Margin Index Research Articles

Experiences of Undergraduate Male Students in Nursing: On the Outside Looking in.

Measures to improve gender diversity of the profession have yielded only a modicum of progress. To investigate the relationship between marginalization and gender minorities in baccalaureate nursing programs in the United States. A descriptive cross-sectional study compared self-reported marginalization in male and female baccalaureate nursing students. The sample was drawn from the American Association of Colleges of Nursing database of US baccalaureate nursing programs, and the Englund Marginality Index (EMI) was used to measure marginalization, along with a demographic survey. In the study, 6480 full-time baccalaureate students from a traditional face-to-face nursing program in the United States participated. The results show that male participants had higher EMI scores (mean = 40.0, SD = 9.1) compared with female nursing students (mean = 35.1, SD = 9.0); t(6478) = 14.9, P < .001. Marginalizing behaviors must not be tolerated or promulgated. More needs to be done to better support and integrate men into nursing programs as they bring forth a unique perspective and skill set to the profession.

Fault diagnosis of air compressor set-up using decision tree based J48 classification algorithm

This paper describes an air compressor fault diagnosis method based on the acquisition of audio signals pertaining to seven faulty and one healthy condition. These audio signals are processed using Local Mean Decomposition (LMD) signal processing technique. Further, statistical indicators have been evaluated for feature extraction considering the decomposed signals. From different statistical indictors mean, variance, root mean square (RMS), root mean amplitude (RMA), absolute mean amplitude (AMA), kurtosis, peak to peak index, waveform index, peak index, impulse index, margin index, skewness, Shannon entropy, standard deviation, log energy entropy, log detector and CPT has been selected for decision tree based J48 classification algorithm. Decision tree based J48 classification algorithm more accurately identified healthy and faulty bearing state in an air compressor with the help of all statistical indicators. Data set consists of 360 instances having 17 attributes with 2 classes (healthy and bearing fault). Higher classification accuracy of J48 algorithm (96.66 %) has been obtained for healthy and faulty bearing conditions. LMD along with decision tree based J48 classification algorithm is quite suitable for processing and monitoring in situ fault features in air compressor set-up.

Performance of posterior third-generation monolithic zirconia crowns in a complete digital workflow: A three-year prospective clinical study

Background/purposeTranslucent monolithic zirconia restorations have recently introduced. The purpose of this study was to evaluate the clinical behavior and the survival rate of the posterior third-generation monolithic zirconia crowns (MZCs) during three years of clinical service. Materials and methodsTwenty-four patients who needed thirty crowns were enrolled in this study. Digital impressions were made, and the crowns were milled and cemented with a resin cement. The crowns outcomes were assessed using the California Dental Association's (CDA) criteria. Gingival index (GI), plaque index (PI), and periodontal probing depth (PPD) for MZCs and contralateral natural teeth (control) were assessed. Margin index (MI) for MZCs was also assessed. Data analysis was conducted using the Wilcoxon signed-rank and the Friedman tests. ResultsThe 3-year survival rate was 100%. All MZCs were rated as satisfactory throughout the follow-up period, and no biological or mechanical complications were observed. No differences were recorded when GI, PI and PPD at 3-year of follow-up were compared to baseline. No differences were recorded between crowned and control teeth. The MI remained stable throughout the study period. ConclusionThe third-generation monolithic zirconia appears to be a good treatment option for the rehabilitation of posterior single teeth.

Uneven Distribution of Urban Green Spaces in Relation to Marginalization in Mexico City

The present study examines the spatial distribution and level of accessibility of urban green spaces (UGSs) within the context of Mexico City, with a particular focus on their relationship with marginalization. The study examined five distinct categories of UGSs based on their size and subsequently analyzed their total surface area per capita in relation to their correlation with the marginalization index. The data were subjected to descriptive statistical analysis, and correlations were computed to investigate the relationships between variables. We found 1353 UGSs accessible for public use with a total area of 2643 ha. Seventy-four percent of them had &lt;1 ha of surface area, and 51% were located in only three municipalities that were mostly middle- and high-income. These municipalities concentrated a higher area of green spaces per capita. We found a negative correlation between the marginality index and the area of UGSs per municipality; the lower the marginality index was, the higher the area of green spaces. These results suggest that a bad distribution of UGSs can increase environmental injustice since urban environmental services are unequally distributed, affecting particularly marginalized populations. This research is a valuable contribution to the existing body of knowledge regarding the accessibility of UGSs in Mexico City, particularly in connection to marginalized communities. It emphasizes the significance of this topic in the context of environmental justice, urban sustainability, and the formulation of urban policy decisions. By engaging with these concerns, individuals can strive to foster a city that promotes fairness and well-being for all of its residents.

