A survey of undergraduate medical students' gender awareness and bias: the Newfoundland and Labrador perspective.

Background: Female physicians and patients experience gender bias in healthcare. The purpose of this research is to explore medical students' gender bias toward physicians and patients and whether their bias varies by gender. Methods: We surveyed medical students at Memorial University between November 2020 and April 2021. We recruited participants through Facebook, email, and e-posters. We collected demographic information, including gender and class year. We used the Nijmegen Gender Awareness in Medicine Scale to measure gender sensitivity, gender role ideology toward patients, and gender role ideology toward doctors. We analyzed the data using averages and t-tests. Results: Mean gender sensitivity scores were 4/5 indicating high gender sensitivity. Gender role ideology toward doctors mean scores were 2/5 indicating that students did not hold strong stereotypical views toward doctors. Although male students scored higher than female students (p<.05), mean scores for gender role ideology toward patients were low for both male and female students (x¯ <2), indicating low stereotyping toward patients. Conclusions: We found that students held largely non-biased ideologies surrounding gender in medicine and that female students were even less biased than male students for gender role ideology toward patients.

Contexte: Les femmes médecins ou patientes sont victimes de préjugés sexistes dans les soins de santé. L'objectif de cette recherche est d'explorer les préjugés sexistes des étudiants en médecine à l'égard des médecins et des patients et de déterminer si ces préjugés varient en fonction du sexe. Méthodes: Nous avons procédé à une enquête auprès des étudiants en médecine de l'Université Memorial entre novembre 2020 et avril 2021. Nous avons recruté des participants au moyen de Facebook, du courrier électronique et d'affiches électroniques. Nous avons recueilli des données démographiques, y compris le sexe et l'année dans le programme. Nous avons utilisé l'échelle de sensibilisation au genre en médecine de Nijmegen pour mesurer la sensibilité au genre, l'idéologie du rôle du genre envers les patients et l'idéologie du rôle du genre envers les médecins. Nous avons analysé les données à l'aide de moyennes et de tests t. Résultats: Les scores moyens de sensibilité au genre étaient de 4/5, ce qui indique une grande sensibilité au genre. Les scores moyens de l'idéologie du rôle du genre à l'égard des médecins étaient de 2/5, ce qui indique que les étudiants n'avaient pas d'opinion stéréotypée à l'égard des médecins. Bien que les étudiants aient obtenu des scores plus élevés que les étudiantes (p<0,05), les scores moyens pour l'idéologie du rôle du genre à l'égard des patients étaient faibles tant pour les étudiants que pour les étudiantes (x¯<2), ce qui indique un faible niveau d'opinions stéréotypées à l'égard des patients. Conclusions: Nous avons constaté que les étudiants avaient des idéologies largement non biaisées concernant le genre en médecine et que les étudiantes étaient encore moins biaisées que les étudiants en ce qui concerne l'idéologie du rôle du genre envers les patients.

Perceptions of gender equity in emergency medicine in Canada.

INTRODUCTION: Women-identifying emergency physicians face gender-based discrimination throughout their careers. The purpose of this study was to explore emergency physician's perceptions and experiences of gender equity in emergency medicine. METHODS: We conducted a secondary analysis of data from a previously conducted survey of Canadian emergency physicians on barriers to gender equity in emergency medicine. Survey responses were analyzed using logistic regression to determine the impact that gender, practice setting, years since graduation, race, equity-seeking status, and parental status had on agreement about gender equity in emergency medicine and five of the problem statements. RESULTS: A total of 710 participants completed the survey. Most identified as women (58.8%), white (77.4%), graduated between 2010 and 2019 (40%), had CCFP (Emergency Medicine) designation (47.9%), an urban practice (84.4%), were parents (62.4%) and did not identify as equity-seeking (79.9%). Women-identifying physicians were less likely to perceive gender equity in emergency medicine, OR 0.52, CI [0.38, 0.73]. Women-identifying physicians were more likely to agree with statements about microaggressions, OR 4.39, CI [2.66, 7.23]; barriers to leadership, OR 3.51, CI [2.25, 5.50]; gender wage gap, OR 13.46, CI [8.27, 21.91]; lack of support for parental leave, OR 2.85, CI [1.82, 4.44]; and education on allyship, OR 2.23 CI [1.44, 3.45] than men-identifying physicians. CONCLUSION: In this study, women-identifying physicians were less likely to perceive that there was gender equity in emergency medicine than men-identifying physicians. Women-identifying physicians agreed that there are greater barriers for career advancement including fewer opportunities for leadership, a gender wage gap, a lack of parental leave policies to support a return to work and a lack of education for men to become allies. Men-identifying physicians were less aware of these inequities. Health systems must work to improve gender equity in emergency medicine and this will require education and allyship from men-identifying physicians.

