Search

Background: Efforts to preoperatively risk stratify and optimize patients before pancreaticoduodenectomy continue to improve outcomes. This study aims to determine the impact of hypoalbuminemia on outcomes following pancreaticoduodenectomy and outline optimal hypoalbuminemia cut-off values in this population. Methods: The ACS-NSQIP (2016–2021) database was used to extract patients who underwent pancreaticoduodenectomy, comparing those with hypoalbuminemia (< 3.0 g/L) to those with normal albumin. Demographics and 30-day outcomes were compared. Multivariable modeling evaluated factors including hypoalbuminemia to characterize their independent effect on serious complications, and mortality. Optimal albumin cut-offs for serious complications and mortality were evaluated using receiver-operating characteristic curves. Results: We evaluated 25,848 pancreaticoduodenectomy patients with 2712 (10.5%) having preoperative hypoalbuminemia. Patients with hypoalbuminemia were older (68.2 vs. 65.1; p < 0.0001), and were significantly more likely to be ASA class 4 or higher (13.9% vs. 6.7%; p < 0.0001). Patients with hypoalbuminemia had significantly more 30-day complications and after controlling for comorbidities hypoalbuminemia remained a significant independent factor associated with 30-day serious complications (OR 1.80, p < 0.0001) but not mortality (OR 1.37, p = 0.152). Conclusions: Hypoalbuminemia plays a significant role in 30-day morbidity following pancreaticoduodenectomy. Preoperative albumin may serve as a useful marker for risk stratification and optimization. [ABSTRACT FROM AUTHOR]

Introduction: In 2019, our center attempted to transition all partial nephrectomies (PNs) to robotic-assisted laparoscopic PN (RALPN). The purpose of this study was to compare RALPN outcomes to laparoscopic PN (LPN) and open PN (OPN) at our institution, as there is limited literature from Canadian centers. Methods: In this single-center, two-surgeon, retrospective cohort study, we compared RALPN outcomes during the early phase of our robotics program to OPN and LPN performed just before the introduction of RALPN. Results: A total of 106 patients underwent OPN, 83 LPN, and 82 RALPN during the study period. Median RALPN RENAL score was 7 vs. 6 for LPN (p<0.05) and 8 for OPN (p=0.10). Median RALPN length of stay (LOS) was two days vs. three and four days for LPN and OPN (p<0.05), respectively. OPN median procedure time was 104 minutes vs. 94 and 82 minutes for LPN and RALPN (p<0.05), respectively. Median OPN operating room (OR) time was 160 minutes vs. 150 and 146 minutes for LPN and RALPN (p<0.05), respectively. There were no significant differences in intraoperative (p=0.92) or postoperative complications rates (p=0.47). RALPN warm ischemia time (WIT) was 17 minutes vs 14.5 and 15 minutes for OPN and LPN (p<0.05), respectively. Median RALPN estimated blood loss (EBL) was 165 ml vs. 250 ml for OPN (p<0.05) and 125 ml for LPN (p=0.15). Conclusions: Although patients who underwent RALPN had longer WIT, they had similar rates of complications, required less total OR time, and had shorter procedure time and LOS compared with OPN and LPN despite similar RENAL score compared to OPN and greater score than LPN. [ABSTRACT FROM AUTHOR]

Empathy is thought to be reduced in videoconference (VC) compared to face-to-face (F2F) therapy. To empirically test this possibility, therapist and client ratings of empathy and its correlates were examined in VC and F2F sessions. Forty-eight students in clinical training programs were randomly assigned to the role of 'therapist' or 'client', forming 24 dyads. Each dyad completed a simulated clinical session in F2F and in VC and reported on empathy and telepresence. Both therapist and client ratings of empathy were significantly lower in VC compared to F2F. Therapist empathy correlated with telepresence, particularly its physical subcomponent, and therapeutic presence, but these associations were not found for clients. The relationship between empathy and telepresence was investigated further in a real-world study. Twelve clients met with clinical psychology trainees over VC and reported on empathy and telepresence. The associations between therapist empathy, total telepresence, and the physical component of telepresence were replicated. Again, client ratings of empathy and telepresence did not correlate. These results provide the first empirical evidence that empathy is reduced in VC teletherapy compared to F2F and highlight the connection between the degree of empathy felt by therapists and their sense of telepresence during teletherapy. [ABSTRACT FROM AUTHOR]

Smartphone ownership and engagement are at an all-time high. Excessive smartphone use may impart smartphone-specific anxiety; specifically, the fear of being unable to access or use one's smartphone, or nomophobia. Young adults, in particular, are at higher risk for nomophobia, given higher ownership of and engagement with smartphones. Notably, little research has been done in a Canadian context. Objective: To conduct an environmental scan of nomophobia prevalence in a Canadian university. Participants: Full-time and part-time university students. Methods: The Nomophobia Questionnaire and demographics were collected via mass emailer of all students at the host institution (n = 1,002). Results: Findings indicate moderate-to-high levels of nomophobia among respondents, with nearly a quarter of respondents reporting severe nomophobia. Respondents who identified as women were an undergraduate, and/or owned an Apple device reported significantly higher nomophobia. Conclusions: This study provides evidence for comparable levels of nomophobia between Canadian post-secondary students and recent global research. Future research should explore nomophobia within a more nationally representative sample. [ABSTRACT FROM AUTHOR]

Purpose: Shared reading provides preschool-age children with the opportunity to learn novel, low-frequency words. Abundant empirical evidence demonstrates that children can learn the meanings of such words during shared reading, referred to as “semantic learning.” However, less is known about whether children learn the spellings of words during shared reading, referred to as “orthographic learning,” and whether this learning is related to early word reading. The present study tested relations between individual differences in 4- to 6-year-old children’s semantic and, critically, orthographic learning during shared reading and their early word reading skill. Method: In an adaptation of the self-teaching paradigm, children listened to a storybook about novel inventions referred to with nonword names. Children then completed orthographic and semantic choice tests, as well as standardized measures of early word reading and phonological awareness. Results: Individual differences in orthographic, but not semantic, learning during shared reading were related to early word reading, after controls for age and phonological awareness. Conclusions: This study provides a novel test of learning during shared reading, helping to specify the relation between orthographic and semantic learning and early word reading skill. These findings hold implications for theoretical perspectives on relations between learning during shared reading and early word reading, as well as implications for educational practice [ABSTRACT FROM AUTHOR]

The present experiments examined the encoding and retrieval conditions in an item-method-directed forget (IMDF) study that included a novel control condition. In the IMDF condition, half of the items were followed by a remember cue whereas the other half were followed by a forget cue. In a remember-both control condition, half of the items were followed by an item identifier called Set A; whereas the other half of the items were followed by a Set B identifier. At the test, items were recalled as a function of the instruction cue or the set identifier. Across two experiments, directed-forgetting effects and associated benefits were found. Further, results from both studies revealed a new way to demonstrate the benefit of IMDF – directed-forgetting participants made more correct source attributions compared to remember-both participants. These benefits were obtained using a within-subjects IMDF paradigm (Experiment 1) as well as a between-subjects IMDF paradigm (Experiment 2). These patterns of results are consistent with several current theories of item-method-directed forgetting. [ABSTRACT FROM AUTHOR]

BACKGROUND: Occupational foot-transmitted vibration (FTV) exposure is common in industries like mining, construction, and agriculture, often leading to acute and chronic injuries. Vibration assessments require technical expertise and equipment which can be costly for employers to perform. Alternatively, researchers have observed that self-reported discomfort can be used as an effective indicator of injury risk. OBJECTIVE: This study aimed to investigate the effect of standing FTV exposure on self-reported ratings of discomfort, and whether these subjective ratings differed by body area and exposure frequency. METHODS: Participants (n = 30) were randomly exposed to standing FTV at six frequencies (25, 30, 35, 40, 45, and 50 Hz) for 20–45 seconds. Following each exposure, participants rated discomfort on a scale of 0–9 in four body areas: head and neck (HN), upper body (UB), lower body (LB), and total body. RESULTS: Results indicated that participants experienced the most discomfort in the LB at higher frequencies (p < 0.001), consistent with the resonance of foot structures. The HN discomfort tended to decrease as the exposure frequency increased, although not statistically significant (p > 0.0167). The UB discomfort remained relatively low across all frequencies. CONCLUSIONS: The study suggests a potential connection between resonant frequencies and discomfort, potentially indicating injury risk. Although self-reported discomfort is insufficient for directly assessing injury risk from FTV, it provides a simple method for monitoring potential musculoskeletal risks related to vibration exposure at resonant frequencies. While professional vibration assessment remains necessary, self-reported discomfort may act as an early indicated of vibration-induced injuries, aiding in implementing mitigation strategies. [ABSTRACT FROM AUTHOR]

