Objectives: This study aimed to summarize validity estimates of International Classification of Diseases (ICD) codes in identifying opioid overdose (OOD) among patient data from emergency rooms, emergency medical services, inpatient, outpatient, administrative, medical claims, and mortality, and estimate the sensitivity and specificity of the algorithms in the absence of a perfect reference standard.
Methods: We systematically reviewed studies published before December 8, 2023, and identified with Medline and Embase. Studies reporting sufficient details to recreate a 2 × 2 table comparing the ICD algorithms to a reference standard in diagnosing OOD-related events were included. We used Bayesian latent class models (BLCM) to estimate the posterior sensitivity and specificity distributions of five ICD-10 algorithms and of the imperfect coroner's report review (CRR) in detecting prescription opioid-related deaths (POD) using one included study.
Results: Of a total of 1990 studies reviewed, three were included. The reported sensitivity estimates of ICD algorithms for OOD were low (range from 25.0% to 56.8%) for ICD-9 in diagnosing non-fatal OOD-related events and moderate (72% to 89%) for ICD-10 in diagnosing POD. The last included study used ICD-9 for non-fatal and fatal and ICD-10 for fatal OOD-related events and showed high sensitivity (i.e. above 97%). The specificity estimates of ICD algorithms were good to excellent in the three included studies. The misclassification-adjusted ICD-10 algorithm sensitivity estimates for POD from BLCM were consistently higher than reported sensitivity estimates that assumed CRR was perfect.
Conclusion: Evidence on the performance of ICD algorithms in detecting OOD events is scarce, and the absence of bias correction for imperfect tests leads to an underestimation of the sensitivity of ICD code estimates.
{"title":"Sensitivity and specificity of International Classification of Diseases algorithms (ICD-9 and ICD-10) used to identify opioid-related overdose cases: A systematic review and an example of estimation using Bayesian latent class models in the absence of gold standards.","authors":"Fiston Ikwa Ndol Mbutiwi, Ayekoe Patrick Junior Yapo, Serge Esako Toirambe, Erin Rees, Rebecca Plouffe, Hélène Carabin","doi":"10.17269/s41997-024-00915-4","DOIUrl":"https://doi.org/10.17269/s41997-024-00915-4","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to summarize validity estimates of International Classification of Diseases (ICD) codes in identifying opioid overdose (OOD) among patient data from emergency rooms, emergency medical services, inpatient, outpatient, administrative, medical claims, and mortality, and estimate the sensitivity and specificity of the algorithms in the absence of a perfect reference standard.</p><p><strong>Methods: </strong>We systematically reviewed studies published before December 8, 2023, and identified with Medline and Embase. Studies reporting sufficient details to recreate a 2 × 2 table comparing the ICD algorithms to a reference standard in diagnosing OOD-related events were included. We used Bayesian latent class models (BLCM) to estimate the posterior sensitivity and specificity distributions of five ICD-10 algorithms and of the imperfect coroner's report review (CRR) in detecting prescription opioid-related deaths (POD) using one included study.</p><p><strong>Results: </strong>Of a total of 1990 studies reviewed, three were included. The reported sensitivity estimates of ICD algorithms for OOD were low (range from 25.0% to 56.8%) for ICD-9 in diagnosing non-fatal OOD-related events and moderate (72% to 89%) for ICD-10 in diagnosing POD. The last included study used ICD-9 for non-fatal and fatal and ICD-10 for fatal OOD-related events and showed high sensitivity (i.e. above 97%). The specificity estimates of ICD algorithms were good to excellent in the three included studies. The misclassification-adjusted ICD-10 algorithm sensitivity estimates for POD from BLCM were consistently higher than reported sensitivity estimates that assumed CRR was perfect.</p><p><strong>Conclusion: </strong>Evidence on the performance of ICD algorithms in detecting OOD events is scarce, and the absence of bias correction for imperfect tests leads to an underestimation of the sensitivity of ICD code estimates.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-29DOI: 10.17269/s41997-024-00919-0
Erin Kostuch, Richard Bélanger, Scott T Leatherdale, Adam G Cole
Objectives: Youth vaping is a concern in Canada. While school-level policies influence student behaviours, few studies have investigated the association between school vaping policies and student vaping. This study reviewed and scored the comprehensiveness of school vaping policies and investigated the association between school vaping policy scores and student vaping.
Methods: Online policy documents from n = 39 schools in Ontario, Alberta, and British Columbia, Canada, participating in the 2021-2022 wave of the COMPASS study were collected, reviewed, and scored for comprehensiveness (/39) using the School Tobacco Policy Index (STPI) rating form. The mean and range of scores for each domain of the STPI were calculated. School policy scores were linked to student vaping data from the COMPASS study. Multilevel logistic regression analyses identified the association between school vaping policy score and student lifetime and current (past 30-day) vaping.
