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Background: Electronic nicotine delivery systems (ENDSs), including electronic cigarettes (e-cigarettes), are rapidly gaining popularity. The aim of this study was to use poison centre data to describe epidemiological trends in ENDS-related exposures. Methods: We conducted an observational case series study using records containing both coded fields and free-text narratives from the British Columbia Drug and Poison Information Centre for all calls involving exposure to ENDS received from 2012 to 2017. We described trends in exposures and exposed people, as well as clinical effects. Results: A total of 243 calls were recorded for 186 unique exposures to ENDS devices, e-juice, e-cigarette cartridges and other associated paraphernalia over the study period. Calls related to ENDS exposures increased nearly sixfold between 2013 and 2014 and did not decline subsequently. Exposures were most frequently documented in children aged 4 years or less (81 [43.5%]), with 58 (31.0%) in 1- and 2-year-olds. Seventy-two exposures (89%) in children aged 4 years or less were due to accidental ingestion, whereas adults aged 25 years or more called the poison centre following ENDS malfunctions (7 [23%], spills (4 [13%]) and exposure to e-juice mistaken for other substances (4 [13%]). Of the 186 exposed people, 87 (46.8%) reported symptoms. Interpretation: British Columbia experienced a sixfold increase in ENDS-related calls to the provincial poison centre between 2012 and 2017, driven by ingestions in young children. Regulatory approaches aimed at minimizing children's access to ENDS, clear labelling of nicotine concentration, and packaging that reduces the likelihood of spills, product confusion and malfunction should be considered. [ABSTRACT FROM AUTHOR]

Background: Although aggregate data suggest a link between snowfall and myocardial infarction (MI), individual risk has yet to be assessed. We evaluated the association between quantity and duration of snowfall and the risk of MI using nonaggregated administrative health data.Methods: We used a case-crossover study design to investigate the association between snowfall and hospital admission or death due to MI in the province of Quebec, Canada, between November and April during 1981-2014. The main exposure measures were quantity (in centimetres) and duration (in hours) of snowfall by calendar day. We computed odds ratios (ORs) and 95% confidence intervals (CIs) for the association between daily snowfall and MI, adjusted for minimum daily temperatures.Results: In all, 128 073 individual hospital admissions and 68 155 deaths due to MI were included in the analyses. The likelihood of MI was increased the day after a snowfall among men but not among women. Compared with 0 cm, 20 cm of snowfall was associated with an OR of 1.16 for hospital admission (95% CI 1.11-1.21) and 1.34 for death (95% CI 1.26-1.42) due to MI the following day among men. Corresponding ORs among women were 1.01 (95% CI 0.95-1.07) and 1.04 (95% CI 0.96-1.13). Similar but smaller associations were observed for snowfall duration (0 h v. 24 h) and MI.Interpretation: Both the quantity and duration of snowfall were associated with subsequent risk of hospital admission or death due to MI, driven primarily by an effect in men. These data have implications for public health initiatives in regions with snowstorms. [ABSTRACT FROM AUTHOR]

Background: Hypothermia can result from exposure to cold or as a consequence of underlying physiologic vulnerabilities. Who, where, when and how British Columbians (and Canadians) die of hypothermia have received little research attention. The objective of this study was to describe the epidemiology of mortality due to hypothermia among residents of British Columbia. Methods: We examined all records in the death registry of the British Columbia Vital Statistics Agency between 1998 and 2012 that had an underlying or contributing cause of death coded for hypothermia or exposure to excessive natural cold. Results: Hypothermia or exposure to excessive natural cold was found to be the underlying or contributing cause in 384 deaths between 1998 and 2012. Mean age of decedents was 52 (SD 20.78) years and 73.2% were male. The annual death rate for hypothermia increased with age, ranging from 0.3 per 100 000 population among people aged 1-34 years to 1.6 per 100 000 population among those older than 75 years of age. The highest annual death rate occurred among older males (2.1 per 100 000 population) followed by older females (1.3 per 100 000 population). Although hypothermia-related deaths occurred year-round, 45.9% occurred during winter months (December, January and February) and, in particular, on days with lower temperatures (mean 0.56°C). Use of alcohol (40.1%) and other psychoactive substances (22.7%) were the most common additional causes of death identified among deaths due to hypothermia. Areas of British Columbia with the lowest population density or lowest socioeconomic status were found to have the highest crude hypothermia-related mortality rates. Interpretation: Our results showed that older people are at higher risk of hypothermia-related death. Among residents of British Columbia who died of hypothermia, the most frequent additional causes of death were alcohol and nonalcohol psychoactive substances. However, further assessment of both the occurrence and determinants of mortality due to hypothermia are needed to inform measures to reduce its impact. [ABSTRACT FROM AUTHOR]

Background: The epidemiology of mortality and morbidity from carbon monoxide poisoning in Canada has received little attention. Our objective was to evaluate trends in mortality and hospital admission rates for unintentional nonfire-related carbon monoxide poisoning across Canada. Methods: Age- and sex-standardized mortality (1981-2009) and hospital admission (1995-2010) rates by age group, sex and site of carbon monoxide exposure were calculated for each province and for all of Canada. We quantified the long-term trends by calculating the average annual percent change. Multivariable Poisson regression was used to estimate incidence rate ratios (IRRs) of carbon monoxide poisoning across age groups, sex and month of occurrence. Results: In Canada, there were 1808 unintentional nonfire-related carbon monoxide poisoning deaths between 1981 and 2009 and 1984 admissions to hospital between 1995 and 2010. Average annual decreases of 3.46% (95% confidence interval [CI] -4.59% to -2.31%) and 5.83% (95% CI -7.79% to -3.83%) were observed for mortality and hospital admission rates, respectively. Mortality (IRR 5.31, 95% CI 4.57 to 6.17) and hospital admission (IRR 2.77, 95% CI 2.51 to 3.03) rates were elevated in males compared with females. Decreased trends in the rates were observed for all sites of carbon monoxide exposure, but the magnitude of this decrease was lowest in residential environments. Deaths and admissions to hospital were most frequent from September to April, with peaks in December and January. Interpretation: Mortality and hospital admission rates for unintentional nonfire-related carbon monoxide poisoning in Canada have declined steadily. Continued efforts should focus on reducing carbon monoxide poisoning during the cooler months and in residential environments. [ABSTRACT FROM AUTHOR]

Research in several jurisdictions has shown that mortality increases during hot weather, for both rural and urban settings, but Canada's rural communities face unique vulnerabilities to heat that are often overlooked. Community health surveys would inform the identification of local populations susceptible to extreme heat and the development of services ready to support them during heat events. Overlooking rural communities in heat research and response could exacerbate many of the social, economic and health divides that are already widely experienced across Canada. [Extracted from the article]