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Human campylobacteriosis is a common zoonosis with a significant burden in many countries. Its prevention is difficult because humans can be exposed to Campylobacter through various exposures: foodborne, waterborne or by contact with animals. This study aimed at attributing campylobacteriosis to sources at the point of exposure. It combined comparative exposure assessment and microbial subtype comparison with subtypes defined by comparative genomic fingerprinting (CGF). It used isolates from clinical cases and from eight potential exposure sources (chicken, cattle and pig manure, retail chicken, beef, pork and turkey meat, and surface water) collected within a single sentinel site of an integrated surveillance system for enteric pathogens in Canada. Overall, 1518 non-human isolates and 250 isolates from domestically-acquired human cases were subtyped and their subtype profiles analyzed for source attribution using two attribution models modified to include exposure. Exposure values were obtained from a concurrent comparative exposure assessment study undertaken in the same area. Based on CGF profiles, attribution was possible for 198 (79%) human cases. Both models provide comparable figures: chicken meat was the most important source (65-69% of attributable cases) whereas exposure to cattle (manure) ranked second (14-19% of attributable cases), the other sources being minor (including beef meat). In comparison with other attributions conducted at the point of production, the study highlights the fact that Campylobacter transmission from cattle to humans is rarely meat borne, calling for a closer look at local transmission from cattle to prevent campylobacteriosis, in addition to increasing safety along the chicken supply chain.

Background: In 2008, the National Advisory Committee on Immunization recommended routine rotavirus immunizations in healthy Canadian infants. Over the following seven years, eight provinces and two territories introduced the rotavirus vaccine into their publicly funded immunization programs. Objective: Assess the burden of rotavirus infections before and after implementation of publicly funded immunization programs. Methods: We analyzed laboratory-confirmed community cases of rotavirus reported to the National Enteric Surveillance Program and hospitalizations of children younger than three years old from 2007 to 2017 with rotavirus diagnosis-specific ICD-10 codes. Rates of illness were calculated for each province for the two years prior to and after implementation of public funding of the vaccine. The year of implementation was not included to accommodate the uptake period of the vaccine. Age-specific rates were assessed in jurisdictions where five years of data were available the year after the vaccine was publicly funded. The pre–post and difference-in-difference (DID) methodologies were applied to hospital discharge data to evaluate changes between the funding and non-funding jurisdictions. Results: Community cases of laboratory-confirmed rotavirus infection reported to the National Enteric Surveillance Program declined by 54% between 2010 and 2017. Rates of hospital discharges decreased significantly among children in six provinces after the adoption of the rotavirus vaccine. Hospital discharge rates in Alberta, Manitoba, Ontario and Prince Edward Island dropped between 53% and 71%, and by 75% for British Columbia and Saskatchewan. Conclusion: Public funding of the rotavirus vaccine appeared to lead to significant reductions in laboratory-confirmed rotavirus cases reported to the National Enteric Surveillance Program and in the rates of rotavirus gastroenteritis-related hospital discharges.

Background: This article presents a descriptive summary of the consumption of various country food (i.e. locally harvested plant and animal foods) products by residents of Yukon (YT), Northwest Territories (NT) and Nunavut (NU). Data were collected as part of the Foodbook study in 2014–2015. Methods: The Foodbook study was conducted by telephone over a one-year period. Respondents were asked about consumption of a wide range of food products over the previous seven days. Residents of the territories were also asked about consumption of regionally-specific country food. Data were weighted to develop territorial estimates of consumption. Data on age, gender, location, income and education were also collected. Results: The national response rate for the Foodbook survey was 19.9%. In total, 1,235 residents of the territories participated in the study (YT, n=402; NT, n=458; NU, n=375). Consumption of any country food during the previous seven days was reported by 77.5%, 60.7%, and 66.4% of participants in NU, NT and YT, respectively. Conclusion: Responses to country food questions asked alongside the main Foodbook questionnaire provide insight on country food consumption in YT, NT and NU.

This article proposes the tax liquidation hypothesis, a predictable pattern of behavior regarding individuals’ decisions to create and subsequently to liquidate “Cash Holding” accounts when facing tax liabilities. Previous research on tax related trading has focused on minimizing the individual tax burden by holding winners and selling losers. This behavior, described as “optimal tax trading” suggests that individuals should sell stocks that have lost value in the short-term while holding onto stocks that have gained value until the stocks can be sold at the preferential long-term capital gains rate. This article proposes the tax liquidation hypothesis based on investor behavioral biases and the current tax environment. Individual investors will hold “cash” accounts that are consistent with their preferences for risk and return. The cash account holdings may differ across individuals, but the pattern and hypotheses regarding formation and liquidation of these accounts for tax reasons should be consistent with the model proposed by this article.

