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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.)

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]

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]

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 deals with the role of the health department and more specifically the public health nurse in the care of the aged based upon a study of the sociomedical needs of old people in Ontario. [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. [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]

Background: In 2018, Canada legalized recreational cannabis use with the purpose of protecting youth and restricting access. However, concerns have been raised that this objective has not been met as rates of cannabis use among youth aged 16–24 have not declined. Youth cannabis use is associated with various adverse effects including psychosis, anxiety, depression, suicidality, respiratory distress, cannabinoid hyperemesis syndrome, and intoxications. Service providers play a crucial role in addressing youth cannabis use. This study aimed to understand Ontario service providers' perceptions, practices, and recommendations on youth cannabis use. Methods: This mixed method study included a survey and two focus groups. The survey was distributed to mental health service providers serving youth aged 16–24 across Ontario who were given the option to participate in a focus group. The survey included closed and open-ended questions regarding perceptions, practices, and recommendations, while the focus groups explored these categories in greater depth. Descriptive statistics were used to analyze close-ended questions and interpretative content analysis was applied for open-ended questions. Focus group data were analyzed using thematic analysis. Results: The survey was completed by 160 service providers and 12 participated in two focus groups. Regarding perceptions, 60% of survey participants agreed with legalization, 26% had a strong understanding of medical versus recreational cannabis, 84% believed that cannabis has physical and mental health risks, and 49% perceived stigmatization. Less than half of the survey participants reported screening or assessing cannabis use, 16% stated they are highly familiar with treating cannabis use, and 67% reported that they rarely work with families. Subthemes identified in the focus groups under perceptions included normalization and stigmatization, harms for youth, and stigma, racism, and discrimination. Subthemes under practice included cannabis not being the primary focus, challenges with screening, assessment, and intervention, and referral to specialized services. Both the survey and focus group participants recommended increasing public education, enhancing service provider training, improving regulation and policies, reducing stigma and minimization, improving service access, and providing more culturally responsive services. Conclusion: Youth cannabis use in Canada remains a significant public health concern, necessitating a more comprehensive plan to protect Ontario youth and reduce associated harms. [ABSTRACT FROM AUTHOR]

This paper addresses the impact on midwifery of its recent integration into the provincial health care system in Ontario, Canada. Data are derived from participant-observation, primary and secondary source documents, and key informant interviews. Based on these data. I argue that midwifery has changed throughout the integration process but it has also successfully resisted change Specifically, the organisation of the midwifery community evolved from an amorphous social movement to a more bureaucratically organised professor The regulation of midwifery also shifted from direct-regulation by clients to professional self-regulation. The educational model of midwifery also changed from an eclectic apprentice-based approach to a more standardised baccalaureate degree programme. The midwifery model of practice, however, was sustained. Although these changes occurred at the hands of key members of the midwifery community, they were made in response to the structural context of the health care system into which they were attempting to become integrated. [ABSTRACT FROM AUTHOR]

Background: There is a widespread commitment to implementing anti-Indigenous racism with health organizations in Canada by introducing cultural safety staff training. In partnership with a public health unit in Ontario, Canada, we developed an evaluation tool to assess the performance of staff who completed an online Indigenous cultural safety education course. Aims: To develop an accountability checklist that could be used for annual employee performance reviews to assess the use and level of knowledge received in professional cultural safety training. Intervention: We co-created a professional development accountability checklist. Five areas of interest were identified: terminology, knowledge, awareness, skills, and behaviours. The checklist comprises of 37 indicators linked to our community collaborators' intended goals as defined in our partnership agreement. Outcomes: The Indigenous Cultural Safety Evaluation Checklist (ICSEC) was shared with public health managers to use during regularly scheduled staff performance evaluations. The public health managers provided feedback on the design, checklist items, and useability of the ICSEC. The pilot of the checklist is in the preliminary stage and data is unavailable about effectiveness. Implications: Accountability tools are important to sustain the long-term effects of cultural safety education and prioritize the wellbeing of Indigenous communities. Our experience can provide guidance to health professionals in creating and measuring the efficacy of Indigenous cultural safety education to foster an anti-racist work culture as well as improved health outcomes among Indigenous communities. [ABSTRACT FROM AUTHOR]