This exploratory study aimed to evaluate the preferences, expectations, and sense of safety of blind or visually impaired persons regarding three types of pedestrian phasing with audible pedestrian signals configurations that exist in Quebec City (Canada). These include: 1) exclusive phasing with non-directional audible pedestrian signals; 2) exclusive phasing with directional audible pedestrian signals; and 3) concurrent phasing with directional audible pedestrian signals. Thirty-two blind or visually impaired persons were asked to complete a survey. Their preferences and expectations regarding audible pedestrian signals were documented through a series of simulations. Their sense of safety regarding the three existing configurations were also documented. Subsequently, semi-directed, individual interviews with 11 of the individuals who had completed the survey were conducted to build off the collected information. No formal consensus regarding many of the issues discussed were established as participants' responses varied too significantly. However, findings suggest that the exclusive phasing with directional audible pedestrian signals configuration is perceived to be the safest option by the participants. This study may have practical implications on the design of intersections (e.g., selection of a type of pedestrian phasing with audible pedestrian signal) and the training of blind or visually impaired pedestrians. The addition of audible pedestrian signals to pedestrian signals heightens the sense of safety of blind or visually impaired persons. This study may have practical implications on the design of intersections with audible pedestrian signals and the selection of a type of audible pedestrian signals based on intersection characteristics. Since many participants reported a lower sense of safety when faced with concurrent phasing, it is recommended that more intensive orientation and mobility interventions be provided to blind or visually impaired pedestrians who use this type of traffic signals. Educating road users about blind or visually impaired pedestrians appears also essential. [ABSTRACT FROM AUTHOR]

BACKGROUND: Evidence suggests that prenatal air pollution exposure alters DNA methylation (DNAm), which could go on to affect long-term health. It remains unclear whether DNAm alterations present at birth persist through early life. Identifying persistent DNAm changes would provide greater insight into the molecular mechanisms contributing to the association of prenatal air pollution exposure with atopic diseases. OBJECTIVES: This study investigated DNAm differences associated with prenatal nitrogen dioxide (NO2) exposure (a surrogate measure of trafficrelated air pollution) at birth and 1 y of age and examined their role in atopic disease. We focused on regions showing persistent DNAm differences from birth to 1 y of age and regions uniquely associated with postnatal NO2 exposure. METHODS: Microarrays measured DNAm at birth and at 1 y of age for an atopy-enriched subset of Canadian Health Infant Longitudinal Development (CHILD) study participants. Individual and regional DNAm differences associated with prenatal NO2 (푛= 128) were identified, and their persistence at age 1 y were investigated using linear mixed effects models (푛= 124). Postnatal-specific DNAm differences (푛= 125) were isolated, and their association with NO2 in the first year of life was examined. Causal mediation investigated whether DNAm differences mediated associations between NO2 and age 1 y atopy or wheeze. Analyses were repeated using biological sex-stratified data. RESULTS: At birth (푛= 128), 18 regions of DNAm were associated with NO2, with several annotated to HOX genes. Some of these regions were specifically identified in males (푛= 73), but not females (푛= 55). The effect of prenatal NO2 across CpGs within altered regions persisted at 1 y of age. No significant mediation effects were identified. Sex-stratified analyses identified postnatal-specific DNAm alterations. DISCUSSION: Regional cord blood DNAm differences associated with prenatal NO2 persisted through at least the first year of life in CHILD participants. Some differences may represent sex-specific alterations, but replication in larger cohorts is needed. The early postnatal period remained a sensitive window to DNAm perturbations. [ABSTRACT FROM AUTHOR]

The potential for healthier consumer food substitutions is an important factor in the study of food environments, dietary choices, and population nutrition promotion. The burden of diet-related non-communicable diseases is unevenly distributed across Canada and variation in the food environment sub-nationally may be an important explanation. We used population-based 24 h dietary recall data from the 2015 Canadian Community Health Survey—Nutrition for Canadian adults (n = 13 919) to examine dietary intakes of two food group pairings (whole grains/refined grains and legumes/red meats) where consumer substitutions have been recognized to be of importance in promoting healthy and sustainable population diet. We used an ANOVA followed by pairwise comparisons with Bonferroni correction to estimate differences in intakes between provinces for daily weight and proportion of total energy consumed. Based on the Global Burden of Disease Study, Canadians consumed below the average daily requirements of legumes and whole grains and well above the required range of red meat, suggesting room for broad improvements to population diet. Findings also demonstrate that there is potential for targeted shifts in dietary intakes among non-consumers of certain foods (e.g., legumes). This study may inform intervention development for the consumer nutrition environment including food accessibility and affordability to reduce non-communicable disease risk. [ABSTRACT FROM AUTHOR]

BACKGROUND: McKenzie standing trunk extension exercises have been used for the management of low back pain (LBP). However, no study to date has investigated the effect of standing trunk extension postures on spinal height and clinical outcomes. OBJECTIVE: To evaluate in subjects with LBP following a period of trunk loading how spinal height, pain, symptoms' centralization and function outcome measures respond to two standing postures interventions: (1) repetitive trunk extension (RTE) and (2) sustained trunk extension (STE). METHODS: A consecutive sample of convenience of people with LBP were recruited to participate in 2-session physical therapy using either RTE or STE in standing. RESULTS: Thirty participants (18 women) with a mean age of 53 ± 17.5 years completed the study. The first session resulted in spinal height increase (spinal growth) of 2.07 ± 1.32 mm for the RTE intervention and 4.54 ± 1.61 mm for the STE group (p < 0.001; ES = 1.67), while the second session (2-week following the first session) resulted in spinal growth of 2.39 ± 1.46 mm for the RTE group and 3.91 ± 2.06 mm for the STE group (p = 0.027; ES = 0.85). The STE group presented with the larger reduction in most pain from 6 to 2 as compared to the RTE group from 6 to 4 between Session 1 and Session 2 (p < 0.001). There was no difference between the groups in Modified Oswestry score and symptoms centralization (p = 0.88 and p = 0.77, respectively). CONCLUSION: People with LBP experienced greater spine growth and improvements of pain during standing STE as compared to RTE. People with LBP could use such postures and movements to alleviate their LBP and improve spine height while in a weight bearing position. [ABSTRACT FROM AUTHOR]

Purpose: Geographic location plays a significant role in the health and wellbeing of those with cancer. This project explored the impact of rurality and social support on distress and quality of life in young adults (YAs) with cancer in Canada. Methods: The current research analyzed data from the Young Adults with Cancer in Their Prime (YACPRIME) study. Participants completed measures of emotional distress (10‐item Kessler Psychological Distress Scale), quality of life (12‐item Short‐form Health Survey), and social support (Medical Outcomes Study—Social Support Survey). Rural and urban‐dwelling survivors were compared using MANOVAs. Bivariate analyses were conducted to explore associations between distress and social support. Findings: Of the sample (N = 379), 26% identified their location as rural. Rural YA cancer survivors reported higher distress and worse physical health‐related quality of life (HRQOL) than survivors from urban areas but similar levels of mental‐health‐related quality of life. Social support appeared to have a marginally greater effect on psychosocial outcomes for urban participants. All types of social support were associated with lower levels of distress. However, different types of social support were associated more strongly with distress depending on a participant's geography. Conclusions: Rural‐dwelling YA cancer survivors experience significantly more distress and poorer physical HRQOL than urban‐dwelling survivors. Different needs and preferences for social support may influence the psychological health of rural cancer survivors. Additional research is needed to determine how best to understand and address distress in rural YAs with cancer. [ABSTRACT FROM AUTHOR]

