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Newborn screening (NBS) for inherited and congenital disorders is a form of secondary disease prevention and a public health responsibility. The development of NBS programs is one of the most important achievements in health care. While the scope of the screening targets has expanded and methods have evolved, the screening process has remained essentially unchanged.In 2006, the Canadian province of Ontario implemented a new provincial NBS program that differs from conventional programs. One of the key differences is the structured and fully funded partnership between the ministry of health, the NBS laboratory, and the treatment centers in the province. Each one of these partners has defined roles and accountability. Another difference is the move away from the conventional recall process to an immediate referral system to selected treatment centers.In this article, we report our experience with the new screening structure and discuss it as a model for future NBS programs., (© 2023. Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature.)

Objectives: Several Canadian provinces and territories have reformed their health systems by centralizing power, resources, and responsibilities. Our study explored motivating factors and perceived impacts of centralization reforms on public health systems and essential operations., Methods: A multiple case study design was used to examine three Canadian provinces that have undergone, or are in the process of undergoing, health system reform. Semi-structured interviews were conducted with 58 participants within public health at strategic and operational levels, from Alberta, Ontario, and Québec. Data were analyzed using a thematic analytical approach to iteratively conceptualize and refine themes., Results: Three major themes were developed to describe the context and impacts of health system centralization reforms on public health: (1) promising "value for money" and consolidating authority; (2) impacting intersectoral and community-level collaboration; and (3) deprioritizing public health operations and contributing to workforce precarity. Centralization highlighted concerns about the prioritization of healthcare sectors. Some core public health functions were reported to operate more efficiently, with less duplication of services, and improvements in program consistency and quality, particularly in Alberta. Reforms were also reported to have diverted funding and human resources away from core essential functions, and diminished the public health workforce., Conclusion: Our study highlighted that stakeholder priorities and a limited understanding about public health systems influenced how reforms were implemented. Our findings support calls for modernized and inclusive governance, stable public health funding, and investment in the public health workforce, which may help inform future reforms., (© 2023. The Author(s).)

Background: Promoting the uptake of vaccination for infectious diseases such as COVID-19 remains a global challenge, necessitating collaborative efforts between public health units (PHUs) and communities. Applied behavioural science can play a crucial role in supporting PHUs' response by providing insights into human behaviour and informing tailored strategies to enhance vaccination uptake. Community engagement can help broaden the reach of behavioural science research by involving a more diverse range of populations and ensuring that strategies better represent the needs of specific communities. We developed and applied an approach to conducting community-based behavioural science research with ethnically and socioeconomically diverse populations to guide PHUs in tailoring their strategies to promote COVID-19 vaccination. This paper presents the community engagement methodology and the lessons learned in applying the methodology., Methods: The community engagement methodology was developed based on integrated knowledge translation (iKT) and community-based participatory research (CBPR) principles. The study involved collaboration with PHUs and local communities in Ontario, Canada to identify priority groups for COVID-19 vaccination, understand factors influencing vaccine uptake and co-design strategies tailored to each community to promote vaccination. Community engagement was conducted across three large urban regions with individuals from Eastern European communities, African, Black, and Caribbean communities and low socioeconomic neighbourhoods., Results: We developed and applied a seven-step methodology for conducting community-based behavioural science research: (1) aligning goals with system-level partners; (2) engaging with PHUs to understand priorities; (3) understanding community strengths and dynamics; (4) building relationships with each community; (5) establishing partnerships (community advisory groups); (6) involving community members in the research process; and (7) feeding back and interpreting research findings. Research partnerships were successfully established with members of prioritized communities, enabling recruitment of participants for theory-informed behavioural science interviews, interpretation of findings, and co-design of targeted recommendations for each PHU to improve COVID-19 vaccination uptake. Lessons learned include the importance of cultural sensitivity and awareness of sociopolitical context in tailoring community engagement, being agile to address the diverse and evolving priorities of PHUs, and building trust to achieve effective community engagement., Conclusion: Effective community engagement in behavioural science research can lead to more inclusive and representative research. The community engagement approach developed and applied in this study acknowledges the diversity of communities, recognizes the central role of PHUs, and can help in addressing complex public health challenges., (© 2024. The Author(s).)

Introduction: Throughout the COVID-19 pandemic, primary care nurses were often redeployed to areas outside of primary care to mitigate staffing shortages. Despite this, there is a scarcity of literature describing their perceptions of and experiences with redeployment during the pandemic. Objectives: This paper aims to: 1) describe the perspectives of primary care nurses with respect to redeployment, 2) discuss the opportunities/challenges associated with redeployment of primary care nurses, and 3) examine the nature (e.g., settings, activities) of redeployment by primary care nurses during the COVID-19 pandemic. Methods: In this qualitative study, semi-structured interviews were conducted with primary care nurses (i.e., Nurse Practitioners, Registered Nurses, and Licensed/Registered Practical Nurses), from four regions in Canada. These include the Interior, Island, and Vancouver Coastal Health regions in British Columbia; Ontario Health West region in Ontario; the province of Nova Scotia; and the province of Newfoundland and Labrador. Data related to redeployment were analyzed thematically. Results: Three overarching themes related to redeployment during the COVID-19 pandemic were identified: (1) Call to redeployment, (2) Redeployment as an opportunity/challenge, and (3) Scope of practice during redeployment. Primary care nurses across all regulatory designations reported variation in the process of redeployment within their jurisdiction (e.g., communication, policies/legislation), different opportunities and challenges that resulted from redeployment (e.g., scheduling flexibility, workload implications), and scope of practice implications (e.g., perceived threat to nursing license). The majority of nurses discussed experiences with redeployment being voluntary in nature, rather than mandated. Conclusions: Redeployment is a useful workforce strategy during public health emergencies; however, it requires a structured process and a decision-making approach that explicitly involves healthcare providers affected by redeployment. Primary care nurses ought only to be redeployed after other options are considered and arrangements made for the care of patients in their original practice area. [ABSTRACT FROM AUTHOR]

In this paper I analyse the implications of "flattening" the curve for long-term care residents in the Province of Ontario, Canada during the first wave of the SARS-CoV-2/COVID-19 pandemic. I then question what the role of healthcare systems are in the response to public health emergencies and problematize their status as entities in need of protection. The ethical implications of this are discussed in light of potential challenges raised by climate change. [ABSTRACT FROM AUTHOR]

