Health Inequity and "Restoring Fairness" Through the Canadian Refugee Health Policy Reforms: A Literature Review

Refugees and refugee claimants experience increased health needs upon arrival in Canada. The Federal Government funded the Interim Federal Health Program (IFHP) since 1957, ensuring comprehensive healthcare insurance for all refugees and refugee claimants seeking protection in Canada. Over the past 4 years, the Canadian government implemented restrictions to essential healthcare services through retrenchments to the IFHP. This paper will review the IFHP, in conjunction with other immigration policies, to explore the issues associated with providing inequitable access to healthcare for refugee populations. It will examine changes made to the IFHP in 2012 and in response to the federal court decision in 2014. Findings of the review indicate that the retrenchments to the 2012 IFHP instigated health outcome disparities, social exclusion and increased costs for vulnerable refugee populations. The 2014 reforms reinstated some services; however the policy continued to produce inequitable healthcare access for some refugees and refugee claimants.

Facilitators and Barriers to Healthy Eating in Aged Chinese Canadians with Hypertension: A Qualitative Exploration

Objectives: To determine the facilitators and barriers influencing healthy eating behaviours among aged Chinese-Canadians with hypertension. Methods: After attending five weeks of dietary educational training (Dietary Approach to Stop Hypertension with Sodium (Na) Reduction for Chinese Canadians; DASHNa-CC), 30 aged Chinese-Canadian participants partook in a telephone interview. Participants were asked to name three facilitators and three barriers that influenced their ability to follow the DASHNa-CC intervention. Telephone transcripts were then analyzed and coded using computer software and categorized into personal, familial, community, and societal facilitators or barriers. Results: Personal factors included health problems, motivation, effects of healthy diet, health-related careers, and dietary habits. Family factors included family structure, support from family members, and critical health events involving family members or relatives. Community factors consisted of educational materials, friends, primary care physicians, and online social networks. Societal factors included accessibility to grocery stores and restaurants. Conclusions: Aged Chinese-Canadian immigrants experience unique facilitators of and barriers to healthy eating, which may warrant further attention from healthcare professionals when educating patients in a culturally-sensitive manner.

Primary care management of concussion in Canada

Concussion has emerged as an important public health issue affecting thousands of Canadians annually. Health care providers including paediatricians, family and emergency medicine physicians, nurses, and nurse practitioners are commonly tasked with the responsibility of providing primary care to patients with acute concussion and those with persistent post-concussion symptoms. In July 2017, Parachute, in collaboration with the Public Health Agency of Canada and Sport Canada released the Canadian Guideline on Concussion in Sport that outlines a standardized and evidence-based approach to the recognition, diagnosis, and management of youth and adults with suspected concussion. In this report, we provide a brief overview of the important roles of primary care providers in the medical assessment, management, and prevention of concussion as outlined in this national best practice guideline.

Teaching the Role of Health Advocate: Reflections on two cross-cultural collaborative advocacy workshops for medical trainees and instructors in Oman

In March 2014, medical educators from Canada and Oman collaborated to shape the foundation of health advocacy training in Oman. Using existing research and innovative tools, two workshops were developed, representing the first formalised approach to health advocacy for medical trainees in Oman. The development and application of the workshops highlighted many unique challenges and opportunities in advocacy training. This article summarises the process of developing and implementing the workshops as well as feedback from the participants and short-term consequences. Furthermore, this article seeks to explore the complexities of designing a cross-cultural curriculum. In particular, it reflects on how the role of health advocate may be perceived differently in various cultural and societal settings. Understanding and adapting to these influences is paramount to creating a successful health advocacy curriculum that is relevant to learners and responsive to the communities in which they work.

The rising incidence of testicular cancer among young men in Canada, data from 1971-2015

BACKGROUND

Testicular cancer is the most common malignancy among young men aged 15-44 in Canada. The goal of this analysis was to examine age-period-cohort effects of testicular cancer incidence between 1971 and 2015.

