Family Social Capital: Links to Weight-Related and Parenting Behaviors of Mothers with Young Children

Family social capital includes the social relationships, values, and norms shared by a family and is positively linked with children’s mental and physical health status. This cross-sectional study addresses a gap in the literature related to family social capital vis-à-vis weight-related behaviors and home environments of 557 mothers and their young children (ages 2 to 9 years). Mothers completed an online survey comprised of valid, reliable questionnaires assessing family relationships and weight-related behavioral and home environment measures. The measures that determined family social capital (i.e., supportive, engaged parenting behaviors; family cohesion; family conflict; and family meal frequency) yielded distinct tertile groups that differed significantly (p < 0.001) on every family social capital measure with large effect sizes. Analysis of variance with Tukey post-hoc test revealed greater family social capital was linked to significantly better maternal health, dietary intake, physical activity, and sleep behavior. Additionally, maternal modeling of healthy eating and physical activity, child feeding practices, and home environments was higher in groups with greater family social capital. Child mental and physical health, physical activity, and sleep quality were better in families with greater family social capital. Findings suggest greater family social capital is linked to healthier weight-related behaviors and home environments. Future intervention studies should incorporate strategies to build family social capital and compare longitudinal outcomes to traditional interventions to determine the relative value of family social capital on health behaviors.     

A paradox of need: Gaps in access to dental care among people who use drugs in Canada's publicly funded healthcare system

In Canada, publicly funded healthcare provides no-cost access to a large but not comprehensive suite of services. Dental care is largely funded by private insurance or patients, creating employment- and income-dependent gaps in care access. Difficulties accessing dental care may be amplified among vulnerable populations, including people who use drugs (PWUD), who may experience greater dental need due to side effects of substance use and health comorbidities, as well as barriers to care. Using data collected between 2014 and 2018 from two ongoing prospective cohort studies of PWUD in Vancouver, Canada, the aim of this study was to explore factors associated with dental care access. Among 1,638 participants, 246 participants (15%) reported never or only occasionally accessing adequate dental care. In generalised linear mixed-effects models, results showed significant negative associations between accessing dental care and using opioids (Adjusted Odds Ratios [AOR] = 0.73, 95% Confidence Interval [CI] = 0.58–0.91), methamphetamine (AOR = 0.75, 95% CI = 0.59–0.95) and cannabis (AOR = 0.78, 95% CI = 0.63–0.97), as well experiencing homelessness (AOR = 0.54, 95% CI = 0.42–0.70) and street-based income generation (AOR = 0.75, 95% CI = 0.59–0.94). There were significant positive associations between adequate dental care and accessing opioid agonist treatment (OAT) for opioid dependence (AOR = 1.36, 95% CI = 1.07–1.72) and receiving income assistance (AOR = 1.70, 95% CI = 1.05–2.77). These results highlight specific substance use patterns and structural exposures that may hinder dental care access, as well as how direct and indirect benefits of income assistance and OAT may improve access. These findings provide support for recent calls to expand healthcare coverage and address dental care inequities.     

Why do patients go off track? Examining potential influencing factors for being at risk of psychotherapy treatment failure

Quality of Life Research - Routine outcome monitoring can support clinicians to detect patients who deteriorate [not-on-track (NOT)] early in psychotherapy. Implemented Clinical Support Tools can...     

A Comparison of Clofarabine-based (GCLAC) and Cladribine-based (CLAG) Salvage Chemotherapy for Relapsed/Refractory AML

Background

Salvage regimens for patients with relapsed/refractory acute myeloid leukemia (rrAML) lack comparative data for superiority. Thus, we conducted a retrospective analysis of clofarabine-based (GCLAC; granulocyte colony-stimulating factor [filgrastim], clofarabine, high-dose cytarabine) versus cladribine-based (CLAG; cladribine, cytarabine, granulocyte colony-stimulating factor [filgrastim]) regimens in rrAML.

The impact of advanced age on short-term outcomes following gastric cancer resection: an ACS-NSQIP analysis

Background

Evidence on short-term outcomes for GC resection in elderly patients is limited by small samples from single-institutions. This study sought to examine the association between advanced age and short-term outcomes of gastrectomy for gastric cancer (GC).

