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- OPEN ACCESSWe have applied a Bauhaus design lens to inform a visual conceptual framework for a rational mental health care system. We believe that Canada’s healthcare system can often be fragmented and does not always allow for service delivery to easily meet patient care needs. Within our proposed framework, the form of services provided follows patient- and healthcare-centred needs. The framework is also informed by the ethics and values of social responsibility, population health, and principles of quality of care. We review evidence for this framework (based on need, acuity, risk, service intensity, and provider level) and describe patient care pathways from intake/triage to three patient-centred tiers of care: (1) primary care (low needs), (2) acute ambulatory transitional care (moderate needs), and (3) acute hospital and complex care (high needs). Within each tier, various models of care are organized from low to high service intensity as informed by reports from the British Columbia Ministry of Health and the World Health Organization. We hope that our model may help to better conceptualize and organize our mental health care system and help providers clarify roles, responsibilities, and accountabilities to improve quality of care.
- OPEN ACCESSThis paper focuses on the multiple ways in which people who live along the rivers of the Brazilian Amazon, known as ribeirinhos, experience malaria outside of a clinical setting. It describes the local understanding of malaria, strategies to distinguish the illness from other febrile sicknesses, challenges for detecting the disease through biomedical diagnosis methods, and vicissitudes of having malaria. It draws on cases from ribeirinhos from a peri-urban community of Manaus and a rural community from Careiro, State of Amazonas, Brazil. Although malaria is biomedically characterized by the pathogens causing the disease, ribeirinhos have developed other standards to define malaria, including the intensity of the symptoms, the interval between the infections, and the types of medications dispensed to them. In the riverine communities studied, the etiology of malaria includes mosquitoes, microbes, water, wind, sun, and person-to-person transmission. Symptoms of malaria were found to overlap with other febrile sicknesses; hence, ribeirinhos developed skills to monitor how a malaise unfolds in their bodies. Experiential knowledge plays a key role in the early detection of malaria. Individuals who have no previous experience with malaria were found to spend more time seeking health care. Equally important, ribeirinhos perceive that malaria is part of the landscape they inhabit.
- OPEN ACCESS
- OPEN ACCESSIntroduction: Food insecurity at the individual level has been shown to be associated with the adoption of risky behavior and poor healthcare-seeking behavior. However, the impact of household food insecurity (HFI) on the utilization of maternal healthcare services (MHS) remains unexplored. In this study, we aimed to investigate whether or not household food insecurity was associated with non/inadequate utilization of MHS. Methods: Participants consisted of 3562 mothers aged between 15 and 49 years and with at least one child. The outcome variable was the utilization of MHS, e.g., institutional delivery, attendance ante-, and pre-natal visits. The explanatory variables included various sociodemographic factors (e.g., age, residence, education, wealth) apart from HFI. HFI was measured using the Household Food Insecurity Access Scale (HFIAS). Result: The prevalence of non- and under-utilization of MHS was 5.3 and 36.5, respectively. In the multivariate analysis, HFI, wealth index, and educational level were independently associated with MHS status. The odds of non- and under-utilization of MHS were 3.467 (CI = 1.058–11.354) and 4.104 (CI = 1.794–9.388) times higher, respectively, among women from households reporting severe food insecurity. Conclusion: Severe HFI was significantly associated with both under- and non-utilization of MHS. Interventions programs that address HFI and the empowerment of women can potentially contribute to an increased utilization of MHS.
- OPEN ACCESS
- Lesya Marushka,
- Malek Batal,
- Donald Sharp,
- Harold Schwartz,
- Amy Ing,
- Karen Fediuk,
- Andrew Black,
- Constantine Tikhonov, and
- Hing Man Chan
Consumption of fish and n-3 fatty acids (n-3 FAs) has been postulated to prevent type 2 diabetes (T2D). Objective: To explore the association between self-reported T2D and fish consumption, dietary n-3 FAs, and persistent organic pollutants (POP) intake in a regionally representative sample of First Nations (FNs) in Manitoba. Design: Data from the cross-sectional First Nations Food, Nutrition and Environment Study (FNFNES) collected from 706 members of 8 Manitoba FNs in 2010 were used. Household interviews were used to collect social and lifestyle data. The consumption of fish was estimated using a traditional food frequency questionnaire. Fish samples were analyzed for the presence of POP. Multiple logistic regression models adjusted for potential risk factors for T2D were developed. Results: A negative, dose–response relationship was found between fish intake and self-reported T2D. Fish consumptions of 2–3 portions per month and ≥1/week were inversely associated with T2D with odds ratio (OR) values of 0.51 (95% CI: 0.28–0.91) and 0.40 (95% CI: 0.19–0.82), respectively, compared with no fish intake. Similarly, intake of n-3 FAs was negatively associated with T2D (OR = 0.48 (95% CI: 0.30–0.77). Dietary POP intake was not associated with T2D. Conclusion: These findings suggest that the consumption of traditionally harvested fish may have a beneficial effect on T2D in Manitoba FNs. - OPEN ACCESSIntroduction: In Canada, the progestin-only dedicated pill is the most widely used method of emergency contraception (EC). This method gained over-the-counter status in Ontario in 2008. Our mixed methods study explored the progestin-only EC knowledge, attitudes, and provision practices of Ontario pharmacists. Methods: From June 2015 to October 2015, we collected 198 mailed surveys from Ontarian pharmacy representatives and conducted 17 in-depth interviews with a subset of respondents. We analyzed these data using descriptive statistics and for content and themes. Results: Results from our English/French bilingual survey indicate that respondents’ knowledge is generally accurate, but confusion persists about the mechanism of action and the number of times the drug can be used in one menstrual cycle. Nearly half (49%) of our survey respondents indicated that progestin-only EC pills are only available behind the counter. Interviewees strongly supported the introduction and promotion of more effective methods of EC in Ontario. Conclusion: Continuing education focusing on both the regulatory status of progestin-only EC and information about the medication appears warranted. Health Canada’s recent approval of ulipristal acetate for use as a post-coital contraceptive may provide a window of opportunity for engaging with health service providers, including pharmacists, about all available modalities of EC in Canada.
- OPEN ACCESS
- Brett Emo,
- Li-Wen Hu,
- Bo-Yi Yang,
- Kahee A. Mohammed,
- Christian Geneus,
- Michael Vaughn,
- Zhengmin (Min) Qian, and
- Guang-Hui Dong
To assess the effects of housing characteristics and home environmental factors on lung function of Chinese children, 6740 children (aged 6–16 years) were recruited from seven cities in Northeast China in 2012. Performance of lung function was determined by comparison of forced vital capacity (FVC), forced expiratory volume (FEV1), peak expiratory flow (PEF), and maximal mid-expiratory flow (MMEF). Multivariate regression models were used to evaluate the associations with lung function deficit. The results showed that housing conditions were associated with lung function deficit in children. The adjusted odds ratios were 0.47 (95% CI: 0.26–0.83) for FVC for “ping-fang” housing compared with “dan-yuan-lou-fang” housing and 2.90 (95% CI: 2.43–3.47) for FEV1 with home renovations completed within two years compared with counterparts. The linear regression models consistently showed a significant association of housing conditions and home environmental factors with lung function measurements across subjects. A residence taller than seven stories was negatively associated with FEV1 (β = −55; 95% CI: −97 to −13). In conclusion, housing conditions and home environmental factors are particularly important to the development of lung function and respiratory health in children. These factors are concerning and action should be taken to improve them. - OPEN ACCESSBackground: Abortion has been available without criminal restriction in Canada since 1988, and approximately 33 000 terminations take place in Ontario each year. Objectives: This study aimed to explore women’s expressed desire for post-abortion support services, document the priorities expressed by women in seeking post-abortion support, and identify actionable strategies to improve post-abortion support services in Ontario. Methods: Between 2012 and 2014 we conducted in-depth, open-ended interviews with 60 Anglophone women from across Ontario who had recently had an abortion. We aimed to rigorously explore the compounding issues of age and geography on women’s abortion experiences. We analyzed our data for content and themes and reported on the findings related to post-abortion support. Results: One third of our participants expressed a desire for post-abortion support, yet few were able to access a timely, affordable, non-directive service. Women were uncertain about how to find services; most contacted a provider recommended by the clinic or searched online. Women were enthusiastic about a talkline format citing anonymity and convenience as the main advantages. Conclusion: Our results suggest that exploring ways to expand post-abortion support services in Ontario is warranted. A talkline format could provide an anonymous, convenient, non-judgmental, and non-directive way to address this unmet need.
