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High-quality data from surveillance of vaccine-preventable disease (VPD) are critical for timely detection of and response to outbreaks. In 2019, the World Health Organization (WHO) Regional Office for Africa (AFRO) began a change from Epi Info, a statistical software package developed by the US Centers for Disease Control and Prevention (CDC), with limited capability to integrate with other information systems, affecting reporting timeliness and data use, to the District Health Information Software 2 (DHIS2), a free, open-source software platform for electronic aggregate Integrated Disease Surveillance and Response (IDSR) and case-based surveillance reporting. A national reporting system was introduced to allow countries to adopt this system. Regionally, the Epi Info database will be replaced by a DHIS2 regional data platform. This report describes phased implementation from 2019 to the present. Phase 1 (2019-2021) involved developing IDSR aggregate and case-based surveillance packages and pilot studies in Mali, Rwanda and Togo. Phase 2 (2022) included extending national implementation to 27 countries and establishing the WHO AFRO DHIS2 regional data platform. Phase 3 (from 2023 onwards) comprised building local capacity and support for national reporting to the regional platform. By February 2024, 8 of 47 AFRO countries had adopted both the aggregate IDSR and case-based surveillance packages, and 2 had successfully transferred VPD surveillance data to the AFRO regional platform. The challenges included limited human and financial resources, establishment of data-sharing and governance agreements, technical support for data transfer, and building local capacity to report to the regional platform. Transition to DHIS2 will ensure efficient data transmission to strengthen detection and response of VPD and public health emergencies through greater system integration and interoperability. Il est essentiel de disposer de donnees de surveillance de qualite sur les maladies a prevention vaccinale (MPV) pour detecter rapidement les flambees epidemiques et y riposter. En 2019, le Bureau regional de l'Organisation mondiale de la Sante (OMS) pour l'Afrique a commence a remplacer Epi Info, un progiciel statistique developpe par les Centers for Disease Control and Prevention (CDC) des Etats-Unis, s'adaptant difficilement a d'autres systemes d'information et ne permettant pas de bien tenir les delais ou de partager les donnees de maniere optimale, par le logiciel d'information sanitaire de district DHIS2 (District Health Information Software 2), une plateforme logicielle libre et gratuite pour les donnees de surveillance integree des maladies et la riposte et les donnees de surveillance basee sur l'identification des cas. Un systeme de notification au niveau national a ete mis en place, offrant aux pays la possibilite d'adopter ce nouveau systeme. Au niveau regional, la base de donnees Epi Info sera remplacee par une plateforme de donnees DHIS2 regionale. Le present rapport decrit la mise en oeuvre progressive de cette plateforme de 2019 a aujourd'hui. La phase 1 (2019-2021) a consiste a elaborer des modules pour les donnees agregees de surveillance integree des maladies et la riposte et de surveillance basee sur les cas; des essais pilotes ont ete menes au Mali, au Rwanda et au Togo. La phase 2 (2022) a vu l'extension de la mise en oeuvre au niveau national a 27 pays et la mise en place de la plateforme de donnees regionale DHIS2 du Bureau regional de l'OMS pour l'Afrique. Les activites de la phase 3 (a partir de 2023) ont porte sur le renforcement des capacites locales et l'appui aux pays pour la transmission des donnees nationales a la plateforme regionale. Les difficultes recensees concernaient le manque de ressources humaines et financieres, la necessite d'etablir des accords de partage et de gouvernance des donnees, l'appui technique pour le transfert des donnees et le renforcement des capacites locales pour la transmission des donnees a la plateforme regionale. En fevrier 2024, 8 pays parmi les 47 pays de la Region africaine de l'OMS avaient adopte les modules pour la surveillance integree des maladies et la riposte et pour la surveillance basee sur les cas, et 2 avaient transfere avec succes leurs donnees de surveillance sur les MPV vers la plateforme regionale. La transition vers la plateforme DHIS2 favorisera une transmission efficace des donnees pour renforcer la detection des MPV et des urgences de sante publique et la riposte a ces evenements grace a une meilleure integration et interoperabilite des systemes., Introduction VPD surveillance is critical to public health, as it provides data for timely detection of and response to VPD cases and outbreaks. High-quality, timely data are necessary to guide [...]

Research into domestic violence has typically focused on the victims, who are usually female. However, shifting the focus to the male perpetrators creates opportunities for earlier intervention to stop the violence. By recognizing the early warning signs, police, community-based supports and governments can target interventions to prevent domestic violence before it escalates or even occurs. This policy brief examines the 10-year history of Calgary Police Service interactions with 934 Calgary men, aged 18 and above, who were eventually charged in domestic violence incidents in 2019. Based on their criminal and domestic encounters with police, the perpetrators fell into four typologies. Of the four groups, one had no history with police and the second had a criminal history but no non-criminal domestic encounters before the 2019 charge. The third group had a history of non-criminal domestic encounters, but no criminal history with police, while the fourth group had a record of both criminal charges and non-criminal domestic encounters with police. Only 27 per cent of the men in this study had no previous interactions with police. These trajectories and typologies reveal discernible increases in criminal activity and domestic encounters with police culminating in domestic violence charges. This information can help to focus legislation, policies and practices which can lead to preventing domestic violence, thus improving on the current model in which police and community organizations often respond to domestic violence only after the fact. Increased police interactions prior to a criminal conviction involving domestic violence mean there is a point at which early intervention may prevent a criminal incident of domestic violence from happening. Interventions can include providing access to counselling and supports while making online resources accessible to men at risk of becoming perpetrators and who are struggling with their behaviour in their intimate relationships. Other prevention efforts could include school-based programs and targeting male-dominated workplaces with domestic violence prevention efforts in order to avert potential first offences. The approach to domestic violence must shift. The victims’ responsibility to keep themselves safe needs to be augmented by a focus on stopping the individuals who perpetuate harm. Our ongoing research agenda is investigating the extent to which police, government and policy-makers may be able to use information about the behaviours and trajectories of offenders to intervene proactively and so prevent incidents of domestic violence from happening.

