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Tuesday, April 3, 2012

Exploring the dimensions of performance in public health

Grand West and Centre Ballroom

10:00 a.m. - 10:30 a.m.
Morning Refreshment Break
Grand Ballroom Foyer

10:30 a.m. - 12:00 p.m.
Concurrent Sessions III, TOPHC Breakout Rooms

21. Just Food, Fast Food, No Food, Slow Food: Local Food Policy and the View from Public Health
Presented by: Catherine L. Mah, Barbara Emanuel, Lynn Roblin, Catherine Schwartz Mendez

12:00 p.m. - 1:30 p.m.
Luncheon
Speaker: Dr. David Butler-Jones, Chief Public Health Officer of Canada
Dr. Butler-Jones will provide welcoming remarks to convention delegates.  In keeping with the day’s theme of exploring the dimensions of performance in public health, he will also outline current Public Health Agency of Canada initiatives related to quality improvement and performance management in public health. As time permits, Butler-Jones will respond to questions from the audience.
The session will be moderated by Dr. Paul Roumeliotis, President, Association of Local Public Health Agencies (alPHa).
Grand Ballroom Foyer

1:00 p.m. - 1:30 p.m.
Poster Presentations: “Guided Tours”

Guided Poster Presentation Tour A: Issues in Environmental Health Tour
i. North Hamilton Child Blood Lead Study
Presented by: Matthew Lawson, Wendy Pigott, Carole Craig
Poster Presentation
Do not need any prior knowledge of the subject matter.
In 2008-2009, City of Hamilton Public Health Services conducted a local study to determine the distribution of blood lead levels (BLLs) in a sample of children less than seven years of age, residing in a targeted geographic higher risk area of North Hamilton. The study was a non-random, self-selected cross-sectional design. Participation included attending a mobile clinic to provide a capillary blood sample (n=643 children), a household risk factor telephone survey and environmental sampling (sub-sample n=196 households). The geometric mean BLL was 0.107 µmol/L; 0.9 per cent of observations were above the national guidance value. Significant predictors of BLLs included: housing construction date pre-1920, lower household income, male sex, recent home renovations and a proxy measure for industrial lead emissions. This proxy demonstrated a strong association with BLL at or above the study follow-up threshold (OR 20, CI 4 - 95; p = <.001) and may reflect long-established, urban neighbourhoods that are also adjacent to long-established lead-emitting industry with unmeasured risks from multiple sources. The geographic distribution of environmental lead sources across the study area is uneven; some neighbourhoods have relatively higher risks of multiple lead sources and are of lower socio-economic status with fewer resources to counteract lead exposure. Several risk and mitigation factors for lead exposure are tightly interwoven with various determinants of health. This suggests the need for a multi-pronged collaborative approach involving: 1) an assortment of disciplines and programs within public health, 2) local physicians serving identified populations at risk; and 3) community stakeholders involved in neighbourhood development strategies.

ii. The Risk of Hodgkin Lymphoma in Canadian Men from Exposure to Multiple Pesticides
Presented by: Garthika Navaranjan, Karin Hohenadel, Paul A. Demers, Aaron Blair, John Spinelli, Punam Pahwa, John  McLaughlin, James Dosman, Shelley Harris
Poster Presentation
Need to have a basic knowledge of the subject matter.
Studies have examined the risk of Hodgkin Lymphoma (HL) from exposure to individual pesticides, while few studies have looked at exposure to multiple pesticides and the risk of HL. Exposure to multiple pesticides is important to consider since pesticide users often use several pesticides over their lifetime. The objective of this study was to determine the risk of HL from exposure to multiple pesticides grouped by various classes and carcinogenic potentials. These analyses were also subset to specific age groups. This poster presentation will examine the main findings of this study as well as highlight important areas for future studies.

iii. The Impact of Pesticide Exposure on Health: Report on the 2011 Ontario College of Family Physicians Pesticide Review
Presented by: Kate Bassil, Margaret Sanborn, Cathy Vakil, Kathleen Kerr, Kelsey Ragan
Poster Presentation
Do not need any prior knowledge of the subject matter.
Concern over the adverse health effects of pesticide exposure has prompted the implementation of cosmetic pesticide bans in Ontario. However, occupational exposures continue and there is evidence to suggest environmental persistence of many pesticides despite these bans. The objective of the current project was to conduct a systematic review of published studies on the association between occupational and non-occupational exposure to pesticides and adult reproductive and respiratory effects, and child neurodevelopmental health outcomes. Epidemiological evidence in this area has rapidly expanded in recent years with the introduction of biomarkers to measure exposure and the development of several prospective pregnancy and birth cohorts. Primary peer-reviewed studies were searched using MEDLINE, EMBASE and TOXNET databases. Studies were collected and organized according to health effect using appropriate MeSH terms. Each study was evaluated by two independent reviewers using the modified Downs and Black quality assessment tool. For reproductive health effects, an association between exposure and reduced fetal growth was reported in several studies. The most commonly reported respiratory effects were adverse lung function and atopic asthma, with a critical period of exposure in children prenatally and during the first year of life. First trimester exposure was the most critical for neuro-developmental problems which included deficits in working memory and increased risk of attention problems. Our findings support attempts to reduce exposure to pesticides and have important implications for current prenatal and children at risk programs that address these exposures.

iv. Towards Estimating the Economic Burden of Waterborne Illness in Canada: What Do We Know, Where Do We Go?
Presented by: Norman Vinson
Poster Presentation
Do not need any prior knowledge of the subject matter.
An estimate of the economic burden of waterborne illness is a crucial piece of information when considering increased investment in water treatment, water infrastructure upgrades, investments in disease surveillance and public health interventions. Unfortunately, no such estimate exists. Impediments to generating such an estimate are the multiplicity of waterborne pathogens and water systems, and the lack of studies and the variability of their results. In this presentation, there will be a discussion on the information that is available for contributing to an estimate, and the information that is missing. In addition, the limitations of existing sources of information will be discussed. Finally, trends in illness data and risk factors will be examined. This presentation will also provide direction for additional research in the area of waterborne illness epidemiology.

