Literature review and protocol for a prospective multicentre cohort study on multimodal prediction of seizure recurrence after unprovoked first seizure.

INTRODUCTION: Epilepsy is a common neurological disorder characterised by recurrent seizures. Almost half of patients who have an unprovoked first seizure (UFS) have additional seizures and develop epilepsy. No current predictive models exist to determine who has a higher risk of recurrence to guide treatment. Emerging evidence suggests alterations in cognition, mood and brain connectivity exist in the population with UFS. Baseline evaluations of these factors following a UFS will enable the development of the first multimodal biomarker-based predictive model of seizure recurrence in adults with UFS. METHODS AND ANALYSIS: 200 patients and 75 matched healthy controls (aged 18-65) from the Kingston and Halifax First Seizure Clinics will undergo neuropsychological assessments, structural and functional MRI, and electroencephalography. Seizure recurrence will be assessed prospectively. Regular follow-ups will occur at 3, 6, 9 and 12 months to monitor recurrence. Comparisons will be made between patients with UFS and healthy control groups, as well as between patients with and without seizure recurrence at follow-up. A multimodal machine-learning model will be trained to predict seizure recurrence at 12 months. ETHICS AND DISSEMINATION: This study was approved by the Health Sciences and Affiliated Teaching Hospitals Research Ethics Board at Queen's University (DMED-2681-22) and the Nova Scotia Research Ethics Board (1028519). It is supported by the Canadian Institutes of Health Research (PJT-183906). Findings will be presented at national and international conferences, published in peer-reviewed journals and presented to the public via patient support organisation newsletters and talks. TRIAL REGISTRATION NUMBER: NCT05724719.

A cross-sectional study of the relationship between frequency of cannabis use and psychiatric symptoms among people seeking mental health and addiction services in Nova Scotia (2019-21).

BACKGROUND: Cannabis use may be a modifiable risk factor for mental health problems; however, the role of cannabis use frequency in population seeking mental health and addiction services remains unclear. This study aimed to: 1) compare the prevalence and functional impact of psychiatric symptoms among frequent, infrequent, and non-users of cannabis; and 2) evaluate the associations between cannabis use frequency and functional impact of psychiatric symptoms in help-seeking individuals. METHODS: Data from the Mental Health and Addictions (MHA) Central Intake system in Nova Scotia, Canada was used. Participants aged 19-64 who received MHA Intake assessments from September 2019 to December 2021 with complete information about substance use were included (N = 20,611). Cannabis use frequency over past 30 days was categorized into frequent (>4 times a month), infrequent (≤4 times a month), and non-use. Psychiatric symptomatology consists of five domains: mood, anxiety, psychosis, cognition, and externalizing behaviors. Multivariate ordinal logistic regression was used to examine the associations between cannabis use frequency and functional impact of psychiatric symptoms. RESULTS: Frequent and infrequent cannabis users had a higher prevalence of psychiatric symptoms in each domain than non-users, while no significant differences were found between frequent and infrequent users. Frequent cannabis use was associated with greater functional impact of psychiatric symptoms in each domain compared to non-users, while infrequent use was only associated with greater functional impact of externalizing behaviors. CONCLUSION: Frequent cannabis use is associated with increased prevalence and functional impact of psychiatric symptoms among adults seeking mental health services.

Development and implementation of a municipal outdoor play policy for children and youth in Nova Scotia, Canada: a community case study.

Background: Children and youth benefit from outdoor play; however, environments and policies to support outdoor play are often limited. The purpose of this paper is to describe a case study of the development of a municipal outdoor play policy in Nova Scotia, Canada. The outdoor play policy was developed by the Town of Truro with support from the UpLift Partnership, a School-Community-University Partnership in Nova Scotia, Canada. UpLift supports the health and well-being of school-aged children and youth using a Health Promoting Schools approach which identifies the important role of municipal government in creating healthy school communities. The UpLift Partnership and the municipality hosted online workshops for municipal staff, community leaders and partners that included content about the importance of outdoor play, barriers and facilitators to outdoor play, best practices for youth engagement, the policy development process, and how policy actions can support outdoor play. Workshop participants developed policy actions for their community of Truro, Nova Scotia to increase opportunities for outdoor play for children and youth. Following the workshops, a small team from the municipality and UpLift drafted an outdoor play policy and submitted it to Truro town council for approval. The outdoor play policy was adopted in Fall 2021 and has since informed recreation and municipal planning decisions. By presenting a case study of the development of this outdoor play policy, we hope other communities may be inspired to develop and adopt their own outdoor play policies to benefit children and youth in their communities.

