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Background: Health literacy is an important public health concern and can be defined as ‘the degree or extent to which the individuals have the capacity to obtain, process and understand basic health information and services to make appropriate health decisions’. Research on health literacy among recent immigrants to Canada is not that extensive. Objective: The purpose of this paper was to describe health literacy status among Nepalese immigrants residing in Calgary, Alberta, Canada. Methods: In 2019, a cross-sectional study, using a self-administered questionnaire, was conducted among Nepalese immigrants in Calgary. The questionnaire comprised 38 questions including sociodemographic information, self-rated health status, having a chronic disease or not, health literacy, sources of health information and preference to gain health information. Results: We received 401 responses: 49.63% were from women, 51.37% were aged 36–55 years, 37.00% had graduate-level education, 44.96% had immigrated to Canada less than 5 years ago and 81.05% were employed full-time/part-time or self-employed. Findings revealed that 17.21% of survey participants had limited health literacy, followed by 40.15% who had marginal health literacy. The majority of the survey participants (71.82%) either always or often got health information from healthcare professionals, followed by online resources (56.61%). Conclusion: Noteworthy levels of limited health literacy and marginal health literacy were observed among the Nepalese immigrant population. Multidirectional, culturally tailored, community-led, collaborative initiatives are needed to improve health literacy among the immigrant population, to lessen health disparities and to promote better health outcomes.

Abstract. As immigration to Canada increases, the complexities associated with serving newcomers (immigrants, refugees, temporary foreign workers, and international students) of diverse ethnogeographical backgrounds also increase. A range of stakeholder groups including researchers, policy makers, immigrant service provider organizations, and newcomer grassroots community organizations aim to help ease the process of settlement and integration for newcomers. A community-based knowledge engagement hub, which has been previously applied in the Indigenous community context, can facilitate the reciprocal flow of knowledge between those involved in newcomer settlement and inform newcomer-centered practice, policy, and research on settlement issues.

Purpose Canada has a globally recognized universal health-care system. However, immigrants experience a number of obstacles in obtaining primary health care (PHC) that may differ within various communities due to the intersection of culture, gender and other identities. To date, no research has been done on the difficulties Nepalese immigrant women in Canada may face accessing PHC. The purpose of this study was to learn about their perceptions of barriers to PHC access and to share the findings with a wide range of stakeholders, including health-care providers and policymakers. Design/methodology/approach The authors conducted a community-engaged qualitative study in Calgary, Alberta, Canada. A total of six focus group discussions (FGD) among 34 participants (each FGD consisted of 5–7 participants) were conducted. The authors collected demographic information before each focus group. The FGDs were audio recorded and transcribed verbatim. The transcriptions were coded and analysed thematically. Findings The focus groups identified long wait times as a major barrier to receiving PHC services. Long wait times in emergency rooms, unable to see family doctors when they were sick, tedious referral procedures, long waits at the clinic even after scheduling an appointment, family responsibilities and work all impacted their access to PHC. Further, a lack of proficiency in English was another significant barrier that impeded effective communication between physicians and immigrant women patients, thus compromising the quality of care. Other barriers mentioned included lack of access to medical records for walk-in doctors, insufficient lab/diagnostic services, a lack of urgent care services and unfamiliarity with the Canadian health-care system. Originality/value Accessible PHC is essential for the health of immigrant populations in Canada. This study recognizes the extent of the barriers among a relatively less studied immigrant population group, Nepalese immigrant women, which will help effectively shape public policy and improve access to PHC for the versatile immigrant population fabric in Canada.

Many developed countries admit internationally educated physicians (IEPs) as highly skilled migrants. The majority of IEPs arrive with the intention of becoming licensed physicians to no avail, resulting in underemployment and underutilization of this highly skilled group of people. Alternative careers in the health and wellness sector provide IEPs opportunities to use their skills and reclaim their lost professional identity; however, this path also includes great challenges. In this study, we determined factors that affect IEPs’ decisions regarding their choice of alternative jobs. We conducted eight focus groups with 42 IEPs in Canada. Factors affecting IEPs’ career decisions were related to their individual situations and tangible aspects of career exploration, including resources and skills. A number of factors were associated with IEPs’ personal interests and goals, such as a passion for a particular career, which also varied across participants. Overall, IEPs interested in alternative careers took an adaptive approach, largely influenced by the need to earn a living in a foreign country and accommodate family needs and responsibilities.