v. Environmental Health Tracking: GIS Mapping of Nitrates in Water
Presented by: Emily Peterson, Steven Johnson, Hong Chen, Paul Gray, Ray Copes
Poster Presentation
Do not need any prior knowledge of the subject matter.
To identify and help protect the population from existing and emerging environmentally related morbidity and mortality, we propose a province-wide environmental health tracking system for Ontario. This system involves the collection, collation and analysis of data related to environmental hazards, environmental exposures and environmentally related diseases and the dissemination of this information to those who need it to make decisions. The objective of this presentation is to demonstrate the utility of environmental health tracking in identifying and assessing environmental health problems in Ontario. More specifically, we will describe in space and time the stream and ground water nitrate levels in Ontario. We examined spatial variation in nitrate levels using geographic information systems (GIS) and applied regression analysis to compare nitrate levels with various agriculture measures. Higher stream water nitrate levels appear to be located within southwestern Ontario, an area with high population density and agriculture activity. Our findings suggest that some agricultural activities, such as the use of commercial fertilizer may play a role in increasing the levels of nitrates in stream water. These new tools can be used to identify areas and populations with small drinking water systems that are most likely to be affected by high contaminant levels. Such information may be useful to health units in taking action, individually or jointly with other organizations, to reduce contaminant levels and ultimately human exposure. These tools can also be used as a guide to deciding where additional information or testing is required.

vi. A Dedicated Bed Bug Group of PHIs and PHNs Teaming to Succeed
Presented by: Allie Lehmann, Tracy Leach
Poster Presentation
Do not need any prior knowledge of the subject matter.
No one is immune from bed bugs. Incidents of infestations in the City of Toronto continue to be reported to Toronto Public Health (TPH) from across all social and economic strata. Infestations cause extreme distress, are expensive and require tremendous effort to be eradicated. These problems are compounded when infestations occur in the most vulnerable populations (individuals with physical, mental health or addictions issues; people living in poverty; the under-housed, homeless or frail elderly) who predominately live in shared living facilities and multi-unit residential buildings. These individuals lack the necessary financial resources and the physical or mental capacity to effectively address bed bug infestations resulting in severe and/or chronic re-infestations. In 2011, TPH obtained on-going base provincial funding ($255,060 annually) for three new public health nurse positions to support bed bug control. The provincial government also provided additional one-time funding in the amount of $1,216,518 for the bed bug control strategy, to be spent by March 31, 2012. TPH created a dedicated bed bug team of public health inspectors (PHIs) and public health nurses (PHNs) to respond. The PHNs are working to help vulnerable people whose infestations have been caused or exacerbated in part by underlying health problems. Through sharing case studies, our presentation will show how the excellent collaboration between PHIs and PHNs operates and translates into successful bed bug eradication and knowledge exchange and teachings for the future.

Guided Poster Presentation Tour B: New Developments in Immunization Tour
i. Evaluation of Electronic Immunization Data Collection Systems
Presented by: Christine Heidebrecht, Jeff Kwong, Michael Finkelstein, Sherman Quan, Shelley L. Deeks
Poster Presentation
Do not need any prior knowledge of the subject matter.
As public health authorities across the country consider the transition from hybrid to fully electronic immunization information systems, existing electronic systems serve as valuable examples. Evaluations of these systems can provide important information to strengthen the systems themselves as well as guide other organizations in the process of designing and implementing augmented approaches to data collection. Informed by a range of resources, the PHAC/CIHR Influenza Research Network Vaccine Coverage theme group has developed an evaluation framework and piloted it in a comprehensive assessment of two electronic influenza immunization data collection systems. This presentation will outline the methods used to assess simplicity, flexibility, data quality, timeliness, acceptability, stability and security.

ii. Systematic Review: Barriers to the Use of Reminder/Recall Interventions for Immunizations
Presented by: Jennifer Pereira, Susan Quach, Christine L. Heidebrecht, Sherman D. Quan, Faron Kolbe, Michael Finkelstein, Jeff C. Kwong
Poster Presentation
Do not need any prior knowledge of the subject matter.
One of the most commonly cited reasons for low coverage is patients or their caregivers simply neglecting to remember that one or more vaccines are due. Reminder/recall (RR) interventions such as letters, postcards or text messages to patients and clinical alerts for physicians have been devised to address this issue but they are not widely implemented. We conducted a systematic review to identify perceived barriers to their use and noted that there were several themes including human and financial resources required to properly implement an RR intervention, lack of confidence in records to identify patients due or overdue for immunization, workflow challenges and expectations of success rate. While many of these can be addressed through appropriate training of immunization staff to efficiently implement an RR measure, others will rely on the development and use of comprehensive immunization registries as well as better communication between health care providers to ensure that immunization records are accurate and up-to-date. The proven benefits of RR interventions can only be met when these barriers are adequately addressed.

iii. Measuring Influenza Immunization Coverage Among Healthcare Workers in Acute Care and Continuing Care Organizations in Canada
Presented by: Susan Quach, Julie Bettinger, Natasha  S.Crowcroft, Jennifer Pereira, Christine Heiderbrecht, Allison McGeer, Maryse Guay, Jeff Kwong, Lois Crowe, Jemila Hamid, Larry Chambers
Poster Presentation
Should be familiar with the topic area.
Annual influenza vaccination is recommended for health care workers as a means to reduce transmission of influenza in health care settings. It is difficult to make comparisons of influenza immunization coverage between institutions, as sources of information vary and this impacts the quality and accuracy of the rates reported. Such information is important for evaluating the success of vaccination programs and assessing whether vaccination coverage targets are met. As a first step to address this issue, this project aims to describe health care organizations’ ability to measure coverage and identify factors that are associated with complete coverage measurement. Further, we hope to identify potential ideal solutions that can be implemented across institutions to address barriers with existing methods.

