Readings Flashcards
What are the determinants of TB in aboriginal people of Canada?
What programmatic factor could be improved to address TB in aboriginal people?
In Canada, the incidence rate of TB is higher among Aboriginal people than the foreign-born and Canadian-born non-Aboriginals, but the greatest burden of disease, as measured by the number of cases, occurs in the foreign-born.
Status Indians in Manitoba and Saskatchewan and the Inuit in Nunavut have the highest incidence rates among Aboriginals in Canada.
In the 1980s, after decades of decline, the incidence of TB among the Inuit began to level off. However, beginning in the late 1990s and continuing until 2010, rates increased, resulting in Canada’s own “U-shaped curve of concern”.
Determinants of TB infection and disease in the Aboriginal people of Canada differ with respect to comorbidities, genetic factors, transmission factors and the social determinants of health when compared to the rest of Canada.
Social determinants of health, including lack of food security, housing, health care access, education and income are seen with higher frequency in Aboriginal groups in Canada.
Programmatic issues in TB prevention in Aboriginal groups in Canada that can be strengthened include strong TB partnerships with communities, increased community awareness, improving adherence to TB medications and underscoring the importance of effective contact investigation.
According to the most recent statistics released in 2012, the current rate of TB among the Canadian-born Aboriginal population is 26.4 per 100,000. Across Canada rates of new active and retreatment TB cases for the Aboriginal population were as follows: North American Indian 22.2 per 100,000 (188 cases), Inuit 198.6 per 100,000 (116 cases) and Métis 7.5 per 100,000 (26 cases).
In 2005, FNIHB set a long-term goal to reduce TB incidence to 3.6 per 100,000 among on-reserve First Nations and Inuit regions in Canada by 2015. Results to date suggest that this goal will not be met.
To meet these goals and achieve a substantial reduction in rates of TB among Canadian-born Aboriginal peoples it seems likely that intensified and coordinated efforts using novel approaches will be necessary.
What are Canadian guidelines around HCW infected with HBV, HCV or HIV?
Guideline recommendations: HIV, HCV and HBV
The following recommendations are common to HCWs infected
with any of the three BBVs (refer to the Guideline for full context
and footnotes on these):
• All HCWs who perform exposure-prone procedures have
ethical and professional obligations to know their HIV/HCV/
HBV status
oo If their status is negative, the HCWs should be tested
at appropriate intervals: as determined by their level of
risk and whenever an exposure has occurred
• HCWs infected with HIV/HCV/HBV who do not perform
exposure-prone procedures do not need any restrictions on
practice based on their BBV status alone
• If a HCW-to-patient transmission of HIV/HCV/HBV occurs,
the HCW should cease clinical practice immediately until
determination for fitness to return to practice is made
Table 2: Recommendations for management of
healthcare workers infected with HIV
Recommendations
HCWs infected with HIV should _seek medical care from a physician
with expertise in HIV management for optimal health maintenanc_e
and should be managed according to current recommendations with
regular monitoring of HIV RNA levels.
HCWs infected with HIV should be restricted from performing
exposure-prone procedures until:
• the HCW is under the care of a physician with expertise in HIV
management; and
• the HCW is either on effective combination antiretroviral therapy or
has been identified as an elite controller; and
• the HCW’s viral load is undetectablea.
HCWs infected with HIV who are on effective combination antiretroviral
therapy (or are elite controllers), and have an undetectable viral load
should have no restrictions on practice based on HIV status alone.
Recommendations for management of
healthcare workers infected with hepatitis C virus
Recommendations
Confirmation of active HCV infection should be done using HCV
RNA testing. HCWs infected with HCV should seek medical care
from a physician with expertise in HCV management for optimal
health maintenance and should be managed according to current
recommendations.
HCWs testing positive for HCV RNA should be restricted from
performing exposure-prone procedures until:
• the HCW is under the care of a physician with expertise in HCV
management; and
• the HCW has completed effective therapya,b; and
• the HCW has tested negative for HCV RNA at least 12 weeks
post‑treatmentb.
Note: Expert Review Panels may individualize practice restrictions to
allow a HCW to perform exposure-prone procedures while on effective
therapy provided the virus is undetectable. The HCW’s practice should
then be restricted post treatment until a sustained virologic response
is confirmed.
HCWs testing negative for HCV RNA 12 weeks post-treatment can be
considered to have a sustained virologic response and should have no
restrictions on practice based on HCV status alone.
Recommendations for management of
healthcare workers infected with hepatitis B virus
Recommendations
HCWs who remain susceptible to HBV (anti-HBs negative and anti-HBc
negative) should be tested at appropriate intervals as determined by
their level of risk and whenever an exposure has occurred.
HCWs born or previously residing in high HBV endemic countries
should be tested for both anti-HBc and HBsAg to fully define HBV
statusa,b.
HCWs infected with HBV should seek medical care from a physician
with expertise in HBV management for optimal health maintenance
and should be managed according to current recommendations with
regular monitoring of HBV DNA levelc.
_HCWs infected with HBV should be restricted from performing
exposure-prone procedures until:
• the HCW is under the care of a physician with expertise in HBV
management; and
• the HCW’s HBV DNA level is below 103 IU/mL (5 x 103 GE/mL)d or
equivalent and monitored regularly (every 3 to 6 months)_e.
HCWs infected with HBV who have HBV DNA levels less than or equal
to 103 IU/mL (5 x 103 GE/mL)d or equivalent should have no restrictions
on practice based on HBV status alone.
What are health consequences of UV exposure?
basal cell carcinoma
squamous cell carcinoma
melanoma
premature aging of skin
cataracts
may suppress cell-mediated immunity
What are the 8 domains of Age-Friendly Cities Project?
In 2006, the World Health Organization (WHO) developed the Global Age-Friendly Cities Project. This project brought together cities from around the world that were interested in supporting healthy aging by becoming more age-friendly. These cities gathered information from seniors, senior-care providers and other groups and individuals with an interest in age-friendly communities. This information helped to identify eight key domains of community life in which communities can become more age-friendly. These domains are:
outdoor spaces and buildings;
transportation;
housing;
social participation;
respect and social inclusion;
civic participation and employment;
communication and information; and
community support and health services.
What are key elements that should be included in job descriptions
Exact title and status (part-time or full-time, permanent or time-limited)
Salient details regarding the job (geographical location, salary, shiftwork, etc.)
Description of core functions/competencies
Prerequisites/requirements (education, professional memberships, experience, language, etc.)
What is forecasting
A method of estimating what may happen in the future that relies on extrapolation of existing trends.
What are evidence-based interventions to modify physician behavior?
audit and feedback,
computerized decision support systems,
continuing medical education,
financial incentives,
local opinion leaders,
marketing / academic detailing
patient-mediated interventions,
reminders, and
multifaceted interventions
Define and contrast impairment, disability and handicap
Impairment
A loss of function or ability
Disability
Functional limitation due to an impairment
Handicap
A condition imposed on a person with disabilities by society, the physical environment, or the person’s attitude
According to the Canadian pandemic plan, what are factors that affect the potential impact of a pandemic?
Virus transmissibility - degree of transmission, speed of spread, season of arrival.
Virulence - clinical severity
Population vulnerability - pre-existing population immunity, unexpected risk factors, special groups and settings
Public health interventions - vaccine (availability, timing, effectiveness), antiviral (availability, resistance), PHSM
Health care system response - access to care, surge capacity, supply availability
Risk communication - behavioral response
What are strategies to reduce childhood obesity according to PHAC in 2012?
Vision: Canada is a country that creates and maintains the conditions for healthy weights so that children can have the healthiest possible lives.
This Framework for Action is comprised of three integrated strategies:
I—Making childhood overweight and obesity a collective priority
for action for F/P/T Ministers of Health and/or Health
Promotion/Healthy Living, who will champion this issue and
encourage shared leadership and joint and/or complementary
action from government departments and other sectors of
Canadian society.
II—Coordinating efforts on three key policy priorities:
> Supportive Environments: making social and physical
environments where children live, learn and play more
supportive of physical activity and healthy eating;
> Early Action: identifying the risk of overweight and obesity
in children and addressing it early; and,
> Nutritious Foods: looking at ways to increase the availability
and accessibility of nutritious foods and decrease the
marketing of foods and beverages high in fat, sugar and/
or sodium to children.
III—Measuring and reporting on collective progress in reducing
childhood overweight and obesity, learning from successful
initiatives, and modifying approaches as appropriate.
Strategies
Evidence shows that childhood overweight and obesity can be
infl uenced by several important factors, including:
> the availability and affordability of nutritious food;
> the accessibility of proper nutrition and support to
mothers during pregnancy;
> the provision of baby-friendly health settings;
> the protection of children from the marketing of foods
and beverages high in fat, sugar and/or sodium;
> the levels of physical activity and healthy eating within
the school environment;
> the early identification of infants and children who are
overweight or obese and referral to an eff ective child
healthy weight program;
> the supportive design of communities to encourage
active living;
> the levels of awareness, skills and knowledge of
Canadians, including parents and caregivers, regarding
the importance of healthy eating and physical activity;
> the need for children and their families to have positive
mental health and have access to community or public
health services.
What are Brighton anaphylaxis criteria?
sudden onset
rapid progression
2+ organ systems:
- at least one major cardiovascular or resp criterion +
- one major derm
+ culpable exposure
+ no alternate explanation
What are the messages to general and at risk population depending on the AQHI levels?
What are criticisms of the AQHI?
AQHI Criticisms
Not validated for rural regions
Most health effects are from long term exposure yet unknown relationship with chronic exposure
Most people spend their time inside, more exposure inside
Doesn’t account for other pollutants (only PM2.5, O3, NO2)
Assumes additive effect
Limited evidence on benefits from messaging
Does not include heat, humidity, allergens
Community average
In the F/P/T public health response plan for biological events, what are the response levels and response goals?
Response levels: routine, heightened, escalated, emergency
Response goals: Outbreak prevention, outbreak control, risk mitigation, mitigate impact/social disruption
- *Normal or routine**
- Info sharing bw jurisdiction and other FPTI authorities
- *Heightened**
- Routine PH response involving one or more jurisdictions
- *Escalated**
- Coordinated FPT response as it is one of:
- An event in multiple jurisdictions within Canada and unusual in progression/severity
- PHEIC occurring outside of Canada
- Potential implications for Canadian HC system
- Potentially require provision of aid
- *Emergency**
- Coordinated FPT response as it is one of:
- Event in Canada causing significant illness w potential for rapid spread
- Risk in Canada has potential for causing significant illness and/or could spread internationally from Canada
- PHEIC that could cause significant illness within Canada
What are the incubation period, PEP and contagious period for vaccine preventable diseases?
Hepatitis A
Incubation: 15-50d - usually 28-30
PEP:
- within 2 weeks,
- <6 months → Ig alone;
- immunocompromised, age>60 years, or liver disease → vaccine + Ig;
- all other contacts → vaccine alone;
Contagiousness: 2 weeks before clinical illness to 7 days after the onset of jaundice
Measles
Incubation: 7-21d (avg 10 to fever, 14 to rash)
PEP:
- >12months vaccine within 72h,
- 6-12mo vaccine within 72h or Ig 3-6d,
- <6mo/IC/preg Ig within 6d
Contagiousness: 4 days before to 4 days after rash onset
Mumps
Incubation: 12-25d (avg 16-18)
PEP: none (vaccinate for future exposures)
Contagiousness: 2 days before to 5 days after parotitis onset
Rubella
Incubation: 14-21d (avg 14-17)
PEP: Ig may be considered in pregnancy if would not consider abortion; test those in first trimester after exposure (IgM/IgG), vaccinate for future exposures
Contagiousness: 1 week before rash to 4 days after
Varicella
Incubation: 10-21d (avg 14-16)
PEP: vacc within 72h, IG if high risk and can’t vacc
Contagiousness: 5 days before rash until all lesions are crusted
Meningococcal disease
Incubation: 2-10d (avg 3-4)
PEP: abx for close contacts (cipro/CTX/rif), strain-specific vaccine for those with ongoing exposures
Contagiousness: 7 days before symptoms to 24h after initiation of antibiotics
Pertussis
Incubation: 6-20d (avg 9-10)
PEP: macrolide for households contacts within 21 dayswhere there is:
- a child <1y ,
- pregnant person
- high-risk contacts
Contagiousness: No longer contagious 5 days after antibiotics.
Haemophilus influenzae
Incubation: Unknown, probably 2-4d
PEP: rifampin for all unimmunized or incompletely
immunized household and child care contacts
Diphtheria
Incubation: 2-5d, occasionally longer
PEP: PCN (IM) or erythro for all close contacts regardless of immunization status; vacc for underimmunized or if >5y from last dose
Tetanus
Incubation: Months to years
PEP (wound mgmt):
- clean/minor - vaccine if underimmunized, vaccine if last dose >10y;
- dirty/major - vacc & IG if underimmunized, vaccine if last dose >5y
Influenza
Incubation: 1-4d (avg 2)
PEP: oseltamivir x 5d for high risk people
Contagiousness: 24h before illness onset to 7 days after
Hepatitis B
Incubation: 45-180d (avg 60-90)
PEP:
- infants born to infected mothers -> vaccine within 12h and HBIG, then vaccine at 1-2 and 6 mos
- susceptible person potentially exposed to infected bodily fluid (bite, sexual activity, needlestick, sharing IVDU equipment) ->
HBIG if known exposure and non immune/status unknown, vaccine series;
if immune with titres >10 milliIUs/mL no treatment.
- suseptible house household or sexual contacts of acute or chronic carrier case needlestick -> vaccinate
Polio
Incubation: 3-35d (avg 7-14d)
PEP: aggressive community immunization
Pneumococcal disease
Incubation: Unclear, may be as short as 1-3d or associated w colonization
No PEP
Order of vaccine: Conjugate vaccine before polysaccharide in older adults (1 mo wait, otherwise have to wait a year)
What are recent trends in STBBI in Canada?
Concerning increases for some sexually transmitted
and blood-borne infections (STBBI) have been
observed in Canada. From 2007 to 2016, the
reported rates for chlamydia, gonorrhea, and
syphilis increased by 49%, 81% and 178%,
respectively (Figure 5).38 Moreover, six cases of
congenital syphilis were reported in Canada in
2015, reversing the previous downward trend
observed from 2011 to 2014.39 This result is disquieting
as it coincides with a rise in syphilis cases
in women of childbearing age. There are numerous
factors that may contribute to some extent to the observed trends, o_ther than a true rise in incidence,
such as improved diagnostic tools, contact tracing,
and case detection_.40
While the number of newly diagnosed HIV infections
remained relatively stable in Canada_, 14% of people
living with HIV were estimated to be unaware of
their status in 2016_.41 Similarly, as of 2016, national
Hepatitis C infection rates remained stable over the
course of previous years.42 An estimated 44% of
Canadians living with Hepatitis C are thought to be
unaware of their status.43
Some communities are disproportionally affected.
For example, g_ay, bisexual and other men who
have sex with men accounted for more than 50%
of new HIV infections in 2016, although they represented
approximately 3% of the male population_in
Canada. Indigenous peoples accounted for 11% of
new HIV infections in 2016, but represented only
5% of the general population.41
Certain sub-populations are at high risk for
Hepatitis C infections, such as people who
inject drugs and people who are incarcerated.
Define AEFI.
What AEFI should be reported?
What are 5 classifications for AEFIs?
An AEFI is any untoward medical occurrence which follows immunization and which does not necessarily have a causal relationship with the usage of the vaccine. The adverse event may be any unfavourable or unintended sign, abnormal laboratory finding, symptom or disease.
AEFIs should be reported when the event:
Has a temporal association with a vaccine;
Has no other clear cause at the time of reporting: A causal relationship between immunization and the event that follows does not need to be proven and submitting a report does not imply or establish causality. Sometimes the vaccinee’s medical history, recent disease, concurrent illness/condition and/or concomitant medication(s) can explain the event(s).
Of particular interest are those AEFIs which:
Meet one or more of the seriousness criteria: An adverse event that is life threatening or results in death, requires hospitalization or prolongation of an existing hospitalization, results in residual disability or causes congenital malformation.
Are unexpected regardless of seriousness: An adverse reaction whose nature, severity, or outcome is not consistent with the term or description used in the local/regional product labeling (e.g., Package Insert or Summary of Product Characteristics) should be considered unexpected.
AEFIs are grouped into five categories (PHO):
Vaccine product-related reaction
Vaccine quality defect-related reaction
Immunization error-related reaction
Immunization anxiety-related reaction
Coincidental event
What are criteria for deciding on health indicators?
Address important issues
Feasible
Scientifically valid
Implications are understood
Provide meaningful information
Single measure
Reported regularly
Relevant and actionable info
Provides comparable info
Tracks progress and performance over time
How to calculate chi-square statistics?
What is NACI’s framework for systematically considering vaccine program recommendations?
NACI’s Framework for for the systematic consideration of ethics, equity, feasibility, and acceptability in vaccine program recommendations
ESSENTIALLY:
Conduct reviews of scientific factors
Then apply EEFA matrices: ethics, equity, feasibility, acceptability
Consult as needed
What types of data are collected in the Canadian Community Health Survey?
How are the results of the Canadian Community Health Survey used?
Participants will be asked questions on multiple topics such as the perception of their physical and mental health state, on chronic conditions, the use of health care services, and behaviors related to health such as smoking, physical activity, consumption of fruits and vegetables and alcohol use.
Data are also collected on a variety of socio-demographics. These data allow for health analysis for specific population groups (by age groups, geography, etc.)
By collecting information about health at the community level, the Canadian Community Health Survey can support:
program design and evaluation
health needs assessments
policy development
advocacy
research
support local health units by providing them with the timely information they need to evaluate existing programs and to design new ones suited to their communities
provide more current, detailed and uniform health information in every province and territory.
Results of our surveys are used for policy-making and program development that affect Canadian communities. The Canadian Community Health Survey has already been instrumental in drawing attention to emerging health issues, such as the decrease in teen smoking.
Your information may also be used by Statistics Canada for other statistical and research purposes.
What are requirements for optimal childhood development?
What is the early development index and what are its 5 domains?
Requirements for optimal childhood development
Time and commitment
Financial resources
Psychological resources
Institutional resources
Skills and knowledge
Good nutrition
Safe and supportive physical environments
Stable and responsive relationships
The Early Development Instrument, or the EDI for short, is a questionnaire developed by Dr. Dan Offord and Dr. Magdalena Janus at the Offord Centre for Child Studies at McMaster University.
The EDI is a 103-item questionnaire completed by kindergarten teachers in the second half of the school year that measures children’s ability to meet age-appropriate developmental expectations in five general domains:
Physical health and wellbeing
Language and cognitive development
Emotional maturity
Social competence
Communication skills and general knowledge
What are drivers of program implementation?
What are types of budget?
Master budget
Operating budget (expense and revenue)
Cash flow budget
Financial budget
Static or forecasting budget
Mnemonic Finance Master Cash Operation
What are the key areas of focus in the TB federal framework?
I. Optimizing and enhancing current efforts to
prevent and control active TB disease
II. Facilitating the identification and treatment
of latent TB infection for those at high risk
of developing active TB disease
III. Championing collaborative action to address
the underlying risk factors for TB (SDoH)
Describe mental health trends in Canada and variations between sub-populations.
What is the suicide rate?
