Thunder Bay Research Articles

Evaluating Facilitators’ Experience Delivering a Stress-Reducing Intervention for Indigenous Women with and without HIV

Indigenous women encounter increased stressful life experiences such as socioeconomic insecurities as well as inequities in health services and outcomes. These stress inequities, which stem from the historical and ongoing effects of settler colonialism, also worsen health outcomes for those women living with HIV. As a part of a broader research project on the impacts of stress-reducing interventions for indigenous women, this study examines the experiences of the women who facilitated the intervention. This research was conducted to evaluate the impacts of a biweekly stress-reducing intervention conducted in Thunder Bay, Ontario. The facilitators of the intervention participated in a focus group in 2019 where they detailed the reach, effectiveness, adoption, and implementation of the intervention. The results suggest that effective stress-reducing interventions should strive to be accessible and inclusive and that doing so can increase program engagement with the service organization hosting the intervention. Further, the results highlight the strengths and challenges of the intervention, including how it helped foster leadership skills and increased indigenous cultural learning among facilitators. These findings demonstrate the strength of community-led interventions and subsequent opportunities for facilitators to grow as leaders. Further, the study highlights how this style of intervention can also encourage participants to engage in other health and wellbeing programs offered by the community partner hosting the intervention. These findings suggest that interventions aimed at reducing stress among indigenous women facing socioeconomic insecurities, including those living with HIV, are both feasible and beneficial for participants, facilitators, and the nonprofit service organizations delivering them.

Developing a New Vegetation Index Using Cyan, Orange, and Near Infrared Bands to Analyze Soybean Growth Dynamics

Remote sensing Vegetation Indices (VIs) are simple, effective, and widely used methods for quantitative and qualitative analysis of vegetation cover, vigor, and growth dynamics. This study developed and assessed a new vegetation index (VI) using Cyan, Orange, and Near Infrared (NIR) bands to assess Soybean growth dynamics. The study was conducted at Lakehead University Agriculture Research Station, Thunder Bay, Canada, over four reproductive stages of Soybean growth (R4–R7). Spectral profiles were created for each stage, and the correlation between each spectral band at different stages was tested. There was no linear correlation between different bands except the correlation between the Cyan and Orange bands at R5 and R6 stages. Existing VIs have also been explored using approximately similar band combinations. Based on this analysis, three VIs were proposed for this new camera, and their behavior at different stages was evaluated using Leaf Area Index (LAI). Cyan and Orange spectral values were relatively high in the first and last growing seasons, while NIR values increased dramatically in the mid-growing seasons and decreased in the last stage. VINIR,O,C index showed the best results for mid-growing seasons (correlation with LAI = 0.39 for R5 and R6). VIC,O index showed a high level of details visually (leaves and background) for R4 and R7 than the other indices and correlated highly with LAI (0.48 and −0.5, respectively). Overall, the study provided new VIs that can be used to effectively analyze Soybean growth dynamics, with different VIs showing reliability over different growing stages.

Comparison of a validated decision-support tool to a standard of care triage system for knee osteoarthritis assessment: a proof-of-concept study.

Patients with knee osteoarthritis (OA) in northwestern Ontario are referred by their primary care provider (PCP) to a centralized assessment clinic for evaluation by an advanced practice physiotherapist (APP) to determine if they will require surgical management. However, many patients are found to not require surgical management, resulting in delays for patients who do. A decision-support tool was developed to address this issue and to guide treatment options by determining the need for surgical or nonsurgical approaches. We used a proof-of-concept method to assess the use of the decision-support tool in northwestern Ontario. Data from 100 consecutive patients assessed for knee OA management were collected from the Thunder Bay centralized assessment clinic. Two levels of agreement analyses (calculated using Cohen κ statistic) were performed, between the APP assessment decision (surgical or non-surgical) and the decision-support tool recommendation, and between the surgeon's decision (surgical or non-surgical) and the decision-support tool recommendation. We found a near-perfect agreement (κ = 0.870, n = 65) between the APP decision and the decision-support tool recommendation, when controlled for patient preference. There was a substantial level of agreement (κ = 0.618, n = 72) between the decision-support tool recommendation and the surgeon's decision. The decision-support tool recommendation showed considerable agreement with the decisions of the APP and surgeon indicating that it could be a valuable tool to guide PCPs caring for patients with knee OA. The applicability of a decision-support tool in northwestern Ontario displayed promising results, but further research is needed to examine the feasibility in a primary care setting.

