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Alcohol use is prevalent among post-secondary students and negatively impacts their academic achievement. Socially constructed gender-based perceptions can promote alcohol misuse on campus. This is a community-based participatory action research aiming to raise awareness of alcohol use and its relation to gender, bridge campus networks targeting alcohol misuse, and develop a sustainable health promotion intervention. Twelve student-peer researchers from two Canadian universities led the project during the 2017-2018 school year. One multi-phased health promotion initiative consisting of poster/video campaigns, a health promotion website, and on-campus events, was implemented on each campus. Student leadership was empowered through the Action Research Cycle and Fletcher's Ladder of Student Involvement. Data were collected through field notes, activity logs, and semi-structured interviews. A thematic analysis determined that student-peer researchers experienced a sense of accomplishment, empowerment, greater interest in the topic, and a desire to sustain the project, but faced challenges regarding the initiative structures, inter-researcher communication, and teamwork distribution. The results demonstrated that both initiatives successfully reached broad student bodies and increased student awareness of alcohol misuse. This intervention addressed culturally manifested drinking norms and demonstrated effective student-led participatory action research. However, the findings were unique to the specific campus culture and may be of limited generalizability.

Objective: This study demonstrates the utility of the Post-Secondary Student Stressors Index (PSSI), an instrument designed to identify and evaluate the sources of student stress. The PSSI is comprised of 46 stressors, rated by severity and frequency, across five domains: academics, learning environment, campus culture, interpersonal, and personal. Participants: Pilot testing of the tool was conducted among n = 535 post-secondary students enrolled at an Ontario university. Methods: Mean severity and frequency ratings were calculated for each stressor on the instrument. Results were plotted, and stratified by sex. T-tests for differences in means across sexes were calculated for each stressor. Results: Female students in this sample consistently rated nearly all stressors on the instrument as more severe than their male counterparts. Females also reported higher frequency ratings on average, indicating that they worried about stressors more often than did males. Domain-specific stressors are discussed. Conclusions: The PSSI can provide post-secondary institutions with the ability to improve the targeting of their mental health promotion and mental illness prevention efforts.

