Canada In March Research Articles

Real-world outcomes associated with use of front-line bevacizumab in ovarian cancer

BackgroundIn the pivotal ICON7 study, addition of bevacizumab to front-line treatment of ovarian cancer (OC) significantly improved overall survival (OS) (p = 0.03) in a high-risk subgroup of patients with suboptimally debulked/unresectable stage III or IV disease, leading to approval in Ontario, Canada in March 2016. Here we describe utilization of bevacizumab for front-line, high-risk OC and determine outcomes in routine clinical practice. MethodsProvincial administrative databases were utilized to identify all patients treated with front-line bevacizumab following its approval. Median OS (mOS) was determined using the Kaplan-Meier method. Factors associated with OS were identified using a Cox proportional hazard model. A comparative effectiveness analysis was performed to determine mOS pre- (2006–2016) and post- (2016–2019) approval. ResultsFrom March 2016 to October 2019, 282 patients received bevacizumab. Mean age was 64 years old, and 58% had stage IV disease. Median survival was 29 months and was longer in stage III (37 months) compared to stage IV disease (28 months). In a comparative effectiveness analysis of patients with stage IV serous OC, post-approval uptake of bevacizumab was low (23%). Median OS was similar pre (26 months) and post (27 months) approval (HR 0.92, 0.75–1.12, p = 0.383). ConclusionsSurvival in real-world patients treated with front-line bevacizumab is shorter than in pivotal clinical trials. Survival in stage IV serous patients has not significantly improved post public reimbursement of bevacizumab. This analysis was limited by poor uptake, however mOS was similar in patients who did and did not receive bevacizumab.

Canadians’ opinions towards COVID-19 data-sharing: a national cross-sectional survey

ObjectivesCOVID-19 research has significantly contributed to pandemic response and the enhancement of public health capacity. COVID-19 data collected by provincial/territorial health authorities in Canada are valuable for research advancement yet...

Student Experience of Emergency Remote Teaching During COVID-19 Early in the 2020/21 Academic Year

In response to the contagious disease coronavirus disease 2019 (COVID-19), a number of health and safety measures were enacted across Canada in March 2020. These measures included the physical closure of postsecondary institutions, including the authors’ institution Carleton University. The physical closure resulted in an abrupt transition from normal in-person teaching to emergency remote teaching (the term emergency remote teaching is used to distinguish it from online teaching, which is not subject to the challenges and constraints associated with an emergency situation). Emergency remote teaching continued at Carleton University for the entire 2020/21 academic year. There were increased resources, training opportunities, supports, and time to prepare for teaching, as compared to the sudden change in the Winter 2020 term. Simultaneously, there were still many ongoing challenges and constraints in the pursuit of optimal remote teaching and learning. Midway through the Fall 2020 term, a questionnaire on the student experience with emergency remote teaching was developed and delivered to undergraduate students in the Department of Systems and Computer Engineering at Carleton University. This paper presents the findings of this questionnaire from the 159 respondents. Results suggest that, on average, academic and intellectual student engagement was slightly worse for emergency remote teaching versus normal in-person teaching. Emergency remote teaching posed some difficulties and challenges, but also provided some advantages that were preferred (e.g., less travel time, ability to rewatch asynchronous lectures). There was a notable worsening of social student engagement, which was associated with increased feelings of isolation and decreased mental health and well-being. There was also a number of students who faced technical barriers with respect to remote teaching, with only 22% indicating that they experienced few or inconsequential technical barriers. This research adds to the discourse on emergency remote teaching, including the lens of engineering education. The paper can help inform future transitions to emergency remote teaching, with some insights potentially useful for online teaching, which is anticipated to continue to increase in its prevalence.

