Explore the vast range of titles available.

Background Social isolation among older adults raises major issues for equity in healthcare in the context of the COVID-19 pandemic. Main text This commentary describes current challenges in preventing social isolation among older adults and proposes pathways to develop inclusive approaches to intervention in this vulnerable population. Building interventions that take account of structural inequities among older persons, as well as their subjective experiences, expectations and perspectives, appears fundamental to improve their health and quality of life in pandemic and post-pandemic contexts. Conclusions We argue that equity-based and person-centered approaches are critical to counter the negative outcomes of social isolation in the vulnerable older population.

Randomized controlled trials (RCTs) have traditionally been considered the gold standard for medical evidence. However, in light of emerging methodologies in data science, many experts question the role of RCTs. Within this context, experts in the USA and Canada came together to debate whether the primacy of RCTs as the gold standard for medical evidence, still holds in light of recent methodological advances in data science and in the era of big data. The purpose of this manuscript, aims to raise awareness of the pros and cons of RCTs and observational studies in order to help guide clinicians, researchers, students, and decision-makers in making informed decisions on the quality of medical evidence to support their work. In particular, new and underappreciated advantages and disadvantages of both designs are contrasted. Innovations taking place in both of these research methodologies, which can blur the lines between the two, are also discussed. Finally, practical guidance for clinicians and future directions in assessing the quality of evidence is offered.

Correspondence analysis (CA) is a multivariate graphical technique designed to explore the relationships among categorical variables. Epidemiologists frequently collect data on multiple categorical variables with the goal of examining associations among these variables. Nevertheless, CA appears to be an underused technique in epidemiology. The objective of this article is to present the utility of CA in an epidemiological context. The theory and interpretation of CA in the case of two and more than two variables are illustrated through two examples. The outcome from CA is a graphical display of the rows and columns of a contingency table that is designed to permit visualization of the salient relationships among the variable responses in a low-dimensional space. Such a representation reveals a more global picture of the relationships among row–column pairs, which would otherwise not be detected through a pairwise analysis. When the study variables of interest are categorical, CA is an appropriate technique to explore the relationships among variable response categories and can play a complementary role in analyzing epidemiological data.

Background In Quebec, Canada, more than a quarter of residents are unattached to a family physician (FP). To streamline attachment requests, centralized waiting lists (CWLs) were implemented in the province. However, FPs can still opt for non-CWL attachment, which may contribute to disparities in access to primary care. The objective of this study was to identify predictive factors for the mode of attachment (CWL vs. non-CWL) and to examine its association with the number of non-urgent emergency department (ED) visits. Methods This population-based retrospective cohort study ( N  = 1,417,838) examined adult patients attached to a FP between April 2017 and June 2021 in Quebec, Canada, using administrative data from the Régie de l’assurance maladie du Québec and the Ministry of Health and Social Services. Random forests were used to assess the relative importance of sociodemographic and health factors in predicting the mode of attachment. An adjusted negative binomial model was fitted to estimate the incidence rate ratio (IRR) of non-urgent ED visits, a proxy for unmet access to primary care, in the year following attachment to a FP. Results Key predictive factors identified include the fiscal year of attachment, age, rurality, and prior healthcare utilization. FPs who attached patients outside the CWLs did so more often in urban areas (+ 3% in metropolitan areas), and non-CWL-attached patients were slightly younger (− 3.4 years) and had generally lower healthcare needs compared with CWL-attached patients. Compared to those attached to a FP through a non-CWL approach, those attached through a CWL had a 4.7% lower incidence rate of ED visits in the year following attachment (IRR = 0.952; 95% CI: 0.946–0.960). Conclusion These findings underscore the potential benefits of fostering greater participation in the CWLs among FPs and patients to promote equity in access to FPs.

Nonrandomized studies, including observational and quasi-experimental studies, are frequently used to determine the effect of a given exposure (e.g., a new practice, intervention or policy) on relevant outcomes in situations in which random assignment to the exposed or unexposed group is not feasible or ethical. A prevalent source of bias in causal inference based on nonrandomized studies is confounding. This type of bias occurs when characteristics that are causally linked to the outcome(s) of interest are imbalanced across the study groups. A known practice to identify these potential confounders is to test for group imbalances statistically based on the observed study data. Limiting the search for confounders to testing for group imbalances fails to consider possible unobserved variables that are relevant in the confounding mechanism. Variables that are strong predictors of the outcome but are only weakly associated with the exposure would be less likely to be selected for adjustment, resulting in uncontrolled confounding and biased results.