The stable isotope hydrology of Sable Island, Nova Scotia, Canada with implications for evaluating the water budget of wild horses.

We investigated the stable isotope hydrology of Sable Island, Nova Scotia, Canada over a five year period from September, 2017 to August, 2022. The δ2H and δ18O values of integrated monthly precipitation were weakly seasonal and ranged from -66 to -15 ‰ and from -9.7 to -1.9 ‰, respectively. Fitting these monthly precipitation data resulted in a local meteoric water line (LMWL) defined by: δ2H = 7.22 ± 0.21 · δ18O + 7.50 ± 1.22 ‰. Amount-weighted annual precipitation had δ2H and δ18O values of -36 ± 11 ‰ and -6.1 ± 1.4 ‰, respectively. Deep groundwater had more negative δ2H and δ18O values than mean annual precipitation, suggesting recharge occurs mainly in the winter, while shallow groundwater had δ2H and δ18O values more consistent with mean annual precipitation or mixing of freshwater with local seawater. Surface waters had more positive values and showed evidence of isolation from the groundwater system. The stable isotopic compositions of plant (leaf) water, on the other hand, indicate plants use groundwater as their source. Fog had δ2H and δ18O values that were significantly more positive than those of local precipitation, yet had similar 17O-excess values. δ2H values of horsehair from 4 individuals lacked seasonality, but had variations typical to those of precipitation on the island. Differences in mean δ2H values of horsehair were statistically significant and suggest variations in water use may exist between spatially disparate horse communities. Our results establish an important initial framework for ongoing isotope studies of feral horses and other wildlife on Sable Island.

Non Breast-Milk-Fed Very Preterm Infants Are at Increased Risk of Iron Deficiency at 4-6-Months Corrected Age: A Retrospective Population-Based Cohort Study.

Iron supplementation is routinely recommended for breast-milk-fed preterm infants. However, the Canadian Pediatric Society recommends no additional iron supplementation for preterm infants fed primarily with iron-rich formula. Other pediatric societies don't provide specific guidance on supplemental iron for formula-fed preterm infants. This study investigated how feeding type influences iron status of very preterm infants at 4-6-months corrected age (CA). A retrospective cohort study was conducted using a population-based database on all very preterm infants (<31 weeks gestational age) born in Nova Scotia, Canada from 2005-2018. Information about feeding type, iron intake from formula, supplemental iron therapy and iron status at 4-6-months CA was extracted. Iron deficiency (ID) was defined as serum ferritin <20 and <12 µg/L at 4-and 6-months CA, respectively. Of 392 infants, 107 were "breast-milk-fed" (exclusively or partially) and 285 were "not breast-milk-fed" (exclusively fed with iron-rich formula) at 4-6-months CA. Total daily iron intake was higher in the non-breast-milk-fed group (2.6 mg/kg/day versus 2.0 mg/kg/day). Despite this, 36.8% of non-breast-milk-fed infants developed ID versus 20.6% of breast-milk-fed infants. ID is significantly more prevalent in non-breast-milk-fed infants than breast-milk-fed infants despite higher iron intake. This suggests the need to revisit recommendations for iron supplementation in non-breast-milk-fed preterm infants.

Changing Roles and Responsibilities of Dietitians from Diverse Settings During the First Three Waves of the COVID-19 Pandemic in Nova Scotia.

Purpose: To explore the impact of the COVID-19 pandemic on Nova Scotian dietitian's roles, responsibilities, and professional development needs.Methods: We conducted a province-wide, online, exploratory survey with registered dietitians during the initial waves of the COVID-19 pandemic. Differences were explored with descriptive statistics by work sector (hospital/acute care; primary health/community or public health (PH); long-term care [LTC]; other [e.g., private practice, retail]).Results: Dietitians (n = 122) reported being most frequently challenged by stress and anxiety, changing work expectations, and rapidly evolving safety protocols during the pandemic. Those working in PH, primary health, and LTC reported experiencing more work responsibilities, more change, and perceived less employer support than dietitians in other sectors. Despite the identified challenges, most participants (70.7%) felt their education and training were sufficient to take on these new work roles. Primary and PH dietitians, however, more frequently perceived their skill sets to be under-utilized than other sectors. Key learnings from practice identified as being important for dietetic education included qualities such as resilience, problem-solving, flexibility, and self-care.Conclusion: These findings will be of interest to health administrators, professional bodies, and academic institutions to inform strategies for strengthening dietetic practice, building resilience, and preparing for future emergencies.

