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Preventive care recommendations to promote health equity
Avoidable disparities in health outcomes persist in Canada despite substantial investments in a publicly funded health care system that includes preventive services. Our objective was to provide preventive care recommendations that promote health equity by prioritizing effective interventions for people experiencing disadvantages.
The guideline was developed by a primary care provider–patient panel, with input from a patient-partner panel with diverse lived experiences. After selecting priority topics, we searched for systematic reviews and recent randomized controlled trials of screening and other relevant studies of screening accuracy and management efficacy. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to develop recommendations and followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) reporting guidance. We managed competing interests using the Guideline International Network principles. The recommendations were externally reviewed by content experts and circulated for endorsement by national stakeholders.
We developed 15 screening and other preventive care recommendations and 1 policy recommendation on improving access to primary care. We recommend prioritized outreach for colorectal cancer screening starting at age 45 years and for cardiovascular disease risk assessment, to help address inequities and promote health. Specific interventions that should be rolled out in ways that address inequities include human papillomavirus (HPV) self-testing, HIV self-testing and interferon-γ release assays for tuberculosis infection. Screening for depression, substance use, intimate partner violence and poverty should help connect people experiencing specific disadvantages with proven interventions. We recommend automatic connection to primary care for people experiencing disadvantages.
Proven preventive care interventions can address health inequities if people experiencing disadvantages are prioritized. Clinicians, health care organizations and governments should take evidence-based actions and track progress in promoting health equity across Canada.
Journal Article
Comparison of common acute respiratory infection case definitions for identification of hospitalized influenza cases at a population-based surveillance site in Egypt
Multiple case definitions are used to identify hospitalized patients with community-acquired acute respiratory infections (ARI). We evaluated several commonly used hospitalized ARI case definitions to identify influenza cases.
The study included all patients from a population-based surveillance site in Damanhour, Egypt hospitalized for a broad set of criteria consistent with community acquired ARIs. Naso- and oropharyngeal (NP/OP) swabs were tested for influenza using RT-PCR. Sensitivity, specificity and PPV for influenza identification was compared between the 2014 WHO Severe Acute Respiratory Infection (SARI) definition (fever ≥38°C and cough with onset within 10 days), the 2011 WHO SARI definition (fever ≥38°C and cough with onset within 7 days), the 2006 PAHO SARI definition, the International Emerging Infections Program (IEIP) pneumonia case definition, and the International Management of Childhood Illness (IMCI) case definitions for moderate and severe pneumonia.
From June 2009-December 2012, 5768 NP/OP swabs were obtained from 6113 hospitalized ARI patients; 799 (13.9%) were influenza positive. The 2014 WHO SARI case definition captured the greatest number of ARI patients, influenza positive patients and ARI deaths compared to the other case definitions examined. Sensitivity for influenza detection was highest for the 2014 WHO SARI definition with 88.6%, compared to the 2011 WHO SARI (78.2%) the 2006 PAHO SARI (15.8%) the IEIP pneumonia (61.0%) and the IMCI moderate and severe pneumonia (33.8% and 38.9%) case definitions (IMCI applies to <5 only).
Our results support use of the 2014 WHO SARI definition for identifying influenza positive hospitalized SARI cases as it captures the highest proportion of ARI deaths and influenza positive cases. Routine use of this case definition for hospital-based surveillance will provide a solid, globally comparable foundation on which to build needed response efforts for novel pandemic viruses.
Journal Article
Rapid Chemical Remediation of Freshwater Enclosures Treated with Conventional Heavy Crude Oil Spills Followed by Enhanced Monitored Natural Recovery
Canada is a top producer and exporter of crude oil but also has many in-land freshwater ecosystems that need protection using non-invasive remediation methods that are effective in sensitive environments. To assess the efficacy of enhanced monitored natural recovery (eMNR) as a secondary remediation strategy for freshwater oil spills, we conducted controlled spills of conventional heavy crude oil (CHV) in a freshwater lake at the IISD-Experimental Lakes Area in northwestern Ontario, Canada, in 2021. Three shoreline enclosures (5 × 10 m) were deployed on a wetland shoreline and treated with ~1.5 kg of weathered CHV. Four days later primary recovery of oil was conducted using shoreline washing followed by secondary remediation of residual oil using eMNR. Three unoiled, reference enclosures were also treated with shoreline washing but not secondary remediation. Polycyclic aromatic compounds (PAC) in water and sediment, and general water quality were monitored in the enclosures for 412 days after oiling. Total PACs in the water, mostly of 2- and 3-ring alkylated compounds, peaked three days after oiling (1188 ± 251 ng/L), declined to half of initial concentrations 8.26–11.75 days later and to near background levels by day 73. Total PACs were elevated in sediment of the oiled enclosures until day 70 likely due to sorption or settling oil but were heterogenous and influenced by pyrogenic compounds. Results from this study suggest that eMNR may be an effective remediation method following primary recovery efforts at sensitive aquatic sites where mechanical recovery is contraindicated.
