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This study documented the provision of services and issues experienced by community organizations supporting older adults and caregivers in the province of Quebec during the coronavirus disease (COVID-19) pandemic, as well as promising strategies to adapt the provision of services in this context. A cross-sectional electronic survey using open- and closed-ended questions was conducted in July 2020. Almost three-quarters of the 307 respondents (71.4%) reported having maintained services at least partially throughout the lockdown, and the majority (85.3%) adapted their services. Among key challenges, participants reported difficulties identifying and supporting older adults at greater risk of vulnerability (54.8%), managing health risks for service users (60.2%), and recruiting volunteers (59.5%). Promising strategies included strategies to reach out to older adults and understand their needs (e.g., systematic phone calls) in addition to direct interventions supporting them (e.g., activities promoting social ties); implementing prevention and protection measures; accessing and using technologies; human resources management (e.g., recruiting new volunteers); finding financial support for their organization; developing intersectoral partnerships (e.g., multisectoral crisis cell); and promoting a positive view of older adults. The integration of multiple perspectives from different stakeholders may help identify strategies potentially transferable to other crises in order to meet older adults’ needs.
It is often assumed that emotional eating occurs when an individual is unable to utilise emotion regulation (ER) to cope with stress. In this stress exposure study, we explored whether manipulating participants’ ER strategies (rumination or self-compassion) influenced their stress-related affect and food consumption. Fifty-three adolescents (Mage = 14.72) were included; half of the participants were instructed to use rumination as their ER strategy, and half were instructed to use self-compassion. We could not demonstrate that the ER strategies differently affected stress-related affect. However, we did find that increased Happiness following ER self-compassion predicted reduced High-Fat Sweet food consumption, whereas increased Happiness following ER rumination instead led to greater High-Fat Sweet food consumption. In participants who ruminated, food consumption reduced feelings of Frustration, but not Boredom or Happiness. Post-hoc exploration revealed that only ER self-compassion, not ER rumination, normalised levels of stress-related affect. The results highlight the need for more research into the complex relationship between ER strategies, affect states, and food types in their effect on emotional eating.
This study aimed to identify perinatal and early-life factors associated with trajectories of psychopathic traits across childhood.
Participants were 1631 children (51.5% girls) from the Quebec Longitudinal Study of Child Development. A wide range of perinatal and early-life factors were assessed from pregnancy to age 2.5 years using medical files and mothers’ reports. Psychopathic traits were assessed via teachers’ reports at ages 6, 7, 8, 10, and 12 years. Latent class growth analyses and multinomial logistic regressions controlling for child sex were conducted. Two-way interaction effects between perinatal/early-life factors and child sex were explored.
Four trajectories of psychopathic traits were identified: High-stable (4.48%), Increasing (8.77%), Decreasing (11.46%), and Low-stable (75.29%). A few perinatal factors and most child-level and family-level early-life factors significantly increased the odds of following the High-stable v. the Low-stable trajectory. Higher levels of psychotropic exposures during pregnancy, socioeconomic adversity, child's physical aggression, child's opposition, mother's depressive symptoms, and hostile parenting increased the likelihood of following the Increasing instead of the Low-stable trajectory. Higher socioeconomic adversity, mother's depressive symptoms, and inconsistent parenting were associated with membership to the High-stable instead of the Decreasing trajectory. Most associations were not moderated by child sex.
These results shed light on the perinatal and early-life factors that are associated with specific pathways of psychopathic traits during childhood and suggest that different factors could be targeted to prevent the exacerbation (v. low and stable levels) or the stability at high levels (v. attenuation) of these traits.
