Canadian Public Health Policy

Objectives Poor housing conditions and household crowding have been identified as important health concerns for Indigenous populations in many countries but have not been explored in relation to adverse birth outcomes in these populations. We investigated housing conditions and adverse birth outcomes in a nationally representative sample of Indigenous people in Canada. Methods Data were from a cohort of births between May 2004 and May 2006 created by linking birth and infant death registration data with the 2006 Canadian census. Log-binomial regression was used to examine associations between housing variables (persons per room and needed household repairs) and three adverse birth outcomes: preterm birth (PTB), small-forgestational-age (SGA) birth, and infant mortality. Separate regression models were run for First Nations, Métis and Inuit mothers, with adjustment for parity and parental socio-economic variables. Results Need for major household repairs was associated with a slightly increased risk of PTB among First Nations and Métis mothers (adjusted RRs 1.12 and 1.13, respectively; 95% CI 0.94-1.34 and 0.89-1.44, respectively) and a moderately increased risk of infant death in all three groups (aRR = 1.69, 95% CI 1.00-2.85). Household crowding was also associated with a slightly elevated risk of PTB in all three groups (aRR = 1.10, 95% CI 0.95-1.29) and with an increased risk of infant mortality among First Nations (aRR = 1.57, 95% CI 0.97-2.53). Conclusion This study highlights the need to improve understanding of links between housing conditions and perinatal health outcomes in Indigenous populations, including examining cause-specific infant mortality in relation to housing characteristics.

Objective Studies of perinatal health outcomes in Canadian First Nations populations have largely focused on limited geographical areas and have been unable to examine outcomes by registered status and community residence. In this study, we compare rates of adverse birth outcomes among First Nations individuals living within vs. outside of First Nations communities and those with vs. without registered status. Methods Data included 13,506 singleton pregnancies from the 2006 Canadian Birth-Census Cohort. Outcomes examined included preterm birth (PTB), small-and large-for-gestational-age birth (SGA, LGA), stillbirth, overall infant mortality, and neonatal and postneonatal mortality. Risk ratios (RRs) were estimated with adjustment for maternal age, education, parity, and paternal education. Results Mothers living in First Nations communities and those with status had elevated adjusted risks of LGA (RR for First Nations community residence = 1.22, 95% CI = 1.09-1.35; RR for status = 1.50, 95% CI = 1.16-1.93). Rates of SGA were significantly lower among mothers with status (adjusted RR = 0.62, 95% CI = 0.44-0.86). Rates of PTB did not vary substantially by residence or by status. Adjusted differences in fatal outcomes could not be estimated, owing to small cell sizes. However, mothers living in First Nations communities had higher crude rates of infant mortality (10.9 vs. 7.7 per 1000), particularly for neonatal mortality (6.1 vs. 2.9). Conclusion Future investigations should explore risk factors, including food security and access to health care services, that may explain disparities in SGA and LGA by status and residence within First Nations populations.

s the world prepares for the next influenza pandemic, governments have made significant funding commitments to vaccine development and antiviral stockpiling. While these are essential components to pandemic response, rapid and accurate diagnostic testing remains an often neglected cornerstone of pandemic influenza preparedness. As outlined in Annex C of the Canadian Pandemic Influenza Plan, 1 accurate laboratory testing is essential to: • identify the earliest Canadian cases of a novel influenza strain; • support public health surveillance; • facilitate clinical management in limited circumstances; • monitor circulating influenza viruses for anti-viral resistance. Laboratory and epidemiologic data will also identify triggers that will escalate pandemic phases and dictate appropriate response measures. Recently, the advantages and limitations of currently available influenza testing methods have been reviewed. 2 Understanding the limitations of these tests is essential when interpreting results. This manuscript briefly reviews tissue culture, rapid antigen detection, and nucleic acid-based testing. It also discusses the limitations of these methodologies and the options for pandemic testing and planning from the perspective of the front-line clinician and public health official. The traditional gold standard for the diagnosis of influenza has been virus isolation using tissue culture. Its turnaround time can be from 1 to 10 days, however, early in the pandemic, this technology will be restricted to a very small number of containment level (CL-3) facilities with approved protocols and trained staff able to safely carry out testing procedures. Nucleic acid testing utilizes sequence-based amplification methods to detect viral RNA. The method most commonly used is reverse transcriptase polymerase chain reaction (RT-PCR) which can be used to detect or subtype influenza A viruses in 4-8 hours. Data show that the increased yield of viral identification by NAT over culture ranges from 8-800% (Table ). This increased sensitivity and improved turnaround time has made NAT the new diagnostic "gold standard". However, NAT requires specialized technical knowledge and equipment and extensive quality assurance, which often restricts their use to larger virology laboratories. Current guidelines suggest that during seasonal influenza, antiviral therapy should be initiated as soon as possible after symptom onset and within 48 hours. The ability to provide rapid and accurate diagnosis while the patient is under observation would be ideal, however even the most rapid methods have a turnaround time of several hours. Despite these disadvantages, there are many features that make NAT the most effective platform for preparing for the next influenza pandemic: 1. In addition to superior sensitivity and specificity, NAT technologies do not require growth of the virus; thus they are safe to perform in all virology laboratories.

