop a road map for recovery using a health equity lens, and inform health policies. To eradicate COVID-19, it is imperative to leave no one behind including migrant populations and re-evaluate how inequities are addressed globally.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123802411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-27DOI: 10.33137/utjph.v2i2.36841
Hoora Emami
I completed my practicum with 4YouandMe, a non-profit created to aid individuals who are interested in sharing health-related data using smartphones and other wearable devices so that they can better understand and navigate health conditions. The Stress and Recovery Study used the Oura ring and smartphones to track and understand the multidimensional components of stress and recovery off-shift in frontline healthcare workers during the current COVID-19 pandemic. My role in this study was actively working as a clinical research coordinator and digital participant engagement expert. This role consisted of calling participants and asking them about their overall study experience, details regarding their stress triggers, their home and work environments, and use of their Oura ring. I was responsible for maintaining contact with about 70 participants and creating contact logs after each phone call. The purpose of these phone calls is to provide support and encourage participant adherence to the study tasks. In addition to this primary role, I also completed an emerging COVID-19 hotspot map that was used in the recruitment process of the study. I outlined regions in the U.S that may become hotspots for COVID cases and may subsequently translate to a higher stressed group of healthcare workers in those areas. Additionally, I contributed to developing adherence tracking frameworks and other study materials used by team members. This study is contributing to the public health literature by using novel methodologies including digital approaches to understanding stress. Looking at digital stress responses and biometric data as signals to predict infection may inform other tools to aid in early detection. Finally, the study aims to determine whether resiliency factors and some social determinants of health modify stress and recovery.
{"title":"Exploring Frontline Healthcare Worker's Stress and Recovery Off-Shift during the COVID-19 Pandemic","authors":"Hoora Emami","doi":"10.33137/utjph.v2i2.36841","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.36841","url":null,"abstract":"I completed my practicum with 4YouandMe, a non-profit created to aid individuals who are interested in sharing health-related data using smartphones and other wearable devices so that they can better understand and navigate health conditions. The Stress and Recovery Study used the Oura ring and smartphones to track and understand the multidimensional components of stress and recovery off-shift in frontline healthcare workers during the current COVID-19 pandemic. My role in this study was actively working as a clinical research coordinator and digital participant engagement expert. This role consisted of calling participants and asking them about their overall study experience, details regarding their stress triggers, their home and work environments, and use of their Oura ring. I was responsible for maintaining contact with about 70 participants and creating contact logs after each phone call. The purpose of these phone calls is to provide support and encourage participant adherence to the study tasks. In addition to this primary role, I also completed an emerging COVID-19 hotspot map that was used in the recruitment process of the study. I outlined regions in the U.S that may become hotspots for COVID cases and may subsequently translate to a higher stressed group of healthcare workers in those areas. Additionally, I contributed to developing adherence tracking frameworks and other study materials used by team members. This study is contributing to the public health literature by using novel methodologies including digital approaches to understanding stress. Looking at digital stress responses and biometric data as signals to predict infection may inform other tools to aid in early detection. Finally, the study aims to determine whether resiliency factors and some social determinants of health modify stress and recovery.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125371835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-27DOI: 10.33137/utjph.v2i2.36999
Jona Gjevori, K. Abdesselam
Methicillin-Resistant Staphylococcus aureus (MRSA) is among the most prevalent nosocomial pathogens globally, causing significant morbidity, mortality, and healthcare costs. MRSA bloodstream infection (BSI) incidence rates in Canadian hospitals have significantly risen by almost 60% and have a mortality of over 20% upon Intensive Care Unit admission. MRSA is believed to be spread through healthcare workers; thus, high hand hygiene compliancy in addition to environmental cleaning are the cornerstone countermeasures to disrupting its transmission. The Public Health Agency of Canada (PHAC), in collaboration with the Canadian Nosocomial Infection Surveillance Program (CNISP), conducts national, sentinel surveillance on healthcare-associated infections like MRSA. As a Student Epidemiologist, I developed a research proposal detailing two study objectives: 1) develop a regression model to predict all incident MRSA BSI rates among acute-care hospitals in Canada using CNISP MRSA BSI incident cases from 2000 to 2019, and 2) create a compartmental (Susceptible-Infected-Recovered-Deceased) model to determine the impact of various Infection Prevention and Control (IPC) measures on the risk of healthcare-associated MRSA BSI transmission specifically. This study hopes to demonstrate that proper IPC compliance is associated with lower incident MRSA BSI rates with the goal being to produce a manuscript draft by 2021. MRSA poses a serious threat to patient safety globally and is becoming a growing national public health concern in Canada; determining which IPC strategy is most effective at disrupting MRSA transmission is essential to reducing incidence and mortality rates.
