Search

Evidence is sparse on how community-based health-promoting programs can be culturally adapted for racially minoritized, immigrant older adult populations. Choose to Move (CTM) is an evidence-based health-promoting program that enhances physical activity and mobility and diminished social isolation and loneliness in older adults in British Columbia, Canada. However, racially minoritized older adults were not reached in initial offerings. We purposively sampled CTM delivery staff (n = 8) from three not-for-profit organizations, in Metro Vancouver, British Columbia, that serve Chinese older adults. We used semistructured interviews, ethnographic observations, and meeting minutes to understand delivery staff's perspectives on factors that influence CTM adaptations for Chinese older adults. Deductive framework analysis guided by an adaptation framework, Framework for Reporting Adaptations and Modifications-Enhanced, found three dominant cultural- and immigration-related factors influenced CTM adaptations for Chinese older adults: (a) prioritizations, (b) familiarity, and (c) literacy. Findings may influence future program development and delivery to meet the needs of racially minoritized older adult populations. [ABSTRACT FROM AUTHOR]

Background and aim: In British Columbia, Canada, clinical guidelines for the treatment of opioid use disorders (OUD) were updated in 2017, during a period in which the potency and composition of the illicit drug supply changed rapidly. We aimed to describe changes in opioid agonist treatment (OAT) prescribing practices at the population level in a setting in which fentanyl and its analogs have become the primary illicit opioid of use. Design, setting and participants: This was a population‐based retrospective cohort study using three linked health administrative databases in British Columbia (BC), Canada. All individuals with at least one OAT dispensation in BC between 1 January 2014 and 31 August 2021 took part. Measurements: To assess changes in OAT prescribing practices over time, we calculated initiation doses, dose titration intervals, maintenance doses and take‐home dosing intervals stratified by medication [methadone, buprenorphine–naloxone and slow‐release oral morphine (SROM)] according to recommended guidelines. Findings A total of 265 410 OAT episodes (57.5% on methadone, 34.5% on buprenorphine–naloxone and 8.0% on SROM) were initiated during the study period. Compared with the guideline recommendation, observed initiation doses were higher among all medications from 2014 (2017 for SROM) to 2021 (buprenorphine–naloxone: 14–29%; methadone: 53–66%; SROM: 26–55%). Titration intervals were shorter for all medications, consistent with guidelines for buprenorphine–naloxone (26–49%), but shorter than recommended for methadone or SROM (28–51% and 12–41%, respectively). Higher maintenance dosing was observed for methadone (68–78%) and SROM (3–21%). Take‐home allowances extending beyond the recommended guideline length increased across medications (buprenorphine–naloxone: 18–35%; methadone: 50–64%; SROM: 34–39%). Changes in prescribing patterns were similar for first‐time OAT initiators. Conclusion: In British Columbia, Canada, from 2014 to 2021, prescribers of opioid agonist treatment (OAT) appeared to initiate both new and experienced OAT clients at higher doses than guideline recommendations, titrate them more rapidly and maintain clients at higher doses. Take‐home dose allowances also gradually increased. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The results of the phase 3 ALSYMPCA trial showed that Radium-223 (Ra-223) improves overall survival (OS) and delays onset of first symptomatic skeletal event vs. placebo in patients with metastatic castration-resistant prostate cancer (mCRPC). The purpose of the REACTIVATE study was to inform the optimal placement of Ra-233 in the treatment sequence by evaluating clinical outcomes and healthcare resource utilization using real-world data from multiple Canadian provinces. METHODS: This retrospective cohort study analyzed patient outcomes according to Ra-223 placement using administrative databases of four Canadian provinces, encompassing 4301 patients with mCRPC who received at least two lines of life-prolonging therapy (LPT) for mCRPC. Outcomes included OS, event-free survival (EFS), and healthcare resource utilization. Each province was analyzed separately. RESULTS: OS, measured from the start of second-line LPT, differed between provinces: those in Ontario receiving second-line Ra-223 had a longer OS vs. those receiving it in third-line or later (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.66-0.95). There was no difference between lines of therapy in patients in British Columbia (HR 1.165, 95% CI, 0.894-1.518, p=0.2576), and OS was numerically worse but not statistically significant in patients receiving Ra-223 in second-line in Quebec (HR 1.44, 95% CI, 0.93-2.24). Other outcomes also varied across provinces, with second-line use of Ra-223 being associated with longer EFS and reduced healthcare utilization vs. third-line use in Ontario but not in Quebec. CONCLUSIONS: Significant heterogeneity exists in the management and outcomes of mCRPC between provinces, particularly regarding the placement of Ra-223 in the treatment sequence. [ABSTRACT FROM AUTHOR]

Background: Advance care planning (ACP) is a process which enables patients to communicate wishes, values, fears, and preferences for future medical care. Despite patient interest in ACP, the frequency of discussions remains low. Barriers to ACP may be mitigated by involving non-physician clinic staff, preparing patients ahead of visits, and using tools to structure visits. An ACP care pathway incorporating these principles was implemented in longitudinal generalist outpatient care, including primary care/family medicine and general internal medicine, in two Canadian provinces. This study aims to understand clinician experiences implementing the pathway. Methods: The pathway was implemented in one family practice in Alberta, two family practices in British Columbia (BC), and one BC internal medicine outpatient clinic. Physicians and allied health professionals delivered structured pathway visits based on the Serious Illness Conversation Guide. Twelve physicians and one social worker participated in interviews or focus groups at the end of the study period. Qualitative data were coded inductively using an iterative approach, with regular meetings between coders. Results: Clinicians described experiences with the ACP care pathway, impact at the clinician level, and impact at the patient level. Within each domain, clinicians described barriers and facilitators experienced during implementation. Clinicians also reflected candidly about potential for future implementation and the sustainability of the pathway. Conclusions: While the pathway was implemented slightly differently between provinces, core experiences were that implementation of the pathway, and integration with current practice, were feasible. Across settings, similar themes recurred regarding usefulness of the pathway structure and its tools, impact on clinician confidence and interactions with patients, teamwork and task delegation, compatibility with existing workflow, and patient preparation and readiness. Clinicians were supportive of ACP and of the pathway. Trial registration: The study was prospectively registered with clinicaltrials.gov (NCT03508557). Registered April 25, 2018. https://classic.clinicaltrials.gov/ct2/show/NCT03508557. [ABSTRACT FROM AUTHOR]

