Author: Emily Holton

Published Dec. 20, 2019

Summary

In Toronto, the Medical Officer of Health issues an extreme cold weather alert when temperatures fall below -15C. Recently, researchers led by St. Michael’s Hospital reviewed coroner’s records and emergency department charts from five downtown hospitals to explore the relationship between weather conditions and hypothermia among adults experiencing homelessness between 2004-2015. They found that while extreme cold temperatures put people at higher risk of hypothermia, most cases of injury and death due to cold occur in moderate winter weather.

This data suggests that the current state of the housing, shelter, respite, and warming centre systems in Toronto leaves many people at risk of injury and death due to cold. For example, there is currently only one warming centre open during extreme cold weather alerts (Metro Hall, with a capacity for 50 people). It is critically important to have a cold weather response strategy that includes low-barrier access to shelter beds and multiple warming centres throughout the winter months, not just on extremely cold days and nights.

Background

In Toronto, extreme cold weather alerts trigger additional services for people experiencing homelessness. One dedicated warming centre opens at Metro Hall, and there are additional overnight street outreach staff. Community agencies are also asked to relax service restrictions and let more people inside.

According to the City’s Shelter Census, most emergency shelters, respite centres and volunteer Out of the Cold programs are at or exceeding capacity. Even when the Metro Hall warming centre is open during extreme cold weather alerts, many people are still left outside. For example, in a recent interview, an outreach worker described how his client was turned away from Metro Hall, leaving her with no option but to sleep on the street. This suggests that more warming centres are needed, and not just during extreme cold weather alerts, but all winter long.

About the Research

Researchers reviewed coroner’s records, and charts from emergency departments at St. Michael’s Hospital, Mount Sinai Hospital, Toronto General Hospital, Toronto Western Hospital, and St. Joseph’s Health Centre to explore the relationship between weather conditions and hypothermia among adults experiencing homelessness in Toronto between 2004 – 2015.

Findings

• Seventy-two percent of hypothermia cases in people experiencing homelessness occur when temperatures are warmer than -15C, the threshold for an extreme cold weather alert.
• Rain, snow and damp amplify the effects of cold temperatures, leading to more cases of hypothermia.
• People who are homeless in Toronto are much more likely to experience hypothermia than the general population. People who are homeless account for 25% of all hypothermic injuries and 20% of hypothermic deaths.
• While moderate winter weather puts people experiencing homelessness at increased risk of injury and death, extreme cold weather further heightens this risk.

Implications

The current state of the housing, shelter, respite and warming centre systems in Toronto leaves many people at risk of injury and death.

It is critically important to have a cold weather response strategy that includes low-barrier access to shelter beds and multiple warming centres throughout the winter months, not just on extremely cold days and nights.

For more information about this evidence brief, please contact MAP Director Dr. Stephen Hwang: Stephen.Hwang@unityhealth.to

References

• Zhang P, Wiens K, Wang R, Luong L, Ansara D, Gower S, Bassil K & Hwang SW. (2019). Cold Weather Conditions and Risk of Hypothermia Among People Experiencing Homelessness: Implications for Prevention Strategies. International Journal of Environmental Research and Public Health.
• CP24 clip

New research led by St. Michael’s Hospital of Unity Health Toronto analyzed the essential medicines lists of 137 countries and found all but one list included one or more medicines that have either been withdrawn by a regulator or not approved for marketing due to adverse effects in other countries. Somalia listed 83 medicines, and did not include a withdrawn medicine on its essential medicines list.

The study, published in PLOS ONE, identified 97 medicines that were withdrawn from markets between 1953 and 2014 but still included on a national essential medicines list. Eleven of these medicines were withdrawn worldwide because of their associations with harm, but were still included on up to 39 lists.

Scientists warn that the unexamined use of artificial intelligence (AI) in health care could result in worse health outcomes for marginalized people…

“AI is already here, especially in radiology and even cancer treatment,” says Dr. Andrew Pinto, a family physician and a scientist at MAP Centre for Urban Health Solutions at St. Michael’s. “The problem is we don’t know if it’s creating bias because we don’t often have data on things like race, gender, identity, education and income,” he explains. “We may inadvertently be replicating biases.”

A program trained on lung scans may seem neutral, but if the training data sets only include images from patients from one sex or racial group, it may miss health conditions in diverse populations. Experts have raised similar concerns about AI programs that diagnose skin cancer, given that decades of clinical research that might be used to train the programs focused mostly on people with light skin.

Over the next year, Pinto will survey health providers and patients, asking providers about the problems they want AI to solve, and asking patients questions like, “How do you feel about the computer creating a risk score for you?” One of Pinto’s concerns with algorithm-based care is that doctors will spend less time listening to patients, trying to understand the complex social determinants that factor into health, and more time looking at screens.

For more than a decade, Dr. Sharmistha Mishra has been helping those with HIV – and the services, programs and policies that impact them the most.

And, she’s done it all using mathematical modeling.

“Mathematical modeling allows us to tease apart mechanisms that might interact and influence how infections might circulate in a population, and how things at various levels could drive transmission or help prevent transmission,” explains Dr. Mishra, who recently received the CAHR-CANFAR Excellence in Research Award in the Epidemiology/Public Health Research Stream.

As a clinician and scientist at St. Michael’s Hospital, Dr. Mishra and her lab use mathematical models to try and understand HIV and STI epidemics – which cannot be addressed through clinical trials and cohort studies alone.

