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Aims: People under age 18 who inject drugs represent a population at risk of health and social harms. Age restrictions at harm reduction programmes often formally exclude this population, but the reason behind such restrictions is lacking in the literature. To help fill this gap, we examine the perspectives of people who use drugs and various other stakeholders regarding whether supervised injection facilities (SIFs) should have age restrictions. Methods: Interviews and focus groups were conducted with a total of 95 people who use drugs and 141 other stakeholders (including police, fire and emergency services personnel, other city employees and officials, healthcare providers, residents and business representatives) in two Canadian cities without SIFs. Findings: We highlight the following thematic areas: mixed opinions regarding specific age restrictions; safety as a priority; different experiences and understandings of youth, agency and drug use; and ideas regarding maturity, ''help'' and other approaches. We note throughout that a familiar vulnerability--agency dichotomy often surfaced in the discussions. Conclusions: This paper contributes new empirical insights regarding youth access to SIFs. We offer considerations that may inform discussions occurring in other jurisdictions debating SIF implementation and may help remove or clarify age-related policies for harm reduction programmes.

We investigated the association between fentanyl injection frequency and sharing of injection equipment among people who inject drugs. We surveyed 249 people who inject drugs in Toronto in 2019. We estimated predicted probabilities of associations between fentanyl injection frequency and injection risk practices. In prior 6 months, 117 (47.0%) of participants injected fentanyl daily, 49 (19.7%) less than daily, and 78 (31.3%) did not inject fentanyl. Participants who injected fentanyl daily shared syringes more often than those not injecting fentanyl (25.0% vs. 4.9%; χ2 = 11.54, p = 0.0007). Participants who injected fentanyl daily (42.4% vs. 11.3%; χ2 = 18.05, p < 0.0001) and less than daily (37.2% vs. 11.3%; χ2 = 5.88 p = 0.02) shared cookers more often than those not injecting fentanyl. Participants who injected fentanyl daily (30.2% vs. 9.7%; χ2 = 9.05, p = 0.003) and less than daily (30.3% vs. 9.7%; χ2 = 4.11, p = 0.04) shared filters more often than those not injecting fentanyl. No differences in probabilities of sharing equipment were detected between participants who injected fentanyl daily and less than daily. People using fentanyl reported injection practices that increased risk for infectious disease transmission. [ABSTRACT FROM AUTHOR]

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The question of intellectual property rights and patenting of the intellectual properties have come to center stage in the global context. In a global knowledge society, with exploding technology and business, newer ideation, inventions and innovations are taking place which are unique to every single individuals and the expanding possibilities of copying and pasting lead to idea stealing, pilferage or plagiarizing which are causing legal injuries to the affected and demand justice in terms of ensuring the intellectual ownership of these newer ideations or inventions or innovations which have implications on the name, fame, popularity and financial ownership of the 3i - ideation, invention and innovation. When stolen or even wrongly claimed for impersonation, or attributed by others to those who do not belong or deserve, justice is denied and social order is adversely affected. Therefore, the current societies across the globe have framed policies and procedures for patenting the rights of those who claim to have absolute or primer ownership of the intellectual ownership of certain properties and ensure legal and statutory protection through appropriate mechanisms. In this context, an attempt is made here to review the intellectual property rights and their patenting policies and procedures in countries like Canada and India. [ABSTRACT FROM AUTHOR]

The global trade and commerce are reviving substantially in the post pandemic period. They, in their train, also bring disputes during operations which are not even foreseen. Something, interestingly, influenced the world of alternate dispute redressal system the world over is the pandemic whose credit can be due to the protocols of the pandemic. An analysis of the judicial system of Canada and the USA and the emerging trends can throw greater insights for understanding the arbitral system in the context of the Judicial Systems of these two neighboring north American countries. It is attempted here to peruse the uncertainty that has been brought to lives during this period and how this has opened up opportunities of alternate dispute redressal system within the Canadian and US Judicial Procedures thereby making the environment promotional for international commercial transactions. Further, the USA and CANADA as the North American neighbors have several similarities and differences that can be observed when a comparative study is carried out. This paper is an attempt to narrate the lessons that can be learnt from the USA and the Canadian judicial systems in respect of international commercial arbitration. [ABSTRACT FROM AUTHOR]

Canada launched the Syrian Refugee Resettlement Initiative in 2015 and resettled over 40,000 refugees. To evaluate the prevalence of depression-level symptoms at baseline and one year post-resettlement and analyze its predictors. Data come from the Syrian Refugee Integration and Long-term Health Outcomes in Canada study (SyRIA.lth) involving 1924 Syrian refugees recruited through a variety of community-based strategies. Data were collected using structured interviews in 2017 and 2018. Depression symptoms were measured using Patient Health Questionnaire 9 (PHQ-9). Analysis for associated factors was executed using multinomial logistic regression. Mean age was 38.5 years (SD 13.8). Sample included 49% males and 51% females settled in Ontario (48%), Quebec (36%) and British Columbia (16%). Over 74% always needed an interpreter, and only 23% were in employment. Prevalence of depression-level symptoms was 15% at baseline and 18% in year-2 (p < 0.001). Significant predictors of depression-level symptoms at year-2 were baseline depression, sponsorship program, province, poor language skills, lack of satisfaction with housing conditions and with health services, lower perceived control, lower perceived social support and longer stay in Canada. Increase in depression-level symptoms deserves attention through focusing on identified predictors particularly baseline depression scores, social support, perceived control and language ability. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to characterize the treatment patterns of women with a self-reported diagnosis of endometriosis in Canada. Methods: Between December 2018 and January 2019 an online cross-sectional survey was administered to women aged 18 to 49 who were members of the Survey Sampling International and two partner panels in Canada. The survey included a prevalence screener and an endometriosis-focused section. Self-reported treatment patterns among women reporting endometriosis diagnosis were analyzed descriptively. Results: Of 30,000 survey respondents, 2004 reported an endometriosis diagnosis (prevalence after weighting of 7%). Treatment status reported by these women was: 34.2% currently treated, 35.9% with prior but no current treatment, and 27.1% never treated. Among women with prior or current treatment, over-the-counter (OTC) medications, contraceptive pills/patches, and surgical procedures were used by 42.0%, 37.1%, and 26.4%, respectively, prior to diagnosis and by 39.9%, 33.0%, and 43.5%, respectively, following diagnosis. First treatments for endometriosis most commonly reported were OTC medications (28.9%) and surgical procedures (21.6%). Second treatments were reported by 46.5% of women, with surgical procedures (26.1%) being the most frequently reported. The most commonly reported endometriosis-associated surgeries were surgical ablation/excision (37.4%). Conclusion: A relevant proportion of women with endometriosis in Canada have multiple therapies with medical management as a first line followed by surgical options. These results emphasize the need to identify more effective and specific endometriosis treatment options and novel strategies. [ABSTRACT FROM AUTHOR]

While sanctioned supervised consumption services (SCS) – monitored spaces where people can consume drugs – are exempt from drug law enforcement, local police interact with SCS in the course of their duties. Policies and protocols to guide SCS–police relationships vary internationally, but appear to be lacking in some jurisdictions. We conducted focus groups with service users (n = 24) and staff (n = 21) at the first three legally sanctioned SCS in Canada's largest city, Toronto. Thematic analysis involved applying a lens of bounded authority, a concept related to police legitimacy. We observed participants discuss desires to keep police away from SCS as grounded in their lived experiences. SCS and overdose events were strongly perceived as spaces and situations where the police should not be present. Participants also expressed concerns that police may exceed or misuse their powers in the vicinity around SCS. Suggestions related to bounding police authority in the context of SCS included establishing physical perimeters of noninterference and sets of clear policies and protocols. Some participants recommended focused training for police, which included mixed opinions on overdose response training. Our study makes a novel contribution to the literature by applying features of bounded authority – a lens previously unexamined in relation to harm reduction programs – to perspectives on SCS–police relationships, enhancing understanding of resistance to police presence inside and around SCS. Future research will make further contributions by applying concepts from police legitimacy to the unique contexts afforded by SCS. [ABSTRACT FROM AUTHOR]

The operation of supervised consumption services (SCS), programs that offer supervised locations for the consumption of drugs such as heroin, other opioids, cocaine, other stimulants, and other drugs, is contingent on cooperative relationships with police. In this manuscript, we focus on an under studied topic: how active duty police officers understand their role with respect to SCS, and their recommendations for improving relationships with these programs. Methods: During 2018, we audio-recorded and transcribed focus group discussions conducted in four police divisions with 26 police constables and 3 officers of other ranks in Toronto, Canada. Officers were asked about their roles relative to SCS, perceived training needs, and how to build cooperative relationships with SCS. We followed an iterative thematic approach to analyze the data. Results: Participants in three divisions were unclear about their roles, duties, and policy governing policing of SCS. Participants in the fourth division had received instructions from the division commander to observe a "distance and discretion policy". However, these participants believed that developing familiarity with the new SCS, instead of keeping a distance, would be a more effective approach to building working relationships with staff, clients, and the local community. There was nearly unanimous skepticism about the willingness of SCS workers to work cooperatively with the police. These perceptions were commonly linked to previous negative experiences with harm reduction workers and, in some cases, staff at the new SCS. Several participants also linked problems in communication to fundamental differences between the philosophies or worldviews of SCS staff versus those of police. Conclusions: Building collaborative SIS-police relationships can be assisted by demystifying the operation of SCS for police, articulating policies, and working toward mutual respect. [ABSTRACT FROM AUTHOR]