Background: As of July 1, 2019, ~18% of all cases in the Ebola virus disease (EVD) outbreak in the Democratic Republic of Congo (DRC) were healthcare-associated (ie, nosocomial) infections (HAIs) and healthcare worker (HCW) infections. Although progress has been achieved, gaps remained in infection prevention and control (IPC), specifically, a need to reinforce standardized, evidence-based IPC practices to effectively address HAIs. The Ministry of Health (MOH), in collaboration with partners, developed an IPC tool kit consisting of >70 documents (ie, terms of reference, standard operating procedures, training modules, etc) to improve HCW IPC knowledge and practices at healthcare facilities among staff. The tool kit incorporated international IPC standards, DRC-specific experiences, and best practices. Thus, it serves as a technical and operational package, covering general guidance (standard precautions) and EVD specific issues. Methods: A decentralized rollout approach was used to disseminate the tool kit content at the various health-system levels over several months. Initially, national-level training of trainers was held, followed by subnational-level training of IPC supervisors and key IPC implementers, and lastly, training of healthcare facility (HCF) IPC focal persons. The 5-day training adhered to the MOH standard of 60% theory and 40% practice. Participants completed evaluations before and after training; changes in knowledge between the pre- and posttraining tests were analyzed and the results of the statistical tests were reported (P < .05 was considered statistically significant). Results: In total, 294 IPC supervisors were trained across 7 subnational commissions. Data were analyzed for 138 participants. Participants were 60.9% IPC supervisors, 8% WASH supervisors, and 31% others. MOH representation was 52.9% The average results before the test were 66% (19.8 of 30), the average posttest results were 72% (21.6 of 30)—a significant improvement. The worst-performing pretest IPC domain was IPC approach, and facility closure was the worst performing for posttest. As of November 11, 15.7% of all cases were HAIs. Conclusions: The IPC training program initiated during an outbreak can increase knowledge and potentially improve practices and confidence. An association with the downward HAI trend is yet to be validated. The MOH anticipates that this tool kit will be the go-to resource for future Ebola outbreaks and that it will be incorporated into the preservice medical curriculum to ensure a resilient heath system.
Proper dietary habits and behaviours are at the heart of maintaining an appropriate nutritional status, an adequate body mass and, as such, avoiding obesity and/ or its comorbidities. A child's diet is highly influenced by the home food environment and upbringing. The aim of the current study was to explore if and how parental feeding practices and eating behaviour are associated with child's eating behaviour and body mass index (BMI).
In 226 Belgian adolescents (10–17y, 51% girls, 10% overweight and 14% underweight) and their parents, eating behaviour was assessed through the Dutch Eating Behaviour Questionnaire. Information on the parental feeding practices was obtained through the Child Feeding Questionnaire and the Comprehensive Feeding Practices Questionnaire. BMI was calculated based on standardised measurements of body height and body weight. Linear regression results, adjusted for age, sex and socioeconomic status, are described below.
Regarding parental eating behaviour, parental external eating enhanced the child's external eating (β = 0.155,p = 0.022), parental restrained eating was associated negatively with the child's emotional (β = −0.214,p = 0.001) and external eating (β = −0.154,p = 0.022), but positively with its restrained eating (β = 0.149,p = 0.022) and BMI (β = 0.183,p = 0.005), while parental emotional eating had no influence. Concerning feeding practices, restriction of the child's access to food and food consumption monitoring, stimulated child's emotional (β = 0.174,p = 0.011; β = 0.173,p = 0.010) and restrained (β = 0.137,p = 0.041; β = 0.159,p = 0.015) eating, and showed a positive association with its BMI (β = 0.143,p = 0.033; β = 0.149,p = 0.023), while allowing the child to make own food choices reduced its external eating (β = −0.169,p = 0.012). Parental pressure to eat (mainly at mealtimes) decreased the child's restrained eating (β = −0.231,p < 0.001) and was negatively associated with its BMI (β = −0.340,p < 0.001). Moreover, child's BMI was inversely related to its external eating (β = −0.207,p = 0.002), but positively to its restrained eating (β = 0.0483,p < 0.001) and to parental healthy modelling (β = 0.192,p = 0.003), involving the child (β = 0.223,p = 0.001) and creating a favourable food environment (β = 0.162,p = 0.013).
