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 However, the core competencies are considered outdated and are facing calls for review, expansion, and revision.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

Early Impacts of the COVID-19 Pandemic on Public Health Systems and Practice in 3 Canadian Provinces From the Perspective of Public Health Leaders: A Qualitative Study.

CONTEXT: The COVID-19 pandemic has impacted health systems worldwide. Studies to date have largely focused on the health care system with less attention to the impact on public health systems and practice. OBJECTIVE: To describe the early impacts of COVID-19 on public health systems and practice in 3 Canadian provinces from the perspective of public health system leaders and synthesize lessons learned. DESIGN: A qualitative study using semistructured virtual interviews with public health leaders between October 2020 and April 2021. The World Health Organization's essential public health operations framework guided data collection and analysis. SETTING: This study involved the Canadian provinces of Alberta, Ontario, and Québec. These provinces were chosen for their large populations, relatively high COVID-19 burden, and variation in public health systems. PARTICIPANTS: Public health leaders from Alberta (n = 21), Ontario (n = 18), and Québec (n = 19) in organizations with a primary mandate of stewardship and/or administration of essential public health operations (total n = 58). RESULTS: We found that the COVID-19 pandemic led to intensified collaboration in public health systems and a change in workforce capacity to respond to the pandemic. This came with opportunities but also challenges of burnout and disruption of non-COVID-19 services. Information systems and digital technologies were increasingly used and there was greater proximity between public health leaders and other health system leaders. A renewed recognition for public health work was also highlighted. CONCLUSIONS: The COVID-19 pandemic impacted several aspects of public health systems in the provinces studied. Our findings can help public health leaders and policy makers identify areas for further investment (eg, intersectoral collaboration, information systems) and develop plans to address challenges (eg, disrupted services, workforce burnout) that have surfaced.

Mental Health Stigma: Explicit and Implicit Attitudes of Canadian Undergraduate Students, Medical School Students, and Psychiatrists.

OBJECTIVES: To compare explicit and implicit stigmatizing attitudes towards mental illness among undergraduate students, medical school students, and psychiatrists, and to assess whether attitudes are associated with education level, exposure to, and personal experience with mental illness. METHODS: Participants from McMaster University were recruited through email. Participants completed a web-based survey consisting of demographics; the Opening Minds Scale for Healthcare Providers (OMS-HC) 12-item survey, which measures explicit stigma; and an Implicit Association Test (IAT), measuring implicit bias toward physical illness (diabetes mellitus) or mental illness (schizophrenia). RESULTS: A total of 538 people participated: undergraduate students ( n = 382), medical school students ( n = 118), and psychiatrists ( n = 38). Psychiatrists had significantly lower explicit and implicit stigma than undergraduate students and medical school students. Having been diagnosed with mental illness or having had a relationship with someone experiencing one was significantly associated with lower explicit stigma. Mean scores on the OMS-HC "disclosure/help-seeking" subscale were higher compared with the "attitudes towards people with mental illness" subscale. There was no correlation between the OMS-HC and IAT. CONCLUSIONS: These findings support the theory that increased education and experience with mental illness are associated with reduced stigma. Attitudes regarding disclosure/help-seeking were more stigmatizing than attitudes towards people with mental illness. The groups identified in this study can potentially benefit from anti-stigma campaigns that focus on reducing specific components of explicit, implicit, public and self-stigma.

Correction to: The Potential Effect of the Psychiatric Clerkship and Contact-Based Hypothesis on Explicit and Implicit Stigmatizing Attitudes of Canadian Medical Students Towards Mental Illness.

The authors would like to correct the footnote of Table 2.

The Potential Effect of the Psychiatric Clerkship and Contact-Based Hypothesis on Explicit and Implicit Stigmatizing Attitudes of Canadian Medical Students Towards Mental Illness.

