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HIV pre-exposure prophylaxis (PrEP) is an effective prevention tool being scaled up in Canada. We describe PrEP uptake and identify demographic correlates of uptake among gay, bisexual, and other men who have sex with men (gbMSM) at elevated HIV risk using data from an online survey of gbMSM residing in Canada between Oct 2017 and Jan 2018. Among the 969 participants at elevated HIV risk who had recently tested for HIV, 96.0%, 83.3%, 72.6%, and 39.7% reported awareness, knowledge, acceptability, and pursuit of PrEP, respectively; 27.1% had ever and 24.6% were currently taking PrEP. The strongest correlate of PrEP uptake was living in a city of ≥ 500,000 inhabitants; others included being out to all or almost all family, friends, and colleagues regarding sexual attraction to men, greater financial coping, and being 30–49 years of age. Improved upscaling of PrEP in Canada may be accomplished through consideration of these disparities.

Contexte : L’enquête Track auprès des utilisateurs de drogues injectables a permis de recueillir des données dans quatorze sites sentinelles au Canada (2017 à 2019). Ces résultats décrivent la prévalence du virus de l’immunodéficience humaine (VIH), de l’hépatite C et des comportements à risque associés à ceux-ci chez les participants autochtones. Méthodes : Des informations sur les caractéristiques sociodémographiques, les déterminants sociaux de la santé, le recours aux services de prévention et au dépistage, la consommation de drogues, les comportements à risque, ainsi que le dépistage, les soins et le traitement du VIH et de l’hépatite C ont été recueillies par l’entremise de questionnaires administrés par un intervieweur. Les échantillons biologiques ont été analysés pour y détecter la présence d’anticorps anti-VIH et anti-hépatite C et l’acide ribonucléique (ARN) de l’hépatite C. Les statistiques descriptives ont été calculées et examinées par un groupe consultatif dirigé par des autochtones, selon l’approche à double perspective (Two-Eyed Seeing). Résultats : Parmi les 2 383 participants, 997 étaient des autochtones (82,9 % étaient des membres des Premières Nations, 14,9 % étaient des Métis et 2,2 % étaient des Inuits). Plus de la moitié (54,5 %) étaient des hommes cisgenres et l’âge moyen était de 38,9 ans. Une grande proportion (84,0 %) des participants ont déclaré que leur santé mentale était de « passable excellente ». Une forte proportion d’entre eux ont été victimes de stigmatisation et de discrimination (90,2 %) ainsi que de violences physiques, sexuelles et/ou psychologiques durant l’enfance (87,5 %) ou de la part d’un partenaire sexuel (78,6 %). Un pourcentage élevé d’entre eux ont déclaré utiliser un programme de distribution de seringues (90,5 %) et avoir été dépisté pour le VIH (87,9 %) et l’hépatite C (87,8 %). La prévalence du VIH était de 15,4 % (78,2 % d’entre eux avaient connaissance de leur statut infectieux) et 36,4 % d’entre eux étaient séropositifs pour l’ARN de l’hépatite C (49,4 % d’entre eux avaient connaissance de leur statut infectieux). Conclusion : L’enquête a révélé des taux élevés de VIH et d’hépatite C. Elle a également révélé des défis liés à l’accès et au maintien des soins et des traitements liés au VIH et à l’hépatite C. Ces renseignements éclairent les stratégies de réduction des méfaits, y compris la nécessité d’accroître la sensibilisation à la prophylaxie d’une manière culturellement pertinente.

