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
Describe the health burden of harmful use of alcohol globally.
According to the WHO global strategy, what are 10 areas for national action?
What are 5 effective public health interventions (SAFER)?
Global strategy to reduce harmful use of alcohol (WHO 2010)
The harmful use of alcohol is a serious health burden, and it affects virtually all individuals on an international scale. Health problems from dangerous alcohol use arise in the form of acute (intoxication, injuries) and chronic conditions (cancer, liver ,etc), and adverse social consequences are common when they are associated with alcohol consumption. Every year, the harmful use of alcohol kills 2.5 million people, including 320 000 young people between 15 and 29 years of age. It is the third leading risk factor for poor health globally, and harmful use of alcohol was responsible for almost 4% of all deaths in the world, according to the estimates for 2004.
The global strategy focuses on ten key areas of policy options and interventions at the national level and four priority areas for global action.
The ten areas for national action are:
leadership, awareness and commitment;
health services’ response;
community action;
drink-driving policies and countermeasures;
availability of alcohol;
marketing of alcoholic beverages;
pricing policies;
reducing the negative consequences of drinking and alcohol intoxication;
reducing the public health impact of illicit alcohol and informally produced alcohol;
monitoring and surveillance.
The four priority areas for global action are:
public health advocacy and partnership;
technical support and capacity building;
production and dissemination of knowledge;
resource mobilization.
Effective public health interventions
- Increase in excise taxes on alcoholic beverages
- Enforcement of bans or comprehensive restrictions on exposure to alcohol advertising (across multiple types of media)
- Enforcement of restrictions on the physical availability of retailed alcohol (via reduced hours of sale)
- Enforcement of drink-driving laws and blood alcohol concentration limits via sobriety checkpoints
- Provision of brief psychosocial intervention for persons with hazardous and harmful alcohol use
or SAFER
- *S**trengthen restrictions on availability
- *A**dvance policies around drunk driving
- *F**acilitate treatment
- *E**nforce bans on advertising
- *R**aise taxes
Infant/child health conditions that are associated with living in low-income families
- Infant mortality
- Low birth weight
- Asthma
- Overweight/obesity
- Unintentional and intentional injuries
- Lower readiness to learn (i.e., prepared for learning and formal schooling)
- Impairment of functional health (e.g., vision, hearing, speech or mobility)
- Emotional and behavioural problems
- Dental caries
What are causes of bloody diarrhea?
Campylobacter
Entamoeba histolytica
Shigella
E Coli (EIEC, STEC, EHEC)
Yersinia enterolitica
Salmonella
What is the Government of Canada directive on Performance Management?
Directive on Performance Management.
Performance agreements must include:
- Clear and measurable work objectives, with associated performance measures, that are linked to the priorities of the organization and of the Government of Canada;
- Observable and measurable expected behaviours;
- A learning and development plan; and
- Sign-off by the manager and employee acknowledging that the content of the performance agreement has been discussed.
A mid year performance review must include:
- A review of progress against established work objectives;
- A r_eview of whether the employee is demonstrating the expected behaviours_;
- A review of learning and development needs and activities;
- Amendments to the performance agreement and learning and development plan, as required; and
- Sign-off by the manager and employee acknowledging that the content of the mid year review has been discussed.
The performance assessment must include:
- A narrative assessment of performance that supports the assigned performance rating(s); and
- Sign-off by the manager and employee acknowledging that the content of the performance assessment has been discussed.
A learning and development plan must be developed for each employee and include:
- Employee career goals and aspirations; and
- Planned activities that support the achievement of the employee_s established work objectives, expected behaviours and continuous development.
A talent management plan must be initiated when:
- Prescribed by the organization’s performance and talent management program;
- Prescribed for the functional community to which the employee belongs;
- Required to support ongoing high performance; and
- Mutually agreed upon by the manager and employee.
A talent management plan must identify the:
- Employee’s career goals and aspirations;
- Employee’s strengths and areas for development;
- Activities to support the continued development of the employee; and
- A timeline and milestones against which to measure the employee’s progress.
A performance improvement plan must be initiated when:
- Employee performance does not meet expectations; or
- Any time the manager determines that a performance issue needs to be documented.
A performance improvement plan must include:
- Specific areas for improvement;
- Actions that will be taken by the employee to address the identified areas needing improvement;
- Description of the support that will be provided by the manager to the employee to improve performance; and
- A timeline and milestones against which to measure the employee’s progress.
Departmental review panels will undertake the following:
- Ensuring that performance and talent management initiatives in the organization are conducted fairly and consistently;
- At least annually, reviewing data on the organization_s management of performance and talent, including progress made against individual action plans for improvement;
- Making recommendations to recognize exceptional performance, as applicable, in accordance with the organizational recognition program; and
- Making recommendations to the deputy head and head of human resources to improve the organization’s performance and talent management programs, as appropriate.
What are steps in the progressive discipline of an underperforming employee?
What factors should be considered when disciplining an employee
Incompetence: Employee lacks the skills or ability to do the job.
Set out clear, reasonable job expectations in company policy.
Communicate clearly job expectations to all employees.
Bring unacceptable work to the attention of the employee promptly.
Provide reasonable supervision, training and instruction.
Give reasonable warning that failure to meet these expectations could result in dismissal.
Allow for time and opportunity to meet the job expectations.
As a final step in the process, if no improvement, dismiss the employee.
Keep complete written records.
Misconduct: Employee breaks rules for keeping the work place efficient and safe.
Give the employee the opportunity to tell his/her story about the misconduct.
Collect all the relevant facts surrounding the misconduct.
Give a verbal warning.
Give a written warning.
Suspend the employee.
As a final step in the process, dismiss the employee.
Keep complete written records.
Factors to consider when disciplining:
- Frequency, impact, severity
- History, mitigating circumstances, expectations
- Policy / precedence
What is the CTFPHC recommendations for screening impaired vision in community-dwelling older adults?
We recommend AGAINST screening for impaired vision in primary care settings for community-dwelling adults aged 65 years and over (Weak recommendation, low quality evidence).
This recommendation applies to community dwelling adults aged 65 years and over who are not already under the care of a specialist ophthalmologist. It does not apply to those known to have a condition predisposed to vision impairment such as glaucoma or diabetes; who live in full-time residential care; or, who have a diagnosis of dementia.
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 is the recommended fish intake limit for fish that are high is methylmercury?
These include fresh/frozen tuna, shark, swordfish, marlin, , king mackerel, chilean sea bass, orange roughy and escolar (Note: Additional health information on escolar is available from Health Canada’s Fact Sheet on escolar and CFIA’s fact sheet.
Canadians who like to consume these types of fish can continue to do so, but should limit their consumption to the amounts shown in the table below. Other types of fish should be chosen to make up the rest of their recommended weekly fish consumption.
General Population - 150 g per week
Specified Women * - 150 g per month
Children 5-11 years old - 125 g per month
Children 1-4 years old - 75 g per month
* Specified women are those who are or may become pregnant or are breastfeeding.
150 grams is equivalent to approximately one cup.
This advice does NOT apply to canned tuna. Information on canned tuna is provided in the next section. (2 cans per week for preg women)
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
Regarding dioxins and furans,
what are sources?
health effects?
Ways to mitigate exposure?
The biggest source of dioxins and furans
in Canada is the large-scale burning of
municipal and medical waste. Other
major sources include:
• the production of iron and steel
• backyard burning of household
waste, especially plastics
• fuel burning, including diesel fuel and
fuel for agricultural purposes and
home heating
• wood burning, especially if the wood
has been chemically treated
Health effects associated with human
exposure to dioxins include:
• skin disorders, such as
chloracne
• liver problems
• impairment of the immune
system, the endocrine system
and reproductive
functions
• effects on the developing
nervous system and other
developmental events
• certain types of cancers
Minimizing Your Risk
If you are concerned about
exposure to dioxins and furans,
consider taking the following
steps:
• Prepare meat and fish in a
way that minimizes your
exposure by trimming visible
fat from food. Bake, broil,
roast, barbecue or microwave
instead of frying, and drain off
extra fat after cooking • Follow the advice in
Canada’s Food Guide to
Healthy Eating, and enjoy a
variety of foods. Vegetables,
fruit and grains contain fewer
dioxins and furans than meat,
milk products and fish.
• Follow provincial/territorial
government advisories about
eating certain types of fish.
• Do not burn garbage, especially
construction materials
that might contain wood
preservatives or plastic.
• Limit the amount of wood you
burn in your fireplace or
stove, and learn about woodburning
techniques that
release fewer dioxins.
• Do not smoke, and keep your
family away from secondhand
smoke as much as
possible.
What are Canada’s main area of risk from climate change?
What are 4 steps in carcinogenesis?
Initiation
Promotion
Progression
Metastasis
Key steps in forming and developing a team.
- Introduction of team members to each other
- Identify relevent skills of all team members
- Assigning roles and responsibilities to team members and ensuring these are understood
- Establish reporting processes and hierarchies within the team and ensure they are understood
- Establish goals and essential tasks of the whole team/unit and ensure these are shared and understood
- Regular team meetings to identify and clarify and issues with understanding of team structure and function
What is the Canadian antimicrobial resistance framework?
SURVEILLANCE
ACTION 1: Establish and strengthen surveillance systems to identify new threats or changing patterns in antimicrobial resistance and use, in human and animal settings.
STEWARDSHIP
ACTION 2: Strengthen the promotion of the appropriate use of antimicrobials in human and veterinary medicine.
ACTION 3: Work with the animal agriculture sector partners to strengthen the regulatory framework on veterinary medicines and medicated feeds, including facilitating access to alternatives and encourage the adoption of practices in order to reduce the use of antimicrobials.
INNOVATION
ACTION 4: Promote innovation through funding collaborative research and development efforts on antimicrobial resistance both domestically and internationally
What are the 10 chemicals of public health concerns (WHO, 2010)?
Air pollution
Arsenic
Asbestos
Benzene
Cadmium
Dioxin
Fluoride
Lead
Mercury
Hazardous pesticides
Discuss diagnostic considerations for latent TB infection diagnosis.
What are 3 elements to consider when assessing a positive tuberculin skin test?
The goal of testing for latent tuberculosis infection (LTBI) is to identify individuals who are at increased risk for the development of active tuberculosis (TB) and therefore would benefit from treatment of LTBI.
Only those who would benefit from treatment should be tested, so a decision to test presupposes a decision to treat if the test is positive.
There are two accepted tests for identification of LTBI: the tuberculin skin test (TST) and the interferon gamma release assay (IGRA).
When interpreting a positive TST, it is important to consider much more than simply the size of the reaction. Rather, the TST should be considered according to three dimensions:
size of induration,
positive predictive value and
risk of disease if the person is truly infected.
As with the TST, IGRAs are surrogate markers of Mycobacterium tuberculosis infection and indicate a cellular immune response to M. tuberculosis.
In general, IGRAs are more specific than the TST in populations vaccinated with Bacille Calmette-Guérin (BCG), especially if BCG is given after infancy or multiple times.
Neither the TST nor IGRAs can separate LTBI from TB disease and therefore have no value for active TB detection. Both tests have suboptimal sensitivity in active TB, especially in HIV-infected people and children.
Both tests appear to correlate well with the gradient of exposure. Both tests are associated with nonspecific variations and reproducibility issues, and borderline values need careful interpretation.
Neither IGRAs nor the TST have high accuracy for the prediction of active TB, although use of IGRAs might reduce the number of people considered for preventive treatment.
Major Recommendations
Both the TST and IGRA are acceptable alternatives for LTBI diagnosis. Either test can be used for LTBI screening in any of the situations in which testing is indicated, with preferences and exceptions noted below.
- Situations in which neither TST nor IGRAs should be used for testing
Neither the TST nor the IGRA should be used for testing people who have a low risk of infection and a low risk that there will be progression to active TB disease if they are infected. However, low-risk individuals are commonly tested before exposure, when repeat testing is likely. In this situation TST is recommended (refer to recommendation 3 below); if the TST is positive then an IGRA may be useful to confirm a positive TST result to enhance specificity.
Neither TST nor IGRA should be used for active TB diagnosis in adults (for children, refer to recommendation 4).
Neither TST nor IGRA should be used for routine or mass screening for LTBI of all immigrants (adults and children).
Neither TST nor IGRA should be used for monitoring anti-TB treatment response.
- Situations in which IGRAs are preferred for testing but a TST is acceptable
People who have received BCG as a vaccine after infancy (1 year of age) and/or have received BCG vaccination more than once.
People from groups that historically have poor rates of return for TST reading.
- Situations in which TST is recommended for testing but an IGRA is NOT acceptable
The TST is recommended whenever it is planned to repeat the test later to assess risk of new infection (i.e. conversions), such as repeat testing in a contact investigation or serial testing of health care or other populations (e.g. corrections staff or prison inmates) with potential for ongoing exposure.
- Situations in which both tests can be used (sequentially, in any order) to enhance sensitivity
Although routine dual testing with both TST and IGRA is not recommended, there are situations in which results from both tests may be helpful to enhance the overall sensitivity:
When the risks of infection, of progression to disease and of a poor outcome are high.
In children (under age 18 years) with suspected TB disease, IGRAs may be used as a supplementary diagnostic aid in combination with the TST and other investigations to help support a diagnosis of TB. However, IGRA should not be a substitute for, or obviate the need for, appropriate specimen collection. A negative IGRA (or TST) does not rule out active TB at any age and especially not in young children.
In addition, repeating an IGRA or performing a TST might be useful when the initial IGRA result is indeterminate, borderline or invalid, and a reason for testing persists.
What strategies are outlined in CPHO 2018 for addressing problematic substance use in youth?
Implement integrated suite of solutions
Collaborate to drive novel approaches
Strengthen multi-disciplinary evidence for decision making
Address trauma and eliminate stigma
Making prevention a priority
Name the 12 determinants of health according to PHAC.
- Income and social status
- Social support networks
- Education and literacy
- Employment/working conditions
- Social environment
- Physical environment
- Personal health practices and coping skills:
- Healthy child development
- Biology and genetic endowment
- Health services
- Gender
- Culture
Mnemonic: S2E2P2H2I - BCG
What is the CTFPHC recommendation for screening on esophageal adenocarcinoma for adults with GERD?
We recommend NOT screening adults (≥18 years) with chronic GERD, for EAC or precursor conditions (Barrett esophagus, dysplasia) (strong recommendation; very low-certainty evidence).
What is the TB surveillance system in Canada?
Canadian Tuberculosis ( ) System
1 = (Laboratory Surveillance)
2 = (Reporting)
The Canadian Tuberculosis Reporting System (CTBRS)
Provincial and territorial tuberculosis control programs participate in the CTBRS national surveillance system by reporting to the Centre for Communicable Diseases and Infection Control (CCDIC), Public Health Agency of Canada (PHAC), all new and re-treatment cases of active tuberculosis that meet the Canadian case definition.
The Canadian Tuberculosis Laboratory Surveillance System (CTLSS)
This national laboratory-based surveillance system was established in 1998 to collect timely data on TB drug resistance across Canada. Participating laboratories include members of the Canadian Tuberculosis Laboratory Technical Network (covering all provinces and territories). These laboratories report data annually on drug susceptibility test results for all TB isolates to the CCDIC, PHAC. Data are reported in both paper and electronic format and comprise the information found on the M. tuberculosis Complex Antimicrobial Susceptibility Reporting Form.
What children group would be excluded from the study population of a study that used the Canada Child Benefit program as a sampling scheme?
Children of families that have not applied for the benefit
Children of families that are not elegible for the benefit (e.g. non-residents of Canada for tax purposes, children in foster care receiving other benefit)
Who can get the Canada child benefit?
You must meet all of the following conditions:
- You live with a child who is under 18 years of age
- You are primarily responsible for the care and upbringing of the child
- You are a resident of Canada for tax purposes
- You or your spouse or common-law partner must be any of the following:
a Canadian citizen
a permanent resident
a protected person
a temporary resident who has lived in Canada for the previous 18 months, and who has a valid permit in the 19th month
an Indigenous person who meets the definition of “Indian” under the Indian Act
You cannot get the Canada child benefit (CCB) for a foster child for any month in which Children’s special allowances (CSA) are payable.
You may get the CCB if you live with and care for a child under a kinship or close relationship program, as long as CSA are not payable for that child.
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 the 8 components of Canada’s vaccine safety program?
Concerns about vaccine safety make some parents hesitant about immunization. Health care providers are pivotal in helping parents understand that Canada is a leader in vaccine safety. The present practice point provides an update on the eight components of Canada’s vaccine safety system:
(1) an evidence-based pre-license review and approval process;
(2) strong regulations for manufacturers;
(3) independent evidence-based vaccine use recommendations;
(4) immunization competency training and standards for health care providers;
(5) pharmacovigilance programs to detect and (6) determine causality of adverse events following immunization (AEFIs);
(7) a program for vaccine safety and efficacy signal detection; and
(8) the Canadian Immunization Research Network’s special immunization clinics for children who have experienced serious AEFIs.
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 is the optimal fluoride concentration in water?
What is the ROI of community water fluoridation?
How many Canadians benefit from CWF?
What is the DMF/DMFT index?
What are the 7 categories and 10 elements from the Oral health Canadian Framework?
By exposing the teeth to a constant low level of fluoride, it helps reduce the cavity-causing effect of foods and bacteria. Fluoride molecules create stronger teeth by hardening tooth enamel, contributing to tooth surface re-mineralization and deterring oral bacteria1. At the population level, water fluoridation is associated with approximately a 25% to 30% reduction in tooth decay in children and adults_2. The recommended concentration for caries prevention (called the optimal level) is 0.7 milligrams/liter (mg/L)3 4 5 or 0.7 parts per million (ppm). Community water fluoridation (CWF) is the process of monitoring and adjusting the fluoride level in drinking water to the optimal level for caries prevention. Water fluoridation has been instrumental in the overall global reduction in dental caries and many communities around the world have access to CWF. The U.S. Centre for Disease Control considers CWF as one of the ten greatest public health achievements of the 20th century6.
CWF is the most cost effective and equitable method to deliver fluoride to the population. This population-based preventive intervention contributes to o_ral health equity by overcoming common social determinants of health including age, education, income, and access to professional dental care. CWF yields a high return on investment that increases according to community population size, with a per capita annual benefit ranging from $5.49 to $93.197 per dollar invested.
In 2017, there are around 13.9 million Canadians (38.7%) who benefit from CWF.
The decay-missing-filled (DMF) index or decayed, missing, and filled teeth (DMFT) index is one of the most common methods in oral epidemiology for assessing dental caries prevalence as well as dental treatment needs among populations and has been used for about 75 years.[1] This index is based on in-field clinical examination of individuals by using a probe, mirror and cotton rolls, and simply counts the number of decayed, missing (due to caries only) and restored teeth. Another version proposed in 1931 [1] counts each affected surface, yielding a decayed, missing, and filled surfaces (DMFS) index. Statistics are available per populations according to age (e.g., “DMF of 12-year old children”). Because the DMF index is done without X-ray imaging, it underestimates real caries prevalence and treatment needs.
Other criticisms: inter-observer bias, no estimates of needs, no indications of number of teeth at risk, does not account for sealants.
- *Improve Oral Health**
1. Improve the oral health of children and youth. - *Access to Care**
2. Improve oral health access for Aboriginal People.
3. Ensure adequate access to oral health care. - *Oral Health Policy**
4. Include oral health as a key part of overall health.
5. Develop Canadian framework about publicly-financed oral health care. - *Surveillance**
6. Develop and maintain information about oral health status. - *Health Protection, Oral Health Promotion and Disease Prevention**
7. Increase access to fluoridated water to help prevent dental cavities. - *Leadership and Workforce**
8. Promote oral public health leadership.
9. Promote professionals working within their capacity and full scope of practice.
10. Encourage a balanced supply of dental professionals.
What are the main pollutants of wood smoke?
What are health risks?
Harm reduction strategies?
Pollutants: PM, CO, VOC, PAH (polycyclic armatic hydrocarbons)
Health risk: ENT irritation, HA, nausea, dizziness, asthma, breathing problems. For smog (hospital admission, premature deaths)
At risk populations: children, people with heart + lung problems
Harm reduction: low emission stove, stove maintenance, clean chimney, burn wisely
What are the source and health effects of the main heavy metals?
Chromium
Mercury
Lead
Cadmium
Arsenic
Cobalt
Copper
Aluminum
Nickel
Manganese
Hydrogen sulfide
Chromium
Sources:
Drinking water
Hot work (welding fumes)
Anticorrosive coatings (chrome plating)
Health effects:
EENT/skin/resp irritation
Nasal septum performation, contact dermatitis, skin ulcers
Pneumoconiosis, asthma
Lung cancer, IARC 1 (hexavalent)
Mercury
Sources:
Metallic: thermometers, dental amalgam, CFL bulbs
Inorganic: fungicide, thimerosal, skin lightening cream
Organic (more toxic): fish
Health effects:
Metallic: erethism (mad hatter, tremor’s shakes)
Inorganic: CNS effects
Organic: minimata disease (tremors, sensory loss, ataxia), developmental delay, dementia
IARC 2B** (organic)**; 3 (inorganic, elemental)
Lead (inorganic more toxic)
Sources:
Contaminated food, soil, air
Gasoline (pre 1989)
Shooting ranges
Stained glass
Jewelry
Paint
Imported goods
Mining, smelting, batteries
Old pipes/solder
Health effects:
Acute abdominal pain
CNS changes: Encephalopathy, Developmental neurotoxicity, Intellectual defects, behavioural problems
Nephrotoxicity
Hemolytic anemia
HTN
IARC 2A** (inorganic)**; 3 (organic)
Cadmium
Sources:
Released by: Metal work, electroplating, mining, waste incineration, fuel combustion
Food (molluscs, veg, cereals)
Smoking
Batteries
Health effects:
Short-term effects:
- Toxic pneumonitis, metal fume fever
- Itai-itai disease (ouch-ouch in Japanese), severe joint/spine pain
- GI side effects
Long-term effects:
- Progressive palmar fibrosis;
- Kidney dysfunction → decreased vit D → osteoporosis;
- Cancer (lung, kidney, prostate, stomach) (IARC 1)
Arsenic
Released by: fossil fuel combustion, metal production, gold mining, pesticides
Sources:
Drinking water
Food (seafood, rice)
Wood preservative (copper chromated arsenate, CCA)
Smoking
Health effects:
Acute - N/V/abd pain, musular cramps, skin thickening, anemia, motor + sensory neuropathy, death
Chronic: (arsenicosis)
• thickening and discoloration of the skin;
• N/V;
• decreased production of blood cells;
• arrhythmias;
• neuropathy in the hands and feet.
Cancer (skin, bladder, liver, kidney, lung) IARC 1
Cobalt
Food, drinking water
Additive to beer (in the past)
Industry
Breathing issues
Cardiac issues at high exposure
Quebec beer drinker’s (cardio)myopathy
Copper
Source:
Water distribution pipes
Health effect:
Cirrhosis
Aluminum
Source:
Hot work
Health effect:
Chronic cough
Alzheimer’s
Nickel
Source:
Smoking
Joint prostheses
Jewelry - rash
Health effect:
Lung cancer
Nasoseptal perforation
Allergic rash
Manganese
Source:
Pesticide
Health effect:
Manganism (like Parkinson’s)
Hydrogen sulfide
Source: natural gas, volcanic gas, microbial anaerobic fermentation of organic matter, accidental exposure
Health effects
Acute: respriatory irritation, SOB, HA, dizziness, stupor, syncope, death
What are the 5 categories of the Canada’s health indicator framework?
What are the components of Health Canada’s healthy eating strategy?
improving healthy eating information (food guide, FOP labelling)
improving nutrition quality of foods (decr Na)
protecting vulnerable populations (marketing to kids)
supporting increased access to and availability of nutritious foods (Nutrition North Canada)
How to calculate a kappa statistic?
k statistic = observed agreement - expected agreement / (1 - expected agreement)
https://www.statisticshowto.com/cohens-kappa-statistic/
See Mayo image.
What are heat and cold health effects?
HEAT
heat Fainting
heat Rash
heat Edema
heat Exhaustion
Exacerbation of resp/CV illness
heat Cramps
heat Stroke
COLD
Windburn
Frostnip
Frostbite
Hypothermia
What criteria can help attribute a foodborne outbreak to norovirus without direct laboratory confirmation?
When it is not possible to get laboratory confirmation of norovirus, health departments can use clinical and epidemiologic criteria to determine if the outbreak was likely caused by norovirus.
The original criteria proposed by Kaplan et alexternal icon are:
A mean (or median) illness duration of 12 to 60 hours,
A mean (or median) incubation period of 24 to 48 hours,
More than 50% of people with vomiting, and
No enteric bacteria found.
When all four criteria are present, it is very likely that the outbreak was caused by norovirus. However, about 30% of norovirus outbreaks do not meet these criteria. If the criteria are not met, it does not mean that the outbreak was not caused by norovirus.
Recently, an alternate set of clinical criteria proposed by Lively et alexternal icon have been identified that are more sensitive for norovirus and more often available during outbreak investigations than the Kaplan criteria. These are:
A greater proportion of cases with vomiting than with fever,
Bloody diarrhea in less than 10% of cases, and
Vomiting in greater than 25% of cases.
What are recent human influenza types circulating?
What are possible reasons for a change in disease incidence?
Correct:
Real increase due to change in virulence/pathogenicity/spread, change in prevalence of risk factors, population at risk, change in treatment/intervention
Random chance
Artefactual:
Patient factors: increased demand or access
Provider factor: Increased testing, misdiagnosis
System: Change in case definition, change in reporting
Test: change in SE/SP, change in threshold
Population: change in denominator, population structure
What are health effects of urban sprawl?
What community design features can encourage active commuting?
What community design features can promote recreational physical activity?
From 2017 CPHO report
It is possible to improve or worsen the health of populations
by changing our physical world. Conditions and chronic
diseases linked to unhealthy living are increasing in
Canada. For example, over 7.8 million Canadians 18 years
and older were living with obesity in 2015, which is more
than a quarter of this population. Obesity increases the
risk for premature death and chronic diseases, such as
cardiovascular disease, cancer and diabetes.
The relationship between the built environment,
healthy living, people’s behaviour and health status
is complex. Even so, cities and communities can be
designed and built to set people up for success so that
healthy choices are the easier choices.
The majority of Canadians – about 80% – live in urban
or suburban areas. While there are trends, the health of
a population varies within the same geographic area. The
rise of urban sprawl is a concern as it has been linked
to sedentary lifestyles, easy access to unhealthy food,
more time spent driving, less physical activity and higher
rates of obesity.
While we know that changing the built environment can
be a cost-effective way to increase physical activity,
less is known about how to improve healthy diets and mental
wellness through neighbourhood design as these are newer
fields of study.
Improving the opportunity to cycle, walk or take public transit
to work or school by changing the built environment is a
growing area of research. Changing the built environment
could significantly influence people’s daily physical activity.
Community design features, such as connected streets, a
mix of residential, commercial, educational and employment
areas, bike paths, and good public transit can support
being active to get to work or other places;
whereas green spaces, waterways, walking paths, trails and recreation facilities can promote recreational physical activity.
Neighbourhoods with easy access to healthier food options
appear to be linked to better diets and better health. Those
with a higher ratio of unhealthy to healthy food options appear
to be linked to poor diets and worse health. However, there
are significant gaps in our knowledge and other factors,
such as affordability, may have a bigger influence on diet than
the built environment.
