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Background: Improving equity and early access to palliative care for underserved populations in Canada is a priority. Little is known regarding access to palliative and end-of-life care in the Black population. Methods: We undertook a scoping review using the framework by Arksey and O'Malley to identify knowledge, access gaps, and experiences of palliative and end-of-life care among Blacks living with life-limiting illnesses in Canada. Primary studies, discussion papers, books, and reports were considered eligible. We followed a comprehensive search strategy developed by an information scientist. Searches were performed in the following bibliographic databases: Medline, EMBASE, PsycINFO via OVID, CINAHL via EBSCOhost, Scopus and Cochrane Library via Wiley. The search strategy was derived from three main concepts: (1) Black people; (2) Canada and Canadian provinces; (3) Palliative, hospice, or end-of-life care. No publication date or language limits were applied. Titles and abstracts were screened for eligibility by one reviewer and full text by two independent reviewers. Results: The search yielded 233 articles. Nineteen articles were selected for full-text review, and 7 articles met the inclusion criteria. These studies were published between 2010 and 2021, and conducted in the provinces of Ontario and Nova Scotia only. Studies used both quantitative and qualitative methods and included cancer decedents, next of kin, family caregivers and religious leaders. Sample sizes in various studies ranged from 6 − 2,606 participants. Included studies reported a general lack of understanding about palliative and end-of-life care, positive and negative experiences, and limited access to palliative and end-of-life care for Blacks, across all care settings. Conclusion: Findings suggest limited knowledge of palliative care and inequities in access to palliative and end-of-life care for Blacks living with life-limiting illnesses in 2 Canadian provinces. There is an urgent need for research to inform tailored and culturally acceptable strategies to improve understanding and access to palliative care and end-of-life care among Blacks in Canada. [ABSTRACT FROM AUTHOR]

The migration literature focusing on understanding interactions between immigrants' integration and transnationalism is replete with mixed findings. However, contemporary consensus among migration scholars suggests that immigrants' integration and transnational connections can occur simultaneously. Focusing on transnational dating—which is understudied—this exploratory study draws on an online qualitative survey with five Ghanaian male immigrants in southwestern Ontario, Canada, to explore how immigrants' attachment to the host society, homeland, and "elsewhere" shape transnational dating behaviour. Transnational dating is conceptualized in this paper as dating partners that live part or most of their life or time detached from each other, yet hold together and create a sense of shared welfare and harmony, namely "datehood" that surpasses national borders. Using the integration‐transnationalism matrix as the theoretical framework, this paper demonstrates that the roles of integration and transnationalism should not be seen as separate influences on participants' transnational dating behaviour given participants' strong attachment to the host society, sending country, and "elsewhere." Importantly, our finding indicates that the motivation for transnational dating is related to transnational connections rather than not feeling integrated into Canadian society. Overall, the finding contributes to discourses on dating, transnational dating, transnationalism, and the conceptual framework of the integration‐transnationalism matrix. Key Messages: The migration literature focusing on understanding interactions between immigrants' integration and transnationalism is replete with mixed findings.This exploratory study has taken a critical step in stimulating a research agenda on transnational dating within the integration‐transnationalism matrix.Our finding indicates that the motivation for transnational dating is related to transnational connections rather than not feeling integrated into Canadian society. [ABSTRACT FROM AUTHOR]

This paper provides a theoretical and empirical intervention into housing research by applying the geospatial lens of the rural-urban space (RUS) to the social problem of homelessness, a conceptual linkage absent in the Canadian context. Drawing on original data from 80 surveys, four focus groups, and a community feedback session, we identify and interrogate key local impacts of systemic shifts in the housing market and associated policy responses in Dufferin County, Ontario, a RUS community located 80km northwest of Toronto. We find that for people experiencing homelessness within RUS communities, the intersecting consequences of multiple forms of structural marginalization, such as low wages and social assistance rates and discrimination, can quickly destabilize housing. We emphasize the importance of attending to housing in RUS communities and developing housing policy strategies. [ABSTRACT FROM AUTHOR]