Abstract Background There is a growing interest in employing community wellness worker models in Indigenous populations to address inequities in healthcare access and outcomes, concerns about shortage in health and mental health human resources, and escalating burden of chronic and complex diseases driving significant increase in health services demand and costs. A thorough review of Indigenous community wellness worker models has yet to be conducted. This rapid review sought to outline the characteristics of a community wellness worker model in Indigenous contexts across the globe, detailing factors shaping implementation challenges and success. Methods A rapid review of the international peer-reviewed and grey literature of OVID Medline, Global Index Medicus, Google, and Google Scholar was conducted from January to June 2022 for Indigenous community wellness/mental health worker models and comparative models. Articles were screened and assessed for eligibility. From eligible articles, data pertaining to study design and sample; description of the program, service, or intervention; model development and implementation; terminology used to describe workers; training features; job roles; funding considerations; facilitators and barriers to success; key findings; outcomes measured; and models or frameworks utilized were extracted. Data were synthesized by descriptive and pattern coding. Results Twenty academic and eight grey literature articles were examined. Our findings resulted in four overarching and interconnected themes: (1) worker roles and responsibilities; (2) worker training, education, and experience; (3) decolonized approaches; and (4) structural supports. Conclusion Community wellness worker models present a promising means to begin to address the disproportionately elevated demand for mental wellness support in Indigenous communities worldwide. This model of care acts as a critical link between Indigenous communities and mainstream health and social service providers and workers fulfill distinctive roles in delivering heightened mental wellness supports to community members by leveraging strong ties to community and knowledge of Indigenous culture. They employ innovative structural solutions to bolster their efficacy and cultivate positive outcomes for service delivery and mental wellness. Barriers to the success of community wellness worker models endure, including power imbalances, lack of role clarity, lack of recognition, mental wellness needs of workers and Indigenous communities, and more.

Abstract Background Family violence, which includes intimate partner abuse, child abuse, and elder abuse, is a serious public health concern. Primary healthcare (PHC) offers a vital opportunity to identify and address family violence, yet barriers prevent the effective implementation of family violence interventions in PHC settings. The purpose of this study is to improve family violence identification and response in Alberta’s PHC settings by exploring readiness factors. Methods An integrated knowledge translation approach, combining implementation science and participatory action research, was employed to develop a readiness assessment tool for addressing family violence within PHC settings in Alberta. The research involved three phases: phase 1 involved a rapid evidence assessment, phase 2 engaged a panel of healthcare and family violence experts to explore readiness components in the Alberta context, and phase 3 utilized a 3-round Delphi consensus-building process to refine readiness indicators. Results Phase 1 findings from a rapid evidence assessment highlighted five main models/tools for assessing readiness to implement family violence interventions in PHC settings. In phase 2, additional concepts were identified through exploration with healthcare and family violence expert panel members, resulting in a total of 16 concepts for assessing family violence readiness within the Alberta PHC context. The 3-round Delphi consensus-building process in Phase 3 involved nine panelists, who collectively agreed on the inclusion of all concepts and indicators, yielding a total of 60 items for the proposed readiness assessment tool for addressing family violence in PHC within Alberta. Conclusion The current study lays the groundwork for future family violence intervention programs, offering insights into key components that promote readiness for implementing comprehensive programs and supporting PHC organizations in effectively addressing family violence.

Abstract With the SARS-CoV-2 pandemic and the need for affordable and rapid mass testing, colorimetric isothermal amplification reactions such as Loop-Mediated Isothermal Amplification (LAMP) are quickly rising in importance. The technique generates data that is similar to quantitative Polymerase Chain Reaction (qPCR), but instead of an endpoint color visualization, it is possible to construct a signal over a time curve. As the number of works using time-course analysis of isothermal reactions increases, there is a need to analyze data and standardize their related treatments quantitatively. Here, we take a step forward toward this goal by evaluating different available data treatments (curve models) for amplification curves, which allows for a cycle threshold-like parameter extraction. In this study, we uncover evidence of a double sigmoid equation as the most adequate model to describe amplification data from our remote diagnostics system and discuss possibilities for similar setups. We also demonstrate the use of multimodal Gompertz regression models. Thus, this work provides advances toward standardized and unbiased data reporting of Reverse Transcription (RT) LAMP reactions, which may facilitate and quicken assay interpretation, potentially enabling the application of machine learning techniques for further optimization and classification.

