Canadian Journal of Public Health-Revue Canadienne De Sante Publique最新文献

{"title":"The association between neighbourhood marginalization and SARS-CoV-2 outcomes in patients presenting to emergency departments.","authors":"Ivy Cheng, Rhonda J Rosychuk, David Seonguk Yeom, Ray L Jewett, Iwona A Bielska, Jake Hayward, Jaspreet Khangura, Rohit Mohindra, Megan Landes, Jeffrey P Hau, Christiaan H Righolt, Murdoch Leeies, Jennifer Grant, Steven C Brooks, Corinne M Hohl","doi":"10.17269/s41997-024-00976-5","DOIUrl":"https://doi.org/10.17269/s41997-024-00976-5","url":null,"abstract":"<p><strong>Objective: </strong>Social and economic marginalizations have been associated with inferior health outcomes in Canada. Our objective was to describe the relationship between neighbourhood marginalization and COVID-19 outcomes among patients presenting to Canadian emergency departments (ED).</p><p><strong>Methods: </strong>We conducted an observational study among consecutive COVID-19 patients recruited from 47 hospitals participating in the Canadian COVID-19 ED Rapid Response Network (CCEDRRN) between March 3, 2020, and July 24, 2022. We linked data with the Canadian Marginalization Index (CAN-Marg). We used multivariable, multi-level logistic regression models to understand the association between dimensions of neighbourhood marginalization, and severe COVID-19 and in-hospital mortality.</p><p><strong>Results: </strong>There were 55,588 eligible patients. Those from neighbourhoods with a higher proportion of recent immigrants (OR = 0.86 per unit increase [0.81, 0.92]), lower workforce participation (OR = 0.84 per unit increase [0.75, 0.94]), and more housing insecurity (OR = 0.81 per unit increase [0.77, 0.86]) were less likely to present to EDs with severe COVID-19. However, patients from materially marginalized neighbourhoods had increased odds of dying in hospital (OR = 1.19 per unit increase [95% CI 1.09, 1.30]) compared to patients from less materially marginalized neighbourhoods. Patients living in neighbourhoods with a higher proportion of recent immigrants (OR = 0.83 per unit increase [0.78, 0.91]) and lower participation in the workforce (OR = 0.77 per unit increase [0.66, 0.87]) experienced lower odds of dying.</p><p><strong>Conclusion: </strong>Despite no association with severe COVID-19 at ED presentation, the only marginalization domain associated with in-hospital mortality was material deprivation. Our findings present insights on ED-seeking behaviour, hospital access, and care that population studies could not.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of the moving epidemic method to guide the launch of palivizumab immunization campaigns for respiratory syncytial virus in Québec, Canada.","authors":"Coralie Raad, Naïm Ouldali, Marc Lebel, Maude Paquette, Rodica Gilca, Jesse Papenburg, Antoine Lewin, Christian Renaud","doi":"10.17269/s41997-024-00985-4","DOIUrl":"https://doi.org/10.17269/s41997-024-00985-4","url":null,"abstract":"<p><strong>Objective: </strong>The COVID-19 pandemic disrupted the seasonal transmission pattern of respiratory syncytial virus (RSV), challenging the launch of palivizumab immunization campaigns. This study explored the performance of the moving epidemic method (MEM) to guide the launch of such campaigns.</p><p><strong>Methods: </strong>Data were collected through a continuous RSV surveillance system (07/2013‒03/2022) in Québec, Canada. Two strategies were compared: (1) a \"preestablished\" approach according to which each annual campaign began on November 1 and ended upon the earliest week with an RSV positivity rate ≤ 10% after March 31; and (2) MEM, according to which each annual campaign began and ended upon meeting an epidemic threshold of RSV positivity. We estimated the proportion of RSV cases that would be covered depending on the approach used for each RSV epidemic.</p><p><strong>Results: </strong>From seasons 2013-2014 through 2019-2020, RSV cases peaked between weeks 1 and 8, and all epidemic curves overlapped with an intraclass correlation coefficient (ICC) of 0.83. From 2013-2014 through 2019-2020, the epidemic periods determined by MEM and the preestablished approach covered similar proportions of RSV cases (MEM = 91.6%, preestablished = 90.7%) and had a similar duration (MEM = 21.3 weeks, preestablished = 21.7 weeks). With MEM, the 2021-2022 epidemic period started at week 29 and ended at week 51, covering 95.7% of cases. With the preestablished approach, the epidemic period started at week 44 and ended at week 8, covering 28.3% of cases.