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The results and interpretations of published Canadian field studies on the reproductive status of fish in waters receiving pulp and paper mill effluent discharges were reviewed. Most of the information was obtained from indicator measurements such as gonad size, fecundity, and serum steroid levels in wild fish sampled at reference and effluent-exposed sites. Difficulties in selecting appropriate sampling sites, natural variability, and the ecological relevance of the indicator measurements were identified as major complicating factors for the interpretation of the field data. Consequently, it was not possible to conclude to what extent, if any, widespread effects on fish reproduction are being caused by pulp and paper mill effluents or that specific manufacturing processes are causing such effects. Further research on the normal variability and predictive capability of reproductive indicators, for example, using an integrated approach (i.e., laboratory testing, mesocosm studies, and field work), is recommended. [ABSTRACT FROM AUTHOR]

This paper examines the political history of the failed struggle to require companies to justify their plant closing decisions in Canada's industrial heartland of Ontario. Demands for the public review of plant closing decisions began, locally, in the auto town of Windsor in the 1950s and 1960s and reached Toronto with the closure of Dunlop Tire in 1970. Another wave of closures struck in 1980, this time reaching deep into rural and small-town Ontario as well as larger industrial towns and cities, generalizing concern. The resulting Select Committee on Plant Shutdowns and Employee Adjustment, created by the Ontario legislature, took it upon itself to conduct the kind of public review of recent closures that was long demanded. Due to the strength of the political opposition to any interference with management rights, it was essential that proponents could point to precedents in Western Europe. Trade unionists also grounded their argument in favour of government regulation in the moral economy idea that long-service workers accrued a proprietary right to their jobs. [ABSTRACT FROM AUTHOR]

Background: This paper provides a critical review of the decision‐making process of the Ontario Ministry of Health and Long‐Term Care (MOHLTC) regarding which migraine treatment drugs will be covered under the Ontario Drug Benefit Formulary (ODB). Main Text: Under MOHLTC policy, triptans and OnabotulinumtoxinA are available to patients only through the Exceptional Access Program (EAP). This policy, and justifications for it, are examined with reference to clinical guidelines, patient experiences, and health policy literature. The contexts and consequences of compromised access are outlined. Improvements in access to these treatments are suggested by highlighting how a country with similar healthcare infrastructure – Australia – employs policies that more adequately meet the needs of migraine patients as they secure treatments. Conclusions: Despite clinically significant gains in the discovery of safe and effective migraine‐specific treatments the ODB thus far has failed to align its practice with current clinical recommendations. This forces patients to rely heavily on medication that, while still effective for some, is potentially suboptimal. This review concludes it is prudent, at minimum, to follow clinical recommendations that advocate for the removal of triptans from EAP and recategorize them as Limited Use drugs. Ideally, moving them to a general benefit would further remove the barriers experienced by patients attempting to access this treatment. [ABSTRACT FROM AUTHOR]

Purpose: The prevalence of substance use disorders among incarcerated individuals in Canada is substantially higher than in the general population. Many incarcerated individuals with opioid use disorder remain untreated due to inadequate access to opioid agonist therapy (OAT). A considerable proportion of overdose-related deaths in the province of Ontario are individuals who have recently been released from prison. The purpose of this paper is to highlight that discontinuation of OAT as a disciplinary measure remains an active concern within prisons in Canada and places individuals with opioid use disorder at increased risk of relapse and resultant overdose death.Design/methodology/approach: This case report describes an incarcerated client with opioid use disorder who was initially stable on OAT, but was forcibly tapered off OAT as a disciplinary measure and subsequently relapsed to illicit opioid use while in custody.Findings: This case calls attention to concerns regarding treatment of opioid use disorder during incarceration, as forcible detoxification from OAT as a disciplinary measure is a highly dangerous practice. The authors discuss concerns regarding diversion and ways in which prison-based OAT programs can be improved to increase their safety and acceptability among correctional staff. Ongoing advocacy is required on the part of health-care workers and policymakers to ensure that individuals are able to appropriately access this life-saving therapy while incarcerated.Originality/value: To the best of the authors' knowledge, this is the first case report to describe forcible tapering of OAT as a disciplinary measure during incarceration. Despite existing evidence emphasizing the significant risk of overdose associated with detoxification from opioids, this case highlights the need for further research into the causes and prevalence of this practice. [ABSTRACT FROM AUTHOR]

Floating Catchment Area (FCA) methods are a popular tool to investigate accessibility to public facilities, in particular health care services. FCA approaches are attractive because, unlike other accessibility measures, they take into account the potential for congestion of facilities. This is done by 1) considering the population within the catchment area of a facility to calculate a variable that measures level of service, and then 2) aggregating the level of service by population centers subject to catchment area constraints. In this paper we discuss an effect of FCA approaches, an artifact that we term demand and level of service inflation. These artifacts are present in previous implementations of FCA methods. We argue that inflation makes interpretation of estimates of accessibility difficult, which has possible deleterious consequences for decision making. Next, we propose a simple and intuitive approach to proportionally allocate demandand and level of service in FCA calculations. The approach is based on a standardization of the impedance matrix, similar to approaches popular in the spatial statistics and econometrics literature. The result is a more intiuitive measure of accessibility that 1) provides a local version of the provider-to-population ratio; and 2) preserves the level of demand and the level of supply in a system. We illustrate the relevant issues with some examples, and then empirically by means of a case study of accessibility to family physicians in the Hamilton Census Metropolitan Area (CMA), in Ontario, Canada. Results indicate that demand and supply inflation/deflation affect the interpretation of accessibility analysis using existing FCA methods, and that the proposed adjustment can lead to more intuitive results. [ABSTRACT FROM AUTHOR]

