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Abstract Background Many studies have described barriers to gender-affirming surgery (GAS) in Canada; however, few have explored why these barriers persist. To address this knowledge gap, we sought to describe documents related to public health insurance (Medicare) for GAS to identify the types of procedures covered, variations in coverage across provinces and territories, and changes in policy over time. Methods We conducted a descriptive cross-sectional study using an environmental scan approach. We queried 23 government websites, the Google search engine, and an online legal database between July 2022 and April 2024 to gather gray literature documents related to GAS and Medicare. Variables from relevant documents were compiled to create a present, at-glance overview of GAS Medicare coverage for all provinces and territories and a timeline of policy changes across Canada. Results Eight provinces and three territories had documents or websites related to GAS Medicare coverage (85%). We identified 15 GAS procedures that were covered variably across Canada. Yukon (n = 14) covered the most types of GAS, while Quebec and Saskatchewan covered the least (n = 6). Mastectomy and genital surgeries were covered across Canada, but other GAS were rarely covered. Five provinces and territories provided coverage for travel-related costs. Our GAS Medicare timeline showed differential expansion of GAS coverage in Canada over the last 25 years. Conclusions We provide previously unreported information regarding GAS Medicare coverage in Canada. We hope our findings will help patients and healthcare providers navigate a complicated public healthcare system. We also highlight barriers within GAS Medicare documents and make recommendations to alleviate those barriers.

Abstract Background Eating disorders have one of the highest mortality rates among psychiatric illnesses. Timely intervention is crucial for effective treatment, as eating disorders tend to be chronic and difficult to manage if left untreated. Clinical practice guidelines play a vital role in improving healthcare delivery, aiming to minimize variations in care and bridge the gap between research and practice. However, research indicates an active guideline implementation approach is crucial to effective uptake. Methods Mixed methods will be used to inform and evaluate our guideline implementation approach. Semi-structured focus groups will be conducted in each of the eight provinces in Canada. Each focus group will comprise 8–10 key stakeholders, including clinicians, program administrators, and individuals with lived experience or caregivers. Qualitative data will be analyzed using conventional content analysis and the constant comparison technique and the results will be used to inform our implementation strategy. The study will then evaluate the effectiveness of our implementation approach through pre- and post-surveys, comparing changes in awareness, use, and impact of the guidelines in various stakeholder groups. Discussion Through a multifaceted implementation strategy, involving the co-creation of educational materials, tailored training, and context-specific strategies, this study intends to enhance guideline uptake and promote adherence to evidence-based practices. Our study will also contribute valuable information on the impact of our implementation strategies.

In February 2019, OUTSaskatoon, a 2SLGBTQ+ resource centre in Saskatoon, SK, received 1.1 M in federal funds to support a five-year project set to intervene in the instances and societal perpetuation of gender-based violence toward the 2SLGBTQ+ community. The project involved partnerships between OUTSaskatoon and the University of Saskatchewan, including a comprehensive research and evaluation stream to accompany the delivery of front-line services and educational activities. During the project’s application to the University’s Research Ethics Board (REB), members of the ethics review committee expressed heightened levels of fear and discomfort not only with the subject-matter, but with the role (and centrality) of the community organization within the research process. The documented experience explores pressing barriers to effective and ethical community-university research partnerships. To this end, the authors explore their communications with the REB alongside the themes of “vulnerability,” “risk-aversion,” and more broadly regarding the timelines of community work versus university processes. Together these themes maintain a culture of academic exceptionalism that causes significant barriers to the development of reciprocal partnerships between community partners and universities. In this case, the outcome was hopeful, as a formal complaint to the REB received a documented apology. In documenting this specific, though not unique, experience, we aim to highlight the possibilities for leaning in and building ethical space between and through community and academic environments to foreground both needed critique and collaborative pathways forward.

