Reaping the benefits of Open Data in public health.

Open Data is part of a broad global movement that is not only advancing science and scientific communication but also transforming modern society and how decisions are made. What began with a call for Open Science and the rise of online journals has extended to Open Data, based on the premise that if reports on data are open, then the generated or supporting data should be open as well. There have been a number of advances in Open Data over the last decade, spearheaded largely by governments. A real benefit of Open Data is not simply that single databases can be used more widely; it is that these data can also be leveraged, shared and combined with other data. Open Data facilitates scientific collaboration, enriches research and advances analytical capacity to inform decisions. In the human and environmental health realms, for example, the ability to access and combine diverse data can advance early signal detection, improve analysis and evaluation, inform program and policy development, increase capacity for public participation, enable transparency and improve accountability. However, challenges remain. Enormous resources are needed to make the technological shift to open and interoperable databases accessible with common protocols and terminology. Amongst data generators and users, this shift also involves a cultural change: from regarding databases as restricted intellectual property, to considering data as a common good. There is a need to address legal and ethical considerations in making this shift. Finally, along with efforts to modify infrastructure and address the cultural, legal and ethical issues, it is important to share the information equitably and effectively. While there is great potential of the open, timely, equitable and straightforward sharing of data, fully realizing the myriad of benefits of Open Data will depend on how effectively these challenges are addressed.

The health effects of climate change: Know the risks and become part of the solutions.

Climate change presents a clear and present danger to human health. Health impacts are already being demonstrated in Canada, which is warming at roughly twice the global rate. A recent United Nations Environment Emissions Gap Report noted that if countries maintain current emission efforts, emissions will exceed the targets laid out in the Paris Agreement and global warming will exceed 2ºC worldwide. An important consequence of global warming is an increase in health risks. Much can be done to prevent and mitigate the health impacts of climate change, and understanding and communicating these has been shown to be one of the best ways of motivating action. This editorial provides an overview of the some of the global and national initiatives underway to decrease emissions, and address the health risks of climate change in general, and highlights some of the national initiatives underway to mitigate the increased risk of infectious diseases in Canada in particular.

Canada Communicable Disease Report 2016 readership survey.

BACKGROUND: The Canada Communicable Disease Report (CCDR) is a peer reviewed scientific journal published since 1975. In 2011, a readership survey was conducted to inform a revitalization process. In late 2016, this survey was repeated to assess progress. OBJECTIVE: To provide information about the results of the CCDR 2016 readership survey, which identified CCDR's readership and their needs, obtained feedback on the journal's revitalization and sought suggestions for further improvement. METHODS: An online readership survey was conducted from September 7 to 28, 2016. Invitations were sent via email to CCDR subscribers. The survey was based on the 2011 version and checked for face-validity. Analysis included descriptive statistics and a qualitative assessment of comments for themes. RESULTS: A total of 549 people responded to the survey (12% participation rate). The majority of respondents worked in public health (61%), clinical care (23%), academia (16%) and laboratory medicine (9%). Approximately 45% of respondents had received CCDR for less than four years, which is consistent with the fact that the number of subscribers more than doubled over this time. Over 90% of respondents reported they read the articles in CCDR (always 15%, often 43%, sometimes 35%). When asked about their primary source of infectious disease information in Canada, CCDR was the number one response, identified by 72% of respondents. When asked "What do you like best about CCDR?" typical comments were that it provided Canadian content, was well written, evidence-based, interesting and relevant. The number one suggestion for improvement was that CCDR should be listed with PubMed. CONCLUSION: The survey results suggest that CCDR has been successfully revitalized and is meeting its readership's needs for a scientific journal on infectious disease with Canadian content, high quality and relevance. Consistent with suggestions for improvement, CCDR will be joining the PubMed database over the next year.

A guide to publishing scientific research in the health sciences.