Individual tree diameter at breast height (DBH) distribution is an important information for forest management planning. Forest managers obtain the DBH data either by field measurements or estimations using predictive models. However, probability distribution models are still lacking or need improvement. Therefore, we aimed to construct and fit diameter distribution models that reflect forest structure and composition change. We evaluated gamma, log-normal, and Weibull probability distribution functions (PDFs) for two commercially important tree species, black spruce (Picea mariana (Mill) B.S.P.) and jack pine (Pinus banksiana Lamb), grown in natural stands across Ontario, Canada. We modelled the parameters of the distributions as a function of stand-level variables for these species. We used DBH data from 735 permanent sample plots. Our results showed that all three evaluated PDFs reflected observed DBH distribution. We demonstrated that the moment-based recovered parameters could represent the maximum likelihood-estimated parameters precisely, and parameters of the PDFs can be modelled as a function of stand-level dynamic covariates. The models unbiasedly predicted the PDF parameters DBH means and DBH classes. The R2 of the model fit ranged between 0.35 and 0.98 for the predicted parameters and 0.90 and 0.97 for the predicted DBH. [ABSTRACT FROM AUTHOR]

• New carbon-sequestration geosystem paradigm proposed for screening CO 2 repositories. • Deposition, burial history 1st-order controls on repository attributes, traps, etc. • Genetic understanding of geology enables property prediction away from data control. • Case-study application to heavily industrialized region of onshore Canada. In this paper, I propose a new geoscience paradigm for evaluating potential carbon-sequestration targets. I introduce the term carbon-sequestration geosystem to study and describe portions of sedimentary basins where all the geologic components necessary for the safe and long-term storage of CO 2 are present. The purpose of this type of analysis, most appropriately applied at a basin-screening stage, is to derive a holistic, genetic, and predictive understanding of the geology – the depositional systems, structural setting and other factors that are direct controls on storage, injectivity, potential for induced seismicity, and other critical factors. To illustrate the concepts, I present a re-evaluation of the geologic carbon-sequestration options in Southern Ontario (Canada) where business and environmental needs, mostly associated with hard-to-abate industries, require urgent action. Legacy wireline-logs, core, and outcrop data are the main data sources available in this onshore setting. The results of this new, independent study are broadly similar to those of previous studies: the Cambrian section, a saline aquifer, is the most likely candidate to be a CO 2 repository. However, the methodology used identified several issues (e.g., stratigraphic heterogeneity, proximity to basement) that will need addressing by targeted data collection and/or analysis before site-selection for a test should be undertaken. [ABSTRACT FROM AUTHOR]

After briefly reviewing the production of nuclear energy and waste in Canada, this paper uses two small Ontario towns as case studies to examine the treatment of low-level radioactive waste and the communities’ responses and narratives to it. Both towns, Port Hope and Kincardine, have long histories of dealing with such waste. Using interviews, relevant websites and past accounts, this paper employs a discourse analysis to understand the differences in risk perceptions and living with the presence of these materials. Ideas from landscape narratives are employed to show that responses in Port Hope are dominated by death, elegy and crime, whereas those in Kincardine are predominately linked to progressivism and optimism. We explore the characteristics of each case to highlight the reasons for these differences. We conclude by emphasizing the potential role of narrative analysis in informing policymaking. [ABSTRACT FROM AUTHOR]

The role of the principalship is that of an expert in assessment, instruction, curriculum and data analysis. In the past, aspiring principals obtained their training through many years of teaching, leading departments, perhaps administering summer programs to gain additional experiences. However , the expectations of working long, unpaid hours; dealing with teacher dissatisfaction; student discipline, public scrutiny on school management issues and the public display of student achievement outcomes from standardized tests have challenged many new principals. This paper attempts to share some preliminary findings from an exploratory conducted with six newly appointed school administrators. [ABSTRACT FROM AUTHOR]

There are many occupational health and safety (OHS) hazards found within the food processing sector. As a result of these hazards, the food processing sector in Ontario, Canada has higher lost time injury rates than other industry sectors traditionally believed to be "unsafe" such as pulp and paper and mining. The purpose of this pilot study was to determine the level of compliance of the food processing sector with the relevant OHS legislation as well as produce a sectorspecific priority list of OHS concerns. Adapted from existing resources, an online legislative gap analysis questionnaire was developed for this study. An invitation to participate was sent to individuals in a database of alumni OHS students/registrants. The survey data was analyzed via frequency distributions. We had a response rate of 31% and almost all respondents were OHS managers or coordinators. A number of legislative gaps were identified with key issues related to inadequate training, lack of relevant OHS policies and insuf- ficient hazard identification activities. The top three concerns from this sector were: 1) manual material handling, 2) slip, trips and falls and 3) energized equipment. These findings can facilitate the development of an action plan to improve the OHS performance of this sector. [ABSTRACT FROM AUTHOR]

Platform-mediated work, whether location-based, as in the case of Uber, or cloudbased, as in the case of Amazon Mechanical Turk, poses severe challenges to effective occupational health and safety (OHS) regulation. While the work performed in the platform environment is not usually very different from work performed in more traditional employment settings, the platform environment often exacerbates those risks by, for example, increasing stress and incentivizing long hours and work intensification. Regulating these hazards is impeded by ambiguities surrounding the legal relationship between platform operators and platform workers that make it uncertain whether the OHS regime even applies. As well the regime itself was not designed to address the conditions of platform work or many of the risks and exacerbating factors it produces. Drawing on existing studies, this article explores the structure of platform-mediated work, examines its incidence in Ontario, Canada, summarizes its associated OHS risks, and provides a detailed analysis of the obstacles to effective regulation under Ontario's OHS regime. [ABSTRACT FROM AUTHOR]

