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Background: Rigorously designed longitudinal studies can inform how best to reduce the widening health gap between Indigenous and non-Indigenous children.Methods: A systematic review was performed to identify and present the breadth and depth of longitudinal studies reporting the health and well-being of Indigenous children (aged 0-18 years) globally. Databases were searched up to 23 June 2020. Study characteristics were mapped according to domains of the life course model of health. Risk of bias was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. Reported level of Indigenous involvement was also appraised; PROSPERO registration CRD42018089950.Results: From 5545 citations, 380 eligible papers were included for analysis, representing 210 individual studies. Of these, 41% were located in Australia (n = 88), 22.8% in the USA (n = 42), 11.9% in Canada (n = 25) and 10.9% in New Zealand (n = 23). Research tended to focus on either health outcomes (50.9%) or health-risk exposures (43.8%); 55% of studies were graded as 'good' quality; and 89% of studies made at least one reference to the involvement of Indigenous peoples over the course of their research.Conclusions: We identified gaps in the longitudinal assessment of cultural factors influencing Indigenous child health at the macrosocial level, including connection to culture and country, intergenerational trauma, and racism or discrimination. Future longitudinal research needs to be conducted with strong Indigenous leadership and participation including holistic concepts of health. This is critical if we are to better understand the systematic factors driving health inequities experienced by Indigenous children globally. [ABSTRACT FROM AUTHOR]

Summary: Increasingly, school districts are looking for insights on how to embed a well-being focus across school communities. Well-being in K-12 education is proven to support positive mental health, improve academic performance and contribute to positive outcomes for students and staff. How districts transition to deeply integrate well-being into existing priorities and practices is not well understood. Insights on such shifts can help inform widespread change in education. In 2020, six Canadian school districts participated in case study research to examine how and why districts were able to shift their culture to one that prioritizes well-being. Fifty-five school community members participated in individual semi-structured interviews to explore their perception of well-being in their school communities. Analysis identified six themes: well-being is wholistic and requires balance, student and staff well-being are interconnected, organizational leadership sustains implementation, connection and voice as a catalyst to well-being, building capacity to support well-being action, and charting and re-charting a course. Findings increase our understanding of system-level change, and provide insights to support well-being in education. Lay Summary: Well-being in K-12 education is proven to support positive mental health, improve academic performance and contribute to positive outcomes for students and staff. How school districts can deeply integrate well-being into existing priorities and practices is not well understood. Many districts are looking for insights on how to embed a well-being focus across school communities. These insights can help inform change in K-12 education. In 2020, six Canadian school districts participated in case study research to examine how and why districts were able to shift their culture to one that prioritizes well-being. Fifty-five participants from six districts took part in interviews on the topic of district well-being prioritization. Supporting documents were also reviewed. Qualitative analysis identified six common themes: well-being is wholistic and requires balance, student and staff well-being are interconnected, organizational leadership sustains implementation, connection and voice as a catalyst to well-being, building capacity to support well-being action, and charting and re-charting a course. Study findings increase our understanding of system-level change in K-12 education. Findings provide valuable 'entry points' for school and district leaders to consider when making well-being a priority in their own contexts. [ABSTRACT FROM AUTHOR]

Background: We studied the impact of fine particulate matter (PM2.5) exposure due to a remote wildfire event in the Pacific Northwest on daily outpatient respiratory and cardiovascular physician visits during wildfire (24-31 August, 2015) and post-wildfire period (1-30 September, 2015) relative to the pre-wildfire period (1-23 August, 2015) in the city of Calgary, Canada.Methods: A quasi-Poisson regression model was used for modelling daily counts of physician visits due to PM2.5 while adjusting for day of the week (weekday versus weekend or public holiday), wildfire exposure period (before, during, after), methane, relative humidity, and wind direction. A subgroup analysis of those with pre-existing diabetes or hypertension was performed.Results: An elevated risk of respiratory disease morbidity of 33% (relative risk: RR) [95% confidence interval (CI): 10%-59%] and 55% (95% CI: 42%-69%) was observed per 10µg/m3 increase in PM2.5 level during and after wildfire, respectively, relative to the pre-wildfire time period. Increased risk was observed for children aged 0-9 years during (RR = 1.57, 95% CI: 1.21-2.02) and after the wildfire (RR = 2.11, 95% CI: 1.86-2.40) especially for asthma, acute bronchitis and acute respiratory infection. The risk of physician visits among seniors increased by 11% (95% CI: 3%-21%), and 19% (95% CI: 7%-33%) post-wildfire for congestive heart failure and ischaemic heart disease, respectively. Individuals with pre-existing diabetes had an increased risk of both respiratory and cardiovascular morbidity in the post-wildfire period (RR = 1.35, 95% CI: 1.09-1.67; RR = 1.22, 95% CI: 1.01-1.46, respectively).Conclusions: Wildfire-related PM2.5 exposure led to increased respiratory condition-related outpatient physician visits during and after wildfires, particularly for children. An increased risk of physician visits for congestive heart failure and ischaemic heart disease among seniors in the post-wildfire period was also observed. [ABSTRACT FROM AUTHOR]

