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Policy-makers desire an optimal balance of financial incentives to improve productivity and encourage improved quality in primary care, while also avoiding issues of risk-selection inherent to capitation-based payment. In this paper we analyze risk-selection in capitation-based payment by using administrative data for patients ( n = 11,600,911) who were rostered (i.e., signed an enrollment form, or received a majority of care) with a primary care physician ( n = 8621) in Ontario, Canada in 2010/11. We analyze this data using a relative distribution approach and compare distributions of patient costs and morbidity across primary care payment models. Our results suggest a relationship between being in a capitation-based payment scheme and having low cost patients (and presumably healthy patients) compared to fee-for-service physicians. However, we do not have evidence that physicians in capitation-based models are reducing the care they provide to sick and high cost patients. These findings suggest there is a relationship between payment type and risk-selection, particularly for low-cost and healthy patients. [ABSTRACT FROM AUTHOR]

This paper investigates the nature of the relationship between satisfaction with high school sexual health education and the pursuit of a post-secondary human sexuality course. In an initial study, first-year university students who received high school sexual health education in Ontario completed a questionnaire which assessed their satisfaction with sexual health education and asked whether students were pursuing or intended to pursue a human sexuality course in university. Students who were less satisfied with high school sexual health education and, in particular, those who did not rate sexual health education as contributing to their understanding of themselves as sexual beings, were more likely to pursue a university-level course. A second qualitative study investigated potential reasons underlying this correlation. Eleven first-year students enrolled in a human sexuality course were interviewed about (a) their satisfaction with their high school sexual health education and (b) their reasons for taking the course. The findings suggest that dissatisfaction with sexual health education may be a result of students perceiving they had not learned enough personally relevant information and/or received a biased education in high school. These factors, which seem to determine dissatisfaction, may motivate students to pursue additional education in university. [ABSTRACT FROM PUBLISHER]

In this paper, we focus on the initial experiences of breastfeeding among mothers to examine the ways that infant-feeding is socially constructed in the hospital. Data comes from 51 in-depth interviews with 17 first-time mothers in Ontario, Canada. Analysis reveals 52 magnified moments that we categorize as Successful, Ultimately Successful and Unsuccessful. For mothers who describe Successful and Ultimately Successful moments, breastfeeding is understood as physiologically natural, and as something they must learn to do. Unsuccessful moments reveal that when health care providers interpret breastfeeding as not working, the breastfeeding discourse frequently shifts to one that incorporates formula as the means to achieve optimal infant health. In other words, in the hospital ‘breast is best’ holds true when breast ‘works’, otherwise mothers are often directed to give their babies formula. While formula appears to be compulsory in these moments, it is not typically understood as a “good or best” infant-feeding practice. For mothers in this situation, the shift from breast to formula is experienced as failures or evidence of inadequacy in their mothering. Paradoxically, our results suggest that formula may not, in and of itself, pose a threat to mothers' overall continued practice of breastfeeding. It appears that Successful and Ultimately Successful moments coincide with the current dominant ‘breast is best’ understanding. Unsuccessful moments, conversely, are insightful because they reveal when and how hospital practices disrupt mothers' understanding of their bodies and their role in providing the ‘best’ form of infant food. The implications for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

In Canada, youth apprenticeships have been promoted as an educational alternative that leads to the development of valuable skills, allows for the opportunity to earn an income while learning and helps youth to gain a head start into lucrative, creative and in-demand careers. Yet, these programmes have remained rather marginal and continue to be perceived as being of lower-status compared to traditional post-secondary educational pathways, such as those leading to university or community college. In this paper, we draw on interview data with former youth apprentices in the province of Ontario to explore their reasons for entering apprenticeships in high school, their experiences in them and their own perceptions about the status and social recognition of apprenticeships. We suggest that policies regarding apprenticeship programmes in Canada need to expand their focus. While emphasis is currently placed on recruiting students by highlighting relatively utilitarian benefits, we argue that more focus needs to be placed on the training offered to apprentices including the commitment of employers to provide quality training on the job, the integration of classroom and on-the-job training and the opportunity for apprentices to move from partial to full participation in communities of practice. [ABSTRACT FROM PUBLISHER]

The widely held view is that effective action on climate change requires commitment by national governments to international agreements. Developed nations like Canada and Australia continue to fall short in their commitments to emissions reduction targets established under the 1997 Kyoto Protocol. Australia refused to ratify its Kyoto commitments until 2008 and Canada withdrew its commitment in 2011. Subnational governments in both countries have been active in developing policy responses to climate change yet remain largely excluded as serious policy partners in national mitigation and adaptation initiatives. This paper utilizes Kingdon’s Multiple Streams Framework to consider why subnational governments address climate change and the main factors shaping their policy choices. The experiences of the Australian state of Victoria and the Canadian province of Ontario provide examples through which to explore the factors contributing to climate policy opportunities and constraints faced by subnational governments in these countries. [ABSTRACT FROM AUTHOR]

This paper offers an examination of gay–straight alliance (GSA) members’ engagement with sex education, sexual health, and prejudice and discrimination in Canadian public high schools. It explores how five students’ (four straight and one gay-identifying) participation in GSAs served as a springboard for learning about and challenging stereotypes; prejudice; and discrimination directed at lesbian, gay, bisexual, trans, and queer/questioning (LGBTQ) people. Queer theory provided the theoretical underpinnings of the study, offering a lens through which to examine the heteronormative underpinnings of education, and a means to interpret how homophobic discourses circulate in school and society. Empirical data were obtained via observational notes from visits to nine GSAs and semi-structured interviews with the five GSA members. Findings suggest that straight allies can use their heterosexual privilege to address LGBTQ issues with their peers. Through GSA involvement, participants learned to interrogate and combat stereotypes about LGBTQ people and HIV-related myths, as well as to engage in queer discussion and political action. [ABSTRACT FROM PUBLISHER]

