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In Canada, foreign-born older adults (FBOAs) have a higher prevalence of chronic conditions and poorer self-reported physical and mental health than their Canadian-born peers. However, very little research has explored FBOAs' experiences of health care after immigration. This review aims to understand the patient experiences of older immigrants within the Canadian health care system. Employing Arksey and O'Malley's framework for scoping reviews, we searched six databases and identified 12 articles that discussed the patient experience of this population. Although we sought to understand patient experience, the studies largely focused on barriers to care, including: communication difficulties, lack of cultural integration, systematic barriers in health care, financial barriers, and intersecting barriers related to culture and gender.This review provides insight into new areas of research and advocates for strengthened policy and/or programming. Our review also highlights that there is a paucity of literature for an ever-growing segment of the Canadian population.

Mucopolysaccharidosis type IIIC (MPSIIIC) is a severe, rare autosomal recessive disorder caused by variants in the heparan-α-glucosaminide N-acetyltransferase (HGSNAT) gene which result in lysosomal accumulation of heparan sulfate. We analyzed clinical presentation, molecular defects and their haplotype context in 78 (27 novel) MPSIIIC cases from 22 countries, the largest group studied so far. We describe for the first time disease-causing variants in the patients from Brazil, Algeria, Azerbaijan, and Iran, and extend their spectrum within Canada, Colombia, Turkey, and the USA. Six variants are novel: two missense, c.773A>T/p.N258I and c.1267G>T/p.G423W, a nonsense c.164T>A/p.L55*, a splice-site mutation c.494-1G>A/p.[P165_L187delinsQSCYVTQAGVRWHHLGSLQALPPGFTPFSYLSLLSSWNC,P165fs], a deletion c.1348delG/p.(D450fs) and an insertion c.1479dupA/p.(Leu494fs). The missense HGSNAT variants lacked lysosomal targeting, enzymatic activity, and likely the correct folding. The haplotype analysis identified founder mutations, p.N258I, c.525dupT, and p.L55* in the Brazilian state of Paraiba, c.493+1G>A in Eastern Canada/Quebec, p.A489E in the USA, p.R384* in Poland, p.R344C and p.S518F in the Netherlands and suggested that variants c.525dupT, c.372-2G>A, and c.234+1G>A present in cis with c.564-98T>C and c.710C>A rare single-nucleotide polymorphisms, have been introduced by Portuguese settlers in Brazil. Altogether, our results provide insights into the origin, migration roots and founder effects of HGSNAT disease-causing variants, and reveal the evolutionary history of MPSIIIC., (© 2019 Wiley Periodicals, Inc.)

Background and Aim of the Study: The hemodynamic performance of stentless aortic bioprostheses has been previously well described. Because the potential for prosthesis-patient mismatch is greatest for small valves in the aortic position, the present study sought to compare the hemodynamic performance and degree of left ventricular (LV) mass regression between valve sizes for the Toronto SPV valve, with special interest in measures of relief of LV outflow obstruction afforded by the smallest valves., Methods: This study included 257 patients (178 men, 79 women; mean age 63.5+/-11.4 years; range: 34-93 years) from six investigative centers with complete echocardiography/Doppler data obtained through three years. Valve sizes implanted were 21 mm (n = 11), 23 mm (n = 23), 25 mm (n = 58), 27 mm (n = 83), and 29 mm (n = 82). Echocardiography was performed at discharge, six months, one year, and yearly thereafter, and interpreted in a centralized core laboratory. Mean gradient, effective orifice area (EOA), indexed EOA, and absolute and percent change in LV mass index were used as markers of hemodynamic performance., Results: For all valve sizes, mean and peak gradients fell and EOA increased early after surgery. There were no differences between groups in the degree to which gradients fell, and EOA increased from discharge to one year follow up. At one year, indexed EOA was 0.9 cm2/m2 for valve sizes 21 and 23 mm, and 1.0-1.2 cm2/m2 for sizes 25, 27 and 29 mm. There was statistically significant LV mass regression for all valve sizes (p <0.05), and no differences between valve sizes in the magnitude of absolute or percent change in LV mass index between baseline and three years., Conclusion: The Toronto SPV valve demonstrates excellent parameters of hemodynamic performance for all valve sizes, including the smallest valves used in only a minority of patients. Findings of indexed EOA > or = 0.9 cm2/m2, and equivalent degrees of LV mass regression for all valve sizes, reinforces the excellent hemodynamic performance of stentless aortic bioprostheses, and suggests that prosthesis-patient mismatch should be minimized with these valves.

Objective: The authors estimated the prevalence of psychoses among the Hutterites in Manitoba, Canada, who lived in 102 communal farms or colonies. The study stemmed from an earlier epidemiological survey of North American Hutterite colonies (1950-1953), in which a low prevalence of psychoses was documented., Method: Psychiatrically ill individuals identified during the previous survey were rediagnosed with DSM-IV criteria. A current provincial health insurance claims database was queried anonymously for the period June 1992-May 1997, and the prevalence rate of disease among Hutterites, identified by distinctive surnames and unique postal addresses, was compared with the rate in the entire population of the province of Manitoba and in a comparison group of persons with Hutterite surnames but with addresses outside the Hutterite colonies., Results: The annual prevalence of schizophrenia among the communal Hutterites, estimated from the database search by using ICD-9 criteria, was consistent with the prevalence found in the prior epidemiological survey (annual mean of 1.2/1,000 population, compared with 1.3/1,000 in the prior survey). The database search yielded a significantly lower prevalence for schizophrenia and other functional psychoses among communal Hutterites as well as among the comparison group, compared to the total Manitoba population. There was also lower prevalence for affective psychoses and adjustment reaction disorders among the communal Hutterites, compared to the total Manitoba population. Rates for neurotic disorders were elevated both among the communal Hutterites and the comparison group., Conclusions: The prevalence of specific psychoses was reduced among the Hutterites, although neurotic disorders were more prevalent. These findings suggest some specificity, although possible artifacts such as ascertainment bias must be considered. Further research is needed to examine genetic and environmental factors that may contribute to reduced prevalence of specific psychoses among the Hutterites.