Medical Assistance in Dying in Canada: An Ethical Analysis of Conscientious and Religious Objections

Article

Eating habits of a population undergoing a rapid dietary transition: portion sizes of traditional and non-traditional foods and beverages consumed by Inuit adults in Nunavut, Canada

Background: To determine the portion sizes of traditional and non-traditional foods being consumed by Inuit adults in three remote communities in Nunavut, Canada. Methods. A cross-sectional study was carried out between June and October, 2008. Trained field workers collected dietary data using a culturally appropriate, validated quantitative food frequency questionnaire (QFFQ) developed specifically for the study population. Results: Caribou, muktuk (whale blubber and skin) and Arctic char (salmon family), were the most commonly consumed traditional foods; mean portion sizes for traditional foods ranged from 10 g for fermented seal fat to 424 g for fried caribou. Fried bannock and white bread were consumed by >85% of participants; mean portion sizes for these foods were 189 g and 70 g, respectively. Sugar-sweetened beverages and energy-dense, nutrient-poor foods were also widely consumed. Mean portion sizes for regular pop and sweetened juices with added sugar were 663 g and 572 g, respectively. Mean portion sizes for potato chips, pilot biscuits, cakes, chocolate and cookies were 59 g, 59 g, 106 g, 59 g, and 46 g, respectively. Conclusions: The present study provides further evidence of the nutrition transition that is occurring among Inuit in the Canadian Arctic. It also highlights a number of foods and beverages that could be targeted in future nutritional intervention programs aimed at obesity and diet-related chronic disease prevention in these and other Inuit communities.

Smoking and dietary inadequacy among Inuvialuit women of child bearing age in the Northwest Territories, Canada

Objective. The prevalence of smoking in Aboriginal Canadians is higher than non-Aboriginal Canadians, a behavior that also tends to alter dietary patterns. Compared with the general Canadian population, maternal smoking rates are almost twice as high. The aim of this study was to compare dietary adequacy of Inuvialuit women of childbearing age comparing smokers versus non-smokers. Research methods & procedures. A cross-sectional study, where participants completed a culturally specific quantitative food frequency questionnaire. Non-parametric analysis was used to compare mean nutrient intake, dietary inadequacy and differences in nutrient density among smokers and non-smokers. Multiple logistic regression analyses were performed for key nutrients inadequacy and smoking status. Data was collected from three communities in the Beaufort Delta region of the Northwest Territories, Canada from randomly selected Inuvialuit women of childbearing age (19-44 years). Results: Of 92 participants, 75% reported being smokers. There were no significant differences in age, BMI, marital status, education, number of people in household working and/or number of self employed, and physical activity between smokers and non-smokers. Non-parametric analysis showed no differences in nutrient intake between smokers and non-smokers. Logistic regression however revealed there was a positive association between smoking and inadequacies of vitamin C (OR = 2.91, 95% CI, 1.17-5.25), iron (OR = 3.16, 95% CI, 1.27-5.90), and zinc (OR = 2.78, 95% CI, 1.12-4.94). A high percentage of women (>60%), regardless of smoking status, did not meet the dietary recommendations for fiber, vitamin D, E and potassium. Conclusions: This study provides evidence of inadequate dietary intake among Inuvialuit of childbearing age regardless of smoking behavior.

Medical Assistance in Dying in Canada: An Ethical Analysis of Conscientious and Religious Objections

Article

Life-history traits of two Salvelinus species and mercury concentrations in fish and prey in ten Canadian lakes (2006-2008)

Mercury concentrations ([Hg]) in Arctic food fish often exceed guidelines for human subsistence consumption. Previous research on two food fish species, Arctic char (Salvelinus alpinus) and lake trout (Salvelinus namaycush), indicates that anadromous fish have lower [Hg] than nonanadromous fish, but there have been no intraregional comparisons. Also, no comparisons of [Hg] among anadromous (sea-run), resident (marine access but do not migrate), and landlocked (no marine access) life history types of Arctic char and lake trout have been published. Using intraregional data from 10 lakes in the West Kitikmeot area of Nunavut, Canada, we found that [Hg] varied significantly among species and life history types. Differences among species-life history types were best explained by age-at-size and C:N ratios (indicator of lipid); [Hg] was significantly and negatively related to both. At a standardized fork length of 500 mm, lake trout had significantly higher [Hg] (mean 0.17 µg/g wet wt) than Arctic char (0.09 µg/g). Anadromous and resident Arctic char had significantly lower [Hg] (each 0.04 µg/g) than landlocked Arctic char (0.19 µg/g). Anadromous lake trout had significantly lower [Hg] (0.12 µg/g) than resident lake trout (0.18 µg/g), but no significant difference in [Hg] was seen between landlocked lake trout (0.21 µg/g) and other life history types. Our results are relevant to human health assessments and consumption guidance and will inform models of Hg accumulation in Arctic fish.

