Applying a climate-biodiversity-health framework to support integrated food systems planning and policy.

Food systems impact different aspects of sustainability and human life, such as pollution, health, climate change, biodiversity loss, water shortage, and soil infertility. However, in many places, food systems are neither resilient nor sustainable. Integrated planning approaches can help to overcome fragmented strategies and policies in ways that improve the sustainability and resilience of food systems. This study explores such an approach by applying a climate-biodiversity-health (CBH) nexus to local and regional food systems in the Comox Valley region, British Columbia, Canada. The CBH nexus is used as an analytical lens to identify systems relationships among food systems, climate change, biodiversity and health issues and strategies in the region. The employs a place-based approach entailing semi-structured interviews with provincial, regional, and local stakeholders in order to develop a holistic understanding of planning challenges, strategies and their outcomes through the CBH lens. Outcomes of this work include a system map that can be used as a framework for elucidating how various strategies align or conflict with different CBH imperatives and can be used to support integrated community sustainability planning and policy-making efforts. The framework is developed within the Comox Valley context, but it can be adapted to other communities. This paper details the development of this framework, the interconnections between different components, and how this framework can be adopted in other communities.

Caregiver burden and mental health: Parent perspectives when raising a child with developmental coordination disorder.

BACKGROUND: Children with Developmental Coordination Disorder (DCD) are at high risk for mental health disorders, stemming from challenges participating in motor activities. Parents of children with DCD report increased caregiver burden exacerbated by insufficient support and services for their child. A paucity of literature exists on parent and child mental health associated with a DCD diagnosis. AIMS: To explore parent perceptions of their child's mental health, and the impact of DCD on family and parental mental health. METHODS AND PROCEDURES: Implementation of a secondary analysis using the impACT for DCD, a cross-sectional online survey of parents of children with self-reported suspected or confirmed diagnosis of DCD living in British Columbia, Canada. Data analysis included descriptive and inferential statistics and content analysis. OUTCOMES AND RESULTS: Of the 237 participants, more than one third of parents (36%) rated their own mental health to be fair or poor, and the majority (90%) expressed concern for their child's mental health. Themes emerged on the impact of DCD on child, parent, and family, influenced by access to resources. CONCLUSIONS AND IMPLICATIONS: Standard of care for DCD needs to include services and supports that address caregiver burden and mental health of children with DCD and their families. WHAT THIS PAPER ADDS: This paper explores parent perceptions of their child(ren)'s and their own mental health when raising a child with DCD in British Columbia (BC). In BC, there is a lack of research on the mental health challenges families face when their child has a diagnosis of DCD. Amongst health care providers, there tends to be a focus on DCD as a motor disorder, with limited understanding and acknowledgement of the mental health component for children and their families. Thus, this study will inform health-care providers, parents, educators, and policy makers on parent-identified mental health needs and the essential services and supports. Unique to this study was the inclusion of a descriptive and exploratory content analysis, providing a holistic understanding of parents' perceptions regarding the impact of DCD on their children and themselves. Our results revealed that parents perceive significant inter-connected impacts of DCD on the child, parents, and family, leading to poor mental health for parents and their child(ren). Limited access to resources and supports results in a negative trajectory for family mental health and well-being. Study results indicate the critical importance of addressing mental health, in addition to motor challenges. Healthcare providers need to adopt a family-centred approach to address the physical and psychosocial impairments associated with DCD, ensuring positive outcomes for children and their families.

"It feels like I'm coming to a friend's house": an interpretive descriptive study of an integrated care site offering iOAT (Dr. Peter Centre).

BACKGROUND: Injectable opioid agonist treatment (iOAT) has proven to be a safe and effective treatment option for severe opioid use disorder (OUD). Yet, iOAT is often isolated from other health and social services. To align with a person-centered care approach, iOAT can be embedded in sites that combine systems and services that have been historically fragmented and that address multiple comorbidities (integrated care sites). The present study investigates the addition of iOAT at an integrated care in Vancouver, British Columbia. We aimed to capture what it means for service users and service providers to incorporate iOAT in an integrated care site and describe the processes by which the site keeps people engaged. METHODS: We conducted 22 interviews with 15 service users and 14 interviews with 13 service providers across two rounds of individual semi-structured interviews (Fall 2021, Summer 2022). The second interview round was precipitated by a service interruption in medication dispensation. Interview audio was recorded, transcribed, and then analysed in NVivo 1.6 following an interpretive description approach. RESULTS: The emergent themes from the analysis are represented in two categories: (1) a holistic approach (client autonomy, de-medicalized care, supportive staff relationships, multiple opportunities for engagement, barriers to iOAT integration) and (2) a sense of place (physical location, social connection and community belonging, food). CONCLUSION: Incorporating iOAT at an integrated care site revealed how iOAT delivery can be strengthened through its direct connection to a diverse, comprehensive network of health and social services that are provided in a community atmosphere with high quality therapeutic relationships.

