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Introduction: People who use drugs are disproportionally affected by sexually transmitted and blood‐borne infections (STBBIs). While the benefits of methadone in reducing injecting‐risk behaviours are well documented, less is known on its impacts on sexual‐related risks, as well as its comparative effectiveness to buprenorphine/naloxone, particularly in the context of highly potent opioids. The aim of this study was to estimate the relative effects of buprenorphine/naloxone and methadone on injecting and STBBI risks among people with prescription‐type opioid use disorder (POUD). Methods: Secondary analysis of a pan‐Canadian pragmatic 24‐week randomized clinical trial comparing methadone and buprenorphine/naloxone models of care among 272 people with POUD (including licit or illicit opioid analgesics, fentanyl). The Risk Behaviour Survey was used to collect injecting and sexual risks at baseline, and weeks 12 and 24. Results: In total, 210 participants initiated treatment (103 buprenorphine/naloxone and 107 methadone). At baseline, 113/205 (55.1%) participants reported recently injecting drugs, 37/209 (17.7%) unsafe injection practices and 67/162 (41.4%) high‐risk sex. Both methadone and buprenorphine/naloxone were associated with reductions in the prevalence of injection drug use and high‐risk sex at weeks 12 and 24 with no interactions between treatment arm and time. Conclusion: Methadone and buprenorphine/naloxone were similarly effective in reducing injecting and sexual risk behaviours among people with POUD. Clinical Trials Registration: clinicaltrials.gov NCT03033732. [ABSTRACT FROM AUTHOR]

Objective: Patients with early rheumatoid arthritis (RA) may present with more tender than swollen joints, which can persist. Elevated tender‐swollen joint difference (TSJD) is often challenging, because there may be multiple causes and it may contribute to overestimating disease activity. Little is known about the phenotype and impact of TSJDs on patient function. Our objective was to evaluate the impact of TSJD on functional outcomes in early RA and to see whether associations vary by joint size. Methods: Data were from patients with active, early RA (≤12 months) enrolled in the Canadian Early Arthritis Cohort, who completed assessments of general function (Multidimensional Health Assessment Questionnaire [MDHAQ]), upper extremity (UE) function (Quality of Life in Neurological Disorders [Neuro‐QoL] UE scale), and work/activity impairment (Work Productivity and Activity Impairment RA) over their first year of follow‐up. A total of 28 joint counts were performed. TSJDs were calculated. Adjusted associations between TSJDs and functional outcomes were estimated in separate multivariable linear mixed effects models. Separate analyses were performed for large‐ versus small‐joint TSJD. Results: Patients (N = 547) were 70% female, mean age 56 (SD 15) years, mean disease duration 5.3 (SD 2.9) months. At baseline, 287 (52%) had TSJD >0 (43% involved large joints and 34% small joints), decreasing to 32% at 12 months. A one‐point increase in TSJD was significantly associated with worse function (MDHAQ: adjusted mean change 0.10, 95% confidence interval [CI] 0.08–0.13; Neuro‐QoL UE function T score: adjusted mean change −0.59, 95% CI −0.76 to −0.43; and greater work impairment: adjusted mean change 1.95%, 95% CI 0.85%–3.05%). Higher large‐joint TSJDs were associated with the worst functional outcomes. Conclusion: Having more tender than swollen joints is common in early RA and is associated with worse function, most notably when involving large joints. Early identification and targeted intervention strategies may be needed. [ABSTRACT FROM AUTHOR]

Background: Children's educational experiences worldwide have been significantly impacted as a result of global school closures during the COVID‐19 pandemic of Spring 2020. A growing number of studies aim to analyse impacts of these changes on social well‐being, with limited studies placing an emphasis on the experiences of students with special educational needs (SENs). This article focusses on parent perspectives regarding impacts of school closures on social well‐being in Canadian children with SEN. Methods: This study uses a mixed‐methods approach, drawing from both qualitative and quantitative survey data from Spring/Summer 2020. Participants (n = 263) were eligible for participation if they were a parent/guardian of a child or adolescent with an SEN. We first conducted a descriptive analysis of the key variables, namely, social well‐being, grade level of the child, internet and device availability, and the presence of other school‐aged children in the home (single child vs. multiple children). Next, we explored the relationship between these using a bivariate correlation. Finally, open‐ended responses were analysed using an inductive approach to qualitative thematic analysis. Results: The majority of parents expressed concern for their child's social well‐being during the Spring 2020 school closures, with increased concerns for younger children. According to parents, children experienced communication barriers to peer interaction and many experienced emotional difficulties as a result. Technology was described as critical for some in maintaining social connections. Parents raised concerns about the impact of limited peer interaction on broader social skill development, in the short and long term. A small number of participants noted feelings of relief and reduced anxiety among their children with SEN. Conclusions: Findings highlight parent views of the negative impact of the pandemic on social well‐being and the critical role in‐person schooling plays in supporting peer relationships for children with SEN. [ABSTRACT FROM AUTHOR]

Objectives: The COVID‐19 pandemic and accompanying public health measures exacerbated many known risk factors for depression, while also increasing numerous health‐related stressors for people with stroke history. Using a large longitudinal sample of older adults, the current study examined the prevalence of incident and recurrent depression among participants with stroke history, and also identified factors that were associated with depression during the pandemic among this population. Methods: Data came from four waves of the Canadian Longitudinal Study on Aging's (CLSA) comprehensive cohort (n = 577 with stroke history; 46.1% female; 20.8% immigrants; mean age = 74.56 SD = 9.19). The outcome of interest was a positive screen for depression, based on the CES‐D‐10, collected during the 2020 CLSA COVID autumn questionnaire. Bivariate and multivariate logistic regression analyses were conducted to identify factors that were associated with depression. Results: Approximately 1 in 2 (49.5%) participants with stroke history and a history of depression experienced a recurrence of depression early in the pandemic. Among those without a history of depression, approximately 1 in 7 (15.0%) developed depression for the first time during this period. The risk of depression was higher among immigrants, those who were lonely, those with functional limitations, and those who experienced COVID‐19 related stressors, such as increased family issues, difficulty accessing healthcare, and becoming ill or having a loved one become ill or die during the pandemic. Conclusions: Interventions that target those with stroke history, both with and without a history of depression, are needed to buffer against the stressors of the COVID‐19 pandemic and support the mental health of this population. Key points: One in seven older adults with a history of stroke experienced depression for the first time in their life during the COVID‐19 pandemic.One in two older adults with a history of stroke and depression experienced a recurrence or persistence of depression during the pandemic.Key factors that were associated with depression during the pandemic included feeling lonely at the beginning of the pandemic, being an immigrant, and experiencing functional limitations.COVID‐19 related stressors that were associated with depression included difficulty accessing healthcare, becoming ill or having a loved one become ill or die, and increased family stress, such as separation from family or increased time spent caregiving. [ABSTRACT FROM AUTHOR]

Background: Transferring from paediatric to adult care can be challenging. Adolescents and young adults (AYAs) with chronic health conditions need to develop a specific set of skills to ensure lifelong medical follow‐up due to the chronicity of their condition. The Transition Readiness Assessment Questionnaire—French version (TRAQ‐FR) is a 19‐item questionnaire measuring such skills. The aims of the study were to (1) describe participant characteristics and (2) identify constructs related to, and predictors of, having learned domain‐specific transition readiness skills. Methods: Participants included 216 AYAs aged 14–20 years (M = 15.93; SD = 1.35; 54.1% male) recruited from five outpatient clinics in a Canadian tertiary hospital. AYAs completed the TRAQ‐FR, the Pediatric Quality of Life Inventory 4.0 (PedsQL) and a sociodemographic questionnaire. Descriptive, bivariate and binary logistic regression analyses were conducted. Results: Overall, participants reported significantly higher scores on the Talking with Providers, Managing Daily Activities and Managing Medications subscales than on the Appointment Keeping and Tracking Health Issues subscales (F[41075] = 168.970, p <.001). At the item level, median scores (on a 5‐point Likert scale) suggest that AYAs had begun practising five of the 19 skills (median scores ≥4; 'Yes, I have started doing this'), while a median score of 1 ('No, I don't know how') was found for one item ('Do you get financial help with school or work?'). At the subscale level, TRAQ‐FR skills and skill gaps were related to AYAs' age, sex and PedsQL scores (ps <.05). Conclusion: Older and female AYAs were more likely to have begun practising specific TRAQ‐FR subscale skills. Better psychosocial functioning was also related to having learned specific transition readiness skills. AYAs show several gaps in transition readiness. Targeted intervention in transition readiness skill development could take into account AYAs' age, sex and psychosocial functioning for a successful transfer to adult care. [ABSTRACT FROM AUTHOR]

