Health Science Inquiry <p style="text-align: center;">Health Science Inquiry is an annual online peer-reviewed journal that seeks to publish the views and thoughts of Canadian graduate students and post-doctoral fellows on pertinent issues in the health sciences. Our editorial team includes student members from universities all across Canada. </p> <h2 style="text-align: center;">Volume #12 "Infectious Diseases" is now accepting submissions!</h2> <p style="text-align: center;"> <span style="text-decoration: underline;"><strong>TWO AWARDS</strong></span> ($150 each) for top scholarly perspective or commentary (chosen by a panel of Canadian university faculty)</p> University of Alberta Library en-US Health Science Inquiry 2562-7791 <p>Health Science Inquiry&nbsp;encourages authors to publish the work under a Creative Commons Attribution 4.0 International licence (CC BY 4.0) that allows others to distribute, remix, tweak, and build upon the work, even commercially, as long as they credit the Author(s) for the original creation. Authors may however choose to have their work distributed under any of the Creative Commons licenses currently available by specifying their preferred licence in the publication agreement. A description of the Creative Commons licences is available here:&nbsp;<a href=";sa=D&amp;ust=1575510108685000" target="_blank" rel="noopener noreferrer" data-content=";sa=D&amp;ust=1575510108685000" data-type="external"></a></p> Conceptualizing "access" of maternal health services in lower-middle-income countries <p>A considerable number of women die each year worldwide due to preventable causes during pregnancy and childbirth. The high mortality of women who die from pregnancy-related issues can be attributed to inadequate access of high-quality maternal health services. However, access is a nebulous concept with a compendium of conceptualizations and definitions. In this paper, we discuss the various conceptualizations of access to maternal health services in lower middle-income countries, and compare how issues related to access differ between high- and lower middle-income countries. This discussion informs two priorities that we suggest for researchers conducting health system improvement work in lower middle-income countries: 1) develop a robust understanding of the barriers to access that continue to persist due to cultural, socioeconomic, and political factors, and 2) formulate frameworks and theories specific to lower middle-income countries to guide research. </p> Bismah Jameel Aeda Bhagaloo Khadija Rashid Umair Majid Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 108 111 10.29173/hsi286 Nutritional Psychiatry: A Solution for Socioeconomic Disparities in Access to Mental Health Care? <p><span lang="EN-US">As in all sectors of healthcare, socioeconomic status (SES) affects an individual’s ability to benefit from psychiatric care.</span><span lang="EN-US">Mood and anxiety disorders are the most common disorders for which psychiatric care is sought, and while there are options for effective treatments available, they are often accompanied by additional costs. Further to costs, issues with the heterogeneity of mental illness have led resarchers to explore other options for psychatric care. Nutritional psychiatry is an emerging field that uses dietary and nutritional approaches to target the gut-brain axis for the prevention and treatment of mental illness, including mood and axiety disorders. Nutritional psychiatry has been promoted as being an advantageous alternative to classic mental health treatments due to it’s broader accessibility, highlighting the lower costs associated with lifestyle changes than medication and psychotherapy. At a glance, this may appear accurate, but upon closer examination, may not be entirely true. Factors surrounding healthy eating, food deserts, the supplement industry, and adherence to lifestyle changes are all barriers present in nutritional psychiatry that are accompanied by added costs. These costs likely contribute to a disparity between low SES and high SES individuals benefitting from the treatment, in a similar way to classic treatments. This commentary reviews these factors to suggest that nutritional psychiatry may not be the accessible treatment option we purport it to be, and that as clinical researchers in the field, we must be aware of these disparities.</span></p> Caroline Wallace Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 155 157 10.29173/hsi288 Assessing the efficacy of Canada's food guide and the barriers of use <p>The landscape of nutrition advice is vast and full of misinformation. A primary source of nutrition advice in Canada comes from the Canadian Food Guide, however, many questions remain regarding the reach and accessibility of the food guide. Specifically, is the population most likely to receive and use this information, the population that needs it the most? Are there barriers to following this guide that Health Canada has failed to address? Is there evidence supporting the efficacy of this food guide in populations at risk for nutrition misinformation or diet-related preventable diseases? This commentary reviews the past research regarding efficacy of previous food guides and highlights potential barriers preventing equal and accessible use of Canada’s Food Guide.