Background: The El Sistema movement uses music as a promising tool to promote healthy childhood development and well-being, particularly in children facing socioeconomic challenges. Recognizing the need to better support underprivileged children in their neighborhood, the community-based organization Share the Warmth (STW) created an El Sistema-inspired music program named STW El Sistema. Owing to their program's recent rise in popularity and corresponding costs, STW El Sistema coordinators partnered with McGill University researchers to formally evaluate and better understand the program's effects on participating children. We sought to understand participating children's lived experiences in STW El Sistema, and their perspectives on the program's impact in their lives and on their well-being.
Nonalcoholic steatohepatitis may cause severe fibrosis, cirrhosis, and hepatocellular carcinoma, but supporting evidence is based on indirect data. Few publications have examined the results of repeat liver biopsies to evaluate progression of fibrosis. The aims of this study were to assess rate of fibrosis progression in untreated patients with nonalcoholic steatohepatitis and to identify associated variables. Among 106 patients, a second liver biopsy was proposed to those who had undergone their first liver biopsy at least 3 years before. None of them had been given pharmacological therapy. Liver biopsy samples were evaluated blindly. Variables were compared between patients with (group P) and without (group NP) fibrosis progression, using a Wilcoxon rank-sum test for numerical variables and a difference of two binomial proportions for categorical ones. Twenty-two patients (median age, 45 years; age range, 20-69 years; 13 women; diabetes in 8 patients, obesity in 10 patients) underwent a second liver biopsy 4.3 years (range, 3.0-14.3 years) after the first. Fibrosis progression was found in 7 patients in group P (31.8%), no progression was found in 15 patients in group NP. There were no differences between both groups regarding age, gender, diabetes, hyperlipidemia, ALT levels, AST-to-ALT ratio levels, albumin levels, prothrombin activity, steatosis, or inflammation. Obesity was significantly more prevalent in group P (86%) than in group NP (27%; P =.01). Basal body mass index was higher in group P (median, 33.2; range, 29.1-38.2) than in group NP (median, 29.0; range, 24.0-38.1; P =.024). Time between biopsies was not different between groups. In conclusion, progression of liver fibrosis was found in a third of nonalcoholic steatohepatitis patients 4.3 years after the first liver biopsy, and obesity and body mass index were the only associated factors with such progression.
Introduction In the COVID-19 pandemic, healthcare workers (HCWs) were at high risk of infection due to their exposure to COVID infections. HCWs were the backbone of our healthcare response to this pandemic; every HCW withdrawn or lost due to infection had a substantial impact on our capacity to deliver care. Primary prevention was a key approach to reduce infection. Vitamin D insufficiency is highly prevalent in Canadians and worldwide. Vitamin D supplementation has been shown to significantly decrease the risk of respiratory infections. Whether this risk reduction would apply to COVID-19 infections remained to be determined. This study aimed to determine the impact of high-dose vitamin D supplementation on incidence of laboratory-confirmed COVID-19 infection rate and severity in HCWs working in high COVID incidence areas. Methods and analysis PROTECT was a triple-blind, placebo-controlled, parallel-group multicentre trial of vitamin D supplementation in HCWs. Participants were randomly allocated in a 1:1 ratio in variable block size to intervention (one oral loading dose of 100 000 IU vitamin D 3 +10 000 IU weekly vitamin D 3 ) or control (identical placebo loading dose+weekly placebo). The primary outcome was the incidence of laboratory-confirmed COVID-19 infection, documented by RT-qPCR on salivary (or nasopharyngeal) specimens obtained for screening or diagnostic purposes, as well as self-obtained salivary specimens and COVID-19 seroconversion at endpoint. Secondary outcomes included disease severity; duration of COVID-19-related symptoms; COVID-19 seroconversion documented at endpoint; duration of work absenteeism; duration of unemployment support; and adverse health events. The trial was terminated prematurely, due to recruitment difficulty. Ethics and dissemination This study involves human participants and was approved by the Research Ethics Board (REB) of the Centre hospitalier universitaire (CHU) Sainte-Justine serving as central committee for participating institutions (#MP-21-2021-3044). Participants provided written informed consent to participate in the study before taking part. Results are being disseminated to the medical community via national/international conferences and publications in peer-reviewed journals. Trial registration number https://clinicaltrials.gov/ct2/show/NCT04483635 .
