OBJECTIVE:There is a paucity of information on the uptake of Medical Assistance in Dying (MAiD) for patients with head and neck cancer (HNC). Our study reports the prevalence, disease characteristics, and nature of the desire for MAiD in patients with HNC who underwent the process in Ontario. The aim is to better understand this population and identify gaps in our current system of care. METHODS:This is a retrospective cross-sectional analysis for the period June 17, 2016 to December 31, 2022. Data were received from the Office of the Chief Coroner Ontario, Canada. RESULTS:Three hundred and fifty-six persons received MAiD. The average age was 72.4 years (SD 12.22) with 260 of the patients being men (73.03%). The most common HNC primary tumor site was the oral cavity 109 (30.6%). The most reported reason was inadequate control of symptoms other than pain (79.21%) followed by inadequate pain control or concerns about it (75%). The patient's private residence (55.62%) was the most common setting. Patients were more likely to live in wealthier neighborhoods and in large urban centers. Future prediction of MAiD uptake shows a linear year-by-year increase. CONCLUSION:The use of MAiD in HNC has been steadily increasing since its legalization and is projected to continue increasing. There is a male predominance that is aligned with the incidence and prevalence of HNC nationally. Overall, MAiD is an increasingly employed choice for HNC patients receiving treatment for disease without curative intent. LEVEL OF EVIDENCE: 4:

BACKGROUND:The impact of COVID-19-related nonpharmaceutical interventions (NPI) on the bacterial composition of upper airway infections remains largely unexplored. OBJECTIVES:We aimed to investigate the incidence and microbiology of peritonsillar abscess (PTA) following the cessation of NPI and to compare these findings with the periods before and during NPI implementation. METHODS:We performed a cross-sectional analysis of all PTA cases and their microbiological findings from 12 March, 2018 to 11 March, 2024, among patients admitted to the Ear-Nose-Throat Department, Aarhus University Hospital. Patients were categorised into three two-year periods in relation to NPI. Age-stratified population data for the catchment area were sourced from Statistics Denmark. RESULTS:A total of 1,030 patients were included. The annual incidence rate of PTA was significantly higher post-NPI (26.9 cases/100,000) compared to both the NPI period (14.9 cases/100,000, p < 0.001) and the pre-NPI period (21.8 cases/100,000, p = 0.003). Increased post-NPI rates were observed across all age groups. The number of cases positive for Streptococcuspyogenes and Fusobacterium necrophorum increased post-NPI (n = 102 and n = 89, respectively) compared to during the NPI period (n = 28 and n = 64, p < 0.001 and p = 0.052, respectively) and pre-NPI (n = 67 and n = 60, p = 0.009 and p = 0.021, respectively). Statistically non-significant increasing trends were found for less prevalent bacteria. CONCLUSION:Following NPI cessation, PTA incidence rates surpassed both the NPI and pre-NPI levels. The rising PTA incidence rates post-NPI were primarily driven by an increasing number of cases positive for S. pyogenes and F. necrophorum, suggesting an immunity debt to these prevalent pathogens.

