Pedestrian-friendly cities have lower rates of diabetes and obesity

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From the New Scientist article

Diabetes and obesity rates can be reduced by transforming towns and cities into places where it is safe and convenient to walk, cycle or take public transport rather than drive.

Gillian Booth at the University of Toronto and her colleagues scoured more than 170 previous studies and discovered consistent evidence that people who live in areas where walking and cycling are practical options are more active and less likely to have diabetes or obesity.

One large study that Booth’s team considered involved 32,767 people and found that the prevalence of obesity among adults living in pedestrian-friendly towns and cities was 43 per cent, compared with 53 per cent of those living in areas where walking was a less practical option.

Another study that involved analysing the blood of 1.1 million adults also demonstrated the benefits of pedestrian-friendly areas. People with normal blood sugar levels at the beginning of the study were 20 per cent more likely to show symptoms of pre-diabetes eight years later if they lived in areas judged less friendly for pedestrians.

Les villes privilégiant les piétons présentent des taux plus faibles de diabète et d’obésité

Extrait de l’article tiré de la revue New Scientist

Il est possible de faire chuter les taux de diabète et d’obésité en transformant les villes en lieux où il est sécuritaire et pratique de marcher, de faire du vélo ou de prendre les transports en commun plutôt que sa voiture.

Gillian Booth, de l’Université de Toronto, ainsi que ses collègues ont passé en revue plus de 170 études antérieures et découvert des preuves démontrant que les personnes qui vivent dans des zones où la marche et le vélo sont des options privilégiées sont plus actives et moins susceptibles de souffrir de diabète ou d’obésité.

Une vaste étude examinée par l’équipe de Mme Booth menée auprès de 32 767 personnes a révélé que la prévalence de l’obésité chez les adultes vivant dans des villes adaptées aux piétons était de 43 %, contre 53 % chez ceux vivant dans des zones où la marche est une option moins pratique.

Une autre étude, qui a consisté à analyser le sang de 1,1 million d’adultes, a également démontré les bienfaits des zones piétonnes. Les personnes dont la glycémie était normale au début de l’étude étaient 20 % plus susceptibles de présenter des symptômes de prédiabète huit ans plus tard si elles vivaient dans des zones jugées moins favorables aux piétons.

Open science, not for-profit discovery, is Canada’s best path to pandemic prevention

Op-ed by Dr. Dan Werb in The Globe & Mail

When a cluster of unexplainable pneumonia cases emerged in Hong Kong and the nearby Chinese city of Guangzhou in November, 2002, the world stood rapt. From a few dozen cases, the epidemic grew to include hundreds; as the numbers mounted, so did the deaths. The new pathogen had all the hallmarks of being pandemic-ready: It could transmit itself efficiently across human populations, it killed more than 10 per cent of those that were infected and it was a virus the world had never seen before.

That virus was severe acute respiratory syndrome, or SARS, the first pathogenic human coronavirus ever detected – and a close relative of SARS-CoV-2, the cause of the COVID-19 pandemic. When SARS first spread to Canada in the spring of 2003, Bob Brunham, a vaccinologist and the director of the BC Centre for Disease Control, helped lead a team that first mapped its genome. But after having seen the virus spread unchecked to every global hemisphere in a matter of months, he decided mapping it wasn’t enough.

If humanity was to ever keep up with emerging pathogenic abominations such as SARS, a leap in vaccine development was urgently needed. It was an audacious gambit because, at the time, the timeline for getting a vaccine to market was measured in decades, not years – making them a poor strategy for fast-moving epidemics. Vaccine production was also totally cornered by pharmaceutical companies, which were the only ones with the estimated US$100-million that was the minimum amount needed to get a viable product to market.

‘A heroic effort that went unrecognized’: Harm reduction workers facing their own burnout

From the Healthy Debate article

The “shadow epidemic” lurking in the COVID-19 background is leaving another group of front-line workers battered and bruised. And Ontario’s opioid crisis is expected to get worse over the next six months, according to the latest data.

