Using focus groups to inform a peer health navigator service for people who are transgender and gender diverse in Saskatchewan, Canada

BACKGROUND

This study investigated healthcare access and quality for people who are transgender and gender-diverse (PTGD) in Saskatchewan (SK), Canada, to inform a larger project that was piloting two peer health navigators for PTGD.

METHODS

Two online focus groups were held. Nineteen participants were recruited to represent a broad range in age, gender and location in SK. Transcripts of the focus groups were analyzed using a thematic approach.

RESULTS

The core theme that was identified was participants' desire for culturally safe healthcare. This core theme had two component themes: (1) systemic healthcare factors and (2) individual healthcare provider (HCP) factors. The healthcare system primarily acted as a barrier to culturally safe healthcare. HCPs could be either barriers or facilitators of culturally safe care; however, negative experiences outweighed positive ones.

CONCLUSIONS

PTGD in SK face discrimination, with delays and barriers to care at all levels of the healthcare system. Peer health navigators can address some of these discrepancies; however, greater support is required for PTGD to be able to access culturally safe healthcare.

PATIENT OR PUBLIC CONTRIBUTION

People with lived experience/PTGD were involved in all stages of this project. They were included on the team as community researchers and co-developed the research project, conducted the focus groups, participated in the analyses and are co-authors. As well, both navigators and all the participants in the focus groups were also PTGD.

Identifying a Cohort of People Who Are Transgender and Gender-Diverse Within Saskatchewan's Administrative Health Databases

This was a retrospective cohort study. Algorithms were developed to identify a cohort of people who were trans and gender diverse (PTGD) among provincial-level administrative health databases (physician, hospital, emergency department, and pharmacy) from April 1, 2012 to September 30, 2020. Then, healthcare usage was compared between the identified cohort and the general population. There were 6466 unique individuals identified in the cohort, out of a total population of 1.2 million Saskatchewan residents (~0.5%). They had a mean age of 42.5 (SD 17.7) years. 1946 (30.1%) had a female sex marker and 4560 (69.9%) had a male sex marker, which may not indicate their lived gender. The cohort had increased healthcare usage 2 years prior to their index date, compared to the general population, which continued to rise to 1 year past their index date across physician, emergency department visits, and hospitalizations. The results for drugs were mixed. The percentage of PTGD identified in Saskatchewan was comparable to other studies. Healthcare utilization among the cohort was higher than the general population. Further research could use external data sources to validate and improve the cohort identification methods. The large majority of individuals with a male sex marker deserves further investigation.

Morphologic changes in red blood cells: An illustrated review of clinically important light microscopic findings

In this article, we provide an illustrated review that may serve as a microscope companion, as well as a reference for the diagnosis of red blood cells alterations and the interpretation of their significance. Beginners in the fields of clinical haematology and haematopathology may benefit from this manuscript's brevity and practical points, while the more advanced will find it useful as a teaching tool.

Is this a blast? An illustrated practical review on peripheral blood smear examination in the paediatric patient

The morphologic findings on a peripheral blood smear can provide important clues that help establish a diagnosis or guide the workup of many clinical disorders. Finding a blast - whether clinically expected or not - is one of the most impactful of such findings. Pathologists, clinical haematologists, technologists, and trainees in the medical field often feel the need to refer to an illustrated reference when encountering suspected blasts and blast-mimics. This article provides a practical concise resource that demonstrates the morphological features of the various types of blasts and illustrates the cytologic characteristics that help distinguish them from their benign mimickers in the paediatric population.

More feed efficient sheep produce less methane and carbon dioxide when eating high-quality pellets

