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Objective: This study describes the incidence of neonatal abstinence syndrome (NAS) in Ontario, Canada by year and health region from 2003 to 2016. Design: The incidence of NAS diagnoses per 1,000 live births was calculated for the 36 local public health agency regions in Ontario from 2003 to 2016 using retrospective hospital admissions data. Infants with a diagnosis of NAS were identified using ICD-10 code P961. Local public health agency level data were aggregated and analyzed by geographic region and by Statistics Canada 2015 Peer Groups. Results: The incidence of NAS in Ontario increased from 0.99 per 1,000 live births in 2003 to 5.94 per 1,000 live births in 2016. There were major differences in NAS incidence by geography, North Western Ontario had the greatest incidence across all years. Health regions with a rural and population center mix or mostly rural population had greater incidence rate of NAS compared to health regions with high density population centers. Conclusions: The incidence of NAS has dramatically increased across Ontario in the last decade. Actions should be taken to combat the continued increase in NAS rates, especially in health regions with disproportionately high incidence of NAS.

OBJECTIVES: This study examined Twitter for public health surveillance during a mass gathering in Canada with two objectives: to explore the feasibility of acquiring, categorizing and using geolocated Twitter data and to compare Twitter data against other data sources used for Pan Parapan American Games (P/PAG) surveillance. METHODS: Syndrome definitions were created using keyword categorization to extract posts from Twitter. Categories were developed iteratively for four relevant syndromes: respiratory, gastrointestinal, heat-related illness, and influenza-like illness (ILI). All data sources corresponded to the location of Toronto, Canada. Twitter data were acquired from a publicly available stream representing a 1% random sample of tweets from June 26 to September 10, 2015. Cross-correlation analyses of time series data were conducted between Twitter and comparator surveillance data sources: emergency department visits, telephone helpline calls, laboratory testing positivity rate, reportable disease data, and temperature. RESULTS: The frequency of daily tweets that were classified into syndromes was low, with the highest mean number of daily tweets being for ILI and respiratory syndromes (22.0 and 21.6, respectively) and the lowest, for the heat syndrome (4.1). Cross-correlation analyses of Twitter data demonstrated significant correlations for heat syndrome with two data sources: telephone helpline calls (r = 0.4) and temperature data (r = 0.5). CONCLUSION: Using simple syndromes based on keyword classification of geolocated tweets, we found a correlation between tweets and two routine data sources for heat alerts, the only public health event detected during P/PAG. Further research is needed to understand the role for Twitter in surveillance. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.17269/s41997-018-0059-0) contains supplementary material, which is available to authorized users.