METHODS

Data were collected from the National Cancer Incidence Reporting System and the Canadian Cancer Registry. Birth cohort models were fit using the National Cancer Institute's web tool. Incidence annual percent changes were estimated using NCI's Joinpoint Regression Program.

RESULTS

Incidence of testicular cancer in Canada has increased steadily since 1971. A birth cohort effect was observed for men born in the years after 1945. The rate of testicular cancer peaks at age 35 and drops off with increasing age.

CONCLUSION

Incidence of testicular cancer has risen dramatically in Canada in recent decades and the cohort effect indicates the need to investigate exposures that have increased since 1945 and that may affect development in young men.

Effects of Culling on Leptospira interrogans Carriage by Rats

We found that lethal, urban rat control is associated with a significant increase in the odds that surviving rats carry Leptospira interrogans. Our results suggest that human interventions have the potential to affect and even increase the prevalence of zoonotic pathogens within rat populations.

An Epidemic of Incompetence: A Critical Review of Addictions Curriculum in Canadian Residency Programs

This article was migrated. The article was marked as recommended. In Canada and the United States, the rising number of apparent opioid-related deaths have given to the aptly-named opioid epidemic. Despite the criticism physicians have received for their role in opioid overprescribing, physicians may very well be in the position to vanquish the opioid epidemic. While the importance of the importance of Addictions training in psychiatry and other disciplines has been recognized in Canada at a national level, training resources are scarce and difficult to implement, even when delivered in online formats. Many have speculated that the delivery of high-quality Addictions training has been hampered by multiple roadblocks endemic to the Canadian medical education system, particularly stigma towards individuals with substance use disorders. In navigating the winds of change in the Competency-Based Medical Education (CBME) era, it remains unclear how Addictions will be embraced. To date, there are no defined addictions competencies in the Canadian CBME infrastructure, despite the critical findings of the Association of Faculties of Medicine report in 2017, which was generated in response to the opioid epidemic. Despite these challenges, those who struggle with addiction can lead full, happy, productive lives if they have the right resources. With time, we can only hope that the increasing visibility of addiction will translate to improved training and curricula for the next generation of physicians.

Geographic and socio-demographic predictors of household food insecurity in Canada, 2011-12

BACKGROUND

Household food insecurity is a potent social determinant of health and health care costs in Canada, but understanding of the social and economic conditions that underlie households' vulnerability to food insecurity is limited.

METHODS

Data from the 2011-12 Canadian Community Health Survey were used to determine predictors of household food insecurity among a nationally-representative sample of 120,909 households. Household food insecurity over the past 12 months was assessed using the 18-item Household Food Security Survey Module. Households were classified as food secure or marginally, moderately, or severely food insecure based on the number of affirmative responses. Multivariable binary and multinomial logistic regression analyses were used to determine geographic and socio-demographic predictors of presence and severity of household food insecurity.

RESULTS

The prevalence of household food insecurity ranged from 11.8% in Ontario to 41.0% in Nunavut. After adjusting for socio-demographic factors, households' odds of food insecurity were lower in Quebec and higher in the Maritimes, territories, and Alberta, compared to Ontario. The adjusted odds of food insecurity were also higher among households reliant on social assistance, Employment Insurance or workers' compensation, those without a university degree, those with children under 18, unattached individuals, renters, and those with an Aboriginal respondent. Higher income, immigration, and reliance on seniors' income sources were protective against food insecurity. Living in Nunavut and relying on social assistance were the strongest predictors of severe food insecurity, but severity was also associated with income, education, household composition, Aboriginal status, immigration status, and place of residence. The relation between income and food insecurity status was graded, with every $1000 increase in income associated with 2% lower odds of marginal food insecurity, 4% lower odds of moderate food insecurity, and 5% lower odds of severe food insecurity.

CONCLUSIONS

The probability of household food insecurity in Canada and the severity of the experience depends on a household's province or territory of residence, income, main source of income, housing tenure, education, Aboriginal status, and household structure. Our findings highlight the intersection of household food insecurity with public policy decisions in Canada and the disproportionate burden of food insecurity among Indigenous peoples.