It has been described as bacterial infections (BIs) due to multidrug-resistant bacteria (MRB) in cirrhosis with acute decompensation (AD), with a potentially poor prognosis. This study aimed to determine the frequency of BIs due to MRB in a tertiary centre and its association with mortality. This is a prospective cohort study. Cirrhotics with AD were enrolled. At admission, polymorphonuclear leukocytes (PMN) count was performed in ascites patients. Blood, urine and fluids cultures were collected in patients with encephalopathy, ascites, digestive bleeding or because of IBs suspicion. Sample cultures were repeated during hospitalization when necessary. BIs diagnosis was established based on international consensus. Association among data versus BIs diagnosis was assessed through respective hypothesis testing. Data association with mortality was verified through univariate/multivariate logistic regression: Odds Ratio (OR), 95% confidence interval (CI). 327 males, median age of 56. Child-Pugh A, B and C were estimated in 22, 197, and 214 cases, respectively, median MELD of 16. BIs were diagnosed in 212/433 (49%) inpatients: 128/212 community-acquired (CA) infections, 22/212 healthcare-associated (HCA) infections and 62 nosocomial infections. The most frequent BIs were spontaneous bacterial peritonitis in 69/212 cases, followed by 59/212 respiratory tract infections and 29/212 urinary tract infections. Bacterial isolation was obtained in 108/212 BIs: 35/108 (32.4%) were MRB. MRB was more frequent in cases with HCA (53%) and nosocomial (41%) infections compared with CA (22%) infections; (P=.0279). Mortality was 17.6% in patients without BIs, 28.8% in non-isolation BIs, 24.7% in non-MRB BIs and 51.4% in BIs due to MRB (P<.001). Multivariate analysis showed that mortality was significantly associated with Child-Pugh C, acute kidney injury, but mainly with MRB BIs (OR 4.41; 95% CI 1.94-10.2; P<.001). MRB frequency was 32.4% among BIs with bacterial isolation. It represents an independent predictor for inpatient mortality.
The advent of the genomic age has created a rapid increase in complexity for the development and selection of drug treatments. A key component of precision medicine is the use of genetic information to improve therapeutic effectiveness of drugs and prevent potential adverse drug reactions. Pharmacoepidemiology, as a field, uses observational methods to evaluate the safety and effectiveness of drug treatments in populations. Pharmacoepidemiology by virtue of its focus, tradition, and research orientation can provide appropriate study designs and analysis methods for precision medicine. The objective of this manuscript is to demonstrate how pharmacoepidemiology can impact and shape precision medicine and serve as a reference for pharmacoepidemiologists interested in contributing to the science of precision medicine. This paper depicts the state of the science with respect to the need for pharmacoepidemiology and pharmacoepidemiological methods, tools and approaches for precision medicine; the need for and how pharmacoepidemiologists use their skills to engage with the precision medicine community; and recommendations for moving the science of precision medicine pharmacoepidemiology forward. We propose a new integrated multidisciplinary approach dedicated to the emerging science of precision medicine pharmacoepidemiology.
