Canadian Urban Centre Research Articles

Availability and Use of Methods To Limit Cross-Contamination of Gluten-Free Foods in Restaurants in a Large Urban Centre in Canada

Availability and Use of Methods To Limit Cross-Contamination of Gluten-Free Foods in Restaurants in a Large Urban Centre in Canada

Preventative behaviours and COVID-19 infection in a Canadian cohort of people living with HIV

Few studies have examined preventative behaviour practices with respect to COVID-19 among people living with HIV (human immunodeficiency virus). Using a cross-sectional survey from a Canadian Institutes of Health Research Canadian HIV Trials Network study (CTN 328) of people living with HIV on vaccine immunogenicity, we examined the relationships between participant characteristics and behavioural practices intended to prevent COVID-19 infection. Participants living in four Canadian urban centers were enrolled between April 2021–January 2022, at which time they responded to a questionnaire on preventative behaviour practices. Questionnaire and clinical data were combined to explore relationships between preventive behaviours and (1) known COVID-19 infection pre-enrolment, (2) multimorbidity, (3) developing symptomatic COVID-19 infection, and (4) developing symptomatic COVID-19 infection during the Omicron wave. Among 375 participants, 49 had COVID-19 infection pre-enrolment and 88 post-enrolment. The proportion of participants reporting always engaging in preventative behaviours included 87% masking, 79% physical distancing, 70% limiting social gatherings, 65% limiting contact with at-risk individuals, 33% self-isolating due to symptoms, and 26% self-quarantining after possible exposure. Participants with known COVID-19 infection pre-enrolment were more likely to self-quarantine after possible exposure although asymptomatic (65.0% vs 23.4%, p < 0.001; Chi-square test). Participants with multiple comorbidities more likely endorsed physical distancing (85.7% vs 75.5%, p = 0.044; Chi-square test), although this was not significant in logistic regression analysis adjusted for age, sex, race, number of household members, number of bedrooms/bathrooms in the household per person, influenza immunization, and working in close physical proximity to others. Overall, participants reported frequent practice of preventative behaviours.

The Tailored Opioid Reduction Strategy (TORS): A Quality Improvement Initiative to Reduce Opioid Prescription Following Hysterectomy

ObjectiveTo evaluate a tailored opioid reduction strategy (TORS) in minimizing opioid prescriptions for patients undergoing hysterectomy. MethodsThis quality improvement initiative was developed by multiple stakeholders at an academic hospital in a Canadian urban centre. The intervention consisted of a three-pronged approach: (1) patient and provider education, (2) perioperative multimodal analgesia, and (3) a targeted opioid reduction strategy. All eligible patients were asked to fill pre- and postoperative questionnaires. Analysis of outcomes pre- and post-TORS implementation as well as intervention compliance was performed. ResultsFrom September 2020 to April 2021, 133 patients who underwent hysterectomy were included in the study, 69 in the pre-intervention group and 64 in the post-intervention group. Of 133 hysterectomies, 78 (58.6%) were performed laparoscopically, 16 (12%) open, 14 (10.5%) vaginally, and 25 (18.8%) robotically. The rate of discharge opioid prescriptions was significantly reduced in the post-intervention group compared with the pre-intervention group (37/64, 58% versus 62/69, 90%, respectively, P < 0.001), as well as the amount of opioid prescribed in oral morphine equivalents (OME) (mean 47 mg pre-intervention, 28 mg post-intervention, P < 0.001). There was no significant difference in patient satisfaction or postoperative pain scores between groups. Overall, compliance with 2 or more components of TORS intervention was seen in 64/64 (100%) cases. ConclusionTORS implementation was successful in reducing the rate of discharge opioid prescriptions and the total amount of opiates prescribed in patients undergoing hysterectomy with no decrease in patient satisfaction or change in postoperative pain scores. We believe it can be applied more broadly across different surgical patient populations to prevent opioid abuse.

Role of cultural brokering in advancing holistic primary care for diabetes and obesity: a participatory qualitative study

ObjectivesDiabetes and obesity care for ethnocultural migrant communities is hampered by a lack of understanding of premigration and postmigration stressors and their impact on social and clinical determinants of health...

