Publications by authors named "Olivia Drescher"

9 Publications

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Barriers to and enablers of attendance at diabetic retinopathy screening experienced by immigrants to Canada from multiple cultural and linguistic minority groups.

Diabet Med 2021 Apr 11;38(4):e14429. Epub 2020 Nov 11.

Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.

Aim: To identify barriers to/enablers of attendance at eye screening among three groups of immigrantsto Canada from cultural/linguistic minority groups living with diabetes.

Methods: Using a patient-oriented research approach leveraging Diabetes Action Canada's patient engagement platform, we interviewed a purposeful sample of people with type 2 diabetes who had immigrated to Canada from: Pakistan (interviews in Urdu), China (interviews in Mandarin) and French-speaking African and Caribbean nations (interviews in French). We collected and analysed data based on the Theoretical Domains Framework covering key modifiable factors that may operate as barriers to or enablers of attending eye screening. We used directed content analysis to code barrier/enabler domains. Barriers/enablers were mapped to behaviour change techniques to inform future intervention development.

Results: We interviewed 39 people (13 per group). Many barriers/enablers were consistent across groups, including views about harms caused by screening itself, practical appointment issues including forgetting, screening costs, wait times and making/getting to an appointment, lack of awareness about retinopathy screening, language barriers, and family and clinical support. Group-specific barriers/enablers included a preference to return to one's country of birth for screening, the impact of winter, and preferences for alternative medicine.

Conclusion: Our results can inform linguistic and culturally competent interventions to support immigrants living with diabetes in attending eye screening to prevent avoidable blindness.
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April 2021

Sound Practices: An Exploratory Study of Building and Monitoring Multiple-Choice Exams at Canadian Undergraduate Medical Education Programs.

Acad Med 2021 02;96(2):271-277

L. Varpio is professor of medicine and associate director of research, Health Professions Education graduate degree program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID:

Purpose: Written examinations such as multiple-choice question (MCQ) exams are a key assessment strategy in health professions education (HPE), frequently used to provide feedback, to determine competency, or for licensure decisions. However, traditional psychometric approaches for monitoring the quality of written exams, defined as items that are discriminant and contribute to increase the overall reliability and validity of the exam scores, usually warrant larger samples than are typically available in HPE contexts. The authors conducted a descriptive exploratory study to document how undergraduate medical education (UME) programs ensure the quality of their written exams, particularly MCQs.

Method: Using a qualitative descriptive methodology, the authors conducted semistructured interviews with 16 key informants from 10 Canadian UME programs in 2018. Interviews were transcribed, anonymized, coded by the primary investigator, and co-coded by a second team member. Data collection and analysis were conducted iteratively. Research team members engaged in analysis across phases, and consensus was reached on the interpretation of findings via group discussion.

Results: Participants focused their answers around MCQ-related practices, reporting using several indicators of quality such as alignment between items and course objectives and psychometric properties (difficulty and discrimination). The authors clustered findings around 5 main themes: processes for creating MCQ exams, processes for building quality MCQ exams, processes for monitoring the quality of MCQ exams, motivation to build quality MCQ exams, and suggestions for improving processes.

Conclusions: Participants reported engaging multiple strategies to ensure the quality of MCQ exams. Assessment quality considerations were integrated throughout the development and validation phases, reflecting recent work regarding validity as a social imperative.
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February 2021

Patients' perspectives on how to improve diabetes care and self-management: qualitative study.

BMJ Open 2020 04 29;10(4):e032762. Epub 2020 Apr 29.

Office of Education and Continuing Professional Development, Laval University, Quebec, Quebec, Canada

Objective: People living with diabetes need and deserve high-quality, individualised care. However, providing such care remains a challenge in many countries, including Canada. Patients' expertise, if acknowledged and adequately translated, could help foster patient-centred care. This study aimed to describe Expert Patients' knowledge, wisdom and advice to others with diabetes and to health professionals to improve diabetes self-management and care.

Design And Methods: We recruited a convenience sample of 21 men and women. Participants were people of diverse backgrounds who are Patient Partners in a national research network (hereafter Expert Patients). We interviewed and video-recorded their knowledge, wisdom and advice for health professionals and for others with diabetes. Three researchers independently analysed videos using inductive framework analysis, identifying themes through discussion and consensus. Expert Patients were involved in all aspects of study design, conduct, analysis and knowledge translation.

