Canadian Provinces Research Articles

Protocol and Statistical Analysis Plan for a Comparative Interrupted Time Series Evaluation of the Impact of Deemed Consent for Organ Donation Legislative Reform in Nova Scotia, Canada

The Canadian province of Nova Scotia recently became the first North American jurisdiction to implement deemed consent for deceased organ donation as part of a comprehensive legislative reform of their donation and transplantation system. This study will examine the performance metrics and effectiveness of this policy in comparison with other Canadian provinces via a natural experiment evaluation. We will use a cross-sectional controlled interrupted time series quasi-experimental design. Our primary outcome will be consent for deceased donation as confirmed at the time of eligibility (prior registered intent to donate will be noted but not be considered positive unless affirmed at the time of eligibility). Secondary outcomes will include identification and referral of patients who are potential donors, rates of family override of previously registered intent to donate, and donation and transplantation rates per million population. Data will be collected from potential donor audits in Nova Scotia and 3 control provinces (provinces in Canada without deemed consent policies). Study outcomes will be compared in Nova Scotia relative to control provinces in the 3 y before and 3 y after the implementation of legislative reform. These provinces were selected as having systems resembling those of Nova Scotia but without deemed consent.Using controlled interrupted time series methodology compared with other Canadian provinces with otherwise similar systems, we aim to isolate the impact of the deemed consent aspect of legislative reform in Nova Scotia using a robust natural experiment evaluation design as much as possible. Careful selection of outcome measures will allow donation and transplantation stakeholders to properly evaluate if similar reforms should be considered in their jurisdictions.

Pregnancy after amputation: A national survey of prosthetic and mobility outcomes in women with lived experience

Background: In pregnancy, women with limb loss or deficiency or lower extremity amputations (LEAs) may experience physiologic changes affecting mobility, prosthesis use, and/or pain. However, little is known about the pregnancy-related experiences of these women. Objective: The objective of this research was to characterize pregnancy-related experiences including complications, impact on prosthesis use, gait aid use, and mobility for women with LEAs. Study Design: A national, self-administered online survey. Data were analyzed using descriptive statistics. Thematic analyses were performed on open-ended questions. Participants were women with 1 or more LEA(s) who had been pregnant within the last 5 years and were recruited via social media, LEA clinics, and word of mouth. Results: Sixteen women from 4 Canadian provinces completed the survey describing 31 pregnancies. A total of 9 had acquired LEAs and 7 had congenital LEAs. All but 1 respondent had unilateral LEAs; most common level was transfemoral (38%). All wore a prosthesis daily and were K-level 4 ambulators. Five (31%) had to decrease or stop prosthesis use, and 6 (25%) required a gait aid or wheelchair during pregnancy. The most common pregnancy-associated complications were low back pain (64%), changes to limb size/prosthesis comfort (64%), reduced balance (44%), falls (38%), and postpartum depression (25%). Conclusion: This survey is the first to describe the many unique challenges women with LEAs may experience in pregnancy and highlights important information for women with LEAs, their health care providers, their rehabilitation team, and avenues for future research.

Trends of antiseizure medication utilization among pregnant people in four Canadian provinces from 1998 to 2023; a study from the Canadian mother-child cohort active surveillance initiative (CAMCCO)

BackgroundEpilepsy management during pregnancy is crucial for both the mother and fetus. The use of antiseizure medications (ASMs) during pregnancy requires careful consideration due to their potential effects on maternal and fetal health.MethodsThis study analyzed trends in ASMs use among pregnant people in four Canadian provinces over 20 years (Manitoba, Saskatchewan, Alberta, and Quebec). Descriptive statistics were utilized to examine the characteristics of the population, with the frequency and patterns of ASM use estimated throughout each trimester. Linear regression models were developed to analyze yearly patterns of ASM utilization for the overall study population, as well as for people with and without epilepsy.ResultsAmong 1,317,141 pregnant individuals across four provinces, 0.7% had epilepsy. Of the total pregnancies, 1.7% (n = 22,783) were exposed to ASMs, comprising 4,392 from pregnant people with epilepsy (PPWE) and 18,391 from those without epilepsy (PPWOE). Results demonstrated varying trends in ASM usage between provinces, with an overall increase in usage among people without epilepsy in Manitoba, Saskatchewan, and Alberta. ASM use among PPWOE surged significantly in Manitoba (24.2–149.1 per 10,000 pregnant people), Saskatchewan (29.4–107.0 per 10,000), and Alberta (65.7–241.7 per 10,000) (p < 0.05). In Alberta, PPWE’s ASM exposure also rose, from 23.6 in 2008 to 43.0 per 10,000 pregnant people in 2021, while Quebec witnessed a decrease from 59.2 in 1998 to 45.5 per 10,000 pregnancies in 2015. Analysis of ASM use by trimester illustrated a substantial decline among PPWOE from 365 days pre-pregnancy to the third trimester in all provinces. ASM utilization by drug class showcased significant shifts, with second-generation ASMs experiencing a notable rise. Carbamazepine, once prominent, declined, making way for lamotrigine. Regional variations underscore diverse preferences, such as clonazepam’s sustained popularity in Manitoba and Quebec.ConclusionThe study identified increasing trends in ASM use, particularly the increased use of second-generation ASMs, and differences in prescription patterns for pregnant individuals with and without epilepsy. These findings reveal changing ASM use patterns, including increased second-generation ASM use and regional disparities, providing valuable insights into real-world prescription practices.