Understanding Why Many People Experiencing Homelessness Reported Migrating to a Small Canadian City: Machine Learning Approach With Augmented Data

Over the past years, homelessness has become a substantial issue around the globe. The largest social services organization in Thunder Bay, Ontario, Canada, has observed that a majority of the people experiencing homelessness in the city were from outside of the city or province. Thus, to improve programming and resource allocation for people experiencing homelessness in the city, including shelter use, it was important to investigate the trends associated with homelessness and migration. This study aimed to address 3 research questions related to homelessness and migration in Thunder Bay: What factors predict whether a person who migrated to the city and is experiencing homelessness stays or leaves shelters? If an individual stays, how long are they likely to stay? What factors predict stay duration? We collected the required data from 2 sources: a survey conducted with people experiencing homelessness at 3 homeless shelters in Thunder Bay and the database of a homeless information management system. The records of 110 migrants were used for the analysis. Two feature selection techniques were used to address the first and third research questions, and 8 machine learning models were used to address the second research question. In addition, data augmentation was performed to improve the size of the data set and to resolve the class imbalance problem. The area under the receiver operating characteristic curve value and cross-validation accuracy were used to measure the models' performances while avoiding possible model overfitting. Factors predicting an individual's stay duration included home or previous district, highest educational qualification, recent receipt of mental health support, migrating to visit family or friends, and finding employment upon arrival. For research question 2, among the classification models developed for predicting the stay duration of migrants, the random forest and gradient boosting tree models presented better results with area under the receiver operating characteristic curve values of 0.91 and 0.93, respectively. Finally, home district, band membership, status card, previous district, and recent support for drug and/or alcohol use were recognized as the factors predicting stay duration. Applying machine learning enables researchers to make predictions related to migrants' homelessness and investigate how various factors become determinants of the predictions. We hope that the findings of this study will aid future policy making and resource allocation to better serve people experiencing homelessness. However, further improvements in the data set size and interpretation of the identified factors in decision-making are required.

The Italian Cultural Presence in Thunder Bay

The Italian Cultural Presence in Thunder Bay

Review of the causes of the unprecedented collapse of the United Grain Growers elevator in Thunder Bay, Ontario

This is a case history of the unprecedented collapse of a pile-supported grain elevator which collapsed suddenly into the harbour in Thunder Bay, Ontario on September 23rd.,1959 after a service life without incident for over 30 years. Many similar grain elevators had been built and operated successfully in the area beginning in the 1880’s. Studies directed at establishing the possible cause(s) included: geotechnical investigations, interrogation of background on design, construction, operation and performance, and a forensic evaluation of evidence revealed during removal of the debris in preparation for reconstruction. The site soil conditions together with features of the collapse are described. The elevator had experienced only minor lateral movements which was in marked contrast to other pile-supported elevators in similar ground conditions nearby. This evidence was considered of particular significance. The collapse is attributed to several factors: the failure of the batter piles, followed by that of vertical piles; to the repairs of the revetment and the associated filling of voids, probably aggravated by a ship collision 6 days before the collapse.

Looking beyond the individual-The importance of accessing health and cultural services for Indigenous women in Thunder Bay, Ontario.