Background: The Tracks survey of people who inject drugs (PWID) collected data in 14 sentinel sites across Canada (2017–2019). These findings describe the prevalence of human immunodeficiency virus (HIV), hepatitis C and associated risk behaviours among Indigenous participants. Methods: Information regarding socio-demographics, social determinants of health, use of prevention services and testing, drug use, risk behaviours, and HIV and hepatitis C testing, care and treatment was collected through interviewer-administered questionnaires. Biological samples were tested for HIV, hepatitis C antibodies and hepatitis C ribonucleic acid (RNA). Descriptive statistics were calculated and reviewed by an Indigenous-led advisory group using the Two-Eyed Seeing approach. Results: Of the 2,383 participants, 997 were Indigenous (82.9% First Nations, 14.9% Métis, 2.2% Inuit). Over half (54.5%) were cisgender male and the average age was 38.9 years. A large proportion (84.0%) reported their mental health as “fair to excellent”. High proportions experienced stigma and discrimination (90.2%) and physical, sexual and/or emotional abuse in childhood (87.5%) or with a sexual partner (78.6%). Use of a needle/syringe distribution program (90.5%) and testing for HIV (87.9%) and hepatitis C (87.8%) were high. Prevalence of HIV was 15.4% (78.2% were aware of infection status) and 36.4% were hepatitis C RNA-positive (49.4% were aware of infection status). Conclusion: High rates of HIV and hepatitis C were identified. Challenges in access to and maintenance of HIV and hepatitis C care and treatment were noted. This information informs harm reduction strategies, including the need to scale-up awareness of prophylaxis in a culturally relevant manner.

Background: The Tracks survey of people who inject drugs (PWID) collected data in 14 sentinel sites across Canada (2017–2019). Objective: To describe the prevalence of human immunodeficiency virus (HIV) and hepatitis C and associated risk behaviours and to examine trends over time. Methods: Information regarding socio-demographics, social determinants of health, use of prevention services and testing, drug use, risk behaviours, and HIV and hepatitis C testing, care and treatment was collected through interviewer-administered questionnaires. Biological samples were tested for HIV, hepatitis C antibodies and hepatitis C ribonucleic acid (RNA). Descriptive statistics were calculated and trends over time were assessed. Results: Of the 2,383 participants, 65.6% were cisgender male, 42.2% were Indigenous, 48.0% completed some high school or less, 62.6% lived in unstable housing and 75.7% had ever been incarcerated. Average age was 40.1 years. The majority experienced stigma and discrimination (88.7%) and physical, sexual and/or emotional abuse in childhood (85.0%) or with a sexual partner (75.9%). The majority reported use of a needle/syringe distribution program (90.1%) and tested for HIV (90.5%) and hepatitis C (90.9%). Among participants who had ever had sex, the majority (59.2%) reported inconsistent condom use during vaginal and/or anal sex with a casual sex partner. Prevalence of HIV was 10.3% (82.9% were aware of infection status) and many (36.9%) were hepatitis C RNA-positive (50.1% were aware of infection status). Most surveillance indicators remained relatively stable from Phase 1 to Phase 4. Changes were found in substances used, and improvements were noted related to HIV and hepatitis C prevalence and care cascade indicators. Conclusion: Many PWID in Canada were living in unstable housing and experienced high levels of stigma and discrimination. Prevalence of HIV and hepatitis C was high in some areas. These findings contribute to the evidence base used to inform targeted prevention and control measures.

Evidence-informed decision making is based on the premise that the entirety of information on a topic is collected and analyzed. Systematic reviews allow for data from different studies to be rigorously assessed according to PICO principles (population, intervention, control, outcomes). However, conducting a systematic review is generally a slow process that is a significant drain on resources. The fundamental problem is that the current approach to creating a systematic review cannot scale to meet the challenges resulting from the massive body of unstructured evidence. For this reason, the Public Health Agency of Canada has been examining the automation of different stages of evidence synthesis to increase efficiencies. In this article, we present an overview of an initial version of a novel machine learning–based system that is powered by recent advances in natural language processing (NLP), such as BioBERT, with further optimizations completed using a new immunization-specific document database. The resulting optimized NLP model at the core of this system is able to identify and extract PICO-related fields from publications on immunization with an average accuracy of 88% across five classes of text. Functionality is provided through a straightforward web interface.