Our results confirm the parents' crucial role in the development of their offspring's dietary habits. Mainly parental external eating, restriction and monitoring of the child's access to food have an unfavourable effect, while allowing child's own food choices and parental restrained eating seem beneficial. Rather unexpected associations between healthy food environment, modelling and child involvement with child's BMI might lie in causal dependencies. A longitudinal investigation could further elucidate the reasons for these observations. We recommend that policies and educational programmes on healthy diet and eating behaviour target not only schools and children, but also parents.
New dietary recommendations focus on a plant-based diet. As dietary habits are formed during adolescence, knowledge on determinants of this food choice in this age-group can help prevention campaigns. Since an unbalanced choice in plant-based food might lead to nutrient deficiencies, it is also crucial to detect its association with nutrient intake and nutrient status.
In 2330 adolescents from the European HELENA study in 2006, a healthy plant-based diet index (hPDI) was calculated based on two 24 h recalls. In Belgium, 69 of them were remeasured in 2016 as young adults. The psychosocial determinants nutritional knowledge, advantages, awareness, social support, social norm, self-efficacy, barriers, availability and intention were tested by multiple linear regression. Nutrient status was determined by 16 markers in fasting blood. Linear regressions with hPDI as predictor and nutrient intake/status as outcome were adjusted for age, sex, socio-economic status, BMI, waist circumference, energy-intake, physical activity and smoking.
There was a strong correlation in hPDI after 10 years (Spearman = 0.56, p < 0.001). Determinants for adolescents’ plant-based diet were in descending order being a girl(β = 0.245;p < 0.001), a higher BMI(β = 0.140;p < 0.001), knowing the advantages(β = 0.104;p < 0.001), having availability over healthy food(β = 0.100;p < 0.001), high self-efficacy(β = 0.087;p < 0.001), health awareness(β = 0.072,p = 0.004), younger age(β = -0.048;p = 0.015) and better nutritional knowledge(β = 0.046;p = 0.020). In adolescents, hPDI was associated with lower energy intake, especially less overall fat, cholesterol, saturated fatty acids, mono-unsaturated fatty acids, proteins and mono/di-saccharides but more fibre. In micronutrients, higher intake of calcium, iron, magnesium, potassium, zinc, copper, vitamin A, C, E, K but less vitamin B12 and D were detected. Concerning nutrient status, hPDI was related to higher low-density cholesterol, vitamin D, vitamin C and beta-carotene levels. In adults, hPDI was associated with lower energy intake, especially less overall fat, cholesterol, saturated fatty acids and mono-unsaturated fatty acids but more carbohydrates and fibre, magnesium and vitamin C; while not with nutrient status. Longitudinally, we confirmed the link with intake of more fiber, potassium and less cholesterol. Additionally, a longitudinal positive association with poly-unsaturated fat intake was seen.
Tracking of hPDI over 10 years proved the importance of targeting these determinants in adolescents. The hPDI was indeed generally linked to a healthier dietary intake, especially more fiber, a healthier fat choice and higher vitamin intake except for lower vitamin B12 and D. Nevertheless, the latter two were not reflected in more deficiencies and nutrient status differences were limited.
Psychosocial stressors deriving from socioeconomic disadvantages in adolescents can result in higher metabolic syndrome (MetS) risk. We aimed to examine whether socioeconomic disadvantages were associated with MetS independent of lifestyle and whether there was a dose response relationship between the number of cumulated socioeconomic disadvantages and the risk of MetS.
