Search

To understand immediate and long-term outcomes following hip fracture surgery in adults with schizophrenia. Retrospective population-based cohort study leveraging health administrative databases from Ontario, Canada. Individuals aged 40–105 years with hip fracture surgery between April 1, 2009 and March 31, 2019 were included. Schizophrenia was ascertained using a validated algorithm. Outcomes were: 30-day mortality; 30-day readmission; 1-year survival; and subsequent hip fracture within 2 years. Analyses incorporated Generalized Estimating Equation models, Kaplan-Meier curves, and Fine-Gray competing risk models. In this cohort study of 98,126 surgically managed hip fracture patients, the median [IQR] age was 83[75–89] years, 69.2% were women, and 3700(3.8%) had schizophrenia. In Fine-Gray models, schizophrenia was associated with subsequent hip fracture (sd RH, 1.29; 95% CI, 1.09–1.53), with male patients with schizophrenia sustaining a refracture 50 days earlier. In age- and sex-adjusted GEE models, schizophrenia was associated with 30-day mortality (OR, 1.31; 95% CI, 1.12–1.54) and readmissions (OR, 1.40; 95% CI, 1.25–1.56). Kaplan-Meier survival curves suggested that patients with schizophrenia were less likely to be alive at 1-year. Study highlights the susceptibility of hip fracture patients with schizophrenia to worse outcomes, including refracture, with implications for understanding modifiable processes of care to optimize their recovery. • Hip fracture patients with schizophrenia have a higher incidence of subsequent hip fracture. • The onset of subsequent hip fracture is significantly earlier in men with schizophrenia. • Immediate secondary fracture prevention in hip fracture patients with schizophrenia is warranted. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, public health measures were used to reduce the spread of COVID-19; it is unknown whether people with chronic conditions differentially adhered to public health measures. The objectives of this study were to evaluate the association between chronic conditions and adherence and to explore effect modification by sex, age, and income. An analysis of data from the Canadian Longitudinal Study on Aging COVID-19 Questionnaires (from April to September 2020) was conducted among middle-aged and older adults aged 50–96 years (n = 28,086). Self-reported chronic conditions included lung disease, diabetes, heart disease, cancer, obesity, anxiety, and depression. Multinomial logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between chronic conditions and low, medium, and high levels of adherence. Effect modification was evaluated using statistical interaction and stratification. Most people (n = 17,435; 62%) had at least one chronic condition, and 2866 (10%) had three to seven chronic conditions. Among those with high adherence to public health measures, 69% had one or more chronic condition (n = 2266). Having three to seven chronic conditions, compared with none, was associated with higher adherence to public health measures (OR: 2.14; 95% CI: 1.12–1.42). Higher adherence was also noted across chronic conditions, for example, those with diabetes had higher adherence (OR: 1.72; 95% CI: 1.53–1.93). There was limited evidence of effect modification by sex, age, or income. Canadians with chronic conditions were more likely to adhere to public health measures; however, future research is needed to understand whether adherence helped to prevent adverse COVID-19 outcomes and if adherence had unintended consequences. [ABSTRACT FROM AUTHOR]

To measure changes in resident-level acute care transfer rates after the PoET Southwest Spread Project (PSSP), and to identify patient and long-term care (LTC) home characteristics associated with acute care transfers after program launch. Quasi-experimental matched (1:1 ratio) cohort study design using linked population-based health administrative data. Sixty publicly funded LTC homes (PSSP = 30; control = 30) in Ontario, Canada, from November 2019 to December 2021. We matched 30 PSSP homes to 30 control homes with similar characteristics and described incidence rates for resident-level acute care transfers during the 7-month post-implementation period. We used generalized linear mixed models to evaluate the association between PSSP implementation and acute care transfers during the post-implementation period. We adjusted resident-level characteristics (ie, age, sex, comorbidity status) and home-level characteristics (ie, rurality status, profit model, COVID-19 impact). We identified a decedent sub-cohort to measure transfer patterns during the last 2 months of life. A matched cohort of 8894 residents (PSSP = 4103; control = 4791) was captured. Incidence rates of transfers increased during the post-implementation period for both PSSP (78.8 to 80.9 transfers per 1000 person-months) and control residents (66.9 to 67.9 transfers per 1000 person-months). After adjusting for covariates of interest, PSSP exposure was associated with a reduction in acute care transfers during the post-implementation period after adjusting for covariates (incidence rate ratio, 0.73; 95% CI, 0.62–0.87; P =.0002). Older age and select health regions were associated with reduced transfers, whereas higher comorbidity status and higher COVID-19 outbreak days were associated with increases. Similar patterns persisted for transfers during the last 2 months of life. This study systematically evaluated the impact of an ethics-based health care intervention in LTC using health care utilization databases. PoET implementation is associated with reduced acute care transfer rates, especially in the last 2 months of life in LTC. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The American Academy of Pediatrics recommends developmental surveillance and screening in early childhood in primary care. The 18-month visit may be an ideal time for identification of children with delays in language and communication, or symptoms of autism spectrum disorder (ASD). Little is known about the predictive validity of developmental screening tools administered at 18 months. Our objective was to examine the predictive validity of the Infant Toddler Checklist (ITC) at the 18-month health supervision visit, using school readiness at kindergarten age as the criterion measure. METHODS: We designed a prospective cohort study, recruiting in primary care in Toronto, Canada. Parents completed the ITC at the 18-month visit. Teachers completed the Early Development Instrument (EDI) when the children were in Kindergarten, age 4-6 years. We calculated screening test properties with 95% confidence intervals (CIs). We used multivariable logistic and linear regression analyses adjusted for important covariates. RESULTS: Of 293 children (mean age 18 months), 30 (10.2%) had a positive ITC including: concern for speech delay (n = 11, 3.8%), concern for other communication delay (n = 13, 4.4%), and concern for both (n = 6, 2.0%). At followup (mean age 5 years), 54 (18.4%) had overall EDI vulnerability, 19 (6.5%) had vulnerability on the 2 EDI communication domains. The ITC sensitivity ranged from 11% to 32%, speci- ficity from 91% to 96%, false positive rates from 4% to 9%, PPV from 16% to 35%, NPV from 83% to 95%. A positive ITC screen and ITC concern for speech delay were associated with lower scores in EDI communication skills and general knowledge (β = -1.08; 95% CI: -2.10, -0.17; β = -2.35; 95% CI: -3.63, -1.32) and EDI language and cognitive development (β = -0.62; 95% CI: -1.25, -0.18; β = -1.22; 95% CI: -2.11, -0.58). CONCLUSIONS: The ITC demonstrated high specificity suggesting that most children with a negative ITC screen will demonstrate school readiness at 4-6 years, and low false positive rates, minimizing over-diagnosis. The ITC had low sensitivity highlighting the importance of ongoing developmental surveillance and screening. [ABSTRACT FROM AUTHOR]

International education offers transformative potential for personal and professional growth. Yet, navigating a new culture can be challenging due to language barriers and cultural differences. This longitudinal research delves into the potential of cultural empathy in promoting adjustment-related well-being of international students, particularly through enhancing their intercultural communication competence (ICC). Drawing upon the Process Model of Intercultural Competence and the Integrated Model of Intercultural Communication Competence, the current study (1) examines the interrelations of English Proficiency, Behavioral Flexibility, Ease of Interactions, Communication Effectiveness, and Communication Appropriateness as factors underlying a higher-order construct of communicative competence; and (2) explores the cross-temporal associations between cultural empathy, the five factors of ICC, and the psychosocial adjustment of international students to their host country. Students from a western Canadian university (N = 213) participated in the current study, who were surveyed three times over a 7-month period. The findings from confirmatory factor analysis underscore the integral role of interaction comfort, as well as effective and appropriate intercultural communication in fostering ICC. The random-intercept cross-lagged panel models reveal differential associations between cultural empathy, psychosocial adjustment, and the ICC factors, highlighting the merits of examining ICC in its constituent elements, as well as the importance of harbouring empathic, effective, and appropriate intercultural communication in cultivating positive intercultural experiences for international students. Together, the present findings provide insights for (1) advancing research on intercultural competence, and (2) developing initiatives in building a more empathic and inclusive global community that welcomes and supports international students in their sojourn. [ABSTRACT FROM AUTHOR]

Background Prostate cancer is the most common noncutaneous cancer in American males. Causal links between dairy, or dietary calcium, and this cancer are considered suggestive but limited. Objectives To evaluate these associations in a large North American cohort, including many with no (or very low) dairy intake and much calcium from nondairy sources. Methods A prospective cohort study of 28,737 Seventh-day Adventist men in the United States and Canada, of whom 6389 were of black ethnicity. Diet was measured by FFQ, and 275 male participants also provided repeated 24-h dietary recalls as a calibration substudy. Incident cancers were mainly found by matching with cancer registries. Analyses used multivariable proportional hazards regressions and regression calibration for some analyses. Results In total, 1254 (190 advanced) incident prostate cancer cases were found during an average 7.8 y of follow-up. Men at the 90th percentile of dairy intake (430 g/d) compared with the 10th percentile (20.2 g/d) had higher prostate cancer risk (HR: 1.27; 95% CI: 1.12, 1.43). Similar findings, comparing the same g/d intakes, were demonstrated for advanced prostate cancers (HR: 1.38; 95% CI: 1.02, 1.88), for nonadvanced cases (HR: 1.27; 95% CI: 1.11, 1.45), in black participants (HR: 1.24; 95% CI: 0.98, 1.58), and when excluding vegan participants (HR: 1.22; 95% CI: 1.03, 1.43). Calibrated dairy (g/d) regressions (all participants and all prostate cancers), adjusting for dietary measurement error, found a HR of 1.75 (95% CI: 1.32, 2.32). Comparing 90th percentile intake to zero intakes (uncalibrated), the HR was 1.62 (95% CI: 1.26, 2.05). There was no evidence of an effect of higher (905 mg/d) compared with lower (349 mg/d) intakes of nondairy calcium (HR: 1.16; 95% CI: 0.94, 1.44). Conclusions Men with higher intake of dairy foods, but not nondairy calcium, had a higher risk of prostate cancer compared with men having lower intakes. Associations were nonlinear, suggesting greatest increases in risk at relatively low doses. [ABSTRACT FROM AUTHOR]

