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Hassan Mahmoodi,1 Fatemah Jalalizad Nahand,2 Abdolreza Shaghaghi,2 Shahin Shooshtari,3 Mohammad Asghari Jafarabadi,4 Hamid Allahverdipour2 1Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran; 2Department of Health Education and Health Promotion, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran; 3Departments of Family Social Sciences and Community Health Sciences, University of Manitoba; St. Amant Research Centre, Winnipeg, Manitoba, Canada; 4Department of Epidemiology and Biostatistics, School of Public Health, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of IranCorrespondence: Hamid AllahverdipourDepartment of Health Education & Promotion, Faculty of Health Sciences, Tabriz University of Medical Sciences, Attar-e-Neyshabouri Street, Golgasht Street, Tabriz 5165665931, IranTel +98 41 333 44 731Email allahverdipour@gmail.comBackground: Life course gender-role traits and social stereotypes could affect the pattern of medication adherence in old age.Objectives: The main purpose of this study was to investigate gender based cognitive determinants of medication adherence in a sample of older adults who suffer from at least a chronic condition.Methods: In this cross-sectional design, 455 older adults participated from five health centers in Tabriz city, Iran from June to August 2017 using a random sampling method. Next, required data about medication adherence, knowledge and beliefs about prescribed medications, perceived self-efficacy in medication adherence, illness perception, and reasons for medication non-adherence were gathered using a structured written questionnaire through face-to-face interviews with the attendees.Results: Low medication adherence was reported by 54.5% of the study participants. Perceived self-efficacy for medication adherence (OR = 1.04; 95% CI: 1.00, 1.08) and medication adherence reason (OR = 0.96; 95% CI: 0.92, 0.99) were two identified strong predictors of medication adherence among the studied older men. Illness perception (OR = 1.02; 95% CI: 1.00, 1.02) and beliefs toward prescribed medication (OR = 0.95; 95% CI: 0.93, 0.98) were both recognized as the significant predictors of medication adherence in the older women subgroup.Conclusion: Gender based variations were noted regarding the medication adherence in the studied sample and attributes of cognitive function were the main pinpointed elucidating parameters for the non-conformity. The explicit cognitive processes must be considered in care provision or interventional programs that target medication adherence in older adults.Keywords: chronic disease, Iran, medication regimen adherence, older adults

The objectives of this study were to explore age variations in predictors of positive and negative self-rated health and examine whether the determinants of positive and negative self-rated health are mirror images. Longitudinal data were used from the National Population Health Survey for a nationally representative cohort of Canadians aged 25 years and older (N = 9,371) to predict positive and negative self-rated health among younger and older Canadian adults separately. Self-rated health was confirmed as a multidimensional concept. There were variations in determinants of positive and negative self-rated health for the younger and the older Canadian adults. Determinants of self-rated health include but are not limited to physical health and functioning. Self-rated health is a dynamic evaluation influenced by changes over time in individuals' physical and psychosocial health, genetic endowment, socioeconomic status and health behaviors. Determinants of positive and negative self-rated health are not mirror images. [ABSTRACT FROM AUTHOR]

The objectives of this study were to examine whether self-rated health differs among older adults of different ethnic backgrounds and to explore what factors may account for potential differences. The study was based on the 1983 and 1996 waves of the Aging in Manitoba study. A self-report measure of ethnic background was used to categorize participants into four groups: British/Canadian, Northern/Central European, Eastern European, and Other. In both 1983 and 1996, older Eastern European adults had significantly reduced odds of rating their health as good or excellent relative to British/Canadian adults. Controlling for demographic variables, socioeconomic status, language spoken, and health status attenuated but did not eliminate the difference. Global, subjective ratings of health are frequently used to measure health. The ethnic differences found here suggest, however, that ratings may be influenced by cultural factors, which may warrant some caution in making comparisons across ethnic groups. [ABSTRACT FROM AUTHOR]

Abstract Background Cumulative trauma disorders (CTDs) are common in musicians and their prevalence has been the subject of a number of studies in most western countries. Such studies are scarce in developing countries despite the possibility that CTDs may have a different prevalence in these countries, especially when considering traditional musical instruments and different methods of playing. Although not formally studied before, according to our experience the prevalence of CTDs seemed to be high among Iranian instrumentalists. We proposed this study to determine the prevalence of CTDs in amateur music students playing one of the two traditional Iranian instruments: Daf and Setar. Methods In a prospective cross sectional study, we interviewed and examined the students of three music training centers in Iran. Seventy eight instrumentalists, who were playing Daf or Setar and twelve students who had not started playing yet were regarded as case and control groups respectively. Some of them also underwent electrodiagnostic studies. Results Forty-seven percent (17 of 36) of the Setar players and 57% (24 of 42) of the Daf players and fifty-three percent (41 of 78) of the instrumentalists as a whole had CTDs. None of them had carpal tunnel syndrome. Conclusions Our study revealed that the prevalence of CTDs in Iranian instrumentalists was unusually high. In addition to age, other variables may be contributory. This needs to be further studied.

