Health Issue In Canada Research Articles

Outbreak investigations of Salmonella and frozen raw breaded chicken: the mitigation of a significant public health issue in Canada.

In May 2017, whole-genome sequencing (WGS) became the primary subtyping method for Salmonella in Canada. As a result of the increased discriminatory power provided by WGS, 16 multi-jurisdictional outbreaks of Salmonella associated with frozen raw breaded chicken products were identified between 2017 and 2019. The majority (15/16) were associated with S. enteritidis, while the remaining outbreak was associated with S. Heidelberg. The 16 outbreaks included a total of 487 cases with ages ranging from 0 to 98years (median: 24years); 79 hospitalizations and two deaths were reported. Over the course of the outbreak investigations, 14 frozen raw breaded chicken products were recalled, and one was voluntarily withdrawn from the market. After previous changes to labelling and the issuance of public communication for these products proved ineffective at reducing illnesses, new industry requirements were issued in 2019, which required the implementation of measures at the manufacturing/processing level to reduce Salmonella to below detectable amounts in frozen raw breaded chicken products. Since implementation, no further outbreaks of Salmonella associated with frozen breaded chicken have been identified in Canada, a testament to the effectiveness of these risk mitigation measures.

Success or failure? Vancouver’s response to the overdose crisis

Addiction is a significant public health issue in Canada, with far-reaching impacts on individuals, families, and communities. In Vancouver, fentanyl addiction stands out as one of the most common and pressing challenges. Fentanyl, an opioid notorious by its street name "down," presents grave risks to users. Motivational interviewing therapy emerges as a widely employed approach for addiction treatment, fostering a client-centered relationship conducive to addressing individualized needs effectively. However, the success of motivational therapy hinges on the readiness of clients for change. This study aims to delineate the scope of addiction issues in Vancouver, Canada, particularly concerning fentanyl addiction. The study aims to highlight the undeniable effects of the fentanyl crisis in Vancouver and the approaches frontline workers need to take by examining field studies in the literature and conducting an interview with a frontline worker in addiction services. By exploring the effects of motivational interviewing therapy, the study seeks to. elucidate its benefits and limitations in mitigating the acute physical and emotional distress associated with fentanyl use. Drawing insights from frontline experiences, there is a need for practical guidance on further enhancing addiction treatment approaches, with a focus on improving therapeutic efficacy and responsiveness to the evolving needs of individuals affected by fentanyl addiction. The prevailing system often assesses individuals primarily through a productivity lens, neglecting their inherent humanity. Therefore, a shift towards a more holistic, long-term approach is imperative to address the root causes of addiction effectively.

Historical Summary of Tick and Animal Surveillance Studies for Lyme Disease in Canada, 1975-2023: A Scoping Review.

Lyme disease (LD) is caused by infection with the bacteria Borrelia burgdorferi sensu lato (Bb) through the bite of an infected Ixodes spp. tick. LD has emerged as a public and animal health issue in Canada, with human incidence increasing in part due to the expansion of Ixodes scapularis ticks and their vertebrate hosts. We sought to provide the first comprehensive summary of published tick and animal surveillance literature regarding LD in Canada to describe changes in LD over time. We conducted a review to identify peer-reviewed LD-focused tick, mammal, and bird surveillance articles in three online databases between 1975 and 2023. Data on study characteristics, data collection years, and surveillance methods and findings were extracted. Descriptive statistics were reported. In total, 115 studies were included for review. Results showed an increase in published surveillance literature and changes in study approaches and their provincial distribution over time, coinciding with increased LD cases in Canada. Seventy-four studies were published after 2014 when Canada's Federal Framework on Lyme Disease Act was introduced, and two-thirds of these studies focused on tick surveillance only. Overall, 58% of studies involved surveillance in Ontario but increases in all other provinces were observed after 2009. Observed changes in five decades of LD-related tick and animal surveillance literature helps document the historical rapid spread of Ixodes and Bb across provinces. This can provide lessons for other regions that may transition from emerging to endemic status for LD in the coming years.

