Canadian Society Research Articles

Nephrology Nurses: Essential Professionals in Sustainable Kidney Care.

The increasing frequency of extreme climate events underscores the need for urgent action on climate change. The health care system contributes 4.6% of greenhouse gas emissions (GHGs) in Canada; thus, it is a major contributor to the country's carbon footprint. Kidney care in particular can involve high amounts of waste (eg, plastic and consumable waste associated with dialysis, transportation, emissions, energy, and water consumption). Therefore, sustainability initiatives within the health care system, and especially in the context of kidney care, have great potential to make a positive impact on planetary health. Here, we outline ways in which nephrology nurses can expand our duty of care to the environment and incorporate sustainability into our work. A small advisory group of nephrology nurses in partnership with the Canadian Association of Nurses for the Environment (CANE) assessed ways that sustainable practices can be incorporated into nephrology nursing. Drawing on the Planetary Health Care model used by the Canadian Society of Nephrology: Sustainable Nephrology Action Planning (SNAP) committee, we assessed how the model could be adapted in the context of kidney care using 3 main actionable themes in their work: reducing the demand for health services, matching the supply of health services with demand, and reducing emissions from the supply of health services. We also reviewed and selected real-world examples of initiatives pursued by colleagues. Through this established framework, we provide recommendations and case examples for nephrology nurses to expand our duty of care to the environment. We describe nursing-led strategies used in Canada to improve environmental sustainability in kidney programs and consider their applicability to other renal programs. In 1 case example, we show how a simple nurse-led initiative at a single dialysis clinic can lower plastic waste and associated costs by $2042.59 per year. More broadly, we provide recommendations and actions for nephrology nurses to improve environmental sustainability in kidney care. Nurses in Canada have many responsibilities within limited timeframes, making it essential to choose sustainable practices that do not exacerbate burnout and high workloads. For sustainable practices to be successful, nurses must integrate them into their existing workflows.

Climate Change and Environmentally Sustainable Kidney Care in Canada: A Knowledge, Attitudes, and Practices Survey of Kidney Care Providers.

Climate change impacts health and threatens the stability of care delivery systems, while healthcare is mobilizing to reduce its significant environmental impact. This study aimed to assess knowledge, attitudes, and practices (KAP) about climate change among Canadian kidney care providers. An electronic KAP survey, created by the Canadian Society of Nephrology-Sustainable Nephrology Action Planning committee, was distributed to kidney care providers across Canada, from March to April 2023. A total of 516 people responded to the survey. Most respondents (79%) identified as women; 83% were aged 30 to 59 years. Nurses and nephrologists made up 44% and 23% of respondents, respectively. About half of the participants felt informed about climate change to an average degree. Most respondents (71%; 349/495 and 62%; 300/489) were either extremely or very concerned about climate change and waste generated in their kidney care program, respectively. The vast majority of respondents (89%; 441/495) reported taking steps to lower their personal carbon footprint. People who felt more informed about climate change presented higher degrees of concern. Similarly, both those who felt more informed and those who reported higher degrees of concern about climate change were more likely to take steps to reduce their carbon footprint. Over 80% of respondents (314/386) were at least moderately interested in learning sessions about environmentally sustainable initiatives in care. This survey is at risk of social acceptability, representative, and subjective bias. Overrepresentation from Quebec and British Columbia, as well as the majority of respondents identifying as women and working in academic centers, may affect generalizability of the findings. Most kidney care providers who responded to this survey are informed and concerned about climate change, and their knowledge is directly associated with attitude and practices. This indicates that educational initiatives to increase awareness and knowledge on climate change will likely lead to practice changes.

Surgical Margin Definition and Assessment in Head and Neck Oncology: A Cross-Sectional Survey of Canadian Head and Neck Surgeons.

