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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 examine the prevalence of major racial discrimination (MRD) in healthcare services and its association with COVID-19 vaccine mistrust and uptake, conspiracy theories, COVID-19-related stressors, community resilience, anxiety, depression, and stress symptoms. The study used a population-based cross-sectional design. Data from the BlackVax dataset on COVID-19 vaccination in Black individuals in Canada was analyzed (n = 2002, 51.66% women). Logistic regression analyses were performed to examine the association between MRD and independent variables. 32.55% of participants declared having experienced MRD in healthcare services. Participants with MRD were less vaccinated against COVID-19, presented higher scores of vaccine mistrust, conspiracy beliefs, COVID-19 related stressors, depression, anxiety, and stress, and had lower scores of community resilience. They were more likely to experience depression (AOR = 2.13, P < 0.001), anxiety (AOR = 2.00, P < 0.001), and stress symptoms (AOR = 2.15, P < 0.001). Participants who experienced MRD were more likely to be unvaccinated (AOR = 1.35, P = 0.009). Racial discrimination experienced by Black individuals in health services is a major public health concern and threat to population health in Canada. Federal, provincial, and municipal public health agencies should adapt their programs, strategies, tools, and campaigns to address the mistrust created by racial discrimination. [ABSTRACT FROM AUTHOR]

Standardized ('plain') packaging is effective in reducing the appeal of cigarettes among young people. This study examined the impact of plain packaging and brand imagery on interest in trying e-cigarettes among youth. Experimental design. Two online experiments were conducted in February 2020 as part of the ITC Youth Tobacco & Vaping Survey, conducted with 13,624 16- to 19-year-olds in Canada, England, and the USA. In the between-group Experiment 1, participants were randomized to view a set of 3 e-cigarette brands, in either their original external packaging ('branded' condition) or standardized olive-green packaging ('standardized' condition), and asked to select the product they would be most interested in trying. The within-group Experiment 2 examined brand imagery directly on devices, including potential differences in appeal among subgroups. Each participant viewed 4 pod-style e-cigarette devices: one 'plain' and 3 in colourful 'skins'. Logistic regression models were conducted to test the effect of condition, adjusting for demographics, smoking and vaping status. In Experiment 1, participants in the 'standardized' packaging condition were significantly more likely to indicate 'I have no interest in trying any of these products' (72.3%) than those in the 'branded' condition (66.9%, AOR 1.45, 95% CI 1.33–1.59). Experiment 2 results indicated differences in e-cigarette appeal by sex in the selection of male- and female-oriented designs, and by cannabis use for a Rastafarian-themed design. Brand imagery on e-cigarettes can target products to specific subgroups. Removal of imagery, in the form of standardized packaging, has the potential to reduce interest in trying e-cigarettes among young people. [ABSTRACT FROM AUTHOR]

It is increasingly recognized that those of lower socioeconomic status (SES) are disproportionately affected by cancer mortality. The association between cervical cancer mortality and SES have been reported; however, it remains poorly understood in the Canadian population. Thus, this study investigates trends in income and education inequalities in cervical cancer mortality in Canada over the last three decades. Trend analysis. A dataset constructed at the census division level (n = 280), comprising the Canadian Vital Statistics Death Database, the Canadian Census of Population, and the National Household Survey was used to measure cervical cancer mortality in Canada. Income and education inequalities in cervical cancer mortality were measured using age-standardized Concentration index (C). Crude cervical cancer mortality rates decreased significantly during the study period. Age-standardized C values were negative for the majority of years for income and education inequalities, reaching significance in some years. Trend analyses indicated an increasing concentration of cervical cancer mortality amongst those with lower education levels. Despite recent decreases in cervical cancer mortality rates, socioeconomic inequalities in cervical cancer mortality in Canada are persistent. Notably, those of lower income and education levels are disproportionately affected, underscoring an opportunity to improve clinical outcomes by addressing these inequalities. [ABSTRACT FROM AUTHOR]

While some countries collect burn clinical data as part of nonspecific trauma datasets, others have developed burn registries allowing for benchmarking of outcome and quality-of-care data. The objectives of this project are to characterize the current state of burn clinical data collection and analysis in Canada, and to explore the interest of Canadian burn centers in contributing to a nation-wide burn registry. A 23-item mixed methods survey was created and delivered via REDCap® to burn directors of 22 burn centers across Canada. Quantitative items were analyzed by means of descriptive statistics, and thematic analysis was used to explore qualitative data. Sixteen (72 %) complete survey responses were received. All respondent units collect burn clinical data. Data are largely collected for quality improvement (69 %) and clinical research (50 %) purposes. Half of the institutions did not analyze their data, and a majority (67 %) did not benchmark their data against other datasets. The majority of respondents (93 %) demonstrated interest in contributing to a Canada-wide burn registry. Although all respondent units are currently collecting burn clinical data, there is an opportunity to improve data analysis, benchmarking, and knowledge translation. Most centers demonstrated interest in contributing to a novel Canadian burn registry. • All respondent Canadian burn units collect burn clinical data; • Data is mostly collected for quality improvement and clinical research purposes; • Half of respondent units declared their data are not currently analyzed; • A majority of units has never benchmarked their data; • Most respondent units were interested in participating in a Canadian burn registry. [ABSTRACT FROM AUTHOR]

To examine the associations between COVID-19 pandemic waves (1–4) and prevalent antipsychotic, antidepressant, benzodiazepine, anticonvulsant, and opioid use among assisted living (AL) residents, by setting (dementia care vs other). Population-based, repeated cross-sectional study. Linked clinical and health administrative databases for residents of all publicly subsidized AL homes (N = 256) in Alberta, Canada, examined from January 2018 to December 2021. Setting-specific quarterly cohorts of residents were derived for pandemic (starting March 1, 2020) and comparable historical (2018/2019 combined) periods. The quarterly proportion of residents dispensed an antipsychotic, antidepressant, benzodiazepine, anticonvulsant, or opioid was examined for each setting and period. Log-binomial generalized estimating equations models estimated prevalence ratios (PR) for period (pandemic vs historical quarterly periods), setting (dementia care vs other AL), and period-setting interactions. On March 1, 2020, there were 2874 dementia care and 6611 other AL residents (mean age 82.4 vs 79.9 years, 68.2% vs 66.1% female, 93.5% vs 42.6% with dementia, respectively). Antipsychotic use increased during waves 2 to 4 for residents of both settings, but this increase was significantly greater for dementia care than other AL residents during waves 3 and 4 (eg, wave 3, PR 1.21, 95% CI 1.14–1.27 vs PR 1.12, 95% CI 1.07–1.17, interaction term P =.029). In both settings, there was a significant but modest increase in antidepressant use and a significant decrease in benzodiazepine use during several pandemic waves. For other AL residents only, there was a small statistically significant increase in anticonvulsant use during waves 2 to 4. No significant pandemic effect was observed for prevalent opioid use in either setting. The persistence of the pandemic-associated increase in antipsychotic, antidepressant, and anticonvulsant use in AL residents, and greater increase in antipsychotic use for dementia care settings, raises concerns about the attendant risks for residents, especially those with dementia. [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]

To synthesize results of six controlled trials of self-care interventions for depression and/or anxiety, focusing on five trials in which lay guidance was compared to self-directed use of the same self-care tools. The trials were conducted in Canada in different target populations. Self-care tools were adapted to each population. Guidance was provided in 3–15 calls over a period of 6–26 weeks. Depression and/or anxiety were assessed at follow-up (6–26 weeks). Pooled analyses used a meta-analytic approach. Engagement with the self-care tools was compared using the standardized difference or Cohen's d effect size. In studies with homogeneous outcomes (three for depression, four for anxiety), the pooled effect sizes of guidance vs. self-directed use of the self-care tools were 0.36 (95% CI 0.10, 0.62, N = 235) for depression and 0.21 (95% CI -0.03, 0.44, N = 285) for anxiety. Guidance consistently led to greater engagement with the tools. The intervention model is a potentially sustainable and accessible alternative to professionally guided self-care for people with mild-moderate depression. Factors which may have limited implementation success include: co-interventions, reduced number of guide calls (3 vs 6 or more), and delivery to dyads (patient-caregiver). [ABSTRACT FROM AUTHOR]

Advance care planning (ACP) within nursing homes (NHs) is an integral component of resident-centered care yet remains an ongoing area for improvement. This study explored health care providers' experiences when facilitating ACP discussions with residents and their families. Interpretive description was used to explore meanings and generate knowledge that is applicable for clinical contexts. A purposive sample of 27 staff members (2 directors of care, 3 assistant directors of care, 1 nurse practitioner, 11 registered nurses, 3 registered practical nurses, and 7 social workers) from 29 NHs located across 3 Canadian provinces that participated in cluster-randomized intervention study to improve ACP. Semistructured interviews were conducted between January and July 2020. Interpretive description methods were used for analysis. Three themes were identified. "Navigating Relational Tensions During ACP with Families" captures the relational tensions that participants experienced while navigating ACP processes with residents and their families. The second theme, "Where's the Doctor?" highlights the general lack of physician involvement in ACP discussions and the subsequent pressures faced by participants when supporting residents and families. The last theme, "Crises Change the Best Laid Plans," illustrates the challenges participants face when trying to adhere to existing care plans during residents' medical crises. Participants' experiences indicate that current ACP processes in NHs do not meet the needs of residents, families, or care teams. Additional support from physicians and changes to structural processes are needed to support resident-centered end-of-life planning within this care context. [ABSTRACT FROM AUTHOR]

