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Driver training has the potential to keep older adults safe behind-the-wheel for longer, yet there is limited evidence describing factors that influence their willingness to participate in training. Focus groups with community-dwelling older drivers (n = 23; 70–90 years) and semi-structured interviews with driving instructors (n = 6) and occupational therapists (n = 5) were conducted to identify these factors. Qualitative descriptive analyses highlighted how self-awareness of behind-the-wheel abilities in later life can influence an older adult's motivation to participate in driver training, as well as their willingness to discuss their behaviors. Collision-involvement and near-misses prompted participants to reflect on their driving abilities and their openness to feedback. Participants' preferences for learning contexts that use a strengths-based approach and validate the driving experience of older drivers, while providing feedback on behind-the-wheel performance, were raised. Older driver training initiatives that consider the needs of the aging population in their design can promote road safety and community mobility. [ABSTRACT FROM AUTHOR]

The anti-ulcer drug ranitidine appears to be more effective than sucralfate in preventing gastrointestinal bleeding from stress ulcers in hospital patients on a ventilator. Researchers randomly assigned 1200 to receive either sucralfate or ranitidine through an intravenous line or a nasogastric tube. Only 1.7% of the patients receiving ranitidine developed gastrointestinal bleeding compared to 3.8% of those receiving sucralfate. There were no significant differences in mortality rates or hospital stay between both groups.

Younger asthmatic children may provide more helpful information in some areas while their parents may provide more helpful information in others. Older children may provide more helpful information in all areas. Fifty-two asthmatic children ages 7 to 17 and their parents rated change in symptoms, evaluated quality of life, and recorded peak flow rates, symptoms and medication use over a one-month period. Ratings of symptom changes in children younger than 11 were better correlated with quality of life whereas parents' ratings were better correlated with asthma control and airway functioning. Older children's ratings were correlated more closely with both., Objective. To explore children's and parents' assessment of children's asthma. Design. Prospective 2-month cohort study in which children and parents were reviewed at baseline and 1-month intervals. Setting. Mid-sized, English-speaking, industrial community serving an urban and regional rural population. Patients or Participants. Fifty-two children, 7 to 17 years old, with a wide range of asthma severity, and their parents. Interventions. We offered patients with inadequately controlled asthma additional inhaled steroid. Main Outcome Measures. Children and parents provided global ratings of change in childhood symptoms and children completed spirometry and the Paediatric Asthma Quality of Life Questionnaire at clinic visits. Patients recorded peak flow rates, symptoms, and medication use in a daily diary. The diary symptom report, medication use, and spirometry were combined to form an asthma control score. Results. In children younger than 11, children's global rating of change in symptoms correlated strongly with changes in quality of life (0.54 to .67) but not with measures of airway caliber or asthma control, while parents' global ratings did not correlate with children's quality of life but showed moderate correlations with airway caliber (0.29 to .48) and asthma control (0.50). In children over the age of 11, correlations with all clinical variables were higher for their own than their parents' global ratings. Conclusions. In children under 11, clinicians can gain complementary information from questioning children and parents. For children over 11, parents can provide little if any information beyond that obtained through questioning the child. Pediatrics 1997;99:165-168; asthma, health-related quality of life, pediatrics., ABBREVIATIONS. HRQL, health-related quality of life; PAQLQ, Paediatric Asthma Quality of Life Questionnaire; FE[V.sub.1], forced expiratory volume in 1 second. Clinicians treating children with asthma have a number of sources [...]