The associations between vaping in young people and alcohol and cannabis co-use remain understudied. The current study examined the effect of vaping frequency on past 30-day alcohol and cannabis use. Using an online survey, regular vapers (N¼1328, aged 16--24) from Canada responded to a demographic and vaping questionnaire and provided information regarding e-cigarette use and alcohol and cannabis co-use. A k-means cluster analysis was used to segment users based on vaping frequency, and a one-way MANOVA tested vaper cluster membership effects on past 30-day alcohol and cannabis use. Pairwise comparisons measured specific mean differences, and crosstabulation with Bonferroni tests examined demographic differences among clusters. Vaper cluster membership had a significant effect on past 30-day alcohol and cannabis use. Daily heavy and binge vapers had higher rates of past 30-day alcohol and cannabis use. Non-daily light vapers were less likely to share their vape and more likely to have never owned a vape. Non-daily light vapers were less likely to use high nicotine concentrations. High vaping frequency places its users at risk for higher alcohol and cannabis use and high-risk vaping behavior. Nicotine caps, among other policies, may be key in reducing high vaping frequency and its negative consequences. [ABSTRACT FROM AUTHOR]

Pandemic-related pressures and responsibilities increase the likelihood of burnout for all health care professionals. The consequences of burnout are significant, as it has been linked to high anxiety, increased turnover, decreased employee morale, higher absenteeism, and lower quality of service. To date, most research explores burnout's relationship with these variables in isolation. This study explores the anxiety, burnout, and employee engagement relationships among community pharmacists during the global pandemic. Pharmacists in the Canadian province of Saskatchewan completed an online questionnaire that asked questions related to their levels of anxiety, burnout, and work engagement among other control variables. The relationships among the variables were explored via SPSS and the moderation and mediation PROCESS macro. The findings suggest that burnout fully mediates the anxiety and employee engagement relationship, suggesting that anxiety alone is not enough to reduce employee engagement. The results confirm burnout's relationship with anxiety and lack of engagement and provide a more specific understanding of burnout's antecedents and consequences, offering important insight for academics and practitioners. Due to the positive implications of eliminating burnout and the importance of employee engagement to organisational performance, managers should seek to reduce workplace stress to avoid burnout and disengagement. [ABSTRACT FROM AUTHOR]

Purpose: Twitter has become a powerful tool for professional development in academia. However, studies from the general population suggest that racialized and gender biases disproportionately empower male and white users. We characterized the demographics of Twitter influencers in Canadian healthcare. Methods: We used the Right Relevance Insight API algorithm to identify Twitter influencers in the healthcare, healthcare research, and health policy domains, and to generated normalized influencer scores based on user connections and engagement. We used facial recognition software to approximate the influencers' race and sex. Results: The majority of influencers identified were white (84%) and/or male (60%). Males had significantly higher influencer scores than females (65.1 ± 8.0 vs. 61.2 ± 6.2, P < 0.05) in health policy. We did not identify any sex- or race-associated disparities among influencers in healthcare or healthcare research. Conclusion: Male users have significantly higher levels of influence in health policy on Twitter. Given the importance of Twitter as a tool for professional development, it is crucial that institutional leaders and policymakers are aware of potential inequities in user reach. Future studies should evaluate additional factors shaping user influence in healthcare on Twitter, with a focus on equity, diversity, and trustworthiness. [ABSTRACT FROM AUTHOR]

Hypermobility spectrum disorders (HSD) and Ehlers–Danlos syndromes (EDS) are frequently underdiagnosed, contributing to patient dissatisfaction in the healthcare system. This study evaluated the health service utilization, care, and subjective experiences of living with chronic illness among adults with HSD and EDS in the United States and Canada. This was an anonymous, web-based, cross-sectional healthcare survey. The survey obtained basic demographic information, the Patient Assessment of Chronic Illness Care (PACIC+), as well as responses to questions on the use of healthcare and integrative medicine. A total of 353 surveys were received. The most common complementary therapies used were physical therapy (82%), massage (68%), yoga (58%), chiropractic (48%), and meditation (43%). Mean (SD) summary PACIC and PACIC 5 As scores were 2.16 (0.77) and 2.25 (0.83), respectively. Across all PACIC domains, mean scores of individuals whose typical doctor visit was 30 min or at least an hour were significantly higher than those of individuals who indicated typical visits of 15 min (all p < 0.0001 by one-way ANOVA). There was widespread agreement on the importance of patient-provider relationship and trust, physicians' understanding of the individual's complete medical history, and prioritization of physical and emotional safety (>95% agree or strongly agree to each). Individuals with HSD or EDS report low satisfaction with chronic illness care and commonly seek out complementary and self-administered therapies, likely in an attempt to manage symptoms. Respondents reported a desire for greater time and attention from physicians. Results from this study could educate the healthcare community to improve support mechanisms for HSD and EDS populations. Patients with hypermobility spectrum disorders (HSD) or Ehlers–Danlos syndromes (EDS) express a desire for patient-centered care and peer support from other individuals with HSD or EDS. Individuals with HSD or EDS have typically seen multiple doctors for their condition and their satisfaction with chronic care, as measured by the Patient Assessment of Chronic Illness Care (PACIC+), is low. The use of various complementary and integrative health treatments, as well as specialized diets, is common in this population, and might be beneficial for symptom management. Healthcare delivery for HSD and EDS may require a multidisciplinary healthcare team, as complementary and self-care modalities are typically used in addition to physical therapy, pain medication, and other conventional care. [ABSTRACT FROM AUTHOR]

Partner violence resulting in physical injury is more often blamed on men than women for perpetrating the same offence, as men are often perceived to be more capable of inflicting injury. The current study used vignettes in a mixed-model design to examine the influence of perpetrator and observer gender, and weapon presence on observer blame. A split-plot analysis of variance produced a significant effect of perpetrator gender and an interaction effect of perpetrator gender and weapon presence. These findings suggest that perpetrator gender may be more important than weapon presence when examining observer perceptions. [ABSTRACT FROM AUTHOR]

BACKGROUND: There is equivocal evidence regarding the effectiveness of robotic guidance on the (re)learning of voluntary motor skills. Robotic guidance can improve the performance of continuous/ tracking skills, although being seldom more effective than unassisted practice alone. However, most of the previous studies employed robotic guidance on all intervention trials. Recently, we showed that mixing robotic guidance with unassisted practice (i.e., mixed practice) can significantly improve the learning of a golf putting task. Yet, these mixed practice studies involved self-paced movements in a standing posture, thus less applicable to rehabilitation contexts. OBJECTIVE: The current study aimed to investigate the influence of mixed practice on the timing accuracy of an upper-limb, rhythmic, sequential task. The goal was to assess the feasibility of integrating mixed practice with music-based interventions. METHODS: Two groups of participants performed circle-drawing sequences in synchrony with rhythmic auditory signals. They completed a pre-test and an acquisition phase, followed by immediate retention and transfer tests. One group received robotic guidance on 50% of the acquisition trials (i.e., mixed practice), whereas another group always practiced unassisted. The pre-test, retention, and transfer tests were performed unassisted. RESULTS: Both groups significantly improved their timing accuracy and precision between the pre-test and the retention test. CONCLUSION: This study provides further evidence that mixed practice can facilitate the (re)learning of voluntary actions, especially with the type of externally paced upper-limb movements employed in music-based interventions. [ABSTRACT FROM AUTHOR]

Examine beverage intake among families with low income by household participation in federal food assistance programs. Cross-sectional study conducted in fall/winter 2020 via an online survey. Mothers of young children insured by Medicaid at the time of the child's birth (N = 493). Mothers reported household federal food assistance program participation, later categorized as Supplementation Nutrition Program for Women, Infants, and Children (WIC) only, Supplemental Nutrition Assistance Program-Education (SNAP) only, both WIC and SNAP, and neither. Mothers reported beverage intake for themselves and their children aged 1–4 years. Negative binomial and ordinal logistic regression. After accounting for sociodemographic differences between groups, mothers from households participating in WIC and SNAP consumed sugar-sweetened beverages (incidence rate ratio, 1.63; 95% confidence interval [CI], 1.14–2.30; P = 0.007) and bottled water (odds ratio, 1.76; 95% CI, 1.05–2.96; P = 0.03) more frequently than mothers from households in neither program. Children from households participating in WIC and SNAP also consumed soda (incidence rate ratio, 6.07; 95% CI, 1.80–20.45; P = 0.004) more frequently than children in either program. Few differences in intake were observed for mothers or children participating in only WIC or SNAP vs both programs or neither program. Households participating in both WIC and SNAP may benefit from additional policy and programmatic interventions to limit sugar-sweetened beverage intake and reduce spending on bottled water. [ABSTRACT FROM AUTHOR]