Background: Approximately 15%–25% of clinical pregnancies end in miscarriage, with more than 15,000 miscarriages occurring annually in British Columbia, Canada. Despite the significant rates of loss, research and health care services for pregnancy loss remain scarce in British Columbia. Objectives: This study aimed to (1) aid miscarriage recovery through the identification and sharing of equitable pregnancy loss care practices and supports and (2) present policy recommendations to improve prenatal care guidelines and employment standards for pregnancy loss. Design: This research took a patient-oriented methodological approach alongside people with lived/living experience(s) of miscarriage recovery in British Columbia to evaluate access to health care during pregnancy loss, societal understanding of miscarriage, and treatment options that foreground dignity. Methods: The mixed-methods design of this research included policy research on prenatal care guidelines, policy research on provincial and territorial employment legislation for bereavement leave, semi-structured interviews (n = 27), and a discovery action dialogue (n = 4). Results: The findings of this research demonstrate the need for improved prenatal care guidelines for early pregnancy loss, follow-up care after a miscarriage, mental health screening and supports, and bereavement leave legislation. Conclusion: This article includes recommendations to improve equitable access to pregnancy loss care, bereavement leave legislation, and future research in this area. [ABSTRACT FROM AUTHOR]

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

Background: Breastfeeding is not recommended for women living with HIV (WLWH) in Canada. We described the prevalence of breastfeeding and explored experiences of care, support, and stigma related to infant feeding. Setting: Quebec, Ontario, and British Columbia (Canada). Methods: Data were obtained from the HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) surveys, conducted between 2013 and 2018. Results: Breastfeeding was reported by 73.5% of the 786 women who delivered before HIV diagnosis and 7.3% of the 289 women who delivered after HIV diagnosis. Among them, earlier year of delivery, delivery outside of Canada, and African, Caribbean, Black ethnicity were independently associated with increased odds of breastfeeding. Among WLWH who had a live birth during the last year, 77% (40/52) felt that they had received support regarding infant feeding practices, and 77% (23/30) were concerned that not breastfeeding could lead to them being identified as WLWH. Among 71 women within one year postpartum at any one of the study waves, 89% reported having an undetectable viral load. Conclusion: Breastfeeding experiences were common among WLWH, most often prior to HIV diagnosis. Fear of unintentional HIV status disclosure when not breastfeeding and challenges to maintain an undetectable HIV viral load are important issues to address during postpartum care. [ABSTRACT FROM AUTHOR]

Objective: To examine differences in fee-for-service (FFS) payments to men and women radiologists in Canada and evaluate potential contributors. Methods: Publicly available FFS radiology billing data was analyzed from British Columbia (BC), Ontario (ON), Prince-Edward Island (PEI) and Nova Scotia (NS) between 2017 and 2021. Data was analyzed by gender on a per-province and national level. Variables evaluated included year, province, procedure billings, and days worked (BC and ON only). The gender pay gap was expressed as the difference in mean billing payments between men and women divided by mean payments to men. Results: Data points from 8478 radiologist years were included (2474 [29%] women and 6004 [71%] men). The unadjusted difference in annual FFS billings between men and women was $126,657. Overall, payments to women were 81% of payments to men with a 19% gender pay gap. The difference in billings between men and women did not change significantly between 2017 and 2021 (range in gender pay gap, 17–21%) but did vary by province (highest gap NS). Compared to men, women worked fewer days per year (weighted mean 218 ± 29 vs 236 ± 25 days/year, P <.001, 8% difference). Conclusion: In an analysis of fee-for-service payments to radiologists in 4 Canadian provinces between 2017 and 2021, payments to women were 81% of payments to men with a 19% gender pay gap. Payments were lower to women across all years evaluated. Women worked 8% fewer days per year on average than men, which did not fully account for the difference in FFS billing payments between men and women. Summary Statement: In an analysis of fee-for-service payments to Canadian radiologists between 2017 and 2021, payments to women were 81% of payments to men with a 19% gender pay gap which is not fully accounted for by time spent working. Visual Abstract [ABSTRACT FROM AUTHOR]

Simple Summary: Diagnosing most cancers at an earlier stage improves outcomes because treatments are more effective and often less invasive. This study looked at the health patterns of adults enrolled in Alberta's Tomorrow Project before they were diagnosed with cancer to identify factors related to cancers that are caught early or late. These identified factors were then tested in a similar group of adults from the British Columbia Generations Project who also subsequently developed cancer, to see how well they could predict stage at diagnosis. The confirmed health patterns can be used to improve cancer prevention programs and activities to find cancer earlier in people who are at most risk of being diagnosed with late-stage cancer. Risk prediction models for cancer stage at diagnosis may identify individuals at higher risk of late-stage cancer diagnoses. Partial proportional odds risk prediction models for cancer stage at diagnosis for males and females were developed using data from Alberta's Tomorrow Project (ATP). Prediction models were validated on the British Columbia Generations Project (BCGP) cohort using discrimination and calibration measures. Among ATP males, older age at diagnosis was associated with an earlier stage at diagnosis, while full- or part-time employment, prostate-specific antigen testing, and former/current smoking were associated with a later stage at diagnosis. Among ATP females, mammogram and sigmoidoscopy or colonoscopy were associated with an earlier stage at diagnosis, while older age at diagnosis, number of pregnancies, and hysterectomy were associated with a later stage at diagnosis. On external validation, discrimination results were poor for both males and females while calibration results indicated that the models did not over- or under-fit to derivation data or over- or under-predict risk. Multiple factors associated with cancer stage at diagnosis were identified among ATP participants. While the prediction model calibration was acceptable, discrimination was poor when applied to BCGP data. Updating our models with additional predictors may help improve predictive performance. [ABSTRACT FROM AUTHOR]

Purpose: Due to ongoing inequities in the social determinants of health and systemic barriers, homelessness continues to be a significant concern that disproportionately impacts racialized communities. Despite constituting a small proportion of the population, Black individuals are over-represented among people experiencing homelessness in many Canadian cities. However, although Black homelessness in Canada is a pressing issue, it has received limited attention in the academic literature. The purpose of this paper is to examine the reported prevalence of Black homelessness across Canada. Design/methodology/approach: By consulting enumerations from 61 designated communities that participated in the 2018 Nationally Coordinated Point-in-Time Count and two regional repositories – one for homeless counts supported by the government of British Columbia and another from the Rural Development Network – this paper reports on the scale and scope of Black homelessness across Canada. Findings: Significantly, these reports demonstrate that Black people are over-represented among those experiencing homelessness compared to local and national populations. These enumerations also demonstrate significant gaps in the reporting of Black homelessness and inadequate nuance in data collection methods, which limit the ability of respondents to describe their identity beyond "Black." Originality/value: This research provides an unprecedented examination of Black homelessness across Canada and concludes with recommendations to expand knowledge on this important and under-researched issue, provide suggestions for future iterations of homeless enumerations and facilitate the development of inclusive housing policy. [ABSTRACT FROM AUTHOR]

