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The Physical Activity Neighborhood Environment Scale (PANES) has been used internationally; however, PANES properties have not been assessed in all geographical contexts. Our objectives were to assess the reliability and validity of an online and paper version of the PANES in Canadian adults. Reliability was estimated using intraclass correlation coefficients (ICC), percent of overall agreement (p0) and Cohen's Kappa coefficient (κ). Lower 95% confidence interval (CI) ICC ranged from 0.10 to 0.70. Lower 95%CI for κ statistics ranged from −0.20 to 0.64 and p0 ranged from 80.1% to 95.7%. Cronbach's alpha coefficients (α) estimated internal consistency of the PANES (α = 0.58 for the paper version and α = 0.55 for the online version). Mean scores for the PANES Built Environment Index (BEI) significantly differed by neighborhood street pattern (p <.05). The PANES administrated via paper or online provides reliable overall agreement and valid estimates of the self-reported neighborhood built environment supportiveness of physical activity. [ABSTRACT FROM AUTHOR]

Despite increased access to and improvements in contraceptives, unintended pregnancy continues to be a problem globally and is associated with adverse outcomes for mothers and infants. This paper seeks to unravel the mediators of intended versus unintended pregnancies among Black women living with HIV. The paper draws on survey data from a broader multi-country mixed methods study that used a community-based participatory research approach to investigate the psychosocial experiences of Black mothers living with HIV. The study participants were Black mothers living with HIV drawn through venue-based sampling from Ottawa, Canada (n = 89), Port Harcourt, Nigeria (n = 400), and Miami, Florida, United States (n = 201). We used Hierarchical Binary Logistic Regression Modelling (HBLM) to estimate the independent associations of pregnancy intention (intended versus unintended) with blocks of predictor variables (sociodemographic, sociocultural, and psychosocial predictors) at alpha level of 0.5. Specifically, 44.2%, 67.3%, and 17.7% of the women had unintended pregnancies in Ottawa, Miami, and Port Harcourt, respectively. There were important results from the HBLM. The odds of intended relative to unintended pregnancies were (i) reduced in larger households (OR = 0.56, 95% CI = 0.36/0.87), but increased with employment (OR = 7.84, 95% CI = 1.52/40.54) and HIV knowledge (OR = 3.13, 95% CI = 1.42/6.90) in Ottawa; (ii) reduced with age (OR = 0.93, 95% CI = 0.88/0.98), but increased with marriage (OR = 2.90, 95% CI = 1.43/5.88) and social support (pregnancy (OR = 3.77, 95% CI = 1.98/7.19) in Port Harcourt; (iii) reduced with social support (OR = 0.95, 95% CI = 0.91/1.00) but increased with HIV status disclosure (OR = 1.73, 95% CI = 1.01/2.97) and the influence of specific referent (OR = 1.68, 95% CI = 1.13/2.52) in Miami-FL. The incidence of unintended pregnancy is more prevalent among Black women living with HIV in the North American cities relative to the African city. Also, unique combinations of sociodemographic, sociocultural, and psychosocial factors influence pregnancy intention in each city. This implies that policy and practices to address reproductive health needs of WLHIV must consider these contextual issues. [ABSTRACT FROM AUTHOR]

What is known on the subject: Supported housing approaches that include case management and increased opportunities for independence and personal autonomy for people who are living with severe and persistent mental illness (SPMI) have been found to help reduce hospitalizations and use of the emergency department.What is not fully clear is if these types of supported housing arrangements also influence the use of primary health care and other specialist services. What the paper adds to existing knowledge: This study uncovered that individuals experiencing SPMI who lived in supported housing used more primary health care and specialist physician services, in the year following transition to this housing arrangement. What are the implications for practice: The findings of this study suggest that supported housing arrangements for people experiencing SPMI may help in improving the personalization of health services for individual residents, including increasing access to both primary health care and specialist services.This is important for nursing practice, as the findings of the study show that supported housing arrangements for people experiencing SPMI may assist in better supporting their complex health care needs. Introduction: Supported housing for people who are living with severe and persistent mental illness (SPMI) has been found to help reduce hospitalizations and use of the emergency department. What is not fully clear is if these types of supported housing arrangements also influence the use of primary health care and other specialist services. Aim/Question: The aim of this study was to compare the use of health services use of individuals with SPMI, before and after transition to the new supported housing program. Method: Using health care administrative databases, a pre‐post cohort study was conducted examining the health system use of residents who transitioned from custodial to supported housing arrangements between 2017 and 2019. Results: Individuals with SPMI used more primary health care and specialist physician services after transition to the supported housing model. Discussion: The results suggest that a supported housing model may be associated with increased usage of outpatient person‐centred health services in people experiencing SPMI. Implications for Practice: The findings of this study suggest that supported housing arrangements for people experiencing SPMI may help in improving the personalization of health services for individual. This is important for nursing practice, as the findings of the study show that supported housing arrangements may assist in better supporting complex health care needs of individuals. [ABSTRACT FROM AUTHOR]

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Background: Under dentistry's social contract with the public, dental professionals have a social responsibility to address the oral health needs of the population at large. However, dental education places little emphasis on such moral commitments. By ascertaining dental students' stance regarding these notions, we may be able to inform changes in dental education. This paper thus explores dental students' comprehension of dentistry's social contract using the concepts of moral inclusion, moral community and empathy. Methods: A cross-sectional online survey collected information from undergraduate dental students at the Faculty of Dentistry, University of Toronto (N = 430). Moral inclusion was assessed through the breadth of students' moral community by computing a "moral inclusion score" (MIS) from Likert scale responses to statements that asked students about their duty of care for different population groups, wherein a higher MIS indicated a broader moral community and in turn greater moral inclusiveness. Empathy was assessed using Likert scale responses to statements that gauged the extent to which students understood the effect of social determinants on people's health. Association of the MIS with environmental, institutional and student-related factors was also investigated using non-parametric tests and linear regression. Results: The survey yielded a response rate of 51.4% (n = 221). Overall, students in this sample were morally inclusive and displayed empathy. Regression results showed that the MIS was most strongly associated with choosing a small town/rural area as a future practice location (β = 4.76, 95% CI: 0.52, 9.01) and viewing patients as consumers (β = -3.71, 95%CI: -7.13, -0.29). Conclusion: Students in this sample made morally inclusive choices, which implied that they had a basic understanding of the obligations under dentistry's social contract. Improving knowledge and experience with regards to addressing the social and economic determinants of oral health and access to oral health care may positively influence students' perceptions of their professional duties under the social contract. [ABSTRACT FROM AUTHOR]

Background & Aims: Given that standardized language measures alone are inadequate for identifying functionally defined developmental language disorder (fDLD), this study investigated whether non‐linguistic cognitive abilities (procedural learning, motor functions, executive attention, processing speed) can increase the prediction accuracy of fDLD in children in linguistically diverse settings. Methods & Procedures: We examined non‐linguistic cognitive abilities in mono‐ and bilingual school‐aged children (ages 8–12) with and without fDLD. Typically developing (TD) children (14 monolinguals, 12 bilinguals) and children with fDLD (28 monolinguals, 12 bilinguals) completed tasks measuring motor functions, procedural learning, executive attention and processing speed. Children were assigned as fDLD based on parental or professional concerns regarding children's daily language functioning. If no concerns were present, children were assigned as TD. Standardized English scores, non‐verbal IQ scores and years of maternal education were also obtained. Likelihood ratios were used to examine how well each measure separated the fDLD versus TD groups. A binary logistic regression was used to test whether combined measures enhanced the prediction of identifying fDLD status. Outcomes & Results: A combination of linguistic and non‐linguistic measures provided the best distinction between fDLD and TD for both mono‐ and bilingual groups. For monolingual children, the combined measures include English language scores, functional motor abilities and processing speed, whereas for bilinguals, the combined measures include English language scores and procedural learning. Conclusions & Implications: A combination of non‐linguistic and linguistic measures significantly improved the distinction between fDLD and TD for both mono‐ and bilingual groups. This study supports the possibility of using non‐linguistic cognitive measures to identify fDLD in linguistically diverse settings. What this paper adds: What is already known on the subject: Given that standardized English language measures may fail to identify functional language disorder, we examined whether supplementing English language measures with non‐linguistic cognitive tasks could resolve the problem. Our study is based on the hypothesis that non‐linguistic cognitive abilities contribute to language processing and learning. This is further supported by previous findings that children with language disorder exhibit non‐linguistic cognitive deficits. What this paper adds to existing knowledge: The results indicated that a combination of linguistic and non‐linguistic cognitive abilities increased the prediction of functional language disorder in both mono‐ and bilingual children. What are the potential or actual clinical implications of this work?: This study supports the possibility of using non‐linguistic cognitive measures to identify the risk of language disorder in linguistically diverse settings. [ABSTRACT FROM AUTHOR]

