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To understand the impact of ongoing reform of mental health and dementia care in Ontario, an examination of prevalence and health services utilization rates is needed. However, there exists a gap in current prevalence and health services research specific to dementia care in Ontario. The objective of this study was to address these concerns using linked administrative databases to determine the incremental use of health services by elderly Ontarians with dementia. Overall, study results demonstrated that individuals with dementia used services in a pattern similar to non-demented persons, albeit at a higher level. Exceptions were women's use of hospital and home care services, where the most elderly women received significantly fewer services. Thus, the study provided important insight regarding the relative levels of health services used by demented Ontarians. Research in this area will become increasingly important as the population ages and the settings integral to dementia care and management shift and evolve. (Contains 7 tables and 2 notes.)

The objective of this study was to evaluate the reproducibility of a Task Description Questionnaire that was designed to investigate exposures to, and influential factors for, problematic tasks experienced by working pregnant women. The questionnaire comprised questions concerning 22 task components (covering working posture, manual material handling, work pace, prolonged postures and others), eight influential factors contributing to problematic tasks, discomfort (measured using a body map) and level of effort to perform the tasks. Reproducibility of the questionnaire was assessed by interviewing participants on two occasions one week apart for interviews at both 20 and 34 weeks of pregnancy. Eleven and 13 problematic tasks were reported by 21 working pregnant women at 20 and 34 weeks of pregnancy, respectively. These tasks were surveyed using the Task Description Questionnaire. Kappa statistics and correlation coefficients (supplemented by paired t-tests) were used to examine the reproducibility of responses to the questionnaire. The results showed that most of the variables were measured with very good or satisfactory reproducibility. The reproducibility of exposure to work posture was higher than that of exposure to manual material handling. There was no significant difference between test and retest means for the discomfort scores measured on the body map, except for the maximum discomfort score for the whole body in the 34 weeks survey. The study suggests that the questionnaire can be reliably used in the study of problematic tasks experienced by pregnant women. But an initial preview of the questions by the subjects and explanation of the questions given to the subjects by the interviewer may help to produce more reliable results. [ABSTRACT FROM AUTHOR]

BACKGROUND AND RESEARCH OBJECTIVES: Individuals with coronary artery disease undergo coronary artery bypass graft (CABG) surgery to relieve symptoms, improve quality of life, and reduce early death. Pain is the most prevalent symptom identified by persons after CABG surgery. The objective of the study was to compare the prevalence and severity of pain and pain-related interference with activities in men and women 9 weeks after CABG surgery. SUBJECTS AND METHODS: Participants included men (n = 78) and women (n = 17) who were having first-time nonemergency CABG surgery. Pain outcome data were collected via telephone using the McGill Pain Questionnaire and the Brief Pain Inventory-Interference Subscale. RESULTS AND CONCLUSIONS: Forty-seven percent of the women (n = 8) had moderate to severe pain described as the 'worst pain in previous 24 hours with movement' 9 weeks following discharge from CABG surgery. More women were divorced, widowed, or single (P = .0002). There was a statistically significant between-groups difference, with more women reporting moderate to severe pain with movement (P = .03), as well as greater interference with walking (P = .01) and sleeping (P = .01) due to pain. Further research with larger sample sizes should investigate what conditions lead to the sex differences in the pain experience after CABG surgery, what mechanisms and support structures underlie these differences, and how these differences can inform the clinical management of pain. [ABSTRACT FROM AUTHOR]

PURPOSE/OBJECTIVES: To analyze research related to the pediatric oncology population supportive care needs from diagnosis to treatment. DATA SOURCES: Articles published from 1992-2002. DATA SYNTHESIS: 49 studies were included. All six categories of the Supportive Care Needs Framework were found, with most studies addressing one to three of the need categories. Informational (88%) and emotional (84%) needs were identified most frequently. CONCLUSIONS: No one study examined the entire range and types of supportive care needs from diagnosis to treatment. This knowledge is key to planning appropriate care and services. Future research should be directed at understanding the full constellation of needs encountered by parents during this time. Further refinement of the Supportive Care Needs Framework is required to fully define the categories of need. IMPLICATIONS FOR NURSING: Although more research is required, supportive care that focuses on informational and emotional support appears to be most important from diagnosis to treatment. Using a conceptual framework such as the Supportive Care Needs Framework provides a methodology for planning care based on needs. [Abstract for this article also available on page 1055 of printed version. Full article available at www.ons.org/xp6/ONS/Library.xml/ONS_Publications.xml/ONF.xml [ABSTRACT FROM AUTHOR]

