A Scoping Review of Interprofessional Education Training Aimed to Improve 2SLGBTQ+ Health.

OBJECTIVES: This scoping review aims to identify and summarize the available literature on 2-spirited, lesbian, gay, bisexual, transgender, queer, plus (2SLGBTQ+) interprofessional health education and to identify optimal methods of interprofessional training to improve health care professional competency for this patient population. METHODS: A search of PubMed and Embase was conducted and supplemented with a manual search of reference lists from identified articles. Articles were included if they reported an interprofessional education event on the topic of 2SLGBTQ+ health to at least 2 or more groups of health care professionals or students. Article screening was completed independently by 2 reviewers. Data from the included articles were extracted and mapped according to the type of participant (health care students or working health care professionals), type of event (workshop, case-based, course/curriculum, or forum), and type of assessment. RESULTS: One hundred articles were screened, of which 15 articles met the inclusion criteria. Twelve articles focused on interprofessional health education for entry-to-practice students, with the remaining 3 articles involving practicing health care professionals. When mapped by type of event, 1-time case-based and workshop style events were the most used to deliver training. All 15 studies used an immediate presurvey and postsurvey design to evaluate the knowledge and competence of the participants after training. CONCLUSIONS: Interprofessional education for improving 2SLGBTQ+ health is largely delivered within entry-to-practice degree programs via 1-time events with knowledge- and confidence-based assessments. Further research is needed to determine the impact of this training in practice, as well as the applicability for the training of practicing health care professionals.

Unregulated Online Sales are High-Risk Sources of Domestic Swine (Sus scrofa) in Canada: Implications for Invasive Wild Pig and AfricanSwine Fever Risk Preparedness.

Free-ranging wild pig (Sus scrofa) populations may cause widespread environmental damage and transmit diseases at the wildlife-livestock interface. For example, African swine fever (ASF) is a highly contagious viral disease of pigs capable of causing catastrophic economic losses. Prevention and preparedness for ASF require understanding wild and domestic pig movements and distribution. We characterized a "grey" swine market and described the risks it poses, contributing to the threats associated with wild pig populations. We monitored www.kijiji.ca, a Canadian internet classified advertising service, for sales of domestic wild boar, pot-bellied pigs, other breeds, and their hybrids across Canada from 28 April to 30 June 2021. Data collected included seller-defined breed, age, sex, number for sale, sexual intactness, presence of identifying tags or tattoos, and the date and location of listings. Advertisement locations were mapped and compared with existing wild pig distributions, identifying areas new populations might be established, and existing populations supplemented or genetically diversified. We identified 151 advertisements on Kijiji: 34% (n=52/151) from Ontario, 29% (n=44/151) from Alberta, 41% (n=62/151) from existing wild pig populations, and 59% (n=89/151) from areas where wild pigs have not yet been identified. We propose requiring the use of individual animal identifiers (tags/tattoos), genetic analysis, and mandatory reporting for all pig sales in Canada to aid in ASF preparedness and to increase regulation and enforcement of the online swine market.

Shared decision-making for pediatric elective penile surgery.

INTRODUCTION: In pediatric surgery, proxy decision-makers are frequently involved in treatment planning and may experience decisional conflict (DC). Shared decision-making (SDM) approaches may be effective to remedy DC. This study investigates DC and SDM involvement in elective pediatric penile surgery. METHODS: Forty-four parents of children aged <8 years undergoing elective penile surgery consultations at a tertiary pediatric hospital were prospectively enrolled. Patient and physician questionnaires were used to assess the SDM process and the SURE (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) screening test was used to assess DC. RESULTS: Thirty-seven (84.1%) mothers and seven (15.9%) fathers were enrolled for circumcision (n=33, 75.0%) and distal hypospadias repair (n=11, 25.0%) consultations, with 21 (47.7%) choosing to proceed with surgery. Seven (15.9%) participants experienced clinically significant DC. Participant gender was not associated with higher levels of DC (p=0.318). The average patient and physician SDM scores were 88.2±10.0 and 85.3±7.4, respectively, with no correlation found between participant and physician perception of SDM involvement (p=0.168, p=0.276). DC was significantly associated with lower participant and physician ratings of SDM. CONCLUSIONS: There was a high perception of SDM involvement by both parents and pediatric urologists regarding elective penile surgery. Of the 15% of parents experiencing DC, there was an association with lower participant and physician levels of SDM involvement. Despite high SDM scores overall, discrepancies exist between the perceived physician and participant SDM involvement.