Introduction and Aims The aim of our paper is to present trend data concerning public opinion on alcohol policy in the Canadian province of Ontario over a 16-year period (1996-2011), to assess if the level of support for alcohol control policies changed over this period and if any changes in public support for alcohol policy parallel real changes in alcohol distribution in Ontario. Design and Methods Selected policy-related items from 10 probability surveys of Ontario adults were analysed by means of logistic regression. Results A significant decline was found for attitudes supporting restricting corner stores sales and government control of liquor stores. A weaker decline was seen for attitudes towards reducing the number of places to buy alcohol. However, an increasing trend for attitudes favouring the status quo or greater control through taxes and hours of sale was found. There was no significant trend for attitudes towards maintaining the current level or reducing the number of liquor or beer stores. While there was some variation in trends in support by demographic characteristics and drinking level, not one sector stood out. Discussion and Conclusions A gradual erosion of support is evident and concurrent with gradual increase in access to alcohol in Ontario during the time-period under study. The decline in support for alcohol control measures seems to be a general rather than a focused development. It appears that this was largely due to a shift in a greater percentage supporting the status quo, not a move towards increasing access to alcohol. [ABSTRACT FROM AUTHOR]

Local bioenergy will play a crucial role in national and regional sustainable energy strategies. Effective siting and feedstock procurement strategies are critical to the development and implementation of bioenergy systems. This paper aims to improve spatial decision-support in this domain by shifting focus from homogenous (forestry or agricultural) regions toward heterogeneous regions--i.e., areas with a presence of both forestry and agricultural activities; in this case, eastern Ontario, Canada. Multiple land-cover and resource map series are integrated in order to produce a spatially distributed GIS-based model of resource availability. These data are soft-linked with spreadsheet-based linear models in order to estimate and compare the quantity and supply-cost of the full range of non-food bioenergy feedstock available to a prospective developer, and to assess the merits of a mixed feedstock stream relative to a homogenous feedstock stream. The method is applied to estimate bioenergy production potentials and biomass supply-cost curves for a number of cities in the study region. Comparisons of biomass catchment areas; supply-cost curves; resource density maps; and resource flow charts demonstrate considerable strategic and operational advantages to locating a facility within the region's "transition zone" between forestry and agricultural activities. Existing and emerging bioenergy technologies that are feedstock agnostic and therefore capable of accepting a mixed-feedstock stream are reviewed with emphasis on "intermediates" such as wood pellets; biogas; and bio-oils, as well as bio-industrial clusters. [ABSTRACT FROM AUTHOR]

This paper concentrates on a seminal figure in the history of Canadian education who has never previously been the subject of historical examination: Duncan McArthur. As Deputy Minister, then Minister of Education, in Ontario between 1934 and 1942, he guided the province’s public schools during a period of dramatic reorganisation within a context transformed throughout the interwar years by modernity, economic instability, urbanisation and industrialisation. Under McArthur’s leadership, revised programmes of study formally introduced the rhetoric of progressive education into Canada’s most populous public school system. This rhetoric wove together three distinct themes – meliorism, efficiency and child study – articulating a progressivist educational vision for Ontario’s teachers and students. [ABSTRACT FROM PUBLISHER]

In some communities in the Province of Ontario, Canada, economic development functions have been outsourced from departments within the city structure to external organizations such as economic development corporations (EDCs). This study takes an in-depth look at the activities of EDCs, with a focus on the rationale for outsourcing, EDCs' policies and strategies, cooperative efforts, and the challenges EDCs face. The paper is based on extensive interviews with 21 CEOs/presidents of these corporations. The findings indicate that EDCs are typically private-public partnerships that exist at local and regional levels, that this approach is part of a comprehensive strategy to deal with the changing field of economic development and the uncertain global economy. [ABSTRACT FROM AUTHOR]

Recent evidence suggests that the Cougar (Puma concolor) has returned to New Brunswick, Quebec, Manitoba, and Ontario. An abundance of sightings have been reported for many decades throughout south-central Ontario, but genetic confirmation has been confounded by a lack of carcasses or DNA. In this paper, we identify (1) genetic evidence of a single Cougar in the wild of Ontario, (2) a gene (cytochrome b) and methodology to distinguish the Cougar from other mammals in Ontario using scats, hair follicles, and soft and hard tissue, and (3) a gene that can distinguish individual Cougars from each other and would distinguish populations of subspecies if they exist in Ontario. Potential Cougar scats and other tissue samples were collected from across Ontario, and hair snares baited with catnip and carnivore lure were placed in locations where Cougar sightings were frequent, near Sudbury, Ontario. We analyzed samples for mtDNA, and one scat sample from the Wainfleet Bog Conservation Area, Port Colborne, Ontario, was positive for Cougar. Evidence from archeological data and Cougar sightings suggests that the historical range of Cougars extended in Ontario from the Great Lakes-St. Lawrence Ecotone south, primarily associated with the Eastern Deciduous Forest Biome and the primary prey of the Cougar, the White-tailed Deer (Odocoileus virginianus) and the North American Elk (Cervus elaphus). The data suggest that Cougar distribution has moved north in recent times due to clear-cutting, along with their primary prey. Further studies of Cougar presence in the province are warranted. [ABSTRACT FROM AUTHOR]

Reconciling diverse forest values within policy and decision-making processes is an ongoing challenge in forestry. The use of environmental impact assessment (EIA) provides potential for improving forest management and making it more responsive to diverse interests. This paper examines EIA in Canadian and Finnish forest planning. In Finland there has been a reluctance to see EIA as a tool for forest planning while in Canada some provinces have long applied EIA to forest management. Ontario, Canada, provides one example of applying EIA to forest planning at a range of scales in order to advance integrated planning and help conflict management. The paper provides a brief analysis of the Finnish forest planning system, an illustration of the Ontario EIA forest management experience, and then considers the application of EIA to Finnish forest management. The paper concludes that EIA may be workable for Finnish state forests and would likely enhance planning and management, but given the existing institutional frameworks EIA would be difficult to apply to private forests. [ABSTRACT FROM AUTHOR]

Abstract: This paper examines the provision of mobility options being one of the important policy areas vital to addressing transportation accessibility of the elderly. A provincial analysis, taking the case of the Province of Ontario in Canada, is warranted given that the country’s highly decentralized system puts provincial policies at the forefront in meeting this challenge. The paper evaluates the important progress made in this policy area and stressed the need to go beyond the traditional policy focus on the less able-bodied elderly and consider the increased heterogeneity of the elderly population with respect to lifestyle, preferences, resources, health and physical abilities. While significant efforts have been made, a more explicit recognition of population aging in Ontario’s transport policy motivation that could strongly influence transport strategies and investments attuned to the mobility concerns in an aging society remains to be seen. The paper summarizes the general concerns in the literature, policy developments, and the challenges in crafting solutions in terms of policy and research for Ontario and other regions with similar institutional setup. [ABSTRACT FROM AUTHOR]

