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Background: A lack of safety data on postpartum medication use presents a potential barrier to breastfeeding and may result in infant exposure to medications in breastmilk. The type and extent of medication use by lactating women requires investigation. Methods: Data were collected from the CHILD Cohort Study which enrolled pregnant women across Canada between 2008 and 2012. Participants completed questionnaires regarding medications and non-prescription medications used and breastfeeding status at 3, 6 and 12 months postpartum. Medications, along with self-reported reasons for medication use, were categorized by ontologies [hierarchical controlled vocabulary] as part of a large-scale curation effort to enable more robust investigations of reasons for medication use. Results: A total of 3542 mother-infant dyads were recruited to the CHILD study. Breastfeeding rates were 87.4%, 75.3%, 45.5% at 3, 6 and 12 months respectively. About 40% of women who were breastfeeding at 3 months used at least one prescription medication during the first three months postpartum; this proportion decreased over time to 29.5% % at 6 months and 32.8% at 12 months. The most commonly used prescription medication by breastfeeding women was domperidone at 3 months (9.0%, n = 229/2540) and 6 months (5.6%, n = 109/1948), and norethisterone at 12 months (4.1%, n = 48/1180). The vast majority of domperidone use by breastfeeding women (97.3%) was for lactation purposes which is off-label (signifying unapproved use of an approved medication). Non-prescription medications were more often used among breastfeeding than non-breastfeeding women (67.6% versus 48.9% at 3 months, p < 0.0001), The most commonly used non-prescription medications were multivitamins and Vitamin D at 3, 6 and 12 months postpartum. Conclusions: In Canada, medication use is common postpartum; 40% of breastfeeding women use prescription medications in the first 3 months postpartum. A diverse range of medications were used, with many women taking more than one prescription and non-prescription medicines. The most commonly used prescription medication by breastfeeding women were domperidone for off-label lactation support, signalling a need for more data on the efficacy of domperidone for this indication. This data should inform research priorities and communication strategies developed to optimize care during lactation. [ABSTRACT FROM AUTHOR]

Objectives: Chronic hepatitis C (CHC) infection affects more than 70 million people worldwide and imposes considerable health and economic burdens on patients and society. This study estimated 2 understudied components of the economic burden, patient out-of-pocket (OOP) costs and time costs, in patients with CHC in a tertiary hospital clinic setting and a community clinic setting.Methods: This was a multicenter, cross-sectional study with hospital-based (n = 174) and community-based (n = 101) cohorts. We used a standardized instrument to collect healthcare resource use, time, and OOP costs. OOP costs included patient-borne costs for medical services, nonprescription drugs, and nonmedical expenses related to healthcare visits. Patient and caregiver time costs were estimated using an hourly wage value derived from patient-reported employment income and, where missing, derived from the Canadian census. Sensitivity analysis explored alternative methods of valuing time. Costs were reported in 2020 Canadian dollars.Results: The mean 3-month OOP cost was $55 (95% confidence interval [CI] $21-$89) and $299 (95% CI $170-$427) for the community and hospital cohorts, respectively. The mean 3-month patient time cost was $743 (95% CI $485-$1002) (community) and $465 (95% CI $248-$682) (hospital). The mean 3-month caregiver time cost was $31 (95% CI $0-$63) (community) and $277 (95% CI $174-$380) (hospital). Patients with decompensated cirrhosis bore the highest costs.Conclusions: OOP costs and patient and caregiver time costs represent a considerable economic burden to patient with CHC, equivalent to 14% and 21% of the reported total 3-month income for the hospital-based and community-based cohorts, respectively. [ABSTRACT FROM AUTHOR]

This study examined the elevated risk of intimate partner violence (IPV) among persons with mental health-related disabilities (MH-RD) and the extent to which known risk factors accounted for this phenomenon. Data were drawn from a nationally representative sample of 33,127 Canadians collected in 2014 as part of Statistics Canada's General Social Survey. Results showed that respondents with MH-RD had more than three-fold increased odds of both overall and severe IPV victimization. Although females were more likely to possess a MH-RD, males and females with MH-RD reported similarly elevated odds of IPV victimization. Risk factors that contributed to a significant reduction in elevated odds of IPV for respondents with MH-RD were child maltreatment (CM), respondents' nonprescription drug abuse, and perpetrators' jealous, monitoring, and socially isolating behaviors. The inability to test additional risk factors and bidirectionality in the relationship between MH-RD and IPV may have contributed to the failure to fully account for these respondents' elevated odds of IPV. Future research is needed to understand the complex mechanisms contributing to the elevated risk of IPV and enhance prevention and intervention strategies for this underresearched and underserved vulnerable population. [ABSTRACT FROM AUTHOR]