</p> Hana Dibe Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 162 164 10.29173/hsi291 Digital health in a broadband land <p>The rapid rise and widespread integration of digital technologies (e.g., smartphones, personal computers) into the fabric of our society has birthed a modern means of delivering healthcare, known as digital health. Through leveraging the accessibility and ubiquity of digital technologies, digital health represents an unprecedented level of reach, impact, and scalability for healthcare interventions, known as digital behaviour change interventions (DBCIs). The potential benefits associated with employing DBCIs are of particular interest for populations that are disadvantaged to receiving traditional healthcare, such as rural populations. However, several factors should be considered before implementing a DBCI into a rural environment, notably, digital health literacy. Digital health literacy describes the skills necessary to successful navigate and utilize a digital health solution (e.g., DBCI). Given their limited access to high-speed internet, higher cost associated for similar services, and poorer development of information and communication technologies (ICTs), most rural populations likely report lower digital health literacy – specifically, computer literacy, the ability to utilize and leverage digital technologies to solve problems. Hence, DBCIs should address this ‘digital divide’ between urban and rural populations before implementation. Practical solutions could include evaluating rural communities’ access to ICTs, needs assessments with rural community members, as well as integrating rural community stakeholders into the design of digital literacy education and interventions.</p> Wuyou Sui Danica Facca Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 140 143 10.29173/hsi294 Reflecting on environment to understand diversifying health perspectives <p>People hold health conceptions that are shaped by their environments. In Canada, these ideas and subsequent research approaches are often developed further through academic training. Current public health perspectives and approaches are largely focused on Western worldviews of health. I share my reflections on my environments, and continued journey as a student in academia that led me to question the current standard of teaching uniform health perspectives. Fostering a singular-worldview learning environment translate to future scholars missing opportunities to learn promising discourses – such as strength-based approaches – that may be more effective in application, including in Indigenous health research. I suggest ways in which environments that foster the appreciation and comprehension of diverse health perspectives can be built.</p> Laurie-Ann Lines Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 119 122 10.29173/hsi296 Shedding light on maternal sunlight exposure during pregnancy and considerations for public health policy <p>Sunlight exposure during pregnancy could be implicated in the physiological development and growth of the fetus, as well as long-term health after birth. Although several studies suggest the involvement of ultraviolet radiation-mediated vitamin D synthesis, current knowledge regarding the effects of sunlight exposure during pregnancy remains limited. We aimed to (i) summarize the existing body of research studying the influence of sunlight exposure on fetal growth-related birth outcomes and long-term health outcomes and (ii) determine its implications for therapeutics and public health policy. Of the studies identified on birth outcomes, the majority (5/8) demonstrated an association between sunlight exposure and reduced adverse birth outcomes (e.g., low birth weight, preterm births, small for gestational age, etc.), 2/8 studies showed no association, and 1/8 suggested a negative association between sunlight exposure and reduction of these adverse birth outcomes. Of the studies examining long-term health outcomes, sunlight exposure during pregnancy was shown to promote skeletal growth and development (2/6), and reduce the incidence of multiple sclerosis (2/6), asthma (2/6) and pneumonia (1/6). However, several of these studies used different methodologies and populations making it difficult to compare and integrate findings. Based on these results, we examined: the importance of exposure at different stages of pregnancy, proposed mechanisms by which sunlight exposure could lead to optimal outcomes, epidemiological differences influencing the findings, and necessary practical considerations prior to the implementation of public health policy recommendations. While these findings are promising, more rigorous research is warranted to support these recommendations.</p> Peter Anto Johnson John Christy Johnson Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 112 118 10.29173/hsi298 Examining chronic pain through the lens of the socioeconomic gradient <p>Longstanding evidence reveals the existence of a gradient of health running along the socioeconomic spectrum. This is denoted by a graded association between health and levels of socioeconomic status, including factors such as gender, income, education, and occupational roles. This gradient is found across many chronic diseases including heart failure, arthritis, type 2 diabetes, ulcers, and certain cancers, all of which commonly possess debilitating pain diagnoses. Here, I examine chronic pain and its severity through the lens of this socioeconomic gradient across three perspectives along with their potential limitations. First, I discuss how this gradient represents risk factors for greater pain severity, disability, and comorbidity. Then, I explore potential underlying health determinants and how one’s position on this spectrum may predetermine their chance of receiving optimal care for their pain. Finally, I end with the prospect of better clinical and biological understanding of chronic pain severity with the inclusion of this socioeconomic gradient.