Greater Toronto Area Research Articles

Implementation and adaptation of a hub-based psychiatric and primary care program: A qualitative descriptive analysis of The Seamless Care Optimizing the Patient Experience (SCOPE) Mental Health program.

The Seamless Care Optimizing the Patient Experience (SCOPE)-Mental Health program is a comprehensive case management and psychiatric care initiative that supports primary care physicians in independent medical practices. This program offers a range of services that aims to enhance primary care capacity for mental health and provide accessible clinical care for patients. With its flexible hub-based approach, this program allows participating sites to tailor their implementation based on their available resources and specific needs within their community. The aim of this quality improvement initiative was to investigate the evolution of this collaborative mental health model, focusing on specific site adaptations, local implementation challenges, and opportunities for ongoing development and sustainability across SCOPE sites in the Greater Toronto Area. This evaluation employed a qualitative descriptive design where semi-structured interviews, guided by the Reach Effectiveness Adoption, Implementation, and Maintenance framework were conducted with staff from all 8 SCOPE-Mental Health sites. Site representatives were interviewed virtually between March and July 2023 and data were analyzed using qualitative content analysis. The SCOPE-Mental Health model permits flexibility through specific local adaptations led by community need that leverage existing assets either at the site or within the individual community. Adoption by primary care physicians was crucial to program success and facilitated efficiency and interprofessional collaboration. Maintenance efforts included pathway refinement, and marketing and funding considerations. Challenges to program development included continuity of staff, physician compensation issues, and electronic health record interoperability. The SCOPE-Mental Health program fosters linkages among unaffiliated primary care offices, hospitals, and community-based resources to improve mental health care. Key recommendations include advocating for sustainable funding and facilitated mechanisms for psychiatric consultations. This initiative offers valuable insights for healthcare organizations seeking to develop similar programs, emphasizing the need for tailored approaches and ongoing evaluation to ensure a lasting impact in underserved communities.

Characteristics of logs with signs of oviposition by the polyphagous xylophage Asian longhorned beetle (Coleoptera: Cerambycidae).

During the eradication program undertaken against Anoplophora glabripennis (Motschulsky) in the Greater Toronto Area, information was collected on the numerous signs of injury found on wounded trees. Herein, we used a portion of this information to assess the characteristics of logs with signs of oviposition (i.e., pits). Specifically, we related the basal diameter, type (log bole vs. log branch), height above ground, and branch hierarchy level of logs with pits to tree size (i.e., height and diameter at breast height) and level of infestation intensity. In general, pits were concentrated on logs from the bole and branches that were 8-14cm in diameter in the lower 8 m of the bole and in the first 2 levels of the branching hierarchy. Oviposition pit location was strongly influenced by tree size-both height and diameter at breast height, with more pits on the lower bole in small trees and then higher on the bole and into the branches as tree size increased. As tree-level infestation intensity increased, pits were found on both larger and smaller diameter portions of the trees, presumably as preferred oviposition sites became saturated. These findings can improve the efficacy of surveillance activities for A. glabripennis.

Bicycle facilities and women's cycling frequency – An intersectional analysis of gendered travel behaviour

Bicycle facilities are a widely used sustainable transportation policy tool, but their role in mitigating gendered barriers to cycling is less studied. This paper presents the findings from an online household survey conducted in the Greater Toronto Area (GTA), Canada, focusing on 10 neighbourhoods- five with a newly constructed facility and five without. In this work, we explore how socially influenced and intersectional gendered experiences (expressed through age, employment, having children and trip-chaining) may influence commute-related cycling, in the presence or absence of bicycle facilities. Results from binomial logistic regression models indicate a higher likelihood of cycling at least once a week, for commuting purpose, amongst women who are 30–44 years old, who work part-time or are students, who have children, and who engage in trip chaining during commute, in neighbourhoods with a bicycle facility. We also found that in the absence of bicycle facilities, women’s likelihood of cycling frequently was no different than men’s. Using a feminist geography lens, we argue that the presence of new bicycle facilities potentially allowed some women to minimize the barriers they experience when cycling, including social expectations around feminine performance on streets. We show the importance of intersectional analyses in cycling research. By addressing women’s traditional gender roles, opportunities and patriarchal division of labor, transportation policy can positively influence women's participation in cycling.

