Katherine Rouleau - Academia.edu (original) (raw)

Papers by Katherine Rouleau

Cambridge University Press eBooks, Dec 22, 2022

Canadian Family Physician, Nov 1, 2007

This article is also in English on page1853.

Canadian family physician Medecin de famille canadien, 2019

OBJECTIVE To compare the national health systems of Canada and Brazil and how both countries have... more OBJECTIVE To compare the national health systems of Canada and Brazil and how both countries have addressed similar challenges in their primary care sectors. COMPOSITION OF THE COMMITTEE A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with colleagues in Brazil and collaborated to undertake a between-country comparison, comparing and contrasting various elements of both countries' efforts to strengthen primary care over the past few decades. METHODS Following a literature review, the authors collectively reflected on their experiences in an attempt to explore the past and current state of family medicine in Canada and Brazil. REPORT The Brazilian and Canadian primary care systems are faced with similar challenges, including geography, demographic changes, population health inequities, and gaps in universal access to comprehensive primary care services. Although the approaches to addressing these challenges are different in both...

Canadian family physician Medecin de famille canadien, 2019

OBJECTIVE To develop an ethical framework for collaboration in international academic partnership... more OBJECTIVE To develop an ethical framework for collaboration in international academic partnerships in family medicine. COMPOSITION OF THE COMMITTEE A subgroup of the Besrour Centre of the College of Family Physicians of Canada including family medicine and bioethics experts began to collaborate in 2014 to undertake the development of an ethical framework and tools for the establishment of ethically sound international academic partnerships. METHODS Following 2 consultative workshops and a wider consultation process with the Besrour Centre global community, the authors developed an ethical framework and tools for approval by the Besrour Centre leadership in November 2017. REPORT Partnerships are essential to family practice and to the field of international development. The flawed nature of many North-South research partnerships underlines the importance of and need for delineating core principles for ethically sound partnerships, of which 10 have been identified in this process: acc...

A compter de la fete du Canada cette annee, les refugies et les medecins qui les traitent sont la... more A compter de la fete du Canada cette annee, les refugies et les medecins qui les traitent sont lances ensemble sur une route perilleuse. Jason Kenney, ministre de la Citoyennete, de l’Immigration et du Multiculturalisme, annoncait, le 25 avril 2012, un recul important sur le plan de la

Canadian Journal of Public Health, 2021

Objective The primary objective was to determine the association between public health preventive... more Objective The primary objective was to determine the association between public health preventive measures and children’s outdoor time, sleep duration, and screen time during COVID-19. Methods A cohort study using repeated measures of exposures and outcomes was conducted in healthy children (0 to 10 years) through The Applied Research Group for Kids (TARGet Kids!) COVID-19 Study of Children and Families in Toronto, Canada, between April 14 and July 15, 2020. Parents were asked to complete questionnaires about adherence to public health measures and children’s health behaviours. The primary exposure was the average number of days that children practiced public health preventive measures per week. The three outcomes were children’s outdoor time, total screen time, and sleep duration during COVID-19. Linear mixed-effects models were fitted using repeated measures of primary exposure and outcomes. Results This study included 554 observations from 265 children. The mean age of participan...

Childhood Obesity, 2021

Background: Few studies have published mediation analyses to quantify the role concurrent BMI pla... more Background: Few studies have published mediation analyses to quantify the role concurrent BMI plays in the relationship between growth and cardiometabolic risk (CMR) outcomes. Methods: We used data from a longitudinal cohort study conducted in children aged 0-60 months through The Applied Research Group for Kids (TARGet Kids!) in Canada. Four age and sex standardized BMI (zBMI) trajectories were identified using latent class mixed models. CMR were assessed using a CMR score. Concurrent zBMI was the zBMI measured on the same visit as CMR. Mediation analyses were performed comparing each trajectory with the reference trajectory. Results: One thousand one hundred sixty-five children were included. On average, compared with being in the stable low trajectory, being in the catch-up trajectory was associated with an increased CMR score of 0.42, 0.28 of which was mediated through concurrent zBMI [95% confidence interval (CI) 0.17 to 0.41, p = 0.001]; being in the stable high trajectory was associated with an increased CMR score of 0.23, 0.24 through concurrent zBMI (95% CI 0.18 to 0.31, p < 0.001). Similarly, being in the rapid accelerating trajectory was associated with an increased CMR score of 1.43, 1.18 of which was through concurrent zBMI (95% CI 0.89 to 1.50, p < 0.001). Conclusions: There was a strong evidence that the effect of BMI trajectories on CMR was indirect via concurrent BMI. It is important for researchers to choose the most appropriate analytic method based on the study hypothesis to understand the total or direct effect of growth patterns on cardiometabolic disease risk in children.

