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Smith JN, Guttmann A, Kopp A, Vandermorris A, Shouldice M, Harron KL. Association of maternal risk factors with infant maltreatment: an administrative data cohort study. Arch Dis Child 2023; 109:23-29. [PMID: 37758290 DOI: 10.1136/archdischild-2022-325239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/06/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE We aimed to evaluate the risk of infant maltreatment associated with commonly used criteria for home visiting programmes: young maternal age, maternal adversity (homelessness, substance abuse, intimate partner violence), newcomer status and mental health concerns in Ontario, Canada. DESIGN This retrospective cohort study included infants born in hospital in Ontario from 1 April 2005 to 31 March 2017 captured in linked health administrative and demographic databases. Infants were followed from newborn hospitalisation until 1 year of age for child maltreatment captured in healthcare or death records. The association between type and number of maternal risk factors, and maltreatment, was analysed using multivariable logistic regression modelling, controlling for infant characteristics and material deprivation. Further modelling explored the association of each year of maternal age with maltreatment. RESULTS Of 989 586 infants, 434 (0.04%) had recorded maltreatment. Maternal age <22 years conferred higher risk of infant maltreatment (adjusted OR (aOR) 5.5, 95% CI 4.5 to 6.8) compared with age ≥22 years. Maternal mental health diagnoses (aOR 2.0, 95% CI 1.6 to 2.5) were also associated with maltreatment, while refugee status appeared protective (aOR 0.6, 95% CI 0.4 to 1.0). The odds of maltreatment increased with higher numbers of maternal risk factors. Maternal age was associated with maltreatment until age 28 years. CONCLUSION Infants born to young mothers are at greater risk of infant maltreatment, and this association remained until age 28 years. These findings are important for ensuring public health interventions are supporting populations experiencing structural vulnerabilities with the aim of preventing maltreatment.
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Affiliation(s)
- Jennifer N Smith
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- The London School of Hygiene and Tropical Medicine (affiliated at the time of acquiring REB approval), London, UK
| | - Astrid Guttmann
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Ashley Vandermorris
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle Shouldice
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Katie L Harron
- The London School of Hygiene and Tropical Medicine (affiliated at the time of acquiring REB approval), London, UK
- ICES, Toronto, Ontario, Canada
- UCL Great Ormond Street Institute of Child Health, London, UK
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Factors Affecting Young Mothers’ Access to Child Healthcare Services: A Behavioural Analysis to Guide the Development of Interventions. BEHAVIOUR CHANGE 2022. [DOI: 10.1017/bec.2022.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Young mothers are more likely to access healthcare for their children in emergent care settings and less likely to use preventive care. This study examines the healthcare-seeking behaviours of young mothers to inform the design of tailored interventions. Semi-structured interviews with nine young mothers (aged ≤ 25 years) who were attending a supported playgroup in Brisbane, Australia were conducted and explored using the Capability, Opportunity and Motivation and Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). Five behavioural themes were identified (navigating the system, complex referral pathways, delays and long wait times, understanding child development, and connecting to services) and the role of the supported playgroup in shaping young mothers’ understanding of child development and connecting them to services was highlighted. Recommended strategies to address these factors include opportunities for young mothers to learn about child developmental milestones, improving young mothers’ health literacy, increasing young mothers’ skills and/or the availability of support to help them navigate health services, and providing more accessible entry points for child assessments, referrals, or early intervention programs.
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Marcellus L, Tonmyr L, Jack SM, Gonzalez A, Sheenan D, Varcoe C, Kurtz Landy C, Campbell K, Catherine N, MacMillan H, Waddell C. Public health nurses' perceptions of their interactions with child protection services when supporting socioeconomically disadvantaged young mothers in British Columbia, Canada. CHILD ABUSE & NEGLECT 2022; 124:105426. [PMID: 34995927 DOI: 10.1016/j.chiabu.2021.105426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/10/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Children of girls and young women experiencing socioeconomic disadvantage are at risk of maltreatment and associated health and developmental problems. Nurse-Family Partnership (NFP) is an early intervention program designed to improve child and maternal health outcomes. The effectiveness of NFP is being evaluated in British Columbia (BC) through a randomized controlled trial, augmented by a process evaluation to identify influences on how NFP was implemented. OBJECTIVE To describe how public health nurses providing NFP perceived their interactions with child protection professionals. PARTICIPANTS AND SETTING Forty-seven public health nurses across BC. METHODS The principles of interpretive description informed the qualitative component of the process evaluation. Data from interviews and focus groups were analyzed using the framework analysis approach. A thematic framework was generated through processes of coding, charting and mapping, with a focus on organizational and systems influences. RESULTS Nurses' practice in supporting families often involved engagement with child protection services. Four themes about the nature of this work were identified: 1) developing a deeper understanding of the disciplinary perspectives of child protection, 2) striving for strengthened collaboration, 3) navigating change and uncertainty, and 4) responding to family and community complexity. CONCLUSIONS Participants valued the contribution of child protection professionals and expressed willingness to collaborate to support families. However, collaboration was constrained by multiple structural barriers. Collaborative models offer possibilities for integrated practice, although can be difficult to implement within current health and child protection systems and child protection regulatory contexts.