- OPEN ACCESSLittle is known about how the body composition of parents of preschool-aged children is associated with their food parenting practices. In this study, we examined associations between parental body composition and food parenting practices in a sample of Canadian families with preschool-aged children. We conducted a cross-sectional analysis of 68 parents and 52 preschool-aged children. Measures included height, weight, waist circumference (WC), and percentage of fat mass (%FM) measured by BOD POD™. Parents completed an adapted version of the Comprehensive Feeding Practices Questionnaire. To account for correlated observations within families, we used generalized estimating equations with linear regression modelling to examine associations between parent body composition and food parenting practices, with child body mass index (BMI) z-score, child sex, parental sex, and family household income entered as covariates in all models. Parent BMI, WC, and %FM were each significantly and inversely associated with the encouragement of a balanced diet (= −0.021, p = 0.006;
= −0.007, p = 0.038;
= −0.010, p = 0.034, respectively) and child involvement in meal planning and preparation (
= −0.082, p = 0.002;
= −0.025, p = 0.032;
= −0.038, p = 0.049, respectively). We provide preliminary evidence that overweight/obesity may be associated with select food parenting practices in Canadian families with preschool-age children. Parental body composition may be an important consideration in intervention strategies that target food parenting practices.
- OPEN ACCESSYoung mothers constitute a vulnerable population in Canada. Teens with children are at significant risk of subsequent pregnancy, a dynamic that can exacerbate health, emotional, and socio-economic challenges. We aimed to understand better the dynamics shaping “rapid repeat pregnancy” among young mothers in Ottawa, explore young mothers’ subsequent pregnancy experiences, and identify how services could be improved in Canada’s capital. In 2016, we conducted in-depth interviews with 10 young mothers and semi-structured interviews with 10 key informants working with pregnant and parenting youth. We analyzed interviews for content and themes using a multi-phased, iterative process. Four major themes emerged: (1) young mothers often plan their pregnancies actively or passively; (2) violence before, during, and after pregnancy is common; (3) mental health and substance abuse issues shape pregnancy risk; and (4) becoming pregnant often serves as a source of motivation for young mothers. Our results further indicate that young mothers have difficulty finding youth-friendly, non-judgmental support services and that integrated, multidisciplinary services offering individually tailored support and building on women’s strengths will likely be more successful in helping young mothers prevent subsequent pregnancies. Increasing awareness about existing services and supporting efforts that approach teen pregnancy comprehensively and holistically appear warranted.
- OPEN ACCESS
- Claire N. Freeman,
- Lena Scriver,
- Kara D. Neudorf,
- Lisbeth Truelstrup Hansen,
- Rob C. Jamieson, and
- Christopher K. Yost
Wastewater treatment plants (WWTPs) have been identified as hotspots for antimicrobial resistance genes (ARGs) and thus represent a critical point where patterns in ARG abundances can be monitored prior to their release into the environment. The aim of the current study was to measure the impact of the release of the final treated effluent (FE) on the abundance of ARGs in the receiving water of a recently upgraded WWTP in the Canadian prairies. Sample nutrient content (phosphorous and nitrogen species) was measured as a proxy for WWTP functional performance, and quantitative PCR (qPCR) was used to measure the abundance of eight ARGs, the intI1 gene associated with class I integrons, and the 16S rRNA gene. The genes ermB, sul1, intI1, blaCTX-M, qnrS, and tetO all had higher abundances downstream of the WWTP, consistent with the genes with highest abundance in the FE. These findings are consistent with the increasing evidence suggesting that human activity affects the abundances of ARGs in the environment. Although the degree of risk associated with releasing ARGs into the environment is still unclear, understanding the environmental dimension of this threat will help develop informed management policies to reduce the spread of antibiotic resistance and protect public health. - OPEN ACCESSInnovative, highly processed foods are often designed to “substitute” for traditional, less-processed items in the diet. Yet, concerns about the unhealthfulness of diets high in highly processed foods are growing. Their dominance in the diet has been hypothesized to relate, in part, to the strategic use of on-package nutrition promotion. Our goal was to compare front-of-package (FOP) labelling on highly processed products that appear to have been explicitly designed as substitutes for traditional foods with the FOP labelling on their traditional counterparts. FOP references were recorded from packaged foods in three major Toronto grocery stores (N = 20520). Foods were categorized as substitute or traditional counterparts if these had (1) immediate interchangeability within the diet, (2) inherently different formulation, and (3) the substitute was more heavily processed than its traditional counterpart. Eight substitute–traditional pairs were identified, comprising 18% of products in the data set. Substitute foods were more likely than traditional products to bear FOP nutrition, “organic”, and “natural” references. Substitute foods bore 1.21 times more FOP references, the majority of which highlighted nutrients inherent to the traditional counterpart. Our findings support the contention that highly processed foods may be displacing less-processed foods at least in part through the use of strategic on-package marketing.
- OPEN ACCESSThe objective is to support development of a nutritional intervention for Chinese immigrants with diabetes by defining current deficiencies and identifying modifiable factors and mechanisms of change. Semi-structured interviews conducted with 13 ethnic Chinese with type 2 diabetes identified modifiable problems related to culturally relevant diabetes resources and low cultural acceptability of recommended diets. These factors could be addressed through creation of resources developed in partnership with Chinese-speaking health care professionals and persons with diabetes.
- OPEN ACCESSIn 2017, mifepristone and misoprostol became available for early pregnancy termination as the combination pack Mifegymiso® in Ottawa, Ontario, Canada. We conducted 40 semi-structured telephone interviews with Ottawa residents who had abortions before mifepristone’s introduction (n = 20) and after mifepristone–misoprostol became available (n = 20) to explore their experiences obtaining care. We audio-recorded and transcribed all interviews and analyzed these data for content and themes using deductive and inductive techniques. Prior to the introduction of mifepristone, our participants reported obtaining abortion care at two facilities and many faced long wait times. Those who had an abortion after mifepristone became available reported obtaining care from a wider array of providers and few waited more than two weeks. However, several mifepristone–misoprostol users reported having to go through a process that involved as many as 10 health service encounters. Both groups reflected positively on their abortion experiences, but some patients who obtained mifepristone–misoprostol outside of an abortion clinic did not feel as well informed as they would have liked. The introduction of mifepristone appears to have expanded the number of service delivery points and reduced wait times for those seeking abortion care in Ottawa. Identifying ways to expand access to medication abortion information and streamline services appears warranted.
- OPEN ACCESS
- OPEN ACCESS
- Tiff-Annie Kenny,
- Philippe Archambault,
- Pierre Ayotte,
- Malek Batal,
- Hing Man Chan,
- William Cheung,
- Tyler D. Eddy,
- Matthew Little,
- Yoshitaka Ota,
- Claudel Pétrin-Desrosiers,
- Steve Plante,
- Julien Poitras,
- Fernando Polanco,
- Gerald Singh, and
- Mélanie Lemire
Ocean conditions can affect human health in a variety of ways that are often overlooked and unappreciated. Oceans adjacent to Canada are affected by many anthropogenic stressors, with implications for human health and well-being. Climate change further escalates these pressures and can expose coastal populations to unique health hazards and distressing conditions. However, current research efforts, education or training curriculums, and policies in Canada critically lack explicit consideration of these ocean–public health linkages. The objective of this paper is to present multiple disciplinary perspectives from academics and health practitioners to inform the development of future directions for research, capacity development, and policy and practice at the interface of oceans and human health in Canada. We synthesize major ocean and human health linkages in Canada, and identify climate-sensitive drivers of change, drawing attention to unique considerations in Canada. To support effective, sustained, and equitable collaborations at the nexus of oceans and human health, we recommend the need for progress in three critical areas: (i) holistic worldviews and perspectives, (ii) capacity development, and (iii) structural supports. Canada can play a key role in supporting the global community in addressing the health challenges of climate and ocean changes. - OPEN ACCESS
- Carole A. Estabrooks,
- Sharon E. Straus,
- Colleen M. Flood,
- Janice Keefe,
- Pat Armstrong,
- Gail J. Donner,
- Véronique Boscart,
- Francine Ducharme,
- James L. Silvius, and
- Michael C. Wolfson
The Royal Society of Canada Task Force on COVID-19 was formed in April 2020 to provide evidence-informed perspectives on major societal challenges in response to and recovery from COVID-19. The Task Force established a series of working groups to rapidly develop policy briefings, with the objective of supporting policy makers with evidence to inform their decisions. This paper reports the findings of the COVID-19 Long-Term Care (LTC) working group addressing a preferred future for LTC in Canada, with a specific focus on COVID-19 and the LTC workforce. First, the report addresses the research context and policy environment in Canada’s LTC sector before COVID-19 and then summarizes the existing knowledge base for integrated solutions to challenges that exist in the LTC sector. Second, the report outlines vulnerabilities exposed because of COVID-19, including deficiencies in the LTC sector that contributed to the magnitude of the COVID-19 crisis. This section focuses especially on the characteristics of older adults living in nursing homes, their caregivers, and the physical environment of nursing homes as important contributors to the COVID-19 crisis. Finally, the report articulates principles for action and nine recommendations for action to help solve the workforce crisis in nursing homes. - OPEN ACCESSThe COVID-19 pandemic has highlighted the challenges governments face in balancing civil liberties against the exigencies of public health amid the chaos of a public health emergency. Current and emerging pandemic response strategies may engage diverse rights grounded in civil liberties, including mobility rights, freedom of assembly, freedom of religion, and the right to liberty and security of the person. As traditionally conceived, the discourses of civil rights and public health rest on opposite assumptions about the burden of proof. In the discourse of civil and political rights of the sort guaranteed under the Canadian Charter of Rights and Freedoms, the onus rests on government to show that any limitation on rights is justified. By contrast, public health discourse centers on the precautionary principle, which holds that intrusive measures may be taken—lockdowns, for example—even in the absence of complete evidence of the benefits of the intervention or of the nature of the risk. In this article, we argue that the two principles are not so oppositional in practice. In testing for proportionality, courts recognize the need to defer to governments on complex policy matters, especially where the interests of vulnerable populations are at stake. For their part, public health experts have incorporated ideas of proportionality in their evolving understanding of the precautionary principle. Synthesizing these perspectives, we emphasize the importance of policy agility in the COVID-19 response, ensuring that measures taken are continually supported by the best evidence and continually recalibrated to avoid unnecessary interference with civil liberties.
