The Canadian Neighbourhood Early Childhood Development (CanNECD) Socioeconomic Index: Stability and Measurement Invariance Over Time.

Objectives and Approach The CanNECD SES Index is a composite of 10 Canadian Census and Income Tax Filer variables, aggregated to 2,038 custom neighbourhoods covering all of Canada. The baseline 2006 Index accounted for 32% of the neighbourhood-level variance in overall developmental vulnerability in Kindergarten children, as measured by the Early Development Instrument (EDI). Other existing SES indices accounted for 17% at most. The Index now has two additional time points (2011 and 2016), which allows an evaluation of its consistency over time. Our objective is to assess three aspects of the Index’s temporal consistency. The first is the consistency of the strength of association between the Index and vulnerability rates across EDI developmental domains. The second is the consistency of neighbourhoods’ quintile rank over time. Finally, we use Confirmatory Factor Analysis in an SEM framework to assess the Index’s measurement invariance over time. Results For each EDI domain, the strength of association between Index scores and neighbourhood-level vulnerability rates were either maintained or minimally declined over time. Additionally, neighbourhood quintile rankings were highly consistent over time with over 60% of neighbourhoods in the same quintile between 2006 and 2016, and fewer than 3% with a greater than one-quintile change. Finally, our preliminary measurement invariance results show at least configural invariance over the three time points. Conclusion / implications Our results confirm the stability of the CanNECD Index, justifying its utility for: mapping SES indicators across neighbourhoods and over time, contextualizing neighbourhood-level developmental vulnerability in young children, and identifying interesting neighbourhoods for future study, especially those where the children are faring much better than predicted by the Index

Defying Expectations: Can We Identify Neighbourhoods with “Other Than Expected” Developmental Outcomes?

Objectives To contribute to the evidence on the association between neighbourhood-level child development in Kindergarten and neighbourhood SES, our objective was to quantify the sociodemographic and child development characteristics of the neighbourhoods that “defy expectations”: high SES neighbourhoods with much-worse-than-expected child outcomes, and low SES neighbourhoods with much-better-than-expected child outcomes. Approach Using exploratory and model-based Latent Profile Analysis (LPA), we identified homogenous profile groups of 2038 customized Canadian neighbourhoods using ten SES indicators. We identified the most parsimonious number of profile groups and validated and characterized the derived groups of neighbourhoods using neighbourhood and aggregated child characteristics. Next, as our outcome, we created quartile groups for developmental vulnerability risk, measured with the Early Development Instrument (EDI), to match the number of derived neighbourhood profile groups. Last, we used contingency table analysis to identify neighbourhoods that defy expectations, and then characterized these neighbourhoods using descriptive statistics and correlational analysis. Results The LPA identified four neighbourhood SES groups which we labelled “Low” (31.6%), “Low-moderate” (12.7%), “High-moderate” (38.4%) and “High” (17.4%). These four SES groups were cross-tabulated with quartile groups of EDI vulnerability risk. Inspection of the resulting 4-by-4 contingency table showed that within the “Low” SES profile group 57 (8.9%) neighbourhoods had much-better-than-expected developmental vulnerability risk. Conversely, within the “High” SES profile group, 12 (3.4%) neighbourhood had much-worse-than-expected developmental vulnerability risk. Additionally, these analyses identified large provincial differences in the proportion of neighbourhoods that defy expectation. In 12 provinces and territories in the study, the proportion of neighbourhoods that defied expectations within each province ranged from zero to 50%. Conclusion The identification of neighbourhoods that defy expectations contributes to our understanding of neighbourhood factors influencing child development. Using mixed-methods approaches, these neighbourhoods can be compared to nearby neighbourhoods from the same SES profile group that do not defy expectations, in an effort to identify contextual factors that differentiate them

Does social capital flatten the social gradient in early childhood development? An ecological study of two provinces in Canada

