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A key public health response to the COVID-19 pandemic is the mandate to stay home and practice physical distancing. In Canada, with essential activities such as grocery shopping, outdoor exercise and transportation, people need to be able to safely navigate dense, urban spaces while staying at least two metres or six feet apart. This pandemic has exacerbated the health inequities across neighbourhoods in cities like Toronto, Canada which are often segregated along racial and income lines. These inequities impact who has access to urban infrastructure that promotes health and quality of life. Safety in a time of COVID-19 goes beyond just exposure to the virus, it is complicated by notions of who belongs where, and who has access to what resources. The built environment has a role in maintaining and promoting physical and mental health during this pandemic and beyond it. This paper puts forwards three considerations for built environment interventions to promote health equitably: (i) addressing structural determinants of health and embedding anti-racist intersectional principles, (ii) revisiting tactical urbanism as a health promotion tool and (iii) rethinking community engagement processes through equity-based placemaking. This paper outlines four built environment interventions in Toronto, Canada that seek to address the challenges in navigating urban space safely in the short term, including street design that prioritizes pedestrians, protected cycling infrastructure, access to inclusive green space and safe, affordable housing. Longer-term strategies to create health-promoting urban environments that are equitable are discussed and may be valuable to other cities with similar urban equity concerns. [ABSTRACT FROM AUTHOR]

With an increasing number of children diagnosed with Autism-Spectrum-Disorder in Canada, this paper focuses on how their mothers, as Asian immigrant women, experience the process of diagnosis and learn to parent their children. By taking two Asian (Korean and Chinese) mothers' critical personal narratives as major data sources, this paper aims to explore the diagnosis process of Autism-Spectrum-Disorder through a sociocultural lens on the intersectionality of (im)migrants and their cultural competence, and argues that their identity (re)construction and learning for parenting take place at the intersectionality of race, gender, class, and disability. This paper highlights possible implications for everyone involved in this 'medical' process, in the context of Canadian or other similar multicultural societies. Asian immigrant mothers usually have to deal with children with Autism-Spectrum-Disorder (ASD) and they have bitter experience of mistreatment tied to race, gender and class. This study reveals how Asian immigrant mothers struggled in their integration to Canadian society as well as their experiences of denial into Canada's medical system. The stories of these two women shed lights on the social and cultural aspects of immigrant mothers' learning strategies, including how they utilize accessible resources and networks for their children's treatment and diagnosis. This paper suggests that policymakers need to consider the social and cultural aspects of diagnosis in immigrant families to better fit their needs and provide them appropriate medical and social support. [ABSTRACT FROM AUTHOR]

This paper contributes to the growing body of work on precarious labor, immigration, and social gerontology by examining the racialization of precarious employment across the life course. In particular, the authors examine the impact of precarious employment and discrimination among racialized older immigrants in Canada. Racialized older immigrants are more likely to be disadvantaged by the effects of lifelong intersections of economic and social discrimination rooted in racialization, gender, ageism, and socio-economic status. Drawing from a narrative-photovoice project that focused on the life stories of older immigrants living in Quebec and British Columbia, this paper presents the in-depth stories and photographs of four participants to highlight how intersections of race, gender, age, immigration status, and ability shape and structure experiences of aging, labor market participation and caregiving relationships. [ABSTRACT FROM AUTHOR]

Copyright of Anthropologica is the property of CASCA 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.)