Abstract Su406: Acceptability and Effectiveness of a Novel, Video-Based CPR and AED Education Program in Canadian Schools

Background: Early cardiopulmonary resuscitation (CPR) and defibrillation are critical for favorable outcomes after sudden cardiac arrest (SCA). Scientific evidence supports CPR and Automated External Defibrillator (AED) training in school-age children. Few studies have used gamified, video-based training to teach students. This national project aimed to assess the acceptability and effectiveness of a brief, video-based educational program (CardiacCrash™), developed by the Heart and Stroke Foundation to teach students hands-only CPR and AED use within a classroom setting. Methods/Results: This study reports preliminary data from two Canadian provinces (Ontario, Alberta). The acceptability and effectiveness of training was measured using a pre/post survey evaluating students’ self-confidence in recognizing SCA, calling for help, and providing bystander CPR, including the use of an AED. CPR performance was measured by using Little Anne QCPR manikins that collected data on CPR effectiveness throughout the training session. Results are stratified by student cohort (elementary—grades 4-8, and secondary—grades 9-12). A total of 1273 students from 6 Ontario and 7 Alberta schools were trained between October 2023 to April 2024. The average age for elementary students (n=729; 47.3% male) was 11.2 ± 1.3 years, and 39.9% had previous CPR training. The average age for secondary students (n=544; 54.4% male) was 15.5 ± 1.1, and 42.6% had previous CPR training. Both groups thought the training was easy (86%), fun (81%), the correct duration (59%) and would recommend it to their friends (85%). All outcome variables improved post-training for both elementary and secondary students, including the self-confidence to recognize and assist in cases of SCA (p=0.008 for both cohorts), (Figure 1). Secondary students were significantly better at providing effective compressions vs. elementary for most CPR measures (Table 2). Conclusion: Preliminary data suggest that CardiacCrash™, a video-based educational program, is acceptable to school-age students and effective at teaching them to perform CPR and use an AED. While both elementary and secondary students achieved acceptable CPR performance, secondary students performed higher quality CPR.

EPID-30. THE COST OF HOSPITAL-BASED CARE AMONG CANADIAN PATIENTS WITH MALIGNANT CENTRAL NERVOUS SYSTEM TUMOURS IN COMPARISON TO THOSE WITH LUNG AND COLORECTAL CANCERS IN THE YEAR PRECEDING THEIR CANCER DIAGNOSIS

Abstract BACKGROUND Approximately 12% of the Canadian GDP was spent on healthcare in 2023. While hospital-based care (HC) constitutes a significant portion of this expenditure, the costs may vary depending on the cancer type. We investigate the HC cost of patients with malignant central nervous system tumours (CNS cancer) and compare it to patients with common cancers in Canadian provinces. METHODS We obtained data between 2010 and 2014 from the Canadian Institute for Health Information’s in-patient and ambulatory care datasets. HC cost was estimated using a 12-month look back period prior to diagnosis date for each patient, including cost related to cancer diagnosis and general healthcare. Choosing colorectal (CRC) and lung (LC) cancers to be the common cancers, patients who were 15 years of age or older and had a diagnosis of one of these cancers were included. We used quantile regression to investigate the factors associated with HC cost. RESULTS A total of 4,498 (CNS), 41,028 (CRC) and 29,747 (LC) patients were included from Alberta and Ontario, Canada. Encounter type (in-patient/out-patient), province (AB/ON), and comorbidities (Yes/No) were the top three factors contributing to HC cost. Adjusting for encounter type, comorbidities and age, the HC costs for CNS patients were $0.7k and $2.4k higher than CRC patients at 50th and 90th percentile, respectively, and $1.0k higher than LC patients at 90th percentile in Ontario. While in Alberta, HC costs for CNS patients were $0.2k and $0.8k higher than CRC patients at 50th and 90th percentile, respectively, and $1.0k lower than LC patients at both 50th and 90th percentiles. CONCLUSIONS We compared HC cost among Canadian patients with different cancer types; significant HC cost differences between patients with CNS and common cancer were observed. Further investigations are warranted to understand drivers of the cost differences.