Introduction: Promoting health equity is a key goal of many public health systems. However, little is known about how equity is conceptualized in such systems, particularly as standards of public health practice are established. As part of a larger study examining the renewal of public health in two Canadian provinces, Ontario and British Columbia (BC), we undertook an analysis of relevant public health documents related to equity. The aim of this paper is to discuss how equity is considered within documents that outline standards for public health. Methods: A research team consisting of policymakers and academics identified key documents related to the public health renewal process in each province. The documents were analyzed using constant comparative analysis to identify key themes related to the conceptualization and integration of health equity as part of public health renewal in Ontario and BC. Documents were coded inductively with higher levels of abstraction achieved through multiple readings. Sets of questions were developed to guide the analysis throughout the process. Results: In both sets of provincial documents health inequities were defined in a similar fashion, as the consequence of unfair or unjust structural conditions. Reducing health inequities was an explicit goal of the public health renewal process. In Ontario, addressing "priority populations" was used as a proxy term for health equity and the focus was on existing programs. In BC, the incorporation of an equity lens enhanced the identification of health inequities, with a particular emphasis on the social determinants of health. In both, priority was given to reducing barriers to public health services and to forming partnerships with other sectors to reduce health inequities. Limits to the accountability of public health to reduce health inequities were identified in both provinces. Conclusion: This study contributes to understanding how health equity is conceptualized and incorporated into standards for local public health. As reflected in their policies, both provinces have embraced the importance of reducing health inequities. Both concepualized this process as rooted in structural injustices and the social determinants of health. Differences in the conceptualization of health equity likely reflect contextual influences on the public health renewal processes in each jurisdiction. [ABSTRACT FROM AUTHOR]

This article provides results from interviews and a focus group conducted at two different points in time in the first year of the COVID-19 pandemic, which explored impacts of the pandemic and adaptation among water advocacy organizations in southern Ontario, Canada. Our findings show that despite the destabilizing and sometimes devastating impact of COVID-19 on grassroots organizations and their programs, by disrupting business as usual the pandemic also created the conditions for experimentation, innovation, the establishment of new capacities and strategic foci. In this paper, we share descriptive narratives from water activists in our geographic area about how they adapted and innovated their work despite the challenges of the pandemic. Our findings illustrate and add nuance to themes emerging in the literature about the impacts of the pandemic on environmental advocacy groups and other nonprofit organizations, and generate new themes for further exploration. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal for the Scholarship of Teaching & Learning is the property of Society for Teaching & Learning in Higher Education and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Setting: Public health practitioners are called to effectively communicate with the public on climate change. The climate crisis requires swift action that starts with public awareness of climate-related health impacts and leads to public support for individual, community and systemic actions to mitigate and adapt to climate change., Intervention: This paper discusses learnings about public opinion research and communication strategies and how a health-focused climate communication campaign-#MakeItBetter-could help to increase awareness and engage new audiences, including public health partners, in conversations about climate change in order to reduce climate-related health impacts for current and future generations. The #MakeItBetter campaign was grounded in evidence-informed messaging, being sensitive to health inequities. Emerging research and pre-campaign testing suggest that framing climate change as a health issue is a promising practice., Outcomes: The #MakeItBetter campaign appeals to parents/caregivers to learn more about climate-related health impacts, take protective action for children and support multi-level climate action. The campaign launch secured 89 news stories, including multicultural media coverage. Longer-term evaluation is required to determine the campaign's effectiveness in building public support for climate action., Implications: An innovative approach to climate communication that draws on the intersections between behavioural and climate sciences and engages in multi-sectoral collaboration can spur both climate action and health protection, aiding public health practitioners and partners in effectively communicating the urgency for climate action. More work is needed to support communication on climate change as an inequity multiplier and promote climate action and community resilience for health equity co-benefits.

Ontario families are required to provide up-to-date vaccination records as children begin schooling. Exemptions are allowed on both medical and nonmedical (religious or philosophical) grounds. In a recent report, Toronto Public Health (2019) called for an end to nonmedical exemptions - a proposal some allege infringes the Canadian Charter of Rights and Freedoms right to freedom of religion and conscience. This paper explores whether and to what extent vaccine refusal is protected under the Charter and argues that the elimination of nonmedical exemptions can be justified under Section 1 of the Charter. The issue of mandatory vaccination may take on special urgency in the coming months and years, if and when a vaccine is found for COVID-19., (Copyright © 2020 Longwoods Publishing.)

This paper is about the clinical principle of informed choice-the hallmark feature of the midwifery model of care in Ontario, Canada. Drawing on ethnographic history interviews with midwives, I trace the origins of the idea of informed choice to its roots in the social movement of midwifery in North America in the late 1960s and 1970s. At that time informed choice was not the distinctive feature of midwifery but was deeply embedded what I call midwifery's feminist experiment in care. But as midwifery in Ontario transitioned from a social movement to a full profession within the formal health care system, informed choice was strategically foregrounded in order to make the midwifery model of care legible and acceptable to a skeptical medical profession, conservative law makers, and a mainstream clientele. As mainstream biomedicine now takes up the rhetoric of patient empowerment and informed choice, this paper is at once a nuanced history of the making of the concept and also a critique of the ascendant 'regime of choice' in contemporary health care, inspired by the reflections of the midwives in my study for whom choice is impossible without care. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to provide a narrative of our experience with community-driven change using our "Developer/Adapter" research method in Northern Ontario, Canada, so it can be explored in other First Nations contexts. The goal of our currently funded research is to identify community solutions and knowledge and implement community-developed interventions to better support older Indigenous persons, especially those in rural and remote communities, to "age in place" and remain independent in the community through timely access to relevant care. Our Developer/Adapter research method was developed in response to the community-identified need for self-determination to overcome the limitations of traditional Western approaches and effectively plan and execute change in Indigenous communities. Our approach commits to supporting a selfdetermining voice for Indigenous people and working collaboratively to develop wholistic care interventions. We believe this approach can generate compelling data for policy and practice change in both Canada and Australia. [ABSTRACT FROM AUTHOR]

Background: Extreme cold weather alert programs have been implemented in some areas to address the significant health impacts of exposure to cold. One such program is the Toronto Cold Weather Program (TCWP) that was implemented in the City of Toronto since 1996 to protect the public from extreme weather conditions. In this paper, we aim to evaluate the effectiveness of the TCWP in reducing mortality and morbidity outcomes related to cold temperatures., Methods: We applied a quasi-experimental study design using the Difference-in-Differences method coupled with propensity-score-matching to determine the effect of the TCMP on daily hospitalizations and deaths due to cardiovascular disease (CVD), coronary heart disease (CHD) or cerebrovascular disease, using two complementary analytical approaches., Results: Overall, the analysis did not detect an impact on reduced mortality/morbidity in the City of Toronto from the TCMP. For example, we obtained a Risk Difference (RD) of -0.88 (per 1,000,000 people) (95% CI: -3.27 to 1.51) and a Risk Ratio (RR) of 0.98 (95% CI: 0.91 to 1.05) people for CVD hospitalizations., Conclusions: The TCWP was not found to be effective in reducing cold related mortality and morbidity which demonstrates the importance of improving existing policies related to cold in Canada and other countries., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Dietetic educators and practicum coordinators (PC) play critical roles in preparing students for practice. Dietitians have made significant progress in the development of educational curricula, competencies, and other resources to support knowledge and skill attainment in public health. There are identified gaps in the literature concerning practical training in sustainable food systems and public health, creating barriers in knowledge exchange and improvements in practicum programs in Canada. This paper discusses the potential opportunities and challenges associated with the number of placements for practical training in public health based on interviews with PCs in Ontario. The findings are limited to the perspectives of 7 PCs with experience in practical training and are a starting point for ongoing evaluation. Identified opportunities within traditional and "emerging settings" for practical training in public health included: the uniqueness of the experience, the potential for students to learn outside their comfort zones, and greater possibilities for dietitians in new roles and settings. Challenges included the need for significant PC engagement with nondietetic preceptors and a narrow view of dietetic practice among some dietitians. Interprofessional teams, emerging settings, and flexible learning approaches may create and support practical training opportunities in food systems and public health going forward.

