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Objective: People are living longer than ever before. Many arrive at a later stage of life in poor health and with inadequate financial and social resources. The purpose of this paper is to describe people’s general state of preparedness for their future as older persons, identify specific attitudes towards ageing and key characteristics that portend a lesser degree of preparedness, and identify the issues that need greater emphasis. Design: Cross-sectional survey. Setting: 502 adult participants enlisted on an online polling panel in Canada. Methods: Demographics, attitudes towards the future self and ageing and the responses to the ‘Preparedness for the Future Questionnaire’ (Prep-FQ) were analysed. Descriptive statistics were used to highlight overall and domain scores (possible score 0–100). Regression models were used to link key demographic characteristics and attitudes to a lower Prep FQ score. Results: The average age of participants was 54.1 years old (range 30–91). The majority (97%) felt it was important to think about themselves as an older person, yet less than 25% of people regularly spent time thinking about what it would be like for them as an older person. The average score on the Prep FQ was 61.6 (range 25–99). Items with the lowest scores were related to advance serious illness planning (medical care, funeral and legacy planning). Factors associated with a higher Prep FQ score included being female, having more education, thinking about when they are older and feeling positive about themselves as an older person. Conclusion: Helping people think and plan ahead more for healthy ageing may help some people move forward with confidence in creating a long, high-quality life and high-quality death. Helping ‘at-risk’ people plan for serious illness in advance is a high-priority target for improving people’s general state of preparedness for the future.

In this commentary, we respond to Barth and colleagues and critique their premise that Western-based research with population-level administrative data is the best and only valid evidence on which to base child welfare policy and practice changes. We offer an alternative viewpoint on what forms of evidence should be brought to bear as we consider re-envisioning the child welfare system, highlighting the importance of lived experience and the need to consider the evidence regarding all marginalized racial and ethnic groups. We argue that evidence should represent the perspectives of those with lived experience and that collaborative child welfare research can strengthen the validity of analyses and interpretations. We hold that Barth et al. ask and answer the wrong questions. We press for deeper critical reflection, a more nuanced intersectional lens, and urgent action to address structural and institutional racism in the child welfare system.

