Search

We sought to characterize overdose and non-overdose mortality among PLWH amidst the illicit drug toxicity crisis in British Columbia, Canada. A population-based analysis of PLWH (age ≥19) in British Columbia accessing healthcare from April 1996 to March 2017 was conducted using data from the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) cohort linkage. Underlying causes of deaths were stratified into overdose and non-overdose causes. We compared (bivariate analysis) health-related characteristics and prescription history between PLWH died of overdose and non-overdose causes between April 2009 and March 2017. Among 9,180 PLWH, we observed 962 deaths (142 [14.7%] overdoses; 820 [85.2%] other causes). Compared to those who died from other causes, those who died of overdose were significantly younger (median age [Q, Q3]: 46 years [42, 52] vs. 54 years [48, 63]); had an indication of chronic pain (35.9% vs. 27.1%) and hepatitis C virus (64.8% vs. 50.4%), but fewer experienced hospitalization in the year before death. PLWH who died were most likely to be prescribed with opioids (>50%) and least likely with opioid agonist therapy (<10%) in a year before death. These findings highlight the syndemic of substance use, HCV, and chronic pain, and how the crisis is unqiuely impacting females and younger people. [ABSTRACT FROM AUTHOR]

Introduction: Calciphylaxis is a lethal and rare disease characterized by ischemic and necrotic skin lesions caused by vascular calcification of adipose tissue. There have been many risk factors analyzed in the literature; however, the pathogenesis of calciphylaxis is still not well understood and treatment options are limited due to the lack of interventional studies. Our objectives were to describe risk factors, prevalence, incidence, and outcomes for calciphylaxis in hemodialysis patients within the Fraser Health Renal Program. Methods: This was a retrospective matched case-control study of hemodialysis patients within the Fraser Health Renal Program. Hemodialysis patients with calciphylaxis were matched to hemodialysis patients without calciphylaxis in a 1:2 ratio for age and sex from September 2, 2017 to July 3, 2020. Findings: There was a total of 40 calciphylaxis cases matched to 80 controls. In the univariate analysis, peritoneal dialysis, higher body mass index, lower serum iron, lower transferrin saturation, sevelamer, cinacalcet, warfarin, iron (PO), and insulin were associated with increased risk of calciphylaxis. In the multivariate analysis, only peritoneal dialysis, serum iron, sevelamer, and warfarin were identified as significant and strong risk factors associated with calciphylaxis. A low prevalence of 1.9% and high mortality rate of 57.5% at 12 months was found for calciphylaxis cases. Discussion: Significant risk factors associated with calciphylaxis were peritoneal dialysis, serum iron, sevelamer, and warfarin. Future studies should further investigate the impact of minimizing exposure to these risk factors to reduce calciphylaxis development. [ABSTRACT FROM AUTHOR]

Background: Factors that impact recurrence in stages IB to IV include larger tumor, high-risk histology, older age, and lymphovascular invasion (LVI); however, local studies on risk factors for recurrence in British Columbia and our local recurrence patterns have not been well studied. Furthermore, the efficacy of treatment modalities including surgery and chemoradiation in the different stages of cervical cancer have not been clarified in this population. Objectives: The purpose of this study is to determine the disease and treatment characteristics of stages IB to IV cervical cancer which are associated with survival differences within British Columbia. Methods/Design: We performed a retrospective population study. A chart review on cervical cancer patients in British Columbia between 1 January 2010 and 31 December 2017 was done. Demographic data and treatment details were collected. Data were analyzed using multivariate Cox regressions, pairwise comparison using the Log-Rank test, and chi-square tests. Results: We included 780 patients (stage I: 31.5%, II: 20.0%, III: 34.5%, and IV: 3.3%). LVI and p16 negativity were associated with decreased overall survival (OS), and multivariate analyses show them to be independent risk factors for poorer survival. Surgical resection in stage I was associated with improved survival, but not with stages II–IV. The use of radical radiation therapy (RT), brachytherapy, and concurrent chemotherapy were independently associated with improved survival in stages II–IV. Peri-RT chemotherapy was not associated with survival benefit in adeno/adenosquamous carcinoma. There were 180 recurrences (23.1%), mostly distant metastases (42.8%). There were fewer recurrences after resection of tumors <2 cm compared to tumors 2 cm or larger (6.49% vs 31.3%, p = 0.00011). Only 37.7% of recurrence/metastases were treated with first-line carboplatin/paclitaxel/bevacizumab, but it was associated with better OS compared to other regimens (median OS 40.1 vs 24.8 months, p = 0.03). Conclusion: A significant portion of patients with localized cervical cancer relapse despite radical therapy, with LVI and p16 negativity associated with poorer survival. Surgical resection may still play a role in stage IB disease, while RT, brachytherapy, and concurrent chemotherapy should be considered first-line therapy in stage II–IV diseases. First-line carboplatin, paclitaxel, and bevacizumab for recurrence shows improved survival. [ABSTRACT FROM AUTHOR]