Was There a Crisis? Living Standards in Lower Canada, 1760 to 1848

Abstract Lower Canada, now the Canadian province of Quebec, is believed to have faced an agricultural crisis in the early 1800s, leading to declining living standards, a debated topic due to lack of data. This paper uses new data on real wages, literacy, and infant mortality to quantitatively assess living standards from 1760 to 1850. The findings show no evidence of a crisis; instead, there are only indications of improvements during the period.

Evaluation of CO2 storage potential of Carboniferous sandstones in the Maritime Provinces of Canada

The suitability of Carboniferous sandstones in three regions of the Maritime Provinces of Canada for geological carbon storage was evaluated: the Horton Bluff Formation in the Windsor Sub-basin, the lower Cumberland Group sandstones in the Cumberland–Sackville Sub-basin, and the Pennsylvanian sandstones of Prince Edward Island. the properties of potential reservoirs and characteristics of vertical seals and barriers to lateral migration were evaluated using previously collected well logs, sample descriptions, core analyzes and seismic interpretations. Reservoir quality was found to be the limiting factor in all three regions. Sandstones in the upper Hurd Creek Member of the Horton Bluff Formation locally have porosities up to 15% and permeabilities up to 25 milliDarcies at depths up to 1200 m. their aggregate thickness may be suitable for GCS, but individual sandstones are thin and likely of limited lateral extent. the lower Cumberland Group contains sand-dominated successions up to 1 km thick with low porosity (5–7%) where known in the subsurface. Sandstone bodies in the Bradelle, Green Gables, and Cable Head formations beneath Prince Edward Island exceed tens of meters in thickness with porosities averaging up to 10–12% and permeabilities up to 10 milliDarcies. Evaporites in the overlying Windsor Group would provide a suitable seal for the Horton Bluff Formation; in other areas the top seal would be provided by mud-prone heterolithic intervals. the evaluated areas may provide opportunities for small onshore storage projects. Further work is warranted to delineate reservoir trends and verify the integrity of potential top seals and traps.

Nothing to hide: How governments justify the adoption of ag-gag laws.

Mainstream practices for producing meat, eggs, and dairy raise numerous concerns regarding public health, animal welfare, and environmental integrity. However, governments worldwide have expanded anti-whistleblower legislation that constrains informed public debate. Since 2019, several Canadian provinces have adopted so-called "ag-gag" laws designed to prevent hidden-camera investigations on farms and meat processing facilities. How do governments across Canada justify ag-gag laws as serving the public interest? To what extent do agricultural industry interests shape government adoption of ag-gag laws? Using Freedom of Information requests and debate records from provincial legislatures, we find that biosecurity is the most prominent justification for ag-gag laws, and that governments exhibit a close, collaborative relationship with industry actors. This case demonstrates that when it comes to contested sites of capital accumulation, governments are drawing on new spatial-legal tools to protect the status quo interests of private industry by dissuading dissent, debate, and public scrutiny.

