Pub Date : 2021-09-15DOI: 10.33137/utjph.v2i2.36749
K. Serota, A. Ho
Legalizing medical assistance in dying (MAiD) has transformed how palliative and hospice care providers (PHCPs) engage in end of life conversations with patients and their loved ones. We do not currently know how PHCPs in the Toronto area have experienced this tremendous shift, and what challenges they have faced in transforming their practice to accommodate MAiD conversations. We must understand the unique challenges faced by PHCPs so that we can improve the education, resources, and supports available to these essential healthcare providers. We also must ensure that Canadians receive the highest quality care at the end of life, whether or not they choose to pursue a medically assisted death. To examine these unique challenges, I interviewed 22 PHCPs to document their experiences of engaging in end-of-life conversations in the post-MAiD era. Participants included physicians, nurses, social workers, and other allied health professionals employed in faith-based and secular institutions. Their personal beliefs about MAiD varied widely; some identified as conscientious objectors, while others actively engaged in MAiD assessment and provision. Initial thematic analysis revealed that challenges include translating the federal legislation into medical practice; navigating inefficient institutional policies and role ambiguity; developing conversation techniques to share MAiD information with patients and families in a balanced way that is informative yet uncoercive; and, navigating the ethical and organizational issues that arise when patients with declining capacity pursue MAiD. Finally, PHCPs shared personal experiences of burnout, emotional weight, and stigma. Understanding how these factors impact the work and lives of PHCPs allows us to develop targeted strategies to improve the institutional policies surrounding MAiD conversations, referrals, and procedures, as well as decrease the negative personal and emotional consequences of engaging in end-of-life conversations in the post-MAiD era.
{"title":"Improving end-of-life conversations in the post-MAiD era","authors":"K. Serota, A. Ho","doi":"10.33137/utjph.v2i2.36749","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.36749","url":null,"abstract":"Legalizing medical assistance in dying (MAiD) has transformed how palliative and hospice care providers (PHCPs) engage in end of life conversations with patients and their loved ones. We do not currently know how PHCPs in the Toronto area have experienced this tremendous shift, and what challenges they have faced in transforming their practice to accommodate MAiD conversations. We must understand the unique challenges faced by PHCPs so that we can improve the education, resources, and supports available to these essential healthcare providers. We also must ensure that Canadians receive the highest quality care at the end of life, whether or not they choose to pursue a medically assisted death. To examine these unique challenges, I interviewed 22 PHCPs to document their experiences of engaging in end-of-life conversations in the post-MAiD era. Participants included physicians, nurses, social workers, and other allied health professionals employed in faith-based and secular institutions. Their personal beliefs about MAiD varied widely; some identified as conscientious objectors, while others actively engaged in MAiD assessment and provision. Initial thematic analysis revealed that challenges include translating the federal legislation into medical practice; navigating inefficient institutional policies and role ambiguity; developing conversation techniques to share MAiD information with patients and families in a balanced way that is informative yet uncoercive; and, navigating the ethical and organizational issues that arise when patients with declining capacity pursue MAiD. Finally, PHCPs shared personal experiences of burnout, emotional weight, and stigma. Understanding how these factors impact the work and lives of PHCPs allows us to develop targeted strategies to improve the institutional policies surrounding MAiD conversations, referrals, and procedures, as well as decrease the negative personal and emotional consequences of engaging in end-of-life conversations in the post-MAiD era.","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":"131596892","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.v2i2.36839
Yiran Wang
Food insecurity has long been a public health issue in Northwestern Ontario, which adds a substantial burden on social costs and health care. Food insecurity is further exacerbated during the COVID-19 pandemic, due to the closure or limited hours of emergency food and transportation services. Low-income seniors (age>65 years old) face additional risks of food insecurity due to their vulnerability to the coronavirus. To help reduce food insecurity in this specific population, an emergency food program named “Senior Food Bags” was established by Roots to Harvest at the City of Thunder Bay, which provides insights on incorporating skill-building into food distribution activities. As a dietetic intern, I participated in the planning and implementation of the project. Considering that a lack of fresh produce, limited cooking skills, and comorbidities are major barriers for local low-income seniors, we aim to impart seniors with basic cooking skills and create recipes to consider health concerns. Hence, a weekly recipe was developed to encourage seniors to use healthy ingredients (e.g. fresh and preserved produces of proteins, grains, fruits, and vegetables) included in the bag for meal preparation. No ID was required, and seniors were respectfully approached for communication during the distribution. The mid-term survey suggested that all senior participants (n=40) thought the project helped reduce food insecurity during COVID-19. 1/3 of participants mentioned being more confident and capable of preparing healthier meals. The project illustrated that skill-building and dignified services in emergency food programs can do more than provide food. To enhance the capacity of food security, the first step is to equip individuals with intentions and skills to combat food challenges. Therefore, in addition to food distribution, food donor projects should also focus on fostering individuals’ food literacy development to empower them and aid public health.
