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The diet proposed by the EAT-Lancet Commission has faced criticism concerning its affordability. This study aimed to investigate the cost associated with a greater alignment to the EAT-Lancet reference diet in the province of Québec, Canada. The dietary habits of 1147 French-speaking adults were assessed using repeated web-based 24-h recall data collected between 2015 and 2017 in the cross-sectional PRÉDicteurs Individuels, Sociaux et Environnementaux (PREDISE) study. Diet costs were calculated using a Nielsen food price database. Usual dietary intakes and diet costs were estimated using the National Cancer Institute’s multivariate Markov Chain Monte Carlo method. Adherence to the EAT-Lancet diet was assessed using the EAT-Lancet dietary index (EAT-I). Associations between diet costs and EAT-I scores were evaluated using linear regression models with restricted cubic splines. After adjustment for energy intake, a higher EAT-I score (75th v. 25th percentiles) was associated with a 1·0 $CAD increase in daily diet costs (95 % CI, 0·7, 1·3). This increase in diet costs was mostly driven by the following component scores of the EAT-I (75th v. 25th percentiles, higher scores reflecting greater adherence): vegetables (1·6 $CAD/d, 95 % CI: 1·2, 2·1), free sugars (1·6 $CAD/d, 95 % CI: 1·3, 1·9), fish and plant-based proteins (1·4 $CAD/d, 95 % CI: 1·0, 1·8), fruits (0·9 $CAD/d, 95 % CI: 0·4, 1·3) and whole grains (0·4 $CAD/d, 95 % CI: 0·0, 0·8). Inversely, a greater score for the poultry and eggs component was associated with reduced diet costs (–1·2 $CAD/d, 95 % CI: −1·7, −0·7). This study suggests that adhering to the EAT-Lancet diet may be associated with an increase in diet costs in the province of Québec.
Dans un climat de crise manifeste des voies traditionnelles de représentation politique, les formes de communication directe entre gouvernants et gouvernés suscitent de plus en plus l’intérêt des sciences sociales. Partant d’un ensemble de cahiers de doléances ouverts dans la Somme entre fin 2018 et début 2019 dans le contexte de la mobilisation des Gilets jaunes, cet article prend le parti d’interroger ces cahiers comme une source à part entière, et non pas simplement comme un contenant d’informations. Cela implique d’examiner les liens étroits entre le support et le contenu en mobilisant nos différentes compétences disciplinaires (histoire, sociologie, cartographie, statistique). Cette recherche permet de dégager l’autonomie relative de ce corpus à l’égard d’autres formes de mobilisation, d’identifier les contextes de production des doléances ainsi que les contraintes qui sont liées à cette forme spécifique de communication avec les autorités. L’analyse de quelques thèmes centraux – le travail, la pauvreté et l’impôt – nous introduit à des idéaux de redistribution et de justice sociale qui sont au cœur de ces écrits. Nous essayons enfin de décrire les contours de cette communauté que les doléances dessinent, avec ses ayants droits et ses exclus.
We evaluated the added value of infection control-guided, on demand, and locally performed severe acute respiratory coronavirus virus 2 (SARS-CoV-2) genomic sequencing to support outbreak investigation and control in acute-care settings.
Design and setting:
This 18-month prospective molecular epidemiology study was conducted at a tertiary-care hospital in Montreal, Canada. When nosocomial transmission was suspected by local infection control, viral genomic sequencing was performed locally for all putative outbreak cases. Molecular and conventional epidemiology data were correlated on a just-in-time basis to improve understanding of coronavirus disease 2019 (COVID-19) transmission and reinforce or adapt control measures.
Results:
Between April 2020 and October 2021, 6 outbreaks including 59 nosocomial infections (per the epidemiological definition) were investigated. Genomic data supported 7 distinct transmission clusters involving 6 patients and 26 healthcare workers. We identified multiple distinct modes of transmission, which led to reinforcement and adaptation of infection control measures. Molecular epidemiology data also refuted (n = 14) suspected transmission events in favor of community acquired but institutionally clustered cases.