Contexte : L’enquête Track auprès des utilisateurs de drogues injectables (UDI) a permis de recueillir des données dans quatorze sites sentinelles au Canada (2017 à 2019). Objectifs : Décrire la prévalence du virus de l’immunodéficience humaine (VIH), de l’hépatite C et des comportements à risque associés à ceux-ci, et examiner les tendances observées au fil du temps. Méthodes : Des informations sur les caractéristiques sociodémographiques, les déterminants sociaux de la santé, le recours aux services de prévention et au dépistage, la consommation de drogues, les comportements à risque, ainsi que le dépistage, les soins et le traitement du VIH et de l’hépatite C ont été recueillis par l’entremise de questionnaires administrés par un intervieweur. Les échantillons biologiques ont été analysés pour y détecter la présence d’anticorps anti-VIH et anti-hépatite C et l’acide ribonucléique (ARN) de l’hépatite C. Les statistiques descriptives ont été calculées et les tendances observées au fil du temps ont été évaluées. Résultats : Parmi les 2 383 participants, 65,6 % étaient des hommes cisgenres, 42,2 % étaient autochtones, 48 % avaient un niveau d’instruction égal ou inférieur au secondaire, 62,6 % se trouvaient dans une situation de logement précaire et 75,7 % avaient déjà été incarcérés. L’âge moyen était de 40,1 ans. La majorité des participants ont été victimes de stigmatisation et de discrimination (88,7 %) ainsi que de violences physiques, sexuelles et/ou psychologiques durant l’enfance (85 %) ou de la part d’un partenaire sexuel (75,9 %). La majorité des participants ont déclaré utiliser un programme de distribution de seringues (90,1 %) et avoir été dépisté pour le VIH (90,5 %) et l’hépatite C (90,9 %). Parmi les participants ayant des antécédents de relations sexuelles, la majorité (59,2 %) a déclaré utiliser le préservatif de manière irrégulière lors de relations vaginales ou anales avec un partenaire sexuel occasionnel. La prévalence du VIH était de 10,3 % (82,9 % d’entre eux avaient connaissance de leur statut infectieux) et de nombreux participants (36,9 %) étaient séropositifs pour l’ARN de l’hépatite C (50,1 % d’entre eux avaient connaissance de leur statut infectieux). La plupart des indicateurs de surveillance sont restés relativement stables entre la phase 1 et la phase 4. Des changements ont été observés au niveau des substances utilisées, et des améliorations ont été notées en ce qui concerne la prévalence du VIH et de l’hépatite C et les indicateurs de la cascade de soins. Conclusion : De nombreux UDI au Canada se trouvaient dans une situation de logement précaire et étaient confrontés à des niveaux élevés de stigmatisation et de discrimination. La prévalence du VIH et de l’hépatite C était élevée dans certaines régions. Ces résultats contribuent aux données probantes utilisées pour informer les mesures de prévention et de contrôle ciblées.

La compréhension de l’épidémiologie de la COVID-19 chez les enfants et les jeunes au Canada aidera à éclairer les mesures de santé publique dans les milieux où les enfants se rassemblent. En date du 27 avril 2020, les gouvernements des provinces et territoires ont fourni à l’Agence de la santé publique du Canada des renseignements détaillés sur 24 079 cas, dont 3,9 % (n = 938) avaient moins de 20 ans. Le taux de détection pour 100 000 habitants était plus faible dans ce groupe d’âge (11,9 pour 100 000), par rapport aux personnes âgées de 20 à 59 ans (72,4 pour 100 000) et de 60 ans et plus (113,6 pour 100 000). L’âge médian des personnes de moins de 20 ans était de 13 ans, et les cas étaient répartis également entre les hommes et les femmes. Parmi les provinces et territoires comptant plus de 100 cas, 1,6 % à 9,8 % des cas étaient âgés de moins de 20 ans. Les cas de ce groupe d’âge étaient plus susceptibles d’être asymptomatiques, soit 10,7 % comparativement à 2,4 % chez les 20 à 59 ans et à 4,1 % chez les 60 ans et plus. Les enfants et les jeunes ont moins souvent connu des résultats graves, mais 2,2 % (n = 15/672) des cas dans ce groupe d’âge étaient suffisamment graves pour nécessiter une hospitalisation. Selon les renseignements disponibles sur l’exposition, 11,3 % (n = 59/520) des cas âgés de moins de 20 ans n’avaient aucun contact connu avec un cas. Les résultats du Canada correspondent à ceux d’autres pays.

