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Objective: Understand health resource, medication use, and cost of adults with chronic migraine who received guideline‐recommended onabotulinumtoxinA (botulinum toxin) treatment frequency and then continued or reduced/stopped. Background: Botulinum toxin may be a beneficial treatment for chronic migraine; the trajectory of health resources utilization among those with continued or reduced/stopped use is unclear. Methods: A retrospective population‐based cohort study utilizing administrative data from Alberta, Canada (2012–2020), was performed. A cohort of adults who received ≥5 botulinum toxin treatment cycles for chronic migraine over 18 months (6‐month run‐in; 1‐year pre‐index period) were grouped into those who (1) continued use (≥3 treatments/year), or (2) stopped or reduced use (stopped for 6 months then received 0 or 1–2 treatments/year, respectively) over a 1‐year post‐index period. Health resources and medication use were described, and pre–post costs were assessed. A second cohort that received ≥3 treatments/year immediately followed by 1 year of stopped or reduced use was considered in sensitivity analysis. Results: Pre–post health resource, medication use, and costs were similar among those with continued use (n = 3336). Among those who stopped or reduced use (n = 1099; 756 stopped, 343 reduced), health resource, medication use, and costs were lower in the post‐ (total median per‐person cost [IQR]: all‐cause $4851 [$8090]; migraine‐related $835 [$1915]) versus pre‐ (all‐cause $6096 [$7207]; migraine‐related $2995 [$1950]) index period (estimated cost ratios [95% CI]: total all‐cause 0.86 [0.79, 0.95]; total migraine‐related 0.44 [0.40, 0.48]). In the second cohort (n = 3763), return to continued use (≥3 treatments/year) occurred in up to 70.4% in those with reduced use. Conclusions: Of adults treated with botulinum toxin for chronic migraine, 75.2% had continued use, stable health resource and medication use, and costs over a 2 year period. In those that stopped/reduced use, the observed lower health resource and migraine medication use may indicate improved symptom control, but the resumption of guideline‐recommended treatment intervals after reduced use was common. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify, categorize, and describe practitioners' perspectives regarding factors that help and hinder sustainability of Tier I (universal) systems within School-Wide Positive Behavioral Interventions and Supports (SWPBIS). Seventeen participants involved in sustaining Tier I SWPBIS over several years within a school district were interviewed and asked what events affected its long-term implementation through a qualitative approach called the Critical Incident Technique (CIT). A total of 227 critical incidents were recorded and sorted into emergent unitary clusters based on content analysis. These categories then underwent rigorous reliability and validity checks, including expert analysis, inter-rater agreement, and participant feedback. This process yielded 13 categories that represent the participants' experience of sustainability: Continuous Teaching, Positive Reinforcement, SWPBIS Team Effectiveness, Staff Ownership, School Administrator Involvement, Adaptation, Community of Practice, Use of Data, Involving New Personnel, Access to External Expertise, Maintaining Priority, Staff Turnover, and Conflict of Personal Beliefs/Mistaken Beliefs.

Research on effectiveness of school bullying interventions has lagged behind descriptive studies on this topic. The literature on bullying intervention research has only recently expanded to a point that allows for synthesis of findings across studies. The authors conducted a meta-analytic study of school bullying intervention research across the 25-year period from 1980 through 2004, identifying 16 studies that met our inclusion criteria. These studies included 15,386 K through 12 student participants from European nations and the United States. Applying standard meta-analysis techniques to obtain averaged effect size estimates across similar outcomes, the authors found that the intervention studies produced meaningful and clinically important positive effects for about one-third of the variables. The majority of outcomes evidenced no meaningful change, positive or negative. The authors conclude that school bullying interventions may produce modest positive outcomes; that they are more likely to influence knowledge, attitudes, and self-perceptions rather than actual bullying behaviors; and that the majority of outcome variables in intervention studies are not meaningfully impacted. (Contains 4 tables.)

Background: Self-administered subcutaneous immunoglobulin G (SCIg) reduces nursing time and eliminates the need for treatment at ambulatory care clinics, as compared with clinic-based intravenously administered IgG (IVIg), and are therapeutically equivalent. Estimating the economic impact of self-administered SCIg versus clinic-administered IVIg therapy may guide treatment recommendations. Methods: A retrospective population-based cohort study using administrative data from Alberta was performed; those treated with IgG between April 1, 2012 and March 31, 2019 were included. Costs for medical laboratory staff and nursing time, as well as ambulatory care visits were considered. Univariate generalized linear model regression with gamma distribution and log link was used to compare cost ($CDN 2020) between SCIg and IVIg administration. Stratified analysis by age (≥ 18-years; < 18-years) was performed. Results: Among 7,890 (6,148 adults; 1,742 children) individuals who received IgG, the average administration cost per patient-year of self-administered SCIg was $5,386 (95% confidence interval [CI] $5,039, $5,734) lower than clinic-administered IVIg; per patient-year cost of self-administered SCIg was $817 (95% CI $723, $912) versus $6,204 (95% CI $6,100, $6,308) for clinic-administered IVIg. The per patient-year cost of self-administered SCIg was $5,931 (95% CI $5,543, $6,319) lower among adults and $3,177 (95% CI $2,473, $3,882) lower among children compared with clinic-administered IVIg. An estimated $31.0 million (95% CI $29.0, $33.0) in cost savings to the health system would be realised if 80% of individuals switched from clinic-administered IVIg to self-administered SCIg. Conclusions: Self-administered SCIg is substantially less costly from a health care payer perspective in Canada. Within this type of health system, switching to self-administered SCIg has the potential to reduce overall health care costs, lessen nursing burden, and may increase clinic-based capacity for others. [ABSTRACT FROM AUTHOR]

Background: An increasing number of patients with end-of-life (EOL) conditions, particularly those with advanced cancer, are presenting to the emergency department (ED). Objectives: To assess the characteristics, management and short-term outcomes of ED patients with advanced cancer compared to patients with other EOL conditions. Methodology/Design: A secondary analysis of a prospective cohort study. Setting/Participants: Volunteer emergency physicians in two Canadian EDs identified presentations for advanced cancer and other EOL conditions with the aid of a modified screening tool March–August 2018. Results: Among the 663 presentations by patients with EOL conditions, 272 (41%) presented with advanced cancer. The majority of presentations for advanced cancer (81%) or other EOL conditions (77%) were by patients with unmet palliative care (PC) needs. Patients with advanced cancer were significantly less likely to have active goals of care (GOC) documented on their charts (53% vs. 75%; p < 0.001). While no significant differences were found between the groups, the majority of presentations involved imaging, investigations, consultations, and hospitalization. Presentations for advanced cancer were more likely to receive a postdischarge referral (38% vs. 23%; p < 0.001). Referrals to PC consultations or postdischarge referrals were infrequent. Regression analysis found that patients with advanced cancer were associated with shorter length of stay (LOS). Conclusions: The majority of presentations for advanced cancer or other EOL conditions involved significant resource use. Patients with cancer experienced shorter LOS; however, had less documentation of GOC and gaps in referrals to PC services were identified. Interventions should be explored to promote early GOC discussions and PC referrals in this patient group. [ABSTRACT FROM AUTHOR]