{"title":"Combat Food Insecurity amid the COVID-19 Pandemic","authors":"Yiran Wang","doi":"10.33137/utjph.v2i2.36839","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.36839","url":null,"abstract":"Food insecurity has long been a public health issue in Northwestern Ontario, which adds a substantial burden on social costs and health care. Food insecurity is further exacerbated during the COVID-19 pandemic, due to the closure or limited hours of emergency food and transportation services. Low-income seniors (age>65 years old) face additional risks of food insecurity due to their vulnerability to the coronavirus. To help reduce food insecurity in this specific population, an emergency food program named “Senior Food Bags” was established by Roots to Harvest at the City of Thunder Bay, which provides insights on incorporating skill-building into food distribution activities. \u0000As a dietetic intern, I participated in the planning and implementation of the project. Considering that a lack of fresh produce, limited cooking skills, and comorbidities are major barriers for local low-income seniors, we aim to impart seniors with basic cooking skills and create recipes to consider health concerns. Hence, a weekly recipe was developed to encourage seniors to use healthy ingredients (e.g. fresh and preserved produces of proteins, grains, fruits, and vegetables) included in the bag for meal preparation. No ID was required, and seniors were respectfully approached for communication during the distribution. The mid-term survey suggested that all senior participants (n=40) thought the project helped reduce food insecurity during COVID-19. 1/3 of participants mentioned being more confident and capable of preparing healthier meals. \u0000The project illustrated that skill-building and dignified services in emergency food programs can do more than provide food. To enhance the capacity of food security, the first step is to equip individuals with intentions and skills to combat food challenges. Therefore, in addition to food distribution, food donor projects should also focus on fostering individuals’ food literacy development to empower them and aid public health.","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":"115825402","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.v2i2.36762
M. B. Hossain, L. Mosquera, Mohammad Karim
Introduction: The instrumental variable (IV)-based methods (e.g., two-stage least square [2SLS], two-stage residual inclusion [2SRI], and nonparametric causal bound [NPCB]) can be used to address non-adherence in pragmatic trials. These methods require assumptions, e.g., exclusion restriction, although they are known to handle unmeasured confounding. The inverse probability-weighted per-protocol [IPW-PP] method is useful in the same setting but requires different assumptions (no unmeasured confounding). Although all these methods aim to address the same problem, comprehensive simulations to compare their performance are absent in the literature. We performed extensive simulations when (1) confounding is present, (2) confounder is unmeasured but exclusion restriction is met, (3) exclusion restriction is violated, and (4) non-adherence is one-sided and differential. Method: We compared the performance in terms of bias, standard error (SE), mean squared error (MSE), and 95% confidence interval coverage probability. Results: For setting-1, IPW-PP outperforms IV-methods in terms of bias, SE, MSE, and coverage for <80% non-adherence but produces high bias beyond that point. IPW-PP also has high biases, but 2SLS and 2SRI work well for setting-2. For setting-3, 2SLS and 2SRI perform the worst in all scenarios; IPW-PP produces unbiased estimates when necessary confounders are measured and adjusted. For setting-4, IPW-PP has less bias, but 2SLS and 2SRI have higher SE and MSE. NPCB has wider bounds in all scenarios. We also analyze a two-arm trial to estimate the effect of vitamin A supplementation on childhood mortality after addressing non-adherence. Conclusion: We need to be cautious using the IPW-PP when non-adherence is very high or strong unmeasured confounding and should avoid using the IV methods when the exclusion restriction assumption is violated or high differential non-adherence. Since assumptions are different and often untestable for IPW-PP and IV methods, we suggest analyzing data using both methods for a robust conclusion.
