Ethnic and racialized disparities in the use of screening services for pap smears and mammograms in Canada.

BACKGROUND: Breast and cervical cancers pose significant health challenges for women globally, emphasizing the critical importance of effective screening programs for early detection. In Canada, despite the implementation of accessible healthcare systems, ethnic and racialized disparities in cancer screening persist. This study aims to assess ethnic and racialized disparities in breast and cervical cancer screening in Canada. METHODS: Using 2015-2019 data from the Canadian Community Health Survey, we analyzed women aged 18-70 in distinct ethnic and racial groups. The primary outcome was mammography or Papanicolaou test (pap smear). The secondary outcome was time since the last screening. We used weighted multivariable logistic regression to estimate the odds of having a pap smear or mammography across the ethnic and racialized groups, adjusted for relevant covariates. Results were reported as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: We included 14,628,067 women of which 72.5% were White, 8.4% Southeast Asian, 4.7% South Asian, 3.4% Indigenous, 2.7% Black, 2.0% West Asian, and 1.6% Latin American. In comparison with the White reference group, a higher odds ratio of not having a pap smear was estimated for the West Asian (5.63; CI 3.85, 8.23), South Asian (5.19; CI 3.79, 7.12), Southeast Asian (4.35; CI 3.46, 5.46), and Black groups (2.62; CI 1.82, 3.78). Disparities in mammography screening were found only for the Southeast Asian group with higher odds of not having screening (1.85; CI 1.15, 2.98) compared to the White reference group. CONCLUSION: This study reveals significant disparities in pap smear and mammography screenings affecting various ethnic groups, particularly in West Asia, South Asian, and Black communities. These findings underscore the urgent need for targeted interventions, policies, and healthcare strategies to address these gaps and ensure equitable access to essential breast and cervical cancer prevention across all ethnicity.

Improving accessibility to radiotherapy services in Cali, Colombia: cross-sectional equity analyses using open data and big data travel times from 2020.

In this study, we evaluated and forecasted the cumulative opportunities for residents to access radiotherapy services in Cali, Colombia, while accounting for traffic congestion, using a new people-centred methodology with an equity focus. Furthermore, we identified 1-2 optimal locations where new services would maximise accessibility. We utilised open data and publicly available big data. Cali is one of South America's cities most impacted by traffic congestion. METHODOLOGY: Using a people-centred approach, we tested a web-based digital platform developed through an iterative participatory design. The platform integrates open data, including the location of radiotherapy services, the disaggregated sociodemographic microdata for the population and places of residence, and big data for travel times from Google Distance Matrix API. We used genetic algorithms to identify optimal locations for new services. We predicted accessibility cumulative opportunities (ACO) for traffic ranging from peak congestion to free-flow conditions with hourly assessments for 6-12 July 2020 and 23-29 November 2020. The interactive digital platform is openly available. PRIMARY AND SECONDARY OUTCOMES: We present descriptive statistics and population distribution heatmaps based on 20-min accessibility cumulative opportunities (ACO) isochrones for car journeys. There is no set national or international standard for these travel time thresholds. Most key informants found the 20-min threshold reasonable. These isochrones connect the population-weighted centroid of the traffic analysis zone at the place of residence to the corresponding zone of the radiotherapy service with the shortest travel time under varying traffic conditions ranging from free-flow to peak-traffic congestion levels. Additionally, we conducted a time-series bivariate analysis to assess geographical accessibility based on economic stratum. We identify 1-2 optimal locations where new services would maximize the 20-min ACO during peak-traffic congestion. RESULTS: Traffic congestion significantly diminished accessibility to radiotherapy services, particularly affecting vulnerable populations. For instance, urban 20-min ACO by car dropped from 91% of Cali's urban population within a 20-min journey to the service during free-flow traffic to 31% during peak traffic for the week of 6-12 July 2020. Percentages represent the population within a 20-min journey by car from their residence to a radiotherapy service. Specific ethnic groups, individuals with lower educational attainment, and residents on the outskirts of Cali experienced disproportionate effects, with accessibility decreasing to 11% during peak traffic compared to 81% during free-flow traffic for low-income households. We predict that strategically adding sufficient services in 1-2 locations in eastern Cali would notably enhance accessibility and reduce inequities. The recommended locations for new services remained consistent in both of our measurements.These findings underscore the significance of prioritising equity and comprehensive care in healthcare accessibility. They also offer a practical approach to optimising service locations to mitigate disparities. Expanding this approach to encompass other transportation modes, services, and cities, or updating measurements, is feasible and affordable. The new approach and data are particularly relevant for planning authorities and urban development actors.