Background: Chronic hepatitis C virus (HCV) infection is common among people who inject drugs (PWID) and is associated with morbidity and premature death. Although HCV can be cured, treatment may be inaccessible. We studied HCV testing, status and treatment among marginalized people who use drugs in Ottawa, Canada, a setting with universal insurance coverage for physician services. Methods: We analyzed data from the Participatory Research in Ottawa: Understanding Drugs study, a cross-sectional, peer-administered survey of people who use drugs from 2012 to 2013. We linked responses to population-based health administrative databases and used multivariable Poisson regression to identify factors independently associated with self-reported HCV testing, self-reported positive HCV status, and database-determined engagement in HCV treatment. Results: Among 663 participants, 562 (84.8%) reported testing for HCV and 258 (45.9%) reported HCV-positive status. In multivariable analysis, HCV-positive status was associated with female gender (RR 1.27; 95%CI 1.04 to 1.55), advancing age (RR 1.03/year; 95%CI 1.02 to 1.04), receiving disability payments (RR 1.42; 95%CI 1.06 to 1.91), injecting drugs (RR 5.11; 95%CI 2.64 to 9.91), ever injecting with a used needle (RR 1.30; 95%CI 1.12 to 1.52), and ever having taken methadone (RR 1.26; 95%CI 1.05 to 1.52). Of HCV positive participants, 196 (76%) were engaged in primary care but only 23 (8.9%) had received HCV therapy. Conclusions/Importance: Although HCV testing and positive status rates are high among PWID in our study, few have received HCV treatment. Innovative initiatives to increase access to HCV treatment for PWID are urgently needed. [ABSTRACT FROM AUTHOR]

Purpose Strong leadership has been shown to foster change, including loyalty, improved performance and decreased error rates, but there is a dearth of evidence on effectiveness of leadership development programs. To ensure a return on the huge investments made, evidence-based approaches are needed to assess the impact of leadership on health-care establishments. As a part of a pan-Canadian initiative to design an effective evaluative instrument, the purpose of this paper was to identify and summarize evidence on health-care outcomes/return on investment (ROI) indicators and metrics associated with leadership quality, leadership development programs and existing evaluative instruments.Design/methodology/approach The authors performed a scoping review using the Arksey and O’Malley framework, searching eight databases from 2006 through June 2016.Findings Of 11,868 citations screened, the authors included 223 studies reporting on health-care outcomes/ROI indicators and metrics associated with leadership quality (73 studies), leadership development programs (138 studies) and existing evaluative instruments (12 studies). The extracted ROI indicators and metrics have been summarized in detail.Originality/value This review provides a snapshot in time of the current evidence on ROI indicators and metrics associated with leadership. Summarized ROI indicators and metrics can be used to design an effective evaluative instrument to assess the impact of leadership on health-care organizations. [ABSTRACT FROM AUTHOR]

Background: Atazanavir/ritonavir and darunavir/ritonavir are common protease inhibitor-based regimens for treating patients with HIV. Studies comparing these drugs in clinical practice are lacking.Methods: We conducted a retrospective cohort study of antiretroviral naïve participants in the Canadian Observational Cohort (CANOC) collaboration initiating atazanavir/ritonavir- or darunavir/ritonavir-based treatment. We used separate Fine and Gray competing risk regression models to compare times to regimen failure (composite of virologic failure or discontinuation for any reason). Additional endpoints included virologic failure, discontinuation due to virologic failure, discontinuation for other reasons, and virologic suppression.Results: We studied 222 patients treated with darunavir/ritonavir and 1791 patients treated with atazanavir/ritonavir. Following multivariable adjustment, there was no difference between darunavir/ritonavir and atazanavir-ritonavir in the risk of regimen failure (adjusted hazard ratio 0.76, 95% CI 0.56 to 1.03) Darunavir/ritonavir-treated patients were at lower risk of virologic failure relative to atazanavir/ritonavir treated patients (aHR 0.50, 95% CI 0.28 to 0.91), findings driven largely by high rates of virologic failure among atazanavir/ritonavir-treated patients in the province of British Columbia. Of 108 discontinuations due to virologic failure, all occurred in patients starting atazanavir/ritonavir. There was no difference between regimens in time to discontinuation for reasons other than virologic failure (aHR 0.93; 95% CI 0.65 to 1.33) or virologic suppression (aHR 0.99, 95% CI 0.82 to 1.21).Conclusions: The risk of regimen failure was similar between patients treated with darunavir/ritonavir and atazanavir/ritonavir. Although darunavir/ritonavir was associated with a lower risk of virologic failure relative to atazanavir/ritonavir, this difference varied substantially by Canadian province and likely reflects regional variation in prescribing practices and patient characteristics. [ABSTRACT FROM AUTHOR]

Progressive public health authorities in high-income countries have advocated supervised consumption facilities, where people who use illicit drugs can consume them in a hygienic, supervised environment, as a way of reducing drug-related risks to both people who use drugs and communities. However, the planning of such facilities has often met with strong reactions from the local community. ‘Not in my backyard’ (NIMBY) type reactions are frequently encountered and public opinion polling is limited in its ability to provide detailed insights into the reasons why people support or oppose these facilities in Toronto and Ottawa. We explore perceptions of residents and business representatives to the proposed implementation of supervised consumption facilities, and examine their perceptions of risks from these facilities. We collected qualitative data from 2008–2010 using focus groups and interviews with 38 residents and 17 business representatives in these two large Canadian cities lacking supervised consumption facilities. We used thematic analysis to examine expressed benefits and risks regarding supervised consumption facilities amongst community members. These participants saw these facilities as potentially risk-reducing, but recognised that the facilities could also create risks for their communities. While community members accepted that facilities could have positive health effects, they expressed a level of concern regarding the risk of public nuisance associated with supervised consumption facilities that seemed unwarranted based on the existing evidence. Discussions on the risks involved in the establishment of supervised consumption facilities should move beyond a focus on the benefits to facility users, to exploring community-level benefits and risks, and integrate evidence regarding actual risk experiences from other locations. Similar approaches may apply to NIMBY concerns related to other contentious issues. [ABSTRACT FROM AUTHOR]

Objective: The optimal timing of biologic agent treatment in polyarticular juvenile idiopathic arthritis (JIA) is unknown. This study evaluated the costs and outcomes of first-line treatment with etanercept (ETN), an anti-tumor necrosis factor (anti-TNF) agent, compared with step-wise therapy in JIA.Methods: We compared 2 strategies: methotrexate (MTX) plus ETN as first-line therapy (ETN-first) and MTX monotherapy followed by ETN (ETN-second), using a cohort state-transition model of newly diagnosed JIA patients. The model's time horizon was 5 years, and the perspective was that of the Canadian health care system. The base case patient was 11 years old, weighed 40 kg, and had 5 or more active joints. Direct costs were calculated and discounted at a rate of 3% per year. Outcomes were expressed as quality-adjusted life years (QALYs). Scenario analyses varied multiple parameters simultaneously to model more severely and more mildly affected patients.Results: ETN-first, compared to ETN-second, yielded a discounted incremental cost of $16,893 (95% confidence interval [95% CI] 9,348-25,310), incremental QALY of 0.19 (95% CI 0.08-0.32), and an incremental cost-effectiveness ratio of $88,815 per QALY gained. The results were sensitive to the cost of ETN, the time horizon of the model, and estimates of the efficacy of the first-line therapies. The cost per QALY for treating patients with severe JIA was $33,960.Conclusion: First-line therapy of ETN and MTX is relatively expensive compared to MTX alone, but may be economically attractive for more severely affected patients. More research is needed regarding the efficacy of first-line anti-TNF agents. [ABSTRACT FROM AUTHOR]

Background and Aims Supervised injection facilities (legally sanctioned spaces for supervised consumption of illicitly obtained drugs) are controversial public health interventions. We determined the optimal number of facilities in two Canadian cities using health economic methods. Design Dynamic compartmental model of HIV and hepatitis C transmission through sexual contact and sharing of drug use equipment. Setting Toronto and Ottawa, Canada. Participants Simulated population of each city. Interventions Zero to five supervised injection facilities. Measurements Direct health-care costs and quality-adjusted life-years (QALYs) over 20 years, discounted at 5% per year; incremental cost-effectiveness ratios. Findings In Toronto, one facility cost $4.1 million and resulted in a gain of 385 QALYs over 20 years, for an incremental cost-effectiveness ratio (ICER) of $10 763 per QALY [95% credible interval (95CrI): cost-saving to $278 311]. Establishing one facility in Ottawa had an ICER of $6127 per QALY (95CrI: cost-saving to $179 272). At a $50 000 per QALY threshold, three facilities would be cost-effective in Toronto and two in Ottawa. The probability that establishing three, four, or five facilities in Toronto was cost-effective was 17, 21, and 41%, respectively. Establishing one, two, or three facilities in Ottawa was cost-effective with 13, 35, and 41% probability, respectively. Establishing no facility was unlikely to be the most cost-effective option (14% in Toronto and 10% in Ottawa). In both cities, results were robust if the reduction in needle-sharing among clients of the facilities was at least 50% and fixed operating costs were less than $2.0 million. Conclusions Using a $50 000 per quality-adjusted life-years threshold for cost-effectiveness, it is likely to be cost-effective to establish at least three legally sanctioned spaces for supervised injection of illicitly obtained drugs in Toronto, Canada and two in Ottawa, Canada. [ABSTRACT FROM AUTHOR]