Introduction: The age of diagnosis is crucial for optimal health outcomes; however, some individuals with Autism Spectrum Disorder (ASD) may not be diagnosed until adulthood. Limited information is available about the lived experience of receiving a diagnosis during adulthood. Thus, we aimed to investigate stakeholders' experiences about the ASD diagnosis during adulthood. Method: We interviewed 18 individuals including 13 adults with ASD who had received a late diagnosis during adulthood and 5 parents of individuals with ASD from various Canadian provinces. Results: Using a thematic analysis, three main themes emerged: (a) noticing differences and similarities, (b) hindering elements to diagnosis, and (c) emotional response to diagnostic odyssey. Conclusion: This study adds to the literature about experiences of receiving ASD diagnosis in adulthood. Given the impact of diagnosis on individuals, it is important to minimize the barriers to ensure individuals who require ASD-related supports can access them in a timely and effective manner. This study highlights the importance of receiving an ASD diagnosis and facilitates positive health outcomes. The findings from the current study can be used to guide adult diagnostic processes and practices to help make ASD diagnosis more accessible. [ABSTRACT FROM AUTHOR]

Team-based care is recognized as a foundational building block of high-performing primary care. The purpose of this study was to identify primary care practice characteristics associated with team functioning and examine whether there is relationship between team composition or size and team functioning. We sought to answer the following research questions: (1) are primary care practice characteristics associated with team functioning; and (2) does team composition or size influence team functioning. This cross-sectional correlational study was conducted in Fraser East, British Columbia, Eastern Ontario Health Unit, Ontario and Central Zone, Nova Scotia in Canada. Data were collected from primary care practices using an organization survey and the Team Climate Inventory (TCI) as a measure team functioning. The independent variables of interest were: physicians' payment model, internal clinic meetings to discuss clinical issues, care coordination through informal and ad hoc exchange, care coordination through electronic medical records and sharing clinic mission, values and objectives among health professionals. Potentially confounding variables were as follows: team size, composition, and practice panel size. A total of 63 practices were included in these analyses. The overall mean score of team climate was 73 (SD: 10.75) out of 100. Regression analyses showed that care coordination through human interaction and sharing the practice's mission, values, and objectives among health professionals were positively associated with higher functioning teams. Care coordination through electronic medical records and larger team size were negatively associated with team climate. This study provides baseline data on what practice characteristics are associated with highly functioning teams in Canada. [ABSTRACT FROM AUTHOR]

Objective: This cross-sectional analysis describes the entry to practice and continuing registration of cohorts from the two accredited naturopathic medical educational programs in Canada. Methods: Cohorts from the Canadian College of Naturopathic Medicine (CCNM)-Toronto and CCNM-Boucher were included and analyzed based on jurisdiction of registration, time between graduation and registration, current registration status, and the percentage achieving advanced training and certification. Results: A total of 565 graduates from CCNM-Toronto and 296 graduates from CCNM-Boucher were analyzed. 53.3% (n=459) were registered with the naturopathic regulator in Ontario, 34.0% (n=293) with the naturopathic regulator in British Columbia, 9.1% (n=78) with other regulators or professional associations in Canada and 3.6% (n=31) internationally. 47.3% (n=360) acquired registration within 5 to 7 months of graduation and 23.1% (n=176) within 8 to 11 months. The registration status of 74.8% (n=644) was listed as active. Of the naturopathic doctors (NDs) working in jurisdictions where these certifications are optional, 69.0% (n=392) had their prescribing certification and 49.8% (n=302) had their Intravenous and Injection Therapies (IVIT) certification. Conclusion: This cross-sectional analysis indicated that 2 to 3 years following graduation, the NDs sampled have a similar or higher retention rate as other healthcare professionals. The majority of graduates are registered to practice in the same province as the naturopathic program they attended. A higher percentage of NDs practicing in British Columbia than in Ontario have additional training and certification in prescribing and intravenous therapies, which may be a reflection of the broader scope of practice in that province. [ABSTRACT FROM AUTHOR]

Background: Care aides (certified nursing assistants, personal support workers) are the largest workforce in long‐term care (LTC) homes (nursing homes). They provide as much as 90% of direct care to residents. Their health and well‐being directly affect both quality of care and quality of life for residents. The aim of this study was to understand the impact of COVID‐19 on care aides working in LTC homes during the first year of the pandemic. Methods: We conducted semi‐structured interviews with a convenience sample of 52 care aides from 8 LTC homes in Alberta and one in British Columbia, Canada, between January and April 2021. Nursing homes were purposively selected across: (1) ownership model and (2) COVID impact (the rate of COVID infections reported from March to December 2020). Interviews were recorded and analyzed using inductive content analysis. Results: Care aides were mainly female (94%) and older (74% aged 40 years or older). Most spoke English as an additional language (76%), 54% worked full‐time in LTC homes, and 37% worked multiple positions before "one worksite policies" were implemented. Two themes emerged from our analysis: (1) Care aides experienced mental and emotional distress from enforcing resident isolation, grief related to resident deaths, fear of contracting and spreading COVID‐19, increased workload combined with staffing shortages, and rapidly changing policies. (2) Care aides' resilience was supported by their strong relationships, faith and community, and capacity to maintain positive attitudes. Conclusions: These findings suggest significant, ongoing adverse effects for care aides in LTC homes from working through the COVID‐19 pandemic. Our data demonstrate the considerable strength of this occupational group. Our results emphasize the urgent need to appropriately and meaningfully support care aides' mental health and well‐being and adequately resource this workforce. We recommend improved policy guidelines and interventions. [ABSTRACT FROM AUTHOR]

Food insecurity is widely documented among people living with HIV (PLWH) worldwide, and it presents significant challenges across the spectrum of HIV care and support. In North America, the prevalence of food insecurity among PLWH exceeds 50%. In the province of British Columbia (BC), it exceeds 65%. It comes as no surprise that food has become an essential tool in supporting and engaging with PLWH. Over the past decade, however, a shift has taken place, and food has become an incentive to boost uptake and outcomes of prevention, testing, treatment, and support. To explore this practice, we drew on a qualitative case study of incentives in the care and support of PLWH. This paper presents the findings of a targeted analysis of interviews (N = 25) that discuss food incentives and explores two main themes that shed light on this practice: (1) Using food to engage versus to incentivize and (2) Food is more beneficial and more ethical. Providers perceived food more positively than other incentives, despite the goal remaining somewhat the same. Incentives, such as cash or gift cards, were considered ethically problematic and less helpful (and potentially harmful), whereas food addressed a basic need and felt more ethical. [ABSTRACT FROM AUTHOR]