Sexuality is an aspect of health and development that is often overlooked among people with physical disabilities, particularly adolescents. Studies have demonstrated that youth with physical disabilities show considerably lower levels of sexual knowledge and receive inadequate sex education compared to their peers without such disabilities. The data for this paper are part of a qualitative study that explored the experiences, barriers and challenges associated with sex education for youth with physical disabilities from the perspectives of young people themselves, their parents and the health professionals who work with them. The findings from this study highlight the tendency for parents, educators and health professionals to place the responsibility of delivering sex education to young people with physical disabilities on someone else who they believe to be more appropriately qualified to handle these types of situations. As a result, the findings illustrate that adolescents with physical disabilities do not always receive the necessary combination of comprehensive sex education within school environments, specialized information from health professionals, and informal sex education from family and peers that they require in order to gain the knowledge and skills needed to understand their own sexual capabilities and make informed decisions about their sexual health and intimate relationships. [ABSTRACT FROM AUTHOR]

Abstract: A growing range of studies have begun to document the health and well-being benefits associated with contact with nature. Most studies rely on generalized self-reports following engagement in the natural environment. The actual in-situ experience during contact with nature, and the environmental features and factors that evoke health benefits have remained relatively unexplored. Smartphones offer a new opportunity to monitor and interact with human subjects during everyday life using techniques such as Experience Sampling Methods (ESM) that involve repeated self-reports of experiences as they occur in-situ. Additionally, embedded sensors in smartphones such as Global Positioning Systems (GPS) and accelerometers can accurately trace human activities. This paper explores how these techniques can be combined to comprehensively explore the perceived health and well-being impacts of contact with nature. Custom software was developed to passively track GPS and accelerometer data, and actively prompt subjects to complete an ESM survey at regular intervals throughout their visit to a provincial park in Ontario, Canada. The ESM survey includes nine scale questions concerning moods and emotions, followed by a series of open-ended experiential questions that subjects provide recorded audio responses to. Pilot test results are used to illustrate the nature, quantity and quality of data obtained. Participant activities were clearly evident from GPS maps, including especially walking, cycling and sedate activities. From the ESM surveys, participants reported an average of 25 words per question, taking an average of 15 s to record them. Further qualitative analysis revealed that participants were willing to provide considerable insights into their experiences and perceived health impacts. The combination of passive and interactive techniques is sure to make larger studies of this type more affordable and less burdensome in the future, further enhancing the ability to understand how contact with nature enhances health and well-being. [Copyright &y& Elsevier]

Abstract: While the “social determinants of health” view compels us to explore how social structures shape health outcomes, it often ignores the role individual agency plays. In contrast, approaches that focus on individual choice and personal responsibility for health often overlook the influence of social structures. Amartya Sen's “capabilities” framework and its derivative the “health capabilities” (HC) approach attempts to accommodate both points of view, acknowledging that individuals function under social conditions over which they have little control, while also acting as agents in their own health and well-being. This paper explores how economic, social, and cultural resources shape the health capability of people with diabetes, focusing specifically on dietary practices. Health capability and agency are central to dietary practices, while also being shaped by immediate and broader social conditions that can generate habits and a lifestyle that constrain dietary behaviors. From January 2011 to December 2012, we interviewed 45 people with diabetes from a primary care clinic in Ontario (Canada) to examine how their economic, social, and cultural resources combine to influence dietary practices relative to their condition. We classified respondents into low, medium, and high resource groups based on economic circumstances, and compared how economic resources, social relationships, health-related knowledge and values combine to enhance or weaken health capability and dietary management. Economic, social, and cultural resources conspired to undermine dietary management among most in the low resource group, whereas social influences significantly influenced diet among many in the medium group. High resource respondents appeared most motivated to maintain a healthy diet, and also had the social and cultural resources to enable them to do so. Understanding the influence of all three types of resources is critical for constructing ways to enhance health capability, chronic disease self-management, and health. [Copyright &y& Elsevier]

The Greater Involvement of People Living with HIV/AIDS Principle (GIPA) has been a core commitment for many people involved in the community-based HIV/AIDS movement. GIPA refers to the inclusion of people living with HIV/AIDS in service delivery and decision-making processes that affect their lives. Despite its central importance to the movement, it has received little attention in the academic literature. Drawing on focus group discussions among staff members and volunteers of AIDS service organizations, activists, and community members, we explore challenges to the implementation of the GIPA principle in community-based HIV/AIDS organizations in Ontario, Canada. Our findings reveal ways in which implementing GIPA has become more complicated over recent years. Challenges relating to health, stigma and disclosure, evolving HIV/AIDS organizations, and GIPA-related tensions are identified. This paper considers our findings in light of previous research, and suggests some implications for practice. [ABSTRACT FROM PUBLISHER]

Abstract: Using a sociology of diagnosis approach, this paper discusses the implication of high cholesterol being promoted as a disease rather than a risk factor for cardiovascular diseases. Drawing on data collected during the spring/summer of 2012 from 49 in-depth interviews with women over the age of forty concerned with high cholesterol in Ontario, Canada, I explore participants' understanding of the issue of high cholesterol as a disease. More specifically, I examine where blame and responsibility for high cholesterol are placed and if they vary by women's class background. My findings reveal that all the participants believed in and internalized the diagnosis of high cholesterol. However, the disease is blamed on ‘lifestyle choices’, and individual responsibilities, while women's awareness of the social determinants of health varies by class. I argue the sense of urgency surrounding high cholesterol is worrisome and the sole focus on lifestyle choice as both the cause and solution to high cholesterol is problematic for three reasons: it assumes that individual responsibility is adequate; it minimizes the socioeconomic constraints women face on a daily basis; and it reinforces the idea that individuals can be blamed for their health problems. [Copyright &y& Elsevier]