Objective: Despite a brief decline during the COVID-19 pandemic, vaping behaviors among adolescents continue to be an international public health concern because of associated health risks and harms. A thorough investigation of existing interventions preventing adolescent vaping is needed to help address this public health crisis and reduce serious and avoidable vaping-related health risks. We reviewed the literature to identify public health interventions aimed at preventing adolescent vaping and summarized their key components and outcome measures., Design: We conducted a scoping review of the literature using the Joanna Briggs Institute methodology searching in MEDLINE, CINAHL, Embase, PubMed, PsycINFO, ProQuest, and Web of Science. Two reviewers screened 589 records for relevance. Studies from any location, reported in English, and described vaping prevention interventions targeting adolescents were included. Records were excluded if they were reported in other languages, published outside the review timeframe, lacked an evaluation, focused on cessation-based interventions, or were review articles. Data extracted included intervention type, key components, and outcome measures., Results: Thirty-eight included articles were identified and categorized into three intervention categories: school-based, public education/risk communication campaigns, and public policies/government regulations. Key components of the interventions included format, duration, and topics. Formats varied from single to multi-sessions. Prominent topics covered included risks and harms associated with vaping, and the most frequently reported outcome measures used were knowledge, attitudes, and beliefs., Conclusion: Our findings summarize existing public health interventions found in the literature and insights into approaches used to address the global adolescent vaping crisis., (© 2024 The Author(s). Public Health Nursing published by Wiley Periodicals LLC.)

Canada's healthcare system is experiencing a health and human resource (HHR) crisis. The available evidence of the scope of the problem and potential solutions, however, is not commensurate with the scale and urgency of the crisis. The use of linked health administrative data to study the health, well-being and work patterns of the health workforce offers critical insights into how the workforce is functioning at a population level. Efforts to rapidly expand the use of these data are needed to understand the scope of the HHR crisis, find opportunities for improvement and drive change., (Copyright © 2024 Longwoods Publishing.)

Aim: To assess the feasibility of Diabetic Foot Care Group (DFCG), a social media-based self-management education and support intervention, for people with diabetes (PWD) empowerment in diabetes-related foot ulceration prevention., Methods: A partially randomized preference trial was conducted among 32 PWD. DFCG was implemented through Facebook. Participants in the intervention group joined the DFCG in addition to their usual care, while the control group received usual care. Data were collected online using questionnaires on participants' DFCG acceptance, engagement and preliminary efficacy on nine diabetes foot care-related outcomes at baseline, one, and three months post-intervention., Results: The participants' study intervention acceptability and engagement rates were 84.2% and 55.2%, respectively. DFCG efficacy rate compared to usual care was 88.9% to 22.2%. Three diabetes foot care-related outcomes increased significantly in the intervention group three-month post-intervention: foot self-care adherence ( p  = 0.001, η p 2  = 0.35), preventive foot self-care practice ( p  = 0.002, η p 2  = 0.33), and physical health status ( p  < 0.02, η p 2  = 0.23)., Conclusion: DFCG is feasible and could effectively improve diabetes foot care-related outcomes., Innovation: Social media is an innovative approach healthcare professionals could utilize to virtually support PWD in ongoing learning and engagement in optimal foot self-care activities., Trial Registration: ClinicalTrials.gov, Identifier: NCT04395521., Competing Interests: The authors declare that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter discussed in this manuscript., (© 2024 The Authors. Published by Elsevier B.V.)

