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Background: There is an increasing prevalence of multiple conditions (multimorbidity) and multiple medications (polypharmacy) across many populations. Previous literature has focused on the prevalence and impact of these health states separately, but there is a need to better understand their co-occurrence., Methods and Findings: This study reported on multimorbidity and polypharmacy among middle-aged and older adults in two national datasets: the Canadian Longitudinal Study on Aging (CLSA) and the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Using consistent methodology, we conducted a cross-sectional analysis of CLSA participants and CPCSSN patients aged 45 to 85 years as of 2015. When multimorbidity was defined as two or more conditions, the prevalence was 66.7% and 52.0% in the CLSA and CPCSSN cohorts, respectively. The prevalence of polypharmacy was 14.9% in the CLSA cohort and 22.6% in the CPCSSN cohort when defined as five or more medications. Using the same cut-points, the co-occurrence of multimorbidity and polypharmacy was similar between the two cohorts (CLSA: 14.3%; CPCSSN: 13.5%). Approximately 20% of older adults (65 to 85 years) were living with both multimorbidity and polypharmacy (CLSA: 21.4%; CPCSSN: 18.3%), as compared to almost 10% of middle-aged adults (45 to 64 years) living with this co-occurrence (CLSA: 9.2%; CPCSSN: 9.9%). Across both cohorts and age groups, females had consistently higher estimates of multimorbidity, polypharmacy and the co-occurrence of multimorbidity and polypharmacy., Conclusions: This study found that multimorbidity and polypharmacy are not interchangeable in understanding population health needs. Approximately one in five older adults in the CLSA and CPCSSN cohorts were living with both multimorbidity and polypharmacy, double the proportion in the younger cohorts. This has implications for future research, as well as health policy and clinical practice, that aim to reduce the occurrence and impact of multimorbidity and unnecessary polypharmacy to enhance the well-being of aging populations., Competing Interests: The authors have no conflict of interest to disclose. The opinions expressed are the authors’ own and do not reflect the views of the Canadian Longitudinal Study on Aging (CLSA) or the Canadian Primary Care Sentinel Surveillance Network (CPCSSN)., (Copyright: © 2025 Nicholson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Highly pathogenic avian influenza (HPAI) H5N1 has caused the deaths of more than 100 million birds since 2021, and human cases since 1997 have been associated with significant morbidity and mortality. Given recent detections of HPAI H5N1 in dairy cattle and H5N1 RNA detections in pasteurized retail milk in the United States, we established the pan-Canadian Milk Network in April 2024. Through our network of collaborators from across Canada, retail milk was procured longitudinally, approximately every 2 weeks, and sent to a central laboratory to test for the presence of influenza A virus RNA. Between 29 April and 17 July 2024, we tested 109 retail milk samples from all 10 Canadian provinces (NL, NS, PEI, NB, QC, ON, MB, SK, AB, and BC). All samples tested negative for influenza A virus RNA. This nationwide initiative was established for rapid retail milk screening as per the earliest reports of similar undertakings in the United States. Our independent testing results have aligned with reporting from federal retail milk testing initiatives. Despite no known HPAI infections of dairy cattle in Canada to date, H5N1 poses a significant threat to the health of both humans and other animals. By performing routine surveillance of retail milk on a national scale, we have shown that academic networks and initiatives can rapidly establish nationwide emerging infectious disease surveillance that is cost-effective, standardized, scalable, and easily accessible. Our network can serve as an early detection system to help inform containment and mitigation activities if positive samples are identified and can be readily reactivated should HPAI H5N1 or other emerging zoonotic viruses be identified in agricultural or livestock settings, including Canadian dairy cattle., Competing Interests: The authors declare that they have no competing interests.

Understanding the dietary patterns of First Nations is crucial for addressing health disparities and promoting well-being. Historical assaults (colonization and loss of control over their lands) have strongly altered dietary practices and impacted health outcomes for generations. Canada conducts regular surveys to assess the extent to which individuals adhere to dietary guidelines. However, Indigenous peoples living on reserves are excluded from these surveys. This study aims to assess the diet quality of First Nations adults using the Healthy Eating Food Index-2019 (HEFI-2019) and the Canadian Healthy Eating Index 2007 (C-HEI 2007) and identify their influencing factors. Data were collected from adults (19 years and older) across ninety-two First Nations communities throughout Canada. Participants provided information on sociodemographic factors and dietary intake using structured questionnaires and 24 h dietary recalls. Statistical analyses included mean scores and regression models to assess associations between dietary indices and influencing factors. The mean HEFI-2019 and C-HEI 2007 scores among First Nations adults were 35/80 and 49/100, respectively, indicating suboptimal adherence to dietary guidelines compared to the Canadian population. Factors such as region, age, sex, education level, number of working people in the household, smoking status, and traditional food intake significantly influenced diet quality. This study underscores the importance of understanding and improving the diet quality of First Nations adults as measured by HEFI-2019 and C-HEI 2007 scores. While acknowledging the low adherence to dietary guidelines, particularly in younger age groups, the study highlights the positive influence of traditional foods on diet quality within Indigenous communities., Competing Interests: The authors declare there are no competing interests.

Background: More than 80% of the Canadian population lives in urban settings. Urban areas usually bring exposure to poorer air quality, less access to green spaces, and higher building density. These environmental factors may endanger child development., Objective: To assess the relationship of urban environmental exposures during pregnancy with cognitive abilities, motor function, externalizing and internalizing symptoms in children., Method: We included 6,279 mother-child pairs from 3 Canadian population-based birth-cohorts (3D Cohort Study in Montreal, Quebec City, and Sherbrooke, AOF Study in Calgary, CHILD Study in Edmonton, Vancouver, Toronto, and Winnipeg). We estimated 7 environmental exposures of the built environment, surrounding greenness, and air pollution, around participant's home addresses during pregnancy. Validated neuropsychological tests were used to assess non-verbal and verbal abilities, gross and fine motor function, externalizing and internalizing symptoms at child's age 2 to 5 years. We assessed associations of each environmental exposure indicator with each of the 6 outcomes, using multivariate linear regression models. We conducted analyses separately by city of recruitment and combined estimates in meta-analyses., Results: Overall, urban environment during pregnancy was not associated with cognitive abilities (e.g., -0.81 non-verbal points 95 %CI [-2.10; 0.48] per 1 μg/m 3 increase in PM 2.5 ), motor function, or externalizing and internalizing symptoms. In individual cohorts, we found associations of some environmental exposures, in particular building density, fine particles, and nitrogen dioxide with non-verbal abilities, verbal abilities, and fine motor function, but overall confidence intervals in the meta-analyses included the null., Conclusion: We found no evidence of a relationship of prenatal built environment, surrounding greenness, and air pollution with cognitive abilities, motor functions or externalizing and internalizing symptoms in childhood. Urban environment has been shown to influence health across the lifecourse, however, specific exposures during pregnancy do not seem associated with poorer neurodevelopment in children of 2- to 5- year., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The development of leadership skills has been the topic of several position statements over recent decades, and the need of medical leaders for a specific training was emphasized during the COVID-19 crisis, to enable them to adequately collaborate with governments, populations, civic society, organizations, and universities. However, differences persist as to the way such skills are taught, at which step of training, and to whom. From these observations and building on previous experience at the University of Ottawa, a team of medical professors from Lyon (France), Ottawa, and Montreal (Canada) universities decided to develop a specific medical leadership training program dedicated to faculty members taking on leadership responsibilities. This pilot training program was based on a holistic vision of a transformation model for leadership development, the underlying principle of which is that leaders are trained by leaders. All contributors were eminent French and Canadian stakeholders. The model was adapted to French faculty members, following an inner and outer analysis of their specific needs, both contextual and related to their time constraints. This pilot program, which included 10 faculty members from Lyon, was selected to favor interactivity and confidence in older to favor long-term collaborations between them and contribute to institutional changes from the inner; it combined several educational methods mixing interactive plenary sessions and simulation exercises during onescholar year. All the participants completed the program and expressed global satisfaction with it, validating its acceptability by the target. Future work will aim to develop the program, integrate evaluation criteria, and transform it into a graduating training.

Background: Skin cancer prevention relies on effective sun safety practices. Previous studies have shown that LGBTQ+ individuals exhibit lower sunscreen use and higher tanning bed usage compared to their non-LGBTQ+ counterparts. This study is the first to assess skin cancer risk factors, sun-protective behaviors, and skin cancer concerns among LGBTQ+ individuals across Canada., Methods: A national survey study was conducted between July 2020 and March 2024 and included LGBTQ+ respondents aged ≥ 16 years who had completed the survey. Responses were summarized using frequency counts/percentages for categorical variables and means/standard deviations for continuous variables. Logistic regression models were used to calculate age- and gender-adjusted odds ratios for subgroup analyses., Results: Of the 700 LGBTQ+ participants included (59.3% women; median age 38 years), the majority had a Fitzpatrick skin phototype (FSP) I-III (76.4%). Concerningly, 60% reported >10 lifetime sunburns, 58% reported ≥1 blistering sunburn, 34% had used a tanning bed ≥1 time in their lifetime, and 69% reported having a tan in the last 12 months. Sunscreen was worn regularly by only half of the respondents, and half of the participants agreed or strongly agreed with "I look better and/or healthier with a tan". Additional comparisons are presented based on gender, FSP, education, and income., Conclusion: The findings of this study highlight the need for public health campaigns tailored to the LGBTQ+ community, emphasizing culturally sensitive sun safety education, particularly for LGBTQ+ men, individuals with FSP IV-VI, and those with lower education levels, to help reduce future skin cancer risk.