Histamine2-receptor blockers appear to be effective in preventing gastrointestinal bleeding in people with stress ulcers. Several meta-analyses of the effectiveness of anti-ulcer drugs have produced mixed results. Researchers reviewed 63 randomized clinical trials of anti-ulcer drugs in the prevention of overt and silent gastrointestinal bleeding. Histamine2-receptor blockers significantly reduced both overt and silent bleeding when compared to antacids, a placebo or no therapy. Sucralfate and antacids reduced overt bleeding compared to placebo or no therapy, but neither appeared more effective than histamine2-receptor blockers. However, sucralfate lowered the incidence of pneumonia when compared to antacids and histamine2-receptor blockers. In fact, histamine2-receptor blockers were associated with an increased incidence of pneumonia. Sucralfate appeared to reduce mortality rates when compared to antacids and histamine2-receptor blockers., Purpose.--To resolve discrepancies in previous systematic overviews and provide estimates of the effect of stress ulcer prophylaxis on gastrointestinal bleeding, pneumonia, and mortality in critically ill patients. Data identification.--Computedzed search of published and unpublished research, bibliographies, pharmaceutical and personal files, and conference abstract reports. Study Selection.--Independent review of 269 articles identified 63 relevant randomized trials for inclusion. Data Abstraction.--We made independent, duplicate assessment of the methodologic quality, population, intervention, and outcomes of each trial. Results.--The source of discrepancies between prior meta-analyses included incomplete identification of relevant studies, differential inclusion of non-English language and nonrandomized trials, different definitions of bleeding, provision of additional information through direct correspondence with authors, and different statistical methods. The current overview demonstrates that prophylaxis with [histamine.sub.2]-receptor antagonists decreases the incidence of overt gastrointestinal bleeding (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.42 to 0.79) and clinically important bleeding (OR, 0.44; 95% CI, 0.22 to 0.88). There is a trend to- ward decreased overt bleeding when antacids are compared with no therapy Off@ 0.66; 95% CI, 0.37 to 1.17). [Histamine.sub.2]-receptor antagonists and antacids are associated with a trend toward lower clinically important bleeding rates than sucralfate is. There is a trend toward an increased risk of pneumonia associated with [histamine.sub.2]-receptor antagonists as compared with no prophylaxis (OR, 1.25; 95% CI, 0.78 to 2.00). Sucralfate is associated with a lower incidence of nosocomial, pneumonia when compared with antacids (OR, 0.80; 95% CI, 0.56 to 1.15) and [histamine.sub.2]-receptor antagonists (OR, 0.77; 95% CI, 0.60 to 1.01). Sucralfate is also associated with a reduced mortality rate (OR, 0.73; 95% CI, 0.54 to 0.97) relative to antacids and to [histamine.sub.2]-receptor antagonists (OR, 0.83; 95% CI, 0.63 to 1.09). Conclusions.--Our results emphasize the need for registries to include all randomized trials and demonstrate the importance of explicit methodology for systematic reviews. There is strong evidence of reduced clinically important gastrointestinal bleeding with [histamine.sub.2]-receptor antagonists. Sucralfate may be as effective in reducing bleeding as gastric pH-altering drugs and is associated with lower rates of pneumonia and mortality. However, the data are insufficient to determine the net effect of sucralfate compared with no prophylaxis. (JAMA. 1996;275:308-314)

Articular cartilage functions as a shock absorber and facilitates the free movement of joints. Currently, there are no therapeutic drugs that promote the healing of damaged articular cartilage. Limitations associated with the two clinically relevant cell populations, human articular chondrocytes and mesenchymal stem cells, necessitate finding an alternative cell source for cartilage repair. Human embryonic stem cells (hESCs) provide a readily accessible population of self-renewing, pluripotent cells with perceived immunoprivileged properties for cartilage generation. We have developed a robust method to generate 3D, scaffold-free, hyaline cartilage tissue constructs from hESCs that are composed of numerous chondrocytes in lacunae, embedded in an extracellular matrix containing Type II collagen, sulphated glycosaminoglycans and Aggrecan. The elastic (Young's) modulus of the hESC-derived cartilage tissue constructs (0.91 ± 0.08 MPa) was comparable to full-thickness human articular cartilage (0.87 ± 0.09 MPa). Moreover, we have successfully scaled up the size of the scaffold-free, 3D hESC-derived cartilage tissue constructs to between 4.5 mm and 6 mm, thus enhancing their suitability for clinical application. [ABSTRACT FROM AUTHOR]

Risk prediction scores are important tools to support clinical decision-making for patients with coronavirus disease (COVID-19). The objective of this paper was to validate the 4C mortality score, originally developed in the United Kingdom, for a Canadian population, and to examine its performance over time. We conducted an external validation study within a registry of COVID-19 positive hospital admissions in the Kitchener-Waterloo and Hamilton regions of southern Ontario between March 4, 2020 and June 13, 2021. We examined the validity of the 4C score to prognosticate in-hospital mortality using the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals calculated via bootstrapping. The study included 959 individuals, of whom 224 (23.4%) died in-hospital. Median age was 72 years and 524 individuals (55%) were male. The AUC of the 4C score was 0.77, 95% confidence interval 0.79–0.87. Overall mortality rates across the pre-defined risk groups were 0% (Low), 8.0% (Intermediate), 27.2% (High), and 54.2% (Very High). Wave 1, 2 and 3 values of the AUC were 0.81 (0.76, 0.86), 0.74 (0.69, 0.80), and 0.76 (0.69, 0.83) respectively. The 4C score is a valid tool to prognosticate mortality from COVID-19 in Canadian hospitals and can be used to prioritize care and resources for patients at greatest risk of death. [ABSTRACT FROM AUTHOR]

