Development of the Healthy Eating Food Index (HEFI)-2019 measuring adherence to Canada's Food Guide 2019 recommendations on healthy food choices

The release of Canada’s Food Guide (CFG) in 2019 by Health Canada prompted the development of indices to measure adherence to these updated dietary recommendations for Canadians. This study describes the development and scoring standards of the Healthy Eating Food Index (HEFI)-2019, which is intended to measure alignment of eating patterns with CFG-2019 recommendations on food choices among Canadians aged 2 years and older. Alignment with the intent of each key recommendation in the CFG-2019 was the primary principle guiding the development of the HEFI-2019. Additional considerations included previously published indices, data on Canadians’ dietary intakes from the 2015 Canadian Community Health Survey (CCHS) – Nutrition, and expert judgement. The HEFI-2019 includes 10 components: Vegetables and fruits (20 points), Whole-grain foods (5 points), Grain foods ratio (5 points), Protein foods (5 points), Plant-based protein foods (5 points), Beverages (10 points), Fatty acids ratio (5 points), Saturated fats (5 points), Free sugars (10 points), and Sodium (10 points). All components are expressed as ratios (e.g., proportions of total foods, total beverages, or total energy). The HEFI-2019 score has a maximum of 80 points. Potential uses of the HEFI-2019 include research as well as monitoring and surveillance of food choices in population-based surveys. Novelty: ● The Healthy Eating Food Index-2019 was developed to measure adherence to the 2019 Canada's Food Guide recommendations on healthy food choices. ● The HEFI-2019 includes 10 components, of which 5 are based on foods, 1 on beverages and 4 on nutrients, for a total of 80 points.

Online Symptoms Self-Assessment During Covid-19 Pandemic: an Analysis of a Covid-19 Portal Responses from Canada.

Background: Covid-19 case was first identified in Canada on January 25, 2020, on a Toronto resident who had travelled to Wuhan China, and not long after, the WHO declared the viral infection a pandemic. Ontario health West created an online self-assessment portal that allowed individuals in the health region and adjourning areas to report any covid related symptoms.Method: Record level data obtained the Ontario Health West self-assessment portal were analyzed. Descriptive statistics using charts and graphs were used to characterize the distribution of responses to the portal. In-depth analysis using correlation, lead-lag analysis, and trend comparison with actual Public Health Canada covid-19 cases for the region were also conducted.Results: A total of 34,144 distinct responses were recorded on the portal between April 10 and July 29, 2020, with 1,250 (3.7%) responding positively to one of the emergency symptoms questions. Trend analysis showed a peak portal response in May 2020 with a smaller rise subsequently in July 2020, coinciding with actual covid-19 peak in the region. The five most reported symptoms on the portal were sore throat (17.2%), headache (12.9%), fatigue (12.3%), digestive problems (12.2%) and cough (9.1%). For four sub-regions, trend of self-report on the portal positively lagged actual public health covid-19 cases, while for one sub-region, the trend positively led the actual public health covid-19 cases for the area.Conclusion: We found correlation between online covid-19 self- assessment data and the confirmed covid-19 cases in the Southwestern region of Ontario. Trends in the covid-19 associated emergency symptoms reported on the portal also tracked confirmed covid-19 cases in the community. Peak response to the portal coincided with the peak volume of confirmed cases in Ontario during the first wave of covid-19 pandemic in Canada, suggesting some consistency between the experiences of portal users and patterns of COVID-19 illness in the community. The portal was a useful tool at the person-level because it provided guidance to individuals about how to access appropriate health services according to the symptoms that they reported and connected them with primary care, reducing unnecessary visit to health facilities for covid-19 related care.