Objectives: The aim of this study was to determine the associations between glucocorticoid administration during chemotherapy for hematologic malignancy and hyperglycemia, new-onset diabetes, and mortality in Ontario, Canada. Hospitalization and emergency room utilization during the chemotherapy treatment period were also described., Methods: We conducted a retrospective cohort study using health administrative data from ICES, Ontario, to assess risk of new-onset diabetes, new-onset hyperglycemia, and hyperglycemia for individuals with leukemia, non-Hodgkin lymphoma (NHL), and Hodgkin lymphoma (HL) receiving glucocorticoids during chemotherapy between 2006 and 2016. Using multivariable regression models, we determined the associations between glucocorticoid exposure and our outcomes of interest, controlling for age, sex, marginalization, and comorbidities., Results: Our cohort included 19,530 individuals; 71.1% (n=13,893) received a glucocorticoid. The highest proportion of hyperglycemia occurred with leukemia (25.4%, n=1,301). Of the 15,580 individuals with no history of diabetes, those with leukemia had the highest rate of new-onset diabetes (7.1%, n=279) and new-onset hyperglycemia (18.1%, n=641), and glucocorticoid exposure increased the risk of new-onset diabetes (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.01 to 1.64, p=0.04) and new-onset hyperglycemia (HR 1.28, 95% CI 1.09 to 1.5, p=0.003). Hyperglycemia during chemotherapy increased the risk of all-cause mortality for the combined (HR 1.18, 95% CI 1.09 to 1.27, p<0.0001) and NHL (HR 1.16, 95% CI 1.04 to 1.28, p=0.007) cohorts., Conclusions: Hyperglycemia is common during hematologic chemotherapy treatment and is associated with a modest increased risk of all-cause mortality. Routine screening, monitoring, and management of hyperglycemia should be an integral part of treatment plans for leukemia, NHL, or HL, with or without glucocorticoid administration., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Quality integrated care, which involves primary care and mental health clinicians working together, can help identify and treat adolescent depression early. We explored systemic barriers to quality integrated care at the provincial level in Ontario, Canada using a learning system approach., Methods: Two Ontario Health Teams (OHTs), regional networks designed to support integrated care, completed the Practice Integration Profile (PIP) and participated in focus groups., Results: The OHTs had a median PIP score of 69 out of 100. Among the PIP domains, the lowest median score was case identification (50), and the highest one was workspace (100). The focus groups generated 180 statements mapped to the PIP domains. Workflow had the highest number of coded statements (59, 32.8%)., Discussion: While the primary care practices included mental health clinicians on-site, the findings highlighted systemic barriers with adhering to the integrated care pathway for adolescent depression. These include limited access to mental health expertise for assessment and diagnosis, long wait times for treatment, and shortages of clinicians trained in evidence-based behavioral therapies. These challenges contributed to the reliance on antidepressants as the first line of treatment due to their accessibility rather than evidence-based guidelines., Conclusion: Primary care practices, within regional networks such as OHTs, can form learning systems to continuously identify the strategies needed to support quality integrated care for adolescent depression based on real-world data., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Objective: The objective of the review is to systematically examine the emerging literature related to public health interventions aimed at preventing adolescent vaping., Introduction: The prevalence of vaping among adolescents is a rising concern worldwide. A thorough investigation of existing public health interventions to prevent vaping among adolescents is imperative to reduce serious and avoidable vaping-related health risks for this cohort. Many vaping-prevention interventions have been described in the literature, but their key components and outcomes have not been summarized., Inclusion Criteria: All English literature related to public health interventions preventing adolescent (aged 10 to 18 years) vaping from all countries will be included., Methods: This review will follow the JBI methodology for scoping reviews. A comprehensive search of academic and gray literature using MEDLINE (Ovid), CINAHL (EBSCOhost), Embase (Ovid), PubMed, PsycINFO (Ovid), ProQuest (Health and Medicine and Sociology Collections), and Web of Science Core Collection will be performed. Articles will be screened for inclusion by 2 independent reviewers. Results will be extracted using customized tools and summarized in a final report using narrative synthesis and presented in table format., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 JBI.)