</p> Christophe Tanguay-Sabourin Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 144 147 10.29173/hsi300 Challenges in remaining "UpToDate" <p>Our understanding of the prevalence of mental health disorders (MHDs) in society is in the midst of a paradigm shift: where MHDs were once considered rare within a population, studies through the last decade have converged to the conclusion that they are, in fact, near universal. Consequently, the demand for mental health treatment has resulted in the training of Primary-Care Physicians (PCPs) to identify, diagnose, and treat common MHDs. As generalists, PCPs require specialised point-of-care clinical resources to educate their patients and provide them with evidence-based treatment plans; UpToDate is one such resource. As a database of synthesized peer-reviewed medical information, written and approved by physician-experts from their review of contemporary peer-reviewed literature, this resource is considered a gold standard. Here, we examine an MHD-specific investigative case study on Generalized Anxiety Disorder where the synthesized UpToDate medical information was found to be in conflict with the original studies. In this era of unrelenting bombardment of digital data, the responsibility of assessing the truth of the information falls to the consumer. While a reliance on reputable information-sharing platforms facilitates both the access and assessment of truth, we discuss the risks of unintended errors, their propagation, and the potential impact at the point-of-care. </p> Vinita Akula Kevin Dick Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 88 92 10.29173/hsi302 The information theory of aging <p>Humans have sought to cheat death for as long as we have been cognizant of our mortality. History’s early explorers of the frontier of immortality include alchemists in the pursuit of an elixir of life and emperors who, ironically, hastened their own death from the consumption of mercurial concoctions. Scientifically grounded approaches to the extension of the human lifespan emerged in the 20<sup>th</sup> century and were based on hormonal rejuvenation, calorie restriction, and most recently, the consumption of supplements with purported anti-aging effects. A combination of three “longevity drugs” has recently been championed by Dr. David Sinclair, co-discoverer of the lifespan-regulating sirtuin enzymes, and author of the epigenetics-focused Information Theory of Aging (ITA). In this work, we investigate the evidence behind Sinclair’s ITA, highlight concerns related to his regimen, and reflect on the possibility that we are at a nexus in time preceding a dramatic increase in human healthspans. Promisingly, if the ITA holds true, individuals will be uniquely empowered to “hack” their own immortality.</p> Aleksandar Vujin Kevin Dick Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 148 154 10.29173/hsi304 Vaccines in the 21st century <p>Vaccines have been crucial in reducing mortality and morbidity around the world, particularly in low- and middle-income countries. Furthermore, vaccinations have also resulted in a considerable amount of economic savings. However, there are a growing number of individuals who express a strong skepticism of vaccine safety and effectiveness. These “vaccine-hesitant” individuals choose to reject or delay vaccine administration. A number of strategies have been developed to address the various socioeconomic and cultural circumstances of each vaccine-hesitant individual. However, there is a need to clarify the various factors that promote vaccine acceptance, delay, and rejection. In this article, we discuss the factors that promote vaccine hesitancy from recent research, describe some of the interventions we know to be effective in reducing hesitancy, and develop an agenda for researchers and students interested in vaccine hesitancy research.</p> Umair Majid Mobeen Ahmad Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 123 127 10.29173/hsi285 Mitigating the effects of the climate crisis through health policy <p>In Canada, the climate crisis has had profound impacts on health, including increased health problems as well as decreased access to healthcare services. Without mitigation, the climate crisis is expected to exacerbate an abundance of negative health outcomes and health system disruptions in Canada, including: food, water, and shelter insecurity; increased health problems caused by severe weather; and forced displacement from geographically vulnerable areas. Governmental action could be taken to mitigate the effects of the climate crisis and improve healthcare in the country.</p> <p>This report synthesizes current literature on how the climate crisis is affecting health in Canada. It also recommends 3 actions that can be taken to mitigate the effects of the climate crisis and improve the country’s health. Actions include: conducting climate change and health vulnerability assessments (CCHVAs), enhancing support for climate action research, and reducing CO2 emissions in the healthcare sector.