{"title":"Predicting Methicillin-Resistant Staphylococcus aureus (MRSA) Bloodstream Infection Incidence Rates using Canadian Nosocomial Infection Surveillance Program (CNISP)","authors":"Jona Gjevori, K. Abdesselam","doi":"10.33137/utjph.v2i2.36999","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.36999","url":null,"abstract":"Methicillin-Resistant Staphylococcus aureus (MRSA) is among the most prevalent nosocomial pathogens globally, causing significant morbidity, mortality, and healthcare costs. MRSA bloodstream infection (BSI) incidence rates in Canadian hospitals have significantly risen by almost 60% and have a mortality of over 20% upon Intensive Care Unit admission. MRSA is believed to be spread through healthcare workers; thus, high hand hygiene compliancy in addition to environmental cleaning are the cornerstone countermeasures to disrupting its transmission. The Public Health Agency of Canada (PHAC), in collaboration with the Canadian Nosocomial Infection Surveillance Program (CNISP), conducts national, sentinel surveillance on healthcare-associated infections like MRSA. As a Student Epidemiologist, I developed a research proposal detailing two study objectives: 1) develop a regression model to predict all incident MRSA BSI rates among acute-care hospitals in Canada using CNISP MRSA BSI incident cases from 2000 to 2019, and 2) create a compartmental (Susceptible-Infected-Recovered-Deceased) model to determine the impact of various Infection Prevention and Control (IPC) measures on the risk of healthcare-associated MRSA BSI transmission specifically. This study hopes to demonstrate that proper IPC compliance is associated with lower incident MRSA BSI rates with the goal being to produce a manuscript draft by 2021. MRSA poses a serious threat to patient safety globally and is becoming a growing national public health concern in Canada; determining which IPC strategy is most effective at disrupting MRSA transmission is essential to reducing incidence and mortality rates.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133766859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-27DOI: 10.33137/utjph.v2i2.36838
Amy Chang, N. Schwartz, R. Truscott
The Ontario Cancer Profiles is an interactive dashboard for the public containing population-level cancerstatistics created by Ontario Health (Cancer Care Ontario). The tool contains data on cancer burden, cancerscreening measures, and cancer risk factors by Local Health Integration Network (LHIN) and Public Health Unit (PHU). It can be used for health system planning, measuring health systems performance, monitoring the impact of interventions, and to help identify new areas of research. There were 9 new modifiable cancer risk factors proposed to be included in future updates of the dashboard. The proposed risk factors include: access to care, active transportation, binge drinking, alcohol abstinence, inadequate fruit consumption, inadequate vegetable consumption, sedentary behaviour, second-hand smoke exposure, and sun safety. My practicum consisted of two main objectives: to conduct a literature review on the association between the proposed risk factors and cancer and to determine the prevalence of exposure of the identified risk factors in Ontario using 2015 to 2017 CCHS data. I performed a literature review to examine current evidence linking each proposed risk factor with cancer risk to determine the inclusion or exclusion of the indicator in the analysis. An analysis was performed with the selected variables in CCHS. Each indicator was age-standardized, and both standardized and crude ratios of individuals engaging in selected indicator activities were calculated. The results were examined for reliability using the produced coefficient of variation values. The estimates for each risk indicators allowed for the identification of target population that may be at higher risk of developing cancer due to greater exposure to the risk factors. They also serve as useful predictors for areas of improvement in regions with a high prevalence, such as healthy living within the community, and a guide to implementing preventative measures, screening, or treatment plans that may have been lacking.
