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Self-collection may provide an opportunity for innovation within population-based human papillomavirus (HPV) cervical cancer screening programs by providing an alternative form of engagement for all individuals. The primary objective was to determine willingness to self-collect a vaginal sample for primary HPV screening and factors that impact willingness in individuals who participated in the Human Papillomavirus For Cervical Cancer (HPV FOCAL) screening trial, a large randomized controlled cervical screening trial. A cross-sectional online survey was distributed between 2017 and 2018 to 13,176 eligible participants exiting the FOCAL trial. Bivariate and multivariable logistic regression assessed factors that influence willingness to self-collect on 4945 respondents. Overall, 52.1% of respondents indicated willingness to self-collect an HPV sample. In multivariable analysis, the odds of willingness to self-collect were significantly higher in participants who agreed that screening with an HPV test instead of a Pap test was acceptable to them (odds ratio (OR): 1.45 (95% confidence interval (CI): 1.15, 1.82), those who indicated that collecting their own HPV sample was acceptable to them (p < 0.001), and those with higher educational ascertainment (OR: 1.31, 95% CI: 1.12, 1.54). The findings offer insight into the intentions to self-collect in those already engaged in screening, and can inform cervical cancer screening programs interested in offering alternative approaches to HPV-based screening.

The Human Papillomavirus FOr CervicAL cancer (HPV FOCAL) trial is a large randomized controlled trial comparing the efficacy of primary HPV testing to cytology among women in the population‐based Cervix Screening Program in British Columbia, Canada. We conducted a cost‐effectiveness analysis based on the HPV FOCAL trial to estimate the incremental cost per detected high‐grade cervical intraepithelial neoplasia of grade 2 or worse lesions (CIN2+). A total of 19,009 women aged 25 to 65 were randomized to one of two study groups. Women in the intervention group received primary HPV testing with reflex liquid‐based cytology (LBC) upon a positive finding with a screening interval of 48 months. Women in the control group received primary LBC testing, and those negative returned at 24 months for LBC and again at 48 months for exit screening. Both groups received HPV and LBC co‐testing at the 48‐month exit. Incremental costs during the course of the trial were comparable between the intervention and control groups. The intervention group had lower overall costs and detected a larger number of CIN2+ lesions, resulting in a lower mean cost per CIN2+ detected ($7551) than the control group ($8325), a difference of ‐$773 [all costs in 2018 USD]. Cost per detected lesion was sensitive to the costs of sample collection, HPV testing, and LBC testing. The HPV FOCAL Trial results suggest that primary HPV testing every 4 years produces similar outcomes to LBC‐based testing every 2 years for cervical cancer screening at a lower cost., The Human Papillomavirus FOr CervicAL cancer (HPV FOCAL) trial is a large randomized controlled trial comparing primary HPV testing to liquid‐based cytology for cervical cancer screening. We conducted a cost‐effectiveness analysis alongside the HPV FOCAL trial. Results showed the intervention group yielded a higher rate of detected cervical intraepithelial neoplasia of grade 2 or worse lesions (CIN2+) at a lower mean cost per CIN2+ detected ($7551) than the control group ($8325), a difference of −$773. Findings suggest that primary HPV testing is cost‐effective compared to liquid‐based cytology.

Purpose Currently, people leaving prisons face concurrent risks from the COVID-19 pandemic and the overdose public health emergency. The closure or reduction of community services people rely on after release such as treatment centres and shelters has exacerbated the risks of poor health outcomes and harms. This paper aims to learn from peer health mentors (PHM) about changes to their work during overlapping health emergencies, as well as barriers and opportunities to support people leaving prison in this context. Design/methodology/approach The Unlocking the Gates (UTG) Peer Health Mentoring Program supports people leaving prison in British Columbia during the first three days after release. The authors conducted two focus groups with PHM over video conference in May 2020. Focus groups were recorded and transcribed, and themes were iteratively developed using narrative thematic analysis. Findings The findings highlighted the importance of peer health mentorship for people leaving prisons. PHM discussed increased opportunities for collaboration, ways the pandemic has changed how they are able to provide support, and how PHM are able to remain responsive and flexible to meet client needs. Additionally, PHM illuminated ways that COVID-19 has exacerbated existing barriers and identified specific actions needed to support client health, including increased housing and recovery beds, and tools for social and emotional well-being. Originality/value This study contributes to our understanding of peer health mentorship during the COVID-19 pandemic from the perspective of mentors. PHM expertise can support release planning, improved health and well-being of people leaving prison and facilitate policy-supported pandemic responses.

Background: Long-term safety of a single negative human papillomavirus (HPV) test for cervical cancer screening is unclear. The HPV FOr cerviCAL Cancer Trial (FOCAL) was a randomized trial comparing HPV testing with cytology. The FOCAL-DECADE cohort tracked women who received one HPV test during FOCAL, and were HPV negative, for up to 10 years to identify cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and grade 3 or worse (CIN3+) detected through a provincial screening program. Methods: FOCAL participants who received one HPV test, were negative, and had at least one post-FOCAL cervix screen were included (N = 5,537). We constructed cumulative incidence curves of CIN2+/CIN3+ detection, analyzed cumulative risk of detection at intervals post-HPV test, calculated average incidence rates for detection, and compared hazard across ages. Results: Ten years after one negative HPV test, the probability of CIN2+ detection was lower than 1%, with most lesions detected 7 years or later. Average incidence rates of CIN2+/CIN3+ lesions over follow-up were 0.50 [95% confidence interval (CI), 0.31–0.78] and 0.18 (95% CI, 0.07–0.36) per 1,000 person-years, respectively. Hazards were higher for younger ages (nonsignificant trend). Conclusions: Among women with a single negative HPV test, long-term risk of CIN2+ detection was low, particularly through 7 years of follow-up; thus, one negative HPV test appears to confer long-term protection from precancerous lesions. Even 10-year risk is sufficiently low to support extended testing intervals in average-risk populations. Impact: Our findings support the safety of screening policies using HPV testing alone at 5-year or longer intervals.

This study describes long-term viral load (VL) trajectories and their predictors among women living with HIV (WLWH), using data from Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment (SHAWNA), an open prospective cohort study with linkages to the HIV/AIDS Drug Treatment Program. Using Latent Class Growth Analysis (LCGA) on a sample of 153 WLWH (1088 observations), three distinct trajectories of detectable VL (≥50 copies/ml) were identified: ‘sustained low probability of detectable VL’, characterized by high probability of long-term VL undetectability (51% of participants); ‘ high probability of delayed viral undetectability’, characterized by a high probability VL detectability at baseline that decreases over time (43% of participants); and ‘ high probability of detectable VL’, characterized by a high probability of long-term VL detectability (7% of participants). In multivariable analysis, incarceration (adjusted odds ratio (AOR) = 3.24; 95%CI:1.34–7.82), younger age (AOR = 0.96; 95%CI:0.92–1.00), and lower CD4 count (AOR = 0.82; 95%CI:0.72–0.93) were associated with ‘ high probability of delayed viral undetectability’ compared to ‘sustained low probability of detectable VL.’ This study reveals the dynamic and heterogeneous nature of WLWH’s long-term VL patterns, and highlights the need for early engagement in HIV care among young WLWH and programs to mitigate the destabilizing impact of incarceration on WLWH’s HIV treatment outcomes.

