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Aims To quantify thoracic lymphatic burden in paediatric Fontan patients using MRI and correlate with clinical status. Methods and results Paediatric Fontan patients (<18-years-old) with clinical cardiac MRI that had routine lymphatic 3D T2 fast spin echo (FSE) imaging performed from May 2017 to October 2019 were included. 'Lymphatic burden' was quantified by thresholding-based segmentation of the 3D T2 FSE maximum intensity projection image and indexed to body surface area, performed by two independent readers blinded to patient status. There were 48 patients (27 males) with median age at MRI of 12.9 (9.4–14.7) years, time from Fontan surgery to MRI of 9.1 (5.9–10.4) years, and follow-up time post-Fontan surgery of 9.4 (6.6–11.0) years. Intraclass correlation coefficient between two observers for lymphatic burden was 0.96 (0.94–0.98). Greater lymphatic burden correlated with post-Fontan operation hospital length of stay and duration of chest tube drainage (r s = 0.416, P = 0.004 and r s = 0.439, P = 0.002). Median lymphatic burden was greater in patients with chylous effusions immediately post-Fontan (178 (118–393) vs. 113 (46–190) mL/m2, P = 0.028), and in patients with composite adverse Fontan status (n = 13) defined by heart failure (n = 3), transplant assessment (n = 2), recurrent effusions (n = 6), Fontan thrombus (n = 2), and/or PLE (n = 6) post-Fontan (435 (137–822) vs. 114 (51–178) mL/m2, P = 0.003). Lymphatic burden > 600 mL/m2 was associated with late adverse Fontan status with sensitivity of 57% and specificity of 95%. Conclusion Quantification of MR lymphatic burden is a reliable tool to assess the lymphatics post-Fontan and is associated with clinical status. [ABSTRACT FROM AUTHOR]

To support Canadians ages 2 years and older in improving their dietary intake, Health Canada released a revised Canada's Food Guide (CFG) in 2019. This study aimed to explore the knowledge and perceptions of the 2019 CFG among children ages 9–12 years old from Southwestern Ontario. From September–November 2021, interviews were conducted with children by video conference. Thirty-five children (50% girls, 80% White; mean age 9.9 years) participated. Data were analyzed using a hybrid thematic approach with inductive and deductive analyses. Children expressed a lack of knowledge on certain foods (i.e., plant-based proteins, whole grains, and highly processed foods) that are highlighted in the CFG. Children also expressed confusion around food groups, including recommended proportions and categorization of some foods (e.g., dairy products and plant-based proteins). Children generally expressed positive perceptions regarding CFG and its eating habit recommendations, i.e., "Cook more often", "Eat meals with others", and "Enjoy your food", and they suggested strategies to improve adherence to these recommendations, including providing children more responsibility and independence with food preparation tasks and minimizing family time conflicts. Children's perceptions of the CFG can help inform public health policies and programmatic strategies designed to support children's food choices and eating habits. [ABSTRACT FROM AUTHOR]

Introduction: Unhealthy food and beverage marketing in various media and settings contributes to children's poor dietary intake. In 2019, the Canadian federal government recommended the introduction of new restrictions on food marketing to children. This scoping review aimed to provide an up-to-date assessment of the frequency of food marketing to children and youth in Canada as well as children's exposure to this marketing in various media and settings in order to determine where gaps exist in the research. Methods: For this scoping review, detailed search strategies were used to identify relevant peer-reviewed and grey literature published between October 2016 and November 2021. Two reviewers screened all results. Results: A total of 32 relevant and unique articles were identified; 28 were peer reviewed and 4 were from the grey literature. The majority of the studies (n = 26) examined the frequency of food marketing while 6 examined actual exposure to food marketing. Most research focussed on children from Ontario and Quebec and television and digital media. There was little research exploring food marketing to children by age, geographical location, sex/gender, race/ethnicity and/or socioeconomic status. Conclusion: Our synthesis suggests that unhealthy food marketing to children and adolescents is extensive and that current self-regulatory policies are insufficient at reducing the presence of such marketing. Research assessing the frequency of food marketing and preschooler, child and adolescent exposure to this marketing is needed across a variety of media and settings to inform future government policies. [ABSTRACT FROM AUTHOR]

Purpose: The Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging (RIC) Study is quantifying the association between cumulative radiation exposure from fetal and/or childhood medical imaging and subsequent cancer risk. This manuscript describes the study cohorts and research methods. Methods: The RIC Study is a longitudinal study of children in two retrospective cohorts from 6 U.S. healthcare systems and from Ontario, Canada over the period 1995–2017. The fetal-exposure cohort includes children whose mothers were enrolled in the healthcare system during their entire pregnancy and followed to age 20. The childhood-exposure cohort includes children born into the system and followed while continuously enrolled. Imaging utilization was determined using administrative data. Computed tomography (CT) parameters were collected to estimate individualized patient organ dosimetry. Organ dose libraries for average exposures were constructed for radiography, fluoroscopy, and angiography, while diagnostic radiopharmaceutical biokinetic models were applied to estimate organ doses received in nuclear medicine procedures. Cancers were ascertained from local and state/provincial cancer registry linkages. Results: The fetal-exposure cohort includes 3,474,000 children among whom 6,606 cancers (2394 leukemias) were diagnosed over 37,659,582 person-years; 0.5% had in utero exposure to CT, 4.0% radiography, 0.5% fluoroscopy, 0.04% angiography, 0.2% nuclear medicine. The childhood-exposure cohort includes 3,724,632 children in whom 6,358 cancers (2,372 leukemias) were diagnosed over 36,190,027 person-years; 5.9% were exposed to CT, 61.1% radiography, 6.0% fluoroscopy, 0.4% angiography, 1.5% nuclear medicine. Conclusion: The RIC Study is poised to be the largest study addressing risk of childhood and adolescent cancer associated with ionizing radiation from medical imaging, estimated with individualized patient organ dosimetry. [ABSTRACT FROM AUTHOR]

