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Inuit face worse cancer survival rates and outcomes than the general Canadian population. Persistent health disparities cannot be understood without examining the structural factors that create inequities and continue to impact the health and well-being of Inuit. This scoping review aims to synthesise the available published and grey literature on the structural factors that influence cancer care experienced by Inuit in Canada. Guided by Inuit input from Pauktuutit Inuit Women of Canada as well as the Joanna Briggs Institute scoping review methodology, a comprehensive electronic search along with hand-searching of grey literature and relevant journals was conducted. A total of 30 papers were included for analysis and assessment of relevance. Findings were organised into five categories as defined in the a priori framework related to colonisation, as well as health systems, social, economic, and political structures. The study results highlight interconnections between racism and colonialism, the lack of health service information on urban Inuit, as well as the need for system-wide efforts to address the structural barriers in cancer care. [ABSTRACT FROM AUTHOR]

Objectives. To examine if Aboriginal health research conducted within the field of social sciences reflects the population and geographic diversity of the Aboriginal population. Study Design. Review. Methods. We searched the Web of Science Social Science Citation Index, the Arts and Humanities Citation Index and Scholars Portal for the time period 1995-2005 using search terms to reflect different names used to refer to Canada's Aboriginal peoples. Citations that did not focus on health or Canada were eliminated. Each paper was coded according to 7 broad categories: Aboriginal identity group; geography; age; health status; health determinants; health services; and methods. Results. Based on the 96 papers reviewed, the results show an under-representation of Métis and urban Aboriginal peoples. Most of the papers are on health status and non-medical determinants of health, with a particular focus on chronic conditions and life-style behaviours. Only 6 papers examined traditional approaches to healing and/or access to traditional healers/medicines. A small number involved the use of community-based research methods. Conclusions. Further research is required to address gaps in the current body of literature. Community-based research studies are necessary to address gaps that are most relevant to Aboriginal peoples. [ABSTRACT FROM AUTHOR]

Inuit Canadians are on average about 20 years younger and have a 10-year lower life expectancy than other Canadians. While there have been improvements in Inuit health status over time, significant health disparities still remain. This paper will review the peer-reviewed literature related to Inuit child, youth, and maternal health between 2000 and 2010, investigate which thematic areas were examined, and determine what proportion of the research is related to each group. Establishing areas of research concentrations and scarcities may help direct future research where it is needed. We followed a systematic literature review and employed peer-reviewed research literature on child, youth, and maternal health which were selected from 3 sources, MEDLINE, CINAHL, and the Circumpolar Health Bibliographic Database. The resulting references were read, and summarized according to population group and thematic area. The thematic areas that emerged by frequency were: infectious disease; environment/environmental exposures; nutrition; birth outcomes; tobacco; chronic disease; health care; policy, human resources; interventions/ programming; social determinants of health; mental health and wellbeing; genetics; injury; and dental health. The 72 papers that met the inclusion criteria were not mutually exclusive with respect to group studied. Fiftynine papers (82%) concerned child health, 24 papers (33%) youth health, and 58 papers (81%) maternal health. The review documented high incidences of illness and significant public health problems; however, in the context of these issues, opportunities to develop research that could directly enhance health outcomes are explored. [ABSTRACT FROM AUTHOR]

Background: A surgical readiness assessment is a major step in the medical journey of trans people seeking gender-affirming surgery. Much of the peer-reviewed literature surrounding surgical readiness assessments emphasizes the perspectives of academics and clinicians, leaving the voices of trans and gender diverse patients largely unheard. Aims: This paper foregrounds patient experiences with surgery readiness assessments to discuss the tensions, challenges and opportunities they generate. Methods: We conducted a thematic analysis of 35 in-depth interviews with trans people who accessed or were seeking to access gender-affirming surgery in British Columbia. Results: We developed three main themes to capture participants' narratives of their surgical assessment experiences. The first, assessments as gatekeeping, explores the stories of people who described their assessments as outdated and even discriminatory processes. The second, assessments as a barrier to care, discusses the informational missteps, bureaucratic regulations, economic issues, and geographic concerns that made assessments difficult to access. The third, assessments as useful, includes positive stories about assessments that often involved feeling supported by an assessor and feeling prepared for the next steps. Discussion: These narratives demonstrate how much variation exists among people's experiences of readiness assessments for gender-affirming surgery. No matter how their actual assessment turned out, many participants approached their appointments with a great deal of anxiety and trepidation. We attributed this stress was to challenges ranging from lengthy wait times, arbitrary medical gatekeeping, a lack of access to knowledgeable and supportive providers, unclear or changing administrative processes, and insufficient communication. To address these challenges, it is crucial for the medical system to create more accessible pathways with centralized, up-to-date information for people trying to access assessments. Patients are best served by multi-disciplinary gender-affirming teams that provide individualized care. [ABSTRACT FROM AUTHOR]

In cold region environments, any alteration in the hydro-climatic regime can have profound impacts on river ice processes. This paper studies the implications of hydro-climatic trends on river ice processes, particularly on the freeze-up and ice-cover breakup along the Athabasca River in Fort McMurray in western Canada, which is an area very prone to ice-jam flooding. Using a stochastic approach in a one-dimensional hydrodynamic river ice model, a relationship between overbank flow and breakup discharge is established. Furthermore, the likelihood of ice-jam flooding in the future (2041–2070 period) is assessed by forcing a hydrological model with meteorological inputs from the Canadian regional climate model driven by two atmospheric–ocean general circulation climate models. Our results show that the probability of ice-jam flooding for the town of Fort McMurray in the future will be lower, but extreme ice-jam flood events are still probable. [ABSTRACT FROM AUTHOR]