The Australian sheep industry aims to increase the efficiency of sheep production by decreasing the amount of feed eaten by sheep. Also, feed intake is related to methane production, and more efficient (low residual feed intake) animals eat less than expected. So we tested the hypothesis that more efficient sheep produce less methane by investigating the genetic correlations between feed intake, residual feed intake, methane, carbon dioxide, and oxygen. Feed intake, methane, oxygen, and carbon dioxide were measured on Merino ewes at postweaning (1,866 at 223 d old), hogget (1,010 sheep at 607 d old), and adult ages (444 sheep at 1,080 d old). Sheep were fed a high-energy grower pellet ad libitum for 35 d. Individual feed intake was measured using automated feeders. Methane was measured using portable accumulation chambers up to 3 times during this feed intake period. Heritabilities and phenotypic and genotypic correlations between traits were estimated using ASReml. Oxygen (range 0.10 to 0.20) and carbon dioxide (range 0.08 to 0.28) were generally more heritable than methane (range 0.11 to 0.14). Selecting to decrease feed intake or residual feed intake will decrease methane (genetic correlation [] range 0.76 to 0.90) and carbon dioxide ( range 0.65 to 0.96). Selecting to decrease intake ( range 0.64 to 0.78) and methane ( range 0.81 to 0.86) in sheep at postweaning age would also decrease intake and methane in hoggets and adults. Furthermore, selecting for lower residual feed intake ( = 0.75) and carbon dioxide ( = 0.90) in hoggets would also decrease these traits in adults. Similarly, selecting for higher oxygen ( = 0.69) in hoggets would also increase this trait in adults. Given these results, the hypothesis that making sheep more feed efficient will decrease their methane production can be accepted. In addition, carbon dioxide is a good indicator trait for feed intake because it has the highest heritability of the gas traits measured; is cheaper, faster, and easier to measure than feed intake and has strong phenotypic and genetic correlations with feed intake. Furthermore, selection for feed intake, feed efficiency, methane, and carbon dioxide can be done early in sheep at postweaning age or hoggets. This early selection reduces the generation interval for breeding, thereby increasing response to selection.

Increasing the visibility of thin NITINOL vascular implants

New implants for vascular therapy like flow diverters are made of tiny braided wires. The radio opacity of these wires is poor, which makes assessment of implant expansion and exact positioning difficult. Additional markers only allow the estimation of the current device position, but they also induce artefacts that impair the assessment during the intervention and in follow-up examination. A new strategy to increase implant visibility is the braiding of composite wires with a radiopaque core along the whole implant. This paper shows some useful combinations of these new wires on a phantom study with five vascular implants.

A novel technique for the measurement of CBF and CBV with robot-arm-mounted flat panel CT in a large-animal model

BACKGROUND AND PURPOSE

Endovascular therapy is an emerging treatment option in patients with acute ischemic stroke and especially in cases presenting late after symptom onset. Information about remaining viable tissue as measured with perfusion imaging is crucial for proper patient selection. The aim of this study was to investigate whether perfusion imaging with C-arm CT in the angiography suite is feasible and provides measurements comparable with ones made by CTP.

MATERIALS AND METHODS

The MCA was occluded surgically in 6 sheep. Perfusion studies were performed before surgery, immediately after, and at 3 hours after MCA occlusion by using a robotic flat panel detector C-arm angiographic system. For comparison, conventional CTP was performed at the same time points. Two different protocols with the C-arm CT were tested. Images were analyzed by 2 readers with regard to the presence and size of perfusion abnormalities.

RESULTS

With C-arm CT, perfusion abnormalities were detected with a high sensitivity and specificity when vessel occlusion was confirmed by criterion standard DSA. No difference was found between lesions sizes measured with the 2 C-arm CT protocols and CTP. Growth of the CBV lesions with time was captured with C-arm CT and CTP.

CONCLUSIONS

In this small study, it was feasible to qualitatively measure CBV and CBF by using a flat panel detector angiographic system.

Genetic correlations between body weight change and reproduction traits in Merino ewes depend on age