Geographic Disparities in Access to Cancer Clinical Trials in Canada.

This study aims to evaluate geographic disparities in access to cancer clinical trials across Canada. Cancer clinical trial data recorded within the clinicaltrials.gov and reporting the conduct of any of these trials in Canada, 2005 to 2023 were reviewed. Frequency analyses of the number of clinical trials that were registered on clinicaltrials.gov for Canada, individual Canadian provinces, main Canadian urban centers, and different cancer types, according to the funding source (industry versus non-industry), as well as according to different periods (using 3-y intervals) were conducted. Moreover, a comparison of cancer clinical trials per 10,000 persons was done between Canada and the United States. The number of cancer clinical trials per 10,000 individuals (according to the 2021 census) in each province/territory varied between 6.79 (New Brunswick) to 0 (the 3 territories). The number of cancer clinical trials in relation to 1000 projected cancer cases for some of the common tumor types in Canada was then reviewed. The highest number was for lymphoma clinical trials (32.85), whereas the lowest number was for bladder cancer clinical trials (7.06). Most of the trials have industry funding (69%). Using 3-year intervals, the highest number of cancer clinical trials was observed from 2014 to 2016 (778 trials), and the lowest number was observed from 2020 to 2022 (633 trials). Access to clinical trials in Canada is not equitably distributed, with geographical and primary tumor site disparities. Moreover, access to cancer clinical trials has been negatively impacted during the time of the COVID-19 pandemic.

Pandemic-time bike lanes in three large Canadian urban centres- differences in use and public perception by socio-demographic groups and geographical contexts

The COVID-19 pandemic led to fast and ambitious implementation of bike lanes in many Canadian cities and also presented a window of opportunity to study the effects of new cycling infrastructure. While an emerging literature has focused on the use of cycling infrastructure that resulted from pandemic-time street reallocation initiatives, not much is known about the differences in the use and public perception of these bike lanes across various socio-demographic groups and between different urban contexts. We explored this topic using data from an online survey of 2078 Canadians residing in Toronto, Montréal, and Vancouver regions in Canada, collected in the summer of 2021. Results revealed that 45% respondents had used a bike lane at least once during the first year of the pandemic. In addition, 42% supported maintenance and enhancement of these facilities post-pandemic. Results from a multinomial logistic regression show that women, individuals with household incomes of less than $ 100,000, and those with multiple cars, had lower odds of using the new bike lanes, indicating the benefits of bike lanes may not have been equal across the population. Models showed that those who live within 5 km from facilities, and those who were frequest cyclists pre-pandemic, were more likely used them more frequently. Younger adults (aged 18 to 29), women, individuals with a university education, and those who used the bike lanes, were more likely to support maintenance and enhancement of these facilities. There were regional variations in both use and support, which may relate to local planning processes and the politics of mobility. The findings offer novel insights into where and among whom these facilities are less popular, which may inform future targeted policy efforts and advocacy.

Multimorbidity in Large Canadian Urban Centres

Abstract Introduction Although health outcomes are related to the characteristics of the geographic areas in which people live, there is limited knowledge on how the prevalence of multimorbidity varies within and across major Canadian urban centres. Our goal was to assess the level of between-neighbourhood variation in the prevalence of multimorbidity in Canada's large urban centres, controlling for compositional effects associated with demographic and socioeconomic factors. Methods Cross-sectional data from the 2015-2018 cycles of the Canadian Community Health Survey (CCHS) were used. Respondents (20 years and older) residing in one of the 35 census metropolitan areas (CMAs) were included (N = 100,803). Census tracts (CTs), relatively small and stable geographic areas nested within CMAs, were used as a measure of neighbourhood. To assess the between-neighbourhood differences in multimorbidity prevalence, we fitted sequential random intercept logistic regression models. Results During the 2015-2018 period, 8.1% of residents of large urban centres in Canada had multimorbidity. The results from the unadjusted model indicate that 13.4% of the total variance in multimorbidity could be attributed to the between-neighbourhood differences. After adjustment for overall characteristics of the CMAs in which these neighbourhoods are located, as well as for individual-level demographic and socioeconomic factors related to compositional effects, 11.0% of the individual variance in multimorbidity could still be attributed to the between-neighbourhood differences. Discussion and Conclusions There is significant and substantial geographic variation in multimorbidity prevalence across neighbourhoods in Canada's large urban centres. Residing in some neighbourhoods could be associated with increased odds of having multimorbidity, even after accounting for overall characteristics of the CMAs in which these neighbourhoods are located, as well as individual-level factors.

