Using the precaution adoption process model and the health belief model to understand radon testing and mitigation: a pre-post quasi-experimental study.

BACKGROUND: Despite being the leading cause of lung cancer for non-smokers, few Canadians take action to test for and mitigate radon. This study's aim was twofold: (1) to investigate predictors of radon testing and mitigation using the Precaution Adoption Process Model (PAPM) and Health Belief Model (HBM); and (2) to assess the impact on beliefs of receiving radon results above health guidelines. METHODS: A convenience sample within Southeastern Ontario households was recruited to test their homes for radon (N = 1,566) for a pre-post quasi-experimental study. Prior to testing, participants were surveyed on risk factors and HBM constructs. All participants whose homes tested above the World Health Organization's radon guideline (N = 527) were surveyed after receiving their results and followed for up to 2 years after. Participants were classified into PAPM stages and regression analyses were conducted to determine predictors between different stages (from deciding to test onwards). Paired bivariate analyses compared responses before and after receiving results. RESULTS: Perceived benefits from mitigating was associated with progressing through all stages in the study's scope. Perceived susceptibility to and severity of illness and perceptions of cost and time to mitigate were associated with progression through some PAPM stages. Homes with smokers or individuals under 18 were associated with not progressing through some stages. Home radon level was associated with mitigation. Attitudes towards many HBM constructs significantly decreased after receiving a high radon result. CONCLUSIONS: Public health interventions should target specific radon beliefs and stages to ensure households test and mitigate for radon.

Asymptomatic surveillance testing for COVID-19 in health care professional students: lessons learned from a low prevalence setting.

The novel coronavirus disease of 2019 (COVID-19) pandemic has severely impacted the training of health care professional students because of concerns of potential asymptomatic transmission to colleagues and vulnerable patients. From May 27th, 2020, to June 23rd 2021; at a time when B.1.1.7 (alpha) and B.1.617.2 (delta) were the dominant circulating variants, PCR testing was conducted on 1,237 nasopharyngeal swabs collected from 454 asymptomatic health care professional students as they returned to their studies from across Canada to Kingston, ON, a low prevalence area during that period for COVID-19. Despite 46.7% of COVID-19 infections occurring in the 18-29 age group in Kingston, severe-acute-respiratory coronavirus-2 was not detected in any of the samples suggesting that negligible asymptomatic infection occurred in this group and that PCR testing in this setting may not be warranted as a screening tool.

COVID-19 Vaccine Uptake in Southeastern Ontario, Canada: Monitoring and Addressing Health Inequities.

CONTEXT: Implementation of a population-based COVID-19 vaccine strategy, with a tailored approach to reduce inequities in 2-dose coverage, by a mid-sized local public health agency in southeastern Ontario, Canada. PROGRAM: Coverage maps and crude and age-standardized coverage rates by material and social deprivation, urban/rural status, and sex were calculated biweekly and reviewed by local public health planners. In collaboration with community partners, the results guided targeted strategies to enhance uptake for marginalized populations. EVALUATION: The largest gaps in vaccine coverage were for those living in more materially deprived areas and rural residents-coverage was lower by 10.9% (95% confidence interval: -11.8 to -10.0) and 9.3% (95% confidence interval: -10.4 to -8.1) for these groups compared with living in less deprived areas and urban residents, respectively. The gaps for all health equity indicators decreased statistically significantly over time. Targeted strategies included expanding clinic operating hours and availability of walk-in appointments, mobile clinics targeted to marginalized populations, leveraging primary care partners to provide pop-up clinics in rural and materially and socially deprived areas, and collaborating with multiple partners to coordinate communication efforts, especially in rural areas. DISCUSSION: The scale and scope of monitoring and improving local vaccine uptake are unprecedented. Regular review of health equity indicators provided critical situational awareness for decision makers, allowing partners to align and tailor strategies locally and in collaboration with one another. Health care providers and pharmacies/pharmacists are key partners who require innovative support to increase uptake in marginalized groups. Continued engagement of other community partners such as schools, municipalities, and local service groups is also crucial. A "hyper local" approach is needed along with commitment from partners in all sectors and at all levels to reduce barriers to vaccination that lie further upstream for marginalized groups.

Development and assessment of a hospital admissions-based syndromic surveillance system for COVID-19 in Ontario, Canada: ACES Pandemic Tracker.