Reducing wait times and avoiding unnecessary use of high-cost mental health services through a Rapid Access and Stabilization Program: protocol for a program evaluation study.

BACKGROUND: Emergency psychiatric care, unplanned hospital admissions, and inpatient health care are the costliest forms of mental health care. According to Statistics Canada (2018), almost 18% (5.3 million) of Canadians reported needing mental health support. However, just above half of this figure (56.2%) have reported their needs were fully met. In light of this evidence there is a pressing need to provide accessible mental health services in flexible yet cost-effective ways. To further expand capacity and access to mental health care in the province, Nova Scotia Health has launched a novel mental health initiative for people in need of mental health care without requiring emergency department visits or hospitalization. This new service is referred to as the Rapid Access and Stabilization Program (RASP). This study evaluates the effectiveness and impact of the RASP on high-cost health services utilization (e.g. ED visits, mobile crisis visits, and inpatient treatments) and related costs. It also assesses healthcare partners' (e.g. healthcare providers, policymakers, community leaders) perceptions and patient experiences and satisfaction with the program and identifies sociodemographic characteristics, psychological conditions, recovery, well-being, and risk measures in the assisted population. METHOD: This is a hypothesis-driven program evaluation study that employs a mixed methods approach. A within-subject comparison (pre- and post-evaluation study) will examine health services utilization data from patients attending RASP, one year before and one year after their psychiatry assessment at the program. A controlled between-subject comparison (cohort study) will use historical data from a control population will examine whether possible changes in high-cost health services utilization are associated with the intervention (RASP). The primary analysis involves extracting secondary data from provincial information systems, electronic medical records, and regular self-reported clinical assessments. Additionally, a qualitative sub-study will examine patient experience and satisfaction, and health care partners' impressions. DISCUSSION: We expect that RASP evaluation findings will demonstrate a minimum 10% reduction in high-cost health services utilization and corresponding 10% cost savings, and also a reduction in the wait times for patient consultations with psychiatrists to less than 30 calendar days, in both within-subject and between-subject comparisons. In addition, we anticipate that patients, healthcare providers and healthcare partners would express high levels of satisfaction with the new service. CONCLUSION: This study will demonstrate the results of the Mental Health and Addictions Program (MHAP) efforts to provide stepped-care, particularly community-based support, to individuals with mental illnesses. Results will provide new insights into a novel community-based approach to mental health service delivery and contribute to knowledge on how to implement mental health programs across varying contexts.

Family and emergency physicians' knowledge and attitudes toward organ donation and deemed consent: Human Organ and Tissue Donation Act in Nova Scotia.

OBJECTIVE: To understand Nova Scotian family physicians' and emergency department (ED) physicians' knowledge of, attitudes about, and experience with organ donation and transplantation in the context of the Human Organ and Tissue Donation Act (HOTDA). DESIGN: An electronic, self-administered survey. SETTING: Nova Scotia. PARTICIPANTS: All family physicians and ED physicians practising in Nova Scotia. MAIN OUTCOME MEASURES: Demographic characteristics, experience with organ donation and transplantation, knowledge about organ donation and HOTDA, attitudes toward organ donation and HOTDA, and opportunities for and barriers to the implementation of the HOTDA in clinical practice. Survey results were analyzed using descriptive statistics. RESULTS: Overall, 211 family physicians and 73 ED physicians responded to the survey. Most respondents had favourable attitudes around organ donation and most supported a deemed consent model. Nearly three-quarters of family physicians indicated they have a conversation around organ donation only if it is initiated by the patient. In the ED setting, the most common barriers to organ donation and deemed consent were lack of familiarity with the organ donation referral process, refusal of permission from families, and unknown wishes of the deceased. CONCLUSION: Family physicians and ED physicians had positive attitudes toward organ donation, including high support for a deemed consent model. However, specific knowledge gaps and training topics were identified that should be addressed within the context of this model.

Surgery under siege: A case study of leg amputation in 18th century Louisbourg, Nova Scotia, Canada.

