Feasibility of restricting e-cigarettes to prescription only for smoking cessation.

E-cigarette use among youth in Canada has risen to epidemic proportions. E-cigarettes are also moderately useful smoking cessations aids. Restricting e-cigarettes to prescription only smoking cessation aids could help limit youth's access to them while keeping them available as therapies for patients who smoke conventional cigarettes. In Canada, drugs or devices must be approved by regulatory bodies such as Health Canada in order to become licensed prescription medications. A similar situation is underway in Australia, where e-cigarettes have been restricted to prescription only. This commentary explores the feasibility of a similar regulation for e-cigarettes in Canada as prescription smoking cessation aids.

Insufficient Sleep and Behavioral Health in the Military: A 5-Country Perspective.

PURPOSE OF REVIEW: The goal of this paper was to highlight the degree to which sleep, behavioral health, and leader involvement were interrelated using data from militaries in five English-speaking countries: Australia, Canada, New Zealand, the UK, and the United States. RECENT FINDINGS: Many service members reported sleeping fewer than the recommended 7 h/night: 34.9%, 67.2%, and 77.2% of respondents from New Zealand, Canada, and the United States, respectively. Countries reporting shorter sleep duration also reported fewer insomnia-related difficulties, likely reflecting higher sleep pressure from chronic sleep loss. Across all countries, sleep problems were positively correlated with behavioral health symptoms. Importantly, leader promotion of healthy sleep was positively correlated with more sleep and negatively correlated with sleep problems and behavioral health symptoms. Insufficient sleep in the military is ubiquitous, with serious implications for the behavioral health and functioning of service members. Leaders should attend to these risks and examine ways to promote healthy sleep in service members.

Endotyping in ARDS: one step forward in precision medicine.

BACKGROUND: The Berlin definition of acute respiratory distress syndrome (ARDS) includes only clinical characteristics. Understanding unique patient pathobiology may allow personalized treatment. We aimed to define and describe ARDS phenotypes/endotypes combining clinical and pathophysiologic parameters from a Canadian ARDS cohort. METHODS: A cohort of adult ARDS patients from multiple sites in Calgary, Canada, had plasma cytokine levels and clinical parameters measured in the first 24 h of ICU admission. We used a latent class model (LCM) to group the patients into several ARDS subgroups and identified the features differentiating those subgroups. We then discuss the subgroup effect on 30 day mortality. RESULTS: The LCM suggested three subgroups (n1 = 64, n2 = 86, and n3 = 30), and 23 out of 69 features made these subgroups distinct. The top five discriminating features were IL-8, IL-6, IL-10, TNF-a, and serum lactate. Mortality distinctively varied between subgroups. Individual clinical characteristics within the subgroup associated with mortality included mean PaO2/FiO2 ratio, pneumonia, platelet count, and bicarbonate negatively associated with mortality, while lactate, creatinine, shock, chronic kidney disease, vasopressor/ionotropic use, low GCS at admission, and sepsis were positively associated. IL-8 and Apache II were individual markers strongly associated with mortality (Area Under the Curve = 0.84). PERSPECTIVE: ARDS subgrouping using biomarkers and clinical characteristics is useful for categorizing a heterogeneous condition into several homogenous patient groups. This study found three ARDS subgroups using LCM; each subgroup has a different level of mortality. This model may also apply to developing further trial design, prognostication, and treatment selection.

Diabetes mellitus in pregnancy across Canada.

BACKGROUND: Contemporary estimates of diabetes mellitus (DM) rates in pregnancy are lacking in Canada. Accordingly, this study examined trends in the rates of type 1 (T1DM), type 2 (T2DM) and gestational (GDM) DM in Canada over a 15-year period, and selected adverse pregnancy outcomes. METHODS: This study used repeated cross-sectional data from the Canadian Institute of Health Information (CIHI) hospitalization discharge abstract database (DAD). Maternal delivery records were linked to their respective birth records from 2006 to 2019. The prevalence of T1DM, T2DM and GDM were calculated, including relative changes over time, assessed by a Cochrane-Armitage test. Also assessed were differences between provinces and territories in the prevalence of DM. RESULTS: Over the 15-year study period, comprising 4,320,778 hospital deliveries in Canada, there was a statistically significant increase in the prevalence of GDM and T1DM and T2DM. Compared to pregnancies without DM, all pregnancies with any form of DM had higher rates of hypertension and Caesarian delivery, and also adverse infant outcomes, including major congenital anomalies, preterm birth and large-for-gestational age birthweight. CONCLUSION: Among 4.3 million pregnancies in Canada, there has been a rise in the prevalence of DM. T2DM and GDM are expected to increase further as more overweight women conceive in Canada.

