Exploring the well-being of community pharmacy professionals, turnover intention and patient safety: Time to include operational responsibility.

Background: The COVID-19 pandemic added significant occupational pressures on community pharmacists. The objective of this research project was to investigate the level of distress and burnout among community pharmacy professionals and its association with their retention within their occupation as well as patient safety outcomes. Method: We conducted a cross-sectional study on 722 community pharmacy professionals from all Canadian provinces using an online survey, including scientifically validated measures. The data were analyzed using multiple regression analysis. Results: In Canada, 85% of community pharmacy professionals reported their mental health had suffered since the COVID-19 pandemic. Younger pharmacy professionals and those paid hourly reported a worsening level of mental health and an increasing level of turnover intention. Pharmacists with more dynamic/disrupted work schedules and those working for a large pharmacy chain (more than 25 pharmacies in Canada) reported lower levels of mental health quality. Pharmacy professionals working in pharmacies that are open more than 70 hours a week reported a lower level of patient safety culture. Pharmacists' mental health was the significant predictor of their turnover intention, implying a heightened risk to professional effectiveness and retention. Compassion satisfaction was positively associated with patient safety culture and safety behaviour, while compassion fatigue and secondary traumatic stress were significantly associated with pharmacists' level of risk-taking behaviours. Conclusion: This study emphasized the importance of prioritizing the mental health and well-being of community pharmacy professionals and demonstrated individual and systemic factors predicting the well-being and turnover intention of community pharmacists, as well as patient safety culture within their pharmacy. This research makes a case to consider actions to shift the monitoring focus from community pharmacists (also known as "individual responsibility") to community pharmacies (also known as "operational responsibility") for managing patient safety. Additionally, community pharmacists should be provided with the professional autonomy to affect their working conditions and alleviate the stress that has the potential to negatively affect the delivery of care.

Virtual care and the influence of a pandemic: Necessary policy shifts to drive digital innovation in healthcare.

The potential for virtual healthcare to improve access to primary care services in Canada has long been a topic of discussion; however, implementation has been slow despite growing interest among the public. Non-essential service lockdowns implemented in 2020 in response to the COVID-19 pandemic catalyzed rapid and widespread uptake of virtual healthcare delivery. It is important to consider how to maintain equitable access to virtual care following the pandemic. We conducted a narrative scoping review to understand barriers related to the sustained adoption of virtual primary care delivery in Canada. Barriers at the system, healthcare provider, and patient levels were related to digital health infrastructure, and the regulatory environment governing virtual care provision and remuneration for healthcare professionals. The article identifies areas where policy shifts by health system leaders could sustain the longer-term availability of Canadian virtual care services.

Drug use, homelessness and health: responding to the opioid overdose crisis with housing and harm reduction services.

BACKGROUND: Canada is in the midst of an opioid overdose crisis and Alberta has one of the highest opioid use rates across the country. Populations made vulnerable through structural inequities who also use opioids, such as those who are unstably housed, are at an increased risk of experiencing harms associated with opioid use. The main purpose of this study was to explore if there was an association between unstable housing and hospital use for people who use opioids. METHODS: Analysis utilized self-reported data from the Alberta Health and Drug Use Survey which surveyed 813 Albertans in three cities. Hospital use was modeled using a logistic regression with our primary variable of interest being housing unstable status. Chi square tests were conducted between hospital use and variables associated with demographics, characteristics of drug use, health characteristics, and experiences of receiving services to establish model inclusion. RESULTS: Results revealed a significant association between housing instability and hospital use with unstably housed individuals twice as likely torequire hospital care. CONCLUSIONS: Results highlight the importance of concurrently addressing housing instability alongside the provision of harm reduction services such as safe supply and supervised consumption sites. These findings have significant implications for policy and policymakers during the opioid overdose epidemic, and provide a foundation for future areas of research.

Recognizing and responding to women experiencing homelessness with gendered and trauma-informed care.