Multidisciplinary care is recommended for patients with advanced chronic kidney disease (CKD). A formalized, risk-based approach to CKD management is being adopted in some jurisdictions. In Ontario, Canada, the eligibility criteria for multidisciplinary CKD care funding were revised between 2016 and 2018 to a 2 year risk of kidney replacement therapy (KRT) greater than 10% calculated by the 4-variable Kidney Failure Risk Equation (KFRE). Implementation of the risk-based approach has led to the discharge of prevalent CKD patients.The primary objective of this study was to determine the frequency of occurrence of death and KRT initiation in patients discharged from CKD clinic.Retrospective cohort study.Single center multidisciplinary CKD clinic in Ontario, Canada.Four hundred and twenty five patients seen at least once in 2013 at the multidisciplinary CKD clinic.Outcomes included discharge status, death, re-referral and KRT initiation. Reasons for discharge were recorded.Outcomes were extracted from available electronic medical records and the provincial death registry between the patient's initial clinic visit in 2013 and January 1, 2020. KFRE-2 scores were calculated using the 4-variable KFRE equation. The hazard rates of death and KRT after discharge due to stable eGFR/low KFRE were compared to patients who remained in the clinic.Of the 425 CKD patients, 69 (16%) and 19 (4%) were discharged to primary care and general nephrology, respectively. Of those discharged, 7 (8%) were re-referred to nephrology or CKD clinic, while only 2 (2%) discharged patients required subsequent KRT. The hazard of mortality was reduced after discharge from the clinic due to stable eGFR/low KFRE (adjusted HR = 0.45 [95% CI, 0.25-0.78,Single center, observational retrospective study design and unknown kidney function over time post discharge for most patients.Discharge of low risk patients from multidisciplinary CKD clinic appears feasible and safe, with fewer than 1 in 40 discharged patients subsequently initiated on KRT over the following 7 years.Des soins multidisciplinaires sont recommandés pour les patients atteints d’insuffisance rénale chronique (IRC) de stade avancé. Une approche officielle de gestion de l’IRC, axée sur le risque, est en cours d’adoption dans certaines juridictions. En Ontario, au Canada, les critères d’admissibilité pour le financement des soins multidisciplinaires d’IRC ont été révisés entre 2016 et 2018 en fonction d’un risque supérieur à 10 % d’amorcer une thérapie de remplacement rénal (TRR) dans les 2 ans (risque calculé par l’équation KFRE [Kidney Failure Risk Equation] à 4 variables). La mise en œuvre de cette approche fondée sur le risque a mené au congé des patients prévalents atteints d’IRC.L’objectif principal de cette étude était de déterminer la fréquence des décès et de l’amorce d’une TRR chez les patients ayant reçu leur congé de la clinique d’IRC.Étude de cohorte rétrospective.Une clinique multidisciplinaire d’IRC de l’Ontario (Canada).425 patients vus au moins une fois en 2013 à la clinique multidisciplinaire d’IRC.L’état de santé au moment du congé, le décès, la réorientation du patient vers la clinique multidisciplinaire et l’initiation d’une TRR comptaient parmi les résultats d’intérêt. Les raisons du congé ont été enregistrées.Les résultats ont été extraits des dossiers médicaux électroniques disponibles et du registre provincial des décès entre la première visite à la clinique en 2013 et le 1er janvier 2020. Les scores KFRE-2 ont été calculés avec l’équation KFRE à 4 variables. Le taux d’incidence de décès et de TRR suivant un congé motivé par un DFGe stable ou un faible score KFRE a été comparé à celui des patients restés à la clinique.Des 425 patients inclus, 69 (16 %) avaient reçu leur congé en soins primaires et 19 (4 %) en néphrologie générale. Parmi les patients sortis, 7 (8 %) ont été réorientés vers une clinique de néphrologie ou d’IRC et seulement 2 (2 %) ont dû éventuellement amorcer une TRR. Un DFGe stable et un score KFRE faible ont contribué à réduire le taux de mortalité après le congé de la clinique (RR corrigé = 0,45 [IC à 95 %: 0,25-0,78;Étude rétrospective observationnelle dans un seul center. La fonction rénale au fil du temps après le congé de l’hôpital était inconnue pour la plupart des patients.Donner leur congé de la clinique multidisciplinaire d’IRC aux patients à faible risque apparaît possible et sûr; moins d’un patient sur 40 ayant dû amorcer une TRR dans les 7 années suivantes.

Purpose: The UMass Chan Medical School/New England AIDS Education and Training Center Community-Based HIV and Viral Hepatitis Fellowship was launched in 2014 to train physicians and nurse practitioners to become experts in outpatient management of HIV, hepatitis B and C, and latent tuberculosis. The purpose of this study was to identify areas of strength and improvement and understand fellows’ perceptions of the program and its impact on their current positions and career trajectories. Methods: Qualitative study utilizing a semi-structured interview guide with (11) fellowship graduates (8 MDs; 3 NPs). 45 to 60 min interviews were conducted in April and May 2021, recorded and transcribed. Transcripts were analyzed for representative themes and general patterns in the data. Results: Results indicate high satisfaction with the fellowship, which left a positive and indelible impact on their careers and patient care. Fellows highlighted the program’s commitment to health equity, its role in transforming them into leaders and advocates for HIV in primary care, and their ability to balance their work and training demands with their personal lives and needs. The fellowship motivated them to become more involved in public health initiatives, serve marginalized communities and reduce their health disparities. They expressed confidence in their ability to independently manage outpatient HIV, viral hepatitis B and C, and latent tuberculosis, and found areas of overlap with their work in primary care. Conclusion: As the care of people with HIV becomes more commonplace in primary care clinics, it is imperative that primary care providers receive the necessary training and education to meet this need. Our study of 11 former fellows shows that the Community-Based HIV and Viral Hepatitis Fellowship offers such training, spreads it to other institutions, and can be a model for other programs nationwide.