The Annals of Family Medicine, 2020

BMJ Global Health, 2019

IntroductionFinancing of primary healthcare (PHC) is the key to the provision of equitable univer... more IntroductionFinancing of primary healthcare (PHC) is the key to the provision of equitable universal care. We aimed to identify and prioritise the perceived needs of PHC practitioners and researchers for new research in low- and middle-income countries (LMIC) about financing of PHC.MethodsThree-round expert panel consultation using web-based surveys of LMIC PHC practitioners, academics and policy-makers sampled from global networks. Iterative literature review conducted in parallel. First round (Pre-Delphi survey) elicited possible research questions to address knowledge gaps about financing. Responses were independently coded, collapsed and synthesised to two lists of questions. Round 2 (Delphi Round 1) invited panellists to rate importance of each question. In Round 3 (Delphi Round 2), panellists ranked questions in order of importance.ResultsA diverse range of PHC practitioners, academics and policy-makers in LMIC representing all global regions identified 479 knowledge gaps as p...

The Journal of Pediatrics, 2019

Objectives To determine the association between cow's milk-fat and nonÀhigh-density lipoprotein (... more Objectives To determine the association between cow's milk-fat and nonÀhigh-density lipoprotein (non-HDL) cholesterol, a marker of cardiovascular disease (CVD) risk in young children, and whether this association is mediated by the typical volume of cow's milk consumed. Study design A longitudinal study in 2-to 8-year-old children (n = 2890) was conducted through The Applied Research Group for Kids (TARGet Kids!), a practice-based research network in Toronto, Canada. Generalized estimating equations were used to examine the relationship between parent-reported cow's milk-fat percentage intake and serum non-HDL cholesterol concentrations as well as having high non-HDL cholesterol (³3.75 mmol/L [145 mg/ dL]), adjusting for covariates including age, sex, body mass index z score, breastfeeding duration, mother's ethnicity, and parental history of CVD. Bootstrap resampling (10 000 repetitions) was used to assess whether typical volume consumed mediated the association between cow's milk-fat percentage and non-HDL cholesterol. Results In total, 156 (5.4%) had high non-HDL cholesterol. Each percent increase in cow's milk-fat was associated with a 0.035 mmol/L (1.35 mg/dL) (P < .001) and 0.024 mmol/L (0.92 mg/dL) (P = .01) increase in non-HDL cholesterol, unadjusted and adjusted for covariates respectively. Cow's milk-fat percentage was not associated with greater odds of having high non-HDL cholesterol. Volume of cow's milk partially mediated the association between cow's milk-fat percentage and non-HDL cholesterol, accounting for 28% of the relationship (P < .001). Conclusions Consumption of higher-fat cow's milk was associated with a small increase in non-HDL cholesterol but not greater odds of having high non-HDL cholesterol. Further research is needed to assess this relationship with other CVD risk factors in young children.

BMC Medical Research Methodology, 2019

Background: Measuring body mass index (BMI) has been proposed as a method of screening for preven... more Background: Measuring body mass index (BMI) has been proposed as a method of screening for preventive primary care and population surveillance of childhood obesity. However, the accuracy of routinely collected measurements has been questioned. The purpose of this study was to assess the reliability of height, length and weight measurements collected during well-child visits in primary care relative to trained research personnel. Methods: A cross-sectional study of measurement reliability was conducted in community pediatric and family medicine primary care practices. Each participating child, ages 0 to 18 years, was measured four consecutive times; twice by a primary care team member (e.g. nurses, practice personnel) and twice by a trained research assistant. Inter-and intra-observer reliability was calculated using the technical error of measurement (TEM), relative TEM (%TEM), and a coefficient of reliability (R). Results: Six trained research assistants and 16 primary care team members performed measurements in three practices. All %TEM values for intra-observer reliability of length, height, and weight were classified as 'acceptable' (< 2%; range 0.19% to 0.70%). Inter-observer reliability was also classified as 'acceptable' (< 2%; range 0.36% to 1. 03%) for all measurements. Coefficients of reliability (R) were all > 99% for both intra-and inter-observer reliability. Length measurements in children < 2 years had the highest measurement error. There were some significant differences in length intra-observer reliability between observers. Conclusion: There was agreement between routine measurements and research measurements although there were some differences in length measurement reliability between practice staff and research assistants. These results provide justification for using routinely collected data from selected primary care practices for secondary purposes such as BMI population surveillance and research.

