Lean is a widely used quality improvement methodology initially developed and used in the automotive and manufacturing industries but recently expanded to the healthcare sector. This systematic literature review seeks to independently assess the effect of Lean or Lean interventions on worker and patient satisfaction, health and process outcomes, and financial costs. We conducted a systematic literature review of Medline, PubMed, Cochrane Library, CINAHL, Web of Science, ABI/Inform, ERIC, EMBASE and SCOPUS. Peer reviewed articles were included if they examined a Lean intervention and included quantitative data. Methodological quality was assessed using validated critical appraisal checklists. Publically available data collected by the Saskatchewan Health Quality Council and the Saskatchewan Union of Nurses were also analysed and reported separately. Data on design, methods, interventions and key outcomes were extracted and collated. Our electronic search identified 22 articles that passed methodological quality review. Among the accepted studies, 4 were exclusively concerned with health outcomes, 3 included both health and process outcomes and 15 included process outcomes. Our study found that Lean interventions have: (i) no statistically significant association with patient satisfaction and health outcomes; (ii) a negative association with financial costs and worker satisfaction and (iii) potential, yet inconsistent, benefits on process outcomes like patient flow and safety. While some may strongly believe that Lean interventions lead to quality improvements in healthcare, the evidence to date simply does not support this claim. More rigorous, higher quality and better conducted scientific research is required to definitively ascertain the impact and effectiveness of Lean in healthcare settings.

Flipped Classroom is a model that’s quickly gaining recognition as a novel teaching approach among health science curricula. The purpose of this study was four-fold and aimed to compare Flipped Classroom effectiveness ratings with: 1) student socio-demographic characteristics, 2) student final grades, 3) student overall course satisfaction, and 4) course pre-Flipped Classroom effectiveness ratings. The participants in the study consisted of 67 Masters-level graduate students in an introductory epidemiology class. Data was collected from students who completed surveys during three time points (beginning, middle and end) in each term. The Flipped Classroom was employed for the academic year 2012–2013 (two terms) using both pre-class activities and in-class activities. Among the 67 Masters-level graduate students, 80% found the Flipped Classroom model to be either somewhat effective or very effective (M = 4.1/5.0). International students rated the Flipped Classroom to be significantly more effective when compared to North American students (X2 = 11.35, p < 0.05). Students’ perceived effectiveness of the Flipped Classroom had no significant association to their academic performance in the course as measured by their final grades (rs = 0.70). However, students who found the Flipped Classroom to be effective were also more likely to be satisfied with their course experience. Additionally, it was found that the SEEQ variable scores for students enrolled in the Flipped Classroom were significantly higher than the ones for students enrolled prior to the implementation of the Flipped Classroom (p = 0.003). Overall, the format of the Flipped Classroom provided more opportunities for students to engage in critical thinking, independently facilitate their own learning, and more effectively interact with and learn from their peers. Additionally, the instructor was given more flexibility to cover a wider range and depth of material, provide in-class applied learning opportunities based on problem-solving activities and offer timely feedback/guidance to students. Yet in our study, this teaching style had its fair share of challenges, which were largely dependent on the use and management of technology. Despite these challenges, the Flipped Classroom proved to be a novel and effective teaching approach at the graduate level setting.

Background: The purpose of this systematic review was to examine the association and directionality between mental health disorders and substance use among adolescents and young adults in the U.S. and Canada. Methods: The following databases were used: Medline, PubMed, Embase, PsycINFO, and Cochrane Library. Meta-analysis used odds ratios as the pooled measure of effect. Results: A total of 3656 studies were screened and 36 were selected. Pooled results showed a positive association between depression and use of alcohol (odds ratio (OR) = 1.50, 95% confidence interval (CI): 1.24–1.83), cannabis (OR = 1.29, 95% CI: 1.10–1.51), and tobacco (OR = 1.65, 95% CI: 1.43–1.92). Significant associations were also found between anxiety and use of alcohol (OR = 1.54, 95% CI: 1.19–2.00), cannabis (OR = 1.36, 95% CI: 1.02–1.81), and tobacco (OR = 2.21, 95% CI: 1.54–3.17). A bidirectional relationship was observed with tobacco use at baseline leading to depression at follow-up (OR = 1.87, CI = 1.23–2.85) and depression at baseline leading to tobacco use at follow-up (OR = 1.22, CI = 1.09–1.37). A unidirectional relationship was also observed with cannabis use leading to depression (OR = 1.33, CI = 1.19–1.49). Conclusion: This study offers insights into the association and directionality between mental health disorders and substance use among adolescents and young adults. Our findings can help guide key stakeholders in making recommendations for interventions, policy and programming.

