Birth and postnatal outcomes among infants of immigrant parents of different admission categories and parents born in Canada: a population-based retrospective study.

BACKGROUND: Most studies of disparities in birth and postnatal outcomes by parental birthplace combine all immigrants into a single group. We sought to evaluate heterogeneity among immigrants in Canada by comparing birth and postnatal outcomes across different immigration categories. METHODS: We conducted a population-based retrospective study using Statistics Canada data on live births and stillbirths (1993-2017) and infant deaths (1993-2018), linked to parental immigration data (1960-2017). We classified birthing parents as born in Canada, economic-class immigrants, family-class immigrants, or refugees, and evaluated differences in preterm births, small-for-gestational-age (SGA) and large-for-gestational-age (LGA) births, stillbirths, and infant deaths among singleton births by group. RESULTS: Among 7 980 650 births, 1 715 050 (21.5%) were to immigrants, including 632 760 (36.9%) in the economic class, 853 540 (49.8%) in the family class, and 228 740 (13.4%) refugees. Compared with infants of Canadian-born birthing parents, infants of each of the 3 immigrant groups had higher risk of preterm birth, SGA birth, and stillbirth, but lower risk of LGA birth and neonatal death. Compared with infants of economic-class immigrants, infants of refugees had higher risk of early preterm birth (0.9% v. 0.8%, adjusted risk ratio [RR] 1.08, 95% confidence interval [CI] 1.01-1.15) and LGA birth (9.2% v. 7.5%, adjusted RR 1.12, 95% CI 1.10-1.15), but lower risk of SGA birth (10.2% v. 11.0%, adjusted RR 0.92, 95% CI 0.90-0.94), while infants of family-class immigrants had higher risk of SGA birth (12.2% v. 11.0%, adjusted RR 1.01, 95% CI 1.00-1.02). Risk of stillbirth, neonatal death, and overall infant death did not differ significantly among immigrant groups. INTERPRETATION: Heterogeneity exists in outcomes of infants born to immigrants to Canada across immigration categories. These results highlight the importance of disaggregating immigrant populations in studies of health disparities.

Embedding anti-racism in Schools of Public Health: a pathway to accountability for progress towards equity.

The importance of seeing race as a socially constructed idea continues to produce unfair differences between humans and establishes power relations that lead to injustice and exposure to death. Since the racial justice movement in early 2020, there has been a heightened awareness of, and increased interest in, addressing historic racial disparities across Schools of Public Health (SPH) in Canada. Steps have been taken to recognize systemic racism and increase diversity through structural reforms to advance equity and inclusion; however, addressing racism demands collectively uprooting racist institutional designs still inherent in learning, teaching, research, service, and community engagement. This commentary highlights the need for sustained commitment to establishing longitudinal benchmarks for greater racial equity among students, staff, and faculty; revising curricula to include historic and contemporary narratives of colonialism and slavery; and providing community-engaged learning opportunities as instrumental to dismantle systemic drivers of racial health inequities locally and globally. We also advocate for intersectoral collaboration, mutual learning, and sharing of resources across SPH and partner agencies to accomplish a continual collective agenda for racial health equity and inclusion that is intersectional in Canada, while being held accountable to Indigenous and racialized communities.

