University of Toronto Journal of Public Health最新文献

{"title":"Comparisons of Propensity Score Methods for Time to Event Outcomes: Evaluation through Simulations and Oral Squamous Cell Carcinoma Case Study","authors":"Sophie Ma, B. I. Said, A. Hosni, Wei Xu, S. Keshavarzi","doi":"10.33137/utjph.v2i2.36761","DOIUrl":"https://doi.org/10.33137/utjph.v2i2.36761","url":null,"abstract":"Introduction & Objective: In observational studies, it is recommended to use propensity score (PS) methods or covariate adjustment for confounding effect adjustment. However, few guidelines are available regarding the choice of PS approaches or covariate adjustment for the best performance in a particular data. In this study, we compared different PS methods and conventional covariate adjustment to investigate the treatment effect for the overall population on time-to-event outcomes. \u0000Methods: In the Monte Carlo simulations, we compared the hazard ratio (HR) and precision estimated using covariate adjustment and eight different PS approaches, including matching, stratification, and inverse probability of treatment weighting (IPTW). In the Oral Squamous-Cell Carcinoma Cancer case study, we applied the aforementioned PS approaches to compare the effect of receiving post-operative radiation therapy (PORT) and having engraftable tumors on different time-to-event clinical outcomes. \u0000Results: In the simulations, both IPTW and covariate adjustment produced unbiased HR estimates with small uncertainty. In the case study, covariate adjustment showed that patients with engraftable tumors were twice as likely to have local/regional recurrence (HR 1.98 [1.23, 3.18], p-value<0.005) and any recurrence or death (HR 2.02 [1.38, 2.96], p-value<0.001); patients received PORT were twice as likely to develop either local, regional, or distance recurrence (HR 2.12 [1.32, 3.41], p-value<0.005). Results produced by IPTW were consistent with covariate adjustment method (within ± 0.1 differences). \u0000Conclusion: Covariate adjustment and the IPTW method performed well across simulations and the case study. In practice, care should be taken to select the most suitable method when estimating the treatment, exposure or intervention effect on time-to-event outcomes.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130406185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Challenge of Vaccine Nationalism","authors":"Keltie Hamilton, Devanshi Shah, Danica Fitzsimmons","doi":"10.33137/utjph.v2i1.37272","DOIUrl":"https://doi.org/10.33137/utjph.v2i1.37272","url":null,"abstract":"The COVID-19 pandemic has had a devastating impact on global health for almost two years, resulting in nearly 200 million cases and over 4 million deaths worldwide. Despite a range of non-invasive public health measures, (i.e. physical distancing, and masks) vaccines have been one of the more critical and effective interventions to slow the pandemic. Produced at record-breaking speeds, the highly efficacious mRNA vaccines represented hope for many. Including global health organizations who have called for strategies to maximize vaccine equity since their conception. While many high-income countries (HICs) agreed to prioritize global vaccine equity; in truth, individual health outweighed community health. The reality of HICs vaccine purchasing behaviors and distribution have exposed a different agenda - one that aligns with a neoliberal emphasis on individuals and profits at the expense of global good. This commentary questions the efficacy of global health agreements and the commitment from wealthy countries to address global health inequities through a one health framework. Ultimately, concluding that the path to global vaccine equity will require a commitment to global good. Vaccine nationalism and lack of equitable global health policy continues to fuel a never-ending health crisis. HICs must be held accountable for the lack of commitment to global health equity.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128784900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using the 3I+E Framework to assess provincial policy decisions for the sale of cannabis in Ontario, Saskatchewan and Quebec","authors":"R. Sandhu, Guneet Saini, E. Alvarez","doi":"10.33137/utjph.v2i1.34726","DOIUrl":"https://doi.org/10.33137/utjph.v2i1.34726","url":null,"abstract":"Objective: This paper examines policy decisions regarding public or private retail models chosen for the recreational use of cannabis in the provinces of Ontario, Saskatchewan and Quebec to demonstrate the application of the 3I+E framework for policy analysis. \u0000Methods: The 3I+E framework includes considerations of institutions, interests, ideas and external factors that play a role in adopting a particular policy. A retrospective comparative approach using this framework was conducted. Relevant newspaper articles, press releases, consultation reports and primary policy papers were reviewed. \u0000Results: Ontario employed a mixed model for the sale of cannabis while Saskatchewan chose