In This Issue - March 2024

Updates and Review:

Measles Update and Resources
Oral Health Month: Infant Feeding and Early Childhood Caries
Update: Vaccine Preventable Disease (VPD) Program
Practical Guide to STI Risk Assessment for Clinicians
CBT Postpartum Depression Program for Parents in Niagara
Respiratory Surveillance Review

Educational Opportunities:

FREE TRAINING: Breastfeeding Level 1
Reproductive and perinatal mental illness: An introduction for health care professionals

Measles Update and Resources

Measles is circulating internationally and there are cases in Ontario. While there are no known cases of measles in Niagara, patients may come to your clinic for assessment and testing.

Public Health Ontario recently released three documents: a measles guidance, an epidemiological summary, and infection, prevention and control recommendations to assist in the identification and management of individuals suspected to have measles.

Niagara Region Public Health continues to monitor the situation and will provide updates to healthcare providers via Medical Advisories and updates to our website.

Resources:

Oral Health Month: Feeding and Early Childhood Caries

Infants are susceptible to early childhood caries as soon as their teeth begin to erupt. Early childhood caries is a severe form of tooth decay in primary teeth.

Infants may be at an increased risk of early childhood caries when put to bed with a bottle that contains milk, juice or formula. Nighttime unrestricted at-will breastfeeding may also increase the risk of early childhood cavities due to sugar found within breastmilk.

Recommendations for Well-baby Visits:

Conduct a visual assessment of the infant's tongue, teeth, cheeks and gums. Look for any chalky white, brown or black spots.
Encourage only water in nighttime bottles
After feeding wipe child's gums and teeth with a damp clean cloth. Once the first tooth appears, brush twice a day for two minutes using a rice grain size of fluoridated toothpaste.
Infants should visit a dental professional as soon as their first tooth erupts
Fluoride varnish is free for those zero to 17 at Public Health. Fluoride varnish strengthens tooth enamel and protects teeth from childhood through to senior years.

For any questions, please contact the Dental Program.

UPDATE: Vaccine Preventable Disease (VPD) Program

March Break may be over, but the increased risk for post travel vaccine preventable disease outbreaks isn't. Make sure your patients are up to date with all routine vaccinations.

Daylight savings time also serves as a reminder to change your vaccine fridge thermometer batteries. This ensures your thermometer is working properly which helps to ensure patient safety.

Health care provider action:

Access the latest provincial immunization resources for health care professionals, including the Publicly Funded Immunization Schedules for Ontario and the Immunization Well-Child Toolkit. Share Ontario's routine immunization Schedules with your patients.
While the vaccination schedule starts at two months of age, begin vaccine discussions as early as you can. The Immunization Communication Tool: For Immunizers can help you have these conversations with parents.
Order vaccine(s) using our updated order forms. The vaccine manufacturers are updating packaging. You may find some of your orders look different from previous orders.
Change thermometer batteries at least every four to six months
Change fridge thermometer batteries at least every four to six months. Ensure to take note of all temperatures (current, maximum and minimum) prior to changing the batteries.

More information:

Contact the Vaccine Preventable Disease program at 905-688-8248 or 1-888-505-6074 ext. 7396

Practical Guide to STI risk assessment for Clinicians

Caring for your patient’s sexual and reproductive health is an important part of their overall well-being. To help patients understand the importance of STI testing, care providers should start the conversation.

Although specific causes for the increase in STIs have yet to be determined, there is some evidence that changing sexual networks, concurrent partners and/or non-monogamy, and a decrease in condom use are contributing factors.

Patients often seek testing because of symptoms, but screening is recommended based on risk. Because of the high rates of asymptomatic infection, many positive infections are missed with this approach. Patients may also underestimate their own risk leading to a mismatch between a person’s perceived and actual risk. Because screening and testing are both low-effort interventions, regular screening for risk is encouraged. Below are some tips and phrases that can help you with this task.

Practical tips:

Have free condoms available in your office or washrooms
Offer testing options such as self-collected swabs when possible
Ask about and affirm your patient's gender identity and sexual orientation
Ask questions about the gender and sexual orientation of their partners so you can accurately assess their risk
Let them know they can ask questions without judgment

Conversation starters:

"STI testing is offered to everyone, would you like to be tested today?"
"I'd like to check in about your risks for sexually transmitted infections. Have you had any new sexual partners since you were last tested?
"We like to have a sense of your risks for sexually transmitted infections because most of the time people don't show symptoms. When STIs go undiagnosed, they can cause serious health issues. In recent months, how many sexual partners have you had?"
"Sexual health is an important part of your overall health, so I'd like to talk about any risks you might have. The types of sex you have, and who your partners are, influence your risk. What are the genders of your partners? Do you have vaginal, anal, and oral sex?"

Phrases to help the conversation along:

“Even if you’re in monogamous relationship, it’s a good idea to test occasionally.”
“Condoms are a great tool to prevent sexually transmitted infections – and regular testing is another.”
“Testing is easy – we can get a urine sample and use a swab for chlamydia and gonorrhea, and get a blood sample for HIV and syphilis.”
“Sexually transmitted infections are easily treated or managed. It’s better to know than to wonder.”