Day-to-day impact of COVID-19 and other factors associated with risk of nonfatal overdose among people who use unregulated drugs in five cities in the United States and Canada

BackgroundThe COVID-19 pandemic has compounded the longstanding drug poisoning crisis in Canada and the United States (US). Research is needed to understand the contributions of COVID-19 and subsequent infection control measures. We sought to estimate the prevalence of and factors associated with nonfatal overdose among participants in nine prospective cohorts of people who use unregulated drugs (PWUD) in Canada and the US. MethodsData were derived from nine cohorts of PWUD in urban centres in Canada (Vancouver, BC) and the US (Baltimore, MD; Miami, FL; Chicago, IL; Los Angeles, CA) between May, 2020 and April, 2021. Multivariable logistic regression was used to identify factors associated with nonfatal overdose among participants who used unregulated drugs in the past month. ResultsAmong 885 participants (including 253 females), 41 (4.6 %) experienced a non-fatal overdose in the past month, and 453 (51.2 %) reported being highly impacted day-to-day by the pandemic. In multivariable analyses, people who experienced a non-fatal overdose were more likely to be female (Adjusted Odds Ratio [AOR]=2.18;95 % Confidence Interval [CI]=1.10–4.30); unstably housed/homeless (AOR=2.16;95 % CI=1.11–4.26); engaged in medications for opioid use disorder (AOR=2.45;95 % CI=1.19–4.97); and highly impacted day-to-day (AOR=2.42;95 % CI=1.22–5.10). ConclusionOur findings may reflect characteristics of participants who experienced a compounding of vulnerabilities during the pandemic and thus are vulnerable to overdose, including women, those unstably housed/homeless, and those who perceived their daily lives were highly impacted by the pandemic. Multi-level interventions are needed to remediate the vulnerabilities and address the main driver of poisoning crisis.

Investigating concentrated exclusion in telecommunications development: Engaging rural voices from Northern Canada

Since the COVID-19 pandemic, access to adequate, affordable, reliable broadband has become essential to many aspects of modern life. However, while urban centers in Canada already benefit from high-speed broadband services, many rural/remote and Northern communities face increasingly concentrated spaces of exclusion associated with digital divides. Inequalities in broadband services in Northern Canada have long been recognized by the federal government, which has initiated policies, regulations and funding programs to support the deployment of better connectivity infrastructure and services. Historically, many of these initiatives reflect a top-down approach that fails to consider the diversity of the communities and regions they are designed to support. Here, we focus on a case study of a policy consultation held by the national telecommunications regulator in an effort to learn current issues and challenges in the North. Consistent with existing research, our findings revealed that the most frequently reported challenges are the high cost of access, slow speeds, and limited competition. We also point out fewer submissions from smaller rural communities and argue that policymakers and researchers should pay closer attention to place-based challenges identified in different types of communities, and adopt more precise engagement tools and processes to encourage input from community members.

Novel Smart Sensor Platform for Monitoring Multiple Pressure Injury Risk Factors: A Feasibility Study in a Post-Acute Care Facility.

