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Using a behavioural intervention to target nutrition during pregnancy may be key in meeting recommendations for healthy eating. The aim was to assess the use of a short-term dietary intake measurement tool (3-day food intake record) to infer long-term habitual dietary intake during pregnancy (using a short-form food frequency questionnaire). A convenience sample (n=90) between 12- and 18-weeks’ gestation were recruited from a larger randomised controlled trial for cross-sectional analysis. Participants completed a 44-item food frequency questionnaire and 3-day food intake record. Using the participant food intake record, the investigator blindly completed a second frequency questionnaire. The frequency questionnaires were scored using Dietary Quality Scores (DQS) and compared. Aggregate data were evaluated using a Wilcoxon signed rank test, and individual-level data were evaluated using a Bland-Altman plot. No significant difference was observed in the scores (Z=-1.88, p=0.06), with small effect size (r=0.19). The Bland-Altman plot showed that comparing the DQS derived from the two different dietary assessments underestimated scores by a mean difference of 0.4 points (95% limits of agreement: -3.50 to 4.26). The data points were evenly spread suggesting no systematic variation for over- or underestimation of scores. Minimal difference was observed between the functionality of the two assessment instruments. However, the food intake record can be completed by pregnant individuals to estimate short-term nutrient intake, and then scored by the investigator to estimate long-term dietary quality. Combining these two instruments may best capture the most accurate representation of dietary habits over time.
This chapter explores the idea of gendered social performance through the texts of Plutarch and Sima Qian. Chandra Giroux investigates two categories of social performance in particular: friendship and authority, and death and grief. Both categories are approached from the perspective of each author’s own social performance in these scenarios as well as how they represent the social performance of women in them. Through an investigation of Plutarch’s and Sima Qian’s self-representations of their own social performances, she argues that both authors attempt to establish themselves as exemplary figures, ones that focus on the idea of the maintenance of harmony. In this way, Plutarch’s and Sima Qian’s actions are meant as a mirror for their readers’ own lives. In comparison, the chapter analyzes the examples of Timokleia and Timoxena in Plutarch’s corpus, as well as that of Nie Ying in Sima Qian’s work, to explore the authors’ notions of the ideal female reaction to friendship and authority, as well as that of death and grief. In this analysis, Giroux finds that both authors’ representations of women are based in the gender expectations of their respective societies. It is thus the differences between their cultures’ approaches to gender relations that dictate how Plutarch and Sima Qian understood the ideal female reaction to death, grief, friendship, and authority.
High rates of psychiatric comorbidities have been found in people with problem gambling (PBG), including substance use, anxiety, and mood disorders. Psychotic disorders have received less attention, although this comorbidity is expected to have a significant impact on the course, consequences, and treatment of PBG. This review aimed to estimate the prevalence of psychotic disorders in PBG.
Methods
Medline (Ovid), EMBASE, PsycINFO (Ovid), CINAHL, CENTRAL, Web of Science, and ProQuest were searched on November 1, 2023, without language restrictions. Studies involving people with PBG and reporting the prevalence of schizophrenia spectrum and other psychotic disorders were included. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal checklist for systematic reviews of prevalence data. The pooled prevalence of psychotic disorders was calculated using a random effects generalized linear mixed model and presented with forest plots.
Results
Of 1,271 records screened, 22 studies (n = 19,131) were included. The overall prevalence of psychotic disorders was 4.9% (95% CI, 3.6–6.5%, I2 = 88%). A lower prevalence was found in surveyed/recruited populations, compared with treatment-seeking individuals and register-based studies. No differences were found for factors such as treatment setting (inpatient/outpatient), diagnoses of psychotic disorders (schizophrenia only/other psychotic disorders), and assessment time frame (current/lifetime). The majority of included studies had a moderate risk of bias.
Conclusions
These findings highlight the relevance of screening problem gamblers for schizophrenia spectrum and other psychotic disorders, as well as any other comorbid mental health conditions, given the significant impact such comorbidities can have on the recovery process.
There is strong evidence that a biodiversity crisis is underway, fuelled by pollution, climate change, and invasive species. These impacts are especially important in northern Canadian regions. However, insect and other arthropod monitoring in Northern Canada urgently needed for land preservation is lacking. This paper presents the Nunavik Sentinels, a community-based participatory research programme (see definition, Table 1), that is aiming to fill those knowledge gaps while promoting collaboration among all stakeholders (organisations and members of northern communities, and scientists). Nunavik Sentinels is a unique insect-monitoring programme facilitated by the Montréal Insectarium – Espace pour la vie (Montréal, Québec, Canada), making entomology accessible to Indigenous youth by providing them with tools to lead expeditions in unexplored habitats and involving them in data collection. We present how this programme came to existence and its four-pillar framework (i.e., training land camp, summer employment, educational kit, and research). We touch upon how the programme is continually evolving. Finally, we demonstrate the benefits of the programme and how it will help better define the actions to be taken to prepare for future changes in northern biodiversity.