Abstract: This paper extends the burgeoning interest in emotion, health and place by investigating the emotionally complex experiences of aging and care in rural settings. Featuring a thematic analysis of 44 semi-structured interviews and two focus groups with older people and their carers in rural Ontario (Canada) we examine the importance and implications of emotions within and across multiple scales at which care relationships, expectations and responsibilities are negotiated. With the aim of broadening the discussion surrounding geographical dimensions of ethical care, our approach draws on feminist care ethics to understand the multifaceted ways in which emotions shape and are shaped by experiences of aging and caring at the interpersonal, household and community scales. The findings reveal how emotions are central, yet often-overlooked and even hidden within care relationships among older rural people and their carers. We argue that ethical care is contingent on recognizing and valuing the situated emotions involved in doing care work, sustaining care relationships and asking for care. In doing so, we demonstrate how qualitative research on the emotional geographies of care can contribute to the development of informed policies that are contextually sensitive and, ultimately, have the potential to build more ethical rural conditions of care. [Copyright &y& Elsevier]

Purpose - The purpose of this paper is to provide an overview of the challenges and benefits of a challenge grant. Design/methodology/approach - The paper explains the University of Waterloo Library's first-hand experiences in seeking and acquiring a challenge grant from the Kresge Foundation. Findings - The challenge grant can provide libraries with a unique opportunity to raise their profiles, enlist the support of key leaders, generate excitement about their organizations' work and future plans, and raise additional funds. Originality/value - The paper provides practical suggestions that offer incentive and encouragement to seek a challenge grant due to the many benefits that accrue to a library development program. [ABSTRACT FROM AUTHOR]

With the implementation of new policies supporting renewable natural gas production from organic wastes, Canada began replacing traditional disposal methods with highly integrated biogas production strategies. Herein, data from published papers, Canadian Biogas Association, Canada's national statistical agency, and energy companies' websites were gathered to gain insight into the current status of anaerobic digestion plants in recovering energy and resource from organic wastes. The availability of materials prepared for recycling by companies and local waste management organizations and existing infrastructures for municipal solid waste management were examined. Governmental incentives and discouragements in Canada and world anaerobic digestion leaders regarding organic fraction municipal solid waste management were comprehensively reviewed to identify the opportunities for developing large-scale anaerobic digestion in Canada. A range of anaerobic digestion facilities, including water resource recovery facilities, standalone digesters, and on-farm digesters throughout Ontario, were compared in terms of digestion type, digester volume, feedstock (s), and electricity capacity to better understand the current role of biogas plants in this province. Finally, technology perspectives, solutions, and roadmaps were discussed to shape the future in terms of organic fraction municipal solid waste management. The findings suggested that the biogas industry growth in Canada relies on provincial energy and waste management policies, advanced technologies for diverting organic waste from landfills, improving biogas yield using existing pretreatment methods, and educating farmers regarding digester operations. [ABSTRACT FROM AUTHOR]

Some communities in Ontario procure potable water through water sharing arrangements (WSAs) with other neighbouring communities. This paper explores factors influencing First Nation and municipal participation in WSAs in Ontario. Specifically, we assess whether First Nations communities – many of which suffer persistently poor drinking water conditions – are less likely to be engaged in WSAs than municipalities. We assess this question by applying regression analyses to a unique data set characterizing 419 Ontario communities: 118 First Nations communities and 301 municipalities. Compared to Ontario municipalities, First Nations in Ontario have a lower rate of participation in WSAs. Our regression analyses suggest that community likelihood of WSA participation is strongly associated with factors like geography, regional wealth, and proximity to neighbouring communities with water supply. [ABSTRACT FROM AUTHOR]

Purpose – The present study seeks to explore the minds and thoughts of emergency management professionals in Ontario in order to better understand the institution, and engage them in a renewed dialogue with communities, academia and other stakeholders. The intention is to strengthen the institution of emergency management, which is the foundation of disaster mitigation. Design/methodology/approach – The study is based on interviews conducted with emergency management professionals from the public, private and non-governmental organization (NGO) sectors in the Province of Ontario, Canada. The questions were a combination of structured and open-ended questions to elicit rich details on emergency management professionals' views. Analysis of interview transcriptions highlighted the attitudes and perceptions of the interviewees with respect to themselves, their own organizations, their role in emergency management, and their jurisdictions. The study also provided an opportunity for respondents to provide examples or comments to illustrate their responses. A total of 43 interviews have been analyzed for this paper. Findings – The research objective of enhancing the understanding of the institution of emergency management through the minds of emergency management professionals in Ontario has been successfully achieved. It is clear that emergency managers and other professionals engaged in consulting, response and humanitarian assistance activities realize their role and responsibilities quite well. The majority of participants felt that politics and a lack of understanding of one anothers' roles often limit progress. A clear consensus regarding engaging community players in the development of mitigation strategies and resource allocation emerged in this study. Originality/value – The research conducted is the first of its kind in the province of Ontario in Canada. With the help of personal interviews and survey questionnaire, a better understanding of the emergency management institution and professionals working in this field could be realized. [ABSTRACT FROM AUTHOR]

If properly conceived, sustainable marketing should be one of the many tools used to balance preservation and tourism priorities at heritage sites. The problem, however, is that limited guidance is available to assist in the development of a sustainable marketing plan. This paper tests a proposed sustainable heritage tourism marketing model using a World Heritage Site case study – the Rideau Canal in Ottawa, Canada. A lacuna between the model's components and the marketing activities at the Rideau Canal is observed. In combination with other mixed results found in the literature, it confirms that the fundamental challenge is short-termism while sustainable marketing requires long-term investments. This study offers a framework and rational for sustainable heritage tourism marketing at the Rideau Canal and other heritage sites around the world. Given that “sustainable marketing” is a relatively new concept, this study offers an important contribution to the marketing literature. [ABSTRACT FROM PUBLISHER]

Purpose - This paper aims to explore the transportation needs of adults in Toronto who have acquired brain injuries (ABIs).Design/methodology/approach - A survey was completed by staff working with clients in a community brain injury organization.Findings - The survey showed that that some people with ABIs who do not use mobility devices and/or do not have obvious physical disabilities, could benefit from the city's door-to-door accessible public transit service (Wheel-Trans). They are currently excluded from Wheel-Trans based on the eligibility criteria for this service.Research limitations/implications - This survey only looks at people with ABIs who are accessing services from an ABI community agency, thus it overlooks those who are not and may not be doing so due to lack of transportation. Also the survey is completed by staff rather than ABI clients, which may lead to different answers/perspectives.Practical implications - A change to the eligibility criteria of Wheel-Trans could increase the independence of some people with ABIs and could also increase their participation in society.Originality/value - Based on a literature review by the author, there is no existing research that examines transportation and ABIs in Canada. [ABSTRACT FROM AUTHOR]

