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Background Evidence that opioid agonist therapy (OAT) is associated with increased odds of hepatitis C virus (HCV) treatment initiation among people who use drugs (PWUD) is emerging. The objective of this study was to determine the association between current OAT and HCV treatment initiation among PWUD in a population-level linked administrative dataset. Methods The British Columbia Hepatitis Testers Cohort was used for this study, which includes all people tested for or diagnosed with HCV in British Columbia, linked to medical visits, hospitalizations, laboratory, prescription drug, and mortality data from 1992 until 2019. PWUD with injecting drug use or opioid use disorder and chronic HCV infection were identified for inclusion in this study. HCV treatment initiation was the main outcome, and subdistribution proportional hazards modeling was used to assess the relationship with current OAT. Results In total, 13 803 PWUD with chronic HCV were included in this study. Among those currently on OAT at the end of the study period, 47% (2704/5770) had started HCV treatment, whereas 22% (1778/8033) of those not currently on OAT had started HCV treatment. Among PWUD with chronic HCV infection, current OAT was associated with higher likelihood of HCV treatment initiation in time to event analysis (adjusted hazard ratio 1.84 [95% confidence interval {CI}, 1.50, 2.26]). Conclusions Current OAT was associated with a higher likelihood of HCV treatment initiation. However, many PWUD with HCV currently receiving OAT have yet to receive HCV treatment. Enhanced integration between substance use care and HCV treatment is needed to improve the overall health of PWUD.

Objectives Addressing the needs of ethnic minorities will be key to finding undiagnosed individuals living with hepatitis B (HBV), hepatitis C (HCV), or human immunodeficiency virus (HIV). To inform screening initiatives in British Columbia (BC), Canada, the factors associated with HBV and/or HCV and/or HIV infection among different ethnic groups within a large population-based cohort were assessed. Methods Persons diagnosed with HBV, HCV, or HIV in BC between 1990 and 2015 were grouped as East Asian, South Asian, Other Visible Minority (African, Central Asian, Latin American, Pacific Islander, West Asian, unknown ethnicity), and Not a Visible Minority, using a validated name-recognition software. Factors associated with infection within each ethnic group were assessed with multivariable multinomial logistic regression models. Results Participants included 202 521 East Asians, 126 070 South Asians, 65 210 Other Visible Minorities, and 1 291 561 people who were Not a Visible Minority, 14.4%, 3.3%, 4.5%, and 6.3% of whom had HBV and/or HCV and/or HIV infections, respectively. Injection drug use was most prevalent among infection-positive people who were Not a Visible Minority (22.1%), and was strongly associated with HCV monoinfection, HBV/HCV coinfection, and HCV/HIV coinfection, but not with HBV monoinfection among visible ethnic minorities. Extreme material deprivation and social deprivation were more prevalent than injection drug use or problematic alcohol use among visible ethnic minorities. Conclusions Risk factor distributions varied among persons diagnosed with HBV and/or HCV and/or HIV of differing ethnic backgrounds, with lower substance use prevalence among visible minority populations. This highlights the need for tailored approaches to infection screening among different ethnic groups.

BACKGROUND & AIMS: Hepatitis C virus (HCV) reinfection among high risk groups threatens HCV elimination goals. We assessed HCV reinfection rates among men who have sex with men (MSM) in British Columbia (BC), Canada. METHODS: We used data from the BC Hepatitis Testers Cohort, which includes nearly 1.7 million individuals tested for HCV or HIV in BC. MSM who had either achieved sustained virologic response (SVR) after successful HCV treatment, or spontaneous clearance (SC) and had ≥1 subsequent HCV RNA measurement, were followed from the date of SVR or SC until the earliest of reinfection, death, or last HCV RNA measurement. Predictors of reinfection were identified by Cox proportional modelling. The earliest study start date was November 6th , 1997 and latest end date was April 13th , 2018. RESULTS: Of 1,349 HCV-positive MSM who met the inclusion criteria, 493 had SC while 856 achieved SVR. 349 (25.65%) had HIV coinfection. We identified 98 reinfections during 5203 person-years (PYs) yielding a reinfection rate of 1.88/100PYs. The reinfection rate among SC (2.74/100PYs) was more than twice that of those with SVR (1.03/100 PYs). Problematic alcohol use (aHR 1.73, 95% CI 1.003-2.92), injection drug use (aHR 2.60, 95% CI 1.57-4.29) and HIV coinfection (aHR 2.04, 95% CI 1.29-3.23) were associated with increased risk of HCV reinfection. Mental health counselling history (aHR 0.24, 95% CI 0.13-0.46) was associated with reduced HCV reinfection risk. CONCLUSIONS: There is the need to engage MSM in harm reduction and prevention services following treatment to reduce reinfection risk.