Materials and Methods:
The present study included 1,037 European adolescents (aged 12.5–17.5) of the 3,528 total HELENA participants. Sociodemographic variables and lifestyle were assessed through self-reported questionnaires. Disadvantaged groups included adolescents with low educated parents, low family affluence, migrant origin, unemployed parents, and from non-traditional families. MetS score was calculated as the sum of sex- and age-specific z-scores of waist circumference, HOMA-IR index, mean of z-scores of diastolic and systolic blood pressure and mean of z-score of HDL-C multiplied by -1 and z-score of TG. A higher score indicates poor metabolic health. Linear mixed-effects models were used to study the association between social disadvantages and MetS risk score. Models were adjusted for sex, age, pubertal status (Tanner stage) and lifestyle (diet quality, physical activity, alcohol consumption and smoking status).
Adolescents with low educated mothers showed a higher MetS score (0.54 [0.09–0.98]; β [99% confidence interval]) compared to high-educated mothers. Adolescents who accumulated more than three disadvantages (0.69 [0.08–1.31]) or with missing information on disadvantages (0.72 [0.04–1.40]) had a higher MetS risk compared to non-socioeconomically disadvantaged groups. Stronger associations between socioeconomic disadvantages and MetS were found in male in comparison with female adolescents.
Out of the studied socioeconomic disadvantages, maternal education is the most important determinant of adolescent's MetS risk independently of sex, age, Tanner stage, smoking status, alcohol consumption, diet quality and physical activity. Social vulnerabilities (migrant background, unemployment status and belonging to a non-traditional family) were not associated with a higher MetS risk in European adolescents. However, we found a dose-response relationship between the number of factors related to social disadvantage and adolescents’ MetS risk with adolescents accumulating three or more socioeconomic disadvantages showing the highest risk. Stronger associations between socioeconomic disadvantages and MetS were found in male compared to female adolescents. Policy makers should focus on low educated families to tackle health disparities.
Psychosocial stress, uncontrolled eating and obesity are three interrelated epidemiological phenomena already present during youth. This broad narrative conceptual review summarises main biological underpinnings of the stress–diet–obesity pathway and how new techniques can further knowledge. Cortisol seems the main biological factor from stress towards central adiposity; and diet, physical activity and sleep are the main behavioural pathways. Within stress–diet, the concepts of comfort food and emotional eating are highlighted, as cortisol affects reward pathways and appetite brain centres with a role for insulin, leptin, neuropeptide Y (NPY), endocannabinoids, orexin and gastrointestinal hormones. More recently researched biological underpinnings are microbiota, epigenetic modifications and metabolites. First, the gut microbiota reaches the stress-regulating and appetite-regulating brain centres via the gut–brain axis. Second, epigenetic analyses are recommended as diet, obesity, stress and gut microbiota can change gene expression which then affects appetite, energy homeostasis and stress reactivity. Finally, metabolomics would be a good technique to disentangle stress–diet–obesity interactions as multiple biological pathways are involved. Saliva might be an ideal biological matrix as it allows metagenomic (oral microbiota), epigenomic and metabolomic analyses. In conclusion, stress and diet/obesity research should be combined in interdisciplinary collaborations with implementation of several -omics analyses.
To investigate whether adherence to the adapted Mediterranean Diet Score for Adolescents (MDS_A) and the adapted Mediterranean Diet Quality Index for Adolescents (KIDMED_A) is associated with better food/nutrient intakes and nutritional biomarkers.
The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study is a cross-sectional study aiming to obtain comparable data on a variety of nutritional and health-related parameters in European adolescents aged 12·5–17·5 years.
Nine European countries.
European adolescents (n 2330) recruited to the HELENA study. Dietary intake was obtained with 24 h dietary recalls, an FFQ and a Food Choices and Preferences questionnaire. MDS_A was calculated as a categorical variable using cut-offs (MDS_A), as a continuous variable (zMDS_A) and with energy adjustments (zEnMDS_A). The KIDMED_A score was also calculated.