OBJECTIVE: The purpose of this study was to assess if having completed a psychiatric clerkship or having increased exposure to mental illness in general was associated with reduced explicit and implicit stigmatizing attitudes towards mental illness in undergraduate medical students. METHODS: A secondary analysis of data specific to medical students from McMaster University was completed. Data were obtained through a cross-sectional survey administered electronically. It consisted of a demographic questionnaire, the Opening Minds Scale for Healthcare Providers (OMS-HC) 12-item survey, and an Implicit Association Test (IAT). The OMS-HC was used as a measure of explicit stigmatizing attitudes, whereas the IAT was used as a measure of implicit bias. All analyses were completed using Stata/IC 15 and were two-tailed with significance defined as p < 0.05. RESULTS: Individuals that self-reported either having had a mental illness or diagnosis by a health care professional had significantly lower levels of explicit stigma. Final-year medical students had significantly lower levels of implicit stigmatizing attitudes than first-year medical students. Neither having completed a psychiatric clerkship nor having a close relationship with someone experiencing a mental illness was significantly associated with the explicit or implicit stigmatizing attitudes of medical students. CONCLUSION: More years in medical school and self-identifying or receiving a diagnosis of mental illness are associated with reduced stigmatizing attitudes, whereas having completed the psychiatric clerkship and having a close relationship with an individual experiencing mental illness were not. This study suggests that the psychiatric clerkship may have limited impact on the stigmatizing attitudes of medical students.

Oral Soft Tissue Metastasis from Breast Cancer as the Only Primary Source: Systematic Review.

Background Breast cancer is one of the most lethal neoplasms causing death. Oral cavity is the rare site of distant metastasis from breast cancer. Very little research has been conducted to date to analyze breast cancer as the sole primary source of metastasis to the oral soft tissues. The goal of this study was to examine the published cases of oral soft tissue metastasis from breast cancer as the only primary source to date. Methods An electronic search of the published literature was performed without publication year limitation in PubMed/Medline, Scopus, Google Scholar, Web of Science, Science Direct, Embase, and Research Gate databases, using mesh keywords like ("Breast cancer", OR "Breast carcinoma") AND ("Metastasis" OR "Metastases"), And ("Oral soft tissues" OR "Tongue" OR "Palate" OR "Tonsil" OR "Buccal mucosa" OR "Floor of mouth" OR "Vestibule" OR "Salivary glands"). We also searched all related journals manually. The reference list of all articles was also checked. Results Our research revealed 88 relevant papers (September 1967-September 2023) with 96 patients in total. The most predominant oral soft tissues involved were salivary glands followed by the gingiva, tonsils, tongue, and buccal mucosa. A total of 23% of patients died with an average survival time of 1 to 15 months. Conclusions Oral soft tissue metastasis from breast cancer is a rare event and has a bad prognosis. More cases need to be published to raise awareness of these lesions.

Renal Cell Carcinoma Metastasizing to Oral Soft Tissues: Systematic Review.

Background Renal cancer metastasis to oral region is very rare. Studies have been published analyzing the cases of metastatic tumors to the oral cavity by many researchers. Very few research studies have been conducted till date to analyze the renal cancer metastasis as the sole primary source to the oral soft tissues. The goal of this study was to examine the published cases of oral soft tissue metastasis from renal cell carcinoma as the only primary source from 1911 to 2022. Materials and Methods An electronic search of the published literature was performed without publication year limitation in PubMed/Medline, Scopus, Google Scholar, Web of Science, Science Direct, Embase, and Research Gate databases, using mesh keywords like ("Renal cancer," or "Renal carcinoma" or "Renal cell cancer" or "Renal cell carcinoma"), and ("Metastasis" or "Metastases"), and ("Oral soft tissues" or "Tongue" or "Palate" or "Tonsil" or "Buccal mucosa" or "Salivary glands"). We also searched related journals manually and the reference lists. Results Our research revealed a total of 226 relevant articles with 250 patients. Parotid glands and tongue were the most common sites of metastasis. 23% patients died with a survival time of 10 days to 4 years. Conclusions Oral soft tissue metastasis from renal cell carcinoma has a bad prognosis. More cases need to be published in order to raise awareness of these lesions.

Factors Associated with Initiating Cannabis Use After Legalization in Canada: A Cross-Sectional Study.