BACKGROUND: The COVID-19 pandemic has continued to pose a major global public health risk. The importance of public health surveillance systems to monitor the spread and impact of COVID-19 has been well demonstrated. The purpose of this study was to describe the development and effectiveness of a real-time public health syndromic surveillance system (ACES Pandemic Tracker) as an early warning system and to provide situational awareness in response to the COVID-19 pandemic in Ontario, Canada. METHODS: We used hospital admissions data from the Acute Care Enhanced Surveillance (ACES) system to collect data on pre-defined groupings of symptoms (syndromes of interest; SOI) that may be related to COVID-19 from 131 hospitals across Ontario. To evaluate which SOI for suspected COVID-19 admissions were best correlated with laboratory confirmed admissions, laboratory confirmed COVID-19 hospital admissions data were collected from the Ontario Ministry of Health. Correlations and time-series lag analysis between suspected and confirmed COVID-19 hospital admissions were calculated. Data used for analyses covered the period between March 1, 2020 and September 21, 2020. RESULTS: Between March 1, 2020 and September 21, 2020, ACES Pandemic Tracker identified 22,075 suspected COVID-19 hospital admissions (150 per 100,000 population) in Ontario. After correlation analysis, we found laboratory-confirmed hospital admissions for COVID-19 were strongly and significantly correlated with suspected COVID-19 hospital admissions when SOI were included (Spearman's rho = 0.617) and suspected COVID-19 admissions when SOI were excluded (Spearman's rho = 0.867). Weak to moderate significant correlations were found among individual SOI. Laboratory confirmed COVID-19 hospital admissions lagged in reporting by 3 days compared with suspected COVID-19 admissions when SOI were excluded. CONCLUSIONS: Our results demonstrate the utility of a hospital admissions syndromic surveillance system to monitor and identify potential surges in severe COVID-19 infection within the community in a timely manner and provide situational awareness to inform preventive and preparatory health interventions.

Exploratory study of "real world" implementation of a clinical poverty tool in diverse family medicine and pediatric care settings.

BACKGROUND: Poverty is associated with increased morbidity related to multiple child and adult health conditions and increased risk of premature death. Despite robust evidence linking income and health, and some recommendations for universal screening, poverty screening is not routinely conducted in clinical care. METHODS: We conducted an exploratory study of implementing universal poverty screening and intervention in family medicine and a range of pediatric care settings (primary through tertiary). After attending a training session, health care providers (HCPs) were instructed to perform universal screening using a clinical poverty tool with the question "Do you ever have difficulty making ends meet at the end of the month?" for the three-month implementation period. HCPs tracked the number of patients screened and a convenience sample of their patients were surveyed regarding the acceptability of being screened for poverty in a healthcare setting. HCPs participated in semi-structured focus groups to explore barriers to and facilitators of universal implementation of the tool. RESULTS: Twenty-two HCPs (10 pediatricians, 9 family physicians, 3 nurse practitioners) participated and 150 patients completed surveys. Eighteen HCPs participated in focus groups. Despite the self-described motivation of the HCPs, screening rates were low (9% according to self-reported numbers). The majority of patients either supported (72%) or were neutral (22%) about the appropriateness of HCPs screening for and intervening on poverty. HCPs viewed poverty as relevant to clinical care but identified time constraints, physician discomfort, lack of expertise and habitual factors as barriers to implementation of universal screening. CONCLUSIONS: Poverty screening is important and acceptable to clinicians and patients. However, multiple barriers need to be addressed to allow for successful implementation of poverty screening and intervention in health care settings.

Retrieving and applying knowledge to different examples promotes transfer of learning.

Introducing variability during learning often facilitates transfer to new contexts (i.e., generalization). The goal of the present study was to explore the concept of variability in an area of research where its effects have received little attention: learning through retrieval practice. In four experiments, we investigated whether retrieval practice with different examples of a concept promotes greater transfer than repeated retrieval practice with the same example. Participants watched video clips from a lecture about geological science and answered application questions about concepts: either the same question three times or three different questions. Experiments 3 and 4 also included conditions that involved repeatedly studying the information in the application questions (either the same example or three different examples). Two days later, participants took a final test with new application questions. All four experiments showed that variability during retrieval practice produced superior transfer of knowledge to new examples. Experiments 3 and 4 also showed a testing effect and a benefit from studying different examples. Overall, these findings suggest that repeatedly retrieving and applying knowledge to different examples is a powerful method for acquiring knowledge that will transfer to a variety of new contexts. (PsycINFO Database Record

Microbial source tracking of private well water samples across at-risk regions in southern Ontario and analysis of traditional fecal indicator bacteria assays including culture and qPCR.