But unlike mainstream health-care providers, harm reduction workers do not have benefits like danger pay or strong unions to support them. With jobs characterized by low wages, stigma and political red-tape, overworked harm reduction professionals are seeing burnout on the front lines.

“I have watched harm reduction workers over the past two years, from the first wave, where they really quickly pivoted because they realized if supervised consumption sites closed, tons of people who were relying on their services would die,” says Gillian Kolla, postdoctoral fellow at the MAP Centre for Urban Health Solutions at St. Michael’s Hospital. “They literally moved mountains heroically from day to day, to still provide services in the midst of COVID. They did this with zero funding, they did this by begging and borrowing (personal protective equipment) in the initial wave. It was an absolutely heroic effort that went largely unrecognized.”

New study finds COVID-19 hotspots in Canadian urban centres

News release by Canadian Medical Association Journal

A new study shows hotspots of SARS-CoV-2 infections in Canadian cities across four provinces, linked to occupation, income, housing and proxies for structural racism. The study, which looked at infections in 16 urban centres in British Columbia, Manitoba, Ontario and Quebec, is published in CMAJ (Canadian Medical Association Journal.)

The COVID-19 pandemic has had variable impacts across provinces and within cities, with some regions more affected than others. To better understand the factors contributing to the concentration of SARS-CoV-2 infections in geographic areas, researchers analyzed provincial surveillance data from January 2020 to February 2021.

“Understanding the factors associated with geographic patterns of transmission within cities can help identify the populations and, specifically, the contexts with the greatest risks,” write Yiqing Xia, McGill University, Montréal, Quebec, and Huiting Ma, Unity Health Toronto, Toronto, Ontario, with coauthors. “Geographic analyses can enable better allocation of resources, tailoring of policies and implementation of context-specific strategies to more effectively and efficiently curb local transmission.”

There were 62 709 SARS-CoV-2 cases in BC, 15 089 in Manitoba, 239 160 in Ontario and 215 928 in Quebec recorded in the 16 census metropolitan areas that were included in the study. They accounted for 81%, 57%, 83% and 80% of all confirmed cases in each province, respectively. Researchers observed concentrations of cases according to social determinants of health, such as income, housing, essential work, visible minority status and more. They found that visible minority status was the social determinant of health that was important across all cities, with variations in the others.

“This study provides comprehensive and robust evidence of high geographic concentration of SARS-CoV-2 cases within Canadian cities in BC, Manitoba, Ontario and Quebec,” write senior authors Dr. Mathieu Maheu-Giroux, McGill University, and Dr. Sharmistha Mishra, Unity Health Toronto, with coauthors. “These hotspots are largely defined along social determinants related to occupation, income, housing and proxies for structural racism.”

The 16 regions included:

  • British Columbia – Vancouver, Kelowna and Abbotsford–Mission
  • Manitoba – Winnipeg
  • Ontario – Toronto, Ottawa, Hamilton, Kitchener–Cambridge–Waterloo, St. Catharines–Niagara and Windsor
  • Quebec – Montréal, Québec City, Gatineau, Sherbrooke, Saguenay, Trois-Rivières

These findings are consistent with those of other studies from Canada as well as Sweden, the United States and other countries showing higher rates of SARS-CoV-2 in racialized communities or diverse neighbourhoods.

The authors call for city-specific public health supports like geographic hot-spot initiatives, such as vaccination rollouts and access to mobile and outreach testing with wrap-around support for quarantine and isolation, that are tailored to effectively reach and meet the prevention and care needs of communities at disproportionate risk of COVID-19.

Geographically prioritized allocation of resources and services that are tailored to the local drivers of inequalities in acquisition and transmission risk offer a path forward in the public health response to SARS-CoV-2,” they conclude.