Cultural planning is often explained as a strategic approach to urban cultural development; an approach that involves the 'mapping' and leveraging of a wide range of 'cultural resources' (arts, culture, and heritage). However, it is increasingly being questioned whether cultural planning is anything more than a fairly traditional arts policy with a different name. In particular, it has been observed in Australia that cultural plans usually fail to address more than arts sector concerns. The objective of this paper is to investigate whether this assessment applies to cultural planning practice in Ontario, the province at the forefront of the current 'municipal cultural planning' push in Canada. An examination of all cultural plans in Ontario's mid-size cities and interviews conducted with municipal staff members overseeing these initiatives shows that whereas several municipalities do follow an arts-driven policy agenda, this is not the case with most mid-size cities in the province. [ABSTRACT FROM AUTHOR]

This paper offers a discussion of a new social movement in Ontario, which organises politically around the intersection of poverty and health. It examines the day-to-day practices of the campaign and its coalition of poor people and health professionals and the implications of this grassroots movement for healthcare. It also discusses the significance of this type of 'direct action casework' more broadly for anti-poverty and healthcare movements in the post-welfare state context. [ABSTRACT FROM AUTHOR]

This paper examines two sociolinguistic lexical variables, 'work' and 'to dwell,' in the spoken French of former immersion students in their first or fourth year at a bilingual university in Ontario, Canada. Their patterns of use are compared to those of non-immersion graduates in the same institution, to Ontario high school immersion students, to former immersion students living in daily contact with French in Montreal, Canada, and to native speakers of Canadian French. The results suggest that, while under-performing in relation to the Montreal learners and the native speakers, the former immersion university students are at an advantage over their non-immersion university and their high school immersion counterparts in mastering socially stratified lexical variants, but that this advantage does not extend to socially neutral variants. The results are discussed in light of the relative levels of exposure to 'naturalistic' French experienced by the various speaker groups. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study conducted to test a model linking new graduate nurses' perceptions of structural empowerment to their experiences of workplace bullying and burnout in Canadian hospital work settings using Kanter's work empowerment theory. Background. There are numerous anecdotal reports of bullying of new graduates in healthcare settings, which is linked to serious health effects and negative organizational effects. Methods. We tested the model using data from the first wave of a 2009 longitudinal study of 415 newly graduated nurses (<3 years of experience) in acute care hospitals across Ontario, Canada. Variables were measured using the Conditions of Work Effectiveness Questionnaire, Negative Acts Questionnaire-Revised and Maslach Burnout Inventory-General Survey. Results. The final model fit statistics revealed a reasonably adequate fit (χ² = 14.9, d.f. = 37, IFI = 0.98, CFI = 0.98, RMSEA = 0.09). Structural empowerment was statistically significantly and negatively related to workplace bullying exposure (β = -0.37), which in turn, was statistically significantly related to all three components of burnout (Emotional exhaustion: β = 0.41, Cynicism: β = 0.28, Efficacy: β = -0.17). Emotional exhaustion had a direct effect on cynicism (β = 0.51), which in turn, had a direct effect on efficacy (β = -0.34). Conclusion. The results suggest that new graduate nurses' exposure to bullying may be less when their work environments provide access to empowering work structures, and that these conditions promote nurses' health and wellbeing. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to understand how Canadian farmwomen conceptualise food safety within the context of their daily food provisioning activities. We conducted a conventional qualitative content analysis of interview transcripts from a study that explored the food provisioning practices of farmwomen in Alberta (n = 6), Ontario (n = 6), and Nova Scotia (n = 10). Farmwomen provided a conceptualisation of food safety that appears to stem from their dual role as food producer and gatekeeper of the family meal. As food producers, they have an intimate knowledge of primary food production practices; as gatekeeper of the family meal, they draw on this knowledge to provide safe food for their families, either by growing or raising it themselves, obtaining it from local, trusted producers, or purchasing food that has been subject to Canada's food safety regulatory system, which safeguards the food produced in Canada. By knowing what has gone into their food, farmwomen feel that they are able to provide healthy, quality food for their families. [ABSTRACT FROM AUTHOR]

Abstract: In recent years, the Not-In-My-Back-Yard (NIMBY) phenomenon has become increasingly prevalent with regard to harm reduction sites, addiction treatment facilities and their clients. Drawing from a case study of community conflict generated by the relocation of a methadone clinic into a rapidly gentrifying neighbourhood in downtown Toronto, Canada, this article offers a unique analysis of oppositional strategies regarding the perceived (socio-spatial) ‘disorder of drugs’. Based on interviews with local residents and business owners this article suggests the existence of three interrelated oppositional strategies, shifting from a recourse to urban planning policy, to a critique of methadone maintenance treatment (MMT) practice, to explicit forms of socio-spatial stigmatization that posited the body of the (methadone) ‘addict’ as abject agent of infection and the clinic as a site of contagion. Exploring the dialectical, socio-spatial interplay between the body of the addict and the social body of the city, this article demonstrates the unique aspects of opposition to the physically, ideologically and discursively contested space of addiction treatment. Representations of the methadone clinic, its clients and the larger space of the neighbourhood, this paper suggests, served to situate addiction as a ‘pathology (out) of place’ and recast the city itself as a site of safe/supervised consumption. [Copyright &y& Elsevier]