Purpose: Geographic location plays a significant role in the health and wellbeing of those with cancer. This project explored the impact of rurality and social support on distress and quality of life in young adults (YAs) with cancer in Canada. Methods: The current research analyzed data from the Young Adults with Cancer in Their Prime (YACPRIME) study. Participants completed measures of emotional distress (10‐item Kessler Psychological Distress Scale), quality of life (12‐item Short‐form Health Survey), and social support (Medical Outcomes Study—Social Support Survey). Rural and urban‐dwelling survivors were compared using MANOVAs. Bivariate analyses were conducted to explore associations between distress and social support. Findings: Of the sample (N = 379), 26% identified their location as rural. Rural YA cancer survivors reported higher distress and worse physical health‐related quality of life (HRQOL) than survivors from urban areas but similar levels of mental‐health‐related quality of life. Social support appeared to have a marginally greater effect on psychosocial outcomes for urban participants. All types of social support were associated with lower levels of distress. However, different types of social support were associated more strongly with distress depending on a participant's geography. Conclusions: Rural‐dwelling YA cancer survivors experience significantly more distress and poorer physical HRQOL than urban‐dwelling survivors. Different needs and preferences for social support may influence the psychological health of rural cancer survivors. Additional research is needed to determine how best to understand and address distress in rural YAs with cancer. [ABSTRACT FROM AUTHOR]

BACKGROUND: Very few studies have properly identified how peer victimization is associated with lower achievement in middle or high school. In this context, this study examined how peer victimization at the beginning of middle school is linked with subsequent student achievement. Specifically, it assessed if the behavioral, affective, and cognitive dimensions of engagement in school play a mediation role in the relationship between peer victimization and student achievement. METHODS: The sample of this study included 683 seventh graders attending 3 schools in Montreal, Canada. Students self‐reported peer victimization at the beginning and end of grade 7. They also reported their levels of student engagement on the 3 dimensions (behavioral, affective, and cognitive) across 3 time points in seventh and eighth grades. Student achievement in language arts across these 2 years was also obtained through school records. RESULTS: Peer victimization significantly predicted lower achievement over time (b = −.24, p ≤.001). Peer victimization predicted lower achievement in grade 8 indirectly through affective student engagement (b = −.11, p <.05). Post hoc analyses showed that peer victimization still predicted lower achievement in grade 8 indirectly through a decrease in affective engagement (b = −.14, p <.05). However, when considered alone, a decrease in cognitive engagement also acted as a mediator (b = −.09, p <.05), suggesting a strong link with affective engagement. CONCLUSION: Our findings expose the importance to promote student engagement in school and achievement for victimized youth. [ABSTRACT FROM AUTHOR]

Background: The context in which school‐based health‐promoting interventions are implemented is key for the delivery and success of these interventions. However, little is known about whether school culture differs by school deprivation. Methods: Using data from PromeSS, a cross‐sectional study of 161 elementary schools in Québec, Canada, we drew from the Health Promoting Schools theoretical framework to develop four measures of health‐promoting school culture (i.e., school physical environment, school/teacher commitment to student health, parent/community engagement with the school, ease of principal leadership) using exploratory factor analysis. One‐way ANOVA with post‐hoc Tukey‐Kramer analyses was used to examine associations between each measure and social and material deprivation in the school neighborhood. Results: Factor loadings supported the content of the school culture measures and Cronbach's alpha indicated good reliability (range: 0.68‐0.77). As social deprivation in the school neighborhood increased, scores for both school/teacher commitment to student health and parent/community engagement with the school decreased. Implications for School Health Policy, Practice, and Equity: Implementation of health‐promoting interventions in schools located in socially deprived neighborhoods may require adapted strategies to address challenges related to staff commitment and parental and community involvement. Conclusion: The measures developed herein can be used to investigate school culture and interventions for health equity. [ABSTRACT FROM AUTHOR]

Background: Consideration of sex‐ and gender‐related factors is critical for understanding and supporting health and wellbeing. Although both sex and gender influence people with developmental disabilities, there is relatively little research on these factors and their influences among individuals with fetal alcohol spectrum disorder (FASD), a complex neurodevelopmental disability impacting an estimated 4%–5% of the population. Understanding sex‐ and gender‐related differences in FASD is needed to facilitate evidence‐informed assessment, treatment planning, and advocacy. To begin unpacking these factors, we investigated sex‐based differences in clinical presentation and experiences among individuals assessed for FASD across the lifespan. Methods: We analyzed 2574 clinical records from 29 FASD diagnostic centers in Canada. Participants ranged in age from 1 to 61 years (mean 15.2 years), and more than half (58.3%) were male at birth. Study variables included participant demographics, physical indicators of prenatal alcohol exposure (PAE), neurodevelopmental impairment, FASD diagnosis, co‐occurring physical and mental health diagnoses, and environmental adversity. Results: There were no significant differences between males and females with respect to FASD diagnostic outcome or physical indicators of PAE. However, males experienced significantly more neurodevelopmental impairment. Females experienced higher rates of endocrine problems, anxiety, and depressive/mood disorders, whereas males had higher rates of attention deficit‐hyperactivity disorder, conduct disorder, and oppositional defiant disorder. Adversity also differed by sex, with females experiencing higher rates of trauma and legal problems with victimization/custody, and males having more difficulties with school and offending/incarceration. Sex‐based differences were most apparent in adolescents (13–17 years) and adults (≥25 years). Conclusions: Individuals with PAE/FASD experience notable sex‐related differences in clinical presentation and experiences across the lifespan. Findings from this study should help to guide researchers, service providers, and policy makers to improve FASD screening, diagnosis, and intervention and better address the needs of individuals with PAE/FASD of all genders. [ABSTRACT FROM AUTHOR]

This article describes the founding and growth of the Canadian Statistical Sciences Institute (CANSSI), starting from its early roots and continuing through to establishment as a mature research enterprise. The goal is to present a historical record of events and activities that were important in the development of CANSSI. [ABSTRACT FROM AUTHOR]

This study examines gender differences in cumulative abuse, measured by the Juvenile Victimization Questionnaire, bystander intervention outcomes and survivors' long‐term health, using student survey data from seven universities (N = 4080). By conducting chi‐squared tests, t‐tests and regression analyses, the results show that more female students reported higher cumulative abuse than male students. Survivors of cumulative abuse reported higher intimate partner violence (IPV) victimisation. Female survivors reported poorer mental health, while male survivors were more involved in alcohol and drug use. Most survivors remembered the bystander presence at the incident of abuse as neither helpful nor harmful, which was not significantly different by gender. Findings suggest that campus service providers need to tailor services considering the gendered effects of cumulative abuse on IPV and its long‐term health ramifications to enhance the effectiveness of services for college students. [ABSTRACT FROM AUTHOR]

Background: The Canadian 24-Hour Movement Guidelines for Children and Youth (“Guidelines”) not only pioneered the notion of an integrated movement continuum from sleep to vigorous-intensity physical activity but also introduced a new branded Guideline visual identity. Objectives: This study evaluated youths’ (N = 46) attention to and thoughts about the Guidelines and the brand. Design: A cross-sectional between-participants randomized intervention design was used. Sample: Canadian youth between 10 and 17 years of age comprised the study sample. Interventions: Participants were randomly assigned to view either branded Guidelines (n = 26) or unbranded Guidelines (n = 20). Youths’ eye-movements (e.g., dwell time, fixation count) were recorded during Guideline viewing. Participants completed a follow-up survey assessing brand perceptions and Guideline cognitions. Results: The branded Guidelines neither drew greater overall attention nor led to more positive brand perceptions or Guideline cognitions compared to the unbranded Guidelines. Conclusions: Exploratory analyses provide valuable, yet preliminary insight into how branding and Guideline content may shape how Guidelines are perceived and acted upon. These findings inform an agenda for future health education resources. [ABSTRACT FROM AUTHOR]