ESPAñOL: En este estudio, evaluamos y pronosticamos las oportunidades acumulativas para que los residentes accedan a los servicios de radioterapia en Cali, Colombia, teniendo en cuenta la congestión del tráfico, utilizando una nueva metodología centrada en las personas con un enfoque de equidad. Además, identificamos 1-2 ubicaciones óptimas donde los nuevos servicios maximizarían la accesibilidad. Utilizamos datos abiertos y macrodatos disponibles públicamente. Cali está entre las ciudades Sudamericanas más afectadas por la congestión del tráfico.Metodología: Usando un enfoque centrado en las personas, probamos una plataforma digital basada en la web desarrollada a través de un diseño participativo iterativo. La plataforma integra datos abiertos, incluyendo la ubicación de los servicios de radioterapia, los microdatos sociodemográficos desagregados de la población y los lugares de residencia, y los macrodatos de tiempos de viaje de la API de Google Distance Matrix. Usamos algoritmos genéticos para identificar ubicaciones óptimas para nuevos servicios. Pronosticamos oportunidades acumulativas de accesibilidad (ACO, por sus siglas en inglés) para el tráfico que va desde la congestión máxima hasta condiciones de flujo libre, con evaluaciones horarias hechas del 6 al 12 de julio de 2020 y del 23 al 29 de noviembre de 2020. La plataforma digital interactiva está públicamente disponible.Resultados Primarios y Secundarios: Presentamos estadísticas descriptivas y mapas de calor de la distribución de la población basados en isócronas de ACO de 20 minutos para viajes en coche. No existe un estándar nacional o internacional establecido para estos umbrales de tiempo de viaje. La mayoría de los informantes clave encontraron razonable el umbral de 20 minutos. Estas isócronas conectan el centroide poblacional ponderado de la zona de análisis de tráfico del lugar de residencia con la zona correspondiente del servicio de radioterapia con menor tiempo de viaje bajo condiciones variables de tráfico, que van desde el flujo libre hasta niveles de congestión de tráfico máximo. Además, realizamos un análisis bivariado de series temporales para evaluar la accesibilidad geográfica basada en el estrato económico. Identificamos 1-2 ubicaciones óptimas donde los nuevos servicios maximizarían el ACO de 20 minutos durante la congestión máxima del tráfico.Resultados: La congestión del tráfico redujo significativamente la accesibilidad a los servicios de radioterapia, afectando particularmente a las poblaciones vulnerables. Por ejemplo, el ACO urbano de 20 minutos en coche se redujo del 91% de la población urbana de Cali para viajes de hasta 20 minutos al servicio con flujo libre de tráfico, al 31% cuando hay congestión pico de tráfico durante la semana del 6 al 12 de julio de 2020. Los porcentajes representan la población con viajes de hasta 20 minutos en coche desde la residencia hasta el servicio de radioterapia. Grupos étnicos específicos, individuos con menor nivel educativo y residentes en las afueras de Cali experimentaron efectos desproporcionados, con la accesibilidad disminuyendo al 11% durante el tráfico máximo en comparación con el 81% durante el tráfico de flujo libre para hogares de bajos ingresos. Predecimos que agregar estratégicamente suficientes servicios en 1-2 ubicaciones en el este de Cali mejoraría notablemente la accesibilidad y reduciría las inequidades. Las ubicaciones recomendadas para los nuevos servicios se mantuvieron consistentes en nuestras dos mediciones.Estos hallazgos subrayan la importancia de priorizar la equidad y la atención integral en la accesibilidad a la atención médica. También ofrecen un enfoque práctico para optimizar las ubicaciones de los servicios para mitigar las disparidades. Es factible y accesible expandir este enfoque para abarcar otros modos de transporte, servicios y ciudades, o actualizar las mediciones. El nuevo enfoque y los datos son particularmente relevantes para las autoridades de planificación y los actores del desarrollo urbano.

PORTUGUêS: Neste estudo, avaliamos e previmos as oportunidades cumulativas para os residentes acessarem serviços de radioterapia em Cali, Colômbia, levando em consideração o congestionamento do tráfego, utilizando uma nova metodologia centrada nas pessoas com um foco na equidade. Além disso, identificamos 1-2 locais ideais onde os novos serviços poderiam maximizar a acessibilidade. Utilizamos dados abertos e big data disponíveis publicamente. Cali está entre as cidades sulamericanas mais afetadas pela congestionamento do tráfego.Metodologia: Usando uma abordagem centrada em pessoas, testamos uma plataforma digital baseada na web que foi desenvolvida através de um design participativo iterativo. A plataforma integra dados abertos, incluindo a localização dos serviços de radioterapia, microdados sociodemográficos desagregados por população e locais de residência, e big data da API Google Distance Matrix para os tempos de viagem. Utilizamos algoritmos genéticos para identificar locais ideais para novos serviços. Previmos oportunidades cumulativas de acessibilidade (ACO, por suas siglas em inglês) para o tráfego que varia desde o congestionamento máximo até condições de fluxo livre, com avaliações horárias de 6 a 12 de julho de 2020 e de 23 a 29 de novembro de 2020. A plataforma digital interativa está disponível publicamente.Resultados Primários e Secundários: Apresentamos estatísticas descritivas e mapas de calor da distribuição populacional baseados em isócronas de ACO de 20 minutos para viagens de carro. Não existe um padrão nacional ou internacional estabelecido para esses limites de tempo de viagem. A maioria dos entrevistados-chave considerou razoável o limite de 20 minutos. Essas isócronas conectam o centroide ponderado pela população da zona de análise de tráfego no local de residência e sua zona correspondente do serviço de radioterapia com o menor tempo de viagem sob condições variáveis de tráfego (que vão desde fluxo livre até níveis máximos de congestionamento do tráfego). Além disso, realizamos uma análise bivariada de séries temporais para avaliar a acessibilidade geográfica baseada na estratificação econômica. Identificamos 1-2 locais ideais onde os novos serviços maximizariam a ACO de 20 minutos durante o pico de congestionamento do tráfego.Resultados: O congestionamento do tráfego reduziu significativamente a acessibilidade aos serviços de radioterapia, afetando particularmente as populações vulneráveis. Por exemplo, a ACO urbana de 20 minutos de carro foi reduzida de 91% durante um fluxo livre de tráfego, para 31% durante picos de congestionamento de tráfego entre a semana de 6 a 12 de julho de 2020. As porcentagens representam a população com viagens de até 20 minutos de carro de sua residência até o serviço de radioterapia. Grupos étnicos específicos, indivíduos com menor nível educacional e residentes nos arredores de Cali experimentaram resultados desproporcionais, com a acessibilidade diminuindo para 11% durante o tráfego com congestionamento máximo em comparação com 81% durante o fluxo livre de tráfego para domicílios de baixa renda. Prevemos que adicionar estrategicamente serviços suficientes em 1-2 locais no leste de Cali melhoraria significativamente a acessibilidade e reduziria as desigualdades. Os locais recomendados para os novos serviços permaneceram consistentes em ambas medições. Esses resultados ressaltam a importância de priorizar a equidade e o atendimento integral na acessibilidade aos cuidados de saúde. Eles também oferecem uma abordagem prática para otimizar os locais dos serviços a fim de minimizar as desigualdades. A expansão dessa abordagem para abranger outros modos de transporte, serviços e cidades, ou a atualização das medições, é viável e acessível. A nova abordagem e os dados são particularmente relevantes para as autoridades de planejamento e os agentes do desenvolvimento urbano.