Multilevel linear regression analysis showed positive associations for zMDS_A and KIDMED_A with serum levels of vitamin D, vitamin C, plasma folate, holo-transcobalamin, β-carotene and n-3 fatty acids, while negative associations were observed with trans-fatty acid serum levels. For categorical indices, blood biomarkers showed few significant results. zMDS_A and KIDMED_A showed positive associations with vegetables and fruits intake, and negative associations with energy-dense and low-nutritious foods. zMDS_A and KIDMED_A were positively associated with all macronutrients, vitamins and minerals (all P < 0·0001), except with monosaccharides and PUFA for KIDMED_A and cholesterol for both indices (P < 0·05).
zMDS_A and KIDMED_A have shown the strongest associations with the dietary indicators and biomarkers that have been associated with the Mediterranean diet before, and are therefore considered the most appropriate and valid Mediterranean diet scores for European adolescents.
Stakeholders from the innovation field in Québec (Canada) have collectively stressed the need to formalize the process for evaluating innovative technologies in the province. In the context of innovation, and more so for non-pharmaceutical technologies where the pace of development is rapid and the lifecycle short, evidence supporting the added value can be limited and uncertainties are common. Therefore, pragmatic approaches are needed to guide recommendations and to assure that the process is rigorous, transparent and fair.
Inspired by international experiences, the Institut national d'excellence en santé et services sociaux (INESSS) has developed a novel framework, where four types of recommendations are possible (introduction, refusal, limited or conditional introduction). The starting point is an evaluation of the technology's added value, for the patient, the population and the healthcare system, and the identification of uncertainties. The value of addressing uncertainty with further research is assessed, based on the value-of-information theory, and the distinct characteristics of medical devices are taken into account (e.g. learning curve effect, irrecoverable costs and incremental innovation). Those elements interact to support the formulation of recommendations by INESSS’ advisory committee.
The development of the framework was an iterative process supported by the use of the preliminary framework for the assessment of several innovative technologies. Challenges with its use were identified, and led to methodological and operational improvements. So far, the experience with the framework is positive and stakeholders confirm its relevance to support fair and reasonable recommendations for innovations.
In the rapidly changing landscape of innovation, HTA has to adapt to the challenges of assessing technologies in a context of promise and uncertainties. The framework developed by INESSS is a tool for supporting timely and fair value-based decision-making, which will benefit the healthcare system, and the patients and population it serves.
To analyse the Nutritional Knowledge Test (NKT) using Item Response Theory (ITR) analysis and to assess the construct validity of the Nutritional Knowledge Scale (NKTS) and its associations with adolescent food group consumption and nutritional biomarkers.
Multicentre investigation conducted in ten European cities.
Adolescents aged 12·5–17·5 years (n 3215) who completed over 75 % of the NKT.
Factor analysis indicated that the NKT can be analysed with a one-dimensional model. Eleven out of twenty-three items from the NKT presented adequate parameters and were selected to be included in the NKTS. Nutrition knowledge was positively associated with consumption of fruits, cereals, dairy products, pulses, meat and eggs, and fish, as well as with blood concentrations of vitamin C, β-carotene, n-3 fatty acids, holo-transcobalamin, cobalamin and folate; nutrition knowledge was negatively associated with intake of olives and avocado, alcohol and savoury snacks.
The NKTS assessed nutritional knowledge adequately and it is proposed as a new tool to investigate this subject in future studies.
Major depressive disorder (MDD) is underdiagnosed and undertreated in schizophrenia, and has been strongly associated with impaired quality of life.
To determine the prevalence and associated factors of MDD and unremitted MDD in schizophrenia, to compare treated and non-treated MDD.
Participants were included in the FondaMental Expert Centers for Schizophrenia and received a thorough clinical assessment. MDD was defined by a Calgary score ≥6. Non-remitted MDD was defined by current antidepressant treatment (unchanged for >8 weeks) and current Calgary score ≥6.