Introduction: In 2011, the Canadian Institutes of Health Research launched a Strategy for Patient-Oriented Research (POR) for healthcare and academic institutions to increase patient participation in health research. POR considers patients and caregivers as partners with scientific investigators, healthcare professionals and administrative decision-makers. As POR becomes a standard worldwide, the how-to, practical aspects of POR integration in healthcare institutions remain uncharted territory. A more accurate POR range in health research would improve healthcare systems. Yet the availability of standardised accreditation has not been achieved. The research question for this scoping review arose from a patient-partner in our team who experienced organisational challenges in healthcare institutions related to her role. It will overview and map the available evidence of organisational structures and changes that enable the integration of POR within healthcare institutions globally. This should serve our future projects to propose standardised pan-Canadian POR accreditation protocols., Methods and Analysis: Following Joanna Briggs Institute (JBI) methods and predetermined eligibility, we will perform a qualitative scoping review, searching for healthcare institution's organisational structures and changes in Patient-Oriented Research (POR)-related accreditation, criteria and procedures in academic peer-reviewed databases and grey literature. The scoping review's steps are as follows: (1) framing the research question; (2) targeting the documentation; (3) selecting documents by two reviewers; (4) charting/extracting data; (5) summarising and reporting the results. The search strategy will be applied to three databases for academic literature, and a search for grey literature will be performed. Emergent documents from academic studies or grey literature describing the organisational structure or changes to integrate POR within healthcare institutions, from 2012 to the present and in English or French, will be included. All articles will be analysed by two reviewers individually for inclusion. Extracted quantitative and qualitative data will describe eligible studies and POR-relevant elements. Tables mapping the organisational structures will be presented., Ethics and Dissemination: The methodology consists of exploring published evidence; therefore, ethics approval is not required. Patient-partners will provide feedback on findings and strategies for disseminating the results. Dissemination activities will include peer-reviewed publication, co-creation of teaching seminars and academic presentations., Trial Registration Number: The review was registered prospectively with Open Science Framework (OSF). Available: https://osf.io/4t6ud., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The Canadian Consortium on Neurodegeneration in Aging (CCNA) was created by the Canadian federal government through its health research funding agency, the Canadian Institutes for Health Research (CIHR), in 2014, as a response to the G7 initiative to fight dementia. Two five-year funding cycles (2014-2019; 2019-2024) have occurred following peer review, and a third cycle (Phase 3) has just begun. A unique construct was mandated, consisting of 20 national teams in Phase I and 19 teams in Phase II (with research topics spanning from basic to clinical science to health resource systems) along with cross-cutting programs to support them. Responding to the needs of researchers within the CCNA teams, a unique sample of 1173 deeply phenotyped patients with various forms of dementia was accrued and studied over eight years (COMPASS-ND). In the second phase of funding (2019-2024), a national dementia prevention program (CAN-THUMBS UP) was set up. In a short time, this prevention program became a member of the World Wide FINGERS prevention consortium. In this article, the challenges, successes, and impacts of CCNA in Canada and internationally are discussed. Short-term deliverables have occurred, along with considerable promise of impacts in the longer term. The creation of synergy, networking, capacity building, engagement of people with lived experience, and economies of scale have contributed to the considerable success of CCNA by all measures. CCNA is evidence that an organized "centrally-organized" approach to dementia research can catalyze important progress nationally and yield significant and measurable results., Competing Interests: Declaration of conflicting interestsDrs. Krista Lanctot, Manuel Montero-Odasso, Sylvie Belleville, and Julie Robillard, are Editorial Board Members of this journal but were not involved in the peer-review process of this article nor had access to any information regarding its peer-review.

Objectives: Youth vaping is a concern in Canada. While school-level policies influence student behaviours, few studies have investigated the association between school vaping policies and student vaping. This study reviewed and scored the comprehensiveness of school vaping policies and investigated the association between school vaping policy scores and student vaping., Methods: Online policy documents from n = 39 schools in Ontario, Alberta, and British Columbia, Canada, participating in the 2021-2022 wave of the COMPASS study were collected, reviewed, and scored for comprehensiveness (/39) using the School Tobacco Policy Index (STPI) rating form. The mean and range of scores for each domain of the STPI were calculated. School policy scores were linked to student vaping data from the COMPASS study. Multilevel logistic regression analyses identified the association between school vaping policy score and student lifetime and current (past 30-day) vaping., Results: The mean total policy score was 10.2/39 (range 0‒24), and 28% of schools scored 0/39. The majority of school policies did not identify enforcement approaches or available preventive or cessation resources. Increasing STPI score was not associated with the odds of student lifetime or current vaping in multilevel logistic regression analyses., Conclusion: The STPI quickly identified components of school vaping policies that were missing. The overall score of most school vaping policies in our sample was low and most school vaping policies lacked many important components. Future studies should explore factors associated with adolescent vaping and identify effective prevention measures., Competing Interests: Declarations. The COMPASS study has been supported by a bridge grant from the CIHR Institute of Nutrition, Metabolism and Diabetes (INMD) through the “Obesity – Interventions to Prevent or Treat” priority funding awards (OOP-110788; awarded to STL), an operating grant from the CIHR Institute of Population and Public Health (IPPH) (MOP-114875; awarded to STL), a CIHR project grant (PJT-148562; awarded to STL), a CIHR bridge grant (PJT-149092; awarded to KP/STL), a CIHR project grant (PJT-159693; awarded to KP), a research funding arrangement with Health Canada (#1617-HQ-000012; contract awarded to STL), a CIHR-Canadian Centre on Substance Use and Addiction (CCSA) team grant (OF7 B1-PCPEGT 410–10-9633; awarded to STL), and a project grant from the CIHR Institute of Population and Public Health (IPPH) (PJT-180262; awarded to STL/KP). A SickKids Foundation New Investigator Grant, in partnership with CIHR Institute of Human Development, Child and Youth Health (IHDCYH) (Grant No. NI21-1193; awarded to KP) funds a mixed-methods study examining the impact of the COVID-19 pandemic on youth mental health, leveraging COMPASS study data. The COMPASS-Quebec project additionally benefits from funding from the Ministère de la Santé et des Services Sociaux of the province of Québec, and the Direction régionale de santé publique du CIUSSS de la Capitale-Nationale. Conflict of interest: The authors declare no competing interests. Ethics approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Ontario Tech University Research Ethics Board (#17240), University of Waterloo Office of Research Ethics (ORE #30118), and participating school board review committees) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent for publication: NA., (© 2024. The Author(s).)

Ixodes scapularis and Ixodes pacificus are vectors of a range of pathogens of public health significance in North America. These ticks transmit pathogens to and from wild animal reservoir host species, but also bite humans and expose them to the pathogens. We describe the geographical and temporal distribution of the pathogen Babesia odocoilei, the causative agent of cervid babesiosis. Ixodes spp. ticks collected through active and passive surveillance were submitted to the National Microbiology Laboratory of the Public Health Agency of Canada for analysis of the presence of B. odocoilei from 2018 to 2021. Generalized linear models were constructed to evaluate the temporal change of B. odocoilei prevalence across Canada. Babesia odocoilei-positive I. scapularis are widespread across south-central and eastern regions of Canada, with an overall prevalence of 12.0 % in both nymphs (CI 95 % : 11.4-12.6) and adults (CI 95 % : 11.9-12.1) collected in passive surveillance and 13.2 % (CI 95 % : 12.9-13.5) and 10.0 % (CI 95 % : 9.8-10.2) in nymphs and adult, respectively, collected in active surveillance. A single I. pacificus tick tested positive in active surveillance out of 29 ticks collected in British Columbia, while no B odocoilei-positive I. scapularis were found in passive surveillance among the 11 adult ticks tested. Although B. odocoilei infection prevalence of adult I. scapularis was significantly higher in 2019 (14.1 %) than in 2018 (7.4 %), it remained stable from 2019 to 2021, suggesting that this pathogen may already be well established in endemic tick populations. The results provided in this article represent, to date, the most comprehensive picture of B. odocoilei distribution and prevalence in ticks in Canada and highlight the interest of maintaining One Health surveillance approaches to give added insight into disease transmission cycles for less well-characterized microorganisms., Competing Interests: Declaration of competing interest None to declare., (Crown Copyright © 2024. Published by Elsevier GmbH. All rights reserved.)

