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BACKGROUND: Health promotion and disease prevention have been increasingly recognized as activities that may be within the scope of emergency medicine. The purpose of this feasibility study was to identify health risks and offer immediate interventions to adult patients who have drug and/or alcohol problems, incomplete immunization, are overdue for a Pap (Papanicolaou) smear, and/or are smokers. METHODS: The study took place in a busy tertiary Emergency Department (ED) serving an inner-city population with a significant proportion of patients who are homeless, substance abusers, working poor, and/or recent immigrants. A convenience sample of patients completed a computer-based health-risk survey. Trained health promotion nurses offered appropriate interventions to patients following review and discussion of their self-reported data. Interventions included counseling for problem drinking, substance abuse, and smoking cessation, screening for cervical cancer, and immunization. RESULTS: From October 20, 2000 to June 30, 2003, we enrolled 2366 patients. One thousand and eleven subjects (43%) reported substance abuse and 1095 (46%) were smokers. Of the 158 smokers contacted in follow-up, 19 (12%) had quit, 63 (40%) had reduced the number of cigarettes/day and 76 (48%) reported no change. Of 1248 women surveyed, 307 (25%) were overdue for a Pap smear and 54 (18%) received this intervention. Forty-four percent of subjects were overdue for at least one immunization and of those, 414 (40%) were immunized in the ED. CONCLUSION: At-risk patients can be identified using a computer-based screening tool, and appropriate interventions can be given to a proportion of these patients in a busy inner city ED without increasing wait time. [ABSTRACT FROM AUTHOR]

This article explores the increasing impact of natural disasters on healthcare leadership and disaster preparedness, particularly in Fort McMurray, Alberta. It underscores the importance of building disaster resilience in healthcare, distinguishing between emergencies, disasters, and catastrophes, and advocating for a multi-dimensional resilience approach. The need for robust electronic communication channels and comprehensive family-oriented evacuation plans, considering family and pet safety, is emphasized. The protection of vulnerable patients, the importance of resilient healthcare infrastructure, and dedicated protective equipment for first responders are also discussed. The article highlights the critical role of government support in flood prevention and disaster preparedness. Through the experiences of Fort McMurray, the article demonstrates the necessity of comprehensive disaster planning and the crucial role of healthcare systems in rapid recovery and adaptation in the face of disasters. It aims to contribute to an improved understanding and strategies for managing such critical situations in the future., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: During the period of time referenced in the article, I was employed by the Government of Alberta.

Homelessness continues to be a pervasive public health problem throughout Canada. Hospital Emergency Departments (EDs) and inpatient wards have become a source of temporary care and shelter for homeless patients. Upon leaving the hospital, homeless patients are not more equipped than before to find permanent housing. The Bridge Healing program in Edmonton, Alberta, has emerged as a novel approach to addressing homelessness by providing transitional housing for those relying on repeated visits to the ED. This paper describes the three essential components to the Bridge Healing model: partnership between the ED and a Housing First community organization; facility design based on The Eden Alternative™ principles; and grassroots community funding. This paper, in conjunction with the current pilot project of the Bridge Healing facilities, serves as a proof of concept for the model and can inform transitional housing approaches in other communities.

Emerging evidence shows that homelessness continues to be a chronic public health problem throughout Canada. The Bridge Healing Program has been proposed in Edmonton, Alberta, as a novel approach to combat homelessness by using hospital emergency departments (ED) as a gateway to temporary housing. Building on the ideas of Tiny Villages, the Bridge Healing Program provides residents with immediate temporary housing before transitioning them to permanent homes. This paper aims to understand effective strategies that underlie the Tiny Villages concept by analyzing six case studies and applying the lessons learned to improving the Bridge Healing Program. After looking at six Tiny Villages, we identified four common elements of many successful Tiny Villages. These include a strong community, public support, funding with few restrictions, and affordable housing options post-graduation. The Bridge Healing Program emphasizes such key elements by having a strong team, numerous services, and connections to permanent housing. Furthermore, the Bridge Healing Program is unique in its ability to reduce repeat ED visits, lengths of stay in the ED, and healthcare costs. Overall, the Bridge Healing Program exhibits many traits associated with successful Tiny Villages and has the potential to address a gap in our current healthcare system.