Temporal and spatial changes in land cover in wetland ecosystems indicate the severity of degradation. Understanding such processes in the past, present, and future might be necessary for managing any type of development plan. Therefore, this research has monitored and analyzed the Hoor Al-Azim International Wetland to determine the orientation of its changes in various future scenarios. Wetland status modeling was conducted using developed hybrid approaches and cellular automata along with evaluating the accuracy of the modeled maps. The dynamics of the landscape were simulated using a higher accuracy approach in three scenarios-Water Conservation, Water Decreasing, and Business-as-Usual- to get the level of degradation of the wetland. The results showed that the amount of water in the wetland has decreased in all three periods, and the salt lands and vegetation have undergone drastic changes. The water bodies experienced a reduction of 148,139 ha between 1985 and 2000, followed by a decrease of 9107 ha during the 2000-2015 period. However, based on the results, these developments are expressed better by the developed hybrid approach than the CA-MC approach and are more reliable for future simulation. The figure of merit index, which assesses the hybrid model's accuracy, yielded a value of 18.12%, while the CA-MC model's accuracy was estimated at 14.42%. The assessment of degradation in hexagonal units showed the least degradation in the water conservation scenario compared with the other two scenarios in 2030., (© 2024. The Author(s).)

Objectives: Cancer is a leading cause of death among people living with intellectual or developmental disabilities (IDD). There is little empirical evidence documenting survival or comparing outcomes to those without IDD. This study investigated the association between IDD and cancer survival among adults with breast (female), colorectal, or lung cancer., Methods: A population-based retrospective cohort study was conducted in Ontario, Canada, with routinely collected data. Patients with breast, colorectal, or lung cancer were included (2007‒2019). IDD status before cancer was determined using an established administrative data algorithm. The outcomes of interest included death from any cause and death from cancer. Cox proportional hazards models and competing events analyses using multivariable cause-specific hazards regression were completed. Analyses were stratified by cancer type. Interactions with age, sex, and stage at diagnosis, as well as sensitivity analyses, were completed., Results: The final cohorts included 123,695 breast, 98,809 colorectal, and 116,232 lung cancer patients. Individuals with IDD experienced significantly worse survival than those without IDD. The adjusted hazard ratios of all-cause death were 2.74 (95% CI 2.41‒3.12), 2.42 (95% CI 2.18‒2.68), and 1.49 (95% CI 1.34‒1.66) times higher for breast, colorectal, and lung cancer patients with IDD relative to those without. These findings were consistent for cancer-specific deaths. With few exceptions, worse survival for people with IDD persisted regardless of stage at diagnosis., Conclusion: People with IDD experienced worse cancer survival than those without IDD. Identifying and intervening on the factors and structures responsible for survival disparities is imperative., (© 2024. The Author(s) under exclusive license to The Canadian Public Health Association.)