BACKGROUND AND AIMS: Reported associations between previous incarceration and the risk of overdose-related death are substantially heterogeneous and previous studies are limited by an inability to control for confounding factors in risk assessment. This study investigated the associations of overdose-related death with previous incarceration and the number or cumulative duration of previous incarcerations, and individual or neighbourhood characteristics that may potentially modify the associations. Design and setting A cohort study using a 20% random sample of residents in British Columbia, Canada. PARTICIPANTS: 765,690 persons aged 23 years or older at baseline of January 1, 2015. Mean age was 50 years; 49% were males. MEASUREMENTS: Previous incarcerations that occurred during the 5-year exposure period (January 2010 to December 2014) were identified using provincial incarceration records. Overdose-related deaths that occurred during the 3-year follow-up period (January 2015 to December 2017) were identified using linked administrative health data. Baseline individual and neighbourhood characteristics were assessed using the provincial health insurance data. FINDINGS: In the cohort, 5,743 persons had an incarceration history during the exposure period, and 634 persons died from drug overdose during the follow-up period. The mortality rate was 897 and 22 per 100,000 person-years for persons who did and did not have an incarceration history, respectively. After adjusting for baseline individual and neighbourhood characteristics (without any interaction term), persons who had an incarceration history were 4.04 times (95% confidence interval 3.23-5.06) more likely to die from drug overdose compared with persons without an incarceration history. The association was stronger for females, persons without diagnoses of substance use disorder, and persons without dispensation of opioids for pain or benzodiazepines (P < 0.001 for each interaction term). There was no discernible linear trend between the number or cumulative duration of previous incarcerations and the risk of overdose-related death. CONCLUSIONS: Previous incarceration appears to be a major risk factor for overdose-related death.

The large and growing population of people who experience incarceration makes prison health an essential component of public health and a critical setting for reducing health inequities. People who experience incarceration have a high burden of physical and mental health care needs and have poor health outcomes. Addressing these health disparities requires effective governance and accountability for prison health care services, including delivery of quality care in custody and effective integration with community health services. Despite the importance of prison health care governance, little is known about how prison health services are structured and funded or the methods and processes by which they are held accountable. A number of national and subnational jurisdictions have moved prison health care services under their ministry of health, in alignment with recommendations by the World Health Organization and the United Nations Office on Drugs and Crime. However, there is a critical lack of evidence on current governance models and an urgent need for evaluation and research, particularly in low- and middle-income countries. Here we discuss why understanding and implementing effective prison health governance models is a critical component of addressing health inequities at the global level.

Given sub-optimal HIV care outcomes for people living with HIV (PLWH) post-release from incarceration, we systematically searched peer-reviewed literature (2010-2021) describing controlled trial interventions aimed at improving Antiretroviral Therapy (ART) adherence and care linkage following release from correctional facilities for PLWH. Of 392 studies, 16 (4%) met the inclusion criteria. All studies were conducted in the United States and involved some form of intensive case management. Trials that scored highest in terms of study quality provided cell phones for engagement, reported sustained viral load suppression as a measurable outcome to infer ART adherence, and measured longitudinal data collected for at least 3-to-6 months following release. The two trials that demonstrated improved HIV viral load suppression involved Peer Navigators, and incentivized undetectable viral load, respectively. Facilitating support for addictions and addressing other social and structural barriers to achieving optimal health is also of vital importance in bridging care gaps for PLWH.Debido a los resultados suboptimos en los cuidados de las personas que viven con VIH después de su liberación del encarcelamiento, nosotros realizamos una revisión sistemática de la literatura (2010–2021) que describe ensayos control de intervenciones para mejorar la adherencia a la terapia antiretrovirales (TAR) y el vinculo con la atención medica después de la liberación del encarcelamiento de las personas que viven con VIH. De los 392 estudios, 16 (4%) cumplieron con los criterios de inclusión. Todos los estudios fueron realizados en los Estados Unidos e incluyen alguna forma de cuidados con manejo intensivo. Los ensayos que tenían los puntajes mas altos en términos de calidad proveían teléfonos celulares para la vinculación, reportaban supresión de la carga viral sostenida como medida indirecta de adherencia al TAR, y han medido datos longitudinales por lo menos de tres a seis meses después de la liberación carcelaria. Los dos ensayos que demostraron mejora en la supresión de la carga viral del VIH involucraban a los pares navegadores e incentivaban la carga viral no detectable, respectivamente. Facilitando el soporte para la adicción y el entendimiento de otras barreras sociales y estructurales para alcanzar una salud optima, es de vital importancia para superar las brechas en la atención de las personas que viven con VIH.

ObjectiveTo study participant’s acceptability of and attitudes towards human papillomavirus (HPV) testing compared with cytology for cervical cancer screening and what impact having an HPV positive result may have in future acceptability of screening.DesignCross-sectional online survey of clinical trial participants.SettingPrimary care, population-based Cervix Screening Program, British Columbia, Canada.ParticipantsA total of 5532 participants from the HPV FOCAL trial, in which women received HPV and cytology testing at study exit, were included in the analysis. Median age was 54 years. The median time of survey completion was 3 years after trial exit.Outcome measuresAcceptability of HPV testing for primary cervical cancer screening (primary); attitudes and patient perceptions towards HPV testing and receipt of HPV positive screen results (secondary).ResultsMost respondents (63%) were accepting of HPV testing, with the majority (69%) accepting screening to begin at age 30 years with HPV testing. Only half of participants (54%) were accepting of an extended screening interval of 4–5 years. In multivariable logistic regression, women who received an HPV positive screen test result during the trial (OR=1.41 95% CI 1.11 to 1.80) or were older (OR=1.01, 95% CI 1.00 to 1.02) were more likely to report HPV testing as acceptable.ConclusionsIn this evaluation of acceptability and attitudes regarding HPV testing for cervix screening, most are accepting of HPV testing for screening; however, findings indicate heterogeneity in concerns and experiences surrounding HPV testing and receipt of HPV positive results. These findings provide insights for the development of education, information and communication strategies during implementation of HPV-based cervical cancer screening.Trial registration numbersISRCTN79347302 and NCT00461760.

To explore the perceptions of oral health and access to care experiences of men with a history of incarceration and to identify factors contributing to current oral health inequities within their community.A qualitative approach was used via focus group discussions among 18 men with a history of incarceration and 10 staff members of a non-profit organization working with individuals who are involved in or at risk of involvement with the criminal justice system. All discussions were audiorecorded and transcribed verbatim. A thematic analysis was undertaken usingThe participants ranged in age from 29 years to 69 years, came from a variety of ethnic backgrounds, and had different prison setting experiences. Five major themes emerged: not on the radar, stigma of incarceration, being shot down, caught in the system, and institutional conditioning.The personal backgrounds, experiences with health and dental care during prison time, and the unique challenges faced by men with a history of incarceration influenced their perceptions and their ability to access dental services. Dental professionals can help to change these perceptions and experiences by creating a safe space for these individuals to access and receive care comfortably.Explorer la perception sur la santé buccodentaire et l’accès aux soins des hommes ayant des antécédents d’incarcération et cibler les facteurs qui contribuent aux inégalités actuelles en matière de santé buccodentaire au sein de leur communauté.Une approche qualitative a été utilisée au moyen de groupes de discussion comprenant 18 hommes ayant des antécédents d’incarcération et 10 membres du personnel d’un organisme sans but lucratif qui travaillent avec des personnes impliquées ou à risque d’être impliquées dans le système de justice pénale. Toutes les discussions ont fait l’objet d’un enregistrement sonore et ont été transcrites mot pour mot. Une analyse thématique a été effectuée au moyen du programme de données qualitativesLes participants étaient âgés de 29 ans à 69 ans, étaient issus d’origines ethniques variées et avaient vécu différentes expériences en milieu carcéral. Cinq thèmes principaux sont ressortis, y compris ce qui ne figure pas sur l’écran radar, les préjugés associés à l’incarcération, être rejetés, être coincés dans le système, et le conditionnement institutionnel.Les antécédents personnels, les expériences en matière de santé et de soins buccodentaires au cours de la peine d’emprisonnement, et les enjeux uniques auxquels sont confrontés les hommes ayant des antécédents d’incarcération ont influencé leur perception des services buccodentaires et leur capacité d’y accéder. Les professionnels dentaires peuvent aider à changer la perception et les expériences de ces personnes en créant un endroit sécuritaire pour eux, qui leur permet d’accéder aux services et de les recevoir confortablement.