To determine the effect of recreational cannabis legalization (RCL) and/or recreational cannabis commercialization (RCC) on emergency department (ED) visits, hospitalizations, and deaths due to substance use, injury, and mental health among those aged 11 years and older. A systematic review of six electronic databases up to February 1, 2023. Original, peer-reviewed articles with interrupted time series or before and after designs were included. Four independent reviewers screened articles and assessed risk of bias. Outcomes with 'critical' risk of bias were excluded. Protocol registered on PROSPERO (# CRD42021265183). After screening and risk of bias assessment, 29 studies were included which examined ED visits or hospitalizations for cannabis use or alcohol (N = 10), opioid mortality (N = 3), motor vehicle fatalities or injury (N = 11), and intentional injury/mental health (N = 5). Rates or number of cannabis-related hospitalizations increased after RCL in Canada and the USA. Immediate increases in rates of cannabis-related ED visits were found after both RCL and RCC in Canada. Rates of traffic fatalities increased after RCL and RCC in certain jurisdictions in the USA. RCL was associated with increased rates of cannabis-related hospitalizations. RCL and/or RCC was associated with increased rates of cannabis-related ED visits, consistently shown across sex and age groups. The effect on fatal motor vehicle incidents was mixed, with observed increases found after RCL and/or RCC. The effect of RCL or RCC on opioids, alcohol, intentional injury, and mental health is not clear. These results inform population health initiatives and international jurisdictions considering RCL implementation. [ABSTRACT FROM AUTHOR]

To evaluate changes in mental health and well-being (eg, quality of work life, health, intention to leave) among nursing home managers from a February 2020 prepandemic baseline to December 2021 in Alberta, Canada. Repeated cross-sectional survey. A random sample of nursing homes (n = 35) in urban areas of Alberta was selected on 3 strata (region, size, ownership). Care managers were invited to participate if they (1) managed a unit, (2) worked there for at least 3 months, and (3) worked at least 6 shifts per month. We measured various mental health and well-being outcomes, including job satisfaction (Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale), burnout (Maslach Burnout Inventory—exhaustion, cynicism, efficacy), organizational citizenship behaviors (constructive efforts by individuals to implement changes to improve performance), mental and physical health (Short Form–8 Health Survey), burden of worry, and intention to leave. We use mixed effects regression to examine changes at the survey time points, controlling for staffing and resident acuity. The final sample included 181 care managers (87 in the pre-COVID survey; 94 in the COVID survey). Response rates were 66.9% and 82.5% for the pre-COVID and COVID surveys, respectively. In the regression analysis, we found statistically significant negative changes in job satisfaction (mean difference −0.26, 95% CI –0.47 to −0.06; P =.011), cynicism (mean difference 0.43, 95% CI 0.02-0.84; P =.041), exhaustion (mean difference 0.84, 95% CI 0.41-1.27; P <.001), and SF-8 mental health (mean difference −6.49, 95% CI –9.60 to −3.39; P <.001). Mental health and well-being of nursing home managers worsened during the pandemic, potentially placing them at risk for leaving their jobs and in need of improved support. These findings should be a major concern for policy makers, particularly given serious prepandemic workforce shortages. Ongoing assessment and support of this understudied group are needed. [ABSTRACT FROM AUTHOR]

To describe professional and personal experiences of nursing home care leaders during early waves of the COVID-19 pandemic. Qualitative interpretive description. Eight sites across 2 Canadian provinces. Sites varied by COVID-19 status (low or high), size (<120 or ≥120 beds), and ownership model (for-profit or not-for-profit). We recruited 21 leaders as participants: 14 managers and 7 directors of care. Remote Zoom-assisted semi-structured interviews conducted from January to April 2021. Concurrent data generation and inductive content analysis occurred throughout. Sampling ceased once we reached sufficient analytic variation and richness to answer research questions. Most participants were female, ≥50 years of age, and born in Canada. We found 4 major themes. (1) Responsibility to protect: Extreme precautions were employed to protect residents, staff, and leaders' families. Leaders experienced profound distress when COVID-19 infiltrated their care homes. (2) Overwhelming workloads: Changing public health orders and redeployment to pandemic-related activities caused administrative chaos. Leaders worked double shifts to cope with pandemic demands and maintain their usual work. (3) Mental and emotional toll: All participants reported symptoms of anxiety, depression, and insomnia, leading to ongoing exhaustion. Shifting staff focus from caring to custodial enforcement of isolation caused considerable distress, guilt, and grief. (4) Moving forward: The pandemic spotlighted deficiencies in the nursing home context that lead to inadequate quality of resident care and staff burnout. Some leaders indicated their pandemic experience signaled an unanticipated end to their careers. Nursing home leaders faced mental distress and inordinate workloads during the pandemic. This is an urgent call for systemic change to improve working conditions for leaders and quality of care and quality of life for residents. Nursing home leaders are at increased risk of burnout, which must be addressed to mitigate attrition in the sector. [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]

• The pandemic state of emergency resulted in overall increases of opioid toxicities. • Important differences were noted among people with and without opioid use disorder. • People with opioid use disorder experienced a sustained rise in opioid toxicities. • Similar increases were not observed in people without opioid use disorder. • Adaption of supports in public health emergencies is needed for undisrupted access. Across Canada, the COVID-19 pandemic occurred amidst an ongoing drug toxicity crisis. Although elevated rates of substance-related harms have been observed nationally, it remains unknown if the pandemic state of emergency led to disproportionate increases in opioid toxicities among people with opioid use disorder (OUD) compared to those without. We conducted a population-based repeated cross-sectional time series analysis of fatal and non-fatal opioid toxicities between January 1, 2014, and December 31, 2021, in Ontario, Canada. We used interventional autoregressive integrated moving average models to examine the impact of the pandemic on monthly rates of opioid toxicities per 100,000 Ontario residents stratified by people with and without OUD. We identified 80,296 opioid toxicities of which 53.5 % occurred among people with OUD. Among 52,052 unique individuals, 60.5 % were male and 46.2 % were 25–44 years old. Between January 2014 and December 2021, the rate of opioid toxicities increased from 2.6 to 10.5 per 100,000 (rate ratio [RR]=4.07). The magnitude of this increase differed among people with OUD (0.8 to 7.4 per 100,000; RR=9.35) and without OUD (1.8 to 3.1 per 100,000; RR=1.74). We observed a significant ramp increase in the overall rate of opioid toxicities following the declaration of the pandemic emergency in March 2020 (+0.19 per 100,000 monthly, 95 % CI: 0.029, 0.36, p = 0.021). In a stratified analysis, we found a similar ramp increase among people with OUD (+0.19 per 100,000 monthly, 95 % CI: 0.10, 0.28, p < 0.001); however, this was not observed among people without OUD (p = 0.95). The rate of opioid toxicities accelerated across Ontario following the pandemic-related state of emergency, with the majority of this increase among people with OUD. The important differences observed among people with OUD compared with those without, highlights the critical need for improved access to harm reduction and treatment interventions among this population. [ABSTRACT FROM AUTHOR]

• Policy responses to the COVID-19 pandemic impacted alcohol control. • We developed a classification scheme based on WHO policy domains to map alcohol control policy changes. • Over 100 changes to alcohol control policies were observed during just three months. • Most alcohol control policies during the COVID-19 pandemic impacted alcohol availability. • Few policies weakened alcohol control by allowing take away or home delivery of alcohol. Policy changes in response to the COVID-19 pandemic have impacted on alcohol control. This study describes the development and application of a classification scheme to map alcohol policy changes during the first three-months of the COVID-19 pandemic in five countries and/or subnational jurisdictions. A pre-registered systematic review of policy decisions from March to May 2020, in Australia/New South Wales, Canada/Ontario, Chile, Italy and the United Kingdom. One author extracted the data for each jurisdiction using a country-specific search strategy of government documents. We coded policy changes using an adapted WHO classification scheme, whether the policy was expected to tighten or loosen alcohol control, have mainly immediate or delayed impact on consumption and harm and impact the general population versus specific populations. We present descriptive statistics of policy change. We developed a classification scheme with four levels. Existing policy options were insufficient to capture policy changes in alcohol availability, thus we added seventeen new sub-categories. We found 114 alcohol control policies introduced across the five jurisdictions, covering five (out of ten) WHO action areas. The majority aimed to change alcohol availability, by regulating the operation of alcohol outlets. All countries introduced closures to on-premise alcohol outlets and, except Chile, allowed off-sales via take away or home delivery. We also observed several pricing policies introducing subsidies to support the alcohol industry. Seventy-four percent of policy changes were expected to tighten alcohol control and 12.3 % to weaken control. Weakening policy changes were mostly related to retail mode switching or expansion (allowing take away or home delivery). Alcohol control policies during the first three months of the COVID-19 pandemic were targeted primarily at alcohol availability and about one tenth might weaken alcohol control. Temporary changes to alcohol retail during the COVID-19 pandemic, if made permanent, could significantly expand alcohol availability. [Display omitted] [ABSTRACT FROM AUTHOR]

