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Although cannabis was legalized in Canada in 2018 and is one of the most used substances in Canada, few studies have examined how individuals with different patterns of cannabis use differ in their attempts to decrease or abstain from cannabis. The current study examined how groups of cannabis users, which were formed on the basis of demographic characteristics, substance use patterns, mental health symptoms, and self-reported quality of life differed on their experiences with cannabis cessation. A sample of 147 Canadian adult participants who had attempted to decrease or quit cannabis were recruited from the community (n = 84, 57.14%) and crowdsourcing (n = 63, 42.86%). Four profiles of cannabis users emerged using a Latent Profile Analysis: low-risk (n = 62, 42.18%), rapidly escalating high-risk (n = 40, 27.21%), long-term high severity (n = 35, 23.81%), and long-term lower severity (n = 10, 6.80%). Individuals in the rapidly escalating profile had attempted to decrease their cannabis use more times compared to other profiles. More participants in the long-term high severity group found their use stayed the same or got worse after their last cessation attempt, compared to the low-risk group where more individuals indicated their use stopped. The results of the current study indicate that cannabis users differ in their attempts at reducing or ceasing cannabis use and that they may benefit from different intensity of cannabis interventions. [ABSTRACT FROM AUTHOR]

Aim: To address: What are the experiences of 2SLGBTQQIA+ parents using parenting supports and services to meet their children's early childhood development needs (<5 years of age)? Design: Whittemore and Knafl's (2005) integrative review methodology. Methods: Electronic databases were searched from 2000 to October 14, 2022 for empirical studies or reviews addressing the research question. The title and abstract of 12,158 articles were screened for inclusion in the review by two independent researchers; 175 of these articles underwent full‐text review. Studies selected were critically appraised using a Joanna Briggs Institute Critical Appraisal tool. Relevant key findings were extracted from each study and entered into N‐VIVO‐12. Thematic content analysis was employed and PRISMA guidelines were adhered to. Results: A total of 18 articles (15 qualitative and three multi‐method studies) met the inclusion criteria and were selected for the review. Seven themes were revealed from analysis of the studies: (1) 2SLGBTQQIA+ Status kept a secret; (2) Forced to come out; (3) Heteronormative messaging; (4) Feeling excluded; (5) Stigmatised; (6) Parents act as educators; and (7) Positive experiences. Conclusion: This integrative review provides nurses with insight into the experiences of 2SLGBTQQIA+ parents using health care services for their young child. Implications for the Profession: This article highlights what changes nurses need to make to their practice to ensure appropriate, inclusive care for clients of diverse sexual and gender identities and their families. Impact: Health care providers, especially nurses, have an opportunity to improve the experiences of these families and positively impact their health and well‐being. Additionally, there is a need for research with the 2SLGBTQQIA+ parent community and the use of rigorous methodological techniques, including clearly linking participants' gender and sexual identities with study findings, to improve our understanding of 2SLGBTQQIA+ parent experiences. Patient or Public Contribution: Although there was no direct patient contribution to the work since it was an integrative review of the literature, indirectly patient contributions are incorporated from the original research results of studies incorporated into this review. [ABSTRACT FROM AUTHOR]

Canada and the United States have recently evaluated the decriminalization of drugs as multiple provinces and states put motions forward to consider drug decriminalization legislation. The influence of factors such as demographics, substance use, perceived substance use risk, and personality have not been widely studied in predicting attitudes toward drug decriminalization. A total of 504 participants were drawn from university (n = 269, 53.37%) and community samples (n = 235, 46.63%) through online social media groups and posts (i.e., Facebook, Twitter, Reddit, etc). Analyses indicated that male gender, single or non-married relationship status, living outside of Atlantic Canada, higher problematic alcohol use scores, lower Extraversion, higher Open-mindedness, and lower perceived risk of using substances emerged as significant predictors of support for drug decriminalization. These findings have important implications as public attitudes toward a substance influence drug policy. [ABSTRACT FROM AUTHOR]

Objectives Night shiftwork has been linked to various health outcomes. Knowing where and to what extent workers are exposed to this type of shiftwork can help prioritize areas for intervention and further study. This study describes recent estimates of exposure to night shiftwork in Canada for 2011, and temporal trends from 1997 to 2010. Methods Estimates by occupation, industry, province, and sex were calculated using data from the Survey of Labour and Income Dynamics (SLID) from 1996 to 2011. Workers who reported rotating or regular night shifts were classified as exposed to shiftwork involving nights, while those reporting other types of shiftwork, outside of regular daytime and evening shifts, were classified as possibly exposed. Results, with 97.5% confidence intervals (CIs), were summarized for three exposure categories: exposed workers, possibly exposed workers, and evening shift workers. Trends in 3-year rolling averages were described. Results In 2011, approximately 1.8 million Canadians (97.5% CI, 1.7–1.8 million), or 12% of the working population (97.5% CI, 11–12%), were exposed to night shiftwork; 45% were female. An additional 2.6 million were possibly exposed (97.5% CI, 2.5–2.7 million workers), and 745 000 worked evening shifts (97.5% CI, 701 000–792 000). This amounts to 17% (97.5% CI, 17–18%) and 4.9% (97.5% CI, 4.6–5.2%) of the labour force, respectively. Industries with the highest prevalence were accommodation and food services (20%; 97.5% CI, 18–22%), forestry, fishing, mining, oil, and gas (19%; 97.5% CI, 16–23%), and healthcare and social assistance (18%; 97.5% CI, 17–19%). By occupation, the highest prevalence of exposure was in occupations in protective services (37%; 97.5% CI, 32–42%), professional occupations in health (35%; 97.5% CI, 32–39%), and machine operators and assemblers in manufacturing (24%; 97.5% CI, 22–28%). The overall number of exposure workers increased by 29% from 1997 to 2010, but the overall proportion remained relatively the same (11% and 12%, respectively). The proportion of female workers exposed increased by 2%. Conclusions These estimates characterize exposure to night shiftwork in Canada. Continued collection of shiftwork data, with greater detail on scheduling, workplace and personal factors, is needed for high-quality surveillance and investigations of shiftwork and health. [ABSTRACT FROM AUTHOR]

