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The COVID-19 pandemic brought about changes to the lives of families with young children. It has been associated with physical and psychological risk, yet the impact on younger children is poorly examined. The aim of this qualitative study was to examine how the COVID-19 pandemic impacted the day-to-day life of parents of young children living in a small northern city in British Columbia, Canada. Ten mothers with children aged 0-5 years participated in a six-week longitudinal study between November 2020 and March 2021. This article presents data from entry and exit interviews that were analysed using Todorov's narrative theory. Three key themes were identified: (1) gaps in health services; (2) gaps in early childhood education and programs; and (3) changes to/lost social interactions. Limited opportunities to engage with providers caused frustration and left parents feeling disempowered or dissatisfied. Family support and well-being were negatively impacted by a loss in social connectivity. Despite unpredictability and worries about child development, most of the mothers found ways to cherish the time to 'stop and refocus'. Overall, the families evidenced resilience, despite a loss in relational habits.

Background: Transition from residency to unsupervised practice represents a critical stage in learning and professional identity formation, yet there is a paucity of literature to inform residency curricula and emergency department transition programming for new faculty., Objective: The objective of this study was to develop consensus-based recommendations to optimize the transition to practice phase of emergency medicine training., Methods: A literature review and results of a survey of emergency medicine (EM) residency program directors informed focus groups of recent (within 5 years) EM graduates. Focus group transcripts were analyzed following conventional content analysis. Preliminary recommendations, based on identified themes, were drafted and presented at the 2022 Canadian Association of Emergency Physicians (CAEP) Academic Symposium on Education. Through a live presentation, symposium attendees representing the Canadian national EM community participated in a facilitated discussion of the recommendations. The authors incorporated this feedback to construct a final set of 14 recommendations, 8 targeted toward residency training programs and 6 specific to department leadership., Conclusion: The Canadian EM community used a structured process to develop 14 best practice recommendations to enhance the transition to practice phase of residency training as well as the transition period in the career of junior attending physicians., (© 2023. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)

Background: Modern health surveillance and planning requires an understanding of how preventable risk factors impact population health, and how these effects vary between populations. In this study, we compare how smoking, alcohol consumption, diet and physical activity are associated with all-cause mortality in Canada and the United States using comparable individual-level, linked population health survey data and identical model specifications., Methods: The Canadian Community Health Survey (CCHS) (2003-2007) and the United States National Health Interview Survey (NHIS) (2000, 2005) linked to individual-level mortality outcomes with follow up to December 31, 2011 were used. Consistent variable definitions were used to estimate country-specific mortality hazard ratios with sex-specific Cox proportional hazard models, including smoking, alcohol, diet and physical activity, sociodemographic indicators and proximal factors including disease history., Results: A total of 296,407 respondents and 1,813,884 million person-years of follow-up from the CCHS and 58,232 respondents and 497,909 person-years from the NHIS were included. Absolute mortality risk among those with a 'healthy profile' was higher in the United States compared to Canada, especially among women. Adjusted mortality hazard ratios associated with health behaviours were generally of similar magnitude and direction but often stronger in Canada., Conclusion: Even when methodological and population differences are minimal, the association of health behaviours and mortality can vary across populations. It is therefore important to be cautious of between-study variation when aggregating relative effect estimates from differing populations, and when using external effect estimates for population health research and policy development., (© 2022. The Author(s).)

Background: National health surveys linked to vital statistics and health care information provide a growing source of individual-level population health data. Pooling linked surveys across jurisdictions would create comprehensive datasets that are larger than most existing cohort studies, and that have a unique international and population perspective. This paper's objectives are to examine the feasibility of pooling linked population health surveys from three countries, facilitate the examination of health behaviours, and present useful information to assist in the planning of international population health surveillance and research studies., Data and Methods: The design, methodologies and content of the Canadian Community Health Survey (2003 to 2008), the United States National Health Interview Survey (2000, 2005) and the Scottish Health Survey (SHeS) (2003, 2008 to 2010) were examined for comparability and consistency. The feasibility of creating common variables for measuring smoking, alcohol consumption, physical activity and diet was assessed. Sample size and estimated mortality events were collected., Results: The surveys have comparable purposes, designs, sampling and administration methodologies, target populations, exclusions, and content. Similar health behaviour questions allow for comparable variables to be created across the surveys. However, the SHeS uses a more detailed risk factor evaluation for alcohol consumption and diet data. Therefore, comparisons of alcohol consumption and diet data between the SHeS and the other two surveys should be performed with caution. Pooling these linked surveys would create a dataset with over 350,000 participants, 28,424 deaths and over 2.4 million person-years of follow-up., Discussion: Pooling linked national population health surveys could improve population health research and surveillance. Innovative methodologies must be used to account for survey dissimilarities, and further discussion is needed on how to best access and analyze data across jurisdictions.