The Annals of Family Medicine, 2019

The authors agreed to bid for funding through their shared professional network-the World Organiz... more The authors agreed to bid for funding through their shared professional network-the World Organization of Family Doctors (WONCA)-because the aim of the grant aligns with Wonca's academic mission. Funding came from Ariadne Labs through Brigham and Women's Hospital, which is the recipient of a Bill & Melinda Gates Foundation grant. Ariadne Labs is a joint center between Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health. Its mission is to create scalable health care solutions that deliver better care at the most critical moments in people's lives, everywhere. The findings and conclusions contained within are those of the authors, and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation, nor of the whole of WONCA.

Academic Pediatrics, 2017

What's New: Temperament is associated with obesity risk in preschoolers, but its relationship wit... more What's New: Temperament is associated with obesity risk in preschoolers, but its relationship with outdoor play is unknown. In this cross-sectional analysis of a cohort, temperament was associated with outdoor playtime, and thus may be an important consideration in preschoolers' health interventions.

Canadian family physician Medecin de famille canadien, 2016

To find a common global definition of family medicine. Since 2012, the College of Family Physicia... more To find a common global definition of family medicine. Since 2012, the College of Family Physicians of Canada has hosted the Besrour Conferences to reflect on its role in advancing the discipline of family medicine globally. The Besrour Papers Working Group, which was struck at the 2013 conference, was tasked with developing a series of papers to highlight the key issues, lessons learned, and outcomes emerging from the various activities of the Besrour collaboration. The working group comprised members of various academic departments of family medicine in Canada and abroad who attended the conferences. Searching both definition of family medicine and history of family medicine yields a variety of defining features. Visiting family medicine training programs worldwide highlights this discrepancy. It is not an easy task to define family medicine-one of its key attributes is its adaptability to a local context, but this makes aggregation of data challenging. There is a lack of clarity ...

Canadian family physician Médecin de famille canadien, 2015

To provide an overview of the main methodologic challenges to finding definitive evidence of the ... more To provide an overview of the main methodologic challenges to finding definitive evidence of the positive effects of family medicine and family medicine training on a global scale. In 2012, 2013, and 2014, the College of Family Physicians of Canada hosted the Besrour Conferences to reflect on its role in advancing the discipline of family medicine globally. The Besrour Papers Working Group, which was struck at the 2013 conference, was tasked with developing a series of papers to highlight the key issues, lessons learned, and outcomes emerging from the various activities of the Besrour collaboration. The working group comprised members of various academic departments of family medicine in Canada and abroad who attended the conferences. We performed a scoping review to determine the methodologic obstacles to understanding the positive effects of family medicine globally. The main obstacle to evaluating family medicine globally is that one of its core dimensions and assets is its local...

Canadian family physician Médecin de famille canadien, 2007

Global Health Action, 2014

Background: Global health is increasingly a major focus of institutions in high-income countries.... more Background: Global health is increasingly a major focus of institutions in high-income countries. However, little work has been done to date to study the inner workings of global health at the university level. Academics may have competing objectives, with few mechanisms to coordinate efforts and pool resources. Objective: To conduct a case study of global health at Canada's largest health sciences university and to examine how its internal organization influences research and action. Design: We drew on existing inventories, annual reports, and websites to create an institutional map, identifying centers and departments using the terms 'global health' or 'international health' to describe their activities. We compiled a list of academics who self-identified as working in global or international health. We purposively sampled persons in leadership positions as key informants. One investigator carried out confidential, semistructured interviews with 20 key informants. Interview notes were returned to participants for verification and then analyzed thematically by pairs of coders. Synthesis was conducted jointly. Results: More than 100 academics were identified as working in global health, situated in numerous institutions, centers, and departments. Global health academics interviewed shared a common sense of what global health means and the values that underpin such work. Most academics interviewed expressed frustration at the existing fragmentation and the lack of strategic direction, financial support, and recognition from the university. This hampered collaborative work and projects to tackle global health problems. Conclusions: The University of Toronto is not exceptional in facing such challenges, and our findings align with existing literature that describes factors that inhibit collaboration in global health work at universities. Global health academics based at universities may work in institutional siloes and this limits both internal and external collaboration. A number of solutions to address these challenges are proposed.

