Profiling disease burden and Borrelia seroprevalence in Canadians with complex and chronic illness.

Lyme disease, caused by vector-borne Borrelia bacteria, can present with diverse multi-system symptoms that resemble other conditions. The objective of this study was to evaluate disease presentations and Borrelia seroreactivity in individuals experiencing a spectrum of chronic and complex illnesses. We recruited 157 participants from Eastern Canada who reported one or more diagnoses of Lyme disease, neurological, rheumatic, autoimmune, inflammatory, gastrointestinal, or cardiovascular illnesses, or were asymptomatic and presumed healthy. Intake categories were used to classify participants based on their perceived proximity to Lyme disease, distinguishing between those with a disclosed history of Borrelia infection, those with lookalike conditions (e.g. fibromyalgia syndrome), and those with unrelated ailments (e.g. intestinal polyps). Participants completed three questionnaires, the SF-36 v1, SIQR, and HMQ, to capture symptoms and functional burden, and provided blood serum for analysis at an accredited diagnostic lab. Two-tiered IgG and IgM serological assessments (whole cell ELISA and Western blot) were performed in a blinded fashion on all samples. The pattern of symptoms and functional burden were similarly profound in the presumptive Lyme and Lyme-like disease categories. Borrelia seroprevalence across the study cohort was 10% for each of IgG and IgM, and occurred within and beyond the Lyme disease intake category. Western blot positivity in the absence of reactive ELISA was also substantial. Fibromyalgia was the most common individual diagnostic tag disclosed by two-tier IgG-positive participants who did not report a history of Lyme disease. Within the IgG seropositive cohort, the presence of antibodies against the 31 kDa Outer Surface Protein A (OspA) was associated with significantly better health outcomes. Previously, this marker has been linked to treatment-refractory Lyme arthritis. Overall, our findings support prior observations of phenotypic overlap between Lyme and other diseases. Seropositivity associated with non-specific symptoms and functional impairment warrants further mechanistic investigation and therapeutic optimization.

Qualitative analysis of values and motivation reported by families utilizing a paediatric virtual care emergency clinic launched during the SARS-CoV-2 pandemic.

PURPOSE: This is the first study to take an in-depth qualitative approach to identify motivating factors for caregivers who chose the paediatric emergency virtual care option in Canada during the SARS-CoV-2 pandemic. The role that virtual care may play moving forward is also considered. METHODS: Between May 2020 and May 2021, 773 respondents attending the virtual clinic completed a follow-up survey with open-ended questions. For qualitative content analysis, comments were coded and analysed until thematic saturation was reached. Sub-codes were subsumed into major coding categories to identify themes. RESULTS: Three major themes, including safety, reassurance and convenience, and an overarching theme of satisfaction emerged from this analysis. Paediatric virtual clinic use was motivated in part by a desire to avoid the hospital environment. In-person Emergency Department visits were reported to be challenging and stressful, particularly due to perceived infection risk. Respondents appreciated that the clinic provided reassurance by assisting in navigating the healthcare system during a time of uncertainty and felt the virtual option allowed them to use healthcare resources responsibly. The convenience and ease of access to virtual care allowed for improved family-centred care in vulnerable populations. The overarching theme of satisfaction was emphasized by numerous comments for this service to be offered post-pandemic. CONCLUSION: Our study indicates that virtual care was an attractive option for caregivers due to the safety, reassurance, and convenience provided. The strong patient desire for continued availability post-pandemic will be important considerations in this rapidly developing area of care.

RéSUMé: OBJECTIF: Il s'agit de la première étude à adopter une approche qualitative approfondie pour identifier les facteurs de motivation des aidants qui ont choisi l'option des soins virtuels d'urgence pédiatrique au Canada pendant la pandémie de SRAS-CoV-2. Le rôle que les soins virtuels pourraient jouer à l'avenir est également envisagé. MéTHODES: Entre mai 2020 et mai 2021, 773 personnes ayant participé à la clinique virtuelle ont répondu à une enquête de suivi comportant des questions ouvertes. Pour l'analyse qualitative du contenu, les commentaires ont été codés et analysés jusqu'à ce que la saturation thématique soit atteinte. Les sous-codes ont été subsumés en grandes catégories de codage afin d'identifier les thèmes. RéSULTATS: Trois thèmes principaux, à savoir la sécurité, le réconfort et la commodité, ainsi qu'un thème général de satisfaction ont émergé de cette analyse. L'utilisation de la clinique virtuelle pédiatrique a été motivée en partie par le désir d'éviter l'environnement hospitalier. Les visites en personne dans les services d'urgence ont été jugées difficiles et stressantes, notamment en raison du risque d'infection perçu. Les personnes interrogées ont apprécié que la clinique les rassure en les aidant à s'orienter dans le système de santé pendant une période d'incertitude et ont estimé que l'option virtuelle leur permettait d'utiliser les ressources de santé de manière responsable. La commodité et la facilité d'accès aux soins virtuels ont permis d'améliorer les soins centrés sur la famille dans les populations vulnérables. Le thème général de la satisfaction a été souligné par de nombreux commentaires pour que ce service soit offert après la pandémie. CONCLUSION: Notre étude indique que les soins virtuels sont une option attrayante pour les aidants en raison de la sécurité, du réconfort et de la commodité qu'ils procurent. Le désir profond des patients de continuer à bénéficier de ces services après la pandémie sera un élément important à prendre en compte dans ce domaine de soins qui se développe rapidement.