Rationale and objectives: Medical humanities are becoming increasingly recognized as positively impacting medical education and medical practice. However, the extent of medical humanities teaching in medical schools is largely unknown. We reviewed medical school curricula in Canada, the UK and the US. We also explored the relationship between medical school ranking and the inclusion of medical humanities in the curricula. Methods: We searched the curriculum websites of all accredited medical schools in Canada, the UK and the US to check which medical humanities topics were taught, and whether they were mandatory or optional. We then noted rankings both by Times Higher Education and U.S. News and World Report and calculated the average rank. We formally explored whether there was an association between average medical school ranking and medical humanities offerings using Spearman's correlation and inverse variance weighting meta‐analysis. Results: We identified 18 accredited medical school programmes in Canada, 41 in the UK, and 154 in the US. Of these, nine (56%) in Canada, 34 (73%) in the UK and 124 (80%) in the US offered at least one medical humanity that was not ethics. The most common medical humanities were medical humanities (unspecified), history, and literature (Canada); sociology and social medicine, medical humanities (unspecified), and art (UK); and medical humanities (unspecified), literature and history (US). Higher ranked medical schools appeared less likely to offer medical humanities. Conclusions: The extent and content of medical humanities offerings at accredited medical schools in Canada, the UK and the US varies, and there appears to be an inverse relationship between medical school quality and medical humanities offerings. Our analysis was limited by the data provided on the Universities' websites. Given the potential for medical humanities to improve medical education and medical practice, opportunities to reduce this variation should be exploited. [ABSTRACT FROM AUTHOR]

Background: After giving birth, women experience significant changes related to maternal self‐efficacy and social support and are at risk of experiencing postpartum anxiety and depression. Problem: No studies have focused on the relationship between parity and infant age and their impact on psychosocial outcomes, particularly in a Canadian context. Aim: To explore the relationship between parity and infant age on perceived maternal self‐efficacy, social support, postpartum anxiety, and postpartum depression. Methods: Women from three Canadian provinces within the first 6 months postpartum completed standardized online questionnaires. Multivariate analysis of covariance was used to examine the primary aim. Findings: A total of 561 women (56.5% primiparous, 55.1% infant 0‐3 months) participated. There were significant main effects for both parity (P <.001) and age of infant (P <.001), but no significant interaction (P =.463). Primiparous women had lower maternal self‐efficacy (P =.004) and higher postpartum anxiety (P =.000) than multiparous women. Women with younger infants had more perceived social support (P =.002). Women with older infants had higher levels of postpartum anxiety (P =.003) and depression (P =.000). Discussion: The transition that women experience, independent of parity, within the first six months is dynamic with women of older infants experiencing more postpartum mental health concerns and less perceived social support. Our findings emphasize that postnatal support should extend beyond the typical six‐week follow‐up period. Conclusions: Additional studies are warranted to determine ways to provide ongoing support throughout the first six months and beyond to improve maternal well‐being and address postpartum needs. [ABSTRACT FROM AUTHOR]

Aim: To examine factors of a hypothetical model related to stressors, burnout and turnover in nurses from developed and developing countries—Canada, Japan, the United States, Malaysia and Thailand. Design: A cross‐sectional questionnaire‐based study. Methods: Conducted between April 2016 and October 2017, the Maslach Burnout Inventory, Intention to Leave Scale, and Nursing Stress Scale collected data from acute care hospital nurses in Canada (n = 309), Japan (n = 319), Malaysia (n = 242), Thailand (n = 211) and the United States (n = 194). Results: Compared to other countries, burnout "exhaustion" was the highest in Japan and "cynicism" and intention to leave the job were the highest in Malaysia. Thailand had lower burnouts and turnover than other countries and higher professional efficacy than Japan and Malaysia. In all countries, reducing stressors is important for reducing burnout and intention to leave jobs, especially as they relate to "lack of support." [ABSTRACT FROM AUTHOR]

Patient‐reported outcome measures (PROMs) for chronic wounds mainly focus on specific types of wounds. Our team developed the WOUND‐Q for use with all types of wounds in any anatomic location. We conducted 60 concept elicitation interviews with patients in Canada, Denmark, the Netherlands, and the United States. Analysis identified concepts of interest to patients and scales were formed and refined through cognitive interviews with 20 patients and input from 26 wound care experts. Scales were translated into Danish and Dutch. An international field‐test study collected data from 881 patients (1020 assessments) with chronic wounds. Rasch measurement theory (RMT) analysis was used to refine the scales and examine psychometric properties. RMT analysis supported the reliability and validity of 13 WOUND‐Q scales that measure wound characteristics (assessment, discharge, and smell), health‐related quality of life (life impact, psychological, sleep impact, and social), experience of care (information, home care nurses, medical team, and office staff), and wound treatment (dressing and suction device). The WOUND‐Q can be used to measure outcomes in research and clinical practice from the perspective of patients with any type of wound. [ABSTRACT FROM AUTHOR]

Background & Aims: Given that standardized language measures alone are inadequate for identifying functionally defined developmental language disorder (fDLD), this study investigated whether non‐linguistic cognitive abilities (procedural learning, motor functions, executive attention, processing speed) can increase the prediction accuracy of fDLD in children in linguistically diverse settings. Methods & Procedures: We examined non‐linguistic cognitive abilities in mono‐ and bilingual school‐aged children (ages 8–12) with and without fDLD. Typically developing (TD) children (14 monolinguals, 12 bilinguals) and children with fDLD (28 monolinguals, 12 bilinguals) completed tasks measuring motor functions, procedural learning, executive attention and processing speed. Children were assigned as fDLD based on parental or professional concerns regarding children's daily language functioning. If no concerns were present, children were assigned as TD. Standardized English scores, non‐verbal IQ scores and years of maternal education were also obtained. Likelihood ratios were used to examine how well each measure separated the fDLD versus TD groups. A binary logistic regression was used to test whether combined measures enhanced the prediction of identifying fDLD status. Outcomes & Results: A combination of linguistic and non‐linguistic measures provided the best distinction between fDLD and TD for both mono‐ and bilingual groups. For monolingual children, the combined measures include English language scores, functional motor abilities and processing speed, whereas for bilinguals, the combined measures include English language scores and procedural learning. Conclusions & Implications: A combination of non‐linguistic and linguistic measures significantly improved the distinction between fDLD and TD for both mono‐ and bilingual groups. This study supports the possibility of using non‐linguistic cognitive measures to identify fDLD in linguistically diverse settings. What this paper adds: What is already known on the subject: Given that standardized English language measures may fail to identify functional language disorder, we examined whether supplementing English language measures with non‐linguistic cognitive tasks could resolve the problem. Our study is based on the hypothesis that non‐linguistic cognitive abilities contribute to language processing and learning. This is further supported by previous findings that children with language disorder exhibit non‐linguistic cognitive deficits. What this paper adds to existing knowledge: The results indicated that a combination of linguistic and non‐linguistic cognitive abilities increased the prediction of functional language disorder in both mono‐ and bilingual children. What are the potential or actual clinical implications of this work?: This study supports the possibility of using non‐linguistic cognitive measures to identify the risk of language disorder in linguistically diverse settings. [ABSTRACT FROM AUTHOR]

Objective: To shorten the Patient Engagement In Research Scale (PEIRS) to its most essential items and evaluate its measurement properties for assessing the degree of patients' and family caregivers' meaningful engagement as partners in research projects. Methods: A prospective cross‐sectional web‐based survey in Canada and the USA, and also paper‐based in Canada. Participants were patients or family caregivers who had engaged in research projects within the last 3 years, were ≥17 years old, and communicated in English. Extensive psychometric analyses were conducted. Results: 119 participants: 99 from Canada, 74 female, 51 aged 17‐35 years and 50 aged 36‐65 years, 60 had post‐secondary education, and 74 were Caucasian/white. The original 37‐item PEIRS was shortened to 22 items (PEIRS‐22), mainly because of low inter‐item correlations. PEIRS‐22 had a single dominant construct that accounted for 55% of explained variance. Analysis of PEIRS‐22 scores revealed the following: (1) acceptable floor and ceiling effects (<15%), (2) internal consistency (ordinal alpha = 0.96), (3) structural validity by fit to a Rasch measurement model, (4) construct validity by moderate correlations with the Public and Patient Engagement Evaluation Tool, (5) good test‐retest reliability (ICC2,1 = 0.86) and (6) interpretability demonstrated by significant differences among PEIRS‐22 scores across three levels of global meaningful engagement in research. Conclusions: The shortened PEIRS is valid and reliable for assessing the degree of meaningful patient and family caregiver engagement in research. It enables standardized assessment of engagement in research across various contexts. Patient or public contribution: A researcher‐initiated collaboration, patient partners contributed from study conception to manuscript write‐up. [ABSTRACT FROM AUTHOR]

