The Core Competencies for Public Health in Canada: Opportunities and Recommendations for Modernization.

CONTEXT: The 2008 Public Health Agency of Canada's (PHAC's) "Core Competencies for Public Health in Canada" (the "Canadian core competencies") outline the skills, attitudes, and knowledge essential for the practice of public health. The core competencies represent an important part of public health practice, workforce development, and education in Canada and internationally. However, the core competencies are considered outdated and are facing calls for review, expansion, and revision. OBJECTIVE: To examine the literature on public health competencies to identify opportunities and recommendations for consideration when reviewing and updating the Canadian core competencies. METHODS: This narrative literature review included 4 components: 3 literature searches conducted between 2021 and 2022 using similar search strategies, as well as an analysis of competency frameworks from comparable jurisdictions. The 3 searches were conducted in collaboration with the Health Library to identify core competency-relevant scholarly and gray literature published in English since 2007. Reference lists of sources identified were also reviewed. During the data extraction process, one researcher screened each source, extracted competency-relevant information, and categorized these data into key findings. RESULTS: After identifying 2392 scholarly and gray literature sources, 166 competency-relevant sources were included in the review. Findings from these sources were synthesized into 3 main areas: (1) competency framework methodology and structure; (2) competencies to add; and (3) competencies to modify. DISCUSSION: These findings demonstrate that updates to Canada's core competencies are needed and overdue. Recommendations to support this process include establishing a formal governance structure for the competencies' regular review, revision, and implementation, as well as ensuring that priority topics applicable across all competency categories are integrated as overarching themes. Limitations of the evidence include the potential lack of applicability and generalizability to the Canadian context, as well as biases associated with the narrative literature review methodology.

Identification of acute vaccine-preventable hepatitis in individuals with chronic hepatitis in British Columbia between 1991 and 2007.

BACKGROUND: In British Columbia (BC), hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccines are provincially funded for persons with chronic hepatitis infections. PURPOSE: To assess the effectiveness of BC public health follow-up of HBV and hepatitis C virus (HCV) cases and immunization policy by determining the number of vaccine-preventable acute hepatitis infections reported following a chronic HBV or HCV diagnosis, by examining demographic characteristics and by observing temporal trends. METHODS: All newly identified cases of HAV, HBV and HCV between 1991 and October 2007 were extracted from the BC integrated Public Health Information System and linked to ascertain cases of hepatitis suprainfection. RESULTS: Between 1991 and October 2007, 30 BC residents with chronic HBV and 104 with HCV were subsequently diagnosed with HAV. Acute HBV was identified in 162 persons previously diagnosed with HCV. Significantly more men than women developed hepatitis suprainfection (P<0.0001), but women were of a younger age when they were diagnosed with HAV (P=0.02) and acute HBV (P=0.0002). HAV suprainfection cases among those with HCV peaked in 1998 at 33 cases and declined to zero cases in 2007. In comparison, HBV suprainfection among individuals with chronic HCV peaked in 1996 at 26 cases and declined to two cases in 2007. DISCUSSION: Cases of HAV and acute HBV have declined among HCV-infected individuals. However, despite the availability of publicly funded vaccines for high-risk groups, a substantial number of acute HBV infections post-HCV identification are still identified, indicating that follow-up and vaccination coverage should be improved in these populations.

Trends in age disparities between younger and middle-age adults among reported rates of chlamydia, gonorrhea, and infectious syphilis infections in Canada: findings from 1997 to 2007.