Corporate Fraud, Earnings Management and Firm Value: Empirical Application of M-Scores

Background: Corporate fraud and earnings management have been controversial and discussed extensively in the literature, as companies consider the practices strategic and creative to keep their companies afloat and sustain a desired firm value. While this unethical practice has remained illegal, unethical and a global concern, the trajectory to higher incentives by executives to insider dealings to keep the stock price attractive by managers is unacceptable, this study provides new insight and implications of corporate fraud and earnings management on firm value. Objective: This paper investigates the effect of corporate fraud and earnings management on firm value from the perspective of the application of Beneish M-Score manipulation and probability index as indicators to detect corporate fraud and earnings management on Tobin’s Q as a surrogate of firm value The main aim is to establish the consequence of corporate fraud and earnings management on firm value and highlights the forms of corporate fraud and earnings management, stakeholders concerns and unattractiveness of fraud corporate in whatever capacity. Method: Using descriptive statistics and inferential analysis, the study provides evidence that leverage index, sales growth and sales and administrative expense exerted positive effects and channels for corporate fraud and earning management of the selected Nigerian-listed consumer goods manufacturing companies. We found that while each of the day’s sales trade receivables index, assets quality index, leverage index and sales growth quality index exerted positive effects, the gross margin index, depreciation index and total accruals to total index exhibited negative insignificant effects. However, the joint attributes of corporate fraud and earnings management had a positive significant effect on Tobin’s Q as a firm value surrogate Our Conclusion: The study contributing to knowledge, provides new empirical evidence of the application of the Beneish M-Score model as a novelty to the probability incentive for corporate fraud and earnings management in the companies examined.

Psychometric Validity of the Areas of Work Life Scale (AWS) in Teachers and Healthcare Workers in México.

The areas of work life scale (AWS) has shown to be a suitable marker of perceived fit between employees' abilities and the psychosocial demands of the job, but validation studies are practically nonexistent in the Latino population. The purpose of this study was twofold: firstly, to examine the factor structure, reliability, and invariance between sex and occupation of the AWS scale, and secondly, to test the AWS-burnout relationship within the framework of the structural mediational model proposed by Leiter and Maslach (2005). N = 305 health workers and N = 324 teachers from different work settings answered the AWS and MBI-GS scales. In this study, 64.4% of the participants were females (N = 405), and the mean age was 34.7 (sd = 11.7, rank = 56). Robust methods for statistical analyses were used. The results showed that the original version had marginal fit indices due to a method effect (negative phrasing items), and when seven negative items were removed, a final best model was found (CFI = 0.997; RMSEA = 0.060; SRMRu = 0.047). Non-invariance between occupation and sex was found, and the internal consistency was from marginal to satisfactory (ω = 0.658 to 0.840). The mediational structural model tested confirmed the expected associations between AWS and burnout. In conclusion, the Mexican translation of the AWS in its 22-reduced version showed reliability and validity in Mexican work contexts, specifically in healthcare workers and teachers.

Research on gearbox fault detection model based on ridge regression and decision tree

Gearbox is widely used in mechanical equipment and plays an important role in mechanical transmission. Therefore, it is necessary to detect and diagnose the fault of the gearbox in time. This paper needs to establish a fault detection model of the gearbox to detect whether the gearbox is in a fault state. Because the result can only be yes or no, the ridge regression model is first established. However, because the difference between the original sample data is not obvious, the accuracy of the obtained ridge regression model is low. Therefore, this study extracts the features of the data of the four parts, and defines five indicators: effective value, pulse index, skewness index, margin index and kurtosis index. The decision tree model is established with 70 % of the sample data. Firstly, the depth of the largest tree is set to 5. Secondly, the importance of the feature is determined according to the size of the Gini value, and the fault detection decision tree model is constructed. Finally, the model is tested with 30 % of the test data, and the accuracy is 91.17 %. The precision rate is 88.9 %, and the recall rate is 94.12 %. It is considered that the model is more reliable.