- OPEN ACCESS
- Tania Bubela,
- E. Richard Gold,
- Vivek Goel,
- Max Morgan,
- Karen Mossman,
- Jason Nickerson,
- David Patrick, and
- Aled Edwards
In the event of the current COVID-19 pandemic and in preparation for future pandemics, open science can support mission-oriented research and development, as well as commercialization. Open science shares skills and resources across sectors; avoids duplication and provides the basis for rapid and effective validation due to full transparency. It is a strategy that can adjust quickly to reflect changing incentives and priorities, because it does not rely on any one actor or sector. While eschewing patents, it can ensure high-quality drugs, low pricing, and access through existing regulatory mechanisms. Open science practices and partnerships decrease transaction costs, increase diversity of actors, reduce overall costs, open new, higher-risk/higher-impact approaches to research, and provide entrepreneurs freedom to operate and freedom to innovate. We argue that it is time to re-open science, not only in its now restricted arena of fundamental research, but throughout clinical translation. Our model and attendant recommendations map onto a strategy to accelerate discovery of novel broad-spectrum anti-viral drugs and clinical trials of those drugs, from first-in-human safety-focused trials to late stage trials for efficacy. The goal is to ensure low-cost and rapid access, globally, and to ensure that Canadians do not pay a premium for drugs developed from Canadian science. - OPEN ACCESS
- Gordon J.G. Asmundson,
- Cindy Blackstock,
- Marie Claire Bourque,
- Glenn Brimacombe,
- Allison Crawford,
- S. Hélène Deacon,
- Ken McMullen,
- Patrick J. McGrath,
- Christopher Mushquash,
- Sherry H. Stewart,
- Jennifer Stinson,
- Steven Taylor, and
- Marsha Campbell-Yeo
The COVID-19 pandemic has had a significant impact on the mental health of the people of Canada. Most have found it challenging to cope with social distancing, isolation, anxiety about infection, financial security and the future, and balancing demands of work and home life. For some, especially those who have had to face pre-existing challenges such as structural racism, poverty, and discrimination and those with prior mental health problems, the pandemic has been a major impact.The Policy Briefing Report focuses on the current situation, how the COVID-19 pandemic has exacerbated significant long-standing weaknesses in the mental health system and makes specific recommendations to meet these challenges to improve the well-being of the people of Canada.The COVID-19 pandemic has had a detrimental effect on mental health of people in Canada but the impact has been variable, impacting those facing pre-existing structural inequities hardest. Those living in poverty, and in some socially stratified groups facing greater economic and social disadvantage, such as some racialized and some Indigenous groups and those with preexisting mental health problems, have suffered the most. Some occupational groups have been more exposed to the virus and to psychological stress with the pandemic. The mental health care system was already overextended and under resourced. The pandemic has exacerbated the problems. The care system responded by a massive move to virtual care. The future challenge is for Canada to strengthen our knowledge base in mental health, to learn from the pandemic, and to provide all in Canada the support they need to fully participate in and contribute to Canada’s recovery from the pandemic. - OPEN ACCESSIntroduction: Early childhood overweight and obesity, as a result of unhealthy dietary habits and sedentary life, is a growing global public health concern, particularly in Canada. There are limited data on how socioeconomic factors influence dietary habits of young children living in developed countries. Methods: We conducted a scoping review to examine the existing literature on how socioeconomic settings influence food consumption patterns of children 2–5 years old in developed countries. The inclusion criteria were relevant articles in the English language between 2007 and 2019. Results: From the initial 1854 articles, only 12 articles from Europe, Canada, and the United States met the inclusion criteria. There are differences in eating patterns of preschool-aged children based on parental education, whereas income level did not have a clear influence on dietary patterns. The existing studies suffer from a variety of limitations that limit a cohesive conclusion. Conclusion: Studies with children 2–5 years old are scarce. Parental education seems to influence the dietary habits of young children, whereas the role of income is not clear. There is a need for further high-quality research, preferably longitudinal studies, to inform health promotion initiatives and preventive strategies to facilitate healthy growth and development in young children.
- OPEN ACCESSCOVID-19 presents an opportunity to preserve a rich and diverse historical record—one intended to honour all experiences and voices and in recognition of ongoing systemic inequalities shaping the pandemic. But policy changes are necessary in three key areas: how memory institutions are funded and supported, the gaps in our capacity to preserve the digital records that reflect how we communicate with one another today, and how to preserve and make accessible valuable scholarly research into the societal impact of COVID-19. Our goal is to begin a conversation about priorities for archival preservation, the need for greater equity and justice in our preservation practices, and ways to safeguard the existence of historical records that will allow us in future to bear witness, with fairness and truth and in a spirit of reconciliation, to our society’s response to COVID-19.
- OPEN ACCESSThe influenza pandemic of 1918–1920, which killed 50 000 Canadians, spurred the creation of a federal department of public health. But in the intervening century, public health at all levels has remained, as Marc Lalonde put it in 1988, the “poor cousin” in the health care system (Lalonde 1988, p. 77). Punctuated by sporadic investment during infectious disease crises, such as polio in the early 1950s, public health is less of a priority as the cost of tertiary health interventions rises. While public health potentially involves a broad range of interventions, this paper focuses on the history of public health interventions around infectious disease. COVID-19 has forced us to relearn the importance of maintaining basic infectious/communicable disease control capacity and revealed the cost of our failure to do so. It has also drawn our attention to the intersection between social inequality, racism, and colonialism and vulnerability to disease. In addition to investing in our capacity to contain disease outbreaks as they occur, we must plan now for how to achieve greater health equity in the future by addressing underlying economic and social conditions and providing meaningful access to preventive care for all. This is how we build a truly resilient society. Governments at all levels have recognized the importance of social factors in shaping health and illness for decades. But greater health equity will result only from genuine action on this knowledge. Action will arise from public advocacy in support of prevention, and a new level of engagement and collaboration between affected individuals and communities, public health experts, and governments.