Background: Cancer is a leading cause of death among people living with intellectual or developmental disabilities (IDD). Although studies have documented lower cancer screening rates, there is limited epidemiological evidence quantifying potential diagnostic delays. This study explores the risk of metastatic cancer stage for people with IDD compared to those without IDD among breast (female), colorectal, and lung cancer patients in Canada., Methods: Separate population-based cross-sectional studies were conducted in Ontario and Manitoba by linking routinely collected data. Breast (female), colorectal, and lung cancer patients were included (Manitoba: 2004-2017; Ontario: 2007-2019). IDD status was identified using established administrative algorithms. Modified Poisson regression with robust error variance models estimated associations between IDD status and the likelihood of being diagnosed with metastatic cancer. Adjusted relative risks were pooled between provinces using random-effects meta-analyses. Potential effect modification was considered., Results: The final cohorts included 115,456, 89,815, and 101,811 breast (female), colorectal, and lung cancer patients, respectively. Breast (female) and colorectal cancer patients with IDD were 1.60 and 1.44 times more likely to have metastatic cancer (stage IV) at diagnosis compared to those without IDD (relative risk [RR], 1.60; 95% confidence interval [CI], 1.16-2.20; RR, 1.44; 95% CI, 1.24-1.67). This increased risk was not observed in lung cancer. Significant effect modification was not observed., Conclusions: People with IDD were more likely to have stage IV breast and colorectal cancer identified at diagnosis compared to those without IDD. Identifying factors and processes contributing to stage disparities such as lower screening rates and developing strategies to address diagnostic delays is critical., (© 2023 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Background: Cancer is a leading cause of death among adults living with intellectual or developmental disabilities (IDD). However, few epidemiological studies exist worldwide quantifying inequalities in cancer stage at diagnosis and survival for people with IDD relative to those without IDD., Methods: A population-based, retrospective cohort study was conducted using provincial health and social administrative data in Manitoba, Canada. Adults (≥18 years) with a cancer diagnosis between 2004 and 2017 were included. Lifetime IDD was identified before the cancer diagnosis using an established algorithm. Modified Poisson regression with robust error variance was used to estimate the association between IDD status and metastatic cancer at diagnosis. Multivariable Cox proportional hazards analyses were used to the effect of IDD on overall survival following the cancer diagnosis., Results: The staging and prognosis cohorts included 62,886 (n = 473 with IDD) and 74,143 (n = 592 with IDD) cancer patients, respectively. People living with IDD were significantly more likely to be diagnosed with metastatic cancer and die following their cancer diagnosis compared to those without IDD (RR=1.20; 95 % CI 1.05-1.38; HR= 1.53; 95 % CI 1.38-1.71). Significant heterogeneity by sex was identified for cancer survival (p = 0.005)., Discussion: People with IDD had more advanced cancer stage at diagnosis and worse survival relative to those without IDD. Identifying and developing strategies to address the factors responsible that contribute to these disparities is required for improving patient-centred cancer care for adults with IDD., Competing Interests: Declaration of Competing Interest DD reports advisory board attendance for Merck Canada, Novartis, Jazz Pharmaceuticals, Pfizer, and AstraZeneca, honoraria for education content from Boehringer-Ingelheim and Bristol Myers Squibb, and a research grant from AstraZeneca. All other authors report having no conflicts of interest to disclose., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Human activities are prone to be the main drivers of land use land cover (LULC) changes, which have cascading effects on the environment and ecosystem services. The main objective of this study is to assess the historical spatiotemporal distributions of LULC changes as well as estimated future scenarios for 2035 and 2045 by considering the explanatory variables of LULC changes in Zanjan province, Iran. The LULC time-series technique was applied using three Landsat images for the years 1987, 2002, and 2019. Multi-layer Perceptron Artificial Neural Network (MLP-ANN) is applied to model the relationships between LULC transitions and explanatory variables. Future land demand was calculated using a Markov chain matrix and multi-objective land optimization in a hybrid simulation model. Validation of the model's outcome was performed using the Figure of Merit index. The residential area in 1987 was 6406.02 ha which increased to 22,857.48 ha in 2019 with an average growth rate of 3.97%. Agriculture increased annually by 1.24% and expanded to 149% (890,433 ha) of the area occupied in 1987. Rangeland showed a decline concerning its area, with only about 77% (1,502,201 ha) of its area in 1987 (1,166,767 ha) remaining in 2019. Between 1987 and 2019, the significant net change was a conversion from rangeland to agricultural areas (298,511 ha). Water bodies were 8 ha in 1987, which increased to 1363 ha in 2019, with an annual growth rate of 15.9%. The projected LULC map shows the rangeland will further degrade from 52.43% in 2019 to 48.75% in 2045, while agricultural land and residential areas would be expanded to 940,754 ha and 34,727 ha in 2045 from 890,434 ha and 22,887 ha in 2019. The findings of this study provide useful information for the development of an effective plan for the study area., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: The goal of this research study was to measure changes in the quality of life (QoL) of adults with profound intellectual and multiple disabilities (PIMD) and complex care needs following their transition from a large institutional residence to smaller community homes in Central Canada., Method: A pre- post-transition quasi-experimental time-series longitudinal study design was implemented to measure the impact of community transition on the QoL of study participants. QoL was assessed in eight domains (self-determination; emotional, physical, and material wellbeing; rights; personal development; social inclusion; and interpersonal relations) by proxy at two time points (Time 1: pre-transition and Time 2: at least 6 months post-transition) using the standardized tool San Martin Scale. The study group included 33 persons with PIMD and complex care needs (20 men [60%] and 13 women [40%]) aged 24-55 years (M = 42.52; SD = 8.07). Paired-samples t-test was conducted to determine significant changes in the QoL of study participants following their community transition., Results: Between pre- and post-transition, study participants experienced significant improvements in all the eight domains of QoL evaluated as well as in global QoL. Mean differences ranged from 5.67 (SD = 5.16, t (32) = 6.31, p = .001) for rights to 1.73 (SD = 3.10, t (32) = 3.19, p = .003) for physical wellbeing. Mean global QoL improved significantly from 99.97 (SD = 16.54) pre-transition to 120.42 (SD = 10.54) post-transition (M diff = 17.55, t (32) = 6.69, p = .001)., Conclusions: This longitudinal study provides evidence of improved QoL for persons with PIMD following deinstitutionalization., Competing Interests: Declaration of Competing Interest The authors report no declarations of competing interest., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Introduction: Prior studies examining the relationship between work- related injuries and healthcare use among middle-aged and older workers were mainly cross-sectional and reported inconsistent results., Objective: The objective of this study was to examine the associations between work-related injuries and 10 types of healthcare service use for any cause among middle-aged and older Canadian workers using longitudinal data., Methods: Our study involved longitudinal analysis of baseline and 18-month follow-up Maintaining Contact Questionnaire data from the Canadian Longitudinal Survey on Aging (CLSA) for a national sample of Canadian males and females aged 45-85 years who worked or were recently retired (N = 24,748)., Results: Among CLSA participants who worked or were recently retired, 361 per 10,000 reported a work-related injury within the year prior to the survey. Work-related injuries decreased with increasing age. Work-related injury was associated with emergency department visits, overnight hospitalization, visits to dentists, and visits to physiotherapists, occupational therapists, or chiropractors at follow-up in bivariate analyses. Compared to those with no work-related injuries, Canadians with work-related injuries had used, on average, a significantly higher number of health services within the last 12 months prior their survey. When controlling for the contribution of various socio-demographic, work-related, and health-related characteristics, work-related injuries remained a significant predictor of emergency department visits and visits to physiotherapists, occupational therapists, or chiropractors., Conclusions: The relationship between work-related injuries, emergency department visits, and visits to physiotherapists, occupational therapists, or chiropractors in middle-aged and older workers in Canada suggests that workplace injuries can be associated with ongoing health problems., Practical Applications: Healthcare services used by injured employees must be considered priorities for employment insurance coverage, if not already covered. Future research should more fully examine whether pre-existing health conditions predict both work-related injury and subsequent health problems. Injury-specific healthcare use following work-related injuries in middle-aged and older workers, as well as economic costs, should also be examined., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The rising prevalence of multimorbidity poses challenges to health systems globally. The objectives of this study were to investigate: 1) the association between multimorbidity and depressive symptoms; and 2) whether social support plays a protective role in this association., Methods: A prospective population-based cohort study was conducted to analyze baseline and 3-year follow-up data of 16,729 community dwelling participants aged 65 and above in the Canadian Longitudinal Study of Aging (CLSA). Multimorbidity was defined as having three or more chronic conditions. The 10-item Center for Epidemiologic Studies Depression scale (CESD-10) was used to measure depressive symptoms. The 19-item Medical Outcomes Study (MOS) Social Support Survey was employed to assess perceived social support. Multivariate logistic regression models were used to examine the association between multimorbidity, social support and depressive symptoms., Results: Multimorbidity was very common among participants with a prevalence of 70.6%. Fifteen percent of participants had depressive symptoms at baseline. Multimorbidity was associated with increased odds of having depressive symptoms at 3-year follow-up (adjusted odds ratio, aOR = 1.51, 95% CI 1.33, 1.71), and developing depressive symptoms by follow-up among those with no depressive symptoms at baseline (aOR = 1.65, 95% CI 1.42, 1.92). Social support was consistently associated with decreased odds of depressive symptoms, regardless of level of multimorbidity., Conclusion: Multimorbidity was positively associated with depressive symptoms over time, but social support served as a protective factor. As a modifiable, protective factor, emphasis should be placed in clinical practice to assess social support and refer patients to appropriate services, such as support groups. Similarly, health policy should focus on ensuring that older adults have access to social support opportunities as a way to promote mental health among older adults. Community organizations that offer social activities or support groups play a key role in this respect and should be adequately supported (e.g., with funding)., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Zhang 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.)

