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The immune cell niche associated with oral dysplastic lesion progression to carcinoma is poorly understood. We identified T regulatory cells (Treg), CD8+ effector T cells (Teff) and immune checkpoint molecules across oral dysplastic stages of oral potentially malignant disorders (OPMD). OPMD and oral squamous cell carcinoma (OSCC) tissue sections (N = 270) were analyzed by immunohistochemistry for Treg (CD4, CD25 and FoxP3), Teff (CD8) and immune checkpoint molecules (PD-1 and PD-L1). The Treg marker staining intensity correlated significantly (p < 0.01) with presence of higher dysplasia grade and invasive cancer. These data suggest that Treg infiltration is relatively early in dysplasia and may be associated with disease progression. The presence of CD8+ effector T cells and the immune checkpoint markers PD-1 and PD-L1 were also associated with oral cancer progression (p < 0.01). These observations indicate the induction of an adaptive immune response with similar Treg and Teff recruitment timing and, potentially, the early induction of exhaustion. FoxP3 and PD-L1 levels were closely correlated with CD8 levels (p < 0.01). These data indicate the presence of reinforcing mechanisms contributing to the immune suppressive niche in high-risk OPMD and in OSCC. The presence of an adaptive immune response and T-cell exhaustion suggest that an effective immune response may be reactivated with targeted interventions coupled with immune checkpoint inhibition. [ABSTRACT FROM AUTHOR]

Introduction: British Columbia (BC) declared an overdose public health emergency in 2016. Since then, BC has consistently reported the highest overdose death rates of any province in Canada. In the context of the COVID‐19 pandemic, overdose deaths in BC reached a record high in 2020. This analysis reports on changes in the profile of people who have died of overdose since BC's declaration of COVID‐19 as a public health emergency on 17 March 2020. Methods: Using BC Coroners Service data, Chi‐square tests and multivariable logistic regression were conducted to compare demographic, geographic and post‐mortem toxicology data between people who died of overdose before (17 March–31 December 2019) and after (17 March–31 December 2020) BC's declaration of COVID‐19 as a public health emergency. Results: Overdose deaths observed since 17 March 2020 (n = 1516) more than doubled those observed in the same period in 2019 (n = 744). In the adjusted logistic regression model, odds of death in the post compared to pre‐COVID‐19 period was significantly higher among males compared to females, among all older age groups compared to people aged 30–39, and was lower in public buildings compared to private residences. Discussion and Conclusions: Alongside a significant increase in overdose deaths since BC's declaration of COVID‐19 as a public health emergency, the demographic profile of people who have died of overdose has changed. Ongoing overdose prevention efforts in BC must seek to reach people who remain most isolated, including older adults, who during dual public health emergencies are facing compounded risk of preventable mortality. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to compare the physical activity parenting practices (PAPPs) parents report using with the PAPPs incorporated in the published literature. Methods: PAPPs in the literature were identified by reviewing the content of 74 published PAPP measures obtained from current systematic reviews supplemented with a literature search. The types of PAPPs used by parents were identified by surveying a stratified sample of 134 Canadian and US parents of 5- to 12 year-old children. Items from the literature and parent responses were coded using the same coding scheme. Differences between the PAPPs emphasized by the parents and the literature were examined. Results: Parents significantly emphasized different issues than what is measured in the literature (P < .001). Parents emphasized more control (13.6% vs. 6.9%), modeling and teaching (13.2% vs. 9.2%), and structural strategies (32.2% vs. 28.6%) and less autonomy support (11.8% vs. 14.0%), logistical support (9.9% vs. 12.8%), and responsiveness strategies (19.3% vs. 28.5%). Conclusions: Physical activity practices most often employed by parents are not the ones emphasized in current measures. The extent to which putting more emphasis on the areas identified by parents will increase the predictive validity of the measures warrants further examination. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to examine the association between parent and adolescent levels of physical activity, sedentary behaviors, and sleep among a group of overweight and obese adolescents. Methods: Baseline data of parent-adolescent pairs who enrolled in a lifestyle modification intervention were analyzed for this study (n = 176). Participants completed questionnaires about their screen time (TV, video game, and computer time), wore an accelerometer for 8 days, and completed a sleep diary for 1 week. In total, 98 parent-adolescent dyads provided valid data for the analyses. Multivariable regression analyses were conducted to assess the relationship between parent and adolescent's moderate-to-vigorous activity (MVPA), step counts, sedentary behaviors, and sleep duration. Analyses were split by weekday, weekday evening and weekend. Results: Parent-adolescent MVPA was significantly associated on weekdays (b = 0.18; SE = 0.08; β = 0.26), weekday evenings (b = 0.21; SE = 0.08; β = 0.28), and weekends (b = 0.29; SE = 0.12; β = 0.27). This study found associations between parent-child video game time on weekends (b = 1.10; SE = 0.49; β = 0.24) and computer time on weekdays (b = 0.42; SE = 0.19; β = 0.23). Adolescent sleep was associated with parental sleep on weekdays only (b = 0.38; SE = 0.09; β = 0.46). Conclusion: The findings warrant further investigation into the direction and mechanism of the relationship between parent and adolescent weight related behaviors. [ABSTRACT FROM AUTHOR]