Conclusion:
SARS-CoV-2 genomic sequencing can refute or strengthen transmission hypotheses from conventional nosocomial epidemiological investigations, and guide implementation of setting-specific control strategies. Our study represents a template for prospective, on site, outbreak-focused SARS-CoV-2 sequencing. This approach may become increasingly relevant in a COVID-19 endemic state where systematic sequencing within centralized surveillance programs is not available.
This study examined the effectiveness of an integrated care pathway (ICP), including a medication algorithm, to treat agitation associated with dementia.
Design:
Analyses of data (both prospective and retrospective) collected during routine clinical care.
Setting:
Geriatric Psychiatry Inpatient Unit.
Participants:
Patients with agitation associated with dementia (n = 28) who were treated as part of the implementation of the ICP and those who received treatment-as-usual (TAU) (n = 28) on the same inpatient unit before the implementation of the ICP. Two control groups of patients without dementia treated on the same unit contemporaneously to the TAU (n = 17) and ICP groups (n = 36) were included to account for any secular trends.
Intervention:
ICP.
Measurements:
Cohen Mansfield Agitation Inventory (CMAI), Neuropsychiatric Inventory Questionnaire (NPIQ), and assessment of motor symptoms were completed during the ICP implementation. Chart review was used to obtain length of inpatient stay and rates of psychotropic polypharmacy.
Results:
Patients in the ICP group experienced a reduction in their scores on the CMAI and NPIQ and no changes in motor symptoms. Compared to the TAU group, the ICP group had a higher chance of an earlier discharge from hospital, a lower rate of psychotropic polypharmacy, and a lower chance of having a fall during hospital stay. In contrast, these outcomes did not differ between the two control groups.
Conclusions:
These preliminary results suggest that an ICP can be used effectively to treat agitation associated with dementia in inpatients. A larger randomized study is needed to confirm these results.
This article documents how the COVID-19 crisis has affected the drinking behavior of Latin European wine consumers. Using a large online survey conducted during the first lockdown in France, Italy, Portugal, and Spain (n = 7,324 individuals), we reconstruct the purchasing and consumption patterns of the respondents. The number of people who maintained their wine consumption frequency is significantly higher than those who increased or decreased their consumption. Wine consumption frequency held up better than other types of alcohol (beer and spirits). We analyze heterogeneities among countries and individuals by employing the Marascuilo procedure and an ordered logit model. The latter identifies the impact of demographic, commercial, and psychosocial factors on wine consumption frequency. The results shed light on changes in wine consumer behavior during the first lockdown and consider possible post-lockdown trends that could be useful to industry players. (JEL Classifications: D5, L66, Q1)
The development and maintenance of body composition and functions require an adequate protein intake with a continuous supply of amino acids (AA) to tissues. Body pool and AA cellular concentrations are tightly controlled and maintained through AA supply (dietary intake, recycled from proteolysis and de novo synthesis), AA disposal (protein synthesis and other AA-derived molecules) and AA losses (deamination and oxidation). Different molecular regulatory pathways are involved in the control of AA sufficiency including the mechanistic target of rapamycin complex 1, the general control non-derepressible 2/activating transcription factor 4 system or the fibroblast growth factor 21. There is a tight control of protein intake, and human subjects and animals appear capable of detecting and adapting food and protein intake and metabolism in face of foods or diets with different protein contents. A severely protein deficient diet induces lean body mass losses and ingestion of sufficient dietary energy and protein is a prerequisite for body protein synthesis and maintenance of muscle, bone and other lean tissues and functions. Maintaining adequate protein intake with age may help preserve muscle mass and strength but there is an ongoing debate as to the optimal protein intake in older adults. The protein synthesis response to protein intake can also be enhanced by prior completion of resistance exercise but this effect could be somewhat reduced in older compared to young individuals and gain in muscle mass and function due to exercise require regular training over an extended period.
