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MSpace is the University of Manitoba’s Institutional Repository. The purpose of MSpace is to acquire, preserve and provide access to the scholarly works of University faculty and students within an open access environment.

 

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Open Access
Perspectives on HIV care and support services for African, Caribbean, and Black women living with HIV in Winnipeg, Manitoba
(2024-06-13) Njeze, Chinyere; Mignone, Javier (Community Health Sciences); Woodgate, Roberta (Nursing); Logie, Carmen (University of Toronto); Hatala, Andrew
Abstract: Introduction: African, Caribbean, and Black (ACB) women in Manitoba are overrepresented in HIV infections relative to other racial groups. Yet, there are no community-based or participatory studies that have explored the stories of these women. The goal of this study was to explore how ACB women living with HIV in Winnipeg experience care and support to call attention to their lived realities, including highlighting the historical and cultural oppressions. Methods: Study participants were ACB women living with HIV (n=10) in Winnipeg, as well as healthcare staff (n=12). The qualitative research design was informed by critical race and feminist theoretical frameworks, incorporating intersectionality and constructivist grounded theory methodology for data generation, organization, and analysis. This study was also community-based and collaborated with several HIV-focused clinics in Winnipeg. The study focused on providing insight and developing a theoretical lens into the experiences of HIV care and support by HIV-positive ACB women through in-depth, semi-structured face-to-face and phone interviews. Results: Study findings revealed the specific life histories and themes of ACB women in Winnipeg, particularly highlighting trauma that informs and shapes their experiences. ACB women with HIV in Winnipeg and their care staff also expressed a lack of cultural care and support, how ACB women bear multiple loads, face language problems, experience long waiting times, and do not feel welcomed, including dealing with the cost of HIV medication. Findings show that the difficulties ACB women face involve multiple intersecting forms of oppression within social and health services and are at various levels. At the same time, ACB women commit to using HIV care, self-accepting their HIV-positive identity, connecting with religion and spirituality, and creating a stronger sense of themselves in order to live well with their condition. Implications: This study generates new knowledge and understanding of the experiences of ACB women living with HIV in Winnipeg, Manitoba. Study participants indicated a demand for consideration of the holistic needs of ACB women, which may include their cultural, linguistic, religious, and racial or ethnic characteristics. Stories from these women can inform future public health practices and interventions regarding HIV care and support in Winnipeg and across Canada.
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Open Access
The role of Nix in calcium signaling, gene expression, and oxidative phenotype of skeletal muscle
(2024-06-11) Field, Jared; West, Adrian (Physiology and Pathophysiology); Czubryt, Michael (Physiology and Pathophysiology); Marzban, Hassan (Human Anatomy and Cell Sciences); Perry, Christopher (York University); Gordon, Joseph
Mitochondrial quality control is an essential component of muscle biology, with multiple muscular diseases/pathologies associated with dysregulation of this process (e.g., sarcopenia, cachexia, mitochondrial myopathies, and the remodeling associated with obesity and insulin resistance). The protein Nix serves an important role as a mitophagy receptor protein that mediates removal of dysfunctional fragments of mitochondria through the autophagic process. Human genome-wide association studies have connected polymorphisms in the Nix gene with development of mitochondrially-dependent disorders such as schizophrenia and cognitive decline. In muscle, Nix expression has been connected with aging and has been implicated in starvation-induced muscle atrophy. Additionally, Nix has also been implicated as an important factor in models of lipid-induced insulin resistance of muscle, as well as a potential mediator of calcium signaling within the cell. Together this demonstrates the complex, but important, biology of Nix. However, a model to study Nix in skeletal muscle is lacking. To advance our understanding of Nix in physiologically healthy muscle, we generated and characterised a mouse line harbouring a muscle-specific deletion of Nix. I found evidence of compensated mitochondrial myopathy within muscle that manifests as reduced metabolic rate and capacity for aerobic exercise. Intriguingly, I found that Nix also regulates calcium signaling within muscle to produce a shift towards expression fast fiber types when Nix is deleted in muscle. Previously in cell culture experiments, pharmacological inhibition of Nix was found to restore insulin sensitivity following lipotoxicity-induced insulin resistance. With muscle knockout of Nix, I found heightened sensitivity to insulin that was associated with an mTOR/S6K mechanism described previously in cells. Given the variety of roles described for Nix in muscle, I took the first steps towards uncovering muscle-specific regulation of Nix expression through in vitro studies. To this end, I found that Nix is a direct target of the transcription factors MEF2D of the myogenic program. In summary, I found that deletion of Nix has multiple possible protective effects including protecting metabolism from lipid overload while also directing muscle oxidative phenotype. I have characterized a model to study the biology of Nix, which in addition to novel findings related to calcium and myostatin signaling, provides the basis to study Nix in diseases of muscle or diseases that etiologically involve muscle.