Purpose: Pain is common in youngsters. No matter its nature, youngsters' consideration of pain is complex since its communications vary as a function of several components. The aim of this study is to explore the youngsters' perception linked to their experience of physiological pain at the home/family setting, as well as their experience with the utilisation of over‐the‐counter pain medication as needed. Design and methods: A qualitative exploratory study was undertaken with 22 youngsters aged 5–17 years old. Semidirected interviews led to the understanding of these components by means of the pain experiences. Thematic analysis allowed the detection of the themes and subthemes emerging from the verbatim collected with the participants. Results: The way pain is described is influenced by the child's development, previous experiences, and the projection of having pain. The pain communication is influenced by the severity perceived, the beliefs of the youngster experiencing pain, the comparison of the pain communication with his brothers and sisters, as well as the anticipated consequences of expressing his pain. The choice of behaviour towards pain is influenced by self‐management through nonpharmacological management, with medicines if needed, and by family modelization. Practice implications: This study confirms that previous pain experiences, beliefs related to pain tolerance and intended reactions of parents exert influence not only on the communication of pain, but also on youngsters' behaviour towards pain. It is important to consider these elements whenever youngsters' pain is evaluated. [ABSTRACT FROM AUTHOR]

Pharmaceuticals and personal care products (PPCPs) include over-the-counter and prescription drugs, veterinary drugs, fragrances, and cosmetics. PPCPs have been detected in aquatic environments at low concentrations and are emerging as contaminants of concern. PPCPs are primarily released into aquatic environments via untreated sewage, wastewater treatment plants, landfill leachate and can affect aquatic life through persistence, bioaccumulation, and toxicity. However, there are limited reviews of lethal and sublethal effects of PPCP exposures on aquatic organisms. To understand PPCP toxicity on aquatic organisms, a literature review was conducted that identified aquatic organisms known to be affected by PPCPs; concentrations of PPCPs reported as producing sublethal and lethal effects in aquatic organisms; and research gaps on PPCP aquatic toxicity. Twelve PPCPs were selected from three seminal studies for review, including bisphenol A, carbamazepine, erythromycin, fluoxetine, linear alkylbenzene sulfonate, metoprolol, naproxen, nonylphenol, ofloxacin, sertraline, sulfamethoxazole, and triclosan. Many aquatic species were affected by PPCPs at sublethal and lethal exposures, including sublethal effects at environmentally relevant concentrations. Because lethal effects were seldom observed at environmentally relevant concentrations, many studies considered PPCPs non-toxic. Few studies have compared effects of PPCPs on the same organisms for identical exposure parameters (time and concentration), resulting in wide variation in reported toxicity levels with limited consensus in the academic literature. Consensus in lethal concentrations was reported for Daphnia magna with 48 h exposure for bisphenol A and triclosan and Vibrio fischeri with 15 min exposure to carbamazepine. Environmentally relevant sublethal concentrations were higher than water quality guidelines developed for Canada and predicted no-effect concentrations derived globally. Species sensitivity distributions for some PPCPs show that aquatic species are affected lethally at environmentally relevant concentrations. More studies on indirect and long-term ecological effects along with testing chronic toxicity of PPCPs at environmentally relevant concentrations are recommended. These will help guide future research to determine extent and magnitude of PPCP concentrations in aquatic environments and help inform management decisions to reduce sources of PPCPs into the environment. Future management requires effective monitoring strategies regarding use, disposal, occurrence, and impacts at different life cycle stages of PPCPs in the environment. [ABSTRACT FROM AUTHOR]