There are significant income‐related inequities in oral health and access to oral health care. Public dental programs generally aim to increase access to oral health care for individuals with financial barriers through government payments for appointments. Low engagement from both oral health care providers and intended patients are common challenges in delivery of public dental programs, and are impediments to program impact and outcomes. Still, these programs rarely address the systemic issues that affect the experiences of intended users. This accentuates the importance of monitoring of program delivery to refine or adapt programs to better meet needs of service providers and users. As such, specifying program goals and developing a related monitoring strategy are critical as Canada begins to implement a national public dental program. Drawing on an example of a pediatric public dental program for children from low‐income families or with severe disabilities in Ontario, Canada, this article illustrates how an implementation and evaluation framework could be applied to measure implementation and impact of the national program. The RE‐AIM framework measures performance across five domains: (1) Reach, (2) Effectiveness (patient level), (3) Adoption, (4) Implementation (provider, setting, and policy levels), and (5) Maintenance (all levels). Given the disparities in oral disease and access to oral health care, the results can be used most effectively to adapt programs if relevant stakeholders participate in reviewing data, investigating quality gaps, and developing improvement strategies. [ABSTRACT FROM AUTHOR]

Many recent reports on Aboriginal issues have identified three major deficits in Canadian universities: a lack of Aboriginal curriculum content, a lack of faculty role models, and low student enrollment. Many health professional schools have responded by recruiting more Aboriginal students and by introducing Native content into their curricula. This paper describes the six-year experience of the annual program of the Visiting Lectureship on Native Health at the University of Toronto as one of the ways to increase the Aboriginal curricular content. The three-week program covers the selected Aboriginal health issue by sequentially exploring its historical background, the extent of the current problem and its future solutions. Over six years, 37 Native speakers delivered 83 lectures, 19 public fora and 98 seminars and workshops to 3 universities and 12 professional and community agencies. Over 7,900 individuals have participated in the program and the response has been very positive.

Copyright of Canadian Bulletin of Medical History is the property of University of Toronto Press 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.)

This paper investigates responsibility/irresponsibility as an important regulatory strategy, in two distinct but interrelated social sites - people living with AIDS and HIV, and lesbians and gay men, especially within the Canadian province of Ontario. This responsibility/irresponsibility technique of governance is developing in response to the struggles of people with AIDS and community-based AIDS groups and lesbians and gay men and the alternative strategies of regulation articulated through these struggles. Practices of `resistance' and activism alter the grounds of hegemonic regulation/governance and point towards new techniques of governance. I show how responsibilizing and normalizing strategies in the context of social struggles over AIDS and sexual regulation allows for those constructed as `responsible' to be managed through forms of self-regulation and professional forms of governance of their lives. For those who continue to be constructed as `irresponsible' forms of criminal law, policing and public health governance are called into action. [ABSTRACT FROM AUTHOR]

Medically trained health professionals have been central to the development of policy responses to the coronavirus 2019 (COVID‐19) crisis. In their multiple roles—as clinicians, public health leaders, members of scientific advisory boards, and also as media pundits and health professionals—they have helped shape discourses of science‐based policy options during the first 2 years of the pandemic. In particular, health professionals as a collective voice insisted on the necessity of society‐wide measures of social control to curb the morbidity and mortality of the virus. These measures, in turn, informed the political and moral imagination of the political class, the media and the larger public. Yet, as emerging evidence suggests, measures of social control posed a serious and long‐term risk for health equity. In this discussion piece on the first 2 years of COVID‐related public health directives, we interrogate the tensions that advocating for extensive and protracted measures of social control can pose to the social contract between medicine and society, health equity and democracy. To illustrate these tensions, we discuss the public fallout between vocal members of the OSAT, an ad hoc biomedical‐led organization, and the Government of Ontario in light of the disagreement on the scope of 'stay home' orders to manage the third wave of the pandemic in the Spring of 2021 and, more recently, the mass protest against mass‐scale public health measures in Ottawa, Canada. We argue that while decision making under emergency conditions is a difficult task, the legitimacy of the social contract between medicine and society depends on medical experts' judicious exercise of public health ethics principles. We offer a set of recommendations for building a more collaborative response to future health crises. [ABSTRACT FROM AUTHOR]

This paper analyzes the community health of the Wikwemikong Unceded Indian Reserve (WUIR), Ontario, Canada. Results are reported from fieldwork including participant observation, key informant interviewing and self-reported data measuring health status, risk behaviour, place of residence, self-identity, and personal history extracted from 350 interviews conducted during a community-wide needs assessment. The research aimed to create a health plan for the community; however, subsequent analysis of the needs assessment results indicates that internal diversity exists in health status and needs between the seven villages that comprise WUIR. The analysis suggests variation in health status and risk-taking behaviour among community members may be related to varying colonial histories among the villages. The implications of intra-community variation in health status in First Nations are discussed in relation to influential health policy theories such as the determinants of health and health transfer policy in Canada. [Copyright &y& Elsevier]

