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Supplemental material, sj-docx-1-psg-10.1177_22925503231161067 for Patient Factors Associated With Increased Cancer Worry, Fatigue, and Impact on Work Following a Breast Cancer Diagnosis: A Cross-Sectional Analysis by Sophocles H. Voineskos, Lucas Gallo, Manraj Kaur, Elena Tsangaris, Lauren Griffith, Jonas A. Nelson, Anne F. Klassen and Andrea L. Pusic in Plastic Surgery

Additional file 2. a: Predictors of loneliness during the COVID-19 pandemic, adjusted for pre-pandemic loneliness and participant characteristics in the pre-pandemic period using an alternative cut-off value “≥4”. b: Predictors of loneliness during the COVID-19 pandemic, adjusted for pre-pandemic loneliness and participant characteristics in the pre-pandemic period using an alternative cut-off value “≥6”. c: Predictors of loneliness during the COVID-19 pandemic, adjusted for pre-pandemic loneliness and participant characteristics in the pre-pandemic period using lagged linear regression. d: Predictors of ln(loneliness) during the COVID-19 pandemic, adjusted for pre-pandemic ln(loneliness) and participant characteristics in the pre-pandemic period using lagged linear regression.

Supplemental material, sj-docx-1-psg-10.1177_22925503231161067 for Patient Factors Associated With Increased Cancer Worry, Fatigue, and Impact on Work Following a Breast Cancer Diagnosis: A Cross-Sectional Analysis by Sophocles H. Voineskos, Lucas Gallo, Manraj Kaur, Elena Tsangaris, Lauren Griffith, Jonas A. Nelson, Anne F. Klassen and Andrea L. Pusic in Plastic Surgery

Additional file 1. a: Comparison of sociodemographic and health characteristics of the CLSA Baseline cohort and participants completing the COVID-19 Exit Questionnaire. b: Comparison of sociodemographic and health characteristics from CLSA Follow-up1 for participants who completed the COVID-19 Exit questionnaire (n=24,114) and participants who did not completethe COVID-19 Exit questionnaire (n=18,343).

Background The Coronavirus Disease-2019 (COVID-19) pandemic has created a spectrum of adversities that have affected older adults disproportionately. This paper examines older adults with multimorbidity using longitudinal data to ascertain why some of these vulnerable individuals coped with pandemic-induced risk and stressors better than others – termed multimorbidity resilience. We investigate pre-pandemic levels of functional, social and psychological forms of resilience among this sub-population of at-risk individuals on two outcomes – self-reported comprehensive pandemic impact and personal worry. Methods This study was conducted using Follow-up 1 data from the Canadian Longitudinal Study on Aging (CLSA), and the Baseline and Exit COVID-19 study, conducted between April and December in 2020. A final sub-group of 9211 older adults with two or more chronic health conditions were selected for analyses. Logistic regression and Generalized Linear Mixed Models were employed to test hypotheses between a multimorbidity resilience index and its three sub-indices measured using pre-pandemic Follow-up 1 data and the outcomes, including covariates. Results The multimorbidity resilience index was inversely associated with pandemic comprehensive impact at both COVID-19 Baseline wave (OR = 0.83, p&thinsp

Objectives: This scoping review aims to understand the extent and type of evidence about preclinical mobility limitation (PCML) intervention studies that have been implemented in middle age and older adult populations. Introduction: Individuals with PCML could be at a high risk of future functional losses and progression to disability. Interventions implemented effectively in the preclinical stage might be beneficial to preventing or delaying disability progression. An overview of studies undertaken on this emerging topic is now due. Inclusion criteria: Rehabilitation intervention studies that measure PCML outcomes or assess individuals at the stage of PCML will be included. Studies will be considered if the participants are middle-aged (45-64yrs) or older adults (≥ 65yrs) in any setting, including community-dwelling, hospital discharges, or institutional settings. Methods: A search will be conducted in seven databases (MEDLINE, EMBASE, AMED, PsycINFO, CINAHL, Web of Science and Cochrane CENTRAL) to locate relevant intervention studies (English publications from inception onwards). The search strategy will be generated using the PCC framework (population, concept, context) and refined after consulting with a McMaster research librarian. In addition, a manual search from the reference list of retrieved papers and review articles will also be performed. Two reviewers will use predefined inclusion/exclusion criteria to independently review titles, abstracts, and full texts of potential articles. Any disagreements on study selection will be resolved by discussion or consensus involving a third reviewer. Data will be collected and reported according to a predefined data extraction chart and described using qualitative content analysis. Keywords: preclinical mobility limitation; middle-aged; older adults; intervention