• School-based population survey in British Columbia, Canada (unweighted n = 38,015) • Youth in care reported worse general and mental health than youth not in care. • Youth in care missed needed medical care more frequently than youth not in care. • Female and non-binary youth in care had worse health and more missed care than males. • Negative health care experiences and transportation were barriers for youth in care. Youth in care (YIC) are a marginalized population with high health care needs and barriers to access, resulting in lifelong health disparities. This study examines the health of Canadian YIC and their engagement with the Canadian health care system on a population level. Data were retrieved from the 2018 British Columbia Adolescent Health Survey, a cross-sectional population survey of Grade 7–12 students (ages 12–19 years) in British Columbia, Canada (n = 38,015). Primary outcomes were self-rated general health and mental health, missed medical care, and missed mental health care among YIC. Secondary outcomes included health care access and gender differences. Multivariate analyses adjusted for age, gender, and food insecurity. YIC represented 1.9 % of the weighted sample population. Compared to non-YIC, YIC accessed health care more frequently from mental health professionals and youth-focused clinics and less frequently from family physicians. YIC reported worse general health (AOR 1.81 [99 % CI 1.40–2.34]) and mental health (AOR 1.81 [99 % CI 1.42–2.32]) than non-YIC. Adjusted for health status, YIC experienced more missed medical care (AOR 1.96 [99 % CI 1.46–2.62]) but comparable missed mental health care to non-YIC. Significant barriers for YIC included negative health care experiences and transportation. Among YIC, female and non-binary genders also had increased risk for worse health and missed care compared to males. YIC in Canada have inequitably unmet health care needs. Many complex factors contribute to this disparity and its correlation with out-of-home care. Further action is needed to reduce health care barriers for YIC. [ABSTRACT FROM AUTHOR]

• Many mental health disorders first emerge during early childhood or adolescence. • Wait times for children's mental health services have been an international and widespread problem. • Long wait times prolong the emotional distress of children and/or adolescents and their caregivers which can exacerbate mental health difficulties. • The majority of research in this area has been conducted in the United Kingdom and Canada and focus on one waitlist strategy. • Common strategies include alternative service delivery models, increasing system capacity, and improving intake and assessment processes. Background: Although many mental health disorders first emerge during early childhood or adolescence, there is a significant gap between demand and availability of mental health resources, leading to long waitlists for services. Objective: The objective of this scoping review was to identify and characterize the research literature related to the range of waitlist management strategies that have been implemented in outpatient child and adolescent mental health care. Methods: Electronic databases reviewed included: Medline (Ovid), Embase (Ovid), PubMed, PsychINFO, SCOPUS, CINAHL, and ISI Web of Science. Grey literature databases included: OpenGrey, Conference Papers Index, and Proquest Digital Dissertations. Articles were screened by two reviewers in two steps: first by title and abstract, then full text level. Data were extracted using an a-priori developed data extraction framework, which was piloted and modified iteratively. Results: A total of 119 papers related to waitlist interventions in child and adolescent mental health were reviewed. Of these 119 papers, 11% were reviews, summary, or theoretical papers; 8% used a randomized control trial design and 2.5% were trial protocols. Most studies used less rigorous designs, such as uncontrolled before-and- after designs. The large majority focused on just one waitlist strategy each. The most commonly used approaches included: prioritization/triage and initial assessment; brief consultation and advice or brief therapy approaches; group-based models; interim services; increasing capacity; and strategies to decrease non-attendance. Most studies were conducted in the United Kingdom or Canada. Discussion: While mental health systems are complex, most studies examining waitlist initiatives explored the implementation of single initiatives. It is unlikely that a single waitlist strategy can be effective in managing wait times for children's mental health. Rather, consistent and systemic approaches to address wait times that consider the impact of the reduction approach on the patient, the program, and the community are needed. [ABSTRACT FROM AUTHOR]

To synthesize recommendations on assessing and managing behavioral and psychological symptoms of dementia (BPSDs) in existing clinical practice guidelines on dementia care to learn from and adapt recommendations to a Canadian context and language for describing BPSDs. Systematic review. Moderate to high-quality clinical practice guidelines on dementia care that made 1 or more recommendations on BPSD assessment or management. We searched MEDLINE, Embase, JBI EBM, PsycINFO, AgeLine, and gray literature for clinical practice guidelines on dementia care making recommendations on BPSD, published between January 1, 2011, and October 13, 2022. Two independent reviewers conducted study screening and data abstraction. Four independent reviewers completed quality appraisal using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool; included guidelines had a mean overall AGREE II score ≥4. Our systematic review identified 23 moderate to high-quality clinical practice guidelines (264 recommendations). The mean overall quality score on the AGREE II tool ranged from 4 to 6.5. Recommendations were clearly presented (mean clarity of presentation score 73.5%), but guideline applicability was not consistently addressed (mean applicability score 39.3%). BPSD was the most prevalent term describing neuropsychiatric symptoms (number of guidelines [n] = 14). People with lived experience contributed to 6 guidelines (26.1%). Ten guidelines (43.5%) described 1 or more health equity considerations. Guidelines made recommendations for assessing and managing agitation (n = 12), aggression (n = 10), psychosis (n = 11), depression (n = 9), anxiety (n = 5), apathy (n = 6), inappropriate sexual behavior (n = 3), nighttime behavior (n = 5), and eating disturbances (n = 3). There was substantial variability in recommendation statements, evidence quality assigned to each statement, and strength of recommendations. There are several moderate to high-quality clinical practice guidelines making recommendations on BPSD assessment and management, but variability in recommendation statements across guidelines and insufficient consideration of guideline applicability may hamper guideline dissemination and implementation in clinical practice. [ABSTRACT FROM AUTHOR]

This study measures public health policies' and healthcare system's influence, by assessing the contributions of avoidable deaths, on the gender gaps in life expectancy and disparity (GGLD and GGLD, respectively) in the United States (US) and Canada from 2001 to 2019. To estimate the GGLE and GGLD, we retrieved age- and sex-specific causes of death from the World Health Organization's mortality database. By employing the continuous-change model, we decomposed the GGLE and GGLD by age and cause of death for each year and over time using females as the reference group. In Canada and the US, the GGLE (GGLD) narrowed (increased) by 0.9 (0.2) and 0.2 (0.3) years, respectively. Largest contributor to the GGLE was non-avoidable deaths in Canada and preventable deaths in the US. Preventable deaths had the largest contributions to the GGLD in both countries. Ischemic heart disease contributed to the narrowing GGLE/GGLD in both countries. Conversely, treatable causes of death increased the GGLE/GGLD in both countries. In Canada, "treatable & preventable" as well as preventable causes of death narrowed the GGLE while opposite was seen in the US. While lung cancer contributed to the narrowing GGLE/GGLD, drug-related death contributed to the widening GGLE/GGLD in both countries. Injury-related deaths contributed to the narrowing GGLE/GGLD in Canada but not in the US. The contributions of avoidable causes of death to the GGLE declined in the age groups 55–74 in Canada and 70–74 in the US, whereas the GGLE widened for ages 25–34 in the US. Canada experienced larger reduction in the GGLE compared to the US attributed mainly to preventable causes of death. To narrow the GGLE and GGLD, the US needs to address injury deaths. Urgent interventions are required for drug-related death in both countries, particularly among males aged 15–44 years. • Avoidable causes of death contributed to the narrowing GGLE/GGLD in Canada. • Avoidable causes of death contributed to the narrowing GGLE and the widening GGLD in the US. • Drug-related deaths contributed to the widening GGLE/GGLD in both countries. • Injury deaths contributed to the narrowing GGLE in Canada but not in the US. [ABSTRACT FROM AUTHOR]

Despite thousands of licensed cannabis retail stores operating across Canada, there remains a significant illicit cannabis market. Some cannabis users continue to buy cannabis from dealers, illicit stores, and/or illicit online retailers. Data are from the 2021 British Columbia Cannabis Use Survey. Respondents (n = 8473) were 19 years or older, lived in British Columbia at the time of the survey, and reported using cannabis in the past 12 months. Buying cannabis from all types of illicit sources was more common among younger cannabis users, those who use cannabis more frequently and started using cannabis before the age of 17 (vs. 19 or older), and among those who co-use cannabis with other drugs. Specifically, buying cannabis from a dealer was more common among men, those with lower educational attainment, and those who seek the lowest prices when buying cannabis. In contrast, those using cannabis for medical (vs. non-medical) purposes were more likely to report getting cannabis from illicit retail stores, while buying cannabis from illicit websites was more common among people who use edible cannabis products. Consistent with other studies, younger and more frequent cannabis users were more likely to report buying cannabis from illicit sources. However, these findings suggest there is significant heterogeneity among those who buy cannabis from different types of illicit sources, which should be carefully considered when developing policies and strategies aimed at encouraging consumers to transition to legal sources. [ABSTRACT FROM AUTHOR]

