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

Setting: Homelessness is a significant and growing public health concern across Canada. In Kingston, Ontario, the number of people experiencing chronic homelessness has more than doubled from 136 people in 2020 to 296 in 2023.

Intervention: An emergency shelter-in-place hotel program was established in April 2020 to provide non-congregate shelter to people experiencing homelessness and vulnerable to SARS-CoV-2 infections. Beyond preventing COVID transmission, the unintentional consequence was that a population that experienced chronic homelessness reduced drug consumption and became stable. In 2022, with increased funding from the Ministry of Health and the City of Kingston, a new Housing First program was implemented to transition individuals from homelessness to long-term stable housing.

Outcomes: Between November 2022 and June 2023, a total of 34 clients initiated the program. Of these clients, 10 completed the program and were successfully housed, 10 remained active participants, and 14 were discharged before completion. Strengths and challenges were identified. Diverse services provided to meet the population's needs and strong collaborations with various community partners were facilitating factors. Inadequate external resources, a lack of evening and prosocial activities, and outside peers (not part of the program) who influenced recovery plans were identified as challenges.

Implications: This program illustrates that simultaneously integrating housing, community building, mental health, and addiction services is possible and provides an innovative way to stabilize this vulnerable population of people experiencing homelessness. Results from this program and the knowledge generated through implementation are being used to further scale up the program.

Health Canada recently issued a Marketing Authorization to expand the eligibility of the dairy-related exemption for Canadian front-of-pack labelling (FOPL) regulations. The 2024 Marketing Authorization exempts dairy-related products that are a 'source of calcium,' rather than only 'high in' calcium as previously regulated, from displaying a 'High in' front-of-pack nutrition symbol, regardless of their saturated fat and sodium levels. The Marketing Authorization, heavily influenced by the food industry, lacks strong scientific evidence to support its adoption. Although there is a high prevalence of inadequate calcium intakes among Canadians, the Marketing Authorization will exempt more dairy-related products that are significant contributors of saturated fat and sodium for Canadians. While providing very little calcium, many dairy-related products, particularly cheese products, are 'high in' saturated fat and/or sodium. Expanding the exemption criteria will allow dairy-related products with little health benefits to be reflected as 'healthy' (i.e., not display a 'High in' nutrition symbol), blunting the potential impact that FOPL regulations could have on improving the diets of Canadians. We strongly urge Health Canada to reconsider the expansion of the exemption and encourage others to conduct policy-relevant research and participate in the policy decision-making process to promote evidence-informed public health policies for the health of Canadians.

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 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.

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: Task sharing can fill health workforce gaps, improve access to care, and enhance health equity by redistributing health services to providers with less training. We report learnings from a demonstration project designed to assess whether lay student vaccinators can support community immunizations.

Intervention: Between July 2022 and February 2023, 27 undergraduate and graduate students were recruited from the University of Toronto Emergency First Responders organization and operated 11 immunization clinics under professional supervision. Medical directives, supported with online and in-person training, enabled lay providers to administer and document vaccinations when supervised by nurses, physicians, or pharmacists. Participants were invited to complete a voluntary online survey to comment on their experience.

Outcomes: Lay providers administered 293 influenza and COVID-19 vaccines without adverse events. A total of 141 participants (122 patients, 17 lay vaccinators, 1 nurse, and 1 physician) responded to our survey. More than 80% of patients strongly agreed to feeling safe and comfortable with lay providers administering vaccines under supervision, had no concerns with lay vaccinators, and would attend another lay vaccinator clinic. Content and thematic analysis of open-text responses revealed predominantly positive experiences, with themes about excellent vaccinators, organized and efficient clinics, and the importance of training, communication, and access to regulated professionals. The responding providers expressed comfort working in collaborative immunization teams.

Implications: Lay student providers can deliver vaccines safely under a medical directive while potentially improving patient experiences. Rather than redeploying scarce professionals, task sharing strategies could position trained lay vaccinators to support immunizations, improve access, and foster community engagement.