Background: Public health advocacy is central to the work of many health professionals, including nurses. Although deemed to be a core competency for public health practitioners, courses described in the literature often lack a focus on experiential learning, which is an essential component to acquiring public health advocacy skills., Method: This article describes an innovative, 12-week graduate course that provides students with a combination of theory and experiential learning through an opportunity to engage in political advocacy, community mobilization, and media engagement on a current public health issue., Results: An advocacy campaign undertaken by students to increase community access to the overdose reversal medication naloxone is described in light of the current North American overdose epidemic. Key considerations for teaching public health advocacy to facilitate development of nursing courses elsewhere are highlighted., Conclusion: Public health advocacy education is important and needs to be expanded both within the nursing profession and across all disciplines. [J Nurs Educ. 2019;58(12):698-703.]., (Copyright 2019, SLACK Incorporated.)

In March 2014, medical educators from Canada and Oman collaborated to shape the foundation of health advocacy training in Oman. Using existing research and innovative tools, two workshops were developed, representing the first formalised approach to health advocacy for medical trainees in Oman. The development and application of the workshops highlighted many unique challenges and opportunities in advocacy training. This article summarises the process of developing and implementing the workshops as well as feedback from the participants and short-term consequences. Furthermore, this article seeks to explore the complexities of designing a cross-cultural curriculum. In particular, it reflects on how the role of health advocate may be perceived differently in various cultural and societal settings. Understanding and adapting to these influences is paramount to creating a successful health advocacy curriculum that is relevant to learners and responsive to the communities in which they work., Competing Interests: CONFLICTS OF INTEREST Dr Jessica Breton declares no conflicts of interest. Dr Louis H. Francescutti received an honorarium from the OMSB to develop and teach the advocacy workshops described in this article and to cover travel and accommodation expenses. Dr Yousef Al-Weshahi was working as a part-time visiting faculty member for the OMSB and also received an honorarium for leading the workshops.

Competing Interests: Competing interests: James Downar reports personal fees from Joule, Inc. (a subsidiary of the Canadian Medical Association), outside the submitted work. He is a current member and former co-Chair of the Physicians Advisory Committee for Dying with Dignity Canada, a not-for-profit organization that advocates for legalization and access to medical assistance in dying in Canada.

Natural disasters are on the increase. How healthcare systems respond to their communities' need for medical attention after such events will be very challenging. The situation is even more complicated when such facilities are forced to unexpectedly close and evacuate because they are in harm's way. There are important lessons to be learned from these events, yet people are slow to share what they experienced.

To pursue research, education, and health policy in one's career, broadly defined as academic medicine, is one of the most important decisions of a trainee doctor's career. Despite this, there is scant literature on which factors influence trainees' choices towards clinical work or academic research. As the MD/PhD is a relatively young training path compared to the traditional PhD (Doctor of Philosophy) and MD (Doctor of Medicine) programs, it prompts the question: at the crossroads of a career, what sways the individual to select an MD, PhD, or MD/PhD program? This is a valuable question to be answered for trainees who are considering multiple career paths, for educators who want to guide undifferentiated students, and for policy makers who develop and coordinate research programs. "Intellectual stimulation" is the most consistently identified personal value which draws trainees to academic medicine. Mentorship is linked strongly to success in the field. Conversely, long training periods, a lack of autonomy, and financial considerations are deterrents from a career in academic medicine. Insight into the decision-making process is provided by recent Canadian trainees in these respective fields, in a series of short interviews., Competing Interests: Competing interests: No competing interests were disclosed.

Over 2 decades ago, the United States National Academy of Sciences described injuries as "the most under-recognized major public health problem facing the nation." Our progress since then has been limited. Injuries still account for nearly 1 out of every 10 deaths in the world, and the global burden of injury is projected to increase over the next decade, predominately in low- and middle-income countries. Despite this, injury prevention receives scant attention from legislators, the education system, and, most strikingly, the health care system. The lifestyle medicine community, however, is beginning to focus on injury prevention and will play an increasing role in helping control the burden of injury. Lifestyle medicine practitioners are in a tremendous position to promote injury prevention. Physical activity and positive lifestyle changes can be accompanied with an increased focus on preventing injury. Lifestyle medicine can prevent injuries by supporting legislation, advancing medical advocacy, providing community education, and linking clinical care with injury prevention.