This article is also in English on page1853.

Canadian family physician Médecin de famille canadien, 2007

ur world is shrinking: international travel has topped 1 billion per year, international migratio... more ur world is shrinking: international travel has topped 1 billion per year, international migration now approaches 200 million a year, telecommunication reaches the heart of Africa, and e-mail allows families to maintain contact around the world. Advances in economic development, education, science, and technology offer opportunities to improve health, but many of these advances are not available in a large part of our world. The World Health Organization recognizes that disparities in people's ability to achieve health are of global concern; disparities in health bring with them the threats of epidemics, deepening poverty, and political conflict. As such, global health inequities are a pertinent concern for us, our families, and future generations. The current global shortage of trained health workers contributes to health disparities. 2 This crisis is most profound in the poorest countries, and, in particular, in sub-Saharan Africa. 3 The expression "international health" describes health-related work in an international setting (outside the country where one lives and practises) and relates to health practices, policies, and systems in other countries. The term "global health" relates more to health issues that transcend national borders, class, race, ethnicity, and culture, and includes the care of certain populations, such as immigrants and refugees, both locally and abroad. 4 In this article, we explore the roles and opportunities for family physicians in global health, especially related to primary care and family practice.

Canadian family physician Medecin de famille canadien, 2017

To demonstrate how family medicine has been recognized and integrated into primary health care sy... more To demonstrate how family medicine has been recognized and integrated into primary health care systems in contrasting contexts around the world and to provide an overview of how family physicians are trained and certified. Since 2012, the College of Family Physicians of Canada has hosted the Besrour Conferences to reflect on its role in advancing the discipline of family medicine globally. The Besrour Papers Working Group, which was struck at the 2013 conference, was tasked with developing a series of papers to highlight the key issues, lessons learned, and outcomes emerging from the various activities of the Besrour collaboration. The working group comprised members of various academic departments of family medicine in Canada and abroad who attended the conferences. An initial search was conducted in PubMed using a family medicine hedge of MeSH terms, text words, and family medicine journals, combined with text words and terms representing low- and middle-income countries and the c...

Cambridge University Press eBooks, Dec 22, 2022

Canadian Family Physician, Nov 1, 2007

This article is also in English on page1853.

Canadian family physician Medecin de famille canadien, 2019

OBJECTIVE To compare the national health systems of Canada and Brazil and how both countries have... more OBJECTIVE To compare the national health systems of Canada and Brazil and how both countries have addressed similar challenges in their primary care sectors. COMPOSITION OF THE COMMITTEE A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with colleagues in Brazil and collaborated to undertake a between-country comparison, comparing and contrasting various elements of both countries' efforts to strengthen primary care over the past few decades. METHODS Following a literature review, the authors collectively reflected on their experiences in an attempt to explore the past and current state of family medicine in Canada and Brazil. REPORT The Brazilian and Canadian primary care systems are faced with similar challenges, including geography, demographic changes, population health inequities, and gaps in universal access to comprehensive primary care services. Although the approaches to addressing these challenges are different in both...

Canadian family physician Medecin de famille canadien, 2019

OBJECTIVE To develop an ethical framework for collaboration in international academic partnership... more OBJECTIVE To develop an ethical framework for collaboration in international academic partnerships in family medicine. COMPOSITION OF THE COMMITTEE A subgroup of the Besrour Centre of the College of Family Physicians of Canada including family medicine and bioethics experts began to collaborate in 2014 to undertake the development of an ethical framework and tools for the establishment of ethically sound international academic partnerships. METHODS Following 2 consultative workshops and a wider consultation process with the Besrour Centre global community, the authors developed an ethical framework and tools for approval by the Besrour Centre leadership in November 2017. REPORT Partnerships are essential to family practice and to the field of international development. The flawed nature of many North-South research partnerships underlines the importance of and need for delineating core principles for ethically sound partnerships, of which 10 have been identified in this process: acc...