What I say, or how I say it? Ethnic accents and hiring evaluations in the Greater Toronto Area

This study investigated accent bias against job applicants with extralocal (non-Canadian) English accents in the Greater Toronto Area. Verbal guises recorded by British, Chinese, German, Indian, Jamaican, and Nigerian women and by Canadian women with at least one parent from these countries were evaluated by forty-eight human resources students, who rated the content of job interview responses and the candidates’ ‘expression’ and ‘employability’, determined what job they should be interviewed for, and provided commentary. Canadian voices were especially privileged in comments on speech. Quantitative analysis of responses reflected bias against extralocal voices. Consequently, we provide recommendations for relevant stakeholders.

The Risk Perception of the Chinese Diaspora during the COVID-19 Pandemic: Targeting Cognitive Dissonance through Storytelling.

The global COVID-19 pandemic in 2020 required risk communications to mitigate the virus' spread. However, social media not only conveyed health information to minimize the contagion, but also distracted from the threat by linking it to an externalized 'other'-primarily those appearing to be of Chinese descent. This disinformation caused the attribution of blame to Chinese people worldwide. In Canada's Greater Toronto Area, Chinese individuals reported widespread public stigma that compounded their risk of contagion; to the degree that it was driven by cognitive dissonance, it generated experiences of social and cultural vulnerability. In this paper, we draw on the aforementioned study's findings to explain how the risk perception and threat appraisal of Chinese diaspora individuals were impacted by different cognitive dissonance pathways. These findings explore how storytelling is a viable intervention with which to target and mitigate cognitive dissonance. Indeed, the mechanisms of cognitive dissonance can modify risk perception and mitigate social and cultural vulnerability, thereby averting potential long-term negative consequences for one's mental health and well-being. We hope our guidance, training educators to target pathways of cognitive dissonance by drawing on storytelling (with humour), can assist them to better convey information in ways that are more inclusive during public health emergencies.

Anti-Black Medical Gaslighting in Healthcare: Experiences of Black Women in Canada.

Stereotype about Black people contribute to nurses and healthcare providers gaslighting and dismissing of their health concerns. Despite the popularity of the term medical gaslighting in mainstream literature, few studies have explored the experiences of Black women during pregnancy and childbirth. This paper aims to provide an in-depth insight into Black women's experiences of anti-Black medical gaslighting when accessing care during pregnancy and childbirth. Utilizing qualitative methods, we conducted 24 semi-structured interviews with Black women in the Greater Toronto Area. We used thematic analysis to ground the data analysis and to generate insight into Black women's experiences. Three overarching themes: 1) Not Being Understood: Privileging of Medical Knowledge Contributing to the Downplaying of Health Concerns, 2) Not Being Believed: Stereotypes Contributing to Dismissive Healthcare Encounters and 3) Listen to Us: Turning off the Cycle of Medical Gaslighting. These themes highlight ways anti-Black medical gaslighting manifests in Black women's healthcare encounters to create differential access to treatment and care. Anti-Black medical gaslighting contributes to differential access to treatment and care. Improving equitable access to treatment and care must involve addressing structural and epistemic biases in healthcare and fostering a culture of listening to humanize the experience of illness.

Understanding the Risk of Social Vulnerability for the Chinese Diaspora during the COVID-19 Pandemic: A Model Driving Risk Perception and Threat Appraisal of Risk Communication-A Qualitative Study.