Objective To describe the lessons learned for public health decision-makers from an analysis of Acute Care Enhanced Surveillance (ACES) data for the heatwaves experienced in Ontario, Canada in the summer of 2018. Introduction The Acute Care Enhanced Surveillance (ACES) system provides syndromic surveillance for Ontario’s acute care hospitals. ACES receives over 99% of acute care records for emergency department (ED) visits; mean daily volume is 17,500 visits. ACES uses a maximum entropy classifier and generates more than 80 standard syndromes, fifteen of which are actively monitored for aberrational activity and are considered of higher public health relevance, including RESP (respiratory infection, non-croup), ILI (influenza-like illness), TOX (toxicological, chemical/drug exposure), AST (asthma), OPI (opioid exposure), CELL (cellulitis), GASTRO (gastroenteritis), ENVIRO (environmental, heat/cold exposure), MH (mental health), EOH (alcohol intoxication), DERM (rash), and SEP (bacteremia, sepsis). Syndromic surveillance provides a salient source of public health surveillance during extreme heat events; monitoring real-time ED visits can inform local public health authorities of health impacts, provide situation awareness to initiate and/or inform public health response, and help decision-makers allocate resources according to geographic (or demographic) vulnerability. While the use of syndromic surveillance has been well-characterized to monitor infectious disease outbreaks, its use to monitor the heat-health impacts is relatively novel for ACES users, specifically local public health authorities. This report describes the the data collected during an extended extreme heat event in Ontario, Canada, to highlight the value of syndromic surveillance during extreme heat events and make recommendations regarding incorporating ACES data into routine workflows. Methods Temperature data were retrieved from Environment Canada historical databases for mid-June to mid-July 2018. Aggregate counts per day for total ED visits and and for individual syndromes were retrieved from ACES databases. Descriptive statistics were used to analyze all datasets. Results An extreme heat event occurred in the southern region of Ontario in early summer, 2018. Environment Canada issues heat warnings for regions throughout Canada according to region-specific criteria; for southern Ontario, heat warnings are issued when 2 or more consecutive days of daytime maximum temperatures are expected to reach 31°C or when 2 or more consecutive days of humidex values are expected to reach 40. Extended heat warnings are issued when the event lasts beyond 2 days. An extended heat event occurred June 29 to July 5, 2018. Although the region is large, temperature data from Environment Canada’s climate monitoring station at Toronto’s Pearson Airport are shown (Figure 1) as an example of the temperatures observed for this time period in the region. Conclusions Lessons learned from an analysis of ACES data during an extreme heat event: 1. The ENVIRO syndrome provides real-time monitoring of the health impacts during a heat event and may provide proxy for estimating the indirect effects of heat (e.g., impacts on chronic conditions). Public health authorities can monitor local health impacts during an extreme heat event. 2. Patients seeking help at the ED do not appear to be skewed in acuity, sex nor age. This does not necessarily reflect the population that experiences the greatest impact from extreme heat, but rather those that are seeking help at the ED for the direct effects of heat. That said, an increase in ENVIRO counts does not indicate whether the increase is due to greater exposure to the heat (or sun), engaging in vigorous outdoor activity during the event (recreational or occupational), or lack of access to air conditioning. 3. ED visits for ENVIRO can be geolocated to determine areas experiencing greater health impacts. This may allow allocation of resources to specifically address vulnerabilities. ACES has built-in mapping capabilities that allows a geovisualization of the home addresses for patients. Furthermore, aggregate counts for relevant syndromes are available for registered users on the Public Health Information Management System (PHIMS), a web-accessible GIS tool for situational awareness that gives public health decision-makers access to real time health impacts in concert with demographics, weather, and other emergency management information.

Lyme borreliosis, caused by the bacterium, Borrelia burgdorferi, is an emerging vector-borne infectious disease in Canada. According to the Public Health Agency of Canada (PHAC), by the year 2020, 80% of Canadians will live in Lyme endemic areas. An understanding of the association of Ixodes scapularis, the main vector of Lyme disease, with it hosts is a fundamental component in assessing changes in the spatial distribution of human risk for Lyme disease. Through the application of Geographic Information System (GIS) mapping methods and spatial analysis techniques, this study examines the population dynamics of the black-legged Lyme tick and its primary host, the white-tailed deer, in eastern Ontario, Canada. By developing a habitat suitability model through a GIS-based multi-criteria decision making (MCDM) analysis, the relationship of the deer habitat suitability map was generated and the results were compared with deer harvest data. Tick submission data collected from two public health units between 2006 and 2012 were used to explore the relationship between endemic ticks and deer habitat suitability in eastern Ontario. The positive correlation demonstrated between the deer habitat suitability model and deer harvest data allows us to further analyze the association between deer habitat and black-legged ticks in our study area. Our results revealed that the high tick submission number corresponds with the high suitability. These results are useful for developing management strategies that aim to prevent Lyme from becoming a threat to public health in Canada. Further studies are required to investigate how tick survival, behaviour and seasonal activity may change with projected climate change.

Morbidity and mortality from exposure to extreme cold highlight the need for meaningful temperature thresholds to activate public health alerts. We analyzed emergency department (ED) records for cold temperature–related visits collected by the Acute Care Enhanced Surveillance system—a syndromic surveillance system that captures data on ED visits from hospitals in Ontario—for geographic trends related to ambient winter temperature. We used 3 Early Aberration Reporting System algorithms of increasing sensitivity—C1, C2, and C3—to determine the temperature at which anomalous counts of cold temperature–related ED visits occurred in northern and southern Ontario from 2010 to 2016. The C2 algorithm was the most sensitive detection method. Results showed lower threshold temperatures for Acute Care Enhanced Surveillance alerts in northern Ontario than in southern Ontario. Public health alerts for cold temperature warnings that are based on cold temperature–related ED visit counts and ambient temperature may improve the accuracy of public warnings about cold temperature risks.