RéSUMé: INTRODUCTION: Les femmes médecins urgentistes sont confrontées à une discrimination fondée sur le sexe tout au long de leur carrière. L'objectif de cette étude était d'explorer les perceptions et les expériences des médecins urgentistes en matière d'équité entre les sexes en médecine d'urgence. MéTHODES: Nous avons procédé à une analyse secondaire des données d'une enquête menée précédemment auprès des médecins urgentistes canadiens sur les obstacles à l'équité entre les sexes en médecine d'urgence. Les réponses au sondage ont été analysées à l'aide d'une régression logistique pour déterminer l'incidence que le sexe, le milieu de pratique, les années écoulées depuis l'obtention du diplôme, la race, le statut de demandeur d'équité et le statut parental avaient sur l'accord sur l'équité entre les sexes en médecine d'urgence et cinq des énoncés de problème. RéSULTATS: Au total, 710 participants ont répondu à l'enquête. La plupart d'entre eux sont des femmes (58.8 %), de race blanche (77.4 %), ont obtenu leur diplôme entre 2010 et 2019 (40 %), ont le titre de CCMF (médecine d'urgence) (47.9 %), exercent en milieu urbain (84.4 %), sont parents (62.4 %) et ne se déclarent pas en quête d'équité (79.9 %). Les médecins s'identifiant à des femmes étaient moins susceptibles de percevoir l'équité entre les sexes en médecine d'urgence, OR 0.52, IC [0.38,0.73]. Les médecins s'identifiant comme femmes étaient plus susceptibles d'être d'accord avec les déclarations sur les microagressions, OR 4.39, IC [2.66, 7.23] ; obstacles au leadership, OR 3.51, IC [2.25, 5.50] ; écart salarial entre les hommes et les femmes, OR 13.46, IC [8.27, 21.91] ; le manque de soutien pour le congé parental, OR 2.85, IC [1.82, 4.44]; et l'éducation sur l'alliance, OR 2.23 IC [1.44, 3.45] que les médecins s'identifiant comme hommes. CONCLUSION: Dans cette étude, les médecins s'identifiant à des femmes étaient moins susceptibles de percevoir qu'il y avait une équité entre les sexes en médecine d'urgence que les médecins s'identifiant à des hommes. Les femmes médecins s'accordent à dire qu'il existe davantage d'obstacles à l'avancement professionnel, notamment moins d'opportunités de leadership, un écart salarial entre les hommes et les femmes, un manque de politiques de congé parental pour favoriser le retour au travail et un manque d'éducation des hommes pour qu'ils deviennent des alliés. Les médecins s'identifiant à des hommes étaient moins conscients de ces inégalités. Les systèmes de santé doivent s'efforcer d'améliorer l'équité entre les sexes dans la médecine d'urgence, ce qui nécessitera une formation et un allié de la part des médecins qui s'identifient aux hommes.

Dental Insurance Coverage, Dentist Visiting, and Oral Health Status among Asian Immigrant Women of Childbearing Age in Canada: A Comparative Study.

OBJECTIVES: This study examined the dental insurance coverage, dentist visits, self-perceived oral health status, and dental problems among Asian immigrant women of childbearing age in contrast to Canadian women of childbearing age and non-Asian immigrant women of childbearing age. Potential barriers to dental care services among Asian immigrant women were explored. METHODS: This analysis utilized data from the combined Canadian Community Health Survey from 2011 to 2014. The analytical sample consisted of 5737 females whose age was between 20 and 39 years. Multivariable logistic regression models assessed immigrant status and other factors in relation to the indicators of dental health (i.e., dental visit, self-perceived oral health, acute teeth issue, and teeth removed due to decay). RESULTS: Amongst Asian women immigrants of childbearing age, there was a significantly lower frequency of dentist visits compared to non-immigrant counterparts (OR = 0.53; 95% CI: 0.37-0.76). The most commonly reported reason for not seeking dental care in the last three years was that the "respondent did not think it was necessary". Relative to Canadian born women of same age bracket, Asian women of childbearing age reported fewer acute teeth issues (OR = 0.67; 95% CI: 0.49-0.91) and had a greater risk of tooth extracted due to tooth decay (OR = 3.31; 95% CI: 1.64-6.68). Furthermore, for Asian women immigrants, their major barriers to dental care included low household income (≤$39,999 vs. $40,000-$79,999 OR = 0.26) and a lack of dental insurance (no vs. yes OR = 0.33). CONCLUSIONS: Asian immigrant women showed lower utilization of dental services than non-immigrant women. A perceived lack of necessity, lower household income, and dental insurance coverage were major barriers to professional dental usage for most Asian immigrants of childbearing age.

