COVID-19 outcome trends by vaccination status in Canada, December 2020-January 2022.

Background: The coronavirus disease 2019 (COVID-19) pandemic in Canada has evolved rapidly. Since late 2020, COVID-19 vaccines have been relied on to protect against severe outcomes in the presence of circulating variants of concern (VOC). Objective: This surveillance report provides a retrospective descriptive analysis of national trends in COVID-19 cases and severe outcomes by vaccination status, contextualizing trends against case demographics and circulating VOCs, from December 2020 to January 2022. Methods: Case and vaccination coverage surveillance data were obtained from the National COVID-19 Case Dataset and the Canadian COVID-19 Vaccination Coverage Surveillance System for 12 of 13 provinces and territories. Descriptive analyses were produced to describe trends over time among individuals aged 12 years and older by COVID-19 outcome, vaccination status, and demographics. Age-standardized and age-stratified incidence rates and incidence rate ratios were computed for cases, hospitalizations, and deaths. Results: From mid to late-2021, incidence rates for cases and severe outcomes were consistently lowest among those with a completed primary series and highest among those who were unvaccinated. Unvaccinated individuals were much more likely to be hospitalized or to die compared to those with a completed primary series in all variant periods. Age-specific rates of severe outcomes were consistently highest among those aged 80 years and older across all vaccination statuses. Conclusion: Vaccination remains one of the most important public health interventions, particularly among older adults, to protect against COVID-19 severe outcomes as the pandemic evolves. Routine monitoring of COVID-19 outcomes by vaccination status can identify changes in COVID-19 epidemiology and inform public health action and policy.

Chronic health effects associated with electronic cigarette use: A systematic review.

Introduction: Over the last decade, e-cigarette use has been on the rise but with growing health concerns. The objective of this systematic review was to update findings for chronic health outcomes associated with e-cigarette use from the 2018 National Academies of Sciences, Engineering, and Medicine (NASEM) report. Methods: Three bibliographic databases were searched to identify studies comparing the chronic health effects of e-cigarette users (ECU) to non-smokers (NS), smokers, and/or dual users indexed between 31 August 2017 and 29 January 2021. Two independent reviewers screened abstracts and full texts. Data were extracted by one reviewer and verified by a second one. Outcomes were synthesized in a narrative manner using counts and based on statistical significance and direction of the association stratified by study design and exposure type. Risk of bias and certainty of evidence was assessed. The protocol was prospectively registered on Open Science Framework https://osf.io/u9btp. Results: A total of 180 articles were eligible. This review focused on 93 studies for the 11 most frequently reported outcomes and from which 59 reported on daily e-cigarette use. The certainty of evidence for all outcomes was very low because of study design (84% cross-sectional) and exposure type (27% reported on exclusive ECU, i.e., never smoked traditional cigarettes). Overall, the summary of results for nearly all outcomes, including inflammation, immune response, periodontal and peri-implant clinical parameters, lung function, respiratory symptoms, and cardiovascular disease, suggested either non-significant or mixed results when daily ECU was compared to NS. This was also observed when comparing exclusive ECU to NS. The only notable exception was related to oral health where most (11/14) studies reported significantly higher inflammation among daily ECU vs. NS. Compared to the smokers, the exclusive-ECUs had no statistically significant differences in inflammation orperiodontal clinical parameters but had mixed findings for peri-implant clinical parameters. Conclusions: This review provides an update to the 2018 NASEM report on chronic health effects of e-cigarette use. While the number of studies has grown, the certainty of evidence remains very low largely because of cross-sectional designs and lack of reporting on exclusive e-cigarette exposure. There remains a need for higher quality intervention and prospective studies to assess causality, with a focus on exclusive e-cigarette use.

Sociodemographic Factors Associated With Meeting the Canadian 24-Hour Movement Guidelines Among Adults: Findings From the Canadian Health Measures Survey.

BACKGROUND: This study examined associations between sociodemographic factors and meeting versus not meeting the new Canadian 24-Hour Movement Guidelines recommendations. METHODS: The study is based on 7651 respondents aged 18-79 years from the 2007 to 2013 Canadian Health Measures Survey, a nationally representative, cross-sectional survey. Sociodemographic factors included age, sex, household education, household income, race, having a chronic condition, smoking status, alcohol consumption, and body mass index. Participants were classified as meeting or not meeting each of the time-specific recommendations for moderate to vigorous physical activity, sedentary behavior, and sleep duration. RESULTS: Being an adult aged 18-64 years, normal weight, nonsmoker, and not having a chronic condition were associated with meeting the integrated guidelines. Being aged 18-64 years, male, normal weight, nonsmoker, not having a chronic condition, having a higher household education, and higher household income were associated with meeting the moderate to vigorous physical activity recommendation; being aged 18-64 years was associated with meeting the sedentary behavior recommendation; and being white, not having a chronic condition, and having a higher household income were associated with meeting the sleep duration recommendation. CONCLUSIONS: Few Canadian adults met the 2020 Canadian 24-Hour Movement Guidelines, and disparities across sociodemographic factors exist. Implementation strategies and dissemination approaches to encourage uptake and adoption are necessary.