Background: It is unclear whether parathyroidectomy guided by intraoperative parathormone (PTH) monitoring is predictive of operative success in patients with normohormonal hyperparathyroidism (nhHPT), a variant of primary hyperparathyroidism (pHPT) in which patients develop clinical manifestations similar to those of pHPT. This study examined intraoperative PTH monitoring in patients undergoing parathyroidectomy for nhHPT. Methods: We performed a retrospective review of prospectively collected data from adult (age > 18 yr) patients who underwent parathyroidectomy for pHPT at 1 of 2 North American medical centres (in Calgary, Alberta, Canada, or Miami, Florida, United States) between 2007 and 2015. In patients with nhHPT, we used the criterion of an intraoperative decrease of more than 50% in PTH after abnormal gland excision. We defined operative success as continuous eucalcemia more than 6 months after parathyroidectomy. Results: Of 333 patients, 38 (11.4%) had nhHPT, with mean preoperative calcium and PTH levels of 2.7 mmol/L and 53 pg/dL, respectively. An intraoperative decrease of more than 50% in PTH level was seen in 27 patients (71.0%) with nhHPT and 265 patients (89.8%) with classic pHPT at 5 minutes (p < 0.001); the corresponding values at 20 minutes were 35 (92.1%) and 286 (96.9%). Although 5 patients (13.2%) with nhHPT did not reach this criterion until 20 minutes, the rate of operative success was still 97.0% at long-term follow-up (mean 13 mo, range 6-67 mo). Of the 38 patients, 3 (7.9%) did not have an intraoperative decrease of more than 50% in PTH level by 20 minutes. Two of the 3 achieved operative success and remained normocalemic, and 1 developed recurrent disease at 12 months. Conclusion: Parathyroidectomy guided by intraoperative PTH monitoring accurately predicted operative success in patients with nhHPT. Intraoperative PTH monitoring may also help identify multiglandular disease in patients with nhHPT, using criteria similar to those in classic pHPT, with comparable operative success. Contexte : On ne sait pas si la parathyroidectomie guidee par la surveillance peroperatoire de la parathormone (PTH) permet de predire le succes operatoire chez les patients atteints d'hyperparathyroidie normo-hormonale (nhHPT), une variante de l'hyperparathyroidie primaire (pHPT) qui entraine chez les patients des manifestations cliniques similaires a celles de la pHPT. Cette etude a exa mine la surveillance peroperatoire de la PTH chez des patients subissant une parathyroidectomie pour une nhHPT. Methodes : Nous avons effectue une revue retrospective des donnees recueillies prospectivement aupres de patients adultes (> 18 ans) ayant subi une parathyroidectomie pour une pHPT a l'un ou l'autre de 2 centres medicaux nord-americains (a Calgary, en Alberta, au Canada, et a Miami, en Floride, aux Etats-Unis) entre 2007 et 2015. Chez les patients atteints de nhHPT, nous avons utilise le critere d'une diminution peroperatoire de plus de 50 % de la PTH apres l'ablation de la glande anormale. Le critere de succes operatoire consistait en une eucalcemie continue plus de 6 mois apres la parathyroidectomie. Resultats : Sur 333 patients, 38 (11,4 %) avaient une nhHPT, avec des taux moyens de calcium et de PTH preoperatoires de 2,7 mmol/L et 53 pg/dL, respectivement. Une diminution peroperatoire de plus de 50 % du niveau de PTH a ete observee chez 27 patients (71,0 %) avec nhHPT et 265 patients (89.8 %) avec pHPT classique a 5 minutes (p < 0,001); les valeurs correspondantes a 20 minutes etaient 35 (92,1 %) et 286 (96,9 %). Bien que 5 patients (13,2 %) avec nhHPT n'aient pas atteint ce critere avant 20 minutes, le taux de succes operatoire etait encore de 97,0 % lors du suivi a long terme (moyenne 13 mois, intervalle 6-67 mois). Sur les 38 patients, 3 (7,9 %) n'ont pas eu de diminution peroperatoire de plus de 50 % du taux de PTH avant 20 minutes. Pour 2 de ces 3 patients, l'operation a reussi; ils sont demeures normocalcemiques. L'autre patient a developpe une maladie recurrente a 12 mois. Conclusion : La parathyroidectomie guidee par la surveillance peroperatoire de la PTH a permis de predire avec precision le succes operatoire chez les patients atteints de nhHPT. La surveillance peroperatoire de la PTH peut egalement aider a detecter une maladie multiglandulaire chez les patients atteints de nhHPT, par l'utilisation de criteres similaires a ceux de la pHPT classique, avec succes operatoire comparable., Primary hyperparathyroidism (pHPT) affects about 50 per 100 000 people annually, and its clinical manifestations have adverse effects on bone, kidney and cognitive function. (1), (2) With the advent of [...]

Background: Sentinel lymph node biopsy (SLNB) for melanoma plays a central role in determining prognosis and guiding treatment and surveillance strategies. Despite widely published guidelines for SLNB, variation exists in its use. We aimed to determine the frequency of and predictive factors for SLNB in patients with clinically node-negative melanoma in British Columbia. Methods: A retrospective review was performed of patients with clinically node-negative melanoma diagnosed between January 2015 and December 2017. Patients included had a Breslow depth greater than 0.75 mm or a Breslow depth less than or equal to 0.75 mm with ulceration, or a mitotic rate greater than or equal to 1/[mm.sup.2]. SLNB was considered to be indicated for clinical stages IB to IIC (American Joint Committee on Cancer's AJCC Cancer Staging Manual, seventh edition). Results: A total of 759 patients were included. SLNB was performed in 54.8% (363/662) of patients when indicated. SLNB was more likely to be performed for tumours with a Breslow depth greater than 1.0 mm or a mitotic rate greater than or equal to 1/[mm.sup.2]. SLNB was less likely to be performed in patients older than 75 years and with a nonextremity tumour location. Compliance with SLNB guidelines decreased distant recurrence but did not significantly affect regional recurrence, nor did it have a significant impact on overall survival among patients aged 75 years and younger. Conclusion: SLNB is being underutilized in British Columbia. These results are concerning and highly relevant given the rapidly evolving field of adjuvant systemic therapy for high-risk patients and the increased proportion of patients who should be considered for SLNB on the basis of the eighth edition of the AJCC Cancer Staging Manual and current guidelines. Efforts should be made to increase the use of SLNB in appropriate patients. Contexte : Dans les cas de mélanome, la biopsie des ganglions sentinelles (BGS) est déterminante pour le pronostic et l'orientation des traitements et des stratégies de surveillance. Malgré des lignes directrices largement publiées pour la BGS, son utilisation est variable. Nous avons voulu déterminer la fréquence des BGS et les facteurs propices à son utilisation chez les patients atteints de mélanome dont les ganglions sont cliniquement négatifs en Colombie-Britannique. Méthodes : Une revue rétrospective des cas de mélanome avec ganglions cliniquement négatifs a été effectuée entre janvier 2015 et décembre 2017. Les patients inclus présentaient un indice de Breslow supérieur à 0,75mm ou inférieur ou égal à 0,75mm avec ulcération, ou un taux mitotique supérieur ou égal à 1/[mm.sup.2]. La BGS était jugée indiquée pour les stades cliniques IB à IIC (septième édition de VAJCC Cancer Staging Manual de l'American Joint Committee on Cancer). Résultats : En tout, 759 patients ont été inclus. Une BGS a été effectuée chez 54,8% (363/662) d'entre eux lorsqu'elle était indiquée. La BGS était plus susceptible d'être effectuée en présence de tumeurs ayant un indice de Breslow supérieur à 1,0mm ou un taux mitotique supérieur ou égal à 1/[mm.sup.2]. La BGS était moins susceptible d'être effectuée chez les patients de plus de 75 ans qui présentaient une tumeur n'affectant pas les membres. Le respect des lignes directrices relatives à la BGS a permis de réduire les récidives à distance, mais n'a pas affecté significativement les récurrences régionales et n'a pas eu d'impact significatif sur la survie globale chez les patients de 75 ans et moins. Conclusion : La BGS est sous-utilisée en Colombie-Britannique. Ces conclusions sont inquiétantes et très importantes compte tenu de l'évolution rapide des traitements adjuvants systémiques pour les patients à haut risque et de la proportion croissante de patients qui y seraient candidats selon la huitième édition de l'AJCC Cancer Staging Manual et les lignes directrices actuelles. Il faut déployer des efforts pour accroître l'utilisation de la BGS chez les patients qui y sont candidats., In Canada, cutaneous malignant melanoma accounts for approximately 3% of all new cancer diagnoses and 80% of skin cancer-related deaths. (1,2) The lifetime risk of developing melanoma is 1 in [...]