Access to cultural activities and culturally relevant healthcare has always been significant for achieving holistic Indigenous health and continues to be a key factor in shaping the health journey of Indigenous individuals and communities. Previous research has indicated the importance of cultural practices and services in sustaining cultural identity for Indigenous peoples, which is a major influence on their wellbeing. This study marks the first phase in a project aimed at establishing an Indigenous healing program and uses a qualitative research approach to understand the health and cultural services that Indigenous women want and require in Thunder Bay, Ontario. During interviews, participants (n = 22) answered questions around their understandings of health and wellbeing, and how they are able to incorporate cultural practices into their circle of care. Thematic analysis was performed on interview transcripts, and 4 key themes were identified: 'independence and self-care', 'external barriers to accessing services', 'finding comfort in the familiar' and 'sense of community'. Together these themes illustrate how Indigenous women feel a strong sense of personal responsibility for maintaining their health despite the multiple environmental factors that may act as barriers or supports. Furthermore, the necessity of embedding cultural practices into Indigenous women's circle of care is highlighted by the participants as they describe the mental, spiritual, social, and emotional health benefits of engaging in cultural activities within their community. The findings demonstrate the need for current modes of care to look beyond the individual and consider the impacts that socio-environmental factors have on Indigenous women. To accomplish this, we hope to increase access to health and cultural services through the creation of an Indigenous healing program that can be adequately incorporated into Indigenous women's circle of care if they wish to do so.

By youth for youth: Empowering youth experiencing homelessness in Managua, Nicaragua.

There is a dearth of effective, evidence-based programming to support youth experiencing homelessness, particularly in low- and middle-income countries where the majority of these young people live. Programs focused on youth engagement and leadership appear to be promising means to effectively engage and promote positive outcomes in this population. By Youth for Youth (BYFY) is a peer-led youth leadership framework developed to promote youth engagement, empowerment, and skill development. To date, BYFY has been successfully implemented with promising process and outcome indicators for youth experiencing homelessness, both in Toronto and with Indigenous youth in Thunder Bay. In this article, we present the application of BYFY with 30 street-involved youth in Managua, Nicaragua. We highlight the key implementation factors leading to BYFY's success in Nicaragua as perceived by facilitators from the implementing organization, Covenant House International, and youth leaders. Using a General Inductive analysis of interview data, field notes, and artistic output generated by the project (rap video, graffiti art, street theater), we identify the processes that appeared to underlie positive outcomes observed in participants, including creating a sense of safety and providing opportunities to challenge negative self-perceptions. This article provides evidence for a scaleable model for youth engagement and empowerment that (a) is practical to implement in low-resource settings and (b) is effective at engaging street-involved youth across diverse cultures and contexts. We summarize practical implications and actionable measures that can be taken by stakeholders to capitalize on these findings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Treatment of Native Youth Requires Incorporating Culture, Recognizing Trauma

Treatment of Native Youth Requires Incorporating Culture, Recognizing Trauma

Design and Performance Characteristics of a Hybrid Photovoltaic-Thermal Regeneration System under Indoor and Outdoor Solar Radiation Conditions of Thunder Bay, Ontario

Numerous energy sources continuously emit large amounts of waste energy into the earth's atmosphere. Significant losses, nearly 85% of the incident light on a PV panel, are either reflected from the PV surface, accounting for up to 20%, or dissipated as heat. In this work, a novel lab-scale hybrid photovoltaic-thermal regeneration (HPVT-R) system is designed, constructed, and tested to restore some of the reflection losses in the PV system. The new HPVT-R system design permits the PV and thermal co-systems to perform autonomously while revitalizing some of the reflection losses by hybridization. Thorough testing of the HPVT-R system was performed under lab-scale indoor simulated light and outdoor solar radiation conditions in Thunder Bay, Ontario. The HPVT-R system regenerated approximately 14 % of the reflected light in these tests, transforming it into electrical power and heat. Under the solar-simulated lights, the indoor test setup regenerated around 17 mW of electric power from the reflected light accounting for slightly less than 1% of more electric power per unit PV surface area. However, the outdoor solar radiation tests rejuvenated nearly 137 mW of electric power, accounting for approximately 3% more electric power per unit PV surface area, with a conversion efficiency of nearly 7%. Regarding heat energy, the HPVT-R system regenerated approximately 34% more in indoor and outdoor performances entirely from the reflected light. This research investigates the performance aspects of the HPVT-R system operated under different working conditions.