Access to high-quality primary care has been identified as a pressing need for adults with intellectual and developmental disabilities (IDD). Interprofessional primary care teams offer comprehensive and coordinated approaches to primary care delivery and are well-positioned to address the needs of adults with IDD. The overall aim of this article is to describe the current provision of interprofessional primary care for adults with IDD from the perspectives of patients, caregivers, and health providers. Results provide important insights into the current state of practice and highlight a critical need for further work in the field to develop processes to engage in team-based care and demonstrate the value of the approach for this population., (©AAIDD.)

Residents of long-term care (LTC) homes have potentially painful conditions and are prescribed opioids to manage their pain, despite the risks associated with the use of these high-risk medications. Therefore, the overall aim of this study was to describe the associations between resident and facility characteristics of residents prescribed long-term opioid therapy and those who remained on opioids or had opioids deprescribed. We conducted a retrospective cohort study utilizing health administrative databases housed within ICES. Our cohort included 26,592 of 121,564 LTC residents (21.9%) of Ontario LTC homes who were prescribed long-term opioid therapy at cohort inception. Of these residents, 4,299 (16.2%) residents had opioids deprescribed during the follow-up period. Opioid deprescribing was associated with younger age, high comorbidity, and co-prescription with benzodiazepines and gabapentinoids. Our findings suggest that there is variation in the characteristics of residents who continued long-term opioid therapy and those who subsequently had opioids deprescribed, and these characteristics need to be considered as part of individualized pain management plans of care., Competing Interests: Declaration of Competing Interest The authors declare that there are no potential conflicts with respect to the research, authorship, and/or publication of this article., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Aim: To assess the extent to which Canadian undergraduate baccalaureate nursing programs have incorporated Canadian competencies for Registered Nurses in primary care into their curricula., Background: Canadian competencies for Registered Nurses in primary care have several benefits, including their ability to inform primary care education in undergraduate nursing programs and to assist in building a robust primary care nursing workforce., Design: We conducted a national cross-sectional survey of undergraduate baccalaureate nursing programs (n = 74)., Methods: The survey was conducted between April-May 2022. We used a modified version of the "Community Health Nurses' Continuing Education Needs Questionnaire". Respondents indicated their level of agreement on a 6-point Likert scale with 47 statements about the integration of the competencies in their program (1 = strongly disagree; 6 = strongly agree)., Results: The response rate was 51.4%. The overall mean across the six competency domains was 4.73 (SD 0.30). The mean scores of each domain ranged from 4.23 (SD 1.27) for Quality Assurance, Evaluation and Research to 5.17 (SD 0.95) for Communication., Conclusions: There are gaps in how these competencies are included in undergraduate education programs and opportunities to strengthen education for this growing workforce in Canada., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: We aimed to differentiate the practice patterns of nurses in specialized and advanced roles in a cross-sectional study., Method: Canadian nurses completed a self-report questionnaire (June 2017-September 2017). Demographic data and time spent in five domains of advanced practice were compared across three nurse groups. Regression analysis examined factors associated with domain involvement., Results: Respondents ( n = 1,107) represented all provinces/territories, including 396 specialized nurses (SNs), 211 clinical nurse specialists (CNSs) and 490 nurse practitioners (NPs). Nurses across all groups were the most involved in direct comprehensive care and the least involved in research. NPs were more involved in direct comprehensive care compared to CNSs ( p < 0.001) and SNs ( p < 0.001). CNSs were more involved than SNs and NPs in support of systems, education, research and professional leadership ( p < 0.001). Role type, years as an advanced practice nurse and specialist certification were modest predictors of domain involvement., Conclusion: Distinguishing how specialized and advanced nursing roles contribute to healthcare can inform policies to support their optimal utilization in healthcare systems., (Copyright © 2023 Longwoods Publishing.)

