Search

Competing Interests: Intérêts concurrents :: Dale Kalina déclare avoir reçu des honoraires de consultation et de conférence de la société Shaping Minds, des honoraires de consultation relatifs à la prévention et au contrôle des infections du Appleby College et des honoraires de consultation de la société FaceDrive. Le Dr Kalina déclare recevoir une rémunération en tant que membre du corps professoral de la société Woundpedia et du Projet ECHO Ontario sur les soins de la peau et des plaies; il a accordé des entrevues aux médias (sans rémunération); a prononcé des conférences et participé à des panels de discussions pour le McMaster University Health Leadership Academy, Halton Public Health, le Burlington Ontario Health Team, le Collège canadien des leaders en santé, le Brazilian Canadian Chamber of Commerce, Ontario and New York: Covid Comparisons Webinar et the Masaryk University Faculty of Medicine; il a participé à des assemblées publiques sur la COVID-19 en lien avec le Joseph Brant Hospital, le Burlington Dental Academy, Gerrie Electric, Head Injury Rehabilitation Ontario, White Rabbit Treatment Homes, Tansley Wood Retirement Home et Tyndall Retirement and Nursing Home. Le Dr Kalina déclare faire partie d’un comité consultatif de la société ViiV Healthcare et il est responsable principal de l’information médicale au Brant Community Healthcare Centre. Le Dr Kalina déclare détenir des actions de la société FaceDrive et reçoit des échantillons de médicaments de la société Gilead. Aucun autre intérêt concurrent n’a été déclaré.

Competing Interests: Intérêts concurrents :: Aucun déclaré.

Competing Interests: Intérêts concurrents :: Mehdi Aloosh déclare avoir reçu un soutien financier du Boston College pour ses déplacements. Aucun autre intérêt concurrent n’a été déclaré.

This commentary highlights the importance of social and nature prescribing programs reflecting culturally diverse perspectives and practices. Creating and holding space for Indigenous and other worldviews should be a key priority of nature prescribing, a relatively recent practice in Canada that recognizes and promotes health benefits associated with engaging in a variety of activities in natural settings. Central to designing and delivering nature prescribing that is culturally inclusive and grounded in fulfilling obligations of reconciliation is recognizing the ongoing dominance of Western worldviews and their associated implications for decolonizing and Indigenizing nature-based programming. Consciously working to expand Western values, with the aim of extending nature prescribing practices beyond mere nature exposure to fostering emotional connections to nature, is a critically important part of the ongoing development of nature-based interventions and nature prescribing., Competing Interests: None of the authors have any conflicts of interest.

Introduction: Social prescribing is defined as "a means for trusted individuals in clinical and community settings to identify that a person has nonmedical, health-related social needs and to subsequently connect them to nonclinical supports and services within the community by co-producing a social prescription-a nonmedical prescription, to improve health and well-being and to strengthen community connections." Globally, there is growing interest in social prescribing as a holistic approach to health and well-being, with almost 30 countries involved in the social prescribing movement. In Canada, great strides are being made in social prescribing research, policy and practice, with all of this work being supported by the Canadian Institute for Social Prescribing., Competing Interests: The authors have no conflicts of interest to declare.