A Critical Minority: The Marginalization of Male Faculty in Nursing Academia.

The purpose of this study was to investigate the relationship between gender and marginalization in nursing academia. Men continue to be significantly underrepresented in nursing academia because they experience numerous barriers to their integration and success in the profession. A descriptive cross-sectional design was implemented in this pilot study to investigate differences in perceived marginalization between male versus female faculty teaching in Commission on Collegiate Nursing Education-accredited colleges. Marginality was measured using the Englund Marginality Index (EMI). Male nursing faculty participants reported higher scores on the EMI ( M = 43.6, SD = 9.9) than female faculty ( M = 37.2, SD = 9.6), t (1428) = 6.0, p < .001. As the nursing faculty shortage continues to increase, it is imperative that leaders in nursing education steer their efforts toward attracting a more robust and diverse faculty population.

COVID-19 case rates, spatial mobility, and neighbourhood socioeconomic characteristics in Toronto: a spatial-temporal analysis.

This study has two primary research objectives: (1) to investigate the spatial clustering pattern of mobility reductions and COVID-19 cases in Toronto and their relationships with marginalized populations, and (2) to identify the most relevant socioeconomic characteristics that relate to human mobility and COVID-19 case rates in Toronto's neighbourhoods during five distinct time periods of the pandemic. Using a spatial-quantitative approach, we combined hot spot analyses, Pearson correlation analyses, and Wilcoxon two-sample tests to analyze datasets including COVID-19 cases, a mobile device-derived indicator measuring neighbourhood-level time away from home (i.e., mobility), and socioeconomic data from 2016 census and Ontario Marginalization Index. Temporal variations among pandemic phases were examined as well. The paper identified important spatial clustering patterns of mobility reductions and COVID-19 cases in Toronto, as well as their relationships with marginalized populations. COVID-19 hot spots were in more materially deprived neighbourhood clusters that had more essential workers and people who spent more time away from home. While the spatial pattern of clusters of COVID-19 cases and mobility shifted slightly over time, the group socioeconomic characteristics that clusters shared remained similar in all but the first time period. A series of maps and visualizations were created to highlight the dynamic spatiotemporal patterns. Toronto's neighbourhoods have experienced the COVID-19 pandemic in significantly different ways, with hot spots of COVID-19 cases occurring in more materially and racially marginalized communities that are less likely to reduce their mobility. The study provides solid evidence in a Canadian context to enhance policy making and provide a deeper understanding of the social determinants of health in Toronto during the COVID-19 pandemic.

Optimal Scheduling of Power Systems with High Proportions of Renewable Energy Accounting for Operational Flexibility

The volatility and uncertainty of high-penetration renewable energy pose significant challenges to the stability of the power system. Current research often fails to consider the insufficient system flexibility during real-time scheduling. To address this issue, this paper proposes a flexibility scheduling method for high-penetration renewable energy power systems that considers flexibility index constraints. Firstly, a quantification method for flexibility resources and demands is introduced. Then, considering the constraint of the flexibility margin index, optimization scheduling strategies for different time scales, including day-ahead scheduling and intra-day scheduling, are developed with the objective of minimizing total operational costs. The intra-day optimization is divided into 15 min and 1 min time scales, to meet the flexibility requirements of different time scales in the power system. Finally, through simulation studies, the proposed strategy is validated to enhance the system’s flexibility and economic performance. The daily operating costs are reduced by 3.1%, and the wind curtailment rate is reduced by 4.7%. The proposed strategy not only considers the economic efficiency of day-ahead scheduling but also ensures a sufficient margin to cope with the uncertainty of intra-day renewable energy fluctuations.