A mixed methods study on poisoning and injury-related emergency department visits associated with opioids in Canada, 2011 to 2022: from the Canadian hospitals injury reporting and prevention program

BackgroundThe opioid crisis is a serious public health issue in Canada. There have been many surveillance programs and research studies on opioid-related emergency department (ED) visits at a national, provincial, regional or municipal level. However, no published studies have investigated the in-depth contexts surrounding opioid-related ED visits. In addition, few studies have examined injuries other than poisonings in those visits. The objective of this study is to investigate the contextual factors and co-occurrence of poisonings and injuries among the opioid-related ED visits in a Canadian sentinel surveillance system on injuries and poisonings from 2011 to 2022.MethodsThis study used a mixed methods design. The data source was the Canadian Hospitals Injury Reporting and Prevention Program. We first selected all opioid-related ED visits during our study period and then identified the contextual factors through a content analysis of the combination of the narrative description and other variables in the patients’ records. The contextual factors were organized into themes as opioid use context, social resource utilization, bystander involvement, and prior naloxone use. The opioid use context was used as a co-variable to examine the other themes and ED presentations (poisonings and other injuries). Quantitative descriptive approach was used to analyze all the contexts and ED presentations.ResultsThe most common opioid use context was non-prescribed opioid use without intention to cause harm, followed by self-poisoning, children’s exposure, and medication error. Various rare contexts occurred. Paramedics participated in 27.9% of visits. Police and security guards were involved in 5.1% and 2.3% of visits, respectively. Child welfare or social workers were involved in 0.4% of visits. Bystanders initiated 18.9% of the ED visits. Naloxone use before arriving at the ED occurred in 23.4% of the visits with a variety of administrators. The majority of patients presented with poisoning effects, either with poisoning effects only or with other injuries or conditions.ConclusionsOur study has provided an in-depth analysis of contextual factors and co-occurrence of poisonings and injuries among opioid-related ED visits in Canada. This information is important for ED programming and opioid-related poisoning and injury intervention and prevention.

Aging In The Face of Diabetes: Severe Hypoglycemia in Older Adults

Global rates of type 1 and type 2 diabetes (T1D, T2D) continue to climb, despite medical advancements. Older adults constitute one of the fastest growing segments of the diabetes population, backed by the world’s unprecedented aging population, decreased diabetes mortality rates, and the obesity epidemic. In Canada, individuals aged ≥65 years account for more than a quarter of all prevalent diabetes cases, far exceeding the other age groups. Older adults with diabetes face the highest risks of microvascular and macrovascular complications, which, compared to younger age cohorts, can contribute to significant functional loss, frailty, and premature mortality. A considerable amount of research links intensive glucose-lowering with insulin or secretagogues to reduced cardiovascular disease. However, the consequent risk of severe hypoglycemia and related sequelae can be particularly catastrophic for older adults, exacerbated by coexisting health conditions and age-related social needs. Approximately 40% of Canadians with T2D aged ≥65 years currently use secretagogues, while 27% use insulin—alongside all those with T1D. Longitudinal evidence suggests that since the year 2000, hospital admission rates for hypoglycemia have consistently surpassed those for hyperglycemia, especially among individuals aged 75 years and above. Economic modelling estimates that the Canadian healthcare system spends $125,932 CAD per year on iatrogenic hypoglycemia, with the bulk of these costs likely allocated to people ≥65 years. Diabetes in older adults is a pressing public health issue in Canada, marked by clinical diversity and widespread use of medications that are prone to cause hypoglycemia. This review outlines recent epidemiologic findings on severe hypoglycemia among community-dwelling older adults with T1D or T2D treated with insulin or secretagogues. Understanding the complex factors contributing to severe hypoglycemia in this population is crucial for developing tailored prevention strategies that are both effective and safe.

Epidemiology and factors associated with mortality among pediatric major trauma patients in Nova Scotia: A 17-year retrospective analysis