Mental health varies considerably among Canadians,
with some sub-populations being much more likely
to report low self-rated mental health. For example,
for the period of 2010 to 2013, adults who identified
as bisexual were close to three times more
likely, and adults who identified as gay or lesbian,
were approximately twice more likely, to report low
self-rated mental health than adults who identified
as heterosexual. These higher rates could be linked
to internalized stress related to gender expectations
and experienced discrimination.3
In Canada, _suicide rates remained stable from
2000 to 2017. On average, 11 Canadians die by
suicide every day.14 In 2017, the suicide rate among
males was three times higher than the rate among
females. Suicide rates were highest among middleaged
males.14 Some Indigenous communities are
disproportionally affected._Areas with a relatively
high Inuit population had a 6.5 times higher suicide
rate than areas with a low concentration of
Indigenous peoples.3 Suicide rates in areas primarily
inhabited by First Nations and Métis peoples
were also significantly higher (four and three times,
respectively) than in areas with a non-Indigenous
peoples majority.3 The impacts of intergenerational
trauma can ultimately manifest in poor mental health
and practices that may place individuals at risk for
suicide. However, it is important to note that not all
Indigenous communities experience high suicide
rates. For example, over 60% of First Nations bands
had a suicide rate of zero.15 Protective factors can
include opportunities to speak and learn one’s traditional
language, cultural identity, and connection to
the land.16, 17
What are sun safety tips to prevent skin cancer?
What are factors affecting UV index?
What are health effects from UV?
What are risk factors for skin cancer?
Most cases of skin cancer are preventable. You can reduce your risk of getting skin cancer by following these safety tips:
Cover up. When the UV Index is 3 or higher, protect your skin as much as possible. Wear light-coloured, long-sleeved shirts, pants, and a wide-brimmed hat made from breathable fabric. When you buy sunglasses, make sure they provide protection against both UVA and UVB rays.
Limit your time in the sun. K_eep out of the sun and heat between 11 a.m. and 3 p.m._ The UV index in Canada can be 3 or higher during those times. When your shadow is shorter than you, the sun is very strong. Look for places with lots of shade, like a park with big trees, partial roofs, awnings, umbrellas or gazebo tents. Always take an umbrella to the beach.
Use the UV Index forecast. Tune in to local radio and TV stations or check online for the UV index forecast in your area. When the UV index is 3 or higher, wear protective clothing, sunglasses, and sunscreen, even when it’s cloudy. Factors affecting UV index = cloud cover, altitude, aerosols, air pollution (SO2, NO2), snow cover.
Use sunscreen. Put sunscreen on when the UV index is 3 or higher. Use sunscreen labelled “broad spectrum” and “water resistant” with an SPF of at least 30.
Drink plenty of cool liquids (especially water) before you feel thirsty. If sunny days are also hot and humid, stay cool and hydrated to avoid heat illness. Dehydration (not having enough fluids in your body) is dangerous, and thirst is not a good indicator of dehydration.
Avoid using tanning equipment. There is no such thing as a ‘healthy’ tan. Using tanning equipment damages your skin and increases your risk of developing melanoma, the deadliest form of skin cancer.
Ask your doctor, nurse or pharmacist if any of the medications you are taking could be harmful to you if you are exposed to UV rays. The best way to find skin cancer in its early stages is to examine your skin often. See your doctor right away if you notice any of the following: abnormally dark or discoloured patches or spots bleeding, crusting or change in the colour, size or shape of a mole.
Also, better workplace policies
Health effects from UV:
BCC, SCC, melanoma, cataracts, keratinic actinosis, seborrheic keratosis, elastosis/skin agin.
Risk factors for skin cancer:
Sun exposure, skin type, moles, tanning bed, males, photosensitizing meds, personal + family history.
What are surveillance systems for antimicrobial resistance in Canada? (7)
Canadian Antimicrobial Resistance Surveillance System (CARSS)
Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS)
Canadian Nosocomial Infection Surveillance Program (CNISP)
Enhanced surveillance of antimicrobial-resistant gonorrhea program (ESAG)
Canadian Tuberculosis Laboratory Surveillance System
National Microbiology Laboratory of the Public Health Agency of Canada (the Agency)
Laboratory for Foodborne Zoonoses
What are evidence-based recommendations for vaccination and screening in immigrants and refugees to Canada?
Vaccinate MMRV DTaP-IPV HBV-HPV
Screen HBV, HCV, HIV, schisto/strongy, IDA, dental pain, vision, cervical Ca.
• Vaccination (against measles, mumps, rubella,
diphtheria, tetanus, pertussis, polio, varicella, hepatitis B
and human papillomavirus)andscreening (for hepatitis
B, tuberculosis, HIV, hepatitis C, intestinal parasites, iron
deficiency, dental pain, loss of vision and cervical cancer)
should be routinely provided to at-risk immigrants.
Detecting and addressing malaria, depression, posttraumatic
stress disorder, child maltreatment, intimate
partner violence, diabetes mellitus and unmet
contraceptive needs should be individualized to improve
detection, adherence and treatment outcomes.
Measles, mumps and rubella
Vaccinate all adult immigrants without immunization records
using one dose of measles–mumps–rubella vaccine.
Vaccinate all immigrant children with missing or uncertain
vaccination records using age-appropriate vaccination for
measles, mumps and rubella.
Diphtheria, pertussis, tetanus and polio
Vaccinate all adult immigrants without immunization records
using a primary series of tetanus, diphtheria and inactivated
polio vaccine (three doses), the first of which should include
acellular pertussis vaccine.
Vaccinate all immigrant children with missing or uncertain
vaccination records using age-appropriate vaccination for
diphtheria, pertussis, tetanus and polio.
Varicella
Vaccinate all immigrant children < 13 years of age with
varicella vaccine without prior serologic testing.
Screen all immigrants and refugees from tropical countries
≥ 13 years of age for serum varicella antibodies, and
vaccinate those found to be susceptible.
Hepatitis B
Screen adults and children from countries where the seroprevalence
of chronic hepatitis B virus infection is moderate
or high (i.e., ≥ 2% positive for hepatitis B surface antigen),
such as Africa, Asia and Eastern Europe, for hepatitis B
surface antigen, anti-hepatitis B core antibody and antihepatitis
B surface antibody.
Refer to a specialist if positive for hepatitis B surface antigen
(chronic infection).
Vaccinate those who are susceptible (negative for all three
markers).
Tuberculosis
Screen children, adolescents < 20 years of age and refugees
between 20 and 50 years of age from countries with a high
incidence of tuberculosis as soon as possible after their arrival
in Canada with a tuberculin skin test.
If test results are positive, rule out active tuberculosis and
then treat latent tuberculosis infection.
Carefully monitor for hepatotoxity when isoniazid is used.
HIV
Screen for HIV, with informed consent, all adolescents and
adults from countries where HIV prevalence is greater than
1% (sub-Saharan Africa, parts of the Caribbean and
Thailand).
Link HIV-positive individuals to HIV treatment programs and
post-test counselling.
Hepatitis C
Screen for antibody to hepatitis C virus in all immigrants and
refugees from regions with prevalence of disease ≥ 3% (this
excludes South Asia, Western Europe, North America, Central
America and South America).
Refer to a hepatologist if test result is positive.
Intestinal parasites
Strongyloides: Screen refugees newly arriving from Southeast
Asia and Africa with serologic tests for Strongyloides, and
treat, if positive, with ivermectin.
Schistosoma: Screen refugees newly arriving from Africa with
serologic tests for Schistosoma, and treat, if positive, with
praziquantel.
Malaria
Do not conduct routine screening for malaria.
Be alert for symptomatic malaria in migrants who have lived
or travelled in malaria-endemic regions within the previous
three months (suspect malaria if fever is present or person
migrated from sub-Saharan Africa). Perform rapid diagnostic
testing and thick and thin malaria smears.
Depression
I_f an integrated treatment program is available, screen
adults for depression using a systematic clinical inquiry or
validated patient health questionnaire (PHQ-9 or
equivalent)._
Individuals with major depression may present with somatic
symptoms (pain, fatigue or other nonspecific symptoms).
Link suspected cases of depression with an integrated
treatment program and case management or mental
health care.
Post-traumatic stress disorder
Do not conduct routine screening for exposure to
traumatic events, because pushing for disclosure of
traumatic events in well-functioning individuals may result
in more harm than good.
Be alert for signs and symptoms of post-traumatic stress
disorder (unexplained somatic symptoms, sleep disorders
or mental health disorders such as depression or panic
disorder).
Child maltreatment
Do not conduct routine screening for child maltreatment.
Be alert for signs and symptoms of child maltreatment
during physical and mental examinations, and assess
further when reasonable doubt exists or after patient
disclosure.
A home visitation program encompassing the first two
years of life should be offered to immigrant and refugee
mothers living in high-risk conditions, including teenage
motherhood, single parent status, social isolation, low
socioeconomic status, or living with mental health or drug
abuse problems.
Intimate partner violence
Do not conduct routine screening for intimate partner
violence.
Be alert for potential signs and symptoms related to
intimate partner violence, and assess further when
reasonable doubt exists or after patient disclosure.
Type 2 diabetes mellitus
Screen immigrants and refugees > 35 years of age from
ethnic groups at high risk for type 2 diabetes (those from
South Asia, Latin America and Africa) with fasting blood
glucose.
Iron-deficiency anemia
Women
Screen immigrant and refugee women of reproductive age
for iron-deficiency anemia (with hemoglobin).
If anemia is present, investigate and recommend iron
supplementation if appropriate.
Children
Screen immigrant and refugee children aged one to four
years for iron-deficiency anemia (with hemoglobin).
If anemia is present, investigate and recommend iron
supplementation if appropriate.
Dental disease
Screen all immigrants for dental pain. Treat pain with
nonsteroidal anti-inflammatory drugs and refer patients to
a dentist.
Screen all immigrant children and adults for obvious
dental caries and oral disease, and refer to a dentist or oral
health specialist if necessary.
Vision health
Perform age-appropriate screening for visual impairment.
If presenting vision < 6/12 (with habitual correction in
place), refer patients to an optometrist or ophthalmologist
for comprehensive ophthalmic evaluation.
Contraception
Screen immigrant women of reproductive age for unmet
contraceptive needs soon after arrival to Canada.
Provide culturally sensitive, patient-centred contraceptive
counselling (giving women their method of choice, having
contraception on site and fostering a good interpersonal
relationship).
Vaccination against human papillomavirus
Vaccinate 9- to 26-year-old female patients against human
papillomavirus .
Cervical cytology
Screen sexually active women for cervical abnormalities by
Papanicolaou (Pap) test.
Information, rapport and access to a female practitioner
can improve uptake of screening and follow-up.
What are the 6 steps along which audiences move in relation to their behavior change according to the WHO communications continuum?
- Awareness
- Relevance
- Awareness of solutions
- Capacity to change
- Cost-benefit analysis
- action, decision
What is the CTFPHC recommendations on the use of pelvic examinations to screen for non-cervical conditions?
The Task Force recommends NOT performing a screening pelvic examination to screen for noncervical cancer, pelvic inflammatory disease, or other gynecological conditions in asymptomatic women.
(Strong recommendation; moderate-quality evidence)
Describe the controversy with Canada, the Rotterdam Convention and chrysotile asbestos.
At the 2011 meeting of the Rotterdam Convention in Geneva, the Canadian delegation surprised many with a refusal to allow the addition of chrysotile asbestos fibers to the Rotterdam Convention.[5][6][7][8] Hearings are scheduled in the EU in the near future to evaluate the position of Canada and decide on the possibility of a punitive course of action.[9][10][11]
In continuing its objection, Canada is the only G8 country objecting to the listing. Kyrgyzstan, Kazakhstan and Ukraine also objected. Vietnam had also raised an objection, but missed a follow-up meeting on the issue.[12] In taking its position, the Canadian Government contrasted with India, which withdrew its long-standing objection to the addition of chrysotile to the list just prior to the 2011 conference. (India later reversed this position in 2013.)[13]
Numerous non-governmental organizations have publicly expressed criticism of Canada’s decision to block this addition.[14][15][16][17][18]
In September 2012, Canadian Industry minister Christian Paradis announced the Canadian government would no longer oppose inclusion of chrysotile in the convention.[19]
Eight of the largest chrysotile producing and exporting countries opposed such a move at the Rotterdam Conference of Parties in 2015: Russia, Kazakhstan, India, Kyrgyzstan, Pakistan, Cuba, and Zimbabwe.[13]
What 3 criteria of disease eradicability?
Indicators of eradicability: (mnemonic they can’t HIDe)
Humans are essential for the life cycle of the agent (i.e., no other vertebrate reservoir, no environmental amplification)
effective Intervention
a sensitive/specific practical Diagnostic tool is available to detect transmission
Other considerations for pursuing eradication:
Cost-effectiveness analysis
social and political commitment
public health importance
equity
What are different types of regression?
Multivariable - multiple confounders/variables controlled for
+
Either
Logistic regression - binary outcome being assessed (eg alive/dead)
Linear regression - continuous outcome (eg blood pressure)
Cox proportional hazards - hazard data
Poisson regression - rate outcome
What are environmental health roles of:
- Public Health Unit
- Municipal government
- Provincial and Territorial governement
- Federal government
Public Health Unit
Enforcement of water and food safety regulations (including restaurant food safety)
Assessment of local environmental risks
Monitoring and follow-up of reportable diseases
Investigation of environmental contamination, clusters of disease
Municipal Government
Waste disposal, recycling, water and sewage treatment/collection/distribution
Provincial and Territorial Government
Water and air quality standards
Industrial emission regulation
Toxic waste disposal
Federal Government
Designating and regulating toxic substances
Regulating food products (e.g. Health Canada (drugs), CFIA)
Setting policy for pollutants that can travel across provincial boundaries
International
Multilateral agreements (e.g. Kyoto Protocol, UN Convention on Climate Change, International Joint Commission)
What are trends in colorectal cancer?
Trends in colorectal cancer
Colorectal cancer incidence rates are declining in males and females. The recent declines are likely due in part to increased use of colorectal cancer screening which can identify and remove precancerous polyps, which can in turn reduce incidence.
Death rates have also been declining. Most of this decline is likely driven by decreased incidence, as well as by improved diagnosis and treatment.
Chances (probability) of developing or dying from colorectal cancer
It is estimated that about 1 in 14 Canadian men will develop colorectal cancer during their lifetime and 1 in 32 will die from it.
It is estimated that about 1 in 18 Canadian women will develop colorectal cancer during their lifetime and 1 in 37 will die from it.
According to the PHAC Canadian Guidelines on Sexually Transmitted Infections redarding syphilis:
What are recent trends and risk factors?
When is screening recommended?
Key Information
Public health importance
Syphilis is of considerable public health importance in Canada as evidenced by a steep increase in rates since 2014. Left untreated, syphilis has many associated complications. Gay, bisexual and other men who have sex with men (gbMSM) are disproportionately affected. Higher rates are still reported in this population although an increasing number of outbreaks in heterosexual populations have been reported in Canada since 2017. Congenital syphilis is also re-emerging with the highest number of cases ever being reported in 2018 and 2019.
Note: Syphilis infections are reportable to local public health authorities in all provinces and territories.
Screening
Routine screening is recommended for people with risk factors for syphilis and for pregnant people.
Screening is of particular importance in pregnancy for the prevention of congenital syphilis and its impact on pregnancy outcomes. Universal screening is recommended for pregnant people during the first trimester or at first prenatal visit. Repeat screening at 28 to 32 weeks and again at delivery is recommended for pregnant people at ongoing risk of infection or reinfection and in areas experiencing outbreaks of syphilis. Consider screening more frequently pregnant people at ongoing risk of infection. Screen all woman who deliver a stillborn infant after 20 weeks gestation.
Diagnostic testing
Syphilis is usually diagnosed through serology regardless of suspected stage of infection. Interpretation of serology results can be complex, and different testing algorithms may be used by provinces and territories. Consult with your local laboratory regarding testing protocols.
Treatment
Infectious syphilis (primary, secondary and early latent stages): Long-acting Benzathine Penicillin G 2.4 million units intramuscular as a single dose.
Longer duration syphilis (late latent and tertiary syphilis): Three (3) weekly doses of Benzathine penicillin G-LA 2.4 million units IM.
Neurosyphilis requires more aggressive treatment with intravenous antibiotics, and should be managed by, or in consultation with, an infectious disease specialist.
Follow-up
Post treatment serologic testing is used to assess treatment response. It should be done at recommended intervals, which vary depending on stage of infection.
Partner notification
T_est and treat sexual or perinatal contacts._ The trace-back period will depend on the stage of infection of the index case.
What are 5 steps in information cycle?
Collection
Retention
Use (Analysis, interpretation, dissemination)
Disclosure
Destruction
What are the 4 criteria used to decide on toxic substances that will be virtually eliminated from the environment as a precaution and preventive approach as outlined in the Toxic Substances Management Policy?
The federal Toxic Substances Management Policy puts forward a preventive and precautionary approach to deal with substances that enter the environment and could harm the environment or human health.
A Candidate Substance is scientifically assessed based on consideration of:
1) CEPA-toxic or equivalent; [Canadian Environmental Protection Act (CEPA)]
2) Predominantly Anthropogenic;
3) Bioaccumulative; and
4) Persistent.
If all aspects are met, the substance is deemed for Virtual Elimination from the environment (track 1). If the aspects are not all met, Life-cycle management (track 2) to prevent or minimize release into the environment is initialized.
What is the collective impact approach?
Collective Impact is a collaborative, multi-partner approach that brings together a group of collaborating organizations from different sectors to commit to a common agenda designed to produce significant changes in their community.
5 core conditions of the Collective Impact model
Common agenda
A common agenda requires a shared vision for change that includes a common understanding of the problem, a joint approach involving agreed upon actions and a common set of outcomes.
Shared measurement
All participating organizations agree on the ways success will be measured and reported, with a short list of common indicators identified and used for learning and improvement.
Mutually reinforcing activities
Collaborating organizations work as a team on coordinated actions that support each other. Mutually reinforcing activities ensure that each collaborator’s specific set of activities in which they excel are aligned towards achieving the common agenda and shared measures.
Continuous communications
All players engage in frequent and structured open communication to build trust, assure mutual objectives, and create common motivation.
Backbone
The backbone organization guides and supports the Collective Impact collaborating organizations as they work collectively to reach their common agenda. The backbone leads the collection of data and develops shared measurement systems that serve the needs of the collaborative. The backbone organization also leads communications and brings partners and key external stakeholders together to share information and seek opportunities for alignment with other community efforts.
What are principles to guide screen time in children?
What are health risks to screen time?
Evidence-based guidance to optimize and support children’s early media experiences involves four principles: minimizing, mitigating, mindfully using and modelling healthy use of screens.
Screen time can include time in front of a TV, gaming console, computer, tablet or cell phone. Children can learn many good things from technology, but learn more from spending time with you. Technology can take away from time that could be spent playing and being with family. Children that have too much screen time are at risk for becoming overweight, sleep-deprived, less school-ready, less attentive, and less able to self-soothe. Very little physical energy is exerted during screen time.
Set Limits to Screen Time
Setting limits to screen time helps build healthy habits for the future. It is important to create rules and to share these rules with other adults in your child’s life. For your child’s safety when using tablets, computers or phones, look for apps that provide parental controls which can help block sites and enforce time limits.
Screen time for children younger than 2 years is not recommended. For children aged 2 to 5 years, limit routine or regular screen time to less than 1 hour per day.
Be a Good Example
Set a good example by modeling healthy screen time habits. Cell phones and other devices take your attention away from your child which can be dangerous. Your child is more likely to act-out in order to get your attention when you are distracted. Engaging your child using play and books is better for your child’s brain and social development than screens.
Creating Healthy Habits
Keeping devices in a common area can help you control when and how your child uses screen time. It is important for you to know how your child is using technology. Screens and television programs that are not meant for children can have a negative effect on their development. Watch and talk to your child while they are using screens. Choose content that is right for your child’s age. Turn off screens one hour before bed to help your child fall asleep easier. Turn off screens during mealtimes and other times when they are not necessary.
Describe a structured approach to evaluating a study or data?