Background & Aims Public health measures introduced to limit transmission of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), which causes coronavirus disease 2019 (COVID‐19), also disrupted various healthcare services in many regions worldwide, including British Columbia (BC), Canada. We assessed the impact of these measures, first introduced in BC in March 2020, on hepatitis C (HCV) testing and first‐time HCV‐positive diagnoses within the province. Methods De‐identified HCV testing data for BC residents were obtained from the provincial Public Health Laboratory. Weekly changes in anti‐HCV, HCV RNA and genotype testing episodes and first‐time HCV‐positive (anti‐HCV/RNA/genotype) diagnoses from January 2018 to December 2020 were assessed and associations were determined using segmented regression models examining rates before vs after calendar week 12 of 2020, when measures were introduced. Results Average weekly HCV testing and first‐time HCV‐positive diagnosis rates fell immediately following the imposition of public health measures by 62.3 per 100 000 population and 2.9 episodes per 1 000 000 population, respectively (P

Background & Aims We evaluated the effect of direct-acting antiviral (DAA)-induced sustained virologic response (SVR) on all-cause, liver- and drug-related mortality in a population-based cohort in British Columbia, Canada. Methods We used data from the British Columbia Hepatitis Testers Cohort, which includes people tested for HCV since 1990, linked with data on medical visits, hospitalizations, prescription drugs and mortality. We followed people who received DAAs and people who did not receive any HCV treatment to death or December 31, 2019. We used inverse probability of treatment weighting to balance the baseline profile of treated and untreated individuals and performed multivariable proportional hazard modelling to assess the effect of DAAs on mortality. Results Our cohort comprised 10,851 people treated with DAAs (SVR 10,426 [96%], no-SVR: 425) and 10,851 matched untreated individuals. Median follow-up time was 2.2 years (IQR 1.3–3.6; maximum 6.2). The all-cause mortality rate was 19.5/1,000 person-years (PY) among the SVR group (deaths = 552), 86.5/1,000 PY among the no-SVR group (deaths = 96), and 99.2/1,000 PY among the untreated group (deaths = 2,133). In the multivariable model, SVR was associated with significant reduction in all-cause (adjusted hazard ratio [aHR] 0.19; 95% CI 0.17–0.21), liver- (adjusted subdistribution HR [asHR] 0.22, 95% CI 0.18–0.27) and drug-related mortality (asHR 0.26, 95% CI 0.21–0.32) compared to no-treatment. Older age and cirrhosis were associated with higher risk of liver-related mortality while younger age, injection drug use (IDU), problematic alcohol use and HIV/HBV co-infections were associated with a higher risk of drug-related mortality. Conclusions DAA treatment is associated with a substantial reduction in all-cause, liver- and drug-related mortality. The association of IDU and related syndemic factors with a higher risk of drug-related mortality calls for an integrated social support, addiction, and HCV care approach among people who inject drugs. Lay summary We assessed the effect of treatment of hepatitis C virus infection with direct-acting antiviral drugs on deaths from all causes, liver disease and drug use. We found that treatment with direct-acting antiviral drugs is associated with substantial lowering in risk of death from all causes, liver disease and drug use among people with hepatitis C virus infection.