Orientation and mobility for children with visual impairments during COVID-19: Responses from O&M professionals to a disruption of traditional services

After lockdowns and school closings associated with COVID-19 began throughout the United States and Canada in March 2020, this research was completed to explore how the pandemic affected access to orientation and mobility (O&M) services. Using qualititave responses from a mixed methodology study, this article reports the findings from 318 individuals, including both O&M specialists and dually certified teachers of students with visual impairments (TVIs) and O&M specialists. Four major themes emerged through data analysis, including (1) prioritization of O&M goals for students with visual impairments, (2) personal factors affecting access to O&M training, (3) access to O&M services through virtual learning, and (4) creative approaches to O&M instruction during the pandemic. Within these themes, professionals, students, and families alike were asked to assume roles that went beyond traditional expectations. Questions and concerns that professionals in the field need to consider when looking at the future of O&M services were raised as part of this research, including a number of ideas for future studies.

Perspective on Cancer Control: Whither the Tobacco Endgame for Canada?

Aims: In 2014, in response to evidence that Canada’s tobacco use would lead, inexorably, to substantial morbidity and mortality for the foreseeable future, a group of experts convened to consider the development of a “Tobacco Endgame” for Canada. The “Tobacco Endgame” defines a time frame in which to eliminate structural, political, and social dynamics that sustain tobacco use, leading to improved population health. Strategies: A series of Background Papers describing possible measures that could contribute to the creation of a comprehensive endgame strategy for Canada was prepared in advance of the National Tobacco Endgame Summit hosted at Queen’s University in 2016. At the summit, agreement was reached to work together to achieve <5% tobacco use by 2035 (<5 by ’35). A report of the proceedings was shared widely. Achievements: Progress since 2016 has been mixed. The Summit report was followed by a national forum convened by Health Canada in March 2017, and in 2018, the Canadian Government adopted “<5 × ’35” tobacco use target in a renewed Canadian tobacco reduction strategy. Tobacco use has declined in the last 5 years, but at a rate slower than that which will be needed to achieve the <5 by ’35 goal. There remain > 5 million smokers in Canada, signaling that smoking-related diseases will continue to be an enormous health burden. Furthermore, the landscape of new products (e-cigarettes and cannabis) has created additional risks and opportunities. Future directions: A bold, reinvigorated tobacco control strategy is needed that significantly advances ongoing policy developments, including full implementation of the key demand-reduction policies of the WHO Framework Convention on Tobacco Control. Formidable, new disruptive policies and regulations will be needed to achieve Canada’s Endgame goal.

Health care providers\u2019 ethical perspectives on waiver of final consent for Medical Assistance in Dying (MAiD): a qualitative study

BackgroundWith the enactment of Bill C-7 in Canada in March 2021, people who are eligible for medical assistance in dying (MAiD), whose death is reasonably foreseeable and are at risk of losing decision-making capacity, may enter into a written agreement with their healthcare provider to waive the final consent requirement at the time of provision. This study explored healthcare providers’ perspectives on honouring eligible patients’ request for MAiD in the absence of a contemporaneous consent following their loss of decision-making capacity.MethodA critical qualitative methodology, using a feminist ethics theoretical lens with its focus on power and relationality, was used to examine how socio-political and environmental contexts influenced healthcare providers' moral agency and perspectives. Semi-structured interviews were conducted with 30 healthcare providers (13 physicians, six nurse practitioners, nine nurses and two social workers) from across Canada who provide MAiD-related care.ResultsThemes identified include; (1) balancing personal values and professional responsibilities, (2) anticipating strengths and limitations of the proposed waiver of final consent amendment, (3) experiencing ethical influences on decisions to enter into written agreements with eligible patients, (4) recognizing barriers to the enactment of MAiD in the absence of a contemporaneous consent and (5) navigating the potential for increased risks and burden.DiscussionTo our knowledge, this is the first study in Canada to explore healthcare providers’ perspectives on waiving the final consent for MAiD using a written agreement. Most participants supported expanding eligible people’s access to MAiD following loss of capacity, as they believed it would improve the patients’ comfort and minimize suffering. However, the lack of patients’ input at the time of provision and related ethical and legal challenges may impact healthcare providers’ moral agency and reduce some patients’ access to MAiD. Providers indicated they would enter into written agreements to waive final consent for MAiD on a case-by-case basis. This study highlights the importance of organizational, legal and professional support, adequate resources, clear policies and guidelines for the safety and wellbeing of healthcare providers and to ensure equitable access to MAiD.