Effectiveness of an eHealth intervention for reducing psychological distress and increasing COVID-19 knowledge and protective behaviors among racialized sexual and gender minority adults: A quasi-experimental study (#SafeHandsSafeHearts).

PURPOSE: Sexual and gender minority and racialized populations experienced heightened vulnerability during the Covid-19 pandemic. Marginalization due to structural homophobia, transphobia and racism, and resulting adverse social determinants of health that contribute to health disparities among these populations, were exacerbated by the Covid-19 pandemic and public health measures to control it. We developed and tested a tailored online intervention (#SafeHandsSafeHearts) to support racialized lesbian, gay, bisexual, transgender, queer, and other persons outside of heteronormative and cisgender identities (LGBTQ+) in Toronto, Canada during the pandemic. METHODS: We used a quasi-experimental pre-test post-test design to evaluate the effectiveness of a 3-session, peer-delivered eHealth intervention in reducing psychological distress and increasing Covid-19 knowledge and protective behaviors. Individuals ≥18-years-old, resident in Toronto, and self-identified as sexual or gender minority were recruited online. Depressive and anxiety symptoms, and Covid-19 knowledge and protective behaviors were assessed at baseline, 2-weeks postintervention, and 2-months follow-up. We used generalized estimating equations and zero-truncated Poisson models to evaluate the effectiveness of the intervention on the four primary outcomes. RESULTS: From March to November 2021, 202 participants (median age, 27 years [Interquartile range: 23-32]) were enrolled in #SafeHandsSafeHearts. Over half (54.5%, n = 110) identified as cisgender lesbian or bisexual women or women who have sex with women, 26.2% (n = 53) cisgender gay or bisexual men or men who have sex with men, and 19.3% (n = 39) transgender or nonbinary individuals. The majority (75.7%, n = 143) were Black and other racialized individuals. The intervention led to statistically significant reductions in the prevalence of clinically significant depressive (25.4% reduction, p < .01) and anxiety symptoms (16.6% reduction, p < .05), and increases in Covid-19 protective behaviors (4.9% increase, p < .05), from baseline to postintervention. CONCLUSION: We demonstrated the effectiveness of a brief, peer-delivered eHealth intervention for racialized LGBTQ+ communities in reducing psychological distress and increasing protective behaviors amid the Covid-19 pandemic. Implementation through community-based organizations by trained peer counselors supports feasibility, acceptability, and the importance of engaging racialized LGBTQ+ communities in pandemic response preparedness. This trial is registered with ClinicalTrials.gov, number NCT04870723.

Substance-related poisoning hospitalizations and homelessness in Canada: a descriptive study. / Étude descriptive des liens entre les hospitalisations pour intoxication liée à la consommation de substances et l'itinérance au Canada.

INTRODUCTION: The objective of this analysis is to describe patient demographics, the context, characteristics and outcomes of a substance-related poisoning, and the recorded mental disorder of people with housing and those experiencing homelessness. METHODS: Hospitalization data for Canada (except Quebec) from 1 April 2019 to 31 March 2020 were retrieved from the Canadian Institute for Health Information (CIHI) Discharge Abstract Database using ICD-10-CA codes for up to 25 diagnoses for substance-related poisonings, homelessness status and other characteristics relevant to the patient's hospitalization. We compared the characteristics of people experiencing homelessness with those of people who were housed, and their substance-related poisoning hospitalizations, using chi-square, t tests and Fisher exact test. RESULTS: There was a higher proportion of males, younger individuals and people with recorded mental disorders among people experiencing homelessness hospitalized for a substance-related poisoning than among their housed counterparts. Substance-related poisonings among people experiencing homelessness were more likely to be accidental, involve opioids and stimulants (most frequently fentanyl and its analogues and heroin), result in lengthier hospitalizations and end with leaving the hospital against medical advice. CONCLUSION: These findings can be used to strengthen strategies and interventions to reduce substance-related harms in priority populations, particularly those experiencing homelessness.