Background: Little is known about the perspectives and experiences of family members of very elderly patients who are admitted to the intensive care unit. Aim: To describe family members’ perspectives about care provided to very elderly critically ill patients. Design: Multicenter, prospective, cohort study. Participants and setting: In total, 535 family members of patients aged 80 years or older admitted to 22 intensive care units for more than 24 h. Results: Family members reported that the “patient be comfortable and suffer as little as possible” was their most important value and “the belief that life should be preserved at all costs” was their least important value considered in making treatment decisions. Most family members (57.9%) preferred that life support be used for their family member, whereas 24.1% preferred comfort measures only, and 14.4% were unsure of their treatment preferences. Only 57.3% reported that a doctor had talked to them about treatment options for the patient. Overall, 29.7% of patients received life-sustaining treatments for more than 7 days and 50.3% of these died in hospital. Families were most satisfied with the skill and competency of nurses and least satisfied with being included and supported in the decision-making process and with their sense of control over the patient’s care. Conclusion: There is incongruity between family values and preferences for end-of-life care and actual care received for very elderly patients who are admitted to the intensive care unit. Deficiencies in communication and decision-making may be associated with prolonged use of life-sustaining treatments in very elderly critically ill patients, many of whom ultimately die.

Background: Burn injury represents a significant public health problem worldwide. More than in any other injury, the inflammation and catabolism associated with severe burns can exacerbate nutrient deficiencies resulting in impaired immune function and increased risk of developing infection, organ dysfunction and death. Consequently, over the last few decades numerous trials have evaluated the impact of different nutritional strategies in severe burn injury. Glutamine is of particular interest, as it appears vital for a number of key stress-response pathways in serious illness. The purpose of the current manuscript is to provide the rationale and protocol for a large clinical trial of supplemental enteral glutamine in 2700 severe burn-injured patients. Methods: We propose a multicentre, double-blind, pragmatic, randomized, clinical trial involving 80 tertiary intensive care unit (ICU) burn centres worldwide. We aim to enrol patients with deep second- and/or third-degree burns at moderate or high risk for death. We will exclude patients admitted > 72 h before screening and patients with advanced liver and kidney disease. The study intervention consists of enteral glutamine 0.5 g/kg/day vs. isocaloric maltodextran control delivered enterally. Primary outcome will be six-month mortality. Key secondary outcomes include time to discharge alive from hospital, ICU and hospital mortality, length of stay and health-related quality of life at six months. Significance: This study will be the first large international multicentre trial examining the effects of glutamine in burn patients. Negative or positive, the results of this trial will inform the clinical practice of burns care worldwide. Clinicaltrials.gov ID #NCT00985205, Lay Summary Patients with severe burns need to recover in a hospital burn unit for a long time and are at high risk of developing infections and dying. Proper nutrition and certain nutrients may improve survival in these patients and shorten their stay in the burn unit. Glutamine is a building block of protein that is normally made in the body and is found in different foods we eat. It is of great interest because it has several beneficial effects on the body during serious illness, such as with burn injury. In this study, we will look at the effect of glutamine supplementation on survival and time spent in hospital. A total of 80 burn units around the world will enrol 2700 patients with 2nd or 3rd degree burns over 4 years. Patients will receive either glutamine powder or a placebo through a feeding tube or mixed with food, from admission to the burn unit, until a week after the burn wound has healed. The main outcome for this study is survival at 6 months. Other outcomes include the time taken to be discharged from hospital alive and duration of stay in the burn unit. This study will be the first large international multicentre trial examining the effects of glutamine in burn patients. Glutamine may lead to better survival and less complications in burn patients, who have a devastating and disabling burn injury. If the trial is positive, the results will be used to inform how nutrition should be given to such patients worldwide.

The current study brought together two important areas of scholarship in mass communications: media credibility, and religion and the media. Although both areas have been widely investigated by scholars, there have not been many empirical investigations that examine the potential impact of religion on individual perceptions of media credibility. The authors’ data analysis revealed mixed evidence for an association between religiosity and perceived media credibility. Although the study did not find consistent and overwhelming evidence of a significant single association between religiosity and media credibility, the authors did find strong evidence of a significant association between some form of media credibility and the Internet. Although these associations were multidirectional, they were nevertheless numerous and significant.

