Although barriers related to lesbian, gay, bisexual, transgender and queer (LGBTQ) youth's experiences accessing sexual health services have been examined in detail, research into the experiences and ...perceptions of clinicians providing these services has been conspicuously absent. The aim of this article is to explore the perceptions and experiences of clinicians providing sexual health services for LGBTQ youth. Drawing on in-depth, semi-structured interviews, this study examines 24 clinicians' experiences providing sexual health services to LGBTQ youth in five communities in British Columbia, Canada. Our findings reveal how many clinicians provide services to LGBTQ youth with a lack of cultural competency--either implicitly (e.g. by describing heteronormative practices) or explicitly (e.g. by expressing frustration that they had not been sufficiently provided with appropriate training related to LGBTQ youth sexual health). Institutional norms and values were identified as the dominant barriers in the effective provision of LGBTQ-tailored services. Many clinicians find themselves unprepared to provide culturally competent sexual health services that have both the capacity to address individual-level issues (e.g. promoting condom use) while considering (and adapting services to) the broader socio-cultural and structural conditions that can render LGBTQ youth socially vulnerable.
Summary Objectives Methamphetamine (MA) use has been associated with health problems that commonly present in the emergency department (ED). This study sought to determine whether frequent MA ...injection was a risk factor for ED utilization among street-involved youth. Study design Prospective cohort study. Methods Data were derived from a street-involved youth cohort known as the ‘At Risk Youth Study’. Behavioural data including MA use were linked to ED records at a major inner-city hospital. Kaplan-Meier and Cox proportional hazards methods were used to determine the risk factors for ED utilization. Results Between September 2005 and January 2007, 427 eligible participants were enrolled, among whom the median age was 21 (interquartile range 19–23) years and 154 (36.1%) were female. Within 1 year, 163 (38.2%) visited the ED, resulting in an incidence density of 53.7 per 100 person-years. ED utilization was significantly higher among frequent (i.e. ≥daily) MA injectors (log-rank P = 0.004). In multivariate analysis, frequent MA injection was associated with an increased hazard of ED utilization (adjusted hazard ratio = 1.84, 95% confidence interval 1.04–3.25; P = 0.036). Conclusions Street-involved youth who frequently inject MA appear to be at increased risk of ED utilization. The integration of MA-specific addiction treatment services within emergency care settings for high-risk youth is recommended.
The role that environmental factors play in driving HIV and STI transmission risk among street-involved youth has not been well examined. We examined factors associated with number of sex partners ...using quasi-Poisson regression and consistent condom use using logistic regression among participants enroled in the At Risk Youth Study (ARYS). Among 529 participants, 253 (47.8%) reported multiple partners while only 127 (24.0%) reported consistent condom use in the past 6 months. Homelessness was inversely associated with consistent condom use (adjusted odds ratio aOR=0.47, p=0.008), while unstable housing was positively associated with greater numbers of sex partners (adjusted incidence rate ratio aIRR=1.44, p=0.010). These findings indicate the need for interventions which modify environmental factors that drive risk among young street-involved populations.
The need for protein-rich plant-based foods continues as dietary guidelines emphasize their contribution to healthy dietary patterns that prevent chronic disease and promote environmental ...sustainability. However, the Canadian
provide a regulatory framework that can prevent Canadian consumers from identifying protein-rich plant-based foods. In Canada, protein nutrient content claims are based on the protein efficiency ratio (PER) and protein rating method, which is based on a rat growth bioassay. PERs are not additive, and the protein rating of a food is underpinned by its Reasonable Daily Intake. The restrictive nature of Canada's requirements for supporting protein claims therefore presents challenges for Canadian consumers to adapt to a rapidly changing food environment. This commentary will present two options for modernizing the regulatory framework for protein content claims in Canada. The first and preferred option advocates that protein quality not be considered in the determination of the eligibility of a food for protein content claims. The second and less preferred option, an interim solution, is a framework for adopting the protein digestibility corrected amino acid score as the official method for supporting protein content and quality claims and harmonizes Canada's regulatory framework with that of the USA.