Adults' perceptions of children's disclosures have important implications for the response to that disclosure. Children who experience adult transgressions, such as maltreatment, often choose to disclose this experience to a peer. Thus, peer disclosure recipients may transmit this disclosure to an adult or provide support for the child's own disclosure. Despite this, the influence of peer disclosure on a child witness's credibility, as well as on the perceptions of peer disclosure recipients, is unknown. The present study examined how child witnesses' and peer disclosure recipients' credibility is impacted when the peer either confirms or contradicts the witness's disclosure (or concealment) of an adult transgression. Participants listened to a child witness and peer being interviewed by an adult in one of four disclosure patterns (consistent disclose, consistent conceal, witness disclose/peer conceal, or witness conceal/peer disclose). Participants rated both the witness and the peer on dimensions of credibility (honesty and cognitive competence). Results revealed that both the witness and peer were more credible when their reports were consistent with one another. When inconsistent, the witness/peer who disclosed was considered more credible than the one who concealed. The findings indicate the potential importance of peers in the disclosure process as they may support the witness's report and even be a credible discloser when the witness is reluctant to disclose. [ABSTRACT FROM AUTHOR]

There is growing recognition of the link between diet, inflammation, and disease. Certain dietary patterns were found to either increase (e.g., "Western") or lower (e.g., Mediterranean) inflammatory biomarkers. Furthermore, the consumption of anti-inflammatory foods was related to a decreased risk of developing chronic health conditions. Despite these findings, there is a paucity of research related to the inflammatory nature of diets in Canada. Objective: The purpose of this study was to investigate the inflammatory nature of diets, as measured by the Dietary Inflammatory Index [DII]. Specifically, we determined the association between DII scores and Healthy Eating Index [HEI] Canada scores, as well as adherence to the Canadian Food Guide recommendations. Methods: This study used data from the Canadian Community Health Survey. Diet, health, and sociodemographic information was collected from participants. T-test and ANOVA analyses were conducted to determine if there were significant differences in mean DII scores between population characteristics. Separate regression analyses were performed to explore the association between DII and HEI Canada scores and adherence to CFG recommendations, respectively. Results: Significantly lower mean DII scores (anti-inflammatory) were reported for men, non-smokers and individuals who met physical activity recommendations. Higher adherence to CFG recommendations was associated with lower DII scores. Conclusion: There were significant differences in DII scores across geographical regions and sociodemographic groups in Canada. Future research should examine the regional differences in DII scores to develop targeted interventions and to further explore the relationship between HEI-C and DII scores. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to (a) provide speech-language pathologists and researchers with a play-based procedure to measure the expression of spoken communicative intents by children aged 3 to 4.5 years and (b) present indicators of these children's capacity to produce these intents in this context. Method: A method inspired by TRIAGE (Technique de Recherche d'Informations par Animation d'un Group d'Experts) allowed an advisory group of 16 speechlanguage pathologists to select and agree on definitions of intents to include in this procedure, among a set of 13 preselected intents based on the scientific literature. A longitudinal design including four measuring times was used to verify the production of these intents by 99 French-speaking children (46 boys; Mage = 36.09 months) at 36, 42, 48, and 54 months using the Neighborhood Game, a previously developed elicitation procedure of communicative intents conducted within the context of symbolic play. For each measurement time, the average percentage of children who had produced each intent at least 3 times was calculated with a 95% confidence interval. Nonparametric analysis of variance for longitudinal data was carried out to verify progression with age. Results: A finalized list of eight communicative intents was selected along with their definition and a standardized script to elicit them during symbolic play. The production frequency of most intents showed significant progression between the first and the fourth measurement time. Arguing is the only intent that is still not produced by more than 90% of children at the age of 54 months. Conclusions: This study led to the development of an assessment procedure, which presents ecological validity and elicits the expression of eight communicative intents among 3- to 4.5-year-olds. This procedure can support the work of speech-language pathologists and researchers. The accompanying indicators of children's capacity to produce these intents at a given age in this kind of context are a notable addition to the knowledge on typical language development. [ABSTRACT FROM AUTHOR]

Sexual abuse trauma can have long-term implications for individuals in terms of psychological functioning, relationships, and socio-environmental circumstances, all of which are elements that could explain the CSA intergenerational continuity phenomenon. There are few empirical studies drawing comparisons between families to identify factors associated with the intergenerational (dis)continuity of CSA. The objectives of this study are to compare mother and emerging adult dyads to determine differences between cycle maintainers, cycle breakers, cycle initiators, and a control group in terms of maternal maltreatment histories, mental health, attachment, and socio-environmental characteristics. A sample of 186 dyads was recruited across Canada to participate in an online study. The study represents a cross-sectional design and bivariate and multivariate analyses were used. The results support prior research that there is a higher risk of CSA in dyads where the mother experienced CSA (OR = 1.38). Compared to cycle initiators, maintainers reported greater psychological distress (M = 27.23; 35.18), and lower mother-rated parent-child attachment (M = 115.83; 111.43). Maintainers reported more post-traumatic stress symptoms only in comparison to the control group (M = 24.82; 10.13). Mothers in cycle maintaining dyads were exposed to more acts of domestic violence than those in cycle breaking dyads (OR = 2.43). No group differences were observed for intimate partner attachment. Findings should be replicated using robust methodological designs (e.g., longitudinal, mixed methods). Preventative efforts should target at-risk families to reduce the chance of intergenerational CSA. [ABSTRACT FROM AUTHOR]

This study examined factors associated with weight change in 535 residents in 32 long term care homes where 3-month weight records were available. Trained researchers and standardized measures (e.g., nutrition status, food intake, home characteristics) were used to collect data; weight change was defined as ±2.5%. Just over 25% of the sample lost and 21% gained weight. Weight stability was compared to loss or gain. Weight loss was associated with being male, malnourished (MNA-SF or BMI <25), energy and protein intake and oral nutritional supplement use, while weight gain was associated with being female, and a physically (e.g., less noise) and socially supportive dining room. Weight stability was associated with better cognition. A high proportion of residents had a significant weight change in 3 months. Modifiable factors associated with weight stability or gain suggest focusing interventions that promote food intake and improve the mealtime environment. [ABSTRACT FROM AUTHOR]

Background: Total hip arthroplasty (THA) is a successful procedure that provides pain relief, restores function, and improves quality of life (QOL) for patients with advanced arthritis in their hip joint. To date, little research has examined the role of cognitive appraisal processes in THA outcomes. This study examined the role of cognitive appraisal processes in THA outcomes in the first year post-surgery. Methods: This longitudinal cohort study collected data at pre-surgery, 6 weeks post-surgery, 3 months post-surgery, and 12 months post-surgery. Adults (n = 189) with a primary diagnosis of osteoarthritis were consecutively recruited from an active THA practice at a Canadian academic teaching hospital. Measures included the Hip Disability and Osteoarthritis Outcome Score (HOOS), the Mental Component Score (MCS) of the Rand-36, and the Brief Appraisal Inventory (BAI). Analysis of Variance examined the association between BAI items and the HOOS or MCS scores. Random effects models investigated appraisal main effects and appraisal-by-time interactions for selected BAI items. Results: HOOS showed great improvement over the first 12 months after THA, and was mitigated by three appraisal processes in particular: focusing on problems with healthcare or living situation, and preparing one's family for health changes. MCS was stable and low over time, and the following appraisal processes were implicated by very large effect sizes: not comparing themselves to healthier people, focusing on money problems, preparing their family for their health changes, or trying to shed responsibilities. Conclusions: Appraisal processes are relevant to health outcomes after THA, with different processes coming into play at different points in the recovery trajectory. [ABSTRACT FROM AUTHOR]