Objective: To describe the methodology of the 2014 Ontario Child Health Study (OCHS): a province-wide, cross-sectional, epidemiologic study of child health and mental disorder among 4- to 17-year-olds living in household dwellings.Method: Implemented by Statistics Canada, the 2014 OCHS was led by academic researchers at the Offord Centre for Child Studies (McMaster University). Eligible households included families with children aged 4 to 17 years, who were listed on the 2014 Canadian Child Tax Benefit File. The survey design included area and household stratification by income and 3-stage cluster sampling of areas and households to yield a probability sample of families.Results: The 2014 OCHS included 6,537 responding households (50.8%) with 10,802 children aged 4 to 17 years. Lower income families living in low-income neighbourhoods were less likely to participate. In addition to measures of childhood mental disorder assessed by the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) and OCHS Emotional Behavioural Scales (OCHS-EBS), the survey contains measures of neighbourhoods, schools, families and children, and includes administrative data held by the Ministries of Education and Health and Long-Term Care.Conclusions: The complex survey design and differential non-response of the 2014 OCHS required the use of sampling weights and adjustment for design effects. The study is available throughout Canada in the Statistics Canada Research Data Centres (RDCs). We urge external investigators to access the study through the RDCs or to contact us directly to collaborate on future secondary analysis studies based on the OCHS. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Information & Library Sciences is the property of Canadian Association for Information Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

• Rural broadband strategies in Canada face data and mapping challenges. • Research shows challenges with being deemed "served" or "underserved". • In southwestern Ontario rural Internet quality levels may fall below the government's aspirational targets. • We recommend provider reported data cross-referenced with user experience data and detailed mapping. This paper examines challenges to evidence-based decision-making in the design and implementation of rural broadband investment programs. Our focus is on Canada, and the apparent need for further intra-rural broadband research and better data and mapping for informing public investment decisions, but similar challenges are evident in the international literature. Based on proprietary telecommunication provider datasets, the Canadian Radio-television and Telecommunication Commission (CRTC) estimates that broadband services with advertised speeds that meet its basic universal service targets (50 Mbps download and 10 Mbps upload) are available to 87.4 percent of households in Canada. In rural areas however, services that meet CRTC's speed targets are available to 45.6 percent of households. Moreover, effective speeds and service quality levels that suppliers deliver and users experience tend to fall well below the government's aspirational targets. In response to demand for better broadband, a variety of initiatives are directing public investment to the deployment of regional and rural broadband networks, which are typically owned and operated by private companies. There remains a serious lack of relevant data and its effective use in creating rural broadband strategies and managing public investment projects. Evidence from the literature suggest that this affects the degree and quality of geo-spatial and econometric analysis that results in a limited empirical basis to allocate scarce public investments, aggregate demand of consumers/communities, and assess the outcomes of rural broadband initiatives ex post. This paper provides a historical overview of rural broadband development in Canada and questions if the body of knowledge to inform public investment initiatives has grown sufficiently to ensure their effectiveness and sustainability. With a regional case from southwestern Ontario, Canada, we discuss the findings of the literature review, characterize the broadband data challenge, and discuss the importance of proprietary provider data cross-referenced with Internet user experience data. [ABSTRACT FROM AUTHOR]

The legislation governing protected areas in Ontario, Canada, had not been significantly revised in more than half a century - since its introduction in 1954. During this time, the number of protected areas under the jurisdiction of the Government of Ontario increased from eight to 631 sites, now covering approximately 94,000 ~2 or 9% of the province. In recent decades, many different stakeholders, independent experts, and government panels and agencies have called for new legislation with a mandate to conserve biodiversity and maintain ecological integrity. This paper discusses recent legislative changes that guide the planning and management of protected areas in Ontario, Canada. This paper concludes that the Provincial Parks and Conservation Reserves Act, 2006 is a significant improve- ment to the legislative framework governing Ontario's protected areas, but that concerns remains with regard to adequate government funding and the overall approach to Crown land management. [ABSTRACT FROM AUTHOR]

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]

Buzzelli M. (2005) What explains firm transience in house‐building? A regional analysis of Ontario, Canada, 1991 and 1996, Regional Studies 39 , 699–712. This paper presents cross‐sectional analyses of firm exit (1991) and entry (1996) in house‐building using a geographic information system of firms in Ontario's 48 counties (regions). Ordinary least‐squares and logit regressions of entry and exit rates reveal several regional determinants, some specific to the housing market (prior construction) and others usually found in regional studies of firm dynamics (population density, market growth, incomes, immigration, unemployment and home ownership). The results suggest that housing policy may be best administered at the regional scale – the scale at which builders typically operate in North America. [ABSTRACT FROM AUTHOR]

This paper focuses on the intersection between agriculture and tourism in which production and consumption come together in the form of wine tourism. Wine tourism is an experience which can be conceptualized at different geographical scales and which involves visitor perceptions of physical landscapes and built environment, as well as human interactions. Survey research in Niagara, Ontario wineries is used to provide a general profile of visitors to the winery region and to examine visitor assessment of the wine tourism experience from both a human service quality and an environmental contextual perspective. Overall, the rural landscape is found to be highly important in visitor enjoyment of the wine tourism experience. Niagara is a region of rapid wine tourism growth and this study raises issues in terms of the symbiosis between wineries and tourists and the quality of the wine tourism experience. [ABSTRACT FROM AUTHOR]