Though summer learning loss has been widely documented across both the United States and Canada, there is little knowledge on how parents and teachers view the use of technology in the context of summer vacation, and what the role of digital tools are in potentially alleviating achievement gaps due to summer learning loss. Drawing on 71 parent and 37 teacher interviews from a large-scale Canadian study examining summer learning loss in Ontario through summer literacy and numeracy programs for students (grades 1–3), this study highlights the complexities associated with using digital tool in both home and school life in the summer. Through extensions of Bourdieu's theory of cultural capital, we suggest that digital tools are becoming a new type of valued skillset that parents and educators are acknowledging. In specific, our main findings center around three interrelated themes: i) comfort with technology; ii) home-school connections; and iii) perception of children as digital natives. Results may be fruitful for parents, educators, and policymakers to understand the larger role that digital technology plays amongst Canadian families and teachers during the summer months and school year. Capturing these discussions can maximize both school and home use of digital tools. [ABSTRACT FROM AUTHOR]

Children exposed to domestic violence may be at risk of homicide. Through an analysis of 140 domestic homicide cases in Ontario, Canada, this study sought to identify unique factors that heighten the risk for children in these circumstances. Two groups of domestic homicide cases were compared: cases with no children (No Children, n = 39) and cases where children were part of the family system (Children, n = 101). Further comparison was made of cases in which children were killed (n = 20) to cases in which children were present but not killed (n = 81). Overall, there were few unique differences between the groups and most of the significant findings were based on expected demographic characteristics related to having children in the family. Other significant results included a higher percentage of reports made to legal counsel/services within child-specific cases and a higher percentage of reports made to family members in cases where children were not killed. These results indicate that children who lose parents to domestic homicide share similar high-risk circumstances as children who have been killed in this context. Practical implications of the study's findings are discussed. Highlights: This study examined children's risk of homicide in the context of domestic violence. The study compared domestic homicide cases of families with and without children. Study results generally indicated few unique differences between groups. Results suggest that children exposed to domestic homicide are at similar risk to children who are not domestic homicide victims. [ABSTRACT FROM AUTHOR]

COVID-19 restrictions have necessitated child/youth mental health providers to shift towards virtually delivering services to patients' homes rather than hospitals and community mental health clinics. There is scant guidance available for clinicians on how to address unique considerations for the virtual mental healthcare of children and youth as clinicians rapidly shift their practices away from in-person care in the context of the COVID-19 pandemic. Therefore, we bridge this gap by discussing a six-pillar framework developed at Hospital for Sick Children (SickKids) in Toronto, Ontario, Canada, for delivering direct to patient virtual mental healthcare to children, youth and their families. We also offer a discussion of the advantages, disadvantages, and future implications of such services. [ABSTRACT FROM AUTHOR]

Background: Posterior fossa ependymoma (PFE) comprises 2 groups, PF group A (PFA) and PF group B (PFB), with stark differences in outcome. However, to the authors' knowledge, the long‐term outcomes of PFA ependymoma have not been described fully. The objective of the current study was to identify predictors of survival and neurocognitive outcome in a large consecutive cohort of subgrouped patients with PFE over 30 years. Methods: Demographic, survival, and neurocognitive data were collected from consecutive patients diagnosed with PFE from 1985 through 2014 at the Hospital for Sick Children in Toronto, Ontario, Canada. Subgroup was assigned using genome‐wide methylation array and/or immunoreactivity to histone H3 K27 trimethylation (H3K27me3). Results: A total of 72 PFE cases were identified, 89% of which were PFA. There were no disease recurrences noted among patients with PFB. The 10‐year progression‐free survival rate for all patients with PFA was poor at 37.1% (95% confidence interval, 25.9%‐53.1%). Analysis of consecutive 10‐year epochs revealed significant improvements in progression‐free survival and/or overall survival over time. This pertains to the increase in the rate of gross (macroscopic) total resection from 35% to 77% and the use of upfront radiotherapy increasing from 65% to 96% over the observed period and confirmed in a multivariable model. Using a mixed linear model, analysis of longitudinal neuropsychological outcomes restricted to patients with PFA who were treated with focal irradiation demonstrated significant continuous declines in the full‐scale intelligence quotient over time with upfront conformal radiotherapy, even when correcting for hydrocephalus, number of surgeries, and age at diagnosis (‐1.33 ± 0.42 points/year; P = .0042). Conclusions: Data from a molecularly informed large cohort of patients with PFE clearly indicate improved survival over time, related to more aggressive surgery and upfront radiotherapy. However, to the best of the authors' knowledge, the current study is the first, in a subgrouped cohort, to demonstrate that this approach results in reduced neurocognitive outcomes over time. In a subgroup‐specific manner, the results of the current study demonstrate that survival among patients with posterior fossa ependymoma has improved over time, and this improvement clearly is related to a change in practice with regard to pursuing aggressive surgical resections with upfront postoperative radiotherapy in all patients. This significant improvement highlights an urgent need for the implementation of early intervention and neuroprotective strategies. [ABSTRACT FROM AUTHOR]