How cost-effective is group-based pelvic floor muscle training (PFMT) for treating urinary incontinence in older women? Economic evaluation conducted alongside an assessor-blinded, multicentre randomised non-inferiority trial with 1-year follow-up. Participants : A total of 362 women aged ≥ 60 years with stress or mixed urinary incontinence. Twelve weekly 1-hour PFMT sessions delivered individually (one physiotherapist per woman) or in groups (one physiotherapist per eight women). Urinary incontinence-related costs per woman were estimated from a participant and provider perspective over 1 year in Canadian dollars, 2019. Effectiveness was based on reduction in leakage episodes and quality-adjusted life years. Incremental cost-effectiveness ratios and net monetary benefit were calculated for each of the effectiveness outcomes and perspectives. Both group-based and individual PFMT were effective in reducing leakage and promoting gains in quality-adjusted life years. Furthermore, group-based PFMT was ≥ 60% less costly than individual treatment, regardless of the perspective studied: –$914 (95% CI –970 to –863) from the participant's perspective and –$509 (95% CI –523 to –496) from the provider's perspective. Differences in effects between study arms were minor and negligible. Adherence to treatment was high, with low loss to follow-up and no between-group differences. Compared with standard individual PFMT, group-based PFMT was less costly and as clinically effective and widely accepted. These results indicate that patients and healthcare decision-makers should consider group-based PFMT to be a cost-effective first-line treatment option for urinary incontinence. ClinicalTrials.gov NCT02039830. [ABSTRACT FROM AUTHOR]

• The prevalence of hypertriglyceridemia-associated acute pancreatitis (HTG-AP) was 3%. • HTG-AP patients had a worse clinical course than biliary-AP patients. • The quality of the follow-up post hospital discharge was suboptimal in HTG-AP patients. Hypertriglyceridemia (HTG) is known as the third most common cause of acute pancreatitis (AP). To study the prevalence and outcomes of HTG-AP as well as the quality of the follow-up post HTG-AP hospitalization in Canada. This retrospective multicenter study was performed in patients admitted with AP (ICD 10 code K85) in quaternary care hospitals between 2012 and 2018. For every case of HTG-AP (TG ≥ 5.6 mmol/L on admission), two controls of biliary-AP were selected and matched for sex and age at the time of admission. Out of 1490 admitted AP patients, 40 (3%) had HTG-AP. The average TG concentration was higher in patients admitted to the ICU compared to those who were not (27.34 mmol/L vs 13.02 mmol/L). Compared to biliary-AP group, the HTG-AP patients had more frequent severe Balthazar grade (45% vs 25%) with longer duration of hospitalisation (nine versus five days) and more frequent ICU admission (38% vs 8%). Furthermore, only 35% of HTG-AP patients were referred to specialized clinics and 42.5% were left with no follow-up. Only 17% of newly discovered HTG-AP patients were started on fibrate at discharge. In comparison to biliary-AP, HTG-AP patients had a worse clinical course of pancreatitis. Furthermore, the quality of the follow-up post HTG-AP hospitalization was suboptimal. This could be explained by of the lack of knowledge of health care providers concerning the proper diagnosis and management of chylomicronemia syndromes, leading to this condition to be frequently missed or underdiagnosed. [ABSTRACT FROM AUTHOR]

To examine changes in the prescribing of end-of-life symptom management medications in long-term care (LTC) homes during the COVID-19 pandemic. Retrospective cohort study using routinely collected health administrative data in Ontario, Canada. We included all individuals who died in LTC homes between January 1, 2017, and March 31, 2021. We separated the study into 2 periods: before COVID-19 (January 1, 2017, to March 17, 2020) and during COVID-19 (March 18, 2020, to March 31, 2021). For each LTC home, we measured the percentage of residents who died before and during COVID-19 who had a subcutaneous symptom management medication prescription in their last 14 days of life. We grouped LTC homes into quintiles based on their mean prescribing rates before COVID-19, and examined changes in prescribing during COVID-19 and COVID-19 outcomes across quintiles. We captured 75,438 LTC residents who died in Ontario's 626 LTC homes during the entire study period, with 19,522 (25.9%) dying during COVID-19. The mean prescribing rate during COVID-19 ranged from 46.9% to 79.4% between the lowest and highest prescribing quintiles. During COVID-19, the mean prescribing rate in the lowest prescribing quintile increased by 9.6% compared to before COVID-19. Compared to LTC homes in the highest prescribing quintile, homes in the lowest prescribing quintile experienced the highest proportion of COVID-19 outbreaks (73.4% vs 50.0%), the largest mean outbreak intensity (0.27 vs 0.09 cases/bed), the highest mean total days with a COVID-19 outbreak (72.7 vs 24.2 days), and the greatest proportion of decedents who were transferred and died outside of LTC (22.1% vs 8.6%). LTC homes in Ontario had wide variations in the prescribing rates of end-of-life symptom management medications before and during COVID-19. Homes in the lower prescribing quintiles had more COVID-19 cases per bed and days spent in an outbreak. [ABSTRACT FROM AUTHOR]

Background: Despite the growing utility of cardiovascular magnetic resonance (CMR) for cardiac morphology and function, sex and age-specific normal reference values derived from large, multi-ethnic data sets are lacking. Furthermore, most available studies use a simplified tracing methodology. Using a large cohort of participants without history of cardiovascular disease (CVD) or risk factors from the Canadian Alliance for Healthy Heart and Minds, we sought to establish a robust set of reference values for ventricular and atrial parameters using an anatomically correct contouring method, and to determine the influence of age and sex on ventricular parameters. Methods and results: Participants (n = 3206, 65% females; age 55.2 ± 8.4 years for females and 55.1 ± 8.8 years for men) underwent CMR using standard methods for quantitative measurements of cardiac parameters. Normal ventricular and atrial reference values are provided: (1) for males and females, (2) stratified by four age categories, and (3) for different races/ethnicities. Values are reported as absolute, indexed to body surface area, or height. Ventricular volumes and mass were significantly larger for males than females (p < 0.001). Ventricular ejection fraction was significantly diminished in males as compared to females (p < 0.001). Indexed left ventricular (LV) end-systolic, end-diastolic volumes, mass and right ventricular (RV) parameters significantly decreased as age increased for both sexes (p < 0.001). For females, but not men, mean LV and RVEF significantly increased with age (p < 0.001). Conclusion: Using anatomically correct contouring methodology, we provide accurate sex and age-specific normal reference values for CMR parameters derived from the largest, multi-ethnic population free of CVD to date. Clinical trial registration: ClinicalTrials.gov, NCT02220582. Registered 20 August 2014—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02220582. [ABSTRACT FROM AUTHOR]

To examine the real-world safety of adding bevacizumab to first-line irinotecan-based chemotherapy for patients with metastatic colorectal cancer (mCRC). Patients diagnosed with CRC in three Canadian provinces (Ontario, Saskatchewan and British Columbia) who received publicly funded bevacizumab and/or irinotecan from 2000 to 2016 were identified from cancer registries. Propensity score 1:1 matching (PSM) and inverse probability of treatment weighting (IPTW) were performed to contemporaneous and historical controls, adjusting for baseline demographic and clinical characteristics. Safety end points evaluated during first-line treatment plus 30 days included mortality within 30 days and all-cause-, chemotherapy- and bevacizumab-related hospitalisations. Chemotherapy- and bevacizumab-related visits were defined as hospitalisations for specific conditions commonly associated with chemotherapy (e.g. infections) or bevacizumab (e.g. arteriovenous thromboembolism) using most responsible diagnosis codes. In PSM and IPTW-weighted cohorts, we assessed event frequencies using odds ratios from logistic regressions and event rate ratios using negative binomial regression models. The results from each province and comparison were pooled using random-effects meta-analysis. We identified 16 250 mCRC patients who received first-line irinotecan-based treatment. In PSM cohorts, bevacizumab was associated with fewer deaths within 30 days of treatment compared with contemporaneous (pooled odds ratio = 0.62; 95% confidence interval 0.50–0.75) and historical controls (pooled odds ratio = 0.73; 95% confidence interval 0.58–0.93). Hospitalisations were more frequent among patients treated with bevacizumab compared with historical controls but similar to contemporaneous controls. As patients receiving bevacizumab were exposed to a longer average treatment duration, across their full treatment duration, patients receiving bevacizumab had significantly lower rates of hospitalisations (contemporaneous pooled rate ratio = 0.56; 95% confidence interval 0.47–0.67; historical pooled rate ratio = 0.73; 95% confidence interval 0.56–0.95). Similar trends were observed for chemotherapy- and bevacizumab-related hospitalisations and in IPTW-weighted cohorts. We did not observe any increase in rates of hospitalisation or death within 30 days of treatment among mCRC patients treated with bevacizumab plus chemotherapy versus chemotherapy alone; these findings should be interpreted with caution due to the risk of residual confounding. • Bevacizumab with chemotherapy to treat metastatic colorectal cancer increased hospital visits during treatment compared with chemotherapy alone. • Patients receiving bevacizumab experienced lower rate of hospitalisation over longer treatment duration than chemotherapy alone. • No observed increase in deaths within 30 days of treatment suggests bevacizumab toxicity to be manageable in the real world. • Comparative real-world safety evaluation with population-based administrative data enables valuable ongoing pharmacovigilance. [ABSTRACT FROM AUTHOR]

Background Concerns regarding the adequacy of vegetarian diets with respect to fracture risk continue. Objectives We aimed to explore the influence of 5 previously defined dietary patterns on hip fracture risk and whether this association is modified by concomitant calcium and vitamin D supplementation. Methods The Adventist Health Study 2 is a prospective cohort study in which participants were enrolled during 2002–2007; proportional hazards regression analyses were used to estimate fracture risk. Participants reside throughout the United States and Canada. A total of 34,542 non-Hispanic white peri- and postmenopausal women and men 45 y and older responded to the biennial hospital history form and were followed for a median of 8.4 y. Results The study identified 679 incident hip fractures during 249,186 person-years of follow-up. Fracture risk varied according to dietary pattern, with a clear effect modification by concurrent supplementation with both vitamin D and calcium. In multivariable models, including adjustment for calcium and vitamin D supplementation, female vegans had 55% higher risk of hip fracture (HR: 1.55; 95% CI: 1.06, 2.26) than nonvegetarians (NVEGs), whereas there was no association between diet pattern and hip fracture risk in men. When further stratifying females on supplement use with both vitamin D and calcium, vegans taking both supplements were at no greater risk of hip fracture than the subjects with other dietary patterns including the NVEGs. Conclusions Without combined supplementation of both vitamin D and calcium, female vegans are at high risk of hip fracture. However, with supplementation the excessive risk associated with vegans disappeared. Further research is needed to confirm the adequacy of a vegan diet supplemented with calcium and vitamin D with respect to risk of fracture. [ABSTRACT FROM AUTHOR]