Objective The aim of this study was to systematically review the literature on gendered implications of incarceration for HIV outcomes and engagement in care for women living with HIV (WLWH). Design We systematically searched seven bibliographic databases, for peer-reviewed English-language studies, published between 2007 and 2017 reporting on incarceration, women (transgender inclusive) and HIV. Methods Articles were included for evaluation if they reported outcomes for at least one of three measures of interest: viral load, antiretroviral therapy (ART) adherence or engagement in care among WLWH along incarceration trajectories. Results Out of 1119 studies, 24 (2%) met the inclusion criteria. Of these 24 studies, the majority (n = 23) were conducted in the USA, 19 included samples of women and men and seven studies were transgender inclusive. Our review did not reveal clear sex differences in HIV outcomes during periods of incarceration; however, studies reporting postincarceration outcomes demonstrated significant sex disparities in all three outcomes of interest. Following incarceration, women were less likely to be virally suppressed, less likely to achieve optimal ART adherence and less likely to be engaged in care. Conclusion Despite growing numbers of incarcerated WLWH globally, there is a substantial gap in research examining the impact of incarceration on HIV outcomes for WLWH. Significant sex disparities in HIV outcomes and engagement in care exist along incarceration trajectories for WLWH, especially postincarceration. For improved health outcomes, research is needed to examine the experiences of WLWH throughout incarceration trajectories to develop interventions tailored to the specific needs of WLWH both during and following incarceration.

As part of a participatory health research project seeking to support men in achieving their health goals during the transition from prison to community, a workshop program was developed and piloted in a Community Residential Facility in British Columbia, Canada. The pilot program was evaluated through feedback surveys at each of the 16 workshops and a focus group interview at the end of the program. Workshops were highly valued by participants and seen as a means for (1) building skills relevant to their health and wellness, (2) working toward changing attitudes and behaviors adopted in prison, and (3) helping others and accepting help from others. Similar programs may be an effective support for men working to achieve their health goals during other transitions (e.g., bereavement, cancer patients, returning soldiers, and veterans).

Background Interruptions in healthcare services contribute to an elevated risk of overdose in the weeks following release from incarceration. This study examined the association of use of community healthcare with nonfatal and fatal overdose in the 30 days following release. Methods We conducted a retrospective cohort study using linked administrative data from a random sample of 20% of the population of British Columbia. We examined releases from provincial correctional facilities between January 1, 2015 – December 1, 2018. We fit multivariate Andersen-Gill models to examine nonfatal overdoses after release from incarceration and applied Standard Cox regression for analyses of fatal overdoses. Results There were a combined 16,809 releases of 6,721 people in this study. At least one overdose occurred in 2.8% of releases. A community healthcare visit preceded the first nonfatal overdose in 86.4% of releases with a nonfatal overdose event. Only 48.4% of people who had a fatal overdose used community healthcare. In adjusted analysis, people who had used community healthcare had a higher hazard of healthcare-attended nonfatal overdose (aHR 2.83 95% CI 2.13, 3.78) and lower hazard of fatal overdose (aHR 0.58, 95%CI 0.28, 1.19). Conclusions Community healthcare visits after release from custody may be an important opportunity to provide overdose prevention and harm reduction supports. Policies and resourcing are needed to facilitate better connection to primary healthcare during the transition to community. Providers in community should be equipped to offer care to people who have recently experienced incarceration in a way that is accessible, acceptable and trauma-informed.

Background During the transition between prison and community, people are at greatly increased risk for adverse health outcomes. This study describes a peer health mentoring program that supports women in the first 3 days after their release from a provincial correctional facility in British Columbia. Methods We used a participatory health research framework to develop multimethod processes to describe the Unlocking the Gates Peer Health Mentoring Program. Mentors are women with incarceration experience. Between 2013 and 2018, women released from Alouette Correctional Centre for Women were invited to access the program. All program clients were invited to participate in the surveys and interviews. We analyzed survey and interview data using descriptive analysis for quantitative data and content analysis for qualitative data. Results There were 346 program contacts from 340 women over the study period. For every contact, a telephone interview was conducted. Among the 346 contacts, 173 women met their mentor, of whom 172 (99.4%) completed the intake and consent forms. A total of 105 women (61.0%) completed a program activity feedback survey at the end of the mentoring period. Women identified a range of needed supports during the transition from prison to community, including access to clothing, social assistance, housing and health care. Participants described a mix of emotions surrounding release, including excitement, anxiety, hope, and a wish for understanding and support. Within 3 days of release, 49 participants (46.7%) had accessed a family physician, and 89 (84.8%) had accessed at least 1 community resource. Ninety-eight participants (93.3%) reported that their mentor assisted them in accessing community resources. Interpretation Peer health mentoring provides valuable, multifaceted support in helping women to navigate health and social services and to meet their basic needs. Strengthening health supports during the transition from prison to community is critical to promoting the health and well-being of women leaving prison.

Despite women living with HIV (WLWH) being disproportionately criminalized and overrepresented within correctional facilities, there remains limited longitudinal research with WLWH examining factors that make WLWH vulnerable to incarceration. Data are drawn from SHAWNA (

IMPORTANCE: There is limited information about the relative effectiveness of cervical cancer screening with primary human papillomavirus (HPV) testing alone compared with cytology in North American populations. OBJECTIVE: To evaluate histologically confirmed cumulative incident cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) detected up to and including 48 months by primary HPV testing alone (intervention) or liquid-based cytology (control). DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial conducted in an organized Cervical Cancer Screening Program in Canada. Participants were recruited through 224 collaborating clinicians from January 2008 to May 2012, with follow-up through December 2016. Women aged 25 to 65 years with no history of CIN2+ in the past 5 years, no history of invasive cervical cancer, or no history of hysterectomy; who have not received a Papanicolaou test within the past 12 months; and who were not receiving immunosuppressive therapy were eligible. INTERVENTIONS: A total of 19 009 women were randomized to the intervention (n = 9552) and control (n = 9457) groups. Women in the intervention group received HPV testing; those whose results were negative returned at 48 months. Women in the control group received liquid-based cytology (LBC) testing; those whose results were negative returned at 24 months for LBC. Women in the control group who were negative at 24 months returned at 48 months. At 48-month exit, both groups received HPV and LBC co-testing. MAIN OUTCOMES AND MEASURES: The primary outcome was the cumulative incidence of CIN3+ 48 months following randomization. The cumulative incidence of CIN2+ was a secondary outcome. RESULTS: Among 19 009 women who were randomized (mean age, 45 years [10th-90th percentile, 30-59]), 16 374 (8296 [86.9%] in the intervention group and 8078 [85.4%] in the control group) completed the study. At 48 months, significantly fewer CIN3+ and CIN2+ were detected in the intervention vs control group. The CIN3+ incidence rate was 2.3/1000 (95% CI, 1.5-3.5) in the intervention group and 5.5/1000 (95% CI, 4.2-7.2) in the control group. The CIN3+ risk ratio was 0.42 (95% CI, 0.25-0.69). The CIN2+ incidence rate at 48 months was 5.0/1000 (95% CI, 3.8-6.7) in the intervention group and 10.6/1000 (95% CI, 8.7-12.9) in the control group. The CIN2+ risk ratio was 0.47 (95% CI, 0.34-0.67). Baseline HPV-negative women had a significantly lower cumulative incidence of CIN3+ at 48 months than cytology-negative women (CIN3+ incidence rate, 1.4/1000 [95% CI, 0.8-2.4]; CIN3+ risk ratio, 0.25 [95% CI, 0.13-0.48]). RESULTS: Among 19 009 women who were randomized (mean age, 45 years [10th-90th percentile, 30-59]), 16 374 (8296 [86.9%] in the intervention group and 8078 [85.4%] in the control group) completed the study. At 48 months, significantly fewer CIN3+ and CIN2+ were detected in the intervention vs control group. [Table: see text] CONCLUSIONS AND RELEVANCE: Among women undergoing cervical cancer screening, the use of primary HPV testing compared with cytology testing resulted in a significantly lower likelihood of CIN3+ at 48 months. Further research is needed to understand long-term clinical outcomes as well as cost-effectiveness. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN79347302

We aimed to determine if a history of recent imprisonment affects access to primary care. Using patient roles, we telephoned to request an initial appointment with all family physicians (n = 339) who were accepting new patients in British Columbia, Canada. We sequentially assigned patient scenarios: male or female recently released from prison; male or female control. Controls were 1.98 (95% CI, 1.59-2.46) times as likely to be offered an appointment compared with persons recently released from prison, with an absolute risk difference of 41.8% (95% CI, 31.0-52.5). Our study suggests discrimination is a barrier to primary care for people released from prison, even with universal health insurance. We need to improve access to primary care during the high-risk period following prison release.