BACKGROUND: The purpose of this study is to highlight the experiences of women who are often hidden in what we know and understand about homelessness, and to make policy and practice recommendations for women-centred services including adaptations to current housing interventions. METHODS: Three hundred survey interviews were conducted with people experiencing homelessness in Calgary, Alberta, Canada. The survey instrument measured socio-demographics, adverse childhood experiences, mental and physical health, and perceived accessibility to resources. Eighty-one women participants were identified as a subsample to be examined in greater depth. Descriptive statistics and logistic regressions were calculated to provide insight into women respondents' characteristics and experiences of homelessness and how they differed from men's experiences. RESULTS: Women's experiences of homelessness are different from their male counterparts. Women have greater mental health concerns, higher rates of diagnosed mental health issues, suicidal thoughts and attempts, and adverse childhood trauma. The results should not be considered in isolation, as the literature suggests, because they are highly interconnected. CONCLUSION: In order to ensure that women who are less visible in their experiences of homelessness are able to access appropriate services, it is important that service provision is both gender specific and trauma-informed. Current Housing First interventions should be adapted to ensure women's safety is protected and their unique needs are addressed.

Effect of provincial spending on social services and health care on health outcomes in Canada: an observational longitudinal study.

BACKGROUND: Escalating health care spending is a concern in Western countries, given the lack of evidence of a direct connection between spending and improvements in health. We aimed to determine the association between spending on health care and social programs and health outcomes in Canada. METHODS: We used retrospective data from Canadian provincial expenditure reports, for the period 1981 to 2011, to model the effects of social and health spending (as a ratio, social/health) on potentially avoidable mortality, infant mortality and life expectancy. We used linear regressions, accounting for provincial fixed effects and time, and controlling for confounding variables at the provincial level. RESULTS: A 1-cent increase in social spending per dollar spent on health was associated with a 0.1% (95% confidence interval [CI] 0.04% to 0.16%) decrease in potentially avoidable mortality and a 0.01% (95% CI 0.01% to 0.02%) increase in life expectancy. The ratio had a statistically nonsignificant relationship with infant mortality (p = 0.2). INTERPRETATION: Population-level health outcomes could benefit from a reallocation of government dollars from health to social spending, even if total government spending were left unchanged. This result is consistent with other findings from Canada and the United States.

Using the ages and stages questionnaire in the general population as a measure for identifying children not at risk of a neurodevelopmental disorder.

BACKGROUND: Early detection of neurodevelopmental disorders (NDDs) enables access to early interventions for children. We assess the Ages and Stages Questionnaire (ASQ)'s ability to identify children with a NDD in population data. METHOD: Children 4 to 5 years old in the National Longitudinal Survey of Children and Youth (NLSCY) from cycles 5 to 8 were included. The sensitivity, specificity, positive and negative predictive values were calculated for the ASQ at 24, 27, 30, 33, 36 and 42 months. Fixed effects regression analyses assessed longitudinal associations between domain scores and child age. RESULTS: Specificity for the ASQ was high with 1SD or 2SD cutoffs, indicating good accuracy in detecting children who will not develop a NDD, however the sensitivity varied over time points and cut-offs. Sensitivity for the 1 SD cutoff at 24 months was above the recommended value of 70% for screening. Differences in ASQ domains scores between children with and without NDD increases with age. CONCLUSIONS: The high specificity and negative predictive values of the ASQ support its use in identifying children who are not at the risk of developing a NDD. The capacity of the ASQ to identify children with a NDD in the general population is limited except for the ASQ-24 months with 1SD and can be used to identify children at risk of NDD.

An overview of the statistical methods reported by studies using the Canadian community health survey.

BACKGROUND: The Canadian Community Health Survey (CCHS) is a cross-sectional survey that has collected information on health determinants, health status and the utilization of the health system in Canada since 2001. Several hundred articles have been written utilizing the CCHS dataset. Previous analyses of statistical methods utilized in the literature have focused on a particular journal or set of journals to understand the statistical literacy required for understanding the published research. In this study, we describe the statistical methods referenced in the published literature utilizing the CCHS dataset(s). METHODS: A descriptive study was undertaken of references published in Medline, Embase, Web of Knowledge and Scopus associated with the CCHS. These references were imported into a Java application utilizing the searchable Apache Lucene text database and screened based upon pre-defined inclusion and exclusion criteria. Full-text PDF articles that met the inclusion criteria were then used for the identification of descriptive, elementary and regression statistical methods referenced in these articles. The identification of statistical methods occurred through an automated search of key words on the full-text articles utilizing the Java application. RESULTS: We identified 4811 references from the 4 bibliographical databases for possible inclusion. After exclusions, 663 references were used for the analysis. Descriptive statistics such as means or proportions were presented in a majority of the articles (97.7%). Elementary-level statistics such as t-tests were less frequently referenced (29.7%) than descriptive statistics. Regression methods were frequently referenced in the articles: 79.8% of articles contained reference to regression in general with logistic regression appearing most frequently in 67.1% of the articles. CONCLUSIONS: Our study shows a diverse set of analysis methods being referenced in the CCHS literature, however, the literature heavily relies on only a subset of all possible statistical tools. This information can be used in identifying gaps in statistical methods that could be applied to future analysis of public health surveys, insight into training and educational programs, and also identifies the level of statistical literacy needed to understand the published literature.