To explore if older adults with osteosarcopenia are at a greater risk of falls, fractures, frailty, and worsening life satisfaction and activities of daily living (ADL) compared to those with normal bone mineral density (BMD) and without sarcopenia. The baseline and 3-year follow-up of a longitudinal study. Community-dwelling people aged 65 years or older in Canada. Caucasian participants 65 years or older that completed the Canadian Longitudinal Study on Aging (CLSA) 2015 baseline interview, physical measurements and 3-year follow-up were included. Osteopenia/osteoporosis was defined as BMD T score below −1 SD according to the World Health Organization, and sarcopenia was defined as low grip strength and/or low gait speed according to the Sarcopenia Definition Outcomes Consortium. Osteosarcopenia was defined as the coexistence of osteopenia/osteoporosis and sarcopenia. Self-reported incident falls and fractures in the last 12 months before the 3-year follow-up were measured. Frailty was assessed through the Rockwood Frailty Index (FI); life satisfaction through the Satisfaction With Life Scale (SWLS); and ADL through the Older American Resources and Services modules. Multivariable logistic and linear regression, including subgroup analyses by sex, were conducted. The sample of 8888 participants (49.1% females) had a mean age (SD) of 72.7 (5.6) years. At baseline, neither osteopenia/osteoporosis nor sarcopenia (reference group) was present in 30.1%, sarcopenia only in 18.4%, osteopenia/osteoporosis only in 29.2%, and osteosarcopenia in 22.3%. Osteosarcopenia was significantly associated with incident falls and fractures in males [adjusted odds ratio (aOR), 1.90, 95% CI 1.15, 3.14, and aOR 2.60, 95% CI 1.14, 5.91, respectively] compared to males without osteopenia/osteoporosis or sarcopenia. Participants with osteosarcopenia had worsening ADL of 0.110 (estimated β coefficient 0.110, 95% CI 0.029, 0.192) and a decrease in their SWLS by 0.660 (estimated β coefficient −0.660, 95% CI −1.133, −0.187), compared to those without. Osteosarcopenia was not associated with frailty for both males and females. Osteosarcopenia was associated with self-reported incident falls and fractures in males and worse life satisfaction and ADL for all participants. Assessing and identifying osteosarcopenia is essential for preventing falls and fractures. Furthermore, it improves life satisfaction and ADL. [ABSTRACT FROM AUTHOR]

To evaluate the impact of a multicenter intervention to reduce potentially inappropriate antipsychotic use in Canadian nursing homes at the individual and facility levels. Longitudinal, population-based cohort study to evaluate the Canadian Foundation for Healthcare Improvement's Spreading Healthcare Innovations Initiative to reduce potentially inappropriate antipsychotic use in 6 provinces/territories. Adults in nursing homes in 6 provinces/territories in Canada between 2014 and 2016. The sample involved 4927 residents in 45 intervention homes and 122,570 residents in 1193 control homes in the first quarter of the study. Assessment data based on the Resident Assessment Instrument 2.0 were used in both settings to track antipsychotic use and to obtain risk-adjusters for a quality indicator on potentially inappropriate use. Quality improvement teams in participating organizations were provided with education, training, and support to implement localized strategies intended to reduce antipsychotic medication use in residents without diagnosis of psychosis. At the resident level, we found that the odds of remaining on potentially inappropriate antipsychotics were 0.75 in intervention compared with control homes after adjusting for age, sex, aggressive behavior, and cognition. These findings were evident within the pooled Canadian data as well as within provinces. At the facility level, the intervention homes had greater improvements in risk-adjusted quality indicator performance than the control homes, and this was true for the worst, median, and best-performing homes at baseline. There was no major change in the quality indicator for worsening of behavior symptoms. The Canadian Foundation for Healthcare Improvement intervention was associated with a reduction in potentially inappropriate antipsychotic use at both the individual and facility levels of analysis. This improvement in performance was independent of secular trends toward reduced antipsychotic use in participating provinces. This suggests that substantial improvements in medication use may be achieved through targeted, collaborative quality improvement initiatives in long-term care. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Antipsychotic medications are often used for the first-line management of behavioral and psychological symptoms of dementia (BPSD) contrary to guideline recommendations. The Optimizing Practices, Use, Care and Services–Antipsychotics (OPUS-AP) strategy aims to improve the well-being of long-term care (LTC) residents with major neurocognitive disorder (MNCD) by implementing a resident-centered approach, nonpharmacologic interventions, and antipsychotic deprescribing in inappropriate indications. Prospective, closed cohort supplemented by a developmental evaluation. Residents of designated wards in 24 LTC centers in Québec, Canada. Provincial guidelines were disseminated, followed by the implementation of an integrated knowledge translation and mobilization strategy, including training, coaching, clinical tools, evaluation of clinical practices, and a change management strategy. Antipsychotic, benzodiazepine, and antidepressant prescriptions; BPSD; and falls were evaluated every 3 months, for 9 months, from January to October 2018. Semistructured interviews (n = 20) were conducted with LTC teams to evaluate the implementation of OPUS-AP. Of 1054 residents, 78.3% had an MNCD diagnosis and 51.7% an antipsychotic prescription. The cohort included 464 residents with both MNCD and antipsychotic prescription. Antipsychotic deprescribing (cessation or dose decrease) was attempted in 220 of the 344 residents still admitted at 9 months. Complete cessation was observed in 116 of these residents (52.7%) and dose reduction in 72 (32.7%), for a total of 188 residents (85.5%; 95% confidence interval: 80.1%, 89.8%). A decrease in benzodiazepine prescriptions and improvements in Cohen-Mansfield Agitation Inventory scores were observed among residents who had their antipsychotics deprescribed. Caregivers and clinicians expressed satisfaction as a result of observing an improved quality of life among residents. Antipsychotic deprescribing was successful in a vast majority of LTC residents with MNCD without worsening of BPSD. Based on this success, phase 2 of OPUS-AP is now under way in 129 LTC centers in Québec. [ABSTRACT FROM AUTHOR]

Patients aged 70 years and older may be suboptimally treated with cancer therapy because of the lack of clinical trial data in this population. The Comprehensive Geriatric Assessment can be time consuming, and access to geriatricians is limited. This study aims to determine whether gait speed (GS) analysis is equivalent to the widely accepted Vulnerable Elders Survey 13 (VES-13) in identifying vulnerable or frail patients in need of a Comprehensive Geriatric Assessment. A pilot prospective cohort study was carried out at a tertiary cancer centre in Toronto, Canada, in a radiation oncology breast follow-up clinic. GS analysis and VES-13 were completed by each patient at the same clinic visit. GS of <1 meter/second (m/s) and VES-13 score ≥3 were considered abnormal. Sensitivity, specificity, positive and negative predictive values, and Kappa characteristic were calculated for GS compared with VES-13. Twenty-nine participants aged 70 years and older with any stage of breast cancer were included. The GS was 67% sensitive and 95% specific for abnormal VES-13 scores. The GS had an 86% positive predictive value and 86% negative predictive value for abnormal scores on VES-13. Overall, the GS showed a substantial strength of agreement with the VES-13 (kappa 0.66, P <.0001). The GS analysis compared very well with VES-13 scores, and this may be a reasonable alternative to VES-13 screening. This pilot data warrant further study in a larger group of patients. [ABSTRACT FROM AUTHOR]

To assess (1) temporal changes (2008–2015) in nursing home (NH) length of stay (LoS) in 3 Canadian health jurisdictions (Edmonton, Calgary, Winnipeg), (2) resident admission characteristics associated with LoS, and (3) temporal changes of admission characteristics in each of the 3 jurisdictions. Retrospective cohort study using data previously collected in Translating Research in Elder Care (TREC), a longitudinal program of applied health services research in Canadian NHs. 7817 residents admitted between January 2008 and December 2015 to a stable cohort of 18 NHs that have consistently participated in TREC since 2007. LoS was defined as time between a resident's first NH admission and final discharge from the NH sector. Analyses included descriptive statistics, Kaplan Meier estimates (unadjusted LoS), and Cox proportional hazard regressions (adjusted LoS), adjusted for resident characteristics (eg, age, cognitive performance, and health instability). We also controlled for NH size and ownership. In jurisdictions with increasing care needs, unadjusted median LoS [95% confidence interval (CI)] decreased over time (2008 and 2009 vs 2014 and 2015 admissions); in Calgary from 1.837 (95% CI 1.618, 2.275) to 1.328 (95% CI 1.185, 1.489) years and in Edmonton from 1.927 (95% CI 1.725, 2.188) to 1.073 (95% CI 0.936, 1.248) years. In Winnipeg, care needs and LoS remained constant (2.163, 95% CI 1.867, 2.494, vs 2.459, 95% CI 2.155, 2.883, years). Resident characteristics including higher physical dependency [hazard ratio (HR) 1.205, 95% CI 1.133, 1.282], higher cognitive impairment (HR 1.112, 95% CI 1.042, 1.187), or higher health instability (HR 1.333, 95% CI 1.224, 1.452) were associated with lower LoS. Adjustment for resident characteristics reduced jurisdictional LoS differences and rendered temporal LoS differences within jurisdictions statistically nonsignificant. In jurisdictions where care needs at admission have increased since 2008, resident LoS has decreased. Jurisdictional differences in care needs and LoS indicate that health policies may affect these outcomes. Variations of resident outcomes by policy environment require additional scrutiny. [ABSTRACT FROM AUTHOR]