Background: Blended online courses, which combine synchronous and asynchronous online activities, have expanded rapidly in higher education. How to enhance student engagement in such courses is unclear, although it is recognized that student engagement is malleable through instructional strategies. Objectives: Given the above, this study aims to examine the influence of categories of strategies on student engagement in blended online courses. Methods: A conceptual framework of instructional strategies indicated as fostering student engagement in the relevant literature was first presented, divided in eight categories (structure, pace, relevance, active, choice, relationships, explanations, guide). Then a research framework linking the categories of strategies to student engagement dimensions (emotional‐cognitive, social, behavioral) was built and tested in blended online courses. Data collected in various disciplines and university levels at four universities (n = 482) were examined using partial least squares structural equation modeling. Results and Conclusions: The structural model examination confirmed the combined effects of categories of instructional strategies on student engagement in such courses in all disciplines. Particularly, this study revealed that 1) establishing trusting relationships, 2) demonstrating the relevance of activities, content, and resources, and 3) maintaining a sustained course pace significantly impacted student engagement in blended online courses in all disciplines. Takeaways: This study draws upon the blended learning literature to bring together key instructional strategies that foster student engagement while highlighting empirical quantitative evidence of their effects on student engagement in blended online courses. Detailed measures of categories of instructional strategies and student engagement dimensions also provide reliable instruments for future research. Lay Description: What is currently known about the subject matter?: Student engagement has important repercussions on perseverance, in‐depth learning, satisfaction, and academic success.Blended online courses merge the benefits of synchronous interactions and online flexibility in terms of time, place, or even study pace.Student engagement is influenced by contextual variations like course modalities and instructional strategies.The literature lacks a quantitative large‐scale portrait of how instructional strategies influence student engagement in blended online courses in higher education. What does this paper add to the existing body of research?: Partial least squares structural equation modelling was used to examine the effects of eight categories of instructional strategies on emotional‐cognitive, social, and behavioural dimensions of student engagement.Emotional‐cognitive engagement is largely affected by instructional strategies, while social and behavioural engagement are moderately affected by these.Establishing trusting relationships; demonstrating the relevance of activities, content, and resources; and maintaining a sustained course pace have the most significant effects on student engagement in blended online courses. Implications of study findings for practitioners: Teachers should explicitly support students in the process of developing interpersonal relationships in blended online courses to foster student social engagement, that is, interactions and sense of connectedness between them.Ensuring a sustained pace, dynamism, and a diversity of teaching and learning activities, both synchronously and asynchronously, promotes student engagement in blended online courses.Highlighting or demonstrating the relevance of activities and contents fosters emotional‐cognitive and behavioural student engagement. [ABSTRACT FROM AUTHOR]

Background: Although lithium is considered the gold-standard treatment for bipolar disorder (BD), it is associated with a variety of major endocrine and metabolic side effects, including parathyroid hormone (PTH) dependent hypercalcemia. Aside from surgery and medication discontinuation, there are limited treatments for hypercalcemia. This paper will assess data from a randomized controlled trial (RCT). Methods: This is a secondary analysis of an RCT that explored the effects of atorvastatin (n = 27) versus placebo (n = 33) on lithium-induced nephrogenic diabetes insipidus (NDI) in patients with BD and major depressive disorder (MDD) using lithium (n = 60), over a 12-week period. This secondary analysis will explore serum calcium levels and thyroid stimulating hormone (TSH) measured at baseline, week 4, and week 12. Results: At 12-weeks follow-up while adjusting results for baseline, linear regression analyses found that corrected serum calcium levels were significantly lower in the treatment group (mean (M) = 2.30 mmol/L, standard deviation (SD) = 0.07) compared to the placebo group (M = 2.33 mmol/L, SD = 0.07) (β = − 0.03 (95% C.I.; − 0.0662, − 0.0035), p = 0.03) for lithium users. There were no significant changes in TSH. Conclusion: In lithium users with relatively normal calcium levels, receiving atorvastatin was associated with a decrease in serum calcium levels. Although exciting, this is a preliminary finding that needs further investigation with hypercalcemic patients. Future RCTs could examine whether atorvastatin can treat PTH dependent hypercalcemia due to lithium and other causes. [ABSTRACT FROM AUTHOR]

This paper used a structural perspective to examine unmet healthcare needs in women at risk for eating disorders in Canada utilizing the Canadian Community Health Survey. The results revealed that body dissatisfied women had reported significantly higher unmet needs compared to body satisfied women (χ 2(1) =29.31, p <.05). Body dissatisfied women were also more likely to identify structural reasons for unmet needs. Considering the high costs associated with eating disorders, barriers creating inequitable health services need to be addressed in clinical practice, organizational structures, policy, and in research to improve treatment pathways. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine the association between immigrants' sense of community belonging and self-rated general and mental health status in Canada as well as estimate how this relationship is moderated by sex differences. Design/methodology/approach: This cross-sectional study used pooled data from seven cycles of the Canadian Community Health Survey (N = 98,011) conducted between 2005 and 2018. Data were pooled to increase the sample size of the immigrant population. The surveys covered content areas such as well-being, sociodemographic, chronic diseases, self-rated general and mental health. A binary logistic regression fitted the model. Both univariate and multivariate analyses were performed between predictor variables and immigrants' self-rated general and mental health. Descriptive statistics and adjusted odds ratios and 95% confidence intervals were estimated. Sex differences were also assessed. Findings: This study found that slightly more than half of the respondents were female (53.2%). Generally, immigrants with a weak sense of community belonging were more likely to rate their general and mental health as poor although the association is stronger in mental health. Also factors such as older age, lower educational level, those single or never married, smoking status, physical inactivity, overweight or obesity and life stress were predictors of both poor self -rated general and mental health among immigrants. Sex differences in these risk factors were also noted. Research limitations/implications: This study has several limitations that should be noted. The first limitation is the fact that causality cannot be deduced due to the cross-sectional nature of our pooled data. Secondly, responses from this data are subject to recall bias given that the data were self-reported. Therefore, the interpretation of these results must be done with caution. Further, questions regarding the primary exposure variable of this study were restrictive. The definition of the local community which forms part of the one-item community belonging question did not define what is meant by local community, and as such, the question might be subject to different interpretations (i.e. urban or rural geography?). Lastly, this study's findings did not stratify immigrants into countries or continents of origin. Immigrants from some countries or continents may be more prone to mental health than others. Originality/value: This study shows a link between weak immigrants' sense of community belonging and poor self-rated general and mental health status in Canada and provides suggestive evidence of how contextual factors influence health outcomes differently in society. [ABSTRACT FROM AUTHOR]

This paper examines the longitudinal effects of the COVID-19 pandemic on older adults (65+) with multimorbidity on levels of depression, anxiety, and perceived global impact on their lives. Baseline (2011–2015) and Follow-up 1 (2015–2018) data from the Canadian Longitudinal Study on Aging (CLSA), and the Baseline and Exit waves of the CLSA COVID-19 study (April–December, 2020) (n = 18,099). Multimorbidity was measured using: a) an additive scale of chronic conditions; and b) six chronic disease clusters. Linear Mixed Models were employed to test hypotheses. Number of chronic conditions pre-pandemic was associated with pandemic levels of depression (estimate = 0.40, 95% CI: [0.37,0.44]); anxiety (estimate = 0.20, 95% CI: [0.18, 0.23]); and perceived negative impact of the pandemic (OR = 1.04, 95% CI: [1.02, 1.06]). The associations between multimorbidity and anxiety decreased during the period of the COVID-19 surveys (estimate = −0.02, 95% CI: [−0.05, −0.01]); whereas the multimorbidity association with perceived impact increased (OR = 1.03, 95% CI: [1.01, 1.05]). This study demonstrates that pre-pandemic multimorbidity conditions are associated with worsening mental health. Clinicians treating mental health of older adults need to consider the joint effects of multimorbidity conditions and pandemic experiences to tailor counseling and other treatment protocols. [ABSTRACT FROM AUTHOR]

