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Risk communication is a foundation of the practice of public health. It is traditionally based on a carefully considered epidemiological computation of the likelihood of experiencing a condition given the presence of a particular exposure or behaviour. The extent to which numerical precision is important in such communication is a function of the availability of good statistics, the ability of the target audience to appreciate the meaning of the statistics, and the emotional heft represented by the chosen statistic. There is an inherent danger, however, in overweighting the latter consideration at the expense of the former two. When emotional impact and behavioural change become goals to the exclusion of complete scientific credibility, we risk brushing against the realm of propaganda in service of unexplored unconscious societal moralism. In this era of heightened distrust of state authority, it behooves public health communication to avoid the suggestion of data misrepresentation in service of behaviour change, regardless of how socially desirable that change might be.

Panspermia is the theory that life has been transported between bodies in the solar system by means of asteroid or cometary impact. Assuming that panspermia is true, and that genetically related microbial life exists outside of our planet, then it is possible that such life could pose an infectious threat to the terrestrial biosphere. We offer several assumptions of the characteristics that such life might possess and extrapolate the likely epidemiological compartment approach to be applied when attempting to model the impact of an Earthly epidemic originating from an extraterrestrial pathogen.

Performance-based financing (PBF)—a supply-side strategy that incentivizes health providers based on predefined quality and quantity criteria—introduced an innovative approach to reaching the poor by means of using PBF equity instruments. These PBF equity instruments include paying providers more to reach out to poor women, selecting services used by the poor, subsidizing user fees to reduce out-of-pocket expenses, and adding complementary demand-side intervention. Before the implementation of the PBF equity instrument in Cameroon, there were few initiatives/schemes to enable the poor to access maternal health services. Moreover, there is a significant research gap on how the equity elements are defined and implemented across contexts. This study aims to understand (i) how health facilities define and classify the poor and vulnerable in the context of PBF, (ii) how the equity elements are implemented at the community and facility levels, and (iii) the potential impact on access to and the use of maternal health services at the facility level and challenges in the implementation process. We used key informant interviews and focus group discussions (FGDs) based on a grounded theory approach to gain an understanding of the social processes and experiences. Data were collected from three districts in the Southwest region of Cameroon from April 2021 to August 2021. Data were transcribed and analyzed using MaxQDA. The thematic analysis approach/technique was used to analyze data. Key informant interviews and focus groups were conducted with 79 participants, including 28 health professionals and service administrators, 27 pregnant women, and 24 community health workers in three districts. Health facilities employed various subjective approaches to assess and define poor and vulnerable (PAV) persons. Home visits were reported to have an impact in reaching the poor and vulnerable to improve access to maternal services. Meanwhile, a delay in the payment of PBF incentives was reported to be the main challenge that had a negative relationship with the consistent provision of care to the poor and vulnerable, especially in private health facilities. The theory generated from our findings suggests that the impact of the PBF equity elements specific to maternal health depends on (i) a shared understanding of the definition of PAV among different stakeholders, including providers and users, as well as how the PAV is operationalized (structure), and (ii) the appropriate and timely payment of incentives to health facilities and health providers.