HIV pre-exposure prophylaxis (PrEP) is an effective prevention tool being scaled up in Canada. We describe PrEP uptake and identify demographic correlates of uptake among gay, bisexual, and other men who have sex with men (gbMSM) at elevated HIV risk using data from an online survey of gbMSM residing in Canada between Oct 2017 and Jan 2018. Among the 969 participants at elevated HIV risk who had recently tested for HIV, 96.0%, 83.3%, 72.6%, and 39.7% reported awareness, knowledge, acceptability, and pursuit of PrEP, respectively; 27.1% had ever and 24.6% were currently taking PrEP. The strongest correlate of PrEP uptake was living in a city of ≥ 500,000 inhabitants; others included being out to all or almost all family, friends, and colleagues regarding sexual attraction to men, greater financial coping, and being 30-49 years of age. Improved upscaling of PrEP in Canada may be accomplished through consideration of these disparities.

Cognitive-behavioral therapy (CBT) is effective for treating chronic pain, but little is known about the mechanisms that might facilitate or hinder its utility when delivered by videoconference. In...

Background In 2017, the international European Men-who-have-sex-with-men Internet Survey (EMIS-2017) collected data from 50 countries, including Canada for the first time. Objective To provide an overview of the Canadian EMIS-2017 data to describe the sexually transmitted and other bloodborne infection (STBBI) related needs of gay, bisexual and other men who have sex with men (gbMSM). Methods The EMIS-2017 questionnaire was an updated version of EMIS-2010. It included self-reported sociodemographic data, experience of discrimination, mental health and substance use, knowledge of preexposure prophylaxis (PrEP) for HIV, sexual practices and history of STBBI testing and diagnosis. Analysis was largely descriptive. Results Of the 6,059 respondents from Canada, 5,165 participants met the inclusion criteria for this analysis. The majority of participants were born in Canada (79.3%); and over half of the respondents (56.7%) were under the age of 39. In terms of discrimination related to their attraction to other men, participants reported high levels of intimidation (31.9%), verbal abuse (22.1%) and physical violence (1.5%) in the previous year. Regarding mental health, 23.9% had a moderate to severe depression/anxiety score. Almost two-thirds (64.1%) indicated substance use and one-fifth (21.5%) reported chemsex (or the use of stimulant drugs to make sex more intense or last longer). Only 8.4% of participants reported use of PrEP for HIV; however, 51.7% reported being likely to use PrEP if it was available and affordable. Sexual practices, such as condom use, varied by PrEP use with 91.3% of men using PrEP reporting condomless anal intercourse (CAI) compared with 71.5% of men not on PrEP. In terms of STBBI testing, 1.5% reported being diagnosed with hepatitis C and 9.0% reported an HIV diagnosis. Of those with an HIV diagnosis, most were on treatment (99.1%) and had an undetectable viral load (96.7%). Conclusion gbMSM in Canada experienced stigma, discrimination and mental health problems; substance use was high as were high-risk sexual practices, such as CAI, among some groups of men. There was a gap between the proportion of men who were interested in PrEP and those who actually used it; and comprehensive STBBI testing was low.These findings can inform public health action and provide a baseline to examine the impact of current and new interventions.