Engaging Knowledge Users with Mental Health Experience in a Mixed-Methods Systematic Review of Post-secondary Students with Psychosis: Reflections and Lessons Learned from a Master's Thesis.

Engaging knowledge users (KUs) as research team members throughout the research process helps generate relevant knowledge and may improve uptake of research results. The purpose of this article is to describe how an integrated knowledge translation (iKT) approach was embedded within a master's thesis project comprising a mixed-methods systematic review. KUs were engaged in four distinct phases of the systematic review process, including (1) proposal development; (2) development of the research question and approach; (3) creation of an advisory panel; and (4) an end of study meeting to interpret findings and plan dissemination of findings. The extent of each KU's engagement on the research team fluctuated during the study. Challenges included maintaining the same KUs throughout the project and maintaining the scope of the project to align with a master's thesis. Our suggestions for optimizing graduate student iKT projects include having regular team meetings and periodically checking in with team members to encourage reflection on overall engagement and progress of the project. Overall, KUs helped create a research project designed to address their needs and provided input on how results might translate into implications for clinical practice, education, academic policy, and future research within their respective contexts.

The Platelet Fraction Is a Novel Reservoir to Detect Lyme Borrelia in Blood.

Serological diagnosis of Lyme disease suffers from considerable limitations. Yet, the technique cannot currently be replaced by direct detection methods, such as bacterial culture or molecular analysis, due to their inadequate sensitivity. The low bacterial burden in vasculature and lack of consensus around blood-based isolation of the causative pathogen, Borrelia burgdorferi, are central to this challenge. We therefore addressed methodological optimization of Borrelia recovery from blood, first by analyzing existing protocols, and then by using experimentally infected human blood to identify the processing conditions and fractions that increase Borrelia yield. In this proof-of-concept study, we now report two opportunities to improve recovery and detection of Borrelia from clinical samples. To enhance pathogen viability and cultivability during whole blood collection, citrate anticoagulant is superior to more commonly used EDTA. Despite the widespread reliance on serum and plasma as analytes, we found that the platelet fraction of blood concentrates Borrelia, providing an enriched resource for direct pathogen detection by microscopy, laboratory culture, Western blot, and PCR. The potential for platelets to serve as a reservoir for Borrelia and its diagnostic targets may transform direct clinical detection of this pathogen.

Post-secondary students with symptoms of psychosis: A mixed-methods systematic review.

Post-secondary students are at a heightened risk of psychosis, yet little is known about this population. The aim of this study was to conduct a mixed-methods systematic review of psychosis among post-secondary students, including student characteristics, overall prevalence, risk factors, interventions, and their reported experiences. Procedures were modelled on the Joanna Briggs Institute approach, while PRISMA guided conduct and reporting. A librarian created a systematic search of nine databases, and quality was assessed using JBI Critical Appraisal Tools. We pooled and analysed data according to objectives and recorded data using synthesis tables and narrative summaries. 26 articles published between 2006 and 2018 are included. The average age of participants was 21 years, and most identified as female and Caucasian. The prevalence of psychosis was often measured in a way that limited comparison across studies. Risk factors associated with symptoms of psychosis included substance use, depression, and younger age. Other risk factors trending towards a relationship included racial discrimination and anxiety. Protective factors included self-esteem and self-concept clarity. Five interventions were studied, with mixed results, and only three studies reported on the experience of students. While five promising interventions are identified, inadequate testing and replication limit confidence in their effectiveness and there is a notable deficit in qualitative evidence exploring the experiences of these students. Integrating knowledge on risk factors, interventions, and experiences of students with psychosis will help tailor and facilitate their health care while protecting their right to education.

Lyme Disease Frontiers: Reconciling Borrelia Biology and Clinical Conundrums.

Lyme disease is a complex tick-borne zoonosis that poses an escalating public health threat in several parts of the world, despite sophisticated healthcare infrastructure and decades of effort to address the problem. Concepts like the true burden of the illness, from incidence rates to longstanding consequences of infection, and optimal case management, also remain shrouded in controversy. At the heart of this multidisciplinary issue are the causative spirochetal pathogens belonging to the Borrelia Lyme complex. Their unusual physiology and versatile lifestyle have challenged microbiologists, and may also hold the key to unlocking mysteries of the disease. The goal of this review is therefore to integrate established and emerging concepts of Borrelia biology and pathogenesis, and position them in the broader context of biomedical research and clinical practice. We begin by considering the conventions around diagnosing and characterizing Lyme disease that have served as a conceptual framework for the discipline. We then explore virulence from the perspective of both host (genetic and environmental predispositions) and pathogen (serotypes, dissemination, and immune modulation), as well as considering antimicrobial strategies (lab methodology, resistance, persistence, and clinical application), and borrelial adaptations of hypothesized medical significance (phenotypic plasticity or pleomorphy).