Background: As the average age of the HIV-positive population increases, there is increasing need to monitor patients for the development of comorbidities as well as for drug toxicities.Methods: We examined factors associated with the frequency of measurement of liver enzymes, renal function tests, and lipid levels among participants of the Canadian Observational Cohort (CANOC) collaboration which follows people who initiated HIV antiretroviral therapy in 2000 or later. We used zero-inflated negative binomial regression models to examine the associations of demographic and clinical characteristics with the rates of measurement during follow-up. Generalized estimating equations with a logit link were used to examine factors associated with gaps of 12 months or more between measurements.Results: Electronic laboratory data were available for 3940 of 7718 CANOC participants. The median duration of electronic follow-up was 3.5 years. The median (interquartile) rates of tests per year were 2.76 (1.60, 3.73), 2.55 (1.44, 3.38) and 1.42 (0.50, 2.52) for liver, renal and lipid parameters, respectively. In multivariable zero-inflated negative binomial regression models, individuals infected through injection drug use (IDU) were significantly less likely to have any measurements. Among participants with at least one measurement, rates of measurement of liver, renal and lipid tests were significantly lower for younger individuals and Aboriginal Peoples. Hepatitis C co-infected individuals with a history of IDU had lower rates of measurement and were at greater risk of having 12 month gaps between measurements.Conclusions: Hepatitis C co-infected participants infected through IDU were at increased risk of gaps in testing, despite publicly funded health care and increased risk of comorbid conditions. This should be taken into consideration in analyses examining factors associated with outcomes based on laboratory parameters. [ABSTRACT FROM AUTHOR]

Background: Community stakeholders express a range of opinions about supervised injection facilities (SIFs). We sought to identify reasons for ambivalence about SIFs amongst community stakeholders in two Canadian cities. Findings: We used purposive sampling methods to recruit various stakeholder representatives (n = 141) for key informant interviews or focus group discussions. Data were analyzed using a thematic process. We identified seven reasons for ambivalence about SIFs: lack of personal knowledge of evidence about SIFs; concern that SIF goals are too narrow and the need for a comprehensive response to drug use; uncertainty that the community drug problem is large enough to warrant a SIF(s); the need to know more about the "right" places to locate a SIF(s) to avoid damaging communities or businesses; worry that a SIF(s) will renew problems that existed prior to gentrification; concern that resources for drug use prevention and treatment efforts will be diverted to pay for a SIF(s); and concern that SIF implementation must include evaluation, community consultation, and an explicit commitment to discontinue a SIF(s) in the event of adverse outcomes. Conclusions: Stakeholders desire evidence about potential SIF impacts relevant to local contexts and that addresses perceived potential harms. Stakeholders would also like to see SIFs situated within a comprehensive response to drug use. Future research should determine the relative importance of these concerns and optimal approaches to address them to help guide decision-making about SIFs. [ABSTRACT FROM AUTHOR]

Background: The re-emergence of syphilis among HIV-positive gay and other men who have sex with men (MSM) requires vigilance. We estimated incidence of and risk factors for first and subsequent syphilis diagnoses among MSM in HIV care in Ontario, Canada. Methods: We analyzed data from 2,280 MSM under follow-up from 2006 to 2010 in the Ontario HIV Treatment Network Cohort Study (OCS), a multi-site clinical cohort. We obtained syphilis serology results via record linkage with the provincial public health laboratory. Rates were calculated using Poisson regression. Results: First syphilis diagnoses occurred at a rate of 2.0 per 100 person-years (95 % CI 1.7, 2.4; 121 cases) whereas the re-diagnosis rate was 7.5 per 100 person-years (95 % CI 6.3, 8.8; 136 cases). We observed higher rates over time and among men who were aged <30 years, receiving care in the two largest urban centers, or had a previous syphilis diagnosis. Syphilis diagnosis was less common among Indigenous men, men with higher CD4 cell counts, and, for first diagnoses only, among men with less than high school education. Conclusions: Compared to reported cases in the general male population, incidence of a new syphilis diagnosis was over 300 times greater among HIV-positive MSM but year-to-year changes reflected provincial trends. Re-diagnosis was common, suggesting treatment failure or re-infection. Novel syphilis control efforts are needed among HIV-positive MSM. [ABSTRACT FROM AUTHOR]

Background: Prenatal care reduces perinatal morbidity. However, there are no population-based studies examining the adequacy of prenatal care among women living with HIV. Accordingly, we compared the prevalence of adequate prenatal care among women living with and without HIV infection in Ontario, Canada. Methods: Using administrative data in a universal single-payer setting, we determined the proportions of women initiating care in the first trimester and receiving adequate prenatal care according to the Revised-Graduated Prenatal Care Utilization Index . We also determined the proportion of women with HIV receiving adequate prenatal care by immigration status. We used generalized estimating equations with a logit link function to derive adjusted odds ratios (aORs) and 95 % confidence intervals (CI) for all analyses. Results: Between April 1, 2002 and March 31, 2011, a total of 1,132,135 pregnancies were available for analysis, of which 634 (0.06 %) were among women living with HIV. Following multivariable adjustment, women living with HIV were less likely to receive adequate prenatal care (36.1 % versus 43.3 %; aOR 0.74, 95 % CI 0.62 to 0.88) or initiate prenatal care in the first trimester (50.8 % versus 70.0 %; aOR 0.51, 95 % CI 0.43 to 0.60) than women without HIV. Among women with HIV, recent (i.e. ≤ 5 years) immigrants from Africa and the Caribbean were less likely to receive adequate prenatal care (25.5 % versus 38.5 %; adjusted odds ratio 0.51; 95 % CI, 0.32 to 0.81) than Canadian-born women. Conclusion: Despite universal health care, disparities exist in the receipt of adequate prenatal care between women living with and without HIV. Interventions are required to ensure that women with HIV receive timely and adequate prenatal care. [ABSTRACT FROM AUTHOR]

This paper describes the results of an investigation for the degree of equivalence of realizations of the triple points of argon and oxygen between the 'National Institute of Standards -Egypt (NIS)' and 'Institut Nationale de Métrologie - France (LNE-Cnam).' The investigation was carried out through measurements of the argon and oxygen triple points (83.8058 K and 54.3584 K, respectively), as defining fixed points on the ITS-90 that are used in the calibration of capsule standard platinum resistance thermometers. The main objective of this work was to compare the realizations of both of the fixed-point cells and to establish the degree of equivalence between the two laboratories. As defined by the MRA, the degree of equivalence between two measurements (each consisting of a measured value $$m_{i}$$ and its uncertainty $$u_{i})$$ is expressed by the difference between the measured values, $$m_{1} - m_{2}$$ , and the expanded pair uncertainty of this difference $$U_\mathrm{p}$$ . Two cells, containing argon and oxygen, which had been fabricated and filled at LNE-Cnam, were used as artifacts exchanged between the two laboratories. The comparison measurements revealed temperature differences of 0.28 mK and 0.39 mK with expanded pair uncertainties of 0.66 mK and 0.74 mK for the argon and oxygen points, respectively. A detailed description of the equipment used in the two laboratories and an analysis of the comparison results will be presented in this paper. [ABSTRACT FROM AUTHOR]

Background: Since 2000, reported syphilis cases increased ten-fold in Canada, particularly among men who have sex with men (MSM) co-infected with HIV. We characterized temporal patterns of of syphilis testing in a large cohort of HIV patients in Ontario, Canada. Methods: We analyzed data from a multi-site cohort of people in HIV care from 2000 to 2009. Data were obtained from medical charts, interviews and record linkage with the syphilis test database at the Public Health Ontario Laboratories. We estimated the proportion that had syphilis testing at least once per year and the period and annual prevalence of reactive tests. Results: Among 4232 participants, the annual proportion tested rose from 2.7% (95%CI 1.9, 3.5) in 2000 to 54.6% (95%CI 52.9, 56.3) in 2009. Testing was most common for participants who were men who have sex with men (MSM), aged <30, recently diagnosed with HIV, were antiretroviral treatment naive, had routine HIV lab testing at least twice in that year, or tested for syphilis in the preceding year. The proportion with at least one reactive test in 2000-09 was 21.0% (95%CI 19.4, 22.7) for MSM, 5.3% (95%CI 3.3, 7.4) for non-MSM males, and 2.6% (95%CI 1.2, 4.0) for women. Among MSM, the annual prevalence of reactive syphilis tests with high RPR titre (⩾1:16) peaked at 3.8% in 2009. Conclusions: The burden of syphilis co-infection rose considerably among HIV-positive MSM, such that by 2009, at least 1 in 5 men had laboratory evidence of current or past infection. Interventions may be needed to boost syphilis testing to achieve goals set by guidelines even in settings with universal health care. [ABSTRACT FROM AUTHOR]