OBJECTIVE: Direct measures of health care affordability from the user perspective are needed to monitor equitable access to publicly funded health care in Canada. The objective of our study was to develop a survey-based measure of health care affordability applicable to the Canadian context. We developed items after focus group exploration of access and cost barriers in the health care trajectory. We administered an initial instrument by telephone to a randomly-selected sample of 750 respondents in metropolitan, rural, and remote settings in Quebec. After analysis we developed a new, self-administered version eliciting the frequency of problem access due to five affordability dimensions. This version was mailed to a subset of participants. We conducted exploratory and confirmatory factor analysis. We used ordinal logistic regression modelling to examine how individual items and the subscale score predicted indicators of difficult access. We looked for effect modification by income categories. The five items load on a single construct with good internal consistency (α = 0.77). The overall score, 0 to 5, reflects the sum of problems with health care affordability due to direct and indirect costs. The item and subscale scores are sensitive to income status, with affordability problems more prevalent among low-income than high-income respondents. Each unit increase in the subscale score predicts increased likelihood of unmet needs (OR = 1.54), emergency room use (OR = 1.41), and delay-related health problem aggravation (OR = 1.80). DISCUSSION: This subscale reliably and validly measures cost barriers to medically necessary services in Canada, and can potentially be applied in other settings with publicly funded health systems. It can be used to monitor and compare health care equity.

Objective: Daily consumption of supplements containing 400 μg of folic acid in the periconception period may reduce the risk of neural tube defects (NTDs) by as much as 70%. However, despite explicit recommendations, folic acid consumption among women likely to become pregnant remains low. The objectives of this study were: to evaluate women's knowledge and beliefs with regard to folic acid; to estimate the frequency of vitamin supplement consumption; and to identify its determinants during the periconception period. In 1999-2000, a questionnaire was completed by 1,240 pregnant women in 10 Quebec hospitals. Results: Seventy percent of the respondents were aware of the preventive role of folic acid but only 25% had taken the recommended dose of supplements during the periconception period. Supplement consumption is associated with the pregnancy planning intensity score (OR: 1.06; 95% CI: 1.02 -1.11), knowledge score (OR: 1.11; 95% CI: 1.07 -1.16) and belief in the usefulness of supplements (OR: 1.56; 95% CI: 1.02 -2.39). These results indicate that further efforts are needed to inform the population and promote the optimal use of folic acid supplements. La traduction du résumé se trouve à la fin de l'article.

Objective: To quantify moderate-to-vigorous physical activity (MVPA) at postpartum in women with recent gestational diabetes mellitus, using an accelerometer and self-reported measurements from participants of the LINDA-Brasil study. Materials and methods: In a cross-sectional sample (n = 391), MVPA was assessed via a waist-worn accelerometer and the international physical activity questionnaire (IPAQ), focusing on leisure time and commuting domains. Results: The median postpartum period was 7.3 months (interquartile range [IQR]: 4.0-14.0). When restricted to 10-minute bouts, device-measured MVPA was 22.31 minutes/week (IQR: 0-65.8), whereas total time spent on MVPA was 213.8 minutes/week (IQR: 137.7-320.0). Higher education and pregnancy complications were associated with lower device-based MVPA. Self-reported leisure-time MVPA in 10-minute bouts was 0 minutes/week (IQR: 0-0). However, including commuting time, it increased to 90 minutes/week (IQR: 10.0-210.0). Based on total device-measured MVPA, 71.6% (CI 66.9-76.0) met the recommended 150 minutes/week. This proportion decreased to 8.4% (95% CI: 5.9-11.7) in 10-minute bouts MVPA. Based on the IPAQ, 7.4% (95% CI: 5.0-10.5) reached the guideline through leisure-time activity and 26.8% (95% CI: 22.5-31.5) through combined leisure and commuting. Conclusion: Women with gestational diabetes mellitus at postpartum were highly active based on device-measured MVPA. Nevertheless, applying the 10-minute bout reduced these estimates across devices and self-reported measurements. These findings provide crucial information for public policies addressing this high-risk population.