“You should brush your teeth better”: a randomized controlled trial comparing best-possible versus as-usual toothbrushing

BackgroundMost people’s tooth brushing performance is deficient, even when they are encouraged to brush to the best of their abilities. The aim of the present study was to explore the nature of this deficit by comparing best-possible vs. as-usual brushing.MethodsUniversity students (N = 111) were randomly assigned to receive one of two instructions: “brush your teeth as usual” (AU-instruction) or “brush your teeth to the best of your abilities” (BP-instruction). Video analyses assessed brushing performance. The marginal plaque index (MPI) assessed after brushing was used as an indicator of brushing effectiveness. A questionnaire assessed subjectively perceived oral cleanliness (SPOC).ResultsParticipants in the BP group brushed their teeth longer (p = 0.008, d = 0.57) and used interdental devices more often (p < 0.001). No group differences emerged in the distribution of brushing time among surfaces, the percentage of brushing techniques used beyond horizontal scrubbing, or the appropriate use of interdental devices (all p > 0.16, all d < 0.30). Plaque persisted at the majority of the sections of the gingival margins, and the groups did not differ in this respect (p = 0.15; d = 0.22). SPOC values in the BP group were higher than those in the AU group (p = 0.006; d = 0.54). Both groups overestimated their actual oral cleanliness by approximately twofold.ConclusionsCompared to their usual brushing effort, study participants increased their effort when asked to brush their teeth in the best possible manner. However, that increase in effort was ineffective in terms of oral cleanliness. The results indicate that people’s concept of optimized brushing refers to quantitative aspects (e.g., longer duration, more interdental hygiene) rather than qualitative aspects (e.g., considering inner surfaces and gingival margins, appropriate use of dental floss).Trial registrationThe study was registered in the appropriate national register (www.drks.de; ID: DRKS00017812; date of registration: 27/08/2019 - retrospectively registered).

Conflicts in the land of tequila: a geographical approach to the socio-spatial challenges in Guadalajara

The global population faces a series of emerging conflicts related to marginalization and insecurity. The Mexican population also presents these signs as a result of the growing economic inequality that exacerbates social tensions whose evidence is the increase in violence and crime. Hence, the objective was to synthesize the problems presented by the Guadalajara Metropolitan Area (ZMG) between 2010 and 2019 regarding the degree of marginalization of its population from the point of view of geography. Methodology considered office work for the selection of publication that address the topics: indicators of marginalization and insecurity, complemented by field work such as the three exploratory tours in the area during 2017-2019. The results were: a) map of the ZMG and its conurbation in 2019; b) distribution of marginalization in the ZMG related to the type of road in 2019 and c) the degree of marginalization in relation to the location of the central municipalities and those outside the study area. Therefore, the conclusions were: 1) between 2010 and 2019 the standard of living of the ZMG population decreased since the marginalization index went from being mostly low to medium and 2) the public policies implemented between 2010-2019 failed to break with the delays and insecurity among the population residing in the ZMG, a trend that was consolidated at the national level.

Impact of Neighborhood Social Deprivation on Health Care Costs Associated With TAVR

BACKGROUND: Cumulative costs of transcatheter aortic valve replacement (TAVR) differ in the referral, procedural and postprocedural phases depending on patient comorbidities, type of procedure, and procedural complications. Our goal was to determine the association between neighborhood measures of social deprivation and TAVR costs in each of the 3 phases. METHODS: Demographics, patient comorbidities, procedural details, in-hospital complications, and costs for adults undergoing TAVR between 2017 and 2020 in Ontario, Canada were obtained from administrative databases and linked to social deprivation data using the Ontario Marginalization Index. The 3 dimensions of social deprivation assessed were (1) material deprivation, (2) residential instability, and (3) ethnic concentration. Hierarchical generalized linear models were used to determine the association between neighborhood social deprivation and cumulative TAVR costs, reported in 2018 Canadian dollars. RESULTS: We identified a total of 7617 TAVR referrals with 3784 patients undergoing TAVR within our study period. Cumulative mean costs in the referral, procedural and postprocedural phases were $8116±$11 374, $32 790±$17 766, and $18 901±$32 490, respectively. After adjustment for clinical and demographic variables, higher factor scores in residential instability were associated with greater cumulative costs in the postprocedural phase, whereas higher factor scores in the other 2 dimensions of marginalization were not significantly associated with higher costs in any of the 3 phases. CONCLUSIONS: This analysis shows that residential instability is associated with higher cumulative costs in the postprocedural phase of TAVR. This lays the foundation for future studies to understand the mechanism of this finding and identify potential mitigation policies.

