As part of an ongoing program assessing the biodiversity and impacts of parasites in Arctic ungulates we examined 72 fecal samples from muskoxen on Banks Island, Northwest Territories, Canada for Giardia and Cryptosporidium. Cryptosporidium spp. were not detected, but 21% of the samples were positive for Giardia. Sequencing of four isolates of Giardia demonstrated G. duodenalis, Assemblage A, a zoonotic genotype.

The Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice (BETTER) trial demonstrated the effectiveness of an approach to chronic disease prevention and screening (CDPS) through a new skilled role of a ‘prevention practitioner’(PP). The PP has appointments with patients 40–65 years of age that focus on primary prevention activities and screening of cancer (breast, colorectal, cervical), diabetes and cardiovascular disease and associated lifestyle factors. There are numerous and occasionally conflicting evidence-based guidelines for CDPS, and the majority of these guidelines are focused on specific diseases or conditions; however, primary care providers often attend to patients with multiple conditions. To ensure that high-level evidence guidelines were used, existing clinical practice guidelines and tools were reviewed and integrated into blended BETTER tool kits. Building on the results of the BETTER trial, the BETTER tools were updated for implementation of the BETTER 2 program into participating urban, rural and remote communities across Canada. A clinical working group consisting of PPs, clinicians and researchers with support from the Centre for Effective Practice reviewed the literature to update, revise and adapt the integrated evidence algorithms and tool kits used in the BETTER trial. These resources are nuanced, based on individual patient risk, values and preferences and are designed to facilitate decision-making between providers across the target diseases and lifestyle factors included in the BETTER 2 program. Using the updated BETTER 2 toolkit, clinicians 1) determine which CDPS actions patients are eligible to receive and 2) develop individualized ‘prevention prescriptions’ with patients through shared decision-making and motivational interviewing. The tools identify the patients’ risks and eligible primary CDPS activities: the patient survey captures the patient’s health history; the prevention visit form and integrated CDPS care map identify eligible CDPS activities and facilitate decisions when certain conditions are met; and the ‘bubble diagram’ and ‘prevention prescription’ promote shared decision-making. The integrated clinical decision-making tools of BETTER 2 provide resources for clinicians and policymakers that address patients’ complex care needs beyond single disease approaches and can be adapted to facilitate CDPS in the urban, rural and remote clinical setting. The registration number of the original RCT BETTER trial was ISRCTN07170460 .

Aboriginal peoples in the Canadian Arctic are exposed to persistent organic pollutants (POPs) and metals mainly through their consumption of a traditional diet of wildlife items. Recent studies indicate that many human chemical levels have decreased in the north, likely due to a combination of reduced global chemical emissions, dietary shifts, and risk mitigation efforts by local health authorities. Body burdens for chemicals in mothers can be further offset by breastfeeding, parity, and other maternal characteristics. We have assessed the impact of several dietary and maternal covariates following a decade of awareness of the contaminant issue in northern Canada, by performing multiple stepwise linear regression analyses from blood concentrations and demographic variables for 176 mothers recruited from Nunavut and the Northwest Territories during the period 2005-2007. A significant aboriginal group effect was observed for the modeled chemicals, except for lead and cadmium, after adjusting for covariates. Further, blood concentrations for POPs and metals were significantly associated with at least one covariate of older age, fewer months spent breastfeeding, more frequent eating of traditional foods, or smoking during pregnancy. Cadmium had the highest explained variance (72.5%) from just two significant covariates (current smoking status and parity). Although Inuit participants from the Northwest Territories consumed more traditional foods in general, Inuit participants from coastal communities in Nunavut continued to demonstrate higher adjusted blood concentrations for POPs and metals examined here. While this is due in part to a higher prevalence of marine mammals in the eastern Arctic diet, it is possible that other aboriginal group effects unrelated to diet may also contribute to elevated chemical body burdens in Canadian Arctic populations.