More than 1 million Canadian adults play recreational ice hockey. Compared to elite players, very little is known about the physical and health characteristics of people who play the game for fun. Analyzing data from Statistics Canada's 2011/12 Canadian Community Health Survey, the paper found that there is an association between physically active males age 35 or over who play ice hockey regularly (at least once a week) and enhanced health more so than other physically active males. While these players are larger in body size, they have significantly lower rates of diabetes, high blood pressure and heart disease and report significantly higher rates of self-assessed health. Given the potential health benefits associated with this high intensity sport, the paper discusses ways in which participation can be promoted among less physically active adults and people who are new to the game or who have historically lower levels of participation including women and recent immigrants. Finally, the paper argues that compared to the very high costs associated with child and youth hockey, participation in adult recreational ice hockey is quite affordable. [ABSTRACT FROM AUTHOR]

Given the disproportionate alcohol-related consequences experienced by North American Indigenous youth, there is a critical need to identify related risk and protective factors. Self-compassion, which has been found to mitigate the effects of trauma exposure, may serve as one such protective factor given the high degree of historical trauma and contemporary discrimination identified as contributing to the alcohol-related disparities experienced by Indigenous communities. However, no research has examined how self-compassion (i.e. the ability to be kind and accepting and to extend compassion toward oneself) plays a unique role in Indigenous peoples' experiences with alcohol. First Nation adolescents between the ages of 11 and 18 living on a reserve in Eastern Canada (N = 106, Mage = 14.6, 50.0% female) completed a pencil-and-paper survey regarding their alcohol use, alcohol-related problems, and self-compassion. Self-compassion was significantly inversely associated with alcohol-related problems (b = -.51, p =.01, 95%CI [-.90, −.12], and significantly interacted with frequency of alcohol use in predicting alcohol-related problems (b = -.42, p =.04, 95%CI [-.82, −.03]). Simple slopes analyses revealed that the association between frequency of alcohol use and frequency of experiencing alcohol-related problems was significant and positive at low (b = 4.68, p <.001, 95%CI [2.62, 6.73]), but was not significant at high (b = -.29, p =.89, 95%CI [−4.35, 3.77]) levels of self-compassion. Binary logistic regression revealed that higher scores of self-compassion were associated with a lower odds of being in the high-risk group for AUD (OR = 0.90, 95%CI [0.83, 0.98], p =.02). Our results suggest self-compassion may be protective against experiencing alcohol problems in Indigenous youth and thus may be a target for behavioral interventions. [ABSTRACT FROM AUTHOR]

Background The COVID-19 pandemic has led to large proportions of the labour market moving to remote work, while others have become unemployed. Those still at their physical workplace likely face increased risk of infection, compared to other workers. The objective of this paper is to understand the relationship between working arrangements, infection control programs (ICP), and symptoms of anxiety and depression among Canadian workers, not specifically working in healthcare. Methods A convenience-based internet survey of Canadian non-healthcare workers was facilitated through various labour organizations between April 26 and June 6, 2020. A total of 5180 respondents started the survey, of which 3779 were assessed as employed in a full-time or part-time capacity on 2 March 2020 (prior to large-scale COVID-19 pandemic responses in Canada). Of this sample, 3305 (87.5%) had complete information on main exposures and outcomes. Anxiety symptoms were measured using the Generalised Anxiety Disorder screener (GAD-2), and depressive symptoms using the Patient Health Questionnaire screener (PHQ-2). For workers at their physical workplace (site-based workers) we asked questions about the adequacy and implementation of 11 different types of ICP, and the adequacy and supply of eight different types of personal protective equipment (PPE). Respondents were classified as either: working remotely; site-based workers with 100% of their ICP/PPE needs met; site-based workers with 50–99% of ICP/PPE needs met; site-based workers with 1–49% of ICP/PPE needs met; site-based workers with none of ICP/PPE needs met; or no longer employed. Regression analyses examined the association between working arrangements and ICP/PPE adequacy and having GAD-2 and PHQ-2 scores of three and higher (a common screening point in both scales). Models were adjusted for a range of demographic, occupation, workplace, and COVID-19-specific factors. Results A total of 42.3% (95% CI: 40.6–44.0%) of the sample had GAD-2 scores of 3 and higher, and 34.6% (95% CI: 32.–36.2%) had PHQ-2 scores of 3 and higher. In initial analyses, symptoms of anxiety and depression were lowest among those working remotely (35.4 and 27.5%), compared to site-based workers (43.5 and 34.7%) and those who had lost their jobs (44.1 and 35.9%). When adequacy of ICP and PPE was taken into account, the lowest prevalence of anxiety and depressive symptoms was observed among site-based workers with all of their ICP needs being met (29.8% prevalence for GAD-2 scores of 3 and higher, and 23.0% prevalence for PHQ-2 scores of 3 and higher), while the highest prevalence was observed among site-based workers with none of their ICP needs being met (52.3% for GAD-2 scores of 3 and higher, and 45.8% for PHQ-2 scores of 3 and higher). Conclusion Our results suggest that the adequate design and implementation of employer-based ICP have implications for the mental health of site-based workers. As economies re-open the ongoing assessment of ICP and associated mental health outcomes among the workforce is warranted. [ABSTRACT FROM AUTHOR]

Oceanic conditions along the Atlantic Coast of North America are changing rapidly. Surface water temperatures in the Gulf of Maine have increased faster than 99% of the global oceans, and major infrastructure projects, including the largest windfarm in the world, are under development along this seaboard. In Canada and the US, the Atlantic sea scallop (Placopecten magellanicus) supports lucrative fisheries, which were originally founded on an extensive scientific framework focusing on stock assessment. The sea scallop is an ideal sentinel species, as it is highly sensitive to changes in marine conditions. We used a drop camera system to estimate the number and size of scallops, as well as the distribution of their reproductive potential, over 70,000 km2 of the continental shelf in 2016–2018, an area that nearly covers the entire range of this species. In total, we estimated that there were 34 billion individual scallops (95% confidence limits: 22–46 billion) within the species' range. In this paper, we examine the role of the sea scallop as a baseline sentinel species that can be used to measure the impacts of environmental change and anthropogenic developments. [ABSTRACT FROM AUTHOR]

Background: The literature has opposing views regarding the magnitude of the association between substance use and TBI. Most studies have examined clinical samples which are not representative of the entire head injured population. Clinical samples provide very limited insight into TBI patients whom do not seek care. Objectives: This paper examines the associations between TBI and substance use/misuse. Its primary aim is to test whether or not individuals with a past-year TBI have higher rates of substance use/misuse than Canadians without a TBI or back and/or spine injury controls drawing on self-report population level data. Methods: Using the 2009-2010 Canadian Community Health Survey, a nationally representative cross-sectional survey of Canadians 12 years and older, this paper assessed substance use (i.e., illicit drug use; drinking and binge drinking; current smoking) among those with a TBI, as compared to two control groups: (1) individuals with a back or spinal injury (BSI); and (2) healthy noninjured controls. Multivariate regressions (logistic and multinomial), both unadjusted and adjusting for a range of injury and sociodemographic covariates, were used in hypothesis testing. Results: Those with a past-year TBI demonstrated significantly elevated rates of illicit drug use relative to non-injured Canadians. Relative to the BSI group those with a TBI were less likely to drink alcohol, did not differ in binge drinking, cigarette smoking and illicit drug use. Conclusion: Health care professionals working with the TBI population should integrate screening, brief intervention, and referral programming as a means to reduce future harm related to substance misuse. [ABSTRACT FROM AUTHOR]

Background: Evaluating gender differences in publication rates after conference presentations is an avenue to assess women's contributions to academic medicine. The objective of this study was to assess gender differences in publication rates, time to publication, and subspeciality of publication of abstracts presented at Canadian otolaryngology conferences over an 11-year period. Methods: Cross-sectional data was obtained from online conference schedules of annual Canadian Society of Otolaryngology–Head and Neck Surgery national meetings between 2009 and 2020. A total of 2111 abstract titles were searched in MedLine via PubMed. Gender of the first and senior author, publication status of presented work, and subspeciality of publication were extracted. Results: Of 2111 scientific abstracts presented between 2009 and 2020, female first and senior authors accounted for 29.0% and 12.8% of published abstracts, respectively. There was a significant difference in the publication rate of senior authors by gender (p < 0.01). Male senior authors had a 9.70% higher rate of publication compared to female senior authors. Posters with a female first author were 33.0% (OR: 0.67; 95% CI 0.49–0.91) less likely to be published compared to posters with a male first author. Similarly, posters with a female senior author were 34.0% (OR: 0.66; 95% CI 0.45–0.96) less likely to be published. There was a significant difference in discipline of publication by gender of the senior author (p < 0.001). Male senior authors were more likely to supervise projects in otology while female senior authors were more likely to supervise projects in education and pediatrics. The time to publication and impact factor of the journal of publication did not differ by gender. Conclusion: Gender disparities exist in the publication rates of first and senior authors at Canadian otolaryngology meetings. Female senior authors have significantly lower publication rates compared to their male colleagues and differences exist in publication rates after poster presentations. Investigation of gender gaps in academic medicine, research productivity, and publications is essential for development of a diverse, equitable, and inclusive workforce in otolaryngology. [ABSTRACT FROM AUTHOR]