Optimal EV scheduling and voltage security via an online bi-layer steady-state assessment method considering uncertainties

Steady-state voltage security region (SVSR) is an important criterion that can intuitively and effectively evaluate the power system's operation security and overall safety margin. However, there is no literature on its application to electric vehicle (EV) proliferation. Since EV introduces dynamism and uncertainties to the grid, most existing indices cannot assess the grid accurately. Given this, we propose a load margin index (LMI) based on SVSR considering uncertainties. This is used to assess the impact of EV proliferation via a bi-layer optimal EV scheduling model. The upper layer of the model solves a dispatching plan for EV aggregators (EVA) by maximizing the LMI and minimizing the deviation between the upper and lower layer power schedules. The lower layer models each EV's charging/discharging strategy by minimizing the EV's operating cost, the EV user's target residual energy, and the deviation between the lower and upper layer schedules. We also employ a real-time scheduling plan to further adjust the day-ahead scheduling due to forecast errors. A case study based on the IEEE-33 node distribution network verifies the practicability and effectiveness of the proposed method.

#3144 KIDNEY TRANSPLANT-RELATED KNOWLEDGE AMONG SOUTH ASIAN COMPARED TO WHITE CANADIAN PATIENTS

Abstract Background and Aims Kidney transplant (KT) is the best treatment for many patients with kidney failure. However, patients from racialized communities are less likely to receive KT. Gaps in transplant-related knowledge may be one of the potential reasons for the observed inequities in accessing KT. Here we compare patient characteristics and KT-related knowledge between South Asian (SA) versus white Canadians with kidney failure using the “Knowledge Assessment of Renal Transplantation” (KART) questionnaire. Method Secondary analysis of data from a cross-sectional convenience sample of white and SA adults with kidney failure. Sociodemographic data, self-reported information about racialized status and KART score were collected through electronic data capture. The association between racialized status and participant demographics were assessed using ANOVA, Kruskal–Wallis test or chi squared test, as appropriate. The independent association between racialized status and KART scores was assessed by multivariable adjusted linear or multinomial logistic regression, with adjustment for immigration status, age, marital status, education, gender, Ontario Marginalization Index material deprivation quintile, Charlson Comorbidity Index and ethnicity. Results Among 578 participants (mean [SD] age: 57 [14] years, 64% male), 43% were white and 16% were SA. 84% vs 27% of SA vs white participants were immigrants. The Charlson Comorbidity Index score was &amp;gt;=4 for of 31[40%] SA vs 105[51%] white participants (p&amp;lt;0.001). The median (interquartile range) KART score of white vs SA participants was 17[6] vs 14[7] (p&amp;lt;0.001). In a univariable linear regression model the KART score was significantly associated with SA status (B: -3.27 ([95% CI]: -4.76, -1.77, p&amp;lt;0.001). This association remained significant after adjustment for potential confounding (B: -3.36 ([95% CI]: -5.05, -1.67, p&amp;lt;0.001) (Table 1). 26% of SA vs. 41% of white participants scored in the highest tertile for KART score (p&amp;lt;0.001) (Fig. 1). The relative risk ratio to be in the lowest KART tertile was 3.09 [95% CI: 1.49, 6.43] for SA compared to white participants in our final, adjusted multinomial model. Conclusion SA participants with kidney failure are commonly immigrants who have poorer KT-related knowledge compared to white participants. Our findings indicate the need to develop culturally relevant KT related patient education for South Asian Canadian communities.

