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Several studies have demonstrated higher rates of Clostridioides difficile infection (CDI) in adults with inflammatory bowel disease (IBD). We conducted a population-based study comparing the risk of hospitalization with CDI in children with and without IBD.Using health administrative data and validated algorithms, we identified all children (16 years) diagnosed with IBD in 5 Canadian provinces, then age and sex matched to 5 children without IBD. Province-specific 5-year incidence rates of hospitalization with CDI were pooled and generalized linear mixed-effects models were used to estimate the crude incidence rate ratio (IRR) comparing (1) children with and without IBD and (2) children with Crohn disease and ulcerative colitis. Hazard ratios (HR) from Cox proportional hazards models adjusting for age, sex, rural/urban household, and income were pooled using fixed-effects models.The incidence rate of CDI identified during hospitalization was 49.06 [95% confidence interval (CI), 39.40-61.08] per 10,000 person-years (PY) in 3593 children with IBD compared to 0.39 (95% CI, 0.13-1.21) per 10,000 PY in 16,284 children without IBD (crude IRR, 133.4, 95% CI, 42.1-422.7; adjusted HR, 68.2, 95% CI, 24.4-190.4). CDI was identified less often in children with Crohn disease than ulcerative colitis (crude IRR, 0.51, 95% CI, 0.32-0.82; adjusted HR, 0.69, 95% CI, 0.46-1.05).Children with IBD have a markedly higher incidence of CDI identified during a hospitalization relative to children without IBD. Consequently, symptomatic children with IBD who are hospitalized should be screened for CDI.

Urban flooding has become one of the most common natural hazards threatening people’s lives and assets globally due to climate change and rapid urbanization. Hydraulic structures, e.g., sluicegates and pumping stations, can directly influence flooding processes and should be represented in flood modeling and risk assessment. This study aims to present a robust numerical model by incorporating a hydraulic structure simulation module to accurately predict the highly transient flood hydrodynamics interrupted by the operation of hydraulic structures to support object-level risk assessment. Source-term and flux-term coupling approaches are applied and implemented to represent different types of hydraulic structures in the model. For hydraulic structures such as a sluicegate, the flux-term coupling approach may lead to more accurate results, as indicated by the calculated values of NSE and RMSE for different test cases. The model is further applied to predict different design flood scenarios with rainfall inputs created using Intensity-Duration-Frequency relationships, Chicago Design Storm, and surveyed data. The simulation results are combined with established vehicle instability formulas and depth-damage curves to assess the flood impact on individual objects in an urbanized case study area in Zhejiang Province, China.

Background Collaborative care models improve inflammatory bowel disease (IBD) patient outcomes, yet little is known about the capacity or available resources to deliver such model of care in Canada. We aimed to describe the structure and process characteristics of clinical care delivery models for IBD across Canada, including the number of collaborative care centers. Methods A cross-sectional study was conducted between November 2017 and October 2018 through an online survey. This survey was distributed to gastroenterologists at community and academic centers across Canada who provide care for IBD patients. Comparisons between collaborative and non-collaborative centers were analyzed using chi-squares or t-tests. Descriptive statistics of respondent demographics were also generated. Results Seventy-two gastroenterologists from 62 unique IBD centers completed the survey. A total of 7 unique collaborative centers and 55 unique non-collaborative centers were identified. There were significant differences between collaborative and non-collaborative centers in some aspects of access to IBD care, patient assessment and referral process, and patent education and empowerment. Notably, very few centers had processes for implementing and evaluating evidence-based clinical pathways, and auditing quality indicators. Conclusions Our findings identify areas for improving the quality of IBD care in Canada. Expanding the number of and access to collaborative care centers in Canada is needed, in addition to increased focus on patient education, communication, and implementation of evidence-based care pathways.

Background and Aims Although venous thromboembolism [VTE] is a well-known complication of inflammatory bowel disease [IBD] in adults, limited data exist on the risk in children. We report the incidence of VTE among children with and without IBD. Methods We conducted a matched cohort study within a distributed network of population-based Canadian provincial health administrative databases. Children Results The 5-year incidence of VTE among 3593 children with IBD was 31.2 [95% CI 23.7–41.0] per 10 000 person-years [PY] compared to 0.8 [95% CI 0.4–1.7] per 10 000 PY among 16 289 children without IBD [unadjusted IRR 38.84, 95% CI 16.59–90.83; adjusted HR 22.91, 95% CI 11.50–45.63]. VTE was less common in Crohn’s disease than ulcerative colitis [unadjusted IRR 0.47, 95% CI 0.27–0.83; adjusted HR 0.52, 95% CI 0.29–0.94]. The findings were similar for deep vein thrombosis and pulmonary embolism when comparing children with and without IBD. Conclusions The risk of VTE is much higher in children with IBD than controls without IBD. While the absolute risk is low, we found a higher incidence rate than previously described in the pediatric literature. Conference Presentation: An abstract based on the data included in this paper was presented at Canadian Digestive Diseases Week [Montréal, Canada] in March 2020.

There is little literature related to access to inflammatory bowel disease (IBD) care that incorporates the perspective of key system stakeholders, such as primary healthcare providers (PHCP), despite their clear and integral role in facilitating access.This study aimed to identify barriers to referring patients to speciality IBD care as perceived by referring PHCP. In particular, we sought to understand PHCP satisfaction with the current IBD specialist referral system, as well as indicators of geographic variance to access.A population-based survey was mailed out to currently practising PHCPs who have referred or who are currently referring patients to IBD speciality care in Nova Scotia (Canada). Descriptive statistics and multivariate analyses were performed. Qualitative comments were themed using framework analysis to identify key barriers.The majority of PHCP (57%) were dissatisfied with the current referral process due to long patient wait times and perceived system inefficiency. Key areas of geographic variance in access included access to speciality care in the community and patient wait times. PHCPs suggested ideas to improve access including increased gastroenterologist supply, particularly in rural areas, and the creation of a provincial centralized referral and triage process.PHCPs play an important role in identifying and managing patients with IBD in partnership with gastroenterologists. This study identifies key PHCP perceived barriers that may prevent patients from accessing speciality IBD care. Understanding and addressing barriers to access from multiple stakeholder perspectives, including PHCPs, has the potential to support informed system redesign and overcome access inequities.Primary healthcare providers (e.g. family doctors and nurse practitioners) play an important role in connecting patients with speciality health care. Patients with digestive diseases, such as inflammatory bowel diseases (e.g. Crohn’s and colitis), may rely on primary healthcare providers to connect them with inflammatory bowel disease specialists (e.g. gastroenterologists). Past research on access to inflammatory bowel disease care has focused on the patient perspective; however, almost no research has focused on how primary healthcare providers perceive access to inflammatory bowel disease speciality care, despite their important role in facilitating access. This paper focuses on what 155 primary healthcare providers in Nova Scotia (Canada) perceive as key barriers for their patients when accessing speciality Inflammatory bowel disease care. This paper also presents potential improvements to the referral process and healthcare system, as suggested by primary healthcare providers, which may improve global access to inflammatory bowel disease care.