Abstract: Transit agencies implement many strategies in order to provide an attractive transportation service. This article aims to evaluate the impacts of implementing a combination of strategies, designed to improve the bus transit service, on running time and passenger satisfaction. These strategies include using smart card fare collection, introducing limited-stop bus service, implementing reserved bus lanes, using articulated buses, and implementing transit signal priority (TSP). This study uses stop-level data collected from the Société de transport de Montréal (STM)’s automatic vehicle location (AVL) and automatic passenger count (APC) systems, in Montréal, Canada. The combination of these strategies has lead to a 10.5% decline in running time along the limited stop service compared to the regular service. The regular route running time has increased by 1% on average compared to the initial time period. The study also shows that riders are generally satisfied with the service improvements. They tend to overestimate the savings associated with the implementation of this combination of strategies by 3.5–6.0min and by 2.5–4.1min for both the regular route and the limited stop service, respectively. This study helps transit planners and policy makers to better understand the effects of implementing a combination of strategies to improve running time and passenger’s perception of these changes in service. [Copyright &y& Elsevier]

Chronic beryllium disease (CBD) is clinically similar to other granulomatous diseases such as sarcoidosis. It is often misdiagnosed if a thorough occupational history is not taken. When appropriate, a beryllium lymphocyte proliferation tests (BeLPT) need to be performed. We aimed to search for CBD among currently diagnosed pulmonary sarcoidosis patients and to identify the occupations and exposures in Ontario leading to CBD. Questionnaire items included work history and details of possible exposure to beryllium. Participants who provided a history of previous work with metals underwent BeLPTs and an ELISPOT on the basis of having a higher pretest probability of CBD. Among 121 sarcoid patients enrolled, 87 (72%) reported no known previous metal dust or fume exposure, while 34 (28%) had metal exposure, including 17 (14%) with beryllium exposure at work or home. However, none of these 34 who underwent testing had positive test results. Self-reported exposure to beryllium or metals was relatively common in these patients with clinical sarcoidosis, but CBD was not confirmed using blood assays in this population. [ABSTRACT FROM AUTHOR]

17α-ethynylestradiol (EE2), a synthetic estrogen prescribed as a contraceptive, was measured in Shorthead Redhorse Suckers (ShRHSs) (Moxostoma macrolepidotum) collected near a wastewater treatment plant (WWTP) in the St. Clair River (Ontario, Canada). We detected EE2 in 50% of the fish samples caught near the WWTP (Stag Island), which averaged 1.6±0.6ng/g (wet weight) in males and 1.43±0.96ng/g in females. No EE2 was detected in the samples from the reference site (Port Lambton) which was 26km further downstream of the Stag Island site. Only males from Stag Island had VTG induction, suggesting the Corunna WWTP effluent as a likely source of environmental estrogen. EE2 concentrations were correlated with total body lipid content (R 2 =0.512, p <0.01, n =10). Lipid normalized EE2 concentrations were correlated with δ15N (R 2 =0.436, p <0.05, n =10), suggesting higher EE2 exposures in carnivores. Our data support the hypothesis of EE2 bioaccumulation in wild fish. [Copyright &y& Elsevier]

Abstract: In recent years, several transit agencies have been trying to be more competitive with the automobile to attract choice riders. Transit agencies can only be competitive if they can provide services that are reliable, have a short access and egress time, and have run times that are comparable to automobiles. Several transit agencies try to be competitive through offering faster service, such as limited-stop (express) bus service. This study uses AVL and APC data, in addition to a disaggregate data obtained from a travel behavior survey, to select stops and estimate run times for a new limited-stop service that will run parallel to a heavily used bus route (67 Saint-Michel) in Montréal, Canada. Three different scenarios are developed based on theory and practice to select stops to be incorporated in the new limited service. The time savings for each scenario are then evaluated as a range and a fourth scenario is developed. A limited-stop service is recommended based on selecting stops serving both directions of the route, major activity points and stop spacing. This study shows that implementing a limited-stop service would yield substantial time savings for both, the new limited service and the existing regular service running in parallel. [Copyright &y& Elsevier]

Background: Viral load (VL) monitoring is an essential component of the care of HIV positive individuals. Rates of VL monitoring have been shown to vary by HIV risk factor and clinical characteristics. The objective of this study was to determine whether there are differences among regions in Canada in the rates of VL testing of HIV-positive individuals on combination antiretroviral therapy (cART), where the testing is available without financial barriers under the coverage of provincial health insurance programs. Methods: The Canadian Observational Cohort (CANOC) is a collaboration of nine Canadian cohorts of HIV-positive individuals who initiated cART after January 1, 2000. The study included participants with at least one year of follow-up. Generalized Estimating Equation (GEE) regression models were used to determine the effect of geographic region on (1) the occurrence of an interval of 9 months or more between two consecutive recorded VL tests and (2) the number of days between VL tests, after adjusting for demographic and clinical covariates. Overall and regional annual rates of VL testing were also reported. Results: 3,648 individuals were included in the analysis with a median follow-up of 42.9 months and a median of 15 VL tests. In multivariable GEE logistic regression models, gaps in VL testing >9 months were more likely in Quebec (Odds Ratio (OR) = 1.72, p < 0.0001) and Ontario (OR = 1.78, p < 0.0001) than in British Columbia and among injection drug users (OR = 1.68, p < 0.0001) and were less likely among older individuals (OR = 0.77 per 10 years, p < 0.0001), among men having sex with men (OR = 0.62, p < 0.0001), within the first year of cART (OR = 0.15, p < 0.0001), among individuals on cART at the time of the blood draw (OR = 0.34, p < 0.0001) and among individuals with VL < 50 copies/ml at the previous visit (OR = 0.56, p < .0001). Conclusions: Significant variation in rates of VL testing and the probability of a significant gap in testing were related to geographic region, HIV risk factor, age, year of cART initiation, type of cART regimen, being in the first year of cART, AIDS-defining illness and whether or not the previous VL was below the limit of detection. [ABSTRACT FROM AUTHOR]

Study Design: Decision analysis. Objective: To identify the best treatment for nonspecific neck pain. Summary of Background Data: In Canada and the United States, the most commonly prescribed neck pain treatments are nonsteroidal anti-inflammatory drugs (NSAIDs), exercise, and manual therapy. Deciding which treatment is best is difficult because of the trade-offs between beneficial and harmful effects, and because of the uncertainty of these effects. Methods: (Quality-adjusted) life expectancy associated with standard NSAIDs, Cox-2 NSAIDs, exercise, mobilization, and manipulation were compared in a decision analytic model. Estimates of the course of neck pain, background risk of adverse events in the general population, treatment effectiveness and risk, and patient-preferences were input into the model. Assuming equal effectiveness, we conducted a baseline analysis using risk of harm only. We assessed the stability of the baseline results by conducting a second analysis that incorporated effectiveness data from a high-quality randomized trial. Results: There were no important differences across treatments. The difference between the highest and lowest ranked treatments predicted by the baseline model was 4.5 days of life expectancy and 3.4 quality-adjusted life-days. The difference between the highest and lowest ranked treatments predicted by the second model was 7.3 quality-adjusted life-days. Conclusion: When the objective is to maximize life expectancy and quality-adjusted life expectancy, none of the treatments in our analysis were clearly superior. [ABSTRACT FROM AUTHOR]

Background. Despite strong evidence and recommendations supporting the treatment of latent tuberculosis infection, many affected health care workers at risk of acquiring tuberculosis from and potentially transmitting tuberculosis to their patients do not receive treatment. The objective of this study was to determine whether health care workers were less likely than non-health care workers to initiate treatment for latent tuberculosis infection. Methods. in this retrospective cohort study that used the disease management database from a specialized downtown Toronto tuberculosis clinic, patients with latent tuberculosis infection were included if they had risk factors for progression of disease and were excluded if they had contraindications to treatment. Results. Our final cohort consisted of 308 patients with latent tuberculosis infection. The overall treatment initiation rate was 58%. We found that, when a number of confounding variables, including age, foreign birth, contact with persons with active tuberculosis, tuberculosis skin test conversion, bacille Calmette- Guérin vaccination, abnormal chest radiograph findings, comorbidities, and income, were considered and/or controlled for, the odds of a health care worker initiating treatment were approximately one-half of those of a non-health care worker (adjusted odds ratio, 0.55; 95% confidence interval, 0.32-0.93). Conclusion. We conclude that, in our clinic, health care workers are less likely than non-health care workers to initiate treatment for latent tuberculosis infection. [ABSTRACT FROM AUTHOR]