Genomic surveillance of Canadian airport wastewater samples allows early detection of emerging SARS-CoV-2 lineages

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has shown wastewater (WW) surveillance to be an effective means of tracking the emergence of viral lineages which arrive by many routes of transmission including via transportation hubs. In the Canadian province of Ontario, numerous municipal wastewater treatment plants (WWTPs) participate in WW surveillance of infectious disease targets such as SARS-CoV-2 by qPCR and whole genome sequencing (WGS). The Greater Toronto Airports Authority (GTAA), operator of Toronto Pearson International Airport (Toronto Pearson), has been participating in WW surveillance since January 2022. As a major international airport in Canada and the largest national hub, this airport is an ideal location for tracking globally emerging SARS-CoV-2 variants of concern (VOCs). In this study, WW collected from Toronto Pearson’s two terminals and pooled aircraft sewage was processed for WGS using a tiled-amplicon approach targeting the SARS-CoV-2 virus genome. Data generated was analyzed to monitor trends of SARS-CoV-2 lineage frequencies. Initial detections of emerging lineages were compared between Toronto Pearson WW samples, municipal WW samples collected from the surrounding regions, and Ontario clinical data as published by Public Health Ontario. Results enabled the early detection of VOCs and individual mutations emerging in Ontario. On average, the emergence of novel lineages at the airport preceded clinical detections by 1–4 weeks, and up to 16 weeks in one case. This project illustrates the efficacy of WW surveillance at transitory transportation hubs and sets an example that could be applied to other viruses as part of a pandemic preparedness strategy and to provide monitoring on a mass scale.

Dermacentor species (Acari: Ixodidae) in western Canada, with detection of Dermacentor similis.

Numerous tick species are undergoing significant range expansion in Canada, including several Dermacentor spp Koch (Acari: Ixodidae). With the recent description of Dermacentor similis Lado in the western United States, additional research is required to determine the current range of this species. Five hundred ninety-eight Dermacentor spp. were collected from companion animals in the western Canadian provinces of British Columbia, Alberta, and Saskatchewan. Ticks were morphologically identified to species, followed by PCR and gel electrophoresis of the ITS-2 partial gene target (n = 595). Ninety-seven percent (n = 579/595) generated valid banding patterns. The banding pattern for the majority (74%, n = 206/278) of Dermacentor spp. from southern British Columbia was consistent with D. variabilis (Say), while 26% (n = 72/278) was consistent with D. andersoni Stiles. For samples from Alberta, 38% (n = 3/8) had banding patterns consistent with D. variabilis and 63% (n = 5/8) with D. andersoni. All (n = 293) ticks from Saskatchewan had banding patterns consistent with D. variabilis. After the description of D. similis was published, DNA sequencing of mitochondrial (16S rDNA gene, COI gene) and nuclear (ITS-2) markers was used to confirm the identity of 40 samples. Twenty-seven samples that had banding patterns consistent with D. variabilis from British Columbia were confirmed to be D. similis. One sample from Alberta and five from Saskatchewan were confirmed to be D. variabilis and seven samples from British Columbia were D. andersoni. The ITS-2 amplicons were not useful for differentiating between D. variabilis and D. similis. These results provide evidence of D. similis in western Canada and highlight that sequences of the mitochondrial genes are effective for distinguishing D. andersoni, D. variabilis, and D. similis.

The Implementation of the Advocacy Intervention for Midlife and Older Women Who Have Experienced Intimate Partner Violence: Protocol for a Randomized Controlled Trial.

Midlife and older women who experience intimate partner violence (IPV) often have less access to supports and services than younger women. There is far less focus on research and supports for midlife and older women compared to younger women experiencing IPV, and often, neither elder abuse nor IPV services meet their needs. Few interventions are available to meet the needs of midlife and older women. The goal of this randomized controlled trial is to test the effectiveness of an advocacy intervention for midlife and older women who experience IPV and to learn from the experiences of those who implement and participate in the program. This trial is a 2-arm, unblinded, parallel, pragmatic randomized controlled trial with a qualitative component. Eligible participants will be women who live in the Maritime provinces of Canada (New Brunswick, Nova Scotia, and Prince Edward Island), who are in midlife and older (aged approximately ≥50 years), and who are currently in a relationship with an abusive partner or have recently left an abusive partner. Facilitators will be trained to deliver the intervention. The intervention will be entirely virtual and will consist of 2 components: (1) an empowerment component, which will involve sharing resources and information with the women; and (2) a social support component, which will include providing support and encouragement to women for 12 weeks. Quantitative effectiveness data will be collected from all trial participants at baseline, 3 months after the intervention, and 9 months after the intervention about the incidence and severity of IPV, physical and mental health, and safety behaviors and strategies. Qualitative interviews will be conducted with the facilitators and intervention group participants. Control group participants will receive a static, nontailored version of the advocacy intervention for midlife and older women (AIM) intervention materials after baseline data collection. A total of 12 facilitators have been trained to deliver the AIM intervention to trial participants. Participant recruitment and data collection will be completed in January 2025. Data analysis will continue throughout the data collection period, and the results will be disseminated by December 2025. This research will result in the adaptation and testing of a program to support and empower midlife and older women in the Maritime provinces of Canada who experience IPV. International Standard Randomized Controlled Trial Registry ISRCTN30646991; https://doi.org/10.1186/ISRCTN30646991. DERR1-10.2196/57886.