Background: Physical inactivity is an important risk factor for cardiovascular disease (CVD). Atlantic Canada is a region with lower physical activity (PA) levels and poorer CVD outcomes than the rest of Canada. Yet, within-region variation is expected. This study aimed to assess the association between PA and CVD and how this relationship varied on a regional level. Methods: This cross-sectional study used data from the Atlantic Partnership for Tomorrow’s Health (PATH) Study. The cohort included 823 CVD cases and 2469 age-, sex-, and province of residence-matched controls between the ages 35 and 69. Data collected included self-reported CVD and PA levels as well as information on sociodemographic characteristics, health status, and lifestyle behaviours. Simple and multiple logistic regression were used to assess the association between PA and CVD. Results: High PA levels were associated with a 26% reduction in the mean probability of CVD compared with low PA levels across the total population. Compared with high PA levels, moderate and low PA levels were associated with increased odds of CVD across all 4 provinces. However, regional variation was observed, with higher odds of CVD for low-to-moderate PA levels in Newfoundland and Labrador and New Brunswick compared with Nova Scotia and Prince Edward Island. Conclusions: Atlantic Canadians experience regional inequalities in the association between PA and CVD. Future work needs to explore underlying pathways driving these regional differences, which may be the impetus for interventions that mitigate risk and CVD burden in populations of greatest need. Résumé: Introduction: L’inactivité physique est un facteur de risque important de maladies cardiovasculaires (MCV). Le Canada atlantique est une région où les taux d’activité physique (AP) sont faibles et les issues des MCV sont moins bonnes que dans le reste du pays. Cependant, on s’attend à des variations entre les régions. La présente étude a pour objectif d’évaluer l’association entre l’AP et les MCV, et la façon dont cette relation varie sur le plan régional. Méthodes: Cette étude transversale a utilisé les données de l’étude La VOIE atlantique (le Partenariat de l’Atlantique pour la santé de demain). La cohorte comptait 823 cas de MCV et 2 469 témoins de 35 à 69 ans appariés selon l’âge, le sexe et la province de résidence. Les données collectées étaient les suivantes : les MCV et les taux d’AP, ainsi que les renseignements sur les caractéristiques sociodémographiques, l’état de santé et les comportements liés au mode de vie. Nous avons utilisé la régression logistique simple et multiple pour évaluer l’association entre l’AP et les MCV. Résultats: Les taux élevés d’AP ont été associés à une réduction de 26 % de la probabilité moyenne des MCV comparativement à des taux faibles d’AP dans l’ensemble de la population. Comparativement à des taux élevés d’AP, les taux faibles et modérés d’AP ont été associés à une probabilité accrue de MCV dans les 4 provinces. Toutefois, nous avons observé des variations régionales lors de taux faibles à modérés d’AP, soit une probabilité plus élevée de MCV à Terre-Neuve-et-Labrador et au Nouveau-Brunswick qu’en Nouvelle-Écosse et à l’Île-du-Prince-Édouard. Conclusions: Les Canadiens de l’Atlantique montrent des inégalités régionales dans l’association entre l’AP et les MCV. D’autres travaux sont nécessaires pour étudier les voies sous-jacentes entraînant ces différences régionales et peuvent donner lieu à des interventions qui allègent le risque et le fardeau des MCV au sein des populations dont les besoins sont les plus grands.

Individuals living with cancer have been shown to have a higher burden of comorbid disease and multimorbidity in comparison to their cancer-free counterparts consequently, leaving them at risk of polypharmacy (i.e., ≥ 5 medications) and its potential negative effects. The primary aim of the current study was to examine the self-reported prevalence of and association between multimorbidity and prescription medication use in a population-based sample of adult cancer survivors (CS). This retrospective, nested case–control study drew participant data from the Atlantic Partnership for Tomorrow’s Health cohort. CS (n = 1708) were matched to 4 non-cancer controls (n = 6832) by age and sex. Prevalence of polypharmacy by number of chronic conditions and age was estimated with 95% CI. Logistic regression was used to examine the association between multimorbidity and polypharmacy while adjusting for sociodemographic and lifestyle factors. The comorbidity–polypharmacy score was also calculated as an estimate of disease burden. Multimorbidity was common in both CS (53%) and non-cancer controls (43%); however, a significantly higher percentage of CS reported multimorbidity (p

Although smoking is the primary risk factor for lung cancer, 15-25% of lung cancers occur in never smokers. Emerging evidence suggests lifestyle factors are associated with lung cancer risk, but few studies among never smokers exist.A case-control study of never smokers within the Canadian Partnership for Tomorrow's Health was conducted. At recruitment, participants provided data on lifestyle, health history and sociodemographic factors. Incident lung cancers were identified through linkage with administrative health records. Cases (n = 190) were matched to controls (n = 760) on age, sex, and follow-up time. Logistic regression analyses, adjusted for matching factors and annual income, were used to identify associations between lifestyle factors and lung cancer risk.Consumption of 5 servings of fruits and vegetables/day was associated with higher risk of lung cancer (OR 1.50, 95% CI 1.03-2.17). Short or long sleep (≤ 6 or 9 h/night) was also associated with increased risk of lung cancer (OR 1.52, 95% CI 1.01-2.29). No associations were observed for obesity measures, alcohol consumption, or physical activity.Our findings provide evidence of a potential role between sleep, fruits and vegetable consumption, and lung cancer risk in a pan-Canadian, non-smoking population. However, the sample size is modest, and further investigation is needed.