Developing a machine learning model to predict patient need for computed tomography imaging in the emergency department.

Overcrowding is a well-known problem in hospitals and emergency departments (ED) that can negatively impact patients and staff. This study aims to present a machine learning model to detect a patient's need for a Computed Tomography (CT) exam in the emergency department at the earliest possible time. The data for this work was collected from ED at Thunder Bay Regional Health Sciences Centre over one year (05/2016-05/2017) and contained administrative triage information. The target outcome was whether or not a patient required a CT exam. Multiple combinations of text embedding methods, machine learning algorithms, and data resampling methods were experimented with to find the optimal model for this task. The final model was trained with 81, 118 visits and tested on a hold-out test set with a size of 9, 013 visits. The best model achieved a ROC AUC score of 0.86 and had a sensitivity of 87.3% and specificity of 70.9%. The most important factors that led to a CT scan order were found to be chief complaint, treatment area, and triage acuity. The proposed model was able to successfully identify patients needing a CT using administrative triage data that is available at the initial stage of a patient's arrival. By determining that a CT scan is needed early in the patient's visit, the ED can allocate resources to ensure these investigations are completed quickly and patient flow is maintained to reduce overcrowding.

Physical and biological evolution of constructed reefs – long-term assessment and lessons learned

Artificial reefs are widely used to restore lost or damaged habitat, particularly spawning habitat. However, reefs are often designed without consideration for testing design features and constructed without clear objectives or a long-term assessment plan to evaluate changes in reef characteristics. To mitigate for degradation of lake trout spawning habitat in Thunder Bay, Lake Huron, we constructed 29 cobble reefs in 2010–11. Reef design incorporated height, orientation, and size as replicated factors. In addition to assessment of reef use by lake trout, we evaluated the biotic and abiotic changes in the reefs over five years post-construction and compared them to two adjacent degraded reefs and a semi-natural reef. Each reef was mapped annually by side-scan sonar to examine changes in the physical structure, such as slumping. Divers surveyed a subset of the reefs each year, and sampled substrate to quantify benthic macroinvertebrates, including zebra mussels. Algal colonization and round gobies were evaluated qualitatively. Temperature, dissolved oxygen, and sediment accumulation were measured over the winter at the vertical center and base of two reefs each year. Little physical change or sedimentation occurred. Qualitative abundance of coregonine eggs, presence of other fishes, and colonization by algae and macroinvertebrates increased throughout the monitoring period, indicating that the reefs have long-term value for a diversity of species.

A colonial legacy of cultural and epistemic genocide: limited education access, family dislocation and premature death of Indigenous Youth in Northern Ontario, Canada

ABSTRACT Using a philosophical framework of epistemic injustice and epistemic resistance (Fricker, 2007; Medina, 2013), we examine the recent deaths of nine Indigenous youths in a Northern Ontario city, Thunder Bay. We first document various reports and then we interrogate the impact of this violence on Indigenous communities, considering the egregious impact of epistemic injustice as it plays out on a personal and on a systemic and structural level. We theorise ways to counterbalance this systemic injustice and highlight the current efforts of epistemic resistance within the Indigenous community. We close with discussion around historical responses to this long history of cultural and epistemic genocide and how we can interrogate the structural construction of epistemic injustice and further promote epistemic resistance.