Background The influence of sex and gender on the risk of dementia, its clinical presentation and progression is increasingly being recognized. However, current dementia strategies have not explicitly considered sex and gender differences in the management of dementia to ensure equitable care. The objective of this study was to examine the moderating effect of sex on the quality of care following the implementation of the Quebec Alzheimer Plan (QAP). Methods We conducted a secondary analysis of the evaluation of the QAP consisting of a retrospective chart review of 945 independent, randomly-selected patient charts of males and females 75+ years old with dementia and a visit to one of 13 participating Family Medicine Groups before (October 2011–July 2013) and after (October 2014 – July 2015). The quality of dementia care score, based on Canadian and international recommendations and consensus guidelines, consisted of documented assessments in 10 domains. We used a mixed linear regression model to measure the interaction between sex and the implementation of the QAP on the quality of dementia care score, adjusting for age and number of medications. Results We found that improvements in the quality of dementia care following the QAP were larger for men than women (mean difference = 4.97; 95%CI: 0.08, 9.85). We found that men had a larger improvement in four indicators (driving assessments, dementia medication management, Alzheimer Society referrals, and functional status evaluation), while women had a smaller improvement in three (home care needs, behavioural and psychological symptoms of dementia, and weight). Men were prescribed fewer anticholinergics post-QAP, while women were prescribed more. Cognitive testing improved in men but decreased for women following the QAP; the opposite was observed for caregiver needs. Conclusion While the overall quality of care improved after the implementation of the QAP, this study reveals differences in dementia management between men and women. While we identified areas of inequalities in the care received, it is unclear whether this represents inequities in access to care and health outcomes. Future research should focus on better understanding sex and gender-specific needs in dementia to bridge this gap and better inform dementia strategies.

Background While the negative impact of postoperative complications on hospital costs, survival, and cancer recurrence is well known, few studies have quantified the impact of postoperative complications on patient-centered outcomes such as functional status. The objective of this study was to estimate the impact of postoperative complications on recovery of functional status after elective abdominal surgery in elderly patients. Methods Elderly patients (70 years and older) undergoing elective abdominal surgery, with a planned length of stay >1 day, were prospectively enrolled between July 2012 and December 2014. The primary outcome was time to recovery to the preoperative functional status measured by the short physical performance battery (SPPB) preoperatively and at 1 week, 1, 3, and 6 months after surgery. The comprehensive complication index was calculated to grade the severity and number of postoperative complications. A Weibull survival model with interval censoring was performed, controlling for age, sex, body mass index (BMI), comorbidities (Charlson comorbidity index−CCI), frailty, presence of cancer, nutritional status, wound class, preoperative functional status, and surgical approach. Results Hundred and forty-nine patients (79 men and 70 women) were included in the analysis. Mean age was 77.7 ± 4.9 years, mean BMI was 27.2 ± 5.5 kg/m 2 , and the median CCI was 3 (IQR 2–6). The mean preoperative SPPB score was 9.62 ± 2.33. A total of 52 patients (34.9 %) experienced one or more postoperative complications, including four mortalities, and a total of 72 complications. The mean comprehensive complication index score for these patients was 25.7 ± 23.8. In the presence of all other variables included in the model, a higher comprehensive complication index score was found to significantly decrease the hazard of recovery (HR 0.96, CI 0.94–0.98, p value = 0.0004) and hence increase the time to recovery. Conclusion Following elective abdominal surgery, elderly patients who experience a greater number and more severe postoperative complications take longer to return to their preoperative functional status.

Background Choice of insulin delivery for type 1 diabetes can be difficult for many parents and children. We evaluated decision coaching using a patient decision aid for helping youth with type 1 diabetes and parents decide about insulin delivery method. Methods A pre/post design. Youth and parent(s) attending a pediatric diabetes clinic in a tertiary care centre were referred to the intervention by their pediatric endocrinologist or diabetes physician between September 2013 and May 2015. A decision coach guided youth and their parents in completing a patient decision aid that was pre-populated with evidence on insulin delivery options. Primary outcomes were youth and parent scores on the low literary version of the validated Decisional Conflict Scale (DCS). Results Forty-five youth (mean age = 12.5 ± 2.9 years) and 66 parents (45.8 ± 5.6 years) participated. From pre- to post-intervention, youth and parent decisional conflict decreased significantly (youth mean DCS score was 32.0 vs 6.6, p  < 0.0001; parent 37.6 vs 3.5, p  < 0.0001). Youth’s and parents’ mean decisional conflict scores were also significantly improved for DCS subscales (informed, values clarity, support, and certainty). 92% of youth and 94% of parents were satisfied with the decision coaching and patient decision aid. Coaching sessions averaged 55 min. Parents (90%) reported that the session was the right length of time; some youth (16%) reported that it was too long. Conclusion Decision coaching with a patient decision aid reduced decisional conflict for youth and parents facing a decision about insulin delivery method.