The purpose of this study was to further validate a novel instrument to measure satisfaction with end-of-life care, called the Canadian Health Care Evaluation Project (CANHELP) questionnaire. Data were collected by a cross-sectional survey of patients who had advanced, life-limiting illnesses and their family caregivers, and who completed CANHELP, a global rating of satisfaction, and a quality of life questionnaire. We conducted factor analysis, assessed internal consistency using Cronbach’s alpha, and evaluated construct validity by describing the correlation amongst CANHELP, global rating of satisfaction and the quality of life questionnaire scores. There were 361 patient and 193 family questionnaires available for analysis. In the factor analysis, we identified six easily interpretable factors which explained 55.4% and 60.2% of the variance for the patient and caregiver questionnaire, respectively. For the patient version, the subscales derived from these factors were Relationship with Doctors, Illness Management, Communication, Decision-Making, Role of the Family, and Your Well-being. For the family questionnaire, the factors were Relationship with Doctors, Characteristics of Doctors and Nurses, Illness Management, Communication and Decision-Making, Your Involvement, and Your Well-being. Each subscale for each questionnaire had acceptable to excellent internal consistency (Cronbach’s alpha ranged from 0.69—0.94). We observed good correlations between the CANHELP overall satisfaction score and global rating of satisfaction (correlation coefficient 0.49 and 0.63 for patient and family, respectively) which was greater than the correlations between CANHELP and the quality of life instruments. We conclude that the CANHELP Questionnaire is a valid and internally consistent instrument to measure satisfaction with end-of-life care.

The Civil Contingencies Act (2004) requires UK primary care trusts (PCTs) to plan and respond to major health incidents. We carried out a cross-sectional survey of all PCTs in the north-west region of England using a telephone interview with a structured questionnaire. We assessed: (1) staff members responsible for emergency planning; (2) risk assessment; (3) training and exercises; and (4) the planned response to a major incident. Response rate was 61% (20/33). Twelve out of 20 employed an emergency planning officer. All responding PCTs had participated in a tabletop exercise in the previous year and nine of 20 in a live exercise in the previous three years. Nine provided major incident training to new staff. Fifteen had discussed major incident preparations with their local acute trust but none could quantify the support they would be able to provide in terms of accelerated discharges. We have revealed potentially serious deficiencies in the emergency preparedness of many PCTs. PCTs are expected to play a vital role in coordinating the National Health Service (NHS) response to a major incident and these results have important implications for the ability of the NHS as a whole to effective respond to such incidents.

American Indians experience significant health disparities compared to the general U.S. population. The Steps to a Healthier Anishinaabe program adopted a unique framework to implement health promotion intervention activities in multiple American Indian communities in Michigan. By enabling each community to tailor interventions to their specific culture and health priorities, the program is characterized by a culturally competent and community-driven approach to decrease the impact of chronic diseases on the health of Michigan's American Indians. This article describes the community-based framework and argues that multisite, community-tailored health promotion programs are a promising approach to reducing health disparities in minority populations.

Past third-person effect (TPE) research indicates that individuals perceive that the media are more influential on others than on oneself. However, recent studies find a reverse effect, where individuals perceive a greater effect on oneself than on others when media messages are positive and desirable to be influenced by. This study sought to examine the reverse of the TPE, or the first-person effect, from corporate commercial advertisements. Brand awareness advertisements and public affairs advertisements were used to measure both the perceptual and the behavioral components of TPE theory. Findings indicate that corporate commercial public affairs advertisements are found to be socially desirable to be influenced by and that individuals are likely to act on that perception in the form of legislative support of the issues that corporations promote.

A 57-year-old patient with schizophrenia and epilepsy presented to the emergency department with clinical signs of severe hyponatraemia. The patient was incontinent of urine and neurological signs were present; she was eventually transferred to the high dependency unit (HDU). Several causes for the low sodium were considered, but the discovery of a large number of empty water bottles in the patient's home confirmed the suspected diagnosis of water intoxication during a psychotic state. The patient's plasma sodium levels were restored over the course of several days and she was eventually transferred home uneventfully.

Study in the area of the development of the God concept of children has been attempted by many writers in the past several years. Several theories have been put forth as to the nature of the formation of a child's God concept with some of the theories dealing with the great influence the parents have on this development. This article will give special attention to the theory of Symbolic Interaction and how its major tenets (reference group, interpretation, role-taking, Self, and Mind) offer a social psychology approach to the development of the child's God concept as seen in parent-child interactions around religious gestures and symbols.