RéSUMé: L'importance de voir la race comme une idée socialement construite continue de produire des différences inéquitables entre les gens et d'établir des relations de pouvoir qui mènent à l'injustice et à l'exposition à la mort. Depuis que le mouvement pour la justice raciale s'est enclenché au début de 2020, il existe une conscience aiguë des disparités raciales historiques entre les écoles de santé publique (ESP) du Canada et un intérêt accru pour le redressement de ces disparités. Des mesures ont été prises pour reconnaître le racisme systémique et accroître la diversité par des réformes structurelles visant à promouvoir l'équité et l'inclusion; cependant, pour aborder le racisme, il faut collectivement arracher les modèles institutionnels racistes qui font encore partie intégrante de l'apprentissage, de l'enseignement, de la recherche, des services et de la participation de la communauté. Dans notre commentaire, nous soulignons le besoin d'un engagement soutenu à établir des repères longitudinaux pour une plus grande équité raciale dans la population étudiante, au sein du personnel et dans le corps professoral, à revoir les programmes d'études pour y inclure les discours historiques et contemporains du colonialisme et de l'esclavage, et à offrir des possibilités d'enseignement faisant appel aux communautés, car elles contribueront à démanteler les moteurs systémiques des iniquités raciales en santé à l'échelle locale et mondiale. Nous promulguons aussi la collaboration intersectorielle, l'apprentissage mutuel et le partage des ressources entre les ESP et les organismes partenaires afin de concrétiser un plan d'action collective continue en faveur de l'équité raciale en santé et de l'inclusion ­ un plan qui sera intersectionnel au Canada et qui rendra des comptes aux communautés autochtones et racisées.

Sex and gender differences in healthcare utilisation trajectories: a cohort study among Quebec workers living with chronic pain.

OBJECTIVES: Chronic pain (CP) is a poorly recognised and frequently inadequately treated condition affecting one in five adults. Reflecting on sociodemographic disparities as barriers to CP care in Canada was recently established as a federal priority. The objective of this study was to assess sex and gender differences in healthcare utilisation trajectories among workers living with CP. DESIGN: Retrospective cohort study. PARTICIPANTS: This study was conducted using the TorSaDE Cohort which links the 2007-2016 Canadian Community Health Surveys and Quebec administrative databases (longitudinal claims). Among 2955 workers living with CP, the annual number of healthcare contacts was computed during the 3 years after survey completion. OUTCOME: Group-based trajectory modelling was used to identify subgroups of individuals with similar patterns of healthcare utilisation over time (healthcare utilisation trajectories). RESULTS: Across the study population, three distinct 3-year healthcare utilisation trajectories were found: (1) low healthcare users (59.9%), (2) moderate healthcare users (33.6%) and (3) heavy healthcare users (6.4%). Sex and gender differences were found in the number of distinct trajectories and the stability of the number of healthcare contacts over time. Multivariable analysis revealed that independent of other sociodemographic characteristics and severity of health condition, sex-but not gender-was associated with the heavy healthcare utilisation longitudinal trajectory (with females showing a greater likelihood; OR 2.6, 95% CI 1.6 to 4.1). CONCLUSIONS: Our results underline the importance of assessing sex-based disparities in help-seeking behaviours, access to healthcare and resource utilisation among persons living with CP.

Enhancing perceived leadership of nursing students through a student-led dedicated education unit in a community setting: A feasibility study.

BACKGROUND: Leadership competence is important to ensure the provision of safe and high-quality care in hospitals. PURPOSE: The aim was to demonstrate the feasibility of enhancing the perceived leadership competence of nursing students through an innovative health education strategy, consisting of a student-led dedicated education unit (DEU) informed by a service-learning approach in a community setting. DESIGN: Feasibility study in a three-phase process: I: Design; II: Acceptability and implementation; III: Expansion to a different setting. In phase II the DEU was piloted with 62 students using a pretest/post-test with control group design. In phase III it was piloted with 20 students in the expansion setting. METHODS: The DEU was implemented and tested in Barcelona (Spain) between 2014 and 2019. To assess acceptability and implementation, students' perceived leadership competence was measured using the Self-Assessment Leadership Instrument. We also obtained satisfaction ratings using an ad hoc questionnaire. RESULTS: Satisfaction was high among students, as well as among service users who received health education. In phase II, students' post-test self-ratings of their leadership competence were higher in both the intervention and control groups, but the increase was significantly greater among students who participated in the DEU (25.84 % vs. 16.72 %, p = .012). Similar results were obtained in the expansion phase, with students in the intervention group once again showing a significant increase in perceived leadership skills (12.89 %, p = .005). CONCLUSIONS: Student-led DEUs appear to be an effective way of enhancing perceived leadership competence among senior nursing students.