Abstract Study Design A prospective cohort study. Introduction Physical factors that predict hand dexterity and the recovery of hand dexterity after a distal radius fracture (DRF) have not yet been examined. Purpose of the Study The first objective was to evaluate the recovery of hand dexterity comparing the injured and uninjured hands during the year after a DRF. The second objective was to determine the effect of age and sex on hand dexterity of the injured hand. Methods Hand dexterity was examined bilaterally for the manipulation of 3 different sized objects (small, medium, and large) using the NK hand dexterity test. The measurements took place at 3, 6, and 12 months after DRF. Generalized linear modeling was performed, with age and sex as covariates, to assess changes over time, and between sides. Results Overall, 242 patients with DRF (45 males and 197 females) with a mean age of 60.2 years with SD of 11.26, participated in the study. Statistical differences in hand dexterity were found between the injured and uninjured hands across all time intervals (P <.001). The effect size for the deficit between the injured and uninjured hands decreased across the time intervals and ranged from 0.19 to 0.38 for large objects, from 0.17 to 0.25 for medium objects, and from 0.11 to 0.32 for small objects. For each 1-year increase in age, hand dexterity scores were 0.3-0.4 seconds slower. Sex had much less effect, with annual increases of 0.1 seconds in hand dexterity scores. Conclusions Scores on the NK dexterity test improved between 3 and 6 months and then worsened between 6 and 12 months; at no point did dexterity equal the uninjured side. Greater attention to measuring and treating dexterity may be needed to provide a complete recovery after DRF. Scores will be affected by age and sex. Level of Evidence Prognosis, 2a. [ABSTRACT FROM AUTHOR]

Abstract Study Design Descriptive/Longitudinal cohort. Introduction Distal radius fracture (DRF) is a common fall related fragility fracture that is known to be an early and independent predictor of secondary osteoporotic (OP) fractures. Changes in falls risk status, bone status and general health has not been evaluated prospectively in a population that has sustained a DRF. Purpose of the Study The purpose of our study was to describe the status of fracture-specific pain/disability, fall risk factors such as physical activity (PA) and fear of falling (FOF), bone mineral density (BMD) and general health status (HS) in people with a DRF and how these variables change over four years with respect to sex, age, incidence of secondary falls and secondary OP fractures. Methods Patients (n = 94) self-reported their fracture-specific pain and disability (Patient-Rated Wrist Evaluation), PA (Rapid Assessment of Physical Activity), FOF (Modified Fall Efficacy Scale), HS (12-item Short Form Health Survey) and completed dual-energy X-ray absorptiometry scan based BMD assessment (lumbar spine and total hip) at baseline (1-2 weeks post-fracture), six months and four years after DRF. Descriptive statistics and general linear models were used to describe changes in recovery patterns over four years. Results There was significant (p<0.001) improvement in fracture-specific pain/disability (60 points), FOF (1 point) and physical HS (11 points) between baseline and 4 year follow-up. There were no significant changes in PA and BMD. When stratified with respect to age, sex, presence of subsequent falls and OP fractures, there were no significant differences in fracture-specific pain/disability, PA, FOF, and BMD at baseline, six months or four years after DRF. The physical HS was significantly (p<0.05) less/poorer among those with secondary falls (lower by 2-6 points) and fractures (lower by 5-6 points) compared to those without. Similarly, mental HS was significantly (p<0.05) poorer among people with secondary falls (lower by 2-6 points) and in 50-64 year age group (lower by 3-5 points) than those without secondary falls and in 65-80 year age group, respectively. Conclusion Post DRF, the majority of the improvement in fracture-specific pain/disability, FOF and HS was completed at six months and very small changes were observed between the six month and four year follow-up. Level of Evidence NA. [ABSTRACT FROM AUTHOR]

• Material deprivation and lesbian identity showed a significant impact on depression. • Material deprivation and bisexuality showed a significant impact on depression in men. • Social deprivation did not show any significant influence on depression in sexual minority adults. As the aging population grows across the world, exploring the impact of social environment on minority populations' aging and well-being would be an essential step towards building an inclusive society. Using the Canadian Longitudinal Study on Aging (CLSA) and Canadian Urban Environmental Health Research Consortium (CANUE) data, the study investigated the relationship between deprivation and depression level in aging sexual minority people to examine how neighborhood level social and material deprivation influence mental health. 48,792 survey respondents were included in our analyses and the average age was 62.9. The study had 47,792 heterosexual, 760 gay/lesbian, and 240 bisexual individuals (23,977 men and 24,815 women). Regression analyses were conducted while controlling for age in each model. Results revealed that neighborhood material deprivation has a significant impact on mental health outcomes of aging lesbian women and bisexual men. The study provides an opportunity for intervention considerations for materially deprived neighborhoods to serve the aging sexual minority people residing in such areas. [ABSTRACT FROM AUTHOR]

• After COVID-19, enrolment in MOUD increased immediately followed by a gradual decline. • The impact of COVID-19 policies on enrolment in individual MOUD was mixed. • RMG practices may have contributed to support retention in MOUD. In anticipation of COVID-19 related disruptions to opioid use disorder (OUD) care, new provincial and federal guidance for the management of OUD and risk mitigation guidance (RMG) for prescription of pharmaceutical opioids were introduced in British Columbia, Canada, in March 2020. This study evaluated the combined impacts of the COVID-19 pandemic and counteracting OUD policies on enrollment in medications for OUD (MOUD). Using data from three cohorts of people with presumed OUD in Vancouver, we conducted an interrupted time series analysis to estimate the combined effects impact of the COVID-19 pandemic and counteracting OUD policies on the prevalence of enrollment in MOUD overall, as well as in individual MOUDs (methadone, buprenorphine/naloxone, slow-release oral morphine) between November 2018 and November 2021, controlling for pre-existing trends. In sub-analysis we considered RMG opioids together with MOUD. We included 760 participants with presumed OUD. In the post-COVID-19 period, MOUD and slow-release oral morphine prevalence rates showed an estimated immediate increase in level (+7.6%, 95% CI: 0.6%, 14.6% and 1.8%, 95% CI: 0.3%, 3.3%, respectively), followed by a decline in the monthly trend (-0.8% per month, 95% CI: −1.4%, −0.2% and −0.2% per month, 95% CI: −0.4, −0.1, respectively). There were no significant changes in the prevalence trends of enrollment in methadone, buprenorphine/naloxone, or when RMG opioids were considered together with MOUD. Despite immediate improvements in MOUD enrollment in the post-COVID-19 period, this beneficial trend reversed over time. RMG opioids appeared to have provided additional benefits to sustain retention in OUD care. [ABSTRACT FROM AUTHOR]

Unregulated stimulant use is rising globally, though trends in use of cocaine and crystal methamphetamine (CM), the two most commonly used unregulated stimulants in North America, are poorly characterized in many settings. In this study we examined patterns and associations between the injection of cocaine and CM over time in an urban Canadian setting. The study collected data from two prospective cohorts of people who inject drugs in Vancouver, Canada, between 2008 and 2018. We applied a time series analysis, using multivariable linear regression to detect relationships between reported CM and cocaine injection and year, controlling for covariates. The study used cross-correlation to evaluate the relative trajectories of each substance over time. Among 2056 participants, per annum rates of reported injection cocaine use declined significantly over the duration of this study from 45 % to 18 % (p < 0.001), while rates of CM injection increased from 17 % to 32 % (p < 0.001). Multivariable linear regression showed that recent CM injection was negatively associated with recent cocaine injection (β = −0.609, 95 % CI = −0.750, −0.467). Cross-correlation demonstrated that injection CM use was associated with a decrease in the likelihood of cocaine injection 12 months later (p = 0.002). These findings demonstrate an epidemiological shift in patterns of injection stimulant use, with rising CM injection associated with a corresponding decrease in cocaine injection over time. Strategies are urgently needed that help to treat and reduce harm among the growing population of people who inject CM. • Changes in injection stimulant use were compared in Vancouver between 2008 and 2018. • Injection cocaine use decreased while injection CM use increased over that time. • Rising CM injection rates were associated with decreasing cocaine injection rates. • No significant changes in overall rates of injection stimulant use were detected. [ABSTRACT FROM AUTHOR]

Patient satisfaction is key to the success of methadone maintenance treatment (MMT), and yet how MMT satisfaction is affected by the increasingly common use of crystal methamphetamine among people receiving opioid treatment remains poorly understood. We aimed to assess the association between crystal methamphetamine use and MMT dissatisfaction. We employed generalized estimating equations to examine the relationship between crystal methamphetamine use and MMT dissatisfaction among patients receiving MMT within two prospective cohorts in Vancouver, Canada, between December 2016 and March 2020. Of the 836 participants receiving MMT, the median age was 47 years, and 55.3 % self-identified as male at baseline. In a multivariable model, those reporting more than weekly crystal methamphetamine use were more likely to report MMT dissatisfaction (Odds ratio: 1.40, 95 % confidence interval: 1.05–1.86) compared to those reporting less than monthly crystal methamphetamine use. Among our sample of people receiving MMT, we noted a positive association of frequent crystal methamphetamine use with MMT dissatisfaction. Our study suggests a need for novel strategies to better understand and address frequent methamphetamine use among those receiving MMT, particularly given recent shifts in substance use patterns involving the rising co-use of methamphetamines and opioids. • The increasing crystal meth use poses challenges for methadone maintenance treatment. • Frequent crystal meth use is associated with increased methadone dissatisfaction. • Improved care options are needed for patients engaging in frequent crystal meth use. [ABSTRACT FROM AUTHOR]

