In brief

September 2016   Comments

Surprising new take on low-sodium diets

Low-sodium diets (less than 3 grams per day) may not be beneficial and may actually increase the risk of heart disease, stroke and death compared with average sodium consumption (4-5 grams per day). This finding comes from a large study involving more than 130,000 people from 49 countries, led by investigators from McMaster University and Hamilton Health Sciences. The study results, published in The Lancet, suggest that the only people who need to worry about reducing sodium in their diet are those with hypertension who consume higher-than-average amounts of sodium. The data highlight the importance of reducing high sodium intake in these individuals but do not support reducing intake to below average consumption levels.

Current intake of sodium in Canada is typically 3.5-4.0 grams per day. Some guidelines have recommended that the entire population lower sodium intake to below 2.3 grams per day. These new data suggest that the majority of Canadians are actually consuming the right amount of sodium.

Obesity and the risk of multiple sclerosis

A study published in PLOS Medicine suggests the presence of a causal association between BMI and risk of developing multiple sclerosis. The study, conducted by a team led by researchers from the Jewish General Hospital in Montreal, investigated whether inherited genetic variation that influences BMI is associated with increased risk of MS. The study method they chose decreases the probability that effects linked to obesity, such as smoking, are driving the association. They found evidence to indicate that a change in BMI from overweight to obese increased the risk of MS by 41 per cent. This BMI change is equivalent to an average-sized adult woman increasing her weight to 180 pounds from 150 or an average-sized adult man increasing his weight to 210 pounds from 170.

Causes of the progressive neurological disorder are poorly understood and treatments have modest effects. MS is a more immediate consequence of obesity in children and young adults than coronary artery disease, which presents much later in life. As a result, the study provides a more pressing incentive for younger people to modify their diet, exercise regularly and control their weight.

Tropical parasite emerges in the North

An outbreak of Cryptosporidium, an intestinal parasite common in the tropics, has been identified for the first time in the Arctic. The discovery was made by a team from the McGill University Health Centre in collaboration with the Nunavik Department of Public Health, Institut national de santé publique du Québec and Health Canada. The strain of the parasite they found, Cryptosporidium hominis subtype 1d, is more typically seen in low-income countries than in North America and is spread from human to human rather than through contact with animals.

Transmitted by the fecal-oral route, Cryptosporidium causes diarrhea, cramps and vomiting. Cryptosporidiosis can last several weeks and can be fatal for young children and those with a weakened immune system.

Repeated Cryptosporidium infections can cause growth delays and difficulty at school in children. Treatment for cryptosporidiosis in Canada is only available under a special access program.

The researchers examined an outbreak of Cryptosporidium that occurred between April 2013 and April 2014 across 10 villages in Nunavik, Que. The discovery was documented in PLOS Neglected Tropical Diseases.

Shedding moonlight on sleep patterns and activity levels

The moon’s possible influence over human behaviour has been the object of speculation for centuries. An international group of researchers, led by investigators from the Children’s Hospital of Eastern Ontario, examined the sleeping patterns and daily activity levels of 5,812 children from five continents during three moon phases. The researchers chose to focus on children because they have greater sleep needs and their behaviours are more easily changed than adults. The results were published in Frontiers in Pediatrics.

Data were collected over 28 months. Nocturnal sleep duration was roughly one per cent shorter (5 minutes per night) during a full moon than during a new moon. The researchers said the magnitude of this effect was unlikely to be important from a public health standpoint, and no other activity variables differed significantly between moon phases.

Further research is needed to determine if human biology is synchronized with the lunar cycle in some other way or if the full moon has a larger influence on subgroups of vulnerable children, such as those with mental or physical illnesses.

