The Health Information Seeking Behavior of Punjabi Elders During the COVID-19 Pandemic in Canada.

Health Information Seeking Behavior (HISB) refers to the behavior and strategies used to attain, clarify, or confirm health information. The uptake of health information depends on system-level and individual-level factors. The purpose of the present study is to understand the sources from which Punjabi elders obtain COVID-19 vaccine-related information and their information seeking behavior. A cross-sectional survey was conducted among 391 Punjabi elders aged 50+ years in the Greater Toronto Area (GTA), Ontario. The survey questions included the need for COVID-19 vaccine information, the type of information sought, sources of information, and barriers to seeking information. Descriptive analysis was conducted using frequencies and percentages, and logistic regression was performed to understand the associations between participants' sociodemographic characteristics and HISB. The results suggested that Punjabi elders are more likely to use informal sources and less likely to seek information from health professionals and government health and wellness websites. The results also suggested that most participants do not cross-check their information with other sources and are more likely to cross-check the information with family/friends, compared to credible care providers, across all demographics. Ultimately, there may be a need for stakeholders to collaborate to regulate the accuracy and type of health-information that is disseminated through media, and to tailor health communication to the health information seeking behavior of this population.

Involuntary delayed retirement and mental health of older adults.

OBJECTIVE: This study examined the association of multiple mental health measures with involuntary delayed retirement (IDR) in working older adults (≥ 65 years) in the USA. METHODS: Data were derived from the Health and Retirement Study, focusing on two combined waves of working older adults in 2010 and 2012. IDR was measured as the desire to stop working but the inability to do so due to financial constraints. In addition, mental health outcomes included depression, anxiety, anger-in, and anger-out. Using Stata 16.0, primary analyses were conducted for descriptive statistics and multivariable logistic regression. The odds ratios were reported with 95% confidence intervals (CIs). RESULTS: Older adults who reported IDR were more likely to have depression (OR = 3.20, CI = 1.03-9.88), anxiety (OR = 2.12, CI = 1.00-5.18), and anger-in (OR = 1.71, CI = 1.12-2.60) compared to those who did not report IDR. However, IDR was not significantly associated with anger-out in older adults who worked past the traditional retirement age. CONCLUSION: The findings suggest that IDR is likely to act as a stressor and affects the mental health of older adults aged 65 and more. Policymakers should pay more attention to helping older adults maintain positive mental health even if they are required to work past retirement age.

Unmet Primary Health Care Needs among Nepalese Immigrant Population in Canada.

BACKGROUND: Immigrants represent over one-fifth (21.9%) of the Canadian population, which is an increasing trend. Primary care is a gateway to accessing the healthcare system for the majority of Canadians seeking medical services; however, Canada reported a growing shortage of healthcare providers, mainly primary care practitioners. Canadians, including immigrants, encounter many unmet healthcare needs due to various reasons. This study aimed to assess unmet healthcare (UHC) needs and associated factors among Nepalese immigrants residing in Calgary. METHODS: A cross-sectional study using a self-administered questionnaire was conducted in 2019. UHC needs were measured based on a single-item question: "During the past 12 months, was there ever a time that you felt you needed medical help, but you did not receive it". A follow-up question was asked to learn about associated unmet needs factors, and the responses were categorized into availability, accessibility, and acceptability. Descriptive and multivariable logistic regression was employed to assess the association between UHC needs and its predictors by using STATA version 14.2. RESULTS: Of 401 study participants, nearly half of the participants (n = 187; 46.63%) reported UHC needs, which was not significantly different among male and female participants (p = 0.718). UHC needs were nearly two times higher among those aged 26-45 (AOR 1.93) and those ≥56 years (AOR 2.17) compared to those under 25 years of age. The top reasons reported for unmet needs were long waits to access care (67.91%), healthcare costs (57.22%), and lack of knowing where to get help (31.55%). Overall, "services availability when required" was a leading obstacle that accounted for UHC needs (n = 137, 73.26%). Nearly two-thirds (n = 121, 64.71%) of participants reported that "accessibility of services" was a barrier, followed by "acceptability (n = 107, 57.22%). Those who reported UHC needs also reported an impact on their lives personally and economically. The most commonly reported personal impact was mental health impact, including worry, anxiety, and stress (67.38%). The most common economic impact reported due to UHC needs was increased use of over-the-counter drugs (33.16%) and increased healthcare costs (17.20%). CONCLUSIONS: UHC needs are presented in the Nepalese immigrant population. Accessibility to healthcare is limited for several reasons: waiting time, cost, distance, and unavailability of services. UHC needs impact individuals' personal health, daily life activities, and financial capacity. Strategies to improve access to PHC for disadvantaged populations are crucial and need to be tackled effectively.

