Provincial Survey Research Articles

The cost-utility of integrated cervical cancer prevention strategies in the Ontario setting – Can we do better?

IntroductionA universal, publicly funded, school-based human papillomavirus (HPV) vaccination program in grade eight girls was initiated in Ontario in 2007. We present a cost-utility analysis of integrated cervical cancer prevention programs from the healthcare payer perspective. MethodsOur analysis was based on linked HPV transmission and disease history models. We obtained data from the literature, provincial surveys and Ontario population-based linked health administrative datasets. We modeled combinations of vaccination and screening strategies. We considered vaccination based on the Ontario experience, as well as conservative and optimistic scenarios, varying coverage, vaccine effectiveness and duration of protection. We considered 900 screening scenarios (screening start age: 21–70 years, screening interval: 3–20 years; 1-year time steps). The current schedule screens every 3 years starting at age 21 years. We examined (1) first vaccinated cohort (low herd-immunity), and (2) steady state, i.e. all cohorts were vaccinated (high herd-immunity). ResultsAdding vaccination to the current screening schedule was cost-effective (<C$10,000/quality-adjusted life year (QALY)) across all scenarios. Delaying screening start and/or extending screening intervals increased both expected QALYs and cost, and increased overall NHB for screening schedules with a start age of 25–35 years and 3–10-year intervals for most scenarios. ConclusionDelaying screening start age and/or extending screening intervals in vaccinated cohorts is likely to be cost-effective. Consideration should be given to both the short- and long-term implications of health policy decisions, particularly for infectious disease interventions that require long time intervals to reach steady state.

Population studies of tree-defoliating insects in Canada: a century in review

AbstractOur review highlights research during the past century focussed on the population ecology of outbreak-prone insect defoliators in Canadian forests. Based on reports from national and provincial surveys that began in the 1930s, there have been at least 106 insect defoliators reported to outbreak, most of which are native Lepidoptera, Hymenoptera (sawflies), or Coleoptera (in order of frequency from most to least). Studies comparing life-history traits of outbreak versus non-outbreak species to better understand why certain species are more outbreak-prone indicate several traits especially common among outbreak species, including egg clustering and aggregative larval feeding. There have been at least 50 time-series studies examining the spatiotemporal population behaviour of 12 major defoliator species. These studies provide evidence for both regular periodicity and spatial synchrony of outbreaks for most major species. Life-table studies seeking to understand the agents causing populations to fluctuate have been carried out for at least seven outbreak species, with the majority identifying natural enemies (usually parasitoids) as the major driver of outbreak collapse. Our review concludes with several case studies highlighting the impact and historical underpinnings of population studies for major defoliator species and a discussion of potential avenues for future research.

Patient perspectives of methadone formulation change in British Columbia, Canada: outcomes of a provincial survey.

BackgroundIn British Columbia, Canada, methadone maintenance treatment formulation transitioned from the oral liquid compound Tang™-flavoured methadone to the ten-times more concentrated cherry-flavoured Methadose™ in February 2014. We quantitatively describe perceptions and reported consequences among a sample of patients on methadone maintenance treatment following this transition.MethodsA province-wide survey was used. Bivariable analyses utilized independent samples t-tests, Phi associations, and Chi-square tests. Multivariable logistic regression analyses evaluated factors related to dependent variables – namely, increases in dose, pain, dope sickness, and the need to supplement with additional opioids.ResultsFour hundred five methadone maintenance treatment patients from fifty harm reduction sites across British Columbia reported transitioning to Methadose™ in February 2014. The majority (n = 258; 73.1 %) heard about the formulation change from their methadone provider or pharmacist. Adjusted models show worse taste was positively associated with reporting an increasing dose (OR = 2.46; CI:1.31–4.61), feeling more dope sick (OR = 3.39; CI:1.88–6.12), and worsening pain (OR = 4.65; CI:2.45–8.80). Feeling more dope sick was positively associated with dose increase (OR = 2.24; CI:1.37–3.66), and supplementing with opioids (OR = 8.81; CI:5.16–15.05).ConclusionsMethadone maintenance treatment policy changes in British Columbia affect a structurally vulnerable population who may be less able to cope with transitions and loss of autonomy. There may be a psychosocial component contributing to the perception of Methadose™ tasting worse, and increased dope sickness, pain, and dose. Our study shows the pronounced negative impacts medication changes can have on patients without informed, coordinated efforts. We stress the need to engage all stakeholders allowing for communication about the reasons, risks and consequences of medication policy changes and provision of additional psychosocial support.