Potential Utility of a Climate-Sensitive Structural Stand Density Management Model for Red Pine Crop Planning

The objectives of this study were to evaluate and exemplify the potential utility of a climate-sensitive modular-based structural stand density management model (SSDMM) developed for red pine (Pinus resinosa Aiton) in crop planning decision making. Firstly, the model’s predictive ability was assessed using a retrospective validation approach without consideration of climate change effects. Although limited in scope and applicability, the preliminary results revealed that the magnitude of the mean prediction error for the principal determinates governing stand development did not exceed ±15%. Secondly, the potential utility of the model was illustrated within a spatial-based forest management planning context for a range of climate change scenarios. These exemplifications included three conventional crop plan simulations (initial spacing (IS), IS plus one commercial thinning (CT) treatment, and IS plus two CTs) developing under three climate change scenarios (1971–2000 climate norms, and 4.5 and 8.5 representative concentration pathways) over 75-year rotations (2022–2097) at three geographically diverse locales (north-eastern (Kirkland Lake), north-central (Thessalon), and north-western (Thunder Bay) Ontario, Canada). Resultant developmental indices and (or) productivity metrics were contrasted in terms of (1) regional-specific differences in temporal stand dynamical patterns and rotational yields with increasing climatic change severity, and (2) silvicultural effectiveness of the crop plans within and across locales for each climate change scenario. Climate-wise, although the results revealed marginal regional differences across a multitude of rotational outcome metrics, declines in mean tree size and merchantable volume productivity, and most importantly utility pole production within unthinned plantations, were among the most consequential and consistent negative outcomes associated with climate-induced site productivity declines. Silviculturally, crop plans that included thinning treatments relative to their counterparts that did not, yielded trees of greater mean size and were able to maintain utility pole production status while not achieving similar levels of site occupancy or volumetric productivity. Management-wise, maintenance of pole production status along with concurrent increases in fiscal worth even in light of climate change outweighed the marginal decline in volumetric productivity that was associated with the thinning regimes. In summary, the validation results provided a measure of predictive performance relative to the underlying calibration data set whereas the exemplifications illustrated the model’s potential operational utility in spatial-based forest management planning. For managers aspiring to maintain the historical productivity legacy of red pine through optimal density management decision making while acknowledging prediction uncertainty when forecasting stand development trajectories under climate change, the SSDMM provides an optional decision-support tool for designing climate-smart crop plans during the Anthropocene.

From Port Hope to Thunder Bay

The career of Joseph Goodwin King (1844-1910), grain elevator operator at Port Hope and Port Arthur, Ontario, sheds light on many aspects of Canadian agricultural and economic history— the role of railway companies in the grain trade, the decline of Lake Ontario grain ports, the rise of Thunder Bay on Lake Superior as the major Canadian grain port for western Canada, as well as improvements in North American grain cleaning and drying methods, and grain elevator construction.

Walking the Old Road: A People's History of Chippewa City and the Grand Marais Anishinaabe by Staci Lola Drouillard (review)