(Table 1) Rodent (lemming and vole) densities in 5 study areas in the Canadian Arctic

Lemmings construct nests of grass and moss under the snow during winter, and counting these nests in spring is 1 method of obtaining an index of winter density and habitat use. We counted winter nests after snow melt on fixed grids on 5 areas scattered across the Canadian Arctic and compared these nest counts to population density estimated by mark-recapture on the same areas in spring and during the previous autumn. Collared lemmings were a common species in most areas, some sites had an abundance of brown lemmings, and only 2 sites had tundra voles. Winter nest counts were correlated with lemming densities estimated in the following spring (r(s) = 0.80, P < 0.001), but less well correlated with densities the previous autumn (r(s) = 0.55, P < 0.001). Winter nest counts can be used to predict spring lemming densities with a log-log regression that explains 64% of the observed variation. Winter nest counts are best treated as an approximate index and should not be used when precise, quantitative lemming density estimates are required. Nest counts also can be used to provide general information about habitat-use in winter, predation rates by weasels, and the extent of winter breeding.

(Table 1) Annual mean concentrations of atmospheric a- and g-Hexachlorocyclohexane at stations Alert, Canada and Zeppelin, Norway

Twelve year datasets of weekly atmospheric concentrations of alpha- and gamma-HCH were compared between the two Arctic monitoring stations of Alert, Nunavut, Canada, and Zeppelin Mountain, Svalbard, Norway. Time-series analysis was conducted with the use of dynamic harmonic regression (DHR), which provided a very good model fit, to examine both the seasonal behaviour in these isomers and the longer-term, underlying trends. Strong spatial differences were not apparent between the two sites, although subtle differences in seasonal behaviour and composition were identified. For example, the composition of gamma-HCH to total HCH (alpha + gamma) was greater at Zeppelin compared to Alert, probably reflecting this site's proximity to major use regions of lindane. Pronounced seasonality in air concentrations for gamma-HCH was marked by a 'spring maximum event' (SME), confirming earlier studies. For alpha-HCH, the SME was much weaker and only evident at Alert, whereas at Zeppelin, seasonal fluctuations for alpha-HCH were marked by elevated concentrations in summer and lower concentrations during winter, with this pattern most apparent for the years after 2000. We attribute this difference in spatial and temporal patterns to the Arctic oscillation. A similar climatic pattern was not evident at either site in the gamma-HCH data. Seasonally adjusted, long-term trends revealed declining concentrations at both sites for alpha- and gamma-HCH over the entire time-series. Recent legislation affecting lindane use appear to account for this decline in gamma-HCH, with little evidence of a delay or 'lag' between the banning of lindane in Europe (a main source region) or Canada, and a decline in air concentrations observed at both Arctic sites.

Dionne Brand, Austin Clarke, and Tessa McWatt: Blackening Canada

This project analyzes contemporary black diasporic writing in Canada, arguing that Dionne Brand, Austin Clarke and Tessa McWatt evince a unique form of double-consciousness in their writings. Their work transforms African-American double-consciousness by locating it simultaneously within both the black diaspora and the practice of Canadian multiculturalism. The objective of this project is to offer a critical framework for situating these writers within the legacy of both Black Atlantic and Canadian cultural production. These writers do not aim to resolve their double-consciousness but rather dwell within that contradictory doubleness and hyphenation, forcing nation and diaspora to contend with one another in a discomfiting and unsettling dialogue. These authors employ the absences of the black diaspora to imagine new forms of black cultural production, multicultural citizenship and national identity. Their works produce a grammar of diasporic double-consciousness that locates the absented origins of diaspora within Canada. Brand’s depiction of temporality and Clarke’s tracing of movement explore the continuities between nation and diaspora while re-membering neglected aspects of the history of black Canada, such as the life and death of Albert Johnson. McWatt extends this blackening of nation by depicting coalitions between diasporic, indigenous, raced and sexed subjects. These authors transform hegemonic Canadian narratives of nation by dwelling in the hyphen, while their evocation of memory, absence, trauma, and desire gives blackness new meaning and legitimacy.