FRANçAIS: Dans cette étude, nous avons évalué et prévu les opportunités cumulées pour les résidents d'accéder aux services de radiothérapie à Cali, en Colombie, tout en tenant compte de la congestion du trafic en utilisant une nouvelle méthodologie centrée sur les personnes avec axée sur l'équité. De plus, nous avons identifié 1 à 2 emplacements optimaux où de nouveaux services maximiseraient l'accessibilité. Nous avons utilisé des données ouvertes et des macrodonnées tenues à disposition du public. Cali est l'une des villes d'Amérique du Sud les plus touchées par la congestion du trafic.Méthodologie: En utilisant une approche centrée sur les personnes, nous avons testé une plateforme numérique basée sur le web développée à travers une conception participative itérative. La plateforme intègre des données ouvertes, y compris la localisation des services de radiothérapie, les microdonnées sociodémographiques désagrégées de la population et les lieux de résidence, ainsi que les mégadonnées des temps de trajet de l'API Google Distance Matrix. Nous avons utilisé des algorithmes génétiques pour identifier les emplacements optimaux pour de nouveaux services. Nous avons prévu les opportunités cumulatives d'accessibilité (ACO, désignant l'acronyme en anglais) pour le trafic allant de la congestion maximale aux conditions de flux libre, avec des évaluations horaires du 6 au 12 juillet 2020 et du 23 au 29 novembre 2020. La plateforme numérique interactive est disponible publiquement.Résultats Primaires et Secondaires: Nous présentons des statistiques descriptives et des cartes thermiques de la distribution de la population basées sur des ACO de 20 minutes pour les trajets en voiture. Il n'existe pas de norme nationale ou internationale établie pour ces seuils de temps de trajet. La majorité des informateurs clés ont trouvé le seuil de 20 minutes raisonnable. Ces isochrones relient le centroïde pondéré par la population de la zone d'analyse du trafic au lieu de résidence à la zone correspondante du service de radiothérapie avec le temps de trajet le plus court sous des conditions de trafic variables allant du flux libre aux niveaux de congestion de trafic maximum. De plus, nous avons réalisé une analyse bivariée des séries chronologiques pour évaluer l'accessibilité géographique en fonction de la stratification économique. Nous avons identifié 1 à 2 emplacements optimaux où de nouveaux services maximiseraient l'ACO de 20 minutes pendant la congestion maximale du trafic.Résultats: La congestion du trafic a considérablement réduit l'accessibilité aux services de radiothérapie, affectant particulièrement les populations vulnérables. Par exemple, l'ACO urbain de 20 minutes en voiture est passé de 91 % de la population urbaine de Cali pour des trajets de jusqu'à 20 minutes vers le service avec un flux de trafic libre à 31 % lors des pics de congestion de trafic pendant la semaine du 6 au 12 juillet 2020. Les pourcentages représentent la population avec des trajets de jusqu'à 20 minutes en voiture depuis la résidence jusqu'au service de radiothérapie. Des groupes ethniques spécifiques, des individus ayant un niveau d'éducation inférieur et des résidents des périphéries de Cali ont subi des effets disproportionnés, avec une accessibilité diminuant à 11 % pendant le trafic maximal par rapport à 81 % pendant le flux de trafic libre pour les ménages à faible revenu. Ajouter suffisamment de services à 1-2 emplacements stratégiques dans l'est de Cali a le potential d'améliorer considérablement l'accessibilité et réduirait les inégalités. Les emplacements recommandés pour les nouveaux services sont restés cohérents dans nos deux mesures. Ces conclusions soulignent l'importance de prioriser l'équité et une prise en charge globale dans le cadre de l'accessibilité aux soins de santé. Elles offrent également une approche pratique pour optimiser les emplacements des services afin de réduire les disparités. Il est faisable et abordable d'étendre cette approche pour inclure d'autres modes de transport, services et villes, ou pour mettre à jour les mesures. La nouvelle approche et les données sont particulièrement pertinentes pour les autorités de planification et les acteurs du développement urbain.

Effectiveness of immunoglobulin replacement therapy in preventing infections in patients with chronic obstructive pulmonary disease: a systematic review.

PURPOSE: Immunoglobulin replacement therapy is a standard treatment for patients with antibody production deficiencies, which is of interest in patients with chronic obstructive pulmonary disease (COPD). This systematic review, registered with PROSPERO (CRD42021281118), assessed the current literature regarding immunoglobulin replacement therapy on COPD clinical outcomes in patients with low immunoglobulin G (IgG) serum concentrations. METHODS: Literature searches conducted from inception to August 23, 2021, in databases including MEDLINE, EMBASE, and CINAHL. Population (sex, age, comorbidities), baseline clinical characteristics (pulmonary function testing results, IgG levels), and outcome (hospitalizations, emergency department visits) were extracted after title/abstract and full text screening. The Cochrane risk of bias assessment form was used for risk of bias assessment of randomized controlled trials and the National Heart, Lung, and Blood Institute (NHLBI) assessment was used for pre and post studies. RESULTS: A total of 1381 studies were identified in the preliminary search, and 874 records were screened after duplicates were removed. Screening 77 full texts yielded four studies that were included in the review. CONCLUSION: It is unclear whether immune globulin replacement therapy reduces acute exacerbation frequency and severity in COPD. Current evidence suggests that it is worth considering, but better developed protocols for administration of immune globulin supplementation is required for future randomized controlled trials.