Rather than racism targeted toward service users, this paper adds to the sparse corpus of articles that reports on racism and microaggressions experienced by racialized social work practitioners. Based on two qualitative exploratory research studies in Canada, the findings suggest that racism continues to be a significant problem for racialized social workers. In addition to the oft-mentioned category of individual racism, four other "modern" forms of racism are explored: cultural racism, institutional racism, epistemological racism, and aversive racism. The importance of broadening the categories of racism is that these other forms are less familiar and thus are more likely to be unnoticed yet have profound effects on practitioners. [ABSTRACT FROM AUTHOR]

Background: Computer‐based assessment allows for the monitoring of reader behaviour. The identification of patterns in this behaviour can provide insights that may be useful in informing educational interventions. Objectives: Our study aims to explore what different patterns of reading activity exist, and investigates their interpretation and consistency across different task sets (units), countries, and languages. Three patterns were expected: on‐task, exploring and disengaged. Methods: Using log data from the PISA 2012 digital reading assessment (9226 students from seven countries), we conducted hierarchical cluster analyses with typical process indicators of digital reading assessments. We identified different patterns and explored whether they remained consistent across different units. To validate the interpretation of the identified patterns, we examined their relationship to performance and student characteristics (gender, socio‐economic status, print reading skills). Results and Conclusions: The results indicate a small number of transnational clusters, with unit‐specific differences. Cluster interpretation is supported by associations with student characteristics—for example, students with low print reading skills were more likely to show a disengaged pattern than proficient readers. Exploring behaviour tended to be exhibited only once across the three units: It occurred in the first unit for proficient readers and in later units for less skilled readers. Major Takeaways: Behavioural patterns can be identified in digital reading tasks that may prove useful for educational monitoring and intervention. Although task situations are designed to evoke certain behaviours, the interpretation of observed behavioural patterns requires validation based on task requirements, assessment context and relationships to other available information. Lay Description: What is already known about the subject matter?: Students differ in how they read, comprehend and use digital information.Indicators from process data provide insight about how students engage with digital reading tasks. What does this paper add to the subject matter?: Based on multiple process indicators, a small number of clusters indicating different behavioural activity can be distinguished.These clusters can be described as on‐task, passive, hasty, exploring, disengaged, persistent and lost interest.A meaningful interpretation of the clusters must consider the requirements of the underlying tasks. Implications for practice and/or policy: Knowledge of how students engage with digital resources may provide useful feedback for teachers to guide students' learning or intervene when they struggle.Educational monitoring: The high comparability of country‐specific results suggests an invariant set of solution strategies in the digital reading assessment. [ABSTRACT FROM AUTHOR]

Small cities tend to have modest immigrant settlement services and cultural amenities, engendering a distinct sense of place among immigrants and impacting their wellbeing differently from large cities. To study the impacts of place characteristics on settlement needs, this photovoice research examines the sense of place among immigrant women through their attribution of meanings to places of comfort and discomfort as they settled in a small city in Canada. Thirty-two immigrant women of different immigration admission statuses, i.e., economic, family, and refugee classes, ranging in age from 19 to 48, took photographs of places that they considered to be either comfortable or uncomfortable. Most participants were from Asia, Africa, and South America, and they had lived in Canada for less than 10 years. Findings indicated that these women appreciated the warmth and support extended to them by settlement services provider organizations, libraries, and faith-based organizations, attesting to the relational nature of the place. Nevertheless, immigrant women dreaded harsh winter conditions and felt unsafe in downtown areas. A close read of these women's photo stories revealed that their apprehensions about punitive winter conditions are closely linked to their role as primary household caregivers who take their children to public places. Their sense of vulnerability towards downtown areas demonstrates female subordination and their distaste for public spaces. Immigrant women sought comfort in locales that this paper terms "restorative space," showing their creative use of private and public spaces for relaxation. This study contributes to our understanding of the gendered and interwoven nature of the self, social, and physical spaces. The findings from this study call for settlement policies that attend to distinct characteristics of local places to better serve the settlement needs of immigrants. [ABSTRACT FROM AUTHOR]