Purpose: Forensic mental health programs (FMHPs) in Ontario, Canada provide rehabilitation and supervision services. However, models available to guide their delivery are primarily adapted from fields outside of forensic mental health. To partially fill this gap, this paper aims to provide a general review of the process a multi-professional team took to develop the Integrated Forensic Program [IFP]-Ottawa Model of Risk Management & Recovery. Design/methodology/approach: Working groups were initiated to identify the needs of patients in their local setting, conduct a literature review on care delivery models in forensic mental health and build a service delivery model specific to forensic mental health. Findings: The resulting model places patient engagement at its centre and encompasses eight domains of need that contribute towards the patient's recovery and the management of the safety risk they pose to the public, namely, the basic needs, diversity and spirituality, social, occupational, psychological, substance use, physical health and mental health domains. Practical implications: The IFP-Ottawa Model of Risk Management & Recovery provides a framework to which therapeutic group services for persons in FMHPs can be aligned. Originality/value: The leadership teams in FMHPs could use this framework and the method used for its development to ensure group services provided at their FMHPs are evidence-informed and coincide with their patients' specific needs. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Evaluating the features and performance of health information systems can serve to strengthen the systems themselves as well as to guide other organizations in the process of designing and implementing surveillance tools. We adapted an evaluation framework in order to assess electronic immunization data collection systems, and applied it in two Ontario public health units. Methods The Centers for Disease Control and Prevention's Guidelines for Evaluating Public Health Surveillance Systems are broad in nature and serve as an organizational tool to guide the development of comprehensive evaluation materials. Based on these Guidelines, and informed by other evaluation resources and input from stakeholders in the public health community, we applied an evaluation framework to two examples of immunization data collection and examined several system attributes: simplicity, flexibility, data quality, timeliness, and acceptability. Data collection approaches included key informant interviews, logic and completeness assessments, client surveys, and on-site observations. Results Both evaluated systems allow high-quality immunization data to be collected, analyzed, and applied in a rapid fashion. However, neither system is currently able to link to other providers' immunization data or provincial data sources, limiting the comprehensiveness of coverage assessments. We recommended that both organizations explore possibilities for external data linkage and collaborate with other jurisdictions to promote a provincial immunization repository or data sharing platform. Conclusions Electronic systems such as the ones described in this paper allow immunization data to be collected, analyzed, and applied in a rapid fashion, and represent the infostructure required to establish a population-based immunization registry, critical for comprehensively assessing vaccine coverage. [ABSTRACT FROM AUTHOR]

The number of people with dementia worldwide will reach 115.4 million by 2050. This accelerating crisis has sparked research on how to design neighbourhoods for those with early dementia, and how to empower them through built environment changes to remain in their community for as long as possible. There are numerous benefits for persons with dementia who continue access to their neighbourhood: physical activity, sense of dignity, social interaction, autonomy and psychological wellbeing. In this paper, I examine 17 recommendations (urban design and land use strategies) identified as ‘dementia-friendly’, within dementia design and planning literature. Each is then examined against the planning frameworks for a mid-size suburban municipality in Ontario and assessed for its financial impact on a base case subdivision using pro forma analysis. The effect on the financial return for a developer was minimal, demonstrating that establishing these recommendations as policy is viable, through regulation and incentives. [ABSTRACT FROM AUTHOR]

Objective: Technology is essential in the facilitation of many operations in higher educational institutions. The use of web-based platforms to deliver academic content, including practice-based training, has gained popularity. However, their use in practicum process administration is not well studied. In the 2020/2021 academic year, a graduate program in the Faculty of Health Science within a public university in Ontario incorporated the InPlace platform to streamline the administration of the practicum process, including goal setting. This study aimed to understand the user experience of the platform in facilitating competency-based learning. Methods: Twelve students participated in two focus group sessions that lasted approximately 1.5 hr each. Two staff members participated in one-on-one semi-structured interviews. The System Usability Scale (SUS) was used as a measure of the platform's usability. Other outcomes included staff and students' user experience. Result: Overall, the students and staff believe the platform is good for facilitating competency-based learning. The SUS score was 61.8 (95% confidence interval, [56.7, 66.9]). Eight students (66.7%) indicated that the platform was useful in helping them navigate their learning goals. Staff expressed appreciation of the program with respect to communication, practicum process, and overall program administration. Some suggestions for improving the platform were made. Conclusion: The practicum placement platform has shown some initial benefits in communication and practicum process administration. In a future configuration of similar platforms, the implementation of the suggestions provided in this study may be necessary to improve usability and enhance the facilitation of competence-based learning. [ABSTRACT FROM AUTHOR]

Due to the COVID-19 pandemic, aquatic facilities were initially closed but then allowed to open with strict public health measures in place. However, it is unclear how these measures impacted pool operations. This study surveyed municipal pool operators in Ontario regarding what public health measures were adopted during the pandemic (March 2020 to March 2022). Results were reported using frequency descriptions and t-tests were conducted to compare responses during and after the pandemic. Overall, 48 pool operators participated, representing a response rate of 23.6%. Every operator made changes to pool entry procedures, implemented social distancing measures, posted public health notices and reduced swim class sizes. Some operators had issues hiring enough qualified staff and, in fact, had to reduce their hours or even close the facility. In addition, labour-intensive duties included increased frequency of cleaning and health screening of every pool visitor. The changes to pool operations and closures may have adversely impacted the mental health of staff and the public, respectively. In anticipation of another pandemic, it is recommended that pool operators provide training and support to their staff. Also, future pandemic guidelines ought to address both public health as well as occupational health and safety best practices. [ABSTRACT FROM AUTHOR]

Despite a rhetorical turn towards prevention in homelessness policy and research, the work of youth homelessness prevention continues to be frustrated by persistent structural barriers. In this article, we examine how youth homelessness prevention is being implemented in the province of Ontario, with a focus on targeted provincial support programs and local shelter diversion practices. Drawing on interviews with workers in the homeless-serving sector, we describe the implementation of these initiatives and identify points of frustration and potential that workers encounter as they try to prevent experiences of homelessness for youth. We contend that these points of frustration illuminate persistent structural barriers that continue to forestall the work of youth homelessness prevention. Meanwhile, points of potential demonstrate the importance of empowering workers to creatively adapt and offer responsive services. Taken together, these signal the critical importance of two aspects of contemporary homelessness prevention typologies—primordial prevention and empowerment. We end by offering aspirations for action, a political reframing of the policy recommendations sections more typical of social science research articles. We do so to affirm our commitment to advancing the work of structural transformation that is required to achieve the right to housing for all, including youth. [ABSTRACT FROM AUTHOR]