During the first wave of the COVID-19 pandemic, immigrants were among the most socially vulnerable in Western countries. The Chinese diaspora in Canada were one such group due to the widespread cultural stigma surrounding their purported greater susceptibility to transmit and become infected by COVID-19. This paper aims to understand the social vulnerability of the Chinese diaspora in the Greater Toronto Area, Canada, during the first wave of COVID-19 from an explanation of their risk perception and threat appraisal of risk communication. We conducted secondary data analysis of 36 interviews using critical realism. The participants self-identified as being of Chinese descent. The results were used to develop a model of how social vulnerability occurred. In brief, cognitive dissonance was discovered to generate conflicts of one's cultural identity, shaped by social structures of (i) stigma of contagion, (ii) ethnic stigma, and (iii) public sentiment, and mediated by participants' threat appraisal and (iv) self-reliance. We assert that risk communicators need to consider their audiences' diverse socialization in crafting messages to modify behaviors, create a sense of responsibility, and mitigate public health threats. A lack of awareness of one's cognitive dissonance driven by cultural vulnerability may heighten their social vulnerability and prevent them from taking action to protect themself from high-risk events.

Invisible Wounds: Exploring the Coping Strategies of Black Survivors of Homicide Victims in Canada.

Canada has experienced a steady increase in homicide. Specifically, out of the 10 provinces and 3 territories, Ontario has consistently experienced the highest number of homicides, the majority concentrated within predominantly African, Caribbean, and Black (ACB) communities in the Greater Toronto Area (GTA). Despite this disproportionate reality, there is limited research on the ways in which survivors of homicide victims cope with the murder of their loved ones. This article explores the identification and characterization of coping strategies for ACB survivors of homicide victims residing in five neighbourhoods in the GTA. Participants in this study provided their insights and experiences, highlighting the coping mechanisms employed, the influence of cultural identity, and the challenges they experienced in accessing adequate care following the death of their loved ones. Implications for future research, policy and practice are discussed.

Impact of childhood nephrotic syndrome on obesity and growth: a prospective cohort study.

Children with nephrotic syndrome are at risk of obesity and growth impairment from repeated steroid treatment. However, incidence and risk factors for obesity and short stature remain uncertain, which is a barrier to preventative care. Our aim was to determine risk, timing, and predictors of obesity and short stature among children with nephrotic syndrome. We evaluated obesity and longitudinal growth among children (1-18years) enrolled in Insight into Nephrotic Syndrome: Investigating Genes, Health, and Therapeutics. We included children with nephrotic syndrome diagnosed between 1996-2019 from the Greater Toronto Area, Canada, excluding congenital or secondary nephrotic syndrome. Primary outcomes were obesity (body mass index Z-score ≥ + 2) and short stature (height Z-score ≤ -2). We evaluated prevalence of obesity and short stature at enrolment (< 1-year from diagnosis) and incidence during follow-up. Cox proportional hazards models determined the association between nephrotic syndrome classification and new-onset obesity and short stature. We included 531 children with nephrotic syndrome (30% frequently relapsing by 1-year). At enrolment, obesity prevalence was 23.5%, 51.8% were overweight, and 4.9% had short stature. Cumulative incidence of new-onset obesity and short stature over median 4.1-year follow-up was 17.7% and 3.3% respectively. Children with frequently relapsing or steroid dependent nephrotic syndrome within 1-year of diagnosis were at increased risk of new-onset short stature (unadjusted hazard ratio 3.99, 95%CI 1.26-12.62) but not obesity (adjusted hazard ratio 1.56, 95%CI 0.95-2.56). Children with ≥ 7 and ≥ 15 total relapses were more likely to develop obesity and short stature, respectively. Obesity is common among children with nephrotic syndrome early after diagnosis. Although short stature was uncommon overall, children with frequently relapsing or steroid dependent disease are at increased risk of developing short stature. Effective relapse prevention may reduce steroid toxicity and the risk of developing obesity or short stature.

