Exploring the geographical distribution of human cryptosporidiosis in Southern Ontario from 2011 to 2014.

Introduction: Pertussis, commonly known as whooping cough, is a bacterial respiratory tract infection caused by Bordetella pertussis. Pertussis affects more than 48 million people worldwide annually, most of whom are under the age of 5.
 Hypothesis & Objectives: The hypothesis being investigated is that pertussis incidence, between 2005 and 2016, is not equally distributed across public health units in southern Ontario. We aim to identify disease cluster locations and associate geospatial fluctuations in incidence rates with putative risk factors.
 Materials and Methods: Data was sourced from Public Health Ontario on pertussis incidence in southern Ontario for all ages, specifically for each public health unit’s geographical area. A choropleth map was generated using data smoothed by empirical Bayesian estimation in a spatial analysis context. Following the creation of an incidence map for southern Ontario, the spatial scan test was applied to elucidate the existence of any disease clusters at a public health unit level. Moran’s I was used to determine whether there was evidence of any spatial dependence in pertussis incidence. Finally, putative risk factors were assessed in Poisson regression models and spatial Poisson regression models as potential predictor variables.
 Results and Discussion: The flexible spatial scan test identified three spatial clusters where incidence rates of pertussis were higher than expected. A spatial Poisson regression model was fit that included predictor variables of socioeconomic status and population density. For every 100 people/km2 increase in population density there was a significant 6% increase in pertussis incidence (p=0.03). Interestingly, vaccination rates were not found to be predictive of pertussis incidence nor did the variable improve the model. This epidemiological study identifies where pertussis incidence is clustered and what variables it is associated with, both of which are valuable for public health purposes and as a reference for future research into pertussis.

The researcch about the geographic distribution of diary cattle breeders, is held in Subdistrict of Selo, Cepogo, Musuk, Boyolali, Mojosongo, Teras, and Banyudono, Boyolali regency. This research aims to investigate potential areas for dairy attle breeding and the physical factors (availability of groundwater, average temperature, altitude, accesibility) that contribute most to the density of cattle in the research site. In addition, it investigates the differences m water supply for dairy cattle breeding and the ratio of income to cost at every morphological units as well as the effect of the amount of water supply on milk production and the effect of the Ca content of groundwater on the density of dairy cattle. The methods use in the research is survey method. The data colleted in the research consist of 200 primary data of the respondents taken from head of dairy cattle breeders families using a questionnare. Secondary data are obtained from related agencies, reference books and other authorized source dealing with the research yopic. In order to find out the differences in water supply for dairy cattle breeding and the ratio of income to cost, a statistical measurenment with Anova test is carried out. A multiple regression test is used to find out the effects of the availability of groundwater, altitude, average temperature, and accesibility on the density of dairy cattle. A simple regression test is used to find out the effects of water supply on milk producctin and the Ca sontent of groundwater on the density of dairy cattle.The result of the research indicate that the research site consist of four morphological units, namely the Volcanic slope, Volcanic foot, fluvio Volcanic foot, fluvio volcanic plain. The potential areas for dairy cattle breeding are situated at an altitude of 700 meters, temperature 17o C – 21o C especially the areas in the subdistrict of Selo and Cepogo. The result of the statistical test indicate that the most differences in the amount of water supply for dairy attle breeding as well as in the rasio between income and cost among morphological units. Water supply for dairy cattle breeding has no effect on milk production, whereas the Ca content of groundwater has no effect on the density of dairy cattle.

Moving Knowledge to Action: How Can We Optimally Support Different Healthcare Settings to Reach Their IPAC Goals?

