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Background: The INFINITY total ankle implant is a widely and successfully used option for total ankle arthroplasty. The purpose of this study is to assess the 2-year survivorship, complication rates, patient-reported outcomes, and radiologic findings of prospectively enrolled patients undergoing a fixed-bearing total ankle arthroplasty (TAA). This study sought to determine if factors such as traditional vs patient-specific instrumentation, preoperative degree of arthritis, deformity, or etiology of arthritis impact surgical or clinical outcomes., Methods: A total of 143 prospectively enrolled patients (148 ankles) underwent TAA with a fixed-bearing total ankle implant between 2017 and 2019 at 9 different institutions by 9 different surgeons. A total of 116 completed 2-year follow-up. Patients were stratified by instrumentation used, degree of preoperative deformity, the Canadian Orthopaedic Foot and Ankle Society (COFAS) grading system, and etiology of arthritis. Outcomes used included implant survivorship and adverse events within 2 years of surgery. Additionally, patient-reported outcomes and radiographs were collected at 6-month, 1-year, and 2-year postoperatively. PROMs used included Ankle Osteoarthritis Score (AOS), Patient-Reported Outcomes Measurement Information System (PROMIS) global health score, the Foot and Ankle Outcome Score (FAOS), and patient satisfaction (rated from excellent to poor)., Results: Implant survivorship at 2 years was 97.79%. There were 17 reoperations (11.5%), with 4 of the implants requiring revision (2.7%). Significant improvements in all PROMs were observed among all subgroups at all postoperative time points without significant variation between subgroups. Patients classified as COFAS type 2 arthritis preoperatively demonstrated significantly more improvement in FAOS Total Symptom Score at the 1- and 2-year measurements than COFAS type 3 patients at both time points., Conclusion: Total ankle arthroplasty with a fixed-bearing implant system is a safe and reliable treatment option for patients with end-stage arthritis regardless of degree of deformity or COFAS grading., Level of Evidence: Level II, prospective cohort study., Competing Interests: Ethical ApprovalEthical approval for this study was obtained from Medical University of South Carolina institutional review board Pro00080181. Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Jesse Doty, MD, reports grants or contracts from any entity; royalties or licenses; consulting fees; and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Stryker. Donald R. Bohay, MD, FACS, reports consulting fees; and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Stryker. G. Andrew Murphy, MD, Paul T. Fortin, MD, and Anand Vora, MD, report support for the present manuscript from Wright Medical. David A. Friscia, MD, reports support for the present manuscript; consulting fees; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events; and support for attending meetings and/or travel from Stryker. ICMJE forms for all authors are available online.

Objective: The aim of this study was to understand the experiences of pregnant people and new parents in Canadian federal prisons for women, and to better understand their ability to participate in the institutional Mother Child Program., Methods: This qualitative case study used semi-structured interviews with people who experienced federal incarceration during pregnancy or the early parenting years., Findings: Major themes in the analysis include: 1) Reasons why- and why not- to participate in the Mother Child Program; 2) Mothering from inside; 3) Health care; and 4) Strategies and survival., Key Conclusions: Mothers describe multiple reasons for choosing not to participate or being ineligible for the Mother Child Program; separation as common and traumatic; health services as inadequate; and mental health concerns being met with punishment. Alternatives to incarceration are recommended., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Paynter et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: To (1) compare changes in parenting self-efficacy, social support, postpartum anxiety, and postpartum depression in Canadian women before and during the early COVID-19 pandemic; (2) explore how women with a newborn felt during the pandemic; (3) explore ways that women coped with challenges faced., Methods: A cross-sectional design was used. Prior to the pandemic, an online survey was conducted with women who an infant 6 months old or less in one of the three Eastern Canadian Maritime provinces. A similar survey was conducted during the pandemic in mid-2020., Results: Pre-COVID, 561 women completed the survey, and 331 women during the pandemic. There were no significant differences in parenting self-efficacy, social support, postpartum anxiety, and depression between the cohorts. Difficulties that women reported because of COVID-19 restrictions included lack of support from family and friends, fear of COVID-19 exposure, feeling isolated and uncertain, negative impact on perinatal care experience, and hospital restrictions. Having support from partners and families, in-person/virtual support, as well as engaging in self-care and the low prevalence of COVID-19 during the summer of 2020 helped women cope., Clinical Relevance: Women identified challenges and negative impacts due to the COVID-19 pandemic, although no differences in psychosocial outcomes were found. Consideration of public health policy during the postpartum period for the ongoing COVID-19 pandemic is needed., Conclusion: While there were no significant differences in psychosocial outcomes, there were still challenges and negative impacts that women identified., (© 2022 Sigma Theta Tau International.)