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Affiliation(s)
- Lenora Marcellus
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada.
| | - Lil Tonmyr
- Public Health Agency of Canada, Family Violence Surveillance, 785 Carling, AL 6807B, Ottawa, ON K1A 0K9, Canada.
| | - Susan M Jack
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.
| | - Debbie Sheenan
- Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada
| | - Colleen Varcoe
- School of Nursing, T201-2211 Wesbrook Mall, University of British Columbia, Vancouver, BC V6T 2B5, Canada.
| | | | - Karen Campbell
- School of Nursing, Western University, London, ON N6A 3K7, Canada.
| | - Nicole Catherine
- Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada.
| | - Harriet MacMillan
- Offord Centre for Child Studies, McMaster Innovation Park, Suite 201A, McMaster University, 1280 Main St. West, Hamilton, ON L8S 4K1, Canada.
| | - Charlotte Waddell
- Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada.
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Yoshioka-Maeda K, Fujii H. Mothers susceptible to child maltreatment and requiring public health nurses' continuous support. Public Health Nurs 2021; 39:48-61. [PMID: 34755376 DOI: 10.1111/phn.13004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to identify the characteristics of mothers who are at a high risk for future child maltreatment and therefore, require continuous support from public health nurses (PHNs) to prevent child maltreatment and those who do not require it. DESIGN AND SAMPLES This retrospective cross-sectional study included women who were registered in 2018 for being at risk for future child maltreatment and required help with childrearing in City A within the Tokyo metropolis. MEASUREMENTS Public health nurses registered data pertaining to each mother, including demographic data, family-related variables, assessment by PHNs, use of maternal and child healthcare services, and continuity of support from PHNs. RESULTS Of the 206 cases, the discontinued group-comprising those who no longer needed PHNs' support-included 83 cases (40.3%) and the continuing group-comprising those needed continuing support-included 123 cases (59.7%). Logistic regression analysis showed that those with marital conflicts, maternal mental instability, lack of parenting skills, and not moving out of the city were more likely to require continuous PHNs' support. CONCLUSIONS By identifying these factors, PHNs can identify new mothers who need continuous support and provide more concentrated care for them. Thus, support from PHNs can help prevent child maltreatment.
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Affiliation(s)
- Kyoko Yoshioka-Maeda
- Department of Health Promotion, National Institute of Public Health, Saitama, Japan
| | - Hitoshi Fujii
- Department of Medical Statistics, School of Nursing, Mejiro University, Saitama, Japan
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Taillieu TL, Cheung K, Sareen J, Katz LY, Tonmyr L, Afifi TO. Caregiver Vulnerabilities Associated With the Perpetration of Substantiated Child Maltreatment in Canada: Examining the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) 2008. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP11618-NP11646. [PMID: 31771400 DOI: 10.1177/0886260519889941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Most of the research on caregiver vulnerabilities associated with the perpetration of child maltreatment (CM) focuses on perpetrators of child physical or sexual abuse. Less is known about the association of specific caregiver vulnerabilities and the risk of other CM types or how these vulnerabilities are related to child harm. The aim of the study was to examine the association of caregiver's vulnerabilities with types of substantiated CM and child physical and mental/emotional harm as a result of maltreatment. Data were from the Canadian Incidence Study of Reported Child Abuse and Neglect collected in 2008 (CIS-2008). The CIS-2008 consisted of investigations of children aged 15 years and younger from 112 child welfare sites across Canada (N = 15,980). Descriptive statistics and logistic regression were used to examine relationships between caregiver vulnerabilities and outcomes of interest. Caregiver vulnerabilities were prevalent among cases of CM substantiated by child welfare agencies across Canada. Low social support, domestic violence, mental health issues, and substance abuse problems were noted among a substantial proportion of abusive caregivers. Caregiver cognitive impairments and domestic violence perpetration were associated with increased odds of child physical harm, but only among children aged 0 to 4 years. Most individual types of caregiver vulnerabilities were associated with increased odds of child mental or emotional harm across all child age groups. Insight into caregiver vulnerabilities associated with the perpetration of CM may help inform intervention targets prior to a family's involvement in the child welfare system.