−Y a-t-il des différences entre les groupes ? Les groupes sont-il comparables? Y a-t-il des tendances dans le temps? Validité interne
−Dues au hasard? Erreur aléatoire (pas de différence statistiquement significative)
−Dues à un biais ?
oSélection (échantillonnage, représentativité, couverture, données manquantes – exhaustivité des cas)
oInformation (définition du problème, méthode et outils de collecte)
oConfusion
−Dues à une causalité inverse?
−« Réelles » ? (différence statistiquement significative non expliquée par un biais)
oLe choix de la méthode statistique est approprié pour les données?
−Si différence « réelle »,
−Plausibilité d’un lien de causalité ?
−Quelle est la signification « clinique » / populationnelle du résultat (au-delà de la signification statistique)?
−Quelle est l’interprétation des données? Modification réelle vs artéfactuelle du paramètre?
−Quelles sont les explications possibles (Mnémonique BEDEET, ou Agent-Hôte-Environnement?
oBiologiques (ex: développement d’une antibiorésistance)
oÉpidémiologique (ex: chgmt comportement, mesure de santé publique, ↑ suspicion ou recherche de soins, ↑ déclaration)
oDémographique (ex: augmentation de la taille de la population, diminution des naissances) Vérifier si données standardisées
oÉconomique (ex: changement de prix d’une intervention, investissements)
oÉcologique (ex: changements climatiques)
oTechnologiques (ex: nouveau test, nouveau traitement, nouvelle intervention de prévention – vaccination ou dépistage, nouvelles indications de test / traitement, erreurs de laboratoire)
−Quelles sont les explications possibles (séquence de la recherche de soins à la déclaration du cas)
oDemande de soins par la personne: influencé par les campagnes de sensibilisation, médias, etc.
oSuspicion clinique par le professionnel de la santé: influencé par les formations, conférences, publications etc.
oTest: ∆ indications cliniques, ∆ performance, ∆ seuil de positivité, nouvelle technologie, erreur de labo
oDéfinition de cas: ∆ critères diagnostiques, ∆ classification des maladies (CIM-10 vs CIM-9), ∆ indicateurs utilisés
oTraitement: performance, ∆ technologie, ∆ critères d’inclusion / exclusion → taux de survie, durée de la maladie
oDéclaration à la santé publique ou inscription dans une base de données: exhaustivité des cas? batch reporting? surveillance active vs passive?
−À quelle population cette association s’applique-t-elle? Peut-elle être généralisée? Validité externe
−Quelles sont les limites, les éléments manquants ou les prochaines étapes pour raffiner la compréhension du phénomène?
What is the spaulding classification?
What are the Canadian Society for Exercise Physiology (CSEP) recommended amounts of physical activity by age?
CSEP 0-1
30 min/day tummy time, interactive floor-based play (more is better)
CSEP 1-4
180 min PA/day at any intensity (preschoolers should include 60 min/day energetic play)
Limit recreational screen time to 1h/day
CSEP 5-17
60 min MVPA/day, VPA 3x/wk, muscle/bone strengthening 3x/wk, several hrs/day of light PA
Limit recreational screen time to 2h/day
CSEP 18+
150 min MVPA/wk in bouts of 10+min, muscle/bone strengthening 2x/wk
65+: add activities to enhance balance and prevent falls
What are 4 tick-borne illnesses?
Babesiosis
Lyme disease
Anaplasmosis
Rocky mountain spotted fever
What are principles of harm reduction?
- Focus on harm / Priority on immediate goals / Pragmatic
- Human rights / Person centered / Autonomy / Involve people who use drugs
- Trauma informed
- Maximize intervention options
How are cold chain breaches of vaccines managed?
What vaccine cannot be used during pregnancy or breastfeeding?
Zoster (pregnant)
HPV (pregnant)
BCG
Live zoster
LAIV (pregnant)
MMR (pregnant)
Smallpox (unless post-exposure/outbreak)
Oral typhoid
Varicella (pregnant)
Yellow fever
What are Canada’s low risk alcohol drinking guidelines?
YOUR LIMITS
Reduce your long-term health risks by
drinking no more than:
• 10 drinks a week for women, with no
more than 2 drinks a day most days
• 15 drinks a week for men, with no
more than 3 drinks a day most days
Plan non-drinking days every week to
avoid developing a habit.
SPECIAL OCCASIONS
Reduce your risk of injury and harm by
drinking no more than 3 drinks (for women)
or 4 drinks (for men) on any single occasion.
Plan to drink in a safe environment. Stay
within the weekly limits outlined above
in Your limits.
WHEN ZERO’S THE LIMIT
Do not drink when you are:
• driving a vehicle or using machinery and tools
• Taking medicine or other drugs that interact
with alcohol
• Doing any kind of dangerous physical activity
• Living with mental or physical health problems
• Living with alcohol dependence
• Pregnant or planning to be pregnant
• Responsible for the safety of others
• Making important decisions
DELAY YOUR DRINKING
Alcohol can harm the way the body and brain
develop. Teens should speak with their parents
about drinking. If they choose to drink, they
should do so under parental guidance; never
more than 1–2 drinks at a time, and never more
than 1–2 times per week. They should plan
ahead, follow local alcohol laws and consider the
Safer drinking tips listed in this brochure.
Youth in their late teens to age 24 years should
never exceed the daily and weekly limits outlined
in Your limits.
What are risk and protective factors for suicide?
What are PH interventions to prevent suicide?
Risk factors:
a prior suicide attempt
mental illness like depression
a sense of hopelessness or helplessness, this means that you believe your life or current situation won’t improve
misuse of alcohol or substances
chronic (long-term) physical pain or illness
trauma, for example:
violence
victimization, like bullying
childhood abuse or neglect
suicide by a family member or friend
events that affect multiple generations of your family
Other factors that can increase the risk of suicide include:
significant loss, including: personal (relationships), social, cultural, financial (job loss)
major life changes or stressors, such as: unemployment, homelessness, poor physical health or physical illness, the death of a loved one, harassment, discrimination
lack of access to or availability of mental health services
personal identity struggles (sexual, cultural)
lack of support from family, friends or your community
sense of isolation
Protective factors:
positive mental health and well-being
a sense of hope, purpose, belonging and meaning
social support
healthy self-esteem and confidence in yourself
asking for help if you’re having thoughts of suicide
a sense of belonging and connectedness with your: family, friends, culture, community
Other ways to help protect against risk of suicide include:
a strong identity (personal, sexual, cultural)
access to appropriate mental health services and support
good coping and problems-solving skills, and the ability to adapt to change and new situations
supportive environments where you’re accepted and valued (school, workplace, community)
positive relationships (peers, family, partner)
PH interventions:
Restrict means (Control access to painkillers/pesticides, Restrict access to firearms, Erect barriers in place where suicide by jumping)
Access to MH care
Restrictive alcohol policies
Responsible media reporting
Public education + awareness
School based education (MH literacy, suicide risk awareness, skills training)
HCW training, suicide screening
Gatekeeper training
Helplines
Crisis intervention supports
Postvention
Targeted interventions (Trans, indigenous)
Addres upstream factors (SDoH, childhood abuse, unemployment, poverty, cultural continuity, social equity and supports etc)
Bullying prevention
Who is eligible for medical assistance in dying in Canada?
In order to be eligible for medical assistance in dying, you must meet all of the following criteria. You must:
be eligible for health services funded by the federal government, or a province or territory (or during the applicable minimum period of residence or waiting period for eligibility) generally, visitors to Canada are not eligible for medical assistance in dying
be at least 18 years old and mentally competent. This means being capable of making health care decisions for yourself.
have a grievous and irremediable medical condition
make a voluntary request for medical assistance in dying that is not the result of outside pressure or influence
give informed consent to receive medical assistance in dying
What are epi trends for breast cancer?
Trends in breast cancer
The breast cancer incidence rate in women in Canada rose between 1984 and 1991. The rate has fluctuated since then, with an overall small decrease.
The increase until the early 1990s occurred partly because mammography was used more often, which meant that more cases of breast cancer were found. The reasons for the later fluctuation are not clear but may include long-term changes in hormonal factors, like if a woman started having her menstrual periods when she was young, breastfeeding and oral contraceptive use.
The slight decrease in rate in 2002 coincided with a large drop in the use of HRT among postmenopausal women when its role in breast cancer was publicized.
The breast cancer death rate peaked in 1986 and has been declining since. This reduction in death rates likely reflects the impact of screening and improvements in treatment for breast cancer.
Chances (probability) of developing or dying from breast cancer
It is estimated that about 1 in 8 Canadian women will develop breast cancer during their lifetime and 1 in 33 will die from it.
What are the steps to a situational assessment (6)?
Step 1: Identify key questions to be answered The first step in a situational assessment is to determine what you need to inform planning decisions. Use the three broad questions and sub-questions below to shape the direction of the situational assessment and develop your research questions.
- What is the situation? What impact does the current situation have on health outcomes, quality of life and other societal costs, such as noise, air pollution or increased healthcare spending? Which groups of people are at higher risk of health problems and poorer quality of life? Which settings or situations are high risk, or pose a unique opportunity for intervention? How do local stakeholders perceive the situation? What is their capacity to act? What are their interests, mandates, current activities? What are the needs, perceptions and supported directions of key influential community members, and the community-at-large?
- What influences are making the situation better and worse? What high-risk or negative health behaviours by various groups of people are affecting the situation? Which underlying causes or conditions are driving these behaviours (e.g. individual, community, organizational or system-level causes)? Are there protective factors that can help avoid or alleviate the situation (such as ensuring walkable communities or encouraging strong parent-child relationships)? Which strengths and weaknesses present in your organization may affect your course of action? Which opportunities and threats in your environment may affect your course of action?
- What possible actions can you take to address the situation? What are other organizations doing, or what have they done in the past, to address this situation? Specifically, what local policies, programs and environmental supports are being developed or implemented within the community? What evaluation data are available for these activities? What is the best available evidence that exists to support various courses of action?
Step 2: Develop a data gathering plan Questions you develop in the first step will determine data needed. Too much data can become overwhelming; however, you also want a comprehensive plan. Therefore, it is a good idea to develop a data gathering plan to organize sources of data, tasks, and persons responsible. Ensure your data gathering plan includes diverse types of data (e.g. community health status indicators, environmental scans, or best practices); different methods of data collection (e.g. surveys, document review, and literature review); and varied sources of data (e.g. partner organizations, community, and government). Some sources of information to consider to define the situation include Community Health Status Reports produced by public health units, Rapid Risk Factor Surveillance System (RRFS),5 Canadian Community Health Survey (CCHS), 6 and the Public Health Agency of Canada (PHAC) Infobase. 7 The National Collaborating Centre for Methods and Tools (NCCMT) has created evidence search pyramids8 for major health areas including mental health, injury prevention and environmental health. The search pyramids support the use of more highly-synthesized forms of information, such as guidelines and reviews. Using these more highly-synthesized sources can help save you time.9 You can use the pyramids to find literature in your field that has been pre-appraised for methodological quality. It is also important to critically appraise the literature you find, if it has not already been appraised. The Critical Skills Appraisal Program (CASP) has developed eight free and publicallyavailable critical appraisal tools10 designed for methodological quality assessment of research. Consider using these to evaluate the literature located by your search. In terms of specific sources of highly-synthesized evidence as described in the search pyramids, see the National Guidelines Clearinghouse11 and Turning Research Into Practice database for guidelines (summary-level evidence),12 and Health Evidence for reviews (syntheses).13 Health Evidence offers a registry of systematic review-level evidence that is pre-appraised and offers quality scores of strong, moderate, or weak for every review included in its regisry. For examples of programs and interventions, visit the Canadian Best Practices Portal, which may indicate some programs that offer outcome or evaluation data.14
Step 3: Gather the data Now that you have identified the research questions and developed a data gathering plan, the next step is to collect data. It is important to note that there are two types of data collection - primary and secondary data collection. Primary data is data that you and your situational assessment team collect yourselves; for example, via surveys, key informant interviews or focus groups. When collecting primary data it is important to ensure that people collecting the data have the right skills to do so properly. Ensure that your primary data collectors are trained, since this increases their confidence and ability to collect data consistently and correctly. Also ensure that data collection is standardized and done ethically, including documenting informed consent. Secondary data is collected by someone else; for example, by the provincial or federal government, a researcher, or a partner organization. A literature search is also an example of secondary data collection. If you are carrying out a literature search, document your search strategies, including search terms, and your inclusion and exclusion criteria. As another example of secondary data, Analytic Services at Public Health Ontario developed an interactive database, called Snapshots,15 using core indicators developed by the Association of Public Health Epidemiologists in Ontario (APHEO). These online dashboards provide information on indicators from a variety of data sources for Ontario and specific public health unit regions.
Step 4: Organize, synthesize and summarize the data The amount of data generated during a situational assessment can be overwhelming. One of the easiest ways to organize information is to arrange the data according to your original key questions (step 1). For example, if your question was ‘What groups of people are at higher risk of health and quality of life problems’, organize findings that answer this question together. Using the Ecological Model16 to organize findings could help identify connections of the policy and environmental contexts with the social and individual contexts, allowing you to determine areas you want to address. Two widely-used models in the private sector that may help you understand your findings are SWOT or Force Field Analyses. A SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis or a Force Field Analysis can help to determine facilitators and barriers to improving the situation. The Introduction to Planning Health Promotion Programs Workbook 4 provides more information about how to conduct a SWOT or Force Field Analysis. If possible, summarize findings in a paragraph or five to six bullet points. This will offer others a quick understanding of results and can be useful in any communication products that you develop.
Step 5: Communicate the information A lot of time and effort has gone into your situational assessment. Make sure the results are not lost in a report! Colleagues, partner organizations and decision makers are all interested in your findings. Therefore, it is important to communicate key findings to each of your stakeholders in a manner that is understandable to each distinct audience. Consider which information each of your different stakeholders needs to know, and how you can best convey it to them. One strategy is to develop a communication plan which includes your key audience, communication objectives, channels, and communication products. You can sometimes use the same communication products for different audiences – as long as their communication style and your communication objectives for each audience are aligned.
Step 6: Consider how to proceed with planning It is now time to utilize your findings and decide on your next steps. Consider: • How do you perceive your ability to affect the situation with the available time, financial resources and mandate? • What are the gaps in data quality or quantity, relative to stakeholder expectations? • How might that restrict your ability to make evidence-informed decisions about goals, audiences, objectives, strategies, activities and resources? • What are your next steps in the planning process? Will you proceed now, or must you revisit research questions, project scope or resources?
What are examples of passive and active surveillance systems in Canada?
Passive:
- Notifiable diseases
- Hospital and billing data
- Vital statistics
Active:
- Cencus
- Surveys like CCHS
- Impact
What are examples of primary health care performance indicators in Canada?
Social Determinants of Health
Smoking Rate
Overweight and Obesity Rate — Youth, Adults
Fruit and Vegetable Consumption Rate
Physical Activity Rate During Leisure Time
Health System Resources — Health System Inputs and Characteristics
Family Medicine Physician Supply
Registered Nurses/Nurse Practitioners (RNs/NPs) Employed in a PHC Setting
Uptake of Information and Communication Technology (ICT) in Primary Health Care
Access to Comprehensive, High-Quality Health Services — Health System Outputs
Population With a Regular Medical Doctor
Difficulties Obtaining After-Hours Primary Health Care
Appropriate, Effective and Safe — Health System Outputs
Smoking Cessation Advice From a Regular Medical Doctor
Eye Examinations in Adults With Diabetes
Influenza Immunization for Seniors
Colorectal Cancer Screening
Ambulatory Care Sensitive Conditions (ACSCs) Hospitalization Rate
Medication Lists in Primary Health Care Using a Computerized System
https://www.cihi.ca/sites/default/files/phc_handout_en.pdf
What are reasons for a false positive non-treponemal syphilis test?
What are reasons for a false negative non-treponemal syphilis test?
False positive
Pregnancy
Lyme disease
Pinta
Yaws
Non-treponemal test in previously positive
Rheumatologic disorder
False negative
Too early
Lab error
Immunosuppression (RPR)
Late latent/tertiary (RPR)
Risk factors for obesity
Risk factors for CVD
Risk factors for obesity:
SES
Immigration status
Ethnicity
Education
Income
Rural residence
Low physical activity
Poor diet
Alcohol consumption
Screen time
Inadequate sleep
Risk factor for CVD:
Hypertension
Age
FHx
Ethnicity
Education level
Income
High cholesterol
Obesity
Smoking
DM
Stress
Alcohol
Low physical activity
What are pros and cons of mandatory helmet legislation for cyclists?
PROS:
Reducing head injuries
CONS:
Risk compensation
Reducing cycling, physical activity
Costs of helmets
Distraction from more effective interventions (separating cars and bikes)
L’incidence du cancer du sein est de 10,6 pour 100 000 personnes-années chez les femmes de plus de 50 ans ayant un niveau élevé d’activité physique et de 16,2 pour 100 000 personnes-années chez les autres femmes de plus de 50 ans (inactives). 20% des femmes de 50 ans et plus de votre région ont un niveau élevé d’activité physique. 80% des femmes de plus de 50 ans de votre population sont inactives. Votre population compte 8 000 000 d’individus dont 21% sont des femmes de plus de 50 ans. (Supposez qu’un lien de causalité existe entre l’activité physique et le cancer du sein.) a. Quelle est la différence de risque? b. Quelle est la fraction attribuable chez les exposées? Interprétez cette valeur c. Quelle est la fraction attribuable dans la population? Interprétez cette valeur Incidence dans la population (par 100 000) : d. Combien de cas seraient prévenus si toutes les femmes de 50 ans et plus avaient un niveau élevé d’activité physique?
a. Quelle est la différence de risque? = Risque chez les exposées – Risque chez les non-exposées = (16,2-10,6) par 100 000 = 5,6 par 100 000 b. Quelle est la fraction attribuable chez les exposées? Interprétez cette valeur = (Risque chez les exposées – Risque chez les non-exposées) / Risque chez les exposées = Différence de risque / Risque chez les exposés = (5,6 par 100 000 / 16,2 par 100 000) = 34,57 % Interprétation : Un peu plus du tiers (ou 34,57%) des cancers du sein chez les femmes inactives pourraient être évités si toutes les femmes inactives atteignaient un niveau élevé d’activité physique. c. Quelle est la fraction attribuable dans la population? Interprétez cette valeur Incidence dans la population (par 100 000) : = (0,8 x 16,2) + (0,2 x 10,6) = 15,1 par 100 000 Fraction attribuable dans la population : = (Risque dans la population – Risque chez les non exposées)/Risque dans la population = (15,1-10,6)/15,1 = 29,8 % Interprétation : Environ 3 cancers du sein sur 10 pourraient être évité chez les femmes de plus de 50 ans si toutes les femmes atteignaient un niveau d’activité physique élevé. d. Combien de cas seraient prévenus si toutes les femmes de 50 ans et plus avaient un niveau élevé d’activité physique? Nombre de femmes de plus de 50 ans = 21% x 8 000 000 = 1 680 000 femmes Nombre de cas prévenus = Nombre de femmes de 50 ans x proportion d’inactives x différence de risque = 1 680 000 x 80% x 5,6 par 100 000 = 75 cas OU = Nombre de femmes de 50 ans x risque populationnel de cancer x fraction attribuable population = 1 680 000 x 15,1 par 100 000 x 29,8% = 75 cas
What are health impacts associated with noise?
What would be an approach to assessing the health impacts of noise?
What are examples of mitigation measures?
What are examples of indicators for noise?