iv. Ethnic Disparities in Influenza Immunization in Canada
Presented by: Susan Quach, Jemila Hamid, Jennifer Pereira, Christine Heidebrecht, Shelley L. Deeks, Natasha S. Crowcroft, Sherman Quan, Stephanie Brien, Jeff Kwong
Poster Presentation
Do not need any prior knowledge of the subject matter.
Much research has been conducted in the U.S. describing ethnic disparities in influenza vaccine coverage. However, there has been a lack of Canadian data on this subject. Given the distinct differences in vaccine access and ethnic populations, data from the U.S. are likely not generalizable to the Canadian population. To assess the presence of ethnic disparities in influenza vaccine coverage across 12 ethnic groups, we conducted a study using data from the Canadian Community Health Survey. Results from this study will be helpful for highlighting gaps in coverage which can guide health promotion activities and policies directed at improving immunizations in under-served groups.

v. Serogroup C Invasive Meningococcal Disease in Ontario, Canada, 2000-10: Vaccine Impact Assessment
Presented by: Anne Wormsbecker, Vica Dang, Frances Jamieson, Sarah Wilson, Prasad Rawte, Natasha S. Crowcroft, Shelley L. Deeks
Poster Presentation
Need to have a basic knowledge of the subject matter.
This scientific presentation of the epidemiology of serogroup C invasive meningococcal disease (IMD) in Ontario from 2000-10 will inform participants of descriptive epidemiologic characteristics of the disease, including age of cases, annual incidence and case-fatality ratio, during a time period that encompasses the introduction of meningococcal C conjugate vaccine in 2004-05. Audience members will also be introduced to a cohort analysis that compares rates of serogroup C IMD among those who are eligible for the publicly funded vaccine versus among those who are not. The cohort analysis describes both direct and indirect impacts of the vaccination program.

Guided Poster Presentation Tour C: Infectious Diseases Tour
i. Estimating Sexual Transmission of Enteric Illness in Toronto
Presented by: Kristine Cooper, Sylvia Ota, Anne Arthur, Effie Gournis
Poster Presentation
Do not need any prior knowledge of the subject matter.
The extent of sexual transmission of gastroenteric illness (GI) is not well captured in traditional public health surveillance data. Behavioural risk factors and exposure data collected during routine public health investigations of these cases are often incomplete or inaccurate, especially as they relate to confirming sexual activities that may involve oral-anal contact. This study aimed to improve estimates by considering information on sexually transmitted infections (STI). Reportable disease data stored in the Integrated Public Health Information System, for Toronto residents reported with a GI from January 1, 2006 to December 31, 2010, were considered. Information on case demographics, reported risk factors, any additional reported GIs, and any reported sexually transmitted infection was also extracted and analyzed. Statistical analyses were carried out using SAS Version 9.1. Of those individuals with a GI/STI co-infection, all reported sexual contact as an exposure. All individuals were male, aged 40-45 years and reported MSM (men who have sex with men) behaviour. Of the GI cases without a documented STI co-infection, but with an STI reported within the five-year analysis period, 87.8 per cent reported sexual contact. Demographic characteristics were comparable to co-infected individuals. Seventy-four and a half per cent of cases with a recurrent GI reported sexual contact and 17.4 per cent of GI cases with no known STI and no additional GI, reported sexual contact. These results highlight the need for targeted health promotion messages to high-risk individuals and suggest that a history with a reportable STI and multiple GIs may serve as an important marker for sexually transmitted enteric disease.

ii. Descriptive and Analytic Examination of Public Health Laboratory Parasitology Data
Presented by: Anna Majury, Allison Maier
Poster Presentation
Do not need any prior knowledge of the subject matter.
A descriptive and analytic examination of two parasitology test result data sets was undertaken. The first set, from the Eastern Ontario public health laboratories, contained 20 months of data while the second, from all public health laboratories in Ontario, contained eight months. The goal of the study was to describe Ontario parasite infections and identify their risk factors using routinely collected information. Additionally, the data was used to assess current protocols for parasite testing in public health laboratories and to propose alternatives which optimize the allocation of laboratory resources. The two data sets were analyzed separately; in total 42,377 patients records were obtained. Of these, an average of 11 per cent were multiple samples from a patient submitted on the same day with 99 per cent having the same result, thereby suggesting that multiple specimens for a single patient may not be necessary. Across the province, three per cent of parasite tests were positive; the most prevalent parasites were Dientamoeba fragilis, Giardia lamblia and Cryptosporidium species. Age, gender and season of submission were found to be weak risk factors. For Dientamoeba fragilis, Giardia lamblia and Cryptosporidium infections, a rural setting was found to have an odds ratio of approximately two. The strongest risk factor for parasite infection was positive response to travel, with odds ratios between five and 16 based on stratification criteria. Based on this relationship, six protocol alternatives based on travel exclusion criteria and rapid high throughput screening for common parasites were considered; four of these alternatives were identified as more effective than current procedures. Future analyses on these data sets were proposed.

iii. Use of Multinomial Logistic Regression Case-Case Analysis versus Binomial Logistic Regression Case-Control Analysis: A Comparison of Methods and Findings Pertaining to an Investigation of Salmonella Enteritidis (SE) Cases in Ontario
Presented by: Dean Middleton, Csaba Varga, Ryan Walton, Laura Rosella
Poster Presentation
Need to have a basic knowledge of the subject matter.
In Ontario, the rate of SE has been increasing steadily since 2002. An investigation was undertaken in 2010-2011 to understand the reasons for this increase. Multinomial logistic regression case-case analysis was used as a technique to identify risk factors for acquiring human infections caused by specific SE phage types. One benefit of multinomial logistic regression is that it can analyze greater than two outcomes for a particular pathogen (e.g., SE), and it compares the laboratory sub-types of interest (e.g., SE phage type 13) to other SE sub-types (e.g., SE phage type 1, 4, 8, etc.). In this way, the methodology allows for case-case comparisons that allow us to make inferences using case-only data, and thus eliminates the need for control data required in a case-control study. The presentation will provide information on the technique of multinomial logistic regression case-case analysis and compare the findings with the more traditional binomial logistic regression case-control analysis when applied to the same SE investigation.