Integration of life cycle assessment and system dynamics modeling for environmental scenario analysis: A systematic review.

System dynamics (SD) is widely recognized as a tool for simulating spatial and temporal dynamics in life cycle assessment (LCA) studies of the product system. However, there is no agreement on how SD and LCA could be applied effectively together in a consistent way. To address this gap, this research conducted a systematic literature review, analyzing 54 scientific articles published worldwide between 2010 and 2023, to explore the joint application of LCA with SD. The study aimed to answer three research questions: (1) What can be considered an integration of LCA and SD? (2) How can SD and LCA be effectively integrated? and (3)What are the advantages and constraints of this integration? The results highlighted the popularity of LCA and SD as impact assessment tools for sustainable design, each with its own strengths and limitations. Two primary integration types were identified when LCA was jointly applied with SD: (1) inclusion of the life cycle inventory and characterization factors in an SD model, and (2) inclusion of SD model results in an LCA. In the second type of integration, SD models the components of the technical system, and its outcomes served as input for scenario analysis, providing temporal and potentially spatial inventory data for the LCA model. The integrated approach offers a comprehensive understanding of product sustainability, aids decision-making, and enhances stakeholder engagement. The study also identifies knowledge gaps in the joint application of SD and LCA for environmental scenario analysis, suggesting the incorporation of optimization tools and strategy guidance for policy makers.

Dental health status, dentist visiting, and dental insurance of Asian immigrants in Canada.

OBJECTIVE: This study examined the dental care utilization and self-preserved dental health of Asian immigrants relative to non-immigrants in Canada. Factors associated with oral health-related disparities between Asian immigrants and other Canadians were further examined. METHODS: We analyzed 37,935 Canadian residents aged 12 years and older in the Canadian Community Health Survey 2012-2014 microdata file. Factors (e.g., demographics, socioeconomic status, lifestyles, dental insurance coverage, and year of immigration) associated with disparities in dental health (e.g., self-perceived teeth health, dental symptoms during past one month, and teeth removed due to decay in past one year) and service utilization (e.g., visiting dentist within the last three years, visiting dentist more than once per year) between Asian immigrants and other Canadians were examined using multi-variable logistic regression models. RESULTS: The frequency of dental care utilization was significantly lower in Asian immigrants than their non-immigrant counterparts. Asian immigrants had lower self-perceived dental health, were less likely to be aware of recent dental symptoms, and more likely to report tooth extractions due to tooth decay. Low education (OR = 0.42), male gender(OR = 1.51), low household income(OR = 1.60), non-diabetes(OR = 1.87), no dental insurance(OR = 0.24), short immigration length (OR = 1.75) may discourage Asian immigrants from dental care utilization. Additionally, a perceived lack of necessity to dentist-visiting was a crucial factor accounting for the disparities in dental care uptake between Asian immigrants and non-immigrants. CONCLUSION: Asian immigrants showed lower dental care utilization and oral health than native-born Canadians.

Using Kane's framework to build an assessment tool for undergraduate medical student's clinical competency with point of care ultrasound.

INTRODUCTION: Point-of-care ultrasonography (POCUS) is a portable imaging technology used in clinical settings. There is a need for valid tools to assess clinical competency in POCUS in medical students. The primary aim of this study was to use Kane's framework to evaluate an interpretation-use argument (IUA) for an undergraduate POCUS assessment tool. METHODS: Participants from Memorial University of Newfoundland, the University of Calgary, and the University of Ottawa were recruited between 2014 and 2018. A total of 86 participants and seven expert raters were recruited. The participants performed abdominal, sub-xiphoid cardiac, and aorta POCUS scans on a volunteer patient after watching an instruction video. The participant-generated POCUS images were assessed by the raters using a checklist and a global rating scale. Kane's framework was used to determine validity evidence for the scoring inference. Fleiss' kappa was used to measure agreement between seven raters on five questions that reflected clinical competence. The descriptive comments collected from the raters were systematically coded and analyzed. RESULTS: The overall agreement between the seven raters on five questions on clinical competency ranged from fair to moderate (κ = 0.32 to 0.55). The themes from the qualitative data were poor image generation and interpretation (22%), items not applicable (20%), poor audio and video quality (20%), poor probe handling (10%), and participant did not verbalize findings (14%). CONCLUSION: The POCUS assessment tool requires further modification and testing prior before it can be used for reliable undergraduate POCUS assessment.

