Explore the vast range of titles available.

Objectives Despite the high prevalence of mental disorders among youth (age 12 to 17) and emerging adults (age 18 to 24), few receive mental health (MH) services. Using a cross-sectional study design, we examined population characteristics associated with MH service use in this age group from 2011 to 2016. Methods Data were from six cycles of the Canadian Community Health Survey (2011–2016). Population characteristics associated with service use were analyzed using logistic regression models for each year. Changes in odds ratios over time were used to examine trends. Results Presence of a mood or anxiety disorder had the largest magnitude of association on MH service use in every year. Trends suggested an increased association size between self-rated MH status and service use; lower self-rated MH was associated with a 62% increase in odds of service use in 2011 and an 83% increase in 2016. Being female was associated with increased odds of MH service use (range: 59–107%). Compared with white respondents, individuals who were East and Southeast Asian or South Asian had decreased odds of MH service use. While the association size varied for South Asians, there was a trend toward decreasing likelihood of accessing care (55% decreased odds in 2011, 74% in 2016) for East and Southeast Asians. Conclusion Trends suggest changes in population characteristics associated with access to MH care (e.g., self-rated MH status) as well as persistent inequity in MH service use in Canada for males and individuals from Asian ethnic groups.

Background Population-based studies in Canada and the United States estimate chronic physical health conditions affect between 20 to 30% of children aged 0 to 17. Challenges in measuring chronic conditions include the use of inconsistent definitions and algorithms that capture a limited number of conditions. Thus, we developed a chronic health condition (CHC) algorithm using administrative data to determine whether a child has a CHC based on (1) the diagnosis recorded for the visit, (2) the number of visits, and (3) within a specific reference period. Methods Data were from the cross-sectional 2014 Ontario Child Health Study, linked with Ontario Health Insurance Plan (OHIP) administrative health data. Unweighted prevalence estimates and agreement analyses (Cohen’s Kappa, sensitivity, specificity) were used to compare the survey parent-reported and algorithm-based presence of a CHC. Results 31.8% and 27.1% of children and youth had a CHC based on administrative and survey data, respectively. Agreement between administrative and survey data was poor ( k  = 0.17). Among a few specific conditions, agreement varied depending on the type of condition (e.g., diabetes k  = 0.77 vs health conditions k  = 0.21). Conclusion We found considerable discrepancies between administrative and survey-reported data. The results highlight the importance of using algorithms developed from multiple datasets to examine complex research questions, such as the measurement of chronicity.

Background National legislative guidelines for sleep and rest are lacking in the Canadian licensed childcare sector. No review of Canadian legislation for licensed childcare facilities has focused on sleep. This paper provides a review of the Canadian provincial and territorial legislative landscape, regarding sleep, rest, and naps in licensed childcare centers. Methods Childcare statutes and regulations for each province and territory were identified and downloaded on a particular date. Statutes and regulations were reviewed focusing on sections articulating licensed childcare facility mandates governing sleep, rest, naps, and sleep equipment. An excel file was used to facilitate systematic data retrieval and comparisons across provinces and territories. Two authors developed and discussed themes that summarized data from the documents. Results No statutes indicated recommendations for sleep, rest, or naps. Only one regulation defined rest (Alberta). Our analysis of regulations identified four themes representing sleep, rest, and naps: programming (general programming, daily programming); space (dedicated space, amount of space, age-specific space); equipment (developmental appropriateness, acceptable sleep equipment, age-specific equipment); and safety (staffing during sleep/rest, sleep position, sleep monitoring, sleep equipment safety, prohibited practices). In Canada, minimal regulatory consistency is evident in required sleep programming, space, acceptability of sleep equipment, and sleep safety considerations. Most jurisdictions’ regulations indicated necessity for developmentally appropriate rest or sleep areas and equipment, in particular for infants, but there was minimal consistency in defining infant age groups. Conclusions Although we identified themes related to sleep across regulations, childcare regulations differ in their definitions of infants and specifications for children’s sleep and rest in licensed Canadian childcare facilities. Without adequate definitions in legislative components of appropriate sleep duration linked to children’s developmental stages, childcare facilities lack guidance to support healthy sleep for children in their care. Future research can examine translation of healthy sleep guidelines into government legislation and mandates for sleep, rest, and naps among young children in licensed childcare.