Gut dysfunction and microbial dysbiosis comorbidities are of particular interest in recent autism research, as gastrointestinal distress is present in up to 90% of autism spectrum disorder cases and therefore may play a key role in the pathogenesis of this disorder. This scoping review aims to integrate the results of studies conducted in the past 6 years examining the association between gut microbiota and autism spectrum disorder, specifically with regard to the characterization of autism spectrum disorder microbiota and potential therapeutic interventions. Studies related to the gastrointestinal microbiome of subjects with autism spectrum disorder were identified through PubMed, SCOPUS, PsycInfo, and Google Scholar databases. Studies were screened and selected based on defined inclusion and exclusion criteria; 19 studies were included. Research continues to report differences between microbiota of individuals with autism spectrum disorder and controls; however, the types and abundances of bacteria present remain inconsistent. Promising treatment interventions for autism spectrum disorder, including special diets, dietary supplementation, and of particular interest, microbiota transfer therapy, are also being explored. Research regarding the link between gut microbiota and autism spectrum disorder renders exciting results; however, it is still in its infancy of investigation. Rigorous methodologies are required to support and strengthen the reliability of existing results, and to further our understanding of the pathogenesis of autism spectrum disorder. Lay abstract Gastrointestinal distress and gut microbial imbalances are commonly found in children with autism spectrum disorder, and therefore may play a key role in the development of the disorder. This scoping review aimed to examine the extent, range and nature of research conducted in the past 6 years that focused on furthering our understanding of autism spectrum disorder and its association with gut microbiota. A literature review was performed with predetermined key words. Studies were screened and selected based on defined inclusion and exclusion criteria. A total of 19 studies were included for final analysis. While there are continuous reports of differences in gut microbiota between autism spectrum disorder and neurotypical individuals, knowledge about the consistency in the presence and abundance of bacterial species, as well as metabolites, remains deficient. Treatments such as special diets, vitamin, prebiotic, probiotic, and microbiota transfer therapy show promising therapeutic potential, yet are in their infancy of investigation. Overall, further research with rigorous methodologies is required to support and strengthen the reliability of existing findings. Future research should aim to increase sample sizes, eliminate biases, and subgroup autism spectrum disorder groups to help accommodate for inter-individual variation. As increasing evidence of a unique autism spectrum disorder microbiome and metabolome is acquired, autism spectrum disorder-specific biomarkers can be identified. These biomarkers have great implications in terms of elucidating the molecular mechanisms of autism spectrum disorder, preventing the onset of autism spectrum disorder, and improving treatments for individuals with autism spectrum disorder.

Problem Too much or too little gestational weight gain (GWG) can negatively impact maternal and fetal health, according to Institute of Medicine Guidelines. Background Health care providers are key players in providing reliable evidence-informed prenatal advice related to appropriate GWG. However, there appears to be inconsistent GWG communication among healthcare providers during prenatal care. Aim To determine pregnant women and new mothers’ perceptions of healthcare provider GWG and dietary counselling during the pregnancy period. Methods A reliable and validated cross-sectional electronic survey was administered to currently pregnant women and women who had recently given birth. The web-based questionnaire was self-administered and took 10–25 min. Findings A total of 1507 eligible women participated in the survey. More than half (57%) reported that their healthcare provider talked to them about personal weight gain limits. Of these participants, about a third (34%) of participants were counselled regularly at each or most visits. Among the women that were not counselled on personal GWG limits, over half (56%) reported that healthcare provider guidance would have been helpful to achieve their target weight. Less than half (45%) of participants reported that their healthcare providers discussed dietary requirements or changes in pregnancy. Discussion These findings highlight areas for improvement in prenatal dialogue, which can support better outcomes for both mother and baby. Conclusion A better understanding of pregnant and mothers’ perceptions about weight and diet counselling is needed to understand what may need greater attention and clarification and to improve such dialogue.

OBJECTIVES: Canadians have reason to care about indoor air quality as they spend over 90% of the time indoors. Although indoor radon causes more deaths than any other environmental hazard, only 55% of Canadians have heard of it, and of these, 6% have taken action. The gap between residents’ risk awareness and adoption of actual protective behaviour presents a challenge to public health practitioners. Residents’ perception of the risk should inform health communication that targets motivation for action. In Canada, research about the public perception of radon health risk is lacking. The aim of this study was to describe residents’ perceptions of radon health risks and, applying a theoretical lens, evaluate how perceptions correlate with protection behaviours. METHODS: We conducted a mixed online and face-to-face survey (N = 557) with both homeowners and tenants in Ottawa-Gatineau census metropolitan area. Descriptive, correlation, and regression analyses addressed the research questions. RESULTS: Compared to the gravity of the risk, public perception remained low. While 32% of residents expressed some concern about radon health risk, 12% of them tested and only 3% mitigated their homes for radon. Residents’ perceptions of the probability and severity of the risk, social influence, care for children, and smoking in home correlated significantly with their intention to test; these factors also predicted their behaviours for testing and mitigation. CONCLUSION: Health risk communication programs need to consider the affective aspects of risk perception in addition to rational cognition to improve protection behaviours. A qualitative study can explore the reasons behind the gap between testing and mitigation.