A compter de la fete du Canada cette annee, les refugies et les medecins qui les traitent sont la... more A compter de la fete du Canada cette annee, les refugies et les medecins qui les traitent sont lances ensemble sur une route perilleuse. Jason Kenney, ministre de la Citoyennete, de l’Immigration et du Multiculturalisme, annoncait, le 25 avril 2012, un recul important sur le plan de la

Canadian Journal of Public Health, 2021

Objective The primary objective was to determine the association between public health preventive... more Objective The primary objective was to determine the association between public health preventive measures and children’s outdoor time, sleep duration, and screen time during COVID-19. Methods A cohort study using repeated measures of exposures and outcomes was conducted in healthy children (0 to 10 years) through The Applied Research Group for Kids (TARGet Kids!) COVID-19 Study of Children and Families in Toronto, Canada, between April 14 and July 15, 2020. Parents were asked to complete questionnaires about adherence to public health measures and children’s health behaviours. The primary exposure was the average number of days that children practiced public health preventive measures per week. The three outcomes were children’s outdoor time, total screen time, and sleep duration during COVID-19. Linear mixed-effects models were fitted using repeated measures of primary exposure and outcomes. Results This study included 554 observations from 265 children. The mean age of participan...

Childhood Obesity, 2021

Background: Few studies have published mediation analyses to quantify the role concurrent BMI pla... more Background: Few studies have published mediation analyses to quantify the role concurrent BMI plays in the relationship between growth and cardiometabolic risk (CMR) outcomes. Methods: We used data from a longitudinal cohort study conducted in children aged 0-60 months through The Applied Research Group for Kids (TARGet Kids!) in Canada. Four age and sex standardized BMI (zBMI) trajectories were identified using latent class mixed models. CMR were assessed using a CMR score. Concurrent zBMI was the zBMI measured on the same visit as CMR. Mediation analyses were performed comparing each trajectory with the reference trajectory. Results: One thousand one hundred sixty-five children were included. On average, compared with being in the stable low trajectory, being in the catch-up trajectory was associated with an increased CMR score of 0.42, 0.28 of which was mediated through concurrent zBMI [95% confidence interval (CI) 0.17 to 0.41, p = 0.001]; being in the stable high trajectory was associated with an increased CMR score of 0.23, 0.24 through concurrent zBMI (95% CI 0.18 to 0.31, p < 0.001). Similarly, being in the rapid accelerating trajectory was associated with an increased CMR score of 1.43, 1.18 of which was through concurrent zBMI (95% CI 0.89 to 1.50, p < 0.001). Conclusions: There was a strong evidence that the effect of BMI trajectories on CMR was indirect via concurrent BMI. It is important for researchers to choose the most appropriate analytic method based on the study hypothesis to understand the total or direct effect of growth patterns on cardiometabolic disease risk in children.

The Annals of Family Medicine, 2020

BMJ Global Health, 2019

IntroductionFinancing of primary healthcare (PHC) is the key to the provision of equitable univer... more IntroductionFinancing of primary healthcare (PHC) is the key to the provision of equitable universal care. We aimed to identify and prioritise the perceived needs of PHC practitioners and researchers for new research in low- and middle-income countries (LMIC) about financing of PHC.MethodsThree-round expert panel consultation using web-based surveys of LMIC PHC practitioners, academics and policy-makers sampled from global networks. Iterative literature review conducted in parallel. First round (Pre-Delphi survey) elicited possible research questions to address knowledge gaps about financing. Responses were independently coded, collapsed and synthesised to two lists of questions. Round 2 (Delphi Round 1) invited panellists to rate importance of each question. In Round 3 (Delphi Round 2), panellists ranked questions in order of importance.ResultsA diverse range of PHC practitioners, academics and policy-makers in LMIC representing all global regions identified 479 knowledge gaps as p...