Objective We aimed to assess the potential prevention benefits of HIV treatment as prevention (TasP) in resource-rich countries and examine the potential interactions between TasP and other prevention strategies by reviewing mathematical models of TasP. Method Multiple databases were searched for mathematical models published in the previous 5 years (from July 2007 to July 2012). The nine models located were set in Canada, Australia and the United States. Results These models' predictions suggested that the impact of expanding treatment rates on expected new infections could range widely, from no decrease to a decrease of 76%, depending on the time horizon, assumptions and the form of TasP modeled. Increased testing, reducing sexually transmitted infections and reducing risky practices were also predicted to be important strategies for decreasing expected new infections. Sensitivity analysis suggests that current uncertainties such as the effectiveness of highly active antiretroviral therapy outside of heterosexual transmission, less than ideal adherence, and risk compensation, could impact on the success of TasP at the population level. Conclusion The results from large scale pilots and community randomized controlled trials will be useful in demonstrating how well this prevention approach works in real world settings, and in identifying the factors that are needed to support its effectiveness.

Venue sampling is a common sampling method for populations of men who have sex with men (MSM); however, men who visit venues frequently are more likely to be recruited. While statistical adjustment methods are recommended, these have received scant attention in the literature. We developed a novel approach to adjust for frequency of venue attendance (FVA) and assess the impact of associated bias in the ManCount Study, a venue-based survey of MSM conducted in Vancouver, British Columbia, Canada, in 2008-2009 to measure the prevalence of human immunodeficiency virus and other infections and associated behaviors. Sampling weights were determined from an abbreviated list of questions on venue attendance and were used to adjust estimates of prevalence for health and behavioral indicators using a Bayesian, model-based approach. We found little effect of FVA adjustment on biological or sexual behavior indicators (primary outcomes); however, adjustment for FVA did result in differences in the prevalence of demographic indicators, testing behaviors, and a small number of additional variables. While these findings are reassuring and lend credence to unadjusted prevalence estimates from this venue-based survey, adjustment for FVA did shed important insights on MSM subpopulations that were not well represented in the sample.

High rates of both illicit drug use and depression are consistently reported among gay men. However, little is known about how beliefs about drug use shape clinical encounters between gay men and health professionals, and that in turn affect clinical communication and care, particularly in relation to depression. We compared ‘doctor’ and ‘patient’ beliefs about the role of illicit drug use in gay men’s depression. Semi-structured interviews were conducted during August–December 2006 with 16 general medical practitioners working in seven ‘gay-friendly’ practices in Sydney, Adelaide and a rural-coastal city in New South Wales, and during February–May 2008 with 40 gay men with depression recruited through four Sydney and Adelaide practices. A thematic analysis of these two sets of interviews found that doctors expressed the beliefs that: illicit drug use is related to depression in gay men; illicit drug use impedes effective diagnosis and treatment of depression in gay men; and illicit drug use increases the level of complexity involved in caring for gay men with depression. Gay men expressed the beliefs that: illicit drug use is closely related to depression; illicit drug use can be helpful in dealing with difficult experiences; and illicit drug use is just what you do as a gay man living in a big city. Both groups believed drug use and depression were related, but doctors emphasised the negative outcomes of drug use and interpreted these in relation to health. Gay men believed that drugs could have both negative and positive uses and differentiated between health and social outcomes. While the doctors articulated a pragmatic position on drug use, which is consistent with harm reduction principles, communication with gay male patients could be enhanced if both groups acknowledged their divergent views of illicit drugs and their potential role in mental health.

Aims: Respondent-driven sampling (RDS) is increasingly being used to sample hidden populations, such as people who inject drugs (PWIDs). This study compared samples of PWID recruited from RDS and service-based sampling methods to explore whether RDS captured a less visible group of PWID that differed in their risk profile than those captured using service-based sampling.Methods: An RDS study of PWID was conducted in Sydney, Australia in 2009. RDS participants’ frequency of use of NSP and pharmacies was calculated. Population estimates were calculated for RDS participant characteristics and were compared with sample proportions from two separate studies, which recruited participants from needle and syringe programmes (NSP) and pharmacies.Findings: Only 12% of the RDS sample may not have been accessible through either an NSP or a pharmacy. RDS participants were just as risky in their injecting practices and were more likely to access HCV prevention services than participants recruited from service-based sam...