Background: The variability observed across different profiles of adjustment in children exposed to intimate partner violence (IPV) and the factors associated with resilience in this population are not yet well understood., Objective: Within a biopsychosocial framework, this study aimed to identify and describe profiles of adjustment in a cohort of children who had previously experienced IPV exposure, as well as the specific risk and promotive factors that significantly predicted membership in the identified adjustment profiles. The moderating effect of children's biological sex was also tested., Participants and Setting: Population-based administrative data on all residents of the Province of Manitoba (Canada) over a 12-year period (2006-2017) were used to create a cohort of 3886 children aged 6-11 years who experienced IPV exposure and to extract information on these children and their mothers., Method: Within a retrospective cohort study design, all study variables were extracted by linking multiple administrative health, social and justice datasets that were available in the Manitoba Population Research Data Repository., Results: Person-centered latent class analysis revealed four distinct adjustment profiles in the cohort of children, which differed for boys and girls. These included a resilient profile in which children showed no adjustment problems, as well as three profiles showing different combinations of children's externalizing problems and physical health problems. Positive maternal mental and physical health were the strongest predictors of resilient profile membership in both boys and girls., Conclusions: Study results suggest interconnectedness among biological, psychological and social domains in shaping the adjustment of children exposed to IPV and corroborate existing evidence on the key role that mothers play in promoting the resilience of these children. Thus, future resilience research with this group and resilience-promoting programming for IPV-affected families would benefit from adopting a multisystemic biopsychosocial resilience framework that simultaneously accounts for factors at all levels of human ecologies., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Complete physical examinations (CPE) can identify health disparities in persons with intellectual or developmental disabilities. The objective of this study was to determine and compare rates of CPE among Manitoba adults with and without intellectual or developmental disabilities over time and to identify factors that were associated with receiving a CPE., Method: A retrospective cohort study using linked administrative health and non-health data from 1995 to 2015 was conducted. Poisson and logistic regression were used to calculate CPE rates and examine factors associated with CPE., Results: The rates of CPE are decreasing over time and are higher among Manitobans with an intellectual or developmental disability. Characteristics such as being male, living rurally, low socioeconomic status, and high continuity of care led to lower odds of receiving a CPE., Conclusions: The current state of CPE provision to adults with intellectual or developmental disabilities in Manitoba is encouraging but needs improvement., (© 2021 John Wiley & Sons Ltd.)