During the summer of 2015, the Pan American and Parapan American Games took place in the Greater Toronto area of Ontario, Canada, bringing together thousands of athletes and spectators from around the world. The Acute Care Enhanced Surveillance (ACES) system—a syndromic surveillance system that captures comprehensive hospital visit triage information from acute care hospitals across Ontario—monitored distinct syndromes throughout the games. We describe the creation and use of a risk assessment tool to evaluate alerts produced by ACES during this period. During the games, ACES generated 1420 alerts, 4 of which were considered a moderate risk and were communicated to surveillance partners for further action. The risk assessment tool was useful for public health professionals responsible for surveillance activities during the games. Next steps include integrating the tool within the ACES system.

Private water supplies, which are the primary source of drinking water for rural communities in developed countries, are at risk of becoming fecally contaminated. It is important to identify the source of contamination in order to better understand and address this human health risk. Microbial source tracking methods using human, bovine and general Bacteroidales markers were performed on 716 well water samples from southeastern Ontario, which had previously tested positive for Escherichia coli. The results were then geospatially analyzed in order to elucidate contamination patterns. Markers for human feces were found in nearly half (49%) of all samples tested, and a statistically significant spatial cluster was observed. A quarter of the samples tested positive for only general Bacteroidales markers (25.7%) and relatively few bovine specific marker positives (12.6%) were found. These findings are fundamental to the understanding of pathogen dynamics and risk in the context of drinking well water and will inform future research regarding host-specific pathogens in private well water samples.

Research to date has provided limited insight into the complexity of water-borne pathogen transmission. Private well water supplies have been identified as a significant pathway in infectious disease transmission in both the industrialised and the developing world. Using over 90,000 private well water submission records representing approximately 30,000 unique well locations in south-eastern Ontario, Canada, a spatial analysis was performed in order to delineate clusters with elevated risk of E. coli contamination using 5 years of data (2008-2012). Analyses were performed for all years independently and subsequently compared to each other. Numerous statistically significant clusters were identified and both geographic stability and variation over time were examined. Through the identification of spatial and temporal patterns, this study provides the basis for future investigations into the underlying causes of bacterial groundwater contamination, while identifying geographic regions that merit particular attention to public health interventions and improvement of water quality.

BACKGROUND: Funders of health research in Canada seek to determine how their funding programs impact research capacity and knowledge creation.OBJECTIVE: To evaluate the impact of a focused grants and award program that was cofunded by the Canadian Institutes of Health Research Institute of Nutrition, Metabolism and Diabetes, and the Canadian Association of Gastroenterology; and to measure the impact of the Program on the career paths of funded researchers and assess the outcomes of research supported through the Program.METHODS: A survey of the recipients of grants and awards from 2000 to 2008 was conducted in 2012. The CIHR Funding Decisions database was searched to determine subsequent funding; a bibliometric citation analysis of publications arising from the Program was performed.RESULTS: Of 160 grant and award recipients, 147 (92%) completed the survey. With >$17.4 million in research funding, support was provided for 131 fellowship awards, seven career transition awards, and 22 operating grants. More than three-quarters of grant and award recipients continue to work or train in a research-related position. Combined research outputs included 545 research articles, 130 review articles, 33 book chapters and 11 patents. Comparative analyses indicate that publications supported by the funding program had a greater impact than other Canadian and international comparators.CONCLUSIONS: Continuity in support of a long-term health research funding partnership strengthened the career development of gastroenterology researchers in Canada, and enhanced the creation and dissemination of new knowledge in the discipline.