Neighbourhoods may not be set up to address social
isolation and loneliness. Communities with houses that
have front yards or that are close to the street, have destinations
to walk to and have places for people to gather could
encourage social interaction. Studies suggest that green
spaces are linked to a variety of health benefits including
lower risk for premature death. Ties to the land, water, family,
community and identity, as well as a holistic, interconnected
view of health and well-being are important components
of Indigenous culture that can provide insight into healthy
neighbourhood design.
Going forward, decision-makers and planners at all levels
should take a multi-sectoral, collaborative approach and
consider health as an important outcome, as appropriate,
when making infrastructure planning decisions. More
targeted and hypothesis-driven research, standardized
data collection and systematic evaluations of the health
impact of community design features are needed. With the
diversity of communities and cities across Canada, considering
context and engaging citizens are important for
ensuring that a community’s unique needs are met when
designing for healthy living.
What are different types for risk for an organization?
Financial
Operational
Organizational
Privacy
Security
Technology
Equity
Governance
Environmental
Legal
What are Canadian roles and responsibilities in pandemic response?
Canadian roles and responsibilities
Federal
National case definition
Border security
Quarantine at border
Liaison with WHO and other national governments
National guidance on response
NML
Stockpile for key drugs
Travel advisories
Province
Guidance documents
Provincial regulations to make disease reportable
Provincial level surveillance
Designate hospitals for treatment
Local (vary by province)
Local surveillance
Case and contact management
Provision of guidance and communications
What are CTFPHC recommendations for breast cancer?
For women aged _40 to 49 year_s, we recommend NOT screening with mammography; the decision to undergo screening is conditional on the relative value a woman places on possible benefits and harms from screening. (Conditional recommendation; low-certainty evidence)
For women aged 50 to 69 years, we recommend screening with mammography every two to three years; the decision to undergo screening is conditional on the relative value that a woman places on possible benefits and harms from screening. (Conditional recommendation; very low-certainty evidence)
For women aged 70 to 74 years, we recommend screening with mammography every two to three years; the decision to undergo screening is conditional on the relative value that a woman places on possible benefits and harms from screening. (Conditional recommendation; very low-certainty evidence)
Recommendations on other screening modalities, apart from mammography, for breast cancer screening:
We recommend N_OT using magnetic resonance imaging (MRI), tomosynthesis or ultrasound to screen for breast cancer in women not at increased risk._ (Strong recommendation; no evidence)
We recommend NOT performing clinical breast examinations to screen for breast cancer. (Conditional recommendation; no evidence)
We recommend NOT advising women to practice breast self-examination to screen for breast cancer. (Conditional recommendation; low-certainty evidence)
How is the reproduction number calculated?
What are the Es of injury prevention?
mnemonic (second letters) C-D-2M-3N-V
Economic incentives
Education
Emergency response
Empowerment
Enforcement
Engineering
Environment/administrative
Evaluation
What are the CTFPHC recommendations around childhood obesity?
Prevention recommendations apply to healthy weight children and youth 0–17 years of age (i.e.maintain a healthy BMI trajectory according to the WHO Growth Charts for Canada ). They do not apply to children and youth with eating disorders, or who are underweight, overweight, or obese.
Management recommendations apply to children and youth 2–17 years of age who are overweight or obese. Children and youth with health conditions where weight loss is inappropriate are excluded.
Growth monitoring
Applies to all children and youth aged 0–17: we recommend growth monitoring at all appropriate primary care visitsi using the WHO Growth Charts for Canada. Strong recommendation
Structured behavioural interventions
Applies to children and youth of HEALTHY weight aged 0–17: we recommend that primary care practitioners NOT routinely offer structured behavioural interventionsii (SBI) aimed at preventing overweight and obesity in healthy children. Weak recommendation
Applies to OVERWEIGHT or OBESE children and youth aged 2–17: we recommend that primary care practitioners offer or refer children and youth to structured behavioural interventions aimed at healthy weight management. Weak recommendation
Pharmacological interventions
Applies to children and youth aged 2–11 years: we recommend that primary care practitioners NOT offer Orlistat aimed at healthy weight management. Strong recommendation
Applies to children and youth aged 12–17 years: we recommend that primary care practitioners NOT offer Orlistat aimed at healthy weight management. Weak recommendation
Surgical interventions
Applies to overweight or obese children and youth aged 2–17: we recommend that primary care practitioners NOT routinely refer for surgical interventions. Strong recommendation
How are the following calculated?
- Attributable risk
- Attributable risk percent
- Population attributable risk
- Population attributable fraction
Attributable risk
- risk difference
- portion of incidence in exposed group that is due to exposure
- risk in exposed - risk in unexposed
Attributable risk percent
Represents the excess risk in the exposed population that can be attributed to the risk factor
(RR-1)/RR x 100% or (Re-Ru)/Re x 100%
Population attributable risk
Amount of absolute risk of a health-related state or event in a population that can be attributed to the exposure
Assumes that the exposure causes the outcome
Risk in population - risk in unexposed
Population attributable fraction
Proportion of disease which can be attributed to an exposure of interest
(Rp-Ru)/Rp x 100%
Levin’s formula: Prevalence(RR-1)/1+prevalence(RR-1)
What are recent trends in the Canadian Tobacco, Alcohol and Drugs Survey (CTADS -2017):
Prevalence of current smokers among youth and adults (male/female)?
Ever tried electronic cigarettes?
Alcohol use above guidelines?
Cannabis in the past year?
Opioid pain relievers in past year?
Smoking summary:
Cig smoking prevalence 15% (M 17%, F 13%) in 2017, up from 13% in 2015,
15-19yo = 8% (M 10%, F 6%)
20-24yo = 16% (M 20%, F 11%)
E-cig, ever tried 15%, 15-19yo = 23%, 20-24yo = 29%
Cannabis prevalence, 15% (up from 12% in 2015), M 19%, F 11%.
At least one of 6 drugs = 15%
Current Cigarette Smoking
T_he prevalence of current cigarette smoking in 2017 was 15% (4.6 million smokers), an increase from 13% (3.9 million smokers) in 2015. A higher percentage of males (17% or 2.5 million) than females (13% or 2.1 million) were current smokers_. Eleven percent (11% or 3.3 million) of Canadians reported smoking daily and 4% (1.3 million) reported smoking occasionally. Daily smokers smoked an average of 13.7 cigarettes per day, unchanged from 2015 (13.8). Male daily smokers smoked an average of 14.9 cigarettes per day compared to 12.1 cigarettes per day for female daily smokers.
Youth Cigarette Smoking (Aged 15-19 Years)
In 2017, the prevalence of current cigarette smoking among youth aged 15 to 19 was 8% (159,000), unchanged from 2015 (10%). The prevalence of current smoking for male youth was 10%, higher than for female youth at 6%. Three percent (3%) of youth reported smoking daily while 5% reported smoking occasionally. Youth who reported smoking daily smoked an average of 9.4 cigarettes per day, unchanged from 2015. There was no difference in the average number of cigarettes smoked per day by male and female youth daily smokers.
Young Adult Cigarette Smoking (Aged 20-24 Years)
The prevalence of current cigarette smoking among young adults aged 20 to 24 was 16% (387,000) in 2017, unchanged from 2015 (18%). The prevalence of current smoking for young adult males was 20%**, higher than for **females in this age group at 11%.
The prevalence of daily smoking among young adults was 9%, while 7% smoked occasionally. Daily smoking among males (11%) was higher than among females (7%). Young adults who reported smoking daily smoked an average of 10.7 cigarettes per day, unchanged from 2015. Young adult males who reported smoking daily smoked an average of 12.1 cigarettes per day, higher than for young adult females (8.2).
Adult Cigarette Smoking (Aged 25 Years and Older)
The prevalence of current cigarette smoking among Canadian adults aged 25 years and older was 16% (4.0 million), an increase from 13% (3.2 million) reported in 2015. There was no difference in the prevalence of current smoking between males (17%) and females (14%).
There was an increase in the prevalence of daily smoking among adults to 12% (3.0 million) in 2017, from 10% in 2015, while occasional smoking was unchanged at 4%. There was no difference in the prevalence of daily smoking between adult males (13%) and adult females (11%). The prevalence of daily smoking among adult males (13%) was unchanged from 2015 (11%), there was an increase among adult females (11%) from 2015 (8%).
Adults who reported smoking daily smoked an average of 13.9 cigarettes per day, unchanged from 2015. Adult males who reported smoking daily smoked an average of 15.3 cigarettes per day, higher than adult females (12.4).
Use of Any Tobacco Product
The survey asked about past-30-day use of a number of tobacco products including: cigarettes (including menthol), cigars, little cigars or cigarillos, smokeless tobacco, water-pipe and pipes.
In 2017, 18% (5.3 million) of Canadians aged 15 years and older reported using at least one tobacco product in the past 30 days, higher than the 15% (4.6 million) reported in 2015. The prevalence of past-30-day use of at least one tobacco product was 9% (185,000) among youth aged 15 to 19, a decrease from 13% in 2015. Twenty-one percent (21% or 497,000) of young adults aged 20 to 24 reported use of at least one tobacco product in the past 30 days, unchanged from 2015 (24%). Among adults aged 25 years and older, the prevalence of past-30-day use of at least one tobacco product was 18% (4.6 million), an increase from 15% in 2015. Past-30-day use of at least one tobacco product was higher among males (21% or 3.1 million) than females (14% or 2.2 million).
Menthol CigarettesFootnote1
Among Canadians aged 15 years and older, 1% (434,000) reported smoking menthol cigarettes in the past 30 days, unchanged from 2015 (2% or 476,000). Also unchanged from 2015 were past-30-day use of menthol cigarettes among youth aged 15 to 19 (1% or 18,000) and adults 25 years and older (1% or 375,000). Prevalence of past-30-day use of menthol cigarettes decreased to 2% (41,000) among young adults aged 20 to 24, from 4% in 2015. There was no difference in the prevalence of past-30-day use of menthol cigarettes between males and females.
Among Canadians aged 15 years and older who reported smoking menthol cigarettes in the past 30 days, almost one-third (29% or 126,000) reported that their usual brand of cigarettes was menthol.
Cigars
In 2017, 2% (577,000) of Canadians aged 15 years and older reported smoking any type of cigar Footnote 22 in the past 30 days, unchanged from 2015 (2%). The prevalence of past-30-day use of any type of cigar was 3% (55,000) among youth aged 15 to 19, 5% (119,000) among young adults aged 20 to 24 and 2% (403,000) among adults aged 25 years and older; all unchanged from 2015.
In 2017, 1% (414,000) of Canadians aged 15 years and older reported smoking little cigars or cigarillos in the past 30 days, unchanged from 2015 (2%). Two percent (2% or 45,000) of Canadian youth aged 15 to 19, 4% (89,000) of young adults aged 20 to 24 and 1% (280,000) of adults aged 25 years and older reported smoking a little cigar or cigarillo in the past 30 days; all unchanged from 2015.
Among youth aged 15 to 19 who smoked little cigars or cigarillos in the past 30 days, 61% (26,000) reported smoking a flavoured little cigar or cigarillo.
Water-pipe Tobacco
Past-30-day use of a water-pipe to smoke tobacco was reported by 1% (208,000) of Canadians aged 15 years and older, unchanged from 2015. One percent (1% or 30,000) of youth aged 15 to 19, and 3% (75,000) of young adults aged 20 to 24, reported using a water-pipe to smoke tobacco in the past 30 days, unchanged from 2015. The prevalence of past-30-day use of a water-pipe to smoke tobacco among adults aged 25 years and older was not reportable due to small sample size.
Smokeless Tobacco
In 2017, the prevalence of past-30-day smokeless tobacco use was 1% (225,000) for Canadians aged 15 years and older. Two percent (2%) of youth aged 15 to 19 and 1% of young adults aged 20 to 24 reported past-30-day use of smokeless tobacco. These results were unchanged from 2015. The prevalence of past-30-day use of smokeless tobacco among adults aged 25 years and older was not reportable due to small sample size.
Cigarette Sources
In 2017, current smokers were asked where they usually get their cigarettes. The majority (71%) reported buying them at a small grocery or corner store, unchanged from 2015. Fourteen percent (14%) of current smokers bought their cigarettes at a supermarket or at another kind of store, 7% were given their cigarettes by family, friends or others, 3% purchased their cigarettes on or from a First Nations Reserve and 1% bought them from friends or someone else they know; all unchanged from 2015.
Among youth who were too young to legally be sold cigarettes in their province of residence, 50% reported usually obtaining their cigarettes from a regular retail outlet, while 44% usually got them from a social source such as for free from a family member; both unchanged from 2015.
Nine percent (9% or 401,000) of current smokers aged 15 years and older reported purchasing cigarettes on a First Nations reserve in the past 6 months, unchanged from 2015. Eleven percent (11%) of youth smokers aged 15 to 19, 10% of young adult smokers aged 20 to 24 and 9% of adult smokers aged 25 years and older reported making such purchases.
Smoking Cessation
In 2017, 26% (7.8 million) of Canadians aged 15 years and older reported being former smokers. Six percent (6% or 462,000) of former smokers had quit less than one year ago (short-term quitters), while the remaining 94% (7.3 million) had quit for one year or more (long-term quitters); both unchanged from 2015.
Among daily cigarette smokers aged 15 years and older, 44% (1.4 million) had made at least one quit attempt lasting 24 hours in the past year, unchanged from 2015. More than 1 in 4 daily smokers (28%) tried to quit on two or more separate occasions, also unchanged from 2015.
Daily smokers were asked if they were considering quitting, and 57% (1.8 million) reported they were considering quitting in the next 6 months, unchanged from 2015. Among this group, 35% (597,000) were considering quitting in the next 30 days, also unchanged from 2015.
Electronic Cigarettes
In 2017, 15% (4.6 million) of Canadians aged 15 years and older had ever tried an e-cigarette, an increase from 13% (3.9 million) in 2015. Twenty-three percent (23% or 460,000) of youth aged 15 to 19, and 29% (704,000) of young adults aged 20 to 24, had ever tried an e-cigarette, both unchanged from 2015. Thirteen percent (13% or 3.5 million) of adults aged 25 years and older had ever tried an e-cigarette, an increase from 2015 (11%). Nineteen percent (19% or 2.2 million) of males had ever tried an e-cigarette, which was higher than females (12% or 1.8 million).
Past-30-day use of e-cigarettes was reported by 3% (863,000) of Canadians aged 15 years and older, unchanged from 2015. Six percent (6% or 127,000) of youth aged 15 to 19, 6% (145,000) of young adults aged 20 to 24 and 2% (590,000) of adults aged 25 years and older had used an e-cigarette in the past 30 days; all unchanged from 2015.
Among past-30-day e-cigarette users, 65% (557,000) were current smokers, 20% (173,000) were former smokers and 15% (133,000) were never smokers. Of these never smokers, 58% (77,000) were youth aged 15 to 19 and 33% (45,000) were young adults aged 20 to 24. The prevalence of past-30-day e-cigarette use among adult never smokers aged 25 years and older was not reportable due to small sample size.
Among Canadians aged 15 years and older who had used an e-cigarette in the past 30 days, 43% reported using a fruit flavour the last time they used an e-cigarette, 22% tobacco flavour and 14% candy/dessert. Most youth aged 15 to 19 (69%) and young adults aged 20 to 24 (62%) reported using a fruit flavour, while among adults aged 25 years and older, 33% reported using a fruit flavour and 29% reported using tobacco flavour.
Among Canadians who had ever tried an e-cigarette, 64% (3.0 million) reported that the last e-cigarette they used contained nicotine, 24% (1.1 million) reported using an e-cigarette that did not contain nicotine, and 12% (546,000) were uncertain.
Thirty-two percent (32% or 1.1 million) of current or former smokers reported using e-cigarettes as a cessation aid in the past two years. CTADS did not include questions about the success of smoking cessation attempts using e-cigarettes.
E-cigarette Sources and Reasons for Use
Almost half (49% or 2.2 million) of those who ever tried an e-cigarette reported that they borrowed, shared or bought them from a friend or relative. Twenty-three percent (23% or 1.0 million) bought them from a vape shop or vapour lounge and 12% (546,000) from a convenience store or gas station.
Among past-30-day e-cigarette users, the most commonly reported reasons for using e-cigarettes were because e-cigarettes help people to quit smoking cigarettes (69%), e-cigarettes might be less harmful than smoking cigarettes (58%) and e-cigarettes may be less harmful than cigarettes to people around them (56%). Respondents could provide more than one answer.
Perceived Risk of Harm of Cigarettes and E-cigarettes
Canadians were asked how much they think people risk harming themselves when they smoke cigarettes or use an e-cigarette.
Smoking cigarettes once in a while was perceived to be a “moderate risk” or “great risk” by most Canadians (64%). The majority (85%) thought there was “great risk” of harm from smoking cigarettes on a regular basis. Almost half (48%) of Canadians perceived using an e-cigarette once in a while to be a “moderate risk” or “great risk”. Using an e-cigarette on a regular basis was thought to pose “moderate risk” or “great risk” of harm by 65% of Canadians. Almost one in four Canadians were unaware how much a person risked harming themselves by using an e-cigarette once in a while (23%), or on a regular basis (24%).
Provinces
Provincial prevalence of current smoking for those aged 15 years and older ranged from a low of 12% in Prince Edward Island to a high of 20% in Newfoundland and Labrador. Average cigarettes smoked per day among daily smokers ranged from a low of 12.7 cigarettes per day in Ontario to a high of 18.6 in Newfoundland and Labrador.
Past-30-day use of at least one tobacco product (cigarettes, cigars, little cigars or cigarillos, smokeless tobacco, water-pipe and pipe) ranged from a low of 16% in Ontario and Prince Edward Island to a high of 22% in Newfoundland and Labrador and Saskatchewan.
Past-30-day use of e-cigarettes ranged from a low of 2% in Newfoundland and Labrador and Ontario to a high of 6% in New Brunswick.
Drug Use
T_he survey asked about past-year use of illegal drugs including cannabis, cocaine or crack, ecstasy, speed or methamphetamines, hallucinogens and heroin._
The prevalence of past-year use of at least one of six illegal drugs was 15% (4.5 million), an increase from 13% (3.7 million) in 2015. This increase was due to an increase in use of cannabis and cocaine between the two survey cycles.
Overall, the prevalence of past-year illegal drug use was higher among males (19% or 2.8 million) than females (11% or 1.7 million). Past-year use of at least one of these six illegal drugs was also higher among youth aged 15 to 19 (20% or 396,000) and young adults aged 20 to 24 (35% or 816,000) than among adults aged 25 years and older (13% or 3.3 million).
Cannabis Use
Cannabis was the most prevalently used illegal drug.
In 2017, the prevalence of past-year cannabis use was 15% (4.4 million), an increase compared to 2015 (12% or 3.6 million), and compared to 2013 (3.1 million). In 2017, past-year cannabis use was more prevalent among males (19% or 2.7 million) than females (11% or 1.7 million), which is consistent with previous cycles. The prevalence of past-year cannabis use among males increased from 2015 (15%), whereas for past-year cannabis use there was no change among females.
Past-year use of cannabis was more prevalent among youth aged 15 to 19 (19% or 390,000) and young adults aged 20 to 24 (33% or 780,000) than among adults aged 25 years and older (13% or 3.2 million). Past-year use of cannabis among adults aged 25 years and older increased from 2015 (10%), whereas there was no change among youth aged 15 to 19 and young adults aged 20 to 24. The mean age of initiating use of cannabis was 18 years old for males, unchanged from 2015; and 19 years old for females, up from 18 years old in 2015.
Among people who have used cannabis in the past year, 37% (or 1.6 million) reported using it for medical purposes, an increase from 24% (831,000) in 2015. The survey does not collect information on how people obtained the cannabis for medical purposes.
Of the methods used to consume cannabis in the past 12 months, smoking was the most common. Ninety-one percent (91% or 4 million) of those who used cannabis in the past year smoked cannabis. Other common methods of consumption include mixing cannabis with tobacco (22% or 942,000), chasing (smoking a tobacco product right after smoking cannabis – 34% or 1.5 million), consuming cannabis in edibles (brownies, etc. – 38% or 1.6 million), and vaporizing (29% or 1.3 million). Those who reported using cannabis may have tried more than one method over the past 12 months.
The majority (75% or 3.3 million) of those who reported using cannabis in the past year reported using cannabis in the past 3 months, an increase from 2015 (72% or 2.6 million). Of those who had used cannabis in the past 3 months, many reported consuming cannabis on a daily or almost daily basis (32% or 1 million, unchanged from 33% or 840,000 in 2015).
Provincial prevalence of past-year cannabis use ranged from 11% (750,000) in Quebec to 23% (940,000) in British Columbia.
Other Illegal Drug Use
Respondents were asked about past-year use of illegal drugs including cocaine or crack, ecstasy, speed or methamphetamines, hallucinogens and heroin. This section excludes cannabis.
Past-year use of at least one of five illegal drugs was 3% (987,000), an increase from 2% (678,000) compared to 2015, and 2% (458,000) compared to 2013. This increase is associated with an increase in the use of cocaine, compared to 2015 and 2013.
Overall, prevalence of past-year use of these illegal drugs was higher among males (5% or 719,000) than females (2% or 268,000). There was an increase in past-year use of illegal drugs for both males and females, compared to 2015 (5% vs. 3% and 2% vs. 1% respectively).
Past-year use of at least one of five illegal drugs was higher among youth aged 15 to 19 (4% or 81,000) and young adults aged 20 to 24 (10% or 241,000) than among adults aged 25 and older (3% or 665,000).
While past-year illegal drug use remained low, there was an increase in the prevalence of use of cocaine; 2% (730,000) of Canadians reported using cocaine, an increase from 1% (353,000) compared to 2015, and 1% (259,000) compared to 2013. Cocaine use among adults aged 25 and older was 2% in 2017, an increase from 1% in 2015, and 1% in 2013. There was no change in the prevalence of use of hallucinogens (1% or 443,000), or ecstasy (1% or 271,000). The prevalence of heroin, speed/methamphetamine or salvia use was not reportable due to small sample size.
Past-year use was more prevalent among males than females for cocaine (4% males vs. 1% females) and hallucinogens (2% males vs. 1% females).
Use and Problematic Use of Psychoactive Pharmaceutical Drugs
CTADS includes questions relating to the use and problematic use of three classes of psychoactive pharmaceutical drugs: opioid pain relievers, stimulants (such as medication prescribed for Attention Deficit Hyperactivity Disorder), and tranquillizers and sedatives. While these drugs are prescribed for therapeutic purposes, they have the potential to be used in a problematic manner due to their psychoactive properties.
Among respondents who had reported using psychoactive pharmaceuticals, further questions were asked to determine whether the drugs were used for reasons other than for prescribed therapeutic purposes including use for the experience, for the feeling they caused, to get high, to feel better (improve mood) or to cope with stress or problems. In the text below, such non-therapeutic use will be referred to as problematic use.
The overall prevalence of psychoactive pharmaceutical use among Canadians aged 15 years and older was 22% (6.5 million), unchanged from 2015 (22% or 6.2 million). The prevalence of past-year psychoactive pharmaceutical use in 2017 was higher among females (24% or 3.6 million) than males (20% or 2.9 million). The prevalence of use was lower among youth aged 15 to 19 (17% or 332,000) than young adults aged 20 to 24 (21% or 492,000) and adults aged 25 years and older (23% or 5.7 million). The prevalence of psychoactive pharmaceutical use for males and females was unchanged from 2015 (18% or 2.6 million males and 25% or 3.6 million females). The prevalence of use for each age category was unchanged from 2015: 15% (311,000) of youth aged 15 to 19; 19% (455,000) of young adults aged 20 to 24; and 22% (5.5 million) of adults aged 25 and older.
In 2017, of those who reported having used psychoactive pharmaceuticals in the past year, 5% (302,000) engaged in problematic use of such a drug (i.e., used it for the experience, for the feeling it caused, to get high or for “other” reasons). The prevalence of past-year problematic use among those who used psychoactive pharmaceuticals in 2017 was not reportable for females and adults aged 25 years and older due to small sample size. One percent (1% or 336,000) of the population aged 15 and older engaged in problematic use of psychoactive pharmaceuticals in the past year, an increase from 2015 (0.6% or 173,000)Footnote3.
Opioid Pain Relievers
O_f the three classes of psychoactive pharmaceuticals, opioid pain relievers were the most used with 12% (3.5 million) of Canadians aged 15 years and older reporting having used such a drug in the past year, unchanged from 2015 (13% or 3.8 million)_. There was no difference in the prevalence of past-year opioid pain reliever use between females (12% or 1.8 million) and males (11% or 1.6 million) and both were unchanged from 2015 (14% or 2 million and 12% or 1.7 million, respectively).
Among the 12% of Canadians who used opioid pain relievers in the past year, 3% (100,000) reported problematic use of them. Among all Canadians aged 15 and older, the prevalence of problematic use of opioids was not reportable due to small sample size. The prevalence of problematic use of opioids was also not reportable for females, for young adults aged 20 to 24 and for adults aged 25 years and older in the overall population due to small sample size.
Stimulants
Stimulants are defined as products that can be obtained from a doctor such as Ritalin, Concerta, Adderall, Dexedrine or others, and that are prescribed by doctors to help people who have attention or concentration problems (such as ADHD).
In 2017, 2% (714,000) of Canadians aged 15 years and older reported having used a stimulant in the past year, an increase from 2015 (1% or 338,000), and from 1% (256,000) in 2013. There was no difference between males and females (3% or 418,000 and 2% or 296,000, respectively). Past-year use of stimulants was higher among youth aged 15 to 19 (5% or 108,000) and young adults aged 20 to 24 (6% or 128,000) than among adults aged 25 years and older (2% or 478,000).
Of those who reported past-year stimulant use, 19% (103,000) reported problematic use of such a drug, representing less than one percent (0.3%) of Canadians aged 15 years and older. Problematic use of stimulants among males was higher than females (0.6% or 81,000 vs. 0.1% or 21,000 respectively)Footnote4. The prevalence of problematic use of stimulants among those who used stimulants in the past year was 18% (19,000) for youth aged 15 to 19 and 41% (43,000) for young adults aged 20 to 24. These are unchanged from 2015 for youth aged 15 to 19 (22% or 20,000) and young adults aged 20 to 24 (41% or 37,000). The prevalence for adults aged 25 and older was not reportable due to small sample size.
Sedatives
In 2017, 12% (3.5 million) of Canadians aged 15 years and older reported past-year use of sedatives, unchanged from 2015 (11% or 3.1 million). The prevalence of such reported use by females (14% or 2.1 million) was higher than that of males (9% or 1.3 million) and both were unchanged from 2015 (14% or 2 million and 7% or 176,000, respectively). Past-year use of sedatives was higher among adults aged 25 years and older (13% or 3.2 million) than youth aged 15 to 19 (5% or 101,000) and young adults aged 20 to 24 (8% or 176,000).
In 2017, of those who reported past-year use of sedatives, 1% (49,000) reported using sedatives to get high. This is less than one percent (0.2%) of the population aged 15 and older and unchanged from 2015 (0.3%). The prevalence of reported having used sedatives to get high among females and adults aged 25 years and older was not reportable due to small sample size. Among those who reported having used sedatives, youth aged 15 to 19 reported the highest prevalence of sedative use to get high (15% or 15,000), followed by young adults aged 20 to 24 (11% or 19,000).
Harms Related to Illegal Drug Use
Respondents were asked if there ever was a time that they felt their illegal drug use had a harmful effect on one of eight factors: physical health, friendships and social life, financial position, home life or marriage, work, studies, or employment opportunities, legal problems, difficulty learning or housing problems.
