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The conceptualization of the Scholarship of Teaching and Learning [SoTL] has evolved over its 30-year history. This study sought to understand how faculty, staff, and students at a research-intensive institution in Ontario, Canada label and describe SoTL. We performed an environmental scan that consisted of: 1) mining academic journal titles to identify names commonly used to describe systematic inquiry into teaching and learning; 2) a campus-wide survey of faculty, staff, and students; and 3) interviews with select faculty members who perform SoTL work. We identified several dichotomies between the findings from these three methods and discuss the meanings of these findings in relation to the 4M, micro-meso-macro-mega levels, framework.

With over 1 in 5 Canadians identifying as an immigrant, Canada has been proud to call itself a nation of immigrants with a commitment to supporting refugees, from accepting thousands of Vietnamese refugees in the 1970s to Syrians fleeing civil war in 2015. In 2017, 44,000 refugees came as government-sponsored or privately sponsored refugees, having been offered permanent residency in Canada prior to arrival. Fewer arrive as asylum seekers -- 24,000 in 2016, 40% of whom arrived via the Canada-US border. Given Canada's geographic location, individuals may arrive by air, sea, or land across the longest shared land border in the world with the United States. In 2011, Canadian officials reported 4,205 claims made at this border. This number nearly quintupled in 2018, with 19,085 claims, totaling nearly 40,000 asylum claims since 2016 and coinciding with the changes in US governmental administration and their immigration and temporary resident policies. Families reported that for them, the US was no longer safe and they sought asylum in Canada. Due to the Safe Third Country Agreement, which does not permit asylum claims from the United States at official border crossings, many asylum seekers have crossed through unofficial border crossings, most of them in the provinces of Quebec and Manitoba. This article touches upon a number of issues that have come to light with the rising numbers of children who are asylum seekers trickling across the US-Canada border.

Background/Objectives: The World Federation of the Deafblind Global Report 2023 reports that many countries do not have a comprehensive identification, assessment, and referral system for persons with deafblindness, a combination of hearing and vision loss, across all age groups and geographic regions. The scan seeks to inform researchers, policymakers, and community-based organizations about the status of and gaps in sensory healthcare initiatives in Canada, with the intent to raise awareness to enhance the integration and coordination of eye and ear care services. Methods: We conducted an environmental scan of Canada's healthcare system and current public health policies addressing vision and hearing care in Canada at the federal and provincial levels. The scan was conducted using published literature searches from five scientific databases—Embase, Medline, PsycINFO, PubMed, and CINAHL—in combination with the gray literature review of federal, provincial, and territorial governments and non-profit organizations' websites from April 2011–October 2022. Out of 1257 articles screened, 86 studies were included that met the inclusion/exclusion criteria. In total, 13 reports were included in the gray literature search, with 99 total articles used in the analysis. Results: The thematic findings indicate stigma and discrimination toward individuals with disabilities and marginalized communities (Indigenous people, rural communities, recent immigrants, people of older age, and people with disabilities), including hearing, vision, or dual sensory loss, persist. Barriers to vision and hearing healthcare access include inadequate policies, underinvestment in vision and/or hearing services, limited collaboration and coordinated services between hearing and vision services, discrepancies in insurance coverages, and lack of health system support. Conclusions: This scan demonstrates the persisting barriers to vision and/or hearing services present in Canada, stemming from inadequate policy and limited service coordination. Future work to address gaps, evaluate public education, and develop integrated sensory healthcare initiatives to enhance coordinated eye and ear care services, as recommended in the WHO Report on Hearing and Vision, is imperative. [ABSTRACT FROM AUTHOR]