BackgroundAdverse childhood experiences (ACEs) are potentially traumatic exposures experienced during childhood, for example, neglect. There is growing evidence that the coronavirus disease 2019 (COVID-19) pandemic and related socioeconomic conditions contributed to an increased risk of ACEs. As public health programs/services are re-evaluated and restored following the state of emergency, it is important to plan using an ACEs-informed lens. The aim of this study was to identify and prioritize initiatives or activities that Public Health Ontario (PHO) could undertake to support Ontario public health units’ work towards ACEs-informed pandemic recovery plans.MethodsThe Child Health and Nutrition Research Initiative method was adapted to conduct a priority-setting exercise (May–October 2022). Two online surveys were administered with members of the Healthy Growth and Development (HGD) Evidence Network, comprised of public health unit staff working in child and family health/HGD from Ontario’s 34 public health units. In the first survey, participants were asked to propose activities or initiatives that PHO could undertake to support Ontario public health units’ work towards ACEs-informed planning. In the second survey, participants were asked to score the final list of options against pre-determined prioritization criteria (for example, relevance). Responses were numerically coded and used to calculate prioritization scores, which were used to rank the options.ResultsIn all, 76% of public health units (n = 26) responded to the first survey to identify options. The 168 proposed ideas were consolidated into a final list of 13 options, which fall under PHO’s scientific and technical support mandate areas (data and surveillance, evidence synthesis, collaboration and networking, knowledge exchange and research). A total of 79% of public health units (n = 27) responded to the follow-up survey to prioritize options. Prioritization scores ranged from 76.4% to 88.6%. The top-ranked option was the establishment of a new provincial ACEs community of practice.ConclusionsOver three quarters of public health units contributed to identifying and ranking 13 options for PHO to support public health units in considering and addressing ACEs through pandemic recovery planning. In consultation with the ACEs and Resilience Community of Practice, recently formed on the basis of this exercise, PHO will continue to use the ranked list of options to inform work-planning activities/priorities.

Public health risks associated with the intensification of dairy farming are an emerging concern. Dairy cattle are a reservoir for a number of pathogens that can cause human illness. This study examined the spatial distribution of dairy cattle density and explored temporal patterns of human campylobacteriosis and cryptosporidiosis notifications in New Zealand from 1997 to 2015. Maps of dairy cattle density were produced, and temporal patterns of disease rates were assessed for urban versus rural areas and for areas with different dairy cattle densities using descriptive temporal analyses. Campylobacteriosis and cryptosporidiosis rates displayed strong seasonal patterns, with highest rates in spring in rural areas and, for campylobacteriosis, summer in urban areas. Increases in rural cases often preceded increases in urban cases. Furthermore, disease rates in areas with higher dairy cattle densities tended to peak before areas with low densities or no dairy cattle. Infected dairy calves may be a direct or indirect source of campylobacteriosis or cryptosporidiosis infection in humans through environmental or occupational exposure routes, including contact with animals or feces, recreational contact with contaminated waterways, and consumption of untreated drinking water. These results have public health implications for populations living, working, or recreating in proximity to dairy farms.

BackgroundRoad-related injuries and deaths are among the most significant and avoidable public health problems in Canada. Modifications to the built environment (BE) can reduce injury rates for vulnerable road users (VRUs) and other priority populations who experience disproportionate risk. This paper highlights public health professionals’ experiences working in injury prevention across Ontario public health units (PHUs) navigating barriers and facilitators to BE change. Their perspectives offer valuable insights that can support future BE change work in the Ontario public health context, thus illustrating the importance of including practitioners’ voices in injury prevention research.MethodsQualitative data were collected for a larger pan-Canadian study examining barriers and facilitators to BE change from the perspectives of injury prevention and transport professionals working across a variety of sectors, including public health, using key informant interviews (KI) and virtual focus groups (VFGs). Participants (n = 9) from four PHUs are included in this present study: Peel Region; York Region; Peterborough; and Ottawa. Thematic analysis was used to organize and code the data in relation to the guiding principles of the Ontario Public Health Standards (OPHS), situating our results within the broader context of public health and road-related injury prevention in Ontario.ResultsMajor barriers included motor vehicle prioritization and decision-making structures. Facilitators included partnerships and collaboration, champions and advocates, and access to data. Lastly, participants highlighted the important role of public health in BE change discussions and decision-making for road-related injury prevention.ConclusionPublic health professionals’ insights about barriers and facilitators show that some of their work aligns with the existing OPHS. Needs of local populations are clearly identified, while local data illustrating the impact of public health interventions are lacking. There are limits to PHU’s capacities, as well as the capacities of communities, which can be strengthened through the work of champions and advocates. Partnerships, collaboration, and engagement are also significant facilitators to BE change, aligning with the OPHS, but PHUs need to be involved more in BE change processes in order to prioritize the safety needs of VRUs in local communities.

