Andrew Papadopoulos

Component costs of foodborne illness: a scoping review

BackgroundGovernments require high-quality scientific evidence to prioritize resource allocation and the cost-of-illness (COI) methodology is one technique used to estimate the economic burden of a disease. However, variable cost inventories make it difficult to interpret and compare costs across multiple studies.MethodsA scoping review was conducted to identify the component costs and the respective data sources used for estimating the cost of foodborne illnesses in a population. This review was accomplished by: (1) identifying the research question and relevant literature, (2) selecting the literature, (3) charting, collating, and summarizing the results. All pertinent data were extracted at the level of detail reported in a study, and the component cost and source data were subsequently grouped into themes.ResultsEighty-four studies were identified that described the cost of foodborne illness in humans. Most studies (80%) were published in the last two decades (1992–2012) in North America and Europe. The 10 most frequently estimated costs were due to illnesses caused by bacterial foodborne pathogens, with non-typhoidal Salmonella spp. being the most commonly studied. Forty studies described both individual (direct and indirect) and societal level costs. The direct individual level component costs most often included were hospital services, physician personnel, and drug costs. The most commonly reported indirect individual level component cost was productivity losses due to sick leave from work. Prior estimates published in the literature were the most commonly used source of component cost data. Data sources were not provided or specifically linked to component costs in several studies.ConclusionsThe results illustrated a highly variable depth and breadth of individual and societal level component costs, and a wide range of data sources being used. This scoping review can be used as evidence that there is a lack of standardization in cost inventories in the cost of foodborne illness literature, and to promote greater transparency and detail of data source reporting. By conforming to a more standardized cost inventory, and by reporting data sources in more detail, there will be an increase in cost of foodborne illness research that can be interpreted and compared in a meaningful way.

A Systematic Review of Waterborne Disease Outbreaks Associated with Small Non-Community Drinking Water Systems in Canada and the United States

Background Reports of outbreaks in Canada and the United States (U.S.) indicate that approximately 50% of all waterborne diseases occur in small non-community drinking water systems (SDWSs). Summarizing these investigations to identify the factors and conditions contributing to outbreaks is needed in order to help prevent future outbreaks. Objectives The objectives of this study were to: 1) identify published reports of waterborne disease outbreaks involving SDWSs in Canada and the U.S. since 1970; 2) summarize reported factors contributing to outbreaks, including water system characteristics and events surrounding the outbreaks; and 3) identify terminology used to describe SDWSs in outbreak reports. Methods Three electronic databases and grey literature sources were searched for outbreak reports involving SDWSs throughout Canada and the U.S. from 1970 to 2014. Two reviewers independently screened and extracted data related to water system characteristics and outbreak events. The data were analyzed descriptively with ‘outbreak’ as the unit of analysis. Results From a total of 1,995 citations, we identified 50 relevant articles reporting 293 unique outbreaks. Failure of an existing water treatment system (22.7%) and lack of water treatment (20.2%) were the leading causes of waterborne outbreaks in SDWSs. A seasonal trend was observed with 51% of outbreaks occurring in summer months (p<0.001). There was large variation in terminology used to describe SDWSs, and a large number of variables were not reported, including water source and whether water treatment was used (missing in 31% and 66% of reports, respectively). Conclusions More consistent reporting and descriptions of SDWSs in future outbreak reports are needed to understand the epidemiology of these outbreaks and to inform the development of targeted interventions for SDWSs. Additional monitoring of water systems that are used on a seasonal or infrequent basis would be worthwhile to inform future protection efforts.