Lessons from Dr. Alexander Augusta, a Black surgeon who trained in Canada in the 1850s before serving in the Civil War

Interview by Marlene Leung, Unity Health Toronto with Dr. Nav Persaud

Dr. Alexander Augusta was a Black physician who studied medicine in Toronto in the mid-1800s after being refused admission to medical schools in the United States because of racism. Although he completed his medical training in Canada and practiced for a brief period in Toronto, he returned to America to fight for the Union in the Civil War, becoming the first African-American surgeon in the Union army. He went on to hold many distinguished and groundbreaking positions as a medical educator in the States, and, with full military honours, was buried at Arlington National Cemetery.

Dr. Nav Persaud, family physician at Unity Health Toronto and Canada Research Chair in Health Justice, recently co-authored a new paper about the remarkable life and career of Dr. Augusta. We spoke with Dr. Persaud about his interest in researching Augusta’s life in Canada and what his story can teach us about racism and the disparities that exist today in Canadian medicine.

Q: What initially sparked your interest in researching Dr. Alexander Augusta?  

Dr. Persaud: It started when I was thinking about how the history of medicine is pretty homogenous and focuses largely on the accomplishments of white men. I wondered if there were other important stories out there that had been overlooked, and that’s when I came across a book by Dr. Heather Butts (who co-authored the paper) that looked at healthcare in the U.S. during the Civil War era. That’s where I learned about Dr. Augusta.

Most of what’s written about him focuses on his time in America. Augusta’s remarkable time in Canada hadn’t been carefully examined, so that’s why we chose to focus on his decade here.

Q: This paper was published in the Canadian Medical Education Journal, why do you feel Augusta’s story is important for medical and healthcare students to know?

Dr. Persaud: Augusta’s experience here in Canada can help us understand the disparities that exist today in Canadian medicine. Even today, medical schools don’t represent the populations that they serve, and if you want to understand why, part of that means going back to Augusta’s time.

Augusta had some pretty good reasons to stay in Canada, he was barred from getting into U.S. medical schools, and people were still being enslaved in the U.S. But he decided to go back to the States and put his life at risk fighting for the Union, rather than staying in Canada. Fighting against the Confederates in the Civil War was obviously very important to him, but things weren’t easy for him here.

During his brief time here, Augusta spoke out against racism and discrimination in Canada. When there was a proposal to create a segregated colony for Black people on Ontario’s Manitoulin Island, he advocated against it, drawing parallels to the American south. He also was president of the Association for the Education of Coloured People in Canada, a group that helped ensure Black children had the necessary supplies and supports to succeed at school. It appears he never worked at a large hospital in Toronto, but after the Civil War he headed a hospital in the United States.

His story counters the very simplistic narrative of America being bad, and Canada being good. Sometimes there is this idea of Canadian exceptionalism in comparison to America, and people assume that racism wasn’t a problem in Canada and isn’t a problem today. Augusta’s life shows that it’s a much-more nuanced story than that. Obviously there was a good reason for him to come here, and racism in America was a big part of that. But there was also good reasons for him to leave Canada, and racism was one of them.

Emergency department visits for drug overdoses disproportionately higher among homeless population during the pandemic: study

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From Unity Health Toronto

A study of emergency department (ED) visits for drug overdoses in Ontario during the COVID-19 pandemic reveals that overdoses were disproportionately higher among people experiencing homelessness.

The findings, published in Addiction, show that in Ontario from June to September 2020, when the province was reopening after wave 1 lockdown measures, weekly rates of ED visits for drug overdoses more than doubled among homeless individuals compared to the same time the year prior. Increases of this magnitude were not observed among the stably housed or those living in low-income neighborhoods.

The study shows that the impacts of the pandemic have disproportionately harmed individuals experiencing homelessness, and suggests that greater supports are needed to address the intersection of homelessness and drug use.

“These findings confirm one shameful truism of this pandemic – that vulnerable populations have been time and time again disproportionately impacted by the COVID-19 pandemic,” said Michael Liu, lead author of the study, a research coordinator at St. Michael’s MAP Centre for Urban Health Solutions, and visiting scholar at ICES.