</p> Ashley Farrell Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 103 107 10.29173/hsi287 Vaccination policy strategies in Ontario <p>Vaccination is considered to be one of the greatest public health achievements, contributing to a substantial decline in infectious disease mortality in Canada. However, a growing threat of vaccine hesitancy has led to an upsurge in the prevalence and incidence of vaccine-preventable diseases across the globe, including Canada. Vaccine hesitancy is on the rise in the province of Ontario. Parental vaccine hesitancy, vaccine misconceptions, rising non-medical vaccine exemption rates, and low childhood vaccination coverage has led to a resurgence in vaccine-preventable diseases, especially measles. Given the importance of achieving high vaccine coverage to avoid vaccine-preventable diseases and their dire consequences, vaccine hesitancy is an important issue that needs to be addressed. There is no perfect solution to address vaccine hesitancy. Understanding the complex mix of factors that determine individual and collective vaccination behaviour is vital to designing effective vaccination policies, programs, and targeted interventions. This article critiques current vaccine policy strategies and outlines a policy approach to address parental vaccine hesitancy and prevent future vaccine-preventable disease outbreaks, specifically in Ontario, and more broadly within Canada. Providing support to healthcare providers and primary care physicians; and empowering parents, schools, students, families, and communities in Ontario, will slowly but surely mitigate vaccine hesitancy and enable healthy vaccination behaviours. Healthcare system-based interventions seem to be the most comprehensive approach that requires coordinated efforts and partnerships between community-based organizations and vaccination providers to ensure inclusive and integrated service delivery.</p> Ankur Chhabra Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 98 102 10.29173/hsi289 The rise of electronic cigarettes <p>Electronic cigarettes (ECs) have quickly gained popularity among adolescents and adults, and have begun to replace conventional cigarettes as a source of nicotine. Although little is known about the impact of the exposure of chemical constituents of ECs, two major constituents, propylene glycol and vegetable glycerin have been implicated as formaldehyde-releasing agents. The wide variety of EC flavours appeal to users of all ages with reports showing a positive correlation between EC use and sweet flavorings. In addition, although marketing strategies advertise ECs as tools to facilitate smoking cessation, the evidence supporting this role is weak. In terms of its effect on users with pre-existing cardiovascular diseases, the data is conflicting regarding whether ECs have an impact on cardiovascular function. Although it is obvious that their safety and efficacy needs to be better understood, it is nonetheless essential to review what the research conducted so far has shown.</p> Simran Bhullar Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 93 97 10.29173/hsi292 The gut-brain axis and microbial therapeutics <p>Given the vast personal and economic burdens of psychiatric disorders, specifically mood and anxiety disorders, finding appropriate treatments for all those affected is critical. Due to the various presentations of psychiatric indications, no one treatment method is efficacious in all patients. Thus, a more personalized, but feasible treatment method is necessary for properly treating and preventing these disorders from becoming refractory and more burdensome. In recent years, there has been a growing appreciation for research in the field of the “gut-brain axis” (GBA), specifically as a target for psychiatric disorders. Researchers have found the gut to be influenced not only by similar determinants to that of psychiatric indications, but also highly modifiable using GBA treatments such as probiotics and fecal microbiota transplant (FMT). This is compelling evidence for the use of the GBA as a target for disorders such as depression and anxiety and for development of personalized treatment methods.</p> Arthi Chinna Meyyappan Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 127 130 10.29173/hsi295 Revealing obesity through diet-gene interactions <p>The increasing prevalence of obesity is becoming a global health concern due to its association with chronic diseases including type 2 diabetes, non-alcoholic fatty liver disease, and cardiovascular diseases. Obesity occurs when energy intake outweighs energy expenditure, leading to a conventional intervention strategy being “eat less and move more.” However, this strategy does not consider the influence of genetic factors and their interactions with environmental factors (diets and physical activity), making obesity prevention and management inefficient. To better understand obesity, research in nutrigenetics and nutrigenomics seek to explore the influence of genetic variations on dietary responses, and how dietary components alter gene expression in obese individuals. Current evidence suggests that variations in genes involved in lipid regulation, carbohydrate metabolism, and energy homeostasis are strongly associated with the risk of obesity and its related metabolic syndromes. In addition, diet-gene interactions influence intervention effectiveness for obesity management. By examining obesity-related metabolic pathways, we can reveal the functional basis of diet-gene interactions in relation to obesity risk. Although limitations exist within the current literature, emerging evidence indicates that obesity risk and intervention can be affected by diet-gene interactions, and continued research is needed for further exploration.