Background: Public Health Ontario (PHO) infection prevention and control (IPAC) specialists provided field support during the COVID-19 pandemic by conducting on-site and virtual IPAC assessments to long-term care and retirement homes (LTC/RHs) between April 2020 and June 2021. Reports from these IPAC assessments were analyzed and the most common challenges were identified. Methods: IPAC specialists in collaboration with local public health units (PHU) conducted 139 on-site and 33 virtual visits to LTC/RHs in Ontario, using an assessment tool developed by PHO. Following each assessment, a report with findings and recommendations for enhancing IPAC practices in the LTC/RHs were shared with the home and PHU. A thematic analysis of the reports found common challenges in several areas. Results: Analysis of 172 assessment reports identified challenges and gaps in several areas resulting in a total of 415 recommendations made to LTC/RHs. Recommendation areas addressed included: personal protective equipment (PPE) use – 115 (28%), screening process – 89 (21%), physical distancing – 66 (16%), environmental cleaning –66 (16%), hand hygiene – 44 (11%), cohorting – 26 (6%), and other areas – 9 (2%). Inappropriate use and reuse of PPE, such as universal wearing of full droplet and contact PPE regardless of resident COVID-19 status and double masking were observed. Other common themes included incorrect screening and physical distancing practices, and improper use of the disinfecting wipes and cleaning products. Often, there was no defined process for cleaning high-touch surfaces or tracking when cleaning had occurred and deficiencies in the auditing process were noted.

A quasi-experimental study was conducted to determine whether or not a protected water supply (bottled drinking water) could prevent or delay cryptosporidial infections among children residing in an endemic community. A total of 176 children residing in a semiurban slum area in southern India were enrolled preweaning and received either bottled (n = 90) or municipal (n = 86) drinking water based on residence in specific streets. Weekly surveillance visits were conducted until children reached their second birthday. Stool samples were collected every month and during diarrheal episodes, and were tested for the presence of Cryptosporidium species by polymerase chain reaction. Differences in the incidence of cryptosporidiosis between bottled and municipal water groups were compared using Poisson survival models, and a propensity score model was developed to adjust for the effect of potential confounders. A total of 186 episodes of cryptosporidiosis, mostly asymptomatic, were observed in 118 (67%) children during the follow-up period at a rate of 0.59 episodes per child-year. Diarrhea associated with Cryptosporidium species tended to be longer in duration and more severe. Stunting at 6 months was associated with a higher risk of cryptosporidiosis (rate ratio [RR] = 1.40; 95% confidence interval [CI], 1.03-1.91). A higher gastrointestinal disease burden was also seen in children with cryptosporidiosis. Drinking bottled water was not associated with a reduced risk of cryptosporidiosis (adjusted RR = 0.86; 95% CI, .60-1.23). This study documented a high burden of cryptosporidiosis among children in an endemic Indian slum community. The lack of association between drinking bottled water and cryptosporidiosis suggests possible spread from asymptomatically infected individuals involving multiple transmission pathways.