Shared decision-making in older children and parents considering elective adenotonsillectomy.

OBJECTIVES: Shared decision-making describes a collaborative process in which healthcare providers and patients/families make treatment decisions using the best available evidence, while taking into account the patient's values and preferences. The objectives of this study were to assess the level of decisional conflict and shared decision-making experienced by older children and their parents when considering elective adentonsillectomies. DESIGN: A prospective cohort study. SETTING: Paediatric otolaryngology clinic in a teaching hospital. PARTICIPANTS: Participants included 53 children older than 9 years and their parents who underwent consultation for tonsillectomy with or without adenoidectomy. MAIN OUTCOMES MEASURES: Children and parents completed the Decisional Conflict Scale (DCS) and Shared Decision-Making Questionnaire-Patient Version (SDM-Q-9). Surgeons completed the Shared Decision-Making Questionnaire-Physician Version (SDM-Q-Doc). RESULTS: Overall, 10 (19%) parents and 18 (34%) children reported clinically significant decisional conflict. Parents who opted not to proceed with surgery had significantly higher DCS scores than those who decided to proceed with surgery. Both parents and children SDM-Q-9 and total DCS scores were significantly negatively correlated. Physician SDM-Q-Doc and parent total DCS scores were negatively correlated, while parent and physician SDM scores were positively correlated. CONCLUSIONS: Many older children and parents reported significant decisional conflict when considering elective paediatric otolaryngology surgery. Decisional conflict levels for both children and parents decreased with greater perceived levels of shared decision-making. Older children did not appear to discern the same levels of shared decision-making as parents and surgeons. Future research should assess methods to implement shared decision-making into clinical practice for clinicians, parents and children when appropriate.

Rubber plantations and drug resistant malaria: a cross-sectional survey in Cambodia.

BACKGROUND: The ongoing spread of artemisinin resistant Plasmodium falciparum malaria is a major threat to global health. In response, countries in the Greater Mekong Sub-region, including Cambodia, have declared ambitious goals to eliminate malaria. Major challenges include the lack of information on the at-risk population-individuals who live or work in or near the forest where the malaria vectors are found, including plantation workers. This study aimed to address this knowledge gap through a cross-sectional survey conducted in rubber plantations in Cambodia in 2014. METHODS: The survey was conducted in two rounds in four provinces and included a malaria prevalence survey, analysis for the K13 genetic mutation, and a comprehensive behavioural questionnaire. Forty plantations were included in each round, and 4201 interviews were conducted. An additional 701 blood samples were collected from family members of plantation workers. RESULTS: Overall malaria prevalence was relatively low with adjusted PCR prevalence rate of 0.6% for P. falciparum and 0.3% for Plasmodium vivax, and was very heterogenous between plantations. There was little difference in risk between permanent residents and temporary workers, and between the two rounds. The main risk factors for P. falciparum infection were smaller plantations, age under 30 years, lack of self-reported use of a treated net and recent travel, especially to the Northeastern provinces. Proximity of plantations to the forest was also a risk factor for malaria in round one, while male gender was also a risk factor for malaria by either species. CONCLUSIONS: With Cambodia's P. falciparum elimination target on the horizon, identifying every single malaria case will become increasingly important. Plantations workers are relatively accessible compared to some other at-risk groups and will likely remain a high priority. Ongoing surveillance and adaptive strategies will be critical if malaria elimination is to be achieved in this setting.

Bayesian Phylogenetic Analysis of Avipoxviruses from North American Wild Birds Demonstrates New Insights into Host Specificity and Interspecies Transmission.