Access to health services can differ greatly based on ethno-racial identity and immigration status. We examined the reporting of ethno-racial data and immigration status in published literature on the health of newcomer children. An integrative scoping review was performed using the methodological framework outlined by Arksey and O'Malley (2005). 4147 articles were identified and 75 studies included in the final analysis. 67% (50/75) did not describe the participants immigration status at all. Most studies (65%, 49/75) also did not report participants' ethno-racial identities. Of those that did, 65% (17/26) reported participant ethnicity alone, and 15% (4/26) reported race alone, while 19% (5/26) reported both race and ethnicity. We found that most studies on newcomer children did not report immigration status or ethno-racial identity. In doing so, studies may ignore the specific impacts of racism and xenophobia on health and access to care. [ABSTRACT FROM AUTHOR]

Challenges exist for the management of diabetes care in First Nations populations. RADAR (Reorganizing the Approach to Diabetes through the Application of Registries) is a culturally appropriate, innovative care model that incorporates a disease registry and electronic health record for local care provision with remote coordination, tailored for First Nations people. This study assessed the effectiveness of RADAR on patient outcomes and diabetes care organization in participating communities in Alberta, Canada. It revealed significant improvements in outcomes after 2 years, with 91% of patients achieving a primary combined end point of a 10% improvement in or persistence at target for A1C, systolic blood pressure, and/or LDL cholesterol. Qualitative assessment showed that diabetes care organization also improved. These multimethod findings support tailored diabetes care practices in First Nations populations. [ABSTRACT FROM AUTHOR]

Background: Fetal alcohol spectrum disorder (FASD) resulting from prenatal alcohol exposure (PAE) is a common neurodevelopmental disorder, but substantial interindividual heterogeneity complicates timely and accurate assessment, diagnosis, and intervention. The current study aimed to identify classes of children and adolescents with PAE assessed for FASD according to their pattern of significant neurodevelopmental functioning across 10 domains using latent class analysis (LCA), and to characterize these subgroups across clinical features. Methods: Data from the Canadian National FASD Database, a large ongoing repository of anonymized clinical data received from diagnostic clinics across Canada, was analyzed using a retrospective cross‐sectional cohort design. The sample included 1440 children and adolescents ages 6 to 17 years (M = 11.0, SD = 3.5, 41.7% female) with confirmed PAE assessed for FASD between 2016 and 2020. Results: Results revealed an optimal four‐class solution. The Global needs group was characterized by high overall neurodevelopmental impairment considered severe in nature. The Regulation and Cognitive needs groups presented with moderate but substantively distinguishable patterns of significant neurodevelopmental impairment. The Attention needs group was characterized by relatively low probabilities of significant neurodevelopmental impairment. Both the Global and Regulation needs groups also presented with the highest probabilities of clinical needs, further signifying potential substantive differences in assessment and intervention needs across classes. Conclusions: Four relatively distinct subgroups were present in a large heterogeneous sample of children and adolescents with PAE assessed for FASD in Canada. These findings may inform clinical services by guiding clinicians to identify distinct service pathways for these subgroups, potentially increasing access to a more personalized treatment approach and improving outcomes. [ABSTRACT FROM AUTHOR]

Background COVID-19 continues to disproportionately impact families of children with developmental disabilities (DD). There is an urgent need to understand these families' experiences, particularly those that face economic or social marginalization. This qualitative study sought to identify the experiences of families of children with DD during the COVID-19 pandemic. Methods Using phenomenology, in-depth interviews (IDIs) were conducted with caregivers and health care providers of children with DD living in a large urban Canadian city. Interviews were recorded, transcribed, and coded using inductive coding methods by two independent coders. Transcripts were analyzed within and across stakeholder groups using thematic analysis. Results A total of 25 IDIs were conducted in 2020. 3 main themes and 7 sub-themes emerged related to the experiences of parents and health care providers for children with DD: families reported difficulty adhering to public health measures leading to isolation and increased parental stress; restricted access to in-person services worsened behaviour and development; and worsened household financial security in already marginalized families. Conclusions Our study demonstrates that families of children with DD have been negatively impacted by the evolving environment from the COVID-19 pandemic, and even more so in those who face social and economic challenges. Public health restrictions have impaired the daily lives of these families and our study suggests that limitations to accessing in-person services may have long-lasting impacts on the well-being of families of children with DD. It is imperative that the unique needs of these families be considered and centred for future interventions. [ABSTRACT FROM AUTHOR]