Provincial and territorial congenital anomalies surveillance: a summary of surveillance programs across Canada. / Surveillance provinciale et territoriale des anomalies congénitales : résumé des programmes de surveillance au Canada.

The Canadian Congenital Anomalies Surveillance Network was established in 2002 to address gaps in the national surveillance of congenital anomalies (CAs) and support the sustainability of high-quality, population-based, CA surveillance systems within provinces and territories. This paper highlights the methodologies of each local CA surveillance system, noting similarities and variabilities between each system, to contribute to enhanced national CA surveillance efforts.

The Canadian Congenital Anomalies Surveillance Network was established in 2002 under the umbrella of the Canadian Perinatal Surveillance System to support highquality, population-based congenital anomalies surveillance systems in Canada. Each local congenital anomalies surveillance system covers diverse populations and geography, operates under different structures and has varying program maturity. Engagement of every jurisdiction is essential for sustaining local and national CA surveillance. Provincial and territorial CA surveillance systems are uniquely positioned to support public health priorities.

Le Réseau canadien de surveillance des anomalies congénitales a été créé en 2002, dans le cadre du Système canadien de surveillance périnatale, afin de soutenir des systèmes de surveillance des anomalies congénitales de haute qualité et fondés sur la population à l'échelle du Canada. Les systèmes locaux de surveillance des anomalies congénitales couvrent des populations et des zones géographiques diverses, fonctionnent selon des structures différentes et ont une maturité variable. La participation de chaque administration est essentielle pour soutenir la surveillance locale et nationale des anomalies congénitales. Les systèmes provinciaux et territoriaux de surveillance des anomalies congénitales sont particulièrement bien placés pour soutenir les priorités en matière de santé publique.

Disparities in positive mental health of sexual and gender minority adults in Canada. / Disparités dans la santé mentale positive des adultes faisant partie d'une minorité sexuelle ou de genre au Canada.

INTRODUCTION: The goal of this study was to examine potential disparities in positive mental health (PMH) among adults in Canada by sexual orientation and gender modality. METHODS: Using 2019 Canadian Community Health Survey (CCHS) Annual Component data (N = 57 034), we compared mean life satisfaction and the prevalence of high self-rated mental health (SRMH), happiness and community belonging between heterosexual and sexual minority adults, and between cisgender and gender minority adults. We used 2019 CCHS Rapid Response on PMH data (N = 11 486) to compare the prevalence of high psychological well-being between heterosexual and sexual minority adults. Linear and logistic regression analyses examined the between-group differences in mean life satisfaction and the other PMH outcomes, respectively. RESULTS: Sexual minority (vs. heterosexual) adults reported lower mean life satisfaction (B = -0.7, 95% CI: -0.8, -0.5) and were less likely to report high SRMH (OR = 0.4, 95% CI: 0.3, 0.5), happiness (OR = 0.4, 95% CI: 0.3, 0.5), community belonging (OR = 0.6, 95% CI: 0.5, 0.7) and psychological well-being (OR = 0.4, 95% CI: 0.3, 0.6). Differences were not always significant for specific sexual minority groups in sexstratified analyses. Gender minority adults reported lower mean life satisfaction and were less likely to report high SRMH and happiness than cisgender adults. CONCLUSION: Future research could investigate how these PMH disparities arise, risk and protective factors in these populations, how other sociodemographic factors interact with sexual orientation and gender identity to influence PMH and changes in disparities over time.

Ambulance Services Attendance for Mental Health and Overdose Before and During COVID-19 in Canada and the United Kingdom: Interrupted Time Series Study.