While grain farming has seen a major shift toward organic production in recent years, the USA continues to lag behind with domestic demand continuing to outpace domestic supply, making the USA an all-around net importer. The Midwestern USA is poised to help remedy this imbalance; however, farmers continue to slowly transition to organic production systems. Existing literature has identified three prevalent narratives that farmers use to frame their organic transition: environmentalism, farm-family legacy and economic factors, in addition to a four and untested religiosity narrative. This study sought to better understand how these different narratives frame grain farmers’ thought processes for transitioning from conventional production systems to certified organic production systems. We co-created narratives around organic production with farmers, which resulted in four passages aligned with the literature: farm-family legacy, economic values, environmental values and Christianity and stewarding Eden. Then, we mailed a paper survey to conventional, in transition and certified organic Indiana grain farmers in order to test how these different narratives motivated organic production. We found that the most prevalent narrative around organic production is the farm-family legacy, which specifically resonated with midsize farmers. We also found that the religious stewardship narrative resonated with a substantial number of organic and mixed practice farmers, which is likely due to Amish farmers within the sample. These results shed light on the role that narratives and associated values play in organic practice use and can inform the organic efforts of agricultural professionals.
Fetal restriction (FR) alters insulin sensitivity, but it is unknown how the metabolic profile associated with restriction affects development of the dopamine (DA) system and DA-related behaviors. The Netrin-1/DCC guidance cue system participates in maturation of the mesocorticolimbic DA circuitry. Therefore, our objective was to identify if FR modifies Netrin-1/DCC receptor protein expression in the prefrontal cortex (PFC) at birth and mRNA in adulthood in rodent males. We used cultured HEK293 cells to assess if levels of miR-218, microRNA regulator of DCC, are sensitive to insulin. To assess this, pregnant dams were subjected to a 50% FR diet from gestational day 10 until birth. Medial PFC (mPFC) DCC/Netrin-1 protein expression was measured at P0 at baseline and Dcc/Netrin-1 mRNA levels were quantified in adults 15 min after a saline/insulin injection. miR-218 levels in HEK-293 cells were measured in response to insulin exposure. At P0, Netrin-1 levels are downregulated in FR animals in comparison to controls. In adult rodents, insulin administration results in an increase in Dcc mRNA levels in control but not FR rats. In HEK293 cells, there is a positive correlation between insulin concentration and miR-218 levels. Since miR-218 is a Dcc gene expression regulator and our in vitro results show that insulin regulates miR-218 levels, we suggest that FR-induced changes in insulin sensitivity could be affecting Dcc expression via miR-218, impacting DA system maturation and organization. As fetal adversity is linked to nonadaptive behaviors later in life, this may contribute to early identification of vulnerability to chronic diseases associated with fetal adversity.
In far-forward combat situations, the military challenged dogma by using whole blood transfusions (WBTs) rather than component-based therapy. More recently, some trauma centers have initiated WBT programs with reported success. There are a few Emergency Medical Service (EMS) systems that are using WBTs, but the vast majority are not. Given the increasing data supporting the use of WBTs in the prehospital setting, more EMS systems are likely to consider or begin WBT programs in the future.
Objective:
A prehospital WBT program was recently implemented in Palm Beach County, Florida (USA). This report will discuss how the program was implemented, the obstacles faced, and the initial results.
Methods:
This report describes the process by which a prehospital WBT program was implemented by Palm Beach County Fire Rescue and the outcomes of the initial case series of patients who received WBTs in this system. Efforts to initiate the prehospital WBT program for this system began in 2018. The program had several obstacles to overcome, with one of the major obstacles being the legal team’s perception of potential liability that might occur with a new prehospital blood transfusion program. This obstacle was overcome through education of local elected officials regarding the latest scientific evidence in favor of prehospital WBTs with potential life-saving benefits to the community. After moving past this hurdle, the program went live on July 6, 2022. The initial indications for transfusion of cold-stored, low titer, leukoreduced O+ whole blood in the prehospital setting included traumatic injuries with systolic blood pressure (SBP) < 70mmHg or SBP < 90mmHg plus heart rate (HR) > 110 beats per minute.