Aim: The aim of this work is to explore the unintended consequences of pandemic public health measures on health care service usage by children with medical complexity. Background: Medical complexity is characterized by the presence of complex, chronic conditions requiring specialized care, substantial health needs, functional dependence and/or limitations, and frequent health care usage. Children with medical complexity are among the highest users of paediatric health care services. Methods: A web‐based, cross‐sectional survey was conducted in British Columbia, Canada, between August and September 2020. Inclusion criteria were (a) parent/guardian of at least one child (age 0 to 18 years, inclusive) with medical complexity and (b) residence in British Columbia. A convenience sample of 156 parents completed the survey. Data were analysed using a series of descriptive analyses (frequencies, cross‐tabulations) and inferential analyses (binary logistic regressions). Results: Respondents provided information for 188 children with medical complexity. Access to allied health therapies (physio, occupational, and speech and language) and medical specialists drastically declined in the initial months of the pandemic, with a shift from in‐person to virtual platforms for these aspects of care. Regression modelling indicated that age and family structure influenced decisions to use in‐patient hospital services. Conclusions: Public health measures implemented in the initial months of the pandemic decreased access to health care services for children with medical complexity. The long‐term ramifications of these measures are unknown. Family structure was found to influence decisions to avoid accessing Emergency Department care. Given the volume of services used by these children, paediatric hospital leaders need to take their unique needs into consideration in disaster planning to ensure minimal disruptions in care. [ABSTRACT FROM AUTHOR]

Objective: It is essential that the embedded process of rural case selection be highlighted and documented to provide reassurance of rigour across rural surgical services supported by generalist surgeons, general practitioners with enhanced surgical skills and general practitioner anaesthetists. This enables feedback and improves the triage and case selection process to ensure the highest quality outcomes. Therefore, this research aims to explore participants' rational criteria for decision making around rural case selection. Design: Participants participated in a series of semi‐structured in‐depth interviews which were coded and underwent thematic analysis. Setting: Six community hospitals in British Columbia, Canada. Participants: General practitioners with enhanced surgical skills, general practitioner anaesthetists, local maternity care providers, and specialists. Results: Based on participant accounts, rural surgical and obstetrical decision‐making processes for local patient selection or regional referral had five major components: (1) Clinical Factors, (2) Physician Factors, (3) Patient Factors, (4) Consensus Between Providers and (5) the Availability of Local Resources. Conclusion: Decision‐making processes around rural surgical and obstetrical patient selection are complex and require comprehensive understanding of local capacity and resources. Current policies and guidelines fail to consider the varying capacities of each rural site and should be hospital specific. [ABSTRACT FROM AUTHOR]

A reappraisal of mitigation strategies against occupational hazards is required to ensure that all health workers – not just those in perceived "high-risk" work environments - are protected. This will mean reducing community-level risks and ensuring that the same level of IPC measures, PPE training and supply is available when needed. Objective: The aims of this study were to investigate occupational and non–work-related risk factors of coronavirus disease 2019 among health care workers (HCWs) in Vancouver Coastal Health, British Columbia, Canada, and to examine how HCWs described their experiences. Methods: This was a matched case-control study using data from online and phone questionnaires with optional open-ended questions completed by HCWs who sought severe acute respiratory syndrome coronavirus 2 testing between March 2020 and March 2021. Conditional logistic regression and thematic analysis were utilized. Results: Providing direct care to coronavirus disease 2019 patients during the intermediate cohort period (adjusted odds ratio, 1.90; 95% confidence interval, 1.04 to 3.46) and community exposure to a known case in the late cohort period (adjusted odds ratio, 3.595%; confidence interval, 1.86 to 6.83) were associated with higher infection odds. Suboptimal communication, mental stress, and situations perceived as unsafe were common sources of dissatisfaction. Conclusions: Varying levels of risk between occupational groups call for wider targeting of infection prevention measures. Strategies for mitigating community exposure and supporting HCW resilience are required. [ABSTRACT FROM AUTHOR]

We explored the experiences of working-age and older adults with acquired vision impairment who pursued braille rehabilitation training, and the facilitators and barriers they encountered throughout this process. Semi-structured interviews of up to 90 min in length were conducted with 14 participants from across Canada who learned braille between the ages of 33 and 67 (Mdn = 46). Transcripts were analyzed by two researchers using interpretive phenomenological analysis. A variety of personal, social and institutional factors characterize the adult braille learning experience. Among these, participants highlight the role of prior identity and experience, the impact of access to resources and the cost of materials and devices needed to maintain braille skills. Findings also emphasize invisible barriers, including the role of societal perceptions towards braille, the level of support provided by family and friends, and the influence of unconscious biases towards braille and aging held by both adult learners and those around them. These findings provide important context to improve policies and practice in adult braille rehabilitation. As the prevalence of age-related vision impairment continues to increase, it will become imperative to understand the unique needs of working-age and older adults with acquired vision impairment who pursue braille. This study is one of the first to explore the experiences of working-age and older adults with acquired visual impairment who pursue braille rehabilitation training. Rehabilitation professionals must take into account prior learning and reading experiences which may shape the braille learning process. Family members require greater access to resources and support during the training process. There is a significant need for public education to address societal misconceptions about braille and blindness that can lead to a reluctance to use braille. Interactions with other braille users foster more empowering definitions of braille that align with the social model understanding of disability. [ABSTRACT FROM AUTHOR]

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

Foot care is a common problem for homeless adults in cities, who often receive fragmented foot care services, resulting in increased foot problems, health complications, hospitalisation, limb removal and disabilities. Among the health factors that negatively affect the homeless, foot health is essential, but often neglected. This study employed a descriptive, cross‐sectional research design to assess the foot care of homeless people and develop recommendations for clinical practice. Using Inlow's 60‐s foot screening method, the foot conditions of a purposive sample of 65 homeless adults were examined in British Columbia, Canada, in 2019–2020. Descriptive and inferential statistics were used to analyse the data. Determinants, such as sex and years of homelessness significantly contributed to homeless individuals' risk of developing foot problems. Differences in perceived and observed foot problems were influenced by equitable access to social health and healthcare services. Foot assessment is not well‐covered by homeless health services and should be implemented as part of the standard medical review of homeless patients. Furthermore, foot assessment should be conducted by healthcare professionals, rather than relying on the standard practice of service users' self‐report. Finally, foot care should be based on tailoring assessments and interventions for the individualised needs of homeless service users. Future research must seek ways to integrate homeless individuals' voices in the development, implementation and evaluation of foot care services. [ABSTRACT FROM AUTHOR]

Physical dating violence (PDV) victimization among adolescents is a serious global problem. Although knowledge of trends in PDV victimization can help guide programming and health policies, little research has examined whether the prevalence of PDV victimization has increased, decreased, or remained stable over time among non-U.S.-based samples of youth. In addition, few studies have directly tested whether disparities in PDV victimization between boys and girls have narrowed, widened, or remained unchanged in recent years. To address these gaps, we used school-based data from the British Columbia Adolescent Health Survey (BC AHS) of 2003, 2008, and 2013 (n boys = 18,441 and n girls = 17,459) to examine 10-year trends in PDV victimization. We also tested whether trends differed across self-reported sex. Data from the 2003 to 2013 BC AHS revealed that recent PDV victimization rates had significantly decreased among youth overall (5.9%-5.0%) and boys (8.0%-5.8%), but not girls (5.3%-4.2%). Although boys had steeper declines than girls in PDV victimization rates, year-by-sex interactions indicate that the sex gap in PDV victimization had not significantly narrowed. Moreover, rates of PDV victimization over the 10-year period indicated significantly higher rates of PDV victimization among boys compared with girls. Despite positive declines in recent rates of PDV victimization among youth, important differences in rates of PDV victimization between boys and girls remain. These findings underscore the need for greater attention to sex differences in research and programming and health policies to reduce PDV victimization and the sex disparities therein. [ABSTRACT FROM AUTHOR]