Comparison of 3R4F cigarette smoke and IQOS heated tobacco product aerosol emissions

In this study, the smoke from a 3R4F research cigarette and the aerosol generated by the Heated Tobacco Product IQOS, also referred to as the Tobacco Heating System (THS) 2.2 in the literature, were compared. The objective was to characterize the gas and suspended particulate matter compositions in the mainstream smoke from a combusted 3R4F cigarette and in the aerosol generated by IQOS during use. The results indicated that the determined aerosol emissions from IQOS were notably lower than in the cigarette smoke under a Health Canada Intense puffing regimen. As an interesting detail in this study, the maximum nicotine concentrations within a puff were practically the same in both the 3R4F smoke and the IQOS aerosol, but the average concentration was lower for the IQOS aerosol. For both products, water constituted a significant proportion of the particulate matter, although it was substantially higher in the IQOS aerosol. Furthermore, combustion-related solid particles observed in the 3R4F smoke contained elements such as carbon, oxygen, potassium, calcium, and silicon. In contrast, IQOS aerosol particulate matter was composed of semi-volatile organic constituents with some minor traces of oxygen and silicon. The particulate matter found in the IQOS aerosol was volatile, which was especially noticeable when exposed to the electron beam of the scanning electron microscope (SEM) and Transmission Electron Microscope (TEM).

Consensus Statement Regarding the Application of Biogen to Health Canada for Approval of Aducanumab

Alzheimer’s disease is a major cause of morbidity and mortality. Currently, there are no disease-modifying pharmacotherapies for this condition. Aducanumab, an amyloid beta-directed monoclonal antibody that targets aggregated forms of amyloid-beta in the brains of people with Alzheimer’s disease, has raised hopes that such a therapy has been discovered, but its approval by the US Food and Drug Administration has engendered a good deal of controversy. A similar application for approval has been submitted to Health Canada. In response to this, a group of Canadian clinical dementia experts representing a number of organizations, including the Canadian Geriatrics Society, was convened by the Canadian Consortium on Neurodegeneration in Aging (CCNA) to discuss the evidence currently available on this agent and seek consensus on what advice they would offer Health Canada on the application. There was wide-spread agreement that it would be premature for aducanumab to receive approval for the treatment of Alzheimer’s disease. It was also noted that the Canadian health-care system is poorly prepared at this time to deal with a disease-modifying therapeutic with targeting, administration, and monitoring characteristics like aducanumab. In this paper, the consensus reached is presented along with its underlying rationale.

Online Symptoms Self-Assessment During Covid-19 Pandemic: An Analysis of a Covid-19 Portal Responses from Canada.

BackgroundCovid-19 case was first identified in Canada on January 25, 2020, on a Toronto resident who had travelled to Wuhan China, and not long after, the WHO declared the viral infection a pandemic. Ontario health West created an online self-assessment portal that allowed individuals in the health region and adjourning areas to report any covid related symptoms.MethodRecord level data obtained the Ontario Health West self-assessment portal were analyzed. Descriptive statistics using charts and graphs were used to characterize the distribution of responses to the portal. In-depth analysis using correlation, lead-lag analysis, and trend comparison with actual Public Health Canada covid-19 cases for the region were also conducted.ResultsA total of 34,144 distinct responses were recorded on the portal between April 10 and July 29, 2020, with 1,250 (3.7%) responding positively to one of the emergency symptoms questions. Trend analysis showed a peak portal response in May 2020 with a smaller rise subsequently in July 2020, coinciding with actual covid-19 peak in the region. The five most reported symptoms on the portal were sore throat (17.2%), headache (12.9%), fatigue (12.3%), digestive problems (12.2%) and cough (9.1%). For four sub-regions, trend of self-report on the portal positively lagged actual public health covid-19 cases, while for one sub-region, the trend positively led the actual public health covid-19 cases for the area.ConclusionWe found correlation between online covid-19 self- assessment data and the confirmed covid-19 cases in the Southwestern region of Ontario. Trends in the covid-19 associated emergency symptoms reported on the portal also tracked confirmed covid-19 cases in the community. Peak response to the portal coincided with the peak volume of confirmed cases in Ontario during the first wave of covid-19 pandemic in Canada7, suggesting some consistency between the experiences of portal users and patterns of COVID-19 illness in the community. The portal was a useful tool at the person-level because it provided guidance to individuals about how to access appropriate health services according to the symptoms that they reported and connected them with primary care, reducing unnecessary visit to health facilities for covid-19 related care.

