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Objective Hypoxic-ischemic encephalopathy (HIE) affects millions of newborns annually, especially in low-resource settings. Real-time monitoring of hypoxic-ischemic brain damage is urgently needed for assessment of severity and management of neonates with birth asphyxia. Aim of the work is monitoring of near-infrared spectroscopy (NIRS)-measured cerebral regional oxygen saturation (cRSO 2) and cerebral fractional tissue oxygen extraction (FTOE) in neonates after birth asphyxia in relation to their clinical course. Study Design Forty asphyxiated-term and near-term neonates with mild to severe HIE admitted at neonatal intensive care unit of Alexandria University Maternity Hospital from March to October 2019, received therapeutic hypothermia (TH) and had continuous NIRS monitoring of cRSO 2 for 72 hours. Infants were categorized into HIE with seizing and nonseizing groups, and abnormal and normal magnetic resonance imaging (MRI) groups. Results Clinical seizures (CS) occurred in 15 (37.5%) of HIE neonates and 13.3% of them died (n = 2). In the current study, significantly higher cRSO 2 and lower FTOE values were found in the seizing infants as compared with nonseizing group (p < 0.001). NIRS-measured day 2-cRSO 2 and day 1-FTOE were associated with CS in newborns with HIE and day 1-cRSO 2 and FTOE were associated with abnormal MRI at 1 month of age. cRSO 2 values were found to correlate positively with initial Thompson score especially in days 1 and 2. Further, neonates with CS were more likely to have MRI abnormalities at follow-up. Conclusion NIRS measures may highlight differences between asphyxiated neonates who develop CS or later MRI abnormalities and those who do not. Key Points Day 1 FTOE is the early and sensitive predictor for both clinical seizures and abnormal MRI. Cerebral oxygenation metrics help in selecting patients in urgent need of an early MRI scan. Cerebral oxygenation metrics can be used hand in hand with clinical assessment using Thompson score at admission to select patient candidate for therapeutic hypothermia. [ABSTRACT FROM AUTHOR]

While there have been notable advancements in child health in Egypt, disparities in child mortality still exist. Understanding these disparities is crucial to addressing them. The objective of this study is to explore the factors linked to child mortality in Egypt, providing a comprehensive understanding of the disparities in child mortality rates. The study utilises cross-sectional data from Egypt's Demographic and Health Survey (EDHS) in 2014 to examine child mortality. The dataset consists of 15,848 observations from mothers with children born within five years prior to the survey. The choice of explanatory variables was guided by the Mosely and Chen Framework and logistic multivariate regression was used to conduct the analyses. The study finds lower education, early childbearing, insufficient birth spacing, lack of breastfeeding, and absence of improved toilet facilities (proxy for living conditions) were all significantly linked to an increased likelihood of child loss. Additionally, poorer people in rural settings experienced the worst child mortality. The findings align with the World Health Organization's Conceptual Framework for Action on the Social Determinants of Health (CSDH). Recommended policy interventions include targeting women in rural areas, improving living conditions and removing financial/other barriers to accessing care. [ABSTRACT FROM AUTHOR]

Unstable hemodynamics and prematurity are the main players in intraventricular hemorrhage (IVH) development. Our objective was to study 8 the use of superior vena cava flow (SVCF), left ventricular output (LVO), and right ventricular output (RVO), and anterior cerebral artery (ACA) Doppler measures in prediction of IVH in the first week of life in preterm infant ≤ 32 weeks and birth weight ≤ 1500 g. This prospective cohort study was conducted in 55NICU of Alexandria University maternity hospital. Of 147 enrolled patients, 132 infants born ≤ 32 weeks GA and birth weight ≤ 1500 g were eligible for- the study. One hundred twenty-seven infants completed the study. Infants were scanned for ACA-RI using transfontanellar ultrasound, and SVCF, LVO, and RVO using functional echocardiography in the first 24 h after birth. Patients had another two scans on DOL3 and 7 to detect IVH development. Low SVCF and high ACA-RI significantly increased the risk of IVH using logistic regression models with OR, 3.16; 95%CI, 1.19–8.39; P = 0.02 and OR, 1.64; 95%Cl, 1.10–2.44; P = 0.02, respectively. Low SVCF and high ACA-RI significantly increased risk of catastrophic IVH P = 0.025 and 0.023, respectively. Combined use of low SVCF < 55 ml/kg/min and ACA-RI > 0.75 is predictor of IVH with sensitivity 40.8% and 82.1% specificity. Conclusions: There are strong relations between both low SVCF and high ACA-RI, and IVH development in premature neonates ≤ 32 weeks and birth weight ≤ 1500 g, with more significance towards catastrophic IVH. Admission RSS and LVO are the strongest factors affecting SVCF. Maternal anemia, patent ductus arteriosus size (mm/kg), and capillary refill time were significantly associated with high ACA-RI. These findings help in more understanding of pathophysiological factors affecting central perfusion that might affect the longer term neurodeveopmental outcome. Trial registration: This work was registered in clinical trial.gv no NCT05050032. What is Known: •Whether SVCF and RI-ACA can predict IVH in preterm neonates is still debatable. What is New: •Low SVC flow and high ACA-RI significantly increased risk of IVH, confirming the role of hypoperfusion-reperfusion cycle in IVH development. The most striking result that combined metrics using the cut-off value of < 41 ml/kg/min for SVCF and > 0.85 for ACA-RI "in the first day of life" can correctly reject the presence of IVH in 98% of patients "during the first week of life." [ABSTRACT FROM AUTHOR]

Despite of growing evidence of the beneficial effects of placental transfusion techniques, there is no available sufficient data about their effects on vulnerable hemodynamics and myocardium of premature infants. The purpose of this work is to study ventricular functions and hemodynamics after applying different placental transfusion techniques, delayed cord clamping (DCC), cut cord milking (C-UCM), and intact cord milking (I-UCM). Sixty-four infants delivered whether by C-section or vaginal delivery were randomly assigned to undergo C-UCM (20–30 cm), I-UCM (3–4 strippings), and DCC (30–60 s). Functional echocardiography was done on day 1 and day 3 of life for 57 infants. Primary outcome variable was superior vena cava flow measurement in infants having placental transfusion in the first 24 h of life and between 64 and 72 h. Secondary outcomes were other echocardiographic and clinical hemodynamic parameters, and biventricular functions in those infants. Of a total 196 preterm infants ≤ 32 weeks delivered in the study period, from January 2021 to August 2021, 57 infants were eligible and survived till the second examination. They were randomly assigned to the three groups. Neonates randomly assigned to DCC had significantly higher superior vena cava flow and lower right ventricular systolic function in the first 24 h of life. This finding vanished at day 3. Neonates undergone different methods of placental transfusions had similar hemoglobin, admission temperature, and mean blood pressure in the first 24 h of life. Conclusion: Despite their potential benefits, placental transfusions have shown to alter the hemodynamics and adversely affect myocardial function of premature neonates. Trial registration: This trial was registered in the clinical trial gov NCT04811872. What is Known: • Placental transfusion techniques might have benefits regarding prematurity- related morbidities and mortality. What is New: • Placental transfusion might adversely affect the myocardium and alter hemodynamics in premature infants. [ABSTRACT FROM AUTHOR]

