Ministry of Health and Long Term Care

Background: The safe transport of infectious substances is a critical biosafety and health security function. Mishandling during packaging or shipping can lead to occupational exposure, environmental contamination, and public health risks. Aim: This paper aims to outline the regulatory frameworks, classification systems, packaging requirements, and operational practices necessary for the safe transport of infectious materials. Methods: A comprehensive review of international and U.S. regulatory guidelines, including WHO, UN Model Regulations, DOT Hazardous Materials Regulations, and IATA standards, was conducted. Key operational domains such as classification, packaging, marking, labeling, documentation, and emergency response were analyzed. Results: Infectious substances are categorized into Category A (high-risk, UN 2814/2900) and Category B (moderate-risk, UN 3373), with exemptions for low-risk specimens. Category A requires UN-certified triple packaging and strict documentation, while Category B mandates robust containment and standardized markings. Training for all stakeholders is essential, with renewal every three years. Emergency preparedness and spill management protocols are integral to risk mitigation. Conclusion: Safe transport of infectious substances demands a unified system integrating regulatory compliance, standardized packaging, competency-based training, and emergency readiness. Adherence to these measures prevents exposure, ensures diagnostic continuity, and strengthens public health resilience.

Background: Heavy metal exposure, stemming from both environmental and occupational sources, poses a significant global health risk. While some metals are essential in trace amounts, others like lead, arsenic, and mercury are toxic, causing multisystem damage through mechanisms like oxidative stress and enzyme inhibition. Diagnosis is challenging due to nonspecific symptoms that mimic common diseases. Aim: This comprehensive review aims to detail the interprofessional approaches required for the effective assessment and management of heavy metal toxicity. It synthesizes information on etiology, pathophysiology, diagnostic testing, and collaborative care strategies. Methods: The review outlines the critical procedures for accurate diagnosis, including the selection of appropriate biological specimens (blood, urine, hair) based on the metal's pharmacokinetics and the timing of exposure. It emphasizes advanced analytical techniques like Inductively Coupled Plasma Mass Spectrometry (ICP-MS) and the importance of rigorous quality control to prevent contamination and ensure result reliability. Results: Accurate diagnosis hinges on correlating a plausible exposure history with consistent clinical symptoms and confirmatory laboratory testing. The clinical significance of test results must be interpreted within the context of population reference ranges and individual patient factors, as even low-level exposures can be harmful to vulnerable groups. Conclusion: Effective management of heavy metal toxicity necessitates a coordinated, interprofessional effort. This involves clinicians, nurses, laboratory personnel, and toxicologists working together to ensure accurate diagnosis, guide interventions like chelation therapy, implement exposure mitigation, and protect public health.

Background: Viral gastroenteritis, commonly known as the "stomach flu," is a highly contagious infection causing inflammation of the stomach and intestines. It is a major global health concern, leading to significant morbidity, healthcare burdens, and economic costs, with norovirus and rotavirus being the most prevalent pathogens. Aim: This article aims to provide a comprehensive overview of viral gastroenteritis by synthesizing its clinical manifestations, outlining evidence-based nursing care strategies, and exploring the role of health data analytics in improving prevention, outbreak management, and public health surveillance. Methods: The review synthesizes current clinical guidelines and best practices. It details the diagnostic approach, which is primarily based on clinical presentation and symptom assessment, with laboratory confirmation reserved for severe or outbreak scenarios. Nursing interventions are framed within a patient-centered model, focusing on thorough assessment, hydration management, and education. Results: The primary clinical manifestations include acute onset of watery diarrhea, vomiting, abdominal cramps, and nausea, which can lead to dehydration and electrolyte imbalances, particularly in vulnerable populations. Effective management is centered on vigorous oral or intravenous rehydration. Results highlight that meticulous nursing care—encompassing fluid balance monitoring, symptom control, and strict infection prevention protocols—is critical to patient recovery and containing transmission. Furthermore, leveraging health data enables real-time outbreak detection and informs targeted public health interventions. Conclusion: A multifaceted approach combining prompt clinical management, diligent nursing care, and robust health data systems is essential for reducing the impact of viral gastroenteritis.

BackgroundRespiratory syncytial virus (RSV) surged in the 2022–2023 respiratory season after low activity during the pandemic. To monitor the RSV season in real time and support healthcare planning, Ontario introduced daily hospital bed census reporting of RSV hospitalizations by age group (0–17, 18–64, 65 years and older).ObjectivesTo assess the completeness and quality of the newly introduced real-time surveillance compared to end-of-season ICD-10 coded hospitalization discharge abstract data (DAD) from November 22, 2022, to March 31, 2023.MethodsRespiratory syncytial virus hospitalizations from both data sources were compared to RSV laboratory positivity to assess concordance with overall RSV activity. A longitudinal comparison by age group was assessed by time-lagged cross-correlation of the daily submission data versus DAD data, including cross correlation coefficients for each time lag, confidence bound and the highest correlation value.ResultsBoth data sources followed trends in RSV positivity. Data by age groups showed an early peak of paediatric admissions followed by a peak in adult and older adult hospitalizations. Daily surveillance consistently underestimated hospitalizations with a peak of 430 beds by DAD on January 7, 2023, versus 322 beds (75%) for daily reporting on the same day. The maximum correlation coefficient values were 0.67 (all ages), 0.57 (0–17 years), 0.66 (18–64 years) and 0.63 (65 years and older).ConclusionImplementation of daily hospital reporting provided accurate trending in RSV hospitalizations by age group to inform within season healthcare and public health planning.