The Understanding of Maternal Smoking among Women who were Smoking or had Quit Smoking during Pregnancy.

BACKGROUND: Maternal tobacco smoking during pregnancy is associated with adverse health effects for the woman, fetus, and child, including such serious effects as preterm birth, low birth weight, stillbirth, and neonatal and sudden infant death. Smoking cessation during pregnancy reduces health risks. PURPOSE: In order to support pregnant women to quit smoking, it is essential to know determinants of quitting smoking in pregnancy. The purpose of this research was to examine women's understanding of maternal smoking, in terms of their beliefs, in relation to quitting smoking during pregnancy. METHODS: The study was a cross-sectional survey with anonymous questionnaires. The sample consisted of 161 pregnant and postnatal women who were continuing or had continued to smoke during pregnancy or had quit smoking during pregnancy. Logistic regression was used to determine the impact of women's understanding of maternal smoking on quitting smoking in pregnancy. RESULTS: A large majority of the women had low to moderate understanding of maternal smoking. Those with higher levels of understanding were more likely to quit smoking during pregnancy than were those with a low level of understanding. Not having children prior to the current pregnancy or childbirth also increased the likelihood of quitting smoking during pregnancy while being without a partner combined with having a longer duration of smoking decreased the likelihood of quitting smoking during pregnancy. CONCLUSION: As a modifiable factor, pregnant women's understanding of maternal smoking can be readily targeted with informational interventions in an effort to help them quit smoking.

The Effects of Cancer Beliefs and Sociodemographic Factors on Colorectal Cancer Screening Behaviours in Newfoundland and Labrador.

Objectives: This study investigated the beliefs about cancer treatment, outcomes, and screening among adults aged 50−74 in Newfoundland and Labrador and whether these beliefs or sociodemographic factors were associated with differences in colorectal cancer (CRC) screening behaviours. Methods: This analysis uses data collected from an online survey of adults on cancer awareness and prevention in NL. Chi-square tests were used to assess differences in distributions of beliefs based on CRC screening behaviour. Logistic regression was used to identify sociodemographic factors independently associated with CRC screening behaviour. Results: A total of 724 participants were included in the analysis, 57.4% of which had ever had CRC screening. Most held positive beliefs about cancer outcomes and treatment. Only beliefs about screening affected CRC screening behaviour. People who never had CRC screening were more likely to believe their worries about what might be found would prevent them from screening (χ2 = 9.380, p = 0.009); screening is only necessary if they have symptoms (χ2 = 15.680, p < 0.001); and screening has a high risk of leading to unnecessary surgery (χ2 = 6.824, p = 0.032). Regression identified that men had higher likelihood of having had CRC screening than women in our study (OR = 1.689, 95%CI = 1.135−2.515), as did all age groups compared to ages 50−54. No associations were found with the other sociodemographic factors studied. Conclusion: Beliefs about cancer screening appear to play some role in CRC screening behaviour, but the absolute effect was small. The relatively few sociodemographic associations with screening behaviour suggest that NL's CRC screening program is equitably reaching people from different socioeconomic backgrounds.

Influencing factors for effective teaching evaluation of massively open online courses in the COVID-19 epidemics: An exploratory study based on grounded theory.

Many factors affect the teaching of massively open online courses (MOOCs). In this study, to explore the factors that influence the effective teaching of MOOCs, a large number of relevant studies are analyzed. Based on grounded theory, semi-structured interviews were conducted with 30 students and teachers who used MOOCs for online teaching. The interview data were subjected to four research processes -open coding, axial coding, selective coding, and saturation testing- to explore the factors influencing MOOCs' effective teaching and the interactions between them. The results demonstrate that: (1) Effective teachers, effective tuition, effective communication, active online learning, social support guarantees, and online course design have important positive effects on effective teaching, while only certain online learning behaviors will seriously affect the teaching effectiveness of MOOC, resulting in negative effects. (2) Effective communication is essential for effective teaching in MOOCs; effective teachers are the leading factor, thus teachers should take the initiative to study and understand the students to understand their various learning needs and difficulties. (3) Reasonable and effective classroom teaching design is key to improving MOOCs' teaching efficiency. (4) E-learning is respected, cared for, and valued by society, including cognition, emotion, and learning platform support from family, school, teachers, and classmates, and has an important impact on students' motivation and the effects of online learning. The results of this study further clarify factors influencing effective teaching of MOOCs, thus helping to enrich and supplement the theory of effective teaching and evaluation and providing theoretical guidance for teachers to effectively implement MOOC teaching.

Study protocol for CELLAR (COVID-related Eating Limitations and Latent dietary effects in the Atlantic Region): population-based observational study to monitor dietary intakes and purchasing during COVID-19 in four Atlantic Canadian provinces.