Physician Management and CT Ordering in the Emergency Department for Primary Headaches.

OBJECTIVE: Management of primary headache (PHA) varies across emergency departments (ED), yet there is widespread agreement that computed tomography (CT) scans are overused. This study assessed emergency physicians' (EPs) PHA management and their attitudes towards head CT ordering. METHODS: A cross-sectional study was undertaken with EPs from one Canadian center. Drivers of physicians' perceptions regarding the appropriateness of CT ordering for patients with PHA were explored. RESULTS: A total of 73 EPs (70% males; 48% with <10 years of practice) participated in the study. Most EPs (88%) did not order investigations for moderate-severe primary headaches; however, CT was the common investigation (47%) for headaches that did not improve. Computed tomography ordering was frequently motivated by the need for specialist consultation (64%) or admission (64%). A small proportion (27%) believed patients usually/frequently expected a scan. Nearly half of EPs (48%) identified patient imaging expectations/requests as a barrier to reducing CT ordering. Emergency physicians with CCFP (EM) certification were less likely to perceive CT ordering for patients with PHA as appropriate. Conversely, those who identified the possibility of missing a condition as a major barrier to limiting their CT use were more likely to perceive CT ordering for patients with PHA as appropriate. CONCLUSIONS: Emergency physicians reported consistency and evidence-based medical management. They highlighted the complexities of limiting CT ordering and both their level of training and their perceived barriers for limiting CT ordering seem to be influencing their attitudes. Further studies could elucidate these and other factors influencing their practice.

Time trends in preeclampsia and gestational diabetes in Denmark and Alberta, Canada, 2005-2018-A population-based cohort study.

INTRODUCTION: Preeclampsia and gestational diabetes mellitus share risk factors such as obesity and increased maternal age, which have become more prevalent in recent decades. We examined changes in the prevalence of preeclampsia and gestational diabetes between 2005 and 2018 in Denmark and Alberta, Canada, and investigated whether the observed trends can be explained by changes in maternal age, parity, multiple pregnancy, comorbidity, and body mass index (BMI) over time. MATERIAL AND METHODS: This study was a register-based cohort study conducted using data from the Danish National Health Registers and the provincial health registers of Alberta, Canada. We included in the study cohort all pregnancies in 2005-2018 resulting in live-born infants and used binomial regression to estimate mean annual increases in the prevalence of preeclampsia and gestational diabetes in the two populations across the study period, adjusted for maternal characteristics. RESULTS: The study cohorts included 846 127 (Denmark) and 706 728 (Alberta) pregnancies. The prevalence of preeclampsia increased over the study period in Denmark (2.5% to 2.9%) and Alberta (1.7% to 2.5%), with mean annual increases of 0.03 (95% confidence interval [CI] 0.02-0.04) and 0.06 (95% CI 0.05-0.07) percentage points, respectively. The prevalence of gestational diabetes also increased in Denmark (1.9% to 4.6%) and Alberta (3.9% to 9.2%), with average annual increases of 0.20 (95% CI 0.19-0.21) and 0.44 (95% CI 0.42-0.45) percentage points. Changes in the distributions of maternal age and BMI contributed to increases in the prevalence of both conditions but could not explain them entirely. CONCLUSIONS: The prevalence of both preeclampsia and gestational diabetes increased significantly from 2005 to 2018, which portends future increases in chronic disease rates among affected women. Increasing demand for long-term follow up and care will amplify the existing pressure on healthcare systems.

Social Determinants of Health and Pediatric Emergency Department Outcomes: A Systematic Review and Meta-Analysis of Observational Studies.

STUDY OBJECTIVE: Social determinants of health contribute to disparities in pediatric health and health care. Our objective was to synthesize and evaluate the evidence on the association between social determinants of health and emergency department (ED) outcomes in pediatric populations. METHODS: This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity Extension guidelines. Observational epidemiological studies were included if they examined at least 1 social determinant of health from the PROGRESS-Plus framework in relation to ED outcomes among children <18 years old. Effect direction plots were used for narrative results and pooled odds ratios (pOR) with 95% confidence intervals (CI) for meta-analyses. RESULTS: Fifty-eight studies were included, involving 17,275,090 children and 103,296,839 ED visits. Race/ethnicity and socioeconomic status were the most reported social determinants of health (71% each). Black children had 3 times the odds of utilizing the ED (pOR 3.16, 95% CI 2.46 to 4.08), whereas visits by Indigenous children increased the odds of departure prior to completion of care (pOR 1.58, 95% CI 1.39 to 1.80) compared to White children. Public insurance, low income, neighborhood deprivation, and proximity to an ED were also predictors of ED utilization. Children whose caregivers had a preferred language other than English had longer length of stay and increased hospital admission. CONCLUSION: Social determinants of health, particularly race, socioeconomic deprivation, proximity to an ED, and language, play important roles in ED care-seeking patterns of children and families. Increased utilization of ED services by children from racial minority and lower socioeconomic status groups may reflect barriers to health insurance and access to health care, including primary and subspecialty care, and/or poorer overall health, necessitating ED care. An intersectional approach is needed to better understand the trajectories of disparities in pediatric ED outcomes and to develop, implement, and evaluate future policies.

