From the CBC News article

With opioid-related deaths mounting across Canada, health experts are warning that drug checking services are now more important than ever in helping users make informed decisions — and one Toronto pilot program is helping to do just that.

Launched in October 2019, Toronto’s Drug Checking Service helps to keep users aware of the content of the drugs that they are taking by anonymously collecting and analyzing samples from five downtown harm-reduction agencies.

The funding for the pilot program is set to run out by the end of this year, but with volatility in the unregulated drug supply leading to the rise in deaths, some say this type of service — which is free and available to everyone — is crucial for users to be able to make more informed choices.

“We are currently the only drug checking program up and running in Ontario, so we see our service as a vital part of harm-reduction services being offered,” said Hayley Thompson, project manager with Toronto’s Drug Checking Service.

“[We] would like to see … drug checking being available in more Ontario jurisdictions, or Canadian jurisdictions for that matter.”

The program, which is funded by Health Canada’s Substance Use and Addictions Program and St. Michael’s Hospital Foundation, collects anywhere from 10 to 30 samples daily from the agencies, which also serve as safe consumption sites.

From the Toronto Star article

The call for COVID-19 booster shots to blunt the fast-moving Omicron wave pushed millions of Ontarians to get third doses.

But data shows some high-risk populations — those who would benefit most from the protection — are lagging in third-dose coverage, with experts warning more efforts are needed to reach these vulnerable groups.

Some highest-risk groups that were initially prioritized for third doses, including organ transplant patients, are generally well-protected, according to the most-recent data from non-profit research group ICES, formerly known as the Institute for Clinical Evaluative Sciences.

However, just 22 per cent of pregnant Ontarians — a group among those considered highest-risk — have received third doses. And just 10 per cent of homeless people under age 65 are boosted, the data shows.

Dr. Stephen Hwang, a physician and research scientist at St. Michael’s Hospital and director of the MAP Centre for Urban Health Solutions, said lower vaccination rates among the homeless population highlight the need for sustained and creative ways to offer first, second and third doses to this group at high-risk for COVID.

Among Ontarians under age 64 who have recently experienced homelessness, 64 per cent have their first dose, while 53 per cent have had two doses; just 10 per cent in this age group are boosted. Vaccine uptake is higher in the homeless population over age 65, the ICES data shows, with 80 per cent having at least one dose, 75 per cent with two doses and 32 per cent with three doses.

Hwang called efforts to vaccinate those who use the shelter system “heroic,” but said it’s also vital to find other avenues to offer vaccines, such as in community centres and supervised injection sites.

From the Toronto Star article

In the first year of the COVID-19 pandemic, Dr. Sam Elfassy noticed a worrying trend.

The gastroenterologist at St. Joseph’s Health Centre in Toronto often asks patients about their drinking habits, as he treats chronic illnesses in the liver. But the responses he began to receive were alarming: most of his patients said they were drinking more than before, even those who never drank regularly.

As the pandemic endures, physicians worry these concerning trends will continue. Dr. Andrew Pinto, a family physician with Unity Health in Toronto, said some signs are already pointing toward yes.

“In my clinical work, I’ve seen more folks who are drinking, and usually it’s part of coping with stress,” Pinto said.

He added stress is creeping up again among his patients as of late, with the rising number of COVID-19 cases and the enduring uncertainty. This, especially when the pandemic felt like it was nearing its end in the fall, when case numbers were low.

“Things seemed like they were getting better, and now again it’s become a very challenging situation,” Pinto said. He worries most about who have lost their jobs or income, those with precarious housing and those coping alone without any social support.

From the Unity Health Toronto article

Dr. Andrew Pinto, scientist at MAP Centre for Urban Health Solutions and founder and director of the Upstream Lab, has been awarded a CIHR Applied Public Health Chair in Upstream Prevention in Primary Healthcare. We spoke with [him] to learn more about the impact of this award.

What does this CIHR Chair mean for you and your research team?

Being awarded this CIHR Chair means we can continue our work with individuals and communities to “go upstream” of the negative social and economic policies that impair their health, and co-design solutions and rigorously evaluate them. This Chair will help sustain our work over the next six years, and achieve our vision of being a resource nationally and internationally.

Which research projects and work will it contribute to?

This will support four new research areas at the Upstream Lab, including bringing together the latest evidence on the most effective upstream interventions and supporting scale-up and studying how health organizations implement upstream action to improve population health.

We will identify gaps in the evidence, and obtain funding to develop and evaluate new upstream interventions. We will also link upstream efforts in health care to rapid responses to future health threats in collaboration with public health.

Is there anything else you’d like to add about this achievement?

We will also host an annual international Upstream Summer Institute to engage more early-career researchers and graduate students in this work. This is one of only seven Chairs funded across the country, and the only one at the University of Toronto. The COVID-19 pandemic has demonstrated the crucial need for these Applied Public Health Chairs.