OBJECTIVE: Paleopathological analysis of a below-knee amputation was conducted to explore the sociocultural reasons why the amputation took place. MATERIALS: Older adolescent male (18-21 years) from the New Englander mass burial at the 18th century Fortress of Louisbourg. METHODS: Macroscopic assessment and archival data. RESULTS: A surgical amputation of the right tibia and fibula, distal to the knee was identified. The cross-sectional diaphysis of the leg has kerf marks and a splinter (breakaway point) at the posterior-lateral border of the tibia suggesting the leg gave way from its own weight or was manually removed once most of the sawing was complete. CONCLUSIONS: Archival records suggest frostbite from prolonged exposure to freezing temperatures and trauma from unsafe working conditions at the Fortress were the main causes that led to amputation. SIGNIFICANCE: This case study highlights the importance of contextualizing cases of amputation to understand factors leading to the amputation procedure and techniques used in the past, and the social and living conditions of the individual. LIMITATIONS: Observations were restricted to skeletal material as soft tissue decomposed and there was no material evidence suggestive of amputation associated with this individual in their grave. SUGGESTIONS FOR FUTURE RESEARCH: Full trauma assessment of the Fortress of Louisbourg skeletal collection to provide additional insight into injury sustained at Louisbourg and 18th century surgical practices.

Pre-hospital mortality among pediatric trauma patients in Nova Scotia.

OBJECTIVES: Limited data exist on pre-hospital pediatric trauma mortality in Canada. The Nova Scotia Trauma Registry is a provincial population-based registry that captures data from the Medical Examiner Service. This study examined the characteristics of pediatric trauma patient mortality in the pre-hospital and in-hospital settings. METHODS: We conducted a cohort study of major pediatric traumas recorded in our provincial database from April 1, 2001 to March 31, 2018. Characteristics of pre-hospital and in-hospital deaths were compared with t tests and Chi-square analyses. Multivariate regression modeling was used to identify predictors of pre-hospital mortality. The geographic distribution of pre-hospital trauma was assessed using choropleth maps. RESULTS: We identified 1,258 pediatric traumas, resulting in 217 deaths (137 pre-hospital, 80 in-hospital). Males accounted for 62.7% of fatalities. The 15-17 age group accounted for most deaths in both groups (pre-hospital 61.3%; in-hospital 41.3%). Injuries sustained in rural areas resulted in 74.7% of all deaths. For both groups, blunt trauma was the predominant injury type and motor vehicle collisions, the most prevalent injury mechanism. Patients who died pre-hospital had a higher mean age (13.3 vs. 10.7, p = 0.002) and a greater proportion were intentional injuries (23.4% vs. 15%; p = 0.02). Urban residency was more frequently observed in in-hospital deaths (57.5% vs. 36.5%, p < 0.001). Pre-hospital mortality was associated with increasing age (OR 1.1), higher injury severity score (OR 1.1), and intentional injury (OR 15.6). CONCLUSION: Over 10% of major pediatric traumas resulted in pre-hospital death, primarily from motor vehicle collisions in rural areas. Compared to in-hospital mortality, patients who died pre-hospital were older with more severe injuries and more likely to have intentionally injured themselves. These results underscore the importance for emergency physicians and EMS systems to consider geographic factors and injury patterns, advocate for improved injury prevention programs, mental health supports, and delivery of on-scene critical care services.

