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Infertility is a common diagnosis: in its original, heteronormative definition, it is known to impact about 1 in 6 couples worldwide. Governments across Canada and beyond have been increasingly providing support for those undergoing fertility treatment, and BC is the most recent province to announce funding, beginning in 2025. As the amount of proposed funding is not sufficient to cover treatment for all who seek it, we look to examples from other provinces and countries to guide us in forming criteria that balance fair access with likelihood of successful treatment. A majority of Canadian provinces currently provide publicly funded fertility care, albeit with highly variable models. Quebec previously introduced a model with generous coverage, including up to three cycles of in vitro fertilization (IVF), along with medications, associated procedures, and embryo transfers for each live birth. Due to high costs, this funding was removed and reintroduced in 2021 with a more restrictive model, as well as age cutoffs for IVF and embryo transfers. In Ontario, the current funding model was introduced in 2015 and covers intrauterine insemination cycles and one cycle of IVF in patients younger than 43 years of age. Other provinces have offered a fertility treatment tax credit. While the BC announcement stated that one cycle of IVF with medications will be covered, the details on how this finite resource will be distributed are still unclear. We hope BC will consider the lessons learned from other provinces and countries and implement a program that is fair and accessible to those who need it. [ABSTRACT FROM AUTHOR]

With limited phosphorus (P) supplies, increasing P demand, and issues with P runoff and pollution, developing an ability to reuse the large amounts of residual P stored in agricultural soils is increasingly important. In this study, we investigated the potential for residual soil P to maintain crop yields while reducing P applications and losses in Canada. Using a P cycling model coupled with a soil P dynamics model, we analyzed soil P dynamics over 110 years across Canada's provinces. We found that using soil residual P may reduce mineral P demand as large as 132 Gg P year−1 (29%) in Canada, with the highest potential for reducing P applications in the Atlantic provinces, Quebec, Ontario, and British Columbia. Using residual soil P would result in a 21% increase in Canada's cropland P use efficiency. We expected that the Atlantic provinces and Quebec would have the greatest runoff P loss reduction with use of residual soil P, with the average P loss rate decreasing from 4.24 and 1.69 kg ha−1 to 3.45 and 1.38 kg ha−1, respectively. Ontario, Manitoba, and British Columbia would experience relatively lower reductions in P loss through use of residual soil P, with the average runoff P loss rate decreasing from 0.44, 0.36, and 4.33 kg ha−1 to 0.19, 0.26, and 4.14 kg ha−1, respectively. Our study highlights the importance of considering residual soil P as a valuable resource and its potential for reducing P pollution. [ABSTRACT FROM AUTHOR]

Lyme disease cases reported in seven Canadian provinces from 2009 to 2019 through the Lyme Disease Enhanced Surveillance System are described herein by demographic, geography, time and season. The proportion of males was greater than females. Bimodal peaks in incidence were observed in children and older adults (≥60 years of age) for all clinical signs except cardiac manifestations, which were more evenly distributed across age groups. Proportions of disease stages varied between provinces: Atlantic provinces reported mainly early Lyme disease, while Ontario reported equal proportions of early and late-stage Lyme disease. Early Lyme disease cases were mainly reported between May through November, whereas late Lyme disease were reported in December through April. Increased awareness over time may have contributed to a decrease in the proportion of cases reporting late disseminated Lyme disease. These analyses help better describe clinical features of reported Lyme disease cases in Canada. [ABSTRACT FROM AUTHOR]

Background: Comprehensiveness of primary care has been declining, and much of the blame has been placed on early-career family physicians and their practice choices. To better understand early-career family physicians' practice choices in Canada, we sought to identify the factors that most influence their decisions about how to practice. Methods: We conducted a qualitative study using framework analysis. Family physicians in their first 10 years of practice were recruited from three Canadian provinces: British Columbia, Ontario, and Nova Scotia. Interview data were coded inductively and then charted onto a matrix in which each participant's data were summarized by code. Results: Of the 63 participants that were interviewed, 24 worked solely in community-based practice, 7 worked solely in focused practice, and 32 worked in both settings. We identified four practice characteristics that were influenced (scope of practice, practice type and model, location of practice, and practice schedule and work volume) and three categories of influential factors (training, professional, and personal). Conclusions: This study demonstrates the complex set of factors that influence practice choices by early-career physicians, some of which may be modifiable by policymakers (e.g., policies and regulations) while others are less so (e.g., family responsibilities). Participants described individual influences from family considerations to payment models to meeting community needs. These findings have implications for both educators and policymakers who seek to support and expand comprehensive care. [ABSTRACT FROM AUTHOR]