{"title":"Performance of statistical methods to address treatment non-adherence in pragmatic clinical trials with point-treatment settings: a simulation study","authors":"M. B. Hossain, L. Mosquera, Mohammad Karim","doi":"10.33137/utjph.v2i2.36762","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.36762","url":null,"abstract":"Introduction: The instrumental variable (IV)-based methods (e.g., two-stage least square [2SLS], two-stage residual inclusion [2SRI], and nonparametric causal bound [NPCB]) can be used to address non-adherence in pragmatic trials. These methods require assumptions, e.g., exclusion restriction, although they are known to handle unmeasured confounding. The inverse probability-weighted per-protocol [IPW-PP] method is useful in the same setting but requires different assumptions (no unmeasured confounding). Although all these methods aim to address the same problem, comprehensive simulations to compare their performance are absent in the literature. We performed extensive simulations when (1) confounding is present, (2) confounder is unmeasured but exclusion restriction is met, (3) exclusion restriction is violated, and (4) non-adherence is one-sided and differential. \u0000Method: We compared the performance in terms of bias, standard error (SE), mean squared error (MSE), and 95% confidence interval coverage probability. \u0000Results: For setting-1, IPW-PP outperforms IV-methods in terms of bias, SE, MSE, and coverage for <80% non-adherence but produces high bias beyond that point. IPW-PP also has high biases, but 2SLS and 2SRI work well for setting-2. For setting-3, 2SLS and 2SRI perform the worst in all scenarios; IPW-PP produces unbiased estimates when necessary confounders are measured and adjusted. For setting-4, IPW-PP has less bias, but 2SLS and 2SRI have higher SE and MSE. NPCB has wider bounds in all scenarios. We also analyze a two-arm trial to estimate the effect of vitamin A supplementation on childhood mortality after addressing non-adherence. \u0000Conclusion: We need to be cautious using the IPW-PP when non-adherence is very high or strong unmeasured confounding and should avoid using the IV methods when the exclusion restriction assumption is violated or high differential non-adherence. Since assumptions are different and often untestable for IPW-PP and IV methods, we suggest analyzing data using both methods for a robust conclusion.","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":"133326528","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 : 2021-09-13DOI: 10.33137/utjph.v2i2.37004
Oghenefego (Fego) Akpomi-Eferakeya, J. Horrigan, R. Heale, E. Donato
Workplace violence (WPV) is an ongoing problem in health care. Most of the cases of WPV are caused by the patients, patients’ families, and friends. Violence in hospitals among registered nurses has led to 56% of lost time injuries, and in 2018, Ontario’s Workplace Safety and Insurance Board (WSIB) reported 13% of lost time injuries due to WPV. The Public Services Health and Safety Association (PSHSA) created the Violence Assessment Tool [VAT] to predict the possible risk of violence from patients in acute care settings. Health care workers can use the VAT to assess risk, apply possible control measures and improve their safety. As part of a larger study, the aim of this research is to explore nurses’ perceptions of the utilization of the VAT in assessing the potential risk of violence, and to identify any gaps, challenges, or improvements needed in the VAT. An Interpretive Description research design by Sally Thorne in (2016) will be used. The model that will guide this study is the Haddon Matrix framework of workplace violence prevention. The study will involve three focus groups via zoom virtual meetings with 6 to 8 participants per session, and an expected total of 18-24 participants. Focus group interviews will use semi-structured questions to guide the discussion among nurses working in a Northeastern Ontario hospital. Interpretive description data analysis will be guided by Thorne’s processes of data analysis. This will be the first study to examine nurses’ perceptions of the VAT in Ontario. The findings of this study will help to determine the predictive validity of the VAT and any potential changes that may be needed. The findings of this study could lead to reduced violence and associated costs within the healthcare sector.
{"title":"Nurses Perceptions of the Utilization of the Violence Assessment Tool (VAT) in Northeastern Ontario","authors":"Oghenefego (Fego) Akpomi-Eferakeya, J. Horrigan, R. Heale, E. Donato","doi":"10.33137/utjph.v2i2.37004","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.37004","url":null,"abstract":"Workplace violence (WPV) is an ongoing problem in health care. Most of the cases of WPV are caused by the patients, patients’ families, and friends. Violence in hospitals among registered nurses has led to 56% of lost time injuries, and in 2018, Ontario’s Workplace Safety and Insurance Board (WSIB) reported 13% of lost time injuries due to WPV. The Public Services Health and Safety Association (PSHSA) created the Violence Assessment Tool [VAT] to predict the possible risk of violence from patients in acute care settings. Health care workers can use the VAT to assess risk, apply possible control measures and improve their safety. As part of a larger study, the aim of this research is to explore nurses’ perceptions of the utilization of the VAT in assessing the potential risk of violence, and to identify any gaps, challenges, or improvements needed in the VAT. An Interpretive Description research design by Sally Thorne in (2016) will be used. The model that will guide this study is the Haddon Matrix framework of workplace violence prevention. The study will involve three focus groups via zoom virtual meetings with 6 to 8 participants per session, and an expected total of 18-24 participants. Focus group interviews will use semi-structured questions to guide the discussion among nurses working in a Northeastern Ontario hospital. Interpretive description data analysis will be guided by Thorne’s processes of data analysis. This will be the first study to examine nurses’ perceptions of the VAT in Ontario. The findings of this study will help to determine the predictive validity of the VAT and any potential changes that may be needed. The findings of this study could lead to reduced violence and associated costs within the healthcare sector.