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Objectives: This population-based observational study explores the associations between individual-level and neighbourhood-level indices of active living with inpatient mental healthcare use among adults with an underlying chronic cardiometabolic condition., Design and Setting: Data from the 2013-2014 Canadian Community Health Survey were linked longitudinally to hospital records from the 2013/2014‒2017/2018 Discharge Abstract Database and to a geocoded measure of active living environments (ALE). Relationships between individuals' leisure-time physical activity and neighbourhood ALE with risk of hospital admission for mental health disorders were assessed using multivariable Cox regressions., Participants: A national cohort was identified from the survey data of 24 960 respondents aged 35 years and above reporting having been diagnosed with diabetes, hypertension and/or heart disease., Outcome Measure: Potentially avoidable hospitalisation for a mood, anxiety or substance use disorder over a 5-year period., Results: More than half (52%) of adults aged 35 years and above with a cardiometabolic disease were physically inactive in their daily lives, and one-third (34%) resided in the least activity-friendly neighbourhoods. The rate of being hospitalised at least once for a comorbid mental disorder averaged 8.1 (95% CI: 7.0 to 9.3) per 1000 person-years of exposure. Individuals who were at least moderately active were half as likely to be hospitalised for a comorbid mental health problem compared with those who were inactive (HR: 0.50 (95% CI: 0.38 to 0.65)). No statistically discernible associations between neighbourhood ALE and hospitalisation risks were found after controlling for individuals' behaviours and characteristics, including in separate models stratified by age group and by sex., Conclusions: The evidence base to support prioritisation of interventions focusing on the built environment favouring mental health-promoting physical activity among higher-risk adults at the population level, independently of individual-level behaviours and characteristics, remains limited., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Most socio-epidemiological studies on diabetes incidence, prevalence, or hospitalization focus on individual-level risk factors. This population-based cohort study sought to advance understanding on the associations of contextual characteristics and risk of diabetes-related avoidable hospitalization (DRAH) among at-risk Canadians., Data and Methods: A national cohort was compiled from the 2013/2014 Canadian Community Health Survey, representing 5.1 million adults aged 35 years and older, reporting having been diagnosed with diabetes, hypertension, or heart disease. Their information was linked longitudinally to hospitalization data from the 2013/14 to 2017/18 Discharge Abstract Database as well as to measures of geographic variability from the Material and Social Deprivation Index and the Index of Remoteness. Cox regression models were used to examine associations between the contextual indices and first occurrence of a DRAH., Results: Residents in the most rural and remote communities were 50% more likely (hazard ratio (HR): 1.51, 95% confidence interval (95% CI): 1.26 to 1.80) to experience a DRAH than those in the most urbanized and accessible communities, and residents in the most socially deprived areas were significantly more likely (HR: 1.44, 95% CI: 1.26 to 1.65) to be hospitalized than those in the most socially privileged areas, controlling for individuals' sociodemographic characteristics and health behaviours. Neighbourhood material deprivation did not exercise a statistically significant influence on hospitalization risk after adjusting for the other residential characteristics., Interpretation: There is a clear and significant gradient in diabetes-related hospitalization risk among Canadians with an underlying cardiometabolic condition by degree of residential remoteness and of neighbourhood social deprivation, independently of individual characteristics and despite Canada's universal healthcare system.

Energy projects may profoundly impact Indigenous peoples. We consider effects of Canada's proposed Trans Mountain oil pipeline expansion on the health and food sovereignty of the Tsleil-Waututh Nation (TWN) through contamination and impeded access to uncontaminated traditional foods. Federal monitoring and TWN documentation show elevated shellfish biotoxin levels in TWN's traditional territory near the terminus where crude oil is piped. Although TWN restoration work has re-opened some shellfish-harvesting sites, pipeline expansion stands to increase health risk directly through rising bioaccumulating chemical toxins as well as through increased hazardous biotoxins. Climate change from increased fossil fuel use, expected via pipeline expansion, also threatens to increase algae blooms through higher temperature and nutrient loading. As the environmental impact assessment process failed to effectively consider these local health concerns in addition to larger impacts of climate change, new assessment is needed attending to linked issues of equity, sustainability and Indigenous food sovereignty.

Background: It is hypothesised that complex interactions between genetic and environmental factors give rise to allergy and asthma in childhood. The Canadian Healthy Infant Longitudinal Development (CHILD) study was designed to explore these factors., Methods: CHILD is a longitudinal, general population birth cohort study following infants from mid-pregnancy to age 5 years. Over this time period, biological samples, questionnaires, clinical measures and environmental data are collected., Results: A total of 3624 families have been recruited, and many thousands of samples and questionnaires have been collected, annotated, and archived. This report outlines the rationale and methodology for collecting and storing diverse biological samples from parents and children in this study, and the mechanisms for their release for analyses., Conclusions: The CHILD sample and data repository is a tremendous current and future resource and will provide a wealth of information not only informing studies of asthma and allergy, but also potentially in many other aspects of health relevant for Canadian infants and children., (© 2014 John Wiley & Sons Ltd.)

Objective: To review the risk factors, management, and prevention of recreational water-related illness in family practice., Sources of Information: Original and review articles from January 1998 to February 2012 were identified using PubMed and the search terms water-related illness, recreational water illness, and swimmer illness., Main Message: There is a 3% to 8% risk of acute gastrointestinal illness (AGI) after swimming. The high-risk groups for AGI are children younger than 5 years, especially if they have not been vaccinated for rotavirus, and elderly and immunocompromised patients. Children are at higher risk because they swallow more water when swimming, stay in the water longer, and play in the shallow water and sand, which are more contaminated. Participants in sports with a lot of water contact like triathlon and kite surfing are also at high risk, and even activities involving partial water contact like boating and fishing carry a 40% to 50% increase in risk of AGI compared with nonwater recreational activities. Stool cultures should be done when a recreational water illness is suspected, and the clinical dehydration scale is a useful clinical tool for assessing the treatment needs of affected children., Conclusion: Recreational water illness is the main attributable cause of AGI during swimming season. Recognition that swimming is a substantial source of illness can help prevent recurrent and secondary cases. Rotavirus vaccine is highly recommended for children who will swim frequently.