Alterations in tissue microstructure in normal-appearing white matter (NAWM), specifically measured by diffusion tensor imaging (DTI) fractional anisotropy (FA), have been associated with cognitive outcomes following stroke. The purpose of this study was to comprehensively compare conventional DTI measures of tissue microstructure in NAWM to diverse vascular brain lesions in people with cerebrovascular disease (CVD) and to examine associations between FA in NAWM and cerebrovascular risk factors. DTI metrics including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were measured in cerebral tissues and cerebrovascular anomalies from 152 people with CVD participating in the Ontario Neurodegenerative Disease Research Initiative (ONDRI). Ten cerebral tissue types were segmented including NAWM, and vascular lesions including stroke, periventricular and deep white matter hyperintensities, periventricular and deep lacunar infarcts, and perivascular spaces (PVS) using T1-weighted, proton density-weighted, T2-weighted, and fluid attenuated inversion recovery MRI scans. Mean DTI metrics were measured in each tissue region using a previously developed DTI processing pipeline and compared between tissues using multivariate analysis of covariance. Associations between FA in NAWM and several CVD risk factors were also examined. DTI metrics in vascular lesions differed significantly from healthy tissue. Specifically, all tissue types had significantly different MD values, while FA was also found to be different in most tissue types. FA in NAWM was inversely related to hypertension and modified Rankin scale (mRS). This study demonstrated the differences between conventional DTI metrics, FA, MD, AD, and RD, in cerebral vascular lesions and healthy tissue types. Therefore, incorporating DTI to characterize the integrity of the tissue microstructure could help to define the extent and severity of various brain vascular anomalies. The association between FA within NAWM and clinical evaluation of hypertension and disability provides further evidence that white matter microstructural integrity is impacted by cerebrovascular function. [ABSTRACT FROM AUTHOR]

Traditional face-to-face learning is often replaced by virtual learning because it can be more feasible and cost-effective, and more recently due to the need for social distancing. The objective was to evaluate the effectiveness of two innovative knowledge translation (KT) interventions; in-person stakeholder-hosted, interactive, problem-based seminars (SHIPS) versus online problem-based tutorials (e-PBL) in changing knowledge, readiness to change, and self-efficacy with respect to the use of rehabilitation outcome measures. Physical and occupational therapists (n = 124) were recruited from four sites across Canada to participate in either an e-PBL or SHIPS. Evaluations of KT impact measured knowledge, self-efficacy to implement outcome measures in practice, and readiness to change. There were 112 participants who completed the study. Following the intervention, the mean knowledge scores for both groups improved, but there was greater improvement in participants who completed SHIPS. For self-efficacy and readiness to change, there was no significant difference between groups six months following the interventions. E-PBL was as good as a SHIPS for improving and retaining self-efficacy and readiness to change. Knowledge improved more with workshops than online delivery, while improvements in self-efficacy and readiness to change improved similarly regardless of delivery. This study compared the relative efficacy of internet and workshop-based education, focusing specifically on the use of outcome measures in physical and occupational therapy practice. Improvements in the self-efficacy of rehabilitation professionals with respect to outcome measure use had lasting effects regardless of KT intervention type, as it was retained six months following the intervention. Results from this study show that online interventions may be as effective as face-to-face workshops for improving readiness to change and self-efficacy for using outcome measures in practice by rehabilitation professionals. This is valuable information given the recent global pandemic, the need for social distancing, and the potential for learning interventions to focus within the online environment in the future. [ABSTRACT FROM AUTHOR]

Background: The Canadian 24-Hour Movement Guidelines for Children and Youth (“Guidelines”) not only pioneered the notion of an integrated movement continuum from sleep to vigorous-intensity physical activity but also introduced a new branded Guideline visual identity. Objectives: This study evaluated youths’ (N = 46) attention to and thoughts about the Guidelines and the brand. Design: A cross-sectional between-participants randomized intervention design was used. Sample: Canadian youth between 10 and 17 years of age comprised the study sample. Interventions: Participants were randomly assigned to view either branded Guidelines (n = 26) or unbranded Guidelines (n = 20). Youths’ eye-movements (e.g., dwell time, fixation count) were recorded during Guideline viewing. Participants completed a follow-up survey assessing brand perceptions and Guideline cognitions. Results: The branded Guidelines neither drew greater overall attention nor led to more positive brand perceptions or Guideline cognitions compared to the unbranded Guidelines. Conclusions: Exploratory analyses provide valuable, yet preliminary insight into how branding and Guideline content may shape how Guidelines are perceived and acted upon. These findings inform an agenda for future health education resources. [ABSTRACT FROM AUTHOR]

With age, children become increasingly likely to make initial disclosures of transgressions, such as maltreatment, to peers. The present study examined adults' credibility evaluations of children's disclosures to peers across two studies. Study 1 examined credibility evaluations when children disclosed (or concealed) to a peer compared to an adult. Study 2 examined credibility ratings when children disclosed consistently or inconsistently across peer and adult interviews. Children were interviewed by a same-age peer and an adult regarding an event where an adult confederate spilled water on a laptop and broke it. In Study 1, participants heard a child interviewed by either a same-age peer or adult. In Study 2, participants heard a child interviewed by both the same-age peer and adult. In both studies, participants evaluated the child's credibility. Children who disclosed the transgression were rated as significantly less credible than those who concealed the transgression; however, credibility ratings did not differ by whether the child was interviewed by a peer or adult (Study 1). Furthermore, children who concealed the transgression across both interviews were rated as significantly more credible than children who disclosed in both interviews or disclosed to the peer, but not the adult, interviewer (Study 2). The current study provides the first evidence that peer disclosures may hinder children's credibility and that adults may be hesitant to believe children's disclosures of an adult's transgression. [ABSTRACT FROM AUTHOR]

Objective: To explore the prevalence and severity of smartphone addiction among a sample of Canadian university students. Participants: A sample of 925 full-time university students enrolled at the host institution were recruited. Participants were primarily undergraduates (70.2%), women (77.1%), and owned an Apple smartphone (70.3%). Methods: Participants completed an online questionnaire including a modified version of the Smartphone Addiction Scale (SAS) and demographics (i.e., degree pursing, gender, type of phone, faculty). Descriptive statistics for SAS sum score were calculated. Univariate ANOVAs were performed to explore differences in smartphone addiction among demographics. Results: Mean SAS sum score was 92.00 (i.e., "moderate" addiction level), 95% CI [90.52, 93.49]. Significant ANOVAs were found for degree, phone type, and faculty. Post-hoc tests revealed undergraduates and Apple users reported significantly higher smartphone addiction. Conclusions: The prevalence and severity of smartphone addiction among Canadian university students represents a budding health concern for postsecondary students. [ABSTRACT FROM AUTHOR]

Preterm infants are at risk for adverse neurodevelopmental outcomes, especially language delay. Preterm infants < 29 weeks' gestational age, cared for in Canadian Neonatal Follow-Up Network affiliated hospitals, were assessed between 18 to 21 months corrected age using the Bayley-III. Bayley-III Language Composite Scores were compared using univariate and multivariate analyses for children in three primary language groups: English, French and other. 6146 children were included. The primary language at home was English, French or another language for 3708 children (60%), 1312 children (21%) and 1126 children (18%), respectively, and overall, 44% were exposed to two or more languages at home. Univariate analysis showed that primary language was associated with lower Bayley-III Language scores; however, multivariate analyses demonstrated that neither primary language nor language of administration were significantly associated with lower language scores when adjusted for gestational age, other developmental delays and sociodemographic factors, but multiple language exposure was. Sociodemographic and other factors are more important in determining language development than primary language at home. Further studies are needed to examine the association between exposure to multiple languages and lower Bayley-III language scores in preterm infants. [ABSTRACT FROM AUTHOR]

