Vancouver Coastal Health (VCH) is a regional health authority that provides health services including primary, secondary, tertiary and quaternary care, home and community care, mental health services, population and preventive health and addictions services in part of Greater Vancouver and the Coast Garibaldi area.VCH is one of five publicly funded regional healthcare authorities within the Canadian province of British Columbia. The government of British Columbia, through the British Columbia Ministry of Health, sets province-wide goals, standards and performance agreements for health service delivery by the seven health authorities..
AIMS:There is a paucity of data on how Early Psychosis Intervention (EPI) services adapt to the challenges of rural practice, including geographical isolation and provider shortages. This qualitative study seeks to fill this gap by exploring the experiences of EPI programs in rural and remote communities in Canada. METHODS:An introductory email was sent to 117 EPI contacts, inviting them to first complete a survey and then participate in a semi-structured interview if their program contained a rural component. The interviews were conducted between June 2023-January 2024 via Zoom or phone by a member of our research team, while another member took detailed notes. Qualitative data was analyzed using thematic analysis. RESULTS:Twenty-five representatives from seventeen distinct EPI programs with a rural and remote component across seven Canadian provinces and one Canadian territory participated in the interviews. Several barriers to establishing EPI programs in rural and remote areas were identified, including limited access to care, challenges in referral processes, geographical and technological constraints, and funding limitations. Facilitators of successful program delivery included the use of virtual care, standardized care models, strong leadership and teamwork, and adaptive resourcefulness in addressing local needs. CONCLUSION:Identifying and addressing these barriers and leveraging facilitators can enhance the accessibility and effectiveness of EPI service delivery in rural and remote areas.
The ongoing toxic drug crisis in Canada, driven largely by fentanyl proliferation, has led to ever-escalating overdose rates. The Safer Alternatives for Emergency Response (SAFER) program was launched in Vancouver, British Columbia (BC) in 2021 to reduce overdose risk by offering prescribed pharmaceutical alternatives, including fentanyl medications. This study aimed to evaluate satisfaction and the program’s perceived impact on health and social outcomes among SAFER participants. Data were collected from 78 SAFER participants through baseline interviewer-administered questionnaires. The primary outcome was self-reported changes in drug use, health status and social outcomes. Descriptive statistics summarized participant characteristics and outcomes. Among 78 participants, with 22 (28
Introduction Learning health systems (LHS) aim to improve care through repeated cycles that link data, learning and action. These systems have a goal to uphold equity through purposefully including patients and other stakeholders in co-design and using real-world data to identify and respond to inequities. However, evidence shows that LHS do not automatically produce equitable outcomes, and a gap persists between stated equity goals and the practical mechanisms used to build equity into system design, measurement and decision-making. This scoping review examines how equity and related concepts, including antiracism and Indigenous self-determination, are operationalised within LHS.Methods and analysis We will conduct a scoping review using the Joanna Briggs Institute methodology and report the findings in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. To capture equity-oriented learning beyond formally labelled systems, we define LHS by function rather than name, focusing on systems that demonstrate linkages between data use, learning and action. We will search PubMed/MEDLINE, CINAHL, Embase, Scopus, Web of Science and PsycINFO, supplemented by hand searches of relevant journals for peer-reviewed articles published from 2015 to July 2026. Two reviewers will independently screen titles, abstracts and full texts. Using a structured extraction form, we will chart how equity is defined and operationalised within LHS, including governance and decision-making processes, data and measurement practices, learning activities and contextual factors that shape equity-oriented learning. We will synthesise findings descriptively and thematically to map where in the LHS cycle equity is operationalised, what equity dimensions are addressed and where reporting gaps remain. Findings will inform researchers, health system leaders and communities on how equity can be built into routine LHS processes.Ethics and dissemination Ethics approval is not required as this review synthesises published literature. Findings will be disseminated through peer-reviewed publications and conference presentations.
Background: Beaches are popular summertime destinations in Canada. However, they can be affected by specific fecal pollution sources, increasing the risk of recreational water illness. Objectives: This study was conducted to determine the risks of acute gastrointestinal illness (AGI) among Canadian beachgoers and to evaluate the influence of different fecal indicator bacteria (FIB) and other water quality measures on assessing these risks. Methods: In a prospective cohort design, beachgoers were recruited at sites across Canada from 2023 to 2025. Sociodemographic characteristics and exposures were determined through an on-site survey, with a 7-day follow-up survey to determine risks of AGI. Bayesian mixed-effects logistic regression models were fitted to evaluate the effects of an ordinal water contact variable (no contact, minimal contact, body immersion, and swallowed water) on the incident risk of AGI, with an interaction included for water quality indicators. The levels of six FIB and water quality measures were assessed: Escherichia coli, enterococci DNA, three microbial source tracking DNA markers (human HF183/BacR287, human mitochondria, seagull Gull4), and turbidity. Results: A total of 4085 participants were recruited, with 67.6% completing the follow-up survey. The overall incident risk of AGI was 2.6%. Both swallowing water and body immersion increased AGI risks compared to no water contact: median of 20 excess cases (95% Credible Interval [CrI]: 4, 64) and 5 excess cases (95% CrI: 1, 19) of AGI predicted per 1000 beachgoers, respectively. Escherichia coli and seagull DNA marker levels were associated with AGI among those who had water contact, particularly among those who reported swallowing water. Discussion: While the overall burden of AGI due to beach water contact in Canada was low, increased risks are associated with E. coli levels particularly among those who swallow water. This could be related to fecal contamination from seagulls. However, there is substantial uncertainty in the predicted effect sizes. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement This work was supported by the Canadian Institutes of Health Research (CIHR), grant numbers PJT 185894 and PJT 192023 (P.I. Young) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Toronto Metropolitan University Research Ethics Board gave ethical approval for this work (REB# 2023-043). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors [https://github.com/iany33/Beach\_cohort\_AGI][1] [1]: https://github.com/iany33/Beach_cohort_AGI