Background Calls to a telephone health helpline (THHL) have been previously evaluated for the ability to monitor specific syndromes, such as fever and influenza-like-illness or gastrointestinal illness. This method of surveillance has been shown to be highly correlated with traditional surveillance methods, and to have potential for early detection of community-based illness. Self-sampling, or having a person take his/her own nasal swab, has also proven successful as a useful method for obtaining a specimen, which may be used for respiratory virus detection. Methods This study describes a self-swabbing surveillance system mediated by a nurse-led THHL in Ontario whereby syndromic surveillance concepts are used to recruit and monitor participants with influenza-like illness. Once recruited, participants collect a nasal specimen obtained by self-swabbing and submit for testing and laboratory confirmation. Enumeration of weekly case counts was used to evaluate the timeliness of the self-swabbing surveillance system through comparison to other respiratory virus and influenza surveillance systems in Ontario. The operational efficiency of the system was also evaluated. Results The mean and median number of days between the day that a participant called the THHL, to the day a package was received at the laboratory for testing were approximately 10.4 and 8.6 days, respectively. The time between self-swab collection and package reception was 4.9 days on average, with a median of 4 days. The self-swabbing surveillance system adequately captured the 2014 influenza B season in a timely manner when compared to other Ontario-based sources of influenza surveillance data from the same year; however, the emergence of influenza B was not detected any earlier than with these other surveillance systems. Influenza A surveillance was also evaluated. Using the THHL self-swabbing system, a peak in the number of cases for influenza A was observed approximately one week after or during the same week as that reported by the other surveillance systems. Conclusion This one-year pilot study suggests that the THHL self-swabbing surveillance system has significant potential as an adjunct tool for the surveillance of influenza viruses in Ontario. Recommendations for improving system efficacy are discussed. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3674-9) contains supplementary material, which is available to authorized users.

KFL&A Public Health makes use of several GIS tools to assist with problem solving and decision making based on geographic and demographic data maps. The Social Determinant of Health (SDOH) Mapper is a GIS tool that displays various social determinants of health layers as they apply to specific geographic areas, therefore allowing the user to visualize trends in marginalization and deprivation for a specified population in Ontario. This tool allows the user to more easily consider vulnerable populations in relation to other environmental and geographic data when making public health decisions.

This roundtable session will involve a hands-on, interactive workshop where participants will be taught how to use three web-based surveillance tools (Public Health Information Management System, Social Determinants of Health Mapper, and South Eastern Integrated Information Portal). The tools apply deprivation and marginalization indices, as well as other environmental and geographic layers, to virtual maps. With the help of these tools, the user will be able to easily track vulnerable populations. The layers available in the tools, and how they apply to specific geographic areas, are important to consider when making public health decisions so as to improve health equity and act on social determinants of health.

This session will provide an overview of the pilot project regarding a laboratory-linked telephone health helpline based surveillance system. The surveillance system uses syndromic surveillance tools for early detection of illness and links it to a specimen available for laboratory testing. Through the health helpline, people with influenza-like illness are recruited and sent a nasal swab to obtain a specimen via self-swabbing that can be used to test for influenza viruses. The surveillance system is available to all residents of Ontario and was in operation for one year. Some of the results, analyses, and limitations of this project will be discussed during this session.

The South Eastern Integrated Information Portal (SHIIP) is a portal-based technology solution that provides real-time feedback and summarized data to enhance and help plan care. This tool supports the Health Links program, which provides a new model for care in Ontario at the clinical level, in which all health care services in a community accessed by a patient are coordinated into a single plan. SHIIP provides the technology to enables a multi-agency care process by collecting patient demographic and clinical data from hospital databases. Some projected benefits include enhanced patient experience, reduced workflow and improvements in the efficiency of access to patient information.

The PHIMS tool is a GIS application that allows for real-time surveillance of various environmental and demographic data. PHIMS displays the data as layers on virtual maps as they relate to specific regions in Ontario, and the tool can be accessed through a web-based user interface. Users can visualize their map from several basemaps and apply colour-coded layers. Environmental layers help to predict and prepare for emergencies and to track weather events. Additionally, PHIMS enables users to determine where the most vulnerable populations reside so that they can prioritize resources during an emergency situation.

The purpose of the workshop was to receive input from the Canadian pediatric inflammatory bowel diseases research community to develop a research funding opportunity for a Canadian pediatric inflammatory bowel diseases network and data platform supported by the Canadian Institutes for Health Research, in partnership with the Foundation for Children with Intestinal and Liver Disorders. Leaders from across the country came together, with the objectives of identifying the scientific goals for a Canadian pediatric inflammatory bowel disease network, the required infrastructure, and an appropriate governance structure needed to achieve such a network and data platform, as well as other elements needed to ensure the successful implementation of a network.

