Health Research In Canada Research Articles

Canadian Institutes of Health Research funding of prison health research: a descriptive study.

Health research provides a means to define health status and to identify ways to improve health. Our objective was to define the proportion of grants and funding from the Government of Canada's health research investment agency, the Canadian Institutes of Health Research (CIHR), that was awarded for prison health research, and to describe the characteristics of funded grants. In this descriptive study, we defined prison health research as research on the health and health care of people in prisons and at the time of their release. We searched the CIHR Funding Decisions Database by subject and by investigator name for funded grants for prison health research in Canada in all competitions between 2010 and 2014. We calculated the proportion of grants and funding awarded for prison health research, and described the characteristics of funded grants. During the 5-year study period, 21 grants were awarded that included a focus on prison health research, for a total of $2 289 948. Six of these grants were operating grants and 6 supported graduate or fellowship training. In total, 0.13% of all grants and 0.05% of all funding was for prison health research. A relatively small proportion of CIHR grants and funding were awarded for prison health research between 2010 and 2014. If prison health is a priority for Canada, strategic initiatives that include funding opportunities could be developed to support prison health research in Canada.

Reconciling community-based Indigenous research and academic practices: Knowing principles is not always enough

Historically, Indigenous health research in Canada has failed to engage Indigenous peoples and communities as primary stakeholders of research evidence. Increasingly, research ethics and methodologies are being positioned as tools for Indigenous self-determination. In response, mainstream institutions have developed new ethical principles for research involving Indigenous people. While these transformations are necessary steps towards re-orienting research practices, they are not prescriptive. In this paper, we make visible three dilemmas from a case study in which Indigenous health research frameworks provided limited guidance or were unclear about how to balance community priorities with Indigenous research principles. We also discuss the strategies used to resolve each of these dilemmas.We draw examples from a project that examined the lived experiences of children and youth living with FASD and their caregivers. This project was conducted in collaboration with Sheshatshiu Innu First Nation, an Indigenous community in Labrador, Canada. In doing so, we argue that knowing the key guiding principles in Indigenous health research is not always enough, and that the ‘real-world’ context of practices and relationships can lead to conflicts that are not easily resolved with adherence to these principles.

Using Principal Component Analysis to Identify Priority Neighbourhoods for Health Services Delivery by Ranking Socioeconomic Status.

Objectives. Socioeconomic status (SES) is a comprehensive indicator of health status and is useful in area-level health research and informing public health resource allocation. Principal component analysis (PCA) is a useful tool for developing SES indices to identify area-level disparities in SES within communities. While SES research in Canada has relied on census data, the voluntary nature of the 2011 National Household Survey challenges the validity of its data, especially income variables. This study sought to determine the appropriateness of replacing census income information with tax filer data in neighbourhood SES index development. Methods. Census and taxfiler data for Guelph, Ontario were retrieved for the years 2005, 2006, and 2011. Data were extracted for eleven income and non-income SES variables. PCA was employed to identify significant principal components from each dataset and weights of each contributing variable. Variable-specific factor scores were applied to standardized census and taxfiler data values to produce SES scores. Results. The substitution of taxfiler income variables for census income variables yielded SES score distributions and neighbourhood SES classifications that were similar to SES scores calculated using entirely census variables. Combining taxfiler income variables with census non-income variables also produced clearer SES level distinctions. Internal validation procedures indicated that utilizing multiple principal components produced clearer SES level distinctions than using only the first principal component. Conclusion. Identifying socioeconomic disparities between neighbourhoods is an important step in assessing the level of disadvantage of communities. The ability to replace census income information with taxfiler data to develop SES indices expands the versatility of public health research and planning in Canada, as more data sources can be explored. The apparent usefulness of PCA also contributes to the improvement of SES measurement and calculation methods, and the freedom to input area-specific data allows the present method to be adapted to other locales.

Using a Delphi process to define priorities for prison health research in Canada

ObjectivesA large number of Canadians spend time in correctional facilities each year, and they are likely to have poor health compared to the general population. Relatively little health research has...