Health associations with meeting the Canadian 24-hour movement guidelines for adults: Results from the Canadian Health Measures Survey.

BACKGROUND: The Canadian 24-Hour Movement Guidelines for Adults (18-64 years and 65 years or older) were launched in October 2020 and provide evidence-based recommendations for physical activity, sedentary behaviour and sleep. The purpose of this study was to examine whether meeting the 24-Hour Movement Guidelines overall, and different combinations of recommendations within the guidelines, was associated with health indicators in a representative sample of Canadian adults. DATA AND METHODS: Participants were 8,297 adults aged 18 to 79 from cycles 1 to 3 of the Canadian Health Measures Survey. They were classified as meeting or not meeting each of the recommendations required for overall guideline adherence: moderate-to-vigorous physical activity (150 minutes or more per week), sedentary behaviour (8 hours or less per day or 9 hours or less per day of sedentary time, including 3 hours or less per day of recreational screen time) and sleep duration (7 to 9 hours per day for adults 18 to 64 years old, 7 to 8 hours per day for adults aged 65 years or older). A combination of self-reported and device-based measures were used. Indicators of adiposity (n=2), aerobic fitness (n=1) and cardiometabolic health (n=7) were measured. RESULTS: A total of 19.1% of the sample met none of the recommendations, 43.9% met one of them, 29.8% met two and 7.1% met all three. Compared with meeting no recommendations, meeting one, two and all three recommendations was associated with better health for one, six and seven health indicators, respectively (p < 0.05). Compared with adults meeting two or fewer recommendations, those who met all three recommendations had more favourable body mass index; waist circumference; aerobic fitness scores; and triglyceride, insulin, C-reactive protein and serum glucose levels (p < 0.05). INTERPRETATION: These findings provide support for the 24-Hour Movement Guidelines and show that less than 1 in 10 Canadian adults are meeting all three of the healthy movement behaviour guidelines.

Associations between meteorological factors and emergency department visits for unintentional falls during Ontario winters. / Associations entre facteurs météorologiques et nombre de visites aux services d'urgence en raison de chutes accidentelles pendant les hivers ontariens.

INTRODUCTION: Unintentional falls are a leading cause of injury-related hospital visits among Canadians, especially seniors. While certain meteorological conditions are suspected risk factors for fall-related injuries, few studies have quantified these associations across a wider range of age groups and with population-based datasets. METHODS: We applied a time-stratified case-crossover study design to characterize associations of highly-spatially-resolved meteorological factors and emergency department (ED) visits for falls, in Ontario, among those aged 5 years and older during the winter months (November to March) between 2011 and 2015. Conditional logistic models were used to estimate the odds ratios (ORs) and their 95% confidence intervals (CIs) for these visits in relation to daily snowfall accumulation, including single-day lags of up to one week before the visit, and daily mean temperature on the day of the visit. Analyses were stratified by age and sex. RESULTS: We identified 761 853 fall-related ED visits. The odds for these visits was increased for most days up to a week after a snowfall of 0.2 cm or greater (OR = 1.05-1.08) compared to days with no snowfall. This association was strongest among adults aged 30 to 64 years (OR = 1.16-1.19). The OR for fall-related ED visits on cold days (less than -9.4 °C) was reduced by 0.05 relative to days with an average daily temperature of 3.0 °C or higher (OR = 0.95; 95% CI: 0.94, 0.96), and this pattern was evident across all ages. There were no substantive differences in the strength of this association by sex. CONCLUSION: Snowfall and warmer winter temperatures were associated with an increased risk of fall-related ED visits during Ontario winters. These findings are relevant for developing falls prevention strategies and ensuring timely treatment.

Physical activity, screen time and sleep duration: Combined associations with psychosocial health among Canadian children and youth.