Findings:
From the date of onset through December 31, 2022, Palm Beach County Fire Rescue transported a total of 881 trauma activation patients, with 20 (2.3%) receiving WBT. Overall, nine (45%) of the patients who had received WBTs so far remain alive. No adverse events related to transfusion were identified following WBT administration. A total of 18 units of whole blood reached expiration of the unit’s shelf life prior to transfusion.
Conclusion:
Despite a number of logistical and legal obstacles, Palm Beach County Fire Rescue successfully implemented a prehospital WBT program. Other EMS systems that are considering a prehospital WBT program should review the included protocol and the barriers to implementation that were faced.
Constrictive pericarditis is rare in children and can be difficult to diagnose. It has been described in adults after sclerotherapy of oesophageal varices but not in children. We report two cases of chronic constrictive pericarditis after sclerotherapy of oesophageal varices in children with portal cavernoma. Constrictive pericarditis should be considered as a cause of refractory ascites.
Les difficultés cognitives consécutives aux troubles neurocognitifs majeurs (TNCM) engendrent des enjeux dans la réalisation d’activités de la vie quotidienne. Ce projet visait à identifier auprès des proches aidants et des intervenants des situations nécessitant des méthodes optimisant l’apprentissage pour faciliter l’engagement de personnes vivant avec un TNCM dans leurs activités de la vie quotidienne. Des entrevues individuelles semi-dirigées, d’une durée de 60 à 90 minutes, ont été menées auprès de proches aidants et d’intervenants. Les résultats montrent que les activités quotidiennes et domestiques sont notamment affectées par les difficultés à repérer ou à utiliser les objets, à garder en tête la tâche en cours, à mettre en séquences des étapes, à ne pas se laisser distraire par autre chose et à constater ses difficultés pour s’y adapter. Les proches aidants souhaitent du soutien dans l’application des méthodes optimisant l’apprentissage pour contribuer au maintien de l’autonomie des personnes vivant avec un TNCM.
To identify factors influencing Black immigrant mothers’ perceptions and concerns about child weight and to compare children’s diet quality according to these perceptions and concerns.
Design:
Mothers’ perceptions and concerns about child weight were assessed with sex-specific figure rating scales and the Child Feeding Questionnaire, respectively. Participants’ weights and heights were measured and characterised using WHO references. Children’s dietary intakes were estimated using a 24-h dietary recall. Children’s diet quality was evaluated using the relative proportion of their energy intake provided by ultra-processed products, which were identified with the NOVA classification. χ2 tests, multivariate logistic regressions and t tests were performed.
Setting:
Ottawa, Ontario, Canada.
Participants:
Black immigrant mothers of Sub-Saharan African and Caribbean origin (n 186) and their 6–12-year-old children.
Results:
Among mothers, 32·4 % perceived their child as having overweight while 48·4 % expressed concerns about child weight. Girls and children with overweight or obesity were significantly more likely to be perceived as having overweight by their mothers than boys and normal-weight children, respectively. Mothers of children living with obesity, but not overweight, were significantly more likely to be concerned about their child’s weight than mothers of normal-weight children. Children’s diet quality did not differ according to mothers’ perceptions and concerns.
Conclusions:
Children’s gender and weight status were major determinants of perceptions and concerns about child weight among Black immigrant mothers. Including knowledge about mothers’ perceptions and concerns about child weight will help nutrition professionals develop interventions tailored to specific family needs within the context of their cultural backgrounds.
In this article, I address collecting and re(p)(m)atriation as research orientations. I draw on examples from Métis music to situate the impact of collection-oriented research, to interrogate my own practice as a Métis-music scholar, and to point to possibilities for the future. In presenting a history of collecting alongside an overview of re(p)(m)atriation, I offer readers an opportunity to meditate on the pervasiveness of collection-oriented research and how we might create a new ethnomusicology—meditations encouraged through poetic expressions. I suggest that twenty-first century ethnomusicology needs to turn towards rematriation, not only as an act of returning artifacts, but also as a way of orienting our work as scholars.