Results: The mean total policy score was 10.2/39 (range 0‒24), and 28% of schools scored 0/39. The majority of school policies did not identify enforcement approaches or available preventive or cessation resources. Increasing STPI score was not associated with the odds of student lifetime or current vaping in multilevel logistic regression analyses.
Conclusion: The STPI quickly identified components of school vaping policies that were missing. The overall score of most school vaping policies in our sample was low and most school vaping policies lacked many important components. Future studies should explore factors associated with adolescent vaping and identify effective prevention measures.
{"title":"Exploring the cross-sectional association between the strength of school vaping policies and student vaping behaviours using data from the 2021-2022 COMPASS Study.","authors":"Erin Kostuch, Richard Bélanger, Scott T Leatherdale, Adam G Cole","doi":"10.17269/s41997-024-00919-0","DOIUrl":"https://doi.org/10.17269/s41997-024-00919-0","url":null,"abstract":"<p><strong>Objectives: </strong>Youth vaping is a concern in Canada. While school-level policies influence student behaviours, few studies have investigated the association between school vaping policies and student vaping. This study reviewed and scored the comprehensiveness of school vaping policies and investigated the association between school vaping policy scores and student vaping.</p><p><strong>Methods: </strong>Online policy documents from n = 39 schools in Ontario, Alberta, and British Columbia, Canada, participating in the 2021-2022 wave of the COMPASS study were collected, reviewed, and scored for comprehensiveness (/39) using the School Tobacco Policy Index (STPI) rating form. The mean and range of scores for each domain of the STPI were calculated. School policy scores were linked to student vaping data from the COMPASS study. Multilevel logistic regression analyses identified the association between school vaping policy score and student lifetime and current (past 30-day) vaping.</p><p><strong>Results: </strong>The mean total policy score was 10.2/39 (range 0‒24), and 28% of schools scored 0/39. The majority of school policies did not identify enforcement approaches or available preventive or cessation resources. Increasing STPI score was not associated with the odds of student lifetime or current vaping in multilevel logistic regression analyses.</p><p><strong>Conclusion: </strong>The STPI quickly identified components of school vaping policies that were missing. The overall score of most school vaping policies in our sample was low and most school vaping policies lacked many important components. Future studies should explore factors associated with adolescent vaping and identify effective prevention measures.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-29DOI: 10.17269/s41997-024-00906-5
Alexandra Nunn, Amanda M Perri, Hilary Gordon, John P D Harding, C K Jennifer Loo, John Tuinema
Objectives: In the first year of pandemic measures, opioid-related deaths across Ontario's (ON) 34 public health units (PHUs) increased by 60%. Death rates for all seven Northern ON PHUs were above the provincial average. This study describes and compares factors surrounding opioid-related deaths before and after pandemic measures were introduced, for Northern ON compared to the rest of ON.
Methods: Aggregate data were provided for Northern ON and the rest of the province by the Office of the Chief Coroner/Ontario Forensic Pathology Services. Opioid-related deaths were cohorted by date of death for the year before and after pandemic measures were introduced on March 16, 2020. Chi-square tests were used to compare between cohorts and geographies to determine significant differences for each variable, and for dichotomized levels within variables. P-values < 0.05 were considered statistically significant a priori.
Results: In Northern ON, the number of opioid-related deaths approximately doubled from the pre-pandemic cohort (n = 185) to the early pandemic cohort (n = 365). Compared to the rest of ON, higher proportions of deaths occurred in Northern ON among individuals who lived and died in private residences, among women (although the majority of decedents were male) and among individuals employed in mining, quarrying, and oil and gas industries. Compared to the pre-pandemic year, in Northern ON, higher proportions of opioid-related deaths involved fentanyl and stimulants as direct contributors, and the majority involved evidence of inhaled drugs.
Conclusion: Differences between the circumstances of death in Northern ON and in the rest of ON suggest opportunities to tailor interventions.