to fully privatize cannabis retail within the province and Quebec decided to sell through the public sector. Government institutions, particularly the party in power and the number of seats they hold, as well as existing policy legacies for alcohol retail, appeared to have a strong ability to influence policy decisions in all three jurisdictions. Interest groups, including municipal and labor unions and private cannabis companies had a limited role in swaying government decisions toward a particular model. Beliefs and values of citizens regarding cannabis retail did not appear to play a large role. In Ontario particularly, an external factor, namely a major political shift towards a conservative government had a large role in the mixed model chosen in the jurisdiction. \u0000Conclusion: Overall, the policy decision for cannabis retail is multifactorial and the interaction between stakeholders and interest groups with the government influences which model was ultimately chosen in each jurisdiction.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115907874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A call for mandatory planetary health education in public health and health services research programs","authors":"V. Haldane, Anna Cooper Reed, D. Toccalino, Yina Shan, I. Berry, C. Sue-Chue-Lam","doi":"10.33137/UTJPH.V2I1.34761","DOIUrl":"https://doi.org/10.33137/UTJPH.V2I1.34761","url":null,"abstract":"The effects of global climate and environmental change endanger health, health systems, and public health infrastructure. As future public health and health services professionals, researchers, and clinicians, we will be tasked with protecting and promoting the health of communities in the face of these realities. However, there is limited integration of the environment-health nexus into the curricula of public health and health services research programs. Planetary health, an integrative paradigm linking the complex dynamics between the health of people to the natural systems on which we depend, offers an inroad to equipping emerging health system leaders with the skills and knowledge to protect people and the planet. We call on our institutions to follow other health disciplines, such as medicine, and embed planetary health and environmentally sustainable healthcare practices into core educational offerings.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124037192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translating risk to preventable burden by estimating numbers of bicycling injuries preventable by separated infrastructure on a Toronto, Ontario corridor","authors":"Calum Thompson, Michael Branion-Calles, Anne Harris","doi":"10.33137/UTJPH.V2I1.35209","DOIUrl":"https://doi.org/10.33137/UTJPH.V2I1.35209","url":null,"abstract":"Objectives: Bicycling is a form of active transportation with a number of health benefits but carries a high risk of injury compared to other transportation modes. Safety intervention evaluations often produce results in the form of ratios, which can be difficult to communicate to policy-makers. The primary objective of this study was to estimate the number of bicycling injuries on an urban corridor preventable by separated bicycling infrastructure. \u0000Methods: Stakeholders identified a key corridor with multiple segments having bicycling infrastructure but most of the corridor lacking similar infrastructure. We counted bicyclist volume along this route and used secondary data to supplement counts missing due to COVID-19. We used two reference studies including local bicycling population to estimate benefit of separated bicycling infrastructure and applied this to a city-wide estimate of baseline risk of injury per kilometre bicycled, which used a combination of secondary data sources including police, health care and travel survey data. Finally, we adjusted baseline risk to account for increased bicyclist volume during and following the COVID-19 pandemic. \u0000Results: We estimated installation of fully separated cycle tracks along one Toronto corridor would prevent approximately 152.9 injuries and 0.9 fatalities over a 10-year period. \u0000Discussion: Our results underscore the benefits of separated bicycling infrastructure. We identify several caveats for our results, including the limitations of studies used to estimate relative risk of infrastructure. Our method could be adapted for use in other cities or along other corridors. Finally, we discuss the role of preventable burden estimates as a knowledge translation tool.