Canadian Provinces Research Articles

The impact of COVID-19 public health measures on the utilization of antipsychotics in schizophrenia in Manitoba – A population-based study

PurposeDuring the COVID-19 pandemic, public health measures were implemented, yet it is unknown whether these measures affected medication access in those with schizophrenia (SCZ). This study aimed to assess whether the antipsychotic utilization in SCZ changed during the pandemic. MethodsWe used dispensed prescription drug data from the Canadian province of Manitoba in individuals with SCZ using linked administrative data from the Manitoba Population Research Data Repository. The quarterly incident and prevalent dispensation of antipsychotics at two periods were compared with the expected trend (April 1, 2015 to April 1, 2020 and 2021) using linear autoregression. We stratified the primary results by age and sex and examined multiple subgroups. ResultsThere were 9045 individuals with SCZ in the first fiscal quarter of 2020. The prevalent use of the most common antipsychotics were: olanzapine (206.7/1000), risperidone (190.8/1000), quetiapine (174.4/1000), and clozapine (100.9/1000). The overall prevalent use of antipsychotics remained stable during the pandemic compared with the expected trend. A significant decrease in the incident use in April–June 2020 (estimate: -1.3, 95%CI:-2.2,-0.3) was noted compared with the expected. A significantly higher incidence of atypical antipsychotics (estimate: 1.4, 95%CI: 0.2,2.5) and risperidone separately (estimate: 1.8, 95%CI: 0.2,3.3) was noted in 2021 compared with expected. ConclusionThis study found a decline in the receipt of antipsychotics for people with SCZ during the initial implementation of COVID-19 public health measures, particularly on the overall incidence. Future work on investigating the impact of these trends on SCZ outcomes is needed to inform future pandemic-related policies.

Longer-term impacts of the COVID-19 pandemic on obstructive sleep apnoea (OSA)-related healthcare: a province-based study

RationaleFollowing marked reductions in sleep medicine care early in the COVID-19 pandemic, there is limited information about the recovery of these services. We explored long-term trends in obstructive sleep apnoea...

Prognostic Factors in Patients Diagnosed with Gallbladder Cancer over a Period of 20 Years: A Cohort Study.

Gallbladder cancer (GBC) is an uncommon cancer. This study aimed to determine the outcomes of GBC in relation to geographic, demographic, and clinical factors in a Canadian province from 2000 to 2019. This population-based retrospective cohort study included all patients diagnosed with gallbladder cancer (GBC) in Saskatchewan, Canada, from 2000 to 2019. Cox proportional multivariate regression analysis was conducted to identify factors associated with poorer outcomes. In total, 331 patients with a median age of 74 years and male-female ratio of 1:2 were identified. Of these patients, 305 (92%) had a pathological diagnosis of GBC. Among patients with documented staging data, 64% had stage IV disease. A total of 217 (66%) patients were rural residents, and 149 (45%) were referred to a cancer center. The multivariate analysis for patients with stage I-III GBC showed that stage III disease [hazard ratio (HR), 2.63; 95% confidence interval (CI), 1.09-6.34)] and urban residence (HR, 2.20; 95% CI, 1.1-4.39) were correlated with inferior disease-free survival. For all patients, stage IV disease (HR, 3.02; 95% CI, 1.85-4.94), no referral to a cancer center (HR, 2.64; 95% CI, 1.51-4.62), lack of surgery (HR, 1.63; 95% CI, 1.03-2.57), a neutrophil-lymphocyte ratio of >3.2 (HR, 1.57; 1.05-2.36), and age of ≥70 years (HR, 1.51; 95% CI, 1.04-2.19) were correlated with inferior overall survival. In this real-world context, the majority of patients with GBC were diagnosed at a late stage and were not referred to a cancer center. For those with early-stage GBC, living in an urban area and having stage III disease were linked to worse outcomes. Across all stages of GBC, stage IV disease, older age, absence of surgery, lack of referral to a cancer center, and a high neutrophil-to-lymphocyte ratio were associated with poorer survival.