Aims: To investigate real‐world clinical outcomes in adults with type 1 diabetes who initiated the Omnipod Insulin Management System (Insulet Corp., Acton, MA, USA) compared to a matched cohort who maintained multiple daily injection therapy. Methods: This retrospective observational study used data from the Canadian LMC Diabetes Registry. Adults with type 1 diabetes who switched from multiple daily injections to the Omnipod system as usual standard of care between January 2011 and April 2019 were matched to a cohort of adults with type 1 diabetes who maintained multiple daily injection therapy, using propensity‐score matching. The primary outcome was change in HbA1c at 3‐ to 6‐month follow‐up. Results: Propensity‐score matching resulted in a final analytical cohort of 286 individuals (143/cohort). HbA1c in the Omnipod cohort was reduced by a mean ± sd of –3 ± 10 mmol/mol (–0.2 ± 1.0%; P = 0.005) with no change in the MDI cohort [0 ± 10 mmol/mol (0.0 ± 1.0%); P = 0.74]. HbA1c change was seen only in persons with baseline HbA1c ≥75 mmol/mol (≥9.0%) [Omnipod cohort: –15 ± 12 mmol/mol (–1.4 ± 1.1%); P < 0.001] with a between‐treatment difference [mean (95% CI)] of –12 (–18, –6) mmol/mol [–1.1 (–1.6, –0.5) %, P < 0.001]. The median total daily dose of insulin was lower following Omnipod initiation (baseline 0.63 U/kg vs follow‐up 0.53 U/kg; P < 0.001), with no change in the MDI cohort (baseline 0.68 U/kg vs follow‐up 0.67 U/kg; P = 0.23). Conclusions: Adults with type 1 diabetes who initiated use of the Omnipod system in a real‐world clinical setting had lower HbA1c and total daily dose of insulin at 3‐ to 6‐month follow‐up compared to a matched cohort of adults who maintained multiple daily injection therapy. A treatment difference in HbA1c change was seen only in people with baseline HbA1c ≥ 75 mmol/mol (9.0%). (Clinical trials registration: NCT04226378). [ABSTRACT FROM AUTHOR]

Child homicides are rare occurrences, but when they occur, they often cause significant outrage. This paper examines the role of varying degrees of intimacy between victims and perpetrators in determining characteristics in child homicide cases. Focusing on 533 cases of child homicide between 1985 and 2012 in Ontario, Canada, characteristics of intrafamilial and extrafamilial cases, biological and step/foster parents, and maternal and paternal perpetrators are compared. Results show that characteristics of the child homicide vary depending on the degree of intimacy between victims and perpetrators, including: perpetrator and victim age, weapon use, suicide following the offence, sexual violence and use of excessive force. These findings provide support for developmental victimology and a routine activities theoretical perspective. Suggestions for future research and policy implications are also discussed. 'Examines the role of varying degrees of intimacy between victims and perpetrators in determining characteristics in child homicide cases' Key Practitioner Messages: Younger children are at a greater risk of homicide from family members, while older children are at a greater risk of homicide from individuals outside the family.Developmental victimology and routine activities theory can contribute to a better understanding of the dynamics between victims and perpetrators in child homicide.Collaboration should take place between researchers, child death review committees, mental health services, social services and policymakers to improve child homicide prevention and intervention initiatives. [ABSTRACT FROM AUTHOR]

Objective: This questionnaire‐based survey assessed the attitudes of dental hygiene students towards treating elderly patients. Methods: The 14‐item UCLA 14‐item Geriatrics Attitudes Scale (GAS‐14) questionnaire was used in this survey. A further set of nine questions evaluated the opinions of the students towards the existing geriatric curriculum in their respective institutions. Students from five dental hygiene schools from three countries (Switzerland, Belgium and Canada) participated in this survey. General demographic information from the participants was collected. Mean GAS‐14 scores were calculated; ANOVA and Bonferroni's tests were used for statistical analyses (p < 0.05). Results: Three hundred eighty‐five students (Switzerland: n = 157, mean age = 25.38 ± 4.6 years; Belgium: n = 82, mean age = 27.58 ± 12.8 years; Canada: n = 146, mean age = 25.95 ± 12.3 years) completed the survey for a response rate of 86.3%. The overall GAS‐14 scores for Switzerland, Belgium and Canada were 3.61 ± 0.42, 3.24 ± 0.37 and 3.32 ± 0.36, respectively. Switzerland scored significantly higher than Belgium and Canada (p < 0.0001). Overall scores revealed a significant effect of progressive training (p = 0.010). The GAS‐14 score was influenced by the nationality of the participants (p < 0.0001), but not influenced by sex, age, origin, religion, or marital and accommodation statuses. Majority of the students (75.8%) agreed that geriatric dentistry was an important part of their education. 77.4% agreed that they would like hands on experience in treating the elderly patient during their education. 85.1% of the participants considered mobile dental clinics as a good solution for the provision of dental care to the institutionalized elders. Conclusions: The general attitudes of DH students towards treating the elderly patients are on an acceptable level and improved as they progressed through their dental hygiene academic programmes. [ABSTRACT FROM AUTHOR]

Change‐point detection regains much attention recently for analyzing array or sequencing data for copy number variation (CNV) detection. In such applications, the true signals are typically very short and buried in the long data sequence, which makes it challenging to identify the variations efficiently and accurately. In this article, we propose a new change‐point detection method, a backward procedure, which is not only fast and simple enough to exploit high‐dimensional data but also performs very well for detecting short signals. Although motivated by CNV detection, the backward procedure is generally applicable to assorted change‐point problems that arise in a variety of scientific applications. It is illustrated by both simulated and real CNV data that the backward detection has clear advantages over other competing methods, especially when the true signal is short. The Canadian Journal of Statistics 48: 366–385; 2020 © 2020 Statistical Society of Canada [ABSTRACT FROM AUTHOR]

In the context of low consumption of vegetables and fruits and milk and alternatives among Canadian mothers and children, novel strategies are needed to improve maternal and child nutrition. This study evaluated the long‐term effects of an evidence‐informed healthy eating blog on dietary intakes and food‐related behaviours of mothers and their child. The study presents a secondary outcome analysis of a randomised controlled trial in which 84 mothers (mean age of 37.6 ± 6.7 years) of 2‐ to 12‐year‐old children living in Quebec City, Canada, were randomly assigned to a dietary intervention delivered through a healthy eating blog written by a registered dietitian (RD; n = 42) or a control group (n = 42) during a period of 6 months. Dietary intakes, maternal eating behaviours, food parenting practices, and body weight were measured at baseline, 3 months, at the end of the intervention (6 months), and 6‐month post‐intervention (12 months). Differences between groups were assessed with mixed linear models. Globally, this study found no evidence of long‐term differences in mean dietary intakes in mothers exposed to the blog and their children as well as other food‐related outcomes and body weight compared with the control condition. Potential predictors of adherence to dietary recommendations in mothers and children (e.g., involvement of children in household food activities) were identified. In conclusion, a healthy eating blog written by an RD did not result in evidence of any long‐term differences in dietary intakes and food‐related behaviours in mothers and their children compared with the control condition. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of human saliva decontamination protocols on bond strength of resin cement to zirconia (Y‐PSZ), wettability, and microbial decontamination. Materials and methods: Zirconia plates were sandblasted and divided into (a) not contaminated, (b) contaminated with human saliva and: (c) not cleaned, (d) cleaned with air‐water spray, (e) cleaned with 70% ethanol, (f) cleaned with Ivoclean, or (g) cleaned with nonthermal atmospheric plasma (NTAP). The wettability and microbial decontamination of the surfaces were determined after saliva contamination or cleaning. Monobond Plus (Ivoclar Vivadent) was applied after cleaning, followed by Variolink LC (Ivoclar Vivadent). The samples were stored 1 week before shear bond strength (SBS) testing, and data (SBS and wettability) were analyzed by one‐way analysis of variance and Tukey test (α =.05). Results: Saliva contamination reduced SBS to zirconia compared to not contaminated. Both Ivoclean and NTAP produced higher SBS compared to not cleaned and were not significantly different from the not contaminated. Ivoclean produced the highest contact angle, and NTAP the lowest. With the exception of using just water‐spray, all cleaning protocols decontaminated the specimens. Conclusions: Both Ivoclean and NTAP overcame the effects of saliva contamination, producing an SBS to zirconia comparable to the positive control. Clinical significance: Dental ceramics should be cleaned prior to resin cementation to eliminate the effects of human saliva contamination, and Ivoclean and NTAP are considered suitable materials for this purpose. [ABSTRACT FROM AUTHOR]