Looking at COVID-19 effects on intimate partner and sexual violence organizations in Canada through a feminist political economy lens: a qualitative study.

OBJECTIVES: Intimate partner violence and sexual violence organizations such as women's shelters play a crucial role in advancing gender equality in Canada. COVID-19 has challenged how such organizations operate. This study explored how intimate partner violence and sexual violence organizations in Canada have been affected by COVID-19 and the consequences on service delivery. METHODS: We interviewed 17 frontline and management staff from intimate partner violence and sexual violence organizations and programs across Canada, and analyzed the data using thematic analysis and applying a feminist political economy lens. RESULTS: We identified the following themes: (1) Adapting; (2) Struggling financially; (3) Resourcefulness; (4) Troubles connecting; (5) Narrowing scope of work; and (6) Burden of care. CONCLUSION: A feminist political economy framework considers the gendered impact of the pandemic and related measures on the workforce. Both the pandemic and measures to control it have affected intimate partner violence and sexual violence organizations in Canada, the staff working in these organizations, and the quality of relationships between staff and clients. Intimate partner and sexual violence organizations in Canada have been chronically underfunded and their predominantly female staff underpaid, affecting their ability to meet the needs of women. The onset of COVID-19 not only worsened these issues but converged with a shift in focus to more pandemic-related tasks, further limiting the scope and reach of organizations. Whether the adaptations, innovations, and perseverance demonstrated by such organizations and staff can tip the balance in favour of more equitable policy and outcomes remains to be seen.

RéSUMé: OBJECTIFS: Les organismes de lutte contre la violence conjugale et la violence sexuelle, comme les hébergements pour femmes, jouent un rôle crucial dans la promotion de l'égalité des genres au Canada. La COVID-19 a remis en question le mode de fonctionnement de ces organisations. Cette étude a examiné la manière dont les organismes de lutte contre la violence conjugale et sexuelle au Canada ont été affectés par la COVID-19 et les conséquences sur la prestation de services. MéTHODES: Nous avons mené des entrevues avec 17 intervenantes de première ligne et membres de la direction d'organismes et de programmes de lutte contre la violence conjugale et sexuelle à travers le Canada. Les données ont été analysées à l'aide d'une analyse thématique et en appliquant une optique d'économie politique féministe. RéSULTATS: Nous avons identifié les thèmes suivants : 1) adaptation; 2) difficultés financières; 3) ingéniosité; 4) difficultés à établir des liens; 5) réduction du champ d'action; et 6) charge de travail. CONCLUSION: Un cadre d'économie politique féministe permet d'examiner l'impact genré de la pandémie et des mesures connexes sur le personnel. La pandémie a eu des répercussions sur les organismes de lutte contre la violence conjugale et la violence sexuelle au Canada, sur le personnel qui y travaille et sur la qualité des relations entre le personnel et les clients. Les organisations de lutte contre la violence ont souffert d'un sous-financement chronique et leur personnel, majoritairement féminin, a été sous-payé, ce qui a nui à leur capacité de répondre aux besoins des femmes. L'apparition du COVID-19 a non seulement aggravé ces problèmes, mais a aussi entraîné un changement d'orientation vers des tâches plus liées à la pandémie, ce qui a limité encore davantage le champ d'action des organismes. Il reste à voir si les adaptations, les innovations et la persévérance dont font preuve ces organisations et leur personnel peuvent faire pencher la balance en faveur d'une politique et de résultats plus équitables.

Service provider perspectives on how COVID-19 and pandemic restrictions have affected intimate partner and sexual violence survivors in Canada: a qualitative study.

