ABSTRACT
Recent decades have seen an increase in the popularity of international education. Approximately 500,000 international students were in Canada in 2018 and this number is projected to grow. While we know that many international students decide to stay in Canada, we do not fully understand the decision-making process employed by international students regarding staying in Canada or going back home after completing their education. The purpose of this study was to explore how international students make decisions about their post-graduation destination and what factors they see as pivotal in shaping their decision-making process. We utilized a symbolic interactionist approach to analyze qualitative semi-structured interviews with 60 international students enrolled in post-secondary programs in Canada. Our findings suggest that the meaning students attach to staying in Canada varies from obtaining permanent residency to working for a few months upon graduation. We also demonstrate that for most students, the decision to stay in Canada is formed gradually and is shaped by familial obligations, cultural climate they experience in Canada, employment opportunities available to them upon graduation, and the possibility of obtaining permanent residency.
ABSTRACT
BACKGROUND: Identifying children at malnutrition risk on admission to hospital is considered best practice; however, nutrition screening in pediatric populations is not common. The aim of this study was to determine which screening tool is able to identify children with malnutrition on admission to hospital. METHODS: A nurse administered 2 pediatric nutrition screening tools, Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) and Pediatric Nutrition Screening Tool (PNST) to patients admitted to medicine and surgery units (n = 165). The Subjective Global Nutritional Assessment (SGNA) was then completed by a dietitian, blinded to the results of the screens. Sensitivity, specificity, and κ were calculated for both screening tools against the SGNA. A receiver operating characteristic (ROC) curve assessed alternate cutoffs for each tool. Length of hospital stay (LOS) was used to assess prospective validity. RESULTS: Using the recommended cutoffs, the sensitivity of STRONGkids was 89%, specificity 35%, and κ 0.483. The sensitivity of PNST was 58%, specificity 88%, and κ 0.601. Using adjusted cutoffs, PNST's sensitivity improved to 87%, specificity 71%, and κ 0.681, and STRONGkids specificity improved to 61%, sensitivity 80%, and κ 0.5. Children identified at nutrition risk had significantly longer LOS (P < 0.05). CONCLUSION: This study showed neither tool was appropriate for clinical use based on published cutoffs. By adjusting the cutoffs using ROC curve analysis, both tools improved overall agreement with the SGNA without significantly impacting the prospective validity. PNST with adjusted cutoffs is the most appropriate for clinical use in this population.