Background Family and friend caregivers play significant roles in advocating for and ensuring quality health and social care of residents in Assisted Living (AL) homes. However, little is known about how the COVID-19 pandemic and related visitor restrictions affected their health and mental well-being. We examined the prevalence and correlates of anxiety and depressive symptoms among caregivers of AL residents during the initial wave of COVID-19 in two Canadian provinces. Methods A cross-sectional web-based survey was conducted among family/friend caregivers of AL residents in Alberta and British Columbia (Oct 28, 2020—Mar 31, 2021) to collect data on their sociodemographic, health and caregiving characteristics, as well as concerns about residents’ health and social care before and during the first wave of the pandemic. A clinically significant anxiety disorder and depressive symptoms were assessed with the GAD-7 and CES-D10 instruments, respectively. Separate multivariable (modified) Poisson regression models identified caregiver correlates of each mental health condition. Results Among the 673 caregivers completing the survey (81% for Alberta residents), most were women (77%), white (90%) and aged ≥ 55 years (81%). Clinically significant anxiety and depression were present in 28.6% and 38.8% of caregivers respectively. Both personal stressors (comorbidity level, income reduction, low social support) and caregiving stressors exacerbated by the pandemic were independently associated with caregiver anxiety and depression. The latter included increased concern about the care recipients’ depression (adjusted risk ratio [adjRR] = 1.84, 95% confidence interval [CI] 1.19–2.85 for caregiver anxiety and adjRR = 1.75, 95% CI 1.26–2.44 for caregiver depressive symptoms) and reported intention to withdraw the resident from AL because of COVID-19 (adjRR = 1.24, 95%CI 0.95–1.63 for caregiver anxiety and adjRR = 1.37, 95%CI 1.13–1.67 for caregiver depressive symptoms). Conclusions Caregivers of residents in AL homes reported significant personal and caregiving-related stressors during the initial wave of COVID-19 that were independently associated with an increased likelihood of experiencing clinically significant anxiety and depressive symptoms. Healthcare providers and AL staff should be aware of the prevalence and varied correlates of caregivers’ mental health during public health crises so that appropriate screening and support may identified and implemented.

COVID-19 has negatively affected the mental health and well-being of adults, and thus it is important to examine potential factors which may influence mental health during the pandemic. We thus examined the association between pet ownership and depression/anxiety symptoms based on mental health disorder status during the COVID-19 pandemic. We included 12,068 cognitively healthy participants (45–86 years at study entry) from the Canadian Longitudinal Study on Aging (CLSA) comprehensive cohort who completed the first follow-up ([FU1]; 2015–2018), and COVID-19 Survey entry (April–May 2020) and exit (September-December 2020). Participants self-reported at FU1 if they owned a pet (yes/no). Participants were dichotomized as with or without a mental health disorder based on self-reported diagnosis of depression, anxiety, or mood disorders at baseline assessment (2011–2015) or FU1. Depressive symptoms were indexed using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) at FU1, and COVID-19 entry/exit surveys. Anxiety symptoms were assessed using the General Anxiety Disorder Questionnaire (GAD-7) at COVID-19 entry/exit surveys. Final models adjusted for age, sex, body mass index, income, education, living status, smoking status, relationship status, and alcohol intake. Forty-percent of participants owned a pet at FU1. Among those without a mental health disorder, there were no significant differences in CESD-10 between participants who owned pets compared with those without pets. For people with a mental health disorder, pet owners had higher CESD-10 (estimated mean difference range: 0.56–1.02 points; p < 0.05) and GAD-7 scores (estimated mean difference range: 0.28–0.57 points; p < 0.05) at both COVID-19 entry and exit surveys. Among people with mental health disorders, pet ownership was associated with poor mental health symptoms during April 2020 to December 2020 of the COVID-19 pandemic.