BACKGROUND: The COVID-19 pandemic may increase risk of intimate partner and sexual violence and make relevant services less accessible. This study explored the perspectives of intimate partner and sexual violence workers across Canada on how the COVID-19 pandemic has affected the survivors with whom they work. METHODS: Using a qualitative descriptive design, we interviewed 17 management and frontline staff of organizations supporting survivors of intimate partner and sexual violence across Canada. RESULTS: We identified 4 themes that describe the impacts of COVID-19 on intimate partner and sexual violence survivors, from the perspective of service providers: (1) No escape; (2) Isolation; (3) Tough decisions; and (4) Heightened vulnerability. These narrative findings are presented first, followed by an analysis within a social determinants of health framework. Interpreting our findings against such a framework revealed a complex interplay of social determinants, notably social support, access to services, and poverty, that produced several challenges for intimate partner and sexual violence survivors during COVID-19. CONCLUSION: According to service providers, intimate partner and sexual violence survivors in Canada faced several challenges during the pandemic, including reduced ability to escape their situations, increased isolation, increasingly complex decisions, and heightened vulnerability. Our findings demonstrate the critical need to adopt a broader, more holistic approach in tackling  intimate partner and sexual violence by also addressing socioeconomic issues such as poverty and marginalization.

Challenges, coping responses and supportive interventions for international and migrant students in academic nursing programs in major host countries: a scoping review with a gender lens.

BACKGROUND: International and migrant students face specific challenges which may impact their mental health, well-being and academic outcomes, and these may be gendered experiences. The purpose of this scoping review was to map the literature on the challenges, coping responses and supportive interventions for international and migrant students in academic nursing programs in major host countries, with a gender lens. METHODS: We searched 10 databases to identify literature reporting on the challenges, coping responses and/or supportive interventions for international and migrant nursing students in college or university programs in Canada, the United-States, Australia, New Zealand or a European country. We included peer-reviewed research (any design), discussion papers and literature reviews. English, French and Spanish publications were considered and no time restrictions were applied. Drawing from existing frameworks, we critically assessed each paper and extracted information with a gender lens. RESULTS: One hundred fourteen publications were included. Overall the literature mostly focused on international students, and among migrants, migration history/status and length of time in country were not considered with regards to challenges, coping or interventions. Females and males, respectively, were included in 69 and 59% of studies with student participants, while those students who identify as other genders/sexual orientations were not named or identified in any of the research. Several papers suggest that foreign-born nursing students face challenges associated with different cultural roles, norms and expectations for men and women. Other challenges included perceived discrimination due to wearing a hijab and being a 'foreign-born male nurse', and in general nursing being viewed as a feminine, low-status profession. Only two strategies, accessing support from family and other student mothers, used by women to cope with challenges, were identified. Supportive interventions considering gender were limited; these included matching students with support services' personnel by sex, involving male family members in admission and orientation processes, and using patient simulation as a method to prepare students for care-provision of patients of the opposite-sex. CONCLUSION: Future work in nursing higher education, especially regarding supportive interventions, needs to address the intersections of gender, gender identity/sexual orientation and foreign-born status, and also consider the complexity of migrant students' contexts.

COVID-19, promotion and provision of palliative care: reaching out, accounting for linguistic diversity.

The combined forces of economic globalization and international migration have resulted in specific challenges to palliative care systems. The COVID-19 pandemic has and is still greatly affecting elder populations as well as those across the age continuum living with long-standing chronic conditions or with pre-existing diverse unmet needs. While health promotion and palliative care may appear to be conceptually opposing fields, we argue that palliative care can and should fit under the umbrella of the health promotion continuum. This commentary seeks to discuss the importance of linguistic literacy and communication imperatives in the context of access to palliative care, given the broad, diversified and sensitive scope of care. While the pandemic has demonstrated that the public health responses of migrant host societies are deeply intertwined with policies as well as local rules and constraints, the promotion and provision of safe, timely and appropriate palliative care can be achieved through a sensitive assessment of differential contexts of diversity. The pandemic has painfully illustrated the need for a strong, respectful and equitable working partnership within the professions as well as with the civic society in order for the palliative needs of those exposed to a sustained risk not to be forgotten.