Head and neck squamous cell carcinomas (HNSCC) are responsible for a significant amount of morbidity and mortality in Canada. Surgical margins are one of the most important factors used to guide treatment; however, currently there is a lack of consensus on the ideal surgical margin definition, sampling, and assessment method. To understand the current perspectives and practice patterns of Canadian head and neck surgeons with respect to surgical margin: (1) definition, (2) sampling, (3) pathological assessment. A 24-question cross-sectional survey was sent via email through the Canadian Society of Otolaryngology-Head & Neck Surgery (CSOHNS), and responses were gathered from December 19, 2023, to March 12, 2024. Responses were aggregated and reported using descriptive statistics. The survey was conducted in Canada among self-reported staff head and neck oncology surgeons with membership in the CSOHNS. A total of 36 staff head and neck oncology surgeons responded from across Canada. The most common (58.3%) definition of a negative surgical margin for oral cavity HNSCC was ">5 mm formalin fixed paraffin embedded distance." To obtain surgical margins, surgeons were split with 44.1% using only a tumor bed approach and 32.4% using only a specimen-driven approach. A dedicated head and neck pathologist is always available more commonly for final pathological assessment (63.6%) versus intraoperative frozen section assessment (15.5%). Finally, most surgeons reported having a synoptic standardized reporting system for annotating margin status (78.8%). The results of this survey provide a current-state analysis of head and neck surgeons across Canada and set the stage for future efforts to be directed toward standardizing the collection method and reporting criteria for surgical margins in HNSCC.

Retraction: Do surrounding people's emotions affect judgment of the central person's emotion? Comparing within cultural variation in holistic patterns of emotion perception in the multicultural Canadian society.

[This retracts the article DOI: 10.3389/fnhum.2022.886971.].

“It’s Not a System of Care”: Black Youth’s Stories of Family Separation and Anti-Black Racism in Ontario’s Child Welfare System

The Black family unit and community plays a critical role in Black youths’ self-development, cultural socialization, and ability to navigate the impacts of structural anti-Black racism embedded in Canadian society. However, Black families are at an increased risk of separation from their children in Ontario’s child welfare system. Utilizing anti-Black racism theory, this study investigates the narratives of 27 Black Caribbean youth in the Greater Toronto Area with lived experience in out-of-home care. Using a narrative inquiry as a methodological approach, the findings reveal that Black youth in out-of-home care experienced: (1) social, psychological, and cultural isolation; (2) the disregard of their hygiene and unique hair needs and; (3) a critical conscious awareness of anti-Black racism. Recommendations for practice, research, and policy are discussed to adequately respond to the needs of Black children and their families.

Between Canada and Italy; or, lives and identities in transition: A reading of Where She Has Gone by Nino Ricci

This article focuses on the third novel of Nino Ricci's trilogy about Italian immigration in Canada. More precisely, taking my cue from the theme of nostos in the sense of a search for a fully-fledged identity, I will analyse the way that Where She Has Gone dramatizes the protagonist's predicament in terms of personal conflicts, psychological trauma and sexual ambiguities. Vittorio Innocente is a hero whose life seems to be split between Canada and Italy: this is at the origin of his personal crisis which is characterized by a deeply ingrained sense of peril. In many respects, the main point of the story is represented by the protagonist's return to Italy where he intends to meet all those people who knew him. In fact, he left for Canada as an eight-year-old boy with his pregnant mother who died during the journey after giving birth to a daughter named Rita. While living in Toronto, Vittorio has an incestuous relationship with his younger half-sister Rita, who was the fruit of their mother's adultery in Valle del Sole (Molise). The most dramatic moment of the diegesis takes place when Vittorio meets Rita in Valle del Sole as both are returning from Canada by different routes. Significantly, by looking into their mother's past, they both decide to give up their tormented relationship. The protagonist's journey back to his native village can be seen not only as that of an intellectual in search of his own roots but also as a compelling wish to meet, after many years, his own historic and socio-cultural past in order to better understand his unresolved life as well as his role in Canadian society.

African single mothers and their children in Canada: transnational experiences and sources of support

ABSTRACT African immigrants comprise an increasing proportion of Canada’s immigrant population and face myriad challenges upon arrival. There are few studies that examine the experiences of African single-parents and their struggles as they try to integrate into Canadian society with their children. This qualitative study sought to highlight the experiences of single mothers and their children. Semi-structured interviews were conducted with a total of 15 participants comprising eight children and seven mothers. Demographic questionnaires were used to gather background information about each participant. Some of the challenges the mothers experienced included lack of recognition of their foreign educational credentials and work experience, under-employment, financial insecurity, and lack of mental health support networks in Canada. The participants’ sources of support included immigrant settlement agencies, schools, government subsidies, faith communities, and their extended family members outside of Canada. The data demonstrate a need to ensure expeditious assessment, and where warranted, recognition of immigrants’ foreign educational and work experience to facilitate access to their professional careers. There is also a need to establish culturally responsive supports to foster the wellbeing of immigrants.