Reid talks about an accompanying editorial from a physician who, by nature of demographics, was directly affected by the change in US border regulations. Similarly, he questions Dr Stanbrook's qualifications to talk about the impact of a conference boycott on the 25% of US physicians who trained outside of the US. He can only interpret that Dr Stanbrook believes that the interests of science are more important than the rights of individuals. He's confident that most Canadians would not agree.

Background Children (aged 4 to 11) and youth (aged 12 to 17) with chronic health conditions (CHC; e.g., asthma, diabetes) are at an increased risk of developing mental health (MH) problems relative to those without CHC. We examined how patterns of visits received for CHC influenced receipt of MH care. Methods Using secondary analysis of health administrative data and the 2014 Ontario Child Health Study, we documented the types of MH services contacts (specialized and general health professionals) children had. Hierarchical logistic regressions were used to test the contribution of previous physical healthcare use in predicting MH services. We controlled for factors known to influence MH service access, including previous MH services. The moderating effect of parents who perceive a need for MH help and having a family physician (FP) was also examined. Results For every one-visit increase in FP and specialist visits for a CHC, the odds of children having contact with specialized services increased 1.06 and 1.18 times, respectively. The odds of children whose parents recognized a need for MH help were 16.58 times more likely to report specialized services and 5.49 times more likely to report general services, than children whose parents did not perceive a need. The odds of children with an FP using general MH services (e.g., walk-in clinic, pediatrician, emergency department) were reduced by 81%, compared to those without an FP. Conclusion While previous physical healthcare use increases the odds of MH service contact, perceived need for treatment and having a FP were stronger predictors. Children with a FP who receive MH services in the primary care setting seem to have less general MH services. These findings underscore the importance of patient-centred care approaches that prioritize patients’ and families’ perspectives and the pivotal role of FP in MH treatment. Key points • Children and youth with chronic health conditions (CHC; e.g., asthma, diabetes, allergies) are at an increased risk of developing mental health (MH) problems relative to those without CHC. • Among children and youth with CHC, the frequency of follow-up appointments will vary depending on the condition type, availability of services, and best-practice guidelines. • This research examined how patterns of visits received for CHC influenced subsequent receipt of MH care after controlling for known predictors of MH service contact. • While previous physical healthcare use increases the odds of MH service contact, perceived needs and having a family physician were found to be stronger predictors. • Children with a family physician who receive MH services in the primary care setting seem to have less general MH services (e.g., walk-in clinics, pediatricians, emergency departments).

IntroductionMental health conditions are a major public health challenge. Though typically diagnosed in adolescence, these conditions may arise during early childhood. Considerable evidence shows that engagement in healthy movement behaviours (ie, regular physical activity, reduced sedentary behaviour and sufficient sleep) is associated with a lower risk of mental health conditions in adolescents and adults. However, whether these behaviours have the same protective effect during early childhood is less clear. The MOvement behaviours and irritaBILITY in early childhood (MOBILITY) study was established to investigate the association between 24-hour movement behaviours and trajectories of early childhood mental health.Methods and analysisMOBILITY is a prospective observational cohort study of toddlers’ and preschoolers’ (aged 2–4 years) movement behaviours and mental health, which will be assessed at three data collection points (baseline and 6- and 12-month follow-ups). Mental health indicators (ie, irritability, internalising, externalising and prosocial behaviour) will be assessed via parent-report questionnaires, and movement behaviours will be assessed via ActiGraph accelerometers and sleep diaries. Primary analyses will include using: (1) compositional data analysis to examine prospective relationships between overall movement behaviour compositions and trajectories of mental health indicators, (2) isotemporal substitution modelling to determine whether the prospective association between independent movement behaviours and trajectories of mental health indicators is contingent on other movement behaviours and (3) the ‘Goldilocks’ approach to determine optimal time use compositions to promote favourable trajectories in mental health symptomology.Ethics and disseminationEthical approval for this study was received from the Health Sciences Research Ethics Board at Western University, London, Ontario, Canada. The findings of this novel research will have implications for informing updates of evidence-based movement behaviour guidelines, as well as the development and implementation of preventive mental health interventions. Study findings will be disseminated via publications and conference presentations for academic audiences, infographics and short videos for community partners, early childhood educators and parents, as well as actionable recommendations for physicians and healthcare providers.