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121314464","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 : 2021-09-13DOI: 10.33137/utjph.v2i2.36764
Ziqian Zhuang, Wei Xu, Rahi Jain
Introduction: High dimensional Selection with Interactions for Binary Outcome (HDSI-BO) algorithm can incorporate interaction terms and combine with existing techniques for feature selection. Simulation studies have validated the ability of HDSI-BO to select true features and consequently, improve prediction accuracy compared to standard algorithms. Our goal is to assess the applicability of HDSI-BO in combining different techniques and measure its predictive performance in a real data study of predicting height indicators by social-life and well-being factors. Methods: HDSI-BO was combined with logistic regression, ridge regression, LASSO, adaptive LASSO, and elastic net. Two-way interaction terms were considered. Hyperparameters used in HDSI-BO were optimized through genetic algorithms with five-fold cross-validation. To measure the performance of feature selection, we fitted final models by logistic regression based on the sets of selected features and used the model’s AUC as a measure. 30 trials were repeated to generate a range of the number of selected features and a 95% confidence interval for AUC. Results: When combined with all of the above methods, HDSI-BO methods achieved higher final AUC values both in terms of mean and confidence interval. In addition, HDSI-BO methods effectively narrowed down the sets of selected features and interaction terms compared with standard methods. Conclusion: The HDSI-BO algorithm combines well with multiple standard methods and has comparable or better predictive performance compared with the standard methods. The computational and time complexity of HDSI-BO is higher but still acceptable. Considering AUC as the single metric cannot comprehensively measure the feature selection performance. More effective metrics of performance should be explored for future work.
介绍:HDSI-BO (High dimensional Selection with Interactions for Binary Outcome)算法可以将交互项与现有的特征选择技术相结合。仿真研究已经验证了HDSI-BO选择真实特征的能力，因此，与标准算法相比，提高了预测精度。我们的目标是评估HDSI-BO在结合不同技术时的适用性，并在通过社会生活和幸福因素预测身高指标的实际数据研究中测量其预测性能。方法:采用logistic回归、脊回归、LASSO、自适应LASSO、弹性网等方法对HDSI-BO进行综合评价。考虑了双向相互作用条件。通过遗传算法优化HDSI-BO中使用的超参数，并进行五次交叉验证。为了衡量特征选择的性能，我们基于选择的特征集通过逻辑回归拟合最终模型，并使用模型的AUC作为度量。重复进行30次试验，以产生所选特征的数量范围和AUC的95%置信区间。结果:HDSI-BO方法与上述所有方法联合使用时，在平均值和置信区间上均获得更高的最终AUC值。此外，与标准方法相比，HDSI-BO方法有效地缩小了所选特征和交互项的集合。结论:HDSI-BO算法与多种标准方法结合良好，预测性能与标准方法相当或更好。HDSI-BO的计算复杂度和时间复杂度较高，但仍然可以接受。将AUC作为单一指标不能全面衡量特征选择性能。应该为今后的工作探索更有效的绩效指标。
{"title":"High dimensional Selection with Interactions for Binary Outcome (HDSI-BO) Algorithm in Classifying Height Indicators Through Social-life and Well-being Factors","authors":"Ziqian Zhuang, Wei Xu, Rahi Jain","doi":"10.33137/utjph.v2i2.36764","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.36764","url":null,"abstract":"Introduction: High dimensional Selection with Interactions for Binary Outcome (HDSI-BO) algorithm can incorporate interaction terms and combine with existing techniques for feature selection. Simulation studies have validated the ability of HDSI-BO to select true features and consequently, improve prediction accuracy compared to standard algorithms. Our goal is to assess the applicability of HDSI-BO in combining different techniques and measure its predictive performance in a real data study of predicting height indicators by social-life and well-being factors. \u0000Methods: HDSI-BO was combined with logistic regression, ridge regression, LASSO, adaptive LASSO, and elastic net. Two-way interaction terms were considered. Hyperparameters used in HDSI-BO were optimized through genetic algorithms with five-fold cross-validation. To measure the performance of feature selection, we fitted final models by logistic regression based on the sets of selected features and used the model’s AUC as a measure. 30 trials were repeated to generate a range of the number of selected features and a 95% confidence interval for AUC. \u0000Results: When combined with all of the above methods, HDSI-BO methods achieved higher final AUC values both in terms of mean and confidence interval. In addition, HDSI-BO methods effectively narrowed down the sets of selected features and interaction terms compared with standard methods. \u0000Conclusion: The HDSI-BO algorithm combines well with multiple standard methods and has comparable or better predictive performance compared with the standard methods. The computational and time complexity of HDSI-BO is higher but still acceptable. Considering AUC as the single metric cannot comprehensively measure the feature selection performance. More effective metrics of performance should be explored for future work.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122375560","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 : 2021-09-13DOI: 10.33137/utjph.v2i2.36895