By means of a diet furnishing about 7 μg of Zn per rat daily, studies at the University of Wisconsin1-4 have convincingly demonstrated the indispensability of Zn in the nutrition of rats, although the Zn-deficient diet permitted the experimental rats to gain about 8 g per rat weekly during the 10 week period on the diet.4 The findings have invalidated the conclusion from our laboratory5 several years ago that the element probably is not a dietary essential. We have recently prepared a diet furnishing not more than 2 to 4 μg of Zn per rat daily. Young rats restricted to it quickly developed extreme degrees of deficiency. Because the studies have been temporarily interrupted, owing to the transfer of one of us (H.G.D.) to another laboratory, we have decided to make a preliminary report on the work at this time.Diet. The diet was : casein hydrolysate (tryptic)† 15.00, egg white (cooked) 3.00, sucrose 66.29, salts 5.71, butter fat 10.00, and Oleum Percomorphum 50%, 2 drops per 100 g diet (approximately 2800 v...

Duncan, Huffman and Robinson1 reported that calves restricted to whole milk diets alone, or supplemented with iron, copper and manganese, eventually manifest tetany which is indistinguishable from tetany in rats on a magnesium-low diet.2 The tetany was prevented and serum magnesium was restored to normal by the administration of magnesium carbonate or magnesium oxide.3 Since the content of magnesium in milk appears to be rather low, in relation to the calcium and phosphorus, it is possible that prolonged restriction to milk diets of young of other species might eventuate in magnesium deficiency, as suggested by Schmidt and Greenberg.4 According to data cited by Cox and Mueller,5 milk of cows and humans may contain about 0.013 and 0.005% magnesium respectively. Analyses of rat milk gave 0.031% magnesium.5But in several investigations rats have been reared to adulthood on cow milk supplemented with iron and copper and in no instance have symptoms been reported which indicate the occurrence of magnesium defi...

SummaryA study of the resistance to the intraperitoneal injection of Type I pneumococci of 39 rats showing pantothenic acid deficiency in contrast to 36 controls fed pantothenic acid failed to reveal a significant change in the susceptibility of the experimental group. Similarly, no marked change in susceptibility was observed in 175 mice showing pantothenic acid deficiency in contrast to the survival percentage of 141 controls receiving the vitamin (normal animals). However, the difference is great enough to warrant the conclusion that acute pantothenic acid deficiency in mice may slightly increase the resistance to Type I pneumococcus. Certainly the results give no indication of decreased resistance to this organism in pantothenic acid deficiency.

Great interest is centered on the synthesis of essential nutrients by microorganisms of the digestive tract.1, 2, 3, 4, 5, 6 The cecum, aptly referred to as a “fermentation vat,”6 is generally regarded as the principal site of this important function in the rat.Although quite a few reports have been made concerning the inhibitory effects of certain sulfonamides on the enteric synthesis of various vitamins very little experimental work has been done on the role of the cecum as a favorable site for such activity. The latter studies have been concerned only with the synthesis of B-complex vitamins7, 8, 9 and the utilization of phytin phosphorus.10During the past year our investigation of factors affecting vitamin K synthesis in the intestinal tract11 has included observations on cecectomized rats. The timeliness of certain of our findings prompts this short communication.Stock rats about 35 days old were started on a vitamin K-free diet of the following composition: casein (Smaco, vitamin-free) 18, glucose (...

Rowntree and associates1 have reported a high incidence of abdominal sarcoma in Wistar rats, as well as albino rats from the Buffalo and Yale strains, when fed crude wheat germ oil prepared by ether extraction. Great variability occurred in the rate of tumor production. In rats given 1 cc of oil daily tumors appeared in about 100 to 200 days; with 4 cc daily the average was about 54 days. The nature of the neoplastic agent has not been determined but since it appears to be absent from refined ether-extracted wheat germ oil, and wheat germ oils not obtained by means of ether, it is possible that the factor is produced by some action of ether on wheat germ. Owing to the tendency of unsaturated fatty compounds to undergo oxidation while in contact with ether containing peroxides2 it appeared to us that the neoplastic agent might have arisen through the action of such peroxides, formed in the extraction of wheat germ with ether, although the latter was reported to be peroxide-free before it was used.We have t...