Inequitable access to health care, social inequities, and racist and discriminatory care has resulted in the trend toward poorer health outcomes for Indigenous infants and their families when compared to non‐Indigenous families in Canada. How Indigenous mothers experience care during an admission of their infant to the Neonatal Intensive Care Unit has implications for future health‐seeking behaviors which may influence infant health outcomes. Nurses are well positioned to promote positive health care interactions and improve health outcomes by effectively meeting the needs of Indigenous families. This qualitative study was guided by interpretive description and the Two‐Eyed Seeing framework and aimed to understand how Indigenous mothers experience accessing and using the health care system for their infants. Data were collected by way of interviews and a discussion group with self‐identifying Indigenous mothers of infants less than two years of age living in Hamilton, Ontario, Canada. Data underwent thematic analysis, identifying nursing strategies to support positive health care interactions and promote the health and wellness of Indigenous infants and their families. Building relationships, providing holistic care, and taking a trauma‐informed approach to the involvement of child protection services are three key strategies that nurses can use to positively impact health care experiences for Indigenous families. [ABSTRACT FROM AUTHOR]

The social environment in which lesbian, gay, bisexual, transgender, and queer (LGBTQ) youths live influences health and well-being. We describe the development of the LGBTQ Supportive Environments Inventory (LGBTQ SEI), designed to quantify the LGBTQ-inclusiveness of social environments in the United States and Canada. We quantify aspects of the social environment including: (1) presence/quality of LGBTQ youth-serving organizations; (2) LGBTQ-inclusive community resources; and (3) socioeconomic and political environment. Using geographic information systems (GIS) tools, we aggregated data to buffers around 397 schools in three regions. The LGBTQ SEI can be used to assess the role of the social environment in reducing health disparities for LGBTQ youths. [ABSTRACT FROM AUTHOR]

Objectives: Occupational exposure to antineoplastic agents occurs in various environments and is associated with increased cancer risk and adverse reproductive outcomes. National-level information describing the location and extent of occupational exposure to antineoplastic agents is unavailable in Canada and most other countries. CAREX Canada aimed to estimate the prevalence and relative levels of occupational exposures to antineoplastic agents across work setting, occupation, and sex. Methods: 'Exposure' was defined as any potential for worker contact with antineoplastic agents. Baseline numbers of licensed workers were obtained from their respective professional bodies. For unlicensed workers, Census data or data extrapolated from human resources reports (e.g., staffing ratios) were used. Prevalence was estimated by combining population estimates with exposure proportions from peer-reviewed and grey literature. Exposure levels (classified as low, moderate, and high) by occupation and work setting were estimated qualitatively by combining estimates of contact frequency and exposure control practices. Results: Approximately 75 000 Canadians (0.42% of the total workforce) are estimated as occupationally exposed to antineoplastic agents; over 75% are female. The largest occupational group exposed to antineoplastic agents is community pharmacy workers, with 30 200 exposed. By work setting, 39 000 workers (52% of all exposed) are located in non-hospital settings; the remaining 48% are exposed in hospitals. The majority (75%) of workers are in the moderate exposure category. Conclusions: These estimates of the prevalence and location of occupational exposures to antineo-plastic agents could be used to identify high-risk groups, estimate disease burden, and target new research and prevention activities. The limited secondary data available for developing these estimates highlights the need for increased quantitative measurement and documentation of antineoplastic agent contamination and exposure, particularly in work environments where use is emerging. [ABSTRACT FROM AUTHOR]