(1) Background: Canada had a unique approach to COVID-19 vaccine policy making. The objective of this study was to understand the evolution of COVID-19 vaccination policies in Ontario, Canada, using the policy triangle framework. (2) Methods: We searched government websites and social media to identify COVID-19 vaccination policies in Ontario, Canada, which were posted between 1 October 2020, and 1 December 2021. We used the policy triangle framework to explore the policy actors, content, processes, and context. (3) Results: We reviewed 117 Canadian COVID-19 vaccine policy documents. Our review found that federal actors provided guidance, provincial actors made actionable policy, and community actors adapted policy to local contexts. The policy processes aimed to approve and distribute vaccines while continuously updating policies. The policy content focused on group prioritization and vaccine scarcity issues such as the delayed second dose and the mixed vaccine schedules. Finally, the policies were made in the context of changing vaccine science, global and national vaccine scarcity, and a growing awareness of the inequitable impacts of pandemics on specific communities. (4) Conclusions: We found that the triad of vaccine scarcity, evolving efficacy and safety data, and social inequities all contributed to the creation of vaccine policies that were difficult to efficiently communicate to the public. A lesson learned is that the need for dynamic policies must be balanced with the complexity of effective communication and on-the-ground delivery of care. [ABSTRACT FROM AUTHOR]

Introduction: The Canadian government has committed to a national action plan (NAP) to address violence against women (VAW). However, a formalized plan for implementation has not been published. Building on existing recommendations and consultations, we conducted the first formal and peer-reviewed qualitative analysis of the perspectives of leaders, service providers and survivors on what should be considered in Canada’s NAP on VAW. Methods: We applied thematic analysis to qualitative data from 18 staff working on VAW services (11 direct support, 7 in leadership roles) and 10 VAW survivor participants of a community-based study on VAW programming during the COVID-19 pandemic in the Greater Toronto Area (Ontario, Canada). Results: We generated 12 recommendations for Canada’s NAP on VAW, which we organized into four thematic areas: (1) invest into VAW services and crisis supports (e.g. strengthen referral mechanisms to VAW programming); (2) enhance structural supports (e.g. invest in the full housing continuum for VAW survivors); (3) develop coordinated systems (e.g. strengthen collaboration between health and VAW systems); and (4) implement and evaluate primary prevention strategies (e.g. conduct a gender-based and intersectional analysis of existing social and public policies). Conclusion: In this study, we developed, prioritized and nuanced recommendations for Canada’s proposed NAP on VAW based on a rigorous analysis of the perspectives of VAW survivors and staff in Canada’s largest city during the COVID-19 pandemic. An effective NAP will require investment in direct support organizations; equitable housing and other structural supports; strategic coordination of health, justice and social care systems; and primary prevention strategies, including gender transformative policy reform. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Midwifery Research & Practice is the property of Canadian Association of Midwives and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The decision to substantiate child maltreatment is one of the many complex decisions workers must make daily. Utilizing data from the Ontario Incidence study 2013, this paper examines what child, family and environmental characteristics workers paid attention to when making the determination that a child had experienced maltreatment. This study adds to the Canadian body of research on factors that influence the decision to substantiate maltreatment by exploring the Ontario population. Caregiver risk factors, uncooperative parents, older children, and children with emotional or mental health concerns all increase the likelihood of substantiation. The decision to substantiate current maltreatment was strongly influenced by the workers' assessment of the future risk of maltreatment. Further research is need to explore worker and organizational factors that also influence this risk focus and how much of an influence the current risk assessment tools have on the workers' assessment of future risk and substantiation. [ABSTRACT FROM AUTHOR]

The lack of adequate data on fertility and mortality has long hampered the study of Canadian population growth during the period before the beginning of a national system of vital registration. Attempts to trace the growth of the Canadian population have usually involved assuming that Canadian mortality patterns followed a course similar to that in Britain or the United States. The purpose of this paper is to take a new look at mortality change in Ontario during the nineteenth century by using Canadian census data to construct estimates of expectation of life at birth in the period from 1861 to 1921. Relying on techniques developed for the study of Third World populations, we will construct life tables for the Ontario population for each decade from 1861 1921. In the final section of the paper, we will compare the course of change in mortality in Ontario with the pattern in Quebec as revealed in the recent work of Bourbeau and Légaré (1982). [ABSTRACT FROM AUTHOR]

Simple Summary: The atmosphere is an important transport pathway of microplastics to remote and urban environments. We assessed the efficacy of moss bags as an active biomonitoring technique for atmospheric microplastic deposition. Microplastics were observed in all moss bags deployed along an urban intensity gradient; moss bags exposed in the most densely populated and trafficked areas accumulated a higher number of microplastics compared with those exposed in low-density areas. Microplastics (plastic particles <5 mm) were first identified in the environment during the 1970s and have since become ubiquitous across every environmental compartment. However, few studies have focused on atmospheric microplastics, and even fewer have used biological monitoring to assess their atmospheric deposition. Here, we assess the efficacy of moss bags as an active biomonitoring technique for atmospheric microplastic deposition. Moss (Pleurozium schreberi) bags were exposed in duplicate at nine deployment sites across a gradient of urban intensity in southern Ontario, Canada. A total of 186 microplastics (mp) were detected in the moss bags, resulting in a mean accumulation of 7.9 mp g−1 dry weight moss across all sites during the exposure period (45 days). The median microplastic length was 0.56 mm (range 0.03–4.51 mm), and the dominant microplastic type was fibres (47%), followed by fragments (39%). Microplastic accumulation significantly increased with urban intensity, ranging from 3.7 mp g−1 in low-density suburban areas to 10.7 mp g−1 in densely populated and trafficked urban areas. In contrast, microfibres by proportion dominated in suburban (62%) compared with urban areas (33%). Microplastic deposition was estimated to range from 21 to 60 mp m−2 day−1 across the nine deployment sites. The results suggest that moss bags may be a suitable technique for the active biomonitoring of atmospheric microplastic deposition in urban environments. [ABSTRACT FROM AUTHOR]