RéSUMé: OBJECTIFS: Il existe peu de données sur la mortalité liée aux traumatismes pédiatriques pré-hospitaliers au Canada. La Nouvelle-Écosse. Le registre des traumatismes est un registre provincial fondé sur la population qui saisit les données du Medical Examiner Service. Cette étude a examiné les caractéristiques des traumatismes pédiatriques la mortalité des patients en milieu pré-hospitalier et hospitalier. MéTHODES: Nous avons mené une étude de cohorte des traumatismes pédiatriques majeurs enregistrés dans notre province base de données du 1er avril 2001 au 31 mars 2018. Caractéristiques des services pré-hospitaliers et les décès hospitaliers ont été comparés aux tests-t et aux analyses du chi carré. La modélisation multivariée de régression a été utilisée pour identifier les prédicteurs de la mortalité pré-hospitalière. La répartition géographique des traumatismes pré-hospitaliers a été évaluée à l'aide de cartes choroplèthes. RéSULTATS: Nous avons identifié 1258 traumatismes pédiatriques, entraînant 217 décès (137 pré-hospitaliers, 80 hospitalier les hommes représentaient 62,7% des décès. Le groupe des 15 à 17 ans représentait la plupart des décès dans les deux groupes (avant l'hôpital 61,3%; à l'hôpital 41,3%). Blessures subies dans les régions rurales ont entraîné 74,7% de tous les décès. Pour les deux groupes, le traumatisme contondant était le type de blessure prédominant et les collisions de véhicules à moteur, les blessures les plus fréquentes. Les patients décédés avant l'hospitalisation avaient un âge moyen plus élevé (13,3 vs 10,7, p = 0,002) et une plus grande proportion étaient des blessures intentionnelles (23,4% contre 15%; p = 0,02). La résidence en milieu urbain était plus fréquemment observée dans les décès à l'hôpital (57,5% contre 36,5%, p < 0.001). La mortalité pré-hospitalière était associée à une augmentation de l'âge (CP 1.1) le score de gravité des blessures (CP 1.1) et les blessures intentionnelles (CP 15.6). CONCLUSIONS: Plus de 10% des traumatismes pédiatriques majeurs ont entraîné un décès avant l'hôpital, principalement à cause de troubles moteurs les collisions de véhicules dans les régions rurales. Comparativement à la mortalité à l'hôpital, les patients qui sont décédés avant. les établissements de soins palliatifs étaient plus âgés et plus susceptibles d'avoir intentionnellement subi des blessures plus graves. Ces résultats soulignent l'importance pour les médecins d'urgence et les systèmes de SMU pour tenir compte des facteurs géographiques et des tendances en matière de blessures, préconiser amélioration des programmes de prévention des blessures, du soutien en santé mentale et de la prestation sur place services de soins intensifs.

'Feeling Ready': A Feminist Poststructural Analysis of Postpartum Sexual Health.

There exists a lack of literature surrounding how postpartum individuals define feeling 'ready' to resume sexual activities after childbirth. Many factors may influence feelings of desire or readiness for sexual activities, such as breastfeeding. Therefore, it is important to understand why and how postpartum individuals understand and make meaning of their experiences surrounding postpartum sexual activities, as well as how those experiences are influenced or negotiated through relations of power. This study was guided by feminist poststructuralism and discourse analysis. Eleven participants who were between 1 and 6 months postpartum and living in Nova Scotia, Canada, were interviewed using semi-structured interviews. Participants challenged certain discourses surrounding sexual activities postpartum, including the social discourse that positions sexual activities as a requirement within romantic relationships and the discourse that positions health care providers as the authority on postpartum sexual health. 'Feeling ready' centered on four main issues: (1) navigating physical recovery; (2) personal knowing and emotional readiness; (3) the 6-week check; and (4) redefining intimacy. This article describes one branch of the findings within the overall study. Choosing to resume sexual activities postpartum, or feeling ready to do so, is individual, fluid, and complex. This research has important implications for practice and policy, specifically as it pertains to postpartum care.

Assessing spatial impacts of historical pulp mill effluent on trophic dynamics in a coastal marine ecosystem using stable isotope (δ13C and δ15N) analysis.

Boat Harbour, Nova Scotia was a tidal estuary that was converted into a wastewater treatment facility for pulp mill effluent in 1967. Treated effluent from Boat Harbour was discharged into the coastal Northumberland Strait, contributing significant nutrient and freshwater inputs into the coastal environment, potentially impacting local biogeochemistry and ecosystem structure. This study used stable isotope analysis of carbon (δ13C) and nitrogen (δ15N) of representative taxa to assess spatial variability in nutrient sources and trophic dynamics. Results identified stable isotope variation with depleted δ13C and δ15N values in taxa near Boat Harbour. Blue mussel (Mytilus edulis) and mummichog (Fundulus heteroclitus) were the most suitable bioindicators for identifying variation in nutrient sources. Stable isotope signatures in this study may be reflective of residual pulp mill effluent-derived nutrients, differences in marine versus terrestrial nutrient sources, and a pronounced coastal salinity gradient. The present study defined the baseline nutrient conditions of the Northumberland Strait and will be useful in assessing the effectiveness of remediation activities.

Dick van Velzen and the Burnside warehouse organ scandal in Nova Scotia, Canada.