Background Diagnostic errors unfortunately remain common. Electronic differential diagnostic support (EDS) systems may help, but it is unclear when and how they ought to be integrated into the diagnostic process. Objective To explore how much EDS improves diagnostic accuracy, and whether EDS should be used early or late in the diagnostic process. Setting 6 Canadian medical schools. A volunteer sample of 67 medical students, 62 residents in internal medicine or emergency medicine, and 61 practising internists or emergency medicine physicians were recruited in May through June 2020. Intervention Participants were randomised to make use of EDS either early (after the chief complaint) or late (after the complete history and physical is available) in the diagnostic process while solving each of 16 written cases. For each case, we measured the number of diagnoses proposed in the differential diagnosis and how often the correct diagnosis was present within the differential. Results EDS increased the number of diagnostic hypotheses by 2.32 (95% CI 2.10 to 2.49) when used early in the process and 0.89 (95% CI 0.69 to 1.10) when used late in the process (both p<0.001). Both early and late use of EDS increased the likelihood of the correct diagnosis being present in the differential (7% and 8%, respectively, both p<0.001). Whereas early use increased the number of diagnostic hypotheses (most notably for students and residents), late use increased the likelihood of the correct diagnosis being present in the differential regardless of one's experience level. Conclusions and relevance EDS increased the number of diagnostic hypotheses and the likelihood of the correct diagnosis appearing in the differential, and these effects persisted irrespective of whether EDS was used early or late in the diagnostic process. [ABSTRACT FROM AUTHOR]

Background/Objective: Hip- and knee-muscle-strengthening programs are effective in improving short-term patient-reported and disease-oriented outcomes in individuals with patellofemoral pain (PFP), but few to no data exist on moderate- to longterm postrehabilitative outcomes. The first purpose of the study was to assess differences in pain, function, strength, and core endurance in individuals with PFP before, after, and 6 mo after successful hip- or knee-muscle-strengthening rehabilitation. The second purpose was to prospectively follow these subjects for PFP recurrence at 6, 12, and 24 mo postrehabilitation. Methods: For 24 mo postrehabilitation, 157 physically active subjects with PFP who reported treatment success were followed. At 6 mo postrehabilitation, pain, function, hip and knee strength, and core endurance were measured. At 6, 12, 18, and 24 mo, PFP recurrence was measured via electronic surveys. Results: Sixty-eight subjects (43%) returned to the laboratory at 6 mo. Regardless of rehabilitation program, subjects experienced significant improvements in pain and function, strength, and core endurance pre- to postrehabilitation and maintained improvements in pain and function 6 mo postrehabilitation (Visual Analog Scale/Pain--pre 5.12 ± 1.33, post 1.28 ± 1.14, 6 mo 1.68 ± 2.16 cm, P < .05; Anterior Knee Pain Scale/ Function--pre 76.38 ± 8.42, post 92.77 ± 7.36, 6 mo 90.27 ± 9.46 points, P < .05). Over the 24 mo postrehabilitation, 5.10% of subjects who responded to the surveys reported PFP recurrence. Conclusions: The findings support implementing a hip- or knee-muscle-strengthening program for the treatment of PFP. Both programs improve pain, function, strength, and core endurance in the short term with moderate- and long-term benefits of improved pain and function and low PFP recurrence. [ABSTRACT FROM AUTHOR]

Background: Emerging adulthood is associated with heavy drinking. Despite overall heavy use, studies show considerable heterogeneity in emerging adult drinking habits. Lau-Barraco and colleagues (2016 b) identified three subtypes (high, moderate, low) of emerging adult heavy drinkers based on patterns of use across common drinking situations. Heavy situational drinkers had more alcohol problems, mental health symptoms, and coping/conformity motives for alcohol use. Objective: Our goal was to replicate and extend the aforementioned study, expecting to find the same subgroups, then examining whether certain risk factors predicted subgroup membership. Methods/Results: Undergraduates (N = 497) completed online self-report measures and a latent profile analysis (LPA) found support for three similar subtypes; low, "moderate" (higher endorsement of pleasant emotion/social pressure situations, relative to the low group), and high. Univariate ANOVAs, followed by pairwise comparisons, found that heavy situational drinkers scored highest on measures of alcohol problems, problem gambling, drug use, depression, and anxiety compared to the other two groups, and consistent with previous findings. Conclusions: This study showed that emerging adults who drink heavily across various situations are likely to engage in other addictive behaviors and struggle with mental health symptoms. Identifying one's personal risk factors and their riskiest drinking situations is critical for developing targeted intervention programs and increasing the understanding of the heterogeneous nature of drinking behaviors in emerging adults in Canada. [ABSTRACT FROM AUTHOR]

Background: Recently, the Canadian Orthopaedic Foot and Ankle Society (COFAS) proposed a classification system addressing adjunct procedures in the treatment for end-stage ankle arthritis. We reviewed Patient-Reported Outcome Measures Information System (PROMIS) data to determine if outcomes of total ankle arthroplasty (TAA) correlated with postoperative COFAS classification. We hypothesize that as COFAS classification increases, patients will demonstrate greater improvement in the change between pre- and postoperative PROMIS scores. Methods: From June 2015 to December 2018, a total of 127 patients underwent 132 TAA. Demographic factors and preoperative and most recent postoperative PROMIS scores were collected. Univariate, multivariate and post hoc analyses with a significance threshold of P <.05 were performed. Results: Eighty-seven patients with a mean follow-up of 13.6±7.3 months and complete PROMIS scores were classified into COFAS types 1-4. Significant differences were identified in the PROMIS Pain Interference domain comparing COFAS types 2 and 4 and COFAS types 3 and 4. These results demonstrate that more complex ankles with a higher COFAS score had worse interval improvement in PROMIS scores. Additionally, multivariate linear regression showed that age and BMI were associated with worse physical function and depression, whereas diabetes and a history of prior surgeries were associated with improved postoperative function. Conclusion: The COFAS postoperative classification system is useful for categorizing end-stage ankle arthritis. Further research into the ideal timing of surgery and higher-level studies to better determine TAA efficacy with different classification systems is warranted. This information can be helpful with preoperative counseling about treatment outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Our 1-year longitudinal study tracked the development of cognate awareness among second (L2) and third language (L3) learners of French in French immersion in Grades 1 and 2 to explore the impact of orthographic overlap and cognate status (true vs. false) on children's ability to recognize cognate relationships. We also assessed the impact of French L2/L3 status on performance. Method: We compared performance on three conditions (true cognates with same and similar spellings, false cognates with same spellings) within and across grades. We used a direct measure of cognate awareness that required children (n = 81) to distinguish true from false cognates presented orally and in print. Results: Overall, Grade 1 children failed to recognize cognate relationships between true cognates with similar spellings, but successfully recognized true cognates with same spellings. Performance on all conditions increased significantly between Grades 1 and 2. The greatest improvement was seen on true cognates with similar spellings. Performance on false cognates was inferior to performance on true cognates with same spellings in Grade 1, and inferior to performance on both same and similar spelled true cognates in Grade 2. No differences were found due to L2/L3 status. Conclusions: Among sequential learners of L2/L3 French in the early stages of additional language learning, cognate awareness is impacted by the degree of orthographic overlap, as well as by cognate status. Children's ability to recognize cross-language orthographic and semantic relationships improves substantially across the early elementary grades. [ABSTRACT FROM AUTHOR]

Objective To evaluate the risk of severe infection and infection-related mortality among patients with newly diagnosed SLE. Methods We conducted an age- and gender-matched cohort study of all patients with incident SLE between 1 January 1997 and 31 March 2015 using administrative health data from British Columbia, Canada. Primary outcome was the first severe infection after SLE onset necessitating hospitalization or occurring during hospitalization. Secondary outcomes were total number of severe infections and infection-related mortality. Results We identified 5169 SLE patients and matched them with 25 845 non-SLE individuals from the general population, yielding 955 and 1986 first severe infections during 48 367 and 260 712 person-years follow-up, respectively. The crude incidence rate ratios for first severe infection and infection-related mortality were 2.59 (95% CI: 2.39, 2.80) and 2.20 (95% CI: 1.76, 2.73), respectively. The corresponding adjusted hazard ratios were 1.82 (95% CI: 1.66, 1.99) and 1.61 (95% CI: 1.24, 2.08). SLE patients had an increased risk of a greater total number of severe infections with crude rate ratio of 3.24 (95% CI: 3.06, 3.43) and adjusted rate ratio of 2.07 (95% CI: 1.82, 2.36). Conclusion SLE is associated with increased risks of first severe infection (1.8-fold), a greater total number of severe infections (2.1-fold) and infection-related mortality (1.6-fold). [ABSTRACT FROM AUTHOR]