Background: Dementia is an increasing concern in many countries, especially in those experiencing rapid growth in the proportion of older adults in their population.Objective: This study aims to describe trends and demographic characteristics of incident dementia cases in community-dwelling older adults managed by primary care physicians.Methods: We used electronic medical records from the Canadian Primary Care Sentinel Surveillance Network database to conduct a retrospective analysis to determine the number of, and trends for, incident diagnoses of dementia. Age-standardized annual incidence rates were calculated. Participants in our cohort are Canadian community dwelling seniors aged 65+ years who were not diagnosed with dementia before baseline with at least six years of record at their primary care clinics.Results: The cohort consisted of 39 067 patients of whom 57% were females; the mean (SD) follow-up was 8.4 (1.5) years. During follow-up, 4935 patients were diagnosed with dementia. The risk for dementia diagnosis increased with increasing age but decreased in the last four years among people aged 80 and older at baseline (P < 0.001). People with dementia were more likely to be females (P = 0.001) and urban residents (P < 0.001), they are less likely to be classified into the least deprived group (P = 0.012).Conclusions: The incidence of dementia diagnosis increased with age except in the oldest old in both sexes. This may be attributed to the effect of mortality competing risk. Future research on the association between risk factors and dementia should consider studying dementia among the oldest old separately to minimize bias. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether the genotypic resistance profile inferred from WGS could accurately predict phenotypic resistance for ESBL-producing Escherichia coli isolated from patient samples in Canadian hospital laboratories.Methods: As part of the ongoing CANWARD study, 671 E. coli were collected and phenotypically confirmed as ESBL producers using CLSI M100 disc testing criteria. Isolates were sequenced using the Illumina MiSeq platform, resulting in 636 high-quality genomes for comparison. Using a rules-based approach, the genotypic resistance profile was compared with the phenotypic resistance interpretation generated using the CLSI broth microdilution method for ceftriaxone, ciprofloxacin, gentamicin and trimethoprim/sulfamethoxazole.Results: The most common genes associated with non-susceptibility to ceftriaxone, gentamicin and trimethoprim/sulfamethoxazole were CTX-M-15 (n = 391), aac(3)-IIa + aac(6')-Ib-cr (n = 121) and dfrA17 + sul1 (n = 169), respectively. Ciprofloxacin non-susceptibility was most commonly attributed to alterations in both gyrA (S83L + D87N) and parC (S80I + E84V), with (n = 187) or without (n = 197) aac(6')-Ib-cr. Categorical agreement (susceptible or non-susceptible) between actual and predicted phenotype was 95.6%, 98.9%, 97.6% and 88.8% for ceftriaxone, ciprofloxacin, gentamicin and trimethoprim/sulfamethoxazole, respectively. Only ciprofloxacin results (susceptible or non-susceptible) were predicted with major error (ME) and very major error (VME) rates of <3%: ciprofloxacin (ME, 1.5%; VME, 1.1%); gentamicin (ME, 0.8%-31.7%; VME, 4.8%); ceftriaxone (ME, 81.8%; VME, 3.0%); and trimethoprim/sulfamethoxazole (ME, 0.9%-23.0%; VME, 5.2%-8.5%).Conclusions: Our rules-based approach for predicting a resistance phenotype from WGS performed well for ciprofloxacin, with categorical agreement of 98.9%, an ME rate of 1.5% and a VME rate of 1.1%. Although high categorical agreements were also obtained for gentamicin, ceftriaxone and trimethoprim/sulfamethoxazole, ME and/or VME rates were ≥3%. [ABSTRACT FROM AUTHOR]