Mental health reform in Ontario is moving in the direction of community-based delivery of mental health services. At the same time psychosocial rehabilitation is emerging as a field of professional study for those who work in the community with individuals suffering from a mental illness. This paper offers a reflection on how terms popularized in mental health such as empowerment and value ought to communicate an existential movement rather than reified technological jargon. [ABSTRACT FROM AUTHOR]

Background: Post-streptococcal glomerulonephritis (PSGN) is a rare immune-mediated condition that typically occurs in children as a result of group A streptococcus (GAS) infection. PSGN is not considered a disease of public health significance, or reportable, in Canada. Higher incidence of PSGN has been described among Indigenous people in Canada. No national or provincial guidance exists to define or manage PSGN outbreaks.Objective: To describe an outbreak of seven paediatric cases of PSGN in a remote First Nations community in northwestern Ontario and the development of a community-wide public health response.Methods: Following a literature review, an intervention was developed involving screening of all children in the community for facial or peripheral edema or skin sores, and treatment with antibiotics if noted. Case, contact and outbreak definitions were also developed. The purpose of the response was to break the chain of transmission of a possible nephritogenic strain of streptococcus circulating in the community. Relevant demographic, clinical and laboratory data were collected on all cases.Outcome: Seven paediatric cases of PSGN presented to the community nursing station between September 25 and November 29, 2017. Community-wide screening for skin sores was completed for 95% of the community's children, including 17 household contacts, and as a result, the last of the cases was identified. Nineteen adult household contacts were also screened. Ten paediatric contacts and two adult contacts with skin sores were treated with one dose of intramuscular penicillin, and six paediatric contacts received oral cephalexin. No further cases were identified following the screening.Conclusion: PSGN continues to occur in Indigenous populations worldwide at rates higher than in the overall population. In the absence of mandatory reporting in Canada, the burden of PSGN remains underappreciated and could undermine upstream and downstream public health interventions. Evidence-based public health guidance is required to manage outbreaks in the Canadian context. The community-based response protocol developed to contain the PSGN outbreak in this First Nations community can serve as a model for the management of future PSGN outbreaks. [ABSTRACT FROM AUTHOR]

Objectives: Oral health inequalities impose a substantial burden on society and the healthcare system across Canadian provinces. Monitoring these inequalities is crucial for informing public health policy and action towards reducing inequalities; however, trends within Canada have not been explored. The objectives of this study are as follows: (a) to assess trends in income‐related inequalities in oral health in Ontario, Canada's most populous province, from 2003 to 2014, and (b) to determine whether the magnitude of such inequalities differ by age and sex. Methods: Data representative of the Ontario population aged 12 years and older were sourced from the Canadian Community Health Survey (CCHS) cycles 2003 (n = 36,182), 2007/08 (n = 36,430) and 2013/14 (n = 41,258). Income‐related inequalities in poor self‐reported oral health (SROH) were measured using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII) and compared across surveys. All analyses were sample‐weighted and performed with STATA 15. Results: The prevalence of poor SROH was stable across the CCHS cycles, ranging from 14.1% (2003 cycle) to 14.8% (2013/14 cycle). SII estimates did not change (18.7‐19.0), while variation in RII estimates was observed over time (2003 = 3.85; 2007/08 = 4.47; 2013/14 = 4.02); differences were not statistically significant. SII and RII were lowest among 12‐ to 19‐year‐olds and gradually higher among 20‐ to 64‐year‐olds. RII was slightly higher among females in all survey years. Conclusion: Absolute and relative income‐related inequalities in SROH have persisted in Ontario over time and are more severe among middle‐aged adults. Therefore, oral health inequalities in Ontario require attention from key stakeholders, including governments, regulators and health professionals. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications 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.)

This article explores how the recent and growing promotion of local foods by public health units in Ontario, Canada, rhetorically interpellates the “good” health citizen as someone who not only takes responsibility for personal health but, through the consumption and support of “local food,” also accepts and fulfills her responsibilities to care for the local economy, the community’s well-being, and the natural environment. Drawing on Charland’s concept of constitutive rhetoric, we analyze a selection of public health unit documents about local food to develop a textured account of the complex, multifaceted forms of health citizenship they constitute. Our analysis reveals that, despite their appeals to environmental sustainability and community well-being, these materials primarily characterize the ideal health citizen as an informed consumer who supports the interests of the neoliberal state through individualized lifestyle behaviors, consuming goods produced and distributed through private enterprise. By exhorting individuals to “buy local,” public health discourse therefore frames responsible health citizenship principally in consumerist terms that constrain the range of available options for citizens to engage in meaningful action vis-à-vis their food systems. [ABSTRACT FROM AUTHOR]