The Canadian Medical Association (CMA) is the representative body for the physicians of Canada. Over the past year, the association has been devoting significant time and resources to considering the important issues involved in care at the end of life. It has conducted a series of public town hall meetings across the country to allow Canadians to express their view on these issues, the only organization to have done so. The CMA will be appearing before the Supreme Court in the Carter case in October 2014 as a "friend of the court" and will continue to represent the views of the medical profession in these complex and difficult areas.

Distracted driving caused by cellphone use is a significant source of needless injuries. These injuries place unnecessary financial burden, emotional stress and health care resource misuse on society. This paper states the Canadian Association of Emergency Physician's (CAEP's) position on cellphone use while driving. In recent years, numerous studies were conducted on the danger of cellphone use while driving. Research has shown that cellphone use while driving negatively impacts cognitive functions, visual fields, reaction time and overall driving performances. Some studies found that cellphone use is as dangerous as driving under the influence of alcohol. Moreover, vehicle crash rates were shown to be significantly higher when drivers used cellphones. Countermeasures have been implemented in recent years. Over 50 countries worldwide have laws limiting the use of cellphones while driving. Six Canadian provinces, Newfoundland and Labrador, Nova Scotia, Quebec, Ontario, British Columbia and Saskatchewan, currently have legislation prohibiting cellphone use. Other provinces are considering implementing similar bans. As emergency physicians, we must advocate for injury prevention. Cell phone related road traumas are avoidable. CAEP supports all measures to ban cellphone use while driving.

The intensity of physician workload has been increasing with the well-documented changes in the financing, organization and delivery of care. It is possible that these stressors have reached a point where they pose a serious policy issue for the entire healthcare system through their diminution of physician's ability to effectively interact with patients as they are burned out, stressed and dissatisfied. This policy question is framed in a conceptual model linking workloads with five key outcomes (patient care quality, individual performance, absenteeism, turnover and organizational performance) mediated by physician stress and satisfaction. This model showed a good fit to the data in a structural equation analysis. Ten of the 12 hypothesized pathways between variables were significant and supported the mediating role of stress and satisfaction. These results suggest that workloads, stress and satisfaction have significant and material impacts on patient care quality, individual performance, absenteeism, turnover and organizational performance. Implications of these results and directions for future research are discussed.

Purpose: The purpose of this paper is to explore the impact of hospital emergency department culture on the job satisfaction, patient commitment, and extra-role performance of Canadian emergency physicians. The conceptual model related four cultural archetypes from the competing valued model to the three outcome variables., Design/methodology/approach: In total, 428 Canadian emergency physicians responded to a national survey. The conceptual model was tested via structural equation modeling via LISREL 8., Findings: Culture had a relatively weak impact on the outcomes. Human resources culture related positively to job satisfaction while bureaucratic culture related positively to patient commitment. Patient commitment, but not job satisfaction strongly and positively related to extra-role behavior. A direct relationship between entrepreneurial culture and extra-role behavior emerged from an extended analysis., Practical Implications: Organizational culture seems to have more distal relationships with outcome variables and its influence is likely to be mediated by more proximal workplace variables., Originality/value: Of value by showing that a key modern leadership challenge is to create the kind of work culture that can become a source of competitive advantage through generating particular organizational outcomes valued by stakeholders.

Purpose: The purpose of this paper is to report on gender differences in emergency physicians with respect to their attitudes, knowledge, and practices concerning health promotion and disease prevention., Design/methodology/approach: A mail survey of 325 male and 97 female Canadian emergency physicians., Findings: Results suggest female emergency physicians report having greater knowledge of health promotion topics, spend more time with each of their patients in the emergency setting, and engage in more health promotion counseling in the emergency setting than do their male counterparts., Originality/value: The paper argues that in the future, educating and socializing emergency physicians, both male and female, in the practice of health promotion will enhance the potential of the emergency department to be a more effective resource for their community.

