Development of a guide to applying precaution in local public health.

PURPOSE: The precautionary principle (PP) urges actions to prevent harm even in the face of scientific uncertainty. Members of Toronto Public Health (TPH) sought guidance on applying precaution. METHODS: We searched five bibliographic databases (yield 60 articles from 1996 to 2009 and 8 from 2009 to 2011) and Google (yield 11 gray literature sources) for material relevant to local public health. From these sources, we extracted questions until saturation was reached (n =55). We applied these questions retrospectively to eight case studies where TPH felt precaution was applied. We ranked questions for their importance in applying precaution. RESULTS: Our final guide included 35 questions in five domains: context, assessment, alternative interventions, implementation, and monitoring and evaluation. Importance rankings varied across cases, but the role of stakeholders in driving precautionary action was consistent. Monitoring and evaluation components could have been strengthened across cases. CONCLUSION: The TPH guide can assist municipal environmental health practitioners in applying precaution in a more transparent manner.

Enhancing undergraduate public health education through public health interest groups.

PURPOSE: Since 2007, all Canadian medical schools have had at least one established student-led public health interest group (PHIG). The Association of Faculties of Medicine of Canada (AFMC), the Public Health Task Group, and the Public Health Agency of Canada (PHAC) have supported these PHIGs. The authors describe the activities and structure of PHIGs in Canada from 2007 to 2011, plus the extent to which PHIGs met the objectives set out for them by the AFMC Public Health Task Group. METHOD: Using a standardized template, the authors analyzed funding applications and reports that PHIG executives submitted to the AFMC from 2007 through 2011. The authors created activity categories and collected simple counts of activities within categories. They then used these data to assess how successfully PHIGs have been able to meet their objectives. RESULTS: Fifty-two funding applications, 50 interim reports, and 48 final reports were available for analysis. All 17 Canadian medical schools had at least one established PHIG between 2007 and 2011, and 9 schools (53%) applied for PHIG funding in all four years. Academic activities such as lectures, seminars, and workshops were the most common activities conducted by PHIGs, followed by career exploration and networking. CONCLUSIONS: This study found that the AFMC, with funding support from PHAC, was instrumental in initiating PHIGs in 82% (n = 14) of Canadian medical schools. With consistent funding, national networking opportunities, and a common operating structure, PHIGs have been able to accomplish AFMC's objectives for increasing public health awareness amongst medical students.

Local public health response to vaccine-associated measles: case report.

BACKGROUND: The most appropriate public health approach to vaccine-associated measles in immunocompromised patients is unknown, mainly because these cases are rare and transmission of vaccine-associated measles has not been previously documented. In this case report, we describe Peel Public Health's response to a vaccine-associated measles case in an immunocompromised child in Ontario, Canada. CASE PRESENTATION: A five-year-old Canadian-born boy with a history of a hematopoetic stem cell transplant three years previously received live attenuated measles, mumps, and rubella (MMR) vaccine. Over the subsequent 7 to 14 days, he developed an illness clinically consistent with measles. There was no travel history or other measles exposure. Serology and polymerase chain reaction (PCR) testing confirmed acute measles infection. Following discussion with pediatric infectious diseases specialists, but prior to the availability of virus sequencing, it was felt that this case was most likely due to vaccine strain. Although no microbiologically confirmed secondary cases of vaccine-associated measles have been previously described, we sent notification letters to advise all contacts of measles symptoms since the likelihood of transmission from an immunocompromised patient was low, but theoretically possible. We decided to stratify contacts into immune competent and compromised and to deal with the latter group conservatively by excluding them as if they were exposed to wild-type measles because the risk of transmission of disease in this population, while presumably very low, is unknown. However, no contacts self-identified as immunocompromised and there were no secondary cases. Subsequent genotyping confirmed that this case was caused by vaccine strain measles virus. CONCLUSION: The public health approach to contact tracing and exclusions for vaccine-associated measles in immunocompromised patients is unclear. The rarity of secondary cases provides further evidence that the risk to the general public is likely extremely low. Although the risk appears negligible, exclusion and administration of immune globulin may be considered for susceptible, immunocompromised contacts of cases of vaccine-associated measles in immunocompromised patients.