Background: In prior studies, higher mortality was observed among patients who had elective surgery on a Friday rather than earlier in the week. We investigated whether mortality after elective surgery was associated with day of the week of surgery in a Canadian population and whether the association was influenced by surgeon experience and volume.Methods: We conducted a population-based retrospective cohort study in the province of Ontario, Canada. We included adults who underwent 1 of 12 elective daytime surgical procedures from Apr. 1, 2002, to Dec. 31, 2012. The primary outcome was 30-day mortality. We used generalized estimating equations to compare outcomes for surgeries performed on different days of the week, adjusting for patient and surgeon factors.Results: A total of 402 899 procedures performed by 1691 surgeons met our inclusion criteria. The median length of hospital stay was 6 (interquartile range 5-8) days. Surgeon experience varied significantly by day of week (p < 0.001), with surgeons operating on Fridays having the least experience. Nearly all of the patients who had their procedure on a Friday had postoperative care on the weekend, as compared with 49.1% of those whose surgery was on a Monday (p < 0.001). We found no difference in the 30-day mortality between procedures performed on Fridays and those performed on Mondays (adjusted odds ratio 1.08, 95% confidence interval 0.97-1.21).Interpretation: Although surgeon experience differed across days of the week, the risk of 30-day mortality after elective surgery was similar regardless of which day of the week the procedure took place. [ABSTRACT FROM AUTHOR]

Background: Falls among community-dwelling older adults are a serious public health concern. While evidence-based fall prevention strategies are available, their effective implementation requires broad cross-sector coordination that is beyond the capacity of any single institution or organization. Community groups comprised of diverse stakeholders that include public health, care providers from the public and private sectors and citizen volunteers are working to deliver locally-based fall prevention. These groups are examples of collective impact and are important venues for public health professionals (PHPs) to deliver their mandate to work collaboratively towards achieving improved health outcomes. This study explores the process of community-based group work directed towards fall prevention, and it focuses particular attention on the collaborative leadership practices of PHPs, in order to advance understanding of the competencies required for collective impact.Methods: Four community groups, located in Ontario, Canada, were studied using an exploratory, retrospective, multiple case study design. The criteria for inclusion were presence of a PHP, a diverse membership and the completion of an initiative that fit within the scope of the World Health Organization Fall Prevention Model. Data were collected using interviews (n = 26), focus groups (n = 4), and documents. Cross-case synthesis was conducted by a collaborative team of researchers.Results: The community groups differed by membership, the role of the PHP and the type of fall prevention initiatives. Seven practice themes emerged: (1) tailoring to address context; (2) making connections; (3) enabling communication; (4) shaping a vision; (5) skill-building to mobilize and take action; (6) orchestrating people and projects; and (7) contributing information and experience. The value of recognized leadership competencies was underscored and the vital role of institutional supports was highlighted.Conclusion: To align stakeholders working towards fall prevention for community-dwelling older adults and establish a foundation for collective impact, public health professionals employed practices that reflected a collaborative leadership style. Looking ahead, public health professionals will want to shift their focus to evaluating the effectiveness of their group work within communities. They will also need to assess outcomes and evaluate whether the anticipated reductions in fall rates among community-dwelling older adults is being achieved. [ABSTRACT FROM AUTHOR]

Background: As public opinion is an important part of the health equity policy agenda, it is important to assess public opinion around potential policy interventions to address health inequities. We report on public opinion in Ontario about health equity interventions that address the social determinants of health. We also examine Ontarians' support and predictors for targeted health equity interventions versus universal interventions.Methods: We surveyed 2,006 adult Ontarians through a telephone survey using random digit dialing. Descriptive statistics assessed Ontarians' support for various health equity solutions, and a multinomial logistic regression model was built to examine predictors of this support across specific targeted and broader health equity interventions focused on nutrition, welfare, and housing.Results: There appears to be mixed opinions among Ontarians regarding the importance of addressing health inequities and related solutions. Nevertheless, Ontarians were willing to support a wide range of interventions to address health inequities. The three most supported interventions were more subsidized nutritious food for children (89%), encouraging more volunteers in the community (89%), and more healthcare treatment programs (85%). Respondents who attributed health inequities to the plight of the poor were generally more likely to support both targeted and broader health equity interventions, than neither type. Political affiliation was a strong predictor of support with expected patterns, with left-leaning voters more likely to support both targeted and broader health equity interventions, and right-leaning voters less likely to support both types of interventions.Conclusions: Findings indicate that the Ontario public is more supportive of targeted health equity interventions, but that attributions of inequities and political affiliation are important predictors of support. The Ontario public may be accepting of messaging around health inequities and the social determinants of health depending on how the message is framed (e.g., plight of the poor vs. privilege of the rich). These findings may be instructive for advocates looking to raise awareness of health inequities. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Public Administration is the property of Wiley-Blackwell 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.)