Objectives: The Healthy Kids Community Challenge is a large-scale, centrally-coordinated, community-based intervention in Ontario, Canada that promotes healthy behaviours towards improving healthy weights among children. With the goal of exploring tools available to evaluators, we leveraged electronic medical records from primary care physicians to assess child weights prior to launch of the Healthy Kids Community Challenge. This study compares the baseline (i.e. pre-intervention) prevalence of overweight and obesity in children 1–12 years of age living within and outside Healthy Kids Community Challenge communities. Design: Cross-sectional analysis of a primary care patient cohort. Setting: Electronic Medical Record Administrative data Linked Database (EMRALD) in Ontario, Canada. Participants: A cohort of 19 920 Ontario children who are rostered to an EMRALD physician. Children were 1–12 years of age at a primary care visit with recorded measured height and weight, between January 1, 2014 and December 31, 2015. Outcome measure: Overweight and obesity as determined by age- and sex-standardized body mass index using World Health Organization’s Growth Standards. Results: In Healthy Kids Community Challenge communities, 25.6% (95% CI 24.6–26.6%) of children had zBMI above normal (i.e. >1) compared to 26.7% (95% CI 25.9–27.5%) for children living outside of Healthy Kids Community Challenge communities. Conclusions: Despite some differences in sociodemographic characteristics, zBMI of children aged 1–12 years were similar inside and outside of Healthy Kids Community Challenge community boundaries prior to program launch. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical features, efficacy and safety of treatment regimens, and outcomes of childhood‐ and adult‐onset Takayasu arteritis (TAK). Methods: The study was designed as a retrospective cohort study comparing patients with childhood‐onset TAK (from 1986 onward) to patients with adult‐onset TAK (from 1988 onward) who were followed up until 2014 or 2015 at 4 centers in Ontario, Canada. Demographic, clinical, laboratory, and angiographic features, treatment regimens, and outcomes were recorded throughout the course of the disease. Disease activity and damage scores were completed retrospectively. Results: Twenty‐nine children and 48 adults (median age at diagnosis 12.1 years and 31.2 years, respectively) were included. A lower predominance of females was observed among the childhood‐onset TAK cohort (76% versus 100% of patients with adult‐onset TAK; P < 0.01), and children had a shorter delay to diagnosis (median 6.0 months versus 12.2 months for adults; P = 0.03). The distribution of vascular involvement was also different, with children having significantly more aortic and renal artery involvement and a higher frequency of arterial hypertension. Relapses in the first year after diagnosis were common both in children (39%) and in adults (28%). Two children, but no adults, died. Conclusion: Childhood‐onset TAK has a lower female predominance and a higher frequency of aortic and renal involvement compared to adult‐onset TAK. Relapses and disease burden were high in both groups, corroborating the need for careful monitoring of disease activity and aggressive therapeutic management. [ABSTRACT FROM AUTHOR]

Background: Food insecurity is associated with a wide array of negative health outcomes and higher health care costs but there has been no population-based study of the association of food insecurity and mortality in high-income countries. Methods: We use cross-sectional population surveys linked to encoded health administrative data. The sample is 90,368 adults, living in Ontario and respondents in the Canadian Community Health Survey (CCHS). The outcome of interest is all-cause mortality at any time after the interview and within four years of the interview. The primary variable of interest is food insecurity status, with individuals classed as “food secure”, “marginally food insecure”, “moderately food insecure”, or “severely food insecure”. We use logistic regression models to determine the association of mortality with food insecurity status, adjusting for other social determinants of health. Results: Using a full set of covariates, in comparison to food secure individuals, the odds of death at any point after the interview are 1.28 (CI = 1.08, 1.52) for marginally food insecure individuals, 1.49 (CI = 1.29, 1.73) for moderately food insecure individuals, and 2.60 (CI = 2.17, 3.12) for severely food insecure individuals. When mortality within four years of the interview is considered, the odds are, respectively, 1.19 (CI = 0.95, 1.50), 1.65 (CI = 1.37, 1.98), and 2.31 (CI = 1.81, 2.93). Interpretation: These findings demonstrate that food insecurity is associated with higher mortality rates and these higher rates are especially large for the most severe food insecurity category. Efforts to reduce food insecurity should be incorporated into broader public health initiatives to reduce mortality. [ABSTRACT FROM AUTHOR]