Dick van Velzen practiced as a pediatric pathologist at Alder Hey Children's Hospital in Liverpool, England from September 1988 until December 1995; he then relocated to the IWK-Grace Health Centre, a children's and maternity hospital in Halifax, Nova Scotia, Canada, where he practiced until he was fired for cause in January 1998. About a year and a half later, his practice in Liverpool came under increasing scrutiny, with the initial focus on the massive collection of post-mortem pediatric organs he had accumulated for planned future research on sudden infant death syndrome. Soon, a Parliamentary Inquiry began investigating the full scope of his Liverpool practice. During the Inquiry, another organ-hoarding scandal erupted; van Velzen, when leaving Halifax after his dismissal, had put his family's personal belongings into a storage facility at Burnside Industrial Park and then did not pay bills. As his belongings were being prepared for auction, formalin-fixed organs were found, and a Canada-wide arrest warrant for disrespect for human remains was issued by the Halifax Police. While the Alder Hey scandal resulted in a 535-page-long Parliamentary Report and the Human Tissue Act, van Velzen was never charged criminally in the UK. The largely unknown story of his second organ scandal in Halifax, is related here. Although he had obtained the body parts with the consent of the parents of the child to which they had belonged, his failure to properly identify and store them traumatized parents already impacted by his organ-hoarding in the UK, traumatized additional parents in Halifax, and resulted in significant waste of public resources in investigating the case. He pled guilty to "indignity to a human body" in Canada and was fined and placed on 12 months' probation.

Observed size distribution changes in American lobsters over a 12-year period in southwestern Nova Scotia, Canada.

Size distribution and size frequency information of American lobsters (Homarus americanus) are often used to help estimate the age distributions, and reproductive output for the species and to guide the determination of appropriate minimum legal sizes for the fishery. This study used truncated linear regression models to estimate the effects of sampling year, sampling month, lobster sex and water depth on the lobster size. A dataset of almost 130,000 trap-caught lobsters from the two most important lobster fishing areas of Atlantic Canada collected over a 12-year period (2004-2015) was analyzed. It was shown that truncated models can help to account for biases due to the trap sampling method from vessels and from wharf samplings. There were significant annual and seasonal changes in size distribution, and data collected outside the fishing season showed a significant increase in carapace length in 2014 and 2015, potentially reflecting a northward shift of the range of lobster populations due to more favourable settlement and recruitment habitats. Size also increased in late summer, likely due to moult. Our results demonstrated that landed lobsters, especially females, were smaller than the predicted size-at-maturity in the region (96.5 mm carapace length), which could have long-term repercussions for the stock's reproductive potential.

Understanding and addressing changing administrative workload in primary care in Canada: protocol for a mixed-method study.

INTRODUCTION: Many Canadians struggle to access the primary care they need while at the same time primary care providers report record levels of stress and overwork. There is an urgent need to understand factors contributing to the gap between a growing per-capita supply of primary care providers and declines in the availability of primary care services. The assumption of responsibility by primary care teams for services previously delivered on an in-patient basis, along with a rise in administrative responsibilities may be factors influencing reduced access to care. METHODS AND ANALYSIS: In this mixed-methods study, our first objective is to determine how the volume of services requiring primary care coordination has changed over time in the Canadian provinces of Nova Scotia and New Brunswick. We will collect quantitative administrative data to investigate how services have shifted in ways that may impact administrative workload in primary care. Our second objective is to use qualitative interviews with family physicians, nurse practitioners and administrative team members providing primary care to understand how administrative workload has changed over time. We will then identify priority issues and practical response strategies using two deliberative dialogue events convened with primary care providers, clinical and system leaders, and policy-makers.We will analyse changes in service use data between 2001/2002 and 2021/2022 using annual total counts, rates per capita, rates per primary care provider and per primary care service. We will conduct reflexive thematic analysis to develop themes and to compare and contrast participant responses reflecting differences across disciplines, payment and practice models, and practice settings. Areas of concern and potential solutions raised during interviews will inform deliberative dialogue events. ETHICS AND DISSEMINATION: We received research ethics approval from Nova Scotia Health (#1028815). Knowledge translation will occur through dialogue events, academic papers and presentations at national and international conferences.

Understanding the uptake of virtual care for first and return outpatient appointments in child and adolescent mental health services: a mixed-methods study.