Screen Time and Socioemotional and Behavioural Difficulties Among Indigenous Children in Canada: Temps d'écran et difficultés socio-émotionnelles et comportementales chez les enfants autochtones du Canada.

OBJECTIVES: To describe screen time levels and determine their association with socioemotional and behavioural difficulties among preschool-aged First Nations, Métis, and Inuit children. METHOD: Data were taken from the Aboriginal Children's Survey, a nationally representative survey of 2-5-year-old Indigenous children in Canada. Socioemotional and behavioural difficulties were defined using parent/guardian reports on the Strengths and Difficulties Questionnaire. Multiple linear regression analyses were conducted separately for First Nations, Métis, and Inuit participants, and statistically adjusted for child age, child sex, and parent/guardian education. Statistical significance was set at P < 0.002 to adjust for multiple comparisons. RESULTS: Of these 2-5-year-old children (mean [M] = 3.57 years) 3,085 were First Nations (53.5%), 2,430 Métis (39.2%), and 990 Inuit (7.3%). Screen time exposure was high among First Nations (M = 2 h and 58 min/day, standard deviation [SD] = 1.89), Métis (M = 2 h and 50 min [SD = 1.83]), and Inuit children (M = 3 h and 25 min [SD = 2.20]), with 79.7% exceeding recommended guidelines (>1 h/day). After adjusting for confounders, screen time was associated with more socioemotional and behavioural difficulties among First Nations (total difficulties ß = 0.15 [95% CI, 0.12 to 0.19]) and Métis (ß = 0.16 [95% CI, 0.12 to 0.20]) but not Inuit children (ß = 0.12 [95% CI, 0.01 to 0.23]). CONCLUSIONS: Screen time exposure is high among Indigenous children in Canada, and is associated with more socioemotional and behavioural difficulties among First Nations and Métis children. Contributing factors could include enduring colonialism that resulted in family dissolution, lack of positive parental role models, and disproportionate socioeconomic disadvantage. Predictors of poor well-being should continue to be identified to develop targets for intervention to optimize the health and development of Indigenous children.

Diabetes during pregnancy among Métis people in Alberta: a retrospective cohort study.

BACKGROUND: Diabetes in pregnancy is an important public health concern for Indigenous populations. We sought to evaluate the prevalence and outcomes of pre-existing and gestational diabetes among Métis pregnancies compared with other pregnancies in Alberta, Canada. METHODS: We conducted a retrospective cohort study using administrative health data from 2006 to 2016 and the Métis Nation of Alberta Identification Registry to compare the prevalence of pre-existing and gestational diabetes among all singleton Métis births with non-Métis births. We compared 10 maternal and neonatal outcomes using adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in multivariable analyses. RESULTS: The study population included 7902 Métis and 471 886 non-Métis births. The age-standardized prevalence of pre-existing diabetes was 1.7% (95% CI 1.4%-2.1%) for Métis and 1.1% (95% CI 1.1%-1.2%) for non-Métis pregnancies. For gestational diabetes, the age-standardized prevalence was 6.3% (95% CI 5.6%-6.9%) for Métis and 5.4% (95% CI 5.3%-5.4%) for non-Métis pregnancies. After adjusting for parity, maternal weight, age, smoking during pregnancy and material and social deprivation, Métis pregnancies had 1.72 times higher prevalence of preexisting diabetes (adjusted OR 1.72, 95% CI 1.15-2.56) and 1.30 times higher prevalence of gestational diabetes (adjusted OR 1.30, 95% CI 1.08-1.57) than non-Métis pregnancies. Métis pregnancies with pre-existing diabetes had nearly 3 times the odds of developing preeclampsia (adjusted OR 2.96, 95% CI 1.27-6.90), while those with gestational diabetes had 48% higher odds of large-for-gestational-age infants (adjusted OR 1.48, 95% CI 1.00-2.19). INTERPRETATION: Métis pregnancies have an increased prevalence of pre-existing and gestational diabetes than non-Métis pregnancies and an elevated risk of some perinatal outcomes. Interventions to tackle these health inequities should address both physiologic and cultural dimensions of health, informed by Métis perspectives.

Transitions in health care settings for frequent and infrequent users of emergency departments: a population-based retrospective cohort study.

BACKGROUND: Efforts to reduce emergency department (ED) volumes often target frequent users. We examined transitions in care across ED, hospital, and community settings, and in-hospital death, for high system users (HSUs) compared to controls. METHODS: Population-based databases provided ED visits and hospitalizations in Alberta and Ontario, Canada. The retrospective cohort included the top 10% of all the ED users during 2015/2016 (termed HSUs) and a random sample of controls (4 per each HSU) from the bottom 90% per province. Rates of transitions among ED, hospitalization, community settings, and in-hospital mortality were adjusted for sociodemographic and ED variables in a multistate statistical model. RESULTS: There were 2,684,924 patients and 579,230 (21.6%) were HSUs. Patient characteristics associated with shorter community to ED transition times for HSUs included Alberta residence (ratio of hazard ratio [RHR] = 1.11, 95% confidence interval [CI] 1.11,1.12), living in areas in the lower income quintile (RHR = 1.06, 95%CI 1.06,1.06), and Ontario residents without a primary health care provider (RHR = 1.13, 95%CI 1.13,1.14). Once at the ED, characteristics associated with shorter ED to hospital transition times for HSUs included higher acuity (e.g., RHR = 1.70, 95% CI 1.61, 1.81 for emergent), and for many diagnoses including chest pain (RHR = 1.71, 95%CI 1.65,1.76) and gastrointestinal (RHR = 1.66, 95%CI 1.62,1.71). Once admitted to hospital, HSUs did not necessarily have longer stays except for conditions such as chest pain (RHR = 0.90, 95% CI 0.86, 0.95). HSUs had shorter times to death in the ED if they presented for cancer (RHR = 2.51), congestive heart failure (RHR = 1.93), myocardial infarction (RHR = 1.53), and stroke (RHR = 1.84), and shorter times to death in-hospital if they presented with cancer (RHR = 1.29). CONCLUSIONS: Differences between HSUs and controls in predictors of transitions among care settings were identified. Co-morbidities and limitations in access to primary care are associated with more rapid transitions from community to ED and hospital among HSUs. Interventions targeting these challenges may better serve patients across health systems.. TRIAL REGISTRATION: Not applicable.

