Rosemont College

Raloxifene has been available in Canada for postmenopausal osteoporosis since 1998. However, its benefit-to-risk ratio became questioned after evidence of increased risk of thrombosis and fatal stroke emerged in the early 2000s. We aimed to describe the use of raloxifene over time. We identified community-dwelling females aged ≥ 66years initiating raloxifene between 1999/05 and 2022/12 through the Ontario Drug Benefit program, plotted the number of incident and prevalent users by calendar year, and estimated persistence with therapy using a 60-day permissible gap. Patient characteristics were described using medical and pharmacy claims within the year prior to initiation. We identified 21,896 eligible females (mean age = 74.2 [SD = 6.2] years, 5% fracture history, 57% oral bisphosphonate history). The number of patients initiating raloxifene increased to an annual high of 3,824 in 2001 followed by a 15% drop in 2002 (n = 3,252) before a gradual decline from 2,113 in 2003 to 90 in 2022. In contrast, the number of prevalent users remained >5,000 annually between 2003 and 2011, with a gradual drop from 4,670 in 2012 to 959 in 2022. Overall, 29% persisted with therapy for ≥ 3years. Besides known population-level treatment trends (increased statins, decreased estrogen therapy), little differences in patient characteristics were identified over time. Raloxifene initiation has declined substantially since 2003, and overall utilization has declined rapidly since 2012. While less than 100 initiators were identified annually in recent years, around 1,000 continue to take raloxifene every year. Raloxifene thus remains a relevant option among select patients with osteoporosis.

We aimed to assess whether high-sensitivity C-reactive protein (hsCRP) levels could predict the development of psoriatic arthritis (PsA) in patients with psoriasis. We analyzed data from a prospective cohort of patients with psoriasis without PsA at enrollment. Participants were assessed annually by a rheumatologist for signs and symptoms of PsA. Information on patient demographics, psoriasis features, medications and musculoskeletal symptoms was collected. hsCRP levels were measured in serum samples collected at baseline using standard commercial assays. The association between hsCRP levels and risk of development of PsA was assessed using multivariable Cox proportional hazards model adjusted for age, sex, psoriasis severity and duration, nail lesions, body mass index (BMI), fatigue, and medication use. A total of 589 patients with psoriasis observed from 2006 to 2019 were analyzed. During the follow up period, 57 patients developed PsA. The mean level of hsCRP was 3.1 ± 5.5 mg/L (hsCRP levels in patients with incident PsA, 5.4 ± 13.1 mg/L). Significantly higher levels of hsCRP at baseline were found in patients with arthralgia, obesity, and in women. Higher hsCRP levels were associated with future development of PsA in multivariable analyses (hazard ratio 1.04; 95% confidence interval 1.01-1.07; P = 0.007). Similar effect size was seen in men and women. No significant interaction was found between hsCRP and sex or BMI. Higher levels of systemic inflammation, as measured by hsCRP levels, are associated with future development of PsA.

The initial response to coronavirus disease 2019 (COVID-19) in Ontario included suspension of cancer screening programs and deferral of diagnostic procedures and many treatments. Although the short-term impact of these measures on female cancers is well documented, few studies have assessed the mid- to long-term impacts. To compare annual billing prevalence and incidence rates of female cancers during the COVID-19 period (2020-2022) to pre-COVID-19 levels (2015-2019). Retrospective analysis of aggregated claims data for female cancer diagnostic codes from the Ontario Health Insurance Plan (OHIP). Linear regression analysis was used to fit pre-COVID-19 (2015-2019) data for each OHIP billing code and extrapolate counterfactual values for the years of 2020-2022. Excess billing rates were calculated as the difference between projected and actual rates for each year. In 2020, OHIP billing prevalence rates for cervical, breast, uterine, and ovarian cancers decreased relative to projected values for that year by -50.7/100k, -13.9/100k, -3.5/100k, and -3.8/100k, respectively. The reverse was observed in 2021 with rate increases of 47.8/100k, 59.1/100k, 2.5/100k, and 3.7/100k, respectively. In 2022, the excesses were further amplified, especially for cervical and breast cancers (111.2/100k and 78.67/100k, respectively). The net excess patient billing rate for 2020-2022 was largely positive for all female cancer types (108.3/100k, 123.7/100k, 5.2/100k, and 1.8/100k, respectively). Analysis of billing incidence rates showed similar trends. The expected female cancer billing rate decreases in 2020 were followed by large increases in 2021 and 2022, resulting in a cumulative excess during the COVID-19 period. Further research is required to assess the nature of these changes.