Experiencing sexual violence is an important risk factor for trauma symptoms, and these symptoms significantly impair psychosocial functioning. Sexual and gender minority university students are more likely than their heterosexual and cisgender peers to experience sexual violence (e.g., sexual harassment, unwanted sexual contact, or sexual coercion) while attending university, but research on the consequences of these experiences is needed to inform service provision to these vulnerable populations. Using a large-scale study of university-based sexual violence in Quebec, the current study examined how gender and sexual minority status were associated with the severity of trauma symptoms among students who experienced sexual violence (N = 1,196). Findings indicated that compared with their cisgender peers, gender minority students experienced significantly higher levels of trauma symptoms as a result of sexual violence, controlling for the severity of sexual violence behaviors experienced and other variables. Among cisgender women, but not cisgender men, sexual minority identity was also associated with higher levels of trauma symptoms, controlling for severity of sexual violence behaviors experienced and other variables. Furthermore, gender of perpetrator and amount of sexual violence moderated the associations between sexual identity and trauma symptoms among cisgender women. These findings not only suggest that gender minority and some sexual minority university students are more likely to experience sexual violence, but that they are also more likely to experience negative psychological sequelae as a consequence of these experiences. Ultimately, these findings may suggest the need for services that are more supportive of the specific needs of gender and sexual minority students with regard to sexual violence. [ABSTRACT FROM AUTHOR]

Background Reports on the adequacy of vitamin D status of pregnant women are not available in Canada. Objectives The objectives of this study were to examine vitamin D status across pregnancy and identify the correlates of vitamin D status of pregnant women in Canada. Methods Pregnant women (≥18 years) from 6 provinces (2008–2011) participating in a longitudinal cohort were studied. Sociodemographic data, obstetrical histories, and dietary and supplemental vitamin D intakes were surveyed. Plasma 25-hydroxyvitamin D (25OHD) was measured using an immunoassay standardized to LC-MS/MS from samples collected during the first (n  = 1905) and third trimesters (n  = 1649) and at delivery (n  = 1543). The proportion of women with ≥40 nmol/L of plasma 25OHD (adequate status) was estimated at each time point, and factors related to achieving this cut point were identified using repeated-measures logistic regression. Differences in 25OHD concentrations across trimesters and at delivery were tested a using repeated-measures ANOVA with a post hoc Tukey's test. Results In the first trimester, 93.4% (95% CI: 92.3%–94.5%) of participants had 25OHD ≥40 nmol/L. The mean plasma 25OHD concentration increased from the first to the third trimester and then declined by delivery (69.8 ± 0.5 nmol/L, 78.6 ± 0.7 nmol/L, and 75.7 ± 0.7 nmol/L, respectively; P  < 0.0001). A lack of multivitamin use early in pregnancy reduced the odds of achieving 25OHD ≥40 nmol/L (ORadj = 0.33; 95% CI: 0.25–0.42) across all time points. Factors associated with not using a prenatal multivitamin included multiparity (ORadj = 2.08; 95% CI: 1.42–3.02) and a below-median income (ORadj = 1.39; 95% CI: 1.02–1.89). Conclusions The results from this cohort demonstrate the importance of early multivitamin supplement use to achieve an adequate vitamin D status in pregnant women. [ABSTRACT FROM AUTHOR]

Aim: To examine factors of a hypothetical model related to stressors, burnout and turnover in nurses from developed and developing countries—Canada, Japan, the United States, Malaysia and Thailand. Design: A cross‐sectional questionnaire‐based study. Methods: Conducted between April 2016 and October 2017, the Maslach Burnout Inventory, Intention to Leave Scale, and Nursing Stress Scale collected data from acute care hospital nurses in Canada (n = 309), Japan (n = 319), Malaysia (n = 242), Thailand (n = 211) and the United States (n = 194). Results: Compared to other countries, burnout "exhaustion" was the highest in Japan and "cynicism" and intention to leave the job were the highest in Malaysia. Thailand had lower burnouts and turnover than other countries and higher professional efficacy than Japan and Malaysia. In all countries, reducing stressors is important for reducing burnout and intention to leave jobs, especially as they relate to "lack of support." [ABSTRACT FROM AUTHOR]

Background Agitation associated with dementia impacts delivery of medical care and is a major reason for institutionalization in dementia patients. This study examines the association of medication use and other clinical factors with patients' 'dischargeability' (i.e., amount of time until a patient is considered dischargeable from an inpatient unit). Methods This study was a retrospective chart review examining 200 patients with dementia and agitation, hospitalized at a Canadian acute care geriatric ward between November 2007 and November 2018. The main outcome measure was time until a patient was deemed dischargeable. Univariate linear regression analyses, followed by multiple linear regression analyses, were used. Results Risperidone and quetiapine were the most commonly prescribed medications, but were not associated with time until dischargeable. Olanzapine (40.9 vs. 16.2 days until dischargeable, β = 0.23, p = .001), regular benzodiazepine (32.7 vs. 16.5 days until dischargeable, β = 0.15, p = .027), and as-needed ('PRN') benzodiazepine use (31.7 vs. 15.9 days until dischargeable, β =0.19, p = .006) were independently associated with prolonging time until dischargeable. Conclusions Olanzapine, benzodiazepine, and PRN benzodiazepine use were associated with longer time until patients with dementia and agitation were considered ready for discharge. This raises the question as to whether the risks of these medications outweigh the benefits in a hospital setting. [ABSTRACT FROM AUTHOR]

Child homicides are rare occurrences, but when they occur, they often cause significant outrage. This paper examines the role of varying degrees of intimacy between victims and perpetrators in determining characteristics in child homicide cases. Focusing on 533 cases of child homicide between 1985 and 2012 in Ontario, Canada, characteristics of intrafamilial and extrafamilial cases, biological and step/foster parents, and maternal and paternal perpetrators are compared. Results show that characteristics of the child homicide vary depending on the degree of intimacy between victims and perpetrators, including: perpetrator and victim age, weapon use, suicide following the offence, sexual violence and use of excessive force. These findings provide support for developmental victimology and a routine activities theoretical perspective. Suggestions for future research and policy implications are also discussed. 'Examines the role of varying degrees of intimacy between victims and perpetrators in determining characteristics in child homicide cases' Key Practitioner Messages: Younger children are at a greater risk of homicide from family members, while older children are at a greater risk of homicide from individuals outside the family.Developmental victimology and routine activities theory can contribute to a better understanding of the dynamics between victims and perpetrators in child homicide.Collaboration should take place between researchers, child death review committees, mental health services, social services and policymakers to improve child homicide prevention and intervention initiatives. [ABSTRACT FROM AUTHOR]

Objective: This questionnaire‐based survey assessed the attitudes of dental hygiene students towards treating elderly patients. Methods: The 14‐item UCLA 14‐item Geriatrics Attitudes Scale (GAS‐14) questionnaire was used in this survey. A further set of nine questions evaluated the opinions of the students towards the existing geriatric curriculum in their respective institutions. Students from five dental hygiene schools from three countries (Switzerland, Belgium and Canada) participated in this survey. General demographic information from the participants was collected. Mean GAS‐14 scores were calculated; ANOVA and Bonferroni's tests were used for statistical analyses (p < 0.05). Results: Three hundred eighty‐five students (Switzerland: n = 157, mean age = 25.38 ± 4.6 years; Belgium: n = 82, mean age = 27.58 ± 12.8 years; Canada: n = 146, mean age = 25.95 ± 12.3 years) completed the survey for a response rate of 86.3%. The overall GAS‐14 scores for Switzerland, Belgium and Canada were 3.61 ± 0.42, 3.24 ± 0.37 and 3.32 ± 0.36, respectively. Switzerland scored significantly higher than Belgium and Canada (p < 0.0001). Overall scores revealed a significant effect of progressive training (p = 0.010). The GAS‐14 score was influenced by the nationality of the participants (p < 0.0001), but not influenced by sex, age, origin, religion, or marital and accommodation statuses. Majority of the students (75.8%) agreed that geriatric dentistry was an important part of their education. 77.4% agreed that they would like hands on experience in treating the elderly patient during their education. 85.1% of the participants considered mobile dental clinics as a good solution for the provision of dental care to the institutionalized elders. Conclusions: The general attitudes of DH students towards treating the elderly patients are on an acceptable level and improved as they progressed through their dental hygiene academic programmes. [ABSTRACT FROM AUTHOR]