Objectives: The purpose of this study was to examine the associations between emergency department (ED) visits for conjunctivitis and ambient air pollution levels in urban regions across the province of Ontario, Canada.Material and Methods: Information from the National Ambulatory Care Reporting System was used to create time-series records, for the period of April 2004 to December 2011, on emergency department visits of patients suffering from conjunctivitis. A total of 77 439 emergency department visits for conjunctivitis were analyzed. A time-stratified case-crossover design was applied, completed with meta-analysis in order to pool inter-city results. Odds ratio (OR) for an emergency department visit was calculated in different population strata per one-unit increase (one interquartile range - IQR increase in a pollutant's daily level) while controlling for the impacts of temperature and relative humidity.Results: Statistically significant positive results were observed in the female population sample, for nitrogen dioxide (NO2) exposure lagged 5-8 days, with the highest result for the 7-day lag (OR = 1.035, 95% CI: 1.018-1.052) and for fine particulate matter with a median aerodynamic diameter of less than 2.5 μm (PM2.5), for lags 6 and 7 days, with the highest result for lag 7 (OR = 1.017, 95% CI: 1.003-1.031). In the male population sample, statistically significant positive results were observed for NO2; at lag 5 days (OR = 1.024, 95% CI: 1.004-1.045) and for ozone (O3), at lags 0-3 and 7 days, with the highest result for lag 0 (OR = 1.038, 95% CI: 1.012-1.056). Also for males, statistically significant results were observed in the case of PM2.5 exposure lagged by 5 days (OR = 1.003, 95% CI: 1.000-1.038) and sulfur dioxide (SO2) exposure lagged by 1 and 2 days (OR = 1.016, 95% CI: 1.000-1.031 and OR = 1.018, 95% CI: 1.002-1.033).Conclusions: The findings of this study suggest that there are associations between levels of air pollution and ED visits for conjunctivitis, with different temporal trends and strength of association by age, sex, and season. [ABSTRACT FROM AUTHOR]

Background: Comprehensive systems for surveilling prescription opioid-related harms provide clear evidence that deaths from prescription opioids have increased dramatically in the United States. However, these harms are not systematically monitored in Canada. In light of a growing public health crisis, accessible, nationwide data sources to examine prescription opioid-related harms in Canada are needed. We sought to examine the performance of 5 algorithms to identify prescription opioid-related deaths from vital statistics data against data abstracted from the Office of the Chief Coroner of Ontario as a gold standard.Methods: We identified all prescription opioid-related deaths from Ontario coroners' data that occurred between Jan. 31, 2003, and Dec. 31, 2010. We then used 5 different algorithms to identify prescription opioid-related deaths from vital statistics death data in 2010. We selected the algorithm with the highest sensitivity and a positive predictive value of more than 80% as the optimal algorithm for identifying prescription opioid-related deaths.Results: Four of the 5 algorithms had positive predictive values of more than 80%. The algorithm with the highest sensitivity (75%) in 2010 improved slightly in its predictive performance from 2003 to 2010.Interpretation: In the absence of specific systems for monitoring prescription opioid-related deaths in Canada, readily available national vital statistics data can be used to study prescription opioid-related mortality with considerable accuracy. Despite some limitations, these data may facilitate the implementation of national surveillance and monitoring strategies. [ABSTRACT FROM AUTHOR]

Objectives: We determined trends over time in the prevalence of neonatal drug withdrawal syndrome (NWS) in England compared with that reported in the USA, Western (W) Australia and Ontario, Canada. We also examined variation in prevalence of NWS according to maternal age, birth weight and across the English NHS by hospital trusts.Design and Setting: Retrospective study using national hospital administrative data (Hospital Episode Statistics) for the NHS in England between 1997 and 2011. NWS was identified using international classification of disease codes in hospital admission records. We searched the research literature and contacted researchers to identify studies reporting trends in the prevalence of NWS.Main Outcome Measures: Prevalence of NWS by calendar year per 1000 live births for each country/state. For births in England, prevalence by maternal age group and birth weight group. Prevalence by NHS trust and region at birth, and funnel plot to show outlying English NHS hospital trusts (>3 SD of mean prevalence).Main Results: Mean prevalence rates of recorded NWS increased in all four countries. Rates stabilised in England and W. Australia from the early 2000s and rose steeply in the USA and Ontario during the late 2000s. The most recent prevalence rates were 2.7/1000 live births in England (2011; 1544 cases); 2.7/1000 in W. Australia (2009); 3.6/1000 in the USA (2009) and 5.1/1000 in Ontario (2011). The highest prevalence in England was among babies born to mothers aged 25-34 years at delivery and among babies born with low birth weight (1500-2500 g). In England in 2011, 8.6% of hospital trusts had a recorded prevalence outside 3 SD of the overall average (7% above, 1% below). The North East region of England had the highest recorded prevalence of NWS.Conclusions: Although recorded NWS is stable in England and W. Australia, rising rates in the USA and Ontario may reflect better recognition and/or increased use of prescribed opiate analgesics and highlight the need for surveillance. The extent to which different prevalence rates by hospital trust reflect variation in occurrence, recognition or recording requires further investigation. [ABSTRACT FROM AUTHOR]