This study documented the provision of services and issues experienced by community organizations supporting older adults and caregivers in the province of Quebec during the coronavirus disease (COVID-19) pandemic, as well as promising strategies to adapt the provision of services in this context. A cross-sectional electronic survey using open- and closed-ended questions was conducted in July 2020. Almost three-quarters of the 307 respondents (71.4%) reported having maintained services at least partially throughout the lockdown, and the majority (85.3%) adapted their services. Among key challenges, participants reported difficulties identifying and supporting older adults at greater risk of vulnerability (54.8%), managing health risks for service users (60.2%), and recruiting volunteers (59.5%). Promising strategies included strategies to reach out to older adults and understand their needs (e.g., systematic phone calls) in addition to direct interventions supporting them (e.g., activities promoting social ties); implementing prevention and protection measures; accessing and using technologies; human resources management (e.g., recruiting new volunteers); finding financial support for their organization; developing intersectoral partnerships (e.g., multisectoral crisis cell); and promoting a positive view of older adults. The integration of multiple perspectives from different stakeholders may help identify strategies potentially transferable to other crises in order to meet older adults’ needs.
Evidence suggests that pregnant women who test positive for COVID-19 may develop more severe illness than non-pregnant women and may be at greater risk for psychological distress. The relationship between COVID-19 status (positive, negative, never tested) and symptoms of depression was examined in a survey study (May to September 2020) of pregnant women (n = 869). Pregnant women who reported testing positive for COVID-19 were significantly more likely to report depressive symptoms compared with women who tested negative (P = 0.027) and women who were never tested (P = 0.005). Findings indicate that pregnant women who test positive for COVID-19 should be screened and monitored for depressive symptoms.
Older persons experiencing a longer length of stay (LOS) or delayed discharge (DD) may see a decline in their health and well-being, generating significant costs. This review aimed to identify evidence on the impact of cognitive impairment (CI) on acute care hospital LOS/DD. A scoping review of studies examining the association between CI and LOS/DD was performed. We searched six databases; two reviewers independently screened references until November 2019. A narrative synthesis was used to answer the research question; 58 studies were included of which 33 found a positive association between CI and LOS or DD, 8 studies had mixed results, 3 found an inverse relationship, and 14 showed an indirect link between CI-related syndromes and LOS/DD. Thus, cognitive impairment seemed to be frequently associated with increased LOS/DD. Future research should consider CI together with other risks for LOS/DD and also focus on explaining the association between the two.
Old age constitutes a vulnerable stage for developing gambling-related problems. The aims of the study were to identify patterns of gambling habits in elderly participants from the general population, and to assess socio-demographic and clinical variables related to the severity of the gambling behaviours. The sample included N = 361 participants aged in the 50–90 years range. A broad assessment included socio-demographic variables, gambling profile and psychopathological state. The percentage of participants who reported an absence of gambling activities was 35.5 per cent, while 46.0 per cent reported only non-strategic gambling, 2.2 per cent only strategic gambling and 16.3 per cent both non-strategic plus strategic gambling. Gambling form with highest prevalence was lotteries (60.4%), followed by pools (13.9%) and bingo (11.9%). The prevalence of gambling disorder was 1.4 per cent, and 8.0 per cent of participants were at a problematic gambling level. Onset of gambling activities was younger for men, and male participants also reached a higher mean for the bets per gambling-episode and the number of total gambling activities. Risk factors for gambling severity in the sample were not being born in Spain and a higher number of cumulative lifetime life events, and gambling severity was associated with a higher prevalence of tobacco and alcohol abuse and with worse psychopathological state. Results are particularly useful for the development of reliable screening tools and for the design of effective prevention programmes.
Older subjects are susceptible to develop gambling problems, and researchers have attempted to assess the mechanisms underlying the gambling profile in later life. The objective of this study was to identify the main stressful life events (SLE) across the lifespan which have discriminative capacity for detecting the presence of gambling disorder (GD) in older adults. Data from two independent samples of individuals aged 50+ were analysed: N = 47 patients seeking treatment at a Pathological Gambling Outpatient Unit and N = 361 participants recruited from the general population. Sexual problems (p < 0.001), exposure to domestic violent behaviour (p < 0.001), severe financial problems (p = 0.002), alcohol or drug-related problems (p = 0.004) and extramarital sex (p < 0.001) were related to a higher risk of GD, while getting married (p = 0.005), moving to a new home (p = 0.003) and moving to a new city (p = 0.006) decreased the likelihood of disordered gambling. The accumulated number of SLE was not a predictor of the presence of GD (p = 0.732), but patients who met clinical criteria for GD reported higher concurrence of SLE in time than control individuals (p < 0.001). Empirical research highlights the need to include older age groups in evidence-based policies for gambling prevention, because these individuals are at high risk of onset and/or progression of behavioural addiction-related problems such as GD. The results of this study may be useful for developing reliable screening/diagnostic tools and for planning effective early intervention programmes aimed to reduce the harm related to the onset and evolution of problem gambling in older adults.
