Background:The importance of sex and gender in the diagnosis and management of health conditions is well established, but the extent to which this evidence is integrated into clinical practice guidelines remains unknown. We aimed to determine the proportion of Canadian clinical practice guidelines that integrate evidence on sex and gender considerations. Methods:We searched the Canadian Medical Association's CPG Infobase, PubMed, all provincial/territorial websites and websites of professional organizations for English-and French-language Canadian clinical practice guidelines published between January 2013 and June 2015 on selected conditions identified as priorities by policy-makers and practitioners. Citations and text were searched electronically using keyword terms related to sex and gender. Three investigators independently analyzed and categorized the content of text-positive clinical practice guidelines based on clinical relevance for practitioners. Results:Of the 118 clinical practice guidelines that met the inclusion criteria, 79 (66.9%) were text-positive for sex and/or gender keywords; 8 (10%) of the 79 used the keywords only in relation to pregnancy. Of the remaining 71 guidelines, 25 (35%) contained sex-related diagnostic or management recommendations. An additional 5 (7%) contained recommendations for sex-specific laboratory reference values, 29 (41%) referred to differences in epidemiologic features or risk factors only, and 12 (17%) contained nonrelevant mentions of search keywords. Twenty-five (35%) of the text-positive guidelines used the terms "sex" and/or "gender" correctly. higher in women than in men, with increased risk of driving impairment. 19 Rochon and colleagues 20 discovered that, in Ontario, men with dementia who were prescribed antipsychotic drugs had significantly higher risks for hospital admission and death than did women with dementia. Similarly, social risk factors are associated with higher rates of suicide in older men, which suggests that more aggressive screening and treatment may be required. [21][22][23] The extent to which evidence about sex and gender is integrated into clinical practice guidelines for diagnosis and management of diseases remains unknown. We conducted a systematic review to investigate the integration of sex and gender evidence into Canadian clinical practice guidelines published between 2013 and 2015 for noncommunicable health conditions. Methods Data sources and inclusion criteriaProtocols for this review are posted on Open Science Framework and follow PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines (www.prisma-statement.org/). The review search focused on selected health conditions identified as priorities by policymakers and practitioners [24][25][26][27][28][29][30] (Box 1). We considered only 2 cancers, lung and colorectal, because they are among the leading causes of death from cancer for both females and males, 31 and important sex and/or gender differences in prevalence, risk and screening, path...

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Background The province of Ontario, Canada, has instituted indefinite school closures (SC) as well as other social distancing measures to mitigate the impact of the novel coronavirus disease 2019 (COVID-19) pandemic. We sought to evaluate the effect of SC on reducing attack rate and the need for critical care during COVID-19 outbreaks, while considering scenarios with concurrent implementation of self-isolation (SI) of symptomatic cases. Methods We developed an age-structured agent-based simulation model and parameterized it with the demographics of Ontario stratified by age and the latest estimates of COVID-19 epidemiologic characteristics. Disease transmission was simulated within and between different age groups by considering inter- and intra-group contact patterns. The effect of SC of varying durations on the overall attack rate, magnitude and peak time of the outbreak, and requirement for intensive care unit (ICU) admission in the population was estimated. Secondly, the effect of concurrent community-based voluntary SI of symptomatic COVID-19 cases was assessed. Results SC reduced attack rates in the range of 7.2–12.7% when the duration of SC increased from 3 to 16 weeks, when contacts among school children were restricted by 60–80%, and in the absence of SI by mildly symptomatic persons. Depending on the scenario, the overall reduction in ICU admissions attributed to SC throughout the outbreak ranged from 3.3 to 6.7%. When SI of mildly symptomatic persons was included and practiced by 20%, the reduction of attack rate and ICU admissions exceeded 6.3% and 9.1% (on average), respectively, in the corresponding scenarios. Conclusion Our results indicate that SC may have limited impact on reducing the burden of COVID-19 without measures to interrupt the chain of transmission during both pre-symptomatic and symptomatic stages. While highlighting the importance of SI, our findings indicate the need for better understanding of the epidemiologic characteristics of emerging diseases on the effectiveness of social distancing measures.