Background: Specialist LINK is a real-time, non-urgent telephone collaboration line designed to link family doctors and specialists. The purpose was to reduce wait times, improve efficiency and enhance the coordination of patient care through enhanced communication between primary and specialty care. The aim of this study was to determine the awareness and utilization of Specialist LINK and Primary Care Network (PCN) Clinical Pathways among family physicians. Methods: A family physician experience cross-sectional survey was conducted from March to May 2018 in Calgary and Area. The survey was designed to assess family physicians' awareness and utilization of Specialist LINK and PCN Clinical Pathways. We also used a 1–10 scale for respondents to rate the utility of Specialist LINK (1 was least useful and 10 represented highly useful). To obtain a true representative sample, family physicians were selected through a random sampling method. We applied multiple approaches to ensure a high response rate: paper survey, telephone reminders, and an on-site survey for non-responders. Results: A total of 251 participants completed the survey of the 650 randomly selected family physicians (Response rate≈39%). Eighty-nine percent of the family physicians were aware of Specialist LINK [95% Confidence Interval (84–92%)]. The average rating was 8.1 (on a scale of 1–10) for the usefulness of Specialist LINK. We found that the odds of being aware of Specialist LINK were two times higher in female family physicians compared to male physicians. Also, those with less than 5 years of experience, the odds of being aware of Specialist LINK were around five times higher compared to those with 5 or more years of experience. Fifty-five percent of family physicians were aware of PCN Clinical Pathways (95% CI = 48–60%); of those, 82% were accessing and following PCN Clinical Pathways in their clinical practice. The average rating was 7.9 (on a scale of 1–10) for the usefulness of PCN Clinical Pathways. Conclusion: Most of the respondents in Calgary and area were aware of Specialist LINK and a large proportion of them were using it to access advice for their patients. [ABSTRACT FROM AUTHOR]

Canada has been discussing whether to implement an orphan drug policy for more than 25 years. Recently, the federal government announced funding for orphan drugs starting in 2022, and the Canadian Senate has recommended that the country develop an orphan drug policy. This paper uses a list of orphan drugs approved by the United States Food and Drug Administration between 2008 and 2017, inclusive. It then compares Canada, which has no orphan drug policy, and Australia, which has had such a policy since 1997. There was no difference between the countries in the proportion of orphan drugs approved, the time drugs spent in the regulatory review process, and any delay in marketing the drugs in the respective countries compared to the United States. Both Canada and Australia approved virtually all of the drugs that offered a moderate to significant therapeutic improvement. If Canada hopes to provide faster access to orphan drugs, especially those that are therapeutically innovative, it will need to develop a policy that is significantly different from that in Australia. [ABSTRACT FROM AUTHOR]

Large samples based confidence interval is frequently used by environmental scientists as an approximate data summary about the log-normal regression mean. It has been shown by simulation that the coverage probability of such an interval is below the intended nominal level for small samples. To overcome this difficulty, a complicated small sample corrected interval has been recently proposed in the literature which substantially improves the coverage probability. In this paper, similar improvement are obtained by simply replacing the quantile of the normal distribution by the appropriate quantile of Student t distribution as will be demonstrated in this paper by simulation. The advantage of our proposed interval is its simplicity and thus will be easier to use in applications. As an illustration, we use the method to study the relationship between the flow and concentration of total phosphorous (TP) at four upstream/downstream sampling locations on the Fraser River of British Columbia. Our interests in developing intervals for the mean TP level at each location as well as the ratio of the mean at a downstream location to that at an upstream location. Such study is important in tracing the evolution of pollutants in an ecosystem and thus in setting policies for pollution control. [ABSTRACT FROM AUTHOR]

This paper proposes an alternative formulation for the Sen-Shorrocks-Thon (SST) index of poverty intensity that is appropriate for survey data with sampling weights. It also decomposes the SST index into the poverty rate, the average poverty gap ratio among the poor, and the overall Gini index of poverty gap ratios. To account for sampling variation in estimates of poverty intensity, this paper uses the bootstrap method to compute confidence intervals and presents international comparisons using Luxembourg Income Study (LIS) data from the 1970s to the 1990s. Cross-sectional and longitudinal analyses indicate that the percentage change in poverty intensity can be approximated by the sum of percentage changes in the poverty rate and average poverty gap ratio, since changes in the overall Gini index of poverty gap ratios are negligible. In the early 1970s poverty intensity in Canada and the United States was almost indistinguishable, but in the 1970s Canadian poverty intensity decreased. Large increases in poverty intensity occurred in the 1980s in the United States, the United Kingdom, and Sweden. [ABSTRACT FROM AUTHOR]

This is the second in a series of papers that deal with care-giving in Canada, as based on data available from the Canadian General Social Survey (2007). Building on the first paper, which reviewed the differences between short-term, long-term and end-of-life ( EOL) caregivers, this paper uniquely examines the caregiver supports employed by EOL caregivers when compared to non- EOL caregivers (short-term and long-term caregivers combined). Both papers employ data from Statistics Canada's General Social Survey ( GSS Cycle 21: 2007). The GSS includes three modules, where respondents were asked questions about the unpaid home care assistance that they had provided in the last 12 months to someone at EOL or with either a long-term health condition or a physical limitation. The objective of this research paper was to investigate the link between the impact of the care-giving experience and the caregiver supports received, while also examining the differences in these across EOL and non- EOL caregivers. By way of factor analysis and regression modelling, we examine differences between two types of caregivers: (i) EOL and (ii) non- EOL caregivers. The study revealed that with respect to socio-demographic characteristics, health outcomes and caregiver supports, EOL caregivers were consistently worse off. This suggests that although all non- EOL caregivers are experiencing negative impacts from their care-giving role, comparatively greater supports are needed for EOL caregivers. [ABSTRACT FROM AUTHOR]

Summary: This study contributes to the ongoing efforts to address systemic inequality within social work by examining Canadian social workers' attitudes toward immigrants who are permanent residents (PR), refugees, temporary residents (TR), or undocumented immigrants. Using a cross-sectional design with a convenience sample (n = 653), we explore how social workers' attitudes toward immigrants vary in relation to (a) respondents' demographics, (b) contact with immigrants, (c) perceptions of equal opportunities among immigrants, (d) perceptions of deservingness for immigrants with different legal statuses, and (e) the impact of the COVID-19 pandemic on these attitudes. Findings: While Canadian social workers generally express positive attitudes toward immigrants, there is a slightly stronger endorsement for PR and refugees to access public services compared to nonstatus (NS) immigrants and TR. Social workers who identify as conservative or have limited contact with immigrants are more likely to perceive NS immigrants as potential criminal threats or burdens on the healthcare system. Significantly, a majority of respondents feel that their social work training inadequately prepares them to work effectively with immigrants. Applications: Canadian social workers advocate for principles of diversity, inclusion, and commitment to social justice. However, perceptions regarding which immigrants deserve access to social services vary based on legal status, suggesting a limitation in social workers' professional mandate. The study discusses implications for social work education and training, emphasizing the need to address and unsettle systemic racism within the profession. [ABSTRACT FROM AUTHOR]

Background: We initially reported on the cost-effectiveness of a 6-month randomized controlled implementation trial which evaluated Health TAPESTRY, a primary care program for older adults, at the McMaster Family Health Team (FHT) site and 5 other FHT sites in Ontario, Canada. While there were no statistically significant between-group differences in outcomes at month 6 post randomization, positive outcomes were observed at the McMaster FHT site, which recruited 40% (204/512) of the participants. The objective of this post-hoc study was to determine the cost-effectiveness of Health TAPESTRY based on data from the McMaster FHT site. Methods: Costs included the cost to implement Health TAPESTRY at McMaster as well as healthcare resource consumed, which were costed using publicly available sources. Health-related-quality-of-life was evaluated with the EQ-5L-5L at baseline and at month 6 post randomization. Quality-adjusted-life-years (QALYs) were calculated under an-area-under the curve approach. Unadjusted and adjusted regression analyses (two independent regression analyses on costs and QALYs, seemingly unrelated regression [SUR], net benefit regression) as well as difference-in-difference and propensity score matching (PSM) methods, were used to deal with the non-randomized nature of the trial. Sampling uncertainty inherent to the trial data was estimated using non-parametric bootstrapping. The return on investment (ROI) associated with Health TAPESTRY was calculated. All costs were reported in 2021 Canadian dollars. Results: With an intervention cost of $293/patient, Health TAPESTRY was the preferred strategy in the unadjusted and adjusted analyses. The results of our bootstrap analyses indicated that Health TAPESTRY was cost-effective compared to usual care at commonly accepted WTP thresholds. For example, if decision makers were willing to pay $50,000 per QALY gained, the probability of Health TAPESTRY to be cost effective compared to usual care varied from 0.72 (unadjusted analysis) to 0.96 (SUR) when using a WTP of $50,000/QALY gained. The DID and ROI analyses indicated that Health Tapestry generated a positive ROI. Conclusion: Health TAPESTRY was the preferred strategy when implemented at the McMaster FHT. We caution care in interpreting the results because of the post-hoc nature of the analyses and limited sample size based on one site. [ABSTRACT FROM AUTHOR]