Background: The HPV FOCAL Trial is a RCT comparing human papilloma virus (HPV) with Liquid Based Cytology (LBC) screening for cervical cancer. Results are presented for the comparison of the Safety and Control arms after two rounds. Methods: HPV FOCAL included randomisation of women aged 25–65 into the Safety arm, where they were initially screened with HPV and the Control arm, where they received entry screening with LBC, with both arms screened again with LBC at 24 months. Results: There are 6203 (Safety) and 6075 (Control) women included in this analysis. For the Safety vs Control arms, Round 1 screening resulted in increased detection of cervical intraepithelial neoplasia 2 or worse (CIN2+),15.3 vs 10.4 per 1000, RR=1.48 (95%CI=1.08–2.03) and higher colposcopy referral rates, 5.6% vs 3.2%. LBC screening at 24 months resulted in similar colposcopy referral rates, 1.5% vs 1.9%, and decreased CIN2+ detection, 2.0 vs 4.7 per 1000, RR=0.43 (95%CI=0.21–0.88) in the Safety vs Control arms. CIN2+ detection and colposcopy referral rates declined with increasing age in both arms. One round of HPV screening detected similar levels of CIN2+ as two rounds of LBC screening. Interpretation: CIN2+ detection at 2 years was lower in those screened by HPV, indicating an improved 2-year negative predictive value of the HPV test.

Objectives: The intervention objectives were to evaluate and describe the feasibility of using a community-based research (CBR) approach to adapt and implement HIV-prevention materials and tools with incarcerated men. We found no prior published reports about CBR HIV-prevention education in Canadian correctional facilities. Methods: Twelve members of the correctional Peer Education Committee (PEC) and Aboriginal PEC, whom a correctional nurse identified as being interested in preventive health, were purposively invited to participate. Eight participants were serving life sentences, three were Aboriginal and their education levels ranged from below grade 8 to 11 years of post-secondary education. The setting was a medium-security federal correctional facility, housing 324 men. The intervention was guided by CBR and ‘greater involvement of people with AIDS’ principles. Participants were invited to attend four workshops, over seven days in May 2014, and to provide their insights regarding future scaled-up CBR HIV prevention. Each workshop included an HIV-prevention presentation and a focus group discussion, two of which were audio-recorded. Findings: All participants attended all sessions. Synthesis of mixed-method findings, with quantitative and qualitative data triangulation, demonstrated two major outcomes: ‘new knowledge was generated’ regarding feasibility of CBR HIV prevention in a men’s correction facility; and ‘capacity building occurred’ with increased participants’ social capital. Thirty incarcerated men requested HIV testing following the intervention, because participants spread their knowledge about HIV prevention to others. Participants asked to become ‘health ambassadors’ – champion advisors for future scaled-up CBR HIV-prevention intervention for the entire correctional facility. Conclusion: CBR HIV prevention is feasible within a Canadian men’s correctional facility.

Supplemental Digital Content is Available in the Text. This descriptive case series among adults documents that pain can return temporarily at healed, previously pain-free injury sites during acute opioid withdrawal., Withdrawal pain can be a barrier to opioid cessation. Yet, little is known about old injury site pain in this context. We conducted an exploratory mixed-methods descriptive case series using a web-based survey and in-person interviews with adults recruited from pain and addiction treatment and research settings. We included individuals who self-reported a past significant injury that was healed and pain-free before the initiation of opioids, which then became temporarily painful upon opioid cessation—a phenomenon we have named withdrawal-associated injury site pain (WISP). Screening identified WISP in 47 people, of whom 34 (72%) completed the descriptive survey, including 21 who completed qualitative interviews. Recalled pain severity scores for WISP were typically high (median: 8/10; interquartile range [IQR]: 2), emotionally and physically aversive, and took approximately 2 weeks to resolve (median: 14; IQR: 24 days). Withdrawal-associated injury site pain intensity was typically slightly less than participants' original injury pain (median: 10/10; IQR: 3), and more painful than other generalized withdrawal symptoms which also lasted approximately 2 weeks (median: 13; IQR: 25 days). Fifteen surveyed participants (44%) reported returning to opioid use because of WISP in the past. Participants developed theories about the etiology of WISP, including that the pain is the brain's way of communicating a desire for opioids. This research represents the first known documentation that previously healed, and pain-free injury sites can temporarily become painful again during opioid withdrawal, an experience which may be a barrier to opioid cessation, and a contributor to opioid reinitiation.

HPV FOCAL is a randomized control trial of cervical cancer screening. The intervention arm received baseline screening for high-risk human papillomavirus (HPV) and the control arm received liquid-based cytology (LBC) at baseline and 24 months. Both arms received 48-month exit HPV and LBC cotesting. Exit results are presented for per-protocol eligible (PPE) screened women. Participants were PPE at exit if they had completed all screening and recommended follow-up and had not been diagnosed with cervical intraepithelial neoplasia Grade 2 or worse (CIN2+) earlier in the trial. Subgroups were identified based upon results at earlier trial screening. There were 9,457 and 9,552 and women aged 25-65 randomized to control and intervention and 7,448 (77.8%) and 8,281 (86.7%), respectively, were PPE and screened. Exit cotest results were similar (p = 0.11) by arm for PPE and the relative rate (RR) of CIN2+ for intervention vs. control was RR = 0.83 (95% CI: 0.56-1.23). The RR for CIN2+ comparing intervention women baseline HPV negative to control women with negative cytology at baseline and at 24 months, was 0.68 (95% CI: 0.43-1.06). PPE women who had a negative or CIN1 colposcopy in earlier rounds had elevated rates (per 1,000) of CIN2+ at exit, control 31 (95% CI: 14-65) and intervention 43 (95% CI: 25-73). Among PPE women HPV negative at exit LBC cotesting identified little CIN2+, Rate = 0.3 (95% CI: 0.1-0.7). This per-protocol analysis found that screening with HPV using a 4-year interval is as safe as LBC with a 2-year screening interval. LBC screening in HPV negative women at exit identified few additional lesions.

KEY POINTS Globally and in Canada, incarcerated populations have a higher prevalence of both acute and chronic health conditions than the general population.[1][1],[2][2] People who experience incarceration have an increased risk of death across almost all disease categories and are particularly

Objective To estimate the impact of implementing primary human papilloma virus liquid-based cytology (LBC) screening on four-year rates of referral for colposcopy in the British Columbia screening program. Methods We used data on referral for colposcopy from an RCT (HPV FOCAL) comparing HPV testing every four years with LBC testing every two years. We also used data from population screening with conventional cytology among women aged 25 to 69. The predicted effect of adoption of either trial protocol on rates of referral for colposcopy was estimated using trial age-specific result and screening result-specific rates weighted by their screening program distribution. The cumulative age-specific rates of referral for colposcopy over four years were calculated. Results Use of HPV testing initially increased rates of referral for colposcopy in the trial, but over four years the cumulative rates of referral were similar to those for LBC except in women aged 25 to 29, in whom a substantial excess persisted. Four-year rates of referral for colposcopy declined with age in women screened with HPV testing, LBC, and conventional cytology. Extrapolating the trial results to the distribution in the provincial screening program, implementation of either HPV or LBC throughout the provincial population would approximately double the current rates of referral for colposcopy. Conclusion Compared with LBC screening, primary screening for HPV increased rates of referral for colposcopy only among women aged 25 to 29. In contrast to current practice, referral for colposcopy was largely driven by the trial protocol recommendations for the management of abnormal results and not by which screening test was used.