Health professionals consider the evaluation of eating habits to be challenging, given the potential biases of dietary questionnaires based on self-reported data. Circulating carotenoid concentrations are reliable biomarkers of dietary carotenoid intake and could be useful in the validation of dietary assessment tools. However, there is a sex difference in circulating carotenoids, with women displaying higher concentrations compared with men independent of intake. The aim of the present study was to identify the correlates of plasma carotenoid concentrations among men (n 155) and women (n 110) enrolled in six fully controlled dietary interventions with varying dietary carotenoid intakes. We looked at the associations of post-intervention fasting plasma carotenoid concentrations (α-carotene, β-carotene, β-cryptoxanthin, lutein, lycopene and zeaxanthin) with physical and metabolic characteristics. We found that increased body weight (r –0·47, P<0·0001) and waist circumference (r –0·46, P<0·0001) were associated with lower plasma total carotenoid concentrations, while elevated plasma LDL-cholesterol (r 0·49, P<0·0001) and HDL-cholesterol (r 0·50, P<0·0001) concentrations were correlated with higher total carotenoids in plasma. Women had significantly higher plasma total carotenoid concentrations compared with men, despite significantly lower dietary carotenoid intake. Adjustment of circulating carotenoid concentrations for plasma HDL-cholesterol eliminated sex difference in plasma carotenoid concentrations. Our results suggest that physical characteristics as well as plasma lipids are associated with circulating carotenoid concentrations and that these variables should be taken into account when using plasma carotenoids as biomarkers for food intake in men and women.
This issue of International Psychogeriatrics contains three papers from three continents that explore the use of sedatives–hypnotics and opioids in the treatment of older adults (Hamina et al., 2018; Machado-Duque et al., 2018; Tseng et al., 2018), and a fourth paper reporting on a qualitative study that addresses the broader question of training needs in dementia in a setting of rapid economic and demographic changes (Xu et al., 2018).
To assess the relative validity of a new, web-based, self-administered 24 h dietary recall, the R24W, for assessment of energy and nutrient intakes among French Canadians.
Design
Each participant completed a 3d food record (FR) and the R24W on three occasions over a 4-week period. Intakes of energy and of twenty-four selected nutrients assessed by both methods were compared.
Setting
Québec City metropolitan area.
Subjects
Fifty-seven women and fifty men (mean (sd) age: 47·2 (13·3) years).
Results
Equivalent proportions of under-reporters were found with the R24W (15·0%) and the FR (23·4%). Mean (sd) energy intake from the R24W was 7·2% higher than that from the FR (10 857 (3184) kJ/d (2595 (761) kcal/d) v. 10 075 (2971) kJ/d (2408 (710) kcal/d); P<0·01). Significant differences in mean nutrient intakes between the R24W and the FR ranged from –54·8% (i.e. lower value with R24W) for niacin to +40·0% (i.e. higher value with R24W) for alcohol. Sex- and energy-adjusted deattenuated correlations between the two methods were significant for all nutrients except Zn (range: 0·35–0·72; P<0·01). Cross-classification demonstrated that 40·0% of participants were classified in the same quartile with both methods, while 40·0% were classified in the adjacent quartile and only 3·6% were grossly misclassified (1st v. 4th quartile). Analysis of Bland–Altman plots revealed proportional bias between the two assessment methods for 8/24 nutrients.
Conclusions
These data suggest that the R24W presents an acceptable relative validity as compared with the FR for estimating usual dietary intakes in a cohort of French Canadians.
The present study aimed to develop and validate a questionnaire assessing social support for healthy eating in a French-Canadian population.
Design
A twenty-one-item questionnaire was developed. For each item, participants were asked to rate the frequency, in the past month, with which the actions described had been done by family and friends in two different environments: (i) at home and (ii) outside of home. The content was evaluated by an expert panel. A validation study sample was recruited and completed the questionnaire twice. Exploratory factor analysis was performed on items to assess the number of subscales. Internal consistency reliability was assessed using Cronbach’s ɑ. Test–retest reliability was evaluated with intraclass correlations between scores of the two completions.