613 patients were included and 175 (28.5%) were identified with current MDD. MDD has been significantly associated with respectively paranoid delusion (odds ratio 1.8; P = 0.01), avolition (odds ratio 1.8; P = 0.02), blunted affect (odds ratio 1.7; P = 0.04) and benzodiazepine consumption (odds ratio 1.8; P = 0.02). Antidepressants were associated with lower depressive symptoms score (5.4 v. 9.5; P < 0.0001); however, 44.1% of treated patients remained in non-remittance MDD. Nonremitters were found to have more paranoid delusion (odds ratio 2.3; P = 0.009) and more current alcohol misuse disorder (odds ratio 4.8; P = 0.04). No antidepressant class or specific antipsychotic were associated with higher or lower response to antidepressant treatment. MDD was associated with Metabolic syndrome (31.4 v. 20.2%; P = 0.006) but not with increased C-reactive protein.
Antidepressant administration is associated with lower depressive symptom level in patients with schizophrenia and MDD. Paranoid delusions and alcohol misuse disorder should be specifically explored and treated in cases of non-remission under treatment. MetS may play a role in MDD onset and/or maintenance in patients with schizophrenia.
This note proposes a practical way for modelling and projecting health insurance expenditures over short time horizons, based on observed historical data. The present study is motivated by a similar age structure generally observed for health insurance claim frequencies and yearly aggregate losses on the one hand and mortality on the other hand. As an application, the approach is illustrated for German historical inpatient costs provided by the Federal Financial Supervisory Authority. In particular, similarities and differences to mortality modelling are addressed.
During the warmer Holocene Period, two major climatic crises affected the Central African rainforests. The first crisis, around 4000 cal yr BP, caused the contraction of the forest in favor of savanna expansion at its northern and southern periphery. The second crisis, around 2500 cal yr BP, resulted in major perturbation at the forest core, leading to forest disturbance and fragmentation with a rapid expansion of pioneer-type vegetation, and a marked erosional phase. The major driver of these two climatic crises appears to be rapid sea-surface temperature variations in the equatorial eastern Atlantic, which modified the regional atmospheric circulation. The change between ca. 2500 to 2000 cal yr BP led to a large increase in thunderstorm activity, which explains the phase of forest fragmentation. Ultimately, climatic data obtained recently show that the present-day major rise in thunderstorms and lightning activity in Central Africa could result from some kind of solar influence, and hence the phase of forest fragmentation between ca. 2500 to 2000 cal yr BP may provide a model for the present-day global warming-related environmental changes in this region.
Memory strategies help seniors remember information that is essential for the performance of their daily activities and contribute to their independence in the context of declining memory skills. This study aimed to analyze the categories, the diversity, and relevance of memory strategies known by seniors, and to identify individual characteristics that correlated with these variables.
The sample consisted of 294 participants aged 60 and over who decided to take part in a cognitive vitality promotion program. An adapted version of the memory situation questionnaire (Troyer, 2001) was administered to identify the memory strategies that seniors would use in five daily life situations. A scoring grid, also adapted from the questionnaire's original version (Troyer, 2001), was used to quantify the relevance of the strategies that were reported by participants.
All participants mentioned at least once that they would use a strategy from the physical category of memory strategies. Out of a possible range of 26 strategies, participants answered an average of 6.14 (SD = 1.7) different answers across the five situations. Based on expert consensus, 67.7% of the mentioned memory strategies were relevant. Diversity and relevance were significantly higher when trying to remember appointments, things to bring or phone numbers (p ≤ 0.05). The level of education, cognitive skills, and participation in leisure activities were related to diversity and relevance of reported strategies.
Seniors know various and relevant memory strategies to perform daily activities. The advantages of integrating strategies that they already know in cognitive health promotion programs should be considered in further studies.
To describe dietary patterns by applying cluster analysis and to describe the cluster memberships of European children over time and their association with body composition changes.
The analyses included k-means clustering based on the similarities between the relative frequencies of consumption of forty-three food items and regression models were fitted to assess the association between dietary patterns and body composition changes.
Primary schools and pre-schools of selected regions in Italy, Estonia, Cyprus, Belgium, Sweden, Hungary, Germany and Spain.