Patients with thick cutaneous pT4 malignant melanoma are at high risk for metastatic disease, and optimal staging is poorly defined. This study examines the frequency and modality of pre-operative staging to provoke thought on optimal staging. A retrospective study was performed of patients with clinical T4N0 melanoma diagnosed between 2015–2017. The modality (sentinel lymph node biopsy and/or imaging), timing, and findings of staging investigations were assessed. One hundred thirty-six patients with pT4a or pT4b cutaneous melanoma and clinically negative regional lymph nodes were included. Forty patients underwent no staging. Thirty-six patients underwent pre-operative imaging, and of these, regional or distant disease was identified in seven patients (19%). Another 36 patients underwent upfront sentinel lymph node biopsy concurrently with wide local excision. A positive sentinel lymph node biopsy was found in eight (22%) of these patients, of which two had regional or distant metastatic disease on postoperative imaging. Of 16 who underwent a sentinel lymph node biopsy after negative pre-operative imaging, three had a positive sentinel lymph node biopsy. Staging is non-standardized and underutilized in patients with thick melanoma. With evolving systemic treatment options, a well-defined approach to staging, with consideration for pre-operative imaging in pT4 patients, is essential for high-risk patients. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: The incidence of colorectal cancer (CRC) is decreasing in individuals >50 years due to organised screening but has increased for younger individuals. We characterized symptoms and their timing before diagnosis in young individuals. Methods: We identified all patients diagnosed with CRC between 1990–2017 in British Columbia, Canada. Individuals <50 years (n = 2544, EoCRC) and a matched cohort >50 (n = 2570, LoCRC) underwent chart review to identify CRC related symptoms at diagnosis and determine time from symptom onset to diagnosis. Results: Across all stages of CRC, EoCRC presented with significantly more symptoms than LoCRC (Stage 1 mean ± SD: 1.3 ± 0.9 vs. 0.7 ± 0.9, p = 0.0008; Stage 4: 3.3 ± 1.5 vs. 2.3 ± 1.7, p < 0.0001). Greater symptom burden at diagnosis was associated with worse survival in both EoCRC (p < 0.0001) and LoCRC (p < 0.0001). When controlling for cancer stage, both age (HR 0.87, 95% CI 0.8–1.0, p = 0.008) and increasing symptom number were independently associated with worse survival in multivariate models. Conclusions: Patients with EoCRC present with a greater number of symptoms of longer duration than LoCRC; however, time from patient reported symptom onset was not associated with worse outcomes. [ABSTRACT FROM AUTHOR]