Enhancing public trust in the food safety regulatory system

OBJECTIVE It is worth examining how public health agencies can enhance the publics trust in the food safety regulatory system. This paper will focus on the food safety system, which can be defined as those involved in the safe manufacture, storage, handling, display, distribution, sale or offer for sale, preparation, processing or service of food. Specifically, the paper will summarize and discuss literature relating to public expectation of public health agency action regarding protecting the food supply and recent policy reforms. METHODS A meta-interpretation was conducted to identify common themes in peer-reviewed publications and media sources. Literature searches retrieved 39 relevant articles published, resulting in 19 peer-reviewed articles, 8 media, 8 government reports, and 4 legislation documents. RESULTS The public expects a safe food system and they lack confidence in the current system. They desire increased scientifically transparent communication from a trusted source, a stronger public health presence, a coordinated food safety regulatory system, and increased access to inspection results. CONCLUSIONS Public health agencies must communicate easily understood transparent, scientific information to the public. Inspection disclosure systems have been effective in increasing transparency. Public health agencies must have a strong presence in a coordinated food safety regulatory framework.

Understanding the attitudes and perceptions of vegetarian and plant-based diets to shape future health promotion programs.

Vegetarian diets have become a prominent area of interest. However, little research has focused on the attitudes and perceptions on vegetarian diets. The purpose of this scoping review was to methodologically search the literature and summarize public perceptions and attitudes towards a vegetarian diet. Using the information found from this review, the Health Belief Model can be applied to shape future health promotion initiatives to move individuals towards a vegetarian or plant-based diet. The main findings indicate that vegetarian diets are generally perceived in a positive light. There are many barriers to consuming this diet such as health concerns, an unwillingness to make dietary changes, and an enjoyment of eating meat.

Using core competencies to build an evaluative framework: outcome assessment of the University of Guelph Master of Public Health program

BackgroundMaster of Public Health programs have been developed across Canada in response to the need for graduate-level trained professionals to work in the public health sector. The University of Guelph recently conducted a five-year outcome assessment using the Core Competencies for Public Health in Canada as an evaluative framework to determine whether graduates are receiving adequate training, and identify areas for improvement.MethodsA curriculum map of core courses and an online survey of University of Guelph Master of Public Health graduates comprised the outcome assessment. The curriculum map was constructed by evaluating course outlines, assignments, and content to determine the extent to which the Core Competencies were covered in each course. Quantitative survey results were characterized using descriptive statistics. Qualitative survey results were analyzed to identify common themes and patterns in open-ended responses.ResultsThe University of Guelph Master of Public Health program provided a positive learning environment in which graduates gained proficiency across the Core Competencies through core and elective courses, meaningful practicums, and competent faculty. Practice-based learning environments, particularly in collaboration with public health organizations, were deemed to be beneficial to students’ learning experiences.ConclusionsThe Core Competencies and graduate surveys can be used to conduct a meaningful and informative outcome assessment. We encourage other Master of Public Health programs to conduct their own outcome assessments using a similar framework, and disseminate these results in order to identify best practices and strengthen the Canadian graduate public health education system.

Using Business Plan Development as a Capstone Project for MPH Programs in Canada: Validation Through the Student Perspective

Master of Public Health (MPH) programs have been developed across Canada as a response to the need for adequately trained individuals to work in the public health sector. Educational institutions that deliver MPH programs have a responsibility to ensure that graduates of their program have the essential knowledge, skills and attitudes to begin a successful career in public health. The Public Health Agency of Canada has created the core competencies for public health to guide the development, delivery and evaluation of MPH programs. In Canada, a capstone project is the recommended method of evaluating the MPH graduate’s ability to demonstrate proficiency in the public health core competencies. A business plan that develops the framework for a public health program is an ideal capstone project currently used in practice within the University of Guelph MPH program. This group assignment incorporates all 36 of the public health core competencies while providing students with a real-world public health experience, and should be considered for inclusion within MPH programs across Canada. Business planning provides students the opportunity to engage in practice-based learning, applying theoretical knowledge to practice. Further, the ability to develop realistic but financially feasible public health problems is an invaluable skill for MPH graduates. As the development of programs becomes more restricted and the continuation of other programs are under constant threat, the ability to develop a sound business plan is a required skill for individuals entering the public health sector, and will ensure students are able to maximize outcomes given tight fiscal budgets and limited resources.