BACKGROUND: The COVID-19 pandemic impacted mental health and health care systems worldwide. OBJECTIVE: This study examined the COVID-19 pandemic's impact on ambulance attendances for mental health and overdose, comparing similar regions in the United Kingdom and Canada that implemented different public health measures. METHODS: An interrupted time series study of ambulance attendances was conducted for mental health and overdose in the United Kingdom (East Midlands region) and Canada (Hamilton and Niagara regions). Data were obtained from 182,497 ambulance attendance records for the study period of December 29, 2019, to August 1, 2020. Negative binomial regressions modeled the count of attendances per week per 100,000 population in the weeks leading up to the lockdown, the week the lockdown was initiated, and the weeks following the lockdown. Stratified analyses were conducted by sex and age. RESULTS: Ambulance attendances for mental health and overdose had very small week-over-week increases prior to lockdown (United Kingdom: incidence rate ratio [IRR] 1.002, 95% CI 1.002-1.003 for mental health). However, substantial changes were observed at the time of lockdown; while there was a statistically significant drop in the rate of overdose attendances in the study regions of both countries (United Kingdom: IRR 0.573, 95% CI 0.518-0.635 and Canada: IRR 0.743, 95% CI 0.602-0.917), the rate of mental health attendances increased in the UK region only (United Kingdom: IRR 1.125, 95% CI 1.031-1.227 and Canada: IRR 0.922, 95% CI 0.794-1.071). Different trends were observed based on sex and age categories within and between study regions. CONCLUSIONS: The observed changes in ambulance attendances for mental health and overdose at the time of lockdown differed between the UK and Canada study regions. These results may inform future pandemic planning and further research on the public health measures that may explain observed regional differences.

Machine learning in epidemiology: Neural networks forecasting of monkeypox cases.

This study integrates advanced machine learning techniques, namely Artificial Neural Networks, Long Short-Term Memory, and Gated Recurrent Unit models, to forecast monkeypox outbreaks in Canada, Spain, the USA, and Portugal. The research focuses on the effectiveness of these models in predicting the spread and severity of cases using data from June 3 to December 31, 2022, and evaluates them against test data from January 1 to February 7, 2023. The study highlights the potential of neural networks in epidemiology, especially concerning recent monkeypox outbreaks. It provides a comparative analysis of the models, emphasizing their capabilities in public health strategies. The research identifies optimal model configurations and underscores the efficiency of the Levenberg-Marquardt algorithm in training. The findings suggest that ANN models, particularly those with optimized Root Mean Squared Error, Mean Absolute Percentage Error, and the Coefficient of Determination values, are effective in infectious disease forecasting and can significantly enhance public health responses.

Molecular profile and epidemiological traits of Streptococcus suis isolated from diseased pigs in western Canada reveal multiple-serotype infection: Implications for disease control.

Objective: Streptococcus suis is a major agent of disease in modern swine operations, linked to increased mortality, treatment costs, and secondary infections. Although it is ubiquitous in swine, only a fraction of pigs develop clinical disease. The goals of this study were to profile isolates obtained from diseased pigs in western Canada and to investigate potential associations with disease severity. Procedure: Isolates of S. suis (n = 128) from 75 diagnostic submission and 63 premises were paired with epidemiological surveys completed by submitting practitioners (n = 22). Whole-genome sequencing was used to type isolates. Results: The most prevalent serotypes identified were 1/2 (7.8%, 10/128), 2 (9.3%, 12/128), 3 (9.3%, 12/128), and 7 (7.8%, 10/128); and sequence types 28 (17%, 23/128) and 839 (14%, 19/128). There was no association between serotype or sequence type and organ source or barn location. Approximately 74% (14/19) of the premises had diseased animals colonized by > 1 S. suis serotype, but only 1 pig was simultaneously infected with multiple serotypes and sequence types. Serotype distribution from diseased pigs in western Canada differed from that of those in other geographic regions. Conclusion: Infection of diseased pigs by multiple serotypes should be considered when disease control strategies are implemented. No association between S. suis type and isolation organ was identified.