Octreotide LAR is a long‐acting somatostatin analogue (SSA) used in the management of metastatic gastroenteropancreatic neuroendocrine tumors (GEP NETs). It requires intramuscular (IM) injection. Missed IM injections cause subcutaneous nodules (SCNs) on radiologic images. We reviewed the rates of SCNs in a real‐world cohort of GEP NETs receiving octreotide LAR and explored treatment outcomes. Patients commencing octreotide LAR between August 5, 2010 and March 8, 2018 at a single cancer center in Canada were identified from pharmacy records. Patients were included if they had a computed tomography (CT) scan performed at the time of progression and a preceding CT with pelvis included to enable assessment for the presence of nodules. Fisher's exact test was used to examine predictors of SCNs, and Kaplan–Meier curves summarized differences in progression free (PFS) and overall survival (OS) that were compared with log‐rank tests. Of 243 patients receiving octreotide LAR, 45 had all required CT images available for central review. SCNs were found in 20/45 (44%) of patients on the last scan showing stable disease before progression and were numerically but not statistically more likely in females (OR: 2.36, 95% CI: 0.66–8.29, p =.23). There was an increased risk of SCNs in patients with a skin‐to‐muscle distance >38 mm (the length of an octreotide LAR needle) on CT (OR: 5.09, 95% CI: 1.39–16.6, p =.018) and a trend toward increased risk in obese patients (OR: 5.71, 95% CI: 1.26–23.4, p =.061). PFS (HR: 1.01, 95% CI: 0.56–1.78, p =.98) and OS (HR: 0.86, 95% CI: 0.41–1.8, p =.70) was similar between those with/without SCNs. In conclusion, almost half of patients receiving octreotide LAR had SCNs; however, missed administration of SSA did not appear to result in worse survival in this small study. Factors such as sex, younger age skin‐to‐muscle distance, and obesity may affect SCN development and should be considered when choosing an SSA. [ABSTRACT FROM AUTHOR]

Sclerosing encapsulating peritonitis (SEP) is a rare condition characterised by a fibrotic peritoneal membrane encasing loops of bowel often resulting in obstruction. We present a case of SEP complicated by non-resolving small bowel obstruction in the context of prior malignancies and surgical complications. A literature review on SEP was performed to outline potential aetiologies, diagnostic investigations and treatment strategies that may be considered in the management of this disease. [ABSTRACT FROM AUTHOR]

Objective: Previous research has evaluated the sources of post-secondary student stress, but has failed to explore whether stressors fluctuate over time. The purpose of this research was to use the Post-Secondary Student Stressors Index to examine whether stressors changed significantly and meaningfully over the course of an academic year. Due to the timing of data collection, results also provide context around students' experiences of stress during the COVID-19 pandemic. Method: Cross-sectional data was collected at 3 time points via online surveys over the course of the 2020–2021 academic year from >10,000 students. Participants attended 15 post-secondary institutions across Canada, representing 9 provinces and 1 territory. Validated instruments were used to assess levels of stress, distress and the severity of student-specific stressors. Kruskal–Wallis ranked tests and multiple pairwise comparison analyses were conducted to assess whether the mean severity of stressors changed over time. Standard effect sizes were calculated using Cohen's d. Results: Mean levels of stress and psychological distress were high at the start of the study and remained high across time points. A similarly high level of stress was observed on average for student-specific stressors. While significant differences in mean severity were observed over time for some stressors, standardized effect sizes were negligible, suggesting little meaningful change and consistent levels of chronic stress over the course of the academic year. Conclusions: This is the first paper to examine trends in student-specific stress using a nationwide sample of Canadian post-secondary students during the first year of the COVID-19 pandemic. Patterns observed in student-specific stressors reflected changes likely to be indicative of the pandemic, including the most severe stress associated with academics, finances and concerns for the future. Implications for future research are discussed, in particular, the importance of examining stressors related to COVID-19 and their impact on student mental health. [ABSTRACT FROM AUTHOR]