Examination of Physicians' Perception of the Indications of Colorectal Stents in the Management of Malignant Large Bowel Obstruction: A Provincial Survey.

Introduction. Data are conflicting when assessing indications for colorectal self-expandable metallic stents (SEMS) in managing acute malignant large bowel obstruction (MLO). In November 2014, European and American Societies published guidelines to aid in understanding which patients might benefit from colorectal stenting. Yet, there remain marked disparities in clinical practice. Methods. A web-based survey was sent to Gastroenterologists and Surgical Specialists across Quebec to assess physicians' knowledge and adherence to the indications for colonic SEMS placement in the management of MLO using eight clinical scenarios. Results. Out of 112 respondents, 74% preferred surgical intervention in young, healthy individuals with MLO. Advanced age and comorbidities motivated 56.3% (95% CI 47.1–65.5%) of participants to opt for SEMS placement. In palliative settings of patients undergoing chemotherapy including bevacizumab, a minority of respondents followed guidelines, 12.5% (95% CI 6.4–18.6%) for young patients and 25.0% for elderly patients (95% CI 17.0–33.0%). The pooled overall adherence to guidelines was 50.4% (95% CI 40.7–59.3%). Conclusion. This survey suggests that guidelines recommendations are not being implemented by at least half of specialists involved in the care of patients with MLO. Future studies should attempt to identify possible barriers responsible for this impaired knowledge translation and tailored educational initiatives planned accordingly.

A Provincial Population-Based Survey on Attitudes towards Wills of Individuals with Dementia and Related Issues

MethodsZZThe target population was registered residents in a province aged 19 years or older. The population forming the sampling frame was 1478821 (as of May 31, 2013). With a confidence interval of 2% and significance level of 5%, 2540 participants were sampled. This survey used a structured questionnaire composed of two main parts : seven items of general information (sex, age, residence, marital status, education, occupation, and income) and Testamentary CapacityRelated Questionnaire-12 items (TCRQ-12) comprising four items of basic knowledge and eight items of specific situational questions, using a five point Likert scale.

A provincial population-based survey on attitudes toward will and testamentary capacity of individuals with dementia

START psychological intervention versus treatment as usual with outcome HADS (hospital anxiety and depression scale) total, anxiety and depression subscales, HADS caseness and quality of life (HSQ). Costs were measured using the CSRI (Client Services Receipt Inventory).Results:At twoyears, the follow-up rate was over 80%. We will report in the results of the intervention at two years according to both pre-specified primary analysis and sensitivity analysis in depression, depressive and anxiety symptoms and quality of life and on costs for people with dementia. Conclusions: Family carers for dementia require tailored affordable interventions to enable them to cope without becoming depressed. The intervention was manual based, standardised and supervised. The high fidelity ratings and lack of therapist clustering suggest the intervention can be delivered consistently. This manual based intervention can be taught to psychology graduates rapidly and delivered relatively cheaply. 1 Livingston G, Barber J, Rapaport P, Knapp M, Griffin M, King D et al.. BMJ 2013;347:f6276. 2 Knapp M, KingD, RomeoR, Schehl B, Barber J, GriffinM et al. BMJ 2013;347:f6342.

Dental caries disparities in early childhood: A study of kindergarten children in British Columbia.