Abstract: Proposals to establish pan-Canadian licensure for physicians have broad support amongst medical groups to address physician shortages in underserved rural communities. The concept has also elicited concern from some stakeholders that its implementation could exacerbate rural physician workforce shortages by prompting an exodus of rural physicians to urban centres. An environmental scan of reports from key medical groups published within the past 10 years was conducted to determine factors influencing rural physician practice patterns. Data from membership surveys of the Society of Rural Physicians of Canada and the Canadian Medical Association - conducted in fall 2022 - were reviewed to determine whether licensure is a factor in rural physicians' decisions to leave or stay in practice in rural Canada. Factors contributing to physicians' decisions to leave rural practice identified in the environmental scan included lack of infrastructure support, inability to find locum coverage, inadequate support for team-based care and effects of high workloads on wellness. A common theme found in responses to the membership surveys was the recognition of licensing restrictions as barriers preventing rural physicians from practising in multiple provinces or territories. Survey respondents also voiced strong support for national licensure implementation. Pan-Canadian licensure holds promise as a strategy to enhance the recruitment and retention of physicians in rural communities. It could also provide physicians flexibility to work in multiple jurisdictions to address the health workforce needs of underserved communities.Les propositions visant à établir un permis d'exercice pancanadien pour les médecins bénéficient d'un large soutien de la part des groupes médicaux afin de remédier aux pénuries de médecins dans les communautés rurales mal desservies. Ce concept a également suscité des inquiétudes de la part de certaines parties prenantes qui craignent que sa mise en oeuvre n'aggrave les pénuries de médecins en milieu rural en provoquant l'exode de ces derniers vers les centres urbains. Une analyse environnementale des rapports des principaux groupes médicaux publiés au cours des dix dernières années a été effectuée pour déterminer les facteurs influençant les modes de pratique des médecins ruraux. Les données des enquêtes sur les membres de la Société de la médecine rurale du Canada et de l'Association médicale canadienne-menées à l'automne 2022-ont été examinées pour déterminer si le permis d'exercice est un facteur dans la décision des médecins ruraux de quitter ou de rester en pratique dans les régions rurales du Canada. Les facteurs contribuant à la décision des médecins de quitter la pratique rurale, identifiés dans l'analyse de l'environnement, comprenaient le manque de soutien en matière d'infrastructure, l'incapacité à trouver une couverture de suppléance, le soutien inadéquat des soins en équipe et les effets des charges de travail élevées sur le bien-être. Un thème commun ressorti des réponses aux enquêtes menées auprès des membres est la reconnaissance des restrictions en matière de permis d'exercice en tant qu'obstacles empêchant les médecins ruraux d'exercer dans plusieurs provinces ou territoires. Les répondants à l'enquête ont également exprimé leur soutien à la mise en place d'un système national de permis d'exercice. Le permis d'exercice pancanadien est une stratégie prometteuse pour améliorer le recrutement et la fidélisation des médecins dans les communautés rurales. Il pourrait également permettre aux médecins de travailler dans plusieurs administrations afin de répondre aux besoins en personnel de santé des communautés mal desservies., (Copyright © 2024 Copyright: © 2024 Society of Rural Physicians of Canada.)

Introduction: This study examined the prevalence of functional difficulties and associated factors in Canadian children/youth aged 5 to 17 years diagnosed with autism spectrum disorder (ASD)., Methods: We analyzed data from the 2019 Canadian Health Survey on Children and Youth (CHSCY), a nationally representative survey of Canadian children/youth that used the Washington Group Short Set on Functioning (WG-SS) to evaluate functioning in six daily tasks. For each functional domain, binary outcomes were derived (no/some difficulty, a lot of difficulty/no ability). We used logistic regression to identify associations between demographic characteristics, educational experiences, and perceived mental and general health and the most common functional difficulties, namely those related to remembering/concentrating, communication and self-care. All estimates were weighted to be representative of the target population. The bootstrap method was used to calculate variance estimates., Results: Analysis of the records of 660 children/youth with ASD revealed that the most common functional difficulties were remembering/concentrating (22%; 95% CI: 18-27), communicating (19%; 95% CI: 15-23) and self-care (13%; 95% CI: 10-17). Lower perceived mental health was associated with increased functional difficulties with remembering/concentrating. ASD diagnosis at a lower age and lower perceived general health were associated with increased functional difficulty with communication. Parental expectations for postsecondary education were associated with decreased functional difficulty for self-care., Conclusion: One or more functional difficulties from the WG-SS was present in 39% of Canadian children/youth aged 5 to 17 years with ASD. Functional difficulties with remembering/concentrating, communication and self-care were most common., Competing Interests: None.

Introduction: Respiratory therapists (RTs) faced morally distressing situations throughout the COVID-19 pandemic, including working with limited resources and facilitating video calls for families of dying patients. Moral distress is associated with a host of adverse psychological and functional outcomes (e.g. depression, anxiety, symptoms of posttraumatic stress disorder [PTSD] and functional impairment) and consideration of position departure. The purpose of this study was to understand the impact of moral distress and its associated psychological and functional outcomes on consideration to leave a clinical position among Canadian RTs during the COVID-19 pandemic., Methods: Canadian RTs (N = 213) completed an online survey between February and June 2021. Basic demographic information (e.g. age, sex, gender) and psychometrically validated measures of moral distress, depression, anxiety, stress, PTSD, dissociation, functional impairment, resilience and adverse childhood experiences were collected., Results: One in four RTs reported considering leaving their position. RTs considering leaving reported elevated levels of moral distress and adverse psychological and functional outcomes compared to RTs not considering leaving. Over half (54.5%) of those considering leaving scored above the cut-off for potential diagnosis of PTSD. Previous consideration to leave a position and having left a position in the past each significantly increased the odds of currently considering leaving, along with system-related moral distress and symptoms of PTSD, but the contribution of these latter factors was small., Conclusions: Canadian RTs considering leaving their position reported elevated levels of distress and adverse psychological and functional outcomes, yet these individual-level factors appear unlikely to be the primary factors underlying RTs' consideration to leave, because their effects were small. Further research is required to identify broader, organizational factors that may contribute to consideration of position departure among Canadian RTs., Competing Interests: MM is a Director at Cambridge Memorial Hospital, the Research Institute of St. Joseph’s Healthcare Hamilton and St. Joseph’s Healthcare Hamilton Foundation. KH received a novice researcher grant from Hamilton Research Institute for ultrasound study in respiratory therapists. SR is employed by the Atlas Institute for Veterans and Families. HS and CO are employed by Homewood Health, Inc. AM is the Executive Vice President at Homewood Health, Inc.