In genomics, it is often of interest to study the structural change of a genetic network between two phenotypes. Under Gaussian graphical models, the problem can be transformed to estimating the difference between two precision matrices, and several approaches have been recently developed for this task such as joint graphical lasso and fused graphical lasso. However, the multivariate Gaussian assumptions made in the existing approaches are often violated in reality. For instance, most RNA‐Seq data follow non‐Gaussian distributions even after log‐transformation or other variance‐stabilizing transformations. In this work, we consider the problem of directly estimating differential networks under a flexible semiparametric model, namely the nonparanormal graphical model, where the random variables are assumed to follow a multivariate Gaussian distribution after a set of monotonically increasing transformations. We propose to use a novel rank‐based estimator to directly estimate the differential network, together with a parametric simplex algorithm for fast implementation. Theoretical properties of the new estimator are established under a high‐dimensional setting where p grows with n almost exponentially fast. In particular, we show that the proposed estimator is consistent in both parameter estimation and support recovery. Both synthetic data and real genomic data are used to illustrate the promise of the new approach. The Canadian Journal of Statistics 48: 187–203; 2020 © 2019 Statistical Society of Canada [ABSTRACT FROM AUTHOR]

This article addresses issues in creating public‐use data files in the presence of missing ordinal responses and subsequent statistical analyses of the dataset by users. The authors propose a fully efficient fractional imputation (FI) procedure for ordinal responses with missing observations. The proposed imputation strategy retrieves the missing values through the full conditional distribution of the response given the covariates and results in a single imputed data file that can be analyzed by different data users with different scientific objectives. Two most critical aspects of statistical analyses based on the imputed data set, validity and efficiency, are examined through regression analysis involving the ordinal response and a selected set of covariates. It is shown through both theoretical development and simulation studies that, when the ordinal responses are missing at random, the proposed FI procedure leads to valid and highly efficient inferences as compared to existing methods. Variance estimation using the fractionally imputed data set is also discussed. The Canadian Journal of Statistics 48: 138–151; 2020 © 2019 Statistical Society of Canada [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association between dentists' geographic density and perceptions of market competition with clinical decision‐making among a representative sample of dentists in Ontario, Canada's most populated province. Methods: Competition was quantified using dentist density, defined as the number of dental clinics lying within a one kilometre radius around the respondents' clinic address and by self‐reported perceived pressure from other dental clinics. The outcome (clinical decision‐making or treatment intensity) was measured using a set of clinical scenarios, which categorized dentists as either relatively aggressive or conservative. Associations were assessed using bivariate analysis and logistic and linear regression. Results: Dentists who perceived large competitive pressure from other dentists (OR = 1.63, 95% CI: 1.07‐2.49) were relatively more aggressive in their treatment choices. Interestingly, dentists located in very low dentist density areas (OR = 1.31, 95% CI: 1.03‐1.68) were also relatively more aggressive in their treatment choices. Conclusion: This study is the first to explore the impact of competition on the clinical decision‐making of dentists in a Canadian context. It presents a valuable addition to the competition literature and helps to understand current dynamics in the Canadian dental care market. [ABSTRACT FROM AUTHOR]

An Ornstein–Uhlenbeck (OU) process is employed as a versatile model to capture the mean‐reverting and stochastic evolution of many variables in various fields of applications including finance and economics. Within the OU setting, we develop a new estimation method to determine the unknown change‐point location under the assumption that the volatilities before and after the change point in a time series are unequal. Our method hinges on the concept of a weighted least sum of squared errors approach and enhanced by a fusion of an iterative algorithm. The consistency of the change‐point estimator is established. This article highlights a numerical implementation on simulated and observed financial market data demonstrating the significant flexibility and accuracy of our proposed modelling and estimation method. The Canadian Journal of Statistics 48: 62–78; 2020 © 2019 Statistical Society of Canada [ABSTRACT FROM AUTHOR]

Context: Medical schools of geographically large nations have expanded into rural areas to facilitate the development of a sustainable rural pipeline of physicians. Preceptor, or clinical teacher, recruitment at these sites has been an ongoing challenge. However, residents‐as‐teachers (RaT) curricula have not been modified to support the development of rural teachers. This study aimed to compare teaching opportunities between rural and urban family medicine residents and to identify mechanisms underlying potential differences. Methods: Year‐1 and Year‐2 family medicine residents at seven Canadian institutions participated in a mixed‐methods study utilising a quantitative survey and a qualitative interview. Rural and urban residents rated the quantity and types of teaching opportunities available during their training, from which a chi‐squared analysis was completed. Volunteer respondents participated in a structured interview, from which a thematic analysis was performed. Results: Rural family medicine residents had fewer opportunities to teach compared to their urban colleagues. This discrepancy was seen across multiple domains, including informal opportunities when on family medicine rotations, χ2 (4, n = 242) = 45.26, P <.000, Bonferroni's adjusted P <.000. Thematic analysis centred around determining factors influencing teaching opportunities and identified that the academic context, personal factors and programme factors were key dimensions. Within these dimensions, the number of medical students, a desire to be an educator and administrative support were cited as influences on teaching opportunities. Conclusions: The lack of teaching opportunities for rural trainees is attributable to a combination of practical and organisational factors revealed through thematic analysis. If rural graduates are not comfortable balancing the demands of service and teaching, this could compound the already prevalent issue of rural preceptor recruitment. It is essential to develop a rural‐focused RaT curriculum to close this gap and produce competent educators who are ready to inspire generations of rural physicians. As arguments mount for increasing the amount of training in rural family medicine environments, requiring the need for educational expertise in those contexts, our field may have overlooked how hard it is for trainees to develop rural environment‐focused teaching skills. [ABSTRACT FROM AUTHOR]

Introduction: Catheter ablation (CA) has been increasingly used to treat atrial fibrillation (AF) in patients with heart failure (HF), however, its safety at the population‐level has not yet been evaluated. To assess the safety of CA in AF‐HF patients, the frequency and potential risk factors for adverse events (AEs) within 30 days post‐CA were determined. Methods: A population‐based cohort of AF‐HF patients who underwent CA in Quebec, Canada (2000‐2017) was constructed using administrative databases. Major AEs included all‐cause mortality, cerebrovascular accident (CVA), pericardial effusion requiring drainage (PERD), vascular AEs, hemorrhage/hematoma, and pulmonary embolism. Univariate logistic regression models were employed to assess potential risk factors for major AEs. Results: Of 700 AF‐HF patients who underwent CA (median age 64.5 years [interquartile range, IQR, 56.2‐71.0], 22.0% female, and median CHA2DS2‐Vasc 3 [IQR, 2‐4]), 14 (2.0%) patients developed 16 major AEs within 30 days of CA. Hemorrhage/hematoma was the most frequent major AE (four patients; 0.6%) followed by all‐cause mortality, CVA/TIA, PERD, and vascular AEs (three patients each; 0.4%). Coronary artery disease (odds ratio [OR], 3.9 [95% confidence interval, CI, 1.2‐12.3]) and age ≥65 years (OR, 3.1 [95% CI, 1.1‐9.8]) were identified predictors for the composite outcome of major AEs. More than half of the patients (57.2%) underwent a second CA within a median of 0.8 (IQR, 0.2‐2.2) years from the date of first CA. Conclusion: CA performed in the AF‐HF population portends a relatively low incidence of major AEs. A larger study is required to determine whether certain patient factors are independently associated with a higher risk of post‐CA AEs. [ABSTRACT FROM AUTHOR]

Aim: To evaluate effectiveness of specific policy and practice changes to the process of registration for internationally educated nurses. Background: Little research exists to inform registration policy for internationally educated health professionals. Introduction: Internationally educated nurse employment can help address nursing shortages. Regulators assess competencies for equivalency to Canadian‐educated nurses, but differences in health systems, education and practice create challenges. Methods: The study setting was a Canadian province. We used a mixed methods approach, with a pre–post‐quasi‐experimental design and a qualitative evaluation. Previous analysis of relationships between applicant variables, registration outcomes and timelines informed changes to our registration process. Implementation of these changes composes the intervention. Comparisons between pre‐ and post‐implementation exemplar subgroups and timeline analyses were conducted using descriptive statistics, univariate analysis and non‐parametric tests. Data were collected from complete application files before (n = 426) and after (n = 287) implementation of the intervention. Interviews, focus groups and consultations were completed with various stakeholders. Findings: The time between steps in the process was significantly reduced following implementation. Stakeholders reported an increase in perceived efficiency, transparency and use of evidence. Discussion: Results indicated that initial impacts of the policy changes streamlined the process for applicants and staff. Conclusion: Maintaining a consistent and systematic review of an organization's data coupled with implementation of findings to effect policy and practice change may have an important impact on regulatory policy. Implications for Nursing Policy: These findings represent the beginning of an international policy conversation. Policy changes based on organizational data can underlie major process improvement initiatives. Ongoing nursing shortages across the globe and increasing mobility of nurses make it important to have efficient and transparent regulatory policy informed by evidence. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether the discontinuation of tumor necrosis factor inhibitors (TNFi) during pregnancy is associated with any changes of the disease course in women with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). Methods: Pregnant women with RA and JIA from the US and Canada were enrolled in the Organization of Teratology Information Specialists (OTIS) Autoimmune Diseases in Pregnancy Project, a prospective cohort study. Information about medication and disease activity (patient‐reported outcome measures) was collected prior to gestational week 20 and at gestational week 32. Associations between patterns of TNFi continuation or discontinuation and disease activity changes were tested in unadjusted and multivariate analyses. Results: Among 490 women (397 with RA, 93 with JIA) enrolled between 2005 and 2017, 122 (24.9%) discontinued a TNFi before gestational week 20, 201 (41.0%) received a TNFi beyond week 20, and 167 (34.1%) did not receive a TNFi during pregnancy. At the time of enrollment, disease activity was low to minimal in 72.9% of women. TNFi discontinuation was not associated with a clinically important worsening of patient reported outcome measures at the third trimester. Univariate but not multivariate analysis showed that women receiving TNFi beyond week 20 were more likely to experience improved disease activity scores at the third trimester. Conclusion: Discontinuing TNFi before gestational week 20 seems feasible in women with RA and JIA who enter pregnancy with well‐controlled disease. [ABSTRACT FROM AUTHOR]

