Rising syphilis rates in Canada, 2011-2020.

Background: Syphilis rates are of public health concern in Canada, with multiple jurisdictions reporting outbreaks over the past five years. The objective of this article is to describe trends in infectious and congenital syphilis in Canada 2011-2020. Methods: Routine surveillance of syphilis is conducted through the Canadian Notifiable Disease Surveillance System (CNDSS). In response to rising rates of syphilis, all provinces and territories (P/Ts) have also submitted enhanced surveillance data on infectious syphilis to the Public Health Agency of Canada through the Syphilis Outbreak Investigation Coordinating Committee (SOICC) starting in 2018. Descriptive analyses of CNDSS and SOICC surveillance data 2011-2020 by age, sex, pregnancy status, male sexual orientation and P/Ts were performed. Results: The national rate of infectious syphilis increased from 5.1 per 100,000 population in 2011 to 24.7 per 100,000 population in 2020.The rates increased in almost all P/Ts, with the Prairie provinces reporting the greatest relative increases from 2016 to 2020 (more than 400%). Rates in males were consistently higher than rates in females over the past 10 years; however, from 2016 to 2020, rates among females increased by 773%, compared with 73% among males. Although the proportion of cases who self-identify as gay, bisexual and other men who have sex with men decreased from 54% to 38% between 2018 and 2020, they still represent a high proportion of cases (according to data from eight P/Ts). From 2016 to 2020, rates of infectious syphilis increased in every age group, especially in females aged 15-39 years. Confirmed early congenital syphilis cases for 2020 increased considerably from prior years, with 50 cases reported in 2020, compared with 4 cases in 2016. Conclusion: Infectious and congenital syphilis rates are a growing concern in Canada and the nature of the syphilis epidemics across Canada appears to be evolving, as evidenced by recent trends. More data and research are needed to better understand the drivers associated with the recent changes in the epidemiology of syphilis in Canada.

A scoping review documenting cancer outcomes and inequities for adults living with intellectual and/or developmental disabilities.

INTRODUCTION: Emerging evidence suggests adults with intellectual and/or developmental disabilities (IDD) may be at risk of inequities in cancer experiences and outcomes. Individuals with IDD may experience multiple barriers that could worsen outcomes and experience. These barriers may be connected to features of IDD or the healthcare system overall. Future research and program planning to support adults with IDD and cancer must be informed by evidence that acknowledges potential disparities, underlying determinants, and knowledge deficits. OBJECTIVE: We conducted a scoping review to systematically map the evidence describing and comparing cancer-related outcomes along the cancer continuum from risk to mortality for adults with IDD. We identified specific factors observed to influence those outcomes. METHODS: We followed the expanded Arksey & O'Malley framework for conducting the scoping review. We searched for literature in PubMed and Embase databases. We abstracted cancer-related data, IDD-related data, and data related to physical and social determinants of health. RESULTS: Of the 2796 studies retrieved, 38 were included for review. Most studies focused on screening outcomes and experiences. Studies reported that adults with IDD experienced inequities at various points along the cancer continuum. Numerous social and physical determinants of health influenced the experiences and outcomes of adults with IDD. CONCLUSION: This scoping review identified significant gaps in the literature. Of note was the focus on cancer screening and lack of attention to larger systems of oppression that may influence poor cancer experiences and outcomes for adults with IDD. There is strong need to improve both quality and quantity of research in this area.

A potential role for insulin treatment during pregnancy in reducing postpartum psychological distress in maternal obesity: an administrative population health study.

BACKGROUND: Studies have found an association between obesity and an increased risk for peripartum depression, which has also been linked to decreased placental lactogen levels. In addition, women with obesity treated for gestational diabetes with insulin were found to have increased levels of placental lactogen. Treatment options exist for perinatal and postpartum depression however they pose a risk to the developing offspring. Thus, prevention as well as markers for early identification of peripartum depression are needed. Therefore, our study objective is to identify the association between insulin treatment in pregnancy and the risk of postpartum psychological distress (abbreviated here as PPD) among cohorts of women with and without obesity. METHODS: Administrative health data (2002/03-2018/19) were used to identify a cohort of women (age 15+ years) who gave birth (N = 250,746) and had no pre-existing mood/anxiety disorders or diabetes (N = 222,863 excluded). Women were then divided into two groups: lean (N = 17,975) and with obesity (N = 9908), which was identified by a recorded maternal weight of > 38 to < 65.6 kg and ≥ 85 to < 186 kg (respectively). The risk of PPD within one year after delivery with and without insulin treatment was assessed by Poisson regression analysis. Models were adjusted for maternal age group (at pregnancy start date) and area-level income (at delivery). RESULTS: The unadjusted risk of PPD was higher in the obesity group (8.56%; 95% CI 8.00-9.15) than in the lean group (6.93%; 95% CI 6.56-7.33). When no insulin treatment was given during pregnancy, mothers with obesity had a significantly higher risk of PPD than the lean group (aRR 1.27; 95% CI 1.17-1.39; p < 0.0001). However, when women with obesity and insulin treatment were compared to the lean group with no insulin treatment, no significant difference in the risk of PPD was observed between the groups (aRR 1.30; 95% CI 0.83-2.02; p = 0.248). CONCLUSION: This is the first study to demonstrate a positive association between insulin treatment in pregnancy among women with obesity and reduced PPD rates, suggesting insulin as a possible preventative measure. However, the biological mechanism behind the observed positive effect of insulin on PPD rates remains to be investigated.