We examined individual-level syringe coverage among 417 people who inject drugs who were recruited from pharmacies in New South Wales in 2009. There was a U-shaped distribution of syringe coverage with many people having very high (51%) or very low (23%) coverage. Overall, two-thirds of respondents (63%) reported adequate coverage (≥ 100%). Respondents who had not used a needle and syringe program in the previous month were more likely to report inadequate coverage (AOR 2.25, 95% CI 1.25-4.05) as were those who reported daily or more frequent injecting (AOR 3.69, 95% CI 2.00-6.81). Inadequate syringe coverage was not independently associated with receptive needle sharing. The level of syringe coverage was high among this sample, and met targets set out by UNAIDS and other organisations. We found that inadequate syringe coverage was not independently correlated with receptive needle sharing, possibly because coverage is sufficient to diminish the relationship between syringe availability and sharing behaviours.

Background Respondent-driven sampling (RDS) is a form of chain-referral sampling that is increasingly being used for HIV behavioural surveillance. When used for surveillance purposes, a sampling method should be relatively inexpensive and simple to operate. This study examined whether an RDS survey of people who inject drugs (PWID) in Sydney, Australia, could be successfully conducted through the use of minimal and existing resources. Method The RDS survey was conducted on the premises of a local needle and syringe program (NSP) with some adjustments to take into account the constraints of existing resources. The impact of the survey on clients and on staff was examined by summarizing NSP service data and by conducting post-survey discussions with NSP staff. Results From November 2009 till March 2010, 261 participants were recruited in 16 waves. A significant increase was found in the number of services provided by the NSP during and after data collection. Generally, staff felt that the survey had a positive impact by exposing a broader group of people to the NSP. However, conducting the survey may have led to privacy issues for NSP clients due to an increased number of people gathering around the NSP. Conclusions This study shows that RDS can be conducted with the use of minimal and existing resources under certain conditions (e.g., use of a self-administered questionnaire and no biological samples taken). A more detailed cost-utility analysis is needed to determine whether RDS’ advantages outweigh potential challenges when compared to simpler and less costly convenience methods.

Our aim was to clarify the role of alcohol and other drug (AOD) use in major depression among gay men attending general medical practices. A secondary analysis was conducted on survey data collected from 531 gay men attending high-HIV-caseload general practices in Adelaide and Sydney, Australia. The survey contained demographic, social, behavioural and AOD variables. Participants were classified into those with (n = 130) and without major depression (n = 401) using the PHQ-9 screening tool. Although rates of drug use were very high in the sample, multivariate logistic regression analysis showed that the majority of variables independently associated with major depression were social and behavioural factors. Only one AOD variable was associated with major depression: the use of three or more drug types in the past 6 months. Attending to specific patterns of AOD use may assist in the identification of gay men most at risk of major depression.

Respondent-driven sampling (RDS) is a relatively new form of sampling hidden populations. RDS has the ability to produce valid population estimates, provided that certain assumptions are met. This study examined whether an RDS survey of people who inject drugs (PWID) conducted in South East Sydney was able to meet the assumptions and requirements necessary to produce valid population estimates. From November 2009 to March 2010, 261 participants were recruited in 16 waves. While the method's requirements and assumptions were largely met, an apparent lack of random recruitment and the low proportion of coupons returned were sources of concern. This study shows that RDS can be used successfully in Australia as a means of recruiting PWID. However, more work is needed to confirm the soundness of the assumptions on which the calculation of valid population estimates are based.

The aim of this review was to develop an overview of the sampling methods used in developed countries for behavioural surveillance among men who have sex with men. We abstracted information from peer-reviewed and non-peer-reviewed publications and, when needed, contacted first authors and surveillance authorities. Out of the 40 developed countries, 26 surveillance systems were identified in 23 countries. These surveillance systems made use of one or a combination of: venue-based sampling (n = 16); web-based sampling (n = 11); gay press/mail-out (n = 8); or respondent-driven sampling (n = 4). Differences in the sampling methods used were found by year of implementation and by region. More information is needed to better assess the strengths and limitations of the range of sampling methods. There was substantial variation in the way sampling methods were applied, most especially in venue-based sampling. To improve the ability to compare indicators across countries, key elements of the sampling methods should be standardized.