From the nice work to the hard work: “Troubling” community‐based CareMongering during the COVID‐19 pandemic

AbstractCareMongering is a virtually organized community‐based response to COVID‐19 formed in Canada in March 2020, in response to growing concerns about the pandemic. The goal of CareMongering is to care for community members, particularly those experiencing social exclusion, by organizing groups at a local level to support access to basic necessities, services, and resources (e.g., providing groceries and childcare to frontline workers). Following from feminist calls to “trouble” care, we explore the uncomfortable relations that emerged while practicing CareMongering through a case study of a group in Ontario, Canada. Using semi‐structured interviews with group members and organizers and ethnographic content analysis of Facebook group activity, we examine (1) difficult interactions on the group's public Facebook page, (2) strategies used to moderate the group, and (3) the affective and embodied experiences involved in virtually organizing CareMongering. We illustrate our findings through vignettes of one of the author's experiences as a CareMongering group member and composite narratives of social media interactions. We argue that by enacting critical community care, CareMongering groups have the potential to practice care that goes beyond simply caring for or about community needs to also care with communities. The hard work of critical community care involves an intersectional, reflexive, and relational approach that addresses underlying inequalities and promotes actions aimed toward making structural and collective change.

Reopening Oral Health Services during the COVID-19 Pandemic through a Knowledge Exchange Coalition.

Background:The COVID-19 novel coronavirus closed oral health care in Nova Scotia (NS) Canada in March 2020. Preparing for a phased reopening, a knowledge exchange coalition (representing government, academia, hospitals, oral health professions, and regulators) developed return-to-work (RTW) guidelines detailing the augmentation of standard practices to ensure safety for patients, oral health care providers (OHPs), and the community. Using online surveys, this study explored the influence of the RTW guidelines and related education on registered NS OHPs during a phased return to work.Methods:Dissemination of R2W guidelines included website or email communiques and interdisciplinary education webinars that coincided with 2 RTW phases approved by the government. Aligned with each phase, all registered dentists, dental hygienists, and dental assistants were invited to complete an online survey to gauge the influence of the coalition-sponsored education and RTW guidelines, confidence, preparedness, and personal protective equipment use before and after the pandemic.Results:Three coalition-sponsored multidisciplinary webinars hosted 3541 attendees prior to RTW. The response to survey 1 was 41% (881/2156) and to survey 2 was 26% (571/2177) of registrants. Survey 1 (82%) and survey 2 (89%) respondents “agreed/strongly agreed” that R2W guidelines were a primary source for guiding return to practice, and most were confident with education received and had the skills needed to effectively treat patients during the COVID-19 pandemic. Confidence and preparedness improved in survey 2. Gowns/lab coat use for aerosol-generating procedures increased from 26% to 93%, and the use of full face shields rose from 6% to 93% during the pandemic.Conclusions:A multistakeholder coalition was effective in establishing and communicating comprehensive guidelines and web-based education to ensure unified reintegration of oral health services in NS during a pandemic. This multiorganizational cooperation lay the foundation for responses to subsequent waves of COVID-19 and may serve as an example for collaboratively responding to future public health threats in other settings.Knowledge Transfer Statement:The return-to-work strategy that was developed, disseminated, and assessed through this COVID-19 knowledge exchange coalition will benefit oral health practitioners, professional regulators, government policy makers, and researchers in future pandemic planning.

Prenatal Care Disruptions and Associations With Maternal Mental Health During the COVID-19 Pandemic.