Risk prediction models are frequently used to identify individuals at risk of developing hypertension. This study evaluates different machine learning algorithms and compares their predictive performance with the conventional Cox proportional hazards (PH) model to predict hypertension incidence using survival data. This study analyzed 18,322 participants on 24 candidate features from the large Alberta’s Tomorrow Project (ATP) to develop different prediction models. To select the top features, we applied five feature selection methods, including two filter-based: a univariate Cox p-value and C-index; two embedded-based: random survival forest and least absolute shrinkage and selection operator (Lasso); and one constraint-based: the statistically equivalent signature (SES). Five machine learning algorithms were developed to predict hypertension incidence: penalized regression Ridge, Lasso, Elastic Net (EN), random survival forest (RSF), and gradient boosting (GB), along with the conventional Cox PH model. The predictive performance of the models was assessed using C-index. The performance of machine learning algorithms was observed, similar to the conventional Cox PH model. Average C-indexes were 0.78, 0.78, 0.78, 0.76, 0.76, and 0.77 for Ridge, Lasso, EN, RSF, GB and Cox PH, respectively. Important features associated with each model were also presented. Our study findings demonstrate little predictive performance difference between machine learning algorithms and the conventional Cox PH regression model in predicting hypertension incidence. In a moderate dataset with a reasonable number of features, conventional regression-based models perform similar to machine learning algorithms with good predictive accuracy.

Background There is increasing evidence demonstrating the importance of the neighbourhood built environment in supporting physical activity. Physical activity provides numerous health benefits including improvements in health-related fitness (i.e., muscular, cardiorespiratory, motor, and morphological fitness). Emerging evidence also suggests that the neighbourhood built environment is associated with health-related fitness. Our aim was to summarize evidence on the associations between the neighbourhood built environment and components of health-related fitness in adults. Methods We undertook a systematic review following PRISMA guidelines. Our data sources included electronic searches in MEDLINE, Embase, CINAHL, Web of Science, SPORTDiscus, Environment Complete, ProQuest Dissertations and Theses, and Transport Research International Documentation from inception to March 2021. Our eligibility criteria consisted of observational and experimental studies estimating associations between the neighbourhood built environment and health-related fitness among healthy adults (age ≥ 18 years). Eligible studies included objective or self-reported measures of the neighbourhood built environment and included either objective or self-reported measures of health-related fitness. Data extraction included study design, sample characteristics, measured neighbourhood built environment characteristics, and measured components of health-related fitness. We used individual Joanna Briggs Institute study checklists based on identified study designs. Our primary outcome measure was components of health-related fitness (muscular; cardiorespiratory; motor, and morphological fitness). Results Twenty-seven studies (sample sizes = 28 to 419,562; 2002 to 2020) met the eligibility criteria. Neighbourhood destinations were the most consistent built environment correlate across all components of health-related fitness. The greatest number of significant associations was found between the neighbourhood built environment and morphological fitness while the lowest number of associations was found for motor fitness. The neighbourhood built environment was consistently associated with health-related fitness in studies that adjusted for physical activity. Conclusion The neighbourhood built environment is associated with health-related fitness in adults and these associations may be independent of physical activity. Longitudinal studies that adjust for physical activity (including resistance training) and sedentary behaviour, and residential self-selection are needed to obtain rigorous causal evidence for the link between the neighbourhood built environment and health-related fitness. Trial registration Protocol registration: PROSPERO number CRD42020179807.

Identifying high-risk individuals for targeted intervention may prevent or delay hypertension onset. We developed a hypertension risk prediction model and subsequent risk sore among the Canadian population using measures readily available in a primary care setting. A Canadian cohort of 18,322 participants aged 35–69 years without hypertension at baseline was followed for hypertension incidence, and 625 new hypertension cases were reported. At a 2:1 ratio, the sample was randomly divided into derivation and validation sets. In the derivation sample, a Cox proportional hazard model was used to develop the model, and the model's performance was evaluated in the validation sample. Finally, a risk score table was created incorporating regression coefficients from the model. The multivariable Cox model identified age, body mass index, systolic blood pressure, diabetes, total physical activity time, and cardiovascular disease as significant risk factors (p $$\chi^{2}$$ χ 2 statistic = 8.75, p = 0.07; calibration slope 1.006). A point-based score for the risks of developing hypertension was presented after 2-, 3-, 5-, and 6 years of observation. This simple, practical prediction score can reliably identify Canadian adults at high risk of developing incident hypertension in the primary care setting and facilitate discussions on modifying this risk most effectively.