- OPEN ACCESS
- Stefan Baral,
- Andrew Bond,
- Andrew Boozary,
- Eva Bruketa,
- Nika Elmi,
- Deirdre Freiheit,
- S. Monty Ghosh,
- Marie Eve Goyer,
- Aaron M. Orkin,
- Jamie Patel,
- Tim Richter,
- Angela Robertson,
- Christy Sutherland,
- Tomislav Svoboda,
- Jeffrey Turnbull,
- Alexander Wong, and
- Alice Zhu
Those experiencing homelessness in Canada are impacted inequitably by COVID-19 due to their increased exposure, vulnerability of environment and medical comorbidities, and their lack of access to preventive care and treatment in the context of the pandemic. In shelter environments one is unable to effectively physically distance, maintain hygiene, obtain a test, or isolate. As a result, unique strategies are required for this population to protect them and those who serve them. Recommendations are provided to reduce or prevent further negative consequences from the COVID-19 pandemic for people experiencing homelessness. These recommendations were informed by a systematic review of the literature, as well as a jurisdictional scan. Where evidence did not exist, expert consensus from key providers and those experiencing homelessness throughout Canada was included. These recommendations recognize the need for short-term interventions to mitigate the immediate risk to this community, including coordination of response, appropriate precautions and protective equipment, reducing congestion, cohorting, testing, case and contact management strategies, dealing with outbreaks, isolation centres, and immunization. Longer-term recommendations are also provided with a view to ending homelessness by addressing the root causes of homelessness and by the provision of adequate subsidized and supportive housing through a Housing First strategy. It is imperative that meaningful changes take place now in how we serve those experiencing homelessness and how we mitigate specific vulnerabilities. These recommendations call for intersectoral, collaborative engagement to work for solutions targeted towards protecting the most vulnerable within our community through both immediate actions and long-term planning to eliminate homelessness. - OPEN ACCESSSignificant public discourse has focused recently on police–civilian interactions involving with persons with mental illness (PMI). Despite increasing public attention, and growing demands for policy change, little is actually known about the myriad of ways in which Canadian police encounter PMI in the context of routine police work. To assist policymakers in developing evidence-informed policy, this paper attempts to shed light on present difficulties associated with addressing fundamental questions, such as the prevalence of mental health related issues in police calls for service. To do this, we attempt to map the size and scope of police calls for service involving PMI, drawing on both the available scientific data and the limited knowledge to be gleaned from available police reports. Our focus is on two broad categories of police interactions with citizens: public safety concerns (wellness checks, suicide threats, missing persons, mental health apprehensions) and crime prevention and response (encountering PMI as victims–complainants and (or) as potential suspects). We also explore the challenges policy-makers face in relying on police data and the importance of overcoming weaknesses in data collection and sharing in relation to the policing of uniquely vulnerable groups. This paper concludes with some key recommendations for addressing gaps highlighted.
- OPEN ACCESS
- Jennifer Brennan,
- Frank Deer,
- Roopa Desai Trilokekar,
- Leonard Findlay,
- Karen Foster,
- Guy Laforest,
- Leesa Wheelahan, and
- Julia M. Wright
Post-secondary education (PSE) is a vital part of civil society and any modern economy. When broadly accessible, it can enable socioeconomic mobility, improve health outcomes, advance social cohesion, and support a highly skilled workforce. It yields public benefits not only in improved well-being and economic prosperity, but also in reduced costs in health care and social services. Canada also relies heavily on the PSE sector for research. During the COVID-19 pandemic, PSE has supported research related to the pandemic response and other critical areas, including providing expert advice to support public health and government decision-making, while maintaining educational programs and continuing to contribute to local and regional economies. But the pandemic effort has stretched already strained PSE resources and people even further: for decades, declining public investment has driven increases in tuition and decreases in faculty complement, undermining Canada’s research capacity and increasing student debt as well as destabilizing the sector through a growing reliance on volatile international education markets. Given the challenges before us, including climate change, reconciliation, and the pandemic, it is imperative that we better draw on the full range of experience, knowledge, and creativity in Canada and beyond through an inclusive, stable, and globally engaged PSE. Supporting PSE’s recovery will be key to Canada’s ongoing pandemic response and recovery. The recommendations in this report are guided by a single goal—to make the post-secondary sector a more effective partner and support in building a more equitable, sustainable, and evidence-driven future for Canada, through and beyond the COVID-19 pandemic. - OPEN ACCESS
- Victoria Esses,
- Jean McRae,
- Naomi Alboim,
- Natalya Brown,
- Chris Friesen,
- Leah Hamilton,
- Aurélie Lacassagne,
- Audrey Macklin, and
- Margaret Walton-Roberts
Canada has been seen globally as a leader in immigration and integration policies and programs and as an attractive and welcoming country for immigrants, refugees, temporary foreign workers, and international students. The COVID-19 pandemic has revealed some of the strengths of Canada’s immigration system, as well as some of the fault lines that have been developing over the last few years. In this article we provide an overview of Canada’s immigration system prior to the pandemic, discuss the system’s weaknesses and vulnerabilities revealed by the pandemic, and explore a post-COVID-19 immigration vision. Over the next three years, the Government of Canada intends to bring over 1.2 million new permanent residents to Canada. In addition, Canada will continue to accept many international students, refugee claimants, and temporary foreign workers for temporary residence here. The importance of immigration for Canada will continue to grow and be an integral component of the country’s post-COVID-19 recovery. To succeed, it is essential to take stock, to re-evaluate Canada’s immigration and integration policies and programs, and to expand Canada’s global leadership in this area. The authors offer insights and over 80 recommendations to reinvigorate and optimize Canada’s immigration program over the next decade and beyond. - OPEN ACCESS
The need for a federal Basic Income feature within any coherent post-COVID-19 economic recovery plan
COVID-19 has shone a harsh light on the extent of poverty in Canada. When normal economic activity was interrupted by the exigencies of public health driven lockdowns, the shutdown disproportionately affected people who, before the pandemic, were living on incomes beneath the poverty line or dependent upon low-paying hourly remunerated jobs, usually part time and without appropriate benefits. Those living beneath the poverty line in Canada, three million of welfare poor and working poor, include a disproportionately large population of Black and Indigenous people and people of colour. This paper addresses the challenge of inclusive economic recovery. In particular, we propose that the federal government introduce a Basic Income guarantee for all residents of Canada as part of a comprehensive social safety net that includes access to housing, child care, mental and physical health care, disability supports, education, and the many other public services essential to life in a high-income country. Residents with no other income would receive the full benefit that would be sufficient to ensure that no one lives in poverty, while those with low incomes would receive a reduced amount. - OPEN ACCESSContact tracing has played a central role in COVID-19 control in many jurisdictions and is often used in conjunction with other measures such as travel restrictions and social distancing mandates. Contact tracing is made ineffective, however, by delays in testing, calling, and isolating. Even if delays are minimized, contact tracing triggered by testing of symptomatic individuals can only prevent a fraction of onward transmissions from contacts. Without other measures in place, contact tracing alone is insufficient to prevent exponential growth in the number of cases in a population with little immunity. Even when used effectively with other measures, occasional bursts in call loads can overwhelm contact tracing systems and lead to a loss of control. We propose embracing approaches to COVID-19 contact tracing that broadly test individuals without symptoms, in whatever way is economically feasible—either with fast and cheap tests that can be deployed widely, with pooled testing, or with screening of judiciously chosen groups of high-risk individuals. These considerations are important both in regions where widespread vaccination has been deployed and in those where few residents have been immunized.
- OPEN ACCESSThis paper summarizes COVID-19 disease epidemiology in Canada in the pre-vaccine era—from January through to December 2020. Canadian case numbers, risk factors, disease presentations (including severe and critical disease), and outcomes are described. Differences between provinces and territories in geography, population size and density, health demographics, and pandemic impact are highlighted. Key concepts in public health response and mitigation are reviewed, including masking, physical distancing, hand washing, and the promotion of outdoor interactions. Adequate investment in public health infrastructure is stressed, and regional differences in screening and testing strategies are highlighted. The spread of COVID-19 in Canadian workplaces, long-term care homes, and schools is described and lessons learned emphasized. The impact of COVID-19 on vulnerable populations in Canada—including Indigenous Peoples, ethnic minorities and newcomers, people who use drugs, people who are homeless, people who are incarcerated, and people with disabilities—is described. Sex and gender disparities are also highlighted. Author recommendations include strategies to reduce transmission (such as test–trace–isolate), the establishment of nationally standardized definitions and public reporting, the protection of high risk and vulnerable populations, and the development of a national strategy on vaccine allocation.