How benchmarking motivates colostrum management practices on dairy farms: A realistic evaluation.

This study used realistic evaluation to determine how, and in which circumstances, providing dairy farmers with benchmarked data on their calves can motivate improved colostrum management practices. Dairy farmers from British Columbia, Canada, were recruited through 2 veterinary clinics that offered benchmarking of calf data as part of their services. For approximately 8 wk, blood samples were collected from newborn calves to evaluate serum total protein concentrations as an indicator of the effectiveness of the farmer's colostrum management. These data were analyzed separately for heifer calves ("replacement calves") and non-replacement calves, including males and beef crossbred females ("surplus calves"). The results of these analyses were benchmarked against other participating herds and presented to dairy farmers (n = 27) by their herd veterinarian (n = 7). Follow-up interviews were conducted separately with the farmers and veterinarians after each meeting to determine their perspectives on the utility of this benchmarking strategy. Therefore, a total of 42 interviews were coded, and realistic evaluation was used to determine common contexts and mechanisms that contributed to the success or failure of the benchmark meeting, with success characterized by farmers' expressed intention to improve their colostrum management practices. Four important contexts were identified that influenced the outcome of the benchmark meetings: (1) farm resources (e.g., facility limitations), (2) the farmer's perception of their calf performance, (3) management strategies, and (4) the farmer's personal values. Depending on these contexts, some farmers intended to improve their calf care practices based on resources the benchmark meeting provided, which included illustrative data and veterinary advice. These resources motivated change through influencing farmer decision-making, which depended on the value they saw in the data as a decision-making tool. The economic or moral interest farmers expressed in their surplus calves also influenced whether farmers intended to implement management changes. Recommendations for future implementation of benchmarking include targeting producers who are motivated to improve and who value the future performance of their calves, those who have engaged calf care personnel, and those who prefer data-driven decision-making. This study supports the important role veterinarians can play in motivating improved calf care practices through providing benchmarking services.

Identification of people with low prevalence diseases in administrative healthcare records: A case study of HIV in British Columbia, Canada.

INTRODUCTION: Case-finding algorithms can be applied to administrative healthcare records to identify people with diseases, including people with HIV (PWH). When supplementing an existing registry of a low prevalence disease, near-perfect specificity helps minimize impacts of adding in algorithm-identified false positive cases. We evaluated the performance of algorithms applied to healthcare records to supplement an HIV registry in British Columbia (BC), Canada. METHODS: We applied algorithms based on HIV-related diagnostic codes to healthcare practitioner and hospitalization records. We evaluated 28 algorithms in a validation sub-sample of 7,124 persons with positive HIV tests (2,817 with a prior negative test) from the STOP HIV/AIDS data linkage-a linkage of healthcare, clinical, and HIV test records for PWH in BC, resembling a disease registry (1996-2020). Algorithms were primarily assessed based on their specificity-derived from this validation sub-sample-and their impact on the estimate of the total number of PWH in BC as of 2020. RESULTS: In the validation sub-sample, median age at positive HIV test was 37 years (Q1: 30, Q3: 46), 80.1% were men, and 48.9% resided in the Vancouver Coastal Health Authority. For all algorithms, specificity exceeded 97% and sensitivity ranged from 81% to 95%. To supplement the HIV registry, we selected an algorithm with 99.89% (95% CI: 99.76% - 100.00%) specificity and 82.21% (95% CI: 81.26% - 83.16%) sensitivity, requiring five HIV-related healthcare practitioner encounters or two HIV-related hospitalizations within a 12-month window, or one hospitalization with HIV as the most responsible diagnosis. Upon adding PWH identified by this highly-specific algorithm to the registry, 8,774 PWH were present in BC as of March 2020, of whom 333 (3.8%) were algorithm-identified. DISCUSSION: In the context of an existing low prevalence disease registry, the results of our validation study demonstrate the value of highly-specific case-finding algorithms applied to administrative healthcare records to enhance our ability to estimate the number of PWH living in BC.

Maternal Transfer and Effects of Selenium on Early Life Stage Development of Redside Shiner (Richardsonius balteatus).