A repeated cross-sectional study of socio-economic inequities in dietary sodium consumption among Canadian adults: implications for national sodium reduction strategies.

INTRODUCTION: In many countries including Canada, excess consumption of dietary sodium is common, and this has adverse implications for population health. Socio-economic inequities in sodium consumption seem likely, but research is limited. Knowledge of socio-economic inequities in sodium consumption is important for informing population-level sodium reduction strategies, to ensure that they are both impactful and equitable. METHODS: We examined the association between socio-economic indicators (income and education) and sodium, using two outcome variables: 1) sodium consumption in mg/day, and 2) reported use of table salt, in two national surveys: the 1970/72 Nutrition Canada Survey and the 2004 Canadian Community Health Survey, Cycle 2.2. This permitted us to explore whether there were any changes in socio-economic patterning in dietary sodium during a time period characterized by modest, information-based national sodium reduction efforts, as well as to provide baseline information against which to examine the impact (equitable or not) of future sodium reduction strategies in Canada. RESULTS: There was no evidence of a socio-economic inequity in sodium consumption (mg/day) in 2004. In fact findings pointed to a positive association in women, whereby women of higher education consumed more sodium than women of lower education in 2004. For men, income was positively associated with reported use of table salt in 1970/72, but negatively associated in 2004. CONCLUSIONS: An emerging inequity in reported use of table salt among men could reflect the modest, information-based sodium reduction efforts that were implemented during the time frame considered. However, for sodium consumption in mg/day, we found no evidence of a contemporary inequity, and in fact observed the opposite effect among women. Our findings could reflect data limitations, or they could signal that sodium differs from some other nutrients in terms of its socio-economic patterning, perhaps reflecting very high prevalence of excess consumption. It is possible that socio-economic inequities in sodium consumption will emerge as excess consumption declines, consistent with fundamental cause theory. It is important that national sodium reduction strategies are both impactful and equitable.

Longitudinal analysis of the association between removal of dental amalgam, urine mercury and 14 self-reported health symptoms.

BACKGROUND: Mercury vapor poses a known health risk with no clearly established safe level of exposure. Consequently there is debate over whether the level of prolonged exposure to mercury vapor from dental amalgam fillings, combining approximately 50% mercury with other metals, is sufficiently high to represent a risk to health. The objective of our study is to determine if mercury exposure from amalgam fillings is associated with risk of adverse health effects. METHODS: In a large longitudinal non-blind sample of participants from a preventative health program in Calgary, Canada we compared number of amalgam fillings, urine mercury measures and changes in 14 self-reported health symptoms, proposed to be mercury dependent sub-clinical measures of mental and physical health. The likelihood of change over one year in a sample of persons who had their fillings removed was compared to a sample of persons who had not had their fillings removed. We use non-parametric statistical tests to determine if differences in urine mercury were statistically significant between sample groups. Logistic regression models were used to estimate the likelihood of observing symptom improvement or worsening in the sample groups. RESULTS: At baseline, individuals with dental amalgam fillings have double the measured urine mercury compared to a control group of persons who have never had amalgam fillings. Removal of amalgam fillings decreases measured urine mercury to levels in persons without amalgam fillings. Although urine mercury levels in our sample are considered by Health Canada to be too low to pose health risks, removal of amalgam fillings reduced the likelihood of self-reported symptom deterioration and increased the likelihood of symptom improvement in comparison to people who retained their amalgam fillings. CONCLUSIONS: Our findings suggest that mercury exposure from amalgam fillings adversely impact health and therefore are a health risk. The use of safer alternative materials for dental fillings should be encouraged to avoid the increased risk of health deterioration associated with unnecessary exposure to mercury.