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Affiliation(s)
| | | | | | | | - Lil Tonmyr
- Public Health Agency of Canada, Ottawa, Ontario, Canada
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Characteristics of Pregnant Women and New Mothers Identified as Being At-Risk for Child Maltreatment in Early Pregnancy. WOMEN 2021. [DOI: 10.3390/women1040016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pregnant women and new mothers who have risk factors of child maltreatment are “at high risk for future child maltreatment.” Early detection of them is crucial to prevent it. This community-based, retrospective, cross-sectional, observational study aimed to identify the characteristics of pregnant women, and those in their postpartum period, identified as at-risk cases for child maltreatment. We used data from the municipal pregnancy registration system in City A and analyzed 206 cases identified as “at-risk for child maltreatment” from 1 April 2017 to 31 March 2018. They were categorized into two groups: a pregnancy group (131 cases, 63.6%) and a postpartum group (75 cases, 36.4%). Logistic regression analysis revealed that women who reported having poor relationships with their parents and participated in the interview in their early stages of their pregnancy were less likely to be registered as at-risk cases for child maltreatment after delivery. The results suggest that public health nurses (PHNs) can conduct interviews with pregnant women during the early stages of pregnancy to prevent child maltreatment in community settings. Additionally, to ensure safe delivery and childrearing environments, PHNs need to assess the family support capacity of each registered case and provide assistance to those without parental support.
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Levi D, Ibrahim R, Malcolm R, MacBeth A. Mellow Babies and Mellow Toddlers: Effects on maternal mental health of a group-based parenting intervention for at-risk families with young children. J Affect Disord 2019; 246:820-827. [PMID: 30795486 DOI: 10.1016/j.jad.2018.12.120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/15/2018] [Accepted: 12/24/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Parental risk factors can have a significant detrimental impact on child development, yet most parenting interventions do not address parental mental health. There is also a dearth of evidence regarding parenting interventions for families with children under two years old. Mellow Parenting (MP) is a suite of parenting interventions targeting at-risk families with complex needs, including those with very young children. Preliminary studies suggest that MP can improve both parent and child outcomes, but no evaluation has been conducted in routine practice. METHODS Using a real-world design we analysed routine data from a UK cohort of n = 183 mother-child dyads, collected over a 21-month period. Data were gathered immediately pre- and post-intervention. Outcomes included maternal mental health, parenting confidence, daily parenting stress, and child behaviour. Intention-to-treat and 'completer' analyses were performed. Associations between attendance, participant demographics, and pre-post change in outcomes were modelled. RESULTS MP participation was associated with improvements in maternal mental health (d = 0.36), parenting confidence (d = 0.42), and a component of child psychosocial behaviour (conduct problems; d = 0.36), but not overall child difficulties, or daily parenting stress. Mothers with a partner experienced larger benefits in mental health and parenting confidence compared to single mothers. Younger mothers, and those with a history of mental health problems, attended more intervention sessions. LIMITATIONS The study used real-world data and was thus uncontrolled, limiting causal interpretations. CONCLUSIONS This is the first study to explore MP participation on a multi-site national level and suggests that group-based parenting interventions may be effective for at-risk families. These results should be expanded upon via controlled studies that incorporate follow-up data.