Abstract Objective The COVID-19 pandemic has had detrimental effects on mental health. Literature on the impact on individuals with eating disorders is slowly emerging. While outpatient eating disorder services in Canada have attempted to transition to virtual care, guidelines related to optimal virtual care in this field are lacking. As such, the objective of our Canadian Consensus Panel was to develop clinical practice guidelines related to the provision of virtual care for children, adolescents, and emerging adults living with an eating disorder, as well as their caregivers, during the COVID-19 pandemic and beyond. Methods Using scoping review methodology (with literature in databases from 2000 to 2020 and grey literature from 2010 to 2020), the Grading of Recommendations, Assessment, Development, and Evaluation system, the Appraisal of Guidelines, Research and Evaluation tool, and a panel of diverse stakeholders from across Canada, we developed high quality treatment guidelines that are focused on virtual interventions for children, adolescents, and emerging adults with eating disorders, and their caregivers. Results Strong recommendations were supported specifically in favour of in-person medical evaluation when necessary for children, adolescents, and emerging adults, and that equity-seeking groups and marginalized youth should be provided equal access to treatment. For children and adolescents, weak recommendations were supported for telehealth family-based treatment (FBT) and online guided parental self-help FBT. For emerging adults, internet cognitive-behavioural therapy (CBT)-based guided self-help was strongly recommended. Weak recommendations for emerging adults included CBT-based group internet interventions as treatment adjuncts, internet-based relapse prevention Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) guided self-help, telehealth relapse prevention using MANTRA, and guided CBT-based smartphone apps as treatment adjuncts. For caregivers of children and adolescents, weak recommendations were supported for virtual parent meal support training, and moderated online caregiver forums and support groups. For caregivers of emerging adults, guided parental self-help CBT was strongly recommended, and unguided caregiver psychoeducation self-help was weakly recommended. Conclusions Several gaps for future work were identified including the impact of sex, gender, race, and socioeconomic status on virtual care among children, adolescents, and emerging adults with eating disorders, as well as research on more intensive services, such as virtual day hospitals.

Abstract Objectives Eating disorders are common and serious conditions affecting up to 4% of the population. The mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to which treatment they should use. Our objective was to produce such a guideline. Methods Using systematic review, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, and the assembly of a panel of diverse stakeholders from across the country, we developed high quality treatment guidelines that are focused on interventions for children and adolescents with eating disorders. Results Strong recommendations were supported specifically in favour of Family-Based Treatment, and more generally in terms of least intensive treatment environment. Weak recommendations in favour of Multi-Family Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga and atypical antipsychotics were confirmed. Conclusions Several gaps for future work were identified including enhanced research efforts on new primary and adjunctive treatments in order to address severe eating disorders and complex co-morbidities.

New York City has a long history of gentrification, well demonstrated by the strategies of “revitalization” and “re-development” that have occurred in Harlem throughout the last century. Less well known is the historical, political, and social context surrounding New York’s Pier 45, also known as the Christopher Street Pier. As a historically-known gathering spot for lesbian, gay, bisexual and transgender individuals, the Christopher Street Pier gained recognition for harbouring what could be described as a queer public. However, recent processes of gentrification have changed Pier 45 into the Hudson River Park, ostensibly privatizing the site. With reference to Braidotti’s nomadic subject, this paper explores the Christopher Street Pier as a representation of queer geographies. Further, it argues that the re-appropriation of the once queer public space of Pier 45 exposes a municipal agenda of surveillance in relation to sexualized and racialized identities. Through reference to the activist practices of FIERCE, a local NGO, I show how the nomadic subjectivities of queer youth open up a discussion of ethical responsibility and point toward strategic movements of resistance in the face of gentrification in New York’s West Village.