Posture, temperature, and moisture have been identified as critical modifiable risk factors in pressure injury (PI) development. Microclimate is defined as temperature and humidity at the interface of the support surface and body. To our knowledge, no studies have used sensor technology to measure these parameters simultaneously in real time. Continuous monitoring of repositioning and microclimate provide real-time actionable insights to help deliver personalized care and measure the effectiveness of interventions. To evaluate the ability of a smart surface platform to collect and document clinical data on monitoring patients' movement and microclimate simultaneously and to compare data generated to nursing observations in order to construct an algorithm that is expected to evolve over time: (1) comparing the blinded data from nurses interacting with the patients and the system; and (2) data being collected is validating an algorithm that is expected to become more accurate over time. This prospective, descriptive single-site trial was conducted at a tertiary care facility in a large urban centre in Canada. Patients identified at risk of PIs received standard of care while placed on the smart surface for timed intervals. Nurses' assessment data were collected at three hourly timepoints using a comprehensive tool developed for the study. Sensors monitored patients' interface pressure moisture and temperature every four seconds. A comparative statistical analysis was conducted between the two datasets retrospectively. The study included a total of 104 participants; mean age of 59 years (range 21-92, ± 19.15). Sensor monitoring hours (1,407) generated 1,101,780 frames of surface data. A total of 511 nursing assessments were recorded during the study period. Sensor-generated data correlated strongly with nurse-collected data at cross-sectional intervals. There was a high level of agreement between information collected from sensors and nursing assessments: 94.7% for moisture (p<0.05), and 87.1% for temperature (p<0.05). Nurse-recorded posture assessments were compared to the smart surface platform interface pressure visualizations to determine the device's posture detection, resulting in a 92% accordance (matching 552 out of 600 nurse postures), with a binomial test determining the posture results to be statistically significant (p<0.05) (CI 95%). In addition, moisture events were matched to nurse assessments with 94.7% in accordance, identifying 39 bladder incontinence and 93 non-urinary moisture events (125 total events captured out of 132). The technology's ability to capture PI risk factors supports nursing practice. Supplementary data generated has the potential to improve efficiency of professional caregiver workflow and patient outcomes by informing targeted microclimate management strategies and decreasing unnecessary interventions. The large volume of data collected will be used as a basis for artificial intelligence applications with the potential to inform other clinical decision-making areas.

The place of the public under COVID-19.

Over the past several decades, scholars have lamented the erosion of “true” public space through the rise of semi‐public and private spaces where access is determined, and usage is increasingly regulated (e.g., through curfews and restrictions on use). Writing in the midst of the sixth wave of COVID‐19, the importance of inclusive, open spaces in Canadian urban centres is evident: these are spaces that allow for movement and participation (ideally) across axes of identity and difference. Yet, public spaces are also bound up with the heightened regulation of bodies to supress contagion through social distancing and restrictions on use. While some bodies are in place (and take up space) in public in this context, other bodies face limitations pertaining to discrimination, surveillance, health, and access. This viewpoint highlights the importance of retaining and producing inclusive public spaces and the need to think critically about the urban experience under COVID‐19.

Decision Needs and Preferred Strategies for Shared Decision-Making in Rheumatoid Arthritis: Perspectives of Canadian Urban Indigenous Women.

ObjectiveDecision‐making for treatment of rheumatoid arthritis (RA) is complex, with multiple beneficial medication options available, but with the potential for treatment‐related adverse effects and significant economic considerations. Indigenous patients make treatment decisions informed by an interplay of clinical, family, and societal factors. Shared decision‐making may represent an approach to support treatment decisions in a culturally congruent manner. Our objective was to identify aspects of arthritis care that Indigenous participants found relevant for shared decision‐making and to explore preferences for shared decision‐making strategies.MethodsA purposive sampling from rheumatology clinics that provide services to Indigenous patients in a Canadian urban center was used to recruit participants for interviews. Seven participants were recruited to reach content saturation. Interview content was coded by 2 individuals, including an Indigenous patient with RA, and the data were analyzed via thematic analysis.ResultsParticipants were all women ages 37–61 years living with RA. Participants supported the idea that shared decision‐making would be beneficial, primarily to support decisions around treatment plans and medication changes. Shared decision‐making approaches would need to reflect Indigenous‐specific content areas, such as benefits and risks of therapy informed by data from Indigenous patient populations and inclusion of traditional modes of healing. All participants were interested in having a decision coach and preferred that decision aids be in both paper and electronic formats for accessibility.ConclusionThis study advances knowledge in the priority areas and specific content needed in the shared decision‐making process and the preferences of shared decision‐making strategies relevant and appropriate for urban Indigenous women living with RA in Canada.