</p><p><strong>Conclusion: </strong>During normal RSV seasons, MEM is an effective alternative to the preestablished approach. However, MEM appears significantly more robust to disruptions of RSV's seasonal pattern.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute gastrointestinal illness burden associated with water recreation in high-income countries: A scoping review.","authors":"Henry Ngo, Charlotte Winder, Nicole Ricker, E Jane Parmley, Heather M Murphy","doi":"10.17269/s41997-024-00963-w","DOIUrl":"https://doi.org/10.17269/s41997-024-00963-w","url":null,"abstract":"<p><strong>Objectives: </strong>The burden of acute gastrointestinal illness (AGI) attributable to natural water recreation in Canada is unknown. Understanding the burden can help prioritize public health interventions and resource allocation for reduction of disease. Our objectives were to compile estimates of AGI burden associated with natural water recreation, identify knowledge gaps in water recreation epidemiology, and evaluate methods applicable for developing a burden estimate for Canada.</p><p><strong>Methods: </strong>We conducted a scoping review of the literature. From a total of 2752 unique records identified, 35 met eligibility for inclusion. Articles were chosen if they examined burden in natural waterways, were written in English, and were based in countries of similar economic status to Canada in non-tropical regions. Burden was defined as either: incidence or prevalence, disability-adjusted life years (DALYs), quality-adjusted life years (QALYs), or economic cost.</p><p><strong>Results: </strong>Swimming or wading were the predominant forms of recreation examined (n = 32/35; 91.4%). Waterways studied were primarily marine or coastal beaches (n = 24/35; 68.6%) and were located within or adjacent to urban areas (n = 29/35; 82.9%). The most common indicator for burden was incidence or prevalence (n = 30/35; 85.7%). Prospective cohort studies (n = 17/35; 48.6%) and predictive modelling based on microorganism concentrations (n = 9/35; 25.7%) were the most common methods of estimation.</p><p><strong>Conclusion: </strong>The review highlighted several knowledge gaps regarding recreational waterborne disease burden. Freshwater recreation, rural waterways, and recreational activities other than swimming and wading require further study. We propose that quantitative microbial risk assessment may be an appropriate, cost-effective method to estimate recreational waterborne disease burden in Canada.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparison of perinatal outcomes associated with gestational diabetes mellitus testing practices in British Columbia: A population-based retrospective cohort study.","authors":"Sabrina Luke, Mary Kathryn Bohn, Amelie Boutin, Ellen Giesbrecht, Hilary Vallance, Wee-Shian Chan, Vilte Barakauskas","doi":"10.17269/s41997-024-00977-4","DOIUrl":"https://doi.org/10.17269/s41997-024-00977-4","url":null,"abstract":"<p><strong>Objectives: </strong>This study sought to compare one-step versus two-step testing approaches for gestational diabetes mellitus (GDM) and to investigate the associations between testing approach, degree of glucose impairment, and perinatal outcomes.</p><p><strong>Methods: </strong>A retrospective population-based cohort study was conducted by combining BC's Perinatal Data Registry with laboratory and billing information from 2010 to 2014. Pregnancy characteristics were compared by GDM testing approach. Logistic regression was conducted to determine the association between testing approach, degree of glucose impairment, and outcomes.</p><p><strong>Results: </strong>Approximately 17% of pregnant individuals were diagnosed with GDM using the one-step test, compared to 6% using the two-step test. The odds ratios of adverse outcomes were below 1.75 for GDM pregnancies regardless of testing approach used (compared to the group with negative results on the two-step test). A dose-dependent trend was observed between increasing glucose intolerance and odds of preterm birth. The odds of large for gestational age infants (LGA) and shoulder dystocia were significantly higher when all 75 g test values were within one standard deviation below one-step diagnostic thresholds (adjOR 1.94[1.73-2.17] and 1.85[1.55-2.21], respectively).