The present work were determined to evaluate the latent effect of three acaricides Ortus Super®5%EC, Vertimec® 1.8% EC and Delmite®7.5% SC on the biological aspects of the coccinellid predator, Stethorus gilvifrons Mulsant as predator of the tow spotted mite, Tetranychus urticae Koch at laboratory conditions (30±1◦C and 70±5% RH.). All experimented acaricides were affected on the biology of S. gilvifrons. Vertimec® was the most effective on T. urticae and associated predator, S. gilvifrons than Ortus Super® and Delmite®. Using Delmite® proved to be the safest amongst other acaricides on this predator. [ABSTRACT FROM AUTHOR]

The aim of this study is to study cardio-respiratory effects of nasal high-frequency oscillatory ventilation (NHFOV) vs. NCPAP as an initial mode of ventilation in moderate-late-preterm infants. A randomized controlled trial was conducted in NICU of Alexandria University Maternity Hospital (AUMH). One-hundred late-moderate-preterm infants were randomly assigned to either NHFOV-group (n = 50) or NCPAP-group (n = 50). For both groups, functional echocardiography was performed in the first 24 h to detect hemodynamic changes and respiratory outcome was monitored throughout the hospital stay. The main outcomes were hemodynamic measurements and myocardial function using functional echocardiography of those infants along with the respiratory outcome and complications. Kaplan–Meier survival plot was used representing time course of NCPAP and NHFOV failure. Left ventricular output values were not significantly different in both groups with median 202 ml/kg /min and IQR (176–275) in NCPAP-group and 226 ml/kg/min with IQR (181–286) in NHFOV group. Nevertheless, ejection fraction and fractional shortening were significantly higher in NHFOV-group with P 0.001. The time to weaning, the time to reach 30%-FIO2, the need for invasive ventilation, oxygen support duration, and maximal-FIO2 were significantly more in NCAPAP group.     Conclusion: NHFOV is an effective and promising tool of non-invasive-ventilation which can be used as a primary modality of respiratory support in preterm infants with variable forms of respiratory distress syndrome without causing detrimental effect on hemodynamics or significant respiratory complications.     Trial registration: NCT05706428 (registered on January 21, 2023).What is Known:• NHFOV might be beneficial as a secondary mode of ventilation and might have an impact on hemodynamics.What is New:• NHFOV can be used as an initial mode of ventilation with CDP beyond the reported pressure limits of CPAP without causing neither CO2 retention nor adverse hemodynamic consequences.What is Known:• NHFOV might be beneficial as a secondary mode of ventilation and might have an impact on hemodynamics.What is New:• NHFOV can be used as an initial mode of ventilation with CDP beyond the reported pressure limits of CPAP without causing neither CO2 retention nor adverse hemodynamic consequences. [ABSTRACT FROM AUTHOR]

The effect of Gaussian dynamics on the line shapes in linear absorption and two-dimensional correlation spectroscopy is well understood as the second-order cumulant expansion provides exact spectra. Gaussian solvent dynamics can be well analyzed using slope line analysis of two-dimensional correlation spectra as a function of the waiting time between pump and probe fields. Non-Gaussian effects are not as well understood, even though these effects are common in nature. The interpretation of the spectra, thus far, relies on complex case to case analysis. We investigate spectra resulting from two physical mechanisms for non-Gaussian dynamics, one relying on the anharmonicity of the bath and the other on non-linear couplings between bath coordinates. These results are compared with outcomes from a simpler log-normal dynamics model. We find that the skewed spectral line shapes in all cases can be analyzed in terms of the log-normal model, with a minimal number of free parameters. The effect of log-normal dynamics on the spectral line shapes is analyzed in terms of frequency correlation functions, maxline slope analysis, and anti-diagonal linewidths. A triangular line shape is a telltale signature of the skewness induced by log-normal dynamics.We find that maxline slope analysis, as for Gaussian dynamics, is a good measure of the solvent dynamics for log-normal dynamics. [ABSTRACT FROM AUTHOR]

The effect of Gaussian dynamics on the line shapes in linear absorption and two-dimensional correlation spectroscopy is well understood as the second-order cumulant expansion provides exact spectra. Gaussian solvent dynamics can be well analyzed using slope line analysis of two-dimensional correlation spectra as a function of the waiting time between pump and probe fields. Non-Gaussian effects are not as well understood, even though these effects are common in nature. The interpretation of the spectra, thus far, relies on complex case to case analysis. We investigate spectra resulting from two physical mechanisms for non-Gaussian dynamics, one relying on the anharmonicity of the bath and the other on non-linear couplings between bath coordinates. These results are compared with outcomes from a simpler log-normal dynamics model. We find that the skewed spectral line shapes in all cases can be analyzed in terms of the log-normal model, with a minimal number of free parameters. The effect of log-normal dynamics on the spectral line shapes is analyzed in terms of frequency correlation functions, maxline slope analysis, and anti-diagonal linewidths. A triangular line shape is a telltale signature of the skewness induced by log-normal dynamics.We find that maxline slope analysis, as for Gaussian dynamics, is a good measure of the solvent dynamics for log-normal dynamics. [ABSTRACT FROM AUTHOR]

Background Lactoferrin (LTF) is a promising drug in the prevention of late-onset sepsis (LOS) in preterm infants as it causes priming of the immune system before the occurrence of insult. Aim The aim of this study is to evaluate the effect of LTF in the prevention of LOS. Participants and methods Preterm infants of gestational age less than or equal to 34 weeks showing no signs of sepsis in the first 72 h and admitted to NICU of Alexandria University Children Hospital from August 2019 to April 2020 were included in this study. Fifty six patients were randomly allocated into two groups: LTF group (n=28 patients) and control group (n=28 patients). Patients in the LTF group received LTF for 28 days postnatally or till 36 weeks postmenstrual age, whichever is reached first. All patients were monitored for development of LOS. Results Compared with the control group, LTF treatment was associated with a significantly lower incidence of culture-proven LOS (8/28 vs. 2/28, respectively) with a P value of 0.036. The administration of LTF decreased the serum C-reactive protein level at the end of the study in comparison with the level at the beginning of the study in the LTF group, with a mean value of 5.44±16.18 versus 3.71±2.57, respectively (P=0.021), and in comparison with the control group, with a mean value of 5.44 ±16.18 versus 27.45±55.20, respectively (P=0.021). Conclusion LTF reduces the incidence of culture-proven LOS in preterm neonates aged less than or equal to 34 weeks. LTF has been proven to have antiinflammatory properties through its ability to decrease the C-reactive protein level. [ABSTRACT FROM AUTHOR]