INTRODUCTION: Poor diet is a leading preventable risk for the global burden of non-communicable disease. Robust measurement is needed to determine the effect of COVID-19 on dietary intakes and consumer purchasing, given the widespread changes to consumer food environments and economic precarity. The research objectives are as follows: (1) describe dietary intakes of foods, beverages and nutrients of concern during the COVID-19 pandemic; (2) quantify change in diet during COVID-19 as compared with prepandemic, previously captured in the provincial samples of the population-representative 2015 Canadian Community Health Survey-Nutrition and (3) examine how household purchasing practices predict dietary intakes during COVID-19. METHODS AND ANALYSES: Observational study of diet, using a population-based stratified probability sampling strategy allocated via dual-frame (landline and cellphone) calls to random-digit dialled numbers, followed by age-sex group quotas. The base population comprises the four provinces of the Atlantic region of Canada, jurisdictions with an excess burden of pre-existing dietary risk, compared with the rest of Canada. Our aim is n=1000 to obtain reliable estimates at a regional level to describe intakes and compare with prepandemic baseline. Data collection entails 12 weeks participation: (1) enrolment with sociodemographics (key dietary risk predictors such as age, sex, gender, pre-COVID-19 income, employment, household composition, receipt of economic relief, rural residence); (2) two 24hour diet recalls using the online ASA-24 Canada 2018 tool; and (3) online uploads of household food purchase receipts over the 12 weeks enrolled. Participation incentives will be offered. ETHICS AND DISSEMINATION: This research protocol received funding from the Canadian Institutes of Health Research (FRN VR5 172691) and ethics review approval from the Dalhousie University Research Ethics Board. Study protocol and instruments and a de-identified dataset will be made publicly available. We will submit the findings to peer-reviewed journals, as well as conferences geared towards scientific and decision-maker audiences.

Feasibility and measurement error in using food supply data to estimate diet costs in Canada.

OBJECTIVE: The cost of food is a key influence on diet. The majority of diet cost studies match intake data from population-based surveys to a single source of food supply prices. Our aim was to examine the methodological significance of using food supply data to price dietary intakes. METHODS: Nationally representative 24-hour dietary recall data from the 2015 Canadian Community Health Survey-Nutrition (CCHS-N) was matched to the 2015 Canadian Consumer Price Index (CPI) food price list. Proportions and means of reported intakes covered by the 2015 CPI price list were used to compare reported intakes of food groups and food components of interest and concern overall, and by quartile of CPI coverage. SETTING: Canada. PARTICIPANTS: 20,487 Canadians ages one and older. RESULTS: The CPI covered on average 76.3% of total dietary intake (g) without water. Staple food groups that were more commonly consumed had better CPI price coverage than those less commonly consumed. Yet some food groups (vegetables, additions, sweets) that were also commonly consumed by Canadians were not well covered by price data. Individuals in the poorest CPI coverage quartile reported consuming significantly greater fibre (g), gram weight (g), dietary fibre (g), and energy (kcal) as compared to those with the best coverage. CONCLUSIONS: Differential CPI price coverage exists among food components and commonly consumed food groups; additionally dietary intake differs significantly in the population by CPI coverage. Methodological refinements are needed to better account for error when using prices from food supply data to estimate diet costs.

A single-entry model and wait time for hip and knee replacement in eastern health region of Newfoundland and Labrador 2011-2019.

BACKGROUND: A single-entry model in healthcare consolidates waiting lists through a central intake and allows patients to see the next available health care provider based on the prioritization. This study aimed to examine whether and to what extent the prioritization reduced wait times for hip and knee replacement surgeries. METHOD: The survival regression method was used to estimate the effects of priority levels on wait times for consultation and surgery for hip and knee replacements. The sample data included patients who were referred to the Orthopedic Central Intake clinic at the Eastern Health region of Newfoundland and Labrador and had surgery of hip and knee replacements between 2011 and 2019. RESULT: After adjusting for covariates, the hazard of having consultation booked was greater in patients with priority 1 and 2 than those in priority 3 when and at 90 days after the referral was made for both hip and knee replacements. Regarding wait time for surgery after the decision for surgery was made, while the hazard of having surgery was lower in priority 2 than in priority 3 when and indifferent at 182 days after the decision was made, it was not significantly different between priority 1 and priority 3 among hip replacement patients. Priority levels were not significantly related to the hazard of having surgery for a knee replacement after the decision for surgery was made. Overall, the hazard of having surgery after the referral was made by a primary care physician was greater for patients in high priority than those in low priority. Preferring a specific surgeon indicated at referral was found to delay consultation and it was not significantly related to the total wait time for surgery. Incomplete referral forms prolonged wait time for consultation and patients under age 65 had a longer total wait time than those aged 65 or above. CONCLUSION: Patients with high priority could have a consultation booked earlier than those with low priority and prioritization in a single entrance model shortens the total wait time for surgery. However, the association between priority levels and wait for surgery after the decision for surgery was made has not well-established.