Illicit drug toxicity (i.e. overdose) is the leading cause of unnatural death in British Columbia, with 2021 recording a 26% increase since 2020, and more deaths than recorded in any prior year. This rise has been largely driven by the increased toxicity of the illicit drug supply. While harm reduction and treatment interventions have reduced deaths, these services alone are insufficient to stop the illicit drug toxicity crisis. Calls are mounting to provide access to a "safe supply" of drugs. One size does not fit all, and a diverse range of substances must be made widely available to separate British Columbians from the illicit drug supply. [ABSTRACT FROM AUTHOR]

Introduction: British Columbia (BC) declared a public health emergency in April 2016 in response to a rapid rise in overdose deaths. Further understanding of health care utilization is needed to inform prevention strategies for individuals who overdose from illegal drugs. Methods: The Provincial Overdose Cohort includes linked administrative data on health care utilization by individuals who experienced an illegal drug overdose event in BC between 1 January 2015 and 30 November 2016. Overdose cases were identified using data from ambulance services, coroners' investigations, poison control centre calls and hospital, emergency department and physician administrative records. In total, 10 455 overdose cases were identified and compared with 52 275 controls matched on age, sex and area of residence for a descriptive analysis of health care utilization. Results: Two-thirds (66%) of overdose cases were male and about half (49%) were 20-39 years old. Over half of the cases (54%) visited the emergency department and about one-quarter (26%) were admitted to hospital in the year before the overdose event, compared with 17% and 9% of controls, respectively. Nevertheless, nearly onefifth (19%) of cases were recorded leaving the emergency department without being seen or against medical advice. High proportions of both cases (75%) and controls (72%) visited community-based physicians. Substance use and mental health-related concerns were the most common diagnoses among people who went on to overdose. Conclusion: People who overdosed frequently accessed the health care system in the year before the overdose event. In light of the high rates of health care use, there may be opportunities to identify at-risk individuals before they overdose and connect them with targeted programs and evidence-based interventions. Further work using the BC Provincial Overdose Cohort will focus on identifying risk factors for overdose events and death by overdose. [ABSTRACT FROM AUTHOR]

Background: Parents have the potential to substantively influence their child's physical activity. This study identified the parenting practices of US and Canadian parents to encourage or discourage their 5-12 year-old child's physical activity and to examine differences in parenting practices by country, parental sex, age of child, and income.Methods: The sample consisted of 134 US and Canadian parents (54.5% US; 60.4% female) recruited from a web-based panel by a polling firm. The parents answered open-ended questions about what they and other parents do to encourage or discourage their child to be active. Responses were coded using a scheme previously developed to code items used in the published literature. Coded responses were summarized by domain and dimension with differences in responses by country, parental sex, age of child, or household income assessed with a log-linear analysis.Results: The 134 parents provided 649 and 397 responses to ways that parents encourage or discourage their child's physical activity, respectively. Over 70% of responses for practices that encourage physical activity were related to structure of the environment, parental encouragement, and co-participation. The most common response was co-participation in activity with the child. Of the practices that discourage physical activity, 67% were related to structure of the environment, lack of parental control, and modeling poor behaviors. The most common response was allowing screen time. There were no differences in response by country, parental sex, child age, or household income.Conclusions: Parents most often encouraged physical activity through structure and emotional support and discouraged physical activity through lack of structure and control. Understanding how parents influence their child's physical activity may help improve intervention strategies. The current results will inform the development of a physical activity parenting practices instrument. [ABSTRACT FROM AUTHOR]

Background: Parents are an important influence on children's dietary intake and eating behaviors. However, the lack of a conceptual framework and inconsistent assessment of food parenting practices limits our understanding of which food parenting practices are most influential on children. The aim of this study was to develop a food parenting practice conceptual framework using systematic approaches of literature reviews and expert input. Method: A previously completed systematic review of food parenting practice instruments and a qualitative study of parents informed the development of a food parenting practice item bank consisting of 3632 food parenting practice items. The original item bank was further reduced to 110 key food parenting concepts using binning and winnowing techniques. A panel of 32 experts in parenting and nutrition were invited to sort the food parenting practice concepts into categories that reflected their perceptions of a food parenting practice conceptual framework. Multi-dimensional scaling produced a point map of the sorted concepts and hierarchical cluster analysis identified potential solutions. Subjective modifications were used to identify two potential solutions, with additional feedback from the expert panel requested. Results: The experts came from 8 countries and 25 participated in the sorting and 23 provided additional feedback. A parsimonious and a comprehensive concept map were developed based on the clustering of the food parenting practice constructs. The parsimonious concept map contained 7 constructs, while the comprehensive concept map contained 17 constructs and was informed by a previously published content map for food parenting practices. Most of the experts (52%) preferred the comprehensive concept map, while 35% preferred to present both solutions. Conclusion: The comprehensive food parenting practice conceptual map will provide the basis for developing a calibrated Item Response Modeling (IRM) item bank that can be used with computerized adaptive testing. Such an item bank will allow for more consistency in measuring food parenting practices across studies to better assess the impact of food parenting practices on child outcomes and the effect of interventions that target parents as agents of change. [ABSTRACT FROM AUTHOR]