Social capital is thought to buffer the negative effects of low income on health and thereby flatten the social gradient. Child development research on social capital has suggested that social networks of adults and children in a neighborhood may play a protective role in children's outcomes. Yet little is known about how this relationship applies to diverse developmental outcomes in early childhood. This study examines whether the presence of role model adults and the willingness of neighbors to help keep children safe moderates the relationship between neighborhood income and five developmental outcomes for children in kindergarten: (1) physical health and well-being, (2) social competence, (3) emotional maturity, (4) language and cognitive development, and (5) communication and general knowledge. We linked neighborhood-level data on child development from two Canadian provinces, British Columbia (BC, n = 100) and Ontario (n = 482), to neighborhood-level data on social capital from the Ontario Kindergarten Parent Survey, and the BC Social Capital Study; and income data from the 2006 Canadian Census. Multiple regression analyses were conducted to examine the main and interaction effects of social capital and income in relation to child development outcomes. In Ontario, higher levels of social capital were associated with better child outcomes on all five developmental domains. Similar trends were observed in BC. Higher levels of social capital flattened the income gradient in language and cognitive development in both provinces, and social competence in Ontario. Implications for research and practice are discussed

The Shape of the Socioeconomic Gradient: Testing to Functional Form of the Relationship between Socioeconomic Status and Early Child Development

Introduction The literature provides abundant evidence of socioeconomic gradients in health outcomes. However, it is unclear, and particularly understudied in early child development research, whether these observed gradients are linear, whether they diminish as socioeconomic status (SES) increases, and if they ultimately reverse in slope at the highest SES values. Objectives and Approach We linked neighbourhood-level Census and Tax Filer data with Early Development Instrument (EDI) data across Canada. The EDI is a kindergarten teacher-completed measure of five domains of early child development. We used this linked database to statistically compare and choose the most appropriate functional form of the relationship between each of the EDI domains (dependent variables), and the Canadian Neighbourhoods and Early Child Development (CanNECD) study's SES index (predictor) in regression models. Model comparison approaches included: visual checks of lines fitted using Generalized Additive Models, Akaike and Bayesian Information Criterions, Ramsay’s RESET, J and Cox tests. Results The results indicate the optimal functional form of the gradient varies across domains of the EDI. The best model for the Physical Health and Well-Being domain was quadratic, suggesting there may be some reversal in slope at higher values of SES. The best models for the Social Competence and Language and Cognitive Development domains were logarithmic, indicating diminishing returns to SES but with no slope reversal. The best model for the Emotional Maturity domain was linear, suggesting the gradient was consistent across all values of SES. The best fit for the Communication Skills and General Knowledge domain was a cubic ‘S’ curve, suggesting the curve is positive and concave for lower levels of SES but curves upwards beyond a certain SES threshold. Conclusion/Implications The results demonstrate the importance of examining functional forms when modeling socioeconomic gradients. Assuming linear relationships between SES and health outcomes (early child development, in this case) may distort and bias the true nature of the relationships, thus leading to misinterpretations, especially at the highest and lowest values of SES

Neighbourhood-level socioeconomic status and prevalence of teacher-reported health disorders among Canadian kindergarten children

BackgroundThe evidence on the association between neighborhood-level socioeconomic status (SES) and health disorders in young children is scarce. This study examined the prevalence of health disorders in Canadian kindergarten (5–6 years old) children in relation to neighborhood SES in 12/13 Canadian jurisdictions.MethodsData on child development at school entry for an eligible 1,372,980 children out of the total population of 1,435,428 children from 2004 to 2020, collected using the Early Development Instrument (EDI), were linked with neighborhood sociodemographic data from the 2006 Canadian Census and the 2005 Taxfiler for 2,058 neighborhoods. We examined the relationship using linear regressions. Children’s HD included special needs, functional impairments limiting a child’s ability to participate in classroom activities, and diagnosed conditions.ResultsThe neighborhood prevalence of health disorders across Canada ranged from 1.8 to 46.6%, with a national average of 17.3%. The combined prevalence of health disorders was 16.4%, as 225,711 children were identified as having at least one health disorder. Results of an unadjusted linear regression showed a significant association between neighborhood-level SES and prevalence of health disorders (F(1, 2051) = 433.28, p < 0.001), with an R2 of 0.17. When province was added to the model, the R2 increased to 0.40 (F(12, 2040) = 115.26, p < 0.001). The association was strongest in Newfoundland & Labrador and weakest in Ontario.ConclusionOur study demonstrated that the prevalence of health disorders among kindergarten children was higher in lower SES neighborhoods and varied by jurisdiction in Canada, which has implications for practice and resource allocation