Introduction Occupational data in prospective cohort studies is often underutilized due to the human and financial resources required to code open-ended text, such as job titles. Recognizing the value of occupational data in health research, as well as potential errors associated with manual coding, an Automated Coding Algorithm (ACA)-NOC algorithm was developed utilizing a Natural Language Processing approach. Objectives We tested the ACA-NOC algorithm on two regional cohorts of a pan-Canadian cohort study, which represents the largest dataset an algorithm of this kind has been applied to. This process will harmonize and greatly expand the utility of the occupational data, enrich the research platforms, and further refine the efficiency of the algorithm. Methods The ACA-NOC algorithm was tested on data from the Canadian Partnership for Tomorrow’s Health (CanPath), a longitudinal cohort examining the role of genetic, environmental, lifestyle, and behavioural factors in the development of cancer and chronic disease. Using an iterative and interactive approach, the algorithm was applied to job title data from 111,000 questionnaires from two regional cohorts, coding the data to the Canadian National Occupation Classification (NOC) system. The algorithm was further refined based on each round of analysis, increasing the quantity of accurately coded data. Results Results from this research demonstrate the ability to refine the ACA-NOC algorithm with a 10% overall improvement in exact matching from the baseline algorithm. There were also instances where the algorithm performance was superior to the manual coding. The utilization of the algorithm offers significant savings in time, human resources and cost compared to a singular manual coding approach. Conclusions The coding and harmonization of this multi-cohort data demonstrates the value of the ACA-NOC algorithm, while increasing the utility of the CanPath data and research related to occupational health. Future research may involve comparisons between CanPath and international cohorts.

Objectives Psychosocial factors have been hypothesized to increase the risk of cancer. This study aims (1) to test whether psychosocial factors (depression, anxiety, recent loss events, subjective social support, relationship status, general distress, and neuroticism) are associated with the incidence of any cancer (any, breast, lung, prostate, colorectal, smoking‐related, and alcohol‐related); (2) to test the interaction between psychosocial factors and factors related to cancer risk (smoking, alcohol use, weight, physical activity, sedentary behavior, sleep, age, sex, education, hormone replacement therapy, and menopausal status) with regard to the incidence of cancer; and (3) to test the mediating role of health behaviors (smoking, alcohol use, weight, physical activity, sedentary behavior, and sleep) in the relationship between psychosocial factors and the incidence of cancer. Methods The psychosocial factors and cancer incidence (PSY‐CA) consortium was established involving experts in the field of (psycho‐)oncology, methodology, and epidemiology. Using data collected in 18 cohorts (N = 617,355), a preplanned two‐stage individual participant data (IPD) meta‐analysis is proposed. Standardized analyses will be conducted on harmonized datasets for each cohort (stage 1), and meta‐analyses will be performed on the risk estimates (stage 2). Conclusion PSY‐CA aims to elucidate the relationship between psychosocial factors and cancer risk by addressing several shortcomings of prior meta‐analyses., Psychosocial factors and cancer incidence (PSY‐CA) consortium endeavor to understand the role of several different psychosocial factors—including depression and anxiety—in the onset of cancer. The study will employ the use of individual participant data meta‐analyses, combining results from several large, international cohorts with longitudinal designs. Furthermore, PSY‐CA aims to elucidate the role of health behaviors in the relationship between psychosocial factors and cancer risk.

Background: While neighborhood walkability has been shown to positively influence health behaviors, less is known about its impact on chronic disease. Our aim was to examine the association between walkability and self-reported physical activity in relation to chronic health conditions in an Atlantic Canadian population. Methods: Using data from the Atlantic Partnership for Tomorrow&rsquo, s Health, a prospective cohort study, we employed both a cross-sectional and a prospective analytical approach to investigate associations of walkability and physical activity with five prevalent chronic diseases and multimorbidity. Results: The cross-sectional data show that participants with the lowest neighborhood walkability were more likely to have reported a pre-existing history of cancer and depression and least likely to report chronic respiratory conditions. Participants with low physical activity were more likely to have a pre-existing history of diabetes, chronic respiratory disease, and multimorbidity. Follow-up analyses showed no significant associations between walkability and chronic disease incidence. Low levels of physical activity were significantly associated with diabetes, cancer and multimorbidity. Conclusions: Our data provides evidence for the health protective benefits of higher levels of physical activity, and a reduction in prevalence of some chronic diseases in more walkable communities.

Extreme natural hazards such as tsunamis or storm surges have been frequently reported in recent years, posting serious threat to people and their properties. Numerical modelling has provided an indispensable tool to predict these hazardous events and assess their risks. However, most of the current models are based on the assumption of “clean” water and neglect the impact of floating debris as observed in reality. The interactive processes between the floating debris and the background fluid flow have not been well explored and understood. Few reliable modelling tool has been reported for simulating and predicting these complicated processes.This work presents a two-way dynamic method to couple a 2D shallow flow hydrodynamic model with a discrete element method (DEM) model for simulating and analyzing the interactive process between fluid flow and floating debris under the extreme hydraulic conditions induced by tsunami or flash flooding. The proposed two-way coupling approach uses the high-resolution water depth and velocity predicted by the hydrodynamic model to quantify the hydrostatic and dynamic forces acting on the floating objects; the corresponding counter forces on the fluid are subsequently taken into account by including extra source terms in the governing shallow water equations (SWEs) of hydrodynamic model. This new approach lifts the limitation of traditional approaches that reply on calibrated empirical parameters to quantify the forces. In developing the resulting coupled model, a multi-sphere method (MSM) is adopted and implemented in the DEM model to simulate solid debris. This method ensures that the interaction of fluid and solid is realistically modelled and the application is not restricted by shapes and sizes of debris.The new coupling model is validated against a dam-break flume experiment with three floating objects impacting two fixed obstacles. The predicted results in terms of water depth and floating object displacements in both horizontal and vertical directions compare well with the experimental observations. Furthermore, the new coupled model is computationally accelerated by implementation on modern GPUs to achieve high-performance computing. It provides a robust and innovative modelling tool for the simulation of large-scale flooding process including debris impact and assess the resulting risk.