Health impacts
NOISE-INDUCED HEARING LOSS
NOISE-INDUCED SLEEP DISTURBANCE
INTERFERENCE WITH SPEECH COMPREHENSION
HIGH ANNOYANCE
AN APPROACH FOR ASSESSING THE HEALTH IMPACTS OF NOISE
IDENTIFICATION OF HUMAN RECEPTORS IN PROJECT AREAS
ASSESSMENT OF BASELINE NOISE
ASSESSMENT OF PROJECT-RELATED NOISE
MITIGATION
ASSESSMENT OF RESIDUAL IMPACTS
SOUND LEVEL MONITORING
Examples of mitigation measures
- Erect a sound barrier around construction site
- Alter routes of construction vehicles into area to reduce need for reversing alarms
- Use machinery with improved technological effiiciency to reduce noise production
- Alter orientation and design of construction site to maximize physical distance between construction and residents
- Reduce the maximum blast noise produced in exchange for increased number of blasts (evidence-based)
Examples of indicators
- Noise complaints made by residents to local council about construction noise
- % of residents reporting sleep disturbance pre and post construction commencement
- % of residents reporting extreme annoyance pre and post construction commencement
- % change in background noise levels in decibals before and after construction commencement
What actions could be taken to mitigate the higher incidence rate of TB among aboriginal people around:
- SDoH
- TB-specific porgramming
KEY MESSAGES/POINTS
• In Canada, the incidence rate of TB is higher among Aboriginal people than the foreign-born and Canadian-born non-Aboriginals, but the greatest burden of disease, as measured by the number of cases, occurs in the foreign-born.
• Status Indians in Manitoba and Saskatchewan and the Inuit in Nunavut have the highest incidence rates among Aboriginals in Canada.
• In the 1980s, after decades of decline, the incidence of TB among the Inuit began to level off. However, beginning in the late 1990s and continuing until 2010, rates increased, resulting in Canada’s own “U-shaped curve of concern”.
• Determinants of TB infection and disease in the Aboriginal people of Canada differ with respect to comorbidities, genetic factors, transmission factors and the social determinants of health when compared to the rest of Canada.
• Social determinants of health, including lack of food security, housing, health care access, education and income are seen with higher frequency in Aboriginal groups in Canada.
• Programmatic issues in TB prevention in Aboriginal groups in Canada that can be strengthened include strong TB partnerships with communities, increased community awareness, improving adherence to TB medications and underscoring the importance of effective contact investigation.
• According to the most recent statistics released in 2012, the current rate of TB among the Canadian-born Aboriginal population is 26.4 per 100,000. Across Canada rates of new active and retreatment TB cases for the Aboriginal population were as follows: North American Indian 22.2 per 100,000 (188 cases), Inuit 198.6 per 100,000 (116 cases) and Métis 7.5 per 100,000 (26 cases).
What are the data sources (6) in the national West Nile Virus surveillance system?
Canadian Blood Services or Hema-Quebec (asymptomatic human cases)
Notifiable disease surveillance system (clinically symptomatic human cases)
Canadian Wildlife Health Cooperative (dead birds)
Canadian Food Inspection Agency (equine cases)
Mosquito surveillance (positive mosquito pools/total pools tested in Saskatchewan, Manitoba, Ontario and Quebec)
National Microbiology Laboratory (California serogroup testing)
What are different types of outdoor air pollutants?
Air pollutants overview - see attached image
Air pollution describes a collection of airborne pollutants that contribute to our air quality. The term “pollutants” recognizes that these substances are undesirable because of their impact on human health, the environment and the economy.
These air pollutants are all very different. They differ in their chemical composition, reaction properties, emission sources, how long they last in the environment before breaking down, their ability to move long or short distances, and their eventual impacts.
However, they also share a number of similarities, and so can be grouped into four general categories:
Criteria Air Contaminants and related pollutants (e.g. SO2, NOx, Volatile Organic Compounds, etc..)
Persistent Organic Pollutants (POPs)(e.g. dioxins and furans)
Heavy Metals (HM) (e.g. mercury)
Toxics (e.g. benzene)
Criteria Air Contaminants and related pollutants are cause to air issues such as smog and acid rain. They are produced in varying quantities by a number of sources, including the burning of fossil fuels.
Persistent Organic Pollutants are a collection of pollutants that can last in the environment for long periods of time and are capable of travelling great distances. Similar to heavy metals, POPs are of particular concern because they can enter the food supply, bioaccumulate in body tissues, and have significant impacts on human health and the environment, even in low concentrations.
Heavy metals are basic metal elements such as mercury and lead. This group of pollutants can be transported by the air and enter our water and food supply. Although trace amounts of some metals are needed by our body, heavy metals are poisonous in low concentrations and can bioaccumulate in body tissues.
Toxic Pollutants form a broad category of pollutants that are poisonous or toxic to human health and the environment. Although this category has some overlap with the other types of air pollutants presented here (CAC, HM, POPs etc), it also includes many more pollutants that have been determined to be toxic.
The Canadian Environmental Protection Act, 1999 (CEPA 1999; schedule 1) provides a list of pollutants of concern that are subject to legislative control and management. CEPA 1999 has also legislated that these pollutants be reported to the National Pollutant Release Inventory (NPRI).
What are the federal and provincial roles in health?
FEDERAL
- Setting and administering national standards for the health care system through the Canada Health Act
- Provides health care funding to the provinces and territories through the Canada Health Transfer + tax support for health-related costs
- Provide certain direct health care services to some population groups
- Responsible for the regulation of certain products e.g. food, pharmaceuticals, chemicals, pesticides, medical devices
- Supports health research
- Supports health promotion and protection
- Supports disease monitoring and prevention
Or by agency:
health protection (Health Canada)
public health (PHAC)
medical research (CIHI)
regulation (biologics and genetic therapies directorate)
finance and delivery to special groups (FNIHB)
international liaison
funder (20% through Canada Health Transfer)
PROVINCIAL LEVEL
Administration of their health insurance plans;
Planning and funding of care in hospitals and other health facilities;
Services provided by doctors and other health professionals;
Planning and implementation of health promotion and public health initiatives; and
Negotiation of fee schedules with health professionals.
Fund supplementary benefits for certain groups (e.g., low-income residents and seniors), such as drugs prescribed outside hospitals, ambulance costs, and hearing, vision and dental care, that are not covered under the Canada Health Act.
As well, each province and territory has an independent workers’ compensation agency, funded by employers, which funds services for workers who are injured on the job.
https://www.canada.ca/en/health-canada/services/canada-health-care-system.html
What are causes of injury in children?
MVT
Suffocation
Drowning
Burns
Falls
Poisoning
Fiream
Struck by/against
Distinguish different types of discrete and and continuous data.
Discrete data
- Nominal (M/F)
- Ordinal (likert scale)
Continuous data
- Interval-scale data (not true 0 e.g. celcius)
- Ratio-scale data (with real 0 value e.g. kelvin))
What are the health risks of vaping with nicotine?
What are tips to prevent injuries from batteries and vaping devices?
Vaping can increase your exposure to chemicals that could harm your health (e.g. cause lung damage). Vaping could also expose you to nicotine, which is addictive.
There are also concerns about the appeal of vaping products among youth and their potential to promote tobacco use.
If you are a smoker, vaping is a less harmful option than smoking.
Health risks of vaping with nicotine
Nicotine is not known to cause cancer. It is approved for use in nicotine replacement therapies, such as the patch or nicotine gum. However, there are risks linked to nicotine.
Nicotine is a highly addictive substance. Vaping with nicotine could:
_lead to dependence_Footnote1
cause nicotine addiction among users who would not have started using nicotine otherwise (e.g. smoking)
Children and youth are especially susceptible to the harmful effects of nicotine, including addiction. They may become dependent on nicotine with lower levels of exposure than adults.Footnote2
Nicotine:
can affect memory and concentration
is known to alter teen brain development
Exposure to nicotine during adolescence may causeFootnote3Footnote4
reduced impulse control
cognitive and behavioural problems
_Vaping may predispose youth to addiction to nicotine and possibly other drugs._Footnote5Footnote1
Nicotine poisoning
Vaping liquid containing nicotine is poisonous, particularly to young children.
Even in small amounts, vaping liquid containing nicotine can be very harmful if:
swallowed
absorbed through the skin
T_here have been fatalities as well as non-fatal nicotine poisoning caused by children swallowing vaping liquid._
When buying a container of vaping liquid with nicotine, look for one that has a child-resistant closure and a ‘poison’ hazard symbol. The closure and symbol are required by law. They help protect children in three ways:
The closure makes it harder for a child to gain access to the liquid in the container.
The poison hazard symbol reminds parents and caregivers to keep the product out of sight and reach of children.
Children are taught that the hazard symbol means Danger! Do not touch.
Tips to handle vaping liquids safely
Store out of sight and reach of young children and pets.
Store vaping liquid in a cool, dry place where it cannot be confused for food, drinks, or medicine.
Close the container securely after each use.
Wash your hands immediately after handling vaping liquid.
If someone has swallowed vaping liquids, seek emergency medical attention or call 9-1-1.
Read more about household chemical safely.
Health risks of other chemicals in vaping
There are health risks linked to other chemicals found in vaping products.
Vaping substances have fewer and different chemicals than in tobacco products.
Vegetable glycerine and propylene glycol are the main liquids in vaping products. These are considered safe for use in many consumer products such as cosmetics and sweeteners. However, the long-term safety of inhaling the substances in vaping products is unknown and continues to be assessed.
Chemicals used for flavour in vaping products are used by food manufacturers to add flavour to their products. While safe to eat, these ingredients have not been tested to see if they are safe to breathe in.
There is no burning during vaping but the vaping process needs the liquid to be heated. This can create new chemicals, such as formaldehydes. Some contaminants (e.g. nickel, tin, aluminum) might also get into the vaping products and then into the vapour.
The amount of substances (including nicotine) a person can be exposed to by vaping is affected by the:
battery power
type of vaping device
settings on the device
combination of internal components
type of vaping liquid and amount of nicotine
user behaviour patterns
user’s experience with vaping
Using vaping products with higher power and temperature settings can produce more chemicals.
Some of these chemicals and contaminants are linked to negative health effects. However, the amount of chemicals and contaminants in vapour is normally at much lower levels than in cigarette smoke.
We are still learning more about how vaping affects health. The long-term health impacts of vaping are unknown. However, there is enough evidence to justify efforts to prevent the use of vaping products by youth and non-smokers.
Popcorn lung
There is a concern that people who vape might get ‘popcorn lung’ from being exposed to diacetyl. Diacetyl is a flavouring chemical used to give butter-like and other flavours to food products, as well as vaping products. However, there have been no reports of popcorn lung occurring due to vaping.
This disease is named popcorn lung because workers in popcorn plants developed it after inhaling heated flavours such as diacetyl.
Popcorn lung, or popcorn worker’s lung, is:
a chronic disease that damages the small airways in the lung
the common term for the medical condition known as bronchiolitis obliterans
While once common in vaping products, steps have been taken to reduce its use.
Second-hand vapour
Second-hand vapour is not harmless but it does contain far fewer chemicals than second-hand smoke. Bystanders can be exposed to vapour that is exhaled by users. The health effects from exposure to second-hand vapour are still unknown. However, the risks are expected to be much lower compared to smoke from a tobacco product.
We recommend that users be cautious around non-users and youth.
There is some evidence that e-cigarette use increases the level of nicotine and other chemicals on indoor surfaces.Footnote1
Device malfunctions
Vaping devices are regulated under the Canada Consumer Product Safety Act. Although uncommon, another risk to consider involves defective batteries or defective vaping products that have caused fires and explosions.
If you notice a safety problem with a vaping device or vaping liquid, you can report the problem:
to the manufacturer or retailer
using our online consumer product safety reporting page
For more information on product safety requirements and how to protect yourself, read about vaping product safety and regulation.
Batteries and vaping devices
Lithium-ion batteries and vaping devices can pose a hazard if they are not properly:
used
stored
carried
charged
Tips to prevent injuries from batteries and vaping devices
Do not modify your device.
Buy batteries that are compatible with your device.
Buy batteries from a trusted source.
Do not carry lithium-ion batteries in your pocket or anywhere they can come into contact with loose coins, keys or other metal objects. Lithium-ion batteries can overheat, catch fire or even explode when in contact with metal objects. Incidents have caused serious injuries.
Keep spare batteries in a protective case.
Read the manufacturer’s instructions for storing and recharging your device.
Do not exceed the recommended charging time.
Read more about battery safety.
Vaping and pregnancy
While vaping products contain fewer harmful chemicals than cigarettes, they may still contain nicotine. Talk to your health care provider about your options of quitting nicotine during pregnancy.
What are evidence-based interventions (as identified by WHO) for integrating preconception health interventions into every HCP contact with women of reproductive age?
Based on the recommendation for integrating PCH interventions into every HCP contact with women of reproductive age, the World Health Organization [13] identified the following evidence-based interventions:
- Prevention of pregnancy in adolescence;
- Prevention of unintended pregnancies;
- Promotion of birth spacing;
- Optimizing pre-pregnancy weight;
- Promotion of healthy nutrition including supplementation/food fortification, such as folic acid intake;
- Promotion of vaccination of children and adolescents.
Furthermore, services for women with special risk factors that increase the risk for preterm birth include:
- Screening for, diagnosis and management of mental health disorders and prevention of intimate partner violence;
- Prevention and treatment of sexually transmitted infections (STIs), including HIV/AIDS;
- Promotion of tobacco use cessation and restriction of exposure to second hand smoke;
- Screening for, diagnosis and management of chronic diseases, including diabetes and hypertension
What are the pillars for the Pan-Canadian Framework on Clean Growth and Climate Change?
pricing carbon pollution,
taking action in each sector of the economy,
adapting to climate change,
and supporting clean technologies, innovation and job creation
Health problems linked to sugar sweetened beverages?
Tooth decay
Increase body weight
Increased risk of diabetes
Increased risk of dyslipidemia and hypertension
What defines an emerging infectious disease?
Emerging infectious disease:
- An infectious disease that has newly appeared in a population
- or that has been known for some time but is rapidly increasing in incidence or geographic range.
What are the 7 components of influenza surveillance in Canada (FluWatch) and their contributing partners ?
What are the program objectives of FluWatch?
What is the ILI definition?
What are the 4 levels of FLU/ILI activity?
How are flu outbreaks defined?
How are flu hospitalizations and deaths reported?
What information is reported from the NML to FluWatch?
What are the 4 phases of WHO’s continuum of pandemic phases?
- *Seven components of influenza surveillance in Canada**
1. Geographic Spread of Influenza/Influenza-like Illness Activity (P/T MoH)
2. Laboratory-Confirmed Detections (Provincial PH labs)
3. Syndromic Surveillance (Sentinel Practitioners, FluWatchers)
4. Outbreak Surveillance (P/T MoH)
5. Severe Outcomes Surveillance (P/T MoH, IMPACT, CIRN - Canadian Immunization Research Network)
6. Strain Characterization and Antiviral Resistance Testing (NML)
7. Vaccine Monitoring (PHAC, Sentinel practitioners, CIRN)
The FluWatch program consists of a network of labs, hospitals, doctor’s offices and provincial andterritorial ministries of health. Program objectives are:
Detect
: to detect and respond to outbreaks and other events of public health concern.
Inform
: to use the data and information to create, improve and apply to public health programsand policies to control the flu.
Enable
: to make sure that the information gathered on the flu in Canada supports internationalflu monitoring and is ready in case of a global outbreak.
Flu-like-illness (ILI) definition:
Sudden onset of flu symptoms with fever and cough and with one or more of the following: sore throat, joint pain, muscle aches, or fatigue which is likely due to the flu.
Children younger than 5 years old might also have symptoms like nausea, vomiting and diarrhea.
Patients younger than 5 years old or 65 and older might not have a fever.
4 levels of ILI activity: no activity, sporadic, localized, widespread
Lab-confirmed flu outbreak: Where there are 2 or more cases of ILI within 7 days, and at least 1 lab-confirmed case of flu in the same setting (on the same floor, or in the same unity or ward).
Flu-like illness (ILI) outbreak in school/work: More than 10% absenteeism that is likely due to ILI.
Each week, the Immunization Monitoring Program Active (IMPACT) network reports the number of children admitted to hospital with the flu (paediatric cases) to FluWatch.
The Canadian Immunization Research Network (CIRN) reports the number of adults admitted to the hospital with the flu each week from participating hospitals across Canada
FluWatch receives information each week from the National Microbiology Laboratory on:
the specific strains of the flu virus (influenza) that are circulating in people in Canada
how those strains compare to the flu viruses that the seasonal flu shot can protect against that doctors prescribe to prevent and treat flu
WHO continuum of pandemic phases
- Interpandemic phase
- Alert phase
- Pandemic phase
- Transition phase
What is the triple aim?
What is the quadruple aim?
The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:
Improving the patient experience of care (including quality and satisfaction);
Improving the health of populations; and
Reducing the per capita cost of health care.
For quadruple aim, add provider wellbeing
What are the characteristics of a learning organization?
Systems thinking
Personal mastery
Mental models
Shared vision
Team learning
What data sources can be used regarding healthcare spending?
To track how health dollars are being spent, we maintain these databases:
National Health Expenditure Database (NHEX), the primary source of health spending information in Canada
Canadian MIS Database (CMDB), the primary source of information on staffing, cost, workload and provision of health services
Canadian Patient Cost Database (CPCD), the data source used to estimate costs by patient group
OECD Health Database (Canadian Segment), maintained by CIHI and Statistics Canada, the data source that includes a consistent series of internationally comparable data for most of the 1,200 variables contained in the Organisation for Economic Co-operation and Development (OECD) database
What is health promotion?
What are characteristics and values of health promotion?
The process of enabling people to increase control over, and to improve, their health.
Values: (mnemonic RISE)
Respect, Inclusion, Social justice and equity, Empowerment,
Characteristics:
- holistic
- strengths-based, enhancing
- participatory approaches,
- complimentary strategies, amplifying
- based on SDoH.
What are the occupational exposure limits (OEL) for noise in Canada?
What are 2 key factors used in exposure duration tables?
Occupational exposure limits (OELs) for noise are typically given as the maximum duration of exposure permitted for various noise levels - those vary per provinces.
They are often displayed in exposure-duration tables like Table 1A and Table 1B. The OELs depend on two key factors that are used to prepare exposure-duration tables: the criterion level and the exchange rate.
When is BCG vaccination recommended in Canada?
BCG vaccination has historically been provided in several provinces/territories of Canada.
With declining rates of TB in many settings and concern about the risk-benefit ratio associated with a live, attenuated vaccine, BCG is currently only recommended in certain high-incidence communities in Canada.
BCG is currently recommended in Canada for infants in high-incidence settings and also may be administered to travellers returning for extended stays to a high TB incidence country where BCG is routinely given.
Major Shifts in Recommendations
BCG is not recommended for adults, such as health care workers, before travel to high-incidence settings.
Recommendations
BCG vaccination is recommended in high-incidence communities for infants in whom there is no evidence of HIV infection or immunodeficiency. If vaccination is delayed beyond 6 months of age, a TST (tuberculin skin test) should be done and documented as negative before vaccination. For infants aged between 2 months and 6 months, an individual assessment of the risks and benefits of tuberculin skin testing prior to BCG vaccination is indicated.
For infants born in Canada who will be moving to and staying for extended periods of time in a country with high TB incidence and where BCG vaccination is still standard practice, vaccination is recommended soon after arrival in the high-incidence country
What are public health emergency preparedness capabilities?
2018 Public Health Emergency Preparedness and Response Capabilities
15 Preparedness and Response Capabilities
- Community Preparedness
- Community Recovery
- Emergency Operations Coordination
- Emergency Public Information and Warning
- Information Sharing
- Public Health Surveillance and Epidemiological Investigation
- Public Health Laboratory Testing
- Nonpharmaceutical Interventions (PHSM)
- Medical Countermeasure Dispensing and Administration
- Medical Materiel Management and Distribution
- Medical Surge
- Mass Care
- Fatality Management
- Responder Safety and Health
- Volunteer Management
6 Domains of preparedness:
Community Resilience: Preparing for and recovering from emergencies
Incident management: Coordinating an effective response Information
Management: Making sure people have information to take action
Countermeasures and Mitigation: Getting medicines and supplies where they are needed
Surge Management: Expanding medical services to handle large events
Biosurveillance: Investigating and identifying health threats
What are PFOS and PFAS?