Purpose: To assess the current practices surrounding Uterine Fibroid Embolization (UFE) in Canada. Methods: An online survey was sent to Canadian Association for Interventional Radiology (CAIR) members. It included questions on symptoms prompting UFE, patient awareness, investigation, UFE settings, the number of UFE procedures, and post-UFE care. The findings were discussed at CAIR's 2023 annual meeting by an expert panel. Results: Out of 792 surveys sent, 87 were filled (11%). Menorrhagia is the most common indication for UFE (87%). Women's awareness of UFE as a treatment option for fibroids is viewed as poor or average by 94% of our survey respondents. Most respondents see patients in clinics (92%) before the procedure and evaluate fibroids with MRI pre-UFE (76%). There is variability in care post-UFE, with 33% of procedures being performed as day surgery while 67% lead to overnight stay. For pain management, intravenous analgesia (including patient-controlled analgesia) is used in 76% (63/83) of cases while 19% (16/83) of respondents mentioned using epidural analgesia. Finally, there is an even split between embolic agent used; non-spherical polyvinyl alcohol (50%) and spherical particles (50%). Conclusion: Respondents believe patients in Canada still have limited awareness of UFE. Interventional radiologists are increasingly involved in the entire patient care trajectory, overseeing pre-and post-procedure care and hospitalizing patients. For pain management after UFE, it is observed that while epidural analgesia has been demonstrated more effective than alternatives, it is not widely used as the primary method., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

People use dietary supplements to offset nutritional deficiencies and manage metabolic dysfunction. While the beneficial effect of fish proteins on glucose homeostasis is well established, the ability of fish peptides to replicate the protein findings is less clear. With financial support from a programmatic Canadian Institutes of Health Research (CIHR) Team grant, we aimed to identify salmon peptide fractions (SPFs) with the potential to mitigate metabolic dysfunction. Additionally, the grant aims included assessing whether vitamin D, a nutrient commonly found in salmon, could potentiate the beneficial effects of salmon peptides. In parallel, technologies were developed to separate and filter the isolated peptides. We employed an integrative approach that combined nutritional interventions in animal models and human subjects to identify metabolic pathways regulated by salmon peptides and other fish nutrients. This combination of interdisciplinary expertise revealed that a SPF could be a therapeutic tool used in the prevention and management of cardiometabolic diseases. Herein, we present a perspective of our CIHR funded grant that utilized a translational approach to establish the cardiometabolic health effects and mechanisms of action of fish nutrients: from animal models to clinical trials., Competing Interests: AM and LB hold patent WO 2021/108916 A1 Peptides for regulating glucose. PLM, GP, M-CV, HJ, CG and JSW declare no conflict of interest.

Background: COVID-19 vaccination has been associated with anaphylaxis and hypersensitivity reactions. Infectious disease physicians and allergists in the Canadian Special Immunization Clinic (SIC) Network developed guidance for evaluating patients with adverse events following immunization (AEFI) including suspected hypersensitivity. This study evaluated management and adverse event recurrence following subsequent COVID-19 vaccinations., Methods: Individuals aged 12 years and older enrolled at participating SICs before February 28, 2023 who were referred for suspected or diagnosed hypersensitivity reaction following COVID-19 vaccination, or for prevaccination assessment of suspected allergy to a COVID-19 vaccine component were included. De-identified clinical assessments and revaccination data, captured in a centralized database, were analyzed. The Brighton Collaboration case definition (BCCD) for anaphylaxis (2023 version) was applied., Results: The analysis included 206 participants from 13 sites: 26 participants referred for pre-vaccination assessment and 180 participants referred for adverse events following COVID-19 vaccination (15/180 [8.3%] with BCCD confirmed anaphylaxis, 84 [46.7%] with immediate hypersensitivity symptoms not meeting BCCD, 33 [18.3%] with other diagnosed hypersensitivity reactions, and 48 [26.7%] participants with a final diagnosis of non-hypersensitivity AEFI). Among participants referred for AEFIs following COVID-19 vaccination, 166/180 (92.2%) were recommended for COVID-19 revaccination after risk assessment, of whom 158/166 (95.2%) were revaccinated (all with a COVID-19 mRNA vaccine). After revaccination, 1/15 (6.7%) participants with prior anaphylaxis, 1/77 (1.3%) with immediate hypersensitivity not meeting criteria for anaphylaxis and 1/24 (4.2%) with other physician diagnosed hypersensitivity developed recurrent AEFI symptoms that met the BCCD for anaphylaxis. All 26 participants referred pre-vaccination, including 9 (34.6%) with history of polyethylene glycol-asparaginase reactions, were vaccinated without occurrence of immediate hypersensitivity symptoms., Conclusions: Most individuals in this national cohort who experienced a hypersensitivity event following COVID-19 vaccination and were referred for specialist review were revaccinated without AEFI recurrence, suggesting that specialist evaluation can facilitate safe revaccination., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: MS has been an investigator on projects funded by GlaxoSmithKline, Merck, Moderna, Pfizer, and Sanofi-Pasteur; all funds have been paid to his institute, and he has not received any personal payments. VC received honoraria from Pfizer, Aralez pharmaceuticals and CSL Behring financial support for publication from CSL Behring. JEMU reports advisory board for Pfizer, clinical trials with Sanofi, and other from Novartis, all outside the current work. KZ reports honoraria from AstraZeneca and Regeneron. JMP is an investigator on projects funded by MedImmune and Merck; all funds have been paid to his institute, and he has not received any personal payments. ZA reports honoraria for speaker fees for Pfizer outside of the submitted work. AM received honoraria for presentations from Pfizer and Sanofi. ADR participated in multicentric studies with ALK for sublingual immunotherapy as investigator. AC received honoraria for presentations from Pfizer, AstraZeneca, GlaxoSmithKline and Moderna. JC received honoraria for presentations from Pfizer, AstraZeneca, and GlaxoSmithKline. KAT has received funding to her institution from the Coalition for Epidemic Preparedness Innovations for vaccine safety studies. All other authors report no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: This study aimed to 1) describe the 2-year postoperative trajectories of leg pain and overall clinical outcome after surgery for radiculopathy, 2) identify the preoperative prognostic factors that predict trajectories representing poor clinical outcomes, and 3) develop and internally validate multivariable prognostic models to assist with clinical decision-making., Methods: This retrospective cohort study included patients enrolled in the Canadian Spine Outcomes and Research Network who were diagnosed with lumbar disc pathology and radiculopathy and had undergone lumbar discectomy at one of 18 spine centers. Potential outcome predictors included preoperative demographic, health-related, and clinical prognostic factors. Clinical outcomes were 1) 2-year univariable latent trajectories of leg pain intensity (numeric pain rating scale) and 2) overall outcomes comprising multivariable trajectories showing the combined postoperative courses of leg and back pain intensity (numeric pain rating scale) together with pain-related disability (Oswestry Disability Index). Each outcome model identified a subgroup of patients classified as experiencing a poor outcome based on minimal change in their clinical status after surgery. Multivariable risk model performance and internal validity were evaluated with discrimination and calibration statistics based on bootstrap shrinkage with 500 resamplings., Results: The authors included data from 1142 patients (47.6% female). The trajectory models identified 3 subgroups based on the patients' postoperative courses of pain or disability: 88.6% of patients in the leg pain model and 71.9% in the overall outcome model experienced a good-to-excellent outcome. The models classified 11.4% (leg pain outcome) and 28.2% (overall outcome) of patients as experiencing a poor clinical outcome, which was defined as minimal improvement in pain or disability after surgery. Eleven individual demographic, health, and clinical factors predicted patients' poor leg pain and overall outcomes. The performance of the multivariable risk model for leg pain was inadequate, while the overall outcome model had acceptable discrimination, calibration, and internal validity for predicting a poor surgical outcome., Conclusions: Patients with lumbar radiculopathy experience heterogeneous postoperative trajectories of pain and disability after lumbar discectomy. Individual preoperative factors are associated with postoperative outcomes and can be combined within a multivariable risk model to predict overall patient outcome. These results may inform clinical practice but require external validation before confident clinical implementation.