Increased risk of oropharyngeal cancers mediated by oral human papillomavirus infection: Results from a Canadian study

BACKGROUND

This study aimed to estimate the extent to which oral sex behavior is associated with an increased risk of oropharyngeal cancers (OPCs), and how much of the association is mediated by oral human papillomavirus (HPV) infection.

METHODS

We used data from a hospital-based case-control study conducted in Montreal, Canada. Information on oral sex behaviors was collected. Oral rinse and oral brush specimens were analyzed for HPV positivity and genotyping. Logistic regression estimated the odds ratios (OR) and 95% confidence intervals (CI) for the association between oral sex behaviors and OPC.

RESULTS

Onset of oral sex practice at age 16 years or younger had an increased risk of OPCs relative to those with onset after age 30 years (OR = 2.98; 95% CI 1.37-6.47). This association decreased (OR = 1.09; 95% CI 0.25-4.71) when restricted to those positive for HPV.

CONCLUSIONS

Our results suggest that the association between oral sex and OPC seems mediated by oral HPV infection.

Geographic and socio-demographic predictors of household food insecurity in Canada, 2011-12

BACKGROUND

Household food insecurity is a potent social determinant of health and health care costs in Canada, but understanding of the social and economic conditions that underlie households' vulnerability to food insecurity is limited.

METHODS

Data from the 2011-12 Canadian Community Health Survey were used to determine predictors of household food insecurity among a nationally-representative sample of 120,909 households. Household food insecurity over the past 12 months was assessed using the 18-item Household Food Security Survey Module. Households were classified as food secure or marginally, moderately, or severely food insecure based on the number of affirmative responses. Multivariable binary and multinomial logistic regression analyses were used to determine geographic and socio-demographic predictors of presence and severity of household food insecurity.

RESULTS

The prevalence of household food insecurity ranged from 11.8% in Ontario to 41.0% in Nunavut. After adjusting for socio-demographic factors, households' odds of food insecurity were lower in Quebec and higher in the Maritimes, territories, and Alberta, compared to Ontario. The adjusted odds of food insecurity were also higher among households reliant on social assistance, Employment Insurance or workers' compensation, those without a university degree, those with children under 18, unattached individuals, renters, and those with an Aboriginal respondent. Higher income, immigration, and reliance on seniors' income sources were protective against food insecurity. Living in Nunavut and relying on social assistance were the strongest predictors of severe food insecurity, but severity was also associated with income, education, household composition, Aboriginal status, immigration status, and place of residence. The relation between income and food insecurity status was graded, with every $1000 increase in income associated with 2% lower odds of marginal food insecurity, 4% lower odds of moderate food insecurity, and 5% lower odds of severe food insecurity.

CONCLUSIONS

The probability of household food insecurity in Canada and the severity of the experience depends on a household's province or territory of residence, income, main source of income, housing tenure, education, Aboriginal status, and household structure. Our findings highlight the intersection of household food insecurity with public policy decisions in Canada and the disproportionate burden of food insecurity among Indigenous peoples.

Cost-effectiveness analysis of secukinumab in ankylosing spondylitis from the Canadian perspective

AIM

To assess the cost-effectiveness of interleukin (IL)-17A inhibitor secukinumab vs the currently licensed biologic therapies in ankylosing spondylitis (AS) patients from a Canadian healthcare system perspective.

METHODS

A decision analytic model (semi-Markov) evaluated the cost-effectiveness of secukinumab 150 mg compared to certolizumab pegol, adalimumab, golimumab, etanercept and etanercept biosimilar, and infliximab and infliximab biosimilar in a biologic-naïve population, over 60 years of time horizon (lifetime). The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI 50) response rate was used to assess treatment response at week 12. Non-responders or patients discontinuing initial-line of biologic therapy were allowed to switch to subsequent-line biologics. Model input parameters (short-term and long-term changes in BASDAI and Bath Ankylosing Spondylitis Functional Index [BASFI], withdrawal rates, adverse events, costs, resource use, utilities, and disutilities) were obtained from clinical trials, published literature, and other Canadian sources. Benefits were expressed as quality-adjusted life years (QALYs). Cost and benefits were discounted with an annual discount rate of 1.5% for all treatments.

