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BackgroundDespite advances in clinical management, cytomegalovirus (CMV) infection remains a serious complication and an important cause of morbidity and mortality following kidney transplantation. Here, we explore the importance of viral load kinetics as predictors of risk and potential guides to therapy to reduce transplant failure in a large longitudinal Genome Canada Transplant Consortium (GCTC) kidney transplant cohort.MethodsWe examined the relationship between CMV infection rates and clinical characteristics, CMV viral load kinetics, and graft and patient outcomes in 2510 sequential kidney transplant recipients in the British Columbia Transplant Program. Transplants were performed between January 1, 2008, and December 31, 2018, were managed according to a standard protocol, and were followed until December 31, 2019, representing over 3.4 million days of care.ResultsLongitudinal CMV testing was performed in 2464 patients, of whom 434 (17.6%) developed a first episode of CMV viremia at a median of 120 (range: 9–3906) days post-transplant. Of these patients, 93 (21.4%) had CMV viremia only and 341 (78.6%) had CMV viremia with clinical complications, of whom 21 (4.8%) had resulting hospitalization. A total of 279 (11.3%) patients died and 177 (7.2%) patients lost their graft during the 12 years of follow-up. Patients with CMV infection were at significantly greater risk of graft loss (p=0.0041) and death (p=0.0056) than those without. Peak viral load ranged from 2.9 to 7.0 (median: 3.5) log10 IU/mL, the duration of viremia from 2 to 100 (15) days, and the viral load area under the curve from 9.4 to 579.8 (59.7) log10 IU/mL × days. All three parameters were closely inter-related and were significantly increased in patients with more severe clinical disease or with graft loss (p=0.001). Duration of the first CMV viremic episode greater than 15 days or a peak viral load ≥4.0 log10 IU/mL offered simple predictors of clinical risk with a 3-fold risk of transplant failure.ConclusionViral load kinetics are closely related to CMV severity and to graft loss following kidney transplantation and provide a simple index of risk which may be valuable in guiding trials and treatment to prevent transplant failure.

Abstract Background Stimulant use has been rising among people with opioid use disorder in recent years in North America, alongside a parallel rise in illicit drug toxicity (overdose) deaths. This study aimed to examine the association between stimulant use and overdose mortality. Methods Data from a universal health insurance client roster were used to identify a 20% random general population sample (aged ≥12) in British Columbia, Canada between January 1 2015 and December 31 2018 (N = 1,089,682). Provincial health records were used to identify people who used opioids and/or stimulants. Fatal overdose observed during follow-up (January 12,015- December 312,018) was retrieved from Vital Statistics Death Registry and BC Coroners Service Data. Potential confounders including age, sex, health region, comorbidities and prescribed medications were retrieved from the provincial client roster and health records. Results We identified 7460 people who used stimulants and or opioids. During follow-up there were 272 fatal overdose events. People who used both opioids and stimulants had more than twice the hazard of fatal overdose (HR: 2.02, 95% CI: 1.47-2.78, p

In Canada, it is challenging to find examples of positive population mental health interventions that meet scientific standards of evidence. It is even more difficult to identify effective interventions that address health equity. The discrepancy between standards of evidence in the health sciences, and the evidence that can be gleaned from social experiments, is not new. Efforts to reconcile these differences show a general tendency toward controlled interventions in public health. However, it is possible to extract findings from quasi-experimental interventions that meet scientific standards while also showing promise of positive impacts on mental health equity. This article describes work undertaken in 2015 to begin to address this evidence gap.

Introduction: British Columbia (BC) declared a public health emergency in April 2016 in response to a rapid rise in overdose deaths. Further understanding of health care utilization is needed to inform prevention strategies for individuals who overdose from illegal drugs. Methods: The Provincial Overdose Cohort includes linked administrative data on health care utilization by individuals who experienced an illegal drug overdose event in BC between 1 January 2015 and 30 November 2016. Overdose cases were identified using data from ambulance services, coroners’ investigations, poison control centre calls and hospital, emergency department and physician administrative records. In total, 10 455 overdose cases were identified and compared with 52 275 controls matched on age, sex and area of residence for a descriptive analysis of health care utilization. Results: Two-thirds (66%) of overdose cases were male and about half (49%) were 20–39 years old. Over half of the cases (54%) visited the emergency department and about one-quarter (26%) were admitted to hospital in the year before the overdose event, compared with 17% and 9% of controls, respectively. Nevertheless, nearly one fifth (19%) of cases were recorded leaving the emergency department without being seen or against medical advice. High proportions of both cases (75%) and controls (72%) visited community-based physicians. Substance use and mental health–related concerns were the most common diagnoses among people who went on to overdose. Conclusion: People who overdosed frequently accessed the health care system in the year before the overdose event. In light of the high rates of health care use, there may be opportunities to identify at-risk individuals before they overdose and connect them with targeted programs and evidence-based interventions. Further work using the BC Provincial Overdose Cohort will focus on identifying risk factors for overdose events and death by overdose.

L’augmentation des méfaits attribuables aux opioïdes constitue un problème de plus en plus préoccupant en santé publique au Canada. Cette analyse a utilisé les données de la Base de données sur la morbidité des hôpitaux et du Système national de rapports sur les soins ambulatoires pour déterminer le nombre d’hospitalisations et de visites aux services d’urgence en raison d’un empoisonnement aux opioïdes au Canada. Le nombre d’hospitalisations pour empoisonnement aux opioïdes a augmenté au cours des 10 dernières années, atteignant 15,6 par tranche de 100 000 habitants en 2016-2017, et celui des visites aux services d’urgence en raison d’un empoisonnement aux opioïdes a également augmenté en Alberta et en Ontario, les deux provinces qui ont recueilli des données des services d’urgence assez détaillées pour être analysées. Ces résultats soulignent l’importance de la surveillance pancanadienne des méfaits attribuables aux opioïdes, ainsi que la nécessité de politiques fondées sur des données probantes pour aider à les réduire.

BACKGROUND: Hepatitis C virus (HCV) eradication leads to reduced morbidity, mortality and transmission. Despite the disproportionate burden of HCV among sex workers, data regarding the HCV care continuum in this population remain negligible.

BACKGROUND: Undertreated pain is common among people who use illicit drugs (PWUD), and can often reflect the reluctance of health care providers to provide pain medication to individuals with substance use disorders.

Leaving hospital against medical advice (AMA) is common among people who use illicit drugs (PWUD) and is associated with severe health-related harms and costs. However, little is known about the prevalence of and factors associated with leaving AMA among PWUD.Data were collected through two Canadian prospective cohort studies involving PWUD between September 2005 and July 2011 and linked to a hospital admission/discharge database. Bivariable and multivariable generalized estimating equations were used to examine factors associated with leaving hospital AMA among PWUD who were hospitalized.Among 488 participants who experienced at least one hospitalization, 212 (43.4%) left the hospital AMA at least once during the study period. In multivariable analyses, factors positively and significantly associated with leaving hospital AMA included: unstable employment (AOR = 1.92; 95% confidence interval [CI]: 1.22-3.03); recent incarceration (AOR = 1.63; 95%CI: 1.07-2.49); ≥ daily heroin injection (AOR = 1.49; 95%CI: 1.05-2.11); and younger age per year younger (adjusted odds ratio [AOR] = 1.04; 95%CI: 1.02-1.06).We found a substantial proportion of PWUD in this setting left hospital AMA and that various markers of risk and vulnerability were associated with this phenomenon. Our findings highlight the need to address substance abuse issues early following hospital admission. These findings further suggest a need to develop novel interventions to minimize PWUD leaving hospital prematurely.