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Objectives: To compare the trajectories of motor and cognitive decline in older adults who progress to dementia with the trajectories of those who do not. To evaluate the added value of measuring motor and cognitive decline longitudinally versus cross‐sectionally for predicting dementia. Design: Prospective cohort study with 5 years of follow‐up. Setting: Clinic based at a university hospital in London, Ontario, Canada. Participants: Community‐dwelling participants aged 65 and older free of dementia at baseline (N=154). Measurements: We evaluated trajectories in participants' motor performance using gait velocity and cognitive performance using the MoCA test twice a year for 5 years. We ascertained incident dementia risk using Cox regression models and attributable risk analyses. Analyses were adjusted using a time‐dependent covariate. Results: Overall, 14.3% progressed to dementia. The risk of dementia was almost 7 times as great for those whose gait velocity declined (hazard ratio (HR)=6.89, 95% confidence interval (CI)=2.18–21.75, p=.001), more than 3 times as great for those with cognitive decline (HR=3.61, 95% CI=1.28–10.13, p=.01), and almost 8 times as great in those with combined gait velocity and cognitive decline (HR=7.83, 95% CI=2.10–29.24, p=.002), with an attributable risk of 105 per 1,000 person years. Slow gait at baseline alone failed to predict dementia (HR=1.16, 95% CI=0.39–3.46, p=.79). Conclusion: Motor decline, assessed according to serial measures of gait velocity, had a higher attributable risk for incident dementia than did cognitive decline. A decline over time of both gait velocity and cognition had the highest attributable risk. A single time‐point assessment was not sufficient to detect individuals at high risk of dementia. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: This study aimed to investigate effects of individual nurse and hospital characteristics on patient adverse events and quality of care using a multilevel approach. Design: This is a secondary analysis of a combination of nurse survey data (N = 1,053 nurses) and facility data (N = 63 hospitals) in Canada. Methods: Multilevel ordinal logistic regression was employed to examine effects of individual nurse and hospital characteristics on patient adverse events. Multilevel linear regressions were used to investigate effects of individual nurse and hospital characteristics on quality of care. Findings: Organizational safety culture was associated with patient adverse events and quality of care. Controlling for effects of nurse and hospital characteristics, nurses in hospitals with a stronger safety culture were 64% less likely to report administration of wrong medication, time, or dose; 58% less likely to report patient falls with injury; and 60% less likely to report urinary tract infections; and were more likely to report higher levels of quality of care. Additionally, the effects of individual‐level baccalaureate education and years of experience on quality of care differed across hospitals, and hospital‐level nurse education interacted with individual‐level baccalaureate education. Conclusions: This study makes significant contributions to existing knowledge regarding the positive effect of organizational safety culture on patient adverse events and quality of care. Clinical Relevance: Healthcare organizations should strive to improve their safety culture by creating environments where healthcare providers trust each other, work collaboratively, and share accountability for patient safety and care quality. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: This study investigates whether dental hygienists are routinely conducting oral cancer screenings (OCSs) as per their professional capability and responsibility. Factors that may mediate provision of OCSs, and ability to discuss sensitive topics with patients, are also examined. Methods: A pretested online questionnaire was sent via national and provincial regulatory bodies to target practicing registered dental hygienists across Canada. Analysis was conducted using statistical software. Results: Results of 256 surveys were analysed. Sixty‐four per cent of dental hygienists listed an OCS as part of their regular process of care. Except for the initial examination, respondents were significantly more likely to report being responsible for the OCS than the dentist, P<.001. On average, intraoral components are inspected at higher frequencies (96%) than extraoral components (73%). Confidence in OCS technique was high (70%). The majority felt prepared by their education to conduct OCSs (60%), but those with a bachelor's degree felt more prepared than those with a diploma, P=.005. The average time to conduct an OCS is 4.09 minutes, with most agreeing there is sufficient time in an appointment (57%). Only 37% felt their education prepared them to discuss sensitive topics, level of education had no effect, P>.05. Only 43% of respondents felt confident in their human papillomavirus (HPV) knowledge and comfortable discussing HPV risk factors with patients. Conclusion: Dental hygienists in this study are regularly conducting OCSs; however, they lack comfort discussing sensitive topics such as transmission of oral HPV, and screenings may not be fully comprehensive. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The objective of this population‐based cross‐sectional study was to estimate rural‐urban disparity in the oral health‐related quality of life (OHRQoL) of the Quebec adult population. Methods: A 2‐stage sampling design was used to collect data from the 1788 parents/caregivers of schoolchildren living in the 8 regions of the province of Quebec in Canada. Andersen's behavioural model for health services utilization was used as a conceptual framework. Place of residency was defined according to the Statistics Canada Census Metropolitan Area and Census Agglomeration Influenced Zone classification. The outcome of interest was OHRQoL measured using the Oral Health Impact Profile (OHIP)‐14 validated questionnaire. Data weighting was applied, and the prevalence, extent and severity of negative oral health impacts were calculated. Statistical analyses included descriptive statistics, bivariate analyses and binary logistic regression. Results: The prevalence of poor oral health‐related quality life (OHRQoL) was statistically higher in rural areas than in urban zones (P = .02). Rural residents reported a significantly higher prevalence of negative daily‐life impacts in pain, psychological discomfort and social disability OHIP domains (P < .05). Additionally, the rural population showed a greater number of negative oral health impacts (P = .03). There was no significant rural‐urban difference in the severity of poor oral health. Logistic regression indicated that the prevalence of poor OHRQoL was significantly related to place of residency (OR = 1.6; 95% CI = 1.1‐2.5; P = .022), perceived oral health (OR = 9.4; 95% CI = 5.7‐15.5; P < .001), dental treatment needs factors (perceived need for dental treatment, pain, dental care seeking) (OR = 8.7; 95% CI = 4.8‐15.6; P < .001) and education (OR = 2.7; 95% CI = 1.8‐3.9; P < .001). Conclusion: The results of this study suggest a potential difference in OHRQoL of Quebec rural and urban populations, and a need to develop strategies to promote oral health outcomes, specifically for rural residents. Further studies are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To estimate and test the difference in rates of violent and non‐violent crime during medicated and non‐medicated methadone treatment episodes. Design, Setting and Participants: The study involved linkage of population level administrative data (health and justice) for all individuals (n = 14 530) in British Columbia, Canada with a history of conviction and who filled a methadone prescription between 1 January 1998 and 31 March 2015. Methadone maintenance treatment was the primary independent variable and was treated as a time‐varying exposure. Each participant's follow‐up (mean: 8 years) was divided into medicated (methadone was dispensed) and non‐medicated (methadone was not dispensed) periods with mean durations of 3.3 and 4.6 years, respectively. Measurements: Socio‐demographics of participants were examined along with the main outcomes of violent and non‐violent offences. Findings: During the first 2 years of treatment (≤ 2.0 years), periods in which methadone was dispensed were associated with a 33% lower rate of violent crime [0.67 adjusted hazard ratio (AHR), 95% confidence intervals (CI) = 0.59, 0.76] and a 35% lower rate of non‐violent crime (0.65 AHR, 95% CI = 0.62, 0.69) compared with non‐medicated periods. This equates to a risk difference of 3.6 (95% CI = 2.6, 4.4) and 37.2 (95% CI = 33.0, 40.4) fewer violent and non‐violent offences per 100 person‐years, respectively. Significant but smaller protective effects of dispensed methadone were observed across longer treatment intervals (2.0 to ≤ 5.0 years, 5.0 to ≤ 10.0 years). Conclusions: Among a cohort of Canadian offenders, rates of violent and non‐violent offending were lower during periods when individuals were dispensed methadone compared with periods in which they were not dispensed methadone. [ABSTRACT FROM AUTHOR]