iv. A Descriptive Epidemiologic Report on Invasive Streptococcus Pneumonia
Presented by: Dawn Williams, Ellen O. Chan, Sharon Dolman, Soma Sarkar, Karen Johnson, Cecilia Fung, Jason Garay, Jill Fediurek, Shelley L. Deeks
Poster Presentation
Do not need any prior knowledge of the subject matter.
To describe the epidemiology and serotype distribution of invasive pneumococcal disease (IPD) in Ontario over a five year period, during which time seven and 10 valent pneumococcal conjugate vaccines were in use. Information on confirmed cases of IPD between January 1, 2006 and December 31, 2010 was extracted from Ontario's integrated Public Health Information System using Cognos ReportNet. Serotyping results were entered into iPHIS from January 1, 2009 onwards. intelliHEALTH Ontario was the source of denominator data. Between 2006 and 2010, there were 5,413 confirmed cases of IPD; the overall incidence increased from 7.4 cases per 100,000 population in 2006 to 9.1 cases per 100,000 population in 2010. Median age was 60 years (range seven days to 102 years) and the highest annualized age-specific incidence occurred among older adults (65+ year; 25.8 per 100,000) followed by younger children (<5 years old; 14.7 per 100,000). There was a seasonal distribution, with most cases (71.6 per cent) occurring between October and April. In 2009-2010, the most frequently reported serotypes were 19A (14 per cent) and 7F (13 per cent), which are not covered by PCV7. Serotype 7F is covered by PCV10 and both are covered by the new PCV13. From 2006 to 2010, the incidence of IPD has increased in Ontario. An explanation for this increase has not been clearly identified, but may be the result of increased reporting starting in 2008. As PCV13 was implemented in November 2010, it will be important to monitor the epidemiology of IPD in Ontario, including serotype distribution to assess vaccine impact.

v. Epidemiology of Serogroup B Invasive Meningococcal Disease in Ontario, Canada, 2000-2010
Presented by: Vica Dang, Frances Jamieson, Sarah Wilson, Prasad Rawte, Natasha S. Crowcroft, Karen L. Johnson, Shelley L. Deeks
Poster Presentation
Do not need any prior knowledge of the subject matter.
The introduction of a meningococcal quadrivalent (serogroups A, C, Y and W-135) vaccine into a publicly-funded immunization program has left serogroup B as the only invasive meningococcal disease (IMD) serogroup that is not yet vaccine preventable. Vaccines targeting this serogroup are close to being approved, which prompted an assessment of the epidemiology of serogroup B disease in Ontario between 2000 and 2010. The audience will be informed of the descriptive epidemiology of serogroup B IMD in Ontario including incidence, age distribution, age-specific incidence, case-fatality ratio and strain type distribution over the surveillance period. It is important to assess the potential impact of new vaccines and to provide baseline data prior to vaccine availability.

Guided Poster Presentation Tour D: Meeting the Needs of Special Populations Tour
i. Measuring Preconception Health to Inform Local Programming
Presented by: Cheryl Vamos, Anca Gaston
Poster Presentation
Do not need any prior knowledge of the subject matter.
Preconception health includes biomedical, social and behavioural factors impacting health and well-being during the reproductive years. Preconception health is an important public health topic because those with optimal health before pregnancy are more likely to have positive maternal and birth outcomes. Although the Ontario Public Health Standards identify preconception health as a key area in reproductive health, population health assessment and surveillance activities remain a challenge given that measuring preconception health has received little attention and a standardized set of indicators have yet to be established in Ontario. Based on a review of a preconception health framework and established indicators from the U.S. and currently available local and/or provincial data sources (e.g., CCHS, intelliHEALTH, RRFSS), this paper proposes a working list of indicators which could be used for assessing preconception health in local health units. The proposed indicators, based on the framework and data available, were categorized into: access to health care; family planning; tobacco, alcohol and substance use; nutrition and physical activity; mental health and social support; chronic health conditions; and infections. Important data gaps and other limitations were also identified. In conclusion, understanding the preconception health status of a population is essential to developing, implementing and evaluating effective preconception health interventions; and such an understanding cannot be achieved without a set of clearly defined indicators for which reliable data is readily available.

ii. Kids Have Stress Too!
Presented by: Catherine Willinsky, Kerri Richards
Poster Presentation
Do not need any prior knowledge of the subject matter.
The Kids Have Stress Too! (KHST!®) program is based on evidence that with help, young children can learn practical strategies to relieve stress, and effective ways to respond to stressful situations. By learning to cope with life's ups and downs, children develop healthy strategies that help them to adapt, self-regulate, be resourceful, feel competent and become more resilient. Did you know that: 1) stress can affect children's physical, emotional, social and intellectual well-being 2) children experience everyday stress in a different way than adults 3) extreme stress can have a negative effect on brain development in very young children. Developed by The Psychology Foundation of Canada (PFC), this poster presentation for professionals who work with families and children in early learning and care environments, participants will learn practical strategies to help children enhance their physical, mental, emotional and behavioural coping skills and thinking styles. The preschool and elementary years are an important window of opportunity to build key skills and abilities that will help children learn to deal with stress throughout their lives. KHST! has been professionally evaluated in a range of settings. The results of an evaluation conducted with training participants demonstrated that Early Childhood Educators and parents increased their knowledge and skills, and provided them with a greater ability to recognize and understand the impact of stress on children. The evaluation also showed that participants gained a range of practical coping strategies they could teach children to help them successfully manage their own stress.