Merino sheep in Australia experience periods of variable feed supply. Merino sheep can be bred to be more resilient to this variation by losing less BW when grazing poor quality pasture and gaining more BW when grazing good quality pasture. Therefore, selection on BW change might be economically attractive but correlations with other traits in the breeding objective need to be known. The genetic correlations (rg) between BW, BW change, and reproduction were estimated using records from approximately 7,350 fully pedigreed Merino ewes managed at Katanning in Western Australia. Number of lambs and total weight of lambs born and weaned were measured on approximately 5,300 2-yr-old ewes, approximately 4,900 3-yr-old ewes, and approximately 3,600 4-yr-old ewes. On a proportion of these ewes BW change was measured: approximately 1,950 2-yr-old ewes, approximately 1,500 3-yr-old ewes, and approximately 1,100 4-yr-old ewes. The BW measurements were for 3 periods. The first period was during mating period over 42 d on poor pasture. The second period was during pregnancy over 90 d for ewes that got pregnant on poor and medium quality pasture. The third period was during lactation over 130 d for ewes that weaned a lamb on good quality pasture. Genetic correlations between weight change and reproduction were estimated within age classes. Genetic correlations were tested to be significantly greater magnitude than 0 using likelihood ratio tests. Nearly all BW had significant positive genetic correlations with all reproduction traits. In 2-yr-old ewes, BW change during the mating period had a positive genetic correlation with number of lambs weaned (rg = 0.58); BW change during pregnancy had a positive genetic correlation with total weight of lambs born (rg = 0.33) and a negative genetic correlation with number of lambs weaned (rg = -0.49). All other genetic correlations were not significantly greater magnitude than 0 but estimates of genetic correlations for 3-yr-old ewes were generally consistent with these findings. The direction of the genetic correlations mostly coincided with the energy requirements of the ewes and the stage of maturity of the ewes. In conclusion, optimized selection strategies on BW changes to increase resilience will depend on the genetic correlations with reproduction and are dependent on age.

Transitional cell tumours of the lacrimal drainage apparatus

BACKGROUND

Tumours of the lacrimal drainage apparatus (LDA) are very rare, but can be life-threatening. Seventy percent of lacrimal sac tumours are of epithelial origin, and transitional cell tumours represent an interesting sub-group of these epithelial tumours.

METHODS

A retrospective review of cases of LDA transitional cell tumours co-managed at the Royal National Throat Nose and Ear Hospital and Moorfields Eye Hospital, London.

RESULTS

Twenty cases of transitional cell tumours of the LDA were identified, comprising 10 transitional cell papillomas (TCPs) and 10 transitional cell carcinomas (TCCs). All cases were resected through a modified lateral rhinotomy approach. Limited resection of orbital fat with preservation of orbital functions was required for 2 cases of TCC. Fractionated external beam radiotherapy was administered in 7 cases of TCC. The mean follow up was 80 months (range 11 months-16 years). Recurrences were detected in 4 cases, which were managed by further surgery. Two cases have been lost to follow-up, but the 18 other patients are currently alive and disease free.

CONCLUSION

A favourable outcome can be achieved with transitional cell tumours of the LDA when an optimum management plan is followed.

Do patients with chronic rhinosinusitis with nasal polyps suffer with facial pain?

BACKGROUND

Many patients attribute their symptoms of facial pain or headache to sinus problems. Facial pain is one of the symptoms of rhinosinusitis according to European and American consensus documents. This symptom, however, has been insufficiently studied in the group of patients with chronic rhinosinusitis with nasal polyps (CRSwNP). The aim of this work is to study the symptom of facial pain in patients with CRSwNP.

METHODS

Patients with CRSwNP were prospectively asked to score their facial pain according to the scoring system used in the Sino Nasal Outcome Test 22 (SNOT 22).

RESULTS

Fifty patients fulfilled the inclusion criteria. Thirty-one patients had grade II polyps and 19 patients had grade III polyps. Of these patients, 76% had absent or very mild facial pain. Only 16% of patients had moderate or severe facial pain. All patients with severe facial pain had viscid secretions within their sinuses.

CONCLUSION

Significant facial pain is uncommon in patients with CRSwNP. It is important to consider this when counselling patients before surgery.

Transitional cell tumours of the lacrimal drainage apparatus

BACKGROUND

Tumours of the lacrimal drainage apparatus (LDA) are very rare, but can be life-threatening. Seventy percent of lacrimal sac tumours are of epithelial origin, and transitional cell tumours represent an interesting sub-group of these epithelial tumours.

METHODS

A retrospective review of cases of LDA transitional cell tumours co-managed at the Royal National Throat Nose and Ear Hospital and Moorfields Eye Hospital, London.

