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Soliman Y, Yakandawala U, Leong C, Garlock ES, Brinkman FSL, Winsor GL, Kozyrskyj AL, Mandhane PJ, Turvey SE, Moraes TJ, Subbarao P, Nickel NC, Thiessen K, Azad MB, Kelly LE. The use of prescription medications and non-prescription medications during lactation in a prospective Canadian cohort study. Int Breastfeed J 2024; 19:23. [PMID: 38589955 PMCID: PMC11000278 DOI: 10.1186/s13006-024-00628-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 03/17/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND A lack of safety data on postpartum medication use presents a potential barrier to breastfeeding and may result in infant exposure to medications in breastmilk. The type and extent of medication use by lactating women requires investigation. METHODS Data were collected from the CHILD Cohort Study which enrolled pregnant women across Canada between 2008 and 2012. Participants completed questionnaires regarding medications and non-prescription medications used and breastfeeding status at 3, 6 and 12 months postpartum. Medications, along with self-reported reasons for medication use, were categorized by ontologies [hierarchical controlled vocabulary] as part of a large-scale curation effort to enable more robust investigations of reasons for medication use. RESULTS A total of 3542 mother-infant dyads were recruited to the CHILD study. Breastfeeding rates were 87.4%, 75.3%, 45.5% at 3, 6 and 12 months respectively. About 40% of women who were breastfeeding at 3 months used at least one prescription medication during the first three months postpartum; this proportion decreased over time to 29.5% % at 6 months and 32.8% at 12 months. The most commonly used prescription medication by breastfeeding women was domperidone at 3 months (9.0%, n = 229/2540) and 6 months (5.6%, n = 109/1948), and norethisterone at 12 months (4.1%, n = 48/1180). The vast majority of domperidone use by breastfeeding women (97.3%) was for lactation purposes which is off-label (signifying unapproved use of an approved medication). Non-prescription medications were more often used among breastfeeding than non-breastfeeding women (67.6% versus 48.9% at 3 months, p < 0.0001), The most commonly used non-prescription medications were multivitamins and Vitamin D at 3, 6 and 12 months postpartum. CONCLUSIONS In Canada, medication use is common postpartum; 40% of breastfeeding women use prescription medications in the first 3 months postpartum. A diverse range of medications were used, with many women taking more than one prescription and non-prescription medicines. The most commonly used prescription medication by breastfeeding women were domperidone for off-label lactation support, signalling a need for more data on the efficacy of domperidone for this indication. This data should inform research priorities and communication strategies developed to optimize care during lactation.
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Affiliation(s)
- Youstina Soliman
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Uma Yakandawala
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- College of Pharmacy, Rady Faculty of Health Science, University of Manitoba, Winnipeg, MB, Canada
| | - Christine Leong
- College of Pharmacy, Rady Faculty of Health Science, University of Manitoba, Winnipeg, MB, Canada
| | - Emma S Garlock
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Fiona S L Brinkman
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Geoffrey L Winsor
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Piushkumar J Mandhane
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Theo J Moraes
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Nathan C Nickel
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Interdisciplinary Lactation Centre (MILC), Winnipeg, MB, Canada
| | - Kellie Thiessen
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Lauren E Kelly
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.
- , 417-753 McDermot Ave, R3E 0T6, Winnipeg, MB, Canada.