Introduction: Emerging evidence suggests adults with intellectual and/or developmental disabilities (IDD) may be at risk of inequities in cancer experiences and outcomes. Individuals with IDD may experience multiple barriers that could worsen outcomes and experience. These barriers may be connected to features of IDD or the healthcare system overall. Future research and program planning to support adults with IDD and cancer must be informed by evidence that acknowledges potential disparities, underlying determinants, and knowledge deficits., Objective: We conducted a scoping review to systematically map the evidence describing and comparing cancer-related outcomes along the cancer continuum from risk to mortality for adults with IDD. We identified specific factors observed to influence those outcomes., Methods: We followed the expanded Arksey & O'Malley framework for conducting the scoping review. We searched for literature in PubMed and Embase databases. We abstracted cancer-related data, IDD-related data, and data related to physical and social determinants of health., Results: Of the 2796 studies retrieved, 38 were included for review. Most studies focused on screening outcomes and experiences. Studies reported that adults with IDD experienced inequities at various points along the cancer continuum. Numerous social and physical determinants of health influenced the experiences and outcomes of adults with IDD., Conclusion: This scoping review identified significant gaps in the literature. Of note was the focus on cancer screening and lack of attention to larger systems of oppression that may influence poor cancer experiences and outcomes for adults with IDD. There is strong need to improve both quality and quantity of research in this area., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The spatial and temporal dimensions of environmental impacts of climate and land cover changes are two significant factors altering hydrological processes. Studying the effects of these factors on water quality, provides important insight for water resource management and optimizing land planning given increasing water scarcity and water pollution. The impact of land cover and climate changes on surface water quality was assessed for the Neka River basin in Northern Iran. The widely used Soil and Water Assessment Tool (SWAT) was applied for pollutant modeling, and was calibrated using the Sequential Uncertainty Fitting (SUFI-2) algorithm. An ensemble of 17 CMIP5 climate models under two IPCC greenhouse gas emission scenarios were selected, and future land cover change (LCC) was modeled based on the evolution that occurred in the last decades. We simulated the impacts of climate change (CC) and LCC on sediment, nitrate, and phosphate for the 2035-2065 time slice. The annual loads of sediment, phosphate, and nitrate are projected to decrease under both CC scenarios based on the inter-model average, and generally follow a pattern similar to the change in river discharge. Nitrate concentrations show an increase across all seasons, while the sediment and phosphate concentrations increase in winter and autumn under CC conditions. Results indicate that pollutants are expected to increase under LCC alone, mainly due to the expansion of the cultivated areas. Overall, it seems CC has a greater impact than LCC on the variation of water quality variables in the Neka River basin. With a combined change in climate and land cover, the annual nitrate concentrations are expected to increase by + 19.7% and + 17.9%, under RCP 4.5 and RCP 8.5, respectively. The combined impacts of the CC and LCC caused a decline in the annual sediment and phosphate concentrations by -10.1% and -2.2% under RCP 4.5 and -9%, and -3.2% under RCP 8.5, respectively.

The current study was performed with the aim of the psychometric evaluation of a questionnaire for measuring factors related to women's mental health in an earthquake. This descriptive instrumental study was carried out on a population of 378 women with an earthquake experience in Kerman Province, Iran, in 2017-2018. The formal validity, content validity, criterion validity, factor analysis, and reliability of the questionnaire were measured using Cronbach's alpha coefficient. Moreover, descriptive statistics and Pearson's correlation coefficient were used to report data. In the content validity stage, 34out of 85 items of the questionnaire were eliminated. In the exploratory factor analysis (EFA) stage, 2 items out of the remaining 51 items were removed due to weak factor loading and 49 items were defined in 6 factors. The convergent and divergent validities of the questionnaire were confirmed in relation to the General Health Questionnaire (GHQ) (r = -0.23; P = .030) and World Health Organization Quality of Life-BREF ‎(WHOQOL-BREF) (r = 0.32; P = .001). Using Cronbach's alpha coefficient, the reliability of the questionnaire‎was obtained to be 0.91. The reliability and validity of the study questionnaire were at an appropriate level, and thus, it can be used to perform extensive surveys among women who have ‎experienced earthquake.

Background: Although a large body of research has focused on social isolation and loneliness, few studies have examined social isolation and loneliness together. The objectives of this study were to examine: 1) the relationship between four groups derived from combining social isolation and loneliness (socially isolated and lonely; only socially isolated; only lonely; neither socially isolated nor lonely) and the desire for more social participation, and social support; and 2) the relationship between the four groups and psychological distress., Methods: The study was based on the Comprehensive Cohort of the Canadian Longitudinal Study on Aging. Using CLSA baseline data (unweighted N = 30,079), ordinary and logistic regression analysis was used to examine the cross-sectional relationship between the four social isolation/loneliness groups and desire for more social participation and four types of social support (tangible, positive interaction, affection, and emotional support). Prospective logistic regression analysis was possible for psychological distress, which was derived from the Maintaining Contact Questionnaire administered about 18 months after the baseline questionnaire (unweighted N = 28,789)., Results: Findings indicate that being socially isolated and lonely was associated with the most social support gaps; this group also had an increased likelihood of psychological distress, relative to those who were neither socially isolated nor lonely. Participants who were only socially isolated, and those only lonely also perceived some social support gaps. In addition, the only lonely group was more likely to be psychologically distressed than the only socially isolated group and the neither isolated nor lonely group., Conclusion: Examining the four social isolation/loneliness was useful, as it provided more nuanced risk profiles than would have been possible had we examined social isolation and loneliness separately. Findings may suggest avenues for interventions tailored to the unique needs of at-risk individuals., Competing Interests: The authors have declared that no competing interests exist. The opinions expressed in this manuscript are the author’s own and do not reflect the views of the Canadian Longitudinal Study on Aging.