Background: Families of refugee background have complex, multigenerational mental health and developmental needs that are not accounted for in current programming frameworks in Canada. Providing appropriate support services and educational resources that address the unique concerns of families of refugee background will allow for improved family cohesion and developmental outcomes for children. Parenting programs have been shown to be successful in improving parental stress, parental efficacy, and children's mental health and well-being. This study gathers data about the experiences of caregivers of refugee background in order to develop a novel, multi-dimensional parenting program model using Community-Based Participatory Research (CBPR) principles. Methodology: This was a qualitative, CBPR study using a formative research framework. In-depth interviews (IDIs) were conducted with caregivers of refugee background and service providers that work closely with this population. Data were recorded, transcribed, and coded using deductive and inductive coding methods by two independent coders. Results: A total of 20 IDIs were conducted (7 caregivers and 13 service providers). The main topics that were identified to be incorporated into the program include: features of child development, how to address resettlement issues, child advocacy, and parenting after resettlement. Participants felt that tackling language barriers, addressing the overlapping responsibilities of caregivers attending the sessions, providing incentives, increasing awareness of the program, and using an anti-racist and anti-oppressive approach was key to the program's success. Participants emphasized the need for trauma-informed mental health supports within the program model. Conclusion: This study describes the key considerations for a novel parenting program for families of refugee background, by engaging them as key stakeholders in the program design process. Future iterations of this project would involve a pilot and evaluation of the program. [ABSTRACT FROM AUTHOR]

(1) Background: ADHD is recognized as one of the most common neurodevelopmental disorders. The worldwide prevalence of ADHD is estimated at 5.3%; however, estimates vary as a function of a number of factors, including diagnostic methods, age, sex and geographical location. A review of studies is needed to clarify the epidemiology of ADHD in Canada. (2) Methods: A search strategy was created in PubMed and adapted for MEDLINE and PsycINFO. Papers were included if they examined diagnosed ADHD prevalence and/or incidence rates in any region of Canada, age group and gender. A snowball technique was used to identify additional papers from reference lists, and experts in the field were consulted. (3) Results: Ten papers included in this review reported on prevalence, and one reported on incidence. One study provided an overall prevalence estimate across provinces for adults of 2.9%, and one study provided an overall estimate across five provinces for children and youth of 8.6%. Across age groups (1 to 24 years), incidence estimates ranged from 0.4% to 1.2%, depending on province. Estimates varied by age, gender, province, region and time. (4) Conclusions: The overall Canadian ADHD prevalence estimate is similar to worldwide estimates for adults. Most studies reported on prevalence rather than incidence. Differences in estimates across provinces may reflect the varying number of practitioners available to diagnose and prescribe medication for ADHD across provinces. To achieve a more comprehensive understanding of the epidemiology of ADHD in Canada, a study is needed that includes all provinces and territories, and that considers estimates in relation to age, gender, ethnicity, geographical region, socioeconomic status and access to mental healthcare coverage. Incidence rates need further examination to be determined. [ABSTRACT FROM AUTHOR]