Alcohol use is prevalent among post-secondary students and negatively impacts their academic achievement. Socially constructed gender-based perceptions can promote alcohol misuse on campus. This is a community-based participatory action research aiming to raise awareness of alcohol use and its relation to gender, bridge campus networks targeting alcohol misuse, and develop a sustainable health promotion intervention. Twelve student-peer researchers from two Canadian universities led the project during the 2017–2018 school year. One multi-phased health promotion initiative consisting of poster/video campaigns, a health promotion website, and on-campus events, was implemented on each campus. Student leadership was empowered through the Action Research Cycle and Fletcher's Ladder of Student Involvement. Data were collected through field notes, activity logs, and semi-structured interviews. A thematic analysis determined that student-peer researchers experienced a sense of accomplishment, empowerment, greater interest in the topic, and a desire to sustain the project, but faced challenges regarding the initiative structures, inter-researcher communication, and teamwork distribution. The results demonstrated that both initiatives successfully reached broad student bodies and increased student awareness of alcohol misuse. This intervention addressed culturally manifested drinking norms and demonstrated effective student-led participatory action research. However, the findings were unique to the specific campus culture and may be of limited generalizability. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study was to evaluate the safety and effectiveness of transanal endoscopic microsurgery for rectal neuroendocrine tumours. Method: A retrospective cohort study of all pathology‐confirmed rectal neuroendocrine tumours treated by transanal endoscopic microsurgery from April 2007 to December 2020 at a tertiary care centre was performed. Demographic, clinical, radiographic and pathological data were collected. Characteristics of patients with recurrence were examined. Descriptive statistics were performed. Results: There were 58 patients treated by transanal endoscopic microsurgery excision. Referrals were for primary excision (15, 25.9%), completion re‐excision after incomplete endoscopic removal (38, 65.5%) or locally recurrent rectal neuroendocrine tumours (5, 8.6%). The mean age of patients was 56.4 ± 11.9 years and 26 patients were women (44.8%). Mean tumour size was 7.4 ± 3.8 mm (range 1.0–15.0 mm). Most (86.4%) were Grade 1 tumours. Mean operative time was 37.2 ± 17.2 min and 56 patients (96.6%) were discharged on the same day. All patients had negative margins on final pathology. Of the 38 patients who were referred for completion re‐excision after incomplete endoscopic removal, eight (21.1%) had residual tumour on final pathology. Three recurrences were diagnosed at 2.1, 4.5 and 12.5 years after excision. All recurrences were from Grade 1 or 2 primary tumours, less than 2 cm, and diagnosed radiographically. Conclusion: To date, this is the largest North American study looking at transanal endoscopic microsurgery for rectal neuroendocrine tumours. This technique is effective in managing primary, incompletely excised and recurrent tumours with good clinical and oncological outcomes. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Mental illness stigma has been long acknowledged as a social problem that continues to persist and contribute to social exclusion of affected persons globally.Researchers have explored mental illness stigma in the general public and among health professionals, with little focus on stigma from family members and close relatives of persons with mental illnesses. What the paper adds to existing knowledge?: This study appears to be the first meta‐synthesis of familial mental illness stigma in high‐income countries.Family members or close relatives of persons with mental illnesses may be perpetrators of stigma. That is, the family may enact stigma of mental illness against their relative to "save face" or by avoiding or narrowing their social contacts.Familial stigma is harmful due to the likely disaffection it brings within one's home environment. Familial mental stigma from the existing literature seems to be a by‐product of public stigma and stigma by association What are the implications for practice?: Further research is necessary to look at the existence of familial mental illness stigma as well as available policies to reduce its impact on affected individuals in high‐income countries.Researchers in high‐income countries should endeavour to examine the relationship between familial, public and associative stigma to establish baseline metrics to inform future anti‐stigma programs seeking to reduce familial mental illness stigma. Introduction: Familial mental illness stigma is a pervasive issue but very subtle in high‐income countries. Familial mental illness stigma implies persons living with mental illnesses are discriminated against by their family members or close relatives. Aim/Question: This meta‐synthesis explored the experiences of familial stigma among individuals living with mental illnesses in high‐income countries, focusing on empirical literature, to understand the breadth of current literature and ways to reduce this form of stigma. Method: We conducted a meta‐synthesis through a structured search of qualitative data from six electronic databases (Sociological Abstract, CINAHL, Medline, PsycINFO, Google Scholar and Embase). Inclusion criteria comprised: empirical primary research, primary technique for data collection is qualitative, studies published in a peer‐reviewed journal in the English language between 2000 and 2020, studies reported on experiences of familial mental illness stigma, and studies conducted in high‐income countries. The exclusion criteria were as follows: all grey literature, studies not written in English and non‐peer‐reviewed, studies not focused on familial mental illness stigma, quantitative peer‐reviewed articles on the related concept and peer‐reviewed articles on the related topic before the year 2000. Results: The study identified only 28 peer‐reviewed articles on the topic within two decades. Concealment of familial stigma was found to be detrimental due to the potential for alienation within one's home environment. Disclosure and social contact within the family system were considered as critical interventions to provide some safety nets for individuals with mental illnesses. Discussion and implications for practice: The paucity of studies over the review period highlights the need for further attention to support optimal environments for persons living with mental illnesses. Families' understanding of the difficulties of mental illness stigma is vital to supporting the development of policies and interventions towards the avoidance of social exclusion within societies. Families should make concerted efforts to reduce stigma, and this includes within the family system. Education and training approaches around mental illness‐related stigma should involve individuals with lived experience and their families, as well as service providers and the general public. [ABSTRACT FROM AUTHOR]