Introduction: The prostate-specific antigen (PSA) test is used in Canada to detect prostate cancer (PCa) despite mixed recommendations. Complications arising from false-positives are common, posing as a cancer-screening concern. This work estimates some Canadian rates of PSA screening and identifies men at increased odds for PSA screening. Methods: The Canadian Community Health Survey (CCHS) from 2009/10 (Atlantic Canada; ATL), 2011/2012 (Ontario; ON), and 2013/2014 (Quebec; QC) were used. Lifetime and recent PSA screening with confidence intervals were constructed to estimate PSA screening in ATL, ON, and QC. Two logistic regression models (for men <50 and =50 years of age) were used to determine associations between factors and lifetime PSA screening. Results: PSA screening rates have increased in most age groups for ATL, ON, and QC since 2000/2001. Factors positively associated with lifetime PSA screening in men of all ages were: having a digital rectal exam, having a regular doctor, and having a colorectal exam. Fruit and vegetables consumption and non-smoking status were positively associated with lifetime PSA screening in men <50 years of age. High income and the presence of chronic health conditions were positively associated with lifetime PSA screening in men =50 years of age. Conclusions: PSA screening rates have generally increased since 2000/2001 in Canada. Physician-related factors play a role in men at all ages, while different factors are associated in men <50 years of age and men =50 years of age. Limitations include the generalizability to all of Canada and the potential for recall bias. [ABSTRACT FROM AUTHOR]

Nonequilibrium Molecular Dynamics (MD) simulations coupled to instantaneous normal modes (INMs) analysis are used to study the vibrational relaxation of the acetyl and amino-end amide I modes of the alanine dipeptide (AlaD) molecule dissolved in water (D2O). The INMs are assigned in terms of the equilibrium normal modes using the Effective Atomic Min-Cost algorithm as adapted to make use of the outputs of standard MD packages, a method which is well suited for the description of flexible molecules. The relaxation energy curves of both amide I modes show multiexponential decays, in good agreement with the experimental findings. It is found that ∼85%-90% of the energy relaxes through intramolecular vibrational redistribution. The main relaxation pathways are also identified. The rate at which energy is transferred into the solvent is similar for the acetyl-end and amino-end amide I modes. The conformational changes occurring during relaxation are investigated, showing that the populations of the alpha and beta region conformers are altered by energy transfer in such a way that it takes 15 ps for the equilibrium conformational populations to be recovered after the initial excitation of the AlaD molecule. [ABSTRACT FROM AUTHOR]

There are knowledge gaps in our understanding of the development of chronic disease risks in children, especially with regard to the risk differentials experienced by immigrants and refugees. The Healthy Immigrant Children study employed a mixed-methods cross-sectional study design to characterize the health and nutritional status of 300 immigrant and refugee children aged 3–13 years who had been in Canada for less than 5 years. Quantitative data regarding socioeconomic status, food security, physical activity, diet, and bone and body composition and anthropometric measurements were collected. Qualitative data regarding their experiences with accessing health care and their family lifestyle habits were gathered through in-depth interviews with the parents of newcomer children. Many newcomers spoke about their struggles to attain their desired standard of living. Regarding health outcomes, significantly more refugees (23%) had stunted growth when compared with immigrants (5%). Older children, those with better-educated parents, and those who consumed a poorer-quality diet were at a higher risk of being overweight or obese. Sixty percent of refugees and 42% of immigrants had high blood cholesterol. Significant health concerns for refugee children include stunting and high blood cholesterol levels, and emerging trends indicate that older immigrant children from privileged backgrounds in low-income countries may be more at risk of overweight and obesity. A variety of pathways related to their families' conceptualization of life in Canada and the social structures that limit progress to meeting their goals likely influence the development of health inequity among refugee and immigrant children. Public health initiatives should address these health inequities among newcomer families. [ABSTRACT FROM AUTHOR]

Ultrafast photochemical reactions are initiated by vibronic transitions from the reactant ground state to the excited potential energy surface, directly populating excited-state vibrational modes. The primary photochemical reaction of vision, the isomerization of retinal in the protein rhodopsin, is known to be a vibrationally coherent reaction, but the Franck–Condon factors responsible for initiating the process have been difficult to resolve with conventional time-resolved spectroscopies. Here we employ experimental and theoretical 2D photon echo spectroscopy to directly resolve for the first time the Franck–Condon factors that initiate isomerization on the excited potential energy surface and track the reaction dynamics. The spectral dynamics reveal vibrationally coherent isomerization occurring on the fastest possible time scale, that of a single period of the local torsional reaction coordinate. We successfully model this process as coherent wavepacket motion through a conical intersection on a ∼30 fs time scale, confirming the reaction coordinate as a local torsional coordinate with a frequency of ∼570 cm–1. As a result of spectral features being spread out along two frequency coordinates, we unambiguously assign reactant and product states following passage through the conical intersection, which reveal the key vibronic transitions that initiate the vibrationally coherent photochemistry of vision. [ABSTRACT FROM AUTHOR]

Life history of the parasitoid species, Habrobracon hebetor Say (Hymenoptera: Braconidae) was studied in the laboratory when parasitizing larvae of Cadra cautella (Walker) (Lepidoptera: Pyralidae) infesting stored date fruits. Mean adult longevity was 7.9 and 6.6 days for female and male, respectively. Pre-ovopositional and ovipositional periods lasted < 12h and 7.4 days, respectively. Total number of eggs/ female was 69.3 eggs, with a mean of 9.45 eggs/ day. Mean durations of immature stages reached 14.99 hrs, 2.48 and 5.65 days for egg, larval and pupal stages, respectively. Egg hatchability, pupation and adult emergence recorded more than 95%. The larvae of H. hebetor could externally parasitize all larval instars of C. cautella. However, the parasitoid preferred late larval instars of C. cautella. Parasitism rate was significantly different among the instars. [ABSTRACT FROM AUTHOR]

The notable increases in funding from various donors for health over the past several years have made examining the effectiveness of aid all the more important. We examine the extent to which donor funding for health substitutes for-rather than complements-health financing by recipient governments. We find evidence of a strong substitution effect. The proportionate decrease in government spending associated with an increase in donor funding is largest in low-income countries. The results suggest that aid needs to be structured in a way that better aligns donors' and recipient governments' incentives, using innovative approaches such as performance-based aid financing. [ABSTRACT FROM AUTHOR]