Objectives: To assess real‐world effectiveness, safety, and usage of erenumab in Canadian patients with episodic and chronic migraine with prior ineffective prophylactic treatments. Background: In randomized controlled trials, erenumab demonstrated efficacy for migraine prevention in patients with ≤4 prior ineffective prophylactic migraine therapies. The "Migraine prevention with AimoviG: Informative Canadian real‐world study" (MAGIC) assessed real‐world effectiveness of erenumab in Canadian patients with migraine. Methods: MAGIC was a prospective open‐label, observational study conducted in Canadian patients with chronic migraine (CM) and episodic migraine (EM) with two to six categories of prior ineffective prophylactic therapies. Participants were administered 70 mg or 140 mg erenumab monthly based on physician's assessment. Migraine attacks were self‐assessed using an electronic diary and patient‐reported outcome questionnaires. The primary outcome was the proportion of subjects achieving ≥50% reduction in monthly migraine days (MMD) after the 3‐month treatment period. Results: Among the 95 participants who mostly experienced two (54.7%) or three (32.6%) prior categories of ineffective prophylactic therapies and who initiated erenumab, treatment was generally safe and well tolerated; 89/95 (93.7%) participants initiated treatment with 140 mg erenumab. At week 12, 32/95 (33.7%) participants including 17/64 (26.6%) CM and 15/32 (48.4%) EM achieved ≥50% reduction in MMD while 30/86 (34.9%) participants including 19/55 (34.5%) CM and 11/31 (35.5%) EM achieved ≥50% reduction in MMD at week 24. Through patient‐reported outcome questionnaires, 62/95 (65.3%) and 45/86 (52.3%) participants reported improvement of their condition at weeks 12 and 24, respectively. Physicians observed improvement in the condition of 78/95 (82.1%) and 67/86 (77.9%) participants at weeks 12 and 24, respectively. Conclusion: One‐third of patients with EM and CM achieved ≥50% MMD reduction after 3 months of erenumab treatment. This study provides real‐world evidence of erenumab effectiveness, safety, and usage for migraine prevention in adult Canadian patients with multiple prior ineffective prophylactic treatments. [ABSTRACT FROM AUTHOR]

Objective: To describe the real‐world treatment persistence (defined as the continuation of medication for the prescribed treatment duration), demographics and clinical characteristics, and treatment patterns for patients prescribed erenumab for migraine prevention in Canada. Background: The effectiveness of prophylactic migraine treatments is often undermined by poor treatment persistence. In clinical trials, erenumab has demonstrated efficacy and tolerability as a preventive treatment, but less is known about the longer term treatment persistence with erenumab. Methods: This is a real‐world retrospective cohort study where a descriptive analysis of secondary patient data was conducted. Enrollment and prescription data were extracted from a patient support program for a cohort of patients prescribed erenumab in Canada between September 2018 and December 2019 and analyzed for persistence, baseline demographics, clinical characteristics, and treatment patterns. Descriptive analyses and unadjusted Kaplan–Meier (KM) curves were used to summarize the persistence and dose escalation/de‐escalation at different timepoints. Results: Data were analyzed for 14,282 patients. Median patient age was 47 years, 11,852 (83.0%) of patients were female, and 9443 (66.1%) had chronic migraine at treatment initiation. Based on KM methods, 71.0% of patients overall were persistent to erenumab 360 days after treatment initiation. Within 360 days of treatment initiation, it is estimated that 59.3% (KM‐derived) of patients who initiated erenumab at 70 mg escalated to 140 mg, and 4.4% (KM‐derived) of patients who initiated at 140 mg de‐escalated to 70 mg. Conclusions: The majority of patients prescribed erenumab remained persistent for at least a year after treatment initiation, and most patients initiated or escalated to a 140 mg dose. These results suggest that erenumab is well tolerated, and its uptake as a new class of prophylactic treatment for migraine in real‐world clinical practice is not likely to be undermined by poor persistence when coverage for erenumab is easily available. [ABSTRACT FROM AUTHOR]