An understanding of how older adults conceptualize healthy aging is important for the development of policies, programs, and services designed to promote health; this understanding must reflect the ethno-cultural diversity of the population. This pilot study aimed to examine Canadians' definitions of healthy aging and ethno-cultural variations in these definitions. The baseline data for a sub-sample (n = 535) of the Canadian Longitudinal Study on Aging (CLSA) Tracking Cohort (n = 21,241) were examined. Narrative responses to an open-ended question on healthy aging were analyzed using a previously developed coding system. The most common themes for all the ethno-cultural groups were "lifestyle", "physical activity", and "attitude"; other themes varied by ethno-cultural background. These findings demonstrate that older Canadians from various ethno-cultural backgrounds define healthy aging differently. These variations must be taken into consideration for developing culturally sensitive programs to promote healthy aging among all Canadians. Theorizing on healthy (or 'successful') aging must envision it as a subjective and multidimensional concept., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: There is increasing attention on the cancer burden for adults with intellectual and developmental disabilities (IDD). Emerging evidence suggests there are differences in cancer experiences and outcomes for individuals living with IDD, from risk through survivorship. These differences may be attributed to features of the IDD, such as cognitive deficits and communication, as well as social determinants of health-like lower education levels and ableism. However, there is no comprehensive overview of the literature quantifying these potential disparities and describing the influencing factors. In this paper, we describe a scoping review protocol to systematically review published literature on cancer for adults with IDD. The purpose of this review is to identify differences in cancer risk, stage at diagnosis, treatment and survival along the cancer continuum for adults with IDD and outline potential contributing factors creating these disparities., Methods and Analysis: We will follow Arksey and O'Malley's expanded framework for scoping reviews to conduct this review. We will systematically search electronic databases for peer-reviewed, published journal articles to identify appropriate studies in collaboration with a health science librarian. Two reviewers will independently review titles and abstracts followed by a full-text review to determine whether it meets inclusion criteria. A data chart for collecting and sorting information will be developed in consultation with the team. Results will be collated and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews: PRISMA-Scoping Reviews. Extracted information will be summarised quantitatively and qualitatively to meet review objectives., Ethics and Dissemination: This scoping review will employ a methodology to identify literature related to cancer outcomes and experiences for adults with IDD. Results will be disseminated to relevant stakeholders who care for and support individuals with IDD at local, provincial and national levels and through publishing findings. By highlighting the disparities in the cancer system and gaps in the research, this scoping review can provide direction for future action., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: The objectives of this study were to examine: 1) whether the relationship between social network types, depressive symptoms and life satisfaction is mediated by different types of perceived social support; and, 2) whether social support plays a mediational role for married versus unmarried older adults. Methods: The study was based on national, baseline data (Tracking Cohort) from the Canadian Longitudinal Study on Aging for participants aged 65 to 85 (N = 8782). Five social network types derived from cluster analysis were used as predictors in the mediation analyses, with the four social support subscales of the Medical Outcomes Survey (MOS) Social Support Survey (tangible, emotional, positive social interactions, and affectionate) included as mediators, and depressive symptoms and life satisfaction as outcome variables. Socio-demographic and physical health variables were included as covariates. Results: Significant indirect effects emerged, with less diverse social network structures generally associated with less social support which, in turn, was related to more depressive symptoms and lower life satisfaction. However, different findings emerged for different types of social support, for participants who were married and unmarried, and for depressive symptoms versus life satisfaction. Conclusion: Our findings suggest that restricted social networks that are reflective of social isolation, as well as those that are intermediate in terms of their diversity can create gaps in perceived social support and, consequently, can negatively impact mental health and life satisfaction.

Data linkage holds great promise for generating new information about people with intellectual and developmental disabilities (IDD) as a population, yet few centers have developed the infrastructure to utilize this methodology. Two examples, from Canada and Australia, describe their efforts in building data linkage capabilities, and how linked databases can be used to identify persons with IDD and used for population-based research. The value of data linkage is illustrated through new estimates of prevalence of IDD; health service utilization patterns; associations with sociodemographic characteristics, and with physical and mental health conditions (e.g., chronic diseases, injury, fertility, and depression); and findings on equity in medical treatments. Examples are provided of findings used for governmental policy and program planning.

The Confidence of a decision could be considered as the internal estimate of decision accuracy. This variable has been studied extensively by different types of recording data such as behavioral, electroencephalography (EEG), eye and electrophysiology data. Although the value of the reported confidence is considered as one of the most important parameters in decision making, the confidence reporting phase might be considered as a restrictive element in investigating the decision process. Thus, decision confidence should be extracted by means of other provided types of information. Here, we proposed eight confidence related properties in EEG and eye data which are significantly descriptive of the defined confidence levels in a random dot motion (RDM) task. As a matter of fact, our proposed EEG and eye data properties are capable of recognizing more than nine distinct levels of confidence. Among our proposed features, the latency of the pupil maximum diameter through the stimulus presentation was established to be the most associated one to the confidence levels. Through the time-dependent analysis of these features, we recognized the time interval of 500-600 ms after the stimulus onset as an important time in correlating features to the confidence levels., (Copyright © 2019 IBRO. Published by Elsevier Ltd. All rights reserved.)