We evaluated the effectiveness of ledipasvir/sofosbuvir (LDV/SOF) in treating hepatitis C virus (HCV) genotype 1 and SOF/velpatasvir (SOF/VEL) for all genotypes among people who inject drugs (PWID) and those not injecting drugs and who were on or off opioid agonist therapy (OAT). Study participants comprised a population‐based cohort in British Columbia, Canada. The British Columbia Hepatitis Testers Cohort includes data on individuals tested for HCV from 1990 to 2016 that are integrated with medical visits, hospitalization, and prescription drug data. We classified study participants as off OAT/recent injection drug use (off‐OAT/RIDU), off OAT/past IDU (off‐OAT/PIDU), off OAT/no IDU (off‐OAT/NIDU), on OAT/IDU (on‐OAT/IDU), and on OAT/no IDU (on‐OAT/NIDU). We assessed sustained virologic response (SVR) 10 weeks after HCV treatment among study groups treated with LDV/SOF or SOF/VEL until January 13, 2018. Analysis included 5,283 eligible participants: 390 off‐OAT/RIDU, 598 off‐OAT/PIDU, 3,515 off‐OAT/NIDU, 609 on‐OAT/IDU, and 171 on‐OAT/NIDU. The majority were male patients (64%‐74%) and aged ≥50 years (58%‐85%). The SVRs for off‐OAT/RIDU, off‐OAT/PIDU, off‐OAT/NIDU, on‐OAT/IDU, and on‐OAT/NIDU were 91% (355/390), 95% (570/598), 96% (3,360/3,515), 93% (567/609), and 95% (163/171), respectively. Among those with no SVR, 14 individuals died while on treatment or before SVR assessment, including 4 from illicit drug overdose. In the overall multivariable model, off‐OAT/RIDU, on‐OAT/IDU, male sex, cirrhosis, treatment duration

ObjectiveTo assess the association between long term prescription opioid treatment medically dispensed for non-cancer pain and the initiation of injection drug use (IDU) among individuals without a history of substance use.DesignRetrospective cohort study.SettingLarge administrative data source (containing information for about 1.7 million individuals tested for hepatitis C virus or HIV in British Columbia, Canada) with linkage to administrative health databases, including dispensations from community pharmacies.ParticipantsIndividuals age 11-65 years and without a history of substance use (except alcohol) at baseline.Main outcome measuresEpisodes of prescription opioid use for non-cancer pain were identified based on drugs dispensed between 2000 and 2015. Episodes were classified by the increasing length and intensity of opioid use (acute (lasting Results59 804 participants (14 951 people from each opioid use category) were included in the matched cohort, and followed for a median of 5.8 years. 1149 participants initiated IDU. Cumulative probability of IDU initiation at five years was highest for participants with chronic opioid use (4.0%), followed by those with episodic use (1.3%) and acute use (0.7%), and those who were opioid naive (0.4%). In the inverse probability of treatment weighted Cox model, risk of IDU initiation was 8.4 times higher for those with chronic opioid use versus those who were opioid naive (95% confidence interval 6.4 to 10.9). In a sensitivity analysis limited to individuals with a history of chronic pain, cumulative risk for those with chronic use (3.4% within five years) was lower than the primary results, but the relative risk was not (hazard ratio 9.7 (95% confidence interval 6.5 to 14.5)). IDU initiation was more frequent at higher opioid doses and younger ages.ConclusionsThe rate of IDU initiation among individuals who received chronic prescription opioid treatment for non-cancer pain was infrequent overall (3-4% within five years) but about eight times higher than among opioid naive individuals. These findings could have implications for strategies to prevent IDU initiation, but should not be used as a reason to support involuntary tapering or discontinuation of long term prescription opioid treatment.