The usefulness of "corrected" body mass index vs. self-reported body mass index: comparing the population distributions, sensitivity, specificity, and predictive utility of three correction equations using Canadian population-based data.

BACKGROUND: National data on body mass index (BMI), computed from self-reported height and weight, is readily available for many populations including the Canadian population. Because self-reported weight is found to be systematically under-reported, it has been proposed that the bias in self-reported BMI can be corrected using equations derived from data sets which include both self-reported and measured height and weight. Such correction equations have been developed and adopted. We aim to evaluate the usefulness (i.e., distributional similarity; sensitivity and specificity; and predictive utility vis-à-vis disease outcomes) of existing and new correction equations in population-based research. METHODS: The Canadian Community Health Surveys from 2005 and 2008 include both measured and self-reported values of height and weight, which allows for construction and evaluation of correction equations. We focused on adults age 18-65, and compared three correction equations (two correcting weight only, and one correcting BMI) against self-reported and measured BMI. We first compared population distributions of BMI. Second, we compared the sensitivity and specificity of self-reported BMI and corrected BMI against measured BMI. Third, we compared the self-reported and corrected BMI in terms of association with health outcomes using logistic regression. RESULTS: All corrections outperformed self-report when estimating the full BMI distribution; the weight-only correction outperformed the BMI-only correction for females in the 23-28 kg/m2 BMI range. In terms of sensitivity/specificity, when estimating obesity prevalence, corrected values of BMI (from any equation) were superior to self-report. In terms of modelling BMI-disease outcome associations, findings were mixed, with no correction proving consistently superior to self-report. CONCLUSIONS: If researchers are interested in modelling the full population distribution of BMI, or estimating the prevalence of obesity in a population, then a correction of any kind included in this study is recommended. If the researcher is interested in using BMI as a predictor variable for modelling disease, then both self-reported and corrected BMI result in biased estimates of association.

Transitioning to a guaranteed annual income and the impact on activities of daily living in older adults: Evidence from public pensions in Canada using the CLSA.

OBJECTIVE: Statistically model the likelihood of changes in the activities of daily living (ADLs) over time for three groups of older adults: those on a pension at all time periods, those never on a pension, and those who transition onto a public pension. METHODS: Our study used data from the Canadian Longitudinal Study on Aging (CLSA), a large national survey. We used data from baseline (2010-2015) and the first follow-up wave (2015-2018). We used logistic regression to model the likelihood of ADL changes in males and females by pension receipt status, controlling for several potential confounders and allowing for the impact of public pensions to be modified by baseline income. RESULTS: The magnitudes of the estimates indicated that those who transition to a public pension are less likely to report ADL degradation and more likely to report ADL improvement compared to those with no public pension. In the lowest baseline income group, those who transitioned onto a pension at follow-up had a 15% (male) or 11% (female) lower likelihood of reporting degraded ADL scores compared to those not receiving a pension at follow-up. Those who transitioned onto a pension in the lowest income group were more likely to report an improved ADL score at follow-up. CONCLUSION: Our results could provide evidence for the potential health benefits of more comprehensive guaranteed annual income programs beyond the pension program. The penalty of being low-income was mitigated by the stability of the pension income in terms of ADL improvement or degradation.

RéSUMé: OBJECTIF: Modeler statistiquement la probabilité de changements des activités de la vie quotidienne (AVQ) à travers le temps pour trois groupes d'adultes âgés : ceux qui reçoivent une pension tout le temps, ceux qui ne reçoivent jamais une pension, et ceux qui transitionnent à recevoir une pension pendant la période d'étude. MéTHODES: Notre étude a utilisé les données de l'Étude longitudinale canadienne sur le vieillissement (ÉLCV), une grande enquête nationale. On a utilisé les données de base (2010-2015) et de la première vague (2015-2018). On a utilisé une régression logistique pour modeler la probabilité de changement des AVQ dans les hommes et les femmes par statut de réception de pension, en ajustant plusieurs facteurs de confusion potentielles et pour que l'impact de pensions publiques soient modifiées par le revenu de base. RéSULTATS: La magnitude des estimations a indiqué que ceux qui font une transition à une pension publique sont moins probables de signaler une dégradation des AVQ et plus probables de déclarer une amélioration comparés à ceux qui ne reçoivent pas une pension publique. Parmi le groupe de revenu de base le plus bas, ceux qui ont transitionné à recevoir une pension au suivi avaient 15 % (hommes) ou 11 % (femmes) moins de chance de déclarer une évaluation de AVQ dégradée comparé à ceux qui ne recevaient pas une pension au suivi. Ceux qui ont transitionné à recevoir une pension dans le groupe de revenu de base le plus bas étaient plus probables de déclarer une évaluation de AVQ améliorée au suivi. CONCLUSION: Nos résultats pourraient apporter la preuve pour les avantages potentiels des programmes compréhensifs de revenu garanti qui vont plus loin que les pensions publiques. La pénalité de faire partie du groupe de revenu le plus bas est atténuée par la stabilité des revenus de pension en ce qui concerne l'amélioration ou la dégradation des AVQ.