People who avoid eating animals tend to share their homes with animal companions, and moral dilemma may arise when they are faced with feeding animal products to their omnivorous dogs and carnivorous ...cats. One option to alleviate this conflict is to feed pets a diet devoid of animal ingredients-a 'plant-based' or 'vegan' diet. The number of pet owners who avoid animal products, either in their own or in their pets' diet, is not currently known. The objective of this study was to estimate the number of meat-avoiding pet owners, identify concerns regarding conventional animal- and plant-based pet food, and estimate the number of pets fed a plant-based diet. A questionnaire was disseminated online to English-speaking pet owners (n = 3,673) to collect data regarding pet owner demographics, diet, pet type, pet diet, and concerns regarding pet foods. Results found that pet owners were more likely to be vegetarian (6.2%; 229/3,673) or vegan (5.8%; 212/3,673) than previously reported for members of the general population. With the exception of one dog owned by a vegetarian, vegans were the only pet owners who fed plant-based diets to their pets (1.6%; 59/3,673). Of the pet owners who did not currently feed plant-based diets but expressed interest in doing so, a large proportion (45%; 269/599) desired more information demonstrating the nutritional adequacy of plant-based diets. Amongst all pet owners, the concern most commonly reported regarding meat-based pet foods was for the welfare of farm animals (39%; 1,275/3,231). The most common concern regarding strictly plant-based pet foods was regarding the nutritional completeness of the diet (74%; 2,439/3,318). Amongst vegans, factors which predicted the feeding of plant-based diets to their pets were concern regarding the cost of plant-based diets, a lack of concern regarding plant-based diets being unnatural, and reporting no concern at all regarding plant-based diets for pets. Given these findings, further research is warranted to investigate plant-based nutrition for domestic dogs and cats.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Communities dependent on natural resource extraction (e.g. oil/gas, mining) are routinely exposed to rhetoric that associates notions of progress (including health and social welfare) with a booming ...economy. These places frequently experience demographic and social disruptions associated with reliance on resource-extraction sectors (e.g. the influx of young male workers and money, increasing rates of drug/alcohol consumption, infrastructural shortfalls). However, research regarding the problematic health and social impacts associated with resource-extraction booms are markedly absent from contemporary research pertaining to high-income countries. This paper investigates how an economic boom is perceived to affect young people's health and social well-being in Fort St. John, a booming oil/gas community in British Columbia, Canada. We conducted ethnographic fieldwork (8 weeks), including in-depth interviews with 25 young people (ages 15-25) and 14 health and social service providers. Participants identified education, addictions, and housing as key areas where the negative consequences of living and working in an oil/gas community have affected them the most. The findings illustrate the fallacy of the colloquialism that 'the only drawback to a boom is a bust'. While the issues presented have substantial public health implications, they are generated by - and can be addressed via - sectors outside public health. Partnerships between resource-extraction companies, public health, and community organizations offer innovative and feasible opportunities to address these problems.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Sexually transmitted infections (STI) and mental health and substance use (MHSU) disorders all occur at elevated rates in sexual and gender minorities. These overlapping epidemics, or syndemics, are ...exacerbated by challenges these same populations face in accessing sexual/gender minority-affirming services. Many publicly funded STI clinics are a low barrier and provide sexual minority-competent care. These sites therefore may be uniquely situated to address clients' MHSU-related needs.
We characterize the need and desire for MHSU services among STI clinic clients.
We conducted a waiting room survey at 6 STI clinics in Metro Vancouver, Canada.
We calculated the proportion of clients with self-reported unmet MHSU needs in the previous 12 months and, among these clients, barriers to accessing MHSU services and desire for MHSU services within the STI clinic. We also examined social disparities in barriers to accessing MHSU services.
Among 1115 respondents-65% of whom were sexual minorities-39% reported a recent need for MHSU-related care, most frequently in relation to anxiety (29%), depression (26%), substance use (10%), or suicide ideation (7%). Seventy-two percent of this group had not yet talked to a provider about their concern. Common barriers included shame (26%) and inability to afford the service (24%). Eighty-three percent of clients with unmet MHSU needs indicated that they were comfortable discussing MHSU concerns with an STI clinic provider, and 94% expressed desire to receive MHSU assessments, referrals, or counseling in the STI clinic. Sexual and gender minorities and those attending a suburban clinic were more likely to report barriers to accessing MHSU services.
More than a quarter of STI clinic clients report unmet MHSU health care needs; moreover, these clients report high levels of comfort with and desire to discuss MHSU concerns with STI clinic providers. Sexually transmitted infections clinics are thus opportune sites for syndemic service integration.