Introduction Thyroid hormones have direct and indirect cellular effects on the cardiovascular system. Chronic administration of L-thyroxine (LT4) to children with hypothyroidism may affect cardiovascular dynamics. Aim This cross-sectional observational study measured the blood pressure (BP) and heart rate (HR) of 25 randomly selected children with hypothyroidism in relation to their serum-free thyroxine (FT4), thyroid-stimulating hormone (TSH) levels, and thyroxine dose μg/kg. Patients and methods In total, 25 randomly selected children with a mean age 9.6±4.5 years with the diagnosis of congenital or acquired hypothyroidism. They were on l-thyroxine therapy to keep serum-FT4 and TSH in the normal range for age. Their BP and HR (average of three readings), weight, height, dose of thyroxine, and their serum level of TSH and free T4 levels within 2 weeks before the clinic visit were recorded. The Z scores of the height, height standard deviation score (HSDS), body mass index standard deviation score (BMISDS), systolic (SBPSDS), and diastolic blood pressure standard deviation score (DBPSDS) were calculated (as per the 2004 guideline report on hypertension from the National Heart and Lung Institute), and HR [as per the Monitoring and Diagnosis Group at Oxford (MADOX) systematic review of 2011] was calculated for age and sex. Results The authors studied 25 children with hypothyroidism. Their dose of thyroxine was 2.11±0.7 μg/kg. Their mean serum-FT4 levels were 15.1±2.5 μg/l and TSH level was 3.9±2.8 mIU/ml. Their HtSDS (-0.57±1.4) and BMISDS (0.63±1.63) were within normal. All had normal diastolic blood pressure readings (within 2 standard deviations of the mean for age and sex). Two of the individuals had systolic BPs greater than 2SDS above the mean for age and sex, with normal BMISDS. Both had normal FT4 and TSH levels. One patient had tachycardia [HR=146/min (Z-score +3.2 for age)]. His FT4 and TSH levels were normal. There was a positive correlation between thyroxine dose/kg and serum level of FT4 (r=0.52), HR (r=0.56), SBPSDS (r=0.38), and DBPSDS (r=0.24). There was no significant correlation between the HtSDS on the one hand and FT4, TSH, or thyroxine dose on the other hand. The BMISDS was negatively correlated with TSH level (r=-0.4). Conclusion In this study on hypothyroid children on l-thyroxine therapy, 2 had high systolic BP and one had tachycardia. The significant correlation between the thyroxine dose, FT4 level, and BP and HR should alert the pediatrician to monitor BP andHR closely in relation to TSH and FT4 levels of these patients. [ABSTRACT FROM AUTHOR]

A method is proposed to analyze the intra- and intermolecular vibrational energy flow occurring in biomolecules in solution during relaxation processes. It is based on the assumption that the total energy exchanged between the vibrational modes is minimal and the global process is essentially statistical. This statistical minimum flow method is shown to provide very useful information about the amount and the rate at which energy is transferred between the individual vibrations of the molecule. To demonstrate the performance of the method, an application is made to the relaxation of the amide I mode of N-methylacetamide-d in aqueous D2O solution which yields a detailed quantitative description of the process. [ABSTRACT FROM AUTHOR]

Research approaches that cross disciplinary silos, industry sectors, and political borders are now increasingly prioritized for tackling issues of global concern. Nevertheless, team science can be challenging. The goal of this article is to help researchers proactively consider factors influencing conflicts and successes with an emphasis on the health sciences. [ABSTRACT FROM AUTHOR]

Background Cardiac troponins (cTn) are markers of myocardial injury with well established diagnostic value in adults. However, the benefits of using troponins in neonates with critical duct-dependent congenital cardiac diseases (cDD-CHDs) is questionable. Aim The study aimed to investigate the diagnostic role of cTnI in cDD-CHDs as a marker of myocardial injury and to explore its role in patient's outcome. Methods A case-control study, conducted over 80 neonates; Group I: Forty neonates with cDD-CHDs and Group II: Forty healthy neonates. CBC, CRP, electrolytes, liver and kidney functions, cTnI and echocardiography were done for both groups in first week of life. Then serum level of cTnI were re-evaluated after 3 weeks from initial sampling. Results The mean value of serum cTnI was significantly higher among cases when compared to controls (0.91±1.88 ng/ml versus 0.003±0.006 ng/ml, P<0.001*). The diagnostic performance of cTn I for cardiac injury was at cut-off 0.03 ng/ml with sensitivity 65% and specificity 97.5%. However, the prognostic role of cTnI in predicting death was at serum level of 0.7 ng/ml with 61% sensitivity and 81% specificity. cTn I in cDD-CHD was positively correlated to the severity of heart failure (HF) based on Modified Ross Score. The mean value of survival of the cDD-CHDs neonates was 28.11 days when cTnI is >0.6 ng/ml. Conclusion Initial serum levels of cTnI of cDD-CHD neonates in first week of life might be a useful marker in predicting the 40-days-survival and outcome. [ABSTRACT FROM AUTHOR]

Background: This study aims to summarise and describe the evolution of published economic evaluations of vaccines in Canada, thereby outlining the current state of this expanding and meaningful research. Methods: Using Arksey and O'Malley's scoping review framework we assembled relevant research from both academic and grey literature. Following abstract and full-text review we identified 60 articles to be included in the final analysis. Results: We found that since 1988 there has been a steady increase in the number of economic evaluations on vaccines in Canada. Many of these studies focus on the more recently licensed vaccines, such as influenza (16.7%), human papillomavirus (15.0%) and pneumococcal disease (15.0%). Since 2010 economic evaluations of vaccines have shown increased adherence to economic evaluation guidelines (OR = 4.6, CI 1.33, 18.7), suggesting there has been improvement in the consistency and transparency of these studies. However, there remains room for improvement, for instance, we found evidence that studies who stated a conflict of interest are more likely to assert the vaccine of interest was cost-effective (OR = 7.4; CI 1.04, 17.8). Furthermore, most reports use static models that do not consider herd immunity, and only a few evaluate vaccines post-implementation (ex-post) and traveller's vaccinations. Conclusion: Researchers should examine identified research gaps and continue to improve standardization and transparency when reporting to ensure economic evaluations of vaccines best meet the needs of policy-makers, other researchers and the public. [ABSTRACT FROM AUTHOR]

Echinococcosis is a rare but endemic condition in people in Canada, caused by a zoonotic cestode for which the source of human infection is ingestion of parasite eggs shed by canids. The objectives of this study were to identify risk factors associated with infection and to measure the cost-utility of introducing an echinococcosis prevention program in a rural area. We analyzed human case reports submitted to the Canadian Institutes for Health Information between 2002 and 2011. Over this 10 year period, there were 48 cases associated with E. granulosus/E. canadensis, 16 with E. multilocularis, and 251 cases of echinococcosis for which species was not identified (total 315 cases). Nationally, annual incidence of echinococcosis was 0.14 cases per 100 000 people, which is likely an underestimate due to under-diagnosis and under-reporting. Risk factors for echinococcosis included female gender, age (>65 years), and residing in one of the northern territories (Nunavut, Yukon, or Northwest Territories). The average cost of treating a case of cystic echinococcosis in Canada was $8,842 CAD. Cost-utility analysis revealed that dosing dogs with praziquantel (a cestocide) at six week intervals to control cystic echinococcosis is not currently cost-effective at a threshold of $20,000-100,000 per Quality Adjusted Life Year (QALY) gained, even in a health region with the highest incidence rate in Canada ($666,978 -755,051 per QALY gained). However, threshold analysis demonstrated that the program may become cost-saving at an echinococcosis incidence of 13-85 cases per 100,000 people and therefore, even one additional CE case in a community of 9000 people could result in the monetary benefits of the program outweighing costs. [ABSTRACT FROM AUTHOR]