Floods are known as one of the most damaging natural hazards with devastating influence on people and the environment. Accurately estimating flood frequencies is essential for effective design of flood mitigation systems. Estimation of these frequencies is difficult since extreme events are rare and the length of recorded data is often short. In such situations, extreme flow information from a number of similar sites is combined (pooled) to augment the available at-site information. Pooled flood frequency analysis is a well-known approach used to improve the estimation of extreme flow quantiles at sites with short data records. Identification of pooling groups that will effectively transfer extreme flow information is thus essential. The present paper proposes an approach to improve flood quantile estimates through utilizing the concept of super regions integrated with seasonality-based similarity measures to conduct pooled frequency analysis for extreme flow events. To identify homogeneous regions, this study focuses on the region of influence (ROI), or focussed pooling group approach among hydrological neighborhood techniques. To define the hydrologically similar neighborhood of a target site, a single numeric that measures similarity/dissimilarity between sites is usually utilized. This work investigates the effect of employing catchment physiographic-climate characteristics and several flood seasonality statistics as the similarity measures. Moreover, this study explores and establishes a super region technique that in a hierarchical process employs the two types of similarity measures. A large dataset of catchments across Canada was used to compare the proposed method with more traditional approaches. The effectiveness of these techniques both in terms of constructing homogeneous pooling groups and accurately estimating extreme flow quantiles is explored for the catchments under study. The proposed super region approach was shown to form more reliable homogeneous pooling groups. Analyzing confidence intervals of quantile estimates obtained from pooled and at-site estimates revealed promising improvement. [ABSTRACT FROM AUTHOR]

Background Youth consumption of cigarillos (ie, little cigars) has increased markedly in recent years. In July 2010, the Canadian government banned the sale of flavoured cigarillos and required unflavoured cigarillos to be sold in packs of at least 20 units. This paper assesses changes in young persons' use of cigarillos and regular cigars, which are potential substitutes, following the policy. Methods To investigate of the change in cigar smoking following the policy, we constructed a segmented regression model that allowed the policy to change the height and the slope of the trend in the outcome variables. The model was estimated using data from the 2007-2011 Canadian Tobacco Use Monitoring Surveys. Results We obtained visual and regression-based evidence that use of cigarillos among youth declined following the policy. We also found a small, gradual increase in their use of regular cigars, possibly due to their compensatory switching from cigarillos to regular cigars. Overall, there was a net reduction in cigar use among youth after the intervention. Interpretation The policy achieved its goal of reducing youth's consumption of cigarillos, but may have an unintended consequence of increasing their use of regular cigars. Policymakers should address the possibility that youth switch to regular cigars in response to restricted access to cigarillos. Possible ways of discouraging this substituting behaviour include extending the ban to cover all flavoured cigars and mandating a minimum pack size for all cigars, or raising taxes on flavoured cigars. [ABSTRACT FROM AUTHOR]

Background Fewer than half of individuals with a mental disorder seek formal care in a given year. Much research has been conducted on the factors that influence service use in this population, but the methods generally used cannot easily identify the complex interactions that are thought to exist. In this paper, we examine predictors of subsequent service use among respondents to a population health survey who met criteria for a past-year mood, anxiety or substance-related disorder. Methods To determine service use, we use an administrative database including all physician consultations in the period of interest. To identify predictors, we use classification tree (CART) analysis, a data mining technique with the ability to identify unsuspected interactions. We compare results to those from logistic regression models. Results We identify 1213 individuals with past-year disorder. In the year after the survey, 24% (n=312) of these had a mental health-related physician consultation. Logistic regression revealed that age, sex and marital status predicted service use. CART analysis yielded a set of rules based on age, sex, marital status and income adequacy, with marital status playing a role among men and by income adequacy important among women. CART analysis proved moderately effective overall, with agreement of 60%, sensitivity of 82% and specificity of 53%. Conclusion Results highlight the potential of data-mining techniques to uncover complex interactions, and offer support to the view that the intersection of multiple statuses influence health and behaviour in ways that are difficult to identify with conventional statistics. The disadvantages of these methods are also discussed. [ABSTRACT FROM AUTHOR]

• First trends analysis of data from the national Canadian Cannabis Survey. • Past-year cannabis use increased since non-medical cannabis legalization in Canada. • The proportion of past-year consumers using cannabis frequently is unchanged. • Past-year use of edibles, drinks and vape pens/cartridges has increased. • Legal purchasing is displacing the illicit cannabis market in Canada. Cannabis use for non-medical purposes was legalized and regulated in Canada through the Cannabis Act in October 2018. This paper examined trends in use of cannabis for non-medical purposes and related indicators from pre- to post-legalization in Canada (2018–2022). Data from 5 years of the Canadian Cannabis Survey, an annual web-based survey administered to Canadians 16 years of age or older, were used in the analysis (n 2018 =12,952; n 2019 =11,922; n 2020 =10,821; n 2021 =10,733; n 2022 =10,048). Cannabis measures include questions about use, types of products, sources, risk perceptions and beliefs, and exposure to public education campaigns and health warnings. Adjusted logistic regression models tested differences in outcomes over time. Past 12-month cannabis consumption increased among Canadians from 22 % in 2018 to 27 % in 2022 (AOR=1.41;99 % CI:1.28–1.54). Similarly, daily/almost daily (DAD) consumption increased from 5 % in 2018 to 7 % in 2022 (AOR=1.36;99 % CI:1.16–1.59). Consumption of dried flower, hash/kief, and concentrates/extracts (e.g., wax, shatter, budder) decreased since 2018, whereas consumption of edibles, beverages and vape pens/cartridges increased (p < 0.001). Legal purchasing increased from 4 % in 2018 to 69 % in 2022, while accessing cannabis through social and illegal sources decreased over time (p < 0.001). More Canadians are reporting cannabis consumption since legalization and regulation of cannabis for non-medical purposes, continuing a pre-existing trend despite an increase in awareness of the risks of consuming cannabis. Trends in product use indicate a transition from dried flower and concentrates/extracts towards consumption of cannabis foods, drinks and vape pens/cartridges. The legal market is increasingly displacing the illicit cannabis market in Canada. [ABSTRACT FROM AUTHOR]

Background: There is inconsistent utilisation of clinical practice guidelines (CPGs) for cardiovascular disease (CVD) screening and management by healthcare professionals to identify CVD risk factors early and to intervene using current recommendations. To address this issue, the Cardiovascular Assessment Screening Program (CASP) was developed, implemented, and evaluated. This manuscript reports on the second phase of an exploratory sequential mixed methods study that tested the effectiveness of the CASP with nurse practitioners (NPs) and patients in Canada. Methods: A two-armed, non-blinded, cluster randomised controlled trial (cRCT) compared the NP-led implementation of CASP with usual care by NPs in community practice clinics across one Canadian province. The NPs were the cluster variable as their screening practices could be affected by their educational training, resources, or other factors. NPs were eligible for inclusion in the study if they were located in different urban and rural community settings and could conduct follow-up visits with patients. NPs recruited and enrolled the patients from their own practices as participants if they were healthy individuals, aged 40–74 years, with no established CVD or vascular disease. Researchers randomly allocated the NPs (n = 10) to the intervention group (IG) or the control group (CG). Results: Eight (8) NPs and 167 patients participated in the cRCT study. Patient participant-level data were analysed by the originally assigned groups IG (n = 68) and CG (n = 99). Utilising GLM (generalized linear modeling) more IG patients (90%; n = 61) received comprehensive CVD screening compared to the CG patients (2%; n = 2), RR = 30.2, 95% CI [8.76, 103.9], p <.0001, controlling for the effect of NP and BP category. Conclusion: NP implementation of CASP was effective for comprehensive screening compared to usual care and led to identifying previously unknown CVD risk factors, calculated FRS, heart health priorities and personalised goal-setting. Trial registration: ClinicalTrial.gov ID#: NCT03170752, date of registration 2017/05/31. [ABSTRACT FROM AUTHOR]