Abstract: Ice‐sheets flowing over soft sediments produce undulations in the bed, typically of metres in relief, of which drumlins are the most abundant and widely investigated. Consensus regarding their mechanism of formation has yet to be achieved. In this paper we examine the spatial organization of drumlins in order to provide an improved description of the phenomenon and to guide hypotheses of their formation. We review the literature highlighting contradictory findings regarding drumlin spatial organization and then use this to motivate our study based on a large sample (42 488) of drumlins from Canada, Britain and Norway. Are there typical arrangements in drumlin positioning and are they organized in a regular spatial manner (patterned) or are they distributed randomly? We recognize that drumlin fields are inherently patchy and therefore apply inhomogeneous spatial statistics in order to study their distribution. This shows that whilst drumlins are occasionally randomly placed, their main state is non‐ random. They exhibit a strong and statistically significant signal of regularity across lengths scales of 100 to 1200 m. We conclude that patterning is a near ubiquitous property of drumlins. This finding of regularity demonstrates spatial self‐organization in the bedforming process with drumlins as an emergent manifestation of sub‐glacial sediment mobility. Kilometre‐scale interactions between drumlins must occur as they evolve, or interactions may arise as a consequence of growth or migration. Hypotheses or models are required that can explain the regular spacing of drumlins. We highlight three suggestions for such self‐organization: instability in the coupling of ice flow–sediment flux–bed shape; local feedback between sediment mobility and relief; and coarsening by growth or migration. © 2017 The Authors. Earth Surface Processes and Landforms published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Vitamin B6 is important in fetal development, but little is known of the vitamin B6 status of pregnant women and newborns in North America and potential modifying factors. This prospective study determined maternal and cord plasma concentrations of pyridoxal 5′ phosphate (PLP; an indicator of vitamin B6 status) in a convenience sample of 368 Canadian pregnant women and their newborns. The association of maternal intake of vitamin B6 and fetal genetic variants with cord plasma PLP and homocysteine concentrations was also examined. Dietary and supplemental intakes of vitamin B6 were assessed in early and mid to late pregnancy. PLP concentrations were measured in maternal plasma in early pregnancy and at delivery, and in cord plasma. Six fetal variants of the MTHFR and CβS genes were assessed for their association with cord plasma PLP and homocysteine concentrations. Geometric mean (95% CI) PLP concentrations were 107 (98, 116) nmol/L in early pregnancy and 58 (53, 62) nmol/L at delivery, respectively, and 296 (275, 319) nmol/L in cord blood ( p < .0001). During early pregnancy and at delivery, 3.6% and 5.5% of women had plasma PLP concentrations <20 nmol/L, respectively. Ninety eight percent of the women with supplemental B6 intake of at least the recommended dietary allowance had PLP concentrations >20 nmol/L. Fetal genetic variants were not associated with cord PLP and homocysteine concentrations. Vitamin B6 deficiency is uncommon in a cohort of Canadian pregnant women due largely to prevalent vitamin B6 supplement use. [ABSTRACT FROM AUTHOR]

Through an examination of transnational advocacy and the Indigenous-Canada relationship, this article advances a compliance model of reconciliation to suggest that reconciliation might be compelled through pressure upon states to comply with their human rights obligations. Drawing upon constructivism, conflict resolution theory, and social psychology, the article proposes that compliance and reconciliation converge as a result of behavioral adjustment and the internalization of values through enforced performance. The article uses four examples for illustration: (1) challenges at the UN Human Rights Committee against gender discrimination in the Indian Act, (2) Canada's belated endorsement in 2010 of the United Nations Declaration of the Rights of Indigenous Peoples, (3) insider-outsider pressure that Canada comply with its human rights obligations with respect to its missing and murdered indigenous women and girls, and (4) the Hul'qumi'num Treaty Group's land claim petition before the Inter-American Commission for Human Rights. The article concludes that transnational advocacy in the Indigenous-Canada context has had slight to moderate effect in making reconciliation happen. [ABSTRACT FROM AUTHOR]

Aim: The objectives of this exploratory study were (1) to describe the experience of fatigue in adults with cerebral palsy (CP) inclusive of all levels of the Gross Motor Function Classification System (GMFCS); and (2) to determine if physical activity level, sedentary time, age, or body composition can predict fatigue in adults with CP.Method: An observational study was conducted in an outpatient setting in Ontario, Canada. Participants included adults with CP (n=41; GMFCS levels I-V; mean age 33.7y, standard deviation [SD] 12.3y). Fatigue was measured using the Fatigue Impact and Severity Self-Assessment (FISSA) questionnaire. Habitual physical activity and sedentary time were measured using accelerometry. Body mass index (BMI) and waist circumference were reported as measures of body composition.Results: The mean (SD) FISSA score for all participants was 84.5 (30.6), ranging from 54.0 (18.3) (GMFCS level I) to 93.6 (21.9) (GMFCS level V). Significant positive relationships (regression coefficient β [95% confidence intervals]) were observed between BMI and FISSA scores (1.9 [0.73-3.1]), waist circumference and FISSA scores (0.71 [0.19-1.2]), and age and FISSA scores (0.99 [0.26-1.7]). A significant negative relationship was observed between moderate-to-vigorous physical activity (MVPA) per hour and FISSA scores -6.4 [-12 to -0.83]). Backwards stepwise regression analysis revealed BMI (1.8 [0.61-2.9]) and MVPA per hour (-5.4 [-10 to -0.30]) were significant predictors of FISSA scores.Interpretation: Health care providers should consider the importance of weight management and physical activity to prevent and treat fatigue in this population. [ABSTRACT FROM AUTHOR]

Background The experience of having human immunodeficiency virus (HIV) is often associated with co-occurring mental health issues. Community mental health services are an important source of support for persons with HIV living in the community. Persons with intellectual disability (ID) are vulnerable to HIV and may have unique support needs beyond those without ID receiving community care. This study compared support needs of men with HIV in community mental health programmes, with and without ID. Methods The sample was composed of 138 HIV-positive men with and without ID receiving mental health case management from one community organisation in Ontario, Canada, on 31 March 2013. Staff-rated needs across 16 domains grouped into four clusters were measured using the Camberwell Assessment of Need: Basic needs (accommodation, food, public transportation, money and benefits); self-care/functional needs (looking after the home, self-care and daytime activities); health/safety needs (physical health, psychological distress, psychotic symptoms, safety to self and safety to others); and social needs (company, intimate relationships and sexual expression). Adjusted logistic regression models examined the association between ID and each need domain. Results One-quarter of the sample ( n = 34/138, 24.6%) had co-occurring ID. Those with ID were more likely to have needs in the basic cluster [odds ratios: food 4.05 (1.14, 14.44), P:0.031; benefits 2.58 (1.05, 6.32), P:0.038)] and self-care/functional cluster [looking after the home (2.75 (1.17, 6.49), P:0.021); self-care (2.72 (1.18, 6.27), P:0.019)], but were less likely to have need for sexual expression: 0.35 (0.14,0.90), P:0.030) (social cluster). There were no differences in the domains in the health/safety cluster. Conclusion Despite elevated cognitive needs in the basic and self-care/functional clusters for the ID group, limited other differences suggest that with moderate additional targeting, community mental health programmes for persons with HIV may be appropriate for men with ID. [ABSTRACT FROM AUTHOR]

Background: Recent evidence suggests that early exposure to low maternal sensitivity is a risk factor for obesity in children and adolescents. A separate line of study shows that the seven-repeat (7R) allele of the dopamine-4 receptor gene (DRD4) increases susceptibility to environmental factors including maternal sensitivity. The current study integrates these lines of work by examining whether preschoolers carrying the 7R allele are more vulnerable to low maternal sensitivity as it relates to overweight/obesity risk. Method: The Maternal Adversity Vulnerability and Neurodevelopment (MAVAN) project in Canada was used as the discovery cohort (N = 203), while the Generation R study in the Netherlands was used as a replication sample (N = 270). Regression models to predict both continuous BMI z-scores and membership in any higher BMI category based on established World Health Organization (WHO) cutoffs for 48 months of age were completed. Results: In both cohorts, there was a significant maternal sensitivity by DRD4 by sex interaction predicting higher body mass indices and/or obesity risk. As hypothesized, post hoc testing revealed an inverse relationship between maternal sensitivity and body mass indices in 7R allele carriers relative to noncarriers. This finding was strongest in girls in the Canadian cohort and in boys in the Dutch cohort. Conclusions: Many children who carry the 7R allele of DRD4 appear to be more influenced by maternal sensitivity as it relates to overweight/obesity risk, consistent with a plasticity effect. Given the relatively small sample sizes available for these analyses, further replications will be needed to confirm and extend these results. [ABSTRACT FROM AUTHOR]