{"title":"Examining prevalence of cancer risk factors across Ontario for the Ontario Cancer Profiles tool","authors":"Amy Chang, N. Schwartz, R. Truscott","doi":"10.33137/utjph.v2i2.36838","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.36838","url":null,"abstract":"The Ontario Cancer Profiles is an interactive dashboard for the public containing population-level cancerstatistics created by Ontario Health (Cancer Care Ontario). The tool contains data on cancer burden, cancerscreening measures, and cancer risk factors by Local Health Integration Network (LHIN) and Public Health Unit (PHU). It can be used for health system planning, measuring health systems performance, monitoring the impact of interventions, and to help identify new areas of research. There were 9 new modifiable cancer risk factors proposed to be included in future updates of the dashboard. The proposed risk factors include: access to care, active transportation, binge drinking, alcohol abstinence, inadequate fruit consumption, inadequate vegetable consumption, sedentary behaviour, second-hand smoke exposure, and sun safety. My practicum consisted of two main objectives: to conduct a literature review on the association between the proposed risk factors and cancer and to determine the prevalence of exposure of the identified risk factors in Ontario using 2015 to 2017 CCHS data. I performed a literature review to examine current evidence linking each proposed risk factor with cancer risk to determine the inclusion or exclusion of the indicator in the analysis. An analysis was performed with the selected variables in CCHS. Each indicator was age-standardized, and both standardized and crude ratios of individuals engaging in selected indicator activities were calculated. The results were examined for reliability using the produced coefficient of variation values. The estimates for each risk indicators allowed for the identification of target population that may be at higher risk of developing cancer due to greater exposure to the risk factors. They also serve as useful predictors for areas of improvement in regions with a high prevalence, such as healthy living within the community, and a guide to implementing preventative measures, screening, or treatment plans that may have been lacking.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125549068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-15DOI: 10.33137/utjph.v2i2.37006
Stephanie Ziembicki, T. Kirkham, P. Demers, Cheryl E Peters, Melanie Gorman-Ng, H. Davies, T. Tenkate, S. Kalengé, Nicola Blagrove-Hall, Kate Jardine, V. Arrandale
Introduction: Diesel engine exhaust (DEE) is a known carcinogen and a common occupational exposure in Canada, particularly within construction. The use of diesel-powered equipment in the construction industry is widespread, but little is known about DEE exposures and occupational disease in this work setting. The objective of this study was to characterize and identify key determinants of DEE exposure at construction sites in Ontario. Methods: Diesel particulate matter (DPM) measurements were taken from workers employed on seven infrastructure construction worksites in Ontario. Full-shift personal air samples were collected from workers using a constant-flow pump and SKC aluminum cyclone with 37-mm quartz fibre filters in an open-faced cassette. Samples were analyzed for elemental carbon (EC), a surrogate of DEE exposure, following NIOSH method 5040. Exposures were compared to recommended health-based limits, including the Dutch Expert Committee on Occupational Safety (DECOS) limit (1.03µg/m3 respirable EC) and the Finnish Institute of Occupational Health (FIOH) recommendation (5µg/m3 respirable EC). A determinants of exposure model was constructed. Results: In total, 126 DPM samples were collected, ranging from <0.47-52.58µg/m3 with a geometric mean (GM) of 4.23µg/m3 (geometric standard deviation (GSD)=3.05). Overall, 44.8% of samples exceeded the FIOH limit, mostly within underground worksites (93.5%), and 88.8% exceeded the DECOS limit. Underground workers (GM=13.20µg/m3, GSD=1.83) had exposures approximately 4-times higher than below grade workers (GM=3.56µg/m3, GSD=1.94) and 9-times higher than aboveground workers (GM=1.49µg/m3, GSD=1.75). Work grade, enclosed cabs, and seasonality were identified as the major determinants of exposure. Conclusions: This study provides a better understanding of current DPM exposure in Canadian construction. Most exposures were above recommended health-based limits, signifying a need to further reduce DPM levels in construction. These results can inform a hazard reduction strategy including a new occupational exposure limit and targeted intervention/control measures to reduce DPM exposure and the burden of occupational cancer.