When patients are discharged from the hospital and return home, they are at risk of adverse events if the continuity of care is broken. So far, the evidence for transitional care models to reduce readmission rates has focused mainly on patients with a single condition. Based on this observation, we identified the population that may benefit the most from the development of a new transitional care model, as part of the INSTEAD project, by consensus between patients and professionals in hospitals and the community. To ensure continuity of care, it is necessary to consider the patients' perception, their understanding of the care plan and changes impacting the home care plan. Interprofessional collaboration is essential to achieve this., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article. Tous les auteurs font partie du comité de pilotage du projet INSTEAD.

Introduction: The Canadian government has committed to a national action plan (NAP) to address violence against women (VAW). However, a formalized plan for implementation has not been published. Building on existing recommendations and consultations, we conducted the first formal and peer-reviewed qualitative analysis of the perspectives of leaders, service providers and survivors on what should be considered in Canada's NAP on VAW., Methods: We applied thematic analysis to qualitative data from 18 staff working on VAW services (11 direct support, 7 in leadership roles) and 10 VAW survivor participants of a community-based study on VAW programming during the COVID-19 pandemic in the Greater Toronto Area (Ontario, Canada)., Results: We generated 12 recommendations for Canada's NAP on VAW, which we organized into four thematic areas: (1) invest into VAW services and crisis supports (e.g. strengthen referral mechanisms to VAW programming); (2) enhance structural supports (e.g. invest in the full housing continuum for VAW survivors); (3) develop coordinated systems (e.g. strengthen collaboration between health and VAW systems); and (4) implement and evaluate primary prevention strategies (e.g. conduct a gender-based and intersectional analysis of existing social and public policies)., Conclusion: In this study, we developed, prioritized and nuanced recommendations for Canada's proposed NAP on VAW based on a rigorous analysis of the perspectives of VAW survivors and staff in Canada's largest city during the COVID-19 pandemic. An effective NAP will require investment in direct support organizations; equitable housing and other structural supports; strategic coordination of health, justice and social care systems; and primary prevention strategies, including gender transformative policy reform., Competing Interests: Priya Shastri and Elizabeth Tremblay are employed by the Toronto Region Violence Against Women Coordinating Committee (VAWCC). The VAWCC is funded by the Ontario Ministry of Children, Community and Social Services (MCCSS), which is a primary funder of many VAW organizations in the Greater Toronto Area. Maria Huijbregts is employed by Family Service Toronto, which receives funding from MCCSS.

Introduction: The COVID-19 pandemic has had major economic, social and psychological consequences for adolescents and young adults. It is unclear whether those with a history of adverse childhood experiences (ACEs) were particularly vulnerable. We examined whether a history of ACEs was associated with financial difficulties, lack of emotional support, feeling stressed/anxious, feeling down/depressed, increased alcohol and/or cannabis use and increased conflict with parents, siblings and/or intimate partners among 16- to 21-year-olds during the pandemic., Methods: Data were collected in November and December 2020 from respondents aged 16 to 21 years (n = 664) participating in the longitudinal and intergenerational Well-being and Experiences Study (Wave 3) conducted in Manitoba, Canada. Age-stratified associations between ACEs and pandemic-related stressors/symptoms were examined with binary and multinomial logistic regression., Results: A history of ACEs was associated with pandemic-related financial difficulties (adjusted relative risk ratio [aRRR] range: 2.44-7.55); lack of emotional support (aRRR range: 2.13-26.77); higher levels of feeling stressed/anxious and down/depressed (adjusted odds ratio [aOR] range: 1.78-5.05); increased alcohol and cannabis use (aOR range: 1.99-8.02); and increased relationship conflict (aOR range: 1.98-22.59). Fewer associations emerged for older adolescents and these were not to the same degree as for young adults., Conclusion: Adolescents and young adults with a history of ACEs reported increased odds of pandemic-related stressors and symptoms, and may need more resources and greater support compared to peers without an ACE history. Differences in results for adolescents and young adults suggest that interventions should be tailored to the needs of each age group., Competing Interests: Tracie O. Afifi is an Associate Scientific Editor with Health Promotion and Chronic Disease Prevention in Canada, but has recused herself from the review process for this article. The authors have no conflicts of interest.