Participants (n 8341) in the baseline (2–9 years old) and follow-up (4–11 years old) surveys of the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) study.
Three persistent clusters were obtained at baseline and follow-up. Children consistently allocated to the ‘processed’ cluster presented increased BMI (β=0·050; 95 % CI 0·006, 0·093), increased waist circumference (β=0·071; 95 % CI 0·001, 0·141) and increased fat mass gain (β=0·052; 95 % CI 0·014, 0·090) over time v. children allocated to the ‘healthy’ cluster. Being in the ‘processed’–‘sweet’ cluster combination was also linked to increased BMI (β=0·079; 95 % CI 0·015, 0·143), increased waist circumference (β=0·172; 95 % CI 0·069, 0·275) and increased fat mass gain (β=0·076; 95 % CI 0·019, 0·133) over time v. the ‘healthy’ cluster.
Children consistently showing a processed dietary pattern or changing from a processed pattern to a sweet pattern presented the most unfavourable changes in fat mass and abdominal fat. These findings support the need to promote overall healthy dietary habits in obesity prevention and health promotion programmes targeting children.
The current study provided psychometric information on the parent and child version of the Behavioural Inhibition System (BIS)/Behavioural Approach System (BAS) scale. Parent-child agreement was evaluated (N = 217, 7.5 to 14 years, 50% boys). Moreover, absolute and rank order stability of mother-reported BIS/BAS scores over a 2-year period were assessed (N = 207, 5.5 to 11 years at baseline, 49% boys). Only full measurement invariant (sub-)scales were considered in the parent-child agreement and longitudinal stability assessment. Parent and child ratings were found to be measurement invariant but discrepant on BAS Drive and BAS Reward Responsiveness. In younger children, child ratings on BAS Drive tended to be higher than parent ratings, whereas in older children, child ratings tended to be lower than parent ratings. Further, the discrepancy between the BAS Drive ratings of fathers and children was higher than the discrepancy between the BAS Drive ratings of mothers and children. Finally, the study results suggested 2-year absolute and rank order stability of the measurement-invariant, mother-reported BIS and BAS Drive scores in children aged 5.5 to 11 years at baseline.
Objectives: The Quebec Trauma Care Continuum (TCC) was initiated in 1991 with the objective of providing accessible, continuous, efficient, and high quality services for all injury cases in the province.
Methods: The TCC design relied on three key components: (i) the designation of a network of acute care and rehabilitation facilities with specific mandates and responsibilities; (ii) the elaboration of transfer protocols, standing agreements, and governing structures to ensure fluid and optimal patient flow; and (iii) the close monitoring of several indicators to facilitate the continuous evaluation and improvement of the network.
Results: Between 1992 and 2002, in-hospital mortality following major trauma decreased from 51.8 percent to 8.6 percent, followed by an additional 24 percent drop between 1999 and 2012. We also observed a 16 percent decrease in average LOS but no change in the incidence of complications or unplanned readmissions. These changes translate into 186 lives saved per year and cost savings, due to shorter LOS, of 6.3 million CD$ per year. The risk-adjusted incidence of in-hospital mortality following major injury between 2006 and 2012 (7 percent) was the lowest of all Canadian provinces.
Conclusions: Strategic transformation of a network's structure and processes, supported by continuous monitoring of validated quality indicators, can lead to significant and sustainable improvements in clinical outcomes. It is hoped that the Quebec trauma story will inspire other jurisdictions and other healthcare sectors.
The use of modern graphenic materials for improving oxygen barriers in food packaging and anti-corrosion barriers in coatings is explored by compounding and casting graphene nanoplatelets (GNP) with polyethylene (PE) and epoxy (EP). The GNP / PE films show comparable oxygen transmission rates to the neat PE films, indicating that further processing will be necessary to realize the desired enhancements. Early corrosion tests indicate that the GNP / EP coatings are providing more protection than the neat EP coatings on steel. Experiments to expand on these results are underway.