Despite good manufacturing practices and rigorous cleaning and sanitizing procedures established in dairy processing plants, microbiological contamination remains the main cause of products being noncompliant or atypical and hence not fit for human consumption. The objective of this study was to isolate, identify, and characterize bacteria, yeasts, and molds associated with substandard dairy products in Canada and to create a collection of reference isolates. In addition to conventional microbiological characterization, each isolate was tested for biofilm-forming ability and susceptibility to heat, antimicrobial agents, and common industrial disinfectants. Among the 105 microbial strains isolated from pasteurized milk, cream, and cheese samples, 24 bacterial isolates, belonging mainly to the genus Pseudomonas, were shown to be moderate or strong biofilm producers in 96-well plates and highly resistant to peracetic acid (100 ppm, 5 min contact time) and sodium hypochlorite (70 ppm, 5 min contact time). In addition, 56 bacterial isolates, including Acinetobacter baumannii, Enterobacter bugandensis, Klebsiella pneumoniae, and Pseudomonas spp., were found resistant to ampicillin, fosfomycin or ceftriaxone, while 14 others, such as Bacillus spp. and Macrococcus spp., withstood a heat treatment equivalent to low-temperature, long-time pasteurization (63°C for 30 min). This descriptive study provides new information on potential problematic microorganisms in dairies and will guide the development of novel control strategies intended to prevent and reduce microbiological contamination and the associated economic losses., (The Authors. Published by Elsevier Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

Background: Individuals with a lower socioeconomic position (SEP) often have higher intakes of ultraprocessed food (UPF) and lower intakes of minimally processed food (MPF); however, studies have not examined trends in absolute and relative gaps and gradients in UPF and MPF intake using multiple indicators of SEP., Objectives: We examined within-year absolute and relative gaps and gradients in UPF and MPF intake and trends between 2004 and 2015 according to 6 indicators of SEP among nationally representative samples of adults in Canada., Methods: Adults (≥18 y) in the Canadian Community Health Survey-Nutrition 2004 (n = 20,880) or 2015 (n = 13,970) reported SEP (individual and household education, household income adequacy, household food insecurity, neighborhood material and social deprivation) and completed a 24-h dietary recall. Multivariable linear regression assessed within-year absolute and relative gaps and gradients in the proportion of energy from UPF and MPF and trends between 2004 and 2015., Results: The largest and most consistent within-year inequities in UPF and MPF intake were for individual and household educational attainment. Overall and among males, higher SEP groups had more favorable intakes over time based on trends in absolute and relative gaps and gradients in UPF and MPF intake by household food insecurity [for example, the absolute gap in UPF intake declined from -1.2% (95% confidence interval: -5.3%, 2.9%) to -7.9% of energy (95% confidence interval: -11.2%, -4.5%) in the overall population]. Overall and among males, lower SEP groups had more favorable intakes over time based on trends in absolute and relative gaps in UPF and MPF intake by neighborhood material deprivation., Conclusions: Socioeconomic inequalities in UPF and MPF intake were most pronounced for individual and household education. Between 2004 and 2015, several inequalities in UPF and MPF intake emerged according to household food insecurity (favoring higher SEP groups) and neighborhood material deprivation (favoring lower SEP groups)., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Combining pathogen reduction technology (PRT) with blood screening may alleviate concerns over the risk of transfusion-transmitted infections (TTI) and support changes in blood donor selection to potentially increase blood availability. This study aimed to estimate the residual risk of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) transfusion-transmission in Canada after implementing PRT, while eliminating deferrals for sexual risk behaviors., Study Design and Methods: A probabilistic approach that combined Bayesian networks with Monte Carlo simulations was used to estimate the risk of transfusing HIV-, HBV-, or HCV-contaminated blood components. Different scenarios were considered to compare the current residual risk after PRT implementation, with and without donor deferral criteria for sexual risk behaviors. Donor profiles and blood component outcomes were simulated based on a literature review including the prevalence and incidence of HIV, HBV, and HCV in the Canadian blood donor population; the use of current blood screening assays; and HIV, HBV, and HCV blood donor viral loads., Results: In the universal PRT scenario (i.e., with PRT/without deferral criteria), the estimated risks of HIV, HBV, and HCV transmission were significantly lower than those in the currently observed scenario (i.e., without PRT/with deferral criteria)., Conclusions: This risk model suggests that PRT for platelets and plasma (and eventually for RBCs when available) significantly reduces the residual risks of HIV, HBV and HCV transfusion-transmission and could enable the removal of blood donor deferral criteria for sexual risk behaviors., (© 2024 AABB.)

Objective: To characterise consumption of ultra-processed foods and drinks (UPF) across a range of socio-demographic characteristics of Canadians., Design: Cross-sectional study. The national-level 2015 Canadian Community Health Survey-Nutrition provided data on all foods and drinks consumed on the previous day via a 24-hour dietary recall. All food items were classified according to the type of industrial processing using the NOVA system. Multivariable linear regression models examined associations between a range of socio-demographic characteristics and the mean energy contribution (% of total daily energy intake) from total UPF and UPF subgroups., Setting: The ten Canadian provinces., Participants: Canadians aged 2 or older ( n 20 103)., Results: UPF contributed, on average, nearly half (44·9 %) of total daily energy intake of Canadians. Children aged 6-12 and adolescents aged 13-18 consumed over half of total daily energy from UPF (adjusted means of 51·9 % and 50·7 %, respectively). Recent and long-term immigrants consumed a significantly lower share of energy from UPF (adjusted means of 42·2 % and 45·1 %, respectively) compared with non-immigrants (54·4 %), as did the food secure (42·8 %) v . those in moderately (48·1 %) or severely food-insecure households (50·8 %). More modest differences were observed for intake of total UPF and UPF subgroups by sex, education, income adequacy and region of residence., Conclusion: Levels of UPF consumption in 2015 in Canada were pervasive in all socio-demographic groups and highest among children and adolescents, non-immigrants and those living in food-insecure households. These findings can inform public health interventions to reduce UPF consumption and promote healthier diets in various socio-demographic groups.

Background: Educating future physicians about sexual and gender minority (SGM) patients and their health care needs is an important way to mitigate discrimination and health disparities faced by this community. Canada, across its 17 medical schools, lacks a national standard for teaching this essential topic. This paper aims to review the best practices for teaching an SGM curriculum in undergraduate medical education and synthesize this information into actionable propositions for curriculum development., Methods: A scoping literature review was conducted to identify best practices for SGM teaching. The review elicited peer-reviewed and grey literature on best practices for SGM teaching, policy documents, and opinion pieces from medical education authorities and SGM advocacy groups. Through an iterative process with all authors, the Canadian Queer Medical Students Association (CQMSA), and the Association of Faculties of Medicine of Canada (AFMC), a set of propositions was developed., Results: The search yielded 1347 papers, of which 89 were kept for data extraction. The main outcomes of these papers were sorted along five repeating themes, which formed the basis for six propositions; two more propositions were then added after discussion with all authors., Conclusion: We present eight propositions for the development of a national standard for SGM education at the undergraduate medical level. These include standardizing learning objectives across all schools, using established curricular models to guide curriculum development, interweaving concepts across all levels of training, diversifying teaching modalities, providing faculty training, ensuring a safe space for SGM students and faculty, using OSCEs as a teaching tool, and involving the local SGM community in curriculum development and delivery., Competing Interests: All authors have no financial or personal conflicts of interest to declare., (© 2024 Giffin, Glow, Lebo, Freeman, Miladinovic, Hansen, Brown, Karsenti; licensee Synergies Partners.)

Objective: Guidelines recommend deprescribing benzodiazepine receptor agonists (BZRA) in older adults, yet implementation in clinical practice remains limited. Adapting effective, evidence-based interventions to a new context is a resource-saving strategy. In Canada, the D-PRESCRIBE intervention comprised a patient educational brochure and a pharmaceutical opinion inviting physicians to revise BZRA prescribing and consider safer alternatives. Due to its effectiveness on BZRA deprescribing among Canadian older adults, we aimed to adapt the D-PRESCRIBE intervention to the Belgian community setting., Design: Recommendations from the ADAPT guidance, that provides a systematic approach for adapting interventions to new contexts, were followed. We conducted a mixed-methods study that comprised (1) group discussions and cognitive interviews to assess the acceptability and need for adaptation of the intervention's components and (2) a survey on the adapted pharmaceutical opinion. A research committee involving stakeholders' representatives decided on the adaptations, respecting the core functions of both tools. Changes in intervention components were reported following the Model for Adaptation Design and Impact framework., Setting: Belgian French-speaking community setting., Participants: Six older adults (≥65 years), six general practitioners (GPs) and seven pharmacists participated in the group discussions or interviews. 46 GPs and 91 pharmacists responded to the survey., Results: Participants welcomed the brochure positively. Still, some changes in the vocabulary, wording, photos and icons were made for several purposes including making the patient feel concerned about the brochure and softening the use of fear. The pharmaceutical opinion aroused mixed perceptions. Its name, layout and content were adapted to enhance its acceptability and fit with our healthcare system, practices and national guidelines. The survey highlighted several enablers and barriers to its use from the perspectives of GP and pharmacist., Conclusions: The Canadian D-PRESCRIBE intervention was adapted to the Belgian setting following a thorough and transparent process. Its feasibility will be tested in a future pilot study (NCT:05929417)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Following the detection of novel highly pathogenic avian influenza virus (HPAIV) H5N1 clade 2.3.4.4b in Newfoundland, Canada, in late 2021, avian influenza virus (AIV) surveillance in wild birds was scaled up across Canada. Herein, we present the results of Canada's Interagency Surveillance Program for Avian Influenza in Wild Birds during the first year (November 2021-November 2022) following the incursions of HPAIV from Eurasia. The key objectives of the surveillance program were to (i) identify the presence, distribution, and spread of HPAIV and other AIVs; (ii) identify wild bird morbidity and mortality associated with HPAIV; (iii) identify the range of wild bird species infected by HPAIV; and (iv) genetically characterize detected AIV. A total of 6,246 sick and dead wild birds were tested, of which 27.4% were HPAIV positive across 12 taxonomic orders and 80 species. Geographically, HPAIV detections occurred in all Canadian provinces and territories, with the highest numbers in the Atlantic and Central Flyways. Temporally, peak detections differed across flyways, though the national peak occurred in April 2022. In an additional 11,295 asymptomatic harvested or live-captured wild birds, 5.2% were HPAIV positive across 3 taxonomic orders and 19 species. Whole-genome sequencing identified HPAIV of Eurasian origin as most prevalent in the Atlantic Flyway, along with multiple reassortants of mixed Eurasian and North American origins distributed across Canada, with moderate structuring at the flyway scale. Wild birds were victims and reservoirs of HPAIV H5N1 2.3.4.4b, underscoring the importance of surveillance encompassing samples from sick and dead, as well as live and harvested birds, to provide insights into the dynamics and potential impacts of the HPAIV H5N1 outbreak. This dramatic shift in the presence and distribution of HPAIV in wild birds in Canada highlights a need for sustained investment in wild bird surveillance and collaboration across interagency partners., Importance: We present the results of Canada's Interagency Surveillance Program for Avian Influenza in Wild Birds in the year following the first detection of highly pathogenic avian influenza virus (HPAIV) H5N1 on the continent. The surveillance program tested over 17,000 wild birds, both sick and apparently healthy, which revealed spatiotemporal and taxonomic patterns in HPAIV prevalence and mortality across Canada. The significant shift in the presence and distribution of HPAIV in Canada's wild birds underscores the need for sustained investment in wild bird surveillance and collaboration across One Health partners., Competing Interests: The authors declare no conflict of interest.

