Conceptualising community engagement as an infinite game implemented through finite games of 'research', 'community organising' and 'knowledge mobilisation'.

Meaningful community engagement process involves focusing on the community needs, building community capacity and employing culturally tailored and community-specific strategies. In the current practices of community-engaged health and wellness research, generally, community engagement activities commence with the beginning of a particular research project on a specific topic and end with the completion of the project. The outcomes of the community engagement, including the trust, partnership and contribution of the community to research, thus remain limited to that specific project and are not generally transferred and fostered further to the following project on a different topic. In this viewpoint article, we discussed a philosophical approach to community engagement that proposes to juxtapose community engagement for the specific short-term research project and the overarching long-term programme of research with the finite game and infinite game concepts, respectively. A finite game is a concept of a game where the players are known, rules are fixed and when the agreed-upon goal is achieved, the game ends. On the other hand, in infinite games, the players may be both known and unknown, have no externally fixed rules and have the objective of continuing the game beyond a particular research project. We believe community engagement needs to be conducted as an infinite game that is, at the programme of research level, where the goal of the respective activities is not to complete a research project but to successfully engage the community itself is the goal. While conducting various research projects, that is, finite games, the researchers need to keep an infinite game mindset throughout, which includes working with the community for a just cause, building trust and community capacity to maximise their contribution to research, prioritising community needs and having the courage to lead the community if need be. Patient or Public Contribution: While preparing this manuscript, we have partnered actively with community champions, activists, community scholars and citizen researchers at the community level from the very beginning. We had regular interactions with them to get their valuable and insightful inputs in shaping our reflections. Their involvement as coauthors in this paper also provided a learning opportunity for them and facilitated them to gain insight on knowledge engagement. All authors support greater community/citizen/public involvement in research in an equitable manner.

Community-Driven Prioritization of Primary Health Care Access Issues by Bangladeshi-Canadians to Guide Program of Research and Practice.

Research around probable solutions to immigrants accessing health care in Canada is not extensive, and the perspective of immigrant communities on priorities and potential solutions has not been captured effectively. The purpose of this article is to describe a research initiative that involved grassroots community members as producers of research priorities on primary care access issues. This study aimed to seek input from an immigrant community in Calgary, Canada. Members of the Bangladeshi community of Calgary were asked through a survey to rank 10 predefined primary care access topics as to what they felt constituted priorities for solution-oriented research (1, highest; 10, lowest). We used frequencies and percentages to describe the participant demographics. Ratings of preferred research themes were analyzed on the basis of relative weighted priority rank. We received 432 responses: 51.2% female; 58.9% aged 36 to 55 years; 90.5% had university-level education; 46.2% immigrated to Canada between 10 and 19 years ago; 82.5% employed full/part-time or self-employed. Lack of resources, lack of knowledge, health care cost, and workplace-related barriers were among the top-ranked topics identified as solution-oriented research priorities. Through partnerships and reciprocal learning, public input can increase insider perspectives to help develop interventions that align with the needs of community members.

Barriers to cervical cancer screening faced by immigrant women in Canada: a systematic scoping review.

BACKGROUND: The objective of this scoping study is to review the published literature and summarize findings related to barriers experienced by immigrant women in Canada while accessing cervical cancer screening. METHODS: Electronic databases of peer-reviewed articles and grey literature were searched using comprehensive sets of keywords, without restricting the time period or language. Articles were selected based on the following criteria: (a) the study population consisted of Canadian immigrant women and healthcare providers and other stakeholders serving immigrant women, (b) the research focused on the barriers to accessing cervical cancer screening, and (c) the study was conducted in Canada. RESULTS: Extracted data were grouped and analyzed, resulting in barriers comprised of six themes: economic barriers, cultural barriers, language barriers, healthcare system-related barriers, knowledge-related barriers, and individual-level barriers. Lack of education, low income, preference for a female physician, lack of knowledge, lack of effective communication, and embarrassment were some of the most common barriers mentioned. CONCLUSIONS: Immigrant access to health services, including cervical cancer screening, is a complex issue concerning a wide range of barriers. Our findings offer insights into barriers to cervical cancer screening in immigrant communities in Canada that can be used to assist policymakers, healthcare providers, and researchers enhance the health and well-being of these populations by mitigating barriers and improving screening.

What is the scope of improving immigrant and ethnic minority healthcare using community navigators: A systematic scoping review.