Background: Individuals experiencing multimorbidity have more complex healthcare needs, use more healthcare services, and access multiple service providers across the healthcare continuum. They also experience higher rates of functional decline. Rehabilitation therapists are well positioned to address these functional needs; however, little is known about the influence of rehabilitation therapy on patient outcomes, and subsequent unplanned healthcare utilization for people with multimorbidity. The aims of this study were to: 1) describe and compare the characteristics of people with multimorbidity receiving: home care rehabilitation therapy alone, other home care services without rehabilitation therapy, and the combination of home care rehabilitation therapy and other home care services, and 2) determine the association between home care rehabilitation therapy and subsequent healthcare utilization among those recently discharged from an acute care unit., Methods: This retrospective cohort study used linked health administrative data housed within ICES, Ontario, Canada. The cohort included long-stay home care clients experiencing multimorbidity who were discharged from acute care settings between 2007-2015 (N = 43,145). Descriptive statistics, ANOVA's, t-tests, and chi-square analyses were used to describe and compare cohort characteristics. Multivariable logistic regression was used to understand the association between receipt of rehabilitation therapy and healthcare utilization., Results: Of those with multimorbidity receiving long-stay home care services, 45.5% had five or more chronic conditions and 46.3% required some assistance with ADLs. Compared to people receiving other home care services, those receiving home care rehabilitation therapy only were less likely to be readmitted to the hospital (OR = 0.78; 95% CI: 0.73-0.83) and use emergency department services (OR = 0.73; 95% CI: 0.69-0.78) within the first 3-months following hospital discharge., Conclusions: Receipt of rehabilitation therapy was associated with less unplanned healthcare service use when transitioning from hospital to home among persons with multimorbidity. These findings suggest rehabilitation therapy may help to reduce the healthcare burden for individuals and health systems. Future research should evaluate the potential cost savings and health outcomes associated with providing rehabilitation therapy services for people with multimorbidity., (© 2023. The Author(s).)

Background: Scope of practice enactment is poorly understood in the primary care setting., Purpose: The following research objectives were addressed: (1) to revise and adapt the Actual Scope of Practice (ASCOP) questionnaire for use in the primary care setting, and (2) to determine internal consistency, construct validity, and sensitivity of the modified instrument., Methods: To address the first objective, a narrative literature review and synthesis and an expert panel review was conducted. To address the second objective, a cross-sectional survey of 178 registered nurses who worked in primary care was conducted., Results: The ASCOP, with few modifications, addressed key attributes of nursing scope of practice in the primary care setting. The modified instrument yielded acceptable alpha coefficients ranging from 0.66 to 0.91. Total mean score of 4.8 (SD  =  .67) suggests that registered nurses within interprofessional primary care teams almost always engage in activities reflected in the modified instrument., Conclusions: The modified instrument is the first instrument validated to measure nursing scope of practice enactment in the primary care setting. Findings from this study support the use of the modified ASCOP questionnaire as a reliable and valid measure of scope of practice enactment among primary care registered nurses.

