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Background Differential access to healthcare has contributed to a higher burden of illness and mortality among First Nations compared to other people in Canada. Throughout the Coronavirus Disease 2019 (COVID-19) pandemic, First Nations organizations in Manitoba partnered with public health and Manitoba government officials to ensure First Nations had early, equitable and culturally safe access to COVID-19 diagnostic testing and vaccination. In this study, we examined whether prioritizing First Nations for vaccination was associated with faster uptake of COVID-19 vaccines among First Nations versus All Other Manitobans (AOM). Methods and findings In this retrospective cohort study, we used linked, whole-population administrative data from the Manitoba healthcare system (February 2020 to December 2021) to determine rates of COVID-19 diagnostic testing, infection, and vaccination, and used adjusted restricted mean survival time (RMST) models to test whether First Nations received their first and second vaccine doses more quickly than other Manitobans. The cohort comprised 114,816 First Nations (50.6% female) and 1,262,760 AOM (50.1% female). First Nations were younger (72.3% were age 0 to 39 years) compared to AOM (51% were age 0 to 39 years) and were overrepresented in the lowest 2 income quintiles (81.6% versus 35.6% for AOM). The 2 groups had a similar burden of comorbidities (65.8% of First Nations had none and 6.3% had 3 or more; 65.9% of AOM had none and 6.0% had 3 or more) and existing mental disorders (36.9% of First Nations were diagnosed with a mood/anxiety disorder, psychosis, personality disorder, or substance use disorder versus 35.2% of AOM). First Nations had crude infection rates of up to 17.20 (95% CI 17.15 to 17.24) COVID-19 infections/1,000 person-months compared with up to 6.24 (95% CI 6.16 to 6.32) infections/1,000 person-months among AOM. First Nations had crude diagnostic testing rates of up to 103.19 (95% CI 103.06 to 103.32) diagnostic COVID-19 tests/1,000 person-months compared with up to 61.52 (95% CI 61.47 to 61.57) tests/1,000 person-months among AOM. Prioritizing First Nations to receive vaccines was associated with faster vaccine uptake among First Nations versus other Manitobans. After adjusting for age, sex, income, region of residence, mental health conditions, and comorbidities, we found that First Nations residents received their first vaccine dose an average of 15.5 (95% CI 14.9 to 16.0) days sooner and their second dose 13.9 (95% CI 13.3 to 14.5) days sooner than other Manitobans in the same age group. The study was limited by the discontinuation of population-based COVID-19 testing and data collection in December 2021. As well, it would have been valuable to have contextual data on potential barriers to COVID-19 testing or vaccination, including, for example, information on social and structural barriers faced by Indigenous and other racialized people, or the distrust Indigenous people may have in governments due to historical harms. Conclusion In this study, we observed that the partnered COVID-19 response between First Nations and the Manitoba government, which oversaw creation and enactment of policies prioritizing First Nations for vaccines, was associated with vaccine acceptance and quick uptake among First Nations. This approach may serve as a useful framework for future public health efforts in Manitoba and other jurisdictions across Canada., Author(s): Nathan C. Nickel 1,*, Wanda Phillips-Beck 2,*, Jennifer E. Enns 1, Okechukwu Ekuma 1, Carole Taylor 1, Sarah Fileatreault 1, Nkiru Eze 1, Leona Star 2, Josée Lavoie 3, [...]

We describe changes in the comprehensiveness of services delivered by family physicians in 4 Canadian provinces (British Columbia, Manitoba, Ontario, Nova Scotia) during the periods 1999-2000 and 2017-2018 and explore if changes differ by years in practice. We measured comprehensiveness using province-wide billing data across 7 settings (home, long-term care, emergency department, hospital, obstetrics, surgical assistance, anesthesiology) and 7 service areas (pre/postnatal care, Papanicolaou [Pap] testing, mental health, substance use, cancer care, minor surgery, palliative home visits). Comprehensiveness declined in all provinces, with greater changes in number of service settings than service areas. Decreases were no greater among new-to-practice physicians. Key words: comprehensive health care; scope of practice; primary care; family medicine; cohort effect; Canada https://doi.org/10.1370/afm.2945, INTRODUCTION Declining comprehensiveness of family physician practice has been documented across multiple jurisdictions, (1-8) with accompanying speculation that this is driven by lack of interest or inadequate training among more [...]