Avian pox is commonly diagnosed in a variety of North American wild and domestic birds, yet little is known about the evolutionary relationships among the causative poxviruses. This study aimed to determine the phylogenetic relationships among isolates identified in different avian host species to better characterize the host range of specific viral strains and compare the genetic variability within and between viral clades. Skin lesions grossly and microscopically consistent with poxvirus infection from 82 birds collected in Canada, the United States, and the U.S. Virgin Islands were included in this study. A total of 12 avian species were represented; the most common species sampled were wild turkeys (Meleagris gallopavo), mourning doves (Zenaida macroura), and American crows (Corvus brachyrhynchos). Poxvirus samples from these birds were genotyped using PCR that targeted the 4b core protein gene followed by amplicon sequencing. Bayesian phylogenetic analyses of these viruses, in conjunction with publicly available sequences, representing avipoxvirus strains from six continents revealed statistically significant monophyletic clades based on genetic distances of sequences within and between observed clades. Genetic variation within the fowlpox clade was low compared to the canarypox clade. Host and geographic origins of viral isolates revealed overall clustering of viral strains within avian species, with a few exceptions. No genetic differences were observed between viruses from Canada and the United States within individual species. These results are novel in their characterization and comparison of the phylogenetic relationships of poxvirus isolates in wild bird species from North America. Further, we provide new data on the level of host specificity and specific strains circulating in North America.

El análisis filogenético bayesiano de los avipoxvirus de las aves silvestres de América del Norte demuestra nuevos conocimientos sobre la especificidad del huésped y la transmisión interespecífica. La viruela aviar se diagnostica comúnmente en una variedad de aves silvestres y domésticas de América del Norte, pero se sabe poco sobre las relaciones evolutivas entre los poxvirus. Este estudio tuvo como objetivo determinar las relaciones filogenéticas entre aislamientos identificados en diferentes especies de hospedadores aviares para caracterizar mejor el rango de hospedadores de cepas virales específicas y comparar la variabilidad genética dentro y entre los clados virales. Se incluyeron en este estudio lesiones cutáneas que eran consistentes macro y microscópicamente con la infección por poxvirus de 82 aves recolectadas en Canadá, Estados Unidos y las Islas Vírgenes de los Estados Unidos. Un total de 12 especies de aves fueron representadas; las especies más comunes en la muestra fueron los pavos silvestres (Meleagris gallopavo), huilota común (Zenaida macroura) y cuervos americanos (Corvus brachyrhynchos). Las muestras de poxvirus de estas aves fueron genotipadas mediante PCR que se enfocó en el gene de la proteína central 4b seguido de secuenciación de amplicón. Los análisis filogenéticos bayesianos de estos virus, junto con las secuencias disponibles públicamente, que representan cepas de avipoxvirus de seis continentes revelaron clados monofiléticos estadísticamente significativos basados en distancias genéticas de las secuencias dentro y entre los clados observados. La variación genética dentro del clado de la viruela del pollo fue baja en comparación con el clado de virus de canario. El huésped y los orígenes geográficos de los aislamientos virales revelaron un agrupamiento general de cepas virales dentro de las especies aviares, con algunas excepciones. No se observaron diferencias genéticas entre los virus de Canadá y los Estados Unidos dentro de las especies individuales. Estos resultados son novedosos en la caracterización y comparación de las relaciones filogenéticas de los aislados de poxvirus en especies de aves silvestres de América del Norte. Además, se proporcionan nuevos datos sobre el nivel de especificidad del huésped y las cepas específicas que circulan en América del Norte. Key words: Bayesian analysis, mourning dove, phylogenetic, poxvirus, sequencing, wild turkey, 4b gene.

Lymphoproliferative Disease Virus in Wild Turkeys (Meleagris gallopavo) from Manitoba and Quebec, Canada.

This study describes the first recognized clinical case of lymphoproliferative disease virus (LPDV) in Canada and extends the range of LPDV in Canada through its detection in Manitoba and Quebec. We assessed the prevalence of LPDV in eastern wild turkeys (Meleagris gallopavo silvestris) with the use of whole, clotted blood from live birds in Manitoba (n = 65) and tissue samples collected postmortem in Quebec (n = 4). We tested for LPDV proviral DNA through PCR amplification and sequencing of a portion of the gag (p31) gene. Samples were also tested for reticuloendotheliosis virus (REV) by PCR. Twenty-four birds (34.8%) were positive for LPDV, including all diagnostic cases. One bird (1.4%) from Quebec had gross and microscopic lesions consistent with LPDV. Two turkeys (2.9%) were REV positive, one (1.4%) of which was co-infected with LPDV. Phylogenetic analysis of LPDV strains from Quebec and Manitoba grouped with previously sequenced samples from Ontario and publicly available sequences from a North American lineage. This study contributes valuable information toward ongoing surveillance and monitoring of LPDV in North America.