Examining the Stability and Durability of Child Care Arrangements during the COVID-19 Pandemic in Canada

La pandémie de COVID-19 a provoqué d'importantes perturbations dans tous les secteurs du travail et de la vie familiale, y compris les services de garde éducatifs à l'enfance (SGÉE). Les recherches démontrent que l'instabilité (soit les interruptions aux services de garde) et l'absence de durabilité des SGÉE (soit le maintien des mêmes services de garde au fil du temps) peuvent exacerber le stress des parents et nuire au développement de l'enfant. S'inspirant des données d'un sondage original réalisé en décembre 2020 auprès de 882 parents de jeunes enfants de quatre provinces canadiennes, les autrices ont examiné les choix des parents au sujet de la garde d'enfants avant la pandémie et les répercussions de la COVID-19 sur ces dispositions, dans l'immédiat et à long terme. Dans leur échantillon, elles ont trouvé que a) les services hors du domicile étaient plus instables et plutôt moins durables que ceux à domicile; b) la perte d'accès pendant la pandémie à cause de la fermeture des centres de la petite enfance était moins marquée en Colombie-Britannique, ce qui était toutefois contrebalancé par un taux relativement élevé de retraits volontaires; c) l'Ontario a présenté un taux relativement élevé de pertes d'accès en raison des fermetures et des retraits volontaires; d) dans l'ensemble, 64 % des dispositions en matière de garde se sont révélées durables, mais e) la durabilité était plus faible dans les familles à plus faible revenu et en Ontario. En revanche, la durabilité était beaucoup plus élevée au Québec, ce qui fait ressortir le rôle possible des investissements dans les politiques des SGÉE pour protéger les parents et les enfants en cas d’événements déstabilisants.

Unionization rates, inequality, and poverty in Canadian provinces 2000–2020

Unions can increase the power of workers through both collective bargaining and political avenues, potentially creating less income inequality and poverty. However, this potential may not be realized. Drawing on power resource theory, this study uses panel data to investigate the connection between unionization and two measures of after-tax inequality – the income share of the top 1% and the Gini coefficient – and three measures of poverty – the percentage of the population below the low-income cut-off, the average income of the bottom decile, and the percent of the population below the low-income measure – between Canadian provinces from 2000 to 2020. We find that unionization is negatively associated with income inequality in Canada. This relationship is statistically significant. However, we do not find evidence of any statistical association between unionization and poverty in Canada.

Level of patient contact and Impact of Event scores among Canadian healthcare providers during the COVID-19 pandemic

BackgroundHealthcare providers (HCP) continue to provide patient care during the COVID-19 pandemic despite the known risks for transmission. Studies conducted early in the pandemic showed that factors associated with higher levels of distress among HCP included being of younger age, female, in close contact with people with COVID-19, and lower levels of education. The goal of this study was to determine if level of patient contact was associated with concern for post-traumatic stress disorder (PTSD) as measured by the Impact of Event Scale-Revised (IES-R).MethodsThis cross-sectional study, embedded within a prospective cohort study, recruited HCP working in hospitals in four Canadian provinces from June 2020 to June 2023. Data were collected at enrolment and annually from baseline surveys with the IES-R scale completed at withdrawal/study completion. Modified Poisson regression was used to determine the association between level of patient contact and concern for PTSD (i.e., IES-R scores ≥24).ResultsThe adjusted rate ratio (RR) associated with concern for PTSD among HCP with physical contact/direct patient care was 1.19 (95% confidence interval (CI) 1.03, 1.38) times higher than for HCP with no direct contact. In fully adjusted linear regression models, physical care/contact was associated with higher avoidance and hyperarousal scores, but not intrusion scores.ConclusionsAdministrators and planners need to consider the impact of heightened and ongoing stress among HCP by providing early screening for adverse emotional outcomes and delivery of tailored preventive strategies to ensure immediate and long-term HCP health.

Indirect impact of childhood 13-valent pneumococcal conjugate vaccine (PCV13) in Canadian older adults: a Canadian Immunization Research Network (CIRN) retrospective observational study

Background13-valent pneumococcal conjugate vaccine (PCV13) has been part of publicly funded childhood immunisation programmes in Ontario and British Columbia (BC) since 2010. We assessed the indirect impact of infant PCV13...