Background: Homelessness is becoming an international public health issue in most developed countries, including Canada. Homelessness is regarded as both political and socioeconomic problems warranting broad and consistent result-oriented approaches.Methods: This paper represents the qualitative findings of a project that explored risk factors associated with family homelessness and strategies that could mitigate and prevent homelessness among families using a focused ethnographic study guided by the principles of participatory action research (PAR). The sample includes 36 family members residing at a family shelter who participated in focus groups over two years (between April 2016 and December 2017). Most of the participants were single-parent women.Results: The analysis yielded five major themes including, life challenges, lack of understanding of the system, existing power differentials, escaping from hardship, and a theme of proposed solutions for reducing family homelessness in the community.Conclusion: The findings illustrated the complex nature of family homelessness in Ontario; that the interaction of multiple systems can put families at risk of homelessness. Findings from this study underscore the need for urgent housing protocols aimed at educating homeless families on how to navigate and understand the system, enhance their conflict resolution skills, and develop strategies beyond relocation to help them to cope with difficulties with housing. [ABSTRACT FROM AUTHOR]

Since the mid-1990s, the reuse of brownfield properties for urban intensification has emerged as a core strategy in government efforts to remediate pollution and support renewal, regeneration, and retrofitting. While upper levels of government in Canada engaged in early efforts to devise policies, programs, and funding strategies to support redevelopment, the job of overseeing it has fallen mainly to local governments. This paper investigates the role of municipalities in Ontario, Canada's most populous and industrialized province, in managing and facilitating brownfields redevelopment. Survey data from 43 municipalities, coupled with information gathered from six site visitations and provincial information, reveal that despite common goals, tools, and approaches put forward by Ontario municipalities in their Community Improvement Plans, the management of planning, funding, and redevelopment issues continues to be a challenge for many, resulting in some very proficient municipalities and numerous hopeful ones with limited capacity to address this demanding issue. [ABSTRACT FROM AUTHOR]

Background: In Ontario, Canada, Indigenous communities experience some of the province's worst drinking water, with issues ranging from deteriorating water quality to regulatory problems and lack of support. When water is known, or suspected, to be unsafe for human consumption, communities are placed under a Drinking Water Advisory. Between 2004 and 2013, approximately 70% of all on-reserve communities in Ontario were under at least one Drinking Water Advisory. Despite the widespread impact of Drinking Water Advisories on health and wellbeing, little is known about First Nation individuals' perceptions and experiences living with a Drinking Water Advisory. This study presents information shared by members of a community who have lived with Boil Water Advisories on and off for many years, and a long-term Boil Water Advisory since 2017. The goal of this paper is to unpack and explore the Boil Water Advisories from the perspective of community members and provide considerations for current and future Boil Water Advisory management. Methods: Methodological choices were driven by the principles of community-based participatory research. Two data collection methodologies were employed: hard copy surveys and interviews. Results: Forty-four individuals (19.5%) completed a survey. Eight Elders and 16 key informants participated in 20 interviews. Respondents expressed varying degrees of uncertainty regarding protective actions to take while under a Boil Water Advisory. Further, 79% of men but only 46% of women indicated they always adhere to the Boil Water Advisory. Knowledge gaps that could lead to risky behaviours were also identified. Finally, Boil Water Advisories were demonstrated to have physical, financial, and time impacts on the majority of respondents. Conclusions: A direct outcome was the identification of a critical need to reinforce best practices for health protection through community education and outreach. More broadly, Chief and Council were able to use the findings to successfully advocate for improved drinking water for the community. Additionally, benefits of participatory research and community ownership include enhanced local research capacity, and increased awareness of, and desire for, research to inform decisions. [ABSTRACT FROM AUTHOR]