Introduction Physiologically, growth hormone (GH) increases lean body mass and has a lipolytic function. However, long-term changes in weight status during GH treatment, as a function of pretreatment weight status have not previously been reported in large data sets. Aim To identify the growth response to GH therapy in those who were before treatment underweight versus normal weight short children. Patients and methods A retrospective study, we studied the auxologic data of 78 short, prepubertal children [height standard deviation score (HtSDS) less than -2 SDS below the mean for age and sex] with normal GH secretion [idiopathic short stature (ISS)]. Two groups were identified according to their pretreatment body mass index standard deviation score (BMISDS). Nineteen children were underweight (BMISDS < -2) and 59 children had normal BMISDS (>-2). All children received daily subcutaneous dose of GH (0.03-0.05 mg/kg/day) to keep their insulin-like growth factor-1 (IGF-1) level between 0 and 2 SD for 2 years. Results Before GH treatment, the underweight ISS group had significantly lower IGF-1 level versus the normal weight group with IGF-1 SD -1.633±0.766 SD versus -0.749 ±1.197 SD, respectively. Age and HtSDS did not differ among the two underweight and normal weight groups. Treatment with GH for 2 years was associated with a significant increase in the BMISDS in the underweight group (BMISDS increased by 0.45 SD) from -2.063±0.344 before treatment with GH versus -1.633±0.766 after treatment but not in the normal weight group. The HtSDS increased significantly in both groups after GH therapy, but the increase was greater in children with normal weight versus those with underweight as the increment in HtSDS was 0.42 and 0.374 SD, respectively. The difference of HtSDS from mid-parental HtSDS in low BMI versus normal BMI groups was -0.91 and -1.212 SD, respectively Conclusions GH therapy for 2 years significantly increased the IGF-1 level and improved BMISDS and HtSDS in underweight children with ISS. The BMISDS was better in the underweight group, but their HtSDS was less compared with the normal weight group. [ABSTRACT FROM AUTHOR]

This study is to examine the cost-effectiveness of deployment strategies of oral cholera vaccines (OCVs) in controlling cholera in Bangladesh. We developed a dynamic compartment model to simulate costs and health outcomes for 12 years for four OCVs deployment scenarios: (1) vaccination of children aged one and above with two doses of OCVs, (2) vaccination of population aged 5 and above with a single dose of OCVs, (3) vaccination of children aged 1–4 with two doses of OCVs; and (4) combined strategy of (2) and (3). We obtained all parameters from the literature and performed a cost-effectiveness analysis from both health systems and societal perspectives, in comparison with the base scenario of no vaccination. The incremental cost-effectiveness ratios (ICERs) for the four strategies from the societal perspective were $2,236, $2,250, $1,109, and $2,112 per DALY averted, respectively, with herd immunity being considered. Without herd immunity, the ICERs increased substantially for all four scenarios except for the scenario that vaccinates children aged 1–4 only. The major determinants of ICERs were the case fatality rate and the incidence of cholera, as well as the efficacy of OCVs. The projection period and frequency of administering OCVs would also affect the cost-effectiveness of OCVs. With the cut-off of 1.5 times gross domestic product per capita, the four OCVs deployment strategies are cost-effective. The combined strategy is more efficient than the strategy of vaccinating the population aged one and above with two doses of OCVs and could be considered in the resource-limited settings. [ABSTRACT FROM AUTHOR]

Background: Inequalities in the use of postnatal care services (PNC) in Ghana have been linked to poor maternal and neonatal health outcomes. This has ignited a genuine concern that PNC interventions with a focus on influencing solely individual-level risk factors do not achieve the desired results. This study aimed to examine the community-level effect on the utilization of postnatal care services. Specifically, the research explored clusters of non-utilization of PNC services as well as the effect of community-level factors on the utilization of PNC services, with the aim of informing equity-oriented policies and initiatives.Methods: The 2014 Ghana Demographic and Health Survey GDHS dataset was used in this study. Two statistical methods were used to analyze the data; spatial scan statistics were used to identify hotspots of non-use of PNC services and second two-level mixed logistic regression modeling was used to determine community-level factors associated with PNC services usage.Results: This study found non-use of PNC services to be especially concentrated among communities in the Northern region of Ghana. Also, the analyses revealed that community poverty level, as well as community secondary or higher education level, were significantly associated with the utilization of PNC services, independent of individual-level factors. In fact, this study identified that a woman dwelling in a community with a higher concentration of poor women is less likely to utilize of PNC services than those living in communities with a lower concentration of poor women (Adjusted odds ratio (AOR) = 0.60, 95%CI: 0.44-0.81). Finally, 24.0% of the heterogeneity in PNC services utilization was attributable to unobserved community variability.Conclusion: The findings of this study indicate that community-level factors have an influence on women's health-seeking behavior. Community-level factors should be taken into consideration for planning and resource allocation purposes to reduce maternal health inequities. Also, high-risk communities of non-use of obstetric services were identified in this study which highlights the need to formulate community-specific strategies that can substantially shift post-natal use in a direction leading to universal coverage. [ABSTRACT FROM AUTHOR]

Adolescents and young adults are the main perpetrators and victims of violence in almost all parts of the world. Theories of human behavior predict that the intention to behave violently is formed in part by the individual's attitude toward violent behavior. The purpose of this study was thus to investigate factors which both promote and protect against violent youth attitudes in Toronto, Canada's largest urban center. Multinomial logit models were fit separately for males and females in Grades 7 to 9 using cross-sectional data from the 2006 International Youth Survey. Odds ratios were estimated for the associations between levels of attitude toward violence and select factors in each of the biological, familial, peer-related, school and community domains. A graded effect of school attachment on violent attitude was observed for both sexes; male and female students who do not like school at all are 9.89 (3.15-31.0) and 6.49 (2.19-19.2) times as likely as those who like school a lot to have the "most" versus "least" violent attitude, respectively. For every one-unit increase in (negative) perception of neighborhood score, male and female students are 1.15 (1.07-1.23) and 1.20 (1.12-1.28) times as likely to have the "most" versus "least" violent attitude. The number of victimization events was associated with attitude toward violence in males but not females, while the reverse was true for academic performance and exposure to prejudice. Our findings highlight the important relationships between connections to social environments and youth attitudes toward violence, and identify modifiable factors which may be amenable to intervention. Sex-specific differences in the predictors of violent youth attitudes warrant additional investigation and have implications for policy design. [ABSTRACT FROM AUTHOR]