The higher religiosity of women in the Western Christian societies is one of the best documented findings in the religious scholarship. In spite of the recent vibrancy of secular movements in North America, the higher religiosity of women appears persistent. As a result, the gender ratio is greatly skewed in the secular groups in favour of males. For instance, for every atheist female in North America, there are at least three males. Using the Canadian General Social Surveys of 1985–2014, this paper examines how the gender religiosity gap has evolved among the Canadian-born. Throughout the period, Canadian-born women are found less likely to be unaffiliated and show a greater frequency of religious attendance. The religious attendance gap is found to be closing. The unaffiliation gap, on the other hand, seems to have widened in the 21st century. Limiting the analyses to the gainfully employed respondents only reduces the religious attendance gap. For the high earners, the attendance gap effectively disappears, while a large unaffiliation gap persists into the 2010s. This pattern is best explained by the recent literature asserting that men and women are differentially socially sanctioned for the adoption of a secularized identity. The alleged sexism of the new secular movements is also noted as a potential explanation. The examination of the recent Canadian data on perceived religious and gender discrimination produces evidence congruent with both of these potential explanations. [ABSTRACT FROM AUTHOR]

Using two recent nationally representative Canadian surveys, this paper investigates how secularization affects civic participation, inclusive of political engagement and philanthropy. Three mutually exclusive categories of secularized individuals are considered. The analysis suggests that Canadian secular groups are relatively less engaged with politics and volunteer fewer hours, compared with the actively religious. They are, however, found to contribute significantly more money to secular causes, controlling for a wide range of individual attributes. Various explanations are explored. [ABSTRACT FROM PUBLISHER]

In this paper we contend neo-liberal education policy which supports the creation of schooling choices in public education systems is reshaping, conflating and branding ethnicity. We make these points in reference to school choice in Toronto, Canada, and the establishment of an Africentric ethno-centric school. We argue that one of the registers within which education and ethnicity in Toronto operates relates to the conflation of commodification, ethnicity and geography, and that this conflation indicates one of the limits of school choice as a possible way to redress Black student disadvantage. We suggest education policy, which enables the establishment of ethno-centric schools, enters the realm of other debates about race, equity and difference that include the practices of marketing and branding. [ABSTRACT FROM AUTHOR]

When combined with therapeutic plasma exchange (TPE) and immunosuppression, upfront universal administration of caplacizumab was shown to be effective in the management of immune thrombotic thrombocytopenic purpura (iTTP). However, access to this drug remains challenging in many jurisdictions. We retrospectively review results of a single-institution experience with caplacizumab over a 3-year period. During the study period, we treated 48 patients with iTTP, of which 11 (23%) received caplacizumab. Eight of these 11 patients (73%) were female; the median age was 45 years (IQR 37.0-58.5). All received TPE within 24 h of admission (median 9 exchanges, IQR 7.0-12.5), and high-dose steroids. Caplacizumab was initiated for a median of 6 days after admission (IQR 2.5-8.0) and continued for a median of 26 days (IQR 14.0-33.0). Five patients (45%) had refractory disease at caplacizumab initiation. Ten patients (91%) survived, reaching clinical remission. Platelet normalization was reached with a median of 4 days following caplacizumab initiation (IQR 1.5-4.0). Complications included minor bleeding (n = 1) and local allergic reaction (n = 1). No patients experienced TTP exacerbation; relapse occurred in two patients (18%) over 1-5 years of follow-up. Caplacizumab appeared to be effective and safe, despite delayed initiation and in the setting of refractory disease. [ABSTRACT FROM AUTHOR]

Quantifying a proposed project's greenhouse gas (GHG) emissions and scrutinizing their effect on climate change are increasingly required in Canadian environmental assessment (EA) processes. This paper investigates to what degree an EA authority's intention for the inclusion of GHG considerations has resulted in implementation into environmental impact statements (EISs) by proponents and how these considerations influence the achievement of GHG reduction targets. Fifteen projects across five Canadian jurisdictions were reviewed. The examination revealed that well-developed intentions by EA authorities did not necessarily result in proponents following guidelines for GHG consideration in their EISs due to the absence of regulation or clearly defined policies. Conversely, even though intentions by an EA authority are underdeveloped in some jurisdictions, EISs sometimes exhibited thorough GHG assessments due to mechanisms in the EA process through which GHG consideration by the proponent could be compelled. The examination did not reveal how GHG consideration in EA currently assists in meeting reduction targets. A GHG emissions limit imposed during the EA process could link EA to success in meeting these targets. [ABSTRACT FROM AUTHOR]

Reconciling diverse forest values within policy and decision-making processes is an ongoing challenge in forestry. The use of environmental impact assessment (EIA) provides potential for improving forest management and making it more responsive to diverse interests. This paper examines EIA in Canadian and Finnish forest planning. In Finland there has been a reluctance to see EIA as a tool for forest planning while in Canada some provinces have long applied EIA to forest management. Ontario, Canada, provides one example of applying EIA to forest planning at a range of scales in order to advance integrated planning and help conflict management. The paper provides a brief analysis of the Finnish forest planning system, an illustration of the Ontario EIA forest management experience, and then considers the application of EIA to Finnish forest management. The paper concludes that EIA may be workable for Finnish state forests and would likely enhance planning and management, but given the existing institutional frameworks EIA would be difficult to apply to private forests. [ABSTRACT FROM AUTHOR]

This paper explores the lessons to be learned from why the neighbouring banking systems of Canada and the United States, that share numerous commonalities, fared so differently during two major financial crises. The explanations are deeply rooted in different tolerances for industry concentration and state involvement, and the divergent routes of the development of their financial systems, founding institutions, on-going governance and regulation, and competitive structures. Canada's success during the more recent 2007-09 financial crisis is attributed to more effective regulation and conservative banking practices, including (self-) imposed stricter limits on bank leverage, much stricter limits on unconventional mortgages, and less reliance on the use of more 'creative' investment types (e.g. subprime lending) and structured products. [ABSTRACT FROM AUTHOR]