Ice-marginal lakes impact glacier mass balance, water resources, and ecosystem dynamics and can produce catastrophic glacial lake outburst floods (GLOFs) via sudden drainage. Multitemporal inventories of ice-marginal lakes are a critical first step in understanding the drivers of historic change, predicting future lake evolution, and assessing GLOF hazards. Here, we use Landsat-era satellite imagery and supervised classification to semi-automatically delineate lake outlines for four ∼5 -year time periods between 1984 and 2019 in Alaska and northwest Canada. Overall, ice-marginal lakes in the region have grown in total number (+183 lakes, 38 % increase) and area (+483 km 2 , 59 % increase) between the time periods of 1984–1988 and 2016–2019. However, changes in lake numbers and area were notably unsteady and nonuniform. We demonstrate that lake area changes are connected to dam type (moraine, bedrock, ice, or supraglacial) and topological position (proglacial, detached, unconnected, ice, or supraglacial), with important differences in lake behavior between the sub-groups. In strong contrast to all other dam types, ice-dammed lakes decreased in number (six fewer, 9 % decrease) and area (-51 km 2 , 40 % decrease), while moraine-dammed lakes increased (56 more, 26 % and +479 km 2 , 87 % increase for number and area, respectively) at a faster rate than the average when considering all dam types together. Proglacial lakes experienced the largest area changes and rate of change out of any lake position throughout the period of study and moraine-dammed lakes which experienced the largest increases are associated with clean-ice glaciers (<19 % debris cover). By tracking individual lakes through time and categorizing lakes by dam type, subregion, and topological position, we are able to parse trends that would otherwise be aliased if these characteristics were not considered. This work highlights the importance of such lake characterization when performing ice-marginal lake inventories and provides insight into the physical processes driving recent ice-marginal lake evolution. [ABSTRACT FROM AUTHOR]

Background: Presentations to the emergency department (ED) by patients with end-of-life (EOL) conditions for their acute care needs are common. Objectives: The objective of this study was to identify and describe the ED management across presentations to the ED for EOL conditions. Design: Prospective observational cohort study. Settings/Subjects: Emergency physicians in two Canadian ED's were asked to identify presentations by adult patients with EOL conditions using a modified screening tool. Measurements: Patient characteristics and ED management for each presentation were collected through chart review by trained research assistants. Descriptive analyses were conducted as appropriate and bivariate comparisons of dichotomous and continuous variables were completed using χ2 tests and using t test or Wilcoxon rank-sum test, respectively. Results: Physicians identified 663 ED presentations for EOL conditions, with advanced cancer (41%), dementia (23%), and chronic obstructive pulmonary disease (16%) being the most common EOL conditions. The majority of presentations involved consultations (77%), hospitalization (65%), and numerous investigations (97%), including blood work (97%) and imaging (92%). The majority of patients with EOL conditions had a history of ED visits (68%). Using a modified screening tool, 78% of presentations involved patients with unmet palliative care needs, but only 1% of presentations involved a palliative consultation or admission to a palliative care unit. Conclusion: Presentations to the ED for EOL conditions involve significant ED resources; however, only a handful of patients are referred to palliative services. Patients with EOL conditions are appropriate targets for palliative services and community support outside the ED. [ABSTRACT FROM AUTHOR]

Heterosexual women trust mating-relevant advice received from gay men more than that received from heterosexual women. This trust is predicated on women's perception that gay men lack ulterior sexual motives and romantically pursue other gay men. However, this trust may not hold in all cultures. For example, in both Samoa and the Istmo Zapotec of Southern Mexico, women take part in mate competition against feminine same-sex attracted males—referred to as fa'afafine and muxe, respectively—who regularly engage in sexual activity with masculine men. The present studies sought to replicate and extend research on women's trust in males who are same-sex attracted. Experiments were conducted in Canada, Samoa, and the Istmo Zapotec, with women randomly assigned to consider the likelihood of various mate-poaching behaviors performed by either a rival woman or a same-sex attracted male. In Canada, women were more trusting of cisgender gay men than other women. Similarly, Samoan women were more trusting of fa'afafine than other women. In the Istmo Zapotec, women were equally distrustful of women and feminine muxe gunaa, whereas more masculine muxe nguiiu were rated as more trustworthy than women and muxe gunaa. These results illustrate that women's trust in same-sex attracted males varies both between and within cultural contexts, perhaps impacted by the relative femininity of the male in question. [ABSTRACT FROM AUTHOR]

Previous research indicates that Euro-American women are more upset by imagining their male partners committing homosexual infidelities than heterosexual ones. The present studies sought to replicate these findings and extend them to two non-Western cultures wherein masculine men frequently engage in sexual interactions with feminine third-gender males. Across six studies in three cultural locales (Canada, Samoa, and the Istmo Zapotec), women were asked to rate their degree of upset when imagining that their partner committed infidelity that was heterosexual in nature, as well as infidelity that was homosexual. In two Canadian undergraduate samples, women reported greater upset at imagining partner infidelity with a female, whereas a community sample of middle-aged women reported equal upset across infidelity types. Samoan women reported substantially less upset at the thought of partner infidelity with a third-gender male (fa'afafine) than with a female. Istmo Zapotec women reported equal upset toward infidelity with a female or a third-gender male (muxe), whereas a second Zapotec sample reported slightly greater upset at the thought of infidelity with a muxe. Results illustrate how cultural contexts moderate the degree to which same-sex infidelity scenarios are upsetting to women. [ABSTRACT FROM AUTHOR]