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Yoshioka-Maeda K, Kuroda M. Characteristics and related factors of Japanese mothers who have faced difficulties with childrearing. Public Health Nurs 2017; 34:422-429. [PMID: 28419536 DOI: 10.1111/phn.12328] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To identify characteristics of mothers who face difficulties with childrearing. DESIGN AND SAMPLE Cross-sectional study. During 2014, 221 mothers and 248 children living in City A within the Tokyo metropolis were registered as requiring help with childrearing. Nursing records of 205 mothers (92.8%) and their 227 children (91.5%) were available. We excluded 29 mothers and children owing to incomplete data for a final sample of 176 mothers (79.6%) and 198 children (79.8%). MEASURES Difficulties with childrearing were assessed by self-reported questionnaires at the newborn child's 4-month health checkups. Data on maternal and child variables were collected from nursing records. RESULTS The "Difficulties group" included 59 mothers (35.4%) and their 70 children. Logistic regression analysis showed that mothers who were aged 40 years or older, who had a total score on the Edinburgh Postnatal Depression Scale of 9 or greater, who used more child-care support services, and who were monitored more frequently by public health nurses had a high risk of facing difficulties with childrearing. CONCLUSIONS Periodic monitoring by PHNs is a key strategy to improve the impact of the difficulties of childrearing for mothers of yoshien jido and their children.
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Affiliation(s)
- Kyoko Yoshioka-Maeda
- Department of Community Health Nursing, School of Nursing, Tokyo Medical University, Tokyo, Japan
| | - Mariko Kuroda
- Department of Community Health Nursing, School of Nursing, Tokyo Medical University, Tokyo, Japan
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Mikton C. Adapting and retesting evidence-based child maltreatment prevention programs: a case study in Canada. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2016; 35:168-70. [PMID: 26605566 DOI: 10.24095/hpcdp.35.8/9.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This special issue of Health Promotion and Chronic Disease Prevention in Canada is timely, as child maltreatment is a significant public health problem; globally, the number affected is at least in the hundreds of millions. One-quarter of adults report having been physically abused and over one-third emotionally abused as children; one in 5 women and one in 13 men report having been sexually abused. Recent national surveys of violence against children conducted in Africa and in other low- and middle-income countries reveal rates of childhood physical, sexual and emotional abuse even higher than the global rates.
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Affiliation(s)
- C Mikton
- Prevention of Violence (PVL), Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention (NVI), Noncommunicable Diseases and Mental Health, World Health Organization
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Tonmyr L. Guest Editor's response. Health Promot Chronic Dis Prev Can 2016; 36:S2368738X36040331. [PMID: 27089156 PMCID: PMC5607837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Lil Tonmyr
- Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
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Tonmyr L. The Nurse-Family Partnership: evidence-based public health in response to child maltreatment. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2015; 35:141-2. [PMID: 26605562 DOI: 10.24095/hpcdp.35.8/9.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Too many Canadian children are exposed to child maltreatment-neglect, emotional maltreatment, exposure to intimate partner violence, and physical and sexual abuse. Retrospective data indicates that 32% of Canadian adults have experienced childhood abuse. There is evidence that child maltreatment is associated with a wide array of negative health consequences across the life span. These consequences expand across physical, mental, developmental and social domains to include suicide, substance abuse, anxiety, depression and physical health problems. Experts have asked for coordinated national leadership in protecting children from maltreatment. They also envision broadening the mandate for injury prevention to include not only physical injury but also emotional injury and harm.
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Affiliation(s)
- L Tonmyr
- Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
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Potter D, Nasserie T, Tonmyr L. A review of recent analyses of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS). Health Promot Chronic Dis Prev Can 2015; 35:119-29. [PMID: 26605559 PMCID: PMC4911131 DOI: 10.24095/hpcdp.35.8/9.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
INTRODUCTION The objective of this analysis is to identify, assess the quality and summarize the findings of peer-reviewed articles that used data from the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) published since November 2011 and data from provincial oversamples of the CIS as well as to illustrate evolving uses of these datasets. METHODS Articles were identified from the Public Health Agency of Canada's data request records tracking access to CIS data and publications produced from that data. At least two raters independently reviewed and appraised the quality of each article. RESULTS A total of 32 articles were included. Common strengths of articles included clearly stated research aims, appropriate control variables and analyses, sufficient sample sizes, appropriate conclusions and relevance to practice or policy. Common problem areas of articles included unclear definitions for variables and inclusion criteria of cases. Articles frequently measured the associations between maltreatment, child, caregiver, household and agency/referral characteristics and investigative outcomes such as opening cases for ongoing services and placement. CONCLUSION Articles using CIS data were rated positively on most quality indicators. Researchers have recently focussed on inadequately studied categories of maltreatment (exposure to intimate partner violence [IPV]), neglect and emotional maltreatment) and examined factors specific to First Nations children. Data from the CIS oversamples have been underutilized. The use of multivariate analysis techniques has increased.
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Affiliation(s)
- D Potter
- Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - T Nasserie
- Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - L Tonmyr
- Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
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