Objectives: Differences in health among migrant groups are related to the length of stay in host countries. We examined the health of people reporting Caribbean ethnic origins within and outside of Canada; and the possible associations between length of stay and poorer physical and mental health outcomes. Method: Analyses were conducted on population data collected in Canada (2000/2001, 2003, 2005), Jamaica (2005) and Guyana (2005). Physician-diagnosed and self-rated health measures were used to assess physical and mental health statuses. Results: Rates of chronic conditions were generally higher among people reporting Caribbean ethnic origins in Canada compared to those living in the Caribbean region. Self-rated fair or poor general health rates, however, were higher among participants in the Caribbean region. Higher rates of any mood disorders were also found among Caribbean region participants in comparison to those in Canada. Logistic regression analyses revealed that new Caribbean immigrants (less than 10 years since immigration) in Canada had better physical health than those who were more established. Those who immigrated more than 20 years ago showed consistently better health conditions than those who had immigrated between 11 and 20 years ago. This healthy immigration effect, however, was not present for all chronic conditions among all Caribbean origin migrant groups. Moreover, mood disorders were highest among new immigrants compared to older immigrants. Conclusions: When and where ethnic Caribbeans migrate to and emigrate from matters in health statuses. These results have implications for policies related to health and well-being in support of ethnic Caribbean origin individuals who relocate to Canada. The paper concludes with suggestions for future studies regarding the health of ethnic origin Caribbeans living within and outside their regions of birth. [ABSTRACT FROM AUTHOR]

A central premise of the first demographic transition theory is that demographic change would occur more slowly in rural than urban areas. Few studies, however, have investigated whether rural areas remain holdouts during the second demographic transition. To address this gap, this study (1) examines trends among rural and urban families in Canada and the United States over a 30-year period and (2) determines whether compositional differences in demographic, socioeconomic, and religious factors explain current differences between rural and urban families. We find that rural Canadian women continue to have, on average, 0.6 more children than urban women. However, rural families do not trail behind urban families on any other indicator of family change. In fact, rural women in both countries are now significantly more likely to cohabit and roughly 10 percentage points more likely to have children outside of marriage than urban women. These differences are largely explained by lower levels of education and income among rural American women and fewer immigrants in rural Canada. Examining family change through a rural–urban lens fills important empirical gaps and yields novel insights into current debates on the fundamental causes of ongoing family change in high-income countries. [ABSTRACT FROM AUTHOR]

BACKGROUND: Studies across the globe generally reported increased mortality risks associated with particulate matter with aerodynamic diameter ≤2.5 μm (PM2.5) exposure with large heterogeneity in the magnitude of reported associations and the shape of concentration-response functions (CRFs). We aimed to evaluate the impact of key study design factors (including confounders, applied exposure model, population age, and outcome definition) on PM2.5 effect estimates by harmonizing analyses on three previously published large studies in Canada [Mortality-Air Pollution Associations in Low Exposure Environments (MAPLE), 1991-2016], the United States (Medicare, 2000-2016), and Europe [Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), 2000-2016] as much as possible. METHODS: We harmonized the study populations to individuals 65+ years of age, applied the same satellite-derived PM2.5 exposure estimates, and selected the same sets of potential confounders and the same outcome. We evaluated whether differences in previously published effect estimates across cohorts were reduced after harmonization among these factors. Additional analyses were conducted to assess the influence of key design features on estimated risks, including adjusted covariates and exposure assessment method. A combined CRF was assessed with meta-analysis based on the extended shape-constrained health impact function (eSCHIF). RESULTS: More than 81 million participants were included, contributing 692 million person-years of follow-up. Hazard ratios and 95% confidence intervals (CIs) for all-cause mortality associated with a 5-μg/m³ increase in PM2.5 were 1.039 (1.032, 1.046) in MAPLE, 1.025 (1.021, 1.029) in Medicare, and 1.041 (1.014, 1.069) in ELAPSE. Applying a harmonized analytical approach marginally reduced difference in the observed associations across the three studies. Magnitude of the association was affected by the adjusted covariates, exposure assessment methodology, age of the population, and marginally by outcome definition. Shape of the CRFs differed across cohorts but generally showed associations down to the lowest observed PM2.5 levels. A common CRF suggested a monotonically increased risk down to the lowest exposure level. [ABSTRACT FROM AUTHOR]