Background: Despite the availability of a universal influenza vaccination program in the United States and Canada, seasonal influenza vaccine (SIV) uptake among the elderly remains suboptimal. Understanding the factors that determine SIV uptake in this important population subgroup is essential for designing effective interventions to improve seasonal influenza vaccination among the elderly. We evaluated the determinants of SIV uptake in the elderly in the United States and Canada. Methods: We systematically searched relevant bibliographic databases and websites from 2000 to 2017 for population-based clinical trials or observational studies conducted in community-based elderly individuals in the United States or Canada, irrespective of health status. Two reviewers independently screened the identified citations for eligibility using a two-stage sifting approach to review the title/abstract and full-text article. We gathered data on determinants of uptake (any vaccine receipt) and adherence (receipt of vaccine in more than one season) to seasonal influenza vaccination. Where possible, we pooled the data using inverse variance methods to minimize the variance of the weighted average. Results: Five cross-sectional studies on SIV uptake (none on adherence) from the United States met our eligibility criteria. Being older (pooled odds ratio [POR] = 1.44, 95% Confidence Interval [CI] = 1.11, 1.86); White (POR = 1.33, 95% CI = [1.10, 1.64]); and having higher income (POR = 1.06, 95% CI = [1.04, 1.09]); and health insurance (POR = 1.40, 95% CI = [1.25, 1.55]) were associated with increased SIV uptake. Conclusion: Older, ethnically White, higher income elderly individuals with access to health insurance coverage and a regular health care provider have higher SIV uptake in the United States. There was limited evidence for other socioeconomic and health-related determinants. Further studies are needed to provide an evidence base for planning more effective influenza vaccination programs in the United States. [ABSTRACT FROM AUTHOR]

• The pandemic state of emergency resulted in overall increases of opioid toxicities. • Important differences were noted among people with and without opioid use disorder. • People with opioid use disorder experienced a sustained rise in opioid toxicities. • Similar increases were not observed in people without opioid use disorder. • Adaption of supports in public health emergencies is needed for undisrupted access. Across Canada, the COVID-19 pandemic occurred amidst an ongoing drug toxicity crisis. Although elevated rates of substance-related harms have been observed nationally, it remains unknown if the pandemic state of emergency led to disproportionate increases in opioid toxicities among people with opioid use disorder (OUD) compared to those without. We conducted a population-based repeated cross-sectional time series analysis of fatal and non-fatal opioid toxicities between January 1, 2014, and December 31, 2021, in Ontario, Canada. We used interventional autoregressive integrated moving average models to examine the impact of the pandemic on monthly rates of opioid toxicities per 100,000 Ontario residents stratified by people with and without OUD. We identified 80,296 opioid toxicities of which 53.5 % occurred among people with OUD. Among 52,052 unique individuals, 60.5 % were male and 46.2 % were 25–44 years old. Between January 2014 and December 2021, the rate of opioid toxicities increased from 2.6 to 10.5 per 100,000 (rate ratio [RR]=4.07). The magnitude of this increase differed among people with OUD (0.8 to 7.4 per 100,000; RR=9.35) and without OUD (1.8 to 3.1 per 100,000; RR=1.74). We observed a significant ramp increase in the overall rate of opioid toxicities following the declaration of the pandemic emergency in March 2020 (+0.19 per 100,000 monthly, 95 % CI: 0.029, 0.36, p = 0.021). In a stratified analysis, we found a similar ramp increase among people with OUD (+0.19 per 100,000 monthly, 95 % CI: 0.10, 0.28, p < 0.001); however, this was not observed among people without OUD (p = 0.95). The rate of opioid toxicities accelerated across Ontario following the pandemic-related state of emergency, with the majority of this increase among people with OUD. The important differences observed among people with OUD compared with those without, highlights the critical need for improved access to harm reduction and treatment interventions among this population. [ABSTRACT FROM AUTHOR]

Whereas supervised consumption services (SCSs) are common in many community settings, they are seldomly found in acute care hospitals. As hospitals present unique circumstances that can shape the impacts of an SCS, careful consideration of local implementation contexts and practices is required. We explored the pre-implementation stage of an SCS, to examine how an SCS is made and made differently in relation to the material-discursive context of the hospital. We conducted 11 focus groups with 83 staff and clinicians at an inner-city hospital in Toronto, Canada. Data analysis followed principles of grounded theory and was informed by an 'evidence making interventions' framework. While most participants indicated they would support the establishment of an SCS at the hospital, multiple enactments of an SCS emerged. An SCS was enacted: as a means to reduce drug-related risks for all people who use drugs, as an opportunity to intervene on patients' drug use, as a means to centralize drug use, and as a transformative intervention for the hospital. In our findings, harm reduction, abstinence, security, and risk mitigation goals existed closely together, yielding overlaying realities. Our findings revealed various enactments of an SCS, some of which are likely to negatively affect people who use drugs and service access. As more hospitals consider the implementation of an SCS, understanding how an SCS is made in practice will be key to building a service that focuses on the needs of people who use drugs. [ABSTRACT FROM AUTHOR]

Background: The objective of disease screening is to encourage high-risk subjects to seek health care diagnosis and treatment. Mobile phone apps can effectively screen mental health conditions, including depression. However, it is not known how effective such screening methods are in motivating users to discuss the obtained results of such apps with health care professionals. Does a mobile phone depression-screening app motivate users with high depressive symptoms to seek health care professional advice? This study aimed to address this question.Method: This was a single-cohort, prospective, observational study of a free mobile phone depression app developed in English and released on Apple's App Store. Apple App Store users (aged 18 or above) in 5 countries, that is, Australia, Canada, New Zealand (NZ), the United Kingdom (UK), and the United States (US), were recruited directly via the app's download page. The participants then completed the Patient Health Questionnaire (PHQ-9), and their depression screening score was displayed to them. If their score was 11 or above and they had never been diagnosed with depression before, they were advised to take their results to their health care professional. They were to follow up after 1 month.Results: A group of 2538 participants from the 5 countries completed PHQ-9 depression screening with the app. Of them, 322 participants were found to have high depressive symptoms and had never been diagnosed with depression, and received advice to discuss their results with health care professionals. About 74% of those completed the follow-up; approximately 38% of these self-reported consulting their health care professionals about their depression score. Only positive attitude toward depression as a real disease was associated with increased follow-up response rate (odds ratio (OR) 3.2, CI 1.38-8.29).Conclusions: A mobile phone depression-screening app motivated some users to seek a depression diagnosis. However, further study should investigate how other app users use the screening results provided by such apps. [ABSTRACT FROM AUTHOR]

The emotional impacts of witnessing and responding to overdose and overdose-related deaths have been largely overlooked during the drug toxicity overdose crisis in North America. Scarce research has analyzed these impacts on the health and well-being of harm reduction workers, and the broader determinants of harm reduction work. Our study investigates the experiences and impacts of witnessing and responding to frequent and escalating rates of overdose on harm reduction workers in Toronto, Canada. Using semi-structured interviews, 11 harm reduction workers recruited from harm reduction programs with supervised consumption services in Toronto, Canada, explored experiences with and reactions to overdose in both their professional and personal lives. They also provided insights on supports necessary to help people cope with overdose-related loss. We used thematic analysis to develop an initial coding framework, subsequent iterations of codes and emergent themes. Results revealed that harm reductions workers experienced physical, emotional, and social effects from overdose-related loss and grief. While some effects were due to the toll of overdose response and grief from overdose-related losses, they were exacerbated by the lack of political response to the scale of the drug toxicity overdose crisis and the broader socio-economic-political environment of chronic underfunding for harm reduction services. Harm reduction workers described the lack of appropriate workplace supports for trauma from repeated overdose response and overdose-related loss, alongside non-standard work arrangements that resulted in a lack of adequate compensation or access to benefits. Our study highlights opportunities for organizational practices that better support harm reduction workers, including formal emotional supports and community-based supportive care services. Improvement to the socio-economic-political determinants of work such as adequate compensation and access to full benefit packages are also needed in the harm reduction sector for all workers. [ABSTRACT FROM AUTHOR]