Background: To evaluate if there are departures from the WHO Child Growth Standards (WHO-CGS) in postnatal growth of healthy 'Canadian' children in Ontario up to age 2 years, including by infant feeding and ethnicity.Methods: We included data on 9964 healthy, singleton children born in Ontario, Canada. Smoothed weight, length and body mass index (BMI) percentile curves were generated using quantile regression for the Canadian cohort from birth to age 2 years. Differences in percentile values were calculated comparing Canadian children vs. the WHO-CGS.Results: Canadian children under age 2 years were longer than the WHO-CGS at the 10th (0.8 cm), 50th (1.3 cm) and 90th (1.9 cm) percentiles. Canadian children incrementally surpassed the WHO-CGS in weight after age 6 months, and in BMI after 9 months. By age 2 years, the 50th percentile weight of Canadian males was 823 g (95% confidence interval (CI) 680, 965) higher than the WHO-CGS 50th percentile. Weight differences were seen regardless of feeding practice, and were greatest among children of mothers born in Canada and Europe/Western nations, and least for those of East Asian/Pacific or South Asian heritage. Among Canadian breastfed males, 18% (95% CI 16, 19) of newborns and 26% (95% CI 20, 33) toddlers aged 2 years were classified by WHO-CGS as weighing >90th percentile - much higher than the expected rate of 10%. Similarities were seen for differences in BMI.Conclusions: Healthy Canadian infants/toddlers are longer and heavier than the WHO-CGS norms. Explanations for these discrepancies require further elucidation. [ABSTRACT FROM AUTHOR]

Background: The goals of our study were to describe the types of family accommodation for parents of hospitalized children and to examine their influence on the pediatric hospital experience.Methods: This multi-site cohort survey included 10 hospitals in Ontario Province, Canada. Participants were parents of inpatient children (n = 1240). Main outcome measures included ratings of three parent-reported measures of hospital experience: overall hospital experience; willingness to recommend the hospital to family or friends; and how much the accommodation type helped parent stay involved in their child's hospital care.Results: Parents most often stayed in the child's room (74.7%), their own home (12.3%), hotel (4.0%) or a Ronald McDonald House (3.0%). Accommodation varied based on hospital, parent and child factors. Length of stay and the child's health status were significant predictors for overall hospital experience and recommending the hospital to family or friends, but accommodation type was not. Families who stayed at a Ronald McDonald House reported greater involvement in their child's care compared with other accommodation types (odds ratio: 1.54-20.73 for contrasted accommodation types).Conclusion: Use of different overnight accommodations for families of hospitalized pediatric patients in Canada is similar to a previous report of U.S. family hospital accommodations. In contrast to the previous U.S. findings, Canadian hospital experience scores were lower and accommodation type was not a significant predictor of overall hospital experience or willingness to recommend the hospital. In Canada, as in the U.S., families who stayed at a Ronald McDonald House reported that this accommodation type significantly improved their ability to be involved in their child's care. [ABSTRACT FROM AUTHOR]

Background: The Child and Youth Mental Health (ChYMH) assessment system was developed by interRAI (i.e., an international collective of researchers and clinicians from over thirty countries) in response to the unprecedented need for a coordinated approach to delivery of children's mental health care. Many interRAI instruments are used across Canada and internationally, but the ChYMH represents the first assessment specifically for children and youth. In the present paper, a short overview of the development process of the ChYMH is provided, and then the psychometric properties of several embedded scales on the ChYMH are examined.Methods: Participants included 1297 children and youth and their families who completed the ChYMH after being referred to mental health agencies within Ontario, Canada. In addition, smaller subsets of participants (N = 48-53) completed additional criterion measures, including the Social Skills Improvement System (SSIS), the Child and Adolescent Functional Assessment Scale (CAFAS), the Child Behavior Checklist (CBCL), and the Brief Child and Family Phone Interview (BCFPI).Results: Results demonstrated that the ChYMH subscales had strong internal-consistency (Cronbach's higher than .70), and correlated well with the criterion measures.Conclusions: Findings support the clinical utility of the ChYMH for use among clinically referred children and youth. Implications for children's mental health assessment and practice are discussed. [ABSTRACT FROM AUTHOR]

Background Most national surveys examining diet leave large segments of the Aboriginal population under-represented. The present study aimed to: (i) review primary research studies that investigated the dietary intakes of Canadian school-aged Aboriginal youths; (ii) summarise the tools and methodologies currently used to measure diet in this population; and (iii) identify knowledge gaps and suggest areas of future research. Methods A systematic review of research published between January 2004 and January 2014 related to the diets of Canadian school-aged (6-18 years) Aboriginal youths was undertaken, including Medline, Scopus, ERIC, Web of Science and Google Scholar databases. Studies were summarised based on purpose, year, sample population, setting, dietary assessment method and main findings. Results Twenty-four studies were reviewed, all of which were cross-sectional in design. Most ( n = 16; 67%) were from Ontario or Quebec, investigated the diets of First Nations ( n = 21; 88%) youths and took place in remote or isolated settings ( n = 18; 75%). Almost all of the studies used the 24-h recall to assess intake ( n = 19; 79%), of which 89% used a single recall. The findings suggest that the diets of Aboriginal youths could be improved. Of particular concern are inadequate intakes of vegetables and fruit, milk and alternatives, fibre, folate, vitamin A, vitamin C, calcium and vitamin D, concomitant with an excess consumption of sugar sweetened beverages, snacks and fast foods. Traditional foods remain important but tend to be consumed infrequently. Conclusions The diets of Canadian Aboriginal youths are energy-dense and nutrient-poor. The diets of Inuit and Métis youths, in particular, and perceptions of a balanced diet warrant further investigation. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the relationship between goal achievement measured by the Canadian Occupational Performance Measure (COPM) and child, goal, and intervention factors. Participants were 41 preschool children with cerebral palsy (CP) who were in the context-focused therapy arm of a randomized controlled trial. Factors including child age, Gross Motor Function Classification System (GMFCS) level, type and complexity of goals, and intervention strategies were analyzed. Children made large, positive mean changes on the COPM over 6 months (Performance = 3.8, SD = 1.9; Satisfaction = 4.3, SD 4.3) with younger children showing greater change. The COPM scores had low to moderate correlations with change on the Pediatric Evaluation of Disability Inventory and the Gross Motor Function Measure (GMFM-66). Regression analysis indicated that age, but not GMFCS level influenced COPM change scores. Goal complexity and intervention strategies were not significantly related to COPM change scores. The results provide support for using the COPM as an individualized measure of change in young children with CP receiving intervention. [ABSTRACT FROM AUTHOR]