Objectives: The value of chickenpox vaccination is still debated in the literature and by jurisdictions worldwide. This uncertainty is reflected in the inconsistent uptake of the vaccine, where some countries offer routine childhood immunization programs, others have targeted programs, and in many the vaccine is only privately available. Even across the countries that have universal funding for the vaccine, there is a diversity of schedules and dosing intervals. Using an agent-based model of chickenpox and shingles, we conducted an economic evaluation of chickenpox vaccination in Alberta, Canada.Methods: We compared the cost-effectiveness of 2 common chickenpox vaccination schedules, specifically a long dosing interval (first dose: 12 months; second dose: 4-6 years) and a short dosing interval (first dose: 12 months; second dose: 18 months).Results: The economic evaluation demonstrated a shorter dosing interval may be marginally preferred, although it consistently led to higher costs from both the societal and healthcare perspectives. We found that chickenpox vaccination would be cost-saving and highly cost-effective from the societal and healthcare perspective, assuming there was no impact on shingles.Conclusion: Chickenpox vaccine was cost-effective when not considering shingles and remained so even if there was a minor increase in shingles following vaccination. However, if chickenpox vaccination did lead to a substantial increase in shingles, then chickenpox vaccination was not cost-effective from the healthcare perspective. [ABSTRACT FROM AUTHOR]

The present study comparatively assesses how Afghan refugees in Pakistan understand both the factors and barriers affecting their food security status before and after refuge. Through qualitative in-depth interviews with 25 Afghan refugee families, we assess how quality of life, together with perceptions of a balanced meal, food environments both pre- and post-migration and push and pull factors of migration, impact food security and food choices for refugee families. Furthermore, our results reveal that regardless of the length of protracted status for Afghan refugees, food insecurity remains as a consistent condition for refugee families. [ABSTRACT FROM AUTHOR]

Nitrogen management is the major challenge due to narrow understanding of yield and N uptake relationship on salt-affected soils. To address this problem, a lysimeter experiment for rice and wheat was conducted on salt-affected soil with two lower (15 and 30 %) and three higher N rates (15, 30 and 45 %) with 50 and 100 % SGR. NO3 - leaching was greater with higher N rates (up to 188 mg Leachate-1) in rice as compared to wheat. After the harvesting of rice and wheat, maximum decrease in soil pHs (7.75 %), ECe (41.50 %), SAR (63.64 %) was with N130 G100 which indicated that applied gypsum 100 % SGR with higher N rate ameliorated the soil more efficiently as compared to 50 % SGR. The highest yields recorded with N130 + 100 % SGR. The highest NUE (15.88 g/g) was with treatment G100 N130 in rice but in wheat (NUE, 44.76 g/g) G100 N70 proved to be the best. It was concluded that G100 N130 proved to be the best and reduced the environmental risks. [ABSTRACT FROM AUTHOR]

Background Pregnancy termination is an illegal medical procedure in Ghana and 88% of induced abortions are performed in unsafe conditions, thus recipients face an elevated risk of abortion-related complications. This study aims to explore the associations between sociodemographic factors and reporting having terminated a pregnancy among Ghanaian women. Methods Logistic regression models were estimated using data from the 2014 Ghana Demographic and Health Survey (n=9396). ORs were computed for the associations between reporting pregnancy termination and select demographic and socio-economic factors. Results Education level, employment status, financial status and marital status of women are significantly associated with reporting having terminated a pregnancy. Conclusions Women who are employed, cohabit with a partner and are considered middle class or wealthy are more likely than their counterparts to report having terminated a pregnancy. Ghanaian women with intermediate levels of education are more likely than both their more- and less-educated counterparts to report having terminated a pregnancy. These findings highlight the need for the development of policies aimed at reducing unsafe abortions associated with unintended pregnancies. Specific recommendations include providing family planning education and outreach to high-risk groups to reduce unintended pregnancies and improving working conditions for expectant mothers, including provisions for paid maternity leave and job protection. [ABSTRACT FROM AUTHOR]

Research evidence suggests that the prevalence of mental health conditions in Canada has increased while a considerable percentage of people with a mental health issue do not seek professional mental health services. Weighted logistic regression models were used to determine whether age, sex, income, and education predict the self-reported mental health status of Canadians and their odds of utilizing mental health services. This study found clear disparities in reporting mental health and utilization of mental health services. Young adults (aged 25 to 44) have 1.4 times (95% CI: 1.3 to 1.6 times) higher odds of reporting poorer mental health status than seniors (aged 65 or older). Females are 2.7 times (95% CI: 2.3 to 3.1 times) more likely to utilize mental services than males. The lowest income group (<$15,000) has 2.2 times (95% CI: 1.9 to 2.4 times) higher odds of rating poorer mental health status than the highest income group (>$80,000). The least educated group (

Cryptosporidium is a leading cause of pediatric diarrhea in resource-limited settings; yet, few studies report the health care costs or societal impacts of this protozoan parasite. Our study examined direct and indirect costs associated with symptomatic cryptosporidiosis in infants younger than 12 months in Kenya, Peru and Bangladesh. Inputs to the economic burden model, such as disease incidence, population size, health care seeking behaviour, hospital costs, travel costs, were extracted from peer-reviewed literature, government documents, and internationally validated statistical tools for each country. Indirect losses (i.e. caregiver income loss, mortality, and growth faltering) were also estimated. Our findings suggest that direct treatment costs per symptomatic cryptosporidiosis episode were highest in Kenya ($59.01), followed by Peru ($23.32), and Bangladesh ($7.62). The total annual economic impacts for the 0–11 month cohorts were highest in Peru ($41.5M; range $0.88-$599.3M), followed by Kenya ($37.4M; range $1.6-$804.5M) and Bangladesh ($9.6M, range $0.28-$91.5M). For all scenarios, indirect societal costs far outweighed direct treatment costs. These results highlight the critical need for innovative improvements to current prevention, diagnostic and treatment strategies available in resource poor settings, as well as the need for solutions that span multiple disciplines including food and water safety, sanitation and livestock production. [ABSTRACT FROM AUTHOR]