</p><p><strong>Conclusion: </strong>The frequency of GDM was three times higher with the use of the one-step test versus the two-step test. Abnormal results on the two-step test are associated with preterm birth at an odds ratio below 1.75. Pregnant individuals with one-step test results just below diagnostic criteria may be at greater odds for LGA. The benefits of more stringent testing practices need to be weighed against the impact of additional GDM diagnoses.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safer Opioid Supply programs: Hydromorphone prescribing in Ontario as a harm reduction intervention to combat the drug poisoning crisis.","authors":"Rose A Schmidt, Adrian Guta, Nanky Rai, Andrea Sereda, Emmet O'Reilly, Jessica Hales, Gillian Kolla, Carol Strike","doi":"10.17269/s41997-024-00979-2","DOIUrl":"https://doi.org/10.17269/s41997-024-00979-2","url":null,"abstract":"<p><strong>Setting: </strong>The crisis of unregulated fentanyl-related overdose deaths presents a significant public health challenge. This article describes the implementation and evaluation of four Safer Opioid Supply programs (SSPs) in Ontario, one in London and three in Toronto.</p><p><strong>Intervention and implementation: </strong>SSPs aim to curtail overdose fatalities while connecting individuals using drugs to healthcare services. The programs involve a daily dispensed prescription of immediate-release hydromorphone tablets for take-home dosing alongside an observed dose of long-acting opioids like slow-release oral morphine. Implemented within a multidisciplinary primary care framework, these programs emphasize patient-centred approaches and comprehensive health and social support.</p><p><strong>Outcomes: </strong>In our study conducted in 2020/2021, clients and service providers reported that receiving pharmaceutical opioids through these programs improved the clients' health and well-being. The regulated supply was reported to lead to decreases in overdose incidents, use of unregulated substances, and criminalized activities. Increased engagement with healthcare and harm reduction services and improvements in social determinants of health, such as food security, were also reported. Despite these positive outcomes, some implementation challenges, including capacity issues and provider burnout, were described by service providers.</p><p><strong>Implications: </strong>Our findings suggest that the combination of safer supply, wrap-around support, and harm reduction within primary care settings can lead to increased healthcare engagement, HIV/HCV prevention, testing, and treatment uptake, reducing the burden of infectious diseases and overdose risk. SSPs have the potential to meaningfully reduce overdose rates, address the ongoing overdose crisis, and if scaled up, influence population-level outcomes.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative microbial risk assessment of acute gastrointestinal illness attributable to freshwater recreation in Ontario.","authors":"Henry Ngo, E Jane Parmley, Nicole Ricker, Charlotte Winder, Heather M Murphy","doi":"10.17269/s41997-024-00969-4","DOIUrl":"https://doi.org/10.17269/s41997-024-00969-4","url":null,"abstract":"<p><strong>Objectives: </strong>The burden of disease associated with acute gastrointestinal illness (AGI) in Canada is estimated to be ~ 20 million cases/year. One known risk factor for developing AGI is recreation in freshwater bodies such as lakes. The proportion of cases attributable to freshwater recreation in Canada, however, is currently unknown. The study objective was to estimate the risk of developing AGI from exposure to Giardia, Cryptosporidium, Campylobacter, Escherichia coli O157:H7, norovirus, and Salmonella during freshwater recreation in Ontario, Canada.</p><p><strong>Methods: </strong>A quantitative microbial risk assessment (QMRA) was conducted to estimate the number of AGI cases per 1000 recreational events associated with freshwater recreation. QMRA utilizes four steps: hazard identification, exposure assessment, dose-response modelling, and risk characterization. A probabilistic model was developed using the following inputs accounting for uncertainty and variability: published data on pathogen prevalence and concentration in freshwaters in Ontario (hazard identification), recreator water ingestion volumes (exposure), pathogen-specific dose-response models, and ratios between numbers of infections and symptomatic disease cases to estimate illness risks (risk characterization).