Resources:

CBT Postpartum Depression Program for Parents in Niagara

Postpartum depression (PPD) affects one in five people who have recently given birth, but only 15 per cent can access evidence-based treatment due to long waitlists and lack of availability of affordable care. Current clinical practice guidelines recommend evidence-based psychotherapies, like cognitive behavioural therapy (CBT), as first-line treatments for the vast majority of parents with PPD.

Public Health Nurse-delivered cognitive behavioural therapy (CBT) shows reductions in postpartum depression and anxiety among new parents who have given birth. Niagara Region Public Health (NRPH) now offers this intervention as a Prenatal/Postpartum Depression Group (nine-week intervention) for:

pregnant people, or people who have given birth in the last 18 months who are feeling depressed, down or anxious

Patients who are expecting, or who have recently had a baby and are experiencing any depressive symptoms can be referred to the program by a physician using the Family Health Referral Form. There are upcoming classes starting April 23 and in May. Keep an eye on our clinics and classes page for upcoming group dates. Alternatively, patients can sign up online when classes are available. Join us in helping new and expecting parents access treatment for postpartum depression.

Respiratory Surveillance

Surveillance Update: Influenza Activity is Lower

Public Health Ontario's most recent respiratory laboratory surveillance data indicates activity for both influenza A and influenza B is lower compared to previous weeks
Provincially, Seasonal Human Coronavirus is the most commonly circulating virus (based on percent positivity)
In Niagara, there are 897 cases of influenza so far this season; 22,228 across Ontario

2023 - 2024 Respiratory Season

Please note: Seasonal human coronavirus refers to non-pandemic human coronaviruses.

Data source: Public Health Ontario’s Ontario Respiratory Virus Tool, data as of March 2^nd, 2024

Niagara reports flu activity surveillance information weekly on Fridays

For more detail on the 2023 to 2024 respiratory season, please visit Public Health Ontario’s page for the Ontario Respiratory virus Tool.

Educational Opportunities; physician typing on keyboard

FREE TRAINING: Breastfeeding - Making a Difference (Level 1)

Niagara Region Public Health is hosting a two-day live virtual workshop series for community health care professionals and hospital staff practicing in Niagara who currently work with expectant or new parents as well as their families. This series will take place on May 7 and May 14, 2024.

Keynote Speaker: Kathy O’Grady, RN, IBCLC, Lactation Consultant, Co-Director Breastfeeding Committee for Canada National BFI Quality Improvement Project, Baby-Friendly Initiative Assessor and Educator for Quintessence Foundation will provide this opportunity on Zoom.

Note: Participants must attend both session dates and may be eligible to receive IBLCE CERPS (Continuing Education Recognition Points).

Training Highlights:

This training is provided at no cost to the participant
There will be a panel presentation and Q & A with individuals who have lived experience breastfeeding

Learning Objectives:

Assessment: identify early breastfeeding problems for healthy term infants, and infants with health challenges or special needs
Management: provide effective and confident care that facilitates the initiation and maintenance of breastfeeding
Support: develop comprehensive care plans for the breastfeeding dyad and enhanced awareness of community-based supports
Explore best practices regarding skin-to-skin, caloric intake, milk supply, alternative feeding methods and equipment, and frequent, early removal of breastmilk

Please register on the Professional Development Opportunities Page
REGISTRATION DEADLINE IS APRIL 19, 2024

Reproductive and perinatal mental illness: An introduction for health care professionals

This comprehensive and accessible introductory training is designed for health care professionals from a variety of disciplines who wish to gain a key understanding of perinatal mental illness.

Postpartum women incur more hospitalizations than any other phase in the female life cycle and suicide is one of the leading causes of maternal deaths in Canada and the United States. Perinatal mood and anxiety disorders (PMADs) are the most underdiagnosed, underreported and untreated complications of childbirth; and yet are highly responsive to treatment and proper care, particularly with early identification. The background of women’s reproductive mental health as well as race and ethnicity are especially important factors to learn about relative to the socio-cultural impact of outcomes for women suffering from perinatal mental illness.

This training provides a foundational understanding of evidence-informed and widely accepted practices in working with this population. An overview of screening tools for assessing PMADs will be provided, along with addressing the impact of COVID-19 on maternal mental health. In addition, the increasing rate of paternal mental illness will be contextualized.

Learning Objectives:

Discuss basic terminology used in the field of perinatal mental health
List the range of the diagnoses that occur during the childbearing years; and their clinical presentation relative to reproductive mental health
Review basic screening tolls uses to assess PMADs
Describe factors that elevate risk
Identify signs of heightened perinatal suicidality
Elucidate the role of race in outcomes for perinatal women of colour

When: Wednesday, April 24, 2024 from 1 p.m. to 4 p.m.

Where: Online (Zoom)

Registration: For full program overview and registration details please visit https://cvent.me/rRLgzE