Marginalization Influences Access, Outcomes, and Discharge Destination Following Total Joint Arthroplasty in Canada’s Universal Healthcare System

BackgroundThe influence of socioeconomic status on outcomes following total joint arthroplasty (TJA) in the Canadian single-payer healthcare system is yet to be elucidated. The objective of the present study was to evaluate the impact of socioeconomic status on TJA outcomes. MethodsThis was a retrospective review of 7,304 consecutive TJA (4,456 knees and 2,848 hips) performed between January 1, 2001 and December 31, 2019. The primary independent variable was the average census marginalization index. The primary dependent variable was functional outcome scores. ResultsThe most marginalized patients in both the hip and knee cohorts had significantly worse preoperative and postoperative functional scores. Patients in the most marginalized quintile (V) showed a decreased odds of achieving a minimal important difference in functional scores at 1-year follow-up (odds ratio [OR] 0.44; 95% confidence interval [CI] [0.20, 0.97], P = .043). Patients in the knee cohort in the most marginalized quintiles (IV and V) had increased odds of being discharged to an inpatient facility with an OR of 2.07 (95% CI [1.06, 4.04], P = .033) and OR of 2.57 (95% CI [1.26, 5.22], P = .009), respectively. Patients in the hip cohort in V quintile (most marginalized) had increased odds of being discharged to an inpatient facility with an OR of 2.24 (95% CI [1.02, 4.96], P = .046). ConclusionDespite being a part of the Canadian universal single-payer healthcare system, the most marginalized patients had worse preoperative and postoperative function, and had increased odds of being discharged to another inpatient facility. Level of EvidenceIV.

Comparison of modified bass, rolling, and current toothbrushing techniques for the efficacy of plaque control – A randomized trial

ObjectsThis study aimed to compare the effectiveness of the modified Bass technique (MBT), the Rolling technique and the current brushing technique(CBT) for plaque removal and to assess the acceptability of the first two brushing techniques. Methods180 participants were randomly assigned to PowerPoint-based training with a demonstration of either the MBT plus basic toothbrushing, the Rolling technique plus basic toothbrushing, or the basics of tooth brushing alone (CBT group). The participants were asked to brush their teeth based on what they had learned. The Turesky modification of the plaque index of Quigley & Hein (TQHI) and marginal plaque index (MPI) were assessed at the baseline examination and after 1, 2, and 4 weeks. Brushing sequence, brushing technique, and brushing duration were measured immediately after training and at each subsequent interview. ResultsAfter instruction (0 weeks), all groups showed a significant decrease in TQHI and MPI (p<0.001), followed by a gradual increase. There was no difference in the overall effect of plaque removal between the groups(p>0.05). MBT had a better effect on cervical plaque removal than the Rolling technique after 4 weeks (p<0.05). More participants in the Rolling group were able to fully master the brushing technique during the whole four weeks. ConclusionsThere was no difference in the overall plaque removal effect among the three groups. The MBT was most effective in removing plaque at the cervical margin but more difficult to master. Clinical Significance StatementThis study was conducted to compare the teaching and plaque removal effects of two brushing techniques and to understand which method is better for plaque removal as well as adoption. This study provides a reference and basis for future clinical work and oral hygiene education.

Oral health-related quality of life and oral manifestations of Syrian children with congenital heart disease: a case-control study

BackgroundThere was an immense need for studies evaluating the oral health status of Syrian children with congenital heart disease (CHD) and its impact on their quality of life. No contemporary data are available. The objective of this study was to investigate oral manifestations and oral health-related quality of life (OHRQoL) of children with CHD and compare them with healthy controls aged 4–12 years.MethodsA case-control study was undertaken. A total of 200 patients with CHD and 100 healthy children belonging to the same patient’s family were included. Decayed, missed, and filled permanent teeth index (DMFT) and decayed, missed, and filled primary teeth index (dmft), Oral Hygiene Index (OHI), Papillary Marginal Gingivitis Index (PMGI), and dental abnormalities were recorded. The Arabic version of the Child Oral Health-Related Quality of Life Questionnaire (COHRQoL, 36-item) which was divided into 4 different domains (Oral Symptoms, Functional Limitations, Emotional Well-Being, Social Well-Being) were studied. Chi-square test and independent- t-test were used to perform statistical analysis.ResultsCHD patients experienced more periodontitis, dental caries, poor oral health, and enamel defects. The dmft mean was significantly higher in CHD patients than in healthy children (5.245 vs. 2.660, P < 0.05). No significant difference was found between patients and controls in the DMFT Mean (P = 0.731). There was a significant difference between CHD patients and healthy children in the mean of the OHI (5.954 vs. 1.871, P < 0.05), and PMGI (1.689 vs. 1.170, P < 0.05). CHD patients have significantly higher enamel opacities (8% vs. 2%) and hypocalcification (10.5% vs. 2%) than controls. Also, the 4 COHRQoL domains, showed significant differences between CHD children and controls.ConclusionsEvidence about the oral health and COHRQoL of children with CHD was provided. Further preventive measures are still required to improve the health and quality of life of this vulnerable group of children.