Reviewed by: Walking the Old Road: A People's History of Chippewa City and the Grand Marais Anishinaabe by Staci Lola Drouillard Katrina Phillips (bio) Walking the Old Road: A People's History of Chippewa City and the Grand Marais Anishinaabe by Staci Lola Drouillard University of Minnesota Press, 2019 THE CITY OF GRAND MARAIS, nestled along the North Shore of Lake Superior in northern Minnesota, sits two hours north of Duluth, less than an hour south of Grand Portage and the Grand Portage Reservation, and an hour and a half south of Thunder Bay. It is often called the gateway to both the Boundary Waters Canoe Area and to the Gunflint Trail. Grand Marais has been a popular destination for tourists, particularly those from the Twin Cities, since the early twentieth century. As someone who grew up in the region, I should note that the less charitable among us might say it's overrun with tourists, especially during the summer months. However, as Staci Lola Drouillard explains, not many of the people driving along Highway 61 would notice as they drove though Chippewa City, the small town just to the north of Grand Marais. In the nineteenth century, though, Chippewa City was an Anishinaabe community where its residents lived and worked, celebrated and mourned, worshipped and played. The Chippewa City Church—formally known as St. Francis Xavier, now under the domain of the Cook County Historical Society—played a central role in the community, a long-standing fixture alongside what locals called the "Old Shore Road," a well-trodden path to and from Grand Marais (10, 17, 1). Walking the Old Road includes a mixture of oral history and memoir, tracing Drouillard and her family's connections to the area while also including the voices of elders she began interviewing in the late 1980s. Her first interview with artist George Morrison, part of a class assignment at the Minneapolis College of Art and Design, led to more questions and interviews and research. Drouillard's research, driven by the oral interviews, is like her search to find the road between Chippewa City and Grand Marais (2). Her goal, as evidenced by the book's subtitle, is to tell the story of the people of Chippewa City through the voices of those who lived there. The book reads like a conversation, the kind of conversation you have when you're sitting around a bonfire along the shores of Lake Superior, the words intertwined with the crackle of the firewood and the rhythm of the waves on the rocks. From recounting the history of the Ojibwe arrival [End Page 175] at what is known as the Pigeon River and intermarriage with French fur traders, through treaty signings and the Dawes Act to the Nelson Act and eventual Ojibwe dispossession, Drouillard underscores what Chippewa City meant to those who lived there. While its title might suggest that the book is simply a hyperlocal history, Drouillard draws on broader narratives of federal Indian policies while highlighting the devastating effects those policies had on the residents of Chippewa City. Drouillard and her sister do not meet the blood quantum requirement the federal government forced upon the Minnesota Chippewa Tribe, and so they could not inherit their father's parcel of reservation land at Grand Portage. "Not unlike our ancestors before us," Drouillard muses, "we had land only to have it taken away" (50). Drouillard's interviews—and the way she weaves them throughout the book—offer a rich recollection of Chippewa City. Jim Wipson, born in Chippewa City in 1918, shared stories of his grandmother, Kate Frost, and how the two of them would walk the Old Road. "Everybody in Grand Marais knew Kate Frost and her little grandson," he recalled (100). Others shared stories of old traditions like "Happy New Year-ing," of church services sung in Ojibwe and visits to medicine men, of selling homemade crafts to tourists along Highway 61 or in local shops and stands. People who lived in Chippewa City worked in Grand Marais or went to town for medical services, while Grand Marais proprietors relied on Chippewa City labor and wilderness skills to keep their businesses running. "So where...

The impact of land conversion from boreal forest to agriculture on soil health indicators

Climate change is creating opportunities for agricultural expansion northward into the boreal forest. Converting forested land to agricultural land generally results in significant losses of organic matter (OM), which can impact soil health (SH). The objectives of this study were to assess the effects of land conversion on indicators of SH and to use the Comprehensive Assessment for Soil Health (CASH) framework to integrate measures of these indicators into a score to evaluate land conversion effects. Total carbon and nitrogen were also measured in this study. Soils (0–5 and 5–15 cm) were collected from six dairy farms near Thunder Bay, ON, that included a mature forest, a field converted from forest to agriculture <10 years ago and a field converted from forest to agriculture >50 years ago. Land conversion resulted in significant declines in permanganate oxidizable carbon, wet aggregate stability, soil respiration, and concentrations of OM, autoclave citrate extractable protein, total nitrogen, and total carbon. Lower CASH scores in the soils converted to agriculture are interpreted to represent a decline in SH but the scores, along with soil organic matter (SOM) concentrations, remain high (CASH = 80; OM = 6%). There was no effect of time since conversion, suggesting that any degradation to SH happens quickly and is closely tied to declines in SOM.

Deep learning in land-use classification and geostatistics in soil pH mapping: a case study at Lakehead University Agricultural Research Station, Thunder Bay, Ontario, Canada

