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

Objectives: To describe the prevalence, incidence, factors associated with pain-related disabilities, and experiences of limitations due to pain among First Nations, Inuit, and Métis peoples in Canada.

Methods: We conducted a scoping review of the literature. The search strategy, developed with a health sciences librarian, included Indigenous-specific and health peer-reviewed databases, and grey literature for studies from inception to May 23, 2023. We included epidemiological, qualitative, and mixed-methods studies assessing pain-related disability outcomes among First Nations, Inuit, and Métis peoples in Canada.

Synthesis: We screened 5902 citations from the peer-reviewed databases, of which 86 were screened as full-text items, and 49 were screened separately from grey literature sources. Two relevant items were retrieved. In 2017, an epidemiological study reported point prevalence estimates of pain-related disability lasting 6 months or more as follows: 11.4% among Inuit, 20.7% among Métis, and 22.2% among off-reserve First Nations people, with higher prevalence in women than in men. In 2002, a qualitative study highlighted emergent themes related to "difficulty coping with pain" and "suffering" among Cree adults with disabilities from the Mushkegowuk Territory. No studies reported on the incidence or factors associated with pain-related disability.

Conclusion: Our scoping review found two studies on pain-related disabilities among Indigenous peoples in Canada. Continued collaboration with Indigenous partners is required to contextualize these findings and determine appropriate next steps.

Objectives: This study aimed to examine the association between immigration status and women's contraceptive practices based on population data from government surveys.

Methods: A secondary data analysis was conducted on the Quebec Population Health Survey (2014-2015), which aimed to represent 98.8% of the population of Quebec aged 15 years and older through stratified sampling and data weighting (response rate of 61%). Univariate and multivariable analyses were used to compare contraceptive practices between immigrant and Canadian-born women. Two dependent variables were considered: (1) women who used contraception vs. no contraceptive method of any kind, and (2) among women who used contraception, those who used methods that required them to access health care (birth control pill, IUD, or tubal ligation) vs. women who used other methods (condom, coitus interruptus, other).

Results: The logistic regression results revealed a strong association between immigration status and contraceptive practices, at two levels: (1) immigrant women had lower odds to use contraception than Canadian-born women; and (2) of the women who use contraception, immigrants had lower odds than those born in Canada to use feminine medical contraception. These findings held true for immigrant women regardless of the number of years they have spent in Canada. Women who lived in low-income households or who had not had a medical consultation for more than one year also had lower odds to use feminine medical contraception.

Conclusion: Barriers in access to contraceptive care interfere with women's reproductive health and autonomy. The lower odds for immigrant women to use contraception, and particularly the most effective methods, suggest that their contraceptive care needs are at least partially unmet or inadequately addressed. This is concerning given that other studies show no differences in fertility intention between immigrant and Canadian-born women, and high rates of abortion for immigrant women.

Objectives: Machine learning (ML) has received significant attention for its potential to process and learn from vast amounts of data. Our aim was to perform a scoping review to identify studies that used ML to study risk factors for chronic diseases at a population level, notably those that incorporated methods to mitigate algorithmic bias. We focused on ML applications for the most common risk factors for chronic disease: tobacco use, alcohol use, unhealthy eating, physical activity, and psychological stress.

Methods: We searched the peer-reviewed, indexed literature using Medline (Ovid), Embase (Ovid), Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (Ovid), Scopus, ACM Digital Library, INSPEC, and Web of Science's Science Citation Index, Social Sciences Citation Index, and Emerging Sources Citation Index. Among the included studies, we examined whether bias was considered and identified strategies employed to mitigate bias.

Synthesis: The search identified 10,329 studies, and 20 met our inclusion criteria. The studies we identified used ML for a wide range of goals, from prediction of chronic disease development to automating the classification of data to identifying new associations between risk factors and disease. Nine studies (45%) included some discussion of algorithmic bias. Studies that incorporated a broad array of sociodemographic variables did so primarily to improve the performance of a ML model rather than to mitigate potential harms to populations made vulnerable by social and economic policies.

Conclusion: This work contributes to our understanding of how ML can be used to advance population and public health.

Objectives: This nationwide longitudinal study investigates the impact of neighbourhood deprivation on psychological well-being of Canadian adults.

Methods: Utilizing data from the Longitudinal and International Study of Adults (LISA) spanning 2016, 2018, and 2020, we included individuals aged 15 and above across Canada. The 2016 and 2020 samples comprised approximately 17,700 and 12,700 respondents, respectively. LISA data were paired to Neighbourhood Material and Social Deprivation data derived from Canada's 2016 Census. Psychological distress was assessed using the Kessler Scale (K-10), both dimensionally (score) and categorically (above the cut-point prevalence). Multi-level mixed-effects regressions were conducted, adjusting for individual-level variables.