Inflammatory biomarkers may be associated with disease severity and increased mortality in COVID-19 patients but have not been studied in North American populations. We sought to determine whether a set of commonly ordered inflammatory biomarkers can predict 28-day mortality. We analyzed a multi-centered (four) COVID-19 registry cohort from March 4th to December 7th, 2020. This cohort included COVID-19-positive patients admitted to medical wards or intensive care units. Patients presenting to the emergency department for COVID-19 symptoms and then subsequently discharged were also included. We performed Cox-regression analysis to measure whether commonly used biomarkers were associated with an increased 28-day mortality. Of 336 COVID-19-positive patients, 267 required hospital admission, and 69 were seen in the emergency room and discharged. The median age was 63 years (IQR 80–50) and the female-to-male ratio was 49:51. Derivation of internally validated cut-offs suggested that C-reactive protein ≥ 78.4 mg/L, neutrophil-to-lymphocyte ratio ≥ 6.1, lymphocyte-to-white blood cell ratio

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Additional file 1. Interaction effect figures.

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Additional file 1: Table S1. STROBE guidelines for reporting observational (cross-sectional) studies. Table S2. Descriptionof AL in Alberta and British Columbia, Canada. Table S3. Distribution of AL caregiver characteristics, overall and by missing responses for clinically significant anxiety disorder and depressive symptoms. Table S4. Adjusted risk ratios (95% confidence interval) for clinically significant anxiety disorder and depressive symptoms associated with AL caregiver characteristics [following Multiple Imputation of Missing Data].

Additional file 1.

Supplemental material, sj-pdf-1-crd-10.1177_14799731221079305 for Factors associated with participation in life situations in people with COPD by Cassandra D���Amore, Sachi O���Hoski, Lauren E Griffith, Julie Richardson, Roger S Goldstein and Marla K Beauchamp in Chronic Respiratory Disease

Supplemental material, sj-pdf-1-crd-10.1177_14799731221079305 for Factors associated with participation in life situations in people with COPD by Cassandra D���Amore, Sachi O���Hoski, Lauren E Griffith, Julie Richardson, Roger S Goldstein and Marla K Beauchamp in Chronic Respiratory Disease

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Additional file 1: Supplemental Fig. 1. Study cohort creation including Ontario participants of the Canadian Community Health Survey cycles 3–5 who consented to administrative data linkage; CCHS, Canadian Community Health Survey, CC, chronic conditions

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Supplemental Material, sj-pdf-1-ijq-10.1177_16094069211050166 for The Relationship Between Multimorbidity and Self-Reported Health Among Community-Dwelling Older Adults and the Factors that Shape This Relationship: A Mixed Methods Study Protocol Using CLSA Baseline Data by Carly Whitmore, Maureen Markle-Reid, Kathryn Fisher, Jenny Ploeg, Carrie McAiney, Lauren Griffith, Susan Phillips and Andrew Wister in International Journal of Qualitative Methods

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Supplemental Material, sj-pdf-2-ijq-10.1177_16094069211050166 for The Relationship Between Multimorbidity and Self-Reported Health Among Community-Dwelling Older Adults and the Factors that Shape This Relationship: A Mixed Methods Study Protocol Using CLSA Baseline Data by Carly Whitmore, Maureen Markle-Reid, Kathryn Fisher, Jenny Ploeg, Carrie McAiney, Lauren Griffith, Susan Phillips and Andrew Wister in International Journal of Qualitative Methods

Additional file 4. Remaining Stratified Figures for Odds of Hospitalization.

Additional file 9.

Purpose: The purpose of this study was to assess whether there was an association between care-recipient relationship type and the QoL of older adults and their informal caregivers, and whether this association pertained to older adults’ cognitive function. Methods: This was a secondary data analysis. Older adults (n=1230) and their informal caregivers (n=1871) were identified from participants in the National Health and Aging Trends Study (NHATS) Round 5 and the National Study of Caregiving (NSOC) II. A series of bivariate and multivariable regression models examined the associations among the care-recipient relationship type and QoL in older adults and their informal caregivers, adjusted for socio-demographic variables as well as cognitive functioning. Results: Both older adults and caregivers’ QoL outcomes varied by the type of relationship. Recipients cared for by adult-child caregivers or multiple caregivers experienced higher functional limitation than those cared by spousal caregivers (β=.79, CI [.39, 1.19]; β=.50, CI [.17, .82], respectively). “Other” caregivers, such as siblings, friends, etc., had lower odds of experiencing negative emotional burden than spousal caregivers (OR=.26, CI [.13, .52]; OR=.53, CI [.35, .81], respectively). "Other" caregivers were also 51% less likely to experience social strain than spousal caregivers. Lower odds of experiencing negative emotional burdens were also found with multiple caregivers. The association between adult-child caregivers and social strain was explained by the recipients’ cognitive function. Conclusions: Care-recipient relationship type impacts the QoL in both recipients and their informal caregivers. This association appears to be affected by care recipients' cognitive function level.