Overall, 4% (820,000) of Canadians aged 15 years and older reported experiencing at least one harm in the past year due to their illegal drug use, an increase from 2015 (3% or 819,000). The prevalence of reported harm as a result of one’s own illegal drug use was higher among males (6% or 518,000) than females (3% or 302,000), both higher than 2015 (4% or 540,000 and 2% or 278,000, respectively). A higher proportion of youth aged 15 to 19 (5% or 100,000) and young adults aged 20 to 24 (10% or 192,000) reported harm due to their own illegal drug use than adults aged 25 years and older (3% or 527,000). The prevalence among adults aged 25 years and older was an increase from 2015 (2% or 498,000).
The prevalence of reported harm was higher among individuals who reported both the use of an illegal drug and the problematic use of a psychoactive pharmaceutical. Eighteen percent (18% or 820,000) of those who used illegal drugs in the past year and who reported problematic use of psychoactive pharmaceuticals in the past year reported having experienced some harm in the past year due to their drug use. There was increase in the prevalence of reported past-year harm among females who had used illegal drugs and had engaged in problematic use of psychoactive pharmaceuticals in the past year (18% or 302,000 in 2017 vs. 11% or 164,000 in 2015).
Alcohol
The survey asked about alcohol use, including questions examining the quantity of alcohol consumed.
Prevalence of Alcohol Use
In 2017, 78% (23.3 million) of Canadians reported consuming an alcoholic beverage in the past year, unchanged from 2015 (77% or 22.7 million). There was no difference in the prevalence of past-year alcohol use between males and females (79% or 11.6 million and 77% or 11.6 million, respectively). There was an increase in past-year alcohol use among females compared to 2015 (73% or 10.9 million). The prevalence of alcohol use among young adults aged 20 to 24 (83%) was higher than among youth aged 15 to 19 (57%) and adults aged 25 years and older (79%). The prevalence of alcohol use for each age category (i.e., youth aged 15 to 19, young adults aged 20 to 24, and adults 25 years and older) was unchanged from 2015.
Provincial prevalence of alcohol use in the past year ranged from 68% (85,000) in Prince Edward Island to 84% (5.8 million) in Quebec. For all provinces, the prevalence of alcohol use remains unchanged compared to 2015.
Low-Risk Alcohol Use
Canada’s Low-Risk Alcohol Drinking GuidelinesFootnote 55 (LRDG) consists of five guidelines and a series of tips. Guidelines 1 and 2, and acute and chronic effects are explained in the definitions. People who drank within the low-risk alcohol drinking guidelines consume no more than the recommended quantity of alcohol within the number of days specified, whereas those who exceed the guidelines consume more alcohol than recommended within the stated timeframe. The basis of the LRDG is reported alcohol consumption in the 7 days prior to the survey.
A_mong Canadians who consumed alcohol in the past year, 21% (representing 16% of the population aged 15 years and older or 4.7 million) exceeded guideline 1 for chronic effects and 15% (representing 11% of the population aged 15 years and older or 3.3 million) exceeded guideline 2 for acute effects._ A higher percentage of males than females drank in patterns that exceeded both guidelines. The chronic-risk guideline was exceeded by 22% (2.5 million) of males who drank and 19% (2.1 million) of females who drank, while the acute-risk guideline was exceeded by 17% (1.9 million) of males who drank and 13% (or 1.5 million) of females who drank.
Y_oung adults aged 20 to 24 had riskier patterns of alcohol consumption, compared to youth aged 15 to 19 and adults aged 25 years and older. Twenty-nine percent (29% or 552,000) of young adults who drank exceeded the guideline for chronic risk._ In comparison, 18% (203,000) of youth who drank and 20% (3.9 million) of adults who drank exceeded this guideline. The acute-risk guideline was exceeded by 24% (450,000) of young adults who drank compared to 12% (130,000) of youth who drank and 14% (2.7 million) of adults who drank.
The prevalences for risky alcohol consumption are unchanged from 2015.
What population groups are considered at risk for additional immunizations?
BCG: If ++ exposed to sig TB without protective measures and case finding/tx not available (e.g. long term traveller to low-resource, high prevalence country)
Haemophilus influenzae type b (Hib): adults with increased risk of invasive Hib disease - 1 dose regardless of prior history of Hib vaccination and at least 1 year after any previous dose.
At risk conditions: Following HSCT, adults w primary immunodeficiencies, malignant heme disorders, HIV, hypo/asplenia, solid organ transplant recipients, cochlear implant recipients.
Inactivated polio: 1 booster dose for adults at increased risk of exposure to polio.
Increased risk: Travelling to areas where it is known/suspected to be circulating
HCW who have close contact w ind who may be excreting virus
Members of communities w disease caused by polio
People in close contact w those who may be excreting - eg working w refugees, military personnel, on humanitarian missions
Lab workers that could handle specimens
Family or close contacts of adopted infants that may have been/will be vaccinated with OPV
Primary series if prev unimm, one lifetime booster if prev imm
Measles-mumps-rubella (MMR): adults born in or after 1970 - 1 dose, except - travellers, health care workers, students in post-secondary educational settings, and military personnel - 2 doses, at least 4 weeks apart. Adults born before 1970 can be assumed to have acquired natural immunity to measles and mumps and do not need MMR vaccination except - non-immune military personnel or health care workers (2 doses, at least 4 weeks apart), non-immune travellers (1 dose), non-immune students in post-secondary educational settings (consider 1 dose). Rubella-susceptible adults, regardless of age - 1 dose.
Pneumococcal vaccination in general:
infants and children immunization of children who missed routine schedule
immunization of residents of long-term care facilities
immunization of adults who are at high risk of IPD due to lifestyle factors: smokers, persons with alcoholism, persons who are homeless
immunization of all adults _65 years of age and olde_r
Pneumococcal vaccine should be considered for adults who use illicit drugs
Pneumococcal conjugate 13-valent (Pneu-C-13): adults with HIV or immunocompromising conditions (except hematopoietic stem cell transplant recipients [HSCT]) - 1 dose of Pneu-C-13 vaccine followed 8 weeks later by 1 dose of pneumococcal polysaccharide 23-valent (Pneu-P-23) vaccine. Administer Pneu-C-13 vaccine dose at least 1 year after any previous dose of Pneu-P-23 vaccine.
Immunocompromising conditions: Asplenia, sickle cell disease, conj immunodeficiencies, HIV infection, immunosuppressive therapy, cancer, solid organ or islet cell transplant, nephrotic syndrome, after HSCT
Pneumococcal polysaccharide 23-valent: adults at high risk of invasive pneumococcal disease (IPD), including adults with alcoholism, smokers, and persons who are homeless - 1 dose. One dose should be considered for adults who use illicit drugs. Adults at highest risk of IPD, including those with functional or anatomic asplenia or sickle cell disease; hepatic cirrhosis; chronic renal failure; nephrotic syndrome; HIV infection; and immunosuppression related to disease or therapy - 1 booster dose at least 5 years from first vaccination with Pneu-P-23 vaccine.
Meningococcal conjugate quadrivalent: in previously unimmunized adults at high risk of invasive meningococcal disease (IMD) - 2 doses, 8 weeks apart. In previously immunized adults -booster dose every 3 to 5 years if last vaccinated at 6 years of age and younger and every 5 years for those last vaccinated at 7 years of age and older.
Multicomponent meningococcal (4CMenB): adults at high risk of IMD should be considered for immunization - 2 doses of 4CMenB vaccine, at least 4 weeks apart.
Adults at risk: Travellers to sub-Saharan Africa and Hajj or hyperendemic area w known serovar
Occ risk for exposure - lab workers, military
Close contacts of case w serovar protected
Hypo/asplenism, primary ab deficiencies, eculizumab use, HIV
Hepatitis A: adults in high risk groups - 2 doses, 6-36 months apart (depending on product used).
High risk groups: T_ravel to endemic areas_, immigrants from endemic areas, close contacts of children adopted from endemic area, populations at risk of outbreaks or where HepA is highly endemic, close contacts of cases, occ/lifestyle risk of exposure, chronic liver disease, receiving plasma-derived replacement clotting factors
Hepatitis B (HB): adults in high risk groups - 3 or 4 dose schedule (depending on product used). Higher dose of monovalent HB vaccine recommended for those with certain immunocompromising conditions, chronic renal failure and dialysis.
At risk groups: Susceptible to HB and immigrated from a country w high prevalence, household/sexual contacts for cases and carriers, occ/lifestyle risk of exposure, travelling to endemic areas, populations at risk of outbreaks or where HB is highly endemic, residents of group homes for people w DD, inmates, chronic liver disease, chronic renal disease, hemophiliacs, undergone HSCT, awaiting solid organ transplant, congenital immunodeficiencies, HIV
Hepatitis A-hepatitis B: adults without chronic renal failure and immunocompromising conditions: combined vaccine preferred if both hepatitis A and standard dosage hepatitis B vaccines are recommended - 3 or 4 dose schedule.
Influenza: recommended for all adults, with focus on adults at high risk of influenza-related complications - 1 dose annually.
Typhoid: adults with ongoing or intimate exposure to a chronic carrier of Salmonella typhi - 1 dose injectable typhoid vaccine or 4 doses oral typhoid vaccine; re-immunization recommended if at continuing risk.
Rabies: adults at high risk of close contact with rabid animals - 3 doses for pre-exposure immunization. Periodic serologic testing and booster doses (if required) for those at continuing high risk.
Varicella: adults 18 to less than 50 years of age without history of VZV infection (self-reported or diagnosed by a health care provider), documented evidence of immunization with 2 doses of a varicella-containing vaccine or laboratory evidence of immunity - 2 doses. Self-reported history or health care provider diagnosis is not considered a reliable correlate of immunity for pregnant women with significant exposure to varicella zoster virus, immunocompromised individuals and health care workers who are newly hired into the Canadian health care system.
Why are children more susceptible to the toxic effects of lead?
Behavior creates exposure risk: Hand-to-mouth behavior, closer to the ground, unable to screen consumption
High metabolic absortion: High respiratory rate, high gut absorption
During neurodevelopmentally sensitive period
What are the 4 pillars of the Canadian drugs and substances strategy?
Prevention, treatment, harm reduction, enforcement
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 are the findings related to vaping in the last edition of the Canadian Student Tobacco, Alcohol and Drugs Survey (2018-2019)?
Canadian Student Tobacco, Alcohol and Drugs Survey
This is a survey of Canadian students between grades 7 and 12 (secondary I to secondary V in Quebec). It asks about their use of:
vaping products
tobacco
alcohol
drugs
The survey is done every 2 years. The most recent survey was done in 2018-19. It showed that:
34% of students in grades 7-12 had ever tried a vaping product (referred to as an e-cigarette in the survey) and 20% reported using them within the last 30 days.
Specifically, 28% had ever tried an e-cigarette with nicotine and 29% had ever tried an e-cigarette without nicotine.
18% of students have used an e-cigarette with nicotine and 11% had used an e-cigarette without nicotine in the past 30 days.
Most students who had tried a vaping product (such as e-cigarettes) had also tried a cigarette.
54% of all students thought it would be “fairly easy” or “very easy” to get an e-cigarette with nicotine if they wanted one, and 58% thought it would be “fairly easy” or “very easy” to get an e-cigarette without nicotine if they wanted one.
What are health impacts of teenage pregnancy and parenting for mothers and children?
What are risk factors for unprotected teen intercourse and pregnancy?
What are possible public health interventions?
How is adolescent pregnancy rate calculated? What are trends?
Adolescent mothers have higher rates of:
Physical: maternal anemia, eclampsia, repeat pregnancy, domestic violence, STI, smoking
Mental: mental health disorders, depression, substance use, DV, lower self-esteem
Social: low socio-economic status, income, educational attainment, social support, poverty, less prenatal care, less breastfeeding
Children of adolescents are at increased risk for:
Infanthood: prenatal death, premature birth and low birth weight
Childhood: growth and development issues, particularly cognitive and speech and language delays, accidental injury and neglect, challenges with behaviour and in school.
Adolescent: higher risk for substance use, early sexual activity, academic struggles, low vocational options, poverty
- *Risk factors for unprotected intercourse in teens** include:
- experiencing social and family difficulties;
- whose mothers were adolescent mothers;
- undergoing early puberty;
- who have been sexually abused;
- with frequent school absenteeism or lacking vocational goals;
- with siblings who were pregnant during adolescence;
- who use tobacco, alcohol and other substances; and
- who live in group homes, detention centres or are street-involved
- *Public health interventions**
- healthy sexuality education and counseling
- the provision of low cost birth control supplies
- confidential and free sexual health clinic services
- building community partnerships with schools, hospitals, and community-based organizations to deliver healthy sexuality and reproductive health programs and service
Adolescent pregnancy rate = Number of pregnancies (live births, stillbirths, therapeutic abortions) per 1,000 females age 15-19 years
Adolescent pregnancy rate has been declining in Canada over the last 25 years. Over 50% of adolescent pregnancies end in abortion
1.8% of live births in 2018
8.4 births among females aged 15 to 19 years per 1,000 females 2016
3% adolescent pregnancy rate 15-19y (live births + abortions)
What criteria can be used to set priorities for communicable disease surveillance?
Canadian Criteria And Guidelines for considering diseases reportable
- National/international regulatory and prevention programs
- Incidence in Canada
- Severity
- Communicability/potential spread to the general population
- Potential for outbreaks
- Socioeconomic burden
- Preventability
- Risk perception
- Necessity for public health response
- Appearing to increase in incidence or change patterns over the past 5 years
WHO criteria to set priorities for communicable disease surveillance
Burden of disease
CFR/severity
Epidemic potential
Potential threat/changing pattern
Health gain opportunity
Social and economic impact
International regulations or programmes
Public perception
When is rabies prophylaxis indicated after contact with a bat?
Rabies is transmitted only when the virus is introduced into a bite wound, open cuts in skin, or onto mucous membranes such as the mouth or eyes. Three broad categories of exposure are recognized as warranting PEP: bite, non-bite and bat exposures.
Bite exposures: Transmission of rabies occurs most commonly through bites. A bite is defined as any penetration of the skin by teeth.
Non-bite exposures: This category includes contamination of scratches, abrasions or cuts of the skin or mucous membranes by saliva or other potentially infectious material, such as the brain tissue of a rabid animal. Non-bite exposures, other than organ or tissue transplants, have almost never been proven to cause rabies, and PEP is not indicated unless the non-bite exposure involves saliva or neural tissue being introduced into fresh, open cuts or scratches in skin or onto mucous membranes. These exposures require a risk assessment that considers the likelihood of salivary contamination.
Petting a rabid animal or handling its blood, urine or feces is not considered to be an exposure; however, such contact should be avoided. Being sprayed by a skunk is also not considered an exposure. These incidents do not warrant PEP.
Post-exposure prophylaxis is recommended in rare instances of non-bite exposure, such as inhalation of aerosolized virus by spelunkers exploring caves inhabited by infected bats or by laboratory technicians homogenizing tissues infected with rabies virus without appropriate precautions; however, the efficacy of prophylaxis after such exposures is unknown.
Exposures incurred in the course of caring for humans with rabies could theoretically transmit the infection. No case of rabies acquired in this way has been documented, but PEP should be considered for exposed individuals.
Bat exposures: Post-exposure rabies prophylaxis following bat contact is recommended when both the following conditions apply:
• There has been direct contact with a bat; AND
• A bite, scratch, or saliva exposure into a wound or mucous membrane cannot be ruled out.
Direct contact with a bat is defined as the bat touching or landing on a person. When there is no direct contact with a bat, the risk of rabies is extremely rare and rabies PEP is not recommended.
In an adult, a bat landing on clothing would be considered reason for PEP administration only if a bite, scratch, or saliva exposure into a wound or mucous membrane could not be ruled out. Therefore, if a bat lands on the clothing of a person who can be sure that a bite or scratch did not occur and that the bat’s saliva did not contact an open wound or mucous membranes, then PEP is not required.
In a child, any direct contact with a bat (i.e., the bat landing on or touching the child, including contact through clothes) could be considered a reason for PEP administration, as a history to rule out a bite, scratch or mucous membrane exposure may not be reliable.
When a bat is found in the room with a child or adult who is unable to give a reliable history, assessment of direct contact can be difficult. Factors indicating that direct contact may have occurred in these situations include the individual waking up crying or upset while the bat was in the room, or observation of an obvious bite or scratch mark.
What are strategies to maximize response rates in a survey?
- Keep survey as short as possible
- Clear layout and careful design of questionnaire
- Pilot the questionnaire first to identify any issues with usability or comprehension
- Use appropriately timed follow-up reminders to complete the survey
- Use simple language, short sentences etc.
- Personalised covering letter/email conveying the reasons for the survey and its value
- Clear statements of confidentiality
- Consider use of telephone and web based administration of survey – but may introduce biases
- Ensure that written materials are available in appropriate languages
- Offer help to specific groups (e.g. elderly, blind, poor literacy skills)
- Offer incentives, $ or chance to win
What are steps to managing interpersonal conflicts?
In summary:
- Intro: Acknowledge situation, make approach, establish rules of engagement
- Info: Gather information on the problem, its source, underlying needs, emotions and perspectives
- Solutions: Request and assess potential solutions, look for win-win + common areas of agreement
- Agreement: Get buy-in on negotiated solutions, next steps for M&E, escalation prn
- I+M&E: Implement plan then monitor and evaluate
Rule of engagement
Information gathering
Identify the problem
Identify underlying needs of each party
Assess/request potential solutions
Negotiate one or more solutions with parties/Get agreement
Implement
Evaluate and debrief
- Making the approach
- Sharing perspectives
- Building understanding
- Agreeing on solutions
American management conflict:
Step 1: Define the source of the conflict.
The more information you have about the cause of the problem, the more easily you can help to resolve it. To get the information you need, use a series of questions to identify the cause, like, “When did you feel upset?” “Do you see a relationship between that and this incident?” “How did this incident begin?”
As a manager or supervisor, you need to give both parties the chance to share their side of the story. It will give you a better understanding of the situation, as well as demonstrate your impartiality. As you listen to each disputant, say, “I see” or “uh huh” to acknowledge the information and encourage them to continue to open up to you.
Step 2: Look beyond the incident.
Often, it is not the situation but the point of view of the situation that causes anger to fester and ultimately leads to a shouting match or other visible and disruptive result.
The source of the conflict might be a minor issue that occurred months before, but the level of stress has grown to the point where the two parties have begun attacking each other personally instead of addressing the real problem. In the calm of your office, you can get them to look beyond the triggering incident to see the real cause. Once again, probing questions will help, like, “What do you think happened here?” or “When do you think the problem between you first arose?
Step 3: Request solutions.
After getting each party’s viewpoint, the next step is to get them to identify how the situation could be changed. Again, question the parties to solicit their ideas: “How can you make things better between you?”As mediator, you have to be an active listener, aware of every verbal nuance, as well as a good reader of body language.
You want to get the disputants to stop fighting and start cooperating, and that means steering the discussion away from finger pointing and toward ways of resolving the conflict.
Step 4: Identify solutions both disputants can support.
You are listening for the most acceptable course of action. Point out the merits of various ideas, not only from each other’s perspective, but in terms of the benefits to the organization. For instance, you might suggest the need for greater cooperation and collaboration to effectively address team issues and departmental problems.
Step 5: Agreement.
The mediator needs to get the two parties to shake hands and accept one of the alternatives identified in Step 4. The goal is to reach a negotiated agreement. Some mediators go as far as to write up a contract in which actions and time frames are specified. However, it might be sufficient to meet with the individuals and have them answer these questions: “What action plans will you both put in place to prevent conflicts from arising in the future?” and “What will you do if problems arise in the future?
This mediation process works between groups as well as individuals.
What are the steps in managing exposure to bloodborne pathogens? (e.g. needlestick)
What is the risk of transmission of HBV, HCV and HIV after exposure?
What elements should be included in a comprehensive sharps injury prevention program?
Apply the hierarchy of controls to needlestick injuries.
Steps for managing a potential exposure to blood borne pathogens
1. Provide Immediate Care to the Exposure Site
Allow injury to bleed freely
Remove clothing that is contaminated with body fluids
Thoroughly flush exposed area with water or saline
Clean area with soap and water and then dry
2. Notify supervisor or delegate, if applicable
3. Conduct a Risk Assessment of the Exposure
Assess type of exposure (i.e. percutaneous injury, mucous membrane or non-intact skin exposure)
Assess type of fluid (i.e. blood, visibly bloody fluid, other potentially infectious fluid or tissue)
Assess length of time since fluids left Source’s body
Determine if an exposure has occurred:
If no exposure has occurred, notify the Exposed and counsel/reinforce infection prevention and control practices
If an exposure has occurred, serologic testing should be performed
4. Serologic Testing for HBV, HCV and HIV
Obtain consent from the Exposed to do baseline and follow-up serologic testing for HBV, HCV and HIV
Baseline includes antibody to HBV (anti-HBs, anti-HBc) and antigen (HBsAg), HCV and HIV
Repeat HBV at 6 months
Repeat HCV at 3 months and 6 months
Repeat HIV serology at 6 weeks, 3 months and 6 months (if negative on previous testing)
4. Counsel the Exposed
Consider PEP for HIV +/- HBV
Encourage the Exposed to be immunized for hepatitis B if not previously received
While waiting for serology results, the Exposed should:
Abstain from sexual intercourse or use a latex condom
Not donate blood, plasma, organs, tissue or sperm
Not share toothbrushes, razors or needles that may be contaminated with blood or body fluids
Not become pregnant
Post-Exposure Prophylaxis (PEP)
Treatment to prevent infection following an exposure to blood or body fluids is called PEP. PEP is available for HIV and HBV but not HCV and is only provided in hospital emergency departments. If an exposure has occurred, the Exposed must be referred to a hospital emergency department as the decision to recommend PEP is based on the assessment of the attending emergency physician. If the Exposed is started on PEP, a referral should be made to The Ottawa Hospital, General Campus Infectious Diseases Clinic to obtain serology testing results and ensure comprehensive follow-up.
PEP for HIV usually consists of treatment with 2 to 3 antiretroviral drugs for four weeks. PEP should begin as soon as possible after the exposure, preferably within hours after the exposure. Treatment may be considered at later intervals because of the potential benefits of early treatment of HIV infection should seroconversion occur. If the Source HIV test result is negative, PEP is discontinued immediately.
PEP for HBV consists of treatment with hepatitis B immune globulin (HBIG) and hepatitis B vaccine, depending on the exposed person’s susceptibility or immunity to HBV infection. HBIG should be administered within 24 hours.
Risk of Transmission of HBV, HCV and HIV
Several factors influence the risk of infection from a single significant exposure, including:
The virus involved (HBV & HCV are more infectious than HIV)
The type of exposure (a deep injury is more risky than a splash to the eyes)
The amount of blood involved in the exposure (more blood is associated with more risk)
The amount of virus in the Source’s blood at the time of exposure (more virus is associated with more risk)
Hepatitis B Virus (HBV)
For persons who have received Hepatitis B vaccine and have developed immunity to the virus there is virtually no risk for infection. The risk of transmission of HBV following a needle stick or cut exposure (from an infected source) is 6-30%. In the case of human bites where the skin is broken, the risk of transmission (to the person who is bitten) is unknown but is likely to be quite low since the concentration of HBV is 1000 times lower in saliva than in blood. The management of persons with possible exposures to HBV is outlined in the Canadian Immunization Guide, 7th edition (2006), page 193-196.
Hepatitis C Virus (HCV)
The risk of acquiring HCV following a needle stick or cut exposure to an infected source is approximately 1.8%. The risk of infection from an exposure to mucous membranes or non-intact skin is unknown, but is believed to be very small. There is no vaccine against HCV and no treatment available after an exposure that will prevent infection. Immune globulin and antiretroviral drugs are NOT recommended after exposure.
Human Immunodeficiency Virus (HIV)
The risk of acquiring HIV following a needle stick or cut exposure to an infected source is currently estimated at 0.3% (1 in 300).
The risk after exposure of the eye, nose, or mouth or non-intact skin to blood infected with HIV is estimated to be approximately 0.1% (1 in 1,000).
A small amount of blood on intact skin likely poses no risk at all.
Preventing injuries is the most effective way to protect workers. A comprehensive sharps injury prevention program would include:
Recommended guidelines.
Improved equipment design.
Effective disposal systems.
Employee training.
Safe recapping procedures, where necessary.
Surveillance programs.
Hierarchy of controls
Elimination - find ways to eliminate or reduce needle use during procedures, medication delivery, and specimen collection.
Engineering controls - remove or isolate the hazard by using sharps disposal containers or other devices that have an integrated injury prevention feature. Safety devices must be chosen with care as no one device or strategy will work in every situation.
Work-practice controls - Steps that can be taken to reduce injuries include using instruments to grasps needles or load/unload scalpels, avoiding hand-to-hand passage of sharps, separating sharps from other waste, not carry garbage or linen bags close to the body, etc.
Personal Protective Equipment (PPE) - PPE should be used as the last control approach, where appropriate.
What are water disinfection by-products and potential health effects?
Trihalomethanes - increased risk of cancer; liver, kidney, or CNS problems (formed with chlorine/chloramine and organic/inorganic matter)
- Haloacetic acid - increased risk of cancer (formed with chlorine/chloramine and organic/inorganic matter)
- Bromate - increased risk of cancer (formed with bromide and ozone)
- Chlorite - CNS effects, anemia (formed when chlorine dioxide breaks down)
What are components of comprehensive sexual health education?
What are the goals of comprehensive sexual education?
The goals of comprehensive sexual health education are to equip
people with the information, motivation, and behavioural skills to 1)
enhance sexual health and well-being (e.g., having respectful and
satisfying interpersonal relationships, increased self-acceptance,
increased capacity to access sexual and reproductive health
services) and to 2) prevent outcomes that can have a negative impact
on sexual health and well-being (e.g., acquisition and transmission
of sexually transmitted infections [STIs], unintended pregnancies,
sexual coercion/trauma/abuse/harassment, relationship problems).
SPECIFIC COMPONENTS OF SEXUAL HEALTH EDUCATION USING THE IMB MODEL
1. Information/Knowledge
• Should be relevant to the individual’s personal sexual health and well-being
• Can be used to make informed, autonomous decisions
• Can be translated into relevant behaviour change
2. Motivation
• Impact of social norms and peer pressure
• Perceived vulnerability to negative outcomes
• Perceived opportunity for positive outcomes
• Emotional motivation: a person’s level of comfort or discomfort with sexuality (e.g., feelings of self-acceptance and self-worth related to sexuality)
• Personal motivation: beliefs and attitudes towards specific sexual health prevention or promotion acts
• Social motivation: perceived social support or opposition for an individual’s enactment of a sexual health prevention or promotion behaviour
3. Behavioural Skills
• Translating information/knowledge and motivation/attitudes into intentions, confidence (i.e., self-efficacy), and behaviour conducive to sexual health and well-being (e.g., using condoms, dental dams, other barriers [e.g., gloves],and/or birth control)
• Communication through ongoing conversation (e.g., discussing consent, setting sexual limits, expressing sexual preferences; understanding and expressing nonverbal communication)
• Accessing resources/health services
4. Environmental Factors (Understanding and engagement)
• Awareness of the ways that social, cultural, economic, political contexts can negatively/positively affect sexual health and well-being
• Strengthening capacity for self and group advocacy related to sexual health and well-being
• Strengthening access to user-friendly, stigma-free sexual and reproductive health services
PRINCIPLES OF COMPREHENSIVE SEXUAL HEALTH EDUCATION:
-IS ACCESSIBLE TO ALL PEOPLE INCLUSIVE OF AGE, RACE, SEX, GENDER IDENTITY, SEXUAL ORIENTATION, STI STATUS, GEOGRAPHIC LOCATION, SOCIO-ECONOMIC
STATUS, CULTURAL, OR RELIGIOUS BACKGROUND, ABILITY, OR HOUSING STATUS (E.G., THOSE WHO ARE INCARCERATED, HOMELESS, OR LIVING IN CARE FACILITIES).