Canadian politicians' rhetoric on Twitter/X: Analysing prejudice and inclusion towards Muslims using structural topic modelling and rhetorical analysis.

We analysed tweets from five English-speaking Canadian political parties in the year leading up to the 2019 federal election to explore both prejudicial and inclusive rhetoric in relation to Muslim identities on social media. We used structural topic modelling to understand what topics were discussed before moving to a rhetorical approach to analyse how topics were discussed. We identified 10 topics. Seven talked about Muslim groups in primarily inclusive ways, including depicting the positive contributions to Canadian society, creating ideological space for Muslim religious practices and invoking superordinate identities with victims of hate crimes to cultivate solidarity. However, the effectiveness of inclusive rhetoric was sometimes questioned due to omitting the subgroup-specific prejudice faced by Muslims. Prejudicial rhetoric occurred in three of the topics due to the nativist populist PPC party depicting Muslims as a threat to Canadian values, as hostile to people from other religious faiths, and depicting 'elites' in society as concealing the 'true' information concerning Muslims. The study contributes to understanding how politicians attempt to cultivate minority inclusion/exclusion in multicultural contexts through social media, as well as understanding the rhetoric of nativist populism in Canada and its similarities to other Global North contexts.

Making kin: Indigenous relationality in promoting public and political knowledge about religion

Religion is a problematic category when understanding the different sociopolitical dynamics that impact and influence settler Canadian identity and society. However, against the modern western struggles around religion, like that of religion and non-religion, anti-Indigenous racism and Indigenous elimination remain a constant and unifying factor of settler colonialism. Yet Indigenous knowledges are framed by what is called religion through relationality, which informs situated knowledges, the ethos and world views, and the governance of distinct yet related nations/peoples who are human and other-than-human. The problem is that discussions on the intersectional nature of religion and relationality fall short of a critical treatment. This article outlines the issues of settler colonialism in perpetrating Indigenous dispossession, and asks scholars of religion to focus on how ‘making kin’ supports a critical disruption to settler-colonial definitions of religion that promotes public and political understandings of Indigenous relational knowledges.

The ivory tower and the public realm

This essay is a response to the question of whether scholars of religion in the employ of the modern university have an obligation to help meet the challenges and threats ‘to the social order sometimes linked to aspects of religion’ raised at the 2023 annual meeting of the Canadian Society for the Study of Religion. Donald Wiebe argues here that even raising the question ignores, or reveals a failure to understand, the character and purpose of the modern university, which is the pursuit of knowledge for its own sake. The task of the professor, therefore, is simply to transmit accepted knowledge, seek out new knowledge, and confer on students the skills necessary to grow knowledge of the world and its contents. Wiebe maintains, therefore, that even considering the question amounts to an unjustifiable attempt to inflate the importance of the profession, which will result in making scholars of religion in the academy public intellectuals and departments for the study of religion a type of non-governmental organization.

“Invading Indigenous Territory is Not Reconciliation”: Problematizing War Frames in News Coverage of Wet’suwet’en Solidarity Actions

Context: Leading up to the March 2020 global COVID-19 lockdown, an important movement was building power across so-called Canada. What began as a continuation of the decades-long, localized struggle for self-determination in Wet’suwet’en territory quickly became a focal point for nationwide Indigenous resistance, refusal, and solidarity. Analysis: Drawing from literature on media framing, this article examines the use of war frames in early 2020 news depictions of mobilizations in solidarity with Wet’suwet’en. The analysis suggests that war frames are operationalized to simultaneously naturalize police violence while also validating the sovereignty of Indigenous nations. Conclusion and implications: This work contributes not only to the literature on the framing of protests by the mainstream media but also to the ongoing project of unsettling conditions of settler colonial power in Canadian society.