Despite the important instrumental and emotional role that parents play in the lives of children with cystic fibrosis (CF) and congenital heart disease (CHD), qualitative researchers have not examined the similarities and differences between caregivers’ experiences. Informed by thematic analysis, in this qualitative study I explored what it is like to care for a child with a chronic illness from the perspective of CF and CHD parents at a children’s hospital in Canada. Pediatric caregiver stress was qualitatively different between CF and CHD parents, whereas temporal dilemmas were unique sources of stress for CF parents only. To alleviate stress, all parents drew on a three-way, interrelated process to comprehend their child’s illness and acquire perspective. By opening up the social worlds of parents, I illuminate important similarities and differences in the caregiving experience of parents of youth with CF and CHD, and offer novel contributions to the literature. [ABSTRACT FROM PUBLISHER]

In this small-scale study of 5- to 10-year-old Canadian-born children of Somali immigrants living in Toronto, religious and ethnic identity appeared to be more salient for the children than their racial and national identity. This paper speculates on why this may be so, and recommends that issues related to identity be raised and addressed at an early age. [ABSTRACT FROM AUTHOR]

Objectives: To investigate (i) oral health inequalities between off-reserve Aboriginal and non-Aboriginal children entering junior kindergarten (JK) in the Thunder Bay District, Northwest Ontario, Canada, (ii) oral health inequalities between kindergarten-aged (4 years old) Aboriginal children living on reserves in the Sioux Lookout Zone (SLZ), Northwest Ontario and those living off-reserve in the Thunder Bay District and (iii) early childhood caries (ECC) trends among SLZ children between 2001 and 2005. Methods: Cross-sectional oral health data (dmft/s Indices) for 416 (2003/2004), 687 (2004/2005) and 544 (2005/2006) 3- to 5-year olds attending JK in the Thunder Bay District were collected by calibrated dental hygienists with the District’s Health Unit. Secondary analysis of oral health status data from two studies conducted in the SLZ between 2001 and 2005 provided the dmft of random samples of children younger than 6 years of age living in 16–20 First Nations communities. Results: When compared with non-Aboriginal children aged 3–5 years attending the same schools in the Thunder Bay District between 2003 and 2006, off-reserve Aboriginal children had 1.9 to 2.3 times the risk of having ECC (dmft > 0), 2.9 to 3.5 times the risk of a dmft > 3 and 1.8 to 2.5 times the risk of untreated decayed teeth after adjusting the prevalence ratios for child’s age and sex, school’s risk level and clustered-correlated data. The mean dmft of on-reserve Aboriginal 4-year olds in 2005 was 11.2 and 5.9 for their off-reserve Aboriginal counterparts. In 2001, the mean dmft scores (95% confidence interval) of 2-, 3- and 4-year-old Aboriginal children in the SLZ were: 9.1 (8.3–9.9), 12.4 (11.8–13.1), 13.1 (12.1–14.2). In 2005, similarly aged SLZ children had a mean dmft of: 6.2 (5.2–7.1), 8.9 (8.2–9.6), 11.2 (10.5–11.9), representing significant reductions in caries severity (32%, 28% and 14.5%, respectively). Conclusions: Significant disparities in caries experience exist between off-reserve Aboriginal and non-Aboriginal children living in the same locales and between Aboriginal children living on- and off-reserve in northwestern Ontario. The study showed decreased trends in the severity of ECC for children in the SLZ occurring over the 5-year period. Despite this progress, the oral health of young Aboriginal children in Ontario continues to lag far behind that of non-Aboriginal children, demanding further programs and policies to tackle the social determinants of oral health and resolve these inequalities. [ABSTRACT FROM AUTHOR]

This article describes recent trends in the province of Ontario (Canada) and beyond that have begun to create a readiness to bring research to practice in children's mental health. The experience of developing innovative cross-sectoral partnerships in Ontario that facilitate the linkage of research and service is discussed. The Child and Youth Mental Health Information Network is profiled as an emerging collaboration that epitomises such partnerships, and the key knowledge exchange activities of the five partner organisations are described. The article highlights the importance of engaging all levels of the system - clinical, supervisory, management, community, policy and political - in order to create a culture change that truly supports the sharing of information and the process of embedding evidence-based practice in services for children and families. This is a descriptive article that outlines key complementary knowledge exchange activities of each of the partners while highlighting joint initiatives and the value added of the Network. [ABSTRACT FROM AUTHOR]