BackgroundMajor traumatic injury in the pediatric population requires further evaluation to improve patient outcomes. Relatively few Canadian studies have investigated pediatric trauma using population-based data. Our objectives were to describe the epidemiology of pediatric major trauma in Nova Scotia and identify factors associated with in-hospital mortality. MethodsRetrospective cohort study of pediatric major trauma patients (age <18 years) injured in Nova Scotia over a 17-year period (April 2001-March 2018). Data were collected from the Nova Scotia Trauma Registry. Characteristics were compared between patient subgroups using t-tests, chi-square analyses and Fisher's exact test. Temporal trends were evaluated using the Mann-Kendall test. Incidence and mortality rates were mapped using ArcGIS Pro. A multivariate logistic regression model was created to assess for factors associated with in-hospital mortality. ResultsA total of 1258 injuries were observed over the 17-year study period. The incidence of pediatric major trauma was 41.7 per 100,000 person-years. Most patients were male (819/1258; 65.1 %) and resided in urban areas (764/1258; 60.7 %). Blunt trauma accounted for 86.2 % (1084/1258) of injuries, and motor vehicle collisions were the most common cause (448/1258; 35.6 %). Incidence and mortality rates were highest in the 15–17 year age group, with a trend towards increasing incidence among females (p = 0.011). Mortality was 17.2 % (217/1258) of patients; 10.9 % (137/1258) died pre-hospital. No trends were detected in mortality rates. The regression model showed increased odds of in-hospital mortality for every point increase in the ISS (OR 1.05; 95 % CI 1.02 to 1.09) and for every unit decrease in scene GCS (OR 0.63; 95 % CI 0.56–0.71). Rural patients were 2 times more likely to die in-hospital versus urban patients (OR 2.40; 95 % CI 1.01–5.69), and patients injured at home were 6 times more likely to die compared to those injured in other locations (OR 6.19; 95 % CI 1.01–38.11). ConclusionPediatric trauma remains a major public health issue in Canada and beyond. Greater efforts are required to expand our understanding of trauma epidemiology and develop targeted injury prevention strategies, especially for rural inhabitants.

A commentary on suicide prevention training: The process of implementing an ASIST pilot in postsecondary nursing education

This commentary provides an overview of existing literature on suicide and suicide prevention in the context of postsecondary and nursing settings. WHO (2022) reported that more than 50% of the medical workforce are made up of nurses and midwives who are in an optimal position to provide care for individuals who may be at risk for suicide. Suicide continues to be a major public health issue in Canada, with the postsecondary student population being at a heightened risk for mental health crises. A best practice for suicide prevention is education. Applied Suicide Intervention Skills Training (ASIST) has been used and evaluated internationally by various institutions. We present a pilot project for the delivery of ASIST as both a co-curricular activity for nursing students and as professional development for faculty and staff. We include the process for implementing a pilot of ASIST within the postsecondary education setting, and an evaluation plan for the pilot project.

Food insecurity in households of children receiving care at a paediatric obesity management clinic in Montreal: Overall prevalence and changes associated with the COVID-19 pandemic.

ObjectivesFood insecurity and paediatric obesity are two major public health issues in Canada that may have been exacerbated by the COVID-19 pandemic. We assessed food insecurity and its correlates among households of children receiving care at a paediatric obesity management clinic in Montreal. We also assessed whether the prevalence of food insecurity among households of children who received care during the COVID-19 pandemic differed from those who received care before it.MethodsThis is a retrospective, cross-sectional analysis of medical records of children (2 to 17 years) who received care at a paediatric obesity management clinic in Montreal (Maison de santé prévention – Approche 180 [MSP-180]). Children’s household food security status was assessed using Health Canada’s Household Food Security Survey Module.ResultsAmong the 253 children included in the study, 102 (40.3%) lived in households with moderate (n=89; 35.2%) or severe food insecurity (n=13; 5.1%). Food insecurity was more prevalent in households of children who were first- or second-generation immigrants compared with those who were third generation or more (48.3% versus 30.1%; P=0.03). Prevalence of food insecurity among households of children who received care during the COVID-19 pandemic was 5.5% higher than among those who received care before the pandemic, but the difference was not statistically significant (39.6% versus 45.1%; P=0.65).ConclusionsForty per cent of children treated at this paediatric obesity clinic lived in a food insecure household. This prevalence may have increased during the first year of the COVID-19 pandemic, but statistical power was insufficient to confirm it.

COVID-19 School Re-opening Plans: Rolling Back School Food Programming in Canada?