Perinatal and early life factors and asthma control among preschoolers: a population-based retrospective cohort study.

BACKGROUND: Preventing poor childhood asthma control is crucial for short-term and long-term respiratory health. This study evaluated associations between perinatal and early-life factors and early childhood asthma control. METHODS: This retrospective study used administrative health data from mothers and children born 2010-2012 with a diagnosis of asthma before age 5 years, in Alberta, Canada. The outcome was asthma control within 2 years after diagnosis. Associations between perinatal and early-life factors and risk of partly and uncontrolled asthma were evaluated by multinomial logistic regression. RESULTS: Of 7206 preschoolers with asthma, 52% had controlled, 37% partly controlled and 12% uncontrolled asthma 2 years after diagnosis. Compared with controlled asthma, prenatal antibiotics (adjusted risk ratio (aRR): 1.19; 95% CI 1.06 to 1.33) and smoking (aRR: 1.18; 95% CI 1.02 to 1.37), C-section delivery (aRR: 1.11; 95% CI 1.00 to 1.25), summer birth (aRR: 1.16; 95% CI 1.00 to 1.34) and early-life hospitalisation for respiratory illness (aRR: 2.24; 95% CI 1.81 to 2.76) increased the risk of partly controlled asthma. Gestational diabetes (aRR: 1.41; 95% CI 1.06 to 1.87), C-section delivery (aRR: 1.18; 95% CI 1.00 to 1.39), antibiotics (aRR: 1.32; 95% CI 1.08 to 1.61) and hospitalisation for early-life respiratory illness (aRR: 1.65; 95% CI 1.19 to 2.27) were associated with uncontrolled asthma. CONCLUSION: Maternal perinatal and early-life factors including antibiotics in pregnancy and childhood, gestational diabetes, prenatal smoking, C-section and summertime birth, and hospitalisations for respiratory illness are associated with partly or uncontrolled childhood asthma. These results underline the significance of perinatal health and the lasting effects of early-life experiences on lung development and disease programming.

Small for gestational age preterm infants and later adiposity and height: A systematic review and meta-analysis.

BACKGROUND: Overweight and obesity and their consequent morbidities are important worldwide health problems. Some research suggests excess adiposity origins may begin in fetal life, but unknown is whether this applies to infants born preterm. OBJECTIVE: The objective of the study was to assess the association between small for gestational age (SGA) birth and later adiposity and height among those born preterm. DATA SOURCES: MEDLINE, EMBASE and CINAHL until October 2022. STUDY SELECTION AND DATA EXTRACTION: Studies were included if they reported anthropometric (adiposity measures and height) outcomes for participants born preterm with SGA versus non-SGA. Screening, data extraction and risks of bias assessments were conducted in duplicate by two reviewers. SYNTHESIS: We meta-analysed across studies using random-effects models and explored potential heterogeneity sources. RESULTS: Thirty-nine studies met the inclusion criteria. In later life, preterm SGA infants had a lower body mass index (-0.66 kg/m2 , 95% CI -0.79, -0.53; 32 studies, I2 = 16.7, n = 30,346), waist circumference (-1.20 cm, 95% CI -2.17, -0.23; 13 studies, I2 = 19.4, n = 2061), lean mass (-2.62 kg, 95% CI -3.45, 1.80; 7 studies, I2 = 0, n = 205) and height (-3.85 cm, 95% CI -4.73, -2.96; 26 studies, I2 = 52.6, n = 4174) compared with those preterm infants born non-SGA. There were no differences between preterm SGA and preterm non-SGA groups in waist/hip ratio, body fat, body fat per cent, truncal fat per cent, fat mass index or lean mass index, although power was limited for some analyses. Studies were rated at high risk of bias due to potential residual confounding and low risk of bias in other domains. CONCLUSIONS: Compared to their preterm non-SGA peers, preterm infants born SGA have lower BMI, waist circumference, lean body mass and height in later life. No differences in adiposity were observed between SGA preterm infants and non-SGA preterm infants.

Small for date preterm infants and risk of higher blood pressure in later life: A systematic review and meta-analysis.