The association between allostatic load and guaranteed annual income using the Canadian Longitudinal Study on Aging: A cross-sectional analysis of the benefits of guaranteed public pensions.

BACKGROUND: Old Age Security (OAS) represents an public policy through which income-related inequalities in health may be improved. The goal of this cross-sectional study was to investigate the health benefits of receiving OAS in financially insecure older Canadians. METHODS: Using data from the Canadian Longitudinal Study on Aging (CLSA) (n=15,691), ordered logistic regression was used to measure associations between financial insecurity and allostatic load. RESULTS: Receiving OAS as highest personal income source appeared to remove the health penalty of being financially insecure. While financial insecurity was associated with worse allostatic load in both males and females not receiving OAS, those receiving OAS as highest personal income source had better allostatic load compared to other financially insecure older adults (ORM: 0.398, 95 % CI: 0.227, 0.696; ORF: 0.677, 95 % CI: 0.483, 0.949). DISCUSSION: While longitudinal data would be needed to draw causal inferences, these results suggest OAS may play a role improving health outcomes and narrowing income-related health inequalities. Such findings may have important implications on older adults, other vulnerable populations, and future directions of Canadian health and public policy.

A "food insecurity poverty line" to replace the official threshold in Canadian rural and urban settings? A single-person household perspective.

Household food insecurity is associated with both low income and high cost of living, it is a potentially better measure for consumption compared to income. We use data on food insecurity and income from 10 years of the Canadian Community Health Survey (2007-2017) of single-person households (n = 145,044) to estimate the probability of being food insecure at the Canadian poverty thresholds (Market Basket Measure thresholds, or MBMs), and determine the income required to reach that probability in each MBM region, aggregated by province and rural/urban status. A regression model shows the probability of being food insecure at the MBM is approximately 30% which we call the Food Insecurity Poverty Line (FIPL). The income required to meet the FIPL is substantially different from the MBM, sometimes 1.25 times the MBM. This implies that food insecurity is a potential sentinel measure for poverty.

The effectiveness and decay of public health policy actions on infection-control behaviour in the general public: Evidence from a low-COVID prevalence jurisdiction.

BACKGROUND: Public health policies designed to influence individuals' infection-control behaviour are a tool for governments to help prevent the spread of disease. Findings on the impacts of policies are mixed and there is limited information on the effects of removing restrictions and how policies impact behavioural trends. METHODS: We use low-acuity emergency department visits from 12 hospitals in New Brunswick, Canada, (January 2017 -October 2021) as a proxy for infection-control behaviour and provide insight into the effects of the COVID-19 virus on a population with a low prevalence of cases. Quasi-experimental techniques (event studies) are applied to estimate the magnitude and persistence of effects of specific events (e.g., policy changes), to control for COVID-19 cases and vaccines, and to explore how the effectiveness of policy changes during the pandemic as more policies are introduced. RESULTS: Initial tightening of restrictions on March 11, 2020 reduced low-acuity emergency department visits by around 60% and reached a minimum after 30 days. Relaxing policies on social gatherings and personal services gradually increased low-acuity emergency department visits by approximately 50% after 44 days. No effects were found from policies lifting all restrictions, and reinstating a state of emergency on July 31, 2021, and September 24, 2021. CONCLUSION: These results suggest that policy interventions are less likely to be effective at influencing infection control behaviour with time and more policies introduced, and that tracking and publicly reporting case numbers can influence infection control behaviour.

SHoC-IVC: Does assessment of the inferior vena cava by point-of-care ultrasound independently predict fluid status in spontaneously breathing patients with undifferentiated hypotension?