Importance Gestational weight gain (GWG) is an independent and modifiable factor for a healthy pregnancy. Gestational weight gain above or below the Institute of Medicine Guidelines has been shown to impact both maternal and fetal health (eg, gestational diabetes, hypertension, downstream obesity). Healthcare providers (HCPs) have the potential to be reliable sources of evidence-based weight information and advice during pregnancy. Objective The aim of this study was to summarize the literature assessing GWG discussions between patients and their HCPs in a clinical setting to better understand the knowledge that is currently being exchanged. Evidence Acquisition A literature review was conducted by searching Ovid Medline, CINAHL, and Embase databases. All relevant primary research articles in English that assessed GWG discussions were included, whereas intervention studies were excluded. Results A total of 54 articles were included in this review. Although the overall prevalence and content of GWG counseling varied between studies, counseling was often infrequent and inaccurate. Healthcare providers tended to focus more on women experiencing obesity and excessive GWG, as opposed to the other body mass index categories or inadequate GWG. Women of higher socioeconomic status, older age, nulliparous, history of dieting, low physical activity, and those categorized as overweight/obese were more likely to receive GWG advice. Patients also reported receiving conflicting facts between different HCP disciplines. Conclusions The evidence regarding GWG counseling in prenatal care remains variable, with discrepancies between geographic regions, patient populations, and HCP disciplines. Relevance Healthcare providers should counsel their pregnant patients on GWG with advice that is concordant with the Institute of Medicine Guidelines.

OBJECTIVES This review explores the ethical and medical challenges faced by women of advanced maternal age who decide to have children. Assisted reproductive technologies (ARTs) make post-menopausal pregnancy physiologically plausible, however, one must consider the associated physical, psychological, and sociological factors involved. METHODS A quasi-systematic review was conducted in PubMed and Ovid using the key terms post-menopause, pregnancy + MeSH terms [donations, hormone replacement therapy, assisted reproductive technologies, embryo donation, donor artificial insemination, cryopreservation]. Overall, 28 papers encompassing two major themes (ethical and medical) were included in the review. CONCLUSION There are significant ethical considerations and medical (maternal and fetal) complications related to pregnancy in peri- and post-menopausal women. When examining the ethical and sociological perspective, the literature portrays an overall positive attitude toward pregnancy in advanced maternal age. With respect to the medical complications, the general consensus in the evaluated studies suggests that there is greater risk of complication for spontaneous pregnancy when the mother is older (eg, >35 years old). This risk can be mitigated by careful medical screening of the mother and the use of ARTs in healthy women. In these instances, a woman of advanced maternal age who is otherwise healthy can carry a pregnancy with a similar risk profile to that of her younger counterparts when using donated oocytes.

Maya Laxmi Patel,Raywat Deonandan Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada Background: Urbanization is increasing around the world, and in India, this trend has translated into an increase in the size of slum dwellings whose environments are suspected of being associated with poor health outcomes, particularly those relating to women’s nutritional status. With this study, we sought to determine the factors associated with Indian women’s body mass index (BMI) in slum environments, with special attention paid to women with tribal status.Methods: A multiple linear regression analysis was performed on data from the Indian National Family Health Survey (2005–2006), modeling demographic and behavioral factors suspected of being associated with BMI, with additional focus on the measures of social class, specifically caste and tribal status.Results: Increasing BMI is significantly and positively associated with frequency of watching television, having diabetes, age, wealth index, and residency status in the areas of New Delhi, Andhra Pradesh, or Tamil Nadu.Conclusion: Although belonging to a scheduled tribe was not associated with changes in BMI, unadjusted rates suggest that tribal status may be worthy of deeper investigation. Among slum dwellers, there is a double burden of undernutrition and overnutrition. Therefore, a diverse set of interventions may be required to improve the health outcomes of these women. Keywords: slums, India, BMI, women, caste, obesity, poverty

Pelvic binding devices are used in prehospital management of cases of severe physical trauma, such as falls and motor vehicle accidents. From briefly reviewing the published evidence of the procedure’s risks and effectiveness, we conclude that binding represents an inexpensive and easily applied emergency strategy that offers pelvic stability while only minimally raising the risk of bleeding and other undesirable outcomes.

