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

Setting: The federal health portfolio has had a risk communications framework in place since 2006; however, the COVID-19 pandemic pushed the capacity of this plan and the need for communications resources to new levels. Health communicators in the public service face significant challenges: a fragmented mediascape, changes to how people seek and use information, the proliferation of misinformation and disinformation, declining trust in public institutions, and the politicization of science, to name just a few. It has never been more important for health authorities to communicate clearly, consistently, effectively, and from an evidence-based position.

Intervention: This report describes one aspect of how the federal health portfolio has been addressing these challenges. As part of a recent capacity-building initiative, 67 public servants working in health communications participated in a four-part, half-day, advanced seminar series at Carleton University in June 2023. Each session featured an interactive presentation from a leading scholar and/or local practitioner with real-world scenario exercises designed to put their learning into practice. The series explored issues in trust and transparency, algorithmic control and mis- and disinformation, media relations, and risk communication for equity-deserving populations.

Outcomes: At the conclusion of the program, participants were given tools to (1) identify challenges to effective communication brought by a rapidly evolving media environment in which skepticism and misinformation often run rampant; (2) examine how key metrics and behavioural indicators on social media platforms demand different responses from health organizations and agencies who are monitoring and managing social media; (3) consider challenges for health communicators who must serve the public during health crises while also reinforcing public trust in their institutions; and (4) develop successful risk communication strategies for equity-deserving communities by considering specific information needs and tailored dissemination methods to reach the intended audience. Participants expressed high levels of satisfaction in the quality of the training and overwhelmingly reported that it would positively impact their daily work.

Implications: The training program was an innovative and successful initiative to improve knowledge of current priority topics and best practices in risk communication. It illustrated the benefits of continued professional learning, the importance of university-public service partnerships, and how capacity building requires ongoing resource commitments and engaged support from senior management. The program, along with other risk communication training that is currently being implemented, is part of the investment in long-term professional development of risk communicators in the health portfolio.

Objectives: Rabies vaccines in Canada are currently labeled for intramuscular use only; however, intradermal vaccine administration may be equally effective. This study aims to assess the immediate and long-term (≥ 2 years) serological response and boostability of intradermal administration of rabies vaccine for pre-exposure prophylaxis.

Methods: This retrospective cohort study was conducted using data from electronic medical records at the Winnipeg Regional Health Authority Travel Health & Tropical Medicine Services Clinic. Individuals ≥ 18 years of age at time of vaccination who received at least 3 × 0.1 mL doses of intradermal rabies vaccine were included. All charts were reviewed to extract post-primary immunization and post-booster serology results, and t-tests were conducted to evaluate seroprotection (defined as serology ≥ 0.5 IU/mL).

Results: A total of 324 individuals received an intradermal rabies primary pre-exposure vaccination series with follow-up serology within 90 days. Seroprotection was observed in 96% (GMT = 3.36 IU/mL, 95% CI 3.07-3.68). Of these, 68 had serology results 1.8-2.5 years later, with seroprotection declining to 44% (GMT = 0.52 IU/mL, 95% CI 0.41-0.65). However, 100% seroprotection was observed in those who received an intradermal booster dose at ≥ 2 years with follow-up serology (n = 20, GMT = 4.7 IU/mL, 95% CI 3.7-6.2).

Conclusion: Intradermal administration of a primary pre-exposure rabies vaccine series demonstrates a strong serological response. While titers decline over time, the robust serological response demonstrated after a single intradermal booster vaccine dose suggests that a strong anamnestic immune response was maintained. This finding supports existing evidence that intradermal administration of rabies vaccines can be used effectively for rabies pre-exposure and post-exposure prophylaxis.

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: Although past studies have identified sex differences in child maltreatment experiences and poor mental and physical health‒related outcomes, more research is needed to understand child maltreatment among sexual minorities (i.e., those who identify as other than heterosexual) and how child maltreatment and sexual identity are related to depression, anxiety, and at-risk alcohol and cannabis use among emerging adults.

Methods: Data were drawn from the longitudinal Well-Being and Experiences (WE) Study collected from 2017 (14 to 17 years) to 2022 (18 to 23 years) from Manitoba, Canada (n = 584). Descriptive statistics and logistic regression models were computed.