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- Noni E. MacDonald,
- Jeannette Comeau,
- Ève Dubé,
- Janice Graham,
- Margo Greenwood,
- Shawn Harmon,
- Janet McElhaney,
- C. Meghan McMurtry,
- Alan Middleton,
- Audrey Steenbeek, and
- Anna Taddio
COVID-19 vaccine acceptance exists on a continuum from a minority who strongly oppose vaccination, to the “moveable middle” heterogeneous group with varying uncertainty levels about acceptance or hesitancy, to the majority who state willingness to be vaccinated. Intention for vaccine acceptance varies over time. COVID-19 vaccination decisions are influenced by many factors including knowledge, attitudes, and beliefs; social networks; communication environment; COVID-19 community rate; cultural and religious influences; ease of access; and the organization of health and community services and policies.Reflecting vaccine acceptance complexity, the Royal Society of Canada Working Group on COVID-19 Vaccine Acceptance developed a framework with four major factor domains that influence vaccine acceptance (people, communities, health care workers; immunization knowledge; health care and public health systems including federal/provincial/territorial/indigenous factors)—each influencing the others and all influenced by education, infection control, extent of collaborations, and communications about COVID-19 immunization. The Working Group then developed 37 interrelated recommendations to support COVID vaccine acceptance nested under four categories of responsibility: 1. People and Communities, 2. Health Care Workers, 3. Health Care System and Local Public Health Units, and 4. Federal/Provincial/Territorial/Indigenous. To optimize outcomes, all must be engaged to ensure co-development and broad ownership. - OPEN ACCESS
- Annette Majnemer,
- Patrick J. McGrath,
- Jennifer Baumbusch,
- Chantal Camden,
- Barbara Fallon,
- Yona Lunsky,
- Steven P. Miller,
- Genevieve Sansone,
- Tim Stainton,
- John Sumarah,
- Donna Thomson, and
- Jennifer Zwicker
The COVID-19 pandemic has impacted the lives and well-being of all people globally, with consequences being observed across all domains from physical and mental health, to education and employment outcomes, to access to community supports and services. However, the disproportionate impact of the COVID-19 pandemic and its associated public health restrictions on individuals with intellectual and developmental disabilities (IDD) has largely been overlooked. Not only do people with IDD have a greater risk of severe complications and death from the virus as shown in large-scale studies, but they also face significant short- and long-term consequences of COVID-related public health measures on their mental health and well-being. At a time when this vulnerable population is already feeling undervalued, ignored, and forgotten, it is imperative that the risks facing adults and children with IDD—as well as their families and caregivers—are recognized, valued, and addressed through a disability-inclusive approach to Canada’s pandemic policy response planning. This requires both a mainstreaming of disability inclusion into all COVID-19 response and recovery policies as well as disability-specific policies to address the unique barriers and challenges encountered by people with IDD during the pandemic. The recommendations in this policy briefing aim to achieve a more inclusive, accessible, and sustainable Canada for people with IDD both during and after the pandemic—an approach that will result in benefits for all of society. - OPEN ACCESSThe origins of this report, and of the Mental Health and Policing Working Group, can be traced to the unique situation Canadians have faced as a result of the COVID-19 pandemic. The unique circumstances of this global outbreak, which have for many Canadians resulted in serious illness and death, intensified economic uncertainties, altered family and lifestyle dynamics, and generated or exacerbated feelings of loneliness and social dislocation, rightly led the Royal Society of Canada’s COVID-19 Taskforce to consider the strains and other negative impacts on individual, group, and community mental health. With the central role that police too often play in the lives of individuals in mental and (or) emotional crisis, we were tasked with exploring what can be reasonably said about the state of our current knowledge of police responses to persons with mental illness.
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- Mylène Ratelle,
- Andrew Spring,
- Brian Douglas Laird,
- Leon Andrew,
- Deborah Simmons,
- Alexa Scully, and
- Kelly Skinner
Resource development and climate change are increasing concerns regarding safe water for Indigenous people in Canada. A research study was completed to characterize the consumption of water and beverages prepared with water and identify the perception of water consumption in Indigenous communities from the Northwest Territories and Yukon, Canada. As part of a larger research program, data for this study were available from a 24-hour recall dietary survey (n = 162), a health messages survey (n = 150), and an exposure factor survey (n = 63). A focus group was conducted with Elders in an on-the-land camp setting. The consumption of water-based beverages in winter was 0.9 L/day on average, mainly consisting of tea and coffee. Of the 81% of respondents who reported consuming water-based beverages in the previous 24 hours of the survey, 33% drank more bottled water than tap water. About 2% of respondents consumed water from the land (during the winter season). Chlorine smell was the main limiting factor reported to the consumption of tap water. Results from the focus group indicated that Indigenous knowledge might impact both the perception and consumption of water. These findings aim to support public health efforts to enable people to make water their drink of choice. - OPEN ACCESS
- Andrea C. Tricco,
- Wasifa Zarin,
- Fiona Clement,
- Ahmed M. Abou-Setta,
- Janet A. Curran,
- Annie LeBlanc,
- Linda C Li,
- Christina Godfrey,
- Pertice Moffitt,
- David Moher,
- Heather Colquhoun,
- Ian D. Graham,
- Ivan D. Florez,
- Linda Wilhelm,
- Wanrudee Isaranuwatchaia,
- Jackie Mann,
- Marina Hamilton,
- Vasanthi Srinivasan,
- Stephen Bornstein, and
- Sharon E. Straus
This is the introductory paper in a collection of four papers on the Strategy for Patient-Oriented Research (SPOR) Evidence Alliance, a pan-Canadian research initiative that was funded by the Canadian Institutes of Health Research in September of 2017. Here, we introduce the SPOR enterprise in Canada, provide a rationale for the creation of the SPOR Evidence Alliance, provide information on the mandate and approach, and describe how the SPOR Evidence Alliance adds to the health research ecosystem in Canada and beyond. - OPEN ACCESS
- Shelby Fenton,
- Emma K Quinn,
- Ela Rydz,
- Emily Heer,
- Hugh W Davies,
- Robert A Macpherson,
- Christopher B McLeod,
- Mieke W Koehoorn, and
- Cheryl E Peters
A media surveillance analysis was conducted to identify COVID-19 workplace outbreaks and associated transmission risk for new and emerging occupations. We identified 1,111 unique COVID-19 workplace outbreaks using the Factiva database. Occupations identified in the media articles were coded to the 2016 National Occupational Classification (V1.3) and were compared and contrasted with the same occupation in the Vancouver School of Economics (VSE) COVID Risk/Reward Assessment Tool by risk rating. After nurse aides, orderlies, and patient service associates (n = 109, very high risk), industrial butchers and meat cutters, and poultry preparers and related workers had the most workplace outbreaks reported in the media (n = 79) but were rated as medium risk for COVID-19 transmission in the VSE COVID Risk Tool. Outbreaks were also reported among material handlers (n = 61) and general farm workers (n = 28), but these occupations were rated medium–low risk and low risk, respectively. Food and beverage services (n = 72) and cashiers (n = 60) were identified as high-risk occupations in the VSE COVID Risk Tool. Differences between the media results and the risk tool point to key determinants of health that compound the risk of COVID-19 exposure in the workplace for some occupations and highlight the importance of collecting occupation data during a pandemic. - OPEN ACCESS
- Samira Mubareka,
- John Amuasi,
- Arinjay Banerjee,
- Hélène Carabin,
- Joe Copper Jack,
- Claire Jardine,
- Bogdan Jaroszewicz,
- Greg Keefe,
- Jonathon Kotwa,
- Susan Kutz,
- Deborah McGregor,
- Anne Mease,
- Lily Nicholson,
- Katarzyna Nowak,
- Brad Pickering,
- Maureen G. Reed,
- Johanne Saint-Charles,
- Katarzyna Simonienko,
- Trevor Smith,
- J. Scott Weese, and
- E. Jane Parmley
Given the enormous global impact of the COVID-19 pandemic, outbreaks of highly pathogenic avian influenza in Canada, and manifold other zoonotic pathogen activity, there is a pressing need for a deeper understanding of the human-animal-environment interface and the intersecting biological, ecological, and societal factors contributing to the emergence, spread, and impact of zoonotic diseases. We aim to apply a One Health approach to pressing issues related to emerging zoonoses, and propose a functional framework of interconnected but distinct groups of recommendations around strategy and governance, technical leadership (operations), equity, education and research for a One Health approach and Action Plan for Canada. Change is desperately needed, beginning by reorienting our approach to health and recalibrating our perspectives to restore balance with the natural world in a rapid and sustainable fashion. In Canada, a major paradigm shift in how we think about health is required. All of society must recognize the intrinsic value of all living species and the importance of the health of humans, other animals, and ecosystems to health for all. - OPEN ACCESS