As the novel coronavirus (COVID-19) spread across Canada in March 2020, provinces imposed restrictions. These changes impacted how pregnant individuals received prenatal care and experienced childbirth. The stress caused by these changes may negatively affect the well-being of pregnant individuals with impacts on the developing child. This study investigated the impact of the pandemic on prenatal care and birth plans of pregnant individuals in Canada and potential associations with maternal mental health. Data from 4,604 participants was collected from English- and French-speaking Canadians between April 5 and June 1, 2020 as part of the Canada-wide Pregnancy During the COVID-19 Pandemic study. Symptoms of maternal depression, general anxiety, and pregnancy-related anxiety were assessed. Participants also answered questions about disruptions and changes to prenatal care and their birth plans due to the COVID-19 pandemic. Logistic regression was used to estimate associations between prenatal care disruptions and maternal mental health. Cancellation of prenatal appointments and birth plan changes (specifically changes to childcare during birth and change of support person attending the birth) were significantly associated with greater odds of experiencing clinically elevated depression, anxiety, and/or pregnancy-related anxiety symptoms. These results highlight the need for reliable and accessible prenatal care during the pandemic, such as the integration of mental health screenings and co-ordination of prenatal care providers.

Inventive pedagogies and social solidarity: The work of community-based adult educators during COVID-19 in British Columbia, Canada.

The societal lockdown imposed in Canada in March 2020 to stem the spread of COVID-19 severed key points of connection for low-income Canadians who rely upon schools, libraries and even fast-food chains for internet connectivity. This has had dire implications for timely access to vital information and resources, and has revealed the extent to which women, transgender and racialised communities are bearing the brunt of the pandemic’s effects. This article describes a study that investigated the pandemic-related work of community-based adult educators in the ethno-culturally diverse Canadian province of British Columbia. Interviews were conducted with 18 educators who were working on the “front lines” of the pandemic, to document their support of low-income and newcomer communities, to understand how these educators responded in terms of pedagogies and strategies, and to map how these pedagogies and practices might be leveraged for more equitable relationships in post-pandemic community-based education. The authors found that the educators developed a range of inventive and dynamic pedagogies oriented to social solidarity and to taking up intersectional oppressions. These “pandemic pedagogies” may contribute to more equitable and inclusive social–technology relationships in a post-pandemic future.

Does time series analysis confirms the relationship between space weather effects and the failures of electrical grids in South Poland?

Nowadays, when the global and national industry is addicted from various electrical and electronic equipment at a very high level, it is of a special interest to understand the possible origins of the interruptions in the electricity supply. Failures in ground-based electrical and electronic systems, or disturbances of satellites operation caused by influential magnetic storms initiated by the changeable Sun can have a high economic impact on the industry. These strong magnetic storms are triggered by solar-driven disturbances in interplanetary space. Studies of these phenomena have gained a special attention since the incident that had occurred in northern Canada in March 1989. During this event the work of the hydroelectric plant in the region of Quebec was blocked for long, winter hours and many citizens of this region of Canada suffered from a blackout. Analysis performed in the Oak Ridge National Laboratory showed that if that blackout have had taken place in the USA then costs generated only by a not supplied electricity could even reach 6 billion USD.In our paper, we apply time series and statistical analysis tools, i.e. superposed epoch analysis and Wilcoxon Matched Pairs Test, for a large set of data, among them: 4625 failures of electrical grids in southern Poland in 2010, from the total number of 25,616, and 10,656 in the first seven months of 2014, from the total number of 30,155. We investigate only those failures which might be connected with the above described effects. We analyze data of breakdowns with unidentified reasons, as well as failures connected to the aging and electronic devices breakdowns, which occurred during the periods of an increased geomagnetic activity. Based on the data from The Institute of Meteorology and Water Management-National Research Institute we eliminate from the consideration those failures which had meteorological grounds. Our analysis shows the usefulness of these mathematical tools in such a vital for the global and national industry issue, as well, that powerful phenomena of solar origin, somewhat disturbed in 2010 and January–July 2014 the electrical grids productivity in southern Poland.