The effects of feeding frequency on postprandial response of circulating appetite-regulating hormones, insulin, glucose and amino acids, and on physical activity, energy expenditure, and respiratory ...quotient were studied in healthy adult cats. Two experiments were designed as a 2 x 3 replicated incomplete Latin square design. Eight cats, with an average body weight (BW) of 4.34 kg ± 0.04 and body condition score (BCS) of 5.4 ± 1.4 (9 point scale), were fed isocaloric amounts of a commercial adult maintenance canned cat food either once (0800 h) or four times daily (0800 h, 1130 h, 1500 h, 1830 h). Study 1 consisted of three 21-d periods. On day 14, two fasted and 11 postprandial blood samples were collected over 24 hours to measure plasma concentrations of ghrelin, GLP-1, GIP, leptin, PYY, insulin and amino acids, and whole blood glucose. Physical activity was monitored from day 15 to 21 of each period. In Study 2 indirect calorimetry was performed on the last day of each period. Body weight was measured weekly and feed intake recorded daily in both experiments. No effect of feeding regimen on BW was detected. Cats eating four times daily had lesser plasma concentrations of GIP and GLP-1 (P<0.05) and tended to have lesser plasma PYY concentrations (P<0.1). Plasma leptin and whole blood glucose concentrations did not differ between regimens (P>0.1). Cats fed once daily had a greater postprandial plasma amino acid response, and greater plasma ghrelin and insulin concentrations (P<0.05). Physical activity was greater in cats fed four times (P<0.05), though energy expenditure was similar between treatments at fasting and in postprandial phases. Finally, cats eating one meal had a lower fasting respiratory quotient (P<0.05). Overall, these data indicate that feeding once a day may be a beneficial feeding management strategy for indoor cats to promote satiation and lean body mass.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To address the need for a better understanding of the perspective of Canadian youths on tobacco dependence, a qualitative study using ethnographic techniques was conducted to describe the patterns of ...language that they use to describe tobacco dependence and the meaning that it has for them. The study was comprised of three inter-related phases: (1) A secondary analysis of 47 individual unstructured interviews with adolescents was completed to identify the words and phrases they use to explain tobacco dependence; (2) contrast and structural questions focusing on tobacco dependence were developed and used in open-ended interviews with 13 adolescents. Data analysis of the transcribed interviews resulted in a set of 60 key phrases that represented the primary ways youths describe the need to smoke; and (3) interviews were conducted with 14 adolescents that involved an open card sort using the set of 60 key phrases. All card sorts and transcribed interview data were analyzed to identify domains representing types of tobacco dependence and sub-types within each domain. From their descriptions about the need to smoke, five aspects of tobacco dependence were identified: social, pleasurable, empowering, emotional, and full-fledged. This study provides a step in elucidating the construct of tobacco dependence among the young. Further research is required to extend this understanding and to develop appropriate measures.
Decreasing the dietary intake of methionine exerts robust anti‐adiposity effects in rodents but modest effects in humans. Since cysteine can be synthesized from methionine, animal diets are ...formulated by decreasing methionine and eliminating cysteine. Such diets exert both methionine restriction (MR) and cysteine restriction (CR), that is, sulfur amino acid restriction (SAAR). Contrarily, SAAR diets formulated for human consumption included cysteine, and thus might have exerted only MR. Epidemiological studies positively correlate body adiposity with plasma cysteine but not methionine, suggesting that CR, but not MR, is responsible for the anti‐adiposity effects of SAAR. Whether this is true, and, if so, the underlying mechanisms are unknown. Using methionine‐ and cysteine‐titrated diets, we demonstrate that the anti‐adiposity effects of SAAR are due to CR. Data indicate that CR increases serinogenesis (serine biosynthesis from non‐glucose substrates) by diverting substrates from glyceroneogenesis, which is essential for fatty acid reesterification and triglyceride synthesis. Molecular data suggest that CR depletes hepatic glutathione and induces Nrf2 and its downstream targets Phgdh (the serine biosynthetic enzyme) and Pepck‐M. In mice, the magnitude of SAAR‐induced changes in molecular markers depended on dietary fat concentration (60% fat >10% fat), sex (males > females), and age‐at‐onset (young > adult). Our findings are translationally relevant as we found negative and positive correlations of plasma serine and cysteine, respectively, with triglycerides and metabolic syndrome criteria in a cross‐sectional epidemiological study. Controlled feeding of low‐SAA, high‐polyunsaturated fatty acid diets increased plasma serine in humans. Serinogenesis might be a target for treating hypertriglyceridemia.
The proposed mechanism of CR‐specific effects of SAAR on adipose metabolism. (1) Due to the lack of Cys in SAAR diets, it imposes both MR and CR. CR specifically results in decreased biosynthesis of the tripeptide glutathione. (2) Lower hepatic glutathione increases the abundance of the transcription factor Nrf2, which translocates to the nucleus and induces the transcription of Phgdh. (3) Increase in the transcription and translation of Phgdh and Pck‐2 results in higher hepatic serinogenesis (Ser biosynthesis from substrates other than glucose, that is, from oxaloacetic acid). (4) Higher serinogenesis competes with glyceroneogenesis as both pathways use the same set of substrates, which results in lower fatty acid re‐esterification. Note: broken arrows represent the presence of other biochemical intermediates not shown in the figure. Up and down arrows adjacent to the metabolic intermediates represent an increase and decrease, respectively. 3PG, 3‐phosphoglycerate; OAA, oxaloacetic acid; DHAP, dihydroxyacetone phosphate; PEP, phosphoenolpyruvate; FA, fatty acids.
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