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The terrorist attacks of 11 September 2001 had an immediate impact on Canada–U.S. relations. Whereas security became foremost among U.S. concerns, Canada became preoccupied with ensuring that the newly fortified border would not impede trade. Within days of the attacks, Canadian analysts argued that the only way to guarantee open access to U.S. markets would be to negotiate some form of deeper North American economic integration. Previous proposals for a North American Monetary Union were revived, while new initiatives such as a customs union or a“strategic bargain” also emerged. These schemes were designed to forge a“new economic space” in North America. Business think tanks and interest groups played a central role in pushing forward a platform of deeper integration, but the ideas have also made their way into the policy platforms of the Canadian federal government. This paper draws upon discourse analysis and theories of governmentality to interrogate the rhetoric of inevitability that has underpinned these proposals. The fatalism has been justified by allusions to the shifting North American geopolitical relations in the post-September 11 context and the fear and risk that have prevailed since the terrorist attacks. It also, however, resonates more broadly with neoliberal and globalizing narratives that externalize and naturalize market forces, and, therefore, limit alternative futures. More importantly, the logic and language of inevitability have provided advocates of deeper integration with a strategic manoeuvre to downplay concerns regarding the loss of political sovereignty and the transformations to state-society relationships that would result from the new North American economic space that is being imagined. [ABSTRACT FROM AUTHOR]

This paper presents data on and discusses the degree of postglacial stability of the northern Canadian tree limit. Holocene climatic changes have been both directional and synchronous for this region, though deteriorations/ameliorations either (1) lagged from west to east, (2) were buffered by local geographic factors, or (3) were not registered in the fossil record owing to the inherent persistence of the vegetation at some sites. The present northern tree limit in eastern Canada is in equilibrium with the prevailing climate, with the tree populations successfully regenerating both sexually and vegetatively. These tree stands are still occupying their maximum Hypsithermal positions. In contrast, the tree limit, tree line, and intervening forest-tundra ecotone in central and western Canada are out of equilibrium with today's climate. These populations are not sexually regenerative and apparently became established during warmer climates where the tree line was north of its present position. As such, they are susceptible to destruction by further climatic deterioration or anthropogenic disruption. [ABSTRACT FROM AUTHOR]

The existing literature on convergence in Canada largely ignores the underlying geographical dimensions of regional disparities. By using income measures developed from census micro-data files to analyze patterns of convergence across census divisions, we show that regional disparities are increasingly clustered across the Canadian space-economy along (1) East–West and (2) urban–rural gradients. Rural census divisions in the Eastern provinces, in particular, are showing increased signs of distress in terms of differences in levels and growth rates of incomes with other regions in the country. Such findings have important policy implications which are briefly discussed. [ABSTRACT FROM PUBLISHER]

Invasive Haemophilus influenzae type a (iHia) disease was detected in Alaska and Northern Canada in 2002 and 2000, respectively. From 2006 to 2017, 164 iHia cases (Alaska=53, Northern Canada=111) were reported. Rates of iHia disease per 100,000 persons were higher in Northern Canada compared to Alaska and were significantly higher in Indigenous (Alaska 2.8, Northern Canada 9.5) compared to non-Indigenous populations (Alaska 0.1, Northern Canada=0.4). Disease rates were highest in Indigenous children <2 years of age (Alaska 56.2, Northern Canada=144.1) and significantly higher than in non-Indigenous children <2 (Alaska 0.1, Northern Canada 0.4). The most common clinical presentation in children <5 years was meningitis of age and pneumonia in persons ≥5 years old. Most patients were hospitalised (Alaska=87%, Northern Canada=89%) and fatality was similar (Alaska=11%, Northern Canada=10%). MLST testing showed sequence types ST23 and ST576 in Northern Canada and ST576, ST23 and ST56 in Alaska. Alaska and Northern Canada have high rates of iHia disease. A vaccine is needed in these regions to protect young children. [ABSTRACT FROM AUTHOR]

Indigenous peoples in Canada and in the Circumpolar North face a higher disease burden leading to end-stage organ failure and face geographic and systemic barriers to accessing health-care services, including those for end-stage organ failure and organ donation and transplantation (ODT). To address these issues, I present a think tank model used in Saskatchewan, Canada, which focused on ODT and recommended research and policy changes that address inequitable Indigenous access to ODT, most specifically in northern and remote regions. Over the past three years, think tank members, comprised of Indigenous cultural leaders, elders, and persons with lived experience in ODT, and complemented by medical and advocacy exports, have highlighted equity and utility issues as key concerns, and discussed ways in which these issues can be addressed. Recommendations include culturally-safe methods for documenting and tracking Indigenous identity, development of training to address culturally specific needs, and additional funding to support Indigenous transplant donors and recipients. [ABSTRACT FROM AUTHOR]

Correctional populations with opioid use disorder experience increased health risks during community transition periods. Opioid Agonist Treatment (OAT) can reduce these risks, but retention is a key challenge. This study addresses a knowledge gap by describing facilitators and barriers to OAT engagement among federal correctional populations released into the community in Ontario, Canada. This article describes results from a longitudinal mixed-methods study examining OAT transition experiences among thirty-five individuals released from federal incarceration in Ontario, Canada. Assessments were completed within one year of participants' release. Data were thematically analyzed. The majority (77%) of participants remained engaged in OAT, however, 69% had their release suspended and 49% returned to custody. Key facilitators for OAT engagement included flexibility, positive staff rapport, and structure. Fragmented OAT transitions, financial OAT coverage, balancing reintegration requirements, logistical challenges, and inaccessibility of 'take-home' OAT medications were common barriers. Post-incarceration transition periods are critical for OAT retention, yet individuals in Ontario experience barriers to OAT engagement that contribute to treatment disruptions and related risks such as relapse and/or re-incarceration. Additional measures to support community OAT transitions are required, including improved discharge planning, amendments to OAT and financial coverage policies, and an expansion of OAT options. [ABSTRACT FROM AUTHOR]