Perfluorooctane sulfonate
Perfluorooactanoic acid
Synthetic chemical used in consumer products and fire-fighting foams for their water and oil repellant.
Regulated in water as of 2018 with MAC. Adverse effect on liver and endocrine disruptor.
What are criteria for discontinuation of airborne precautions for TB patients?
In summary:
Discontinuation of airborne precautions considers the following criteria:
- establishment of an alternative diagnosis,
- clinical improvement,
- adherence to effective therapy,
- sputum smear and/or culture conversion,
- drug-susceptibility tests that indicate fully sensitive organisms or low clinical suspicion of drug resistance.
Mnemonic: Won, Two, Three
Clinical improvement (won-1)
On adequate treatment (as per lab testing) for 2 weeks (2)
Three consecutive negative smears (3)
Health care organizations and individual health care workers (HCWs) have a shared responsibility to apply effective tuberculosis infection prevention and control measures.
The risk of health care associated transmission of M. tuberculosis varies with the type of setting, HCW occupational group, patient care activity, patient/resident/client population and the effectiveness of tuberculosis (TB) infection prevention and control measures.
The most important contributors to health care associated transmission of M. tuberculosis are patients with unrecognized, respiratory TB disease. Hence, the most important element of any TB management program is rapid diagnosis, isolation and start of effective therapy for these patients.
Remote and isolated health care settings in which at-risk populations are cared for should have access to resources to facilitate implementation of essential administrative, environmental and personal protective controls.
Major Recommendations
All health care settings should have a TB management or infection prevention and control program supported at the highest administrative level. This involves a hierarchical approach to infection prevention and control measures categorized as administrative, environmental and personal protection controls.
Airborne precautions should be initiated immediately for everyone with suspected or confirmed respiratory TB disease admitted to a hospital.
The criteria for discontinuation of airborne precautions include the following: establishment of an alternative diagnosis, clinical improvement, adherence to effective therapy, sputum smear and/or culture conversion, and drug-susceptibility tests that indicate fully sensitive organisms or low clinical suspicion of drug resistance.
U.S. National Institute for Occupational Safety and Health (NIOSH)-certified respirators (N95 or higher filter class) should be used by HCWs providing care for or transporting patients with suspected or confirmed respiratory TB disease.
Masks should be used by patients/people with suspected or confirmed respiratory TB disease when outside an airborne infection isolation room.
Baseline tuberculin skin testing (TST) is recommended for all HCWs in health care and community care settings. Recommendations for periodic and serial (repeated) TST for HCWs vary with the setting. Interferon-gamma release assays are not recommended for serial testing.
What are 4 components of WNV control program?
What are the WNV risk comm messages?
WNV control components: surveillance, breeding ground control, mosquito control, education
Cover exposed skin
When you are outside, wear:
long pants and loose-fitting shirts with long sleeves
socks and a hat
(try a mosquito net over your hat to protect your head
light-coloured clothing (mosquitoes are attracted to dark colours)
Use insect repellent
When you are outside, you should use insect repellents (bug sprays and lotions) that contain the chemicals DEET or Icaridin.
How can you reduce mosquito habitats near your home?
Mosquitoes lay eggs in standing water (water that does not move or flow).
Get rid of standing water around your home by following these tips:
drain or dry off water in:
old tires (even tire swings)
rainwater barrels
children’s toys
flowerpots
wading pools
clean eavestroughs regularly to prevent clogs that trap water
tip fishing boats and gear onto their sides to drain
replace the water in outdoor pet dishes and bird baths at least 2 times a week
Put screens on your windows and doors to keep mosquitoes out of your home.
How should you handle dead animals and wild birds?
If you find a dead animal or bird, do not handle the body with your bare hands. Always wear rubber gloves when touching any dead bird or animal.
Report dead birds that you suspect have West Nile virus.
If you hunt or skin wild animals, remember that West Nile virus can spread through blood-to-blood contact.
To help protect yourself from diseases the animal might have:
always wear gloves when you handle dead animals
always make sure any open wounds on your hands are covered
wash your gloved hands, and then wash your bare hands every time you handle a dead animal
There is no evidence that people can get West Nile virus from eating fully cooked infected birds or animals.
What are CTFPHC recs around screening for hypertension in adults?
- We recommend blood pressure measurement at all appropriate primary care visits. (Strong recommendation; moderate quality evidence)
- We recommend that blood pressure be measured according to the current techniques described in the Canadian Hypertension Education Program (CHEP) recommendations for office and out-of-office blood pressure measurement.* (Strong recommendation; moderate quality evidence)
- For people who are found to have an elevated blood pressure during screening, the CHEP criteria for assessment and diagnosis of hypertension should be applied to determine whether the patient meets diagnostic criteria for hypertension.* (Strong recommendation; moderate quality evidence)
What are the 3 components of AQHI?
Ground-level Ozone (O3)
Fine Particulate Matter (PM2.5)
Nitrogen Dioxide (NO2)
Mnemoni Nope! - NO2 - 03 - PM
What is the definition of a measles outbreak?
How is a measles contact defined?
What is a susceptible individual?
When was measles eliminated in Canada?
What is required to maintain elimination?
What are essential components of case investigation?
When and for how long should susceptible contacts be excluded?
What are key communication messages during measles outbreaks?
MEASLES OUTBREAK Two or more confirmed cases linked, either
epidemiologically or virologically or both.
CONTACT
A contact is defined as any individual who has:
• spent any length of time in a room or enclosed space
with a confirmed measles case during that case’s
infectious period (i.e. approximately 4 days before
rash onset to 4 days after rash onset); or
• spent time in a room previously occupied by a
measles case, during that case’s infectious period,
within 2 hours after that individual left the room/space.
SUSCEPTIBLE INDIVIDUAL
An individual considered susceptible to measles meets
the following criteria:
• lack of documented evidence of vaccination (one
dose for adults 18 years of age and older, born
in 1970 or later; two doses for children 12 months
to 17 years of age) after the first birthday and given
at least 4 weeks apart for MMR vaccine, or 6 weeks
apart for MMRV vaccine;
• lack of laboratory evidence of prior measles
infection; and
• lack of laboratory evidence of immunity (i.e. “reactive”
or “positive” anti-measles IgG antibody or a previous
measles antibody level of ≥200 mIU per ml) (2).
Canada has been free of endemic measles since 1998. Maintaining elimination of this disease will
require enhanced surveillance activities, identifying
and improving immunization coverage in susceptible
populations, and providing education, both to the
public and to health professionals, on the importance
of immunization.
Essential components of case
investigation include confirming the diagnosis, obtaining
vaccination histories, identifying the sources of infection,
and assessing the risk for transmission.
Susceptible contacts that refuse or cannot receive
MMR vaccine or immune globulin may be excluded
from childcare facilities, schools, and post-secondary
educational institutions at the discretion of the Medical
Officer of Health; and may be required to self-isolate from
work places, or other group settings, including travel. If
exclusions occur, the period of exclusion should extend
from 5 days after the first exposure and up to 21 days after
the last exposure.
The following are general messages that could be useful
in any measles outbreak:
• Measles is a highly infectious disease. Its symptoms
include fever, red eyes, runny nose, drowsiness,
irritability and a red blotchy rash that begins on
the face.
• Measles affects all age groups but generally the
disease is more severe in infants and adults. Measles
during pregnancy can result in a higher risk of
premature labour and low infant birth weights.
• Immunization is the best defence against this disease.
Canadians are reminded to keep all vaccinations
up-to-date.
• People who may have been exposed, who are not
immunized and are experiencing symptoms should
contact their health care provider or public health
authority to determine the best course of action. As a
general rule, people who are sick should stay at home
to reduce the risk of spreading an infectious disease.
What are threshold limit values?
TLV-TWA?
TLV-STEL?
TLV-C?
Threshold limit value
TLV-TWA - (Time Weighted Average): time weighted average concentration for 8 hours to which almost all workers can be exposed daily without adverse effect over a working lifetime
TLV-STEL - (Short Term Exposure Limit): 15-min TWA exposure that shouldn’t be exceeded at any time during work day.
TLV-C - (Ceiling): the concentration of a substance that should not be exceeded at any time during work
Describe a structured approach to INTERPRETING a figure at the oral exam.
List examples of discrimination related to anti-Blackness.
Examples of anti-blackness:
- interpersonal racism can be overt (e.g. harassment, violent attacks),10 or subtle and pervasive in the form of daily indignities.
- racial profiling; overpolicing (e.g. surveillance, harassment,
excessive use of force) - underpolicing (e.g. under-responsiveness, abandonment) of Black
over-representation of Black people in criminal justice systems - overrepresentation of Black youth and children in child welfare systems
- systemic discrimination and undertreatment in hospitals and other
healthcare systems; - low representation or absence of Black people in leadership positions across institutions and systems.
Consequences:
- Chronic stress, trauma
- Impact on physical and mental health
- Individual, family, organization
- Reduce access to the material and social resources needed to achieve and maintain good health over a lifetime
- Inequities in access to education, income, employment, housing, and food security can drive inequities in health and wellbeing.
What are characteristics of a good health indicator?
What is the difference between a metric, a health indicator and a health system performance indicator?
Health indicators are measures designed to:
- summarize information about a given priority health topic
- comparable information across different geographic, organizational or administrative boundaries
- relevant, meaningful, actionable information
- can track progress over time
- scientifically valid, feasible
Metric: Information that is quantifiable and is reported as a number. Has value and many uses, but cannot be compared.
Health indicator: Puts metrics into some kind of context, usually using a ratio (per X) and is designed to ensure comparability (e.g., by being risk-adjusted or standardized). Directionality may or may not exist.
Health system performance indicator: A health indicator that has a desired direction (e.g., lower is better).
What are the CTFPHC recommendations around lung cancer?
Low dose computed tomography (LDCT)
For adults aged 55-74 years with at least a 30 pack-year* smoking history who currently smoke or quit less than 15 years ago, we recommend annual screening with LDCT up to three consecutive times. Screening should ONLY be carried out in health care settings with expertise in early diagnosis and treatment of lung cancer.
Weak recommendation; low quality evidence.*pack-year defined as the (average number of cigarette packs smoked daily) x (number of years smoking)
For all other adults, regardless of age, smoking history or other risk factors, we recommend not screening for lung cancer with LDCT.
Strong recommendation; very low quality evidence.
Chest x-ray (CXR)
We recommend that chest x-ray not be used to screen for lung cancer, with or without sputum cytology.
Strong recommendation; low quality evidence.
What are the 7 calls to action under the truth and reconciliation commission under the responsibility of health professionals?
In summary:
- acknowledge current state of health = direct result of previous policies + implement healthcare rights
- measure health outcomes gaps + publish progress
- address health care needs for off-reserve aboriginal
- fund healing centers
- recognize value of aboriginal healing practices
- increase number and retention of aboriginal HCW + provide cultural competency training for all HCW
- require med/nursing students to take a course on Aboriginal health issues
18. We call upon the federal, provincial, territorial, and Aboriginal governments to acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools, and to recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law, and under the Treaties.
19. We call upon the federal government, in consultation with Aboriginal peoples, to establish measurable goals to identify and close the gaps in health outcomes and to publish annual progress reports and assess longterm trends. Such efforts would focus on indicators such as: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services.
20. In order to address the jurisdictional disputes concerning Aboriginal people who do not reside on reserves, we call upon the federal government to recognize, respect, and address the distinct health needs of the Métis, Inuit, and off-reserve Aboriginal peoples.
21. We call upon the federal government to provide sustainable funding for existing and new Aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools, and to ensure that the funding of healing centres in Nunavut and the Northwest Territories is a priority.
22. We call upon those who can effect change within the Canadian health-care system to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients.
23. We call upon all levels of government to: i. Increase the number of Aboriginal professionals working in the health-care field. ii. Ensure the retention of Aboriginal health-care providers in Aboriginal communities. iii. Provide cultural competency training for all healthcare professionals.
24. We call upon medical and nursing schools in Canada to require all students to take a course dealing with Aboriginal health issues, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices. This will require skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism.
What are examples of carbapenemase strains?
What is the cultural safety continuum?
Influenced by trauma informed care, anti-racism, cultural humility
Cultural awareness, sensitivity, competence, safety
Awareness - acknowledging a difference between cultures
Sensitivity - understanding different needs for different cultures, respecting the differences
Competency - having the skills to provide what is needed for these differences (debatably not achievable by those outside the culture)
Safety - self-reflection, examining power imbalances and injustices, and humility can improve safety, this is an outcome perceived by the patient/population involved
What are the pros and cons of:
- regionalization of public health?
- integrating public health inside local health networks?
Integration in local health networks:
- Bring population health perpective in health assessment and planning
- Better integration of health services, from prevention to palliation
- Greater clinical focus than public health focus
- Public health funding susceptible to urgent healthcare needs
- Distraction from other critical PH partnership
- Boundary misalignment
Regionalization
- Better integration in emergency preparedness, maternal child health, flu.
- Population health assessment and surveillance
- Transition costs
- Boundary misalignment
- Loss of critical mass of public health capacity and authority
What are public health actions in the different emergency management cycles?
What is a geometric mean?
Geometric mean is often used in skewed distributions, it is calculated by transforming observations to a log scale to make a distribution of observations more symmetric. The geometric mean is the antilog of the arithmetic mean of the logs.
How is vaccine coverage is monitored in Canada?
How is vaccination coverage calculated?
What are examples of vaccination coverage surveys in Canada?
Most provinces and territories have an electronic immunization registry for their jurisdiction, in order to: identify children who are due or overdue for a vaccine provide health care professionals with a patient’s up-to-date vaccination status measure immunization coverage and help assess immunization programs
We do a survey every 2 years to track coverage for all vaccines recommended by the National Advisory Committee on Immunization.
For example, to calculate vaccination coverage for
pertussis (whooping cough) in 2-year-olds, we:
1. divide the number of 2-year-old children who received the recommended 4 doses of pertussisvaccine before age 2 by the total number of children aged 2
2. multiply the result by 100, to get the percentage
Childhood National Immunization Coverage Survey (cNICS)
cNICS measures coverage for all vaccines given to infants, children and teens every second year.
Survey of Vaccination during Pregnancy
The Survey of Vaccination during Pregnancy measures the uptake of pertussis and influenzavaccination in pregnant women.
Survey of Vaccination during Pregnancy 2019
Adult National Immunization Coverage Survey (aNICS)
aNICS measured coverage for vaccines recommended for adults. As of 2018, it was merged into theSeasonal Influenza Vaccination Coverage Survey.
Seasonal Influenza Vaccination Coverage Survey
The Seasonal Influenza Vaccination Coverage Survey measures coverage for the flu shot in adultsevery year. Every second year, it measures other adult vaccines as well.
What is the CTFPHC recommendations on behavioural interventions for the prevention and treatment of cigarette smoking among school-aged children and youth?
Prevention
We recommend asking children and youth (age 5–18 yr) or their parents about tobacco use by the child or youth and offering brief* information and advice, as appropriate during primary care visits**, to prevent tobacco smoking among children and youth (weak recommendation, low-quality evidence).
Treatment
We recommend asking children and youth (age 5–18 yr) or their parents about tobacco use by the child or youth and offering brief*information and advice, as appropriate during primary care visits **, to treat tobacco smoking among children and youth (weak recommendation, low quality evidence).
What are evidence-based intervention to:
- reduce the incidence of early childhood caries?
- reduce the incidence of dental caries in school-age children?
- improve and maintain the oral health of seniors?
- increase access to dental care in order to reduce health disparities?
Reduce the incidence of Early Childhood Caries (ECC)
Fluoride varnish applications
Xylitol (a non-sugar substitute) to reduce oral bacterial transmissibility between mother and child
Oral health education/promotion
Building capacity in the physician and allied public health workforce
Reduce the incidence of dental caries in school-age children
Topical fluoride applications
Pit and fissure sealants
Oral health education/promotion
Dental screening
Improve and maintain the oral health of seniors
Topical antimicrobials (e.g. chlorhexidine, fluoride varnish)
Addition of oral health checks in general health examinations
Training of professionals in long-term care
Improved oral health policy in long-term care facilities
Increase access to dental care in order to reduce health disparities
Effective public health programs
Reducing barriers to accessing dental care
Community water fluoridation
Describe recent trends in life expectancy in Canada.
Opioid-related deaths have had a
serious impact on life expectancy for both sexes, but
more so for males in British Columbia and Alberta,
contributing to decreases in life expectancy in both
provinces from 2016 to 2017.
With respect to Indigenous
peoples, Inuit were estimated to have a shorter life
expectancy at birth, up to 14 years shorter for males,
and up to 11 years shorter for females, compared
to the overall Canadian population. It is important
to see these data in context; the lasting legacy of
colonization and intergenerational trauma have led
to systemic health inequities for First Nations, Inuit,
and Métis peoples.
What are the criteria for metabolic syndrome (with canadian units)?
High blood pressure (≥ 130/85 mm Hg, or receiving medication)
High blood glucose levels (≥ 5.6 mmol/L, or receiving medication)
High triglycerides (≥ 1.7 mmol/L, or receiving medication)
Low HDL-Cholesterol (< 1.0 mmol/L in men or < 1.3 mmol/L in women)
Large waist circumference (≥ 102 cm in men, 88 cm in women; ranges vary according to ethnicity)
Explain steps involved in public health planning?
PATOS PICE
1.Planifier la planification
a) Clarifier le mandat
b) Préciser les attentes
c) Clarifier le processus décisionnel
d) S’entendre sur les ressources disponibles pour planifier
- budget, temps, nombre de personnes, expertise, données, matériel, ressources informatiques
e) Planifier l’échéancier
f) Préciser les rôles et les responsabilités de chacun
g) Répartir les tâches
2.Assess
a) Définition du problème
b) Contexte
- PESTELEEMO
- FFOM (SWOT)
c) État de santé de base de la population
- Données de surveillance
- Besoins de la population (besoin perçu, exprimé, etc.)
d) Recension des interventions existantes
- Littérature scientifique, littérature grise, documentation, projet de recherche
e) Recension des ressources disponibles
f) Priorisation des besoins de la population
3.Team
a) Experts
b) Partenaires
c) Penser aussi aux opposants potentiels
- Préciser les méthodes de coordination, les processus décisionnels, les rôles et les responsabilités
4.Objectifs
a) Énoncer
b) Prioriser
5.Solutions possibles
a) Dresser un inventaires
b) Prioriser
6.Plan de programme
a) But et objectifs
b) Groupe cible
c) Stratégies
d) Activités
e) Tâches
f) Ressources
g) Indicateurs
h) Modèle logique
7.Implantation
a) Plan d’action
- Rôles et responsabilités: Qui fait quoi?
- Échéancier
- Ressources / Budget
- Procédure de communication
a) Projet pilote / Incrémentale / Subite
b) Gestion du changement
c) Intensité / Continuité / Flexibilité
8.Communication
9.Évaluation
a) Structure
b) Processus
c) Résultats (incluant effets inattendus)
Name 6 population groups more likely to be living in low income.
What are 3 ways to define low income and what are their relative advantage?
Groups of Canadians More Likely to be Living in Low Income
Children
Vulnerable Groups
Indigenous People
People with Disabilities
Recent Immigrants
Single Parents
Unattached Individuals Aged 45–64
Low income cut-offs (relative measure) - considered low income if family spend 20% more on food, shelter and clothing than the average family, data goes back to 1976.
Market basket measure (absolute measure) - considered low income if does not have enough money to buy specific goods and services in its community, more sensitive to differences in cost of living, data starts in 2002.
Low income measure (relative measure) - low income if income is below 50% of median household income, data goes back to 1976, frequently used for international comparisons.
