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

Objective: Fist fighting among hockey players is thought to have long-term impacts on health. Because of methodological concerns of previous studies, we undertook a retrospective cohort study among retired National Hockey League (NHL) players to estimate rates of all-cause mortality according to the cumulative number of fights in their careers.

Methods: The cohort comprised male hockey players, excluding goaltenders, who played in the NHL from 1967 to 2022. We compiled their birth and death data, body mass index at entry, and other characteristics of playing. We used the proportional hazards model, with age at retirement as the time axis, to estimate mortality rates through July 31, 2024, in relation to the total number of fights in the NHL. Hazard ratios (HR) were adjusted for body mass index and year starting in the NHL. Mean survival after retirement by fighting status was also computed.

Results: Among the 5411 retired players, 407 had died, 2082 (38.5%) never fought, and 759 (14.0%) fought ≥ 30 times. We found a positive linear response between the total number of fights and the risk of mortality: the adjusted HR per 10 fights was 1.04 (95% CI, 1.01, 1.07). Using this estimate, compared to non-fighters, the HR for five fights was 1.02 (95% CI, 1.00, 1.03), and for 50 fights it was 1.20 (95% CI, 1.02, 1.41). The mean loss of survival among those who fought ≥ 10 times compared with ≤ 1 time was 2.5, 2.1, and 1.5 years for those who started playing in 1970, 1980, and 1992, respectively.

Conclusion: Our findings suggest that fighting in NHL games increases rates of mortality post-retirement, but that these impacts are substantially less than reported previously. We recommend that the NHL establish standardized methods for collecting fight data to more accurately capture the lifetime fighting history and its associated health impacts for its players.

The urbanization of Indigenous peoples in Canada has increased substantially during recent decades, with over 44% of Indigenous peoples now residing in urban centres. Despite the urban concentration of healthcare services, Indigenous health outcomes remain significantly worse than non-Indigenous health outcomes for people living in urban centres. The historical and subsisting impacts of colonialism have had a profound negative influence on social determinants of health for Indigenous peoples, resulting in higher rates of chronic disease and mortality. Mistrust of the healthcare system, racial discrimination, and medical paternalism remain barriers to accessing care and diminish the quality of care received. This commentary explores how Indigenous-led health services can improve Indigenous health outcomes and how urban reserves could be used to improve the health of urban Indigenous residents.

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.

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.