Emergency departments in most developed countries have been experiencing significant overcrowding under a regime of severe resource constraints. Physicians in emergency departments increasingly find themselves toiling in workplaces that are characterized by diminished availability of, limited access to, and decreased stability of critical resources. Severe resource constraints have the potential to greatly weaken the overall job satisfaction of emergency physicians. This article examines the impact of hospital resource constraints on the job satisfaction of a large sample of emergency physicians in Canada. After controlling for workflow and patient characteristics and for various institutional and physician characteristics, institutional resource constraints are found to be major contributors to emergency physician job dissatisfaction. Resource factors that have the greatest impact on job satisfaction include availability of emergency room physicians, access to hospital technology and emergency beds, and stability of financial (investment) resources.

Introduction: Women's ice hockey is a rapidly growing sport, however little is known about the injuries sustained by this group of athletes., Purpose: The objective of this research was to identify risk factors associated with injury among female recreational ice hockey players., Methods: This prospective study followed players from two women's ice hockey leagues in Edmonton, Canada during the 1997-98 hockey season. The occurrence of injuries was monitored during the season through standardized telephone follow-up. Risk factors were determined using multiple logistic regression., Results: The initial study sample consisted of 314 players, however as the season progressed 19 (6%) were lost to follow-up. The results of the study are based on 295 (94%) participants. A total of 125 injuries were reported; the injury rate was 7.5 injuries/1,000 player-exposures. Risk factors found to be significantly related to the occurrence of injury were: injury in the past year (OR= 1.57), more than 5 years of hockey experience (OR=1.49), and high exposure level (OR=1.41)., Conclusion: This research is the first to quantify personal risk factors associated with injury among female recreational ice hockey players. A sports injury in the previous 12 months appears to be highly associated with injury and further research is required to more fully understand this relationship. The importance of controlling for level of exposure when investigating risk factors for sports injury was demonstrated.

A road construction 'flagger' is a construction crew member whose responsibility it is to safely co-ordinate vehicle traffic through road worksites. Flaggers are suffering injuries and fatalities at the worksite as a result of being struck by moving vehicles, both construction and commuter. These incidents are largely preventable with a more defensive flagger training programme. A cross-Canada provincial survey of occupational health and safety organizations revealed no national co-ordination and standardization in flagperson training. Statistics concerning flagger injury and fatality are disjointed and incomplete, and as such are not useful for evaluating and validating training and job performance. We recommend a revisiting of flagperson training standards and that greater effort is taken in gathering data specifically on flagger injuries and fatalities.

This paper proposes The Dynamic Aviation Data System (DADS), which integrates a variety of existing information sources regarding flight to serve as a tool to pilots in dealing with the challenges of flight. The system is composed of three main parts: a pilot's history on disk; a system that can read proposed flight plans and make suggestions based upon Geographical Information Systems, weather, aircraft, and case report databases that exist throughout North America; and a small hand-held computer that interfaces with the aircraft's instruments and that can be brought into the cockpit to aid the pilot before and during flight. The system is based upon technology that currently exists and information that is already regularly collected. While many issues regarding implementation and cost efficiency of the system need to be addressed, the system shows promise in its ability to make useful flight safety information available to all pilots in order to save lives.

Injuries account for more deaths and hospital admissions among children and adolescents than all diseases combined. The authors report two deaths by asphyxiation that resulted from drawstrings on the children's clothing becoming entangled on slides. Although such incidents are not common, they are preventable. The authors urge physicians to counsel parents and guardians to remove drawstrings from children's clothing, and they call upon the government and the clothing industry to work toward improving the safety standards for the design, manufacture and importation of children's clothing and banning the sale of children's clothing with drawstrings in Canada. In addition, they provide several resources for readers interested in helping reduce playground hazards in their communities.

Pediatric injuries are the leading cause of childhood death and disability and are responsible for more childhood deaths than all other diseases combined. The panel summarized the principles of pediatric injury prevention and reviewed the incidence, epidemiology, and prevention of six common pediatric injuries.