What are the 12-steps of outbreak investigation?
“The 12-step program”
- Confirm outbreak and diagnosis
Are there more cases than expected in a given area in a given time interval among a specific group of people?
Is further investigation needed?
- Consider immediate control measures
- Assemble an outbreak response team
- Establish and maintain communications
- Establish case definition - PPTLS (standard set of criteria for determining if a person should be classified as part of an outbreak, such as lab diagnosis, symptoms, person, place, and time; may be divided into confirmed, probable, and suspect/possible)
- Identify cases and contacts, and obtain information
Line list
Active surveillance
- Organize data in terms of person, place, and time (descriptive epidemiology)
- Define the population at risk
- Develop and test hypotheses
Case-control, cohort, environmental sampling, or
- Implement control measures: The chosen control strategies should take into account epidemiology, study findings, environmental sampling, and theory; practically, control strategies will also be influenced by jurisdictional authority, legal roles, political sensitivity, timeliness of outbreak detection, interpersonal issues, and available resources
Control source (e.g., insecticidal spraying, food recall)
Interrupt transmission (e.g., education or policy to change behaviour, isolation; see case and contact management)
Modify host response (e.g., vaccination)
- Monitor the response
- Summarize in a report
Case definitions
confirmed: high specificity, low sensitivity
probable
suspect: low specificity, high sensitivity
When declare outbreak over?
return to baseline
last time individual may have been exposed to implicated source has been identified
sufficient time has elapsed for potentially exposed individuals to become ill and be reported to investigating public health authorities
When declare outbreak over?
return to baseline
last time individual may have been exposed to implicated source has been identified
sufficient time has elapsed for potentially exposed individuals to become ill and be reported to investigating public health authorities
How is TB treated in Canada?
Treatment of active TB should include two effective drugs at all times, and in the initial phase (first 2 months) at least three effective drugs are recommended.
Treatment should be guided by the results of drug sensitivity testing, which should be performed for all patients with culture-confirmed disease.
All patients with active TB in Canada should be treated with a regimen of isoniazid (INH), rifampin (RMP), pyrazinamide (PZA) and ethambutol (EMB) initially. If the isolate causing disease is fully susceptible to all first-line drugs, the EMB can be stopped, and PZA should be given for the first 2 months. After that it is recommended that only INH and RMP be given for the remainder of therapy – usually another 4 months.
Therapy is prolonged to 9 months if there are risk factors for relapse. These include persistent presence of cavity on the chest x-ray after 2 months or at the end of effective anti-TB therapy, persistent smear and/or culture positivity after 2 months of therapy, or HIV coinfection.
Providers who are initiating TB therapy should provide comprehensive, patient-centred care and be able to monitor that 100% of prescribed doses are taken. Directly observed treatment (DOT) is one method to achieve this and is recommended at a minimum for patients with risk factors for non-adherence, or population groups with historically increased rates of treatment failure or relapse or with inadequate rates of treatment completion, defined as default rates of 5% or greater. It is recommended that all jurisdictions across Canada have the capacity to provide DOT.
Therapy can be given 5 days per week in the initial 2 months, then three times per week if DOT is used, to facilitate treatment supervision. Therapy that is self-administered should be taken daily.
Fixed-dose combination (FDC) preparations of multiple TB medications are not recommended.
Treatment of active disease in pregnant or breastfeeding women should be the same as the standard regimen.
The same drugs, dosing and duration as in the standard regimen are recommended for treatment of active disease in patients with renal insufficiency. However, prolonged dosing intervals are recommended for PZA and EMB from daily to three times per week.
Therapeutic drug monitoring (TDM) is not available in Canada but is available in the United States. The impact of TDM on important outcomes is unknown. Nevertheless, TDM should be considered for patients with renal or hepatic insufficiency, HIV coinfection or known malabsorption.
What are findings from the 2017 Air Quality report?
What are the main objectives of Public Safety Canada according to their 2019-2020 departmental plan?
National Security
Community Safety
Emergency Management
Internal Services
What are 5 principles of good governance?
What are the 6 functions of public health governance?
Principles of good governance (mnemonic A-LIST)
Accountability, Leadership, Integrity, Stewardship, Transparency.
Functions of PH governance:
- Policy development - Lead and contribute to the development of policies that protect, promote, and improve public health
- Resource stewardship - assure the availability of adequate resources (legal, financial, human, technological, and material) to perform essential public health services
- Continuous quality improvement - routinely evaluate, monitor, and set measurable outcomes for improving community health status
- Partner engagement - build and strengthen community partnerships through education and engagement to ensure the collaboration of all relevant stakeholders
- Legal authority - exercise legal authority as applicable by law and understand the roles, responsibilities, obligations, and functions of the governing body, health officer, and agency staff
- Oversight & responsibility for public health performance in the community by providing necessary leadership and guidance to support the public health agency in achieving measurable outcomes
https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC4355716/
What can trigger food safety investigations?
What are the 5 steps of food safety investigations by the CFIA?
Who is responsible for informing the public of a recall?
Who is responsible for removing the food from the markets?
TRIGGERS FOR INVESTIGATION
Suspected or confirmed foodborne illness outbreak
Food test result
Food inspection finding
Complaints from consumers, industry, other government departments or associations
Company-initiated recall
Recall in another country
CFIA audit/assessment/evaluation findings
Referrals from other branches within the CFIA
Referrals from other federal/provincial/territorial, municipal and international governmentdepartments or food safety organizations (for example, the International Food Safety AuthoritiesNetwork) law enforcement or the medical community
Traditional or social media
CFIA 5 steps of food safety investigations
- Trigger;
- Food safety investigation;
- Health risk assessment;
- Recall process; issue recall, inform the public
- Follow-up; steps taken to remediate + prevent
The recalling firm is responsible for contacting all of its clients (for example, distributors or retailers)that have or may have received the recalled food.
The _CFIA’s role is to inform the publi_c, oversee implementation of the recall, provide guidance and verify that industry has effectively removed recalled food from the marketplace.
What are epi trends in colorectal cancer?
Colorectal cancer incidence rates are declining in males and females. The recent declines are likely due in part to increased use of colorectal cancer screening which can identify and remove precancerous polyps, which can in turn reduce incidence.
Death rates have also been declining. Most of this decline is likely driven by decreased incidence, as well as by improved diagnosis and treatment.
It is estimated that about 1 in 14 Canadian men will develop colorectal cancer during their lifetime and 1 in 32 will die from it.
It is estimated that about 1 in 18 Canadian women will develop colorectal cancer during their lifetime and 1 in 37 will die from it.
What is the social and material deprivation index? (INSPQ, Pampalon)
The deprivation index is built from six socioeconomic indicators drawn from the 1991, 1996, 2001, 2006, 2011 and 2016 censuses, including the 2011 National Household Survey (NHS). These indicators were selected because of their known relationship with health status, because of their association with both the material and the social aspects of deprivation, and because of their availability by EA/DA. These indicators are:
The proportion of the population aged 15 years and over without a high school diploma or equivalent;2
The employment to population ratio for the population 15 years and over;
The average income of the population aged 15 years and over;
The proportion of the population aged 15 and over living alone;
The proportion of the population aged 15 and over who are separated, divorced or widowed;
The proportion of single-parent families.
How is PPV or NPV calculated using sensitivity, specificity and prevalence?
PPV =
(sensitivity x prevalence) /
[(sensitivity x prevalence) + ((1 – specificity) x (1 – prevalence))]
NPV =
(specificity x (1 – prevalence)) /
[(specificity x (1 – prevalence)) + ((1 – sensitivity) x prevalence)]
3 chemicals from treated wood
CAC
Chromium, Arsenic, Copper
What are the guidelines for smoking cessation counselling?
Ottawa model 3As: Ask, advise, act
US model 5As:
ASK, ADVISE, ASSESS (willingness to quit), ASSIST, ARRANGE
Motivational interviewing “5 Rs”: Relevance, Risks, Rewards, Roadblocks, Repetition
Regarding preconception health, what are the health effects and clinical practice recommendations for the following;
- Alcohol and substances
- Body weight
- Emotional health and stress
- Environmental toxins
- Medical conditions and genetic risk
- Oral health
- Vaccine preventable diseases
- Tobacco
Alcohol & Substance Use (see Tobacco Use below)
Effects
When under the influence of alcohol, individuals are less likely to adopt safe sex practices and there is an increase in unintended pregnancies [26,159,221].
Alcohol use in pregnancy is the cause of Fetal Alcohol Spectrum Disorder (FASD), a permanent developmental disability [5,26,160,161].
Alcohol and substance use increases the risk of preterm birth, low birth weight and small for gestational age babies, placental abruption and intrauterine growth restriction [5,162,163].
Heavy alcohol consumption and street drugs can cause fertility problems including impotence, alterations in sperm quality for men and disrupted menstrual and ovulation cycles for women [159,162].
Recommendations
Screen all individuals of reproductive age, for at-risk alcohol consumption and drug misuse [26,160,161,163].
Identify at-risk drinking and drug misuse before pregnancy, to allow time to address substance misuse [5,26]. Particular attention should be made to women of advanced maternal age and young women as they may be more at-risk for alcohol use during pregnancy [164].
Provide consistent messaging that abstinence from alcohol and substances is the safest choice for those who are or may become pregnant [26,161,165,166].
Using a harm reduction approach, counsel all sexually active individuals of reproductive age who use alcohol and/or other substances, to make informed decisions regarding alcohol and substance use and to consistently use an effective form of contraception [159,162]. There is no confirmed safe amount of alcohol use during any stage of a pregnancy [26].
There are many different effective screening tools related to alcohol use, some intended for specific ages or populations; however none have been tested for preconception health specifically. The T-ACE screen (like CAGE but instead of guilt its tolerance - needing more than 2 drinks to feel high was the first validated screening questionnaire for risky drinking developed for pregnant women.
Body Weight
Effects
Starting a pregnancy underweight, overweight or obese can negatively affect maternal and fetal health. As pre-pregnancy Body Mass Index (BMI) increases, the _risk of infertility and complications during pregnancy also increase_s [13,33,65,167,168]. Adverse outcomes associated with maternal BMI in the overweight or obese category include gestational diabetes, gestational hypertension, excessive gestational weight gain, miscarriage, stillbirth, Caesarean section, wound infections, preterm delivery, neural tube defects, child obesity, maternal diabetes, hypertensive and thromboembolic disease [27,33,167].
Evidence shows that women who are physically fit before pregnancy have fewer aches and pains during pregnancy and feel they have more energy during their pregnancies [5,169].
Male obesity negatively impacts fertility, sperm quantity and quality [170,171].
Recommendations
Educate women of reproductive age about the impact of their health and weight on their own well-being and on the health and well-being of their children [32].
Advise overweight and obese women of the increased risk of congenital abnormalities and screen appropriately [27,55].
Educate and support individuals to reach a healthy body weight prior to a pregnancy occurring [27,65]. Inform all individuals to aim for at least 30 minutes of moderate exercise (that makes you sweat), five days a week, to enjoy long-term good health [5,172].
Inform men of potential impact of weight on fertility and their own well-being. Encourage men to set goals and develop a plan to reach a healthy weight [6].
Emotional Health & Stress
Effects
Poor preconception mental health is a significant risk factor for pregnancy complications and low birth weight babies [101]. Maternal depression during pregnancy is associated with increased odds for premature delivery and decreased breastfeeding initiation [173]. Women who have experienced perinatal mood disorder (PMD) during pregnancy or in the postpartum period have a greater risk of experiencing PMD in subsequent pregnancies [174,175]. Psychosocial factors such as socioeconomic status, work status, marital status, level of education, access to prenatal care, substance abuse, ethnicity, cultural background, and quality of relationships with partners and parents have been identified as determinants of stress during pregnancy [61,176,177]. High levels of stress may delay conception, impact the ability to conceive and has been linked to adverse pregnancy outcomes [5,176,178,179].
Women with psychosocial stress are also at risk for participation in high risk behaviours. Women with high risk behaviours before pregnancy are more likely to continue them during pregnancy and less likely to access prenatal care [102].
Evidence supports the association between prenatal stress and infection and inflammation during pregnancy which can lead to low birth weight, preterm birth, and additional adverse outcomes or pregnancy complications [61,177,178].
_Intimate partner violence as a child or adolescent increases the risk of violence during pregnanc_y [176]. Women who experience preconception or prenatal violence are 30% less likely to have adequate prenatal care. Abuse can escalate in pregnancy [13,180].
Recommendations
Promote interventions that improve the emotional health of women and reduce stress before conception to reduce the risk including perinatal mood disorders. Intervention may include group counseling, development of coping and economic skills [5,179,181,182].
HCPs should _include queries about violence in the behavioural health assessment of new patient_s, at annual preventive visits, as a part of prenatal care and in response to symptoms or conditions associated with abuse [13,183].
Environmental Toxins
Effects
There are substances in the everyday environment which are known to be harmful and interfere with the endocrine system, affecting fertility and reproductive outcomes for men and women [184,185,186]. Interference with hormone action during critical periods of fetal development can cause irreversible and delayed effects that do not become evident until later in life [187,188]. Environmental toxins (e.g., air pollutants, heavy metals, organic solvents, pesticides) may increase the risk of low birth weight, intrauterine growth restriction, preterm birth, and birth defects [189,190].
Recommendations
Encourage all individuals of reproductive age to investigate and review the harmful substances in their home and workplace environments so that they can adopt prevention strategies before conceiving [186].
Medical Conditions & Genetic Risks
Effects
Some medical conditions (e.g., diabetes, hypertension, thyroid disease), undiagnosed, untreated, or poorly controlled, can be associated with adverse fetal outcomes [5,191,192]. Men and women with pre-existing medical conditions are commonly prescribed medications. Some medications can pose risk to fertility (e.g., affect sperm count and quality), can affect sperm count and quality, and are contraindicated during pregnancy (e.g., increase risk for congenital anomalies). Sometimes, the risk of not taking medication during pregnancy may be more serious than the potential risk associated with taking the medication [6,193].
Recommendation
Investigate family history of genetic disorders such as muscular dystrophy, hemophilia, cystic fibrosis, fragile X syndrome, congenital heart disease, phenylketonuria, dwarfism, sickle cell anemia, and Tay-Sachs disease to increase understanding of possible genetic risk and lead to enhanced pregnancy outcomes [191]. Individuals should have a full medical examination to ensure chronic conditions are under control before conceiving. This should include exploring use of medications known to be safe for a fetus [5,191]. Encourage individuals to speak with a genetic counsellor if they have a family history of genetic disorders [191].
Oral health
Effect
Dental caries and other oral diseases are common in women of reproductive age (>80% of women aged 20-39 years) [191,194]. Pregnant women with periodontal disease, which is a preventable and treatable condition, may have higher risk of delivering a preterm or low birth weight baby [195,196,197]. A mother with recent tooth decay can transmit the caries causing bacteria to the child [197,198,199,200]. Although not directly linked to fertility or birth outcomes, oral health in males contributes positively to physical, mental and social well-being and should be encouraged [198].
Recommendations
Encourage individuals of reproductive age to _visit their dental care professional for regular care to prevent chronic conditions and maintain oral health before pregnanc_y [197,201].
Sexually Transmitted Infections (STI)
Effects
S_ome types of STIs, including HIV, can cause infertility in men and women, adverse pregnancy outcomes including preterm and low birth weight babies, transmission of the infection to fetus/infant, stillbirth or physical and developmental disabilitie_s [202,203,204,205].
Recommendations
Incorporate STI prevention as part of routine patient care. Screen for and treat STIs early to prevent adverse outcomes to fertility, pregnancy and fetal health [13,202,204]. Particular attention should be given to teens as they have the highest rates of STIs among young people [203,204,205].
Tobacco Use
Effects
Women who smoke are more likely to experience reduced fertility as tobacco use can influence conception delay, ovarian function, tubal function, and uterine receptiveness [5,206,207,208]. Smoking in males is associated with erectile dysfunction, low sperm counts, poor motility, altered sperm quality which can lead to failed embryo implantation and adverse birth outcomes including low birth weight [206,207,208,209]. Nicotine exposure during pregnancy contributes to adverse birth outcomes, such as ectopic pregnancy, miscarriage, preterm birth and stillbirth [163,196,206,208]. Smoking in early pregnancy is linked to orofacial clefts in infants, and evidence suggests that smoking could be associated with certain other birth defects [207]. Exposure to second-hand tobacco smoke has been causally linked to cancer, respiratory, cardiovascular diseases, and to adverse effects on the health of infants and children [163,207].
Recommendations
Provide routine screening of tobacco use for all individuals. Brief interventions, of 1-3 minutes, are effective and should be offered to every tobacco user18 . Quit attempts before conception provide an opportunity for women to use nicotine replacement therapies without concern for a developing fetus [13,163,208]. Educate all non-smokers about harms associated with second-hand smoke and harmful effects on pregnant women and unborn children [13,163].
Vaccine Preventable Diseases
Effects
Infection by certain vaccine preventable diseases in women can cause serious birth defects or fetal death [211]. _For rubella and varicella, the syndromes affecting the fetus and infants are most common when a non-immune woman is exposed to the virus during pregnancy, with the greatest risk to the fetus being in the first trimeste_r [212]. Attaining immunity prior to pregnancy accounts for fewer complications related to the illnesses and provides passive immunity for the baby [212,213]. Communicable disease infection of males prior to conception can affect fertility e.g., a common complication of mumps is orchitis, inflammation of the testicles [214].
Recommendations
Provide routine immunity assessment and vaccination, if necessary, to individuals of reproductive age [213]. Women should be advised to _avoid pregnancy for at least 28 days after live vaccination_s since these vaccines cross the placenta and there is a theoretical risk to the fetus [212,213]. Ensure partners and household contacts to a pregnant woman have up to date immunizations [214].
What is the WHO framework around alcohol policy?
S Strengthen restrictions on alcohol availability
A Advance and enforce drink driving counter measures
F Facilitate access to screening, brief interventions and treatment
E Enforce bans or comprehensive restrictions on alcohol advertising, sponsorship, and promotion
R Raise prices on alcohol through excise taxes and pricing policies
What are ethical considerations in pandemic preparedness?
In summary:
Content:
trust/solidarity,
reciprocity
stewardship,
proportionality,
equity/fairness
Process:
openness/transparency,
accountability,
inclusiveness,
reasonableness
Many of the issues encountered in pandemic preparedness and response involve balancing rights, interests and values. Examples include decisions over resource allocation; prioritization guidelines for pandemic vaccine and antiviral medications; adoption of public health measures that may restrict personal freedom; roles and obligations of HCWs and persons providing medical first response, as well as their employers; the potential need for triage in the provision of critical care; and responsibilities to the global community.21 The application of ethical reasoning to pandemic preparedness and response begins with identifying and prioritizing the ethical questions in the issue under consideration. Analysis should include reflection on the ethical considerations associated with the options, taking into account the societal versus individual interests and values that are at stake. Ethical tensions are inevitable. When weighing the options, it is important to be guided by the Canadian pandemic goals. As pandemic planning initiatives fall within the domain of public health, they are guided by a code of ethics that is distinct from traditional clinical ethics.22 Whereas clinical ethics focuses on the health and interests of individuals, public health ethics focuses on the health and interests of a population. When a health risk like a pandemic affects a population, public health ethics predominates, and a higher value is placed on collective interests.