Objective: Our objective was to describe patterns of medication use in a convenience sample of 309 women with a history of intimate partner violence (IPV) participating in a study of women's health after leaving an abusive partner (WHES). Methods: Using data collected through interviews and health assessments, frequencies of past-month use of medications; abuse experienced, health problems and medical diagnoses; and selected demographics were calculated. Associations among abuse history, employment status, health problems, diagnoses, and medications were explored. Comparisons of rates of medication use in women in the WHES and the Canadian Community Health Survey (CCHS) 2.1 were calculated. Findings: Almost half of participants were taking pain and/or psychotropic medications, with almost one third taking antidepressants. Child abuse history, adult sexual assault history and unemployment were associated with taking psychotropic medications. Overall rates of medication use were similar to those of Canadian women of similar age in the CCHS 2.1. However, women in the WHES were more likely to be taking antidepressants, anxiolytics and inhalants, and less likely to be taking oral contraceptives, over-the counter (OTC) pain relievers, and OTC cough and cold medications. The pattern of medication use in women who have experienced IPV differs from that in the general population. The complex associations found among health problems, employment, diagnoses, and medication use highlight the need to consider treatment patterns within the context of the impact of lifetime abuse, economic survival, and parenting demands. Medication use must be understood as only one of a range of health interventions available to assist abused women to promote their health.

The objectives of this study are to describe marijuana use in Canada and explore factors associated with problematic use. METHODS: Data from the 2010-2012 circulations of the Canadian Alcohol and Drug Use Monitoring Survey were used to create three logistic regression models for the purposes of identifying and comparing factors associated with the degree of marijuana use, as determined via the WHO Alcohol, Smoking and Substance Abuse Involvement Screening Test (non-problematic, problematic) and European Monitoring Centre for Drugs and Drug Addiction (experiential, recent, current) methods. RESULTS: Canadians aged 15-24 years are 15 times (p < 0.001) more likely to be current users than Canadians aged 65 or older, with the odds of exhibiting problematic marijuana use being 10 times (p < 0.001) greater. The odds of a male exhibiting problematic marijuana use are 2.46 times (p < 0.001) greater than for females. The odds of exhibiting problematic marijuana use are 41.0% (p = 0.031) and 53.0% (p = 0.008) greater for marijuana users with household incomes $40,000-$80,000 and less than $40,000 respectively compared to those with household income over $80,000. An earlier age of first marijuana use is associated with problematic use but not necessarily with being a current user. The majority of our findings are consistent with the literature, showing that Canadians who are: male, adolescent or young adult, smokers, heavy drinkers, other illicit drug users, and who have poorer mental health status are more likely to engage in any marijuana use, particularly higher levels of marijuana use. These findings can be used to inform the development of policy in Canada to address problematic marijuana use and prepare for its possible legalization.

The number of vulnerable migrants in Canada is on the rise. While debates on immigration policies have been at the forefront, there has been little dialogue regarding the health and well-being of refugees, asylum-seekers and non-status migrants despite the significant health inequities that these populations face. In this context, health research that aims to understand migrants&#39; realities, develop appropriate health and social services and policies, and empower these populations, is needed more than ever. Participatory action research (PAR) is one approach for conducting relevant and empowering research with migrants, however it remains underutilized due to inadequate funding, infrastructure and support. PAR addresses real-life challenges, emphasizes collaboration with communities, and involves all stakeholders, including community-based organizations, in the co-construction and implementation of practical solutions. In this commentary, we call for more research with and for mi...

Saharan Africa and South Asia accounts for 86% of the maternal mortality rate in the world. In Uganda, the maternal mortality ratio (MMR) is still high at 438/100,000 live births while under-five mortality is at 90/1,000 live births. In Uganda, a community health worker strategy, Village Health Teams (VHTs), was introduced in 2001 to help address maternal/ child mortality challenges. VHTs are an equivalent of Health Centre Iresponsible for the health of community members at the household level. VHTs serve as a community's initial point of contact for health and social services, as well as helping to build social capital and understanding of basic health services and lifestyle choices. As of 2014, over 170,000 VHTs have been trained and deployed across Uganda. The purpose of this study was to explore the contribution of VHTs' health promotion practices to maternal health in south west Uganda.

From a holistic perspective, health literacy is a requirement for the well-being of entire populations. It moves beyond the focus on individuals to consider the role of organizations and systems. This perspective offers a context for discussing best practices in health literacy, and implications for research and policy development. This paper offers an overview of the best practices that were presented at the Second Canadian Conference on Literacy and Health. It discusses clear writing in some detail because it was emphasized at the conference. It also considers practices that were addressed less emphatically, such as oral communication between patients and health care professionals, training for health care professionals, non-written means of communication (such as video), and building capacity through action-research. The paper critiques some practices. It also notes the lack of research on the links between health literacy and oral understanding, on the impact of verbal and non-written interventions, and on the effectiveness of these practices on the health outcomes of the population. It briefly discusses policy issues and suggests some future directions.