OBJECTIVE: To describe patterns of virtual and in-person outpatient mental health service use and factors that may influence the choice of modality in a child and adolescent service. DESIGN: A pragmatic mixed-methods approach using routinely collected administrative data between 1 April 2020 and 31 March 2022 and semi-structured interviews with clients, caregivers, clinicians and staff. Interview data were coded according to the Consolidated Framework for Implementation Research (CFIR) and examined for patterns of similarity or divergence across data sources, respondents or other relevant characteristics. SETTING: Child and adolescent outpatient mental health service, Nova Scotia, Canada. PARTICIPANTS: IWK Health clinicians and staff who had participated in virtual mental healthcare following its implementation in March 2020 and clients (aged 12-18 years) and caregivers of clients (aged 3-18 years) who had received treatment from an IWK outpatient clinic between 1 April 2020 and 31 March 2022 (n=1300). Participants (n=48) in semi-structured interviews included nine clients aged 13-18 years (mean 15.7 years), 10 caregivers of clients aged 5-17 years (mean 12.7 years), eight Community Mental Health and Addictions booking and registration or administrative staff and 21 clinicians. RESULTS: During peak pandemic activity, upwards of 90% of visits (first or return) were conducted virtually. Between waves, return appointments were more likely to be virtual than first appointments. Interview participants (n=48) reported facilitators and barriers to virtual care within the CFIR domains of 'outer setting' (eg, external policies, client needs and resources), 'inner setting' (eg, communications within the service), 'individual characteristics' (eg, personal attributes, knowledge and beliefs about virtual care) and 'intervention characteristics' (eg, relative advantage of virtual or in-person care). CONCLUSIONS: Shared decision-making regarding treatment modality (virtual vs in-person) requires consideration of client, caregiver, clinician, appointment, health system and public health factors across episodes of care to ensure accessible, safe and high-quality mental healthcare.

Process and experience of youth researchers within a Health Promoting Schools study in Nova Scotia, Canada.

Youth Participatory Action Research (YPAR) is an approach to research that engages youth across the research process. The peer researcher method is a technique used in YPAR where youth are trained in research and ethics to interview their peers. The purpose of this study was to: (i) describe the process of engaging youth as peer researchers in a Health Promoting Schools (HPS) and student engagement project and (ii) understand the peer researchers' perspectives of their experience throughout the project. Youth from across Nova Scotia, Canada in grades 7-10 (ages 12-16) were recruited as peer researchers in the Summer, 2022. The project included three stages: (i) peer researcher training, (ii) practicing, recruiting and conducting interviews and (iii) data interpretation workshop. To understand the peer researcher's experience, quantitative data were collected from an evaluation questionnaire. Outputs were produced using descriptive statistics. Qualitative data were collected through a focus group and interviews and analyzed using inductive content analysis. A total of 11 youth were recruited and completed peer researcher training. Most youth provided positive feedback on the training with a satisfaction score of 8.7/10. Qualitative analysis indicated benefits to the peer researchers including opportunities to build interview and social skills and learn about other's perspectives. This study provides a detailed overview of how to use a peer researcher method in a YPAR project to involve youth in research related to HPS and student engagement. The research also highlights the benefits of engaging youth in YPAR. Future research will report on the findings from the peer interviews.

Estimating the completeness of physician billing claims for diabetes case ascertainment: a multiprovince investigation. / Estimation de l'exhaustivité des demandes de remboursement des médecins dans une optique de détermination des cas de diabète : étude menée dans plusieurs provinces.

INTRODUCTION: Previous research has suggested that how physicians are paid may affect the completeness of billing claims for estimating chronic disease. The purpose of this study is to estimate the completeness of physician billings for diabetes case ascertainment. METHODS: We used administrative data from eight Canadian provinces covering the period 1 April 2014 to 31 March 2016. The patient cohort was stratified into two mutually exclusive groups based on their physician remuneration type: fee-for-service (FFS), for those paid only on that basis; and non-fee-for-service (NFFS). Using diabetes prescription drug data as our reference data source, we evaluated whether completeness of disease case ascertainment varied with payment type. Diabetes incidence rates were then adjusted for completeness of ascertainment. RESULTS: The cohort comprised 86 110 patients. Overall, equal proportions received their diabetes medications from FFS and NFFS physicians. Overall, physician payment method had little impact upon the percentage of missed diabetes cases (FFS, 14.8%; NFFS, 12.2%). However, the difference in missed cases between FFS and NFFS varied widely by province, ranging from -1.0% in Nova Scotia to 29.9% in Newfoundland and Labrador. The difference between the observed and adjusted disease incidence rates also varied by province, ranging from 22% in Prince Edward Island to 4% in Nova Scotia. CONCLUSION: The difference in the loss of cases by physician remuneration method varied across jurisdictions. This loss may contribute to an underestimation of disease incidence. The method we used could be applied to other chronic diseases for which drug therapy could serve as reference data source.

What are effective vaccine distribution approaches for equity-deserving and high-risk populations during COVID-19? Exploring best practices and recommendations in Canada: protocol for a mixed-methods multiple case codesign study.