Background: Many studies have described barriers to gender-affirming surgery (GAS) in Canada; however, few have explored why these barriers persist. To address this knowledge gap, we sought to describe documents related to public health insurance (Medicare) for GAS to identify the types of procedures covered, variations in coverage across provinces and territories, and changes in policy over time. Methods: We conducted a descriptive cross-sectional study using an environmental scan approach. We queried 23 government websites, the Google search engine, and an online legal database between July 2022 and April 2024 to gather gray literature documents related to GAS and Medicare. Variables from relevant documents were compiled to create a present, at-glance overview of GAS Medicare coverage for all provinces and territories and a timeline of policy changes across Canada. Results: Eight provinces and three territories had documents or websites related to GAS Medicare coverage (85%). We identified 15 GAS procedures that were covered variably across Canada. Yukon (n = 14) covered the most types of GAS, while Quebec and Saskatchewan covered the least (n = 6). Mastectomy and genital surgeries were covered across Canada, but other GAS were rarely covered. Five provinces and territories provided coverage for travel-related costs. Our GAS Medicare timeline showed differential expansion of GAS coverage in Canada over the last 25 years. Conclusions : We provide previously unreported information regarding GAS Medicare coverage in Canada. We hope our findings will help patients and healthcare providers navigate a complicated public healthcare system. We also highlight barriers within GAS Medicare documents and make recommendations to alleviate those barriers. [ABSTRACT FROM AUTHOR]

Objectives: Normative beliefs around gender and sexuality place individuals in the Two Spirit, lesbian, gay, bisexual, trans, and queer (2SLGBTQ) community at risk for poorer health outcomes within the health care system compared with their heterosexual and cisgender counterparts, particularly within gendered areas of care including family planning and fertility intentions. The purpose of this research was to explore the effect that the normative beliefs of heteronormativity and cisnormativity had on the experiences of 2SLGBTQ people engaged in family planning, and to begin to understand how health care providers can provide appropriate, safe, and holistic care. Methods: We conducted a qualitative study using case study methodology and completing semi-structured interviews with 11 participants with diverse genders and sexualities. Findings: For members of the 2SLGBTQ community, family planning is greatly affected by ideals of normal, intersections of identities, health care systems, and community. They may face additional emotional labor and intentional decision-making when related to family planning. Heteronormativity and cisnormativity greatly impact the health care that is received. Conclusions: The findings contribute information in the limited field of research related to the 2SLGBTQ community and may support health care providers in providing holistic care. [ABSTRACT FROM AUTHOR]

This paper draws on the first comprehensive study of Two Spirit, trans, nonbinary, and gender-nonconforming (2STNBGN) people in Saskatchewan. Despite challenges, including rising conservatism and targeted political attacks, we temper assumptions that trans and queer people want to leave Saskatchewan for other locations where the 2STNBGN community is assumed to be bigger. Many of our participants described choosing to stay in the province as an intentional way to build community, advocate for support, and cultivate belonging. We further explore a distinctly prairie politic that includes Two Spirit and Indigiqueer projects of belonging to land and community, cross-provincial trans community organizing, and a complicated geography that supersedes binaries between urban and rural. Our research tells us that gender-diverse people on the prairies are enacted through a "grounded relationality," a context-dependent, binary-resistant expression through place, whether that place is land, city, country, or small-town paint store. Ultimately, our research shows that despite an increasingly chilly political climate toward 2STNBGN people, Saskatchewan still bears witness to trans joy, innovative activism, and an activated trans community that is invested in a future that they are a part of. Plain Language Summary: This research is unique in its discussion of Two Spirit, trans, nonbinary, and gender-nonconforming (2STNBGN) people in the Canadian province of Saskatchewan. We talk about the ways that people on the prairies, especially Two Spirit and Indigiqueer folks, feel connected to the land and their community and further that gender-diverse people express and understand themselves in ways that aren't tied to strict divisions between urban and rural or gender and sexuality. Even though the political climate in Saskatchewan isn't always welcoming to gender-diverse people, our research found that there's still a lot of happiness and activism in the trans community here. They're working toward a future where they feel included and valued. Many of the people we talked to actually choose to stay in Saskatchewan on purpose to build community and push for social change. [ABSTRACT FROM AUTHOR]

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