This paper presents the writer's pedagogical development and delivery of a new undergraduate course in applied sustainability and public health in civil engineering design in the Department of Civil Engineering at Queen's University in Kingston, Canada. This innovative course introduces undergraduate civil engineering students to methods in sustainability indicators, life-cycle analysis, environmental input-output analysis, and risk analysis to evaluate the environmental impacts and public health impacts of civil engineering design. The paper discusses the learning objectives and course themes of preventive design, multicriteria decision making, and systems-level analysis. The course syllabus and the design project in which students were asked to design a water transmission pipeline and evaluate its environmental impacts are discussed in detail. An overview of the pedagogical methods and student evaluation tools employed in the course is given. An evaluation of learning outcomes and student impressions of the course suggest that topics on design for environment, sustainable development in an international context, and the interface between sustainability, engineering, and policy development should be included in future editions of the course. [ABSTRACT FROM AUTHOR]

Resource allocation is a critical issue for public health decision-makers. Yet little is known about the level and type of resources needed to build capacity to plan and implement comprehensive programs. This paper examines the relationships between investments and changes in organizational capacity and program implementation in the first phase (1998-2003) of the Ontario Heart Health Program (OHHP)--a province-wide, comprehensive public health program that involved 40 community partnerships. The study represents a subset of findings from a provincial evaluation. Investments, organizational capacity of public health units and implementation of heart health activities were measured longitudinally. Investment information was gathered annually from the provincial government, local public health units and community partners using standard reports, and was available from 1998 to 2002. Organizational capacity and program implementation were measured using a written survey, completed by all health units at five measurement times from 1994 to 2002. Combining provincial and local sources, the average total investment by year five was $1.66 per capita. Organizational capacity of public health units and implementation of heart health activities increased both before and during the first 2 years of the OHHP, and then plateaued at a modest level for capacity and a low level for implementation after that. Amount of funding was positively associated with organizational capacity, yet this association was overpowered by the negative influence of turnover of a key staff position. Regression analysis indicated that staff turnover explained 23% of local variability in organizational capacity. Findings reinforce the need for adequate investment and retention of key staff positions in complex partnership programs. Better accounting of public health investments, including monetary and in-kind investments, is needed to inform decisions about the amount and duration of public health investments that will lead to effective program implementation. [ABSTRACT FROM AUTHOR]

The outbreak of severe acute respiratory syndrome (SARS) in Toronto and other cities in 2003 showed a heightened sensitivity of places in the global economy to rapid changes brought on by the acceleration of social and ecological relationships. The spread of the SARS virus may be a predictable consequence of these processes. The paper investigates how processes of globalisation have affected the transmission and response to SARS within the context of the global cities network. Little work has been done on the relationship of global city formation and the spread of infectious disease. Arguing that this relationship may be central to understanding the intricate capillary structures of the globalised network, the paper focuses on how pathogens interact with economic, political and social factors. These relationships exist both in the network and in global cities themselves, thereby posing new issues for public health and epidemiological efforts at disease containment and tracking. [ABSTRACT FROM AUTHOR]

Collaboration between hospitals and community organisations has been promoted over the past 20 years by various levels of government, hospital associations, health promotion advocates, and others at the state/province, national and international levels as a way to improve the‘efficiency of the system’, reduce duplication, enhance effectiveness and service coordination, improve continuity of care, and enhance community capacity to address complex issues. Nevertheless, and despite a growing literature on interagency collaboration, systematic documentation and empirical analysis of hospital−community collaboration (HCC) is almost completely lacking in the literature, particularly as regards collaborations that address the determinants of health beyond the hospital walls. In this paper, we describe the methodology and key findings from a research study of HCC. TheHospital Involvement in Community Action(HICA) study undertook detailed qualitative case studies (in four urban, suburban, rural and northern locations) and a telephone survey (of 139 community organisations in a large urban centre) in order to learn about the range of collaborations and working relationships that exist between hospitals and community agencies in the province of Ontario (Canada), and the factors that influenced (enabled and/or hindered) HCC. Particular attention was paid to barriers and enablers at three nested levels of context (policy, hospital and community) and, drawing primarily on the qualitative case studies, it is this aspect that is the focus of this paper. That such collaborations continue to be widespread despite a generally unfavourable policy environment and hospital institutional culture that poses significant barriers, suggests that the extent to which HCC flourishes (or exists at all) crucially depends on the presence and ongoing enthusiasm/commitment of one or more‘champions’ within the hospital, and the commitment of both parties to overcome the marked cultural differences between hospital and community. We conclude with a discussion of implications for policy and practice. [ABSTRACT FROM AUTHOR]

Background: Public health systems in Canada have undergone significant policy renewal over the last decade in response to threats to the public's health, such as severe acute respiratory syndrome. There is limited research on how public health policies have been implemented or what has influenced their implementation. This paper explores policy implementation in two exemplar public health programs -chronic disease prevention and sexually-transmitted infection prevention - in Ontario, Canada. It examines public health service providers', managers' and senior managements' perspectives on the process of implementation of the Ontario Public Health Standards 2008 and factors influencing implementation., Methods: Public health staff from six health units representing rural, remote, large and small urban settings were included. We conducted 21 focus groups and 18 interviews between 2010 (manager and staff focus groups) and 2011 (senior management interviews) involving 133 participants. Research assistants coded transcripts and researchers reviewed these; the research team discussed and resolved discrepancies. To facilitate a breadth of perspectives, several team members helped interpret the findings. An integrated knowledge translation approach was used, reflected by the inclusion of academics as well as decision-makers on the team and as co-authors., Results: Front line service providers often were unaware of the new policies but managers and senior management incorporated them in operational and program planning. Some participants were involved in policy development or provided feedback prior to their launch. Implementation was influenced by many factors that aligned with Greenhalgh and colleagues' empirically-based Diffusion of Innovations in Service Organizations Framework. Factors and related components that were most clearly linked to the OPHS policy implementation were: attributes of the innovation itself; adoption by individuals; diffusion and dissemination; the outer context - interorganizational networks and collaboration; the inner setting - implementation processes and routinization; and, linkage at the design and implementation stage., Conclusions: Multiple factors influenced public health policy implementation. Results provide empirical support for components of Greenhalgh et al's framework and suggest two additional components - the role of external organizational collaborations and partnerships as well as planning processes in influencing implementation. These are important to consider by government and public health organizations when promoting new or revised public health policies as they evolve over time. A successful policy implementation process in Ontario has helped to move public health towards the new vision.