Darwinian sexual selection theory holds that mate selection occurs inter-sexually, and mate competition occurs intra-sexually for opposite-sex partners. We demonstrate that inter-sexual mate competition can also occur among humans at appreciable rates that vary by culture. In Canada, inter-sexual mate competition was both rare and inconsequential. However, data from two disparate non-Western cultures—Samoa and the Istmo Zapotec (Oaxaca, Mexico)—show that women frequently compete with feminine same-sex attracted males to acquire and maintain masculine male mates (i.e., men). Inter-sexual mate competition most commonly involved feminine males attempting to poach women's masculine male sexual partners. During these interactions, women and feminine males both attempted to manipulate the man who was the object of sexual competition; feminine males attempted to entice the target man, whereas women engaged in guarding and emotionally punitive behaviours. We do not anticipate that inter-sexual mate competition will be common in most species or across all cultures. However, when males and females prefer the same sexual partners, who themselves behave in a bisexual manner, then inter-sexual mate competition can ensue. [ABSTRACT FROM AUTHOR]

Importance Higher levels of red cell distribution width (RDW) are associated with adverse outcomes, especially in selected cohorts with or at risk for chronic disease. Whether higher RDW or the related parameter standard deviation of the red blood cell distribution (SD-RBC) can predict a broader range of outcomes in the general population is unknown. Objective To evaluate the association of RDW and SD-RBC with the risk of adverse outcomes in people from the general population. Design Population-based retrospective cohort study. Setting Health care system in a Canadian province (Alberta). Participants All 3,156,863 adults living in Alberta, Canada with at least one measure of RDW and SDRBC between 2003 and 2016. Data were analyzed in September 2018. Exposure RDW and SD-RBC, classified into percentiles (<1, 1–5, 5–25, 25–75, 75–95, 95–99, >99). Main outcomes All-cause death, first myocardial infarction, first stroke or transient ischemic attack, placement into long-term care (LTC), progression to renal replacement therapy (initiation of chronic dialysis or pre-emptive kidney transplantation), incident solid malignancy, and first hospitalization during follow-up. Results Over median follow-up of 6.8 years, 209,991 of 3,156,863 participants (6.7%) died. The risk of death increased with increasing RDW percentile. After adjustment, and compared to RDW in the 25th to 75th percentiles, the risk of death was lower for participants in the <25th percentiles but higher for participants in the 75th-95th percentiles (HR 1.42, 95% CI 1.40,1.43), the 95th-99th percentiles (HR 1.86, 95% CI 1.83,1.89) and the >99th percentile (HR 2.18, 95% CI 2.12,2.23). Similar results were observed for MI, stroke/TIA, incident cancer, hospitalization and LTC placement, but no association was found between RDW and ESRD. Findings were generally similar for SD-RBC, except that all associations tended to be stronger than for RDW, and both lower and higher values of SD-RBC were independently associated with ESRD. Conclusion and relevance RDW and SD-RBC may be useful as prognostic markers for people in the general population, especially for outcomes related to chronic illness. SD-RBC may be superior to RDW. [ABSTRACT FROM AUTHOR]

The linkages between myth, public memory, and the construction of nationalism are profound. Since the nineteenth century, historians, intellectuals, and politicians have reflected, critiqued, and shaped the enduring notion that Canadians have constructed a "peaceable kingdom" in North America. Although the subject matter and thrust of their efforts varied dramatically, the ease in which the peaceable kingdom became embraced suggests that by the early twentieth-first century the ideal is firmly entrenched as part of Canada's cultural and scholarly orientation. Its persistence can be explained to a great degree because it has proven to be remarkably elastic; its appeal reaches across ideological and cultural divides. This article explores two intriguing paradoxes related to these developments. First, the peaceable kingdom ideal often chafes against the country's narrative because from the earliest moments of European contact with Indigenous peoples through to the recent past with the country's participation in the Afghanistan war, Canadians have engaged in violent episodes and armed conflict. Second, even historians and other scholars who argue against the substance of the peaceable kingdom idea are prone to using the myth as a popular reference to draw attention to their work or frame their research. [ABSTRACT FROM AUTHOR]

The prevalence of chronic kidney disease and end-stage renal disease requiring dialysis therapy continues to increase worldwide, and despite technological advances, treatment remains resource intensive. Thus, the increasing burden of dialysis therapy on finite health-care budgets is an important consideration. The principles of allocative efficiency and the concept of 'opportunity cost' can be used to assess whether dialysis is economically justified; if dialysis is to be provided, cost-minimization and cost-utility analyses can be used to identify the most efficient dialysis modality. Existing studies have examined the cost, and where relevant the effectiveness, of the various currently available peritoneal dialysis and haemodialysis modalities. In this Review, we discuss variations in the intrinsic costs of the available dialysis modalities as well as other factors, such as variation by country, available health-care infrastructures, the timing of dialysis initiation and renal transplantation. We draw on data from robust micro-costing studies of the various dialysis modalities in Canada to highlight key issues. [ABSTRACT FROM AUTHOR]

Emerging research clearly indicates that human behavior is contributing to climate change, notably, the use of fossil fuels as a form of energy for everyday behaviors. This dependence on oil in North America has led to assertions that the current level of demand is the social equivalent to an "addiction." The purpose of this study was to apply behavioral economic demand curves—a broadly applicable method of evaluating relative reinforcer efficacy in behavioral models of addiction—to North American oil consumption to examine whether such claims of oil addiction are warranted. Toward this end, we examined government data from the United States and Canada on per capita energy consumption for transportation and oil prices between 1995 and 2008. Our findings indicate that consumption either persisted or simultaneously increased despite sharp increases in oil price per barrel over the past decade. [ABSTRACT FROM AUTHOR]

A multi-index drought (MID) model was developed to combine the strengths of various drought indices for agricultural drought risk assessment on the Canadian prairies, as related to spring wheat crop yield. The model automatically selects and combines optimum drought indices derived from the preceding and current months as they become available to better match the conditions (both spatially and temporally) where they work well. The cross-validation results showed that (1) the prediction accuracy of the MID model is better than (or occasionally equal to) using any single drought index for all modelling stages, (2) drought indices derived from the recharge period are useful for early drought risk detection, (3) model prediction accuracy improved as the growing season progressed with the most accurate assessments at the beginning of August, and (4) the model performed best in the more arid locations in the southern prairies, which tend to have a more variable precipitation regime. The model assessment results provide the spatial intensity distribution of possible drought progression and recession before and during the growing season, and can be used with complementary information in agricultural drought risk management and mitigation strategies. Copyright © 2011 Royal Meteorological Society [ABSTRACT FROM AUTHOR]