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127316360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of COVID-19 Among Healthcare Workers In Ontario, Canada During The First Pandemic Wave","authors":"Sabrina Chiodo, Emmalin Buajitti, L. Rosella","doi":"10.33137/UTJPH.V2I1.35936","DOIUrl":"https://doi.org/10.33137/UTJPH.V2I1.35936","url":null,"abstract":"Aim and Objectives: This study aims to describe and compare COVID-19 cases among healthcare workers, long-term care residents, and the general population in Ontario, Canada, considering baseline characteristics, trends over time, and socioeconomic status. \u0000Methods: This study used test-confirmed COVID-19 case reports between March 13th, 2020 to June 15th, 2020, reported by Ontario’s Public Health Units to the Ontario Ministry of Health Public Health Case and Contact Management Solution (CCM). Cases were stratified into three sub-populations based on risk group characteristics identified in CCM data: healthcare workers, long-term care residents, and the general population. The residential postal codes of the cases reported to CCM were linked to area-level socioeconomic characteristics of material deprivation from the Ontario Marginalization Index (ON-MARG). Demographic characteristics and case outcomes were captured in CCM data for each case. \u0000Results: COVID-19 cases among healthcare workers were more concentrated between working ages of 20–59 and in females, compared to the general population and long-term care cases. Additionally, hospitalization and mortality were low among healthcare workers compared to the other sub-populations. Over time, COVID-19 cases decreased among healthcare workers. For both healthcare workers and the general population, more cases were observed in areas of high material deprivation, and this disparity between high- and low- income areas increased over time. \u0000Conclusion: Healthcare workers are a known high-risk group for COVID-19. For the surveillance of this disease, it is important to understand how they compare to other population groups regarding infection, hospitalization, and mortality. Our analysis shows clear socioeconomic gradients in the distribution of the disease. Thus, focusing our efforts on identifying and testing healthcare workers that work or live in lower socioeconomic areas would benefit the residents and workers in these areas and support the ongoing COVID-19 response.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123924617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Road Traffic Injury During the COVID-19 Pandemic: Cured or a Continued Threat?","authors":"Nahomi Amberber, A. Howard, M. Winters, M. Harris, I. Pike, Alison Machperson, Marie-Soleil Cloutier, S. Richmond, B. Hagel, P. Fuselli, L. Rothman","doi":"10.33137/utjph.v2i1.34737","DOIUrl":"https://doi.org/10.33137/utjph.v2i1.34737","url":null,"abstract":"Road traffic injury, one of the leading causes of preventable morbidity and mortality in Canada, declined substantially as an indirect outcome of the first wave of the COVID-19 pandemic. Public health policies encouraging people to ‘stay at home’ and ‘practice physical distancing’ precipitated shifts in vehicle volumes and speed, transportation mode, and collision rates. Toronto data from January to June 2020 showed a decrease in road transportation, and a simultaneous decrease in road traffic collisions. However, reduced traffic volumes also led to increased vehicle speeds which can result in an increase in injury severity involving pedestrians and cyclists. As the pandemic progresses, an emphasis on safe, active transportation and equitable distribution of street infrastructure throughout the city is essential. A public health approach to road safety includes implementation of evidence-based road safety infrastructure enabled by access to timely transportation data to evaluate changes made.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124549188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Four Dates, One Future","authors":"D. Harris, Jean-Paul R. Soucy, David J. Kinitz, Kuanling Liu, A.J. Rajendran, S. Sturrock, K. St. Cyr, R. Christensen","doi":"10.33137/utjph.v1i1.34435","DOIUrl":"https://doi.org/10.33137/utjph.v1i1.34435","url":null,"abstract":"For nearly 150 years the University of Toronto has integrated public health into its teaching and research. From early lectures in sanitation (1871) to the discovery of insulin (1921), the University of Toronto’s rich history is reflected in its prominence as a global leader in public health research and education. Therefore, it is fitting for the University of Toronto to host an academic journal of public health that showcases both high-impact scholarship and public health practice. Founded in 2020, the University of Toronto Journal of Public Health has an ambitious, yet essential, vision: to foster the next generation of public health researchers and practitioners in order to improve population health nationally and globally. In this editorial, we honour the diverse and complementary nature of the fields of biostatistics, epidemiology, health policy and practice, and social and behavioural health sciences by highlighting an important historical date from each. We reflect on these milestones within a historical and contemporary context, and conclude by considering the importance of each discipline for the future of public health in Canada and abroad.