Background: The postnatal period remains unstandardized in terms of care and postnatal visits with a dearth of information on the experience from Canadian women., Purpose: To explore (1) with whom and how often women receive postnatal follow-up visits and (2) the postnatal care experiences of Canadian mothers., Methods: Using a cross-sectional design, women who had given birth within the past 6 months were recruited to complete an online survey. Frequencies were computed for quantitative outcomes and thematic analysis was used for qualitative responses., Results: A total of 561 mothers completed the survey. Women saw on average 1.9 different postnatal healthcare providers, primarily family doctors (72.4%). 3.2% had no postnatal visits and 37.6% had 4  or more within 6 weeks. 76.1% women were satisfied with their postnatal care. Women's satisfactory care in the postnatal period was associated with in-person and at home follow-ups, receiving support, and receiving timely, appropriate care for self and newborn. Unsatisfactory care was associated with challenges accessing care, experiencing gaps in follow-up visits, and having unsatisfactory assessment for their own recovery., Conclusion: There is considerable variation in the timing and frequency of postnatal visits. While many women are experiencing satisfactory care, women are still reporting dissatisfaction and are facing challenges.

Objective: The objective of this review is to chart the evidence relating to food security among African Canadian communities to inform future research and offer insight related to food security in African Canadian communities., Introduction: Achieving food security is of global importance to meet the United Nations Sustainable Development Goals. As a social determinant of health, food security, which refers to the unrestricted physical, economic, and timely access to safe and nutritious foods, impacts more than 4 million Canadians. Yet, little is known about food security and the differential impacts of food insecurity among African Canadians. This scoping review sought to describe the current state of food security among African Canadians., Inclusion Criteria: Sources were considered for inclusion if they: i) focused on Canada, ii) involved African Canadians, and iii) examined food security., Methods: This scoping review was conducted in accordance with JBI methodology. Databases and relevant websites containing peer-reviewed, unpublished, and gray literature were searched. Ancestry searching and forward citation tracing were completed. No restrictions were placed on date of publication. Language restrictions were limited to English and French. In instances where articles were unavailable, authors of potential sources were contacted at the full-text review phase to request access to their article. Data were extracted independently by two team members, and are presented narratively and in tabular format., Results: The search of databases yielded a total of 1183 records. Ancestry tracing yielded 287 records. After removing duplicates, 1075 titles and abstracts were screened for eligibility and 80 advanced to full-text screening. Seventy-five full-text articles were excluded for not meeting the inclusion criteria, leaving five articles that underwent data extraction. All five included studies involved African Canadian participants in Canada. All studies focused on adults; one study included women and men participants, while four focused exclusively on women. One study involving women participants included cisgender and transgender women as well as those identifying as queer. Study designs reflected qualitative (n = 2), quantitative (n = 1), and mixed methods (n = 2) designs., Conclusions: This review begins to fill a gap in understanding the current evidence available on food security as it impacts African Canadians. The findings of this review represent existing research, describing the type of evidence available and methodologies used, before suggesting implications for research and practice. The inclusion of only five studies reveals the limited evidence regarding the current state of food security among African Canadians. Further, included studies were exclusively conducted in urban settings and predominantly in one province. There is a need for further research in rural communities, in other provinces and territories, as well as with younger and older participants. The urgent need to collect race-disaggregated data in Canada is evident., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 JBI.)