The Post-Secondary Student Stressors Index (PSSI) was created to facilitate improved evaluation of the sources of post-secondary student stress. This study reports evidence in support of the validity of the tool using a large, nationwide cross-sectional sample of students attending universities across Canada during the 2020–2021 academic year. We provide additional evidence for the construct validation of the PSSI, including internal structure evidence and relations to other variables by estimating multiple-indicator, multiple-cause models and investigating Spearman's rho correlation coefficients between the PSSI and like constructs. Based on index validation guidelines, results provide further support for the internal structure of the PSSI, demonstrating hypothesized relationships with like constructs and manifest variables, as well as acceptable goodness-of-fit statistics. Similarly, correlation coefficients were statistically significant and in line with directionality hypotheses. The results of this research provide further evidence for the validity of the PSSI among varied university student populations in Canada and addresses several of the limitations identified in earlier preliminary psychometric work on the instrument. [ABSTRACT FROM AUTHOR]

Little research has explored the process of disclosure decision-making from antecedents to outcomes. This paper presents a model of decision-making about disclosure of a mental health condition to the immediate supervisor in the workplace shortly after starting a new job. A qualitative descriptive design was employed to explore participants' experiences of the disclosure decision-making process, the disclosure event itself (if applicable), and their perceptions of the impact of the decision on personal, interpersonal, and organizational outcomes. The transcripts were coded and analyzed using directed content analysis. Twenty-eight participants were purposively selected to represent different disclosure decisions, sex, diagnoses, and maintenance of employment. Analysis identified goals and conditions/context were important antecedents for the disclosure decision. All participants discussed concerns about prejudice and discrimination if they disclosed, and, for those who chose to disclose, high stress and anxiety were described during the disclosure event; however, supervisor reactions were generally described as positive. Regardless of the disclosure strategy adopted, participants reported that their disclosure decision helped to support their self-acceptance and recovery. For those who disclosed, most perceived a positive response by their supervisor. However, the pervasive concerns of prejudice indicate there is still much work to be done. Decision-making about disclosure of a mental health condition to the immediate supervisor in the workplace is a complex process. Disclosure goals, the relationship with the supervisor and the workplace context are important antecedents to the disclosure decision. Careful consideration should be given to the planning of disclosure, particularly related to what information will be shared, how it will be shared, and an appropriate level of emotional content to enhance the likelihood of a positive response from the supervisor. Disclosure planning should take the supervisor's style and organizational norms into account. [ABSTRACT FROM AUTHOR]

Sexual abuse and exploitation (SEA) perpetrated by UN peacekeepers while on mission is a violation of human rights and undermines the goal of upholding human rights in countries that host peacekeeping missions. In addition to survivors, children fathered by peacekeepers are also victims of SEA that need protection. Stigma poses negative life course consequences for SEA survivors and their peacekeeper-fathered children. However, there is a considerable lack of empirical research concerning the stigma experiences of SEA survivors and their children in post-colonial contexts. The present study addresses this knowledge gap by drawing on The United Nations Stabilization Mission in Haiti as a case study to examine the lived experiences of stigma among SEA survivors and their resultant children. Using 18 qualitative semi-structured interviews conducted in 2017 with Haitian women raising peacekeeper-fathered children, we organized qualitative codes according to Link and Phelan's conceptual model of stigma. The stigmatization process was explored through the themes of labeling, stereotyping, separation, and status loss and discrimination, as described by Link and Phelan. In addition, we nuanced the lived experiences of stigma by discussing the buffering roles of familial acceptance, skin phenotype, and the Haitian context. The findings have implications for the UN. We advocate that stigma be recognized and acted upon as a fundamental protection concern for SEA survivors and their children. Accordingly, the UN has an obligation to provide stigma-related supports for victims and complainants as well as to facilitate long-term child support for the children left behind by peacekeepers. [ABSTRACT FROM AUTHOR]