The objective of this paper was to describe results of a public health-administered, provincial dental survey of children aged 4-6 years old in British Columbia, and assess the changes in rates of dental caries geographically and by neighbourhood socio-economic status between baseline (2006/07) and follow-up data collection (2009/10). The study design involved two retrospective cohorts of kindergarten children who received a public health-administered dental assessment in the years 2006/07 and 2009/10. Neighbourhood socio-economic status was measured by an index created from Canadian Census and Tax Filer data sets. The dental outcomes included previous decay experience, untreated visible decay, and urgent treatment needs. The analysis comprised dental outcomes for 35,602 kindergarten children in 2006/07 and 35,215 children in 2009/10. There was a modest decrease in dental decay rates between surveys, with rates of decay experience - previous and untreated - of 38.9% and 36.7% respectively. However, there were disparities, with almost 50% of children with dental decay in the most socio-economically disadvantaged neighbourhoods, and approximately 30% with dental decay in the least disadvantaged areas. The kindergarten dental survey had extensive coverage, was at the population level, and enabled analysis of change in early childhood dental decay rates over time and by geography. Although overall rates improved, dental health inequalities persisted in both survey years at both regional and neighbourhood levels.

167: Supports and Resources Used by Adults Regarding Child Development: Results from a Provincial Survey

Adult knowledge of child development shapes their expectations and feedback to children as they learn and grow. Effective guidance of children by adults is influenced by their knowledge of child development. There are gaps in our understanding about what information and resources adults access related to child development. Research has focused on knowledge of child development among parents despite an increased acknowledgement that children are exposed to a range of adult influences. To review the supports and services used by adults regarding child development, including: (1) what information sources are used, and; (2) what key people or professionals are accessed for advice about children? To determine whether these supports and services vary by parents versus non-parents, urban versus rural residence, or if the adult was a parent of a child with a special health care need (SHCN). A telephone survey of 1,451 randomly selected adults – both parents and non-parents – was conducted in 2013 and explored parenting supports and services, and included demographic information. Data were analyzed using univariate and bivariate techniques (P<0.05). Key information sources regarding child development identified included books (68%), television/media (43%), recreation centres (41%), and the public library (38%). Key parenting supports were family members or friends (76%), family doctors or pediatricians (61%), and teachers (54%). Parents were more likely to access any resource or support than non-parents. Adults living in urban settings were more likely to use physicians, child-care providers, the public library, and phone advice services for information about children than rural adults. Parents of children with SHCN were more likely to contact teachers and developmental specialists about their children than parents of children without SHCN. Online access of information was preferred by 47%. Adults use a variety of information sources regarding child development, and access these resources through the internet and in various community settings or organizations. Information is also obtained from social networks including family and friends. Health service providers and educators in particular are a key source of information for adults about child development. There is an opportunity to make accessible already existing programs and services that support families and children that target both parents and non-parents using the venues, organizations and professionals identified from this survey.

Linking nurses' perceptions of patient care quality to job satisfaction: the role of authentic leadership and empowering professional practice environments.

A model linking authentic leadership, structural empowerment, and supportive professional practice environments to nurses' perceptions of patient care quality and job satisfaction was tested. Positive work environment characteristics are important for nurses' perceptions of patient care quality and job satisfaction (significant factors for retention). Few studies have examined the mechanism by which these characteristics operate to influence perceptions of patient care quality or job satisfaction. A cross-sectional provincial survey of 723 Canadian nurses was used to test the hypothesized models using structural equation modeling. The model was an acceptable fit and all paths were significant. Authentic leadership had a positive effect on structural empowerment, which had a positive effect on perceived support for professional practice and a negative effect on nurses' perceptions that inadequate unit staffing prevented them from providing high-quality patient care. These workplace conditions predicted job satisfaction. Authentic leaders play an important role in creating empowering professional practice environments that foster high-quality care and job satisfaction.

The association between socioeconomic status and blood pressure control in diagnosed hypertension patients

