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kwong e.w.-y., pang s.m.-c., choi p.-p. & wong t.k.-s. (2010) Influenza vaccine preference and uptake among older people in nine countries. Journal of Advanced Nursing 66(10), 2297–2308. Aim. This paper is a report of a study delineating factors that influence older people’s preferences and uptake of the influenza vaccine in nine countries. Background. Vaccination uptake for the aging population in many countries still remains below the World Health Organization recommended rate. Older people who perceive higher susceptibility to and severity of influenza, and more benefits from vaccination and action cues prompting vaccination, tend to accept the vaccine, but those with more perceived barriers to vaccination are less likely to accept it. Method. A total of 208 older people from China, Indonesia, Turkey, Korea, Greece, Canada, the United Kingdom, Brazil and Nigeria were recruited to 14 vaccinated and 12 unvaccinated focus groups. They shared their experiences of influenza, and influenza vaccination, and promotion of influenza vaccination in focus groups. The data were collected in 2007. Findings. We identified five themes and generated a hypothetical framework for in-depth understanding of vaccination behaviour among older people. Participants’ vaccine preferences were determined by their behavioural beliefs in vaccination, which were based on their probability calculation of susceptibility to and severity of influenza and vaccine effectiveness, and their utility calculation of vaccine, healthcare and social costs. Action cues prompting vaccination and vaccine access further affected the vaccine uptake of participants with vaccine preferences. Vaccination coverage was likely to be higher in the countries where normative beliefs in favour of vaccination had formed. Conclusion. The hypothetical framework can be used to guide healthcare providers in developing strategies to foster normative beliefs of older people in vaccination, provide effective action cues and promote vaccine access. [ABSTRACT FROM AUTHOR]

Methadone treatment for heroin addiction has been available for 40 years, but there is relatively little research on the effectiveness of Canadian programs. This paper describes one-year retention among the client cohorts entering the British Columbia Methadone Program during expansion between 1996 and 1999, and examines some factors previously shown to influence retention. Fifty-two percent of program entrants were still receiving methadone one year after entry; 24% had left the program at one year but later returned. Age at program entry and average daily dose of methadone were important predictors of continuation. In the logistic regression, only the 1999 year-of-entry cohort appeared to have a different retention trajectory. Year of entry is not a significant predictor of time in the program for those receiving daily or short carry doses only, and other results are consistent between models. Retention rates in the BC Methadone Program are favourable and consistent with published rates. Program expansion does not reduce retention, once the effects of client age and dose are accounted for. Adequate daily dosing appears crucial to both initial retention and return to treatment. [ABSTRACT FROM AUTHOR]

Copyright of Vascular Access is the property of Canadian Vascular Access Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction and Aims: Recent years have witnessed increased attention to how cannabis use impacts the use of other psychoactive substances. The present study examines the use of cannabis as a substitute for alcohol, illicit substances and prescription drugs among 473 adults who use cannabis for therapeutic purposes.Design and Methods: The Cannabis Access for Medical Purposes Survey is a 414-question cross-sectional survey that was available to Canadian medical cannabis patients online and by hard copy in 2011 and 2012 to gather information on patient demographics, medical conditions and symptoms, patterns of medical cannabis use, cannabis substitution and barriers to access to medical cannabis.Results: Substituting cannabis for one or more of alcohol, illicit drugs or prescription drugs was reported by 87% (n = 410) of respondents, with 80.3% reporting substitution for prescription drugs, 51.7% for alcohol, and 32.6% for illicit substances. Respondents who reported substituting cannabis for prescription drugs were more likely to report difficulty affording sufficient quantities of cannabis, and patients under 40 years of age were more likely to substitute cannabis for all three classes of substance than older patients.Discussion and Conclusions: The finding that cannabis was substituted for all three classes of substances suggests that the medical use of cannabis may play a harm reduction role in the context of use of these substances, and may have implications for abstinence-based substance use treatment approaches. Further research should seek to differentiate between biomedical substitution for prescription pharmaceuticals and psychoactive drug substitution, and to elucidate the mechanisms behind both. [Lucas P, Walsh Z, Crosby K, Callaway R, Belle-Isle L, Kay B, Capler R, Holtzman S. Substituting cannabis for prescription drugs, alcohol, and other substances among medical cannabis patients: The impact of contextual factors. Drug Alcohol Rev 2016;35:326-333]. [ABSTRACT FROM AUTHOR]