Background: Cannabis use has increased since the Government of Canada legalized nonmedical use in October 2018. We investigated demographic factors associated with initiating cannabis use after legalization. Materials and Methods: We used data from the 2018 and 2019 National Cannabis Survey and constructed multivariable regression models. Respondents' data were weighted and bootstrapped. We report relative measures of association as adjusted odds ratios (ORs) and absolute measures of association as adjusted risk increases (RIs). Results: Among the 58,195 households surveyed, 28,566 provided complete data (49%) and our weighted analysis represented 27,904,258 Canadians aged ≥ 15 years. Approximately one in five Canadians endorsed use of cannabis (19.8%), predominantly for nonmedical (9.5%) or combined medical and nonmedical (5.8%) reasons. Those who initiated cannabis use in the past 3 months (1.9%) were more likely to be younger (25-34 years vs. ≥ 65 years; adjusted OR 1.7, 95% confidence interval [CI] 1.1-2.8; adjusted RI 1.1%, 95% CI 0.1-2.0%), endorse poor to fair versus good to excellent physical health (adjusted OR 2.0, 95% CI 1.3-3.1; adjusted RI 1.7%, 95% CI 0.3-3.1%), and reside outside of Quebec (adjusted OR 1.4, 95% CI 1.1-2.0; adjusted RI 0.1%, 95% CI 0.6-1.1%). The 1% of Canadians who endorsed initiating use of cannabis due to legalization were more likely to reside outside of Quebec (adjusted OR 1.9, 95% CI 1.1-3.2; adjusted RI 0.5%, 95% CI 0.2-0.9%). Conclusion: Canadians initiating cannabis use after nonmedical legalization were likely to be younger and endorse worse physical health, and half of those using cannabis reported therapeutic use. Stricter policies, lower social acceptance, and less availability of cannabis in Quebec appear to have curtailed initiation of use after legalization.

Promise and peril: how health system reforms impacted public health in three Canadian provinces.

OBJECTIVES: Several Canadian provinces and territories have reformed their health systems by centralizing power, resources, and responsibilities. Our study explored motivating factors and perceived impacts of centralization reforms on public health systems and essential operations. METHODS: A multiple case study design was used to examine three Canadian provinces that have undergone, or are in the process of undergoing, health system reform. Semi-structured interviews were conducted with 58 participants within public health at strategic and operational levels, from Alberta, Ontario, and Québec. Data were analyzed using a thematic analytical approach to iteratively conceptualize and refine themes. RESULTS: Three major themes were developed to describe the context and impacts of health system centralization reforms on public health: (1) promising "value for money" and consolidating authority; (2) impacting intersectoral and community-level collaboration; and (3) deprioritizing public health operations and contributing to workforce precarity. Centralization highlighted concerns about the prioritization of healthcare sectors. Some core public health functions were reported to operate more efficiently, with less duplication of services, and improvements in program consistency and quality, particularly in Alberta. Reforms were also reported to have diverted funding and human resources away from core essential functions, and diminished the public health workforce. CONCLUSION: Our study highlighted that stakeholder priorities and a limited understanding about public health systems influenced how reforms were implemented. Our findings support calls for modernized and inclusive governance, stable public health funding, and investment in the public health workforce, which may help inform future reforms.

RéSUMé: OBJECTIFS: Plusieurs provinces et territoires canadiens ont réformé leur système de santé en centralisant le pouvoir, les ressources et les responsabilités. Notre étude a exploré les facteurs sous-jacents et les impacts perçus des réformes de centralisation sur les systèmes et les opérations essentielles de santé publique. MéTHODES: Nous avons mené une étude de cas multiples pour examiner la situation de trois provinces canadiennes qui ont subi ou qui sont en train de réaliser une réforme du système de santé. Des entrevues semi-structurées ont été menées auprès de 58 participants de la santé publique aux niveaux stratégique et opérationnel, en Alberta, en Ontario et au Québec. De façon itérative, nous avons thématiquement analysé les données recueillies. RéSULTATS: Trois thèmes principaux ont été formulés pour décrire le contexte et les impacts des réformes de centralisation du système de santé sur la santé publique : 1) la promesse d'une « optimisation des ressources ¼ et la consolidation de l'autorité, 2) l'impact sur la collaboration intersectorielle et communautaire, et 3) la privatisation des opérations de santé publique et la précarisation de la main-d'œuvre. La centralisation a mis en lumière des préoccupations quant à la priorité accordée aux services de santé. Certaines fonctions essentielles de la santé publique fonctionneraient de manière plus efficace, avec moins de dédoublement des services et des améliorations de la cohérence et de la qualité des programmes, notamment en Alberta. Les réformes auraient aussi détourné des fonds et des ressources humaines des fonctions essentielles de base et auraient réduit les effectifs de la santé publique. CONCLUSION: Notre étude a mis en exergue les priorités des parties prenantes et une compréhension limitée des systèmes de santé publique qui ont influencé la manière dont les réformes ont été mises en œuvre. Nos résultats soutiennent les appels à une gouvernance plus modernisée et inclusive, à un financement stable de la santé publique et à un investissement dans le personnel de santé publique, pouvant ainsi contribuer à alimenter les futures réformes.