This study aims to explore the impact of fly ash (FA) on two types of free-floating aquatic plants, Eichhornia crassipes and Pistia stratiotes, growing in two different locations. The stress caused by FA has led to a significant biochemical alteration in several leaf properties, including ascorbic acid, relative water, and chlorophyll, as well as anatomical changes in leaf, petiole, and stolon in the growing plants at highly contaminated sites (HCS) relative to the low contaminated site (LCS). According to the study, HCS plants lose total chlorophyll overall, have shallower ascorbic acid levels, and have higher RWC than LCS plants. These findings imply that both species are highly resilient to pollution. The assessment of the shape and size of the epidermis, cortex, palisade cells, air space, bundle sheath, xylem cavity, phloem cells, vascular bundle, parenchyma, pith of the leaves, petioles, and stolon in the HCS is shorter than the LCS. The APTI values of E. crassipes (8.407%) and P. stratiotes (9.681%) are higher in HCS than the values of E. crassipes (7.729%) and P. stratiotes (9.077%) in LCS. These results suggest that both species exhibit greater APTI values in plants from HCS, indicating their tolerance to pollution. We target six water bodies in HCS and LCS to assess the FA-containing water quality. We calculated the water quality using WA-WQI and CCME-WQI. The higher WA-WQI scores indicate higher water pollution levels. The value of WA-WQI is higher in HCS sites included in the KTPP colony (93.94), Amalhanda (91.43), and Barunan Ghoshpara (89.07) than in LCS sites such as in Kashinathpur (88.59), but the CCME-WQI scores are 64.33, 76.09 and 75.71 respectively. The investigation highlights that both species are exceptionally suitable as stress-tolerant plants for fly ash and possess the potential to serve as an option for the restoration of water bodies impacted by fly ash. This study will enhance our comprehension of the potential advantages of these plants, particularly in the phytoremediation of polluted aquatic ecosystems.

Introduction: While existing reflections on participatory action research (PAR) emphasize the benefits experienced by participants in such studies, they often fail to critically interrogate the PAR process. This gap underscores the significance of process-oriented papers that illuminate the dynamics, supports, and hurdles of PAR, crucial for aligning scholarly endeavors with its fundamental principles of equitable participation, social transformation, and reflexivity. This paper aimed to bridge these gaps by presenting insights from both older adults with age-related vision loss (ARVL) and university researchers, shedding light on their application of PAR principles during the initial stages of a project focused on identifying research priorities. Methods: The foundational PAR study, forming the basis of this paper, involved eight older adults aged 65 and above with ARVL. Additionally, three university researchers participated, including a faculty member and two students (one pursuing a PhD and the other an MSc). The PAR process encompassed three half-day meetings, dedicated to investigating how environmental factors (physical, social, cultural, political, and institutional) influence the engagement of older adults with ARVL in their daily activities. Following completion of the three half-day meetings, the university co-researchers conducted individual interviews with each older adult, as well as a collective reflexive exercise involving the university co-researchers, to delve into their personal journey through the PAR process, encompassing achievements, challenges, and encountered tensions. Results: The study’s outcomes were distilled into three central thematic domains: (1) attentiveness to power differentials; (2) realization of personal and social transformation; and (3) a steadfast commitment to reflexivity. Discussion: This paper endeavors to fill a void within the existing PAR landscape by providing process-oriented insights that spotlight the intricacies of the PAR journey, inclusive of encountered challenges. By candidly acknowledging these challenges, future scholars will be better equipped to harness PAR in a manner that is truly aligned with its core principles.

IntroductionThe Building on Existing Tools to Improve Cancer and Chronic Disease Prevention and Screening in Primary Care (BETTER) programme trains allied health professionals working in primary care settings to develop personalised chronic disease ‘prevention prescriptions’ with patients. However, maintenance of health behaviour changes is difficult without ongoing support. Sustainable options to enhance the BETTER programme and ensure accessibility to underserved populations are needed. We designed the BETTER Women programme, which uses a digital app to match patients with a trained peer health coach (PHC) who provides ongoing support for health behaviour change after receipt of a BETTER prevention prescription in primary care.Methods and analysisWe will conduct a type 1 hybrid implementation-effectiveness patient-randomised trial. Interested women aged 40–68 years will be recruited from three large, sociodemographically distinct primary care clinics (urban, suburban and rural). Patients will be randomised 1:1 to intervention or wait-list control after receipt of their BETTER prevention prescription. We will aim to recruit 204 patients per group (408 total). Effectiveness will be assessed by the primary outcome of targeted behaviours achieved for each participant at 6 months, consisting of three cancer screening tests (cervical, breast and colorectal) and four behavioural determinants of cancer and chronic disease (diet, smoking, alcohol use and physical activity). Data will be collected through patient survey and clinical chart review, measured at 3, 6 and 12 months. Implementation outcomes will be assessed through patient surveys and interviews with patients, peer health coaches and healthcare providers. An embedded economic evaluation will examine cost per quality-adjusted life-year and per additional health behavioural targets achieved.Ethics and disseminationThis study has been approved by Women’s College Hospital Research Ethics Board (REB), the Royal Victoria Regional Health Centre REB and the University of Toronto REB. All participants will provide informed consent prior to enrolment. Participation is voluntary and withdrawal will have no impact on the usual care received from their primary care provider. The results of this trial will be published in peer-reviewed journals and shared via conference presentations. Deidentified datasets will be shared on request, after publication of results.Trial registration numberNCT04746859.