Introduction Gestational weight gain (GWG) outside of the 2009 Institute of Medicine guidelines may be harmful to women and their fetuses. Prenatal health care providers (HCPs) are important sources of health information, but not all discuss GWG with their patients. The Canadian Obesity Network's 5As (ask, assess, advise, agree, and assist) of Healthy Pregnancy Weight Gain (5As) is a tool developed to help HCPs counsel their patients on GWG. The main objective of this study was to evaluate the impact of the 5As tool on patient perceptions of GWG discussions with their HCP and to identify suggestions to improve the tool. Methods A quasiexperimental study design was conducted whereby HCPs were trained in using the 5As tool (intervention). Patients were then queried at baseline and postintervention using an electronic questionnaire measuring patient-perceived 5As counseling. Inclusion criteria for pregnant women were (1) currently attending their first appointment with participating HCPs, (2) English-speaking, and (3) over 18 years of age. Results One hundred pregnant women (50 baseline, 50 postintervention) and 15 HCPs (11 midwives, 4 obstetricians) participated. Participants receiving care from 5As-trained HCPs reported scores twice as high (P = .047) in being asked about and were approximately 3 times more likely to be advised an exact amount of target weight gain (P = .03). HCPs suggested improving patient handouts and HCP education on GWG guidelines as well as reducing the content presented in the 5As tool. Discussion The 5As Tool is effective at initiating HCP-mediated GWG counseling; further research is needed to examine the usefulness of the 5As in clinical practice throughout the length of a full pregnancy. Whether the uptake of the 5As tool contributes to prenatal behavior change remains to be established. Future steps include modifying the tool based on HCP feedback, the development of novel knowledge translation tools, and improved HCP and patient education.

BACKGROUND: In gestational surrogacy, a woman incubates an embryo to which she is not genetically related. Genetic distance from both her and the commissioning parents is increased further when donor gametes are employed. Ethical implications vary depending on the extent to which the parents and surrogates share genetic material with the produced child. PURPOSE: This paper seeks to address two primary questions: What do selected ethical frameworks tell us of (1) the relationship between genetic motherhood, gestational motherhood, social motherhood, and marital fidelity? And (2) the effects of gestational surrogacy and gamete donation on our understanding of lineage and heritability? METHODS: Current literature and thought on these questions were considered through the classical ethics lenses of religion, the adoption standard, and Western liberalism. RESULTS: A genetic link between the parents and the child serves to simplify the adoption process (if one is required) and supports a family’s desire to resemble as much as possible a traditional biological family, thus providing a minimum set of challenges to religious or conservative hesitations. CONCLUSION: Inasmuch as gestational surrogacy, with or without donor gametes, is tolerated in a variety of ethical contexts; the basis of its acceptance may be the Western liberal celebration of contractual agreement.

The lengths of gestation of 68 confirmed miscarriages from an in vitro fertilization (IVF) program were compared to expected gestational ages from the literature in order to elucidate patterns of early, undiagnosed miscarriages. The peak frequency of miscarriages in the IVF group was earlier than expected, suggesting that the rate of early miscarriage in the general population might be underestimated.

Introduction The world’s population is rapidly aging. Unregulated health care workers (UHCWs) are emerging as a potentially important workforce in the care of older adults. Objective A review was conducted to identify the activities of UHCWs with respect to contributions and limitations. Methods A systematic integrative literature review was conducted using online databases (LILACS, PubMed, EMBASE, CINAHL, and grey literature). The inclusion criteria were as follows: (i) description of UHCW activities related to older adults; and (ii) description of UHCW activities performed in Brazil or Canada. Results Eleven papers were included in this review. In both countries, UHCW activities included health promotion, mental health care, and rehabilitation. In Brazil, UHCWs performed integrated care, while in Canada UHCWs performed personal care and housekeeping. Conclusion These results highlight the potential and limits of UHCWs who provide care for the aging population. Such information is important to health and social policy making and household decision making.