Aim Investigate changes in alcohol use and related harm using the first multisite, controlled, longitudinal study of Managed Alcohol Programs (MAPs). MAPs provide regular doses of alcohol, accommodation, social supports and healthcare to unstably housed people with alcohol dependence. Methods A multisite, quasi-experimental, longitudinal study was conducted in day centres, shelters and residential programs for unstably housed people. There were 59 MAP participants from six Canadian cities and 116 local controls. Self-reported alcohol consumption and harms were assessed at 0-2, 6 and 12 months. Liver function test results were accessed for MAP participants. Results Both groups had similar reductions in mean drinks per day (MAP: -8.11; controls: -8.54 controls, P < 0.001) and days drinking per month (MAP: -2.51 days, P < 0.05; control: -4.81 days, P = 0.0001) over 6–-12 months. Both reduced non-beverage alcohol consumption. MAP participants reported significantly fewer harms at both 0-2 and 6 months than controls. MAP participants had similar total consumption to controls, but spread out over more days (25.41 versus 19.64 days per month, P = 0.001). After leaving a MAP, participants' liver status deteriorated, with increases in both aspartate transaminase and bilirubin levels. MAP sites with effective policies on outside drinking drank less and had fewer harms. Conclusion MAP participants drank less hazardously than controls, especially with effective management of non-MAP drinking. Reductions in alcohol use and harms occurred for both groups, although MAP participants reported fewer harms at 0-6 months. Departing an MAP was associated with deterioration in liver status. Although providing stable housing, MAPs did not worsen health or increase alcohol use. [ABSTRACT FROM AUTHOR]

Background: Deficit accumulation frailty indices (FIs) are widely used to characterize frailty. FIs vary in number and composition of items; the impact of this variation on reliability and clinical applicability is unknown.Method: We simulated 12 000 studies using a set of 70 candidate deficits in 12 080 community-dwelling participants 65 years and older. For each study, we varied the number (5, 10, 15, 25, 35, 45) and composition (random selection) of items defining the FI and calculated descriptive and predictive estimates: frailty score, prevalence, frailty cutoff, mortality odds ratio, predicted probability of mortality for FI = 0.28 (prevalence threshold), and FI cutoff predicting 10% mortality over the follow-up. We summarized the estimates' medians and spreads (0.025-0.975 quantiles) by number of items and calculated intraclass correlation coefficients (ICCs).Results: Medians of frailty scores were 0.11-0.12 with decreasing spreads from 0.04-0.24 to 0.10-0.14 for 5-item and 45-item FIs. The median cutoffs identifying 15% as frail was 0.19-0.20 and stable; the spreads decreased with more items. However, medians and spreads for the prevalence of frailty (median: 11%-3%), mortality odds ratio (median: 1.24-2.19), predicted probability of mortality (median: 8%-17%), and FI cutoff predicting 10% mortality (median: 0.38-0.20) varied markedly. ICC increased from 0.19 (5-item FIs) to 0.84 (45-item FIs).Conclusions: Variability in the number and composition of items of individual FIs strongly influences their reliability. Estimates using FIs may not be sufficiently stable for generalizing results or direct application. We propose avenues to improve the development, reporting, and interpretation of FIs. [ABSTRACT FROM AUTHOR]

Background: Compared with those with a higher socio-economic position (SEP), individuals with a lower SEP have higher cancer morbidity and mortality. However, the contribution of modifiable risk factors to these inequities is not known. This study aimed to quantify the mediating effects of modifiable risk factors to associations between SEP and cancer morbidity and mortality.Methods: This study used a prospective observational cohort design. We combined eight cycles of the Canadian Community Health Survey (2000/2001-2011) as baseline data to identify a cohort of adults (≥35 years) without cancer at the time of survey administration (n = 309 800). The cohort was linked to the Discharge Abstract Database and the Canadian Mortality Database for cancer morbidity and mortality ascertainment. Individuals were followed from the date they completed the Canadian Community Health Survey until 31 March 2013. Dates of individual first hospitalizations for cancer and deaths due to cancer were captured during this time period. SEP was operationalized using a latent variable combining measures of education and household income. Self-reported modifiable risk factors, including smoking, excess alcohol consumption, low fruit-and-vegetable intake, physical inactivity and obesity, were considered as potential mediators. Generalized structural equation modelling was used to estimate the mediating effects of modifiable risk factors in associations between low SEP and cancer morbidity and mortality in the total population and stratified by sex.Results: Modifiable risk factors together explained 45.6% of associations between low SEP and overall cancer morbidity and mortality. Smoking was the most important mediator in the total population and for males, accounting for 15.5% and 40.2% of the total effect, respectively. For females, obesity was the most important mediator.Conclusions: Modifiable risk factors are important mediators of socio-economic inequities in cancer morbidity and mortality. Nevertheless, more than half of the variance in these associations remained unexplained. Midstream interventions that target modifiable risk factors may help to alleviate inequities in cancer risk in the short term. However, ultimately, upstream interventions that target structural determinants of health are needed to reduce overall socio-economic inequities in cancer morbidity and mortality. [ABSTRACT FROM AUTHOR]