Virus de la enfermedad linfoproliferativa en pavos silvestres (Meleagris gallopavo) de Manitoba y Quebec, en Canadá. Este estudio describe el primer caso clínico reconocido del virus de la enfermedad linfoproliferativa (LPDV) en Canadá y extiende el rango de detección de este virus a través de su detección en Manitoba y Quebec. Se evaluó la prevalencia del virus de la enfermedad linfoproliferativa en pavos silvestres (Meleagris gallopavo silvestris) de la parte oriental, mediante el uso de sangre coagulada de aves vivas en Manitoba (n = 65) y de muestras de tejidos recolectadas postmortem en Quebec (n = 4). Se analizó el ADN proviral del virus de la enfermedad linfoproliferativa del pavo a través de la amplificación por PCR y la secuenciación de una parte del gene gag (p31). Las muestras también se analizaron para detectar el virus de la reticuloendoteliosis (REV) mediante PCR. Veinticuatro aves (34.8%) resultaron positivas para la presencia del virus de la enfermedad linfoproliferativa, incluyendo todos los casos diagnósticos. Un ave (1.4%) de Quebec tenía lesiones macroscópicas y microscópicas compatibles con este virus. Dos pavos (2.9%) fueron positivos a la presencia del virus de la reticuloendoteliosis, uno (1.4%) de los cuales se co-infectó con el virus de la enfermedad linfoproliferativa. El análisis filogenético de cepas del virus de la enfermedad linfoproliferativa de Quebec y Manitoba agrupó a estos virus con muestras previamente secuenciadas de Ontario y secuencias disponibles públicamente de un linaje de América del Norte. Este estudio aporta información valiosa para la vigilancia y el monitoreo continuos del virus de la enfermedad linfoproliferativa en América del Norte.

DETECTION OF LYMPHOPROLIFERATIVE DISEASE VIRUS IN CANADA IN A SURVEY FOR VIRUSES IN ONTARIO WILD TURKEYS ( MELEAGRIS GALLOPAVO).

The successful reintroduction of Wild Turkeys ( Meleagris gallopavo) to Ontario, Canada, has led to established populations in southern portions of the province and currently allows for biannual hunting seasons. These populations geographically overlap Domestic Turkey farms, an important sector of the provincial agri-food industry. Potential pathogen transmission between Wild Turkeys and Domestic Turkeys ( Meleagris gallopavo) is a concern, because they are susceptible to infection with many of the same pathogens and have direct and indirect contact in outdoor or open farm settings and contaminated environmental substrates. However, data concerning potential poultry pathogens in Wild Turkeys in Canada are scarce. Thus, we assessed the prevalence and geographic distribution of geographically relevant viruses in Ontario Wild Turkeys. Oropharyngeal and cloacal swabs were tested for avian influenza viruses (AIV) by real-time reverse transcriptase (RT)-PCR ( n=207), pooled tissues for lymphoproliferative disease virus (LPDV; n=183) and reticuloendotheliosis virus ( n=119) by PCR, and gross skin lesions by real-time RT-PCR for avian poxvirus ( n=8). We sequenced a fragment of the gag polyprotein (p31) gene of LPDV on a subset ( n=10) of LPDV-positive samples for phylogenetic analysis and tested additional upland game bird species ( n=39) and domestic fowl for LPDV ( n=17). To the best of our knowledge, we document the first detection of LPDV in Wild Turkeys in Canada, with a prevalence of 65% (119/183). Phylogenetic analysis revealed that LPDV sequences from Ontario were genetically similar to other North American strains and did not group into separate clades. Reticuloendotheliosis virus was detected in 4% (5/119) of LPDV-positive Wild Turkeys. Grossly evident skin lesions from five Wild Turkeys tested positive for poxvirus, and all turkeys tested negative for AIV. This study provides evidence of LPDV circulation in Canada and provides a baseline for comparison with future Wild Turkey pathogen surveillance and monitoring in Ontario and elsewhere.