Homelessness and suicidality: How new emigrants confront the dilemma? Evidence from existing research conducted in Canada

Framed under systematic review design, this study aimed to extract specific evidence that how homelessness is associated with suicidality among new emigrants to Canada. Database search strategy was adopted and biasness in selection of studies was avoided by consulting with two independent reviewers. 18 studies were sampled purposively. It is concluded that migration to Canada is an important component of Canadian society. However, like other social processes there are certain cons of migration to Canada. The newly emigrated individual confronts economic vulnerability whereby homelessness is one of its outcomes. Homelessness is directly and indirectly associated with suicidality

Homelessness and suicidality: How new emigrants confront the dilemma? Evidence from existing research conducted in Canada

Framed under systematic review design, this study aimed to extract specific evidence that how homelessness is associated with suicidality among new emigrants to Canada. Database search strategy was adopted and biasness in selection of studies was avoided by consulting with two independent reviewers. 18 studies were sampled purposively. It is concluded that migration to Canada is an important component of Canadian society. However, like other social processes there are certain cons of migration to Canada. The newly emigrated individual confronts economic vulnerability whereby homelessness is one of its outcomes. Homelessness is directly and indirectly associated with suicidality

A Canadian Commentary on the NKF-ASN Task Force Recommendations on Reassessing the Inclusion of Race in Diagnosing Kidney Disease

In 2021, a committee was commissioned by the Canadian Society of Nephrology (CSN) to comment on the 2021 National Kidney Foundation (NKF)- American Society of Nephrology (ASN) Task Force recommendations on the use of race in glomerular filtration rate (GFR) estimating equations. The committee met on numerous occasions and agreed on several recommendations. However, the committee did not achieve unanimity, with a minority group disagreeing with the scope of the commentary. As a result, this report presents the viewpoint of the majority members. We endorsed many of the recommendations from the NKF-ASN Task Force, most importantly that race should be removed from the eGFR creatinine-based equation. We recommend an immediate implementation of the new CKD-EPI equation (2021), which does not discriminate among any group while maintaining precision. Additionally, we recommend that Canadian laboratories and provincial kidney organizations advocate for increased testing and access to cystatin C as the combination of cystatin C and creatinine in revised equations leads to more precise estimates. Lastly, we recommend that future research studies evaluating the implementation of the new equations and changes to screening, diagnosis, and management across provincial health programs be prioritized in Canada.

Intersectional highlighting in queer immigrants’ English learning through dating: Dominant ideologies, individual agency, and implications for second language education

Drawing on a combined framework of raciolinguistics, imagined community, and language learner agency, this article presents an ethnographic case study exploring two Chinese queer immigrants’ English learning experiences embedded in dating relationships in Canada. Applying the theoretical construct of “intersectional highlighting”, I scrutinize critical events in which racial hierarchy intersects with gendered sexual values in key participants’ dating stories and further investigate how language leaner agency plays a key role in overcoming ideological constraints in English learning processes. Findings reflect performativity in language learning, highlighting the interplay between micro-level semiotic practices of learners’ doing and talking of identities and macro-level social structures of racial, gender, and sexual ideologies circulated in Canadian society. Further, I argue for a race-centered decolonial approach in the study of racialized queer immigrants’ English learning and propose pedagogical strategies to stimulate language learner agency assisting marginalized learners navigate disadvantageous discourses in and beyond second language classrooms.

The Banff 2022 Kidney Meeting Work Plan: Data-driven refinement of the Banff Classification for renal allografts

The XVIth Banff Meeting for Allograft Pathology was held in Banff, Alberta, Canada, from September 19 to 23, 2022, as a joint meeting with the Canadian Society of Transplantation. In addition to a key focus on the impact of microvascular inflammation and biopsy-based transcript analysis on the Banff Classification, further sessions were devoted to other aspects of kidney transplant pathology, in particular T cell–mediated rejection, activity and chronicity indices, digital pathology, xenotransplantation, clinical trials, and surrogate endpoints. Although the output of these sessions has not led to any changes in the classification, the key role of Banff Working Groups in phrasing unanswered questions, and coordinating and disseminating results of investigations addressing these unanswered questions was emphasized. This paper summarizes the key Banff Meeting 2022 sessions not covered in the Banff Kidney Meeting 2022 Report paper and also provides an update on other Banff Working Group activities relevant to kidney allografts.