There is a global need to understand how the quality of home care for persons living with dementia is perceived by their most frequent formal caregivers, personal support workers (PSW), especially given the expected rise in the prevalence of dementia. The aim of this study was to explore the perceptions of PSW regarding what constitutes quality home care for persons with dementia. Qualitative content analysis was undertaken to interpret semi‐structured interviews with PSW (N = 15). Study findings indicate that quality home care is perceived to be (1) person‐centered; (2) provided by PSW with dementia‐specific education and training; (3) facilitated by specific PSW experiences, abilities and characteristics; (4) enhanced by accessible information, services and education for persons with dementia and their caregivers; (5) provided by an inclusive dementia care team; and (6) facilitated by organisational supports and respect. However, findings also indicated differences in what PSW perceive as quality home care versus what they are experiencing when providing care for persons with dementia. Participants advocated for increased supports to them through ongoing dementia‐specific education and training, increased teamwork among care providers, increased wages, sufficient and qualified staffing, and increased exchange of client information. The findings highlight the importance of exploring front‐line workers' perspectives and how they can help revise current healthcare policies and inform future policy development. [ABSTRACT FROM AUTHOR]

Calicioids are a group of lichenized and non-lichenized fungi that are superficially similar to each other in appearance. Many members of this group tend to be restricted to old-growth forests, for which they have been used as indicators. However, the definition of old-growth varies among jurisdictions and forest types. In addition, variables other than tree age, which is often used to define old-growth, have been postulated to be important for influencing the presence of calicioids (e.g., continuity, scale, and ecological and structural variability). These variables, in combination, can be taken to indicate something about forest condition, particularly its ecological integrity. To understand better the ability of calicioids to serve as indicators of forest condition, we recorded the number of species in 51 stands across a chronosequence in Canada's most homogenous forest ecosystem with the most frequent natural disturbance regime; the boreal forest. We restricted our sampling spatially and temporally in stands with similar tree cover and soil type. We recorded the number of species and biomass of all lichens in each stand along with forest stand attributes. We constructed 13 competing models to explain calicioid species diversity and show that stand age is important, but only in combination with stand condition. The strongest positive correlations were between calicioid density and lichen biomass and richness. Therefore, calicioid diversity appears to be a good indicator of habitat condition or conservation value in the boreal forest, which includes continuity. Similar research in other forest types that are more heterogeneous and have longer natural disturbance regimes will help build a better understanding of how calicioids can be reliably used as indicators of forest quality more broadly for conservation purposes. [ABSTRACT FROM AUTHOR]

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Moose (Alces alces) hunting and other means of forest food production employed by members ofFirstNations communities are undertaken as part oftheir treaty rights in Ontario, articulated in specific nation-to-nation agreements with the Government of Canada on behalf of the British Crown. Aroland First Nation in Northwestern Ontario is party to Treaty 9 (1905), which overtly protects the community's rights to hunt throughout the unoccupied tracts of Crown land claimed as "traditional territory." Traditional use supersedes provincial authority and, as such, is not managed by provincial policy or regulation. This jurisdictional divide has presented an interesting history and many challenges for both provincial managers and First Nations land users. Strained relationships between provincial authorities and First Nations, emergent from decades of misunderstandings of jurisdictional authority, have presented difficulty in all aspects of natural resource management. In this paper, we engaged community-based researchers in an exploration of the community's perspective of the current and historical management regime. In collaboration with community members, we interpret the results, discuss implications, and provide considerations for future managers and policy makers. We also quantified the annual moose harvest by Aro land and Ginoogaming First Nations that is only estimated by provincial managers; our results show provincial calculations may underestimate total harvests by up to 40%. This error could have significant implications for future moose populations, wildlife managers, and both provincial and First Nations hunters. The potential for such errors serves to highlight our call for provincial authorities to seek and engage First Nations perspectives and participation in moose management for the benefit of the entire community. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Geographer is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: While new environmental policies and procedures often are developed incrementally, they can also result from crises or other significant events. In situations where policies and procedures are introduced in response to a crisis, questions about the strengths and weaknesses of existing mechanisms, and the extent to which they can be used to address concerns, may be ignored. This paper explores the complexities of introducing new policies and processes where planning systems and procedures already exist. Drinking water source protection policies that are being developed in response to the tragic events in Walkerton, Ontario, Canada serve as the context for the inquiry. Three case study watersheds were selected to reflect the diversity of municipal jurisdictions and water supply systems in Ontario. A content analysis was undertaken on regulatory and non-regulatory policy documents to determine the extent to which they addressed elements of the multi-barrier approach for drinking water safety. Findings from the research reveal considerable evidence of the multi-barrier approach in the policy and guiding documents analyzed. Policy development in response to a crisis can advance progress on the issue of drinking water safety and coincide with emerging governance strategies. Policy effectiveness may be enhanced by considering existing policies as well as contextual and jurisdictional differences. [ABSTRACT FROM AUTHOR]

This paper is concerned with the regional firm-size structure of housebuilding in Canada based on a case study of the province of Ontario. Using an innovative database of builders in Ontario and geographic information systems, measures of regional firm-size structure are developed and are modeled with data from the Canadian census. The results corroborate established models in the city systems and industrial organization literatures in that industrial concentration is negatively associated with regional population size, economic diversity, and economic performance. Small housebuilding firms abound in large, diverse and economically vibrant regions, especially large urban regions, and thereby maintain industrial deconcentration. [ABSTRACT FROM AUTHOR]

Antiretroviral medications are expensive, and people living with HIV often experience challenges accessing and paying for medication due to various obstacles. We used concept mapping to explore the challenges people living with HIV in Ontario, Canada, face when accessing medication. In brainstorming, 68 participants generated 447 statements in response to the focus prompt "Some people living with HIV have trouble getting and paying for prescription drugs because ... ". These were consolidated into 77 statements, which were sorted (n = 30) and rated (n = 32) on importance and commonality. A ten-cluster concept map consisting of individual- and health system-related clusters was generated. Clusters included: (1) Stigma, (2) Medication-Related Issues, (3) Individual Challenges, (4) Basic Needs, (5) Immigration, (6) Coverage, (7) Trillium Drug Program, (8) Access to Services, (9) System-Level Issues and (10) Access to Professional Services. Statements in Coverage and Basic Needs were rated most important and common although there was variability by Ontario residence and drug coverage mechanisms. Strategies to address challenges were generated in Interpretation (n = 25 participants). Given that continuous access to antiretroviral therapy is necessary to fully realize treatment benefits, policies and interventions that address these challenges are needed. [ABSTRACT FROM AUTHOR]