Background Improvements in tolerability and cure rates of hepatitis C virus (HCV) with direct acting antiviral (DAA) treatment led to expansion of patients treated for HCV; however, research examining the impact of these changes on linkage to care and treatment initiation among patients with hepatitis B (HBV) and HIV co-infection is limited. We compared the care cascades for patients with HBV and HIV co-infection before and after the introduction of DAAs, among a large population-based cohort in British Columbia (BC). Methods We analyzed data from the BC Hepatitis Testers Cohort, including all individuals tested for HCV or HIV between 1992 and 2015 at the BC Centre for Disease Control Public Health Laboratory, as well as cases of HIV (1980–2015), HCV (1990–2015), HBV (1990–2015), and active tuberculosis (1990–2015) included in registries of reportable diseases in BC. Care cascades were stratified by HIV and HBV co-infection and compared for all individuals with HCV alive at the end of 2012 (pre-DAA) and 2017 (post-DAA), including the following stages: (1) HCV diagnosed; (2) HCV RNA tested; (3) HCV RNA positive; (4) HCV genotyped; (5) initiated antiviral treatment; and (6) sustained viral response (SVR). Results 53,030 individuals diagnosed with HCV were alivein 2012 and 52,987 in 2017, were included in respective care cascades. In comparison to the pre-DAA era (2012), there were considerable increases in genotyping, treatment, and cure among individuals from all co-infection categories in 2017. For example, the proportion of those with known active infection who initiated treatment was 52% versus 23% among HCV/HIV (p Conclusion Considerable improvements have been noted in linkage to care and treatment of HCV in BC following introduction of DAAs, particularly among patients with HBV and HIV co-infections. Disclosure No significant relationships.

Background Enumeration or measurement of populations of men who have sex with men (MSM) is critical to developing and evaluating sexually transmitted and bloodborne infection (STBBI) prevention and treatment programs. However, there is a lack of data sources in which sexual orientation or behaviour is measured. In this study, we present the development and validation of a novel model (i.e., ‘computational phenotype’) to predict MSM status using multiple data sources. Methods Three disease case surveillance databases (HIV, hepatitis B and C, and syphilis), a public health laboratory database (which performs ≥95% of all HIV, hepatitis C and syphilis tests in British Columbia), and five administrative health record databases were linked and aggregated, resulting in a retrospective cohort of 727,091 adult men from 1990 to 2013. Self-reported MSM status (‘gold-standard’) from the three disease case surveillance databases was used to develop a multivariable prediction model for identifying MSM in the larger cohort. Models were selected using ‘elastic-net’ (combination of lasso and ridge regression), implemented through the GLMNet package in R, and a final model optimized area under the receiver operating characteristics curve (AUC). Results History of gonorrhea and syphilis diagnoses, HIV tests in the past year, history of visit to identified gay and bisexual men’s clinics, and residence in MSM-dense neighborhoods (based on self-reported MSM) were all positively associated with being MSM. The selected model had a sensitivity of 72%, specificity of 94%, and AUC of 92%. Combining self-reported MSM (n=6,280) and predicted MSM (n=85,521), a total of 91,801 men (13% of the cohort) were classified as MSM. Conclusion Applying a computational phenotyping method to administrative data yielded a cohort of 85,521 MSM, which may be used to monitor and evaluate health outcomes and healthcare utilization. Sensitivity and specificity of this model were comparable to interviewer-administered self-report measures of sexual orientation. Disclosure No significant relationships.

Background Increasing rates hepatitis C virus (HCV) infection associated with ongoing risk activity have been reported after successful cure or viral clearance. We assessed factors associated with reinfection after treatment-induced or spontaneous clearance (SC) in both HIV-infected and uninfected men who have sex with men (MSM) in British Columbia. Methods We followed HIV-infected and uninfected MSM who achieved sustained virologic response (SVR) to HCV treatment or had SC with ≥1 subsequent HCV RNA measurement in the British Columbia Hepatitis Testers Cohort. Crude reinfection rates per 100 person-years (PYs) were calculated. Cox regression was used to model adjusted hazard ratios (HRs) and 95% confidence intervals (CI) for reinfection. Results We identified 1,349 HCV-infected MSM with SVR (n=856) or SC (n=493), of which 349 (26%) were HIV-positive. HIV-infected MSM were more likely to have histories of injection drug use (41% vs 21%), alcohol use (22% vs 14%) and mental health disorders (47% vs 28%), compared to HIV uninfected. A total of 98 reinfections were identified, yielding an overall reinfection rate of 1.9 per 100 PY (1.0 for SVR patients and 2.7 for SC). HIV-infected MSM had higher rates of reinfection (3.1 vs 1.6 per 100 PY) than HIV uninfected individuals. In multivariable analysis, age Conclusion Rates of HCV reinfection remain elevated among HIV-infected and uninfected MSM. Substance use is driving reinfection among HIV-negative MSM, while sexual transmission may be more important among HIV-positive MSM. Disclosure No significant relationships.

