Social participation is a key determinant of successful and healthy aging and therefore an important emerging intervention goal for health professionals. Despite the interest shown in the concept of ...social participation over the last decade, there is no agreement on its definition and underlying dimensions. This paper provides an inventory and content analysis of definitions of social participation in older adults. Based on these results, a taxonomy of social activities is proposed. Four databases (Medline, CINAHL, AgeLine and PsycInfo) were searched with relevant keywords (Aging OR Ageing OR Elderly OR Older OR Seniors AND Community involvement/participation OR Social engagement/involvement/participation) resulting in the identification of 43 definitions. Using content analysis, definitions were deconstructed as a function of who, how, what, where, with whom, when, and why dimensions. Then, using activity analysis, we explored the typical contexts, demands and potential meanings of activities (main dimension). Content analysis showed that social participation definitions (
n = 43) mostly focused on the person’s involvement in activities providing interactions with others in society or the community. Depending on the main goal of these social activities, six proximal to distal levels of involvement of the individual with others were identified: 1) doing an activity in preparation for connecting with others, 2) being with others, 3) interacting with others without doing a specific activity with them, 4) doing an activity with others, 5) helping others, and 6) contributing to society. These levels are discussed in a continuum that can help distinguish social participation (levels 3 through 6) from parallel but different concepts such as participation (levels 1 through 6) and social engagement (levels 5 and 6). This taxonomy might be useful in pinpointing the focus of future investigations and clarifying dimensions specific to social participation.
Reducing inappropriate antibiotic prescribing for acute upper respiratory tract infections (AURIs) requires a better understanding of the factors associated with this practice.
To determine the ...prevalence of antibiotic prescribing for nonbacterial AURIs and whether prescribing rates varied by physician characteristics.
Retrospective analysis of linked administrative health care data.
Primary care physician practices in Ontario, Canada (January-December 2012).
Patients aged 66 years or older with nonbacterial AURIs. Patients with cancer or immunosuppressive conditions and residents of long-term care homes were excluded.
Antibiotic prescriptions for physician-diagnosed AURIs. A multivariable logistic regression model with generalized estimating equations was used to examine whether prescribing rates varied by physician characteristics, accounting for clustering of patients among physicians and adjusting for patient-level covariates.
The cohort included 8990 primary care physicians and 185 014 patients who presented with a nonbacterial AURI, including the common cold (53.4%), acute bronchitis (31.3%), acute sinusitis (13.6%), or acute laryngitis (1.6%). Forty-six percent of patients received an antibiotic prescription; most prescriptions were for broad-spectrum agents (69.9% 95% CI, 69.6% to 70.2%). Patients were more likely to receive prescriptions from mid- and late-career physicians than early-career physicians (rate difference, 5.1 percentage points CI, 3.9 to 6.4 percentage points and 4.6 percentage points CI, 3.3 to 5.8 percentage points, respectively), from physicians trained outside of Canada or the United States (3.6 percentage points CI, 2.5 to 4.6 percentage points), and from physicians who saw 25 to 44 patients per day or 45 or more patients per day than those who saw fewer than 25 patients per day (3.1 percentage points CI, 2.1 to 4.0 percentage points and 4.1 percentage points CI, 2.7 to 5.5 percentage points, respectively).
Physician rationale for prescribing was unknown.
In this low-risk elderly cohort, 46% of patients with a nonbacterial AURI were prescribed antibiotics. Patients were more likely to receive prescriptions from mid- or late-career physicians with high patient volumes and from physicians who were trained outside of Canada or the United States.
Ontario Ministry of Health and Long-term Care, Academic Medical Organization of Southwestern Ontario, Schulich School of Medicine and Dentistry, Western University, and Lawson Health Research Institute.