{"title":"Opioid-related deaths in Northern Ontario in the early COVID-19 pandemic period.","authors":"Alexandra Nunn, Amanda M Perri, Hilary Gordon, John P D Harding, C K Jennifer Loo, John Tuinema","doi":"10.17269/s41997-024-00906-5","DOIUrl":"https://doi.org/10.17269/s41997-024-00906-5","url":null,"abstract":"<p><strong>Objectives: </strong>In the first year of pandemic measures, opioid-related deaths across Ontario's (ON) 34 public health units (PHUs) increased by 60%. Death rates for all seven Northern ON PHUs were above the provincial average. This study describes and compares factors surrounding opioid-related deaths before and after pandemic measures were introduced, for Northern ON compared to the rest of ON.</p><p><strong>Methods: </strong>Aggregate data were provided for Northern ON and the rest of the province by the Office of the Chief Coroner/Ontario Forensic Pathology Services. Opioid-related deaths were cohorted by date of death for the year before and after pandemic measures were introduced on March 16, 2020. Chi-square tests were used to compare between cohorts and geographies to determine significant differences for each variable, and for dichotomized levels within variables. P-values < 0.05 were considered statistically significant a priori.</p><p><strong>Results: </strong>In Northern ON, the number of opioid-related deaths approximately doubled from the pre-pandemic cohort (n = 185) to the early pandemic cohort (n = 365). Compared to the rest of ON, higher proportions of deaths occurred in Northern ON among individuals who lived and died in private residences, among women (although the majority of decedents were male) and among individuals employed in mining, quarrying, and oil and gas industries. Compared to the pre-pandemic year, in Northern ON, higher proportions of opioid-related deaths involved fentanyl and stimulants as direct contributors, and the majority involved evidence of inhaled drugs.</p><p><strong>Conclusion: </strong>Differences between the circumstances of death in Northern ON and in the rest of ON suggest opportunities to tailor interventions.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-29DOI: 10.17269/s41997-024-00904-7
Bridget Steele, Priya Shastri, Catherine Moses, Elizabeth Tremblay, Monique Arcenal, Patricia O'Campo, Robin Mason, Janice Du Mont, Maria Hujbregts, Amanda Sim, Alexa R Yakubovich
Objectives: Staff at violence against women (VAW) organizations provide essential services for survivors of violence. The increase in VAW during the COVID-19 pandemic placed additional pressures on VAW staff. We investigated the impacts of the pandemic on the mental health of VAW staff in the Greater Toronto Area to inform recommendations for policy and practice.
Methods: We conducted a community-based, mixed-methods study on the processes, experiences, and outcomes of adapting VAW programming during the pandemic using a sequential explanatory approach. Throughout 2021, we conducted a survey of direct support and leadership staff who worked on VAW services ("VAW staff") followed by semi-structured interviews with VAW staff purposively sampled from the survey. We descriptively analyzed quantitative survey data on the mental health of 127 VAW staff. We then applied thematic analysis to qualitative data from 18 interviews with VAW staff. We used the qualitative data to support interpretation and enrich the quantitative findings regarding staff mental health.
Results: In the survey, 81% of leadership and 61% of direct support staff indicated that their work was more distressing during the pandemic. Participants reported moderate symptoms of vicarious trauma and mild symptoms of anxiety and depression. We generated three themes from the qualitative data to help explain these findings: (1) challenges related to changing work environments; (2) distress over not meeting client needs; and (3) difficulties in adapting self-care strategies in response to pandemic stressors.
Conclusion: VAW organizations require increased resources and flexible funding to hire and retain more staff to respond to higher and more complex caseloads during public health emergencies. With more structural supports in place, VAW organizations could create more time and space to develop their trauma-informed organizational practices: for example, establishing a culture of connection and learning among staff virtually and in-person and facilitating a range of self-care opportunities.
{"title":"The mental health of staff at violence against women organizations during the COVID-19 pandemic: Findings from a mixed-methods study of service providers in Canada's largest city.","authors":"Bridget Steele, Priya Shastri, Catherine Moses, Elizabeth Tremblay, Monique Arcenal, Patricia O'Campo, Robin Mason, Janice Du Mont, Maria Hujbregts, Amanda Sim, Alexa R Yakubovich","doi":"10.17269/s41997-024-00904-7","DOIUrl":"https://doi.org/10.17269/s41997-024-00904-7","url":null,"abstract":"<p><strong>Objectives: </strong>Staff at violence against women (VAW) organizations provide essential services for survivors of violence. The increase in VAW during the COVID-19 pandemic placed additional pressures on VAW staff. We investigated the impacts of the pandemic on the mental health of VAW staff in the Greater Toronto Area to inform recommendations for policy and practice.</p><p><strong>Methods: </strong>We conducted a community-based, mixed-methods study on the processes, experiences, and outcomes of adapting VAW programming during the pandemic using a sequential explanatory approach. Throughout 2021, we conducted a survey of direct support and leadership staff who worked on VAW services (\"VAW staff\") followed by semi-structured interviews with VAW staff purposively sampled from the survey. We descriptively analyzed quantitative survey data on the mental health of 127 VAW staff. We then applied thematic analysis to qualitative data from 18 interviews with VAW staff. We used the qualitative data to support interpretation and enrich the quantitative findings regarding staff mental health.</p><p><strong>Results: </strong>In the survey, 81% of leadership and 61% of direct support staff indicated that their work was more distressing during the pandemic. Participants reported moderate symptoms of vicarious trauma and mild symptoms of anxiety and depression. We generated three themes from the qualitative data to help explain these findings: (1) challenges related to changing work environments; (2) distress over not meeting client needs; and (3) difficulties in adapting self-care strategies in response to pandemic stressors.</p><p><strong>Conclusion: </strong>VAW organizations require increased resources and flexible funding to hire and retain more staff to respond to higher and more complex caseloads during public health emergencies. With more structural supports in place, VAW organizations could create more time and space to develop their trauma-informed organizational practices: for example, establishing a culture of connection and learning among staff virtually and in-person and facilitating a range of self-care opportunities.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-26DOI: 10.17269/s41997-024-00907-4
Kara Thompson, Stephanie Cooper, William Langille, Brynn Webber, Rachael MacDonald-Spracklin, Mark Asbridge, Bryce Barker, Darren Kruisselbrink, Janine Olthuis, Catherine Paradis, Sherry Stewart, Tim Stockwell, Robert Strang
Objective: This study assessed the quality of campus alcohol policies against best practice to assist campus decision-makers in strengthening their campus alcohol policies and reducing student alcohol use and harm.