Background: We developed an evidence service that draws inputs from Health Systems Evidence (HSE), which is a comprehensive database of research evidence about governance, financial and delivery arrangements within health systems and about implementation strategies relevant to health systems. Our goal was to evaluate whether, how and why a 'full-serve' evidence service increases the use of synthesized research evidence by policy analysts and advisors in the Ontario Ministry of Health and Long-Term Care as compared to a 'self-serve' evidence service.Methods: We attempted to conduct a two-arm, 10-month randomized controlled trial (RCT), along with a follow-up qualitative process evaluation, but we terminated the RCT when we failed to reach our recruitment target. For the qualitative process evaluation we modified the original interview guide to allow us to explore the (1) factors influencing participation in the trial; (2) usage of HSE, factors explaining usage patterns, and strategies to increase usage; (3) participation in training workshops and use of other supports; and (4) views about and experiences with key HSE features.Results: We terminated the RCT given our 15% recruitment rate. Six factors were identified by those who had agreed to participate in the trial as encouraging their participation: relevance of the study to participants' own work; familiarity with the researchers; personal view of the importance of using research evidence in policymaking; academic background; support from supervisors; and participation of colleagues. Most reported that they never, infrequently or inconsistently used HSE and suggested strategies to increase its use, including regular email reminders and employee training. However, only two participants indicated that employee training, in the form of a workshop about finding and using research evidence, had influenced their use of HSE. Most participants found HSE features to be intuitive and helpful, although registration/sign-in and some page formats (particularly the advanced search page and detailed search results page) discouraged their use or did not optimize the user experience.Conclusions: The qualitative findings informed a re-design of HSE, which allows users to more efficiently find and use research evidence about how to strengthen or reform health systems or in how to get cost-effective programs, services and drugs to those who need them. Our experience with RCT recruitment suggests the need to consider changing the unit of allocation to divisions instead of individuals within divisions, among other lessons.Trial Registration: This protocol for this study is published in Implementation Science and registered with ClinicalTrials.gov ( HHS/FHS REB 10-267 ). [ABSTRACT FROM AUTHOR]

Background: Quality Improvement (QI) approaches are used extensively in healthcare settings and increasingly in public health. However, the proliferation of QI in Canadian public health settings is unknown. Purpose: The purpose of this study was to (a) assess the QI maturity in Ontario local public health units in Canada, and (b) to determine the relevance of the QI Maturity Tool in a Canadian setting Methods: The QI Maturity Tool (Version 5) was used to conduct a cross-sectional assessment of the QI maturity of 36 local public health units in Ontario, Canada. After tool items were reviewed for relevance, individuals most responsible for QI at each health unit were surveyed. Descriptive statistics were used to analyze the data. Results: Thirty-one individuals responded (response rate: 86%). Respondents reported strong leadership support for QI, but limited training and resources available to advance this area. Approximately half of public health units were found to be at the 'beginner' stage of QI maturity; 19% and 26% were in the 'emerging' and 'progressive' stages, respectively. Only 3% were in the 'achieving' stage and none are in the 'excelling' stage. Implications: The QI Maturity Tool is valuable for determining the maturity of QI in Ontario public health settings. There appears to be strong support for advancing QI across local public health in Ontario, but limited infrastructure to enable associated QI activities. [ABSTRACT FROM AUTHOR]