RESULTS

In the biologic-naïve population, secukinumab 150 mg dominated all comparators, as patients treated with secukinumab 150 mg achieved the highest QALYs (16.46) at the lowest cost (CAD 533,010) over a lifetime horizon vs comparators. In the deterministic sensitivity analysis, results were most sensitive to changes in baseline BASFI non-responders, BASDAI 50 at 3 months and discount rates. Probabilistic sensitivity analysis showed that secukinumab 150 mg demonstrated higher probability of achieving maximum net monetary benefit vs all comparators at various cost thresholds.

CONCLUSIONS

This analysis demonstrates that secukinumab 150 mg is the most cost-effective treatment option for biologic-naïve AS patients compared to certolizumab pegol, adalimumab, golimumab, etanercept and etanercept biosimilar, and infliximab and infliximab biosimilar for a lifetime horizon in Canada. Treatment with secukinumab translates into substantial benefits for patients and the healthcare system.

When Health Care is Displaced by State Interests: Building Dialogue Through Shared Findings

Health sociologists interested in how macro state influences affect micro health care practices have much to gain from meta-ethnography research. In this article, we bring together insights from two separate empirical studies on state health care services involving HIV/AIDS as a way to speak to larger issues about the organization and production of medical expertise and governance in health care systems. We use Noblit and Hare's meta-ethnography approach to bring these studies into conversation and identify six shared "organizers" of health care encounters. The organizers illustrate how state health interests operate across institutional contexts and impact the work of providers in seemingly unrelated health care settings. On the basis of this synthesis, we conclude that state interests both structure and create conflict in health care settings. We believe this perspective offers the potential to advance the goals of health sociology and the field of qualitative health research in general.

A Comparison of Inpatient Adult Psychiatric Services in Italy and Canada

We examine the possibility the Organisation for Economic Co-operation and Development (OECD) bed count for Italy may be an underestimation of the actual beds available. We compared bedded services for mental disorders in two regions in Italy and Canada respectively. We found out that if we consider acute psychiatric beds only, the district of Ferrara has 30 beds (8.5 per 100,000) and the Middlesex and Elgin Counties have 89 beds (16.3 beds for 100,000). However, if we include the rehabilitation beds (that are located within a hospital setting in Ontario and in a residential community setting in Ferrara), we find that the district of Ferrara has 95 beds (27.0 per 100,000) and the Middlesex and Elgin Counties have 176 beds (32.3 per 100,000). As a result, the 10/100,000 beds rate for Italy reported by the OECD is an underestimate compared to figures reported for most other countries, as the beds included are hospital beds only.

MEDTalks: a student-driven program to enhance undergraduate student understanding and interest in medical schools in Canada

Given the lack of programs geared towards educating undergraduate students regarding medical school, the purpose of this study was to evaluate whether medical student-driven initiative program, MEDTalks, enhanced undergraduate student understanding of medical school in Canada and stimulated interest in pursuing medicine. The MEDTalks program that ran between January and April 2018 in the University of Ottawa consisted of 5 teaching sessions, each including large-group lectures, small group case-based learning, physical skills tutorials, and anatomy lab demonstrations, to mimic the typical Medical School curriculum. At the end of the program, undergraduate student learners were invited to complete a feedback questionnaire. Twenty-nine participants provided feedback. Twenty-five reported that MEDTalks allowed them to gain exposure to the University of Ottawa Medical Program; 27 said that it gave them a greater understanding of the teaching structure; and 25 responded that it increased their interest in attending medical school. The MEDTalks program successfully developed greater understanding of medical school and helped stimulate interest in pursuing medical studies in undergraduate students.