Death by suicide and attempted suicide among Inuit youth is now considered a public health emergency of epidemic proportion, with rates among the highest worldwide. A strong sense of cultural identity and pride, as well as social capital, has been identified as being protective against suicide. The Canadian Institute for Health Research (CIHR) Guidelines for Health Research Involving Aboriginal People call for communities to be included in the conception, planning and implementation of research. The authors took first steps towards sharing the responsibility of designing a community initiative with the youth of Naujaat, Nunavut, a community located directly on the Arctic Circle. With the objectives of promoting open listening and exploration of community needs and enhancing self-determination and sustainability, we postulated a youth resiliency project that will be co-authored by the community. This paper describes the joint work process. We recount how Inuit youth take ownership of the project with the guidance of Ms. Elizabeth Haqpi, a Naujaat Elder. The article will particularly reflect on the process of balancing the different perspectives and expectations while enjoying the richness of mutual learning through keeping each other accountable. [ABSTRACT FROM AUTHOR]

Canada has been a host country to migrants for decades through its attractive immigration policy. To enrich the literature, this article analyses the impact of immigration on the Canadian labour market at the regional level. For this purpose, 10 provinces of Canada have been selected for this study with the data spanning over 12 years from 2006 to 2017. Through the empirical analysis, the article finds there is a significant negative impact of immigration on the native employment level. Whereas the opposite results are found on the national level and the impact on the income of native workers is found to be negative and significant. The employed natives are also found to be migrating to other states at a higher rate in regions where immigration is higher. These results show that natives employees in the labour market tend to migrate and immigration hence offsetting the wage effects on the regional level. [ABSTRACT FROM AUTHOR]

The Canadian Environmental Assessment Act 2012, which came into force on 6 July 2012, virtually eliminates the core of federal-level environmental assessment in Canada. Under the new law, federal environmental assessments will be few, fragmentary, inconsistent and late. Key decision-making will be discretionary and consequently unpredictable. Much of it will be cloaked in secrecy. The residual potential for effective, efficient and fair assessments will depend heavily on requirements under other federal legislation and on the uneven diversity of provincial, territorial and Aboriginal assessment processes. This paper reviews the key characteristics of the new law in light of 10 basic design principles for environmental assessment processes, and considers the broader international implications of the Canadian retreat from application of these principles. [ABSTRACT FROM PUBLISHER]

Ultimately, the enhancement we need to deliver through environmental assessment is confidence that every approved undertaking will move us positively towards a desirable and durable future. In Canada, the most promising steps in this direction have been in several major project assessment reviews with public hearings and independent panels that applied a contribution to sustainability test. The most recent and advanced case is the review of a proposed C$16.2 billion natural gas infrastructure undertaking in the Northwest Territories. The Panel's application of the contribution to sustainability test compared the cumulative effects, equity and legacy implications of a range of project pace and scale alternatives. The Panel concluded that the project would offer positive overall contributions only if 176 recommendations were implemented. While the Panel's process was slow and the governments accepted only the most modest recommendations, the Panel's review set a new standard of analytical practice. This paper examines how the review was done and assesses its strengths and limitations, with particular attention to the design and application of the contribution to sustainability test. [ABSTRACT FROM AUTHOR]

Copyright of Annals of the Association of American Geographers is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This paper examines the experience with regional cumulative effects assessment (CEA) in the Great Sand Hills, Saskatchewan, Canada, and the lessons that emerge for better practice. The benefits of a regional approach to CEA are widely discusssed; however, in practice, regional CEA, particularly in Canada, has fallen short of its potential. Part of the reason for this, arguably, is the lack of strategic frameworks to support good practice. Most attempts at regional CEA have been constrained by the strong influence of project-based environmental assessment, and are focused on modeling past and present stressors and responses, rather than on projecting cumulative trends and systematically identifying and evaluating desirable futures. Regional CEA is inherently futures-oriented. This requires a supporting SEA framework, structured scenario-based analysis, a multi-scaled perspective, and an integrated approach to CEA and regional plan development. [ABSTRACT FROM AUTHOR]

The James Bay Agreement reinforces the rights of the Crees to 500,000 km² of territory in the boreal forest and taiga of northern Quebec. In it, consultation and environmental assessment (EA) mechanisms were set up to ensure the Crees' direct involvement in environmental decisions. This paper addresses three matters: the influence of Native involvement in the EA process; updating the EA process under the Agreement to in-corporate the apparently new tools of strategic environmental assessments (SEAs); and adaptation of the concept of SEA to the Native context. Our analysis focuses on the experience gained from large hydroelectric development projects, recent and planned mining developments, and forestry operations. [ABSTRACT FROM AUTHOR]