Home as a place of caring is theorized using the literature from geography, sociology, housing and feminist studies. To support our theorization, grounded theory is used to capture and interpret the experiences of women caring for children with long-term care needs in the home. Eleven semi-structured interviews conducted with women in Ontario, Canada uncovered differences in the way the women perceived their homes and highlighted their multiple and complex experiences. The findings revealed three key issues. First, women do not want their homes to be completely defined by long-term care activities as many other types of activities are situated in their homes. Second, long-term care activities and schedules are not segregated but become deeply embedded and enmeshed within the spatial and temporal practices and processes of family life. Third, the meanings, characteristics and ideal of 'home' portrayed in popular culture and the academic literature often clashed with what the women experienced on a daily basis. Analysis revealed the tensions surrounding 'reconstructing spaces in the home' and 'the home as a private and public place' which are indicative of the women's struggles with the disjuncture between the ideal and lived home. The women's experiences challenge us to consider new ways of theorizing the home, and the home when it is a place where long-term care is provided. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The aim of the review was to present the best 10 clinical articles for the last 50 years (1956-2006) from the Division of General Surgery, Hospital for Sick Children (HSC), Toronto, Canada. These articles were judged by the major change (impact) in clinical practice of pediatric general surgery after their publication. Methods: All clinical articles from 1956 to 2006 inclusively written by members of the division (while working at HSC) were evaluated. The 2 authors of this article (retired honorary staff surgeon and recently trained chief surgical resident/fellow) separately rated the articles. Each lead author (if possible) was asked to comment on “the significance of their paper, then and now.” If the lead author was unavailable, 1 of the 2 authors of this article commented on the articles. Results: The best 10 clinical articles selected involved spleen trauma, necrotizing enterocolitis, esophageal replacement, Hirschsprung''s disease, tracheal compression, fecal incontinence, gastroesophageal reflux, diaphragmatic hernia, and ruptured appendix. There were 8 staff members and 5 surgical residents/fellows who were lead authors, along with 10 staff from other divisions, departments, and/or hospitals. Conclusion: The conservative management of splenic trauma was judged the best article from this Division that made the largest clinical impact for the last 50 years. [Copyright &y& Elsevier]

Objective: To determine the cost effectiveness of a public health legislative/educational strategy to reduce tap water scalds in children less than 10 years of age. Design: Cost-effectiveness analysis conducted from the government perspective over a 10-year time horizon. Population: Children under 10 years of age in Ontario, Canada Interventions: Legislation to set thermostat settings on new domestic water heaters to lower temperatures (maximum 49°C) plus annual educational notices to utility customers versus status quo. Main outcome measures: The burden of tap water scalds, healthcare resource utilization, the cost and effectiveness of the proposed intervention, and the probabilities assigned to health outcomes were modeled in a decision analysis based on population-based data, patient charts, and the published medical literature. All costs and health outcomes beyond 1 year were discounted at 3%. Results: An estimated 182 children under 10 require medical care for tap water scald injuries annually in Ontario (13.98 per 100 000). Of these, 65 require emergency department (ED) care only (median cost $C149 per injury), 103 require ED care with clinic follow-up ($C577 per injury), 14 require hospital admission ($C5203 per injury), and two require surgical skin grafting ($C28 526 per injury). The estimated cost of the intervention was $C51 000 annually, with a projected 56% reduction in tap water scald injuries. Over 10 years, the intervention group would show total costs of $C1.17 million and 704 scalds, compared with $C1.65 million and 1599 scalds in the status quo group. Therefore, the intervention would be cost saving, with an incremental ratio of $C531 saved per scald averted. Sensitivity analyses showed that the intervention would remain cost saving through a wide range of variable estimates. Conclusions: Legislation to lower thermostat settings on domestic water heaters plus annual educational notices to utility customers would generate cost savings while reducing the morbidity from tap water scalds in children. [ABSTRACT FROM AUTHOR]

A current objective in Canada is a provision of childcare services for all children. This objective has not been achieved as many children, especially those with disabilities, are often denied services from publicly funded daycare centres. The authors argue that policy discussions framed from an inclusive perspective provide a better understanding of how the Ontario child care system should function to ensure daycare services for children of disabilities. They interviewed the directors of 354 licensed preschools in Toronto about the inclusion of children with disabilities into their centres. Analysis revealed that only 2.4% of the students in these centres were identified as having a disability; the two most frequently identified disabilities were Autism Spectrum Disorders and speech and language disorders. The majority of directors stated that they would turn away a child because of a disability. The centres that were most inclusive had service providers come into the centre, but very few (17%) of these centres had resource teachers as support. The analysis further indicates a large number of centres that currently are not identified as capable of providing special need services and are not directly operated by the Ministry of Education. With staff development and funding, these centres have the potential to provide services to children of disabilities. [ABSTRACT FROM AUTHOR]