Due to climate change and rapid urbanization, urban flooding has become one of the major natural hazards threatening the safety of people and their properties and affecting the overall sustainability of cities across the globe, especially developing countries such as China. Flood modelling has now provided an indispensable tool to support urban flood risk assessment and management, and inform the planning of cities that are more resilient to flooding.Hydraulic structures, e.g. regulation gates and pumping stations, play an important role in urban flood risk management. However, direct simulation of these hydraulic structures is not a current practice in 2D urban flood modelling. This work presents and applies a robust numerical approach to directly simulate the effects of hydraulic structures in a 2D high-resolution urban flood model. An additional computational module is developed and fully coupled to a GPU-accelerated finite volume shock-capturing urban flood model to directly simulate the highly transient flood waves through hydraulic structures. The improved flood model is applied to reproduce a flood event induced by Typhoon “Lekima” in 2019 in Yuhuan, Zhejiang Province, China. At 3m resolution, the model is able to simulate the complete process of the flood event in nearly 3.5 times faster than real time, demonstrating the efficiency and robustness of the new fully coupled model for high-resolution food modelling in cities. Further simulations are performed to systemically investigate the effect of hydraulic structures and different operational regulations on flood dynamics and associated risks, demonstrating the importance of directly considering hydraulic structures and their operations in 2D high-resolution urban flood modelling.

The population of Atlantic Canada is aging rapidly and has among the highest rates of chronic disease in the country. This cross-sectional study drew data from the Atlantic Partnership for Tomorrow's Health (Atlantic PATH) study to investigate the association between physical activity and self-rated health among adults in this population. The results suggest that physical activity is associated with and may help to improve perceived health status of individuals with one or more chronic conditions. The findings support literature suggesting that physical activity can be beneficial for adults as they age with chronic disease.

Background Inflammatory bowel disease (IBD) increases the risk of venous thromboembolism (VTE) in patients of all ages but the risk of VTE among Canadian children with IBD has not previously been investigated. Aims Report the incidence of VTE and subtypes pulmonary embolism (PE) and deep vein thrombosis (DVT) in children with and without IBD. Methods Children diagnosed with IBD Results 3127 children with IBD (1826 CD; 1045 UC) were matched to 15,635 children without IBD. The cumulative incidence of VTE within 5 years of IBD diagnosis was 2.8 (95% CI 2.1–3.8) per 1000 PYs compared to 0.13 (95% CI 0.07–0.24) per 1000 PYs in children without IBD (Table). The 5-year cumulative incidences of VTE, DVT, and PE were significantly higher in children with IBD than in children without IBD (VTE: IRR 21.44, 95% CI 10.73–42.82; DVT: IRR 25.15, 95% CI 11.12–56.89; PE: IRR 4.01, 95% CI 1.22–13.18). Compared to UC patients, children with CD were at lower risk of VTE (IRR 0.53, 95% CI 0.29–0.96) and numerically, but not statistically, lower risk of DVT (IRR 0.59, 95% CI 0.30–1.14). Conclusions Although VTEs are relatively rare among children with IBD, these children are at much greater risk than children without IBD. Gastroenterologists caring for these patients should be cognizant of VTE risk and provide appropriate prophylaxis to those at high risk of VTE. Funding Agencies CCC

Individuals living with cancer have been shown to have a higher burden of comorbid disease and multimorbidity in comparison to their cancer-free counterparts consequently, leaving them at risk of polypharmacy (i.e., ≥ 5 medications) and its potential negative effects. The primary aim of the current study was to examine the self-reported prevalence of and association between multimorbidity and prescription medication use in a population-based sample of adult cancer survivors (CS).This retrospective, nested case-control study drew participant data from the Atlantic Partnership for Tomorrow's Health cohort. CS (n = 1708) were matched to 4 non-cancer controls (n = 6832) by age and sex. Prevalence of polypharmacy by number of chronic conditions and age was estimated with 95% CI. Logistic regression was used to examine the association between multimorbidity and polypharmacy while adjusting for sociodemographic and lifestyle factors. The comorbidity-polypharmacy score was also calculated as an estimate of disease burden.Multimorbidity was common in both CS (53%) and non-cancer controls (43%); however, a significantly higher percentage of CS reported multimorbidity (p 0.001). Prescription medication use was also found to be significantly higher among CS (2.3 ± 2.6) compared to non-cancer controls (1.8 ± 2.3; p 0.0001). Exploratory comorbidity-polypharmacy score analyses indicated that CS had a significantly higher overall disease burden than the age/sex-matched non-cancer controls.As CS appear to be at a higher risk of multimorbidity and polypharmacy and by extension, increased healthcare burden, ongoing education on the prevention of medication-related harm, and interventions to reduce the occurrence of both co-morbid disease and unnecessary medications are warranted.

We evaluated the relationship between mental health and shift work in the Atlantic Partnership for Tomorrow's Health (PATH) cohort study. In a matched study with 12,413 participants, including 4155 shift workers and 8258 non-shift workers, we utilized general linear models and logistic regression models to assess the differences in depression, anxiety, and self-rated health. Shift workers reported higher levels of each of the mental health-related domains compared to non-shift workers. There was a significant increased risk of depression (OR = 1.13, 95% CI, 1.00–1.27) and poor self-rated health (OR = 1.13, 95% CI, 1.14–1.55) among shift workers compared to non-shift workers. Shift workers were more likely to have increased rates of depression and poor self-rated health, as well as depressive and anxiety symptom scores compared to non-shift workers. As a result, shift workers may be at increased risk of comorbidity, poor quality of life, missed work, and early retirement.

Context: The increasing prevalence of obesity and diabetes greatly influences the risk for cardiovascular (CV) comorbidities and affects the quality of life of many people. However, the relationship among diabetes, obesity, and cardiovascular risk is complex and requires further investigation to understand the biological milieu connecting these conditions. Objective: The aim of the current study was to explore the relationship between biological markers of adipose tissue function (adiponectin) and CV risk (apolipoprotein B) in body mass index (BMI)–matched participants with and without diabetes. Design: Nested case-control study. Setting: The Atlantic Partnership for Tomorrow’s Health (PATH) cohort represents four Atlantic Canadian provinces: Newfoundland and Labrador, New Brunswick; Nova Scotia; and Prince Edward Island. Participants: The study population (n = 480) was aged 35 to 69 years, 240 with diabetes and 240 without diabetes. Main Outcome Measures: Groups with and without diabetes were matched for sex and BMI. Both measured and self-reported data were used to examine disease status, adiposity, and lifestyle factors. Immunoassays were used to measure plasma markers. Results: In these participants, plasma adiponectin levels were lower among those with diabetes than those without diabetes; these results were sex-specific, with a strong relationship seen in women. In contrast, in participants matched for sex and adiposity, plasma apoB levels were similar between participants with and those without diabetes. Conclusion: Measures of adiposity were higher in participants with diabetes. However, when matched for adiposity, the adipokine adiponectin exhibited a strong inverse association with diabetes., Adults with diabetes and matched controls demonstrate similar plasma apolipoprotein B levels and a sex-specific inverse association between plasma adiponectin levels and the prevalence of diabetes.