Background: In response to the ongoing overdose crisis, some clinicians in Canada have started prescribing immediate release hydromorphone (IRH) as an alternative to the toxic unregulated drug supply. This practice is often referred to as safer supply. We aimed to identify and characterize patients receiving safer supply IRH and their prescribers in Ontario.Methods: Using provincial administrative health data, we identified individuals with opioid use disorder prescribed safer supply IRH from January 2016 to March 2020 and reported the number of initiations over time. We summarized demographic, health, and medication use characteristics among patients who received safer supply IRH, and examined select clinical outcomes including retention and death. Finally, we characterized prescribers of safer supply IRH and compared frequent and infrequent prescribers.Results: We identified 534 initiations of safer supply IRH (447 distinct individuals) from 155 prescribers. Initiations increased over time with a peak in the third quarter of 2019 (103 initiations). Patients' median age was 42 (interquartile range [IQR] 34-50), and most were male (60.2%), urban residents, (96.2%), and in the lowest neighborhood income quintile (55.7%), with 13.9% having overdosed in the previous one year. The prevalence of HIV was 13.9%. The median duration on IRH was 272 days (IQR 30-1,244) and OAT was co-prescribed in 62.9% of courses. Death while receiving IRH or within 7 days of discontinuation was rare (≤5 courses;≤0.94 per person-year for each).Conclusions: Clinicians are increasingly prescribing safer supply IRH in Ontario. Patients prescribed safer supply IRH had demographic and clinical characteristics associated with high risk of death from opioid-related overdose. Short-term deaths among people receiving safer supply IRH were rare. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to compare the potential dietary impact of proposed and final front-of-pack labelling (FOPL) regulations (published in Canada Gazette I (CG1) and Canada Gazette II (CG2) , respectively) by examining the difference in the prevalence of foods that would require a 'High in' front-of-pack nutrition symbol and nutrient intakes from those foods consumed by Canadian adults., Design: Foods in a generic food composition database ( n 3676) were categorised according to the details of FOPL regulations in CGI and CGII , and the differences in the proportion of foods were compared. Using nationally representative dietary survey data, potential intakes of nutrients from foods that would display a 'High in' nutrition symbol according to CGI and CGII were compared., Setting: Canada., Participants: Canadian adults (≥ 19 years; n 13 495)., Results: Compared with CGI , less foods would display a 'High in' nutrition symbol (Δ = -6 %) according to CGII (saturated fat = -4 %, sugars = -1 %, sodium = -3 %). Similarly, potential intakes of nutrients-of-concern from foods that would display a 'High in' nutrition symbol were reduced according to CGII compared with CGI (saturated fat = -21 %, sugars = -2 %, sodium = -6 %). Potential intakes from foods that would display a 'High in' nutrition symbol were also reduced for energy and nutrients-to-encourage, including protein, fibre, calcium and vitamin D., Conclusions: Changes to FOPL regulations may have blunted their potential to limit intakes of nutrients-of-concern; however, they likely averted potential unintended consequences on intakes of nutrients-to-encourage for Canadians (e.g. calcium and vitamin D). To ensure policy objectives are met, FOPL regulations must be monitored regularly and evaluated over time.

Objectives: Overdose prevention centers (OPCs) provide a safe place where people can consume preobtained drugs under supervision so that a life-saving medical response can be provided quickly in the event of an overdose. OPCs are programs that are established in Canada and have recently become legally sanctioned in only a few United States jurisdictions., Methods: We conducted a systematic review that summarizes and identifies gaps of economic evidence on establishing OPCs in North America to guide future expansion of OPCs., Results: We included 16 final studies that were evaluated with the Consolidated Health Economic Evaluation Reporting Standards and Drummond checklists. Eight studies reported cost-effectiveness results (eg, cost per overdose avoided or cost per quality-adjusted life-year), with 6 also including cost-benefit; 5 reported only cost-benefit results, and 3 cost offsets. Health outcomes primarily included overdose mortality outcomes or HIV/hepatitis C virus infections averted. Most studies used mathematical modeling and projected OPC outcomes using the experience of a single facility in Vancouver, BC., Conclusions: OPCs were found to be cost-saving or to have favorable cost-effectiveness or cost-benefit ratios across all studies. Future studies should incorporate the experience of OPCs established in various settings and use a greater diversity of modeling designs., Competing Interests: Author Disclosures Author disclosure forms can be accessed in the Supplemental Material section. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies or the US government., (Copyright © 2024. Published by Elsevier Inc.)

The COVID-19 pandemic has significantly changed life and work patterns and reshaped the healthcare industry and public health strategies. It posed considerable challenges to public health emergency operations centers (PHEOCs). In this period, digital technologies such as modeling, simulation, visualization, and mapping (MSVM) emerged as vital tools in these centers. Despite their perceived importance, the potential and adaptation of digital tools in PHEOCs remain underexplored. This study investigated the application of MSVM in the PHEOCs during the pandemic in Canada using a questionnaire survey. The results show that digital tools, particularly visualization and mapping, are frequently used in PHEOCs. However, critical gaps, including data management issues, technical and capacity issues, and limitations in the policy-making sphere, still hinder the effective use of these tools. Key areas identified in this study for future investigation include collaboration, interoperability, and various supports for information sharing and capacity building.

Numerous research methodologies have been used to examine food environments. Existing reviews synthesizing food environment measures have examined a limited number of domains or settings and none have specifically targeted Canada. This rapid review aimed to 1) map research methodologies and measures that have been used to assess food environments; 2) examine what food environment dimensions and equity related-factors have been assessed; and 3) identify research gaps and priorities to guide future research. A systematic search of primary articles evaluating the Canadian food environment in a real-world setting was conducted. Publications in English or French published in peer-reviewed journals between January 1 2010 and June 17 2021 and indexed in Web of Science, CAB Abstracts and Ovid MEDLINE were considered. The search strategy adapted an internationally-adopted food environment monitoring framework covering 7 domains (Food Marketing; Labelling; Prices; Provision; Composition; Retail; and Trade and Investment). The final sample included 220 articles. Overall, Trade and Investment (1%, n = 2), Labelling (7%, n = 15) and, to a lesser extent, Prices (14%, n = 30) were the least studied domains in Canada. Among Provision articles, healthcare (2%, n = 1) settings were underrepresented compared to school (67%, n = 28) and recreation and sport (24%, n = 10) settings, as was the food service industry (14%, n = 6) compared to grocery stores (86%, n = 36) in the Composition domain. The study identified a vast selection of measures employed in Canada overall and within single domains. Equity-related factors were only examined in half of articles (n = 108), mostly related to Retail (n = 81). A number of gaps remain that prevent a holistic and systems-level analysis of food environments in Canada. As Canada continues to implement policies to improve the quality of food environments in order to improve dietary patterns, targeted research to address identified gaps and harmonize methods across studies will help evaluate policy impact over time., (© 2024. The Author(s).)

Background: The Episodic Disability Questionnaire (EDQ) is a generic 35-item patient-reported outcome measure of presence, severity and episodic nature of disability. We assessed the measurement properties of the Episodic Disability Questionnaire (EDQ) with adults living with HIV., Methods: We conducted a measurement study with adults living with HIV in eight clinical settings in Canada, Ireland, United Kingdom, and United States. We electronically administered the EDQ followed by three reference measures (World Health Organization Disability Assessment Schedule; Patient Health Questionnaire; Social Support Scale) and a demographic questionnaire. We administered the EDQ only 1 week later. We assessed the internal consistency reliability (Cronbach's alpha; > 0.7 acceptable), and test-retest reliability (Intra Class Correlation Coefficient; > 0.7 acceptable). We estimated required change in EDQ domain scores to be 95% certain that a change was not due to measurement error (Minimum Detectable Change (MDC95%)). We evaluated construct validity by assessing 36 primary hypotheses of relationships between EDQ scores and scores on the reference measures (> 75% hypotheses confirmed indicated validity)., Results: Three hundred fifty nine participants completed the questionnaires at time point 1, of which 321 (89%) completed the EDQ approximately 1 week later. Cronbach's alpha for internal consistency ranged from 0.84 (social domain) to 0.91 (day domain) for the EDQ severity scale, and 0.72 (uncertainty domain) to 0.88 (day domain) for the EDQ presence scale, and 0.87 (physical, cognitive, mental-emotional domains) to 0.89 (uncertainty domain) for the EDQ episodic scale. ICCs for test-retest reliability ranged from 0.79 (physical domain) to 0.88 (day domain) for the EDQ severity scale and from 0.71 (uncertainty domain) to 0.85 (day domain) for the EDQ presence scale. Highest precision was demonstrated in the severity scale for each domain (MDC95% range: 19-25 out of 100), followed by the presence (MDC95% range: 37-54) and episodic scales (MDC95% range:44-76). Twenty-nine of 36 (81%) construct validity hypotheses were confirmed., Conclusions: The EDQ possesses internal consistency reliability, construct validity, and test-retest reliability, with limited precision when administered electronically with adults living with HIV across in clinical settings in four countries. Given the measurement properties, the EDQ can be used for group level comparisons for research and program evaluation in adults living with HIV., (© 2024. The Author(s).)