Le profil moléculaire et les caractéristiques épidémiologiques de Streptococcus suis isolés de porcs malades dans l'ouest du Canada révèlent une infection à sérotypes multiples : implications pour la maitrise de la maladie. Objectif: Streptococcus suis est un agent pathogène majeur dans les exploitations porcines modernes, lié à une mortalité accrue, aux coûts de traitement et aux infections secondaires. Bien qu'elle soit omniprésente chez le porc, seule une fraction des porcs développe une maladie clinique. Les objectifs de cette étude étaient de dresser le profil des isolats obtenus à partir de porcs malades dans l'ouest du Canada et d'étudier les associations potentielles avec la gravité de la maladie. Procédure: Des isolats de S. suis (n = 128) provenant de 75 soumissions pour diagnostic et de 63 sites ont été associés à des enquêtes épidémiologiques réalisées auprès des praticiens soumettant les échantillons (n = 22). Le séquençage du génome entier a été utilisé pour typer les isolats. Résultats: Les sérotypes les plus répandus identifiés étaient 1/2 (7,8 %, 10/128), 2 (9,3 %, 12/128), 3 (9,3 %, 12/128) et 7 (7,8 %, 10/128); et les types de séquence 28 (17 %, 23/128) et 839 (14 %, 19/128). Il n'y avait aucune association entre le sérotype ou le type de séquence et la source d'organes ou l'emplacement de la ferme. Environ 74 % (14/19) des exploitations abritaient des animaux malades colonisés par > 1 sérotype de S. suis, mais 1 seul porc était infecté simultanément par plusieurs sérotypes et types de séquences. La répartition des sérotypes chez les porcs malades de l'ouest du Canada différait de celle des porcs d'autres régions géographiques. Conclusion: L'infection des porcs malades par plusieurs sérotypes doit être envisagée lors de la mise en oeuvre de stratégies de maitrise de la maladie. Aucune association entre le type de S. suis et l'organe d'isolement n'a été identifiée.(Traduit par Dr Serge Messier).

Temporal patterns of bovine leukemia virus infection in dairy herds in Atlantic Canada.

Objective: The primary objective was to determine the youngest age group where bovine leukemia virus (BLV)-infected dairy animals were identified. The secondary objective was to investigate associations between age-specific management practices and BLV infection status of different age groups of dairy calves and heifers. Procedure: For enrolled herds, BLV status was determined using blood samples from pre-weaned calves, weaned calves, and breeding-age heifers; and bulk tank milk from the adult herd. A questionnaire investigating age-specific management factors was administered for each herd. Ordinal logistic regression was performed to identify management factors associated with the youngest age range in which BLV was identified. Results: Fifty-three dairy herds from the 4 provinces in Atlantic Canada were enrolled. Bovine leukemia virus was most commonly earliest identified in pre-weaned heifers (18 herds, 32.1%) and the adult herd (18 herds, 32.1%). Ordinal logistic regression revealed that BLV was first identified in older age groups more often than in younger age groups when herds regrouped weaned heifers at least once, when fly control was used for breeding-age heifers, when herds practiced foot trimming on breeding-age heifers, and when bred heifers were brought in. Conclusion: Producers can use results to identify the youngest age group(s) in which BLV is identified and to tailor management strategies to prevent new infections.