Purpose: New regulations are in place at the federal and provincial levels in Canada regarding the way medical cannabis is to be controlled. We present them together with guidance for the safe use of medical cannabis and recent clinical trials on cannabis and pain.Source: The new Canadian regulations on the use of medical cannabis, the provincial regulations, and the various cannabis products available from the Canadian Licensed Producers were reviewed from Health Canada, provincial licensing authorities, and the licensed producers website, respectively. Recent clinical trials on cannabis and pain were reviewed from the existing literature.Principal Findings: Health Canada has approved a new regulation on medical marijuana/cannabis, the Marihuana for Medical Purposes Regulations: The production of medical cannabis by individuals is illegal. Health Canada, however, has licensed authorized producers across the country, limiting the production to specific licenses of certain cannabis products. There are currently 26 authorized licensed producers from seven Canadian provinces offering more than 200 strains of marijuana. We provide guidance for the safe use of medical cannabis. The recent literature indicates that currently available cannabinoids are modestly effective analgesics that provide a safe, reasonable therapeutic option for managing chronic non-cancer-related pain.Conclusion: The science of medical cannabis and the need for education of healthcare professionals and patients require continued effort. Although cannabinoids work to decrease pain, there is still a need to confirm these beneficial effects clinically and to exploit them with acceptable benefit-to-risk ratios. [ABSTRACT FROM AUTHOR]

BACKGROUND: Since the mid 1990's, Canada has introduced partial direct-to-consumer advertising (DTCA) of prescription drugs through administrative policy shifts. Little documentation exists on how regulation occurs in practice. OBJECTIVE: To evaluate Health Canada's response to complaints about DTCA. METHODS: We use case studies about DTCA spanning from 2000 to 2011 to examine the stringency of regulation by Health Canada. The aim was to identify key themes in Health Canada's approach to regulation from a public health perspective. All of the material related to the cases was independently read by each of the authors and any disagreements in interpretation were resolved through discussion. RESULTS: We identified six weaknesses in how Health Canada deals with DTCA: failure to act on concerns about promotion for unapproved 'off-label' uses, possible financial inducements to use a product, advertisements perceived to stimulate unwarranted fear about disease risks, and advertising of products with serious safety concerns identified in Health Canada safety advisories; ineffective enforcement actions undertaken by Health Canada; and lack of transparency in Health Canada's decision-making. CONCLUSIONS: There is an astonishing degree of discordance between public health priorities and regulation of DTCA in Canada. The current approach to enforcement is notable both for its lack of teeth and lack of accountability and transparency. [ABSTRACT FROM AUTHOR]