Results: Acknowledging and accepting the reality of diabetes, receiving support from family and care teams and not letting diabetes control one's life are essential to live well with diabetes. To improve diabetes care, health professionals should understand and acknowledge the impact of diabetes on patients and their families, and communicate with patients openly, respectfully, with empathy and cultural competency.

Conclusion: Expert Patients pointed to a number of areas of improvement in diabetes care that may be actionable individually by patients or health professionals, and also collectively through intergroup collaboration. Improving the quality of care in diabetes is crucial for improving health outcomes for people with diabetes.
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April 2020

Identifying Barriers and Enablers to Attending Diabetic Retinopathy Screening in Immigrants to Canada From Ethnocultural Minority Groups: Protocol for a Qualitative Descriptive Study.

JMIR Res Protoc 2020 Feb 12;9(2):e15109. Epub 2020 Feb 12.

Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.

Background: Immigrants to Canada belonging to ethnocultural minority groups are at increased risk of developing diabetes and complications, including diabetic retinopathy, and they are also less likely to be screened and treated. Improved attendance to retinopathy screening (eye tests) has the potential to reduce permanent complications, including blindness.

Objective: This study aims to identify the barriers and enablers of attending diabetic retinopathy screening among ethnocultural minority immigrants living with diabetes in Quebec and Ontario, Canada, to inform the development of a behavior change intervention to improve diabetic retinopathy screening attendance.

Methods: The research question draws on the needs of patients and clinicians. Using an integrated knowledge translation approach, the research team includes clinicians, researchers, and patient partners who will contribute throughout the study to developing and reviewing materials and procedures, helping to recruit participants, and disseminating findings. Using a convenience snowball strategy, we will recruit participants from three target groups: South Asian and Chinese people, and French-speaking people of African descent. To better facilitate reaching these groups and support participant recruitment, we will partner with community organizations and clinics serving our target populations in Ontario and Quebec. Data will be collected using semistructured interviews, using topic guides developed in English and translated into French, Mandarin, Hindi, and Urdu, and conducted in those languages. Data collection and analysis will be structured according to the Theoretical Domains Framework (TDF), which synthesizes predominant theories of behavior change into 14 domains covering key modifiable factors that may operate as barriers or enablers to attending eye screening. We will use directed content analysis to code barriers and enablers to TDF domains, then thematic analysis to define key themes within domains.

Results: This study was approved for funding in December 2017, and the research ethics board approved the conduct of the study as of January 13, 2018. Data collection then began in April 2018. As of August 28, 2018, we have recruited 22 participants, and analysis is ongoing, with results expected to be published in 2020.

Conclusions: Findings from this study will inform the codevelopment of theory-informed, culturally- and linguistically-tailored interventions to support patients in attending retinopathy screening.

International Registered Report Identifier (irrid): DERR1-10.2196/15109.
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February 2020

Omega-3 polyunsaturated fatty acid profiles and relationship with cardiometabolic risk factors in Cree (Eeyouch) of Northern Québec.

Int J Circumpolar Health 2016 15;75:30361. Epub 2016 Jul 15.

Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Québec, QC, Canada.

Background: n-3 long-chain polyunsaturated fatty acids (LC-PUFAs) from fish are known modulators of cardiometabolic risk factors.

Objective: To examine fatty acids (FAs) status and the relationship between n-3 LC-PUFA and cardiometabolic risk factors in Cree participants.

Design: We analyzed data from a cross-sectional study (n=829) conducted in Cree adults (aged 18-74 years) from 7 communities of the James Bay territory of Quebec (Canada) in 2005-2009. Sociodemographic, lifestyle, clinical and anthropometric data were collected. FAs were quantified in red blood cells (RBCs) under fasting conditions.

Results: A total of 89% of the participants were overweight (with 69% obesity), 33% had hypertriglyceridemia, 44% had low plasma HDL-c and 77% had fasting plasma insulin ≥90 pmol/l. Total n-3 PUFAs accounted for 6% of total FAs and were higher among older participants, while n-6 PUFAs accounted for 31% of total FAs and were higher among younger participants. According to the adjusted multiple linear regression models, n-3 LC-PUFA was associated (p<0.05) with higher total cholesterol, LDL-c and apo B-100, and was also associated (p<0.05) with lower blood glucose.