Background: There is growing evidence that neighborhood environments are related to depressive mood in the general population. Older adults may be even more vulnerable to neighborhood factors than ...other adults. The aim of this paper is to review empirical findings on the relationships between neighborhood characteristics and depressive mood among older adults. Methods: A search of the literature was undertaken in PsycINFO and MEDLINE. Results: Nineteen studies were identified. Study designs were most often cross-sectional, included large sample sizes, and controlled for major individual characteristics. Mediational effects were not investigated. Statistical analysis strategies often included multilevel models. Spatial delimitations of neighborhood of residence were usually based on administrative and statistical spatial boundaries. Six neighborhood characteristics were assessed most often: neighborhood socioeconomic disadvantage, neighborhood poverty, affluence, racial/ethnic composition, residential stability, and elderly concentration. Selected neighborhood characteristics were associated with depressive mood after adjusting for individual variables. These associations were generally theoretically meaningful. Conclusions: Neighborhood variables seem to make a unique and significant contribution to the understanding of depressive mood among older adults. However, few studies investigated these associations and replication of results is needed. Several substantive neighborhood variables have been ignored or neglected in the literature. The implications of neighborhood effects for knowledge advancement and public health interventions remain unclear. Recommendations for future research are discussed.
Abstract
Background
Understanding the profiles of different upper extremity fractures, particularly those presenting as a 1st incident can inform prevention and management strategies. The purpose of ...this population-level study was to describe first incident fractures of the upper extremity in terms of fracture characteristics and demographics.
Methods
Cases with a first adult upper extremity (UE) fracture from the years 2013 to 2017 were extracted from administrative data in Ontario. Fracture locations (ICD-10 codes) and associated characteristics (open/closed, associated hospitalization within 1-day, associated nerve, or tendon injury) were described by fracture type, age category and sex. Standardized mean differences of at least 10% (clinical significance) and statistical significance (
p
< 0.01) in ANOVA were used to identify group differences (age/sex).
Results
We identified 266,324 first incident UE fractures occurring over 4 years. The most commonly affected regions were the hand (93 K), wrist/forearm(80 K), shoulder (48 K) or elbow (35 K). The highest number of specific fractures were: distal radius (DRF, 47.4 K), metacarpal (30.4 K), phalangeal (29.9 K), distal phalangeal (24.4 K), proximal humerus (PHF, 21.7 K), clavicle (15.1 K), radial head (13.9 K), and scaphoid fractures (13.2 K). The most prevalent multiple fractures included: multiple radius and ulna fractures (11.8 K), fractures occurring in multiple regions of the upper extremity (8.7 K), or multiple regions in the forearm (8.4 K). Tendon (0.6% overall; 8.2% in multiple finger fractures) or nerve injuries were rarely reported (0.3% overall, 1.5% in distal humerus). Fractures were reported as being open in 4.7% of cases, most commonly for distal phalanx (23%). A similar proportion of females (51.5%) and males were present in this fracture cohort, but there were highly variant age-sex profiles across fracture subtypes. Fractures most common in 18–40-year-old males included metacarpal and finger fractures. Fractures common in older females were: DRF, PHF and radial head, which exhibited a dramatic increase in the over-50 age group.
Conclusions
UE fracture profiles vary widely by fracture type. Fracture specific prevention and management should consider fracture profiles that are highly variable according to age and sex.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Levasseur M, Gauvin L, Richard L, Kestens Y, Daniel M, Payette H, for the NuAge Study. Associations between perceived proximity to neighborhood resources, disability, and social ...participation among community-dwelling older adults: results from the VoisiNuAge Study. Objective To examine the associations between perceived proximity to neighborhood resources, disability, and social participation and the potential moderating effect of perceived proximity to neighborhood resources on the association between disability and social participation in community-dwelling older women and men. Design Cross-sectional. Setting Community. Participants Older adults (296 women, 258 men). Interventions Not applicable. Main Outcome Measures Data for age, education, depressive symptoms, frequency of participation in community activities, perceived proximity to neighborhood resources (services, amenities), and functional autonomy in daily activities (disability) were collected by means of interviewer-administered questionnaire. Results Greater perceived proximity to resources and lower level of disability were associated with greater social participation for both women ( R2 =.10; P <.001) and men ( R2 =.05; P <.01). The association between disability and social participation did not vary as a function of perceived proximity to neighborhood resources in women (no moderating effect; P =.15). However, in men, greater perceived proximity to neighborhood resources enhanced social participation ( P =.01), but only in those with minor or no disability. Conclusions Future studies should investigate why perceived proximity to services and amenities is associated with social participation in older men with minor or no disabilities and with women overall, but has no association in men with moderate disabilities.