Labor Market Integration of High-Skilled Immigrants in Canada: Employment Patterns of International Medical Graduates in Alternative Jobs.

Background: International medical graduates (IMGs) in Canada are individuals who received their medical education and training outside Canada. They undergo a complex licensing procedure in their host country and compete for limited opportunities available to become practicing physicians. Many of them cannot succeed or do not have the resources or interest to undergo this complex and unpredictable career pathway and seek alternative career options. In this study, we aimed to understand how IMGs integrate into the alternative job market, their demographic characteristics, and the types of jobs they undertake after moving to Canada. Methods: An anonymous cross-sectional, online, nationwide, and open survey was conducted among IMGs in Canada. In addition to demographic information, the questionnaire included information on employment status, types of jobs, professional experience, and level of medical education and practice (e.g., specialties, subspecialties, etc.). We conducted a survey of 1740 IMGs in total; however, we excluded responses from those IMGs who are currently working in a clinical setting, thus limiting the number of responses to 1497. Results: Of the respondents, 43.19% were employed and 56.81% were unemployed. Employed participants were more likely to be older males, have stayed longer in Canada, and had more senior-level job experience before moving to Canada. We also observed that the more years that had passed after graduation, the higher the likelihood of being employed. The majority of the IMGs were employed in health-related nonregulated jobs (50.45%). The results were consistent across other demographic characteristics, including different provinces, countries of origin, gender, time since graduation, and length of stay in Canada. Conclusions: This study found that certain groups of IMGs, such as young females, recent immigrants, recent graduates, and less experienced IMGs had a higher likelihood of being unemployed. These findings will inform policymakers, immigrant and professional service organizations, and researchers working for human resources and professional integration of skilled migrants to develop programs and improve policies to facilitate the employment of IMGs through alternative careers.

Knowledge translation in health and wellness research focusing on immigrants in Canada.

INTRODUCTION Knowledge translation (KT) is a relatively new concept referring to transfers of knowledge into practice in collaboration with multiple sectors that work for the health and wellness of society. Knowledge translation is crucial to identifying and addressing the health needs of immigrants. AIM To scope the evidence on KT research engaging immigrants in the host country regarding the health and wellness of immigrants. METHODS This study followed a scoping review approach suggested by Arksey O'Malley. We identified relevant studies from both academic and grey literature using structured criteria, charted the data from the selected studies, collated, summarised and report the results. RESULTS Analysis of the eligible studies found two types of KT research: integrated KT and end-of-grant KT. Meeting or discussion with community-level knowledge-users were common KT activities among immigrants, but they were involved in the entire research process only if they were hired as members of research teams. Most KT research among immigrants explored cancer screening and used a community-based participatory action research approach. Barriers and enablers usually came from researchers rather than from the community. There was little practice of evaluation and defined frameworks to conduct KT research among immigrants in Canada. CONCLUSION This study can help the researchers and other stakeholders of health and wellness of the immigrant population to identify appropriate KT research activities for immigrants and where KT research is required to facilitate the transfer of research knowledge into action.

Primary care access barriers faced by immigrant populations in their host countries: a systematic review protocol aiming to construct a conceptual framework using root cause analysis to capture 'what leads to what'.

INTRODUCTION Understanding primary care access or health service utilisation challenges among immigrant communities is important for tailoring services to community needs, which is the core of precision population health. AIM We aim to inventory the primary care access barriers faced by immigrant communities through a comprehensive systematic review and develop a conceptual framework to explain the barriers, using a root cause analysis approach. METHODS Academic databases of primary research articles and grey literature will be searched using appropriate keywords. Relevant information will be extracted into tabular format from finally selected literature. Our proposed approach of framing the barriers to identify the root causes is adapted from the root cause analysis method, which is the process of identifying and understanding the underlying causes to discover the root causes of problems. RESULTS The study will produce a systematic, quantified and documented list of the barriers faced by immigrants in a solution-oriented approach. DISCUSSION The proposed research, as a first step towards determining possible mitigation strategies for health-care access by immigrants, will provide the background needed to devise and test tailored interventions to improve future access to health care for immigrants. We will follow the integrated knowledge translation or community engagement knowledge mobilization approach, where we are engaged with community-based citizen researchers from the inception of our programme. We plan to disseminate the results of our review through meetings with key stakeholders and social media outreach, followed by journal publications and presentations on relevant platforms.