Tendances temporelles de l'infection par le virus de la leucémie bovine dans les troupeaux laitiers des provinces atlantiques canadiennes. Objectif: L'objectif principal était de déterminer le groupe d'âge le plus jeune dans lequel les animaux laitiers infectés par le virus de la leucémie bovine (BLV) ont été identifiés. L'objectif secondaire était d'étudier les associations entre les pratiques de gestion spécifiques à l'âge et le statut d'infection par le BLV de différents groupes d'âge de veaux et de génisses laitiers. Procédure: Pour les troupeaux inscrits, le statut BLV a été déterminé à l'aide d'échantillons de sang provenant de veaux présevrés, de veaux sevrés et de génisses en âge de se reproduire; et de lait de réservoir en vrac du troupeau adulte. Un questionnaire portant sur les facteurs de gestion spécifiques à l'âge a été administré pour chaque troupeau. Une régression logistique ordinale a été réalisée pour identifier les facteurs de gestion associés à la tranche d'âge la plus jeune dans laquelle le BLV a été identifié. Résultats: Cinquante-trois troupeaux laitiers des quatre provinces atlantiques canadiennes ont été inscrits. Le virus de la leucémie bovine a été le plus souvent identifié le plus tôt chez les génisses pré-sevrées (18 troupeaux, 32,1 %) et dans le troupeau adulte (18 troupeaux, 32,1 %). La régression logistique ordinale a révélé que le BLV a été identifié pour la première fois plus souvent dans les groupes d'âge plus âgés que dans les groupes d'âge plus jeunes lorsque les troupeaux regroupaient au moins une fois les génisses sevrées, lorsque le contrôle des mouches était utilisé pour les génisses en âge de se reproduire, lorsque les troupeaux pratiquaient le parage des pattes des génisses en âge de se reproduire., et quand les taures saillies étaient intégrées au troupeau. Conclusion: Les producteurs peuvent utiliser les résultats pour identifier le(s) groupe(s) d'âge le plus jeune dans lequel le BLV est identifié et pour adapter les stratégies de gestion afin de prévenir de nouvelles infections.(Traduit par Dr Serge Messier).

Arthritis is associated with high nutritional risk among older Canadian adults from the Canadian Longitudinal Study on Aging.

This study assessed the association between arthritis, functional impairment, and nutritional risk (NR). Cross-sectional data were from the Canadian Longitudinal Study on Aging, a nationally representative sample of 45-85-year-old community-dwelling Canadians (n = 41,153). The abbreviated Seniors in the Community: Risk Evaluating for Eating and Nutrition II (SCREEN II-AB) Questionnaire determined NR scores (continuous), and high NR (score < 38); the Older American Resources and Services scale measured functional impairment. NR scores and status (low/high) were modelled using multiple linear and logistic regressions, respectively. Analyses adjusted for demographic characteristics, functional impairment, and health (body mass index, self-rated general and mental health). Additional analyses stratified the models by functional impairment. People with arthritis had poorer NR scores (B: - 0.35, CI - 0.48, - 0.22; p < 0.05) and increased risks of high NR (OR 1.11, 95% CI 1.06, 1.17). Among those with functional impairment, the likelihood of high NR was 31% higher in people with arthritis compared to those without arthritis (95% CI 1.12, 1.53). Among those with no functional impairment, the likelihood of high NR was 10% higher in people with arthritis compared to those without (95% CI 1.04, 1.16). These relationships differed based on the type of arthritis. Arthritis is associated with high NR in community-dwelling older adults, both with and without functional impairment. Findings highlight the need for further research on these relationships to inform interventions and improve clinical practices.

Burnout among elementary and high school teachers in three Canadian provinces: prevalence and predictors.

Background: Burnout is a longstanding issue among educators and has been associated with psychological and physical health problems such as depression, and insomnia. Objective: To assess the prevalence and predictors of the three dimensions of burnout (emotional exhaustion, depersonalization and lack of professional accomplishment) among elementary and high school teachers. Methods: This is a quantitative cross-sectional study with data collected via an online survey. The Maslach Burnout Inventory-Educator Survey (MBI-ES), the Brief Resilience Scale (BRS) and the Perceived Stress Scale were used, respectively, to assess burnout, resilience and stress among teachers. Data was collected between September 1st, 2022 and August 30th, 2023. SPSS (version 28, IBM Corp) was used for the data analysis. Results: Overall, 1912 educators received a link to the online survey via a text message, and 780 completed the burnout survey questions, resulting in a response rate of 41%. The prevalence of emotional exhaustion, depersonalization, and lack of professional accomplishment were 76.9, 23.2, and 30.8%, respectively. Participants with high-stress symptoms were 6.88 times more likely to experience emotional exhaustion (OR = 6.88; 95% CI: 3.31-14.29), 2.55 times (OR = 2.55; 95% CI: 1.65-3.93) more likely to experience depersonalization and 2.34 times (OR = 2.34; 95% CI: 1.64-3.35) more likely to experience lack of professional fulfilment. Additionally, respondents with low resilience were 3.26 times more likely to experience emotional exhaustion symptoms (OR = 3.26; 95% CI: 2.00-5.31), than those with high resilience. Males were about 2.4 times more likely to present with depersonalization compared to female teachers, whilst those who indicated their marital status as partnered or cohabiting and those who selected "other" were 3.5 and 7.3 times, respectively, more likely to present with depersonalization compared with those who were single. Finally, Physical Education were 3.8 times more likely to present with depersonalization compared with English teachers. Conclusion: The current study highlights the predictive effects of low resilience and high stress on the three dimensions of burnout among teachers in Canada. Interventions aimed at addressing systemic stress and fostering resilience are needed to reduce burnout among teachers.