Competing Interests: The authors declare no conflicts of interest.

Introduction: Unhealthy food and beverage marketing in various media and settings contributes to children's poor dietary intake. In 2019, the Canadian federal government recommended the introduction of new restrictions on food marketing to children. This scoping review aimed to provide an up-to-date assessment of the frequency of food marketing to children and youth in Canada as well as children's exposure to this marketing in various media and settings in order to determine where gaps exist in the research., Methods: For this scoping review, detailed search strategies were used to identify relevant peer-reviewed and grey literature published between October 2016 and November 2021. Two reviewers screened all results., Results: A total of 32 relevant and unique articles were identified; 28 were peer reviewed and 4 were from the grey literature. The majority of the studies (n = 26) examined the frequency of food marketing while 6 examined actual exposure to food marketing. Most research focussed on children from Ontario and Quebec and television and digital media. There was little research exploring food marketing to children by age, geographical location, sex/gender, race/ethnicity and/or socioeconomic status., Conclusion: Our synthesis suggests that unhealthy food marketing to children and adolescents is extensive and that current self-regulatory policies are insufficient at reducing the presence of such marketing. Research assessing the frequency of food marketing and preschooler, child and adolescent exposure to this marketing is needed across a variety of media and settings to inform future government policies., Competing Interests: None.

Background: This 8-week pilot stepped-wedge randomized controlled trial evaluated the MoveStrong program for teaching adults who have frailty/pre-frailty about balance and functional strength training and sufficient protein intake to prevent falls and improve mobility., Methods: We recruited individuals aged 60 years and over, with a FRAIL scale score of 1 or higher and at least one chronic condition, who were not currently strength training. The program included 16 exercise physiologist-led hour-long group sessions and two dietitian-led hour-long nutrition sessions. We analyzed secondary outcomes-weight, gait speed, grip strength, physical capacity (fatigue levels), sit-to-stand functioning, dynamic balance, health-related quality of life (HRQoL), physical activity levels and protein intake-using a paired t test and a generalized estimating equation (GEE)., Results: Of 44 participants (mean [SD] age 79 [9.82] years), 35 were pre-frail and 9 were frail. At follow-up, participants had significantly improved grip strength (1.63 kg, 95% CI: 0.62 to 2.63); sit-to-stand functioning (2 sit-to-stands, 95% CI: 1 to 3); and dynamic balance (1.68 s, 95% CI: 0.47 to 2.89). There were no significant improvements in gait speed, HRQoL index scores, self-rated health, physical activity levels (aerobic activity and strength training) or protein intake. GEE analysis revealed an interaction between exposure to MoveStrong and gait speed, sit-to-stand functioning, dynamic balance and HRQoL index scores. The total cost to administer the program and purchase equipment was CAD 14 700, equivalent to CAD 377 per participant., Conclusion: Exploratory analyses suggest MoveStrong exercises may improve gait speed, sit-to-stand functioning, dynamic balance and HRQoL index scores in older individuals who are frail and pre-frail., Competing Interests: The authors have no conflicts of interest to disclose.

Introduction: Paramedics, firefighters, police officers and other public safety personnel (PSP) as well as Canadian Armed Forces (CAF) members are frequently exposed to stressors and demanding work environments. Although their specific work-related tasks may vary, a commonality between these occupations is the significant likelihood of repeated exposure to potentially psychologically traumatic events (PPTE) over the course of their careers. Due in part to these repeated exposures, CAF members and PSP are at an elevated risk of mental health concerns including posttraumatic stress disorder. The purpose of this study was to obtain a more in-depth understanding of the trauma- and non-trauma-related experiences of active or retired PSP and CAF members that may be implicated in mental health issues and resultant treatment and recovery., Methods: Study participants were recruited during inpatient treatment at a private mental health and addictions inpatient hospital in Canada. We conducted and audiotaped semistructured focus groups and transcribed the discussions. Interpretive phenomenological analysis and thematic coding generated a coding scheme from which to identify concepts and linkages in the data., Results: Analysis generated four primary themes: interpersonal relationships, personal identity, mental health toll and potential moral injury. A variety of subthemes were identified, including family dynamics, inability to trust, feelings of professional/personal betrayal, stigma within the CAF/PSP culture, increased negative emotions about self/others, and a reliance on comradery within the service., Conclusion: The information gathered is critical to understanding the perspectives of PSP and military members as the career stressors and related exposure to PPTE of these occupations are unique., Competing Interests: The authors have no conflicts of interest to disclose.