Background: The effectiveness of public health measures (PHMs) depends on population adherence. Social media were suggested as a tool to assess adherence, but representativeness and accuracy issues have been raised., Objective: The objectives of this repeated cross-sectional study were to compare self-reported PHM adherence and sociodemographic characteristics between people who used Twitter (subsequently rebranded X) and people who did not use Twitter., Methods: Repeated Canada-wide web-based surveys were conducted every 14 days from September 2020 to March 2022. Weighted proportions were calculated for descriptive variables. Using Bayesian logistic regression models, we investigated associations between Twitter use, as well as opinions in tweets, and self-reported adherence with mask wearing and vaccination., Results: Data from 40,230 respondents were analyzed. As self-reported, Twitter was used by 20.6% (95% CI 20.1%-21.2%) of Canadians, of whom 29.9% (95% CI 28.6%-31.3%) tweeted about COVID-19. The sociodemographic characteristics differed across categories of Twitter use and opinions. Overall, 11% (95% CI 10.6%-11.3%) of Canadians reported poor adherence to mask-wearing, and 10.8% (95% CI 10.4%-11.2%) to vaccination. Twitter users who tweeted about COVID-19 reported poorer adherence to mask wearing than nonusers, which was modified by the age of the respondents and their geographical region (odds ratio [OR] 0.79, 95% Bayesian credibility interval [BCI] 0.18-1.69 to OR 4.83, 95% BCI 3.13-6.86). The odds of poor adherence to vaccination of Twitter users who tweeted about COVID-19 were greater than those of nonusers (OR 1.76, 95% BCI 1.48-2.07). English- and French-speaking Twitter users who tweeted critically of PHMs were more likely (OR 4.07, 95% BCI 3.38-4.80 and OR 7.31, 95% BCI 4.26-11.03, respectively) to report poor adherence to mask wearing than non-Twitter users, and those who tweeted in support were less likely (OR 0.47, 95% BCI 0.31-0.64 and OR 0.96, 95% BCI 0.18-2.33, respectively) to report poor adherence to mask wearing than non-Twitter users. The OR of poor adherence to vaccination for those tweeting critically about PHMs and for those tweeting in support of PHMs were 4.10 (95% BCI 3.40-4.85) and 0.20 (95% BCI 0.10-0.32), respectively, compared to non-Twitter users., Conclusions: Opinions shared on Twitter can be useful to public health authorities, as they are associated with adherence to PHMs. However, the sociodemographics of social media users do not represent the general population, calling for caution when using tweets to assess general population-level behaviors., (©José Denis-Robichaud, Erin E Rees, Patrick Daley, Christina Zarowsky, Assane Diouf, Bouchra R Nasri, Simon de Montigny, Hélène Carabin. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 13.08.2024.)

The COVID-19 pandemic undeniably impacted population health and several aspects of community organization, including service delivery and social cohesion. Intersectoral collaboration and equity, two key dimensions of community resilience, proved central to an effective and equitable response to the pandemic. Yet the factors that enabled or constrained communities' capacity to enact intersectoral collaboration and equity-focused action in such times of urgency and uncertainty remain poorly understood. This descriptive qualitative study aimed to (1) describe the processes through which intersectoral collaboration and equity-focused action were deployed during the first wave of COVID-19 and (2) identify factors enabling and constraining these processes. We conducted semi-directed interviews with 35 representatives of the governmental, institutional, and public and third sectors from four municipal regional counties of the Estrie region (Québec, Canada). We coded detailed interview notes following a codebook thematic analysis approach. We identified three processes through which intersectoral collaboration and equity-focused action were deployed: (1) networking; (2) adaptation, creation and innovation; and (3) human-centred action. Examples of levers which supported the deployment of these processes included capitalizing on pre-existing networks, adapting practices and services, and investing in solidarity and mutual aid. The influencing factors we describe represent concrete targets for resilience-building action. Although focused on the COVID-19 pandemic, our findings are relevant to other types of health, social, environmental or economic crises, and may guide health promotion and community development practitioners towards more effective community resilience-building responses., (© The Author(s) 2024. Published by Oxford University Press.)

Aims: This study investigates stigma predictors across ages and genders, addressing a critical gap in understanding diverse populations to reduce related suboptimal clinical and psychosocial outcomes., Methods: Cross-sectional analysis of self-reported data from BETTER, a Canadian registry of people with type 1 diabetes. Participants (n = 709) completed the 19-item-Diabetes-Stigma Assessment-Scale (DSAS-1) categorized into treated differently, blame and judgment, and identity concerns sub-scales. Associations with diabetes distress (DDS-17-score/102), depression (PHQ-9-score/27), social-support (ESSI-score/34), fear of hypoglycemia (HFS-II-score/132), and hyperglycemia-avoidance-behaviours (HAS-score/88) were computed., Results: Perceived stigma was highest in youth aged 14-24 years (46·0 ± 15·6, p < 0·001) and women (41·2 ± 15·7, p = 0·009), compared to other age groups and men. Blame and Judgment contributed to most of stigma perception. Youth perceived significantly more blame and judgment (p < 0·001) and identity concerns (p = 0·001) compared to middle-aged adults and seniors. Women perceive significantly more blame and judgment compared to men (p < 0·001). The perception of being treated differently was not reported to be an issue across ages and genders. Participants with higher scores of depression, diabetes-distress, fear of hypoglycemia, hyperglycemia-avoidance behaviours, and lesser social-support, reported increased stigma., Conclusions: Stigma varies by age and gender, underscoring the need for targeted interventions to reduce it. Challenging stereotypes and reducing stigma-related stressors are essential for better outcomes., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Anne-Sophie Brazeau reports financial support was provided by JDRF Canada. Anne-Sophie Brazeau reports financial support was provided by Canadian Institutes of Health Research., (Copyright © 2024 Research Trust of DiabetesIndia (DiabetesIndia) and National Diabetes Obesity and Cholesterol Foundation (N-DOC). Published by Elsevier Ltd. All rights reserved.)

Introduction: Developing professionalism notably involves learning how to make professional judgements in ambiguous situations. The Concordance of Judgement Test (CJT) is a learning tool that was proposed to develop professionalism competencies, but it was never performed in dentistry or used with a synchronous methodology. The present study evaluated the feasibility of the use of CJT in the context of dental education, to foster professionalism and stimulate reflexivity and discussion., Materials and Methods: After different steps of optimization, a questionnaire presenting 12 vignettes was submitted to 33 Canadian students. Second, after an additional optimization, a questionnaire of 7 vignettes was submitted to 87 French students. An immediate educational feedback was proposed after each vignette to promote reflexivity and discussions during the experience., Results: The overall experience of the students was reported as good, thanks to the feedback of real-life situations. This promoted reflexivity and stimulated discussion between students and educators regarding professionalism issues. The students considered CJT as a relevant and well-adapted tool, and reported positive feelings regarding the inter-university aspect of the activity. The mean score of the panel members was close to 80/100 and the mean score of the students was 5 to 10 points lower, which is in agreement with docimological performance., Conclusion: The results suggested that the use of CJT in a synchronous way was a feasible and relevant tool to motivate the students to improve their professionalism, and to stimulate their reflexivity and discussion. The students reported positive experience with CJT, and we believe that this tool can be integrated in the dental curriculum., (© 2024 The Authors. European Journal of Dental Education published by John Wiley & Sons Ltd.)