Results: Compared to heterosexual or straight sexual identity: homosexual, gay or lesbian; bisexual; and different or other identity were associated with an increased likelihood of experiencing child maltreatment, with the most robust relationships for bisexual identity and all child maltreatment outcomes. Indicating "I don't know" for sexual identity compared to heterosexual identity was associated with 7.45 increased odds of exposure to intimate partner violence in adjusted models. Bisexual identity compared to heterosexual identity had the most robust association, with increased odds of depression, anxiety, at-risk alcohol use, and at-risk cannabis use. Findings provide some evidence to suggest that trends may be worse for some mental health and substance use outcomes among sexual minorities who also experience child maltreatment.

Conclusion: Preventing child maltreatment among all children, including youth identifying as other than heterosexual, is a public health priority. Such efforts will work towards optimizing mental health and reducing substance use in early adulthood.

Objective: The COVID-19 pandemic affected the action of collaborative networks, connecting organizations from the public, community, and private sectors. Intersectoral action is a recognized strategy for tackling complex problems and reducing social inequalities. This study aims to understand how the COVID-19 pandemic modified local intersectoral action to improve the living conditions of rural populations.

Methods: Data for this qualitative, case study were collected through semi-structured individual interviews, observation sessions, and documentary analysis. Actor-network theory was used as the theoretical framework. Data collection took place from March 2021 to June 2022. The data were processed using a thematic analysis inspired by the analytical framework.

Results: The pandemic disrupted local intersectoral action, hampering networking operations and promoting a sectoral approach. Strategies favouring networking (use of technology and the liaison work of collective stakeholders) made it possible to create spaces for negotiating shared interests, identifying common causes, committing players to new roles, and sharing resources.

Conclusion: When faced with disruptions, networks can be flexible, testifying to the relevance of intersectoral action to meet the needs of the population. Even if the network was in a state of near-fragmentation before the pandemic, its reconstitution and remobilization were relatively easy for the community organizers.

Setting: The Dalla Lana School of Public Health (DLSPH) at the University of Toronto.

Intervention: The DLSPH entered its inaugural cohort of Doctor of Public Health (DrPH) students in 2021. Development and launch of the program stemmed from the school's strategic plan to offer advanced public health training and was the first such university offering the DrPH in Canada. This paper reflects on the overarching launch experience of the program and its innovation in practice.

Outcomes: Early interest in the program is strong and the entry requirement for at least 5 years of real-world experience drives the program's distinction in Canada. The inaugural cohort was instrumental in constructive criticism and harvestable suggestions via evaluations, reflections, and appreciative inquiry-a likely result of the lived professional experiences of students who enrolled in this program. A key feature is the hybrid nature of the program consisting of a series of in-person on-campus forums ("burst weeks") over the first half of the degree requirements. In addition to allowing in-person components of the core course, agenda components continually evolve to meet students' stated needs and competencies.

Implications: The deliberate focus on the foundational competencies of leadership was fostered through classes on leadership of self as well as leadership and governance of organizations. Special lectures are curated to ensure that new and emerging concepts challenging society and today's public health leaders are addressed in an ongoing leadership series. The focus is not on developing new leaders but on catalyzing the leaders who constitute this professional cohort to higher levels of responsibility.

Intervention: Triple P is a multilevel parenting program aimed at promoting children's emotional, social, and behavioural competence and preventing behavioural problems through supporting parents in positive parenting.

Research question: Examine the rollout of the Triple P system parenting program on child maltreatment rates in Manitoba, Canada, using administrative data analysis and document review of policies and programs.

Methods: This population-based retrospective cohort study included 962,170 children aged 18 years or younger. Administrative healthcare and social services data from the Manitoba Population Research Data Repository were used to compare child maltreatment indicators before (1989-2004) and after (2005-2018) Triple P implementation.

Results: Compared to before Triple P implementation, injury hospitalization rates were lower in the early (2005-2011) and later (2012-2018) periods of implementation. Maltreatment hospitalization and violent death rates were not statistically different in the early period, but they were lower in the later period of Triple P implementation. The interrupted time-series analysis showed that after Triple P intervention in 2005, injury hospitalization rates increased until 2012, followed by a gradual decline through 2018, compared to the expected trend without the intervention. Maltreatment hospitalization trends displayed a decline until 2012, followed by an increase, and then a gradual decline from 2014 to 2018 relative to the anticipated trend without the intervention. These trends varied by age, sex, income quintiles, and region.

Conclusion: Triple P is one of several programs that may have contributed to reductions in child maltreatment rates observed in Manitoba since the implementation of the program.