Attention toward who can use which gender binary, multi-stall bathroom has brought to the forefront, once again, the ways in which youth are supported or marginalized. No study has documented sexual and gender minority youths' experiences with and perspectives about bathrooms. We collected qualitative data in 2014-2015. Participants were 25 lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth, aged 14-19, in the United States and Canada. Their comments describe first- and second-hand bathroom experiences, identify advocacy efforts, and highlight the roles of peers and adults in making bathrooms safe (or not). Youth emphasized the importance of gender-neutral bathrooms in fostering a sense of safety and inclusivity. Adult support and gay-straight alliances (GSAs) were important contributors to a welcoming environment and fostered advocacy efforts for gender-neutral bathrooms. We encourage purposeful inclusivity of youths' voices when enacting bathroom-specific policies and legislation that directly influence their health and well-being. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the use of Indigenous philosophies and ways of knowing as a means to critique, understand and improve the care of Indigenous infants and families in the neonatal intensive care unit (NICU). Background: The ability of health professionals to provide culturally safe and equitable care to Indigenous infants and their families can affect infant development and long‐term health outcomes. Research suggests that family involvement in care benefits both the infant and their family, but there is limited research that addresses the experience of Indigenous families in the NICU and advances understanding of how nurses involve Indigenous families in their infants' care. Design: A discursive, critical review will be presented to outline the assumptions of Indigenous philosophies and to explore how the consideration and implementation of Indigenous ways of knowing can improve the nursing care of Indigenous infants and their families in the NICU. Method: First, our subjective positioning as Indigenous nurses and as health researchers is described. Second, our understanding of Indigenous philosophical frameworks and how these approaches fit in the context of the philosophy of science is defined. Third, the key elements of an Indigenous philosophical paradigm are described. Fourth, an application of Indigenous paradigms to supporting the care of Indigenous infants and families in the NICU context is made. Conclusions: An Indigenous philosophical approach to nursing is ideal for understanding and improving the experiences of Indigenous infants and families in the NICU. This approach allows nurses to critically analyse the history and legacy of colonialism and its impact on the health and wellbeing of Indigenous peoples. By prioritising the voices and concerns of Indigenous families in the clinical setting and in nursing research, nurses can better understand the experiences of these families in the NICU and use strengths‐based approaches to facilitate family involvement in care. Relevance to clinical practice: The application of Indigenous philosophies in the nursing context can be used to inform the care of Indigenous infants and families in the NICU. Potential benefits include improved therapeutic relationships between nurses and Indigenous families, and increased uptake of parent‐led interventions in nursing practice, which may lead to improved health outcomes for Indigenous infants in the NICU and throughout their subsequent development. [ABSTRACT FROM AUTHOR]

Children’s musculoskeletal (MSK) injury pain remains poorly managed. This survey of pediatric emergency physicians and orthopedic surgeons assessed analgesia administration practices and discharge advice for children with acute MSK pain; 683 responses were received. Ibuprofen was the most commonly reported analgesic used in the emergency department (52%) and at discharge (68%). Most (85%) reported using oral opioids in the previous 6 months. Codeine use was the most commonly reported opioid used in the emergency department (38%) and at home (51%). For equal levels of pain, younger children received less opioids than older children. Younger physicians and recent graduates chose acetaminophen and codeine more than older and more experienced colleagues, who preferred ibuprofen and non-codeine containing opioid compounds (P < .001 and .006, respectively). Orthopedic surgeons reported less ibuprofen use than pediatric emergency physicians (P < .001). Choice of analgesic agents is heterogeneous among physicians and is influenced by pain severity, child’s age, and physician characteristics. [ABSTRACT FROM PUBLISHER]

Background: In the case of a pandemic, individuals may alter their behaviour. A dynamic model incorporating social distancing can provide a mechanism to consider complex scenarios to support decisions regarding antiviral stockpile size while considering uncertainty around behavioural interventions. We have examined the impact of social distancing measures on the demand for limited healthcare resources such as antiviral drugs from a central stockpile during a severe pandemic. Methods: We used an existing age-structured model for pandemic influenza in Canada and biologically plausible scenarios for severe influenza transmission within the population. We incorporated data from published reports regarding stated intentions to change behaviour during a pandemic as well as the magnitude and duration of time that individuals expected to maintain the behavioural change. We ran simulations for all combinations of parameter values to identify the projected antiviral requirements in each scenario. Results: With 12 weeks of distancing, the effect is relatively small for the lowest R0 of 1.6 with a projected stockpile to treat 25.6% being required (IQR = 21.7 - 28.7%) unless the proportion of people involved (81%) and magnitude of the behaviour change is large (69% reduction in contacts). If 24 weeks of distancing occurs, with only a low to moderate reduction in contacts (38% or less), it is not possible to bring treatment requirements below 20% regardless of what proportion of the population engages in distancing measures when transmissibility is high (R0 = 2.0; stockpile size = 31%, IQR = 29.2 - 33.5%). Conclusions: Our results demonstrate that the magnitude and duration of social distancing behaviours during a severe pandemic have an impact on the need for antiviral drugs. However, significant investments over a long period of time (>16 weeks) are required to decrease the need for antiviral treatment to below 10% of the total population for a highly transmissible viral strain (R0 > 1.8). Encouraging individuals to adopt behaviours that decrease their daily contact rate can help to control the spread of the virus until a vaccine becomes available however; relying on these measures to justify stockpiling fewer courses of treatment will not be sufficient in the case of a severe pandemic. [ABSTRACT FROM AUTHOR]