The Ontario Government has recently passed a new Liquor Licence Act, based on the recommendations of a special advisory committee. This paper describes how the advisory committee framed the issues and arrived at a lengthy document detailing 73 recommendations on issues such as licence classification, the control of special permit functions days and hours of operation, legal drinking age, alcohol advertising, the civil liabilities of alcohol providers and server training. The key actors and considerations are discussed as well as the subsequent Cabinet action on the report and the implementation process currently underway. The paper concludes with an assessment from both an administrative and a public health perspective, with particular attention to the limited role which research played in these policy decisions. [ABSTRACT FROM AUTHOR]

This paper presents the results of a reconsideration of earlier work that finds an association between daily hospital admissions for respiratory distress and daily concentrations of sulphate (lag 1) as well as daily maximum concentrations of ozone (lags 1 and 3). These associations are found even after clustering the data by hospital of admission and accounting for the effects of temperature. We use an adaptation of their generalized estimating equation technique for clustered data, that daily data being for southern Ontario summers from 1983 to 1988. Like them, we adjust for daily maximum temperatures. However, unlike the earlier work returned to ours includes daily average humidity as a potential explanatory variable in our model. Our analysis also differs from theirs in that we cluster the data by census subdivision to reduce the risk of confounding pollutant levels with population size within regions. Moreover, we log-transform the explanatory variables and then high-pass filter the resulting data. We also deviate from the earlier analysis by taking account of measurement error incurred in using surrogate measures of the explanatory variables. To do so we use new methodology designed for our study but of potential value in other applications. That methodology requires a spatial predictive distribution for the unmeasured explanatory variables. Each day about 700 missing measurements for each of these variables can then be imputed over the geographical domain of the study. With these imputations we get a measure of imputation error through the covariance of the predictive distribution. Along with the predictive distribution we require an impact model to link-up with the predictive distribution. We describe that model and show how it uses the imputed measurements of the missing values of the explanatory variables. We also show how through that model, uncertainty about these values is reflected in our analysis and in commensurate uncertainties in the inferences made. Apart from its substantive objectives, our analysis serves to test the new methods with the earlier results serving as a foil. The reassuring qualitative agreement between our findings and the earlier results seems encouraging. [ABSTRACT FROM AUTHOR]

Background: The BETTER intervention is an effective comprehensive evidence-based program for chronic disease prevention and screening (CDPS) delivered by trained prevention practitioners (PPs), a new role in primary care. An adapted program, BETTER HEALTH, delivered by public health nurses as PPs for community residents in low income neighbourhoods, was recently shown to be effective in improving CDPS actions. To obtain a nuanced understanding about the CDPS needs of community residents and how the BETTER HEALTH intervention was perceived by residents, we studied how the intervention was adapted to a public health setting then conducted a post-visit qualitative evaluation by community residents through focus groups and interviews. Methods: We first used the ADAPT-ITT model to adapt BETTER for a public health setting in Ontario, Canada. For the post-PP visit qualitative evaluation, we asked community residents who had received a PP visit, about steps they had taken to improve their physical and mental health and the BETTER HEALTH intervention. For both phases, we conducted focus groups and interviews; transcripts were analyzed using the constant comparative method. Results: Thirty-eight community residents participated in either adaptation (n = 14, 64% female; average age 54 y) or evaluation (n = 24, 83% female; average age 60 y) phases. In both adaptation and evaluation, residents described significant challenges including poverty, social isolation, and daily stress, making chronic disease prevention a lower priority. Adaptation results indicated that residents valued learning about CDPS and would attend a confidential visit with a public health nurse who was viewed as trustworthy. Despite challenges, many recipients of BETTER HEALTH perceived they had achieved at least one personal CDPS goal post PP visit. Residents described key relational aspects of the visit including feeling valued, listened to and being understood by the PP. The PPs also provided practical suggestions to overcome barriers to meeting prevention goals. Conclusions: Residents living in low income neighbourhoods faced daily stress that reduced their capacity to make preventive lifestyle changes. Key adapted features of BETTER HEALTH such as public health nurses as PPs were highly supported by residents. The intervention was perceived valuable for the community by providing access to disease prevention. Trial registration: #NCT03052959, 10/02/2017. [ABSTRACT FROM AUTHOR]

Background: Effectively addressing the social determinants of health and health equity are critical yet still-emerging areas of public health practice. This is significant for contemporary practice as the egregious impacts of health inequities on health outcomes continue to be revealed. More public health organizations seek to augment internal organizational capacity to address health equity while the evidence base to inform such leadership is in its infancy. The purpose of this paper is to report on findings of a study examining key factors influencing the development and implementation of the social determinants of health public health nurse (SDH-PHN) role in Ontario, Canada. Methods: A descriptive qualitative case study approach examined the first Canadian province-wide initiative to add SDH-PHNs to each public health unit. Data sources were documents and staff from public health units (i.e., SDH-PHNs, Managers, Directors, Chief Nursing Officers, Medical Officers of Health) as well as external stakeholders. Data were collected through 42 individual interviews and 226 documents. Interview data were analyzed using framework analysis methods; Prior's approach guided document analysis. Results: Three themes related to the SDH-PHN role implementation were identified: (1) 'Swimming against the tide' to lead change as staff navigated ideological tensions, competency development, and novel collaborations; (2) Shifting organizational practice environments impacted by initial role placement and action to structurally embed health equity priorities; and (3) Bridging policy implementation gaps related to local-provincial implementation and reporting expectations. Conclusions: This study extends our understanding of the dynamic interplay among leadership, change management, ideological tensions, and local-provincial public health policy impacting health equity agendas. Given that the social determinants of health lie outside public health, collaboration with communities, health partners and non-health partners is essential to public health practice for health equity. The study findings have implications for increasing our knowledge and capacity for effective system-wide intervention towards health equity as a critical strategic priority for public health and for broader public policy and community engagement. Appropriate and effective public health leadership at multiple levels and by multiple actors is tantamount to adequately making inroads for health equity. [ABSTRACT FROM AUTHOR]

Background: Given the context-specific nature of health research prioritization and the obligation to effectively allocate resources to initiatives that will achieve the greatest impact, evaluation of priority setting processes can refine and strengthen such exercises and their outcomes. However, guidance is needed on evaluation tools that can be applied to research priority setting. This paper describes the adaption and application of a conceptual framework to evaluate a research priority setting exercise operating within the public health sector in Ontario, Canada.Methods: The Nine Common Themes of Good Practice checklist, described by Viergever et al. (Health Res Policy Syst 8:36, 2010) was used as the conceptual framework to evaluate the research priority setting process developed for the Locally Driven Collaborative Projects (LDCP) program in Ontario, Canada. Multiple data sources were used to inform the evaluation, including a review of selected priority setting approaches, surveys with priority setting participants, document review, and consultation with the program advisory committee.Results: The evaluation assisted in identifying improvements to six elements of the LDCP priority setting process. The modifications were aimed at improving inclusiveness, information gathering practices, planning for project implementation, and evaluation. In addition, the findings identified that the timing of priority setting activities and level of control over the process were key factors that influenced the ability to effectively implement changes.Conclusions: The findings demonstrate the novel adaptation and application of the 'Nine Common Themes of Good Practice checklist' as a tool for evaluating a research priority setting exercise. The tool can guide the development of evaluation questions and enables the assessment of key constructs related to the design and delivery of a research priority setting process. [ABSTRACT FROM AUTHOR]

Background: Public Health Systems Research is an emerging field of research that is gaining importance in Canada., Methods: On October 22 and 23, 2012, public health researchers, practitioners, and policy-makers came together at the Accelerating Public Health Systems Research in Ontario: Building an Agenda think tank to develop a research agenda for the province., Results: This agenda included the identification of the six top priorities for research in Ontario: public health performance, evidence-based practice, public health organization and structure, public health human resources, public health infrastructure, and partnerships/linkages., Conclusions: This paper explores the priorities in detail and hopes to bring more attention to this area of research.