Objective The Changing Childbirth in British Columbia study explored women’s preferences and experiences of maternity care, including women’s role in decision-making. Methods Following content validation by community members, we administered a cross-sectional online survey exploring novel topics, including drivers for interventions, and experiences of autonomy, respect, or mistreatment during maternity care. Using the Mothers Autonomy in Decision-Making (MADM) scale as an outcome measure in a mixed-effects analysis, we examined differential experiences by socio-demographic and prenatal risk profile, type of care provider, interventions received, and nature of communication with care providers. Results A geographically representative sample of Canadian women (n = 2051) reported on 3400 pregnancies. Most women (95.2%) preferred to be the lead decision-maker during care. Patients of physicians had significantly lower autonomy (MADM) scores than midwifery clients as did women who felt pressured to accept interventions. Women who had a difference in opinion with their provider, and those who felt their provider seemed rushed reported the lowest MADM scores. Conclusion Women’s autonomy is significantly altered by model of maternity care, the nature of interactions with care providers, and women’s ability for self-determination. Practice Implications If health professionals acquire skills in person-centred decision-making experience of autonomy among pregnant women may improve.

The purpose of this research was to engage, empower and enhance the health and well-being of incarcerated women. The integration of primary health care, community-based participatory research, a settings approach to health promotion, and transformative action research guided the design of this study. A partnership between incarcerated women who became peer-researchers, correctional staff, and academic researchers facilitated the equitable contribution of expertise and decision-making by all partners. The study was conducted in a short sentence (two years or less), minimum/medium security Canadian women’s correctional centre. Of the approximately 200 women that joined the research team, 115 participated in writing a ‘paragraph of passion’ while incarcerated between November, 2005 and August, 2007. Participatory, inductive qualitative, narrative and content analysis were used to illuminate four themes: expertise, transformation, building self-esteem, as well as access and support. The women organized monthly health forums in the prison to share their new knowledge and life experience with other incarcerated women, correctional staff, academics, and community members, and in doing so have built bridges and relationships, some of which have lasted to the present day.

Purpose – Women in prison throughout the world experience higher rates of mental and physical illness compared with the general population and compared with men in prison. The paper finds no published studies that report on men or women in prison engaging in participatory health research to address their concerns about nutrition and fitness. The purpose of this paper is to describe a pilot nutrition and fitness program, which resulted from a unique prison participatory health research project. Design/methodology/approach – Women in prison designed, led, and evaluated a six-week pilot fitness program in a minimum/medium security women's prison. Pre- and post-program assessments included a self-administered questionnaire and body measures. Open-ended questionnaire responses illuminated the quantitative findings. Findings – Sixteen women in prison completed the program evaluation. Weight, body mass index, waist-to-hip ratio, and chest measurements decreased, and energy, sleep, and stress levels improved by the end of the program. Research limitations/implications – As a component of a participatory research project, incarcerated women designed and led a nutrition and fitness program, which resulted in improved body measures and self-reported health benefits. Originality Value – Incarceration provides opportunities to engage women in designing their own health programs with consequent potential long-term “healing” benefits.

In 1998, the North American Primary Care Research Group (NAPCRG) adopted a groundbreaking Policy Statement endorsing responsible participatory research (PR) with communities. Since that time, PR gained prominence in primary care research.To reconsider the original 1998 Policy Statement in light of increased uptake of PR, and suggest future directions and applications for PR in primary care. This work contributed to an updated Policy Statement endorsed by NAPCRG in 2015.32 university and 30 community NAPCRG-affiliated research partners, convened a workshop to document lessons learned about implementing processes and principles of PR. This document emerged from that session and reflection and discussion regarding the original Policy Statement, the emerging PR literature, and our own experiences.The foundational principles articulated in the 1998 Policy Statement remain relevant to the current PR environment. Lessons learned since its publication include that the maturation of partnerships is facilitated by participatory processes that support increased community responsibility for research projects, and benefits generated through PR extend beyond research outcomes. Future directions that will move forward the field of PR in primary care include: (i) improve assessment of PR processes to better delineate the links between how PR teams work together and diverse PR outcomes, (ii) increase the number of models incorporating PR into translational research from project inception to dissemination, and (iii) increase application of PR approaches that support patient engagement in clinical settings to patient-provider relationship and practice change research.PR has markedly altered the manner in which primary care research is undertaken in partnership with communities and its principles and philosophies continue to offer means to assure that research results and processes improve the health of all communities.

Complete Round 1 data (baseline and 12-month follow-up) for HPV FOCAL, a randomized trial establishing the efficacy of HPV DNA testing with cytology triage as a primary screen for cervical cancer are presented. Women were randomized to one of three arms: Control arm - Baseline liquid-based cytology (LBC) with ASCUS results triaged with HPV testing; Intervention and Safety arms - Baseline HPV with LBC triage for HPV positives. Results are presented for 15,744 women allocated to the HPV (intervention and safety combined) and 9,408 to the control arms. For all age cohorts, the CIN3+ detection rate was higher in the HPV (7.5/1,000; 95%CI: 6.2, 8.9) compared to the control arm (4.6/1,000; 95%CI: 3.4, 6.2). The CIN2+ detection rates were also significantly higher in the HPV (16.5/1,000; 95%CI: 14.6, 18.6) vs. the control arm (10.1/1,000; 95%CI: 8.3, 12.4). In women ≥35 years, the overall detection rates for CIN2+ and CIN3+ were higher in the HPV vs. the control arm (CIN2+:10.0/1,000 vs. 5.2/1,000; CIN3+: 4.2/1,000 vs. 2.2/1,000 respectively, with a statistically significant difference for CIN2+). HPV testing detected significantly more CIN2+ in women 25-29 compared to LBC (63.7/1,000; 95%CI: 51.9, 78.0 vs. 32.4/1,000; 95%CI: 22.3, 46.8). HPV testing resulted in significantly higher colposcopy referral rates for all age cohorts (HPV: 58.9/1,000; 95%CI: 55.4, 62.7 vs.30.9/1,000; 95%CI: 27.6, 34.6). At completion of Round 1 HPV-based cervical cancer screening in a population-based program resulted in greater CIN2+ detection of across all age cohorts compared to LBC screening.

Background Burkholderia contaminans is an emerging pathogen in the cystic fibrosis (CF) setting. Included in the Burkholderia cepacia complex (Bcc), B. contaminans is a Gram negative, motile, obligate aerobe previously classified as a pseudomonad. Previous reports have described B. contaminans isolation from patients in Portugal, Switzerland, Spain, Argentina and the USA. This, however, is the first report relating to B. contaminans affecting Irish patients with CF, initially detected in a paediatric setting. Case presentation Burkholderia contaminans was identified in the routine analysis of sputum from a fourteen year old boy, at his annual review and subsequently from the sputum from his 19 year old brother. RecA gene sequencing and pulsed field gel electrophoresis (PFGE) were unable to distinguish between the isolates, which demonstrated with susceptibility to ciprofloxacin, cotrimoxazole, meropenem, pipercillin/tazobactam and ceftazidime. Both isolates were resistant to aztreonam, with reduced susceptibility to tobramycin. Following treatment with intravenous meropenem and ceftazidime, oral ciprofloxacin and nebulised tobramycin for 6 weeks, sputum specimens from both patients were negative for B. contaminans. No other member of the local CF cohort proved positive. Conclusions Bcc bacteria are associated with poor prognosis in CF and decreased life expectancy, specifically leading to a more rapid decline in lung function and, in some cases, to a fatal necrotizing pneumonia known as the “cepacia syndrome”. Some species exhibit innate resistance to multiple antimicrobial agents and their transmission rate can be high in susceptible patients. In that context, we describe the first incidence of CF-related B. contaminans in Ireland and its successful eradication from two patients, one paediatric, using an aggressive antimicrobial regimen.