Redistributing health: New directions in population health research in Canada

The Canadian Geographer / Le Géographe canadienVolume 59, Issue 1 p. e5-e6 Geography of Health Reviews / Comptes rendus en géographie de la santé Redistributing health: New directions in population health research in Canada First published: 03 March 2015 https://doi.org/10.1111/cag.12148Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume59, Issue1Special Issue: alt.gisSpring / printemps 2015Pages e5-e6 RelatedInformation

Interdisciplinary promises versus practices in medicine: The decoupled experiences of social sciences and humanities scholars

This paper explores social scientists' and humanities (SSH) scholars' integration within the academic medical research environment. Three questions guided our investigation: Do SSH scholars adapt to the medical research environment? How do they navigate their career within a culture that may be inconsistent with their own? What strategies do they use to gain legitimacy? The study builds on three concepts: decoupling, doxa, and epistemic habitus. Twenty-nine semi-structured interviews were conducted with SSH scholars working in 11 faculties of medicine across Canada. Participants were selected through purposeful and snowball sampling. The data were analyzed by thematic content analysis. For most of our participants, moving into medicine has been a challenging experience, as their research practices and views of academic excellence collided with those of medicine. In order to achieve some level of legitimacy more than half of our participants altered their research practices. This resulted in a dissonance between their internalized appreciation of academic excellence and their new, altered, research practices. Only six participants experienced no form of challenge or dissonance after moving into medicine, while three decided to break with their social science and humanities past and make the medical research community their new home. We conclude that the work environment for SSH scholars in faculties of medicine does not deliver on the promise of inclusiveness made by calls for interdisciplinarity in Canadian health research.

What is ‘South Asian’? A quantitative content analysis evaluating the use of South Asian ethnic categorization in Canadian health research

The use of ‘South Asian’ ethnic categorization was investigated to determine if there is consistency in its use in health research in Canada. Quantitative content analysis and a secondary qualitative content analysis were carried out on articles retrieved from a systematic review of Canadian health research conducted on ‘South Asians’ from 2005 to 2012. About 22% of articles (n = 31) examining South Asian health in Canada failed to include an explicit definition of ‘South Asian’. The failure to use a consistent operationalized definition throughout the study and the inappropriate application of findings to the relevant South Asian subpopulations were the major problems noted in the literature. Given the contextuality and fluidity of ethnic identity, the authors recommend the consistent use of explicit definitions of the specific subgroup of interest and that findings based on specific subgroups not be applied to the ‘South Asian community’ at large.

Sharing What We Know about Living a Good Life: Indigenous Approaches to Knowledge Translation.

Knowledge Translation (KT), a core priority in Canadian health research, policy, and practice for the past decade, has a long and rich tradition within Indigenous communities. In Indigenous knowledge systems the processes of "knowing" and "doing" are often intertwined and indistinguishable. However, dominant KT models in health science do not typically recognize Indigenous knowledge conceptualizations, sharing systems, or protocols and will likely fall short in Indigenous contexts. There is a need to move towards KT theory and practice that embraces diverse understandings of knowledge and that recognizes, respects, and builds on pre-existing knowledge systems. This will not only result in better processes and outcomes for Indigenous communities, it will also provide rich learning for mainstream KT scholarship and practice. As professionals deeply engaged in KT work, health librarians are uniquely positioned to support the development and implementation of Indigenous KT. This article provides information that will enhance the ability of readers from diverse backgrounds to promote and support Indigenous KT efforts, including an introduction to Indigenous knowledge conceptualizations and knowledge systems; key contextual issues to consider in planning, implementing, or evaluating KT in Indigenous settings; and contemporary examples of Indigenous KT in action. The authors pose critical reflection questions throughout the article that encourage readers to connect the content with their own practices and underlying knowledge assumptions.