Background: Over the last three decades, there has been worldwide recognition of peer support contributions to improve mental healthcare provision. However, in the current literature, little attention has been paid to exploring perspectives of peer supporters on their involvement in mental health services provision. The purpose of the present study was to examine peer supporters' perspectives on the implementation of a transitional discharge model (TDM), an intervention for the community integration of people with mental illness. Methods: This paper represents ethnographic qualitative data collected as part of a study that used mixed methods to evaluate the implementation of TDM across nine hospitals from the Province of Ontario, in Canada. The study involved a sample of 66 peer supporters, who were recruited from participating Consumer/Survivor Initiative Organizations and Peer Support Programs. The study collected data using two sets of focus groups, which were held at 6 months and 1-year post implementation. Data analysis used an ethnography model of qualitative analysis. Results: Peer supporters expressed that their involvement in mental healthcare enhanced clients' autonomy and hope about their recovery, as well as established a safety net and reduced hospital readmissions. Peer supporters articulated that they assumed several roles to facilitate clients' transition from hospital to the community. These roles included: assisting clients in building their capacity and developing healthy routines; attending regular on-ward and community meetings; accompanying clients to their appointments; and working with clients to set goals for their recovery. The study showed hindrances to effective implementation of peer support programs, such as a lack of understanding and appreciation of peer supporter roles, lack of careful allocation of peer supporters to clients, and an absence of appropriate protocols for ensuring the safety and supervision of the peer supporters. Conclusions: Results of the TDM implementation demonstrated that involving peer supporters in mental healthcare delivery may benefit clients by enhancing autonomy and hope about their recovery, as well as establishing a safety net and reducing hospital readmissions. Results from the study have the potential to inform healthcare professionals and managers of strategies for developing effective peer support programs. [ABSTRACT FROM AUTHOR]

Background: Historically transgender adults have experienced barriers in accessing primary care services. In Ontario, Canada, health care for transgender adults is accessed through primary care; however, a limited number of practitioners provide care, and patients are often waiting and/or traveling great distances to receive care. The purpose of this protocol is to understand how primary care is implemented and delivered for transgender adults. The paper presents how the case study method can be applied to explore implementation of health services delivery for the transgender population in primary care. Methods: Case study methodology will be used to explore this phenomenon in different primary care contexts. Normalization Process Theory is used as a guide. Three cases known to provide transgender primary care and represent different Ontario primary care models have been identified. Comparing transgender care implementation and delivery across different models is vital to understanding how care provision to this population can be supported. Qualitative interviews will be conducted. Participants will also complete the NoMAD (NOrmalization MeAsure Development) survey, a tool measuring implementation processes. The tool will be modified to explore the implementation of primary care services for transgender individuals. Documentary evidence will be collected. Cross-case synthesis will be completed to compare the cases. Discussion: Findings will provide an Ontario perspective on the implementation and delivery of primary care for transgender adults in different primary care models. Results may be applicable to other primary care settings in Canada and other nations with similar systems. Barriers and facilitators in delivery and implementation will be identified. Providing an understanding and increasing awareness of the implementation and delivery of primary care may help to reduce the invisibility and disparities transgender individuals experience when accessing primary care services. Understanding delivery of care could allow care providers to implement primary care services for transgender individuals, improving access to health care for this vulnerable population. [ABSTRACT FROM AUTHOR]

This paper examines the role of in-migrants in the functional transformation of amenity-rich places. Its overarching goal is to determine if and how internal migrants arriving from larger settlement areas (i.e., counterurbanites) are contributing to the creation of functionally diverse (hybrid), or functionally limited (pure) commercial landscapes in places endowed with heritage assets. We focus on Paris, an historic town situated at the confluence of the Grand and Nith Rivers in southern Ontario. Three objectives guide the research: (1) to determine which commercial landscape form (hybrid or pure) and landscape generating process (creative enhancement or destruction) best characterizes the downtown; (2) to establish counterurbanite presence in this commercial core; and (3) to assess their role in the downtown's recent evolution. Evidence gleaned from secondary sources, and local fieldwork reveals that creative enhancement (functional addition), rather than creative destruction (functional displacement) is the dominant process. This has given rise to a hybrid landscape, where quotidian businesses (i.e., those selling ordinary goods and services) accompany five non-quotidian (i.e., distinctive) product types (i.e., authentic heritage, infused heritage, heritage-enhanced, faux-authentic heritage, and non-heritage boutique), each relying in different ways on the town's heritage assets. Information gathered from 35 proprietors finds that counterurbanites, and other inmigrants, dominate the downtown core, with only six non-migrant proprietors represented. In-comers, including counterurbanites, sell both quotidian and nonquotidian products, with non-migrant vendors offering only ordinary goods and services. These findings reveal that by selling both product types, counterurbanites are contributing to the creation of a hybrid landscape in the city's countryside. Their attraction is thus an important ingredient for facilitating diversity and economic viability in small settlement areas. [ABSTRACT FROM AUTHOR]