M. Amri
The World Health Organization (WHO), as the most prominent global health institution as a specialized agency of the United Nations, has expressed concern for health equity as part of its mandate, “the attainment by all peoples of the highest possible level of health”. However, there is a lack of clarity around the WHO’s fundamental definition and conceptualization of equity. Through drawing on the WHO’s Urban Health Equity Assessment and Response Tool (Urban HEART) as an illustrative case, the aim is to determine how the WHO operationalizes equity in practice. Preliminary findings suggest there is no consistent understanding of what the goal of Urban HEART is. This research has direct implications for practice: not only can the findings be applied to other global health work that seeks to improve equity, but the WHO is planning to reinstate Urban HEART. As such, this research may be beneficial in guiding these plans. Further, the findings yield an important consideration for global and public health policy and practice more broadly: the need to clarify objectives around equity (e.g. because how equity is defined determines the work undertaken and the populations served).
{"title":"The World Health Organization’s approach to equity","authors":"M. Amri","doi":"10.33137/utjph.v2i2.36895","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.36895","url":null,"abstract":"The World Health Organization (WHO), as the most prominent global health institution as a specialized agency of the United Nations, has expressed concern for health equity as part of its mandate, “the attainment by all peoples of the highest possible level of health”. However, there is a lack of clarity around the WHO’s fundamental definition and conceptualization of equity. Through drawing on the WHO’s Urban Health Equity Assessment and Response Tool (Urban HEART) as an illustrative case, the aim is to determine how the WHO operationalizes equity in practice. Preliminary findings suggest there is no consistent understanding of what the goal of Urban HEART is. This research has direct implications for practice: not only can the findings be applied to other global health work that seeks to improve equity, but the WHO is planning to reinstate Urban HEART. As such, this research may be beneficial in guiding these plans. Further, the findings yield an important consideration for global and public health policy and practice more broadly: the need to clarify objectives around equity (e.g. because how equity is defined determines the work undertaken and the populations served).","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132428845","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 : 2021-09-13DOI: 10.33137/utjph.v2i2.36996
Gul-e-Naghma Saeed, Sabrin Hossain, N. Schoueri-Mychasiw, Daisy Radha Singla
Background: Patient-centered research has emerged as a promising model to adequately address the needs and preferences of patient populations with mental disorders. The Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) Trial aims to increase access to psychological treatment and implements a multi-stakeholder perspective to understand the needs/preferences of perinatal populations with symptoms of depression and anxiety. Specifically, this pragmatic, non-inferiority randomized effectiveness trial examines whether Behavioral Activation (BA) delivered via telemedicine is as effective as in-person treatment. However, due to COVID-19, the study suspended in-person BA sessions and completely shifted to telemedicine. To ensure BA remains widely accessible, the SUMMIT team strives to resume in-person treatment in the near future. Objective: To gain perspectives of key stakeholders on the potential barriers and facilitators for SUMMIT participants to resume in-person BA sessions in a COVID-19 context. Methods: A focus group discussion (1 hour) was conducted via Zoom with N=9 stakeholders, including patient advocates, nurses, clinicians, and researchers. Qualitative data was coded using NVivo and content analysis was performed to quantify frequently endorsed themes. Results: The majority of stakeholders considered resuming in-person BA sessions to be a challenge amidst COVID-19, with more barriers than facilitators mentioned overall. Most commonly endorsed barriers that participants may face when attending in-person treatment included arranging childcare (n=8; 89%) and discomfort/fear of coming to the hospital (n=6; 67%). The most widely endorsed facilitators for resuming in-person treatment during COVID-19 were clearly communicating hospital and transportation safety precautions to participants (n=7; 78%) and conducting in-person sessions at an off-site location (n=6; 67%). Conclusion: This study identified critical facilitators of resuming in-person BA sessions that can inform: (1) how to resume in-person BA sessions and (2) the development and implementation of strategies to make BA more patient-centered for perinatal populations during COVID-19. Objective: To gain perspectives of key stakeholders on the potential barriers and facilitators for SUMMIT participants to resume in-person BA sessions in a COVID-19 context. Methods: A focus group discussion (1 hour) was conducted via Zoom with N=9 stakeholders, including patient advocates, nurses, clinicians, and researchers. Qualitative data was coded using NVivo and a content analysis was performed to quantify frequently endorsed themes. Results: The majority of stakeholders considered resuming in-person BA sessions to be a challenge amidst COVID-19, with more barriers than facilitators mentioned overall. Most commonly endorsed barriers that participants may face when attending in-person treatment included arranging childcare (n=8; 89%) and discomfort/fear of comin