Barriers and facilitators to using a clinical decision support tool for the management of osteoarthritis pain in patients undergoing hemodialysis: a qualitative study

BackgroundWhile osteoarthritis is a significant issue within the hemodialysis population and contributes to reduced quality of life, pain related to osteoarthritis is poorly managed by healthcare professionals (HCPs) in hemodialysis settings due to the absence of clinical guidance applicable to this population. The purpose of this study was to explore the perceptions of HCPs on the barriers and facilitators to using a clinical decision support tool for osteoarthritis pain management in the hemodialysis setting.MethodsA qualitative descriptive study was conducted. Purposeful and snowball sampling techniques were used to recruit hemodialysis clinicians from academic and community settings across multiple Canadian provinces. One-to-one interviews were conducted with clinicians using a semi-structured, open ended interview guide informed by the Theoretical Domains Framework, a behavior change framework. A general inductive approach was applied to identify the main themes of barriers and facilitators.ResultsA total of 11 interviews were completed with 3 nephrologists, 2 nurse practitioners and 6 pharmacists. Findings revealed 6 main barriers and facilitators related to the use of the clinical decision support tool. Alignment of the tool with practice roles emerged as a key barrier and facilitator. Other barriers included challenges related to the dialysis environment, varying levels of clinician comfort with pain medications, and limited applicability of the tool due to patient factors. An important facilitator was the intrinsic motivation among clinicians to use the tool.ConclusionsMost participants across the included hemodialysis settings expressed satisfaction with the clinical decision support tool and acknowledged its overall potential for improving osteoarthritis pain management among patients on hemodialysis. Future implementation of the tool may be limited by existing roles and practices at different institutions. Increased collaboration among hemodialysis and primary care teams may promote uptake of the tool.

Geographic distribution of conversion therapy prevalence in Canada. Findings from a national cross-sectional survey, 2020

Background: Conversion therapy practices (CTPs) are discredited efforts that target lesbian, gay, bisexual, trans, queer, Two-Spirit, or other (LGBTQ2S+) people and seek to change, deny, or discourage their sexual orientation, gender identity, and/or gender expression. This study aims to investigate the prevalence of CTPs across Canadian provinces and territories and identify whether CTP bans reduce the prevalence of CTPs. Methods: We collected 119 CTPs from 31 adults (18+) in Canada who have direct experience with CTPs, know people who have gone to CTPs, or know of conversion therapy practitioners using a 2020 anonymous online survey. Mapping analysis was conducted using ArcGIS Online. CTP prevalence was compared between provinces/territories with and without bans using chi-square tests. Results: Three provinces and eleven municipalities had CTP bans. The prevalence of CTPs in provinces/territories with bans was 2.34 per 1,000,000 population (95% CI 1.65, 3.31). The prevalence of CTPs in provinces/territories without bans was 4.13 per 1,000,000 population (95% CI 3.32, 5.14). Accounting for the underlying population, provinces/territories with the highest prevalence of CTPs per 1,000,000 population were New Brunswick (6.69), Nova Scotia (6.50), and Saskatchewan (6.37). Conclusions: Findings suggest only 55% of Canadians were protected under CTP bans. The prevalence of CTPs in provinces/territories without bans was 1.76 times greater than provinces/territories with bans. CTPs are occurring in most provinces/territories, with higher prevalence in the west and the Atlantic. These findings and continued efforts to monitor CTP prevalence can help inform policymakers and legislators as society is increasingly acknowledging CTPs as a threat to the health and well-being of LGBTQ2S+ people.

Da religião à espiritualidade na educação: rumo a uma regulamentação política da espiritualidade?

The analysis of the emergence of the concept of spirituality in public education policies reveals various tensions at work in the religious and secular fields. Is this emergence a ploy by large religious groups to preserve influence in societies that are putting an end to official alliances with them? Has the concept of spirituality become broad enough to designate any search for meaning, and also to satisfy the aspiration for formal equality between all forms of beliefs, cults, and non-beliefs? This article addresses the issue of spirituality and how it has been integrated into the school legislation of the Canadian province of Quebec. It analyzes the creation in that province of the Spiritual Care and Guidance and Community Involvement Service. Designed to be neutral, it is aimed at both religious and non-religious students, in an effort to promote a logic of equality.