Methods: Drawing on empirical literature and expert opinion, we developed an evidence-based scoring rubric to assess the quality of campus alcohol policies across 10 alcohol policy domains. Campus alcohol policy data were collected from 12 Atlantic Canadian universities. All extracted data were verified by the institutions and then scored.
Results: On average, post-secondary institutions are implementing only a third of the evidence-based alcohol policies captured by the 10 domains assessed. The average campus policy score was 33% (range 15‒49%). Of the 10 domains examined, only enforcement achieved an average score above 50%, followed closely by leadership and surveillance at 48%. The two heaviest-weighted domains-availability and access, and advertising and sponsorship-had average scores of 27% and 24%, respectively. However, if post-secondary campuses adopted the highest scoring policies from across all 12 campuses, they could achieve a score of 74%, indicating improvement is possible.
Conclusion: Atlantic Canadian universities are collectively achieving less than half their potential to reduce student alcohol-related harm. However, this study identifies opportunities where policies can be enhanced or modified. The fact that most policies are present at one or more campuses highlights that policy recommendations are an achievable goal for campuses. Campuses are encouraged to look to each other as models for improving their own policies.
{"title":"Assessing the implementation of evidence-based alcohol policies on Atlantic Canadian post-secondary campuses: A comparative analysis.","authors":"Kara Thompson, Stephanie Cooper, William Langille, Brynn Webber, Rachael MacDonald-Spracklin, Mark Asbridge, Bryce Barker, Darren Kruisselbrink, Janine Olthuis, Catherine Paradis, Sherry Stewart, Tim Stockwell, Robert Strang","doi":"10.17269/s41997-024-00907-4","DOIUrl":"https://doi.org/10.17269/s41997-024-00907-4","url":null,"abstract":"<p><strong>Objective: </strong>This study assessed the quality of campus alcohol policies against best practice to assist campus decision-makers in strengthening their campus alcohol policies and reducing student alcohol use and harm.</p><p><strong>Methods: </strong>Drawing on empirical literature and expert opinion, we developed an evidence-based scoring rubric to assess the quality of campus alcohol policies across 10 alcohol policy domains. Campus alcohol policy data were collected from 12 Atlantic Canadian universities. All extracted data were verified by the institutions and then scored.</p><p><strong>Results: </strong>On average, post-secondary institutions are implementing only a third of the evidence-based alcohol policies captured by the 10 domains assessed. The average campus policy score was 33% (range 15‒49%). Of the 10 domains examined, only enforcement achieved an average score above 50%, followed closely by leadership and surveillance at 48%. The two heaviest-weighted domains-availability and access, and advertising and sponsorship-had average scores of 27% and 24%, respectively. However, if post-secondary campuses adopted the highest scoring policies from across all 12 campuses, they could achieve a score of 74%, indicating improvement is possible.</p><p><strong>Conclusion: </strong>Atlantic Canadian universities are collectively achieving less than half their potential to reduce student alcohol-related harm. However, this study identifies opportunities where policies can be enhanced or modified. The fact that most policies are present at one or more campuses highlights that policy recommendations are an achievable goal for campuses. Campuses are encouraged to look to each other as models for improving their own policies.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-26DOI: 10.17269/s41997-024-00918-1
Antoine Lewin, Marc Germain, Renée Bazin, Yves Grégoire, Gaston De Serres, Christian Renaud
Objectives: Conventional serological approaches lack sensitivity for the detection of recent SARS-CoV-2 infections in vaccinated individuals, as these individuals exhibit a blunted anti-nucleocapsid (N) response. This limitation was recently addressed by the development of a "ratio-based approach", which compares longitudinally collected specimens. Here, we used this approach to estimate the incidence of SARS-CoV-2 infection and reinfection in Québec (Canada) during the Omicron wave.