Although Canada has one of the lowest tuberculosis incidence rates in the world, certain groups are disproportionately affected, including foreign born people from high incidence countries. The Winnipeg Regional Health Authority has initiated a process to decentralize latent tuberculosis infection (LTBI) management at primary care clinics in Winnipeg. One of these clinics is BridgeCare Clinic which provides services to government-assisted refugees. The present study describes the BridgeCare Clinic LTBI program and reviews program outcomes from January 2015 to October 2016. Refugees at BridgeCare Clinic receive comprehensive care, including LTBI screening and treatment. The LTBI program is managed by physicians, nurse practitioners, and primary care nurses under a patient-centered model of care. An accessible interpretation service, education to clients, and laboratory sampling at the clinic with free IGRA testing are important components of the program. Anonymized data on client outcomes were statistically analyzed and qualitative interviews were conducted with senior staff. During the study period, 274 IGRA tests were ordered with 158 negative results (57.7%) and 101 positive results (36.9%). Of 45 clients eligible (from January to December 2015) for LTBI treatment, 11 (24.4%) declined to receive treatment and 34 (75.6%) started treatment. Twenty-seven (79.4%) clients completed treatment, 3 (8.8%) clients moved out of province, and 4 (11.8%) did not complete treatment. The most recent World Health Organization strategy for tuberculosis control calls for integrated, patient-centered care and prevention. Aligned with these WHO recommendations, our experience suggests that LTBI care and treatment can be delivered effectively in a primary care setting using an integrated patient-centered approach.

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Housing insecurity is a major barrier to leaving domestic violence; it may force abused women to live in inadequate conditions or to return to their abusers. Immigrant women face additional barriers. Longitudinal interviews with 37 abused immigrant women living in three Canadian cities investigated key causes of housing insecurity. Results show a need to target systemic factors, a diversity of issues foregrounded along pathways into and out of homelessness, and complex indicators of risk. Advocacy is key to exiting abuse and obtaining secure housing, and cultural competency in services is needed to adequately support immigrant women experiencing domestic violence.

Background: Indigenous communities are often portrayed from a deficit-based lens; however, Indigenous communities have self-determined perspectives of health and well-being that are strength based. The objective of this study will be to systematically map the literature on perspectives, concepts, and constructs of wellness and well-being in Indigenous communities in Canada. Methods: A scoping review protocol was designed following the Arksey and O'Malley framework. We will search the following electronic databases (from inception onwards): MEDLINE, EMBASE, Web of Science, CINAHL, Academic Search Complete, Anthropology Plus, Bibliography of Native North Americans, Canadian Business and Current Affairs, and Circumpolar Health Bibliographic Database. Grey literature will be identified through searching dissertation databases, Google Scholar, and conference abstracts. We will include all types of literature in English, published and unpublished, including any study design, reviews and meta-analyses, dissertations, reports, and books. The literature considered should describe or reflect Indigenous perspectives that identify concepts or constructs related to well-being or wellness; literature can be from any setting in Canada. Two reviewers will independently screen all citations, full-text reports, and abstract data. Data analysis will involve quantitative descriptions (e.g. frequencies) and qualitative content analysis methods. Discussion: This review will provide a synthesis of the literature on Indigenous perspectives, concepts, and constructs of wellness and well-being in Canada. We anticipate the study will contribute to improve our understanding of how Indigenous communities conceptualize and embody wellness. Our findings will provide a basis for engaging Indigenous stakeholders in future health research and informing future interpretations of how wellness is conceptualized, whether written or unwritten.

Disease modeling is increasingly being used to evaluate the effect of health intervention strategies, particularly for infectious diseases. However, the utility and application of such models are hampered by the inconsistent use of infectious disease modeling terms between and within disciplines. We sought to standardize the lexicon of infectious disease modeling terms and develop a glossary of terms commonly used in describing models’ assumptions, parameters, variables, and outcomes. We combined a comprehensive literature review of relevant terms with an online forum discussion in a virtual community of practice, mod4PH (Modeling for Public Health). Using a convergent discussion process and consensus amongst the members of mod4PH, a glossary of terms was developed as an online resource. We anticipate that the glossary will improve inter- and intradisciplinary communication and will result in a greater uptake and understanding of disease modeling outcomes in heath policy decision-making. We highlight the role of the mod4PH community of practice and the methodologies used in this endeavor to link theory, policy, and practice in the public health domain.