The current study examined the joint effects of stress, social support, and self-esteem on adjustment to university. First-year undergraduate students (N = 115) were assessed during the first semester and again 10 weeks later, during the second semester of the academic year. Multiple regressions predicting adjustment to university from perceived social support (friends and family), self-esteem (academic, social, and global), and stress were conducted. From the fall to winter semesters, increased social support from friends, but not from family, predicted improved adjustment. Decreased stress predicted improved overall, academic, personal-emotional, and social adjustment. Increased global, academic, and social self-esteem predicted decreased depression and increased academic and social adjustment. Results are discussed with respect to potential mechanisms through which support and self-esteem may operate.

Background: Mental health walk-in clinics (MHWCs) are a model of service delivery that has gained increasing interest and traction. The aim of the study was to better understand how MHWC use is related to use of other services provided by agencies. Objectives: (1) Explore if and how MHWCs are used alongside other services, including the different time points (e.g. MHWCs used exclusively, MHWCs used before other agency services); (2) identify correlates of MHWC use alongside other agency services. Design: Administrative data from two child and youth mental health agencies in Ontario were extracted, including demographics, visit data, and presenting concerns. Methods: In this exploratory, descriptive study, analyses of administrative data were conducted to identify patterns and correlates of MHWC use before other agency services, compared with MHWC use exclusively. Results: More than half of families used MHWCs and other agency services before or concurrently with other agency services. Child age, guardianship, and disposition at discharge emerged as correlates of MHWC use before other agency services. Conclusions: MHWCs are sufficient for some families, easing the pressure on other agency services. For the remaining families, MHWCs can help support them at the beginning of their service use journey.

A substantial number of children experience persistent or recurrent problems and may need more than one episode of care. However, there is a paucity of research on recurrent service use. The present study examined the rates and predictors of re-accessing community-based care. Secondary data analyses were conducted on administrative data from 5 mental health agencies in Ontario ( N  = 1802). Approximately a third (29.6%) of children who had an episode of care re-accessed services again within 4 years; the median time to re-access was 386 days or 12.68 months. Social content (e.g., age, parental marital status) and treatment system (e.g., spacing of visits) variables predicted re-accessing services, although predictors varied based on how services were re-accessed. A better understanding of the factors that influence recurrent service use may help mental health agencies better prepare for and facilitate this process for families.

Background Glucagon-like peptide-1 receptor agonists are a viable option for the prevention of Alzheimer’s disease (AD) but the mechanisms of this potential disease modifying action are unclear. We investigated the effects of once-weekly exenatide (EQW) on AD associated proteomic clusters. Methods The Exenatide Study of Cardiovascular Event Lowering study compared the cardiovascular effects of EQW 2 mg with placebo in 13,752 people with type 2 diabetes mellitus. 4,979 proteins were measured (Somascan V0.4) on baseline and 1-year plasma samples of 3,973 participants. C-reactive protein (CRP), ficolin-2 (FCN2), plasminogen activator inhibitor 1 (PAI-1), soluble vascular cell adhesion protein 1 (sVCAM1) and 4 protein clusters were tested in multivariable mixed models. Results EQW affected FCN2 (Cohen’s d -0.019), PAI-1 (Cohen’s d -0.033), sVCAM-1 (Cohen’s d 0.035) and a cytokine-cytokine cluster (Cohen’s d 0.037) significantly compared with placebo. These effects were sustained in individuals over the age of 65 but not in those under 65. Conclusions EQW treatment was associated with significant change in inflammatory proteins associated with AD. Trial Registration EXSCEL is registered on ClinicalTrials.gov: NCT01144338 on 10th of June 2010.