Objectives Canadian regulations have made it challenging for the international medical graduates (IMGs) to get jobs in their original profession as physicians. Consequently, alternative careers are gaining interest among IMGs to avoid underemployment or unemployment. We conducted research to identify the factors that IMGs consider for taking up an alternative career in Canada. Based on those understandings, we aimed to create a database where information about health-related alternative jobs is presented in a searchable way, which can aid IMGs’ strategic job search. Data description We first determined job searching preferences and constraints for IMGs regarding alternative career through focus groups. We used their preferred and constraining factors for collecting job-specific information through systematically reviewing job advertisements. Using this information, we created a database that contains available alternative career pathways for IMGs living in Canada. In total, we have identified 1374 job titles under 192 unique job categories comprising 47 National Occupational Classification (NOC) codes that could be suitable for IMGs seeking an alternative career based on their own short, intermediate, and long-term career goals. We expect that this database will help IMGs in deciding on alternative careers.

Background Digital equity denotes that all individuals and communities have equitable access to the information technology required to participate in digital life and can fully capitalize on this technology for their individual and community gain and benefits. Recent research highlighted that COVID-19 heightened the existing structural inequities and further exacerbated the technology-related social divide, especially for racialized communities, including new immigrants, refugees, and ethnic minorities. The intersection of challenges associated with racial identity (eg, racial discrimination and cultural differences), socioeconomic marginalization, and age- and gender-related barriers affects their access to health and social services, education, economic activity, and social life owing to digital inequity. Objective Our aim is to understand the current state of knowledge on digital equity and the digital divide (which is often considered a complex social-political challenge) among racialized communities in urban cities of high-income countries and how they impact the social interactions, economic activities, and mental well-being of racialized city dwellers. Methods We will conduct an integrative review adapting the Whittemore and Knafl methodology to summarize past empirical or theoretical literature describing digital equity issues pertaining to urban racialized communities. The context will be limited to studies on multicultural cities in high-income countries (eg, Calgary, Alberta) in the last 10 years. We will use a comprehensive search of 8 major databases across multiple disciplines and gray literature (eg, Google Scholar), using appropriate search terms related to digital “in/equity” and “divide.” A 2-stage screening will be conducted, including single citation tracking and a hand search of reference lists. Results will be synthesized using thematic analysis guidelines. Results As of August 25, 2022, we have completed a systematic search of 8 major academic databases from multiple disciplines, gray literature, and citation or hand searching. After duplicate removal, we identified 8647 articles from all sources. Two independent reviewers are expected to complete the 2-step screening (title, abstract, and full-text screening) using Covidence followed by data extraction and analysis in 4 months (by December 2022). Data will be extracted regarding digital equity–related initiatives, programs, activities, research findings, issues, barriers, policies, recommendations, etc. Thematic analysis will reveal how barriers and facilitators of digital equity affect or benefit racialized population groups and what social, material, and systemic issues need to be addressed to establish digital equity for racialized communities in the context of a multicultural city. Conclusions This project will inform public policy about digital inequity alongside conventional systemic inequities (eg, education and income levels); promote digital equity by exploring and examining the pattern, extent, and determinants and barriers of digital inequity across sociodemographic variables and groups; and analyze its interconnectedness with spatial dimensions and variations of the urban sphere (geographic differences). International Registered Report Identifier (IRRID) DERR1-10.2196/40068

This study explored the perspectives of new immigrant workers regarding occupational health and safety and workplace conditions that increase workers’ vulnerability to sustaining injury or illness. Using an interpretive research approach and semi-structured qualitative interviews, 42 new immigrant workers from a range of industries operating in two cities in a province in Canada were interviewed. Seventy-nine percent of the workers were highly qualified. A constant comparative approach was used to identify key themes across the workers’ experiences. The findings revealed that new immigrant workers have an incomplete understanding of occupational health and safety. In many workplaces, poor job training, little worker support, lack of power in the workplace, and a poor workplace safety culture make it difficult for workers to acquire occupational health and safety information and to implement safe work practices. This study proposes workplace policies and practices that will improve worker occupational health and safety awareness and make workplaces safer for new immigrant workers.