From Words to Deeds First of all, I would like to thank UNESCO for inviting me, as chairman [President] of the International Council for Adult Education, to speak to you. Along with the other representatives of civil-society organizations, we have come here to work with you to advance the right to lifelong learning. We do so because we are convinced that the continuing development of knowledge and skills within the adult population is one of the most strategic investments that societies must make today. Furthermore, this is an urgent investment, without which mankind will not have the internal resources to cope with the challenges ahead, The bloody conflicts that arise, as was again the case last night in two African countries and as we see all too often on all continents, clearly demonstrate this. Without an informed and internally strong civil society, such disasters become inevitable. Yes, without spreading the freedom to learn and without strengthening the foundations of everyday diplomatic skills, the possibility of solving conflicts other than by bloody means becomes virtually inconceivable, regardless of the country. Adult education is an essential tool for peace. But how, then, can we truly succeed in investing in the lifelong learning of our citizens? During the preparatory discussions leading up to CONFINTEA VI, international, national, and nongovernmental partners all agreed that at this sixth International Conference on Adult Education we would have to move from words to action. For each and every partner, the mantra quickly became "from rhetoric to action," and has remained so in this final session of CONFINTEA VI. But if we are to truly move from words to action, there are two questions we must consider. First: why is it important, and even urgent, for adults and young people outside the school system to develop their potential? And second: what action do we take, how do we make this possible from here on in? Why Has It Become Necessary to Extend Education Throughout Life? The reason, or rather the reasons, for lifelong learning are important because they are the basis of the political will that this conference calls on us all to show. Why, then, should we invest in developing adults' capacity for initiative and in increasing their capacity for action? First, because the Millennium Development Goals, the MDGs, are not achievable without the active and informed participation of the entire population. We cannot fight HIV/AIDS without prevention. We cannot stem the rapid spread of this pandemic, any more so than that of malaria, without an informed population that is aware of preventive measures and without educational and health promotion activities. This is what we call adult education. We will not be able to provide primary education for all children in the world without the active participation of parents, without giving them the means to equip themselves for this purpose and without parental education. This, too, is what we call adult education. We will not succeed in reducing hunger in the world without overcoming the food crisis, without helping farmers and rural populations to increase yields on their land, and without investing heavily in agricultural expansion or popularization. And this is what we mean by adult education. The text presenting the Millennium Development Goals does not at any point mention education for adults and young people outside school, though it is in fact implied everywhere as a necessary condition for the realization of these goals. We cannot take on these eight major challenges that mankind set itself at the beginning of this millennium if 20%, 30%, 40%, or even 60% of the adult population has no way of accessing tools to work towards these goals. None of the Millennium Development Goals can be achieved without the active participation of young people and adults, and therefore without their education. …

Diet has been associated with many chronic conditions that fall within the mandate of the Institute of Nutrition, Metabolism, and Diabetes (INMD) of the Canadian Institutes of Health Research. These chronic conditions represent a significant proportion of the economic and societal impact of disease in Canada. The INMD’s vision is to position Canada as a leader in knowledge creation through health research that benefits all Canadians and the global community. This document outlines the strategic priorities of the INMD and will be used to guide the use of its resources for the near future.

The Sodium Reduction Strategy for Canada includes an identification of priority areas for future research, based on a workshop convened by the Canadian Institutes of Health Research (CIHR) and partners. A strong portfolio of research is essential to addressing current developments and controversies raised in relation to the health outcomes associated with dietary sodium. CIHR aims to provide leadership in working together with other funders and partners to catalyze a broad range of sodium research.