Background and aims: Parallels between the persistent overconsumption of food and addictive drugs have given rise to the notion of food addiction. In a large community sample of Canadian adults, the current study examined the prevalence of food addiction and its relationship with obesity, quality of life and multiple indicators of impulsivity. A secondary goal was to analyze differences between obese and non‐obese individuals with and without food addiction. Design Cross‐sectional in‐person assessment. Setting: Hamilton, Ontario, Canada. Participants: A total of 1432 community adults (age = mean ± standard deviation = 38.93 ± 13.7; 42% male) recruited from the general community using print, bus and internet advertisements. Measurements: Yale Food Addiction Scale 2.0, anthropometrics (including body mass index), body composition (e.g. body fat, muscle mass, body water), World Health Organization Quality of Life scale and impulsivity measures, including impulsive personality traits, delay discounting and behavioral inhibition. Findings The prevalence of food addiction was 9.3% and substantially below that of obesity (32.7%), although food addiction was significantly more common among obese individuals (18.5%, P < 0.001). Food addiction was associated with significantly lower quality of life in all domains (βs = −0.21 to −0.34, Ps < 0.001) and significantly higher impulsive personality traits, particularly negative and positive urgency (βs = 0.37 and 0.30, Ps < 0.001). Subgroup contrasts within both the obese and non‐obese strata revealed that food addiction was associated with significantly lower quality of life in all domains (Ps < 0.001). Food addiction among non‐obese individuals was also associated with higher body mass index (P < 0.001). Conclusion: In a general community sample, food addiction was present in slightly fewer than one in 10 individuals, approximately one‐third the prevalence of obesity, but with twice the prevalence among obese individuals. Food addiction appears to be associated with substantively lower quality of life and elevations in impulsivity, particularly in deficits in emotional regulation. [ABSTRACT FROM AUTHOR]

Background: There are significant concerns that the COVID‐19 pandemic may have negative effects on substance use and mental health, but most studies to date are cross‐sectional. In a sample of emerging adults, over a two‐week period during the pandemic, the current study examined: (1) changes in drinking‐related outcomes, depression, anxiety, and posttraumatic stress disorder and (2) differences in changes by sex and income loss. The intra‐pandemic measures were compared to pre‐pandemic measures. Methods: Participants were 473 emerging adults (Mage = 23.84; 41.7% male) in an existing longitudinal study on alcohol misuse who were assessed from June 17 to July 1, 2020, during acute public health restrictions in Ontario, Canada. These intra‐pandemic data were matched to participant pre‐pandemic reports, collected an average of 5 months earlier. Assessments included validated measures of drinking, alcohol‐related consequences, and mental health indicators. Results: Longitudinal analyses revealed significant decreases in heavy drinking and adverse alcohol consequences, with no moderation by sex or income loss, but with substantial heterogeneity in changes. Significant increases in continuous measures of depression and anxiety were present, both of which were moderated by sex. Females reported significantly larger increases in depression and anxiety. Income loss >50% was significantly associated with increases in depression. Conclusions: During the initial phase of the pandemic, reductions in heavy drinking and alcohol consequences were present in this sample of emerging adults, perhaps due to restrictions on socializing. In contrast, there was an increase in internalizing symptoms , especially in females, highlighting disparities in the mental health impacts of the pandemic. [ABSTRACT FROM AUTHOR]

An average of 37 children die of hyperthermia inside parked vehicles annually in the USA. The majority of cases are due to a caregiver forgetting them (~55%), while ~13% are due to intentionally leaving children unattended and ~28% occur when children climb into unlocked vehicles. The cause of four per cent is unknown. There are no published data on incidence in Canada. Through information provided from provincial and territorial coroner's offices, Canadian government agencies and media reports, six cases of vehicular hyperthermia deaths were confirmed since 2013. Three were attributed to children left unintentionally in vehicles; one occurred after a child climbed into an unlocked vehicle and two cases are undetermined. Attention or memory lapses are hypothesized to occur due to distraction, stress, fatigue, or routine changes. Educating caregivers about the dangers of leaving children in vehicles and providing preventative strategies through anticipatory guidance may reduce these tragedies (see graphic abstract). [ABSTRACT FROM AUTHOR]