PO0434: Utilization Rates of Brachytherapy for Prostate Cancer: A Population Based Study in a Canadian Province

PO0434: Utilization Rates of Brachytherapy for Prostate Cancer: A Population Based Study in a Canadian Province

Unpacking the Effects of Decriminalization: Understanding Drug Use Experiences and Risks among Individuals Who Use Drugs in British Columbia

ObjectivesOn January 31, 2023, a three-year exemption from the Controlled Drugs and Substances Act was granted to the Canadian province British Columbia (BC), allowing the cumulative possession of 2.5 g of specific unregulated drugs amongst adults. The goals of the policy are to reduce health, social, and economic harms associated with criminalization, stigma, drug overdose deaths, as well as drug seizures, arrests, and associated enforcement and court costs. As the inaugural year has passed, we aimed to assess people who use drugs’ awareness and knowledge of the, as well as the policy’s impact on their drug use patterns and overdose risk.MethodsWe conducted 100 telephone-based semi-structured interviews with people who use drugs from across BC, exploring changes in drug use experiences and perceived overdose risk since the implementation of the policy. Participants also completed an interviewer-administered survey assessing socio-demographics and substance use patterns. We utilized a qualitative content analysis approach to analyze the interview data.ResultsOur findings indicate a general awareness of the policy among participants, although some policy details were often misunderstood, and participants expressed the need for more widespread dissemination of policy information. While the majority of participants reported that their drug use patterns remained unchanged after decriminalization, some made subtle adjustments, such as carrying under the 2.5 g threshold to minimize the risk of criminalization. Participants highlighted several policy benefits and concerns, including its potential to reduce criminalization and stigmatization, but also increase public drug consumption. Participants offered suggestions for policy improvement.ConclusionThese findings underscore the need for ongoing monitoring of the impacts of decriminalization regarding its potential impact on people who use drugs’ drug use patterns and related risks. Reevaluation of the possession threshold and efforts to enhance education and awareness about the policy could help achieve the policy’s goals.

Controls on regional sulphate distribution in shallow groundwater in the western Canadian Interior Plains

Sulphate (SO4), predominantly derived from sulphur (S)-bearing glacial sediments distributed widely across the Canadian Interior Plains, contributes to high groundwater salinity and can be detrimental to riparian and dry-land ecosystems, agricultural production, and water use. While previous researchers investigated SO4 distribution and dynamics in shallow groundwater at local scales (<1500 km2), we examine SO4 occurrence in groundwater at larger scales, and to depths of ~150 m, considering variations in geology, glacial history, climate, and geochemical and hydrogeological settings in the Canadian province of Alberta. Sulphate concentrations in groundwater vary considerably, with 15 % of 139,130 samples above the 500 mg/L Canadian drinking water aesthetic objective. Analysis of δ34SSO4 and δ18OSO4 from 179 wells throughout Alberta shows SO4 is dominantly derived from oxidation of S-bearing material. At this large scale, marine shale bedrock subcrops, glacial ice flow directions, and climate control SO4 distribution. Groundwater contains less SO4 (<200 mg/L) in western Alberta compared to the east due to a lack of S-bearing bedrock, higher groundwater recharge rates, thinner glacial sediments, and increased groundwater circulation. Focusing on a region in south-central Alberta (Red Deer area), hydrogeological characteristics relating to SO4 formation, recharge, permeability, hydraulic gradient, and travel time are included in a principal component analysis to identify six groundwater groups at varying stages of evolution and SO4 concentrations depending on their hydrogeological setting. Low SO4 concentrations are associated with areas of high recharge, where SO4 has been leached from the sediments, or with more evolved bedrock groundwater where SO4 has been reduced or was recharged in pre-glacial times. High SO4 concentrations are found in areas of lower recharge and permeability, where flushing occurs more slowly. Combining the Red Deer area and province-wide analyses, we identify seven regions across Alberta with characteristic distribution and controls on SO4 occurrence in shallow groundwater.