Background: Transplant rates in Ontario rose steeply in the decade prior to the COVID-19 pandemic. Reasons for that increase remain unclear, but the inter-organizational arrangement of organ donation programs may have contributed. However, there is a paucity of literature investigating these inter-organizational arrangements, with a limited understanding of how communication facilitates organ donation. Understanding these arrangements may help to re-establish rising organ donation rates post-pandemic., Objective: To describe interprofessional interactions of Organ and Tissue Donation Coordinators (OTDCs) during organ donation cases, within organ donation programs in Ontario, from an organizational perspective (describing structure, context, process)., Methods: Mixed-method social network analysis (SNA) approach analyzing 14 organ donation cases just before the COVID-19 pandemic., Results: Structure: Social network graphs depict the joint work performed by hospital staff and OTDCs, with a great part of the communication being processed through the OTDC., Context: Network density ranged from 0.05 to 0.24 across cases, and health care professionals perceived an atmosphere of shared vision and trust among team members., Process: Most networks had a degree centralization <0.50 suggesting a decentralized information flow, and participants perceived decisions being jointly made. The characteristic path length of cases ranged from 1.6 to 3.2, suggesting potential for rapid information diffusion. Overall, data reinforced the OTDC role of intermediator within the communication process, and hospital staff perceived OTDCs as central players. Hospital staff and OTDCs reported frustration with some aspects of the flow of information during the organ allocation processes., Conclusion: Findings from this study provide a network map of communications within organ donation cases and reinforce the importance of the OTDC role. Opportunities for quality improvement within these processes are identified., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Introduction: At a population level, there is a poor understanding of the incidence and pre-disposing risk factors of postpartum haemorrhage (PPH) among women with inherited bleeding disorders (IBD)., Aim: To determine the incidence of PPH, and identify maternal factors associated with risk of PPH among women with IBD., Methods: We conducted a retrospective cohort study using data housed within ICES (formerly known as the Institute for Clinical Evaluative Sciences). The cohort included women with an in-hospital, live or stillborn delivery, between January 2014 and December 2019. The primary outcome was PPH (identified by ICD-10 code O72). PPH incidence and risk factors were compared between women with and without IBD. Temporal trends were assessed using the Cochrane-Armitage test. Between group differences were assessed using standardised differences (std. difference)., Results: Total 601,773 women were included; 2002 (.33%) had an IBD diagnosis. PPH incidence was 1.5 times higher (7.3 vs. 4.9 cases/100 deliveries, std. difference .1) among women with IBD compared to women without. Women with IBD were slightly older (31.7 vs. 30.7 years), had higher rates of hypertension, previous PPH, and induction of labour. Women with IBD were more frequently diagnosed with anaemia (4.8% vs. 1.8%; std difference .17) and had lower haemoglobin levels at admission for delivery compared to women without IBD., Conclusions: This study contributes to the literature regarding obstetric bleeding among women with IBD, showing that anaemia at delivery may be an important risk factor for PPH. Given their predisposition to anaemia, clarifying this relationship will optimise management and outcomes., (© 2022 John Wiley & Sons Ltd.)

Background: Globally, registered nurses (RNs) are increasingly working in primary care interdisciplinary teams. Although existing literature provides some information about the contributions of RNs towards outcomes of care, further evidence on RN workforce contributions, specifically towards patient-level outcomes, is needed. This study synthesized evidence regarding the effectiveness of RNs on patient outcomes in primary care., Methods: A systematic review was conducted in accordance with Joanna Briggs Institute methodology. A comprehensive search of databases (CINAHL, MEDLINE Complete, PsycINFO, Embase) was performed using applicable subject headings and keywords. Additional literature was identified through grey literature searches (ProQuest Dissertations and Theses, MedNar, Google Scholar, websites, reference lists of included articles). Quantitative studies measuring the effectiveness of a RN-led intervention (i.e., any care/activity performed by a primary care RN) that reported related outcomes were included. Articles were screened independently by two researchers and assessed for bias using the Integrated Quality Criteria for Review of Multiple Study Designs tool. A narrative synthesis was undertaken due to the heterogeneity in study designs, RN-led interventions, and outcome measures across included studies., Results: Forty-six patient outcomes were identified across 23 studies. Outcomes were categorized in accordance with the PaRIS Conceptual Framework (patient-reported experience measures, patient-reported outcome measures, health behaviours) and an additional category added by the research team (biomarkers). Primary care RN-led interventions resulted in improvements within each outcome category, specifically with respect to weight loss, pelvic floor muscle strength and endurance, blood pressure and glycemic control, exercise self-efficacy, social activity, improved diet and physical activity levels, and reduced tobacco use. Patients reported high levels of satisfaction with RN-led care., Conclusions: This review provides evidence regarding the effectiveness of RNs on patient outcomes in primary care, specifically with respect to satisfaction, enablement, quality of life, self-efficacy, and improvements in health behaviours. Ongoing evaluation that accounts for primary care RNs' unique scope of practice and emphasizes the patient experience is necessary to optimize the delivery of patient-centered primary care., Protocol Registration Id: PROSPERO: International Prospective Register of Systematic Reviews. 2018. ID=CRD42 018090767 ., (© 2022. The Author(s).)