{"title":"Current diesel engine exhaust exposure in the Ontario construction industry","authors":"Stephanie Ziembicki, T. Kirkham, P. Demers, Cheryl E Peters, Melanie Gorman-Ng, H. Davies, T. Tenkate, S. Kalengé, Nicola Blagrove-Hall, Kate Jardine, V. Arrandale","doi":"10.33137/utjph.v2i2.37006","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.37006","url":null,"abstract":"Introduction: Diesel engine exhaust (DEE) is a known carcinogen and a common occupational exposure in Canada, particularly within construction. The use of diesel-powered equipment in the construction industry is widespread, but little is known about DEE exposures and occupational disease in this work setting. The objective of this study was to characterize and identify key determinants of DEE exposure at construction sites in Ontario. \u0000Methods: Diesel particulate matter (DPM) measurements were taken from workers employed on seven infrastructure construction worksites in Ontario. Full-shift personal air samples were collected from workers using a constant-flow pump and SKC aluminum cyclone with 37-mm quartz fibre filters in an open-faced cassette. Samples were analyzed for elemental carbon (EC), a surrogate of DEE exposure, following NIOSH method 5040. Exposures were compared to recommended health-based limits, including the Dutch Expert Committee on Occupational Safety (DECOS) limit (1.03µg/m3 respirable EC) and the Finnish Institute of Occupational Health (FIOH) recommendation (5µg/m3 respirable EC). A determinants of exposure model was constructed. \u0000Results: In total, 126 DPM samples were collected, ranging from <0.47-52.58µg/m3 with a geometric mean (GM) of 4.23µg/m3 (geometric standard deviation (GSD)=3.05). Overall, 44.8% of samples exceeded the FIOH limit, mostly within underground worksites (93.5%), and 88.8% exceeded the DECOS limit. Underground workers (GM=13.20µg/m3, GSD=1.83) had exposures approximately 4-times higher than below grade workers (GM=3.56µg/m3, GSD=1.94) and 9-times higher than aboveground workers (GM=1.49µg/m3, GSD=1.75). Work grade, enclosed cabs, and seasonality were identified as the major determinants of exposure. \u0000Conclusions: This study provides a better understanding of current DPM exposure in Canadian construction. Most exposures were above recommended health-based limits, signifying a need to further reduce DPM levels in construction. These results can inform a hazard reduction strategy including a new occupational exposure limit and targeted intervention/control measures to reduce DPM exposure and the burden of occupational cancer.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115782249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-15DOI: 10.33137/utjph.v2i2.37005
Jessica J. Wong, P. Côté, A. Tricco, T. Watson, L. Rosella
Introduction: We assessed the effect of self-reported back pain on health care utilization and costs in a population-based sample of Ontario adults. Methods: We conducted a population-based matched cohort study of Ontarian respondents aged ≥18 years of Canadian Community Health Survey (CCHS) from 2003-2012. CCHS data were individually linked to health administrative data to measure health care utilization and costs up to 2018. We propensity-score matched (hard-matched on sex) adults with self-reported back pain to those without back pain, accounting for sociodemographic, health-related, and behavioural factors. We evaluated back pain-specific and all-cause health care utilization and costs from healthcare payer perspective adjusted to 2018 Canadian dollars. Poisson and linear (log-transformed) models were used to assess healthcare utilization rates and costs. Results: After propensity-score matching, we identified 36,806 pairs (21,054 for women, 15,752 for men) of CCHS respondents with and without back pain (mean age 51 years; SD=18). Compared to propensity-score matched adults without back pain, adults with back pain had two times the rate of back pain-specific visits (women: rate ratio [RR] 2.06, 95% CI 1.88-2.25; men: RR 2.32, 95% CI 2.04-2.64), 1.1 times the rate of all-cause physician visits (women: RR 1.12, 95% CI 1.09-1.16; men: RR 1.10, 95% CI 1.05-1.14), and 1.2 times the costs (women: 1.21, 95% CI 1.16-1.27; men: 1.16, 95% CI 1.09-1.23). Incremental annual per-person costs were higher in adults with back pain versus those without (women: $395, 95% CI $281-$509; men: $196, 95% CI $94-$300), corresponding to $532 million for women and $227 million CAD for men annually in Ontario. Conclusions: Adults with back pain had considerably higher health care utilization and costs compared to adults without back pain. These findings provide the most recent, comprehensive, and high-quality estimates of the health system burden of back pain to inform healthcare policy and decision-making. New strategies to reduce the substantial burden of back pain are warranted.