Introduction Overweight children with asthma may display impaired response to inhaled corticosteroids (ICS), possibly due to non-eosinophilic inflammation or weight-related lung compression; these mechanisms may differentially affect response to ICS and leukotriene receptor antagonists (LTRAs). We assessed whether weight status modified the response to low-dose ICS and LTRA Step-2 monotherapy. Methods A historical cohort study from clinical data linked to administrative databases was conducted among children aged 2–18 years with specialist-diagnosed asthma who were initiating or continuing a Step-2 monotherapy from 2000 to 2007 at the Montreal Children’s Hospital Asthma Centre. The outcome was time-to-management failure defined as any step-up in therapy, acute care visit, hospitalisation or oral corticosteroids for asthma, whichever occurred first. The independent and joint effects of weight status (body mass index [BMI] percentile) and time-varying treatment on time-to-management failure were estimated with marginal structural Cox models. The likelihood ratio test (LRT) and relative excess risk due to interaction (RERI) were computed to assess treatment effect modification by weight status on the multiplicative and additive scales. Results Of the 433 and 85 visits with a low-dose ICS and LTRA prescription, respectively, 388 management failures occurred over 14 529 visit-weeks of follow-up. Children using LTRA compared with low-dose ICS tended to have an overall higher risk of early management failure (HR 1.52; 95% CI 0.72 to 3.22). Irrespective of treatment, the hazard of management failure increased by 5% (HR 1.05; 95% CI 1.01 to 1.10) for every 10-unit increase in BMI percentile. An additional hazard reduction of 17% (HR 0.83; 95% CI 0.70 to 0.99) was observed for every 10-unit increase in BMI percentile among LTRA users, but not for ICS (HR 0.95; 95% CI 0.86 to 1.04). The LRT indicated a departure from exact multiplicativity (p<0.0001), and the RERIs for ICS and LTRA were −0.05 (95% CI −0.14 to 0.05) and −0.52 (95% CI −1.76 to 0.71). Conclusions Weight status was associated with earlier time-to-management failure in children prescribed Step-2 therapy. This hypothesis-generating study suggests that LTRA response increases in children with higher BMI percentiles, although further research is warranted to confirm findings.
In adults, chronic exposure to air pollution is associated with elevated blood pressure, but few studies have examined this relationship in youth. We investigated the association between annual ambient concentrations of air pollutants (fine particulate matter [PM2.5] and nitrogen dioxide [NO2]) and systolic blood pressure (SBP) among adolescents in Montréal, Canada.Participants were students aged 15 to 17 years who provided SBP and residential postal code data in 2004/05 through their enrolment in the Nicotine Dependence in Teens study. Annual estimates for 2004 of residential exposure to NO2 and PM2.5 were provided by the Canadian Urban Environmental Health Research Consortium and linked to participants' residential postal code. Elevated SBP was defined as SBP ≥ 90th percentile adjusted for age, sex and height. Logistic regression was used to estimate odds ratios and 95% confidence intervals (CIs) for each pollutant with respect to elevated SBP, adjusted for relevant confounders.The sample consisted of 508 adolescents (mean age: 16.9, 46% male); 4% had elevated SBP. Although estimates were not statistically significant, there were generally modest positive associations between pollutant levels and SBP. The adjusted prevalence odds ratio of elevated SBP was 1.33 (95% CI: 0.64, 3.05) for every interquartile range (IQR) increase in residential PM2.5 levels (2.1μg/m3). Similarly, the adjusted prevalence odds ratio of elevated SBP was 1.17 (95% CI: 0.47, 2.70) for every IQR increase in residential NO2 levels (10.2 ppb).Findings support a possible relationship between exposure to air pollutants and increased SBP in adolescents, warranting further investigation for this important public health concern.Chez l’adulte, l’exposition chronique à la pollution atmosphérique est associée à une élévation de la pression artérielle, mais peu d’études ont porté sur ce lien chez les jeunes. Nous avons étudié l’association entre les concentrations ambiantes annuelles de polluants atmosphériques (particules fines [PM2,5] et dioxyde d’azote [NO2]) et la pression artérielle systolique (PAS) chez des adolescents à Montréal (Canada).Les participants étaient des élèves de 15 à 17 ans ayant fourni des données sur leur PAS et le code postal de leur lieu de résidence en 2004-2005 dans le cadre de l’étude sur la dépendance à la nicotine chez les adolescents (NICO). Les estimations annuelles de l’exposition résidentielle au NO2 et aux PM2,5 pour 2004, fournies par le Canadian Urban Environmental Health Research Consortium, ont été couplées au code postal du lieu de résidence des participants. La PAS a été jugée élevée lorsqu’elle était supérieure ou égale au 90e