• Understanding the drivers of pandemic-coincident increases in overdose is important. • Emerging research considers the potential role of income support payments. • Ecological analyses found unequal distributions overdose increases across regions. • Results found no correlation between support payments and overdose in BC. • Desynchronized payment structures may explain deviations from previous research. Pandemic income support payments have been speculatively linked to an increased incidence of illicit drug poisoning (overdose). However, existing research is limited. Collating Canadian Emergency Response Benefit (CERB) payment data with data on paramedic attended overdose and illicit drug toxicity deaths for the province of British Columbia at the Local Health Area (LHA) level, we conducted a correlation analysis to compare overdose rates before, during and after active CERB disbursement. There were 20,014,270 CERB-entitled weeks identified among residents of British Columbia for the duration of the pandemic response program. Approximately 52 % of all CERB entitled weeks in the study were among females and approximately 48 % were among males. Paramedic-attended overdoses increased uniformly across the pre-CERB, CERB and post-CERB periods, while illicit drug toxicity deaths sharply increased and then remained high over the period of the study. Correlation analyses between overdose and CERB-entitled weeks approached zero for both paramedic-attended overdoses and illicit drug toxicity deaths. These findings suggest that attributing the pandemic increase in overdose to income support payments is unfounded. Sustained levels of unacceptably high non-fatal and fatal drug poisonings that further increased at the start of the pandemic are reflective of complex pre-existing and pandemic-driven changes to overdose risk. [ABSTRACT FROM AUTHOR]

To evaluate the scale-up of the OPUS-AP program to improve the care of residents at long-term care (LTC) centers through the systematic implementation of resident-centered approaches to care, the application of nonpharmacologic interventions for the management of behavioral and psychological symptoms of dementia (BPSD), and the deprescribing of antipsychotics where these are not clinically indicated. Prospective, closed cohort. Residents with major neurocognitive disorder (MNCD) from 24 (phase 1) and 129 (phase 2) publicly funded LTC centers in Quebec, Canada. The primary outcome was antipsychotic deprescribing (cessation or dose reduction). Secondary outcomes included changes in benzodiazepine and antidepressant prescriptions, BPSD, and falls. Comparisons were made between assessments at baseline and after 9 months. OPUS-AP phase 2 was conducted from March to December 2019 in 329 clinical wards at 129 LTC centers. At baseline, the 10,601 included residents had a mean age of 82.9: 64.6% were of female sex, 73.7% had a diagnosis of MNCD, and 47.0% had an antipsychotic prescription. These characteristics were similar to those of the 1054 residents at the 24 LTC centers in phase 1. In phase 2, successful antipsychotic deprescribing was achieved for 77.1% of residents in whom this approach was attempted, compared to 85.5% in phase 1. Phase 1 and 2 showed statistically significant improvements in the Cohen-Mansfield Agitation Inventory score and reduced use of benzodiazepines in residents with successful antipsychotic deprescribing. These improvements were of a smaller magnitude in phase 2. Statistically significant reductions in falls were observed in phase 2. The scale-up of the OPUS-AP program from 24 to 129 LTC centers was successful and resulted in a significant reduction in antipsychotic use, as well as improvement in BPSD, and reductions in benzodiazepine use and falls in residents with successful antipsychotic deprescribing. [ABSTRACT FROM AUTHOR]

The closure of schools to prevent the spread of COVID-19 prompted concerns of deteriorating lifestyle behaviours, mental health, and wellbeing of children, particularly those in socioeconomically disadvantaged settings. We assessed changes in lifestyle behaviours (physical activity, screen time, eating habits and bed/wake-up times), mental health and wellbeing during the first lockdown in Spring 2020 as perceived by school children from disadvantaged settings, and examined determinants of these changes. Cross-sectional study. We surveyed 1095 grade 4 to 6 students (age 9–12 years) from 20 schools in socioeconomically disadvantaged communities in northern Canada. Students reported on changes in lifestyle behaviours, mental health and wellbeing during the lockdown. Determinants of these perceived changes were examined in multivariable regression models. A majority of students reported declines in physical activity, having late bed/wake-up times, and modest improvements in mental health and wellbeing. Many students reported increases rather than decreases in screen time and snacking. Positive attitudes toward being active, eating healthy, going to sleep on time and being healthy were strongly associated with maintaining healthy lifestyle behaviours during the lockdown. Positive attitudes toward active and healthy living and healthy lifestyle behaviours were associated with maintaining positive mental health and wellbeing during the lockdown. The considerable changes in lifestyle behaviors, superimposed on the pre-existing burden of unhealthy lifestyle behaviours, put this generation of children at increased risk for future chronic disease. Findings call for effective health promotion of active and healthy lifestyles to benefit both physical and mental health. [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]

Investments in public health – prevention of illnesses, and promotion, surveillance, and protection of population health – may improve population health, however, effects may only be observed over a long period of time. To investigate the potential long-run relationship between expenditures on public health and avoidable mortality from preventable causes. We focused on the country spending the most on public health in the OECD, Canada. We constructed a longitudinal dataset on mortality, health care expenditures and socio-demographic information covering years 1979–2017 for the ten Canadian provinces. We estimated error correction models for panel data to disentangle short-from long-run relationships between expenditures on public health and avoidable mortality from preventable causes. We further explored some specific causes of mortality to understand potential drivers. For comparison, we also estimated the short-run relationship between curative expenditures and avoidable mortality from treatable causes. We find evidence of a long-run relationship between expenditures on public health and preventable mortality, and no consistent short-run associations between these two variables. Findings suggest that a 1% increase in expenditures on public health could lead to 0.22% decrease in preventable mortality. Reductions in preventable mortality are greater for males (−0.29%) compared to females (−0.09%). These results are robust to different specifications. Reductions in some cancer and cardiovascular deaths are among the probable drivers of this overall decrease. By contrast, we do not find evidence of a consistent short-run relationship between curative expenditures and treatable mortality, except for males. This study supports the argument that expenditures on public health reap health benefits primarily in the long run, which, in this case, represents a reduction in avoidable mortality from preventable causes. Reducing public health expenditures on the premise that they have no immediate measurable benefits might thus harm population health outcomes in the long run. • Literature on health expenditures and health outcomes rarely separates long-run and short-run. • Public health requires time to produce health effect, hence a need to model the long-run relationship. • Expenditures on public health are associated with a long run reduction of preventable mortality. • This long run relationship is stronger for preventable mortality among males than females. • There is a limited influence of curative expenditures on treatable mortality. [ABSTRACT FROM AUTHOR]

• Reliance on a toxic, illegal drug supply is a main driver of overdose in Canada. • Decriminalization was perceived as unlikely to reduce overdose deaths. • Regulation was seen as the necessary policy approach for reducing overdose deaths. • Under decriminalization, people continue to be exposed to toxic drugs. • The model of regulation is critical to the effectiveness of regulation. North America and the province of British Columbia (BC), Canada, is experiencing an unprecedented number of overdose deaths. In BC, overdose has become the leading cause of death for people between the ages of 10–59 years old. In January 2023, BC decriminalized personal possession of a number of illegal substances with one aim being to address overdose deaths through stigma reduction and promoting access to substance use services. We conducted a qualitative study to understand people who use drugs' (PWUD) perceptions of the new decriminalization policy, immediately prior to its' implementation (October-December 2022). To contextualize decriminalization within broader drug policy, we also asked PWUD what they perceived as the priority issues drug policy ought to address and the necessary solutions. Our final sample included 38 participants who used illegal drugs in the past month. We identified four themes: 1) The illicit drug supply as the main driver of drug toxicity deaths 2) Concerns about the impact of decriminalization on drug toxicity deaths 3) Views towards decriminalization as a policy response in the context of the drug toxicity crisis 4) Regulation as a symbol of hope for reducing drug toxicity deaths. From our data it became clear that many anticipated that decriminalization would have minimal or no impact on the overdose crisis. Regulation was perceived as the necessary policy approach for effectively and candidly addressing the drivers of the ongoing overdose crisis. These findings are important as jurisdictions consider different approaches to moving away from prohibition-based drug policy. [ABSTRACT FROM AUTHOR]

The purpose of this study was to develop a grounded theory of how to promote personal development in high-performance sport environments. Individual interviews were conducted with 32 members of the Canadian junior and senior national biathlon teams, including 18 athletes (9 women, 9 men, M age = 20.8 years, SD = 2.9), 5 coaches (1 woman, 4 men), 3 technical leaders (2 women, 1 man), and 6 parents (3 mothers, 3 fathers). Follow-up interviews were conducted with five key participants. Straussian grounded theory methodology was used. Analytic techniques included open coding, constant comparison, questioning, memoing, diagramming, and theoretical integration. The grounded theory is based on the core category that personal development is a continual and individualized process. Three propositions represent how to promote athletes' personal development process. Proposition 1: Athletes use realistic self-evaluation and goal setting. Proposition 2: Athletes experience different situations and reflect on their areas for personal development. Proposition 3: Athletes perceive and receive social support. The grounded theory portrays propositions that can be used to promote athletes' personal development in high-performance sport environments. It may inform future applied research and the delivery of sport psychology support to high-performance athletes. • We developed a grounded theory of how to promote personal development in high-performance sport environments. • The grounded theory is based on a core category and three propositions that represent how to promote athletes' personal development process. • Proposition 1: Athletes use realistic self-evaluation and goal setting to promote their personal development. • Proposition 2: Athletes experience different situations and reflect on their areas for personal development. • Proposition 3: Athletes perceive and receive social support that benefit their personal development. [ABSTRACT FROM AUTHOR]