Since their introduction to North America in the 1980s, research to develop effective control tools for invasive mussels (Dreissena polymorpha and D. rostriformis bugensis) has been ongoing across various research institutions using a range of testing methods. Inconsistencies in experimental methods and reporting present challenges for comparing data, repeating experiments, and applying results. The Invasive Mussel Collaborative established the Toxicity Testing Work Group (TTWG) in 2019 to identify "best practices" and guide development of a standard framework for dreissenid mussel toxicity testing protocols. We reviewed the literature related to laboratory‐based dreissenid mussel toxicity tests and determined the degree to which standard guidelines have been used and their applicability to dreissenid mussel testing. We extracted detailed methodology from 99 studies from the peer‐reviewed and gray literature and conducted a separate analysis for studies using presettlement and postsettlement mussels. We identified specific components of methods and approaches that could be refined or standardized for dreissenid mussels. These components included species identification, collection methods, size/age class distinction, maintenance practices, testing criteria, sample size, response measures, reporting parameters, exposure methods, and mortality criteria. We consulted experts in the field of aquatic toxicology and dreissenid mussel biology on our proposed. The final recommendations contained in the present review are based on published standard guidelines, methods reported in the published and gray literature, and the expertise of TTWG members and an external panel. In addition, our review identifies research needs for dreissenid mussel testing including improved methods for early–life stage testing, comparative data on life stages and between dreissenid mussel species, inclusion of a reference toxicant, and additional testing of nontarget species (i.e., other aquatic organisms). Environ Toxicol Chem 2023;42:1649–1666. © 2023 His Majesty the King in Right of Canada. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC. Reproduced with the permission of the Minister of Environment and Climate Change Canada. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA. [ABSTRACT FROM AUTHOR]

Bias pervades every aspect of healthcare including admissions, perpetuating the lack of diversity in the healthcare workforce. Admissions interviews may be a time when applicants to health profession education programs experience discrimination. Between January and June 2021 we invited US and Canadian applicants to health profession education programs to complete a survey including the Everyday Discrimination Scale, adapted to ascertain experiences of discrimination during admissions interviews. We used chi-square tests and multivariable logistic regression to determine associations between identity factors and positive responses. Of 1115 respondents, 281 (25.2%) reported discrimination in the interview process. Individuals with lower socioeconomic status (OR: 1.78, 95% CI [1.26, 2.52], p = 0.001) and non-native English speakers (OR: 1.76, 95% CI [1.08, 2.87], p = 0.02) were significantly more likely to experience discrimination. Half of those experiencing discrimination (139, or 49.6%) did nothing in response, though 44 (15.7%) reported the incident anonymously and 10 (3.6%) reported directly to the institution where it happened. Reports of discrimination are common among HPE applicants. Reforms at the interviewer- (e.g. avoiding questions about family planning) and institution-level (e.g. presenting institutional efforts to promote health equity) are needed to decrease the incidence and mitigate the impact of such events. [ABSTRACT FROM AUTHOR]

This study examines the Canadian Code of Ethics for Registered Nurses as a discursive mechanism for shaping nurses' professional identity using a Foucauldian lens. Nurses are considered essential in healthcare, yet the nursing profession has struggled to be recognized for its discipline‐specific knowledge and expertise and, as such, has remained the subject of and subject to the dominant discourses within healthcare and society generally. Developing a professional identity in nursing begins after the necessary education and training are achieved and embodies the profession's history, values, code of ethics, and expectations of the profession that distinguish it from other professions. Since nurses' professional identity is shaped through discourse, it raises the question of whether there are spaces to reconceptualize nurses' subject position within health care. Since professional identity is considered the embodiment of knowledge and practice, the code of ethics bears examination both for its effect on nurses' professional identity and as a potential site from which to challenge hegemonic assumptions. This article discusses the concept of professional identity in nursing and its development through the discursive formations in the code of ethics. The sources of power/knowledge are examined as both mechanisms of control and as spaces for change. [ABSTRACT FROM AUTHOR]