- PROMOTES HUMAN RIGHTS INCLUDING AUTONOMOUS DECISION-MAKING AND RESPECT FOR THE RIGHTS OF OTHERS.
- IS SCIENTIFICALLY ACCURATE AND USES EVIDENCE-BASED TEACHING METHODS.
- IS BROADLY-BASED IN SCOPE AND DEPTH AND ADDRESSES A RANGE OF TOPICS RELEVANT TO SEXUAL HEALTH AND WELL-BEING.
- IS INCLUSIVE OF THE IDENTITIES AND LIVED EXPERIENCES OF LESBIAN, GAY, BISEXUAL, TRANSGENDER, QUEER, INTERSEX, TWO-SPIRIT, NONBINARY, AND ASEXUAL PEOPLE (LGBTQI2S+), AND OTHER EMERGING IDENTITIES.
- PROMOTES GENDER EQUALITY AND THE PREVENTION OF SEXUAL AND GENDER-BASED VIOLENCE.
- INCORPORATES A BALANCED APPROACH TO SEXUAL HEALTH PROMOTION THAT INCLUDES THE POSITIVE ASPECTS OF SEXUALITY AND RELATIONSHIPS AS WELL AS THE PREVENTION
OF OUTCOMES THAT CAN HAVE A NEGATIVE IMPACT ON SEXUAL HEALTH AND WELL-BEING. - IS RESPONSIVE TO AND INCORPORATES EMERGING ISSUES RELATED TO SEXUAL HEALTH AND WELL-BEING.
- IS PROVIDED BY EDUCATORS WHO HAVE THE KNOWLEDGE AND SKILLS TO DELIVER COMPREHENSIVE SEXUAL HEALTH EDUCATION AND WHO RECEIVE ADMINISTRATIVE SUPPORT TO UNDERTAKE THIS WORK.
OBJECTIVES of comprehensive sexual health education :
1) increasing the use of condoms, dental dams, or other types of barriers, (less unintended pregnancies)
2) increasing STI testing,
3) accessing the human papillomavirus (HPV) vaccine,
4) increasing awareness and use of PrEP and post-exposure prophylaxis (PEP) for HIV prevention,
5) obtaining/discussing consent for sexual activity with partners,
6) building capacity for educators to teach a comprehensive sexual health education curriculum, and
7) increasing capacity for seeking support following sexual assault.
What are steps to budget variance analysis?
- Gather data into a centralized database and create a variance report with differences in what was spent and budgeted to spend
- Evaluate and identify variances for further investigation
Check accuracy of data
Percentage variance
Magnitude of variance
- Investigate and identify reasons for variances
- Compile an explanation of the variances and recommendations for senior management
- Develop and implement plan to address/remedy variances and incorporate into future budget planning
What are 6 pathways for racism to affect health?
Define and contrast racism, intersectionality, epistemic racism, systemic racism and interpersonal racism.
Pathways for racism to effect health:
- (1) economic and social deprivation;
- (2) toxic substances and hazardous conditions;
- (3)discrimination and other forms of socially inflicted trauma (mental physical, and sexual, directly experienced or witnessed, from verbal threats to violent acts;
- (4) targeted marketing of harmful commodities (e.g., “junk” food and psychoactive substances such as , tobacco, alcohol and other licit and illicit drugs); and
- (5) inadequate or degrading medical care; and,
- (6) degradation of ecosystems, including as linked to systematic alienation of Indigenous populations from their lands and corresponding traditional economies
Epistemic racism
Positioning the knowledge of one racialized group as superior to another
Systemic racism
Imbalance of power and resources maintained through inequitable in treatment in law, policies, rules, and regulations
Interpersonal racism
Belief that an individual possesses certain characteristics based on their race alone
Racism
Unjust or unfair systems of power or privilege advantaging a group based on race
Intersectionality
The interconnected nature of social categorizations creating overlapping and interdependent systems of discrimination or disadvantage
How can the measures of risk (RR, OR) be used to calculate:
- population attributable fraction (PAF) and
- exposed attributable fraction (EAF)?
Levin’s formula PAF (from cohort) =
Prevalence of exposure*(RR-1) / [1 + Prevalence of exposure*(RR-1)]
PAF (from case-control) =
Proportion of cases that have the exposure*(OR-1)/OR
EAF = (RR-1)/RR or (OR-1)/OR
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.
In a normal distribution, what proportion of data are within:
- 1 SD of the mean,
- 2 SD of the mean,
- 3 SD of the mean?
- 1 SD of the mean = 68.3%
- 2 SD of the mean = 95.4%
- 3 SD of the mean = 99. 7%
95% = 1.96 SD
What are dimensions of health care quality,
- according to Maxwell (1984)?
- according to Donabedian (1966)?
Maxwell’s dimensions of health care quality
* Access to services
* Relevance to need (for the whole community)
* Effectiveness (for individual patients)
* Equity (fairness)
* Social acceptability
* Efficiency and economy
The Donabedian model is a conceptual model that provides a framework for examining health services and evaluating quality of health care.[1] According to the model, information about quality of care can be drawn from three categories: “structure,” “process,” and “outcomes.”
What is the CTFPHC recommendation around asymptomatic bacteriuria in pregnancy?
We recommend screening pregnant women once during the first trimester with urine culture for asymptomatic bacteriuria (weak recommendation; very low-quality evidence).
Contrast infectiousness, pathogenicity and virulence.
Agent: Characteristics include,
Infectiousness (I): Ability of an organism to establish itself in a susceptible host; I = infected / exposed
Pathogenicity: Probability of an organism to cause disease (e.g., TB is not very pathogenic)
Virulence: Severity of disease caused by organism (e.g., Zika is low-virulence; TB is highly virulent)
What are CTFPHC for screening of developmental delay in children 1-4yo?
We recommend AGAINST screening*1 for developmental delay using standardized tools in children aged 1 to 4 years with no apparent signs of developmental delay and whose parents and clinicians have no concerns about development. (Strong recommendation; low quality evidence)
What are elements of the communication continuum?
Sender
Message
Medium
Receiver
Interpretation
Outcome
What are diseases related to birds?
Psittacosis
Histoplasmosis
Aspergillosis
Cryptococcus
MAC
Salmonella, campy, cryptosporidiosis, wnv
avian influenza
What are the 10 fair information principles from the Personal Information Protection and Electronic Documents Act (PIPEDA)?
Mnemonic
Person consents to collection of accurate data for use/disclosure/retention limited to an identified purpose
Accountable/challengeable organization safeguards those accessible data openly
Principle 1 - Accountability
An organization is responsible for personal information under its control. It must appoint someone to be accountable for its compliance with these fair information principles.
Principle 2 - Identifying Purposes
The purposes for which the personal information is being collected must be identified by the organization before or at the time of collection.
Principle 3 - Consent
The knowledge and consent of the individual are required for the collection, use, or disclosure of personal information, except where inappropriate.
Principle 4 - Limiting Collection
The collection of personal information must be limited to that which is needed for the purposes identified by the organization. Information must be collected by fair and lawful means.
Principle 5 - Limiting Use, Disclosure, and Retention
Unless the individual consents otherwise or it is required by law, personal information can only be used or disclosed for the purposes for which it was collected. Personal information must only be kept as long as required to serve those purposes.
Principle 6 - Accuracy
Personal information must be as accurate, complete, and up-to-date as possible in order to properly satisfy the purposes for which it is to be used.
Principle 7 - Safeguards
Personal information must be protected by appropriate security relative to the sensitivity of the information.
Principle 8 - Openness
An organization must make detailed information about its policies and practices relating to the management of personal information publicly and readily available.
Principle 9 - Individual Access
Upon request, an individual must be informed of the existence, use, and disclosure of their personal information and be given access to that information. An individual shall be able to challenge the accuracy and completeness of the information and have it amended as appropriate.
Principle 10 - Challenging Compliance
An individual shall be able to challenge an organization’s compliance with the above principles. Their challenge should be addressed to the person accountable for the organization’s compliance with PIPEDA, usually their Chief Privacy Officer.
What is the health promotion cube?
What are the 17 SDGs?
No poverty
Zero hunger
Good health and well-being
Quality education
Gender equality
Clean water and sanitation
Affordable and clean energy
Decent work and economic growth
Industry, innovation, and infrastructure
Reduced inequalities
Sustainable cities and communities
Responsible consumption and producction
Climate action
Life below water
Life on land
Peace, justice and strong institutions
Partnerships for the goals
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 is the methodology used by the CTFPHC?
How is the quality of the evidence evaluated? (GRADE)
What are reasons for upgrading or downgrading the GRADE?
How is the strength of the recommendation evaluated?
What are 3 elements that support a conditional recommendation?
Steps:
- Topic selection
- Scoping
- Benefits and harms identified (patient input)
- Protocol development
- Conduct systematic evidence review
- Draft recommendations (patient input, equity, feasibility, acceptability, cost)
- Draft guideline
- Feedback from clinical experts, peer reviewers, stakeholders
- Knowledge translation create tool for primary care and patients (patient input)
- Publication of protocol, guideline, systematic review
- Dissemination to clinicians, patients, policy makers, public
- Clinical Practice
- Evaluation
QUALITY OF EVIDENCE (Grading of Recommendations Assessment, Development and Evaluation system (GRADE))
High quality evidence:
- there is a wide range of studies included in the analyses
- with no major limitations,
- there is little variation between studies,
- and the summary estimate has a narrow confidence interval
- Moderate quality evidence: there are only a few studies and some have limitations but not major flaws, there is some variation between studies, or the confidence interval of the summary estimate is wide.
- Low or very-low quality evidence: the studies have major flaws, there is important variation between studies, or the confidence interval of the summary estimate is very wide.
- Reasons for downgrading:
Risk of bias
Imprecision
Inconsistency
Indirectness
Publication bias
- Reasons for upgrading
Large magnitude of effect
Dose-response gradient
All residual confounding would decrease magnitude of effect (in situations with an effect)
STRENGTH OF RECOMMENDATIONS
Based on:
Quality of evidence +
- The balance between desirable and undesirable effects;
- The variability or uncertainty in values and preferences of citizens;
- Whether or not the intervention represents a wise use of resources.
Strong recommendations are those for which we are confident that the desirable effects of an intervention outweigh its undesirable effects (strong recommendation for an intervention) or that the undesirable effects of an intervention outweigh its desirable effects (strong recommendation against an intervention).
Conditional* recommendations are those for which the desirable effects probably outweigh the undesirable effects (conditional recommendation for an intervention) or undesirable effects probably outweigh the desirable effects (conditional recommendation against an intervention) but uncertainty exists.
The balance between desirable and undesirable effects is small, the quality of evidence is lower, and there is more variability in the values and preferences of individuals.
Define SDoH and structural determinants of health.
What are the roles of public health in addressing health inequity?
SDoH: The economic and social conditions that influence the health of individuals, communities and countries.
SDOH are underpinned by structural factors, such as race, sexual orientation, and the history of colonization among FN communities.
*SDOH can be modified, structural determinants cannot.
Roles of public health in health inequity:
Assess/report
Modify/orient PH interventions
Partner with other services
Lead/participate in policy
What is the grasshopper effect (global distillation)?
Global distillation or the grasshopper effect is the geochemical process by which certain chemicals, most notably persistent organic pollutants (POPs), are transported from warmer to colder regions of the Earth, particularly the poles and mountain tops.
Global distillation explains why relatively high concentrations of POPs have been found in the Arctic environment and in the bodies of animals and people who live there, even though most of the chemicals have not been used in the region in appreciable amounts.
In qualitative research, what is the term used to describe the point at which no new contribution to the emerging findings is obtained from further analysis of interviews/focus groups/observations?
In qualitative research, how is a study population selected?
List 3 benchmarks used by qualitative researchers to assess the quality and validity of qualitative research?
Name 5 qualitative data collection methodologies:
List 2 raw data sources in qualitative methods:
List 4 steps in the iterative process of qualitative data analysis:
Name 1 guideline for best practice in reporting qualitative research:
Theoretical saturation (also known as thematic saturation)
Population selection: Purposive sampling
Benchmarks used by qualitative researchers to assess the quality and validity of qualitative research:
Triangulation
Clear documentation of the research process
Supporting theory with quotes from the transcript
Limitation - process of testing how well the findings of the research fit the data, establishing limits of the theory by identifying and discussing deviant and negative cases.
Falsification - process of modifying the theory to incorporate a case that does not fit with the theory
Member checking - process of testing the interpretive findings with participants
Name 5 qualitative data collection methodologies:
Semi-structured interviews
Narrative interviews
In-depth interviews
Focus groups
Action research
Participant observation
Document review
List 2 raw data sources in qualitative methods:
Transcripts of what was said in interviews and focus groups
Field notes on what was observed by the researcher during observation
List 4 steps in the iterative process of qualitative data analysis:
Some form of review of all the information to gain an initial sense of the data, these ideas might then be fed back to the informants for verification purposes.
The process of organising the data into some manageable form. This is often described as ‘reducing the data’, and usually involves developing codes or categories. However, as will be argued below, this process can be potentially problematic if the desire of the researcher is to maintain the unique richness of qualitative forms of data.
I_nterpreting the data_
Presenting it in some form, e.g. tables, prose, or diagrams.
Name 1 guideline for best practice in reporting qualitative research: Consolidated Criteria for Reporting Qualitative Research (COREQ)
What are hiring steps?
15 Steps of the Hiring Process
- Identify the hiring need
The hiring process begins by identifying a need within your organization. This need could vary from filling a vacated position, better managing a team’s workload, or expanding the reach of organizational tasks. Positions are, in other words, either newly formed or recently vacated.
- Devise A Recruitment Plan
Once an organization identifies a hiring need, it should begin recruitment. In the case of newly formed positions, organizations should clearly identify how the new role aligns with its goals and business plan. Organizations should also keep relevant internal teams and employees apprised of the new position at each stage of the hiring process. It’s important that all those involved in the hiring decision agree to the hiring process, steps, and appropriate communication channels. Recruitment also includes strategizing how to publicize the new position, both internally and externally; criteria for initial candidate screening; what the interview process will look like; and who will conduct interviews.
- Write a job description
The hiring staff should start by generating a job description that includes a prioritized list of job requirements, special qualifications, desired characteristics, and requisite experience. The job description should also include information regarding salary and benefits.
- Advertise the Position
Identifying highly-qualified potential candidates begins internally. Start, therefore, by notifying current employees of the opening. Advertising the job may stop there, if you are determined to fill the position internally. If, however, you are interested in external candidates, you should include this information when you notify internally. External publicity will likely consist of utilizing a combination of the company’s website and social media platforms, job posting sites like LinkedIn, job fairs, industry publications and events, local newspaper advertisements, and word-of-mouth recruitment. Publicity will likely consist of utilizing a combination of the company’s website and social media platforms and job posting sites like LinkedIn, industry publications, and local newspaper advertisements.
- Recruit the Position
Beyond simple job posts, the hiring staff should reach out directly to desirable candidates via LinkedIn, social media, and job fairs. Active recruitment will help generate applications from potential candidates who are not actively searching for new jobs but may be perfect for the available position.
- Review Applications
Your organization likely already has a mechanism in place to receive applications–via email, an applicant tracking system (ATS), etc. In many cases, the review process begins with Human Resource representatives who review the applications and eliminate any candidate who does not meet the minimum requirements for the position or the company more generally. In other instances, the hiring team or hiring manager may prefer to review each application. Once a batch of qualified applications are assembled, the hiring staff should review the remaining candidates and identify those they want to interview.
- Phone Interview/Initial Screening
Initial interviews typically begin with phone calls with HR representatives. Phone interviews determine if applicants possess the requisite qualifications to fill the position and align with an organization’s culture and values. Phone interviews enable organizations to further pare down the list of candidates while expending company resources efficiently.
- Interviews
Depending on the size of the organization and hiring committee, one or several interviews are scheduled for those remaining candidates. Interviews include:
Early interviews are typically one-on-one, in-person interviews between the applicants and the hiring manager. Early interviews conversations typically focus on applicants’ experience, skills, work history, and availability.
Additional interviews with management, staff, executives, and other members of the organization can be either one-on-one or group interviews with the hiring committee. They may be formal or casual; on-site, off-site, or online via Skype, Google Hangouts, etc. Additional interviews are more in-depth; for example, in interviews between a candidate and multiple members of the hiring team interviewer, each member of the hiring team focuses on a specific topic or aspect of the job to avoid redundancy and ensure an in-depth conversation about the role and the candidates qualifications and experience. Note: at this stage, you should also inform the candidates you elect not to request an interview that the search has moved forward and they are no longer under consideration.
Final interviews often include conversations with the company’s senior leadership or a more in-depth discussion with an interviewer from an earlier stage in the hiring process. Final interviews are typically extended only to a very small pool of top candidates.
- Applicant Assessment
Once the interviews are completed, or during their completion, company’s often assign applicants one or more standardized tests. These exams measure a wide range of variables, including personality traits, problem-solving ability, reasoning, reading comprehension, emotional intelligence, and more.
- Background Check
Your initial job posting should indicate that all candidates are subject to a background check. Background checks review candidates’ criminal record, verify employment history and eligibility, and run credit checks. Some organizations also check social media accounts (Facebook, Twitter, etc.) to make sure potential employees are likely to represent the company in a professional manner. Drug testing may also be warranted, depending on the position.
- Decision
After conducting background and reference checks, the hiring staff identifies their top choice. The hiring staff should also select a backup candidate, in case the top choice declines the offer or negotiations fail to produce a signed offer letter. In the event that no candidates meet the hiring criteria, the hiring staff should determine whether or not to start the hiring process over. If so, the hiring staff should discuss whether or not to adjust or alter the hiring process in order to yield more favorable candidates.
- Reference Check
Reference checks should verify any pertinent information shared by the candidate about previous employment–job performance, experience, responsibilities, workplace conduct, etc. A typical question to ask references is “Would you rehire this person?”
- Job offer
Once a top candidate is identified, the organization should extend an initial offer. The offer letter should i_nclude the position’s salary, benefits, paid time off, start date, potential severance pay, working remotely policy, included company equipment and other terms and conditions of employment._ Negotiations are likely to follow. Therefore, the hiring staff should determine internally which elements of the offer letter are negotiable, and which are not. It is typical for terms like salary, flexible work schedule, and working remotely to be negotiable.
- Hiring
After negotiations, once the candidate accepts the job offer they are hired. An accepted offer letter begins a process of filling out and filing paperwork related to employment. Forms and paperwork might include:
Form W-4
Form I-9 and E-Verify
State Withholding and Registrations
A checklist with all required paperwork to be completed by new employees
An organization’s employee handbook
- Onboarding
Hiring a new employee does not conclude the hiring process. Onboarding your new worker in a welcoming and professional way will help integrate them in a manner that lays the groundwork for a long-term productive relationship between them and your company. A _welcome letter i_s strongly advised. From there, relevant management should reach out to the employee before their start date to welcome them to the organization. Their work space should be prepared, cleaned, and equipped with the necessary credentials and equipment before their first day. If an orientation is part of the onboarding process, make sure your employee has a clear understanding of the expectations and scheduling of those events. Lastly, consider assigning your new employee a mentor, which will help them settle in to their new position and organization, and set them up for long term growth and success.
What are elements of a scorecard according to ICES?
- Health determinants and status;
- Community engagement;
- Resources and services; and,
- Integration and responsiveness.
Describe a Canadian framework for applying the precautionary principle to public health issues.
- Is there sufficient evidence to support a reasonable suspicion that the exposure of interest causes the proposed harm? (Apply the Bradford-Hill criteria)
a) Do studies consistently show an effect?
b) Has a strong association been demonstrated?
c) Is this a specific outcome associated with a specific exposure?
d) Has a dose-response (biological gradient) been observed?
e) Has a temporal relationship been observed?
f) Is the relationship biologically plausible?
g) Is the proposed relationship coherent with existing theory and knowledge?
h) Is there an analogy with a proven cause and effect relationship?
i) Does experimental evidence support the relationship? - Is the harm associated with the suspected exposure serious?
- Is the suspected exposure widespread?
- Is there an observed increase in the incidence of the suspected harm that is temporally associated with increased exposure?
- Is the harm associated with the suspected exposure difficult to treat or reverse?
- What are the economic and non-economic costs and benefits of action and non-action?
- Are the proposed control measures proportional to the level of risk? Are the economic costs of removing the exposure minimal? Are the health and societal costs of removing the exposure minimal?
- Are comparable situations being treated similarly according to a standard of practice?
- Is the level of the protective measures consistent with equivalent areas in which scientific data are available?
- If precautionary measures are adopted, is there any new evidence to reduce the level of uncertainty about harm and benefit?
What parameters are including in the
Canadian guidelines for drinking water?
Microbiological:
- Enteric protozoa (giardia, crypto)
- Enteric viruses
- E. Coli
- Total coliforms
- Turbidity
Chemical and physical:
- Many, among them: ammonia, arsenic, benzene, cadmium, chloramines, chromium, cyanobacterial toxins, lead, nitrate, PFOS/PFOA, pH, vynil chloride
Radiological
What is the catch-up schedule for NOT previously immunized children <7 and 7-17yo?
Vaccination for NOT previously immunized, <7yo:
DTaP-IPV:
- 4 doses of DTaP-IPV-containing vaccine.
- if the fourth dose of DTaP-IPV vaccine was given before the fourth birthday, a booster dose of DTaP-IPV or Tdap-IPV vaccine should be provided at 4-6 years of age.
HiB:
- If first visit at 12-14 months of age: 1 dose of Hib-containing vaccine at first visit and booster dose at least 2 months after the previous dose.
- If first visit at 15 months-less than 60 months of age (5yo): 1 dose of Hib-containing vaccine.
- If first visit at 60 months of age or older (5yo), Hib-containing vaccine is not required.
Pneumococcal:
- 12-23 months of age - 2 doses, at least 8 weeks apart.
- 24-59 months of age - 1 dose.
Meningococcal conjugate monovalent:
- 12-59 months of age - 1 dose;
- 5-11 years of age - consider 1 dose.
Measles-mumps-rubella:
- 2 doses, at least 4 weeks apart
Varicella:
- 2doses, at least 3 months apart
Hepatitis B
- 3 doses - months 0, 1 and 6 (first dose = month 0) with at least 4 weeks between the first and second dose, 2 months between the second and third dose, and 4 months between the first and third dose.
Influenza
Vaccination for NOT previously immunized, 7-17yo:
Tdap-IPV:
- 3 doses; 2 doses, 8 weeks apart, third dose 6-12 months after second dose.
- Tdap booster 10y after last dose
Meningococcal:
- Meningococcal conjugate monovalent: 7-11 years of age - consider 1 dose.
- Meningococcal conjugate monovalent or quadrivalent: 12-17 years of age - 1 dose, even if meningococcal conjugate vaccine received at a younger age
MMR:
-2 doses, at least 4 weeks apart.
Varicella:
- 7-12 years of age - 2 doses, at least 3 months apart. 13 years of age and older - 2 doses, at least 6 weeks apart.
Hepatitis B:
- 7-17 years of age - 3 doses, months 0, 1 and 6 (first dose = month 0) with at least 4 weeks between the first and second dose, 2 months between the second and third dose, and 4 months between the first and third dose.
- 11-15 years of age - two doses; schedule depends on the product used.
HPV
- recommended for women up to and including 26 years of age, may be given to women 27 years of age and older at ongoing risk of exposure: HPV bivalent (HPV2) vaccine - months 0, 1 and 6 (first dose = month 0), HPV quadrivalent (HPV4) vaccine - months 0, 2 and 6 (first dose = month 0) or
nonavalent (HPV9) vaccine- months 0, 2 and 6 (first dose = month 0). - recommended for men up to and including 26 years of age, may be given to men 27 years of
age and older at ongoing risk of exposure: HPV4 or HPV9 vaccine - months 0, 2 and 6 (first dose = month 0).
Influenza
What are osteoarthritis risk factors, epi trends and preventive measures?
OA risk factors: age, female
Epi trends: prevalence in 20+ = 13.6% (2016-2017)
Preventive measures: physical activity, avoir overuse, manage weight
What are the 6 steps for planning a health promotion program?
(from the PHO Online Health Program Planner tool)
STEP 1: MANAGE THE PLANNING PROCESS
Purpose: to develop a plan to manage stakeholder participation, timelines, resources, and determine methods for data-gathering, interpretation, and decision making.
Plan to engage stakeholders, including clients and staff, in a meaningful way. Establish a clear timeline for creating a work plan. Plan how you will allocate financial, material, and human resources. Consider the data required to make decisions at each step and include adequate time for data collection and interpretation. Establish a clear decision‐making process. (e.g., by consensus, by committee)
STEP 2: CONDUCT A SITUATIONAL ASSESSMENT
Purpose: to learn more about the population of interest, trends, and issues that may affect implementation, including the wants, needs, and assets of the community.
This step involves identifying: what is the situation; what is making the situation better and what is making it worse; and what possible actions you can take to address the situation. Use diverse types of data (e.g. community health status indicators, stories/testimonials; evaluation findings; “best practice” guidelines), sources of data (e.g. polling companies; community/partner organizations; researchers; governments; private sector); and data collection methods (e.g. stakeholder interviews or focus groups; surveys; literature reviews; review of past evaluation findings or stakeholder mandates/policies).
STEP 3: IDENTIFY GOALS, POPULATIONS OF INTEREST, OUTCOMES AND OUTCOME OBJECTIVES
Purpose: to use situational assessment results to determine goals, populations of interest, outcomes and outcome objectives.
Ensure program goals, populations of interest and outcome objectives are aligned with strategic directions of your organization or group:
goal: a broad statement providing overall direction for a program over a long period of time.
population(s) of interest : group or groups that require special attention to achieve your goal
outcome objective: brief statement specifying the desired change caused by the program
STEP 4: IDENTIFY STRATEGIES, ACTIVITIES, OUTPUTS, PROCESS OBJECTIVES AND RESOURCES Purpose: to _use the results of the situational assessment to select strategies and activities, feasible with available resources, that will contribute to your goals and outcome objectives._ Brainstorm strategies (e.g. health education, health communication, organizational change, policy development) for achieving objectives using one or more health promotion frameworks such as the Ottawa Charter for Health Promotion or the socioecological model. Prioritize ideas by applying situational assessment results. Identify specific activities for each strategy, including which existing activities to start, stop, and continue. Select outputs and develop process objectives. Consider available financial, human and in‐kind resources.
STEP 5: DEVELOP INDICATORS
Purpose: to develop a list of variables that can be tracked to assess the extent to which outcome and process objectives have been met.
For each outcome and process objective consider the intended result and whether: the intended result can be divided into separate components; the intended result can be measured; there is appropriate time for observing a result; required data sources are accessible; and the resources needed to assess the result are available. Define indicators to measure each outcome and process objective and perform a quality check on proposed indicators ensuring they are valid, reliable, and accessible. Indicators are used to determine the extent to which outcomes and process objectives were met.
STEP 6: REVIEW THE PROGRAM PLAN
Purpose: to clarify the contribution of each component of the plan to its objectives, identify gaps, ensure adequate resources, and ensure consistency with the situational assessment findings.