Purpose: Many low- and middle-income countries (LMICs) are struggling to reduce maternal mortality rates, despite increased efforts by the United Nations through the implementation of their Millennium Development Goals program. Industrialized nations, such as Canada, have a collaborative role to play in raising the global maternal health standards. The purpose of this paper is to propose policy approaches for Canadians and other Organization of Economic Cooperation and Development (OECD) nations who wish to assist in reducing maternal mortality rates. Design/methodology/approach: Ten Canadian health experts with experience in global maternal health were interviewed. Using qualitative analytical methods, the authors coded and themed their responses and paired them with peer-reviewed literature in this area to establish a model for improving global maternal health and survival rates. Findings: Findings from this study indicated that maternal health may be improved by establishing a collaborative approach between interdisciplinary teams of health professionals (e.g. midwives, family physicians, OB/GYNs and nurses), literacy teachers, agriculturalists and community development professionals (e.g. humanitarians with diverse linguistic and cultural backgrounds). From this, a conceptual approach was devised for elevating the standard of maternal health. This approach includes specifications by which maternal health may be improved, such as gender justice, women's literacy, freedom from violence against women, food and water security and healthcare accessibility. This model is based on community health center (CHC) models that integrate upstream changes with downstream services may be utilized by Canada and other OECD nations in efforts to enhance maternal health at home and abroad. Research limitations/implications: Maternal mortality may be reduced by the adoption of a CHC model, an approach well suited for all nations regardless of economic status. Establishing such a model in LMICs would ideally establish long-term relationships between countries, such as Canada and the LMICs, where teams from supporting nations would collaborate with local Ministries of Health, non-government organizations as well as traditional birth attendants and healthcare professionals to reduce maternal mortality. Practical implications: All OECD Nations ought to donate 0.7 percent of their GDP toward international community development. These funds should break the tradition of "tied aid", thereby removing profit motives, and genuinely contribute to the wellbeing of people in LMICs, particularly women, children and others who are vulnerable. The power of partnerships between people whose aims are genuinely focused on caring is truly transformative. Social implications: Canada is not a driver of global maternal mortality reduction work but has a responsibility to work in partnership with countries or regions in a humble and supportive role. Applying a comprehensive and interdisciplinary approach to reducing maternal mortality in the Global South includes adopting a CHC model: a community development approach to address social determinants of health and integrating various systems of evidence-informed healthcare with a commitment to social justice. Interdisciplinary teams would include literacy professionals, researchers, midwives, nurses, family physicians, OB/GYNs and community development professionals who specialize in anti-poverty work, mediation/dialogue and education campaigns that emphasize the value of all people regardless of their gender, ethnicity, religion and income. Diasporic Canadians are invaluable members of these teams due to their linguistic and cultural knowledge as well as their enthusiasm for working with their countries of origin. Establishment of long-term partnerships of 5–10 years between a Canadian team and a region or nation in the Global South that is dedicated to reducing maternal mortality and improving women's health are valuable. Canada's midwifery education programs are rated as world leaders so connecting midwives from Canada with those of the Global South will facilitate essential transfer of knowledge such as using birth plans and other evidence-based practices. Skilled attendants at the birth place will save women's lives; in most cases, trained midwives are the most appropriate attendants. Video link to a primer about this paper by Dr Farah Shroff: https://maa.med.ubc.ca/videos-and-media/. Originality/value: There are virtually no retrievable articles that document why OECD nations ought to work with nations in the LMICs to improve maternal health. This paper outlines the reasons why it is important and explains how to do it well. [ABSTRACT FROM AUTHOR]

The proportion of individuals >80 years of age constitute an increasing proportion of patients who present with ST-segment elevation myocardial infarction (STEMI). The objective of this study is to evaluate in-hospital outcomes and 1-year survival of very elderly patients who present with an STEMI and undergo primary percutaneous coronary intervention (pPCI). Between 2009 and 2015, individuals >80 years of age (very elderly patients) with an STEMI presenting at a single tertiary Canadian care center were included in the study. A random sample of 100 individuals aged 65 to 69 years over the same time period were selected as a control group. A total of 284 patients were included in the study population including 100 controls, 164 octogenarians, and 20 nonagenarians. Of total, 1661 pPCIs occurred during this study period with the very elderly population (>80 years) comprising 11.1% of the total pPCIs. Compared with controls, individuals aged >80 are more likely to have a delay in treatment with increased rates of bleeding, acute kidney injury, rehospitalization, and a trend toward longer hospital stays following pPCI for STEMI. Although in-hospital and 1-year mortality were similar between both cohorts >80 years of age with STEMI, their overall survival was reduced compared with controls. [ABSTRACT FROM AUTHOR]