Objectives: In Canada, cannabis prohibition ended in October 2018. Older adults are the fastest growing group of cannabis users and are out-pacing other groups as new users. Clinical evidence indicates that cannabis may be helpful for select medicinal purposes in this population. Yet there is limited research about older adults experiences of starting to use cannabis in later life. The purpose of this study was to begin to address this gap. Methods: This study employed qualitative description. A convenience sample of Canadian community-dwelling older adults who were new users of cannabis were recruited. Data were collected using semi-structured interviews. Data analysis was inductive and thematic. Results: Twelve older adults between the ages of 71 and 85 participated. All of the participants used cannabis for medicinal reasons, however, only one had a prescription. The main reasons for using were: pain management, alternative to prescription or over-the-counter medication, and sleep aide. Most participants obtained cannabis from non-licensed stores. Eleven discussed cannabis use with their family physicians, however, none received prescriptions from them. The main sources of information were friends, cannabis store staff, and the media. Conclusions: Older adults who begin using cannabis are likely using for what they perceive to be medicinal purposes for a range of issues. However, they receive minimal guidance from their family physicians and instead obtain information from non-clinician sources. Clinical implications: Cannabis screening should be included in geriatric assessments and medicine reconciliation. Continuing education for clinicians needs to address knowledge gaps about cannabis use among older adults. [ABSTRACT FROM AUTHOR]

There have been several recent, high-profile cases in the media that have shed light on the perceived leniency in sentencing defendants in sexual assault cases. In a number of these cases, the defendant was well known within their community (e.g., Brock Turner; People v. Turner) or nationally (e.g., Ghomeshi; R v. Ghomeshi). The purpose of this study was to examine how the social status of the defendant (low vs. high), victim social status (low vs. high), victim gender (male vs. female), and the reason the victim was unconscious during the assault (consuming alcohol vs. consuming cold medicine) influenced mock jurors' decisions in a sexual assault case. Mock jurors (N = 489) read a mock trial transcript depicting an alleged sexual assault. Mock jurors were asked to render a dichotomous verdict, continuous guilt rating, and rate their perceptions of the victim and defendant. There was no influence of the variables on mock jurors' dichotomous verdicts; however, social status influenced guilt ratings. There also was a combined influence of the defendant's social status and the reason the victim was unconscious such that when the defendant was described as low status, and the victim was unconscious due to alcohol consumption, the defendant received higher guilt ratings compared with when the victim was unconscious due to cold medicine. Moreover, the victim was perceived as having more control over the situation when the defendant was the star quarterback (i.e., high status), the victim was female, and she was unconscious due to alcohol consumption compared with cold medicine. These results suggest that victims may be blamed based on their perceived social status and other factors that may have influenced their control over the sexual assault, such as alcohol consumption. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance/Introduction In Canada, all natural health products (NHPs) are regulated by Health Canada (HC) under the Food and Drugs Act and the Natural Health Product Regulations . All authorized products undergo pre-market assessment for safety, efficacy and quality and the degree of pre-market oversight varies depending on the risk of the product. Overview In Canada, over 70,000 products have been authorized for sale and over 2000 sites have been licensed to produce NHPs. In the management of NHPs on the Canadian market, HC employs a number of active and collaborative methods to address the most common issues such as contamination, adulteration and deceptive or misleading advertising practices. HC is currently evolving its approaches to NHPs to recognize them as part of the larger group of health products available without a prescription. As such, the regulatory responsibility for all over-the-counter (OTC) drugs, including non-prescription drugs and NHPs, has been transferred to a single federal division. Conclusion As a result of this transition a number of benefits are being realized with respect to government efficiency, clarity for industry, support for new innovations and consolidated government interactions with the Canadian market. [ABSTRACT FROM AUTHOR]

The first part of this investigation developed and described quantitative answers to questions that FDA has posed through the administration of an electronic survey questionnaire. The goal of this part was to qualitatively probe these issues further by conducting telephone interviews with key opinion leaders in the United States, Canada, the United Kingdom and Australia. This study aimed to extend the earlier effort and gain additional insight into issues described above and explored the opinions of thirty six key opinion leaders and stakeholders in the area of OTC medicines regulation from the United States, United Kingdom, Australia, and Canada. Results suggest that potential improvements to the US regulatory framework can include creation of an intermediate, pharmacist-controlled class of OTC medicines, delineation of data. [ABSTRACT FROM AUTHOR]