Introduction: Household food insecurity (HFI) is a persistent public health issue in Canada that may have disproportionately affected certain subgroups of the population during the COVID-19 pandemic. The purpose of this systematic review is to report on the prevalence of HFI in the Canadian general population and in subpopulations after the declaration of the COVID-19 pandemic in March 2020., Methods: Sixteen databases were searched from 1 March 2020 to 5 May 2021. Abstract and full-text screening was conducted by one reviewer and the inclusions verified by a second reviewer. Only studies that reported on the prevalence of HFI in Canadian households were included. Data extraction, risk of bias and certainty of the evidence assessments were conducted by two reviewers., Results: Of 8986 studies identified in the search, four studies, three of which collected data in April and May 2020, were included. The evidence concerning the prevalence of HFI during the COVID-19 pandemic is very uncertain. The prevalence of HFI (marginal to severe) ranged from 14% to 17% in the general population. Working-age populations aged 18 to 44 years had higher HFI (range: 18%-23%) than adults aged 60+ years (5%-11%). Some of the highest HFI prevalence was observed among households with children (range: 19%-22%), those who had lost their jobs or stopped working due to COVID-19 (24%-39%) and those with job insecurity (26%)., Conclusion: The evidence suggests that the COVID-19 pandemic may have slightly increased total household food insecurity in Canada during the COVID-19 pandemic, especially in populations that were already vulnerable to HFI. There is a need to continue to monitor HFI in Canada., Competing Interests: The authors have no conflicts of interest.

Competing Interests: Tracie O. Afifi is an Associate Scientific Editor with the HPCDP Journal, but has recused herself from the review process for this commentary. The authors have no conflicts of interest.

Introduction: Since the outbreak of COVID-19, numerous studies from around the world have reported declines in mental health. However, most of these studies were of low-to-moderate quality and many were based on convenience samples or used mental health measures with low validity, or both. Consequently, it has been difficult to draw conclusions., Methods: Both the 2020 Survey on COVID-19 and Mental Health (SCMH) and the Canadian Community Health Survey (CCHS) (2015-2019) used the Patient Health Questionnaire-9 to screen for major depressive disorder (MDD) in adults aged 18 or older. The prevalence of MDD was compared between the SCMH and the CCHS. Risk and protective factors for MDD in the SCMH were examined using bivariate and logistic regression analyses., Results: Based on SCMH data, 15.2% (95% CI: 14.2-16.2) of Canadians screened positive for MDD. The prevalence of MDD was more than two times higher in the SCMH (during COVID-19) than in the CCHS (predating COVID-19). In bivariate analysis, Canadians reporting five or more COVID-19-related risk factors were close to 30 times more likely to have MDD than those reporting no risk factors. Mastery and a sense of community belonging were protective factors for MDD., Conclusion: After remaining stable for two decades, the prevalence of depression among Canadians increased substantially with the onset of COVID-19. Ongoing monitoring of this common condition associated with major morbidity is vital to determine if elevated levels of MDD persist as we progress through and beyond future waves of COVID-19., Competing Interests: The authors have no conflicts of interest.

This article provides an overview of the integrative medicine approach in pediatric oncology that combines conventional medicine with complementary therapies. As a practice example, the division of pediatric oncology from the Children's Hospital St. Gallen describes their use and experience of two different methods of integrative medicine on a daily basis. However, this review article also shows the lack of studies dedicated to integrative medicine in pediatric oncology, particularly regarding efficacy and safety of the different applications., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Introduction: Ongoing surveillance of youth substance use is essential to quantify harms and to identify populations at higher risk. In the Canadian context, historical and structural injustices make monitoring excess risk among Indigenous youth particularly important. This study updated national prevalence rates of tobacco, alcohol, and marijuana use among Indigenous and non-Indigenous students., Methods: Differences in tobacco, alcohol, and marijuana use were examined, using logistic regression, among 1700 Indigenous and 22 800 non-Indigenous youth in Grades 9-12 who participated in the 2014/15 Canadian Student Tobacco, Alcohol and Drugs Survey. Differences by sex were also examined. Mean age of first alcohol and marijuana use was compared in the two populations using OLS regression. Results were compared to 2008/09 data., Results: While smoking, alcohol, and marijuana rates have decreased compared to 2008/09 in both populations, the gap between the populations has mostly not. In 2014/15, Indigenous youth had higher odds of smoking (odds ratio [OR]: 5.26; 95% confidence interval [CI]: 3.54-7.81) and past-year drinking (OR: 1.43; 95% CI: 1.16- 1.76) than non-Indigenous youth. More Indigenous than non-Indigenous youth attempted quitting smoking. Non-Indigenous males were less likely to have had at least one drink in the past-year compared to non-Indigenous females. Indigenous males and females had higher odds of past-year marijuana use than non-Indigenous males (OR: 1.84; 95% CI: 1.32-2.56) and females (OR: 2.87; 95% CI: 2.15-3.84). Indigenous youth, especially males, drank alcohol and used marijuana at younger ages., Conclusion: Additional policies and programs are required to help Indigenous youth be successful in their attempts to quit smoking, and to address high rates of alcohol and marijuana use., Competing Interests: The authors have no conflict of interest to disclose.