Introduction: Public health preparedness is based on timely and accurate information. Time series forecasting using disease surveillance data is an important aspect of preparedness. This study compared two approaches of time series forecasting: seasonal auto‐regressive integrated moving average (SARIMA) modelling and the artificial neural network (ANN) algorithm. The goal was to model weekly seasonal influenza activity in Canada using SARIMA and compares its predictive accuracy, based on root mean square prediction error (RMSE) and mean absolute prediction error (MAE), to that of an ANN. Methods: An initial SARIMA model was fit using automated model selection by minimizing the Akaike information criterion (AIC). Further inspection of the autocorrelation function and partial autocorrelation function led to 'manual' model improvements. ANNs were trained iteratively, using an automated process to minimize the RMSE and MAE. Results: A total of 378, 462 cases of influenza was reported in Canada from the 2010–2011 influenza season to the end of the 2019–2020 influenza season, with an average yearly incidence risk of 20.02 per 100,000 population. Automated SARIMA modelling was the better method in terms of forecasting accuracy (per RMSE and MAE). However, the ANN correctly predicted the peak week of disease incidence while the other models did not. Conclusion: Both the ANN and SARIMA models have shown to be capable tools in forecasting seasonal influenza activity in Canada. It was shown that applying both in tandem is beneficial, SARIMA better forecasted overall incidence while ANN correctly predicted the peak week. [ABSTRACT FROM AUTHOR]

Objectives. We designed a population-based study of the epidemiology of tuberculosis among foreign-born people in the U.S. and Canada. Challenges included standardizing recruitment and data entry at 22 sites, enrolling individuals who did not speak English and may be undocumented, and obtaining clearance from 36 institutional review boards (IRBs). Methods. We used stratified sampling to recruit patients through the Tuberculosis Epidemiologic Studies Consortium, a research consortium funded by the Centers for Disease Control and Prevention. Because recruitment sites were overseen by more than 30 local IRBs, we developed a simple process to designate a central RB. We translated instruments into 10 main languages, arranged for fast translation of consent "short forms" into other languages, used one telephone interpretation service at all sites, and provided extensive interviewer training including mock interviews with simulated patients. Results. We interviewed 1 ,696 participants in 19 states and provinces. Participants from 99 countries were interviewed in 40 languages. Twenty-three per- cent did not speak English at all; 64% needed an interpreter. More than 20% of participants reported they were undocumented. Participants' age, gender, and birthplaces were broadly similar to the target populations. One-third of local lRBs used the central IRB. Conclusions. Special confidentiality protections, substantial resources for translation and interpretation, and a centralized IRB made possible the recruitment of a representative sample of foreign-born people. The approaches may be applicable to studies of other diseases in multinational populations in the U.S. and Canada. [ABSTRACT FROM AUTHOR]

Simple Summary: The use of antibiotics by veterinarians can be reduced by providing them with periodic feedback on their antibiotic use. This strategy was evaluated among veterinarians in Canada and Israel by using an interrupted time-series study design. The veterinarians were provided with three feedback reports at an interval. The report contained a visualization comparing their prescribing with their peers. The report was supplemented with a guideline on antibiotic prescribing. It was found that the antibiotic prescribing of the veterinarians reduced significantly with some strong indication of geographical variation in the reduction in antibiotic prescribing due to the periodic feedback. This strategy is highly recommended in a veterinary clinic to reduce the unnecessary use of antibiotics. An interrupted time-series study design was implemented to evaluate the impact of antibiotic stewardship interventions on antibiotic prescribing among veterinarians. A total of 41 veterinarians were enrolled in Canada and Israel and their prescribing data between 2019 and 2021 were obtained. As an intervention, veterinarians periodically received three feedback reports comprising feedback on the participants' antibiotic prescribing and prescribing guidelines. A change in the level and trend of antibiotic prescribing after the administration of the intervention was compared using a multi-level generalized linear mixed-effect negative-binomial model. After the receipt of the first (incidence rate ratios [IRR] = 0.88; 95% confidence interval (CI): 0.79, 0.98), and second (IRR = 0.85; 95% CI: 0.75, 0.97) feedback reports, there was a reduced prescribing rate of total antibiotic when other parameters were held constant. This decline was more pronounced among Israeli veterinarians compared to Canadian veterinarians. When other parameters were held constant, the prescribing of critical antibiotics by Canadian veterinarians decreased by a factor of 0.39 compared to that of Israeli veterinarians. Evidently, antibiotic stewardship interventions can improve antibiotic prescribing in a veterinary setting. The strategy to sustain the effect of feedback reports and the determinants of differences between the two cohorts should be further explored. [ABSTRACT FROM AUTHOR]