Limited research examines buprenorphine-naloxone interest among adolescents and young adults (AYA). This longitudinal study examined factors associated with initial buprenorphine-naloxone interest and the time to a positive change in buprenorphine-naloxone interest or enrollment, in addition to identifying reasons for buprenorphine-naloxone disinterest. The study derived data from a cohort of street-involved AYA in Vancouver, Canada between December 2014 and June 2018. The analysis was restricted to AYA who reported weekly or daily illicit opioid use in the last six months but had not initiated buprenorphine-naloxone. The study examined factors associated with initial buprenorphine-naloxone interest using multivariable logistic regression, while multivariable Cox regression identified factors associated with the time to a positive change in buprenorphine-naloxone interest or actual enrollment over follow-up among AYA initially disinterested in buprenorphine-naloxone. Of 281 participants who reported weekly illicit opioid use but were not on buprenorphine-naloxone, 52 (18.5 %) AYA reported initial buprenorphine-naloxone interest, while 68 (24.2 %) AYA who were initially disinterested in buprenorphine-naloxone reported interest or enrollment over follow-up. In multivariable logistic regression, initial interest was positively associated with older age (Adjusted Odds Ratio [AOR] = 1.09, 95 % Confidence Interval [CI]: 1.03–1.15), but negatively associated with self-reported Indigenous identity (AOR = 0.22, 95 % CI: 0.07–0.68). In multivariable Cox regression, recent detoxification program access (Adjusted Hazard Ratio [AHR] = 0.85, 95 % CI: 0.73–0.98) was positively associated with the time to a positive change in buprenorphine-naloxone interest or enrollment. Common reasons for buprenorphine-naloxone disinterest included not wanting opioid agonist treatments (OAT) (initial n = 67, follow-up n = 105); not wanting to experience precipitated withdrawal (initial n = 42, follow-up n = 54), being satisfied with or preferring other OAT (initial n = 33, follow-up n = 52), not knowing what buprenorphine-naloxone is (initial n = 27, follow-up n = 9), previous negative treatment experiences (initial n = 19, follow-up n = 20), and wanting to continue opioid use (initial n = 13, follow-up n = 9), among others. We documented persistent disinterest in buprenorphine-naloxone among AYA, though participants' reasons for disinterest provide insight into the potential benefits of expanding micro-dosing induction; ensuring treatment is culturally safe; and communicating changes in buprenorphine-naloxone programming to AYA. Nevertheless, a need remains to improve the continuum of harm reduction and treatment supports for AYA. • Young people reported low interest in buprenorphine-naloxone (BUP-NAL). • Race-based factors were negatively associated with initial BUP-NAL interest. • Recent detoxification was positively associated with BUP-NAL interest or enrolment over follow-up. • A continuum of harm reduction and treatment supports for young people is needed. [ABSTRACT FROM AUTHOR]

Background: Folate requirements increase during pregnancy and lactation. It is recommended that women who could become pregnant, are pregnant, or are lactating consume a folic acid (FA)-containing supplement. Objectives: We sought to determine breast-milk total folate and unmetabolized folic acid (UMFA) contents and their relation with FA-supplement use and doses in a cohort of Canadian mothers who were enrolled in the MIREC (Maternal-Infant Research on Environmental Chemicals) study. Design: Breast-milk tetrahydrofolate (THF), 5-methyl-THF, 5-formyl-THF, 5,10-methenyl-THF, and UMFA were measured with the use of liquid chromatography-tandem mass spectrometry (n = 561). Total daily supplemental FA intake was based on self-reported FA-supplement use. Results: UMFA was detectable in the milk of 96.1% of the women. Total daily FA intake from supplements was associated with breast folate concentration and species. Breast-milk total folate was 18% higher (P < 0.001) in supplement users (n = 401) than in nonusers (n = 160), a difference driven by women consuming >400 μg FA/d (P ≤ 0.004). 5-Methyl-THF was 19% lower (P < 0.001) and UMFA was 126% higher (P < 0.001) in supplement users than in nonusers. Women who consumed >400 μg FA/d had proportionally lower 5-methyl-THF and higher UMFA than did women who consumed ≤400 μg FA/d. Conclusions: FA-supplement use was associated with modestly higher breast-milk total folate. Detectable breast-milk UMFA was nearly ubiquitous, including in women who did not consume an FA supplement. Breast-milk UMFA was proportionally higher than 5-methyl-THF in women who consumed >400 μg FA/d, thereby suggesting that higher doses exceed the physiologic capacity to metabolize FA and result in the preferential uptake of FA in breast milk. Therefore, FA-supplement doses >400 μg may not be warranted, especially in populations for whom FA fortification is mandatory. [ABSTRACT FROM AUTHOR]

Background: The assessment of polyphenol intake in free-living subjects is challenging, mostly because of the difficulty in accurately measuring phenolic content and the wide presence of phenolics in foods. Objective: The aims of this study were to evaluate the validity of polyphenol intake estimated from food-frequency questionnaires (FFQs) by using the mean of 6 measurements of a 24-h dietary recall (24-HR) as a reference and to apply a unique method-of-triads approach to assess validity coefficients (VCs) between latent "true" dietary estimates, total urinary polyphenol (TUP) excretion, and a surrogate biomarker (plasma carotenoids). Design: Dietary intake data from 899 adults of the Adventist Health Study 2 (AHS-2; 43% blacks and 67% women) were obtained. Pearson correlation coefficients (r), corrected for attenuation from within-person variation in the recalls, were calculated between 24-HRs and FFQs and between 24-HRs and TUPs. VCs and 95% CIs between true intake and polyphenol intakes from FFQs, 24-HRs, and the biomarkers TUPs and plasma carotenoids were calculated. Results: Mean ± SD polyphenol intakes were 717 ± 646 mg/d from FFQs and 402 ± 345 mg/d from 24-HRs. The total polyphenol intake from 24-HRs was correlated with FFQs in crude (r = 0.51, P < 0.001) and deattenuated (r = 0.63; 95% CI: 0.61, 0.69) models. In the triad model, the VC between the FFQs and theoretical true intake was 0.46 (95% CI: 0.20, 0.93) and between 24-HRs and true intake was 0.61 (95% CI: 0.38, 1.00). Conclusions: The AHS-2 FFQ is a reasonable indicator of total polyphenol intake in the AHS-2 cohort. Urinary polyphenol excretion is limited by genetic variance, metabolism, and bioavailability and should be used in addition to rather than as a replacement for dietary intake assessment. [ABSTRACT FROM AUTHOR]

Many adolescents face pressure when it comes to securing social media attention in the form of views, comments and/or likes on their posted content. The purpose of this study was to examine how this pressure impacts adolescents' current relationships with friends in addition to their mental health over time. Participants were Canadian adolescents (Time 1 n = 345; M age = 17.29; 80.6% female) who reported on their felt pressure to gain social media attention, friendship closeness and internalizing symptoms in 3 surveys approximately 4 months apart (from August 2020 to June 2021). We used latent curve modeling with structured residuals (LCM-SR) to model the lagged relations between the aforementioned variables, while also controlling for time spent on social media and number of likes received. LCM-SR builds on multivariate latent curve modeling and autoregressive latent trajectory and allows for the simultaneous testing of between- and within-person stability and change over time. In line with our first hypothesis, results demonstrated that at time points when adolescents experienced more pressure to gain social media attention than usual, their friendship closeness decreased at the next time point. Social media pressure was not a significant predictor of internalizing symptoms, however. Results emphasize the importance of teasing apart within- and between-person effects when examining impacts of adolescent social media use. They also highlight the importance of targeting felt pressures to gain social media attention in order to support healthy adolescent relationships. • Across 3 time points, between 43.6% and 54.2% of adolescents felt pressure to gain social media attention. • Increased social media pressure predicted within-person decreases in friendship closeness at the next time point. • Increased social media pressure did not predict changes in internalizing symptoms. • To support healthy adolescent relationships, it is important to target felt pressure to gain social media attention. [ABSTRACT FROM AUTHOR]

This study aimed to assess the longitudinal predictions between glycated hemoglobin A1c (HbA1c) and physical performance scores in different epidemiological contexts of aging. Material and Methods: Longitudinal data of 1,337 older people from three countries (Canada, Brazil and Colombia) of the International Mobility in Aging Study (IMIAS) were used to assess the relationship between HbA1c and Short Physical Performance Battery (SPPB) scores between 2012 and 2016. Linear Mixed Models grouped by sex and adjusted by Age, Study site, Chronic Conditions, Anthropometric Measures, and Inflammatory Level were used to estimate the influence of HbA1c and covariates on SPPB scores. At the IMIAS baseline, Latin American (LA) cities had higher HbA1c averages compared to Canadian cities, with Natal (Brazil) being the city with the highest HbA1c averages in men and women (6.32 ± 1.49; 6,56 ± 1.70 respectively). SPPB scores were significantly lower in LA cities, and older people in Natal had lower SPPB averages in men (9.67 ± 2.38; p-value < 0.05) and women (8.52 ± 2.33; p-value <0.05). In the multivariate mixed linear models of longitudinal analyses, HbA1c was significantly associated with lower SPPB scores in men (β = -0.25, 95% CI: -0.39 to -0.12, p-value = 0.02) but not in women. High HbA1c levels at baseline were longitudinally associated in older adults from different countries, and this association was observed only in men and not in women. This study highlights a possible influence of gender on this relationship. [ABSTRACT FROM AUTHOR]

Background: Crystal methamphetamine use has substantially increased among people who use opioids in recent years, yet the impact of opioid agonist therapy (OAT) on crystal methamphetamine use remains poorly characterized. Therefore, we sought to examine the relationship between OAT engagement and crystal methamphetamine use and to assess if this relationship differs according to the ongoing use of unregulated opioids.Methods: Data was collected from two harmonized ongoing prospective cohorts of people who use drugs in Vancouver, Canada, between December 2005 and March 2020. We employed multivariable generalized estimating equations to study the relationship between OAT engagement and crystal meth use stratified by ongoing unregulated opioid use.Results: Of 1742 participants who reported frequent opioid use at baseline, the median age was 42 years, and 61.3% were male. Multivariable analyses showed that compared to those who had not received OAT for at least one year: in the absence of ongoing unregulated opioid use, individuals who recently discontinued (adjusted Odds Ratio [aOR] = 0.47, 95% CI = 0.27-0.79), newly initiated (aOR = 0.52, 95% CI = 0.31-0.89), or were retained on OAT (aOR = 0.48, 95% CI = 0.31-0.72) reported a lower frequency of crystal methamphetamine use; in the presence of ongoing unregulated opioid use, individuals who newly initiated OAT reported a greater crystal methamphetamine use frequency (aOR = 1.24, 95% CI = 1.02-1.51).Conclusions: We demonstrated a differential relationship between OAT engagement and crystal methamphetamine use that was conditional on the ongoing use of unregulated opioids. Our findings highlight the complexity of OAT implementation and suggest that polysubstance use patterns should be an important consideration for care providers when devising comprehensive treatment strategies and prognosticating treatment effects. [ABSTRACT FROM AUTHOR]