Introduction: While negative consequences of incident delirium on functional and cognitive decline have been widely studied, very limited data is available regarding functional and cognitive outcomes in Emergency Department (ED) patients. The aim of this study was therefore to evaluate the impact of ED stay-associated delirium on older patient's functional and cognitive status at 60 days post-ED visit. Methods: This study is a planned sub-analysis of a large multicentre prospective cohort study (the INDEED study). This project took place between March and July of the years 2015 and 2016 within 5 participating EDs across the province of Quebec. Independent non-delirious patients aged □65, with an ED stay at least 8hrs were monitored until 24hrs post-ward admission. A 60-day follow-up phone assessment was also conducted. Participants were screened for delirium using the validated Confusion Assessment Method (CAM) and the severity of its symptoms was measured using the Delirium Index. Functional and cognitive status were assessed at baseline as well as at the 60-day follow-up using the validated OARS and TICS-m. Results: A total of 608 patients were recruited, 393 of which completed the 60-day follow-up. Sixty-nine patients obtained a positive CAM during ED-stay or within the first 24 hours following ward admission. At 60-days, those patients experienced a loss of 3.1 (S.D. 4.0) points on the OARS scale compared to non-delirious patients who lost 1.6 (S.D. 3.0) (p = 0.03). A significant difference in cognitive function was also noted at 60-days, as delirious patients’ TICS-m score decreased by 2.1 (S.D. 6.2) compared to non-delirious patients, who showed a minor improvement of 0.5 (S.D. 5.8) (p = 0.01). Conclusion: People who developed ED stay-associated delirium have lower baseline functional and cognitive status than non-delirious patients and they will experience a more significant decline at 60 days post-ED visit.
The Canadian federation was constituted in 1867, inspired by the American Constitution for its federalist system and by the British government for its parliamentary system and constitutional monarchy. It is now composed of ten provinces and three territories. The key characteristic of the Canadian system is the division of executive and legislative powers between the federal and provincial governments. All laws must respect the Canadian Constitution, including the Canadian Charter of Human Rights and Freedoms. Generally, laws regulating adults and children relationships (e.g. parentage, adoption, filiation) fall under the jurisdiction of the provinces or territories. So these laws vary from one jurisdiction to another. That justifies the overview approach we have chosen to present the rules governing these issues in Canada. The federal government is responsible for formation of marriage and divorce and it also has other general powers such as the criminal law power, the spending power, as well as residual powers over matters not assigned by the constitution to provinces and territories. Some matters could be of concurrent jurisdictions (e.g. surrogacy and artificial reproduction for the criminal law implications). There can be complex interactions at times between provincial/territorial and federal law (e.g. Reference re Assisted Human Reproduction Act, 2010 SCC 61). In the province of Quebec, the civil law system is applicable to relationships between persons and property, inspired by the French Napoleonic code, but the relationship between the state and persons has been governed by the common law of English origin. The common law applies in the rest of Canada, either in private or public matters.
CHANGES IN THE TRADITIONAL FAMILY
A. MOTHERS
1. Is maternity automatically established by the birth certificate?
In general, maternity is automatically established by the act of birth in Quebec (art. 523 CCQ), regardless of the circumstances of the child's birth. The adage mater semper certa est is of application in Quebec civil law. Hence, the woman who gives birth to the child is deemed to be the mother of the child. Nevertheless, a declaration from the mother to the registrar of civil status within 30 days of the birth of a child is still required. Failure to declare within that period of time is subject to a fine.
This paper reports on a funded summit, which convened a multidisciplinary group of experts to provide consensus on the research priorities necessary for improving long-term community integration of individuals with traumatic brain injury (TBI) and their caregivers.
Methods
The 2-day summit was directed using the World Café Methodology, to engage stakeholders and collaboratively arrive at a consensus on the problems to be targeted in research. Participants (n=54), drawn from two Canadian provinces, included an interdisciplinary group of researchers, clinicians, representatives from brain injury associations, individuals with TBI, and caregivers. In small groups, participants discussed challenges to long-term community integration and potential initiatives that would address these barriers. Field notes from the discussions were analyzed using qualitative content analysis.
Results
The consensus on prioritized research directions included developing interventions to optimize the functioning and participation of individuals with TBI, reducing caregiver burden, and evaluating how emerging technology can facilitate delivery of care.
Conclusions
The World Café Methodology was an effective method for developing research priorities. The breadth of expertise of participants and the collegial environment allowed for the identification of a broad perspective on important future research directions with potential to enhance the long-term community integration of individuals with brain injury.