Family and religion’s influence on Arab immigrant mothers’ initiation and exclusive breastfeeding

Breastfeeding is known to provide health benefits for newborns and breastfeeding mothers. The World Health Organization and Health Canada recommend exclusive breastfeeding for the first six months of an infant’s life. However, the rates of exclusive breastfeeding practices among Arab immigrant mothers are lower when compared with rates for non-immigrant Canadian mothers and mothers in the immigrants’ countries of origin. Critical ethnography was used to explore the breastfeeding practices among immigrant Arab mothers in Alberta, Canada, and factors influencing their decision or ability to breastfeed exclusively. Face-to-face interviews were conducted with 10 participants, followed by thematic analysis of the qualitative narrative data. The results indicated that family and religion are the sociocultural factors that primarily influenced the mothers’ initiation and exclusive breastfeeding practices. The findings from this study can facilitate culturally safe and sensitive interventions to address Arab mothers’ breastfeeding needs and promote exclusive breastfeeding within this population in Canada.

P.154 Subcutaneous intrathecal catheter and port implants for administration of Nusinersen in patients with Spinal Muscular Atrophy

Background: Until recently, no effective treatment was available for spinal muscular atrophy (SMA). In 2017, Health Canada approved intrathecal Nusinersen a medication that prevents degeneration of the motor neurons in the spinal cord. The administration is intrathecally most commonly via lumbar puncture (LP) to have a direct effect on the motor neurons of the spinal cord. Many older patients with SMA and concomitant spinal deformities present technical challenges to access the thecal sac. Different routes have been described for delivery of the medication whoever these techniques may require sedation, are associated with radiation exposure, and demand experience personnel. Methods: A new surgical technique has been proposed to overcome these obstacles by combining two Health Canada approved devices: 1) an intrathecal catheter designed for intrathecal baclofen pumps and 2) an implantable subcutaneous port designed for intravascular medication administration Results: We describe the technical nuances and outline the clinical outcomes of six patients with complex spine deformities who have undergone such an implant for administration of Nusinersen. Conclusions: We discuss the benefits of the procedure which includes: 1) administration in the outpatient setting without sedation, 2) avoidance of costly imaging and experienced personnel, and 3) placement of the catheter in the cervicothoracic junction.

P.121 Leading the Way to the Future: Implementing Novel Therapeutics for Rare Pediatric Neurological Disorders

Background: Children and Adolescents with rare neurogenetic disorders often have no known cure or disease modifying treatments. Recent advancements in treatments are offering much needed hope to these patients and families. However, these treatments are extremely costly, have complex administration requirements and have many unknown long-term risks and outcomes. Methods: In this presentation, we will discuss our experiences with the implementation process, including developing intricate care pathways, collaborating with multiple disciplines and services, supporting and advocating for our patients and families, and interacting with government agencies and pharmaceutical companies. Case studies will highlight the positive impact these treatments are making on the lives of children and adolescents with rare neurological disorders. Results: Spinal muscular atrophy and Neuronal Ceroid Lipofuscinosis Type 2 are both rare and devastating neurodegenerative conditions with significant morbidity and mortality. Health Canada and government funding agencies recently approved Nusinersen, Onasemnogene abeparvovec for the treatment of SMA and Cerliponase alfa for the treatment of CLN2, leading us to swiftly integrate these treatments into our standard of care. Conclusions: While implementing these novel therapies into clinical practice can be both challenging and rewarding, neuroscience nurses are positioned at the forefront to be leaders in this process at both organizational, national, and international levels.