Sexual exploitation and abuse (SEA) of women and girls by United Nations (UN) peacekeepers is an international concern. However, the typical binary measurement of SEA (indicating that it occurred, or it did not) disregards varying exposure levels and the complex circumstances surrounding the interaction. To address this gap, we constructed an index to quantify the degree to which local women and girls were exposed to UN-peacekeeper perpetrated SEA. Using survey data (n = 2867) from the Democratic Republic of Congo (DRC), eight indicators were identified using a combination of qualitative (thematic analysis of narrative data) and quantitative variables. With further development, this index may offer a more comprehensive and nuanced perspective of peacekeeper-perpetrated SEA that can better inform SEA prevention and intervention efforts. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies Inc. 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.)

Introduction: In metastatic colorectal cancer (mCRC), RAS mutations impart inferior survival and resistance to anti-epidermal growth factor receptor (EGFR) antibodies. KRAS G12C inhibitors have been developed and we evaluated how KRAS G12C differs from other RAS mutations. Patients and Methods: This retrospective review evaluated patients in British Columbia, Canada with mCRC and RAS testing performed between 1 January 2016 and 31 December 2018. Sequencing information from The Cancer Genome Analysis (TCGA) was also obtained and analysed. Results: Age at diagnosis, sex, anatomic location and stage at diagnosis did not differ by RAS mutation type. Progression free survival on first chemotherapy for patients with metastatic KRAS G12C tumours was 11 months. Median overall survival did not differ by RAS mutation type but was worse for both KRAS G12C (27 months) and non-G12C alterations (29 months) than wildtype (43 months) (p = 0.01). Within the TCGA, there was no differential gene expression between KRAS G12C and other RAS mutations. However, eight genes with copy number differences between the G12C and non-G12C RAS mutant groups were identified after adjusting for multiple comparisons (FITM2, PDRG1, POFUT1, ERGIC3, EDEM2, PIGU, MANBAL and PXMP4). We also noted that other RAS mutant mCRCs had a higher tumour mutation burden than those with KRAS G12C mutations (median 3.05 vs 2.06 muts/Mb, p = 4.2e–3) and that KRAS G12C/other RAS had differing consensus molecular subtype distribution from wildtype colorectal cancer (CRC) (p < 0.0001) but not each other (p = 0.14). Conclusion: KRAS G12C tumours have similar clinical presentation to other RAS mutant tumours, however, are associated with differential copy number alterations. [ABSTRACT FROM AUTHOR]

People living with mental illnesses and their families may conceal their conditions to avoid prejudice and discrimination. Stigma often prevents people from receiving adequate health care and other social support services which could exacerbate social and health consequences such as unemployment, homelessness, substance use, and compulsory hospitalization. In this paper, we discuss social contact as a promising anti-stigma strategy for enhancing social interactions among people with mental illnesses, their families, and those without mental illnesses. In particularly, we consider next steps for an approach that works to reduce the stigma-related burden of mental illness. For social contact to be effective in reducing mental illness stigma, it requires broad social buy-in as well as implementation within care systems. Engagement with this approach can be driven through diverse contact-based education using collaborative efforts of society, academic institutions, policy-makers, health professionals, media, and governments. Ultimately, this work aims to consider the next steps in enacting social contact as an anti-stigma strategy through direct interventions and contact-based education. The success of this approach requires pragmatic public policies to support its implementation. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies Inc. 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.)

Objective This study demonstrates the utility of the Post-Secondary Student Stressors Index (PSSI), an instrument designed to identify and evaluate the sources of student stress. The PSSI is comprised of 46 stressors, rated by severity and frequency, across five domains: academics, learning environment, campus culture, interpersonal, and personal. Participants: Pilot testing of the tool was conducted among n = 535 post-secondary students enrolled at an Ontario university. Methods: Mean severity and frequency ratings were calculated for each stressor on the instrument. Results were plotted, and stratified by sex. T-tests for differences in means across sexes were calculated for each stressor. Results: Female students in this sample consistently rated nearly all stressors on the instrument as more severe than their male counterparts. Females also reported higher frequency ratings on average, indicating that they worried about stressors more often than did males. Domain-specific stressors are discussed. Conclusions: The PSSI can provide post-secondary institutions with the ability to improve the targeting of their mental health promotion and mental illness prevention efforts. [ABSTRACT FROM AUTHOR]