Introduction: Following the sudden closure of schools due to the pandemic in 2020, many school food program (SFP) operators lost their operating venues and had to innovate to continue distributing meals to children. Our objective was to assess the impact of the COVID-19 pandemic on the delivery, adaptability, and resiliency of school food programs across Canada by conducting a systematic rapid review., Materials and Methods: Systematic literature searches identified newspaper articles and social media sources related to the adaptations and challenges faced by school food programs across Canada in response to the COVID-19 pandemic. Included sources were assessed and thematically categorized according to the dimensions of the Analysis Grid for Environments Linked to Obesity (ANGELO) and Getting To Equity (GTE) frameworks to identify factors impacting the delivery, adaptability, and resiliency of school food programs in Canada., Results: School food programs in Canada made various efforts to meet existing and new challenges associated with the delivery of these programs to keep feeding school children, particularly those most vulnerable, during the pandemic. Distribution of food kits, prepared meals and gift cards/coupons were successful pathways in ensuring support for food accessibility to students and their families. Increased collaborations between community members and organizations/stakeholders to help maintain food delivery or collectively offer new modes to deliver foods were most frequently cited as key to facilitating school food programming. However, maintenance and sustainability related to operating costs and funding were identified as key challenges to successful school food programming., Conclusion: Our study highlights the swift and substantial transformation school food programs,, underwent in response to the pandemic, driven by the urgent need to ensure that students still had access to nutritious meals and the importance of policy and resource support to bolster the adaptability and resiliency of these programs. Findings on facilitators and challenges to school food programs during the early months of the COVID-19 pandemic can inform development of guidelines to design a robust national Canadian school food program and help make existing programs more sustainable, adaptable, and resilient., Competing Interests: MA, AR, and JR were partially funded by the Feeding Kids, Nourishing Minds School-based Nutrition Research Initiative Graduate Award/Fellowship and/or Catalyst Fund. VM has received funding from the Canada Research Chairs Program; Connaught New Researcher Award, University of Toronto; The Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto; Temerty Faculty of Medicine Pathway Grant, University of Toronto; Canada Foundation for Innovation; and the Ontario Research Fund. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ahmed, Richardson, Riad, McPherson, Sellen and Malik.)

Introduction: The ongoing opioid overdose crisis, which has killed over 30,000 people in Canada since 2016, is driven by the volatility of an unregulated opioid drug supply comprised primarily of fentanyl. The Canadian government has recently funded safer opioid supply (SOS) programs, which include off-label prescriptions of pharmaceutical-grade opioids to high risk individuals with the goal of reducing overdose deaths., Methods: In 2021, we examined the implementation and adaption of four SOS programs in Ontario. These programs use a primary care model and serve communities experiencing marginalisation. We conducted semi-structured interviews with program clients. We present the results of a thematic analysis with the aim of describing clients' self-reported impact of these programs on their health and well-being., Results: We interviewed 52 clients between June and October 2021 (mean age 47 years, 56% men, 17% self-identified Indigenous, 14% living with HIV). Our results indicate multifaceted pathways to improved self-reported health and well-being among clients including changes to drug use practices, fewer overdoses, reduced criminalised activity, improved trust and engagement in health care, and increased social stability (e.g., housing)., Discussion and Conclusion: Most clients reported that the intervention saved their life because of the reduced frequency of overdoses. Findings suggest that SOS programs improved clients' health outcomes and increase opportunities for engagement in health services. Our results provide insight into the mechanisms behind some of the emergent evidence on the impact of safer supply prescribing., (© 2023 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

There has been an increased consumer interest and public health emphasis on plant-based protein foods, resulting in a rise in the availability of highly processed plant-based analogs. The objectives of this study were to assess the nutritional quality and the price of plant-based dairy and meat analogs compared to their respective animal-derived products and to examine the association between processing levels and the nutritional quality among these products. Using a branded food composition database, products in cheese, yogurt, milk, and meat categories were examined (n = 3231). Products were categorized as plant-based analogs versus animal-derived products using the ingredient list. Products were examined for their nutrient content, overall nutritional quality using the Food Standards Australia New Zealand nutrient profiling model, price, and processing levels using the NOVA classification. All plant-based analogs had lower protein and higher total carbohydrate, sugar, and fiber content compared to their respective animal-derived products. Compared to their respective animal-derived products, plant-based milk and meat analogs had lower energy, total fat, and saturated fat content; plant-based yogurt and meat analogs had lower sodium content; and all plant-based dairy analogs had lower calcium content. Plant-based cheese and yogurt analogs were more expensive than animal-based products; however, there was no significant difference among milk and meat products. There was no association between processing levels and overall nutritional quality among dairy and meat products. Plant-based analogs may be part of a healthy and affordable diet to reduce the intakes of nutrients of concern; however, additional compositional guidelines and/or labeling may be needed to highlight the differences in the levels of nutrients to encourage., (© 2023 Institute of Food Technologists. This article has been contributed to by US Government employees and their work is in the public domain in the USA.)

Based on the literature, it is commonly understood that stock prices (SP) are influenced by economic policy uncertainty (PU), with a rise in PU typically having a negative impact on SP. However, the relationship between PU and SP may not always be linear due to the varying risk preferences of individuals. Risk preference theory posits that individuals respond differently to different levels of risk. Therefore, this study aims to investigate whether PU determines SP asymmetrically (i.e., in a non-linear manner) by considering risk preferences and addressing a gap in the literature. To answer this question, the study employs a panel threshold approach to examine the effect of PU on SP in the Group of Seven (G7) countries, namely Canada, France, Germany, Italy, Japan, UK, and the US. In contrast to previous research, this study finds evidence of an asymmetric effect of PU on SP in the G7 countries. Specifically, the panel threshold results reveal that the impact of increased PU on SP is positive up to a certain level (Threshold1), beyond which it becomes negative (Threshold2). These findings are in line with information asymmetry hypothesis, prospect theory, behavioural finance hypothesis, and market liquidity hypothesis and shed light on the asymmetric behaviour of SP in response to varying levels of PU. The implications of these findings are significant for understanding how to manage risks effectively in the financial markets., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Khojah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Canada promulgated mandatory front-of-pack labelling (FOPL) regulations in 2022, requiring pre-packaged foods meeting and/or exceeding recommended thresholds for nutrients-of-concern (i.e., saturated fat, sodium, sugars) to display a "high-in" nutrition symbol. However, there is limited evidence on how Canadian FOPL (CAN-FOPL) regulations compare to other FOPL systems and dietary guidelines. Therefore, the objectives of the study were to examine the diet quality of Canadians using the CAN-FOPL dietary index system and its alignment with other FOPL systems and dietary guidelines., Methods: Nationally representative dietary data from the 2015 Canadian Community Health Survey-Nutrition survey ( n  = 13,495) was assigned dietary index scores that underpin CAN-FOPL, Diabetes Canada Clinical Practice (DCCP) Guidelines, Nutri-score, Dietary Approaches to Stop Hypertension (DASH) and Canada's Food Guide (Healthy Eating Food Index-2019 [HEFI-2019]). Diet quality was examined by assessing linear trends of nutrient intakes across quintile groups of CAN-FOPL dietary index scores. The alignment of CAN-FOPL dietary index system compared with other dietary index systems, with HEFI as the reference standard, was examined using Pearson's correlations and к statistics., Results: The mean [95% CI] dietary index scores (range: 0-100) for CAN-FOPL, DCCP, Nutri-score, DASH, and HEFI-2019 were 73.0 [72.8, 73.2], 64.2 [64.0, 64.3], 54.9 [54.7, 55.1], 51.7 [51.4, 51.9], and 54.3 [54.1, 54.6], respectively. Moving from the "least healthy" to the "most healthy" quintile in the CAN-FOPL dietary index system, intakes of protein, fiber, vitamin A, vitamin C, and potassium increased, while intakes of energy, saturated fat, total and free sugars, and sodium decreased. CAN-FOPL showed moderate association with DCCP ( r  = 0.545, p  < 0.001), Nutri-score ( r  = 0.444, p  < 0.001),  and HEFI-2019 ( r  = 0.401, p  < 0.001), but poor association with DASH ( r  = 0.242, p  < 0.001). Slight to fair agreement was seen between quintile combinations of CAN-FOPL and all dietary index scores ( к  = 0.05-0.38)., Discussion: Our findings show that CAN-FOPL rates the dietary quality of Canadian adults to be healthier than other systems. The disagreement between CAN-FOPL with other systems suggest a need to provide additional guidance to help Canadians select and consume 'healthier' options among foods that would not display a front-of-pack nutrition symbol., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Lee, Ahmed, Julia, Ng, Paper, Lou and L’Abbé.)

Calculated panel reactive antibody (CPRA) is used to help increase sensitized patient's access to transplantation. United Arab Emirates (UAE) has a diverse resident population hence we developed a UAE-CPRA calculator based on HLA antigen frequencies of the different ethnic groups that represent the UAE population. HLA antigen frequencies at serological split antigen level for HLA-A, -B, -C, -DRB1 and -DQB1 of 1002 healthy unrelated donors were performed. We subsequently compared the performance of the UAE CPRA calculator with the Organ Procurement and Transplantation Network (OPTN) and the Canadian CPRA calculators in 110 Kidney Transplant waitlist patients from January 2016 to December 2018. Lin's concordance correlation coefficient showed a moderate agreement between the UAE and OPTN calculator (Rc = 0.949, 95% CI 0.929-0.963) and the UAE and Canadian calculators (Rc = 0.952, 95% CI 0.932-0.965). While there continued to be a moderate agreement (Rc = 0.937, UAE versus OPTN calculator) in the lower sensitized group, a poor agreement (Rc = 0.555, UAE versus OPTN calculator) was observed in the higher sensitized group. In this study, we provide a template for countries to develop their own population-specific CPRA calculator. Implementation of the CPRA algorithm based on HLA frequencies of the multi-ethnic UAE population will be more fitting to increase access to transplantation and improve transplant outcomes. Our study demonstrates that the CPRA calculators developed using the data from the western population had poor correlation in our higher sensitized patients disadvantaging them in potential organ allocations systems. We plan to further refine this calculator by using high resolution HLA typing to address the problem of a genetically diverse population., (© 2023. The Author(s).)