Responding to increasing rates of illicit drug toxicity mortality in British Columbia, regional health authorities introduced various types and models of drug checking services starting in 2016. Uptake has been gradual yet consistent, but motivators and barriers of service use have not been well-described. The British Columbia Harm Reduction Client Survey is a cross-sectional survey conducted at harm reduction sites across British Columbia. Data for the present findings were collected between March 2021 and January 2022. Participants (n = 537) were asked about their use of drug checking services and what prevented them from using available services. Responses were analyzed with descriptive statistics and multivariable logistic regression. Of all participants, 519 (96.6 %) answered the survey question on drug checking with 144 (27.7 %) reporting having used services within six months. Participants highlighted barriers such as not knowing where to access services (21.0 %), or not having services in their area (10.0 %). Among people who did not report recent use of fentanyl, 49.6 % stated they would not use their drugs if they tested positive for fentanyl. Other harm reduction behaviors were positively associated with drug checking, such as use of overdose prevention sites (adjusted odds ratio [AOR]: 2.75, 95 % confidence interval [CI]: 1.65, 4.59) and having a naloxone kit (AOR: 2.67, 95 %CI: 1.14, 6.28). Receipt of opioid agonist therapy in the previous six months was also positively associated with drug checking (AOR: 1.72, 95 %CI: 1.05, 2.83). Drug checking uptake remains low in British Columbia, however this study identified desire for services among participants, suggesting a need for expanded drug checking services. Behavioral change was reported among a high proportion of people who said they would not use their drugs if they tested positive for fentanyl, meaning that immunoassay strips alone have utility in the context of a pervasive fentanyl supply. [ABSTRACT FROM AUTHOR]

Background: Intellectual and Developmental Disabilities (IDD) are defined as physical/mental impairments before age 18. Not only are many IDD patients living into adulthood, but deinstitutionalization has also led to most living in community settings. Little is known about end-of-life needs in these adults, and existing literature does not examine attitudes of Canadian providers. Objective: Thematic and content analysis examined attitudes of Canadian Pediatric Palliative Care (PPC) practitioners on caring for adults with IDD to identify components of care, which could be improved. Design: An anonymized survey was created (Surveymonkey.com) using open-ended and Likert-scale questions, with thematic/subthematic coding on NVivo11. Initial coding included a codebook, which was refined. Independent coding was compared with initial coding. Coded data were reanalyzed after demographic stratification, results discussed, and consensus reached. Settings/Subjects: All Canadian PPC centers responded through snowball sampling (25 of 36 [70%] practitioners). Measurements/Results: Major themes covered communication and decision making, lack of resources (including access to appropriate services), and knowledge/skill/experience gaps among adult palliative care and generalist practitioners. Gaps included complex medical conditions of IDD patients, trajectories, and related management. Knowledge ratings of adult palliative care and generalist practitioners by respondents were evenly distributed, but only pediatricians gave ratings of poor or worse. PPC practitioners are comfortable being consulted by adult palliative care and generalist colleagues. However, frequency of consults varied dramatically, from one to two times/month in British Columbia to never. Conclusions: PPC practitioners across Canada identified several major issues and barriers to optimal palliative care for adults with IDD. [ABSTRACT FROM AUTHOR]

Introduction: Normalization theory posits a process where drug use is socially accommodated in society. We examine the extent of and factors related to police decision to charge young people who use drugs prior to cannabis legalization in Canada in 2018 and situate these findings within normalization theory. Methods: In the Youth Experiences with Police study, young people (aged 16–30 years) who use drugs from three cities in British Columbia, Canada, were recruited using a modified respondent driven sampling approach. Participants were administered a questionnaire focusing on their drug use, past encounters with police, and psychosocial and sociodemographic factors. Results: Among 449 participants, 3.6% of 56 in possession of cannabis by police were charged, whereas 41.2% of 34 in possession of other illicit drugs were charged (p <.001). Bivariate analyses showed prior criminal convictions (p =.001) as well as lower average monthly income (p <.05) was significantly related to being charged by police. Drug use stigma was significantly higher for weekly illicit drug users compared to weekly cannabis and those who did not use drugs weekly (p <.001). Discussion: Greater police discretion toward cannabis suggest it is more socially acceptable or normalized compared to other drugs. Police practices may reflect cultural conditions but could be structurally harmful to marginalized groups. [ABSTRACT FROM AUTHOR]

Women at the lower end of the socioeconomic distribution have higher rates of depression in pregnancy and lower rates of treatment. In this study, we investigate relationships between income and the use of psychotropic mediciness in pregnancy. This retrospective cohort study using population-based administrative datasets included all women who delivered a live infant in the province of British Columbia, Canada (population of 4.6 million), between April 1, 2000, and December 31, 2009. We compared the socioeconomic distribution in use of psychotropic mediciness in pregnancy. We included 305,984 deliveries among 217,721 women. Women at the low end of the income distribution were significantly more likely to have a diagnosis for all mental health conditions, except anxiety, which was more common in women of highest socioeconomic status. The adjusted odds ratios for psychotropic medicine use indicate that women in the lowest income quintile have lower odds of filling a prescription for a psychotropic medicine after controlling for covariates and diagnoses of mental health conditions. However, they were more likely to fill a prescription for an antipsychotic and were more likely to fill psychotropic medicines from three or more different drug categories during pregnancy. Our findings suggest that women of lower socioeconomic status are less likely to fill a prescription for a psychotropic medicine in pregnancy, a finding largely driven by their decreased likelihood of filling an antidepressant. This is despite overall higher rates of mental illness among women of lower socioeconomic status, suggesting a gap in treatment by socioeconomic status. [ABSTRACT FROM AUTHOR]