Setting
Online survey.
Subjects
Men and women from the Québec City area (n 150).
Results
The content validity assessment led to a few changes, resulting in a twenty-two-item questionnaire. Exploratory factor analysis revealed a two-factor structure for both environments, resulting in four subscales: supportive actions at home; non-supportive actions at home; supportive actions outside of home; and non-supportive actions outside of home. Two items were removed from the questionnaire due to low loadings. The four subscales were found to be reliable (Cronbach’s ɑ=0·82–0·94; test–retest intraclass correlation=0·51–0·70).
Conclusions
The Social Support for Healthy Eating Questionnaire was developed for a French-Canadian population and demonstrated good psychometric properties. This questionnaire will be useful to explore the role of social support and its interactions with other factors in predicting eating behaviours.
To develop consensus recommendations for training future clinician educators (CEs) in emergency medicine (EM).
Methods
A panel of EM education leaders was assembled from across Canada and met regularly by teleconference over the course of 1 year. Recommendations for CE training were drafted based on the panel’s experience, a literature review, and a survey of current and past EM education leaders in Canada. Feedback was sought from attendees at the Canadian Association of Emergency Physicians (CAEP) annual academic symposium. Recommendations were distributed to the society’s Academic Section for further feedback and updated by a consensus of the expert panel.
Results
Recommendations were categorized for one of three audiences: 1) Future CEs; 2) Academic departments and divisions (AD&D) that support training to fulfill their education leadership goals; and 3) The CAEP Academic Section. Advanced medical education training is recommended for any emergency physician or resident who pursues an education leadership role. Individuals should seek out mentorship in making decisions about career opportunities and training options. AD&D should regularly perform a needs assessment of their future CE needs and identify and encourage potential individuals who fulfill education leadership roles. AD&D should develop training opportunities at their institution, provide support to complete this training, and advocate for the recognition of education scholarship in their institutional promotions process. The CAEP Academic Section should support mentorship of future CEs on a national scale.
Conclusion
These recommendations serve as a framework for training and supporting the next generation of Canadian EM medical educators.
The present study aimed to develop and validate a questionnaire assessing perceived food environment in a French-Canadian population.
Design
A questionnaire, the Perceived Food Environment Questionnaire, was developed assessing perceived accessibility to healthy (nine items) and unhealthy foods (three items). A pre-test sample was recruited for a pilot testing of the questionnaire. For the validation study, another sample was recruited and completed the questionnaire twice. Exploratory factor analysis was performed on the items to assess the number of factors (subscales). Cronbach’s α was used to measure internal consistency reliability. Test–retest reliability was assessed with Pearson correlations.
Setting
Online survey.
Subjects
Men and women from the Québec City area (n 31 in the pre-test sample; n 150 in the validation study sample).
Results
The pilot testing did not lead to any change in the questionnaire. The exploratory factor analysis revealed a two-subscale structure. The first subscale is composed of six items assessing accessibility to healthy foods and the second includes three items related to accessibility to unhealthy foods. Three items were removed from the questionnaire due to low loading on the two subscales. The subscales demonstrated adequate internal consistency (Cronbach’s α=0·77 for healthy foods and 0·62 for unhealthy foods) and test–retest reliability (r=0·59 and 0·60, respectively; both P<0·0001).
Conclusions
The Perceived Food Environment Questionnaire was developed for a French-Canadian population and demonstrated good psychometric properties. Further validation is recommended if the questionnaire is to be used in other populations.