Aims: Nivolumab has been approved for advanced squamous and non-squamous non-small cell lung cancer (NSCLC) following platinum-based chemotherapy in both Canada and Sweden. We aimed to determine the value-for-money of nivolumab versus docetaxel in a Canadian and Swedish setting based on 5-year data. Methods: These cost effectiveness analyses used partitioned survival models with three mutually exclusive health states: progression-free, progressed disease, and death. All clinical parameters were derived from two registration phase 3 randomized trials, CheckMate 017 and CheckMate 057, with a minimum follow-up of 5 years. Treatment duration was based on time-on-treatment data from the clinical trials. Costs were derived from published sources. The primary outcomes of the analyses were quality-adjusted life-years (QALYs), life-years gained, and incremental cost-effectiveness ratios (ICERs). The model input parameters for each analysis were chosen in line with guidance from the respective HTA authorities. Results: From a Canadian payer perspective, the ICERs were CAN$140,753 per QALY in the squamous population, and CAN$173,804 per QALY in the non-squamous population, assuming a 10-year time horizon and a 5% discount rate for both costs and outcomes. Sensitivity analyses demonstrated that changes to the discount rates for outcomes had the highest impact on the ICERs. In the Swedish analysis, the ICERs were SEK568,895 per QALY in the squamous population and SEK662,991 per QALY in the non-squamous population, assuming a 15-year time horizon, a 3% discount rate, and a 2-year maximum treatment duration for nivolumab. Sensitivity analyses demonstrated that the ICERs were most sensitive to changes in the discount rate for outcomes. Conclusion: These updated analyses, based on more mature trial data with a minimum follow-up of 5 years, generate more favorable ICERs versus the previously submitted HTA assessments that resulted in approval of nivolumab for patients with previously treated NSCLC in Canada and Sweden. [ABSTRACT FROM AUTHOR]

Mental illness is a predominant medical condition in Canada. Marginalized groups in the Canadian population such as those with low income, the poorly educated and ethnic minorities are susceptible to mental health disorders. Using mental health-related emergency department visits as an indicator of mental illness cases, we employ a Bayesian spatio-temporal regression model to estimate mental illness risk across the 35 public health units of Ontario, Canada from 2006 to 2017. The association between mental illness and the following marginalization-related factors: material deprivation, residential instability and ethnic concentration is also evaluated. Over the assessed period, the relative risk of mental illness ranged from 0.45 (95% CI: 0.44–0.46) to 3.29 (95% CI: 3.20–3.37). Health units with elevated levels of material deprivation and residential instability were positively associated with increased mental illness risk whilst areas with higher ethnic concentration were linked with lower risk. Findings showed that the temporal trend of risk continuously increased over the 11 year period, with health units in northern Ontario experiencing higher risk compared to southern units. The management of psychiatric disorders presents a significant challenge to the Canadian health-care system. An understanding of the geographic distribution of mental health risk across space and time can be useful for improved policy-making and public health monitoring. [ABSTRACT FROM AUTHOR]

Indigenous Canadians have a life expectancy 12 years lower than the national average and experience higher rates of preventable chronic diseases compared with non-Indigenous Canadians. Transgenerational trauma from past assimilation policies have affected the health of Indigenous populations. The purpose of this paper is to comprehensively examine the social determinants of health (SDH), in order to identify priorities for health promotion policies and actions. We undertook a series of systematic reviews focusing on four major SDH (i.e. income, education, employment, and housing) among Indigenous peoples in Alberta, following the protocol Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Equity. We found that the four SDH disproportionately affect the health of Indigenous peoples. Our systematic review highlighted 1) limited information regarding relationships and interactions among income, personal and social circumstances, and health outcomes; 2) limited knowledge of factors contributing to current housing status and its impacts on health outcomes; and 3) the limited number of studies involving the barriers to, and opportunities for, education. These findings may help to inform efforts to promote health equity and improve health outcomes of Indigenous Canadians. However, there is still a great need for in-depth subgroup studies to understand SDH (e.g. age, Indigenous ethnicity, dwelling area, etc.) and intersectoral collaborations (e.g. community and various government departments) to reduce health disparities faced by Indigenous Canadians. [ABSTRACT FROM AUTHOR]

Purpose: This article explores first-hand accounts of Canadian bariatric patients' experiences of seeking and obtaining weight loss surgery abroad through the practice of medical tourism. While researchers have identified many of the challenges and associated health and safety risks imposed on patients by engaging in medical tourism generally, little is known about the specific challenges experienced by Canadians seeking bariatric surgery abroad.Method: To better understand these challenges, we conducted thematic analysis on interviews conducted with 20 former Canadian bariatric tourists.Results: Our analysis illuminated three key challenges Canadians face in obtaining bariatric care: (1) stigma and isolation from friends, family and medical professionals; (2) self-directed navigation of domestic and destination health care systems; and (3) challenges with obtaining adequate follow-up care in Canada.Conclusions: While these challenges identified by participants may occur in other forms of medical tourism, it appears that these challenges are occurring simultaneously in cases of bariatric tourism by Canadians. These challenges appear to work in conjunction to heighten the health and safety risks potential Canadian bariatric tourists may be exposed to. Unless structural changes occur to increase domestic availability of bariatric surgery, Canadians are likely to continue seeking this care abroad. [ABSTRACT FROM AUTHOR]

Prediction of flood quantiles at ungauged sites is investigated using several nonparametric regression methods including: local regression and generalized additive models (GAM). These methods are used to describe the relationship between runoff variables and catchment descriptors to predict flood quantiles. Previous work reported the presence of spatial correlation in the residuals for these models. To this end, this study proposes and investigates ways of incorporating spatial components. An L-moments regression technique (LRT) is developed to predict L-moments of target sites and flood quantiles are derived by aggregating quantiles from multiple candidate distributions. The predictive power of the proposed methods is evaluated on a large database of Canadian rivers using cross-validation. The results are examined inside different hydrological regions to assess the behaviour of the methods. The results show that GAM and local regression using, respectively, thin plate spline and kriging provide the best predictive powers among the considered methods. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Pain is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article analyses Ontario’s export-oriented cheese industry and its challenges in the second half of the nineteenth century using an ‘envirotechnical’ approach. The reorganisation of cheese production from farms to rural factories in the 1860s increased opportunities for spoilage and adulteration of milk at the same time that it made detecting and managing the same more difficult, which compelled the provincial dairymen’s associations to develop quasi-managerial roles to contend with these unanticipated challenges. The ‘problem of milk’ highlights the extent to which the rural cheese industry was an ecological and envirotechnical process rather than an entity separate from the non-human world. Ultimately this case study offers one model for combining environmental and business histories at a scale beyond the individual firm while also highlighting the relevance of the local in the development of the global food system in the late-nineteenth century. [ABSTRACT FROM PUBLISHER]