Research into male-on-female domestic violence traditionally focuses on its after-effects, with an emphasis on how victims can keep themselves safe or on the men who have been criminally charged in such incidents. This approach puts the responsibility on the victim to try and protect herself while offering support to the perpetrator only after the violence has occurred to prevent recidivism. This policy brief takes a different approach to understanding points of intervention that might prevent domestic violence from occurring in the first place. Using a robust 10-year dataset supplied by Calgary Police Service, the authors explored a trajectory of criminal behaviour and police interactions prior to an eventual charge for a criminal act involving domestic violence in 2019. While preliminary, the data analysis reported in this brief finds a distinct trajectory of increased criminal behaviour among male perpetrators leading up to a charge in 2019. In fact, the data shows a rising number of police interventions related to complaints involving possible acts of domestic violence during that 10-year period. Very few men in this sample were unknown to police prior to the charge in 2019. Domestic violence frequently makes headlines, and when femicide is committed, it is often accompanied by announcements of public vigils to be held for the victimized woman along with demands for an end to intimate partner violence. But rarely is the question raised, why do men continue to be the major perpetrators of this terrible violent act? And if there is always a passion and commitment to provide support to victims, where is the same passion and commitment to developing policies and strategies to work with men at risk of perpetrating violence and before they commit the offence of domestic violence? The approach of examining male perpetration trajectories analyzed in this policy brief, can help inform legislation, policies, and programs that can not only stop male violence before it starts, but subsequently reduce the suffering of women and their families.

Objectives: Type one diabetes (T1D) in children places substantial responsibility on parents as caregivers. This study investigated caregiver burden in parents of children with T1D by exploring the financial, physical, social, spiritual, and emotional or psychological problems they experienced. Methods: We conducted a qualitative scoping review of the databases PsycINFO, PROSPERO, OVID Medline, OVID EMBASE, Cochrane Library (CDSR and Central), EBSCO CINAHL, ProQuest Dissertations and Theses Global, and SCOPUS. Of 119 full text articles assessed for eligibility, 18 peer-reviewed qualitative studies were included. Studies were considered relevant if they focused on diabetes management and parental burden or the experience of caregiving for a child with T1D. Results: Using thematic analysis, six interrelated themes were identified: (a) experiencing chronic sorrow, (b) assuming responsibility for glucose highs and lows, (c) managing T1D and nighttime sleep disturbances, (d) making career sacrifices and choices to optimize T1D care, (e) navigating social experiences postdiagnosis, and (f) discovering new sources of support through online platforms. Conclusions: This synthesis highlights an all-encompassing experience involved in caretaking for a child with T1D. Caregiving duties lead to a constant sense of vigilance, especially due to fear of hypoglycemic incidents. Parents commonly experience challenges with balancing work demands with T1D management, which lead to career and financial sacrifices. Their burden of care is exacerbated by a lack of reliable respite care but helped somewhat by online peer support. Future research is needed on the care burden differences between mothers and fathers and how sociodemographic factors affect how caregiver burden is experienced.

Primary health care (PHC) transformation continues to be identified as a key pathway to achieve health equity for Indigenous peoples. In Alberta, varying degrees of PHC services exist within First Nations, Métis, and urban contexts that are fragmented, under-resourced, and disconnected from each other, perpetuating existing health inequities. A retrospective policy analysis was conducted to a) analyze federal, provincial, and local policies to advance Indigenous PHC in Alberta; and b) examine the engagement of Indigenous peoples in PHC policy and decision-making. The review found that prior to and into the early 1960s, the federal government controlled Indigenous peoples’ rights to health. By the end of the decade, the federal government shifted their responsibilities to Indigenous peoples in an attempt to reduce their role in health care delivery. In the late 1970s, the federal government reaffirmed their responsibilities in providing PHC to Indigenous peoples by establishing Indigenous-specific policies. This led to the creation of many co-designed reforms and initiatives provincially to increase Indigenous participation in policy throughout the 2000s. Despite these advancements, more work is needed to ensure that health priorities important to Indigenous peoples are appropriately addressed. Future Indigenous PHC-focused policy reforms can enhance Indigenous health experiences by clarifying the roles of federal, provincial, and Indigenous governments in the coordination of PHC; by ensuring Indigenous representation at all relevant decision-making tables; and by actively working to decolonize the health care institution and promote health equity. La transformation des soins de santé primaires (SSP) continue d'être identifiée comme une voie clé pour atteindre l'équité en matière de santé pour les peuples autochtones. En Alberta, il existe divers degrés de SSP au sein des premières nations, des métis et des contextes urbains qui sont fragmentés, manquent de ressources et sont déconnectés les uns des autres, ce qui perpétue les iniquités dans la domaine de la santé. Une analyse rétrospective des politiques a été menée pour a) analyser les politiques fédérales, provinciales et locales visant à faire progresser les soins de santé primaires autochtones en Alberta et b) examiner l'engagement des peuples autochtones dans la politique et la prise de décision en ce qui concerne les SSP. Les résultats de l'analyse ont montré que, jusqu’au début des années 1960, le gouvernement fédéral gérait les droits des peuples autochtones en ce qui concerne la santé. À la fin de la décennie, le gouvernement fédéral a transféré ses responsabilités aux peuples autochtones dans le but de réduire son rôle dans la prestation des soins de santé. À la fin des années 1970, le gouvernement fédéral a réaffirmé ses responsabilités en fournissant des soins de santé primaires aux peuples autochtones, en établissant des politiques spécifiques aux peuples autochtones. Cela a mené à la création de nombreuses réformes et initiatives co-conçues au niveau provincial afin d'accroître la participation des autochtones à la politique tout au long des années 2000. Malgré tous ces progrès, il reste encore du travail à faire pour s'assurer que les priorités de santé importantes pour les peuples autochtones sont prises en compte de manière appropriée. Les futures réformes politiques axées sur les soins de santé primaires autochtones peuvent améliorer les expériences de santé des autochtones en clarifiant les rôles des gouvernements fédéral, provinciaux et autochtones dans la coordination des SSP, en garantissant la représentation des peuples autochtones à toutes les instances de décision pertinentes et en œuvrant activement à la décolonisation de l'institution des SSP pour promouvoir l'équité dans la santé.