To explore the association between socioeconomic status (SES) and blood pressure control in diagnosed hypertension patients. The database of Zhejiang provincial survey on metabolic syndrome which implemented in 2010 in which prior hypoertensive patients were brought into this sutdy. Descriptive statistics were applied to test the distributive differences of relevant factors (age, sex, marital status, hypertension duration, BMI, education level, per capita household yearly income, smoking, alcohol drinking, fruit and vegetable intake) between patients with optimally-controlled blood pressure and those without. The SES of diagnosed hypertension patients was measured separately by two common indicators: education level and the per capita household yearly income. Univariate and multivariate logistic regression models were used to differentiate the association between those two SES indicators and blood pressure control, and the trend of the association was also tested. Totally, 2 394 hypertension patients were diagnosed and identified. Of the patients analysed, the overall mean was (61.53 ± 10.64) years, and 55.7% (1 334 cases) had ≤ 5 years' disease duration. 1 090 achieved optimal blood pressure control, which accounted for a proportion of 45.5%. 1 676 had elementary school education and below, accounting for 70.1%. The patients with per capita household yearly income of < 5 000 Yuan and 5 000-14 999 Yuan groups were 401 (29.4%) and 690 (50.5%) respectively. 416 (17.4%) were smokers and 541 (22.6%) were alcohol drinkers. Based on the statistical tests, we found that the distributions of age, marital status, hypertension duration, body mass index, smoking and alcohol drinking were different between two groups (t or χ² values were 4.57, 5.44, 6.40, 6.21, 5.99, 3.98, respectively, all P values were < 0.05). Optical blood pressure control in higer education level group was significantly better than that of in lower education level (χ² = 12.65, P < 0.001), and there was no statistical significance association between per capita household yearly income and optimal blood pressure control (χ² = 2.78, P = 0.249). Multivariate logistic regression models revealed that, of those two SES indicators, a positive association was shown between education level and optimal blood pressure control: compared with patients in the category of 'elementary school and below, those of 'junior high school and above observed an OR of 1.40 (95% CI: 1.09-1.81). And in further trend χ² test, we identified a trend of such association (χ² trend = 12.74, P = 0.002). However, no significant association has been recognized between per capita household yearly income and optimal blood pressure control: compared with patients in the category of < 5 000 Yuan group, those of 5 000-14 999 Yuan and ≥ 15 000 Yuan groups had OR of 0.93 (95% CI: 0.72-1.20) and 1.04 (95% CI: 0.83-1.31) respectively. Among all diagnosed hypertension patients, those with lower education level have poorer blood pressure control and should be labelled as the key population for intense health education and standardized management to improve their blood pressure control status.

The Cycle of Transparency, Accountability, Corruption, and Administrative Performance: Evidence from Vietnam

This paper investigates the correlation amongst transparency, accountability, corruption, and public administration performance in Vietnam using data from the Vietnam Provincial Governance and Public Administration Performance Index survey in 2012. The Generalised Canonical Analysis is applied to evaluate the meaning of the ‘Don’t Know’ answer which often exists in response to questions on perception of corruption. The results reveal that ‘Don’t Know’ implies corruption. The paper then, shows that a high level of transparency is accompanied with a low level of perception of corruption while impacts of accountability on corruption are mixed. Furthermore, corruption is a critical factor that deteriorates the administration performance whereas transparency and accountability are ineffective in being translated into the quality of administrative services. The results raise the need to closely examine the de-facto forms of transparency and accountability as well as the political will in the fight against corruption to improve the quality of public administrative services in Vietnam.

Feasibility of using emergency department patient experience surveys as a proxy for equity of care

Collecting and examining equity data can help inform quality improvement initiatives but is a relatively new practice in health care. The overall goal of this study was to assess different methods a feasible starting point in measuring equity in an urban Emergency Department (ED) that serves a diverse patient population. Socio-demographic characteristics of patients visiting an ED were compared with tho responded to provincial patient experience surveys routinely administered by mail. Patient experience survey data were collected over an 11-week period in an urban ED using different survey administration methods (face vs. handout) among study participants from vulnerable populations (elderly, low income, homeless, and mental health or substance use issues). Patient populations receiving care in the ED were shown to be different from those who responded to routinely mailed patient experience surveys with elderly patients over income, mental health or substance use and homeless/unstable housing populations under responses. From a total of 111 study participants, the r for surveys that were handed out (p = 0.002), but no significant difference in the percentage of positive responses was evident. Delivering patient experience surveys immediately upon discharge is an effective way of capturing uni responses from patients in vulnerable populations, supporting a valuable means administration method poses important implications when used to inform quality improvement efforts and performance measurement.

Impact of the free-vaccine policy on timely initiation and completion of hepatitis B vaccination in Fujian, China.