Canada’s book trade is fascinating not only because it really consists of two book trades—the Anglophone and the Francophone—but also because it is a site of intense and sustained policy interventions designed to foster greater domestic control. Examining the country’s book policies, Statistics Canada data, trade association membership rosters and trade directories, this paper reveals that Canada’s contemporary book trade is characterized by three features: circa 40 years of government interventions in response to foreign dominance; the central role of foreign firms despite these interventions; and the dominance of Toronto and Montreal as domestic sites of book production. [ABSTRACT FROM AUTHOR]

guruge s., hunter j.a., barker k., mcnally m.j. & magalhães l. (2010) Immigrant women’s experiences of receiving care in a mobile health clinic. Journal of Advanced Nursing 66(2), 350–359. Title. Immigrant women’s experiences of receiving care in a mobile health clinic. Aim. This paper is a report of a study of the experiences of Portuguese-speaking immigrant women who used a mobile health clinic for their reproductive health care. Background. Upon arrival in Canada, immigrant women often are in better health than their Canadian-born counterparts; however, this health status tends to deteriorate over time. One reason for this change is limited access to services. Method. Data collection during 2004 and 2005 involved individual interviews with seven Portuguese-speaking women who received care in a mobile health clinic in Toronto, Canada, and with four clinic care providers. Non-participant observation of the interaction between clients and care providers was also conducted. Interviews conducted in Portuguese were translated into English and transcribed, along with those conducted in English. Interview transcripts were read and re-read in the context of observational notes to develop codes. Emerging codes were grouped together to develop subcategories and categories. Findings. Participants’ experiences of accessing and receiving care in the mobile health clinic were shaped by their perceptions of health, which included physical, mental, social and spiritual aspects, and their pre- and postmigration care experiences. As an alternative model of care delivery, the mobile health clinic was perceived by participants to address their care needs and to help overcome postmigration barriers by providing accessible, holistic, and linguistically and culturally appropriate care. Conclusion. Mobile health clinics should be considered as an alternative care delivery model for immigrant women who may be at a disadvantage because of their socio-economic, cultural, and racialized statuses. [ABSTRACT FROM AUTHOR]

Title. Career trajectories of nurses leaving the hospital sector in Ontario, Canada (1993–2004). Aim. This paper is a report of an analysis of the career trajectories of nurses 1 year after leaving hospitals. Background. Although hospitals are traditionally the largest employers of nurses, technological advances and budgetary constraints have resulted in many countries in relative shrinkage of the hospital sector and a shift of care (and jobs) into home/community settings. It has been often assumed that nurses displaced from hospitals will move to work in the other workplaces, especially the community sector. Method. Employment patterns were tracked by examining a longitudinal database of all 201,463 nurses registered with the College of Nurses Ontario (Canada) between 1993 and 2004. Focusing on the employment categories Active (Working in nursing), Eligible-Seeking nursing employment or Dropout from the nursing labour market, year-to-year transition matrixes were generated by sector and sub-sector of employment, nurse type, age group and work status. Findings. For every nurse practising nursing in any non-hospital job or in the community a year after leaving hospitals, an average of 1·3 and four nurses, respectively, dropped out of Ontario’s labour market. The proportion of nurses leaving hospitals transitioning to the Dropout category ranged from 63·3% (1994–95) to 38·6% (2001–02). The proportion dropping out of Ontario’s market was higher for Registered Practical Nurses (compared to Registered Nurses), increased with age and decreased with degree of casualization in nurses’ jobs. Conclusion. Downsizing hospitals without attention to the potentially negative impact on the nursing workforce can lead to retention difficulties and adversely affects the overall supply of nurses. [ABSTRACT FROM AUTHOR]

This paper examines how and why in March 1995 certain elements of the Canadian government decided to take unilateral forceful action against foreign fishing off the Grand Banks and go against a long tradition of cooperation and multilateralism. In particular, it will address to what extent existing models of decision-making (in particular rational and bureaucratic models) adequately explain the process that went on in Ottawa at this time. The findings are that even though the bureaucratic politics model of decision-making can be used in a parliamentary structure like Canada, it is insufficient to explain Canadian decision-making processes during the Turbot War, and thus must be supplemented by a more inclusive cybernetic approach. [ABSTRACT FROM AUTHOR]

In this paper we investigate the relative predictive power of a number of remote sensing-derived environmental descriptors of land cover and productivity to predict species richness of breeding birds in Ontario, Canada. Specifically, we first developed a suite of environmental descriptors (productivity, land cover, and elevation). These descriptors were based on readily available data, including the MODerate-resolution Imaging Spectroradiometer (MODIS) onboard the Terra and Aqua satellites and terrain data from the Shuttle Radar Topography Mission (SRTM). We then assessed the capacity of the environmental descriptors, using a decision tree approach, to estimate species richness of all breeding birds, and of groups of bird species based on habitat and nesting groupings, using data summarized from the Ontario Breeding Bird Atlas. Results indicated that the variance in the distributions of total bird species richness, as well as richness of habitat and nesting groups, were well predicted by the environmental descriptors (with variance explained ranging between 47 and 75%) with the predictions clearly related to both habitat (as modeled by land cover and land cover diversity) and vegetation productivity. Modeling demonstrates that initial partitioning is most often based on land cover class, indicating that it may be the driving variable of bird species richness; however, information on vegetation productivity and energy were then critical in defining how many species occur in each habitat type. The results indicate that remotely sensed environmental descriptors can provide an effective tool for predicting breeding bird species richness at regional scales. [Copyright &y& Elsevier]

This paper analyzes the community health of the Wikwemikong Unceded Indian Reserve (WUIR), Ontario, Canada. Results are reported from fieldwork including participant observation, key informant interviewing and self-reported data measuring health status, risk behaviour, place of residence, self-identity, and personal history extracted from 350 interviews conducted during a community-wide needs assessment. The research aimed to create a health plan for the community; however, subsequent analysis of the needs assessment results indicates that internal diversity exists in health status and needs between the seven villages that comprise WUIR. The analysis suggests variation in health status and risk-taking behaviour among community members may be related to varying colonial histories among the villages. The implications of intra-community variation in health status in First Nations are discussed in relation to influential health policy theories such as the determinants of health and health transfer policy in Canada. [Copyright &y& Elsevier]