The exposure of Aboriginal peoples in the Canadian Arctic to persistent organic pollutants (POPs) and metals through the consumption of traditional food items is well recognized; however, less information is available for Canadian immigrants. The direct comparison of blood chemical concentrations for expectant primiparous women sampled in the Inuvik and Baffin regions of the Canadian Arctic, as well as Canadian- and foreign-born women from five southern Canadian centers (Halifax, Vancouver, Hamilton, Ottawa, and Calgary), provides relative exposure information for samples of northern and southern mothers in Canada. Based on our analyses, Canadian mothers are exposed to a similar suite of contaminants; however, Inuit first birth mothers residing in the Canadian Arctic had higher age-adjusted geometric mean concentrations for several legacy POPs regulated under the Stockholm Convention, along with lead and total mercury. Significant differences in exposure were observed for Inuit mothers from Baffin who tended to demonstrate higher blood concentrations of POPs and total mercury compared with Inuit mothers from Inuvik. Conversely, northern mothers showed a significantly lower age-adjusted geometric mean concentration for a polybrominated diphenyl ether (PBDE-153) compared to southern mothers. Furthermore, southern Canadian mothers born outside of Canada showed the highest individual concentrations measured in the study: 1700 μg/kg lipids for p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE) and 990 μg/kg lipids for β-hexachlorocyclohexane (β-HCH). Data from Cycle 1 (2007-2009) of the nationally-representative Canadian Health Measures Survey (CHMS) places these results in a national biomonitoring context and affirms that foreign-born women of child-bearing age experience higher exposures to many POPs and metals than their Canadian-born counterparts in the general population.

The objectives of this paper are to describe the planned implementation and evaluation of the Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care (BETTER 2) program which originated from the BETTER trial. The pragmatic trial, informed by the Chronic Care Model, demonstrated the effectiveness of an approach to Chronic Disease Prevention and Screening (CDPS) involving the use of a new role, the prevention practitioner. The desired goals of the program are improved clinical outcomes, reduction in the burden of chronic disease, and improved sustainability of the health-care system through improved CDPS in primary care. The BETTER 2 program aims to expand the implementation of the intervention used in the original BETTER trial into communities across Canada (Alberta, Ontario, Newfoundland and Labrador, the Northwest Territories and Nova Scotia). This proactive approach provides at-risk patients with an intervention from the prevention practitioner, a health-care professional. Using the BETTER toolkit, the prevention practitioner determines which CDPS actions the patient is eligible to receive, and through shared decision-making and motivational interviewing, develops a unique and individualized `prevention prescription’ with the patient. This intervention is 1) personalized; 2) addressing multiple conditions; 3) integrated through linkages to local, regional, or national resources; and 4) longitudinal by assessing patients over time. The BETTER 2 program brings together primary care providers, policy/decision makers and researchers to work towards improving CDPS in primary care. The target patient population is adults aged 40-65. The reach, effectiveness, adoption, implementation, maintain (RE-AIM) framework will inform the evaluation of the program through qualitative and quantitative methods. A composite index will be used to quantitatively assess the effectiveness of the prevention practitioner intervention. The CDPS actions comprising the composite index include the following: process measures, referral/treatment measures, and target/change outcome measures related to cardiovascular disease, diabetes, cancer and associated lifestyle factors. The BETTER 2 program is a collaborative approach grounded in practice and built from existing work (i.e., integration not creation). The program evaluation is designed to provide an understanding of issues impacting the implementation of an effective approach for CDPS within primary care that may be adapted to become sustainable in the non-research setting.

INTRODUCTION: During the past decade, a trend toward increasing cases ofBordetella pertussisin older children and adults has been witnessed in Canada. The National Advisory Committee on Immunization now recommends that the adult formulation of the acellular pertussis (adult dTap) vaccine combined with diphtheria and tetanus toxoids be substituted for diphtheria and tetanus toxoids alone for the 14- to 16-year-old booster dose. In October 2000, the government of the Northwest Territories was one of the first to adopt adult dTap into their territorial immunization program free of charge.OBJECTIVE: To evaluate the effect of the acellular pertussis vaccine in children and adolescents on the epidemiology of pertussis in the Northwest Territories.METHODS: Pertussis is a reportable disease in the Northwest Territories, and data on the incidence rates of pertussis are available from 1989 to 2004. The present study reviews pertussis cases during three four-year periods: the whole-cell vaccine era (1993 to 1996); the preadult dTap era (1997 to 2000); and the postadult dTap era (2001 to 2004).RESULTS: The incidence of pertussis decreased from 18.0 cases per 10,000 population in 1993 to 0.2 cases per 10,000 population in 2004. The number of cases decreased from 186 to 129 to 19 cases in the three chronological time periods (ie, whole-cell vaccine era, preadult dTap era and postadult dTap era, respectively), with the most substantial reduction coming with the introduction of postadult dTap.CONCLUSIONS: There appears to be a decrease in the incidence of pertussis with the targeted introduction of adult dTap in the Northwest Territories.