Guidelines play a central role in clinical practice, but their development often does not meet trustworthiness standards, which makes them vulnerable to conflict of interest. Additional problems -include their insufficient updating, and current formats that do not support shared decision-making. To address these issues, we have created the Rapid Recommendations, in collaboration with the British -Medical Journal. In this innovative approach, we a) identify new practice-changing evidence ; b) incorporate them in updated -systematics reviews in about 45 days ; c) gather an international and unconflicted panel including patients and d) publish trust-worthy recommendation in about 90 days, along with new multilayered evidence summaries and tools that facilitate shared decision-making., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article. T. Agoritsas, R. Siemieniuk, A. Fog Heen, L. Lytvyn, G. Guyatt et P. O. Vandvik sont membres du groupe GRADE, et de MAGIC (http://magicproject.org). T. Agoritsas est éditeur pour l’American College of Physician Journal Club/EvidenceAlerts. G. Guyatt est consultant pour UpToDate.

The nature of Canada's opioid crisis necessitates additional data sources that can provide a more comprehensive picture of the epidemic, in order to provide public health officials and decision-makers with a robust evidence base. Paramedic data provide a conduit into the community where overdoses occur. Prehospital events and circumstances surrounding opioid-related overdoses provide unique opportunities to collect evidence that can contribute to prevention, harm reduction and health promotion efforts. Using data extracted from the Ottawa Paramedic Service (OPS), this proof-of-concept study demonstrated that paramedic response data were useful in providing near real-time epidemiological information (person, time and place) on the opioid epidemic and in assessing trends and opportunities to develop alert triggers. Between January and June 2017, the OPS responded to an average of four opioid-related calls each week. On average, 0.5 mg of naloxone was administered each time. For the study period, linear trends show a small but insignificant increase in calls (p = 0.18). A higher volume of calls occurred between April 16 and 29, 2017. According to local media reports, this spike in paramedic responses was due to the arrival of high-grade fentanyl in Ottawa. With further validation, paramedic data can potentially provide a novel data source to monitor opioid-related overdoses.

Introduction: There is little research done on mental health among pregnant Aboriginal women. Therefore, the purpose of the study was to examine the prevalence of postpartum depression (PPD) and its determinants, including pre-existing depression among non-Aboriginal and Aboriginal women in Canada., Methods: The Maternity Experiences Survey (MES) is a national survey of Canadian women's experiences and practices before conception, up to the early months of parenthood. Predictors of PPD were calculated using the Mantel-Haenszel correction method relative to the risk estimates based on the odds ratio from adjusted regression analysis. The analysis was conducted among women who self-identified as Aboriginal (Inuit, Métis or First Nations living off-reserve) and those who identified as non-Aboriginal., Results: The prevalence of pre-existing depression was higher among self-reported First Nations off-reserve and Métis women than non-Aboriginal women. Inuit women had the lowest prevalence of self-reported pre-existing depression, and Aboriginal women reported a higher prevalence of PPD than non-Aboriginal women. Pre-existing depression was not a predictor for PPD for Inuit or Métis women in this study but was a positive predictor among First Nations off-reserve and non-Aboriginal women. A disproportionally higher number of Aboriginal women reported experiencing abuse, as compared to non-Aboriginal women., Conclusion: Our study demonstrated that common predictors of PPD including anxiety, experiencing stressful life events during pregnancy, having low levels of social support, and a previous history of depression were consistent among non-Aboriginal women. However, with the exception of the number of stressful events among First Nations offreserve, these were not associated with PPD among Aboriginal women. This information can be used to further increase awareness of mental health indicators among Aboriginal women., Competing Interests: The authors have no conflicts of interest to disclose.