The prevalence and patterns of use of point-of-care ultrasound in Newfoundland and Labrador.

INTRODUCTION: Point-of-care ultrasound (POCUS) is used for diagnostic and procedural guidance by physicians in Newfoundland and Labrador (NL). POCUS use is largely limited to urban locations and the training is variable amongst physicians. The primary aim of this study was to determine the prevalence of POCUS devices in NL and the secondary aim was to characterise the patterns of POCUS use amongst physicians in NL. METHODS: This is a mixed-methods cross-sectional study. We determined the prevalence of POCUS devices from purchase records and the patterns of POCUS use through theme-based interviews. The interviews were transcribed, coded and analysed using standardised qualitative methods. RESULTS: Ten physicians (3 females, 5 rural) participated in the interviews. The overall prevalence of POCUS devices in NL was 12.5/100,000 population. Participants in urban areas had more access to POCUS training and devices. Participants used POCUS on a daily or weekly basis to rule in or out life-threatening conditions and improve access to specialist care. The benefits of POCUS included expedited investigations, decreased radiation and increased patient satisfaction. The barriers to using POCUS were lack of training, time, devices, image archiving software, difficulty generating and interpreting images and patient body habitus. CONCLUSION: This is the first study to our knowledge to report the prevalence of POCUS devices in Canada. Physicians who practise in rural NL have limited access to POCUS devices and have identified barriers to POCUS training. Connecting physicians in rural areas with POCUS experts through a province-wide POCUS network may address these barriers and improve healthcare access.

Résumé Introduction: L'échographie ciblée est utilisée par les médecins de Terre-Neuve-et-Labrador (T.-N.-L.) pour guider le diagnostic et certaines interventions. L'échographie ciblée est grandement limitée aux régions urbaines et la formation des médecins sur son utilisation est variable. Cette étude visait en premier lieu à déterminer la prévalence des appareils d'échographie ciblée à T.-N.-L. et en deuxième lieu, à caractériser les habitudes d'utilisation de l'échographie ciblée chez les médecins de T.-N.-L. Méthodes: Il s'agit d'une étude transversale à méthodes mixtes. Nous avons déterminé la prévalence des appareils d'échographie ciblée à partir de registres d'achat, et les habitudes d'utilisation de l'échographie ciblée à partir d'entrevues thématiques. Dix médecins (3 de sexe féminin, 5 de régions rurales) ont participé aux entrevues. Les entrevues ont été transcrites, codées et analysées à l'aide de méthodes qualitatives standardisées. Résultats: La prévalence générale des appareils d'échographie ciblée à T.-N.-L. était de 12.5/100 000 populations. Les participants des régions urbaines avaient un meilleur accès à la formation sur l'échographie ciblée et aux appareils. Les participants utilisaient l'échographie ciblée tous les jours ou toutes les semaines pour inclure ou éliminer les affections potentiellement mortelles et améliorer l'accès aux spécialistes. Les bienfaits de l'échographie ciblée étaient l'accélération des examens, la réduction des rayonnements et une meilleure satisfaction des patients. Les obstacles à l'échographie ciblée étaient l'absence de formation, de temps, d'appareils et de logiciel d'archivage des images, la difficulté à générer et à interpréter les images, et les caractéristiques physionomiques du patient. Conclusion: À notre connaissance, il s'agit de la première étude à avoir rapporté la prévalence des appareils d'échographie ciblée au Canada. Les médecins qui pratiquent dans les régions rurales de T.-N.-L. ont un accès limité aux appareils d'échographie ciblée et ont identifié des obstacles à la formation sur l'échographie ciblée. Pour faire tomber ces obstacles et améliorer l'accès aux soins de santé, il serait utile de relier les médecins des régions rurales à des spécialistes d'échographie ciblée dans un réseau provincial d'échographie ciblée. Mots-clés: Échographie, examen ciblé, services de santé ruraux, formation médicale continue, cadre de compétences.

Evaluating the efficacy of intranasal oxytocin on pain and function among individuals who experience chronic pain: a protocol for a multisite, placebo-controlled, blinded, sequential, within-subjects crossover trial.