- Gail Tomblin Murphy,
- Tara Sampalli,
- Lisa Bourque Bearskin,
- Nancy Cashen,
- Greta Cummings,
- Annette Elliott Rose,
- Josephine Etowa,
- Doris Grinspun,
- Esyllt W. Jones,
- Mélanie Lavoie-Tremblay,
- Kathleen MacMillan,
- Cindy MacQuarrie,
- Ruth Martin-Misener,
- Judith Oulton,
- Rosemary Ricciardelli,
- Linda Silas,
- Sally Thorne, and
- Michael Villeneuve
Nurses represent the highest proportion of healthcare workers globally and have played a vital role during the COVID-19 pandemic. The pandemic has shed light on multiple vulnerabilities that have impacted the nursing workforce including critical levels of staffing shortages in Canada. A review sponsored by the Royal Society of Canada investigated the impact of the pandemic on the nursing workforce in Canada to inform planning and implementation of sustainable nursing workforce strategies. The review methods included a trend analysis of peer-reviewed articles, a jurisdictional scan of policies and strategies, analyses of published surveys and interviews of nurses in Canada, and a targeted case study from Nova Scotia and Saskatchewan. Findings from the review have identified longstanding and COVID-specific impacts, gaps, and opportunities to strengthen the nursing workforce. These findings were integrated with expert perspectives from national nursing leaders involved in guiding the review to arrive at recommendations and actions that are presented in this policy brief. The findings and recommendations from this policy brief are meant to inform a national and sustained focus on retention and recruitment efforts in Canada. - OPEN ACCESS
- R.T. Noel Gibney,
- Cynthia Blackman,
- Melanie Gauthier,
- Eddy Fan,
- Robert Fowler,
- Curtis Johnston,
- R. Jeremy Katulka,
- Samuel Marcushamer,
- Kusum Menon,
- Tracey Miller,
- Bojan Paunovic, and
- Teddie Tanguay
The COVID-19 pandemic has exposed the precarious demand-capacity balance in Canadian hospitals, including critical care where there is an urgent need for trained health care professionals to dramatically increase ICU capacity.The impact of the pandemic on ICUs varied significantly across the country with provinces that implemented public health measures later and relaxed them sooner being impacted more severely. Pediatric ICUs routinely admitted adult patients. Non-ICU areas were converted to ICUs and staff were redeployed from other essential service areas. Faced with a lack of critical care capacity, triage plans for ICU admission were developed and nearly implemented in some provinces.Twenty eight percent of patients in Canadian ICUs who required mechanical ventilation died. Surviving patients have required prolonged ICU admission, hospitalization and extensive ongoing rehabilitation. Family members of patients were not permitted to visit, resulting in additional psychological stresses to patients, families, and healthcare teams. ICU professionals also experienced extreme psychological stresses from caring for such large numbers of critically ill patients, often in sub-standard conditions. This resulted in large numbers of health workers leaving their professions.This pandemic is not yet over, and it is likely that new pandemics will follow. A review and recommendations for the future are provided. - OPEN ACCESS
- Eric Kai-Chung Wong,
- Jennifer Watt,
- Hanyan Zou,
- Arthana Chandraraj,
- Alissa Wenyue Zhang,
- Jahnel Brookes,
- Ashley Verduyn,
- Anna Berall,
- Richard Norman,
- Katrina Lynn Piggott,
- Terumi Izukawa,
- Sharon E. Straus, and
- Barbara Arlena Liu
Atypical disease presentations are common in older adults with COVID-19. The objective of this study was to determine the prevalence of atypical and typical symptoms in older adults with COVID-19 through progressive pandemic waves and the association of these symptoms with in-hospital mortality. This retrospective cohort study included consecutive adults aged over 65 years with confirmed COVID-19 infection who were admitted to seven hospitals in Toronto, Canada, from 1 March 2020 to 30 June 2021. The median age for the 1786 patients was 78.0 years and 847 (47.5%) were female. Atypical symptoms (as defined by geriatric syndromes) occurred in 1187 patients (66.5%), but rarely occurred in the absence of other symptoms (n = 106; 6.2%). The most common atypical symptoms were anorexia (n = 598; 33.5%), weakness (n = 519; 23.9%), and delirium (n = 449; 25.1%). Dyspnea (adjusted odds ratio [aOR] 2.05; 95% confidence interval [CI] 1.62–2.62), tachycardia (aOR 1.87; 95% CI 1.14–3.04), and delirium (aOR 1.52; 95% CI 1.18–1.96) were independently associated with in-hospital mortality. In a cohort of older adults hospitalized with COVID-19 infection, atypical presentations frequently overlapped with typical symptoms. Further research should be directed at understanding the cause and clinical significance of atypical presentations in older adults. - OPEN ACCESSSince the initial outbreak in December 2019, the COVID-19 pandemic has resulted in more than four million deaths worldwide. Ecuador initially experienced one of the worst coronavirus outbreaks in the world. The pandemic quickly overwhelmed health care systems resulting in excess deaths of 37 000 from March to October, 2020. The public health measures taken to stop the spread of the virus had a devastating impact on the economy. There was a sharp contraction (7.8%) in Ecuador’s GDP in 2020. Furthermore, income poverty and inequality increased dramatically. The lasting effects of the pandemic will be harder to overcome. This article recounts and analyzes the COVID-19 pandemic in Ecuador, to draw lessons from this complex experience, and from the benefit of limited but important successes. We also aim to provide suggestions for best practices moving forward.
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- Michèle Hamers,
- Angie Elwin,
- Rosemary-Claire Collard,
- Chris R. Shepherd,
- Emma Coulthard,
- John Norrey,
- David Megson, and
- Neil D'Cruze
In Canada, there have been calls for increased research into and surveillance of wildlife trade and associated zoonotic disease risks. We provide the first comprehensive analysis of Canadian live wildlife imports over a 7-year period (2014–2020), based on data from federal government databases obtained via Access to Information requests. A total of 1 820 313 individual animals (including wild-caught and captive-bred animals but excluding fish, invertebrates, Columbiformes (pigeons), and Galliformes (game birds)), from 1028 documented import records, were imported into Canada during 2014–2020. Birds were the most imported taxonomic class (51%), followed by reptiles (28%), amphibians (19%), and mammals (2%). In total, 22 taxonomic orders from 79 countries were recorded as imported. Approximately half of the animals (49%) were imported for the exotic pet market. Based on existing literature and a review of the Canadian regulatory apparatus, we gesture to these importations' potential implications for zoonotic disease risk and discuss potential biosecurity challenges at the Canadian border. Finally, we identify data gaps that prevent an extensive assessment of the zoonotic disease risk of live wildlife imports. We recommend data collection for all wildlife importation and improved coordination between agencies to accurately assess zoonotic disease risk. - OPEN ACCESS
- Vanessa Gruben,
- Elaine Hyshka,
- Matthew Bonn,
- Chelsea Cox,
- Marilou Gagnon,
- Adrian Guta,
- Martha Jackman,
- Jason Mercredi,
- Akia Munga,
- Eugene Oscapella,
- Carol Strike, and
- Hakique Virani
The International Guidelines on Human Rights and Drug Policy recommend that states commit to adopting a balanced, integrated, and human rights-based approach to drug policy through a set of foundational human rights principles, obligations arising from human rights standards, and obligations arising from the human rights of particular groups. In respect of the Guidelines and standing obligations under UN Treaties, Canada must adopt stronger and more specific commitments for a human rights-based, people-centered, and public health approach. This approach must commit to the decriminalization of people who use drugs and include the decriminalization of possession, purchase, and cultivation for personal consumption. In this report, we will first turn to the legal background of Canada's drug laws. Next, we will provide an overview of ongoing law reform proposals from civil society groups, various levels of government, the House of Commons, and the Senate. We end with a three-staged approach to reform and a series of targeted recommendationscr. - OPEN ACCESS
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- Steve E. Hrudey,
- Heather N. Bischel,
- Jeff Charrois,
- Alex H. S. Chik,
- Bernadette Conant,
- Rob Delatolla,
- Sarah Dorner,
- Tyson E. Graber,
- Casey Hubert,
- Judy Isaac-Renton,
- Wendy Pons,