Objectives: The incidence of pediatric-onset inflammatory bowel disease (IBD) is increasing worldwide. We used population-based health administrative data to determine national Canadian IBD incidence, prevalence, and trends over time of childhood-onset IBD. Methods: We identified children

Purpose To describe and compare the sociodemographic and lifestyle characteristics of urban and rural residents in Atlantic Canada. Methods Cross‐sectional analyses of baseline data from the Atlantic Partnership for Tomorrow's Health cohort were conducted. Specifically, 17,054 adults (35‐69 years) who provided sociodemographic characteristics, measures of obesity, and a record of chronic disease and health behaviors were included in the analyses. Multiple linear regression and logistic regression models were used to calculate the multivariable‐adjusted beta coefficients (β), odds ratios (OR), and related 95% confidence intervals (CI). Findings After adjusting for age, sex, and province, when compared to urban participants, rural residents were significantly more likely to: be classified as very active (OR: 1.19, CI: 1.11‐1.27), be obese (OR: 1.13, 1.05‐1.21), to present with abdominal obesity (OR: 1.08, CI: 1.01‐1.15), and have a higher body fat percentage (β: 0.40, CI: 0.12‐0.68) and fat mass index (β: 0.32, CI: 0.19‐0.46). Rural residents were significantly less likely to be regular or habitual drinkers (OR: 0.83, CI: 0.78‐0.89). Significant differences remained after further adjustment for confounding sociodemographic, lifestyle, and health characteristics. No significant differences in smoking behavior, fruit and vegetable intake, multimorbidity, or waist circumference were found. Conclusions As expected, obesity prevalence was higher in rural Atlantic Canadians. In contrast to much of the existing literature, we found that rural participants were more likely to report higher levels of total physical activity and lower alcohol consumption. Findings suggest that novel obesity prevention strategies may be needed for rural populations.

To evaluate the relationship between anthropometric measures and cardiometabolic health in shift workers compared to non-shift workers. A population health study was conducted with 4155 shift workers and 8258 non-shift workers from the Atlantic Partnership for Tomorrow’s Health (PATH) cohort. Linear and logistic regression models were used to assess the differences in anthropometric measures (body adiposity) and self-reported cardiometabolic disease outcomes (obesity, diabetes, and cardiovascular disease) between shift workers and non-shift workers. There was a significant increased risk of cardiovascular disease, obesity, and diabetes among shift workers compared to matched controls despite higher levels of physical activity and lower levels of sedentary behaviour. Shift workers were 17% more likely to be obese (95% CI 7–27) and 27% more likely to have diabetes (95% CI 8–51). The strength of this association was demonstrated by also controlling for body mass index and fat mass index. Shift work is associated with obesity, cardiovascular disease, and diabetes despite higher levels of physical activity and lower levels of sedentary behaviour. The association between shift work and cardiometabolic health was independent of body mass index for cardiovascular disease and diabetes, and independent of fat mass index for diabetes.

BACKGROUND: Non-melanoma skin cancer (NMSC) rates have been shown to increase in Inflammatory Bowel Disease (IBD) patients taking 6-thioguanine (6-TGN) antimetabolites (Azathioprine and 6-Mercatopurine). There is limited population-based data assessing the risk of NMSC in IBD patients on 6-TGN and anti-tumor necrosis factor (anti-TNF) therapy. AIMS: To determine the risk of NMSC amongst IBD patients on 6-TGN antimetabolites and anti-TNF therapies in a longitudinal, population-based Canadian cohort METHODS: This was a retrospective cohort study using population-based administrative data from Saskatchewan (1970 to 2011). IBD and NMSC cases were identified through application of validated administrative definitions to ICD billing codes. Using population-based drug dispensal data IBD cases were classified as “exposed” and “unexposed” to each of 6-TGN antimetabolites and anti-TNF therapies. Univariate and multivariate conditional logistic regression and cox-proportional hazard analyses were performed. Hazard ratios were adjusted for age, sex, location, and medication. RESULTS: A total of 8713 prevalent IBD cases were identified for inclusion, 51.6% CD and 48.4% UC. There were 349 cases of NMSC, 68 patients were exposed to 6-TGN and 281 non-exposed. The unadjusted hazard ratio (HR) was 0.74 in IBD patients exposed to 6-TGN compared to non exposed, p 0.0276 (95% CI 0.57–0.97). Stratified by age (

The authors request the following corrections to their paper [1]. [...]

Introduction Contemporary work environments increasingly rely upon a 24 hour work cycle resulting in more employees exposed to shift work. 30% of working age Canadians work evening, night and rotating shifts, and 21% of workers in the European Union. Compared to regular daytime work, shift work has the potential for disturbing sleep patterns and disrupting circadian rhythms with adverse health effects. Methods Participation was limited to volunteers from the Atlantic Canadian Provinces (Nova Scotia, New Brunswick, Newfoundland and Labrador, and Prince Edward Island). 12 413 participants, including 4155 shift workers and 8258 non-shift workers (matched 1:2 by age, sex, and education) from the Atlantic Partnership for Tomorrow’s Health (PATH) study. Multiple general linear and logistic regression models were used to assess differences in body adiposity and self-reported cardiometabolic disease outcomes between shift workers and non-shift workers. Results There was a significant increased risk of obesity and diabetes among shift workers compared to their matched controls. Shift workers were 18% more likely to be obese (95% CI: 9 to 29) and 8% more likely to have abdominal obesity (95% CI: 0 to 17). Shift workers were 31% more likely to have diabetes than non-shift workers (95% CI: 11 to 56). The strength of this association was further demonstrated by controlling for participants’ fat mass index (FMI), which resulted in a 28% increased risk of diabetes among shift workers (95% CI: 2 to 60). Despite the increased likelihood of being physically active, regular night shift workers had higher levels of BMI, waist circumference, and fat mass compared with matched controls. Conclusion Despite higher levels of physical activity and lower levels of sedentary behaviour, shift workers were more likely to have increased rates of diabetes and obesity and are subsequently at increased the risk of developing other chronic disease. The effects of shift work on cardiometabolic status may be independent of simple obesity.