Background: Perceived health status indicates people's overall perception of their health, including both physical and psychological dimensions. The aim of this study was to examine the determinants of self-perceived health for Canadians aged 40 and older using data from the Canadian Community Health Survey (2010). Methods: Multiple logistic regression models were employed to identify factors associated with self-perceived health in two age groups: Adults aged 65+ and Adults aged 40-64. Results: We found that higher income was significantly associated with better health status while chronic conditions and stress were associated with worse health status. In the 40-64 and 65+ age groups, individuals in the highest income bracket were 4.65 and 1.94 times, respectively, more likely to report better health than individuals in the lowest income bracket. The difference in the level of income associated health inequities between the two age groups point to the need for understanding the reasons behind lower inequities among seniors and how much the social protections provided by the Canadian government to seniors contribute to lowering inequities. Conclusions: Though Canada has a national public health insurance system providing coverage to all Canadians, health inequities associated with income persist providing further evidence of the importance of the social determinants of health. Examining the extent of these inequities and what factors influence them helps direct policy attention. In addition to documenting inequities, this paper discusses policy options for reducing the identified inequities. [ABSTRACT FROM AUTHOR]

Background: Health care systems around the world have started to develop pharmacists prescribing for minor ailments (PPMA) programs. These programs aim to improve the efficiency of care, reduce physician visits, and increase the accessibility to prescription medication (Rx). This study performed an economic impact analysis of the pharmacists prescribing for minor ailments program in Saskatchewan. Methods: We measured costs for the program and the alternative scenario (i.e. no PPMA program) from a public payer and societal perspective, using primary data on pharmacists prescribing consultations in Saskatchewan. Furthermore, we calculated public payer and societal savings, and return on investment ratios for the program, as well as projecting the costs and benefits over the next 5 years. Results: Overall, we found that from a societal perspective, the Saskatchewan PPMA program saved the province approximately $546,832 in 2014, while according to the public payer perspective, the program was only marginally cost-saving in 2014. After 5 years of implementation, from a societal perspective, cumulative cost savings were projected to be $3,482,660, and the return on investment ratio was estimated to be 2.53. Conclusions: Our results demonstrate that this type of program may prove cost-saving and lead to improved access to the health care system in Canada, especially if savings to society are considered. This type of PPMA program may prove economically feasible and beneficial in many countries considering expanding pharmacists scope of practice. [ABSTRACT FROM AUTHOR]

There is a need for Indigenous-centered research to appraise culture’s role in wellness. Researchers described the development and validity of the Native Wellness Assessment (NWATM). The NWA has culture-as-intervention at its apex. Wellness, culture, and cultural intervention practices (CIPs) are explored from an Indigenous perspective. Indigenous clients completed matching self-report and observer versions of the NWA at three time points during addictions treatment. Statistically and psychometrically, the NWA content and structure performed well, demonstrating that culture is an effective and fair intervention for Indigenous peoples with addictions. The NWA can inform Indigenous health and community-based programs and policy. [ABSTRACT FROM AUTHOR]

Background: This paper describes the methods, strategies and insights gained from a scoping study using a "Two-Eyed Seeing" approach. An evolving technique, Two-Eyed Seeing respects and integrates the strengths of Indigenous knowledge and Western sciences, often "weaving back and forth" between the two worldviews. The scoping study was used to inform a tool for measuring the impact of culturally based addictions treatment services on wellness in Indigenous populations. It formed part of a three-year study, Honouring Our Strengths: Indigenous Culture as Intervention in Addictions Treatment. The scoping study identified and mapped literature on cultural interventions in addictions treatment, and described the nature, extent and gaps in literature. Methods: Using a Two-Eyed Seeing approach, we adapted, applied and enhanced a common framework of scoping studies. In the end stage of the scoping review process, an Ad Hoc Review Group, led by our project Elder, reviewed and interpreted Indigenous and Western understandings within the mapped information. Elements of the scoping study were joined with results from community focus groups with staff at treatment centres. Results: Two-Eyed Seeing contributed differently at each stage of the scoping study. In early stages, it clarified team expertise and potential contributions. At the mid-point, it influenced our shift from a systematic to a scoping review. Near the end, it incorporated Western and Indigenous knowledge to interpret and synthesize evidence from multiple sources. Conclusions: This paper adds to the collective work on augmenting the methodology of scoping studies. Despite the challenges of a Two-Eyed Seeing approach, it enables researchers using scoping studies to develop knowledge that is better able to translate into meaningful findings for Indigenous communities. [ABSTRACT FROM AUTHOR]

Background: This paper describes the methods, strategies and insights gained from a scoping study using a “Two-Eyed Seeing” approach. An evolving technique, Two-Eyed Seeing respects and integrates the strengths of Indigenous knowledge and Western sciences, often “weaving back and forth” between the two worldviews. The scoping study was used to inform a tool for measuring the impact of culturally based addictions treatment services on wellness in Indigenous populations. It formed part of a three-year study, Honouring Our Strengths: Indigenous Culture as Intervention in Addictions Treatment. The scoping study identified and mapped literature on cultural interventions in addictions treatment, and described the nature, extent and gaps in literature. Methods: Using a Two-Eyed Seeing approach, we adapted, applied and enhanced a common framework of scoping studies. In the end stage of the scoping review process, an Ad Hoc Review Group, led by our project Elder, reviewed and interpreted Indigenous and Western understandings within the mapped information. Elements of the scoping study were joined with results from community focus groups with staff at treatment centres. Results: Two-Eyed Seeing contributed differently at each stage of the scoping study. In early stages, it clarified team expertise and potential contributions. At the mid-point, it influenced our shift from a systematic to a scoping review. Near the end, it incorporated Western and Indigenous knowledge to interpret and synthesize evidence from multiple sources. Conclusions: This paper adds to the collective work on augmenting the methodology of scoping studies. Despite the challenges of a Two-Eyed Seeing approach, it enables researchers using scoping studies to develop knowledge that is better able to translate into meaningful findings for Indigenous communities. [ABSTRACT FROM AUTHOR]

Intramolecular vibrational dynamics of polyatomic molecules in solution can be addressed through normal mode analysis based on either equilibrium normal modes (ENMs) or instantaneous normal modes (INMs). While the former offers a straightforward way of examining experimental spectra, the latter provides a decoupled short-time description of the vibrational motions of the molecule. In order to reconcile both representations, a realistic assignment of the INMs in terms of the ENMs is needed. In this paper, we describe a novel method to assign the INMs using the ENMs as templates, which provides a unique relationship between the two sets of normal modes. The method is based specifically on the use of the so-called Min-Cost or Min-Sum algorithm, duly adapted to our problem, to maximize the overlaps between the two sets of modes. The identification of the INMs as the system evolves with time then allows us to quantify the vibrational energy stored in each INM and so monitor the flows of intramolecular vibrational energy within the solute molecule. We also discuss the degree of mixing of the INMs and characterize the way they change with time by means of the corresponding autocorrelation functions. The usefulness of the method is illustrated by carrying out equilibrium molecular dynamics (MD) simulations of the deuterated N-methylacetamide (NMAD) molecule in DO solution. [ABSTRACT FROM AUTHOR]