Unlike other high-income countries, Canada has no national policy for drugs treating rare diseases (orphan drugs). Nevertheless, in 2022, the Canadian government committed to creating a national strategy to make access to these drugs more consistent. Our aim was to study whether recommendations made by the Canadian Agency for Drugs and Technology in Health (CADTH) translated into coverage decisions for orphan drugs in Ontario, the largest Canadian province. This study is the first to look at this question for orphan drugs, which are at the center of policy attention. We included 155 orphan drug-indication pairs approved and marketed in Canada between October 2002 and April 2022. Cohen's kappa was used to test the agreement across health technology assessment (HTA) recommendations and coverage decisions in Ontario. Logistic regression was used to test which factors, relevant to decision-makers, might be associated with funding in Ontario. We found only fair agreement between CADTH's recommendations and coverage decisions in Ontario. Although a positive and statistically significant association between favorable HTA recommendations and coverage was found, more than half of the drugs with a negative HTA recommendation were available in Ontario, predominately through specialized funds. Successful pan-Canadian pricing negotiations were a strong predictor of coverage in Ontario. Despite efforts to harmonize access to drugs across Canada, considerable room for improvement remains. Introducing a national strategy for orphan drugs could help increase transparency, consistency, promote collaborations, and make access to orphan drugs a national priority. • Recommendations by the Canadian Agency for Drugs and Technology in Health do not always translate to provincial coverage decisions for new drugs. • We explored whether Canadian Agency for Drugs and Technology in Health's recommendations are aligned with coverage decisions for orphan drugs in Ontario. • Negative health technology assessment recommendations did not necessarily translate to no pan-Canadian pricing negotiations. • More than half the drugs with negative health technology assessment recommendations were available in Ontario through specialized funds. • A national strategy for orphan drugs could prioritize access to these treatments at a national level and harmonize access, at least to some extent, across Canada. [ABSTRACT FROM AUTHOR]

• All-cancer radiotherapy utilization ratios (RTUR) varied across Canada by 9%, and up to 28% by cancer type. • RTURs were below Ontario benchmarks for many provinces and cancer subsites. • RTURs can be a reasonable surrogate for linked (patient-specific) utilization. Access to radiotherapy (RT) is a key component of a cancer control strategy. However, radiotherapy utilization (RTU) rates fall short of desired benchmarks in certain Canadian provinces. We aimed to describe provincial variations in RTU across Canada. We calculated radiotherapy utilization ratios (RTUR) for each Canadian province from 2016 (RT case counts divided by incidence counts), by cancer type (all cancers, lung, breast, rectal, prostate) and treatment intent (curative, palliative) where data were available. Data were extracted from each provincial RT data repository, cancer registry and/or RT department. We compared RTURs descriptively across provinces and to Ontario benchmarks, and calculated an estimated national RTUR. In provinces with capacity for data linkage, RTURs were compared to a linked (patient-specific) method of calculating utilization, by linking each incident case to whether RT was received within 1 year of diagnosis (RTU-1 yr). Excluding three provinces that included re-treatments, all-cancer RTURs ranged from 0.31 in Manitoba to 0.40 in Nova Scotia. The national all-cancer RTUR was 0.35, which was comparable to Ontario benchmarks (0.34). Larger variations were seen by cancer type, with an absolute difference in RTURs of 28% for lung cancers, 27% for breast cancers, 21% for rectal cancers, and 18% for prostate cancers. RTURs for nearly all provinces were below established Ontario benchmarks for each cancer type, except prostate cancer. RTURs over-estimated RTU-1 yr by at most 5%, except for prostate cancers where they over-estimated RTU-1 yr by up to 15%. RTU varies by province in Canada, and most notably by cancer subsite. More granular data at the regional level and by healthcare facility is required to further tailor strategies aimed at improving RT access. RTURs also serve as a reasonable surrogate for linked RTU, and both methods can contribute meaningfully to measure RTU depending on the context and data availability. [ABSTRACT FROM AUTHOR]