A logic model is a graphic depiction of the relationship between all parts of a program (i.e., goals, objectives, populations, strategies, and activities) and is one way in which a program overview can be communicated. Review the plan to determine whether: strategies effectively contribute to goals and objectives; short-term objectives contribute to long-term objectives; the best activities were chosen to advance the strategy; activities are appropriate to the audiences; and the resources are adequate to implement the activities.
What are evidence-based interventions to improve school nutrition?
1) nutrition standards for competitive foods and beverages (i.e., items sold or served outside the school meal programs);
2) marketing and promotion of foods and beverages at school;
3) access to free drinking water;
4) nutrition education for students;
5) Farm to School programs and school gardens;
6) nutrition-related training for school personnel; and
7) strategies to increase participation in school meals.
What are the steps of the All Hazards Risk Assessment in emergency management planning from Public Safety Canada?
What are the goals of emergency management?
Steps of the All Hazards Risk Assessment in emergency management planning from Public Safety Canada
- Setting the Context – The process of articulating an institution’s objectives and defining its external and internal parameters to be taken into consideration when managing risks.
- Risk Identification (Hazard Identification HI) – The process of finding, recognizing, and recording risks.
- Risk Analysis – The process of understanding the nature and level of risk, in terms of its impacts and likelihood. (Risk asessment RA - probability x severity)
- Risk Evaluation – The process of comparing the results of Risk Analysis with risk criteria to determine whether a risk and/or its magnitude is acceptable or tolerable.
- Risk Treatment – The process of identifying and recommending risk control or Risk Treatment options.
+Monitoring and review
Goals of emergency management:
Save lives, reduce suffering, ensure safety if responders
Protect health, infrastructure, economy, environment, property
What are 3 CTFPHC recommendations for Abdominal Aortic Aneurysm in primary care?
Recommendation 1: We recommend one-time screening with ultrasound for abdominal aortic aneurysm for men aged 65 to 80. (Weak recommendation; moderate quality of evidence)
Recommendation 2: We recommend NOT screening men older than 80 years of age for abdominal aortic aneurysm. (Weak recommendation; low quality of evidence)
Recommendation 3: We recommend NOT screening women for abdominal aortic aneurysm. (Strong recommendation; very low quality of evidence)
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
Regardin blue-green algae, what is it, who is most at risk, what are the symptoms, what key risk communication messages, how can it be prevented?
Who is at risk and how does exposure occur to cyanobacteries?
What are cyanobacteria? Cyanobacteria, or ‘blue-green algae,’ are naturally occurring microscopic organisms found in fresh, brackish, or marine water. Under conditions such as warmer water temperatures, high nutrient loads, and other anthropogenic influences, cyanobacteria can multiply quickly and create blooms, sometimes called harmful algae blooms (HABs), cyanoHABs, or cyanoblooms. Cyanoblooms can occur in Canada at any time of year, but are more common in summer or early fall.1
Cyanobacteria can produce cyanotoxins, high concentrations of which are harmful to animal and human health, in both drinking and recreational water e.g., during a cyanobloom. In rare cases, cyanotoxin exposure has been fatal to humans.2 Not all cyanobacteria species produce toxins, but every bloom should be treated as toxic until known otherwise. There are four main types of cyanotoxin – MICROCYSTIN (Canadian water MAC is for microcystin 0.0015mg/L), nodularin, saxitoxin, and cylindrospermopsin.
Humans, pets, and farm animals e.g., cattle, can be affected by cyanotoxins. C_hildren tend to become sick more easily and frequently than adults_ because of their lower body weight, and the potential developmental effects of cyanotoxins.5 Infants fed formula reconstituted from contaminated drinking water are also at greater risk.6
Cyanotoxin exposure can occur by drinking contaminated water; inhalation and skin contact during swimming, bathing, or showering; consumption of produce irrigated with tainted water;2 and ingesting fish or other foods collected from affected freshwater bodies.
Acute (short-term) exposure can cause:
GI: vomiting, diarrhoea,
Derm: skin irritation, rash,
Systemic: fever, headache, muscle/joint pain,
Neuro: weakness, pale skin, cold hands/feet, numbness of lips/mouth, incoordination, respiratory, and muscular paralysis.
Chronic (long-term) exposure can lead to tumor formation, with microcystin-LR possibly a human carcinogen (Group 2B).7
Climate change is expected to affect bloom timing and cyanobacterial dominance.8
Any indication of a bloom/microcystin presence warrants an advisory for alternative suitable drinking water to reconstitute formula for bottle-fed infants. Toxins are not removed by boiling water, thus advisories such as “do not consume” or ”do not use” are warranted for communities lacking necessary treatment capabilities (e.g., coagulation, flocculation) and alternate drinking and bathing water sought.6 Beaches are often closed during blooms. The public are encouraged to avoid entering water where blooms are present, and should rinse thoroughly afterwards using uncontaminated water
CANADIAN GUIDELINES FOR TOTAL MICROCYSTINS
DRINKING WATER 1.5 µg/L
RECREATIONAL WATER 20 µg/L
Prevention
Take these simple steps to prevent the growth of blue-green algae:
use _phosphate-free detergent_s, personal care and household cleaning products
avoid using fertilizers on lawns, especially fertilizers that contain phosphorus
maintain a natural shoreline on lake and riverfront properties
reduce agricultural runoff by planting or maintaining vegetation along waterways and minimizing fertilizer use
check septic systems to ensure they do not leak into the water source
What is Pearson’s correlation coefficient
r = correlation coefficient r<sup>2</sup> = coefficient of determination (amount of variance in y explained by x)
Measures the association between two continuous variables
What is decentralization?
Decentralization—the transfer of authority and responsibility for public functions from the central government to subordinate or quasi-independent government organizations and/or the private sector.
The three major forms of administrative decentralization – deconcentration, delegation, and devolution – each have different characteristics.
In summary:
- DeConcentration - from central gov’t to lower levels within gov’t (e.g. the ministry)
- DeLegation - from central gov’t to arms-length/public-private orgs (e.g. Ontario Health)
- DeVolution - from central gov’t to regional gov’t (e.g. municipalities)
- Divestment - privatization
Deconcentration. Deconcentration–which is often considered to be the weakest form of decentralization and is used most frequently in unitary states– redistributes decision making authority and financial and management responsibilities among different levels of the central government. It can merely shift responsibilities from central government officials in the capital city to those working in regions, provinces or districts, or it can create strong field administration or local administrative capacity under the supervision of central government ministries.
Delegation. Delegation is a more extensive form of decentralization. Through delegation central governments transfer responsibility for decision-making and administration of public functions to semi-autonomous organizations not wholly controlled by the central government, but ultimately accountable to it. Governments delegate responsibilities when they create public enterprises or corporations, housing authorities, transportation authorities, special service districts, semi-autonomous school districts, regional development corporations, or special project implementation units. Usually these organizations have a great deal of discretion in decision-making. They may be exempt from constraints on regular civil service personnel and may be able to charge users directly for services.
Devolution. A third type of administrative decentralization is devolution. When governments devolve functions, they transfer authority for decision-making, finance, and management to quasi-autonomous units of local government with corporate status. Devolution usually transfers responsibilities for services to municipalities that elect their own mayors and councils, raise their own revenues, and have independent authority to make investment decisions. In a devolved system, local governments have clear and legally recognized geographical boundaries over which they exercise authority and within which they perform public functions. It is this type of administrative decentralization that underlies most political decentralization.
List greehouse gases
CO2
Methane
N2O - nitrous oxide
Fluorinated Compounds
(Water vapour)
List possible housing issues?
Overcrowding
Excessive humidity/mold
Inadequate insulation
Vermin
Inadequate plumbing/water
Inadequate maintenance
No fire alarms
What are the components of a comprehensive school health program?
school environment (social/physical);
health education;
health services;
physical education;
counseling, guidance and mental health;
school food and nutrition services;
worksite health promotion;
and integration of school and community health activities
Pan-Canadian Joint Consortium on Comprehensive School Health:
- Learning and teaching
- Physical and social environment
- Partnerships
- Policies
Describe how to calculate:
- Age or Cause-specific death rate
- Proportionate mortality rate
- Standardized mortality ratio
- Case fatality ratio
Age/cause-specific death rate = total number of deaths during period by age/cause / mid-year population *1000 or 100,000
Proportionate mortality rate = number of deaths due to specific disease during period / total number of deaths from all causes during period *100
Standardized mortality ratio = number of observed deaths / number of expected deaths *100
Case fatality ratio = number of deaths due to specific disease during period / number of persons receiving diagnosis of disease during period *100
What are 10 suggested ways to use
cannabis more safely, based on the best available scientific evidence?
In summary:
- Delay to later in life
- Lower strength products, CBD > THC
- No synthetics
- Don’t smoke it
- Don’t inhale deeply
- Occasional use only
- Don’t drive/operate machinery
- Don’t mix with alcohol
- Don’t use if risk factors for psychosis (PHx, FHx), substance use problem or pregnant
- Don’t combine risky behaviors
Remember that every form of cannabis
use poses risks to your health. The only
way to completely avoid these risks
is by choosing not to use cannabis. If
you decide to use cannabis, follow these
recommendations to lower risks to your
health.
The earlier in life you begin using
cannabis, the higher your risk of
serious health problems. Teenagers,
particularly those younger than 16,
should delay using cannabis for as long
as possible. You’ll lower your risk of
cannabis-related health problems if
you choose to start using cannabis
later in life.
Higher-strength or more powerful
cannabis products are worse for your
health. If you use products with high
tetrahydrocannabinol (THC) content, the
main mind-altering ingredient in cannabis,
you’re more likely to develop severe
problems, such as dependence or mental
health problems. Cannabidiol (CBD),
another cannabis ingredient, can counteract
some of THC’s psychoactive effects.
If you use, choose low-strength
products, such as those with a lower
THC content or a higher ratio of CBD
to THC.
Don’t use synthetic cannabis products.
Compared with natural cannabis products,
most synthetic cannabis products
are stronger and more dangerous. K2
and Spice are examples of synthetic
cannabis products. Using these can lead
to severe health problems, such as seizures,
irregular heartbeat, hallucinations
and in rare cases, death.
Smoking cannabis (for example,
smoking a joint) is the most harmful
way of using cannabis because it
directly affects your lungs. T_here are
safer, non-smoking options like vaping
or taking edibles that are better for
your lungs._Keep in mind that these alternatives
aren’t risk-free either.
If you choose to smoke cannabis,
avoid inhaling deeply or holding your
breath. These practices increase the
amount of toxins absorbed by your
lungs and the rest of your body, and can
lead to lung problems.
The more frequently you use cannabis,
the more likely you are to develop
health problems, especially if you use on
a daily or near-daily basis. Limiting your
cannabis use to occasional use at most,
such as only using once a week or on
weekends, is a good way to reduce your
health risks. Try to limit your use as
much as possible.
Cannabis use impairs your ability to
drive a car or operate other machinery.
Don’t engage in these activities
after using cannabis, or while you still
feel affected by cannabis in any way.
These effects typically last at least six
hours, but could be longer, depending
on the person and the product used.
Using cannabis and alcohol together
further increases your impairment.
Avoid this combination before driving
or operating machinery.
Some people are more likely to
develop problems from cannabis use.
Specifically, people with a personal
or family history of psychosis or
substance use problems, and
pregnant women should not use
cannabis at all.
Avoid combining any of the risky
behaviours described above. The
more risks you take, the greater the
chances of harming your health as a
result of cannabis use.
What are 8 diseases that are screened for during pregnancy?
Syphilis
HIV
Rubella immunity
Gonorrhea
Chlamydia
Hepatitis B
GBS
Asymptomatic bacteriuria
What are the 4 core pillars of the Pan-Canadian STBBI framework for action?
The Pan-Canadian STBBI Framework for Action is composed of four interconnected pillars that span the continuum of STBBI care:
- prevention,
- testing,
- initiation of care and treatment, and
- ongoing care and support.
Strengthening Prevention: Opportunities for Action
1. Improve a_ccess to effective prevention interventions, including safer-sex materials, harm
reduction, testing, treatment, and targeted vaccination programs_.
2. Research, implement, and evaluate innovative biomedical prevention interventions
(e.g., new vaccines and PrEP) and continue to expand the reach of existing vaccines
(e.g., HBV and HPV).
3. Develop and disseminate holistic,
scientifically accurate, culturally- and
age-appropriate, and gender-responsive
sexual health information, resources, and
curricula in school and community settings.
4. Implement sustained interventions to facilitate empowerment and behaviour change
among individuals who engage in risky behaviours.
5. Equip health professionals and front-line providers with knowledge, skills, and resources
to provide equitable access to prevention interventions—including the use of treatment
to prevent STBBI transmission—vaccination, testing, treatment, and contact investigation
programs.
Enhancing Testing: Opportunities for Action
1. Provide health professionals and front-line
service providers with knowledge, skills and
resources to implement person-centred,
culturally-relevant, and integrated testing
that respects patient privacy and rights.
2. Ensure appropriate linkages to prevention,
treatment, and care resources are provided to individuals who have been diagnosed with, or
at risk of, a STBBI.
3. Research, implement, and evaluate innovative and emerging testing technologies, testing
approaches, and sustainable quality assurance systems.
4. Improve availability of, and access to, evidence-based testing technologies and approaches
in a variety of settings.
5. Normalize the offer of STBBI testing among healthcare providers while individual rights to
confidentiality, pre- and post- test counselling, and informed consent are respected.
Ensuring Access to Care and Treatment: Opportunities for Action
1. Develop holistic, culturally-appropriate, and gender-affirming information and education
resources for people to facilitate early treatment.
2. Identify and eliminate barriers that impede timely and affordable access to STBBI treatment,
care and support.
3. Address the health of the whole person by adopting holistic and coordinated approaches,
developing multi-disciplinary outreach programs and strengthening electronic patient
care systems.
4. Provide health professionals and other front-line workers knowledge, skills, and resources
to reach and engage people with appropriate and timely treatment.
5. Expand the application of health-systems tools, including communications technologies and
electronic health records management systems, to improve the quality of treatment care for
people with STBBI.
6. Enhance laboratory surveillance of drug-resistant STBBI to inform effective treatment,
antimicrobial stewardship, and the development of new treatments.
Ensuring Ongoing Care and Support: Opportunities for Action
1. Implement a person-centred approach to care and improve links to health and social
support for people living with chronic STBBI.
2. Empower people living with chronic STBBI to feel engaged in making health decisions
by acknowledging and improving their health literacy and knowledge.
3. Develop and implement interventions that retain and re-engage people with chronic
STBBI with care and support services.
4. Provide health professionals and other front-line providers with knowledge, skills, and
resources to serve the diverse needs of their patients and to improve their ability to offer
culturally-relevant and gender-affirming continuous care and treatment adherence.
5. Develop or expand navigation resources, including electronic health records or peer
navigators to improve the access of people affected by STBBI to treatment, ongoing
care, referrals, support, and to re-engage in care if necessary.
Why heavy metals are associated:
with lung cancer?
with smoking?
LUNG CANCER
Arsenic (smoking)
Cadmium (smoking)
Nickel (smoking)
Lead (possibly)
Chromium
What are chlorine-resistant and chlorine-tolerant organisms?
Chlorine-resistant: (should be removed with filters)
- Toxoplasma
- Cryptosporidium oocysts
Chlorine tolerant:
- Entamoeba histolytica
- Giardia intestinalis
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 preconception individual health interventions?
- Eat a well-balanced diet
- Reduce stress
- Exercise regularly
- Manage chronic medical conditions
- Cease smoking
- Identify and treat women at risk of severe morning sickness
- Avoid alcohol intake
- Maintain a healthy weight
- Cease illicit drug use
- Take multivitamins with folic acid
- Reduce environmental toxin exposure
- Get vaccinated
What are mandatory elements for food labelling in Canada?
Nutrition Facts Table,
list of ingredients,
allergen statements
date marking information, such as best before dates.
What are the 4 components of the sodium reduction strategy in Canada?
What is the adequate intake, upper intake level and current mean daily intake of Sodium for Canadians?
What are the health effects of sodium?
The Sodium Reduction Strategy
for Canada is multi-staged and based
on a three-pronged approach that
includes:
structured voluntary
reduction of sodium levels in
processed food products and foods
sold in food services establishments;
education and awareness of
consumers, industry, health
professionals and other key
stakeholders;
and research.
A
fourth component, monitoring
and evaluation, cuts across all
three other areas.
The Strategy is
comprehensive and integrated; the
recommendations in the four areas
cannot be separated from one another
in that a successful outcome depends
on all being acted upon.
The current mean intake of sodium by Canadians is
about 3,400 mg per day. The Strategy
has an interim sodium intake goal of
a population average of 2300 mg of
sodium per day to be achieved by
2016. The ultimate goal is to lower
sodium intakes to a population mean
whereby as many individuals as
possible (greater than 95%) have
a daily intake below the Tolerable
Upper Intake Level (UL) of
2,300 mg per day. For practical
purposes, achieving this requires
moving the population mean daily
intake of sodium much closer to the
Institute of Medicine of the U.S.
National Academies’ (IOM) recommended
Adequate Intake which is
1,500 mg per day for persons aged
9 to 50 years, and less for those
younger and older than that.
Health Concerns and
International Response
There is a significant body of evidence
linking high sodium intake to
elevated
blood pressure, which is
the leading preventable risk factor
for death worldwide. High blood
pressure is the major cause of
cardiovascular disease and a risk factor
for stroke and kidney disease. There is
also evidence to suggest that a diet
high in sodium is a risk factor for
osteoporosis, stomach cancer and
asthma. According to the World
Health Organization, interventions
to reduce population-wide salt intake
have been shown repeatedly to be
highly cost-effective.
In emergencies, what information is needed to decide on whether to evacuate or shelter in place?
Deciding whether to evacuate or to shelter in-place
Assuming that both options are feasible, the decision to evacuate or to shelter in-place must be based on a balance of the risks associated with the two options.
The primary consideration is the risk of both the exposure level and the exposure duration.
A secondary consideration relates to the intrinsic risks of moving large numbers of people.
Evacuation is the better option when:
- The area is not yet exposed, but will be after a certain time e.g. due to an anticipated shift in wind direction (the time to exposure being longer than the time required for the evacuation).
- The likely duration of exposure is such that the protection offered by in-place sheltering may become insufficient.
Evacuation may also be the better option if:
- The chemicals are widely dispersed and contamination is extensive and persistent.
- The chemicals are suspected as being hazardous, but cannot be identified readily.
- The chemical is highly hazardous.
- The concentration in the air will be hazardous for a prolonged period.
- There is a risk of explosion.
- Number evacuees is relatively small.
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 metabolic steps in pharmacokinetics?
Absorption
Distribution
Metabolism
Excretion
What are components of a successful multifactorial approach for reducint falls among community-dwelling elders?
Assistive devices and other protective equipment
Clinical disease management, including chronic and acute illness (vision, CV, hypotension).
Education (Canadian Falls Prevention Curriculum)
Environmental modification (occupational therapist)
Exercise programs
Medication review and modification (psychotropics)
Nutrition
Vision referral and correction
What are the 4As of policy/intervention options for harmful substances?
Acceptability
Affordability
Availability
Awareness
What are countermeasures to improve pedestrian safety in Canada?
Pedestrians:
- visibility,
- distraction, impairment,
- special groups like children/elderly/special needs,
- enforcement of pedestrian laws
Drivers:
- vehicle speed,
- driver education and training
Roadway design:
- volume dispersion,
- sidewalks,
- rail-grade crossings for trains,
- work zones,
- speed reduction, calming measures
Vehicles:
- softer/sloping vehicle fronts,
- rear view requirements for backing up,
- brake assist system (BAS),
- intelligent speed assistance,
- adaptive headlights,
- pedestrian detection fronts
What are the pillars of the HEALTHY AND SAFE FOOD FOR CANADIANS FRAMEWORK?
Promotion - Helping consumers make informed choices for healthy and safe food
Prevention - Maintaining strong rules for the food industry
Protection - Identifying and addressing food safety risks
How is research critically appraised:
- in quantitative methods?
- in qualitative methods?
Categories of quality in _qualitative r_esearch: (mnemonic CCDT)
Credibility (can be improved with saturation, triangulation, review with participants)
Dependability
Confirmability
Transferability
Categories of quality in quantitative research: (mnemonic VOR)
Internal validity
External validity
Objectivity
Reliability
What are elements of comprehensive mental health services for elderly?
MH includes: mood, anxiety, psychosis, suicide / substances / dementia.
Mental Health Promotion
•Anti-stigma strategies
•Public awareness
•Education and training
•Community-based strategies
Prevention and early Intervention
•Early identification and treatment
•Prevention strategies
•Hope for recovery
Integrated Service System
•Single access point
•Continuum of care
•Caregivers as active partners
•A range of mental health services including specialized
Planning and Foundational Principles/Values
- Use the Seniors’ Mental Health Policy Lens as a tool to assess policies, programs, and services.
- Understand the diversity among older adults, local context, and available resources.
- Integrate well-being and recovery-oriented approaches to care and services.
Implementation Facilitators
- The use of benchmarks to review existing services, staffing, and resource deployment
- Cultural safety as an integral part of implementation
- Partnership and collaboration to generate integration
- The use of technology to facilitate ease of access
- Training, education, and support for health-care providers
What are components of an operational budget?
Salary and wages
Materials and supplies
Services and rents
Reserve contributions
Internal charges and overhead
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
What are actions taken before, during and after meetings?
Before Meeting (preparation)
- Define purpose of meeting and who is attending
- Create agenda and assign meeting roles
- Logistics (time, place, background)
During Meeting (facilitation)
- Ensure discussion is clear, concise and respectful
- Ensure start and end time are respected and meeting agenda met
- may review past minutes
Post Meeting (Summary/ Delegation & evaluation and reporting)
- Summarize and communicate decisions made, action items, and deadlines
- Evaluate meeting
- Potentially report on meeting results to other organizations or levels within own organization
What are different types of data sources
mnemonic VRACS
Vital statistics
Registries
Administrative databases
Census
Surveys
What are options/strategies for risk management?
What are underlying principles to risk management?
From Health Canada Decision-Making Framework for
Identifying, Assessing, and Managing Health Risks
August 1, 2000
Strategies:
Regulation
National guidelines
Education/advice
Voluntary compliance
Economic (incentives, disincentives)
Technological
Taking no action when non is required
Underlying Principles! Maintaining and Improving Health is the Primary Objective
! Involve Interested and Affected Parties
! Communicate in an Effective Way
! Use a Broad Perspective
! Use a Collaborative and Integrated Approach
! Make Effective Use of Sound Science Advice
! Use a “Precautionary” Approach
! Tailor the Process to the Issue and its Context
! Clearly Define Roles, Responsibilities, and Accountabilities
! Strive to Make the Process Transparent
What are 5 opportunities for IPC lapses with regards to instrument sterility?
- Reuse of a single use instrument or piece of equipment
- Improper re-processing of multi-use instrument - did not mechanically clean instrument lumen before high-level disinfection
- Improper storage of correctly processed medical equipment
- Inadequate documentation of processing procedures (i.e. may have correctly following reprocessing but did not record key procedures such as autoclave temperature and pressure or use of biological indicator).
- Mechanical Failure of sterilizer
What are 3 individual actions that can improve air quality?
Three key actions to improve air quality
1. Carpool, ride your bike, take the bus or walk more often
Motor vehicles are a major contributor to smog, especially in large urban areas where traffic is heavy.
Traffic can contribute to smog year-round, even in the winter.
2. In the winter, ask yourself “Do I really need to use my woodstove or fireplace today?”
Burning wood for home heating is a leading cause of smog in the wintertime.
3. Save energy
In Canada, much of the home heating is produced by fossil fuels (coal, gas and oil). Using less energy for home heating and reducing your use of electricity will help clean the air.
Support renewable energy where you can.
What are organization factors that impact the health of employees?
The 13 organizational factors that impact organizational health, the health of individual employees and the financial bottom line, including the way work is carried out and the context in which work occurs, are:
Psychological Support
Organizational Culture
Clear Leadership & Expectations
Civility & Respect
Psychological Competencies & Requirements
Growth & Development
Recognition & Reward
Involvement & Influence
Workload Management
Engagement
Balance
Psychological Protection
Protection of Physical Safety
- Psychological Support
A workplace where co-workers and supervisors are supportive of employees’ psychological and mental health concerns, and respond appropriately as needed. For some organizations, the most important aspect of psychological support may be to protect against traumatic stressors at work.
Why it is important?
Employees that feel they have psychological support have greater job attachment, job commitment, job satisfaction, job involvement, positive work moods, desire to remain with the organization, organizational citizenship behaviours (behaviours of personal choice that benefit the organization), and job performance.
What happens when it is lacking?
Employee perceptions of a lack of psychological support from their organization can lead to:
increased absenteeism
withdrawal behaviours
conflict
strain - which can lead to fatigue, headaches, burnout and anxiety
turnover
loss of productivity
increased costs
greater risk of accidents, incidents and injuries
- Organizational Culture
A workplace characterized by trust, honesty and fairness. Organizational culture, in general, are basic assumptions held by a particular group. These assumptions are a mix of values, beliefs, meanings and expectations that group members hold in common and that they use as cues to what is considered acceptable behaviour and how to solve problems.
Why it is important?
Organizational trust is essential for any positive and productive social processes within any workplace. Trust is a predictor of cooperative behaviour, organizational citizenship behaviours (behaviours of personal choice that benefit the organization), organizational commitment, and employee loyalty. An organization that has a health-focused culture enhances employee well-being, job satisfaction and organizational commitment, which helps to retain and attract employees. A work culture with social support also enhances employee well-being by providing a positive environment for employees who may be experiencing psychological conditions such as depression and anxiety.
What happens when it is lacking?
Culture sets the tone for an organization – a negative culture can undermine the effectiveness of the best programs, policies and services intended to support the workforce. An unhealthy culture creates more stress, which lowers employee well-being. A culture of profit at all costs and constant chaotic urgency can create an environment in which burnout is the norm.
- Clear Leadership & Expectations
A workplace where there is effective leadership and support that helps employees know what they need to do, how their work contributes to the organization and whether there are impending changes.
Why it is important?
Effective leadership increases employee morale, resiliency and trust, and decreases employee frustration and conflict. Good leadership results in employees with higher job well-being, reduced sick leave, and reduced early retirements with disability pensions. A leader who demonstrates a commitment to maintaining his or her own physical and psychological health can influence the health of employees (sickness, presenteeism, absenteeism) as well as the health of the organization as a whole (vigour, vitality, productivity).
What happens when it is lacking?
Leaders who are more instrumental in their approach (focusing on producing outcomes, with little attention paid to the big picture, the psychosocial dynamics within the organization, and the individual employees) are more likely to hear staff health complaints including general feelings of malaise, irritability and nervousness. Similarly, leaders who do not demonstrate visible concern for their own physical and psychological health set a negative example for their staff and can undermine the legitimacy of any organizational program, policy and/or service intended to support employees. Middle managers are at greater risk because they must be leaders and be led simultaneously. This role conflict can lead to feelings of powerlessness and stress.
- Civility and Respect
A workplace where employees are respectful and considerate in their interactions with one another, as well as with customers, clients and the public. Civility and respect are based on showing esteem, care and consideration for others, and acknowledging their dignity.
Why it is important?
A civil and respectful workplace is related to greater job satisfaction, greater perceptions of fairness, a more positive attitude, improved morale, better teamwork, greater interest in personal development, engagement in problem resolution, enhanced supervisor-staff relationships, and reduction in sick leave and turnover. Organizations characterized by civility and respect create a positive atmosphere marked by high spirits and work satisfaction. This civility allows people to enjoy the environment, whether they are staff, clients or customers.