Methods: Consenting plasma donors were included if they donated plasma before December 15, 2021 and during six consecutive periods of ~ 3 months between December 15, 2021 and July 7, 2023 (study period). Anti-N levels were measured with an enzyme-linked immunosorbent assay, and seroconversion was characterized by a ratio of ≥ 1.5 between the optical density of two consecutive samples.
Results: Among the 254 donors, the adjusted proportion of donors (95% confidence interval [CI]) with a new infection ranged between 18.1% (13.2‒23.0) and 24.2% (18.8‒29.7) over Periods 1-5 and fell to 7.9% (4.9‒11.0) during Period 6. During the study period, the proportion of newly infected donors decreased among those aged < 60 (Period 1 = 31.6%, Period 5 = 4.4%), but increased among those aged ≥ 70 (Period 1 = 0.3%, Period 6 = 10.3%). Throughout the study period, 72 (28.3%) reinfections occurred, including two seroconversion events in a single donor. Overall, 87.4% (95% CI = 82.7‒91.2) were infected by SARS-CoV-2 at least once during the study period.
Conclusion: The vast majority of the Québec population may have been infected during the Omicron wave. This longitudinal survey demonstrates the usefulness of the "ratio-based approach" for identifying both new infections and reinfections in a vaccinated population.
{"title":"Incidence of SARS-CoV-2 during the Omicron wave: Results of a longitudinal serosurvey in Québec, Canada.","authors":"Antoine Lewin, Marc Germain, Renée Bazin, Yves Grégoire, Gaston De Serres, Christian Renaud","doi":"10.17269/s41997-024-00918-1","DOIUrl":"https://doi.org/10.17269/s41997-024-00918-1","url":null,"abstract":"<p><strong>Objectives: </strong>Conventional serological approaches lack sensitivity for the detection of recent SARS-CoV-2 infections in vaccinated individuals, as these individuals exhibit a blunted anti-nucleocapsid (N) response. This limitation was recently addressed by the development of a \"ratio-based approach\", which compares longitudinally collected specimens. Here, we used this approach to estimate the incidence of SARS-CoV-2 infection and reinfection in Québec (Canada) during the Omicron wave.</p><p><strong>Methods: </strong>Consenting plasma donors were included if they donated plasma before December 15, 2021 and during six consecutive periods of ~ 3 months between December 15, 2021 and July 7, 2023 (study period). Anti-N levels were measured with an enzyme-linked immunosorbent assay, and seroconversion was characterized by a ratio of ≥ 1.5 between the optical density of two consecutive samples.</p><p><strong>Results: </strong>Among the 254 donors, the adjusted proportion of donors (95% confidence interval [CI]) with a new infection ranged between 18.1% (13.2‒23.0) and 24.2% (18.8‒29.7) over Periods 1-5 and fell to 7.9% (4.9‒11.0) during Period 6. During the study period, the proportion of newly infected donors decreased among those aged < 60 (Period 1 = 31.6%, Period 5 = 4.4%), but increased among those aged ≥ 70 (Period 1 = 0.3%, Period 6 = 10.3%). Throughout the study period, 72 (28.3%) reinfections occurred, including two seroconversion events in a single donor. Overall, 87.4% (95% CI = 82.7‒91.2) were infected by SARS-CoV-2 at least once during the study period.</p><p><strong>Conclusion: </strong>The vast majority of the Québec population may have been infected during the Omicron wave. This longitudinal survey demonstrates the usefulness of the \"ratio-based approach\" for identifying both new infections and reinfections in a vaccinated population.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-25DOI: 10.17269/s41997-024-00912-7
Amber Gillespie, Jillian Stringer, Olaf Berke
Objectives: This research examines the temporal rates and spatial patterns of police-involved Mental Health Act (MHA) apprehensions in Toronto, Canada, from 2014 to 2022. Building from the work of Toronto Police Services (TPS), the goal of this research is to deepen our understanding of MHA apprehensions and provide insights which may be used to guide local mental health reform efforts.
Methods: Using data collected by TPS, an exploratory, descriptive analysis of spatial patterns of MHA apprehension events between 2014 and 2022 at the neighbourhood level was conducted. To identify high-rate clusters, we used a discrete Poisson model in SaTScan, with a circular moving window. Primary and secondary clusters with a relative risk of 1.5 or greater are reported.