In Canada, greenhouse gas (GHG) emissions continue to remain high despite the federal government's commitment to reduce GHG emissions. Environmental policy across Canadian provinces has largely lacked consistency with some provinces implementing targeted policy such as carbon taxes while others have strongly resisted the federal government's attempts to encourage such policy. This study examines the impact of environmental policy on GHG gas emissions across Canadian provinces with policy uniquely measured by public and business sector spending on environmental protection as well as notable province-specific policies. An extended STIRPAT model is specified with the inclusion of proxies for environmental policy using panel data from Canada's ten provinces from 1995 to 2019. The cointegration and the error correction modelling approaches are employed to estimate the non-stationary panel data. A pooled mean group estimation is applied to provide short run and long run coefficients. The findings indicate that although per capita GDP is the main driver of GHG emissions in Canada, environmental policy has a significant mitigating effect, as shown by the negative association between emissions and private and public sector spending on environmental protection in the long run. Furthermore, provinces with targeted policies, such as Ontario's coal phase-out and British Columbia's carbon tax, experienced significant emissions reductions. The theoretical implication is the successful addition of policy variables to the STIRPAT model, providing the model a new application for future research. [Display omitted] • Assess the impact of environmental protection policies on per capita greenhouse gas emissions in Canada. • Utilize public and private expenditures on environmental protection, along with provincial policies. • Extend the STIRPAT model to incorporate environmental protection policies in an empirical model. • Demonstrate a significant negative relationship between environmental protection policies and GHG emissions. • Offer insights with implications for global environmental sustainability efforts. [ABSTRACT FROM AUTHOR]

Introduction: Effective alcohol control measures can prevent and reduce alcohol‐related harms at the population level. This study aims to evaluate implementation of alcohol policies across 11 evidence‐based domains in Canada's 13 jurisdictions. Methods: The Canadian Alcohol Policy Evaluation project assessed all provinces and territories on 11 evidence‐based domains weighted for scope and effectiveness. A scoring rubric was developed with policy and practice indicators and peer‐reviewed by international experts. The 2017 data were collected from publicly‐available regulatory documents, validated by government officials, and independently scored by team members. Results: The average score for alcohol policy implementation across Canadian provinces and territories was 43.8%; Ontario had the highest (63.9%) and Northwest Territories the lowest (38.4%) jurisdictional scores. Only six of 11 policy domains had average scores above 50% with Monitoring and Reporting scoring the highest (62.8%) and Health and Safety Messaging the lowest (25.7%). A 2017 provincial/territorial current best practice score of 86.6% was calculated taking account of the highest scores for any individual policy indicators implemented in at least one jurisdiction across the country. Discussion and Conclusions: Most of the evidence‐based alcohol policies assessed by the Canadian Alcohol Policy Evaluation project were not implemented across Canadian provinces and territories as of 2017, and many provinces showed declining scores since 2012. However, the majority of policies assessed have been implemented in at least one jurisdiction. Improved alcohol policies to reduce related harm are therefore achievable and could be implemented consistently across Canada. [ABSTRACT FROM AUTHOR]

Plasmodiophora brassicae causes clubroot on Brassica vegetables and canola around the world. A diverse assemblage of new pathotypes have been identified on canola in the Canadian province of Alberta since 2012, but the pathotypes present in the rest of Canada have not been assessed in detail in recent years. Brassica vegetable and canola fields in Ontario were surveyed for clubroot in 2017–2019. The pathotype of isolates collected was determined using the Williams differential set. Clubroot samples or soil from six other Canadian provinces were also assessed. Clubroot appears to be spreading on canola in Ontario. Pathotype 6 was found only on vegetables and pathotype 2 was predominant on canola; pathotypes 2X and 3X were also identified on canola. The 'X' indicates collections that were virulent on the first generation of clubroot-resistant canola cultivars in Canada. Prior to 2012, the pathotypes in eastern Canada were 1, 2, 3, 4, 5, and 6 and the pathotypes in western Canada were 3, 5, and 8 with 6 found on vegetables in British Columbia. Additional virulent pathotypes 2X, 3X, and 5X were identified in eastern Canada and pathotype 9 was found in Manitoba. Two instances of rapid shifts in pathotype at research sites were demonstrated, one in Ontario (pathotype 6 to 2) and one in Quebec (pathotypes 2 and 5 to 2X and 5X). [ABSTRACT FROM AUTHOR]