We examined patterns of Canadian Institute for Health Research (CIHR) funding on autism spectrum disorder (ASD) research. From 1999 to 2013, CIHR funded 190 ASD grants worth $48 million. Biomedical research received 43% of grants (46% of dollars), clinical research 27% (41%), health services 10% (7%), and population health research 8% (3%). The greatest number of grants was given in 2009, but 2003 saw the greatest amount. Funding is clustered in a handful of provinces and institutions, favouring biomedical research and disfavouring behavioural interventions, adaptation, and institutional response. Preference for biomedical research may be due to the detriment of clinical research.

Statistical literacy (SL) is an aspect of numeracy and a core educational competency. Overall levels of SL in North American society may be in decline, while evidence abounds of poor SL among researchers globally. Three strategies are recommended to help address poor SL among scholars and science communicators, with a particular focus on the health and medical sciences: (1) mandatory inclusion of computerized statistical platforms in undergraduate statistics classes; (2) requirement for statistical review in peer-reviewed paper submissions; and (3) the exploration of novel methods of results communication.

Loss of arm function occurs in up to 85% of stroke survivors. Home-based telerehabilitation is a viable approach for upper limb training post-stroke when rehabilitation services are not available. Method: A costing analysis of a telerehabilitation program was conducted under several scenarios, alongside a single-blind two-arm randomized controlled trial with participants randomly allocated to control (N=25) or intervention group (N=26). Detailed analysis of the cost for two different scenarios for providing telerehabilitation were conducted. The fixed costs of the telerehabilitation are an important determinant of the total costs of the program. The detailed breakdown of the costs allows for costs of future proposed telerehabilitation programs to be easily estimated. The costs analysis found that a program supplying all required technology costs between CAD$475 per patient and CAD$482 per patient, while a program supplying only a camera would have total costs between CAD$242 per patient and $245 per patient. The findings of this study support the potential implementation of telerehabilitation for stroke survivors for improving accessibility to rehabilitation services. This cost-analysis study will facilitate the implementation and future research on cost-effectiveness of such interventions.

As anthropogenic inputs continue to drive climate change towards a "tipping point" of increasingly severe consequences, associated research has become more important than ever. Even if mitigation efforts are successful in slowing, or even halting, climate change progression, changes have already been triggered that will be felt for decades; the health impacts of these changes will be felt in most populations around the world and will threaten the well-being of billions. Further, it has been suggested that these impacts will be experienced differently, especially depending on geography. As such, it is crucial for location-specific analysis of the potential consequences of climate change to take place. This study constitutes a systematic review of the health consequences that can be expected in Guyana specifically, the results of which are of some relevance to Latin American more generally. Relevant documents selected for full review underwent quantitative and qualitative data analysis. From this analysis, six thematic categories emerged: i) dengue and malaria, ii) other infections, iii) flooding and waterborne diseases, iv) food and water shortages, v) respiratory issues, and vi) natural disasters. These represent the most likely and most severe health consequences that may be exacerbated by climate change impacts in Guyana. Despite these insights, a knowledge and research gap in this field is evident, and a call is made for further research and policy action to better understand and prepare for the upcoming challenges climate change will present.