High fruit and vegetable (FAV) intake is associated with a lower prevalence of chronic diseases. Identifying the ideal number of FAV servings needed to reduce chronic disease risk is, however, difficult because of biases inherent to common self-report dietary assessment tools. The aim of our study was to examine the associations between daily FAV intake and plasma carotenoid concentrations in men and women enrolled in a series of fully controlled dietary interventions. We compiled and analysed data from a group of 155 men and 109 women who participated in six fully controlled dietary interventions and compared post-intervention fasting plasma carotenoid (α-carotene, β-carotene, β-cryptoxanthin, lutein, lycopene, zeaxanthin) concentrations with regard to the daily FAV servings consumed by the participants. We found that plasma β-cryptoxanthin, lutein and zeaxanthin concentrations were positively associated with daily FAV servings (P≤0·005). However, daily FAV intake was negatively associated with plasma α-carotene (P<0·0005) and lycopene (P<0·0001) concentrations, whereas no association was noted with plasma β-carotene. When men and women were analysed separately, we found that for any given number of FAV servings consumed women had higher circulating lutein concentrations compared with men (P<0·01). Significant sex×FAV (P<0·0001) and sex×dietary β-cryptoxanthin (P<0·0005) interactions were also noted favouring higher plasma β-cryptoxanthin concentrations in women than in men for a given FAV consumption. Results from these fully controlled dietary feeding studies indicate that plasma β-cryptoxanthin and lutein concentrations can be used as robust biomarkers of FAV consumption. They also suggest the existence of sex differences influencing circulating β-cryptoxanthin and lutein concentrations following FAV consumption.
Carey and Hix (2011) propose that a proportional electoral system with a moderate number of seats per district offers the best compromise between (1) accurate representation and (2) strong accountability. The argument is that there is a district magnitude (DM) level where the trade-off between proportionality and fragmentation of parties is optimal. This DM is called the sweet spot. We explore this proposition through lab experiments conducted in Brussels and Montreal. We find that the probability of achieving a “good” outcome on both proportionality and the number of parties is slightly higher at moderate DMs. We note, however, that this probability remains low.
Patients may present to Emergency Departments (ED) in shock for various reasons. Emergency medicine physicians may require the use of vasopressors or inotropes to manage these patients. The Critical Care Practice Committee of the Canadian Association of Emergency Physicians (C4) conducted an intensive literature search and guideline development process to help create an evidence based approach for use of these agents in the stabilization of shock.
In 2011 the IRSN conducted several assessments of atmosphericradioactive releases due to the Fukushima Daiichi NPP accident (March11, 2011) and of their impact on Japan’s terrestrial environment.They were based on the IRSN’s emergency management tools and onthe abundant information and technical data gradually publishedin Japan. According to these assessments, the main release phaselasted from March 12 to 25, 2011 and impacted Japanese land in twoevents, the first on 15 and 16 March, in which the main radioactivedeposits were formed, and the second from March 20 to 23, whichwas less significant. The highest amounts of radioactive deposits werefound in an area extending upwards of several tens of kilometersnorthwest of the plant. Lower amounts were discontinuously scatteredin an area extending up to over 250 km away. Initially composedmainly of short-lived radionuclides, the deposits’ activity sharplydecreased in the subsequent weeks. Since the summer of 2011, cesium-134and cesium-137 have become the residual deposits’ main components.According to IRSN estimates, in the absence of protection, the dosesdue to exposure to the radioactive plume during the atmosphericrelease phase may have been potentially higher for people who remainedin coastal areas up to several tens of kilometers north and southof the damaged plant. Thereafter, people living up to 50 km northwestof the plant, outside the 20-km emergency evacuation zone, were potentiallymost vulnerable to residual radioactive deposits over time.
A SiC-based ceramic foam applied in solar thermal processes was characterized in detail in terms of its textural parameters and its radiative properties. Scanning electron microscopy and x-ray µ-tomography were first performed to investigate the 3D texture of the sample at several length scales. Infrared reflectance microscopy was also applied to probe the local optical responses on the struts constituting the foam. Based on the whole set of experimental data, a numerical tool (C++) was implemented to reconstruct virtual SiC foams. A Monte Carlo Ray Tracing code (iMorphRad, C++) was then used to compute the normal spectral emittance for the real SiC foam and for another reconstructed SiC foam with similar textural features. The two numerically determined emittances were then compared with previous infrared spectroscopy experimental measurements. This numerical procedure enables us to propose a methodology for the design of SiC foams with prescribed radiative properties.