Where Sexual Orientation Has No Name: Sexual Orientation Missing Data in the Canadian Community Health Survey (2005-2014).

This study used data from the Canadian Community Health Survey (CCHS) (2005-2014) to analyze the relationships between sexual orientation item nonresponse and interview language, conversation language, migration status (migrant-non-migrant), cultural background, sex, age, education level, and marital status in a cross-sectional sample over 18 (n = 351,713 participants). Item nonresponse rates oscillated between 0.87% in 2007 and 1.4% in 2014. Individuals who self-declared as belonging to cultural groups such as Chinese, South Asian, South East Asian, Arab, Indigenous and Other had higher nonresponse odds compared to people who self-identified as Whites. The results showed significant higher nonresponse odds among immigrants. Women had higher nonresponse rates. The likelihood of non-answer increased with age and decreased with education. French interviews, interviews in other languages and speaking both English and French produced less nonresponse. Contrary to common beliefs, sexual orientation questions are not too controversial. Sexual orientation nonresponse is low and stable over time suggesting that research participants are willing to answer sexual orientation questions. These findings highlight that immigrants and people who self-declare as belonging to different cultural groups may interpret the sexual orientation questions differently.

Where boys don't dance, but women still thrive: using a development approach as a means of reconciling the right to health with the legitimization of cultural practices.

Human rights language has become a common method of internationally denouncing violent, discriminatory or otherwise harmful practices, notably by framing them as reprehensible violations of those fundamental rights we obtain by virtue of being human. While often effective, such women's rights discourse becomes delicate when used to challenge practices, which are of important cultural significance to the communities in which they are practiced. This paper analyses human rights language to challenge the gender disparity in access to health care and in overall health outcomes in certain countries where such disparities are influenced by important cultural values and practices. This paper will provide selected examples of machismo and marianismo discourses in certain Latin American countries on the one hand and of female genital cutting/excision (FGC/E) in practicing countries, both of which exposed to women's rights language, notably for causing violations of women's right to health. In essence, a reflective exercise is provided here with the argument that framing such discourses and practices as women's rights violations. Calling for their abandonment have shown that it may not only be ineffective nor at times appropriate, it also risks delegitimizing associated discourses, norms and practices thereby enhancing criticisms of the women's rights movement rather than adopting its principles. A sensitive community-based collaborative approach aimed at understanding and building cultural discourses to one, which promotes women's capabilities and health, is proposed as a more effective means at bridging cultural and gender gaps.

Developing the culture of ethics in population health intervention research in Canada.

Population health intervention research (PHIR) is a particular field of health research that aims to generate knowledge that contributes to the sustainable improvement of population health by enabling the implementation of cross-sectoral solutions adapted to social realities. Despite the ethical issues that necessarily raise its social agenda, the ethics of PHIR is still not very formalized. Unresolved ethical challenges may limit its focus on health equity. This contribution aims to highlight some of these issues and calls on researchers to develop a culture of ethics in PHIR. Three complementary ways are proposed: to build an ethical concept specific to this field, to promote a shared space for critical reflection on PHIR ethics, and to develop the ethical competence in PHIR for which a preliminary framework is proposed.

Conducting gender-based analysis of existing databases when self-reported gender data are unavailable: the GENDER Index in a working population.

