Search

Critical hope centres optimism and possibilities for change in the midst of struggles for social justice. It was a central tenet of early participatory pedagogy and HIV research. However, critical hope has been overlooked in contemporary HIV research that largely focuses on risk and biomedical interventions in ways that obscure collective agency and community strengths. We conducted a community-based study with transgender (trans) women of colour in Toronto, Canada to adapt an evidence-based HIV prevention intervention. Participants resisted a focus on HIV, instead calling researchers to centre journeys to self-love in contexts of social exclusion. In response, we piloted three arts-based, participatory methods generated with community collaborators: (i) affirmation cards sharing supportive messages with other trans women, (ii) hand-held mirrors for reflecting and sharing messages of self-acceptance and (iii) anatomical heart images to visualize coping strategies. Participants generated solidarity and community through shared stories of self-acceptance within contexts of pain, exclusion and loss. Narratives revealed locating agency and self-acceptance through community connectedness. Critical hope was a by-product of this participatory process, whereby participants shared personal and collective optimism. Participatory and arts-based methods that centre self-acceptance and solidarity can nurture resistance to pathologizing discourses in HIV research. Centring critical hope and participant-generated methodologies is a promising approach to transformative health promotion and intervention research. These methodological insights can be engaged in future participatory work with other marginalized groups facing dominant biomedical risk discourses. Critical hope holds potential as a participatory health promotion strategy for envisioning possibilities for sustainable change. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to characterize and identify factors associated with HIV care among transgender (trans) women living with HIV (TWLWH) in two urban centres in Canada. Methods: Retrospective data were collected from clinic charts of TWLWH aged 16 years and older across seven family medicine, endocrinology and/or HIV clinics in Montreal and Toronto, Canada, from 2018 to 2019 (n = 86). We assessed the proportion of individuals being ever engaged in HIV care [defined as having any recorded antiretroviral therapy (ART) regimen and/or viral load], current ART use, and most recent viral load (suppressed [<200 copies/ml] vs. unsuppressed) overall and compared across subgroups using χ2 tests. Results: All TWLWH in our sample [100.0%, 95% confidence interval (CI): 95.8–100.0%] were engaged in HIV care; most (93.0%, 95% CI: 85.4–97.4%) were currently using ART and most (93.4%, 95% CI: 85.3–97.8%) with complete data (n = 71/76) were virally suppressed. A higher proportion of trans women of colour (100.0%) reported current ART use compared with white trans women (76.9%, p = 0.017). A higher proportion of those with no documented history of injection drug use (IDU; 96.6%) were virally suppressed compared with those with a history of IDU (66.7%, p = 0.022). Although not statistically significant, 96.2% of those currently reporting feminizing hormone use were virally suppressed, compared with 85.0% of those not reporting use (p = 0.202). Conclusions: Once engaged in HIV care, TWLWH in Canada appear to have excellent ART use and viral suppression. Findings can be leveraged to identify target populations to enhance HIV care and to further explore the relationship between gender‐affirming medical care and HIV care. [ABSTRACT FROM AUTHOR]

Mental illness is a predominant medical condition in Canada. Marginalized groups in the Canadian population such as those with low income, the poorly educated and ethnic minorities are susceptible to mental health disorders. Using mental health-related emergency department visits as an indicator of mental illness cases, we employ a Bayesian spatio-temporal regression model to estimate mental illness risk across the 35 public health units of Ontario, Canada from 2006 to 2017. The association between mental illness and the following marginalization-related factors: material deprivation, residential instability and ethnic concentration is also evaluated. Over the assessed period, the relative risk of mental illness ranged from 0.45 (95% CI: 0.44–0.46) to 3.29 (95% CI: 3.20–3.37). Health units with elevated levels of material deprivation and residential instability were positively associated with increased mental illness risk whilst areas with higher ethnic concentration were linked with lower risk. Findings showed that the temporal trend of risk continuously increased over the 11 year period, with health units in northern Ontario experiencing higher risk compared to southern units. The management of psychiatric disorders presents a significant challenge to the Canadian health-care system. An understanding of the geographic distribution of mental health risk across space and time can be useful for improved policy-making and public health monitoring. [ABSTRACT FROM AUTHOR]