The Journal of Pediatrics, 2019

Objectives To determine the association between cow's milk-fat and nonÀhigh-density lipoprotein (... more Objectives To determine the association between cow's milk-fat and nonÀhigh-density lipoprotein (non-HDL) cholesterol, a marker of cardiovascular disease (CVD) risk in young children, and whether this association is mediated by the typical volume of cow's milk consumed. Study design A longitudinal study in 2-to 8-year-old children (n = 2890) was conducted through The Applied Research Group for Kids (TARGet Kids!), a practice-based research network in Toronto, Canada. Generalized estimating equations were used to examine the relationship between parent-reported cow's milk-fat percentage intake and serum non-HDL cholesterol concentrations as well as having high non-HDL cholesterol (³3.75 mmol/L [145 mg/ dL]), adjusting for covariates including age, sex, body mass index z score, breastfeeding duration, mother's ethnicity, and parental history of CVD. Bootstrap resampling (10 000 repetitions) was used to assess whether typical volume consumed mediated the association between cow's milk-fat percentage and non-HDL cholesterol. Results In total, 156 (5.4%) had high non-HDL cholesterol. Each percent increase in cow's milk-fat was associated with a 0.035 mmol/L (1.35 mg/dL) (P < .001) and 0.024 mmol/L (0.92 mg/dL) (P = .01) increase in non-HDL cholesterol, unadjusted and adjusted for covariates respectively. Cow's milk-fat percentage was not associated with greater odds of having high non-HDL cholesterol. Volume of cow's milk partially mediated the association between cow's milk-fat percentage and non-HDL cholesterol, accounting for 28% of the relationship (P < .001). Conclusions Consumption of higher-fat cow's milk was associated with a small increase in non-HDL cholesterol but not greater odds of having high non-HDL cholesterol. Further research is needed to assess this relationship with other CVD risk factors in young children.

BMC Medical Research Methodology, 2019

Background: Measuring body mass index (BMI) has been proposed as a method of screening for preven... more Background: Measuring body mass index (BMI) has been proposed as a method of screening for preventive primary care and population surveillance of childhood obesity. However, the accuracy of routinely collected measurements has been questioned. The purpose of this study was to assess the reliability of height, length and weight measurements collected during well-child visits in primary care relative to trained research personnel. Methods: A cross-sectional study of measurement reliability was conducted in community pediatric and family medicine primary care practices. Each participating child, ages 0 to 18 years, was measured four consecutive times; twice by a primary care team member (e.g. nurses, practice personnel) and twice by a trained research assistant. Inter-and intra-observer reliability was calculated using the technical error of measurement (TEM), relative TEM (%TEM), and a coefficient of reliability (R). Results: Six trained research assistants and 16 primary care team members performed measurements in three practices. All %TEM values for intra-observer reliability of length, height, and weight were classified as 'acceptable' (< 2%; range 0.19% to 0.70%). Inter-observer reliability was also classified as 'acceptable' (< 2%; range 0.36% to 1. 03%) for all measurements. Coefficients of reliability (R) were all > 99% for both intra-and inter-observer reliability. Length measurements in children < 2 years had the highest measurement error. There were some significant differences in length intra-observer reliability between observers. Conclusion: There was agreement between routine measurements and research measurements although there were some differences in length measurement reliability between practice staff and research assistants. These results provide justification for using routinely collected data from selected primary care practices for secondary purposes such as BMI population surveillance and research.

The Annals of Family Medicine, 2019

The authors agreed to bid for funding through their shared professional network-the World Organiz... more The authors agreed to bid for funding through their shared professional network-the World Organization of Family Doctors (WONCA)-because the aim of the grant aligns with Wonca's academic mission. Funding came from Ariadne Labs through Brigham and Women's Hospital, which is the recipient of a Bill & Melinda Gates Foundation grant. Ariadne Labs is a joint center between Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health. Its mission is to create scalable health care solutions that deliver better care at the most critical moments in people's lives, everywhere. The findings and conclusions contained within are those of the authors, and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation, nor of the whole of WONCA.

Academic Pediatrics, 2017

What's New: Temperament is associated with obesity risk in preschoolers, but its relationship wit... more What's New: Temperament is associated with obesity risk in preschoolers, but its relationship with outdoor play is unknown. In this cross-sectional analysis of a cohort, temperament was associated with outdoor playtime, and thus may be an important consideration in preschoolers' health interventions.

Canadian family physician Medecin de famille canadien, 2016

To find a common global definition of family medicine. Since 2012, the College of Family Physicia... more To find a common global definition of family medicine. Since 2012, the College of Family Physicians of Canada has hosted the Besrour Conferences to reflect on its role in advancing the discipline of family medicine globally. The Besrour Papers Working Group, which was struck at the 2013 conference, was tasked with developing a series of papers to highlight the key issues, lessons learned, and outcomes emerging from the various activities of the Besrour collaboration. The working group comprised members of various academic departments of family medicine in Canada and abroad who attended the conferences. Searching both definition of family medicine and history of family medicine yields a variety of defining features. Visiting family medicine training programs worldwide highlights this discrepancy. It is not an easy task to define family medicine-one of its key attributes is its adaptability to a local context, but this makes aggregation of data challenging. There is a lack of clarity ...