The extent to which the free-vaccine policy impacts the initiation and completion of a hepatitis B vaccine series is poorly understood. The aim of this study was to evaluate the impact of the free-vaccine policy on hepatitis B vaccination. A provincial survey was conducted in 2006 in Fujian Province, south-east of China, where the free-vaccine policy for hepatitis B was announced in 2002 and implemented in 2003. A total of 1628 children were investigated, and 1443 (88.6%) were included in this analysis. Among the children studied, 55.2% were vaccinated within 24 h of birth, and 76.1% completed the hepatitis B vaccine series on time. The rate of hepatitis B surface antibody positivity increased from 29.9% among children born in 1992 to 90.5% among children born in 2005, while the corresponding HBV infection rate decreased from 30.4% to 1.72%. Logistic regression indicated that, compared to children born between 1996 and 2001, the odds ratios (ORs) for timely initiation were 2.57 (95% confidence interval [CI], 1.71-3.84), 5.24 (95% CI, 3.26-8.43) and 9.06 (95% CI, 4.48-18.34) among children born in 2003, 2004 and 2005, respectively; the corresponding ORs for completing the vaccine series were 4.23 (95% CI, 1.97-9.10), 3.76 (95% CI, 1.81-7.82) and 4.94 (95% CI, 1.74-14.00) among children born in 2003, 2004 and 2005, respectively. Children with delayed vaccine initiation (>24 h after birth) were less likely to complete the vaccine series than those who received a timely first dose (OR = 0.02, 95% CI, 0.005-0.09). The impact of the free-vaccine policy on vaccine initiation and vaccine series completion did not differ by children's residence area (rural vs urban). As hypothesized, the odds of completing the vaccine series increased after the free-vaccine policy was announced in 2002 among children with delayed initiation (>24 h after birth) but not among those with timely initiation (≤ 24 h after birth). In conclusion, the free-vaccine policy significantly improved the timely initiation and completion of the vaccine series. The impact of this policy on completion of the vaccine series was larger among children with delayed vaccine initiation.

Obesity, lifestyle and socio-economic determinants of vitamin D intake: a population-based study of Canadian children.

Vitamin D intake in childhood is primarily for the prevention of rickets. Inconsistent evidence has associated adequate blood concentrations with a decreased risk of certain health conditions. Further, obese individuals may have lower vitamin D status. The estimated average requirement (EAR) for children recently doubled to 400 IU/day. Our aim was to examine dietary intake of vitamin D in different body mass index (BMI) categories, in addition to assessing determinants. Data from two provincial surveys of grade 5 children, including a food frequency questionnaire and measured BMI, were used. Rao-Scott chi-square statistic tested the bivariate association between provinces and adequate dietary vitamin D intake. Key correlates were examined using multi-level logistic regression. Those below the EAR differed between Alberta (78%) and Nova Scotia (81%). Those drinking &lt;2 glasses of milk/day had 0.02 times the odds of meeting the EAR (95% CI: 0.01-0.02) compared to those drinking more. No significant difference was observed for BMI, though those consuming &lt;1 glass of milk/day were more likely to be obese than those consuming ≥2 glasses/day. Income and physical activity were negatively correlated with meeting the EAR. Many children did not meet the EAR for vitamin D from dietary sources and milk consumption was an important determinant. Given trends towards a more sedentary lifestyle and limited sun exposure, we recommend prioritizing public health efforts to support dietary vitamin D intake alongside interventions to increase physical activity and reduce sedentary behaviour. Further investigation is required to determine the need for targeted strategies for obese children.

Analysis on associated factors of uncontrolled hypertension among elderly hypertensive patients in Southern China: a community-based, cross-sectional survey.