iii. Health Risks among Transport Truck Drivers: Results from a Health and Wellness Survey
Presented by: Beatrice McDonough, Lisa Dolovich, Ric Angeles, Michelle Howard, Francine Marzanek-Lefebvre
Poster Presentation
Do not need any prior knowledge of the subject matter.
A health and wellness survey was developed using a collaborative partnership with community champions in the transport sector and focus groups with drivers and management. The survey was administered to truck driving companies to identify the health needs of a high risk, marginalized population of male truck drivers. Thirteen trucking companies (15-200 drivers per company) were given a self-administered survey that was developed from existing published health surveys and supplemented by information from qualitative interviews with two trucking company champions. Reminders were made via company emails, postings and through dispatchers. The challenges of working in the industry included long unpredictable hours and stress from driving conditions. How these challenges impact health through nutrition, physical activity, sleep deprivation, fatigue, smoking and family relationships were identified. Of the four hundred and six surveys returned, 96 per cent were from males. Approximately half were 50 years or older and the majority had been working as drivers for 10 or more years. One-third reported sleeping five or fewer hours per night and one-third were current smokers. About half reported low to moderate daily physical activity. The majority indicated that diet was poor or needed improvement. Nearly all reported having a family doctor. The results provide rich data for the individual companies' workplace wellness, occupational health and safety committees and the sector overall. Individual company profiles were developed with comparator information to the aggregate results. Full survey results and health promotion plans targeted to this population will be presented.

iv. Let's Talk Group Intervention: An Innovative, Multi-Disciplinary City of Toronto Service Approach for Vulnerable Clients
Presented by: Nicolette Slovitt, Claudette Holloway
Poster Presentation
Do not need any prior knowledge of the subject matter.
The Investing in Families (IIF) project is an innovative, wraparound approach to service delivery for vulnerable families. Toronto Public Health's IIF team is part of an intersectoral partnership with Toronto Employment and Social Services and Toronto Parks, Forestry and Recreation. Originally, the project was exclusively a home visiting model for vulnerable families. However, public health nurses (PHNs) recognized many families referred to the IIF project experience social isolation, anxiety and feelings of depression. With increasing client referrals and needs, PHNs developed a group intervention called 'Let's Talk'. This group provides opportunities for population-based health promotion strategies. The overarching philosophy of the group is driven by client identification of relevant health issues related to the meaning of their lived experience. The overall goal of 'Let's Talk' is empowering clients to enhance their health and well-being. This is accomplished through conversation, relationship building and sharing health promotion information. The objectives of the Let's Talk intervention are to build on participants' resilience, decrease social isolation and increase social networks. Key interventions of the Let's Talk groups are provided by various professionals within the City of Toronto. Formal evaluation of the Let's Talk strategy will be completed in 2012.

v. Identifying Local Priority Populations: Examining Prevalence and Factors Associated with Access to Care
Presented by: Cheryl Vamos, Martin Huang
Poster Presentation
Do not need any prior knowledge of the subject matter.
Identifying priority populations and reducing health inequalities are key components outlined in the Ontario Public Health Standards. Those without regular access to care may have missed opportunities for health education and counselling, preventative screenings and early interventions. Little research has examined access to care at the local level. The purpose of this study was to examine the temporal and spatial patterns of having access to care in a community (Brant County, Ontario); and to compare factors associated with access among local and provincial populations. Data from the Canadian Community Health Survey (cycles 1.1, 2.1, 3.1, 4.1) were utilized and prevalence rates were examined temporally and spatially using SPSS and ArcMap. Logistic regression examined socio-demographic factors associated with having access to care. Prevalence rates of having a regular medical doctor in Brant remained stable from 2001-08 and slightly higher than provincial levels; however, disparities were revealed across the 16 neighbourhoods. In both Brant and Ontario, sex, education, household income and presence of a chronic condition were significantly associated with access to care. However, year, residence, age, ethnicity, immigrant status and self-perceived general health were found to be significantly associated to access to care in Ontario only. Determinants of access to care and priority populations were identified at the local and neighbourhood levels, which differed from provincial findings. Future efforts should consider: 1) those more vulnerable to poor health at the local level when determining the need and impact of services; and 2) the best populations to target given limited resources and capacities.

vi. Braiding Healing Tools and Education for Commercial Tobacco Cessation
Presented by: Karina Czyzewski, Joyce Helmer, Marilyn Herie, Rosa Dragonetti, Stephanie Sliekers, Peter Selby
Poster Presentation
Do not need any prior knowledge of the subject matter.
IT'S TIME (Indigenous Tools and Strategies on Tobacco: Interventions, Medicines & Education) is a model of collaboration and integration between mainstream cessation resources, and indigenous learning and knowing. This knowledge translation and retooling project is dual purpose: to offer a facilitator's guide for hosting workshops to frontline workers in applied cessation counselling and cessation workshops with people who would like to quit commercial tobacco use. Through an engagement process with indigenous stakeholders, frontline workers and educators (the engagement circle advisory committee), the resource is a combination of teaching circles (following circle protocol with rounds of learning and sharing); First Nations art; interactive, humorous group activities; craft-making; traditional tobacco teachings; collected quit journey stories (narrative healing); and evidence-based cessation tools. Community health representatives and communities tailor resource lesson plans and teaching circles to community needs and utilize the aid resources according to group concerns and desires. Community leaders, inspiring youth and elders, are encouraged as knowledge keepers and story tellers in the teaching circles. Furthermore, a designated amount of nicotine replacement therapies were made available to pilot workshops based on interest and were distributed by project staff. Along with the feedback from these pilots, the resource is a living document, free to the public via the Training Enhancement in Applied Cessation Counselling and Health website (www.teachproject.ca). This project is based out of the Centre for Addiction and Mental Health’s nicotine clinic and tobacco control projects and was funded by the Ministry of Health Promotion and Sport.