Background: In Canada levels of smoking have decreased and levels of physical activity have increased over the last 20 years. However, little research has examined if educational inequalities in either of these important health determinants have changed., Methods: A secondary analysis of Canadian population-based surveys from 1974 through to 2005 was conducted. The prevalence of both smoking and physical activity across educational groups for both men and women, as well as relative and absolute measures of inequality was estimated., Results: Differences in both smoking and physical activity across educational groups in all surveys examined between 1974 and 2005 were found, with lower educational groups more likely to be heavy smokers and inactive in each survey. Both relative and absolute educational inequalities in smoking widened between 1974 and 2005 (relative concentration index (RCI) for smoking 10 plus cigarettes per day changed from -7.9 to -26.9 among men; and from -4.8 to -27.4 among women), with inequalities in physical activity narrowing between 1981 and 1996, then widening between 1996 and 2005 (RCI for inactivity -4.34 to -6.75 among men; -3.57 to -5.54 among women). In general, results among men and women did not differ substantially., Conclusions: It is unlikely that the widening educational inequalities in smoking and physical activity documented here reflect lower knowledge of the consequences of smoking and physical inactivity among lower educated groups. The results suggest more work needs to be done in both designing population health approaches that focus on equity and the creation of supportive environments that provide equal opportunities for behaviour change for all educational groups in Canada.

Objective: To examine the effect of changes in job control on health behaviors, psychological distress and health status., Methods: Using a path analysis model, we examined the effects of change in job control over a 4-year period on levels of physical activity, smoking, and psychological distress; and on self-rated health over an additional 2 years, among a representative sample of 2221 Canadians., Results: Over the 4-year period, 280 respondents reported decreases in job control, and 256 reported increases in job control. Health at baseline was not associated with the likelihood of changes in job control. We found a graded relationship between change in job control and levels of physical activity and psychological distress over a 4-year period; and levels of self-rated health over a 6-year period, with positive change in job control associated in higher levels of physical activity and self-rated health and lower levels of distress., Conclusions: The results of this study suggest that both level of job control and changes in job control have direct and indirect effects on health status over time. Future research should focus on developing precise measures of work exposures, and examine differences between changes in job control due to only changes in perceptions and changes due to work redesign.

This paper outlines the history and rationale of the six National Collaborating Centres for Public Health program, established by the Public Health Agency of Canada in 2004. The Centres are not focused on primary research, but rather on synthesizing the global scientific evidence relevant to public health policies, programs and practices--and its translation into useful "knowledge products" for public health professionals, policy-makers and community groups to inform public health decision-making. The broad principles of knowledge synthesis and translation/exchange (KSTE) for public health applications are reviewed, as are recent publications and websites describing international projects in this burgeoning field. Finally, some best practices for public-health-oriented KSTE derived from experiences in Canada and elsewhere are described.

This discussion paper is intended to start a dialogue about prevention among those who are interested in making workplaces safer and healthier. The following four key themes are presented to build a framework for further discussion and activity: theme 1 -- with multiple causes for workplace injury, illness, and disability, preventing these problems requires multiple solutions, operating in synergy; theme 2 -- efforts to reduce workplace injury, illness, and disability must build on both primary and secondary prevention approaches, merging these to create a more effective strategy; theme 3 -- before which strategies work and which do not can be agreed upon, a shared understanding is needed of how the effectiveness of occupational health interventions should be evaluated; and theme 4 -- building relationships between those who do research and those who use research knowledge is important if relevant research is to be produced that is readily taken up and applied to improve occupational health and safety.

This article reviews the historical development of population health indicators. We have long known that environmental, socioeconomic, early life conditions, individual actions, and medical care all interact to affect health. Present quantitative reporting on the impact of these factors on population health grew out of Bills of Mortality published in the 1500s. Since then, regular censuses, civil registration of vital statistics, and international classification systems have improved data quality and comparability. Regular national health interview surveys and application of administrative data contributed information on morbidity, health services use, and some social determinants of health. More recently, traditional health databases and datasets on "nonhealth" sector determinants have been linked. Statistical methods for map-making, risk adjustment, multilevel analysis, calculating population-attributable risks, and summary measures of population health have further helped to integrate information. Reports on the health of populations remain largely confined to focused areas. This paper suggests a conceptual framework for using indicators to report on all the domains of population health. Future ethical development of indicators will incorporate principles of justice, transparency, and effectiveness.