RESULTS

Twenty cases of transitional cell tumours of the LDA were identified, comprising 10 transitional cell papillomas (TCPs) and 10 transitional cell carcinomas (TCCs). All cases were resected through a modified lateral rhinotomy approach. Limited resection of orbital fat with preservation of orbital functions was required for 2 cases of TCC. Fractionated external beam radiotherapy was administered in 7 cases of TCC. The mean follow up was 80 months (range 11 months-16 years). Recurrences were detected in 4 cases, which were managed by further surgery. Two cases have been lost to follow-up, but the 18 other patients are currently alive and disease free.

CONCLUSION

A favourable outcome can be achieved with transitional cell tumours of the LDA when an optimum management plan is followed.

Merino ewes can be bred for body weight change to be more tolerant to uncertain feed supply

Sheep in Australia experience periods with different feed supply causing them to gain and lose BW during the year. It is more efficient if ewes lose less BW during periods of poor nutrition and gain more BW during periods of good nutrition. We investigated whether BW loss during periods of poor nutrition and BW gain during periods of good nutrition are genetically different traits. We used BW measurements from 2,336 adult Merino ewes managed over 5 yr in a Mediterranean climate in Katanning, Australia. Body weight loss is the difference between 2 BW measured 42 d apart during mating, a period of poor nutrition. Body weight gain is the difference between 2 BW measured 131 d apart during a period of good nutrition between prelambing and weaning. We estimated variance compnents of BW change using 3 methods: 1) as a trait calculated by subtracting the first BW from the second, 2) multivariate analysis of BW traits, and 3) random regression analysis of BW. The h(2) and genetic correlations (rg) estimated using the multivariate analysis of BW and the BW change trait were very similar whereas the random regression analysis estimated lower heritabilities and more extreme negative genetic correlations between BW loss and gain. The multivariate model fitted the data better than random regression based on Akaike and Bayesian information criterion so we considered the results of the multivariate model to be more reliable. The heritability of BW loss (h(2) = 0.05-0.16) was smaller than that of BW gain (h(2) = 0.14-0.37). Body weight loss and gain can be bred for independently at 2 and 4 yr of age (rg = 0.03 and -0.04) whereas at 3 yr of age ewes that genetically lost more BW gained more BW (rg = -0.41). Body weight loss is genetically not the same trait at different ages (rg range 0.13-0.39). Body weight gain at age 3 yr is genetically the same trait at age 4 yr (rg = 0.99) but is different between age 2 yr and the older ages (rg = 0.53 and 0.51). These results suggest that as the ewes reach their mature BW, BW gain at different ages becomes the same trait. This does not apply to BW loss. We conclude that BW change could be included in breeding programs to breed adult Merino ewes that are more tolerant to variation in feed supply.

Outcome of laparoscopy-assisted feeding tube insertion in elderly stroke victims

BACKGROUND

When percutaneous endoscopic gastrostomy (PEG) is not possible, or fails, the patient is referred for laparoscopic gastrostomy or jejunostomy (LAG/J).

METHOD

During 2005-2008, we performed laparoscopy-assisted feeding tube insertion on 15 patients. We assessed the outcome in terms of leaks, infection, longevity etc. The patients were followed-up for up to 12 months.

RESULTS

The procedure was successful in 14/15 patients. However, thirteen died within little more than a year, of whom seven suffered from pneumonia or aspiration.

DISCUSSION

Our study confirms that LAG/J is technically possible, carries a high morbidity, is a last ditch attempt and that it does not change the general prognosis of these debilitated patients.

Age and nutrition influence the concentrations of three branched chain fatty acids in sheep fat from Australian abattoirs