What happens when it is lacking?
A workplace that lacks civility and respect can lead to emotional exhaustion amongst staff, greater conflicts, and job withdrawal. A work environment that is uncivil and disrespectful also exposes organizations to the threat of more grievances and legal risks.
One example of disrespectful behaviour is bullying. Exposure to workplace bullying is associated with psychological complaints, depression, burnout, anxiety, aggression, psychosomatic complaints and musculoskeletal health complaints. Bullying not only affects those directly involved, but also affects bystanders, as they too experience higher levels of stress. A number of provinces currently have legislation to address such behaviours.
- Psychological Competencies & Requirements
A workplace where there is a good fit between employees’ interpersonal and emotional competencies, their job skills and the position they hold. A good fit means that the employees possess the technical skills and knowledge for a particular position as well as the psychological skills and emotional intelligence (self-awareness, impulse control, persistence, self-motivation, empathy and social deftness) to do the job. Note that a subjective job fit (when employees feel they fit their job) can be more important than an objective job fit (when the employee is assessed and matched to the job).
Why it is important?
A good job fit is associated with:
fewer health complaints
lower levels of depression
greater self-esteem
a more positive self-concept
enhanced performance
job satisfaction
employee retention
What happens when it is lacking?
When there is a poor job fit, employees can experience job strain, which can be expressed as emotional distress and provocation, excessive dwelling on thoughts, defensiveness, energy depletion and lower mood levels. Organizationally, job misfit is linked to fewer applicants in the recruitment and training process, lack of enjoyment and engagement, poor productivity, conflict, and greater voluntary turnover.
- Growth & Development
A workplace where employees receive encouragement and support in the development of their interpersonal, emotional and job skills. This type of workplace provides a range of internal and external opportunities for employees to build their repertoire of competencies. It helps employees with their current jobs as well as prepares them for possible future positions.
Why it is important?
Employee development increases goal commitment, organizational commitment and job satisfaction. Employees feel that organizations care when the organization supports growth and development. Skill acquisition and career development directly enhance employee well-being. It is important to ensure that opportunities go beyond learning specific technical skills, and also include opportunities to learn personal and interpersonal skills that are critical to successfully caring for oneself and relating to others.
What happens when it is lacking?
Employees who are not challenged by their work will grow bored, their well-being will suffer, and their performance will drop. When staff do not have opportunities to learn and improve their interpersonal and psychological skills, the result can be conflict, disengagement and distress.
- Recognition and Reward
A workplace where there is appropriate acknowledgement and appreciation of employees’ efforts in a fair and timely manner. This element includes appropriate and regular financial compensation as well as employee or team celebrations, recognition of years served, demonstrating/acting according to organizational values, and/or milestones reached.
Why it is important?
Recognition and reward:
motivates employees
fuels the desire to excel
builds self-esteem
encourages employees to exceed expectations
enhances team success
Employees receiving appropriate recognition and reward have more energy and enthusiasm, a greater sense of pride and participation in their work, and are more likely to treat colleagues and customers with courtesy, respect and understanding.
What happens when it is lacking?
Lack of recognition and reward undermines employee confidence in their work and trust in the organization. Employees may feel demoralized or they may quit. An imbalance between effort and reward is a significant contributor to burnout and emotional distress leading to a range of psychological and physical disorders.
- Involvement and Influence
A workplace where employees are included in discussions about how their work is done and how important decisions are made. Opportunities for involvement can relate to an employee’s specific job, the activities of a team or department, or issues involving the organization as a whole.
Why it is important?
When employees feel they have meaningful input into their work they are more likely to be engaged, to have higher morale, and to take pride in their organization. This feeling, in turn, increases the willingness to make extra effort when required. Job involvement is associated with increased psychological well-being, enhanced innovation, and organizational commitment.
What happens when it is lacking?
If employees do not believe they have a voice in the affairs of the organization, they tend to feel a sense of indifference or helplessness. Job alienation or non-involvement is associated with cynicism and distress, greater turnover, and burnout.
- Workload Management
A workplace where tasks and responsibilities can be accomplished successfully within the time available. A large workload is often described by employees as being the biggest workplace stressor (i.e., having too much to do and not enough time to do it). It is not only the amount of work that makes a difference but also the extent to which employees have the resources (time, equipment, support) to do the work well.
Why it is important?
Most employees willingly work hard and feel a good day’s work is fulfilling and rewarding. Workload management is important because there is a unique relationship between job demands, intellectual demands and job satisfaction. Job demands reduce job satisfaction, while intellectual demands or decision-making latitude, increase job satisfaction. Even when there are high demands, if employees also have high decision-making ability, they will be able to thrive. Having high decision-making latitude also allows for positive coping behaviours to be learned and experienced.
What happens when it is lacking?
Any system subject to excess load without reprieve will break. This is as true for people as it is for equipment. Increased demands, without opportunities for control, result in physical, psychological and emotional fatigue, and increase stress and strain. Emotionally fatigued individuals also have a diminished sense of personal accomplishment and an increased sense of inadequacy. Excessive workload is one of the main reasons employees are negative about their jobs and their employers.
- Engagement
Employees enjoy and feel connected to their work and where they feel motivated to do their job well. Employee engagement can be physical (energy exerted), emotional (positive job outlook and passionate about their work) or cognitive (devote more attention to their work and be absorbed in their job).
Engaged employees feel connected to their work because they can relate to, and are committed to, the overall success and mission of their company. Engagement is similar to, but should not be mistaken for job satisfaction, job involvement, organizational commitment, psychological empowerment, and intrinsic motivation.
Why it is important?
Engagement is important for individual satisfaction and psychological health, and leads to:
increased profitability for company
greater customer satisfaction
enhanced task performance
greater morale
greater motivation
increased organizational citizenship behaviours (behaviours of personal choice that benefit the organization)
What happens when it is lacking?
Organizations that do not promote engagement can see:
negative economic impact in productivity losses
psychological and medical consequences
have greater employee turnover
workplace deviance (in the form of withholding effort)
counterproductive behaviour
withdrawal behaviours
- Balance
Present in a workplace where there is recognition of the need for balance between the demands of work, family and personal life. This factor reflects the fact that everyone has multiple roles employees, parents, partners, etc. These multiple roles can be enriching and allow for fulfillment of individual strengths and responsibilities, but conflicting responsibilities can lead to role conflict or overload. Greater workplace flexibility enables employees to minimize work-life conflict by allowing them to accomplish the tasks necessary in their daily lives.
Work-life balance is a state of well-being that allows a person to effectively manage multiple responsibilities at work, at home and in their community. Work-life balance is different for everyone and it supports physical, emotional, family and community health and does so without grief, stress or negative impact.
Why it is important?
Recognizing the need for work-life balance:
makes employees feel valued and happier both at work and at home
reduces stress and the possibility that home issues will spill over into work, or vice versa
allows staff to maintain their concentration, confidence, responsibility, and sense of control at work
results in enhanced employee well-being, commitment, job satisfaction, organizational citizenship behaviours (behaviours of personal choice that benefit the organization), job performance and reduced stress
What happens when it is lacking?
When work-family role conflict occurs (that is, roles within the workplace and outside it are overwhelming to a person or interfering with one another), health and well-being are undermined by accumulating home and job stress. This imbalance can lead to:
constant tiredness
bad temper
inability to progress
high job stress resulting in dissatisfaction with work and being absent either physically or mentally
These effects can then lead to additional stress-related illness, as well as higher cholesterol, depressive symptoms, and overall decreased health. The impact on the organization can include increased costs due to benefit payouts, absenteeism, disability, and turnover.
Not all employees will have the same work-life balance issues. Age, cultural, gender, family and marital status, care-giver demands, socioeconomic status and many other factors affect an employee’s work-life balance. Organizations will benefit from having flexible arrangements to address this issue.
- Psychological Protection
Workplace psychological safety is demonstrated when employees feel able to put themselves on the line, ask questions, seek feedback, report mistakes and problems, or propose a new idea without fearing negative consequences to themselves, their job or their career. A psychologically safe and healthy workplace actively promotes emotional well-being among employees while taking all reasonable steps to minimize threats to employee mental health.
Why it is important?
When employees are psychologically protected they demonstrate greater job satisfaction, enhanced team learning behaviour and improved performance. Employees are more likely to speak up and become involved. They show increased morale and engagement and are less likely to experience stress-related illness. Psychologically protected workplaces also experience fewer grievances, conflicts and liability risks.
What happens when it is lacking?
When employees are not psychologically safe, they experience demoralization, a sense of threat, disengagement, and strain. They perceive workplace conditions as ambiguous and unpredictable. This demoralization can, in turn, undermine shareholder, consumer, and public confidence in the organization.
- Protection of Physical Safety
This factor includes the work environment itself. Steps can be taken by management to protect the physical safety of employees. Examples include policies, training, appropriate response to incidents or situations identified as risks, and a demonstrated concern for employees’ physical safety.
Why is it important?
Employees who work in an environment that is perceived as physically safe will feel more secure and engaged. Higher levels in the confidence of the safety protection at work results in lower rates of psychological distress and mental health issues. Safety is enhanced through minimizing hazards, training, response to incidents, and the opportunity to have meaningful input into the workplace policies and practices. The concept of ‘safety climate’ is linked to this factor as they both relate to the larger culture or climate of the organization.
What happens when it is lacking?
Failure to protect physical safety results in workplaces that are likely to be more dangerous. Not only could employees be injured or develop illnesses, those who do not see their workplace as physically safe will feel less secure and less engaged.
What are other issues in the workplace that may affect mental health?
Along with the 13 PSRs listed above, there several other key issues in the workplace that affect employee mental health. Within each issue are various factors that organizations need to consider in their efforts to create a mentally healthy workplace. The following is adapted from “Workplace Mental Health Promotion, A How-To Guide” from The Health Communication Unit at the Dalla Lana School of Public Health at the University of Toronto, and the Canadian Mental Health Association, Ontario.
Stigma and Discrimination – Stigma is a personal attitude and belief that negatively labels a group of people, such as those with mental illness. Stigma creates fear and consequently results in discrimination which discourages individuals and their families from getting the help they need.
Stress – Stress refers to potentially negative physical or mental tensions experienced by a person. A stressor is any event or situation that an individual perceives as a threat; precipitates either adaptation or the stress response. Stress can come from both good and bad experiences, so the effects of stress can be positive or negative. Stress is not all bad – without stress, there would be no productivity or engagement. Stress becomes a problem when individuals are not able to handle an event or situation and become overwhelmed.
Demand/control and effort/reward relationships – Major causes of job stress come from problems with conflicts in demand vs. control as well as effort vs. reward. When the demand and control an employee has at work changes, stress results if either factor is not increased or decreased proportionately. The same is true for the relationship between effort and reward. Changes to the organization can make for a more mentally healthy workplace, especially when employees feel appropriately rewarded for their effort and in control of their work.
Presenteeism – Presenteeism is the action of employees coming to work despite having a sickness that justifies an absence, therefore they are performing their work under sub-optimal conditions. When employees come to work not mentally present due to an illness, extreme family/life pressures or stress, they are not giving themselves adequate time to get better. Presenteeism can occur because employees feel
they cannot afford to take the day off
there is no back-up plan for tasks the individual is responsible for
when they return to work, there would be even more to do
committed to personally attending meetings or events
concerned about job insecurity related to downsizing or restructuring
Job Burnout – Job burnout is a state of physical, emotional and mental exhaustion caused by long-term exposure to demanding work situations. Burnout is the cumulative result of stress. Anyone can experience job burnout. However, professions with high job demands and few supports can increase the prevalence of burnout and reduce engagement. Helping professions, such as jobs in health care, teaching or counseling, often have high rates of burnout.
Burnout has three main characteristics:
exhaustion (i.e., the depletion or draining of mental resources)
cynicism (i.e., indifference or a distant attitude towards one’s job)
lack of professional efficacy (i.e., the tendency to evaluate one’s work performance negatively, resulting in feelings of insufficiency and poor job-related self-esteem)
Harassment, Violence, Bullying and Mobbing – Most people think of violence as a physical assault. However, workplace violence is a much broader problem. It is any act in which a person is abused, threatened, intimidated or assaulted in his or her employment. Workplace violence includes:
threatening behaviour – such as shaking fists, destroying property or throwing objects
verbal or written threats – any expression of an intent to inflict harm
harassment – any behaviour that demeans, embarrasses, humiliates, annoys, alarms or verbally abuses a person and that is known or would be expected to be unwelcome. This act includes words, gestures, intimidation, bullying, or other inappropriate activities.
verbal abuse – swearing, insults or condescending language
physical attacks – hitting, shoving, pushing or kicking
bullying – repeated, unreasonable or inappropriate behaviour directed towards an employee (or group of employees) that creates a risk to health and safety
mobbing – ongoing, systematic bullying of an individual by his or her co-workers – this includes rudeness and physical intimidation, as well as more subtle and possibly unintentional behaviour involving social ostracism and exclusion
Most jurisdictional occupational health and safety acts have been expanded to include harm to psychological well-being. Organizations should not tolerate any violent behaviour including aggression, harassment or threats of violence. Violent or aggressive behaviour hurts the mental health of everyone in the organization and creates a psychologically unsafe work environment filled with fear and anxiety.
For more information on workplace violence, see the OSH Answers Violence and Harassment in the Workplace.
Substance Use, Misuse and Abuse at Work – Substance use, misuse, abuse and coping strategies can have a significant impact on mental health at work. Addictions and mental health conditions are often coupled (called a concurrent disorder). However, it is often the addiction that first gets noticed, especially in the workplace. Generally, substance use becomes a problem when an individual has lost control over their use and/or continues to use despite experiencing negative consequences. Employers should look for warning signs that indicate an employee may be struggling with substance abuse. Some signs of substance abuse are similar to those caused by increased stress, lack of sleep and physical or mental illness. Don’t assume that an employee has a substance abuse problem; however, ignoring warning signs will only make the problem worse if someone is indeed struggling
Canada.ca
Compare and contrast direct vs indirect standardization
Direct Standardization: Apply observed rate to standard population, calculate rate ratio, compare.
Indirect Standardization: Apply standard rate to observed population, calculate rate ratio (SMR), compare.
The requirements for calculating SMR for a cohort are:
The number of persons in each age group in the population being studied
The age specific death rates of the general population in the same age groups of the study population
The observed deaths in the study population
What is WHO strategic communication framework?
or what are principles for effective communications?
Accessible
Actionable
Credible and trusted
Relevant
Timely
Understandable
How does stigma lead to poor health outcomes?
What factors increase the chance of developing active TB among indigenous populations?
Factors that increase the chance of developing active TB
close contact with people living with untreated active TB
overcrowded, poorly ventilated homes
food insecurity
having other illnesses, such as diabetes or HIV
smoking
What are the criteria for being designated a baby-friendly health facility?
A hospital providing maternity services or a community health facility is designated as
BABY-FRIENDLY if it meets the criteria for achieving the Ten Steps AND adheres to the International Code of Marketing of Breast-milk Substitutes.
1 WRITTEN BREASTFEEDING POLICY
2 KNOWLEDGE AND SKILLS TO IMPLEMENT BREASTFEEDING POLICIES
3 INFORMING PREGNANT WOMEN AND THEIR FAMILIES
ABOUT BREASTFEEDING
4 SKIN-TO-SKIN CONTACT IMMEDIATELY FOLLOWING BIRTH
5 ASSISTING MOTHERS WITH BREASTFEEDING CHALLENGES
6 SUPPLEMENTING ONLY WHEN MEDICALLY INDICATED
7 MOTHER AND INFANT ROOMING-IN
8 CUE-BASED FEEDING
9 SUPPORT NO ARTIFICIAL TEATS AND SOOTHERS
10 SUPPORT TRANSITION TO BREASTFEEDING SUPPORT IN THE COMMUNITY
What are air pollutants associated with TRAP?
What are risk factors?
What are the health impacts?
What can be done?
Pollutants: NO, NO2, PM2.5, ultra-fine PM
Risk factors:
- Living less than 100m from a major road or less than 500m from a highway,
- people with longer commutes,
- pedestrians/cyclist commuters.
Health impacts:
- all-cause and CV mortality, CV disease,
- asthma in adults, resp sx in adults,
- decreased lung function in all ages,
- lung cancer.
Solutions:
- Raise awareness,
- include buffer zones in planning land use especially for schools, daycares, LTCF, homes.
- Build walking/cycling away from roads.
- Avoid spending time near major raods, especially during rush hours or when exercising.
What are common approaches to public engagement and benefits and challenges?
In-person discussion sessions: offers opportunity for dialogue, costly, time consuming, subject to availability of participants
Online interactive platform; flexible, engages remote or rural, requires online design and moderation
Online questionnaire: flexible, engages remote or rural, participants do not hear perspective of others, needs feedback analysis
Request for feedback: cost-effective,,controlled manner, detailed feedback, participants do not hear perspective of others, needs feedback analysis
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 is food insecurity and what is its burden in Canada?
What are health consequences of food insecurity in children and adults?
What are policy solutions for food insecurity?
Food insecurity: Inability to access sufficient nutritious food (i.e., sufficient quantity and quality)
Drawing on data for 103,500 households from Statistics Canada’s Canadian Community Health Survey conducted in 2017 and 2018, we found that 12.7% of households experienced some level
of food insecurity in the previous 12 months. There were 4.4 million people, including more than 1.2 million children under the age of 18, living in food-insecure households in 2017-18. This is higher than any prior national estimate. Disparities were for households with children (especially lone parent), in Nunavut, Black and Indigenous people.
Among children, exposure to severe food insecurity (measured as child hunger) has been linked to poorer health status
and the subsequent development of a variety of
chronic health conditions, including asthma and depression.
- *Among adults**, associations with chronic diseases, including mood and anxiety disorders, arthritis, asthma, back problems, and
diabetes. And mortality.
Policy strategies to reduce food insecurity (linked to poverty):
A basic income (sometimes called a guaranteed annual income) would establish a minimum level of income for all Canadians by topping up the income of anyone who falls below a designated poverty line. The impact of such a basic income would be most significant for people living in extreme levels of food insecurity.
Basic income is proven to be an effective solution to food insecurity. For example, _Canadian seniors who receive a basic income through Old Age Security and the Guaranteed Income Supplement cut their risk of food insecurity in hal_f.
TO ELIMINATE FOOD INSECURITY, WE NEED TO TACKLE POVERTY
The Eat Think Vote campaign calls on the federal government to study the feasibility of establishing a basic income floor to ensure all Canadians can afford sufficient, safe, healthy and culturally appropriate food.
Removing the financial obstacles to food security can be accomplished through a number of strategies:
Undertaking a feasibility study on the implementation of a basic income to be administered through the tax system and set above the Low Income Measure.
Increasing the National Child Benefit to a level that adequately addresses child poverty and indexing it to the cost of living.
Developing a national housing strategy, including increased federal investment in affordable housing.
Instituting a national Pharmacare program to provide affordable access to pharmaceutical drugs and reduce overall Canadian drug spending.
Developing a publicly funded childcare system that ensures affordable access to child care for low-income parents.
Increasing the Working Income Tax Benefit.
Students also face food insecurity. Read the document developed by Food Secure Canada’s Youth Caucus about Student Hunger and Food Insecurity.
What data sources allow to monitor head injury in Canada?
What are elements of the concussion recognition tool 5?
- Deaths—from the Canadian Vital Statistics Death Database (CVS:D) of Statistics Canada,
- Hospitalizations—from the Hospital Morbidity Database (HMDB) and the Discharge Abstract Database (DAD) of the Canadian Institute for Health Information (CIHI),
- _Emergency department visit_s—from the National Ambulatory Care Reporting System (NACRS) (CIHI) and,
- _Emergency department visit_s—from the Public Health Agency of Canada’s electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP).
Concussion recognition tool:
- Step 1 - red flags, call an ambulance (double vision, LOC, seizure, vomiting, severe HA, weakness, neck pain, change in conciousness or behavior)
- Step 2 - Observable signs - check for visual clues (slow to get up, disorientation, balance difficulty, facial injury)
- Step 3 - Symptoms
- Step 4 - memory assessment
Any child or adult with a suspected concussion should be immediately removed from practice or play and should not return to activity until assessed medicallly, even if the symptoms resolve
What factors affect risk perception?
hazards perceived as risky are:
Coerced vs self-imposed
Industrial vs natural
Exotic
Memorable
Dreaded
Catastrophic
Unknowable, invisible threats
Uncontrollable vs perceived controlled
Unfair
Morally relevant
Untrustworthy sources
Unresponsive process
Affects children
Rapid vs slow-progression
Personnaly aware/affected vs unaware
Novel vs familiar
No rewards/benefits/fun associated with risk
Specific victims vs strangers
After reviewing the research, risk expert David Ropeik identified 14 specific factors that affect perception of danger:
Trust. When people trust the officials providing information about a particular risk — or the process used to assess risk — they tend to be less afraid than when they don’t trust the officials or the process.
Origin. People are less concerned about risks they incur themselves than the ones that others impose on them. This helps explain why people often get angry when they see someone talking on the cell phone while driving — and yet think nothing of doing so themselves.
Control. Perceived control over outcomes also matters. This helps explain why someone is not afraid of driving a car — even though automobile crashes kill thousands of people each year — but may be afraid of flying in an airplane.
Nature. Dangers in nature — such as sun exposure — are perceived as relatively benign, whereas man-made harms — nuclear power accidents or terror attacks — are more menacing.
Scope. Cataclysmic events, capable of killing many people at the same time, are scarier than chronic conditions — which may kill just as many people but over a longer period. That helps explain why a tsunami or earthquake feels scarier than heart disease or diabetes.
Awareness. Saturation media coverage of high-profile disasters raises awareness of particular risks more than others. Likewise, an event that hits close to home, such as having a friend diagnosed with cancer, heightens risk perception.
Imagination. When threats are invisible or hard to understand, people become confused about the nature of the risk, and the event becomes scarier.
Dread. Events that invoke dread — such as drowning or being eaten alive — scare people more than those that do not.
Age affected. Risks are more frightening when they affect children. Asbestos in a school building, for example, may bother people more than asbestos in a factory.
Uncertainty. Events inspire more fear when officials don’t communicate what is known — or when the risks are simply unknown. In the Deepwater Horizon spill, for example, officials could more easily estimate the amount of oil spewing into the ocean than they could predict what effect that would have on wildlife and fisheries.
Familiarity. Novel risks are perceived to be more dangerous than more familiar threats. That’s why West Nile virus may be perceived as more of a risk to health than not testing a smoke detector regularly.
Specificity. Victims who are publicly identified evoke a greater emotional reaction than those who remain nameless and faceless.
Personal impact. Risks that affect people personally are more frightening than those that affect strangers.
Fun factor. Engaging in risky behavior may not seem that way if it involves pleasure. Some examples are drug taking, unsafe sex, and high-risk sports
How are lead levels converted from Canadian to US metrics?
+/- According to the Canadian Paediatric Society in 2019, how is lead toxicity managed based on BLL?
* To convert mcmoL/L to mcg/dL, multiply by 20.72. For example: 0.483 mcmoL/L= 10 mcg/dL
- *5 to 14mcg/dL**
1. Review lab results with the child’s family.
2. Perform routine health maintenance, including neurodevelopmental screening, and assess nutrition.
3. Take a careful PEHH to identify potential sources of exposure. Provide preliminary advice about reducing or eliminating exposure source(s).
4. Contact local public health authority for guidance.
5. Re-test venous BLL at 1 to 3 months to ensure the child’s lead level is not rising. If it is stable or decreasing, retest in 3 months.
6. Provide nutritional counselling related to calcium and iron. Recommend having a fresh fruit with every meal because iron absorption quadruples when taken with vitamin C-containing foods. Encourage the consumption of iron-enriched foods (e.g., cereals, meats). Ensure iron sufficiency with adequate laboratory testing (CBC, ferritin, CRP) andtreatment. Consider starting a multivitamin with iron.
7. Complete a full neurodevelopmental assessment and follow-up. Lead’s effects on development may manifest over years. - *15 to 44mcg/dL**
1. Perform steps as described above for BLLs 5 to 14 mcg/dL.
2. Confirm the BLL with repeat venous sample at 1 to 4 weeks.
3. Additional, specific evaluation of the child, such as abdominal x-ray should be considered based on the PEHH. Gut decontamination may be considered if ingested foreign objectsare visualized on x-ray. Contact your local Poison Centre for assistance. Chelation is not typically recommended for asymptomatic patients. - *>44mcg/dL**
1. Follow guidance for BLLs 15 to 44 mcg/dL.
2. Confirm the BLL with repeat venous testing at 48 hours.
3. Consider hospitalization and/or chelation therapy in consultation with your local Poison Control Centre. Mitigating lead exposures at home, identifying other possible sources,assessing the family’s social situation, and chronicity of the exposure will influence management.
How many Canadians die yearly from tobacco-related diseases?
What are the main themes of Canada’s Tobacco Strategy?
What groups of Canadians have a higher rate of tobacco use (inequity)?
Each year, 45,000 Canadians die from a tobacco-related disease. Canada’s Tobacco Strategy will help us reach the goal of less than 5% tobacco use by 2035.
About Canada’s Tobacco Strategy
We have committed $330 million over the next 5 years to:
h_elp Canadians who smoke to quit or reduce the harms of their addiction to nicotine_ and
protect the health of young people and non-smokers from the dangers of tobacco use
This new strategy notes that tobacco use is not equally spread across the population. It is often linked to other health and social inequities.
Along with our partners we will reach out to groups of Canadians with higher rates of tobacco use. These include:
LGBTQ+
young adults
Indigenous Peoples
This new strategy also notes that giving smokers access to less harmful options than cigarettes will:
help reduce their health risks
possibly save lives
The Tobacco and Vaping Products Act was passed on May 23, 2018. It makes it legal for adults to buy vaping products that contain nicotine, as a less harmful option than smoking. This is part of our broad new vision for dealing with tobacco use.
Themes of Canada’s Tobacco Strategy
The main themes of Canada’s Tobacco Strategy are to:
help Canadians quit tobacco
protect youth and non-tobacco users from nicotine addiction
work with Indigenous groups to create specific plans for Indigenous people
strengthen our science, surveillance and partnerships
Help Canadians quit tobacco
This will be achieved by:
supporting improved services and resources to help people quit smoking
funding programs to explore the most effective ways to help Canadians quit smoking by working with:
researchers
communities
public health groups
giving information on and access to less harmful sources of nicotine
Protect youth and non-tobacco users from nicotine addiction
This will be achieved by:
teaching youth and young adults about the risks of using vaping and tobacco products
enforcing compliance for retailers and producers of tobacco and vaping products
creating a research program to understand and strengthen law enforcement to combat Canada’s illicit tobacco market
putting increased rules and guidelines in place, such as:
regulating vaping products
updating health warning messages
plain and standardized appearance measures
Work with Indigenous groups to create specific plans for Indigenous people
This will be achieved by:
continuing and expanding existing tobacco projects in Indigenous communities
working with national and regional Indigenous groups to co-develop distinct strategies to meet the needs of Canada’s Indigenous peoples
Strengthen our science, surveillance and partnerships
This will be achieved by:
increasing funding to:
study new and unique ways to address tobacco use in Canada
understand the health impacts of new nicotine products and how Canadians use them
aiding research from health stakeholders by publicly releasing:
industry reports
research findings
surveillance findings
maintaining and supporting work done around the world as a part of the World Health Organization’s Framework Convention on Tobacco Control
What are the pillars for the federal framework on Lyme Disease?