This research investigated the impact of varying planning conditions and task types on the accuracy of pupils' speaking abilities. Utilizing the Oxford Placement Test (OPT), 80 intermediate female participants nominated for the research and assigned to four untouched classes. These classes were planned as the individual-planning personal task class (IPPT class), the individual-planning decision-making task class (IPDT class), the class-planning personal task class (CPPT class), and the class-planning decision-making task class (CPDT class). Two concurrent decision making tasks were planned to be conducted both at the beginning and at the end of the experiment, while a six-week intervention was scheduled in between. Three sessions were dedicated to administering the OPT test, the pretest, and the posttest; and the students accomplished two dissimilar task types under two diverse planning situations throughout the other three treatment meetings. The results from the one-way ANOVA discovered that pre-task planning conditions and task types significantly influence the accuracy of speaking. These outcomes reinforce the notion that planning conditions have meaningful results on pupils' accomplishment in personal and decision-making tasks. Consequently, both planning conditions proved real in enhancing students' performance in speaking tasks. It is suggested that educators should give considerable attention to pre-task planning to alleviate EFL pupils' challenges in attaining upper ranks of accuracy in their speaking abilities.

Tasks are as useful devices for identifying learners’ needs and thus for designing specific purpose courses. Hence, the present study aimed at examining the viable effects of three varieties of task manipulation, i.e., oral reproduction, role-play, and group discussion, on the accuracy and fluency components of Iranian EFL learners’ oral speech. For the sake of homogeneity of the participants, 60 L1 Persian EFL students were selected through Oxford Placement Test (OPT) and divided into three 20-participant comparison groups: Oral Reproduction Group (ORG), Role-play Group (RPG), and Group Discussion Group (GDG). Each of the three comparison groups was treated just through a single task. ORG, RPG, and GDG were treated by oral reproduction, role-play, and group discussion tasks, respectively. The participants were pretested and posttested by the speaking part of Preliminary English Test (PET). The three groups were exposed to ten sessions of treatment, each of which lasted one hour and thirty minutes. The results of the study, obtained through ANOVA and Post Hoc analyses, revealed that the three types of task manipulation had significant influence on the fluency and accuracy of the participants’ speech. It was also revealed that GDG, treated through group discussion type of task manipulation, outperformed the other groups in terms of accuracy and fluency achievement. Tasks are hence recommended to be used in EFL teaching and testing contexts in that they are assumed to be effective tools to enhance the accuracy and fluency of English learners’ oral speech.

The article by Harvard et al. (in this issue of the Journal) on the distribution of harm reduction products in British Columbia provides an opportunity to revisit the recent controversy surrounding Insite, the Vancouver safe injection facility. Started in 2003, Insite is North America's first legal supervised injection site. Funded by the BC Ministry of Health and operated by Vancouver Coastal Health in partnership with Portland Hotel Society Community services, Insite is one of this country's important public health successes. Each year, over a quarter of a million visits are registered by over 10,000 individuals for clean and medically supervised drug injection. Insite targets marginalized populations and decreases needle sharing, prevents mortality from overdose, decreases harmful drug-related behaviours and offers both primary health care and addiction counseling and treatment to its clients. In particular, because HIV and hepatitis C infections are endemic among IV drug users (18% and 87%, respectively, of Insite clients), decreasing the risk of transmission is a public health no-brainer. However, the public's health is at risk of being overtaken by opposition to Insite voiced at the Canadian Medical Association meeting in Montreal last August by the then federal Minister of Health. Although the BC Supreme Court recently extended Insite's exception to the Controlled Drugs and Substances Act, this decision is being appealed by the federal government which has stated that it would like to see Insite closed. There is strong and consistent evidence that harm reduction strategies have substantial benefits for the health of high-risk, marginalized and hard-to-reach populations. In particular, several independent scientific evaluations by the BC Centre for Excellence in HIV/AIDS have shown not only that Insite has had an important public health impact since its opening, but also that the feared potential increase in crime rates, drug abuse and drug dealing in the community failed to materialize. 1 Quite to the contrary, there was a 30% increase in detoxification service use among Insite clients and no change in drug-related crimes was reported by the police after introduction of the facility. Decision makers sometimes assert that research results are not informative enough to support policy making. In this case, there are ample research results, as well as local community endorsement, in support of a clear-cut, evidence-based policy. Public health must speak loudly and of one voice in support of Insite and for extending this effective intervention model to other high-risk areas in Canada.

