Newcomers experience unique challenges with respect to vaccination. These challenges are compounded by the need to navigate complex vaccination catch-up schedules upon arrival in their new home countries. Our group has pioneered the development of CANImmunize, a free, bilingual, pan-Canadian digital application designed to empower individuals to manage their vaccination records. To inform how a vaccine tracking app such as CANImmunize might be tailored to meet the unique needs of newcomers, this study sought to determine commonly spoken languages, technology use, and current methods of vaccine tracking among recent newcomers to Canada.Government-assisted refugees attending a health clinic in Ottawa, Canada were invited to complete a 17-question needs assessment survey. The survey captured data on household demographics, spoken languages, country of origin, technology use and methods used to track vaccination history.50 newcomers completed the needs assessment survey. Arabic was the predominant language spoken by surveyed individuals. Although 92% of participants owned a smartphone, the majority did not actively use digital health applications. 18 (36%) participants reported being vaccinated before arriving in Canada. 27 (54%) participants were parents, 23 of whom reported that their children were vaccinated prior to arrival in Canada. 38 (76%) participants indicated that they would use a vaccine tracking app such as CANImmunize if it were translated into their primary language of communication.The results of our study indicate that mobile technology may be a useful tool to help newcomer families stay on track with provincial and territorial immunization schedules.
Objective To develop and internally validate a deep-learning algorithm from fetal ultrasound images for the diagnosis of cystic hygromas in the first trimester. Methods All first trimester ultrasound scans with a diagnosis of a cystic hygroma between 11 and 14 weeks gestation at our tertiary care centre in Ontario, Canada were studied. Ultrasound scans with normal nuchal translucency were used as controls. The dataset was partitioned with 75% of images used for model training and 25% used for model validation. Images were analyzed using a DenseNet model and the accuracy of the trained model to correctly identify cases of cystic hygroma was assessed by calculating sensitivity, specificity, and the area under the receiver-operating characteristic (ROC) curve. Gradient class activation heat maps (Grad-CAM) were generated to assess model interpretability. Results The dataset included 289 sagittal fetal ultrasound images;129 cystic hygroma cases and 160 normal NT controls. Overall model accuracy was 93% (95% CI: 88–98%), sensitivity 92% (95% CI: 79–100%), specificity 94% (95% CI: 91–96%), and the area under the ROC curve 0.94 (95% CI: 0.89–1.0). Grad-CAM heat maps demonstrated that the model predictions were driven primarily by the fetal posterior cervical area. Conclusions Our findings demonstrate that deep-learning algorithms can achieve high accuracy in diagnostic interpretation of cystic hygroma in the first trimester, validated against expert clinical assessment.
Current literature is unclear on the safety and optimal timing of delivery for pregnant individuals with gestational diabetes mellitus, which inspired our study team to conduct a web-based survey study exploring patient and provider opinions on delivery options. However, an incident of fraudulent activity with survey responses prompted a shift in the focus of the research project. Unfortunately, despite the significant rise of web-based surveys used in medical research, there remains very limited evidence on the implications of and optimal methods to handle fraudulent web-based survey responses. Therefore, the objective of this viewpoint paper was to highlight our approach to identifying fraudulent responses in a web-based survey study, in the context of clinical perinatal research exploring patient and provider opinions on delivery options for pregnancies with gestational diabetes mellitus. Initially, we conducted cross-sectional web-based surveys across Canada with pregnant patients and perinatal health care providers. Surveys were available through Research Electronic Data Capture, and recruitment took place between March and October 2023. A change to recruitment introduced a US $5 gift card incentive to increase survey engagement. In mid-October 2023, an incident of fraudulent activity was reported, after which the surveys were deactivated. Systematic guidelines were developed by the study team in consultation with information technology services and the research ethics board to filter fraudulent from true responses. Between October 14 and 16, 2023, an influx of almost 2500 responses (393 patients and 2047 providers) was recorded in our web-based survey. Systematic filtering flagged numerous fraudulent responses. We identified fraudulent responses based on criteria including, but not limited to, identical timestamps and responses, responses with slight variations in wording and similar timestamps, and fraudulent email addresses. Therefore, the incident described in this viewpoint paper highlights the importance of preserving research integrity by using methodologically sound practices to extract true data for research findings. These fraudulent events continue to threaten the credibility of research findings and future evidence-based practices.