Contexte : En 2008, le Comité consultatif national de l’immunisation a recommandé la vaccination systématique contre le rotavirus chez les nourrissons canadiens en bonne santé. Au cours des sept années suivantes, huit provinces et deux territoires ont introduit le vaccin contre le rotavirus dans leurs programmes de vaccination financés par le secteur public. Objectif : Évaluer le fardeau des infections à rotavirus avant et après la mise en œuvre des programmes de vaccination financés par le secteur public. Méthodes : Nous avons analysé les cas communautaires confirmés en laboratoire de rotavirus signalés au Programme national de surveillance des maladies entériques et les hospitalisations d’enfants de moins de trois ans de 2007 à 2017 avec des codes CIM-10 propres au diagnostic du rotavirus. Les taux de maladie ont été calculés pour chaque province pour les deux années précédant et suivant la mise en œuvre du financement public du vaccin. L’année de mise en œuvre n’a pas été incluse pour tenir compte de la période d’adoption du vaccin. Les taux selon l’âge ont été évalués dans les provinces ou territoires où des données sur cinq ans étaient disponibles l’année suivant le financement public du vaccin. La méthode d’analyse de données avant et après la mise en œuvre et la méthode de « différence dans les différences » ont été appliquées aux données sur les congés hospitaliers afin d’évaluer les changements entre les provinces ou territoires qui financent un programme et ceux qui n’en financent pas. Résultats : Les cas communautaires d’infection à rotavirus confirmés en laboratoire signalés au Programme national de surveillance des maladies entériques ont diminué de 54 % entre 2010 et 2017. Les taux de congés hospitaliers ont diminué considérablement chez les enfants de six provinces après l’adoption du vaccin contre le rotavirus. Les taux de congés hospitaliers en Alberta, au Manitoba, en Ontario et à l’Île-du-Prince-Édouard ont chuté de 53 % à 71 %, et de 75 % en Colombie-Britannique et en Saskatchewan. Conclusion : Le financement public du vaccin contre le rotavirus semble avoir entraîné une réduction importante des cas de rotavirus confirmés en laboratoire qui ont été signalés au Programme national de surveillance des maladies entériques et des taux de congés hospitaliers liés à la gastro-entérite à rotavirus.

Corticosteroid injections and physiotherapy exercise programmes are commonly used to treat rotator cuff disorders but the treatments' effectiveness is uncertain. We aimed to compare the clinical effectiveness and cost-effectiveness of a progressive exercise programme with a single session of best practice physiotherapy advice, with or without corticosteroid injection, in adults with a rotator cuff disorder. In this pragmatic, multicentre, superiority, randomised controlled trial (2 × 2 factorial), we recruited patients from 20 UK National Health Service trusts. We included patients aged 18 years or older with a rotator cuff disorder (new episode within the past 6 months). Patients were excluded if they had a history of significant shoulder trauma (eg, dislocation, fracture, or full-thickness tear requiring surgery), neurological disease affecting the shoulder, other shoulder conditions (eg, inflammatory arthritis, frozen shoulder, or glenohumeral joint instability), received corticosteroid injection or physiotherapy for shoulder pain in the past 6 months, or were being considered for surgery. Patients were randomly assigned (centralised computer-generated system, 1:1:1:1) to progressive exercise (≤6 sessions), best practice advice (one session), corticosteroid injection then progressive exercise, or corticosteroid injection then best practice advice. The primary outcome was the Shoulder Pain and Disability Index (SPADI) score over 12 months, analysed on an intention-to-treat basis (statistical significance set at 1%). The trial was registered with the International Standard Randomised Controlled Trial Register, ISRCTN16539266, and EuDRACT, 2016-002991-28. Between March 10, 2017, and May 2, 2019, we screened 2287 patients. 708 patients were randomly assigned to progressive exercise (n=174), best practice advice (n=174), corticosteroid injection then progressive exercise (n=182), or corticosteroid injection then best practice advice (n=178). Over 12 months, SPADI data were available for 166 (95%) patients in the progressive exercise group, 164 (94%) in the best practice advice group, 177 (97%) in the corticosteroid injection then progressive exercise group, and 175 (98%) in the corticosteroid injection then best practice advice group. We found no evidence of a difference in SPADI score between progressive exercise and best practice advice when analysed over 12 months (adjusted mean difference −0·66 [99% CI −4·52 to 3·20]). We also found no evidence of a difference between corticosteroid injection compared with no injection when analysed over 12 months (−1·11 [–4·47 to 2·26]). No serious adverse events were reported. Progressive exercise was not superior to a best practice advice session with a physiotherapist in improving shoulder pain and function. Subacromial corticosteroid injection provided no long-term benefit in patients with rotator cuff disorders. UK National Institute for Health Research Technology Assessment Programme.