The article by Harvard et al. (in this issue of the Journal) on the distribution of harm reduction products in British Columbia provides an opportunity to revisit the recent controversy surrounding Insite, the Vancouver safe injection facility. Started in 2003, Insite is North America's first legal supervised injection site. Funded by the BC Ministry of Health and operated by Vancouver Coastal Health in partnership with Portland Hotel Society Community services, Insite is one of this country's important public health successes. Each year, over a quarter of a million visits are registered by over 10,000 individuals for clean and medically supervised drug injection. Insite targets marginalized populations and decreases needle sharing, prevents mortality from overdose, decreases harmful drug-related behaviours and offers both primary health care and addiction counseling and treatment to its clients. In particular, because HIV and hepatitis C infections are endemic among IV drug users (18% and 87%, respectively, of Insite clients), decreasing the risk of transmission is a public health no-brainer. However, the public's health is at risk of being overtaken by opposition to Insite voiced at the Canadian Medical Association meeting in Montreal last August by the then federal Minister of Health. Although the BC Supreme Court recently extended Insite's exception to the Controlled Drugs and Substances Act, this decision is being appealed by the federal government which has stated that it would like to see Insite closed. There is strong and consistent evidence that harm reduction strategies have substantial benefits for the health of high-risk, marginalized and hard-to-reach populations. In particular, several independent scientific evaluations by the BC Centre for Excellence in HIV/AIDS have shown not only that Insite has had an important public health impact since its opening, but also that the feared potential increase in crime rates, drug abuse and drug dealing in the community failed to materialize. 1 Quite to the contrary, there was a 30% increase in detoxification service use among Insite clients and no change in drug-related crimes was reported by the police after introduction of the facility. Decision makers sometimes assert that research results are not informative enough to support policy making. In this case, there are ample research results, as well as local community endorsement, in support of a clear-cut, evidence-based policy. Public health must speak loudly and of one voice in support of Insite and for extending this effective intervention model to other high-risk areas in Canada.

Twenty years ago, 14 young women were killed at the École Polytechnique de Montréal by a lone gunman. Canadians were shocked and outraged by this act of incomprehensible brutality. Under the leadership of some of the family members of the victims, gun control advocates, public health professionals, health care providers and ordinary citizens mobilized to promote stronger control of firearms. The federal Firearms Act, which created a national registration system for rifles and shotguns, resulted directly from these efforts. Although the epidemic of gun violence is not as severe in Canada as it is in the United States, pro-gun lobbies are active here as well and they have been trying for years to block or reverse progressive legislation and policies aimed at reducing gun-related violence. Now the Conservative Government has allowed a private member bill to move through the House of Commons which would repeal the gun registry. The bill, which has passed second reading, would allow anonymous purchasing of rifles and would eliminate almost 7,000,000 firearm records from the registry. The repeal of gun registration would be a major mistake and a blow to public health and to the safety of Canadians. The number of gunshot deaths in Canada has declined by close to 50% over the past two decades and suicide with firearms has decreased by over 60% among 15-35 year-olds. Murders of women by firearm as well as firearm-related accidents have also declined sharply. While there could be several explanations for these declines, it seems a pretty sure bet that the registration process and its associated rejection or revocation of licenses has played an important role. The effort to dismantle this system is not only poor policy, it is foolish and reflects self-serving politics and questionable legislative ethics. It seems that every once in a while, public health has to fight another rearguard battle from conservative elements of society trying to move us back in time. The current debate reinforces the need for vigilant public health advocacy, strong surveillance programs, long-term impact evaluation of policy and programs, and a continued focus on core values and ethical principles of interventions to ensure that Canadian population health is protected and promoted. Public health practitioners must fight to defeat this bill. Canada deserves strong and consistent policies to enhance rather than decrease gun control in order to prevent tragedies such as the killings at École Polytechnique.

The present study aimed at examining the combined effects of pre-task and online planning time on complexity, accuracy, and fluency in narrativebased texts produced by Iranian intermediate EFL learners. Overall, the implemented studies in this regard point to the facilitative impacts for both pre-task and careful online planning on complexity, accuracy, and fluency with some recorded trade-off effects. Using a between-groups design, sixty homogeneous participants were randomly assigned to four performance conditions: no planning (NP), careful online planning (OLP), pre-task planning (PTP), and both pre-task and careful online planning (POLP). The findings revealed that pre-task and careful online planning don't have any significant effects on the level of complexity. The results also suggested that whereas the provision of abundant online planning time increases the accuracy level, the opportunity to plan prior to performance leads them to generate more fluent written discourse. In addition, compared with the NP condition, pre-task in tandem with careful online planning time enable the participants to produce more accurate, and fluent written discourse that lend support to the Dual-Mode system and Limited Attentional Capacity Model. The findings are of pedagogical significance in that they speak of the efficacy of planning as an important metacognitive learning strategy capable of helping teachers achieve the desirable pedagogical objective of enhanced complexity, accuracy, and fluency of learners' task-based production. Theoretically, the results underscore the effectiveness of planning time in helping language learners overcome the limitation of their attentional capacity and direct them towards aspects of form and meaning.