Purpose: This paper evaluates the long-term impact of a Canadian mass media campaign on general public beliefs about staying active when experiencing low back pain (LBP).Methods: Changes in beliefs about staying active during an episode of LBP were studied using telephone and web-based surveys. Logistic regression analysis was used to investigate changes in beliefs over time and the effect of exposure to campaign messaging.Results: The percentage of survey respondents agreeing that they should stay active through LBP increased annually from 58.9 to ~72.0%. Respondents reporting exposure to campaign messaging were statistically significantly more likely to agree with staying active than respondents who did not report exposure to campaign messaging (adjusted OR, 95% CI = 1.96, 1.73-2.21).Conclusion: The mass media campaign had continued impact on public LBP beliefs over the course of 7 years. Improvements over time were associated with exposure to campaign messaging. [ABSTRACT FROM AUTHOR]

Leisure-based physical activity is socially stratified in Canada. To date, inequalities in physical activity by race or ethnicity, gender, class or sexual orientation, in Canada and elsewhere, have largely been investigated as distinct, additive phenomena. Informed by intersectionality theory, this paper examines whether racial identity, gender, class and sexuality 'intersect' with one another to predict physical activity in data from Cycles 2.1 and 3.1 of the Canadian Community Health Survey (n = 149 574). In particular, we apply the intersectional principle of multiplicativity which suggests that people's experiences of their gender identities are raced, classed and sexualized; their racial experiences are gendered, classed and sexualized, and so forth. We find that the positive effect of income on being physically active is strong among visible minority men, of moderate strength among White men and women and weak to non-existent among visible minority women. We also find that a lesbian, gay or bisexual orientation corresponds with a higher likelihood of being physically active among women (especially among less educated women) but not among men. These multiplicative findings undermine additive approaches to investigating social inequalities in leisure-based physical activity and pave the way for future intersectional analyses of axes of inequality and their diverse, intersecting effects. [ABSTRACT FROM AUTHOR]

Background: Cause-specific (CS) and net survival in a relative survival framework (RS) are two of the most common methods for estimating cancer survival. In this paper, we assess the differences in results produced by two permutations of cause-specific and relative survival applied to estimating cancer survival and disparities in cancer survival, using data from First Nations and non-Aboriginal populations in Canada. Methods: Subjects were members of the 1991 Canadian Census Mortality Cohort, a population-based cohort of adult respondents to the 1991 Long Form Census who have been followed up for incident cancers and death through linkage to administrative databases. We compared four methods: relative survival analyses with ethnicity-specific life tables (RS-ELT); relative survival with general population life tables (RS-GLT); cause-specific survival with a broad definition of cancer death (CS-Broad); and cause-specific survival with a narrow definition of cause of death (CS-Narrow) and applied these to the nine most common cancers among First Nations. Results: Apart from breast and prostate cancers, RS-ELT, RS-GLT, and CS-Broad tended to produce similar estimates of age-standardized five-year survival, whereas CS-Narrow yielded higher estimates of survival. CS-Narrow estimates were particularly unlike those based on the other methods for cancers of the digestive and respiratory tracts. Estimates of disparities in survival were generally comparable across the four methods except for breast and prostate cancers. Conclusions: Cancer surveillance efforts in sub-populations defined by race, ethnicity, geography, socioeconomic status, or similar factors are necessary for identifying disparities and monitoring progress toward reducing them. In the absence of routine monitoring of cancer survival and cancer survival disparities in these populations, estimates generated by different methods will inevitably be compared over time and across populations. In this study, we demonstrate that caution should be exercised in making these comparisons, particularly in interpreting cause-specific survival rates with an unknown or narrow definition of cancer death and in estimates of breast and prostate cancer survival and/or disparities in survival generated by different methods. [ABSTRACT FROM AUTHOR]

Background: In this paper we examine the relationship between social capital and two mental health outcomes—self-rated mental health (SRMH) and heavy episodic drinking (HED)—among the Indigenous populations of Canada. We operationalize a unique definition of social capital from Indigenous specific sources that allows for an analysis of the importance of access to Indigenous networks and communities. We also examine gender variations in the relationship between social capital and the two outcomes, as there is a noticeable lack of research examining the influence of gender in the recent literature on the mental health of Indigenous populations in Canada. Methods: Using data from the 2012 cycle of the Aboriginal Peoples Survey, logistic regression models were estimated to assess if gender was a significant predictor of either SRMH or HED among the entire Indigenous sample. The sample was then stratified by gender and the relationship between two social capital variables—one general and one indigenous-specific—and each mental health outcome was assessed separately among male and female respondents. All analyses were also further stratified into specific Indigenous groups—First Nations, Métis, or Inuit—to account for the unique cultures, histories, and socioeconomic positions of the three populations. Results: Female respondents were more likely to report fair or poor SRMH in the total sample as well as the First Nations and Métis subsamples (OR = 1.48, CI = 1.14–1.91; OR = 1.63, CI = 1.12–2.36; OR = 1.44, CI = 1.01–2.05 respectively). However, female respondents were less likely than males to engage in weekly HED in all three of the same populations (OR = 0.43, CI = 0.35–0.54, all respondents; OR = 0.42, CI = 0.31–0.58, First nations; OR = 0.39, CI = 0.27–0.56, Métis). Social capital from sources specific to Indigenous communities was associated with lower odds of weekly HED, but only among Indigenous men. Meanwhile the strength of family ties was associated with lower odds of reporting fair/poor SRMH among both Indigenous men and women. However, these results vary in strength and significance among the different Indigenous populations of Canada. Conclusions: The results of this paper address a critical gap in the literature on gender differences in SRMH and HED among the Indigenous populations of Canada, and reveal gendered variations in the relationship between social capital and SRMH and HED. These findings support further investigation into the role that social capital and particularly Indigenous-specific forms of social capital may play as a determinant of health. This research could contribute to future mental health initiatives aimed at strengthening the social capital of Indigenous populations and promoting resilient Indigenous communities with strong social connections. [ABSTRACT FROM AUTHOR]

Background: Self-rated health (SRH) is a globally recognized measure of health status. Both impaired sleep (IS) and the presence of multimorbidity are related to poorer SRH, but the precise nature of these associations remains unclear. This study explored the association between IS, multimorbidity, and SRH among Canadian adults. Method: We used 2017-18 Canadian Community Health Survey (CCHS) data for this study. The main variable of interest, self-rated health (SRH), measured participants' health on a 5-point Likert scale, later categorized as "good or better" vs. "fair or poor". The primary predictor, IS, was derived from two variables and categorized into four groups: no sleep issues; fewer sleeping hours (<7 hours) only; trouble sleeping only; and fewer hours & trouble sleeping. Multimorbidity was present (yes/no) if a participant indicated being diagnosed with two or more chronic conditions. Results: Just over one in ten Canadians reported fair/poor SRH and approximately one-quarter had multimorbidity or experienced few sleep hours in combination with trouble sleeping. The adjusted model indicated greater odds of fair/poor SRH associated with the 40-64 years age group, male sex, and lower socio-economic status. It also suggested the presence of multimorbidity (AOR= 4.63, 95% CI: 4.06-5.28) and a combination of fewer sleep hours and troubled sleep (AOR= 4.05, 95% CI: 2.86-5.74) is responsible for poor SRH. Forty-four percent of the total effect of IS on SRH was mediated by multimorbidity. Conclusion: This unique finding highlights the mediating role of multimorbidity, emphasizing the importance of addressing it alongside sleep issues for optimal health outcomes. [ABSTRACT FROM AUTHOR]

Background: Alcohol-induced injury is one of the leading causes of preventable morbidity and mortality. We investigated the relationship between impulsive personality and physical injury (e.g. falls, sports), and whether peak drinking quantity specifically, and/or risky behaviour more generally, mediates the relationship between impulsivity and injury in undergraduates. Method: We used data from the winter 2021 UniVenture survey with 1316 first- and second-year undergraduate students aged 18–25 years (79.5% female) from five Canadian Universities. Students completed an online survey regarding their demographics, personality, alcohol use, risky behaviours, and injury experiences. Impulsivity was measured with the substance use risk profile scale, past 30-day peak alcohol use with the quantity-frequency-peak Alcohol Use Index, general risky behaviour with the risky behaviour questionnaire, and past 6-month injury experience with the World Health Organization's (2017) injury measurement questionnaire. Results: Of 1316 total participants, 12.9% (n = 170) reported having sustained a physical injury in the past 6 months. Mean impulsivity, peak drinking quantity, and risky behaviour scores were significantly higher among those who reported vs. did not report injury. Impulsivity and peak drinking quantity, but not general risky behaviour, predicted injury in a multi-level generalized mixed model. Mediation analyses supported impulsivity as both a direct predictor of physical injury and an indirect predictor through increased peak drinking (both p <.05), but not through general risky behaviour. Conclusion: Results imply emerging adults with impulsive tendencies should be identified for selective injury prevention programs and suggest targeting their heavy drinking to decrease their risk for physical injury. [ABSTRACT FROM AUTHOR]