Paleoecology, Diagenesis and Biological Affinity of Tetradiids in the Upper Ordovician (Sandbian) Black River Group of the Kingston Area, Ontario, Canada

Tetradiids are a group of colonial, tubular fossils that occur globally in Middle to Upper Ordovician strata. Tetradiids were first described as a type of tabulate coral; however, based on their four-fold symmetry, division, and presence of a central-sparry canal, they were recently reinterpreted as a florideophyte rhodophyte algae, a reinterpretation that is tested in this thesis. This study focused on understanding the affinity and taphonomy of this order of fossil. Research was conducted by stratigraphic and petrographic analyses of the Black River Group in the Kingston, Ontario region. Tetradiid occurrences were divided into fragment or colonial, with three morphologies of tetradiids described (Tetradium, Phytopsis and Paratetradium). Morphology is specific to depositional environment, with compact Tetradium consistently within ooid grainstones and open branching Phytopsis and chained Paratetradium consistently within mudstones. Two types of patch reefs were recognized: a Paratetradium bioherm, and a Paratetradium, Phytopsis, stromatolite bioherm. The presence of bioherms implies that tetradiids were capable of hypercalcifying. Preservation styles of tetradiids were investigated, and were compared to brachiopods, echinoderms, mollusks, and ooids. Tetradiids were preferentially preserved as molds and demonstrated complete dissolution of skeletal material. Rare specimens, however, demonstrated preserved horizontal partitions, central plates, and a double wall. Skeletal molds were filled with either calcite spar, mud or encrusted by a cryptomicrobial colony. Both calcitic and aragonitic ooids were discovered. The co-occurrence of aragonitic ooids, aragonitic crytodontids, and the evolution of aragonitic, hypercalcifying tetradiids is interpreted as representing the geochemical favoring of aragonite and HMC in a time of global calcite seas. The geochemical favoring of aragonite is interpreted to be independent to global Mg: Ca ratios, but was the result of increased saturation levels and temperature driven by high atmospheric pCO2. Based on the presence of epitheca, tabulae, septa, and the commonality of growth forms, tetradiids are interpreted as an order of Cnidaria. The evolution of an aragonitic skeleton in tetradiids is interpreted to be the result of de novo acquisition of a skeleton from an unmineralized clade.

An Investigation into the Failure to Implement a Universal School Lunch Program during WWII and Postwar Reconstruction in Canada: The Case of Ontario

The purpose of this research is to investigate the various social, political and economic factors that contributed to Canada���s failure to implement a universal school lunch program during the 1940s. Although Canada developed several other social welfare programs in the post-war period, it remains one of the only industrialized nations that does not provide hot meals to children in elementary or secondary schools. Data from the province of Ontario, a major site of postwar reconstruction and policy-making, has been taken up to inform the broader national discourse on school lunches from the 1940s. National, Ontario provincial and City of Toronto archival records were collected and analyzed according to common themes, in order to identify key barriers that constrained government support of a hot meal program. Archival records were identified using key words, and were limited to materials created between 1930-1952. Analysis suggests that sufficient need for a hot meal program had not been established during the 1940s. Despite misleading nutrition messages, rates of malnutrition and nutrient-related disease were at an all-time low, and many Ontario school boards did not appear to have the necessary infrastructure required to supply all pupils with hot meals. The Canadian government had already employed significant resources to improve existing social security programs by coupling them with health education. This strategy reflected a shift in understanding malnutrition as a knowledge-based problem, as opposed to income-based. This understanding was further reinforced through the moralized dissemination of nutrition information, which placed blame on women for improperly raising their children. Ultimately, the strong uptake of nutrition as a public health issue in Ontario may have limited prospective responses to solutions already utilized in the public health domain, and directed favour away from a universal school lunch program for Canada.