Background: Multimorbidity can be defined as the presence of more than one chronic condition in an individual. Research on multimorbidity has predominantly focused on older adults and few studies have examined multimorbidity in middle-aged people. The objectives of this study were to: 1) examine the prevalence of multimorbidity among middle-aged Canadians; and 2) examine the association between lifestyle factors (smoking, alcohol intake, physical activity) and multimorbidity in this age group., Methods: In this analysis of the Canadian Longitudinal Study on Aging (CLSA) baseline data, we extracted data from 29,841 participants aged 45-64 years from a database of 51,338 people aged 45-85 years. Self-reported data on 27 chronic physical health conditions were used to derive different multimorbidity definitions. We estimated the prevalence of 3+ to 5+ chronic physical health conditions in different subgroups for descriptive purposes. Multivariable logistic regression analyses were performed to determine the association between socio-demographic and lifestyle factors, and multimorbidity using a 3+ multimorbidity case definition., Result: We found that 39.6% (99% CI 38.4-40.7) of participants had three or more chronic conditions with a mean number of chronic condition of 2.41 (99% CI 2.37-2.46). The prevalence of multimorbidity increased with age from 29.7% in the 45-49-year-old age group to 52% in individuals aged 60-64 years. The prevalence of 4+ and 5+ chronic conditions was 24.5 and 14.2% respectively. Analyses indicated that female sex and low income were associated with higher odds of multimorbidity, whereas daily or weekly alcohol intake were associated with lower odds of multimorbidity. Exercise was not associated with multimorbidity. Results were similar when analyses were conducted separately for women and men., Conclusions: Multimorbidity is not limited to older adults, but is a common phenomenon among middle-aged people. Longitudinal research is needed to better understand the temporal relationship between lifestyle factors and multimorbidity.

Background: A large body of research shows that social isolation and loneliness have detrimental health consequences. Identifying individuals at risk of social isolation or loneliness is, therefore, important. The objective of this study was to examine personal (e.g., sex, income) and geographic (rural/urban and sociodemographic) factors and their association with social isolation and loneliness in a national sample of Canadians aged 45 to 85 years., Methods: The study involved cross-sectional analyses of baseline data from the Canadian Longitudinal Study on Aging that were linked to 2016 census data at the Forward Sortation Area (FSA) level. Multilevel logistic regression analyses were conducted to examine the association between personal factors and geographic factors and social isolation and loneliness for the total sample, and women and men, respectively., Results: The prevalence of social isolation and loneliness was 5.1% and 10.2%, respectively, but varied substantially across personal characteristics. Personal characteristics (age, sex, education, income, functional impairment, chronic diseases) were significantly related to both social isolation and loneliness, although some differences emerged in the direction of the relationships for the two measures. Associations also differed somewhat for women versus men. Associations between some geographic factors emerged for social isolation, but not loneliness. Living in an urban core was related to increased odds of social isolation, an effect that was no longer significant when FSA-level factors were controlled for. FSAs with a higher percentage of 65+ year old residents with low income were consistently associated with higher odds of social isolation., Conclusion: The findings indicate that socially isolated individuals are, to some extent, clustered into areas with a high proportion of low-income older adults, suggesting that support and resources could be targeted at these areas. For loneliness, the focus may be less on where people live, but rather on personal characteristics that place individuals at risk., Competing Interests: The authors have declared that no competing interests exist. The opinions expressed in this manuscript are the author’s own and do not reflect the views of the Canadian Longitudinal Study on Aging.

Background: The thick-skinned nose is still one of the most challenging aspects of rhinoplasty. The possible effects of oral isotretinoin on cosmetic results of rhinoplasty in patients with thick nasal skin have been considered during recent years., Methods: In this double-blind placebo-controlled clinical trial, 48 cases were divided into two groups randomly. Oral isotretinoin (0.5-mg/kg) was started on the 31st day after surgery and given every other day for 1 month and after that daily for two additional months in the first group. The second group received a placebo in the same form, sequence and interval as the first group. The cosmetic results based on patient satisfaction and ranking by an expert surgeon were compared between the two groups at 3 months, 6 months and 1 year after surgery., Results: Patient satisfaction and ranking by an expert surgeon in the isotretinoin group at 3 months and 6 months after surgery were significantly better than in the placebo group (p value < 0.05); however, at 12 months after surgery there was no statistically significant difference between the two groups (p value > 0.05)., Conclusion: Though postoperative use of oral isotretinoin in patients with thick nasal skin accelerates improvement in cosmetic results during the early months after surgery, it does not significantly affect the final cosmetic result 1 year after surgery., Level of Evidence Ii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background: According to the fact that women account for the highest rate of victims of mental health loss during disasters, prioritization of their requirements is of remarkable significance. Therefore, the present study was carried out with the aim to prioritize factors related to women's mental health during an earthquake., Methods: This study was conducted using the Delphi method in 2017. Participants consisted of experts including psychologists, counselors and psychiatrists, social medicine specialists, and psychiatric-mental health nurses with experience in service and disaster awareness, especially earthquake. They were selected using purposive and snowball sampling methods. The Delphi method was used in 2 rounds with 21 components and the final attendance of 19 participants and the collective agreement of 75%., Results: Of the 21 factors related to women's mental health during the earthquake, the following components were, respectively, preferred by the participants: psychological well-being training, group relationships and support of women in emergency situations, fair treatment in the provision of rights and services to women, crisis awareness and management of behavior and difficult conditions, and social security during disasters with the total mean standard deviation (SD) of 13.4 (2.4), 13.0 (2.4), 12.7 (2.5), 12.5 (2.4), and 12.3 (2.2), respectively., Conclusion: Training in the field of psychology and disasters, and social and cultural factors were prioritized among factors related to women's mental health during an earthquake. Therefore, the results of this study can be applied by the planners and executives of mental health, women and disasters, and the women's community itself., Competing Interests: Conflicts of interest: The authors declared no conflicts of interests.