INTRODUCTION: Current treatments for chronic pain (eg, opioids) can have adverse side effects and rarely result in resolution of pain. As such, there is a need for adjuvant analgesics that are non-addictive, have few adverse side effects and are effective for pain management across several chronic pain conditions. Oxytocin is a naturally occurring hormone that has gained attention for its potential analgesic properties. The objective of this trial is to evaluate the efficacy of intranasal oxytocin on pain and function among adults with chronic pain. METHODS AND ANALYSIS: This is a placebo-controlled, triple-blind, sequential, within-subject crossover trial. Adults with chronic neuropathic, pelvic and musculoskeletal pain will be recruited from three Canadian provinces (British Columbia, Alberta and Newfoundland and Labrador, respectively). Enrolled patients will provide one saliva sample pretreatment to evaluate basal oxytocin levels and polymorphisms of the oxytocin receptor gene before being randomised to one of two trial arms. Patients will self-administer three different oxytocin nasal sprays twice daily for a period of 2 weeks (ie, 24 IU, 48 IU and placebo). Patients will complete daily diaries, including standardised measures on day 1, day 7 and day 14. Primary outcomes include pain and pain-related interference. Secondary outcomes include emotional function, sleep disturbance and global impression of change. Intention-to-treat analyses will be performed to evaluate whether improvement in pain and physical function will be observed posttreatment. ETHICS AND DISSEMINATION: Trial protocols were approved by the Newfoundland and Labrador Health Research Ethics Board (HREB #20227), University of British Columbia Clinical Research Ethics Board (CREB #H20-00729), University of Calgary Conjoint Health Research Ethics Board (REB20 #0359) and Health Canada (Control # 252780). Results will be disseminated through publication in peer-reviewed journals and presentations at scientific conferences. TRIAL REGISTRATION NUMBER: NCT04903002; Pre-results.

Retention of visa-trainee post-graduate residents in Canada: a retrospective cohort study.

BACKGROUND: Visa trainees (international medical graduates [IMG] who train in Canada under a student or employment visa) are expected to return home after completing their training. We examine the retention patterns of visa trainee residents funded by Canadian (regular ministry and other), foreign, or mixed sources. METHODS: We linked data from the Canadian Post-MD Medical Education Registry with Scott's Medical Database for a retrospective cohort study. Eligible trainees were IMG visa trainees as of their first year of training, started their residency program no earlier than 2000, and exited training between 2006 and 2016. We used Cox regression to compare the retention of visa trainees by funding source. RESULTS: Of 1,913 visa trainees, 431(22.5%), 1353 (70.7%) and 129 (6.8%) had Canadian, foreign, or mixed funding, respectively. The proportion of trainees remaining in Canada decreased over time, with 35.5% (679/1913); 17.7% (186/1052); 10.8% (11/102) in Canada one, five, and ten years, respectively after their exit from PGME training. Trainees who remained on visas (HR: 1.91; [95% CI 1.59, 2.30]), were funded exclusively by foreign sources (HR: 1.46; [95% CI 1.25, 1.69]), and who had graduated from 'Western' countries (HR: 1.39; [95% CI 1.06, 1.84]) were more likely to leave Canada compared to trainees who became citizens/permanent residents, were funded by Canadian sources, or were visa graduates of Canadian medical schools, respectively. CONCLUSIONS: Most visa trainees leave Canada following their training. Trainees with Canadian connections (funding and/or change in legal status) were more likely to remain in Canada.

Sociodemographics and their impacts on risk factor awareness and beliefs about cancer and screening: results from a cross-sectional study in Newfoundland and Labrador.

BACKGROUND: Our objective was to examine cancer risk factor awareness and beliefs about cancer treatment, outcomes, and screening, and how these are mediated by sociodemographic variables, among Newfoundland and Labrador residents. METHODS: Participants aged 35 to 74 were recruited through Facebook advertising, and a self-administered online questionnaire was used to collect data. Descriptive statistics, Spearman rank correlations, and multivariate logistic regression analyses were performed. RESULTS: Of the 1048 participants who responded and met the inclusion criteria for this study, 1019 were selected for this analysis. Risk factor recognition was generally good, though several risk factors had poor awareness: being over 70 years old (53.4% respondents aware), having a low-fiber diet (65.0%), and drinking more than 1 unit of alcohol per day (62.8%). Our results showed that the participants' awareness of risk factors was significantly associated with higher income level (rs = 0.237, P <  0.001), higher education (rs = 0.231, P <  0.001), living in rural regions (rs = 0.163, P <  0.001), and having a regular healthcare provider (rs = 0.081, P = 0.010). Logistic regression showed that among NL residents in our sample, those with higher income, post-secondary education, those in very good or excellent health, and those with a history of cancer all had higher odds of having more positive beliefs about cancer treatment and outcomes. Those with a history of cancer, and those with very good or excellent health, also had higher odds of having more positive beliefs about cancer screening. Finally, compared to Caucasian/white participants, those who were non-Caucasian/white had lower odds of having more positive beliefs about cancer screening. CONCLUSION: Among adults in NL, there was poor awareness that low-fiber diets, alcohol, and age are risk factors for cancer. Lower income and education, rural residence, and not having a health care provider were associated with lower risk factor awareness. We also found a few associations between sociodemographic factors and beliefs about cancer treatment and outcomes or screening. We stress that while addressing awareness is necessary, so too is improving social circumstances of disadvantaged groups who lack the resources necessary to adopt healthy behaviours.