Background: Emergency department efficiency is a priority across Canada. In the United States, scribes may increase the number of patients seen per hour per physician; however, Canadian data are lacking. We sought to implement scribes in a Canadian emergency department with the hypothesis that scribes would increase the number of patients seen per hour per physician. Methods: We conducted a 4-month quality improvement pilot study in a community emergency department in Ottawa, Ontario. Data collection began January 2015 after scribe training. Physicians received shifts with and without a scribe for a period of 4 months. Across the study, the mean number of patients seen per hour was determined for each physician during shifts with and without a scribe. We compared mean (± standard deviation [SD]) number of patients seen per hour based on presence or absence of a scribe by 2-tailed paired-samples t test. Results: Eleven scribes participated and ranged in age from 18 to 23 years. Twenty-two full- or part-time emergency physicians were followed. We documented 463 physician-hours without use of a scribe and 693.75 physician-hours with use of a scribe. Across all 22 physicians, 18 (81.8%) saw more patients per hour with use of a scribe. Overall, the number of patients seen per hour per physician was significantly greater (+12.9%) during shifts with a scribe (mean [± SD] 2.81 [± 0.78]) than during shifts without a scribe (mean [± SD] 2.49 [± 0.60]; p = 0.006). Interpretation: In this pilot study, the use of scribes resulted in an increased number of patients seen per hour per physician. Because this was a small study at a single centre, further research on the effects of scribes in Canada is warranted. [ABSTRACT FROM AUTHOR]

The Canadian Government has announced that over 50,000 refugees from the Middle East will be resettled in Canada by 2018. More than one-third of these refugees are expected to be children. The Canadian Paediatric Society has called for the Canadian government to prepare for the influx of these children. This should include addressing developmental, behavioural, and mental health needs. The focus of this paper is the role of paediatricians and family physicians in caring for the developmental health of refugee children, as a means of supporting their developmental and learning potential. The authors suggest the use of EMPOWER (Education, Migration, Parents and Family, Outlook, Words, Experience of Trauma and Resources), a mnemonic checklist they developed for assessing developmental risk factors in refugee children. EMPOWER can be used along with online web resources such as Caring For Kids New to Canada in providing evidence-informed care to these children. [ABSTRACT FROM AUTHOR]

Background. There is debate surrounding the effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPV). We determined whether PPV was associated with reduced mortality or additional hospitalization for vaccine-preventable infections in patients previously hospitalized for community-acquired pneumonia (CAP). Methods. From 2000 through 2002, adults with CAP admitted to the hospital in Edmonton, Alberta, Canada, were enrolled in a population-based cohort. Postdischarge outcomes during 5 years were ascertained using administrative databases. The primary outcome was the composite of all-cause mortality or additional hospitalization for vaccine-preventable infections. Proportional hazards analysis was used to determine the association between PPV use and outcomes. Results. A total of 2950 patients were followed up for a median of 3.8 years. The mean patient age was 68 years; 52% were male. One-third (np956) received PPV: 667 (70%) before and 289 (30%) during hospitalization. After discharge, 1404 patients (48%) died, 504 (17%) were admitted with vaccine-preventable infections, and 1626 (55%) reached the composite outcome of death or infection. PPV was not associated with reduced risk of the composite outcome (589 [62%] vs 1037 [52%] for those unvaccinated; adjusted hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.79-1.04). Results were not altered in sensitivity analyses using propensity scores (adjusted HR, 0.91; 95% CI, 0.79-1.04), restricting the sample to patients 65 years or older (adjusted HR, 0.90; 95% CI, 0.77-1.04), or considering only those who received PPV at discharge (adjusted HR, 0.84; 95% CI, 0.71-1.00). Conclusions. One-half of patients discharged from the hospital after pneumonia die or are subsequently hospitalized with a vaccine-preventable infection within 5 years. PPV was not associated with a reduced risk of death or hospitalization. Better pneumococcal vaccination strategies are urgently needed. [ABSTRACT FROM AUTHOR]