Precision health through prediction modelling: factors to consider before implementing a prediction model in clinical practice.

INTRODUCTION Precision medical practice emphasises early detection, improved surveillance and prevention through targeted intervention. Prediction models can help identify high-risk individuals to be targeted for healthy behavioural changes or medical treatment to prevent disease development and assist both health professionals and patients to make informed decisions. Concerns exist regarding the adequacy, accuracy, validity and reliability of prediction models. AIM The purpose of this study is to introduce readers to the basic concept of prediction modelling in precision health and recommend factors to consider before implementing a prediction model in clinical practice. METHODS Prediction models developed maintaining proper process and with quality prediction and validation can be used in clinical practice to improve patient care. RESULTS Aspects of prediction models that should be considered before implementation include: appropriateness of the model for the intended purpose; adequacy of the model; validation, face validity and clinical impact studies of the model; a parsimonious model with data easily measured in clinical settings; and easily accessible models with decision support for successful implementation. DISCUSSION Choosing clinical prediction models requires cautious consideration and several practical factors before implementing a model in clinical practice.

Health and well-being literacy initiatives focusing on immigrant communities: an environmental scan protocol to identify "what works and what does not".

INTRODUCTION: Most of the major cities in the developed western countries are characterized by an increasing multiculturalism brought by the immigrant population. The immigrant communities face challenges in the new environment with their health and wellness related unmet needs. It is imperative to find sustainable ways to empower these diverse communities to champion their health and wellness. Community-based health and wellness literacy initiatives (CBHWLI) focusing on immigrant communities can be an important step towards citizen empowerment in this regard. The aim of the present environmental scan is to identify the key factors that might impact a CBHWLI in immigrant communities in Canada in order to facilitate the process in practice and identify the competencies and training required for its implementation. METHODS: This study will gather information from existing literature and online sources as well as will capture expert and lay perspectives on the factors that can impact the effectiveness and sustainability of CBHWLIs through conducting a comprehensive environmental scan: (i) a systematic scoping review of published literature and grey literature, (ii) a comprehensive Internet search, (iii) key informant interviews, and (iv) community consultation. Specific methodological and analytical frameworks will guide each step. ETHICS AND DISSEMINATION: This study is the first step in establishing a practical base for developing CBHWLI implementation research. Once the initial findings have been generated, the second step will involve inviting experts to provide their input. We first plan to disseminate the results of our scoping review and Internet scan through meetings with key stakeholders, to be followed by journal publications and conference or workshop presentations. Ethical approval is not required for the scoping review or Internet scan; however, approval to conduct interviews with key informants and community consultations in the second stage of the study will be sought from the Conjoint Health Research Ethics Board.

Prognostic tools for cardiovascular disease in patients with type 2 diabetes: A systematic review and meta-analysis of C-statistics.

BACKGROUND: Diabetes is associated with an increased risk for cardiovascular diseases (CVD). Risk prediction models are tools widely used to identify individuals at particularly high-risk of adverse events. Many CVD risk prediction models have been developed but their accuracy and consistency vary. OBJECTIVE: This study reviews the literature on available CVD risk prediction models specifically developed or validated in patients with diabetes and performs a meta-analysis of C-statistics to assess and compare their predictive performance. METHODS: The online databases and manual reference checks of all identified relevant publications were searched. RESULTS: Fifteen CVD prediction models developed for patients with diabetes and 11 models developed in a general population but later validated in diabetes patients were identified. Meta-analysis of C-statistics showed an overall pooled C-statistic of 0.67 and 0.64 for validated models developed in diabetes patients and in general populations respectively. This small difference in the C-statistic suggests that CVD risk prediction for diabetes patients depends little on the population the model was developed in (p = 0.068). CONCLUSIONS: The discriminative ability of diabetes-specific CVD prediction models were modest. Improvements in the predictive ability of these models are required to understand both short and long-term risk before implementation into clinical practice.