Background: Round 1 data of human papillomavirus (HPV) FOCAL, a three-arm, randomised trial, which aims to establish the efficacy of HPV DNA testing as a primary screen for cervical cancer, are presented. Methods: The three arms are: Control arm – liquid based cytology with atypical squamous cells of unknown significance (ASC-US) triage with hrHPV testing; Intervention Arm – hrHPV at entry with liquid-based cytology (LBC) triage of hrHPV positives, with exit screen at 4 years; Safety check arm – hrHPV at entry with LBC triage of hrHPV positives with exit screen at 2 years. Results: A total of 6154 women were randomised to the control arm and 12 494 to the HPV arms (intervention and safety check). In the HPV arm, the baseline cervical intraepithelial neoplasia (CIN)2+ and CIN3+ rate was 9.2/1000 (95%CI; 7.4, 10.9) and 4.8/1000 (95%CI; 3.6, 6.1), which increased to 16.1/1000 (95%CI 13.2, 18.9) for CIN2+ and to 8.0/1000 (95%CI; 5.9, 10.0) for CIN3+ after subsequent screening of HPV-DNA-positive/cytology-negative women. Detection rate in the control arm remained unchanged after subsequent screening of ASC-US-positive/hrHPV DNA-negative women at 11.0/1000 for CIN2+ and 5.0/1000 for CIN3+. Conclusion: After subsequent screening of women who were either hrHPV positive/cytology negative or ASC-US positive/HPV negative, women randomised to the HPV arms had increased CIN2+ detection compared with women randomised to the cytology arm.

PurposeThe purpose of this paper is to describe the development, by incarcerated women who were members of a prison participatory health research team, of a survey tool regarding homelessness and housing, the survey findings and recommendations for policy.Design/methodology/approachA survey was developed by incarcerated women in a minimum/medium security women's prison in Canada. Associations were examined between socio‐demographic factors and reports of difficulty finding housing upon release, homelessness contributing to a return to crime, and a desire for relocation to another city upon release. Open‐ended questions were examined to look for recurrent themes and to illuminate the survey findings.FindingsIn total, 83 women completed the survey, a 72 per cent response rate. Of the 71 who were previously incarcerated, 56 per cent stated that homelessness contributed to their return to crime. Finding housing upon release was a problem for 63 per cent and 34 per cent desired relocation to another city upon release. Women indicated that a successful housing plan should incorporate flexible progressive staged housing.Research limitations/implicationsThe present study focuses only on incarcerated women but could be expanded in future to include men.Practical implicationsIncarcerated women used the findings to create a housing proposal for prison leavers and created a resource database of the limited housing resources for women prison leavers.Social implicationsLack of suitable housing is a major factor leading to recidivism. This study highlights the reality of the cycle of homelessness, poverty, crime for survival, street‐life leading to drug use and barriers to health, education and employment that incarcerated women face.Originality/valueHousing is a recognized basic determinant of health. No previous studies have used participatory research to address homelessness in a prison population.

The inaugural collaborative Canadian Prison‐Academic‐Community Health and Education was organized by the Collaborating Centre for Prison Health and Education and supported by the University of British Columbia (UBC), Nicola Valley Institute of Technology (NVIT) and Simon Fraser University (SFU) on 4th and 5th December 2008. The conference objective was to encourage and facilitate collaborative opportunities for enhancing health, education, research, service and advocacy, for the social well‐being and (re)integration of individuals in custody, their families and communities. Four conference goals were articulated: (1) To share promising practices, current evidence and scholarship in health and education related to prison populations. (2) To bring together prison, academic and community members to create collaborative opportunities for partnerships and reciprocal learning. (3) To discuss and develop policy initiatives to promote positive change within prison health and education. (4) To explore the mental, physical, emotional and spiritual aspects of prisoner health and education.

Contexte : Le personnel clinique d'une prison pour femmes en Colombie-Britannique a observe une seroconversion par le virus de l'hepatite C chez les detenues, ce qui nous a amenes a determiner, dans le cadre de notre etude, les caracteristiques des femmes qui declarent ou non avoir consomme des drogues illicites en prison, les tendances de la consommation de drogues en prison, ainsi que les facteurs associes a la consommation de drogues illicites qui pourraient contribuer a la transmission d'infections vehiculees par le sang en prison. Methode : Nous avons cree un ensemble de donnees d'observation transversales d'apres les reponses obtenues a un questionnaire anonyme de 61 questions, que les detenues ont rempli par elles-memes. Resultats : Quatre-vingt-trois p. cent (104/126) des detenues admissibles ont participe a l'etude. Soixante-quatorze p. cent (77/104) ont declare que leur peine d'emprisonnement actuelle etait liee a la consommation de drogues illicites, et 25 % (26/104) ont dit etre d'appartenance ethnique autochtone. Quatre-vingt-treize p. cent (97/104) ont fait etat d'antecedents de consommation de drogues illicites; de ce chiffre, 70 % (68/97) ont declare avoir fait usage de drogues injectables. Trente-six p. cent (37/104) ont declare avoir consomme des drogues illicites en prison, et 21 % (22/104), avoir fait usage de drogues injectables en prison. Cinquante-deux p. cent (54/104) ont dit etre seropositives pour le VHC, et 8 % (8/104) ont dit etre seropositives pour le VIH. Sur les 22 femmes qui s'etaient injecte des drogues en prison, 91 % (20/22) ont dit etre infectees par l'hepatite C, et 86 % (9/22) avaient partage des aiguilles en prison (nettoyees ou non a l'eau de javel au prealable). Les detenues etaient plus susceptibles de declarer avoir consomme des drogues illicites en prison si elles avaient gagne des revenus de sources illicites avant leur incarceration (p = 0,0081, RC = 3,19), si elles s'etaient deja injecte des drogues (p = 0,036, RC = 2,97) et si elles s'etaient deja injecte des drogues au domicile d'un ami ou d'une amie (p = 0,066, RC = 2,70). Interpretation : La majorite des femmes qui disent avoir fait usage de drogues injectables en prison declarent aussi etre seropositives pour le VHC et avoir partage des aiguilles. Les prisons canadiennes presentent des risques de transmission des agents pathogenes vehicules par le sang, et il devrait etre possible d'y implanter des strategies de reduction des mefaits.