Many people living in rural areas rely on privately owned wells as their primary source of drinking water. These water sources are at risk for fecal contamination of human, wildlife, and livestock origin. While traditional bacteriological testing involves culture-based methods, microbial source tracking (MST) assays present an opportunity to additionally determine the source of fecal contamination. This study investigated the main host sources of contamination in private well water samples with high levels of Escherichia coli (E. coli), using MST with human and multi-species specific markers. Fecal contamination of human origin was detected in approximately 50% of samples, indicating that current contamination prevention strategies require reconsideration. The relationship between cattle density and fecal contamination of bovine origin was investigated using a Bovine Bacteroidales specific MST assay. Regional variations of microbial sources were examined, and may inform local primary prevention strategies. Additionally, in order to assess MST and E. coli quantitative real time polymerase chain reaction (qPCR) assays as indicators of fecal contamination, these were compared to E. coli culture methods. Variation in results was observed across all assay methods investigated, suggesting the most appropriate routine bacteriological testing methodology cannot be determined without comparison to a method that directly detects the presence of fecal contamination.

Bacteriological testing of private well water: a trends and guidelines assessment using five years of submissions data from southeastern Ontario.

OBJECTIVE: Rural populations are at an elevated risk of gastrointestinal illness, as they are dependent on private groundwater sources, and water quality remains the responsibility of the owner. Previous research suggests that only a minority of well water owners test their wells for bacteriological contamination. The aim of this study was to use testing records, in conjunction with current provincial guidelines, to assess submission rates and temporal trends in southeastern Ontario. METHODS: Using five years of data (2008-2012) from the Public Health Ontario Laboratory in Kingston, Ontario, submissions of well water samples from unique properties (identified through geocoding) were descriptively analyzed. Temporal trends in guideline compliance were tested using a Cochran Armitage test. Finally, correlations between time and submission numbers were investigated using a 10-year provincial dataset to identify long-term temporal trends. RESULTS: There were 107,547 submissions in the five years studied, 84% of which were geocoded, culminating in 30,687 unique properties. Although 11%-12% of owners met the guidelines in any given year, only 0.3% met them every year in the five-year study. Statistically significant decreases were found temporally both in the number of properties that met current guidelines and in all samples tested. CONCLUSIONS: This study is the first to use submission records, rather than surveys, to definitively demonstrate that private well water submission guidelines are not being met in Ontario. However, there are no consistent guidelines across the country or continent, and limited supporting scientific literature is available. Significant research is required to develop evidence-based policies.

Microbial source tracking and spatial analysis of E. coli contaminated private well waters in southeastern Ontario.

Private water supplies, which are the primary source of drinking water for rural communities in developed countries, are at risk of becoming fecally contaminated. It is important to identify the source of contamination in order to better understand and address this human health risk. Microbial source tracking methods using human, bovine and general Bacteroidales markers were performed on 716 well water samples from southeastern Ontario, which had previously tested positive for Escherichia coli. The results were then geospatially analyzed in order to elucidate contamination patterns. Markers for human feces were found in nearly half (49%) of all samples tested, and a statistically significant spatial cluster was observed. A quarter of the samples tested positive for only general Bacteroidales markers (25.7%) and relatively few bovine specific marker positives (12.6%) were found. These findings are fundamental to the understanding of pathogen dynamics and risk in the context of drinking well water and will inform future research regarding host-specific pathogens in private well water samples.

Triage and protocol recommendations for the parasitology laboratory based on an epidemiological investigation of parasite diagnostics in Ontario laboratories.