Among people living with HIV and hepatitis C virus (HCV), people who inject drugs (PWID) have historically experienced higher mortality rates. Direct-acting antivirals (DAA), which have led to a 90 % HCV cure rate independently of HIV co-infection, have improved mortality rates. However, DAA era mortality trends among PWID with HIV/HCV remain unknown. Using data from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC), we compared pre/post-DAA availability mortality changes in three groups: PWID, men who have sex with men (MSM), and all other participants. We included InCHEHC participants with HIV/HCV followed between 2010 and 2019 in Canada, France, the Netherlands, Spain, and Switzerland. All-cause mortality hazard was compared in the three groups, using Cox proportional hazards regression models adjusted for sex, age, advanced fibrosis/cirrhosis, and pre/post DAA availability. Of the 11,029 participants, 76 % were men, 46 % were PWID, baseline median age was 46 years (interquartile range [IQR] = 40;51), and median CD4 T-cell count was 490 cells/mm3 (IQR = 327;689). Over the study period (median follow-up = 7.2 years (IQR = 3.7;10.0)), 6143 (56 %) participants received HCV treatment, 4880 (44 %) were cured, and 1322 participants died (mortality rate = 1.81/100 person-years (PY) [95 % confidence interval (CI)=1.72–1.91]). Overall, PWID had higher mortality rates than MSM (2.5/100 PY [95 % CI = 2.3–2.6] vs. 0.8/100 PY [95 % CI = 0.7–0.9], respectively). Unlike women with other transmission modes, those who injected drugs had a higher mortality hazard than men who did not inject drugs and men who were not MSM (adjusted Hazard-Ratio (aHR) [95 % CI] = 1.3[1.0–1.6]). Post-DAA availability, mortality decreased among MSM in the Netherlands, Spain, and Switzerland and increased among PWID in Canada (aHR [95 % CI] = 1.73 [1.15–2.61]). Post-DAA availability, all-cause mortality did not decrease in PWID. Determinants of cause-specific deaths (drug-related, HIV-related, or HCV-related) need to be identified to explain persistently high mortality among PWID in the DAA era. [ABSTRACT FROM AUTHOR]

The prevalence of vision disorders is high among geriatric and hospital inpatient populations, yet they often go undetected, resulting in consequences such as falls or prolonged recovery time. A needs assessment study was conducted to investigate levels of vision and the potential prevalence of unmanaged/undiagnosed ocular disorders among adult inpatients in a hospital-based rehabilitation unit. Cross-sectional study. Inpatient rehabilitation units of an acute care hospital system in Ontario, Canada. Adults (n = 112) in a hospital inpatient rehabilitation unit participated from October 2018 to February 2019. Participants were surveyed regarding their demographic, ocular, and medical data and spectacle wear. Visual acuity, contrast sensitivity, visual fields, and stereoacuity plus the spectacle condition were directly assessed. The majority (75%) were found to have reduced habitual vision while in hospital. Nearly 60% of participants reported at least some difficulty reading a newspaper or distinguishing a face or were "not happy with their vision." This was despite 80% of participants reporting that they had an eye care practitioner and 70% that they had an eye examination within the last 2 years. More than half (51.8%) of the participants received the recommendation to follow up with their eye care practitioner on discharge from the hospital. Reduced vision and vision disorders has a high prevalence among hospital patients in rehabilitation units and should be evaluated at or soon after hospital intake. By incorporating vision screening tools, necessary precautions may be taken to avoid possible falls and promote recovery. [ABSTRACT FROM AUTHOR]

Responding to increasing rates of illicit drug toxicity mortality in British Columbia, regional health authorities introduced various types and models of drug checking services starting in 2016. Uptake has been gradual yet consistent, but motivators and barriers of service use have not been well-described. The British Columbia Harm Reduction Client Survey is a cross-sectional survey conducted at harm reduction sites across British Columbia. Data for the present findings were collected between March 2021 and January 2022. Participants (n = 537) were asked about their use of drug checking services and what prevented them from using available services. Responses were analyzed with descriptive statistics and multivariable logistic regression. Of all participants, 519 (96.6 %) answered the survey question on drug checking with 144 (27.7 %) reporting having used services within six months. Participants highlighted barriers such as not knowing where to access services (21.0 %), or not having services in their area (10.0 %). Among people who did not report recent use of fentanyl, 49.6 % stated they would not use their drugs if they tested positive for fentanyl. Other harm reduction behaviors were positively associated with drug checking, such as use of overdose prevention sites (adjusted odds ratio [AOR]: 2.75, 95 % confidence interval [CI]: 1.65, 4.59) and having a naloxone kit (AOR: 2.67, 95 %CI: 1.14, 6.28). Receipt of opioid agonist therapy in the previous six months was also positively associated with drug checking (AOR: 1.72, 95 %CI: 1.05, 2.83). Drug checking uptake remains low in British Columbia, however this study identified desire for services among participants, suggesting a need for expanded drug checking services. Behavioral change was reported among a high proportion of people who said they would not use their drugs if they tested positive for fentanyl, meaning that immunoassay strips alone have utility in the context of a pervasive fentanyl supply. [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]

In high-performance sport, an athlete's ability to overcome setbacks and sustain their pursuit of long-term goals is essential for success. Grit (i.e., passion and perseverance over long-terms) has been linked to success in a variety of domains but is often critiqued for its limited predictive utility when compared to other psychological variables including self-control, conscientiousness, and mental toughness. The purpose of this study was to examine whether grit predicted important athlete outcomes (i.e., various measures of sport performance and athlete well-being) beyond other determinants of success. Data from 214 collegiate student-athletes (111 women, 103 men; M age = 21.02, SD = 2.26) from Western Canadian universities were analysed. When predicting performance, the addition of the grit subscales (i.e., consistency of interests, perseverance of effort, adaptability to situations) explained an additional 11% of variance (R 2 = 0.37, F [7, 203] = 7.16, p <.001) beyond self-control, conscientiousness, and mental toughness in subjective sport performance perceptions; however, grit did not add unique variance when entered into models predicting athlete goal achievement perceptions or highest level of competition. When predicting well-being, addition of the grit subscales added 18% of unique variance (R 2 = 0.43, F [7, 203] = 21.43, p <.001) beyond other determinants of success in eudaimonic well-being, and 5% (R 2 = 0.17, F [7, 203] = 6.95, p <.001) in satisfaction with sport, but did not add any unique variance to the model predicting mood. The partial support of the predictive utility of grit illustrates the complexity of forecasting success in sport and offers evidence that grit should continue to be studied as a motivational disposition in the domain of sport. • Grit subscales (PE, CI, AS) added unique variance to models predicting performance and well-being. • PE was a significant predictor of some measures of performance and well-being, while CI was not. • A new grit subscale—AS—was a significant predictor of some measures of performance and well-being. • Mental toughness was the most consistent predictor of our six performance and well-being. • Conscientiousness and self-control did not significantly contribute to regression models. [ABSTRACT FROM AUTHOR]

Interstitial brachytherapy (ISBT) plays an important role in the management of locally advanced gynaecological malignancies. However, the relationship between urinary toxicity and dose to the urethra is not well understood. We sought to evaluate the correlation between urethral dose and the incidence of genitourinary complications among patients undergoing vaginal high dose rate ISBT. Eighty-three patients treated with ISBT between August 2014 and April 2018 were retrospectively reviewed. CTCAE version 5.0 was used to grade toxicity. Individual treatment plans were evaluated to collect dose parameters. Urethral contours were added to the structure sets using a uniform 1 cm diameter brush and minimum doses to the hottest 0.1, 0.2 and 0.5 cm3 (D0.1cm3, D0.2cm3 and D0.5cm3) of the urethra were obtained. Total (ISBT ± external beam radiotherapy) equivalent doses in 2 Gy fractions (EQD2) received by the targets and organs at risk were calculated. Numerical counts (%) and medians (interquartile range) were used to characterise the data. Fisher's exact and the Mann–Whitney–Wilcox tests were used as appropriate. Receiver operator curve analysis was used to define the urethral threshold dose that correlated to genitourinary toxicity. The median age and follow-up times were 67 years (59–75) and 25 months (16–37), respectively. Patients had predominantly primary endometrial (49%) and vaginal (37%) cancer, with four (5%) patients with metastatic rectal cancer to the vagina. Twenty-four of 79 (30%) patients experienced acute genitourinary toxicity and 34 of 71 (48%) experienced late genitourinary toxicity. In both analyses, the median urethral dose was significantly higher among those with toxicity. Receiver operator curve analysis indicated that D0.1cm3, D0.2cm3 and D0.5cm3 of the urethra were associated with the development of toxicity at doses >78, >71 and >62 Gy, respectively. Urethral dose seems to predict genitourinary toxicity in ISBT of vaginal tumours. Further study with an expanded cohort and longer follow-up is warranted. • A review of 83 patients, treated with high dose rate interstitial brachytherapy, at a tertiary centre in Canada. • Urethral D0.1cm3, D0.2cm3 and D0.5cm3 correlated with the development of acute and late genitourinary toxicity. • This report supports the growing evidence in favour of establishing dose constraints for the urethra in HDR brachytherapy. • Prospective trials using patient-reported outcomes are needed to validate results of this study. [ABSTRACT FROM AUTHOR]