“This is a population that already contends with immeasurable difficulties, and we have failed to protect them during the pandemic. There are clear policies and interventions that need to be put in place to support and protect the most vulnerable within our cities and neighborhoods,” said Mr. Liu, who is also a medical student at Harvard University and a Rhodes Scholar.

Researchers at St. Michael’s Hospital of Unity Health Toronto used data from ICES, the not-for-profit research institute, to categorize over 15.2 million Ontarians into three groups based on their housing status: individuals with a recent history of homelessness, all housed individuals, and individuals living in low-income neighborhoods.

To understand how the pandemic impacted overdoses for the people within these groups, researchers retrospectively analyzed ED data during three stages: pre-pandemic (January 5 to March 16, 2020), peak (March 17 to June 16, 2020), and re-opening periods (June 17 to September 26, 2020). The researchers used corresponding weeks in 2019 as a benchmark to measure against. They found:

  • There was an overall increase in ED visits for overdoses among all three housing groups from 2019 to 2020.
  • The increase was most pronounced in individuals with a recent history of homelessness. There was a 56 percent increase in ED visits for overdoses during the re-opening period of 2020 compared to the same weeks in 2019.
  • Looking just at 2020, rates of ED visits per 100,000 people for drug overdoses among recently homeless individuals were 148 times higher than that of all housed individuals and 22 times higher than that of low-income housed individuals.
  • ED visits for drug overdoses decreased across all groups by approximately 20 percent during the peak period compared with corresponding weeks in 2019.

“Our study shows the enormous toll that drug overdoses have taken on people experiencing homelessness during the pandemic,” said Dr. Stephen Hwang, senior author of the study and Director of MAP Centre for Urban Health Solutions at St. Michael’s Hospital.

“We need to act right now to prevent overdoses, which all too often end up causing tragic and preventable deaths,” said Dr. Hwang, who is also an internal medicine physician and Chair in Homelessness, Housing and Health at St. Michael’s Hospital.

The authors are calling for urgent public health and policy interventions to reduce the burden of drug overdoses and substance-related problems in this population, including greater access to supervised consumption facilities, fentanyl testing strips, naloxone, low-barrier opioid agonist therapies, and tailored office-based addiction treatments. The authors say the services need to be brought directly to people experiencing homelessness through mobile street teams, community-based agencies, and shelter services.

“Difficulties with substance use and homelessness are inextricably linked. Stable housing is necessary – although not sufficient – to address the unacceptably high rates of morbidity and mortality in the homeless population,” said Mr. Liu.

Les visites aux urgences dues à des surdoses de drogue sont disproportionnellement plus nombreuses dans la population des personnes sans-abri en période de pandémie : étude

Par Unity Health Toronto

Une étude portant sur les visites dans les salles d’urgence causées par des surdoses de drogues en Ontario pendant la pandémie de COVID-19 révèle que les surdoses étaient proportionnellement beaucoup plus nombreuses chez les populations de personnes sans-abri.

Les conclusions, publiées dans la revue Addiction, révèlent qu’en Ontario, de juin à septembre 2020, au moment où la province se déconfinait après la première vague de mesures de confinement, les taux hebdomadaires de visites aux urgences en raison de surdoses de drogues ont plus que doublé chez les sans-abris par rapport à la même période l’année précédente. Des augmentations de cette ampleur n’ont pas été observées chez les personnes ayant un logement stable ou vivant dans des quartiers à faibles revenus.

L’étude révèle que les répercussions de la pandémie ont nui de manière disproportionnée aux personnes sans domicile fixe et elle indique que des mesures de soutien plus importantes sont nécessaires pour faire face aux conséquences de la réciprocité entre les personnes sans domicile fixe et la consommation de drogues.