Implications of applying methodological shortcuts to expedite systematic reviews: three case studies using systematic reviews from agri‐food public health

Background The rapid review is an approach to synthesizing research evidence when a shorter timeframe is required. The implications of what is lost in terms of rigour, increased bias and accuracy when conducting a rapid review have not yet been elucidated. Methods We assessed the potential implications of methodological shortcuts on the outcomes of three completed systematic reviews addressing agri‐food public health topics. For each review, shortcuts were applied individually to assess the impact on the number of relevant studies included and whether omitted studies affected the direction, magnitude or precision of summary estimates from meta‐analyses. Results In most instances, the shortcuts resulted in at least one relevant study being omitted from the review. The omission of studies affected 39 of 143 possible meta‐analyses, of which 14 were no longer possible because of insufficient studies (<2). When meta‐analysis was possible, the omission of studies generally resulted in less precise pooled estimates (i.e. wider confidence intervals) that did not differ in direction from the original estimate. Conclusions The three case studies demonstrated the risk of missing relevant literature and its impact on summary estimates when methodological shortcuts are applied in rapid reviews.

Strategies to control community-associated antimicrobial resistance among enteric bacteria and methicillin-resistant Staphylococcus aureus in Canada - executive summary.

Resistance to antimicrobial drugs is a concern that exists worldwide and has a significant impact on human and animal health. Knowledge and practice gaps exist around the control of antimicrobial-resistant infections in Canada, particularly in the community setting. Although much research exists on the control of hospital-acquired resistant infections, currently no comprehensive synthesis or review of the literature exists on the control of antimicrobial-resistant organism infections within the community. In particular, there is little synthesis of information on those infections that represent a large component of community-level impact, namely resistant enteric bacteria and community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA); these infections pose a significant health burden to Canadians. In addition to representing a significant human health impact within the Canadian community, enteric bacteria and MRSA have similar spread and control mechanisms (eg, hygiene and handwashing, sanitation, housing density and crowding, person-to-person spread and animal exposure), thus representing areas for common policy, intervention and other control activities. The objective of the present study was to conduct a formal, comprehensive review of control strategies and interventions available to reduce both the development of antimicrobial-resistant enteric bacteria, specifically Campylobacter species, Salmonella species, verocytotoxigenic Escherichia coli, Shigella species and CA-MRSA, and the spread of such infections within Canadian communities. A comprehensive review was undertaken of the relevant peer-reviewed and grey English language literature from 1970 to the present using a protocol based on a systematic review methodology. A total of 1467 references were identified; of these, 563 met the abstract relevancy screening criteria and of these, 203 were reviewed in detail. Consequently, 66 references were reviewed, from which data were abstracted specifically regarding CA-MRSA, and 57 references were reviewed, from which data were abstracted specifically regarding enteric pathogens. In general, there was reasonable scientific evidence regarding risk groups and risk factors for CA-MRSA. This information provided some insight into potential approaches to control these infections. Identified potential risk groups and risk factors included the following: Children; Specific