Browsing by Author "Amiri, Neda"

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    “The medications are the decision-makers…” Making reproductive and medication use decisions among female patients with rheumatoid arthritis: a constructivist grounded theory
    (2022-01-22) Rebić, Nevena; Munro, Sarah; Garg, Ria; Hazlewood, Glen; Amiri, Neda; Baldwin, Corisande; Ensworth, Stephanie; Proulx, Laurie; De Vera, Mary A.
    Abstract Objective To examine how female patients with RA form decisions about having children, pregnancy, and medication use. Methods We employed a constructivist grounded theory design and recruited female participants who are 18 years or older, have a rheumatologist-confirmed RA diagnosis, live in Canada, and are able to communicate in English or French. We collected data through semi-structured individual and focus group interviews using telephone or video conferencing technology. Data collection and analysis were iterative, employed theoretical sampling, reflexive journaling, and peer debriefing, and culminated in a theoretical model. Results We recruited 21 participants with a mean age of 34 years and median 10 years since RA diagnosis. Overall, 33% had never been pregnant, 57% had previously been pregnant, and 10% were pregnant at the time of interview. Of those who had experienced pregnancy, 64% had at least one pregnancy while diagnosed with RA and of those, 56% used DMARD(s) during a pregnancy. We constructed a patient-centred framework depicting the dynamic relationships between 4 decision-making processes—(1) using medications, (2) having children, (3) planning pregnancy, and (4) parenting—and the substantial impact of healthcare providers on patients’ experiences making these decisions. These processes were further influenced by participants’ intersecting identities and contextual factors, particularly attitudes towards health and medications, disease onset and severity, familial support system, and experiences interacting with the healthcare system. Conclusion Our framework provides insight into how patients make reproductive decisions in the context of managing RA and the opportunities for providers to support them at each decision-making process. A patient-centred care approach is suggested to support female patients with RA in making reproductive and medication choices aligning with their individual desires, needs, and values.
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    Tracking the fate of ambient SO2 using sulfur isotopes, oxidant mixing ratios, and hydrocarbon mixtures.
    (2019-01-15) Amiri, Neda; Norman, Ann-Lise; Reuten, Christian; Du, Ke
    Field measurements for SO2 and the formation of sulfate were investigated in the presence of high concentrations of hydrocarbons in the Athabasca oil sands region to help understand sulfate formation pathways and its environmental impacts (Chapter 2). Results indicated the potential importance of SO2 oxidation in TMI-catalyzed pathway in the region during summer which has not been shown before. Oxidation of SO2 with sCIs is shown to be important in the atmosphere and evidence of the importance of this pathway is observed in the Athabasca oil sands region. The sulphur isotope fractionation factor for oxidation of SO2 with sCIs is investigated for the first time in a series of laboratory studies. Measurements of the sulfur isotope fractionation factor for SO2 oxidation with sCIs formed from limonene at 25°C are presented in chapter 3 and α found to be (34)α_sCI=0.992±0.002. Preliminary data for ∆33S and ∆36S during SO2 oxidation with sCIs were 0.061±0.02 ‰ and -0.87±0.02 ‰, respectively. A 1D box model was performed based on the fractionation factor for SO2 oxidation by sCIs. The results suggest that the sCI pathway may contribute 25% of SO2 oxidation in the atmosphere. Since the Athabasca oil sands region is known to have high emissions of hydrocarbons as well as SO2, investigating the relationship between hydrocarbons and sulfur compounds is of great interest in this region. Sulphate, SO2, and hydrocarbon concentration measurements in the Athabasca oil sands region as part of the JOSM program were used to determine possible sCIs precursors in the region and the role of particles acidity in SOA formation (chapter 4). In addition to monoterpenes, styrene also showed positive correlation with F(s) and can be a precursor to sCIs. Simultaneous data for sulfate and organic compounds in aerosols showed that acid catalyzed enhancement may be an important process for sulfate to ammonium ratio less than 3.
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    “Walking into the unknown…” key challenges of pregnancy and early parenting with inflammatory arthritis: a systematic review and thematic synthesis of qualitative studies
    (2021-04-21) Rebić, Nevena; Garg, Ria; Ellis, Ursula; Kitchin, Vanessa; Munro, Sarah; Hazlewood, Glen; Amiri, Neda; Bansback, Nick; De Vera, Mary A
    Abstract Background To conduct a systematic review and thematic synthesis of qualitative studies on the pregnancy and early parenting experiences of patients with inflammatory arthritis (IA). Methods We searched online databases for English-language, qualitative studies capturing the experiences of females with IA or their healthcare providers with pregnancy and/or early parenthood. We extracted findings from included studies and used thematic synthesis to develop descriptive and higher-order analytical themes. Results Of 20 included studies, our analysis identified 5 analytical themes among patients and 3 among providers. Patients’ reproductive desires, the impact of IA on their ability to experience pregnancy, and the availability of information to guide preparedness informed their pregnancy decisions. Patients’ IA management, pregnancy expectations, and access to support influenced their reproductive experiences. Patients’ experiences seeking information and care revealed substantial gaps in reproductive care provision to patients with IA. Reproductive uncertainty related to IA placed a heavy burden on patients’ emotional and psychological wellbeing. Reproductive care provision was influenced by providers’ perceived professional responsibility to address patients’ reproductive goals, fears of negative outcomes, and capacity to harness patient trust, incorporate reproductive care into rheumatology practice and facilitate multi-disciplinary care coordination. Conclusions Our review illuminated several barriers to experiencing pregnancy among patients with IA, particularly related to pregnancy planning support, availability of information, and care coordination among the patient’s healthcare team. To improve care, these barriers may be mitigated through the provision of relevant, practical, and consistent information as well as patient-centred multi-disciplinary approaches for managing pregnancy among patients with IA.