Maternal transfer of selenium (Se) to developing fish eggs during vitellogenesis can cause larval deformity and mortality. Previous studies have shown wide variation among fish species in both the magnitude of maternal transfer (exposure) and the egg Se concentration causing effects (sensitivity). We studied maternal transfer and effects of Se on early life stage development, survival, and growth of redside shiner (Richardsonius balteatus), a small-bodied cyprinid that has been reported to have relatively high ovary:muscle Se concentration ratios. Gametes were collected from lentic areas in southeast British Columbia (Canada) with a range of dietary Se concentrations related to weathering of waste rock from coal mining. Eggs were fertilized and reared in the laboratory from hatch to the onset of exogenous feeding. Larvae were assessed for survival, length, weight, Se-characteristic deformities, and edema. Eggs from a total of 56 females were collected, with egg Se concentrations from 0.7 to 28 mg/kg dry weight. Maternal transfer varied among sites, with egg:muscle Se concentration ratios ranging from <1 to >4. We also found that sampling residual ovaries can overestimate Se concentrations in ripe eggs by up to a factor of 5.7. A correlation between larval weight and egg Se concentration was identified, although the relationship was weak (r2 < 0.1) and appeared to be a site effect. No other relationships were observed between larval endpoints and egg Se concentrations up to the highest concentration tested, indicating that the effects threshold for this species may be >28 mg/kg dry weight in eggs. These data indicate that redside shiner is less sensitive to maternally transferred Se than most other tested fish species. Environ Toxicol Chem 2023;42:2350-2357. © 2023 SETAC.

Infusing wellness opportunities into integrated youth services.

BACKGROUND: Appropriate health services and health promotion strategies for young people with mental health and substance use (MHSU) concerns are critical for recovery. Foundry, an integrated youth services (IYS) initiative for young people ages 12-24 in British Columbia (BC), Canada, has recently added leisure and recreational activities (referred to as the Wellness Program) into its services. The objectives of this study were to: (1) describe how the Wellness Program was implemented over a two-year period into IYS (2) provide an overview of what the Wellness Program is, who accessed the program since inception and initial evaluation results. METHODS: This study was part of the developmental evaluation of Foundry. A phased approach was used to implement the program at nine centres. Data was accessed from Foundry's centralized platform 'Toolbox' and included activity type, number of unique youth and visits, additional services sought, information about how youth found out about the centre, and demographics. Qualitative data was also accessed from focus groups (n=2) conducted with young people (n=9). RESULTS: Over the two-year period, 355 unique youth accessed the Wellness Program, with 1319 unique visits. Almost half (40%) of youth identified the Wellness Program as the first point of access to Foundry. A total of 384 different programs were offered targeting five wellness domains (physical, mental/emotional, social, spiritual, and cognitive/intellectual). The majority of youth identified as young girls/women (58.2%), 22.6% as gender diverse, and 19.2% as young men/boys. The mean age was 19 years, and most participants were between the ages of 19-24 years (43.6%). From the thematic analysis of focus groups, we found young people enjoyed the social aspect of the program with peers and facilitators, and identified program improvements that are being considered as the program grows. CONCLUSIONS: This study provides insight into the development and implementation of leisure-based activities (known as the Wellness Program) into IYS and can be used as a guide by international IYS initiatives. The initial reach of programs over two years is promising, and these programs are acting as a potential gateway for young people to access other health services.

Serum total protein concentrations in surplus dairy calves in British Columbia.

Objective: This cross-sectional study aimed to evaluate serum total protein (STP) concentrations in surplus calves in British Columbia and explore associated factors including calf breed, sex, hydration, month of sampling, and frequency of calf pickup. Animal: Neonatal dairy and dairy-beef crossbred calves recently purchased from dairy farms and transported to an assembly facility. Procedure: Calves included in this study (N = 1449) were assessed at an assembly facility from March to August 2021, and blood samples were collected to measure STP as an indicator of transfer of passive immunity (TPI). Associations between STP and calf characteristics (breed, sex, hydration), month of sampling, and how frequently calves were collected from the source dairy farms (daily versus twice weekly or less) were evaluated with a linear regression model including farm as a random effect. Results: Of the 1433 serum samples, 24% had STP concentrations that were "poor:" defined as < 5.1 g/dL, and the proportion with poor STP varied widely among farms. Dairy-beef crossbred calves and calves that were dehydrated had higher STP concentrations, whereas those sampled in July had lower STP. This study was limited to calves purchased by 1 calf buyer but represented a large number of calves from 12% of the dairy farms in British Columbia. Conclusion: Approximately 1/4 of surplus dairy calves had poor STP concentrations. Clinical relevance: Ensuring surplus dairy calves have successful TPI is an important opportunity to bolster their health and welfare.