Background: After giving birth, women experience significant changes related to maternal self-efficacy and social support and are at risk of experiencing postpartum anxiety and depression., Problem: No studies have focused on the relationship between parity and infant age and their impact on psychosocial outcomes, particularly in a Canadian context., Aim: To explore the relationship between parity and infant age on perceived maternal self-efficacy, social support, postpartum anxiety, and postpartum depression., Methods: Women from three Canadian provinces within the first 6 months postpartum completed standardized online questionnaires. Multivariate analysis of covariance was used to examine the primary aim., Findings: A total of 561 women (56.5% primiparous, 55.1% infant 0-3 months) participated. There were significant main effects for both parity (P < .001) and age of infant (P < .001), but no significant interaction (P = .463). Primiparous women had lower maternal self-efficacy (P = .004) and higher postpartum anxiety (P = .000) than multiparous women. Women with younger infants had more perceived social support (P = .002). Women with older infants had higher levels of postpartum anxiety (P = .003) and depression (P = .000)., Discussion: The transition that women experience, independent of parity, within the first six months is dynamic with women of older infants experiencing more postpartum mental health concerns and less perceived social support. Our findings emphasize that postnatal support should extend beyond the typical six-week follow-up period., Conclusions: Additional studies are warranted to determine ways to provide ongoing support throughout the first six months and beyond to improve maternal well-being and address postpartum needs., (© 2021 Wiley Periodicals LLC.)

Background: The transition to motherhood is an exciting yet challenging period that requires physical, emotional, and social adjustment. During the postpartum period, mothers require support and information to ensure a smooth transition and adjustment to motherhood. One innovative strategy to provide mothers with this information is mobile health (mHealth), and specifically, text messaging., Objective: To describe the design, development and usability testing of a postnatal text message intervention called Essential Coaching for Every Mother., Methods: First time mothers (n=11) and postpartum healthcare providers (n=18) were involved in iterative interviewing in Halifax, Canada. Adaption of content occurred through three rounds of user testing using semi-structured interviews. The Information Assessment Method (IAM) Parents survey was also completed by mothers., Results: Three cycles of iterative testing were conducted with eight participants (3 mothers, 5 healthcare providers), thirteen participants (8 mothers, 5 healthcare providers) and 8 participants (8 healthcare providers), respectively. Messages evolved from risk-focused to prevention and education focused. Mothers felt the messages addressed their needs and healthcare providers ensured the content was consistent with the messaging currently provided to postpartum mothers., Conclusion: Essential Coaching for Every Mother is the first postnatal educational text message intervention developed for mothers in Halifax, Canada. We sought to involve first time mothers (end-users) and postpartum healthcare providers (experts) in the development and usability evaluation to ensure the intervention adequately met needs and was consistent with current practices related to postpartum education., (Copyright © 2020 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Objective: The objective of this study is to synthesize and describe the evidence relating to food security among African Canadian communities to inform future research and health policy concerning people of African descent., Introduction: Food security denotes the timely access to nutritionally and culturally appropriate foods by individuals, families, groups, and communities. In Canada, there are vulnerable groups who experience higher rates of food insecurity, including immigrant and senior populations as well as Indigenous communities. While there is evidence describing food security among these vulnerable groups, food security among African Canadian communities remains poorly understood. The African Canadian community is an integral component of the Canadian population, yet there is a limited understanding of food security among this group., Inclusion Criteria: This review will focus on the African Canadian population and food security, which encompasses food access, nutrition, and culturally appropriate foods. Evidence obtained from qualitative, quantitative, mixed methods studies, as well as dissertations and gray literature will be considered for inclusion., Methods: This scoping review will be conducted in accordance the JBI scoping review methodology. A comprehensive search strategy developed by a librarian scientist will be used to locate and retrieve relevant sources. A screening tool will be used to screen titles and abstracts as well as the full text of included sources. Data will then be extracted by two independent reviewers, synthesized, and presented narratively, including tables and figures where appropriate.