Guided Poster Presentation Tour E: Enhancing Tools for Public Health Practice Tour
i. Results of a Systematic Literature Search: Knowledge Translation Resources
Presented by: Sunita Chera, Jaime Brown
Poster Presentation
Do not need any prior knowledge of the subject matter.
A systematic and comprehensive literature search was conducted in January 2011 to identify knowledge translation methods and tools relevant to public health. The search aimed to identify resources for the Registry of Methods and Tools, a product of the National Collaborating Centre for Methods and Tools. The Registry of Methods and Tools is an open-access, searchable, online repository of knowledge translation methods (processes) and tools (instruments) that have been screened and summarized with a public health lens. The registry identifies and describes resources for knowledge translation, making them easier for busy public health professionals to find and use. A professional library consultant conducted the search of published literature using 87 search terms and six bibliographic databases. Search results were limited to English language references published between January 2006 and January 2011. The search initially returned 53,822 references. After removing duplicates, two independent reviewers screened the titles and abstracts of 42,729 references for relevance to knowledge translation and public health. Following this, the full-text articles of 562 references assessed as potentially relevant were retrieved and screened for relevance and appropriateness for the Registry of Methods and Tools. The final results of screening identified 105 methods and tools. The results of the search identify the types of knowledge translation methods and tools relevant to public health practice and policy that are currently available in the published literature. Details about our search strategy and screening process will enable participants to apply and adapt our systematic search method to literature reviews in their own work.

ii. Intohealth Partnership: A Collaborative Equity-Focused Approach to Local Policy Development
Presented by: Julie Charlebois, Tara Brown
Poster Presentation
Do not need any prior knowledge of the subject matter.
The Intohealth Partnership conducted a comprehensive assessment of community health needs and perspectives, and current initiatives and policies that impact health equity and wellbeing in Toronto. The community engagement and research was led by a diverse multidisciplinary research team. This poster will guide participants through the assessment process, tools and outcomes.

iii. Evaluating Capacity Building in Public Health
Presented by: Jennifer Robertson, Melody Roberts, Tanya Krimus, Susan Snelling, Lynn Ward
Poster Presentation
Need to have a basic knowledge of the subject matter.
Health promotion capacity building strengthens the ability of individuals, organizations and communities, to develop, implement and sustain health promotion initiatives to address their health concerns. Public Health Ontario, in partnership with its resource centres, developed a framework to understand the fundamentals of capacity building of individual practitioners, organizations with a health promotion mandate and the broader province-wide health promotion system. The poster will present an overview and evaluation of the framework and the process evaluation (activity tracking). Two resource centres will share case studies of the following formative evaluation projects to support the development of capacity building initiatives: 1) The Health Communication Unit (THCU) undertook a needs assessment to provide direction for their services over the next three years. Interviews were conducted with health promotion leads at Ontario health units, focusing on identifying ongoing support requirements related to the THCU service areas and to explore different options for capacity building. Results of the needs assessment are being used to enhance THCU capacity building. 2) From Planning to Action is a technical assistance strategy developed by the Program Training and Consultation Centre to systematically assess the capacity needs of local tobacco control practitioners and plan responsive services. Major steps in the process will be presented, including the completion of a standardized in-person interview to assess the status of local tobacco control programming and the development of a customized and mutually agreed upon learning plan. Findings from this process will be shared, including implications for future capacity building service delivery.

iv. Use of Smartphone Applications in the Reproductive Years
Presented by: Jeff Biletchi, Gillian McDonald
Poster Presentation
Need to have a basic knowledge of the subject matter.
With the aim of promoting healthy behaviours in the reproductive years, the Niagara Region Reproductive Health department is proposing that a new Smartphone application be designed for expectant moms. This application will offer words of advice for pregnant women in a place that will be easy to reach them: on their mobile phones. This new innovative Smartphone application, Mom2B will link individuals in their reproductive years with the information, skills and support necessary to promote and improve healthy birth outcomes, in a fast and accessible way. Mom2B will build self-efficacy among expectant mothers, as this application will test their knowledge and increase skills through a comprehensive approach.

v. Toronto Emergency Medical Services Community Paramedicine Program
Presented by: Adam Thurston
Poster Presentation
Do not need any prior knowledge of the subject matter.
This poster presentation outlines the role of Toronto Emergency Medical Services (EMS). Overviews of the following programs will be presented: 1) Community Referrals by EMS, a partnership with Community Care Access Centres (CCAC); 2) Community Agency Notification, a partnership with community agencies (St. Clair West Services for Seniors, SPRINT); 3) Integrated Client Care Project, a partnership between CCAC, acute and primary care, community pharmacy and Toronto EMS; 4) vaccination program (seasonal influenza vaccinations to the marginalized, homebound clients, shelters and drop-in locations, City of Toronto Long-Term Care Homes and Services, other allied agencies) in partnership with Toronto Public Health (TPH); 5) outreach and wellness clinics at various location and events; and 6) Hot Weather Response initiative in partnership with TPH. These programs demonstrate what is possible when EMS, public health agencies, community organizations and the health care system work together to provide the most appropriate care for the client. A multi-disciplinary approach to caring for clients in the community provides the client with patient-centric care. Instead of making the client fit within the hospital-based health care system, the system now wraps care around the patient in their own home.

vi. Public Health Policy Analysis: Innovative University – Practice Collaboration
Presented by: Robert Schwartz
Poster Presentation
Do not need any prior knowledge of the subject matter.
Public health units, government departments and non-governmental organizations engage frequently in policy development and planning yet often lack the capacity to conduct in-depth, theoretically driven and methodologically sound policy analysis. The Canadian Institutes of Health Research’s Strategic Training Program in Public Health Policy trains postdoctoral, doctoral and masters' students to do precisely this. An innovative program marries expressed needs of organizations for policy analysis and development work with the expertise of mentors and fellows in the program. The session will highlight the results and processes of three projects.