Background: The secondary fracture prevention gap in the osteoporosis field has been previously described as a 'crisis'. Closing this gap is increasingly important in the context of accumulating evidence showing that an incident fragility fracture is associated with an increased risk of subsequent fracture within 1-2 years, known as imminent fracture risk. The objective of this study was to use health services data to characterize the time between index fragility fractures occurring at different osteoporotic sites and subsequent fractures.Methods: This retrospective observational study used de-identified health services data from the publicly funded healthcare system in Ontario, the largest province of Canada. Patients aged > 65 with an index fragility fracture occurring between 2011 and 2015 were identified from the ICES Data Repository using International Classification of Diseases (ICD)-10 codes. We examined median time to subsequent fragility fractures for osteoporotic fracture sites until the end of follow-up (2017). BMD assessment and use of osteoporosis therapies following index fracture were also characterized.Results: Among 115,776 patients with an index fragility fracture, 17.8% incurred a second fragility fracture. Median time between index and second fracture occurring at any site was 555 days (interquartile range: 236-955). For each index fracture site examined, median time from index to second fracture was < 2 years. The proportion of patients with BMD assessment was 10.3% ≤1 year prior to and 16.4% ≤1 year post index fracture. The proportion of patients receiving osteoporosis therapy was 29.8% ≤1 year prior, 34.6% ≤1 year post, and 25.9% > 3 years post index fracture.Conclusions: This cohort of Canadian patients aged > 65 years who experienced a fragility fracture at any site are at imminent risk of experiencing subsequent fracture within the next 2 years and should be proactively assessed and treated. [ABSTRACT FROM AUTHOR]

Background: Cryptosporidiosis is a gastrointestinal disease with global distribution. It has been a reportable disease in Canada since 2000; however, routine molecular surveillance is not conducted. Therefore, sources of contamination are unknown. The aim of this project was to identify species and subtypes of Cryptosporidium in clinical cases from Ontario, the largest province in Canada, representing one third of the Canadian population, in order to understand transmission patterns. Methods: A total of 169 frozen, banked, unpreserved stool specimens that were microscopy positive for Cryptosporidium over the period 2008-2017 were characterized using molecular tools. A subset of the 169 specimens were replicate samples from individual cases. DNA was extracted directly from the stool and nested PCR followed by Sanger sequencing was conducted targeting the small subunit ribosomal RNA (SSU) and glycoprotein 60 (gp60) genes. Results: Molecular typing data and limited demographic data were obtained for 129 cases of cryptosporidiosis. Of these cases, 91 (70.5 %) were due to Cryptosporidium parvum and 24 (18.6%) were due to Cryptosporidium hominis. Mixed infections of C. parvum and C. hominis occurred in four (3.1%) cases. Five other species observed were Cryptosporidium ubiquitum (n = 5), Cryptosporidium felis (n = 2), Cryptosporidium meleagridis (n = 1), Cryptosporidium cuniculus (n = 1) and Cryptosporidium muris (n = 1). Subtyping the gp60 gene revealed 5 allelic families and 17 subtypes of C. hominis and 3 allelic families and 17 subtypes of C. parvum. The most frequent subtype of C. hominis was IbA10G2 (22.3%) and of C. parvum was IIaA15G2R1 (62.4%). Conclusions: The majority of isolates in this study were C. parvum, supporting the notion that zoonotic transmission is the main route of cryptosporidiosis transmission in Ontario. Nonetheless, the observation of C. hominis in about a quarter of cases suggests that anthroponotic transmission is also an important contributor to cryptosporidiosis pathogenesis in Ontario. [ABSTRACT FROM AUTHOR]