BACKGROUND: Historical reports suggest that infants born small for gestational age (SGA) are at increased risk for high blood pressure (BP) at older ages after adjustment for later age body size. Such adjustment may be inappropriate since adiposity is a known cause of cardiovascular and metabolic disease. OBJECTIVES: To assess the association between SGA births and later BP among preterm births, considering potential background confounders and over-adjustment for later body size. METHODS: A database search of studies up to October 2022 included MEDLINE, EMBASE and CINAHL. Studies were included if they reported BP (systolic [SBP] or diastolic [DBP]) (outcomes) for participants born preterm with SGA (exposure) or non-SGA births. All screening, extraction steps, and risk of bias (using the Risk of Bias In Non-randomised Studies of Interventions [ROBINS-I] tool) were conducted in duplicate by two reviewers. Data were pooled in meta-analysis using random-effects models. We explored potential sources of heterogeneity. RESULTS: We found no meaningful difference in later BP between preterm infants with and without SGA status at birth. Meta-analysis of 25 studies showed that preterm SGA, compared to preterm non-SGA, was not associated with higher BP at age 2 and older with mean differences for SBP 0.01 mmHg (95% CI -0.10, 0.12, I2  = 59.8%, n = 20,462) and DBP 0.01 mm Hg (95% CI -0.10, 0.12), 22 studies, (I2  = 53.0%, n = 20,182). Adjustment for current weight did not alter the results, which could be due to the lack of differences in later weight status in most of the included studies. The included studies were rated to be at risk of bias due to potential residual confounding, with a low risk of bias in other domains. CONCLUSIONS: Evidence indicates that preterm infants born SGA are not at increased risk of developing higher BP as children or as adults as compared to non-SGA preterm infants.

Prenatal Nutrition Care in Alberta: The Perspectives of Pregnant Women and Registered Dietitians.

Introduction: Optimizing women's diets in pregnancy improves maternal and child health outcomes; however, the best format for supporting women's nutrition goals in pregnancy is not clear, and access to dietetic services is not standard in prenatal care in Alberta. This study explored women's perceptions about access to Registered Dietitians (RDs) throughout pregnancy and RDs experiences providing prenatal nutrition counselling.Methods: Two studies were conducted. Study A: Pregnant women completed a short survey while attending a prenatal appointment in a large prenatal clinic. The survey assessed women's perspectives about accessing dietetic services during pregnancy. Survey data were analyzed using descriptive statistics. Study B: RDs participated in either a semi-structured phone interview or a focus group and described their experiences working with pregnant women. Data were analyzed using thematic analysis.Results: One hundred pregnant women completed the survey. Ninety percent indicated that they had not seen a RD at this time in pregnancy, and 48% reported that they would like to access a RD in pregnancy, if available. Dietitians discussed the diversity of women's concerns and the challenges to providing prenatal nutrition support.Conclusions: Women have nutrition-related questions during pregnancy. Dietitians experience challenges providing services in the current care systems.

Emergency Department Visits During Pregnancy.

STUDY OBJECTIVE: Pregnant women often seek care in an emergency department (ED). We sought to describe the frequency, characteristics, and factors associated with increased ED visits during pregnancy. METHODS: We conducted a retrospective cohort study using administrative health data of all pregnancies resulting in a live birth at 20 or more weeks of gestation in Alberta, Canada, from 2011 to 2017. The primary outcome was the occurrence of any ED visit during pregnancy. The secondary outcomes were ED visit characteristics and discharge disposition. We calculated rate ratios (RRs) and 95% confidence intervals (CIs) for associations between sociodemographic and clinical factors and increased ED visits during pregnancy using random-effect negative binomial regression adjusting for multiple pregnancies per person during the study period. RESULTS: We included 255,929 pregnancies from 193,965 women. Of all the pregnancy episodes followed, 37.3% (95% CI 37.1 to 37.5) had at least 1 ED visit, resulting in a total of 226,811 ED visits and an overall ED visit rate of 94.0 visits per 100 pregnancies (95% CI 93.6 to 94.3). Most visits were nonobstetric (46.4%) and resulted in ED discharge (85.3%). Increased ED visits were associated with living in remote (RR 6.9; 95 %CI 6.7 to 7.1) or rural (RR 3.4; 95% CI 3.4 to 3.5) areas, younger age (RR 1.9; 95% CI 1.8 to 2.0), intensive prenatal care (RR 1.5; 95% CI 1.5 to 1.5), major/moderate health conditions (RR 1.6; 95% CI 1.6 to 1.6), mental health conditions (RR 1.6; 95% CI 1.5 to 1.6), and high antepartum risk score (RR 1.1; 95% CI 1.1 to 1.1). CONCLUSION: Approximately 1 in 3 women in our sample visited the ED during pregnancy. A higher number of visits occurred in those with rural/remote residence, younger maternal age, and concomitant health conditions.

Oxidative stress and DNA damage resulting from welding fumes exposure among professional welders: A systematic review and meta-analysis.

The present systematic review aimed to evaluate the associations between welding fumes exposure and changes in oxidative stress [superoxide dismutase (SOD) and malondialdehyde (MDA)] and DNA damage [8-hydroxy-2'-deoxyguanosine (8-OHdG) and DNA-protein crosslink (DPC)] markers in professional welders (PROSPERO CRD42022298115). Six electronic bibliographic databases were searched from inception through September 2021 to identify observational epidemiological studies evaluating the association between welding fumes exposures and changes in oxidative stress and DNA damage in professional welders. Two reviewers independently assessed the risk of bias and certainty of the evidence. A narrative synthesis of results was conducted using the Synthesis Without Meta-analysis (SWiM) method. Pooled mean differences with 95% confidence intervals were calculated in a random-effects meta-analysis for the outcomes of interest in the review. From 450 studies identified through the search strategy, 14 observational epidemiological studies were included in the review. Most studies reported significantly higher welding fumes levels in welders than in controls. The narrative synthesis results of SOD showed a significant difference between welders and controls, while the meta-analysis results of MDA did not show a significant difference between the studied groups (MD = 0.26; 95% CI, -0.03, 0.55). The meta-analysis results of 8-OHdG (MD = 9.38; 95% CI, 0.55-18.21) and DPC (MD = 1.07; 95% CI, 0.14-2) revealed significantly differences between the studied groups. The included studies were at high risk of exclusion and confounding bias. The certainty of the evidence for oxidative stress and DNA damage results were very low and moderate, respectively. Exposure to welding fumes and metal particles is associated with DNA damage in professional welders, and 8-OHdG and DPC might be considered reliable markers to assess DNA damage resulting from exposure to welding fumes. We recommend, however, that the evaluation of oxidative stress resulting from welding fumes exposure not be solely based on MDA and SOD.