The UBC Children's Dental Program (CDP) has provided free dental treatments to underserved low-income children, but its preventive component needs to be enhanced. The study aims were: 1) to develop a "waiting-room based" dental education program engaging caregivers of these children, and 2) to assess the program's feasibility, acceptability and effectiveness. In preparation, a situational analysis (SA) included structured interviews with caregivers, and with various stakeholders (e.g., dental students, instructors, health authority) involved in the CDP program. Based on the SA, caregiver-centered education was designed using an interactive power point presentation; after the presentation, each caregiver set personalized goals for modifying his/her child's dental behaviours. Evaluation of the program was done with follow-up telephone calls; the program's effectiveness was assessed by comparing before/after proportions of caregivers brushing their child's teeth, children brushing teeth in the morning and evening, children eating sugar-containing snacks, and children drinking sugar-containing drinks. The program proved to be easy to implement (feasible) and the recruitment rate was 99% (acceptable). The follow-up rate was 81%. The SA identified that the caregivers' knowledge about caries etiology and prevention was limited. All recruited caregivers completed the educational session and set goals for their family. The evaluation demonstrated an increase in caregiver-reported short-term diet and oral self-care behaviours of their children. A dental education program engaging caregivers in the waiting room was a feasible, acceptable and promising strategy for improving shortterm dental behaviours of children.

Objectives: To explore the perspectives of older adults on the acceptability of reminder letters for influenza vaccinations. Methods: We randomly selected 23 family physicians from each Family Health and Primary Care network participating in a demonstration project designed to increase the delivery of preventive services in Ontario. From the roster of each physician, we surveyed 35 randomly selected patients over 65 years of age who recently received a reminder letter regarding influenza vaccinations from their physician. The questionnaires sought patient perspectives on the acceptability and usefulness of the letter. We also conducted followup telephone interviews with a subgroup of respondents to explore some of the survey findings in greater depth. Results: 85.3% (663/767) of patients completed the questionnaire. Sixty-five percent of respondents recalled receiving the reminder (n=431), and of those, 77.3% found it helpful. Of the respondents who recalled the letter and received a flu shot (n=348), 11.2% indicated they might not have done so without the letter. The majority of respondents reported that they would like to continue receiving reminder letters for influenza vaccinations (63.0%) and other preventive services (77.1%) from their family physician. The interview participants endorsed the use of reminder letters for improving vaccination coverage in older adults, but did not feel that the strategy was required for them personally. The general attitude of older adults towards reminder letters was favourable, and the reminders appear to have contributed to a modest increase in influenza vaccination rates.

As I read the paper by Jane Underwood and colleagues on the National Community Health Nursing Study, published in the September/October 2009 issue of the CJPH, 1 I could not help asking myself the question, "Where are the students and new graduates in community health?" The study, based on the analysis of workforce data, a survey and focus groups with urban and rural managers and frontline public health nurses, aimed to describe the status of community health nursing between 2005-2008. The study portrays an older workforce, experienced in collaborating interprofessionally to address community needs and social determinants of health. The authors revealed that only 5% of community nurses were younger than 30 years old. Due to the relatively small percentage of younger nurses who participated in the study, the challenges of new and recent graduates and required supports remain unknown. I anticipate that junior community health nurses or those new to community health will face a steep learning curve as connected, knowledgeable mentors leave the workforce. In recent years, demands for community health nurses have grown exponentially as a result of shortened length of stays in hospital, increased numbers of patients living with chronic illness requiring intervention and monitoring, and an aging population requiring supportive care. However, there have been only modest increases in numbers of community health nurses, and actual declines in visiting nurses in Ontario to exemplify the trends, as outlined by the Nursing Health Services Research Unit. To respond to this situation, Richard et al. (in a previous letter to the editor) concluded that investment in continuing education and training is required. Although most recent graduates have had the necessary exposure to educational preparation to meet the Canadian Community Health Nursing Standards of Practice, 4 Cohen and Gregory indicate that few enter the community health workforce upon graduation to apply that knowledge. Thus, I contend that it is important to uncover the viewpoints of students and novice nurses regarding community health in anticipation of the upcoming workforce demands. We need to create dialogue between community health practitioners, managers, researchers, educators, policy-makers and new graduates to understand this under-representation of novice nurses in community health in Canada and to create strategies to address the issue.