Background: Public health guidelines for chlamydia testing are not sex specific, but young females test at a disproportionally higher rate than males and other age groups. This study aims to describe testing trends across age and sex subgroups, then estimate a test-adjusted incidence of chlamydia in these subgroups to identify gaps in current testing practices. Methods: We used a population-based study to examine observed chlamydia rates by age and sex subgroups: 15–19 years, 20–29 years, 30–39 years and older than 40 years. The study included diagnostic test results recorded by Public Health Ontario Laboratories between Jan. 1, 2010, and Dec. 31, 2018, for individuals living in Peel region, Ontario. We then employed meta-regression models as a method of standardization to estimate the effect of sex and age on standardized morbidity ratio, testing ratio and test positivity, then calculate a test-adjusted incidence of chlamydia for each subgroup. Results: Over the study period, infection, testing and test positivity varied across age and sex subgroups. Observed incidence and testing were highest in females aged 20–29 years, whereas males had the highest standardized test positivity across all age groups. After estimating test-adjusted incidence for each age–sex subgroup, males in the 15–19-year and 30–39-year age groups had an increase in incidence of 60.2% and 9.7%, respectively, compared with the observed incidence. Interpretation: We found that estimated test-adjusted incidence was higher than observed incidence in males aged 15–19 years and 30–39 years. This suggests that infections in males are likely being missed owing to differential testing, and this may be contributing to the persistent increase in reported cases in Canada. Public health programming that targets males, especially in high-risk settings and communities, and use of innovative partner notification methods could be critical to curbing overall rates of chlamydia. [ABSTRACT FROM AUTHOR]

Objective: The ongoing effects of colonialism disproportionately place Indigenous youth at risk for mental health challenges. This meta-analysis examined lifetime and past-year prevalence estimates of mental health challenges among First Nations, Inuit, and Métis youth in Canada.Method: Five electronic databases were searched from their inceptions until June 17, 2021. Studies were included if they assessed mental health challenges among First Nations, Inuit, and/or Métis youth (≤18 years old). Risk of bias was assessed using the Newcastle-Ottawa Scale.Results: A total of 28 articles were eligible. Sixteen studies contained data on First Nations, 2 on Inuit, one on Métis, and 10 aggregated Indigenous participants. Among First Nations participants, pooled prevalence estimates for past-year suicidality (8.9%), mood and/or anxiety (<2.9%), attention-deficit/hyperactivity (2.9%), oppositional defiant (8.8%), and conduct (12.8%) disorder diagnoses were identified. Limited studies containing Inuit, Métis, and aggregated Indigenous participants also found high levels of disruptive disorder symptoms. Data were very limited for lifetime prevalence estimates. Studies assessed to have a moderate or high methodological risk of bias (k = 19) or using measures that are not yet culturally validated (k = 25) may contribute to inaccuracies in prevalence estimates.Conclusion: Existing data suggest that Indigenous youth have a low prevalence of mental health challenges, with the exception of disruptive behaviors. Future studies should use culturally validated tools and partner with Indigenous communities to ensure optimal identification of mental health challenges. [ABSTRACT FROM AUTHOR]

Background: A variety of public health measures have been implemented during the COVID-19 pandemic in Canada to reduce contact between individuals. The objective of this study was to provide empirical contact pattern data to evaluate the impact of public health measures, the degree to which social contacts rebounded to normal levels, as well as direct public health efforts toward age- and location-specific settings.Methods: Four population-based cross-sectional surveys were administered to members of a paid panel representative of Canadian adults by age, gender, official language, and region of residence during May (Survey 1), July (Survey 2), September (Survey 3), and December (Survey 4) 2020. A total of 4981 (Survey 1), 2493 (Survey 2), 2495 (Survey 3), and 2491 (Survey 4) respondents provided information about the age and setting for each direct contact made in a 24-h period. Contact matrices were constructed and contacts for those under the age of 18 years imputed. The next generation matrix approach was used to estimate the reproduction number (Rt) for each survey. Respondents with children under 18 years estimated the number of contacts their children made in school and extracurricular settings.Results: Estimated Rt values were 0.49 (95% CI: 0.29-0.69) for May, 0.48 (95% CI: 0.29-0.68) for July, 1.06 (95% CI: 0.63-1.52) for September, and 0.81 (0.47-1.17) for December. The highest proportion of reported contacts occurred within the home (51.3% in May), in 'other' locations (49.2% in July) and at work (66.3 and 65.4% in September and December). Respondents with children reported an average of 22.7 (95% CI: 21.1-24.3) (September) and 19.0 (95% CI 17.7-20.4) (December) contacts at school per day per child in attendance.Conclusion: The skewed distribution of reported contacts toward workplace settings in September and December combined with the number of reported school-related contacts suggest that these settings represent important opportunities for transmission emphasizing the need to support and ensure infection control procedures in both workplaces and schools. [ABSTRACT FROM AUTHOR]