Using Facebook Advertising to Recruit Representative Samples: Feasibility Assessment of a Cross-Sectional Survey.

BACKGROUND: Facebook has shown promise as an economical means of recruiting participants for health research. However, few studies have evaluated this recruitment method in Canada, fewer still targeting older adults, and, to our knowledge, none specifically in Newfoundland and Labrador (NL). OBJECTIVE: This study aimed to assess Facebook advertising as an economical means of recruiting a representative sample of adults aged 35 to 74 years in NL for a cross-sectional health survey. METHODS: Facebook advertising was used to recruit for a Web-based survey on cancer awareness and prevention during April and May 2018; during recruitment, additional advertisements were targeted to increase representation of demographics that we identified as being underrepresented in our sample. Sociodemographic and health characteristics of the study sample were compared with distributions of the underlying population to determine representativeness. Cramer V indicates the magnitude of the difference between the sample and population distributions, interpreted as small (Cramer V=0.10), medium (0.30), and large (0.50). Sample characteristics were considered representative if there was no statistically significant difference in distributions (chi-square P>.01) or if the difference was small (V≤0.10), and practically representative if 0.10

Maximum likelihood estimation of generalized linear models for adaptive designs: Applications and asymptotics.

Due to increasing discoveries of biomarkers and observed diversity among patients, there is growing interest in personalized medicine for the purpose of increasing the well-being of patients (ethics) and extending human life. In fact, these biomarkers and observed heterogeneity among patients are useful covariates that can be used to achieve the ethical goals of clinical trials and improving the efficiency of statistical inference. Covariate-adjusted response-adaptive (CARA) design was developed to use information in such covariates in randomization to maximize the well-being of participating patients as well as increase the efficiency of statistical inference at the end of a clinical trial. In this paper, we establish conditions for consistency and asymptotic normality of maximum likelihood (ML) estimators of generalized linear models (GLM) for a general class of adaptive designs. We prove that the ML estimators are consistent and asymptotically follow a multivariate Gaussian distribution. The efficiency of the estimators and the performance of response-adaptive (RA), CARA, and completely randomized (CR) designs are examined based on the well-being of patients under a logit model with categorical covariates. Results from our simulation studies and application to data from a clinical trial on stroke prevention in atrial fibrillation (SPAF) show that RA designs lead to ethically desirable outcomes as well as higher statistical efficiency compared to CARA designs if there is no treatment by covariate interaction in an ideal model. CARA designs were however more ethical than RA designs when there was significant interaction.

Traditional Panel Interview versus Multiple Mini-Interview (MMI) in Medical School Admissions: Does Performance differ by Age, Gender, Urban or Rural, or Socioeconomic Status (Findings from one medical school).

This article was migrated. The article was marked as recommended. INTRODUCTION: Globally, medical schools are trying to widen access and to increase the diversity of their student body to be more representative of the population and to meet the future heath care needs of society. Selection methods must not disadvantage the applicants from priority groups. In Memorial University's Faculty of Medicine, rural applicants and applicants from low socioeconomic status are priority groups. Methods: Since 2013, Memorial University has used a combination of traditional panel interviews and MMIs to interview candidates for medical school. We wondered whether applicants who participate in this medical school interview process perform differently on the MMIs compared to the traditional panel interview process and whether performance differs on either of the two interview processes based on age, sex, origin(urban or rural), or socioeconomic status. RESULTS: The mean score on the traditional panel interview was higher than that on the MMI. Females scored higher than males on both the traditional panel interview and the MMI. Applicants aged 22 and younger performed worse on both the traditional panel interview and the MMI than the other age groups. Neighborhood socioeconomic status, and urban/rural living status were not significantly related with applicants' performance on the traditional panel interview or MMI. DISCUSSION: The type of interview is not disadvantaging applicants from Memorial University's priority areas.