Smartphone Use and Mental Health among Youth: It Is Time to Develop Smartphone-Specific Screen Time Guidelines

Smartphone use has become increasingly popular and almost all age cohorts engage in smartphone usage for a wide variety of activities. This study aims to investigate the relationship between high smartphone use and mental health among youth and in two urban centres in Canada. This study is part of the Smart Platform, a digital epidemiological and citizen science initiative. Citizen scientists provided all data via their own smartphones using a custom-built smartphone application. The baseline questionnaire included measures of smartphone screen time behaviours (internet use, gaming, and texting), demographic characteristics, and health outcomes including anxiety, suicide ideation, feelings of depression, and self-rated health. Binary regression models determined the relationship between smartphone use and mental health measures. Among the 437 participants (13–21 years old), 71.2% reported high total smartphones use during a typical week (5 weekdays and 2 weekend days). High weekday and high weekly total smartphone use were associated with an almost two times higher risk of screening positive for anxiety, while high weekend gaming and high total smartphone use were associated with an almost three times higher risk of suicide ideation. Moreover, high weekend total smartphone use was also associated with an almost three times higher risk of poor self-rated mental health. Our findings suggest that high smartphone use’s association with mental health varies by type of activity as well as type of day (weekday/weekend day). Smartphone usage among youth has become near universal and it is important to factor in variations in smartphone usage’s impact on mental health in developing smartphone-specific screen time guidelines by taking into context both type of activities, as well as type of day (weekday/weekend day).

The COVID-19 Era—Influencers of Uneven Sector Performance: A Canadian Perspective

The study estimates the impact of COVID-19 on the labour market outcomes of major industrial sectors in Toronto, the largest urban centre in Canada. Using various economic data, we classify the sectors as distressed, stable, and those requiring ongoing monitoring. Furthermore, we estimate the expected impact of the pandemic shock using the Impulse Response Function (IRF) method. The results show an uneven impact of the pandemic with adverse outcomes for low-paying front-facing sectors, such as accommodation &amp; food services and manufacturing. The post-pandemic projections show lingering negative implications for various sectors. The insights are helpful for policy recommendations, such as targeted responses to address the declines and structural changes in these sectors because of increasing technology adoption and the resulting labour market challenges.

Understanding the Perspectives of Women Who Use Intravenous Drugs and are Experiencing Homelessness in an Urban Centre in Canada: An Analysis of Ethnographic Data

Injection drug use has long been a topic of investigation, whether through a health or criminal justice lens. Whilst these bodies of literature offer important perspectives, missing from the extant literature is evidence, particularly involving women who use drugs, and more specifically evidence about the health beliefs of these women. To address this knowledge gap, we undertook an ethnographic study of homeless women in downtown Ottawa who inject drugs. This included interviews, observations, and artifact analyses. In this paper, we report on these ethnographic data to show the context and nature of the subjective lives of women who use injection drugs and their beliefs and perspectives on health. We use these data to make recommendations for nursing and healthcare practice moving forward.

Social support and HIV prevention behaviors among urban HIV-negative gay, bisexual, and other men who have sex with men.

Supportive social relationships can have direct positive effects on health and mitigate the negative impact of stressors. This study investigated the main effect of perceived social support on STI/HIV risk and prevention behaviors. The buffering effect of perceived social support on the impact of proximal minority stressors, like internalized homonegativity, was also examined on one risk behavior specifically, condomless anal sex (CAS) without HIV preexposure prophylaxis (PrEP) use.HIV-negative gay, bisexual, and other men who have sex with men (GBM) were recruited using respondent driven sampling from three major Canadian urban centers (n = 1,409). GBM completed measures of perceived social support, proximal minority stress, and engagement in STI/HIV risk and prevention behaviors.Higher perceived social support was positively associated with a several health behaviors, including recent STI and HIV testing, discussing HIV status with prospective partners, the use of behavioral HIV-risk reduction strategies during sexual encounters, and a lower likelihood of engaging in CAS without PrEP. There was evidence of moderation as well. Among GBM with higher perceived social support, internalized homonegativity was no longer associated with increased odds of engaging in CAS without PrEP.The results of the current study advance social support theory to GBM in the context of biomedical prevention, showing both evidence of both direct associations and buffering effects on STI/HIV risk and prevention behaviors. This highlights the importance of promoting social support seeking in interventions aimed at improving GBM health. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Report on the Distribution of the Social Determinants of Health and Health Equity in a Forensic Psychiatry Program

