Canadian Journal of Public Health-Revue Canadienne De Sante Publique最新文献

Objective: Transportation is a critical health determinant, yet the last decade has witnessed rapid disinvestment across Canada (particularly in rural contexts) with negative health consequences. We sought to explore and describe the benefits and challenges faced in operating the first community-driven free-transportation scheme in Saskatchewan that emerged in response to widespread unavailability of public transportation due to budget cuts (austerity).

Methods: We conducted a mixed-methods community-based participatory research study involving 22 interviews with bus riders and service administrators. We also performed descriptive statistics and chi-squared analyses on bus rider data (data on 1185 trips routinely collected between July 2023 and December 2023) to explore sociodemographic characteristics and trip purposes of bus riders.

Results: All trips were completed by 616 community members using the free bus service between July 2023 and December 2023. Community members took an average of 5 trips (median = 2.0) with a maximum of 22 trips being taken by one community member (1.9% of all trips). Most trips were by women (53%), and older adults mostly used the free bus for medical purposes (22% of riders were older adults and 34% of these used the bus for medical reasons). Qualitatively, the bus service has increased access to care and promotes social participation and autonomy, especially for older adults. The service however faces some challenges, including funding disruptions and difficulty recruiting and retaining drivers.

Conclusion: Free inter-community transportation (i.e. transportation across cities and municipalities) promotes health equity and access. In contexts without access to public transportation, governments could support community-driven initiatives through increased funding.

Setting: Despite Canada's single-payer health system, marginalized populations often experience poor health outcomes and barriers to healthcare access. In response, mobile health clinics (MHCs) have been deployed in several cities across Canada. MHCs are well established in the United States; however, little is known about their role and impact in a country with universal healthcare. We describe the implementation of an urban MHC and early learnings from a mixed methods process and outcome-oriented evaluation.

Intervention: In February 2021, Parkdale Queen West Community Health Centre, TELUS Health for Good, and University Health Network's Gattuso Centre for Social Medicine partnered to launch a nurse practitioner‒led, community-based MHC in Toronto, Ontario. The MHC provides low-barrier primary healthcare, harm reduction, and mental health services at five convenient locations.

Outcomes: Through an intercept survey (n = 49) and semi-structured interviews (n = 10), we sought to understand the sociodemographic characteristics of clients, their experiences at the MHC, and barriers and facilitators to the MHC in comparison to traditional healthcare settings. Most clients surveyed reported being homeless (61%). Without the MHC, 37% of clients would have accessed care at an emergency department and 18% would not have sought care. Thematic analysis revealed two structural and two relational factors that improved care experiences and care access.

Implications: We demonstrate that in a single-payer health system, MHCs alleviate major barriers to care access for marginalized populations. Learnings provide context to the most salient factors influencing clients' decisions to seek care at MHCs and can inform how these outreach models are designed.

Objective: Our study investigates the efforts of local medical health officers during COVID-19 in Canada, with a focus on explicating enabling factors and barriers to effectively respond through local public health efforts.

Methods: We conducted 26 semi-structured interviews with local-level public health leadership from across Canada and analyzed the transcripts for salient facilitators and barriers to effective local public health practice using the Consolidated Framework for Implementation Research.

Results: Effective local-level public health practice was facilitated by efforts that potentiated synergistic efforts inside and outside of the public health sector, including trust, buy-in, and ample resources. Barriers to effective practice involved uncertainty associated with governance, human resources, and the complexity of the pandemic itself.

Conclusion: Sustained coordinated efforts across organizations together with clear governance mandates are required for robust local emergency management.

Objective: Fist fighting among hockey players is thought to have long-term impacts on health. Because of methodological concerns of previous studies, we undertook a retrospective cohort study among retired National Hockey League (NHL) players to estimate rates of all-cause mortality according to the cumulative number of fights in their careers.

Methods: The cohort comprised male hockey players, excluding goaltenders, who played in the NHL from 1967 to 2022. We compiled their birth and death data, body mass index at entry, and other characteristics of playing. We used the proportional hazards model, with age at retirement as the time axis, to estimate mortality rates through July 31, 2024, in relation to the total number of fights in the NHL. Hazard ratios (HR) were adjusted for body mass index and year starting in the NHL. Mean survival after retirement by fighting status was also computed.

Results: Among the 5411 retired players, 407 had died, 2082 (38.5%) never fought, and 759 (14.0%) fought ≥ 30 times. We found a positive linear response between the total number of fights and the risk of mortality: the adjusted HR per 10 fights was 1.04 (95% CI, 1.01, 1.07). Using this estimate, compared to non-fighters, the HR for five fights was 1.02 (95% CI, 1.00, 1.03), and for 50 fights it was 1.20 (95% CI, 1.02, 1.41). The mean loss of survival among those who fought ≥ 10 times compared with ≤ 1 time was 2.5, 2.1, and 1.5 years for those who started playing in 1970, 1980, and 1992, respectively.

Conclusion: Our findings suggest that fighting in NHL games increases rates of mortality post-retirement, but that these impacts are substantially less than reported previously. We recommend that the NHL establish standardized methods for collecting fight data to more accurately capture the lifetime fighting history and its associated health impacts for its players.

Objective: Social and economic marginalizations have been associated with inferior health outcomes in Canada. Our objective was to describe the relationship between neighbourhood marginalization and COVID-19 outcomes among patients presenting to Canadian emergency departments (ED).

Methods: We conducted an observational study among consecutive COVID-19 patients recruited from 47 hospitals participating in the Canadian COVID-19 ED Rapid Response Network (CCEDRRN) between March 3, 2020, and July 24, 2022. We linked data with the Canadian Marginalization Index (CAN-Marg). We used multivariable, multi-level logistic regression models to understand the association between dimensions of neighbourhood marginalization, and severe COVID-19 and in-hospital mortality.