INTRODUCTION: Immigrants are among the most vulnerable population groups in North America; they face multidimensional hurdles to obtain proper healthcare. Such barriers result in increased risk of developing acute and chronic conditions. Subsequently a great deal of burden is placed on the healthcare system. Community navigator programs are designed to provide culturally sensitive guidance to vulnerable populations in order to overcome barriers to accessing healthcare. Navigators are healthcare workers who support patients to obtain appropriate healthcare. This scoping review systematically searches and summarizes the literature on community navigators to help immigrant and ethnic minority groups in Canada and the United States overcome barriers to healthcare. METHODS: We systematically searched electronic databases for primary articles and grey literature. Study selection was performed following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Articles were selected based on four criteria: (1) the study population was comprised of immigrants or ethnic minorities living in Canada or the United States; (2) study outcomes were related to chronic disease management or primary care access; (3) the study reported effects of community navigator intervention; (4) the study was published in English. Relevant information from the articles was extracted and reported in the review. RESULT: Only one study was found in the literature that focused on navigators for immigrants in Canada. In contrast, 29 articles were found that reported navigator intervention programs for immigrant minorities in the United States. In these studies navigators trained and guided members of several ethnic communities for chronic disease prevention and management, to undertake cancer screening as well as accessing primary healthcare. The studies reported substantial improvement in the immigrant and ethnic minority health outcomes in the United States. The single Canadian study also reported positive outcome of navigators among immigrant women. CONCLUSION: Navigator interventions have not been fully explored in Canada, where as, there have been many studies in the United States and these demonstrated significant improvements in immigrant health outcomes. With many immigrants arriving in Canada each year, community navigators may provide a solution to reduce the existing healthcare barriers and support better health outcomes for new comers.

Renal function trajectory over time and adverse clinical outcomes.

The growing burden of chronic kidney disease (CKD), with its associated morbidity and mortality, is recognized as a major public health problem globally and causing substantial load on health care systems. The current framework for the definition and staging of CKD, based on eGFR levels or presence of kidney damage, is useful for clinical classification of patients, but identifies a huge number of people as having CKD which is too many to target for intervention. The ability to identify a subset of patients, at high risk for adverse outcomes, would be useful to inform clinical management. The current staging system applies static definitions of kidney function that fail to capture the dynamic nature of the kidney disease over time. Now-a-days, it is possible to capture multiple measurements of different laboratory test results for an individual including eGFR values. A new possibility for identifying individuals at higher risk of adverse outcomes is being explored through assessment and consideration of the rate of change in kidney function over time, and this approach will be feasible in the current context of digitalization of health record keeping system. On the basis of the existing evidence, this paper summarizes important findings that support the concept of dynamic changes in kidney function over time, and discusses how the magnitude of these changes affect the future adverse outcomes of kidney disease, particularly the End Stage Renal Disease (ESRD), CVD and mortality.

Wake-up stroke: incidence, risk factors and outcome of acute stroke during sleep in a Japanese population. Takashima Stroke Registry 1988-2003.

Characterization of the time of stroke onset has been plagued by the problem of determining the time of the onset of events that are detected when the patient awakens. Our aim was to evaluate the characteristics, risk factors and acute fatality associated with wake-up stroke. Data was obtained from Takashima Stroke Registry covering approximately 55,000 residents in central Japan. During the period 1988-2003, information about the situation at stroke onset was available for 897 cerebral infarction (CI) and 335 intracerebral hemorrhage (ICH) events. Differences in characteristics and outcome between stroke during sleep and stroke while awake were explored. Among CI and ICH cases, 9.7 and 11.9% suffered from stroke during sleep, respectively. Hypertension and experiencing a severe event were associated with stroke during sleep among CI. Smoking and experiencing a severe event were associated with stroke during sleep and a drinking history reduced the chance of stroke during sleep among ICH. Acute fatality risks did not differ between stroke during sleep and stroke while awake among both CI and ICH cases. About 1 in 10 stroke patients had an onset of stroke during sleep. Hypertensive, smoker and clinically more severely affected patients had a higher prevalence of stroke during sleep. There were no differences between the 2 groups with respect to acute-case fatality.

Community Ecosystem Mapping: A Foundational Step for Effective Community Engagement in Research and Knowledge Mobilization.