Background: The Knee Society Clinical Rating System was developed in 1989 and has been widely adopted. However, with the increased demand for TKA, there is a need for a new, validated scoring system to better characterize the expectations, satisfaction, and physical activities of the younger, more diverse population of TKA patients. Questions/purposes: We developed and validated a new Knee Society Scoring System. Methods: We developed the new knee scoring system in two stages. Initially, a comprehensive survey of activities was developed and administered to 101 unilateral TKA patients (53 women, 48 men). A prototype knee scoring instrument was developed from the responses to the survey and administered to 497 patients (204 men, 293 women; 243 postoperatively, 254 preoperatively) at 15 medical institutions within the United States and Canada. Objective and subjective data were analyzed using standard statistical and psychometric procedures and compared to the Knee Injury and Osteoarthritis Score and SF-12 scores for validation. Based on this analysis, minor modifications led to the new Knee Society Scoring System. Results: We found the new Knee Society Scoring System to be broadly applicable and to accurately characterize patient outcomes after TKA. Statistical analysis confirmed the internal consistency, construct and convergent validity, and reliability of the separate subscale measures. Conclusions: The new Knee Society Scoring System is a validated instrument based on surgeon- and patient-generated data, adapted to the diverse lifestyles and activities of contemporary patients with TKA. This assessment tool allows surgeons to appreciate differences in the priorities of individual patients and the interplay among function, expectation, symptoms, and satisfaction after TKA. [ABSTRACT FROM AUTHOR]

Abstract: Most image classification algorithms rely on computing the distance between the unique spectral signature of a given pixel and a set of possible clusters within an n-dimensional feature space that represents discrete land cover categories. Each scrutinized pixel will ultimately be closest to one of the predefined clusters; different classification algorithms differ in the details of which cluster is considered as closest or most likely, but in general the selected algorithm will label each pixel with the label of the closest cluster. However, pixels expressing virtually identical distances to two or more clusters identify a limitation of this typical classification approach. Conditions for limitations to distance based classification algorithms include when distances are long and the pixel may not clearly belong to any single category, may represent mixed land cover, or can be easily confused spectrally between two or more categories. We propose that retention of the distance to the second closest cluster can shed light on the confidence with which label assignment proceeds and present several examples of how such additional information might enhance accuracy assessments and improve classification confidence. The method was developed with simplicity as a goal, assuming the classification has already been performed, and standard clustering reports are available. Over a test site in central British Columbia, Canada, we illustrate the described technique using classified image data from a nation-wide land cover mapping project. Calculation of multi-spectral Euclidean distances to cluster centroids, standardized by cluster variance, allows comparison of all potential class assignments within a unified framework. The variable distances provide a measure of relative confidence in the actual classification at the level of individual pixels. [Copyright &y& Elsevier]

OBJECTIVE — To compare health resource utilization in patients with diabetes between the U.S. and Canada. RESEARCH DESIGN AND METHODS — We combined measures of health care utilization, personal, demographic, health status, functional status, and comorbid conditions from the current National Health Interview Survey (U.S.) and the National Public Health Survey (Canada). A binary logistic regression analysis was used to examine how country of residence influences the probability of accessing health care resources in adult Caucasian subjects after controlling for potential confounders. RESULTS — Subjects from Canada (n = 521) were more likely to have contact with a general physician (odds ratio [OR] 4.01, 95% CI 2.26-7.14), eye specialists (1.46, 1.08-1.98), and any physician (3.02, 1.03-8.84) in the past year than their American counterparts (n = 825) but were less likely to have had contact with other medical specialists (0.33, 0.24-0.46). Subjects in Canada were also more likely to have been hospitalized overnight (1.79, 1.17-2.75) or to have contact with a health care professional in the previous 12 months (3.35, 1.01-12.81). CONCLUSIONS — Significant disparities exist in health service utilization for adult Caucasian individuals with diabetes in Canada versus the U.S. after controlling for various confounders. From what is known regarding optimal treatment of diabetes, those with diabetes in the U.S. have a greater chance of not receiving recommended care. [ABSTRACT FROM AUTHOR]

The energy budget of a tidally active, shallow silled fjord is discussed. Constriction of the flow over the shallow sill causes a reduction in tidal amplitude and a phase lag across the sill. A generalized expression for the total power extracted from the barotropic tide by dissipation at the sill is derived as a function of the tidal amplitude difference and phase lag of the tidal elevation. Using tide gauge data from both sides of the sill at the entrance to Sechelt Inlet, British Columbia, this generalized expression yields estimates for the energy flux of the barotropic tide, which approach 100 MW during spring tides. From direct measurements of the currents, the estimated frictional dissipation is equal to the flux out of the barotropic tide (within experimental error). A small amount of the energy flux (∼5%) is estimated to go into the generation of a tidal jet, which dissipates within a few kilometers of the sill and contributes to the formation of a mid-water layer. [ABSTRACT FROM AUTHOR]

Focuses on the response of Canadian natives to Irish immigrants who fled to Canada due to famine in Ireland. Theoretical and historiographical contexts of nativism; Effect of the migrants on the demographic profile of Canada; Reason for the dramatic impact of immigration on Quebec; Racial issues in the response of natives to Irish immigrants.

THE STUDY of collective violence has generally reinforced national stereotypes that Canada is a "Peaceable Kingdom" and that the United States is extraordinarily violent. This article assesses the historiography of collective violence since the 1960s and offers specific suggestions for further exploration into Canada's riotous experiences. Scholars often assume that Canada's collective violence has been infrequent and less destructive than American episodes. Future research -- with a focus on nativism, the social legitimacy of the crowd, religious and ethnic conflict, the entrenchment of powerful state institutions, and vigilantism -- might prove otherwise. Regardless, Canadian collective violence will be better understood if it is conceptualized in a North Atlantic context. [ABSTRACT FROM AUTHOR]

Announces the development of a technique for monitoring slow reactivity changes in Canadian deuterium uranium (CANDU) nuclear reactors during low power operation following sustained period of high power operation. Background on operation of CANDU nuclear reactors; Operation mechanics and function of the power doubling halving worth (PDHW); Computer simulations.

Illustrates the role of polling crowds and political patronage in the 1842-1843 elections for legislative members in New Brunswick's House of Assembly. Importance of election-related collective behavior; Complications within Northumberland County's political system; Manifestation of traditional rivalries in recreational or mock battles.