Temporary housing programs (THPs) aim to serve the homeless population. This article explores the impacts of a THP, the Winter Interim Solution to Homelessness (WISH) in London, Canada, which applied a barrier-free, harm reduction model. Adopting an intersectional lens and interpretive description methodology, we analyzed data collected from WISH residents, utilizing a thematic analytic approach. Identified themes included: (1) "(It's) kinda like a real home" (WISH is unlike other shelters); (2) "It's like a buddy system" (A sense of community was fostered); (3) "It's the same size as a jail cell" (Problems with infrastructure); (4) "To keep us on focus" (Un/supportive staff/volunteers); (5) "I'm not sure what I'm going to do after" (The dearth of permanent housing creates trauma); and (6) "Too much bloody money in too little hands" (Distrust of housing providers). Although WISH was helpful to some residents, the temporary nature of the program limited its long-term impact. [ABSTRACT FROM AUTHOR]

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

As health and social service professions increasingly emphasize commitments to equity, advocacy and social justice, non-traditional entrants to the professions increasingly bring much-needed diversity of social backgrounds and locations. Long the domain of elite social classes, the professions are not always welcoming cultures for those from lower social class backgrounds. This paper draws on notions of material, social and cultural capital, along with habitus , to examine the experiences of professionals with lower-class backgrounds, in educational programs and in their professions. The critical interpretive qualitative study draws on interviews with 27 professionals across Canada in medicine, nursing, social work and occupational therapy. While participants were clearly set apart from their colleagues by class origins, which posed distinct struggles, they also brought valuable assets to their work: enhanced connection and rapport with clients/patients, approachability, structural analysis and advocacy, plus nuanced re-envisioning of professional ethics to minimize power dichotomies. Rather than helping lower-class entrants adapt to the professions, it may be more beneficial to alter normative professional cultures to better suit these practitioners. • People from lower-class backgrounds may struggle in the professions. • The material, social and cultural capitals expected cast them as cultural outsiders. • They may more readily enact the social justice and equity aims of the professions. • We need transformational change to professional cultures of elitism and exclusion. [ABSTRACT FROM AUTHOR]

Canadian research examining the overlap between Black women's victimization and criminalization is sparse. This qualitative study addresses this gap by examining the ways in which criminalized Black women's intersecting identities of race, class, and gender influence how they perceive, experience, and respond to intimate partner violence (IPV). Semi-structured interviews were conducted with 25 Black women who experienced IPV. The findings focus on the women (15) who were also charged with an IPV-related offense. Critical race feminism was employed to analyze their narratives. This research has implications for policy, practice, and future research with Black women who are victimized and criminalized. [ABSTRACT FROM AUTHOR]

Vaccine hesitancy has taken a toll on COVID-19 immunization globally. This study aims to characterize three COVID-19-related health concerns (i.e., vaccine hesitancy, anticipated stigma, and risk perception) in Canada and how they differ based on im/migration status and other social determinants. Data were obtained from a nationwide probability sample of the Canadian Perspective Survey Series 3 (June 15 to 21, 2020). Multivariable binary logistic regression analysis was performed to investigate the association between each COVID-19 concern and nativity status, while controlling for socio-demographics. Of 3522 participants aged ≥ 25 years, the estimated overall prevalence of vaccine hesitancy was 16.9%, with im/migrants being greater than non-immigrants (21.5% vs. 15.5%, p < 0.001). After controlling for all covariates, im/migrants had around two-fold greater odds of all three health concerns, including risk perception of accessing care (aOR 2.44, 95% CI 1.89–3.15), anticipated stigma of being targeted (aOR 2.24, 95% CI 1.81, 2.78) and COVID-19 vaccine hesitancy (aOR 1.99, 95% CI 1.57–2.52), compared to their Canadian-born peers. Among vaccine-hesitant individuals (n = 596), im/migrants reported higher concerns, than non-immigrants, on vaccine safety (71.3% vs. 49.5%), side effects (66.4% vs 47.3%) and mistrust in vaccinations (12.5% vs 6.6%) as possible reasons of vaccine refusal. For migrant justice, health authorities should ensure equitable access to COVID-19 vaccines and other health-enhancing resources for im/migrants to mitigate their heightened fear, stigma, and mistrust of new vaccines amidst turbulent times. [ABSTRACT FROM AUTHOR]