Results: From 2014 to 2022, 93,932 MHA apprehensions occurred in Toronto. Apprehension rates were found to vary substantially between neighbourhoods, with approximately 91% of Toronto's 140 neighbourhoods experiencing a net positive increase in rates during the study period after adjusting for population growth. Repeated spatial cluster analysis for each year revealed a range of 4 to 7 clusters annually, with the downtown core consistently emerging as an area of elevated risk (RR range 1.58-1.99).
Conclusion: Rising MHA apprehensions within Toronto highlight the pressing need to confront the city's intensifying mental health needs. These findings offer valuable insights into the patterns and nature of police-involved MHA apprehensions, outline reproducible analysis methods that can be used by others, and support targeted evaluation, expansion, and implementation of downstream initiatives to improve mental health responses.
{"title":"Spatial patterns of Mental Health Act apprehensions in Toronto, Canada, 2014-2022.","authors":"Amber Gillespie, Jillian Stringer, Olaf Berke","doi":"10.17269/s41997-024-00912-7","DOIUrl":"10.17269/s41997-024-00912-7","url":null,"abstract":"<p><strong>Objectives: </strong>This research examines the temporal rates and spatial patterns of police-involved Mental Health Act (MHA) apprehensions in Toronto, Canada, from 2014 to 2022. Building from the work of Toronto Police Services (TPS), the goal of this research is to deepen our understanding of MHA apprehensions and provide insights which may be used to guide local mental health reform efforts.</p><p><strong>Methods: </strong>Using data collected by TPS, an exploratory, descriptive analysis of spatial patterns of MHA apprehension events between 2014 and 2022 at the neighbourhood level was conducted. To identify high-rate clusters, we used a discrete Poisson model in SaTScan, with a circular moving window. Primary and secondary clusters with a relative risk of 1.5 or greater are reported.</p><p><strong>Results: </strong>From 2014 to 2022, 93,932 MHA apprehensions occurred in Toronto. Apprehension rates were found to vary substantially between neighbourhoods, with approximately 91% of Toronto's 140 neighbourhoods experiencing a net positive increase in rates during the study period after adjusting for population growth. Repeated spatial cluster analysis for each year revealed a range of 4 to 7 clusters annually, with the downtown core consistently emerging as an area of elevated risk (RR range 1.58-1.99).</p><p><strong>Conclusion: </strong>Rising MHA apprehensions within Toronto highlight the pressing need to confront the city's intensifying mental health needs. These findings offer valuable insights into the patterns and nature of police-involved MHA apprehensions, outline reproducible analysis methods that can be used by others, and support targeted evaluation, expansion, and implementation of downstream initiatives to improve mental health responses.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-25DOI: 10.17269/s41997-024-00921-6
Wes Regan, Melinda Markey, Juan Solorzano, Mark Lysyshyn
Setting: Regional Public Health Unit (Office of the Chief MHO, Vancouver Coastal Health Authority, BC, Canada).
Intervention: Recognizing the need to invest resources that strategically move public health work "upstream" where policies and investments can shape the determinants of health, the Office of the Chief MHO for Vancouver Coastal Health embarked on a process in 2019 to develop a population health team designed to engage in Healthy Public Policy (HPP) and Health in All Policies (HiAP) approaches to health promotion. The mission and design of this unit was informed by internal and external research and engagement which continued even through the COVID-19 pandemic.
Outcomes: In the fall of 2022, this new unit, the first of its kind in British Columbia, was launched. In 2023, it embarked on strategic planning, engaged in key public policy processes, and implemented priority areas of work to help advance healthy public policy in the region, including the development of processes, tools, and practices to support a more systematic and rigorous approach to this emerging area of public health practice.
Implications: The creation of this new Healthy Public Policy Unit invites discussion within Canada's public health community on the issue of resource allocation to support upstream interventions seeking to build the capacity and effectiveness of HPP and HiAP approaches.
{"title":"Gaining influence: Developing a Healthy Public Policy Unit at Vancouver Coastal Health.","authors":"Wes Regan, Melinda Markey, Juan Solorzano, Mark Lysyshyn","doi":"10.17269/s41997-024-00921-6","DOIUrl":"10.17269/s41997-024-00921-6","url":null,"abstract":"<p><strong>Setting: </strong>Regional Public Health Unit (Office of the Chief MHO, Vancouver Coastal Health Authority, BC, Canada).</p><p><strong>Intervention: </strong>Recognizing the need to invest resources that strategically move public health work \"upstream\" where policies and investments can shape the determinants of health, the Office of the Chief MHO for Vancouver Coastal Health embarked on a process in 2019 to develop a population health team designed to engage in Healthy Public Policy (HPP) and Health in All Policies (HiAP) approaches to health promotion. The mission and design of this unit was informed by internal and external research and engagement which continued even through the COVID-19 pandemic.</p><p><strong>Outcomes: </strong>In the fall of 2022, this new unit, the first of its kind in British Columbia, was launched. In 2023, it embarked on strategic planning, engaged in key public policy processes, and implemented priority areas of work to help advance healthy public policy in the region, including the development of processes, tools, and practices to support a more systematic and rigorous approach to this emerging area of public health practice.</p><p><strong>Implications: </strong>The creation of this new Healthy Public Policy Unit invites discussion within Canada's public health community on the issue of resource allocation to support upstream interventions seeking to build the capacity and effectiveness of HPP and HiAP approaches.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-24DOI: 10.17269/s41997-024-00920-7
Yasaman Dolatshahi, Alexandra Mayhew, Megan E O'Connell, Teresa Liu-Ambrose, Vanessa Taler, Eric E Smith, David B Hogan, Susan Kirkland, Andrew P Costa, Christina Wolfson, Parminder Raina, Lauren Griffith, Aaron Jones
Objectives: We investigated the prevalence and population attributable fraction (PAF) of 12 potentially modifiable risk factors for dementia in middle-aged and older Canadians.