Background Millions of head computed tomography ( CT) scans are ordered annually, but the extent of avoidable imaging is poorly defined. Objectives The objective was to determine the prevalence of likely avoidable CT imaging among adults evaluated for head injury in 14 community emergency departments ( EDs) in Southern California. Methods We conducted an electronic health record ( EHR) database and chart review of adult ED trauma encounters receiving a head CT from 2008 to 2013. The primary outcome was discordance with the Canadian CT Head Rule ( CCHR) high-risk criteria; the secondary outcome was use of a neurosurgical intervention in the discordant cohort. We queried systemwide EHRs to identify CCHR discordance using criteria identifiable in discrete data fields. Explicit chart review of a subset of discordant CTs provided estimates of misclassification bias and assessed the low-risk cases who actually received an intervention. Results Among 27,240 adult trauma head CTs, EHR data classified 11,432 (42.0%) discordant with CCHR recommendation. Subsequent chart review showed that the designation of discordance based on the EHR was inaccurate in 12.2% (95% confidence interval [ CI] = 5.6% to 18.8%). Inter-rater reliability for attributing CCHR concordance was 95% (κ = 0.86). Thus, we estimate that 36.8% of trauma head CTs were truly likely avoidable (95% CI = 34.1% to 39.6%). Among the likely avoidable CT group identified by EHR, only 0.1% (n = 13) received a neurosurgical intervention. Chart review showed none of these were actually 'missed' by the CCHR, as all 13 were misclassified. Conclusion About one-third of head CTs currently performed on adults with head injury may be avoidable by applying the CCHR. Avoidance of CT in such patients is unlikely to miss any important injuries. [ABSTRACT FROM AUTHOR]

Background Current guidelines disagree on the role for applying force to electrodes during electrical cardioversion (ECV) for atrial fibrillation, particularly when using self-adhesive pads. We evaluated the impact of this practice on transthoracic impedance (TTI) with varying force and in individuals with differing body mass indices (BMI). We additionally assessed whether specific prompts could improve physicians' ECV technique. Methods The study comprised three parts: (1) TTI was measured in 11 participants throughout the respiratory cycle and with variable force applied to self-adhesive electrodes in anteroposterior (AP) and anterolateral (AL) configurations. (2) Three participants in different BMI classes then had TTI measured with prespecified incremental force applied. (3) Ten blinded cardiology trainees simulated ECV on one participant with and without prompting (guideline reminders and force analogies) while force applied and TTI were measured. Results The AP approach was associated with 13% lower TTI than AL (P < 0.001). Strongly negative correlations were observed between force applied and TTI in the AL position, irrespective of BMI (P ≤ 0.003). In all cases, 80% of the total reduction in TTI observed was achieved with 8 kg-force (∼80 N). All prompts resulted in significantly greater force applied and modest reductions in TTI. Conclusions Applying force to self-adhesive electrodes reduces TTI and should be considered as a means of improving ECV success. Numerically greater mean force applied with a 'push-up' force analogy suggests that 'concrete' cues may be useful in improving ECV technique. [ABSTRACT FROM AUTHOR]

Objectives To further our understanding of the relationship between Adverse Childhood Experiences (ACEs) and suicidal behaviour, this study investigates the association between three types of ACEs and lifetime suicide attempts, while considering potential gender-specific and mediating effects. Methods Data were obtained from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH), a cross-sectional, population-based survey comprised of respondents aged 18 or older who provided self-reported data on past experiences of suicide attempts, as well as childhood sexual abuse (CSA), childhood physical abuse (CPA) and parental domestic violence (PDV) ( n = 22 559). After testing for ACE by gender interactions, we estimated the odds of lifetime suicide attempts for each ACE and then investigated whether depression, anxiety, substance abuse and chronic pain acted as mediators of the relationship. Results The odds of suicide attempts are significantly higher among those with a history of CPA (OR = 3.29; 99.9% CI 2.33-4.64), CSA (OR = 4.42; 99.9% CI 3.14-6.23) or PDV (OR = 2.52; 99.9% CI 1.69-3.76), when ACEs are mutually adjusted. There is little evidence that gender acts as a moderator; however, depression, anxiety, substance abuse and chronic pain appear to partially mediate the associations. Depression alone accounts for about a quarter of the associations with CSA and CPA. Conclusions Mental health factors and chronic pain appear only to partially mediate relationships between ACEs and lifetime suicide attempts. Future research should look at other pathways with the goal of developing multi-level interventions. [ABSTRACT FROM AUTHOR]

Objective We investigated the inter-rater reliability of Web of Science ( Wo S) and Scopus when calculating the h-index of 25 senior scientists in the Clinical Epidemiology Program of the Ottawa Hospital Research Institute. Materials and methods Bibliometric information and the h-indices for the subjects were computed by four raters using the automatic calculators in Wo S and Scopus. Correlation and agreement between ratings was assessed using Spearman's correlation coefficient and a Bland- Altman plot, respectively. Results Data could not be gathered from Google Scholar due to feasibility constraints. The Spearman's rank correlation between the h-index of scientists calculated with Wo S was 0.81 (95% CI 0.72-0.92) and with Scopus was 0.95 (95% CI 0.92-0.99). The Bland- Altman plot showed no significant rater bias in Wo S and Scopus; however, the agreement between ratings is higher in Scopus compared to Wo S. Conclusion Our results showed a stronger relationship and increased agreement between raters when calculating the h-index of a scientist using Scopus compared to Wo S. The higher inter-rater reliability and simple user interface used in Scopus may render it the more effective database when calculating the h-index of senior scientists in epidemiology. [ABSTRACT FROM AUTHOR]

Background Participation in social and physical activities has a number of benefits for children with or without disabilities. However, individuals with disabilities are often excluded from taking part in social activities. Most of the research on activity participation has focused on adults or youth with milder disabilities. However, children and adolescents with severe and complex needs, including those with autism, are often excluded from this type of research because of their complexities and level of functioning. Thus, we examined the social participation and friendships of children and adolescents with severe developmental disabilities, with and without autism, compared with peers without developmental disabilities. Methods We compared the activity participation and friendships of typically developing children ( n = 210), children with an intellectual disability (ID only; n = 186), and children with autism spectrum disorder plus intellectual disability (ID + ASD; n = 232) between the ages of 3 and 19 years. Parents of these children completed a survey, which included questions about their children's participation in six activities, and the number and quality of their children's friendships. Results Children and adolescents with ID only and ID + ASD were reported to participate in significantly fewer activities and to participate much less frequently than typically developing peers. Those with ID only and ID + ASD were reported to have fewer friends and poorer quality of friendships. In addition, those with ID + ASD participated even less frequently in some activities and had fewer friends relative to those with ID only. Conclusion It is important to find ways to increase the social and activity participation of children and adolescents with ID only and ID + ASD. Future research should examine the barriers to such participation and factors that impact social participation in this population. [ABSTRACT FROM AUTHOR]

Background: The use of standard statistical methods in the medical literature has been studied extensively; however, the adoption of new methods has received less attention. We sought to understand (i) whether there is a perception that new methods are underused, (ii) what the barriers to use of new methods are, (iii) what dissemination activities are used, and (iv) user preferences for learning about new methods.Methods: We conducted a cross-sectional survey of members of the Statistical Society of Canada (SSC) and of principal investigators (knowledge-users) funded by the Canadian Institutes of Health Research (CIHR).Results: There were 157 CIHR respondents (14% response rate), and 39 respondents were statisticians from the Statistical Society of Canada. Seventy percent of CIHR respondents and 82% of statisticians felt that new developments were under-used. Barriers to use of new methods included lack of access to the necessary expertise (selected by over 90% of respondents), lack of suitable software (selected by 81% of statisticians), and lack of time to implement new methods (selected by 78% of statisticians). Greater access to statistical colleagues with an interest in collaboration and availability of software to implement new methods were the top-rated preferences among knowledge-users.Conclusions: There was a clear perception among all respondents that new statistical methods are underused. Encouraging statistical methodologists to develop a knowledge translation plan for improved dissemination and uptake, placing greater value on the role of the statistical collaborator in research, and providing software alongside new methods may improve the use of newly developed statistical methods. [ABSTRACT FROM AUTHOR]