Community engagement is a key strategy for achieving various goals, such as social and environmental change, sustainable development, health promotion, and community building. It involves collaborations and partnerships with the community that help mobilize resources, impact systems, rectify partner dynamics, and function as catalysts for modifying policies, programs, and practices. It also ensures mutual trust among all parties involved, giving community members greater personal agency and involvement potential. We have learned a range of practical aspects of community engagement with communities, particularly with immigrant/racialized communities, by running a community-engaged program of research on the health and wellness issues of immigrant/racialized communities in Calgary, Canada. In this article, we focus on a crucial early step of community engagement-understanding the community ecosystem. The community ecosystem refers to its human, social, and cultural makeups. Understanding this ecosystem requires conscious efforts to comprehend the demography, participate in socio-cultural events, identify community spots, reach out to hard-to-access groups, find the community champions and communication channels/organizations, and reaching out to them to establish relationships. Understanding the community ecosystem allows us to identify the pivotal factors, key actors, and pulse of the community that we are engaging with. This enables us to build mutual trust and goals for research and knowledge mobilization. Subsequently, an empowered, continual, and collaborative partnership becomes possible, resulting in sustained and desirable outcomes.

Employing diffusion of innovation theory for 'not missing the mass' in community-engaged research.

INTRODUCTION: Engaging with minority communities, such as immigrants and ethnic minorities, often involves adopting top-down approaches, wherein researchers and policymakers provide solutions based on their perspective. However, these approaches may not adequately address the needs and preferences of the community members, who have valuable insights and experiences to share. Therefore, community-engaged approaches, which involve collaborative partnerships between community members and researchers to identify issues, co-create solutions, and recommend policy changes, are becoming more recognized for their effectiveness and relevance. Yet, prevailing community engagement efforts often focus on easily reachable and already engaged segments of the community, sometimes overlooking the broader population. METHODS: When working with immigrant and racialized communities, we encountered difficulties in engaging the wider community through traditional researcher-led approaches. We realized that overcoming these challenges required innovative strategies rooted in community-based participatory research principles and the diffusion of innovation theory. We recognized that a nuanced understanding of the community's dynamics and preferences was crucial in shaping our approach and building trust and rapport with the community members. RESULTS: The need to bridge the gap between researcher-led initiatives and community-driven involvement has never been more pronounced. Our experience, chronicled in this article, highlights the journey of our research program with an immigrant/racialized community. This reflection enhances our comprehension of community engagement that deliberately strives to reach a larger cross-section of the community. By providing practical methods for reaching the broader community and navigating the intricacies of engagement, we aim to assist fellow researchers in conducting effective community-engaged research across various minority communities. CONCLUSION: In sharing our insights and successful strategies for community engagement, we hope to contribute to the field's knowledge. Our commitment to fostering meaningful collaboration underscores the importance of co-creating solutions that resonate with the diverse voices within these communities. Through these efforts, we envision a more inclusive and impactful approach to addressing the complex challenges faced by minority populations.

Short-term exposure to air pollution and incidence of stroke and acute myocardial infarction in a Japanese population.

BACKGROUND: Exposure to high levels of air pollution can increase the risk of cardiovascular events. However, there is no clear information in Japan on the effect of pollution on the incidence of stroke and acute myocardial infarction (AMI). Therefore, we investigated the effects of air pollution on the incidence of stroke and AMI in a setting where pollutant levels are rather low. METHODS: Data were obtained from the Takashima Stroke and AMI Registry, which covers a population of approximately 55,000 in Takashima County in central Japan. We applied a time-stratified, bidirectional, case-crossover design to estimate the effects of air pollutants, which included suspended particulate matter (SPM), sulfur dioxide (SO(2)), nitrogen dioxide (NO(2)) and photochemical oxidants (Ox). We used the distributed lag model to estimate the effect of pollutant exposure 0-3 days before the day of event onset and controlled for meteorological covariates in all of the models. RESULTS: There were 2,038 first-ever strokes (1,083 men, 955 women) and 429 first-ever AMI cases (281 men, 148 women) during 1988-2004. The mean pollutant levels were as follows: SPM 26.9 µg/m(3); SO(2) 3.9 ppb; NO(2) 16.0 ppb, and Ox 28.4 ppb. In single-pollutant and two-pollutant models, SO(2) was associated with the risk of cerebral hemorrhage. Other stroke subtypes and AMI were not associated with air pollutant levels. CONCLUSIONS: We observed an association between SO(2) and hemorrhagic stroke; however, we found inconclusive evidence for a short-term effect of air pollution on the incidence of other stroke types and AMI.

Ambient air pollutants and acute case-fatality of cerebro-cardiovascular events: Takashima Stroke and AMI Registry, Japan (1988-2004).

