Evergreen is Canada's first official national mental health framework for children that was developed by the Mental Health Commission of Canada in 2010. The program is primarily an online consultation service, which is a beneficial aspect since it provides widespread access for those seeking mental health services for children, especially those in rural and underserved areas. Despite the program's benefits and high ratings, Canada still lacks an adequate mental health framework for children because not all provinces and territories fulfilled the World Health Organization (WHO) criteria for child mental health, which shows that Evergreen has not been effective. As summarized in this review article, out of the 13 provinces and territories, the four provinces that met the minimum criteria for the WHO guidelines for child mental health policies were Ontario (ON), Alberta (AB), Saskatchewan (SK), and British Columbia (BC), with British Columbia being the leader in child mental health policies in Canada. For those that met the guideline, many performed poorly or failed to meet some of the WHO evaluation criteria for child mental health policies. For future progress, Canada should assess and evaluate its child mental health policies and incorporate that into a new and improved national standard and framework. Mental health data from Canada should also be analyzed to either implement an improved system or to fix old systems such as Evergreen that are currently in place. Finally, child mental health policy for Canada should constantly be reevaluated and improved to compensate for changes over time.

Previous studies have shown that there is increased mortality of cerebrovascular diseases such as stroke among Canadian women. The morbidity of stroke is also higher among Canadian women because they are less likely to recover from stroke, and they generally tend to have a greater disability from a stroke when compared to men. In order to help minimize these issues, six interventional strategies were evaluated using four criteria: 1) the evidence-based criterion, 2) the socioeconomic-based criterion, 3) the ethics-based criterion, and 4) the sustainable-based criterion. Upon analysis, two alternative interventional strategies were recommended: increased public awareness of stroke symptoms and increased public awareness of stroke risk factors among Canadian women.

Introduction: In September 2021 our emergency department (ED) switched from alteplase to tenecteplase for thrombolysis in acute ischemic stroke (AIS) 1 . Recent evidence suggests that tenecteplase may be as safe and effective as alteplase, while easier to dose and administer. We sought to reduce our door-to-needle (DTN) time, as faster treatment of AIS patients with fibrinolytics has been associated with improved outcomes 2 , reductions of in-hospital mortality and symptomatic intracerebral hemorrhage (ICH) 3 . Methods: Direct arriving patients entered into the Get With The Guidelines® Stroke (GWTG-Stroke) Patient Management Tool TM who received thrombolytics and were discharged from January 2019 through July 2022 were included. We compared outcomes before and after the switch from alteplase to tenecteplase in September 2021. The main outcome of this study was DTN time adjusted for demographic and clinical characteristics, including age, race/ethnicity, time of last known well, and presenting NIHSS. Data are presented as odds ratios (ORs) with 95% confidence intervals (CI) and statistical significance set at an alpha of 0.05. Results: Between January 2019 and July 2022, 127 patients met the inclusion criteria for this study, of which 82 received alteplase and 45 received tenecteplase. Patients who received tenecteplase had a median DTN time of 42 minutes (95% CI: 37.5-50.4) versus 60 minutes (95% CI: 60.2-74.9) for those who received alteplase (p<0.0001). A greater percentage of patients received tenecteplase, compared to patients who received alteplase, within 60 minutes (77.8% vs 51.2%, adjusted OR 3.74 (95% CI, 1.56-8.93) (p<0.01) and within 45 minutes (53.3% vs 30.5%, adjusted OR 3.26 (95% CI, 1.39-6.06) (p < 0.01). Rates of ICH within 36 hours did not differ significantly for patients receiving tenecteplase versus alteplase (4.4% versus 3.7%; p = 0.83), however it should be noted that overall ICH rate amongst the included patient population was 3.9% (n = 5). Conclusions: In conclusion, switching from alteplase to tenecteplase for the treatment of acute ischemic stroke significantly reduced DTN time in our ED without increasing ICH.