BACKGROUND: The objective was to determine trends in age disparities between reported rates of chlamydia, gonorrhea, and infectious syphilis among younger versus middle-age Canadians. METHODS: We examined age- and sex-specific reported rates of chlamydia, gonorrhea, and infectious syphilis between 1997 and 2007. Sexually transmitted infection (STI) rates in the younger age group (15-29 years) were compared to the middle-age group (40-59 years) over the 11-year period. We used Poisson regression to examine trends in age-specific (younger:middle-age) rate ratios. RESULTS: Between 1997 and 2007, both the number and rate of reported cases increased for all 3 nationally notifiable STIs. Although chlamydia and gonorrhea rates continued to be higher among younger adults, rates of all 3 STIs increased more dramatically among middle-age adults. Between 1997 and 2007, chlamydia rates increased by 86.8% among adults aged 15 to 29 (P <0.0001) and 165.9% among adults 40- to 59-years-old (P <0.0001). The corresponding increases for gonorrhea were 133.3% (P <0.0001) and 210.2% (P <0.0001) respectively. Infectious syphilis rates increased 5-fold among younger adults compared to an increase of 11-fold among middle-age adults (P <0.0001) since 1997. The reported rate ratios (younger:middle-age) decreased over time for chlamydia (P <0.0001), gonorrhea (P <0.0001), and syphilis (P = 0.005). Males were disproportionately represented among reported chlamydia, gonorrhea, and infectious syphilis cases, constituting 59.8%, 87.6%, and 93.0% of middle-age adult cases, respectively, in 2007. CONCLUSIONS: Middle-age adults may be increasingly affected by chlamydia, gonorrhea and infectious syphilis. There is a need for sexual health information targeting Canada's middle-age adults and their health care providers.

Identification of chronic hepatitis B and hepatitis C co-infection in British Columbia from 1991 to 2007.

OBJECTIVES: To determine the chronic HBV/HCV co-infection identification rate in British Columbia, and examine the demographic characteristics, the order of virus identification, and trends of co-infection over time. METHODS: All newly identified cases of chronic HBV/HCV co-infection between 1991 and October 2007 were extracted from the BC integrated Public Health Information System. Differences according to sex and order of hepatitis identification were evaluated using chi-square, t-tests, and ANOVA. RESULTS: Of 1,815 HBV/HCV co-infected residents, 71.6% were male and the mean age at co-infection diagnosis was 40.5 years (95% CI, 40.0-41.0; range 3-85 years). Among all persons identified with HCV infection, 3.1% were identified as co-infected with HBV and 5.2% of all chronic HBV-infected were diagnosed with HCV. Annual co-infection identification rates peaked at 5.3 per 100,000 in 1996. Females were significantly younger when they were first diagnosed with a hepatitis virus (p=0.0005) at 35.2 years (95% CI, 34.0-36.5; range 3-79 years) than males at 37.9 years (95% CI, 37.0-39.7; range 4-85 years). The majority of co-infections consisted of concurrent diagnoses until 2003; since then, the number of co-infected cases identified with HBV first, HCV first and concurrent virus identification is similar. DISCUSSION: HBV/HCV co-infection identification rates have declined since the late 1990s, but appropriate testing and identification for both viruses are important. Some co-infection cases may be prevented through HBV vaccination and harm reduction activities for those with or at risk for HCV.

Genetic identification of HSD-1, a conserved steroidogenic enzyme that directs larval development in Caenorhabditis elegans.

In C. elegans, steroid hormones function in conjunction with insulin/IGF-1-like signaling in promoting reproductive development over entry into the diapausal dauer stage. The NCR-1 and -2 (NPC1-related) intracellular cholesterol transporters function redundantly in preventing dauer arrest, presumably by regulating the availability of substrates for steroid hormone synthesis. We have identified hsd-1 as a new component of this cholesterol trafficking/processing pathway, using an ncr-1 enhancer screen. HSD-1 is orthologous to 3beta-hydroxysteroid dehydrogenase/Delta(5)-Delta(4) isomerases (3beta-HSDs), which are key steroidogenic enzymes in vertebrates, and is exclusively expressed in two neuron-like XXX cells that are crucial in preventing dauer arrest, suggesting that it is involved in biosynthesis of dauer-preventing steroid hormones. The hsd-1 null mutant displays defects in inhibiting dauer arrest: it forms dauers in the deletion mutant backgrounds of ncr-1 or daf-28/insulin; as a single mutant, it is hypersensitive to dauer pheromone. We found that hsd-1 defects can be rescued by feeding mutant animals with several steroid intermediates that are either downstream of or in parallel to the 3beta-HSD function in the dafachronic acid biosynthetic pathway, suggesting that HSD-1 functions as a 3beta-HSD. Interestingly, sterols that rescued hsd-1 defects also bypassed the need for the NCR-1 and/or -2 functions, suggesting that HSD-1-mediated steroid hormone production is an important functional output of the NCR transporters. Finally, we found that the HSD-1-mediated signal activates insulin/IGF-I signaling in a cell non-autonomous fashion, suggesting a novel mechanism for how these two endocrine pathways intersect in directing development.