This study assessed the extent to which the mere presence of over-the-counter analgesics affected the perception of experimentally-induced pain in healthy adult samples. In Study 1, 68 college undergraduates participating in a cold pressor test (CPT) were randomly assigned to stimulus displays featuring either pain medication cues (i.e. bottles of aspirin and Tylenol) or cues with no obvious relation to pain (i.e. small elephant statue, soda can) and provided ratings of pain severity every 30 seconds for up to four minutes. Contrary to expectations, participants exposed to pain medication cues reported a significantly lower average rating of pain intensity after 30 seconds of exposure to ice water compared to those exposed to pain-irrelevant cues. This effect was relatively short term, as there were no differences between the two conditions on subsequent ratings of pain intensity or overall pain tolerance. These findings were replicated in a second sample (n = 48) with slightly altered stimulus displays. Possible mechanisms that might have contributed to the findings are elaborated in the discussion in addition to directions for future research. [ABSTRACT FROM AUTHOR]

Focuses on the deregulation of prescription drugs to over-the-counter (OTC) status in Canada in September 2005. Reason behind the increasing number of medications shifting to OTC status; Concept of the National Health Service Plan published in Great Britain in July 2000; Classes of drugs being proposed for reclassification by the Medicines and Healthcare products Regulatory Agency.

The article reports on the consideration of the Food and Drug Administration (FDA) in the U.S. about approving a new class of drugs for behind-the-counter sales that is similar to the Canadian category of the drugs. According to FDA spokesperson Chris Kelly, the agency wants to know the perspective of the Canadian government from the country's experience concerning the behind-the-counter drugs. The American pharmacists have supported the plan but have demanded a new scheme for payment, while the Medical Association and other medical groups have strongly opposed the idea.

The article reports on the safety and effectiveness of Canadian over-the-counter pain relievers when used as directed. Information on the findings of a survey conducted by Decima Research for Health Canada in 2003 is presented. The Nonprescription Drug Manufacturers of Canada is planning to conduct a research as part of the Be MedWise campaign that aims to encourage responsible use of medicines.

The article reports on the results of a study conducted by Ipsos Reid in 2006 concerning the risk facing Canadians who take over-the-counter pain relievers. Such Canadians ignore label directions, misuse, over use or combine powerful drugs which may increase their risk for potentially serious side effects. Findings indicated that 41% of respondents are not concerned about the potential side effects.

Reports on the proposal of Health Canada to eliminate statutory barriers against direct-to-consumer advertising of the purported health benefits from using natural health products (NHP) and non-prescription drugs to treat serious diseases. Claims of the proposal's proponents on its impact; Discussion on issues governing its regulatory amendments; Coverage of the licensing regime for NHP and non-prescription drugs.

Reports on the possibility that emergency contraception will become available without a prescription in Canada by April 2005. Target applications of the levonorgestrel drug after unprotected sexual intercourse; Criteria of Health Canada to classify levonorgestrel as a nonprescription medication; Role of pharmacists in the decision of Health Canada.

Reports on the expenditures of Canadian citizens on prescription and non-prescription drugs in 2004, based on a report from the Canadian Institute for Health Information. Percentage of increase in drug cost in 2003; Estimation of the amount spent by Canadians on drugs in 2004; Factors which contributed to the increase in spending on drugs in the country.

Focuses on the debate in Canada over the credibility of natural health product claims. Stand of Health Canada's Natural Health Products Directorate (NHPD) director-general Phil Waddington on the call for clinical trials of natural health products; Policy of the U.S. Food and Drug Administration on natural health products; Discussion on the issues involved in natural health products.

Offers views on the permission given to pharmacists to dispense emergency contraception with out a physician's prescription in Canada. Reason for supporting such health policy by Health Canada; Effectiveness of levonorgestrel in preventing ovulation, fertilization and implantation; Barriers to the use of oral emergency contraception.

The article focuses on the governments of Australia and Canada which have signed a Mutual Recognition Agreement (MRA). The MRA enables both countries to accept each others good manufacturing practice (GMP) audits and inspection of the makers of prescription and over the counter medicines. GMP regulation is the cornerstone of ensuring that medicines on the market have been manufactured to the highest standards of safety and efficacy. The agreement will enable access to the latest products assessed to best regulatory standards in as short a timeframe as possible.

Reports that Health Canada is working to make postcoital contraception available without a prescription across the country. Availability of the drug over-the-counter in Britain and parts of the United States; Challenge of ensuring patients know how to use the product; How the medicine will not displace an established pregnancy.