Cleavitt et al. (2018, Can. J. For. Res. 48(1): 23–31, doi:10.1139/cjfr-2017-0233) report a lack of sugar maple (Acer saccharum Marsh.) regeneration in Hubbard Brook Experimental Forest (HBEF), Watershed 5 (W5), following whole-tree clearcut harvesting and purport that harvesting-induced soil calcium depletion contributed to regeneration failure of this species. In New England, clearcutting is a silvicultural strategy used to promote less tolerant species, especially birch (Betula spp.; Marquis (1969), Birch Symposium Proceedings, USDA Forest Service; Leak et al. (2014), doi:10.2737/NRS-GTR-132), which is just the outcome that the authors report. While this study reports an impressive, long-term data set, given broad interest in sugar maple and sustainability of forest management practices, we feel that it is critical to more fully explore the role of nutrition on sugar maple dynamics, both prior to and during the experiment, and to more fully review the scientific record on the role of whole-tree clearcutting in nutrient-induced sugar maple dynamics. [ABSTRACT FROM AUTHOR]

Background: Treatment of congenital pulmonary airway malformations (CPAMs) is generally surgical resection; however, there is controversy regarding the optimal timing of surgical intervention, especially in asymptomatic patients.Study Design: Using the American College of Surgeons National Surgical Quality Improvement Program-Pediatric Participant Use Files from 2012 to 2015, children who underwent lung resection for CPAMs were identified. Outcomes in children who underwent lung resection during the neonatal period were compared with those who underwent resection beyond the neonatal period, but during the first year of life (non-neonates).Results: A total of 541 patients (20.7% neonates and 79.3% non-neonates) were identified. Neonates had higher rates of preoperative comorbidities and worse postoperative outcomes when compared with non-neonates (morbidity 19.6% vs 5.4%, p < 0.0001). On multivariable regression analysis, the presence of preoperative symptoms (defined as oxygen dependence or ventilatory support) was independently associated with increased morbidity (odds ratio 3.91 [range 1.6 to 9.57], p = 0.003). In a subgroup analysis of asymptomatic neonates compared with asymptomatic non-neonates, there was no difference in overall morbidity (7.4% vs 4.4%, p = 0.33).Conclusions: These data suggest that lung resection for CPAMs in the neonatal period in asymptomatic children are not associated with increased 30-day morbidity. The presence of preoperative symptoms was independently associated with increased morbidity in a multivariable regression model. More data are needed to better understand the long-term outcomes and better define the optimal timing of surgery in this patient population. [ABSTRACT FROM AUTHOR]

Background: Guidelines and experts describe 5% to 10% reductions in body weight as 'clinically important'; however, it is not clear if 5% to 10% weight reductions correspond to clinically important improvements in health-related quality of life (HRQL). Our objective was to calculate the amount of weight loss required to attain established minimal clinically important differences (MCIDs) in HRQL, measured using three validated instruments.Methods: Data from the Alberta Population-based Prospective Evaluation of Quality of Life Outcomes and Economic Impact of Bariatric Surgery (APPLES) study, a population-based, prospective Canadian cohort including 150 wait-listed, 200 medically managed and 150 surgically treated patients were examined. Two-year changes in weight and HRQL measures (Short-Form (SF)-12 physical (PCS; MCID = 5) and mental (MCS; MCID = 5) component summary score, EQ-5D Index (MCID = 0.03) and Visual Analog Scale (VAS; MCID = 10), Impact of Weight on Quality of Life (IWQOL)-Lite total score (MCID = 12)) were calculated. Separate multivariable linear regression models were constructed within medically and surgically treated patients to determine if weight changes achieved HRQL MCIDs. Pooled analysis in all 500 patients was performed to estimate the weight reductions required to achieve the pre-defined MCID for each HRQL instrument.Results: Mean age was 43.7 (SD 9.6) years, 88% were women, 92% were white, and mean initial body mass index was 47.9 (SD 8.1) kg/m2. In surgically treated patients (two-year weight loss = 16%), HRQL MCIDs were reached for all instruments except the SF-12 MCS. In medically managed patients (two-year weight loss = 3%), MCIDs were attained in the EQ-index but not the other instruments. In all patients, percent weight reductions to achieve MCIDs were: 23% (95% confidence interval (CI): 17.5, 32.5) for PCS, 25% (17.5, 40.2) for MCS, 9% (6.2, 15.0) for EQ-Index, 23% (17.3, 36.1) for EQ-VAS, and 17% (14.1, 20.4) for IWQOL-Lite total score.Conclusions: Weight reductions to achieve MCIDs for most HRQL instruments are markedly higher than the conventional threshold of 5% to 10%. Surgical, but not medical treatment, consistently led to clinically important improvements in HRQL over two years.Trial Registration: Clinicaltrials.gov NCT00850356. [ABSTRACT FROM AUTHOR]

Roscoe Reid Graham, a Canadian surgeon trained at the University of Toronto, was a true pioneer in the field of general surgery. Although he may be best known for his omental patch repair of perforated duodenal ulcers--often referred to as the "Graham patch"--he had a number of other significant accomplishments that decorated his surgical career. Dr. Graham is credited with being the first surgeon to successfully enucleate an insulinoma. He ventured to do an essentially brand new operation based solely on his patient's symptoms and physical findings, a courageous move that even some of the most talented surgeons would shy away from. He also spent a large portion of his career dedicated to the study of rectal prolapse, working tirelessly to rid his patients of this awful affliction. He was recognized by a number of different surgical associations for his operative successes and was awarded membership to those both in Canada and the United States. Despite all of these accolades, Dr. Graham remained grounded and always fervent in his dedication to the patient and their presenting symptom(s), reminding us that to do anything more would be "meddlesome." In an age when medical professionals are often all too eager to make unnecessary interventions, it is imperative that we look back at our predecessors such as Roscoe Reid Graham, for they will continually redirect us toward our one and only obligation: the patient. [ABSTRACT FROM AUTHOR]

Background. Sexual abuse may be associated with poorer weight loss outcomes following bariatric treatment. Identifying predictors of abuse would enable focused screening and may increase weight management success. Methods. We analyzed data from 500 consecutively recruited obese subjects from a population-based, regional bariatric program. The prevalence of self-reported sexual abuse was ascertained using a single interview question. Health status was measured using a visual analogue scale (VAS). Multivariable logistic regression was performed to identify sexual abuse predictors. Results. The mean age was 43.7 y (SD 9.6), 441 (88.2%) were females, 458 (91.8%) were white, and the mean body mass index (BMI) was 47.9 kg/m2 (SD 8.1). The self-reported prevalence of past abuse was 21.8% (95% CI 18.4-25.4%). Abused subjects had worse health status (VAS score 53.1 (SD 21.2) versus 58.0 (SD 20.1), P = 0.03). BMI was not associated with abuse (P > 0.5). Age, sex, BMI, and covariate-adjusted independent predictors of abuse included alcohol addiction (adjusted odds ratio 15.8; 95% CI 4.0-62.8), posttraumatic stress disorder (4.9; 2.5-9.5), borderline personality (3.8; 1.0-13.8), depression (2.4; 1.3-4.3), and lower household income (3.4; 1.6-7.0). Conclusions. Abuse was common amongst obese patients managed in a population-based bariatric program; alcohol addiction, psychiatric comorbidities, and low-income status were highly associated with sexual abuse. [ABSTRACT FROM AUTHOR]