“If I Do not Go to Work, They Will Die!” Dual Roles of Older-Adult Personal Support Workers’ Contributions During the COVID-19 Pandemic

AbstractWhen COVID-19 devastated older-adult organizations (long-term care homes and retirement homes), most public attention was directed toward the older-adult residents rather than their service providers. This was especially true in the case of personal support workers, some of whom are over the age of 55, putting them in two separate categories in the COVID-19 settings: (1) a vulnerable and marginalized group who are disproportionately impacted by COVID-19; and (2) essential healthcare workers. Since the current disaster-driven research, practice, and policy have primarily focused on generalized assumptions that older-adults are a vulnerable, passive, and dependent group rather than recognizing their diversity, expertise, assets, and experiences, this study aimed to identify their contributions from the perspective of older-adult personal support worker (OAPSW). This qualitative study conducted in-depth interviews, inviting 15 OAPSWs from the Greater Toronto Area, Canada. This study uncovered the OAPSWs’ contribution at three levels: individual (enhancing physical health, mental health, and overall well-being), work (improving working environment and service and supporting co-workers), and family (protecting their nuclear and extended families). The outcomes inform the older-adult research, practice, policy, public discourse, and education by enhancing the appreciation of older-adults’ diverse strengths and promoting their engagement and contributions in disaster settings.

Ethnic background and distribution of clinical phenotypes in patients with probable progressive supranuclear palsy

BackgroundProgressive Supranuclear Palsy (PSP) is a sporadic neurodegenerative disease without a clear geographic prevalence. Cohorts studied in the UK and India showed no higher prevalence of atypical parkinsonism in South Asian patients. We describe the ethnic and racial background of PSP patients in the Greater Toronto Area (GTA), Canada. MethodsA prospective observational study of patients with clinically probable PSP evaluated at the dedicated Rossy PSP program. Demographic and clinical data were collected at baseline including PSP phenotype. Results were compared with the latest demographic information from the greater Toronto area. ResultsOf the 197 patients screened, 135 had probable PSP and resided within the GTA. The mean age at visit was 71.1 years, disease duration 4.4 years, and disease severity moderate. Compared to our catchment area, there was a higher proportion of patients with a South Asian origin and a lower proportion of patients from East and Southeastern Asia and Africa. A secondary analysis using population census data limited to individuals greater than 65 confirmed the significantly higher representation of South Asians in our clinic but found no differences for other racial and ethnic origins. ConclusionEvaluation of this Toronto cohort found a greater than expected proportion of affected individuals with South Asian ethnic and racial origin. Despite limitations, our results suggest the possibility of a racial and ethnic predisposition to PSP. Further studies are needed to confirm and to address potential associated risk factors, and genome-environmental interactions.

Perturbation of Residential Preferences by COVID-19 Shocks in the Greater Toronto Area

This research investigates the immediate effects of the COVID-19 pandemic on residential preferences in the Greater Toronto Area (GTA), Canada, using a stated preference (SP) survey dataset. The study examines changes in relocation preferences and trends in the GTA after the Ontario government lifted the initial lockdown. The obtained choice data is then modeled using a mixed cross-nested logit model to find substitution patterns across regions and dwelling types, as well as explore residents’ preferences for different dwelling characteristics and the accessibility of their residence, including factors such as telecommuting options. The results reveal that the pandemic caused short-term residential dissonance, with residents tending to want to move to lower-density areas to relocate to their preferred dwelling type, emphasizing telecommuting as a key factor influencing residential relocation preferences. Housing qualities were prioritized over accessibility. The study also found heterogeneous behavior among GTA residents with regard to telecommuting as a factor in residential relocation. The study’s findings are relevant for planners and policymakers in anticipating the potential long-term pandemic-induced home relocation decisions and their impact on future household travel behavior, particularly with regard to telecommuting and accessibility.