Background: Sexual exploitation and abuse (SEA) by UN peacekeepers perpetrated against local women and girls is a concern in the Democratic Republic of Congo (DRC). While stigma associated with sexual and gender-based violence is well documented more broadly, little is known about stigma associated with peacekeeper-perpetrated SEA.Methods: The aim of this study was to examine how the degree of exposure to SEA affects community perceptions of a woman or girl's (1) social status (public stigma) and (2) institutional support in her community (structural stigma). Two poisson regression models with robust variance estimation were constructed utilizing community survey data of SEA experiences from eastern DRC (n = 2867) to quantify these associations. Relevant demographic variables were assessed for confounding and effect modification.Results: The prevalence of public and structural stigma were 62.9 and 19.3% respectively across the sample. A positive relationship was demonstrated between level of exposure of SEA and diminished social status in which women and girls experiencing moderate levels of SEA were at the greatest risk of public stigmatization after adjusting for confounding (RR: 1.94; CI: 1.66-2.26). Similarly, a positive relationship between exposure to SEA and inadequate institutional support was shown for female narrators wherein women and girls experiencing a high degree of SEA were 6.53 times as likely to receive inadequate support (RR: 6.53; CI: 3.63, 11.73). This contrasted with male narrated stories for whom there was no significant association between the SEA exposure level and institutional support.Conclusions: Women/girls with high exposure levels to UN peacekeeper-perpetrated SEA are at the highest risk of public and structural stigmatization, which should be more routinely considered when conceptualizing the consequences of SEA in peacekeeping contexts. The frequent occurrence of both public and structural stigma, coupled with the varying perceptions by sex, demonstrates the need for a multi-faceted approach for stigma reduction. [ABSTRACT FROM AUTHOR]

Although research to date has shown that there can be no health or sustainable development without good mental health, mental illness continues to significantly impact societies. A major challenge confronting people with mental illnesses and their families is the stigma that they endure. In this study, empirical literature was reviewed to assess policies and interventions that seek to reduce familial mental illness stigma across four countries. We used Arksey and O'Malley methodological framework, and a qualitative content analysis was employed to augment the descriptive data extracted. Seven studies published between 2000 and 2020 were analyzed. We propose herein three themes that align with interventions to reduce familial mental illness stigma: transformative education, sharing and disclosure, and social networking and support. The findings indicate that persuasive and purposeful education directed at the public to correct misconceptions surrounding mental illness, with attention to language, may help in reducing familial mental illness stigma. Disclosure of mental illness is encouraged among persons with mental illnesses and their families as a strategy to enhance mutual understanding. Social sharing also affords persons with mental illnesses opportunities to engage with their peers at different levels within the public sphere. Apart from these recommendations, we have noted a paucity of broad governmental-level policies and interventions to comprehensively address the negative attitudes of families toward their relatives. Future work must address this gap to identify effective interventions to create healthier and supportive environments that address familial mental illness stigma. [ABSTRACT FROM AUTHOR]

Abstract Background Sexual exploitation and abuse (SEA) by UN peacekeepers perpetrated against local women and girls is a concern in the Democratic Republic of Congo (DRC). While stigma associated with sexual and gender-based violence is well documented more broadly, little is known about stigma associated with peacekeeper-perpetrated SEA. Methods The aim of this study was to examine how the degree of exposure to SEA affects community perceptions of a woman or girl’s (1) social status (public stigma) and (2) institutional support in her community (structural stigma). Two poisson regression models with robust variance estimation were constructed utilizing community survey data of SEA experiences from eastern DRC (n = 2867) to quantify these associations. Relevant demographic variables were assessed for confounding and effect modification. Results The prevalence of public and structural stigma were 62.9 and 19.3% respectively across the sample. A positive relationship was demonstrated between level of exposure of SEA and diminished social status in which women and girls experiencing moderate levels of SEA were at the greatest risk of public stigmatization after adjusting for confounding (RR: 1.94; CI: 1.66–2.26). Similarly, a positive relationship between exposure to SEA and inadequate institutional support was shown for female narrators wherein women and girls experiencing a high degree of SEA were 6.53 times as likely to receive inadequate support (RR: 6.53; CI: 3.63, 11.73). This contrasted with male narrated stories for whom there was no significant association between the SEA exposure level and institutional support. Conclusions Women/girls with high exposure levels to UN peacekeeper-perpetrated SEA are at the highest risk of public and structural stigmatization, which should be more routinely considered when conceptualizing the consequences of SEA in peacekeeping contexts. The frequent occurrence of both public and structural stigma, coupled with the varying perceptions by sex, demonstrates the need for a multi-faceted approach for stigma reduction.