Background Electronic medical records (EMRs) used in primary care contain a breadth of data that can be used in public health research. Patient data from EMRs could be linked with other data sources, such as a postal code linkage with Census data, to obtain additional information on environmental determinants of health. While promising, successful linkages between primary care EMRs with geographic measures is limited due to ethics review board concerns. This study tested the feasibility of extracting full postal code from primary care EMRs and linking this with area-level measures of the environment to demonstrate how such a linkage could be used to examine the determinants of disease. The association between obesity and area-level deprivation was used as an example to illustrate inequalities of obesity in adults. Methods The analysis included EMRs of 7153 patients aged 20 years and older who visited a single, primary care site in 2011. Extracted patient information included demographics (date of birth, sex, postal code) and weight status (height, weight). Information extraction and management procedures were designed to mitigate the risk of individual re-identification when extracting full postal code from source EMRs. Based on patients’ postal codes, area-based deprivation indexes were created using the smallest area unit used in Canadian censuses. Descriptive statistics and socioeconomic disparity summary measures of linked census and adult patients were calculated. Results The data extraction of full postal code met technological requirements for rendering health information extracted from local EMRs into anonymized data. The prevalence of obesity was 31.6 %. There was variation of obesity between deprivation quintiles; adults in the most deprived areas were 35 % more likely to be obese compared with adults in the least deprived areas (Chi-Square = 20.24(1), p

Objective:Emergency department (ED) overcrowding in Canada is an ongoing problem resulting in prolonged wait times, service declines, increased patient suffering, and adverse patient outcomes. We explored the relationship between socioeconomic status (SES) and ED use in Canada's universal health care system to improve our understanding of the nature of ED users to both improve health care to the most deprived populations and reduce ED patient input.Methods:This retrospective study took information from the National Ambulatory Care Reporting System (NACRS) database for all ED visits in Ontario between April 1, 2003, and March 31, 2010. As there is no direct measure of SES available from ED visit records, a proxy measure of SES was used, namely a deprivation index (DI) developed from material and social factors from the 2006 Canadian census using the patient's residential neighbourhood. DI scores were assigned to ED visit records using Statistics Canada's Postal Code Conversion File, which links postal and census geography.Results:A total of 36,765,189 visits occurred during the study period. A cross-province trend was found wherein the most deprived population used EDs disproportionately more than the least deprived population (relative risk: 1.971 95% confidence interval 1.969–1.973,p< 0.0001). This trend was stable across the entire study period, although the divergence is attenuating.Conclusion:Social determinants of health clearly impact ED use patterns. People of the lowest SES use ED services disproportionately more than other socioeconomic groups. Focused health system planning and policy development directed at optimizing health services for the lowest SES populations are essential to changing ED use patterns and may be one method of decreasing ED overcrowding.

To describe the associations between the socioeconomic status of emergency department (ED) users and age, sex, and acuity of medical conditions to better understand users' common characteristics, and to better meet primary and ambulatory health care needs.A retrospective, observational, population-based analysis. A rigorous proxy of socioeconomic status was applied using census-based methods to calculate a relative deprivation index.Ontario.All Ontario ED visits for the fiscal year April 1, 2008, to March 31, 2009, from the National Ambulatory Care Reporting System data set.Emergency department visits were ranked into deprivation quintiles, and associations between deprivation and age, sex, acuity at triage, and association with a primary care physician were investigated.More than 25% of ED visits in Ontario were from the most deprived population; almost half of those (12.3%) were for conditions of low acuity. Age profiles indicated that a large contribution to low-acuity ED visits was made by young adults (aged 20 to 30 years) from the most deprived population. For the highest-volume ED in Ontario, 94 of the 499 ED visits per day were for low-acuity patients from the most deprived population. Most of the highest volume EDs in Ontario (more than 200 ED visits per day) follow this trend.Overall input into EDs might be reduced by providing accessible and appropriate primary health care resources in catchment areas of EDs with high rates of low-acuity ED visits, particularly for young adults from the most deprived segment of the population.