Essential workers, those who work in a variety of sectors that are critical to sustain the societal infrastructure, were affected both physically and mentally by the COVID-19 pandemic. While the most studied group of this population were healthcare workers, other essential non-health workers such as those working in the law enforcement sector, grocery services, food services, delivery services, and other sectors were studied less commonly. We explored both the academic (using MEDLINE, PsycInfo, CINAHL, Sociological Abstracts, and Web of Science databases) and grey literature (using Google Scholar) to identify studies on the mental health effects of the six pandemics in the last 20 years (2000–2020). We identified a total of 32 articles; all of them pertained to COVID-19 except for one about Ebola. We found there was an increase in depression, anxiety, stress, and other mental health issues among non-health essential workers. They were more worried about passing the infection on to their loved ones and often did not have adequate training, supply of personal protective equipment, and support to cope with the effects. Generally, women, people having lower education, and younger people were more likely to be affected by a pandemic. Exploring occupation-specific coping strategies of those whose mental health was affected during a pandemic using more robust methodologies such as longitudinal studies and in-depth qualitative exploration would help facilitate appropriate responses for their recovery.

INTRODUCTIONPrecision medical practice emphasises early detection, improved surveillance and prevention through targeted intervention. Prediction models can help identify high-risk individuals to be targeted for healthy behavioural changes or medical treatment to prevent disease development and assist both health professionals and patients to make informed decisions. Concerns exist regarding the adequacy, accuracy, validity and reliability of prediction models. AIMThe purpose of this study is to introduce readers to the basic concept of prediction modelling in precision health and recommend factors to consider before implementing a prediction model in clinical practice. METHODSPrediction models developed maintaining proper process and with quality prediction and validation can be used in clinical practice to improve patient care. RESULTSAspects of prediction models that should be considered before implementation include: appropriateness of the model for the intended purpose; adequacy of the model; validation, face validity and clinical impact studies of the model; a parsimonious model with data easily measured in clinical settings; and easily accessible models with decision support for successful implementation. DISCUSSIONChoosing clinical prediction models requires cautious consideration and several practical factors before implementing a model in clinical practice.

Skilled immigrants are critical assets to the social and economic dynamism of Canada. However, they are less likely to find employment matching their skillset due to a lack of inclusive post-immigration professional integration policies and support. They generally earn less and often live below the low-income cutoff relative to their Canadian-born counterparts. This paper aims to review the current situation of low job market integration (LJMI) of skilled immigrants in Canada and its implications on their social integration and mental well-being. Skilled immigrants continue to face disparities in getting desired jobs, despite having sufficient skills and credentials similar if not superior to that of Canadian-borns. Based on the existing literature, this study demonstrates that low job market integration limits skilled immigrants’ productivity, and they experience a lower level of social integration and deteriorated mental well-being. Therefore, initiatives from multidisciplinary and multisector stakeholders are necessary to improve skilled immigrants’ mental well-being by providing equal opportunities devoid of social exclusion and marginalization.

Critical discourse analysis (CDA) is an interdisciplinary research methodology used to analyze discourse as a form of “social practice”, exploring how meaning is socially constructed. In addition, the methodology draws from the field of critical studies, in which research places deliberate focus on the social and political forces that produce social phenomena as a means to challenge and change societal practices. The purpose of this article is to demonstrate the benefits of CDA to population public health (PPH) research. We will do this by providing a brief overview of CDA and its history and purpose in research and then identifying and discussing three crucial principles that we argue are crucial to successful CDA research: (1) CDA research should contribute to social justice; (2) CDA is strongly based in theory; and (3) CDA draws from constructivist epistemology. A key benefit that CDA brings to PPH research is its critical lens, which aligns with the fundamental goals of PPH including addressing the social determinants of health and reducing health inequities. Our analysis demonstrates the need for researchers in population public health to strongly consider critical discourse analysis as an approach to understanding the social determinants of health and eliminating health inequities in order to achieve health and wellness for all.

International Medical Graduates (IMGs), who completed their medical degree and training outside Canada constitute a notable portion of the skilled migrants of the country. However, due to a long and uncertain licensure process and limited opportunities many IMGs look for alternative career pathways where they can utilize their learned skills. Alternative careers in the health and wellness sector may offer such opportunities; however, IMGs’ success in these pathways were also less evident despite their high potential. In this study, we investigated the barriers that IMGs stated to face when attempting alternative jobs in Canada. Eight focus groups with 42 IMGs in Canada were conducted. Using a thematic analysis approach, we identified that IMGs encounter these barriers in different stages of their resettlement journey in Canada, including both the pre-migration and post-migration phases. In the pre-migration phase, IMGs were not aware of the success rates of the licensing pathways and did not have sufficient information regarding potential alternative careers. In the post-migration phase, the lack of information continues to affect IMGs where IMGs exhaust their resources pursuing alternative careers without proper guidance and support. Further, IMGs struggle with taking preparation for alternative careers by obtaining further certifications and completing other prerequisites for some barriers, such as financial constraints. While looking for jobs, some IMGs perceived systemic discrimination such as non-recognition of their credentials and experience. Furthermore, the mismatch of expectations and limited growth opportunities offered by potential careers serve to disincentivize IMGs from pursuing an alternative career. Addressing the current employment inequity experienced by IMGs in Canada warrants research collaborations between organizations supporting IMGs and policymakers that target known barriers to the pursuit of alternative careers by IMGs.