Examination of body image among Canadian adolescents: Relations with physical activity and screen time

Background: Adolescence is a period of life associated with self-perceptions of negative body image. Physical activity levels are low and screen time levels are also high during this stage. These perceptions and behaviours are associated with poor health outcomes, making research on their determinants important. With adolescent populations, certain groups may be at higher risk of body dissatisfaction than others, and body dissatisfaction may influence individual physical activity and screen time levels. Objectives: The objectives of this thesis were to: 1) describe body image among young Canadians, examining possible health inequalities 2) estimate the strength and significance of associations between body satisfaction, physical activity and screen time, and 3) examine the potential etiological role of biological sex. Methods: Objective 1: The 2013/2014 Health Behaviour in School-aged Children study was employed. Sex-stratified Rao-Scott chi-square analyses were conducted to examine associations between socio-demographic factors and body satisfaction. Objective 2: The 2005/2006 and 2013/2014 cross-sectional and 2006 longitudinal HBSC data sets were used. Sex-stratified modified Poisson regressions were conducted and risk estimates and associated confidence intervals obtained. Results: Objective 1: Among males, being older, of East and Southeast Asian ethnicity, and reporting low SES all were associated with body dissatisfaction. Among females, being older, of Arab and West Asian or African ethnicity, being born in Canada, and reporting low SES were all associated with being body dissatisfied. Objective 2: Cross-sectionally, males who reported ‘too fat’ body dissatisfaction were more likely to be physically inactive. Adolescents of both sexes who reported ‘too fat’ body dissatisfaction were more likely to engage in high levels of screen time. Data from the longitudinal component supported the idea that male ‘too fat’ body dissatisfaction temporally leads to physical inactivity, but showed an inverse relationship between body dissatisfaction and screen time. Conclusions: Objective 1: Future prevention efforts in Canada should target subgroups to effectively help those at greatest risk of body dissatisfaction, and ameliorate potential inequalities at the population level. Objective 2: The presence of these relationships may inform future interventions as part of a multi-factorial etiology, in order to increase physical activity and decrease screen time among youth.

Performance Information and Innovation in the Canadian Government (Working Paper 43)

The presentation made at the conference addressed the issue of linkages between performance information and innovation within the Canadian federal government1. This is a three‐part paper prepared as background to that presentation. • Part I provides an overview of three main sources of performance information - results-based systems, program evaluation, and centrally driven review exercises – and reviews the Canadian experience with them. • Part II identifies and discusses a number of innovation issues that are common to the literature reviewed for this paper. • Part III examines actual and potential linkages between innovation and performance information. This section suggests that innovation in the Canadian federal government tends to cluster into two groups: smaller initiatives driven by staff or middle management; and much larger projects involving major programs, whole departments or whole-of-government. Readily available data on smaller innovation projects is skimpy but suggests that performance information does not play a major role in stimulating these initiatives. In contrast, two of the examples of large-scale innovation show that performance information plays a critical role at all stages. The paper concludes by supporting the contention of others writing on this topic: that more research is needed on innovation, particularly on its link to performance information. In that context, other conclusions drawn in this paper are tentative but suggest that the quality of performance information is as important for innovation as it is for performance management. However, innovation is likely to require its own particular performance information that may not be generated on a routine basis for purposes of performance management, particularly in the early stages of innovation. And, while the availability of performance information can be an important success factor in innovation, it does not stand alone. The commonality of a number of other factors identified in the literature surveyed for this paper strongly suggests that equal if not greater priority needs to be given to attenuating factors that inhibit innovation and to nurturing incentives.