BACKGROUND:Stark disparities in COVID-19 infection, mortality and vaccine uptake have been observed between racial groups. However, differences in COVID-19 vaccine confidence between racialized groups and contextual factors that account for such differences have not been explored. We sought to determine socioeconomic profiles associated with COVID-19 vaccine confidence using both conventional and latent profile analyses (LPA). METHODS:A representative sample of 4220 Arab, Asian, Black, Indigenous, Mixed and White adults completed a survey conducted to examine COVID-19 vaccine confidence. We determined vaccine confidence by racial groups, and analyzed factors associated with vaccination confidence between different racialized groups. Regression analysis and LPA were used to determine profiles of vaccine confidence by race. RESULTS:Arab, Black, Indigenous and Mixed group respondents had lower vaccine confidence compared to White individuals, while Asian respondents had higher vaccine confidence compared to other racial groups. Vaccine confidence varied by age, gender, conspiracy beliefs, health literacy and experiences of racial discrimination. LPA produced Profile 1 with high vaccine confidence and health literacy, with low experience of discrimination and conspiracy beliefs; Profile 2 had low vaccine confidence and health literacy, with greatest experiences of discrimination and conspiracy beliefs. Compared to White respondents, Arab (odds ratio = 2.86;95 % CI 2.33-3.52), Indigenous (odds ratio = 2.29; 95 % CI, 1.88-2.78), and Black (odds ratio = 2.19; 95 % CI 1.80-2.66) respondents were more likely to belong to Profile 2. CONCLUSIONS:Vaccine confidence profiles for COVID-19 converge at the intersection of health literacy, experience of discrimination and conspiracy beliefs. COVID-19 vaccine confidence is heterogenous between racialized communities, with lowest confidence among Arab, Black and Indigenous individuals and highest confidence among Asian individuals. Understanding the source of this heterogeneity is crucial to design public health approaches that equitably ensure vaccine coverage among populations at highest risk of COVID-19 and its complications.

Importance Pituitary adenomas (PAs) present a notable economic burden on healthcare systems due to their management's reliance on multimodal, often costly interventions. Objective To determine total and relative healthcare costs for PAs at Ontario-based institutions. Design A retrospective, propensity-score-matched cohort analysis. Setting Ontario, Canada, encompassing public healthcare facilities and covering costs over a 6-year study period. Participants Adults diagnosed with PA (n = 1675) between April 1, 2013, and March 31, 2019, compared to a general population cohort and a hospitalized control cohort matched on demographics and health factors. Intervention/Exposures Analysis of healthcare cost components (inpatient, outpatient, and diagnostic services) and cost trajectories postsurgery for PAs. Main Outcome Measures Primary outcome was total annualized healthcare costs for patients with PA relative to the general and hospitalized cohorts. Relative costs were estimated using a negative binomial regression model. Results Of 1675 patients with PA, total annualized costs were $49,992. Highest total costs were associated with inpatient hospitalization ($24,796) and physician services/diagnostic evaluations ($20,075). After propensity score matching, patients with PA had 12.7 times higher costs [95% confidence interval (CI) (10.9, 14.8), P < .0001] during the preadmission/admission period, which remained elevated postoperatively (P < .05). Total costs did not differ between patients with PA and the hospitalized cohort [RR 0.97, 95% CI (0.92, 1.03); P = .3271] in the preadmission/admission period; however, follow-up costs were 37% lower for patients with PA in the 1st follow-up year [RR 0.63, 95% CI (0.51, 0.77); P < .0001], and up to 50% lower by the 5th year [RR 0.50, 95% CI (0.36, 0.68); P < .0001]. Conclusions This study provided a comprehensive assessment of the economic burden of PAs on the publicly-funded healthcare system. Patients with PA had higher annualized total costs across all observed time periods compared to the general population and lower annualized total costs compared to patients admitted to a surgical ward. Relevance This study highlights the financial impact of PA management on healthcare resources and provides a basis for future research aimed at cost-efficiency improvements in long-term PA care.

Oral human papillomavirus (HPV) infection is a risk for oropharyngeal cancer (OPC), now the leading HPV-related cancer in males in Canada. P16 positivity is a marker of HPV positivity. Since 2015, all major Canadian cancer centers perform routine p16 tumor marker testing of OPCs to define their HPV status but recent data on the HPV-attributable fraction for OPC in Canada do not exist. A retrospective chart review was conducted of all squamous cell OPC cases in patients 18 years and older diagnosed from 2016 to 2020 in 4 major Canadian hospital-based regional oncology centers to determine the HPV attributable fraction for OPC in Canada using p16 as a surrogate marker for HPV. 1154 OPC cases were identified. Most patients (85.4%) were male; about one-third 26 (31.4%) had never smoked. Most OPC (80.6%) were P16 positive. p16 positivity was 27 associated with younger age (mean age p16+ 61.6 vs. p16- 66.5 years, p < 0.0001), male sex 28 (p16+ males 84.0% vs p16+ females 60.9%, p < 0.0001), lower tumor stage (Stage 1 p16+ 29 88.1% vs Stage 4 p16+ 69.4%, p < 0.001), and non-smoking (never smoked 92.3% vs past 30 smoker 82.8% vs current smoker 65.0%, p < 0.001). Logistic regression confirmed these 31 associations. This study, the largest cohort of Canadian patients with OPC yet reported, demonstrates the high attributable fraction for HPV-related OPC. HPV-related OPC was more likely in men, younger individuals, and never smokers. These findings highlight the burden of HPV-related OPC in Canada and support gender-neutral HPV vaccination as an important public health strategy to prevent head and neck cancer.

