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

Objective: For First Nations people and Inuit who live on reserves or in rural and remote areas, a guideline requires their travel to urban centres once their pregnancy reaches 36-38 weeks gestation age to await labour and birth. While not encoded in Canadian legislation, this guideline-and invisible policy-is reinforced by the lack of alternatives. Research has repeatedly demonstrated the harm of obstetric evacuation, causing emotional, physical, and financial stress for pregnant and postpartum Indigenous women and people. Our objective was to describe the costs of obstetric evacuation, as reported in the literature.

Methods: We conducted a systematic review using online searches of electronic databases (Ovid EMBASE, CINAHL, Ovid Healthstar, PubMed, ScienceDirect, PROSPERO, and Cochrane Database of Systematic Reviews) and identified studies that reported costs related to medical evacuation or transportation in rural and remote Indigenous communities. We performed critical appraisal of relevant studies.

Synthesis: We identified 19 studies that met the inclusion criteria. The studies reported various types of cost, including direct, indirect, and intangible costs. Medical evacuation costs ranged from CAD $7714 to CAD $31,794. Indirect and intangible costs were identified, including lost income and lack of respect for cultural practices.

Conclusion: Costs associated with obstetric evacuation are high, with medical evacuation as the most expensive direct cost identified. Although we were able to identify a range of costs, information on financing and funding flows was unclear. Across Canada, additional research is required to understand the direct costs of obstetric evacuation to Indigenous Peoples and communities.

The 2021 federal budget committed funding to a co-sponsored Statistics Canada and Environment and Climate Change Canada initiative aimed at conducting a 'census' of Canadian environments. The goal of the Census of Environment (CoE) is "to deliver a full picture of the complex relationship between ecosystems and the economy, society, and human well-being", with obvious implications for the ongoing monitoring and surveillance of environmental influence on human health. This commentary reflects on the evolution of the CoE initiative in describing two opportunities for population and public health researchers, practitioners, and policy-makers in engaging with the CoE and its data. First, it describes stated CoE commitments to enhancing access to complex environmental data and the provision of data processing to support novel analyses and data utilization. Second, it highlights the relative importance of disaggregating environmental data across a variety of bio-geographical scales to engender a holistic understanding of the health of multiple elements that comprise living systems, including consideration of environmental health equity and intersectoral action. It ends with a constructive critique of the CoE's framing of 'ecosystem accounting' to support its maturation, and advocates for public health involvement in centring the importance of health in this initiative into the future.

The recent surge in anti-trans laws and policies in Canada and the United States has important public health implications, particularly for trans and gender-expansive (TGE) youth. This legislation has the potential to exacerbate minority stress experienced by TGE youth, who already experience higher rates of depression, anxiety, and suicide than their cisgender peers. Social gender affirmation, including respecting affirmed names and pronouns, can reduce the risk of adverse mental health outcomes in TGE youth. However, recent laws requiring parental consent for affirmed names and pronouns in schools can cause additional distress and harm for TGE youth, especially those who lack family support. Public health professionals have a critical role to play in countering the harmful effects of anti-trans legislation by better understanding TGE youth and their needs, advocating for trans rights, supporting trans-led community organizations, and strengthening trans-affirming mental health services.

Objectives: Experiences of discrimination reported during pregnancy are common and are associated with poor mental health and adverse birth outcomes. No Canadian studies have investigated interpersonal discrimination during pregnancy. This study aimed to quantify and identify lived-experiences of discrimination in a Canadian cohort of pregnant individuals, and examine associations with concurrent prenatal anxiety and depression symptoms.

Methods: Pregnant individuals from the pan-Canadian Pregnancy During the Pandemic (PdP) study (n = 1943) completed the Everyday Discrimination Scale (EDS), demographic measures and self-report measures of depression and anxiety symptoms. Descriptive statistics and ANCOVA were used to assess prevalence of discrimination and associated mental health outcomes. Open-text responses (n = 189) to a question investigating reasons for discrimination were analyzed using conventional content analysis.

Results: Approximately three quarters (72%) of pregnant individuals experienced at least one instance of discrimination during their pregnancy or within the year prior. Pregnant individuals experiencing more frequent and/or more types of discrimination were more likely to identify as non-white, not be partnered, have lower socioeconomic status, and have a pre-pregnancy history of anxiety and depression. The most common attributions for interpersonal discrimination were gender, age, and education/income level. Pregnant individuals who experienced more frequent discrimination and/or more types of discrimination were more likely to report clinically significant symptoms of depression and anxiety (n = 623; 35.2% and 49.1%, respectively) compared to those who reported no discrimination (n = 539; 11.5% and 19.1%, respectively). Conventional content analysis of open-text responses generated the following main themes: (1) personal attributes and sociodemographic characteristics, (2) occupation, (3) the COVID-19 pandemic, (4) pregnancy and parenting, and (5) causes outside the self.

Conclusion: Frequent discrimination was associated with more adverse concurrent mental health symptoms. Understanding experiences of discrimination can inform interventions that better address the needs of pregnant individuals and their infants.