Mixed Methods Immigrant Mental Health Research in Canada: A Systematic Review

Canada is home to a growing immigrant population. However, immigrant mental health declines over time following arrival in Canada. Canada's Mental Health Strategy emphasizes the importance of research that gathers information from multiple sources of knowledge to identify the mental health challenges faced by diverse immigrant populations. Mixed methods research (MMR) is well suited for this task. However, a dearth of research exists on the application of MMR to the study of immigrant mental health. A systematic review of the published MMR literature in Canadian immigrant mental health was carried out. Overall, existing MMR studies failed to incorporate correct mixed methods terminology and fully integrate the quantitative and qualitative components of the research. A checklist of important elements to include in MMR studies is offered.

Bridging the gap: Workplace mental health research in Canada.

Over the past few decades, poor employee mental health has become one of Canada's most prevalent and costly occupational health issues. The recently released Canadian National Standard on Psychological Health and Safety is helping to broaden the corporate perspective of mental health and provide organisations with more systematic workplace mental health guidelines. We suggest that it is theoretically and practically important for researchers to continue to pursue the following four areas of occupational mental health research: 1) the development of theory; 2) the standardization of strategy development and evaluation; 3) the improvement of longitudinal research; 4) and the application of workplace mental health strategies in natural workplace settings.Keywords: employee mental health, occupational health, workplace strategiesAs the largest contributor to the disease burden in middle-and high-income countries (World Health Organization [WHO], 2004), mental health problems are significantly impacting billions of people throughout the world (Collins et al., 2011). In Canada alone, approximately 6.7 million people-nearly one fifth of the country's population-are currently living with a mental health problem (Smetanin et al., 2011). Unfortunately, as mental health problems continue to become more prevalent, so do their associated costs. In 2011, it was estimated that the Canadian economy loses approximately $50 billion every single year as a result of mental health problems, and that over the next 30 years, the total jcost to the Canadian economy will likely amount to well over $2.5 ' trillion (Smetanin et al., 2011).Because of these substantial financial losses, government and corporate interest in the mental health of Canadians is rising (Mental Health Commission of Canada [MHCC], 2012). Given that Canadian organisations collectively lose upward of $6 billion annually as a result of productivity declines associated with poor employee mental health (Smetanin et al., 2011), more and more organisational leaders are attempting to invest in the mental health of their employees (MHCC, 2012). With the cumulative 30-year productivity impact expected to be nearly $198 billion (Smetanin et al., 2011), the burden of poor employee mental health is likely to impede the overall growth of the Canadian economy-a consequence that has the potential to affect all Canadians. Because of these significant costs for Canadian organisations and members of the general public, systematic workplace research is still needed to better understand how organisations can prevent, manage, and help treat common employee mental health problems, such as excessive stress, burnout, depression, anxiety, and substance abuse problems.Efforts to improve knowledge about mental health and mental health problems have been relatively infrequent, especially compared with efforts designed to improve knowledge about physical health problems (Jorm, 2000). As a result, many employers and employees tend to have a relatively limited understanding of mental health (Jorm, 2000; WHO, 2000). Unsurprisingly, mental health literacy-one's knowledge, beliefs, and understanding about mental health problems and treatments-is remarkably low throughout the world, especially when compared with the worldwide level of physical health literacy (Jorm, 2000). In fact, mental health literacy is so low that many people with mental health problems suffer from substantial human rights violations, such as discrimination and social stigma (WHO, 2003), which often go unnoticed and unaddressed. As contended by the World Health Organization (2000), although employers have no problem recognising and accommodating an employee with a physical health problem, such as a broken arm or cancer, many employers are either hesitant or unaware of the appropriate responses and accommodations for an employee with a mental health problem.The Impact of Poor Employee Mental Health on the WorkplaceMany Canadian companies experience some of the negative organisational and employee-level consequences associated with poor employee mental health (Dunnagan, Peterson, & Haynes, 2001) . …

Accessing health services through the back door: a qualitative interview study investigating reasons why people participate in health research in Canada