Floating Catchment Area (FCA) methods are a popular tool to investigate accessibility to public facilities, in particular health care services. FCA approaches are attractive because, unlike other accessibility measures, they take into account the potential for congestion of facilities. This is done by 1) considering the population within the catchment area of a facility to calculate a variable that measures level of service, and then 2) aggregating the level of service by population centers subject to catchment area constraints. In this paper we discuss an effect of FCA approaches, an artifact that we term demand and level of service inflation. These artifacts are present in previous implementations of FCA methods. We argue that inflation makes interpretation of estimates of accessibility difficult, which has possible deleterious consequences for decision making. Next, we propose a simple and intuitive approach to proportionally allocate demandand and level of service in FCA calculations. The approach is based on a standardization of the impedance matrix, similar to approaches popular in the spatial statistics and econometrics literature. The result is a more intiuitive measure of accessibility that 1) provides a local version of the provider-to-population ratio; and 2) preserves the level of demand and the level of supply in a system. We illustrate the relevant issues with some examples, and then empirically by means of a case study of accessibility to family physicians in the Hamilton Census Metropolitan Area (CMA), in Ontario, Canada. Results indicate that demand and supply inflation/deflation affect the interpretation of accessibility analysis using existing FCA methods, and that the proposed adjustment can lead to more intuitive results. [ABSTRACT FROM AUTHOR]

Background: This study reports on physicians’ experiences with chronic pain management. For over a decade prescription opioids have been a primary treatment for chronic pain in North America. However, the current opioid epidemic has complicated long-standing practices for chronic pain management which historically involved prescribing pain medication. Caring for patients with chronic pain occurs within a context in which a growing proportion of patients suffer from chronic rather than acute conditions alongside rising social inequities. Methods: Our team undertook an ethnographic approach known as institutional ethnography in the province of Ontario, Canada in order to explore the social organization of chronic pain management from the standpoint of primary care physicians. This paper reports on a subset of this study data, specifically interviews with 19 primary care clinicians and 8 nurses supplemented by 40 hours of observations. The clinicians in our sample were largely primary care physicians and nurses working in urban, rural and Northern settings. Findings: In their reflections on providing care for patients with chronic pain, many providers describe being most challenged by the work involved in helping patients who also struggled with poverty, mental health and addiction. These frustrations were often complicated by concerns that they could lose their license for inappropriate prescribing, thus shifting their work from providing treatment and care to policing their patients for malingering and opioid abuse. Interpretation: Our findings show that care providers find the treatment of patients with chronic pain–especially those patients also experiencing poverty–to be challenging at best, and at worst frustrating and overwhelming. In many instances, their narratives suggested experiences of depersonalization, loss of job satisfaction and emotional exhaustion in relation to providing care for these patients, key dimensions of burnout. In essence, the work that they performed in relation to their patients’ social rather than medical needs seems to contribute to these experiences. Their experiences were further exacerbated by the fact that restricting and reducing opioid dosing in patients with chronic pain has become a major focus of care provision. [ABSTRACT FROM AUTHOR]

While a growing body of research is examining the impacts of prolonged occupational sitting on cardiovascular and other health risk factors, relatively little work has examined the effects of occupational standing. The objectives of this paper were to examine the relationship between occupations that require predominantly sitting and those that require predominantly standing and incident heart disease. A prospective cohort study combining responses to a population health survey with administrative health-care records, linked at the individual level, was conducted in Ontario, Canada. The sample included 7,320 employed labor-market participants (50% male) working 15 hours a week or more and free of heart disease at baseline. Incident heart disease was assessed using administrative records over an approximately 12-year follow-up period (2003-2015). Models adjusted for a wide range of potential confounding factors. Occupations involving predominantly standing were associated with an approximately 2-fold risk of heart disease compared with occupations involving predominantly sitting. This association was robust to adjustment for other health, sociodemographic, and work variables. Cardiovascular risk associated with occupations that involve combinations of sitting, standing, and walking differed for men and women, with these occupations associated with lower cardiovascular risk estimates among men but elevated risk estimates among women. [ABSTRACT FROM AUTHOR]