Setting: Public health measures enacted during the COVID-19 pandemic significantly impacted Nova Scotians experiencing food insecurity. Public Health (PH), Nova Scotia Health, created a provincial Housing Isolation Program (HIP) which addressed barriers to isolation, including food access, for COVID-19 cases and contacts being followed by PH.

Intervention: HIP worked with partners to coordinate and respond to urgent food needs of isolating clients by providing grocery and meal delivery options. HIP also made referrals to government and community partners for income and food supports. This program was intended to minimize the spread of COVID-19 by facilitating isolation while meeting basic needs for people with no other means of support.

Outcomes: From December 2020 to March 2022, HIP completed grocery and meal deliveries for 579 clients, 1351 referrals to a provincial Income Support Program, and 231 referrals to external food supports. HIP staff worked with clients to manage potential perceptions of stigma. Challenges reported included the urgency of food needs, lack of social supports, and availability and accessibility constraints in rural communities, as well as difficulty accessing culturally appropriate foods and special diets.

Implications: This intervention demonstrates the importance of addressing food insecurity during emergency preparedness, planning, and response. During emergencies, planning and mobilizing food access requires an equity-oriented approach to overcome stigma. Broadly, continued reliance on charitable responses creates significant vulnerability during emergencies and addressing root causes of food insecurity through social policy will provide longer-term protection.

The celebrated 1980 announcement that smallpox had been eradicated was made using the following definition of eradication: "Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts: intervention measures are no longer needed." Public health around the world works with this definition of "eradication," setting it as a goal for other infectious disease control programs. The definition is simple. Its application, however, has produced long-running and complex public health campaigns that threaten the commitment of funders, health care providers, and governments. In this paper, the authors demonstrate the disease-specific challenges of eradication through the example of the Global Polio Eradication Initiative (GPEI). While many deem eradication worth its high costs because it is the end of morbidity and mortality from a disease, it does not mean the end of disease control efforts. Public health must be prepared for the possibility of disease reoccurrence in the form of undetected natural reservoirs of disease, lab leaks from stored samples, bioterror attacks using stolen samples, and the synthetic recreation of microbes. This paper clarifies the role of reoccurrence prevention in eradication, calling for its addition in the definition of eradication.

Setting: In Canada, racialized and immigrant women are typically under-screened for breast and cervical cancer. Under-screening is linked to numerous barriers to access, including lack of awareness, fear of pain, the stigma of cancer, socio-cultural factors like language, and various socio-economic factors. To address these barriers, our team developed a series of initiatives to promote awareness of breast and cervical health among Black women.

Intervention: Building on the development of a breast cancer resource hub for Black women, and in partnership with relevant community organizations, we implemented a series of virtual educational and cancer screening events (two of each thus far). Both event series were targeted towards Black women and tailored to their needs.

Outcomes: Each educational event attracted more than 450 attendees and had average attendance times > 1 h. Most (> 87%) survey respondents agreed that an event specifically for Black women helped them feel supported. The 2022 and 2023 screening events provided breast and/or cervical cancer screening for 46 and 48 women, respectively. In both years, most women (> 90% of question respondents) noted that they were (extremely) likely to go for a mammogram or Pap test when next due.

Implications: Both event series provided targeted opportunities for Black women to learn about prevention, risk factors, resources, and screening related to women's cancers. It is possible that, over time, such culturally tailored events can reduce or remove the stigmas associated with cancer and decrease differences in cancer-related knowledge and behaviours between racialized and non-racialized groups.

Objectives: The behavioural sciences provide useful evidence to design effective health promotion interventions, but evidence is infrequently integrated in practice. This study examined associations between theoretical domains framework (TDF) constructs and public health practitioners' use of behavioural science evidence to plan public health actions.

Methods: Using a cross-sectional design, a convenience sample of 160 practitioners were recruited from public health agencies across Canada. Respondents completed an online questionnaire assessing TDF constructs and the use of behavioural science theory and approaches (i.e., evidence) in their practice. Logistic regression analyses allowed for identification of factors associated with evidence use and intentions. All analyses were adjusted for sex, years of experience, and type of public health agency.

Results: Greater skills (OR_adj = 4.1, 95%CI 1.3, 13.5) and stronger intentions/aligned goals (OR_adj = 9.2, 95%CI 2.3, 36.1) were associated with greater use of behavioural science evidence to plan public health actions. Greater perceived capacity to overcome widespread absence of use of behavioural science evidence in their organization (OR_adj = 7.2, 95%CI 1.7, 30.3) was also associated with greater use. More knowledge (OR_adj = 8.6, 95%CI 1.9, 39.1) and stronger beliefs about consequences (OR_adj = 4.0, 95%CI 1.1, 14.7) were significantly associated with stronger intentions/aligned goals.

Conclusion: Findings show that more knowledge, positive attitudes, and stronger perceived competence are associated with greater likelihood of using behavioural science evidence to plan interventions. The use of behavioural science evidence will also require strengthening the norm pertaining to this professional practice in public health organizations.