Necuparanib, A Multitargeting Heparan Sulfate Mimetic, Targets Tumor and Stromal Compartments in Pancreatic Cancer.

Pancreatic cancer has an abysmal 5-year survival rate of 8%, making it a deadly disease with a need for novel therapies. Here we describe a multitargeting heparin-based mimetic, necuparanib, and its antitumor activity in both in vitro and in vivo models of pancreatic cancer. Necuparanib reduced tumor cell proliferation and invasion in a three-dimensional (3D) culture model; in vivo, it extended survival and reduced metastasis. Furthermore, proteomic analysis demonstrated that necuparanib altered the expression levels of multiple proteins involved in cancer-driving pathways including organ development, angiogenesis, proliferation, genomic stability, cellular energetics, and invasion and metastasis. One protein family known to be involved in invasion and metastasis and altered by necuparanib treatment was the matrix metalloprotease (MMP) family. Necuparanib reduced metalloproteinase 1 (MMP1) and increased tissue inhibitor of metalloproteinase 3 (TIMP3) protein levels and was found to increase RNA expression of TIMP3. MMP enzymatic activity was also found to be reduced in the 3D model. Finally, we confirmed necuparanib's in vivo activity by analyzing plasma samples of patients enrolled in a phase I/II study in patients with metastatic pancreatic cancer; treatment with necuparanib plus standard of care significantly increased TIMP3 plasma protein levels. Together, these results demonstrate necuparanib acts as a broad multitargeting therapeutic with in vitro and in vivo anti-invasive and antimetastatic activity.

HIGH PREVALENCE OF MYCOPLASMA AND EIMERIA SPECIES IN FREE-RANGING EASTERN WILD TURKEYS ( MELEAGRIS GALLOPAVO SILVESTRIS) IN ONTARIO, CANADA.

Following extirpation from Ontario, Canada in the early 1900s, Eastern Wild Turkeys (EWTs; Meleagris gallopavo silvestris) were successfully reintroduced to the province in 1984. Despite the subsequent establishment of robust populations and biannual hunting seasons, data on the circulation of potential pathogens in these birds are lacking. Similarly, the interface between EWTs and poultry is poorly understood and includes possible bidirectional pathogen transmission via direct or indirect contact. Mycoplasma and Eimeria spp. are potential pathogens in Galliformes, and our objective was to determine their prevalence and distribution in Ontario EWTs. During the 2015 spring hunting season (April and May), oropharyngeal swabs from 147 hunter-harvested and five opportunistically collected EWTs from southern Ontario were cultured for Mycoplasma spp. The intestinal or cloacal contents of 107 of these birds and an additional 24 opportunistically and biologist-collected EWTs were analyzed for Eimeria spp. using PCR or fecal flotation. At least one Mycoplasma spp. was isolated from 98.7% (150/152) of EWTs, with six species identified. Mycoplasma gallopavonis was identified most commonly in 96.7% (147/152), followed by Mycoplasma gallinaceum in 23.7% (36/152). Potential poultry pathogens ( Mycoplasma meleagridis, Mycoplasma iowae, and Mycoplasma synoviae) were isolated from swabs of five (3.3%) EWTs. Coinfections with up to three Mycoplasma spp. were detected in 36.8% (56/152) of EWTs. Most EWTs tested positive for Eimeria spp. oocysts (75.6%; 99/131). A subset of positive samples ( n=16) were characterized by PCR, which detected the following species: Eimeria meleagrimitis (93.8%), Eimeria adenoeides (93.8%), Eimeria gallopavonis (56.3%), and Eimeria meleagridis (12.5%). The majority (93.8%) of these samples were positive for more than one Eimeria spp. We showed that numerous, mostly nonpathogenic Mycoplasma and Eimeria spp. circulate in EWTs across southern Ontario, and this helped to establish baseline information for comparison with future surveillance and monitoring.