Objective This study aimed to validate a novel, three faced, colour-coded, action-oriented tool: The Stoplight Pain Scale (SPS). Methods A prospective observational cohort study was conducted at a Canadian paediatric emergency department from November 2014 to February 2017. Patients aged 3 to 12 years and their caregivers were asked to rate pain using the SPS and the Faces Pain Scale-Revised (FPS-R). Pain was measured just before analgesia administration, 30 minutes after analgesia administration, and immediately following a painful procedure. Results A total of 227 patients were included; 26.9% (61/227) were 3 to 5 years old while 73.1% (166/227) were 6 to 12 years old. Using Cohen's κ, agreement for SPS and FPS-R was 'fair' for children (0.28 [95% confidence interval {CI} 0.20 to 0.36]) and 'poor' for caregivers (0.14 [95% CI 0.07 to 0.21]), at initial measurement. The SPS had 'fair' agreement between child and caregiver scores, (0.37 [95% CI 0.27 to 0.47]), compared to FPS-R which showed 'poor' agreement (0.20 [95% CI 0.12 to 0.29]). Absolute agreement between child and caregiver SPS scores improved with repeat exposure; 30 minutes after analgesia administration, caregivers and children had fair agreement (κ=0.38, 95% CI 0.28 to 0.48); they had moderate agreement directly following painful procedures (κ=0.46, 95% CI 0.34 to 0.59). Overall, 72.4% (139/192) of children and 60.2% (118/196) of caregivers preferred SPS over FPS-R. Conclusion The SPS demonstrates fair agreement with FPS-R for children and fair-moderate agreement between children and caregivers; agreement improved with repeat use. The SPS is simple and easy to use; it may have a role in empowering direct child and family involvement in pain management. [ABSTRACT FROM AUTHOR]

Background Given the current opioid crisis, caregivers have mounting fears regarding the use of opioid medication in their children. We aimed to determine caregivers' a) willingness to accept, b) reasons for refusing, and c) past experiences with opioids. Methods A novel electronic survey of caregivers of children aged 4 to 16 years who had an acute musculoskeletal injury and presented to two Canadian paediatric emergency departments (ED) (March to November 2017). Primary outcome was caregiver willingness to accept opioids for moderate pain for their children. Results Five hundred and seventeen caregivers participated; mean age was 40.9 (SD 7.1) years with 70.0% (362/517) mothers. Children included 62.2% (321/516) males with a mean age of 10.0 (SD 3.6) years. 49.6% of caregivers (254/512) reported willingness to accept opioids for ongoing moderate pain in the ED, while 37.1% (190/512) were 'unsure'; 33.2% (170/512) of caregivers would accept opioids for at-home use, but 45.5% (233/512) were 'unsure'. Caregivers' primary concerns were side effects, overdose, addiction, and masking of diagnosis. Caregiver fear of addiction (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.01 to 1.25) and side effects (OR 1.25, 95% CI 1.11 to 1.42) affected willingness to accept opioids in the emergency department ; fears of addiction (OR 1.19, 95% CI 1.07 to 1.32), and overdose (OR 1.15, 95% CI 1.04 to 1.27) affected willingness to accept opioids for at-home use. Conclusions Only half of the caregivers would accept opioids for moderate pain, despite ongoing pain following nonopioid analgesics. Caregivers' fears of addiction, side effects, overdose, and masking diagnosis may have influenced their responses. These findings are a first step in understanding caregiver analgesic decision making. [ABSTRACT FROM AUTHOR]

OBJECTIVE To investigate the association of demographic, career, and lifestyle factors with resilience and the association of resilience with mental health out comes in Canadian veterinarians. SAMPLE 1,130 veterinarians in clinical practice across Canada. PROCEDURES An online questionnaire was used to collect participant data and included 5 validated psychometric scales to evaluate resilience (through the Connor Davidson Resilience Scale [CD-RISC]), perceived stress (through the Professional Quality of Life Scale). A multivariable linear regression model was used to investigate associations between CD-RISC scores and demographic, career, and lifestyle characteristics. Univariable linear regression models were used to assess the relationship between resilience scores and other mental health outcomes. RESULTS The strongest positive association was between CD-RISC score and overall health. The level of satisfaction with support from friends and workplace resources had positive associations with the CD-RISC score. The presence of mental illness had the strongest negative association with the CD-RISC score. Being married, working in a small animal practice, or having an associate role were negatively associated with the CD-RISC score. The CD-RISC score had negative associations with scores for perceived stress, anxiety, depression, burnout, and secondary traumatic stress. CONCLUSIONS ANDCLINICAL RELEVANCE Models provided evidence for the role of resilience in protectingagainst negative mental health outcomes in veterinarians. Both personal and workplace factors were associated with resilience, presenting opportunities for intervention at each of these levels. [ABSTRACT FROM AUTHOR]

Despite supportive structural changes to reduce stigma towards lesbian, gay, and bisexual, transgender, queer, and questioning (LGBTQ) Canadian residents, sexual minority youth still face disparities compared to heterosexual peers. We aimed to characterize LGBTQ-supportive environments and political climates, and examine their links to suicidal behavior among sexual minority adolescents in western Canada. Data were from the 2013 British Columbia Adolescent Health Survey, a cluster-stratified random cross-sectional survey of public school students in BC, Canada; We sampled 2678 self-identified LGB and mostly heterosexual students (69% girls) from 274 schools, representing an estimated provincial population of 24,624 sexual minority students in weighted models. Student reports of past-year suicidal ideation, suicidal attempts, and self-harm behaviors were merged with community-level data assessing diverse aspects of LGBTQ-supportive resources and progressive political climates in communities surrounding the schools. Adjusted multilevel models showed that for sexual minority adolescent girls, higher community LGBTQ-supportiveness predicted marginally significant lower suicidal ideation (aOR = 0.94, 95% CI [0.88, 1.01]) and suicidal attempts (aOR = 0.91, 95% CI [0.83, 1.00]) and significantly lower self-harm behaviors (aOR = 0.91, 95% CI [0.85, 0.98]). Further, progressive political climates predicted marginally significant lower suicidal ideation (aOR = 0.89, 95% CI [0.78, 1.02]) and significantly lower self-harm behaviors (aOR = 0.87, 95% CI [0.77, 0.99]). For sexual minority adolescent boys, no community-level variables were associated with suicidal behavior in adjusted models. Thus, LGBTQ-supportive communities and progressive political climates appear to be protective against suicidal behavior among sexual minority adolescent girls, but not sexual minority adolescent boys. [ABSTRACT FROM AUTHOR]