Chronic Rhinosinusitis: Potential Role of Microbial Dysbiosis and Recommendations for Sampling Sites.

Chronic rhinosinusitis (CRS) is an inflammatory condition that affects up to 12% of the human population in developed countries. Previous studies examining the potential role of the sinus bacterial microbiota within CRS infections have found inconsistent results, possibly because of inconsistencies in sampling strategies. The aim of this study was to determine whether the sinus microbiome is altered in CRS and additionally if the middle meatus is a suitable representative site for sampling the sinus microbiome. Swab samples were collected from 12 healthy controls and 21 CRS patients, including all eight sinuses for CRS patients and between one and five sinuses for control subjects. The left and right middle meatus and nostril swabs were also collected. Significant differences in the sinus microbiomes between CRS and control samples were revealed using high-throughput 16S rRNA gene sequencing. The genus Escherichia was over-represented in CRS sinuses, and associations between control patients and Corynebacterium and Dolosigranulum were also identified. Comparisons of the middle meatuses between groups did not reflect these differences, and the abundance of the genus Escherichia was significantly lower at this location. Additionally, intra-patient variation was lower between sinuses than between sinus and middle meatus, which together with the above results suggests that the middle meatus is not an effective representative sampling site

A Pan-Canadian Data Resource for Monitoring Child Developmental Health: The Canadian Neighbourhoods Early Child Development (CanNECD) Database

The Canadian Neighbourhoods Early Child Development (CanNECD) database is a unique resource for research on child developmental health and well-being within the socioeconomic and cultural context of Canadian neighbourhoods. This paper describes the CanNECD database and highlights its potential for advancing research at the intersection of child development, social determinants of health, and neighborhood effects. The CanNECD database contains Pan-Canadian population-level child developmental health data collected through regional implementation of the Early Development Instrument (EDI), geo-coded information on residential neighbourhoods covering all of Canada, and socioeconomic and demographic variables from the Canada Census and Income Taxfiler database. The data are de-identified but linkable across datasets through use of common numeric sequences. The nearly 800,000 records spanning 2003-2014 and representing all Canadian provinces and territories (with the exception of Nunavut) are compiled in a secure electronic collection system at the Offord Centre for Child Studies, McMaster University in Hamilton, Canada. Early studies using the EDI demonstrated its utility as a tool for assessing child developmental health at a population level, and its potential for both community-level and large-scale monitoring of child populations. Research using the CanNECD database is now examining to what extent social determinants and the steepness of the social gradients of developmental health differ between geographical jurisdictions and between different sub-populations. We are also working to identify outlier neighbourhoods in which EDI scores are substantially higher or lower than predicted by a neighbourhood’s demographic and socioeconomic characteristics, and exploring other potentially important determinants of children’s developmental health. Finally, we are examining the extent to which change-over-time in aggregate EDI scores vary geographically, and how well it coincides with changes in socioeconomic factors. Thus, the CanNECD database offers the opportunity for research that will inform national policies and strategies on child developmental health

Establishing a protocol for building a pan-Canadian population-based monitoring system for early childhood development for children with health disorders: Canadian Children's Health in Context Study (CCHICS)