Concentrations sériques des protéines totales chez les veaux laitiers excédentaires en Colombie-Britannique. Objectif: Cette étude transversale visait à évaluer les concentrations sériques des protéines totales (STP) chez les veaux excédentaires en Colombie-Britannique et à explorer les facteurs associés, notamment la race de veau, le sexe, l'hydratation, le mois d'échantillonnage et la fréquence de ramassage des veaux. Animal: Veaux nouveau-nés issus de croisements laitier et laitier-boeuf achetés récemment à des fermes laitières et transportés vers une installation commune. Procédure: Les veaux inclus dans cette étude (N = 1449) ont été évalués dans une installation commune de mars à août 2021, et des échantillons de sang ont été prélevés pour mesurer les STP comme indicateur du transfert de l'immunité passive (TPI). Les associations entre les STP et les caractéristiques des veaux (race, sexe, hydratation), le mois d'échantillonnage et la fréquence à laquelle les veaux ont été ramassés dans les fermes laitières d'origine (quotidiennement versus deux fois par semaine ou moins) ont été évaluées avec un modèle de régression linéaire incluant la ferme comme effet aléatoire. Résultats: Sur les 1433 échantillons de sérum, 24 % présentaient des concentrations de STP « médiocres ¼ définies comme < 5,1 g/dL, et la proportion avec des STP médiocres variait considérablement d'une ferme à l'autre. Les veaux issus de croisements lait-boeuf et les veaux déshydratés présentaient des concentrations de STP plus élevées, tandis que ceux échantillonnés en juillet présentaient des concentrations de STP plus faibles. Cette étude se limitait aux veaux achetés par un acheteur de veaux, mais représentait un grand nombre de veaux provenant de 12 % des fermes laitières de la Colombie-Britannique. Conclusion: Environ le quart des veaux laitiers excédentaires avaient de faibles concentrations de STP. Pertinence clinique: Veiller à ce que les veaux laitiers excédentaires aient un transfert d'immunité passive réussie est une occasion importante de renforcer leur santé et leur bien-être.(Traduit par Dr Serge Messier).

Comparative effectiveness of urine drug screening strategies alongside opioid agonist treatment in British Columbia, Canada: a population-based observational study protocol.

INTRODUCTION: Urine drug tests (UDTs) are commonly used for monitoring opioid agonist treatment (OAT) responses, supporting the clinical decision for take-home doses and monitoring potential diversion. However, there is limited evidence supporting the utility of mandatory UDTs-particularly the impact of UDT frequency on OAT retention. Real-world evidence can inform patient-centred approaches to OAT and improve current strategies to address the ongoing opioid public health emergency. Our objective is to determine the safety and comparative effectiveness of alternative UDT monitoring strategies as observed in clinical practice among OAT clients in British Columbia, Canada from 2010 to 2020. METHODS AND ANALYSIS: We propose a population-level retrospective cohort study of all individuals 18 years of age or older who initiated OAT from 1 January 2010 to 17 March 2020. The study will draw on eight linked health administrative databases from British Columbia. Our primary outcomes include OAT discontinuation and all-cause mortality. To determine the effectiveness of the intervention, we will emulate a 'per-protocol' target trial using a clone censoring approach to compare fixed and dynamic UDT monitoring strategies. A range of sensitivity analyses will be executed to determine the robustness of our results. ETHICS AND DISSEMINATION: The protocol, cohort creation and analysis plan have been classified and approved as a quality improvement initiative by Providence Health Care Research Ethics Board and the Simon Fraser University Office of Research Ethics. Results will be disseminated to local advocacy groups and decision-makers, national and international clinical guideline developers, presented at international conferences and published in peer-reviewed journals electronically and in print.

"The Old Ways Are the Old Ways": A Qualitative Study of Chinese Medicine Care in Indigenous Communities in Canada.

Objectives: Owing to colonization's impacts, Indigenous Peoples in Canada face a disproportionate share of health challenges and suffer inequitable access to health care today. In recent years, an increasing number of Indigenous-led health services have emerged, which-informed by decolonial principles, including "culture-as-cure"-holistically center local Indigenous cultural, spiritual, and healing knowledges and practices. Aligned with decolonial principles, this work examines the delivery of Chinese Medicine (CM) care-an East Asian Indigenous therapeutic approach-in Indigenous communities in British Columbia, Canada. Design: Informed by qualitative interviews with three licensed CM practitioners and one biomedical clinician working in such clinics, the work provides a descriptive account of clinical operations, and thematically explores operational successes and challenges. Results: Four CM clinical programs were identified, all operating on First Nations reserves, including settings at multidisciplinary community health centers, a First Nation Band Council office, and a school gymnasium. Most CM care was delivered free of charge, funded variously by nonprofit agency donations and provincial government reimbursement. Three central themes emerged across the study interviews. The first, transculturalism, emphasizes the conceptual overlap between CM and Indigenous belief systems in the Canadian context, which participants described as a source of strength in building trust for CM care as a nonlocal Indigenous therapeutic approach. The second theme, Cultural Humility, characterizes non-Indigenous practitioners' respectful outlook as guests on Indigenous land, taking community members' lead as to how they might best serve. The final theme, Multidimensional Healing, explores the physical, mental, and emotional healing that practitioners witnessed across their work. Conclusions: Despite economic and logistical challenges, study respondents expressed optimism about the potential for similar traditional medicine clinics to provide culturally resonant primary care in other underserved communities. Further research to learn about the experiences of First Nations community members receiving CM care is warranted.