BACKGROUND: Accurately determining the fluid status of a patient during resuscitation in the emergency department (ED) helps guide appropriate fluid administration in the setting of undifferentiated hypotension. Our goal was to determine the diagnostic utility of point-of-care ultrasound (PoCUS) for inferior vena cava (IVC) size and collapsibility in predicting a volume overload fluid status in spontaneously breathing hypotensive ED patients. METHODS: This was a post hoc secondary analysis of the SHOC-ED data, a prospective randomized controlled trial investigating PoCUS in patients with undifferentiated hypotension. We prospectively collected data on IVC size and collapsibility for 138 patients in the PoCUS group using a standard data collection form, and independently assigned a fluid status (volume overloaded, normal, volume deplete) from a composite clinical chart review blinded to PoCUS findings. The primary outcome was the diagnostic performance of IVC characteristics on PoCUS in the detection of a volume overloaded fluid status. RESULTS: One hundred twenty-nine patients had completed determinant IVC assessment by PoCUS, with one hundred twenty-five receiving successful final fluid status determination, of which one hundred and seven were classified as volume deplete, thirteen normal, and seven volume overloaded. A receiver operating characteristic (ROC) curve was plotted using several IVC size and collapsibility categories. The best overall performance utilized the combined parameters of a dilated IVC (> 2.5 cm) with minimal collapsibility (less than 50%) which had a sensitivity of 85.7% and specificity of 86.4% with an area under the curve (AOC) of 0.92 for predicting an volume overloaded fluid status. CONCLUSION: IVC PoCUS is feasible in spontaneously breathing hypotensive adult ED patients, and demonstrates potential value as a predictor of a volume overloaded fluid status in patients with undifferentiated hypotension. IVC size may be the preferred measure.

RéSUMé: CONTEXTE: La détermination précise de l'état du liquide d'un patient pendant la réanimation au service des urgences (SU) aide à guider l'administration appropriée du liquide dans le cadre d'une hypotension indifférenciée. Notre objectif était de déterminer l'utilité diagnostique de l'échographie au point de soins (PoCUS) pour la taille de la veine cave inférieure (IVC) et l'collapsibilité dans la prédiction d'un état de liquide de surcharge volumique chez les patients souffrant d'une hypotension respiratoire spontanée. MéTHODES: Il s'agissait d'une analyse secondaire post-hoc des données SHOC-ED, un essai contrôlé randomisé prospectif examinant PoCUS chez des patients atteints d'hypotension indifférenciée. Nous avons collecté prospectivement des données sur la taille et la collapsibilité des IVC pour 138 patients du groupe PoCUS à l'aide d'un formulaire de collecte de données standard, et attribué indépendamment un état de fluide (volume surchargé, normal, épuisement du volume) à partir d'une revue de dossier clinique composite mise en aveugle aux résultats PoCUS. Le résultat principal était la performance diagnostique des caractéristiques IVC sur PoCUS dans la détection d'un état de fluide surchargé en volume. RéSULTATS: 129 patients avaient terminé l'évaluation IVC des déterminants par PoCUS, dont 125 ont reçu une détermination finale du statut hydrique, dont 107 ont été classés comme étant une diminution du volume, 13 normaux et 7 surchargés. Une courbe des caractéristiques de fonctionnement du récepteur (ROC) a été tracée en utilisant plusieurs catégories de taille et d'affaissement IVC. La meilleure performance globale a utilisé les paramètres combinés d'une IVC dilatée (> 2,5 cm) avec une collapsibilité minimale (moins de 50%) qui avait une sensibilité de 85,7% et une spécificité de 86,4% avec une zone sous la courbe (AOC) de 0,92 pour prédire un état de fluide surchargé en volume. CONCLUSION: IVC PoCUS est faisable chez les patients adultes souffrant d'une hypotension respiratoire spontanée et démontre une valeur potentielle en tant que prédicteur d'un état de liquide surchargé en volume chez les patients atteints d'hypotension indifférenciée. La taille IVC peut être la mesure préférée.

A ban on marketing of foods/beverages to children: the who, why, what and how of a population health intervention.