Bacteria, protozoa and viruses are ubiquitous in aquatic environments and may pose threats to water quality for both human and ecosystem health. Microbial risk assessment and management in the water sector is a focus of governmental regulation and scientific inquiry; however, stark gaps remain in their application and interpretation. This paper evaluates how water managers practice microbial risk assessment and management in two Canadian provinces (BC and Ontario). We assess three types of entities engaged in water management along the source-to-tap spectrum (watershed agencies, water utilities, and public health authorities). We analyze and compare the approaches used by these agencies to assess and manage microbial risk (including scope, frequency, and tools). We evaluate key similarities and differences, and situate them with respect to international best practices derived from literatures related to microbial risk assessment and management. We find considerable variability in microbial risk assessment frameworks and management tools in that approaches 1) vary between provinces; 2) vary within provinces and between similar types of agencies; 3) have limited focus on microbial risk assessment for ecosystem health and 4) diverge considerably from the literature on best practices. We find that risk assessments that are formalized, routine and applied system-wide (i.e. from source-to-tap) are limited. We identify key limitations of current testing methodologies and looking forward consider the outcomes of this research within the context of new developments in microbial water quality monitoring such as tests derived from genomics and metagenomics based research., (© 2013 Elsevier B.V. All rights reserved.)

Objective: Public health renewal in Canada has highlighted the need for development and expansion of the public health nutrition workforce, particularly in northern and rural communities. The purpose of the present paper is to describe the planning of a more accessible graduate programme for experienced nutrition professionals. The planning effort was challenged by a short timeframe between programme approval and implementation and required intense collaboration with stakeholders and students., Design: The programme planning model developed by The Health Communication Unit (THCU) at the Centre for Health Promotion was used to guide the process. This six-step model was familiar to key stakeholders and involved pre-planning, conducting a situational assessment, establishing goals and objectives, developing strategies and outcome indicators, and monitoring feedback., Results: Resource constraints, short timelines and debates around distance education options presented challenges that were overcome by conducting a thorough needs assessment, creating an advisory committee, engaging key stakeholders in the planning process, and building on existing resources. Extensive involvement of the first cohort of students in ongoing planning and evaluation was particularly helpful in informing the evolution of the programme., Conclusions: The THCU planning model provided a useful framework for stakeholder collaboration and for planning and implementing the new graduate programme in public health nutrition. Preliminary data suggest that graduates are benefiting from their educational experiences through career enhancement opportunities. The evaluation strategies built into the programme design will be useful in informing ongoing programme development.

After a quarter of a century, the Ottawa Charter for Health Promotion, often recognized as a foundational document of health promotion, continues to be relevant for public health. Inspired by the WHO Constitution, the Alma Ata Declaration, and the Lalonde Report, the Ottawa Charter endorses a positive definition of health, situates health as a product of daily life, proposes core values and principles for public health action, and outlines three strategies and five action areas reaching beyond the boundaries of the health care sector. The Charter established a radical agenda for public health, specifically to expressly convey the values public health pursues, thereby increasing the potential for the reflexivity of the field and opportunities to consider complementary values in actions that promote population health. In this paper, we examine how public health has integrated health promotion by exploring examples of changes in public health systems and practice at international and national levels of governance. Nevertheless, an important challenge remains for health promotion: better use of research to understand how the values, principles and processes of health promotion can help to achieve public health mandates. A three-pronged action plan is proposed.

This paper identifies factors that influence where people smoke outdoors and examines the impact of smoking on people who use outdoor public places. Direct observations of smoking at 12 outdoor public places and semi-structured interviews with 35 non-smoking and smoking adults were used to gather information in Toronto, Canada, about where people smoke, and smoking related behaviours, perspectives, and experiences. Observation and interview data show that smoking at building entrances was problematic. In total, approximately 37% of smoking observed across the sites was within 9m of building entrances. Shelter, convenience, the social culture of smoking, visibility, and the presence of non-smokers were key factors that influenced where people smoked. Clearly defined rules for smoking at building entrances may allow users of public spaces to avoid tobacco smoke when entering and exiting. However, further research is needed regarding the effectiveness of outdoor restrictions and potential unintended consequences., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Objective: Public health in Ontario delivers, promotes and provides each fall the universal influenza immunization program. This paper addresses the question of whether Ontario public health agencies are able to provide the influenza immunization program within the Ministry of Health fiscal funding envelope of $5 per dose., Methods: Actual program delivery data from the 2006 influenza season of Wellington-Dufferin-Guelph Public Health (WDGPH) were used to create a model template for influenza clinics capturing all variable costs. Promotional and administrative costs were separated from clinic costs. Maximum staff workloads were estimated. Vaccine clinics were delivered by public health staff in accordance with standard vaccine administration practices., Results: The most significant economic variables for influenza clinics are labour costs and number of vaccines given per nurse per hour. The cost of facility rental was the only other significant cost driver. The ability of influenza clinics to break even depended on the ability to manage these cost drivers. At WDGPH, weekday flu clinics required the number of vaccines per nurse per hour to exceed 15, and for weekend flu clinics this number was greater than 21. We estimate that 20 vaccines per hour is at the limit of a safe workload over several hours. Managing cost then depends on minimizing hourly labour costs., Discussion: The results of this analysis suggest that by managing the labour costs along with planning the volume of patients and avoiding expensive facilities, flu clinics can just break even. However, any increased costs, including negotiated wage increases or the move to safety needles, with a fixed revenue of $5.00 per dose will negate this conclusion.

Objectives: West Nile virus (WNv) emerged in North America in 1999, with the first incursion causing an outbreak of meningoencephalitis in the New York City area which resulted in seven deaths. In the face of WNv, public health professionals recommend various personal protective behaviours (PPBs) that either reduce the risk of mosquito bites (e.g., wearing protective clothing and/or insect repellent when outside at dusk or dawn) or eliminate mosquito breeding sites (e.g., preventing opportunities for standing water to stagnate; cleaning out eavestroughs regularly). This paper evaluates the uptake of the public health message in a WNv hot spot (2002) in order to assess the determinants of the likelihood of undertaking personal protective behaviours to reduce the risk of illness from WNv., Methods: A telephone survey was administered to a random sample of adults (n=1650) living in the L6L and L6K Forward Sortation Areas of Oakville, Ontario, Canada., Results: While close to 100% of survey respondents were aware of WNv and approximately 80% recalled receiving information from the public health department regarding the virus, levels of reported personal protective behaviours were relatively low. Through a multivariable modeling process, a range of determinants emerged to explain outcome levels., Discussion: The message about public education in the face of emerging health threats is clear; that is, that public education is key. But we cannot end the public health presence there--public health researchers must evaluate the uptake of the message.