A Curious Case of Hypercalcemia

Hypercalcemia is a clinical entity commonly seen on Internal Medicine inpatient units. Through standard diagnostic algorithms, the etiology of most cases can be elucidated. Brivaracetam is a novel anti-epileptic agent that binds synaptic vesicle protein 2A shown to significantly reduce seizure frequency. We describe the first case of hypercalcemia secondary to brivaracetam.&#x0D; Résumé&#x0D; L'hypercalcémie est une entité clinique couramment observée sur les unités d'hospitalisation en médecine interne. Grâce à des algorithmes de diagnostic standard, l'étiologie de la plupart des cas peut être élucidée. Brivaracetam est un nouvel agent anti-épileptique qui lie la protéine de vésicule synaptique 2A montrée pour réduire significativement la fréquence de saisie. Nous décrivons le premier cas d'hypercalcémie secondaire à Brivaracetam.&#x0D; &#x0D; &#x0D;

Editorial: Special section of FEMS Microbiology Ecology on the environmental dimension of antibiotic resistance

The emergence of multi-drug-resistant human pathogens increasingly threatens the successful treatment of bacterial infections, and is now widely regarded as a global public health crisis. Antimicrobial resistance is a global problem, and managing resistance will require global action. As a start, many nations are now developing action plans to mitigate the development of antibiotic resistance. These action plans generally have three pillars, innovation, surveillance and stewardship; and are founded on the One Health concept. Namely, that humans and animals (companion and food animal producing) are inextricably linked to each other through the environment. Thus, research on the environmental dimension of antibiotic resistance has become a priority, within the broader context of maintaining the efficacy of antibiotics of crucial importance to human and animal medicine. This FEMS Microbiology Ecology thematic topic concerns recent progress made in our understanding of the environmental dimension of antibiotic resistance, here coined with the acronym EDAR. Most of the manuscripts were contributed by participants of the Third International Symposium on the Environmental Dimension of Antibiotic Resistance, EDAR3, held in Wernigerode, Germany in May 2015. The EDAR3 meeting follows EDAR2 held in Xiamen China in December 2013, and the original EDAR meeting held in Montebello Canada in March 2012. The consensus statement formulated by the participants of EDAR3 was ‘there are linkages between environmental sources of antibiotic resistance and resistance in clinical pathogens, and human activity can increase, expand and mobilize environmental genes responsible for resistance’. For more detail on the status of progress in the field there are several recent reviews that will be of interest (Finley et al . 2013; Durso and Cook 2014; Jechalke et al . 2014; Berendonk et al . 2015; Huijbers et al . 2015; Nesme and Simonet 2015; Williams-Nguyen et al. 2016). Here, we briefly … [↵][1]* Corresponding author: E-mail: kornelia.smalla{at}julius-kuehn.de [1]: #xref-corresp-1-1

Nature connections: Cultural heritage, identity and wellbeing in Vancouver, Canada

Abstract I came to Vancouver, Canada in March 2014 to give a paper on ‘The Cultural Value of the Arts for Health and Well-Being’ at the 4th International Conference on Health, Wellness &amp; Society: Holistic Health 1 at British Columbia University. I knew absolutely nothing about the First Nations people, their arts, culture and history, and how this relates to a Canadian identity. What I know now is that the cultural identity of many of these peoples is linked to their language, and that of the remaining thirty-two indigenous languages in British Columbia, some are near extinction. For these peoples, their language is their way of being and who they are. It is encouraging to learn that projects which promote language revitalization create the opportunity for cultural well-being, through the cultural connections via the traditional values embedded within each indigenous language. In the same way that we know that Western medicine treats the body, not the person, the First Nations peoples’ loss of language is holistically integrated into the whole of their history of colonization, beliefs, medicine, spiritual and cultural practices. Their cultural heritage is interwo-ven to their wellbeing.