Due to overcrowding and subsequent unavoidable close contact, poor ventilation, and decreased hygiene standards and healthcare services as compared with in the community setting, the prison environment is highly conducive to the transmission of infections, including COVID-19. Physical distancing measures may be difficult to implement without introducing interventions that may violate human rights. Given that Indigenous women represent over 41% of federally incarcerated women, this is a cause for concern. Indigenous women are also more likely to have higher rates of numerous chronic conditions, including respiratory illnesses, substantially increasing vulnerability to COVID-19 complications. This can be exacerbated in prisons as access to healthcare may be limited. Outbreaks within the prison setting can not only overwhelm an already over-stretched healthcare system but also spread to the community and disproportionately impact marginalized communities and populations. In this commentary, we explore the public health and human rights implications of COVID-19 in prisons while calling particular attention to the unique needs and circumstances of incarcerated Indigenous women based on international best practice-based guidance to preventive and responsive measures to COVID-19. En raison du surpeuplement et des contacts étroits, de la mauvaise ventilation et des normes d'hygiène et des services de santé réduits qui en découlent inévitablement, le milieu carcéral est hautement propice à la transmission des infections, y compris la COVID-19, comparativement au milieu ouvert. Les mesures de distanciation physique peuvent être difficiles à y appliquer sans introduire des interventions potentiellement contraires aux droits de la personne. Comme les femmes autochtones représentent plus de 41 % de la population carcérale fédérale féminine, il faut s'en inquiéter. Les femmes autochtones sont aussi plus susceptibles de présenter de plus hauts niveaux de nombreux états chroniques, dont les maladies respiratoires, qui accroissent considérablement la vulnérabilité aux complications de la COVID-19. Cette situation est exacerbée en prison, où l'accès aux soins de santé peut être limité. Les éclosions en milieu carcéral peuvent non seulement submerger un système de soins de santé déjà trop sollicité, mais se propager au milieu ouvert et affecter démesurément les communautés et les populations marginalisées. Dans notre commentaire, nous explorons les conséquences, sur le plan de la santé publique et des droits de la personne, de la présence de la COVID-19 dans les établissements pénitentiaires et nous attirons une attention particulière sur les besoins spécifiques et la situation des femmes autochtones incarcérées, en nous fondant sur des directives de prévention et d'intervention face à la COVID-19 fondées sur les pratiques exemplaires internationales.

The Canadian federal government has been recognized internationally for its leadership role in advancing health promotion. The Lalonde Report (1974), emphasized health promotion services as a critical component of the country's health care system. A few years later, a second federal government report expanded Lalonde's definition of health promotion and emphasized the role of broad social, environmental, and political determinants of health .

As a result of working inside homes, city housing inspectors witness hidden and serious threats to public health. However, systems to respond to the range of problems they encounter are lacking. In this study, we describe the impact and enabling environment for integrating a novel Social Service Referral Program within the Inspectional Services Department in Chelsea, MA. To evaluate the first eight months of the program, we used a mixed-methods approach combining quantitative data from 15 referrals and qualitative interviews with six key informants (inspectors, a case manager, and city leadership). The most common services provided to residents referred by inspectors were for fuel, food, and rent assistance; healthcare; hoarding; and homelessness prevention. Half of referred residents were not receiving other social services. Inspectors reported increased work efficiency and reduced psychological burden because of the program. Interviewees described how quality of life improved not only for referred residents but also for the surrounding neighborhood. A simple referral process that made inspectors' jobs easier and a trusted, well-connected service provider funded to carry out the work facilitated the program's uptake and impact. Housing inspectors' encounters with residents present a unique opportunity to expand the public health impact of housing code enforcement.

As a result of working inside homes, city housing inspectors witness hidden and serious threats to public health. However, systems to respond to the range of problems they encounter are lacking. In this study, we describe the impact and enabling environment for integrating a novel Social Service Referral Program within the Inspectional Services Department in Chelsea, MA. To evaluate the first eight months of the program, we used a mixed-methods approach combining quantitative data from 15 referrals and qualitative interviews with six key informants (inspectors, a case manager, and city leadership). The most common services provided to residents referred by inspectors were for fuel, food, and rent assistance; healthcare; hoarding; and homelessness prevention. Half of referred residents were not receiving other social services. Inspectors reported increased work efficiency and reduced psychological burden because of the program. Interviewees described how quality of life improved not ...