Current knowledge creation and mobilization efforts are concentrated in academic institutions. A community-engaged knowledge hub (CEKH) has the potential for transdisciplinary and cross-sectorial collaboration between knowledge producers, mobilizers, and users to develop more relevant and effective research practices as well as to increase community capacity in terms of knowledge production. Objective: To summarize existing original research articles on knowledge hubs or platforms and to identify the benefits, challenges, and ways to address challenges when developing a CEKH. Methods: This study followed a systematic integrative review design. Following a comprehensive search of academic and grey literature databases, we screened 9030 unique articles using predetermined inclusion criteria and identified 20 studies for the final synthesis. We employed thematic analysis to summarize the results. Results: The focus of the majority of these knowledge mobilization hubs was related to health and wellness. Knowledge hubs have a multitude of benefits for the key stakeholders including academics, communities, service providers, and policymakers, including improving dissemination processes, providing more effective community interventions, ensuring informed care, and creating policy assessment tools. Challenges in creating knowledge hubs are generally consistent for all stakeholders, rather than for individual stakeholders, and typically pertain to funding, resources, and conflicting perspectives. As such, strategies to address challenges are also emphasized and should be executed in unison. Conclusions: This study informs the development of a future CEKH through the identification of the benefits, challenges, and strategies to mitigate challenges when developing knowledge hubs. This study addresses a literature gap regarding the comparisons of knowledge hubs and stakeholder experiences.

Background: International medical graduates (IMGs) in Canada are individuals who received their medical education and training outside Canada. They undergo a complex licensing procedure in their host country and compete for limited opportunities available to become practicing physicians. Many of them cannot succeed or do not have the resources or interest to undergo this complex and unpredictable career pathway and seek alternative career options. In this study, we aimed to understand how IMGs integrate into the alternative job market, their demographic characteristics, and the types of jobs they undertake after moving to Canada. Methods: An anonymous cross-sectional, online, nationwide, and open survey was conducted among IMGs in Canada. In addition to demographic information, the questionnaire included information on employment status, types of jobs, professional experience, and level of medical education and practice (e.g., specialties, subspecialties, etc.). We conducted a survey of 1740 IMGs in total; however, we excluded responses from those IMGs who are currently working in a clinical setting, thus limiting the number of responses to 1497. Results: Of the respondents, 43.19% were employed and 56.81% were unemployed. Employed participants were more likely to be older males, have stayed longer in Canada, and had more senior-level job experience before moving to Canada. We also observed that the more years that had passed after graduation, the higher the likelihood of being employed. The majority of the IMGs were employed in health-related nonregulated jobs (50.45%). The results were consistent across other demographic characteristics, including different provinces, countries of origin, gender, time since graduation, and length of stay in Canada. Conclusions: This study found that certain groups of IMGs, such as young females, recent immigrants, recent graduates, and less experienced IMGs had a higher likelihood of being unemployed. These findings will inform policymakers, immigrant and professional service organizations, and researchers working for human resources and professional integration of skilled migrants to develop programs and improve policies to facilitate the employment of IMGs through alternative careers.

OSA is common in chronic kidney disease (CKD) and may accelerate a decline in kidney function. It is not clear whether treatment of OSA with CPAP improves kidney function.Does treatment with CPAP improve kidney function in patients with CKD and coexisting OSA?A randomized, controlled, nonblinded, parallel clinical trial was performed of patients with stages 3 and 4 CKD and coexisting OSA comparing the effect of CPAP vs usual care on the estimated glomerular filtration rate (eGFR) and the urine albumin to creatinine ratio (ACR) over 12 months.Fifty-seven patients were enrolled and 30 were randomized to CPAP. They had moderately severe CKD (eGFR, 38.4 ± 1.5 mL/min/1.73 mAlthough CPAP did not provide additional renal benefits over usual care in all CKD patients, some evidence suggested that CPAP slowed the decline in eGFR in CKD patients with a lower risk of CKD progression. These preliminary data support the need for larger clinical trials exploring the effects of CPAP on kidney function.ClinicalTrials.gov; No.: NCT02420184; URL: www.clinicaltrials.gov.