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114816340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Zika Virus","authors":"Christyl Wilson, E. Lackritz","doi":"10.33137/utjph.v1i1.33813","DOIUrl":"https://doi.org/10.33137/utjph.v1i1.33813","url":null,"abstract":"The epidemic of Zika virus (ZIKV) and its associated complications was first identified in Brazil in 2015, and spread rapidly throughout the Americas and beyond. In response, the World Health Organization (WHO) declared ZIKV infection and associated congenital and neurologic complications a Public Health Emergency of International Concern (PHEIC) in February 2016.  WHO rapidly responded to the outbreak of this emerging pathogen with global coordination of partners, and development of a comprehensive array of resources to guide clinical diagnosis, management, and public health response. \u0000  \u0000Information on ZIKV transmission and disease continued to accumulate after the PHEIC officially ended in November 2016. Consequently, WHO guidance documents produced during the 2015-2016 outbreak were in need of review and update to accurately reflect this growing body of evidence. Furthermore, the rapid accumulation of documents during the emergency response warranted review, collation, and organization of the WHO website for improved accessibility. \u0000  \u0000As part of my internship, all ZIKV guidance documents were reviewed and catalogued. Guidance documents and reports were systematically disseminated to WHO technical leads and tracked to ensure information was updated. The WHO ZIKV website was reorganized to broadly capture all relevant WHO technical resources through a single, organized portal. These activities were a critical component to transform the WHO Zika program from an emergency response to a long-term program, and to ensure dissemination of accurate and up-to-date information to the global health community. \u0000  \u0000This work underscores the critical importance of sustained attention to ZIKV and other emerging pathogens in the inter-epidemic period, when there is the continued need to track transmission, build national capacity for preparedness and response, and advance development of diagnostics and vaccines. Sustained vigilance and investment in these areas is needed to help minimize future outbreaks and improve care for affected patients, families, and communities.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126286178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serotype Replacement After the Introduction of the 13-valent Pneumococcal Conjugate Vaccine in Ontario, Canada, 2007-2018","authors":"Allison Yeung, S. Wijayasri, Sarah E. Wilson, T. Harris, S. Buchan, S. Deeks","doi":"10.33137/utjph.v1i1.33816","DOIUrl":"https://doi.org/10.33137/utjph.v1i1.33816","url":null,"abstract":"Introduction: Invasive pneumococcal disease (IPD) is a disease of public health significance in Ontario, Canada, where publicly funded pneumococcal vaccination programs target children, older adults, and people at high risk of disease. Since the implementation of pneumococcal conjugate vaccines (PCV), serotype replacement has been documented, where non-PCV serotypes replace the niche created by the reduction in vaccine-preventable serotypes. Our objective was to determine whether there has been serotype replacement or a change in IPD severity in Ontario since implementation of the childhood 13-valent (PCV13) program by assessing IPD burden over a 12-year period (2007-2018). \u0000Methods: We included all confirmed IPD cases reported in Ontario’s integrated Public Health Information System (iPHIS) and defined the pre-PCV13 era (January 2007-December 2010) and post-PCV13 era (January 2011-December 2018). We grouped IPD serotypes according to associated vaccine type: PCV13; 23-valent polysaccharide vaccine (unique PPV23); and non-vaccine-preventable (NVP). We used population data to calculate incidence and hospitalization rates (per 100,000 population) by age group, vaccine type, and era. \u0000Results: In the post-PCV13 era, PCV13-specific incidence and hospitalization rates decreased, while the incidence and hospitalizations due to unique PPV23 and NVP serotypes increased; this was consistent across all age groups. The greatest decrease in incidence (RR=0.4) and hospitalizations (RR=0.4) was observed in children <5 years with PCV13 serotypes. There were no distinct age-related trends observed for case fatality ratios; the highest CFR was observed in adults ≥65 years. \u0000Conclusion: A shift in serotype distribution was seen across all age groups; IPD incidence and hospitalization rates due to PCV13 serotypes decreased after PCV13 implementation, but this reduction was offset by the increasing burden and severity of unique PPV23 and NVP serotypes. As IPD continues to be a severe disease, continued surveillance is required to better understand the growing burden of these serotypes and emergence of non-vaccine-preventable serotypes.","PeriodicalId":265882,"journal":{"name":"University of Toronto Journal of Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125672247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}