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

To describe the sociodemographic, clinical, and treatment characteristics of people who are comatose in Canadian complex continuing care (CCC) and long-term care (LTC) settings, and to make recommendations to promote comprehensive care planning for this population. Retrospective, cross-sectional analysis of population data. All residents in the Canadian provinces of Alberta, Ontario, British Columbia, Manitoba, Nova Scotia, Newfoundland, Saskatchewan, and the territory of Yukon with data available from the fiscal year 2015 (April 1, 2015, to March 31, 2016). Demographic, clinical, and treatment variables were extracted from the Resident Assessment Instrument–Minimum Data Set (MDS 2.0) and were reported using descriptive statistics. Of the LTC and CCC populations, 0.07% and 3.5% were identified as comatose, respectively. Overall, people who are comatose in both CCC or LTC settings are younger and have a longer length of stay than those who are not comatose. A higher proportion of people who are comatose experience active infections and irregular bowel elimination patterns, and those who are comatose were more likely to have a feeding tube and require oxygen therapy or suctioning than those who were not comatose. However, a lower proportion of people who were comatose had documented pain. In LTC, one-quarter of people who are comatose are expected to die within 6 months. Although the prevalence of people who are comatose in LTC and CCC settings is low, this population is complex and has significant care needs that require comprehensive assessment and care planning. [ABSTRACT FROM AUTHOR]

Purpose Research has shown that there are important sex and gender-based differences in the work disability duration of men and women. This research is often limited to single jurisdictions, using different outcome measures, and therefore has limited generalisability of findings. This study examined if differences between work disability of men and women differed by province and by duration of work disability. Methods Cohorts of injured workers in the Canadian provinces of British Columbia (BC), Manitoba (MB) and Ontario (ON) were analysed using workers' compensation data for work-related injuries occurring between 2007 and 2011. Work disability duration was measured using cumulative days in receipt of disability benefits paid during one-year post-injury. Poisson models with restricted cubic splines tested whether differences between men and women in the likelihood of transitioning off disability benefits varied by duration of work disability in each province, adjusting for confounders. Results Men transitioned off disability benefits faster than women for claim durations of up to two to four months, after which women transitioned off disability benefits faster until ten months. Differences between men and women were consistent across all jurisdictions. For claims longer than ten months, men transitioned off work disability benefits faster than women in BC and ON, but there were no significant differences between men and women in MB. Conclusions Differences in the work disability duration between men and women vary by province and duration of work disability. Claims management processes need to be sensitive to differences that men and women face and the timing of interventions. [ABSTRACT FROM AUTHOR]

We measured health-related quality of life (HRQOL) using the SF-12 among women living with HIV (WLWH) in Canada between August 2013 and May 2015. We investigated differences by perceived receipt of women-centered HIV care (WCHC), assessed using an evidence-based definition with a 5-point Likert item: “Overall, I think that the care I have received from my HIV clinic in the last year has been women-centered” (dichotomized into agree vs. disagree/neutral). Of 1308 participants, 26.3 percent were from British Columbia, 48.2 percent from Ontario, and 25.5 percent from Québec. The median age was 43 years (interquartile range = 36-51). Most (42.2 percent) were White, 29.4 percent African/Caribbean/Black, and 21.0 percent Indigenous. Overall, 53.4 percent perceived having received WCHC. Mean physical and mental HRQOL scores were 43.8 (standard deviation [SD] = 14.4) and 41.7 (SD = 14.2), respectively. Women perceiving having received WCHC had higher mean physical (44.7; SD = 14.0) and mental (43.7; SD = 14.1) HRQOL scores than those not perceiving having received WCHC (42.9; SD = 14.8 and 39.5; SD = 14.0, respectively; p < .001). In multivariable linear regression, perceived WCHC was associated with higher mental (β = 3.48; 95 percent confidence interval: 1.90, 5.06) but not physical HRQOL. Improving HRQOL among Canadian WLWH, which was lower than general population estimates, is needed, including examining the potential of WCHC as an effective model of clinical care. [ABSTRACT FROM AUTHOR]

Background Bevacizumab is an antiangiogenic agent active in patients with recurrent malignant gliomas. However, evidence for its clinical efficacy is relatively limited so that bevacizumab is approved for this indication in Canada and the United States, but not in the European Union. We reviewed the effectiveness of bevacizumab in patients with recurrent brain tumour using a large population database. Methods This was a retrospective, multicentre, study conducted at the BC Cancer Agency, a public cancer care organisation for the residents of the Canadian province of British Columbia. Cases were identified from the provincial registry and drug database. Patients were eligible if they were treated with bevacizumab with or without lomustine or etoposide for recurrent brain tumour between April 2011 and March 2014. The primary end points were progression-free survival. Secondary endpoints were overall survival and objective response rate. Results A total of 160 patients were included, with a median age of 55 years. The most common diagnosis was glioblastoma multiforme (70.6%), followed by oligodendroglioma (10.6%). Half of the patients had prior metronomic dosing of temozolomide. The median duration of therapy was 3 months. The median progression-free survival was 4.0 months and the 6-month progression-free survival was 29.4%. The median overall survival was 7 months and the 9-month and 12-month overall survival was 28.1% and 20.6%, respectively. The objective response rate was 23.1%. The most common documented reason for bevacizumab discontinuation was disease progression (66.9%), followed by toxicity (6.9%). Conclusions Bevacizumab therapy seems to be effective in delaying disease progression in patients with recurrent brain tumour, but with limited benefits on the overall survival, when used outside the clinical trial setting. [ABSTRACT FROM AUTHOR]

BACKGROUND: Chikungunya virus (CHIKV) is a reemerging pathogen transmitted by Aedes aegypti and Aedes albopictus mosquitoes. The ongoing Caribbean outbreak is of concern due to the potential for infected travelers to spread the virus to countries where vectors are present and the population is susceptible. Although there has been no autochthonous transmission of CHIKV in Canada, there is concern that both Ae. albopictus and CHIKV will become established, particularly under projected climate change. We developed risk maps for autochthonous CHIKV transmission in Canada under recent (1981-2010) and projected climate (2011-2040 and 2041-2070). METHODS: The risk for CHIKV transmission was the combination of the climatic suitability for CHIKV transmission potential and the climatic suitability for the presence of Ae. albopictus; the former was assessed using a stochastic model to calculate R0 and the latter was assessed by deriving a suitability indicator (SIG) that captures a set of climatic conditions known to influence the ecology of Ae. albopictus. R0 and SIG were calculated for each grid cell in Canada south of 60°N, for each time period and for two emission scenarios, and combined to produce overall risk categories that were mapped to identify areas suitable for transmission and the duration of transmissibility. FINDINGS: The risk for autochthonous CHIKV transmission under recent climate is very low with all of Canada classified as unsuitable or rather unsuitable for transmission. Small parts of southern coastal British Columbia become progressively suitable with short-term and long-term projected climate; the duration of potential transmission is limited to 1-2 months of the year. INTERPRETATION: Although the current risk for autochthonous CHIKV transmission in Canada is very low, our study could be further supported by the routine surveillance of Ae. albopictus in areas identified as potentially suitable for transmission given our uncertainty on the current distribution of this species in Canada. [ABSTRACT FROM AUTHOR]