Background: It is unknown whether recovery from coronavirus disease 2019 (COVID-19) infection leads to an increased need for common surgical procedures. Our objective was to conduct an exploratory ...analysis of surgical procedures performed after a documented COVID-19 infection.
Methods: We conducted a retrospective cohort study using routinely collected data from the province of Ontario, Canada. We identified individuals with a positive COVID-19 test between February 1 2020 and May 31 2020, and matched them 1:2 with individuals who had a negative COVID-19 test during the same period. We used physician billing codes to identify the ten most frequent surgical procedures in the COVID-19 cohort. An at-risk period 30 days after the first positive COVID-19 swab (or matched index date in the control group) until November 30 2020 was used. Cox proportional hazard models (adjusted for important baseline differences) are reported with hazard ratios (HR) and 95% confidence intervals.
Results: After exclusions and matching, we had 19,143 people in the COVID-19 cohort, and 38,286 people in the control cohort. The top ten surgical procedures were hand/wrist fracture fixation, cesarean-section, ureteral stent placement, cholecystectomy, treatment of an upper tract urinary stone, hysterectomy, femur fracture repair, hip replacement, transurethral prostatectomy, and appendectomy. There was a significantly reduced hazard of requiring upper tract renal stone surgery (adjusted hazard ratio aHR 0.50, 95% confidence interval CI 0.29-0.87) or ureteral stent placement (aHR 0.54, 95%CI 0.36-0.82), or undergoing a cholecystectomy (aHR 0.43, 95%CI 0.26-0.71) among those with a prior positive COVID-19 test.
Conclusions: After a COVID-19 infection there is not an increased risk of needing several common surgical procedures. There appears to be a reduced risk of renal stone disease treatment and ureteral stent placement, and a reduced risk of cholecystectomy, however understanding the reasons for this will require further study.
An association between high heat and acute kidney injury (AKI) has been reported in warm climates. However, whether this association generalizes to a northern climate, with more variable ...temperatures, is unknown.
Matched case-control study.
Our study focused on older adults (mean age, 80 years) in the northern climate of Ontario, Canada. 52,913 case patients who had a hospital encounter with AKI in April through September 2005 to 2012 were matched with 174,222 controls for exact date, age, sex, rural residence, income, and history of chronic kidney disease.
Heat periods were defined as 3 consecutive days exceeding the 95th percentile of area-specific maximum temperature.
Hospital encounter (inpatient admission or emergency department visit) with a diagnosis of AKI.
ORs (95% CIs) were used to assess the association between heat periods and AKI. To quantify the effect in absolute terms, we multiplied the population incidence rate of AKI in the absence of heat periods by our adjusted OR (an approximate of relative risk).
Heat periods were significantly associated with higher risk for AKI (adjusted OR, 1.11; 95% CI, 1.00-1.23). Heat periods in absolute terms were associated with an additional 182 cases of AKI per 100,000 person-years during the warm season.
We did not know how long persons were outside or if they had access to air conditioning.
In a northern climate, periods of higher environmental heat were associated with a modestly higher risk for hospital encounter with AKI among older adults.