Abstract: Accountability for reasonableness is an ethical framework for fair priority setting process. This framework has been used to evaluate fairness in several contexts, and a few studies have evaluated its acceptability to decision makers. However, no studies have compared the acceptability of the four conditions of the framework to decision makers across health systems and levels of priority setting. This paper reports the elements of fairness described by 184 decision makers involved in priority setting at the macro-, meso- and micro-levels of priority setting in the Canadian (Ontario), Norwegian and Ugandan health care systems and compares them against the four conditions of ‘Accountability for Reasonableness’ and across levels of decision making, and health care systems. Our respondents identified 23 elements of fair priority setting. Most of these (17) were well aligned with the four conditions of Accountability for Reasonableness; six were not. Comparisons across health care system and levels of decision making revealed that four elements (transparency, participatory and among the criteria—need based and objective) were common to all and the rest were common to only the health care systems (but not at all levels), or only the levels of decision making (but not to all health are systems). Perceptions varied remarkably across levels of decision making. The overlap between the elements of fairness found in this study and the conditions of Accountability for Reasonableness demonstrates that the four conditions are recognizable and applicable across health care systems and levels of decision making. However, the framework should be used with flexibility to allow for identification of elements and relevant explicit criteria (such as those identified in this study) – that may not directly fit under any of the four conditions. [Copyright &y& Elsevier]

Abstract: This paper contributes to the literature on the geographies of care and caregiving by examining the implications of weather for providing home and community care for children and older adults. Integrating research from two previous qualitative studies of formal and informal care provisioning in Ontario, Canada, the authors re-analyzed semi-structured interviews with 83 directors, managers, paid staff, volunteers and family members to examine the challenges they faced when providing care during the winter season. Similar to other settings where winter conditions like snow, ice and cold temperatures are commonplace, the studies were set within a health policy context in which there is not enough recognition of the difficulties of weather for coordinating, managing and providing care to disabled, injured, chronically ill and frail individuals. The re-analysis focused on how winter conditions translate into geographical, administrative, economic, operational, physical, social and psychological barriers within and across different ‘scales of care’. The findings indicate that the problems posed by weather are crucial yet often underestimated aspects of home and community care provided by formal and informal caregivers. The analysis of weather-related challenges for care provisioning needs to be extended to other seasonal conditions (e.g., the challenges of delivering care in extreme heat), to the developing world and even to the burgeoning debates on the health implications of global environmental change. [Copyright &y& Elsevier]

The growth of precarious employment poses significant challenges to current social assistance income support policies yet it remains largely neglected in policy-making arenas. Drawing upon qualitative data from a study in Ontario, Canada, this paper examines the particular implications of these challenges for lone mothers, who figure prominently both in non-standard employment and as targets for workfare policies. In the context of changing labour markets, the article considers the potential strengths and limitations of Basic Income approaches to achieving economic security for lone mothers. [ABSTRACT FROM AUTHOR]

Abstract: Conventional wisdom has it that elections other than national ones are “second-order elections,” driven by political conditions in the “first-order” national arena. It has not yet been shown that a sub- or supra-national election can exhibit qualities similar to those of first-order elections. This paper uses the 2003 Ontario Election Study, from a provincial election in extremely decentralized federation, to demonstrate that a sub-national election can be a first-order election. Aggregate evidence shows voters'' interest and turnout is comparable to national elections. Individual-level evidence shows vote choice is determined by arena-specific factors. And dynamic evidence shows that this sub-national campaign had its own homegrown events that influenced voters, just as campaign events influence national elections. [Copyright &y& Elsevier]

In universities, as in everyday life, there is a fundamental need for geographical knowledge, even when no formal departments exist to provide instruction. This need was true in the University of Toronto during the decades before Griffith Taylor was appointed in 1935 to the first university Chair in geography in English-speaking Canada. Using matriculation and annual university course examinations, university calendars and the papers of President Falconer and Professors James Mavor and Harold Innis, I trace the development of geography at the University of Toronto from the mid-nineteenth century to the arrival of Taylor. Courses taught in selected aspects of physical and human geography in the Departments of Geology, Political Economy and History are particularly significant. Underlying this instruction, and also the desire to establish a geography department, was an acute awareness of the fundamental importance of geography to help understand a large regionally complex homeland, and a wider world. [ABSTRACT FROM AUTHOR]

There is a growing body of research in Canada and from other countries acknowledging that immigrants face barriers in accessing health care services. As immigrants make up an increasing percentage of the population in many developed nations, a better understanding and eliminating these barriers is a major priority. This research contributes to current understandings of access among immigrant populations in Canada by exploring perceptions of access to care through focus groups with a diverse group of immigrants living in a Mississauga, Ontario neighbourhood. The results of eight focus groups reveal that immigrants face geographic, socio-cultural and economic barriers when attempting to access health care services in their community. This paper provides policy recommendations relevant to the federal, provincial and local levels for eliminating these barriers. [Copyright &y& Elsevier]

Situated within subaltern cultural studies, and building on the work of Stuart Hall, Homi Bhabha and Mikhail Bakhtin, this essay tells the story of the 'new flâneur', a recent immigrant and refugee group of continental francophone African youth, who are attending an urban French-language high school in south-western Ontario, Canada. In it, I offer an alternative cultural framework of 'translation' and 'negotiation' as a way of seeing that which is supposedly competing and conflicting is indeed re-de-and-transformed and negotiated into New ways that make them radically performed. Their radicalness stems, precisely, from the notation that displaced identities, the focus of the paper, are not oppositionally articulated; on the contrary, they are negotiated, translated, and re-born in a more complex and hybrid space: a third one. This hybridity, I will show, is habitually performed in and through language - in its broad semiological sense. As part of an ethnographic research project, the essay will show the different ways in which the new flâneurs form and perform their identities. Here, the Old and the New are not ethnographically observed in competition; both are translated in the identity formation processes and in the process, they are negotiated so that both are found in the same sentence, in the same garments, at the same time to produce a third hybrid space. To walk is to vegetate To stroll is to live Balzac [ABSTRACT FROM AUTHOR]