A growing body of research has documented a well-established link between socioeconomic conditions and mortality among older adults. This study aims to understand (a) whether housing assets and income are associated with mortality and (b) if the value of housing assets affects the relationship between income and mortality; both questions are studied among older adults aged 65 or over in Canada. Using the population-based linked dataset (2011 Canadian Census Health and Environment Cohorts) of 881,220 older adults over six years of follow-up (2011–2017), this study uses survival analysis to estimate the link between housing assets, income level and mortality. We also assess the potential moderating effect of housing asset levels on the association between income and mortality by categorizing individuals along two dimensions: whether they are income-poor and whether they are housing assets-poor. The mortality rate was higher among both the lowest asset (HR = 1.346) and the lowest income group (HR = 1.203). The association is pronounced for older adults aged 65 to 74. Assets did not significantly moderate the link between income and mortality. Income-related inequalities in mortality are observed among each group of housing asset level. Compared to those who are neither income-poor nor housing assets-poor, individuals who were income poor but not housing assets-poor were more likely to die (HR = 1.067) over seven years of follow-up, and people who were housing assets-poor only were more likely to die (HR = 1.210). Being housing-assets poor and income-poor yielded a higher hazard ratio (HR = 1.291). Housing assets and income are associated with mortality of older adults. It is important to identify people who are assets poor and/or income poor who are at higher risks of mortality. Social policies aimed at reducing income insecurity and housing insecurity can reduce mortality inequalities. • The levels of housing assets and income predicted mortality risks of older adults. • The observed association was manifest in older adults aged 65 to 74. • Housing assets did not moderate the association between income and mortality. • Housing asset poor and income poor were the most vulnerable to mortality risks. [ABSTRACT FROM AUTHOR]

Objective Although death or readmission shortly after hospital discharge is frequent, identifying inpatients at higher risk is difficult. We evaluated whether in-hospital depressive symptoms (hereafter “depression”) are associated with short-term readmission or mortality after discharge from medical wards. Methods Depression was assessed at discharge in a prospective inpatient cohort from 2 Canadian hospitals (7 medical wards) and defined as scores ≥ 11 on the 27-point Patient Health Questionnaire (PHQ-9). Primary outcome was all-cause readmission or mortality 90 days postdischarge. Results Of 495 medical patients [median age 64 years, 51% women, top 3 admitting diagnoses heart failure (10%), pneumonia (10%) and chronic obstructive pulmonary disease (8%)], 127 (26%) screened positive for depression at discharge. Compared with nondepressed patients, those with depression were more frequently readmitted or died: 27/127 (21%) vs. 58/368 (16%) within 30 days and 46 (36%) vs. 91 (25%) within 90 days [adjusted odds ratio (aOR) 2.00, 95% confidence interval 1.25–3.17, P = .004, adjusted for age, sex and readmission/death prediction scores]. History of depression did not predict 90-day events (aOR 1.05, 95% CI 0.64–1.72, P =.84). Depression persisted in 40% of patients at 30 days and 17% at 90 days. Conclusions Depression was common, underrecognized and often persisted postdischarge. Current symptoms of depression, but not history, identified greater risk of short-term events independent of current risk prediction rules. [ABSTRACT FROM AUTHOR]

Background: According to the American Cancer Society, prostate cancer accounts for ~27% of all incident cancer cases among men and is the second most common (noncutaneous) cancer among men. The relation between diet and prostate cancer is still unclear. Because people do not consume individual foods but rather foods in combination, the assessment of dietary patterns may offer valuable information when determining associations between diet and prostate cancer risk. Objective: This study aimed to examine the association between dietary patterns (nonvegetarian, lacto-ovo-vegetarian, pesco-vegetarian, vegan, and semi-vegetarian) and prostate cancer incidence among 26,346 male participants of the Adventist Health Study-2. Design: In this prospective cohort study, cancer cases were identified by matching to cancer registries. Cox proportional hazards regression analysis was performed to estimate HRs by using age as the time variable. Results: In total, 1079 incident prostate cancer cases were identified. Around 8% of the study population reported adherence to the vegan diet. Vegan diets showed a statistically significant protective association with prostate cancer risk (HR: 0.65; 95% CI: 0.49, 0.85). After stratifying by race, the statistically significant association with a vegan diet remained only for the whites (HR: 0.63; 95% CI: 0.46, 0.86), but the multivariate HR for black vegans showed a similar but nonsignificant point estimate (HR: 0.69; 95% CI: 0.41, 1.18). Conclusion: Vegan diets may confer a lower risk of prostate cancer. This lower estimated risk is seen in both white and black vegan subjects, although in the latter, the CI is wider and includes the null. [ABSTRACT FROM AUTHOR]

Background: Vitamin D is fundamental for bone health. A high proportion of Canadian 2- to 8-y-olds do not meet the Estimated Average Requirement (EAR) of 400 IU/d. Objective: The objective was to determine whether vitamin D intakes consistent with the EAR or Recommended Dietary Allowance (RDA), through fortification of additional dairy products, would result in higher vitamin D status in young children. Design: Participants aged 2-8 y (n = 77; Montreal, Canada) were randomly assigned to 1 of 3 dietary vitamin D targets (control; EAR: 400 IU/d; or RDA: 600 IU/d) for 12 wk (January to April 2014). Anthropometric measurements, demographic characteristics, dietary intakes, fasting serum parathyroid hormone, 25-hydroxyvitamin D [25(OH)D], and ionized calcium were compared by using mixed-model ANOVA. Results: Participants' mean ± SD age was 5.1 ± 1.9 y; 54.5% were boys with body mass index z scores of 0.50 ± 0.85. Compliance was 85% overall. No differences were observed in baseline dietary vitamin D intakes or serum 25(OH)D. At 12 wk, the EAR and RDA groups had significantly higher vitamin D intakes [median (IQR): control, 227 (184-305) IU/d; EAR, 410 (363-516) IU/d; and RDA, 554 (493-653) IU/d; P < 0.05] and serum 25(OH)D concentrations (control: 55.8 ± 12.3 nmol/L; EAR: 64.1 ± 10.0 nmol/L; and RDA: 63.7 ± 12.4 nmol/L; P < 0.05) than the control group. Ninety-six percent of children in the EAR and RDA groups and 67% of the control group had 25(OH)D concentrations ≥50 nmol/L. Conclusion: Increasing the vitamin D intakes of young children through fortification of alternative dairy products results in significantly higher serum concentrations of 25(OH)D and a significantly greater proportion of children with serum 25(OH)D ≥50 nmol/L during periods of minimal ultraviolet B radiation exposure. This trial was registered at clinicaltrials.gov as NCT02097160 and had Health Canada Temporary Marketing Authorization Letters for both products (TM-13-0432 and TM-13-0433). [ABSTRACT FROM AUTHOR]

Background The Mediterranean-style dietary pattern has been associated with several cardiometabolic benefits, yet no study has assessed the potential benefits of this diet in adults with type 1 diabetes mellitus (T1DM). Objective The objective of the present study was to examine the association between cardiometabolic profile and alignment of the diet with 1) Canadian nutrient recommendations for T1DM in terms of fat, protein, carbohydrate, saturated fat, dietary fiber, and sodium and 2) a Mediterranean-style dietary pattern among adults with T1DM. Design/participants/setting This is a cross-sectional analysis including 118 adults with T1DM recruited between 2011 and 2013 in Montreal, Canada. Statistical analyses Body mass index (calculated as kg/m 2 ), waist circumference, truncal fat percentage (dual-energy x-ray absorptiometry), blood pressure, and lipid profile values were measured. Insulin sensitivity was estimated (estimated glucose disposal rate). A 3-day food record was completed and physical activity was measured with a motion sensor. Differences for the cardiometabolic profile between groups with a diet meeting the Canadian nutrient recommendations for T1DM (percentage of energy from fat, protein, carbohydrate, saturated fat, as well as grams of dietary fiber and milligrams of sodium) or not were examined with general linear models. A Mediterranean diet score was calculated (range=0 to 44) and Pearson correlations between this score and cardiometabolic variables were computed. Significance was set at P ≤0.05. Results Participants’ mean±standard deviation age was 44.3±12.3 years, glycated hemoglobin was 8.0%±1.1%, and Mediterranean diet score was 20.2±5.0. Having a diet that meets at least three nutritional recommendations was associated with a lower truncal fat percentage (28.0% vs 32.2%; P =0.01) only. In contrast, the Mediterranean diet score was inversely correlated with body mass index ( r =−0.30, P =0.002), waist circumference ( r =−0.31, P =0.002), truncal fat percentage ( r =−0.38, P <0.001), systolic ( r =−0.20, P =0.03) and diastolic blood pressure ( r =−0.23, P =0.01), and was directly correlated with estimated glucose disposal rate ( r =0.22, P =0.03), after adjustments for energy intake, sex, and age. The association with estimated glucose disposal rate was no longer significant ( P =0.055) after adjustment for physical activity level. Conclusions These results suggest that a higher Mediterranean diet score in the context of T1DM is associated with a favorable cardiometabolic profile. Further research is needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: The Canadian Health Measures Survey (CHMS) is an ongoing cross-sectional national survey that includes a measure of 25-hydroxyvitamin D [25(OH)D] by immunoassay. For cycles 1 and 2, the collection period occurred approximately every 2 y, with a new sample of w5600 individuals. Objective: The goal was to standardize the original 25(OH)D CHMS values in cycles 1 and 2 to the internationally recognized reference measurement procedures (RMPs) developed by the US National Institute for Standards and Technology (NIST) and Ghent University, Belgium. Design: Standardization was accomplished by using a 2-step procedure. First, serum samples corresponding to the original plasma samples were remeasured by using the currently available immunoassay method. Second, 50 serum samples with known 25(OH)D values assigned by the NIST and Ghent reference method laboratories were measured by using the currently available immunoassay method. The mathematical models for each step--i.e., 1) YCurrent = XOriginal and 2) YNIST-Ghent = XCurrent -- were estimated by using Deming regression, and the 2 models were solved to obtain a single equation for converting the "original" values to NIST-Ghent RMP values. Results: After standardization (cycles 1 and 2 combined), the percentage of Canadians with 25(OH)D values <40 nmol/L increased from 16.4% (original) to 19.4% (standardized), and values <50 nmol/L increased from 29.0% (original) to 36.8% (standardized). The 25(OH)D standardized distributions (cycles 1 and 2 analyzed separately) were similar across age and sex groups; slightly higher values were associated with cycle 2 in the young and old. This finding contrasts with the original data, which indicated that cycle 2 values were lower for all age groups. Conclusion: The shifts in 25(OH)D distribution brought about by standardization indicate its importance in drawing correct conclusions about potential population deficiencies and insufficiencies and in permitting the comparison of distributions between national surveys. [ABSTRACT FROM AUTHOR]