Supporting young people through the COVID-19 pandemic and beyond: a multi-site qualitative longitudinal study

BackgroundThroughout the COVID-19 pandemic, youth have experienced substantial stress due to abrupt changes in education, finances, and social life, compounding pre-existing stressors. With youth (ages 15–26) often at critical points in development, they are vulnerable to long-term mental health challenges brought on by pandemic trauma.MethodsTo identify youth experiences throughout the pandemic and examine changes over time, we conducted semi-structured interviews among n = 141 youth in two Canadian provinces (Ontario and British Columbia) and across the country of Ireland at three time points over the course of more than one year (August 2020-October 2021). We conducted a qualitative longitudinal analysis using an inductive content approach.ResultsCategories identified were (1) coping with hardship; (2) opportunities for growth; (3) adapting to new ways of accessing services; (4) mixed views on the pandemic: attitudes, behaviour, and perception of policy response; (5) navigating COVID-19 information; (6) transitioning to life after the pandemic; and (7) youth-led recommendations for government and service response. The findings also reveal trends in health and wellness in accordance with prolonged periods of lockdown, changes in weather, and return to normalcy after the availability of COVID-19 vaccines. Key recommendations from youth include incorporating youth voice into decision making, communicating public health information effectively to youth, enhancing service delivery post-pandemic, and planning for future pandemics.ConclusionsThese results provide insights into the extensive longitudinal impacts of the COVID-19 pandemic on young people across three geographical locations. Actively involving youth in decision making roles for future pandemics or public health emergencies is critical.

The Canadian platform for research online to investigate health, quality of life, cognition, behaviour, function, and caregiving in aging (CAN-PROTECT): Study protocol, platform description, and preliminary analyses

Background: Preventing or reducing the risk of cognitive decline and dementia is of great public health interest. Longitudinal data from diverse samples are needed to properly inform clinicians, researchers, and policy makers. CAN-PROTECT is a recently launched online observational cohort study that assesses factors contributing to both risk for incident cognitive decline and dementia and resilience against brain aging, in participants across the lifespan. Methods: Measures of cognition, behaviour, and quality of life administered to both participants and study partners were compared using partial Spearman correlations adjusted for participant and study partner age, sex, and education. In participants, relationships between cognition, behaviour, function, and quality of life were examined using adjusted multivariable linear and negative binomial regression models. Results: In the first three-month window, 2150 participants spanning all Canadian provinces enrolled; 637 nominated study partners had already completed assessments. Engagement with the study was excellent, with many optional assessments completed. Initial analyses demonstrated relationships between cognition, behaviour, function, and quality of life. Discussion: These preliminary results speak to the utility and feasibility of CAN-PROTECT to obtain data relevant to brain health, highlighting the public interest in participating in studies on cognition. The online portal facilitated participation of a geographically diverse sample. This group is ideal to study brain aging, dementia prevention, and early detection of neurodegenerative disease. Longitudinal data will provide additional insights. Several features of CAN-PROTECT are important to consider in terms of assessing risk and resilience in Canadians, and for further development and recruitment of a research-ready cohort.

Improved access and care through the implementation of virtual Hallway, a consultation platform in Nova Scotia: preliminary findings from a feasibility evaluation

BackgroundWhile previous studies have examined various platforms that enable providers to connect, Virtual Hallway (VH) stands out with its unique features. The value add is that this online platform connects primary care providers and specialists for synchronous phone-based conversations and aims to reduce referrals and enhance the quality of referrals. VH allows providers to easily log in, select the required specialty, book call times, receive reminders, and have calls documented, ensuring a high connection rate. In May 2022, the provincial health authority in Nova Scotia, a Canadian province, and VH initiated a feasibility study facilitated through the Health Innovation Hub in Nova Scotia. The goal was to enable primary care providers to connect with specialists, thereby reducing wait times and unnecessary referrals, and facilitating timely access to relevant clinical direction for patients. The current evaluation assessed utilization, value for money in economic analysis, and consultation experiences.MethodsThe study used post, cross-sectional, and cost-benefit study designs. We collected data through various methods, including administratively recorded utilization, theory-driven surveys, and cost data. Utilization was measured by the number of completed consults and the number of healthcare professionals using the VH platform. We analyzed the data using a combination of descriptive statistics and a cost-benefit analysis, which also involved conducting probabilistic sensitivity analysis.ResultsThe study found that approximately 84% of the VH consultations avoided needing in-person specialist referrals. The return on investment was 1.8 (95% CI: 0.8 to 3.0), indicating that the monetary value of the measurable benefits associated with VH exceeded the value of the resources invested. The provider experience survey revealed high satisfaction levels with VH across user groups, with 92% of specialists and 96% of primary care providers reporting being satisfied or highly satisfied with their experience. These positive indicators of provider experience were further supported by the fact that 97% of respondents agreed or strongly agreed that they intended to continue to use VH in their practice, and 97% of respondents agreed or strongly agreed that they would recommend VH to a colleague.ConclusionsThe study suggests that VH was well-received by users, with high levels of satisfaction reported and a reduced need for in-person referrals. It also represented value for money. Further research could explore how the availability of virtual health services can lead to reduced utilization of healthcare resources among different groups of patients.