Objectives This study reviewed existing recommendations for virtual mental healthcare services through the quadruple aim framework to create a set of recommendations on virtual healthcare delivery to guide the development of Canadian policies on virtual mental health services.Design We conducted a systematic rapid review with qualitative content analysis of data from included manuscripts. The quadruple aim framework, consisting of improving patient experience and provider satisfaction, reducing costs and enhancing population health, was used to analyse and organise findings.Methods Searches were conducted using seven databases from 1 January 2010 to 22 July 2022. We used qualitative content analysis to generate themes.Results The search yielded 40 articles. Most articles (85%) discussed enhancing patient experiences, 55% addressed provider experiences and population health, and 25% focused on cost reduction. Identified themes included: screen patients for appropriateness of virtual care; obtain emergency contact details; communicate transparently with patients; improve marginalised patients’ access to care; support health equity for all patients; determine the cost-effectiveness of virtual care; inform patients of insurance coverage for virtual care services; increase provider training for virtual care and set professional boundaries between providers and patients.Conclusions This rapid review identified important considerations that can be used to advance virtual care policy to support people living with mental health conditions in a high-income country.

Abstract Background Perceived financial security impacts physical, mental, and social health and overall wellbeing at community and population levels. Public health action on this dynamic is even more critical now that the COVID-19 pandemic has exacerbated financial strain and reduced financial wellbeing. Yet, public health literature on this topic is limited. Initiatives targeting financial strain and financial wellbeing and their deterministic effects on equity in health and living conditions are missing. Our research-practice collaborative project addresses this gap in knowledge and intervention through an action-oriented public health framework for initiatives targeting financial strain and wellbeing. Methods The Framework was developed using a multi-step methodology that involved review of theoretical and empirical evidence alongside input from a panel of experts from Australia and Canada. In an integrated knowledge translation approach, academics (n = 14) and a diverse group of experts from government and non-profit sectors (n = 22) were engaged throughout the project via workshops, one-on-one dialogues, and questionnaires. Results The validated Framework provides organizations and governments with guidance for the design, implementation, and assessment of diverse financial wellbeing- and financial strain-related initiatives. It presents 17 priority actionable areas (i.e., entry points for action) likely to have long-lasting, positive effects on people’s financial circumstances, contributing to improved financial wellbeing and health. The 17 entry points relate to five domains: Government (All Levels), Organizational & Political Culture, Socioeconomic & Political Context, Social & Cultural Circumstances, and Life Circumstances. Conclusions The Framework reveals the intersectionality of root causes and consequences of financial strain and poor financial wellbeing, while also reinforcing the need for tailored actions to promote socioeconomic and health equity for all people. The dynamic, systemic interplay of the entry points illustrated in the Framework suggest opportunities for multi-sectoral, collaborative action across government and organizations towards systems change and the prevention of unintended negative impacts of initiatives.

The Expanded Programme on Immunization (EPI) and Vaccine Preventable Disease (VPD) Surveillance (VPDS) programs generate multiple data sources (e.g., routine administrative data, VPD case data, and coverage surveys). However, there are challenges with the use of these siloed data for programmatic decision-making, including poor data accessibility and lack of timely analysis, contributing to missed vaccinations, immunity gaps, and, consequently, VPD outbreaks in populations with limited access to immunization and basic healthcare services. Data triangulation, or the integration of multiple data sources, can be used to improve the availability of key indicators for identifying immunization coverage gaps, under-immunized (UI) and un-immunized (zero-dose (ZD)) children, and for assessing program performance at all levels of the healthcare system. Here, we describe the data triangulation processes, prioritization of indicators, and capacity building efforts in Bangladesh, Nigeria, and Rwanda. We also describe the analyses used to generate meaningful data, key indicators used to identify immunization coverage inequities and performance gaps, and key lessons learned. Triangulation processes and lessons learned may be leveraged by other countries, potentially leading to programmatic changes that promote improved access and utilization of vaccination services through the identification of UI and ZD children.