Complete hemopoietic takeover between semiallogeneic adults can be accomplished by the administration of antihost major histocompatibility complex (MHC) monoclonal antibody (mAb) and donor stem cells. The recipients of such treatment are termed antibody-facilitated chimeras, and they have been produced in (BALB/cCr----(BALB/cCr X C3H/HeJ)F1 and DBA/2J----(DBA/2J X C3H/HeJ)F1 strain combinations. Donor stem cells can be derived from spleen, bone marrow, or T-cell-depleted bone marrow. Engraftment by donor hemopoietic cells can be facilitated by mAbs directed toward class I (anti-H-2Kk) or class II (anti-H-2I-Ak) MHC antigens of the host. By monitoring isozymes of glucose phosphate isomerase, it can be shown that the establishment of donor hemopoiesis is stable, persisting for more than a year without graft-versus-host disease. The effect of anti-MHC mAb on pluripotential stem cells was evaluated by the (colony-forming units-spleen) (CFU-S) assay. The number of CFU-S in target (H-2k) bone marrow was reduced by in vitro pretreatment with anti-H-2Kk mAb, but not with anti-H-2I-Ak mAb. In contrast, in vivo administration of either anti-H-2Kk or anti-H-2I-Ak mAb resulted in a marked decrease in the CFU-S capacity of relevant strain mice. These observations suggest that the target of the in vivo mAb treatment may be pluripotential stem cells--or perhaps the hemopoietic microenvironment.

We have previously described a model for bone marrow transplantation that involves preparation of the host with monoclonal antibody against class I or class II antigens instead of irradiation or cytotoxic drugs. This allows engraftment and subsequent repopulation of the host by donor tissue. We have previously reported on chimerism in the peripheral blood of P1----(P1 X P2)F1 animals. In this report, we describe the examination of the bone marrow and spleen stem cell chimerism of these antibody-facilitated (AF) chimeras, by determining, with an isozyme assay, the phenotype of methylcellulose colonies grown from stem cells. We have found a correlation between peripheral blood chimerism and the stem cell constitution of both spleen and bone marrow. The peripheral blood chimerism also correlates with the level of chimerism in macrophages derived from peritoneal exudate cells. These findings indicate that assaying the peripheral blood of such chimeras provides an excellent indication of the degree of chimerism at the stem cell level and stands in sharp contrast to the level of chimerism in certain lymphoid compartments, as described in our accompanying article.

We have generated murine antibody-facilitated (AF) bone marrow chimeras in the genetic combination P1----(P1 X P2)F1 by the simultaneous injection of P1 bone marrow cells and anti-P2 MHC monoclonal antibody into normal (unirradiated) adult (P1 X P2)F1 recipients. These mice have normal life spans and appear to be healthy, with no overt signs of graft-versus-host disease. We have undertaken an extensive survey of the ability of stable, long-term AF chimeras to generate immune responses in vitro and in vivo. Both T and B lymphocyte functions have been analyzed in proliferative and effector cell assays. The AF chimeras respond normally to mitogenic as well as antigenic stimuli, and exhibit normal capacities for cellular collaboration in the generation of immune responses. However, splenic lymphocytes from AF chimeras are substantially and specifically hyporesponsive or nonresponsive to host, P2-encoded, alloantigens in in vitro assays of cell-mediated immunity. This host-specific tolerance is exhibited by the cytotoxic T lymphocyte lineage; T helper cells necessary for the generation of a cytotoxic response may also have decreased reactivity to host determinants. We conclude that our protocol for the production of AF chimeras does not compromise the immune system of chimeric animals but does allow the maintenance of host-specific tolerance, after stable equilibrium has been attained.

We have produced stable murine antibody-facilitated (AF) chimeras by the simultaneous injection of P1 bone marrow cells and anti-P2 monoclonal antibody into normal (unirradiated) adult (P1 X P2)F1 recipients. These AF chimeras are healthy, long-lived, and exhibit no overt signs of graft-versus-host disease. They are immunocompetent and tolerant of host, P2-encoded alloantigens. Donor cell engraftment and takeover, monitored by glucosephosphate isomerase isozyme patterns, is usually complete (greater than 95%) in the peripheral blood, bone marrow, and hemopoietic stem cell compartments of long-term (greater than 3 months posttransplantation) AF chimeras. We report here, however, that splenic, lymph node, and thymic leukocytes of AF chimeras represent donor/host chimeric populations. Spleen cell populations of AF chimeras exhibit substantial chimera-to-chimera variation in the preponderant residual host cell type(s) present. Our interpretations of the implications of these findings are discussed.