BackgroundThe prevalence of hypertension in China has risen dramatically in recent decades, but it is not well understood if hypertension is adequately controlled in the elderly population in Southern China. A provincial survey was performed in order to estimate the prevalence of hypertension control and the associated factors in the elderly population.MethodsA cross-sectional survey was conducted in 6 community health service centers across 12 counties in Southern China from October 2010 to April 2011. Recruitment included a total of 10644 hypertensive subjects aged 60 or older. Basic lab tests and physical examinations were administrated on each subject. In addition, each subject completed a standardized questionnaire.ResultsThe 10644 participants (mean age of 70.3 years) included 5527 women (51.9%), 5117 men (48.1%), 3148 overweight subjects (29.57%), 846 (7.95%) obese subjects, 1654 smokers (15.54%) and 1750 consumers of alcohol (16.44%). The control, treatment and awareness of hypertension were 44.6%, 50.3% and 46.3%, respectively. Most treated hypertensives (68.57%) used combination therapy of antihypertensive medications, and those using long-acting antihypertensive medications had a higher rate of adequately controlled hypertension. Results showed that elderly, living in rural and suburban areas, low education level, family history of hypertension, smoking, excessive salt consumption, lack of physical activity, overweight, obese and diabetes were associated with uncontrolled hypertension.ConclusionsLack of adequate hypertension control is relatively high among the elderly in Southern China. Hypertension awareness and early treatment are needed in this population, especially among suburban population, as well as adopting appropriate antihypertensive medication therapy and healthy lifestyles.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-903) contains supplementary material, which is available to authorized users.

Assessing and catalyzing adoption and implementation of the Alberta Nutrition Guidelines for Children and Youth in recreational sports settings

Although the mandate of recreational facilities is to enhance well-being, many have unhealthy food environments that may paradoxically increase obesity risk. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are government-initiated, voluntary guidelines intended to facilitate children’s access to healthy food and beverage choices in recreational facilities. The purpose of these studies was to investigate (i) awareness, adoption, and implementation of the ANGCY; (ii) factors that influenced uptake of the ANGCY and the nature of the food environment within 3 cases: an adopter, a semi-adopter, and a non-adopter of the ANGCY; and (iii) practical strategies to support healthy food purchases by patrons in recreational settings. Findings from a provincial survey (n = 151 recreational facilities) showed that one-half of facilities had heard of the ANGCY and only 6% had implemented them 1 year following their release. A multiple case study revealed that managers were nutritional gate-keepers of recreational facility food environments, their nutrition-related knowledge, beliefs, and perceptions shaped their adoption and implementation of the ANGCY. Intersectoral linkages with schools and health-promoting partnerships with industry were also important for adoption and implementation to occur. Financial constraints emerged as a strong and consistent barrier to ANGCY uptake. Managers from industry who adopted the ANGCY took a long-term view of profitability and were willing to take small risks, sacrificing short-term profitability to remain on the leading edge of market trends. An intervention tested the impact of increased availability of healthy items, 2 nudges and an economic incentive on purchase of healthy items by patrons at an outdoor community pool. Food availability proved to be an independent environmental determinant of food purchasing behaviours in this context, while mixed evidence was found for the efficacy of nudging. Price reductions appeared ineffectual in this setting. Overall, findings suggest that ANGCY uptake may continue to falter under the current voluntary approach, as the environmental supports for voluntary action are poor and managers fear revenue loss. Multiple strategies will be needed to optimize food selection in recreational settings; however, increasing the availability of healthy foods offers significant potential to improve patrons’ food-purchasing behaviours.

Uptake of pneumococcal vaccines in the Nordic region of Nunavik, province of Quebec, Canada.

Pneumococcal infections constitute an important public health problem in Nordic regions of Canada. Nordic populations are not included in national and provincial immunization surveys and there is no centralized immunization registry in these regions. The objective of this study was to estimate pneumococcal vaccination coverage and delays in immunization of children in Nunavik, Quebec. Immunization records of children born in 1994-2005 were collected in all villages. Children were classified into three groups: born in the period January 1, 1994 to April 30, 1997 and targeted by the 2002 mass campaign with the 23-valent polysaccharide vaccine (PPSV23); born in the period May 1, 1997 to March 31, 2002 and targeted by the 7-valent conjugate vaccine (PCV7) catch-up campaign; born in the period April 1, 2002 to December 31, 2005 and targeted by the PCV7 routine infant program. In the first group (n=896), 86.8% (95% CI: 84.4%-89.0%) were vaccinated with PPSV23. In the second group (n=1,252), 84.3% (95% CI: 82.1%-86.2%) received ≥1 PCV7 dose. In the third group, 90.4% (95% CI: 88.5%-92.1%) received 4 PCV7 doses. Delays >4 weeks in vaccine administration were observed for 26.3% of doses. There were substantial variations between villages for all indicators. In the challenging setting of a Nordic and remote region, uptake rates of pneumococcal vaccines in Nunavik were found to be similar to those measured in population surveys in Quebec.