BACKGROUND: Aedes aegypti and Ae. albopictus are mosquito vectors of more than 22 arboviruses that infect humans. OBJECTIVES: Our objective was to develop regional ecological niche models for Ae. aegypti and Ae. albopictus in the conterminous United States and Canada with current observed and simulated climate and land-use data using boosted regression trees (BRTs). METHODS: We used BRTs to assess climatic suitability for Ae. albopictus and Ae. aegypti mosquitoes in Canada and the United States under current and future projected climates. RESULTS: Models for both species were mostly influenced by minimum daily temperature and demonstrated high accuracy for predicting their geographic ranges under the current climate. The northward range expansion of suitable niches for both species was projected under future climate models. Much of the United States and parts of southern Canada are projected to be suitable for both species by 2100, with Ae. albopictus projected to expand its range north earlier this century and further north than Ae. aegypti. DISCUSSION: Our projections suggest that the suitable ecological niche for Aedes will expand with climate change in Canada and the United States, thus increasing the risk of Aedes-transmitted arboviruses. Increased surveillance for these vectors and the pathogens they carry would be prudent. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To estimate the prevalence of perceived stress, burnout, depression, anxiety, compassion fatigue, compassion satisfaction, resilience, and suicidal ideation among Canadian veterinarians and compare results with those for other populations. SAMPLE: 1,403 veterinarians across Canada. PROCEDURES: The study represented a cross-sectional online survey. The questionnaire incorporated validated psychometric instruments to measure perceived stress, burnout, depression, anxiety, compassion fatigue, and resilience as well as questions regarding suicidal ideation. Means and relative proportions in categories of severity were compared between genders as well as with normative data for the general population and results for veterinarians in the United Kingdom. RESULTS: Approximately 10% of Canadian veterinarians (n = 1,403) completed the survey. Relative to the general population, survey participants had significantly higher mean scores for subscales of burnout and compassion fatigue, anxiety, and depression and significantly lower mean resilience. Relative to males, females had significantly higher mean scores for perceived stress, emotional exhaustion, burnout, secondary traumatic stress, anxiety, and depression and significantly lower mean resilience. Participants also had higher mean scores for anxiety and depression relative to results for United Kingdom veterinarians. The 12-month prevalence of suicidal ideation for participants was 26.2%, which was substantially higher than the estimated prevalence for the general international population (2.1% to 10.0%). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that the mental health of Canadian veterinarians was poor, compared with the mental health of the general population. These results should serve as a call to action for tools and educational programs directed at supporting veterinarian mental wellness in Canada, with special attention paid to the disparate needs of the genders. [ABSTRACT FROM AUTHOR]

Horses are a highly mobile population, with many travelling locally, nationally, and internationally to participate in shows and sporting events. However, the nature and extent of these movements, as well as the potential impact they may have on disease introduction and spread, is not well documented. The objective of this study was to characterise the movement network of a sample of horses in Ontario, Canada, over a 7-month equestrian season. Horse owners (n = 141) documented their travel patterns with their horse(s) (n = 330) by completing monthly online questionnaires between May and November 2015. Directed networks were constructed to represent horse movements in 1-month time periods. A total of 1754 horse movements met the inclusion criteria for analysis. A variety of location types were included in each monthly network, with many including non-facilities such as parks, trails, and private farms. Only 34.3% of competitions attended by participants during the study period were regulated by an official equestrian organisation. Comparisons of the similarity between monthly networks indicated that participants did not travel to the same locations each month, and the most connected locations varied between consecutive months. While the findings should not be generalized to the wider horse population, they have provided greater insight into the nature and extent of observed horse movement patterns. The results support the need to better understand the variety of locations to which horses can travel in Ontario, as different types of locations may have different associated risks of disease introduction and spread. [ABSTRACT FROM AUTHOR]

We explore how principles predicting the success of a medical information commons (MIC) advantaged or disadvantaged three MIC initiatives in three Canadian provinces. Our MIC case examples demonstrate that practices and policies to promote access to and use of health information can help improve individual healthcare and inform a learning health system. MICs were constrained by heterogenous health information protection laws across jurisdictions and risk-averse institutional cultures. A networked approach to MICs would unlock even more potential for national and international data collaborations to improve health and healthcare. [ABSTRACT FROM AUTHOR]