« Ces résultats confirment un triste cliché de cette pandémie, à savoir que les populations vulnérables ont été à maintes reprises touchées de manière disproportionnée par la pandémie de COVID-19 », a déclaré Michael Liu, auteur principal de l’étude, coordonnateur de recherche au Centre MAP pour des solutions de santé urbaine de l’hôpital St. Michael et chercheur invité à l’ICES.

« Il s’agit d’une population qui doit déjà faire face à des difficultés incommensurables, et nous n’avons pas su la protéger pendant la pandémie. Il existe des politiques et des interventions concrètes qui doivent être mises en place pour soutenir et protéger les plus vulnérables dans nos villes et nos quartiers » a déclaré M. Liu, également étudiant en médecine à l’Université de Harvard et boursier Rhodes.

‘A lot of grief, loss and trauma’: Drug consumption sites grapple with record number of overdoses

From the Toronto Star article

Toronto’s supervised drug consumption sites are seeing a record number of overdoses, while the city’s paramedics responded to more fatal overdoses in 2021 than any other recorded year — all signs that experts say point to a worsening opioid crisis both in Ontario and elsewhere.

The toll comes as front-line staff struggle with burnout and grief while navigating the unpredictability of COVID-19 and the latest Omicron wave. And a lack of swift action on the part of policy-makers to reduce opioid-related harms, some critics say, has exacerbated an already dire situation.

“The drug poisoning crisis is not getting better,” said Shaun Hopkins, manager of The Works, a supervised consumption site run by the city of Toronto. “We’re continuing to see records being set in terms of paramedic calls, deaths, overdose numbers.”

The Works saw a record 165 overdoses in December, accounting for 8.8 per cent of all visits to the site that month. It is a marked increase from December 2019, where the rate of overdoses hovered around 1.4 per cent. In January 2022, the rate of overdoses remained high at 5.6 per cent.

Paramedics in Toronto also saw a record number of opioid deaths in 2021, responding to a total of 357 fatal suspected overdose calls. In 2020, paramedics responded to 268 fatal calls. Because paramedics aren’t involved in every opioid fatality, the numbers for opioid-related deaths in 2021 may be higher, said Gillian Kolla, a post-doctoral fellow at St. Michael’s Hospital with expertise in drug policy.

Due to a data lag in Ontario, preliminary numbers of opioid-related fatalities for 2021 are only available up until June, but they hover at 1,415 deaths. In all of 2020, the province saw 2,431 deaths. British Columbia, which released its 2021 data on Monday, saw its deadliest year yet for opioid-related deaths, with 2,224 fatalities.

Cutting through the COVID confusion

Op-ed by Dr. Tara Kiran published on Healthy Debate

Every day, thousands of Canadians are infected with COVID. But this isn’t March 2020. As a result of high rates of vaccination and the particulars of Omicron, the overwhelming majority of those getting COVID currently will not need hospital care. What Canadians do need to be able to ride out this wave is information, support at home and timely access to primary care.

And what primary care teams need is reliable resources to help guide us through the ever-changing thicket of research, public health guidance and tools for prevention and treatment. We need to support most people to manage on their own while also identifying and helping people who need timely interventions to keep them from becoming seriously sick.

On the ground and at the front line, it seems that information – our most valuable asset in the Omicron wave – isn’t getting through clearly.

Helping kids recover after lockdowns: Healthy habits are key

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February 1, 2022 – As children in provinces across Canada settle back into in-person school, new research highlights how important it is to focus on helping kids recover healthy habits – particularly related to diet, physical activity, mental health and screen time.

“Our kids have now spent many months total in lockdown,” said Dr. Katerina Maximova, scientist at MAP Centre for Urban Health Solutions, St. Michael’s Hospital. “Now that many are back in school, the negative effects won’t just disappear. There’s a lot to recover from.”