Objectives Nonoccupational post-exposure prophylaxis ( nPEP) is a strategy to reduce the risk of HIV infection in those with high-risk exposure. This study characterized nPEP awareness among gay, bisexual and other men who have sex with men ( MSM) in Metro Vancouver, British Columbia, Canada after a pilot nPEP programme established in 2012. Methods Momentum Health Study participants were MSM aged ≥16 years recruited via respondent-driven sampling ( RDS) who completed a computer-assisted self-interview. Stratifying patients by HIV status, we used multivariable logistic regression with backward selection to identify factors associated with nPEP awareness. All analyses were RDS-adjusted. Results A total of 51.9% (112 of 173) of HIV-positive and 48.5% (272 of 500) of HIV-negative participants had heard of nPEP. Only 3% (five of 106) of HIV-negative participants who reported recent high-risk sex used nPEP. Generally, nPEP awareness was higher for participants who engaged in sexual activities with increased HIV transmission potential. Factors associated with greater awareness among HIV-negative participants included recent alcohol use, higher communal sexual altruism, previous sexually transmitted infection diagnosis, and greater perceived condom use self-efficacy. Other factors associated with greater awareness among HIV-negative participants included white race/ethnicity, gay sexual identity, more formal education, lower personal sexual altruism, and Vancouver residence. Greater nPEP awareness among HIV-positive participants was associated with greater perceived agency to ask sexual partners' HIV status and more frequently reporting doing so, a higher number of lifetime receptive sex partners, and greater access to condoms. Conclusions Following implementation of an nPEP pilot programme, nPEP awareness among HIV-negative MSM was 51% and use was 3%. These data support the need to expand access to and actively promote nPEP services. [ABSTRACT FROM AUTHOR]

Objectives. We longitudinally examined the social, structural, and geographic correlates of cervical screening among sex workers in Metropolitan Vancouver, British Columbia, to determine the roles that physical and social geography play in routine reproductive health care access. Methods. Analysis drew on (2010-2013) data from an open prospective cohort of sex workers (An Evaluation of Sex Workers' Health Access). We used multivariable logistic regression with generalized estimating equations (GEE) to model correlates of regular cervical screening. Results. At baseline, 236 (38.6%) of 611 sex workers in our sample had received cervical screening, and 63 (10.3%) were HIV-seropositive. In multivariable GEE analysis, HIV-seropositivity (adjusted odds ratio [AOR] = 1.65; 95% confidence interval [CI] = 1.06, 2.58) and accessing outreach services (AOR = 1.35; 95% CI = 1.09, 1.66) were correlated with regular cervical screening. Experiencing barriers to health care access (e.g., poor treatment by health care staff, limited hours of operation, and language barriers) reduced odds of regular Papanicolaou testing (AOR = 0.81; 95% CI = 0.65, 1.00). Conclusions. Sex workers in Metropolitan Vancouver had suboptimal levels of cervical screening. Innovative mobile outreach service delivery models offering cervical screening as one component of sex worker--targeted comprehensive sexual and reproductive health services mayhold promise. [ABSTRACT FROM AUTHOR]

Objective: To illustrate the complexities of assessing the influence of individual organizational factors on outcomes for intensive care unit (ICU) patients in Canada. Methods: In this cross-sectional study, we used retrospectively collected data from all patients admitted to all ICUs in British Columbia between April 01, 1994, and March 31, 1999, or to 20 ICUs in Ontario during 2002. We used responses to a survey about organizational factors for all ICUs in British Columbia and Ontario that was done in 2001. Clustered data regression models were used to assess the influence of organizational factors on outcomes after adjustment for patient-level confounders. Results: Despite adjustment for age, sex, comorbidity score of patients, and limitation of the data sets to minimize confounding, we found variable relationships between ICU outcomes (hospital mortality, ICU length of stay, and hospital length of stay) and any of “closed” administrative model, daily rounds, presence of an ICU medical director, medical director trained in critical care medicine, presence of a nurse leader in the ICU, nurse–patient ratio, and presence of an ICU pharmacist. Closed administrative model was associated with lower hospital mortality (odds ratio [95% confidence interval]: 0.75 [0.66-0.85]), shorter length of ICU stay (rate ratio [95% confidence interval]: 0.76 [0.62-0.92]), and shorter length of hospital stay (rate ratio [5% confidence interval]: 0.78 [0.72-0.84]) in nontertiary ICUs but many other “advantageous” factors were associated with higher mortality. Conclusions: The lack of a consistent relationship between organizational factors and ICU outcomes, and relationships that show increased mortality associated with some advantageous factors, suggests that there is residual confounding in these relationships. Models that adjust for only conventional patient-level confounders are unlikely to provide valid estimates of the influence of organizational factors. [ABSTRACT FROM AUTHOR]

Background: Using cross-sectional data from the Canadian Community Health Survey (2007-2008), this study aimed to examine the impact of community belonging on marijuana use among British Columbian youth aged 12-24. Methods: Bivariable and multivariable multinomial logistic regression was used to examine the association between self-perceived community belonging and youth marijuana use (i.e. never, tried once and more than once lifetime use), and stratified by high and low adult marijuana use regions to determine if the relationships varied by the extent of adult marijuana use in each region. Results: Of 2095 youth respondents, 21.8% had used marijuana at least once in the past year, with the majority (70.9%) reporting a strong sense of community belonging. Weak community belonging increased youth's odds of initiation [Adjusted odds ratio (AOR) = 1.74; 95% Confidence Interval (CI) 1.18-2.56] and odds of more-than-once lifetime use (AOR = 1.40; 95% CI 1.10-1.79), and these associations were increased in regions where adult marijuana use was high. Conclusion: These findings suggest an association between weak sense of community belonging and youth marijuana use, and that use in the general population may increase this relationship. There is a need to better understand how youth interpret 'community belonging', and further explore the relationship between marijuana availability and youth use. [ABSTRACT FROM AUTHOR]

Objectives. We evaluated the public health benefits of traffic laws targeting speeding and drunk drivers (British Columbia, Canada, September 2010). Methods. We studied fatal crashes and ambulance dispatches and hospital admissions for road trauma, using interrupted time series with multiple nonequivalent comparison series. We determined estimates of effect using linear regression models incorporating an autoregressive integrated moving average error term. We used neighboring jurisdictions (Alberta, Saskatchewan, Washington State) as external controls. Results. In the 2 years after implementation of the new laws, significant decreases occurred in fatal crashes (21.0%; 95% confidence interval [CI] = 15.3, 26.4) and in hospital admissions (8.0%; 95% CI = 0.6, 14.9) and ambulance calls (7.2%; 95% CI = 1.1, 13.0) for road trauma. We found a very large reduction in alcohol-related fatal crashes (52.0%; 95% CI = 34.5, 69.5), and the benefits of the new laws are likely primarily the result of a reduction in drinking and driving. Conclusions. These findings suggest that laws calling for immediate sanctions for dangerous drivers can reduce road trauma and should be supported. [ABSTRACT FROM AUTHOR]