Using the latest wave of the Canadian Ethnic Diversity Survey, I investigate whether religious identity and religious intensity associate with the degree to which people trust others, controlling for a wide range of characteristics. The analysis shows that Canadian Roman Catholics are appreciably less trusting than mainline Protestants, and religious nones are situated in between these two groups. With regard to religious intensity, I find that higher commitment negatively correlates with trust in unknown others for Roman Catholics. The reverse is true for Protestants. Results also show stark cross-denominational variations within Protestantism, as two highly committed denominations of Mennonite and Pentecostal are found to be the most and the least trusting religious groups in Canada. No non-Christian religious minority is found statistically significantly less trusting than Canadian Roman Catholics. Considering particularized trust in one's neighbours and co-workers yields comparable conclusions. [ABSTRACT FROM AUTHOR]

Gay men's health researchers in North America have recently attended to sexual and mental health issues affecting ethnic minority men, many of whom are also immigrants. Most of this work is grounded in epidemiological models that focus on relationships between individual HIV risk and sexual behaviors. Consequently, they the frame the sexual health of gay and bisexual immigrants as the product of cultural issues (for example, family and religious homophobia, lack of health education) or gay community issues (prevalence of drug use and casual sex) that lead to self-devaluation, depression, and unprotected sex with multiple partners. Few studies, however, examine these phenomena through the lens of migration and resettlement. Using the narratives from twelve in-depth interviews with settlement and AIDS Service Organization (ASO) workers in Toronto, Ottawa, and London, Ontario, Canada, this article examines four types of post-migration urban encounters that influence sexual health: negotiations of resettlement-related stress, encounters with the urban gay community, encounters with the online gay community, and encounters with sexual health promotion itself. The findings suggest that these encounters are important intervening events that mediate the relationship between the attributes of the immigrant and his sexual health behaviors and outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Hydrological Sciences Journal/Journal des Sciences Hydrologiques is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The commercial fisheries of the United States and Canadian Great Lakes are in a long period of decline. Detailed statistics kept for well over a century document a fluctuating pattern of harvests of the major commercial species. In the 1940s, sea lamprey began to devastate the fisheries, an effect that has not been fully countered. Overfishing, nonnative species, declining nutrient levels, and chemical pollution have contributed to reduced catches. Court decisions in the United States and Canada during the past thirty years have awarded a sizable share of commercial fishing rights to Native North Americans for their own support and sustenance. The Lake Erie yellow perch and walleye fishery, based mainly in Ontario, is the most successful commercial fishing operation in the region. Despite the many environmental and cultural challenges, the Great Lakes fisheries live on. [ABSTRACT FROM AUTHOR]

Background. Yukon, a territory in northern Canada, has one of the highest reported sexually transmitted chlamydia infection rates in the country. Objective. We examined screening practices among physicians and community nurses to elucidate factors that may be contributing to the high rates. Design. Cross-sectional survey. Methods. A questionnaire was distributed to all physicians in Yukon and all community nurses in Yukon's communities. We surveyed sexual health assessment frequency, chlamydia testing frequency and barriers to screening. Comparison of physician testing practices was performed to another Canadian jurisdiction, which previously undertook a similar survey. Survey results were compared to the available laboratory data in Yukon. Results. Eligible physicians and nurses, 79% and 77%, respectively, participated in the survey. Physicians tested 15 to 24-year-old females more frequently than 15 to 24-year-old males for chlamydia (p<0.007). Physicians who asked sexual health assessment questions were more likely to test for chlamydia in both females (p<0.001) and males (p=0.032). More physicians screened females based on risk factors compared to males. General practice physicians in Yukon were more likely to test females for chlamydia than general practice physicians in Toronto, Canada (p<0.001). Community nurses had different testing patterns than physicians, with a lower overall frequency of testing, equal frequency of testing males and females, and in applying risk factor-based screening to both males and females. Barriers to screening included testing causing patient discomfort, patients reluctant to discuss screening, health provider uncomfortable conducting sexually transmitted infection tests and sexual health assessments, among others. Laboratory data in Yukon appear to confirm provider screening patterns. Conclusions. This survey provides valuable information on health provider screening patterns. We have some evidence which suggests that chlamydia testing rates may be higher among patients seen by physicians in Yukon in comparison to another Canadian jurisdiction. However, more consistent application of optimal screening methods with support to "start the conversation" around sexual health may assist in overcoming barriers to screening and in addressing Yukon's high rate of chlamydia. [ABSTRACT FROM AUTHOR]