BACKGROUND: Canada recently adopted the 24-Hour Movement Guidelines for Children and Youth (24-Hour Guidelines) for young people aged 5 to 17 years-an international first, providing integrated recommendations for physical activity, sedentary time and sleep. Since the release of the guidelines, very few studies have examined the associations of adherence to the 24-Hour Guidelines with health outcomes-and none focus on psychosocial health. Therefore, the objective of this study was to assess the associations of meeting the 24-Hour Guidelines and their behaviour-specific recommendations with psychosocial health among Canadian children and youth. DATA AND METHODS: This cross-sectional study included 4,250 children and youth aged 5 to 17 years with valid accelerometer data. The study data were collected from 2009 to 2015 with the Canadian Health Measures Survey and pooled. Moderate-to-vigorous physical activity was measured using accelerometers; screen time, sleep duration and measures of psychosocial health were self- or proxy-reported. Multivariate logistic regression models were used to examine the associations of meeting individual or different combined recommendations from the 24-Hour Guidelines with psychosocial health. RESULTS: There was low overall adherence to all three 24-Hour Guidelines recommendations, especially among youth (children: 13.9%, youth: 4.8%). Meeting two or more of the recommendations was associated with higher odds of positive psychosocial health among youth (odds ratio [OR] = 3.10; 95% confidence interval [CI]: 1.17-8.19). Sleep duration and screen time were strongly associated with social behaviour and psychosocial health among Canadian youth. DISCUSSION: Adherence to the 24-Hour Guidelines was significantly associated with better psychosocial health among Canadian youth.

Injuries and poisonings associated with e-cigarettes and vaping substances, electronic Canadian Hospitals Injury Reporting and Prevention Program, 2011-2019. / Traumatismes et intoxications associés à la cigarette électronique et aux substances de vapotage, base de données électronique du Système canadien hospitalier d'information et de recherche en prévention des traumatismes, 2011-2019.

Electronic cigarettes are devices that deliver nicotine to the user by heating an e-liquid. In Canada, the Tobacco and Vaping Products Act became law on May 23, 2018. The purpose of this study was to describe the cases of injuries and poisonings associated with e-cigarette and vaping substances that presented to Canadian emergency departments within the electronic Canadian Hospitals Injury Reporting and Prevention Program network between 2011 and 2019. A total of 68 cases were retrieved (54.4% males). Of the 68 cases, 8 occurred between 2011 and 2014, while 35 (51.5%) occurred in 2018 or 2019. Ingestions, inhalations and burns were observed.

Of 68 cases of injury or poisoning due to e-cigarette use or vaping between 2011 and 2019, 54.4% involved males. Of the 68 cases, 8 occurred between 2011 and 2014 while 35 (51.5%) occurred in 2018 or 2019. The annual percent change (APC) was 50.7% (95% CI: 15.9­96.1). Children under 5 years of age who either ingested the e-juice or vaping liquid or inhaled from the device accounted for 52.9% of incidents. In two cases, the device's battery exploded in the pocket of an adult male, causing a burn to the thigh. There were 3 traumatic brain injuries as a result of a fall subsequent to vaping.

Parmi les 68 cas de traumatisme ou d'intoxication causés par l'usage de la cigarette électronique ou le vapotage entre 2011 et 2019, 54,4 % concernaient des patients de sexe masculin. Parmi les 68 cas, 8 dataient de 2011 à 2014 et 35 (51,5 %) de 2018 et 2019. La variation annuelle en pourcentage (VAP) a été de 50,7 % (IC à 95 % : 15,9 à 96,1). Des enfants de moins de 5 ans ayant ingéré ou inhalé du liquide à vapoter à même le dispositif comptent pour 52,9 % des incidents. Dans deux cas, la pile du dispositif a explosé dans la poche d'un adulte, provoquant une brûlure à la cuisse. Trois traumatismes cérébraux se sont produits en raison d'une chute survenue à la suite d'une activité de vapotage.

Surveillance from the high ground: sentinel surveillance of injuries and poisonings associated with cannabis. / Surveillance de niveau supérieur : surveillance par sentinelle des blessures et des intoxications associées au cannabis.