The characteristic mutton odour, associated with the cooked meat of older sheep, can be problematic for some consumers who find the odour disagreeable. Branch chain fatty acids (BCFAs) are considered to be the main determinants of mutton odour. In this study, the aim was to identify the factors influencing the BCFA content of animals at abattoirs in Australia. Samples of subcutaneous fat from over the chump (gluteus medius) were collected from 533 sheep carcasses at abattoirs in New South Wales, Victoria and Western Australia. The carcasses were from sheep differing in age, gender, breed and nutrition. The concentrations of three branched chain fatty acids (BCFAs); namely, 4-methyloctanoic (MOA), 4-ethyloctanoic (EOA) and 4-methylnonanoic acids (MNA), were determined. Statistical modelling showed that, with pre-slaughter nutrition in the model as a random term, BCFA concentrations could be used for discriminating the age of sheep. Fat samples from lamb carcasses had lower MOA and EOA concentrations and a higher concentration of MNA in comparison to hogget and mutton (P<0.05). When nutrition was excluded as a random effect from the statistical model, the MOA and MNA concentrations did not differentiate between lamb, hogget and mutton whereas, for EOA, lamb had a lower concentration than mutton (P<0.05) with hogget intermediate. An interaction existed between age and gender (P<0.05) where female lambs had lower EOA concentrations relative to the mutton but not for castrates.

Factors influencing Australian community pharmacists' willingness to participate in research projects - an exploratory study

Objective

To identify the factors influencing Australian community pharmacists' willingness to participate in research projects and their attitudes towards research.

Method

A mixed-method survey instrument comprising demographics, previous participation in research, and perceptions about participation in research was mailed to 267 community pharmacists in New South Wales and the Australian Capital Territory. An analysis of variance test was used to identify similarities and differences between research- and non-research-active respondents. Bivariate correlations and partial least squares (PLS) regression analyses were used to identify barriers and facilitators to research participation.

Key findings

The overall response rate to the survey was 40%. Of these, 70% were classified as previous research participants (PRP), and 30% were classified as non-previous research participants (NPRP). Both groups had mostly favourable attitudes towards research; however, the results revealed several differences between the PRP and NPRP groups. Three items were identified as key facilitators to participation in research for both PRP and NPRP groups - having an interest in the research topic; believing that the research will benefit the customer; and a belief that community pharmacy research is important. Lack of time, either real or perceived, was identified as a key barrier to participation in research for both the PRP and NPRP groups.

Conclusion

Researchers should take into account pharmacists' previous research experience when recruiting pharmacists into research projects. In the case of pharmacists with research experience, emphasis should be on promoting factors that facilitate participation. In the case of pharmacists with little research experience, emphasis should be on reducing barriers to participation.

[Telemedicine in acute stroke care--a health economics view]

Specialized stroke units offer optimal treatment of patients with an acute stroke. Unfortunately, their installation is limited by an acute lack of experienced neurologists and the small number of stroke patients in sparsely populated rural areas. This problem is increasingly being solved by the use of telemedicine, so that neurological expertise is made available to basic and regular care. It has been demonstrated by national and international pilot studies that solidly based and rapid decisions can be made by telemedicine regrading the use of thrombolysis, as the most important acute treatment, but also of other interventions. So far studies have only evaluated improvement in the quality of care achieved by networking, but not of any lasting effect on any economic benefit. Complementary to a medical evaluation, the qualitative economic assessment presented here of German and American concepts of telemetric care indicate no difference in efficacy between various ways of networking. Most noteworthy, when comparing two large American and German studies, is the difference in their priorities. While the American networks achieved targeted improvements in efficacy of care that go beyond the immediate wishes of the doctors involved, this was of only secondary importance in the German studies. Also, in contrast to several American networks, the German telemetry networks have not tended to be organized for future growth. In terms of economic benefits, decentralized organized networks offer a greater potential of efficacy than purely local ones. Furthermore, the integration of inducements into the design of business models is a fundamental factor for achieving successful and lasting existence, especially within a highly competitive market.

Sheep category can be classified using machine learning techniques applied to fatty acid profiles derivatised as trimethylsilyl esters

Eruption of permanent incisors (dentition) is used as a proxy for age for defining meat quality in Australian sheep meat. However, this approach may not be reliable. While not presently available, an objective method could be used to determine sheep age, and thus sheep category, which would then potentially remove any inaccuracies that may occur in classifying sheep meat product. Statistical classification algorithms have been successfully used in bioinformatics. In this paper we review the performance of three algorithms (support vector machines, recursive partitioning and random forests) for determining sheep age. The algorithms were applied to the measured fatty acid profiles of fat samples from 533 carcasses; 254 lamb (<1 year old), 131 hogget (~1–2 years old) and 148 mutton (>2 years old) samples. Three data pretreatments (range transformation, column mean centering and range transformation with mean centering) were also examined to determine their impact on the performance of the algorithms. The random forests algorithm, when applied to mean-centred data, gave 100% predictive accuracy when classifying sheep category. This approach could be used for the development of an objective test for determining sheep age and category.