Effective communication of scientific research is critical to advancing science and optimizing the impact of one's professional work. This article provides a guide on preparing scientific manuscripts for publication in the health sciences. It is geared to health professionals who are starting to report their findings in peer-reviewed journals or who would like to refresh their knowledge in this area. It identifies five key steps. First, adopt best practices in scientific publications, including collaborative writing and ethical reporting. Second, strategically position your manuscript before you start to write. This is done by identifying your target audience, choosing three to five journals that reach your target audience and then learning about the journal requirements. Third, create the first draft of your manuscript by developing a logical, concise and compelling storyline based on the journal requirements and the established structure for scientific manuscripts. Fourth, refine the manuscript by coordinating the input from your co-authors and applying good composition and clear writing principles. The final version of the manuscript needs to meet editorial requirements and be approved by all authors prior to submission. Fifth, once submitted, be prepared for revision. Rejection is common; if you receive feedback, consider revising the paper before submitting it to another journal. If the journal is interested, address all the requested revisions. Scientific articles that have high impact are not only good science; they are also highly readable and the result of a collective and often synergistic effort.

Advancing health equity to improve health: the time is now.

Health inequities, or avoidable inequalities in health between groups of people, are increasingly recognized and tackled to improve public health. Canada's interest in health inequities goes back over 40 years, with the landmark 1974 Lalonde report, and continues with the 2011 Rio Political Declaration on Social Determinants of Health, which affirmed a global political commitment to implementing a social determinants of health approach to reducing health inequities. Research in this area includes documenting and tracking health inequalities, exploring their multidimensional causes, and developing and evaluating ways to address them. Inequalities can be observed in who is vulnerable to infectious and chronic diseases, the impact of health promotion and disease prevention efforts, how disease progresses, and the outcomes of treatment. Many programs, policies and projects with potential impacts on health equity and determinants of health have been implemented across Canada. Recent theoretical and methodological advances in the areas of implementation science and population health intervention research have strengthened our capacity to develop effective interventions. With the launch of a new health equity series this month, the journals Canada Communicable Disease Report and Health Promotion and Chronic Disease Prevention in Canada will continue to reflect and foster analysis of social determinants of health and focus on intervention studies that advance health equity.

TITRE: Promouvoir léquité en santé en vue d'améliorer la santé : le moment d'agir est venu. INTRODUCTION: De plus en plus, les inégalités en santé, soit les disparités évitables en matière de santé entre des groupes de personnes, sont reconnues et prises en compte dans l'objectif d'améliorer la santé publique. L'intérêt du Canada à l'égard des inégalités en santé remonte à plus de 40 ans, lors de la publication historique du rapport Lalonde en 1974. Cet intérêt a été réaffirmé en 2011 par la Déclaration politique de Rio sur les déterminants sociaux de la santé, qui énonce un engagement politique mondial à réduire les inégalités en santé par la mise en œuvre d'une approche axée sur les déterminants sociaux de la santé. Les recherches menées dans ce domaine visent notamment à décrire les inégalités en santé, à suivre leur évolution et à étudier leurs causes multidimensionnelles, de même qu'à élaborer et à évaluer des stratégies permettant de les atténuer. Des inégalités peuvent être observées en ce qui concerne les populations vulnérables aux maladies infectieuses et chroniques, l'incidence des mesures de promotion de la santé et de prévention des maladies, l'évolution des maladies et les résultats des traitements. Un grand nombre de programmes, de politiques et de projets qui pourraient avoir une incidence sur l'équité en santé et les déterminants de la santé ont été mis en œuvre à l'échelle du Canada. Les percées théoriques et méthodologiques récentes dans les domaines de la science de la mise en œuvre et de la recherche interventionnelle en santé des populations ont renforcé notre capacité d'élaborer des interventions efficaces. En lançant ce mois-ci une nouvelle série d'articles sur l'équité en santé, les revues Relevé des maladies transmissibles au Canada et Promotion de la santé et prévention des maladies chroniques au Canada vont continuer à rendre compte des analyses sur les déterminants sociaux de la santé et à les encourager ainsi qu'à insister sur les études d'interventions qui promeuvent l'équité en santé.

How is an international public health threat advanced in Canada? The case of antimicrobial resistance.