BackgroundOpioid-related harms and deaths remain a persistent public health crisis across Ontario, Canada, with non-urban regions facing a disproportionate burden. However, discussions of opioid-related harms across Ontario’s geographic regions have provided an oversimplified assessment, contrasting rural and urban regions which mask the unique challenges and true disparities faced by sparsely populated communities, which are commonly located in the Northern regions. Our study aims to provide a more in depth understanding of the opioid crisis in Ontario across different geographic classifications in accordance to population size, such as rural, urban, and sparsely populated regions, presenting data in both absolute numbers and crude rates with contextual grounding of regional characteristics. A number of different opioid-related indicators such as hospitalizations, overdose rates, opioid service provision and harm reduction supply distribution were analyzed across all 34 of Ontario’s public health units (PHUs) to understand the differences in these indicators based on region across the province. The findings can inform the development of targeted interventions and improve service accessibility for those most affected by the overdose crisis in Ontario.MethodsPublicly-available secondary data for each PHU was collected from several provincial and national data sources and analyzed between November 2024 and January 2025. Annual data from 2022 to 2023 on opioid-related harms, opioid agonist treatment (OAT) prescribers and engagement, and the distribution of harm reduction supplies, as well as annual data from 2024 on opioid-inclusive service provision, were collected. Using Statistics Canada’s 2023 Health Region Peer Group Classification, the PHUS were grouped into four geographic classifications: sparsely populated, rural, urban/rural mix, and urban. Crude average rates were calculated for all indicators. Statistical analysis was performed to assess significance of indicators between regions.ResultsSparsely populated PHUs were primarily located in Northern Ontario, while rural, urban/rural mix, and urban PHUs were mainly concentrated in Southern Ontario. Urban PHUs have the highest number and lowest rate of opioid-related harms (e.g. 947 opioid-related deaths, representing a rate of 12.5 per 100,000 population), while sparsely populated PHUs reflect the opposite trend (e.g. 158 opioid-related deaths, representing a rate of 44.2 per 100,000 population). A similar pattern emerges for harm reduction services and naloxone distribution. The number of treatment services is highest in rural PHUs (n = 237) and lowest in sparsely populated PHUs (n = 83), despite having the highest rate. OAT prescribers, OAT engagement, and needle distribution follow a similar trend. Statistical significance was found between geographic regions for most indicators, except opioid-inclusive support services, harm reduction services, and naloxone distribution.ConclusionSparsely populated and rural PHUs experience the highest burden of opioid-related harms, coupled with limitations in service accessibility, demonstrating a clear need for additional harm reduction services. Decision-makers may be misled into underestimating the crisis in non-urban areas as a result of oversimplified reporting, resulting in inadequate support for these regions. Addressing these disparities is key to reducing opioid-related mortality and ensuring equitable access to life-saving services across Ontario.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-25103-y.

Do autonomous health units fulfil their mandate better than ones that are integrated into municipal structures? Many observers of Ontario's public health system seem to think so, but this assumption is based on very little evidence. This paper seeks to help fill this gap by grounding a comparison of the spending growth of two health units with different governing structures in the multilevel governance literature. The study finds that, after an increase in provincial funding, an autonomous health unit, the Middlesex-London Health Unit, behaved more in accordance with provincial expectations than Hamilton Public Health Services, which is integrated into the City of Hamilton. The paper contributes by providing theoretical and empirical explanations for variation among local health units.

Building evaluation capacity in Ontario's public health units: promising practices and strategies

As public health services are modernized in Ontario, Canada, there is a need to inform the system-level roles and responsibilities of government agencies. The aim of this study was to identify how Public Health Ontario (PHO) can optimally support evidence-based planning and programming in Healthy Growth and Development (HGD) across Ontario. A situational assessment was conducted with key informants from public health andother HGD fields. Key informants were identified using purposeful snowball sampling and included public health nurses, health promoters, and medical officers of health. Analytic strategy: Twenty telephone interviews and seven focus groups were used to collect data. A thematic analysis was conducted concurrently with data collection. Five themes were identified: (a) Transition to the new Ontario Public Health Standards (OPHS) included experiences of adopting the new OPHS within local public health units (PHUs). (b) Collaborating and networking referred to the ability to work with community partners. (c) Data, evidence, and research described the presence of data, evidence, and research to support practice. (d) Decision making, planning, and priority setting described resources available that influenced decision making. (e) Current and emerging issues in HGD included high-priority topics. Public health practice in HGD is complex with many challenges in data and evidence, and making programming decisions without adequate or measurable indicators. A specialized position at PHO is an opportunity to support some of these system-wide needs.