Objective : To develop evidence-based consensus recommendations on the delivery of cervical cancer screening, human papillomavirus (HPV) education, HPV testing, and the optimal tool for cervical cytology within the Canadian health system. Participants : Leading up to a forum held in Ottawa on November 21 and 22, 2003, 254 registrants reviewed position papers through a Web-based discussion group. Experts in program management, clinicat practice, epidemiology, public health, economies, and women’s health, representing 48 organizations, then participated in the 2-day forum to develop consensus recommendations. Evidence : Writing groups prepared position papers on optimal methods for cervical cytology; education concerning HPV; HPV testing in primary screening; HPV testing as a triage tool in cytopathology; and delivery mechanisms for cervical screening. Systematic reviews were the primary source of evidence supplemented by literature searches. Consensus Process : Feedback from Web-based discussions was incorporated into consecutive drafts of position papers. At the forum, recommendations and supporting evidence were presented, further debated in small-group sessions, and discussed in a plenary session. Despite divergent professional mandates and opinions, consensus was achieved on 15 recommendations across all areas. Final recommendations were posted to the Web for further input and circulated for written consensus by participants. Conclusions : The recommendations cover the use of new evidence and technologies in cervical cancer prevention in Canada and provide a framework for provision of HPV education, planning the implementation of new cervical screening technologies in Canada, the development of evaluation plans, and new research areas. Recommendations : 1. In keeping with the ultimate goal of implementing an organized cervical screening program, each province and territory should prioritize the components of an organized screening program, and then incrementally implement the components as feasible. (III-B) 2. Each province and territory should implement a comprehensive population-based cervical screening database that includes data on the target population of eligible women, all screening tests completed, results of all screening tests, all follow-up tests, the diagnoses, and outcomes. The information in this database should be available to the patient and health-care provider to inform their screening decisions. (II-3-B) 3. A set of population-based performance indicators and targets for cervical screening should be developed on a pan-Canadian basis, building on the work previously completed by the Cervical Cancer Prevention Network (CCPN); provincial/territorial cervical screening programs should be regularly evaluated at a provincial/territorial/national level using these indicators. (III-B) 4. HPV information, within a broader sexual health context, should be provided to all Canadians. Education initiatives should be developed to be specific and sensitive to age, sex/gender, culture, language, and sexual orientation, among ether factors. Education initiatives should be devised with input from representatives of the target audience and their educators to maximize effectiveness. Multiple mediums, including public education; health-care providers; and media sources, among ether modes of outreach, should deliver the HPV information. Education topics should include the link between HPV and cervical cancer; epidemiology of HPV in Canada; types of HPV; transmission; symptoms; risk and protective factors; prevention; possible consequences of HPV infection, including cervical cancer; and the importance of cervical screening. Adequate resources need to be allocated to this education plan. (III-3-B) 5. HPV information should be provided to those (including health educators, teachers, youth counsellors, and health-care providers) educating the Canadian public about HPV. (III-B) 6. An expert working group should be convened to prepare a consensus statement on the scientific evidence regarding the link between HPV and cervical cancer, including evidence on HPV transmission, symptoms, risk and protective factors, methods of prevention, and possible consequences of HPV infection, including cervical cancer. This statement should outline what the evidence indicates and where evidence is lacking, and should recognize HPV as a health issue for both men and women. (III-B) 7. Funding should support a research agenda to provide a knowledge base to inform and support HPV education initiatives. (III-B) 8. Liquid-based cytology (LBC) screening should be implemented within the context of an organized program. This recommendation should be re-evaluated within the context of emerging knowledge of the role of HPV testing in primary screening. (II-2-B) 9. The implementation of LBC within the context of an organized screening program should include: (a) a clinical/economic analysis to determine the most appropriate screening interval for LBC; the analysis should include evaluation of the most appropriate ages from initiation to cessation of screening; (b) investment in laboratory equipment and support for operational costs; (c) a comprehensive program of training and continuing education for cytopathologists and cytotechnologists; (d) a program for educating health-care providers in the proper techniques for obtaining LBC specimens and monitoring their quality; (e) enhancement of existing laboratory quality assurance and external review programs to monitor the performance of LBC; (f) a review of the slide limits set by Canadian professional and regulatory bodies for screening LBC slides; (g) evaluation of the use of automated screening instruments for LBC samples including clinical and cost-effectiveness. (III-B) 10. Combined cytology-HPV testing in primary screening of women aged 30 to 69 years should be evaluated within the context of an adequate Canadian organized screening program. Scientific evidence supports the performance of HPV testing in primary screening, but there is insufficient knowledge regarding its implementation within the context of a Canadian public health program to recommend it in routine primary screening. (II-2-B) 11. Evaluation of HPV testing in primary screening should be conducted within a Canadian organized program to optimize screening intervals, screening modalities (including cytologie method and primary screening tool(s)), and target age ranges. Evaluation should establish appropriate assessment and management strategies to triage positive women, cost-effectiveness, and the acceptance of screening policies by health-service providers and women, and should permit the assessment of emerging technologies that are indicated by strong evidence. (II-1-A) 12. A formal Canadian network of researchers and service deliverers should be established to facilitate collaboration and timely diffusion of research and evaluation data to identify adaptation requirements for Canadian organized programs and to coordinate the evaluated implementation of HPV testing in primary screening. (III-B) 13. HPV testing should be used to triage among women 30 years of age and older with an ASC-US (atypical squamous cells of undetermined significance) Papanicolaou (Pap) test. (II-1-A) 14. A nationally led and facilitated pan-Canadian effort should establish a national consensus management algorithm. (III-B) 15. Pan-Canadian coordination and development of quality improvement initiatives should be centrally supported to facilitate consistent, comparable evidence-based approaches to cervical cancer prevention and management. (III-B)

Social responsibility and accountability can be important core values in medical education. At the University of British Columbia, undergraduate medical students engage in prison health community service-learning opportunities in regional correctional facilities.To describe the impact of prison health exposure on pre-clinical medical students, in-depth individual interviews were conducted with individuals who had participated in a prison health medical education program. All interviews were transcribed verbatim, and interpretive descriptive methods were used to inductively derive thematic findings to describe students' experiences.Major themes emerged as students reported how (1) exposure to incarcerated populations increases students' insight into issues that diverse marginalized sub-populations encounter; (2) positive interactions with the incarcerated individuals enhances relationship building; (3) collaboration reinforces teamwork skills and (4) community placements garner important learning opportunities within the medical school curriculum.Our findings demonstrated that pre-clinical exposure to incarcerated individuals and prison health education provided a unique setting for medical students to develop an increased sense of social responsibility and accountability.

Objectives: This health promotion project used participatory processes to engage all stakeholders to design and pilot preventive health tools in partnership with and for individuals with incarceration experience. This article outlines the methods of engaging with this marginalized population and interventions conducted to successfully utilize participation in the planning phases of the project to develop collaborative values, mission, and project scope. Participants: Eighteen men and women with incarceration experience participated through two community organizations that were invited to work as project partners. Setting: Participatory planning was conducted through an iterative process and partnership between an academic institution and community organizations. Intervention: Engagement was developed through community networks and partnership building, including articulation of shared values and formation of a Project Advisory Committee. Participatory planning was facilitated through focus groups and interviews conducted with prison leavers to narrow the scope of the project to three health priority areas. Discussion analysis was conducted using interpretive phenomenological qualitative methodology to extract themes in terms of underlying systemic barriers to health and suggestions for ways to address them. Outcomes: The interventions resulted in collaborative project planning and allowed for the prioritization of promoting holistic health for individuals with incarceration experience in mental health and addiction, cancer, and blood-borne infectious diseases by sharing knowledge, supporting selfadvocacy, and strengthening relationships. Discussion: Community engagement and participatory processes allowed the project to be more relevant to those it serves, and also meaningfully engaged prison leavers in an empowering participatory process to address health inequities.

A reduction in participation rates for cervical cancer screening (CCS) by women aged 20 to 24 in the Canadian province of British Columbia led to this study evaluating young women's knowledge of CCS and identifying barriers to and facilitators of participation in CCS. A qualitative design was used and focus groups were held with a total of 80 women. Barriers to participation in CCS included difficulty finding health-care providers and the invasiveness of the Pap test. Facilitators included assistance with finding a health-care provider, availability of female providers, established relationship with a provider or clinic, and education about Pap tests. Education about the importance of CCS and assistance with finding health-care providers are key factors in increasing young women's participation in screening.

Background In the HPV FOCAL trial, we will establish the efficacy of hr-HPV DNA testing as a stand-alone screening test followed by liquid based cytology (LBC) triage of hr-HPV-positive women compared to LBC followed by hr-HPV triage with ≥ CIN3 as the outcome. Methods/Design HPV-FOCAL is a randomized, controlled, three-armed study over a four year period conducted in British Columbia. It will recruit 33,000 women aged 25-65 through the province's population based cervical cancer screening program. Control arm: LBC at entry and two years, and combined LBC and hr-HPV at four years among those with initial negative results and hr-HPV triage of ASCUS cases; Two Year Safety Check arm: hr-HPV at entry and LBC at two years in those with initial negative results with LBC triage of hr-HPV positives; Four Year Intervention Arm: hr-HPV at entry and combined hr-HPV and LBC at four years among those with initial negative results with LBC triage of hr-HPV positive cases Discussion To date, 6150 participants have a completed sample and epidemiologic questionnaire. Of the 2019 women enrolled in the control arm, 1908 (94.5%) were cytology negative. Women aged 25-29 had the highest rates of HSIL (1.4%). In the safety arm 92.2% of women were hr-HPV negative, with the highest rate of hr-HPV positivity found in 25-29 year old women (23.5%). Similar results were obtained in the intervention arm HPV FOCAL is the first randomized trial in North America to examine hr-HPV testing as the primary screen for cervical cancer within a population-based cervical cancer screening program. Trial Registration International Standard Randomised Controlled Trial Number Register, ISRCTN79347302