Survey for Bacteria and Antimicrobial Resistance in Wild Turkeys ( Meleagris gallopavo) in Ontario, Canada.

Since being successfully reintroduced into Ontario, Canada, wild turkey ( Meleagris gallopavo) populations have undergone robust growth and range expansion. This, along with increases in land use changes from human population growth and subsequent developments in agriculture and livestock production, has heightened opportunities for interactions between wild turkeys, domestic poultry, and humans. As conspecifics, wild and domestic turkeys are susceptible to infection and disease from many of the same pathogens. Thus, transmission by direct or indirect contact is a potential health threat to both groups, particularly with the overlapping range of wild turkeys in Ontario with numerous commercial and backyard poultry operations. However, these threats are difficult to assess due to knowledge gaps in the prevalence and geographic distribution of potential pathogens circulating among wild turkeys. We assessed for potentially pathogenic bacteria in free-ranging, hunter-harvested wild turkeys in Ontario ( n = 152) by cloacal swab culture for Campylobacter spp., Salmonella spp., and Escherichia coli and culture of lung and spleen for Pasteurella multocida, Ornithobacterium rhinotracheale, and Erysipelothrix rhusiopathiae. Antimicrobial resistance testing was also performed on E. coli isolates. Generic E. coli isolates were recovered from 69.1% (105/152) of wild turkeys tested, and two (1.9%) of these isolates exhibited resistance to azithromycin and one (1.0%) to ampicillin. Intermediate susceptibility to chloramphenicol was observed in one (1.0%) isolate. One (0.7%) wild turkey swab tested positive for C. jejuni, but no samples were positive for P. multocida, Salmonella spp., O. rhinotracheale, or E. rhusiopathiae. To our knowledge, this is the first survey of these bacteria and assessment for antimicrobial resistance among wild turkeys in Ontario.

Neonicotinoid detection in wild turkeys (Meleagris gallopavo silvestris) in Ontario, Canada.

The use of neonicotinoid insecticides in agriculture is now recognized for the health risks it poses to non-target wildlife, with associated honey bee mortality especially concerning. Research directed toward the presence and effects of these pesticides on terrestrial vertebrates that consume neonicotinoid-coated seeds, such as wild turkeys (Meleagris gallopavo silvestris), is lacking. This study used liquid chromatography attached to a tandem mass spectrometer to assess the liver from 40 wild turkeys for neonicotinoid and other pesticide residues and compared detected levels of these contaminants across the southern Ontario, Canada. Nine (22.5%) wild turkeys had detectible levels of neonicotinoid residues-clothianidin in eight, and thiamethoxam in three. Two (5.0%) of these turkeys had detectable levels of both clothianidin and thiamethoxam. Fuberidazole was detected in two (5.0%) wild turkeys. The highest level of thiamethoxam detected was 0.16 ppm, while clothianidin was detected at 0.12 ppm, and fuberidazole at 0.0094 ppm. Knowledge of exposure in free-ranging wildlife is critical for better understanding the effects of neonicotinoids on wildlife health; thus, these data help establish baseline data for southern Ontario wild turkeys and provide context for reference values in future analyses.

Mortality and Disease in Wild Turkeys ( Meleagris gallopavo silvestris) in Ontario, Canada, from 1992 to 2014: A Retrospective Review.

Wild turkeys ( Meleagris gallopavo silvestris) were extirpated from Ontario, Canada, in the early 1900s due to unregulated over-hunting and habitat loss. Despite a successful reintroduction program and strong population numbers, information regarding the health of wild turkeys in Ontario is scarce. A 22-yr (1992-2014) retrospective study was performed to evaluate diagnostic data, including the cause(s) and contributors to death, in wild turkeys submitted to the Ontario-Nunavut node of the Canadian Wildlife Health Cooperative (n = 56). Noninfectious diagnostic findings (39/56; 69.6%) were more common than infectious, with emaciation recognized most frequently (n = 19; 33.9%) followed by trauma (n = 11, 19.6%). The majority of deaths due to emaciation occurred in winter and spring (17/18; 94.4%), which is consistent with lack of access to or availability of food resources. Morbidity and mortality due to infectious diseases was diagnosed in 16 (28.6%) wild turkeys. Avian poxvirus was the most common infectious cause of disease (n = 7; 12.5%), followed by bacterial infections (n = 5; 8.9%), the most common of which was Pasteurella multocida . Zinc phosphide toxicosis (n = 7; 12.5%) occurred in two incidents involving multiple birds. This study aims to provide baseline data that can be used for reference and comparison in future wild turkey disease surveillance and population monitoring studies.