The objective of this study was to examine the relationship between adipokines and adiposity in individuals with rheumatoid and osteoarthritis in the Atlantic PATH cohort. Using a nested case-control analysis, participants in the Atlantic PATH cohort with rheumatoid or osteoarthritis were matched for measures of adiposity with participants without a history of arthritis. Both measured and self-reported data were used to examine disease status, adiposity, and lifestyle factors. Immunoassays were used to measure plasma markers. BMI was positively correlated with percentage body fat, fat mass index (FMI), and a change in BMI from 18 years of age in all 3 groups. There were no statistical differences between levels of plasma adipokines; adiponectin levels were 6.6, 7.9, and 8.2 μg/ml, leptin levels were 10.3, 13.7, and 11.5 ng/ml, and resistin levels were 10.0, 12.1, and 10.8 ng/ml in participants without arthritis, with rheumatoid arthritis, and with osteoarthritis, respectively. Those with higher levels of adiponectin were more likely to have osteoarthritis (but not rheumatoid arthritis). No association was found between arthritis types and leptin or resistin. This study demonstrates differences in measures of adiposity and adipokines in specific types of arthritis and highlights the need for more research targeting specific adipokines during arthritic disease progression.

Owing to an aging population and medical advances, the anticipated growth and prevalence of multimorbidity has been recognized as a significant challenge and priority in health care settings. Although physical activity has been shown to play a vital role in the primary and secondary prevention of chronic disease, much less is known about the relationship between physical activity and multimorbidity. The objective of the present study was to examine the relationship between physical activity levels and multimorbidity in male and female adults after adjusting for key demographic, geographical, and lifestyle factors. The study drew data from a prospective cohort in Atlantic Canada (2009-2015). The sample included 18,709 participants between the ages of 35-69. Eighteen chronic diseases were identified. Physical activity levels were estimated based on the long form of the International Physical Activity Questionnaire. Using logistic regression analysis, we found that multimorbid individuals were significantly more likely to be physically inactive (OR=1.26; 95% CI 1.10, 1.44) after adjusting for key sociodemographic and lifestyle characteristics. Additional stratified analyses suggest that the magnitude of the effect between multimorbidity and physical activity was stronger for men (OR=1.41; 95% CI 1.12, 1.79) than women (OR=1.18; CI 1.00, 1.39) and those living in rural (OR=1.43; CI 1.10, 1.85) versus urban (OR=1.20; CI 1.02, 141) areas. Given the generally low levels of physical activity across populations and a growing prevalence of multimorbidity, there is a need for a prospective study to explore causal associations between physical activity, multimorbidity, and health outcomes.

Objectives: To determine the association between inflammatory bowel disease (IBD) and rural/urban household at the time of diagnosis, or within the first 5 years (y) of life. Methods: Population-based cohorts of residents of four Canadian provinces were created using health administrative data. Rural/urban status was derived from postal codes based on population density and distance to metropolitan areas. Validated algorithms identified all incident IBD cases from administrative data (Alberta: 1999–2008, Manitoba and Ontario: 1999–2010, and Nova Scotia: 2000–2008). We determined sex-standardized incidence (per 100,000 patient-years) and incident rate ratios (IRR) using Poisson regression. A birth cohort was created of children in whom full administrative data were available from birth (Alberta 1996–2010, Manitoba 1988–2010, and Ontario 1991–2010). IRR was calculated for residents who lived continuously in rural/urban households during each of the first 5 years of life. Results: There were 6,662 rural residents and 38,905 urban residents with IBD. Incidence of IBD per 100,000 was 33.16 (95% CI 27.24–39.08) in urban residents, and 30.72 (95% CI 23.81–37.64) in rural residents (IRR 0.90, 95% CI 0.81–0.99). The protective association was strongest in children

OBJECTIVE: Youth have distinct health care needs that are not always met within a framework designed for children or adults. In Canada, little attention has been given to how youth utilize health care services and limited data are available. The aim of this study was to identify whether age, sex, socio-economic status (SES) and geographic location were significant mediators of youth health care utilization in Nova Scotia. METHODS: The NSYOUTHS database comprises health care utilization information for all youth aged 12 to 24 years, resident in Nova Scotia between 1997 and 2007. We calculated health care utilization rates by provider, stratified by sex, age, SES, urban/rural residence and year. Negative binomial regression was used to model the variation in health care utilization by sex, SES and urban/rural location. RESULTS: Health care utilization declined over time and varied by age. Females were more frequent users of services. Youth from lower SES areas had fewer family physician contacts but more outpatient, emergency and inpatient contacts compared to those from higher SES areas. Rural residents had fewer family physician and emergency contacts but more outpatient contacts than youth from urban areas. Ten percent of the youth were responsible for 32% of all health care contacts, whereas 11% had no health care contacts. CONCLUSION: Specific subgroups, including youth from rural areas and of lower SES, utilize health care services differently than other youth. The challenge is to provide health care that is responsive to the needs of this heterogeneous population. Meeting this challenge requires accurate information on youth health care utilization.

Urban flooding as a result of inadequate drainage capacity, failure of flood defenses, etc. is usually featured with highly transient hydrodynamics. Reliable and efficient prediction and forecasting of these urban flash floods is still a great technical challenge. Meanwhile, in urban environments, the flooding hydrodynamics and process may be influenced by flow regulation and flood protection hydraulic infrastructure systems, such as sluice gates, which should be effectively taken into account in an urban flood model. However, direct simulation of hydraulic structures is not a current practice in 2D urban flood modeling. This work aims to develop a robust numerical approach to directly simulate the effects of gate structures in a 2D high-resolution urban flood model. A new modeling component is developed and fully coupled to a finite volume Godunov-type shock-capturing shallow water model, to directly simulate the highly transient flood waves through hydraulic structures. Different coupling approaches, i.e., flux term coupling and source term coupling, are implemented and compared. A numerical experiment conducted for an analytical dam-break test indicates that the flux term coupling approach may lead to more accurate results, with the calculated RMSE against water level 28%&ndash, 38% less than that produced by the source term coupling approach. The flux term coupling approach is therefore adopted to improve the current urban flood model, and it is further tested by reproducing the laboratory experiments of flood routing in a flume with partially open sluice gates, conducted in the hydraulic laboratory at the Zhejiang Institute of Hydraulics and Estuary, China. The numerical results are compared favorably with experimental measurements, with a maximum RMSE of 0.0851 for all the individual tests. The satisfactory results demonstrate that the flood model implemented with the flux coupling approach is able to accurately simulate the flow through hydraulic structures, with enhanced predictive capability for urban flood modeling.