</p><p><strong>Results: </strong>The mean estimated AGI risk associated with recreation ranged from 0.8 to 36.7 cases per 1000 swimmers (5th-95th probability interval: 0-226.3 cases/1000) which is in line with previous studies conducted in Lake Ontario, as well as prior QMRAs of freshwater recreation. Upper range predicted values exceeded the Health Canada guideline of less than 20 cases per 1000 recreators.</p><p><strong>Conclusion: </strong>This study shows that QMRA can be used to estimate disease risk in the absence of large-scale epidemiological studies. The results demonstrate a range of risk that is in line with exposure to pristine (low risk estimates) and more contaminated waters (high risk estimates) and capture the potential risk to vulnerable populations.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building a community of practice to address alcohol harms in Canada: Experience from the Canadian Alcohol Policy Evaluation project.","authors":"Tina R Price, Bryany Denning, Victoria Burns, Amy Hlaing, Jacqueline Deroo, Laura Lee Noonan, Kim Brière-Charest, Angela Haché, Kate Dunn, Marion Waysome McIntyre, Ciana Van Dusen, Patrick Brazeau, Jenna Hopson, Julie McEachern, Kate Johnston","doi":"10.17269/s41997-024-00970-x","DOIUrl":"https://doi.org/10.17269/s41997-024-00970-x","url":null,"abstract":"<p><strong>Setting: </strong>Alcohol is a major cause of health and social costs and harms in Canada. While research and awareness of harms caused by alcohol are on the rise, few transdisciplinary platforms exist that are committed to facilitating bold alcohol policy change to reduce health inequities and improve lives.</p><p><strong>Intervention: </strong>In response to feedback heard during engagement for the Canadian Alcohol Policy Evaluation project, an alcohol policy-focused community of practice (CoP) was launched in January 2022. Webinars, roundtable discussions, working group meetings, networking events, and a digital platform allow practitioners from various sectors (e.g. public health, alcohol regulation and distribution, public safety, justice, non-governmental organizations), researchers, and people with lived/living experience (PWLLE) to connect, share experiences and resources, and build capacity.</p><p><strong>Outcomes: </strong>More than 500 members have joined the CoP from all Canadian provinces and territories, and international jurisdictions. CoP members engage in learning opportunities, contribute to letter-writing campaigns in support of alcohol policy initiatives, and lead a working group focused on alcohol warning labels. Through the CoP, members report gaining and applying new knowledge in their work, while also establishing valuable connections and collaborations that have supported positive change.</p><p><strong>Implications: </strong>This cross-jurisdictional, intersectoral alcohol policy CoP facilitates knowledge sharing, networking, and collaboration among practitioners, policymakers, advocates, and PWLLE, while contributing to public health efforts to prevent alcohol harms. Furthermore, as transdisciplinary approaches continue to be prioritized in research and practice, this CoP offers an example that could be applied to other public health initiatives.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovation through collaboration: Identifying opportunities to improve congenital anomalies surveillance in Canada.","authors":"Yonabeth Nava de Escalante, Tanya Bedard, Cora Cole, Kitty Dang, Maya Jeyaraman, Kathryn Johnston, Qun Miao, Lauren Rickert","doi":"10.17269/s41997-024-00949-8","DOIUrl":"https://doi.org/10.17269/s41997-024-00949-8","url":null,"abstract":"<p><strong>Setting: </strong>The burden of congenital anomalies is a significant public health concern. In response to the World Health Organization's recommendations, Canada developed and strengthened congenital anomalies surveillance to build capacity for prevention and optimal health outcomes. Historically, the Public Health Agency of Canada (PHAC) exclusively used hospital discharge data for the Canadian Congenital Anomalies Surveillance System (CCASS). A primary objective of the CCASS is to report prevalence, trends, and factors associated with congenital anomalies in Canada. However, the purpose of hospital discharge data is not for congenital anomalies surveillance; therefore, enhanced local data, which have more complete case ascertainment and additional data quality measures, are necessary.