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Open Access
Effects of time on impurity diffusion and concentration-dependent interdiffusion coefficients in Cu-Ni system
(2024-05-30) Afolabi, Samuel; Liang, Xihui (Mechanical Engineering); Zhaidi, Syed Ali Abbas (Mechanical Engineering); Ojo, Olanrewaju
Considerable focus has been directed toward investigating the interdiffusion coefficients in binary systems, primarily due to their pivotal role in metallurgical processes and material performance assessments. An essential parameter in this context is the isothermal concentration-dependent interdiffusion coefficient. While interdiffusion coefficients are widely recognized as being influenced by temperature and concentration, the element of time can exert substantial influence due to the presence of diffusion-induced stress (DIS) within the system. The present research experimentally investigates the effect of time on concentration-dependent interdiffusion and impurity diffusion coefficients in Cu-Ni binary systems and their alloy compositions. The investigation delves into the effect of solute source concentration and anomalous behaviors of temperature as the attributable indications of DIS at play. To implement the research work, a newly devised numerical diffusion model by Olaye and Ojo [20] is integrated with a forward simulation approach in this study. This model incorporates different atomic diffusion coefficients and ensures solute conservation. The model also merges fully explicit finite difference analyses with the Leapfrog/Dufort-Frankel scheme, thus enabling the determination of concentration-dependent interdiffusion coefficients. This approach overcomes the limitations associated with traditional techniques like the Boltzmann-Matano, Hall, Wagner and Sauer-Freise methods. By applying this method, both the interdiffusion and impurity diffusion coefficients are investigated at various diffusion times. The results reveal that the interdiffusion and impurity diffusion coefficients show time variations as a result of DIS in the system. This phenomenon contrasts the widely accepted notion of the interdiffusion coefficient being solely dependent on concentration and temperature without considering time. Overlooking this critical aspect could have substantial implications in the analysis of diffusion data and an accurate understanding of microstructural transformations initiated by diffusion-controlled phase changes in metallic systems.
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Open Access
Correction: Areas of consensus on unwarranted and warranted transfers between nursing homes and emergency care facilities in Norway: a Delphi study
(2024-05-27) Wiik, Arne B.; Doupe, Malcolm B.; Bakken, Marit S.; Kittang, Bård R.; Jacobsen, Frode F.; Førland, Oddvar
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Open Access
Barriers to cancer treatment for people experiencing socioeconomic disadvantage in high-income countries: a scoping review
(2024-05-28) Bourgeois, Amber; Horrill, Tara; Mollison, Ashley; Stringer, Eleah; Lambert, Leah K.; Stajduhar, Kelli
Abstract Background Despite advances in cancer research and treatment, the burden of cancer is not evenly distributed. People experiencing socioeconomic disadvantage have higher rates of cancer, later stage at diagnoses, and are dying of cancers that are preventable and screen-detectable. However, less is known about barriers to accessing cancer treatment. Methods We conducted a scoping review of studies examining barriers to accessing cancer treatment for populations experiencing socioeconomic disadvantage in high-income countries, searched across four biomedical databases. Studies published in English between 2008 and 2021 in high-income countries, as defined by the World Bank, and reporting on barriers to cancer treatment were included. Results A total of 20 studies were identified. Most (n = 16) reported data from the United States, and the remaining included publications were from Canada (n = 1), Ireland (n = 1), United Kingdom (n = 1), and a scoping review (n = 1). The majority of studies (n = 9) focused on barriers to breast cancer treatment. The most common barriers included: inadequate insurance and financial constraints (n = 16); unstable housing (n = 5); geographical distribution of services and transportation challenges (n = 4); limited resources for social care needs (n = 7); communication challenges (n = 9); system disintegration (n = 5); implicit bias (n = 4); advanced diagnosis and comorbidities (n = 8); psychosocial dimensions and contexts (n = 6); and limited social support networks (n = 3). The compounding effect of multiple barriers exacerbated poor access to cancer treatment, with relevance across many social locations. Conclusion This review highlights barriers to cancer treatment across multiple levels, and underscores the importance of identifying patients at risk for socioeconomic disadvantage to improve access to treatment and cancer outcomes. Findings provide an understanding of barriers that can inform future, equity-oriented policy, practice, and service innovation.
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Open Access
Enhancing the delivery of comprehensive care for people living with HIV in Canada: insights from citizen panels and a national stakeholder dialogue
(2024-05-27) Wilson, Michael G.; Mattison, Cristina; Waddell, Kerry; Bacon, Jean; Becker, Marissa; Bibeau, Christine; Lavis, John N.; Rosenes, Ron; Kendall, Claire E.
