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

Objectives: To generate concrete, youth-derived recommendations for government, policymakers, and service planners to support public health planning for the next pandemic or public health emergency.

Methods: Using a virtual, modified Delphi, Youth Delphi Expert Panel Members rated recommendation items over three rounds, with the option to create their own recommendations items. 'Consensus' was defined a priori if ≥ 70% of the entire group, or subgroups of youth (e.g., age, race/ethnicity, gender and sexual identities), rated items at a 6 or 7 (on a 7-point Likert scale). Items that did not achieve consensus were dropped. Content analysis was used for qualitative responses in Rounds 1 and 2. Youth were engaged as members of an expert advisory committee throughout the design, implementation, and interpretation of findings.

Results: A total of n = 40 youth participated in Round 1 with good retention (> 95%) in subsequent rounds. Youth endorsed eleven recommendations to support public health planning for future pandemics or public health emergencies. Youth prioritized easily accessible and understandable information about pandemics; equitably and efficiently distributed vaccines; increased awareness of timely and accessible mental health and substance use services in schools, workplaces, and communities; and greater investment in free or inexpensive MHSU services.

Conclusions: For Canada to move forward in a relevant, efficient, and ethically sound manner, decisions must be guided by the population that these decisions affect. These recommendations can be used to guide Canada's strategies and policies to prepare for future public health emergencies and pandemics, prioritizing the needs of youth, families/caregivers, and communities.

Objective: Transportation is a critical health determinant, yet the last decade has witnessed rapid disinvestment across Canada (particularly in rural contexts) with negative health consequences. We sought to explore and describe the benefits and challenges faced in operating the first community-driven free-transportation scheme in Saskatchewan that emerged in response to widespread unavailability of public transportation due to budget cuts (austerity).

Methods: We conducted a mixed-methods community-based participatory research study involving 22 interviews with bus riders and service administrators. We also performed descriptive statistics and chi-squared analyses on bus rider data (data on 1185 trips routinely collected between July 2023 and December 2023) to explore sociodemographic characteristics and trip purposes of bus riders.

Results: All trips were completed by 616 community members using the free bus service between July 2023 and December 2023. Community members took an average of 5 trips (median = 2.0) with a maximum of 22 trips being taken by one community member (1.9% of all trips). Most trips were by women (53%), and older adults mostly used the free bus for medical purposes (22% of riders were older adults and 34% of these used the bus for medical reasons). Qualitatively, the bus service has increased access to care and promotes social participation and autonomy, especially for older adults. The service however faces some challenges, including funding disruptions and difficulty recruiting and retaining drivers.

Conclusion: Free inter-community transportation (i.e. transportation across cities and municipalities) promotes health equity and access. In contexts without access to public transportation, governments could support community-driven initiatives through increased funding.

Setting: Alcohol is a major cause of health and social costs and harms in Canada. While research and awareness of harms caused by alcohol are on the rise, few transdisciplinary platforms exist that are committed to facilitating bold alcohol policy change to reduce health inequities and improve lives.

Intervention: In response to feedback heard during engagement for the Canadian Alcohol Policy Evaluation project, an alcohol policy-focused community of practice (CoP) was launched in January 2022. Webinars, roundtable discussions, working group meetings, networking events, and a digital platform allow practitioners from various sectors (e.g. public health, alcohol regulation and distribution, public safety, justice, non-governmental organizations), researchers, and people with lived/living experience (PWLLE) to connect, share experiences and resources, and build capacity.

Outcomes: More than 500 members have joined the CoP from all Canadian provinces and territories, and international jurisdictions. CoP members engage in learning opportunities, contribute to letter-writing campaigns in support of alcohol policy initiatives, and lead a working group focused on alcohol warning labels. Through the CoP, members report gaining and applying new knowledge in their work, while also establishing valuable connections and collaborations that have supported positive change.

Implications: This cross-jurisdictional, intersectoral alcohol policy CoP facilitates knowledge sharing, networking, and collaboration among practitioners, policymakers, advocates, and PWLLE, while contributing to public health efforts to prevent alcohol harms. Furthermore, as transdisciplinary approaches continue to be prioritized in research and practice, this CoP offers an example that could be applied to other public health initiatives.