Canadian family physician Médecin de famille canadien, 2015

To provide an overview of the main methodologic challenges to finding definitive evidence of the ... more To provide an overview of the main methodologic challenges to finding definitive evidence of the positive effects of family medicine and family medicine training on a global scale. In 2012, 2013, and 2014, the College of Family Physicians of Canada hosted the Besrour Conferences to reflect on its role in advancing the discipline of family medicine globally. The Besrour Papers Working Group, which was struck at the 2013 conference, was tasked with developing a series of papers to highlight the key issues, lessons learned, and outcomes emerging from the various activities of the Besrour collaboration. The working group comprised members of various academic departments of family medicine in Canada and abroad who attended the conferences. We performed a scoping review to determine the methodologic obstacles to understanding the positive effects of family medicine globally. The main obstacle to evaluating family medicine globally is that one of its core dimensions and assets is its local...

Canadian family physician Médecin de famille canadien, 2007

Global Health Action, 2014

Background: Global health is increasingly a major focus of institutions in high-income countries.... more Background: Global health is increasingly a major focus of institutions in high-income countries. However, little work has been done to date to study the inner workings of global health at the university level. Academics may have competing objectives, with few mechanisms to coordinate efforts and pool resources. Objective: To conduct a case study of global health at Canada's largest health sciences university and to examine how its internal organization influences research and action. Design: We drew on existing inventories, annual reports, and websites to create an institutional map, identifying centers and departments using the terms 'global health' or 'international health' to describe their activities. We compiled a list of academics who self-identified as working in global or international health. We purposively sampled persons in leadership positions as key informants. One investigator carried out confidential, semistructured interviews with 20 key informants. Interview notes were returned to participants for verification and then analyzed thematically by pairs of coders. Synthesis was conducted jointly. Results: More than 100 academics were identified as working in global health, situated in numerous institutions, centers, and departments. Global health academics interviewed shared a common sense of what global health means and the values that underpin such work. Most academics interviewed expressed frustration at the existing fragmentation and the lack of strategic direction, financial support, and recognition from the university. This hampered collaborative work and projects to tackle global health problems. Conclusions: The University of Toronto is not exceptional in facing such challenges, and our findings align with existing literature that describes factors that inhibit collaboration in global health work at universities. Global health academics based at universities may work in institutional siloes and this limits both internal and external collaboration. A number of solutions to address these challenges are proposed.

This article is also in English on page1853.

Canadian family physician Médecin de famille canadien, 2007

ur world is shrinking: international travel has topped 1 billion per year, international migratio... more ur world is shrinking: international travel has topped 1 billion per year, international migration now approaches 200 million a year, telecommunication reaches the heart of Africa, and e-mail allows families to maintain contact around the world. Advances in economic development, education, science, and technology offer opportunities to improve health, but many of these advances are not available in a large part of our world. The World Health Organization recognizes that disparities in people's ability to achieve health are of global concern; disparities in health bring with them the threats of epidemics, deepening poverty, and political conflict. As such, global health inequities are a pertinent concern for us, our families, and future generations. The current global shortage of trained health workers contributes to health disparities. 2 This crisis is most profound in the poorest countries, and, in particular, in sub-Saharan Africa. 3 The expression "international health" describes health-related work in an international setting (outside the country where one lives and practises) and relates to health practices, policies, and systems in other countries. The term "global health" relates more to health issues that transcend national borders, class, race, ethnicity, and culture, and includes the care of certain populations, such as immigrants and refugees, both locally and abroad. 4 In this article, we explore the roles and opportunities for family physicians in global health, especially related to primary care and family practice.

Canadian family physician Medecin de famille canadien, 2017

To demonstrate how family medicine has been recognized and integrated into primary health care sy... more To demonstrate how family medicine has been recognized and integrated into primary health care systems in contrasting contexts around the world and to provide an overview of how family physicians are trained and certified. Since 2012, the College of Family Physicians of Canada has hosted the Besrour Conferences to reflect on its role in advancing the discipline of family medicine globally. The Besrour Papers Working Group, which was struck at the 2013 conference, was tasked with developing a series of papers to highlight the key issues, lessons learned, and outcomes emerging from the various activities of the Besrour collaboration. The working group comprised members of various academic departments of family medicine in Canada and abroad who attended the conferences. An initial search was conducted in PubMed using a family medicine hedge of MeSH terms, text words, and family medicine journals, combined with text words and terms representing low- and middle-income countries and the c...