{"title":"Resuming In-person Psychological Treatment in the Era of COVID-19","authors":"Gul-e-Naghma Saeed, Sabrin Hossain, N. Schoueri-Mychasiw, Daisy Radha Singla","doi":"10.33137/utjph.v2i2.36996","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.36996","url":null,"abstract":"Background: Patient-centered research has emerged as a promising model to adequately address the needs and preferences of patient populations with mental disorders. The Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) Trial aims to increase access to psychological treatment and implements a multi-stakeholder perspective to understand the needs/preferences of perinatal populations with symptoms of depression and anxiety. Specifically, this pragmatic, non-inferiority randomized effectiveness trial examines whether Behavioral Activation (BA) delivered via telemedicine is as effective as in-person treatment. However, due to COVID-19, the study suspended in-person BA sessions and completely shifted to telemedicine. To ensure BA remains widely accessible, the SUMMIT team strives to resume in-person treatment in the near future. \u0000Objective: To gain perspectives of key stakeholders on the potential barriers and facilitators for SUMMIT participants to resume in-person BA sessions in a COVID-19 context. \u0000Methods: A focus group discussion (1 hour) was conducted via Zoom with N=9 stakeholders, including patient advocates, nurses, clinicians, and researchers. Qualitative data was coded using NVivo and content analysis was performed to quantify frequently endorsed themes. \u0000Results: The majority of stakeholders considered resuming in-person BA sessions to be a challenge amidst COVID-19, with more barriers than facilitators mentioned overall. Most commonly endorsed barriers that participants may face when attending in-person treatment included arranging childcare (n=8; 89%) and discomfort/fear of coming to the hospital (n=6; 67%). The most widely endorsed facilitators for resuming in-person treatment during COVID-19 were clearly communicating hospital and transportation safety precautions to participants (n=7; 78%) and conducting in-person sessions at an off-site location (n=6; 67%). \u0000Conclusion: This study identified critical facilitators of resuming in-person BA sessions that can inform: (1) how to resume in-person BA sessions and (2) the development and implementation of strategies to make BA more patient-centered for perinatal populations during COVID-19. \u0000Objective: To gain perspectives of key stakeholders on the potential barriers and facilitators for SUMMIT participants to resume in-person BA sessions in a COVID-19 context. \u0000Methods: A focus group discussion (1 hour) was conducted via Zoom with N=9 stakeholders, including patient advocates, nurses, clinicians, and researchers. Qualitative data was coded using NVivo and a content analysis was performed to quantify frequently endorsed themes. \u0000Results: The majority of stakeholders considered resuming in-person BA sessions to be a challenge amidst COVID-19, with more barriers than facilitators mentioned overall. Most commonly endorsed barriers that participants may face when attending in-person treatment included arranging childcare (n=8; 89%) and discomfort/fear of comin","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128505444","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 : 2021-09-13DOI: 10.33137/utjph.v2i2.36836
Megan Brown Wollenberg
Action Against Hunger is an international non-governmental organization with six headquarters located around the world that focus on ending hunger in low and middle-income countries. The Canadian office uniquely provides evidenced-based technical support and evaluation for headquarters focused on implementing interventions and programming to mitigate hunger. For my practicum I worked in the International Gender Unit to support ongoing policy development and updating of the organization’s cross-network gender policy. Gender inequalities have direct causal links with malnutrition; yet, in March 2020 the Global Nutrition Report showed that global efforts to mitigate hunger by addressing gender inequalities are behind on most targets. To better capture and learn how to address underlying inequalities and drivers of malnutrition, my practicum research focused on the associations and non-associations between gender, gender-based violence, and malnutrition. This practicum placement had three objectives: 1) to provide a literature review 2) to provide a database comprised of peer-reviewed and grey literature; and, 3) to support new policy development during cross-headquarters discussions, research, and reporting. During this placement I had the opportunity to work online with individuals across five continents and twenty-one countries. This included facilitating break-out policy discussions during policy meetings, as well as semi-structured interviews that were conducted prior to providing a literature review and socio-ecological discussion on gender, gender-based violence and malnutrition. The opportunity to engage in international and cross-cultural collaborative work has been the highlight of my practicum. It has provided the opportunity to not only sharpen my reflexive praxis as a student of public health, but to sharpen my understanding of the policy process at the organizational level. It has additionally illuminated the importance of structural and social contexts in public health research and programming, especially within efforts to address gender inequalities and gender-based violence associated with malnutrition.