Abstract Background People living with human immunodeficiency virus (HIV) are living longer with health-related disability associated with ageing, including complex conditions. However, health systems in Canada have not adapted to meet these comprehensive care needs. Methods We convened three citizen panels and a national stakeholder dialogue. The panels were informed by a plain-language citizen brief that outlined data and evidence about the challenge/problem, elements of an approach for addressing it and implementation considerations. The national dialogue was informed by a more detailed version of the same brief that included a thematic analysis of the findings from the panels. Results The 31 citizen panel participants emphasized the need for more prevention, testing and social supports, increased public education to address stigma and access to more timely data to inform system changes. The 21 system leaders emphasized the need to enhance person-centred care and for implementing learning and improvement across provinces, territories and Indigenous communities. Citizens and system leaders highlighted that policy actions need to acknowledge that HIV remains unique among conditions faced by Canadians. Conclusions Action will require a national learning collaborative to support spread and scale of successful prevention, care and support initiatives. Such a collaborative should be grounded in a rapid-learning and improvement approach that is anchored on the needs, perspectives and aspirations of people living with HIV; driven by timely data and evidence; supported by appropriate decision supports and aligned governance, financial and delivery arrangements; and enabled with a culture of and competencies for rapid learning and improvement.
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Open Access
Cannabis use in a Canadian long-term care facility: a case study
(2024-05-29) Balneaves, Lynda G.; Alraja, Abeer A.; Thompson, Genevieve; Penner, Jamie L.; John, Philip S.; Scerbo, Daniella; van Dyck, Joanne
Abstract Background Following the legalization of cannabis in Canada in 2018, people aged 65 + years reported a significant increase in cannabis consumption. Despite limited research with older adults regarding the therapeutic benefits of cannabis, there is increasing interest and use among this population, particularly for those who have chronic illnesses or are at end of life. Long-term Care (LTC) facilities are required to reflect on their care and policies related to the use of cannabis, and how to address residents’ cannabis use within what they consider to be their home. Methods Using an exploratory case study design, this study aimed to understand how one LTC facility in western Canada addressed the major policy shift related to medical and non-medical cannabis. The case study, conducted November 2021 to August 2022, included an environmental scan of existing policies and procedures related to cannabis use at the LTC facility, a quantitative survey of Healthcare Providers’ (HCP) knowledge, attitudes, and practices related to cannabis, and qualitative interviews with HCPs and administrators. Quantitative survey data were analyzed using descriptive statistics and content analysis was used to analyze the qualitative data. Results A total of 71 HCPs completed the survey and 12 HCPs, including those who functioned as administrators, participated in the interview. The largest knowledge gaps were related to dosing and creating effective treatment plans for residents using cannabis. About half of HCPs reported providing care in the past month to a resident who was taking medical cannabis (54.9%) and a quarter (25.4%) to a resident that was taking non-medical cannabis. The majority of respondents (81.7%) reported that lack of knowledge, education or information about medical cannabis were barriers to medical cannabis use in LTC. From the qualitative data, we identified four key findings regarding HCPs’ attitudes, cannabis access and use, barriers to cannabis use, and non-medical cannabis use. Conclusions With the legalization of medical and non-medical cannabis in jurisdictions around the world, LTC facilities will be obligated to develop policies, procedures and healthcare services that are able to accommodate residents’ use of cannabis in a respectful and evidence-informed manner.
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Diversity and development of Indigenous rehabilitation professional student identity
(2024-05-30) Brown, Cara L.; Beach Ducharme, Debra; Hart, Kimberly; Marsch, Nichol; Chartrand, Louise; Campbell, Melissa; Peebles, Danielle; Restall, Gayle; Fricke, Moni; Murdock, Dustin; Ripat, Jacquie
Abstract Background In Canada, disparities between Indigenous and non-Indigenous Peoples continue to exist in health and education because of the past and current harms of racism and colonization. One step towards closing health gaps is clinicians who can provide health and social care services that are free of racism and mistrust. Indigenous health providers are in the best position to provide this culturally relevant and safe care to their own communities. Therefore, more Indigenous students graduating from health professional programs are required to meet these needs. Indigenous identity support can be a facilitator for Indigenous student academic success but developing one’s Indigenous identity can be challenging in post-secondary education environments. We explored how Indigenous rehabilitation students expressed, and wanted to be supported in their identity and academic success. Methods Using a narrative inquiry approach, we conducted interviews with seven students from the occupational, physical, and respiratory therapy programs of a Canadian university. Students were asked to tell their story of learning about, applying to, and being in their rehabilitation program and how their Indigenous identity impacted these experiences. Data analysis was conducted by Indigenous and non-Indigenous team members, analyzing the stories on interaction of the participant with (1) themselves and others, (2) time, and (3) situation or place. Results The researchers developed seven mini-stories, one for each participant, to illustrate the variation between participant experiences in the development of their Indigenous and professional identity, before and during their rehabilitation program. The students appreciated the opportunities afforded to them by being admitted to their programs in a Indigenous Peoples category, including identity affirmation. However, for most students, being in this category came with feared and/or experienced stigma. The work to develop a health professional identity brought even more complexity to the already complex work of developing and maintaining an Indigenous identity in the colonized university environment. Conclusion This study highlights the complexity of developing a rehabilitation professional identity as an Indigenous student. The participant stories call for universities to transform into an environment where Indigenous students can be fully accepted for their unique gifts and the identities given to them at birth.