Various methods are used to induce or pressure patients into being more adherent with treatment; collectively, we can describe them as leverage. Leverage strategies are common in psychiatric services, and may carry unintended, potentially negative effects. We examine their relationships to experiences and impact of stigma. Data from 137 researcher-administered surveys with adult general psychiatry patients from hospital and community psychiatric services in Toronto, Canada were analyzed, including socio-demographics, service use history, current level of symptoms, insight into mental illness, and stigma scores. Descriptive and bivariate analyses were performed to guide generalized linear models to examine the relationships between multiple domains of leverage and experiences and impact of stigma. Use of leverage strategies is prevalent, ranging from outpatient commitment (10.2%) to financial (21.2%) to access to children or family (31.2%). Regression analyses show being female, having high psychiatric symptomology, financial leverage, and family and/or child access leverage were significantly correlated with stigma experience; similarly, these same factors, except for being female, were also associated with stigma impact. This cross-sectional study shows a significant association between use of some types of leverage and experience and impact of stigma in general psychiatry patients. Care and balance between good intentioned but potentially stigmatizing leveraging practices should be actively considered in clinical decisions to avoid the unintended negative effects. [ABSTRACT FROM AUTHOR]

Existing nutrition knowledge measures tend to be lengthy or tailored for specific contexts, making them unsuitable for population-based surveys. Given the growing emphasis within country-specific dietary guidelines on reducing consumption of highly processed foods, consumers' ability to understand and apply principles related to level of food processing could serve as a proxy measure of general nutrition knowledge. To examine the content validity of the Food Processing Knowledge (FoodProK) score based on subject matter expert consultation with Registered dietitian nutritionists (RDNs). RDNs in Canada (n = 64) completed an online survey, including the FoodProK, in January 2020. Participants rated the "healthiness" of 12 food products from four categories (fruit, meat, dairy, and grains) on a scale from 1 to 10. FoodProK scores were assigned based on concordance of ratings within each food category, with rankings according to the NOVA classification system, with less processed foods representing higher healthiness. For each category, one-way repeated-measures analysis of variance models tested whether the three product ratings were significantly different from one another. Descriptive statistics compared ratings and FoodProK scores across categories. Open-ended feedback was solicited to assess face validity of the score. RDNs' FoodProK scores were strongly associated with level of food processing. Almost one in three RDNs received perfect FoodProK scores, and the mean score was 7.0 of 8.0 possible points. Within each category, the three foods received significantly different healthiness ratings, in the same order as the NOVA system (P < 0.001 for all contrasts). Open-ended responses showed that RDNs did not perceive meaningful differences between the processed meat products, suggesting the need to change one of the products in the meat category. Overall, 80% of RDNs reported level of processing as an important indicator of the healthiness of foods. Level of food processing represents a promising framework for assessing general nutrition knowledge in population-based surveys. [ABSTRACT FROM AUTHOR]

A number of studies have demonstrated that patients with autoimmune disease have lower levels of vitamin D prompting speculation that vitamin D might suppress inflammation and immune responses in children with juvenile idiopathic arthritis (JIA). The objective of this study was to compare vitamin D levels in children with JIA at disease onset with healthy children. We hypothesized that children and adolescents with JIA have lower vitamin D levels than healthy children and adolescents. Data from a Canadian cohort of children with new-onset JIA (n = 164, data collection 2007-2012) were compared to Canadian Health Measures Survey (CHMS) data (n =4027, data collection 2007-2011). We compared 25-hydroxy vitamin D (25(OH)D) concentrations with measures of inflammation, vitamin D supplement use, milk intake, and season of birth. Mean 25(OH)D level was significantly higher in patients with JIA (79 ± 3.1 nmol/L) than in healthy controls (68 ± 1.8 nmol/L P <.05). Patients with JIA more often used vitamin D containing supplements (50% vs. 7%; P <.05). The prevalence of 25(OH)D deficiency (<30 nmol/L) was 6% for both groups. Children with JIA with 25(OH)D deficiency or insufficiency (<50 nmol/L) had higher C-reactive protein levels. Children with JIA were more often born in the fall and winter compared to healthy children. In contrast to earlier studies, we found vitamin D levels in Canadian children with JIA were higher compared to healthy children and associated with more frequent use of vitamin D supplements. Among children with JIA, low vitamin D levels were associated with indicators of greater inflammation. [ABSTRACT FROM AUTHOR]

To examine the association between self-reported food skills and diet quality along with measured food waste among a sample of Canadian parents. Cross-sectional data from surveys to assess food skills, 3-day food records to assess the Healthy Eating Index (HEI)-2015, and food waste measured by household waste audits. Guelph-Wellington, Ontario. Parents (n = 130) with children aged 2–8 years. HEI-2015 scores, daily per capita avoidable and unavoidable food waste (grams). Linear regression using generalized estimating equations to determine unstandardized β estimates of associations between food skills and dependent variables. Models were adjusted for multiple testing, gender, and level of education. Food safety knowledge for cooking hot foods (β = 4.3, P = 0.05), planning (β = 4.5, P = 0.001), and conceptualizing food (β = 4.0, P = 0.03) were positively associated with HEI-2015 scores. Knowledge related to best before dates (β = 25.3, P = 0.05; β = 12.1, P = 0.04), conceptualizing food (β = 34.1, P = 0.01; β = 13.8, P = 0.02), and mechanical techniques (β = 39.2, P = 0.01; β = 20.5, P = 0.004) were associated with more avoidable and unavoidable food waste, respectively. Addressing higher-level food skills with a focus on efficient food preparation practices that make use of all edible portions of foods could play an important role in minimizing food waste and improving diet quality. Additional research in other countries and in a larger, more socioeconomically diverse sample is needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Medical assistance in dying (MAID) was legalized in Canada in 2016. We aimed to characterize the prevalence of psychiatric comorbidity among MAID requesters in order to enhance clinicians' awareness of the potential for psychiatric needs among MAID requesters. Using chart review, we retrospectively abstracted demographic, clinical, and psychosocial variables of MAID requesters at our institution, a 638-bed tertiary care center in Toronto, Canada. Patients requesting MAID between June 2016 and April 2019 were included. Psychiatric comorbidity was the primary dependent variable. 155 patients requested MAID during the study period. Among them, 60 (39%) had documented psychiatric comorbidity, most commonly depression (n =44; 73%). Severe mental illness accounted for 10 cases (6.5% of the total sample). Among patients with psychiatric comorbidity, 25 (41.7%) had at least one MAID eligibility assessment conducted by a psychiatrist, compared to 16 (16.8%) patients without psychiatric comorbidity (χ2=11.649, df=1, p =0.001). Among the 10 patients with severe mental illness (SMI), a psychiatrist conducted a MAID eligibility assessment in 8 patients (80%), compared to 17 patients (34%) without SMI (χ2=7.255, df=1, p =0.007). Patients with psychiatric comorbidity comprise a substantial proportion of patients requesting MAID. These findings highlight the importance of recognizing the psychiatric needs of MAID requesters and involving psychiatry in MAID assessments when warranted. A gap still exists in understanding which factors are most important in determining the need for psychiatric involvement in MAID assessments. We propose recommendations borne from our clinical experience. [ABSTRACT FROM AUTHOR]

Assess the impact of a new pharmaceutical care model on (1) polypharmacy and (2) potentially inappropriate medication (PIM) use in long-term care facilities (LTCFs). Pragmatic quasi-experimental study with a control group. This multifaceted model enables pharmacists and nurses to increase their professional autonomy by enforcing laws designed to expand their scope of practice. It also involves a strategic reorganization of care, interdisciplinary training, and systematic medication reviews. Two LTCFs exposed to the model (409 residents) were compared to 2 control LTCFs (282 residents) in Quebec, Canada. All individuals were aged 65 years or older and residing in included LTCFs. Polypharmacy (≥10 medications) and PIM (2015 Beers criteria) were analyzed throughout 12 months between March 2017 and June 2018. Groups were compared before and after implementation using repeated measures mixed Poisson or logistic regression models, adjusting for potential confounding variables. Over 12 months, for regular medications, polypharmacy decreased from 42% to 20% (exposed group) and from 50% to 41% (control group) [difference in differences (DID): 13%, P <.001]. Mean number of PIMs also decreased from 0.79 to 0.56 (exposed group) and from 1.08 to 0.90 (control group) (DID: 0.05, P =.002). Compared with usual care, this multifaceted model reduced the probability of receiving ≥10 medications and the mean number of PIMs. Greater professional autonomy, reorganization of care, training, and medication review can optimize pharmaceutical care. As the role of pharmacists is expanding in many countries, this model shows what could be achieved with increased professional autonomy of pharmacists and nurses in LTCFs. [ABSTRACT FROM AUTHOR]