Background: Prenatal care reduces perinatal morbidity. However, there are no population-based studies examining the adequacy of prenatal care among women living with HIV. Accordingly, we compared the prevalence of adequate prenatal care among women living with and without HIV infection in Ontario, Canada. Methods: Using administrative data in a universal single-payer setting, we determined the proportions of women initiating care in the first trimester and receiving adequate prenatal care according to the Revised-Graduated Prenatal Care Utilization Index . We also determined the proportion of women with HIV receiving adequate prenatal care by immigration status. We used generalized estimating equations with a logit link function to derive adjusted odds ratios (aORs) and 95 % confidence intervals (CI) for all analyses. Results: Between April 1, 2002 and March 31, 2011, a total of 1,132,135 pregnancies were available for analysis, of which 634 (0.06 %) were among women living with HIV. Following multivariable adjustment, women living with HIV were less likely to receive adequate prenatal care (36.1 % versus 43.3 %; aOR 0.74, 95 % CI 0.62 to 0.88) or initiate prenatal care in the first trimester (50.8 % versus 70.0 %; aOR 0.51, 95 % CI 0.43 to 0.60) than women without HIV. Among women with HIV, recent (i.e. ≤ 5 years) immigrants from Africa and the Caribbean were less likely to receive adequate prenatal care (25.5 % versus 38.5 %; adjusted odds ratio 0.51; 95 % CI, 0.32 to 0.81) than Canadian-born women. Conclusion: Despite universal health care, disparities exist in the receipt of adequate prenatal care between women living with and without HIV. Interventions are required to ensure that women with HIV receive timely and adequate prenatal care. [ABSTRACT FROM AUTHOR]

Importance COPD is the third leading cause of death worldwide. Mortality trends offer an indication of how well a society is doing in fighting a disease. Objective To examine trends in all-cause, lung cancer, cardiovascular and COPD mortalities in people with COPD, overall and in men and women. Design, setting, participants Population, cohort study using health administrative data from Ontario, Canada, 1996 to 2011. Exposure A previously validated COPD case definition was used to identify all people with COPD. Main outcomes and measures All-cause, lung cancer, cardiovascular and COPD mortality rates were determined annually from 1996 to 2011 overall, and in men and women. All-cause trends were compared with all-cause trends in the non-COPD population. All rates were standardised to the 2006 Ontario population. Results The prevalence of COPD was 11.0% in 2011. Over the study period, all-cause mortality decreased significantly more in men with COPD than the non-COPD population. The same was not observed in women. COPD-specific and lung cancer mortalities, which started higher in men with COPD, decreased faster in them than in women with COPD with the two rates becoming more similar over time. Cardiovascular disease mortality declined at a relatively equal rate in both sexes. Conclusions and relevance Mortality in people with COPD has decreased; however, the decrease has been greater in men than in women. Public health interventions and medical care appear to be improving mortality in individuals with COPD but more research is needed to determine if they are benefiting both sexes equally. [ABSTRACT FROM AUTHOR]

Prescription opioid (PO) misuse is a major health concern across North America, and it is the primary cause of preventable death for the 18-35 year old demographic. Medication assisted therapy including methadone and buprenorphine, is the standard of care for patients with opioid-dependence. Moreover, both of these medications are recognized as essential medicines by World Health Organization. In Ontario Canada, the availability of medication assisted therapy has expanded substantially, with almost a ten-fold increase number of patients accessing methadone in Ontario in the past decade. In their manuscript, Fischer et. al. (2016), present a view that expansion of opioid maintenance therapy (OMT) has outpaced true patient need and alternate strategies should be considered as first-line treatments. Here, we present a countering perspective-that medication assisted therapy, along with other harm reduction strategies, should be widely available to all opioid-dependent people as first-line treatments. [ABSTRACT FROM AUTHOR]

Background: The impact of the prescription opioid public health crisis has been illustrated by the dramatic increase in opioid-related deaths in North America. We aimed to identify patterns and characteristics amongst opioid-users whose cause of death was related to opioid toxicity. Methods: This was a population-based study of Ontarians between the years 2006 and 2008. All drug-related deaths which occurred during this time frame were reviewed at the Office of the Chief Coroner of Ontario, and opioid-related deaths were identified. Medical, toxicology, pathology, and police reports were comprehensively reviewed. Narratives, semi-quantitative, and quantitative variables were extracted, tabulated, and analyzed. Results: Out of 2330 drug-related deaths in Ontario, 58% were attributed either in whole or in part, to opioids (n = 1359). Oxycodone was involved in approximately one-third of all opioid-related deaths. At least 7% of the entire cohort used opioids that were prescribed for friends and/or family, 19% inappropriately self-administered opioids (injection, inhalation, chewed patch), 3% were recently released from jail, and 5% had been switched from one opioid to another near the time of death. Accidental deaths were significantly associated with personal history of substance abuse, enrollment in methadone maintenance programs, cirrhosis, hepatitis, and cocaine use. Suicides were significantly associated with mental illness, previous suicide attempts, chronic pain, and a history of cancer. Significance/Conclusion: These results identify novel, susceptible groups of opioid-users whose cause of death was related to opioids in Ontario and provide the first evidence to assist in quantifying the contribution of opioid misuse and diversion amongst opioid-related mortality in Canada. Multifaceted prevention strategies need to be developed based on subpopulations of opioid users. [ABSTRACT FROM AUTHOR]