Abstract Background Virtual care has become an increasingly useful tool for the virtual delivery of care across the globe. With the unexpected emergence of COVID-19 and ongoing public health restrictions, it has become evident that the delivery of high-quality telemedicine is critical to ensuring the health and wellbeing of Indigenous peoples, especially those living in rural and remote communities. Methods We conducted a rapid evidence review from August to December 2021 to understand how high quality Indigenous primary healthcare is defined in virtual modalities. After completing data extraction and quality appraisal, a total of 20 articles were selected for inclusion. The following question was used to guide the rapid review: How is high quality Indigenous primary healthcare defined in virtual modalities? Results We discuss key limitations to the delivery of virtual care, including the increasing cost of technology, lack of accessibility, challenges with digital literacy, and language barriers. This review further yielded four main themes that highlight Indigenous virtual primary healthcare quality: (1) limitations and barriers of virtual primary healthcare, (2) Indigenous-centred virtual primary healthcare, (3) virtual Indigenous relationality, (4) collaborative approaches to ensuring holistic virtual care. Discussion: For virtual care to be Indigenous-centred, Indigenous leadership and users need to be partners in the development, implementation and evaluation of the intervention, service or program. In terms of virtual models of care, time must be allocated to educate Indigenous partners on digital literacy, virtual care infrastructure, benefits and limitations. Relationality and culture must be prioritized as well as digital health equity. Conclusion These findings highlight important considerations for strengthening virtual primary healthcare approaches to meet the needs of Indigenous peoples worldwide.

Abstract Introduction During the pandemic many Canadian hospitals made significant changes to their ‘open family presence’ and ‘visitor policies’ to reduce the spread of COVID-19 by instituting restrictive or ‘zero visiting’ policies in healthcare facilities. These policies have the potential to create great hardship, anxiety and stress for patients, families, caregivers and frontline healthcare providers (HCPs); along with concerns about the quality and safety of patient care. The presence of family members and other caregivers as essential partners in care is an explicit expression of the philosophy of patient- and family-centred care (PFCC) in action. The purpose of this study is to increase our understanding of how changes to family presence and visiting policies and practices during the COVID-19 pandemic have impacted patients, family caregivers and frontline healthcare providers (HCPs) in acute care hospitals. Methods A total of 38 in-depth semi-structured interviews were conducted with patients, family caregivers and HCPs in Canadian provinces who had experience with visiting policies in acute care settings during the pandemic. COVID patients, and the caregivers of COVID patients, were excluded from this study. A maximum variation sampling strategy was used to guide the selection and recruitment of patients, family caregivers and HCPs, based on our interest in gaining a diversity of perspectives and experiences. Results Many patients, family caregivers, and HCPs view family caregiver presence as integral to PFCC, describing the essential roles played by family caregivers prior to the pandemic. There were commonalities across all three groups with respect to their perspectives on the impacts of restrictive visiting policies on patients, family caregivers and HCPs. They fell into four broad integrated categories: (1) emotional and mental health; (2) communication and advocacy; (3) safety and quality of care; and (4) PFCC, trust in the healthcare system, and future decisions regarding accessing needed healthcare. Recommendations for pandemic visiting policies were also identified. Conclusions The findings from this study highlighted several impacts of restrictive family caregiver presence or visiting policies implemented during COVID-19 on patients, family caregivers and HCPs in acute healthcare settings across Canada. Participants emphasized that there is no “one-size-fits-all” caregiver presence policy that will address all patient needs. To be consistent with the practice of PFCC, patients and family caregivers are welcomed as part of the healthcare team in ways that work for them, demonstrating that flexibility in family presence and visiting policies is essential.

Abstract Lateral flow antigen tests have been widely used in the Covid-19 pandemic, allowing faster diagnostic test results and preventing further viral spread through isolation of infected individuals. Accomplishment of this screening must be performed with tests that show satisfactory sensitivity in order to successfully detect the target protein and avoid false negatives. The aim of this study was to create a lateral flow test that could detect SARS-CoV-2 nucleocapsid protein in low concentrations that were comparable to the limits of detection claimed by existing tests from the market. To do so, several adjustments were necessary during research and development of the prototypes until they were consistent with these criteria. The proposed alternatives of increasing the test line antibody concentration and addition of an intermembrane between the conjugate pad and the nitrocellulose membrane were able to increase the sensitivity four-fold and generate a new rapid test prototype called “lateral flow intermembrane immunoassay test” (LFIIT). This prototype showed an adequate limit of detection (2.0 ng mL−1) while maintaining affordability and simplicity in manufacturing processes.

Abstract Background Indigenous peoples of Canada, United States, Australia, and New Zealand experience disproportionately high rates of suicide as a result of the collective and shared trauma experienced with colonization and ongoing marginalization. Dominant, Western approaches to suicide prevention—typically involving individual-level efforts for behavioural change via mental health professional intervention—by themselves have largely failed at addressing suicide in Indigenous populations, possibly due to cultural misalignment with Indigenous paradigms. Consequently, many Indigenous communities, organizations and governments have been undertaking more cultural and community-based approaches to suicide prevention. To provide a foundation for future research and inform prevention efforts in this context, this critical scoping review summarizes how Indigenous approaches have been integrated in suicide prevention initiatives targeting Indigenous populations. Methods A systematic search guided by a community-based participatory research (CBPR) approach was conducted in twelve electronic bibliographic databases for academic literature and six databases for grey literature to identify relevant articles. the reference lists of articles that were selected via the search strategy were hand-searched in order to include any further articles that may have been missed. Articles were screened and assessed for eligibility. From eligible articles, data including authors, year of publication, type of publication, objectives of the study, country, target population, type of suicide prevention strategy, description of suicide prevention strategy, and main outcomes of the study were extracted. A thematic analysis approach guided by Métis knowledge and practices was also applied to synthesize and summarize the findings. Results Fifty-six academic articles and 16 articles from the grey literature were examined. Four overarching and intersecting thematic areas emerged out of analysis of the academic and grey literature: (1) engaging culture and strengthening connectedness; (2) integrating Indigenous knowledge; (3) Indigenous self-determination; and (4) employing decolonial approaches. Conclusions Findings demonstrate how centering Indigenous knowledge and approaches within suicide prevention positively contribute to suicide-related outcomes. Initiatives built upon comprehensive community engagement processes and which incorporate Indigenous culture, knowledge, and decolonizing methods have been shown to have substantial impact on suicide-related outcomes at the individual- and community-level. Indigenous approaches to suicide prevention are diverse, drawing on local culture, knowledge, need and priorities.