- Hannah Safford,
- Mark Servos, and
- Christopher Sikora
Wastewater surveillance for SARS-CoV-2 RNA is a relatively recent adaptation of long-standing wastewater surveillance for infectious and other harmful agents. Individuals infected with COVID-19 were found to shed SARS-CoV-2 in their faeces. Researchers around the world confirmed that SARS-CoV-2 RNA fragments could be detected and quantified in community wastewater. Canadian academic researchers, largely as volunteer initiatives, reported proof-of-concept by April 2020. National collaboration was initially facilitated by the Canadian Water Network.Many public health officials were initially skeptical about actionable information being provided by wastewater surveillance even though experience has shown that public health surveillance for a pandemic has no single, perfect approach. Rather, different approaches provide different insights, each with its own strengths and limitations. Public health science must triangulate among different forms of evidence to maximize understanding of what is happening or may be expected. Well-conceived, resourced, and implemented wastewater-based platforms can provide a cost-effective approach to support other conventional lines of evidence. Sustaining wastewater monitoring platforms for future surveillance of other disease targets and health states is a challenge. Canada can benefit from taking lessons learned from the COVID-19 pandemic to develop forward-looking interpretive frameworks and capacity to implement, adapt, and expand such public health surveillance capabilities. - OPEN ACCESS
- Linda Rabeneck,
- Chris McCabe,
- Mark Dobrow,
- Arlinda Ruco,
- Melissa Andrew,
- Sabrina Wong,
- Sharon Straus,
- Lawrence Paszat,
- Lisa Richardson,
- Chris Simpson, and
- Andrew Boozary
The purpose of this policy briefing is to examine our health care systems through the lens of the COVID-19 pandemic and identify how we can strengthen health care in Canada post-pandemic. The COVID-19 pandemic has provided compelling evidence that substantive changes to our health care systems are needed. Specifically, the pandemic has emphasized structural inequities on a broad scale within Canadian society. These include systemic racial and socioeconomic inequities that must be addressed broadly, including in the delivery of health care. We make recommendations about what we can do to emerge stronger from the pandemic. While these recommendations are not novel, how they are framed and contextualized differs because of the problems in our health care system that have been highlighted and exacerbated by the pandemic.The evidence is clear that socioeconomic circumstances, intergenerational trauma, adverse early life experiences, and educational opportunities are critical factors when it comes to health over the life course. Given the problems in the delivery of health care that the pandemic has revealed, we need a different approach. How health care was organized prior to the COVID-19 pandemic did not produce what people wanted and needed in terms of health care and outcomes. How do we emerge from COVID-19 with an effective, equitable, and resilient health care system for all Canadians?To address health inequities and emerge from the pandemic with strengthened health care in Canada, we must consider how Amartya Sen's capabilities framework on social well-being can be operationalized to achieve better health care and health outcomes. Specifically, we address the need to: strengthen primary care and improve access to primary care;utilize a community-embedded approach to care; andimplement better integration across the care continuum, including integration between primary care and public health.Coherent governance and leadership that are charged with realizing benefits through collaboration will maximize outcomes and promote sustainability. Only when we provide access to high-quality culturally competent care that is centered around the individual and their needs will we be able to make true headway in addressing these long-standing health inequities. - OPEN ACCESS
- James Conklin,
- Maryam Mohammadi Dehcheshmeh,
- Douglas Archibald,
- Jacobi Elliott,
- Amy Hsu,
- Anita Kothari,
- Paul Stolee, and
- Heidi Sveistrup
Long-term care (LTC) residents have an increased risk of social isolation and loneliness, and these risks were exacerbated by pandemic policies that restricted visitors. The designated care partner (DCP) program was introduced in some LTC homes to allow designated family members to safely enter the homes and provide support for residents. We undertook a developmental evaluation (DE) to support the development and implementation of the DCP program in three Ontario LTC homes during the COVID-19 pandemic. Data were collected from 65 staff and DCPs through seven iterations of a DE process. Analysis used directed and inductive coding and theming procedures to create a description of the DCP experience. Themes illustrated the barriers and facilitators to the DCP program and revealed a pervasive deficit of care due to inadequate funding, staff shortages, and an acrimonious relationship between staff and family members. Our project demonstrated a need for additional resources and stronger partnerships between staff and family caregivers. - OPEN ACCESS
- Tannia Valeria Carpio Arias,
- Marta Guijarro-Garvi,
- Yadira Alejandra Morejón-Terán, and
- María Teresa Ruíz-Cantero
The COVID-19 pandemic has amplified concerns about food insecurity, prompting its investigation. An online pilot survey anonymously gathered responses from a non-probabilistic sample of 2058 Ecuadorian women. The Food and Agriculture Organization's Food Insecurity Experience Scale was used to measure moderate or severe food insecurity (MSFI). Data quality was assessed using the Rasch item response theory model; this is a single-parameter logistic model that considers food insecurity severity as a latent trait. The analysis produced MSFI prevalence rates with 90% confidence level margins of error (90%MoE). The highest MSFI was found in women: lacking resources for personal expenses (29.53%, 90%MoE = 3.21) compared to those who had them (12.47, 90%MoE = 1.40); who live in the Amazon region (21.37, 90%MoE = 4.24) versus those living in Highlands (17.66%, 90%MoE = 1.77) or in Coast (13.44%, 90%MoE = 2.40); with three or more children (20.97%, 90%MoE = 4.71) against those without children (12.63%, 90%MoE = 3.57); who experienced income reduction during confinement (18.31%, 90%MoE = 2) compared to those who did not (15.71%, 90%MoE = 1.85); and who are rural (18.13%, 90%MoE = 2.83) versus urban residents (16.63%, 90%MoE = 1.55). This study highlights that the most vulnerable Ecuadorian women experienced the highest food insecurity levels during lockdown, emphasizing the need to consider the intersection between income and sociodemographic factors and their impact on women's food insecurity in future research and policymaking. - OPEN ACCESSCOVID-19 was a stark reminder that understanding a novel pathogen is essential but insufficient to protect us from disease. Biomedical and technical solutions are necessary, but they do not prevent or resolve misinformation, vaccine hesitancy, or resistance to public health measures, nor are they sufficient to advance the development of more equitable and effective healthcare systems. Responding to crises such as pandemics requires deep collaboration drawing on multiple methodologies and perspectives. Along with the science, it is imperative to understand cultures, values, languages, histories, and other determinants of human behaviour. This policy briefing argues that the humanities—a group of methodologically diverse fields, including interdisciplinary studies that overlap significantly with the social determinants of health—are an underused source of cultural and social insight that is increasingly important and could be better leveraged in such collaboration. Humanities disciplines approach health and illness as part of the human condition. Their historical perspective could be more effectively mobilized to explore the social and cultural context in which science exists and evolves, in turn, helping us understand the forces shaping perceptions, concerns, and assumptions.
- OPEN ACCESSThe COVID-19 pandemic highlighted the importance of gathering restrictions in slowing the spread of communicable disease. Many restrictions on activities were applied without identifying how effective the restrictions might be in curtailing disease spread. We present a model that estimates the probability of contacting an infected individual as a function of prevalence and self-reported or hypothesized activities. The model incorporates an age adjustment factor to account for differences between the age demographics of infected versus activity participants. The age adjustment factor was important to include when the difference in prevalence between age groups was sufficiently large, and prevalence and activity group sizes were moderate. We applied our contact probability model to two scenarios to demonstrate how the model may inform the development of public health measures. Our model presents a method for estimating contact probability that could be adopted by jurisdictions considering facility closures or group size limits, or for individuals evaluating their own behaviours in future outbreaks or pandemics.