Results: At baseline, participants' mean age was 47.7 years (50.6% female), and higher social and material deprivation were associated with greater psychological distress. Longitudinally, psychological distress showed distinct temporal patterns based on the type of deprivation. Adjusted models revealed that residing in the most socially deprived neighbourhoods was linked to a greater increase in psychological distress scores over time as compared with the least socially deprived areas. Conversely, the highest degree of material deprivation showed a negative association with increasing distress, contrasting with the lowest material deprivation. A similar trend emerged regarding the prevalence of high psychological distress: in the most socially deprived neighbourhoods, there was an elevated prevalence over time, whereas the highest material deprivation was negatively associated with increasing prevalence.

Conclusion: This study supports the link between mental health and neighbourhood social deprivation, but differs from previous research regarding material deprivation. While material support remains crucial for disadvantaged communities, public health interventions should also address social deprivation.

Objective: To evaluate existing alcohol policies in Canadian provinces and territories (P/Ts) against evidence-based best practice policies aimed at reducing alcohol-related harms and improving population health.

Methods: Alcohol policies in Canadian P/Ts were evaluated across 11 policy domains. The scoring rubric was formulated based on the latest evidence-based public health criteria. Policy domains were weighted to reflect their relative effectiveness and scope. Data were collected by the research team, reviewed and validated by government contacts, and scored by designated team members. Scores were calculated for each P/T and policy domain. Additionally, a Best Existing Policies (BEP) score was calculated to demonstrate the score that could be achieved by any P/T if they adopted all the best policies currently in place somewhere in Canada.

Results: Scored against best practice policy criteria, the average score across all P/Ts was 37%; no province or territory scored ≥ 50%. Across the 11 domains, the highest scores were achieved in Manitoba (44%), Quebec (42%), and Newfoundland and Labrador (41%). Policy domains with the highest scores were screening and treatment interventions (67%), monitoring and reporting (63%), and liquor law enforcement (54%). Policy domains with the highest evidence of effectiveness (e.g., pricing and taxation, physical availability, and control system) were among the lowest scoring (29%, 40%, and 23%, respectively). The BEP score was 80%.

Conclusions: P/T governments have yet to adopt many of the evidence-based alcohol policies available. Improved policy adoption across P/Ts is achievable and could help address the health, social, and economic impacts of alcohol use.

Objectives: The paper describes activities of dietetic education and training programs within Canada to advance Indigenization, decolonization, and reconciliation.

Methods: A self-administered 34-question cross-sectional, online survey was distributed to all Canadian dietetic education and training programs, and available February-May 2022. A matrix question examined key actions and scope at program and/or institutional levels, while question logic and open-ended feedback options supported further description. Additional open-ended questions explored respondents' perspectives on perceived barriers and needed supports for action. Descriptive statistics and deductive codes are presented.

Results: The survey was completed by 20 of 29 dietetic programs (69%). Adding Indigenous-related content to curricula (n = 18) and cultural immersion opportunities within Indigenous settings (n = 16) mainly occurred at the program level. Attracting and supporting Indigenous students/interns, staff, and faculty and preceptors (n = 19) and providing cultural safety training to staff and faculty (n = 17) were common activities of institutions. Respondents identified lack of resources (funding, staff, and time) as systemic barriers and the need for dietetic leadership support to advance processes of Indigenization, decolonization, and reconciliation.

Conclusion: This study established a baseline record of Indigenization, decolonization, and reconciliation activities in Canadian dietetic education and training programs that can inform future work. Programs are encouraged to (1) evaluate current and future activities; (2) ensure activities are part of a comprehensive approach to Indigenization, decolonization, and reconciliation, rooted in Indigenous, social justice, and health equity principles; and (3) consider collaborative action and advocacy to overcome systemic barriers, with the support of dietetic leadership.

Objectives: People migrating to Canada are disproportionately impacted by tuberculosis (TB) disease. Prior to arrival, Immigration, Refugees and Citizenship Canada (IRCC) require an immigration medical exam (IME) intended to detect TB disease in all permanent and select temporary residents. People deemed high risk for TB are then referred for post-landing surveillance. This process has not substantially changed in four decades, prompting our review.

Methods: We performed a retrospective cohort study of people referred for post-landing surveillance in British Columbia (BC) from Aug 1, 2020, to May 31, 2022. Through chart review, clinical and demographic data were recorded from the IME and provincial TB registry. Participants were followed for 2 years to assess for TB disease and to record their clinical outcomes.