Aim: To examine the relation between socio-economic status and (1) receipt (if paediatric otolaryngological surgery, and (2) inclusion of adjuvant procedures. Methods: Using data on myringotomies with insertion of tympanostomy tube and tonsillectomies for all children in Ontario, Canada, from 1996 to 2000. and census data on socio-economic status, we examined the association between socio-economic status and (I) the probability of surgery (myringotomy or tonsillectomy), and (2) the probability that surgery was accompanied by an adjuvant procedure. Results: Lower socio-economic status was associated with increased likelihood that a child's initial surgery was a tonsillectomy rather than a myringotomy (odds ratio per unit increase in the deprivation index = 1.09, p = 0.01, confidence interval 1.06–1.11), and with increased likelihood that those children having a myringotomy would undergo a tonsillectomy during the same hospitalization (odds ratio 1.14, p < 0.0001. confidence interval 1.11–1.16). Children from neighbourhoods with larger immigrant populations were less likely to receive either procedure (odds ratios per 1% increase in the proportion of immigrants = 0.97 (p < 0.0001, confidence interval 0.96–0.97) for myringotomies and 0.97 (p < 0.0001, confidence interval 0.97–0.98) for tonsillectomies). Conclusions: Socio-economic status was associated with treatment selection for the two most common paediatric surgical procedures. Further research should examine whether differences in treatment arise at the level of the primary care physician, the specialist, and/or are due to parental preference. [ABSTRACT FROM AUTHOR]

Gardening metaphors with English middle-class overtones were widely used in the late nineteenth-century child saving writings in Toronto, Canada to explain and promote the ideal mode of parenting and the objective of child saving. An analysis of gardening metaphors contributes to understanding mechanisms of bio-power on the site of child saving. This paper argues that the child saving movement attempted to install a mode of proper parental control that can be described as “the gardening governmentality”– it was primarily positive/productive (yet without excluding repressive elements), individualized, intelligent, and localized. [ABSTRACT FROM AUTHOR]

The article discusses the highlights of a consensus conference on the appropriate use of fluoride supplements for preventing dental caries in Canadian children held in Toronto, Ontario in November 1997. At a conference in April 1992, the Canadian Dental Association (CDA) advised against providing fluoride tablets to babies and toddlers due to higher risk of dental fluorosis. The scientific presenters were charged with the development of suitable fluoride supplement recommendations based on the current scientific information.

Serial and cross-sectional cephalograms were read and the treatment files reviewed, for 521 children of a representative sample, the Burlington Growth Centre sample, to determine the frequency of congenitally missing third molars. All the children had at least two cephalograms taken between the ages of 3 and 21 years, and one of these was taken around 16 years. Of the 521 children studied, 22.3 % had congenitally missing third molars. There was no sex-specificity with respect to congenitally missing third molars or to the number of missing third molars in the maxilla and the mandible. Generally, more teeth were absent when third molars were congenitally missing. A relationship was found to exist between congenitally missing teeth and congenitally missing third molars in females. Thus, when third molars were absent, there was a sex-specificity for other congenitally missing teeth. The probability of specific teeth being missing was higher for those individuals with missing third molars than in the 1,191 10- to 12-year-old children of the overall Burlington Growth Centre sample. [ABSTRACT FROM AUTHOR]

Populations of foster homes, like other populations of social actors, change over time in diverse ways. New foster homes are opened. Existing foster homes undergo life-cycle changes in composition and internal functioning. This article seeks to contribute in a more direct way to an understanding of the dynamics of foster care. Using data from a population of foster homes affiliated with a children's aid society in the regional municipality of Hamilton-Wentworth, Ontario, it investigates several arguments that might help account for the observed pattern of foster home entries into the child welfare system in the time period 1968-90. In particular, we focus on two processes that might be related to the pattern of entries: change in external social, political, and economic conditions, and interpellation processes, that is, change in overall number of foster homes and in the demand for service. This study is the first step in disentangling the complexities of the dynamics of the ecology of foster homes.

The article examines the growing hegemony of the bourgeois family pattern among the Canadian working classes that accompanied the development of a welfare state and focuses on the legal institutionalization and regulation of childhood and sexuality in Ontario and British Columbia, particularly during the inter-war years. The discussion centers on similarities and differences between the provinces with respect to two major issues: first, the enactment of criminal and quasi-criminal legislation, ostensibly universal in application but directed primarily at poor children and the adults responsible for them, to force compliance with middle-class standards of morality and family life; and, second, the administration of many such statutes through the Toronto, Ontario and Vancouver Juvenile Courts. In Canada, as in other jurisdictions, demands for implementation and refinement of legislation aimed at upholding the norms of childhood and heterosexual marriages were accompanied by demands for new enforcement mechanisms.