</p> Chenxuan Wang Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 158 161 10.29173/hsi297 Untangling complexity as a health determinant <p>As the healthcare system has modernized, it has also become rich with complexity. This complexity continues to foster the creation of <em>wicked problems</em> that at first consideration appear inherently insoluble. To compound matters, policy-makers and decision-makers continue to view the healthcare system in a reductionistic, linear manner. This paper advocates that all stakeholders within the system (policy-makers, providers, and patients) become comfortable with complexity as a determinant of health, and offers tools for productively working with complexity, instead of trying to solve it. These tools include complexity heuristics, adjusting to an emergent decision-making paradigm, and easing the anxiety associated with ambiguity and paradox by becoming antifragile. By adopting these methods, the health determinant of complexity within the Canadian healthcare system can be effectively handled. This will lead to sustainable and scalable interventions, strong patient-partners in care, and efficient use of monetary and human resources.</p> Samuel Petrie Paul Peters Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 131 135 10.29173/hsi299 Hand hygiene <p>Abstract: <br />The World Health Organization (WHO) defines Health Care-Associated Infection (HCAI) as an infection a patient acquired in health care settings. In Canada, more than 220,000 patients are infected by HCAIs annually, with 8,500 to 12,000 of these patients resulting in death, thus becoming the fourth leading cause of death for Canadians. Hand hygiene practice is the most critical measure to prevent HCAIs, however, research indicates that in hospitals worldwide, just 40% of health care workers abide by the advised hand hygiene guidelines. A new effective HCAI control and prevention program is needed to sustain benefits, building on prior interventions such as including hand hygiene education that stresses the necessity of this practice in the protocol, providing factual proof of the effectiveness of hand hygiene, the acknowledgment by senior staff of their responsibility as role models for all staff, innovative technological methods, and regular auditing/feedback. With the current outbreak of coronavirus disease (COVID-19) that has infected millions around the world, a new HCAI control and prevention program can increase the compliance rate of handwashing with alcohol-based hand rub/sanitizer amongst healthcare professionals thus aiding in prevention and control of spread within the community. </p> Tishani Sritharan Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 136 139 10.29173/hsi301 Intergenerational connection between environment and mental health Tammy Lu Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 12 13 10.29173/hsi306 Northern Canadian Indigenous and the environment Colin Jamieson Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 16 18 10.29173/hsi309 Protecting the placenta Mariyan Jeyarajah Stephen Renaud Daniel Hardy Genevieve Eastabrook Peeyush Lala Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 14 15 10.29173/hsi308 Climate change and human health Ling Wu Hugh Montgomery Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 18 20 10.29173/hsi310 Tackling environmental health: From research to government <p>Q&amp;A with Elaina MacIntyre, an epidemiologist with Public Health Ontario and a University of Toronto adjunct professor.</p> Alison Howie Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 21 22 10.29173/hsi311 From working with animals to humans <p>Q&amp;A with Nicholas Ogden, an expert on vector-borne diseases and the Director of the Public Health Risk <br>Sciences Division.</p> Supriya Hota Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 24 26 10.29173/hsi313 Where population health meets clean energy <p>Q&amp;A with Jill Baumgartner, health researcher and associate professor at McGill University.</p> Alison Howie Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 23 24 10.29173/hsi312 At the intersection of mental health and drug addiction <p>Q&amp;A with Jibran Khokhar, biomedical science researcher and assistant professor at the University of Guelph</p> Madison Pereira Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 26 27 10.29173/hsi314 We built this city on pollution and mold Sara Ness Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 28 32 10.29173/hsi315 #DistractinglySexist Roula Farag Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 38 41 10.29173/hsi317 Blurred Lines Sarah Laframboise Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 33 37 10.29173/hsi316 Meet Elisabeth Bik Zarwa Saqib Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 42 48 10.29173/hsi318 When social media met nutrition Zoe Lofft Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 56 61 10.29173/hsi319 The art of science storytelling Erika Scott Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 68 73 10.29173/hsi321 Health Science Inquiry in review Kevin Dick Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 49 55 10.29173/hsi303 Anti-vaxxers Sarah Asbury Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 62 67 10.29173/hsi320 Koko Karissa Becknel Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 78 81 10.29173/hsi323 Blue elephant Kevin Mercurio Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 74 77 10.29173/hsi322 Autism spectrum disorders may be linked to air pollution Heather Gerrie Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 10 11 10.29173/hsi305 A week in the life of a geneticist Nikita Telkar Copyright (c) 2020 Health Science Inquiry 2020-08-10 2020-08-10 11 1 82 87 10.29173/hsi324