Background HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections each are associated with increased cancer risk. In this study, we assessed the effect of co-occurrence of HIV, HBV and HCV on all cancers, anal cancer, non-Hodgkin Lymphoma (NHL) and liver cancer. Methods We used the British Columbia Hepatitis Testers Cohort (BC-HTC) which includes all individuals (∼1.7 million) tested for HCV or HIV, or diagnosed with HCV, HIV, or HBV linked with data on cancers. We included individuals tested for all three infections since 1990 and followed them from the date of their last test until the first cancer diagnosis, death, or 12/31/2015. We utilized the Fine and Grey competing risks regression model to estimate adjusted sub-distributional hazard ratios (aHRs) for outcomes, with death as a competing risk. Results Among 514,501 individuals tested for all infections, 12,586 had any cancer (2.45%), 100 had anal cancer (0.02%), 552 had NHL (0.11%), and 1,081 had liver cancer (0.21%) during a median follow-up of 4.19 years. Compared to no infection, the aHR for all cancers was the highest for HIV/HBV co-infections (HR 2.55, 95% CI: 1.91–3.42) followed by triple infections (aHR 2.29, 95% CI: 1.80–2.89). The risk of anal cancer was higher among individuals with HIV (triple infection aHR 22.61, 95% CI: 7.27–70.33), while risk of the liver cancer was higher among those with HBV or HCV mono or co-infections and triple infections. The risk of NHL was the highest among HIV/HBV co-infections followed by triple infection. Conclusion HIV, HBV and HCV infections are associated with an overall higher risk of cancer. The highest risks for anal cancer and NHL were among those living with HIV infection. The observed association between HCV and anal cancer, which may be due to the presence of human papillomavirus and/or residual confounding, requires further investigation. Disclosure No significant relationships.

IntroductionIncreasing evidence indicates that chronic hepatitis C virus (HCV) infection is associated with higher risk of diabetes. Previous studies showed ethnic disparities in the disease burden of diabetes, with increased risk in Asian population. We described the incidence of type 2 diabetes related to HCV infection and assessed the concurrent impact of HCV infection and ethnicity on the risk of diabetes.Research design and methodsIn British Columbia Hepatitis Testers Cohort, individuals were followed from HCV diagnosis to the earliest of (1) incident type 2 diabetes, (2) death or (3) end of the study (December 31, 2015). Study population included 847 021 people. Diabetes incidence rates in people with and without HCV were computed. Propensity scores (PS) analysis was used to assess the impact of HCV infection on newly acquired diabetes. PS-matched dataset included 117 184 people. We used Fine and Gray multivariable subdistributional hazards models to assess the effect of HCV and ethnicity on diabetes while adjusting for confounders and competing risks.ResultsDiabetes incidence rates were higher among people with HCV infection than those without. The highest diabetes incidence rate was in South Asians with HCV (14.7/1000 person-years, 95% CI 12.87 to 16.78). Compared with Others, South Asians with and without HCV and East Asians with HCV had a greater risk of diabetes. In the multivariable stratified analysis, HCV infection was associated with increased diabetes risk in all subgroups: East Asians, adjusted HR (aHR) 3.07 (95% CI 2.43 to 3.88); South Asians, aHR 2.62 (95% CI 2.10 to 3.26); and Others, aHR 2.28 (95% CI 2.15 to 2.42).ConclusionsIn a large population-based linked administrative health data, HCV infection was associated with higher diabetes risk, with a greater relative impact in East Asians. South Asians had the highest risk of diabetes. These findings highlight the need for care and screening for HCV-related chronic diseases such as type 2 diabetes among people affected by HCV.