OBJECTIVES: A study was performed using a subset of Ontario laboratory parasitology data, with three objectives: to describe parasitic infections in Ontario; to identify risk factors for acquiring a parasitic infection using routinely collected information; and to use this information to assess current protocols for parasite testing in laboratories and, in turn, to propose alternatives to optimize the allocation of laboratory resources. METHODS: All parasitology records from January 4, 2010 to September 14, 2010 were reviewed descriptively and risk factor analyses were performed using information collected from requisitions. These results were used to develop preliminary alternative protocols, which considered high-throughput screening tests and inclusion/exclusion criteria for ova and parasite testing; these were then retrospectively analyzed with the dataset to determine appropriateness. RESULTS: Of the 29,260 records analyzed, 10% were multiple samples from single patients submitted on the same day, of which 98% had the same result. Three percent of all parasite tests were positive, with the most prevalent parasites being (in ascending order) Dientamoeba fragilis, Giardia lamblia, Cryptosporidium species and Entamoeba histolytica/dispar. Age and sex were found to be weak risk factors, while rural living was found to be a moderate risk factor for D fragilis, G lamblia and Cryptosporidium infections. The strongest risk factor was travel history, especially for nonendemic parasites. The retrospective analysis of six alternative protocols identified four that may be more efficient than current procedures. CONCLUSIONS: The present study demonstrated that current protocols may be redundant and can be optimized to target prevalent parasites and populations with high risk factors.

OBJECTIFS: Une étude a été menée d'après un sous-groupe de données des laboratoires de parasitologie de l'Ontario pour réaliser trois objectifs : décrire les infections parasitaires en Ontario, déterminer les facteurs de risque d'infection parasitaire d'après la collecte systématique d'information et utiliser l'information pour évaluer les protocoles actuels respectés dans les tests parasitaires en laboratoire, puis proposer des solutions pour optimiser l'affectation des ressources de laboratoire. MÉTHODOLOGIE: Les chercheurs ont effectué une recherche descriptive de tous les dossiers de parasitologie entre le 4 janvier et le 14 septembre 2010, ainsi que des analyses des facteurs de risque à l'aide de l'information figurant dans les réquisitions. Ils ont utilisé les résultats pour préparer de nouveaux protocoles préliminaires, qui tenaient compte des tests de dépistage à haut débit et des critères d'inclusion et d'exclusion des tests d'œufs et de parasites. Ils ont ensuite fait l'analyse rétrospective de l'ensemble des données pour en déterminer la pertinence. RÉSULTATS: Sur les 29 260 dossiers analysés, 10 % provenaient d'échantillons multiples du même patient soumis le même jour, dont 98 % donnaient les mêmes résultats. Par ailleurs, 3 % de tous les tests parasitaires étaient positifs, les parasites les plus prévalents étant (par ordre ascendant) le Dientamoeba fragilis, le Giardia lamblia, les espèces de Cryptosporidium et l'Entamoeba histolytica/dispar. L'âge et le sexe étaient des facteurs de risque faibles, tandis que la vie en milieu rural était un facteur de risque modéré d'infections à D fragilis, à G lamblia et à Cryptosporidium. Les antécédents de voyage étaient les principaux facteurs de risque, particulièrement pour les parasites non endémiques. L'analyse rétrospective des six nouveaux protocoles a établi que quatre d'entre eux seraient plus efficaces que les protocoles actuels. CONCLUSIONS: La présente étude a démontré que les protocoles actuels seraient redondants et pourraient être optimisés pour cibler les parasites prévalents et les populations présentant des facteurs de risque élevés.

A spatial analysis of private well water Escherichia coli contamination in southern Ontario.

Research to date has provided limited insight into the complexity of water-borne pathogen transmission. Private well water supplies have been identified as a significant pathway in infectious disease transmission in both the industrialised and the developing world. Using over 90,000 private well water submission records representing approximately 30,000 unique well locations in south-eastern Ontario, Canada, a spatial analysis was performed in order to delineate clusters with elevated risk of E. coli contamination using 5 years of data (2008-2012). Analyses were performed for all years independently and subsequently compared to each other. Numerous statistically significant clusters were identified and both geographic stability and variation over time were examined. Through the identification of spatial and temporal patterns, this study provides the basis for future investigations into the underlying causes of bacterial groundwater contamination, while identifying geographic regions that merit particular attention to public health interventions and improvement of water quality.

Emergency department surveillance as a proxy for the prediction of circulating respiratory viral disease in Eastern Ontario.