At the beginning of 2020 national school food programs reached more children than any time in history making school food programs the most extensive form of social safety nets in the world. Looking to Canada, school food programs across the country serve more than 1 million students and provide multifaceted benefits including access to healthy fresh food choices, improving learning capacities, promoting nutritional awareness, assisting food-insecure households, and promoting local food procurement. However, since the beginning of the SARS-Cov 2 (COVID-19) pandemic these programs have faced operational challenges resulting in many rolling back their operations while food insecurity rates in Canada have increased dramatically. Framed as a Canadian case study analysis, this paper considers the discursive effects of provincial and territorial school reopening plans and the material consequences felt by SFPs. Specifically, this paper considers the reach, effectiveness, adoption, implementation, and maintenance of provincial and territorial school food programs within the broader conceptualization of ecological public health to consider if these programs were enabled or constrained by school reopening plans. The authors conducted a policy analysis of 57 primary and 164 supportive school reopening documents developed between April 2020 and September 2021. It was found that provincial and territorial school reopening plans primarily focused on measures to limit infectious disease transmission while food discussed in broad terms demonstrated policy makers' limited awareness of the important role of school food programs and support required to maintain them. In turn, two key observations were made: 1) government school reopening plans have overlooked the benefits of school food programs in Canada, and 2) school reopening plan designers missed opportunities to improve school food programs. This paper argues a thorough understanding of the impacts to school food programs by provincial and territorial COVID-19 public health guidelines is needed for politicians, policymakers, and school food practitioners to support the short- and long-term capacity of these programs and to ensure food insecurity and nutritional health issues in Canada continue to be on thepolitical agenda.

Explaining the gaps in psychological distress and suicidal behaviours between non-Indigenous and Indigenous adults living off-reserve in Canada: a cross-sectional study.

Background:Indigenous people are disproportionately affected by mental health issues in Canada. We investigated factors underlying the difference in psychological distress and suicidal behaviours between non-Indigenous and Indigenous populations living off-reserve in Canada.Methods:We conducted a cross-sectional study using data from the 2012 Canadian Community Health Survey — Mental Health. Respondents were aged 18 years and older. We measured the variation in psychological distress (10-item Kessler Psychological Distress Scale scores, ranging from 10 [no distress] to 50 [severe distress]) and the prevalence of lifetime suicidal ideation and suicide plan between the Indigenous and non-Indigenous populations and explained these differences using the Blinder–Oaxaca approach.Results:The overall response rate for the survey was 68.9%, comprising 18 300 respondents (933 Indigenous and 17 367 non-Indigenous adults). We found lower mean psychological distress scores among non-Indigenous people than among Indigenous people (15.1 v. 16.1, p < 0.001) and a lower prevalence of lifetime suicidal ideation (9.2% v. 16.8%, p < 0.001) and plan (2.3% v. 6.8%, p < 0.001). We found that if socioeconomic status among Indigenous people were made to be similar to that of the non-Indigenous population, the differences in mean psychological distress scores and prevalence of lifetime suicidal ideation and suicide plan would have been reduced by 25.7% (women 20.8%, men 36.9%), 10.2% (women 11.2%, men 11.9%) and 5.8% (women 7.8%, men 8.1%), respectively.Interpretation:Socioeconomic factors account for a considerable proportion of the variation in mental health outcomes between non-Indigenous and Indigenous populations in Canada. Improving socioeconomic status among Indigenous people through plans like income equalization may reduce the gap in mental health outcomes between the 2 populations in Canada.

Evaluation of a Heart Failure Telemonitoring Program Through a Microsimulation Model: Cost-Utility Analysis.

BackgroundHeart failure (HF) is a major public health issue in Canada that is associated with high prevalence, morbidity, and mortality rates and high financial and social burdens. Telemonitoring (TM) has been shown to improve all-cause mortality and hospitalization rates in patients with HF. The Medly program is a TM intervention integrated as standard of care at a large Canadian academic hospital for ambulatory patients with HF that has been found to improve patient outcomes. However, the cost-effectiveness of the Medly program is yet to be determined.ObjectiveThis study aims to conduct a cost-utility analysis of the Medly program compared with the standard of care for HF in Ontario, Canada, from the perspective of the public health care payer.MethodsUsing a microsimulation model, individual patient data were simulated over a 25-year time horizon to compare the costs and quality-adjusted life years (QALYs) between the Medly program and standard care for patients with HF treated in the ambulatory care setting. Data were sourced from a Medly Program Evaluation study and literature to inform model parameters, such as Medly’s effectiveness in reducing mortality and hospitalizations, health care and intervention costs, and model transition probabilities. Scenario analyses were conducted in relation to HF severity and TM deployment models. One-way deterministic effectiveness analysis and probabilistic sensitivity analysis were performed to explore the impact on the results of uncertainty in model parameters.ResultsThe Medly program was associated with an average total cost of Can $102,508 (US $77,626) per patient and total QALYs of 5.51 per patient compared with the average cost of Can $97,497 (US $73,831) and QALYs of 4.95 per patient in the Standard Care Group. This led to an incremental cost of Can $5011 (US $3794) and incremental QALY of 0.566, resulting in an incremental cost-effectiveness ratio of Can $8850 (US $6701)/QALY. Cost-effectiveness improved in relation to patients with advanced HF and with deployment models in which patients used their own equipment. Baseline and alternative scenarios consistently showed probabilities of cost-effectiveness greater than 85% at a willingness-to-pay threshold of Can $50,000 (US $37,718). Although the results showed some sensitivity to assumptions about effectiveness parameters, the intervention was found to remain cost-effective.ConclusionsThe Medly program for patients with HF is cost-effective compared with standard care using commonly reported willingness-to-pay thresholds. This study provides evidence for decision makers on the use of TM for HF, supports the use of a nurse-led model of TM that embeds clinically validated algorithms, and informs the use of economic modeling for future evaluations of early-stage health informatics technology.