</p><p><strong>Intervention: </strong>Recognizing these significant limitations, PHAC, the provincial and territorial governments, physicians, public health practitioners, and academics collaborated on a project to enhance the CCASS with regional data and expertise. Subsequently, the Government of Canada InfoBase platform will use this enhanced dataset for national reporting.</p><p><strong>Outcomes: </strong>We developed standardized case definitions, a data submission form, and data quality tools, and surveyed programs to describe local congenital anomalies surveillance practice, and to identify barriers and facilitators that impact congenital anomalies surveillance efforts.</p><p><strong>Implications: </strong>This synergistic collaboration across jurisdictions, disciplines, and health care sectors is essential to support Canada's enhanced congenital anomalies surveillance. We identified common themes on funding, operational requirements, data standardization, and legal and privacy considerations from the survey. These themes can be used to inform policy and decision-makers for sustainable congenital anomalies surveillance and to amplify the current momentum.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between medical fitness facility attendance and incident mental disorders.","authors":"Jonathan Tebbi, Ranveer Brar, Alan Katz, Michelle Di Nella, Clara Bohm, Claudio Rigatto, Navdeep Tangri, Sue Boreskie, Carrie Solmundson, Leanne Kosowan, Darlene Lamont, Paul V J Komenda, David Collister, James M Bolton","doi":"10.17269/s41997-024-00971-w","DOIUrl":"https://doi.org/10.17269/s41997-024-00971-w","url":null,"abstract":"<p><strong>Objective: </strong>This study examined the effects of medical fitness facility (MFF) attendance, a proxy for exercise, on the incidence of mental disorders.</p><p><strong>Methods: </strong>This retrospective cohort study linked members at two MFFs in Winnipeg, Canada, to health administrative databases held at the Manitoba Centre for Health Policy population research data repository. Adults aged ≥ 18 years were assigned an index date at MFF membership enrollment between January 1, 2005, and December 31, 2015, and matched to controls based on propensity score weighting. Cox proportional hazards models generated hazard ratios (HR) comparing the MFF group to controls on incident mental disorders (mood and anxiety disorders, substance use disorders, dementia, personality disorders, schizophrenia, and psychotic disorders).</p><p><strong>Results: </strong>There were 15,407 MFF members and 507,400 controls. Attendance at a MFF was associated with a reduced hazards risk of incident substance use disorders (HR = 0.67, 95% confidence interval (CI) 0.62-0.67), psychotic disorders (HR = 0.69, 95% CI 0.60-0.79), personality disorders (HR = 0.63, 95% CI 0.50-0.78), schizophrenia (HR = 0.69, 95% CI 0.52-0.93), and dementia (HR = 0.69, 95% CI 0.64-0.75).</p><p><strong>Conclusion: </strong>Attending a medical fitness facility was associated with a reduced risk of incident mental disorders. Further research in MFFs as preventive initiatives for mental illness is warranted.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decolonizing urban Indigenous healthcare: The potential of urban reserves.","authors":"Erin Burnley, Patricia Farrugia","doi":"10.17269/s41997-024-00980-9","DOIUrl":"https://doi.org/10.17269/s41997-024-00980-9","url":null,"abstract":"<p><p>The urbanization of Indigenous peoples in Canada has increased substantially during recent decades, with over 44% of Indigenous peoples now residing in urban centres. Despite the urban concentration of healthcare services, Indigenous health outcomes remain significantly worse than non-Indigenous health outcomes for people living in urban centres. The historical and subsisting impacts of colonialism have had a profound negative influence on social determinants of health for Indigenous peoples, resulting in higher rates of chronic disease and mortality. Mistrust of the healthcare system, racial discrimination, and medical paternalism remain barriers to accessing care and diminish the quality of care received. This commentary explores how Indigenous-led health services can improve Indigenous health outcomes and how urban reserves could be used to improve the health of urban Indigenous residents.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}