BackgroundAlthough there is extensive information about why people participate in clinical trials, studies are largely based on quantitative evidence and typically focus on single conditions. Over the last decade investigations into why people volunteer for health research have become increasingly prominent across diverse research settings, offering variable based explanations of participation patterns driven primarily by recruitment concerns. Therapeutic misconception and altruism have emerged as predominant themes in this literature on motivations to participate in health research. This paper contributes to more recent qualitative approaches to understanding how and why people come to participate in various types of health research. We focus on the experience of participating and the meanings research participation has for people within the context of their lives and their health and illness biographies.MethodsThis is a qualitative exploratory study informed by grounded theory strategies. Thirty-nine participants recruited in British Columbia and Manitoba, Canada, who had taken part in a diverse range of health research studies participated in semi-structured interviews. Participants described their experiences of health research participation including motivations for volunteering. Interviews were recorded, transcribed, and analyzed using constant comparisons. Coding and data management was supported by Nvivo-7.ResultsA predominant theme to emerge was 'participation in health research to access health services.’ Participants described research as ways of accessing: (1) Medications that offered (hope of) relief; (2) better care; (3) technologies for monitoring health or illness. Participants perceived standard medical care to be a “trial and error” process akin to research, which further blurred the boundaries between research and treatment.ConclusionsOur findings have implications for recruitment, informed consent, and the dichotomizing of medical/health procedures as either research or treatment. Those with low health status may be more vulnerable to potential coercion, suggesting the need for a more cautious approach to obtaining consent. Our findings also indicate the need for boundary work in order to better differentiate treatment and research. It is important however to acknowledge a categorical ambiguity; it is not always the case that people are misinformed about the possible benefits of research procedures (i.e., therapeutic misconception); our participants were aware that the primary purpose of research is to gain new knowledge yet they also identified a range of actual health benefits arising from their participation.

Ethics is for human subjects too: Participant perspectives on responsibility in health research

Despite the significant literature as well as energy devoted to ethical review of research involving human subjects, little attention has been given to understanding the experiences of those who volunteer as human subjects. Why and how do they decide to participate in research? Is research participation viewed as a form of social responsibility or as a way of obtaining individual benefits? What if anything do research subjects feel they are owed for participation? And what do they feel that they owe the researcher? Drawing on in-depth individual interviews conducted in 2006 and 2007 with 41 subjects who participated in a variety of types of health research in Canada, this paper focuses on subject perspectives on responsibility in research. Highlighting the range of ways that subjects describe their involvement in research and commitments to being a ‘good’ subject, we present a typology of narratives that sheds new light on the diverse meanings of research participation. These narratives are not mutually exclusive or prescriptive but are presented as ideal types typifying a set of circumstances and values. As such, they collectively illuminate a range of motivations expressed by human subjects as well as potential sources of vulnerability. The typology adds a new dimension to the literature in this area and has significant implications for researchers seeking more human-subject centred approaches to research recruitment and retention, as well as research ethics boards trying to better anticipate the perspectives of prospective participants.

Linking Canadian Population Health Data: Maximizing the Potential of Cohort and Administrative Data

Linkage of data collected by large Canadian cohort studies with provincially managed administrative health databases can offer very interesting avenues for multidisciplinary and cost-effective health research in Canada. Successfully co-analyzing cohort data and administrative health data (AHD) can lead to research results capable of improving the health and well-being of Canadians and enhancing the delivery of health care services. However, such an endeavour will require strong coordination and long-term commitment between all stakeholders involved. The challenges and opportunities of a pan-Canadian cohort-to-AHD data linkage program have been considered by cohort study investigators and data custodians from each Canadian province. Stakeholders acknowledge the important public health benefits of establishing such a program and have established an action plan to move forward.

Celebrating top achievements in health research 2012

The Canadian Institutes of Health Research and the CMAJ host an annual competition to celebrate top achievements in health research in Canada. Launched in 2008, the awards highlight achievements that have had a substantial impact on health, health care and health research “by improving our

Future human health research directions for the Canadian Northern Contaminants Program

Studies conducted in the mid-1980s and early 1990s demonstrated that persistent organic pollutants (POPs) and metals were reaching the Arctic ecosystem at unexpectedly high levels, many of which had no Arctic or Canadian sources. Epidemiological and toxicological studies in Canada and in other countries have found that these contaminants may pose a risk to human health. The objective of this paper is to provide the foundation for the discussion on future northern human health research under the Northern Contaminants Program (NCP) in Canada. This short discussion of human health priorities will help guide a path forward for future northern human health research in Canada to address on-going and new health concerns related to contaminants exposure in the Canadian Arctic.