Heightened Nutritional Vulnerability Among Food-insecure Canadians in 2015 Than 2004 (P04-053-19)

ObjectivesHousehold food insecurity is a persistent public health issue in Canada. Analyses of dietary intake data from the 2004 Canadian Community Health Survey (CCHS) showed heightened nutritional vulnerability among adults and, to a lesser degree, children in food-insecure households. Given the rise in food prices since 2004, people in food-insecure households may now be at heightened nutritional risk. The objective of this study is to determine how nutritional vulnerability associated with household food insecurity has changed between 2004 and 2015. MethodsDietary intake was assessed on the 2004 CCHS Nutrition (n = 35,107) and 2015 CCHS Nutrition (n = 20,487) using 24-hour recalls, with household food insecurity assessed using the Household Food Security Survey Module. The National Cancer Institute method was used to estimate usual intakes of nutrients of public health concern (calcium, magnesium, vitamin A, vitamin C, folate, zinc, potassium) for food-insecure participants, by survey year, considering children 1–8 years (yr) and 9–18 yr and male and female adults, 19–64 yr. Prevalence of nutrient inadequacy was assessed using the EAR cut-point approach. Differences in usual intake and prevalence of inadequacy between surveys were assessed using t-tests. Weighted bootstrap technique was utilised to generate variance estimates. ResultsIn 2004 and 2015, 8.4% of individuals lived in moderately or severely food-insecure households. Mean usual intakes were lower and prevalence of nutrient inadequacy were higher across groups in 2015 than 2004, but not all differences were statistically significant. Differences in mean potassium and vitamin C intakes were significant in all groups; differences for folate and magnesium were significant in all groups except older children. Calcium was significantly lower in all groups except adult males, and vitamin A was significantly lower in all groups except young children. Young children had significantly lower intakes of zinc. Older children and male adults had significantly higher prevalence of inadequacy for vitamin C. ConclusionsNutritional vulnerability associated with household food insecurity has worsened over time in Canada and remains an area in need of intervention. Funding SourcesOntario Graduate Scholarship, Canada Graduate Scholarship-Masters, Canadian Institutes of Health Research.

Maternal Area of Residence, Socioeconomic Status, and Risk of Adverse Maternal and Birth Outcomes in Adolescent Mothers.

Adolescent pregnancy is a significant public health issue in Canada. Current evidence highlights the individual role of social determinants of health such as maternal residence and socioeconomic status (SES) on teen pregnancy outcomes. This study evaluated the joint association between residence/SES and adverse adolescent pregnancy outcomes. This was a population-based retrospective cohort study of all singleton, live deliveries (2010-2015) from women aged 15 to 19 who were registered in the Alberta Perinatal Health Program. Information on maternal residence and SES was extracted from the Pampalon Material Deprivation Index data set. The study categorized mothers into four risk dyads: rural/high SES, rural/low SES, urban/high SES, and urban/low SES. Adjusted odds ratios (ORs) of adverse pregnancy outcomes were calculated in logistic regression models (Canadian Task Force Classification II-2). A total of 9606 births from adolescent mothers were evaluated. Thirty percent of adolescent mothers were classified as urban/high SES; 27% were urban/low SES; 7% were rural/high SES; and 36% were placed in the rural/low SES category. Compared with urban/high SES mothers, rural/low SES mothers had increased odds of postpartum hemorrhage (OR 1.57; 95% confidence interval [CI] 1.41-1.74), operative vaginal delivery (OR 1.37; 95% CI 1.18-1.60), Caesarean section (OR 1.39; 95% CI 1.19-1.62), large for gestational age infants (OR 1.39; 95% CI 1.16-1.66), low birth weight (OR 1.11; 95% CI 1.07-1.65), and preterm birth (OR 1.48; 95% CI 1.17-1.87). Rural pregnant adolescents of low SES have the highest odds for adverse pregnancy outcomes. Social determinants of health that affect adolescent pregnancies need further examination to identify high-risk subgroups and understand pathways to health disparities in this vulnerable population.