Surveillance: The establishment of a national medical surveillance program to use data collected by the Public Health Agency of Canada to properly track incidence rates and the associated economic costs of Lyme disease.
Education and Awareness: The creation and distribution of standardized educational materials related to Lyme disease, for use by any public health care provider within Canada, designed to increase national awareness about the disease and enhance its prevention, identification, treatment and management.
Guidelines and Best Practices: The establishment of guidelines regarding the prevention, identification, treatment and management of Lyme disease, and the sharing of best practices throughout Canada
What are the prerequesites for health according to the Ottawa Charter?
Peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity.
What are incubation periods and common culprit foods for foodborne illnesses?
Staph toxin
<6h (high protein/salt)
B. cereus
<6h (rice)
C. botulinum
<6h (canned)
C. perfringens
<6h (starchy foods - beans, gravy, meats)
Norovirus
10-50h (people, shellfish, produce)
Salmonella
6-72h - usually 12-36 (chicken)
Campylobacter
1-10d - usually 2-5 (chicken, pets)
E. coli
2-10d - usually 3-4 (meat, can be contaminated veg)
Listeria
Up to 72d - usually 2-3w (processed items)
Hepatitis A
15-50d (avg 28-30) - usually 28-30 (contaminated berries, travel, food worker)
Cyclospora
Fruit and veg - 7 days
Trichinosis
Pork - 5-45 days
What is the incremental cost effectiveness ratio?
The incremental cost-effectiveness ratio (ICER) is a statistic used in cost-effectiveness analysis to summarise the cost-effectiveness of a health care intervention.
It is defined by the difference in cost between two possible interventions, divided by the difference in their effect.
It represents the average incremental cost associated with 1 additional unit of the measure of effect.
What are components of an organized screening cancer program?
A defined and identifiable target population;
- Strategies to ensure high coverage, such as personal invitations with times and places for screening;
- Adequate clinical facilities for taking Pap tests and laboratory services to examine them;
- Quality control programs for taking and interpreting Pap tests;
- Adequate clinical facilities for diagnosis, treatment and follow-up of women with a detected abnormality;
- An established referral system to help facilitate women through the screening process i.e., a link between the patient, laboratory and clinical facility for providing information about normal Pap test, diagnosis of an abnormal test and/or treatment of any detected abnormality;
- Organized evaluation and monitoring of the impact of the program with established data quality control programs.
What are 3 components for income security?
Actual level of income (absolute + relative to needs)
Assurance that you will receive it
Expectation that it is adequate for needs now and in the future
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 5 principles of trauma-informed care?
The Five Principles of Trauma-Informed Care
Collaboration: Making decisions with the individual and sharing power
Trustworthiness: Task clarity, consistency, and Interpersonal Boundaries
Choice: Individual has choice and control
Empowerment: Prioritizing empowerment and skill building
Safety: Ensuring physical and emotional safety
What are the following financial performance metrics:
- Payback period?
- Breakeven period?
- Return on investment?
- Net present value?
- Internal rate of return?
The payback period is the length of time an investment reaches a break-even point.
ROI tries to directly measure the amount of return on a particular investment, relative to the investment’s cost. To calculate ROI, the benefit (or return) of an investment is divided by the cost of the investment. The result is expressed as a percentage or a ratio.
Net present value (NPV) is the difference between the present value of cash inflows and the present value of cash outflows over a period of time. NPV is used in capital budgeting and investment planning to analyze the profitability of a projected investment or project. This concept is the basis for the Net Present Value Rule, which dictates that only investments with positive NPV values should be considered.
The internal rate of return is a metric used in financial analysis to estimate the profitability of potential investments. The internal rate of return is a discount rate that makes the net present value (NPV) of all cash flows equal to zero in a discounted cash flow analysis. When comparing investment options whose other characteristics are similar, the investment with the highest IRR would probably be considered the best.
What are the CTFPHC recommendations around adult obesity?
Measurement of BMI
These recommendations apply to apparently healthy adults ≥ 18 years of age who present to primary care. These recommendations do not apply to people with eating disorders, or who are pregnant.
We recommend measuring height, weight and calculating BMI at appropriate primary care visits.
(Strong recommendation; very low quality evidence)
Prevention of weight gain
These recommendations do not apply to people with eating disorders, or who are underweight, pregnant, overweight or obese (Body Mass Index [BMI] ≥ 25).
We recommend that practitioners not offer formal, structured interventions aimed at preventing weight gain in normal weight adults.
(Weak recommendation; very low quality evidence)
Management of overweight and obesity
These recommendations apply to adults ≥ 18 years of age who are overweight or obese (25 ≤ BMI < 40). Pregnant women and people with health conditions where weight loss is inappropriate are excluded. These guidelines do not apply to people with BMI ≥ 40, who may benefit from specialized bariatric programs.
F_or adults who are obese (30 ≤ BMI < 40) and are at high risk of diabetes, we recommend that practitioners offer or refer to structured behavioural interventions aimed at weight loss._
(Strong recommendation; moderate quality evidence)
For adults who are overweight or obese, we recommend that practitioners offer or refer to structured behavioural interventions aimed at weight loss.
(Weak recommendation; moderate quality evidence)
For adults who are overweight or obese, we recommend that practitioners not routinely offer pharmacologic interventions (orlistat or metformin) aimed at weight loss.
(Weak recommendation; moderate quality evidence)
What are questions to critically appraised research for:
- RCT?
- Systematic reviews?
- Qualitative research?
CASP randomized controlled trial
Is the basic study design valid for a randomized controlled trial? (Section A)
- Did the study address a clearly focused research question? (PICO)
- Was the assignment of participants to intervention randomized?
- Were all participants who entered the study accounted for at its conclusion? (loss to follow-up, intention to treat analysis)
Was the study methodologically sound? (Section B)
- Were the participants + investigators blinded?
- Were the study groups similar at the start of the RCT? (Table 1)
- Was each study groups treated equally?
What are the results? (Section C)
- Were the effects of intervention reported comprehensively? (power, outcome measurement, missing data, biases, statistical tests, etc)
- Was the precision of the estimated effect reported? (CI)
- Do the benefits of the experimental intervention outweigh harms and costs?
Will the results help locally? (Section D)
- Can the results be applied to your local population and context?
- Would the experimental intervention provide greater value to the people in your care than any of the existing interventions?
CASP SYSTEMATIC REVIEWS
Are the results of the study valid? (Section A)
- Did the review address a clearly focused question?
- Did the authors look for the right type of papers?
- Do you think all the important, relevant studies were included?
- Did the review’s authors do enough to assess quality of the included studies?
- If the results of the review have been combined, was it reasonable to do so?
What are the results? (Section B)
- What are the overall results of the review?
- How precise are the results? (CI)
Will the results help locally? (Section C)
- Can the results be applied to the local population?
- Were all important outcomes considered?
- Are the benefits worth the harms and costs?
CASP QUALITATIVE RESEARCH
Are the results of the study valid? (Section A)
- Was there a clear statement of the aims of the research?
- Is a qualitative methodology appropriate?
- Was the research design appropriate to address the aims of the research?
- Was the recruitment strategy appropriate to the aims of the research?
- Was the data collected in a way that addressed the research issue?
- Has the relationship between researcher and participants been adequately considered?
What are the results? (Section B)
- Have ethical issues been taken into consideration?
- Was the data analysis sufficiently rigorous?
- Is there a clear statement of findings?
Will the results help locally? (Section C)
- How valuable is the research?
What are steps in managing an adverse events in a water distribution system?
Verify accuracy of indicator exceedance (retest)
- Needs 2 E. Coli + for EBWA or 1 E. Coli +other data like chlorine residual)
Gather other data (turbidity, chlorine residuals, other sites)
Notify authorities (PHU, ministry of health/env)
Corrective action (increase disinfection, flush lines)
Decide on advisory, notify public + special populations
Rescind advisory (Rescinded by LPHA)
Define health and public health.
Health (definitions)
WHO: A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
Ottawa Charter: The extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for daily life, not the objective of living.
Indigenous health model: 4 Directions/Medicine Wheel: Physical, Emotional, Spiritual, Mental
Public health (definition)
The organized efforts of society to keep people health and prevent injury, illness, and premature death.
It is a combination of programs, services, and policies that protect and promote the health of all Canadians and prevent inequities.
What are the 2 elements of Karasek’s Job Strain Model
Karasek’s “job strain” model states that the greatest risk to physical and mental health from stress occurs to workers facing high psychological workload demands or pressures combined with low control or decision latitude in meeting those demands.
What are the steps of a cluster investigation?
Causes of liver cancer
Infectious: HBV, HCV
Metabolic: obesity, diabetes, fatty liver/NASH
Toxins: etoh, smoking, aflatoxins, vinyl chloride, anabolic steroids
Other diseases: PBC, A1AT, Wilson
What are health consequences of childhood obesity?
HTN
CVD
T2DM
OSA
Abnormal menstrual cycles
Bone and joint problems
Reduced balance
Low self-esteem
Depression
Feeling judged
Being teased or bullied
What is positive Mental Health?
What are models of mental health?
Positive Mental Health
Capacity to feel, think, act in ways that enhance the ability to enjoy life and deal with challenges (PHAC)
Models of Mental Health
3 Factor: Emotional, Social, Psychological well-being
2 Continua: Mental Health, Mental Illness
What should emergency and precautionary boil water advisories be issued?
What are negative consequences of BWA?
What information should a BWA notice contain?
What are the conditions for rescinding a BWA?
Emergency boil water advisories should be issued in response to the confirmed detection of Escherichia coli (E. coli) in drinking water. The detection of E. coli in drinking water is a definite indication of human or animal faecal contamination and the possible presence of pathogenic microorganisms. If the presence of E. coli is confirmed in drinking water, an emergency boil water advisory should be issued immediately
There are a number of situations which may prompt the issuance of a precautionary boil water advisory. These situations need to be assessed on a case-by-case basis, and require the incident response team to conduct an investigation and site-specific risk assessment. They are outlined below:
1) Persistent presence of total coliforms in the distribution system, despite remedial measures (such as flushing water mains, increasing chlorine residuals);
2) Unexpected changes in source water quality that could overwhelm the treatment system;
3) A breach in system integrity such as a broken water main (e.g., pressure loss).
4) Local maintenance or planned repairs in the distribution system which may cause a significant pressure drop, a breach in system integrity or potential contamination of drinking water;
5) Minor equipment malfunction which may impact treatment efficacy or distribution systems;
6) Unexpected and significant changes in routine monitoring parameters within the distribution system such as pressure, turbidity and disinfectant residuals; and
Possible negative consequences of issuing boil water advisories include the risk of scalding, especially to young children and elderly people, and consumers turning to an unsafe alternative source of drinking water. Boil water advisories can also have significant economic impacts on local businesses and services. The decision to issue an advisory will need to weigh the risks mitigated by the advisory with the potential negative impacts of the advisory.
In circumstances where an advisory is in place for an extended period of time, it is important to consider the possible impact on the public’s awareness and compliance. A number of studies have shown that the public’s willingness to adhere to boil water advisories decreases the longer an advisory is in place, and that ”message fatigue” is a major concern.
Contents of boil water advisory notice
Advisory notices should be clear and understandable to the general public, and include the following elements (CDC, 2013):
Description of the situation, the reason for the advisory, including faecal contaminant level(s);
When the situation occurred;
Any potential adverse health effects from drinking the water (e.g., diarrhea);
Area(s) and population(s) affected, including subpopulations that may be particularly vulnerable if exposed to the contaminant in their drinking water;
Specific guidance on how to boil water, whether alternate water supplies should be used and, if so, recommended sources;
Other actions consumers should take, including when they should seek medical help, if known;
What the water system authority is doing to correct the situation;
When the water system authority expects to resolve the situation, while indicating that the advisory is in place until the public is notified otherwise;
A central point of contact for additional information and where to seek updates as they become available; and
A statement encouraging the notice recipients to share the notice with other persons, communicate with neighbours and check on isolated or vulnerable individuals, where applicable.
Conditions for rescinding a boil water advisory
Criteria for rescinding a boil water advisory should include the resolution of the contamination event that prompted the issuing of the advisory. Boil water advisories are usually rescinded:
if the advisory was issued on evidence of bacteriological water quality conditions: as soon as at least two consecutive sets of bacteriological samples, collected a minimum of 24 hours apart, produce negative results. Additional guidance on actions in response to the presence of E. coli in drinking water, including rescinding boil water advisories, can be found in Part C.
if the advisory was issued on evidence of operational conditions: when the treatment, distribution, or operational malfunction has been corrected and any remaining corrective actions have been completed in order to eliminate any contaminated water, and has been confirmed through bacteriological water quality testing.
if an advisory was issued on evidence of a waterborne outbreak: after the above conditions have been met and when surveillance indicates that the incidence of the illness in the community has returned to background levels. Owing to lengthy incubation periods for some pathogens and their secondary spread, new cases of illness may occur after the period of contamination has passed. Conversely, a lack of new cases may indicate that the boil water advisory is being followed and not that the causative situation has been rectified.
When an advisory is rescinded, it is important that the communication strategy described in Section A.1 be followed. Messages noting that the advisory has been rescinded should be conveyed through all the same communication channels used when the advisory was first issued, ensuring that all affected groups are reached. The notices should highlight any remaining actions required of consumers, as well as where to seek additional information.
After rescinding an advisory, the incident response team should review and evaluate their boil water advisory protocol, in order to better understand and improve the process in the future.
What are CPHA recommendations around cannabis?
RECOMMENDATIONS
CPHA calls upon the federal, provincial/territorial
and municipal governments, and Indigenous peoples’
governing organizations to provide the tools and
approaches necessary to meet the objectives of
the legislation, and to develop and implement coordinated,
pan-Canadian approaches that address:
• Health promotion - to support healthier and safer
behaviours
• Develop and disseminate clear and consistent
information regarding the potential risks and
benefits associated with the use of cannabis,
while recognizing that a preferred approach is to
not consume the product or to delay onset of use
to the extent possible
• Develop and implement policies and programs
that strengthen community capacity and
individual skills that promote healthy behaviours
• Health protection - to ensure that high-quality
cannabis-based products free from harmful byproducts
are available for consumption
• Develop and implement federal regulations
concerning the growing, harvesting, processing
and packaging of cannabis and cannabiscontaining
products for retail sales
• Develop and implement a retail sales model
that expands the system currently in place for
the medical cannabis regime (i.e., e-commerce).
Should storefront retail sales be approved
by any province or territory, such operations
should be restricted to government-controlled,
not-for-profit monopolies or not-for-profit
non-governmental organizations. Under no
circumstance should retail sales be co-located
with sales of other controlled substances such as
alcohol, tobacco and/or pharmaceuticals
• All cannabis containing products should be sold
in resealable, childproof packaging
• A_ll relevant smoke-free bylaws for public spaces,
and workplace tobacco and alcohol consumption
policies should be adapted to include cannabis_
• Prevention and harm reduction - to prevent
or delay the onset of use and to reduce the
likelihood of harm from use, problematic use and/
or overdose
• Establish tax rates for cannabis-containing
products based on THC concentrations (i.e.,
higher tax rates for products with higher THC
concentrations)
• Establish limits on product advertising
• Establish a common minimum age for
consumption across Canada
• Permit alternative approaches for product
consumption, to reduce the reliance on inhaling
cannabis smoke
• Clarify the effects of second-hand cannabis
smoke
• Clarify the unique challenges associated with
the consumption of edible cannabis-containing
products
• Population health assessment - to understand the
extent of cannabis consumption, and measure the
potential impact of the interventions, policies and
programs on the population
• Monitor statistics such as self-reported daily use,
age of initiation, types and potency of products
consumed, reasons for consumption, gender and
socio-economic status
• Strengthen individual health surveillance - to
understand the effect on society and evaluate the
effects of cannabis use
• Monitor statistics such as emergency room
admittances for cannabis overdose and cannabisuse
related injuries
• Monitor use disorders
• Monitor the effect of smoking cannabis and other
consumption vehicles on health
• Evidence-informed services - to help people
who are at risk of developing, or have developed
problems with cannabis (and/or other
psychoactive substances)
• Develop tools to help physicians and other
health and social services professionals identify
individuals at risk of developing a cannabis use
disorder
• Where necessary, adapt current substance use
treatment programs to include cannabis.
These approaches, at all levels of government, must
be based on the best available information of what
works, what is likely to work and what does not
work. As such, CPHA also calls upon governments in
Canada to support, develop and implement research
programs, including cross-jurisdictional research, that
address all aspects of cannabis use, with priorities
developed with the Canadian Institutes of Health
Research. Similarly, underpinning these initiatives
is a requirement for an evaluation plan that provides
timely assessment of what works and isn’t working so
that adjustments can be made.
Furthermore, CPHA calls on all provincial/
territorial governments and Indigenous peoples’
governing organizations to collaborate closely on
the development of all cannabis-related legislation,
regulations and guidelines to minimize jurisdictional
variations in approaches.
Finally, CPHA calls on the Minister of Justice
and Attorney General of Canada to introduce a
moratorium on criminal prosecution related to
possession of small quantities of cannabis for personal
use, as a means of reducing the stigma associated with
court proceedings and a potential criminal record
for a product that will soon be legal. An additional
consideration, once the legislation is implemented, is
the potential effect of criminalization of youth who
provide small quantities of cannabis to other youth
for personal use. Care should be taken to apply the
proposed rules concerning trafficking to reflect the
severity of the crime.
What are the objectives of public health responses to outbreaks (or disease control options)?
Disease control options
control/remove source of pathogen
insecticidal spraying
food recall
interrupt transmission (suppress infected, break chain of transmission, protect unexposed)
education or policy to change behaviour
isolation
modify host response
vaccination
What are CTFPHC recommendations for asymptomatic thyroid dysfunction in primary care?
We recommend against screening* asymptomatic non-pregnant adults aged 18 years and older for thyroid dysfunction in primary care settings (strong recommendation, low-certainty evidence).
This recommendation does not apply to adults who have the following risk factors for thyroid dysfunction: individuals who have had a previously diagnosed thyroid disease or surgery, individuals receiving thyroid medications or medications that may affect thyroid function (i.e., lithium, amiodarone), individuals with previous or ongoing exposure to thyroid radioiodine therapy or head and neck radiotherapy, or individuals with pituitary or hypothalamic diseases.
This recommendation only applies to screening asymptomatic non-pregnant adults aged 18 years and older. While the task force recommends against routinely screening for thyroid dysfunction in this population, clinicians should remain alert to signs and symptoms (e.g., unusual fatigue, unexpected weight loss or gain, menstrual irregularities, goiter, etc.) or risk factors (e.g., pituitary or hypothalamic diseases) suggestive of thyroid dysfunction and investigate accordingly.
Diseases to watch for after flood or evacuation.
What are risk mitigation steps that can be implemented
Foodborne - hep. A, diarrheal diseases (food safety)
Waterborne (avoid unsafe water, BWA)
+/-Vectorborne depending on climate
Respiratory diseases in evacuation shelters (hand/cough hygiene)
Wounds, injuries (wound hygiene, tetanus booster)
Mold
Mental health
If power lost - hypothermia, CO-poisoning, cold chain for vaccine
What are trends in prostate cancer?
Trends in prostate cancer
In Canada, the incidence rate of prostate cancer peaked in 1993 and again in 2001. Each of these peaks was followed by a decline. The decline has been particularly steep since 2011. T_he patterns in prostate cancer incidence largely mirror screening activity using the prostate-specific antigen (PSA) test._
The death rate for prostate cancer has been declining since 1994. The decline likely reflects improved treatment.
Chances (probability) of developing or dying from prostate cancer
It is estimated that about 1 in 9 Canadian men will develop prostate cancer during their lifetime and 1 in 29 will die from it.
What strategies are outlined in the CPHO 2017 for designing healthy living?
Built environment
Active neighbourhoods
Access to healthy foods
Supportive environments
Consider health of populations
Avoid worsening health inequity
Evaluate health impacts
Strengthen existing approaches
Collaborate to collect data/engage citizens
Innovate so healthy choices are easy choices
What are Maslow’s hierarchy of needs?
What are the responsibilities for the PHAC centre for emergency preparedness and response?
The Centre for Emergency Preparedness and Response is Canada’s central coordinating point for public health security issues. Among its many responsibilities, CEPR:
develops and maintains national emergency response plans for the Public Health Agency of Canada and Health Canada;
monitors outbreaks and global disease events;
a_ssesses public health risk_s during emergencies;
contributes to keeping Canada’s health and emergency policies in line with threats to public health security and general security for Canadians in collaboration with other federal and international health and security agencies;
is responsible for the important federal public health rules governing laboratory safety and security, quarantine and similar issues; and
is the health authority in the Government of Canada on bioterrorism, emergency health services and emergency response.
+stockpiles
What are the Canadian drinking water guidelines around lead (2019).
Lead (2019)
_MAC = 0.005 mg/L ALARA (=_5 mcg/L )
Common sources: Leaching from plumbing (lead service lines, lead solder and brass fittings)
Health basis of MAC: Reduced intelligence in children measured as decreases in IQ is the most sensitive and well established health effect of lead exposure. There is no known safe exposure level to lead.
Other: Possible effects include behavioral effects in children. Reduced cognition, increased blood pressure, and renal dysfunction in adults are also possible;.classified as probably carcinogenic to humans
Lead levels should be kept as low as reasonably achievable.
Sampling should be done at the tap to reflect average exposure. The most significant contribution of lead in drinking water is generally from the lead service line that supplies drinking water to the home. The best approach to minimize exposure to lead from drinking water is to remove the full lead service line. Drinking water treatment devices are also an effective option.
What are 5 categories of occupational exposures?
5 categories of occupational exposures
Physical
Biological
Chemical
Ergonomic
Psychosocial
What are 3 dimensions of result-based accountability?
How much did we do? (scope, reach )
How well did we do it? (quality, efficiency)
Is anyone better off? (effectiveness)
What is a nested case-control study?
What is a case-cohort study?
What is a major advantage of a case-cohort study?
A nested case-control study design involves the selection of several healthy controls for each case, typically from those still under observation in the cohort at the time when the case developed the disease [3]. However, nested case-control studies have some limitations:
1) Inefficiency due to the alignment of each selected control subject to its matched case.
2) When there are more than one disease outcomes considered, a strict implementation of the nested case-control design requires the selection of a new set of controls for each distinct disease outcome.
Case-cohort study designs were proposed as an alternative to the nested case-control study design. Case-cohort study requires only the selection of a random sample from the overall cohort, named a subcohort, and all cases.
It has been demonstrated that the case-cohort study design, for a single disease outcome, is more efficient than a nested case-control study design; however, the difference is very small [1]. Compared to the nested case-control studies, a major advantage of the case-cohort design is the ability to study several disease outcomes using the same subcohort. For example, suppose that researchers are interested in whether smoking is a risk factor for diabetes as well as lung cancer. Under this situation, two control groups need to be sampled under the nested case-control design while a case-cohort design only requires one subcohort which is used to evaluate the effect of smoking for both diabetes and lung cancer.
In summary, nested case-control and case-cohort designs are efficient in terms of cost and can be used to evaluate the relationship between the exposure and diseases. Compared to a nested case-control design, the case-cohort design is more efficient and allows an investigator to study several disease outcomes by using the same random sample.
What are ethical considerations with supervised injection sites?
AGAINST
Beneficence, non-maleficence - injecting drugs is inherently dangerous
Duty to provide care, deontologic consideration - participating and witnessing inherently dangerous clinical process of injecting drugs
FOR
Utilitarianism - practical approach to save lives
Solidarity
Respect for autonomy
What are undesirable consequences of gambling?
Explain the goals of healthy public policy in the context of gambling?
What are 4 individual risk factors for problematic gambling?
What are 3 population risk factors for problematic gambling?
What are policy interventions to decrease problematic gambling?
Undesirable consequences:
- Bankruptcy, crime
- dysfunctional relationships
- mental health issues such as depression, anxiety, and suicide
- poor work and academic performance
Individual risk factors
(a) experiencing an early big win;
(b) having mistaken beliefs about the odds of winning;
(c) experiencing financial problems; and
(d) having a history of mental health problems
Population risk factors:
- gambling availability
- gambling modality,
- hours of operation.
Healthy public policy seeks to:
- prevent or mitigate gambling‐related harm,
- promote healthy choices, and
- protect vulnerable or high‐risk populations
Policy interventions:
- Ontarians are not exposed to high‐risk gambling environments and modalities.
Examples of action that results from this principle:
Any planned expansion of gambling in Ontario must be preceded and informed by community consultation and public health‐based risk assessment.
Gambling modalities known to have a high potential for harm, such as EGMs, are controlled and their number limited, and the most problematic features are not permitted.
Research to identify high‐risk environments and modalities is funded.
New gambling venues and modalities are rigorously evaluated, with an emphasis on social and health impacts. - Ontarians have the right to abstain from gambling, and to establish limits on the extent of their participation.
Examples of action that results from this principle:
Self‐exclusion mechanisms are robust, comprehensive, accessible, and culturally competent, and their effectiveness is routinely evaluated.
Patrons have the ability to pre‐establish spending limits.
Opportunities to gain access to cash or credit on‐site are limited.
Communities are consulted about the level and forms of gambling they feel are appropriate for them. - Those who choose to gamble are informed of the odds of winning, and of the potential consequences and risks.
Examples of action that results from this principle:
Odds of winning are clearly posted at tables and on machines.
Evidence‐based awareness and prevention initiatives are supported and evaluated on a routine basis. - Ontarians whose lives are most affected by problem gambling have access to high‐quality, culturally appropriate care.
Examples of actions that result from this principle:
Ontarians have access to services across the province, both in person and online.
Services are built around the needs of clients, including those with co‐occurring disorders such as mental health and substance use problems.
Multicultural, multilingual outreach and services are made available.
Primary care clinicians are supported to provide screening and brief intervention services and are knowledgeable about other available resources/services. - Gambling legislation and regulation must establish a minimum duty of care.
Examples of action that results from this principle:
Advertising of gambling does not promote false beliefs and is not directly or indirectly aimed at vulnerable populations.
Government’s mandate to regulate gambling in the public interest is defined to explicitly include the mitigation of health and safety risks.
Gambling is defined in legislation as a public health issue.
The social responsibility mandate of the regulator is broadened and its scope is clearly defined. - Government regulation and operation of gambling should have as its primary focus the protection of populations at greatest risk of developing gambling problems.
Examples of action that results from this principle:
Strict controls on young people’s access to gambling, and advertising directed toward young people, are in place.
Appropriate interventions are implemented for those clearly exhibiting evidence of dangerous patterns of gambling (e.g. extended length of session). - Government decisions on gambling are based on best evidence, and research on gambling is supported.
Examples of action that results from this principle:
Policy and regulatory changes – and most importantly, any gambling expansion – are subject to rigorous and transparent evaluation on a routine basis.
Government continues to provide support to gambling research, and implementation of research results toward clinical practice guidelines.
Government decisions are informed by best evidence on both public benefits and costs of gambling to individuals, families, communities and society.
A mandatory player card system is introduced and used to prevent and identify gambling problems as well as the proportion of gambling revenues derived from people with gambling problems.
What criteria (3) are used to decide which contaminants are addressed in the canadian drinking water quality guidelines?
Guidelines for Canadian Drinking Water Quality are established specifically for contaminants that meet all of the following criteria:
- Exposure to the contaminant could lead to adverse health effects in humans;
- The contaminant is frequently detected or could be expected to be found in a large number of drinking water supplies throughout Canada; and
- The contaminant is detected, or could be expected to be detected, in drinking water at a level that is of possible human health significance.