Summary T-cell host immune response against hepatitis C virus (HCV) has been suggested to play an important role in determining HCV infection outcome. However, data from human studies are not available. This study examined the effect of primary T-cell deficiency along with other factors on the spontaneous clearance of HCV in a large population-based cohort in British Columbia, Canada. The BC Hepatitis Testers Cohort includes all individuals tested for HCV in BC in 1990-2013 linked with data on their medical visits, hospitalizations and prescription drugs. HCV-positive individuals with at least one valid HCV PCR test on/after HCV diagnosis (n=46 783) were included in this study. To examine factors associated with the spontaneous clearance of HCV, multivariable logistic regression was fitted on the full sample, and Cox proportional hazards model on the HCV seroconverters. Spontaneous clearance was observed in 25.1% (n=11 737) of those tested for HCV. After adjusting for potential confounders, the odds of spontaneous clearance of HCV was lower in people with primary T-cell immunodeficiency (adjusted odds ratio [aOR]: 0.55, 95% CI: 0.32-0.94), and higher in females (aOR: 1.61, 95% CI: 1.54-1.68) and in those coinfected with HBV (aOR: 2.31, 95% CI: 1.93-2.77). Similar results were observed in HCV seroconverters except HBV coinfection was not significant. In conclusion, primary T-cell immunodeficiency is associated with a lower spontaneous clearance of HCV while female sex and coinfection with HBV are associated with a higher spontaneous clearance.

Socioeconomic status (SES) influences all the determinants of health, conditioning health throughout life. The aim of the present study was to explore the relationship between socioeconomic status and obesity in adolescence through an analysis of the patterns of contact between peers as a function of this parameter. A cross-sectional study was performed, analyzing a sample of 235 students aged 14 to 18 and 11 class networks. Social network analysis was used to analyze structural variables of centrality from a sociocentric perspective. We found that adolescents with a medium-low SES presented a two-fold higher probability of being overweight, but we did not detect any differences in the configuration of their social networks when compared with those of normal-weight adolescents. However, we did find significant differences in the formation of networks according to SES in the overall sample and disaggregated by gender, whereby adolescents with a high SES in general presented a higher capacity to form wider social networks. Elucidating the relationship between SES and overweight and its influence on social network formation can contribute to the design of preventative strategies against overweight and obesity in adolescents, since their social environment can provide them with several resources to combat excess weight.

BACKGROUND: Disease-specific estimates of medical costs are important for health policy decision making.OBJECTIVE: To identify predictors of health care costs associated with hepatitis C virus (HCV) seropositivity across disease phases.METHODS: HCV laboratory tests from the BC Centre for Disease Control were linked to administrative data pertaining to health services and drugs dispensed to estimate costs among case subjects and controls. The case group comprised HCV seropositive individuals (n=20,001), and the control group comprised single-tested, HCV seronegative persons (n=70,752) identified between January 1997 and December 2004. Subject observation time was assigned to the three following disease phases: initial phase (after diagnosis), late phase (late-stage liver disease) and predeath phase (12 months before death). Case subjects and controls were matched for age, sex and a propensity score within each phase to determine the net cost attributable to HCV seropositivity, and were adjusted for demographic and clinical factors.RESULTS: Costs increased with disease progression, with hospitalization being the highest cost component in all phases. Initial and late phase net costs (2005 Canadian dollars) were $1,850 and $6,000 per patient per year, respectively. Costs among case subjects were driven by age, comorbidities, mental illness, illicit drug use and HIV coinfection. While predeath case subject and control costs were virtually the same, costs were high and case subjects died at a younger age.CONCLUSION: HCV seropositivity is associated with increased medical costs driven by viral sequelae and medicosocial vulnerabilities (ie, mental illness, illicit drug use and HIV coinfection). Cost mitigation and health outcome improvements will require broad-based prevention programming to reduce vulnerabilities and HCV treatment to prevent disease progression, respectively.