Using a segmented logistic model to predict trees to be harvested in forest growth forecasts

Aim of the study: Predicting future harvested trees is a prerequisite to growth forecasts in managed forest stands. While harvest algorithms have been traditionally used, statistical harvest models could be an interesting alternative approach. The objective of this study was to fit statistical harvest models for different partial cutting treatments.Area of study: The study has been carried out in the province of Quebec, Canada.Material and Methods: Data from provincial control survey were used to fit harvest models for three different partial cutting treatments. A two-segment logistic modelling approach was used. The harvest models were designed to be compatible with the ARTEMIS growth simulator, which is currently in use in this province. Main results: The results showed that the probability of being harvested is different across the treatments and primarily depends on tree diameter at breast height and species. In selection cutting treatments in particular, trees close to the merchantable limit (e.g., 23 cm in this study) tended to be less frequently harvested than those with smaller or larger diameters, yielding a sinusoidal pattern that was well captured by the segmented approach. Research highlights: Although the models were of average accuracy as indicated by fit statistics, they made it possible to compare different scenarios in terms of productivity and rotation length when coupled with the ARTEMIS growth simulator. Moreover, compatibility requirements between the simulator and the harvest models appeared to be a major limitation in some cases.Keywords: Harvesting; statistical model; segmented approach; growth forecasts; managed stands.

Essential medicines are more available than other medicines around the globe.

BackgroundThe World Health Organization (WHO) promotes the development of national Essential Medicines Lists (EMLs) in order to improve the availability and use of medicines considered essential within health care systems. However, despite over 3 decades of international efforts, studies show an inconsistent pattern in the availability of essential medicines. We evaluated and compared the availability of essential medicines, and medicines not included in national EMLs, at global and regional levels.MethodsMedicine availability in the public and private sector were calculated based on data obtained from national and provincial facility-based surveys undertaken in 23 countries using the WHO/HAI methodology. The medicines were grouped according to their inclusion (‘essential’) or exclusion (termed ‘non-essential’) in each country’s EML current at the time of the survey. Availability was calculated for originator brands, generics and any product type (originator brands or generics) and compared between the two groups. Results were aggregated by WHO regions, World Bank country income groups, a wealth inequality measure, and therapeutic groups.FindingsAcross all sectors and any product type, the median availability of essential medicines was suboptimal at 61·5% (IQR 20·6%–86·7%) but significantly higher than non-essential medicines at 27·3% (IQR 3·6%–70·0%). The median availability of essential medicines was 40·0% in the public sector and 78·1% in the private sector; compared to 6·6% and 57·1% for non-essential medicines respectively. A reverse trend between national income level categories and the availability of essential medicines was identified in the public sector.InterpretationEMLs have influenced the provision of medicines and have resulted in higher availability of essential medicines compared to non-essential medicines particularly in the public sector and in low and lower middle income countries. However, the availability of essential medicines, especially in the public sector does not ensure equitable access.

Psychometric Evaluation of the Six-Item Version of the Multigroup Ethnic Identity Measure with East Asian Adolescents in Canada

We examined the psychometric properties of scores on a six-item version of the Multigroup Ethnic Identity Measure (MEIM) among East Asian adolescents in Canada. A series of confirmatory factor analyses (CFA) was conducted for 4,190 East Asians who completed a provincial survey of students in grades 7 through 12. The MEIM measured highly correlated dimensions of ethnic identity (exploration and commitment). Further, multigroup CFA indicated that the scale measured the same constructs on the same metric across three age groups and across four groups with varying degrees of exposure to Canadian and East Asian cultures. The findings suggest the short version of the MEIM can be used to compare levels of ethnic identity across different age or acculturation groups.