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- Etienne Quillet,
- Isabelle Vandeplas,
- Katim Touré,
- Safiétou Sanfo,
- Fatoumata Lamarana Baldé, and
- Liette Vasseur
Transboundary rural communities in West Africa play an important role in the exchange of goods, mainly food, among countries. The COVID-19 pandemic restricted these activities due to the closure of the borders. Semi-structured interviews were conducted in two regions of Senegal and Burkina Faso to examine the impacts of these restrictions on the pillars (availability, access, utilization, and stability) of food security in rural areas on men and women. The data set included 230 interviews, and they were analyzed through thematic content analysis. The results showed a decrease in agricultural production in all the communities due to mainly lack of labor force, and limited access to inputs, resulting in increased post-harvest losses. The disruption of trade and border and market closures affected rural families engaged in transboundary trade. Farmers experienced a sharp loss of household income leading to debts and decapitalization. Availability and diversity of and access to food was also heavily affected. Food security greatly varied among the communities and between countries. Perceptions also varied between men and women in terms of production, mobility, and food consumption. The restriction measures have triggered a spiral of effects and responses seriously impacting long-term food security in already highly vulnerable countries. - OPEN ACCESS
- Changxi Chen,
- Sha Si,
- Juan Du, and
- Hongliang Li
To investigate the epidemiological connection between nonalcoholic fatty liver disease (NAFLD) and Helicobacter pylori (H. pylori). 6,478 retired and active workers, aged 22-69 years, were included in the study. Their baseline measures of height, weight, waist measurement, body mass index, blood pressure, fasting blood sugar, plasma lipid, liver function index, glycosylated hemoglobin, abdominal ultrasonography, and findings from the line “13 C urea breath test” H. pylori test were analyzed, and follow-up with consistent baseline methods and criteria was performed annually. Over a 4-year period, the prevalence of NAFLD increased by 16.9%, with 612 (18.7%) of those who tested positive for H. pylori developing NAFLD, whereas 484 (15.1%) of those who did not test positive for H. pylori were later diagnosed with new NAFLD (χ2 = 14.862, P < 0.05). One of the risk factors identified in the univariable Cox regression model for NAFLD was H. pylori (Hazard Ratio = 1.297; 95.0% confidence interval (CI) 1.150,1.485, P < 0.000); however, H. pylori continued to be an independent factor affecting the risk of NAFLD even after accounting for gender, age, and aspects of the metabolic syndrome (Hazard Ratio = 1.240; 95.0% CI 1.077,1.429, P = 0.003). The growth of NAFLD may be correlated with H. pylori infection. - OPEN ACCESS
- Marie-Eve Desrosiers,
- Lynne Moore,
- David Nguyen-Tri,
- Aubin Armand Keundo,
- Denis Boutin, and
- Caroline Ouellet
Several studies have described interhospital transfer coordination structures in the US but there is a lack of data on Canadian coordination systems. We aimed to develop an inventory of existing interhospital coordinating structures across Canada and to detail how they operate in terms of governance, re-sources, tools, and processes. A cross-sectional survey was designed and ten managers/medical officials from seven coordination structures of interhospital transfers across Canada completed the survey. Findings indicate that coordination systems had similar communication modalities and covered similar services including the provision of medical advice. However, they differed in terms of the profile of staff processing transfers and transportation coordination. Mature structures such as Ontario and Alberta, who manage high annual volumes, distinguish themselves with very clear, standardized, and efficient processes, as well as implemented quality and performance improvement methods including key performance indicators. These results suggest that Canada may benefit from having an inter-provincial community of practice for interhospital transfer coordination structures to promote best practices, identify solutions, and harmonize services and processes. Better harmonization in transfer coordination would improve equity in the access to healthcare services. Future research should focus on the elaboration of evidence-and consensus-based guidelines that apply to the Canadian context. - OPEN ACCESSFarmers globally face significant occupational stressors and are reported to experience high levels of depression, anxiety, burnout, suicide ideation, and suicide. While the impacts of high stress and poor mental health have been well-studied in the general population, and to some extent, in specific occupations, the impacts on farmers are understudied. The objective here was to explore the lived experience of high stress and (or) poor mental health in Canadian farmers, including the perceived impacts. Using a phenomenological approach within a constructivist paradigm, we conducted 75 one-on-one research interviews with farmers and people who work closely with farmers, in Ontario, Canada, between July 2017 and May 2018. We analysed the data via thematic analyses and identified four major themes. Participants described myriad negative impacts of farmers’ high stress and (or) poor mental health: (1) personally, (2) interpersonally, and (3) cognitively, which ultimately negatively impacted them (4) professionally, including consequences for productivity, animals, and farm success. The data described far-reaching, interconnected impacts of high stress and poor mental health on participants, the people and animals in their lives, and most aspects of their farming operations, financial viability, and success. Farmer stress, mental health, and well-being are important considerations in promoting sustainable, successful agriculture.
- OPEN ACCESS
- Ana Deaconu,
- Malek Batal,
- Claudia Irene Calderón,
- Patrick Caron,
- Jessica McNally,
- Emile Frison,
- Geneviève Mercille,
- Mylène Riva, and
- Ben Brisbois
The international collaboration network Food Systems Innovation to Nurture Equity and Resilience Globally (Food SINERGY) unites food system experts concerned with the confluence of environmental, geopolitical, economic, and public health stressors that weaken food systems and increase inequalities. In March 2023, Food SINERGY participants from universities, research institutes, food policy advocacy groups, Indigenous networks, farmers’ associations, consumer organizations, social enterprises, and non-governmental organizations from around the world met in Mont Orford, Québec, for a forum to revisit food system structures across local-to-global scales and to identify key junctures for transformation. This article summarizes the network's discussions in the context of the existing literature. Key knowledge contributions include the importance of diversification throughout the food system for cultivating resilience; the value of food sovereignty in promoting equity across scales; the reconciliation between food sovereignty and equitable trade; the need for consonance between policy environments at different scales to enable positive societal actions; the pioneering role of food system innovations that challenge conventional political and economic structures, with emphasis on agroecology; and the need for critical self-reflection around knowledge production and knowledge use to better serve equitable food systems. These discussion outcomes provide insights for actors seeking to transform food systems in support of equity and resilience. - OPEN ACCESS
- M. Brock Fenton,
- Paul A. Faure,
- Enrico Bernard,
- Daniel J. Becker,
- Alan C. Jackson,
- Tigga Kingston,
- Peter H.C. Lina,
- Wanda Markotter,
- Susan M. Moore,
- Samira Mubareka,
- Paul A. Racey,
- Charles E. Rupprecht, and
- Lisa Worledge
Globally, bats provide critical ecosystem services. Rabies, caused by rabies virus and related lyssaviruses, is one of the most significant zoonoses associated with bats. Bat biologists study bats in the laboratory and the field. To minimize the risk of disease, all bat handlers should be vaccinated against rabies and undergo routine serological testing to measure their rabies virus neutralizing antibody levels. They should use best practices to avoid exposures, such as personal protective equipment, especially gloves appropriate to the size of the bat(s) being handled. Attention to such details will prevent unnecessary exposures and avoid some of the accompanying negative perceptions that endanger bats on a global level. The small body sizes of many bats (<50 g, many <20 g) and small teeth makes their defensive bites easy to overlook. Breaks in the skin, however small, may result in exposure to lyssaviruses in the animals’ saliva. Exposure to blood-feeding bats is less common because these species are geographically restricted to the Neotropics and are the only species whose natural feeding behavior could involve transmission of rabies virus. Understanding viral transmission, preventing exposures, and responding appropriately to bites will minimize the consequences of this deadly zoonosis. - OPEN ACCESS
- Katherine Chong,
- Madisan Chavez,
- Ave Dersch,
- John Doyle,
- Margaret Eggers,
- JoRee LaFrance,
- Myra J Lefthand,
- Findlay MacDermid,
- Claire McAuley,
- Vanessa Simonds,
- Sara L Young, and
- Niladri Basu
Indigenous peoples in North America are disproportionately exposed to environmental contaminants and may face elevated health risks related to unique socio-cultural ties to the land. Conventional human health risk assessment (HHRA) methods do not account for these unique contexts. Regulators (i.e., Health Canada, US EPA) have called for the development of more ethical and efficient HHRA approaches, but to our knowledge no such approaches have been designed in consideration of Indigenous community contexts. RISK21 is a new HHRA approach gaining regulatory attention. We present two case studies piloting RISK21’s use in collaboration with three unique communities (Cold Lake First Nations, Chipewyan Prairie First Nation, Apsáalooke/Crow Nation). Our objectives are first, reflect upon the benefits and challenges of using RISK21 in these contexts; second, compare RISK21-based to conventional assessments; and third, ideate adaptations and improvements to the approach. The RISK21-based analyses had similar descriptive results to the original conventional assessments, including when using less information. We found RISK21 useful for rapid chemical assessment and visually representing data from multiple sources. We recommend areas where RISK21 (and other next-generation HHRA approaches) might be improved for Indigenous community contexts, including increasing the community relevance of communication tools and incorporating holistic and non-conventional information. - OPEN ACCESS
- Danial Habibi,
- Amir Hossein Koochekian,
- Hamid Reza Marateb,
- Homayoon masoudi,
- Hanifeh Mirtavoos-Mahyari,
- Muhammadhosein Moradi,
- Mahdi Akbarzadeh,
- Marjan Mansourian,
- Miguel Ángel Mañanas, and
- Roya Kelishadi
The objective of the present systematic review was to incorporate previous studies investigating the association of birth order with the risk of systolic and diastolic blood pressure (DBP). We employed random-effects and Bayesian meta-analyses, complemented by subgroup and sensitivity analyses, including funnel plots, Begg's rank correlation test, Egger's linear regression test, Galbraith plots, and leave-one-out meta-analysis. Of the 13 articles analyzed, 92% (12 articles) were published from 2010 onwards. The aggregate sample comprised 466 853 firstborns and 646 786 later-born individuals. Geographically, the studies were primarily conducted in Europe (54%), followed by Asia (23%), and America (23%). The pooled mean difference for systolic blood pressure (SBP) under a random-effects model was 0.28 mm Hg (95% CI: −7.03 to 7.59), and for DBP was 0.33 mm Hg (95% CI: −5.38 to 6.04), neither of which reached statistical significance (SBP: Z = 0.08, P = 0.939; DBP: Z = 0.11, P = 0.910). Sensitivity analyses supported these findings. Bayesian meta-analysis presented a 95% credible interval for SBP and DBP ranging from −7.25 to 7.84 and −5.60 to 6.27, respectively. The investigation found no substantial evidence of a significant difference in SBP and DBP between firstborns and later-born individuals, challenging the hypothesis that birth order significantly impacts blood pressure levels. ID registration number: 567971.