Methods: We conducted a cross-sectional study of 30,097 adults aged 45 to 85 with baseline data from the Canadian Longitudinal Study on Aging (2011‒2015). Risk factors and associated relative risks were taken from a highly cited systematic review. We calculated the prevalence of each risk factor using sampling weights. Individual PAFs were calculated both crudely and weighted for communality, and combined PAFs were calculated using both multiplicative and additive assumptions. Analyses were stratified by household income and repeated at CLSA's first follow-up (2015‒2018).
Results: The most prevalent risk factors were physical inactivity (63.8%; 95% CI, 62.8-64.9), hypertension (32.8%; 31.7-33.8), and obesity (30.8%; 29.7-31.8). The highest crude PAFs were physical inactivity (19.9%), traumatic brain injury (16.7%), and hypertension (16.6%). The highest weighted PAFs were physical inactivity (11.6%), depression (7.7%), and hypertension (6.0%). We estimated that the 12 risk factors combined accounted for 43.4% (37.3‒49.0) of dementia cases assuming weighted multiplicative interactions and 60.9% (55.7‒65.5) assuming additive interactions. There was a clear gradient of increasing prevalence and PAF with decreasing income for 9 of the 12 risk factors.
Conclusion: The findings of this study can inform individual- and population-level dementia prevention strategies in Canada. Differences in the impact of individual risk factors between this study and other international and regional studies highlight the importance of tailoring national dementia strategies to the local distribution of risk factors.
{"title":"Prevalence and population attributable fractions of potentially modifiable risk factors for dementia in Canada: A cross-sectional analysis of the Canadian Longitudinal Study on Aging.","authors":"Yasaman Dolatshahi, Alexandra Mayhew, Megan E O'Connell, Teresa Liu-Ambrose, Vanessa Taler, Eric E Smith, David B Hogan, Susan Kirkland, Andrew P Costa, Christina Wolfson, Parminder Raina, Lauren Griffith, Aaron Jones","doi":"10.17269/s41997-024-00920-7","DOIUrl":"https://doi.org/10.17269/s41997-024-00920-7","url":null,"abstract":"<p><strong>Objectives: </strong>We investigated the prevalence and population attributable fraction (PAF) of 12 potentially modifiable risk factors for dementia in middle-aged and older Canadians.</p><p><strong>Methods: </strong>We conducted a cross-sectional study of 30,097 adults aged 45 to 85 with baseline data from the Canadian Longitudinal Study on Aging (2011‒2015). Risk factors and associated relative risks were taken from a highly cited systematic review. We calculated the prevalence of each risk factor using sampling weights. Individual PAFs were calculated both crudely and weighted for communality, and combined PAFs were calculated using both multiplicative and additive assumptions. Analyses were stratified by household income and repeated at CLSA's first follow-up (2015‒2018).</p><p><strong>Results: </strong>The most prevalent risk factors were physical inactivity (63.8%; 95% CI, 62.8-64.9), hypertension (32.8%; 31.7-33.8), and obesity (30.8%; 29.7-31.8). The highest crude PAFs were physical inactivity (19.9%), traumatic brain injury (16.7%), and hypertension (16.6%). The highest weighted PAFs were physical inactivity (11.6%), depression (7.7%), and hypertension (6.0%). We estimated that the 12 risk factors combined accounted for 43.4% (37.3‒49.0) of dementia cases assuming weighted multiplicative interactions and 60.9% (55.7‒65.5) assuming additive interactions. There was a clear gradient of increasing prevalence and PAF with decreasing income for 9 of the 12 risk factors.</p><p><strong>Conclusion: </strong>The findings of this study can inform individual- and population-level dementia prevention strategies in Canada. Differences in the impact of individual risk factors between this study and other international and regional studies highlight the importance of tailoring national dementia strategies to the local distribution of risk factors.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Gestational age at birth (GA) shows an inverse gradient of risk with social-emotional and behavioural outcomes among children born late preterm (≥ 34 and < 37 weeks) and early term (≥ 37 and < 39 weeks). Childcare has the potential to influence this association. This study aimed to estimate the association between GA and social-emotional/behavioural problems among children born between ≥ 34 and < 41 weeks gestation, determine whether this association was modified by childcare use, and describe the relationship between childcare and behavioural and social-emotional functioning at age 5.