This article describes the nurse practitioner (NP) led management of a possible nosocomial exposure of tuberculosis (TB) in a level 3 NICU in Toronto, Canada. 26 babies, premature and term, were identified as being at risk and multiple emergency clinics were set up to diagnose possible infection, prescribe window prophylaxis, and monitor for adverse effects to the medication. The NICU NPs were chosen to organize, co-ordinate, and manage these emergency clinics because of their skills in leadership, diagnosing, therapeutic management, and client relationship building. The clinic was able to achieve 100 percent follow up with each at risk baby, from initial assessment through to completion of window prophylaxis with negative tuberculin skin test. Some insight in to the decision making surrounding possible TB outbreak management is provided, and special considerations around therapeutic management specific to this population are discussed. This incident demonstrates how nurse practitioners can be utilized to provide high quality care, across multiple clinical situations, to meet the needs of the health care system. [ABSTRACT FROM AUTHOR]

Canada has one of the highest incidence rates of brain cancer in the world. This study investigates the space–time variation of brain cancer risk across Southern Ontario, Canada. A Bayesian spatio-temporal regression model is used to estimate the relative risk of brain cancer in the 12 spatial health units of Southern Ontario over a four-year period (2010–2013). This work also explores the association between brain cancer and two potential risk factors: traumatic head injury (THI) and excess body fat (EBF). Across all areal units from 2010–2013, results show that the relative risk of brain cancer ranged from 0.83 (95% credible interval (CI) 0.74–0.91) to 1.26 (95% CI 1.13–1.41). Over the years, the eastern and western health units had persistently higher risk levels compared to those in the central areas. Results suggest that areas with elevated THI rates and EBF levels were also potentially associated with higher brain cancer relative risk. Findings revealed that the mean temporal trend for cancer risk progression in the region smoothly decreased over time. Overall, 50% of the health units displayed area-specific trends which were higher than the region's average, thus indicating a slower decrease in cancer rates for these areas in comparison to the mean trend. [ABSTRACT FROM AUTHOR]

• North American flying squirrels have extremely high levels of free cortisol. • Free cortisol levels can be assessed non-invasively through fecal samples. • Free cortisol levels peaked in autumn and were not impacted by sex or reproduction. Most environments exhibit predictable yearly changes, permitting animals to anticipate them. The hypothalamic–pituitary–adrenal (HPA) axis is a key physiological pathway that enables animals to cope with such changes. Monitoring glucocorticoid (the end products of the HPA axis) levels in wild animals throughout the year can improve our understanding of how this pathway responds to different conditions. For this study, we collected 18 months of data on two species of North American flying squirrels (Glaucomys sabrinus and G. volans) living in a southern Ontario forest where temperature and food availability fluctuate dramatically throughout the year. These squirrels are active year-round, nest communally, and rely on scatter hoarded foods in the winter months. Flying squirrels have extremely high levels of free plasma cortisol relative to other mammals, but it is unknown how these levels are affected by environmental and reproductive factors. For both species, our goals were to (1) validate an enzyme immunoassay (EIA) to measure their fecal glucocorticoid metabolite (FGM) concentrations and (2) assess yearly differences, seasonal changes, and the influence of sex, reproduction, and ambient temperature on FGM concentrations in each species. In the lab, we successfully validated the use of antibody 5α-pregnane-3β, 11β, 21-triol-20-one EIA for FGM analysis in both species. In the field, neither sex nor reproductive status (breeding condition or not) were linked to FGM concentrations in either species. FGM concentrations were higher in autumn compared to the spring and summer. There were no other seasonal differences. We discuss possible explanations for the autumn peak in FGM concentrations (increased energy expenditure and social nesting changes), as well as outline possible avenues for future research. Understanding how individuals and populations respond to environmental change is a critical goal in evolutionary ecology, particularly in the context of a rapidly changing Anthropocene. [ABSTRACT FROM AUTHOR]