Plot Scale Passive Microwave Measurements and Modeling of Layered Snow Using the Multi-layered HUT Model

. The excavation of snow layers was used to compare observed and modeled plot-scale brightness temperature (TB) values for 19 and 37 GHz, with regard to snow water equivalent (SWE), snow type, grain size, and layered structure, for 3 land cover types acquired near Churchill, Manitoba, Canada in March of 2010. In situ snow geophysical measurements were input to the Helsinki University of Technology (HUT) multi-layer snow emission model, and performance was characterized by RMSE and MBE. Emission scattering from depth hoar was disproportionate to its SWE contribution when compared to other snow types, and it also masked observed scattering contributions from upper snow layers. The simulated and observed TB diverged above 130 mm SWE, as the model did not capture scattering extinction or snowpack emission. These may impact the initial effective grain size optimization process if applied to the GlobSnow SWE assimilation technique. Grain size is optimized to fit emission simulations to TB from satellite observations; the model's continued sensitivity to SWE above observed signal saturation may be attributed to the existing snowpack. These inaccuracies may then be carried forward in the assimilation process, through variance calculations used to weight the contributions of assimilation modules, leading to less accurate SWE retrievals.Résumé. L’excavation des couches de neige a été utilisée pour comparer les valeurs observées et modélisées de la température de brillance (TB) à 19 et 37 GHz à l’échelle de la parcelle, en lien avec l’équivalent en eau de la neige (SWE), le type de neige, la taille des grains, et la structure en couches, pour trois types de couverture terrestre acquises près de Churchill au Manitoba (Canada) en mars 2010. Les mesures géophysiques in situ de neige ont été utilisées en entrées du modèle HUT (Helsinki University of Technology), un modèle multicouche d’émission de la neige, et la performance a été caractérisée par l’écart moyen quadratique (RMSE) et l’erreur de justesse moyenne (MBE). La diffusion de l’émission du givre de profondeur était disproportionnée par rapport à sa contribution au SWE en comparaison avec d’autres types de neige et a aussi masqué les contributions observées de la diffusion des couches de neige supérieures. Les valeurs de TB simulées et observées ont divergé au-dessus de 130 mm de SWE, parce que le modèle n’a pas représenté l’extinction de la diffusion ou l’émission du manteau neigeux. Cela peut affecter le processus d’optimisation initiale de la taille effective des grains, s’il est appliqué à la technique d’assimilation GlobSnow SWE. La taille des grains est optimisée pour ajuster les simulations d’émission aux TB provenant des observations par satellite; la sensibilité du modèle au SWE au-dessus de la saturation du signal observé peut être attribuée au manteau neigeux existant. Ces inexactitudes peuvent ensuite être reportées dans le processus d’assimilation, par des calculs de la variance utilisés pour pondérer les contributions des modules d’assimilation ce qui conduit à des résultats moins précis d’estimation du SWE.

Technological Neutrality Explained (&amp; Applied to CBC v. SODRAC)

The term “technological neutrality” surfaced in the Supreme Court’s 2012 copyright jurisprudence though no one, including the Federal Court of Appeal in CBC v. SODRAC , quite knows exactly what it means. This paper analyzes the principle of technological neutrality as comprising two dimensions: as non-discrimination in that new technologies are to be embraced under the Copyright Act for both copyright holders and users; and as non-interference insofar as sufficiently high thresholds of conduct or activity are required before copyright liability will attach to emerging technologies. It may surprise some that both iterations of this principle (though not so named) are well established in Supreme Court copyright jurisprudence. Once these dimensions are understood, we must then struggle with the issue of its application as a “principle” of copyright law. I argue that principles of law assist interpretation by providing direction in the face of ambiguous or absurd statutory meaning in unusual cases. In other words, principles rationalize the law in a way that strict construction of statutory meaning cannot always accomplish. Principles do not compel specific results but rather are a tool that might augur for a particular interpretation of statutory meaning in a given factual context in order to make the law coherent.The paper explores technological neutrality in the factual context of CBC v. SODRAC, tentatively scheduled for argument before the Supreme Court of Canada in March of 2015. After outlining the history of the case in the first part, the paper concludes with an application of the principle of technological neutrality, as non-interference, to the case. The only result coherent with the Supreme Court’s prior case law is to not treat non-usable or dormant incidental copies as reproductions under the Act. The status of permanent copies that serve a useful and identifiable purpose, e.g. archived copies, is less clear though it would not necessarily create incoherence in the law to recognize them as reproductions.