This study investigates the nature of the social interaction profiles observed among youth with intellectual disabilities (ID), defined while considering their relationships with their parents, peers, and teachers, as well as the implication of these profiles for self-esteem, aggressive behaviors, and prosocial behaviors. A sample of 393 youth with mild (48.2%) to moderate (51.8%) levels of ID, aged between 11 and 22 (M = 15.70), was recruited in Canada (n = 141) and Australia (n = 253). Our results revealed four profiles, corresponding to Socially Isolated (23.24%), Socially Integrated (39.83%), Socially Rejected (28.37%) and Socially Connected (8.57%) youth with ID. The socially integrated and connected profiles both presented higher self-esteem, more prosocial behaviors, and less aggressive behaviors than the socially isolated and rejected profiles. [ABSTRACT FROM AUTHOR]

Due to cultural and systemic factors, Chinese-Canadians tend to use mental health services less or when mental health problems are more severe. Services need to be more culturally responsive in their treatment of mental illness. Around important life events, when there may be heightened vulnerability to mental illness, this is especially important. In this study, postpartum cultural practices were examined among recent immigrant, longer-term immigrant, and Canadian-born Chinese women. We conducted a longitudinal cohort study of 493 women in Toronto, Ontario, with livebirths in 2011–2014. Participants completed a demographic survey and Postpartum Rituals Questionnaire. Most women (82.2%) practiced at least one postpartum ritual. Younger age (OR 0.93; 95% CI 0.87–0.99) and greater participation in the heritage culture (OR 1.28; 95% CI 1.02–1.61) were associated with ritual practice. From among five types of postpartum rituals identified (i.e., avoidance of homeostatic disturbances, dietary practices, wind avoidance, organized support, and cold avoidance), dietary practices were most commonly undertaken and cold avoidance was least commonly undertaken. There were differences in postpartum ritual patterns by immigration status, with immigrant women being more likely to undertake a greater number of rituals, to attribute these rituals to Chinese culture, and to ascribe health benefits to these rituals and being less likely to feel forced into performing these rituals. Our findings underscore the importance of clinicians becoming more aware of Chinese postpartum rituals to provide women with culturally competent and patient-centered care. [ABSTRACT FROM AUTHOR]

Objectives: Physicians may be asked to prescribe, recommend, or discuss foods, herbs, and medications for low milk supply. It is unclear how factors such as education, experience, and regulations influence clinical practice. The objective was to document physicians' clinical practice surrounding pharmacologic, nutritional, and herbal products for the management of low milk supply. Methods: Physicians from two Facebook groups completed an anonymous, online survey about their clinical use of pharmaceutical, supplemental, and nutritional substances perceived to increase milk production. The association between practice patterns and lactation medicine expertise or country for different perceived galactagogues was determined. Results: A total of 307 physicians completed the primary portion of the survey. There was no difference in the proportion of physicians in Canada or the United States (U.S.) who were defined as lactation medicine experts. Canadian physicians were more likely to prescribe metformin, levothyroxine, and domperidone for low milk supply compared with U.S.-based physicians. Canadians and experts were more likely than U.S.-based and nonexpert physicians, respectively, to include herbs in their practice. Patient request, personal and clinical experience, and lack of education, research, or access were frequently selected as reasons for or against using a specific substance. Conclusions: The U.S. Food and Drug Administration ban on domperidone affects low milk supply management in North America. Though Canadian physicians prescribed domperidone without limitations, U.S. physicians were less likely to incorporate it into clinical practice. Despite a lack of evidence, physicians in North America frequently used herbs and foods to increase milk production. [ABSTRACT FROM AUTHOR]

Simple Summary: In clinical practice, human epidermal growth factor receptor (HER2)-negative tumors include triple-negative or luminal breast cancer. HER2-negative breast cancer can be further characterized by immunohistochemical (IHC) and in situ hybridization (ISH) scores into HER2 IHC0 or HER2-low (IHC 1+, 2+/ISH−. Interest in HER2-low tumors has increased as data show the efficacy of HER2-targeted therapies in this subgroup. While several studies have examined treatment variations in the overall breast cancer population, there is limited information on the real-world treatment patterns among patients with HER2 (IHC0/-low) metastatic or recurrent breast cancer. Our study addresses this gap by analyzing treatment and outcomes by HER2 status and found that outcomes were similar in the HER2 IHC0 and -low groups. Our findings add value to the general understanding of the clinical differences between HER2 IHC0/-low and de novo/recurrent disease and have important implications for new effective treatment strategies designed for varying levels of HER2 expression. Improved understanding of the biological heterogeneity of breast cancer (BC) has facilitated the development of more effective and personalized approaches to treatment. This study describes real-world evidence on treatment patterns and outcomes for a population-based cohort of patients with human epidermal growth factor receptor (HER2) IHC0 and -low BC with de novo or recurrent disease from Alberta, Canada. Patients 18+ years old diagnosed with HER2 IHC0/-low, de novo/recurrent BC from 2010 to 2019 were identified using Alberta's cancer registry. Analyses of these patients' existing electronic medical records and administrative claims data were conducted to examine patient characteristics, treatment patterns, and survival outcomes. A total of 3413 patients were included in the study, of which 72.10% initiated first line hormonal and non-hormonal systemic therapy. The 1-year overall survival (OS) was 81.09% [95% CI, 79.52–82.69]. Recurrent patients had a higher OS compared to de novo patients: 54.30 months [95% CI, 47.80–61.90] vs. 31.5 months [95% CI, 28.40–35.90], respectively. Median OS was 43.4 months [95% CI, 40.70–47.10] and 35.80 months [95% CI, 29.00–41.70] among patients with HER2-low and HER2 IHC0 cancer, respectively. The study results provide real-world evidence regarding the clinical outcomes of HER2 IHC0/-low and de novo/recurrent disease. [ABSTRACT FROM AUTHOR]

Simple Summary: In this study, we examined whether different types of red meat, processed and unprocessed, contribute to the development of advanced colorectal adenomas, which can be precursors to cancer. Through examining the diets of 1083 individuals at their initial colonoscopy in Calgary, we assessed the impact of meat intake on the presence of these early cancer indicators. We observed that the total amount of red and processed meat, but not unprocessed meat, was associated with the presence of advanced colorectal adenomas at the time of a screening colonoscopy. Our observations provide preliminary evidence that may contribute to a nuanced understanding of diet's role in colorectal health. The association between red meat consumption and colorectal cancer has been rigorously examined. However, a more comprehensive understanding of how the intake of unprocessed red meat contributes to the development of early precancerous colorectal lesions, such as advanced colorectal adenomas (ACRAs), requires further investigation. We examined the associations between different types of red meat intake and ACRAs in a sample population of 1083 individuals aged ≥ 50 years undergoing an initial screening colonoscopy in Calgary, Alberta, Canada. Associations between grams per day of total, processed, and unprocessed red meat from diet history questionnaires and ACRAs were evaluated with multivariable logistic regression models. We also applied cubic spline models fitted with three knots (10th, 50th, and 90th percentiles) to identify potential nonlinear associations. We did not observe a meaningful association between unprocessed red meat intake and the presence of ACRAs. In contrast, for every 10 g/d increase in total and processed meat intake, we observed an increase in the odds of ACRAs at the screening colonoscopy (adjusted odds ratio (OR) = 1.05, 95% [CI = 1.01–1.09], p = 0.04) and (adjusted OR = 1.11, 95% [CI = 1.02–1.20], p = 0.02), respectively. This study highlights the importance of differentiating between types of red meat consumption in the context of dietary risks associated with ACRAs. [ABSTRACT FROM AUTHOR]

Canadian social workers were surveyed about early adversities, mental health, and resilience. Bivariate analysis (n = 236) was conducted to understand relationships between predictor and outcome variables; and logistic regression analyses were conducted for depression, post-traumatic stress disorder, anxiety, and resilience. The impact of pandemic-related factors was also investigated. The results indicate that social workers are experiencing concerning levels of mental health issues, with significantly lower levels of resilience in younger social workers. A trauma and resilience informed approach to workplace policies and practices is urgently required to support social workers' mental health needs. [ABSTRACT FROM AUTHOR]