BACKGROUND: Apart from the conventional risk factors, cerebro-cardiovascular disease (CVD) are also reported to be associated with air pollution, thus lowering the level of exposure might contribute in prevention activities to reduce the associated adverse outcomes. Though few studies conducted in Japan have reported on the CVD mortality but none have explored the effect of air pollutant exposure on the acute case-fatality of CVD. We investigated the effects of air pollution exposure on acute case-fatality of stroke and acute myocardial infarction (AMI) in a setting where pollutant levels are rather low. METHODS: We leveraged the data from the Takashima Stroke and AMI Registry, which covers a population of approximately 55,000 in Takashima County located in central Japan. The study period of 6,210 days (16 years, leap years also taken into account) were divided into quartiles of daily average pollutant concentration; suspended particulate matter (SPM), sulfur dioxide (SO(2)), nitrogen dioxide (NO(2)), and photochemical oxidants (Ox). The stroke and AMI events were categorized to corresponding quartiles based on the pollution levels of the onset day. To study the effects of air pollutants, we estimated the fatality rate ratio across quartiles of the pollutants where the lowest quartile served as the reference. RESULTS: There were 307 (men: 153 and women: 154) fatal stroke cases within 28 days of onset among the 2,038 first ever stroke during 1988-2004. In the same period, there were 142 (men: 94 and women: 54) fatal AMI cases within 28 days of onset among the 429 first ever AMI events. The mean of the measured pollutant levels were as follows: SPM 26.9 µg/m(3), SO(2) 3.9 ppb, NO(2) 16.0 ppb, and Ox 28.4 ppb. Among the pollutants, higher levels of NO(2) showed increased fatality risk. In multi-pollutant model, the highest quartile of NO(2) was associated with 60% higher stroke case-fatality risk in comparison to lowest quartile of NO(2). In the fully adjusted model the fatality-rate ratio was 1.65 (95% CI 1.06-2.57). This association was more prominent among stroke subtype of cerebral infarction. Other pollutant levels did not show any association with stroke or AMI case-fatality. CONCLUSION: We observed association between NO(2) levels, an index of traffic related air pollution, with the acute case-fatality of stroke, especially cerebral infarction in our study population. Further studies are needed in different regions to determine the association between ambient air pollutants and acute cardiovascular fatalities.

Partnering with organisations beyond academia through strategic collaboration for research and mobilisation in immigrant/ethnic-minority communities.

Community-engaged research needs involving community organisations as partners in research. Often, however, considerations regarding developing a meaningful partnership with community organisations are not highlighted. Researchers need to identify the most appropriate organisation with which to engage and their capacity to be involved. Researchers tend to involve organisations based on their connection to potential participants, which relationship often ends after achieving this objective. Further, the partner organisation may not have the capacity to contribute meaningfully to the research process. As such, it is the researchers' responsibility to build capacity within their partner organisations to encourage more sustainable and meaningful community-engaged research. Organisations pertinent to immigrant/ethnic-minority communities fall into three sectors: public, private and non-profit. While public and private sectors play an important role in addressing issues among immigrant/ethnic-minority communities, their contribution as research partners may be limited. Involving the non-profit sector, which tends to be more accessible and utilitarian and includes both grassroots associations (GAs) and immigrant service providing organisations (ISPOs), is more likely to result in mutually beneficial research partnerships and enhanced community engagement. GAs tend to be deeply rooted within, and thus are often truly representative of, the community. As they may not fully understand their importance from a researcher's perspective, nor have time for research, capacity-building activities are required to address these limitations. Additionally, ISPOs may have a different understanding of research and research priorities. Understanding the difference in perspectives and needs of these organisations, building trust and creating capacity building opportunities are important steps for researchers to consider towards building durable partnerships.

Profile of participants and genotype distributions of 108 polymorphisms in a cross-sectional study of associations of genotypes with lifestyle and clinical factors: a project in the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study.