ethnic groups; Athletes; Drug use; Men who have sex with men; Heterosexual high-risk activities; Military; Veterinarians and animal handlers; HIV infection; Tattoo recipients; Living with a carrier or case of CA-MRSA; Emergency departments and hospitalized patients; and Antibiotic use There was a paucity of information on risk groups and risk factors for the community-acquired, antimicrobial-resistant enteric bacterial infections studied; some information exists on risk settings and risk factors for community-acquired enteric bacterial infections (without reference to resistance), but the extent to which this can be extrapolated to resistant infections is unknown; much of this information takes the form of outbreak reports. Potential risk groups and risk factors for community-acquired, antimicrobial-resistant enteric infections included the following: Daycare centres; Schools; Households; Nursing homes; Immunocompromised individuals; Specific sociodemographic factors (ie, rural residents, specific ethnic groups, income, education and access to health services); Population density; and Season There was a paucity of scientifically based information (randomized controlled trials or observational studies) on interventions for CA-MRSA or for the enteric bacterial infections studied (resistant or otherwise). A number of randomized controlled trials have shown the effectiveness of handwashing in the prevention of gastrointestinal illness. A limited number of intervention studies of hospital-acquired MRSA exist; however, the extent to which the results of these studies can be extrapolated to CA-MRSA is unknown. Such extrapolation may be misleading. There was extensive literature concerning recommendations, guidelines and suggested approaches to the control of both CA-MRSA and, to a lesser extent, for enteric bacterial infections in community settings. Although the efficacy of these approaches is plausible, it has, for the most part, not been formally evaluated. Proposed approaches to control these infections included the following: CA-MRSA ○ Hand and personal hygiene; ○ Prudent use of antibiotics; ○ Decolonization; ○ Early diagnosis and appropriate treatment; ○ Education programs (hygiene and antibiotic use); ○ Regular cleaning and laundering in households and facilities; ○ Equipment disinfection; and ○ Exclusion of those with active infection from certain high-risk settings. Community-acquired enteric bacterial infections ○ Hand, household and institutional hygiene; ○ Equipment disinfection in high-risk settings; ○ Public and public health education; ○ Early diagnosis and appropriate treatment; and ○ Exclusion of those with active infection from certain high-risk settings We concluded that formal evaluations of the efficacy of strategies for the control of CA-MRSA and community-acquired enteric infections (resistant and otherwise) are warranted, and should form the basis for public health guidelines and policy. Until such time as evaluations can be undertaken, recommendations for the control of these infections must be largely dependent on historical practice, conventional wisdom, extrapolation from other contexts, consensus and conjecture. Potential interventions that would warrant formal evaluation in various settings and groups include the following: Hand and personal hygiene; Prudent use of antibiotics; Decolonization; Early diagnosis and appropriate treatment; Public education programs (hygiene and antibiotic use); Regular cleaning and laundering in households and facilities; Equipment disinfection; and Exclusion of those with active infection from certain high-risk settings Ongoing collection and evaluation of information (including surveillance and epidemiological studies) on the occurrence, settings, risk factors and risk groups for CA-MRSA and resistant enteric infections are warranted. Such information will be useful in determining disease trends, identifying risk groups, settings and risk factors, and in identifying and evaluating potential interventions.