Objective: To determine whether there is a direct link between quality of life and aerobic capacity among female fibromyalgia patients. Design: Cross-section study. Setting: University of León. Subjects: Twenty-nine women belonging to the León Fibromyalgia and Chronic Fatigue Association. Main measurements: Aerobic capacity and quality of life were measured by means of the Six-Minute Walk Test and the Fibromyalgia Impact Questionnaire. Outcome measures included heart rate and rate of perceived fatigue and dypsnoea. Results: The average distance walked was 432.8 (61.2) m and the total average Fibromyalgia Impact Questionnaire score was 47.5 (18.9). Only item 1 of the Fibromyalgia Impact Questionnaire, physical function, showed any statistically significant link with the distance walked, which had no statistically significant relationship with any of the variables studied. Conclusion: The physical fitness of women with fibromyalgia, as determined by the Six-Minute Walk Test and the Fibromyalgia Impact Questionnaire, has no direct relation with quality of life as the patients perceive it.

The purpose of this study was to determine the effects of an 18-week strength training program on variables related to low-handicap golfers' performance. Ten right-handed male golfers, reporting a handicap of 5 or less, were randomly divided into two groups: the control group (CG) (N = 5, age: 23.9 ± 6.7 years) and the treatment group (TG) (N = 5, age: 24.2 ± 5.4 years). CG players followed the standard physical conditioning program for golf, which was partially modified for the TG. The TG participated in an 18-week strength training program divided into three parts: maximal strength training including weightlifting exercises (2 days a week for 6 weeks), explosive strength training with combined weights and plyometric exercises (2 days a week for 6 weeks), and golf-specific strength training, including swings with a weighted club and accelerated swings with an acceleration tubing system (3 days a week for 6 weeks). Body mass, body fat, muscle mass, jumping ability, isometric grip strength, maximal strength (RM), ball speed, and golf club mean acceleration were measured on five separate occasions. The TG demonstrated significant increases (p < 0.05) in maximal and explosive strength after 6 weeks of training and in driving performance after 12 weeks. These improvements remained unaltered during the 6-week golf-specific training period and even during a 5-week detraining period. It may be concluded that an 18-week strength training program can improve maximal and explosive strength and these increases can be transferred to driving performance; however, golfers need time to transfer the gains.

Objective This study assessed the effect of 2 physiotherapy programs designed to improve flexibility and to reduce the impact of the illness and pain perception in women with the fibromyalgia syndrome (FMS), and compared the effects of the 2 programs in the short and intermediate term. Methods Twenty FMS patients were randomly assigned to 2 training groups, one following a program of kinesiotherapy and active muscular stretching and one using techniques of Global Myofascial Physiotherapy, according to the Mezieres method. Both groups met twice a week for 12 weeks, for a total of 150 minutes each week. Flexibility and illness impact were measured by means of a standard test, whereas pain was assessed by means of thumb palpation. Measurements were taken at the beginning and end of the program and 24 weeks after its end. Results Patients had achieved a statistically significant reduction in the severity of the disease and improved their flexibility level by the end of the program, but had returned to initial values after follow-up. Significant differences were not observed between the 2 treatment groups in the initial values or in the results at the end of the program or after the follow-up, so neither program proved better than the other. Conclusion The FMS patients in this study improved their flexibility level and general well-being using both kinesiotherapy and stretching exercises techniques.