Past research on object constancy has tended to treat the viewer as a passive observer. Here we examine viewers' body and eye movements when they are asked to view photos of people in a gallery setting. Participants considered one individual in each photo, before indicating how socially connected they felt toward them and then moving to a spot in the gallery where they would be most comfortable when talking to them. Photographed individuals varied in their projected distance from the camera (near, far) and in their image resolution (sharp, slightly blurred). Results showed that participants looked more directly at near versus far individuals and at sharp versus blurred individuals. They also rated their social connection as stronger when the images were near versus far and sharp versus blurred. Where participants stood when making these ratings was strongly correlated with the projected distance of the images and with their ratings of social connection. These findings are discussed with regard to brain mechanisms for maintaining stability in our perceptions of geometric and social aspects of our world. They also highlight our inherent tendency to attribute qualities of our perceptual experiences to objects in that world. [ABSTRACT FROM AUTHOR]

PURPOSE Limited English-proficient (LEP) patients with non–small-cell lung cancer (NSCLC) may receive less palliative care services and more likely to receive aggressive end-of-life (EoL) care. Goals of this retrospective cohort study are to compare access to community palliative home care (CPHC), do not resuscitate (DNR) form completion, place of death, and health resource utilization at EoL between English-proficient (EP) and LEP patients with NSCLC in Vancouver, Canada. METHODS All patients with advanced NSCLC referred in 2016 and received medical care were included. Patients were classified as LEP if seen with a medical interpreter. Descriptive statistics and univariate and multivariate analyses were used to compare the outcomes between the two groups. RESULTS One hundred eighty-six patients were referred, 66% EP. Rates of CPHC referral and DNR form completion were the same for both groups (84% and 92%, P = 1.00). LEP patients received earlier access to CPHC (15 v 10 weeks before death, P = .039). Rates of ER visits within 6 months and 30 days of death were 0.89 for EP patients and 0.7 for LEP patients, P = .374, and 0.1 for EP patients and 0.13 for LEP patients, P = .244. Hospitalization rates within 6 months and 30 days of death were 1.4 for EP patients and 1.59 for LEP patients, P = .640, and 0.67 for EP patients and 0.81 for LEP patients, P = .091. EP patients were more likely to have a home death (26% v 14%), whereas LEP patients died in acute care (23% v 14%) or a tertiary palliative care unit (24% v 19%). This was not statistically significant (P = .335). LEP patients had better median overall survival (8.5 v 5.4 months, P < .001), but when controlled by age, mutation, and EP status, only receipt of palliative-intent systemic therapy was statistically significant. CONCLUSION EP and LEP patients with NSCLC have similar referral rates to CPHC, DNR form completion, and EoL health resource utilization. The measured EoL variables did not demonstrate significant disparities between EP and LEP patients. [ABSTRACT FROM AUTHOR]

Nonsuicidal self-injury (NSSI) is associated with intimate partner violence (IPV) perpetration and victimization. However, extant research has not distinguished between unidirectional and bidirectional IPV and has not examined relationships between IPV and functions of self-injury. This study of 1,018 university students revealed a significantly higher prevalence of NSSI among those who reported bidirectional IPV compared with nonviolent individuals. However, rates of NSSI in the unidirectional IPV groups are more similar to rates of NSSI in the bidirectional group than in nonviolent individuals. Individuals who engaged in bidirectional IPV were more likely to endorse interpersonal functions of self-injury than those who engaged in unidirectional IPV or no IPV. In contrast, intrapersonal functions of NSSI were not associated with IPV. Findings suggest that the association between IPV and NSSI may be best understood in the context of relationship conflict, rather than as a distinct correlate of either IPV victimization or IPV perpetration. [ABSTRACT FROM AUTHOR]

Wheelchairs enhance children's mobility and participation in daily life, yet few participation measures are used to evaluate wheeled mobility interventions. The Wheelchair Outcome Measure for Young People (WhOM-YP) addresses this gap, evaluating importance of and satisfaction with client-identified participation outcomes inside and outside home for children aged 18 years and younger who need wheeled mobility interventions. Mixed methods study using semi-structured interviews with nine experienced therapists and nine wheelchair users (11–18 years) evaluated the appropriateness of adult Wheelchair Outcome Measure for younger ages. Four key informants reviewed findings and offered additional modifications. Two-week test-retest reliability and construct validity were examined with children and parents; Spearman correlations were estimated among child and parent scores and Mann-Whitney U Test analyzed difference in outside home participation mean weighted satisfaction scores between new and experienced power mobility users. Modifications included age-appropriate changes, adding visuals to rating scales, and separate child and adult ratings dependent on child's age and abilities. Two week test-retest reliability estimates were as hypothesized; WhOM-YP mean satisfaction and mean weighted satisfaction summary scores for inside and outside home participation demonstrated intraclass correlation coefficient (ICC(2,1)) > 0.70. Discrimination between groups was as predicted; mean weighted satisfaction outside participation difference (p < 0.0001) demonstrated between experienced (median 74.2, n = 22) and inexperienced (median 32.9, n = 10) users. Revised format was conducive for individuals with diverse needs; images helped those with emerging numeracy and literacy skills, and proxy rating could be accommodated. Evidence supports WhOM-YP reliability and validity for measuring participation outcomes in daily life for young people. The WhOM-YP offers a client-centred, individualized, participation focused outcome measure for young people who use wheeled mobility. Therapists, children, youth and parents were consulted throughout its development to ensure that the measure is relevant to their needs. The WhOM-YP can be used with children 18 years-of-age and younger. Consistent ratings over a two-week period of time (when no change was expected) were stronger for those 8 years and older. Children as young as 5 years of age can use this measure to share their views but caution is needed in score interpretation for those below 8 years-of-age. The option of parent-report to augment or provide a proxy measure increases WhOM-YP usefulness in rating individualized participation outcomes for a more age and ability diverse population. This is the first study to examine reliability and validity evidence in regards to using the Wheelchair Outcome Measure for Young People (WhOM-YP) with children who have mobility limitations and their parents. [ABSTRACT FROM AUTHOR]