The Canadian gastrointestinal (GI) research community is a world leader in advancing our understanding of many areas of physiology and pathophysiology relevant to GI disease. These highly successful research programs have created an excellent cohort of graduate and postgraduate research trainees involved in GI research at institutions across Canada. These trainees play an instrumental role in the discoveries and new knowledge that has emerged from their laboratories. Many of them are funded by the Canadian Association of Gastroenterology (CAG) in collaboration with the Canadian Institutes of Health Research (CIHR), the Crohn’s and Colitis Foundation of Canada (CCFC), and a number of industry partners. To recognize the value of the Canadian GI trainees’ outstanding research contributions, and to promote and encourage the continued efforts of the graduate and postgraduate research trainees in basic and clinical sciences, the CAG, CHIR and CCFC held the 11th Symposium on Research Topics in GI diseases on February 22 to 23, 2012 in Montreal, Quebec (in advance of Canadian Digestive Diseases Week [CDDW]). The goal of this meeting was to provide research trainees with an opportunity to informally present their original research from diverse disciplines, to their peers and to a selection of faculty from across Canada. In this forum, trainees actively participated in the discussions of papers in an open setting. This year’s program consisted of a series of superb presentations describing cutting-edge research with 39 podium scientific presentations of basic and clinical gastroenterology-related research, covering GI development, pathogenesis of esophagogastrointestinal inflammation and healing, enteric microbiota and pathogens, including bacteria that promote cancer, and gastric ulceration, enteric nerves, and epithelial transport and barrier function. The addition of a ‘reviewer role’ provided all participants with the opportunity to review another presenter’s abstract (as assigned by the program organizers) in advance of the presentation and to be prepared to ask a question related to the abstract presentation allowing the trainees to function in the ‘session chair role’. The keynote session ‘Developing a translational research program: Perspectives from a Clinician scientist’ was presented by Dr Paul Beck. This year’s career development toolbox session focused on ‘Writing a manuscript’. Dr Catharine Walsh presented a practical talk with key tips that was followed by small group breakout sessions in which trainees were able to begin to implement some of the key points reviewed. This year the program included a combined session and opportunity for interaction with the Scholars and Gastroenterology Residents-in-Training (GRIT) attendees: ‘GI Research: What’s in it for me?’ presented by CAG’s McKenna Lecturer, Dr Richard Hunt. Similar to previous years, a major success of the meeting was that it provided a venue in which trainees could meet their peers from across Canada, develop research skills and initiate collaborations, thus developing contacts for their future research career and the future of Canadian GI research. The majority of participants rated the program as good to excellent, and commented that attendance at the meeting offered great interaction with mentors and trainees. The Research Topics meeting provides a valuable opportunity for young researchers to exchange learning. The CAG is proud to acknowledge its Benefactor Corporate Sponsors: Abbott Canada AstraZeneca Canada Inc Olympus Canada Inc Pentax Canada Inc Janssen Inc Takeda Canada Inc

Background Hgb A1c levels may be higher in persons without diabetes of lower socio-economic status (SES) but evidence about this association is limited; there is therefore uncertainty about the inclusion of SES in clinical decision support tools informing the provision and frequency of Hgb A1c tests to screen for diabetes. We studied the association between neighborhood-level SES and Hgb A1c in a primary care population without diabetes. Methods This is a retrospective study using data routinely collected in the electronic medical records (EMRs) of forty six community-based family physicians in Toronto, Ontario. We analysed records from 4,870 patients without diabetes, age 45 and over, with at least one clinical encounter between January 1st 2009 and December 31st 2011 and one or more Hgb A1c report present in their chart during that time interval. Residential postal codes were used to assign neighborhood deprivation indices and income levels by quintiles. Covariates included elements known to be associated with an increase in the risk of incident diabetes: age, gender, family history of diabetes, body mass index, blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, and fasting blood glucose. Results The difference in mean Hgb A1c between highest and lowest income quintiles was -0.04% (p = 0.005, 95% CI -0.07% to -0.01%), and between least deprived and most deprived was -0.05% (p = 0.003, 95% CI -0.09% to -0.02%) for material deprivation and 0.02% (p = 0.2, 95% CI -0.06% to 0.01%) for social deprivation. After adjustment for covariates, a marginally statistically significant difference in Hgb A1c between highest and lowest SES quintile (p = 0.04) remained in the material deprivation model, but not in the other models. Conclusions We found a small inverse relationship between Hgb A1c and the material aspects of SES; this was largely attenuated once we adjusted for diabetes risk factors, indicating that an independent contribution of SES to increasing Hgb A1c may be limited. This study does not support the inclusion of SES in clinical decision support tools that inform the use of Hgb A1c for diabetes screening.