Forecasting the incidence of salmonellosis in seniors in Canada: A trend analysis and the potential impact of the demographic shift.

Salmonella infections remain an important public health issue in Canada and worldwide. Although the majority of Salmonella cases are self-limiting, some will lead to severe symptoms and occasionally severe invasive infections, especially in vulnerable populations such as seniors. This study was performed to assess temporal trends of Salmonella cases in seniors over 15 years (2014–2028) and assess possible impact of demographic shift on national incidence; taking into account of trends in other age groups. The numbers of reported Salmonella cases in seniors (60 years and over) in eight provinces and territories for a period of fifteen years were analysed (1998–2013) using a time-adjusted Poisson regression model. With the demographic changes predicted in the age-structure of the population and in the absence of any targeted interventions, our analysis showed the incidence of Salmonella cases in seniors could increase by 16% by 2028 and the multi-provincial incidence could increase by 5.3%. As a result, the age distribution amongst the Salmonella cases is expected to change with a higher proportion of cases in seniors and a smaller proportion in children (0–4 years old). Over the next decades, cases of infection, hospitalizations and deaths associated with Salmonella in seniors could represent a challenge to public health due to an aging population in Canada. As life expectancy increases in Canada, identification of unique risk factors and targeted prevention in seniors should be pursued to reduce the impact of the demographic shift on disease incidence.

Individual, programmatic and systemic indicators of the quality of mental health care using a large health administrative database: an avenue for preventing suicide mortality.

Suicide is a major public health issue in Canada. The quality of health care services, in addition to other individual and population factors, has been shown to affect suicide rates. In publicly managed care systems, such as systems in Canada and the United Kingdom, the quality of health care is manifested at the individual, program and system levels. Suicide audits are used to assess health care services in relation to the deaths by suicide at individual level and when aggregated at the program and system levels. Large health administrative databases comprise another data source used to inform population-based decisions at the system, program and individual levels regarding mental health services that may affect the risk of suicide. This status report paper describes a project we are conducting at the Institut national de santé publique du Québec (INSPQ) with the Quebec Integrated Chronic Disease Surveillance System (QICDSS) in collaboration with colleagues from Wales (United Kingdom) and the Norwegian Institute of Public Health. This study describes the development of quality of care indicators at three levels and the corresponding statistical analysis strategies designed. We propose 13 quality of care indicators, including system-level and several population-level determinants, primary care treatment, specialist care, the balance between care sectors, emergency room utilization, and mental health and addiction budgets, that may be drawn from a chronic disease surveillance system.

The potential impact of the demographic shift on the incidence of salmonellosis in seniors in Canada

Background: Salmonella infections remain an important public health issue in Canada and worldwide. Although the majority of Salmonella cases are self-limiting, some will lead to severe symptoms and occasionally invasive infections, especially in vulnerable populations. Among this group, seniors (those 60 years and over) are one sub-population that is expected to change significantly in the next decade, especially considering the Canadian population is experiencing a demographic shift toward an increase in seniors. This study was performed to predict temporal trends of Salmonella cases in seniors by 2028 and assess the possible impacts of a demographic shift on the national incidence. Methods & Materials: The number of reported Salmonella cases in seniors in eight provinces and territories (90% of the Canadian population) for a period of 15 years were analysed using a time-series Poisson regression model taking into account annual seasonal oscillation. Results: Between January 1999 and December 2013, an annual average of 842 Salmonella reported cases were recorded in seniors, resulting in a mean annual incidence rate of 15.45 cases per 100,000 persons. With the demographic changes predicted in the age-structure of the population and in the absence of any targeted interventions, our analysis showed the incidence of Salmonella cases in seniors could increase by 16% by 2028, representing an increase of almost 700 cases per year. As a result, the age distribution of salmonellosis in Canada is expected to increase in seniors from 15% of all reported cases (1999 to 2013) to 26% by 2028. Conclusion: Over the following decades, cases of infection, hospitalizations and deaths associated with Salmonella in seniors could represent a challenge to public health due to an increasing aging population. As higher hospitalization and death rates have been reported for seniors, this would have an enormous impact on the health care system in terms of capacity and expenditures. The economic burden of Salmonella is substantial and hospitalizations and deaths associated with severe infections account for much of this cost. As life expectancy increases in Canada, identification of unique risk factors and targeted prevention in seniors should be pursued to reduce the impact of the demographic shift on disease incidence.