Journal Article
Freshwater Phenanthrene Removal by Three Emergent Wetland Plants
The use of floating wetlands has been receiving increased attention as a minimally invasive method for oil spill remediation, but the species of vegetation incorporated in floating wetlands may influence the success of oil degradation. Therefore, a freshwater microcosm experiment was conducted at the IISD Experimental Lakes Area, Canada to assess the potential of common wetland plants Typha sp., Carex utriculata, and C. lasiocarpa, to remove phenanthrene, a polycyclic aromatic hydrocarbon ubiquitously found at oil spill sites. Triplicate microcosms containing 3L of lake water were established with either Typha sp., Carex utriculata, or C. lasiocarpa and then treated with nominal concentration of 1 mg/L phenanthrene and monitored over 21 days. Two types of reference microcosms were also included: one set with the same plant allocations but not treated with phenanthrene and another with water only and no plants or phenanthrene. Phenanthrene declined by over 89.30% in all microcosms that received the compound, but the decline was more rapid in microcosms that included Typha sp. and C. lasiocarpa, than those with C. utriculate or no plants. Declining phenanthrene concentrations in microcosms without plants may have resulted from biofilm stimulation. Specific conductivity and pH were influenced by plant type but not phenanthrene, while dissolved oxygen was influenced by both. There was no influence of phenanthrene on plant growth rates or root biofilm bioactivity, measured by adenosine triphosphate or oxygen consumption. Results indicate there may be plant-specific factors influencing remediation success which should be explored in future research.
Journal Article
Effects of Environmentally Relevant Residual Levels of Diluted Bitumen on Wild Fathead Minnows (Pimephales promelas)
Transportation of crude oil across North America’s boreal ecozone creates the potential for spills in freshwater where less is known about the sensitivity of resident fish than for marine systems. The sensitivity of wild fathead minnows (FHM) to residual concentrations (ppb range) of the water accommodated fraction (WAF) of diluted bitumen (dilbit) was assessed by exposing them for 21 days followed by a 14 days depuration. Target concentrations were well below detection limits for GC–MS, but were estimated by dilution factor (1:100,000 and 1:1,000,000 WAF:water) to contain less than 0.0003 μg/L of polycyclic aromatic compounds. Confinement and handling stress caused by transfer of wild fish into tanks much smaller than their natural range resulted in mortality and lower body condition among all groups, but interactive effects of oil exposures still resulted in females with smaller cortical alveolar oocytes, and males with larger testicular lobe lumen sizes. Additional studies examining the compounded effects of stress and environmentally relevant oil exposures in wild fishes are needed.
Journal Article
RNA Sequencing of Lake Charr Epidermal Mucus to Assess Molecular Effects of Diluted Bitumen Exposure in a Boreal Lake
Transport of diluted bitumen (dilbit) from Canada’s oil sands region poses risk for leaks and spills of petroleum-derived contaminants into the environment. Exposure of fish to dilbit is known to cause cardiotoxicity, developmental deformities, and impairment in swim performance. However, previous studies have examined the toxicity of dilbit in laboratory settings which does not account for environmental and biological food-web variables that may alter exposure and/or toxicity of dilbit. Moreover, most methods of assessing organism health following oil exposure require lethal sampling. This work is a part of a larger set of experiments where dilbit spills were simulated within enclosures on a lake; the present study assesses the impacts of residual levels of dilbit that may have entered the surrounding lake environment from the enclosures following model spill cleanup. In order to understand the impacts of residual dilbit in an ecosystem setting without use of lethal sampling, epidermal mucus was collected and sequenced from lake charr ( Salvelinus namaycush ) exposed to residual dilbit in a boreal lake. While concentrations reached a maximum of 2.29 μg/L total polycyclic aromatic compounds (ΣPAC) within surface waters, surface water ΣPAC concentrations generally remained below 1 μg/L. Results of RNA sequencing were compared to sequencing data from mucus collected prior to dilbit additions. Differential gene expression and pathway analyses indicated dysregulation of genes associated with intermediary and energy metabolism as well as a trend in upregulation of cyp1a3 in epidermal mucus following dilbit exposure. Thus, results of the present study suggest that lake charr undergo consistent biological responses after exposure to residual levels of dilbit following a model spill, and that mRNA-based analysis of mucus may be a viable method for non-lethal oil exposure assessment. Overall, the results provide insight on the response of wild fish to very dilute dilbit exposures after a model spill cleanup.