Background: Mandatory fortification, prevalent supplement use, and public health guidelines recommending periconceptional supplementation have increased folic acid intakes in North American pregnant women. However, the effects of increased folic acid intakes during pregnancy on maternal and cord blood folate concentrations have not been well established. Objectives: In this prospective study, we determined maternal and cord blood concentrations of folate and unmetabolized folic acid (UMFA) in a cohort of pregnant Canadian women and their newborns and examined the effect of maternal intakes of folate and folic acid and fetal genetic variants in folate metabolism on folate status. Design: Folate and folic acid intakes of 368 Canadian pregnant women were assessed in early (0-16 wk) and late (23-37 wk) pregnancy. Blood concentrations of folate and UMFAwere measured with the use of immunoassays and liquid chromatography-mass spectrometry, respectively, in maternal samples in early pregnancy (12-16 wk), at delivery (28-42 wk), and in cord blood. Four fetal genetic variants of the 5,10-methylenetetrahydrofolate reductase (MTHFR) and dihydrofolate reductase (DHFR) genes were assessed for their association with cord blood concentrations of folate and UMFA. Results: Geometric mean (95% CI) maternal red blood cell (RBC) folate concentrations were 2417 nmol/L (2362, 2472 nmol/L ) and 2793 nmol/L (2721, 2867 nmol/L ) in early pregnancy and at delivery, respectively. The mean (95% CI) cord RBC folate concentration was 2689 nmol/L (2614, 2765 nmol/L). UMFA was detectable in .90% of maternal and cord plasma samples. Although 3 fetal MTHFR and DHFR genetic variants had no effect, the fetal MTHFR 677TT genotype was associated with significantly lower cord serum (P = 0.03) and higher cord RBC (P = 0.02) folate concentrations than those of the wild type. Conclusions: Notwithstanding differences in assays, maternal and cord RBC folate and plasma UMFA concentrations were higher than previously reported values. Functional ramifications of high folate and UMFA concentrations in maternal and fetal circulation warrant additional investigation because an excess folate status may affect long-term health outcomes of the offspring. This study was registered at www.clinicaltrials.gov as NCT02244684. [ABSTRACT FROM AUTHOR]

BACKGROUND: Nutritional assessment commonly includes multiple nutrition indicators (NIs). To promote efficiency, a minimum set is needed for the diagnosis of malnutrition in the acute care setting. OBJECTIVE: The objective was to compare the ability of different NIs to predict outcomes of length of hospital stay and readmission to refine the detection of malnutrition in acute care. DESIGN: This was a prospective cohort study of 1022 patients recruited from 18 acute care hospitals (academic and community), from 8 provinces across Canada, between 1 July 2010 and 28 February 2013. Participants were patients aged ≥18 y admitted to medical and surgical wards. NIs measured at admission were subjective global assessment (SGA; SGA A = well nourished, SGA B = mild or moderate malnutrition, and SGA C = severe malnutrition), Nutrition Risk Screening (2002), body weight, midarm and calf circumference, serum albumin, handgrip strength (HGS), and patient-self assessment of food intake. Logistic regression determined the independent effect of NIs on the outcomes of length of hospital stay (<7 d and ≥7 d) and readmission within 30 d after discharge. RESULTS: In total, 733 patients had complete NI data and were available for analysis. After we controlled for age, sex, and diagnosis, only SGA C (OR: 2.19; 95% CI: 1.28, 3.75), HGS (OR: 0.98; 95% CI: 0.96, 0.99 per kg of increase), and reduced food intake during the first week of hospitalization (OR: 1.51; 95% CI: 1.08, 2.11) were independent predictors of length of stay. SGA C (OR: 2.12; 95% CI: 1.24, 3.93) and HGS (OR: 0.96; 95% CI: 0.94, 0.98) but not food intake were independent predictors of 30-d readmission. CONCLUSIONS: SGA, HGS, and food intake were independent predictors of outcomes for malnutrition. Because food intake in this study was judged days after admission and HGS has a wide range of normal values, SGA is the single best predictor and should be advocated as the primary measure for diagnosis of malnutrition. This study was registered at clinicaltrials.gov as NCT02351661. [ABSTRACT FROM AUTHOR]

Background: Evidence for a role of dietary risk factors in the cause of breast cancer has been inconsistent. The evaluation of overall dietary patterns instead of foods in isolation may better reflect the nature of true dietary exposure in a population. Objective: We used 2 cohort studies to identify and confirm associations between dietary patterns and breast cancer risk. Design: Dietary patterns were derived by using a principal components factor analysis in 1097 breast cancer cases and an age-stratified subcohort of 3320 women sampled from 39,532 female participants in the Canadian Study of Diet, Lifestyle and Health (CSDLH). We conducted a confirmatory factor analysis in 49,410 subjects in the National Breast Screening Study (NBSS) in whom 3659 cases of incident breast cancer developed. Cox regression models were used to estimate HRs for the association between derived dietary factors and risk of breast cancer in both cohorts. Results: The following 3 dietary factors were identified from the CSDLH: healthy, ethnic, and meat and potatoes. In the CSDLH, the healthy dietary pattern was associated with reduced risk of breast cancer (HR for high compared with low quintiles: 0.73; 95% CI: 0.58, 0.91; P-trend = 0.001), and the meat and potatoes dietary pattern was associated with increased risk in postmenopausal women only (HR for high compared with low quintiles: 1.26; 95% CI: 0.92, 1.73; P-trend = 0.043). In the NBSS, the association between the meat and potatoes pattern and postmenopausal breast cancer risk was confirmed (HR: 1.31; 95% CI: 0.98, 1.76; P-trend = 0.043), but there was no association between the healthy pattern and risk of breast cancer. Conclusion: Adherence to a plant-based diet that limits red meat intake may be associated with reduced risk of breast cancer, particularly in postmenopausal women. Am J Clin Nutr 2015;101:817-23. [ABSTRACT FROM AUTHOR]

Objective: The researchers evaluated the impact of a 7-month gardening and 4-month vegetable and fruit snack program on Aboriginal First Nations children's home consumption and preferences toward vegetables and fruit. Methods: The intervention was based on the Social Cognitive Theory. Children in grades 1–6 planted and tended classroom container gardens and prepared and ate what grew. At baseline and 7 months later, children tasted and rated 17 vegetables and fruit using a Likert scale and indicated whether they ate each food at home. Results: Data were collected from 76 of 116 children (65.5%). Preference scores for vegetables, fruit, and vegetables and fruit combined increased over the 7 months (P < .017). Self-reported home consumption did not change. Conclusions and Implications: School interventions have the potential to increase children's preferences for vegetables and fruit. Family participation is likely required, along with increased community availability of produce, to promote home consumption. [ABSTRACT FROM AUTHOR]

The article focuses on a study related to involvement of street youth in gang membership in Canada. Topics include a table depicting factors associated with gang involvement among male and female street-involved youth, gang prevention interventions for high-risk youth and adverse health and social outcomes including delinquency, substance use & traumatic stress symptoms. It discusses the approval of the study by the University of British Columbia/Providence Health Care Research Ethics Boards.

Background: Recent efforts in Canada to reduce industrial trans fatty acids (TFAs) in foods include mandated inclusion of TFA content on food labels and recommendations by Health Canada that encourage the food industry to voluntarily limit TFA content in all vegetable oils and soft margarines and in all other prepackaged foods to <2% and <5% of total fat, respectively. Objective: To assess the impact of these efforts, we measured the concentration of TFAs in human breast milk samples. Design: The TFA content in 639 breast milk samples collected in 2009, 2010, and 2011 from breastfeeding mothers in 10 major cities across Canada was analyzed by gas chromatography. Results: The mean (±SD) TFA contents were 2.7 ± 0.9% (n = 153, range: 1.4-7.2%), 2.2 ± 0.7% (n = 309, range: 1.0-6.8%), and 1.9 ± 0.5% (n = 177, range: 0.9-3.4%) of total milk fat for samples collected in 2009, 2010, and 2011, respectively. These values are considerably lower than the value of 7.2 ± 3.0% (range: 0.1-17.2%) found previously for Canadian human milk in 1992. On the basis of a linear correlation between the percentage of TFAs in the diet and human milk fat established by Craig-Schmidt et al, and assuming that 30% of energy of a lactating mother's diet is derived from fat, we estimated from the TFA human milk fat data that TFA intake of Canadian breastfeeding mothers was 0.9%, 0.5%, and 0.3% of total energy in 2009, 2010, and 2011, respectively. These estimated values are lower than the WHO's maximum recommended intake of 1% of total energy for a healthy diet. Conclusions: The results suggest that the trans fat labeling regulations introduced in 2003 and recommendations by Health Canada in 2007 instructing the food manufacturers and restaurants to limit TFAs in foods have resulted in significant reductions in TFAs in the diets of Canadian breastfeeding mothers and their breast milk. [ABSTRACT FROM AUTHOR]

Background: Greenhouse gas emissions (GHGEs) are a major consequence of our dietary choices. Assessments of plant-based compared with meat-based diets are emerging at the intersection of public health, environment, and nutrition. Objectives: The objective was to compare the GHGEs associated with dietary patterns consumed in a large population across North America and to independently assess mortality according to dietary patterns in the same population. Design: Data from the Adventist Health Study 2 (AHS-2) were used to characterize the differential environmental and health impacts of the following 3 dietary patterns, which varied in the quantity of animal and plant foods: vegetarian, semivegetarian, and nonvegetarian. The GHGE intensities of 210 foods were calculated through life-cycle assessments and by using published data. The all-cause mortality rates and all-cause mortality HRs for the AHS-2 subjects were adjusted for a range of lifestyle and sociodemographic factors and estimated according to dietary pattern. Results: With the use of the nonvegetarian diet as a reference, the mean reductions in GHGEs for semivegetarian and vegetarian diets were 22% and 29%, respectively. The mortality rates for nonvegetarians, semivegetarians, and vegetarians were 6.66, 5.53, and 5.56 deaths per 1000 person-years, respectively. The differences were significant. Compared with nonvegetarians, mortality HRs were lower for semivegetarians (0.86) and vegetarians (0.91). Conclusions: Moderate differences in the caloric intake of meat products provided nontrivial reductions in GHGEs and improved health outcomes, as shown through the mortality analyses. However, this does not mean that diets lower in GHGEs are healthy. [ABSTRACT FROM AUTHOR]