Objectives. Previous studies suggest that dietary patterns and the extent of reliance upon traditional food vary among Inuit communities. Inuit traditional foods are an important source of nutrients such as highly unsaturated n-3 fatty acids (HUFA n-3), whose beneficial effects include protection against ischemic heart disease. Dietary transition is occurring with younger generations consuming less traditional foods and more market foods with low nutrient density. Utilizing erythrocyte membrane fatty acid composition as an indicator of body HUFA n-3 status, which reflects dietary intake levels of traditional Inuit foods, we explored the regional and age variability of highly unsaturated n-3 fatty acids (HUFA n-3) in the International Polar Year Inuit Health Survey. Study design. Cross-sectional health survey. Methods. Participants were recruited through random sampling of households. Fatty acid data were available among 2,200 adults (≥18 yr). Results. HUFA n-3 levels in the Eastern Arctic were significantly higher than in the Western Arctic, with Nunatsiavut (northern Labrador) and Baffin showing the highest HUFA n-3 status compared to Kivalliq, Kitikmeot and Inuvialuit Settlement Region (ISR) (p<0.0001). Fatty acid proportion in erythrocyte membranes showed pronounced differences between coastal communities and inland communities, including a higher HUFA n-3 status among the coastal communities (p<0.0001). Additionally, the HUFA n-3 status showed a strong positive association with age, particularly in Baffin and Kivalliq. HUFA n-3 were inversely associated with saturated (β=-0.98 [SE=0.03], R2=0.36, p<0.0001) and trans fatty acids (β=-0.06 [SE=0.004], R2=0.07, p<0.0001). Conclusions. The present study results provided biochemical support for varying dietary patterns and dietary transition among Inuit across the Canadian Arctic. The analyses also suggested multifactorial determinants of HUFA n-3 status among Canadian Arctic Inuit. A nutritional intervention strategy with multiple approaches may be needed to improve and maintain their HUFA n-3 status. [ABSTRACT FROM AUTHOR]

Objectives. This article describes the review processes required for research being conducted in Canada's 3 northern territories. When conducting research involving human subjects in northern Canada, researchers must go through a 2-step process by submitting protocols to both their university or hospital ethics review boards as well as to northern research institutions. Canada's northern territorial governments have requirements for attaining licensure before any research can be conducted. Methods. A document review was the method used to gather data, and an Internet search of the literature and documents was conducted to gather information. Results. Generally, university and hospital-based ethics review boards have been concerned with the rights of individuals in research. Northern Canadian research protocols require review by territorial government institutions and communities with respect to community rights. Conclusions. The 3 territorial governments of northern Canada take the concept of community and individual participation in research seriously and have enacted processes so that opportunities for such approaches to research are ensured. [ABSTRACT FROM AUTHOR]

The United States and Canada are rather similar in social orientation. However, this is not reflected in health care. Firstly, Canada implemented the principle of universal coverage much earlier than the United States. Secondly, U.S. health care continues to rely much more on private funding and private managing, while Canadian health care relies more on cost containing public funding and governmental budgeting. These differences can be explained, among other things, by their different paths of development since the American Revolutionary War: the United States followed an independent path while Canada was oriented on Europe (for a long period of time). The different governance structures of health care and associated institutions such as lobbying result in a much higher health care expenditure in the United States than in Canada. [ABSTRACT FROM AUTHOR]

Objective. To identify trends in the study of health risk in peer-reviewed and grey literature in Canadian Aboriginal populations from 1960 to 2007. Study design. Systematic literature review and analysis. Methods. Peer-reviewed literature was searched using 5 electronic library databases. The grey literature was searched using 3 online search engines, 4 agency websites and 2 online compiled databases. The search terms used were "Canada," synonyms for Canadian Aboriginal peoples and "risk." Citations were screened for relevance to Aboriginal populations and risks to aspects of human health. Results. Both literatures show an exponential growth in risk-focused study of Canadian Aboriginal health issues over time. There is a geographic foci in the North with the Prairies and the West under-represented. Risk is most commonly used in relation to general health, environmental, zoonotic infections and chronic diseases in the peer-reviewed literature, and general health or environment in the grey literature. Most publications in both literatures are on generalized Aboriginal populations. When specified, a larger proportion of the publications relate to First Nations people, followed by Inuit. Little literature exists on Métis health risks in Canada. Conclusions. There has been an increase in publications about Aboriginal health risk in Canada over time. Trends reflect a research focus on the North and an increased interest in environment and health issues. Greater attention to mental health, addictions and Métis health is required. The increasing use of a risk-based analytical focus has potential implications for understanding the nature of Aboriginal health today and in the future. [ABSTRACT FROM AUTHOR]

Objectives. The objective of this article is to measure the contributions of age groups and causes of death to differences in mortality and life expectancy between residents of Inuit Nunangat and the rest of Canada. Study design. The geographic area of coverage includes communities within Inuit Nunangat, with the addition of Inuvik in the Northwest Territories. Deaths were compiled for 2 5-year periods, 1994 through 1998 and 1999 through 2003, with the mid-year centred on the 1996 and 2001 censuses. Methods. Abridged life tables were constructed according to the revised Chiang method. Age decomposition of differences in life expectancy and cause-deleted life tables were calculated using a discrete approach. The age groups and causes contributing to differences in life expectancy between Inuit Nunangat and the rest of Canada were calculated. Results. Specific age groups contribute more to the difference in life expectancy between Inuit Nunangat and the rest of Canada. For males, over 50% of the difference in life expectancy is due to excess mortality before 25 years of age, while for females nearly 65% is due to excess mortality after the age of 60. Conclusions. Cancer is a major contributor to the difference in life expectancy between residents of Inuit Nunangat and the rest of Canada; reduction in cancer rates would make the greatest contribution to gains in life expectancy. There are clear gender differences in life expectancy and mortality, with the total effect of mortality being greatest for males between 15 and 25 years of age and for females over the age of 60. [ABSTRACT FROM AUTHOR]

Copyright of Annals of the Association of American Geographers is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