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Tricco AC, Parker A, Khan PA, Nincic V, Robson R, MacDonald H, Warren R, Cleary O, Zibrowski E, Baxter N, Burns KEA, Coyle D, Ndjaboue R, Clark JP, Langlois EV, Ahmed SB, Witteman HO, Graham ID, El-Adhami W, Skidmore B, Légaré F, Curran J, Hawker G, Watt J, Bourgeault IL, Leigh JP, Lawford K, Aiken A, McCabe C, Shepperd S, Pattani R, Leon N, Lundine J, Adisso ÉL, Ono S, Rabeneck L, Straus SE. Interventions on gender equity in the workplace: a scoping review. BMC Med 2024; 22:149. [PMID: 38581003 PMCID: PMC10998304 DOI: 10.1186/s12916-024-03346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/07/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Various studies have demonstrated gender disparities in workplace settings and the need for further intervention. This study identifies and examines evidence from randomized controlled trials (RCTs) on interventions examining gender equity in workplace or volunteer settings. An additional aim was to determine whether interventions considered intersection of gender and other variables, including PROGRESS-Plus equity variables (e.g., race/ethnicity). METHODS Scoping review conducted using the JBI guide. Literature was searched in MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, ERIC, Index to Legal Periodicals and Books, PAIS Index, Policy Index File, and the Canadian Business & Current Affairs Database from inception to May 9, 2022, with an updated search on October 17, 2022. Results were reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension to scoping reviews (PRISMA-ScR), Sex and Gender Equity in Research (SAGER) guidance, Strengthening the Integration of Intersectionality Theory in Health Inequality Analysis (SIITHIA) checklist, and Guidance for Reporting Involvement of Patients and the Public (GRIPP) version 2 checklist. All employment or volunteer sectors settings were included. Included interventions were designed to promote workplace gender equity that targeted: (a) individuals, (b) organizations, or (c) systems. Any comparator was eligible. Outcomes measures included any gender equity related outcome, whether it was measuring intervention effectiveness (as defined by included studies) or implementation. Data analyses were descriptive in nature. As recommended in the JBI guide to scoping reviews, only high-level content analysis was conducted to categorize the interventions, which were reported using a previously published framework. RESULTS We screened 8855 citations, 803 grey literature sources, and 663 full-text articles, resulting in 24 unique RCTs and one companion report that met inclusion criteria. Most studies (91.7%) failed to report how they established sex or gender. Twenty-three of 24 (95.8%) studies reported at least one PROGRESS-Plus variable: typically sex or gender or occupation. Two RCTs (8.3%) identified a non-binary gender identity. None of the RCTs reported on relationships between gender and other characteristics (e.g., disability, age, etc.). We identified 24 gender equity promoting interventions in the workplace that were evaluated and categorized into one or more of the following themes: (i) quantifying gender impacts; (ii) behavioural or systemic changes; (iii) career flexibility; (iv) increased visibility, recognition, and representation; (v) creating opportunities for development, mentorship, and sponsorship; and (vi) financial support. Of these interventions, 20/24 (83.3%) had positive conclusion statements for their primary outcomes (e.g., improved academic productivity, increased self-esteem) across heterogeneous outcomes. CONCLUSIONS There is a paucity of literature on interventions to promote workplace gender equity. While some interventions elicited positive conclusions across a variety of outcomes, standardized outcome measures considering specific contexts and cultures are required. Few PROGRESS-Plus items were reported. Non-binary gender identities and issues related to intersectionality were not adequately considered. Future research should provide consistent and contemporary definitions of gender and sex. TRIAL REGISTRATION Open Science Framework https://osf.io/x8yae .
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Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada.
| | - Amanda Parker
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Paul A Khan
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Vera Nincic
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Reid Robson
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Heather MacDonald
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Rachel Warren
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Olga Cleary
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Nancy Baxter
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Ruth Ndjaboue
- École de Travail Social, Université de Sherbrooke, Québec, (Québec), Canada
| | - Jocalyn P Clark
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Etienne V Langlois
- Partnership for Maternal, Newborn and Child Health (PMNCH), World Health Organization (WHO), Geneva, Switzerland
| | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Wafa El-Adhami
- Science in Australia Gender Equity Limited, Greenway, Australia
| | | | - France Légaré
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Janet Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Gillian Hawker
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Jennifer Watt
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | | | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Karen Lawford
- Department of Gender Studies, Haudenosaunee and Anishinaabek Territories, Queen's University, Settlement of Kingston, Canada
| | - Alice Aiken
- Research and Innovation, Dalhousie University, Halifax, Canada
| | | | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - Reena Pattani
- Department of Medicine, Division of Internal Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Évèhouénou Lionel Adisso