A cytological and morphological survey of the black flies of Prince Edward Island revealed 20 species of which 13 represent new provincial records. An additional three species have been recorded in the literature but were not found in this study. All 20 species are widely distributed on the North American mainland. Three species are significant pests of humans, six feed on birds, two species do not take blood, and the remaining species feed on non-human mammals. [ABSTRACT FROM AUTHOR]

Background: In 2014, Alberta, Canada broke new ground in having the first provincial healthcare policy and procedure for advance care planning (ACP), the process of communicating and documenting a person's future healthcare preferences. However, to date public participation and awareness of ACP remains limited. The aim of this initiative was to elicit community group perspectives on how to help people learn about and participate in ACP.Methods: Targeted invitations were sent to over 300 community groups in Alberta (e.g. health/disease, seniors/retirement, social/service, legal, faith-based, funeral planning, financial, and others). Sixty-seven participants from 47 community groups attended a "World Café". Participants moved between tables at fixed time intervals, and in small groups discussed three separate ACP-related questions. Written comments were captured by participants and facilitators. Each comment was coded according to Michie et al.'s Theoretical Domains Framework, and mapped to the Capability, Opportunity and Motivation behavior change system (COM-B) in order to identify candidate intervention strategies.Results: Of 800 written comments, 76% mapped to the Opportunity: Physical COM-B component of behavior, reflecting a need for access to ACP resources. The most common intervention functions identified pertained to Education, Environmental Restructuring, Training, and Enablement. We synthesized the intervention functions and qualitative comments into eight recommendations for engaging people in ACP. These pertain to access to informational resources, group education and facilitation, health system processes, use of stories, marketing, integration into life events, inclusion of business partners, and harmonization of terminology.Conclusions: There was broad support for the role of community groups in promoting ACP. Eight recommendations for engaging the public in ACP were generated and have been shared with stakeholders. [ABSTRACT FROM AUTHOR]

Background: Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction (MI) in young to middle-aged women.Objectives: We aim to define the long-term natural history of SCAD.Methods: We performed a multicenter, prospective, observational study of patients with nonatherosclerotic SCAD presenting acutely from 22 North American centers. We recorded baseline demographics, in-hospital characteristics, precipitating and predisposing conditions, angiographic features (adjudicated), in-hospital and 3-year major adverse cardiovascular events (MACE). Cox regression multivariable analysis was performed.Results: We prospectively enrolled 750 consecutive patients with SCAD from June 2014 to June 2018. Mean age was 51.7 ± 10.5 years, 88.5% were women (55.0% postmenopausal); 31.3% presented with ST-segment elevation myocardial infarction, and 68.3% with non-ST-segment elevation myocardial infarction. Precipitating emotional stressor was reported in 50.3%, and physical stressor in 28.9%. Predisposing conditions included fibromuscular dysplasia in 42.9% (56.4% in those with complete screening), peripartum state 4.5%, and genetic disorders 1.6%. Most patients were treated conservatively (84.3%); 14.1% underwent percutaneous coronary intervention (PCI), 0.7% coronary artery bypass graft. At 3.0-year median follow-up, mortality was 0.8%, recurrent MI 9.9% (extension of previous SCAD 3.5%, de novo recurrent SCAD 2.4%, iatrogenic dissection 1.9%), with overall MACE 14.0%. Presence of genetic disorders, peripartum SCAD, and extracoronary fibromuscular dysplasia were independent predictors of 3-year MACE. Patients who underwent PCI at index hospitalization had similar postdischarge MACE compared with no PCI. At 3 years, 80.0% remained on aspirin and 73.5% on beta-blockade.Conclusions: Long-term mortality and de novo recurrent SCAD was low in our contemporary large SCAD cohort that included low revascularization rate and high use of beta-blockade and aspirin. Genetic disorders, extracoronary fibromuscular dysplasia, and peripartum SCAD were independent predictors of long-term MACE. [ABSTRACT FROM AUTHOR]