BackgroundShifts toward “new public governance” (NPG), where policy decisions and their implementation are “co-produced” by a policy network, have captured the attention of policymakers as an approach that may produce better outcomes. It is particularly promising in mental health, where it is increasingly acknowledged that effective change requires actions by multiple actors across a range of policy and system settings. In Ontario, Canada, the government’s recent mental health reform, Open Minds, Healthy Minds, Ontario’s Comprehensive Mental Health and Addictions Strategy, is unique in terms of its scope and the NPG-inspired processes employed. This study addresses two questions: 1) Who was engaged in the implementation of the Strategy and how were they engaged? and 2) How and why did their involvement contribute to the implementation process and early outcomes?MethodsWe used a single case study design and partnered with the Ontario Ministry of Health. We used two complementary analytical methods: 1) stakeholder analysis, and 2) political landscape analysis. Seventeen interviews were conducted with citizens, government officials and people with lived experience, and 21 documents analyzed using directed content analysis and drawing from theoretical frameworks regarding political and actor-related determinants of implementation.ResultsStakeholder analysis highlighted the wide range of interdependent actors involved, the multiple ways they provided input, and the structures utilized. The political landscape analysis revealed the role of interests as having a large influence on the implementation process and early outcomes, particularly political actors’ decision to tie the process to their election platform. Relational and contextual variables, such as the relative instability of the policy actors, had a negative impact on the process, but that was offset by the perceived level of dedication of the individuals involved.ConclusionOur findings point to five practical insights for policymakers and implementers: being attentive to the power distribution among actors, the importance of building and maintaining trust amongst actors, the opportunity-cost of taking a NPG approach, the timing/sequencing of the process, and the need for careful consider of the type of actors involved and the expertise they bring.Supplementary InformationThe online version contains supplementary material available at 10.1186/s43058-025-00761-6.

BackgroundTo examine the relationship between individual workers employed at more than one LTCH (inter-LTCH connectivity) across LTCH and SARS-CoV-2 outbreaks.MethodsWe conducted a retrospective cohort study using secondary, aggregate data (surveillance and mobile geolocation data) from 179 LTCH in the Greater Toronto Area of Ontario, the province where close to one-third of the Canada’s SARS-CoV-2 cases among long-term care homes residents were reported, between 2020-02-26 and 2020-08-31. The main exposure of interest was the inter-LTCH connectivity, generated from geographic location data procured across mobile apps. Three outcomes were examined: 1) at least one SARS-CoV-2 diagnosis among residents, 2) cumulative cases among residents in each facility, and 3) time to first outbreak.ResultsThe median degree of connectivity for LTCH that experienced an outbreak (59%; 106/179) was 1.2 times the degree of those without an outbreak (6 compared to 5). LTCH with higher inter-LTCH connectivity also had larger numbers of residents and beds, and were more likely to have for-profit ownership. After adjusting for facility-level and neighbourhood-level factors, every additional connection to another LTCH increased the odds of an outbreak in the respective LTCH by 8% (adjusted odds ratio=1.08, 90% credible interval [CrI]: 1.02-1.09). Inter-LTCH connectivity was also associated with higher risk of earlier occurrence of a first SARS-CoV-2 case (adjusted hazard ratio=1.05, 90%CrI: 1.02-1.09), but not with outbreak size. ConclusionsStaff cohorting was associated with reduced importation risk of SARS-CoV-2 cases into LTCH. However, once importation has occurred, other facility-level factors including facility infrastructure and staff benefits are more important in shaping outbreak size. Implementing these structural strategies to meet the LTCH workers and residents’ needs are pivotal to prevent and manage future respiratory virus outbreaks.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-23621-3.