{"title":"Gender and Gender-Based Violence","authors":"Megan Brown Wollenberg","doi":"10.33137/utjph.v2i2.36836","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.36836","url":null,"abstract":"Action Against Hunger is an international non-governmental organization with six headquarters located around the world that focus on ending hunger in low and middle-income countries. The Canadian office uniquely provides evidenced-based technical support and evaluation for headquarters focused on implementing interventions and programming to mitigate hunger. For my practicum I worked in the International Gender Unit to support ongoing policy development and updating of the organization’s cross-network gender policy. Gender inequalities have direct causal links with malnutrition; yet, in March 2020 the Global Nutrition Report showed that global efforts to mitigate hunger by addressing gender inequalities are behind on most targets. To better capture and learn how to address underlying inequalities and drivers of malnutrition, my practicum research focused on the associations and non-associations between gender, gender-based violence, and malnutrition. This practicum placement had three objectives: 1) to provide a literature review 2) to provide a database comprised of peer-reviewed and grey literature; and, 3) to support new policy development during cross-headquarters discussions, research, and reporting. During this placement I had the opportunity to work online with individuals across five continents and twenty-one countries. This included facilitating break-out policy discussions during policy meetings, as well as semi-structured interviews that were conducted prior to providing a literature review and socio-ecological discussion on gender, gender-based violence and malnutrition. The opportunity to engage in international and cross-cultural collaborative work has been the highlight of my practicum. It has provided the opportunity to not only sharpen my reflexive praxis as a student of public health, but to sharpen my understanding of the policy process at the organizational level. It has additionally illuminated the importance of structural and social contexts in public health research and programming, especially within efforts to address gender inequalities and gender-based violence associated with malnutrition.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127819290","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 : 2021-09-13DOI: 10.33137/utjph.v2i2.36834
S. Winkelman
The Ontario HIV Treatment Network (OHTN) is a non-profit network which collaborates with health clinics, AIDS service and community organizations, and policy leaders in order to improve the health and wellbeing of people living with and at risk of HIV. I joined the OHTN as a member of the Collective Impact team, with a focus on examining the barriers and facilitators to Pre-Exposure Prophylaxis (PrEP) uptake in Ontario. PrEP is a once-daily pill which is highly effective in preventing HIV infections for HIV-negative people, however usage remains relatively low in Ontario. In this role, I liaised with the Knowledge Synthesis team at OHTN to collect, analyse, and synthesize recent scientific literature on Pre and Post-exposure prophylaxis (PEP) in order to create a comprehensive annotated bibliography on PrEP research. Key findings were drawn from the research to identify potential next steps to increase PrEP use for priority populations in Ontario. Findings from the annotated bibliography were presented to OHTN staff, and have been used to assist in the development of two PrEP study proposals; 1) a cisgender and transgender women-focused PrEP education package and HIV risk screening tool, and 2) a pharmacist-led PrEP delivery pilot. I also worked with the Testing and Clinical Initiatives team at the OHTN, to aid in the implementation and evaluation of two HIV-testing projects: the GetaTest pharmacy-based HIV-testing study, and the GetaKit HIV self-testing pilot program. In this role I drafted health communication materials; analysed survey data and drafted project reports for stakeholders; and provided perspectives on the HIV-care continuum, particularly on PrEP initiation, adherence, and efficacy. My work with the OHTN was important to public health because it sought to expand access to HIV testing and prevention services for priority populations in Ontario, including men who have sex with men, and cis and trans women.