In practical terms, this means there should be an emphasis placed on trust and solidarity. Successful public health activities require relationship-building and can contribute to creating and maintaining trust between individuals, populations and health authorities. Solidarity is the notion that we are all part of a greater whole, whether an organization, a community, nation or the globe. Another important consideration is reciprocity, meaning that those who face disproportionate burdens in their duty to protect the public (e.g., HCWs and other workers who are functioning in a health care capacity, for example police or fire personnel who are providing medical first response) are supported by society, and that to the extent possible those burdens are minimized. The concept of stewardship is also closely related to trust. Stewardship refers to the responsible planning and management of something entrusted to one’s care, along with making decisions responsibly and acting with integrity and accountability. Trust, stewardship and the proper building of relationships also mean that the power conferred to government and health authorities will not be abused. For example, if restrictions are deemed essential for proper risk management, they must be effective and proportional to the threat, meaning that they should be imposed only to the extent necessary to prevent foreseeable harm. These restrictions should also be counterbalanced with supports to minimize the burden on those individuals affected. 21 World Health Organization. Ethical considerations in developing a public health response to pandemic influenza. The concepts of equity and fairness are very important to Canadians. In a pandemic context, they lead to a number of considerations. As much as possible, benefits and risks should be fairly distributed through the population. This may be difficult, however, in some circumstances, such as a pandemic that differentially affects certain populations or a very severe pandemic if resources are in short supply. Decisions should take health inequities into account and try to minimize them, rather than make them worse. Access to necessary health care may be restricted in a health crisis; however, available resources (e.g., vaccine and antiviral medications) should be distributed in a fair and equitable way. What will constitute fair and equitable distribution will be context dependent. Therefore the transparency and reasonableness of decision-making processes are important.
Good decision-making processes are also essential for ethical decision-making. They involve the following:23,24
- openness and transparency—the process is open for scrutiny, and information about the basis for decisions and when and by whom they were made is publicly accessible;
- accountability—being answerable for decisions;
- inclusiveness—stakeholders are consulted, views are taken into account, and any disproportionate impact on particular groups is considered; and
- reasonableness—decisions should not be arbitrary but rather be rational, proportional to the threat, evidence-informed and practical.
What are steps included in knowledge translation.
What are “knowledge to action” model framework?
Knowledge translation includes synthesis, dissemination, exchange, implementation.
Knowledge to action
(ASSESS)
A. Identify need. Identify, review and select knowledge
(PLAN)
B. Adapt knowledge to local context
C. Identify barriers and facilitators to knowledge use. Select appropriate KT strategies
(IMPLEMENT)
D. Tailor and implement KT strategies
(EVALUATE)
E. Monitor knowledge use
F. Evaluate outcomes
G. Sustain knowledge use
What are actions to prevent drowning?
What are risk factors for drowning?
Interventions to prevent drowning
Provide safe places away from water for pre-school children
Install barriers controlling access to water
Teach school-age children (aged over 6 years) swimming and water safety skills
Build resilience and manage flood risks and other hazards
Train bystanders in safe rescue and resuscitation
Set and enforce safe boating, shipping and ferry regulations
Promote multisectoral collaboration
Strengthen public awareness of drowning through strategic communications
Establish a national water safety plan
Research: advance drowning prevention through data collection and well-designed studies
There are other factors that are associated with an increased risk of drowning, such as:
lower socioeconomic status, being a member of an ethnic minority, lack of higher education, and rural populations all tend to be associated, although this association can vary across countries;
infants left unsupervised or alone with another child around water;
alcohol use, near or in the water;
medical conditions, such as epilepsy;
tourists unfamiliar with local water risks and features;
What are Canada’s Food Guide recommendations for:
- Healthy eating habits?
- Food choices?
Healthy eating habits: (Mnemonic: Mind your Cooking to Enjoy Others)
Be mindful of your eating habits
Cook more often
Enjoy your food
Eat meals with others
Food choices:
Eat plenty of vegetables and fruits, whole grain foods and protein foods.
Choose protein foods that come from plants more often.
Limit highly processed foods. If you choose these foods, eat them less often and in small amounts.
Make water your drink of choice
Use food labels
Be aware that food marketing can influence your choices
What are the clinical criteria for WNV neurological and non-neurological syndromes?
West Nile Virus Neurological Syndrome (WNNS)
Confirmed case
Clinical criteria AND at least one of the confirmed case diagnostic test criteria
Probable case
Clinical criteria AND at least one of the probable case diagnostic test criteria
Suspect case
Clinical criteria in the absence of or pending diagnostic test criteria AND in the absence of any other obvious cause
Clinical criteria
History of exposure in an area where West Nile virus (WNV) activity is occurring (see Comments section)
or history of exposure to an alternative mode of transmission (see Comments section)
and onset of fever
and recent onset of at least one of the following:
encephalitis (acute signs of central or peripheral neurologic dysfunction) or
viral meningitis (pleocytosis and signs of infection, e.g. headache, nuchal rigidity) or
acute flaccid paralysis (e.g. poliomyelitis-like syndrome or Guillain-Barré-like syndrome), or
movement disorders (e.g. tremor, myoclonus) or
Parkinsonism or Parkinsonian-like conditions (e.g. cogwheel rigidity, bradykinesia, postural instability) or
other neurological syndromes
West Nile Virus Non-Neurological Syndrome (WN Non-NS)
Confirmed case
Clinical criteria and at least one of the confirmed case diagnostic test criteria
Probable case
Clinical criteria and at least one of the probable case diagnostic test criteria
Suspect case
Clinical criteria in the absence of or pending diagnostic test criteria and in the absence of any other obvious cause
Clinical Criteria
History of exposure in an area where WN virus (WNV) activity is occurring
or history of exposure to an alternative mode of transmission
and at least two of the following:
fever
myalgia
anthralgia
headache
fatigue
lymphadenopathy
maculopapular rash
What are the CTFPHC recommendations regarding cognitive impairment in older adults?
We recommend not screening asymptomatic adults (≥65 years of age) for cognitive impairment Strong recommendation, low quality evidence
What is PTSD?
Name groups affected by PTSD.
4 priority areas from the federal framework on PTSD
PTSD is a mental disorder that may occur after a
traumatic event where there is exposure to actual
or threatened death, serious injury, or sexual
violence
At risk groups:
Canadian Armed Forces Serving Members and Veterans
Public safety personnel
Health care providers
Other occupations
Indigenous people who work in high-stress occupations and additional considerations.
Other populations:
Survivors of physical, sexual and/or psychological violence
Survivors of disasters
LGBTQ2
Refugees and other newcomers
People experiencing homelessness
FEDERAL FRAMEWORK ON PTSD—AT A GLANCE
SCOPE
The focus of the Framework is on occupation-related PTSD. The Framework also acknowledges people affected by nonoccupation-
related PTSD and broad applicability will be considered in the implementation of federal actions.
PURPOSE
Strengthen knowledge creation, knowledge exchange and collaboration across the federal government, and with partners
and stakeholders, to inform practical, evidence-based public health actions, programs and policies, to reduce stigma and
improve recognition of the symptoms and impacts of PTSD.
VISION
A Canada where people living with PTSD, those close to them, and those at risk of developing PTSD, are recognized and
supported along their path toward healing, resilience, and thriving.
GUIDING PRINCIPLES
- Complement current initiatives and leverage partnerships
- Advance compassionate, non-judgemental and strengths-based approaches
- Base initiatives on evidence of what works or shows promise of working
- Understand and respond to equity, diversity and inclusion
- Apply a public health approach
PRIORITY AREAS
- *DATA AND TRACKING**
1. Explore strategies to support national surveillance activities and examine the feasibility of using health administrative data and enhanced data linkages to capture and report on PTSD.
2. Continue supporting data collection on PTSD. - *GUIDELINES AND BEST PRACTICES**
1. Work with partners and engage experts to compile existing guidance on PTSD and identify where gaps may exist.
2. Continue to support research to bridge PTSD-related information gaps, inform effective guidance for health care providers, and advance evidence-based decision making. - *EDUCATIONAL MATERIALS**
1. Work with partners and engage health care providers to identify current PTSD educational materials, understand the educational gaps, and seek advice on best practices for the dissemination, adaptation, and uptake of educational materials.
STRENGTHENED COLLABORATION
1. Work with partners and stakeholders to identify the best mechanism(s) to increase collaboration among key departments, partners and stakeholders, as well as for ongoing sharing of information, including uptake of common and culturally
appropriate terminology, definitions, and safe language about PTSD and trauma.
How is vaping regulated federally?
How vaping is regulated federally
Vaping products manufactured, labelled, advertised, imported or sold in Canada are subject to, among others, the following Acts and their Regulations:
Tobacco and Vaping Products Act
Canada Consumer Product Safety Act (no health claim product)
Food and Drugs Act (health claim product)
Non-smokers’ Health Act (second hand smoke)
Cannabis Act (cannabis containing products
Tobacco and Vaping Products Act
The Tobacco and Vaping Products Act (TVPA) became law on May 23, 2018.
While continuing to govern tobacco products as was the case under the Tobacco Act which it replaced, the TVPA also applies to vaping products. It aims to protect Canadians from nicotine addiction and from inducements to use tobacco and, in particular for youth, from vaping products use.
Key elements of the TVPA related to vaping products include:
not allowing vaping products to be sold or given to anyone under 18 years of age
not allowing the sale of vaping products that appeal to youth
giving the federal Government the ability to make rules about:
industry reporting
manufacturing standards
product and package labelling (for example, health warnings)
banning the use of certain ingredients and flavours
the promotion of vaping products
For more information about the TVPA, contact the Tobacco Control Directorate by email at hc.tcp.questions-plt.sc@canada.ca.
Canada Consumer Product Safety Act
The manufacturing, importation, advertisement and sale of vaping products that do not make health claims are subject to the Canada Consumer Product Safety Act (CCPSA), while also subject to the TVPA. In addition to other authorities, the CCPSA allows the federal Government to:
carry out inspections
order recalls or other measures
For more information about the CCPSA, contact the Consumer and Hazardous Product Safety Directorate by email at hc.cps-spc.sc@canada.ca.
Food and Drugs Act
The Food and Drugs Act (FDA) applies to vaping products that make a health claim (help quit smoking). This includes products that contain nicotine or any other drugs as defined by the FDA. These products must receive an authorization from Health Canada before they can be:
advertised
sold in Canada
commercially imported
Before issuing a market authorization, Health Canada carefully reviews the evidence provided by the product sponsor. This review is done to confirm the product meets safety, efficacy and quality requirements. A valid site licence from Health Canada is also required before a vaping product can be:
labelled
imported
packaged
manufactured
The TVPA also applies to these vaping products, unless specifically excluded.
Notice: Implications of the Tobacco and Vaping Products Act for the Health Products Regulated Under the Food and Drugs Act
Contact:
Therapeutic Products Directorate at hc.policy.bureau.enquiries.sc@canada.ca
for the review process and regulation of prescription health products under the Food and Drug Regulations
Natural and Non-Prescription Health Products Directorate at hc.nnhpd-dpsnso.sc@canada.ca
for the authorization of non-prescription drugs as well as product and site licences for natural health products
Non-smokers’ Health Act
The Non-smokers’ Health Act (NSHA) addresses the issue of second-hand smoke and vapour. This Act applies to federally regulated workplaces, such as:
banks
ferries
commercial aircraft
federal government offices
For more information about the NSHA, contact the Labour Program at Employment and Social Development Canada.
Cannabis Act
Vaping products containing cannabis are regulated under the Cannabis Act and its regulations. The Cannabis Act became law on October 17, 2018, and establishes the framework for controlling the production, sale and possession of cannabis across Canada. The purpose of the Act is to protect public health and public safety, by, among other things, restricting youth access to cannabis, protecting young persons and others from inducements to using cannabis, and deterring illicit activities in relation to cannabis through appropriate sanctions and enforcement measures.
On October 17, 2019, cannabis extracts, including vaping products, became legal for sale in Canada.
In developing the regulations governing the production and sale of new cannabis products, including vaping products, Health Canada took into consideration risks associated with various routes of exposure to cannabis. Inhalation poses potential health risks because of the greater sensitivity and vulnerability of lung tissue to certain chemicals. For this reason, certain regulatory requirements pertaining to vaping products containing cannabis, are even more stringent than those for other non-inhaled cannabis products.
As with vaping products containing nicotine, the safety of cannabis vaping devices (such as the batteries) is regulated under the CCPSA.
What are risks/benefits of screening?
Benefits: reassurance, less radical treatment, opportunity for cure, cost-benefit, prognosis improvement.
Risks:
- overdiagnosis/overtreatment and anxiety if false positives,
- false reassurance or recklessness if false negative,
- risk of test,
- resource utilization,
- public confidence,
- stigma,
- increased health inequities
What are the 4 moments of hand hygiene?
Before initial patient/patient environment contact
Before aseptic procedure
After body fluid exposure risk
After patient / patient environment contact
What is health litteracy?
What are the health effects of health litteracy?
What are effective strategies?
Health litteracy: “The ability to access, comprehend, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life-course.”
Health effects
Need for prevention and chronic disease self-management, including:
making lifestyle adjustments
understanding and applying complex medical and medication regimen
knowing where and how to access health care services
communicating health care information across the health care system
- in older adult, those with low health litteracy were 2 time more likely to die within 5 years.
Benefits of adequate literacy:
increases patient safety,
improves outcomes (correlates with health behaviors around eating habits, smoking, sleep, alcohol, exercise, etc),
help people understand what to do to stay healthy,
saves time+money,
reaches more people, increases engagement
Strategies:
universal precautions approach
Engage your audience,
use plain language and clear design,
focus on key messages, promote teach-back methods,
use patient friendly resources to enhance teaching
How is the reproduction number calculated?
What are different types of validity?
Internal
External
Criterion
Construct
Content
Face
Statistical conclusion
Internal - how much does the independent variable affect the dependent variable?
External - how well the research applies to the “real world”
Face - does it feel valid?
Construct - how much your research covers the content of the construct (as opposed to things outside it)
Criterion - how well your instrument measures the thing it is supposed to measure
Content - covers the whole of the content in the area you are aiming to assess
Statistical conclusion - doing the right sampling/tests/measures
What is the routine immunization schedule?
2 and 4 mos - routine
DTaP-IPV-Hib
Pneu-Conjugate-13
Rotavirus
*some provinces add HB here, some start at birth, must have 3 doses of HB in schedule
*some provinces add Men-C-C here at 2 or 4 mos
* RSV ppx (palivizumab) if high-risk <37 GA when born and under 6 mos at start of RSV season
6 mos - routine
DTaP-IPV-Hib +/- HB
Rota if 3 dose-shedule (complete series before 8 months)
12 mos - routine
Men-C-C
MMR
Pneu-C-13
*some provinces do Var here
15 mos - routine
*Var
18 mos - routine
DTap-IPV-Hib
*MMRV
*some provinces do HAHB here
4-6 years - routine
*MMRV (if not done previously, 2 doses total))
Tdap(or DTaP)-IPV
Grade 7 - routine
*HB x 2
*HPV x 2
*Men-C-ACYW-135
14-16 - routine
Tdap
When to give influenza, Anyone over 6 mos, once annually
Routine adult immunizations
Td - q10 years
Tdap - one dose bw 27-32 wGA, one dose in adulthood, immunize as early as possible for adults who will be in close contact w young infants
Recombinant zoster - 50+ yrs x 2 doses
HPV 4/9 - up to and including 26yo
Influenza - annually
Measles + mumps - 1 dose if born in or after 1970
Meningococcal conj - 1 dose under 25 if not imm in adolescence
Pneumococcal polysaccharide - 1 dose 65+
Polio - primary series if previously unimm
Rubella - 1 dose if susceptible, post-delivery if susc preg
Varicella - 2 doses if susceptible under age 50, no routine testing 50+ but give 2 doses if known to be seronegative
Pregnancy/breastfeeding - recommended
Hep B when pregnant if seronegative and high risk of exposure
Influenza
Pertussis
Meningococcal *during outbreak
Rabies PEP (pregnancy)
MMR (breastfeeding, if not immune)
Varicella (breastfeeding, if not immune)
What are the pros and cons of different study designs?
- RCT
- Cohort
- Case-control
- Cross-sectional
ADVANTAGES AND DISADVANTAGES OF THE DESIGNS
Randomised Controlled Trial
An experimental comparison study in which participants are allocated to treatment/intervention or control/placebo groups using a random mechanism (see randomisation). Best for study the effect of an intervention.
Advantages:
unbiased distribution of confounders;
blinding more likely;
randomisation facilitates statistical analysis.
Disadvantages:
expensive: time and money;
volunteer bias;
ethically problematic at times.
Crossover Design
A controlled trial where each study participant has both therapies, e.g, is randomised to treatment A first, at the crossover point they then start treatment B. Only relevant if the outcome is reversible with time, e.g, symptoms.
Advantages:
all subjects serve as own controls and error variance is reduced thus reducing sample size needed;
all subjects receive treatment (at least some of the time);
statistical tests assuming randomisation can be used;
blinding can be maintained.
Disadvantages:
all subjects receive placebo or alternative treatment at some point;
washout period lengthy or unknown;
cannot be used for treatments with permanent effects
Cohort Study
Data are obtained from groups who have been exposed, or not exposed, to the new technology or factor of interest (eg from databases). No allocation of exposure is made by the researcher. Best for study the effect of predictive risk factors on an outcome.
Advantages:
ethically safe;
subjects can be matched;
can establish temporality and directionality of events;
can measure disease incidence
eligibility criteria and outcome assessments can be standardised;
administratively easier and cheaper than RCT;
several outcomes can be assessed;
retrospective study quick + inexpensive
Disadvantages:
controls may be difficult to identify;
exposure may be linked to a hidden confounder;
blinding is difficult;
randomisation not present;
for rare disease, large sample sizes or long follow-up necessary, prospective study expensive
Loss to follow-up
Case-Control Studies
Patients with a certain outcome or disease and an appropriate group of controls without the outcome or disease are selected (usually with careful consideration of appropriate choice of controls, matching, etc) and then information is obtained on whether the subjects have been exposed to the factor under investigation.
Advantages:
quick and cheap, efficient
only feasible method for very rare disorders or those with long lag between exposure and outcome;
fewer subjects needed than cross-sectional studies;
May evaluate multiple exposures
Disadvantages:
reliance on recall or records to determine exposure status;
confounders;
selection of control groups is difficult;
potential bias: recall, selection.
Studies just 1 outcome
No incident cases, can only estimate RR with OR
Cross-Sectional Survey
A study that examines the relationship between diseases (or other health-related characteristics) and other variables of interest as they exist in a defined population at one particular time (ie exposure and outcomes are both measured at the same time). Best for quantifying the prevalence of a disease or risk factor, and for quantifying the accuracy of a diagnostic test.
Advantages:
cheap and simple;
ethically safe.
Disadvantages:
establishes association at most, not causality;
recall bias susceptibility;
confounders may be unequally distributed;
Neyman survival bias (=incidence-prevalence bias, survivors disproportionately represented)
group sizes may be unequal
Cannot calculate risk
Temporal association cannot be determined
What are the assumptions of Cox proportional hazard models?
Proportional hazards
Linear covariate relationship
Independance
What are top public health achievements according to Canadian PH association?
Acting on SDoH
Control of Infectious Diseases
Decline in deaths from CHD/Stroke x 1960s
Healthier environments (i.e. less lead, fluoride in water)
Family Planning
Healthier mothers & babies
Motor-vehicle safety
Recognition of tobacco as a health hazard
Safer and healthier foods
Safer workplaces
‘Universal’ policies - i.e. for income, social services, healthcare
Vaccination
What are health inequities and is health equity?
What are the public health roles for addressing health inequity?
Health inequities are disadvantages in health between groups that are:
1) systematic/pervasive,
2) unfair/unjust
3) modifiable/preventable.
For example, Canadians who live in remote or northern regions do not have the same access to nutritious foods such as fruits and vegetables as other Canadians.
Health equity is the absence of unfair systems and policies that cause health inequalities. Health equity seeks to reduce inequalities and to increase access to opportunities and conditions conducive to health for all.
Health equity means that all people can reach their full health potential and are not disadvantaged from attaining it because of their race, ethnicity, religion, gender, age, social class, socioeconomic status or other socially determined circumstance.