Background: With rising reports of antimicrobial resistance in outpatient communities, surveillance of antimicrobial use is imperative for supporting stewardship programs. The primary objective of this article is to assess the levels of antimicrobial use in Canada over time. Methods: Canadian antimicrobial use data from 1995 to 2010 were acquired and assessed by four metrics: population-adjusted prescriptions, Defined Daily Doses, spending on antimicrobials (inflation-adjusted), and average Defined Daily Doses per prescription. Linear mixed models were built to assess significant differences among years and antimicrobial groups, and to account for repeated measurements over time. Measures were also compared to published reports from European countries. Results: Temporal trends in antimicrobial use in Canada vary by metric and antimicrobial grouping. Overall reductions were seen for inflation-adjusted spending, population-adjusted prescription rates and Defined Daily Doses, and increases were observed for the average number of Defined Daily Doses per prescription. The population-adjusted prescription and Defined Daily Doses values for 2009 were comparable to those reported by many European countries, while the average Defined Daily Dose per prescription for Canada ranked high. A significant reduction in the use of broad spectrum penicillins occurred between 1995 and 2004, coupled with increases in macrolide and quinolone use, suggesting that replacement of antimicrobial drugs may occur as new products arrive on the market. Conclusions: There have been modest decreases of antimicrobial use in Canada over the past 15 years. However, continued surveillance of antimicrobial use coupled with data detailing antimicrobial resistance within bacterial pathogens affecting human populations is critical for targeting interventions and maintaining the effectiveness of these products for future generations. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Statistics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The objectives were to explore the tolerance of pediatric emergency medicine (PEM) physicians for risk in choosing when to perform procedural sedation and analgesia (PSA) and to describe adherence to preprocedural fasting guidelines and factors affecting the physicians' decisions. A survey of Canadian PEM physicians who perform PSA was conducted. Respondents were asked about their PSA practices. Risk tolerance was assessed using an economics-based stated preference elicitation method called a discrete choice experiment (DCE). Using a hypothetical clinical situation of a healthy child needing PSA, three fasting scenarios (ingestion of full meal < 2 hours ago, full meal between 2 and 4 hours ago, liquids less than 1 hour ago) were created. For each fasting scenario, 16-choice questions with varying numeric risks of major and minor adverse events were presented and respondents were asked whether they would administer PSA now or wait for guidelines to be met. In this exploratory study, choice data were analyzed using multivariate regression analysis, and preliminary inferential statistics are presented. A total of 114 (63.6%) completed surveys were returned. Respondents were 54% male, were in practice for a median of 6-10 years, and reported following fasting guidelines 53% of the time. Most had institutional fasting policies (70%), used ketamine (in 78% of PSA by 95% of users), and identified patient variables (prolonged pain, parental concern) as more important than environmental variables (patient flow, use of resources) in deciding when to administer PSA. Both major and minor risks of adverse events affected the choice of whether to do immediate PSA or wait until fasting guidelines were met. A 0.1-percentage-point increase in the probability of a major adverse event reduced physician likelihood of performing immediate PSA before meeting fasting guidelines by 17.6 percentage points. In comparison, a 10-percentage-point increase in the probability of a minor adverse event reduced physician likelihood of performing immediate PSA by 17.2%. Respondents were less likely to perform PSA immediately if a child had a full meal < 2 hours ago versus 2-4 hours ago or liquids < 1 hour ago. Sex, highest level of postgraduate training, frequency of performing PSA, and experience with a prior adverse event did not affect the choice to do immediate PSA. Years in practice affected the decision, with those in practice for 6-10 years more likely to perform immediate PSA than those in practice for shorter or longer. Those who reported having an institutional fasting policy were less likely to perform immediate PSA. These results suggest that fasting guidelines are not strictly adhered to in Canadian pediatric emergency departments (EDs) currently, and there is some willingness of physicians to change their sedation practice in light of evidence from hypothetical surveillance data about risks. On the other hand, some physicians suggest that they will follow guidelines regardless of how low the estimated risk is from surveillance data. An understanding of how physicians respond to evidence about small risks and how the information is best understood by this population is interesting for knowledge translation if evidence-based practice guidelines for procedural sedation in the ED are developed in the future. ACADEMIC EMERGENCY MEDICINE 2010; 17:1207-1215 © 2010 by the Society for Academic Emergency Medicine [ABSTRACT FROM AUTHOR]

Objectives: R483 is a thiazolidinedione peroxisome proliferator-activated receptor gamma (PPARγ) agonist with anti-diabetic properties and also a cytochrome P450 2C19 (CYP2C19) substrate. The aim of the clinical studies reported here was to investigate the influence of the CYP2C19 genotype on the pharmacokinetics (PK) of R483 in healthy subjects and in type 2 diabetes mellitus (T2DM) patients. Methods: Data came from two clinical studies, one including 58 Japanese and Caucasian healthy subjects and another including 93 Asian T2DM patients. All subjects received multiple doses of R483, 20 mg once daily for the healthy subjects and 12 mg once daily for the T2DM patients. Blood samples were taken up to 24 h after the last dose to determine plasma concentrations of R483 and its major metabolites. Results: Poor metabolizers (PMs; CYP2C19*2/*2 or *2/*3 or *3/*3) had a higher plasma exposure and a lower clearance of the parent drug than extensive metabolizers (EMs; CYP2C19*1/*1 or *1/*2 or *1/*3). The homozygous PM/EM ratio for the area under the plasma concentration-time curve (AUC) [95% confidence interval] was 3.9 [2.7-5.7] for healthy subjects versus 2.0 [1.5-2.6] in T2DM patients. The heterozygous EMs were all T2DM patients, the PM/EM ratio for AUC was 1.5 [1.2-1.8]. The dose-normalized exposure to R483 was 1.2- (for PMs) and 2.4-fold (for EMs) higher in T2DM patients than in healthy subjects. R483 was well tolerated in both studies. Conclusions: The plasma exposure to R483 was significantly higher in PMs than in EMs. R483 exhibits different PK in healthy subjects and T2DM patients, and the difference in exposure between EM and PM was less pronounced in T2DM patients than in healthy subjects. Factors such as diabetes condition and age may influence the metabolism of R483. This knowledge allowed for a realistic dose recommendation for poor metabolizer T2DM patients. [ABSTRACT FROM AUTHOR]