Context: There are significant concerns about vaccine hesitancy and the equitable distribution of the COVID-19 vaccines. The inclusion of first-contact primary care providers in the vaccine distribution is one approach that can increase vaccine confidence and adoption. Objective: The aim of this study was to examine the experience of nine global jurisdictions that engaged primary care providers to administer COVID-19 vaccines during the pandemic. Study Design and Analysis: A rapid review methodology was adopted. Searches and analyses took place from May 2021 to July 2021. Inclusion criteria were: previously identified jurisdictions focused on COVID-19, referred to the role of primary care, published from January 2020 to July 2021 and in English. Data were extracted based upon study characteristics (e.g., study design) and research questions (e.g., role of primary care, vaccine strategy change over time). Dataset: MEDLINE, CINAHL, the Cochrane Library, SCOPUS and PsychINFO, Google, and the websites of national health departments. Population Studied: Australia, Hong Kong, Germany, France, Israel, Singapore, Spain, United States, and the United Kingdom. Intervention/Instrument: COVID-19 vaccine distribution strategy. Outcome Measures: Primary care involvement. Results: Sixty-two documents met the inclusion criteria. This review found that the vaccine distribution approach started at hospitals in almost all jurisdictions. In some jurisdictions, primary care providers were engaged at the beginning, and the majority included primary care providers over time. Vaccine hesitancy was not explicitly considered in the selection of vaccine distribution approaches. Support to primary care providers was provided through education and training, financial incentives, and organizational support. The barriers to the rollout of the vaccines included individual, organizational and system-level factors. Empirical evidence is lacking on the impact of a primary care-led vaccine distribution approach on vaccine hesitancy, adoption, and equity. Conclusions: Globally, the primary care workforce had an essential role in administering vaccines during the COVID-19 pandemic. Future vaccine distribution approaches need to be informed by evaluating vaccine distribution approaches and their impact on patient and population outcomes., Presenters Monica Aggarwal, PhD, Kristina Kokorelias, Richard Glazier, MD, MPH, Jessica Shiers, BSc, MLIS, Alan Katz, CCFP, MBChB, MSc, [...]

PURPOSE To measure the effectiveness of a 4-month interdisciplinary multifaceted intervention based on a change in care delivery for patients with multimorbidity in primary care practices. METHODS A pragmatic randomized controlled trial with a mixed-methods design in patients aged 18 to 80 years with 3 or more chronic conditions from 7 family medicine groups (FMGs) in Quebec, Canada. Health care professionals (nurses, nutritionists, kinesiologists) from the FMGs were trained to deliver the patient-centered intervention based on a motivational approach and self-management support. Primary outcomes: self-management (Health Education Impact Questionnaire); and self-efficacy. Secondary outcomes: health status, quality of life, and health behaviors. Quantitative analyses used multi-level mixed effects and generalized linear mixed models controlling for clustering within FMGs. We also conducted in-depth interviews with patients, family members, and health care professionals. RESULTS The trial randomized 284 patients (144 in intervention group, 140 in control group). The groups were comparable. After 4 months, the intervention showed a neutral effect for the primary outcomes. There was significant improvement in 2 health behaviors (healthy eating with odds ratios [OR] 4.36; P = .006, and physical activity with OR 3.43; P = .023). The descriptive qualitative evaluation revealed that the patients reinforced their self-efficacy and improved their self-management which was divergent from the quantitative results. CONCLUSIONS Quantitatively, this intervention showed a neutral effect on the primary outcomes and substantial improvement in 2 health behaviors as secondary outcomes. Qualitatively, the intervention was evaluated as positive. The combination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention. Key words: interdisciplinary research; multimorbidity; patient care team; pragmatic clinical trial, INTRODUCTION Much effort has been deployed internationally to improve care and outcomes for persons with multimorbidity in primary care. The Patient-Centered Innovations for Persons with Multimorbidity research program, funded by [...]

Nisseria gonorrhoeae is a sexually transmitted pathogen that has progressively developed resistance to the antimicrobial agents recommended for treatment (1). Third-generation cephalosporins are among the last class of antimicrobial agents [...]