Skilled migration has been an important part of the socioeconomic development and progression of many industrialised Western countries. However, successful migration includes facilitating sociocultural and professional environments, policies, and practices in a way that utilizes the skills of migrants appropriately. Internationally educated physicians (IEPs) are an important part of the health and wellness care program of these countries. Nevertheless, because of regulations and limited available positions, many of these migrated physicians find they cannot enter into the healthcare workforce as practicing physicians. Utilizing their health-related knowledge and skills through nonphysician careers in health and wellness is a beneficial way to integrate these highly skilled professionals into a country’s socioeconomic flow. Despite the availability of alternative careers for IEPs, we identified that these paths are often not explored and facilitated, resulting in un/underemployment and wastage of these highly skilled human resources. A lack of willingness among IEPs, under/overestimation of their transferable skills by themselves and by potential employers, and a lack of strategic support and career guidance are prominent obstacles. A collaborative approach from multiple sectors, including academics, integration service providers, and policy makers, is needed to create awareness of these alternative opportunities and facilitation of the socioeconomic integration of IEPs.

Background: Accessing healthcare for immigrants in Canada is complicated by many difficulties. With the continued and upward trend of immigration to Canada, it is crucial to identify the solutions to the barriers from the perspectives of different immigrant communities as they encounter them including the relatively smaller and less studied population groups of immigrants. As such, Nepalese immigrants in Canada are a South Asian ethnic group who have their own distinct language, culture, and socio-economic backgrounds, however, their experience with accessing healthcare in Canada is scarce in the literature. Methods: We conducted 12 focus group discussions with first-generation Nepalese immigrants who had experiences with primary care use in Canada. Informed consent and demographic information were obtained before each focus group discussion. The verbatim transcription of the focus groups was analyzed using thematic analysis. Results: The participants expressed a range of potential solutions to overcome the barriers, which we presented using the socio-ecological framework into 4 different levels. This includes individual-, community-, service provider-, and government/policy-levels. Individual-level actions included improving self-awareness and knowledge of health in general and navigating the healthcare system and proactively improving the language skills and assimilating into the Canadian culture. Examples of community-level actions included community events to share health information with immigrants, health literacy programs, and driving/carpooling to clinics or hospitals. Actions at the service provider level were mainly focused on enhancing communications, cultural competency training for providers, and ensuring to hire primary care workforce representing various ethnocultural backgrounds. Overall, focus group participants believed that the provincial and federal government, as appropriate, should increase support for dental and vision care support and take actions to increase the healthcare capacity, particularly by employing internationally graduated health professionals. Conclusions: Access to primary care is essential for the health of immigrant populations in Canada. Individuals, community organizations, health service providers, and governments need to work both individually and collaboratively to improve immigrants’ primary care access.

Purpose: Immigrants tend to have lower rates of cancer screening than non-immigrants in Canada. Inequity in screening rates may stem from religious factors, which religious leaders can influence. This study aimed to explore the knowledge and attitudes held by Muslim religious leaders about cancer screening, as well as the role religious leaders perceive they can play in improving cancer screening health literacy among South Asian Muslim immigrant women. Methods: We conducted interviews with 8 Muslim religious leaders in Calgary, Canada. Participants’ knowledge and attitudes were inductively summarized using descriptive analysis, while practices were deductively thematically analyzed using the Socioecological Model and the Communication for Development approaches. Results: We found participants mostly had some knowledge of cancer, but lesser knowledge of different screening tests and of low screening rates among immigrants. Participants proposed that their role as a speaker, access to facilities and community networks, and collaboration with universities and healthcare professionals could help overcome religious misinterpretations and promote cancer screening among South Asian Muslim immigrant women. Conclusion: Religious leaders were highly supportive of incorporating health messaging into faith-based messaging. Future work should focus on implementing the practices recommended in this study with South Asian Muslim immigrant women’s voices at their center.

Schizophrenia is a complex biochemical brain disorder with significant prevalence rates. People suffering from schizophrenia are stigmatized in the society at both the personal and institutional level. With newspapers (print and electronic) serving as the voice of the masses, people with schizophrenia are often negatively represented. In this study we collected all articles of the year 2014 from top-10 online available English language Canadian newspapers by using schizophrenia as a keyword. Readers’ comments and social media sharing information of each of the articles were also collected. Inclusion-exclusion criteria and coding schema were developed to select and categorize relevant articles and comments. Statistical analyses were performed to see the relation of social media sharing with different categories of articles. Our study revealed that news of crime and violence by people with schizophrenia hold the highest representation; subsequently, in these type of articles most of the readers’ com...