Background: Parents are widely recognized as playing a central role in the development of child behaviors such as physical activity. As there is little agreement as to the dimensions of physical activity-related parenting practices that should be measured or how they should be operationalized, this study engaged experts to develop an integrated conceptual framework for assessing parenting practices that influence multiple aspects of 5 to 12 year old children's participation in physical activity. The ultimate goal of this study is to inform the development of an item bank (repository of calibrated items) aimed at measuring physical activity parenting practices.Methods: Twenty four experts from 6 countries (Australia, Canada, England, Scotland, the Netherlands, & United States (US)) sorted 77 physical activity parenting practice concepts identified from our previously published synthesis of the literature (74 measures) and survey of Canadian and US parents. Concept Mapping software was used to conduct the multi-dimensional scaling (MDS) analysis and a cluster analysis of the MDS solution of the Expert's sorting which was qualitatively reviewed and commented on by the Experts.Results: The conceptual framework includes 12 constructs which are presented using three main domains of parenting practices (neglect/control, autonomy support, and structure). The neglect/control domain includes two constructs: permissive and pressuring parenting practices. The autonomy supportive domain includes four constructs: encouragement, guided choice, involvement in child physical activities, and praises/rewards for their child's physical activity. Finally, the structure domain includes six constructs: co-participation, expectations, facilitation, modeling, monitoring, and restricting physical activity for safety or academic concerns.Conclusion: The concept mapping analysis provided a useful process to engage experts in re-conceptualizing physical activity parenting practices and identified key constructs to include in measures of physical activity parenting. While the constructs identified ought to be included in measures of physical activity parenting practices, it will be important to collect data among parents to further validate the content of these constructs. In conclusion, the method provided a roadmap for developing an item bank that captures key facets of physical activity parenting and ultimately serves to standardize how we operationalize measures of physical activity parenting. [ABSTRACT FROM AUTHOR]

Background: Few studies have evaluated the effect of adherence to a lifestyle intervention on adolescent health outcomes. The objective of this study was to determine whether adolescent and parental adherence to components of an e-health intervention resulted in change in adolescent body mass index (BMI) and waist circumference (WC) z-scores in a sample of overweight/obese adolescents.Methods: In total, 159 overweight/obese adolescents and their parents participated in an 8-month e-health lifestyle intervention. Each week, adolescents and their parents were asked to login to their respective website and to monitor their dietary, physical activity, and sedentary behaviours. We examined participation (percentage of webpages viewed [adolescents]; number of weeks logged in [parents]) and self-monitoring (number of weeks behaviors were tracked) rates. Linear mixed models and multiple regressions were used to examine change in adolescent BMI and WC z-scores and predictors of adolescent participation and self-monitoring, respectively.Results: Adolescents and parents completed 28% and 23%, respectively, of the online component of the intervention. Higher adolescent participation rate was associated with a decrease in the slope of BMI z-score but not with change in WC z-score. No association was found between self-monitoring rate and change in adolescent BMI or WC z-scores. Parent participation was not found to moderate the relationship between adolescent participation and weight outcomes.Conclusions: Developing strategies for engaging and promoting supportive interactions between adolescents and parents are needed in the e-health context. Findings demonstrate that improving adolescents' adherence to e-health lifestyle intervention can effectively alter the weight trajectory of overweight/obese adolescents. [ABSTRACT FROM AUTHOR]

Objective In this study, unique body mass index (BMI) trajectories from ages 1 to 20 years were identified; each trajectory according to socio demographic and family characteristics was described. Methods Participants came from two national population surveys ( n = 7,253; n = 901) and were aged 1-6 years at baseline. Children were surveyed biennially over eight waves up to 14-20 years of age. BMI trajectories by sex and survey cohort were identified by group-based trajectory modeling. After crossvalidating trajectories between survey cohorts, the characteristics of trajectory membership were assessed by multinomial regression. Results Four BMI trajectories were found: low, decreasing, medium, and high. The decreasing trajectory was characterized by an overweight or obese childhood followed by a normal-weight adolescence. The low, medium, and high trajectories were characterized by growth curves culminating, by age 20, to BMI 22.6, 29.3, and 34.9 kg/m2, respectively, for males and 20.6, 24.5, and 32.0 kg/m2, respectively, for females. Factors associated with the high trajectory included ethnicity and paternal education (female only), large for gestational age, rural area residence, and maternal smoking. Conclusions The identification and validation of four major trajectories reflect the heterogeneity in patterns of BMI development from 1 to 20 years. [ABSTRACT FROM AUTHOR]