OBJECTIVES: Growing attention has been given to considering sex and gender in health research. However, this remains a challenge in the context of retrospective studies where self-reported gender measures are often unavailable. This study aimed to create and validate a composite gender index using data from the Canadian Community Health Survey (CCHS). METHODS: According to scientific literature and expert opinion, the GENDER Index was built using several variables available in the CCHS and deemed to be gender-related (e.g., occupation, receiving child support, number of working hours). Among workers aged 18-50 years who had no missing data for our variables of interest (n = 29,470 participants), propensity scores were derived from a logistic regression model that included gender-related variables as covariates and where biological sex served as the dependent variable. Construct validity of propensity scores (GENDER Index scores) were then examined. RESULTS: When looking at the distribution of the GENDER Index scores in males and females, they appeared related but partly independent. Differences in the proportion of females appeared between groups categorized according to the GENDER Index scores tertiles (p < 0.0001). Construct validity was also examined through associations between the GENDER Index scores and gender-related variables identified a priori such as choosing/avoiding certain foods because of weight concerns (p < 0.0001), caring for children as the most important thing contributing to stress (p = 0.0309), and ability to handle unexpected/difficult problems (p = 0.0375). CONCLUSION: The GENDER Index could be useful to enhance the capacity of researchers using CCHS data to conduct gender-based analysis among populations of workers.

Canada's universal health-care system: achieving its potential.

Access to health care based on need rather than ability to pay was the founding principle of the Canadian health-care system. Medicare was born in one province in 1947. It spread across the country through federal cost sharing, and eventually was harmonised through standards in a federal law, the Canada Health Act of 1984. The health-care system is less a true national system than a decentralised collection of provincial and territorial insurance plans covering a narrow basket of services, which are free at the point of care. Administration and service delivery are highly decentralised, although coverage is portable across the country. In the setting of geographical and population diversity, long waits for elective care demand the capacity and commitment to scale up effective and sustainable models of care delivery across the country. Profound health inequities experienced by Indigenous populations and some vulnerable groups also require coordinated action on the social determinants of health if these inequities are to be effectively addressed. Achievement of the high aspirations of Medicare's founders requires a renewal of the tripartite social contract between governments, health-care providers, and the public. Expansion of the publicly funded basket of services and coordinated effort to reduce variation in outcomes will hinge on more engaged roles for the federal government and the physician community than have existed in previous decades. Public engagement in system stewardship will also be crucial to achieve a high-quality system grounded in both evidence and the Canadian values of equity and solidarity.

Health and legal literacy for migrants: twinned strands woven in the cloth of social justice and the human right to health care.

BACKGROUND: Based on an analysis of published literature, this paper provides an over-view of the challenges associated with delivering on the right to access quality health care for international migrants to industrialized countries, and asks which group of professionals is best equipped to provide services that increase health and legal literacy. Both rights and challenges are approached from a social justice perspective with the aim of identifying opportunities to promote greater health equity. That is, to go beyond the legal dictates enshrined in principles of equality, and target as an ethical imperative a situation where all migrants receive the particular assistance they need to overcome the barriers that inhibit their equitable access to health care. This assistance is especially important for migrant groups that are further disadvantaged by differing cultural constructions of gender. Viewing the topic from this perspective makes evident a gap in both research literature and policy. The review has found that while health literacy is debated and enshrined as a policy objective, and consideration is given to improving legal literacy as a means of challenging social injustice in developing nations, however, no discussion has been identified that considers assisting migrants to gain legal literacy as a step toward achieving not only health literacy and improved health outcomes, but critical participation as members of their adoptive society. CONCLUSION: Increasing migrant health literacy, amalgamated with legal literacy, aids migrants to better access their human right to appropriate care, which in turn demonstrably assists in increasing social engagement, citizenship and productivity. However what is not evident in the literature, is which bureaucratic or societal group holds responsibility for assisting migrants to develop critical citizenship literacy skills. This paper proposes that a debate is required to determine both who is best placed to provide services that increase health and legal literacy, and how they should be resourced, trained and equipped.

Provider- and patient-related determinants of diabetes self-management among recent immigrants: Implications for systemic change.