PH roles for addressing health inequities:
ASSESS AND REPORT
Assess and report on a) the existence and impact of health
inequities, and b) effective strategies to reduce these inequities.
MODIFY AND ORIENT INTERVENTIONS
Modify and orient interventions and services to reduce inequities,
with an understanding of the unique needs of populations that
experience marginalization.
PARTNER WITH OTHER SECTORS
Partner with other government and community organizations to identify ways to improve health outcomes for populations that experience marginalization.
PARTICIPATE IN POLICY DEVELOPMENT
Lead, support and participate with other organizations in policy
analysis and development, and in advocacy for improvement in health determinants and inequities.
What are steps in the collective bargaining process according to the Canada Labour Code?
Notice to bargain -> direct bargaining
Notice of dispute (15 days)
Ministerial decision
Conciliation (60 days)
Termination of conciliation (21 days)
Acquisition of right to strike/lockout
Mediation
What are Canada’s main area of risk from climate change?
In the PHAC framework for ethical deliberation and decision-making in public health from the PHAC (2017),
what are the steps,
ethical dimensions,
procedural considerations ?
Steps: (IDEA framework)
- Preliminary step
- Identify issue and context
- Determine ethical considerations
- Explore and assess options
- Select best course of action
- Evaluate
Ethical dimensions: (Justice RBT)
- Respect for persons and communities
- Non-maleficence and beneficence
- Trust
- Justice
Procedural considerations: (TRRA-I)
- Transparency
- Responsibility
- Responsiveness
- Accountability
- Inclusiveness
What are the 5 categories of the Canada’s health indicator framework?
What are recent human influenza types circulating?
How is the reproduction number calculated?
What are the 13 occupational carcinogens that contribute the most to the cancer burden in Canada?
What are policy action that could be taken to reduce
workplace exposure to these carcinogens?
These carcinogens are: arsenic, asbestos, benzene, chromium (VI) compounds, diesel engine exhaust, second-hand smoke, nickel compounds, polycyclic aromatic hydrocarbons (PAHs), radon, night shift work, silica (crystalline), solar ultraviolet radiation, and welding fumes.
policy action that could be taken to reduce
workplace exposure to these carcinogens
and include the following:
strengthening occupational exposure limits across all
Canadian jurisdictions so they are upto-
date, rigorous, and evidence-based;
_reducing or eliminating the use of cancer causing
substances with workplace_specific
toxic use reduction policies;
and, creating registries of workplace exposures
to occupational carcinogens that will
facilitate the tracking of exposures over
time. In addition, the report proposes
specific policies that target some of the
individual carcinogens.
What is the prevalence of the most common chronic conditions in Canada?
_Chronic disease continues to be the biggest cause
of disease burden in Canada._Close to half of
Canadian adults over the age of 20 years report
that they are living with at least one of ten common
chronic diseases or conditions (Figure 3).7
On a positive note, recent data suggest declining
incidence rates for a number of chronic diseases in
Canada (Figure 4).7 A report analyzing national data
over the period of 1999 to 2012 from the Canadian
Chronic Disease Surveillance System (CCDSS)
identified decreasing overall incidence trends for
diagnosed asthma, chronic obstructive pulmonary
disease, hypertension, ischemic heart disease, and
stroke.
What is the health promotion cube?
What are substantive and procedural ethical principles?
Substantive values:
Harm principle
Liberty of individuals
Proportionality
Duty to provide care
Reciprocity
Solidarity
Privacy
Equity
Trust
Stewardship
Procedural values:
Inclusive
Reasonable
Open and transparent
Accountable
Responsive
What are the CTFPHC recommendations for colorectal cancer?
Colorectal Cancer—Clinician Recommendation Table
Who do these recommendations apply to?
These recommendations apply to asymptomatic adults aged 50 and older who are NOT at high risk for colorectal cancer (CRC). Adults are at high risk if they have at least one of the following:
Previous CRC or adenomatous polyps (e.g., tubular or villous)
Inflammatory bowel disease (e.g., ulcerative colitis or Crohn’s disease)
Signs or symptoms of CRC (e.g., blood in the stool)
History of CRC in one or more first-degree relatives
Adults with hereditary syndromes predisposing to CRC (e.g., familial adenomatous polyposis or Lynch syndrome)
This tool provides guidance for primary care practitioners on different screening tests, screening intervals, and recommended ages to start and stop screening.
Resources, test availability, and patient preferences should be considered when choosing which screening test is appropriate.
Other recommendations
We recommend not using colonoscopy as a primary screening test for CRC
There is a lack of direct, high-quality evidence of the efficacy of colonoscopy in comparison to that of other screening tests.
Colonoscopy has greater potential for harms (e.g., minor bleeding, major bleeding, perforation, and death) than the other available tests.
Colonoscopy requires more time and expertise to perform, and using colonoscopy for screening means that this test will not be as readily available for people with symptomatic disease, such as visible blood in the stool.
Implementation considerations
An FOBT test is the most convenient, uses the fewest resources, and will likely be the preferred option in most situations.
It is important to note that flexible sigmoidoscopy is an option in specific circumstances based on patient values and preferences (e.g., averse to stool testing, prefers less frequent testing) and resource availability.
Evidence summary
RCT data show that screening those aged 50-74 years for CRC with gFOBT or flexible sigmoidoscopy reduces the incidence of late-stage CRC and CRC mortality.
FIT has greater sensitivity than gFOBT and similar specificity. Therefore, the reported mortality benefits of gFOBT for people aged 50-74 years can be extended to FIT.
The only direct harms noted for either gFOBT or FIT in the studies reviewed were false positives and false negatives.
The harms of flexible sigmoidoscopy are rare but include intestinal perforation, minor bleeding, major bleeding, and death
What are examples of values that are:
- important for the society in public health action
- important for the aims of public health
- important as public health professionals
What is the WHO health system framework?
6 system building blocks
4 overall goals/outcomes
4 “processes”
Building blocks:
Service delivery
Health workforce
Information
Medical products, vaccines & technologies
Financing
Leadership/governance
What are determinants of Indigenous health?
Apply the stigma pathway to health outcomes to the health of indigenous people.
- Distal (Political/social/economic contexts)
Colonialism, history of residential schools
Racism
Discrimination in healthcare, legal system and education
Undermined self-determination
Social exclusion, cultural destruction
Destruction of natural environment
- Intermediate
Health care system
Education system
Community infrastructure
Cultural continuity
- Proximal
Health behaviours
Employment
Income, poverty
Housing, poor living conditions
Food security
What are the steps in investigation an environmental health issue?
What are Bradshaw’s taxonomy of needs?
What are examples of framework to establish priorities?
In summary, prioritization principles:
- Disease burden: impact (magnitude, seriousness), # people affected
- Effectiveness: quality of evidence base, pertinence
- Economical considerations: efficiency, value, availability of resources, cost-benefit, cost-effectiveness, budgetary impact, economy
- Organizational factors: Mandate, timing, urgency, appropriateness, accountability, capacity, optimal service delivery, responsiveness, legality
- Practical matters: Feasibility, acceptability
- Ethical issues: Equity, access, justice in allocation of resources
World Bank:
- Value
- Appropriateness
- Feasibility
- Acceptability
- Cost-benefit
- Timing
Cromwell:
- effectiveness of program, budgetary impact/affordability, equity, number of people likely to benefit, ability to access program, cost-effectiveness, quality of available evidence
Tanios:
- Intervention outcomes and benefits, type of health service, disease impact/burden, therapeutic context, economic impact, environmental impact, quality of evidence, implementation complexity, priorities/fairness, overall context
EOHU matrix:
- efficiency, effectiveness, equity, accountability, responsiveness, economy
OPHS foundations:
- Need, impact, capacity, partnership and collaboration
How does stigma lead to poor health outcomes?
What are the steps to managing an environmental emergency?
−Présentation (Moi, l’autre, échange des coordonnées)
−Description générale de l’événement (modèle journalistique):
−Quoi? Quand? Où (proximité de la pop)?
−Description de la triade A-E-H:
−Quelle substance? Quantité (ex. nb tonnes entreposées)?
−Panache? Cond. météo (vents)? A-t-on pris des mesures env.? Comment (appareil, distance…)? TAGA disponible?
−Quels sont les Sx présentés? Combien de personnes sont touchées? Y a-t-il eu des transferts à l’urgence (Si oui, compléter info avec Md)? Parmi pop et trav.
−Actions réalisées: Quelles mesures de protection ont été mises en place?
−Partenaires… Qui est au courant? Et penser à aviser les autres
−Visite des lieux + cellule interne
−Évaluation des risques à compléter (Propriétés subst., effets à la santé selon niveau exposition, tx recommandé…) Comparer mesures env. aux normes
−Décision + actions suppl. : Mesures de protection (confinement, évacuation, décontamination…) pour pop et trav.
−Communication (Md -risques à la santé, tests à faire et tx- pop, médias)
−Psychosocial (service de consult. sur les lieux, ligne tél., etc.)
−Surveillance
What are the core elements of a Heat Alert and Response System?
What are preventative actions to reduce heat-health risks?
In summary, PH preventive actions for heat:
Assess: heat-health vulnerability resiliency
Promote: healthy communities/individuals + social capital/networks
Prevent by adrressing: GHG emissions, transportation policies, urban heat island effect, climate resiliency
Heat Alert and Response System(s) (HARS) core elements:
Community Mobilization and Engagement—
Requires a coordinating agency to prepare the
community for the upcoming heat season by
identifying community needs, recruiting stakeholders
and developing plans to implement a HARS.
Alert Protocol—Identifies weather conditions
that could result in increased morbidity and
mortality in the region. The protocol is used to alert
the public, as well as government officials and
stakeholders, who then take pre-determined actions
to protect health.
Community Response Plan—Facilitates actions
by individuals to protect themselves during
periods of extreme heat by directing public health
interventions aimed at reaching vulnerable
individuals who require assistance.
Communication Plan—Raises awareness about
the impacts that heat may have on health, and
provides advice through media releases, interviews
and websites on how to reduce health risks.
Evaluation Plan—Assesses HARS activities
and facilitates improvements. Aims to evaluate
the extent to which implemented measures are
timely, relevant, effective, meet local priorities, and
contribute to the reduction of health impacts.
PREVENTATIVE ACTIONS
reduce green-house gas emissions
assess heat-health vulnerability resiliency
build climate resiliency
modify transportation policies
reduce urban heat island effect
promote healthy communities and individuals
improve social capital and social networks
In summary, PH preventive actions are to:
Assess: heat-health vulnerability resiliency
Promote: healthy communities/individuals + social capital/networks
Prevent by adrressing: GHG emissions, transportation policies, urban heat island effect, climate resiliency
What are the steps of a cluster investigation?
What are Maslow’s hierarchy of needs?
What are the strategic objectives and guiding principles of the federal framework for suicide prevention (2016)?
Strategic Objectives
Reduce stigma and raise public awareness.
Connect Canadians, information, and resources.
Accelerate the use of research and innovation in suicide prevention.
Guiding Principles
Build hope and resiliency.
Promote mental health and wellbeing.
Complement current initiatives in suicide prevention.
Be informed by current research and best available evidence.
Apply a public health approach.
Leverage partnerships.
Vision
A Canada where suicide is prevented and everyone lives with hope and resilience
Mission
To prevent suicide in Canada, through partnership, collaboration and innovation while respecting the diversity of cultures and communities that are touched by this issue
Purpose
To guide the federal government’s efforts in suicide prevention through implementation of An Act respecting a Federal Framework for Suicide Prevention (2012)
Legislated Elements (Section 2 of the Act)
Provide guidelines to improve public awareness and knowledge of suicide.
Disseminate information about suicide and its prevention.
Make existing statistics about suicide and related risk factors publicly available.
Promote collaboration and knowledge exchange across domains, sectors, regions and jurisdictions.
Define best practices for suicide prevention.
Promote the use of research and evidence-based practices for suicide prevention.
What are the U.S. EPA 6 criteria air pollutants?
What are the 7 ccommon air contaminants per Health Canada?
U.S EPA criteria air pollutants
Particulate matter (PM-10 and PM-2.5)
Ozone (O3)
Carbon monoxide (CO)
Nitrogen dioxide (NO2)
Sulfur dioxide (SO2)
Lead (Pb)
Particulate matter 2.5 and 10
Particulate matter (PM) consists of airborne particles in solid or liquid form. PM may be classified as primary or secondary, depending on the compounds and processes involved during its formation. Primary PM is emitted at the emissions source in particle form, for example, the smokestack of an electrical power plant or a recently tilled field subject to wind erosion. Secondary PM formation results from a series of chemical and physical reactions involving different precursor gases, such as sulphur oxides and nitrogen oxides, and ammonia reacting to form sulphate, nitrate and ammonium particulate matter.
The size of PM particles largely determines the extent of environmental and health damage caused. For this reason, Environment Canada identifies different sizes of PM:
Total Particulate Matter (TPM) -airborne particulate matter with an upper size limit of approximately 100 micro metre (µm) in aerodynamic equivalent diameter
Particulate Matter <10 microns (PM10) - airborne particulate matter with a mass median diameter less than 10 µm
Particulate Matter < 2.5 microns (PM2.5) - airborne particulate matter with a mass median diameter less than 2.5 µm
Numerous studies have linked PM to aggravated cardiac and respiratory diseases such as asthma, bronchitis and emphysema and to various forms of heart disease. PM can also have adverse effects on vegetation and structures, and contributes to visibility deterioration and regional haze.
Efforts to address particulate matter (PM) levels in the air are important in both the United States and Canada. Canada and the United States have completed a joint transboundary particulate matter science assessment report in support of the Canada-U.S. Air Quality Agreement.
Common air pollutants: carbon monoxide
Carbon Monoxide (CO) is a colourless, odourless, tasteless and poisonous gas. It is a product of incomplete combustion of hydrocarbon-based fuels and is emitted directly from automobile tailpipes. Other lesser but significant sources are the wood industry, residential wood heating and forest fires.
CO can have a significant impact on human health. It enters the bloodstream through the lungs and forms carboxyhemoglobin, a compound that inhibits the blood’s capacity to carry oxygen to organs and tissues. Persons with heart disease are especially sensitive to CO poisoning. Infants, elderly persons, and individuals with respiratory diseases are also particularly sensitive. CO can affect healthy individuals, impairing exercise capacity, visual perception, manual dexterity, learning functions, and ability to perform complex tasks.
Common air pollutants: volatile organic compounds
Volatile organic compounds (VOCs) are carbon-containing gases and vapors such as gasoline fumes and solvents (but excluding carbon dioxide, carbon monoxide, methane, and chlorofluorocarbons). Although there are many thousands of organic compounds in the natural and polluted troposphere that meet the definition of a VOCs, most measurement programs have concentrated on the 50 to 150 most abundant hydrocarbons.
Many individual VOCs are known or suspected of having direct toxic effects on humans, ranging from carcinogenesis to neurotoxicity. A number of individual VOCs (e.g. benzene, dichloromethane) have been assessed to be toxic under the Canadian Environmental Protection Act, 1999 (CEPA 1999). T_he more reactive VOCs combine with nitrogen oxides (NOx) in photochemical reactions in the atmosphere to form ground-level ozone, a major component of smog._ VOCs are also a precursor pollutant to the secondary formation of fine particulate matter (PM2.5). Both ozone and PM2.5 are known to have harmful effects on human health and the environment.
Common air pollutants: sulphur oxides
Sulphur dioxide, or SO2, belongs to a family of sulphur oxide gases (SOx). It is formed from the sulphur contained in raw materials such as coal, oil and metal-containing ores during combustion and refining processes. SO2 dissolves in water vapour in the air to form acids, and interacts with other gases and particles in the air to form particles known as sulphates and other products that can be harmful to people and their environment.
Both SO2 in its untransformed state, and the acid and sulphate transformation products of SO2, can have adverse effects on human health or the environment. SO2 itself can cause adverse effects on respiratory systems of humans and animals, and damage to vegetation. When dissolved by water vapour to form acids it can again have adverse effects on the respiratory systems of humans and animals, and it can cause damage to vegetation, buildings and materials, and contribute to acidification of aquatic and terrestrial ecosystems. When transformed into sulphate particles that are subsequently deposited on aquatic and terrestrial ecosystems, acidification can result, and when sulphate is combined with other compounds in the atmosphere, such as ammonia, it becomes an important contributor to the secondary formation of respirable particulate matter (PM2.5). PM2.5 is known to have harmful effects on human health and the environment, and contribute to visibility impairment and regional haze.
Common air pollutants: ground-level ozone
Ground-level ozone is a colorless and highly irritating gas that forms just above the earth’s surface. It is called a “secondary” pollutant because it is produced when two primary pollutants react in sunlight and stagnant air. These two primary pollutants are nitrogen oxides (NOx) and volatile organic compounds (VOCs).
NOx and VOCs come from natural sources as well as human activities. About 95 per cent of NOx from human activity come from the burning of coal, gasoline and oil in motor vehicles, homes, industries and power plants. VOCs from human activity come mainly from gasoline combustion and marketing, upstream oil and gas production, residential wood combustion, and from the evaporation of liquid fuels and solvents. Significant quantities of VOCs also originate from natural (biogenic) sources such as coniferous forests.
Ozone is known to have significant effects on human health. Exposure to ozone has been linked to pre-mature mortality and a range of morbidity health end-points such as hospital admissions and asthma symptom days. In addition to its effects on human health, ozone can significantly impact vegetation and decrease the productivity of some crops. It can also injure flowers and shrubs and may contribute to forest decline in some parts of Canada. Ozone can also damage synthetic materials, cause cracks in rubber, accelerate fading of dyes, and speed deterioration of some paints and coatings. As well, it damages cotton, acetate, nylon, polyester and other textiles.
The Ozone Annex was added to the Canada-United States Air Quality Agreement (December 2000) to address the transboundary air pollution leading to high levels of ground-level ozone, a major component of smog.
Common air pollutants: ammonia
Ammonia is a colourless gas with a pungent odor that is noticeable at concentrations above 50 ppm. Most of the NH3 emitted is generated from livestock waste management and fertilizer production.
NH3 is poisonous if inhaled in great quantities and is irritating to the eyes, nose, and throat in lesser amounts. It combines in the atmosphere with sulphates and nitrates to form secondary fine particulate matter (PM2.5). PM2.5 is known to have harmful effects on human health and the environment. NH3 can also contribute to the nitrification and eutrophication of aquatic systems.
Common air pollutants: nitrogen oxides
Nitrogen oxides include the gases nitrogen oxide (NO) and nitrogen dioxide (NO2). NOx is formed primarily from the liberation of nitrogen contained in fuel and nitrogen contained in combustion air during combustion processes. NO emitted during combustion quickly oxidizes to NO2 in the atmosphere. NO2 dissolves in water vapour in the air to form acids, and interacts with other gases and particles in the air to form particles known as nitrates and other products that may be harmful to people and their environment.
Both NO2 in its untransformed state, and the acid and nitrate transformation products of NO 2 , can have adverse effects on human health or the environment. NO2 itself can cause adverse effects on respiratory systems of humans and animals, and damage to vegetation. When dissolved by water vapour, the acids formed can have adverse effects on the respiratory systems of humans and animals. Nitric acid (HNO3) can cause damage to vegetation, buildings and materials, and contribute to acidification of aquatic and terrestrial ecosystems. When NO2 is transformed into nitrate particles that are subsequently deposited on aquatic and terrestrial ecosystems, acidification can result. When nitrate is combined with other compounds in the atmosphere, such as ammonia, it becomes an important contributor to the secondary formation of respirable particulate matter (PM2.5). NO2 is one of the two primary contributing pollutants, along with volatile organic compounds (VOCs), to the formation of ground-level ozone. Both ozone and PM2.5 is known to have harmful effects on human health and the environment.
Distinguish types of data, data collection methods and data sources.