Perinatal outcomes of midwife-led care, stratified by medical risk: a retrospective cohort study from British Columbia (2008-2018).

BACKGROUND: Anecdotal evidence suggests that the profile of midwifery clients in British Columbia has changed over the past 20 years and that midwives are increasingly caring for clients with moderate to high medical risk. We sought to compare perinatal outcomes with a registered midwife as the most responsible provider (MRP) versus outcomes among clients with physicians as their MRP across medical risk strata. METHODS: This retrospective cohort study (2008-2018) used data from the BC Perinatal Data Registry. We included all births that had a family physician, obstetrician or midwife listed as the MRP (n = 425 056) and stratified the analysis by pregnancy risk status (low, moderate or high) according to an adapted perinatal risk scoring system. We estimated differences in outcomes between MRP groups by calculating adjusted absolute and relative risks. RESULTS: The adjusted absolute and relative risks of adverse neonatal outcomes were consistently lower among those who chose midwifery care across medical risk strata, compared with clients who had a physician as MRP. Midwifery clients experienced higher rates of spontaneous vaginal births, vaginal births after cesarean delivery and breastfeeding initiation, and lower rates of cesarean deliveries and instrumental births, with no increase in adverse neonatal outcomes. We observed an increased risk of oxytocin induction among high-risk birthers with a midwife versus an obstetrician as MRP. INTERPRETATION: Our findings suggest that compared with other providers in BC, midwives provide safe primary care for clients with varied levels of medical risk. Future research might examine how different practice and remuneration models affect clinical outcomes, client and provider experiences, and costs to the health care system.

Assessing gestational exposure to trace elements in an area of unconventional oil and gas activity: comparison with reference populations and evaluation of variability.

BACKGROUND: Located in Northeastern British Columbia, the Montney formation is an important area of unconventional oil and gas exploitation, which can release contaminants like trace elements. Gestational exposure to these contaminants may lead to deleterious developmental effects. OBJECTIVES: Our study aimed to (1) assess gestational exposure to trace elements in women living in this region through repeated urinary measurements; (2) compare urinary concentrations to those from North American reference populations; (3) compare urinary concentrations between Indigenous and non-Indigenous participants; and (4) evaluate inter- and intra-individual variability in urinary levels. METHODS: Eighty-five pregnant women participating in the Exposures in the Peace River Valley (EXPERIVA) study provided daily spot urine samples over 7 consecutive days. Samples were analyzed for 20 trace elements using inductively-coupled mass spectrometry (ICP-MS). Descriptive statistics were calculated, and inter- and intra-individual variability in urinary levels was evaluated through intraclass correlation coefficient (ICC) calculation for each trace element. RESULTS: When compared with those from North American reference populations, median urinary levels were higher in our population for barium (~2 times), cobalt (~3 times) and strontium (~2 times). The 95th percentile of reference populations was exceeded at least 1 time by a substantial percentage of participants during the sampling week for barium (58%), cobalt (73%), copper (29%), manganese (28%), selenium (38%), strontium (60%) and vanadium (100%). We observed higher urinary manganese concentrations in self-identified Indigenous participants (median: 0.19 µg/g creatinine) compared to non-Indigenous participants (median: 0.15 µg/g of creatinine). ICCs varied from 0.288 to 0.722, indicating poor to moderate reliability depending on the trace element. SIGNIFICANCE: Our results suggest that pregnant women living in this region may be more exposed to certain trace elements (barium, cobalt, copper, manganese, selenium, strontium, and vanadium), and that one urine spot sample could be insufficient to adequately characterize participants' exposure to certain trace elements. IMPACT STATEMENT: Unconventional oil and gas (UOG) is an important industry in the Peace River Valley region (Northeastern British Columbia, Canada). Information on the impacts of this industry is limited, but recent literature emphasizes the risk of environmental contamination. The results presented in this paper highlight that pregnant women living near UOG wells in Northeastern British Columbia may be more exposed to some trace elements known to be related to this industry compared to reference populations. Furthermore, our results based on repeated urinary measurements show that one urine sample may be insufficient to adequately reflect long-term exposure to certain trace elements.

Developing a land-based oral health promotion project with an Indigenous community in northern British Columbia, Canada.