The consequences of parallel paper and electronic medical records (EMR) and their impact on informational continuity are examined. An interdisciplinary team conducted a multi-site, ethnographic field study and retrospective documentation review from January 2010 to December 2010. Three case studies from the sample of older patients with hip fractures who were transitioning across care settings were selected for examination. Analysis of data from interviews with care providers in each setting, field observation notes, and reviews of medical records yielded two themes. First, the lack of interoperability between electronic information systems has complicated, not eased providers’ ability to communicate with others. Second, rather than transforming the system, digital records have sustained health care’s ‘culture of documentation’. While some information is more accessible and communications streamlined, parallel paper and electronic systems have added to front line providers’ burden, not lessened it. Implementation of truly interoperable electronic health information systems need to be expedited to improve care continuity for patients with complex health-care needs, such as older patients with hip fractures. [ABSTRACT FROM AUTHOR]

This paper employs a descriptive case study method to analyze and critically review the emergence of the provincial poverty reduction strategy in Ontario, Canada which was implemented in 2008 and renewed in 2014. The purpose of this study is two-fold: first, it defines the principles of neoliberalism and explores the historical growth of neoliberal thought in Canada, and specifically within Ontario, beginning in the 1980s to the present-day. Drawing on a combination of primary, secondary and grey literature, this paper discusses the ways in which neoliberal ideologies and rhetoric became deeply rooted in political thought and discourse within the province. Employing a critical theory framework, the paper highlights the contrasting ways in which neoliberal values were adopted by the different political parties in power and the detrimental impact this espousal had on individuals living in poverty within Ontario. Second, the paper illustrates the powerful ways in which anti-poverty grassroots movements and social advocacy groups assembled to push for the creation of a provincial poverty reduction strategy. The analysis ends with a critique of the neoliberal influences on the strategy's recommendations and the future outlook of the poverty reduction strategy based on the current political climate within the province. [ABSTRACT FROM AUTHOR]

Reconciling diverse forest values within policy and decision-making processes is an ongoing challenge in forestry. The use of environmental impact assessment (EIA) provides potential for improving forest management and making it more responsive to diverse interests. This paper examines EIA in Canadian and Finnish forest planning. In Finland there has been a reluctance to see EIA as a tool for forest planning while in Canada some provinces have long applied EIA to forest management. Ontario, Canada, provides one example of applying EIA to forest planning at a range of scales in order to advance integrated planning and help conflict management. The paper provides a brief analysis of the Finnish forest planning system, an illustration of the Ontario EIA forest management experience, and then considers the application of EIA to Finnish forest management. The paper concludes that EIA may be workable for Finnish state forests and would likely enhance planning and management, but given the existing institutional frameworks EIA would be difficult to apply to private forests. [ABSTRACT FROM AUTHOR]

Cultural impacts on health experiences and behaviours are profound in the area of reproductive health and family planning. Explored through interviews with family planning healthcare professionals, this paper evaluates their experiences in providing family planning and reproductive healthcare to immigrants in the Greater Toronto and Hamilton area of Ontario, Canada. Results reveal the complexity of delivering care to members of this group, particularly when dealing with language barriers, situations when professional and non-professional interpreters are used, and instances where healthcare professionals realize that they themselves have misconceptions and misunderstandings about other cultures. The paper concludes by discussing future research options and implications for the delivery of reproductive health family planning services to this population. [ABSTRACT FROM AUTHOR]

The City of Edmonton’s Drainage Operations branch oversees the inspection, maintenance, and repair of the city’s drainage network. This network covers an area of 700.6 km2 to serve the city’s growing population of nearly 1 million people. The activities performed by this division consume a large amount of funding and are, therefore, receptive to improvements in productivity. The study presented in this paper was conducted to develop improved work methods and engineered productivity standards for the various drainage operations. The study focused on six crews, which accounted for over 25% of the total drainage operations budget. The six crews were divided based on their respective duties: (1) cleaning mains by low pressure flushing (LPF); (2) cleaning mains by high pressure flushing; (3) scheduled mechanical cleaning of catch basins (CBC); (4) inspecting mains by televising; (5) commercial establishment investigation; and (6) service-line rodding and televising. The study utilized the concept of work simplification and focused on two crew activities—LPF and CBC work tasks—to improve crew work methods, to develop an established work standard, and to verify the proposed improvements based on the simulation model’s output. These activities are described in greater detail in two case studies. The work measurement concept was implemented to develop engineered productivity standards for the remaining crews in order to improve their productivity as well. This paper describes the application of an industrial engineering philosophy of work measurement—lean production theory—and the technique of simulation analysis to capture current work methods, generate and test alternative methods, and develop new productivity standards for drainage maintenance operations crews. [ABSTRACT FROM AUTHOR]