OBJECTIVE:To compare the performance of Google Bard, Microsoft Copilot, GPT-4 with vision (GPT-4) and Gemini Ultra on the OTO Chautauqua, a student-created, faculty-reviewed otolaryngology question bank. STUDY DESIGN:Comparative performance evaluation of different LLMs. SETTING:N/A. PARTICIPANTS:N/A. METHODS:Large language models (LLMs) are being extensively tested in medical education. However, their accuracy and effectiveness remain understudied, particularly in otolaryngology. This study involved inputting 350 single-best-answer multiple choice questions, including 18 image-based questions, into four LLMS. Questions were sourced from six independent question banks related to (a) rhinology, (b) head and neck oncology, (c) endocrinology, (d) general otolaryngology, (e) paediatrics, (f) otology, (g) facial plastics, reconstruction and (h) trauma. LLMs were instructed to provide an output reasoning for their answers, the length of which was recorded. RESULTS:Aggregate and subgroup analysis revealed that Gemini (79.8%) outperformed the other LLMs, followed by GPT-4 (71.1%), Copilot (68.0%), and Bard (65.1%) in accuracy. The LLMs had significantly different average response lengths, with Bard (x̄ = 1685.24) being the longest and no difference between GPT-4 (x̄ = 827.34) and Copilot (x̄ = 904.12). Gemini's longer responses (x̄ =1291.68) included explanatory images and links. Gemini and GPT-4 correctly answered image-based questions (n = 18), unlike Copilot and Bard, highlighting their adaptability and multimodal capabilities. CONCLUSION:Gemini outperformed the other LLMs in terms of accuracy, followed by GPT-4, Copilot and Bard. GPT-4, although it has the second-highest accuracy, provides concise and relevant explanations. Despite the promising performance of LLMs, medical learners should cautiously assess accuracy and decision-making reliability.

BackgroundThe Glasgow Benefit Inventory (GBI) is a widely used patient-reported outcome measure in otorhinolaryngology. A Danish version would serve as a validated tool for assessing quality of life among Danish patients after otorhinolaryngological interventions, enabling both cross-intervention, cross-country and cross-cultural comparisons.Aims/objectivesThis study aimed to translate, culturally adapt and linguistically validate the GBI into Danish.Materials and methodsWe followed the guidelines of the Quality of Life Special Interest Group - Translation and Cultural Adaptation Group established by ISPOR, to ensure a rigorous adaptation process.ResultsA Danish version of the GBI was developed in accordance with the guidelines. Minor adjustments were made to enhance clarity, consistency, and ease of use for Danish respondents. These modifications were carefully considered to preserve the original concepts and intent of the original questionnaire.Conclusions and significanceThe GBI has been successfully translated, culturally adapted, and linguistically validated for use in Danish. This version provides a valuable tool for evaluating the impact of otorhinolaryngological operations/treatments by measuring the patient-reported outcomes in Danish otorhinolaryngology patients. (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic) 2016 (sic)(sic) 2022 (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic) 26 (sic)(sic)(sic)(sic)(sic)(sic)(sic)((sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)).(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic) 7 (sic)(sic)(sic)(sic)(sic)((sic)(sic)(sic)(sic)(sic)(sic)(sic) 47%).(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).(sic)(sic) 4 (sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic) 3 (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), 1 (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).