BACKGROUND: Most diseases are thought to arise from interactions between environmental factors and the host genotype. To detect gene-environment interactions in the development of lifestyle-related diseases, and especially cancer, the Japan Multi-institutional Collaborative Cohort (J-MICC) Study was launched in 2005. METHODS: We initiated a cross-sectional study to examine associations of genotypes with lifestyle and clinical factors, as assessed by questionnaires and medical examinations. The 4519 subjects were selected from among participants in the J-MICC Study in 10 areas throughout Japan. In total, 108 polymorphisms were chosen and genotyped using the Invader assay. RESULTS: The study group comprised 2124 men and 2395 women with a mean age of 55.8 ± 8.9 years (range, 35-69 years) at baseline. Among the 108 polymorphisms examined, 4 were not polymorphic in our study population. Among the remaining 104 polymorphisms, most variations were common (minor allele frequency ≥0.05 for 96 polymorphisms). The allele frequencies in this population were comparable with those in the HapMap-JPT data set for 45 Japanese from Tokyo. Only 5 of 88 polymorphisms showed allele-frequency differences greater than 0.1. Of the 108 polymorphisms, 32 showed a highly significant difference in minor allele frequency among the study areas (P < 0.001). CONCLUSIONS: This comprehensive data collection on lifestyle and clinical factors will be useful for elucidating gene-environment interactions. In addition, it is likely to be an informative reference tool, as free access to genotype data for a large Japanese population is not readily available.

Time lag to hospitalisation and the associated determinants in patients with acute myocardial infarction: the Takashima AMI Registry, Japan.

BACKGROUND: Prompt initiation of treatment is the cornerstone in the management of patients with acute myocardial infarction (AMI). The time lags for AMI hospitalisations were examined to identify the factors influencing the interval. METHODS: Time lag information was available for 273 men and 148 women from the Takashima AMI Registry during 1988-2006. Multivariate regression analyses were performed to evaluate the factors influencing early and late admission. RESULTS: The median time to hospitalisation was 2 h (mean 6.1, SD 18.7). Within 2 h of onset, 59.8% patients arrived and 20.6% arrived during the 2-6 h interval. A substantial number of patients (19.6%) arrived after 6 h and onwards. A time lag of >2 h in hospital admission was significantly influenced by history of hypertension, angina, presence of syncope as an initial symptom and time of AMI onset. A time lag of >6 h shared similar characteristics except for presence of history of angina. CONCLUSIONS: About one-fifth of patients with AMI have prolonged time lag in the study population. Future research intervention and health promotion activities should focus on achieving a reduction in presentation delays.

Involving im/migrant community members for knowledge co-creation: the greater the desired involvement, the greater the need for capacity building.

Researchers need to observe complex problems from various angles and contexts to create workable, effective and sustainable solutions. For complex societal problems, including health and socioeconomic disparities, cross-sectoral collaborative research is crucial. It allows for meaningful interaction between various actors around a particular real-world problem through a process of mutual learning. This collaboration builds a sustainable, trust-based partnership among the stakeholders and allows for a thorough understanding of the problem through a solution-oriented lens. While the created knowledge benefits the community, the community is generally less involved in the research process. Often, community members are engaged to collect data or for consultancy and knowledge dissemination; however, they are not involved in the actual research process, for example, developing a research question and using research tools such as conducting focus groups, analysis and interpretation. To be involved on these levels, there is a need for building community capacity for research. However, due to a lack of funds, resources and interest in building capacity on the part of both researchers and the community, deeper and meaningful involvement of community members in research becomes less viable. In this article, we reflect on how we have designed our programme of research-from involving community members at different levels of the research process to building capacity with them. We describe the activities community members participated in based on their needs and capacity. Capacity-building strategies for each level of involvement with the community members are also outlined.

Meaningful and deep community engagement efforts for pragmatic research and beyond: engaging with an immigrant/racialised community on equitable access to care.

Primary healthcare access is one of the crucial factors that ensures the health and well-being of a population. Immigrant/racialised communities encounter a myriad of barriers to accessing primary healthcare. As global migration continues to grow, the development and practice of effective strategies for research and policy regarding primary care access are warranted. Many studies have attempted to identify the barriers to primary care access and recommend solutions. However, top-down approaches where the researchers and policy-makers 'prescribe' solutions are more common than community-engaged approaches where community members and researchers work hand-in-hand in community-engaged research to identify the problems, codevelop solutions and recommend policy changes. In this article, we reflect on a comprehensive community-engaged research approach that we undertook to identify the barriers to equitable primary care access among a South Asian (Bangladeshi) immigrant community in Canada. This article summarised the experience of our programme of research and describes our understanding of community-engaged research among an immigrant/racialised community that meaningfully interacts with the community. In employing the principles of community-based participatory research, integrated knowledge translation and human centred design, we reflect on the comprehensive community-engaged research approach we undertook. We believe that our reflections can be useful to academics while conducting community-engaged research on relevant issues across other immigrant/racialised communities.