There is concern that antidiabetic incretin-based drugs, including dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide 1 (GLP-1) analogues, can increase the risk of heart failure. Ongoing clinical trials may not have large enough samples to effectively address this issue.We applied a common protocol in the analysis of multiple cohorts of patients with diabetes. We used health care data from four Canadian provinces, the United States, and the United Kingdom. With the use of a nested case-control analysis, we matched each patient who was hospitalized for heart failure with up to 20 controls from the same cohort; matching was based on sex, age, cohort-entry date, duration of treated diabetes, and follow-up time. Cohort-specific hazard ratios for hospitalization due to heart failure among patients receiving incretin-based drugs, as compared with those receiving oral antidiabetic-drug combinations, were estimated by means of conditional logistic regression and pooled across cohorts with the use of random-effects models.The cohorts included a total of 1,499,650 patients, with 29,741 hospitalized for heart failure (incidence rate, 9.2 events per 1000 persons per year). The rate of hospitalization for heart failure did not increase with the use of incretin-based drugs as compared with oral antidiabetic-drug combinations among patients with a history of heart failure (hazard ratio, 0.86; 95% confidence interval [CI], 0.62 to 1.19) or among those without a history of heart failure (hazard ratio, 0.82; 95% CI, 0.67 to 1.00). The results were similar for DPP-4 inhibitors and GLP-1 analogues.In this analysis of data from large cohorts of patients with diabetes, incretin-based drugs were not associated with an increased risk of hospitalization for heart failure, as compared with commonly used combinations of oral antidiabetic drugs. (Funded by the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT02456428.).

With advances in medical practice and fields of research, reviews occupy a key position for summarizing existing knowledge. Due to the differences and overlap in terminology, the full potential for reviews may be lost due to confusion of indistinct approaches. The main objective of this study was to provide a descriptive outline of each of the common review types with their characteristics and examples in a health care system. Ascoping search was conducted using the keywords associated with the literature review typology. The SALSA(Search, Appraisal, Synthesis and Analysis) analytical framework was used to identify and distinguish each type of review. Nine common types of reviews and associated methodologies were evaluated against the already established SALSA framework. Their description, strengths and weaknesses are presented. The results provided a basic idea of different types of reviews based on the intended level of knowledge synthesis by which researchers can identify the appropriate type of review based on their intended audience.

Adverse childhood experiences (ACEs) affect 20%-50% of adults and are associated with considerable adult chronic disease, unhealthy behavior, and early mortality. Physicians seldom identify this history although identification can improve health. Low screening rates are attributed to poor physician knowledge of ACEs and barriers to screening, including a lack of confidence to screen and insufficient training. Female physicians and physicians with personal ACE histories report more confidence to screen and fewer time barriers. Our aims were to identify resident screening practices, ACE knowledge, attitudes, and personal ACE histories and to determine preferred ways to learn more, if required.Family medicine residents were surveyed, using a previously published survey. Items included ACE screening practices, ACE knowledge, attitudes, and personal ACE histories.The response rate was 97% (112/115), and 58% were female. Two percent of residents screened females and males at the first visit, thereafter residents screened women (6.3%) more than men (0.9%). One third of residents identified the correct prevalence of ACE in women and one tenth male prevalence. Unhealthy behaviors or physical chronic disease were not associated with ACE histories. Sixty-five percent of residents were not confident to screen. Twenty-nine percent of residents reported a trauma history. Eighty percent believed it was their role to screen. Formal medical training to screen was received by 45.5%; only five residents recalled training during residency.Resident ACE screening rates were extremely low. Physician educational initiatives are recommended to increase confidence to screen and actual screening prior to graduation.