Objectives: We aimed to explore the impact of social distancing on the incidence and microbiology of peritonsillar abscess (PTA). Methods: We performed a cross-sectional analysis of all patients with PTA and their microbiological findings in the 2 years preceding versus the 2 years following the COVID-19 lockdown in Denmark (11 March 2020), who were admitted to the Ear-Nose-Throat Department, Aarhus University Hospital. Age -stratified population data for the catchment area were obtained from Statistics Denmark. Results: The annual incidence rate was significantly higher in the 2-year period before (21.8 cases/ 100 000 inhabitants) compared with after (14.9 cases/100 000) the lockdown (p < 0.001). The number of cases with growth of Streptococcus pyogenes was significantly higher in the period before (n = 67) compared with after (n = 28) the lockdown (p < 0.001), whereas the number of cases positive for Fusobacterium necrophorum (n = 60 vs. n = 64) and streptococcus anginosus group (SAG) (n = 37 vs. n = 43) were stabile (p 0.79 and p 0.58, respectively). The relative prevalence of S. pyogenes was significantly higher in the period before (67/246 cultures, 27%) compared with after (28/179, 16%) the lockdown (p 0.007). On the contrary, the relative prevalence of F. necrophorum and SAG is significantly lower before (60/246, 24% and 37/246, 15%) compared with after (64/179, 36% and 43/179, 24%) the lockdown (p 0.013 and p 0.023). Discussion: Social distancing had a significant impact on the incidence and microbiology of PTA. Our findings suggest that S. pyogenes-positive PTA is highly related to direct social interaction, and represents a contagious pathogen. By contrast, PTA development caused by F. necrophorum and SAG is unrelated to direct social interaction and may be derived from flora imbalance.

Despite increased risk of severe acute respiratory syndrome coronavirus 2 infections and higher rates of COVID‐19‐related complications, racialized and Indigenous communities in Canada have lower immunization uptake compared to White individuals. However, there is woeful lack of data on predictors of COVID‐19 vaccine mistrust (VM) that accounts for diverse social and cultural contexts within specific racialized and Indigenous communities. Therefore, we sought to characterize COVID‐19 VM among Arab, Asian, Black, and Indigenous communities in Canada. An online survey was administered to a nationally representative, ethnically diverse panel of participants in October 2023. Arabic, Asian, Indigenous, and Black respondents were enriched in the sampling panel. Data were collected on demographics, COVID‐19 VM, experience of racial discrimination, health literacy, and conspiracy beliefs. We used descriptive and regression analyses to determine the extent and predictors of COVID‐19 VM among racialized and Indigenous individuals. All racialized respondents had higher VM score compared to White participants. Among 4220 respondents, we observed highest VM among Black individuals (12.18; ±4.24), followed by Arabic (12.12; ±4.60), Indigenous (11.84; ±5.18), Asian (10.61; ±4.28), and White (9.58; ±5.00) participants. In the hierarchical linear regression analyses, Black participants, women, everyday racial discrimination, and major experience of discrimination were positively associated with COVID‐19 VM. Effects of racial discrimination were mediated by addition of conspiracy beliefs to the model. Racialized and Indigenous communities experience varying levels of COVID‐19 VM and carry specific predictors and mediators to development of VM. This underscores the intricate interaction between race, gender, discrimination, and VM that need to be considered in future vaccination campaigns.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:. To assess the effects of surgical and non-surgical interventions for primary and salvage treatment of GH-secreting pituitary adenomas in adults.

ObjectiveTo investigate the gender of the authors who publish articles of health economic evaluations in medicine and healthcare journals.MethodWe evaluated a random sample of economic evaluations indexed in MEDLINE during 2019. Gender of the first, last and corresponding author was determined by review of the author's first name. Data were summarized as frequency and percentage for categorical items and median and interquartile range (IQR) for continuous items. We also calculated the index of authors per paper.ResultsWe included 200 studies with 1365 authors (median of 6 authors per paper; IQR: 4-9). Gender identification was possible for all authors in the study sample: 802 (59%) were men and 563 (41%) were women. The number of female first, last, and corresponding authors respectively were 78 (39%), 68 (34%), and 80 (40%) for health economic evaluations.DiscussionFemale scientists were underrepresented as co-authors and in prominent authorship positions in health economic evaluations. This study serves as a call to action for the scientific community to actively work towards equity and inclusion.

