title: Impact of a labour disruption affecting local public health on the incidence of chlamydia infections in Toronto.
abstract: BACKGROUND
  Labour disruptions that interrupt services can be a natural experiment to examine the effect of halting a program. A five-week municipal labour disruption in Toronto during the summer of 2009 provided an opportunity to investigate the impact of reduced sexual health services.
  
  
  METHODS
  We examined the incidence of reported chlamydia in Toronto during the five years (2004-2008) preceding the labour disruption and during the periods just before, during, and after the labour disruption. Comparisons of actual reports for 2009 were made to immediately adjacent periods around the labour disruption, to historical trends and to forecasted rates. Interrupted time series analysis was used to test for significant differences in the trend of reported chlamydia incidence.
  
  
  RESULTS
  There was no significant difference in the trend of reported chlamydia incidence around the time of the strike. However, there was a small but significant increase in the incidence of reported chlamydia, particularly among females under 25 years old immediately following the labour disruption. The reported incidence for this group was higher than would be expected based on annual increases and projected seasonal trends.
  
  
  CONCLUSIONS
  There was a small increase in incidence of reported cases of chlamydia for certain groups that went beyond what is expected during the time immediately following the labour disruption. While causation cannot be implied from our ecological study, public health services may play a role in the control of sexually transmitted infections, even in the short-term. This underscores the need for future work to understand whether the changes observed can be attributed to the absence of these services.
authors: Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada ; Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
authors: Andrew D
authors: AD
authors: Pinto
authors: Effie
authors: E
authors: Gournis
authors: Dana
authors: D
authors: Al-Bargash
authors: Rita
authors: R
authors: Shahin
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009864:Ontario / Q000453:epidemiology; D012959:Socioeconomic Factors; D055815:Young Adult