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  • OPEN ACCESS
    The association of typical and atypical symptoms with in-hospital mortality in older adults with COVID-19: a multicentre cohort study
    FACETS • Vol. 7 • pp. 1199 - 1213
    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.
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    How not to manage a pandemic, and how to recover from it: Lessons from Ecuador
    FACETS • Vol. 7 • pp. 1367 - 1384
    Since 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.
  • OPEN ACCESS
    An analysis of Canada's declared live wildlife imports and implications for zoonotic disease risk
    FACETS • Vol. 8 • pp. 1 - 18
    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
    Urgent and long overdue: legal reform and drug decriminalization in Canada
    FACETS • Vol. 9 • pp. 1 - 28
    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
    Comments regarding “A Canadian model for providing high-quality, timely and relevant evidence to meet health system decision-maker needs: the SPOR Evidence Alliance.”
    FACETS • Vol. 8 • pp. 1 - 2
  • OPEN ACCESS
    Wastewater Surveillance for SARS-CoV-2 RNA in Canada
    FACETS • Vol. 7 • pp. 1493 - 1597
    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
    Strengthening health care in Canada post-COVID-19 pandemic
    FACETS • Vol. 8 • pp. 1 - 10
    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.
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    Implementing and improving designated care partner programs in three Ontario long-term care homes
    FACETS • Vol. 8 • pp. 1 - 12
    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
    Social determinants of food insecurity experienced by Ecuadorian women during the COVID-19 pandemic of Summer 2020: an online survey at the individual level
    FACETS • Vol. 9 • pp. 1 - 14
    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 ACCESS
    The humanities and health policy
    FACETS • Vol. 9 • pp. 1 - 10
    COVID-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 ACCESS
    Development of an age-adjusted, activity-based contact probability model for infectious diseases
    FACETS • Vol. 9 • pp. 1 - 11
    The 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.
  • OPEN ACCESS
    Did the COVID-19 pandemic disrupt food security in West African rural communities? Survey results from four regions of Senegal and Burkina Faso
    FACETS • Vol. 9 • pp. 1 - 16
    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
    Prospective cohort study of Helicobacter pylori infection on the risk of nonalcoholic fatty liver disease
    FACETS • Vol. 9 • pp. 1 - 8
    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
    Inventory and characteristics of Canadian interhospital transfer coordination structures
    FACETS • Vol. 10 • pp. 1 - 8
    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 ACCESS
    Poor mental health negatively impacts farmers personally, interpersonally, cognitively, and professionally
    FACETS • Vol. 9 • pp. 1 - 16
    Farmers 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
    Food Systems Innovation to Nurture Equity and Resilience Globally (Food SINERGY): insights from the Food SINERGY network
    FACETS • Vol. 9 • pp. 1 - 15
    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
    Bat handlers, bat bites, and rabies: vaccination and serological testing of humans at risk
    FACETS • Vol. 9 • pp. 1 - 11
    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
    Exploring the use of the RISK21 approach for Indigenous community-based human health risk assessments: two case studies
    FACETS • Vol. 10 • pp. 1 - 16
    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
    Unraveling the link between birth order and blood pressure: insights from a comprehensive systematic review and meta-analysis
    FACETS • Vol. 10 • pp. 1 - 8
    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.