Objectives: Oral health inequalities impose a substantial burden on society and the healthcare system across Canadian provinces. Monitoring these inequalities is crucial for informing public health policy and action towards reducing inequalities; however, trends within Canada have not been explored. The objectives of this study are as follows: (a) to assess trends in income‐related inequalities in oral health in Ontario, Canada's most populous province, from 2003 to 2014, and (b) to determine whether the magnitude of such inequalities differ by age and sex. Methods: Data representative of the Ontario population aged 12 years and older were sourced from the Canadian Community Health Survey (CCHS) cycles 2003 (n = 36,182), 2007/08 (n = 36,430) and 2013/14 (n = 41,258). Income‐related inequalities in poor self‐reported oral health (SROH) were measured using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII) and compared across surveys. All analyses were sample‐weighted and performed with STATA 15. Results: The prevalence of poor SROH was stable across the CCHS cycles, ranging from 14.1% (2003 cycle) to 14.8% (2013/14 cycle). SII estimates did not change (18.7‐19.0), while variation in RII estimates was observed over time (2003 = 3.85; 2007/08 = 4.47; 2013/14 = 4.02); differences were not statistically significant. SII and RII were lowest among 12‐ to 19‐year‐olds and gradually higher among 20‐ to 64‐year‐olds. RII was slightly higher among females in all survey years. Conclusion: Absolute and relative income‐related inequalities in SROH have persisted in Ontario over time and are more severe among middle‐aged adults. Therefore, oral health inequalities in Ontario require attention from key stakeholders, including governments, regulators and health professionals. [ABSTRACT FROM AUTHOR]

Primary objective: This study represents the first large-scale research on high school philosophy in a public education curriculum in North America. Our objective was to identify the impacts of high school philosophy, as well as the challenges of teaching it in its current format in Ontario high schools. Research design: The qualitative research design captured the perspectives of students and teachers with respect to philosophy at the high school level. All data collection was structured around central questions to provide insight into the dynamics of their shared process of teaching/learning. Methods and procedures: We conducted semi-structured with interviews philosophy teachers (n = 9), classroom observations (n = 142), and student focus groups at 16 diverse high schools. Transcripts were coded according to themes. Results: Our findings reflect the complicated nature of philosophy as a discipline characterized by abstract thinking. Participants found it mind-opening, yet challenging, providing educational opportunities that are largely absent in conventional schooling. They saw multiple connections between philosophy and other subjects, but also appreciated its distinctive benefits. Teachers relied primarily on textbooks and contemporary media to deliver the curriculum. We found that a teacher's background in philosophy may influence what is taught in philosophy courses and how, especially given the flexibility of the provincial curriculum. Conclusions: The findings suggest that philosophy is a unique, beneficial subject that teachers enjoy teaching and students greatly value, characterizing it as both difficult and rewarding. Our study revealed that considerable differences exist in how philosophy is taught and learned around the province. The flexibility of the provincial curriculum appears to be an invitation for creative and responsive teaching; however, philosophy teachers' weak preparation can, by their own admission, be a hindrance to effective curriculum delivery. Studying philosophy enhances students' thinking about other academic areas of study and in some cases opens them up to new ways of thinking. [ABSTRACT FROM AUTHOR]

Background: Rising rates of antimicrobial resistance are driven by overuse of antibiotics. Characterizing physician antibiotic prescribing variability can inform interventions to optimize antibiotic use.Objectives: To describe predictors of overall antibiotic prescribing as well as the inter-physician variability in antibiotic prescribing amongst family physicians.Methods: We conducted a 5 year cohort study of antibiotic prescribing rates by family physicians in Ontario, Canada using a repository of electronic medical records. Using multilevel logistic regression models fitted with random intercepts for physicians, we evaluated the association of patient-, physician- and clinic-level characteristics with antibiotic prescribing rates.Results: We included 3956921 physician-patient encounters, 322129 unique patients and 313 physicians from 41 family medicine clinics. Physicians prescribed a median of 54 (interdecile range 28-95) antibiotics per 1000 encounters. Female children aged 3-5 years were most likely to receive antibiotics compared with men ≥65 years (OR 4.01, 95% CI 3.89-4.13). The only significant physician-level predictor was median daily patient visits of ≥20 compared with <10 (OR 1.28, 95% CI 1.06-1.55). The median ORs without and with patient characteristics were 1.68 and 1.69, respectively. Thus, the odds of receiving an antibiotic varied by 1.7-fold for the same patient simply by virtue of encountering two different physicians.Conclusions: We observed substantial inter-physician variability in antibiotic prescribing that could not be explained by sociodemographic and clinical patient differences, suggesting that risk adjustment of antibiotic prescribing practices may not be required for audit and feedback of family physicians working in similar practice settings. [ABSTRACT FROM AUTHOR]