In British Columbia, Canada, First Nations children and youth consistently present with a higher incidence of dental disease. Efforts to improve the oral health status of Indigenous populations have had mixed success, and programs have typically been offered through a Western lens. Recent years have brought calls for oral health professionals to embrace a more holistic approach to health promotion, representative of Indigenous cultures. Colonization has been considered a negative health determinant as it led to the destruction of culture, language, and the removal of Indigenous peoples from their traditional lands. Self-determination and cultural connection are critical to mitigating cultural genocide. Health promotion projects have the potential to support these goals. Fundamental to decolonizing oral health promotion is the development of a sustainable program founded in the traditional ways of Indigenous health and healing. The purpose of this short communication is to report on a collaborative oral health project that used cultural connection as the framework for oral health promotion in a remote Indigenous community.

En Colombie-Britannique, au Canada, les enfants et les jeunes des Premières Nations présentent systématiquement une incidence plus élevée de maladies dentaires. Les efforts visant à améliorer l'état de santé buccodentaire des populations autochtones ont connu un succès mitigé, bien que les programmes aient généralement été offerts dans une optique occidentale. Ces dernières années, les professionnels de la santé buccodentaire ont été appelés à adopter une approche plus globale de la promotion de la santé, représentative des cultures autochtones. La colonisation a été considérée comme un déterminant négatif de la santé, car elle a mené à la destruction de la culture et de la langue, ainsi que l'expulsion des Autochtones de leurs terres traditionnelles. L'autodétermination et le lien culturel sont essentiels pour atténuer le génocide culturel. Les projets de promotion de la santé ont le potentiel de soutenir ces objectifs. L'élaboration d'un programme durable fondé sur les méthodes traditionnelles de santé et de guérison autochtones est essentielle à la décolonisation de la promotion de la santé buccodentaire. L'objectif de cette brève communication est de faire le point sur un projet de santé buccodentaire collaboratif qui a utilisé le lien culturel à titre de cadre pour la promotion de la santé buccodentaire dans une communauté autochtone éloignée.

Learning Circles: A Collaborative Approach to Enhance Local, Healthy and Traditional Foods for Youth in the Northerly Community of Hazelton/Upper Skeena, British Columbia, Canada.

Youth health, long-term food sovereignty and the reclamation of traditional food-related knowledge are areas of concern within Indigenous communities in Canada. Learning Circles: Local Healthy Food to School (LC:LHF2S) built on an exemplar program in four predominantly Indigenous communities. In each, the initiative worked with interested community members to plan, implement and evaluate a range of activities aimed at enhancing access to local, healthy and traditional foods for schools and youth. This case study describes the context, process, outcomes and perceptions of implementation in one of the communities, Hazelton/Upper Skeena, located in northern British Columbia. Data were collected between 2016-2019 and included semi-directed interviews with community members and LCEF (n = 18), process reporting (e.g., LCEF reports, emails, conference calls and tracking data), photographs and video footage, and photovoice. Data were analyzed thematically. Hazelton/Upper Skeena has an active local and traditional food culture. Indigenous governance was supportive, and community members focused on partnership and leadership development, gardens, and food skills work. Findings point to strengths; traditional food, knowledge and practices are valued by youth and were prioritized. LC:LHF2S is a flexible initiative that aims to engage the broader community, and exemplifies some of the best practices recommended for community-based initiatives within Indigenous communities. Results indicate that a LC is a feasible venture in this community; one that can facilitate partnership-building and contribute to increased access to local and traditional food among school-aged youth. Recommendations based on community input may help the uptake of the model in similar communities across Canada, and globally.

Weather and nest cavity characteristics influence fecundity in mountain chickadees.

Background: Examining direct and indirect effects on reproduction at multiple scales allows for a broad understanding of species' resilience to environmental change. We examine how the fecundity of the mountain chickadee (Poecile gambeli), a secondary cavity-nesting, insectivorous bird, varied in relation to factors at three scales: regional weather conditions, regional- and site-level food availability, site-level community dynamics, and nest-level cavity characteristics. We hypothesized that earlier laying dates and higher fecundity (clutch size, nest survival, brood size) would be associated with milder climatic conditions, increased food from insect outbreaks, lower densities of conspecifics and nest predators (red squirrel; Tamiasciurus hudsonicus), and safer (smaller, higher) cavities. Methods: We collected data on laying date, clutch size, brood size, nest fate (success/failure), and cavity characteristics from 513 mountain chickadee nests in tree cavities in temperate mixed coniferous-broadleaf forest in interior British Columbia, Canada, from 2000 to 2011. We surveyed annual abundances of mountain chickadees and squirrels using repeated point counts, and mountain pine beetle (Dendroctonus ponderosae) and lepidopteran defoliators by monitoring host trees and by using regional-scale aerial overview forest insect survey data. We used weather data (temperature, rain, snow) from a local Environment and Climate Change Canada weather station. We modeled laying date, clutch size, daily nest survival, and brood size as a function of predictors at regional-, site-, and nest-scales. Results and Conclusions: Measures of fecundity varied dramatically across years and spatial scales. At the regional (study-wide) scale, chickadees laid earlier and larger first clutches in warmer springs with minimal storms, and daily nest survival (DSR) increased with a 2-year lag in growing season temperature. Despite a doubling of mountain chickadee density that roughly accompanied the outbreaks of mountain pine beetle and lepidopteran defoliators, we found little evidence at the site scale that fecundity was influenced by insect availability, conspecific density, or predator density. At the nest scale, DSR and brood size increased with clutch size but DSR declined with nest cavity size indicating a positive reproductive effect of small-bodied cavity excavators. Double-brooding, rare in chickadees, occurred frequently in 2005 and 2007, coinciding with early breeding, high food availability from insect outbreaks, and warm spring temperatures with 0-1 spring storms. Our results support the idea that fecundity in secondary cavity-nesting species is impacted directly and indirectly by weather, and indirectly through changes in community dynamics (via cavity resource supply). We stress the importance of adopting holistic, community-level study frameworks to refine our understanding of fecundity in opportunistic and climate-sensitive species in future.