{"title":"Challenging the HIV Epidemic in Ontario Through PrEP and HIV Testing","authors":"S. Winkelman","doi":"10.33137/utjph.v2i2.36834","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.36834","url":null,"abstract":"The Ontario HIV Treatment Network (OHTN) is a non-profit network which collaborates with health clinics, AIDS service and community organizations, and policy leaders in order to improve the health and wellbeing of people living with and at risk of HIV. I joined the OHTN as a member of the Collective Impact team, with a focus on examining the barriers and facilitators to Pre-Exposure Prophylaxis (PrEP) uptake in Ontario. PrEP is a once-daily pill which is highly effective in preventing HIV infections for HIV-negative people, however usage remains relatively low in Ontario. In this role, I liaised with the Knowledge Synthesis team at OHTN to collect, analyse, and synthesize recent scientific literature on Pre and Post-exposure prophylaxis (PEP) in order to create a comprehensive annotated bibliography on PrEP research. Key findings were drawn from the research to identify potential next steps to increase PrEP use for priority populations in Ontario. Findings from the annotated bibliography were presented to OHTN staff, and have been used to assist in the development of two PrEP study proposals; 1) a cisgender and transgender women-focused PrEP education package and HIV risk screening tool, and 2) a pharmacist-led PrEP delivery pilot. I also worked with the Testing and Clinical Initiatives team at the OHTN, to aid in the implementation and evaluation of two HIV-testing projects: the GetaTest pharmacy-based HIV-testing study, and the GetaKit HIV self-testing pilot program. In this role I drafted health communication materials; analysed survey data and drafted project reports for stakeholders; and provided perspectives on the HIV-care continuum, particularly on PrEP initiation, adherence, and efficacy. My work with the OHTN was important to public health because it sought to expand access to HIV testing and prevention services for priority populations in Ontario, including men who have sex with men, and cis and trans women.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129098317","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 : 2021-09-05DOI: 10.33137/utjph.v2i2.36828
B. T. Chao, A. Sage, M. Cypel, Mingyao Liu, J. Yeung, X. Bai, D. Van raemdonck, L. Ceulemans, A. Neyrinck, S. Verleden, S. Keshavjee
Introduction: Ex vivo lung perfusion (EVLP) is a normothermic platform used to assess donor lungs. Many have studied biomarkers in lung injury, but it is unclear whether samples taken from one location are representative of the organ. Our objective was to investigate the uniformity of cytokine expression in tissue biopsies and in EVLP perfusates from various locations. Methods: In the tissue study, eight donor lungs were partitioned from apex to base. In each lung, three biopsies were taken from the third, sixth, and ninth slices, while two were taken from the lingula and an injury site. In the perfusate study, four samples were taken from four lobes in eight donors during EVLP. Expressions of IL-6, IL-8, IL-10, and IL-1β were measured using qPCR and ELISA. Results: In the tissue study, the mean intra-biopsy equal-variance F-value was 0.53. The median intra-biopsy coefficient of variation (CV) was 18%. In donors without gross focal injury, the mean comparisons of biopsies in each donor showed that the three consistent slices showed no differences and had a CV of 20%, which was similar to the intra-biopsy CV (p=0.80). Both the lingula and injury biopsies demonstrated larger differences from the rest. The median intra-lung CV of perfusates from different lobes was 4.9%. Conclusion: Intra-biopsy variances were consistent across biopsies. Lungs without gross focal injury demonstrated more consistent gene expression. The lingula is not a representative site due to high signal variability. The consistent measurements in EVLP perfusates provided a uniform picture of the inflammation.
{"title":"Reliability of Donor Lung Sampling in Lung Transplantation","authors":"B. T. Chao, A. Sage, M. Cypel, Mingyao Liu, J. Yeung, X. Bai, D. Van raemdonck, L. Ceulemans, A. Neyrinck, S. Verleden, S. Keshavjee","doi":"10.33137/utjph.v2i2.36828","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.36828","url":null,"abstract":"Introduction: Ex vivo lung perfusion (EVLP) is a normothermic platform used to assess donor lungs. Many have studied biomarkers in lung injury, but it is unclear whether samples taken from one location are representative of the organ. Our objective was to investigate the uniformity of cytokine expression in tissue biopsies and in EVLP perfusates from various locations. \u0000Methods: In the tissue study, eight donor lungs were partitioned from apex to base. In each lung, three biopsies were taken from the third, sixth, and ninth slices, while two were taken from the lingula and an injury site. In the perfusate study, four samples were taken from four lobes in eight donors during EVLP. Expressions of IL-6, IL-8, IL-10, and IL-1β were measured using qPCR and ELISA. \u0000Results: In the tissue study, the mean intra-biopsy equal-variance F-value was 0.53. The median intra-biopsy coefficient of variation (CV) was 18%. In donors without gross focal injury, the mean comparisons of biopsies in each donor showed that the three consistent slices showed no differences and had a CV of 20%, which was similar to the intra-biopsy CV (p=0.80). Both the lingula and injury biopsies demonstrated larger differences from the rest. The median intra-lung CV of perfusates from different lobes was 4.9%. \u0000Conclusion: Intra-biopsy variances were consistent across biopsies. Lungs without gross focal injury demonstrated more consistent gene expression. The lingula is not a representative site due to high signal variability. The consistent measurements in EVLP perfusates provided a uniform picture of the inflammation.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123616579","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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