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Background: In Canada, nearly nine pregnancies end in stillbirth daily. Most of these families will go on to have subsequent pregnancies, but research into how best to care for these parents is lacking. This study explores the lived experiences and the most important aspects of person-centred care for Canadian families experiencing a pregnancy after a stillbirth., Methods: This qualitative descriptive design used secondary data collected from an online, international survey for bereaved parents who reported having experienced a pregnancy subsequent to a stillbirth. Only parents who identified as Canadian were included in this study. Three open text questions were asked about parents' experiences in their subsequent pregnancy. An inductive thematic analysis approach was used with open coding and a constant comparative method., Results: Families' responses fell into six main themes that identified what they would have preferred for high quality, excellent care. These included: (1) recognizing anxiety throughout the subsequent pregnancy, (2) wanting one's voices and concerns to be heard and taken seriously, (3) needing additional and specific clinical care for reassurance, (4) desiring kindness and empathy from caregivers and others, (5) seeking support from others who had also experienced pregnancy after stillbirth; and (6) addressing mixed emotions including guilt, continuity of care and carer, positive thoughts versus more realistic ones, and poignant feelings of self-blame., Conclusions: Participants' responses identified that pregnancy after stillbirth is an extremely stressful time requiring patient-oriented care and support, both physically and psychologically. Families were able to articulate specific areas that would have improved the experience of their subsequent pregnancy. Parents asked for high-quality clinical and psychosocial prenatal care that was specific to them having experienced a prior stillbirth. They also requested connections to others experiencing this similar scenario. Further research is needed to delineate what supports and resources would be needed to ensure this care would be available to all families experiencing pregnancy after stillbirth across Canada and their caregivers., (© 2023. The Author(s).)

Numerous environmental justice studies have confirmed a relationship between population characteristics such as low-income or minority status and the location of environmental health hazards. However, studies of the health risks from exposure to harmful substances often do not consider their toxicological characteristics. We used two different methods, the unit-hazard and the distance-based approach, to evaluate demographic and socio-economic characteristics of the population residing near industrial facilities in the City of Toronto, Canada. In addition to the mass of air emissions obtained from the national pollutant release inventory (NPRI), we also considered their toxicity using toxic equivalency potential (TEP) scores. Results from the unit-hazard approach indicate no significant difference in the proportion of low-income individuals living in host versus non-host census tracts (t(107) = 0.3, P = 0.735). However, using the distance-based approach, the proportion of low-income individuals was significantly higher (+5.1%, t(522) = 6.0, P <0.001) in host tracts, while the indicator for "racialized" communities ("visible minority") was 16.1% greater (t(521) = 7.2, P <0.001) within 2 km of a NPRI facility. When the most toxic facilities by non-carcinogenic TEP score were selected, the rate of visible minorities living near the most toxic NPRI facilities was significantly higher (+12.9%, t(352) = 3.5, P = 0.001) than near all other NPRI facilities. TEP scores were also used to identify areas in Toronto that face a double burden of poverty and air toxics exposure in order to prioritise pollution prevention.

In Canada, the Canadian Council of Ministers for the Environment (CCME) is currently engaged in a process to determine how best to reduce air emissions from oil refineries. The National Framework for Petroleum Refineries Emissions Reduction (NFPRER) is being developed with the input of stakeholders, including nongovernment organizations (NGOs), industry, and regulatory jurisdictions. One component of this framework is the development of a tool to prioritize emissions for reduction based on estimated health impacts. HEIDI II (Health Effects Indicators Decision Index II) is a spreadsheet-based model that prioritizes a series of carcinogenic and noncarcinogenic air toxicicants and criteria air contaminants commonly emitted from Canadian oil refineries. A generic meteorological dispersion model was applied to reported annual emissions data for each of Canada's 20 refineries. Photodegradation rates and ambient levels of each substance were accounted for, and air concentrations were calculated for 20 geographic zones around each refinery. These were coupled to toxicity data derived mainly from Health Canada and the U.S. Environmental Protection Agency (EPA), and applied to target populations of children, adults and seniors. HEIDI II predicts incidence of relevant disease endpoints from each substance emitted, except for benzene, toluene, ethylbenzene, and xylene (BTEX) and polycyclic aromatic hydrocarbons (PAH), which were treated as chemical mixtures. Rankings were based on predicted case incidence or the application of a common health impact metric, disability-adjusted life years (DALYs), to the predicted incidence. Using the DALY approach, priority rankings can be made within each of the chemical classes, or across all three classes together. HEIDI II incorporates several switches that allow the user to investigate alternate scenarios based on stack height, average daily sunlight hours (for calculating photodegradation), and the possibility of emissions below regulatory reporting thresholds.