Enhancing equitable access to education for English language learners: evaluating the impact of a digital multilingual STEM resource in Canada

ABSTRACT In Canada, the substantial increase in English language learners has underscored the pressing need for educational resources that enable them to receive an education appropriate to their academic level while learning the school language. This issue carries significant implications for equitable access to quality education. In this study, we describe a novel multilingual digital resource for grades 6–9 in STEM. The resource offers content in the school languages as well as in Dari, Tigrinya, Arabic, Somali, and Spanish, among others. We examined the factors influencing the use and appreciation of this resource and its impact on students’ attitude towards STEM. This study involved 15 teachers and 161 students from three Canadian provinces. We used data collected by the platform over two years, complemented by student questionnaires, to investigate the relationship between teacher investment in the resource and students’ attitudes towards its content, the relationship between students’ attitudes and their resource use, and the impact of language availability on students’ use of the resource. Our results reveal that using student language as a content transfer tool is a powerful strategy for maximising student engagement in the resource but that the teacher plays a key role in its effectiveness.

Resources to Support Canadian Nurses to Deliver Virtual Care: Environmental Scan.

Regulatory and professional nursing associations have an important role in ensuring that nurses provide safe, competent, and ethical care and are capable of adapting to emerging phenomena that influence society and population health needs. Telehealth and more recently virtual care are 2 digital health modalities that have gained momentum during the COVID-19 pandemic. Telehealth refers to telecommunications and digital communication technologies used to deliver health care, support health care provider and patient education, and facilitate self-care. Virtual care facilitates the delivery of health care services via any remote communication between patients and health care providers and among health care providers, either synchronously or asynchronously, through information and communication technologies. Despite nurses' adaptability to delivering virtual care, many have also reported challenges. This study aims to describe resources about virtual care, digital health, and nursing informatics (ie, practice guidelines and fact sheets) available to Canadian nurses through their regulatory and professional associations. An environmental scan was conducted between March and July 2023. The websites of nursing regulatory bodies across 13 Canadian provinces and territories and relevant nursing and a few nonnursing professional associations were searched. Data were extracted from the websites of these organizations to map out educational materials, training opportunities, and guidelines made available for nurses to learn and adapt to the ongoing digitalization of the health care system. Information from each source was summarized and analyzed using an inductive content analysis approach to identify categories and themes. The Virtual Health Competency Framework was applied to support the analysis process. Seven themes were identified: (1) types of resources available about virtual care, (2) terminologies used in virtual care resources, (3) currency of virtual care resources identified, (4) requirements for providing virtual care between provinces, (5) resources through professional nursing associations and other relevant organizations, (6) regulatory guidance versus competency in virtual care, and (7) resources about digital health and nursing informatics. Results also revealed that practice guidance for delivering telehealth existed before the COVID-19 pandemic, but it was further expanded during the pandemic. Differences were noted across available resources with respect to terms used (eg, telenursing, telehealth, or virtual care), types of documents (eg, guideline vs fact sheet), and the depth of information shared. Only 2 associations provided comprehensive telenursing practice guidelines. Resources relative to digital health and nursing informatics exist, but variations between provinces were also noted. The use of telehealth and virtual care services is becoming mainstream in Canadian health care. Despite variations across jurisdictions, the existing nursing practice guidance resources for delivering telehealth and virtual care are substantial and can serve as a beginning step for developing a standardized set of practice requirements or competencies to inform nursing practice and the education of future nurses.

Rural suicide in Newfoundland and Labrador: A qualitative exploration of health care providers' perspectives.

Residents of rural regions may have higher and unique suicide risks. Newfoundland and Labrador (NL) is a Canadian province replete with rural regions. Despite an abundance of rural suicide research, heterogeneity in rural regions may preclude amalgamating findings to inform prevention efforts. Thus, exploring the unique needs of NL is needed. Importantly, health care providers (HCP) may afford unique perspectives on the suicide-related needs or concerns of rural life. We asked HCPs of residents of rural NL their perceived suicide risk factors, concerns, and needs for rural NL. Twelve HCPs of rural residents of NL completed virtual semi-structured interviews. Interviews were analysed using reflexive thematic analysis [13,14]. HCPs noted individual, psychological, social, and practical factors linked to rural-suicide risk and subsequent needs. Findings highlight the unique challenges of residing and providing health care in rural NL and inform prevention and intervention efforts.