Trends in household food insecurity from the Canadian Community Health Survey, 2017 to 2022.

Income-related food insecurity is an important determinant of health. This study aimed to provide an update on the food security status of Canadian households using the most recent available data from a health-oriented national-level survey. This study also examined trends in food insecurity since 2017, and how these have tracked with changes in price inflation. Data on household food security status in the 10 Canadian provinces came from five annual cycles of the population-representative cross-sectional Canadian Community Health Survey (CCHS): 2017, 2018, 2020 (September to December), 2021, and 2022. The Household Food Security Survey Module was used to categorize household food security status during the previous 12 months as food secure or marginally, moderately, or severely insecure. Before 2019, approximately 1 in 10 households had experienced some level of food insecurity in the previous 12 months (9.6% in 2017 and 11.6% in 2018). Household food insecurity prevalence was slightly lower and stable during the COVID-19 pandemic years (8.5% in fall 2020 and 9.1% in 2021) and increased to 15.6% in 2022. Levels of household food insecurity generally tracked with changes in consumer price inflation. Compared with 2021, there were notable increases in levels of moderate and severe food insecurity in 2022 among one-parent households with children, renters, and those reliant on government financial assistance. The prevalence of household food insecurity in the CCHS was relatively stable from 2017 to 2021, increased in 2022, and generally tracked with changes in price inflation. Monitoring levels of household food insecurity will continue to be important as price inflation eases but the cost of living remains high.

Nurse practitioner medication abortion providers in Canada: results from a national survey

BackgroundIn 2017, nurse practitioners (NPs) became the first non-physician healthcare providers authorised to independently provide medication abortion (MA) in Canada. We aimed to report on demographic and clinical characteristics of...

General unemployment and serious workplace injury rates: Workers compensation claims analysis from the Canadian province of Saskatchewan, 2007-2018.

There is conflicting published evidence that unemployment impacts workplace safety. Some studies suggest that the workplace injury rate decreases during economic contractions, while others propose an increased rate of injuries during periods of economic contractions. This study investigated the association between unemployment rates and traumatic work-related non-fatal injury (WRNFI) in Saskatchewan, 2007-2018, in order to provide new insight into injury prevention. Saskatchewan's retrospective linked workplace claims data from 2007 to 2018 were grouped by year, season, and worker characteristics (e.g., age and sex). Total employment, total labour force, and the number of unemployed workers from the Statistics Canada Labour Force Survey were grouped by year, season, sex, and age. These data were linked to the worker's compensation board injury claim data to determine the number of people at risk, serving as the denominator (offset term) for WRNFI rates, calculated as WRNFI cases per total employed workers. A negative binomial generalized additive model was used to examine the association between unemployment rates and WRNFI, adjusted for age, sex, industry types, and seasons. The WRNFI rate has declined since 2007. On average, workers aged 20-29years had the highest WRNFI rate (541.6 ± 84.8/100,000). Men had 3.2 times higher WRNFI risk than women (RR = 3.2, 95% CI 3.12-3.22), with the highest WRNFI risk observed in the manufacturing (RR = 1.68, 95% CI 1.63-1.73) and construction (RR = 1.67, 95% CI 1.63-1.72) industries. WRNFI risk decreased non-linearly with an increasing unemployment rate, indicating a pro-cyclic pattern. This analysis showed that WRNFI rates tracked unemployment rates. This suggests a need to increase prevention strategies and reduce disincentives for under-reporting during an economic downturn.