Protection of Potatoes and Mortality of Wireworms (Agriotes obscurus) With Various Application Methods of Broflanilide, a Novel Meta-Diamide Insecticide.

Wireworms are primary pests of potatoes in Canada. Presently, the highly toxic organophosphate phorate (i.e., Thimet 20G) is the only effective insecticide in use in Canada. As such, there is an urgent need for novel alternative treatments that provide competitive tuber blemish protection and wireworm reduction with a safer human and environmental portfolio. Herein we evaluated broflanilide, a novel meta-diamide insecticide for both tuber protection and wireworm mortality. When evaluated in field trials in Agassiz, British Columbia over 6 yr, broflanilide applied as a seed piece treatment (SPT) to mother tubers at 1.5-2.0 g AI/100 kg seed (approx. 50 g AI/ha), or as an in-furrow spray (IFS) at 0.23-0.25 g AI/100 m row (approx. 25 g AI/ha) was as effective at reducing blemishes to daughter tubers by wireworms (Agriotes obscurus) as phorate (Thimet 20G at 3230 g AI/ha), bifenthrin (Capture 2EC IFS at 300 g AI/ha) and clothianidin (Titan ST at 312.5 g AI/ha). In addition, broflanilide SPT and IFS applied at the above rates reduced resident wireworms (in the field at the time of planting) by 95.4-99.0% and neonate wireworms (produced from eggs laid during the growing season) by 98.1-100%. Similar results were obtained when broflanilide IFS (nonsystemic) was paired with clothianidin SPT (systemic) for broad-spectrum potato insect pest control. Strategies for the use of broflanilide on wheat (e.g., Teraxxa F4) in rotation with potatoes (Cimegra), both registered in Canada in 2020 are discussed.

The impact of COVID-19 on access to canine integrative medical care in Michigan, USA, and Ontario and British Columbia, Canada.

OBJECTIVE: To determine the effects of the COVID-19 associated restrictions on the ability of owners in Michigan (MI), USA versus Ontario (ON) and British Columbia (BC), Canada, to obtain care for their chronically painful dogs. STUDY DESIGN: Cross-sectional survey. POPULATION: A total of 90 owners met the inclusion criteria for the study. METHODS: An anonymous electronic survey was distributed to owners at four veterinary integrative medicine (IM) clinics during July and August 2020. Two clinics in MI and one each in ON and BC were recruited. Owners were asked about availability of IM care preceding and during COVID-19 restrictions and their opinions of the impact of COVID-19 on their dog's health. The survey asked where owners sought care for their dogs, types of chronic conditions treated, therapeutic modalities used, and if owners had a medical background. Comparisons were made within and between groups. Thematic analysis, Fisher's exact test, chi-square analyses, McNemar's and Wilcoxon signed-rank tests for paired comparisons were performed (p < 0.05). RESULTS: During COVID-19 restrictions, access to IM care was better for dogs in ON and BC than in MI (p < 0.001). The negative effect of the pandemic restrictions to IM care on quality of life was perceived greater by owners in MI than those in ON and BC (p < 0.001). The owners' medical backgrounds had no effect on attempts to access care during this time (p = 0.76). CONCLUSIONS AND CLINICAL RELEVANCE: The results suggest that a widespread disease in humans had an adverse impact on animal welfare. Providers of veterinary care should use this experience to establish protocols to ensure continuity of care for chronically painful animals in the event of a similar situation in the future.

'Forgotten as first line providers': The experiences of midwives during the COVID-19 pandemic in British Columbia, Canada.