Abstract: The fears and beliefs patients hold about invasive medical interventions may affect their perceptions about risk and subsequent decisions to undergo those procedures. Little is known about fears and beliefs in patients undergoing invasive cardiac procedures and their relationship to perceptions of risks. Using a grounded theory approach, 10 men and 10 women referred for their first cardiac catheterization (CATH) from referral centers in Ontario, Canada were interviewed to identify fears and beliefs related to the procedure. Overall, women expressed more fears than men. Fears for both groups arose from: (1) lack of control about (i) physical aspects and (ii) psychosocial aspects of the CATH; (2) an unknown future; and (3) possible medical complications. Beliefs related to health personnel involved in the CATH, the technology used during the CATH and personal coping mechanisms. Men were more inclined to believe in technology, which overrode concerns about the procedure. Participants viewed CATH as a routine and necessary step in determining their future. Patients imputed previously held fears and beliefs and formulated new ones regarding the CATH during the process of anticipating the procedure. They viewed themselves as passive participants and not as actively consenting to the CATH. This paper offers previously undocumented insights from patients regarding CATH and provides the basis for developing future investigations. [Copyright &y& Elsevier]

Background: This paper describes a study that explores the experiences of internationally educated nurses (IENs) in their efforts to gain entry to practice as Registered Nurses (RNs) in the province of Ontario, Canada. Aim: The aim was to uncover, in part, the issues related to professional nursing credentialling. Methods: This study was guided by a biographical narrative (qualitative) research methodology. A convenience sample of 12 IEN students volunteered for this study representing the Philippines, Mainland China, Korea, Ukraine and India. Findings: The findings were that the IENs progress through a three-phase journey in their quest for licensure in Ontario. These phases include: (1) hope – wanting the Canadian dream of becoming an RN in Ontario; (2) disillusionment – discovering that their home-country nursing qualifications do not meet Ontario RN entry to practice; and (3) navigating disillusionment – living the redefined Canadian dream by returning to nursing school to upgrade their nursing qualifications. Conclusions: Professional regulatory nursing bodies and nursing educators, as well as practising nurses, must be aware of the potentially confusing and unpleasant processes IENs go through as they qualify for the privilege of practising nursing in Ontario. [ABSTRACT FROM AUTHOR]

Abstract: This paper contributes to the current debates surrounding private delivery of health care services by addressing the distinctive challenges, constraints and opportunities facing for-profit and non-profit providers of long-term care in rural and small town settings. It focuses on the empirical case of Ontario, Canada where extensive restructuring of long-term care, under the rubric of managed competition, has been underway since the mid-1990s. In-depth interviews with 72 representatives from local governments, public health institutions and authorities, for-profit and non-profit organisations, and community groups during July 2003 to December 2003 form the platform for a qualitative analysis of the implications of managed competition as it relates to the provision of long-term care in the countryside. The results suggest that the introduction and implementation of managed competition has accentuated the problems of service provision in rural communities, and that the long-standing issues of caregiving in rural situations transcend the differences, perceived or otherwise, between for-profit and non-profit provision. Understanding the implications of market-oriented long-term care restructuring initiatives for providers, and their clients, in rural situations requires a re-focussing of research beyond the for- versus non-profit dichotomy. [Copyright &y& Elsevier]

Abstract: This paper examines the efforts of two complementary and alternative occupations, chiropractors and homeopaths, to move from the margins to the mainstream in health care in the province of Ontario. We use a variety of theoretical perspectives to understand how health occupations professionalize: the trait functionalist framework, social closure, the system of professions, and the concept of countervailing powers. The research traces the strategies that the leaders of the two groups are employing, as well as the resources they are able to marshal. These are analyzed within the context of the larger institutional and cultural environment. The data are derived from in-person interviews with 16 leaders (10 chiropractic and 6 homeopathic) identified through professional associations, teaching institutions and informants from the groups. The responses were analyzed with qualitative content analysis. We also used archival materials to document what the leaders were telling us. The data revealed four main strategies: (1) improving the quality of educational programs, (2) elevating standards of practice, (3) developing more peer reviewed research, and (4) increasing group cohesion. Although both groups identified similar strategies, the chiropractors were bolstered by more resources as well as state sanctioned regulation. The efforts of the homeopaths were constrained by scarce resources and the absence of self-regulation. In both cases the lack of strong structural support from government and the established health professions played an important role in limiting what was possible. In the future, it may be to the state''s advantage to modify the overall shape of health care to include alternative paradigms of healing along with conventional medical care. Such a shift would put complementary and alternative medicine occupations in a better position to advance professionally and become formal elements of the established health care system. [Copyright &y& Elsevier]

Abstract: Childhood maltreatment is a common and serious problem for women, particularly in relation to impairment in adulthood. To our knowledge, no system-wide study has addressed the influence of childhood maltreatment on the cost of these women''s adult health service utilization. This paper examines this relationship. The 1990 Ontario Health Survey (OHS) gathered information regarding determinants of physical health status and the use of health services. The 1991 Ontario Mental Health Supplement (OHSUP) examined a variety of childhood experiences as well as the prevalence of psychiatric disorders from a sample of OHS respondents. These were province-wide population health surveys of a probability-based sample of persons aged 15 years and older living in household dwellings in Ontario. The OHSUP randomly selected one member from each participating OHS household to be interviewed regarding personal experiences and mental health. This analysis used data from women aged 15–64 who participated in both the OHS and OHSUP. Self-reported health service utilization was collected in four groups of women—those who reported no history of child abuse, those with a history of physical abuse only, those who reported sexual abuse only, and those who reported both physical and sexual (combined) abuse. We hypothesized that a history of child abuse would result in greater adult health care costs. The results indicated that having a history of combined abuse nearly doubles mean annual ambulatory self-reported health care costs to $775 (95% CI $504–$1045) compared to a mean cost of $400 with no abuse (95% CI $357–$443). Median annual ambulatory self-reported health care costs were also increased in the combined abuse group, to $314 (95% CI $220–$429), compared to $138 (95% CI $132–$169) in those with no abuse. We conclude that child abuse in women is significantly associated with increased adult self-reported health care costs. [Copyright &y& Elsevier]