Introduction: South Asians have a higher than average risk of developing type 2 diabetes. We ascertained the effectiveness of CANRISK, an existing diabetes risk assessment tool, examining its sensitivity and specificity at two different predetermined scoring cut-off points comparing those participants under the age of 40 and those 40 and over. We examined the predictive ability of a model based on CANRISK variables, comparing ethno-specific body mass index (BMI) and waist circumference (WC) cut-off points with the original BMI and WC cut-off points to see if predictive ability could be improved for this population., Methods: Canadian South Asians of unknown diabetes status, age 18 to 78, were recruited across seven provinces from various community or health centers. CANRISK variables were collected followed by oral glucose tolerance testing. Descriptive analysis, logistic regression including alternative ethno-specific BMI and WC cut-off points, and sensitivity and specificity analyses were performed., Results: 832 participants were recruited (584 under age 40). Using the entire study sample, logistic regression models including CANRISK variables predicted dysglycemia effectively (AUC of 0.80). However, by using alternative BMI/WC cut-off points with the scoring algorithm, predictive power via AUC was not improved. Sensitivity and specificity of CANRISK using the original pre-determined "high risk" cut-off point of 33 points in individuals age 40 years or over were 93% and 35%, respectively; in individuals under 40, these were 33% and 92%, respectively. Using the lower pre-determined "moderate risk" cut-off point of 21 points improved the sensitivity to 77% and specificity to 53% in the younger age group., Conclusion: The existing CANRISK is an adequate risk assessment tool for dysglycemia in Canadian South Asians for those age 40 years and over; however, the tool does not work as well for individuals under 40. The lower cut-off of 21 points may be warranted for younger individuals to minimize false negatives. Ethno-specific BMI/WC cutoff points did not improve predictive ability of the CANRISK scoring algorithm as measured by AUC., Competing Interests: Dr. Gina Agarwal was commissioned to lead this project by the Applied Research Division of the Health Promotion and Chronic Disease Prevention Branch of the Public Health Agency of Canada.

The National Collaborating Centres for Public Health (NCCPH) collaborated on the development of an action framework for integrating equity into population health status reporting. This framework integrates the research literature with on-the-ground experience collected using a unique collaborative learning approach with public health practitioners from across Canada. This article introduces the Action Framework, describes the learning process, and then situates population health status reporting (PHSR) in the current work of the public health sector. This is followed by a discussion of the nature of evidence related to the social determinants of health as a key aspect of deciding what and how to report. Finally, the connection is made between data and implementation by exploring the concept of actionable information and detailing the Action Framework for equity-integrated population health status reporting. The article concludes with a discussion of the importance of putting knowledge mobilization at the core of the PHSR process and makes suggestions for next steps. The purpose of the article is to encourage practitioners to use, discuss, and ultimately strengthen the framework., Competing Interests: The authors declare that they have no competing interests.

Introduction: First Nations/Métis populations develop diabetes earlier and at higher rates than other Canadians. The Canadian diabetes risk questionnaire (CANRISK) was developed as a diabetes screening tool for Canadians aged 40 years or over. The primary aim of this paper is to assess the effectiveness of the existing CANRISK tool and risk scores in detecting dysglycemia in First Nations/Métis participants, including among those under the age of 40. A secondary aim was to determine whether alternative waist circumference (WC) and body mass index (BMI) cut-off points improved the predictive ability of logistic regression models using CANRISK variables to predict dysglycemia., Methods: Information from a self-administered CANRISK questionnaire, anthropometric measurements, and results of a standard oral glucose tolerance test (OGTT) were collected from First Nations and Métis participants (n = 1479). Sensitivity and specificity of CANRISK scores using published risk score cut-off points were calculated. Logistic regression was conducted with alternative ethnicity-specific BMI and WC cut-off points to predict dysglycemia using CANRISK variables., Results: Compared with OGTT results, using a CANRISK score cut-off point of 33, the sensitivity and specificity of CANRISK was 68% and 63% among individuals aged 40 or over; it was 27% and 87%, respectively among those under 40. Using a lower cut-off point of 21, the sensitivity for individuals under 40 improved to 77% with a specificity of 44%. Though specificity at this threshold was low, the higher level of sensitivity reflects the importance of the identification of high risk individuals in this population. Despite altered cut-off points of BMI and WC, logistic regression models demonstrated similar predictive ability., Conclusion: CANRISK functioned well as a preliminary step for diabetes screening in a broad age range of First Nations and Métis in Canada, with an adjusted CANRISK cutoff point for individuals under 40, and with no incremental improvement from using alternative BMI/WC cut-off points., Competing Interests: Dr. Gina Agarwal was contracted to lead this project by the Science Integration Division of the Public Health Agency of Canada. Research ethics board approval was obtained from each of the regions in which data were collected and from the Health Canada/Public Health Agency of Canada Research Ethics Board. The authors declare no conflict of interest.

