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 However, the core competencies are considered outdated and are facing calls for review, expansion, and revision.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.

Rates of and factors associated with exclusive and any breastfeeding at six months in Canada: an analysis of population-based cross-sectional data.

BACKGROUND: Breastfeeding has many health, economic and environmental benefits for both the infant and pregnant individual. Due to these benefits, the World Health Organization and Health Canada recommend exclusive breastfeeding for the first six months of life. The purpose of this study is to examine the prevalence of exclusive and any breastfeeding in Canada for at least six months, and factors associated with breastfeeding cessation prior to six months. METHODS: We performed a secondary analysis of breastfeeding-related questions asked on the cross-sectional 2017-2018 Canadian Community Health Survey. Our sample comprised 5,392 females aged 15-55 who had given birth in the five years preceding the survey. Descriptive statistics were carried out to assess the proportion of females exclusively breastfeeding and doing any breastfeeding for at least six months by demographic and behavioural factors. We also assessed, by baby's age, trends in the introduction of solids and liquids, breastfeeding cessation and the reasons females stopped breastfeeding. Multivariate log binominal regression was used to examine the association between breastfeeding at six months and selected maternal characteristics hypothesized a priori to be associated with breastfeeding behaviour. RESULTS: Overall, for at least six months, 35.6% (95% confidence interval (CI): 33.3%-37.8%) of females breastfed exclusively and 62.2% (95% CI: 60.0%-64.4%) did any breastfeeding. The largest decline in exclusive breastfeeding occurred in the first month. Factors most strongly associated with breastfeeding for at least six months were having a bachelor's or higher degree, having a normal body mass index, being married and daily co-sleeping. Insufficient milk supply was given as the most common reason for breastfeeding cessation irrespective of when females stopped breastfeeding. CONCLUSION: Six-month exclusive breastfeeding rates in Canada remain below targets set by the World Health Assembly. Continued efforts, including investment in monitoring of breastfeeding rates, are needed to promote and support exclusive breastfeeding, especially among females vulnerable to early cessation.

The Governance of Core Competencies for Public Health: A Rapid Review of the Literature.

Core competencies for public health (CCPH) define the knowledge, skills, and attitudes required of a public health workforce. Although numerous sets of CCPH have been established, few studies have systematically examined the governance of competency development, review, and monitoring, which is critical to their implementation and impact. This rapid review included 42 articles. The findings identified examples of collaboration and community engagement in governing activities (e.g., using the Delphi method to develop CCPH) and different ways of approaching CCPH review and revision (e.g., every 3 years). Insights on monitoring and resource management were scarce. Preliminary lessons emerging from the findings point towards the need for systems, structures, and processes that support ongoing reviews, revisions, and monitoring of CCPH.

Mental health indicators among pregnant Aboriginal women in Canada: results from the Maternity Experiences Survey. / Indicateurs de santé mentale chez les femmes autochtones enceintes au Canada : résultats de l'Enquête sur l'expérience de la maternité.

INTRODUCTION: There is little research done on mental health among pregnant Aboriginal women. Therefore, the purpose of the study was to examine the prevalence of postpartum depression (PPD) and its determinants, including pre-existing depression among non-Aboriginal and Aboriginal women in Canada. METHODS: The Maternity Experiences Survey (MES) is a national survey of Canadian women's experiences and practices before conception, up to the early months of parenthood. Predictors of PPD were calculated using the Mantel-Haenszel correction method relative to the risk estimates based on the odds ratio from adjusted regression analysis. The analysis was conducted among women who self-identified as Aboriginal (Inuit, Métis or First Nations living off-reserve) and those who identified as non-Aboriginal. RESULTS: The prevalence of pre-existing depression was higher among self-reported First Nations off-reserve and Métis women than non-Aboriginal women. Inuit women had the lowest prevalence of self-reported pre-existing depression, and Aboriginal women reported a higher prevalence of PPD than non-Aboriginal women. Pre-existing depression was not a predictor for PPD for Inuit or Métis women in this study but was a positive predictor among First Nations off-reserve and non-Aboriginal women. A disproportionally higher number of Aboriginal women reported experiencing abuse, as compared to non-Aboriginal women. CONCLUSION: Our study demonstrated that common predictors of PPD including anxiety, experiencing stressful life events during pregnancy, having low levels of social support, and a previous history of depression were consistent among non-Aboriginal women. However, with the exception of the number of stressful events among First Nations offreserve, these were not associated with PPD among Aboriginal women. This information can be used to further increase awareness of mental health indicators among Aboriginal women.

INTRODUCTION: On dispose de peu de recherches sur la santé mentale chez les femmes autochtones enceintes, ce qui nous a conduit à examiner dans cette étude la prévalence de la dépression post-partum (DPP) et ses déterminants, en tenant compte des antécédents de dépression chez les femmes non autochtones et autochtones du Canada. MÉTHODOLOGIE: L'Enquête sur l'expérience de la maternité (EEM) est une enquête nationale portant sur l'expérience et les pratiques des femmes canadiennes préalablement à la conception et jusqu'aux premiers mois de la maternité. On a calculé, à l'aide de la méthode de correction Mantel-Haenszel, les estimations du risque pour les facteurs de prédiction de la DPP en se basant sur les rapport de cotes de l'analyse de régression ajustée. L'analyse a été menée auprès de femmes s'étant auto-identifiées comme autochtones (Inuites, Métisses ou membres des Premières Nations vivant hors réserve) ou comme non autochtones. RÉSULTATS: La prévalence d'antécédents dépression était plus élevée chez les femmes s'étant auto-identifiée comme membre des Premières Nations vivant hors réserve ou métisses que chez les femmes non autochtones, les femmes inuites offraient la plus faible prévalence d'antécédents de dépression autodéclarée. Les femmes autochtones avaient une prévalence plus élevée de DPP que les femmes non autochtones. La présence d'antécédents de dépression n'était pas un facteur de prédiction de DPP chez les femmes inuites et métisses, mais s'est révélée en être un chez les femmes des Premières Nations vivant hors réserve et chez les femmes non autochtones. Un nombre disproportionnellement plus élevé de femmes autochtones que de femmes non autochtones ont déclaré avoir été victimes de violence. CONCLUSION: Notre étude a montré que les facteurs usuels de prédiction de DPP que sont l'anxiété, les événements stressants de la vie pendant la grossesse, un faible niveau de soutien social et des antécédents de dépression étaient bien présents chez les femmes non autochtones mais que, à l'exception du nombre d'événements stressants chez les femmes des Premières Nations vivant hors réserve, ces facteurs n'étaient pas associés à la DPP chez les femmes autochtones. Ces résultats incitent à développer la sensibilité des indicateurs de santé mentale pour les femmes autochtones.