Journal Article
Religion and the Book Trade
This volume brings together a selection of the papers presented at the \"Print Networks\" conference at the National Library of Wales, Aberystwyth, in July 2011. The conference theme, \"Religion and the book trade\", was chosen to mark the four-hundredth anniversary of the publication of the King James Bible. Numerous events throughout the United Kingdom and the English-speaking world took place to commemorate this historic event, the Print Networks conference being one of many. Religious books - be they tracts, sermons, homilies, hymn books, or Bibles - were primarily used by all denominations to spread their version of Christianity, to attract people to their cause, and to retain the loyalty of supporters. But these publications are also credited with the survival of indigenous languages, and, naturally, the printers and distributors of these religious works were crucial to the process of spreading both religion and literacy among the population. The contributions to this book cover a wide gamut of religion and the book trade from the sixteenth to the twentieth centuries. Most of the chapters are concerned with the European book trade and concentrate on Christian religions and cover both Catholic and Protestant, particularly Nonconformist/Dissenter, experiences. Most of the chapters relate to the British and Irish book trade, but there are also contributions discussing Italy and the Netherlands. There are chapters relating to the printers and publishers of religious works; authorship; the issue and production of religious periodicals; the promoters of religious libraries; and clandestine elements of the trade. This volume emphasises the pivotal role played by those in the book trade - printers, publishers or booksellers - in the distribution of religious works, and demonstrates that spreading the ideas of their authors, creators, or translators
would have been far more difficult without their involvement. This book will be of interest to academics, independent scholars, heritage professionals and research students in the fields of book trade history; book arts; bibliography; bookbinding; printing and typographic history; publishing; social and industrial history; and religious history.
eBook
Circulating Extracellular Vesicles as Putative Mediators of Cardiovascular Disease in Paediatric Chronic Kidney Disease
Cardiovascular disease (CVD) is the leading cause of mortality in chronic kidney disease (CKD). However, the pathogenesis of CVD in CKD remains incompletely understood. Endothelial extracellular vesicles (EC‐EVs) have previously been associated with CVD. We hypothesized that CKD alters EV release and cargo, subsequently promoting vascular remodelling. We recruited 94 children with CKD, including patients after kidney transplantation and healthy donors, and performed EV phenotyping and functional EV analyses in the absence of age‐related comorbidities. Plasma EC‐EVs were increased in haemodialysis patients and decreased after kidney transplantation. Thirty microRNAs were less abundant in total CKD plasma EVs with predicted importance in angiogenesis and smooth muscle cell proliferation. In vitro, CKD plasma EVs induced transcriptomic changes in angiogenesis pathways and functionally impaired angiogenic properties, migration and proliferation in ECs. High shear stress, as generated by arterio‐venous fistulas, and uremic toxins were considered as potential drivers of EV release, but only the combination increased EV generation from venous ECs. The resulting EVs recapitulated miRNA changes observed in CKD in vivo. In conclusion, CKD results in the release of EVs with altered miRNA profiles and anti‐angiogenic properties, which may mediate vascular pathology in children with CKD. EVs and their miRNA cargo may represent future therapeutic targets to attenuate CVD in CKD.
Journal Article
Sphingolipids in Atherosclerosis: Chimeras in Structure and Function
Atherosclerosis—a systemic inflammatory disease—is the number one cause of mortality and morbidity worldwide. As such, the prevention of disease progression is of global interest in order to reduce annual deaths at a significant scale. Atherosclerosis is characterized by plaque formation in the arteries, resulting in vascular events such as ischemic stroke or myocardial infarction. A better understanding of the underlying pathophysiological processes at the cellular and molecular level is indispensable to identify novel therapeutic targets that may alleviate disease initiation or progression. Sphingolipids—a lipid class named after the chimeric creature sphinx—are considered to play a critical and, metaphorically, equally chimeric regulatory role in atherogenesis. Previous studies identified six common sphingolipids, namely dihydroceramide (DhCer), ceramide (Cer), sphingosine-1-phosphate (S1P), sphingomyelin (SM), lactosylceramide (LacCer), and glucosylceramide (GluCer) in carotid plaques, and demonstrated their potential as inducers of plaque inflammation. In this review, we point out their specific roles in atherosclerosis by focusing on different cell types, carrier molecules, enzymes, and receptors involved in atherogenesis. Whereas we assume mainly atheroprotective effects for GluCer and LacCer, the sphingolipids DhCer, Cer, SM and S1P mediate chimeric functions. Initial studies demonstrate the successful use of interventions in the sphingolipid pathway to prevent atherosclerosis. However, as atherosclerosis is a multifactorial disease with a variety of underlying cellular processes, it is imperative for future research to emphasize the circumstances in which sphingolipids exert protective or progressive functions and to evaluate their therapeutic benefits in a spatiotemporal manner.
Journal Article