A proteomic approach employing a two dimensional electrophoresis (2-DE) technique with SYPRO Ruby, a fluorescent stain with improved sensitivity and quantitative accuracy, was performed to separate the total proteins from apple fruit at different stages of ripening and senescence. After imaging and statistical analyses were performed on 2340 spots, a total of 316 spots, or approximately 13.5% of the total protein population, was found to be significantly changed in this study. Of the 316 proteins, 219 spots were only present at a specific ripening stage, while 97 spots were significantly different (p0.05) throughout fruit ripening and in response to ethylene treatment. From 316 candidate spots, 221 proteins were further identified by liquid chromatography and mass spectrometry analysis with protein sequence and express sequence tag (EST) data searching. Analysis and identification of proteins revealed that apple fruit ripening is associated with increase of abundance of many proteins with functions such as ethylene production, antioxidation and redox, carbohydrate metabolism, oxidative stress, energy, and defense response. Ethylene treatment increased a group of unique proteins that were not present during normal fruit ripening and have not been previously reported. It also reduced some proteins involved in primary metabolism, including those of the last few steps of the glycolytic pathway. This study demonstrated the complexity and dynamic changes of protein profiles of apple fruit during ripening and in response to exogenous ethylene treatment. Identifying and tracking protein changes may allow us to better understand the mechanism of ripening in climacteric fruit.Postharvest physiology and biochemistry has been conducted on apple fruit for many years. Ethylene plays an important role in ripening and senescence in many climacteric fruit. However, little information is available at the proteome level to investigate fruit ripening and effect of ethylene treatment. The significance of this paper is that it is the first study employing 2-DE and fluorescent dye in the investigation of the apple fruit ripening and influence of ethylene treatment. It reveals some significant biological changes in association with these events and demonstrates significant changed proteins under these conditions. Therefore, our study links the biological events with proteomic information and provides detailed peptide information on all identified proteins. Through the function analysis, those significantly changed proteins are also analyzed. These findings from this paper provide not only proteome information on fruit ripening, but also pave the ground for further quantitative studies using SMR to investigate certain proteins and pathways under the hypothesis involved in fruit ripening. This article is part of a Special Issue entitled: Translational Plant Proteomics.

The study aimed to examine the relationship between cardiovascular disease (CVD) and physical activity (PA) levels in cancer survivors (CS). Using a nested, retrospective follow-up design, this study presents the self-reported prevalence of CVD in an Atlantic Canadian population-based cohort of 1526 CS and 6034 age-sex matched, non-cancer controls ranging from 35 to 69 years of age. Univariate and multiple logistic regression models were used to explore the association between CVD and PA. Overall, CS were 30% more likely to have ever experienced a CVD event than controls (OR = 1.3; 95% CI 1–1.7, p = .07). Survivors were also significantly more likely to report having hypertension (OR = 1.60; 95% CI 1.03–1.3, p = .02) and diabetes (OR = 1.27; 95% CI 1.03–1.16, p = .02). Compared to controls, CS were significantly less likely to engage in high levels of PA. For survivors, compared to those who were least physically active, the odds of having a CVD risk factor was 35% lower for those who were moderately active (OR = 0.65; 95% CI 0.48–0.88) and 45% lower in the most highly active group (OR = 0.55; 95% CI 0.4–0.73). For controls, the odds of having a CVD risk factor was 25% lower for those in the moderately active group (OR = 0.75; 95% CI 0.64–0.88) and 30% lower for those in the high active group (OR = 0.70; 95% CI 0.6–0.81). Low active survivors appear to be at a high risk of CVD-related comorbidity. PA is associated with lower CVD-related comorbidity in CS, suggesting that interventions directed at increasing PA should be implemented to improve long-term health outcomes.

OBJECTIVES: Canada’s progress in establishing a national immunization registry and coordinated immunization schedule across provinces has been slow. The absence of a centralized registry means there are only limited data available on childhood immunization coverage in Canada. The aim of this study was to estimate the completeness and timeliness of immunization for two year-old children in Nova Scotia. METHODS: The study included 8,245 babies born in Nova Scotia during 2006. Immunization data were derived from three sources: Provincial Medical Insurance Physician Billing data, public health records, and self-report by parents. Immunization uptake rates for vaccines included in the Nova Scotia immunization schedule were calculated at ages 12, 18 and 24 months. Logistic regression was used to analyze vaccine uptake in relation to socio-economic factors. A telephone survey of a sample of parents of study children was completed. RESULTS: The overall immunization completeness rate was 49% at 12 months, 40% at 18 months and 58% at 24 months of age. Immunization completeness was significantly higher in more socially disadvantaged communities. CONCLUSIONS: Nova Scotia spends many millions of dollars on vaccine purchase and administration, but, as with numerous Canadian jurisdictions, there is no accurate system for monitoring or evaluating the program. The timeliness and completeness of immunization administration to pre-school children in Nova Scotia is inadequate. Further work should elucidate the barriers and enablers to immunization to ensure that public health education targets those most likely to be under-immunized. A provincial vaccination database should be established to monitor and evaluate the system.

Objectives The prevalence of obesity among populations in the Atlantic provinces is the highest in Canada. Some studies suggest that adequate fruit and vegetable consumption may help body weight management. We assessed the associations between fruit and vegetable intake with body adiposity among individuals who participated in the baseline survey of the Atlantic Partnership for Tomorrow’s Health (Atlantic PATH) cohort study. Methods We carried out a cross-sectional analysis among 26 340 individuals (7979 men and 18 361 women) aged 35–69 years who were recruited in the baseline survey of the Atlantic PATH study. Data on fruit and vegetable intake, sociodemographic and behavioural factors, chronic disease, anthropometric measurements and body composition were included in the analysis. Results In the multivariable regression analyses, 1 SD increment of total fruit and vegetable intake was inversely associated with body mass index (−0.12 kg/m 2 ; 95% CI −0.19 to –0.05), waist circumference (−0.40 cm; 95% CI −0.58 to –0.23), percentage fat mass (−0.30%; 95% CI −0.44 to –0.17) and fat mass index (−0.14 kg/m 2 ; 95% CI −0.19 to –0.08). Fruit intake, but not vegetable intake, was consistently inversely associated with anthropometric indices, fat mass, obesity and abdominal obesity. Conclusions Fruit and vegetable consumption was inversely associated with body adiposity among the participant population in Atlantic Canada. This association was primarily attributable to fruit intake. Longitudinal studies and randomised trials are warranted to confirm these observations and investigate the underlying mechanisms.