Osteoarthritis (OA) is the most prevalent joint disease and is a leading cause of disability, particularly amongst the elderly. OA is caused by articular cartilage degradation. Hyaline articular cartilage covers the ends of bones and enables the smooth articulation of joints by reducing friction and functioning as a shock absorber. Articular cartilage is susceptible to damage and due to its avascular phenotype, self-repair is limited. Current early intervention strategies, including autologous chondrocyte implantation, typically produce fibrous rather than hyaline cartilage and frequently fail to provide a long-term solution. Most patients ultimately require total joint replacement surgery, a late stage treatment option that carries appreciable risks. An alternative early intervention treatment that focusses on replacing damaged tissue with hyaline cartilage is required; tissue engineering provides a platform to move from cell- to tissue-based treatments and facilitates the in vitro generation of hyaline tissue for cartilage repair. Human embryonic stem cells (hESCs) are pluripotent and therefore have the potential todifferentiate into cells from all three germ layers. They can also proliferate indefinitely in vitro without showing signs of cellular senescence. hESCs therefore overcome many of the limitations associated with primary chondrocytes and adult stem cells.This study demonstrates the generation of a successful and highly reproducible protocol for the generation of hESC-derived cartilage. hESC-derived chondrocytes formed mechanically-stable hyaline-like cartilage in pellet culture that was able to repair a partial-thickness defect in ex-vivo organotypic culture. Furthermore, co-culture of hESC-derived cartilage pellets with native cartilage enabled the generation of previously unattainable volumes of healthy hyaline-like cartilage, exceeding 6mm in diameter. In conclusion, this thesis demonstrates the scaffold-free generation of healthy, hyaline tissue engineered cartilage on a scale that has not previously been demonstrated. Use of hESC-derived chondrocytes has overcome limitations of scale-up and has enabled the development of bioengineered cartilage of clinically relevant proportions. This work provides compelling evidence for the use of hESC-derived cartilage in the development of new treatments for cartilage damage.

Supplemental_Table_A1 for Self-management program versus usual care for community-dwelling older adults with multimorbidity: A pragmatic randomized controlled trial in Ontario, Canada by Kathryn Fisher, Maureen Markle-Reid, Jenny Ploeg, Amy Bartholomew, Lauren E Griffith, Amiram Gafni, Lehana Thabane and Marie-Lee Yous in Journal of Comorbidity

The R software has become popular among researchers due to its flexibility and open-source nature. However, researchers in the fields of public health and epidemiological studies are more customary to commercial statistical softwares such as SAS, SPSS and Stata. This paper provides a comprehensive comparison on analysis of health survey data using the R survey package, SAS, SPSS and Stata. We describe detailed R codes and procedures for other software packages on commonly encountered statistical analyses, such as estimation of population means and regression analysis, using datasets from the Canadian Longitudinal Study on Aging (CLSA). It is hoped that the paper stimulates interest among health science researchers to carry data analysis using R and also serves as a cookbook for statistical analysis using different software packages., Comment: There is a data usage issue with the paper and it is requested by the data owner (CLSA) to withdraw the paper at this time

Additional file 1: Supplemental Table 1. List of Chronic Conditions. Supplemental Table 2. Group Differences in Outcomes (Complete Case Analysis).

OBJECTIVE: To determine if multimorbidity is associated with functional status, and to assess if multimorbidity predicts declining functional status over a 5-year time frame, after accounting for baseline functional status and other potential confounding factors. DESIGN: Analysis of an existing population-based cohort study. SETTING: Manitoba. PARTICIPANTS: Community-dwelling adults aged 65 and older. MAIN OUTCOME MEASURES: Age, sex, education, and the Mini-Mental State Examination (MMSE) and Center for Epidemiological Studies Depression Scale (CES-D) scores were recorded for each patient. Multimorbidity was measured using a simple tally of self-reported diseases. Function was measured using the Older Americans Resources and Services scale in 1991 to 1992 and again 5 years later. Good or excellent level of function was compared with level of disability (mild or moderate or higher). Cross-sectional and prospective analyses were conducted. RESULTS: In a cross-sectional analysis, multimorbidity predicted disability. The unadjusted odds ratio (OR) (95% CI) for disability was 1.45 (1.39 to 1.52) for each additional chronic illness. In models adjusting for age, sex, education, and MMSE and CES-D scores, the adjusted OR (95% CI) was 1.35 (1.29 to 1.42) for each additional chronic illness. Multimorbidity also predicted disability 5 years later. The unadjusted OR (95% CI) was 1.31 (1.24 to 1.38). In models adjusting for age, sex, education, and MMSE and CES-D scores in addition to baseline functional status, the adjusted OR (95% CI) was 1.15 (1.09 to 1.24). CONCLUSION: Multimorbidity predicts disability in cross-sectional and prospective analyses.