Hepatitis C virus infection in Saskatchewan First Nations communities: Challenges and innovations.

Hepatitis C virus (HCV) infection has become a major public health issue in Canada, and especially in Saskatchewan First Nations (FNs) communities. One of the challenges in eliminating hepatitis C in Canada is accessing hard-to-reach populations, such as FNs people living on reserves. In Canada, HCV is a notifiable disease but complete and timely surveillance of HCV data is not always possible in remote communities. In addition, national surveillance data are insufficient for determining the number of cases of hepatitis C among FNs populations, because many provinces do not collect information according to ethnicity. Statistics for FN communities are available federally through the First Nations and Inuit Health Branch (FNIHB) in partnership with the communities and the province. There are multiple factors associated with the high rates of HCV in FNs communities, including barriers in accessing preventive services, early diagnosis and treatment. These access issues are largely attributable to issues with geographical remoteness, transportation, education and awareness, and a health care system designed around urban health. New and innovative ways of delivering information and services, such as the mobile hepatitis C clinic (Liver Health Days) and the community-driven Sexually Transmitted Bloodborne Infections (STBBI) Know Your Status program, are proving invaluable in remote FNs communities. Extending these in-community and community-driven programs to other FNs communities and to the prison population could be invaluable in working towards the World Health Organization elimination goals of hepatitis C virus for all.

Healthy Immigrant Effect and Immigrant Women’s Health Issues in Canada: A Scoping Review of Health Measures

The healthy immigrant effect describes a phenomenon in which immigrants lose health advantage overtime as they reside longer in their migrated country. A scoping review was conducted to observe whether this phenomenon is also observable in the Canadian immigrant demographic specific to women’s health issues. A search strategy was used to collect relevant quantitative studies from MEDLINE, Embase, PsycINFO, Healthstar, and CINAHL databases. The studies examined the relationship between duration of residence in Canada and cervical screening rates, intimate partner violence, help seeking rates for intimate partner violence, and a range of obstetrical outcomes including antenatal and postpartum depression, maternal placental syndrome, illness and hospitalization during pregnancy, and preterm birth. The studies reported gradual approximation of immigrant health status and behaviours to long-term resident or Canadian-born patterns. However, the direction of the effect varied for each health measure. Immigrants were less likely to experience intimate partner violence, maternal placental syndrome, illness or hospitalization during pregnancy, and preterm birth, but were more likely to suffer from antenatal and postpartum depression and less cervical screening. Ethnic background and country of origin seem to modulate these effects. Clinical implications of the study encourage the health care system to consider the unique needs and risk factors of the recent immigrant population including economic, language, and social challenges, while discouraging acculturation of immigrants to harmful lifestyles and behaviours. The researchers recommend future studies to account for specific dynamics within ethnic and language groups and to utilize more longitudinal designs.

Preliminary trial of an online acceptance-based behavioural treatment for military, police, and Veterans with chronic pain

Introduction: Chronic pain is a serious health issue in Canada but an even greater issue in military populations. Individuals experiencing chronic pain frequently find attending in-person treatment sessions difficult because of pain flare-ups, discomfort when travelling, and pain-related avoidance behaviours. These challenges function to maintain the pain cycle and prevent engagement in previously enjoyed activities. The purpose of this study was to gather preliminary evidence for the effectiveness of an online acceptance-based behavioural treatment of chronic pain designed specifically for military, police, and Veterans of these forces. Methods: In this preliminary trial, 15 participants engaged in an 8-week online treatment of chronic pain supplemented with optional biweekly group sessions. Participants completed pre- and post-treatment measures relating to key facets of the fear–avoidance model of chronic pain. Results: Participants' scores improved following treatment on measures of pain acceptance, kinesiophobia, and pain catastrophizing, and pain intensity ratings trended in the expected direction. Discussion: These preliminary results support the feasibility of our online acceptance-based treatment of chronic pain when combined with optional biweekly in-person group sessions.

Food crops irrigated with cyanobacteria-contaminated water: an emerging public health issue in Canada

Food crops irrigated with cyanobacteria-contaminated water: an emerging public health issue in Canada