The social determinants of health are important factors that shape a person’s well-being, life expectancy, and quality of life. The environments in which people live, work, and play are paramount in determining their overall health. As such, viewing health as an outcome, not only of individual choices and biomedical factors but also of socioenvironmental influences, can be an important lens to guide health-care practice. This report examined the social determinants of health of people admitted to inpatient units in a forensic psychiatry program in a major Canadian urban centre. Twenty health variables were collected from the Resident Assessment Instrument–Mental Health form. A deprivation scale was created to understand social and material inequality on a gradient. Findings showed that those surveyed had high rates of poor social determinant of health factors, such as low educational attainment, insecure housing, and lack of secure employment before their admission to the program. Chi-square tests showed associations between material deprivation, race, and comorbidity status. The findings may influence a multisectorial approach to mental illness prevention, management, and recovery practices.

Multi-pollutant urban study on acute respiratory hospitalization and mortality attributable to ambient air pollution in Canada for 2001–2012

Humans inhale a mixture of various air pollutants, and there is ambiguity whether these pollutants act independently or in an additive, synergistic, or antagonistic manner. We aimed to examine differences in adverse health effects of short-term exposure to air pollution through single-versus multi-pollutant models. We collected daily ambient air pollutants (O3, NO2 and PM2.5) concentrations from 24 Canadian urban centers from 2001 to 2012. We examined between-pollutant correlations and estimated their associations with respiratory hospitalization and mortality. We applied a generalized quasi-Poisson model to each city adjusting for one and/or two pollutants. Then we employed a Bayesian hierarchical model to pool the city-specific estimates for national estimates. We also examined 0- to 6-day air pollutant lagged effects by season. Overall, we found more frequently significant effects from single-pollutant models (vs. multi-pollutant models), for hospitalization (vs. mortality), for O3 (vs. NO2, PM2.5), for warm (vs. cold) season, and for lags ≤2 days (vs. 3–6 days). The most consistent effects appeared on respiratory hospitalization for 1-day lagged O3 and PM2.5, but not NO2. This study found little additive or antagonistic risk of respiratory health outcomes from multi-pollutant models due to low-to-medium correlations among the specified air pollutants.

Picturing Settlement Experiences: Immigrant Women’s Senses of Comfortable and Uncomfortable Places in a Small Urban Center in Canada

Picturing Settlement Experiences: Immigrant Women’s Senses of Comfortable and Uncomfortable Places in a Small Urban Center in Canada

Continuation of Contraception Following Termination of Pregnancy in a Canadian Urban Centre

Minimal evidence exists on the continuation of contraception following termination of pregnancy. Continuation of effective contraception is important because it has been found to reduce unintended pregnancies. This study aims to determine the rate of continuation and choice of contraception following termination of pregnancy. A cross-sectional analytic study was undertaken of 400 patients undergoing termination of pregnancy over 2 years. Demographic information and contraception choice prior to, at time of, and 6 months following termination were collected. Data were analyzed to assess relationships between patient characteristics and contraceptive choice. Prior to termination, 58.5% of patients were not using contraception and 22.4% used a less effective method (e.g., barrier or fertility awareness). Following termination, 99.7% of patients chose a method of contraception, and 95.2% chose a more effective method (e.g., long acting reversible contraception, permanent sterilization, combined hormonal contraceptives, progesterone-only contraceptive). Six months following termination, 85.8% of patients were using contraception. A more effective method was continued by 37.8%. There were no significant relationships between choice of contraception and age, previous pregnancies, or social determinants of health. Patients living with their sexual partner were significantly more likely to switch to a less effective method of contraception at 6 months. Following termination of pregnancy, almost all patients chose a method of contraception and most continued using contraception 6 months following termination.