Background/aim The successful development and maintenance of professional identity is associated with professional development and retention in the health workforce. This paper explores students' perspectives on the ways pre-entry experiences and curricula content shape professional identity. Methods An online cross-sectional survey was sent to students enrolled in the final year of entry-level programmes in five countries. Descriptive statistical analyses of data were completed. Results The results reflect the perceptions of 319 respondents from five countries. Respondents identified professional education (98%) and professional socialisation during placement (92%) as curricula components with the greatest influence on professional identity formation. Discipline-specific knowledge such as, occupation-focussed models and occupational science were ranked lower than these aspects of practice. The students' length of programme and level of entry-level programme did not impact on these results. Conclusion When designing curricula educators need to be mindful that students perceive practice education and professional socialisation have the greatest affect on professional identity formation. The findings reinforce the need for curricula to provide students with a range of practice experiences, which allow the observation and application of occupation-based practices. It highlights a need for educators to provide university-based curricula activities, which better prepare students for a potential dissonance between explicit occupation-based curricula and observed practice education experiences. The study indicates the need for further research into the role curricula content, and in particular practice education, plays in the multidimensional formation of professional development within entry-level programmes. [ABSTRACT FROM AUTHOR]

Recently we published a meta-analyses of morbidity seen with the use of cow's milk derived fortifier (CMDF) rather than human milk derived fortifier (HMDF) in very low birthweight (VLBW) infants. Here, we further analyse these data to estimate the annual population risk of CMDF-related major morbidity in the United States and Canada. The outcome used was a mortality/morbidity index which was positive if the infants had one or more of death, necrotising enterocolitis, sepsis retinopathy of prematurity or bronchopulmonary dysplasia. Using the risk difference (RD) between the CMDF and HMDF groups we estimated, provisionally, that 4150 additional VLBW infants in the United States and Canada each year, or an additional infant approximately every 2 hours, may be expected to develop a positive mortality/morbidity index in relation to being fed CMDF - over and above the number of infants with a positive index if fed HMDF. We provide an in-depth discussion of the limitations of our estimate. This analysis provides preliminary evidence of the magnitude of population risk of major neonatal morbidity with use of CMDF versus HMDF in VLBW infants in current practice. [ABSTRACT FROM AUTHOR]

This paper examines the relationships between self-reported loneliness and living arrangements. A structured questionnaire with some open-ended questions was administered face-to-face in English, Hindi or Punjabi to a sample of 161 elderly South Asian immigrants 60 or more years of age living in Edmonton, Alberta, Canada in 2003. The majority of respondents said that they never felt lonely. More than one in three (37.3%) respondents indicated that they felt lonely occasionally, frequently or all of the time. Those living alone were significantly more likely to report feeling lonely at least occasionally than were those living with others, especially those living with their spouse in an extended family. The fact that South Asian immigrant seniors typically lived with others, often in an extended family with or without their spouse, and rarely lived alone protected them to some extent from loneliness. However, our findings showed that among those living with others, it was the amount of waking time spent alone at home and the quality of family relationships rather than living arrangement per se that significantly predicted self-reported loneliness. Nevertheless, living in a larger household was associated with spending less time alone. We discuss plausible influences of culture on expectations regarding family and social relationships and on the meaning of being alone, as well as practical implications for addressing loneliness in a multi-cultural society. [ABSTRACT FROM PUBLISHER]

Introduction: Accurate measurement of health inequities is indispensable to track progress or to identify needs for health equity policy interventions. A key empirical task is to measure the extent to which observed inequality in health -- a difference in health -- is inequitable. Empirically operationalizing definitions of health inequity has generated an important question not considered in the conceptual literature on health inequity. Empirical analysis can explain only a portion of observed health inequality. This paper demonstrates that the treatment of unexplained inequality is not only a methodological but ethical question and that the answer to the ethical question -- whether unexplained health inequality is unfair -- determines the appropriate standardization method for health inequity analysis and can lead to potentially divergent estimates of health inequity. Methods: We use the American sample of the 2002-03 Joint Canada/United States Survey of Health and measure health by the Health Utilities Index (HUI). We model variation in the observed HUI by demographic, socioeconomic, health behaviour, and health care variables using Ordinary Least Squares. We estimate unfair HUI by standardizing fairness, removing the fair component from the observed HUI. We consider health inequality due to factors amenable to policy intervention as unfair. We contrast estimates of inequity using two fairness-standardization methods: direct (considering unexplained inequality as ethically acceptable) and indirect (considering unexplained inequality as unfair). We use the Gini coefficient to quantify inequity. Results: Our analysis shows that about 75% of the variation in the observed HUI is unexplained by the model. The direct standardization results in a smaller inequity estimate (about 60% of health inequality is inequitable) than the indirect standardization (almost all inequality is inequitable). Conclusions: The choice of the fairness-standardization method is ethical and influences the empirical health inequity results considerably. More debate and analysis is necessary regarding which treatment of the unexplained inequality has the stronger foundation in equity considerations. [ABSTRACT FROM AUTHOR]

BACKGROUND: Studies across the globe generally reported increased mortality risks associated with particulate matter with aerodynamic diameter ≤2.5 μm (PM2.5) exposure with large heterogeneity in the magnitude of reported associations and the shape of concentration-response functions (CRFs). We aimed to evaluate the impact of key study design factors (including confounders, applied exposure model, population age, and outcome definition) on PM2.5 effect estimates by harmonizing analyses on three previously published large studies in Canada [Mortality-Air Pollution Associations in Low Exposure Environments (MAPLE), 1991-2016], the United States (Medicare, 2000-2016), and Europe [Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), 2000-2016] as much as possible. METHODS: We harmonized the study populations to individuals 65+ years of age, applied the same satellite-derived PM2.5 exposure estimates, and selected the same sets of potential confounders and the same outcome. We evaluated whether differences in previously published effect estimates across cohorts were reduced after harmonization among these factors. Additional analyses were conducted to assess the influence of key design features on estimated risks, including adjusted covariates and exposure assessment method. A combined CRF was assessed with meta-analysis based on the extended shape-constrained health impact function (eSCHIF). RESULTS: More than 81 million participants were included, contributing 692 million person-years of follow-up. Hazard ratios and 95% confidence intervals (CIs) for all-cause mortality associated with a 5-μg/m³ increase in PM2.5 were 1.039 (1.032, 1.046) in MAPLE, 1.025 (1.021, 1.029) in Medicare, and 1.041 (1.014, 1.069) in ELAPSE. Applying a harmonized analytical approach marginally reduced difference in the observed associations across the three studies. Magnitude of the association was affected by the adjusted covariates, exposure assessment methodology, age of the population, and marginally by outcome definition. Shape of the CRFs differed across cohorts but generally showed associations down to the lowest observed PM2.5 levels. A common CRF suggested a monotonically increased risk down to the lowest exposure level. [ABSTRACT FROM AUTHOR]

Using data collected from co-operative education students at two different times over a four-month long work term, we test and find support for the hypothesis that students' approaches to learning explain the relationship between their lifelong learning characteristics and work adjustment. Students' lifelong learning characteristics were positively associated with a deep approach to learning and negatively associated with a disorganized approach to learning (and unrelated to their rational approach to learning), and these in turn influenced work adjustment. We conclude that the development of lifelong learners contributes to students' school-to-work transitions in work-integrated learning programs. The development of lifelong learning characteristics may be an important part of preparing students for organizational entry. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to measure prevalence and predictors of mobile phone access and use among adolescents in Soweto, South Africa. Design/methodology/approach – The current study was an interviewer-administered, cross-sectional survey among adolescents 14-19 years living in a hyper-endemic human immunodeficiency virus (HIV) setting in South Africa. Findings – Of 830 participants; 57 per cent were female. The median age was 18 years (IQR: 17-18). Mobile phone access was high (91 per cent). Almost half of participants (42 per cent) spent more than five hours daily using their mobile phones. Two-thirds (62 per cent) had access to the internet, most (84 per cent) accessed the internet via their mobile phones. Mobile phone access was more likely amongst Sotho language speakers (aOR: 2.87, 95 per cent CI: 1.30-6.36), those living in formal housing (aOR: 3.55, 95 per cent CI: 1.97-6.42) and those who reported heterosexual orientation (aOR: 2.37, CI: 1.35-4.16). Originality/value – This study substantially contributes to the literature about mobile phones usage and patterns among school-going adolescents in Soweto, South Africa. [ABSTRACT FROM AUTHOR]