The Ottawa Charter has been remarkably influential in guiding the development of the goals and concepts of health promotion, and in shaping global public health practice in the past 20 years. However, of the five action areas identified in the Ottawa Charter, it appears that there has been little systematic attention to the challenge of re-orienting health services, and less than optimal progress in practice. The purposes of re-orienting health services as proposed in the Ottawa Charter were to achieve a better balance in investment between prevention and treatment, and to include a focus on population health outcomes alongside the focus on individual health outcomes. However, there is little evidence that a re-orientation of health services in these terms has occurred systematically anywhere in the world. This is in spite of the fact that direct evidence of the need to re-orient health services and of the potential benefits of doing so has grown substantially since 1986. Patient education, preventive care (screening, immunisation), and organisational and environmental changes by health organisations have all been found to have positive health and environmental outcomes. However, evidence of effectiveness has not been sufficient, on its own, to sway community preferences and political decisions. The lack of progress points to the need for significant re-thinking of the approaches we have adopted to date. The paper proposes a number of ways forward. These include working effectively in partnership with the communities we want to serve to mobilise support for change, and to reinforce this by working more effectively at influencing broader public opinion through the media. The active engagement of clinical health professionals is also identified as crucial to achieving sustainable change. Finally we recognize that by working in partnership with like-minded advocacy organizations, the IUHPE could put its significant knowledge and experience to work in leading action to transform health care systems to make a major contribution to the improvement of public health.

Background: New practice standards in Ontario require the ongoing evaluation of public health programs. However, public health units have limited capacity to conduct and use evaluations. Purpose: The purpose of this study was to assess an action research approach as a means to build evaluation capacity in public health units. Setting: 36 Canadian public health units in Ontario. Intervention: Action research for evaluation capacity building. Research Design: Multiple-case study. Data Collection and Analysis: Qualitative, semistructured interviews were held with study participants after the design and implementation of evaluation capacity building strategies in their organizations. Analysis was conducted using the general inductive approach (Thomas, 2006). Findings: Evaluation capacity building is well-supported by an action research approach. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate weight-loss interventions offered by Canadian doctors of chiropractic to their adult patients. This paper reports a secondary analysis of data from the Ontario Chiropractic Observation and Analysis STudy (N c = 42 chiropractors, N p = 2162 patient encounters). Multilevel logistic regression was performed to assess the odds of chiropractors initiating or continuing weight management interventions with patients. Two chiropractor variables and 8 patient-level variables were investigated for influence on chiropractor-directed weight management. In addition, the interaction between the effects of patient weight and comorbidity on weight management interventions by chiropractors was assessed. Around two-thirds (61.3%) of patients who sought chiropractic care were either overweight or had obesity. Very few patients had weight loss managed by their chiropractor. Among patients with body mass index equal to or greater than 18.5 kg/m2, guideline recommended weight management was initiated or continued by Ontario chiropractors in only 5.4% of encounters. Chiropractors did not offer weight management interventions at different rates among patients who were of normal weight, overweight, or obese (P value = 0.23). Chiropractors who graduated after 2005 who may have been exposed to reforms in chiropractic education to include public health were significantly more likely to offer weight management than chiropractors who graduated between 1995 and 2005 (odds ratio 0.02; 95% CI [0.00-0.13]) or before 1995 (odds ratio 0.08; 95% CI [0.01-0.42]). The prevalence of weight management interventions offered to patients by Canadian chiropractors in Ontario was low. Health care policy and continued chiropractic educational reforms may provide further direction to improve weight-loss interventions offered by doctors of chiropractic to their patients. [ABSTRACT FROM AUTHOR]

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Abstract: Home care is the fastest growing segment of Canada’s health care system. Since the mid-1990s, the management and delivery of home care has changed dramatically in the province of Ontario. The objective of this paper is to examine the socio-spatial characteristics of home care use (both formal and informal) in Ontario among residents aged 20 and over. Data are drawn from two cycles of the Canadian Community Health Survey (CCHS Cycle 3.1 2005 and Cycle 4.1 2007) and are analyzed at a number of geographical scales and across the urban to rural continuum. The study found that rural residents were more likely than their urban counterparts to receive government-funded home care, particularly nursing care services. However, rural residents were less likely to receive nursing care that was self-financed through for-profit agencies and were more reliant on informal care provided by a family member. The study also revealed that women and seniors were far more dependent on services that they paid for as compared to informal services. People with lower incomes and poorer health status, as well as rural residents, were also more likely to use informal services. The paper postulates that the introduction of managed competition in Ontario’s home care sector may be effective in more populated parts of the province, including large cities, but at the same time may have left a void in access to for-profit formal services in rural and remote regions. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine the association of community treatment orders (CTO) with community engagement and housing arrangements for one population of psychiatric patients in Ontario, Canada. Socio demographic characteristics and health service utilization information were collected for each patient placed on a CTO during a 3 year period. Information was collected for each of the 84 patients when a CTO was first issued and then updated to reflect both the patient’s ongoing involvement with the legislation and related clinical outcomes. A significant increase in the number of community services and a shift to supportive housing arrangements was found for patients following issuance of a CTO. [ABSTRACT FROM AUTHOR]

Volunteers can support the delivery and sustainability of programs promoting chronic disease awareness to improve health at the community level. This paper describes the development of the peer education component of the Cardiovascular Health Awareness Program (CHAP) and assessment of the volunteer peer educator role in a community-wide demonstration project in two mid-sized Ontario communities. A case study approach was used incorporating process learning, a volunteer survey and debriefing discussions with volunteers. A post-program questionnaire was administered to 48 volunteers. Five debriefing discussions were conducted with 27 volunteers using a semi-structured interview guide. Discussions were audio-recorded and transcribed. Analysis used an editing approach to identify themes, taking into account the community-specific context. Volunteers reported an overall positive experience and identified rewarding aspects of their involvement. They felt well prepared but appreciated ongoing training and support and requested more refresher training. Understanding of program objectives increased volunteer satisfaction. Volunteers continued to develop their role during the program; however, organizational and logistical factors sometimes limited skill acquisition and contributions. The prospect of greater involvement in providing tailored health education resources addressing modifiable risk factors was acceptable to most volunteers. Continued refinement of strategies to recruit, train, retain and support volunteers strengthened the peer education component of CHAP. The experience and contributions of volunteers were influenced by the wider context of program delivery. Process evaluation allowed program planners to anticipate challenges, strengthen support for volunteer activities, and expand the peer educator role. This learning can inform similar peer-led health promotion initiatives. [ABSTRACT FROM AUTHOR]