BACKGROUND: Seasonal outbreaks of winter respiratory viruses are responsible for increases in morbidity and mortality in the community. Previous studies have used hospitalizations, intensive care unit and emergency department (ED) visits as indicators of seasonal influenza incidence. OBJECTIVES: To evaluate whether ED visits can be used as a proxy to detect respiratory viral disease outbreaks, as measured by laboratory confirmation. METHODS: An Emergency Department Syndromic Surveillance system was used to collect ED chief complaints in Eastern Ontario from 2006 to 2010. Comparable laboratory-confirmed cases of respiratory viral infections were collected from the Public Health Ontario Laboratory in Kingston, Ontario. Correlations between ED visits and laboratory-confirmed cases were calculated. RESULTS: Laboratory-confirmed cases of selected respiratory viruses were significantly correlated with ED visits for respiratory and fever/influenza-like illness. In particular, respiratory syncytial virus (Spearman's rho = 0.593), rhinovirus (Spearman's rho = 0.280), influenza A (Spearman's rho = 0.528), influenza B (Spearman's rho = 0.426) and pH1N1 (Spearman's rho = 0.470) increased laboratory test levels were correlated with increased volume of ED visits across a number of age demographics. For the entire study population and all studied viruses, the Spearman's rho was 0.702, suggesting a strong correlation with ED visits. Laboratory-confirmed cases lagged in reporting by between one and two weeks for influenza A and pH1N1 compared with ED visit volume. CONCLUSION: These findings support the use of an Emergency Department Syndromic Surveillance system to track the incidence of respiratory viral disease in the community. These methods are efficient and can be performed using automated electronic data entry versus the inherent delays in the primary care sentinel surveillance system, and can aid the timely implementation of preventive and preparatory health interventions.

HISTORIQUE: Les éclosions saisonnières des virus respiratoires hivernaux sont responsables d'augmentations de la morbidité et de la mortalité dans la collectivité. Les études antérieures faisant appel aux hospitalisations, aux séjours aux unités de soins intensifs et aux consultations à l'urgence comme indicateurs de l'incidence d'influenza saisonnière. OBJECTIFS: Évaluer si les consultations à l'urgence pour déceler les éclosions de maladies respiratoires virales peuvent remplacer les confirmations mesurées en laboratoire. MÉTHODOLOGIE: Les chercheurs ont utilisé un système de surveillance syndromique des urgences pour colliger les principaux problèmes ayant suscité une consultation à l'urgence entre 2006 et 2010 dans l'est de l'Ontario. Ils ont colligé des cas comparables d'infections respiratoires virales confirmés en laboratoire auprès des Laboratoires de santé publique de l'Ontario situés à Kingston, en Ontario. Ils ont calculé les corrélations entre les consultations à l'urgence et les cas confirmés en laboratoire. RÉSULTATS: Les cas confirmés en laboratoire de certains virus respiratoires possédaient une corrélation significative avec les consultations à l'urgence en raison de maladies respiratoire, liées à la fièvre ou de type grippal. Notamment, l'augmentation en laboratoire des taux de virus respiratoire syncytial (Rho de Spearman = 0,593), de rhinovirus (Rho de Spearman = 0,280), d'influenza A (Rho de Spearman = 0,528), d'influenza B (Rho de Spearman = 0,426) et de grippe pH1N1 (Rho de Spearman = 0,470) était corrélée avec l'augmentation du volume de consultations à l'urgence dans plusieurs groupes d'âge. Dans l'ensemble de la population et des virus à l'étude, le Rho de Spearman s'établissait à 0,702, ce qui laisse supposer une forte corrélation avec les consultations à l'urgence. Les déclarations de cas d'influenza A et de grippe pH1N1 confirmés en laboratoire avaient de une à deux semaines de retard par rapport au volume de consultations à l'urgence. CONCLUSION: Ces résultats appuient le recours à un système de surveillance syndromique des urgences pour suivre l'incidence de maladies respiratoires virales dans la collectivité. Ces méthodes sont efficaces et peuvent être effectuées au moyen de saisies de données électroniques automatisées plutôt que de s'associer aux délais inhérents au système de surveillance sentinelle en soins de première ligne, et elles peuvent contribuer à la mise en œuvre rapide d'interventions de santé préventives et préparatoires.