Background: Identification of those who are most at risk of developing specific patterns of disease across different populations is required for directing public health policy. Here, we contrast prevalence and patterns of cross-national disease incidence, co-occurrence and related risk factors across population samples from the U.S., Canada, England and Ireland.Methods: Participants (n = 62,111) were drawn from the US Health and Retirement Study (n = 10,858); the Canadian Longitudinal Study on Ageing (n = 36,647); the English Longitudinal Study of Ageing (n = 7938) and The Irish Longitudinal Study on Ageing (n = 6668). Self-reported lifetime prevalence of 10 medical conditions, predominant clusters of multimorbidity and their specific risk factors were compared across countries using latent class analysis.Results: The U.S. had significantly higher prevalence of multimorbid disease patterns and nearly all diseases when compared to the three other countries, even after adjusting for age, sex, BMI, income, employment status, education, alcohol consumption and smoking history. For the U.S. the most at-risk group were younger on average compared to Canada, England and Ireland. Socioeconomic gradients for specific disease combinations were more pronounced for the U.S., Canada and England than they were for Ireland. The rates of obesity trends over the last 50 years align with the prevalence of eight of the 10 diseases examined. While patterns of disease clusters and the risk factors related to each of the disease clusters were similar, the probabilities of the diseases within each cluster differed across countries.Conclusions: This information can be used to better understand the complex nature of multimorbidity and identify appropriate prevention and management strategies for treating multimorbidity across countries. [ABSTRACT FROM AUTHOR]

Preventive interventions to save children from physical abuse and neglect involve aspects such as period of intervention, repetitions, visitations, duration of visit and competence of the interviewer. Repeated home visitations are essential for effective control of child physical abuse and neglect among disadvantaged or dysfunctional families. poor families.

Education programs that create an awareness in children about sexual abuse influence the effectiveness of interventions that prevent child sexual abuse and abduction. Identification of risk factors for sexual abuse leads to the development of more specific interventions. However, the responsibility for prevention of sexual abuse should not be shifted to the children. Preventive strategies should also aim at preventing adults from becoming perpetrators.

Respiratory failure and blood clotting disorders appear to be risk factors for clinically important bleeding in the stomach and intestines. Clinically important bleeding is obvious bleeding complicated by decreases in blood pressure or increases in heart rate. Bleeding in the stomach or intestines may be caused by stress ulcers. Of 2,252 critically ill patients admitted to intensive care units, 100 had bleeding episodes. Eighty-seven of these 100 patients received preventive therapy for stress ulcers.Thirty-three of the 100 patients had clinically important bleeding. Among these 33 patients, 22 had both respiratory failure and blood clotting disorders, 8 had respiratory failure alone, one had a blood clotting disorder alone and 2 patients had neither risk factor. A total of 847 patients had one or both risk factors for stomach or intestinal bleeding. The mortality rate of patients with clinically important bleeding was 48.5%, compared to 9.1% for all other patients.

Our study aimed to describe patient experience of information coordination between their primary care physician and specialists and to examine the associations between their experience and their personal and primary care characteristics. We conducted a cross-sectional study of Ontario residents rostered to a primary care physician and visited a specialist physician in the previous 12 months by linking population-based health administrative data to the Health Care Experience Survey collected between 2013 and 2020. We described respondents' sociodemographic and health care utilization characteristics and their experience of information coordination between their primary care physician and specialists. We measured the adjusted association between patient-reported measures of information coordination before and after respondents received care from a specialist physician and their type of primary care model. 1,460 out 20,422 (weighted 7.5%) of the respondents reported that their specialist physician did not have basic medical information about their visit from their primary care physician in the previous 12 months. 2,298 out of 16,442 (weighted 14.9%) of the respondents reported that their primary care physician seemed uninformed about the care they received from the specialist. Females, younger individuals, those with a college or undergraduate level of education, and users of walk-in clinics had a higher likelihood of reporting a lack of information coordination between the primary care and specialist physicians. Only respondents rostered to an enhanced fee-for-service model had a higher odds of reporting that the specialist physician did not have basic medical information about their visit compared to those rostered to a Family Health Team (OR 1.22, 95% Cl 1.12–1.40). We found no significant association between respondent's type of primary care model and that their primary care physician was uninformed about the care received from the specialist physician. In this population-based health study, respondents reported high information coordination between their primary care physician and specialists. Except for respondents rostered to an enhanced fee-for-service model of care, we did not find any difference in information coordination across other primary care models. [ABSTRACT FROM AUTHOR]

This document is a correction notice for a research article titled "Associations between Social Isolation Index and changes in grip strength, gait speed, bone mineral density (BMD), and self-reported incident fractures among older adults: Results from the Canadian Longitudinal Study on Aging (CLSA)." The correction addresses errors in the Funding section and provides the correct funding statement. The research was made possible using data and biospecimens collected by the Canadian Longitudinal Study on Aging (CLSA), which is funded by the Government of Canada through the Canadian Institutes of Health Research (CIHR) and the Canada Foundation for Innovation, as well as several provinces. The CLSA is led by Drs. Parminder Raina, Christiana Wolfson, and Susan Kirkland. [Extracted from the article]