INTRODUCTION: In October 2018, Canada legalized the nonmedical use of cannabis for adults. The aim of our study was to present a more recent temporal pattern of cannabis-related injuries and poisonings found in the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) database and provide a descriptive summary of the injury characteristics of cannabis-related cases captured in a nine-year period. METHODS: We conducted a search for cannabis-related cases in the eCHIRPP database reported between April 2011 and August 2019. The study population consisted of patients between the ages of 0 and 79 years presenting to the 19 selected emergency departments across Canada participating in the eCHIRPP program. We calculated descriptive estimates examining the intentionality, external cause, type and severity of cannabis-related cases to better understand the contextual factors of such cases. We also conducted time trend analyses using Joinpoint software establishing the directionality of cannabis-related cases over the years among both children and adults. RESULTS: Between 1 April 2011, and 9 August, 2019, there were 2823 cannabis-related cases reported in eCHIRPP, representing 252.3 cases/100 000 eCHIRPP cases. Of the 2823 cannabis-related cases, a majority involved cannabis use in combination with one or more substances (63.1%; 1780 cases). There were 885 (31.3%) cases that involved only cannabis, and 158 cases (5.6%) that related to cannabis edibles. The leading external cause of injury among children and adults was poisoning. A large proportion of cannabis-related cases were unintentional in nature, and time trend analyses revealed that cannabis-related cases have recently been increasing among both children and adults. Overall, 15.1% of cases involved serious injuries requiring admission to hospital. CONCLUSION: Cannabis-related cases in the eCHIRPP database are relatively rate, a finding that may point to the fact that mental and behavioural disorders resulting from cannabis exposure are not generally captured in this surveillance system and the limited number of sites found across Canada. With Canada's recent amendments to cannabis regulations, ongoing surveillance of the health impacts of cannabis will be imperative to help advance evidence to protect the health of Canadians.

Trends in emergency department visits for acetaminophen-related poisonings: 2011-2019. / Tendances des visites aux services des urgences pour des intoxications liées à l'acétaminophène, 2011 à 2019.

We examined trends in emergency department (ED) presentation rates for acetaminophenrelated poisonings across Canada. A total of 27123 cases of poisoning were seen in the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) sentinel sites between April 2011 and February 2019; of these, 13.7% were related to acetaminophen use. A significant decreasing trend for both sexes was observed for unintentional poisonings (males: -10.3%; females: -8.0%). For intentional poisonings, there was a significant decrease among females only (-5.9%). Females have consistently displayed higher rates of ED presentations for both unintentional and intentional poisoning.

A total of 27123 cases of poisoning were captured in the eCHIRPP database, of which 3721 cases (13.7%) were acetaminophen related. About 50.3% of the poisonings were unintentional, 48.6% were intentional and 1.1% were of undetermined intent. There was a significant decreasing trend in acetaminophen poisonings, among all unintentional poisonings, for both males (−10.3%) and females (−8.0%). Among all intentional poisonings, there was a significant decrease for acetaminophen poisonings among females (−5.9%) but not among males. Compared to males, females had consistently higher rates of emergency department presentations for both unintentional and intentional acetaminophen-related poisonings.

Au total, nous avons relevé, sur les 27123 cas d'intoxication dans la base de données électronique du SCHIRPT, 3721 cas (13,7 %) liés à l'acétaminophène. Environ 50,3 % des intoxications étaient involontaires, 48,6 % intentionnelles et 1,1 % d'intention indéterminée. Nous avons observé une tendance décroissante significative des taux d'intoxication à l'acétaminophène au sein des intoxications involontaires chez les hommes (−10,3 %) comme chez les femmes (−8,0 %). Nous avons constaté une diminution significative des taux d'intoxication à l'acétaminophène au sein des intoxications intentionnelles chez les femmes (−5,9 %) mais pas chez les hommes. Comparativement aux hommes, les femmes présentaient des taux systématiquement plus élevés de consultation à un service des urgences pour des intoxications tant involontaires qu'intentionnelles liées à l'acétaminophène.

Injuries and poisonings associated with methamphetamine use: sentinel surveillance, the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP), 2011-2019. / Blessures et intoxications associées à la consommation de méthamphétamine : surveillance sentinelle à l'aide de la plateforme électronique du Système canadien hospitalierd'information et de recherche en prévention des traumatismes (eSCHIRPT), 2011 à 2019.

Information from emergency department (ED) visits for methamphetamine-related injuries and poisonings between 1 April 2011 and 9 August 2019 were captured from 19 sentinel sites across Canada for all ages. Overall, 1093 cases (97.6/100 000 eCHIRPP cases) were identified (59.4% male), with female patients experiencing more poisonings (71% vs 57.4% for males). Unintentional injuries and poisoning accounted for 14.8% of ED presentations. Self-harm (while or as a result of consuming methamphetamine) accounted for 11.4% of cases. The circumstances surrounding injuries and poisonings associated with methamphetamine are varied and include self-harm, fall-related brain injuries, mental illness, criminal activity and other circumstances. These domains should be taken into account when developing mitigation strategies.