Users' experiences in mental health assessment are multifaceted, including their emotional experiences. Yet, studies of mobile apps for psychiatric assessment have centered on diagnostic accuracy and perceived usability, with little consideration of the impact of user emotional experiences. In this study, we focused on users' perceived usability and emotions and compared the user experience of a paper-and-pencil and an app-based collection of mental health screening questionnaires: EarlyDetect. The System Usability Scale (SUS) and modality-directed emotion questionnaires were administered using paper-and-pencil or iPad. Modality was assigned pseudo-randomly on patients' first visit at a referral-based mental health clinic. We found that patients assigned to the iPad app reported a significantly higher SUS score than patients assigned to paper-and-pencil, qualified by a modality-by-gender interaction where modality effects were significant for men but not for women. Moreover, enjoyment was positively linked to perceived usability, whereas boredom, frustration, and anxiety were negatively linked to usability. Our findings illustrate the added value of studying user experience applied to psychiatric assessments, where both emotions and gender-specific user experience should be taken into consideration. We further discuss the implications for psychiatric assessments via app versus traditional data collection. [ABSTRACT FROM AUTHOR]

The negative effects of exposure to intimate partner violence (IPV) on children have been well documented, including externalizing difficulties such as aggression. Although aggressive behavior is a common concern for these children, sibling aggression in children exposed to IPV has rarely been studied. Our purpose was to investigate similarities and differences in multiple informant reports of aggression by siblings exposed to IPV, and to examine how exposure to IPV was linked to these differing perspectives. Forty-seven sibling dyads and their mothers were recruited from the community. Aggression was assessed by observers, by mothers, and by the siblings themselves, whereas IPV was assessed by both maternal and child report. Informants had very differing views on aggression. Regression results indicated that children's reports of their own exposure to IPV accounted for significant variance in observed aggression between siblings, as well as in the maternal reports of aggression by both siblings. Aggression did not vary by sibling age, sex, or age spacing. Results were discussed within a risk and resilience framework. [ABSTRACT FROM AUTHOR]

The prevalence of arthritis in aging populations continues to rapidly grow. Research has highlighted 2 principal risk factors for progression of arthritis-related biopsychosocial symptoms: age and physical inactivity. This study examined the relationship between and within physical activity and age on biopsychosocial symptoms of arthritis in adults (age > 30 yr). Hierarchical, multiple-regression analyses were conducted on the Canadian Community Health Survey (Cycle 4.2, 2009-2010, N= 19,103). Results revealed that more-active adults had significantly fewer symptoms (physical unstd. B = -.23, p < .001; pyschosocial unstd. B = -.51, p < .001). In addition, as age increased, physical symptoms intensified and psychosocial symptoms tapered (physical unstd. B = .24, p < .001; psychosocial unstd. B = -.45, p < .001). Inactive older adults had the highest level of physical symptoms, while inactive younger adults had the highest level of psychosocial symptoms (p < .001). Findings highlight the need to target physical activity interventions to specific age cohorts and particular biopsychosocial symptomologies. [ABSTRACT FROM AUTHOR]

Background: The mini-Balance Evaluation Systems Test (mini-BESTest) is a valid tool for assessing standing balance in people with spinal cord injury (SCI). Its reliability has not yet been investigated with this population. Objective: To assess the test-retest and inter-rater reliability of the mini-BESTest in adults with SCI in a rehabilitation setting. Methods: Twenty-three participants admitted in a rehabilitation center following an SCI (mean age = 52.2 years, SD = 14.5; 13/23 tetraplegia; 14/23 traumatic injury) and able to stand 30 seconds without help were recruited. They were evaluated twice with the mini-BESTest to establish the test-retest reliability (interval of 1 to 2 days). One of the two sessions was video-recorded to establish the inter-rater reliability (3 physiotherapists). Intraclass correlation coefficients (ICC2,1), weighted kappa (Kw) and Kendall's W were used to determine reliability of total score and individual items. Minimal detectable changes (MDC) were computed. Results. The mini-BESTest total scores showed excellent test-retest (ICC = 0.94) and inter-rater (ICC = 0.96) reliability. Reliability of 50% of the individual items was acceptable to excellent (Κw and W = 0.35–1.00). The MDC of the mini-BESTest total score was 4 points. Conclusion: The mini-BESTest is a reliable tool to assess standing balance in adults with an SCI. A minimal change of 4 points on the total scale is needed to be confident that the change is not a measurement error between two sessions or two raters. [ABSTRACT FROM AUTHOR]

Offender specialization—the tendency to repeat specific offenses—is the basis of practical orientations toward managing offending by the criminal justice system. Alternatively, dominant criminological paradigms postulate that offending versatility is the norm. We consider this incongruity by, first, considering "practice" in action, through the examination of the designations used by the Canadian criminal justice system to categorize offenders based on the assumption of specialization, and whether these determinations accurately reflect the offending behavior of offenders who have committed violent interpersonal crimes. Second, we compare several other measures of specialization among our population to investigate whether different measures produce similar findings regarding the repeat of specific offense types. Official criminal record data, from first offense to the end of the study date (2014), for a population of offenders in a western Canadian city who were convicted of violent interpersonal sexual and nonsexual offenses (N = 110), were used to examine the tendency toward specialization. We employ three measures of specialization: the specialization threshold, mean percent specialization, and the diversity index—across this group of career criminals. Results indicate that evidence of specialization depends on the way in which it is measured. Although there is some support for the treatment of individuals who sexually offend against children as a distinct group compared with those who are violent (sexually or nonsexually) toward adults, there is greater evidence of versatility among all offenders than there is of specialization. Our findings suggest that establishing the risk of future offending using models other than those geared toward offense specialization may be more effective for addressing offending patterns. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the meal- and snack-eating frequency and the nutritional composition of each eating occasion of Canadian high-performance athletes during training. Athletes from 8 Canadian Sport Centres prospectively completed 3-d dietary records including all food, fluid, and supplements consumed. The time of consumption and whether the consumption was a meal or snack were also identified. The dietary records were analyzed for energy (kcal) and macronutrient intake (carbohydrate, protein, and fat) and compared based on gender, age, meal vs. snack, and training vs. rest days. Three hundred twenty-four athletic subjects (64% female and 36% male) completed the study. On average, the athletes ate 4.8 ± 0.8 times daily. Nearly all athletes consumed 3 daily meals of breakfast (98.9%), lunch (97.9%), and dinner (98.7%), with few having snacks: 57%, 71.6%, and 58.1% of athletes consumed an a.m., p.m., and evening snack, respectively. Training-day meal frequency did not differ from that during rest days; however, fewer snacks were consumed on rest days. A.m. and p.m. snacks were consumed significantly more often on training days than rest days. Overall, snacks contributed 24.3% of total daily energy intake. Few dietary variations were discovered between genders, while the youngest athletes (<18 yr) ate less often, especially their morning snack, than the older athletes. In conclusion, Canadian high-performance athletes self-adjusted their energy intakes on training vs. rest days primarily by snacking less and reducing their carbohydrate and protein intakes on rest days, yet they consistently ate regular meals. [ABSTRACT FROM AUTHOR]

Objective: The objective of this research was to determine the school and community characteristics associated with milk and milk alternative (MMA) consumption by Canadian youth. Methods: We analyzed self-reported data from 50,058 Canadian students participating in the 2017-2018 wave of the COMPASS survey. We used logistic and linear regression analyses to identify school- and community-level factors associated with students meeting the MMA guidelines, and factors associated with daily number of MMA servings consumed, respectively. Results: Student-level factors were more strongly associated with MMA consumption than school- and community-level factors. Students who attended schools that provided staff with nutrition training consumed fewer daily servings of MMAs and were less likely to meet MMA guidelines. Students attending schools that received healthy eating grants were more likely to meet MMA guidelines, whereas students attending schools that sold flavored milk in their vending machines were less likely to meet MMA guidelines. Conclusion: Our findings suggest that student-level factors have a stronger association with MMA consumption than school or community factors. Additional research is needed to understand how factors associated with MMA consumption may influence behaviours over time, and how changes to Canada's food guide may impact youth eating habits. [ABSTRACT FROM AUTHOR]