Following the August 1968 Soviet-led invasion of Czechoslovakia, 11,200 Prague Spring refugees were resettled in Canada. This movement included many experienced professionals and skilled tradespeople. This article examines how these refugees navigated language training and barriers to employment, including professional accreditation, and examines how this experience shaped bureaucratic and public views of refugee integration. The focus of this article is primarily on resettlement and integration efforts in Ontario, since roughly half of the Prague Spring refugees were permanently resettled in the province. The article outlines how, as part of its efforts to help the refugees with their economic and social integration, Canadian officials provided assisted passage, initial accommodations, help with securing Canadian employment, and English- or French-language training. Prague Spring refugees navigated professional obstacles, including securing accreditation of their foreign credentials and underemployment in their respective fields. Their successful resettlement and integration depended on intergovernmental cooperation between Canada and its provinces, and the assistance provided by local Czech and Slovak communities across the country. [ABSTRACT FROM AUTHOR]

Agriculture produces food, fiber and biofuels for the world's growing population, however, agriculture can be a major contributor of nitrogen (N) losses including emissions of ammonia (NH 3), nitrous oxide (N 2 O) and nitrate (NO 3 −) leaching and runoff. A Canadian Agricultural Nitrogen Budget for Reactive N (CANBNr) model was developed to estimate the soil N balance in 3487 soil landscape of Canada polygons from 1981 to 2016. The CANBNr model integrates NH 3 emission from fertilizers, manure from housing, storage and field, as well as direct/indirect N 2 O emissions from fertilizers, manures, crop residues and soil organic matter. The NO 3 − leaching is estimated based on the residual soil N (RSN) at harvest and drainage derived with the DeNitrification-DeComposition (DNDC) model. From 1981 to 2016, the N input from fertilizer and N fixation increased at a greater rate than N removal in harvested crops in all provinces of Canada, resulting in an increase in the RSN and N losses. In 2016, the Prairie provinces had lower N losses (11.7 kg N ha−1) from N 2 O, NH 3 and NO 3 − compared with 43.2 kg N ha−1 in central Canada, and 76.5 kg N ha−1 in Atlantic Canada. However, the Prairie provinces had 84.3% of the total Canadian farmland (74.3% of the total Canadian N input), while central Canada had 12.9% of Canadian farmland (21.7% of the total Canadian N input). In the Prairie provinces, the total N 2 O loss from fertilizer N ranged 4.4–8.6 Gg N whereas NH 3 loss ranged from 17.1 to 44.6 Gg N and these values were influenced by both emission intensity and total land area. Total N 2 O losses from manure were highest in Alberta, Ontario and Quebec resulting in 4.8, 4.4, and 3.4 Gg N and NH 3 losses from manure were also highest in these 3 provinces at 61.1, 45.2 and 40.4 Gg N, respectively. Nitrate leaching was impacted by drainage volumes, soil type and N inputs. In the non-growing season, NO 3 − leaching losses (36-yr average) were 63.3 Gg in Ontario and 57.5 Gg N in Quebec compared with 20.8 Gg N for Ontario and 35.5 Gg N for Quebec in the growing season. In contrast, the Prairie provinces showed higher NO 3 − leaching in the growing season (23.1–37.4 Gg N) than in the non-growing season (10.4–13.7 Gg N). In summary, total fertilizer N increased the most over the 36 years in the Prairies which resulted in increased RSN and N leaching losses that will require further intervention. [Display omitted] • Canadian Agricultural Nitrogen Budget for Reactive N (CANBNr) model was developed. • The N budget were simulated at 3487 soil landscape of Canada polygons from 1981 to 2016. • RSN and N losses increased due to the greater increase in N input from fertilizer and N fixation than N removal by crop. • The Prairie provinces had lower N 2 O, NH 3 and NO 3 − leaching losses per hectare farmland than other provinces. [ABSTRACT FROM AUTHOR]