Examining radiation dose in the paediatric population is particularly important due to the vulnerability of paediatric patients (increased radiosensitive tissues and postexposure life-years) and risk for future radiogenic malignancy.To evaluate trends in paediatric computed tomography (CT) use and ionizing radiation exposure using population-based data from Nova Scotia.A retrospective, population-based cohort study of CT use in patients20 years of age, from January 1, 2004 to December 31, 2011, was performed in Nova Scotia. CT examination data were retrieved from a provincial imaging repository. Trends in CT use were described, and both annual and cumulative effective dose exposures were calculated.In total, 29,452 CT events, involving up to 22,867 individuals were retrieved. Overall annual paediatric CT examination rates remained static (range 17.4 to 18.8 per 1000 per year). However, use in children10 years of age decreased by50% (P0.001); this was counterbalanced by a steady increase among 15- to 19-year-olds (P0.0001). Overall, 15.4% of scanned patients underwent ≥2 examinations, of which 58 patients (1.6%) exceeded 50 mSv of exposure.Despite a static rate in CT imaging among the entire cohort, children15 years of age and, particularly, those10 years of age displayed marked reductions in CT use. This may reflect increased awareness of campaigns emphasizing judicious CT use, revised clinical practice guidelines and increased availability of alternative modalities. A small subgroup demonstrated high-dose exposure (50 mSv), and rates in individuals15 years of age steadily increased, suggesting further exposure reduction efforts are necessary.Il est particulièrement important d’examiner les doses de rayonnement dans la population pédiatrique en raison de sa vulnérabilité (augmentation des tissus radiosensibles et années de vie postexposition) et du risque de future tumeur radiogénique.Évaluer les tendances d’utilisation de la tomodensitométrie (TD) en pédiatrie et l’exposition ionisante au moyen de données en population provenant de la Nouvelle-Écosse.Les chercheurs ont réalisé une étude de cohorte rétrospective en population sur l’usage de la TD chez des patients de moins de 20 ans en Nouvelle-Écosse, entre le 1Les chercheurs ont extrait 29 452 TD effectuées auprès de 22 867 personnes. Dans l’ensemble, les taux annuels d’examens TD en pédiatrie sont demeurés inchangés (plage de 17,4 à 18,8 sur 1 000 enfants par année). Cependant, l’utilisation chez les enfants de moins de dix ans a diminué de plus de 50 % (P0,001), ce qui était compensé par une augmentation régulière chez les 15 à 19 ans (P0,0001). Au total, 15,4 % des patients ont subi au moins deux examens, et 58 d’entre eux (1,6 %) ont été exposés à plus de 50 mSv.Malgré un taux inchangé de TD dans l’ensemble de la cohorte, l’utilisation de la TD a beaucoup diminué chez les enfants de moins de 15 ans, et particulièrement ceux de moins de dix ans. Ce résultat reflète peut-être la sensibilisation accrue aux campagnes prônant une utilisation judicieuse de la TD, des guides de pratique clinique révisés et un meilleur accès à d’autres modalités. Un petit sous-groupe a présenté une exposition à de fortes doses (plus de 50 mSv), et les taux chez les personnes de plus de 15 ans augmentaient régulièrement, ce qui démontre la nécessité de poursuivre les efforts pour réduire l’exposition.

The aim of this study was to examine diet quality among participants in the Atlantic Partnership for Tomorrow’s Health (PATH) cohort and to assess the association with adiposity. Data were collected from participants (n = 23,768) aged 35–69 years that were residents of the Atlantic Canadian provinces. Both measured and self-reported data were used to examine adiposity (including body mass index (BMI), abdominal obesity, waist-to-hip ratio and fat mass) and food frequency questionnaires were used to assess diet quality. Overall, diet quality was statistically different among provinces. Of concern, participants across all the provinces reported consuming only 1–2 servings of vegetables and 1–2 servings fruit per day. However, participants also reported some healthy dietary choices such as consuming more servings of whole grains than refined grains, and eating at fast food restaurants ≤1 per month. Significant differences in BMI, body weight, percentage body fat, and fat mass index were also observed among provinces. Adiposity measures were positively associated with consumption of meat/poultry, fish, snack food, sweeteners, diet soft drinks, and frequenting fast food restaurants, and inversely associated with consumption of whole grains and green tea. Although all four provinces are in the Atlantic region, diet quality vary greatly among provinces and are associated with adiposity.

Introduction Inequalities in health attributable to inequalities in society have long been recognized. Typically, those most privileged experience better health, regardless of universal access to health care. Associations between social and material deprivation and mortality from all causes of death— a measure of population health, have been described for some regions of Canada. This study further examines the link between deprivation and health, focusing on major causes of mortality for both rural and urban populations. In addition, it quantifies the burden of premature mortality attributable to social and material deprivation in a Canadian setting where health care is accessible to all. Methods The study included 35,266 premature deaths (1995–2005), grouped into five causes and aggregated over census dissemination areas. Two indices of deprivation (social and material) were derived from six socioeconomic census variables. Premature mortality was modeled as a function of these deprivation indices using Poisson regression. Results Premature mortality increased significantly with increasing levels of social and material deprivation. The impact of material deprivation on premature mortality was similar in urban and rural populations, whereas the impact of social deprivation was generally greater in rural populations. There were a doubling in premature mortality for those experiencing a combination of the most extreme levels of material and social deprivation. Conclusions Socioeconomic deprivation is an important determinant of health equity and affects every segment of the population. Deprivation accounted for 40% of premature deaths. The 4.3% of the study population living in extreme levels of socioeconomic deprivation experienced a twofold increased risk of dying prematurely. Nationally, this inequitable risk could translate into a significant public health burden.