1:30 p.m. - 5:00 p.m.
Concurrent Session IV – Training Workshops, TOPHC Breakout Rooms

31. Producing Knowledge Syntheses that are Both Rigorous and Relevant to Policy-Makers
Presented by: Florence Morestin
Training Workshop
Do not need any prior knowledge of the subject matter.
The objective for this hands-on workshop is to enable participants to apply the proposed knowledge synthesis method of the National Collaborating Centre for Healthy Public Policy (NCCHPP).
Abstract:
Informing policy-making with the best available evidence remains challenging for public health actors, but is essential given the significance of public policies for health. The NCCHPP has developed a method that guides rigorous knowledge syntheses on the effects and equity of the policies under study, as well as on implementation issues that are of concern to policy-makers (costs, feasibility and acceptability). This method involves constructing logic models, reviewing the scientific and grey literatures, and organizing deliberative processes to gather contextual information. This workshop is for public health practitioners who deal with public policies in the context of their work. An emphasis will be put on learning how to construct the logic model of a public policy and how to use an analytical framework looking at both the effects and implementation of the policy under study. In addition, participants will be given tips about how to perform a literature review on a public policy (in a way that differs from literature reviews on simple interventions) and how to organize deliberative processes. The workshop will involve a mix of lectures, examples drawn from our application of the method to a public policy, hands-on exercises and discussions.
Conference Room B

32. Creating Evidence-Informed and Community-Created Programs to Help Pregnant Women Quit Smoking
Presented by: Nadia Minian, Shelley Cleverly, Pat Campbell
Training Workshop
Do not need any prior knowledge of the subject matter.
In this workshop, participants will have the opportunity to learn about evidence-informed and community-created program design processes.
Abstract:
Echo: Improving Women’s Health in Ontario believes there is a need for innovation in program development procedures so that they are evidence-informed as well as contextualized. Integrating these two elements requires steps that support the communities of people, for which health programs are intended, to be the program designers. This respectful and democratic approach to knowledge translation values research as well as community members’ expertise about their experience of a health issue and the complexity of factors in their lives affecting their capacity to be healthy. Evidence-informed and community-created program design processes are believed to be strong practice which will lead to improved health outcomes and reduced health inequities. Echo is currently supporting and evaluating smoking cessation and maternal health demonstration initiatives that were developed using this approach. This workshop will describe a community engagement approach used to support women of child-bearing years, who are experienced with smoking, to design smoking cessation programs for pregnant and postpartum women. The program goal is for these women to quit smoking and remain smoke free for at least six months after delivery. This approach was offered in Echo Conversations in four Ontario communities in late 2010 and early 2011.
VIP Room

33. "If I Had a Hammer...": A Range of Tools for HIV/STBBI Outreach Workers
Presented by: Anneliese Poetz, Barbara A. Anderson
Training Workshop
Need to have a basic knowledge of the subject matter.
This workshop will present tools for outreach planning and practice (based upon needs identified by participants at six regional workshops across Canada) and facilitate discussion among workshop participants concerning how to refine them for use in practice, before they are finalized and made available.
Abstract:
In 2008, the National Collaborating Centre for Infectious Diseases (NCCID) hosted two knowledge translation forums regarding sexually transmitted infections including HIV. In response to subsequent feedback, the NCCID initiated an outreach project to address both the need for evidence-based guidance for planning and the need for knowledge translation at the program level. The Outreach Planning Guide was developed to assist those in public health planning and management to develop outreach programs and to share knowledge of current promising practices in Canada. To address the need for knowledge translation at the program level, a learning site was created in partnership with Alberta Health Services. At this site, a health jurisdiction works with NCCID to scale up public health infectious disease programs using an evidence-based approach. The outreach learning site is intended to serve as a model for program development in other Canadian health jurisdictions. The idea of creating a virtual learning site and what it will look like is still being developed. The basic structure and content may be based on the content of the Outreach Planning Guide with links in each section to accompanying tools or illustrations of how this could be done in practice.
Conference Room C

34. Public Health Pandemic: Lessons Learned and a Table Top Exercise
Presented by: Judyth Gulden, Richard Bochenek
Training Workshop
Do not need any prior knowledge of the subject matter.
By the end of this workshop, each participant is expected to be able to: recognize the risks associated with a large scale public health emergency; highlight best practices and lessons learned for emergency preparedness for use in their communities; promote coordination and collaboration among community partners; have a general understanding of the Incident Management System.
Abstract:
Lessons learned from recent influenza outbreaks have placed concerns about responding to and managing a multi-jurisdictional or global pandemic outbreak at the forefront of public health preparedness planning. Public health communities continue to be concerned as to whether their operational planning and capacity can adequately handle a pandemic that impacts multiple jurisdictions. This exercise will provide a series of discussion points after which participants will make key decisions. Participants will be given 30 minutes to make one or two key decisions at each discussion point. This exercise will bring into focus many pandemic issues that exceed the scope of the exercise but require consideration by all public health professionals. The exercise focuses on five broad issue areas: 1) the Incident Management System and multi-jurisdictional management of events; 2) risk communication; 3) risk assessment; 4) resource management; and 5) continuity of operations planning.
Conference Room F

35. Wicked but Real: Dealing with Complex Public Health Issues Using an Evidence-Informed Approach
Presented by: Jackie Muresan, François-Pierre Gauvin                                                                           
Training Workshop
Need to have a basic knowledge of the subject matter.
This interactive workshop will use a problem-based learning approach to explore how the contributions of an evidence-informed public health (EIPH) approach combined with deliberative processes can be a successful strategy to work through complex public health problems.
Abstract:
Public health decision-makers face increasing expectations from various levels of government and the general public that decisions will be informed by the best available evidence. Yet, they are often challenged with addressing wicked public health problems (e.g., childhood obesity, poverty, health inequities, etc.). A process of evidence-informed public health will be introduced to assist participants with how to find and apply the best available research evidence to the situation at hand. In addition to considering the best available research findings, evidence-informed decision-making involves the consideration of evidence from a variety of sources and involves a complex network of stakeholders. The concept of deliberative processes will be described and discussed as a strategy to contextualize the evidence and engage relevant stakeholders in the decision-making process. The use of deliberative processes is a promising strategy to support stakeholders in: developing a shared understanding of complex problems, gaining an increased awareness of the best available evidence regarding the issues and their potential solutions and triggering actions to collectively tackle the problem being considered. This session is intended for public health decision-makers, policy analysts, civil servants and others who contribute to decisions being made about the planning and delivery of public health programs and services.
Sheraton Hall E