Environmental fate of hexabromocyclododecane from a new Canadian electronic recycling facility

An electronics recycling facility began operation at the municipal landfill site for the City of Edmonton, Canada in March 2008 with the goal of processing 30,000 tonnes of electronic wastes per year. Of the many by-products from the process, brominated fire retardants such as hexabromocyclododecane (HBCD) can evolve off of e-wastes and be released into the environmental media. HBCD has been identified by many countries and international bodies as a chemical of concern because of its ability to bioaccumulate in the ecosystem. An evaluation of the potential emission of HBCD indicates that up to 500 kg per year may be released from a landfill and recycling facility such as that operating in Edmonton. A multimedia fugacity model was used to evaluate the dispersion and fate of atmospherically emitted HBCD traveling into surrounding agricultural land and forested parkland. The model indicates that the three isomers of HBCD partitioned into environmental media similarly. Much of the HBCD is lost through atmospheric advection, but it is also found in soil and sediment. Modeled air concentrations are similar to those measured at locations with a history of e-waste recycling. Since HBCD has been shown to bioaccumulate, the HBCD released from this source has the long-term potential to affect agricultural food crops and the park ecosystem.

Make your voices heard: Don't let the report on child and youth health fade away

Injury prevention, childhood obesity, mental health, Aboriginal child and youth health – these are among the top priorities for the Canadian Paediatric Society (CPS). They are also the focal points of a report from the federally appointed Advisor on Healthy Children and Youth, Dr K Kellie Leitch (1). The report hones in on some of the most important health problems facing young Canadians. If the federal government acts on the key elements of the 100-plus recommendations, there is potential for progress on some pervasive health issues. Dr Leitch’s report was quietly released by Health Canada in March, six months after it was completed. Since the release, there has been no public response from the federal government. With the House slated to rise for summer break in a matter of weeks, the lack of enthusiasm for the report is very disconcerting. The CPS met with Dr Leitch several times during her consultations, and the good news is that she heard us. The key recommendations in Dr Leitch’s report echo what we have been telling governments about for some time, including developing a National Injury Prevention Strategy, and improving access to mental health services for children and youth, including establishing a wait time strategy for paediatric mental health. We know that investments and informed public policy in child and youth mental health and injury prevention can net huge gains – both human and financial. About 14% or 1.1 million Canadians younger than 20 years of age suffer from mental health conditions that affect their daily lives. Unintentional injury remains the leading cause of death in children one to 14 years of age. Dr Leitch also recommends establishing a National Office for Child and Youth Health, reporting to the Minister of Health, to look at the impact of all federal policies and programs on young Canadians. While this Office would be a step forward, it should not preclude the appointment of a federal Canadian Commissioner for Children and Youth. The CPS reiterates its call for a Commissioner, an independent voice to ensure that the views and needs of children and youth are considered in all relevant national public policy decisions – not just those strictly related to health. A Commissioner would push Canada to meet its obligations under the United Nations Convention on the Rights of the Child, and as outlined in A Canada Fit for Children, Canada’s Plan of Action (2). The CPS supports Dr Leitch’s proposal that the federal government adopt an integrated, ‘whole of government’ approach to the health of children and youth, and provide leadership in areas such as national standards, collaboration, surveillance, research and knowledge transfer, and social marketing to improve health outcomes. These are pivotal responsibilities that only the federal government can lead. The CPS and many of its allies have responded to the report in a number of ways. We have written to federal Minister of Health, Tony Clement. We have met with Dr Leitch. We issued a joint news release with the Canadian Medical Association and the College of Family Physicians, two organizations we worked with to develop Canada’s Child and Youth Health Charter; and we are trying to meet with federal officials, including the Minister. We need your help. In the face of competing demands, the voice of children and youth and voices for children and youth are not well heard. This moment has the potential to be a turning point in the federal government’s commitment to young Canadians. As an advocate for children and youth, you can work with us. Write to the Minister of Health. Contact your local Member of Parliament (visit www.gc.ca and follow the links to ‘Contact your MP’ for telephone and e-mail information). Share the report with others in your community, and encourage them to be active too. The voices of paediatricians, other doctors and health professionals on the frontline are powerful testaments to the need for action. The CPS will continue its advocacy in support of the recommendations in the report, working with allied organizations across Canada. If the federal government hears from the hundreds and thousands of people taking care of children and youth in the community and in hospitals, it may finally have no choice but to listen.