Results: Of 1700 participants, 19 (1.1%, 95% CI 0.7, 1.7) were diagnosed with TB disease after arriving in Canada; 580 (34.1%) had prior TB treatment noted on their IME, with a median time from treatment to arrival of 9 years (IQR 4-18 years). The post-landing process took a median of 211 days (IQR 160-282 days) to complete workup. Some participants (611; 35.9%) received either an interferon gamma release assay or tuberculin skin test with 127 (35.5%) and 166 (65.6%) positive results, respectively.

Conclusion: The post-landing surveillance process in BC is slow and resource-intensive for both migrants and the healthcare system, with uncertain impact on outcomes. These findings highlight existing inefficiencies in the process and the need to identify people who are at highest risk.

Objectives: Individuals experiencing homelessness have excess mortality as compared with the general population. This elevated risk of death may persist after individuals are housed, but there has been scant research on this topic. The objective of this study was to examine mortality among residents of a permanent supportive housing program serving people who were previously homeless.

Methods: Deaths were identified among individuals who resided in a 145-unit supportive housing program in Toronto, Canada, between January 1, 2018, and December 31, 2022. Kaplan-Meier curves were used to examine survival.

Results: Of 222 individuals who resided in the supportive housing program, 34 individuals died during the observation period, with 71% of deaths occurring in the housing unit and 21% in hospital. At least one third of deaths were caused by drug overdose. Mean age at death was 56.3 years. Crude mortality rate was 5.10 deaths per 100 person-years of observation. Survival at 5 years of follow-up was 78%, and individuals ≤ 40 years old did not have a survival advantage over those > 40 years old.

Conclusion: Interventions are needed to support health and reduce preventable deaths among formerly homeless residents of permanent supportive housing.

Setting: The GetYourBenefits! Project began as an attempt to convince physicians that it is important to diagnose and treat poverty.

Intervention: The academics worked with community agencies and physician organizations to communicate about the government benefits for which individuals with low incomes and/or disabilities are eligible. The Project Manager and Outreach Officer met with and gave talks to community groups. The Financial Literacy and Empowerment Program Coordinator, Community Financial Counselling Services (CFCS), who leads Manitoba's free tax filing clinics, led the development of the Get Your Benefits booklet. The authors decided communicating about the project was important. The project was funded by the Winnipeg Foundation with the collaboration of the Manitoba government and is being continued by CFCS.

Outcomes: This paper describes how information on accessing benefits has been communicated to physicians, health care providers, and those who work in public health. Over 170,000 booklets were distributed. By the final year of the project (2023), over 85 websites had linked to the project website, a major growth over the nine websites linked in the first year of the project. Several updates a year were sent advising on opportunities for accessing benefits, with more than 270 individuals and organizations receiving these in the last year of the project.

Implications: Accessing these benefits has brought and could bring additional millions of unclaimed federal dollars to eligible individuals across Canada. There is still much to be done.

Objectives: The objective of this study was to develop a model to estimate the hospitalization burden attributable to influenza, respiratory syncytial virus (RSV), enterovirus (EV), human metapneumovirus (HMPV), human parainfluenza virus (HPIV), and other respiratory viruses (OV) in Canada.

Methods: A Poisson regression model was developed using respiratory hospitalization administrative data for the seasons 2010/2011 to 2018/2019.

Results: The estimated average seasonal number of respiratory hospitalizations attributable to influenza was 15,000 in Canada (rate 43.4 hospitalizations per 100,000 population [95%CI 40.9, 46.0]), and 13,000 (rate 36.3 hospitalizations per 100,000 population [95%CI 29.2, 43.4]) for RSV. The estimated average seasonal numbers of hospitalizations attributable to EV, HMPV, HPIV, and OV were 6000 (rate 16.2 hospitalizations per 100,000 population [95%CI 10.7, 21.8]), 4000 (rate 12.4 hospitalizations per 100,000 population [95%CI 7.1, 17.6]), 2000 (rate 5.9 hospitalizations per 100,000 population [95%CI 2.0, 9.8]), and 3000 (rate 8.9 hospitalizations per 100,000 population [95%CI 0.04, 17.7]), respectively.

Conclusion: This study provided updated and new Canadian estimates for hospitalizations attributable to influenza, RSV, EV, HMPV, and HPIV for 2010/2011 to 2018/2019 surveillance seasons. These estimates are important given the emergence of SARS-CoV-2 and the ongoing circulation of seasonal respiratory viruses. Routine burden estimation is pivotal in supporting the implementation and evaluation of public health programs focused at mitigating the impacts of respiratory viruses. Although multiple external factors are at play, this study indicates that influenza and RSV attributable hospitalizations were persisting and generally increasing in Canada in recent years preceding the COVID-19 pandemic.