Results: There were 55,588 eligible patients. Those from neighbourhoods with a higher proportion of recent immigrants (OR = 0.86 per unit increase [0.81, 0.92]), lower workforce participation (OR = 0.84 per unit increase [0.75, 0.94]), and more housing insecurity (OR = 0.81 per unit increase [0.77, 0.86]) were less likely to present to EDs with severe COVID-19. However, patients from materially marginalized neighbourhoods had increased odds of dying in hospital (OR = 1.19 per unit increase [95% CI 1.09, 1.30]) compared to patients from less materially marginalized neighbourhoods. Patients living in neighbourhoods with a higher proportion of recent immigrants (OR = 0.83 per unit increase [0.78, 0.91]) and lower participation in the workforce (OR = 0.77 per unit increase [0.66, 0.87]) experienced lower odds of dying.

Conclusion: Despite no association with severe COVID-19 at ED presentation, the only marginalization domain associated with in-hospital mortality was material deprivation. Our findings present insights on ED-seeking behaviour, hospital access, and care that population studies could not.

Objective: The COVID-19 pandemic disrupted the seasonal transmission pattern of respiratory syncytial virus (RSV), challenging the launch of palivizumab immunization campaigns. This study explored the performance of the moving epidemic method (MEM) to guide the launch of such campaigns.

Methods: Data were collected through a continuous RSV surveillance system (07/2013‒03/2022) in Québec, Canada. Two strategies were compared: (1) a "preestablished" approach according to which each annual campaign began on November 1 and ended upon the earliest week with an RSV positivity rate ≤ 10% after March 31; and (2) MEM, according to which each annual campaign began and ended upon meeting an epidemic threshold of RSV positivity. We estimated the proportion of RSV cases that would be covered depending on the approach used for each RSV epidemic.

Results: From seasons 2013-2014 through 2019-2020, RSV cases peaked between weeks 1 and 8, and all epidemic curves overlapped with an intraclass correlation coefficient (ICC) of 0.83. From 2013-2014 through 2019-2020, the epidemic periods determined by MEM and the preestablished approach covered similar proportions of RSV cases (MEM = 91.6%, preestablished = 90.7%) and had a similar duration (MEM = 21.3 weeks, preestablished = 21.7 weeks). With MEM, the 2021-2022 epidemic period started at week 29 and ended at week 51, covering 95.7% of cases. With the preestablished approach, the epidemic period started at week 44 and ended at week 8, covering 28.3% of cases.

Conclusion: During normal RSV seasons, MEM is an effective alternative to the preestablished approach. However, MEM appears significantly more robust to disruptions of RSV's seasonal pattern.

Objectives: The burden of acute gastrointestinal illness (AGI) attributable to natural water recreation in Canada is unknown. Understanding the burden can help prioritize public health interventions and resource allocation for reduction of disease. Our objectives were to compile estimates of AGI burden associated with natural water recreation, identify knowledge gaps in water recreation epidemiology, and evaluate methods applicable for developing a burden estimate for Canada.

Methods: We conducted a scoping review of the literature. From a total of 2752 unique records identified, 35 met eligibility for inclusion. Articles were chosen if they examined burden in natural waterways, were written in English, and were based in countries of similar economic status to Canada in non-tropical regions. Burden was defined as either: incidence or prevalence, disability-adjusted life years (DALYs), quality-adjusted life years (QALYs), or economic cost.

Results: Swimming or wading were the predominant forms of recreation examined (n = 32/35; 91.4%). Waterways studied were primarily marine or coastal beaches (n = 24/35; 68.6%) and were located within or adjacent to urban areas (n = 29/35; 82.9%). The most common indicator for burden was incidence or prevalence (n = 30/35; 85.7%). Prospective cohort studies (n = 17/35; 48.6%) and predictive modelling based on microorganism concentrations (n = 9/35; 25.7%) were the most common methods of estimation.

Conclusion: The review highlighted several knowledge gaps regarding recreational waterborne disease burden. Freshwater recreation, rural waterways, and recreational activities other than swimming and wading require further study. We propose that quantitative microbial risk assessment may be an appropriate, cost-effective method to estimate recreational waterborne disease burden in Canada.

Objectives: This study sought to compare one-step versus two-step testing approaches for gestational diabetes mellitus (GDM) and to investigate the associations between testing approach, degree of glucose impairment, and perinatal outcomes.

Methods: A retrospective population-based cohort study was conducted by combining BC's Perinatal Data Registry with laboratory and billing information from 2010 to 2014. Pregnancy characteristics were compared by GDM testing approach. Logistic regression was conducted to determine the association between testing approach, degree of glucose impairment, and outcomes.

Results: Approximately 17% of pregnant individuals were diagnosed with GDM using the one-step test, compared to 6% using the two-step test. The odds ratios of adverse outcomes were below 1.75 for GDM pregnancies regardless of testing approach used (compared to the group with negative results on the two-step test). A dose-dependent trend was observed between increasing glucose intolerance and odds of preterm birth. The odds of large for gestational age infants (LGA) and shoulder dystocia were significantly higher when all 75 g test values were within one standard deviation below one-step diagnostic thresholds (adjOR 1.94[1.73-2.17] and 1.85[1.55-2.21], respectively).

Conclusion: The frequency of GDM was three times higher with the use of the one-step test versus the two-step test. Abnormal results on the two-step test are associated with preterm birth at an odds ratio below 1.75. Pregnant individuals with one-step test results just below diagnostic criteria may be at greater odds for LGA. The benefits of more stringent testing practices need to be weighed against the impact of additional GDM diagnoses.