End-stage kidney disease (ESKD) patients are at increased cardiovascular risk. Vitamin D deficiency is associated with depressed heart rate variability (HRV), a risk factor depicting poor cardiac autonomic tone and risk of cardiovascular death. Vitamin D deficiency and depressed HRV are highly prevalent in the ESKD population. We aimed to determine the effects of oral vitamin D supplementation on HRV ((low frequency (LF) to high frequency (HF) spectral ratio (LF:HF)) in ESKD patients on hemodialysis. Fifty-six subjects with ESKD requiring hemodialysis were recruited from January 2013–March 2015 and randomized 1:1 to either conventional (0.25 mcg alfacalcidol plus placebo 3×/week) or intensive (0.25 mcg alfacalcidol 3×/week plus 50,000 international units (IU) ergocalciferol 1×/week) vitamin D for six weeks. The primary outcome was the change in LF:HF. There was no difference in LF:HF from baseline to six weeks for either vitamin D treatment (conventional: p = 0.9 vs. baseline; intensive: p = 0.07 vs. baseline). However, participants who remained vitamin D-deficient (25-hydroxyvitamin D < 20 ng/mL) after treatment demonstrated an increase in LF:HF (conventional: n = 13, ∆LF:HF: 0.20 ± 0.06, p < 0.001 vs. insufficient and sufficient vitamin D groups; intensive: n = 8: ∆LF:HF: 0.15 ± 0.06, p < 0.001 vs. sufficient vitamin D group). Overall, six weeks of conventional or intensive vitamin D only augmented LF:HF in ESKD subjects who remained vitamin D-deficient after treatment. Our findings potentially suggest that while activated vitamin D, with or without additional nutritional vitamin D, does not appear to improve cardiac autonomic tone in hemodialysis patients with insufficient or sufficient baseline vitamin D levels, supplementation in patients with severe vitamin D deficiency may improve cardiac autonomic tone in this higher risk sub-population of ESKD. Trial Registration: ClinicalTrials.gov, NCT01774812.

As one of the most popular social networking sites in the world, Facebook has strong potential to enable peer support and the user-driven sharing of health information. We carried out a qualitative thematic analysis of the wall posts of a public Facebook group focused on dialysis to identify some of the major themes discussed.We searched Facebook using the word 'dialysis'. A Facebook group (Dialysis Discussion Uncensored) with the highest number of members was selected amongst publicly available forums related to dialysis and operated in English (http://www.facebook.com/groups/DialysisUncensored). Two researchers independently extracted information on features of the group including purpose, group members and the user-generated posts on the group wall. Posts were further analysed to develop major themes.Characteristics of a Facebook group based on its participants and activities are presented. Three themes are described with representative quotations. In a period of 2 weeks, we found 1257 wall posts with total of 31 636 likes and 15 972 comments. All messages were in English, and the majority of the participants were dialysis patients. However, we observed the participation of family members and care providers as well. Posts were categorized into three major themes: sharing information, seeking and providing emotional and social support and sharing experience.Findings of this study provide an example of how a social networking platform can enable patients and their families to share information and to encourage peer-based support for managing dialysis-related experiences.

Background Patients with end-stage kidney disease (ESKD) have a high rate of mortality and specifically an increased risk of sudden cardiac death (SCD). Impaired cardiac autonomic tone is associated with elevated risk of SCD. Moreover, patients with ESKD are often vitamin D deficient, which we have shown may be linked to autonomic dysfunction in humans. To date, it is not known whether vitamin D supplementation normalizes cardiac autonomic function in the high-risk ESKD population. The VITamin D supplementation and cardiac Autonomic tone in Hemodialysis (VITAH) randomized trial will determine whether intensive vitamin D supplementation therapies improve cardiac autonomic tone to a greater extent than conventional vitamin D supplementation regimens in ESKD patients requiring chronic hemodialysis. Methods/Design A total of 60 subjects with ESKD requiring thrice weekly chronic hemodialysis will be enrolled in this 2x2 crossover, blinded, randomized controlled trial. Following a 4-week washout period from any prior vitamin D therapy, subjects are randomized 1:1 to intensive versus standard vitamin D therapy for 6 weeks, followed by a 12-week washout period, and finally the remaining treatment arm for 6 weeks. Intensive vitamin D treatment includes alfacalcidiol (activated vitamin D) 0.25mcg orally with each dialysis session combined with ergocalciferol (nutritional vitamin D) 50 000 IU orally once per week and placebo the remaining two dialysis days for 6 weeks. The standard vitamin D treatment includes alfacalcidiol 0.25mcg orally combined with placebo each dialysis session per week for 6 weeks. Cardiac autonomic tone is measured via 24 h Holter monitor assessments on the first dialysis day of the week every 6 weeks throughout the study period. The primary outcome is change in the low frequency: high frequency heart rate variability (HRV) ratio during the first 12 h of the Holter recording at 6 weeks versus baseline. Secondary outcomes include additional measures of HRV. The safety of intensive versus conventional vitamin D supplementation is also assessed. Discussion VITAH will determine whether an intensive vitamin D supplementation regimen will improve cardiac autonomic tone compared to conventional vitamin D supplementation and will assess the safety of these two supplementation regimens in ESKD patients receiving chronic hemodialysis. Trial registration ClinicalTrials.gov, NCT01774812