The Global Health Research Initiative (GHRI) involving the Canadian International Development Agency, the Canadian Institutes of Health Research, Health Canada and the International Development Research Centre seeks to coordinate Canada's research response to global health challenges. In light of numerous calls to action both nationally and internationally, an orientation to applied health policy and systems research, and to public health research and its application is required to redress global inequalities in wealth and health and to tackle well-documented constraints to achieving the United Nations Millennium Development Goals. Over the last four years, the GHRI has funded close to 70 research program development and pilot projects. However, longer-term investment is needed. The proposed dollars 100 million Teasdale-Corti Global Health Research Partnership Program is such a response, and is intended to support teams of researchers and research users to develop, test and implement innovative approaches to strengthening institutional capacity, especially in low- and middle-income countries; to generating knowledge and its effective application to improve the health of populations, especially those most vulnerable; and to strengthen health systems in those countries. While Canada stands poised to act, concerted leadership and resources are still required to support "research that matters" for health and development in low- and middle-income countries.

Background: To examine the association of a mismatch between educational qualifications and occupational attainment and subsequent declines in self-rated health (SRH) in a longitudinal nationally representative Canadian population sample., Methods: This study used longitudinal data from 4045 healthy, working respondents of the Canadian National Population Health Survey. Respondents were categorized as either qualified, overqualified, or underqualified based on the match between their education and the skills required for their current occupation over a 2-year period. Logistic regression analysis estimated the odds of decline in SRH over the following 4-year period, using the match between occupation and education as the main independent variable. Analyses were controlled for a number of confounding variables including health behaviours, mental health, self-esteem, job control, and demographic information., Results: Relative to respondents with university education working in occupations for which they were qualified, respondents with university education, working in occupations for which they were overqualified had a significant risk of decline in SRH between 1996 and 2000, even after adjusting for a number of potential confounders (OR = 2.08, 95% CI 1.11-3.91). In respondents with secondary education or less, differences in occupational attainment were not associated with differences in the odds of decline in SRH., Conclusions: The effect of occupational attainment on health is important for individuals who have invested the most time in their education. Conversely, differential occupational attainment is not associated with differences in the odds of decline in health for participants with lower levels of education.

In this brief primer on prevention, the authors raise some of the scientific, social, behavioural, political and practical issues that must be addressed to integrate effective preventive initiatives into our health system (which includes public health practice). They begin by reviewing the contributions science has and has not made to inform our prevention efforts. The authors further examine what it is we know about changing human behaviour in health-promoting ways. The article closes with a review of the practical challenges for prevention-oriented policies and programs in the health system and in society as a whole. The authors call for increased emphasis on strategies that encourage the creation of supportive environments. Moreover, they identify that we need to try for fewer, but better-thought-out and more sustained, multi-level health promotion and disease prevention interventions. Community-led interventions that identify, address and change local cultural norms that contribute to these health concerns are especially key. Finally, the authors identify the need for rigorous evaluation to ensure that all effects, good and bad, of preventive interventions are fully captured and addressed.

Despite the publication in the mid-1990s of comprehensive practice guidelines for the management of acute low-back pain, both in the United States and elsewhere, this ubiquitous health problem continues to be the main cause of workers' compensation claims in much of the Western world. This paper represents a synthesis of the intervention studies published in the last 4 years and is based on a new approach to categorizing these studies that emphasizes the stage or phase of back pain at the time of intervention and the site or agent of the intervention. Current thinking suggests that medical management in the first 3-4 weeks after the onset of pain should be generally conservative. Several studies of rather heterogeneous interventions focusing on return to work and implemented in the subacute stage (3-4 to 12 weeks after the onset of pain) have shown important reductions in time lost from work (by 30% to 50%). There is substantial evidence indicating that employers who promptly offer appropriately modified duties can reduce time lost per episode of back pain by at least 30%, with frequent spin-off effects on the incidence of new back-pain claims as well. Finally, newer studies of guidelines-based approaches to back pain in the workplace suggest that a combination of all these approaches, in a coordinated workplace-linked care system, can achieve a reduction of 50% in time lost due to back pain, at no extra cost and, in some settings, with significant savings.