Evaluation of Funding Gastroenterology Research in Canada Illustrates the Beneficial Role of Partnerships

Funders of health research in Canada seek to determine how their funding programs impact research capacity and knowledge creation. To evaluate the impact of a focused grants and award program that was cofunded by the Canadian Institutes of Health Research Institute of Nutrition, Metabolism and Diabetes, and the Canadian Association of Gastroenterology; and to measure the impact of the Program on the career paths of funded researchers and assess the outcomes of research supported through the Program. A survey of the recipients of grants and awards from 2000 to 2008 was conducted in 2012. The CIHR Funding Decisions database was searched to determine subsequent funding; a bibliometric citation analysis of publications arising from the Program was performed. Of 160 grant and award recipients, 147 (92%) completed the survey. With >$17.4 million in research funding, support was provided for 131 fellowship awards, seven career transition awards, and 22 operating grants. More than three-quarters of grant and award recipients continue to work or train in a research-related position. Combined research outputs included 545 research articles, 130 review articles, 33 book chapters and 11 patents. Comparative analyses indicate that publications supported by the funding program had a greater impact than other Canadian and international comparators. Continuity in support of a long-term health research funding partnership strengthened the career development of gastroenterology researchers in Canada, and enhanced the creation and dissemination of new knowledge in the discipline.

How much are we spending? The estimation of research expenditures on cardiovascular disease in Canada

BackgroundCardiovascular disease (CVD) is a leading cause of death in Canada and is a priority area for medical research. The research funding landscape in Canada has changed quite a bit over the last few decades, as have funding levels. Our objective was to estimate the magnitude of expenditures on CVD research for the public and charitable (not-for profit) sectors in Canada between 1975 and 2005.MethodsTo estimate research expenditures for the public and charitable sectors, we compiled a complete list of granting agencies in Canada, contacted each agency and the Canadian Institutes of Health Research (CIHR), and extracted data from the organizations’ annual reports and the Reference Lists of health research in Canada. Two independent reviewers scanned all grant and fellowship/scholarship titles (and summary/key words, when available) of all research projects funded to determine their inclusion in our analysis; only grants and fellowships/scholarships that focused on heart and peripheral vascular diseases were selected.ResultsPublic/charitable sector funding increased 7.5 times, from close to $13 million (in constant dollars) in 1975 to almost $96 million (in constant dollars) in 2005 (base year). The Medical Research Council of Canada (MRCC)/CIHR and the Heart & Stroke Foundation of Canada have been the main founders of this type of research during our analysis period; the Alberta Heritage Foundation for Medical Research and the Fonds de la recherche en santé du Quebec have played major roles at the provincial level. The Indirect Costs Research Program and Canada Foundation for Innovation have played major roles in terms of funding in the last years of our analysis.ConclusionPublic/charitable-funded research expenditures devoted to CVD have increased substantially over the last three decades. By international standards, the evidence suggests Canada spends less on health-related research than the UK and the US, at least in absolute terms. However, this may not be too problematic as Canada is likely to free-ride from research undertaken elsewhere. Understanding these past trends in research funding may provide decision makers with important information for planning future research efforts. Future work in this area should include the use of our coding methods to obtain estimates of funded research for other diseases in Canada.