Understanding consumers' food safety practices and knowledge supports food safety education for the prevention of foodborne illness. The objective of this study was to describe Canadian consumer food safety practices and knowledge. This study identifies demographic groups for targeted food safety education messaging and establishes a baseline measurement to assess the effectiveness of food safety interventions over time. Questions regarding consumer food safety practices and knowledge were included in a population-based telephone survey, Foodbook, conducted from November 2014 to March 2015. The results were analyzed nationally by age group and by gender. The results showed that approximately 90% of Canadians reported taking the recommended cleaning and separating precautions when handling raw meat to prevent foodborne illness. Only 29% of respondents reported using a food thermometer when cooking any meat, and even fewer (12%) reported using a food thermometer for small cuts of meat such as chicken pieces. The majority (>80%) of Canadians were aware of the foodborne illness risks related to chicken and hamburger, but fewer (<40%) were aware of the risks related to frozen chicken nuggets, alfalfa sprouts, soft unpasteurized cheese, and unpasteurized juices. Generally, men were less likely to follow cooking instructions on packaging and took fewer steps to prevent cross-contamination than women. The youngest (18 to 29 years) age group was less likely to take steps to avoid cross-contamination and was less aware of the risks associated with eating an undercooked hamburger. The oldest (60+ years) respondents were less likely to be aware of the risks associated with raw eggs, alfalfa sprouts, and unpasteurized juice than the middle (30 to 59 years) age group. As a priority, food safety education in Canada should focus on increasing people's awareness of high-risk foods, specifically foods for which the awareness of risk found in this study was low; targeting messaging to demographic groups as appropriate; and promoting the use of food thermometers when cooking meat and poultry.

Nontyphoidal Salmonella enterica infections are a leading cause of enteric disease in Canada, most commonly associated with foodborne exposures. Raw frozen breaded chicken products (FBCP) have been implicated in 16 Salmonella outbreaks between 2017 and 2019. This study quantified the impact of the 1 April 2019 requirement by the Canadian Food Inspection Agency (CFIA) for manufacturers to reduce Salmonella in raw FBCP. An intervention study approach utilizing the pre–post intervention data with a comparison group methodology was used to: (1) estimate the reduction in FBCP Salmonella prevalence using retail meat FoodNet Canada data; (2) estimate the reduction in the human salmonellosis incidence rate using data from the Canadian National Enteric Surveillance Program; and (3) estimate the proportion of reported cases attributed to FBCP if the human exposure to Salmonella through FBCP was completely eliminated. The FBCP Salmonella prevalence decreased from 28% observed before 1 April 2019 to 2.9% after the requirement implementation. The CFIA requirement was estimated to reduce the human salmonellosis incidence rate by 23%. An estimated 26% of cases during the pre-intervention period can be attributed to FBCP. The CFIA requirement was successful at significantly reducing Salmonella prevalence in retail FBCP, and at reducing salmonellosis burden.

This article proposes the tax liquidation hypothesis, a predictable pattern of behavior regarding individuals' decisions to create and subsequently to liquidate \"Cash Holding\" accounts when facing tax liabilities. Previous research on tax related trading has focused on minimizing the individual tax burden by holding winners and selling losers. This behavior, described as \"optimal tax trading\" suggests that individuals should sell stocks that have lost value in the short-term while holding onto stocks that have gained value until the stocks can be sold at the preferential long-term capital gains rate. This article proposes the taxliquidation hypothesis based on investor behavioral biases and the current tax environment. Individual investors will hold \"cash\" accounts that are consistent with their preferences for risk and return. The cash account holdings may differ across individuals, but the pattern and hypotheses regarding formation and liquidation of these accounts for tax reasons should be consistent with the model proposed by this article.