Abstract The coronavirus pandemic accentuated the need for molecular diagnostic tests. A technique highly used to this end is the Polymerase Chain Reaction (PCR)—a sensitive and specific technique commonly used as the gold standard for molecular diagnostics. However, it demands highly trained personnel and high-maintenance equipment and is relatively time-consuming. An alternative is the Loop-Mediated Isothermal Amplification (LAMP) technique, which doesn’t need sample purification or expensive equipment, and is similar to PCR when compared in sensitivity and specificity. In this paper, we developed an optimized colorimetric Reverse Transcriptase Loop-Mediated Isothermal Amplification (RT-LAMP) Point-of-Care test using a portable device to diagnose COVID-19. Variables such as concentration of primers, magnesium sulfate, betaine, hydrochloride guanidine, Bst, and temperature of the reactions were tested. We also created a pipetting quality control system—using a combination of dyes—to avoid false negatives due to a lack of samples added to the reaction test tube. Mineral oil was incorporated in the composition of the RT-LAMP reactions to avoid evaporation when a heating lid isn't available. The final RT-LAMP test is tenfold more sensitive when compared to the WarmStart Colorimetric Master mix from New England Biolabs with a sensitivity of 5 copies per μL.

Global emergence of the COVID-19 pandemic in 2020 curtailed vaccine-preventable disease (VPD) surveillance activities, but little is known about which surveillance components were most affected. In May 2021, we surveyed 214 STOP (originally Stop Transmission of Polio) Program consultants to determine how VPD surveillance activities were affected by the COVID-19 pandemic throughout 2020, primarily in low- and middle-income countries, where program consultants are deployed. Our report highlights the responses from 154 (96%) of the 160 consultants deployed to the World Health Organization African Region, which comprises 75% (160/214) of all STOP Program consultants deployed globally in early 2021. Most survey respondents observed that VPD surveillance activities were somewhat or severely affected by the COVID-19 pandemic in 2020. Reprioritization of surveillance staff and changes in health-seeking behaviors were factors commonly perceived to decrease VPD surveillance activities. Our findings suggest the need for strategies to restore VPD surveillance to prepandemic levels.

Background: Surgical aortic valve replacement with a rapid deployment valve (RDV) is a relatively recent treatment option. The aim of this study was to compare the hemodynamic performance of balloon-expandable (BE)-RDVs and BE-transcatheter heart valves (THVs) in a high surgical risk and frail-elderly population. Methods: BE-THVs and BE-RDVs were implanted in 138 and 47 patients, respectively, all older than 75 years and with a Canadian Study of Health and Aging category of 5 or above. Echocardiographic assessment was performed at discharge and six months later. Results: At discharge, transprosthetic pressure gradients and indexed effective orifice area (iEOA) were similar in both cohorts. At six-month follow-up, BE-RDVs showed lower peak (14.69 vs. 20.86 mmHg; p

Abstract Background The COVID-19 pandemic has been linked with increased rates of intimate partner violence (IPV) and associated experiences of compounded trauma. The emergence of this global pandemic and the public health measures introduced to limit its transmission necessitated the need for virtually delivered interventions to support continuity of care and access to interventions for individuals affected by IPV throughout the crisis. With the rapid shift to virtual delivery, understanding the barriers to accessing virtually delivering trauma-focused IPV interventions to these individuals was missed. This study aimed to qualitatively describe the challenges experienced by service providers with delivering virtually delivered IPV services that are safe, equitable, and accessible for their diverse clients during the COVID-19 pandemic. Methods The study involved semi-structured interviews with 24 service providers within the anti-violence sector in Alberta, Canada working with and serving individuals affected by IPV. The interviews focused on the perspectives and experiences of the providers as an indirect source of information about virtual delivery of IPV interventions for a diverse range of individuals affected by IPV. Interview transcripts were analyzed using inductive thematic analysis. Results Findings in our study show the concepts of equity and safety are more complex for individuals affected by IPV, especially those who are socially disadvantaged. Service providers acknowledged pre-existing systemic and institutional barriers faced by underserved individuals impact their access to IPV interventions more generally. The COVID-19 pandemic further compounded these pre-existing challenges and hindered virtual access to IPV interventions. Service providers also highlighted the pandemic exacerbated structural vulnerabilities already experienced by underserved populations, which intensified the barriers they face in seeking help, and reduced their ability to receive safe and equitable interventions virtually. Conclusion The findings from this qualitative research identified key determining factors for delivering safe, equitable, and accessible virtually delivered intervention for a diverse range of populations. To ensure virtual interventions are safe and equitable it is necessary for service providers to acknowledge and attend to underlying systemic and institutional barriers including discrimination and social exclusion. There is also a need for a collaborative commitment from multiple levels of the social, health, and political systems.