Context: Recently, updated Canadian surgical and medical abortion practice guidelines were released, mifepristone was approved by Health Canada for first trimester medical abortion (FTMA) as a regular prescription, and nurse practitioners (NPs) began to independently provide abortion care. These changes enabled a shift for abortion provision into primary care. Objective: (1) Describe the abortion care workforce, (2) Evaluate the reported clinical abortion practice compared to current clinical practice guidelines, and (3) Assess stigma and harassment experienced by providers. Study Design: Cross-sectional, self-administered, anonymized survey available in French and English. Setting: National survey of abortion providers in Canada. Population studied: Physicians and NPs providing abortion care in 2019 were contacted through national professional health care organizations. Outcome measures: Respondent demographics, characteristics of first and second trimester surgical and first, second and third trimester medical abortion (STTMA) practices, and stigma and resilience experienced by providers. Results: Between July and December 2020, 435 physicians and 30 NPs were recruited, representing every province and territory in Canada. The highest proportions were from the most populated provinces: Ontario (31.8%) and Quebec (23.6%). Most physicians were family physicians (n=246) or obstetrician-gynaecologists (n=185). Among 358 FTMA respondents, 61.3% reported having less than five years experience and 99.4 % used a mifepristone misoprostol regimen. Of 115 STTMA respondents, 58.5% used an off-label but guideline supported mifepristone misoprostol regimen. Respondents included 222 first and second trimester surgical abortion providers. Only 4.6% of 109 second trimester surgical abortion provider respondents used mifepristone for preoperative cervical ripening. Twelve percent of respondents experienced harassment or violence in 2019, most commonly as picketing or confrontations at their workplace. Conclusion: Introduction of mifepristone and changes in abortion guidelines, regulations and licensing changed the abortion workforce and care in Canada. Respondents reported overall provision of FTMA in line with current guideline. Guideline supported second trimester use of mifepristone has not been fully adopted yet. The results of this study will inform knowledge translation activities directed at health system, policy, and service leaders. [ABSTRACT FROM AUTHOR]

Globally, the mix of private- and public-sector involvement in health care delivery is a focus of political concern. This concern in Canada takes place within the parameters of the federal Canada Health Act. Private for-profit activities in the health care sector in Canadian provinces have moderately shrunk the definition of ‘necessary medical and hospital services’ that must be provided by the public administration system under the federal Canada Health Act. In this article, we argue that the development of new technologies, pharmaceutical innovations, competing (non-health) demands on the federal dollar, and an aging population together create an environment where pressures for economic and political sustainability have led to some erosion of necessary health services in the provinces. Such pressures have, in turn, led to the growth of private commercial-sector health services. Within Canada’s federal system, provincial negotiation of the role of commercial health care organizations has developed in different ways in Ontario and Quebec. Such subnational developments are a significant focus for comparative health policy analysis. [ABSTRACT FROM PUBLISHER]

This article is a comparative study of the law dealing with substitute decision making for incapable patients in end-of-life situations across Canadian provinces. In recent years, this issue has received growing consideration from judicial authorities in Canada and abroad. The article discusses the most significant decisions in Canada, with reference as well to leading cases in the UK, Germany and the US. Future policy and legislative options are discussed as well. [ABSTRACT FROM AUTHOR]

This article identifies some specific types of discursive positioning used by Canadian midwives and pregnant women and shows how an analysis of positioning can contribute to the study of information practices occurring within everyday conversation. It reports initial findings from an ongoing study of midwife-client communication in the Canadian province of Ontario. It uses the concept of the "information ground," a physical environment where information-seeking and exchange occur, to analyze the information needs, seeking, giving and exchange taking place when Ontario midwives and their pregnant clients meet in a clinic or home setting for prenatal visits. The study provides an opportunity to examine several specific information-seeking issues related to the physical space of the midwifery clinic and with relevance to both the everyday life information seeking of midwifery clients and the work-place information seeking of midwives. In Canada, midwifery is a fully or partially licensed profession in six of the ten provinces and one of the three territories. Midwifery services are fully government funded in four provinces.

Examines the issues of ownership and distribution of randon in the two provinces of Canada, Manitoba and Ontario. Information on radium emanations; Analysis of computerized database which reveals information about patients and the uses of randon in the 1930s; Significance of radiotherapy for treating cancer.

Focuses on the difference in tuition fees between Ontario and Quebec in 2003/04. Standard fee at medical schools in Quebec; Reason for low tuition fees in Quebec.