During a detailed palynological study of the Milk River Formation in southern Alberta, Canada, a diverse and well-preserved assemblage of fungi including dispersed fungal spores and isolated fragments of microthyriaceous fruiting bodies were encountered and these are described. Based on ammonites, magnetostratigraphy, and palynomorphs, these strata are dated as latest Santonian to ?earliest Campanian (Late Cretaceous). This palynomorph assemblage represents one of the few documented occurrences of fungi of this age. Eighteen genera of fungal spores and three of microthyriaceous thyriothecia, comprising 45 species are recorded. The fungal assemblage is characterized by species of toruloid spores in chains, and cylindrical spores belonging to Dicellaesporites, Diporicellaesporites, Pluricellaesporites, Reduviasporonites, and Scolecosporites that mainly occur as saprophytes today. Helicoid spores belonging to Involutisporonites and Paragranatisporites are also represented and these generally occur in marshy and swamp-like conditions in an open environment mainly characterized by taxodiaceous forest. Microthyriaceous thyriothecia are represented by several specimens of Asterothyrites menonii, Phragmothyrites eocaenicus, and Trichothyrites sp. Although the assemblage consists of diverse fungal taxa, the dispersed spores and fruiting structures are not abundant, and only a few scattered specimens for many species were recorded. One reason for the low frequency may have been the unfavorable paleoenvironmental conditions which prevailed in these marine to nearshore terrestrial depositional settings. In spite of the low abundances, it is thought that documentation of the fungal occurrences in these strata will be of importance in future biostratigraphic and evolutionary studies of fungi. Many of the fungal species encountered are distinctive and probably restricted stratigraphically, being different from those recorded from the better documented Paleogene/Neogene assemblages, and may prove to be biostratigraphically useful. [ABSTRACT FROM AUTHOR]

ABSTRACT. Alexander von Humboldt's influence in British North America during the nineteenth century was filtered mainly through British imperial applications of "Humboldtian" sciences, including geomagnetism and biogeography. The best-known examples include Edward Sabine and John Henry Lefroy, Royal Artillery officers who, during the 1830s and 1840s, transformed British North American outposts and territories, including Rupert's Land, into Humboldtian sites and regions in Great Britain's imperial "magnetic crusade." Important groundwork had already been laid by John Richardson, who applied data accrued during John Franklin's overland Arctic expeditions during the 1820s to systematize Humboldtian inquiries into the habitability of Canada's Great Northwest. Despite both the relative decline of Humboldtian sciences by midcentury and Humboldt's own reservations about the political ramifications of his science, his "cosmic" outlook circulated in Canada to refine territorial expansionists' scientistic arguments justifying annexation of Rupert's Land after the monopoly of the Hudson's Bay Company expired in 1869. [ABSTRACT FROM AUTHOR]

Since the late 1990s Wilbur Zelinsky's theory of "heterolocalism" has provided human geographers and other social scientists with a new approach to analyzing the spatial patterns and ethnic identities of recent immigrants in the United States. Zelinsky's heterolocal model suggests that, to a degree unknown in the past, new migrants in North American cities may choose to settle in widely dispersed places, rather than in more concentrated ethnic enclaves, while maintaining their ethnic identities. This article expands on and critiques prior work on heterolocalism in Oregon by examining the spatial patterns, ethnic and religious identities, and transnational relationships of two recent refugee groups in three urban areas in the Pacific Northwest. Using data from U.S. and Canadian census records, refugee resettlement agency files, survey questionnaires, structured and unstructured interviews, and participant observation with post-Soviet Russians and Ukrainians in the Vancouver, British Columbia, Seattle, Washington, and Portland, Oregon metropolitan areas, I analyze the spatial patterns and related social networks that define the identities and residential and religious spaces of these groups to test the efficacy of relating heterolocalism and transnationalism across an international boundary. [ABSTRACT FROM AUTHOR]

Issues concerning organ procurement and transplantation in the United States are described and related to the Canadian health care environment. Although the United States has a national organ procurement system and national transplant guidelines are in place, many complications exist regarding the allocation of organ transplant services. Current proposals to increase organ donation are critiqued and new guidelines are proposed for the organ transplantation system. These guidelines help to protect the right of access to these health resources among the socially or economically disadvantaged. Given the similarities between the United States and Canada in terms of population demographics and medical treatment protocols, these guidelines are applicable to both countries in order to more appropriately blend economic and ethical criteria to allocate organ transplantation services more efficiently and effectively. [ABSTRACT FROM AUTHOR]

U.S. and Canadian policies concerning medical technology acquisition and diffusion are compared. Healthcare resources are allocated primarily through insurance incentives in the U.S. and through budget controls in Canada. Techno- logical acquisitions, a small component of healthcare expenditures, are influenced by industry competition in the U.S., and by U.S. marketing in Canada. Healthcare utilization, a large component of expenditures, has caused similar resource allocation issues in both countries. Both countries are becoming more similar in their healthcare policies. Canada is becoming more privatized in financing healthcare services, and the U.S. is moving toward more conservative medicine. Both countries face similar challenges in technological acquisition and diffusion. Care must be taken that administrative hurdles do not alter the stream of returns to technology so that the R&D of beneficial technologies will be encouraged. Also, evaluation methods must objectively measure the economic costs and benefits of technological services so that technologies that yield net benefits to society will be promoted. [ABSTRACT FROM AUTHOR]

A revised permafrost index, computed from mean monthly air temperatures and snowcover data, produces an unambiguous latitudinal zonation of contemporary permafrost. Isarithmic mapping of this ‘surface frost number’ defines a latitudinal zonation that is in substantial agreement with a previous semi-empirical mapping of permafrost in the lowlands of central Canada. A related index, the ‘Stefan frost number,’ employs estimates of soil properties in an approximate engineering solution or the depths of freezing and thawing. Mapping of this index by unclassed choropleth methods provides and estimate of point-to-point variations in permafrost distribution under the assumptions of homogeneous topography and vegetation. The model successfully predicts the presence of permafrost in peatlands outside the zonal limits defined by climatic criteria alone. The frost number provides an easily computed, physically based method for predicting permafrost that lends itself to a variety of cartographic representations of permafrost distribution. [ABSTRACT FROM AUTHOR]