Abstract Introduction Improving health services integration through primary health care (PHC) teams for patients with chronic conditions is essential to address their complex health needs and facilitate better health outcomes. The objective of this study was to explore if and how patients, family members, and caregivers were engaged or wanted to be engaged in developing, implementing and evaluating health policies related to PHC teams. This patient‐oriented research was carried out in three provinces across Canada: British Columbia, Alberta and Ontario. Methods A total of 29 semi‐structured interviews with patients were conducted across the three provinces and data were analysed using thematic analysis. Results Three key themes were identified: motivation for policy engagement, experiences with policy engagement and barriers to engagement in policy. The majority of participants in the study wanted to be engaged in policy processes and advocate for integrated care through PHC teams. Barriers to patient engagement in policy, such as lack of opportunities for engagement, power imbalances, tokenism, lack of accessibility of engagement opportunities and experiences of racism and discrimination were also identified. Conclusion This study increases the understanding of patient, family member, and caregiver engagement in policy related to PHC team integration and the barriers that currently exist in this engagement process. This information can be used to guide decision‐makers on how to improve the delivery of integrated health services through PHC teams and enhance patient, family member, and caregiver engagement in PHC policy. Patient or Public Contribution We would like to acknowledge the contributions of our patient partners, Brenda Jagroop and Judy Birdsell, who assisted with developing and pilot testing the interview guide. Judy Birdsell also assisted with the preparation of this manuscript. This study also engaged patients, family members, and caregivers to share their experiences with engagement in PHC policy.

Abstract The complete blood count (CBC) is one of the most requested tests by physicians. CBC tests, most realized in conventional hematological analyzers, are restricted to centralized laboratories due to frequent maintenance, large devices, and expensive costs required. On the other hand, most handheld CBC devices commercially available show high prices and are not liable to calibration or control procedures, which results in poor quality compared to standard hematology instruments. The Hilab system is a small-handed hematological platform that uses microscopy and chromatography techniques for blood cells and hematimetric parameters analysis through artificial intelligence, machine learning, and deep learning techniques. For clinical evaluation of the handheld CBC device, 450 blood samples were analyzed. The samples encompassed normal (82%) and pathological conditions (18%), such as thalassemias (2.2%), anemias (6.6%), and infections (9.2%). For all analytes, accuracy, precision, method comparison, and flagging capabilities of the Hilab System, were compared with the Sysmex XE-2100 (Sysmex, Japan) results. The sample source (venous and capillary) influences were also evaluated. Pearson correlation, Student t test, bias, and the Bland–Altman plot of each blood count analyte were calculated and shown. The significance level was set at p ≤ 0.05. For clinical evaluation, Hilab System and the Sysmex XE-2100 showed a strong correlation (r ≥ 0.9) for most evaluated parameters. In the precision study, analytes showed CV inside the limits established according to European Federation of Clinical Chemistry and Laboratory Medicine guidelines. The flagging capabilities of the Hilab system, compared to the manual microscopy technique, presented high sensibility, specificity, and accuracy. Venous and capillary samples (p > 0.05) do not differ statistically. Considering the need for point-of-care CBCs, the study indicated that the Hilab system provides fast, accurate, low cost, and robust analysis for reliable clinical use.

Abstract Background Mental health disparities between Indigenous and non-Indigenous people in Canada are related to underlying economic, social, and political inequities that are legacies of colonization and the oppression of Indigenous cultures. It also widely acknowledged that mental health services currently available may not be culturally appropriate in supporting the health needs of Indigenous Canadians. A two-day Indigenous mental health forum examined mental health needs and gaps among Indigenous communities across the Regional Municipality of Wood Buffalo (RMWB) on Treaty 8 territory, in northern Alberta, Canada. This paper outlines the insights generated by stakeholder engagement at the forum to identify and prioritize directions for Indigenous mental health and build a vision and strategy for improving mental health services and programs for the region’s diverse Indigenous population. Methods We applied a modified nominal group technique (NGT) consensus method embedded within Indigenous knowledge to determine key priorities and directions for Indigenous-focused mental health and synthesize information from discussions that occurred at the forum. Following the NGT, a participatory community visioning exercise was conducted with participants to develop a vision, guiding principles, and components of an action plan for an Indigenous mental health strategy for the RMWB. Results Four key themes for setting priorities and directions for Indigenous mental health emerged from roundtable group discussions: 1) understand the realities of mental health experiences for Indigenous peoples, 2) design a holistic and culturally rooted mental health system, 3) foster cross-sectoral engagement and collaboration on mental health service delivery, and 4) focus on children and youth. The community visioning exercise helped stakeholders to visualize a direction or path forward for addressing existing gaps in the mental health system and opportunities for strengthening Indigenous mental health in the region. Conclusions Forum participants described mental health and well-being around holistic concepts of social and emotional well-being. Addressing Indigenous mental health and wellness involves multi-sectoral action in various settings including community and school through programs, policies, and other interventions that promote mental health for all Indigenous peoples, as well as for those at greater risk such as children and youth.