Background: Burn injuries pose a significant burden on both patients and healthcare systems. Yet, costs arising from the consumption of resources by these patients are rarely examined in Canada., Objective: The objective of this study was to assess real-world costs resulting from the initial hospitalization of patients admitted to a major burn unit in Quebec, Canada., Methods: A cost study based on a retrospective cohort was undertaken using in-hospital economic data matched to hospital chart data. Our cohort included all burn-injured patients admitted between April 1, 2017, and March 31, 2021, to the hospital's major burn unit during their initial hospitalization. Descriptive statistics were tabulated for sociodemographic and economic data. Costing data were analyzed unstratified and stratified according to burn severity (i.e., ≥ 20% of total body surface area [TBSA] vs. < 20%). Costs were presented in CAD 2021., Results: Our cohort included 362 patients, including 65 (18%) with TBSA ≥ 20%. The average initial hospitalization cost was $32,360 ($22,783 for < 20% TBSA and $76,121 for ≥ 20% TBSA)., Conclusion: Findings reveal that the total cost of the initial hospitalization, from a public hospital perspective, was $11,714,348. Our study underlines the substantial burden associated with burns and highlights the need for long-term cost evaluations., Competing Interests: Declarations of interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: Intérêts concurrents:: Matthew Herder déclare avoir reçu des subventions des Instituts de recherche en santé du Canada (IRSC) et de l’Agence de la santé publique du Canada et une rémunération à titre de membre du Conseil d’examen du prix des médicaments brevetés. Srinivas Murthy déclare avoir reçu du financement des IRSC, de la Fondation pour la recherche en santé et du Fonds Wellcome. Il est membre du conseil d’administration de l’organisme Universities Allied for Essential Medicines.

The objective of this cross-sectional study was to determine associations between calf management practices, the number of antimicrobial treatments, and antimicrobial resistance in preweaning heifers on Canadian dairy farms. A composite of 5 fecal samples from preweaning calves was collected from 142 dairy farms in 5 provinces and analyzed for phenotypic antimicrobial susceptibility with the microbroth dilution method. Questionnaires were used to capture herd characteristics and calf management practices used on the farm. Calf treatment records were collected during the farm visits. Escherichia coli was isolated from all 142 fecal samples with the highest resistance to tetracycline (41%), followed by sulfisoxazole (36%), streptomycin (32%), chloramphenicol (28%), ampicillin (16%), trimethoprim-sulfamethoxazole (15%), ceftriaxone (4.2%), cefoxitin (2.8%), amoxicillin-clavulanic acid (2.1%), ciprofloxacin (2.1%), nalidixic acid (2.1%), azithromycin (1.4%), and gentamicin (1.4%). Multidrug resistance was observed in 37% of E. coli isolates. Three-quarters of farms used fresh colostrum as the most common type of colostrum fed to calves. Colostrum quality was checked on 49% of farms, but the transfer of passive immunity was only checked on 32% of farms in the last 12 mo. Almost 70% of farms used straw or hay or a combination as the bedding material for calves. Among the 142 farms, a complete set of calf records were collected from 71 farms. In a multivariable logistic regression model, farms with ≥1.99 to 32.57 antimicrobial treatments/calf-year were 3.2 times more likely to have multidrug resistant E. coli in calf feces compared farms with <1.99 antimicrobial treatments/calf-year. Farms using hay or straw beddings were 5.1 times less likely to have multidrug resistant E. coli compared with those with other bedding materials including shavings or sawdust. Bedding management practices on farms may need to be investigated to reduce the potential effect on disseminating multidrug resistant bacteria., (The Authors. Published by Elsevier Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

Competing Interests: Intérêts concurrents:: Aucun déclaré.

Competing Interests: Intérêts concurrents:: Marina Salvadori est une employée de l’Agence de la santé publique du Canada. Sarah Wilson est une employée de Santé publique Ontario. Aucun autre intérêt concurrent n’a été déclaré.

Competing Interests: Intérêts concurrents:: Modupe Tunde-Byass déclare avoir reçu des subventions de recherche de la société Ferring Pharmaceuticals, de l’initiative pour la santé des femmes de l’Hôpital général de North York et de Shoppers Drug Mart, ainsi que du Fonds Exploration de l’Hôpital général de North York. La Dre Tunde-Byass déclare avoir également reçu des honoraires de conférencière de l’Hôpital Women’s College pour le Sommet sur la santé des personnes noires (Black Health Summit), de la société Microsoft, de la Société des obstétriciens et gynécologues du Canada, de l’Université du Manitoba, de l’Association médicale de la Saskatchewan, de la régie sanitaire Vancouver Coastal, de l’Université de l’Alberta, de la Fédération des femmes médecins du Canada, de l’Association médicale canadienne et de l’institut de la haute direction dans le secteur public (Public Sector Executive Institute). Elle a été rémunérée à titre de témoin expert et a reçu un soutien financier du Collège royal des médecins et chirurgiens du Canada, de l’Association des facultés de médecine du Canada, de la Fédération des Ordres des médecins du Canada, de la Fédération des femmes médecins du Canada et de la Société des obstétriciens et gynécologues du Canada pour participer à des réunions. La Dre Tunde-Byass est présidente de l’association des médecins noirs du Canada, cofondatrice de l’initiative « Formation simplifiée en matière de santé des femmes » (Women’s Health Education Made Simple), coprésidente de l’initiative collaborative « Formation en matière de santé des personnes noires » (Black Health Education Collaborative) de l’Hôpital général de North York et vice-présidente du comité « Résultats maternels et néonatals » (Maternal Newborn Outcomes) du Registre et réseau des bons résultats dès la naissance (Better Outcome Registry Network). Aucun autre intérêt concurrent n’a été déclaré.

Background: Kidney transplantation is the optimal treatment for end-stage renal disease. However, highly sensitized patients (HSPs) have reduced access to transplantation, leading to increased morbidity and mortality on the waiting list. The Canadian Willingness to Cross (WTC) program proposes allowing transplantation across preformed donor specific antibodies (DSA) determined to be at a low risk of rejection under the adaptive design framework. This study collected patients' perspectives on the development of this program., Methods: Forty-one individual interviews were conducted with kidney transplant candidates from three Canadian transplant centers in 2022. The interviews were digitally recorded and transcribed for subsequent analyses., Results: Despite limited familiarity with the adaptive design, participants demonstrated trust in the researchers. They perceived the WTC program as a pathway for HSPs to access transplantation while mitigating transplant-related risks. HSPs saw the WTC program as a source of hope and an opportunity to leave dialysis, despite acknowledging inherent uncertainties. Some non-HSPs expressed concerns about fairness, anticipating increased waiting times and potential compromise in kidney graft longevity due to higher rejection risks. Participants recommended essential strategies for implementing the WTC program, including organizing informational meetings and highlighting the necessity for psychosocial support., Conclusion: The WTC program emerges as a promising strategy to enhance HSPs' access to kidney transplantation. While HSPs perceived this program as a source of hope, non-HSPs voiced concerns about distributive justice issues. These results will help develop a WTC program that is ethically sound for transplant candidates., (© 2024 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.)

Introduction: Children's active travel to and from school (AST) and children's independent mobility (CIM) are consistently positively associated with physical activity (PA); however, few researchers have investigated associations between objective measures of the environment and indicators of AST and CIM in national samples., Methods: A national sample of 2,067 Canadian parents of 7- to 12-year-old children was recruited in December 2020. Regression analyses were used in 2023 to assess the association between geographic information system measures of park density, blue space, population density, greenspace, intersection density, and CIM and AST to and from school., Results: Children in areas with high versus low park density (>0.025 vs. ≤0.025) had higher odds of travel to school via active modes (OR: 1.47 [1.14, 1.91], p=0.003). Children in neighborhoods in the highest quartile for neighborhood greenspace (Normalized Difference Vegetation Index) were more likely to travel to home actively than those in areas of lower greenspace (OR: 1.70 [1.18, 2.45], p=0.004). On average, children living in areas in the highest versus the lowest quartile for intersection density were more likely to engage in AST to (OR: 2.43 [1.58, 3.75], p<0.001) and from (OR: 2.77 [1.80, 4.29], p<0.001) school., Conclusions: The observed associations underscore a need for city planners and policymakers to ensure sufficient access to parks and neighborhood greenspace, especially if findings are confirmed in longitudinal studies. More research is needed to investigate the role of intersection density in supporting AST and CIM., (Copyright © 2023 American Journal of Preventive Medicine. All rights reserved.)

Despite the use of various integrated pest management strategies to control the honey bee mite, Varroa destructor, varroosis remains the most important threat to honey bee colony health in many countries. In Canada, ineffective varroa control is linked to high winter colony losses and new treatment options, such as a summer treatment, are greatly needed. In this study, a total of 135 colonies located in 6 apiaries were submitted to one of these 3 varroa treatment strategies: (i) an Apivar® fall treatment followed by an oxalic acid (OA) treatment by dripping method; (ii) same as in (i) with a summer treatment consisting of formic acid (Formic Pro™); and (iii) same as in (i) with a summer treatment consisting of slow-release OA/glycerin pads (total of 27 g of OA/colony). Treatment efficacy and their effects on colony performance, mortality, varroa population, and the abundance of 6 viruses (acute bee paralysis virus [ABPV], black queen cell virus [BQCV], deformed wing virus variant A [DWV-A], deformed wing virus variant B [DWV-B], Israeli acute paralysis virus [IAPV], and Kashmir bee virus [KBV]) were assessed. We show that a strategy with a Formic Pro summer treatment tended to reduce the varroa infestation rate to below the economic fall threshold of 15 daily varroa drop, which reduced colony mortality significantly but did not reduce the prevalence or viral load of the 6 tested viruses at the colony level. A strategy with glycerin/OA pads reduced hive weight gain and the varroa infestation rate, but not below the fall threshold. A high prevalence of DWV-B was measured in all groups, which could be related to colony mortality., (© The Author(s) 2024. Published by Oxford University Press on behalf of Entomological Society of America.)