Objective: To describe the health of First Nations adults residing on Ontario reserves using data from the Ontario First Nations Regional Health Survey (OFNRHS). Method: Communities were randomly selected; individuals were systematically selected based on gender and age. Health questions were parallel to those used in the National Population Health Survey (NPHS) and included general health, chronic conditions, substance use, and health service utilization. Results: Response rate was 86% (N=1094) in participating communities; 23 of 30 selected communities participated. Most OFNRHS respondents reported that their health was good or better. Comparisons of OFNRHS participants with NPHS Ontario respondents showed: some chronic health conditions (including diabetes, high blood pressure) were more common; a greater proportion reported smoking; and a substantially lower proportion indicated that they consumed alcohol in the past year. Conclusions: The OFNRHS provides important province-wide data to inform decisions by the First Nations people about how to intervene effectively to improve their health status.

Objective: To describe the health of First Nations adults residing on Ontario reserves using data from the Ontario First Nations Regional Health Survey (OFNRHS). Method: Communities were randomly selected; individuals were systematically selected based on gender and age. Health questions were parallel to those used in the National Population Health Survey (NPHS) and included general health, chronic conditions, substance use, and health service utilization. Response rate was 86% (N=1094) in participating communities; 23 of 30 selected communities participated. Most OFNRHS respondents reported that their health was good or better. Comparisons of OFNRHS participants with NPHS Ontario respondents showed: some chronic health conditions (including diabetes, high blood pressure) were more common; a greater proportion reported smoking; and a substantially lower proportion indicated that they consumed alcohol in the past year. The OFNRHS provides important province-wide data to inform decisions by the First Nations people about how to intervene effectively to improve their health status. La traduction du résumé se trouve à la fin de l'article.

This paper corrects three widely held misunderstandings about Maxent when used in common sense reasoning: That it is language dependent; That it produces objective facts; That it subsumes, and so is at least as untenable as, the paradox-ridden Principle of Insufficient Reason.

We sought to understand how young bisexual women in Toronto perceive their sexual and reproductive health needs, the challenges to achieving those needs, and the factors contributing both positively and negatively to their sexual and reproductive health. We conducted a community-based research project that included an advisory committee of young bisexual women, academic partners, and a community health centre. Four 2-hour focus group sessions were conducted with a total of 35 participants. Data were analyzed through a constructivist grounded theory approach using Nvivo software. Participants' discussion of their sexual and reproductive health indicated that they perceived social marginalization, particularly biphobia and monosexism, as a significant challenge to their health. Participants also discussed their sexual, reproductive and mental health as interconnected. CONCLUSIONS: Young bisexual women in this study perceived their sexual, reproductive and mental health as interconnected and negatively influenced by social marginalization. This perception is in line with syndemic research that illustrates the interrelationship between psychosocial and sexual health. Researchers should further explore the utility of syndemic theory in understanding the complexity of young bisexual women's health.

We sought to understand how young bisexual women in Toronto perceive their sexual and reproductive health needs, the challenges to achieving those needs, and the factors contributing both positively and negatively to their sexual and reproductive health. We conducted a community-based research project that included an advisory committee of young bisexual women, academic partners, and a community health centre. Four 2-hour focus group sessions were conducted with a total of 35 participants. Data were analyzed through a constructivist grounded theory approach using Nvivo software. Participants&#39; discussion of their sexual and reproductive health indicated that they perceived social marginalization, particularly biphobia and monosexism, as a significant challenge to their health. Participants also discussed their sexual, reproductive and mental health as interconnected. Young bisexual women in this study perceived their sexual, reproductive and mental health as interconnected and ne...

Background: Although body piercing and tattooing seem to be gaining popularity among a diversity of social and age groups, studies of these practices in general adolescent populations are scarce. This study establishes the prevalence of body modification (tattooing and body piercing) among high school students in grades 7-11 (aged 12 to 18). Methods: Data come from a 2002 in-school survey conducted among a representative sample of 2,180 students (81% response rate) enrolled in the 23 high schools of the Outaouais region in Quebec. Systematic sampling was performed. Specific data on tattooing and body piercing are available for 2,145 students (1% non-response rate). Results: A prevalence of 27% for body piercing and 8% for tattooing is observed among high school students. Differences between girls and boys are observed in many ways: i.e., frequency and number of tattoos or piercings; aftercare practices. While most teens say that a "professional" in a studio performed their body modification and that they received aftercare instruction, a high percentage of students report health complications following the procedure. Results show that tattooing and body piercing are common among adolescents and may involve health risks. Consequently, appropriate preventive measures should be adopted by professionals such as school counsellors, nurses, physicians and others who are in contact with teenagers to help them make informed choices. MeSH terms: Tattooing; body piercing; adolescents; survey La traduction du résumé se trouve à la fin de l'article.