Perspectives of parents with lived experience of cytomegalovirus infection, on universal newborn screening for congenital cytomegalovirus (cCMV) in Canada: a patient-led qualitative study

ObjectiveTo understand parental perspectives regarding universal newborn screening (UNS) for congenital cytomegalovirus (cCMV) in Canada.DesignA qualitative, patient-led study using the Patient and Community Engagement Research approach consisting of online focus...

Federal opioid agonist therapy policy: interrupted time series analysis of the impact of the methadone exemption removal across eight provinces in Canada

BackgroundFederal deregulation of opioid agonist therapies are an attractive policy option to improve access to opioid use disorder care and achieve widespread beneficial impacts on growing opioid-related harms. There have been few evaluations of such policy interventions and understanding effects can help policy planning across jurisdictions.MethodsUsing health administrative data from eight of ten Canadian provinces, this study evaluated the impacts of Health Canada’s decision in May 2018 to rescind the requirement for Canadian health professionals to obtain an exemption from the Canadian Drugs and Substance Act to prescribe methadone for opioid use disorder. Over the study period of June 2017 to May 2019, we used descriptive statistics to capture overall trends in the number of agonist therapy prescribers across provinces and we used interrupted time series analysis to determine the effect of this decision on the trajectories of the agonist therapy prescribing workforces.ResultsThere were important baseline differences in the numbers of agonist therapy prescribers. The province with the highest concentration of prescribers had 7.5 more prescribers per 100,000 residents compared to the province with the lowest. All provinces showed encouraging growth in the number of prescribers through the study period, though the fastest growing province grew 4.5 times more than the slowest. Interrupted time series analyses demonstrated a range of effects of the federal policy intervention on the provinces, from clearly positive changes to possibly negative effects.ConclusionsFederal drug regulation policy change interacted in complex ways with provincial health professional regulation and healthcare delivery, kaleidoscoping the effects of federal policy intervention. For Canada and other health systems such as the US, federal policy must account for significant subnational variation in OUD epidemiology and drug regulation to maximize intended beneficial effects and mitigate the risks of negative effects.

Pluvial flood modeling for coastal areas under future climate change – A case study for Prince Edward Island, Canada

It has been increasingly understood that pluvial flooding poses a substantial risk to numerous communities across the globe. This is especially relevant for the Canadian province of Prince Edward Island (PEI), which is susceptible to a compound flood consisting of both inland and coastal flooding. Despite various studies, a comprehensive pluvial flood model still lacks that addresses the complex interplay of compound floods. Therefore, this research aims to bridge the gap in flood mitigation by developing a pluvial flood model for PEI’s coastal communities. The Intensity-Duration-Frequency (IDF) curves under current and future climatic conditions were used to portray rainfall intensity over the study area corresponding to 10-year, 25-year, 50-year, and 100-year return periods. In addition, a hydraulic model (HEC-RAS 2D) was used to drive pluvial flood maps based on two configurations, including detailed flood maps for major municipalities and an island-wide level. The validated results showed consistency in model simulation when compared to observations. The high-resolution flood maps produced by this study can support the development of flood mitigation and adaptation strategies in PEI and other parts of the world.

The associations of supervised consumption services with the rates of opioid-related mortality and morbidity outcomes at the public health unit level in Ontario (Canada): A controlled interrupted time-series analysis.