Introduction Health disorders early in life have tremendous impact on children's developmental trajectories. Almost 80% of children with health disorders lack the developmental skills to take full advantage of school-based education relative to 27% of children without a health disorder. In Canada, there is currently a dearth of nationally representative data on the social determinants of early childhood development for children with health disorders. Evidence from Canada and other countries indicate t

Rehabilitation needs for older adults with stroke living at home: perceptions of four populations

<p>Abstract</p> <p>Background</p> <p>Many people who have suffered a stroke require rehabilitation to help them resume their previous activities and roles in their own environment, but only some of them receive inpatient or even outpatient rehabilitation services. Partial and unmet rehabilitation needs may ultimately lead to a loss of functional autonomy, which increases utilization of health services, number of hospitalizations and early institutionalization, leading to a significant psychological and financial burden on the patients, their families and the health care system. The aim of this study was to explore partially met and unmet rehabilitation needs of older adults who had suffered a stroke and who live in the community. The emphasis was put on needs that act as obstacles to social participation in terms of personal factors, environmental factors and life habits, from the point of view of four target populations.</p> <p>Methods</p> <p>Using the focus group technique, we met four types of experts living in three geographic areas of the province of Québec (Canada): older people with stroke, caregivers, health professionals and health care managers, for a total of 12 groups and 72 participants. The audio recordings of the meetings were transcribed and NVivo software was used to manage the data. The process of reducing, categorizing and analyzing the data was conducted using themes from the Disability Creation Process model.</p> <p>Results</p> <p>Rehabilitation needs persist for nine capabilities (e.g. related to behaviour or motor activities), nine factors related to the environment (e.g. type of teaching, adaptation and rehabilitation) and 11 life habits (e.g. nutrition, interpersonal relationships). The caregivers and health professionals identified more unmet needs and insisted on an individualized rehabilitation. Older people with stroke and the health care managers had a more global view of rehabilitation needs and emphasized the availability of resources.</p> <p>Conclusion</p> <p>Better knowledge of partially met or unmet rehabilitation needs expressed by the different types of people involved should lead to increased attention being paid to education for caregivers, orientation of caregivers towards resources in the community, and follow-up of patients' needs in terms of adjustment and rehabilitation, whether for improving their skills or for carrying out their activities of daily living.</p

Differential prognostic utility of adiposity measures in chronic kidney disease

Objective Adipose tissue contributes to adverse outcomes in chronic kidney disease (CKD), but there is uncertainty regarding the prognostic relevance of different adiposity measures. We analyzed the associations of neck circumference (NC), waist circumference (WC), and body mass index (BMI) with clinical outcomes in patients with mild to severe CKD. Methods The German Chronic Kidney Disease (GCKD) study is a prospective cohort study, which enrolled Caucasian adults with mild to severe CKD, defined as estimated glomerular filtration rate (eGFR): 30–60 mL/min/1.73 m2, or >60 mL/min/1.73 m2 in the presence of overt proteinuria. Associations of NC, WC and BMI with all-cause death, major cardiovascular events (MACE: a composite of non-fatal stroke, non-fatal myocardial infarction, peripheral artery disease intervention, and cardiovascular death), kidney failure (a composite of dialysis or transplantation) were analyzed using multivariable Cox proportional hazards regression models adjusted for confounders and the Akaike information criteria (AIC) were calculated. Models included sex interactions with adiposity measures. Results A total of 4537 participants (59% male) were included in the analysis. During a 6.5-year follow-up, 339 participants died, 510 experienced MACE, and 341 developed kidney failure. In fully adjusted models, NC was associated with all-cause death in women (HR 1.080 per cm; 95% CI 1.009–1.155), but not in men. Irrespective of sex, WC was associated with all-cause death (HR 1.014 per cm; 95% CI 1.005–1.038). NC and WC showed no association with MACE or kidney failure. BMI was not associated with any of the analyzed outcomes. Models of all-cause death including WC offered the best (lowest) AIC. Conclusion In Caucasian patients with mild to severe CKD, higher NC (in women) and WC were significantly associated with increased risk of death from any cause, but BMI was not