Projected estimates of cancer in Canada in 2024.

BACKGROUND: Cancer surveillance data are essential to help understand where gaps exist and progress is being made in cancer control. We sought to summarize the expected impact of cancer in Canada in 2024, with projections of new cancer cases and deaths from cancer by sex and province or territory for all ages combined. METHODS: We obtained data on new cancer cases (i.e., incidence, 1984-2019) and deaths from cancer (i.e., mortality, 1984-2020) from the Canadian Cancer Registry and Canadian Vital Statistics Death Database, respectively. We projected cancer incidence and mortality counts and rates to 2024 for 23 types of cancer, overall, by sex, and by province or territory. We calculated age-standardized rates using data from the 2011 Canadian standard population. RESULTS: In 2024, the number of new cancer cases and deaths from cancer are expected to reach 247 100 and 88 100, respectively. The age-standardized incidence rate (ASIR) and mortality rate (ASMR) are projected to decrease slightly from previous years for both males and females, with higher rates among males (ASIR 562.2 per 100 000 and ASMR 209.6 per 100 000 among males; ASIR 495.9 per 100 000 and ASMR 152.8 per 100 000 among females). The ASIRs and ASMRs of several common cancers are projected to continue to decrease (i.e., lung, colorectal, and prostate cancer), while those of several others are projected to increase (i.e., liver and intrahepatic bile duct cancer, kidney cancer, melanoma, and non-Hodgkin lymphoma). INTERPRETATION: Although the overall incidence of cancer and associated mortality are declining, new cases and deaths in Canada are expected to increase in 2024, largely because of the growing and aging population. Efforts in prevention, screening, and treatment have reduced the impact of some cancers, but these short-term projections highlight the potential effect of cancer on people and health care systems in Canada.

Adaptive immune responses to two-dose COVID-19 vaccine series in healthy Canadian adults ≥ 50 years: a prospective, observational cohort study.

To evaluate immune responses to COVID-19 vaccines in adults aged 50 years and older, spike protein (S)-specific antibody concentration, avidity, and function (via angiotensin-converting enzyme 2 (ACE2) inhibition surrogate neutralization and antibody dependent cellular phagocytosis (ADCP)), as well as S-specific T cells were quantified via activation induced marker (AIM) assay in response to two-dose series. Eighty-four adults were vaccinated with either: mRNA/mRNA (mRNA-1273 and/or BNT162b2); ChAdOx1-S/mRNA; or ChAdOx1-S/ChAdOx1-S. Anti-S IgG concentrations, ADCP scores and ACE2 inhibiting antibody concentrations were highest at one-month post-second dose and declined by four-months post-second dose for all groups. mRNA/mRNA and ChAdOx1-S/mRNA schedules had significantly higher antibody responses than ChAdOx1-S/ChAdOx1-S. CD8+ T-cell responses one-month post-second dose were associated with increased ACE2 surrogate neutralization. Antibody avidity (total relative avidity index) did not change between one-month and four-months post-second dose and did not significantly differ between groups by four-months post-second dose. In determining COVID-19 correlates of protection, a measure that considers both antibody concentration and avidity should be considered.