1093 methamphetamine-related injury and poisoning cases presented to participating emergency departments (EDs). 71.4% of patients aged 10­14 years were female; of those aged 15­19 years, 63.7% were female. 70.4% of the patients aged 20 years plus were male. Of the 689 cases that also involved other substances (63%), 40.9% involved two or more other substances. Alcohol (24.4%), cannabis (10.7%), cocaine (7.7%), heroin (5.4%), opiates (3.6%) and other substances (7.3%) were involved when only one substance other than methamphetamine was used. Compared to males, females had more poisonings, while males more frequently had multiple injuries. Self-harm accounted for 11.4% of cases.

Les services des urgences participants ont traité 1093 cas de blessures et de lésions liées à la méthamphétamine. La proportion de cas concernant les filles était de 71,4 % chez les 10 à 14 ans et de 63,7 % chez les 15 à 19 ans. Chez les patients de 20 ans et plus,70,4 % étaient des hommes. Des 689 cas où d'autres substances étaient en cause (63 %), 40,9 % impliquaient deux substances ou plus. Dans les cas où une seule substance autre que la méthamphétamine était en cause, celle­ci était l'alcool (24,4 %), le cannabis (10,7 %), la cocaïne (7,7 %), l'hé­ roïne (5,4 %), un opiacé (3,6 %) ou une autre substance (7,3 %). La proportion d'intoxications était plus élevée chez les femmes, tandis que les blessures multiples étaient plus fréquentes chez les hommes. Des blessures auto­infligées ont été commises dans 11,4 % des cas.

Surveillance of concussion-related injuries using electronic medical records from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN): a proof-of-concept.

INTRODUCTION: Previous studies on traumatic brain injury trends in Canada have been restricted to hospitalization and emergency department visit data. However, many concussion patients may present first, or only, to family physicians. Therefore, the true burden of concussion in Canada is likely underestimated. The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) collects information electronically from family physicians across Canada and can potentially be used for concussion surveillance. The objective of this study is to explore the feasibility of using data collated from CPCSSN for concussion surveillance purposes and examine trends over time. METHODS: Electronic medical records housed by CPCSSN from 2010 to 2016 were analyzed. Case ascertainment was determined through a combination of International Classification of Diseases, Ninth Revision codes. Binomial regression models were used to calculate the prevalence ratio (PR) of concussion by age, sex, deprivation indices, body mass index, and comorbid conditions. RESULTS: Concussion prevalence rates increased from 2010 to 2016 (p < 0.001). Based on 2016 data, males had a higher prevalence of concussion compared with females (PR = 1.09; 95% CI 1.02, 1.18), and those aged 10-14 (PR = 8.52; 95% confidence interval [CI] 6.34, 11.44) and 15-19 (PR = 7.75; 95% CI 5.84, 10.28) had higher prevalence of concussion compared with those aged 0-4 years. CONCLUSION: This pilot study demonstrates the feasibility of using the CPCSSN system for surveillance of concussion in the Canadian population. The initial findings on prevalence are in agreement with previous studies that have used hospitalization or emergency department data.

The rural-urban gap: differences in injury characteristics. / Écart entre milieu rural et milieu urbain : différences dans les caractéristiques des blessures.

BACKGROUND: Injuries are among the top 10 leading causes of death in Canada. However, the types and rates of injuries vary between rural versus urban settings. Injury rates increase with rurality, particularly those related to motor vehicle collisions. Factors such as type of work, hazardous environments and longer driving distances contribute to the difference in rural and urban injury rates. Further examination of injuries comparing rural and urban settings with increased granularity in the nature of injuries and severity is needed. METHODS: The study population consisted of records from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) from between 2011 and July 2017. Rural and urban status was determined based on postal codes as defined by Canada Post. Proportionate injury ratios (PIRs) were calculated to compare rural and urban injury rates by nature and severity of injury and sex, among other factors. RESULTS: Rural injuries were more likely to involve multiple injuries (PIR = 1.66 for 3 injuries) and crush injuries (PIR = 1.72). More modestly elevated PIRs for rural settings were found for animal bites (1.14), burns (1.22), eye injuries (1.32), fractures (1.20) and muscle or soft tissue injuries (1.11). Injuries in rural areas were more severe, with a higher likelihood of cases being admitted to hospital (1.97), and they were more likely to be due to a motor vehicle collision (2.12). CONCLUSION: The nature of injuries in rural settings differ from those in urban settings. This suggests a need to evaluate current injury prevention efforts in rural settings with the aim to close the gap between rural and urban injury rates.