Objectives: Radium induces bone sarcomas at high doses, but there is controversy about risk at low doses. A previous study in Ontario found an association between the presence of radium in birthplace water supplies and an increased risk of death from bone cancer in young people. An investigation was performed to test the findings of the previous study with an independent group of subjects for whom complete information on radium exposure would be obtained.Methods: A population based case-control study (238 cases; 432 controls) was conducted with incident cases of bone sarcoma identified from the Ontario cancer registry. Residential histories were collected by questionnaire and water samples were obtained and analysed for radium content.Results: There was an association between risk of osteosarcoma and birthplace exposures (odds ratios (ORs) and 90% confidence intervals (90% CIs) 1.77 (1.03-3.00) but not with lifetime measures of exposure. When lifetime exposure was dichotomised, the OR was 1.31 (0.76-2.24) for osteosarcoma. There was no trend with increasing exposure. Bootstrap resampling was used to simulate lifetime doses in a pooled analysis of 1293 subjects from the two Ontario studies. The ORs were 1.38 (1.08-1.73) for all sarcomas, and 1.44 (1.01-1.87) for osteosarcoma. Geometric mean doses in bone were about 26 mRad.Conclusions: An association was found between the presence of radium in birthplace water supplies and increased risk of bone sarcoma in two studies. Increased risk was present for lifetime measures of exposure, but the association was not significant, and there was no dose-response trend. Our findings are compatible with the absence of risk at low doses, but they might also reflect inadequate statistical power to measure a true risk at environmental exposure levels. If the increased risk at environmental doses is causal, risk of bone sarcoma is effectively linearly related to dose over five orders of magnitude. [ABSTRACT FROM AUTHOR]

Background: The worldwide prevalence of depressive disorders among children and youth has been reported in ranges from just under 3% to over 10%. In Canada, 7% of youth report past year depression, which is higher than any other age demographic. Yet, many of these youth do not receive evidence based interventions, increasing their risk for serious lifetime consequences. To better understand low service use, it is crucial to map and evaluate current services. This study aimed to determine the scope and nature of services available to depressed children and youth, and compare services to best evidence treatment guidelines.Methods: Several government and non-government resources were utilized to develop a new multi-sectoral database of depression services for children and youth across Ontario. An online survey was sent to program managers serving children/youth with depression, examining agency characteristics, populations served, services provided, patterns of service use, evaluation activities, and research priorities.Results: 413 agencies with 869 program managers participated, representing mental health, addictions and other sectors. Age groups served included children up to 12 years of age (31%), adolescents aged 13-17 (70%) and transition aged youth (18-25 years) (81%). Over half of respondents worked in the mental health (43.4%) or mental health and addiction (24.4%) sectors. The most frequently provided services were assessment, psychotherapy, case management, and psychoeducation; the most common types of psychotherapy provided included cognitive behavioral therapy, social skills training, and solution-focused therapy. Psychotherapies are offered in widely varying formats, frequencies and durations. Discontinuation rates varied, with higher discontinuation among transition aged youth as compared to children. Respondents identified effective treatment, improving access, and reducing service gaps as top future research priorities.Conclusions: This study provides important new data on service provision and uptake for depressed children and youth. Comparing these results with best-evidence practice guidelines raises significant concerns about the services most commonly offered and their delivery formats. In addition, high early discontinuation rates raise questions about the service experiences of children, youth and their families. Other factors which may contribute to ongoing treatment engagement challenges include access barriers, service or client characteristics, and unintentional treatment impacts. [ABSTRACT FROM AUTHOR]

Abstract FOLLOWING THE LAUNCH OF A PUBLICLY FUNDED influenza immunization program for all residents of Ontario over the age of 6 months, we evaluated 203 parents of children who presented to our emergency department between January and March of the following year (2001). Overall, 54 (27%) of the children had been vaccinated. Parents of non-immunized children were more likely to believe that immunization resulted in a flu-like illness (42% v. 17%; p = 0.001), caused side effects that were more severe than having influenza (36% v. 17%; p = 0.010) and weakened the immune system (52% v. 24%; p < 0.001). Parents of both immunized and non-immunized children incorrectly identified gastrointestinal symptoms as symptoms of influenza. The primary reason for deciding against immunization was the belief that their child was not at risk. After adjustment, children with a chronic disease were more likely than those without a chronic disease to be immunized (adjusted odds ratio [OR] 4.7, 95% confidence interval [CI] 1.8-12.6). Children of parents who discussed immunization with a physician were more likely to be immunized than those who had not discussed immunization with a physician (OR 6.8, 95% CI 2.4-19.2). [ABSTRACT FROM AUTHOR]

Background: In Canada, road traffic injuries are the leading cause of death among children and youth ≤19. Across the country, there is variability in road traffic injury prevention policies and legislation. Our objective was to compare pediatric road traffic related injury hospitalization and death rates across Canadian provinces.Methods: Population-based hospitalization and death rates per 100,000 were analyzed using data from the Discharge Abstract Database and provincial coroner's reports. Road traffic related injuries sustained by children and youth ≤19 years were analyzed by province and cause between 2006 and 2012.Results: The overall transport-related injury morbidity rate for children in Canada was 70.91 per 100,000 population between 2006 and 2012. The Canadian population-based injury hospitalization rates from all transport-related causes significantly decreased from 85.51 to 58.77 per 100,000 (- 4.42; p < 0.01; - 5.42; - 3.41) during the study period. Saskatchewan had the highest overall transport related morbidity rate (135.69 per 100,000), and Ontario had the lowest (47.12 per 100,000). Similar trends were observed for mortality rates in Canada.Conclusions: Transport-related injuries among children and youth have significantly decreased in Canada from 2006 to 2012; however the rates vary by province and cause. [ABSTRACT FROM AUTHOR]