Background Past studies have examined the effects of maternal exposure to water chlorination disinfection by-products (DBPs), such as trihalomethanes (THMs) and haloacetic acids (HAAs) during pregnancy. However, no human-based study has yet evaluated the effect of emerging DBPs, such as haloacetaldehydes (HAs) and haloacetonitriles (HANs) on small-for-gestational-age (SGA) status in newborns. Objective This study aims to assess the association between maternal multiroute exposure to HAs and HANs during the third trimester of pregnancy and SGA status at birth, among neonates delivered by women residing in the Quebec City area (Province of Quebec, Canada). We also evaluated the interaction between exposure to these emerging unregulated by-products and regulated DBPs also found in drinking water (THMs and HAAs), for which a positive association with adverse reproductive outcomes has been suggested in previous studies. Methods We conducted a population-based case-control study in the Quebec City area. SGA newborns (n=330) were compared to 1100 controls, with matching based on calendar week of birth. HA and HAN concentrations in drinking water at participant's tap were estimated using spatio-temporal strategy based on bimonthly measurements carried out at several locations in the participant's distribution system. A computer-assisted telephone interview was completed to collect information on individual habits of water consumption and water related activities in order to determine individual multiroute exposure. This enabled us to estimate the dose of HAs and HANs absorbed daily by each participant. Associations between total HA, HAN concentrations in drinking water and SGA were analyzed. Associations between the daily-absorbed doses of these emerging DBPs and SGA were also analyzed. Odds ratios (ORs) comparing the 4th quartile of exposure to the reference group (the first three quartiles) were obtained by means of conditional logistic regression, and controlling for potential confounders. Results Globally, no evidence of increased risk of SGA was found with total HA and HAN concentrations in tap water when participants in the 4th quartile of exposure were compared to the first three quartiles (OR=1.0; 95% CI [0.7–1.5] and OR=0.8; 95% CI [0.6–1.2], respectively). Similarly, no association was found with the daily-absorbed doses of total HAs or HANs (OR=0.9; 95% CI [0.6–1.3] and OR=1.1; 95% CI [0.7–1.6], respectively). However, a small non statistically significant association was found between the dose of brominated HA and SGA (OR=1.4; 95% CI [0.9–2.1]). Also, in spite of the lack of interaction between other DBP classes, an unexpected negative interaction was observed between concentration of chloral hydrate (CH) (which represents the main HA species), and regulated DBPs (P=0.006). Conclusion In this population, exposure to low levels of HAs and HANs during the third trimester of pregnancy through drinking water was not associated to SGA status in newborns. Nonetheless, more research is needed to clarify possible effect of brominated compounds and interaction between different DBPs.

Raywat Deonandan,1 Nodine Sangwa,1 Steve Kanters,2 Sabin Nsanzimana3 1Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada; 2University of British Columbia, Vancouver, BC, Canada; 3Rwanda Biomedical Center, Kigali, Rwanda Abstract: In 2013, Canadian scholars delivered a 1-week workshop to 30 junior public health professionals in Rwanda. The goal was to improve the Rwandans’ skills and confidence with respect to writing scientific papers for submission to international peer-reviewed global health journals. As a result of the workshop, there was a statistically significant improvement in participants’ reported confidence in many aspects of navigating the publishing process, but no improvement in confidence regarding statistically analyzing their data. Remarkably, as a group, participants were able to write an article for a leading international journal, which was subsequently published. Results indicate that similar interventions would be both successful and well received, especially if targeted to individuals at a similar stage of career progress. Keywords: education, Rwanda, public health, skills

In response to the European financial crisis of 2008-2009, Greece reduced funding for social spending as part of its austerity program, which may have reversed past progress in Greece’s mental health system. Significant increases in depression and suicide rates coincided with the start of the crisis. A slower economic recovery may result from the combination of a less productive work force and out-migration of mental health professionals. In order to alleviate the detrimental effects of this crisis, mental health crisis training, as well as low cost community-based programs should be prioritized in Greece.

Aims: To ascertain the laws and policies of selected high income countries, with respect to the disposition of their citizens seeking assisted reproductive technologies (ARTs) internationally. Study Design: Literature review. Methodology: PubMed, Scopus and Google of various ART terms with terms relating to regulations in the selected nations of Australia, Canada, New Zealand, the UK, the USA, and Israel. Results: All nations except the USA have a federal ART regulatory presence, distinguish between gestational and traditional surrogacy, and between paid and unpaid surrogacy. Policies concerning the repatriation of children produced by ART abroad vary widely. Conclusions: Heterogeneous regulations are one of the drivers of the global reproductive tourism industry. Domestic regulations are likely affected by both the values of a specific population and the needs of the industry.

Introduction:In the new century, worldwide health professionals face new pressures for changes towards more cost-effective and sustainable health care for all populations. Globalization creates daunting challenges as well as new opportunities for institutions and health professionals being more connected and rethink their strategies toward an interprofessional practice. Although Health professionals are paying increased attention to issues of global health, there are no current assessment tools appropriate for evaluating their competency in global health. This study aimed to assess global health competencies of family medicine residents, nursing, physiotherapy and occupational

Reproductive tourism is the act of crossing an international border to seek assisted reproductive services, which can include maternal surrogacy. Ethical analyses of this phenomenon may be poorly served by considering the Western liberal framework alone. In previous studies, we identified 16 domains of ethical interest arising from this industry. In this paper, we sought perspectives in the scholarly literature that inform the development of an alternative to the Western liberal framework, incorporating more communalistic values that were then applied to the pre-identified domains. We concluded that a hybrid Western-communalistic framework, appropriate for helping to guide ethical analyses of reproductive tourism, incorporates an encouragement of thirdparty advocates to overcome power gaps between pertinent actors, and assumes the existence of a universal morality, such that a uniform standard of care can be expected regardless of cultural context.

