How Can We Keep Immigrant Travelers Healthy? Health Challenges Experienced by Canadian South Asian Travelers Visiting Friends and Relatives.

Immigrant travelers who visit friends and relatives (VFR travelers) experience substantially higher rates of travel-related infections than other travelers, in part due to low uptake of pretravel health advice. While barriers to accessing advice have been identified, better characterization is needed to inform targeted interventions. We sought to understand how South Asian VFR travelers perceived and responded to travel-related health risks by conducting group interviews with 32 adult travelers from an ethnoculturally diverse Canadian region. Travelers positioned themselves as knowledgeable of key health risks, despite not seeking pretravel health advice. Their responses to risks were pragmatic and rooted in experience, but often constrained by competing concerns, including rushed travel, familial obligations, cost, and a desire to preserve authentic experiences. Moving beyond risk awareness to reinforcing the value of medical advice and intervention, in a manner that is sensitive to these unique concerns, is needed when delivering tailored health promotion messages to VFR travelers.

Causes and consequences of gestational diabetes in South Asians living in Canada: results from a prospective cohort study.

BACKGROUND: The reasons for the increased risk of gestational diabetes among South Asian women are not well understood. We sought to identify the determinants of gestational diabetes and its impact on newborn health in a prospective birth cohort of South Asian women and their babies. METHODS: As part of the South Asian Birth Cohort (START) prospective birth cohort study in Ontario, we recruited 1012 South Asian women with singleton pregnancies in the second trimester of pregnancy between July 11, 2011, and Nov. 10, 2015. We collected health information and physical measurements and administered an oral glucose tolerance test. Birth weight and skinfold thickness measurements were obtained from their newborns, and cord blood glucose and insulin levels were measured. RESULTS: The incidence of gestational diabetes was 36.3% (95% confidence interval [CI] 33.3%-39.3%); the age-standardized rate was 40.7%. Factors associated with gestational diabetes included maternal age (odds ratio [OR] 1.08 [95% CI 1.04-1.12]), family history of diabetes (OR 1.65 [95% CI 1.26-2.17]), prepregnancy weight (OR 1.025 [95% CI 1.01-1.04]) and low diet quality (OR 1.57 [95% CI 1.16-2.12]). Maternal height was protective against gestational diabetes (OR 0.97 [95% CI 0.95-0.99]). The population attributable risk due to prepregnancy body mass index and low diet quality was 37.3%. Compared to newborns of women without gestational diabetes, those of women with gestational diabetes had a significantly higher birth weight (3267 [standard error (SE) 23] g v. 3181 [SE 17] g, p = 0.005), greater skinfold thickness (11.7 [SE 0.1] mm v. 11.2 [SE 0.1] mm, p = 0.007) and lower insulin sensitivity (glucose/insulin ratio 0.092 [SE 0.009] mmol/pmol v. 0.129 [SE 0.006] mmol/pmol, p = 0.001). INTERPRETATION: The modifiable risk factors of prepregnancy weight and low diet quality accounted for 37% of the population attributable risk of gestational diabetes in our cohort. Intervention studies to lower prepregnancy weight and to prevent gestational diabetes among South Asian women in high-income countries are needed.

Effective communication of public health guidance to emergency department clinicians in the setting of emerging incidents: a qualitative study and framework.

BACKGROUND: Evidence to inform communication between emergency department clinicians and public health agencies is limited. In the context of diverse, emerging public health incidents, communication is urgent, as emergency department clinicians must implement recommendations to protect themselves and the public. The objectives of this study were to: explore current practices, barriers and facilitators at the local level for communicating public health guidance to emergency department clinicians in emerging public health incidents; and develop a framework that promotes effective communication of public health guidance to clinicians during emerging incidents. METHODS: A qualitative study was conducted using semi-structured interviews with 26 key informants from emergency departments and public health agencies in Ontario, Canada. Data were analyzed inductively and the analytic approach was guided by concepts of complexity theory. RESULTS: Emergent themes corresponded to challenges and strategies for effective communication of public health guidance. Important challenges related to the coordination of communication across institutions and jurisdictions, and differences in work environments across sectors. Strategies for effective communication were identified as the development of partnerships and collaboration, attention to specific methods of communication used, and the importance of roles and relationship-building prior to an emerging public health incident. Following descriptive analysis, a framework was developed that consists of the following elements: 1) Anticipate; 2) Invest in building relationships and networks; 3) Establish liaison roles and redundancy; 4) Active communication; 5) Consider and respond to the target audience; 6) Leverage networks for coordination; and 7) Acknowledge and address uncertainty. The qualities inherent in local relationships cut across framework elements. CONCLUSIONS: This research indicates that relationships are central to effective communication between public health agencies and emergency department clinicians at the local level. Our framework which is grounded in qualitative evidence focuses on strategies to promote effective communication in the emerging public health incident setting and may be useful in informing practice.

The evidence base of primary research in public health emergency preparedness: a scoping review and stakeholder consultation.