Objectives: In formulary committee deliberations, evidence for the efficacy of medications is often based on changes in the scale scores of patient-reported outcome measures. Our aim was to examine whether clinician judgement about the efficacy of medications for Alzheimer's disease, when added to scale score evidence, affects formulary committee members' recommendations about providing these medications under public insurance. Methods: The study was conducted using mixed methods. In a survey of formulary committee members in Canada, 32 participants were presented with scenarios that outlined different levels of efficacy for a medication. For each scenario, participants were asked to specify their likelihood of recommending that the medication be provided under public insurance. Of the 32 participants, 23 agreed to take part in an interview to explain the survey results. Content analysis was used to elicit recurrent themes across the interviews. Results: When a medication was disease modifying, use of clinician judgement increased the mean likelihood of recommending that the medication be provided under public insurance. Despite this, some participants felt formulary committees should not use clinician judgement because of risks of subjectivity and bias. However, other participants believed the addition of clinician judgement would enhance the clinical relevance of evidence that might otherwise be based entirely on changes in scale score. Conclusions: Clinician judgement about the efficacy of medications can influence formulary committee recommendations. This suggests the need for a new approach to govern the consideration of expert evidence during formulary committee deliberations. [ABSTRACT FROM AUTHOR]

Background: In Canada, federal regulations allow Nurse Practitioners (NPs) to authorize medical cannabis. Nursing regulatory bodies, however, have been hesitant to include medical cannabis within NPs' scope of practice. As the interest in cannabis increases, NPs have the potential to play a pivotal role in promoting the safe and appropriate use of cannabis. This study aimed to: summarize nursing policies in Canada related to medical cannabis; explore the perspective of nursing regulatory bodies regarding practice and policy issues related to medical cannabis; and examine the inclusion of medical cannabis content within Canadian NP curricula. Methods: A descriptive study was conducted that comprised three phases. The first phase reviewed nursing regulatory bodies' existing policies related to medical cannabis. In the second phase, practice consultants from nursing regulatory bodies were interviewed regarding policies and practices issues related to medical cannabis. The interviews were analyzed using thematic analysis. The third phase was a national survey of NP program coordinators regarding inclusion of cannabis in curricula. Descriptive statistics summarized survey responses. Results: Of the 12 nursing regulatory bodies in Canada, only 7 had policies or statements related to cannabis, with only Ontario allowing NPs to authorize medical cannabis. There was confusion among practice consultants regarding the role of nurses in the administration of medical cannabis and several barriers were identified regarding nursing engagement in care related to medical cannabis, including lack of knowledge and clinical guidelines. 60% of NP programs included cannabis in their curricula, however, less than half addressed the risks and benefits of medical cannabis and dosing and administration protocols. Limited faculty expertise was a barrier to including cannabis content in NP curricula. Conclusion: Nursing regulatory bodies must be proactive in developing policies and educational resources that will support nurses in providing safe and informed care related to cannabis. To ensure patients using medical cannabis receive consistent and safe care from nurses, harmonized regulations and policies are needed across all jurisdictions. Education programs must also provide updated knowledge and training for both registered nurses and NPs that will support them in providing non-judgemental and evidence-based care to the growing number of individuals using cannabis. [ABSTRACT FROM AUTHOR]