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Objectives. Aboriginal communities have a high prevalence of diabetes and heart disease, and limited resources to address them. The objective of this study was to test the effectiveness of prioritizing care with audit and feedback on cholesterol management of diabetic patients. Study design. A controlled before-after intervention trial was conducted among health care providers in Oji-Cree reserves in Sioux Lookout Zone, Ontario. Two communities were randomized to receive an interactive educational workshop and chart audit with feedback on cholesterol management; 2 control communities received usual care. Methods. The primary outcome measure used was the proportion of patients on statins, and the secondary outcome measure was the proportion of patients with LDL>2.5 mmol/L or TC/HDL>4.0 on statins. Outcomes were assessed by chart review at baseline and 10 months post-intervention. Results. Patients in the 2 intervention communities (n=170) and the 2 controls (n=170) were comparable at baseline. The intervention did not increase the proportion of diabetic patients on statins overall or in the subset of patients with elevated cholesterol. The proportion of patients with elevated cholesterol on statins went from 46% to 53% (p=0.48) in the intervention group and from 47% to 50% (p=0.25) in the control group. Conclusions. Audit and feedback listing patients requiring treatment did not increase statin prescription rates in diabetic patients in remote Aboriginal settings. This may be due to elevated baseline rates, the low intensity of feedback and the constraints of the practice environment, such as low staffing and high staff turnover. [ABSTRACT FROM AUTHOR]

Objective: To examine the prevalence and profile of people with co-occurring mental and substance use disorders in relation to numerous demographic, diagnostic, and needs-related variables across a comprehensive system of mental health services using a standard methodology.Method: Data were collected on cases (n = 9839) sampled from specialty tertiary inpatient, specialty outpatient, and community-based mental health programs. Status with respect to co-occurring disorders was based on recorded diagnosis of substance use disorder and the substance abuse measure within the Colorado Client Assessment Record. The demographic and needs profile was compared across groups with or without co-occurring disorders within each level of care.Results: Overall, the prevalence of co-occurring disorders was 18.5%, and highest among clients receiving specialty tertiary inpatient care (28%), and within selected subpopulations such as younger adults (55%) and those with personality disorders (34%). There were few differences between groups based on co-occurring disorders in the specialty inpatient programs. For outpatient and community settings, the clients with co-occurring disorders were distinguished by a more impaired and complex needs profile and more likely to be young, single, male, and of low education. Across all levels of care, having a co-occurring disorder was strongly associated with antisocial and challenging behaviour, legal involvement, and risk of suicide or self-harm.Conclusion: The prevalence estimate of co-occurring disorders is likely representative of a multilevel system of care that serves a large, mixed urban and rural population. Results highlight the need to focus on specific subpopulations and sectors in pursuit of more integrated treatment and support for their mental health and addictions problems. [ABSTRACT FROM AUTHOR]

Policy diffusion is a process whereby political bodies ‘learn’ policy solutions to public health problems by imitating policy from similar jurisdictions. This suggests that diffusion is a critical element in the policy development process, and that its role must be recognised in any examination of policy development. Yet, to date, no systematic work on the diffusion of smoke-free spaces bylaws has been reported. We examined the diffusion of municipal smoke-free bylaws over a 30-year period in the provinces of Alberta and Ontario, Canada, to begin to address this gap and to determine whether spatial patterns could be identified to help explain the nature of policy development. Bylaw adoption and change were analysed within local, regional, and provincial contexts. Geographical models of hierarchical and expansion diffusion in conjunction with the diffusion of innovations framework conceptually guided the analyses. Study findings contribute to a broader understanding of how and why health policies diffuse across time and place. Policy development can be a powerful mechanism for creating environments that support healthy decisions; hence, an understanding of policy diffusion is critical for those interested in policy interventions aimed at improving population health in any jurisdiction. [ABSTRACT FROM AUTHOR]

Presents initial findings of the Canadian Heart Health Initiative, Ontario Project (CHHIOP) which addressed public health capacity in supporting community-based heart health promotion. Discussion on the primary goal of CHHIOP; Illustration of the public health capacity in Ontario; Details of the implementation, capacity and predesposition of the initiative.

Presents a study to determine the extent to which home care practices vary by geographic region. Methods of determining regional variations in Ontario; Results; Suggestion that home care funding needs modification to ensure that all residents have equal access to services.

Evaluates a cold and flu self-care public education campaign by the Ontario Ministry of Health to reduce unnecessary patient visits to doctors. Effectiveness of mass media programs; Details of the public education campaign; Topics covered by evaluation models; Impact of the public education campaign.

Presents an edited version of a keynote address delivered by Ian Potter, Canada's Minister of Public Works and Government Services in July 1997, which deals with the Ottawa Charter for Health Promotion.