OBJECTIVES: Breastfeeding is associated with improved health. Surveillance data show that breastfeeding initiation rates have increased; however, limited work has examined trends in socio-economic inequalities in initiation. The study's research question was whether socio-economic inequalities in breastfeeding initiation have changed over the past 20 years. METHODS: This population-based study is a project within PATHS Equity for Children. Analyses used hospital discharge data for Manitoba mother-infant dyads with live births, 1988-2011 (n=316,027). Income quintiles were created, each with ~20% of dyads. Three-year, overall and byquintile breastfeeding initiation rates were estimated for Manitoba and two hospitals. Age-adjusted rates were estimated for Manitoba. Rates were modelled using generalized linear models. Three measures, rate ratios (RRs), rate differences (RDs) and concentration indices, assessed inequality at each time point. We also compared concentration indices with Gini coefficients to assess breastfeeding inequality vis-a-vis income inequality. Trend analyses tested for changes over time. RESULTS: Manitoba and Hospital A initiation rates increased; Hospital B rates did not change. Significant inequalities existed in nearly every period, across all three measures: RRs, RDs and concentration indices. RRs and concentration indices suggested little to no change in inequality from 1988 to 2011. RDs for Manitoba (comparing initiation in the highest to lowest income quintiles) did not change significantly over time. RDs decreased for Hospital A, suggesting decreasing socio-economic inequalities in breastfeeding; RDs increased for Hospital B. Income inequality increased significantly in Manitoba during the study period. CONCLUSIONS: Overall breastfeeding initiation rates can improve while inequality persists or worsens. KEY WORDS: Health status disparities; social determinants of health; social class; breast feeding OBJECTIFS: L'allaitement est associe a une meilleure sante. Selon les donnees de surveillance, les taux d'initiation de l'allaitement maternel augmentent, mais peu d'etudes examinent les tendances des inegalites socioeconomiques dans l'initiation de l'allaitement. Notre question de recherche etait de savoir si les inegalites socioeconomiques dans l'initiation de l'allaitement maternel ont change au cours des 20 dernieres annees. METHODE: Cette etude populationnelle s'inscrit dans le programme PATHS Equity for Children. Nos analyses ont utilise les donnees de sortie d'hopital du Manitoba pour les dyades mere-nourrisson avec naissances vivantes de 1988 a 2011 (n=316 027). Des quintiles de revenu ont ete crees, contenant chacun ~20% des dyades. Les taux d'initiation de l'allaitement maternel sur trois ans, globaux et par quintile, ont ete estimes pour l'ensemble du Manitoba et pour deux hopitaux. Des taux ajustes selon l'age ont ete estimes pour le Manitoba. Les taux ont ete modelises a l'aide de modeles lineaires generalises. Trois indicateurs, les ratios des taux (RT), les differences de taux (DT) et les indices de concentration, ont permis d'evaluer l'inegalite a chaque point dans le temps. Nous avons aussi compare les indices de concentration aux coefficients de Gini pour evaluer l'inegalite dans l'allaitement par rapport a l'inegalite des revenus. Des analyses des tendances ont servi a deceler les changements au fil du temps. RESULTATS: Les taux d'initiation du Manitoba et de l'hopital A ont augmente; les taux de l'hopital B n'ont pas change. Des inegalites significatives etaient presentes dans pratiquement toutes les periodes et pour les trois indicateurs: RT, DT et indices de concentration. Les RT et les indices de concentration ont fait etat de changements faibles ou nuls dans l'inegalite de 1988 a 2011. Les DT pour le Manitoba (comparant l'initiation du quintile de revenu superieur au quintile inferieur) n'ont pas significativement change au fil du temps. Les DT ont diminue pour l'hopital A, ce qui pourrait signaler une baisse des inegalites socioeconomiques dans l'allaitement; les DT ont augmente pour l'hopital B. L'inegalite des revenus a significativement augmente au Manitoba sur la periode de l'etude. CONCLUSIONS: Les taux d'initiation de l'allaitement maternel peuvent s'ameliorer globalement alors que l'inegalite subsiste ou s'aggrave. MOTS CLES: disparites d'etat sanitaire; determinants sociaux de la sante; classe sociale; allaitement maternel, Evidence regarding the maternal/child health and economic outcomes associated with infant feeding practices has led to increased support for breastfeeding. (1-3) Systematic reviews have identified several factors that predict whether [...]

Leptospirosis is considered the most globally widespread zoonotic illness; it has been classified as an emerging or reemerging infectious disease by the World Health Organization (1) and the US Centers [...]