Distribution of micronutrient powder (MNP), also known as Sprinkles™, is becoming a preferred strategy for addressing micronutrient deficiencies. In response, different formulations are being developed, different producers manufacture MNP, and several organizations coordinate distribution. However, as yet, the supply of MNP as well as experience with large-scale MNP programs is limited. To facilitate expansion of MNP use such that acceptability and compliance are high and effectiveness maintained, product quality, of both powder and packaging, good advocacy among decision makers, and providing good information to the target population are crucial. A meeting was organized in Toronto by the Sprinkles Global Health Initiative and the World Food Programme to review and reach consensus on quality criteria for composition, manufacturing, packaging, and labeling of MNP propose guidelines for wide-scale production, and discuss MNP program experience. It was recognized that the durability of some of the more sensitive micronutrients in their powdered form in the harsh climatic conditions of many countries has implications for formulation, packaging, storage, and handling of the MNP product. A question-and-answer manual would greatly facilitate program design and implementation. It was agreed to form an interim Technical Advisory Group to prepare for formation of a Technical Advisory Group with agreed-upon tasks and responsibilities. The MNP manufacturing manual of the Sprinkles Global Health Initiative can continue to be used, with reference to the recommendations from the Toronto Meeting outlined in this paper. Meanwhile, the Sprinkles Global Health Initiative will not place any encumbrances on production using its manual; however, the brand name Sprinkles™ will stay protected under various trademark laws. [ABSTRACT FROM AUTHOR]

In the context of siting (environmentally) noxious land uses, recent research suggests that the well-being of individuals and communities is impacted as much by the decision-making process as the outcome itself. The study results presented in this paper stem from an ongoing, two-stage quantitative/qualitative investigation of impacts on individual and community well-being associated with the environmental assessment process in Ontario, Canada. This research uses a parallel case-study design to investigate two proposed landfill sites in southern Ontario. Qualitative in-depth interviews (n = 36), conducted across a variety of stakeholder groups, were used to address the following objectives: to explore the nature of concerns experienced by individuals faced with a local landfill site proposal; to explore the effects of the siting process on individuals and communities; and to examine the coping strategies employed by individuals in response to impacts experienced. The work attempts to apply theories of risk society (as conceptualised by Beck and Giddens) at a community scale. In so doing, we build on the work of health geographers attempting to link the social and contextual with the medical. Overall, substantial impacts on individual and community well-being were reported across all stakeholder groups interviewed: these included stress, disempowerment, hostility and divisions within the community. The experience of psychosocial impacts and effectiveness of coping strategies is shaped by certain factors associated with the site and the siting process (including uncertainty and the perceived lack of meaningful participation). The links between risk, process and impacts are theorized using a conceptual framework which incorporates site and process factors, effects on daily life (e.g. feelings of losing control, mistrust), and Gidden's conception of 'ontological security'. These findings have implications for environmental decision-making, as they suggest a need to locate the delicate balance point between community involvement and an expedient decision-making process within variable community contexts.

Background: A growing body of research suggests that the suburbanization of food retailers in North America and the United Kingdom in recent decades has contributed to the emergence of urban 'food deserts', or disadvantaged areas of cities with relatively poor access to healthy and affordable food. This paper explores the evolution of food deserts in a mid-sized Canadian city (London, Ontario) by using a geographic information system (GIS) to map the precise locations of supermarkets in 1961 and 2005; multiple techniques of network analysis were used to assess changing levels of supermarket access in relation to neighbourhood location, socioeconomic characteristics, and access to public transit. Results: The findings indicate that residents of inner-city neighbourhoods of low socioeconomic status have the poorest access to supermarkets. Furthermore, spatial inequalities in access to supermarkets have increased over time, particularly in the inner-city neighbourhoods of Central and East London, where distinct urban food deserts now exist. Conclusion: Contrary to recent findings in larger Canadian cities, we conclude that urban food deserts exist in London, Ontario. Policies aimed at improving public health must also recognize the spatial, as well as socioeconomic, inequities with respect to access to healthy and affordable food. Additional research is necessary to better understand how supermarket access influences dietary behaviours and related health outcomes. [ABSTRACT FROM AUTHOR]

This paper starts by briefly reviewing the history, theory and practice of the settings approach to promoting public health—highlighting its ecological perspective, its understanding of settings as dynamic open systems and its primary focus on whole system organization development and change. It goes on to outline perceived benefits and consider why, almost 20 years after the Ottawa Charter advocated the approach, there remains a relatively poorly developed evidence base of effectiveness. Identifying three key challenges—relating to the construction of the evidence base for health promotion, the diversity of conceptual understandings and real-life practice and the complexity of evaluating ecological whole system approaches—it suggests that these have resulted in an ongoing tendency to evaluate only discrete projects in settings, thus failing to capture the 'added value' of whole system working. It concludes by exploring the potential value of theory-based evaluation and identifying key issues that will need to be addressed in moving forward—funding evaluation within and across settings; ensuring links between evidence, policy and practice; and clarifying and articulating the theories that underpin the settings approach generically and inform the approach as applied within particular settings. [ABSTRACT FROM AUTHOR]

AIM: This paper presents the findings of a staff survey conducted at a 350-bed acute care facility located on the periphery of Toronto, Canada. BACKGROUND: Toronto's severe acute respiratory syndrome (SARS) crisis resulted in trauma-like effects at hospitals hardest hit by the disease. A systematic examination of the impact on staff working in hospitals that saw relatively few cases, while maintaining the precautions associated with elevated alert levels, has not been undertaken. METHODS: A questionnaire was distributed for 1 month commencing 17 April 2003 and 300 completed responses were obtained (approximately one in six staff members). The data collected included demographic and occupational information, in addition to perceptions of SARS' impact on patient care, factors contributing to adverse impacts on patient care, working conditions, decision-making, communication and relations, sources of support, and the impact on workers' lives outside work. Items for these sections were developed by a multi-disciplinary team of health care workers and hospital administrators. RESULTS: In the absence of pre-SARS normative data for the survey, demographic and occupational variables were used to look for patterns of differences between relevant subgroups of respondents. Statistically significant differences were found for gender (73.9% women), nurses (24.7%) vs. others, doctors (20.3%) vs. others, older (40 years or older, 60.0%) vs. younger persons, emergency or intensive care unit workers (8.0%) vs. others, and those employed fewer years at the hospital (less than 5 years: 46.2%) vs. five or more years. These differences varied across the following domains: factors adversely affecting patients, communications, support, working conditions, decision-making and, to a lesser extent, impact on life outside work. While all groups found SARS stressful, nurses reported a greater impact on morale and job satisfaction. Nurses relied more on peer support than doctors, felt less informed and less involved in decision-making than doctors felt, and were more likely to report that infection control procedures were not strict enough. CONCLUSIONS: The between-group differences and the pattern of these differences clearly illustrate the polarizing and stressful impact SARS had at a hospital with only a small number of probable or suspect cases. The clear differences between groups defined by demographics, professions and clinical roles suggest a subtle and pervasive secondary impact of the SARS outbreak, with repercussions health care facilities must contend with while maintaining increased levels of vigilance in the wake of SARS. [ABSTRACT FROM AUTHOR]