Factors influencing vaccine uptake in Black individuals remain insufficiently documented. Understanding the role of COVID-19 related stress, conspiracy theories, health literacy, racial discrimination experiences, and confidence in health authorities can inform programs to increase vaccination coverage. We sought to analyze these factors and vaccine uptake among Black individuals in Canada. A representative sample of 2002 Black individuals from Ontario, Quebec, Alberta, Nova Scotia, New Brunswick, British Columbia, and Manitoba, aged 14 years or older completed questionnaires assessing vaccine uptake, health literacy, conspiracy theories, racial discrimination experiences, COVID-19-related stress, and confidence in health authorities. Mediation analyses were conducted to assess (1) the effect of health literacy on COVID-19 vaccination uptake through confidence and need, COVID-19 related traumatic stress, and racial discrimination, and (2) the effect of conspiracy beliefs on COVID-19 vaccination uptake through the same factors. Overall, 69.57% (95% confidence interval, 67.55%-71.59%) of the participants were vaccinated and 83.48% of them received two or more doses. Those aged 55 years and older were less likely to be vaccinated, as well as those residing in British Columbia and Manitoba. Mediation models showed that the association between health literacy and COVID-19 vaccine uptake was mediated by confidence in health authorities (B = 0.02, p < 0.001), COVID-19-related stress (B = -0.02, p < 0.001), and racial discrimination (B = -0.01, p = 0.032), but both direct and total effects were nonsignificant. Lastly, conspiracy beliefs were found to have a partial mediation effect through the same mediators (B = 0.02, p < 0.001, B = -0.02, p < 0.001, B = -0.01, p = 0.011, respectively). These findings highlight the need for targeted interventions to address vaccine hesitancy and inform approaches to improve access to vaccinations among Black communities.

Racialized and Indigenous communities have been disproportionately affected by COVID-19 infections and mortality, driven by systemic socioeconomic inequalities. However, how these factors specifically influence COVID-19 vaccine uptake is not documented among racialized individuals in Canada. The present study aims to examine COVID-19 vaccine uptake rates and related factors among racialized and Indigenous communities compared to White people in Canada. In total, 41,931 individuals aged 16 and older, consisting mainly of Arab, Asian, Black, Indigenous, and White individuals, were randomly invited to participate from a panel of 420,000 Canadian households. A total of 4220 participants completed this cross-sectional survey study in October 2023. In total, 89.60% of participants were vaccinated: 2.38% received one dose, 31.45% received two doses, 33.46% received three doses, 18.86% received four doses, and 13.86% received five doses and more. There were significant differences according to racial and ethnic background in vaccine uptake (χ2 = 57.45, p < 0.001), with Indigenous and Black individuals having lower vaccination rates (83.54%, OR = 1.98% and 84.76%, OR = 2.16, p < 0.01) compared to White individuals (91.66%). Confidence in health authorities was positively associated with vaccine uptake (B = 0.62, p < 0.001). Conspiracy beliefs partially mediated this association (B = -0.13, p < 0.001). Racial discrimination attenuated vaccine uptake, even if respondents had confidence in health authorities (B = -0.08, p < 0.001). Vaccine uptake was lowest amongst Indigenous and Black communities, placing them at higher risk of severe COVID-19 infection. In addition to mistrust of public health authorities due to racism, racialized communities are affected by conspiracy beliefs that hinder COVID-19 vaccine uptake. A whole-of-society approach to address barriers to vaccine uptake among racialized populations, including wage disparities, racial discrimination, is needed to eliminate racial health disparities and increase vaccination rates in racialized communities.