Methods: Using data from the All Our Families cohort (n = 1324), logistic regression models were used to model the association between GA and social-emotional/behavioural problems (BASC-2 composite scales at age 5). Models were fit with interaction terms between GA and childcare variables (amount, multiplicity, and type of childcare at age 3) to assess effect modification.
Results: GA showed no significant associations with social-emotional/behavioural problems at age 5, though the type of childcare significantly modified the association between GA and externalizing and internalizing problems. Neither the number of hours spent in childcare (amount) nor the number of childcare arrangements used (multiplicity) modified the association between GA and social-emotional/behavioural problems. However, multiplicity was associated with externalizing behavioural problems (aOR = 2.09, 95% CI 1.14‒3.83).
Conclusion: This study found no significant association between GA and social-emotional/behavioural problems at age 5, though childcare type modified this association. Factors such as using multiple childcare arrangements to meet families' childcare needs have the potential to influence a child's social-emotional and behavioural functioning at age 5.
研究目的在晚期早产儿(≥ 34 岁)中,出生时胎龄(GA)与社会情感和行为结果的风险呈反梯度关系:利用 "我们所有的家庭"(All Our Families)队列(n = 1324)中的数据,使用逻辑回归模型来模拟 GA 与社会情感/行为问题(5 岁时的 BASC-2 综合量表)之间的关系。模型中还拟合了 GA 与儿童保育变量(3 岁时儿童保育的数量、多重性和类型)之间的交互项,以评估效应修正:尽管儿童保育类型会显著改变儿童性别与外化和内化问题之间的关系,但儿童性别与 5 岁时的社会情感/行为问题并无明显关联。在托儿所度过的小时数(数量)和所使用的托儿所安排的数量(多重性)都没有改变性别问题与社会情感/行为问题之间的关系。然而,多重性与外化行为问题有关(aOR = 2.09,95% CI 1.14-3.83):本研究发现,GA 与 5 岁儿童的社会情感/行为问题之间没有明显的关联,但儿童保育类型会改变这种关联。使用多种托儿安排以满足家庭的托儿需求等因素有可能影响儿童5岁时的社会情感和行为功能。
{"title":"Childcare use and the social-emotional and behavioural outcomes of late-preterm and early-term born children at age 5: An analysis of the All Our Families longitudinal cohort.","authors":"Nikki Stephenson, Suzanne Tough, Carly McMorris, Tyler Williamson, Sheila McDonald, Amy Metcalfe","doi":"10.17269/s41997-024-00908-3","DOIUrl":"https://doi.org/10.17269/s41997-024-00908-3","url":null,"abstract":"<p><strong>Objectives: </strong>Gestational age at birth (GA) shows an inverse gradient of risk with social-emotional and behavioural outcomes among children born late preterm (≥ 34 and < 37 weeks) and early term (≥ 37 and < 39 weeks). Childcare has the potential to influence this association. This study aimed to estimate the association between GA and social-emotional/behavioural problems among children born between ≥ 34 and < 41 weeks gestation, determine whether this association was modified by childcare use, and describe the relationship between childcare and behavioural and social-emotional functioning at age 5.</p><p><strong>Methods: </strong>Using data from the All Our Families cohort (n = 1324), logistic regression models were used to model the association between GA and social-emotional/behavioural problems (BASC-2 composite scales at age 5). Models were fit with interaction terms between GA and childcare variables (amount, multiplicity, and type of childcare at age 3) to assess effect modification.</p><p><strong>Results: </strong>GA showed no significant associations with social-emotional/behavioural problems at age 5, though the type of childcare significantly modified the association between GA and externalizing and internalizing problems. Neither the number of hours spent in childcare (amount) nor the number of childcare arrangements used (multiplicity) modified the association between GA and social-emotional/behavioural problems. However, multiplicity was associated with externalizing behavioural problems (aOR = 2.09, 95% CI 1.14‒3.83).</p><p><strong>Conclusion: </strong>This study found no significant association between GA and social-emotional/behavioural problems at age 5, though childcare type modified this association. Factors such as using multiple childcare arrangements to meet families' childcare needs have the potential to influence a child's social-emotional and behavioural functioning at age 5.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}