• Child and Youth Advocacy Centres (CYACs) are an emerging service model in Canada. • Case tracking data is valuable in understanding how the model is operationalized. • Client gender, age, and type of assault are associated with use of CYAC services. • This profile contributes to a broader understanding of the CYAC model in Canada. The Child and Youth Advocacy Center (CYAC) model supports a coordinated response for young victims of abuse and their families. The model is prevalent in the United States, with more recent growth across Canada. This descriptive study summarizes case tracking data to profile the client population, referral characteristics, use of services, and associations between client characteristics and service use in child maltreatment investigations referred to the first hospital-based Canadian CYAC over time. This data illustrates the potential to use CYAC case tracking data in understanding the use of, and client populations served by, this emerging collaborative service model in Canada. Participants and Setting Participants included children and youth served at SeaStar Child and Youth Advocacy Center in Halifax, Nova Scotia (N = 1,364) in its first seven years of operation. Descriptive statistics were calculated for client and case characteristics. Differences in characteristics between time periods were assessed using Chi-square tests. Risk ratios (RR) with 95% confidence intervals (CI) for the associations between characteristics and the use of specific services were estimated using log-binomial regression. The most common indication for referral to this CYAC was sexual assault (53.3 %). Most clients were female (60.9 %), with a median client age of 10.0 years (IQR 6.0 to 13.0 years). In over half of all cases the alleged perpetrator was a family member (56.0 %) and most alleged perpetrators were adults (79.9 %). Medical exams were provided in 13.4 % of referrals and were less likely in children aged > 7 years (age 7–12, RR = 0.38, CI 0.27–0.51; and age > 12, RR = 0.41, CI 0.29–0.58), in referrals for sexual assault compared to physical assault (RR = 0.69, CI 0.52–0.90), and when the alleged perpetrator was an acquaintance rather than a family member (RR = 0.48, CI 0.34–0.67). Child and youth advocate support was provided in 76.1 % of cases and was slightly more likely in sexual assault and 'other' types of referrals (RR = 1.14, CI 1.06–1.22; and RR = 1.13, CI 1.02–1.26, respectively). Canine Assisted Intervention (CAI) was offered in 38.6 % of cases and was more likely in referrals for sexual assault (RR = 1.23, CI 1.01–1.50). Of those who had CAI, 41 % had an Accredited Facility Dog present with them during their forensic interview; this accompaniment in interview was more likely for clients who were older (RR = 2.15, CI 1.15–4.01) and female (RR = 2.56, CI 1.34–4.90). There were few differences in client and case characteristics or service use over time. This study provides descriptive context of child maltreatment investigations referred to a Canadian hospital-based CYAC. Given the recognized variability among CYACs in scope and setting, this profile contributes to a broader understanding of the client population and service uptake at a CYAC which varies from the prototypical US-based model most often represented in the existing literature. This information contributes to a more detailed understanding of the CYAC model in practice in Canada, which can help to inform the growth and development of CYACs in the future. [ABSTRACT FROM AUTHOR]

• A mother found to have alienated her child(ren) was not more likely to get a decrease in parenting time, but was more likely to lose her case and lose custody than a father who was found to have alienated his children but the effect sizes were small and not meaningfully significant. • 25 "abusive" alienated parents were mothers (71.4% of 35), and 10 were fathers (28.6% of 35), so the presumption that "abusive" alienated parents are mostly fathers is not reflected in these data. • Alienating mothers' claims of abuse against known "abusive" alienated fathers were not being discredited more often than they were for alienating fathers.ze • Alienating mothers were not more likely than chance to lose custody than alienating fathers when the third party who found PA was a custody assessor or GAL. • Alienating fathers made fewer allegations of abuse against alienated mothers (n = 112), but the percentage of substantiated allegations was similar (7.1%) to those of alienating mothers. • Gender of the alienating parent, number of unsubstantiated allegations of abuse, and an interaction of the variables were not predictors of whether an alienated parent lost custody of their children. There have been legislative efforts to control how child custody decisions are handled in family courts where allegations of abuse and of parental alienation (PA) are levied. The "findings" reported to support such legislation have been based on one unreviewed study with identified methodological issues (Harman & Lorandos, 2021). We tested six pre-registered hypotheses to determine whether there is empirical support for the "research findings" used to support these laws. Five-hundred PA cases were sequentially selected from 4,889 Canadian trial court decisions. Independent coders who were blind to the hypotheses coded all cases for details about custody and allegations of abuse. We failed to find support for the "findings" that have been used to support legislative changes. For example, this study focused only upon cases where PA was determined to actually have occurred in at least one of the children in the family. It differs from Harman & Lorandos (2021) in that this study found that alienating mothers' claims of abuse against known "abusive" alienated fathers were not being discredited more often than they were for alienating fathers. The negative impact of failing to base legislation on a comprehensive consideration of the full scope of scientific evidence available (e.g., Kayden's Law in the reauthorized Violence Against Women's Act, 2022) is discussed. [ABSTRACT FROM AUTHOR]

This study examined several factors affecting the perception of Canadian parents about their children's mental health during COVID-19. The contribution of this research included fresh evidence from examining the demographic and sociological factors influencing children's well-being during COVID-19 using the Canadian context. We used a cross-sectional dataset from Statistics Canada titled Impacts of COVID-19 on Canadians - Parenting during the Pandemic (2020). We relied on an ordered logit model and computed the respective odds ratios. Our results showed that parents with a university degree and those working from home are less concerned about their children's mental health. Nonetheless, having a disabled child, belonging to a minority, having children aged six-to fourteen-years old, and having lost a job or experienced a drop in working hours increased parents' worry. Additionally, having worries about being connected with family and friends, being concerned about work-life balance, feeling lonely at home, and waiting for the reopening of childcare services all increased the likelihood of parents' anxiety about their child's mental health. When running the analysis by province, we saw that being an immigrant and belonging to a minority increased parents' worry only in Ontario and British Columbia. Policymakers are encouraged to foster working-from-home practices as working from home has been linked to less worry about child mental health, mainly among mothers, as indicated in our gender heterogeneity analysis. In addition, it is advised that families with a disabled child, and families belonging to a minority received additional support. Lastly, policymakers are advised to consider the social cost of preventive measures and incorporate this into any future preventative policymaking as the social impact variables were robust across all models. • Examined perceptions of Canadian parents about their children's mental health during COVID-19. • Focused on the role of the individual, household, labor market, and social factors. • The findings demonstrate a key role for the social drivers. • Working from home reduces the likelihood of worry about children's mental health. • We document heterogeneous province and gender effects. [ABSTRACT FROM AUTHOR]

Drug overdose deaths have reached record-breaking levels in North America. Drug checking services (DCS) provide localized information on the contents of drugs to individuals and communities. Depending on the design, individuals can submit drug samples for onsite "real-time" testing or offsite testing. The results can shed light on emerging drugs in the community and support ongoing prevention and surveillance efforts. We sought to describe and report aggregate outcomes of DCS operating in North America. The North American Drug Checking Survey was launched in 2022 to characterize and monitor DCS operating in the region. Sixteen organizations from the US (n = 9), Canada (n = 5), and Mexico (n = 2) responded to the survey. Each organization reported on their program's operations and provided service delivery outcomes (site- or program-level) in the aggregate. Participating organizations reported testing a total of 49,786 drug samples between 2014 and 2022. DCS were run by community-led organizations (44%), health departments (25%), universities (19%), or clinical/private laboratories (19%). The types of samples tested differed between programs (e.g., solids vs. liquids, drug paraphernalia accepted). While most organizations tested onsite using fentanyl test strips (88%) and Fourier-transform infrared (FTIR) spectroscopy (63%), many sent samples offsite for confirmatory testing (63%), most often with mass spectrometry. Common facilitators of operating a DCS included: interest of clients (69%), interest of service providers (63%), and receiving external technical assistance (63%). Barriers included: the lack of funding (81%) or staff (50%), gaps in technical expertise (38%), as well as laws banning the possession and/or distribution of illicit drug samples, drug paraphernalia, or drug checking equipment (38%). DCS are scaling up in North America. Given the evolving and localized nature of illicit drug supplies, supporting the establishment and operations of DCS could enhance the public's understanding of local drug supplies to reduce drug-related harms over time. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has led to an unprecedented global crisis. It has exposed and exacerbated weaknesses in public health systems worldwide, particularly with regards to reaching the most vulnerable populations, disproportionately impacted by the pandemic. The objective of our study was to examine whether and how social inequalities in health (SIH) were considered in the design and planning of public health responses to COVID-19 in jurisdictions of Brazil, Canada, France, and Mali. This article reports on a qualitative multiple case study of testing and contact tracing interventions in regions with high COVID-19 incidence in each country, namely: Manaus (Brazil), Montréal (Canada), Île-de-France (France), and Bamako (Mali). We conducted interviews with 108 key informants involved in these interventions in the four jurisdictions, focusing on the first and second waves of the pandemic. We analyzed our data thematically using a theoretical bricolage framework. Our analysis suggests that the lack of a common understanding of SIH among all actors involved and the sense of urgency brought by the pandemic eclipsed the prioritization of SIH in the initial responses. The pandemic increased intersectoral collaboration, but decision-making power was often unequal between Ministries of Health and other actors in each jurisdiction. Various adaptations to COVID-19 interventions were implemented to reach certain population groups, therefore improving the accessibility, availability, and acceptability of testing and contact tracing. Our study contributes to identifying lessons learned from the current pandemic, namely that the ways in which SIH are understood shape how interventions are planned; that having clear guidelines on how to integrate SIH into public health interventions could lead to more inclusive pandemic responses; that for intersectoral collaboration to be fruitful, there needs to be sufficient resources and equitable decision-making power between partners; and that interventions must be flexible to respond to emerging needs while considering long-standing structural inequalities. • Equity was not prioritized in planning the initial responses to COVID-19. • Stakeholders involved had different perceptions of health inequalities. • Perceptions of health inequalities shaped the approach favored to tackle COVID-19. • Intersectoral collaboration was difficult because of unequal decision-making power. • Adaptations were gradually implemented to address health inequalities. [ABSTRACT FROM AUTHOR]