Nutrition and shiftwork: evaluation of new paramedics' knowledge and attitudes.

PURPOSE: The effect of an oral education intervention on nutrition knowledge was evaluated in new paramedic employees. The evaluation involved measuring knowledge of and attitudes toward nutrition and shiftwork before and after the directed intervention. METHODS: A convenience sample of 30 new paramedic shiftworkers attended a 15-minute education session focused on nutrition management strategies. This matched cohort study included three self-administered surveys. Survey 1 was completed before education, survey 2 immediately after education, and survey 3 after one month of concurrent post-education and employment experience. Knowledge and attitude scores were analyzed for differences between all surveys. RESULTS: Participants were primary care paramedics, 59% of whom were male. They reported that previously they had not received this type of information or had received only a brief lecture. Mean knowledge scores increased significantly from survey 1 to survey 2; knowledge retention was identified in survey 3. A significant difference was found between surveys 2 and 3 for attitudes toward meal timing; no other significant differences were found between attitude response scores. CONCLUSIONS: The education session was successful in improving shiftwork nutrition knowledge among paramedics. Paramedics' attitudes toward proper nutrition practices were positive before the education intervention.

The epidemiology of chronic pain in children and adolescents revisited: a systematic review.

Chronic and recurrent pain not associated with a disease is very common in childhood and adolescence, but studies of pain prevalence have yielded inconsistent findings. This systematic review examined studies of chronic and recurrent pain prevalence to provide updated aggregated prevalence rates. The review also examined correlates of chronic and recurrent pain such as age, sex, and psychosocial functioning. Studies of pain prevalence rates in children and adolescents published in English or French between 1991 and 2009 were identified using EMBASE, Medline, CINAHL, and PsycINFO databases. Of 185 published papers yielded by the search, 58 met inclusion criteria and were reviewed, and 41 were included in the review. Two independent reviewers screened papers for inclusion, extracted data, and assessed the quality of studies. Prevalence rates ranged substantially, and were as follows: headache: 8-83%; abdominal pain: 4-53%; back pain: 14-24%; musculoskeletal pain: 4-40%; multiple pains: 4-49%; other pains: 5-88%. Pain prevalence rates were generally higher in girls and increased with age for most pain types. Lower socioeconomic status was associated with higher pain prevalence especially for headache. Most studies did not meet quality criteria.

Social functioning and peer relationships in children and adolescents with chronic pain: A systematic review.

BACKGROUND: Peer relationships during childhood and adolescence are acknowledged to be negatively impacted by chronic pain; however, to date there has been no synthesis of this literature. OBJECTIVE: To systematically review existing literature describing the social functioning and peer relationships in children and adolescents with recurrent or continuous chronic pain. METHODS: Articles on peer relationship factors studied in samples of children and adolescents with chronic pain published in English or French were identified using EMBASE, Medline, CINAHL and PsycINFO. Two independent reviewers performed initial screenings using study titles and abstracts, and reviewed each eligible article in full. RESULTS: Of 1740 published papers yielded by the search, 42 articles met the inclusion criteria and were included in the present review. Nine studies had peer relationship investigation as the primary purpose of the study; the remaining 33 examined peer relationships as part of a broader study. A range of specific and more general measures was used to examine peer relationships. Across studies, children and adolescents with chronic pain were reported to have fewer friends, be subjected to more peer victimization, and were viewed as more isolated and less likeable than healthy peers. CONCLUSIONS: Children and adolescents with chronic pain have peer relationship deficiencies. However, the majority of studies to date measure peer relationships as part of a broader study and, thus, little attention has been paid specifically to peer relationships in this group. Additional research examining the quality of peer relationships of children and adolescents with chronic pain, as well as development of measures specifically designed to assess these relationships, is needed.