Background Topical cocaine is favoured by many surgeons for sinonasal surgery due to its superior vasoconstrictive and anesthetic properties. However, historical reports suggesting cocaine is ...associated with an increased risk of cardiac events have led many surgeons to turn to alternative topical medications. The objective of this study was to determine whether cocaine use during sinonasal surgery is associated with an increased risk of perioperative cardiac events and death. Methods We conducted a population-based analysis of patients undergoing sinonasal surgery from 2009–2016 using linked administrative health care data sets in Ontario, Canada. We compared patients treated at institutions that primarily use topical cocaine (exposed group) to those treated at institutions that do not use cocaine (unexposed group). Our primary outcome was a composite of major cardiac events or all-cause mortality within 48 hours of surgery. Due to low event rates, the outcome was compared using a Fisher’s exact test. Results Of 10,549 patients who were included in the study, 27.4% were treated at an institution that uses topical cocaine. The rate of the composite of perioperative major cardiac event or all-cause mortality within 48 hours of surgery in the exposed and unexposed groups was, ≤0.2% and 0 (p-value>0.05), respectively. Conclusions In this large real-world cohort of patients undergoing sinonasal surgery, there does not appear to be any significant increased risk of morbidity or mortality associated with cocaine use. These findings have important implications for surgeons performing this procedure.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background and objectives
The aims of the 19th International Society of Blood Transfusion Platelet Immunology Workshop were to compare the sensitivity and specificity of in‐house and commercially ...available methods for the detection of alloantibodies against human platelet antigens. Survey regarding laboratory management of samples collected for the diagnosis of foetal neonatal alloimmune thrombocytopenia was also conducted.
Materials and methods
Twenty‐nine laboratories from 17 countries were invited to participate. Seven serum or plasma samples for antibody identification and eight DNA samples for genotyping were sent to participating laboratories. Additionally, samples, critical reagents, materials and instructions for three exercises, one using a commercial kit (Pak Lx), one on platelet preparation for the detection of anti‐HPA‐3 antibodies and one for testing four anti‐CD109 monoclonal antibodies for anti‐HPA‐15 antibody detection, were provided.
Results
Anti‐HPA‐1a, anti‐HPA‐2b, anti‐HPA‐5b and anti‐GPIV were detected by the majority of the 28 reporting laboratories using their respective in‐house MAIPA assay and/or a commercially available assay. Conversely, very few laboratories correctly identified anti‐HPA‐3a and HPA‐15b. DNA genotyping of HPA and HLA alleles was highly accurate, with just a few discrepancies relative to the expected results. The Pak Lx kit has proven reliable for detecting anti‐HPA‐1a, anti‐HPA‐5a and anti‐HLA; however, it failed at identifying an anti‐HPA‐3a in a clinical sample.
Conclusions
Some anti‐platelet alloantibodies are reliably and consistently detected, yet others remain difficult to detect. Genotyping of HPA and HLA alleles has proven to be highly accurate and robust. Future work should focus on optimizing the detection of anti‐HPA‐3 and anti‐HPA‐15 antibodies.
Accurate estimation of SARS-CoV-2 re-infection is crucial to understanding the connection between infection burden and adverse outcomes. However, relying solely on PCR testing results in ...underreporting. We present a novel approach that includes longitudinal serologic data, and compared it against testing alone among people experiencing homelessness.
We recruited 736 individuals experiencing homelessness in Toronto, Canada, between June and September 2021. Participants completed surveys and provided saliva and blood serology samples every three months over 12 months of follow-up. Re-infections were defined as: positive PCR or rapid antigen test (RAT) results > 90 days after initial infection; new serologic evidence of infection among individuals with previous infection who sero-reverted; or increases in anti-nucleocapsid in seropositive individuals whose levels had begun to decrease.
Among 381 participants at risk, we detected 37 re-infections through PCR/RAT and 98 re-infections through longitudinal serology. The comprehensive method identified 37.4 re-infection events per 100 person-years, more than four-fold more than the rate detected through PCR/RAT alone (9.0 events/100 person-years). Almost all test-confirmed re-infections (85%) were also detectable by longitudinal serology.
Longitudinal serology significantly enhances the detection of SARS-CoV-2 re-infections. Our findings underscore the importance and value of combining data sources for effective research and public health surveillance.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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