Objective To investigate all-cause and cause-specific mortality in SLE patients between two time periods, 1997–2005 and 2006–14. Methods We used an administrative health database from the province of British Columbia, Canada to match all incident SLE patients to 10 non-SLE individuals on sex, age and index date. Cohorts were divided into two subgroups, according to diagnosis year: early cohort 1997–2005 and late cohort 2006–14. The outcome was death [all-cause, renal disease, cancer, infection, cardiovascular disease (CVD) and other]. Hazard ratios (HR) and 95% CIs were estimated using univariate and multivariable Cox models. Results Among 6092 SLE patients and 60 920 non-SLE individuals, there were 451 and 1910 deaths, respectively. The fully adjusted all-cause mortality HR (95% CI) in the overall SLE cohort was 1.85 (1.66, 2.06), with no statistically significant improvement between early and late cohorts [1.95 (1.69, 2.26) vs 1.74 (1.49, 2.04)]. There was excess mortality from renal disease [3.04 (2.29, 4.05)], infections [2.74 (2.19, 3.43)] and CVD [2.05 (1.77, 2.38)], but not cancer [1.18 (0.96, 1.46)], in the overall SLE cohort. There was no statistically significant improvement in cause-specific mortality between early and late cohorts for renal disease [3.57 (2.37, 5.36) vs 2.65 (1.78, 3.93)], infection [2.94 (2.17, 3.98) vs 2.54 (1.84, 3.51)] and CVD [1.95 (1.60, 2.38) vs 2.18 (1.76, 2.71)]. There was no increase in cancer-related mortality in either cohort [1.27 (0.96, 1.69) vs 1.10 (0.82, 1.48)]. Conclusion This population-based study demonstrates a persisting mortality gap in all-cause and cause-specific deaths in SLE patients, compared with the general population. [ABSTRACT FROM AUTHOR]

Objectives: People living with human immunodeficiency virus in Canada can face criminal charges for human immunodeficiency virus non-disclosure before sex, unless a condom is used and their viral load is <1500copies/mL. We measured the reported impact of human immunodeficiency virus non-disclosure case law on violence from sexual partners among women living with human immunodeficiency virus in Canada. Methods: We used cross-sectional survey data from wave 3 participant visits (2017–2018) within Canadian HIV Women’s Sexual and Reproductive Health Cohort Study; a longitudinal, community-based cohort of women living with human immunodeficiency virus in British Columbia, Ontario and Quebec. Our primary outcome was derived from response to the statement: ‘[HIV non-disclosure case law has] increased my experiences of verbal/physical/sexual violence from sexual partners’. Participants responding ‘strongly agree/agree’ were deemed to have experienced increased violence due to the law. Participants responding ‘not applicable’ (i.e. those without sexual partners) were excluded. Multivariate logistic regression identified factors independently associated with increased violence from sexual partners due to human immunodeficiency virus non-disclosure case law. Results: We included 619/937 wave 3 participants. Median age was 46 (interquartile range: 39–53) and 86% had experienced verbal/physical/sexual violence in adulthood. Due to concerns about human immunodeficiency virus non-disclosure case law, 37% had chosen not to have sex with a new partner, and 20% had disclosed their human immunodeficiency virus status to sexual partners before a witness. A total of 21% self-reported that human immunodeficiency virus nondisclosure case law had increased their experiences of verbal/physical/sexual violence from sexual partners. In adjusted analyses, women reporting non-White ethnicity (Indigenous; African/Caribbean/Black; Other), unstable housing and high human immunodeficiency virus–related stigma had significantly higher odds of reporting increased violence from sexual partners due to human immunodeficiency virus non-disclosure case law. Conclusion: Findings bolster concerns that human immunodeficiency virus criminalization is a structural driver of intimate partner violence, compromising sexual rights of women living with human immunodeficiency virus. Human immunodeficiency virus non-disclosure case law intersects with other oppressions to regulate women’s sexual lives. [ABSTRACT FROM AUTHOR]