Exploring Mediators of Mental Health Service Use Among Transgender Individuals in Ontario, Canada.

To determine if and to what degree neighbourhood-level marginalization mediates mental health service use among transgender individuals. This retrospective cohort study identified 2,085 transgender individuals through data obtained from 4 outpatient community and hospital clinics in 3 large cities in Ontario, which were linked with administrative health data between January 2015 and December 2019. An age-matched 1:5 comparison cohort was created from the general population of Ontario. Outcome measures were analysed from March 2020 to May 2022. The primary outcome was mental health service utilization, which included mental health-related visits to primary care providers, psychiatrists, mental health- and self-harm-related emergency department visits, and mental health hospitalizations. Mediation variables included ethnic concentration, residential instability, dependency, and material deprivation at the neighbourhood level and were derived from the Ontario Marginalization Index. This study identified 2,085 transgender individuals from participating outpatient community and hospital clinics, who were matched to the general population (n = 10,425). Overall, neighbourhood-level marginalization did not clinically mediate mental health service use. However, transgender individuals were more likely to be exposed to all forms of neighbourhood-level marginalization, as well as having higher rates of health service use across all outcome measures. In this study, mental health service use among transgender individuals was not clinically mediated by marginalization at the neighbourhood level. This study highlights the need to explore marginalization and mental health service use at the individual level to better understand the mental health disparities experienced by transgender individuals and to ensure that health-care services are inclusive and affirming.

Association between maternal marginalization and infants born with congenital heart disease in Ontario Canada

BackgroundThis study aims to evaluate the impact of socioeconomic status (SES) on the risk of congenital heart disease (CHD) since previous studies have yielded inconsistent results.MethodsWe conducted a population-based retrospective cohort study, including all singleton live and still births in Ontario hospitals from April 1, 2012, to March 31, 2018. We used linked records from the Better Outcomes Registry & Network Information System, the Canadian Institute for Health Information databases, and the Ontario Marginalization Index (ON_Marg). ON_Marg was estimated at a dissemination area level using Canadian Census 2016 data and categorized into quintiles. Multivariable logistic regression models were performed to examine the relationships between four ON_Marg indices (material deprivation, dependency, ethnic concentration, residential instability), as proxies for maternal SES and the risk of infant CHD. We adjusted for maternal age at birth, assisted reproductive technology, obesity, pre-existing health conditions, substance use during pregnancy, mental health conditions before and during pregnancy, rural residence, and infant’s sex in the analysis.ResultsAmong the cohort of 776,799 singletons, 9,359 infants had a diagnosis of CHD. Of those, 3,069 were severe CHD and 493 cases were single ventricle CHD. The prevalence of all infant CHD types was higher for males relative to females. Compared to mothers living in neighbourhoods with the lowest material deprivation, mothers with highest material deprivation had a 27% (adjusted OR = 1.27; 95% CI: 1.18–1.37) higher odds of having an infant diagnosed with CHD. Mothers living in neighbourhoods with the highest minority ethnic and immigrant concentration tend to have infants with 11% lower odds of CHD (adjusted OR = 0.89; 95% CI: 0.82–0.97) as compared to those living in the least ethnically diverse communities. Maternal dependency and residential stability quintiles were not significantly associated with the risk of CHD.ConclusionHigher maternal material deprivation was associated with increasing odds of infant CHD, whereas neighbourhood minority ethnic concentration was inversely associated with the odds of infant CHD. Our study further confirms that poverty is associated with CHD development. Future investigations might focus on the causal pathways between social deprivation, immigrant status, ethnicity, and the risk of infant CHD.