Cryptosporidiosis is an infectious disease of relevance to the cattle industry. The southern region of the Canadian province of Ontario is characterised by widespread cattle farming that is a key contributor to the Canadian dairy industry. Given Ontario's key role in the Canadian dairy industry and the potential impact that cryptosporidiosis can have on cattle operations, identifying areas of increased risk for bovine cryptosporidiosis is important. The primary goal of this study was to explore the distribution of bovine cryptosporidiosis, across the geographical areas served by the 29 Public Health Units (PHUs) of Southern Ontario, in the period 2011-2014. Laboratory data on bovine cryptosporidiosis were collected from the Animal Health Laboratory at the University of Guelph, Canada. Using veterinary clinic locations as a proxy for farm location, choropleth and isopleth maps were produced. Highrisk clusters of bovine cryptosporidiosis were identified using the flexible spatial scan test. Assessment of the potential for spatial misclassification bias resulting from a proxy location variable was conducted. The overall raw farm-level prevalence of bovine cryptosporidiosis was 45% [95% confidence interval, CI: 42%-48%]. A cluster was identified in the central-west region of Southern Ontario (relative risk 1.30 [95% CI: 1.07-1.54, P=0.026]) meaning that cattle in the areas served by the Bruce-Grey-Owen Sound, Huron, Wellington-Dufferin Guelph and Waterloo PHUs were at a higher risk for infection. Given that this area is known for having a high-density of dairy cattle, it should be considered as a target for further surveillance.

This study analyzes the spatial risk distribution of West Nile virus (WNv) in humans and birds across southern Ontario for 2006. The relationship between bird and human risk is also investigated. Surveillance data was obtained for the number of human WNv cases and the fraction of dead birds testing positive in each public health unit. The presence of disease clustering in humans and birds was investigated using a spatial scan test. Choropleth risk maps of regional empirical Bayesian smoothed estimates were created to investigate the spatial distribution of WNv in humans and birds. Isopleth risk maps were created through kriging of smoothed estimates, and were used to identify high-risk areas as well as investigate the relationship between human and bird risk. One disease cluster was found in both humans and birds. The human disease cluster was not significant when the bird data was used as a covariate in the analysis. The choropleth and isopleth maps identified the southern portion of southern Ontario to be the highest risk area for both humans and birds. This study indicates that bird outbreaks are a potential indicator for an increase in human risk. As well, WNv risk is greatest in the southern portion of southern Ontario and is geographically spreading in comparison to previous years.

To identify and explore areas where responsibilities may overlap between family health teams (FHTs) and public health units (PHUs); to identify facilitators or barriers to collaboration; and to identify priority areas for increased collaboration. DESIGN AND CONTEXT: Cross-sectional mixed-methods study of FHTs and PHUs in Ontario, Canada, consisting of a postal survey, key informant interviews and a roundtable meeting. The survey response rate was 46%. Direct client-based services such as giving immunizations, promoting prenatal health and nutrition, and counselling related to smoking cessation were identified as the top three areas of perceived overlap. The greatest interest in collaboration was expressed in the areas of emergency planning and preparedness, immunization, and prenatal health and nutrition. Good communication with a clear understanding of roles and functions was the most important facilitator, and lack of resources and absence of a clear provincial mandate and direction to collaborate were identified as significant barriers. Small, simple client-based projects of interest to both kinds of organization would be the best way to move forward in the short term. Improving communication between FHTs and PHUs, understanding of roles and functions, the use of shared or interoperable information systems and greater clarity from government on the ways in which these two key sectors of the healthcare system are intended to work together were identified as important for the success of increased collaboration.