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BackgroundOver the past several years, the emergence of mobile mental health apps has increased as a potential solution for populations who may face logistical and social barriers to traditional service delivery, including individuals connected to the military. ObjectiveThe goal of the #Here4U App – Military Version is to provide evidence-informed mental health support to members of Canada’s military community, leveraging artificial intelligence in the form of IBM Canada’s Watson Assistant to carry on unique text-based conversations with users, identify presenting mental health concerns, and refer users to self-help resources or recommend professional health care where appropriate. MethodsAs the availability and use of mental health apps has increased, so too has the list of recommendations and guidelines for efficacious development. We describe the development and testing conducted between 2018 and 2020 and assess the quality of the #Here4U App against 16 criteria for rigorous mental health app development, as identified by Bakker and colleagues in 2016. ResultsThe #Here4U App – Military Version met the majority of Bakker and colleagues’ criteria, with those unmet considered not applicable to this particular product or out of scope for research conducted to date. Notably, a formal evaluation of the efficacy of the app is a major priority moving forward. ConclusionsThe #Here4U App – Military Version is a promising new mental health e-solution for members of the Canadian Armed Forces community, filling many of the gaps left by traditional service delivery.

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

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

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

This environmental scan study aimed to determine the current status of mental wellness resources and toolkits on Canadian post-secondary campuses. This study was completed in the summer of 2016 and consisted of three parts: Web search, campus survey, and semi-structured, individual interviews. The Web search of 135 institutions indicated that the size of the campus population influenced the availability and variety of existing mental wellness resources. In the survey conducted, over 80% of the 39 institutions had various services. Mental health-related toolkits listed in the survey were well-perceived and included de-stressing materials and mental health service information. Four common themes emerged in the interviews conducted: (a) accessibility of services, (b) support networks need to shift, (c) mental wellness resources can accomplish multiple purposes, and (d) necessary components to produce an effective mental wellness toolkit. The findings of this study can guide the future development of a potential national mental wellness toolkit for Canadian college campuses.

This study aimed to better understand campus mental health culture and student mental health coping strategies, and to identify the mental health needs of students as well as gaps in mental health services within postsecondary education. A videovoice method was used to identify and document health-related issues and advocate for change. Forty-one interviews were conducted with campus stakeholders at five universities. Five themes involving mental health emerged from the campus interviews: the stigma of mental illness; campus culture related to mental health; mental health services available and barriers to mental health services on campus; accommodations for students' mental health needs; and student mental health coping strategies. A documentary was developed to advocate for better mental health. We conclude that although Canadian campuses are raising awareness about mental health issues, there is not enough mental health infrastructure support on campuses; in particular, accessibility to campus mental health resources needs improvement.

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