SARS-CoV-2 is now endemic and expected to remain a health threat, with new variants continuing to emerge and the potential for vaccines to become less effective. While effective vaccines and natural immunity have significantly reduced hospitalisations and the need for critical care, outpatient treatment options remain limited, and real-world evidence on their clinical and cost-effectiveness is lacking. In this paper, we present the design of the Canadian Adaptive Platform Trial of Treatments for COVID in Community Settings (CanTreatCOVID). By evaluating multiple treatment options in a pragmatic adaptive platform trial, this study will generate high-quality, generalisable evidence to inform clinical guidelines and healthcare decision-making. CanTreatCOVID is an open-label, individually randomised, multicentre, national adaptive platform trial designed to evaluate the clinical and cost-effectiveness of therapeutics for non-hospitalised SARS-CoV-2 patients across Canada. Eligible participants must present with symptomatic SARS-CoV-2 infection, confirmed by PCR or rapid antigen testing (RAT), within 5 days of symptom onset. The trial targets two groups that are expected to be at higher risk of more severe disease: (1) individuals aged 50 years and older and (2) those aged 18-49 years with one or more comorbidities. CanTreatCOVID uses numerous approaches to recruit participants to the study, including a multifaceted public communication strategy and outreach through primary care, outpatient clinics and emergency departments. Participants are randomised to receive either usual care, including supportive and symptom-based management, or an investigational therapeutic selected by the Canadian COVID-19 Outpatient Therapeutics Committee. The first therapeutic arm evaluates nirmatrelvir/ritonavir (Paxlovid), administered two times per day for 5 days. The second therapeutic arm investigates a combination antioxidant therapy (selenium 300 µg, zinc 40 mg, lycopene 45 mg and vitamin C 1.5 g), administered for 10 days. The primary outcome is all-cause hospitalisation or death within 28 days of randomisation. The CanTreatCOVID master protocol and subprotocols have been approved by Health Canada and local research ethics boards in the participating provinces across Canada. The results of the study will be disseminated to policy-makers, presented at conferences and published in peer-reviewed journals to ensure that findings are accessible to the broader scientific and medical communities. This study was approved by the Unity Health Toronto Research Ethics Board (#22-179) and Clinical Trials Ontario (Project ID 4133). NCT05614349.

Background: Within the high-stakes environment of acute care, two intersecting crises silently compromise patient safety and outcomes: hospital-acquired malnutrition (HAM) and healthcare-associated foodborne outbreaks. Patients in emergency and surgical wards are uniquely vulnerable, facing metabolic stress, increased nutritional demand, and exposure to pathogens via food and feeding practices. These dual threats are often managed in professional silos, leading to fragmented responses that fail to address their systemic interdependence. Aim: This narrative review aims to synthesize evidence on the epidemiology, etiology, and interprofessional management of HAM and foodborne illness within emergency and surgical settings. Methods: A comprehensive search of PubMed, CINAHL, Scopus, and Web of Science (2010-2024) was conducted. Results: The review identifies a high prevalence of HAM upon admission and incidence during hospitalization, exacerbated by nil-by-mouth protocols, missed meals, and poor intake monitoring. Concurrently, outbreaks of pathogens like Norovirus and Salmonella are linked to hospital food systems. Key failures include disjointed communication between dietetic and infection control teams, inadequate nursing resources for feeding assistance, and management systems that prioritize cost and efficiency over nutritional safety and infection resilience. Conclusion: HAM and foodborne outbreaks represent a "Code Brown" – a simultaneous metabolic and infectious emergency. Addressing them requires an integrated, hospital-wide strategy that repositions nutrition and food safety as inseparable components of clinical care, underpinned by interprofessional protocols, dedicated resources, and executive-level accountability.

This cross-sectional study examines the association between edible cannabis legalization and emergency department visits for cannabis poisonings in older adults.

BackgroundPrior research has reaffirmed lifestyle risk behaviors to cluster among adolescents. However, the lifestyle cluster effect on suicidal thoughts and behaviors (STBs) was unclear among adolescents in low- and middle-income countries (LMICs). No comparison of such associations was conducted across nations.MethodsData from 45 LMICs were obtained from the Global School-based Student Health Survey (GSHS) between 2009 and 2019. Lifestyle behavior factors were collected through a structured questionnaire. Suicidal ideation, plan, and attempt were ascertained by three single-item questions. Lifestyle risk scores were calculated via a sufficient dimension reduction technique, and lifestyle risk clusters were constructed using a latent class analysis. Generalized linear mixed models with odds ratio (OR) and 95% confidence interval (CI) were used to estimate the lifestyle-STB associations.ResultsA total of 229,041 adolescents were included in the final analysis. The weighted prevalence of suicidal ideation, plan, and attempt was 7.37%, 5.81%, and 4.59%, respectively. Compared with the favorable lifestyle group, the unfavorable group had 1.48-, 1.53-, and 3.11-fold greater odds of suicidal ideation (OR = 1.48, 95%CI: 1.30–1.69), plan (OR = 1.53, 95%CI 1.34–1.75), and attempt (OR = 3.11, 95%CI 2.64–3.65). Four clusters of lifestyle risk behaviors were identified, namely healthy lifestyles (H–L), insufficient intake of vegetables and fruit (V-F), frequent consumption of soft drinks and fast food (D-F), and tobacco smoking and alcohol drinking (S-A) clusters. Compared with H–L cluster, V-F cluster was associated with 43% and 42% higher odds of suicidal ideation and plan, followed by S-A cluster (26% for ideation and 20% for plan), but not significant in D-F cluster (P > 0.05). D-F cluster was associated with 2.85-fold increased odds of suicidal attempt, followed by V-F cluster (2.43-fold) and S-A cluster (1.18-fold).ConclusionsClustering of lifestyle risk behaviors is informative for risk stratification of STBs in resource-poor settings. Lifestyle-oriented suicide prevention efforts should be initiated among school-attending adolescents in LMICs.