Methods

Using ACS-NSQIP data, patients undergoing gastrectomy for GC (2007–2013) were identified. Primary outcome was 30-day major morbidity. Outcomes were compared across age categories (<65, 65–70, 71–75, 76–80, >80 years old). Univariable and multivariable regression was used to estimate the morbidity risk associated with age.

Results

Of 3637 patients, 60.6% were ≥65 years old. Major morbidity increased with age, from 16.3% (<65 years old) to 21.5% (76–80 years old), and 24.1% (>80 years old) (p < 0.001), driven by higher respiratory and infectious events. Perioperative 30-day mortality increased from 1.2% (<65years old) to 6.5% (>80 years old) (p < 0.0001). After adjustments, age was independently associated with morbidity for 76–80 years of age (RR 1.31, 95% CI, 1.08–1.60) and >80 years old (RR 1.49, 95% CI, 1.23–1.81). Predicted morbidity increased by 18.6% in those 75–80 years old and 27.5% in those >80 years old (compared to <65 years old) for total gastrectomy, and by 11.6% and 17.2% for subtotal gastrectomy, for worst case scenario. Morbidity increased by 5.1% in those 75–80 years old and 7.6% in those >80 years old for total gastrectomy, and by 3.1% and 4.7% for subtotal gastrectomy, for best case scenario.

Conclusions

Advanced age, defined as more than 75 years, was independently associated with increased morbidity after GC resection. The magnitude of this impact is further modulated by clinical scenarios. Increased risk in elderly GC patient should be recognized and considered in indications for resection.

     

Cooperative Epigenetic Remodeling by TET2 Loss and NRAS Mutation Drives Myeloid Transformation and MEK Inhibitor Sensitivity

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Curvilinear relationships between resource allocation and life domain‐specific interference

This study investigated the inherent complexities of the work‐life interface (WLI) by examining the relationship between resource allocation (i.e., time and energy dedicated to a particular domain) and perceived interference of individual life domains. Much of the research on the WLI is based on the assumption that a linear pattern best describes the relationship between resource allocation and the interference caused by various life domains; however, this study examined the possibility that curvilinear relationships may be a more appropriate representation. Results indicated that resource allocation is a meaningful predictor of interference, and for many life domains a curvilinear relationship accounts for more variance than a linear one; a breakdown of the sample also revealed this relationship varies by gender. Overall, findings suggest that the nature of the WLI is more individualized and complex than is currently conceptualized in the field.     

Cardiovascular Ion Channel Inhibitor Drug-Drug Interactions with P-glycoprotein

P-glycoprotein (Pgp) is an ATP-binding cassette (ABC) transporter that plays a major role in cardiovascular drug disposition by effluxing a chemically and structurally diverse range of cardiovascular therapeutics. Unfortunately, drug-drug interactions (DDIs) with the transporter have become a major roadblock to effective cardiovascular drug administration because they can cause adverse drug reactions (ADRs) or reduce the efficacy of drugs. Cardiovascular ion channel inhibitors are particularly susceptible to DDIs and ADRs with Pgp because they often have low therapeutic indexes and are commonly coadministered with other drugs that are also Pgp substrates. DDIs from cardiovascular ion channel inhibitors with the transporter occur because of inhibition or induction of the transporter and the transporter’s tissue and cellular localization. Inhibiting Pgp can increase absorption and reduce excretion of drugs, leading to elevated drug plasma concentrations and drug toxicity. In contrast, inducing Pgp can have the opposite effect by reducing the drug plasma concentration and its efficacy. A number of in vitro and in vivo studies have already demonstrated DDIs from several cardiovascular ion channel inhibitors with human Pgp and its animal analogs, including verapamil, digoxin, and amiodarone. In this review, Pgp-mediated DDIs and their effects on pharmacokinetics for different categories of cardiovascular ion channel inhibitors are discussed. This information is essential for improving pharmacokinetic predictions of cardiovascular therapeutics, for safer cardiovascular drug administration and for mitigating ADRs emanating from Pgp.