Conclusion: Overall, this study showed that n-3 LC-PUFA levels measured in the RBCs of the Cree adults are relatively low and tend towards lower levels among youth. These levels might be insufficient to offset the prevalence of cardiometabolic risk factors.
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January 2018

Evaluation of exposure to organophosphate, carbamate, phenoxy acid, and chlorophenol pesticides in pregnant women from 10 Caribbean countries.

Environ Sci Process Impacts 2015 Sep 4;17(9):1661-71. Epub 2015 Aug 4.

Department of Public Health & Preventive Medicine, St George's University, St George's, Grenada.

Pesticides are commonly used in tropical regions such as the Caribbean for both household and agricultural purposes. Of particular concern is exposure during pregnancy, as these compounds can cross the placental barrier and interfere with fetal development. The objective of this study was to evaluate exposure of pregnant women residing in 10 Caribbean countries to the following commonly used classes of pesticides in the Caribbean: organophosphates (OPs), carbamates, phenoxy acids, and chlorophenols. Out of 438 urine samples collected, 15 samples were randomly selected from each Caribbean country giving a total of 150 samples. Samples were analyzed for the following metabolites: six OP dialkylphosphate metabolites [dimethylphosphate (DMP), dimethylthiophosphate (DMTP), dimethyldithiophosphate (DMDTP), diethylphosphate (DEP), diethylthiophosphate (DETP) and diethyldithiophosphate (DEDTP)]; two carbamate metabolites [2-isopropoxyphenol (2-IPP) and carbofuranphenol]; one phenoxy acid 2,4-dichlorophenoxyacetic acid (2,4-D); and five chlorophenols [2,4-dichlorophenol (DCP), 2,5-dichlorophenol (2,5-DCP), 2,4,5-trichlorophenol (TCP), 2,4,6-trichlorophenol (2,4,6-TCP), and pentachlorophenol (PCP)]. OP metabolites were consistently detected in ≥60% of the samples from Antigua and Barbuda, Bermuda, and Jamaica. Of the carbamate metabolites, 2-IPP was detected in seven of the 10 Caribbean countries with a detection frequency around 30%, whereas carbofuranphenol was detected in only one sample. The detection frequency for the phenoxy acid 2,4-D ranged from 20% in Grenada to a maximum of 67% in Belize. Evidence of exposure to chlorophenol pesticides was also established with 2,4-DCP by geometric means ranging from 0.52 μg L(-1) in St Lucia to a maximum of 1.68 μg L(-1) in Bermuda. Several extreme concentrations of 2,5-DCP were detected in four Caribbean countries-Belize (1100 μg L(-1)), Bermuda (870 μg L(-1)), Jamaica (1300 μg L(-1)), and St Kitts and Nevis (1400 μg L(-1)). 2,4,5-TCP, 2,4,6-TCP, and pentachlorophenol were rarely detected. This biomonitoring study underscores the need for Caribbean public health authorities to encourage their populations, and in particular pregnant women, to become more aware of the potential routes of exposure to pesticides and to utilize these chemicals more cautiously given the possible adverse effects such exposures can have on their unborn children and infants.
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September 2015

Methylmercury exposure, PON1 gene variants and serum paraoxonase activity in Eastern James Bay Cree adults.

J Expo Sci Environ Epidemiol 2014 Nov 22;24(6):608-14. Epub 2014 Jan 22.

1] Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec, QC, Canada [2] Département de médicine sociale et préventive, Université Laval, Québec, Quebec, Canada [3] Laboratoire de toxicologie, Institut national de santé publique du Québec, Québec, Quebec, Canada.

There is growing evidence that cardiovascular health can be affected by exposure to methylmercury (MeHg), by a mechanism involving oxidative stress. Paraoxonase 1 (PON1) is a high-density lipoprotein-bound enzyme that hydrolyzes toxic oxidized lipids and protects against cardiovascular diseases. Evidence from in vitro studies indicates that MeHg can inhibit PON1 activity but little is known regarding this effect in humans. We investigated whether increased blood mercury levels are associated with decreased serum PON1 activity in Cree people who are exposed to MeHg by fish consumption. We conducted a multi-community study of 881 Cree adults living in Eastern James Bay communities (Canada). Multivariate analyses considered sociodemographic, anthropometric, clinical, dietary and lifestyle variables and six PON1 gene variants (rs705379 (-108C/T), rs662 (Q192R), rs854560 (L55M), rs854572 (-909C/G), rs854571 (-832C/T) and rs705381 (-162C/T)). In a multiple regression model adjusted for all potential confounding factors and the rs854560 PON1 variant, a statistically significant MeHg*rs705379 interaction was observed. Blood mercury levels were inversely associated with serum PON1 activities in individual homozygous for the -108T allele (P=0.009). Our results suggest a gene-environment interaction between the rs705379 polymorphism and MeHg exposure on PON1 activity levels in this aboriginal population. This finding will need to be replicated in other population studies.
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November 2014

Evaluation of pyrethroid exposures in pregnant women from 10 Caribbean countries.