Asthma clinic attendance improves quality of life of Jamaican asthmatic children and their parents

BACKGROUND

With the increasing incidence of paediatric asthma, there has been a corresponding increase in the physical, emotional and financial burden. This has led to a greater interest in determining the impact of asthma and its treatment on many aspects of patient functioning and wellbeing.

AIM

To assess the usefulness of the Asthma Clinic established in Jamaica in 1997 by ascertaining whether there has been improvement in quality of life of children and care-givers who attend the clinic.

METHODS

The quality of life of patients and their parents/care-givers before attending the Asthma Clinic of Bustamante Hospital for Children in Kingston, Jamaica was compared with that of 1 year afterwards. Parents or guardians were interviewed using the Pediatric Asthma Quality of Life Questionnaire which consists of three domains [symptoms (ten questions), emotional (eight questions) and activity (five questions)] and the Pediatric Asthma Caregiver's Quality of life Questionnaire which consist of two domains [emotional (nine questions) and activity (four questions)].

RESULTS

Quality of life improved in patients and their parents/care-givers in all domains.

CONCLUSION

Attendance at an asthma clinic in Jamaica improved the quality of life of asthmatic children and their parents/care-givers.

Idiopathic pustular vulvitis

A 31-year-old woman presented in the 23rd week of her third pregnancy with extremely painful pustular vulvitis, unresponsive to antibiotics. Although the histological findings were was consistent with a diagnosis of hidradenitis suppurativa (HS), bridged comedones, the hallmark of this disease, were absent and there were no dermal sinuses. Incision and drainage of the pustules provided only temporary improvement, which was briefly maintained with oral clindamycin and topical steroids. After the birth, a course of isotretinoin produced almost total clearance, a response not typically found in HS. This patient's condition may represent a variant of HS, and if so, it would be the first case report of de novo HS in pregnancy, but its clinical features and evolution differed so much from those in HS that the possibility of a previously unrecognised condition cannot be excluded.

Anatomical and functional aspects of the septo-hippocampal projections

The origins, distribution, and cellular targets of the septo-hippocampal projections are reviewed. It appears that the distribution of acetylcholinesterase-positive neurons in the medial septum and diagonal bands and those cells labelled after injections of horseradish peroxidase into the hippocampus coincide; however, the possibility of a non-acetylcholinesterase septal projection remains. Good agreement is found between the distribution of hippocampal acetylcholinesterase and the patterning of silver grains after injection of [3H]leucine into the medial septum. A major target of septal efferents to the hippocampus is the interneuron population; the possibility of septal mediation of intrahippocampal circuitry via this anatomical arrangement is discussed.

Role of controlled trials in evaluating preventive medicine procedures

A number of large controlled trials evaluating methods of preventing cardiovascular disease are reviewed, mainly for their methodological lessons. They include trials of treatment for hypertension (Veterans Administration, Australian, and the Hypertension Detection and Follow-up Program); of coronary heart disease prevention by drugs (post-infarction beta-blockers, the WHO trial of clofibrate, and the Lipid Research Clinics Program); and of health education (the Multiple Risk Factor Intervention Trial and the WHO European Multifactorial Trial). Although important evidence has emerged, expectations from large trials of this kind are now more sober. Their findings have to be considered alongside the rest of the evidence, and preventive policy can only be based on a best judgment. Any hope of 'proof' is naive.

Implications of genetic research for control measures

Coronary heart disease and hypertension are 'mass' diseases to which nearly all individuals are in varying degree susceptible. Incidence rates, population differences and time trends are determined by environment and lifestyle. Within populations the different levels of precursors in individuals are probably genetically determined to a large degree. Genetic and environmental approaches to research are interdependent, but the contribution of genetic advances to control measures is currently confined to less common conditions or to individuals at exceptionally high risk.