The purpose of this study is to elucidate the multiple pathways linking shift work exposure to cardiometabolic risk (CMR) through the intermediates of circadian disruption, sleep disturbances, and stress. A cross-sectional study was conducted at Kingston Health Sciences Center that included female hospital workers, 160 who worked a day-only schedule and 168 who worked rotating days and nights. Participants completed questionnaires, a clinical exam, and wore accelerometers to collect sleep data for 8 days. Participants also collected urine samples at each void during a 24-h collection period, on the day shift for day-only workers and the night shift for rotating shift workers, for cortisol and melatonin measures. We adapted and tested a conceptual model proposed by Knutsson and Boggild for circadian disruption, sleep, and stress mechanistic pathways linking shift work to CMR using structural equation modeling techniques. Status as a rotating shift worker was associated with increased circadian disruption of cortisol and melatonin production compared to day-only workers (P < .001). Increased circadian disruption was associated with an increased CMR (P = .01). Rotating shift work was associated with sleep disturbances (P = .002) and increased job stress (P < .001), but neither was associated with CMR. We conclude that rotating shift work is associated indirectly with increased CMR. This association is mediated by circadian disruption as indicated by attenuated melatonin and cortisol, and flatter cortisol curves.

Background: Naturally occurring retirement communities (NORCs), unplanned communities with a high proportion of older adult residents, offer a model to support older adults to age well in place. The aim of this paper is to provide a comprehensive description of the methods used to identify and engage NORCs appropriate for the development of supportive service programming in Canada., Methods: Three steps were used to identify and select NORCs in which to develop supportive service programming including: 1) identification of potential NORCs using Canadian Census Dissemination Areas, the Ontario Marginalization Index and Google Maps, 2) engagement of property owner/manager to determine the availability of common space for communal programming and willingness of the owner to support programming and, 3) engagement of older adult residents within the NORC to co-design programming., Results: Four cities in the south-east, south-central, and south-west of Ontario, Canada were identified to develop NORCs with supportive service programming. Using the methods described, six NORCs were identified, landlords and older adult residents were engaged, and programs initiated between April 2018 and March 2019. The sites included two private high-rise apartments, a city-owned low-rise subsidized apartment complex, two multi-building private high-rise complexes and a mobile home community. An average of 35 (min 20, max 78) older adult members were engaged in an average of 20.5 unique activity sessions at each site per month. On average, social (54%) and physical activities (30%) were more common than nutritional (10%) and knowledge-sharing (8%)., Conclusions: The increased prevalence of unplanned, geographically-bound NORCs creates an opportunity for governments, social and health service providers and policy makers to support healthy aging in their communities. Our experience with the creation of six new NORCs with supportive service programming provides a tested set of methods that can be applied in other communities., (© 2022. The Author(s).)

Introduction: Over the last 20 years, the Canadian province of Ontario implemented several new models of primary care focusing on changes to physician remuneration, clinics led by nurse practitioners and the introduction of interprofessional primary care teams. Health outcome and cost evaluations of these models thus far have been mostly cross-sectional and in some cases results from these studies were conflicting. The aim of this population-based study is to investigate short, medium and long-term effectiveness of these reforms over the past 15-20 years., Methods and Analysis: This is the protocol for a retrospective cohort study including fee-for-service (FFS) and community health centre cohorts (control cohorts) or patients who switched from either being unattached or from FFS to a new practice model (eg, capitation, enhanced FFS, team, nurse practitioner-led) from 1997 to 2020. The primary outcome is total healthcare costs and secondary outcomes are primary care costs, other (non-primary care) health costs, hospitalisations, length of stay, emergency department visits, accessibility and mortality. A combination of hard and propensity matching will be used where relevant. Outcomes will be adjusted for demographic and health factors and measured annually. Interrupted time series models will be used where data permits and difference-in-differences methods will be used otherwise., Ethics and Dissemination: Ethics approval has been received from Queens University and Memorial University. The dissemination plan includes conference presentations, papers, brief evidence summaries targeted at select audiences and knowledge brokering sessions with key stakeholders., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)