Background: In Canada, active tuberculosis (TB) disease rates remain disproportionately higher among the Indigenous population, especially among the Inuit in the north. We used mathematical modeling to evaluate how interventions might enhance existing TB control efforts in a region of Nunavut.Methods: We developed a stochastic, agent-based model of TB transmission that captured the unique household and community structure. Evaluated interventions included: (i) rapid treatment of active cases; (ii) rapid contact tracing; (iii) expanded screening programs for latent TB infection (LTBI); and (iv) reduced household density. The outcomes of interest were incident TB infections and total diagnosed active TB disease over a 10- year time period.Results: Model-projected incidence in the absence of additional interventions was highly variable (range: 33-369 cases) over 10 years. Compared to the 'no additional intervention' scenario, reducing the time between onset of active TB disease and initiation of treatment reduced both the number of new TB infections (47% reduction, relative risk of TB = 0.53) and diagnoses of active TB disease (19% reduction, relative risk of TB = 0.81). Expanding general population screening was also projected to reduce the burden of TB, although these findings were sensitive to assumptions around the relative amount of transmission occurring outside of households. Other potential interventions examined in the model (school-based screening, rapid contact tracing, and reduced household density) were found to have limited effectiveness.Conclusions: In a region of northern Canada experiencing a significant TB burden, more rapid treatment initiation in active TB cases was the most impactful intervention evaluated. Mathematical modeling can provide guidance for allocation of limited resources in a way that minimizes disease transmission and protects population health. [ABSTRACT FROM AUTHOR]

Go-along interviews, which are interviews conducted while being in and moving within participant selected spaces, were conducted with 66 lesbian, gay, bisexual, transgender, and queer adolescents (14–19 years old) in their self-identified communities to explore perceived community attributes, including safe spaces, resources, and supports; this article highlights methodological lessons learned. Successful recruitment in 2 countries and varied community settings required partnership with local lesbian, gay, bisexual, transgender, and queer supporting agencies, including school-based gay–straight alliances. Youth chose to walk, use public transportation, and drive to community locations, identifying numerous formal and informal resources in their communities. Participant reflections highlighted that go-along interviews can be conducted in safe ways that encourage lesbian, gay, bisexual, transgender, and queer youth to express themselves about communities in which they live, study, work, play, and relax. [ABSTRACT FROM AUTHOR]

Background: The world is currently confronting the first influenza pandemic of the 21st century. Influenza vaccination is an effective preventive measure, but the unique epidemiological features of swine-origin influenza A (H1N1) (pH1N1) introduce uncertainty as to the best strategy for prioritization of vaccine allocation. We sought to determine optimal prioritization of vaccine distribution among different age and risk groups within the Canadian population, to minimize influenza-attributable morbidity and mortality. Methodology/Principal Findings: We developed a deterministic, age-structured compartmental model of influenza transmission, with key parameter values estimated from data collected during the initial phase of the epidemic in Ontario, Canada. We examined the effect of different vaccination strategies on attack rates, hospitalizations, intensive care unit admissions, and mortality. In all scenarios, prioritization of high-risk individuals (those with underlying chronic conditions and pregnant women), regardless of age, markedly decreased the frequency of severe outcomes. When individuals with underlying medical conditions were not prioritized and an age group-based approach was used, preferential vaccination of age groups at increased risk of severe outcomes following infection generally resulted in decreased mortality compared to targeting vaccine to age groups with higher transmission, at a cost of higher population-level attack rates. All simulations were sensitive to the timing of the epidemic peak in relation to vaccine availability, with vaccination having the greatest impact when it was implemented well in advance of the epidemic peak. Conclusions/Significance: Our model simulations suggest that vaccine should be allocated to high-risk groups, regardless of age, followed by age groups at increased risk of severe outcomes. Vaccination may significantly reduce influenza-attributable morbidity and mortality, but the benefits are dependent on epidemic dynamics, time for program roll-out, and vaccine uptake. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: To test the hypothesis that emotional intelligence, as measured by the Bar-On Emotional Quotient Inventory (EQ-I) 125 (Multi Health Systems, Toronto, Ontario, Canada) personal inventory, would correlate with resident performance. Design: Prospective survey. Setting: University-affiliated, multiinstitutional anesthesiology residency program. Participants: Current clinical anesthesiology years one to three (PGY 2-4) anesthesiology residents enrolled in the University of Pittsburgh Anesthesiology Residency Program. Measurements: Participants confidentially completed the Bar-On EQ-I 125 survey. Results of the individual EQ-I 125 and daily evaluations by the faculty of the residency program were compiled and analyzed. Main Results: There was no positive correlation between any facet of emotional intelligence and resident performance. There was statistically significant negative correlation (−0.40; P < 0.05) between assertiveness and the “American Board of Anesthesiology essential attributes” component of the resident evaluation. Conclusions: Emotional intelligence, as measured by the Bar-On EQ-I personal inventory, does not strongly correlate to resident performance as defined at the University of Pittsburgh. [Copyright &y& Elsevier]