Search

Drug-resistant tuberculosis (TB) is a major global health challenge in part because there are fewer effective treatments and these treatments have been prolonged and more toxic. The evidence base for more effective, shorter, standardized treatments is evolving rapidly. Herein, we report the first case of pre-extensively drug-resistant pulmonary TB treated with a novel six-month all oral bedaquiline, pretomanid and linezolid (BPaL) regimen in Canada. Recent clinical trial data supporting BPaL therapy is presented in the context of current and evolving clinical guidelines. In this article, we highlight significant implementation challenges and make recommendations for what needs to be addressed to ensure safe programmatic use of BPaL in Canada. Key recommendations include the development of infrastructure for timely access to novel TB drug susceptibility testing, streamlining access to novel TB drugs, and cautious use of such drugs in collaboration with care teams with expertise in drug-resistant TB management. [ABSTRACT FROM AUTHOR]

Importance: Scanning the environment is critical for driving safety. The ScanCourse is a functional assessment that assesses a person's ability to scan the environment for visual information while in motion. Measurement properties for the ScanCourse have been reported; however, its predictive validity is unknown. Objective: To determine the predictive validity of the ScanCourse for on-road driving performance and establish clinical cutoff scores. Design: Retrospective chart reviews were conducted over a 6-mo period. Setting: Four Canadian driver rehabilitation programs. Participants: Charts from patients with neurological or vision conditions were eligible if they contained ScanCourse and on-road driving evaluation results between September 1, 2008, and August 30, 2018. Three hundred twenty-five charts were included for analysis. Outcomes and Measures: Area under the curve (AUC) analysis was used to determine the predictive validity of ScanCourse scores for on-road outcomes; cutoff scores were established by optimizing sensitivity and specificity. Results: The ScanCourse had an AUC of.702. The optimal cutoff score was 18/20 with a sensitivity of 76.7% and a specificity of 47.1%. Conclusions and Relevance: Assessing the scanning abilities of at-risk drivers who intend to return to driving after sustaining an injury can help identify safety risks and inform interventions. The ScanCourse was found to have acceptable discriminatory ability for on-road driving performance. This study provides evidence supporting its continued use as a screening tool to assess driver fitness with an identified optimal cutoff score for clinical use. What This Article Adds: Measuring the predictive ability of the ScanCourse assessment in relation to on-road driving performance provides occupational therapists with an evidence-based clinical tool to assist with screening fitness to drive among at-risk people. [ABSTRACT FROM AUTHOR]

The CAD$1 billion transformation of Toronto’s Regent Park neighbourhood from Canada’s largest public housing site to a mixed income community is likely to inform the next several decades of public housing redevelopment policy both nationally and internationally. This paper focuses on the process and impacts of large-scale redevelopment, in the context of attempts to build a physically and socially inclusive neighbourhood incorporating non-market and market housing in downtown Toronto. Drawing from in-depth interviews with 32 Regent Park community leaders and other key decision makers, the paper explores how resident engagement and leadership development opportunities impact redevelopment processes in mixed income initiatives. Results focus on three key emerging areas of both strength and concern: (1) efforts to build community alongside the redevelopment as an integral, evolving and place-specific strategy; (2) the impacts and challenges of both a strong institutional environment in Regent Park and a sense of weak institutional memory; and (3) formal and informal leadership and mentorship opportunities and their contribution towards the development of engagement and cohesion in Regent Park. The opportunity for low-income housing initiatives to support knowledge building and learning, preservation of institutional memory and local leadership development is significant in the context of examining physical and social redevelopment. [ABSTRACT FROM AUTHOR]