OC31: Women's satisfaction with the OSCAR (One‐Stop Clinic Assessment of Risk) model of first‐trimester combined screening

Objectives: This study evaluated women’s satisfaction with the OSCAR (One-Stop Clinic Assessment of Risk) first-trimester combined screening (FTS) model introduced in Calgary, Canada in March 2006. Methods: The FTS OSCAR model provides pretest counseling, phlebotomy, blood assay for fβ-hCG, PAPP-A (Delfia TM Xpress), nuchal translucency (NT) scan, the FTS risk calculation (Astraia) and post-test counseling during a 90-min appointment. A satisfaction survey was developed to measure expectations and satisfaction with these various components of service. Additional information collected included the women’s demographics, their recall of their screen result (positive or negative) and whether they felt reassured with testing. Between 13 March 2006–2007, all women referred for the 11–13 + 6 week FTS who agreed to complete the survey were included. Results: Response rate was 75% (3763/5013). Overall, 98.1% of the women were either very satisfied or satisfied and 95.6% felt their expectations were met. These results were independent of maternal age, parity and education. Most women were reassured by testing regardless of results (99.3% and 82.1% of the screen-negative and screen-positive (≥1/300 women, respectively). Most (93%) stated that screening early in pregnancy and receiving test results at the same visit (95.6%) was very important. Conclusions: The FTS OSCAR model meets women’s expectations and is associated with a high degree of satisfaction in terms of timing of screening and rapid availability of results. A high proportion of women were reassured by their results regardless of whether they were screen negative or positive. There was also a relatively low uptake of prenatal diagnosis among the screen-positive women (49%). This may imply that women favor the personal risk assessment and benefit from the 1-1 post-counseling of the OSCAR model. Further research is under way to address these questions.

OC32: Pregnancy choices after prenatal diagnosis of aneuploidy in a setting in which elective pregnancy termination is not locally available

Objectives: This study evaluated women’s satisfaction with the OSCAR (One-Stop Clinic Assessment of Risk) first-trimester combined screening (FTS) model introduced in Calgary, Canada in March 2006. Methods: The FTS OSCAR model provides pretest counseling, phlebotomy, blood assay for fβ-hCG, PAPP-A (Delfia TM Xpress), nuchal translucency (NT) scan, the FTS risk calculation (Astraia) and post-test counseling during a 90-min appointment. A satisfaction survey was developed to measure expectations and satisfaction with these various components of service. Additional information collected included the women’s demographics, their recall of their screen result (positive or negative) and whether they felt reassured with testing. Between 13 March 2006–2007, all women referred for the 11–13 + 6 week FTS who agreed to complete the survey were included. Results: Response rate was 75% (3763/5013). Overall, 98.1% of the women were either very satisfied or satisfied and 95.6% felt their expectations were met. These results were independent of maternal age, parity and education. Most women were reassured by testing regardless of results (99.3% and 82.1% of the screen-negative and screen-positive (≥1/300 women, respectively). Most (93%) stated that screening early in pregnancy and receiving test results at the same visit (95.6%) was very important. Conclusions: The FTS OSCAR model meets women’s expectations and is associated with a high degree of satisfaction in terms of timing of screening and rapid availability of results. A high proportion of women were reassured by their results regardless of whether they were screen negative or positive. There was also a relatively low uptake of prenatal diagnosis among the screen-positive women (49%). This may imply that women favor the personal risk assessment and benefit from the 1-1 post-counseling of the OSCAR model. Further research is under way to address these questions.