From the U of T Department of Family & Community Medicine News

Dr. Andrew Pinto, an Associate Professor in the Department of Family and Community Medicine (DFCM) and family physician and public health specialist at St. Michael’s Hospital, Unity Health Toronto, has been awarded a prestigious $1.15 million Canadian Institutes of Health Research grant to advance health and health equity in Canada.

One of only seven new Applied Public Health Chairs, and the only one awarded at the University of Toronto, the Chair position will allow Dr. Pinto to continue working with individuals and communities to “go upstream” of the negative social and economic policies that impair health, co-design solutions, and rigorously evaluate them.

The position, a “CIHR Applied Public Health Chair in upstream action at the individual-, organizational- and policy-level to improve health and reduce inequities” stems from Dr. Pinto’s work as director of the Upstream Lab.

“The COVID-19 pandemic has highlighted the dramatic impact that social factors can have on the health of individuals and communities,” explains Dr. Pinto, who is also a Dalla Lana School of Public Health faculty member and Associate Director for Clinical Research for the University of Toronto Practice-Based Research Network (UTOPIAN). “At the Upstream Lab we are working to tackle these social factors and improve health outcomes through research, education and policy change. This Chair position will help sustain our core functions for the next six years, allowing us to develop as a resource nationally and internationally.”

The funding will support four key research areas, including bringing together the latest evidence on the most effective upstream interventions and supporting scale-up and studying how health organizations implement upstream action to improve population health.

It will also complement Dr. Pinto’s role as artificial intelligence lead with EXITE (EXploring Innovative TEchnologies in Family Medicine), a DFCM innovation collaborative that is working to adapt, apply and develop innovative technologies for use in primary care delivery and education.

“As we study existing upstream actions, identify gaps and develop new solutions, big data and artificial intelligence can help us identify patterns and support proactive care. At the same time, we must identify and address negative consequences for individuals communities made vulnerable by social and economic policies.”

From the CBC News article

Ontario researchers are looking into reasons behind the busiest times in the province’s emergency departments to help relieve the extreme burden facing hospital staff.

Within the last year, hospitals in eastern Ontario and across the province have reported reaching or exceeding capacity as COVID-19 cases surge.

“It’s been a two-year sprint for us,” said Dr. Atul Kapur, who works in the emergency department of The Ottawa Hospital.

He said with COVID-19 protocols and the volume of patients coming through the doors, the hospital’s ER is currently “at or very close to our historic peaks.”

This wave is different than earlier waves of the pandemic, though, as data shows visits to the emergency room have not coincided with the case peaks of the pandemic, according to Dr. Tara Kiran, a family physician at St. Michael’s Hospital and a researcher at the University of Toronto

Kiran said ERs have typically been at their busiest when overall COVID-19 cases were down in the province. Researchers also found emergency department volume was higher in Ontario in the year leading up to the pandemic compared to the pandemic months.

From the Toronto Star article

To mark how far we’ve come during the COVID-19 pandemic, the Star has profiled 20 of the people who helped get more than 25 million doses into arms.

Tara Kiran — The family doctor

As a family physician at St. Michael’s Hospital, Dr. Tara Kiran knew she would one day help vaccinate her own patients against COVID-19.

But even before vaccines arrived in Canada, Kiran also knew she could play a larger role, as vice-chair of quality and innovation at the University of Toronto’s Department of Family and Community Medicine.

With U of T colleagues, Kiran created interactive online modules for primary care physicians — accessible to anyone — to provide guidance on the vaccines, from the safety of mRNA vaccines to how to help patients feel confident.

Kiran put aside her other academic work to produce the modules, which she calls a “one-stop way for people to learn” to help bring emerging evidence to the doctor’s office.

Throughout the pandemic, Kiran has co-led bi-weekly webinars for primary care physicians covering top-of-mind COVID issues. Since vaccines were approved, 600 to 900 family doctors regularly join the webinars, many telling Kiran they provide a place to review the latest evidence and a sense of community during a challenging time.

“The notes I get telling me it’s made a difference make my day,” says Kiran, who has also used her platform to push for a more equitable pandemic response.

This year, the Star profiled Kiran’s efforts to help hesitant patients feel more confident. The story followed a mother and daughter as they consulted Kiran on whether to get vaccinated.

“We think of anti-vaxxers as an extreme group. But there are so many people who come from humble circumstances who’ve been struggling with the decision about their vaccines. I think (the story) helped people to empathize and better understand what people are going through when they’re not sure about a vaccine.”

A study of all clinical practice guidelines published in national general medical journals in Australia, Canada, the United Kingdom, and the United States over a period of eight years – including the pandemic period – has found that the panels developing recommendations are mostly made up of white men and frequently exclude racialized women.

The study, led by researchers at St. Michael’s Hospital of Unity Health Toronto, reviewed 237 clinical practice guidelines published between June 2014 and June 2021, including those related to COVID-19. A total of 3,696 unique guideline panel members were involved in the development of these guidelines. Only seven per cent of panel members were racialized women, while white men made up 46 per cent of members.