Background: Estimating rates of disease importation by travellers is a key activity to assess both the risk to a country from an infectious disease emerging elsewhere in the world and the effectiveness of border measures. We describe a model used to estimate the number of travellers infected with SARS-CoV-2 into Canadian airports in 2021, and assess the impact of pre-departure testing requirements on importation risk., Methods: A mathematical model estimated the number of essential and non-essential air travellers infected with SARS-CoV-2, with the latter requiring a negative pre-departure test result. The number of travellers arriving infected (i.e. imported cases) depended on air travel volumes, SARS-CoV-2 exposure risk in the departure country, prior infection or vaccine acquired immunity, and, for non-essential travellers, screening from pre-departure molecular testing. Importation risk was estimated weekly from July to November 2021 as the number of imported cases and percent positivity (PP; i.e. imported cases normalised by travel volume). The impact of pre-departure testing was assessed by comparing three scenarios: baseline (pre-departure testing of all non-essential travellers; most probable importation risk given the pre-departure testing requirements), counterfactual scenario 1 (no pre-departure testing of fully vaccinated non-essential travellers), and counterfactual scenario 2 (no pre-departure testing of non-essential travellers)., Results: In the baseline scenario, weekly imported cases and PP varied over time, ranging from 145 to 539 cases and 0.15 to 0.28%, respectively. Most cases arrived from the USA, Mexico, the United Kingdom, and France. While modelling suggested that essential travellers had a higher weekly PP (0.37 - 0.65%) than non-essential travellers (0.12 - 0.24%), they contributed fewer weekly cases (62 - 154) than non-essential travellers (84 - 398 per week) given their lower travel volume. Pre-departure testing was estimated to reduce imported cases by one third (counterfactual scenario 1) to one half (counterfactual scenario 2)., Conclusions: The model results highlighted the weekly variation in importation by traveller group (e.g., reason for travel and country of departure) and enabled a framework for measuring the impact of pre-departure testing requirements. Quantifying the contributors of importation risk through mathematical simulation can support the design of appropriate public health policy on border measures., (© 2024. Crown.)

Introduction: Improving sustainable transportation options will help cities tackle growing challenges related to population health, congestion, climate change and inequity. Interventions supporting active transportation face many practical and political hurdles. Implementation science aims to understand how interventions or policies arise, how they can be translated to new contexts or scales and who benefits. Sustainable transportation interventions are complex, and existing implementation science frameworks may not be suitable. To apply and adapt implementation science for healthy cities, we have launched our mixed-methods research programme, CapaCITY/É. We aim to understand how, why and for whom sustainable transportation interventions are successful and when they are not., Methods and Analysis: Across nine Canadian municipalities and the State of Victoria (Australia), our research will focus on two types of sustainable transportation interventions: all ages and abilities bicycle networks and motor vehicle speed management interventions. We will (1) document the implementation process and outcomes of both types of sustainable transportation interventions; (2) examine equity, health and mobility impacts of these interventions; (3) advance implementation science by developing a novel sustainable transportation implementation science framework and (4) develop tools for scaling up and scaling out sustainable transportation interventions. Training activities will develop interdisciplinary scholars and practitioners able to work at the nexus of academia and sustainable cities., Ethics and Dissemination: This study received approval from the Simon Fraser University Office of Ethics Research (H22-03469). A Knowledge Mobilization Hub will coordinate dissemination of findings via a website; presentations to academic, community organisations and practitioner audiences; and through peer-reviewed articles., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Given the increasing number and the diversity of dietary quality indices used for research, and the differences between settings, there is a need to identify valid indices of dietary quality in different contexts and populations and to identify their associations with health-related outcomes., Objectives: The primary objective of this scoping review is to identify the tools used in determining dietary quality among First Nations and to describe the changes in diet. The second objective is to describe the associations identified in studies that have measured the relationship between health and dietary quality among First Nations; and the third objective is to identify factors associated with diet quality., Methods: PubMed, Embase, CINAHL, Global Health, and Web of Science were searched from inception to June 2021 and updated in February 2022. Articles were included if the research subjects were First Nations, or if articles reported disaggregated subset data for First Nations. Eligible studies focused on nutrition and diet and were published in English or French., Results: A total of 151 articles were included in the analysis. Studies used several indicators to measure if individuals adhered to dietary guidelines. Traditional food consumption was frequently used as an indicator of diet quality (n = 96). The consumption of store-bought foods was used as an indicator in 28 studies. Some studies used other diet quality indicators such as the Healthy Eating Index (n = 5) and ultra-processed food "NOVA" classification (n = 6). A trend for decreasing traditional food intake over time was apparent, alongside an increase in store-bought food intake. This trend was accompanied with declining health status, including the increased prevalence of overweight and obesity, diabetes, metabolic diseases, and dental caries., Conclusion: This scoping review showed that diet quality among First Nations is improved when traditional foods are consumed. Reduced diet quality was associated with increased risk of noncommunicable diseases., (© The Author(s) 2023. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Context: Best practice guidelines for the recovery and return to work (RTW) of people with mental disorders recommend access to the services of an interdisciplinary team combining pharmacological, psychological and work rehabilitation interventions. In the Canadian context, primary healthcare services are responsible for providing these services for people with common mental disorders, such as depressive or anxiety disorders. However, not everyone has easy access to these recommended primary healthcare services, and previous studies suggest that multiple personal, practice-related and organizational factors can influence the patient's journey. Moreover, previous studies documented that family physicians often work in silos and lack the knowledge and time needed to effectively manage by themselves patients' occupational health. Thus, the care and service trajectories of these patients are often suboptimal and can have important consequences on the person's recovery and RTW., Objective and Population Studied: Our study aimed to gain a better understanding of the patient journeys and the factors influencing their access to and experience with primary healthcare services while they were on sick leave due to a common mental disorder., Methods: A descriptive qualitative research design was used to understand and describe these factors. Conventional content analysis was used to analyze the verbatim., Results: Five themes describe the main factors that influenced the patient's journey of the 14 participants of this study: (1) the fragmented interventions provided by family physicians; (2) patients' autonomy in managing their own care; (3) the attitude and case management provided by the insurer, (4) the employer's openness and understanding and (5) the match between the person's needs and their access to psychosocial and rehabilitation services., Conclusions: Our findings highlight important gaps in the collaborative practices surrounding the management of mental health-related sick leave, the coordination of primary healthcare services and the access to work rehabilitation services. Occupational therapists and other professionals can support family physicians in managing sick leaves, strengthen interprofessional and intersectoral collaboration and ensure that patients receive needed services in a timelier manner no matter their insurance coverage or financial needs., Patients of Public Contribution: This study aimed at looking into the perspective of people who have lived or are currently experiencing a sick leave related to a mental health disorder to highlight the factors which they feel hindered their recovery and RTW. Additionally, two patient partners were involved in this study and are now engaged in the dissemination of the research results and the pursuit of our team research programme to improve services delivered to this population., (© 2024 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Background: Adolescents who experience overweight or obesity commonly persist in these conditions into adulthood, thereby elevating their vulnerability to health issues. The focus of this study is on health risk markers such as body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), body surface area (BSA), and cardiorespiratory fitness (CRF). The objectives include updating normative values for BMI, WC, WHtR, and BSA in Canadian adolescents, establishing cardiometabolic risk zones, and developing a composite score considering both anthropometric and CRF markers., Methods: Involving 1864 adolescents, the study used the LMS method to generate percentile norms, stratified by age and sex. Cardiometabolic risk zones were established for each marker based on Z-scores, and a composite score was created., Results: An increase in WC of 5.8 and 7.4 cm for boys and girls, respectively, was observed since 1981. Forward multiple regression analyses were conducted to assess the robustness and validity of the proposed model. The results indicated that the model explained nearly 90% (R 2 = 0.890) of the common variance between the composite score and the retained independent variables. Moreover, the model demonstrated a mean absolute error (MAE) of approximately 6 percentiles, confirming its high precision. Furthermore, these analyses yielded key thresholds for identifying adolescents at risk: the 70th percentile for high cardiometabolic risk and the 85th percentile for very-high risk., Conclusions: Individually, WC or WHtR seem to be better markers for evaluating cardiometabolic risk than BMI during adolescence. However, CRF showed comparable importance to anthropometric markers in determining cardiometabolic risk. The simultaneous inclusion of anthropometric and CRF markers provides a better picture of the global cardiometabolic risk in adolescents.