导言:我们评估了自我报告的背部疼痛对安大略省成年人的医疗保健利用和成本的影响。方法:我们对2003-2012年加拿大社区健康调查(CCHS)中年龄≥18岁的安大略省受访者进行了一项基于人群的匹配队列研究。CCHS数据单独与卫生行政数据相关联，以衡量截至2018年的卫生保健利用和成本。考虑到社会人口统计学、健康相关和行为因素，我们将自我报告背痛的成年人与无背痛的成年人进行了倾向评分匹配(性别硬匹配)。我们从医疗保健付款人的角度评估了背痛特异性和全因医疗保健的利用和成本，调整为2018年加元。使用泊松和线性(对数转换)模型来评估医疗保健利用率和成本。结果:在倾向得分匹配后，我们确定了36,806对(女性21054对，男性15752对)有或没有背痛的CCHS受访者(平均年龄51岁;SD = 18)。与倾向评分匹配的无背痛的成年人相比，患有背痛的成年人因背痛而就诊的比率是前者的两倍(女性:比率比[RR] 2.06, 95% CI 1.88-2.25;男性:RR 2.32, 95% CI 2.04-2.64)，全因就诊率的1.1倍(女性:RR 1.12, 95% CI 1.09-1.16;男性:RR 1.10, 95% CI 1.05-1.14)，是成本的1.2倍(女性:1.21,95% CI 1.16-1.27;男性:1.16,95% CI 1.09-1.23)。有背痛的成年人的年人均增量费用高于无背痛的成年人(女性:395美元，95% CI 281- 509美元;男性:$196,95% CI $94-$300)，相当于安大略省女性每年$ 5.32亿加元，男性每年$ 2.27亿加元。结论:与没有背痛的成年人相比，有背痛的成年人有更高的医疗保健利用率和成本。这些发现提供了最新的、全面的、高质量的背部疼痛卫生系统负担估计，为卫生保健政策和决策提供信息。减轻背痛负担的新策略是必要的。
{"title":"The Effect of Back Pain on Health Care Utilization and Costs","authors":"Jessica J. Wong, P. Côté, A. Tricco, T. Watson, L. Rosella","doi":"10.33137/utjph.v2i2.37005","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.37005","url":null,"abstract":"Introduction: We assessed the effect of self-reported back pain on health care utilization and costs in a population-based sample of Ontario adults. \u0000Methods: We conducted a population-based matched cohort study of Ontarian respondents aged ≥18 years of Canadian Community Health Survey (CCHS) from 2003-2012. CCHS data were individually linked to health administrative data to measure health care utilization and costs up to 2018. We propensity-score matched (hard-matched on sex) adults with self-reported back pain to those without back pain, accounting for sociodemographic, health-related, and behavioural factors. We evaluated back pain-specific and all-cause health care utilization and costs from healthcare payer perspective adjusted to 2018 Canadian dollars. Poisson and linear (log-transformed) models were used to assess healthcare utilization rates and costs. \u0000Results: After propensity-score matching, we identified 36,806 pairs (21,054 for women, 15,752 for men) of CCHS respondents with and without back pain (mean age 51 years; SD=18). Compared to propensity-score matched adults without back pain, adults with back pain had two times the rate of back pain-specific visits (women: rate ratio [RR] 2.06, 95% CI 1.88-2.25; men: RR 2.32, 95% CI 2.04-2.64), 1.1 times the rate of all-cause physician visits (women: RR 1.12, 95% CI 1.09-1.16; men: RR 1.10, 95% CI 1.05-1.14), and 1.2 times the costs (women: 1.21, 95% CI 1.16-1.27; men: 1.16, 95% CI 1.09-1.23). Incremental annual per-person costs were higher in adults with back pain versus those without (women: $395, 95% CI $281-$509; men: $196, 95% CI $94-$300), corresponding to $532 million for women and $227 million CAD for men annually in Ontario. \u0000Conclusions: Adults with back pain had considerably higher health care utilization and costs compared to adults without back pain. These findings provide the most recent, comprehensive, and high-quality estimates of the health system burden of back pain to inform healthcare policy and decision-making. New strategies to reduce the substantial burden of back pain are warranted.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126913459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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