Sexual Harassment of Canadian Medical Students: A National Survey

BACKGROUND

Despite explicit policies and reporting mechanisms in academia designed to prevent harassment and ensure respectful environments, sexual harassment persists. We report on a national survey of Canadian medical students' experiences of sexual harassment perpetrated by faculty, patients and peers, their responses to harassment, and their suggestions for improving the learning environment.

METHODS

With ethics approval from all 17 Canadian universities with medical schools, an invitation to participate in an anonymous, electronic survey was included in three Canadian Federation of Medical Students' newsletters (2016). Narrative information about sexual harassment during medical training, perpetrators, ways of coping, sources of support, formal and informal reporting/discussion, and suggestions for change was sought. Three authors then conducted a qualitative analysis and identified emergent themes.

FINDINGS

When asked to estimate the number of occurrences of SH experienced during medical school, 188 students reported 807 incidents perpetrated by peers, patients, and, to a lesser extent, faculty. Perpetrators were almost always men and 98% of victims were women. What emerged was a picture of social, educational, and individual conditions under which sexual harassment becomes normalised by faculty, peers and victims. Students often tried to ignore harassment despite finding it confusing, upsetting, and embarrassing. They offered strategies for schools to raise awareness, support students, and prevent or mitigate harms going forward.

INTERPRETATION

Sexual harassment is a part of the Canadian medical education environment where most who reported harassment are subject to the dual vulnerabilities of being learners and women. Although survey respondents recognised the systemic nature of the problem, as individuals they often described shame and self-blame when victimised, came up with solutions that implied they were the problem, and often reported thinking silence was less risky than confrontation or official reporting. Many participants believed in the transformative power of education - of themselves and faculty - as a means of improving the medical environment whilst we await social change.

A Meta-Study of Qualitative Research Examining Sport and Recreation Experiences of Indigenous Youth

Participation in sport and recreation may contribute to various holistic benefits among Indigenous youth in Canada. However, there is a need for a consolidated evidence base to support the development of sport and recreation opportunities that could facilitate such holistic benefits. The purpose of this research was to produce a meta-study of qualitative research examining sport and recreation experiences of Indigenous youth in Canada. Following record identification and screening, 20 articles were retained for analysis and synthesis. Strengths and weaknesses of included studies were identified through the meta-method and meta-theory analysis. The meta-data analysis revealed five themes that represent the sport and recreation experiences of Indigenous youth. Working collaboratively with community members, our final meta-synthesis situated these five themes within the integrated Indigenous ecological model. This review consolidates the qualitative evidence base, and provides direction for future research and practice.

Facilitating Interviews in Qualitative Research With Visual Tools: A Typology

Visual methods are gaining traction in qualitative research to support data generation, data analysis, and research dissemination. In this article, I propose a preliminary typology that categorizes five identified purposes of applying visual methods in qualitative interviews: to (a) enable communication, (b) represent the data, (c) enhance data quality and validity, (d) facilitate the relationship, and (e) effect change. Examples of visual tools are presented to demonstrate their utility in addressing these five aims. An existing ethical framework for visual tool use in qualitative research is then presented to structure a discussion on ethical considerations related to confidentiality, consent, representations and audiences, fuzzy boundaries between researchers and participants, authorship and ownership, and minimizing harm. Future directions include testing and extending the typology with respect to other visual methods and qualitative research processes, and research to evaluate the effectiveness of various visual tools at achieving the aims represented in the typology.

Early hospital readmission and survival in patients with cirrhosis: A population-based study

BACKGROUND

Readmission in patients with cirrhosis is common. We aimed to determine the association between early hospital readmission and survival in the general population of patients with cirrhosis.

METHODS

This retrospective cohort study used routinely collected health care data from Ontario. We identified adults with cirrhosis using a validated case definition, and included those with at least one hospital admission between 1992 and 2016 resulting in discharge. Patients were classified into two groups based on timing of readmission after index admission: 1) ≤90 days, or 2) >90 days or no readmission. We described overall survival (OS) 90 days after the index hospitalization by readmission status using Kaplan-Meier curves and the log-rank test. The association between readmission and OS was evaluated using a multivariate Cox proportional hazards regression model.