Dr. Mishra uses mathematical modeling to try and understand why HIV epidemics are established and persist, where and when they persist, and what leads to differences in their size and characteristics across different regions. Her lab also uses this modeling to understand the best combinations of HIV and/or STI prevention tools, which help control epidemics…

A message from Dr. Stephen Hwang, director of MAP Centre for Urban Health Solutions.

Earlier this year, the Centre for Urban Health Solutions (C-UHS) became MAP Centre for Urban Health Solutions. Today, we make our new name official with the launch of our new website.

Why MAP? It’s not an acronym. Instead, it represents our vision and our purpose.

Together with our community and policy partners, we are charting the way to the world’s healthiest cities: places where people, communities, and the political, economic, social, environmental, and health infrastructures come together so that everyone can thrive.

We are St. Michael’s MAP to a healthier future for all.

Although our old name (C-UHS) was relatively new, now is the right moment to update it. The past year has been a time of tremendous growth and excitement at the centre. We have expanded to almost double our team of scientists and research staff. Our two-year, $25 million fundraising campaign has reached a milestone of $18 million. This past summer, MAP scientists also received more than $18 million in federal funding and two new Canada Research Chair appointments. After many months of planning, we are on the cusp of launching 10 national, solutions-focused networks to target and interrupt the health effects of inequality in cities across Canada. These networks will come together in a MAP-hosted national symposium in March 2020.

MAP’s mission is, as always, to create a healthier future for all. Internationally recognized for groundbreaking science and innovation, MAP scientists continue to change the way the world understands the health consequences of social inequality in cities. Our focus on solutions and deep commitment to community and policy partnerships remain the same.

Please join us as we work together to address critical urban health challenges in our communities. I hope you’ll explore our new site to learn more about our scientists, our purpose and our work. Join our newsletter and follow MAP on Twitter to watch our progress and learn more about the issues we study.

This is an exciting time at MAP. Thank you for being part of it.

Sincerely,

Dr. Stephen Hwang
Director, MAP Centre for Urban Health Solutions

I am from Savannah, Ga., one of those places where there were very particular expectations for what black boys did after high school, and the military was one of them. My commanding officer suggested I should go to college. I had to take a special test in order for the navy to pay for my tuition. The test listed particular occupations that I would be good at, and nursing and law were first on the list. Because you had to go to graduate school to get a law degree, the military wouldn’t pay for that. So my only option was nursing. I had no interest in it, but here was my opportunity.

When I was an undergraduate, I didn’t have a lot of money, so I lived in a very rough, low-income neighbourhood. It was very different from the type of neighbourhood I grew up in and I found it fascinating. I would look out my window at night and see things that I had never seen before. People behaved in ways that were bizarre to me. I don’t think I’d ever met somebody who was high on drugs before.

I really wanted to be out in the street working with people, because when people were sick or struggling with their addiction they almost never went to the hospital, they always went to community clinics. I wanted to be there…

An advisory council set up by the Liberals has proposed the biggest change to Canadian healthcare in decades. It calls it a national project, a transformation, and a universal public program for prescription drugs. The research of Dr. Nav Persaud, a family physician and a scientist at St. Michael’s MAP Centre for Urban Health Solutions, was cited in the report as “a starting point” for determining which drugs all Canadians should have free access to.

Number of new HIV cases in Canada has increased in recent years, in contrast to the downward trend elsewhere.

Researchers are launching a study on HIV self-testing kits with the aim of gaining federal approval for the first such device in Canada.

Sean Rourke, a scientist with the Centre for Urban Health Solutions at St. Michael’s Hospital, said the clinical trial will begin in Toronto on Wednesday before expanding across the country in coming weeks.

The neuropsychologist said data will be collected on 1,000 people who will take the one-minute, finger-prick blood test at sexual health clinics in several provinces.

Rourke said he’s hopeful the study’s findings will persuade Health Canada to approve the first HIV self-test for use as early as 2020.

Rourke, who serves on the board of the Canadian Foundation for AIDS Research, said the number of new HIV cases in Canada has increased in recent years, in contrast to the downward trend seen in other G7 countries…

Adults living with low incomes are less likely to be screened for colorectal, cervical and breast cancer, says researchers from the Department of Family and Community Medicine (DFCM) in a study. It used social determinants of health to examine cancer screening disparities among patients of the St. Michael’s Hospital Academic Family Health Team.

Lead investigators Drs. Aisha Lofters and Tara Kiran, Assistant Professors at DFCM and family physicians at St. Michael’s Hospital, also found that housing status – whether the patient owns, rents or lives in a special housing arrangement– is linked with a patient’s likelihood to get screened for cancer.

“Our goal was to figure out if there are particular groups of patients where we could do a better job ensuring they are receiving regular screenings for cancer,” says Dr. Lofters, a researcher and physician at St. Michael’s Hospital.

“The point of screening is to catch cancer at an early stage or, even better, catch an abnormality before it turns into cancer so doctors can focus on treatment and prevention before it spreads.”

People who are transgender are significantly less likely to receive cancer screenings than the general population, raising their risk of developing the disease undetected in situations that could have been preventable.

A new study published Wednesday in the journal Canadian Family Physician found that about 33 per cent of eligible transgender patients had been screened for breast cancer, compared to 65 per cent of other eligible patients.

Screening rates for other types of cancer presented similar differences, with transgender patients being about 60 per cent less likely to have been screened for cervical cancer and 50 per cent less likely to have been screened for colorectal cancer, after adjusting for age and other risk factors.

“If they’re not getting screened, they have a higher risk of developing a cancer that we know could be prevented,” the study’s lead author, Dr. Tara Kiran of St. Michael’s Hospital in Toronto, told CTV News in an interview.