Translating evidence into practice: the role of health research funders

BackgroundA growing body of work on knowledge translation (KT) reveals significant gaps between what is known to improve health, and what is done to improve health. The literature and practice also suggest that KT has the potential to narrow those gaps, leading to more evidence-informed healthcare. In response, Canadian health research funders and agencies have made KT a priority. This article describes how one funding agency determined its KT role and in the process developed a model that other agencies could use when considering KT programs.DiscussionWhile ‘excellence’ is an important criterion by which to evaluate and fund health research, it alone does not ensure relevance to societal health priorities. There is increased demand for return on investments in health research in the form of societal and health system benefits. Canadian health research funding agencies are responding to these demands by emphasizing relevance as a funding criterion and supporting researchers and research users to use the evidence generated.Based on recommendations from the literature, an environmental scan, broad circulation of an iterative discussion paper, and an expert working group process, our agency developed a plan to maximize our role in KT. Key to the process was development of a model comprising five key functional areas that together create the conditions for effective KT: advancing KT science; building KT capacity; managing KT projects; funding KT activities; and advocating for KT. Observations made during the planning process of relevance to the KT enterprise are: the importance of delineating KT and communications, and information and knowledge; determining responsibility for KT; supporting implementation and evaluation; and promoting the message that both research and KT take time to realize results.SummaryChallenges exist in fulfilling expectations that research evidence results in beneficial impacts for society. However, health agencies are well placed to help maximize the use of evidence in health practice and policy. We propose five key functional areas of KT for health agencies, and encourage partnerships and discussion to advance the field.

Making the case for human rights in global health education, research and policy.

If the 2010 CPHA conference is a bellwether of mainstream Canadian public and global health practice, its dearth of human rights papers suggests that, outside a small scholarly cohort, human rights remain marginal therein. This potential 'rights gap' conflicts with growing recognition of the relationship between health and human rights and ergo, the importance of human rights education for health professionals. This gap not only places Canadian health research outside the growing vanguard of academic research on health and human rights, but also ignores a potentially influential tool for achieving health equity. I suggest that human rights make a distinctive contribution to such efforts not replicated within other social justice and equity approaches, making human rights education a crucial complement to other ethical training. These contributions are evident in the normative specificity of the right to health in international law and its legally binding nature, in the success of litigation, the successful advocacy for AIDS treatment and the growing adoption of rights-based approaches to health. Canadian academic and research institutions should take up their rightful place within health and human rights research, education and practice globally, including by ramping up human rights-oriented education for health professionals within Canadian universities.

SU‐D‐BRC‐01: Multi‐Fraction Dose Distributions for Image‐Guided IMRT of Prostate: Impact on TCP and NTCP

Purpose: IMRT of the prostate consists of multiple stages of treatment planning and dose delivery, each with inherent anatomical uncertainties. Differential filling of the bladder and rectum can displace the prostate during a course of treatment. The purpose of this study was to assess the effectiveness of adapting to these anatomical changes using various CT image‐guided adaptive (IGART) strategies. Methods: Our computer model is based on the Philips Pinnacle treatment planning system. A multi‐fraction simulation of 5‐field IMRT (76 Gy/35 fractions) yields the daily dose accumulation in individual tissue elements. Using megavoltage CT studies of 13 prostate cases, cumulated dose distributions are mapped onto the reference treatment plan. Total dose‐volume histograms are then processed to estimate the changes in tumor control probability (TCP) and normal tissue complication probability (NTCP) for various IGART scenarios. Results: Retargeting of the prostate generally maintains the intended TCP (typically 0.9 versus 0.8 with No Image Guidance) but is often associated with an enhanced risk of rectal toxicity (NTCP rises to 0.05 when Image Guidance is applied). This effect is due mainly to a systematic anterior shift caused by sag in the treatment couch (average 10mm). Without image‐guidance, this offset goes uncorrected, resulting in poorer coverage of the target with consistent avoidance of rectal exposure. Conclusions: Geometric repositioning without dose re‐planning is sufficient to maintain the intended TCP. IGART corrects for sag in the treatment couch and this results in greater risk of rectal toxicity, compared with no IGART. Smaller PTV margins could offset this effect, emphasizing the need for integrated image guided and intensity modulated delivery for optimal results. In the extreme, daily IMRT re‐planning based on in‐room imaging could exploit maximum benefits of this technology but this would require significantly more computing resources and streamlining of procedures at the treatment console.Research funding was provided by the Canadian Health Research Institutes and the Ontario Research and Development Challenge Fund (OCITS Project), with Philips Medical Systems as an industry partner.