BACKGROUND: Effective public health emergency preparedness and response systems are important in mitigating the impact of all-hazards emergencies on population health. The evidence base for public health emergency preparedness (PHEP) is weak, however, and previous reviews have noted a substantial proportion of anecdotal event reports. To investigate the body of research excluding the anecdotal reports and better understand primary and analytical research for PHEP, a scoping review was conducted with two objectives: first, to develop a thematic map focused on primary research; and second, to use this map to inform and guide an understanding of knowledge gaps relevant to research and practice in PHEP. METHODS: A scoping review was conducted based on established methodology. Multiple databases of indexed and grey literature were searched based on concepts of public health, emergency, emergency management/preparedness and evaluation/evidence. Inclusion and exclusion criteria were applied iteratively. Primary research studies that were evidence-based or evaluative in nature were included in the final group of selected studies. Thematic analysis was conducted for this group. Stakeholder consultation was undertaken for the purpose of validating themes and identifying knowledge gaps. To accomplish this, a purposive sample of researchers and practicing professionals in PHEP or closely related fields was asked to complete an online survey and participate in an in-person meeting. Final themes and knowledge gaps were synthesized after stakeholder consultation. RESULTS: Database searching yielded 3015 citations and article selection resulted in a final group of 58 articles. A list of ten themes from this group of articles was disseminated to stakeholders with the survey questions. Survey findings resulted in four cross-cutting themes and twelve stand-alone themes. Several key knowledge gaps were identified in the following themes: attitudes and beliefs; collaboration and system integration; communication; quality improvement and performance standards; and resilience. Resilience emerged as both a gap and a cross-cutting theme. Additional cross-cutting themes included equity, gender considerations, and high risk or at-risk populations. CONCLUSIONS: In this scoping review of the literature enhanced by stakeholder consultation, key themes and knowledge gaps in the PHEP evidence base were identified which can be used to inform future practice-oriented research in PHEP.

Outbreak of type E foodborne botulism linked to traditionally prepared salted fish in Ontario, Canada.

On April 17, 2012, two adult females presented to the hospital with symptoms of botulism. Patient A displayed shortness of breath, increasing lethargy, ptosis, and fixed and dilated pupils, and was intubated after admission. Patient B presented with shortness of breath, vomiting, and stridor. Both patients consumed a meal consisting of a traditionally prepared salted fish, fesikh, on the evening of April 16 during a gathering to celebrate Sham el-Nessim, an Egyptian holiday marking the beginning of spring. Foodborne botulism was suspected based on symptoms and consumption of potentially hazardous food. Antitoxin was administered to both patients on April 18. Another attendee of the Sham el-Nessim gathering (patient C), who also consumed the implicated food, developed symptoms consistent with botulism on April 18. Clinical specimens from all three symptomatic attendees tested positive for either Clostridium botulinum or type E botulinum neurotoxin. Fesikh remaining from the shared meal contained both type E botulinum neurotoxin and C. botulinum type E organisms. Unsold fesikh shad and fesikh sardines tested positive for C. botulinum type E, while unsold fesikh mullet pieces in oil tested positive for both C. botulinum type E and type E botulinum neurotoxin. After consultation with public health investigators, all fesikh products were voluntarily withheld from sale by the manufacturer prior to laboratory confirmation of contamination. Additional illnesses were likely prevented by these precautionary holds, which underscores the importance of timely public health action based on epidemiological evidence available in advance of laboratory results. This is the first documented outbreak of foodborne botulism associated with fesikh to occur in Canada.

Hepatic alveolar hydatid disease (Echinococcus multilocularis) in a boxer dog from southern Ontario.

A 2-year-old boxer dog from southern Ontario was evaluated because of acute onset lethargy. Exploratory laparotomy revealed a hemorrhagic, destructive, liver mass. Histology, immunohistochemistry, and polymerase chain reaction confirmed Echinococcus multilocularis as the cause of the hepatic mass. This constitutes the first description of endemic E. multilocularis in Ontario.

Hydatidose alvéolaire hépatique(Echinococcus multilocularis)chez un chien Boxer du Sud de l'Ontario. Un chien Boxer âgé de 2 ans du Sud de l'Ontario a été évalué en raison d'un début soudain d'une léthargie. Une laparatomie exploratoire a révélé une masse hépatique hémorragique et destructrice. L'histologie, l'immunohistochimie et l'amplification en chaîne par la polymérase ont confirmé Echinococcus multilocularis comme la cause de la masse hépatique. Il s'agit de la première description d'E. multilocularis endémique en Ontario.(Traduit par Isabelle Vallières).

A new surveillance and spatio-temporal visualization tool SIMID: SIMulation of infectious diseases using random networks and GIS.

In this paper we discuss the SIMID tool for simulation of the spread of infectious disease, enabling spatio-temporal visualization of the dynamics of influenza outbreaks. SIMID is based on modern random network methodology and implemented within the R and GIS frameworks. The key advantage of SIMID is that it allows not only for the construction of a possible scenario for the spread of an infectious disease but also for the assessment of mitigation strategies, variation and uncertainty in disease parameters and randomness in the progression of an outbreak. We illustrate SIMID by application to an influenza epidemic simulation in a population constructed to resemble the Region of Peel, Ontario, Canada.