There is increasing recognition in Canada and elsewhere of the need for population-level interventions related to diet. One example of such an intervention is a ban on the marketing of foods/beverages to children, for which several health organizations have or are in the process of developing position statements. Considering the federal government's inaction to impose restrictions that would yield meaningful impact, there is opportunity for the health community to unite in support of a stronger set of policies. However, several issues and challenges exist, some of which we outline in this commentary. We emphasize that, despite challenges, the present and predicted future of diet-related illness in Canadian children is such that population-level intervention is necessary and becoming increasingly urgent, and there is an important role for the health community in facilitating action.

Effect of the COVID-19 pandemic on the socioeconomic composition of emergency department presentations.

OBJECTIVES: This study highlights how socioeconomic trends in the emergency department (ED) for low-acuity visits change with the onset of COVID-19, identifies societal inequities exacerbated by the pandemic, and demonstrates the geographical regions where these inequities occur. METHODS: We accessed 1,285,000 ED visits from 12 different facilities across New Brunswick from January 2017 to October 2020. Using a deprivation index developed by Statistics Canada as a measure of socioeconomic status, and controlling for additional factors, we perform a logistic regression to determine the influence of the COVID-19 pandemic on low-acuity visits of individuals from the most deprived quintile (Q5). We constructed a heat map of New Brunswick to highlight regions of high deprivation. RESULTS: The proportion of Q5 individuals in the ethnocultural composition domain accessing the ED for low-acuity visits increased from 22.91% to 24.72% with the onset of the pandemic. Our logistic regression showed the log odds of being considered Q5 in the ethnocultural composition domain when visiting the ED for a low-acuity reason increased by 6.3% if the visit occurred during the pandemic, and increased by 101.6% if the visit occurred in one of the 3 major regions of New Brunswick. CONCLUSION: Individuals visiting EDs for low-acuity reasons during the COVID-19 pandemic were more likely to be from the most diverse quintile in the ethnocultural domain, and the inequities were concentrated in the most urban regions in New Brunswick. This demonstrates that urban areas are where inequities are disproportionately faced for ethnically diverse individuals and demonstrates where policies could be focused.

RéSUMé: OBJECTIFS: Notre étude montre l'évolution des tendances socioéconomiques des visites aux services d'urgence (SU) pour des affections mineures avec l'apparition de la COVID-19 et indique les iniquités sociétales exacerbées par la pandémie et les régions géographiques où ces iniquités se manifestent. MéTHODE: Nous avons eu accès à 1 285 000 visites aux SU de 12 établissements du Nouveau-Brunswick entre janvier 2017 et octobre 2020. À l'aide d'un indice de défavorisation élaboré par Statistique Canada pour mesurer le statut socioéconomique et après avoir apporté des ajustements pour tenir compte des effets d'autres facteurs, nous avons effectué une analyse de régression logistique pour déterminer l'influence de la pandémie de COVID-19 sur les visites de personnes du quintile le plus défavorisé (Q5) pour des affections mineures. Nous avons construit une carte de densité du Nouveau-Brunswick pour représenter les régions très défavorisées. RéSULTATS: La proportion de personnes du Q5 dans le domaine de la composition ethnoculturelle ayant visité les SU pour des affections mineures est passée de 22,91 % à 24,72 % après le début de la pandémie. Selon notre analyse de régression logistique, la probabilité logarithmique pour une personne ayant visité les SU pour une affection mineure d'être considérée comme faisant partie du Q5 dans le domaine de la composition ethnoculturelle augmentait de 6,3 % si la visite avait eu lieu durant la pandémie, et elle augmentait de 101,6 % si la visite avait eu lieu dans l'une des trois grandes régions du Nouveau-Brunswick. CONCLUSION: Les personnes ayant visité les SU pour des affections mineures durant la pandémie de COVID-19 étaient plus susceptibles d'appartenir au quintile le plus diversifié dans le domaine ethnoculturel, et les iniquités étaient concentrées dans les régions les plus urbaines du Nouveau-Brunswick. L'étude démontre que c'est dans les agglomérations urbaines que les personnes d'origines ethniques diverses font face à des iniquités démesurées, et elle indique où les politiques pourraient être ciblées.

Alcohol access and purchasing behaviour during COVID-19 pandemic restrictions: An exploration of sociodemographic, health and psychosocial correlates in two Canadian provinces.