COPING STRATEGIES AND PSYCHOLOGICAL WELL-BEING AMONG BHUTANESE REFUGEES RESETTLED IN OTTAWA, CANADA

Since 2008, more than 6000 Bhutanese refugees have been resettled in over 21 communities across Canada, with nearly 300 individuals residing in Ottawa. This resettling process is associated with physical and psychological stress, as individuals acclimatize to a new country. A lack of understanding of the impact of this transition exists. This study assessed the relationship between coping strategies and psychological well-being of Bhutanese refugees resettled in Ottawa. A cross sectional survey of a representative sample of Bhutanese adults (n = 110) was conducted between November and December 2015. Coping strategies and psychological well-being were measured using the Brief COPE and General Well-being (GWB) scales. The total GWB mean score of 69.04 ± 12.09 suggests that respondents were in moderate distress. GWB did not significantly differ by sex, marital status, religion, employment, part time or full time job, or length of stay in Canada. Using multiple linear regression, significant independent variables from univariate analysis with GWB (age, education, positive reframing, self-blame and venting) were modeled to determine the best predictors of general well-being (GWB, F (11, 96) = 3.61, p < .001, R² = 21.2%). Higher levels of education and positive reframing were associated with greater GWB scores while self-blame and ages 41-50 were inversely associated with general well-being. It was found that above 66% of the unemployed participants were from age groups 41 and above. This finding suggests that career guidance services and vocational training to address unemployment may benefit this community. Nurses can provide support and counselling to assist refugees to minimize the use of negative coping strategies like self-blame and venting and promote positive coping strategies. Further, collaboration between nurses, other interdisciplinary professionals and community organizations is necessary to address social determinants of health and enhance refugee psychological well-being.

Proving My Competency One Test at a Time: Internationally Educated Nurses and the Canadian English Language Benchmark Assessment for Nurses

Abstract Professional language assessment is a new concept that has great potential to benefit Internationally Educated Professionals and the communities they serve. This thesis reports on a qualitative study that examined the responses of 16 Canadian English Language Benchmark Assessment for Nurses (CELBAN) test-takers on the topic of their perceptions of the CELBAN test-taking experience in Ontario in the winter of 2015. An Ontario organization involved in registering participants distributed an e-mail through their listserv. Thematic analyses of focus group and interview transcripts identified 7 themes from the data. These themes were used to inform conclusions to the following questions: (1) How do IENs characterize their assessment experience? (2) How do IENs describe the testing constructs measured by the CELBAN? (3) What, if any, potential sources of construct irrelevant variance (CIV) do the test-takers describe based on their assessment experience? (4) Do IENs feel that the CELBAN tasks provide a good reflection of the types of communicative tasks required of a nurse? Overall, participants reported positive experiences with the CELBAN as an assessment of their language skills, and noted some instances in which they felt some factors external to the assessment impacted their demonstration of their knowledge and skill. Lastly, some test-takers noted the challenge of completing the CELBAN where the types of communicative nursing tasks included in the assessment differed from nursing tasks typical of an IENs country or origin. The findings are discussed in relation to literature on high-stakes large-scale assessment and IEPs, and a set of recommendations are offered to future CELBAN administration. These recommendations include (1) the provision of a webpage listing all licensure requirements (2) monitoring of CELBAN location and dates in relation to the wider certification timeline for applicants (3) The provision of additional CELBAN preparatory materials (4) Minor changes to the CELBAN administrative protocols. Given that the CELBAN is a relatively new assessment format and its widespread use for high-stakes decisions (a component of nursing certification and licensure), research validating IEN-test-taker responses to construct representation and construct irrelevant variance is critical to our understanding of the role of competency testing for IENs.

Stitching Settler Identities: Canadian Quilts and Their Makers, 1800-1880

Stitching Settler Identities: Canadian Quilts and their Makers, 1800-1880 explores the making, use, and circulation of handmade settler quilts as representation of nineteenth-century women’s social, cultural and economic histories in Canada. An important part of Canadian settlement history is the making and use of handmade quilts in the settler homestead. Handmade coverlets that provided both physical and emotional warmth in the home were a measure of a settler-woman’s careful management of resources and a display of her innovation and creativity. Few settler women recorded their daily experiences; however, most women could sew and quilts offered a method of expression that allowed them to reflect and portray their identities. Thus far, the few studies of quilts have been limited to exhibition catalogues or research that considers a quilt’s aesthetics or its historic significance. While several scholars have called for a reclassification of textile production and needle arts to advance the way in which settler women were viewed as social beings – creating, producing, communicating, and circulating cultural values, most studies on quilts have overlooked a coverlet’s materiality. This study aims to expand the research on quilts as material culture within the context of art history by also considering a quilt’s materiality and when possible, its maker's biography.