Background: Attention to research and planning are increasingly being devoted to newcomer health, but the needs of newcomers with disabilities remain largely unknown. This information is difficult to determine since population-level data are rarely available on newcomers or on people with intellectual and developmental disabilities (IDD), although in Ontario, Canada these databases are accessible. This study compared the prevalence of IDD among first generation adult newcomers to adult non-newcomers in Ontario, and assessed how having IDD affected the health profile and health service use of newcomers. Methods: This population-based retrospective cohort study of adults aged 19–65 in 2010 used linked health and social services administrative data. Prevalence of IDD among newcomers (n = 1,649,633) and non-newcomers (n = 6,880,196) was compared. Among newcomers, those with IDD (n = 2,830) and without IDD (n = 1,646,803) were compared in terms of health conditions, and community and hospital service use. Results: Prevalence of IDD was lower in newcomers than non-newcomers (171.6 versus 898.3 per 100,000 adults, p<0.0001). Among newcomers, those with IDD were more likely than those without IDD to have comorbid physical health disorders, non-psychotic, psychotic and substance use disorders. Newcomers with IDD were also more likely to have psychiatry visits, and frequent emergency department visits and hospitalizations. Conclusion: First generation adult newcomers have lower rates of IDD than non-newcomers. How much of this difference is attributable to admission policies that exclude people expected to be high health service users versus how much is attributable to our methodological approach is unknown. Finding more medical and psychiatric comorbidity, and more health service use among newcomers with IDD compared to newcomers without IDD is consistent with patterns observed in adults with IDD more generally. To inform polices that support newcomers with IDD future research should investigate reasons for the prevalence finding, barriers and facilitators to timely health care access, and pathways to care. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic obstructive pulmonary disease (COPD) are more likely to be readmitted than patients with other chronic medical conditions, yet knowledge regarding such readmissions is limited. We aimed to determine factors associated with readmission within 30 days of a COPD hospitalization or death with an emphasis on examining aspects of socioeconomic status and specific comorbidities. Methods: A population-based cohort study was conducted using health administrative data from Ontario, Canada. All hospitalizations for COPD between 2004 and 2014 were considered. The primary exposures were socioeconomic status as measured by residential instability (an ecologic variable), and comorbidities such as cardiovascular disease and cancer. Other domains of socioeconomic status were considered as secondary exposures. Logistic regression with generalized estimating equations was used to examine the effect of exposures, adjusting for other patient factors, on 30-day readmission or death. Results: There were 126,013 patients contributing to 252,756 index COPD hospitalizations from 168 Ontario hospitals. Of these hospitalizations, 19.4% resulted in a readmission and 2.8% resulted in death within 30 days. After adjusting for other factors, readmissions or death were modestly more likely among people with the highest residential instability compared to the lowest (OR 1.05, 95% CI 1.01–1.09). Comorbidities such as cardiovascular disease and cancer, as well as other aspects of low socioeconomic status also increased readmission or death risk. Interpretation: Socioeconomic status, measured in various ways, and many comorbidities predict 30-day readmission or death in patients hospitalized for COPD. Strategies that address these factors may help reduce readmissions and death. [ABSTRACT FROM AUTHOR]

Introduction: Previous Canadian epidemiologic studies have identified associations between occupations and prostate cancer risk, though evidence is limited. However, there are no well-established preventable risk factors for prostate cancer, which warrants the need for further investigation into occupational factors to strengthen existing evidence. This study uses occupation and prostate cancer information from a large surveillance cohort in Ontario that linked workers' compensation claim data to administrative health databases. Methods: Occupations were examined using the Occupational Disease Surveillance System (ODSS). ODSS included 1 231 177 male workers for the 1983 to 2015 period, whose records were linked to the Ontario Cancer Registry (OCR) in order to identify and follow up on prostate cancer diagnoses. Cox proportional hazard models were used to calculate age-adjusted hazard ratios and 95% CI to estimate the risk of prostate cancer by occupation group. Results: A total of 34 997 prostate cancer cases were diagnosed among workers in ODSS. Overall, elevated prostate cancer risk was observed for men employed in management/administration (HR 2.17, 95% CI = 1.98-2.38), teaching (HR 1.99, 95% CI = 1.79-2.21), transportation (HR 1.20, 95% CI = 1.16-1.24), construction (HR 1.09, 95% CI = 1.06-1.12), firefighting (HR 1.62, 95% CI = 1.47-1.78), and police work (HR 1.20, 95% CI = 1.10-1.32). Inconsistent findings were observed for clerical and farming occupations. Conclusion: Associations observed in white collar, construction, transportation, and protective services occupations were consistent with previous Canadian studies. Findings emphasize the need to assess job-specific exposures, sedentary behaviour, psychological stress, and shift work. Understanding specific occupational risk factors can lead to better understanding of prostate cancer etiology and improve prevention strategies. [ABSTRACT FROM AUTHOR]

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

Background: Population trends of disease prevalence and incidence over time measure burden of disease and inform healthcare planning. Neuromuscular disorders (NMD) affect muscle and nerve function with varying degrees of severity and disease progression. Objective: Using health administrative databases we described trends in incidence, prevalence, and mortality of adults and children with NMD. We also explored place of death and use of palliative care. Methods: Population-based (Ontario, Canada) cohort study (2003 to 2014) of adults and children with NMD identified using International Classification of Disease and health insurance billing codes within administrative health databases. Results: Adult disease prevalence increased on average per year by 8% (95% confidence interval (CI) 6% to 10%, P <.001), with the largest increase in adults18-39 years. Childhood disease prevalence increased by 10% (95% CI 8% to 11%, P <.0001) per year, with the largest increase in children 0 to 5 years. Prevalence increased across all diagnoses except amyotrophic lateral sclerosis and spinal muscular atrophy for adults and all diagnoses for children. Adult incidence decreased by 3% (95% CI -4% to -2%, P <.0001) but incidence remained stable in children. Death occurred in 34,336 (18.5%) adults; 21,236 (61.8%) of whom received palliative care. Death occurred in 1,009 (5.6%) children; 507 (50.2%) of whom received palliative care. Mortality decreased over time in adults (odds ratio (OR) 0.86, 95% CI 0.86–0.87, P <.0001) and children (OR 0.79, 95% CI 0.76–0.82, P <.0001). Use of palliative care over time increased for adults (OR 1.18, 95% CI 1.09 to 1.28, P <.0001) and children (OR 1.22, 95% CI 1.20 to 1.23, P <.0001). Conclusions: In both adults and children, NMD prevalence is rising and mortality rates are declining. In adults incidence is decreasing while in children it remains stable. This confirms on a population-based level the increased survival of children and adults with NMD. [ABSTRACT FROM AUTHOR]

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