Supplemental material, Zoratti_-_HHCMP_Supplement for A Profile of Older Adults With a History of Stroke Receiving Home Care in Ontario, Canada by Michael J. Zoratti, Kathryn Fisher, Dawn Guthrie and Lauren E. Griffith in Home Health Care Management & Practice

Additional file1. Digital Content 1. Risk Perception Questionnaire.

Additional file 2. Digital Content 2. Sample size calculation.

Diagnostic Definitions for Index Conditions (Diabetes, Dementia, Stroke) and Co-morbid Conditions. (DOCX 22 kb)

Supplemental Material, JOC_Expert_Panel_Journal_of_Comorbidity_Supplemental_Appedix_1 for Key factors to consider when measuring multimorbidity: Results from an expert panel and online survey by Lauren E Griffith, Andrea Gruneir, Kathryn A Fisher, Kathryn Nicholson, Dilzayn Panjwani, Christopher Patterson, Maureen Markle-Reid, Jenny Ploeg, Arlene S Bierman, David B Hogan, and Ross Upshur in Journal of Comorbidity

Supplemental Material, JOC_Expert_Panel_Journal_of_Comorbidity_Supplemental_Appedix_2 for Key factors to consider when measuring multimorbidity: Results from an expert panel and online survey by Lauren E Griffith, Andrea Gruneir, Kathryn A Fisher, Kathryn Nicholson, Dilzayn Panjwani, Christopher Patterson, Maureen Markle-Reid, Jenny Ploeg, Arlene S Bierman, David B Hogan, and Ross Upshur in Journal of Comorbidity

Background Minor fractures (e.g. wrist, ankle) are risk factors for lower physical health-related quality of life (HRQoL) in seniors. Recent studies found that measures of frailty were associated with decreased physical and mental HRQoL in older people. As most people with minor fractures go to emergency departments (EDs) for treatment, measuring their frailty status in EDs may help stratify their level of HRQoL post-injury and provide them with appropriate health care and services after discharge. This study thus examines the HRQoL of seniors visiting EDs for minor fractures at 3 and 6 months after discharge, according to their frailty status. Methods This prospective sub-study was conducted within the larger Canadian Emergency Team Initiative (CETI) cohort. Independent seniors (≥65 years) were recruited in 7 Canadian EDs after treatment for various minor fractures. Frailty status in the ED phase was assessed by the Canadian Study of Health and Aging--Clinical Frailty Scale (CSHA-CFS). The SF-12 questionnaire was completed at 3 and 6 months after ED discharge to ascertain HRQoL. Demographic and clinical data were collected. Linear mixed models were used to test for differences between frailty levels and HRQoL outcomes, controlling for confounding variables and repeated measures over time. Results The sample comprised 334 participants with minor fractures. Prevalence of frailty was as follows: 56.6 % very fit-well; 32.3 % well with treated comorbidities-apparently vulnerable; and 11.1 % mildly-moderately frail. After adjusting for confounding variables, the frailest group showed significantly lower mean HRQoL scores than the fittest group on the physical scale at 3 months (49.3 ± 3.7 vs 60.9 ± 2.0) and 6 months (48.7 ± 3.8 vs 61.1 ± 1.8), as well as on the mental scale at 3 months (59.5 ± 4.4 vs 69.6 ± 1.9). Analyses exploring differences in proportion of patients with HRQoL

The process used to generate a Goal Attainment Scaling (GAS) Score [53, 90]. (DOC 62 kb)

Study flow and planned timeline. (DOC 69 kb)

Cost-effectiveness plan. (DOCX 12 kb)

Screenshot of virtual learning center login page and training modules. (DOC 439 kb)