Competing Interests: Intérêts concurrents:: Erica Barbazza déclare avoir reçu du financement du programme Actions Marie Skłodowska-Curie du programme-cadre européen Horizon 2020 et des honoraires de consultation de l’Organisation mondiale de la santé. Tara Kiran déclare avoir reçu du financement de Santé Canada et des honoraires de l’Association médicale de l’Ontario, du Collège des médecins de famille de l’Ontario, du ministère ontarien de la Santé, de l’Association médicale canadienne et du Collège canadien des médecins de famille. Aucun autre intérêt concurrent n’a été déclaré.

Background: Anxiety disorders (ADs) are associated with increased healthcare use (HCU), and individuals may seek healthcare through various pathways according to clinical and individual characteristics. This study aimed to characterize care trajectories (CTs) of individuals with ADs., Methods: This is a retrospective cohort study using the Care Trajectories - Enriched Data cohort, a linkage between the Canadian Community Health Surveys (CCHS), and health administrative data from Quebec. The cohort included 5143 respondents reporting ADs to the CCHS between 2009 and 2016. We measured CTs over 5 years before CCHS using a state sequence analysis., Results: The cohort was categorized into five types of CTs. Type 1 (52.7 %) was the lowest care-seeking group, with fewer comorbidities. Type 2 (24.0 %) had higher levels of physical and mental health comorbidities and moderate HCU, mainly ambulatory visits to general practitioners. Type 3 (13.1 %) represented older patients with the highest level of physical illnesses and high HCU, predominantly ambulatory consultation of specialists other than psychiatrists. Types 4 and 5 combined young and middle-aged patients suffering from severe psychological distress. HCU of type 4 (6.7 %) was high, mainly consultations of ambulatory psychiatrists, and HCU of type 5 (3.5 %), was the highest and mostly in acute care., Limitations: Administrative and survey data may have coding errors, missing data and self-report biases., Conclusion: Five types of CTs showed distinct patterns of HCU often modulated by physical and mental health comorbidities, which emphasizes the importance of considering ADs when individuals seek care for other mental health conditions or physical illness., Competing Interests: Declaration of competing interest The authors declared no potential conflicts of interest., (Copyright © 2023. Published by Elsevier B.V.)

Background and Purpose: The purpose of this article is to document the development and validation process of an instrument adapted for French-speaking nurses and to measure the occurrence of omitted nursing care (ONC) in the intensive care unit (ICU). Methods: An electronic Delphi panel, involving ICU nursing experts from the province of Quebec (Canada), was used to develop the intensive care unit omitted nursing care (ICU-ONC) instrument. For the validation process, an electronic cross-sectional survey was conducted. Results: A total of 564 nurses participated in the validation study. Exploratory factor analysis performed on 478 complete observations supports the presence of a single-factor structure for the 22-item ICU-ONC instrument. Coefficient alpha for the scale was .93, 95% confidence interval (CI) was [0.92, 0.94], item-partial total correlations ranged from .49 and .68, and the mean/median interitem correlations were .38 and .37, respectively. Moderate negative correlations were found between the ICU-ONC instrument overall score and two related constructs: nurses' perception of the quality as well as the safety of care. Conclusions: Our current understanding of ONC in the ICU is based on the results drawn from the administration of generic instruments to ICU nurses. The novel 22-item ICU-ONC instrument can help better estimate the occurrence of the phenomena in the ICU., (© Copyright 2024 Springer Publishing Company, LLC.)

Introduction: The mass gathering event (MGE) industry is growing globally, including in countries such as Canada. MGEs have been associated with a greater prevalence of injury and illness when compared with daily life events, despite most participants having few comorbidities. As such, adequate health, safety, and emergency medical planning is required. However, there is no single entity regulating these concerns for MGEs, resulting in the responsibility for health planning lying with event organizers. This study aims to compare the legislative requirements for MGE medical response systems in the 13 provinces and territories of Canada., Methods: This study is a cross-sectional descriptive analysis of Canadian legislation. Lists of publicly available legislative requirements were obtained by means of the emergency medical services directors and Health Ministries. Descriptive statistics were performed to compare legislation., Results: Of the 13 provinces and territories, 10 responded. For the missing 3, a law library review confirmed the absence of specific legislation. Most ( n = 6; 60%) provinces and territories referred to provisions in their Public Health laws. Four confirmed that MGE medical response was a municipal or local concern to be addressed by the event organizers., Conclusions: No provinces could list specific legislation guiding safety, health, and medical response for an MGE.

Abstract: Treatment of chronic pain should be multimodal and include pharmacological, physical, and psychological treatments. However, because various barriers to physical and psychological treatments (PPTs) exist, a better understanding of biopsychosocial factors leading to their use is relevant. This study aimed to explore the association between gender identity, gender-stereotyped personality traits, and the use of PPTs in chronic pain management. The ChrOnic Pain trEatment cohort, a self-reported data infrastructure resulting from a web-based recruitment of 1935 people living with chronic pain (Quebec, Canada) was analyzed. Gender identity was operationalized as women, men, and nonbinary. Gender-stereotyped personality traits were measured using the Bem Sex-Role Inventory (feminine, masculine, androgynous, undifferentiated). A checklist of 31 types of PPTs that can be used for chronic pain management was presented to participants (yes/no). From the 1433 participants, 85.5% reported using at least one PPT. Hot-cold therapies (43.4%), exercise (41.9%), and meditation (35.2%) were the most frequently used PPTs, but most popular PPTs were not the same among women and men. Women reported a significantly higher use of PPTs in general (87.2% vs 77.2%; P < 0.001). Multivariable and interaction analyses showed that identifying as a man decreased the odds of reporting the use of PPTs (odds ratio: 0.32, 95% confidence interval: 0.11-0.92) but only among participants who scored high on both masculine and feminine personality traits (those classified as androgynous). The high prevalence of PPTs use found in our study is positive. Our results are relevant for a more personalized promotion of PPTs for chronic pain management., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Association for the Study of Pain.)

Exposure to halogenated flame retardants (HFRs) has been associated with various adverse effects on human health. Human exposure to HFRs mainly occurs through diet, ingesting contaminated dust, and inhaling contaminated air. Understanding and characterizing the variables linked to these exposure pathways is essential for developing effective risk assessment and mitigation strategies. We investigated indoor environment quality, physiological factors, and diet as potential predictors of HFRs concentration in children's plasma and stool. A selected number of HFRs, including polybrominated diphenyl ethers (PBDEs), Dechlorane-like compounds, and emerging halogenated flame retardants, were measured in children from eastern Quebec (Canada). Information on indoor environment quality, physiological factors, and diet was obtained through self-report questionnaires. Our results show that lower brominated compounds, which are more volatile, were primarily correlated to indoor environment quality. Notably, the use of air purifiers was associated with lower BDE47 and BDE100 levels in blood and newer residential buildings were associated with higher concentrations of BDE47. A significant seasonal variation was found in stool samples, with higher levels of lower brominated PBDEs (BDE47 and BDE100) in samples collected during summer. No association between household income or maternal education degree and HFRs was found. Among emerging compounds, Dec602 and Dec603 were associated with the most variables, including the use of air dehumidifiers, air conditioning, and air purifiers, and the child's age and body fat percentage., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Morbidity and mortality remain important concerns for veal production which traditionally involves very young calves being transported directly from dairy farms to calf-raising facilities or sold through auction markets from dairy farms. There are few studies that examine the relationship between transfer of passive immunity and health outcomes in veal production in Québec. The objective of this study was to investigate the risk factors associated with morbidity and mortality in milk and grain-fed veal facilities in Québec. Between October 2017 and December 2018, a prospective cohort study was conducted on 59 batches of milk- and grain-fed veal calves from Montérégie and Centre du Québec regions in Québec, Canada. A total of 30 calves per batch were randomly sampled for the transfer of passive immunity (TPI) status using the Brix refractometer (serum threshold ≥ 8.4%). Throughout the production cycle, arrival, treatment, mortality, and slaughter records of each batch of calves were extracted and used to quantify individual- and group-level risk factors. Morbidity and mortality were modelled through generalized linear mixed models (GLMMs) using a logit link, as function of categorical variables (individual inadequate TPI, arrival season, purchasing sites, and arrival weights) and a continuous variable (proportion of inadequate TPI in the batch). Given that the health and performance data are usually collected retrospectively under commercial settings, incomplete data was recognized as a potential issue. Thus, multiple imputation models were used. From 59 batches where 1729 calves were sampled for measuring TPI, 1084 calves had a serum Brix% < 8.4% giving a prevalence of 62.7% of inadequate TPI. The prevalence of morbidity and mortality in those 59 batches were not associated with the batch-level inadequate TPI prevalence. On the other hand, individual calves with inadequate TPI had higher odds of morbidity (OR: 1.56; 95% CI: 1.2-2.05, P = 0.001) compared to those calves with adequate TPI. Odds of mortality, on the other hand, were not significantly affected by inadequate TPI (OR:1.27; 95% CI: 0.74-2.18, P = 0.3). Calves arriving to the facility during the winter season had lower odds of mortality than those arriving in fall (OR:0.16; 95% CI: 0.03-0.78, P = 0.02). In conclusion, this study suggests that inadequate TPI, as assessed upon arrival in veal farms, remains an important concern for negative health outcomes in veal calves., Competing Interests: Declaration of Competing Interest Authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)