Abstract: The rise of neo-liberalism, which suggests that only markets can deliver maximum economic efficiency, has been a driving force behind the trend towards using market-based solutions to correct health care problems. However, the broad application of market-based reforms has tended to assume the presence of fully functioning markets. When there are barriers to markets functioning effectively, such as the absence of adequate competition, recourse to market-based solutions can be expected to produce less than satisfactory, if not paradoxical results. One such case is rehabilitation homecare in Ontario, Canada. In 1996, a “managed competition” model was introduced as part of a province-wide reform of home care in an attempt to encourage high quality at competitive prices. However, in the case of rehabilitation home care services, significant obstacles to achieving effective competition existed. Notably, there were few private provider agencies to bid on contracts due to the low volume and specialized nature of services. There were also structural barriers such as the presence of unionized employees and obstacles to the entry of new providers. This paper evaluates the impact of Ontario''s managed competition reform on community-based rehabilitation services. It draws on data obtained through 49 in-depth key informant interviews and a telephone survey of home care coordinating agencies and private rehabilitation provider agencies. Instead of reducing costs and improving quality, as the political rhetoric promised, the analysis suggests that providing rehabilitation homecare services under managed competition resulted in higher per-visit costs and reduced access to services. These findings support the contention that there are limits to market-based reforms. [Copyright &y& Elsevier]

In this paper we examine how the researcher's body can be used as a tool for data collection in the process of ethnographic fieldwork. We focus in particular on the tensions inherent in undertaking embodied ethnographic research in the sexualized setting of a queer women's bathhouse event in Toronto, Canada. Our discussion addresses three moments within the research process: preparing our bodies to attend the bathhouse; positioning our bodies within the spaces of the bathhouse; and interacting with our bodies during the event. Through this discussion we argue that the body of the researcher is a contested site of knowledge production. [ABSTRACT FROM AUTHOR]

Despite large welfare caseload declines in Ontario in recent years, little is known about the longer-term circumstances of people who leave welfare or remain on a much-changed system. This paper reports on a second round of qualitative interviews with current and former workfare participants in Toronto. The findings demonstrate how the lives of most remain marked by poverty, hunger and uncertainty, and reveal contradictions between the realities of their daily lives and the government's "work-first" strategy. Rather than "one size fits all," the respondent experiences suggest the need for different pathways to sustainable employment, as well as recognition that for some the labour market is an unlikely destination. [ABSTRACT FROM AUTHOR]

This study examines the reading interests and preferences of Russian-speaking immigrants in Toronto with regard to periodicals, and discusses Russian-language periodicals published in the Greater Toronto Area as both a source of information for Russian-speaking read- ers and an indispensable resource for documenting numerous aspects of the Russian-speaking community to be preserved as historical record. The paper uses findings from a survey of the reading habits and interests of Russian-speaking immigrants conducted in the fall of 2001 in Toronto, and the data from a descriptive list of selected Russian-language periodical publications published in Toronto in the spring and summer of 2002. It illustrates that combining the survey technique with bibliographic work is of great benefit to both community studies and studies of the ethnic press. [ABSTRACT FROM AUTHOR]

In this paper I draw on interviews with professional visual artists in Toronto, Canada to reconstruct an occupation-specific reading of the urban landscape. I use a detailed examination of one specific occupational identity to reveal the intricate relationship between self, work, and context at different spatial scales. The underlying mechanism that supports the articulation and negotiation of artistic identities, I argue, is the sustained tension between absence and presence, visibility and invisibility within different spaces of the urban fabric. [ABSTRACT FROM AUTHOR]

In this paper I examine the role of the studio as a central site of artistic identity construction and maintenance. Using ten case studies drawn from interviews with contemporary women visual artists from Toronto, Canada, I argue that women artists value studio space because it powerfully reinforces their sense of commitment and belonging to a predominantly male-dominated profession. I consider how women cope with the demands of artistic practice when they are unable to establish a spatially separate workspace by addressing the experiences of artists who are parents. I demonstrate how women artists who are primary care-givers are rarely adequately protected from the interruptions of daily life and have grown accustomed to working in fragments of time and space. While these women may appear willing to concede space to others, when space is crucial to their artistic practice, they have a remarkably strong influence on the form of their creative environment. I maintain, then, that the studio as a fixed physical space continues to be a very real necessity for women artists in all stages of their careers. [ABSTRACT FROM AUTHOR]

This paper sought to examine chronic disease risk behaviour latent classes and their association with Body Mass Index (BMI), assessing for gender differences. Participants were youth (n = 116,086; grades 9-12) enrolled in the COMPASS study (Ontario, Canada) during 2013, 2014, 2015. Multilevel latent class analysis was used to identify underlying, homogenous classes of youths' engagement in physical activity, smoking, binge drinking and marijuana use. Adjusted multilevel models regressed BMI on the latent classes controlling for ethnicity and grade. Three latent classes were identified: active experimenters (ACE), inactive clean youth (INC) and inactive substance users (INSU). This study found that gender differences are apparent in chronic disease risk behaviour latent classes and their association with BMI. INC males (OR = 0.85, 95% CI = 0.78, 0.93) were associated with a lower odds of overweight/obesity relative to active males who experimented with substance use. As for females, the class with the highest proportion of youth using substances were associated with higher odds (Females: OR = 1.2, 95% CI = 1.1, 1.4) of overweight/obesity relative to their active experimenting peers. As such, youth in latent classes with substance use are associated with higher BMI and weight status. Successful interventions may include school policies/programs that limit screen time use, as they were seen to have a positive effect on PA engagement and including social-influences approaches for substance use. Future research and interventions should be gender-specific as our results show that different latent classes are associated with obesity across genders. [ABSTRACT FROM AUTHOR]