Reproductive medical tourism is by some accounts a multibillion dollar industry globally. Transnationally, it involves the travel between nations of individuals seeking assisted reproductive technologies in foreign countries. Through a structured literature review, we identified the demographic characteristics of those seeking these services. Data from 14 peer-reviewed studies were synthesized. Most studies described travel within Europe, with Belgium being the destination most often cited. Key findings include that those travelling for reproductive purposes are typically over 35 years of age, likely to selfidentify as homosexual, bisexual or transgendered. The most frequently mentioned reason for travel was the lack of appropriate services in the home country.

Aims: Online social networks, such as Facebook, are growing in popularity amongst physicians, and represent a potential avenue for the compromising of their privacy and professional boundaries. We sought to determine the extent to which family doctors are sharing personal information on Facebook. Study Design: Observational. Place and Duration of Study: Ottawa, Ontario, Canada. Data was collected between May and August of 2012. Methodology: From the website of the College of Physicians and Surgeons of Ontario, all 1000 family physicians active in the Ottawa region were identified. A database was then created of subjects’ publicly shared information (i.e., information available to the general public) for those with accessible profiles on Facebook. Chi square and t-tests were performed to explore demographic patterns for those with viewable profiles; binary logistic regression was used to identify factors associated with Facebook visibility. Results: While only 10.2% of family physicians had publicly viewable profiles, 81.4% of those featured a visible profile photo; 91.2% could be messaged directly by any member of the public; a majority shared limited personal information, including recent online activities and place of education; 24% shared their place of work; 15% had visible lists of family members; and 14% disclosed their relationship status. From logistic regression, there were no significant factors associated with whether a physician was viewable on Research Article British Journal of Medicine & Medical Research, 4(1): 244-251, 2014 245 Facebook. Conclusion: While a minority of physicians have a publicly accessible Facebook profile, those that do are sharing personal information that may expose them to unwanted intrusions into their personal lives and unexpected patient interactions outside of the office. Physicians should be aware of options for making their online information less publicly accessible.

Background: In 2004, in the midst of civil war, Sri Lanka was struck by a large tsunami, devastating coastal communities. Methods: In the immediate aftermath of the 2004 Asian tsunami, while providing emergency aid, a Canadian NGO interviewed children living in both a refugee camp and an affected village in Sri Lanka. Results: Complete data were available for 63 respondents, aged 3 to 17 years. There were significant reports of sleeping problems, crying, and somatic symptoms consistent with psychological trauma, which were more likely among the village residents than the camp residents. If a respondent had been affected by the war, via family death or injury, then they were more likely to have been similarly affected by the tsunami, as well. Conclusion: These findings are useful for developing strategies to address current emergency situations, such as the Syrian refugee crisis, in which children are likely to be similarly doubly traumatized. Keywords: Stressors, tsunami, children, Sri Lanka

Raywat Deonandan, James Gomes, Eric Lavigne, Thy Dinh, Robert Blanchard Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada Abstract: Students in a fourth year epidemiology course were surveyed after participating in a formal Science Research Day in which they presented original research, in poster form, to be judged by scientists from the community. Of 276 participating students, 80 (29%) responded to the study survey. As a result, 19% of respondents were more likely to pursue a career in science, and 27.5% were more likely to pursue a career in epidemiology. Only one respondent reported being less likely to pursue a science career, while seven were less likely to pursue epidemiology. A majority of respondents felt that the poster experience was on par with, or superior to, a comparable research paper, in terms of both educational appeal and enjoyment. Mandatory, formal poster presentations are an innovative format for teaching advanced health sciences, and may more accurately reflect the realities of a science career than do more traditional educational formats. Keywords: epidemiology, education, undergraduate, research–teaching nexus