From Sept 2005 to May 2012, 1015 street-involved youth were enrolled into the At-Risk Youth Study, a prospective cohort of youth aged 14-26 who use illicit drugs in Vancouver, Canada. Data were collected through semiannual interviewer administered questionnaires. Generalized estimating equation logistic regression was used to identify factors independently associated with being unable to access addiction treatment. The enclosed manuscript notes the implications and limitations of this study, as well as possible directions for future research. This study was funded by the US National Institutes of Health (NIH) and Canadian Institutes of Health (CIHR). [ABSTRACT FROM AUTHOR]

Adequate dietary protein intake throughout pregnancy is essential to ensure healthy fetal development. Insufficient and excessive maternal dietary protein intakes are both associated with intrauterine growth restriction, resulting in low birth weight infants. The aim of this study was to analyze the dietary protein intake patterns of healthy pregnant women in Vancouver, British Columbia, during early and late gestation. We hypothesized that women would be consuming higher protein during late stages of pregnancy compared with early stages of pregnancy. Interviewer-administered food frequency questionnaires were collected prospectively from 270 women at 16- and 36-week gestation; food frequency questionnaires from 212 women met study criteria. Maternal anthropometrics at both stages and infant weight at birth were collected. Wilcoxon signed rank tests were used to determine significant gestational differences in protein intakes. Spearman correlation was used to determine the influence of protein intakes and maternal anthropometrics on pregnancy outcomes. Median (25th and 75th percentiles) protein intakes adjusted for body weight were 1.5 (1.18 and 1.79) and 1.3 (1.04 and 1.60) g/kg per day at 16- than 36-week gestation, respectively. Primary protein sources were identified as dairy products. Protein intakes were negatively correlated with birth weight (P < .05), whereas maternal height, weight, body mass index, and weight gain to 36-week gestation were positively correlated with birth weight (P < .05). This study provides current dietary protein intake patterns among healthy Canadian women during pregnancy and indicates higher intakes than current Dietary Reference Intakes recommended dietary allowance of 1.1 g/kg per day, especially during early gestation. [ABSTRACT FROM AUTHOR]

Background: Influenza is a major cause of morbidity and mortality in Canada, with up to 7000 influenza-related deaths occurring every year. The elderly and individuals with chronic diseases are at increased risk for influenza-related morbidity and mortality. Methods: We conducted a 2-year, community cluster-randomized trial targeting elderly people and at-risk groups to assess the effectiveness of pharmacy-based influenza vaccination clinics on influenza vaccination rates. Small rural communities in interior and northern British Columbia were randomly allocated to the intervention or control. In the intervention communities, pharmacy-based influenza vaccination clinics were held and were promoted to eligible patients using personalized invitations from the pharmacists, invitations distributed opportunistically by a pharmacist to eligible patients presenting to pharmacies during the flu season and community-wide promotion using posters and the local media. The main outcome measure was a difference in the mean influenza vaccination rates. The immunization rates were calculated using the number of immunizations given in each community divided by the population size estimated from the census data. Results: Baseline influenza immunization rates in the population ≥65 years of age were the same in the control (n = 10, mean 85.6% [SD 16.6]) and intervention (n = 14, mean 83.8% [SD 16.3]) communities in 2009 (p = 0.79). In 2010, the mean influenza immunization rate was 56.9% (SD 28.0) in the control communities (n = 15) and 80.1% (SD 18.4) in the intervention communities (n = 14) (p = 0.01) for those ≥65 years of age. However, in 2010, for those 2 to 64 years with chronic medical conditions, the immunization rates were lower in the intervention communities (mean 16.3% [SD 7.1]) compared with the control communities (mean 21.2% [SD 5.8]) (p = 0.04). Conclusion Clinics were feasible and well attended and they resulted in increased vaccination rates for elderly residents. In contrast, vaccination rates in the younger population with comorbidities remained low and unchanged. [ABSTRACT FROM AUTHOR]

Pharmacists across Canada have varying degrees of ability to prescribe medications depending on their jurisdiction of licensure. The purpose of this study was to the evaluate attitudes, beliefs, and perceptions of independent pharmacist prescribing among health authority- and community-based pharmacists. This prospective, cross-sectional online survey assessed the perceptions of independent pharmacist prescribing of health authority and community pharmacists practising in northern British Columbia (BC), which was defined as within the geographical boundaries of Northern Health. Responses were analysed using descriptive statistics and a regression analysis. There were 45 respondents to the survey: 22 community pharmacists and 23 health authority pharmacists. Both community and health authority pharmacists held positive perceptions of independent pharmacist prescribing and did not identify any barriers to incorporating independent pharmacist prescribing into their practice. Respondents were highly likely to apply for independent pharmacist prescribing authority, if available. Pharmacists in BC are currently not able to independently prescribe schedule I medications. The provincial regulatory body has proposed a framework for a Certified Pharmacist Prescriber designation, which if approved would allow pharmacists to prescribe in collaborative practice settings. This study provides some insight into the perception of pharmacists in northern BC in pursuing this designation, which may be valuable for planning purposes in case of adoption of the framework. These results are also likely applicable to other non-urban practice settings in Canada. Pharmacists in northern BC perceived independent pharmacist prescribing positively and a high proportion were likely to apply for this authority if it were permitted via legislation. [ABSTRACT FROM AUTHOR]

This study aimed to investigate if exercise therapy and polypharmacy was associated with frailty state transitions for home care service recipients. Longitudinal cohort-study using client-level health information collected using interRAI home care (RAI-HC) assessments. Population-based study with Canadian home care clients in Alberta, British Columbia, Ontario and the Yukon. Home care clients aged 65 years and older. A Markov chain multistate transition logistic regression model was used to calculate ORs for state transitions with exercise therapy and polypharmacy as independent variables. In total, 250,428 home care clients experiencing 402,005 frailty state transitions were included in the analyses. At baseline, 39.4% of clients were categorized as nonfrail, 30.2% were categorized as prefrail, and 30.4% were categorized as frail. Nonfrail clients using polypharmacy were more likely to become prefrail (OR 1.16) and frail (OR 1.11). Pre-frail clients using polypharmacy were more likely to become frail (OR 1.06), and they were less likely to become nonfrail (OR 0.80). Frail clients using polypharmacy were significantly less likely to become prefrail (OR 0.82) or nonfrail (OR 0.62). Nonfrail clients who participated in exercise therapy were more likely to become prefrail (OR 1.05). Prefrail clients who participated in exercise therapy were more likely to become nonfrail (OR 1.26). Frail clients who participated in exercise therapy were more likely to become nonfrail (OR 1.27) and prefrail (OR 1.12). This study suggests that frailty among home care clients can be reversed. Frailty state improvement occurred significantly more often among home care clients receiving exercise therapy and significantly less often among clients with polypharmacy. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the rate changes of new HIV infections in British Colombia.