Background: First Nations Peoples endure disproportionate rates of stillbirth compared with non-First Nations Peoples. Previous interventions have aimed at reducing stillbirth in First Nations Peoples and providing better bereavement care without necessarily understanding the perceptions, knowledge and beliefs that could influence the design of the intervention and implementation., Aim: The aim of this review was to understand the perceptions, knowledge and beliefs about stillbirth prevention and bereavement of First Nations Peoples from the US, Canada, Aotearoa/New Zealand, and Australia., Methods: This review was conducted in accordance with the JBI methodology for a convergent integrated mixed method systematic review. This review was overseen by an advisory board of Aboriginal Elders, researchers, and clinicians. A search of eight databases (PubMed, MEDLINE, PsycInfo, CINAHL, Embase, Emcare, Dissertations and Theses and Indigenous Health InfoNet) and grey literature was conducted. All studies were screened, extracted, and appraised for quality by two reviewers and results were categorised, and narratively summarised., Results: Ten studies were included within this review. Their findings were summarised into four categories: safeguarding baby, traditional practices of birthing and grieving, bereavement photography and post-mortem examination. The results indicate a diversity of perceptions, knowledge and beliefs primarily around smoking cessation and bereavement practices after stillbirth. However, there was a paucity of research available., Conclusions: Further research is needed to understand the perceptions, knowledge and beliefs about stillbirth among First Nations Peoples. Without research within this area, interventions to prevent stillbirth and support bereaved parents and their communities after stillbirth may face barriers to implementation., Competing Interests: Conflict of interest None declared., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Benzodiazepines are a class of medications that are being frequently prescribed in Canada but carry significant risk of harm. There has been increasing clinical interest on the potential "sparing effects" of medical cannabis as one strategy to reduce benzodiazepine use. The objective of this study as to examine the association of medical cannabis authorization with benzodiazepine usage between 2013 and 2021 in Alberta, Canada., Methods: A propensity score matched cohort study with patients on regular benzodiazepine treatment authorized to use medical cannabis compared to controls who do not have authorization for medical cannabis. A total of 9690 medically authorized cannabis patients were matched to controls. To assess the effect of medical cannabis use on daily average diazepam equivalence (DDE), interrupted time series (ITS) analysis was used to assess the change in the trend of DDE in the 12 months before and 12 months after the authorization of medical cannabis., Results: Over the follow-up period after medical cannabis authorization, there was no overall change in the DDE use in authorized medical cannabis patients compared to matched controls (- 0.08 DDE, 95% CI: - 0.41 to 0.24). Likewise, the sensitivity analysis showed that, among patients consuming ≤5 mg baseline DDE, there was no change immediately after medical cannabis authorization compared to controls (level change, - 0.04 DDE, 95% CI: - 0.12 to 0.03) per patient as well as in the month-to-month trend change (0.002 DDE, 95% CI: - 0.009 to 0.12) per patient was noted., Conclusions: This short-term study found that medical cannabis authorization had minimal effects on benzodiazepine use. Our findings may contribute ongoing evidence for clinicians regarding the potential impact of medical cannabis to reduce benzodiazepine use., Highlights: • Medical cannabis authorization had little to no effect on benzodiazepine usage among patients prescribed regular benzodiazepine treatment in Alberta, Canada. • Further clinical research is needed to investigate the potential impact of medical cannabis as an alternative to benzodiazepine medication., (© 2024. The Author(s).)

Objective: The objective of this review is to investigate First Nations populations' perceptions, knowledge, attitudes, beliefs, and myths about stillbirth., Introduction: First Nations populations experience disproportionate rates of stillbirth compared with non-First Nations populations. There has been a surge of interventions aimed at reducing stillbirth and providing better bereavement care, but these are not necessarily appropriate for First Nations populations. As a first step toward developing appropriate interventions for these populations, this review will examine current perceptions, knowledge, attitudes, beliefs, and myths about stillbirth held by First Nations people from the United States, Canada, Aotearoa/New Zealand, and Australia., Inclusion Criteria: The review will consider studies that include individuals of any age (bereaved or non-bereaved) who identify as belonging to First Nations populations. Eligible studies will include the perceptions, knowledge, attitudes, beliefs, and myths about stillbirth among First Nations populations., Methods: This review will follow the JBI methodology for convergent mixed methods systematic reviews. The review is supported by an advisory panel of Aboriginal elders, lived-experience stillbirth researchers, Aboriginal researchers, and clinicians. PubMed, MEDLINE (Ovid), CINAHL (EBSCOhost), Embase (Ovid), Emcare (Ovid), PsycINFO (EBSCOhost), Indigenous Health InfoNet, Trove, Informit, and ProQuest Dissertations and Theses will be searched for relevant information. Titles and abstracts of potential studies will be screened and examined for eligibility. After critical appraisal, quantitative and qualitative data will be extracted from included studies, with the former "qualitized" and the data undergoing a convergent integrated approach., Review Registration: PROSPERO CRD42023379627., Competing Interests: DP, ZM, SH, CV, and CS are paid employees of JBI, The University of Adelaide. CS is deputy editor in chief of JBI Evidence Synthesis , but was not involved in the editorial processing of this manuscript. The other authors declare no conflicts of interest., (Copyright © 2023 JBI.)