Use of online health information is positively associated with citizen knowledge, empowerment, self-care, health outcomes, and quality of life. However, little is known about how mothers with incomes below the poverty threshold and with education levels of high school or less use and interact with the Internet as a key source of lay knowledge and skills for infant care and childrearing. Our objective in this study was to understand mothers' perceptions of their experience in using online information for these purposes. To obtain a rich and nuanced understanding of their experience, we used a qualitative study approach based on 40 individual semi-structured interviews with mothers. Adopting Freidson's concept of "lay referral system" to grasp mothers' experience with online parenting information, we found that they relied on this information source extensively. Our findings showed that Internet-based information and online interactions were part of their lay referral system and modified to some extent how they interacted with their lay consultants (family and friends). Three major themes emerged in relation to how the Internet functioned as a component of the mothers' lay referral systems: (1) strategic use of the Internet for better parenting; (2) critical stance towards the Internet; and (3) strengthening of autonomy, skills, and self-confidence. Mothers with spouses and an active social network were more likely to use online information to complement information obtained from their entourage or from professionals than were mothers with a less active social network or who were more socially isolated. Highlights: Mothers with incomes below the poverty threshold and with low educational attainment made extensive use of Internet-based information for child care and parenting. Mothers applied critical judgment to use online information strategically. For some mothers, information obtained or shared on the Internet replace conversations with family members or professionals. [ABSTRACT FROM AUTHOR]

Two-spirit, lesbian, gay, bisexual and transgender (2SLGBTQ+) people are disproportionately represented among those experiencing poverty. Both 2SLGBTQ+ people and people experiencing poverty face poorer health outcomes and greater difficulty accessing healthcare. Evidence of intersectional impacts of 2SLGBTQ+ status and poverty on health can help to inform economic and health policy. The objective of this review is to determine what is known about the health of 2SLGBTQ+ people in Canada experiencing poverty. Following the PRISMA framework, we searched and summarized Canadian literature on 2SLGBTQ+ poverty indexed in Medline, Sociological Abstracts, PsycInfo and EconList (N  = 33). 2SLGBTQ+ poverty-related literature remains sparse but is expanding as illustrated by the fact that most (31/33) studies were published in the past decade. Half the studies analysed poverty as a focal variable and half as a covariate. Intersectionality theory assists in understanding the three health-related themes identified—healthcare access, physical health and mental health and substance use—as these outcomes are shaped by intersecting social structures that result in unique forms of discrimination. Those at the intersection of poverty and 2SLGBTQ+ status face poorer health outcomes than other 2SLGBTQ+ people in Canada. Discrimination was an overarching finding that explained persistent associations between 2SLGBTQ+ status, poverty and health. Research that directly interrogated the experiences of 2SLGBTQ+ populations experiencing poverty was sparse. In particular, there is a need to conduct research on underrepresented 2SLGBTQ+ sub-groups who are disproportionately impacted by poverty, including transgender, bisexual and two-spirit populations. [ABSTRACT FROM AUTHOR]