A survey on dentists practicing in the Hawaiian region and assessing their preparedness and knowledge of bioterrorism is presented.

A study was conducted to assess the objective knowledge of mental health professionals in Hawaii related to evidence-based early psychological interventions for victims of mass trauma as well as their perceived response readiness to a bioterrorism associated event. The findings suggest that that more attention needs to be focused on bioterrorism preparedness training of mental health professional to improve their ability to respond effectively.

Limited studies have shown high rates of gonorrheal and chlamydial infections among incarcerated adolescents, however, this population has not been routinely targeted for sexually transmitted disease (STD) screening. This study was done to ascertain the feasibility of screening females for STDs at a juvenile detention facility in Honolulu, Hawaii, and to determine the prevalence of chlamydial and gonorrheal infections in this population. Between January 2000 and December 2001, pelvic examination-based STD screening was offered to all female detainees, on selected dates. Specimens from multiple anatomical sites were cultured for Neisseria gonorrhoeae. Endocervical swabs were tested for Chlamydia trachomatis using a DNA probe (GenProbe[R]). One-hundred one of 204 (50%) eligible females were screened. Fourteen of 101 (13.9%) females were screen positive for chlamydial infection, while six of 101 (5.9%) were culture positive for infection with N. gonorrhoeae. Three females were co-infected with both organisms. The high STD rates justify the institution of a routine screening program for this high risk and previously underserved group. KEY WORDS: chlamydia; gonorrhea; adolescents; women's health.

Methamphetamine abuse is epidemic in Hawaii, but the extent of use among pregnant women is unknown. We sought to define the prevalence of use during pregnancy. We conducted a cross-sectional study of consecutive births between November and December 1999, and determined that the prevalence of drug metabolites in meconium were fatty acid ethyl esters: 72 (17.1%); cotinine: 33 (7.7%); opiates: 4 (0.9%); delta-9 tetrahydrocannabinal: 1 (0.2%); and methamphetamine: 3 (0. 7%). Including three positives discovered solely through forensic testing, the overall prevalence of methamphetamine exposure during pregnancy was 1.4% (6/443). The prevalence of methamphetamine was low compared to the prevalence of fatty acid ethyl esters, reportedly indicative of ethanol exposure, and cotinine, a tobacco metabolite. In Hawaii, more attention should be directed towards alcohol and tobacco use during pregnancy.

Byline: Manfred Koo Seen Lin (1), Alan Katz (2), Henk Van Den Bosch (3), Brian Kennedy (4), Eva Stefanski (1), Peter Vadas (1), Waldemar Pruzanski (1) Abstract: Adjuvant arthritis (AA) is an accepted model of inflammatory arthritis. Until now, however, there is little information about inflammatory mediators, specifically in relation to the arachidonic acid cascade in AA. Our objective was to study the expression of secretory (sPLA.sub.2) and cytosolic (cPLA.sub.2) phospholipases A.sub.2 in various organs during the course of AA. AA was induced in Lewis rats which were sacrificed at days 0, 7, 14, 21, 28 and 42. Expression of sPLA.sub.2 mRNA and protein and mRNA of cPLA.sub.2 in paws, regional lymph nodes, spleen, liver, lungs and aorta was investigated. Serum sPLA.sub.2 activity increased from 15213 +- 1131 to a maximum of 32455 +- 4109 nmol/30 on day 21. Maximal increase in sPLA.sub.2 mRNA in paws, lung and aorta was observed on day 14, and in the lymph nodes and spleen on day 28. In the liver, trace levels were found with no corresponding protein expression. In paws, lung, aorta and lymph nodes maximum increase in sPLA.sub.2 protein was noted on day 14 whereas the spleen showed constant sPLA.sub.2 protein level during AA. cPLA.sub.2 mRNA detected in all organs, did not significantly change during the course of AA, with the exception of regional lymph nodes where the message increased between 14 and 28 day. Induction of mRNA and protein of sPLA.sub.2 in several organs is an evidence that AA is a systemic inflammatory process. The parallelity of the sPLA.sub.2 expression to the severity of inflammatory process, implies that sPLA.sub.2 may play pathogenic role in AA. Lack of enhancement of cPLA.sub.2 mRNA may mean that this enzyme is either not induced in AA, or it increases earlier in the course of the inflammatory process. Author Affiliation: (1) Inflammation Research Group and, The Wellesley Central Hospital Research Institute, USA (2) Department of Pathology, The Toronto Hospital, University of Toronto, Ontario, Canada (3) Centre for Biomembranes and Lipid Enzymology, University of Utrecht, The Netherlands (4) Merck Frosst Centre for Therapeutic Research Pointe Claire-Dorval, Quebec, Canada Article History: Registration Date: 03/10/2004