Background: As population health needs become more complex, addressing those needs increasingly requires the knowledge, skills, and judgment of multiple types of human resources for health (HRH) working interdependently. A growing emphasis on team-delivered health care is evident in several jurisdictions, including those in Canada. However, the most commonly used HRH planning models across Canada and other countries lack the capacity to plan for more than one type of HRH in an integrated manner. The purpose of this paper is to present a dynamic, multi-professional, needs-based simulation model to inform HRH planning and demonstrate the importance of two of its parameters-division of work and clinical focus-which have received comparatively little attention in HRH research to date., Methods: The model estimates HRH requirements by combining features of two previously published needs-based approaches to HRH planning-a dynamic approach designed to plan for a single type of HRH at a time and a multi-professional approach designed to compare HRH supply with requirements at a single point in time. The supplies of different types of HRH are estimated using a stock-and-flow approach., Results: The model makes explicit two planning parameters-the division of work across different types of HRH, and the degree of clinical focus among individual types of HRH-which have previously received little attention in the HRH literature. Examples of the impacts of these parameters on HRH planning scenarios are provided to illustrate how failure to account for them may over- or under-estimate the size of any gaps between the supply of and requirements for HRH., Conclusion: This paper presents a dynamic, multi-professional, needs-based simulation model which can be used to inform HRH planning in different contexts. To facilitate its application by readers, this includes the definition of each parameter and specification of the mathematical relationships between them.

The postpartum period is an exciting yet stressful time for first-time mothers, and although the experience may vary, all mothers need support during this crucial period. In Canada, there has been a shift for universal postpartum services to be offered predominantly online. However, due to a paucity of literature, it is difficult to determine the degree to which mothers' needs are being effectively addressed. The aim of this study was to examine and understand how first-time mothers accessed support and information (online and offline) during the first 6 months of their postpartum period. Using feminist poststructuralism methodology, data were collected from focus groups and e-interviews, and analyzed using discourse analysis. Findings indicate that peer support is greatly valued, and mothers often use social media to make in-person social connections. Findings highlight how accessing support and information is socially and institutionally constructed and provide direction for health professionals to provide accessible postpartum care.

Background: Planning for human resources for health (HRH) is central to health systems strengthening around the world, including in the Caribbean and Jamaica. In an effort to align Jamaica's health workforce with the changing health needs of its people, a partnership was established between Jamaican and Canadian partners. The purpose of the work described in this paper is to describe the development and application of a needs-based HRH simulation model for pharmacists in Jamaica's largest health region., Methods: Guided by a Steering Committee of Jamaican stakeholders, a simulation modelling approach originally developed in Canada was adapted for the Jamaican context. The purpose of this approach is to promote understanding of how various factors affect the supply of and/or requirements for HRH in different scenarios, and to identify policy levers for influencing each of these under different future scenarios. This is done by integrating knowledge of different components of the health care system into a single tool that shows how changes to different parameters affect HRH supply or requirements. Data to populate the model were obtained from multiple administrative databases and key informants. Findings were validated with the Steering Committee., Results: The model estimated an initial shortage of 110 full-time equivalent (FTE) pharmacists in the South East Region that, without intervention, would increase to a shortage of about 150 FTEs over a 15-year period. In contrast to the relatively small impact of a large enrollment increase in Jamaica's pharmacy training programme, interventions to increase recruitment of pharmacists to the public sector, or improve productivity - through, for example, the use of support staff and/or new technologies - may have much greater impact on reducing this shortage., Conclusions: The model represents an improvement on the HRH planning tools previously used in Jamaica in that it supports the estimation of HRH requirements based directly on measures of population health need. Both the profession (pharmacists) and country (Jamaica) considered here are under-studied. Further investments by Jamaica's MoH in continuing to build capacity to use such models, in combination with their efforts to enhance health information systems, will support better informed HRH planning in Jamaica.