Centralization and integration of public health systems: Perspectives of public health leaders on factors facilitating and impeding COVID-19 responses in three Canadian provinces.

The extent to which power, resources, and responsibilities for public health are centralized or decentralized within a jurisdiction and how public health functions are integrated or coordinated with health care services may shape pandemic responses. However, little is known about the impacts of centralization and integration on public health system responses to the COVID-19 pandemic. We examine how public health leaders perceive centralization and integration facilitated and impeded effective COVID-19 responses in three Canadian provinces. We conducted a comparative case study involving semi-structured interviews with 58 public health system leaders in three Canadian provinces with varying degrees of centralization and integration. Greater public health system centralization and integration was seen by public health leaders to facilitate more rapidly initiated and well-coordinated provincial COVID-19 responses. Decentralization may have enabled locally tailored responses in the context of limited provincial leadership. Opacity in provincial decision-making processes, jurisdictional ambiguity impacting Indigenous communities, and ineffectual public health investments were impediments across jurisdictions and thus appear to be less impacted by centralization and integration. Our study generates novel insights about potential structural facilitators and impediments of effective COVID-19 pandemic responses during the second year of the pandemic. Findings highlight key areas for future research to inform system design that support leaders to manage large-scale public health emergencies.

Challenges in the Classification of Oral Submucous Fibrosis and Proposing a New Classification Based on Systematic Review of Literature.

Aims and Objectives: Oral submucous fibrosis is one of the common oral potentially malignant disorders that can result in severe morbidity. Due to its widespread involvement in the oral cavity and high risk of malignant transformation, the diagnosis and treatment of this disease at an early stage is essential to prevent further complications. This research was carried out to review various classification systems of oral submucous fibrosis documented in the literature to date, including their benefits and drawbacks, thus focusing on a need to discover some reliable classification systems. Materials and Methods: An electronic search of the published English literature was performed without publication year limitation in PubMed/Medline, Science Direct, Web of Science, Google Scholar, and Scopus databases using keywords like ('Oral submucous fibrosis' OR 'Oral submucous fibroses'), AND ('Classification' OR 'Grade' OR 'Stage'), AND ('Clinical', OR/ AND 'Histological', OR/AND 'Functional') following PRISMA guidelines. A manual search of all related Dental and Medical journals was also performed. We also checked the reference lists of the relevant articles for any other possible information on the subject. Results: The search strategy revealed 31 relevant articles and it could be appreciated that oral submucous fibrosis has been classified in seven different ways. Each system is enclosed with its own limitations and benefits. Conclusion: From this research, it can be concluded that despite the existence of several classification systems for oral submucous fibrosis, at present, no classification scheme is considered to be reliable that could help in the accurate assessment of the progression of the disease and classifying oral submucous fibrosis still remains a challenging task for clinicians, surgeons, and pathologists. We have postulated a proposed new classification system based on our literature research, but still robust research is needed in this aspect.

Plasma Fibrinogen Degradation Products as the Nonsurgical Diagnostic Tool for Oral Submucous Fibrosis: A Systematic Review.