RESULTS

Our study included 115,081 patients. The median OS was shorter in patients readmitted in ≤90 days (4.1 years, IQR 0.9, 13.1) compared with those readmitted in >90 days or not readmitted during the study period (9.6 years, IQR 3.2, 21.9, p <0.001). Adjusting for potential confounders, those readmitted in ≤90 days had a higher hazard of death than those not readmitted (hazard ratio [HR] 1.56, 95% CI 1.53 to 1.59, p <0.001).

CONCLUSIONS

Early readmission in patients with cirrhosis is a strong predictor of decreased OS. Our results suggest that patients with cirrhosis who have an early readmission should be further studied to determine whether this risk is modifiable. They can also be used to discuss long-term prognosis with patients and family members.

Post Your Journey: Instagram as a Support Community for People With Fibromyalgia

Fibromyalgia is a chronic illness with primary symptoms of widespread pain and fatigue. Social media applications have become a recent resource allowing individuals with fibromyalgia to interact in a virtual community devoted to the illness. This study explores how such a community develops and maintains itself on Instagram and the ways it creates social capital for its users. Data are derived from Instagram posts and open-ended questionnaires completed by users living with fibromyalgia who use the application. Using content analysis and semiotic methodology, the study analyzes the diverse ways in which users shared their experiences with fibromyalgia, the management of its symptoms, and issues encountered in accessing health care systems. Instagram aids in the development of a community by facilitating intimate and supportive interactions about the illness and the creation of personalized day-to-day narratives accessible to all. Norms of trust, acceptance, and reciprocity characterize the diversity of interactions in this community.

The Prevalence of Sexual Abuse by K-12 School Personnel in Canada, 1997-2017

Studies surrounding the sexual abuse of children by school personnel in Canadian contexts are infrequent and often limited in their scope. The present study addresses this drawback with a contribution of data gathered from disciplinary decisions of educator misconduct, media reports, and published case law concerning child/student sexual abuse cases (between 1997 and 2017) that involved any individual employed (or formerly employed) in a Canadian K-12 school. The study revealed a number of interesting points about the larger student victim and offender demographic patterns and characteristics across Canada. The study found 750 cases involving a minimum of 1,272 students and 714 offenders, 87% of which were male. Moreover, 86% of all offenders were certified teachers, and offenders employed grooming as the main tactic in 70% of the cases. Of the child/student victims, 75% were female, 55% were sexually abused on school property, and more than two-thirds of all victims were in high school at the time the offense was committed. The study also found that excluding Ontario and B.C., the media was the sole source of information for 50-86% of all cases depending on the province/territory. Finally, almost three-quarters of offenders from the study were charged with at least one criminal offense, and of the cases that proceeded to trial, 70% resulted in findings of guilt.

Better Doctor-Patient Relationships Are Associated with Men Choosing More Active Depression Treatment

BACKGROUND

Men tend to have low rates of treatment uptake for depression. The quality of the relationship with their family physician may be a factor influencing attitudes toward treatment. The present study was developed to explore this issue in a nationally representative sample of Canadian men.

METHODS

An online survey of 1000 Canadian men was conducted to inquire about men's relationship with their family physician and hypothetical treatment choices for depression. Main analyses were conducted among 819 men who indicated having a regular primary care physician.

RESULTS

Two thirds of men with a family physician (n = 534; 65%) indicated they would pursue treatment if they were suffering from depression. Multinomial logistic regression, controlling for age, employment, education level, and current depressive symptoms indicated that positive perceptions of the patient-doctor relationship were associated with men being more likely to opt for pharmacotherapy (n = 183; odds ratio [OR], 1.06; P < .001), and individual psychotherapy (n = 277; OR, 1.04; P < .001), compared with a wait-and-see/no treatment approach (n = 285).