To the Editor: I read with great interest the report by Lefebvre et al. about a Neisseria gonorrhoeae isolate identified in Canada demonstrating a ceftriaxone MIC of 1 mg/L (1). [...]

Using the Manitoba Centre for Health Policy as an example, this commentary discusses how even small investments in population health data can create a multitude of research benefits. The authors highlight that through infrastructure development such as acquiring databases, facilitating access to data and developing data management practices, new, innovative research can be achieved at relatively low cost. KEY WORDS: Data linkage; health care research; investments; population; health A travers l'exemple du Centre de la politique des soins de sante du Manitoba, le present commentaire montre que meme de petits investissements dans les donnees de sante des populations peuvent presenter une multitude d'avantages pour la recherche. Les auteurs soulignent que par le developpement d'infrastructures (acquisition de bases de donnees, facilitation de l'acces aux donnees et elaboration de pratiques de gestion des donnees), on peut realiser de la recherche nouvelle et innovatrice a prix relativement abordable. MOTS CLES: couplage de donnees; recherche sur les soins de sante; investissement; population; sante La traduction du resume se trouve a la fin de l'article. Can J Public Health 2016;107(4-5):e480-e481 doi: 10.17269/CJPH.107.5659, In recent years, interest in health informatics and administrative data has increased dramatically. Several countries, including Canada, New Zealand, members of the European Union, Australia and the UK, have made [...]

Features for artificial vision and pattern recognitions for weapon targets are developed by applying linkages between biologically motivated Hebbian learning algorithms and statistical classification techniques. The evaluation of the features reveal the parameters of a particular target or target class resulting to effective separability of the targets from clutter depending on a relatively small number of features.

Leptospirosis is an acute infectious disease caused by a type of bacteria transmitted in the urine of animals. Human infections can be caused by indirect contact with contaminated water or soil. Symptoms can include jaundice, bleeding into the skin, fever, chills and muscle pains. Usually the disease is mild, and responds to antibiotic treatment; severe infections can damage the kidneys and liver. In the United States, Hawaii consistently has the highest incidence of this condition; most outbreaks are sporadic. A report is presented of an outbreak of leptospirosis that occurred on the island of Kauai in the summer of 1987. Three young men who had been swimming in the Waimea River were hospitalized for suspected leptospirosis. An investigation revealed 16 others who had been swimming in the area virtually every day. Eight cases of leptospirosis were confirmed. They reported flu-like symptoms including headache, fever, chills, nausea, vomiting, muscle aches, and jaundice. The infected young men ranged in age from 10 to 24 years (average of 14) and the average duration of symptoms was six days. It is believed that cattle in the area were the source of the outbreak; three months before the outbreak several cows in the pasture near the swim area had miscarried. (Consumer Summary produced by Reliance Medical Information, Inc.)

Salmonellosis is a serious disease caused by infection with the bacteria Salmonella. This bacteria is found in a number of food items. Eggs are particularly susceptible to contamination by this bacteria, and have been responsible for a number of outbreaks of this disease. In 1970, legislation was passed requiring more extensive inspection of eggs to prevent such outbreaks. Declines in outbreaks were seen following passage of this legislation, but they have since begun to rise. This study examined the prevalence of Salmonella contamination in eggs sold in supermarkets in Hawaii. Cartons of eggs from 12 available brands were collected and tested using two different protocols. Results showed that 10 (9.4 percent) of the 106 cartons were contaminated. Contamination was limited to 3 of the 12 brands. A total of 10 tested positive for Salmonella, and seven of these were from one egg processor. Investigation of the company that processed the contaminated eggs revealed that faulty equipment was responsible. Regular testing of eggs for Salmonella is required, with emphasis on processing procedures. Reliance upon visual inspection alone is inadequate. (Consumer Summary produced by Reliance Medical Information, Inc.)