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Open Access
Practice variation in urine collection methods among pre-toilet trained children with suspected urinary tract infection: a systematic review
(2024-05-03) Wilson, Lucy M.; Tam, Clara; Wai Lai, Veronica Ka; Ajayi, Motunrayo; Lê, Mê-Linh; Oketola, Banke; Klassen, Terry P.; Aregbesola, Alex
Abstract Background Urinary tract infections (UTIs) are a common cause of acute illness among infants and young children. There are numerous methods for collecting urine in children who are not toilet trained. This review examined practice variation in the urine collection methods for diagnosing UTI in non-toilet-trained children. Methods A systematic review was completed by searching MEDLINE (Ovid), Embase (Ovid), CENTRAL (Ovid), PsycInfo (Ovid), CINAHL (EBSCO), and JBI (Ovid) from January 1, 2000 until October 9, 2021 and updated on May 24, 2023. Studies were included if they were conducted in an acute care facility, examined pre-toilet trained children, and compared one urine collection method with another for relevant health care outcomes (such as length of stay in an ED, or re-visits or readmissions to the ED) or provider satisfaction. Two independent reviewers screened the identified articles independently, and those included in the final analysis were assessed for quality and bias using the Newcastle-Ottawa Scale. Results Overall, 2535 articles were reviewed and 8 studies with a total of 728 children were included in the final analysis. Seven studies investigated the primary outcome of interest, practice variation in urine collection methods to diagnose a UTI. The seven studies that investigated novel methods of urine collection concluded that there were improved health care outcomes compared to conventional methods. Novel methods include emerging methods that are not captured yet captured in clinical practice guidelines including the use of ultrasound guidance to aid existing techniques. Three studies which investigated healthcare provider satisfaction found preference to novel methods of urine collection. Conclusions There is significant practice variation in the urine collection methods within and between countries. Further research is needed to better examine practice variation among clinicians and adherence to national organizations and societies guidelines. PROSPERO registration number CRD42021267754.
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Open Access
Engaging patient and community stakeholders in the optimization of the Compassionate And Loving Mindset towards heart health risk (CALM Hearts) physical activity intervention: a description of initial work and protocol for future engagement activities
(2024-05-01) Chudyk, Anna M.; Kullman, Sasha; Pool, Donna; Duhamel, Todd A.; Ashe, Maureen; Strachan, Shaelyn
Abstract Background Participatory research approaches systematically integrate the perspectives of individuals, organizations, or communities that have a direct interest in a study’s processes and outcomes (i.e., stakeholders) in research design and implementation. This supports interventions that are developed “by, not for” end-users, thereby increasing acceptability, uptake, and adherence. However, participatory approaches are relatively under-utilized in intervention development and behavioral change intervention research, in part, due to inadequate reporting of methodology. Therefore, to improve transparency in planning and reporting, we (a) describe how we engaged patients and community organizations (i.e., patient and community partners) in grant development for a self-compassion and physical activity behaviour change intervention for women with cardiovascular risk factors and (b) present a protocol for engaging patient and community partners in the optimization and implementation of the intervention moving forward. Methods Our participatory research approach was guided by the Strategy for Patient-Oriented Research patient engagement framework and our prior stakeholder engagement work. Four patients and three community partners were engaged at the level of Involve, meaning their perspectives informed directions, processes, and decisions at major project milestones. Specifically, patient and community partners engaged in three separate meetings during grant development wherein they: (a) established a Terms of Reference to guide engagement activities and expectations; (b) shaped the grant through guided conversations about research priorities, outcomes, and intervention delivery components that could be targeted for optimization and (c) co-developed a protocol that specifies how relationships will be initiated with future patient partners, proposes engagement activities across the research cycle, and includes plans for formal evaluation of engagement processes. Conclusions Participatory research approaches provide valuable insights into the development of behavioural interventions, especially when stakeholders can partner early and have a meaningful impact. By detailing our engagement activities to date, we hope to model an approach to engaging stakeholders in behavioral intervention development and demonstrate the impacts of doing so.