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Santa Ono
- Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Linda Rabeneck
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
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Shaw SY, Leung S, Isac S, Musyoki H, Mugambi M, Kioko J, Musimbi J, Olango K, Kuria S, Ongaro MK, Walimbwa J, Melon M, Emmanuel F, Moses S, Blanchard JF, Pickles M, Lazarus L, Lorway RR, Becker ML, Mishra S, Bhattacharjee P. Assessing awareness and use of HIV self-testing kits after the introduction of a community-based HIV self-testing programme among men who have sex with men in Kenya. PLOS Glob Public Health 2023; 3:e0001547. [PMID: 37594918 PMCID: PMC10437899 DOI: 10.1371/journal.pgph.0001547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/18/2023] [Indexed: 08/20/2023]
Abstract
Men who have sex with men (MSM) bear a disproportionate burden of new HIV infections in Kenya, while experiencing discrimination, leading to suboptimal levels of HIV care. HIV self-testing (HIVST) is a tool to increase HIV screening and earlier diagnosis; however, questions remain regarding how best to scale-up HIVST to MSM in Kenya. The main objective of this study was to examine changes in knowledge and use of HIVST after implementation of a community-led HIVST project. Participants were MSM recruited from Kisumu, Mombasa, and Kiambu counties. Data were collected from two rounds (Round 1: 2019; Round 2: 2020) of serial cross-sectional integrated biological and behavioural assessments (IBBA), pre-, and post-project implementation. Two main outcomes were measured: 1) whether the respondent had ever heard of HIVST; and 2) whether they had ever used HIVST kits. Changes in outcomes between IBBA rounds were examined using modified multivariable Poisson regression models; adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI) are reported. A total of 2,328 respondents were included in main analyses. The proportion of respondents who had heard of HIVST increased from 75% in Round 1 to 94% in Round 2 (aPR: 1.2, 95% CI: 1.2-1.3), while those reporting using an HIVST kit increased from 20% to 53% (aPR: 2.3, 95% CI: 2.0-2.6). Higher levels of education and HIV programme awareness were associated with both outcomes. Awareness and use of HIVST kits increased after implementation of a community-led HIVST implementation project, demonstrating the importance of integration with existing community groups.
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Affiliation(s)
- Souradet Y. Shaw
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stella Leung
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Helgar Musyoki
- National Syndemic Disease Control Council, Nairobi, Kenya
| | - Mary Mugambi
- National Syndemic Disease Control Council, Nairobi, Kenya
| | - Japheth Kioko
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Janet Musimbi
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | | | | | | | - Memory Melon
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Faran Emmanuel
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephen Moses
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James F. Blanchard
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Pickles
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, England
| | - Lisa Lazarus
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert R. Lorway
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marissa L. Becker
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sharmistha Mishra
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Parinita Bhattacharjee
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Gelova SP, Doherty KN, Alasmar S, Chan K. Intrinsic base substitution patterns in diverse species reveal links to cancer and metabolism. Genetics 2022; 222:iyac144. [PMID: 36149294 PMCID: PMC9630983 DOI: 10.1093/genetics/iyac144] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/07/2022] [Indexed: 11/12/2022] Open
Abstract
Analyses of large-scale cancer sequencing data have revealed that mutagenic processes can create distinctive patterns of base substitutions, called mutational signatures. Interestingly, mutational patterns resembling some of these signatures can also be observed in normal cells. To determine whether similar patterns exist more generally, we analyzed large data sets of genetic variation, including mutations from 7 model species and single nucleotide polymorphisms in 42 species, totaling >1.9 billion variants. We found that base substitution patterns for most species closely match single base substitution (SBS) mutational signature 5 in the Catalog of Somatic Mutations in Cancer (COSMIC) database. SBS5 is ubiquitous in cancers and also present in normal human cells, suggesting that similar patterns of genetic variation across so many species are likely due to conserved biochemistry. We investigated the mechanistic origins of the SBS5-like mutational pattern in Saccharomyces cerevisiae, and show that translesion DNA synthesis and sugar metabolism are directly linked to this form of mutagenesis. We propose that conserved metabolic processes in cells are coupled to continuous generation of genetic variants, which can be acted upon by selection to drive the evolution of biological entities.
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Affiliation(s)
- Suzana P Gelova
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON K1H 8M5, Canada
- Ottawa Institute of Systems Biology, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Kassidy N Doherty
- Biopharmaceutical Sciences Undergraduate Program, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Salma Alasmar
- Biopharmaceutical Sciences Undergraduate Program, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kin Chan
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON K1H 8M5, Canada
- Ottawa Institute of Systems Biology, University of Ottawa, Ottawa, ON K1H 8M5, Canada
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