Objective: Perinatal mental illness can negatively impact pregnant and postpartum women and gender-diverse birthing persons, their children, and families. This study aimed to describe population-level trends in perinatal mental health service use, including outpatient and acute care contacts, to guide decisions about investments in evidence-based treatment.

Methods: In this repeated cross-sectional population-based surveillance study in Ontario, Canada, we measured monthly rates of mental health service use for perinatal people (conception to 1 year postpartum) from January 2007 to December 2021. Event rates were calculated by dividing the number of contacts in a given month by the total eligible perinatal time for that month expressed in per 1000 person-months. Rates by service type (outpatient, acute care), diagnosis, and sociodemographic characteristics, and by history of pre-existing mental illness were also calculated.

Results: In total, 22-28% of perinatal people had perinatal mental health service use annually (10-15% in pregnancy, 17-21% in postpartum). Perinatal mental health outpatient care rates decreased initially (2007-2012), stabilized, and then increased after March 2020. Acute care rates were stable from 2007 to 2015, then increased (especially for anxiety and substance/alcohol use disorders). Across all contact types, the highest rates were in postpartum vs. pregnancy, those aged < 25 and > 40 years, non-immigrants, urban-dwellers, and those with pre-existing mental illness.

Conclusion: Ensuring rapid access to evidence-based supports and services for perinatal mental illness is essential. Groups with increased need based on sociodemographic and clinical characteristics may benefit from targeted supports and services to ensure optimal treatment and prevent adverse outcomes.

Objective: Using data from a population-based cross-sectional survey, we aim to measure the prevalence, risk factors, and impact of COVID-19 on household food insecurity, housing insecurity, and the double burden of experiencing both.

Methods: Data were collected from July to November 2022. We used simple and multivariable logistic regression models to investigate the factors contributing to food insecurity, housing insecurity, and the double burden. Additionally, we computed the relative excess risk due to interaction (RERI) to determine whether any significant interactions contributed to the increased risk of experiencing the double burden.

Results: Around 27% of our study participants were food insecure, 54% were housing insecure, and 22% were food and housing insecure (double burden). Respondents' gender, age, ethnicity, education, and income were associated with experiencing the double burden of food and housing insecurity. Additionally, this study found a significant statistical interaction between residence location and employment status, with both employed and unemployed individuals in urban areas facing higher odds of experiencing the double burden of food and housing insecurity compared to retired individuals in either urban or rural areas; the relative excess risk due to interaction analysis suggests that increasing employment opportunities may have a more substantial impact on reducing this burden in urban areas.

Conclusion: Findings from this study provide important insights into addressing the issue of food and housing insecurity, especially through improving employment opportunities for vulnerable populations in Canada. Comprehensive systems-oriented intersectoral policies are much needed to improve households' experience of multiple need insecurities.

Objectives: The concept of "readiness to practice" has not been clearly delineated within an Indigenous health context. This systematic review occurred on a multi-database survey of published primary literature. The primary objective of this review was to determine what it takes for clinicians to be ready to practice with Indigenous populations.

Methods: This review identified articles published in the last 20 years within Canada, the United States, New Zealand, and Australia. The databases that were searched included CINAHL, Medline (via Ovid), Embase (via Ovid), Scopus, and Web of Science, with an additional hand search of references from relevant articles. This search took place from January to May 2022, with subsequent analysis from May to September 2022.

Results: Primary studies were coded using quantitative content analysis procedures and quantified codes were subjected to exploratory factor analyses. Four factors described a competent clinician across studies, including a relational disposition, decolonized practice, cultural immersion, and Indigenous professional support.

Conclusion: This sphere of literature is relatively novel and there do not appear to be many individuals directly commenting on attributes needed to be prepared to work with Indigenous communities. There exist potential gaps in knowledge that could be addressed by conversations with Indigenous stakeholders and implementation of health education programs that focus on developing Indigenous-specific competencies.

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.

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.