Public health physician perspectives on developing and deploying clinical practice guidelines during the 2009 H1N1 pandemic.

During the H1N1 outbreak of 2009, local public health units engaged in consultations with various levels of government to develop clinical practice guidelines. These guidelines provide specific clinical considerations around prevention, management, and treatment associated with the particular pathogen involved and are used by frontline healthcare professionals across many healthcare settings. In this article, we report on the lessons learned by Medical Officers of Health from across Canada on the guideline development and deployment processes and provide suggestions to improve guidelines development and deployment during future pandemic situations.

Social connection as a public health adaptation to extreme heat events.

Climate change is an increasingly important public health issue, reflected in morbidity and mortality outcomes during extreme heat events. At the same time, the harms of social isolation with respect to a wide range of health outcomes are becoming better understood. Given that older adults are at higher risk during hot weather and at higher risk of social isolation, they are among those at highest risk for adverse impacts of extreme heat events. While specific strategies to reduce heat exposure have been described in the literature and promoted in public health practice, these may not be readily available to socially isolated older adults. As such, it is crucial to identify key approaches to address risk due to social isolation in the aging population, and to acknowledge their limitations and barriers. Interventions rooted in social connection, a concept widely applied in interventions for public health and social well-being, should be applied as a tool for adaptation to extreme heat events.

RéSUMé: Le changement climatique est un problème de santé publique de plus en plus important, qui se reflète dans les résultats de la morbidité et de la mortalité lors des épisodes de chaleur extrême. Au même temps, les mals de l'isolement social en ce qui concerne un large éventail de résultats pour la santé sont de mieux en mieux compris. Étant donné que les personnes âgées sont plus à risque durant les temps chaud et à risque d'isolement social, elles font partie des personnes les plus exposées aux effets négatifs d'événements de chaleur extrême. Bien que des stratégies spécifiques pour réduire l'exposition à la chaleur aient été décrites dans la littérature et promues dans la pratique de la santé publique, elles peuvent ne pas être facilement accessibles aux personnes âgées socialement isolées. Comme tel, il est essentiel d'identifier les approches clés pour réduire les risques dus à l'isolement social de la population vieillissante et de reconnaître leurs limites et obstacles. Les interventions enracinées dans la connexion sociale, un concept largement appliqué dans les interventions pour la santé publique et le bien-être social, devraient être appliquées comme un outil d'adaptation aux événements de chaleur extreme.

The Direct Economic and Opportunity Costs of the Medical College Admissions Test (MCAT) for Canadian Medical Students.

This article was migrated. The article was marked as recommended. Background The Association of Faculties of Medicine of Canada, Future of Medical Education in Canada report shared a collective vision to improve social accountability, including a review of admissions policies to enhance student diversity. This study explored if and how the Medical College Admissions Test (MCAT) might mediate the socioeconomic diversity of Canadian medical schools by quantifying the costs and other cost-related factors of preparing for the exam. Methods A 34-question anonymous and bilingual (English and French) online questionnaire was sent to the 2015 first-year cohort of Canadian medical students. Developed collaboratively, the survey content focused on MCAT preparation and completion activities, associated costs, and students' perceptions of MCAT costs. Findings The survey response rate was 32%. First-year medical students were more likely than the Canadian population to belong to high-income families (63% vs. 36%) and less likely to be from rural locations (4.5% vs. 19%). Use of MCAT preparation materials was reported by nearly every MCAT test-taker (95.3%): of those, 76.4% used free practice tests; 59.8% paid for practice tests; 45.1% registered for preparation courses; and 3.3% hired a private tutor. In terms of writing the MCAT, the total economic costs per respondent are estimated at $6,357 ($4,755-$7,958) and total direct costs per respondent are estimated at $2,970 ($1,882- $4,058). Opportunity costs represented the majority of economic costs, at $3,387 ($2,872 - $3,901), or 53.2%. MCAT preparation costs are estimated to be $2,372 ($1,373-$3,372), or 79.9% of total direct costs and 37.3% of economic costs. Most respondents agreed, 76%, that the MCAT posed a financial hardship. Conclusion The financial demands of preparing for and completing the MCAT quantified in this study highlight an admissions requirement that is likely contributing to the current student diversity challenges in Canadian medical schools. In the spirit of social accountability, perhaps it is time to prioritize equitable alternative for assessing applicants' academic readiness for medical school.