High-throughput in vivo analysis of gene expression in Caenorhabditis elegans.

Using DNA sequences 5' to open reading frames, we have constructed green fluorescent protein (GFP) fusions and generated spatial and temporal tissue expression profiles for 1,886 specific genes in the nematode Caenorhabditis elegans. This effort encompasses about 10% of all genes identified in this organism. GFP-expressing wild-type animals were analyzed at each stage of development from embryo to adult. We have identified 5' DNA regions regulating expression at all developmental stages and in 38 different cell and tissue types in this organism. Among the regulatory regions identified are sequences that regulate expression in all cells, in specific tissues, in combinations of tissues, and in single cells. Most of the genes we have examined in C. elegans have human orthologs. All the images and expression pattern data generated by this project are available at WormAtlas (http://gfpweb.aecom.yu.edu/index) and through WormBase (http://www.wormbase.org).

Expression analysis of ABC transporters reveals differential functions of tandemly duplicated genes in Caenorhabditis elegans.

We have previously identified 60 predicted ABC transporter genes in the Caenorhabditis elegans genome and classified them into eight groups. As an initial step towards understanding how these putative ABC genes work in worms, we generated promoter-fluorescent protein fusions for the entire family to address when and where these genes are turned on in vivo. Both Aequoria green fluorescent protein (GFP) and Discosoma red fluorescent protein (RFP) were used as reporters in our transgenic assay. Observable expression is more frequently seen from fusions to genes in subfamilies B, C, D and E than those in subfamilies A and G. Sixteen worm ABC genes are found in tandem duplications, forming two four-gene clusters and four two-gene clusters. Fifteen out of the 16 duplicated gene promoters drove different or partially overlapping expression patterns, suggesting active functions for these duplicated genes. Furthermore, our results suggest that an internal promoter can cause differential expression of genes within an operon. Finally, our observations suggest that it is possible for coding sequences to function as a regulatory region for a neighbouring gene.

ATP-binding cassette protein E is involved in gene transcription and translation in Caenorhabditis elegans.

ATP-binding cassette protein E (ABCE) gene has been annotated as an RNase L inhibitor in eukaryotes. All eukaryotic species show the ubiquitous presence and high degree of conservation of ABCEs, however, RNase L is present only in mammals. This indicates that ABCEs may function not only as RNase L inhibitors, but also may have other functions that have yet to be determined. As an initial investigation into the novel functions of ABCE, we characterized the gene (Y39E4B.1) in Caenorhabditis elegans by a combination of data mining and functional assays. ABCE promoters drove GFP expressions in hypoderm, pharynx, vulvae, head, and tail neurons at all developmental stages. Three genes, rpl-4, nhr-91, and C07B5.3, were previously found to interact with ABCE. Our expression data showed overlapping expression patterns of ABCE and rpl-4 and nhr-91, but not C07B5.3. RNAi against ABCE resulted in embryonic lethality and slow growth. These data suggest that ABCE protein might be involved in the control of translation and transcription, work as shuttle protein between cytoplasm and nucleus, and possibly as a nucleocytoplasmic transporter. In addition, RNAi data suggest that ABCE and NHR-91 may function in vulvae development and molting pathways in C. elegans. Furthermore, our data suggest that ABCE, along with its interacting components, functions in a well-conserved pathway.