Introdução: Infecções por patógenos resistentes a antimicrobianos impactam na morbimortalidade, conduta clínica e custos da doença. A Organização Mundial de Saúde elencou bactérias resistentes relevantes globalmente, pelo impacto na saúde pública; dentre as quais estão as bactérias gram-negativas resistentes a carbapenêmicos (CRGNB), os enterococos resistentes à vancomicina (VRE) e o Staphylococcus aureus resistente à meticilina (MRSA). Objetivos: Objetivou-se compilar os custos da infecção por MRSA, VRE ou CRGNB, em pacientes adultos internados em unidades de cuidado crítico (UCC), tendo como modelo o Complexo Hospital de Clínicas da Universidade Federal do Paraná (CHC-UFPR). Métodos: Para avaliação do custo da doença, os cálculos da terapia farmacológica (TF) foram realizados com base no “Guia de uso racional de antimicrobianos: diretrizes de uso e prevenção de infecções” do CHC-UFPR. Para medicamentos com dose dependente do peso definiu-se 70kg. A perspectiva considerada foi a do Sistema Único de Saúde (SUS) e, portanto, os valores dos medicamentos foram extraídos da lista da Câmara de Regulação do Mercado de Medicamentos 04/19, considerando o preço máximo de venda ao governo e imposto sobre circulação de mercadorias e serviços de 18%; valores das técnicas diagnósticas (Metodologia: convencional) foram extraídos do sistema de gerenciamento da tabela de procedimentos, medicamentos, órteses, próteses e materiais especiais do SUS, 04/19; preços dos materiais médico-hospitalares utilizados na administração do medicamento e no diagnóstico, foram coletados no banco de preços em saúde, período 10/18 a 04/19. Contabilizou-se o custo da diária hospitalar do paciente em UCC, incluindo custos diretos, utilizando dados de 2018 do CHC-UFPR. Resultados: O diagnóstico somou custo médio de R$43,60 (min. 37,48 – máx. 49,71), independente da etiologia. O valor médio da diária hospitalar totalizou R$1353,73 (753,79- 2033,25). O agente causal e foco da infecção levam a variações na TF, refletindo nos custos. Em infecções por MRSA o preço médio diário da TF de escolha foi de R$97,94 (65,50-129,92) (infecção de corrente sanguínea – ICS, de partes moles, osteoarticular, pneumonia – PNM ou endocardite) e R$146,91(98,25-194,88) (sistema nervoso central – SNC). Infecções por VRE apresentaram preço médio diário da TF desde R$307,48 (300,82-323,50) (infecção intra-abdominal – IIA, manutenção) a R$460,11 (450,60-482,77) (IIA, dose de ataque). A TF diária de infecções por CRGNB apresentaram valores mais distintos: R$19,99 (8,96-32,94) para infecção do trato urinário e R$1.456,17 (804,29-2172,44) para ICS, IIA, do SNC ou PNM. Conclusão: Os dados compilados ilustram o alto custo de infecções por MRSA, VRE e CRGNB em pacientes adultos críticos. Tais custos impactam no orçamento público, salientando a importância de alternativas para minimizar o custo dessas infecções; como técnicas de diagnóstico rápidas, a fim de adequar a terapia e evitar a disseminação dos patógenos.

When health systems are overwhelmed during a public health crisis regular care is often delayed and deaths result from lapses in routine care. Indigenous primary healthcare (PHC) can include a range of programmes that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health (SDoH) and a focus on redressing health inequities. We examined how Indigenous PHC mobilises and innovates during a public health crisis to address patient needs and the broader SDoH. A rapid review methodology conducted from January 2021 – March 2021 was purposefully chosen given the urgency with COVID-19, to understand the role of Indigenous PHC during a public health crisis. Our review identified five main themes that highlight the role of Indigenous PHC during a public health crisis: (1) development of culturally appropriate communication and education materials about vaccinations, infection prevention, and safety; (2) Indigenous-led approaches for the prevention of infection and promotion of health; (3) strengthening intergovernmental and interagency collaboration; (4) maintaining care continuity; and (5) addressing the SDoH. The findings highlight important considerations for mobilising Indigenous PHC services to meet the needs of Indigenous patients during a public health crisis such as the COVID-19 pandemic.

Background Among Indigenous peoples in Canada, access to high-quality healthcare remains an important determinant of health. The shift to virtual and remote-based approaches, expedited during the COVID-19 pandemic, influenced the ways in which individuals accessed care and the quality of care received. This study sought to determine which elements are required for effective and sustainable virtual care approaches for delivery of primary care to Indigenous patients and develop quality indicators grounded in Indigenous community and experience. We share a conceptual framework to understand how Indigenous patients access and define high-quality virtual care, grounded in Indigenous patient experiences and worldviews.Methods Using principles of patient-oriented research, we grounded this work in social justice and participatory action research. We sought to gain an in-depth understanding of the Indigenous experiences of virtual care and specifically of primary care. This was developed through semistructured interviews with Indigenous patients and Indigenous virtual primary care providers.Results Thirteen participants were interviewed between 5 August 2021 and 25 October 2021. Using Framework Analysis, we constructed four domains including access, relationships, quality and safety as being primary facets of defining high-quality Indigenous virtual primary care.Discussion The results presented here indicate that the shift to virtual care, largely seen in response to the COVID-19 pandemic, does not compromise quality of care, nor does it lead to negative patient experiences. Optimal care is possible in virtual settings for some care needs and types of appointments and has the potential to decrease barriers to access and improve patient experiences of safety and quality while facilitating patient/provider relationships.Conclusion In summary, high-quality Indigenous virtual care benefits from attention to patients’ experiences of access, relationships, safety and quality with their service providers and healthcare teams.