Background: Incarcerated populations are at particular risk for developing specific health conditions. Prior studies of prisons in developing countries have focused on the threat of communicable diseases, though anecdotal evidence suggests that chronic conditions are of particular concern. This study constitutes the first published investigation of health complaints offered by residents of a prison in the South American nation of Guyana. Method: In 2010, a medical team sent by the Toronto non-governmental organization Ve’ahavta visited the Mazaruni prison in the interior of Guyana. Data on patient encounters was collected as part of the triage activity. Results: Care was given to 108 patients, staff and family members. Contrary to literature expectations, 50% of complaints concerned musculoskeletal issues, while only 11% were genitor-reproductive. Upon examination, 30.6% of patients were experiencing musculoskeletal problems, most commonly back pain. Conclusion: Future medical interventions to this and comparable low- and middle-income country prisons should more vigorously consider physiotherapeutic interventions, in addition to the expected addressing of infectious diseases.

In December, 2010, Canada’s 6 year old Assisted Human Reproduction Act was successfully challenged in the Supreme Court of Canada. There may be important implications for public health and the evolution of reproductive technologies in this country.

Children with cerebral palsy associated with periventricular leukomalacia frequently develop unprovoked epileptic seizures. This article reports an analysis of risk factors for epilepsy in children with radiologically confirmed periventricular leukomalacia. This cohort was screened for epilepsy and for an array of clinical and demographic factors. Of 154 subjects with radiologically confirmed periventricular leukomalacia, 40 (26.0%) had epilepsy. In the epileptic group, radiologic pathology other than periventricular leukomalacia was uncommon. Significant associations were found between epilepsy and cerebral palsy patterns other than spastic diparesis, mental handicap, cortical visual impairment, neonatal seizures, and severe periventricular leukomalacia. Only the presence of neonatal seizures was significantly associated with epilepsy once other risk factors were controlled in the regression model. Some previous studies have shown an association between neonatal seizures and later epilepsy for cerebral palsy in general. This is the first report of such an association for a single predominant type of cerebral pathology.

Background: Ethics education and research on medical residents is needed because, unlike medical students or experienced doctors, medical residents have to perform multiple roles simultaneously – student, teacher and clinician – thus exposing them to unique ethical stressors. In this paper we reviewed the literature concerning ethics education in postgraduate pediatrics training programs. Our goal was not to simply describe educational strategies and programs, but also to explore measurements and experiences of current practices to address gaps in ethics education during residency. Method: We conducted a structured literature review to explore the extent of ethics education in pediatric residency programs. Results: Twelve relevant studies were found. The studies suggest that existing training regimens are insufficient to meet the real life ethical challenges experienced in actual practice, particularly with respect to palliative care and the commission of clinical errors. Conclusions: The increasing diversity of culture and beliefs in the clinical workplace is also serving to complicate educational needs. An interdisciplinary approach, spread over the entirety of a physician’s training, is a proposed solution worthy of more attention.

On March 23, 2010, US President Barack Obama signed into law the Patient Protection and Affordable Care Act (PPACA) (United States of America, 2010), commonly called “Obamacare.” Representing the most significant revision of the American health care system in over four decades, PPACA is aimed primarily at decreasing the number of uninsured Americans and reducing the overall out-of-pocket costs of individual health care.

BACKGROUND: Patient satisfaction and convenience are an important factor root canal therapy. This study was conducted to evaluate the patient satisfaction with rubber dam during root canal treatment. MATERIALS & METHODS: This descriptive cross-sectional study was carried out on the patients referring to a private office of an endodontist (one of the researcher) in 2015. A total number of 70 patients were selected randomly and given a researcher made questionnaire base on satisfaction with rubber dam, consisting of demographic and satisfaction variables, after treatment to complete. Data analysis was performed at both descriptive and inferential levels. For descriptive statistics, the central tendency and dispersion measures along with box plot were applied and for inferential statistics, Mann-Whitney U and Kruskal-Wallis tests were used. Data were analyzed by SPSS-18 software. P