INTRODUCTION: Alcohol access has changed in Canada during the COVID-19 pandemic. This study compares the use of two novel purchasing modes (via delivery and in excess/stockpiling) to traditional, in-person purchasing to determine if their use is associated with sociodemographic and psychosocial characteristics, perceived COVID-19 health risk or consumption frequency. METHODS: We draw on cross-sectional survey data from 2000 residents of the Canadian provinces of Nova Scotia and New Brunswick, ages 19 years and older that were administered online and by telephone. Associations between purchasing modes and sociodemographic and psychosocial characteristics, perceived COVID-19 health risk or consumption frequency were assessed using logistic regression. RESULTS: About 70% of people who drink purchased in-person, 17% used delivery and 30% purchased in excess/stockpiled. Sociodemographic and psychosocial attributes varied among those at increased odds of using each purchasing mode. Those at higher COVID-19 health risk were at higher odds of getting alcohol delivered. Increased drinking frequency was associated with alcohol delivery and purchasing in excess/stockpiling. DISCUSSION AND CONCLUSIONS: This study highlights the need for increased public health considerations regarding changes to alcohol regulations. Alcohol delivery and purchasing in excess/stockpiling is positively associated with heavier drinking. Drinkers at higher COVID-19 health risk were more likely to purchase online for delivery, which suggests novel purchasing modes may serve a partial public health function.

With great inequality comes great responsibility: the role of government spending on population health in the presence of changing income distributions.

OBJECTIVES: To determine the association between provincial government health and social spending and population health outcomes in Canada, separately for men and women, and account for the potential role of income inequality in modifying the association. METHODS: We used data for nine Canadian provinces, 1981 to 2017. Health outcomes and demographic data are from Statistics Canada; provincial spending data are from provincial public accounts. We model the ratio of social-to-health spending ("the ratio") on potentially avoidable mortality (PAM), life expectancy (LE), potential years of life lost (PYLL), infant mortality, and low birth weight baby incidence. We interact the ratio with the Gini coefficient to allow for income inequality modification. RESULTS: When the Gini coefficient is equal to its average (0.294), the ratio is associated with desirable health outcomes for adult men and women. For example, among women, a 1% increase in the ratio is associated with a 0.04% decrease in PAM, a 0.05% decrease in PYLL, and a 0.002% increase in LE. When the Gini coefficient is 0.02 higher than average, the relationship between the ratio and outcomes is twice as strong as when the Gini is at its average, other than for PAM for women. Infant-related outcomes do not have a statistically significant association with the ratio. CONCLUSION: Overall, outcomes for men and women have similar associations with the ratio. Inequality increases the return to social spending, implying that those who benefit the most from social spending reap higher benefits during periods of higher inequality.

RéSUMé: OBJECTIFS: Déterminer l'association entre les dépenses sociales et de santé du gouvernement provincial et les conditions de santé de la population du Canada, séparément pour hommes et femmes, et expliquer le role que l'inégalité salariale pourrait jouer dans la modification de cette association. MéTHODES: Nous avons utilisé les données pour neuf provinces canadiennes, de 1981 à 2017. Les conditions de santé et les données démographiques parviennent de Statistiques Canada, les données sur les dépenses provinciales parviennent de comptes publiques provinciaux. Nous avons modélisé le rapport de dépenses social-à-santé (« le rapport ¼) sur la mortalité potentiellement évitable (MPE), l'espérance de vie (EV), les années de vie potentielles perdues (AVPP), la mortalité d'enfant et l'incidence d'un poids à la naissance faible. Nous interagissons le rapport avec le coefficient de Gini pour permettre la modification d'inégalité salariale. RéSULTATS: Quand le coefficient de Gini est égal à sa moyenne (0,294), le rapport est associé avec des conditions de santé désirables pour hommes et femmes adultes. Par example, en femmes, une augmentation de 1 % dans le rapport est associé avec une réduction de 0,04 % en MPE, une réduction de 0,05 % en AVPP, et une augmentation de 0,002 % en EV. Quand le coefficient de Gini est 0,02 plus haut que la moyenne, la relation entre le rapport et les résultats est deux fois plus fort que quand le Gini est à sa moyenne, à part la MPE en femmes. Les résultats liés aux nouveau-nés n'ont pas une association statistique significative avec le rapport. CONCLUSION: Globalement, les résultats pour hommes et femmes ont des associations semblables avec le rapport. L'inégalité augmente le retour aux dépenses sociales, insinuant que ceux et celles qui profitent le plus de dépenses sociales récoltent plus de bénéfices pendant des périodes de plus grande inégalité.