Canada recently mandated front-of-pack (FOP) labelling regulations, where foods meeting and/or exceeding recommended thresholds for nutrients-of-concern (i.e., saturated fat, sodium, and sugars) must display a 'high-in' FOP nutrition symbol. However, there is limited research on the amounts and sources of foods consumed by Canadians that would require a FOP symbol. The objective was to examine the intakes of nutrients-of-concern from foods that would display a FOP symbol and to identify the top food categories contributing to intakes for each nutrient-of-concern. Using the first day 24-hour dietary recall from the nationally representative 2015 Canadian Community Health Survey-Nutrition (CCHS), Canadian adults' intakes of nutrients-of-concern from foods that would display a FOP symbol was examined. Foods were assigned to 1 of 62 categories to identify the top food categories contributing to intakes of energy and nutrient-of-concern that would display a FOP symbol for each nutrient-of-concern. Canadian adults (n = 13,495) consumed approximately 24% of total calories from foods that would display a FOP symbol. Foods that would display a FOP symbol for exceeding thresholds for nutrients-of-concern accounted for 16% of saturated fat, 30% of sodium, 25% of total sugar, and 39% of free sugar intakes among Canadian adults. The top food category contributing intakes of each nutrient-of-concern that would display a FOP symbol were nutrient-specific: Processed meat and meat substitutes for saturated fat; Breads for sodium; and Fruit juices & drinks for total and free sugars. Our findings show that Canadian FOP labelling regulations have the potential to influence the intakes of nutrients-of-concern for Canadian adults. Using the findings as baseline data, future studies are warranted to evaluate the impact of FOP labelling regulations., Competing Interests: MA, APN, and MRL received a competitive research grant from the Institute for the Advancement of Food and Nutrition Sciences (IAFNS) to analyze National Health and Nutrition Examination Survey (NHANES) data to determine sodium intakes and sources in diets of Americans. APN currently works at the Canadian Sugar Institute. However, none of the organizations had a role in this research. No other authors have competing interests to declare., (Copyright: © 2023 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: Genomic sequencing can generate complex results, including variants of uncertain significance (VUS). In general, VUS should not inform clinical decision-making. This study aimed to assess the public's expected management of VUS., Methods: An online, hypothetical survey was conducted among members of the Canadian public preceded by an educational video. Participants were randomized to 1 of 2 arms, VUS or pathogenic variant in a colorectal cancer gene, and asked which types of health services they expected to use for this result. Expected health service use was compared between randomization arms, and associations between participants' sociodemographic characteristics, attitudes, and medical history were explored., Results: Among 1003 respondents (completion rate 60%), more participants expected to use each type of health service for a pathogenic variant than for a VUS. However, a considerable proportion of participants expected to request monitoring (73.4%) and consult health care providers (60.9%) for a VUS. There was evidence to support associations between expectation to use health services for a VUS with family history of genetic disease, family history of cancer, education, and attitudes toward health care and technology., Conclusion: Many participants expected to use health services for a VUS in a colorectal cancer predisposition gene, suggesting a potential disconnect between patients' expectations for VUS management and guideline-recommended care., Competing Interests: Conflict of Interest The authors declare no conflicts of interest., (Copyright © 2023 American College of Medical Genetics and Genomics. Published by Elsevier Inc. All rights reserved.)

Background: Canada's first alongside midwifery unit (AMU) was intentionally informed by evidence-based birth environment design principals, building on the growing evidence that the built environment can shape experiences, satisfaction, and birth outcomes., Objectives: To assess the impact of the built environment of the AMU for both service users and midwives. This study aimed to explore the meanings that individuals attribute to the built environment and how the built environment impacted people's experiences., Methods: We conducted a mixed-methods study using a grounded theory methodology for data collection and analysis. Our research question and data collection tools were underpinned by a sociospatial conceptual approach. All midwives and all those who received midwifery care at the unit were eligible to participate. Data were collected through a structured online survey, interviews, and focus group., Results: Fifty-nine participants completed the survey, and interviews or focus group were completed with 28 service users and 14 midwives. Our findings demonstrate high levels of satisfaction with the birth environment. We developed a theoretical model, where "making space" for midwifery in the hospital contributed to positive birth experiences and overall satisfaction with the built environment. The core elements of this model include creating domestic space in an institutional setting, shifting the technological approach, and shared ownership of the unit., Conclusions: Our model for creating, shifting, and sharing as a way to make space for midwifery can serve as a template for how intentional design can be used to promote favorable outcomes and user satisfaction.

Purpose: To assess the cross-sectional association between dietary indexes (DI) that underlie, respectively, the Nutri-score (NS), the proposed Canadian 'High In' Symbol (CHIL) and the Diabetes Canada Clinical Practice Guidelines (DCCP) with food consumption, nutrient intakes and metabolic markers., Methods: 1836 adults (18-74 years) participating in the representative ESTEBAN study, conducted in mainland France in 2014-2016, were included in the analysis. Food consumption was assessed with three repeated 24 h dietary recalls. Anthropometric measurements and biomarkers of metabolic risk (cholesterol-total, LDL (Low Density Lipoprotein), HDL (High Density Lipoprotein)-triglycerides, glucose) were obtained through a clinical examination and fasting blood draw. The DI were assessed for their association with food consumption, dietary intakes and metabolic biomarkers as quintiles and continuous variables using multi-adjusted linear regression. Heathier diets were assigned to lower scores., Results: Correlations between scores ranged from + 0.62 between CHIL-DI and NS-DI to + 0.75 between NS-DI and DCCP-DI. All DIs discriminated individuals according to the nutritional quality of their diets through food consumption and nutrient intakes (healthier diets were associated with lower intakes of energy, added sugars and saturated fat; and with higher intakes of fiber, vitamins and minerals). NS-DI was associated with blood glucose (adjusted mean in Q1 = 5 vs. Q5 = 5.46 mmol/dl, p trend  = 0.001) and DCCP-DI was associated with BMI (Q1 = 24.8 kg/m 2 vs. Q5 = 25.8 kg/m 2 , p trend  = 0.025), while CHIL showed no significant association with any anthropometric measures or biomarkers., Conclusions: This study provides elements supporting the validity of the nutrient profiling systems underlying front-of-package nutrition labellings (FOPLs) to characterize the healthiness of diets., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Introduction: Diet has an impact on weight status, health, and physical performance. Assessing the usual at-home dietary intakes of military personnel can help ascertain their nutritional status before field training or operations. Preference for foods consumed on a routine basis can also impact the military's preference for and consumption of field rations. Military personnel are limited by the inherent nature of the field rations and availability of calories and food types; and despite previous studies indicating a high acceptability of the field rations, it is unknown whether military personnel self-select the same number of calories when faced with a restricted list of field ration options as they would from their usual foods. Although field rations are intended to be nutritionally sufficient for standard military operations, there are limited data on the ad libitum intake of nutrients of Canadian Armed Forces (CAF) personnel from field rations in comparison to the military dietary reference intake (MDRI) recommendations, which establishes standards intended to meet the nutritional requirements of military personnel on duty. Thus, assessing the adequacy of their usual diets at home and longer-term sustenance on field rations in relation to MDRIs can provide insight on CAF personnel's operational readiness. The objectives of this study were to describe and compare, in a convenience sample of CAF, their ad libitum nutrient intakes from the consumption of self-selected field rations at home with their usual home intakes and to compare both with MDRI recommendations., Materials and Methods: Eighteen CAF participants weighed and recorded their dietary intake from the ad libitum consumption of field rations at home and their usual at-home diets. Both MDRIs and the Institute of Medicine's dietary reference intake recommendations were used to assess the adequacy of intakes for each individual. Paired Student's t-test or Wilcoxon-matched paired tests were used to compare nutrient intake levels between usual at-home diets and field rations consumed at home., Results: Mean daily energy intakes were similar between ad libitum intakes from field rations (2,688 ± 619 kcal) and usual home diets (2,657 ± 580 kcal), although participants had significantly higher intakes of protein and fat from their home diets and higher intakes of carbohydrates from the field rations (P ≤ 0.05). Participants had less than the recommended intakes of some micronutrients (vitamins A and D, folate, calcium, magnesium, and potassium), from both their home diets and field rations, but adequate intakes of vitamin C and iron., Conclusions: The results of this study showed no difference in energy intake between the consumption of field rations and home diets, with levels consistent with recommendations for individuals with average physical activity levels. The results also demonstrated less than the recommended intakes (in comparison with MDRIs) of some nutrients from both home diets and self-selected consumption of field rations, warranting further research into nutritional adequacy for operational readiness., (© The Association of Military Surgeons of the United States 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)