Background: Inappropriate use of Caesarean Section (CS) delivery is partly to blame for Ghana's high maternal mortality rate. However, previous research offered mixed findings about factors associated with CS use. The goal of this study is to examine use of CS in Ghana and the socioeconomic factors associated with it. Methods: Data from the nationally representative 2014 Ghana Demographic and Health Survey (GDHS) was used after permission from the Monitoring and Evaluation to Assess and Use Results (MEASURE) Demographic and Health Survey (DHS) program. Univariable and multivariable logistic regression models were fitted to examine the socioeconomic inequalities in CS use. The independent variables included maternal age, marital status, religion, ethnicity, education, place of residence, wealth quintile, and working status. Concentration index (CI) and rate-ratios were computed to ascertain the level of CS inequalities. Results: Out of the 4294 women, 11.4% had CS delivery. However, the percentage of CS delivery ranged from 5% of women in the poorest quintile to 27.5% of women in the richest qunitle. Significant associations were detected between CS delivery and maternal age, parity, education, and wealth quintile. Conclusions: This study revealed that first, even though Ghana has achieved an aggregate CS rate consistent with WHO recommendations, it still suffers from inequities in the use of CS. Second, both underuse of CS among poorer women in Ghana and overuse among rich and educated women are public health concerns that need to be addressed. Third, the results show in spite of Ghana's free maternal care services policies, wealth status of women continues to be strongly and signtificantly associated with CS delivery, indicating that there are indirect health care costs and other reasons preventing poorer women from having access to CS which should be understood better and addressed with appropriate policies. [ABSTRACT FROM AUTHOR]

Background: Many women still deliver outside a health facility in Ghana, often under unhygienic conditions and without skilled birth attendants. This study aims to examine the social determinants influencing the use of health facility delivery among reproductive-aged women in Ghana. Methods: Nationally representative data from the 2014 Ghana Demographic and Health Survey was used to fit univariable and multivariable logistic regression models to estimate the influence of the social determinants on health facility delivery. Andresen's health care utilization model was used as the conceptual framework guiding this study.. Results: Only 72% of deliveries take place at a health facility in Ghana. The results of the adjusted model indicate that place of residence, financial status, education, religion, parity and perceived need were significantly associated with health facility delivery. First, urban women had a higher likelihood of health facility delivery than rural women (Adjusted Odds ratio [AOR] =2.21; 95% Confidence interval [CI] = 1.53–3.19). Second, middle-class and rich women were 1.57 (95%CI = 1.18–2.08) times and 6.91 (95%CI = 4.12–11.59) times, respectively more likely to deliver at health facility compared to the poor. Third, women with either at least secondary education (AOR = 2.04; 95%CI = 1.57–2.64) or primary education (AOR = 1.39, 95%CI = 1.02–1.92) were more likely to deliver at health facility than women with no education. In terms of parity, first time mothers were 1.58 (95% CI = 1.18–2.12) times more likely to deliver at health facility than those who had given birth three or more times before. Finally, regarding perceived need, women who were aware of pregnancy complications were 1.32 (95%CI = 1.02–1.70) times more likely to use health facility delivery than those who were not informed about pregnancy complications. Conclusions: First, in spite of Ghana's free maternal health services policy, poorer women were much less likely to have a health facility delivery, which points to the need to understand the indirect costs and other financial barriers preventing women from delivering at a health facility. Second, many of the identified variables influence the demand and not just the supply for health care services, and highlight the importance of the social determinants of health and investments in interventions that extend beyond improving physical access. [ABSTRACT FROM AUTHOR]

Following publication of the original article [1], these errors were flagged: [ABSTRACT FROM AUTHOR]

Background: This paper describes the methods, strategies and insights gained from a scoping study using a "Two-Eyed Seeing" approach. An evolving technique, Two-Eyed Seeing respects and integrates the strengths of Indigenous knowledge and Western sciences, often "weaving back and forth" between the two worldviews. The scoping study was used to inform a tool for measuring the impact of culturally based addictions treatment services on wellness in Indigenous populations. It formed part of a three-year study, Honouring Our Strengths: Indigenous Culture as Intervention in Addictions Treatment. The scoping study identified and mapped literature on cultural interventions in addictions treatment, and described the nature, extent and gaps in literature.Methods: Using a Two-Eyed Seeing approach, we adapted, applied and enhanced a common framework of scoping studies. In the end stage of the scoping review process, an Ad Hoc Review Group, led by our project Elder, reviewed and interpreted Indigenous and Western understandings within the mapped information. Elements of the scoping study were joined with results from community focus groups with staff at treatment centres.Results: Two-Eyed Seeing contributed differently at each stage of the scoping study. In early stages, it clarified team expertise and potential contributions. At the mid-point, it influenced our shift from a systematic to a scoping review. Near the end, it incorporated Western and Indigenous knowledge to interpret and synthesize evidence from multiple sources.Conclusions: This paper adds to the collective work on augmenting the methodology of scoping studies. Despite the challenges of a Two-Eyed Seeing approach, it enables researchers using scoping studies to develop knowledge that is better able to translate into meaningful findings for Indigenous communities. [ABSTRACT FROM AUTHOR]

Background: Cultural interventions offer the hope and promise of healing from addictions for Indigenous people.a However, there are few published studies specifically examining the type and impact of these interventions. Positioned within the Honouring Our Strengths: Culture as Intervention project, a scoping study was conducted to describe what is known about the characteristics of culture-based programs and to examine the outcomes collected and effects of these interventions on wellness.Methods: This review followed established methods for scoping studies, including a final stage of consultation with stakeholders. The data search and extraction were also guided by the "PICO" (Patient/population, Intervention, Comparison, and Outcome) method, for which we defined each element, but did not require direct comparisons between treatment and control groups. Twelve databases from the scientific literature and 13 databases from the grey literature were searched up to October 26, 2012.Results: The search strategy yielded 4,518 articles. Nineteen studies were included from the United States (58%) and Canada (42%), that involved residential programs (58%), and all (100%) integrated Western and culture-based treatment services. Seventeen types of cultural interventions were found, with sweat lodge ceremonies the most commonly (68%) enacted. Study samples ranged from 11 to 2,685 clients. Just over half of studies involved quasi-experimental designs (53%). Most articles (90%) measured physical wellness, with fewer (37%) examining spiritual health. Results show benefits in all areas of wellness, particularly by reducing or eliminating substance use problems in 74% of studies.Conclusions: Evidence from this scoping study suggests that the culture-based interventions used in addictions treatment for Indigenous people are beneficial to help improve client functioning in all areas of wellness. There is a need for well-designed studies to address the question of best relational or contextual fit of cultural practices given a particular place, time, and population group. Addiction researchers and treatment providers are encouraged to work together to make further inroads into expanding the study of culture-based interventions from multiple perspectives and locations. [ABSTRACT FROM AUTHOR]