Background: While higher rates and earlier onset of frailty have been reported among adults with intellectual and developmental disabilities (IDD), research on how best to support these individuals is lacking., Method: An international consultation relied on three consensus building methods: the Nominal Group Technique, an NIH consensus conference approach, and a Delphi survey., Results: There is agreement that person-centered planning and aging in place should be guiding principles. Frailty must be considered earlier than in the general population with the recognition that improvement and maintenance are viable goals. Intersectoral collaboration is needed to coordinate assessments and actions. Safety and planning for the future are important planning considerations, as are the needs of caregivers. Ongoing research is needed., Conclusion: The statement offers guidance to respond to frailty among adults with IDD and fosters ongoing exchange internationally on best practice. As new evidence emerges, the statement should be revisited and revised., (© 2018 John Wiley & Sons Ltd.)

Objectives: To determine recent mortality rates among Ontarian adults with intellectual and developmental disabilities (IDDs) and investigate changes over time in contrast to the general population. To determine the most commonly reported underlying causes of death and explore related coding practices., Methods: Using linked health administrative data, four cohorts of adults with IDD aged 25-99 living in Ontario were followed for 1 year (one cohort for each year between 2011 and 2014). Deaths (2011 to 2014) and causes of death (2011 to 2013) were identified, and age-standardized mortality rates were calculated annually. For 2013, overall and sex-specific standardized mortality ratios (SMRs) were calculated. Mortality ratios were also examined across 5-year age groups. Commonly reported causes of death were tabulated by ICD-10 chapter, differences by sex examined, and cause-specific SMRs calculated. All deaths with IDD diagnostic codes reported as underlying cause of death were identified., Results: Mortality rates among individuals with IDD have been decreasing over time; in 2014, the mortality rate was 22.6 deaths per 1000 person-years. Disparities in mortality rates relative to the general population decreased with increasing age. Men with IDD had higher mortality rates than women with IDD. The most common causes of death among individuals with IDD were cardiovascular disease, neoplasms, and diseases of the respiratory system. An IDD diagnostic code was reported as cause of death in 3.8% of cases., Conclusions: The ongoing excess mortality among Ontarians with IDD should be closely monitored by policy makers and service providers. Attention to cause of death reporting should be considered so that cause of death can be thoroughly examined.

It is well-documented that social isolation is detrimental to health and well-being. What is less clear is what types of social networks allow older adults to get the social support they need to promote health and well-being. In this study, we identified social network types in a national sample of older Canadians and explored whether they are associated with perceived availability of different types of social support (affectionate, emotional, or tangible, and positive social interactions). Data were drawn from the baseline questionnaire of the Canadian Longitudinal Study on Aging for participants aged 65-85 (unweighted n = 8,782). Cluster analyses revealed six social network groups. Social support generally declined as social networks became more restricted; however, different patterns of social support availability emerged for different social network groups. These findings suggest that certain types of social networks place older adults at risk of not having met specific social support needs.

Context: Considering the importance of psychological issues during disasters and the key role of women in the family and society, a preventive approach toward mental health improvement in women is of great importance., Aims: This study aimed to identify the mental health needs of women in natural disasters through a preventive approach., Settings and Design: The present qualitative study was conducted through content analysis method and semi-structured interviews with 40 specialists and seven women who had experienced natural disasters. The study participants were selected through snowball and purposive sampling., Subjects and Methods: A heterogeneous sample was selected. To ensure the reliability and verifiability of data, the texts of the interviews were approved by each interviewee., Statistical Analysis Used: Thematic analysis was used to report findings., Results: In this study, two themes, seven main categories, and 21 subcategories and secondary codes were extracted. The themes were internal physical (biological) and external environmental (social, political and legal measures, cultural and spiritual measures, psychology, and lifestyle) factors., Conclusions: The dimensions related to the mental health of women are multifactorial and beyond only psychological variables. The improvement of the mental health of women can be achieved through aggregation of perspectives in different organizational, governmental, and political areas in collaboration within the society with a healthy gender perspective free of discrimination, inequality, and injustice., Competing Interests: There are no conflicts of interest.

Aim and Background: Mental health and empowerment are two of the women's essential needs. These two related concepts play an important role in women's lives. Therefore, this study aimed to investigate empowerment of women and its relation with mental health problem prevention during difficult situations., Methods: This qualitative study was conducted through semi-structured interviews with 33 experts in the fields of psychology, social sciences, women studies, medicine and crisis management specialists using snowball sampling in cities of Tehran, Isfahan, Tabriz, and Mashhad during the year 1395 (March 2016-March 2017). Samples were selected heterogeneously. The interview transcripts and codes were presented to the participants, and structural analysis was used for data evaluation., Results: The factors related to empowerment of women with consideration to their mental health were determined based on Longew theory and interviews and include: welfare (primary needs (biological and security) and developmental needs (social needs and dignity), access (facilities and values), knowledge (about inequalities and rights), participation (in politics, decision-making and society), and control (implementation and institutionalization of the above-mentioned needs)., Conclusions: The indicators determined in this study show that empowerment has an important role in determining women's real position in society. Since women make up half of the population and affect society as a whole, the advantages of empowerment of women will be felt in the entire society., Competing Interests: There were no conflicts of interest in this study.