Grain agriculture is one of the main economic activities in Thunder Bay. However, farming faces many challenges: shorter growing seasons, severe weather conditions, climate change, and limited services and economic support. Lakehead University Agricultural Research Station (LUARS) is continuously working toward improving farming in Northern Ontario and testing different agricultural initiatives. Precision agriculture (PA) is one of the strategic means to improve Northern Ontario farming and sustain agricultural operations. Hence, PA requires accurate and up-to-date baseline information; the aim of this study is to develop baseline spatial information (land cover and soil pH variability maps) for the LUARS using remote sensing technology. A set of aerial images were acquired from the remotely piloted aircraft system (RPAS) and created an orthophoto (7-cm spatial resolution). A detailed land cover map was produced using a deep learning algorithm. We collected soil samples from three different sections (plots) of the area to analyze soil pH variations. Different geostatistical methods [ordinary kriging, Simple kriging, and empirical Bayesian kriging (EBK)] and deterministic interpolation techniques: local polynomial interpolation (LPI) and inverse distance weighted (IDW) were tested to map the spatial distribution of soil pH. A land cover classification achieved an overall accuracy of 73% and a Kappa coefficient of 0.70. Most of the homogeneous agricultural plots indicated higher producer’s and user’s classification accuracies. There was no linear correlation between soil sample data and vegetation indices derived from RPAS images to test the linear regression for soil pH mapping. EBK, LPI, and IDW produced soil pH maps with higher accuracies for Secs. 1–3, respectively.

Thriving in three Northwestern Ontario communities

Disease-based models of health often fail to consider socio-economic models that perpetuate optimal health. The promotion of human thriving, rather than merely surviving, can be achieved by promoting optimal health indicators that facilitate overall wellbeing. Such interventions are those that promote a high quality of life, otherwise conceptualized as a “life worth living,” and can consist of life activities that exist outside of traditional health care intervention. Despite the continuous rise of health outcomes in Canada, it is likely that the cost associated with thriving may reduce the likelihood that optimal health will be achieved by many. Previous studies have generated the cost of thriving calculated for a single individual living in the Greater Toronto Area and have found that the cost of thriving is below the median annual income for this region. In the current study, this framework has been applied to three additional communities in Northwestern Ontario. Results indicated that when costs of thriving in Thunder Bay, Sioux Lookout, and a small remote community were compared, costs of thriving were highest in more rural and remote areas. Given the limited availability of regional data, it was not possible to generate specific total costs for all communities in this review. Overall, health promotion and wellbeing approaches can be diversified by using evidence-based, strength-based health interventions. Such approaches can be offered in conjunction with traditional public health initiatives, to better foster individual-level health (through disease reduction) and wellbeing (such as promoting hope, belonging, meaning, and purpose) within community.

Geographic inequalities in paediatric emergency department visits in Ontario and Alberta: a multilevel analysis of 2.5 million visits

BackgroundResearch on intra- and inter-regional variations in emergency department (ED) visits among children can provide a better understanding of the patterns of ED utilization and further insight into how contextual features of the urban environment may be associated with these health events. Our objectives were to assess intra-urban and inter-urban variation in paediatric emergency department (PED) visits in census metropolitan areas (CMAs) in Ontario and Alberta, Canada and explore if contextual factors related to material and social deprivation, proximity to healthcare facilities, and supply of family physicians explain this variation.MethodsA retrospective, population-based analysis of data on PED visits recorded between April 1, 2015 and March 31, 2017 was conducted. Random intercept multilevel regression models were constructed to quantify the intra- (between forward sortation areas [FSAs]) and inter- (between CMAs) variations in the rates of PED visits.ResultsIn total, 2,537,442 PED visits were included in the study. The overall crude FSA-level rate of PED visits was 415.4 per 1,000 children population. Across CMAs, the crude rate of PED visits was highest in Thunder Bay, Ontario (771.6) and lowest in Windsor, Ontario (237.2). There was evidence of substantial intra- and inter-urban variation in the rates of PED visits. More socially deprived FSAs, FSAs with decreased proximity to healthcare facilities, and CMAs with a higher rate of family physicians per 1,000 children population had higher rates of PED visits.ConclusionsThe variation in rates of PED visits across CMAs and FSAs cannot be fully accounted for by age and sex distributions, material and social deprivation, proximity to healthcare facilities, or supply of family physicians. There is a need to explore additional contextual factors to better understand why some metropolitan areas have higher rates of PED visits.