Background: Choline needs are increased in pregnancy. Choline can be used as a source of methyl for homocysteine remethylation to methionine, but choline synthesis requires methyls from methionine. Vitamin B-12 deficiency increases choline use for homocysteine methylation. Objectives: We investigated whether poor vitamin B-12 status occurs and contributes to low plasma choline and altered biomarkers of choline synthesis in pregnant women. With the use of a post hoc analysis, we addressed the association of maternal plasma vitamin B-12 status with postnatal growth rates in term infants. Design: Blood was analyzed for a prospective study of 264 and 220 pregnant women at 16 and 36 wk of gestation, respectively, and 88 nonpregnant women as a reference. Results: The proportion of women with a plasma total vitamin B-12 concentration <148 pmol/L (deficient) or 148-220 pmol/L (marginal) increased with pregnancy and pregnancy duration, which affected 3% and 9% of nonpregnant women, 10% and 21% of women at 16wk of gestation, and 23% and 35% of women at 36wk of gestation, respectively. Plasma free choline, betaine, and dimethylglycine were lower in women at 36 wk of gestation with a deficient or marginal compared with sufficient plasma total vitamin B-12 concentration (>220 pmol/L). Plasma total vitamin B-12 was positively associated with the increase in plasma free choline from midgestation to late gestation (P < 0.001). The postnatal growth rate to 9 mo was lower in infant boys of women classified as total vitamin B-12 deficient compared with sufficient. Conclusion: This study shows that maternal vitamin B-12 status is related to choline status in late gestation in a folate-replete population and may be a determinant of infant growth even in the absence of undernutrition. [ABSTRACT FROM AUTHOR]

Abstract: Material deprivation is an important determinant of health inequalities in adults but there remains debate about the extent of its importance for adolescent wellbeing. Research has found limited evidence for an association between adolescent health and socio-economic status, leading authors to suggest that there is an ‘equalisation’ of health across socio-economic groups during the adolescent stage of the life-course. This paper explores this ‘equalisation’ hypothesis for adolescent psychological wellbeing from a geographical perspective by investigating associations between neighbourhood deprivation and self-esteem in Britain and Canada. Data from the British Youth Panel (BYP) and the National Longitudinal Survey of Children and Youth (NLSCY) on adolescents aged 11–15 for the time period 1994–2004 were used to estimate variations in low self-esteem between neighbourhoods using multilevel logistic regression. Models were extended to estimate associations between self-esteem and neighbourhood deprivation before and after adjustment for individual and family level covariates. Moderation by age, sex, urban/rural status, household income and family structure was investigated. There were no significant differences in self-esteem between the most deprived and most affluent neighbourhoods (Canada unadjusted OR = 1.00, 95% CI 0.76, 1.33; Britain unadjusted OR = 1.25, 95% CI 0.74, 2.13). The prevalence of low self-esteem was higher (in Canada) for boys in the least deprived neighbourhoods compared to other neighbourhoods. No other interactions were observed. The results presented here offer some (limited) support for the socio-economic equalisation in youth hypothesis from a geographical perspective: with specific reference to equalisation of the relationship between neighbourhood deprivation and self-esteem and psychological health in early adolescence. This contrasts with previous research in the United States but supports related work from Britain. The lack of interactions with key social and economic variables suggests that findings might apply across a range of family circumstances and different communities in Britain and Canada. Policy implications are discussed. [Copyright &y& Elsevier]

Background: A high-calorie diet has been a standard of care in cystic fibrosis (CF) for >3 decades. However, energy requirements may have changed with new treatments and milder genotypes. Objectives: The objectives of this study were to describe longitudinal trends in nutritional status and to evaluate the relation between nutritional status and lung function. Design: This longitudinal cohort study included 909 individuals followed at the Adult CF Clinic in Toronto from 1985 to 2011. Nutritional status was classified on the basis of WHO BMI guidelines. Multivariable linear regression with the use of generalized estimating equations was applied to evaluate the relation between BMI and lung function. Results: The proportion of underweight individuals decreased from 20.6% before 1990 to 11.1% in the most recent decade, whereas the proportion of overweight and obese subjects increased from 7.0% to 18.4% (P < 0.001). Overweight and obese subjects were older, had better lung function, had milder genotypes, and were more often male and pancreatic sufficient. Multivariable regression analyses showed that within the underweight group, an increase in BMI resulted in improved lung function, whereas this effect was half of that in overweight individuals. The greatest advantage of improved nutrition on lung function was observed in the underweight group and in pancreatic- insufficient patients. Conclusions: Modification to a high-fat diet may be required in some individuals with CF to optimize nutritional health. Higher BMI is associated with improvements in lung function, although the lung function benefit of increasing one's BMI (in kg/m2) to >25 is small and needs to be balanced against the known health risks of obesity. [ABSTRACT FROM AUTHOR]

Abstract: The International Classification of Functioning, Disability and Health framework describes human functioning through body structure and function, activity and participation in the context of a person''s social and physical environment. This work tested the temporal relationships of these components. Our hypotheses were: 1) there would be associations among physical impairment, activity limitations and participation restrictions within time; 2) prior status of a component would be associated with future status; 3) prior status of one component would influence status of a second component (e.g. prior activity limitations would be associated with current participation restrictions); and, 4) the magnitude of the within time relationships of the components would vary over time. Participants from Canada with primary hip or knee joint replacement (n = 931), an intervention with predictable improvement in pain and disability, completed standardized outcome measures pre-surgery and five times in the first year post-surgery. These included physical impairment (pain), activity limitations and participation restrictions. ICF component relationships were evaluated cross-sectionally and longitudinally using path analysis adjusting for age, sex, BMI, hip vs. knee, low back pain and mood. All component scores improved significantly over time. The path coefficients supported the hypotheses in that both within and across time, physical impairment was associated with activity limitation and activity limitation was associated with participation restriction; prior status and change in a component were associated with current status in another component; and, the magnitude of the path coefficients varied over time with stronger associations among components to three months post surgery than later in recovery with the exception of the association between impairment and participation restrictions which was of similar magnitude at all times. This work enhances understanding of the complexities of the ICF component relationships in evaluating disability over time. Further longitudinal studies including evaluation of contextual factors are required. [Copyright &y& Elsevier]

Abstract: Background: Patients with thalassemia have low circulating levels of many nutrients, but the contribution of dietary intake has not been assessed. Objective: Our objective was to assess dietary intake in a large contemporary sample of subjects with thalassemia. Design: A prospective, longitudinal cohort study using a validated food frequency questionnaire was conducted. Participants/setting: Two hundred and twenty-one subjects (19.7±11.3 years, 106 were female) were categorized into the following age groups: young children (3 to 7.9 years), older children/adolescents (8 to 18.9 years), and adults (19 years or older); 78.8% had β-thalassemia and 90% were chronically transfused. This study took place at 10 hematology outpatient clinics in the United States and Canada. Main outcome measures: We conducted a comparison of intake with US Dietary Reference Intakes and correlated dietary intake of vitamin D with serum 25-OH vitamin D and dietary iron with total body iron stores. Statistical analyses performed: Intake was defined as inadequate if it was less than the estimated average requirement. χ2, Fisher''s exact, and Student''s t test were used to compare intake between age categories and logistic regression analysis to test the relationship between intake and outcomes, controlling for age, sex, and race. Results: More than 30% of subjects consumed inadequate levels of vitamin A, D, E, K, folate, calcium, and magnesium. The only nutrients for which >90% of subjects consumed adequate amounts were riboflavin, vitamin B-12, and selenium. Dietary inadequacy increased with increasing age group (P<0.01) for vitamins A, C, E, B-6, folate, thiamin, calcium, magnesium, and zinc. More than half of the sample took additional supplements of calcium and vitamin D, although circulating levels of 25-OH vitamin D remained insufficient in 61% of subjects. Dietary iron intake was not related to total body iron stores. Conclusions: Subjects with thalassemia have reduced intake of many key nutrients. These preliminary findings of dietary inadequacy are concerning and support the need for nutritional monitoring to determine which subjects are at greatest risk for nutritional deficiency. Future research should focus on the effect of dietary quality and nutritional status on health outcomes in thalassemia. [Copyright &y& Elsevier]

Abstract: It has been theorized that suicide behaviours amongst indigenous peoples may be an outcome of mass trauma experienced as a result of colonization. In Canada, qualitative evidence has suggested that the Indian Residential School System set in motion a cycle of trauma, with some survivors reporting subsequent abuse, suicide, and other related behaviours. It has been further postulated that the effects of trauma can also be passed inter-generationally. Today, there are four generations of Canadian First Nations residential school survivors who may have transmitted the trauma they experienced to their own children and grandchildren. No empirical study has ever been undertaken to demonstrate this dynamic. This study is therefore the first to investigate whether a direct or indirect exposure to Canada''s residential school system is associated with trauma and suicide behaviour histories. Data were collected in 2002/2003 from a representative sample of Manitoba, Canada, First Nations adults (N = 2953), including residential (N = 611) and non-residential school attendees (N = 2342). Regression analyses showed that for residential school attendees negative experiences in residential school were associated with a history of abuse, and that this history and being of younger age was associated with a history of suicide thoughts, whereas abuse history only was associated with a history of suicide attempts. For First Nations adults who did not attend a residential school, we found that age 28–44, female sex, not having a partner, and having a parent or grandparent who attended a residential school was associated with a history of abuse. This history, along with age and having had a parent or grandparent who attended residential school was associated with a history of suicide thoughts and attempts. In conclusion, this is the first study to empirically demonstrate, at the population level, the mental health impact of the residential school system on survivors and their children. [Copyright &y& Elsevier]