Objective The incidence of thyroid cancer has significantly increased in recent decades. Although most thyroid cancers are small and carry an excellent prognosis, a subset of patients present with advanced thyroid cancer, which is associated with increased rates of morbidity and mortality. The management of thyroid cancer requires a thoughtful individualized approach to optimize oncologic outcomes and minimize morbidity associated with treatment. Because endocrinologists usually play a key role in the initial diagnosis and evaluation of thyroid cancers, a thorough understanding of the critical components of the preoperative evaluation facilitates the development of a timely and comprehensive management plan. The following review outlines considerations in the preoperative evaluation of patients with thyroid cancer. Methods A clinical review based on current literature was generated by a multidisciplinary author panel. Results A review of considerations in the preoperative evaluation of thyroid cancer is provided. The topic areas include initial clinical evaluation, imaging modalities, cytologic evaluation, and the evolving role of mutational testing. Special considerations in the management of advanced thyroid cancer are discussed. Conclusion Thorough and thoughtful preoperative evaluation is critical for formulating an appropriate treatment strategy in the management of thyroid cancer.

IntroductionThere has been a growing awareness of the need for rigorously and transparent reported health research, to ensure the reproducibility of studies by future researchers. Health economic evaluations, the comparative analysis of alternative interventions in terms of their costs and consequences, have been promoted as an important tool to inform decision-making. The objective of this study will be to investigate the extent to which articles of economic evaluations of healthcare interventions indexed in MEDLINE incorporate research practices that promote transparency, openness and reproducibility.Methods and analysisThis is the study protocol for a cross-sectional comparative analysis. We registered the study protocol within the Open Science Framework (osf.io/gzaxr). We will evaluate a random sample of 600 cost-effectiveness analysis publications, a specific form of health economic evaluations, indexed in MEDLINE during 2012 (n=200), 2019 (n=200) and 2022 (n=200). We will include published papers written in English reporting an incremental cost-effectiveness ratio in terms of costs per life years gained, quality-adjusted life years and/or disability-adjusted life years. Screening and selection of articles will be conducted by at least two researchers. Reproducible research practices, openness and transparency in each article will be extracted using a standardised data extraction form by multiple researchers, with a 33% random sample (n=200) extracted in duplicate. Information on general, methodological and reproducibility items will be reported, stratified by year, citation of the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement and journal. Risk ratios with 95% CIs will be calculated to represent changes in reporting between 2012–2019 and 2019–2022.Ethics and disseminationDue to the nature of the proposed study, no ethical approval will be required. All data will be deposited in a cross-disciplinary public repository. It is anticipated the study findings could be relevant to a variety of audiences. Study findings will be disseminated at scientific conferences and published in peer-reviewed journals.

Background Chronic dizziness can cause significant functional impairment. Outcome measures used in this patient population have not been examined systematically. Consequently, providers lack consensus on the ideal outcome measures to assess the impact of their interventions. Objective and Methods We conducted a scoping review to summarize existing literature on outcomes in chronic dizziness (with a minimum of 6 mo of patient follow-up). Among other details, we extracted and analyzed patient demographics, medical condition(s), and the specific outcome measures of each study. Results Of 19,426 articles meeting the original search terms, 416 met final exclusion after title/abstract and full-text review. Most studies focused on Ménière's disease (75%) and recurrent benign paroxysmal positional vertigo (21%). The most common outcome measures were hearing (62%) and number of attacks by American Academy of Otolaryngology–Head & Neck Surgery criteria (60%). A minority (35%) looked formally at quality-of-life metrics (Dizziness Handicap Index or other). Conclusions Ménière's disease and benign paroxysmal positional vertigo are overrepresented in literature on outcome assessment in chronic dizziness. Objective clinical measures are used more frequently than quality-of-life metrics. Future work is needed to identify the optimal outcome measures that reflect new knowledge about the most common causes of chronic dizziness (including persistent postural-perceptual dizziness and vestibular migraine) and consider what is most important to patients.