Maximova gathered in-depth information on students’ lived experiences of COVID-19-related lockdowns, and how they affected kids’ mental health and lifestyle behaviours. Her research found that school closures prompted deteriorating lifestyle behaviours, mental health, and well-being of children. Disruptions led to feelings of boredom and lack of purpose, and limited opportunities for social interaction led to loneliness and an increase in screen time. Unchecked, these changes could mean an increased risk of chronic disease and mental illness in adulthood.

Concerningly, the negative effects were more pronounced for kids in socioeconomically disadvantaged settings.

“Pre-COVID, kids with lower socioeconomic status were already at higher long-term risk of chronic disease, including mental illness,” said Maximova. “However these findings indicate that this generation could be facing an extraordinary burden.”

The study is among the first COVID-19 research based on young kids’ first-hand reports and experience (other research is based mainly on parent views).

The findings underscore the crucial need for investments into evidence-based programs to promote health and wellness for all kids, particularly in schools in disadvantaged neighbourhoods. The APPLE Schools initiative, designed by Maximova and colleagues at the University of Alberta, is one such school-based innovation that has helped thousands of kids improve some of the health behaviours explored in this study. It impacts the lives of 21,000 students annually in 74 schools across British Columbia, northern Alberta, Northwest Territories, and Manitoba, with plans to expand to Ontario.

Read the research:

Aider les enfants à se rétablir après les confinements : l’importance de saines habitudes

Le 1er février 2022 – Alors que les enfants des provinces canadiennes reprennent le chemin de l’école, une nouvelle étude souligne l’importance de les aider à retrouver de saines habitudes, notamment en ce qui concerne l’alimentation, l’activité physique, la santé mentale et le temps passé devant les écrans.

« Nos enfants ont passé de nombreux mois en confinement total », a déclaré la Dre Katerina Maximova, scientifique au MAP. « Même si de nombreux élèves sont de retour à l’école, les effets négatifs ne vont pas disparaître. Il leur faudra du temps pour s’en remettre. »

La Dre Maximova a recueilli des informations approfondies sur les expériences vécues par les élèves lors des confinements liés à la COVID-19, et sur la manière dont ils ont nui à la santé mentale et aux habitudes de vie des jeunes. Ses recherches ont révélé que les fermetures d’écoles ont entraîné une détérioration des habitudes de vie, de la santé mentale et du bien-être des enfants. Les perturbations ont suscité des sentiments d’ennui et de vide; les possibilités limitées d’interaction sociale ont conduit à la solitude et à une augmentation du temps passé devant les écrans. Si on les ignore, ces changements pourraient entraîner un risque accru de maladies chroniques et de troubles mentaux à l’âge adulte.

Il est inquiétant de constater que les effets négatifs étaient plus prononcés chez les enfants issus de milieux socio-économiques défavorisés.

« Avant l’arrivée de la COVID-19, les enfants ayant un statut socio-économique faible présentaient déjà un risque plus élevé de maladies chroniques à long terme, y compris de maladies mentales », a déclaré madame Maximova. « Ces résultats suggèrent que cette génération pourrait être confrontée à un très lourd fardeau. »

L’étude est l’une des premières recherches en temps de COVID-19 basées sur les témoignages et l’expérience des jeunes enfants (les autres recherches sont principalement basées sur les points de vue des parents).

Ses conclusions soulignent le besoin crucial d’investir dans des programmes fondés sur des données probantes pour promouvoir la santé et le bien-être de tous les enfants, en particulier dans les écoles des quartiers défavorisés. L’initiative APPLE Schools, conçue par la Dre Maximova et ses collègues de l’Université de l’Alberta, est un exemple de ce type d’innovation scolaire qui a aidé des milliers d’enfants à améliorer certains des comportements de santé examinés dans cette étude. L’initiative a une incidence sur la vie de 21 000 élèves chaque année dans 74 écoles de la Colombie-Britannique, du nord de l’Alberta, des Territoires du Nord-Ouest et du Manitoba, et bientôt de l’Ontario.

Lisez l’étude scientifique (en anglais) :