With the implementation of new policies supporting renewable natural gas production from organic wastes, Canada began replacing traditional disposal methods with highly integrated biogas production strategies. Herein, data from published papers, Canadian Biogas Association, Canada's national statistical agency, and energy companies' websites were gathered to gain insight into the current status of anaerobic digestion plants in recovering energy and resource from organic wastes. The availability of materials prepared for recycling by companies and local waste management organizations and existing infrastructures for municipal solid waste management were examined. Governmental incentives and discouragements in Canada and world anaerobic digestion leaders regarding organic fraction municipal solid waste management were comprehensively reviewed to identify the opportunities for developing large-scale anaerobic digestion in Canada. A range of anaerobic digestion facilities, including water resource recovery facilities, standalone digesters, and on-farm digesters throughout Ontario, were compared in terms of digestion type, digester volume, feedstock (s), and electricity capacity to better understand the current role of biogas plants in this province. Finally, technology perspectives, solutions, and roadmaps were discussed to shape the future in terms of organic fraction municipal solid waste management. The findings suggested that the biogas industry growth in Canada relies on provincial energy and waste management policies, advanced technologies for diverting organic waste from landfills, improving biogas yield using existing pretreatment methods, and educating farmers regarding digester operations. [ABSTRACT FROM AUTHOR]

Some communities in Ontario procure potable water through water sharing arrangements (WSAs) with other neighbouring communities. This paper explores factors influencing First Nation and municipal participation in WSAs in Ontario. Specifically, we assess whether First Nations communities – many of which suffer persistently poor drinking water conditions – are less likely to be engaged in WSAs than municipalities. We assess this question by applying regression analyses to a unique data set characterizing 419 Ontario communities: 118 First Nations communities and 301 municipalities. Compared to Ontario municipalities, First Nations in Ontario have a lower rate of participation in WSAs. Our regression analyses suggest that community likelihood of WSA participation is strongly associated with factors like geography, regional wealth, and proximity to neighbouring communities with water supply. [ABSTRACT FROM AUTHOR]

Canada’s book trade is fascinating not only because it really consists of two book trades—the Anglophone and the Francophone—but also because it is a site of intense and sustained policy interventions designed to foster greater domestic control. Examining the country’s book policies, Statistics Canada data, trade association membership rosters and trade directories, this paper reveals that Canada’s contemporary book trade is characterized by three features: circa 40 years of government interventions in response to foreign dominance; the central role of foreign firms despite these interventions; and the dominance of Toronto and Montreal as domestic sites of book production. [ABSTRACT FROM AUTHOR]

In universities, as in everyday life, there is a fundamental need for geographical knowledge, even when no formal departments exist to provide instruction. This need was true in the University of Toronto during the decades before Griffith Taylor was appointed in 1935 to the first university Chair in geography in English-speaking Canada. Using matriculation and annual university course examinations, university calendars and the papers of President Falconer and Professors James Mavor and Harold Innis, I trace the development of geography at the University of Toronto from the mid-nineteenth century to the arrival of Taylor. Courses taught in selected aspects of physical and human geography in the Departments of Geology, Political Economy and History are particularly significant. Underlying this instruction, and also the desire to establish a geography department, was an acute awareness of the fundamental importance of geography to help understand a large regionally complex homeland, and a wider world. [ABSTRACT FROM AUTHOR]

In this paper we examine how the researcher's body can be used as a tool for data collection in the process of ethnographic fieldwork. We focus in particular on the tensions inherent in undertaking embodied ethnographic research in the sexualized setting of a queer women's bathhouse event in Toronto, Canada. Our discussion addresses three moments within the research process: preparing our bodies to attend the bathhouse; positioning our bodies within the spaces of the bathhouse; and interacting with our bodies during the event. Through this discussion we argue that the body of the researcher is a contested site of knowledge production. [ABSTRACT FROM AUTHOR]