Objectives: the purpose of this research was to determine the feasibility of engaging incarcerated women in community-based participatory research and to identify, by and with the women, the health concerns to be addressed. Design: the integration of primary health care, community-based participatory research, a settings approach to health promotion and transformative action research guided the overall design of this study. Participants: Incarcerated women, correctional centre staff and academic researchers participated collaboratively. Setting. The study was conducted in the main short sentence (two years or less) minimum/medium security women’s correctional centre in a Canadian province. Results: In-depth interviews were conducted with 16 incarcerated women; in-depth group interviews were facilitated with 16 correctional centre staff. Twenty-one themes, which emerged from participatory, inductive and content analysis of the data, were presented at a face-to-face meeting attended by 120 incarcerated women, 10 correctional centre staff and 5 academic researchers. Underlying values and principles for the project were identified prior to a discussion of the results. During the course of this meeting, the themes were converged into five major categories: addictions and mental health; HIV, hepatitis and infections; health care in prison; life skills and re-entry into society (including homelessness and housing); and children, family and relationships. Numerous suggestions for health interventions and participatory projects were generated, each relating to one of the five major categories. Conclusions: this study was unique in that, to our knowledge, no other studies have utilized community-based participatory research methods in which incarcerated women played a role in designing the research questions and tools, collecting the data, analyzing the data, interpreting the data and authoring the publications and presentations. This study demonstrated that it is feasible for incarcerated women to engage in developing and utilizing community-based participatory research methods and that these methods can be grounded in a settings approach to whole prison health promotion. (Global Health Promotion, 2009; 16 (4): pp. 43—53)

To examine patients' perceptions and experiences of having family medicine residents in the office.Descriptive survey; questionnaire completed by patients.Outpatient office of 4 family physicians in the greater Vancouver area, affiliated with the Department of Family Medicine at the University of British Columbia.A total of 265 English-speaking adult patients attending the office.Patients' self-reported perceptions and experiences of having family medicine residents in the office.Response rate was 94.7% (251 of 265 patients completed the questionnaire). Although 81% of respondents had seen residents in the office, 59% did not understand a resident's training or thought residents were medical students. The 3 main reasons participants gave for choosing to have residents involved in their care were the following: to contribute to training future doctors (61.8%); to obtain 2 opinions instead of 1 (20%); and residents are most up-to-date (11.2%). The most common reasons for choosing not to see residents were the following: to continue relationships with their own doctors (54.2%); to avoid the need to repeat history (18.6%); and the perception that residents are less experienced (16.9%). Having a resident involved in their care was perceived as a positive experience by 95.5% of respondents who had seen residents. Overall satisfaction with care and overall comfort in dealing with residents were ranked good to excellent by 91.8% and 90.8% of respondents, respectively. About 71% of patients said they would choose to have residents involved in their care.Respondents reported very positive experiences with having family medicine residents in the office. Overall comfort and satisfaction with seeing family medicine residents was reported to be extremely high, and most patients surveyed would choose to have family medicine residents involved in their care. Patients needed to know more about the resident's level of training and the role of residents in patient-resident interactions.

To study the feasibility of self-collected specimens for testing human papillomavirus (HPV) status among hard-to-reach women, outreach nurses recruited women in women’s centres, shelters and alleys in Vancouver’s Downtown Eastside. Of the 151 participants for whom samples were available, 43 (28.5%) tested positive for high-risk HPV. Outreach nurses were able to recontact 81.4% of the participants who tested positive and referred them for further testing. About 14% (21/151) of participants had never received a Papanicolaou smear in British Columbia, as compared with 8.3% (608/7336) of women in the BC general population (p < 0.05). This difference suggests that self-collection of specimens for HPV testing is a feasible method to reach women who have not previously participated in cervical cancer screening programs.

Background: Female prison inmates are underscreened and are at higher risk of cervical cancer. The impact of a nurse-led Pap screening intervention was examined, which included information sessions and Pap testing clinics. Method: Pap screening rates for 650 inmates at the Burnaby Correctional Centre for Women were compared both before and during the 20-week intervention period. These rates were determined by record linkage of Correction Branch inmate records and Cervical Cancer Screening Program patient records. Associations between socio-demographic factors and Pap screening rates were also examined. Results: A higher proportion of inmates was screened during the intervention period (26.9%) than during the preintervention period (21.0%) (although the difference was not statistically significant (p=0.06)). Very short-stay inmates were less frequently screened in the preceding two years before the intervention. Inmates with no high school education and longer lengths of incarceration were significantly more likely to receive Pap testing during the intervention period as compared to the preintervention period. Conclusion: The nurse-led intervention resulted in a modest improvement in the proportion of inmates receiving Pap screening. Unfortunately, the benefit of the nurse clinician did not reach, to a greater extent, inmates who had not been previously screened or who were inadequately screened. There is need for further work to target this hardest-to-reach group.

Barriers to publication can be overcome through a peer support writing group in an academic department of family practice. This study describes the experience and outcomes of a writing group in a family practice department.A writing group was established to provide collaboration in identifying potential research and/or writing projects, to assist individual faculty to complete unfinished work for submission, to match journals appropriate to the individual group member's work, and to provide peer support for faculty members through attention to group process. Resource materials included instructions for authors for various journals and writing support literature. Minutes were taken at each meeting, and the manuscripts presented were tracked. Individual publication records in CVs and citations in Index Medicus were used to generate pre-group and post-group publication records for group participants and nonparticipants.The writing group met 23 times in 36 months. Attendance ranged from 3 to 10 participants. Fifty writing projects were discussed, and 12 of the discussed manuscripts were published in indexed journals. The seven most frequent attendees increased their publications as first author from one publication over the 3 years prior to the writing group to 10 publications over the first 3 years of the writing group. Comparison of the attendees' publication records with nonparticipant members of the department demonstrated an increase in publication success for participants.A peer support writing group, emphasizing group process and respectful collaboration, has increased the publication frequency of faculty in a Canadian department of family practice.

Dysphagia is common after stroke, presenting in 55% of all hospital-admitted patients with acute disease, and, depending on the lesion site and volume, can linger as a chronic problem for years.[1][1] It is estimated that every year in Canada there are 21 000 new elderly patients with dysphagia

Objective: To review a 1995 Pap smear screening program at Burnaby Correctional Centre for Women (BCCW). Method: 129 inmates (15%), were screened in BCCW in 1995. General population data were obtained from the British Columbia Cervical Cytology Screening Program (BC CCSP) Registry. Results: BCCW inmates aged 25–29 years were 11 times more likely to have high grade cytologic abnormalities on Pap smear screening compared with age-matched general population (p

A common strategy for health services research involves linking the records held in administrative databases using personal name data. Studies may also require following individuals over time, again necessitating names. Multiple names became a dilemma in our research of a screening intervention for female prisoners in British Columbia, Canada, such that we excluded from database linkage those women's records with at least five surnames or at least four first given names.1 We found no reports in the health services research literature regarding multiple names. We describe the distribution of aliases within a female prison population and compare the sociodemographic characteristics of prisoners with and without aliases. We discuss the implications for healthcare studies involving people with multiple names. We investigated the multiple names of 847 female prisoners at the Burnaby Correctional Centre for Women in 2000-1. These women were serving federal sentences (at least two years, including life sentences), provincial sentences (less than two years), or remanded to custody (awaiting sentencing). We took data from the centre's inmate records for the cervical cancer screening linkage …

A flow cytometer has been constructed which measures total fluorescence and the distribution of fluorescence along isolated, stained mammalian chromosomes. In this device, chromosomes flow lengthwise at 4 m/sec through a 1-micrometer thick laser beam. The fluorescence from each chromosome is recorded at 10 nsec intervals; the sequence of recorded values represents the distribution of fluorescence along the chromosome and is stored in the memory of a waveform recorder. The total fluorescence of each chromosome is also measured and recorded. Preliminary studies show that doublets of 1.83 micrometers diameter microspheres flow with their long axes parallel to the direction of flow and that the two microspheres are resolved in the slit-scan profile. Ethidium bromide stained Muntjac and Chinese hamster chromosomes have also been slit-scanned. Centromeres were resolved in many of the Nos. 1 and 2 Chinese hamster chromosomes and the Nos. 1 and X + 3 Muntjac chromosomes.