BACKGROUND: An estimated 250,000 Canadians are infected with the hepatitis C virus (HCV). The present study describes a cohort of individuals with HCV referred to community-based, integrated prevention and care projects developed in British Columbia. Treatment outcomes are reported for a subset of individuals undergoing antiviral therapy at four project sites.METHODS: Four demonstration projects based on a public health nurse and physician partnership were established in rural and small urban centres in British Columbia. Comprehensive medical assessments determined whether individuals received treatment, or counselling and education. Outcomes of the treatment group were compared with published randomized controlled trials. Client demographics were mapped using geographical information systems applications.RESULTS: A total of 1795 individuals were referred to the clinics for medical assessment between Septmber 2001 and December 2005. After assessment, 26% were eligible for therapy, while 74% received counselling and education. Wait times decreased annually, with one-half of all referrals assessed within 30 days. Combination antiviral therapy was initiated in 363 clients with interferon plus ribavirin (n=36) or pegylated interferon plus ribavirin (n=327). Treatment outcomes were available for 205 individuals. The overall rate of sustained virological response was 61% (126 of 205 individuals). The number of individuals assessed at each site represented, on average, 20% of the total cumulative reported HCV cases in the catchment areas.DISCUSSION: The study findings illustrate how a public health nurse and physician partnership can service a population with complex medical needs while simultaneously increasing local capacity. Treatment outcomes were comparable with published clinical trials.

Background In British Columbia (BC), Canada, (pop 4.6 million), prenatal screening for rubella, syphilis, and HIV is routinely recommended while hepatitis C (HCV) screening is based on risk criteria. We determined testing uptake and case detection rates at prenatal screening for these important perinatally transmissible pathogens. Methods We identified prenatal specimens for women aged 16–45 years between 2007–11 from the BC Public Health Reference Microbiology Laboratory and calculated the proportion of unique women screened for rubella, syphilis, HIV, and HCV per calendar year. Records were linked to laboratory surveillance data, permitting inclusion of prior testing history for HIV and HCV, to determine if detected cases were newly diagnosed at screening (new diagnoses/100,000) or a previously identified case. HIV and HCV prevalence were defined as all new and prior diagnoses among screened women (prevalence/100,000). Results Of the 233,203 women who underwent one or more prenatal screening in the study period, 96.9% were screened for rubella, 93.3% for syphilis, 93.8% for HIV, and 21.5% for HCV. Over 5 years, syphilis, HIV, and HCV screening increased by 4.4%, 4.3%, and 8.3%, respectively. The overall syphilis diagnosis rate was 15.4/100,000 and decreased over the study period. For HIV, the overall new diagnosis rate and prevalence was 5.1 and 45.9/100,000 respectively; for HCV the corresponding values were 82.8 and 551.5/100,000. The new diagnosis rates for HIV and HCV decreased over the study period while there were no significant changes in prevalence. Conclusion In BC, prenatal screening for syphilis and HIV is high and improving annually with declining diagnosis rates. Previous research in BC suggests HCV prevalence in pregnant women in BC is underestimated based on risk-based screening. The low HCV screening rates and high prevalence observed in our study corroborates the need to consider broader prenatal HCV screening.

The numerous hospitals in existence in the city of Zamora in the Middle Ages were considerably streamlined in the Early Modern Era. The foundation of the Sotelo hospital in the 16th century and the La Encarnación hospital in the 17th century endowed the city with two main centres offering medical and health care. This study focused on an analysis of the patients who received care at the La Encarnación hospital, which was governed by the City Council and the Cathedral Chapter. A patient profile was constructed from admission and mortality records, depending on the case. However, the main focus was an analysis of the hospital’s area of influence, which was found to amply exceed its immediate geographical context., El gran número de hospitales que tuvo la ciudad de Zamora durante la Edad Media quedó notablemente simplificado en la época Moderna. La fundación en el siglo XVI del hospital de Sotelo y en el XVII de La Encarnación, supuso dotar a la ciudad con dos importantes centros que ofrecía atención médico-sanitaria. Este trabajo está centrado en el de La Encarnación, entre cuyos administradores se hallaban el Ayuntamiento y el Cabildo de la Catedral, y el objeto de análisis han sido los asistidos. A partir de los registros de ingreso y defunciones, dependiendo del momento, hemos trazado el perfil de los mismos, pero, sobre todo, nos hemos centrado en el radio de influencia del establecimiento, que, como hemos podido comprobar, superaba ampliamente el marco geográfico de emplazamiento.