• Stimulant safer supply can prevent toxicity deaths and promote wellbeing and dignity. • Crystal methamphetamine was the most preferred stimulant safer supply substance. • Preference for crystal methamphetamine differed by age, gender and drug use history. • One size fits all approaches to safer supply are unlikely to be effective. • People who use drugs should be consulted in safer supply program design. As safer supply programs expand in Canada, stimulant safer supply is often overlooked despite the harms and criminalization faced by people who use stimulants. The 2021 Harm Reduction Client Survey was administered at 17 harm reduction sites around British Columbia, Canada. The survey included a question about what specific substance participants would want to receive as stimulant safer supply. We investigated preference of stimulant safer substance by looking at frequency of stated preference and by using multivariable logistic regression to understand factors associated with the most frequently chosen substance. Of 330 participants who reported a stimulant safer supply preference, 58.5% (n = 193) chose crystal methamphetamine, 13% (n = 43) crack cocaine and 12.4% (n = 41) cocaine powder. The options that were available by prescription at the time of data collection were chosen by under 11% of participants (dextroamphetamine n = 21, methylphenidate n = 15). A preference for crystal methamphetamine was associated with being 29 and under compared to 50 and over (AOR: 3.96, 95% CI: 1.42–11.07, p -value: 0.01); self-identifying as a cis man versus a cis woman (AOR: 1.75, 95% CI: 1.03–2.97, p -value: 0.04); and using drugs every day (AOR: 15.43, 95% CI: 3.38–70.51, p -value: < 0.01) or a few times a week (AOR: 8.90, 95% CI: 1.78–44.44, p -value: 0.01) compared to a few times a month. Preference of stimulant safer supply is associated with age, gender, and substance use characteristics. Safer supply programs that offer limited substances risk being poorly accessed, resulting in a continued reliance on an unregulated supply. Moreover, programs that do not offer a range of substances can contribute to health inequities. [ABSTRACT FROM AUTHOR]

Recent federal proposals in Canada have called for changes in the delivery and funding of school lunches. Yet little evidence has documented the nutritional quality of meals eaten by school children, which is needed to inform school lunch reforms. To assess the dietary contributions of lunch foods to daily food and nutrient intakes on school days and compare dietary intakes across eating locations (school, home, and off campus). Cross-sectional analyses of school day data from the 2015 Canadian Community Health Survey—Nutrition. Children aged 6 to 17 years who completed a 24-hour dietary recall falling on a school day in 2015 (n=2,540). Mean percent of daily intakes of energy, food groups, and nutrients contributed by foods reported at lunch and energy-adjusted intakes of nutrients and food groups consumed during the lunch meal. Descriptive statistics were used to assess the percent of daily energy, nutrients, and food groups contributed by lunch foods. Multivariable linear regression models examined differences in dietary outcomes across eating locations for the full sample and stratified by age group, with separate models for children aged 6 to 13 and 14 to 17 years. On average, foods reported at lunch provided ∼26% of daily calories on school days. Relative to energy, lunch foods provided lower contributions of dark green and orange vegetables, whole fruit, fruit juice, whole grains, milk and alternatives, fluid milk; minimally nutritious foods including sugar-sweetened beverages; and several related nutrients including total sugars; vitamins A, D, B-6, and B-12; riboflavin; and calcium. Yet, lunch foods provided proportionally higher contributions of grain products, non–whole grains, meat and alternatives, and sodium. Children aged 14 to 17 years who ate lunch at school reported higher intakes of total vegetables and fruit, whole fruit, whole grains, fiber, vitamin C, and magnesium but reported fewer calories from sugar-sweetened beverages compared with their peers who ate lunch off campus. Relative to its contribution to energy, lunch on school days contributed to proportionally lower intakes of many healthful foods such as dark green and orange vegetables, whole fruit, whole grains, and fluid milk but also proportionally lower intakes of other high-fat and high-sugar foods including sugar-sweetened beverages. This study adds to the growing body of evidence on dietary concerns during school time for Canadian children and highlights particular nutritional challenges for adolescents consuming lunch off campus. [ABSTRACT FROM AUTHOR]

A significant proportion of patients with brain metastases have a poor prognosis, with a life expectancy of 3–6 months. To determine the optimal radiotherapeutic strategy for brain metastases in this population, we conducted a randomised feasibility study of whole brain radiotherapy (WBRT) versus stereotactic radiosurgery (SRS). Patients with a life expectancy of 3–6 months and between one and 10 brain metastases with a diameter ≤4 cm were enrolled at six Canadian cancer centres. Patients were randomly assigned (1:1) to receive either WBRT (20 Gy in five fractions) or SRS (15 Gy in one fraction). The primary end point was the rate of accrual per month. Secondary feasibility and clinical end points included the ratio of accrued subjects to screened subjects. This trial is registered with ClinicalTrials.gov (number NCT02220491). In total, 210 patients were screened to enrol 22 patients into the trial; 20 patients were randomised between the two arms. Two patients did not receive treatment because one patient died and another patient withdrew consent after being enrolled. Patients were accrued between January 2015 and November 2017; the accrual rate was 0.63 patients/month. The most common reasons for exclusion were anticipated median survival outside the required range (n = 40), baseline Karnofsky Performance Score below 70 (n = 28) and more than 10 brain metastases (n = 28). The median follow-up was 7.0 months and the median survival was 7.0 months for all patients in the trial. The median intracranial progression-free survival was 1.8 months in the SRS arm and 9.2 months in the WBRT arm. There were five grade 3+ toxicities in the SRS arm and one grade 3+ toxicity in the WBRT arm; no grade 5 toxicities were observed. The cumulative rates of retreatment were 40% in the SRS arm and 40% in the WBRT arm. A randomised trial evaluating WBRT versus SRS in patients with one to 10 metastases and a poor prognosis is feasible. A slower than expected accrual rate and difficulties with accurate prognostication were identified as issues in this feasibility study. A larger phase III randomised trial is planned to determine the optimal treatment in this patient population. • The optimal management of brain metastases in patients with poor prognosis is controversial • Randomised feasibility study of whole brain radiotherapy (WBRT) versus stereotactic radiosurgery (SRS) • Patients had a life expectancy of 3–6 months and 1– 10 brain metastases • 210 patients were screened to enrol 22 patients into the trial; 20 patients were randomised • A randomised study of WBRT versus SRS is feasible in this patient population and a larger phase III trial is planned. [ABSTRACT FROM AUTHOR]

The aim of the study was to examine the association between meeting combinations of the Canadian 24-h movement guidelines and academic performance in adolescents. This cross-sectional study used the 2017 Ontario Student Drug Use and Health Survey, a survey representative of Ontario students in grades 7–12 attending publicly funded schools. A total of 10,160 students were included in the analysis. Moderate to vigorous physical activity (MVPA), screen time, sleep duration, and academic performance were self-reported. A multiple linear regression model was used to examine differences in academic performance between adolescents meeting and those not meeting the combinations of movement guidelines (≥60 min/day of MVPA; ≤2 h/day of screen time; 9–11 h/night of sleep for ages 11–13 years, 8–10 h/night for ages 14–17 years, and 7–9 h/night for ages 18 years or older). Covariates included age, sex, ethnicity, subjective socio-economic status, body mass index z-score, and substance use. We found that 5.1% of students met all three movement guidelines, whereas 39.0% did not meet any. Middle school students who met all three guidelines or either the screen time or sleep guideline displayed better academic performance than those who met none of the guidelines. High school students who met the screen time and sleep guidelines displayed better academic performance than those who did not meet any guidelines. Adhering to screen time and sleep duration recommendations is associated with better academic performance among adolescents. • Of all students, 5.1% met all three movement guidelines, whereas 39.0% did not meet any. • Sleep and screen time are more linked with academic achievement than physical activity. • Some differences were found between middle and high school students. [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]

To investigate the impact of simulated patients on dietetics students' and interns' communication and nutrition-care competence. Pre-post observational study in which students' communication and nutrition-care competence was evaluated during the first and final clinical nutrition simulations in winter, 2017. University of Guelph, Canada. Seventeen undergraduate students enrolled in Applied Clinical Skills (NUTR*4120) and 15 graduate students/interns enrolled in Practicum in Applied Nutrition II (FRAN*6720). Selected communication and nutrition-care performance indicators (PI) (undergraduates = 18; graduate = 33) included in the Canadian Integrated Competencies for Dietetic Education and Practice, each measured out of a maximum of 3 points. Grand means of communication and nutrition-care PI scores were compared across 2 time points using paired t tests, at a significance level of.05. Undergraduates' (n = 15) communication and nutrition-care PI scores increased by 0.9 ± 0.35 (49.7%) and 0.8 ± 0.22 (45.8%) points, respectively (both P <.001). Graduate students' communication and nutrition-care PI scores increased by 0.4 ± 0.45 (18.5%) and 0.7 ± 0.59 (37.9%) points, respectively (both P <.01). Simulated patients incorporated into clinical nutrition courses increase dietetics students' and interns' communication and nutrition-care competence. More research using comprehensive practice-based competency assessment tools is needed in larger samples of students and interns. [ABSTRACT FROM AUTHOR]