Introduction: Osteoporosis prevention is heavily reliant on education programs, which are most effective when tailored to their intended audience. Most osteoporosis prevention education is designed for older adults, making application of these programs to younger adults difficult. Designing programs for young adults requires understanding the information-seeking practices of young adults, so that knowledge about osteoporosis can be effectively translated., Methods: Individual interviews were conducted with 60 men and women-multiethnic, Canadian young adults-to explore both the sources and types of information they search for when seeking information on nutrition or bone health., Results: The results of this study raised themes related to the sources participants use, to their interests and to ways of engaging young adults. Prevention programs should make use of traditional sources, such as peers, family members and medical professionals, as well as emerging technologies, such as social media. Choice of sources was related to the perceived authority of and trust associated with the source. Messaging should relate to young adult interests, such as fitness and food-topics on which young adults are already seeking information-rather than being embedded within specific osteoporosis awareness materials. Engaging young adults means using relatable messages that are short and encourage small changes. Small gender-based differences were found in the information-seeking interests of participants. Differences related to age were not examined., Conclusion: Creating short, action-oriented messages that are designed to encourage small changes in behaviour and are packaged with information that young adults are actively seeking is more likely to result in active engagement in prevention behaviours., Competing Interests: The author declares no conflicts of interest.

Introduction: This study describes the use of prescription medications and psychological counselling in the past 12 months among Canadian adults with a self-reported mood and/or anxiety disorder diagnosis; the sociodemographic and clinical characteristics associated with their use; and reasons for not using them., Methods: We used data from the 2014 Survey on Living with Chronic Diseases in Canada-Mood and Anxiety Disorders Component. The study sample (n = 2916) was divided into four treatment subgroups: (1) taking medication only; (2) having received counselling only; (3) both; or (4) neither. We combined the first three subgroups and carried out descriptive and multivariate logistic regression analyses comparing those who are taking medication and/or have received counselling in the past 12 months, versus those doing neither. Estimates were weighted to represent the Canadian adult household population living in the 10 provinces with diagnosed mood and/or anxiety disorders., Results: The majority (81.8%) of Canadians with a mood and/or an anxiety disorder diagnosis reported they are taking medications and/or have received counselling (47.6% taking medications only; 6.9% received counselling only; and 27.3% taking/having received both). Upon controlling for individual characteristics, taking medications and/or having received counselling was significantly associated with older age; higher household income; living in the Atlantic region or Quebec versus Ontario; and having concurrent disorders or mood disorders only. Symptoms controlled without medication was the most common reason for not taking medications, while preferring to manage on their own and taking medications were among the common reasons for not having received counselling., Conclusion: The majority of Canadian adults with a mood and/or an anxiety disorder diagnosis are taking medications, while few have received counselling. Insights gained regarding the factors associated with these treatments, and reasons for not using them, emphasize the importance of discussing treatment options and perceived barriers with patients to ensure they receive the best treatment according to their needs and preference., Competing Interests: The authors declare no conflict of interest. No external financial or material support was obtained for this study.

Introduction: The Public Health Agency of Canada adapted a Finnish diabetes screening tool (FINDRISC) to create a tool (CANRISK) tailored to Canada's multi-ethnic population. CANRISK was developed using data collected in seven Canadian provinces. In an effort to extend the applicability of CANRISK to northern territorial populations, we completed a study with the mainly Inuit population in the Kitikmeot region of Nunavut., Methods: We obtained CANRISK questionnaires, physical measures and blood samples from participants in five Nunavut communities in Kitikmeot. We used logistic regression to test model fit using the original CANRISK risk factors for dysglycemia (prediabetes and diabetes). Dysglycemia was assessed using fasting plasma glucose (FPG) alone and/or oral glucose tolerance test. We generated participants' CANRISK scores to test the functioning of this tool in the Inuit population., Results: A total of 303 individuals participated in the study. Half were aged less than 45 years, two-thirds were female and 84% were Inuit. A total of 18% had prediabetes, and an additional 4% had undiagnosed diabetes. The odds of having dysglycemia rose exponentially with age, while the relationship with BMI was U-shaped. Compared with lab test results, using a cut-off point of 32 the CANRISK tool achieved a sensitivity of 61%, a specificity of 66%, a positive predictive value of 34% and an accuracy rate of 65%., Conclusion: The CANRISK tool achieved a similar accuracy in detecting dysglycemia in this mainly Inuit population as it did in a multi-ethnic sample of Canadians. We found the CANRISK tool to be adaptable to the Kitikmeot region, and more generally to Nunavut.