This study aimed to assess the impact of the implementation of legally sanctioned supervised consumption sites (SCS) in the Canadian province of Ontario on opioid-related deaths, emergency department (ED) visits and hospitalisations at the public health unit (PHU) level. Monthly rates per 100,000 population of opioid-related deaths, ED visits and hospitalisations for PHUs in Ontario between December 2013 and March 2022 were collected. Aggregated and individual analyses of PHUs with one or more SCS were conducted, with PHUs that instituted an SCS being matched to control units that did not. Autoregressive integrated moving average models were used to estimate the impact of SCS implementation on opioid-related deaths, ED visits and hospitalisations. Twenty-one legally sanctioned SCS were implemented across nine PHUs in Ontario during the study period. Interrupted time series analyses showed no statistically significant changes in opioid-related death rates in aggregated analyses of intervention PHUs (increase of 0.02 deaths/100,000 population/month; p = 0.27). Control PHUs saw a significant increase of 0.38 deaths/100,000 population/month; p < 0.001. No statistically significant changes were observed in the rates of opioid-related ED visits in intervention PHUs (decrease of 0.61 visits/100,000 population/month; p = 0.39) or controls (increase of 0.403 visits; p = 0.76). No statistically significant changes to the rates of opioid-related hospitalisations were observed in intervention PHUs (0 hospitalisations/100,000 population/month; p = 0.98) or controls (decrease of 0.05 hospitalisations; p = 0.95). This study did not find significant mortality or morbidity effects associated with SCS availability at the population level in Ontario. In the context of a highly toxic drug supply, additional interventions will be required to reduce opioid-related harms.

From Policy to Prediction: Assessing Forecasting Accuracy in an Integrated Framework with Machine Learning and Disease Models.

To improve the forecasting accuracy of the spread of infectious diseases, a hybrid model was recently introduced where the commonly assumed constant disease transmission rate was actively estimated from enforced mitigating policy data by a machine learning (ML) model and then fed to an extended susceptible-infected-recovered model to forecast the number of infected cases. Testing only one ML model, that is, gradient boosting model (GBM), the work left open whether other ML models would perform better. Here, we compared GBMs, linear regressions, k-nearest neighbors, and Bayesian networks (BNs) in forecasting the number of COVID-19-infected cases in the United States and Canadian provinces based on policy indices of future 35 days. There was no significant difference in the mean absolute percentage errors of these ML models over the combined dataset []. In two provinces, a significant difference was observed [], yet posthoc tests revealed no significant difference in pairwise comparisons. Nevertheless, BNs significantly outperformed the other models in most of the training datasets. The results put forward that the ML models have equal forecasting power overall, and BNs are best for data-fitting applications.

How to build resiliency in autistic individuals: an implication to advance mental health

IntroductionIndividuals on the autism spectrum (ASD) often experience poor mental health and coping strategies compared to their peers due to social exclusion and co-occurring conditions. Resiliency has been identified as a key factor in preventing adverse outcomes and promoting mental health. Therefore, it is important to determine what strategies can be used to build resiliency among autistic individuals. The current paper is one of the first studies that aims to collect information from autistic individuals and their caregivers on potential strategies to enhance resiliency.MethodsWe interviewed 18 participants from various provinces in Canada, comprising of 13 autistic individuals and 5 parents. We used thematic analysis to identify patterns in the data.ResultsThematic analysis revealed three themes to indicate strategies that could be used to enhance resiliency, including: (a) self-reliant strategies, (b) using community-based facilities, and (c) contextual and individual characteristics.ConclusionAlthough the body of literature on resiliency is evolving, this paper provides a unique perspective as it is one of the few studies that considers the experiences of individuals on the spectrum. In addition, this study focuses on identifying and describing specific strategies that can be used to enhance resiliency and mental health, which consequently can help address the existing gaps in knowledge and practice.

Investigating a Train-the-Trainer Model of Supervision and Peer Review for Child Interviewers in Canadian Police Services

AbstractThis project, conducted in one Canadian province, investigated whether a train-the-trainer model of supervision and peer review could improve the interviewing skills of police officers new to interviewing children. At 6 police services, 2 “interview specialists” were chosen by criteria (e.g. having conducted &gt; 30 interviews with children), commitment (minimum 2 years to project), and performance evaluation of a mock and field interview. Specialists received additional training on leading group peer review and individual supervision. They carried out these activities over a 9-month period with 3–4 trainees (new interviewers) per site. Trainees’ interview performance was evaluated with mock and field interviews pre and post intervention. Qualitative interviews about project feasibility were carried out with the specialists at the end of the project, and the results of those interviews comprise the focus of this paper. At the time of the qualitative interviews, only 9 specialists and 5 sites remained in the project. Their interviews revealed that organizational buy-in was critical theme. Other emergent themes were that (different) training is needed for all levels of interviewing experience including interview specialists, that peer review formats are not one-size-fits-all across services, and that fostering a culture of peer review enhances cohesion.