Following the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) treatment algorithm for chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), patients suffering from severe uncontrolled CRSwNP are recommended to receive oral corticosteroids, (revision) sinus surgery, systemic biologicals, and/or aspirin treatment after desensitization (ATAD). Given the major differences in indications, outcomes, practical considerations, risks and costs of these key pillars of treatment, there is a growing need to define criteria for each treatment option and list the clinically relevant and major considerations for them. This EUFOREA document therefore provides an expert panel overview of the expected outcomes, specific considerations and (contra)indications of the five major treatment arms of severe uncontrolled CRSwNP: oral corticosteroids, primary and revision sinus surgery, biological treatment, and ATAD. This overview of treatment considerations is needed to allow physicians and patients to consider the different options in the context of providing optimal and personalized care for severe uncontrolled CRSwNP. In conclusion, the five major treatment options for severe uncontrolled CRSwNP have intrinsic advantages, specific indications, and considerations that are of importance to the patient, the physician, and the society. This EUFOREA statement supports the unmet need to define criteria for the indication of every treatment pillar of CRSwNP.

This systematic review and meta‐analysis examined the prevalence and factors associated with vaccine hesitancy and vaccine unwillingness in Canada. Eleven databases were searched in March 2022. The pooled prevalence of coronavirus disease 2019 (COVID‐19) vaccine hesitancy and unwillingness was estimated. Subgroup analyses and meta‐regressions were performed. Out of 667 studies screened, 86 full‐text articles were reviewed, and 30 were included in the systematic review. Twenty‐four articles were included in the meta‐analysis; 12 for the pooled prevalence of vaccine hesitancy (42.3% [95% CI, 33.7%–51.0%]) and 12 for vaccine unwillingness (20.1% [95% CI, 15.2%−24.9%]). Vaccine hesitancy was higher in females (18.3% [95% CI, 12.4%−24.2%]) than males (13.9% [95% CI, 9.0%−18.8%]), and in rural (16.3% [95% CI, 12.9%−19.7%]) versus urban areas (14.1% [95%CI, 9.9%−18.3%]). Vaccine unwillingness was higher in females (19.9% [95% CI, 11.0%−24.8%]) compared with males (13.6% [95% CI, 8.0%−19.2%]), non‐White individuals (21.7% [95% CI, 16.2%−27.3%]) than White individuals (14.8% [95% CI, 11.0%−18.5%]), and secondary or less (24.2% [95% CI, 18.8%−29.6%]) versus postsecondary education (15.9% [95% CI, 11.6%−20.2%]). Factors related to racial disparities, gender, education level, and age are discussed.

Background The effects of the COVID-19 pandemic have been more pronounced for socially disadvantaged populations. We sought to determine how access to SARS-CoV-2 testing and the likelihood of testing positive for COVID-19 were associated with demographic factors, socioeconomic status (SES) and social determinants of health (SDH) in three Canadian provinces. Methods An observational population-based cross-sectional study was conducted for the provinces of Ontario, Manitoba and New Brunswick between March 1, 2020 and April 27, 2021, using provincial health administrative data. After excluding residents of long-term care homes, those without current provincial health insurance and those who were tested for COVID-19 out of province, records from provincial healthcare administrative databases were reviewed for 16,900,661 healthcare users. Data was modelled separately for each province in accordance to a prespecified protocol and follow-up consultations among provincial statisticians and collaborators. We employed univariate and multivariate regression models to examine determinants of testing and test results. Results After adjustment for other variables, female sex and urban residency were positively associated with testing, while female sex was negatively associated with test positivity. In New Brunswick and Ontario, individuals living in higher income areas were more likely to be tested, whereas in Manitoba higher income was negatively associated with both testing and positivity. High ethnocultural composition was associated with lower testing rates. Both high ethnocultural composition and high situational vulnerability increased the odds of testing positive for SARS-CoV-2. Discussion We observed that multiple demographic, income and SDH factors were associated with SARS-CoV-2 testing and test positivity. Barriers to healthcare access identified in this study specifically relate to COVID-19 testing but may reflect broader inequities for certain at-risk groups.