OBJECTIVE: To explore midwives' experiences working on the frontlines of the COVID-19 pandemic in British Columbia, Canada. DESIGN: Qualitative study involving three semi-structured focus groups and four in-depth interviews with midwives. SETTING: The COVID-19 pandemic in British Columbia, Canada from 2020-2021. PARTICIPANTS: 13 midwives working during the first year of the COVID-19 pandemic in British Columbia. FINDINGS: Qualitative analysis surfaced four key themes. First, midwives faced a substantial lack of support during the pandemic. Second, insufficient support was compounded by a lack of recognition. Third, participants felt a strong duty to continue providing high-quality care despite COVID-19 related restrictions and challenges. Lastly, lack of support, increased workloads, and moral distress exacerbated burnout among midwives and raised concerns around the sustainability of their profession. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Lack of effective support for midwives during the initial months of the COVID-19 pandemic exacerbated staffing shortages that existed prior to the pandemic, creating detrimental gaps in essential care for pregnant people, especially with increasing demands for homebirths. Measures to support midwives should combat inequities in the healthcare system, mitigating the risks of disease exposure, burnout, and professional and financial impacts that may have long-lasting implications on the profession. Given the crucial role of midwives in women- and people-centred care and advocacy, protecting midwives and the communities they serve should be prioritized and integrated into pandemic preparedness and response planning to preserve women's health and rights around the world.

Evaluating the use of hair as a non-invasive indicator of trace mineral status in woodland caribou (Rangifer tarandus caribou).

Trace mineral imbalances can have significant effects on animal health, reproductive success, and survival. Monitoring their status in wildlife populations is, therefore, important for management and conservation. Typically, livers and kidneys are sampled to measure mineral status, but biopsies and lethal-sampling are not always possible, particularly for Species at Risk. We aimed to: 1) determine baseline mineral levels in Northern Mountain caribou (Rangifer tarandus caribou; Gmelin, 1788) in northwestern British Columbia, Canada, and 2) determine if hair can be used as an effective indicator of caribou mineral status by evaluating associations between hair and organ mineral concentrations. Hair, liver, and kidney samples from adult male caribou (nHair = 31; nLiver, nKidney = 43) were collected by guide-outfitters in 2016-2018 hunting seasons. Trace minerals and heavy metals were quantified using inductively-coupled plasma mass spectrometry, and organ and hair concentrations of same individuals were compared. Some organ mineral concentrations differed from other caribou populations, though no clinical deficiency or toxicity symptoms were reported in our population. Significant correlations were found between liver and hair selenium (rho = 0.66, p<0.05), kidney and hair cobalt (rho = 0.51, p<0.05), and liver and hair molybdenum (rho = 0.37, p<0.10). These findings suggest that hair trace mineral assessment may be used as a non-invasive and easily-accessible way to monitor caribou selenium, cobalt, and molybdenum status, and may be a valuable tool to help assess overall caribou health.

Integrating Indigenous healing practices within collaborative care models in primary healthcare in Canada: a rapid scoping review.

OBJECTIVES: In November 2020, a series of reports, In Plain Sight, described widespread Indigenous-specific stereotyping, racism and discrimination limiting access to medical treatment and negatively impacting the health and wellness of Indigenous Peoples in British Columbia, Canada. To address the health inequalities experienced by Indigenous peoples, Indigenous healing practices must be integrated within the delivery of care. This rapid scoping review aimed to identify and synthesise strategies used to integrate Indigenous healing practices within collaborative care models available in community-based primary healthcare, delivered by regulated health professionals in Canada. ELIGIBILITY CRITERIA: We included quantitative, qualitative and mixed-methods studies conducted in community-based primary healthcare practices that used strategies to integrate Indigenous healing practices within collaborative care models. SOURCES OF EVIDENCE: We searched MEDLINE, Embase, Indigenous Studies Portal, Informit Indigenous Collection and Native Health Database for studies published from 2015 to 2021. CHARTING METHODS: Our data extraction used three frameworks to categorise the findings. These frameworks defined elements of integrated healthcare (ie, functional, organisational, normative and professional), culturally appropriate primary healthcare and the extent of community engagement. We narratively summarised the included study characteristics. RESULTS: We identified 2573 citations and included 31 in our review. Thirty-nine per cent of reported strategies used functional integration (n=12), 26% organisational (n=8), 19% normative (n=6) and 16% professional (n=5). Eighteen studies (58%) integrated all characteristics of culturally appropriate Indigenous healing practices into primary healthcare. Twenty-four studies (77%) involved Indigenous leadership or collaboration at each phase of the study and, seven (23%) included consultation only or the level of engagement was unclear. CONCLUSIONS: We found that collaborative and Indigenous-led strategies were more likely to facilitate and implement the integration of Indigenous healing practices. Commonalities across strategies included community engagement, elder support or Indigenous ceremony or traditions. However, we did not evaluate the effectiveness of these strategies.