Auditing and Analysis of Natural Gas Consumptions in Small- and Medium-Sized Industrial Facilities in the Greater Toronto Area for Energy Conservation Opportunities

This paper presents the findings of fifteen energy audits conducted on industrial sites in Canada’s Greater Toronto Area (GTA). The audits covered a range of industries including food processing, packaged goods, and finishing processes (powder-coating). The primary focus of the audits was to analyze the natural gas consumption and the performance of major-gas-consuming equipment. The audits identified natural-gas-consuming equipment that could be optimized to yield energy and operational cost savings and greenhouse gas (GHG) reduction opportunities. Food production plants’ energy intensity ranges from 5.59 m3/ft2 to 17.73 m3/ft2. Therefore, there is a significant opportunity to improve energy consumption through better technology integration. The results of the audits indicate a trend of an increase in the percentage of non-productive consumption with non-productive time. The proposed energy-saving measures include reducing non-productive natural gas consumption, gas-fired equipment tune-up, optimizing boiler loads, and reducing oven exhaust by using variable frequency drives (VFDs). The findings of this study could be used to develop a demand-side management program specifically for small- and medium-sized industrial facilities in the Greater Toronto Area and other parts of Canada.

Reducing falls among residents of retirement homes: A DNP project.

Falls among older adults (OAs) living in retirement homes (RHs) in Canada are a major public health concern due to high morbidity and mortality as well as significant healthcare expenditures. This quality improvement (QI) initiative, conducted for the author's Doctor of Nursing Practice (DNP) project, aimed to decrease fall rates and ED transfers related to falls among OAs in six RHs across the Greater Toronto Area in Ontario, Canada through a multipart intervention with two primary goals. First, the project aimed to facilitate RH NPs' implementation of a comprehensive fall risk assessment and fall prevention strategy in their practice by incorporating the Stopping Elderly Accidents, Deaths & Injuries (STEADI) toolkit into their armamentarium. Second, it sought to enhance the knowledge of the RHs' registered practical nurses (RPNs), personal support workers (PSWs), and unregulated care providers (UCPs) in assessing fall risk and incorporating fall prevention strategies in their daily practice. By improving NP, RPN, PSW, and UCP knowledge and increasing (by 20%) RPN, PSW, and UCP use of fall prevention strategies, this QI initiative successfully reduced fall rates in the RHs by 40.4%, with no falls requiring transfer to the ED, in the postintervention period. The results of this project highlight the need for an interdisciplinary approach to fall risk reduction in RHs that includes implementation of multifactorial intervention strategies as well as effective organizational policies and procedures for maximum impact.

The Safety and Efficacy of a “No Touch” Abortion Program Implemented in the Greater Toronto Area During the COVID-19 Pandemic

ObjectivesTo evaluate the safety and efficacy of first-trimester “No Touch” medication abortion programs at 2 clinics in Toronto, Ontario during their early implementation in response to the COVID-19 pandemic. MethodsThis retrospective study included all patients who underwent virtual consultation for mifepristone-misoprostol medication abortion between April 2020–August 2022 at 2 reproductive health clinics. In response to the pandemic, “No Touch” abortion protocols have been developed that align with the Canadian Protocol for the Provision of Medical Abortion via Telemedicine. Records were reviewed for demographic information, clinical course, investigations required, confirmation of complete abortion and adverse events. The primary outcome was complete medication abortion, defined as expulsion of the pregnancy without requiring uterine aspiration. ResultsA total of 277 patients had abortions initiated in the “No Touch” or “Low Touch” care pathways and had sufficient follow-up to determine outcomes. Of these patients, 92.8% (95% CI 89.7%–95.8%) had a complete medication abortion (n = 257) and 76.1% (n = 159) remained “No Touch” throughout their care. Investigations were performed for 102 participants before or after their abortion, classifying them as “Low Touch”. Nineteen patients (6.9%) underwent uterine aspiration. The rate of adverse events was low, with 1 case of a missed ectopic pregnancy and 1 patient requiring hospitalization for endometritis. Conclusions“No Touch” provision of mifepristone-misoprostol medication abortion care was safe and effective with outcomes comparable to previous studies. These results provide evidence for the efficacy and safety of a “No Touch” approach in the Canadian context, which has the potential to reduce barriers to accessing abortion care.