Background: Health Canada's Surveillance Tool (HCST) Tier System was developed in 2014 with the aim of assessing the adherence of dietary intakes with Eating Well with Canada's Food Guide (EWCFG). HCST uses a Tier system to categorize all foods into one of four Tiers based on thresholds for total fat, saturated fat, sodium, and sugar, with Tier 4 reflecting the unhealthiest and Tier 1 the healthiest foods. This study presents the first application of the HCST to examine (i) the dietary patterns of Canadian children, and (ii) the applicability and relevance of HCST as a measure of diet quality.Methods: Data were from the nationally-representative, cross-sectional Canadian Community Health Survey 2.2. A total of 13,749 participants aged 2-18 years who had complete lifestyle and 24-hour dietary recall data were examined.Results: Dietary patterns of Canadian children and adolescents demonstrated a high prevalence of Tier 4 foods within the sub-groups of processed meats and potatoes. On average, 23-31 % of daily calories were derived from "other" foods and beverages not recommended in EWCFG. However, the majority of food choices fell within the Tier 2 and 3 classifications due to lenient criteria used by the HCST for classifying foods. Adherence to the recommendations presented in the HCST was associated with closer compliance to meeting nutrient Dietary Reference Intake recommendations, however it did not relate to reduced obesity as assessed by body mass index (p > 0.05).Conclusions: EWCFG recommendations are currently not being met by most children and adolescents. Future nutrient profiling systems need to incorporate both positive and negative nutrients and an overall score. In addition, a wider range of nutrient thresholds should be considered for HCST to better capture product differences, prevent categorization of most foods as Tiers 2-3 and provide incentives for product reformulation. [ABSTRACT FROM AUTHOR]

The article focuses on the integration and relation of ecosystem health (ecohealth) and ecological medicine (ecomedicine) in veterinary medicine and education. It discusses how ecomedicine is important in the practice of veterinary medicine, and in its science as part for ecohealth. It also mentions the initiatives in Canada in ecohealth in veterinary medicine in the country.

Abstract: In Canada, there are two known regional foci where wildlife populations are infected with bovine tuberculosis (Mycobacterium bovis) and considered to be disease reservoirs. Free-ranging populations of wood bison (Bison bison athabascae) in and around Wood Buffalo National Park (WBNP) and wapiti (Cervus elaphus manitobensis) in and around Riding Mountain National Park (RMNP) are infected with bovine tuberculosis. In this paper, we provide an overview of these diseased wild ungulate populations and the complexities of attempting to manage issues relating to bovine tuberculosis in and around protected areas. We do not describe the quantitative science and epidemiological data in detail from these case histories, but instead compare and contrast these two cases from a broader perspective. This is achieved by reviewing the context and process by which a diverse group of stakeholders engage and develop strategies to address the controversial problems that diseased wildlife populations often present. We suggest that understanding the factors that drive the strategic-level management processes is equally important for addressing a wildlife disease problem as the tactical-level issues, such as design and implementation of technically sound field research and management programs. Understanding the experiences within the WBNP and RMNP areas, particularly the strategies that have failed or succeeded, may prove useful to understanding and improving management approaches when wildlife are infected with M. bovis. Applying this understanding is consistent with the principles of adaptive management in which we learn from previous experiences to develop better strategies for the future. [Copyright &y& Elsevier]

During the first half of the century, the majority of anthrax outbreaks in Canada occurred in the southern portions of Ontario and Quebec and were often associated with pastures contaminated by effluent from textile industries dealing with imported animal materials. In 1952, introduction of Federal regulations requiring disinfection of these materials greatly reduced the incidence of anthrax in eastern Canada. Since 1962, domestic outbreaks of the disease have been reported almost exclusively in cattle in the western prairie provinces. Between 1962 & 1993, nine anthrax epizootics have been recorded in the bison herds of the Northwest Territories and northern Alberta resulting in the deaths of at least 1309 animals. During the nothern epizootics there has been a strong sex bias in mortalities with the majority of carcasses being sexually mature bulls. The northern epizootics occur during drought conditions in the late summer, preceded by a wet spring, and end with the arrival of coolers weather. It has been hypothesized that stress factors associated with these meteorological conditions coupled with breeding stress during the late summer rut may predispose the bulls to infection. Alternatively, the meteorological conditions may work to concentrate anthrax spores in the environment into low lying wallows preferentially utilized by the bulls. Recent genetic analyses of Bacillus anthracis isolates from Canada and the United States have identified that, while closely related to isolates from domestic outbreaks, isolates from northern bison epizootics form their own distinct strain. This suggests that the establishment of anthrax in northern Canada was a singular event that occurred prior to the first recognized epizootic in 1962. A review of the agricultural history of northern Canada has identified several situations in the first half of the century which may have provided the opportunity for the transfer of anthrax from cattle to the indigenous bison. [ABSTRACT FROM AUTHOR]