What do we know about health-related knowledge translation in the Circumpolar North? Results from a scoping review

Background Health research knowledge translation (KT) is important to improve population health outcomes. Considering social, geographical and cultural contexts, KT in Inuit communities often requires different methods than those commonly used in non-Inuit populations. Objectives To examine the extent, range and nature of literature about health-related KT in Inuit communities. Design A scoping review was conducted. A search string was used to search 2 English aggregator databases, ProQuest and EBSCOhost, on 12 March 2015. Study selection was conducted by 2 independent reviewers using inclusion and exclusion criteria. To be included, studies had to explicitly state that KT approaches were used to share human health research results in Inuit communities in the Circumpolar North. Articles that evaluated or assessed KT approaches were thematically analysed to identify and characterize elements that contributed to KT success or challenges. Results From 680 unique records identified in the initial search, 39 met the inclusion criteria and were retained for analysis. Of these 39 articles, 17 evaluated the KT approach used; thematic analysis identified 3 themes within these 17 articles: the value of community stakeholders as active members in the research process; the importance of local context in tailoring KT strategies and messaging; and the challenges with varying and contradictory health messaging in KT. A crosscutting gap in the literature, however, included a lack of critical assessment of community involvement in research. The review also identified a gap in assessments of KT in the literature. Research primarily focused on whether KT methods reflected the local culture and needs of the community. Assessments rarely focused on whether KT had successfully elicited its intended action. Conclusions This review synthesized a small but burgeoning area of research. Community engagement was important for successful KT; however, more discussion and discourse on the tensions, challenges and opportunities for improvement are necessary.Background Health research knowledge translation (KT) is important to improve population health outcomes. Considering social, geographical and cultural contexts, KT in Inuit communities often requires different methods than those commonly used in non-Inuit populations. Objectives To examine the extent, range and nature of literature about health-related KT in Inuit communities. Design A scoping review was conducted. A search string was used to search 2 English aggregator databases, ProQuest and EBSCOhost, on 12 March 2015. Study selection was conducted by 2 independent reviewers using inclusion and exclusion criteria. To be included, studies had to explicitly state that KT approaches were used to share human health research results in Inuit communities in the Circumpolar North. Articles that evaluated or assessed KT approaches were thematically analysed to identify and characterize elements that contributed to KT success or challenges. Results From 680 unique records identified in the initial search, 39 met the inclusion criteria and were retained for analysis. Of these 39 articles, 17 evaluated the KT approach used; thematic analysis identified 3 themes within these 17 articles: the value of community stakeholders as active members in the research process; the importance of local context in tailoring KT strategies and messaging; and the challenges with varying and contradictory health messaging in KT. A crosscutting gap in the literature, however, included a lack of critical assessment of community involvement in research. The review also identified a gap in assessments of KT in the literature. Research primarily focused on whether KT methods reflected the local culture and needs of the community. Assessments rarely focused on whether KT had successfully elicited its intended action. Conclusions This review synthesized a small but burgeoning area of research. Community engagement was important for successful KT; however, more discussion and discourse on the tensions, challenges and opportunities for improvement are necessary.Background Health research knowledge translation (KT) is important to improve population health outcomes. Considering social, geographical and cultural contexts, KT in Inuit communities often requires different methods than those commonly used in non-Inuit populations. Objectives To examine the extent, range and nature of literature about health-related KT in Inuit communities. Design A scoping review was conducted. A search string was used to search 2 English aggregator databases, ProQuest and EBSCOhost, on 12 March 2015. Study selection was conducted by 2 independent reviewers using inclusion and exclusion criteria. To be included, studies had to explicitly state that KT approaches were used to share human health research results in Inuit communities in the Circumpolar North. Articles that evaluated or assessed KT approaches were thematically analysed to identify and characterize elements that contributed to KT success or challenges. Results From 680 unique records identified in the initial search, 39 met the inclusion criteria and were retained for analysis. Of these 39 articles, 17 evaluated the KT approach used; thematic analysis identified 3 themes within these 17 articles: the value of community stakeholders as active members in the research process; the importance of local context in tailoring KT strategies and messaging; and the challenges with varying and contradictory health messaging in KT. A crosscutting gap in the literature, however, included a lack of critical assessment of community involvement in research. The review also identified a gap in assessments of KT in the literature. Research primarily focused on whether KT methods reflected the local culture and needs of the community. Assessments rarely focused on whether KT had successfully elicited its intended action. Conclusions This review synthesized a small but burgeoning area of research. Community engagement was important for successful KT; however, more discussion and discourse on the tensions, challenges and opportunities for improvement are necessary.

Stool submission data to help inform population-level incidence rates of enteric disease in a Canadian community.

Laboratory-based surveillance data is essential for monitoring trends in the incidence of enteric disease. Current Canadian human enteric surveillance systems report only confirmed cases of human enteric disease and are often unable to capture the number of negative test results. Data from 9116 hospital stool specimens from the Waterloo Region in Canada, with a mixed urban and rural population of about 500 000 were analysed to investigate the use of stool submission data and its role in reporting bias when determining the incidence of enteric disease. The proportion of stool specimens positive for Campylobacter spp. was highest in the 15-29 years age group, and in the 5-14 years age group for Salmonella spp. and E. coli O157:H7. By contrast, the age-specific incidence rates were highest for all three pathogens in the 0-4 years age group which also had the highest stool submission rate. This suggests that variations in age-specific stool submission rates are influencing current interpretation of surveillance data.