On September 21, 2016, the United Nations General Assembly held a high-level meeting on antimicrobial resistance (AMR). Participating political leaders committed to coordinate action across the human and animal health, agriculture and environmental sectors and to work at national, regional and international levels with the public sector, private sector, civil society and all other relevant actors, including the public. The objective of this article is to outline how the Public Health Agency of Canada (PHAC) has been working to address AMR in Canada. PHAC has used a One Health approach and has been working at the federal level with other government departments and nationally with the provinces, territories, professional organizations and other key players to address AMR. To date, the federal response has focused on surveillance, stewardship and innovation across multiple sectors, including human health, animal health, regulatory actions and research. PHAC is currently working with the provinces and territories as well as key experts in the field to develop a pan-Canadian AMR Framework and subsequent action plan that will outline best practices and approaches to AMR across human and animal health. The Framework will build on previous work done by PHAC and the federal/provincial/territorial Pan-Canadian Public Health Network Council, and recognizes the research expertise in Canada, the need to ensure actions are based on evidence, and to combat AMR through infection prevention and control. The three articles in this issue are examples of the foundational work that has been done federally by PHAC, in developing the Canadian AMR Surveillance System (CARSS), and nationally, through task groups of the Public Health Network Council, in identifying where to strengthen human surveillance of AMR and best practices for stewardship in the human health care system. While we remain in an early stage of national, coordinated AMR action, momentum is building to ensure Canada can respond to this global health threat with a One Health approach involving multiple sectors at local, national and international levels that are all well-aligned with the World Health Organization Global Action Plan.

Advancing health equity to improve health: The time is now†.

Health inequities, or avoidable inequalities in health between groups of people, are increasingly recognized and tackled to improve public health. Canada's interest in health inequities goes back over 40 years, with the landmark 1974 Lalonde report, and continues with the 2011 Rio Political Declaration on Social Determinants of Health, which affirmed a global political commitment to implementing a social determinants of health approach to reducing health inequities. Research in this area includes documenting and tracking health inequalities, exploring their multidimensional causes, and developing and evaluating ways to address them. Inequalities can be observed in who is vulnerable to infectious and chronic diseases, the impact of health promotion and disease prevention efforts, how disease progresses, and the outcomes of treatment. Many programs, policies and projects with potential impacts on health equity and determinants of health have been implemented across Canada. Recent theoretical and methodological advances in the areas of implementation science and population health intervention research have strengthened our capacity to develop effective interventions. With the launch of a new health equity series this month, the journals Canada Communicable Disease Report (CCDR) and Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice (HPCDP Journal) will continue to reflect and foster analysis of social determinants of health and focus on intervention studies that advance health equity.

Why has the Ebola outbreak in West Africa been so challenging to control?

West Africa is in the midst of the largest Ebola outbreak ever; there have been over 1000 deaths and many new cases are reported each day. The World Health Organization (WHO) declared it an outbreak in March 2014 and on August 6, 2014 the WHO declared the outbreak a public health emergency of international concern. Based on the number of deaths and total number of cases reported to the WHO as of August 11, 2014, the current outbreak has an overall mortality rate of 55%. Outbreak control measures against Ebola virus disease are effective. Why then, has this outbreak been so challenging to control? Ebola is transmitted through bodily fluids and immediately attacks the immune system, then progressively attacks the major organs and the lining of blood vessels. Sierra Leone, Guinea and Liberia are small countries that have limited resources to respond to prolonged outbreaks, especially in rural areas. This has been made more challenging by the fact that health care workers are at risk of contracting Ebola virus disease. Treatment to date has been supportive, not curative and outbreak control strategies have been met with distrust due to fear and misinformation. However, important progress is being made. The international response to Ebola is gaining momentum, communication strategies have been developed to address the fear and mistrust, and promising treatments are under development, including a combination of three monoclonal antibodies that has been administered to two American Ebola infected health care workers. The National Microbiology Laboratory of the Public Health Agency of Canada (PHAC) has been supporting laboratory diagnostic efforts in West Africa and PHAC has been working with the provinces and territories and key stakeholders to ensure Canada is prepared for a potential Ebola importation.