What are the 6 objectives of the national immunization strategy?
- Canada has evidence-based goals for vaccine preventable disease rates and immunization coverage
- Canada is better able to identify under and un-immunized populations and has an enhanced understanding of the determinants of vaccine acceptance and uptake
- Canadians have timely and equitable access to immunization
- Canada has the evidence needed to develop and implement evidence-based interventions, to improve immunization coverage rates
- Canadians have the information and tools needed to make evidence-based decisions on immunization
- Canada understands the key barriers to, and best practices in, improving immunization coverage and invests in addressing them
Distinguish process steps for HIA vs HEIA
- *HIA Process** (SSARME)
- Screening
- Scoping
- Appraising
- Reporting
- *- Monitoring**
- Evaluation
- *HEIA Steps**
1. Scoping
2. Potential impacts
3. Mitigation
4. Monitoring
5. Dissemination
What are best practices for managing TB in homeless populations?
Building partnership with housing/shelter provider
Written TB infection control plan
Health care liaison
Optimize sleeping arrangements (1.2m apart, head-to-toe)
Optimize ventilation (6 total air changes per hour, UV germicidal irradiation)
Support hygiene measures - (facial tissue, trash cans, disposable masks, hand hygiene)
Screen + educate staff + volunteers
Non-stigmatizing TB screening at client intake, offer LTBI treatment
Administrative measures: TB risk assessment, clear communication pathways, register of facility staff+clients, track bed assignments, implement cough alert protocol, maintain records of training
Why is antimicrobial resistance increasing worldwide?
What are recent trends in AMR in Canada?
Reasons for antimicrobial resistance: Use in vet medicine and agriculture, over-prescribing, OTC, inadequate IPC, global travel
Antimicrobial resistance (AMR) describes the capability
of disease-causing microorganisms to withstand
antimicrobial treatments such as antibiotics, thereby
limiting available treatment options. AMR has been
identified by the World Health Organization as one
of the ten most significant threats to global health.
Globalization, travel, and medical tourism mean that
Canada shares this threat.52, 53 If left unchecked, it is
estimated that AMR could cause 10 million deaths a
year worldwide by 2050.54
Concerning national AMR trends were observed
for several infectious diseases. For example,
rates of community-acquired methicillin-resistant
Staphylococcus aureus (MRSA) infections increased
by 62% between 2012 and 2017; Neisseria gonorrhoeae
infections resistant to azithromycin increased
by 50% from 2015 to 2016.53 While infection rates
of some of the most resistant organisms, carbapenemresistant
Enterobactericeae (CRE), have been
stable, a very worrisome trend can be found in
the five-fold increase, between 2014 and 2017,
in the number of people who are carriers of these
bacteria.55 However, some progress has been
made in Canada to reduce AMR, primarily in hospital
settings. For example, healthcare-associated
Clostridioides difficile and healthcare-associated
MRSA infections decreased respectively by 36%
and 6% from 2012 to 2017.55
What are the criteria for evaluating a meta-analysis?
Checklist for Meta-analysis
Study question
Objectives clearly stated
Clinically relevant and focused study question included
Effectiveness of intervention not convincingly demonstrated in clinical trials
Literature search
Comprehensive literature search conducted
Searched information sources listed (ie, PubMed, Cochrane database)
Terms used for electronic literature search provided
Reasonable limitations placed on search (ie, English language)
Manual search conducted through references of articles, abstracts
Attempts made at collecting unpublished data
Data abstraction
Structured data abstraction form used
Number of authors (>2) who abstracted data given
Disagreements listed between authors and how they were resolved
Characteristics of studies listed (ie, sample size, patient demographics)
Inclusion and exclusion criteria provided for studies
Number of excluded studies and reasons for exclusion included
Evaluation of results
Studies were combinable
Appropriate statistical methods used to combine results
Results displayed
Sensitivity analysis conducted
Evaluation for publication bias
Publication bias addressed through evaluation methods such as funnel plot or sensitivity analysis
Applicability of results
Results were generalizable
Funding source
Funding source(s) stated
No conflict of interest seen
Name reproductive health outcomes that preconception health can improve:
Many of the maternal and paternal risk factors for poor birth outcomes, such as lifestyle behaviours, are modifiable in the preconception period [4,5,6]. In fact, research has shown that PCH has positive impacts on many reproductive health outcomes and is cost effective for specific interventions, such as folic acid supplementation and diabetes care [7,8].
While it is not an exhaustive list, PCH can:
- prevent preterm births;
- improve birth weight;
- prevent congenital anomalies, including neural tube defects;
- reduce infant mortality;
- reduce maternal mortality [1].
What are the 6 domains from the Canadian Chronic Disease Indicators (CCDI) framework and examples of indicators for each?
The CCDI comprises six domains:
Data sources include CCHS, CHMS, CCDSS, DAD, CTADS, CIS, LFS, GSS, CCR.
(1) social and environmental determinants;
education: % pop with < high school (CCHS)
income: % pop living below LICO (CIS - canadian income survey)
employment: average annual unemployment rate (LFS - labour force survey)
community belonging: % pop report very strong/somewhat strong sense of belonging to local community (CCHS)
(2) maternal and child health risk and protective factors;
Maternal DM/HTN: rate of pregnant women with diagnosed DM/HTN (DAD)
Preterm birth: % live births before 37 weeks (DAD)
BF: % women report BF child for at least first 6 months of life (CCHS)
Second-hand smoke: % households with children <15yo with regular child exposure to ETS (CTADS)
Family violence: %pop report physical or sexual abuse or exposure to violence (GSS - General Social Survey)
(3) behavioural risk and protective factors;
physical activity, sleep, nutrition, stress (CCHS, CHMS)
drug/smoking (CTADS)
(4) risk conditions;
obesity, elevated sugar, cholesterol, HTN (CHMS, CCDSS)
(5) disease prevention practices; and
contact with HCP, screening, vaccination (CCHS)
(6) health outcomes/status
general health, morbidity prevalence/incidence (CCDSS, CCHS, CCR)
What are 3 indicators related to microbial drinking water quality?
Total coliforms
- Group of bacteria found in digestive tracts and environment
- Possible contamination and a risk of waterborne disease
Fecal coliforms
- Mainly found in digestive tracts and feces
- More specific indicator of fecal contamination
E. coli
- Almost always comes from animal feces
- Significant risk to human health
Enteric protozoa
Enteric virus
Turbidity
Chlorine residuals
Contrast primary and secondary vaccine failure.
Primary vaccine failure could be defined as the failure to seroconvert or the failure to mount a protective immune response after vaccination despite seroconversion, whereas secondary vaccine failure is the gradual waning of immunity over time.
What is the injury pyramid?
Pyramid showing escalation of injuries through levels.
Level 1: Injuries that do not receive attention in a health institution;
Level 2: Injuries resulting in primary care treatment;
Level 3: Injuries requiring emergency treatment;
Level 4: Injuries requiring hospitalization or that result in disability;
Level 5: Fatal injuries.
List 4 types of cost outcomes.
- Direct health costs - actual costs of delivering intevention e.g. drugs, nursing staff, lab tests
- Direct non-health costs - transport, support services, pension payouts, disability benefits, unemployment benefits (EI)
- Indirect costs - e.g. days lost from work, reduced productivity
- Intangible costs - e.g. pain, psychological harm, stigma
Risk factors for alcohol use in pregnancy
Partner who drinks heavily
Past hx of sexual abuse
Mental illness
Polysubstance abuse
Social isolation and lack of social support
Principles of TB outbreak management:
What are the objectives of TB contact investigation?
When is source-case investigation recommended?
What are high, medium and low priority contacts?
How many TST are done for high-priority contacts versus other contacts?
What are the priorities in outbreaks occurring in elderly residents in long-term care?
- *Contact investigation has three main objectives.** In order of priority these are as follows:
1. Identify and initiate treatment of secondary cases of active TB disease.
2. Identify and treat the source case who infected the index case, if the index case is under 5 years old.
3. Identify contacts with LTBI in order to offer preventive treatment
Only respiratory tuberculosis (TB), with limited exceptions, is infectious; contact follow-up should be carried out for both sputum smear-negative and smear-positive cases. The objective of contact follow-up is to identify and treat any secondary cases, and to identify contacts with latent TB infection (LTBI) in order to offer preventive treatment. Source-case investigation is recommended for children under 5 years old with a diagnosis of active TB disease. Interviews with the infectious case to identify contacts should include questions about locations/activities of potential exposure as well as specific named contacts. The discussion of site-based, social network contact investigation as well as the section on contact follow-up in homeless populations has been expanded from the 6th edition of the Standards. Prioritization of contact follow-up is recommended by the infectiousness of the source case, extent of exposure and immunologic vulnerability of those exposed. Thus, the most effort is put into contacts who are most at risk of being infected and/or most at risk of developing active TB disease if infected. The classic concentric-circle approach to contact follow-up is no longer recommended. Rather, the initial follow-up should include non-household contacts from the outset when case infectiousness and contact vulnerability indicate, rather than waiting. Contacts may be grouped as follows:
High priority household contacts plus close non-household contacts who are immunologically vulnerable, such as children under 5 years.
Medium priority close non-household contacts with daily or almost daily exposure, including those at school and work.
Low priority casual contacts with lower amounts of exposure.
For smear-positive/cavitary/laryngeal TB, it is recommended that the initial contact follow-up include both high- and medium-priority contacts.
For smear-negative, non-cavitary pulmonary TB, the initial contact follow-up should be for high-priority contacts only.
In both situations, contact investigation is iterative: it should be expanded if the initial follow-up results indicate that transmission has occurred.
A single evaluation at least 8 weeks after the end of exposure (with tuberculin skin testing [TST] and symptom assessment) is recommended in most non-household contact settings, in order to maximize participation and minimize overdiagnosis of “conversion” related to boosting. Initial plus 8 week post-exposure TST is recommended for household and other high-priority contacts. Two-step TST is not recommended in the setting of a contact investigation. TST is no longer recommended as a primary assessment tool in the contact follow-up of elderly residents in long-term care, in whom it is less reliable and for many of whom the risks of treatment of LTBI in old age will outweigh any benefit. The focus for these individuals should be on early detection of secondary cases.
What are the recommendations for pre-conception Folic Acid and Multivitamin Supplementation for the Primary and Secondary Prevention of Neural Tube Defects and Other Folic Acid-Sensitive Congenital Anomalies?
Pre-conception Folic Acid and Multivitamin Supplementation for the Primary and Secondary Prevention of Neural Tube Defects and Other Folic Acid-Sensitive Congenital Anomalies
In Canada multivitamin tablets with folic acid are usually available in 3 formats: regular over-the-counter multivitamins with 0.4 to 0.6 mg folic acid, prenatal over-the-counter multivitamins with 1.0 mg folic acid, and prescription multivitamins with 5.0 mg folic acid. (III)
Recommendations
- Women should be advised to maintain a healthy folate-rich diet; however, folic acid/multivitamin supplementation is needed to achieve the red blood cell folate levels associated with maximal protection against neural tube defect. (III-A)
- All women in the reproductive age group (12–45 years of age) who have preserved fertility (a pregnancy is possible) should be advised about the benefits of folic acid in a multivitamin supplementation during medical wellness visits (birth control renewal, Pap testing, yearly gynaecological examination) whether or not a pregnancy is contemplated. Because so many pregnancies are unplanned, this applies to all women who may become pregnant. (III-A)
- Folic acid supplementation is unlikely to mask vitamin B12 deficiency (pernicious anemia). Investigations (examination or laboratory) are not required prior to initiating folic acid supplementation for women with a risk for primary or recurrent neural tube or other folic acid-sensitive congenital anomalies who are considering a pregnancy. It is recommended that folic acid be taken in a multivitamin including 2.6 ug/day of vitamin B12 to mitigate even theoretical concerns. (II-2A)
- Women at HIGH RISK, for whom a folic acid dose greater than 1 mg is indicated, taking a multivitamin tablet containing folic acid, should be advised to follow the product label and not to take more than 1 daily dose of the multivitamin supplement. Additional tablets containing only folic acid should be taken to achieve the desired dose. (II-2A)
- Women with a LOW RISK for a neural tube defect or other folic acid-sensitive congenital anomaly and a male partner with low risk require a diet of folate-rich foods and a daily oral multivitamin supplement containing 0.4 mg folic acid for at least 2 to 3 months before conception, throughout the pregnancy, and for 4 to 6 weeks postpartum or as long as breast-feeding continues. (II-2A)
- Women with a MODERATE RISK for a neural tube defect or other folic acid-sensitive congenital anomaly or a male partner with moderate risk require a diet of folate-rich foods and daily oral supplementation with a multivitamin containing 1.0 mg folic acid, beginning at least 3 months before conception. Women should continue this regime until 12 weeks’ gestational age. (1-A) From 12 weeks’ gestational age, continuing through the pregnancy, and for 4 to 6 weeks postpartum or as long as breast-feeding continues, continued daily supplementation should consist of a multivitamin with 0.4 to 1.0 mg folic acid. (II-2A)
- Women with an increased or HIGH RISK for a neural tube defect, a male partner with a personal history of neural tube defect, or history of a previous neural tube defect pregnancy in either partner require a diet of folate-rich foods and a daily oral supplement with 4.0 mg folic acid for at least 3 months before conception and until 12 weeks’ gestational age. From 12 weeks’ gestational age, continuing throughout the pregnancy, and for 4 to 6 weeks postpartum or as long as breast-feeding continues, continued daily supplementation should consist of a multivitamin with 0.4 to 1.0 mg folic acid. (I-A). The same dietary and supplementation regime should be followed if either partner has had a previous pregnancy with a neural tube defect. (II-2A)
LOW risk group: Women or their male partners with no personal or family history of health risks for folic acidsensitive birth defects.
MODERATE risk group: Women with the following personal or co-morbidity scenarios (1 to 5) or their male partner with a personal scenario (1 and 2):
- Personal positive or family history of other folate sensitive congenital anomalies (limited to specific anomalies for cardiac, limb, cleft palate, urinary tract, congenital hydrocephaly)
- Family history of NTD in a first or second-degree relative
- Maternal diabetes (type I or II) with secondary fetal teratogenic risk. Measurement of red blood cell folate levels could be part of the pre-conception evaluation to determine the multivitamin and folic acid supplementation dose strategy (1.0 mg with RBC folate < 906 and 0.4 to 0.6 mg with RBC folate > 906) with a multivitamin)
- Teratogenic medications with secondary fetal teratogenic effects by folate inhibition via anticonvulsant medications (carbamazepine, valproic acid, phenytoin, primidone, phenobarbital), metformin, methotrexate, sulfasalazine, triamterene, trimethoprim (as in cotrimoxazole), and cholestyramine
- Maternal GI malabsorption conditions secondary to co-existing medical or surgical conditions that have been shown to result in decreased RBC folate levels (Crohn’s or active Celiac disease, gastric bypass surgery, advanced liver disease, kidney dialysis, alcohol overuse)
INCREASED/HIGH risk group: Women or their male partners with a personal NTD history or a previous neural tube defect pregnancy
Compare the health benefits of vaping compared to smoking.
Health effects of vaping vs smoking
If you are a smoker:
quitting smoking is the best thing you can do to improve your health. There is support available to help you quit.
completely replacing cigarette smoking with vaping will reduce your exposure to harmful chemicals.Footnote1
there are short-term general health improvements if you completely switch from smoking cigarettes to vaping products.Footnote1
Vaping is less harmful than smoking. Many of the toxic and cancer-causing chemicals in tobacco and the tobacco smoke form when tobacco is burned.Footnote2Footnote3Footnote4
Vaping products do not:
produce smoke
contain tobacco
involve burning
Except for nicotine, vaping products typically contain:
a fraction of the 7,000 chemicals found in tobacco smoke
lower levels of several of the harmful chemicals found in smoke
Vaping to help quit smoking
Quitting smoking can be difficult, but it is possible. Vaping products and e-cigarettes deliver nicotine in a less harmful way than smoking cigarettes. These products may reduce health risks for smokers who can’t or don’t want to quit using nicotine:
on their own
by using counselling services
by using medication or approved nicotine replacement therapies like:
gums
patches
lozenges
While evidence is still emerging, some evidence suggests that using e-cigarettes is linked to improved rates of success.
While quitting cigarettes, you may go through a time when you use both cigarettes and vaping products. Switching from tobacco cigarettes to vaping will reduce your exposure to many toxic and cancer causing chemicals.
What interventions can reduce vaccine hesitancy?
Interventions
“The advice of a health professional is the most important factor in whether a person receives a vaccine” - Dr. Ian Gemmill
Enhancing access to vaccination: Improve convenience and access to vaccination
Home visits
Reduce client out-of-pocket costs
Vaccination programs in schools and childcare centres
Increasing community demand for vaccinations
Engagement of religious or other influential leaders to promote vaccination in the community
Social mobilisation and mass media:
“Play the issue, not the opponent”; adversarial approaches to anti-vax advocates can create the false impression that vaccination is a contested intervention
Employing reminder and follow-up (recall systems)
Non-financial incentives
Mandating vaccinations / sanctions for non-vaccination
2 Canadian provinces (Ontario, New Brunswick) and all US states require children to be vaccinated prior to attending school, but allow for medical, religious, and philosophical exemptions
Some other provinces (e.g., Alberta) do not require immunization, but will exclude a child from school if there is a VPD outbreak
WHO has no official stance on mandatory immunization
Other approaches: Vaccination is not mandatory in Australia, but it provides nontaxable payments to parents for each child who meets immunization requirements between 18-24 months and again between 4-5 years of age; immunization is mandatory in Latvia, and philosophical or religious exemptions are not permitted
Enhancing provision of vaccines – provider level:
Start early
Present vaccination as default approach
Be honest about side effects and reassure of robust vaccine safety system
Tell stories in addition to providing scientific facts
Build trust with patients/parents
A qualitative study reported that a mother’s trust is obtained when a provider spends time discussing vaccines, does not deride her concerns, is knowledgeable, and provides satisfactory answers
Focus on protection for the child and community
Address pain: 5P approach
Pharmacologic: Use least-painful brand when possible; if under 12 can use topical anesthetics; if under 2 consider providing sweet-tasting solution
Physical: Breastfeeding during vaccination for infants < 2yrs; <1mo encourage skin-to-skin contact
Positioning: <3yrs encourage holding during injections or patting/rocking after injection; encourage sitting up instead of supine position
Psychological: Distraction techniques, deep breathing
Procedural: educate parents of children of all ages about pain management for vaccine injection before or on the day of vaccination; for children under 10, parents should be present; do not aspirate; inject the most painful vaccine last; provide tactile distraction at the time of injection (e.g., Buzzy Helps, Shotblocker)
Electronic immunization records
Standing orders
Provider reminders
Communications training for HCW: Focus on building a trusting relationship; “overselling” vaccines increases hesitance; aim to increase patient knowledge and awareness about vaccination (see table below)
Religious considerations in immunization
God’s will: Some Plain people and practitioners of Dutch or Christian Reform believe that vaccination interferes with God’s will
Porcine-derived gelatin is used in Varivax, Zostavax, and MMR as a stabilizer; Islamic scholars posit that “the transformation of pork products into gelatin alters them sufficiently to make it permissible for observant Muslims to receive vaccines containing pork gelatin”; for practitioners of Judaism, non-oral porcine-derived products are acceptable
Human cell lines derived from fetal cells from legal abortions that occurred the 1960s are used in the production of MMR, varicella, hep A, rabies, Quadracel, and Tdap; vaccines do not contain human cells; the Vatican has affirmed that “‘In the absence of effective alternatives, individuals may use the morally tainted vaccines,’ and assert that it is necessary to ‘provide for the good of one’s children,’ including the prevention of disease where possible.”
Immunoglobulin immunizations are blood products and may be declined by Jehovah’s Witnesses
Epidemiology of vaccine hesitancy in Canada
Data from the Childhood National Immunization Coverage Survey, 2013
Prevalence of parents/guardians reporting that their children had never received an immunization: 1.5%
Proportion of parents who agree vaccines are safe: 95%
Proportion of parents who agree vaccines are effective: 97%
Proportion of parents with concerns about vaccine side effects: 70%
Proportion of parents who strongly agree that alternative practices (e.g., chiropractic, homeopathy) can replace vaccines: 5%
Between 75-90% of two-year-olds are up-to-date on their immunizations, depending on the antigen (highest for MMR and polio, lowest for Var)
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.
What strategies are outlined in the 2016 CPHO for preventing family violence?
Creating and enforcing laws and policies
Developing strategies/frameworks/initiatives
Increasing knowledge and awareness
Creating safe and supportive communities
Promoting healthy families and relationships
Targeting at-risk populations
What elements are included in a multi-barrier source-to-tap approach to drinking water management?
A multi-barrier source-to-tap approach for the management of drinking water includes
1) the protection of source water,
2) the use of appropriate and consistently effective drinking water treatment,
3) a well-maintained distribution system, _qualified personne_l, routine verification of drinking water quality,
4) and communication and public education.
What are leading cause of infant deaths in Canada?
What are social risk factors for infant death?
1 Congenital malformations
Inequalities in Infant Mortality in Canada
About 3.7 out of 1 000 babies born in Canada will not live past their first birthday.
Leading causes of infant deaths (2018):
Other: Severe lack of oxygen, Infection, SIDS
Risk factors of infant death include:
Low maternal education
Inadequate housing
Lack of access to health care
Food insecurity
Poverty
Unemployment
While the infant mortality rate in Canada has improved over the past few decades, this improvement is not equally distributed. Infant mortality is strongly associated with socioeconomic status in Canada:
Canadians living in the most materially deprived areas have rates of infant mortality 1.6 times higher than the rates of those living in the least deprived areas.
Areas where more Indigenous peoples live have a higher infant mortality rate:
Inuit 3.9 times higher
First Nations 2.3 times higher
Métis 1.9 times higher
Inequities experienced by First Nations, Inuit and Métis populations are a direct result of colonial policies and practices that included massive forced relocation, loss of lands, creation of the reserve system, banning of Indigenous languages and cultural practices, and creation of the residential school system. Unaddressed intergenerational trauma adds to the ongoing challenges faced by Indigenous peoples.
Many infant deaths are preventable. Addressing inequalities in education, income, and material deprivation may improve conditions that influence the health of both the mother-to-be and the infant.
Define Health in all Policies and healthy public policy
Differentiate from healthy public policy
Health in all policies + Healthy public policy in summary:
- Non-health sectors, intersectoral
- Systematic consideration during planning process
- Seeks to have positive impact on health + SDoH, to improve pop health + equity
- Avoids harmful effects
Health policy dictates who should do what to whom, when they should do it, how much is available for doing, where they should do it, and who should pay for it.
Healthy public policy concerns policies written in other sectors (such as education or transportation), which may have an important impact on health because they modify known social determinants of health. The intent is to ensure that this health impact is positive, and that policy makers include health considerations in their planning.
What are data sources
for population health assessment and implementation
and evaluation of public health interventions?
- PH data sources:
- Surveillance data
- Vital statistics, mortality data
- Census
- Surveys
- Registries
- Administrative databases: hospital admission/outpatient, physician billing, prescription database, EMS
- EMR data
- Laboratory data
- Call lines, service user views
- Gov/city partners: police/EMS/fire
- NGOs
- Community perspective: stories, testimonials, interviews and focus groups
Evidence base for interventions:
- Academic research: systematic reviews, meta-analysis, RCT, case-control studies, cohort, qualitative studies, evaluations
- Grey literature from community/partner organizations, private sector, best practice guidelines/standards, evaluation findings, environmental scans
- Expert consultation
- Academic research: systematic reviews, meta-analysis, RCT, case-control studies, cohort, qualitative studies, evaluations
Organization by domains:
- Sociodemographic profile - Develop a community profile (age, sex etc, pop #s) that is the focus of the HNA - statistics Canada
- Epidemiology - Describe epidemiology of mental health of the relevant population - P/T mental health surveys, hospitalisation database, physician billing, prescription database
- Comparative assessment - compare local provision against national norms - CCDSS
- Service user views - patient surveys, satisfaction
- Resources available - description of healthcare and allied health available for mental health (e.g. community psychologists, dedicated psychiatric facilities)
- Healthcare utilization - emergency department visits, EMS call outs
Distinguish criteria for screening programs and vaccine programs.
Screening program criteria:
- Condition (4): 1) burden, 2) latent state, 3) natural history, 4) accepted treatment
- Test (2): 1) suitable, 2) acceptable
- Program (4): 1) who pts are, 2) economically balanced for society, 3) continuous process, 4) facilities for dx+tx
Erickson De Wals vaccine program criteria:
Appropriate disease (1) - burden of disease
Good vaccine (5) - safety, immunogenicity, effectiveness, cost-effective, ease of administration
Good program (10) -
feasible, acceptable,
delivery strategy, sufficiently researched implementation, can be evaluated, comparable to others,
legal/political/ethical/equity considerations
What are the basic principles of workers’ compensation (Meredith Report 1913)?
No fault compensation
Collective liability
Security of paument
Exclusive jurisdiction
Independent board
Distinguish types of data, data collection methods and data sources.
What statistical tests are used for:
Comparing 2 proportions between 2 groups
Comparing means between groups
Comparing 2 continuous variables
Comparing 2 proportions between 2 groups
Chi-square/Fisher’s exact
Paired = McNemar
Comparing means between groups (non-parametric)
2 groups = t-test (Wilcoxon rank sum)
2 Paired groups = Paired t-tests (Wilcoxon signed rank)
>2 groups = ANOVA (Kruskal-Wallis)
Comparing 2 continuous variables (non-parametric)
Correlation: Pearson (Spearman)
Linear regression
What are the epi trends for lung cancer?
Trends in lung cancer
In Canada, the incidence rate of lung cancer is higher in men than in women. In males, the rate of lung cancer began decreasing in 1990. In females, the lung cancer incidence rate began decreasing in 2011.
The difference in incidence rates and trends between the sexes is likely because of differences in tobacco use. More men smoked than females, and men’s smoking rates began to decline earlier than women’s smoking rates.
In males, the death rate from lung cancer began to level off in the late 1980s and has been declining ever since. The death rate for females was increasing until 2006 but is now decreasing. Men continue to have a higher rate of lung cancer death than women.
Chances (probability) of developing or dying from lung cancer
It is estimated that about 1 in 14 Canadian men will develop lung cancer during their lifetime and one in 16 will die from it.
It is estimated that about 1 in 15 Canadian women will develop lung cancer during their lifetime and one in 19 will die from it.
What are the objectives of the PHAC national immunization strategy?
In June 2001, the CDMH approved the development of an NIS, with the following five components: “Go Plan a Safe Procurement Registry”
■ National Goals and Objectives
■ Immunization Program Planning
■ Vaccine Safety
■ Vaccine Procurement
■ Immunization Registry Network
In its 2016 Budget, the Government of Canada committed $25M over five years to increase immunization coverage rates. F/P/T partners have worked together to establish a set of short term objectives.
Objective #1: Canada has evidence-based goals for vaccine preventable disease rates and immunization coverage
Objective #2: Canada is better able to identify under and un-immunized populations and has an enhanced understanding of the determinants of vaccine acceptance and uptake
Objective #3: Canadians have timely and equitable access to immunization
Objective #4: Canada has the evidence needed to develop and implement evidence-based interventions, to improve immunization coverage rates
Objective #5: Canadians have the information and tools needed to make evidence-based decisions on immunization
Objective #6: Canada understands the key barriers to, and best practices in, improving immunization coverage and invests in addressing them