INTRODUCTION: The WHO has stated that vaccine hesitancy is a serious threat to overcoming COVID-19. Vaccine hesitancy among underserved and at-risk communities is an ongoing challenge in Canada. Public confidence in vaccine safety and effectiveness and the principles of equity need to be considered in vaccine distribution. In Canada, governments of each province or territory manage their own healthcare system, providing an opportunity to compare and contrast distribution strategies. The overarching objective of this study is to identify effective vaccine distribution approaches and advance knowledge on how to design and implement various strategies to meet the different needs of underserved communities. METHODS AND ANALYSIS: Multiple case studies in seven Canadian provinces will be conducted using a mixed-methods design. The study will be informed by Experience-Based CoDesign techniques and theoretically guided by the Socio-Ecological Model and the Vaccine Hesitancy Matrix frameworks. Phase 1 will involve a policy document review to systematically explore the vaccine distribution strategy over time in each jurisdiction. This will inform the second phase, which will involve (2a) semistructured, in-depth interviews with policymakers, public health officials, researchers, providers, groups representing patients, researchers and stakeholders and (2b) an analysis of population-based administrative health data of vaccine administration. Integration of qualitative and quantitative data will inform the identification of effective vaccine distribution approaches for various populations. Informed by this evidence, phase 3 of the study will involve conducting focus groups with multiple stakeholders to codesign recommendations for the design and implementation of effective vaccine delivery strategies for equity-deserving and at-risk populations. ETHICS AND DISSEMINATION: This study is approved by the University of Toronto's Health Sciences Research Ethics Board (#42643), University of British Columbia Behavioural Research Ethics Board (#H22-01750-A002), Research Ethics Board of the Nova Scotia Health Authority (#48272), Newfoundland and Labrador Health Research Ethics Board (#2022.126), Conjoint Health Research Ethics Board, University of Calgary (REB22-0207), and University of Manitoba Health Research Board (H2022-239). The outcome of this study will be to produce a series of recommendations for implementing future vaccine distribution approaches from the perspective of various stakeholders, including equity-deserving and at-risk populations.

Protocol for validating an algorithm to identify neurocognitive disorders in Canadian Longitudinal Study on Aging participants: an observational study.

INTRODUCTION: In population-based research, disease ascertainment algorithms can be as accurate as, and less costly than, performing supplementary clinical examinations on selected participants to confirm a diagnosis of a neurocognitive disorder (NCD), but they require cohort-specific validation. To optimise the use of the Canadian Longitudinal Study on Aging (CLSA) to understand the epidemiology and burden of NCDs, the CLSA Memory Study will validate an NCD ascertainment algorithm to identify CLSA participants with these disorders using routinely acquired study data. METHODS AND ANALYSIS: Up to 600 CLSA participants with equal numbers of those likely to have no NCD, mild NCD or major NCD based on prior self-reported physician diagnosis of a memory problem or dementia, medication consumption (ie, cholinesterase inhibitors, memantine) and/or self-reported function will be recruited during the follow-up 3 CLSA evaluations (started August 2021). Participants will undergo an assessment by a study clinician who will also review an informant interview and make a preliminary determination of the presence or absence of an NCD. The clinical assessment and available CLSA data will be reviewed by a Central Review Panel who will make a final categorisation of participants as having (1) no NCD, (2) mild NCD or, (3) major NCD (according to fifth version of the Diagnostic and Statistical Manual of Mental Disorders criteria). These will be used as our gold standard diagnosis to determine if the NCD ascertainment algorithm accurately identifies CLSA participants with an NCD. Weighted Kappa statistics will be the primary measure of agreement. Sensitivity, specificity, the C-statistic and the phi coefficient will also be estimated. ETHICS AND DISSEMINATION: Ethics approval has been received from the institutional research ethics boards for each CLSA Data Collection Site (Université de Sherbrooke, Hamilton Integrated Research Ethics Board, Dalhousie University, Nova Scotia Health Research Ethics Board, University of Manitoba, McGill University, McGill University Health Centre Research Institute, Memorial University of Newfoundland, University of Victoria, Élisabeth Bruyère Research Institute of Ottawa, University of British Columbia, Island Health (Formerly the Vancouver Island Health Authority, Simon Fraser University, Calgary Conjoint Health Research Ethics Board).The results of this work will be disseminated to public health professionals, researchers, health professionals, administrators and policy-makers through journal publications, conference presentations, publicly available reports and presentations to stakeholder groups.