Aims and Objectives: Oral submucous fibrosis (OSMF) is known to be one of the most common premalignant conditions of the oral cavity. Areca nut (AN) is considered to be the disease's primary cause, while there are other potential causes as well. However, routine clinical practice has revealed that not all people who chew AN exhibit clinical signs of OSMF, and few people are reported to have it even without chewing AN. So, there must be other factors contributing to OSMF. Plasma fibrinogen degradation products (FDPs) have recently been discovered to be an early sign of this disease, indicating a potential link between the two. This review aims to examine the studies which have been published in the literature that explain the role of plasma FDPs in contributing to OSMF. Materials and Methods: An electronic search of the published literature was performed without publication year limitation in PubMed/ Medline, Scopus, Google Scholar, Web of Science, Science Direct, Embase, and Research gate databases, using mesh keywords like ('Oral submucous fibrosis' OR 'Oral submucous fibrosis') AND ('Fibrinogen degradation products' OR 'Plasma fibrinogen degradation products') AND ('Clinical grades' OR 'Histological grades') AND ('Diagnosis'). A manual search of all related journals was also done. We also referred to the reference lists of papers. The risk of bias was evaluated with the GRADE criteria (from the Grading of Recommendations Assessment, Development, and Evaluation Working Group). Results: The search revealed a total of 12 relevant studies from 1979 to 2022. Nine out of 12 studies demonstrated the definite presence of plasma FDPs in such cases. Conclusions: Although the studies documented in the literature showing evidence of plasma FDPs in patients with OSMF are very few in number, their detection signifies an important clinical finding. More research is still required in this aspect to establish stronger evidence.

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.

Correlates of explicit and implicit stigmatizing attitudes of Canadian undergraduate university students toward mental illness: A cross-sectional study.

OBJECTIVE: To assess explicit and implicit attitudes toward mental illness of undergraduate students and explore associated variables. Participants: Year 1-4 undergraduate students from a large Canadian university (n = 382). Methods: Participants completed demographics, the Opening Minds Scale for Healthcare Providers, and an Implicit Association Test. Two-tailed independent and paired-samples t-tests, and ANOVA were performed with significance level at p < .05. Results: About 67.5% self-reported having experienced a mental illness and 31.2% had been diagnosed. Lower explicit stigma was associated with females, those with a history of mental illness diagnosis, and those who have had a close relationship with someone experiencing a mental illness. Faculty of Social Sciences students had significantly lower explicit stigma scores than Faculty of Engineering students. Implicit stigma did not show significant associations with any factors. Conclusions: A high proportion of undergraduate students experience mental illness. Increased exposure and experience were associated with reduced explicit stigma.

Characteristics of Canadians likely to try or increase cannabis use following legalization for nonmedical purposes: a cross-sectional study.

BACKGROUND: The Government of Canada legalized nonmedical use of cannabis in October 2018. Our objectives were to determine the percentage of Canadians intending to try or increase their cannabis use following legalization and to explore characteristics associated with this intent. METHODS: We used data from the 2018 National Cannabis Survey and constructed multivariable regression models. Respondents' data were weighted and bootstrapped. We report relative measures of association as adjusted odds ratios (ORs) and absolute measures of association as adjusted risk increases (RIs). RESULTS: Among the 39 000 households selected for recruitment for the survey, 17 089 respondents provided complete data (43.8%) and our weighted analysis represented 27 808 081 Canadians aged 15 years and older. An estimated 18.5% of respondents (95% confidence interval [CI] 17.6%-19.5%) indicated they intended to try or increase cannabis use following legalization. Being more likely to try or increase cannabis use was associated with younger age (15-24 yr v. ≥ 65 yr; adjusted OR 3.8, 95% CI 2.6-5.6; adjusted RI 20.1%, 95% CI 13.9%-26.2%), cannabis use in the past 3 months versus no use (adjusted OR 3.3, 95% CI 2.8-3.9; adjusted RI 20.4%, 95% CI 17.1%-23.6%), higher income (≥ $80 000 v. < $40 000; adjusted OR 1.5, 95% CI 1.3-1.9; adjusted RI 6.1%, 95% CI 3.2%-9.0%) and poor or fair mental health versus good to excellent mental health (adjusted OR 2.0, 95% CI 1.6-2.6; adjusted RI 11.5%, 95% CI 6.7%-16.2%). INTERPRETATION: Nearly 1 in 5 respondents reported that they intended to try or increase cannabis use after legalization; however, intention may not translate into behaviour. Continued monitoring should help to establish rates and patterns of cannabis use among Canadians following legalization.