Background & Aims: Insurance, race, and ethnicity can affect outcomes of patients with cirrhosis, but findings from prospective studies are unclear. We investigated the role of insurance status and race and ethnicity (race/ethnicity) on inpatient and 90-day postdischarge outcomes in a large inpatient cohort of patients with cirrhosis., Methods: We used data from the North American Consortium for the Study of End-Stage Liver Disease (NACSELD) database, from 13 tertiary care centers. Insurance status (uninsured, Medicare, Medicaid, private, and Canadian), race, and ethnicity, were analyzed independent of clinical covariates for their association with transfer to the intensive care unit, acute on chronic liver failure (ACLF), length of hospital stay, inpatient and 90-day death or liver transplantation, and readmission to the hospital within 90 days. Multi-variable analyses and interaction terms were created for insurance, race/ethnicity, and for each outcome, with or without Canadian patients., Results: We analyzed data from 2640 patients in the NACSELD database (971 with private insurance, 770 with Medicare, 456 Canadians, 265 with Medicaid, 178 uninsured, 540 non-Caucasian and 220 Hispanic); 23% required admittance to the intensive care unit, 12% developed NACSELD-defined ACLF, 7% died, 5% underwent liver transplantation. Of the 2288 patients discharged from hospital, 13% underwent liver transplantation, 19% died, and 42% were readmitted within 90 days. In the univariate model, uninsured patients accounted for the highest percentage of alcohol- or bleeding-related admissions and the lowest proportion of outpatient cirrhosis-related medication users. Canadians had the lowest rifaximin use and but higher proportions had hepatic encephalopathy, compared with other groups. Lack of insurance was higher among non-Caucasians, regardless of Hispanic ethnicity. In multi-variable analysis, lack of insurance was associated with ACLF (P = .02) and inversely associated with inpatient liver transplant (P = .05) and 90-day liver transplant (P = .02), regardless of whether Canadians were included or specific insurance type. Race or ethnicity were not significantly associated with outcomes., Conclusions: In analyzing the NACSELD database, we found that insurance status, but not race or ethnicity, were independently associated with ACLF and inpatient or 90-day liver transplantation, regardless of inclusion of Canadian patients., (Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Rationale & Objective: On account of the high prevalence of cardiovascular disease in patients with kidney failure, clinical practice guidelines recommend regular screening for asymptomatic coronary artery disease (CAD) in patients on the kidney transplant waitlist. To date, the cost-effectiveness of such screening has not been evaluated. A Canadian-Australasian randomized controlled trial of screening kidney transplant candidates for CAD (CARSK) is currently is being conducted to answer this question. We conducted a cost-utility analysis to determine, before completion of the trial, the cost-effectiveness of no further screening versus regular screening for asymptomatic CAD and to evaluate potential influential variables that may affect results of the economic evaluation., Study Design: A modeled cost-utility analysis., Setting & Population: A theoretical cohort of adult Australian and New Zealand kidney transplant candidates on the waitlist., Intervention: No further screening for asymptomatic CAD versus regular protocolized screening (annual or second yearly) for CAD after kidney transplant waitlisting., Outcomes: Incremental cost-effectiveness ratio, reported as cost per quality-adjusted life-year (QALY)., Model, Perspectives, & Timeframe: Markov microsimulation model, health system perspective and over a lifetime horizon., Results: In the base case, the incremental cost-effectiveness ratio of no further screening was $11,122 per QALY gained when compared with regular screening. No further screening increased survival by 0.49 life-year or 0.35 QALY. One-way sensitivity analyses identified the costs of transplantation in the first year and CAD prevalence as the most influential variables. Probabilistic sensitivity analyses showed that 94% of the simulations were cost-effective below a willingness-to-pay threshold of $50,000 per QALY gained., Limitations: Rates of cardiovascular events in waitlisted candidates and transplant recipients are limited in the contemporary era. The results may not be generalizable to populations outside Australia and New Zealand., Conclusions: No further screening for CAD after waitlisting is likely to be cost-effective and may improve survival. Precision around CAD prevalence estimates and health care resource use will reduce existing uncertainty., (Copyright © 2019 National Kidney Foundation, Inc. All rights reserved.)

Home blood pressure (BP) telemonitoring and pharmacist case management reduce BP, but cost-effectiveness assessments are mixed. We examined the incremental cost-effectiveness of this intervention vs usual care in Canadians with cerebrovascular disease. A Markov decision model cost-utility analysis examining community-residing, high-risk patients with a recent nondisabling cerebrovascular event was created. A lifetime time horizon and health care payer perspective were used. Achieved BP, future cardiovascular risks, and attendant consequences on quality-adjusted life years and Canadian dollar costs were modeled. BP telemonitoring was assumed to occur for 3 months, then quarterly. Life tables were used to determine overall mortality, adjusted by cardiovascular disease mortality. Relative efficacies of intervention-associated BP lowering, resource use, and costs were obtained from Canadian published literature. Reduction in systolic BP of 9.7 mmHg was used in the base case; subsequently, robust sensitivity analyses were conducted. The results showed that, over the lifetime horizon, telemonitoring with case management led to net health care savings of $1929 Canadian and increased per-patient QALYs by 0.83. These findings were robust to sensitivity analysis, with the intervention remaining dominant or highly cost-effective. Increasing telemonitoring costs by 50% still resulted in the intervention being dominant; if the costs of telemonitoring plus case management were 2-3 times base case cost, incremental cost-effectiveness was $1200-$4700 per quality-adjusted life year gained. In conclusion, home BP telemonitoring and pharmacist case management poststroke lowered costs and improved QALYs. Strategies and funding for broad implementation of this dominant strategy should be implemented., (©2018 Wiley Periodicals, Inc.)

Objectives: Appropriate use of imaging for adult patients with cervical spine (C-spine) injuries in the emergency department (ED) is a longstanding issue. Guidance for C-spine ordering exists; however, the effectiveness of the decision support implementation in the ED is not well studied. This systematic review examines the implementation and effectiveness of evidence-based interventions aimed at reducing C-spine imaging in adults presenting to the ED with neck trauma., Methods: Six electronic databases and the gray literature were searched. Comparative intervention studies were eligible for inclusion. Two independent reviewers screened for study eligibility, study quality, and extracted data. The change in imaging was reported using individual odds ratios (ORs) with 95% confidence intervals (CIs) using random effects., Results: A total of 990 unique citations were screened for relevance of which six before-after studies and one randomized controlled trial were included. None of the studies were assessed as high quality. Interventions consisted primarily of locally developed guidelines or established clinical decision rules such as the NEXUS or the Canadian C-spine rule. Overall, implementation of interventions aimed at reducing C-spine image ordering resulted in a statistically significant reduction in imaging (OR = 0.69, 95% CI = 0.51-0.93); however, heterogeneity was high (I 2  = 82%). Subgroup analysis revealed no differences between studies that specified enrolling alert and stable patients compared to unspecified trauma (p = 0.81) or between studies employing multifaceted versus nonmultifaceted interventions (p = 0.66). While studies generally provided details on implementation strategies (e.g., teaching sessions, pocket cards, posters, computerized decision support) the effectiveness of these implementation strategies were frequently not reported., Conclusion: There is moderate evidence regarding the effectiveness of interventions to reduce C-spine image ordering in adult patients seen in the ED with neck trauma. Given the national and international focus on improving appropriateness and reducing unnecessary C-spine imaging through campaigns such as Choosing Wisely, additional interventional research in this field is warranted., (© 2017 by the Society for Academic Emergency Medicine.)