Objective To determine the efficacy of high-dose folic acid for the prevention of preeclampsia in twin pregnancies.Methods Secondary analysis of a randomized controlled trial in 70 obstetrical sites in Argentina, Australia, Canada, Jamaica, and the UK between 2011 and 2015. Eligible women pregnant with twins who were aged 18 y or older and between 8 and 16 completed weeks' gestation were randomized between to receive daily high-dose folic acid (4.0–5.1 mg) or placebo. The primary outcome was preeclampsia, presenting as hypertension after 20 weeks' gestation with significant proteinuria. Secondary outcomes included severe preeclampsia, preterm birth, and adverse fetal and neonatal outcomes.Results Of 2464 participants randomized between 18 April 2011 and 14 December 2015, 462 (18.8%) had a confirmed twin pregnancy. Thirty-four of these participants withdrew consent or did not have primary outcome data available, and 428 women were analyzed. The rate of preeclampsia was significantly higher in the folic acid group compared to the placebo group in crude analyses (17.2 versus 9.9%; relative risk 1.75 [95% CI 1.06–2.88], p = .029). Multivariable analyses attenuated this effect, rendering it not statistically significant (RR 1.58 [95% CI 0.95–2.63], p = .079).Conclusion High-dose folic acid supplementation was not significantly associated with preeclampsia in a subgroup of twin pregnancies. Although a suggested elevated risk cannot be confirmed, these results may help to gain novel insights in the etiology of preeclampsia, which continues to be poorly understood.Clinical trial registration ClinicalTrials.gov NCT01355159.
To determine the efficacy of high dose folic acid supplementation for prevention of pre-eclampsia in women with at least one risk factor: pre-existing hypertension, prepregnancy diabetes (type 1 or 2), twin pregnancy, pre-eclampsia in a previous pregnancy, or body mass index ≥35.Randomised, phase III, double blinded international, multicentre clinical trial.70 obstetrical centres in five countries (Argentina, Australia, Canada, Jamaica, and UK).2464 pregnant women with at least one high risk factor for pre-eclampsia were randomised between 2011 and 2015 (1144 to the folic acid group and 1157 to the placebo group); 2301 were included in the intention to treat analyses.Eligible women were randomised to receive either daily high dose folic acid (four 1.0 mg oral tablets) or placebo from eight weeks of gestation to the end of week 16 of gestation until delivery. Clinicians, participants, adjudicators, and study staff were masked to study treatment allocation.The primary outcome was pre-eclampsia, defined as hypertension presenting after 20 weeks' gestation with major proteinuria or HELLP syndrome (haemolysis, elevated liver enzymes, low platelets).Pre-eclampsia occurred in 169/1144 (14.8%) women in the folic acid group and 156/1157 (13.5%) in the placebo group (relative risk 1.10, 95% confidence interval 0.90 to 1.34; P=0.37). There was no evidence of differences between the groups for any other adverse maternal or neonatal outcomes.Supplementation with 4.0 mg/day folic acid beyond the first trimester does not prevent pre-eclampsia in women at high risk for this condition.Current Controlled Trials ISRCTN23781770 and ClinicalTrials.gov NCT01355159.
Introduction Cannabis use in pregnancy and post partum is increasing. Accessibility to cannabis has expanded due to the legalisation of cannabis in Canada. Therefore, there is a critical need to monitor the impact of cannabis on pregnancy outcomes and infant neurodevelopment. This pilot study will assess the feasibility of modern recruitment and data collection strategies adapted to the current cannabis environment and inform the design of a multicentre prospective birth cohort. Methods and analysis We will establish a pregnancy and birth cohort of 50 cannabis users and 50 non-users recruited before delivery. We will follow the participants at regular visits from recruitment to 12 weeks post partum. Participants will provide demographic and socioeconomic data, report their cannabis use patterns, and provide biological samples. Biological samples include maternal and infant urine and blood, breastmilk/chestmilk, cord blood, cord tissue, placenta and meconium. All samples will be processed and stored at −80°C until analysis by immunoassay or liquid chromatography-tandem mass spectrometry to determine the presence of cannabis metabolites. In addition, partners will be invited to provide additional socioeconomic and substance use data. Ethics and dissemination Ethics was obtained from Ottawa Health Science Network Research Ethics Board through Clinical Trials Ontario (3791). Our findings will be published in peer-reviewed journals, presented at scientific conferences and shared broadly with patients, healthcare decision-makers, and project partners online and through social media. Trial registration number NCT05309226 .Cite Now
Computed tomography is recommended as part of the diagnostic investigation for adults with a first generalised epileptic seizure * Data on the effectiveness of such a strategy in identifying patients with treatable lesions are conflicting * This study of 119 patients with a first seizure showed that computed tomography had a high diagnostic yield * Patients without neurological symptoms and who did not misuse alcohol did not have focal lesions on computed tomography * Routine tomography should be performed in most patients but may be unnecessary in those with uncomplicated seizures related to withdrawal of alcohol CONCLUSION Both the diagnostic yield and the resulting interventions justify computed tomography of the brain in most adult patients in casualty departments who have had a first generalised seizure.However, in patients who have uncomplicated seizures related to withdrawal from alcohol-suggested by two or more "yes" answers to the four CAGE questions and by the absence offocal neurological symptoms on clinical examinationcomputed tomography may not be mandatory, which would thus greatly reduce the number of scans that yield no positive diagnosis.
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