The findings, published in The Lancet, suggest that clinical guidelines – which offer recommendations for health care professionals on how to diagnose and treat a medical condition and shape the care patients receive – may not be developed by those most qualified and this could have negative implications for patients.

“Panels can make recommendations about which medicines should be used, who should be screened for cancers and when surgery is appropriate,” said Dr. Nav Persaud, lead author of the study and a Scientist at the MAP Centre for Urban Health Solutions at Unity Health Toronto.

“It’s important that panels are made up of individuals best positioned to provide important guidance. We know that many important roles tend to be filled by white men,” said Dr. Persaud, who is also a family physician at St. Michael’s Hospital of Unity Health Toronto.

The study also found 79 per cent of guideline panels included four or more white men while nearly 40 per cent included no racialized women. The findings were similar across the four international jurisdictions analyzed – where the most common category of panel member was white men and the least common was racialized women.

The authors are calling for greater transparency in panel recruitment processes and say that guideline producers should ensure that they fairly or equitably recruit and retain panel members. They are also calling for governments and other funders to require fair processes. Twenty-eight per cent of guidelines either did not mention the selection process or declared that the panel was formed without explaining how.

“This finding by itself is a reason to view guidelines in general with some skepticism. In particular, we should question whether these guidelines will exacerbate existing health inequities,” said Dr. Persaud.

Op-ed by Dr. Nav Persaud from the The Hill Times

Covid-19 will not take a break this holiday season, so we must remain focused on slowing its spread and on addressing what underlies each wave. Just as global vaccine inequity puts us all at risk by leaving billions unprotected, unfairness here at home continues to threaten health. While we focus on omicron’s rise, now is the time to implement changes that will make Canada more resilient to threats like this pandemic.

We just co-authored a report outlining 13 recommendations toward an equitable pandemic recovery. If paid sick leave will not made available to everyone during this pandemic of a virus that causes a cough, when will we ever get it? Studies show that paid sick leave reduces the spread of infectious diseases.

People with a low income were more likely to be affected by Covid and less able to adhere to public health advice. A universal living income has been studied in many countries including Finland and we know that that financial security can be provided without discouraging people from working.

Lire cet article en français

TORONTO STAR

Opinion piece written by Dr. Sloane Freeman and Dr. Ripudaman Minhas

After coping with the isolation and uncertainty of virtual school, this fall’s return to in-person learning has been a breath of fresh air for many students.

As pediatricians working in school-based clinics in Toronto, we have witnessed the deterioration of students’ well-being with school closures. Since September, we have watched many of our patients once again thrive in in-person learning environments, with clear positive impacts on their mental, physical and academic well-being. As we nervously watch daily COVID counts and await further information about the Omicron variant, we must do everything possible to keep schools safely open.

While teachers quickly created online learning environments in response to pandemic-related school closures in spring 2020, vital pieces of the school experience could not be translated into a virtual space. Across age ranges, students have remarked on the tragic impacts of prolonged social isolation from their peers. They have mourned disrupted social customs and rites like attending birthday parties, camps, graduations, concerts and sports tournaments. We know there have been huge impacts on mental health, with record-high numbers of calls to crisis lines, mental health referrals, and admissions for eating disorders.

L’importance de l’apprentissage en personne : des nouvelles en provenance du terrain

TORONTO STAR

Article d’opinion rédigé par la D^re Sloane Freeman et le D^r Ripudaman Minhas

Après avoir fait face à l’isolement et à l’incertitude inhérents aux classes virtuelles, le retour à l’apprentissage en personne, cet automne, a constitué une véritable bouffée d’air frais pour de nombreux élèves.

En tant que pédiatres travaillant dans des cliniques scolaires à Toronto, nous avons été témoins de l’impact négatif de la fermeture des écoles sur le bien-être des élèves. Depuis septembre, nous avons vu nombre de nos patients s’épanouir à nouveau dans des environnements d’apprentissage en personne, avec des effets positifs évidents sur leur bien-être mental, physique et scolaire. Alors que nous surveillons attentivement le nombre quotidien de cas de COVID-19 et que nous espérons en savoir plus sur le variant Omicron, il est impératif de prendre toutes les mesures nécessaires pour que les écoles restent ouvertes, en toute sécurité.

Au printemps 2020, alors que les enseignantes et les enseignants ont rapidement créé des environnements d’apprentissage en ligne en réponse aux fermetures d’écoles liées à la pandémie, des éléments essentiels de l’expérience scolaire n’ont pas pu être transposés dans un espace virtuel. Quelle que soit leur tranche d’âge, les élèves ont souligné les conséquences douloureuses d’un isolement social prolongé. Ils ont dû faire le deuil de traditions et de rites sociaux, comme la participation à des fêtes d’anniversaire, à des camps de vacances, à des remises de diplômes, à des concerts et à des tournois sportifs. Nous savons qu’il y a eu d’énormes répercussions sur la santé mentale, avec un nombre record d’appels aux lignes de crise, d’aiguillages vers des services de santé mentale et d’admissions hospitalières en raison de troubles alimentaires.