Age-varying effects of repeated emergency department presentations for children in Canada.

OBJECTIVES: Repeated presentations to emergency departments (EDs) may indicate a lack of access to other health care resources. Age is an important predictor of frequent ED use; however, age-varying effects are not generally investigated. This study examines the age-specific effects of predictors on ED presentation frequency for children in Alberta and Ontario, Canada. METHODS: This retrospective study used population-based data during April 2010 to March 2017. Data were extracted from the National Ambulatory Care Reporting System for children aged <18 who were members of the top 10% of ED users in any one of the fiscal years 2011/2012 to 2015/2016 along with a comparison sample from the bottom 90%. A marginal regression model studied the age-varying associations on the frequency of ED presentations with province, sex, access to primary health care provider (for Ontario only), area of residence and lowest neighbourhood income quintile. RESULTS: There were 2,481,172 patients who made 9,229,156 ED presentations. The effects of sex, lowest income quintile, rural residence, access to primary health care provider and province on the frequency of presentations varied by age. Notably, boys go from having more frequent presentations than girls when aged ≤5 (i.e. adjusted intensity ratio [IR]=1.04 at age 5, 95% confidence interval [CI] = 1.03,1.06) to less frequent for ages 8-11 years and beyond 14 (i.e. IR = 0.80 at age 15, 95% CI = 0.78,0.81). Adolescents aged ≥15 without access to a primary care provider had more frequent presentations compared to those with a primary care provider. CONCLUSIONS: When examining the frequency of ED presentations in children, age-varying effects of predictors should be considered. Our more nuanced examination of age provides insights into how health services might better target programmes for different ages to potentially reduce unnecessary ED use by providing other health care alternatives.

Systematic Review and Meta-analysis: First Nations, Inuit, and Métis Youth Mental Health.

OBJECTIVE: The ongoing effects of colonialism disproportionately place Indigenous youth at risk for mental health challenges. This meta-analysis examined lifetime and past-year prevalence estimates of mental health challenges among First Nations, Inuit, and Métis youth in Canada. METHOD: Five electronic databases were searched from their inceptions until June 17, 2021. Studies were included if they assessed mental health challenges among First Nations, Inuit, and/or Métis youth (≤18 years old). Risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS: A total of 28 articles were eligible. Sixteen studies contained data on First Nations, 2 on Inuit, one on Métis, and 10 aggregated Indigenous participants. Among First Nations participants, pooled prevalence estimates for past-year suicidality (8.9%), mood and/or anxiety (<2.9%), attention-deficit/hyperactivity (2.9%), oppositional defiant (8.8%), and conduct (12.8%) disorder diagnoses were identified. Limited studies containing Inuit, Métis, and aggregated Indigenous participants also found high levels of disruptive disorder symptoms. Data were very limited for lifetime prevalence estimates. Studies assessed to have a moderate or high methodological risk of bias (k = 19) or using measures that are not yet culturally validated (k = 25) may contribute to inaccuracies in prevalence estimates. CONCLUSION: Existing data suggest that Indigenous youth have a low prevalence of mental health challenges, with the exception of disruptive behaviors. Future studies should use culturally validated tools and partner with Indigenous communities to ensure optimal identification of mental health challenges.

Optimizing COPD Acute Care Patient Outcomes Using a Standardized Transition Bundle and Care Coordinator: A Randomized Clinical Trial.

BACKGROUND: Acute exacerbations of COPD (AECOPD) are associated with high morbidity and mortality and frequent readmissions. RESEARCH QUESTION: What is the effectiveness of a COPD transition bundle, with and without a care coordinator, on rehospitalizations and ED revisits? STUDY DESIGN AND METHODS: Two patient cohorts were selected: (1) the group exposed to the transition bundle and (2) the group not exposed to the transition bundle (usual care group). Patients exposed subsequently were randomized to a care coordinator. An AECOPD transition bundle was implemented in the hospital; patients randomized to the care coordinator were contacted ≤ 72 h after discharge. Six hundred four patients (320 to the care coordinator and 284 to routine care) who met eligibility criteria from five hospitals across three cities in Alberta, Canada, were exposed to the transition bundle, whereas 3,106 patients discharged from the same hospitals received the usual care. Primary outcomes were 7-day, 30-day, and 90-day readmissions, median length of stay (LOS), and 30-day ED revisits. RESULTS: The transition bundle cohort were 83% (relative risk [RR], 0.17; 95% CI, 0.07-0.35) less likely to be readmitted within 7 days and 26% (RR, 0.74; 95% CI, 0.60-0.91) less likely to be readmitted within 30 days of discharge. Ninety-day readmissions were unchanged (RR, 1.05; 95% CI, 0.93-1.18). The transition bundle was associated with a 7.3% (RR, 1.07; 95% CI, 1.0-1.15) relative increase in LOS and a 76% (RR, 1.76; 95% CI, 1.53-2.02) greater risk of a 30-day ED revisit. The care coordinator did not influence readmission or ED revisits. INTERPRETATION: The COPD transition bundle reduced 7- and 30-day hospital readmissions while increasing LOS and ED revisits. The care coordinator did not improve outcomes. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT03358771; URL: www. CLINICALTRIALS: gov.