The role that socioeconomic status/income play in accounting for the increased prevalence of type 2 diabetes has not been sufficiently studied in Canada. The primary purpose of the present study was to determine the unadjusted and adjusted effect of income on type 2 diabetes. The secondary purpose was to determine the adjusted effect of income on diabetes associated conditions such as high blood pressure and being overweight or obese, and its main behavioral factor of physical inactivity. This is a cross-sectional, population-based study. Data was analyzed from four cycles of the Canadian Community Health Survey (CCHS). It was conducted by Statistics Canada and covered the time period of 2000–2008 in the province of Saskatchewan, Canada. In this study, four separate and distinct multivariate models were built to determine the independent effect of income on type 2 diabetes and the associated conditions of high blood pressure, being overweight or obese, and physical inactivity. The total sample size was comprised of 27,090 residents from Saskatchewan. After statistically controlling for age, only six covariates were independently associated with type 2 diabetes prevalence including: having high blood pressure (OR = 3.26), visible minority cultural status (OR = 2.17), being overweight or obese (OR = 1.97), being of male gender (OR = 1.76), having a household income of $29,999 per year (OR = 1.63) and being physically inactive (OR = 1.15). In this study, household income was strongly and independently associated with type 2 diabetes prevalence, its associated conditions of high blood pressure and being overweight or obese, and its main behavioral factor of physical inactivity. We suggest that income is an important but frequently overlooked factor for type 2 diabetes and worthy of further investigation, appropriate public debate and timely policy intervention.

The purpose of this study is to conduct a systematic review and meta-analysis to evaluate the risk of depression and suicidality among diabetic patients. Methods: Medline, PubMed, EMBASE, Cochrane library, and Psych INFO were searched for studies published from 2008 onwards. Meta-analysis was conducted to estimate the pooled effect size. Sources of heterogeneity were investigated by subgroup analysis and meta-regression. Results: In total, 5750 articles were identified and of those, 17 studies on suicidality and 36 on depression were included in this study. Our analysis suggests a positive relationship between diabetes and depression (cohort studies odds ratio (OR) 1.49, 95% confidence interval (CI): 1.36–1.64 and cross-sectional studies OR 2.04, 95% CI, 1.73–2.42). Pooled OR values for suicidal ideation, attempted suicide, and completed suicide were 1.89 (95% CI: 1.36–2.63), 1.45 (95% CI: 1.07–1.96), and 1.85 (95% CI: 0.97–3.52), respectively. All findings were statistically significant except for completed suicide. Conclusions: The increased risk of depression and suicidality in diabetic patients highlights the importance of integrating the evaluation and treatment of depression with diabetes management in primary healthcare settings. Further research in this area is needed.

The purpose of this systematic review and meta-analysis was to address disparities related to sexual health among students by examining the effectiveness of sexually transmitted infection (STI) preventive interventions in educational settings. PubMed, Medline, Cochrane Library, Public Health Database, and EMBASE databases were used to conduct searches. Information relating to studies, programs, participants, and quantitative outcome variables were extracted. Risk of bias was assessed and meta-analysis was conducted. This systematic review included 16 articles. The outcomes were classified into behavioral and psychosocial categories. The behavioral category included sexual partners, sexual activity, condom use, STI/HIV testing, and alcohol/drug use before sex. The psychosocial category consisted of knowledge, motivational factors, and skills. Interventions had a significantly positive impact on both behavioral (OR, 1.28; 95% CI, 1.17–1.39) and psychosocial (OR, 1.92; 95% CI, 1.36–2.72) outcomes. Among the psychosocial outcomes, the interventions were most effective at promoting knowledge (OR, 3.17; 95% CI, 2.13–4.72), followed by enhancing motivational factors (OR, 1.69; 95% CI, 1.04–2.75) and increasing behavioral skills (OR, 1.43; 95% CI, 1.13–1.81). The results of this systematic review provide empirical evidence for public health professionals and policy makers regarding planning, implementation, evaluation, and modification of STI preventive intervention programs in educational settings.