OBJECTIVE: To examine provider- and patient-related factors associated with diabetes self-management among recent immigrants. DESIGN: Demographic and experiential data were collected using an international survey instrument and adapted to the Canadian context. The final questionnaire was pretested and translated into 4 languages: Mandarin, Tamil, Bengali, and Urdu. SETTING: Toronto, Ont. PARTICIPANTS: A total of 130 recent immigrants with a self-reported diagnosis of type 2 diabetes mellitus who had resided in Canada for 10 years or less. MAIN OUTCOME MEASURES: Diabetes self-management practices (based on a composite of 5 diabetes self-management practices, and participants achieved a score for each adopted practice); and the quality of the provider-patient interaction (measured with a 5-point Likert-type scale that consisted of questions addressing participants' perceptions of discrimination and equitable care). RESULTS: A total of 130 participants in this study were recent immigrants to Canada from 4 countries of origin-Sri Lanka, Bangladesh, Pakistan, and China. Two factors were significant in predicting diabetes self-management among recent immigrants: financial barriers, specifically, not having enough money to manage diabetes expenses (P = .0233), and the quality of the provider-patient relationship (P = .0016). Participants who did not have enough money to manage diabetes were 9% less likely to engage in self-management practices; and participants who rated the quality of their interactions with providers as poor were 16% less likely to engage in self-management practices. CONCLUSION: Financial barriers can undermine effective diabetes self-management among recent immigrants. Ensuring that patients feel comfortable and respected and that they are treated in culturally sensitive ways is also critical to good diabetes self-management.

Searching for sex- and gender-sensitive tuberculosis research in public health: finding a needle in a haystack.

Despite broadening consideration of sex- and gender-based issues in health research, when seeking information on how sex and gender contribute to disease contexts for specific health or public health topics, a lack of consistent or systematic use of terminology in health literature means that it remains difficult to identify research with a sex or gender focus. These inconsistencies are driven, in part, by the complexity and terminological inflexibility of the indexing systems for gender- and sex-related terms in public health databases. Compounding the issue are authors' diverse vocabularies, and in some cases lack of accuracy in defining and using fundamental sex-gender terms in writing, and when establishing keyword lists and search criteria. Considering the specific case of the tuberculosis (TB) prevention and management literature, an analysis of sex and gender sensitivity in three health databases was performed. While there is an expanding literature exploring the roles of both sex and gender in the trajectory and lived experience of TB, we demonstrate the potential to miss relevant research when attempting to retrieve literature using only the search criteria currently available. We, therefore, argue that for good clinical practice to be achieved; there is a need for both public health researchers and users to be better educated in appropriate usage of the terminology associated with sex and gender. In addition, public health database indexers ought to accept the task of developing and implementing adequate definitions of sex and gender terms so as to facilitate access to sex- and gender-related research. These twin advances will allow clinicians to more readily recognize and access knowledge pertaining to systems of redress that respond to gendered risks that compound existing health inequalities in disease management and control, particularly when dealing with already complex diseases. Given the methodological and linguistic challenges presented by the multidimensional and highly contextual nature of definitions of sex and gender, it will be important that this review task be undertaken using a multidisciplinary approach.

Health-related quality of life and tuberculosis: a longitudinal cohort study.

BACKGROUND: Active tuberculosis (TB) disease can impose substantial morbidity, while treatment for latent TB infection (LTBI) has frequent side effects. We compared health-related quality of life (HRQOL) between persons diagnosed and treated for TB disease, persons treated for LTBI, and persons screened but not treated for TB disease or LTBI, over one year following diagnosis/initial assessment. METHODS: Participants were recruited at two hospitals in Montreal (2008-2011), and completed the Short Form-36 version 2 (SF-36) at baseline, and at 1, 2, 4, 6, 9, and 12 months thereafter. Eight domain scores and physical and mental component summary (PCS and MCS, respectively) scores were calculated from responses. Linear mixed models were used to compare mean scores at each evaluation and changes in scores over consecutive evaluations, among participants treated for TB disease and those treated for LTBI, each compared to the control group. RESULTS: Of the 263 participants, 48 were treated for TB disease, 105 for LTBI, and 110 were control participants. Fifty-four percent were women, mean age was 35 years, and 90% were foreign-born. Participants treated for TB disease reported significantly worse mean scores at baseline compared to control participants (mean PCS scores: 50.0 vs. 50.7; mean MCS scores: 46.4 vs. 51.1), with improvement in mean MCS scores throughout the study period. Scores reported by participants treated for LTBI and control participants were comparable throughout the study. CONCLUSION: TB disease is associated with decrements in HRQOL as measured by the SF-36. This is most pronounced during the weeks after diagnosis and treatment initiation, but is no longer evident after two months.