Strengths and weaknesses of the humanitarian Cluster Approach in relation to sexual and reproductive health services in northern Uganda.

Implementation of the Cluster Approach has been a major recent development in the humanitarian system. The aim of this study was to explore the strengths and weaknesses of the humanitarian Cluster Approach in relation to services for sexual and reproductive health (SRH) [including gender-based violence (GBV)] in northern Uganda, which is recovering from over 20 years of armed conflict. Face-to-face and telephone, semistructured, qualitative interviews were conducted in 2009 with purposively selected key informants from governmental, non-governmental, United Nations and donor agencies working in northern Uganda. Respondents noted a number of contributions of the Cluster Approach, including improved co-ordination of SRH services and stronger advocacy. However, concerns were raised about the low prioritisation, limited leadership and capacity, and standard setting for SRH services. Concerns were also raised about limited planning and capacity for dissolution of the Clusters in the transition to recovery and development in northern Uganda. Despite a number of contributions made by the Cluster Approach, particularly for responding to GBV, there were many concerns about its limited influence on SRH services. There were also concerns that the transition to recovery and development in northern Uganda may not result in reproductive health services being sufficiently strengthened.

Canadian medical students' perceptions of public health education in the undergraduate medical curriculum.

PURPOSE: To understand the perceptions and attitudes of Canadian medical students toward their undergraduate medical public health curriculum and to identify student suggestions and priorities for curriculum change. METHOD: Five focus groups of 11 or 12 medical students from all years of medical school were recruited at McMaster University Faculty of Health Sciences, Université de Sherbrooke Faculty of Medicine and Health Sciences, University of Toronto Faculty of Medicine, University of Manitoba Faculty of Medicine, and University of British Columbia Faculty of Medicine between February and April 2006. A professional facilitator was hired to conduct the focus groups using a unique, computer-based facilitation system. Questions in both the focus group and an accompanying survey sought to determine medical students' understanding and exposure to public health and how this impacted their attitudes and choices toward careers in the public health medical specialty of community medicine. The transcripts were independently reviewed and analyzed by each of the authors to identify themes. RESULTS: Four major themes related to students' desired curriculum change were identified: (1) poor educational experiences in public health courses, (2) lack of positive role models, especially exposure to community medicine specialists, (3) emphasis on statistics and epidemiology, and (4) negative attitudes toward public health topics. CONCLUSIONS: Students are disillusioned, disengaged, and disappointed with the public health curriculum currently being provided at the Canadian medical schools studied. Many medical students would prefer a public health curriculum that is more challenging and has more applied field experience and exposure to public health physician role models.

Assessing Canadian medical students' familiarity with and interest in pursuing a career in community medicine.

OBJECTIVES: Following the SARS outbreak, large gaps in the public health workforce have been identified. This study sought to understand the perceptions and attitudes of Canadian medical students with regard to public health to determine how this impacted their choice towards a career in Community Medicine (CM). METHODS: Five focus groups of 11-12 medical students from all years were recruited at McMaster University, Université de Sherbrooke, University of Toronto, University of Manitoba and the University of British Columbia. A professional facilitator was hired to conduct the focus groups using a unique computer-based facilitation system. Questions in both the focus group and an accompanying survey sought to determine medical students' understanding and exposure to public health and how this impacted their attitude and choice towards a career in community medicine. The transcripts were independently reviewed and analyzed by each of the authors to identify themes. RESULTS: Four major themes related to choosing Community Medicine as a career were identified: 1) poor understanding of the role of Community Medicine specialists in public health practice, 2) perceived lack of clinical work and relevance of public health to clinical practice, 3) perceived lack of exclusivity of Community Medicine specialty, 4) incentives and disincentives to pursuing Community Medicine. CONCLUSION: Better education of students on the role of CM specialists through increasing exposure to role models and demystifying inaccurate perceptions of CM through integration of public health with clinical medicine may potentially increase medical student entry into Community Medicine.