Accurately documenting the current and future costs of hypertension is required to fully understand the potential economic impact of currently available and future interventions to prevent and treat hypertension. The objective of this work was to calculate the healthcare costs attributable to hypertension in Canada and to project these costs to 2020. Using population-based administrative data for the province of Alberta, Canada (>3 million residents) from 2002 to 2010, we identified individuals with and without diagnosed hypertension. We calculated their total healthcare costs and estimated costs attributable to hypertension using a regression model adjusting for comorbidities and sociodemographic factors. We then extrapolated hypertension-attributable costs to the rest of Canada and projected costs to the year 2020. Twenty-one percent of adults in Alberta had diagnosed hypertension in 2010, with a projected increase to 27% by 2020. The average individual with hypertension had annual healthcare costs of $5768, of which $2341 (41%) were attributed to hypertension. In Alberta, the healthcare costs attributable to hypertension were $1.4 billion in 2010. In Canada, the hypertension-attributable costs were estimated to be $13.9 billion in 2010, rising to $20.5 billion by 2020. The increase was ascribed to demographic changes (52%), increasing prevalence (16%), and increasing per-patient costs (32%). Hypertension accounts for a significant proportion of healthcare spending (10.2% of the Canadian healthcare budget) and is projected to rise even further. Interventions to prevent and treat hypertension may play a role in limiting this cost growth., (© 2015 American Heart Association, Inc.)

Multi-site neuroimaging studies offer an efficient means to study brain functioning in large samples of individuals with rare conditions; however, they present new challenges given that aggregating data across sites introduces additional variability into measures of interest. Assessing the reliability of brain activation across study sites and comparing statistical methods for pooling functional data are critical to ensuring the validity of aggregating data across sites. The current study used two samples of healthy individuals to assess the feasibility and reliability of aggregating multi-site functional magnetic resonance imaging (fMRI) data from a Sternberg-style verbal working memory task. Participants were recruited as part of the North American Prodrome Longitudinal Study (NAPLS), which comprises eight fMRI scanning sites across the United States and Canada. In the first study sample (n=8), one participant from each home site traveled to each of the sites and was scanned while completing the task on two consecutive days. Reliability was examined using generalizability theory. Results indicated that blood oxygen level-dependent (BOLD) signal was reproducible across sites and was highly reliable, or generalizable, across scanning sites and testing days for core working memory ROIs (generalizability ICCs=0.81 for left dorsolateral prefrontal cortex, 0.95 for left superior parietal cortex). In the second study sample (n=154), two statistical methods for aggregating fMRI data across sites for all healthy individuals recruited as control participants in the NAPLS study were compared. Control participants were scanned on one occasion at the site from which they were recruited. Results from the image-based meta-analysis (IBMA) method and mixed effects model with site covariance method both showed robust activation in expected regions (i.e. dorsolateral prefrontal cortex, anterior cingulate cortex, supplementary motor cortex, superior parietal cortex, inferior temporal cortex, cerebellum, thalamus, basal ganglia). Quantification of the similarity of group maps from these methods confirmed a very high (96%) degree of spatial overlap in results. Thus, brain activation during working memory function was reliable across the NAPLS sites and both the IBMA and mixed effects model with site covariance methods appear to be valid approaches for aggregating data across sites. These findings indicate that multi-site functional neuroimaging can offer a reliable means to increase power and generalizability of results when investigating brain function in rare populations and support the multi-site investigation of working memory function in the NAPLS study, in particular., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Published practice guidelines and economic evaluations have come to different conclusions regarding optimal pharmacotherapy for the treatment of uncomplicated hypertension. The drivers of these disparities are not clear. Greater understanding is needed for clinicians, researchers and policy makers to determine the most effective and sustainable strategies., Objectives: To identify how cost and cost-effectiveness considerations are used to generate recommendations by major hypertension guidelines, and determine key drivers of cost-effectiveness conclusions in available economic evaluations., Methods: A systematic search and narrative review of major hypertension guidelines and health technology assessments of first-line antihypertensive therapy were performed., Results: Of the eight guidelines identified, formal cost-effectiveness analysis was rarely integrated in the formulation of recommendations. When guidelines considered costs, recommendations remained incongruent. Two economic evaluations were identified (United Kingdom and Canada); however, these differed in their conclusion of the most cost-effective agent and attractiveness of calcium channel blockers. Review of these economic evaluations suggests that cost-effectiveness conclusions are strongly influenced by relative costs of drug classes; when relative differences in drug costs are lower, the impact on associated conditions such as heart failure and diabetes influences cost-effectiveness conclusions., Conclusion: In the setting of finite health care resources and significant budget impact due to high population prevalence, cost effectiveness is an important consideration in the treatment of uncomplicated hypertension. Identification of key drivers of cost effectiveness will assist interpretation and conduct of current and future economic evaluations.

Background: Despite increased cancer incidence and mortality among overweight and obese men and women, U.S. studies have reported the reduced use of cancer screening among these subjects. We sought to analyze the relationship between overweight/obesity and cancer screening practices using population-based Canadian data., Methods: Responses from adults surveyed in the Canadian Community Health Survey 2003 who provided complete information regarding variables of interest were analyzed. Cancer screening modalities included Pap smear testing, mammography, and fecal occult blood testing, and were based on contemporary recommendations of the Canadian Task Force for Preventive Health. The association between overweight/obesity and cancer screening was explored using logistic regression after adjusting for demographic and socioeconomic factors, health habits, healthcare access, and obesity-related comorbidity. The analysis was conducted in 2007., Results: Compared to normal-weight controls, overweight and obese women were significantly less likely to have undergone cervical cancer screening. In the fully adjusted model, increasing obesity was associated with decreasing odds of Pap smear testing, with overweight, Class-I, -II, and -III obesity having 95% ORs of 0.87 (0.81, 0.94); 0.79 (0.72, 0.88); 0.62 (0.54, 0.71); and 0.61 (0.53, 0.72), respectively. The prevalence of biennial breast and colorectal cancer screenings was largely unaffected by weight in the adjusted analyses., Conclusions: Overweight and obesity are associated with markedly lower utilization of cervical cancer screening, despite increased disease risks. This association is independent of sociodemographic factors, comorbidity, and healthcare access. This is consistent with findings in U.S. populations, and suggests that patient and provider factors serve as greater barriers to screening than do healthcare system factors.