percentile ajusté pour l’âge, le sexe et la taille. Une régression logistique a servi à estimer les rapports de cotes et les intervalles de confiance (IC) à 95 % pour l’association entre chaque polluant et une PAS élevée, avec ajustement pour les variables de confusion pertinentes.L’échantillon comprenait 508 adolescents (âge moyen : 16,9 ans; 46 % étant de sexe masculin), dont 4 % avec une PAS élevée. Même si les estimations ne sont pas statistiquement significatives, des associations positives généralement modestes ont été constatées entre les concentrations de polluants et la PAS. Le rapport de cotes ajusté de la prévalence d’une PAS élevée était de 1,33 (IC à 95 % : 0,64 à 3,05) par augmentation de chaque intervalle interquartile (IIQ) de concentration résidentielle de PM2,5 (2,1 μg/m3). De même, le rapport de cotes ajusté de la prévalence d’une PAS élevée était de 1,17 (IC à 95 % : 0,47 à 2,70) par augmentation de chaque IIQ de concentration résidentielle de NO2 (10,2 ppb).Les résultats corroborent l’existence d’un lien possible entre l’exposition aux polluants atmosphériques et l’élévation de la PAS chez les adolescents, ce qui justifie une analyse approfondie portant sur cet important problème de santé publique.Our cohort study investigated the relation between air pollution exposure and systolic blood pressure in a Quebec adolescent population. Adolescents living in more polluted areas reported lower levels of physical activity and greater cigarette use in the past three months, and had greater material and social deprivation, than those living in the less polluted areas. Results cannot exclude a meaningful association between long-term exposure to air pollution and the prevalence of elevated systolic blood pressure in Montréal adolescents.Cette étude de cohorte porte sur le lien entre l’exposition à la pollution atmosphérique et la pression artérielle systolique au sein d’un échantillon pleinement représentatif de la population adolescente québécoise. Par rapport aux adolescents vivant dans les quartiers moins pollués, les adolescents vivant dans les quartiers plus pollués ont fait état d’un niveau d’activité physique inférieur et d’une consommation de cigarettes supérieure au cours des trois mois précédant l’étude, et ils étaient davantage défavorisés sur le plan matériel et social. D’après nos résultats, on ne peut exclure l’existence d’une association significative entre l’exposition à long terme à la pollution atmosphérique et la prévalence d’une pression artérielle systolique élevée chez les adolescents montréalais.
This paper defends the ethical and empirical significance of direct engagement with terminally ill children and adolescents in PPC research on health-related quality of life. Clinical trials and other forms of health research have resulted in tremendous progress for improving clinical outcomes among children and adolescents diagnosed with a life-threatening illness. Less attention has been paid, however, to engaging this patient population directly in studies aimed at optimizing health-related quality of life in PPC. Though not restricted to care at the end of life, PPC—and by extension PPC research—is in part dependent on recognizing the social complexities of death and dying and where health-related quality of life is a fundamental element. To explore these complexities in depth requires partnership with terminally ill children and adolescents, and acknowledgement of their active social and moral agency in research. Principles of pediatric research ethics, theoretical tenets of the "new sociology of the child(hood)," and human rights codified in the United Nations Convention on the Rights of the Child (UNCRC) underpin the position that a more engagement-centered approach is needed in PPC research. The ethics, sociologies and human rights of engagement will each be discussed as they relate to research with terminally ill children and adolescents in PPC. Qualitative method(ologies) presented in this paper, such as deliberative stakeholder consultations and phenomenology of practice can serve as meaningful vehicles for achieving i) participation among terminally ill children and adolescents; ii) evidence-bases for PPC best practices; and iii) fulfillment of research ethics principles. PPC research based on direct engagement with PPC patients better reflects their unique expertise and social epistemologies of terminal illness. Such an approach to research would strengthen both the ethical and methodological soundness of HRQoL inquiry in PPC.
Il testo Les Bijoux e stato pubblicato per la prima volta sul giornale Gil Blas il 27 marzo 1883 e, un anno dopo, e stato inserito nella raccolta intitolata Clair de lune. Si tratta di una novella di poche pagine la cui storia si svolge a Parigi. Si compone di cinque parti che svolgono un ruolo fondamentale nella costruzione del suo schema. Nella prima parte Maupassant presenta il tema dell’incontro romantico e di un matrimonio combinato; nella seconda, ci offre l’immagine della donna mascher...