CONCLUSION

The quality of the doctor-patient relationship is an important element in helping men choose active treatment for depression.

Early-Stage Cannabis Regulatory Policy Planning Across Canada's Four Largest Provinces: A Descriptive Overview

Background: Observing and documenting major shifts in drug policy in a given jurisdiction offer important lessons for other settings worldwide. After nearly a century of prohibition of non-medical use and sale of cannabis, Canada federally legalized the drug in October 2018. Across this geographically large and diverse country, there is a patchwork of cannabis policies as the provinces and territories have developed their own regulatory frameworks. Objectives: As drug policy transitions are often studied well after implementation, we document early stage cannabis regulatory policy planning in the four most populous provinces of Québec, Ontario, Alberta, and British Columbia. Methods: In June 2018, we systematically searched peer-reviewed and gray literature (such as web content, reports, and policy documents authored by varied authorities and organizations) to identify key aspects of the evolving provincial cannabis legalization frameworks. In the absence of peer-reviewed studies, we reviewed primarily gray literature. Results: For each of the four provinces examined, we provide a succinct overview of early-stage public consultation, plans for cannabis distribution and retail, other key regulatory features, endorsements of a public health approach to legalization, general alignment with alcohol policy, and contentious or standout issues. Conclusions/Importance: Our review clearly illustrates that cannabis legalization in Canada is not unfolding as monolithic policy, despite a federal framework, but with divergent approaches. The public health outcomes that will result from the different provincial/territorial regulatory systems remain to be measured and will be closely monitored.

Declining Admission and Mortality Rates for Subarachnoid Hemorrhage in Canada Between 2004 and 2015

Background and Purpose- The purpose of this study was to assess recent trends in the admission and mortality rates for subarachnoid hemorrhage in Canada. Methods- This retrospective cross-sectional study was based on data retrieved from the Canadian Institute for Health Information for all patients diagnosed with subarachnoid hemorrhage in Canada between 2004 and 2015. Adjusted admission rate, in-hospital mortality rates, and discharge disposition were calculated. Results- A total of 19 765  patients were diagnosed with subarachnoid hemorrhage between 2004 and 2015. The mean age was 58.1 years, and 40.3% were men. The annual hospitalization rate was 6.34 per 100 000 person-years, declining by -0.67% annually. In-hospital mortality rate was 21.5%. Conclusions- The Canadian subarachnoid hemorrhage admission and mortality rates are lower than previously reported, with a declining trend.

Contextualizing Canada's hepatitis C virus epidemic

In 2016, Canada signed on to the World Health Organization (WHO) 2030 hepatitis C virus (HCV) disease elimination targets. Most of Canada's HCV disease burden is among five disproportionately affected population groups: 1) Baby boomers, who are at increased risk of dying from decompensated cirrhosis and hepatocellular carcinoma and for whom one-time screening should be recommended to identify those undiagnosed; 2) People who inject drugs (PWID), whose mortality risks include HCV infection, HCV acquisition risks and co-morbid conditions. While HCV infection in PWID can be effectively cured with direct-acting antivirals, premature deaths from acquisition risks, now exacerbated by Canada's opioid crisis, will need to be addressed to achieve the full benefits of curative treatment. PWID require syndemic-based solutions (harm reduction, addictions and mental health support, and management of co-infections, including HIV); 3) Indigenous populations who will require wellness-based health promotion, prevention, care and treatment designed by Indigenous people to address their underlying health disparities; 4) Immigrants who will require culturally designed and linguistically appropriate services to enhance screening and engagement into care; and (5) For those incarcerated because of drug-related crimes, decriminalization and better access to harm reduction could help reduce the impact of HCV infections and premature mortality. A comprehensive prevention, care and treatment framework is needed for Canada's vulnerable populations, including those co-infected with HIV, if we are to achieve the WHO HCV elimination targets by 2030. The aim of this review is to describe the HCV epidemic in the Canadian context.