The impact of tuberculosis on health utility: a longitudinal cohort study.

PURPOSE: To estimate health utility derived from the Short Form-36 (SF-36) questionnaire and Standard Gamble instrument for persons diagnosed and treated for tuberculosis (TB) disease, those diagnosed and treated for latent TB infection (LTBI), and those screened but not treated for TB disease or LTBI over the year following their diagnosis/initial assessment. METHODS: Participants were recruited at two Montreal hospitals (2008-2011) and completed the SF-36 and Standard Gamble at baseline and at follow-up visits 1, 2, 4, 6, 9, and 12 months thereafter. SF-6D health utility scores were derived from SF-36 responses. Linear mixed models were used to compare mean health utility at each evaluation and changes in health utility between participants treated for TB disease, those treated for LTBI, and those in the control group. RESULTS: Of the 263 participants, 48 were treated for TB disease, 105 for LTBI, and 110 were control participants. Fifty-four percent were women, mean age was 35 years, and 90% were foreign-born. Participants treated for TB disease reported worse health utility compared with control participants at the baseline visit (mean SF-6D: 0.69 vs. 0.81; mean Standard Gamble: 0.64 vs. 0.96). They reported successive improvement at months 1 and 2 that was then sustained throughout follow-up. Health utility reported by participants treated for LTBI and control participants was comparable throughout the study. CONCLUSION: Treatment for TB disease had a substantial negative impact on health utility, particularly during the first 2 months of treatment. However, treatment for LTBI did not have a substantial impact.

Does a change in health research funding policy related to the integration of sex and gender have an impact?

We analyzed the impact of a requirement introduced in December 2010 that all applicants to the Canadian Institutes of Health Research indicate whether their research designs accounted for sex or gender. We aimed to inform research policy by understanding the extent to which applicants across health research disciplines accounted for sex and gender. We conducted a descriptive statistical analysis to identify trends in application data from three research funding competitions (December 2010, June 2011, and December 2011) (N = 1459). We also conducted a qualitative thematic analysis of applicants' responses. Here we show that the proportion of applicants responding affirmatively to the questions on sex and gender increased over time (48% in December 2011, compared to 26% in December 2010). Biomedical researchers were least likely to report accounting for sex and gender. Analysis by discipline-specific peer review panel showed variation in the likelihood that a given panel will fund grants with a stated focus on sex or gender. These findings suggest that mandatory questions are one way of encouraging the uptake of sex and gender in health research, yet there remain persistent disparities across disciplines. These disparities represent opportunities for policy intervention by health research funders.

Differences between immigrants at various durations of residence and host population in all-cause mortality, Canada 1991-2006.

We used data from the 1991-2006 Canadian Census Mortality and Cancer Follow-up Study to compare all-cause mortality for immigrants with that of the Canadian-born population. The study addressed two related questions. First, do immigrants have a mortality advantage over the Canadian-born? Second, if immigrants have a mortality advantage, does it persist as their duration of residence increases? The analysis fitted sex-stratified hazard regression models for the overall sample and for selected countries of birth (UK, China, India, Philippines, and the Caribbean). Predictors were assessed at baseline. Mortality was lower among immigrants than the Canadian-born even after adjusting for a selected group of socio-demographic and socio-economic factors. The mortality differences persisted even after long residence in Canada, but appeared to be dependent on the age of the individual and the country of origin. Interpreted in light of known explanations of immigrant mortality advantage, the results mostly reflect selection effects.