Copyright of Higher Education Quarterly is the property of Wiley-Blackwell 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: We reviewed the literature on the association between pre-pregnancy multimorbidity (co-occurrence of two or more chronic conditions) and adverse maternal outcomes in pregnancy and postpartum. Data sources: Medline, EMBASE, and CINAHL were searched from inception to September, 2021. Study selection: Observational studies were eligible if they reported on the association between ≥ 2 co-occurring chronic conditions diagnosed before conception and any adverse maternal outcome in pregnancy or within 365 days of childbirth, had a comparison group, were peer-reviewed, and were written in English. Data extraction and synthesis: Two reviewers used standardized instruments to extract data and rate study quality and the certainty of evidence. A narrative synthesis was performed. Results: Of 6,381 studies retrieved, seven met our criteria. There were two prospective cohort studies, two retrospective cohort studies, and 3 cross-sectional studies, conducted in the United States (n=6) and Canada (n=1), and ranging in size from n=3,110 to n=57,326,681. Studies showed a dose-response relation between the number of co-occurring chronic conditions and risk of adverse maternal outcomes, including severe maternal morbidity or mortality, hypertensive disorders of pregnancy, and acute health care use in the perinatal period. Study quality was rated as strong (n=1), moderate (n=4), or weak (n=2), and the certainty of evidence was very low to moderate. Conclusion: Given the increasing prevalence of chronic disease risk factors such as advanced maternal age and obesity, more research is needed to understand the impact of pre-pregnancy multimorbidity on maternal health so that appropriate preconception and perinatal supports can be developed. [ABSTRACT FROM AUTHOR]

Canada is not immune to the dramatic economic changes that are transforming society in other industrialized countries, where once-thriving factory and resource towns are dying, while educated knowledge workers in more cosmopolitan centres prosper. Where this growing inequality between communities and social classes takes root, worrisome social and political developments can develop, such as the polarization occurring in the U.S. and parts of Europe. Canada's 10 largest cities have been the primary driver of economic growth in recent years, and Canada is unusual in the degree to which its population is concentrated in a relatively small number of cities. To date, Canada's largest cities have been doing well and Canada has not so far seen the contrast so evident in the United States between highly successful cities and large cities in decline, such as Detroit and Cleveland. However, a ranking of national cities using "vitality" scores highlights a growing inequality between Canada's largest cities and its midsize and smaller cities. In many communities in the Atlantic region, in Quebec beyond its two major cities, and in the northern regions of B.C. and Ontario, harder times may lie ahead. Their populations are stagnating, their employment rates for people of prime working age are distressingly low, and their proportion of lowincome families is high. Urban decline can lead to further poverty, significant population aging and more pressure on higher levels of government to provide services that these communities can no longer afford. The strength of cities primarily revolves today around human capital and the ability of a community to develop or attract a highly skilled labour force. If Canada is to avoid a future where just a few cities are economic and demographic "winners" and the rest are "losers," policy-makers will need to consider how to help keep midsized cities from being increasingly left behind, whether that be through diversifying immigration patterns, targeted investment outside large urban areas, or other approaches. The pandemic, which has led some employers to rethink the need to keep workers in expensive big-city downtown offices, could create new opportunities to reinvigorate smaller, lower-cost centres. However, without a change in the pattern of divergence between Canada's dynamic cities and the rest, the societal and political strife that has unfolded elsewhere could someday happen here. [ABSTRACT FROM AUTHOR]

Mini-Med Schools (MiMS) are an opportunity for health sciences and social work undergraduates to discuss health-related topics with Innu and Atikamekw youth in Canada. More than 500 undergraduates and 1,000 students have taken part in the project since its beginning in 2011. This study aims to assess the impact of both 1) MiMS's predeparture training and 2) the MiMS themselves on undergraduates' prejudices toward Indigenous peoples. Satisfaction of the undergraduates taking part in the activity was also assessed. Seventy-eight undergraduates were recruited and completed the Old-fashioned and Modern Prejudiced Attitudes Toward Aboriginals Scales (O-PATAS and M-PATAS) at baseline, after the pre-departure training, and after the MiMS. They also completed satisfaction surveys. This study shows a reduction of prejudices after participating to a MiMS, but no effect of a pre-departure training. The activities were overall appreciated by undergraduates and most of them would like to take part again in the MiMS. [ABSTRACT FROM AUTHOR]