Objective: To demonstrate the application of a needs-based framework for health human resources (HHR) planning to illustrate the potential effects of policies on the shortage of Registered Nurses (RNs) in Canada., Methods: A simulation model was developed to simultaneously estimate the supply of and requirements for RNs based on data on the health needs of Canadians with current service delivery patterns and levels of productivity as a baseline scenario. The potential individual and cumulative effects of various policy scenarios on the 'gap' between these were simulated., Results: A baseline scenario estimated a shortage of about 11,000 RN FTEs in 2007 for Canada, increasing to over 60,000 by 2022. However, multifaceted approaches have the potential to eliminate the estimated shortage., Conclusions: Estimating the requirements for health human resources must explicitly consider population health needs, levels of service delivery and HHR productivity while changing supply to meet requirements involves consideration of a broad range of comprehensive interventions. Investments in improved data collection and planning tools are needed to support more effective HHR planning. The estimated Canadian shortage of RNs based on current circumstances can be resolved in the short to medium tern through modest improvements in RN retention, activity and productivity., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Health human resource planning has traditionally been based on simple models of demographic changes applied to observed levels of service utilization or provider supply. No consideration has been given to the implications of changing levels of need within populations over time. Recently, needs based resource planning models have been suggested that incorporate changes in needs for care explicitly as a determinant of health care needs., Methods: In this paper, population indicators of morbidity, mortality and self-assessed health are analyzed to determine if health care needs have changed across birth cohorts in Canada from 1994 to 2005 among older age groups. Multivariate regression analysis was used to estimate the age pattern of health by birth year with interaction terms included to examine whether the association of age with health was conditional on the birth year., Results: Results indicate that while the probability of mortality, mobility problems and pain rises with age, the rate of change is greater for those born earlier. The probability of self-assessed poor health increases with age but the rate of change with age is constant across birth years., Conclusions: Even in the short time period covered, our analysis shows that health care needs by age are changing over time in Canada.

(1) Febuxostat is a selective inhibitor of xanthine oxidase. Its use in the management of hyperuricemia and gout is being studied. (2) In a 52-week, phase III randomized clinical trial, febuxostat was superior to allopurinol for lowering uric acid levels. Its efficacy in preventing gout attacks was similar to that of allopurinol. Despite a similar rate of adverse effects, individuals on febuxostat were more likely to stop treatment than those on allopurinol. (3) The most commonly observed adverse effects with febuxostat include liver function test abnormalities, diarrhea, headache, nausea, vomiting, abdominal pain, and dizziness. (4) Given that renal dysfunction is a risk factor for hyperuricemia and gout, the safety and efficacy of febuxostat in this population should be considered, but only limited data are available. (5) The diffusion of febuxostat may be limited by its price relative to that of allopurinol, regardless of whether febuxostat proves to have advantages in specific populations.

(1) Atrasentan (Xinlay(R)) is an anti-cancer drug from a new class of agents called selective endothelin-A receptor antagonists. The orally administered drug is being studied in a subset of patients with advanced prostate cancer. (2) Phase II and III studies evaluating time to clinical and radiographic progression failed to demonstrate a significant benefit with atrasentan versus placebo. (3) The adverse effects, observed more frequently in those treated with atrasentan than in placebo-treated patients, were peripheral edema, rhinitis, headache, infection, dyspnea, and heart failure. (4) Atrasentan's role in the various stages of advanced prostate cancer, and relative to the chemotherapeutic agent docetaxel, has not been determined.

An assessment study was conducted with Canadian nurses (N = 177) in HIV/AIDS care to determine how social support influences the relationship between job stress and health (job satisfaction and burnout). The assessment study revealed that social support and coping both moderate the effects of these stressors on nurses' health and functioning outcomes (i.e., job satisfaction and burnout). Accordingly, the follow-up study tested the effectiveness of an intervention designed to enhance social support, promote the use of certain coping strategies for managing occupational stress, and prevent burnout in nurses. Telephone support groups, co-led by an expert facilitator and an expert AIDS nurse, were tested in a demonstration project for nurses in HIV/AIDS care (n = 30). The nurse participants reported that the intervention enhanced their coping, confidence, relationships, client care, and connections to the HIV/AIDS nursing community.