Primary and secondary prevention of cardiac disease: bridging the two solitudes.

Clinical cardiovascular medicine uses two models for atherosclerosis: primary and secondary prevention. The essential goal of both strategies is risk factor modification, but intervention strategies and funding mechanisms to achieve these goals have traditionally differed, leading to professional and clinical segregation. The current system defies biological reality, patients and families are not well served, and important opportunities for improved care are lost. Developing a more inclusive paradigm of primary and secondary prevention remains a significant challenge. Such a paradigm could transform a longstanding trend of two solitudes where efforts in one area rarely benefit from new developments in the other. New models need to be developed that balance and integrate diagnostic, curative and preventive care, and that coordinate public health and personal health services. Working on 'bridging strategies' will help create synergies that will lead the way to further integration and will help improve the heart health of the population.

The experiences of women with heart disease: what are their needs?

PURPOSE: To identify experiences and needs of women with coronary artery disease. METHODS: Qualitative research utilizing focus groups and grounded theory. Women were recruited from the University of Ottawa Heart Institute Alumni, a group of former Heart Institute patients, and from the Heart Institute cardiac rehabilitation program. FINDINGS: All women had difficulties recognizing their symptoms as heart disease and 35% reported they were initially misdiagnosed. In the post-diagnosis period, the experiences of older and younger women differed. For women over 60, maintaining their functional capacity, memory problems and a focus on resiliency were the main issues. For women under 60, emotionally focussed concerns were predominant. Both groups had to contend with over-protective family members. CONCLUSIONS: These findings could contribute to the development of more effective public education campaigns. They also highlight the need for programs and research in the area of women's heart health and rehabilitation that address emotional aspects of the illness.

Sex differences in cardiac rehabilitation.

OBJECTIVE: To determine and compare the baseline characteristics and outcomes between men and women in a Canadian cardiac rehabilitation program. DESIGN: Nonrandomized, retrospective, observational study with a before and after research design. SETTING: The Prevention and Rehabilitation Centre at the University of Ottawa Heart Institute, Ottawa, Ontario, a tertiary cardiac care centre. PATIENTS: Three hundred and eighty-seven patients, 82% male aged 59+/-10 years and 18% female aged 61+/-4 years, who were enrolled in the on-site cardiac rehabilitation program between November 1, 1995 and April 1, 1997. INTERVENTION: A three-month, multifactorial cardiac rehabilitation program that incorporates exercise training, risk factor modification, education and psychosocial support. MAIN RESULTS: Fewer than 20% of all rehabilitation participants (n=70; 18%) were women; most participants were under 65 years of age. More women than men had a primary diagnosis of myocardial infarction (42% versus 28%, respectively), whereas men were more likely than women to have had coronary artery bypass grafting (45% versus 23%, respectively). Men and women had similar mean baseline measures of body mass index, blood pressure and glucose levels, whereas women had significantly higher mean baseline measures of total cholesterol (5.6 mmol/L versus 5.0 mmol/L for men, P 0.001), low density lipoprotein (LDL) cholesterol (3.4 mmol/L versus 3.1 mmol/L, P=0. 012) and high density lipoprotein (HDL) cholesterol (1.2 mmol/L versus 1.0 mmol/L, P 0.001). Baseline LDL to HDL ratios were 3.3 for men and 3.0 for women (not significant), and total cholesterol to HDL ratios were 5.4 and 4.9 for men and women, respectively. Men had a higher exercise capacity than women coming into the program (metabolic equivalent [METs] 6.6 versus 4.9, respectively, P 0.001), had a higher baseline activity level (1114 kcal/week versus 617 kcal/week, P=0.001) and scored higher than women in all health-related quality of life scores. After the program, there were no significant sex differences in improvement in MET level, physical activity or risk factor profile. Although men exercised more than women (increase of 557 kcal/week versus 343 kcal/week, respectively), this was not statistically significant. In health-related quality of life scores, both men and women improved in all scores, although women reported less increase than men in their level of overall vitality (P=0.016). CONCLUSION: Women are the minority of cardiac rehabilitation patients, although they appear to benefit equally well from the program.