Key found to DNA-based nanomachines

Researchers at McMaster University have established a way to harness DNA as the engine of a microscopic “machine” they can turn on to detect trace amounts of substances that range from viruses and bacteria to cocaine and metals. It’s a completely new platform that can be adapted to many kinds of uses. DNA is best known as a genetic material, but it is also a very programmable molecule that lends itself to engineering for synthetic applications. The new method, described in Nature Communications, shapes separately programmed pieces of DNA material into pairs of interlocking circles. The first remains inactive until it is released by the second, like a bicycle wheel in a lock. When the second (locking) circle is exposed to even a trace amount of the target substance, it opens, freeing the first circle of DNA, which replicates quickly and creates a signal, such as a colour change. The DNA-based nanomachine is being further developed into a user-friendly detection kit that will enable rapid testing of a variety of substances. It could move to clinical testing within a year.

Published research from CNA members

Jones, K. A. (2016). Uniting nursing theory and current practice to manage suicide in Canada. Journal of Nursing Education and Practice, 6(9), 73-81. doi:10.5430/jnep.v6n9p73

During the last thirty years, more than 100,000 Canadians have died by suicide, remaining one of Canada’s critical public health concerns. According to the World Health Organization there is one suicide every forty seconds worldwide, an increase of 60% since 1950. Suicide is the single greatest source of violent deaths internationally, generating more deaths per annum than casualties of war and homicides combined. Twenty-five years ago, Canada’s National Task Force on Suicide investigated the suicide phenomenon and created its first report in pursuance of the development of better policies. The exploration for suicide risk factors (variables that denote an increased probability for suicide) has been embarked on by a variety of researchers and clinicians, but Canada’s suicide rate still exceeds the average in comparison to other countries. Although this Canadian public health crisis persists and escalates each year, it is a preventable concern that requires a new methodology. The purpose of this journal article is to explore and examine ethical issues surrounding the suicide epidemic in Canada. It will review the changes in Canada’s prevention and treatment of suicidality during the last few decades and the challenges that nurses currently face when treating suicidal patients. Additionally, it suggests that suicide may be better managed by utilizing the Collaborative Assessment and Management of Suicide (CAMS) framework combined with the Human Becoming Theory as a foundation for the nurse clinician; and that qualitative contribution to the treatment of suicide is paramount. This article encourages health care providers to re-evaluate their current suicide risk assessments by not only reviewing nursing theory, but implementing formalized suicide tools. Although this article frequently makes reference to the nursing profession, it is intended to broaden interest in CAMS for a variety of health care specialists in the mental health arena. Therefore, the terms’ nurse and health care professional are used interchangeably throughout to address a larger audience.

Holroyd-Leduc, J., Resin, J., Ashley, L., Barwich, D., Elliott, J., Huras, P., … Muscedere, J. (2016). Giving voice to older adults living with frailty and their family caregivers: Engagement of older adults living with frailty in research, health care decision making, and in health policy. Research Involvement and Engagement, 2(23). doi:10.1186/s40900-016-0038-7

Older adults are the fastest growing segment of Canada’s population resulting in an increased number of individuals living with frailty. Although aging and frailty are not synonymous the proportion of those who are frail increases with age. Frailty is not defined by a single condition, but rather a health state characterized by an increased risk of physical, mental, or social decline, deterioration of health status, and death. Recognizing frailty is important because earlier detection allows for program implementation focused on prevention and management to reduce future hospitalization, improve outcomes, and enhance vitality and quality of life. Even though older adults living with frailty are significant users of health care resources, their input is under-represented in research, health care decision making, and health policy formulation. As such, engaging older adults living with frailty and their family caregivers is not only an ethical imperative, but their input is particularly important as health and social care systems evolve from single-illness focused to those that account for the complex and chronic needs that accompany frailty. In this review, we summarize existing literature on engaging older adults living with frailty and their family caregivers across three settings: research, health and social care, and policy. We discuss strategies and barriers to engagement, and ethical and cultural factors and implications. Although this review is mainly focused on Canada it is likely to be broadly applicable to many of the health systems in the developed world where aging and frailty pose important challenges.

Abstracts reprinted with permission

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