Unmet Healthcare Needs Among Migrant Populations in Canada: Exploring the Research Landscape Through a Systematic Integrative Review.

OBJECTIVES: Migrants are a growing part of the Canadian population, yet they encounter many unmet healthcare needs. These needs arise from the difference between the services deemed necessary, often based on their unique socio-cultural background, and the services actually received. Therefore, a systematic integrative review was conducted to (1) identify the literature on unmet healthcare needs among different migrant populations in Canada, and (2) compile the reported factors associated with these unmet needs in various migrant groups. DESIGN: We systematically searched all major databases and grey literature sources. We included original articles that studied unmet healthcare needs among immigrants, refugees, and/or temporary migrants in Canada. RESULTS: Thirty-one studies reported unmet healthcare needs among migrants in Canada. We found five categories of unmet needs across different groups of migrants including immigrants, refugees, and temporary migrants. Immigrants and refugees face unique factors that influence the development of unmet needs, such as socio-cultural differences, communication difficulties, and lack of information. Alternatively, temporary migrants have unmet needs due to factors associated with their immigration clauses, such as healthcare coverage being conditional to work permit renewal or precarious living conditions associated with work-related housing. CONCLUSION: Further research is required on unmet needs of migrants that considers the variation of unmet needs and their causal factors within different groups of migrants, in particular, refugee claimants, foreign workers, international students, and elderly migrants.

Overcoming the Challenges Faced by Immigrant Populations While Accessing Primary Care: Potential Solution-oriented Actions Advocated by the Bangladeshi-Canadian Community.

INTRODUCTION: Immigrants continue to face significant challenges in accessing primary healthcare (PHC) that often negatively impact their health. The present research aims to capture the perspectives of immigrants to identify potential approaches to enhance PHC access for this group. METHODS: Focus group discussions (FGDs) were conducted among a sample of first-generation Bangladeshi immigrants who had experience with PHC in Canada. A total of 13 FGDs (7 among women, 6 among men) were conducted with 80 participants (women = 42, men = 38) in their preferred language, Bangla. We collected demographic information prior to each focus group and used descriptive statistics to identify the socio-demographic characteristics of participants. We applied thematic analysis to examine qualitative data to generate a list of themes of possible approaches to improve PHC access. RESULTS: The focus group findings identified different levels of approaches to improve PHC access: individual-, community-, service provider-, and policy-level. Individual-level approaches included increased self-awareness of health and wellness and personal knowledge of cultural differences in healthcare services and improved communication skills. At the community level, supports for community members to access care included health education workshops, information sessions, and different support programs (eg, carpool services for senior members). Suggested service-level approaches included providers taking necessary steps to ensure an effective doctor-patient relationship with immigrants (eg, strategies to promote cultural competencies, hiring multicultural staff). FGD participants also raised the importance of government- or policy-level solutions to ensure high quality of care (eg, increased after-hour clinics and lab/diagnostic services). CONCLUSIONS: Although barriers to immigrants accessing healthcare are well documented in the literature, solutions to address them are under-researched. To improve healthcare access, physicians, community health centers, local health agencies, and public health units should collaborate with members of immigrant communities to identify appropriate interventions.

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.

Lifetime risk of stroke in Japan.

BACKGROUND AND PURPOSE: Lifetime risk (LTR) is an epidemiologic measure that expresses the probability of disease in the remaining lifetime for an index age. The LTR for stroke has not been reported for the Japanese population. METHODS: We included all participants from the Suita Study who were cardiovascular disease-free at baseline. Age (in years) was used as the time scale. Age-specific stroke incidence and all-cause mortality were calculated with the person-year method, and we estimated the sex- and index age-specific LTRs of first-ever stroke and its subtypes, taking into account the competing risk of death. RESULTS: We followed up 5498 participants from 1989 to 2005 for a total of 67 475 person-years. At age 55 years, the LTR for stroke, after accounting for competing risks of death, was 18.3% for men and 19.6% for women. The LTR for cerebral infarction was 14.6% for men and 15.5% for women, and the LTR for intracerebral hemorrhage was 2.4% for men and 1.4% for women at the index age of 55 years. The LTR for stroke remained similar across other index ages of 45, 55, and 65 years. CONCLUSIONS: The observed probabilities illustrate that approximately 1 in 5 men and women of middle age will experience stroke in their remaining lifetime. This easy understandable information can be used as an important index to assist in public health education and planning.