Environ Int 2014 Feb 5;63:201-6. Epub 2013 Dec 5.

Laval University CHUQ Research Center, Québec, Canada; Institut national de santé publique du Québec, Canada.

Pyrethroid pesticides are commonly used in tropical regions such as the Caribbean as household insecticides, pet sprays, and where malaria is endemic, impregnated into mosquito-repellent nets. Of particular concern is exposure during pregnancy, as these compounds have the potential to cross the placental barrier and interfere with fetal development, as was shown in limited animal studies. The objective of this study was to evaluate exposure to pyrethroids to pregnant women residing in 10 English-speaking Caribbean countries. Pyrethroid exposures were determined by analyzing five pyrethroid metabolites in urine samples from 295 pregnant women: cis-DBCA, cis-DCCA, trans-DCCA, 3-PBA, and 4-F-3-PBA. Pyrethroid metabolite concentrations in Caribbean pregnant women were generally higher in the 10 Caribbean countries than levels reported for Canadian and U.S. women. In Antigua & Barbuda and Jamaica participants the geometric mean concentrations of cis-DBCA was significantly higher than in the other nine countries together (p<0.0001 and <0.0012 respectively). For cis- and trans-DCCA, only Antigua & Barbuda women differed significantly from participants of the other nine Caribbean countries (p<0.0001). Urinary 4-F-3-PBA and 3-PBA levels were significantly higher in Antigua & Barbuda (p<0.0028 and p<0.0001 respectively) as well as in Grenada (p<0.0001 and p<0.007 respectively). These results indicate extensive use of pyrethroid compounds such as permethrin and cypermethrin in Caribbean households. In Antigua & Barbuda, the data reveals a greater use of deltamethrin. This study underscores the need for Caribbean public health authorities to encourage their populations, and in particular pregnant women, to utilize this class of pesticides more judiciously given the potentially adverse effects of exposure on fetuses and infants.
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February 2014

Evaluation of a public health intervention to lower mercury exposure from fish consumption in Bermuda.

PLoS One 2012 15;7(10):e47388. Epub 2012 Oct 15.

Department of Population Health and Environment, Research Center CHUQ, Québec, Canada.

Objectives: To assess the efficacy of a public health intervention to reduce blood mercury (Hg) concentration levels in pregnant Bermudian women.

Methods: In 2003, we conducted a study entitled "Prenatal exposure of the Bermudian Population to Environmental Contaminants" which provided Bermuda's first baseline data on prenatal exposure to several environmental contaminants, including Hg. The mean Hg concentration from 42 healthy newborns measured in umbilical cord blood was 41.3 nmol/L, ranging from 5-160 nmol/L. This concentration was much higher than expected, being approximately 8 times the general levels found in Canada and the U.S. Furthermore, we estimated that 85% of total Hg measured was in the form of methylmercury (MeHg), indicating that seafood consumption was the primary source of Hg exposure during pregnancy in Bermuda. Locally sourced seafood was identified as the most significant possible contributory source of Hg exposure. In 2005 the authors began a complementary research programme to study the levels of Hg in local commercial fish species. Coming out of this research were specific local fish consumption guidelines issued by the Department of Health advising pregnant women to avoid those local fish species found to be high in Hg while still encouraging consumption of fish species having lower Hg levels.

Results: In 2010, under another research initiative, we returned to Bermuda to carry out another evaluation of Hg in human blood. Hg was measured in the blood of 49 pregnant women. The arithmetic mean Hg blood concentration was 6.6 nmol/L and the geometric mean 4.2 nmol/L. The maximum concentration found was 24 nmol/L.

Conclusions: Hg exposure of Bermudian pregnant women has dropped significantly by a factor of around 5 since the foetal cord blood study in 2003.
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July 2013