Abstract Background There is a severe paucity in available resources to facilitate a safe and effective pediatric to adult health care transition for patients with chronic disease. Aims This study aims to better understand the experiences of key stakeholder groups involved in pediatric to adult transition of care across various chronic disease specialties within a tertiary care urban environment. Methods A focus group was conducted on July 12th, 2018 at Women’s College Hospital with key stakeholder groups. Questions focused on the top issues related to pediatric to adult transition of care and an ideal transition model for their respective patient populations. The second part of this study included individual interviews with patients and carepartners. Focus group meetings and individual interviews were both audio-recorded and transcribed for qualitative thematic analysis. Results Seventeen pediatric and adult care physicians representing ten chronic disease specialties were represented. Seven patients and care partners were interviewed. Major focus group themes included: disproportionate access to resources between and within specialties (n=10), lack of mental health support in the adult setting (n=8), fragmentation of care due to multiple providers as a result of patients leaving for employment or education (n=6), patients feeling alienated due to decrease in allied health support or due to shorter appointment times (n=8), and difficulty retaining consistent care due to missed appointments as a result of inconsistent communications or change in location for education or employment (n=7). Ideal care models were suggested to include: centralized intake procedure to identify patients who may require extra support (n=9), education for scheduling administrators about second chances after a no-show (n=5), implementation of joint clinics with pediatric and adult care teams or back-and-forth clinic sessions to ensure bidirectional provider comfort before discharge to adult care system (n=4), and implementation of a dedicated transitions navigator or point of contact for patients (n=10). The individual patient and carepartner interviews emphasized the need for: centralized and comprehensive online resource (n=7), simple and clear educational content introducing the adult healthcare system (n=7), opportunities to meet and share information with other individuals in a similar position (n=3), and availability of a transitions navigator (n=4). Conclusions Current pediatric to adult transition of care resources are fragmented, allocated inefficiently, difficult to ascertain and often constrained to a specific condition or location. Future efforts should focus on improving the care transition process for high-risk patient populations by taking a comprehensive approach utilizing innovative, and multidisciplinary solutions. Funding Agencies None

Abstract Background The transition from the pediatric to adult care healthcare system for adolescents and young adults (AYAs) with inflammatory bowel disease (IBD) is complex. This group requires support to prepare for and adapt to adult care due to the manifestation of the disease, expectations for self-management, and simultaneous life transitions. To address this need, a multi-site randomized controlled trial (RCT) is being conducted to evaluate the impact of a multimodal transition intervention on functional, clinical, and psychosocial outcomes for AYAs with IBD. An embedded qualitative study explored participants’ perspectives of the intervention's acceptability and appropriateness to support the translation of findings into practice. Aims Using in-depth individual qualitative interviews with a purposive sample of AYAs in both the intervention and control arms of the RCT, this qualitative study aimed to understand AYAs’ experiences preparing for and undergoing service transitions, developing self-management skills, and engaging with the intervention. Methods Semi-structured interviews were held via videoconference with 21 AYAs aged 16-18 years participating in the RCT (intervention arm n=11; control arm n=10) in Toronto, Canada. Purposive sampling was used to recruit AYAs with diverse demographic and clinical characteristics at different stages of the healthcare transition. Interviews were audio-recorded, transcribed verbatim, and analyzed using an inductive approach to reflexive thematic analysis. Results The analysis yielded four overarching themes related to 1) individual, familial, and system-level factors promoting transition readiness, 2) areas of strength and areas for growth regarding self-management skill development, 3) perceptions of the multimodal transition intervention, including barriers and facilitators to engagement, and 4) recommendations for future transition care, including refinement of the intervention. Findings to date indicate the criticality of considering AYAs’ support systems, learning styles, and communication preferences when designing and implementing transition interventions. The qualitative data analysis is ongoing, and the full results will be presented. Conclusions The perspectives of AYAs with IBD can inform the development and refinement of clinical interventions, ensuring they are tailored to recipients’ unique needs and preferences and promote engagement and skill development during pediatric-adult transitions. Funding Agencies CCCThe Leona M. and Harry B. Helmsley Charitable Trust