Prescription Trends of Thiazide Diuretics in a Canadian Primary Care Population From 2015 to 2021

BackgroundHypertension Canada 2017 guidelines favoured the use of thiazide (TZ)-like diuretics, such as CLTD (chlorthalidone) and indapamide (IND) over hydrochlorothiazide (HCTZ). Health Canada warned in 2019 that HCTZ may be associated with increased risk of skin cancer. Our study looked at the changes in TZ prescriptions from 2015 to 2021 in Ontario, Canada. MethodsA retrospective cohort study was conducted of adults with hypertension, using electronic medical record data from the University of Toronto Practice-Based Research Network database covering mostly the Greater Toronto area. Outcomes included the proportion of patients who received a prescription of HCTZ, CLTD, or IND each month. Interrupted time-series analysis was used to evaluate the change in outcomes after publication of the 2017 guidelines and 2019 safety warning. Prescription trends were stratified by prescribing physicians’ sex and year of medical school graduation. ResultsA total of 100,428 patients with hypertension were included in the cohort, with 31,700 patients who received at least one TZ prescription from 343 family physicians. We found a declining trend in HCTZ prescriptions over time, accompanied by an increase in IND and CLTD prescriptions, with statistically significant but transient changes in prescription rates after publication of the 2017 guidelines and the 2019 safety warning for all 3 medications. Female physician and early-career physician prescription rates changed faster than that of their counterparts immediately after the Health Canada safety warning was issued. ConclusionsTZ diuretic prescription patterns have changed in recent years, but Hypertension Canada’s 2017 guidelines and the 2019 Health Canada safety warning did not have a sustained significant impact on the change in prescription rates of HCTZ, IND, and CLTD.

Pilot study: Occupational and public health consequences of elevated temperatures in restaurant kitchens

Restaurant kitchens are relatively warm and can be made even warmer when the outdoor temperature is excessive. Hot indoor conditions can lead to workers experiencing health effects such as heat stress as well as negatively impact food storage and food cooling. This study’s objective was to simultaneously identify potential occupational health and public health effects inside restaurant kitchens due to warm conditions. Wet Bulb Globe Temperature (WBGT) measurements were collected and the results were compared to the corresponding Threshold Limit Value and Action Limit. Internal temperatures of refrigerators and freezers were gathered and observations were made of any food being held inside the kitchen. Eight premises in the Greater Toronto Area were included in this study. Five of the sites had average WBGT values at or above the Action Limit, which is when heat stress management programs are recommended. Most sites had refrigerators operating over the required 4°C and three sites had freezers operating above the requisite −18°C. Food was observed to be held at temperatures that can promote bacterial growth in 50% of the sites. This study found that hot kitchen environments could result in both heat stress conditions as well as compromise cold food storage and food holding.

Cross-sectional study to assess the impact of the COVID-19 pandemic on healthcare services and clinical admissions using statistical analysis and discovering hotspots in three regions of the Greater Toronto Area

ObjectivesThe COVID-19 pandemic disrupted healthcare services, leading to the cancellation of non-urgent tests, screenings and procedures, a shift towards remote consultations, stalled childhood immunisations and clinic closures which had detrimental...

Modeling of construction vibration impacts in transit project applications

This presentation explores some of the challenges related to predicting the vibration impact from construction activities associated with new mass transit infrastructure. Pre-construction assessment methods are examined and compared against as-measured construction vibration monitoring data. Practical considerations and limitations of construction vibration monitoring are also discussed, citing examples, and insight from the ongoing projects, especially in the Greater Toronto Area.

Changes in Shared Decision-Making Roles and Perceived Stress in Syrian Refugee Parents Resettled in the Greater Toronto Area

This study explored changes in shared decision-making roles (day-to-day, financial, and major life decisions) and their relationships to perceived stress among 148 Syrian refugee parents after resettling in Toronto using a generalized estimated equation model. Parents were categorized as “towards shared” decision-making for 20.3%, 23.0%, and 21.6% of day-to-day, major life, and financial decisions, respectively. In families where both parents were unemployed, those who “always shared” making financial decisions had significantly lower perceived stress than those “towards shared” (p = .02). Understanding the cultural contexts of gender roles and the impact of acculturation may help promote better post-migration strategies.