36. Media Advocacy and Public Health
Presented by: Jason Chapman, Tara Maher
Training Workshop
Do not need any prior knowledge of the subject matter.
The purpose of this workshop is to learn how media advocacy can support public policy development.
Abstract:
Media advocacy is an approach which strategically uses the media to pursue policy change. It can be a powerful tool to support the development of healthy public policy. This workshop will help participants understand the role of media advocacy within a policy development strategy and the specific techniques used by media advocates to gain access to the media and frame media coverage from a policy perspective.
Sheraton Hall C

37. Vaccinology 101
Presented by: Shelley L. Deeks, Natasha S. Crowcroft, Jill Fediurek, Tara Harris, Margaret McIntyre
Training Workshop
Should be familiar with the topic area.
In this workshop, participants will learn about vaccines and how they work, as well as how vaccine components may influence the immune response and safety profile. We will also further explore vaccine safety.
Abstract:
Immunization is a core component of public health practice and many providers have vaccine-related questions. Effective delivery of immunizations requires both an understanding and ability to communicate basic information on vaccine effectiveness and safety, how the body responds to vaccines, as well as the concept of population health. Adverse events following immunization (AEFI) do occur. However, the public’s tolerance for an AEFI is minimal as vaccines are mostly given to healthy individuals. There is also the additional complexity of discerning causal versus temporal reactions associated with vaccine. As the success of Ontario’s immunization program increases (with the disappearance of vaccine preventable diseases), the challenge of communicating the benefits of immunization and any associated AEFI’s will also increase.  We will review what is required in order to make scientific decisions regarding whether a new vaccine program should be implemented, as well as what is needed after program implementation to ensure vigilance is maintained. This will be done through presentations followed by a case scenario and small working group sessions where the audience will decide whether a new vaccine should be included in Ontario’s immunization program and what requirements will need to be in place if this occurs.
Sheraton Hall A

38. Aboriginal Cultural Safety Programs to Promote Health Equity
Presented by: Chandrakant Shah, Allison Reeves
Training Workshop
Do not need any prior knowledge of the subject matter.
This workshop will highlight cultural safety principles and the Aboriginal Cultural Safety Initiative. 
Abstract:
The first segment of this workshop will review the principles of cultural safety as well as how cultural safety shapes public health policy and public health programs. The second segment will highlight the Aboriginal Cultural Safety Initiative, a program developed at Anishnawbe Health Toronto, designed to teach Aboriginal cultural safety to health sciences students in colleges and universities. This program overview will include information on the impacts of post-colonial policies on determinants of health for Aboriginal people and resultant health outcomes as well as concepts of Aboriginal health and healing. The final segment will include exercises for workshop participants on the application of cultural safety principles to public health program planning and service delivery.
Windsor Room

39. Building Public Health Capacity for Intersectoral Action to Advance Health Equity through Action on the Social Determinants of Health
Presented by: Sume Ndumbe-Eyoh, Hannah Moffatt, Claire Betker, Lesley Dyck
Training Workshop
Do not need any prior knowledge of the subject matter.
This interactive and participatory workshop will highlight intersectoral action for health as an approach to advance health equity through action on the social determinants of health.
Abstract:
Building on 10 Promising Practices to Guide Local Public Health Practice to Reduce Social Inequities in Health identified by the Sudbury & District Health Unit, this workshop will include discussion about a rapid review of intersectoral action for health and examine roles for public health. Complex problems require complex solutions that can only be generated through public health and other sectors (e.g., finance, education, housing, etc.) working together to identify problems, share resources and evaluate outcomes. The workshop will highlight and build on public health's long-standing history of providing leadership on health issues and working through coalition structures. The workshop will examine: evidence on intersectoral action to advance health equity; types of problems intersectoral action can be used to address; different intersectoral approaches and entry points for action at local, regional, provincial/territorial and national levels; strategies and tools to support and strengthen intersectoral action; methods to assess and evaluate intersectoral action. Public health takes on a range of roles in intersectoral action including leadership, coordinating and consultative roles. Participants are encouraged to bring examples of their own intersectoral work.
Conference Room DE

40. Molecular Methods of Outbreak Investigation: What's New and How to Interpret the Results
Presented by: George Broukhanski, Vanessa Allen, Cyril Guyard, Roberto Melano
Training Workshop
Need to have a basic knowledge of the subject matter.
We will present new and improved methods of detection and typing of pathogenic bacteria which were developed and implemented at the Public Health Ontario Laboratories and using case examples will demonstrate how these methods help in investigation and prevention of outbreaks.
Abstract:
Outbreaks of infectious diseases have significant impact on Canadians. Emerging strains of pathogenic bacteria are causing larger outbreaks with more severe outcomes. They are harder to prevent and control due to novel drug resistance mechanisms and new features of bacteria which make them better adapted to their environment and give them higher chances of survival. Currently there is a gap between advanced results generated by the laboratories and implementation of the data for infection control practices. This workshop is intended to close this gap by providing guidelines for interpretation of the results which will be used by participants to assess data from case examples.
Sheraton Hall B

3:00 p.m. - 3:30 p.m.
Afternoon Refreshment Break
Grand Ballroom Foyer

5:00 p.m. – 7:00 p.m.
Unfortunately due to scheduling difficulties, TOPHC has been advised by the event organizer of the need to cancel the 'Fireside Chat' moderated by Steve Paikin, TVO originally scheduled for Tuesday April 3, 2012, from 5 to 7 pm at the TOPHC conference.   Fireside Chat organizer, the Ministry of Health and Long-Term and the TOPHC team apologize for any inconvenience this may cause and look forward to opportunities in the future to discuss Ontario's Children.