Climate Change and Sustainability in Kidney Care in Canada: A Knowledge, Attitudes, and Practices (KAP) Survey by the Canadian Society of Nephrology's Sustainable Nephrology Action Planning Committee

Climate Change and Sustainability in Kidney Care in Canada: A Knowledge, Attitudes, and Practices (KAP) Survey by the Canadian Society of Nephrology's Sustainable Nephrology Action Planning Committee

The Banff 2022 Kidney Meeting Report: Reappraisal of microvascular inflammation and the role of biopsy-based transcript diagnostics

The XVI-th Banff Meeting for Allograft Pathology was held at Banff, Alberta, Canada, from 19th to 23rd September 2022, as a joint meeting with the Canadian Society of Transplantation. To mark the 30th anniversary of the first Banff Classification, premeeting discussions were held on the past, present, and future of the Banff Classification. This report is a summary of the meeting highlights that were most important in terms of their effect on the Classification, including discussions around microvascular inflammation and biopsy-based transcript analysis for diagnosis. In a postmeeting survey, agreement was reached on the delineation of the following phenotypes: (1) "Probable antibody-mediated rejection (AMR)," which represents donor-specific antibodies (DSA)-positive cases with some histologic features of AMR but below current thresholds for a definitive AMR diagnosis; and (2) "Microvascular inflammation, DSA-negative and C4d-negative," a phenotype of unclear cause requiring further study, which represents cases with microvascular inflammation not explained by DSA. Although biopsy-based transcript diagnostics are considered promising and remain an integral part of the Banff Classification (limited to diagnosis of AMR), further work needs to be done to agree on the exact classifiers, thresholds, and clinical context of use.

The state of COVID-19 vaccine confidence and need in Black individuals in Canada: Understanding the role of sociodemographic factors, health literacy, conspiracy theories, traumatic stressors and racial discrimination

BackgroundBlack communities in Canada have been among the most affected by the COVID-19 pandemic, in terms of number of infections and deaths. They are also among those most hesitant about vaccination against COVID-19. However, while a few studies have documented the factors associated with COVID-19 vaccine hesitancy, those related to vaccine confidence remain unknown. To respond to this gap, this study aims to investigate factors associated to vaccine confidence in Black individuals in Canada. MethodsA total of 2002 participants (1034 women) aged 14 to 89 years old (Mean age = 29.34, SD = 10.13) completed questionnaires assessing sociodemographic information, COVID-19 vaccine confidence and need, health literacy, conspiracy beliefs, major racial discrimination, and traumatic stressors related to COVID-19. ResultsResults showed an average score of COVID-19 vaccine confidence and need of 33.27 (SD = 7.24), with no significant difference between men (33.48; SD = 7.24) and women (33.08; SD = 7.91), t (1999) = 1.19, p = 0.234. However, there were significant differences according to employment status, migration status, age, inhabited province, spoken language, education, marital status, religion, and income. The linear regression model explained 25.8 % of the variance and showed that health literacy (B = 0.12, p < 0.001) and traumatic stressors related to COVID-19 (B = 0.21, p < .001) predicted COVID-19 vaccine confidence and need positively, while conspiracy beliefs (B = −1.14, p < 0.001) and major racial discrimination (B = −0.20, p = 0.044) predicted it negatively. ConclusionsThis study showed that building the confidence of Black communities in vaccines requires health education, elimination of racial discrimination in the Canadian society and a focus on certain groups (e.g., young people, those living in Quebec and Ontario). The results also argue in favor of involving community leaders and organizations in the development and implementation of vaccination-related tools, strategies and programs by city, provincial and federal public health agencies.

The Emotional Impact and Coping Mechanisms Following Adverse Patient Events Among Canadian Vascular Surgeons and Trainees.

This study's objective is to evaluate the emotional experiences, coping mechanisms, and support resources for Canadian vascular surgeons and trainees following an adverse patient event or near miss. This is a cross-sectional survey study of all Canadian Society for Vascular Surgery (CSVS) members from October to November 2021. We collected data on participant experiences with adverse events, their emotional responses, the coping mechanisms used, and their perceptions on available support resources. The survey was sent to 233 CSVS members yielding 66 responses. The majority (77%) of respondents had experiences with adverse event causing serious patient harm. The most common negative experience following an adverse event included feelings of negativity towards oneself, general distress, and anxiety about potential for future errors. The most common coping mechanism was seeking advice from a mentor or close colleague. Peers (82%) and senior colleagues (59%) were the most preferred sources of support. Most of the respondents would reach out to a mentor if they had 1, but 30% reported no mentor or close colleague for support. Adverse patient events and near misses have serious negative impact on the lives of Canadian vascular surgeons and trainees. Peers and senior colleagues are the most desired source for support, but this is not universally available. Organized efforts are needed to bring awareness in our vascular surgery community on the ubiquitous nature and detrimental effects of adverse events.