Objective: This study describes characteristics of psychiatry inpatients with developmental disabilities (DD) and their admissions to psychiatry wards in 2 acute care hospitals. It also compares differences in lengths of stay between admissions of this group with a comparison sample of inpatient admissions without DD. Method: A retrospective chart review was conducted on all individuals with DD who were psychiatric inpatients at 2 Kingston, Ontario, general hospitals, within a 4-year period (1994 to 1998). A comparison sample of admissions of patients without DD was chosen. Frequency tables were used to describe the inpatients with DD and to describe the 2 samples of admissions. Nonparametric statistics were used to compare the median length of stay between the 2 samples. Associations between length of stay and other covariates were explored within the sample of patient admissions with DD. Results: The 62 individuals with DD had 101 admissions over the study period. Suicidal ideation was the most common admission reason (46%), and mood disorder was the most common discharge diagnosis (29%). The median length of stay for patients with DD was 8 days, which did not differ meaningfully from the comparison sample. Variables that were significantly associated with length of stay among individuals with DD included sex, referral source, and diagnosis. Conclusion: When individuals with DD are psychiatric inpatients, their length of stay is affected by some factors that have been identified in previous studies not specific to DD (for example, referral source and diagnosis). Our finding that male patients with DD have longer lengths of stay than do female patients in the same sample has not been reported in previous research.

Skin ulcers of the lower extremities have a chronic, relapsing course and often are difficult to manage. Leg ulcers remain a significant management challenge to health care professionals. This article focuses on the various causes of leg ulcers, with an emphasis on venous disease. Characteristic clinical findings and appropriate treatment options are discussed. Finally, the latest advances in the treatment of venous ulcers and their implications for clinical practice are emphasized.

Much of the recent increase in hospital admission rates and mortality associated with hepatitis C in Canada is believed to be because of a higher prevalence of hepatitis C virus infection among those born between 1945 and 1965 (the baby boomer generation). We explored the effects of birth cohort on the rates of and projected trends in hospital admissions associated with hepatitis C.The hospital records of 17 344 inpatients with a diagnosis of chronic hepatitis C and liver disease, including liver cancer, were extracted from the Canadian Discharge Abstract Database for April 2004 to March 2011. For each 5-year birth cohort from 1915 to 1984, regression analysis was used to estimate the temporal trends associated with the average age of the cohort during the study period. Future hospital admissions were predicted based on the assumption that past trends would continue.Hospital admissions associated with hepatitis C and liver disease increased an average of 6.0% (95% confidence interval [CI] 4.4%-7.7%) a year over the study period. As of 2010, hospital admission rates were highest for the 1950-1954 and 1955-1959 birth cohorts, at 17.6 (95% CI 13.2-23.5) and 13.7 (95% CI 10.3-18.2) times the rate for the 1970-1974 birth cohort. The corresponding same-age rate ratios predicted under a status quo scenario were 3.6 (95% CI 2.3-4.9) and 3.4 (95% CI 2.1-4.7). Same-age rate ratios were significantly higher for the four 5-year birth cohorts between 1950 and 1969 compared with other birth cohorts.Hospital admissions associated with chronic hepatitis C and liver disease were significantly higher for the 1950-1954 and 1955-1959 birth cohorts than for most other birth cohorts. Without further interventions, the disease burden associated with hepatitis C will continue to increase for most birth cohorts, likely peaking after age 70 years. The substantial disease burden emerging in younger birth cohorts should be monitored.

The approved indication of H2 blockers is the reduction of gastric acid secretion; H2 blockers are widely prescribed to alleviate the symptoms of peptic ulcer disease, erosive gastroesophageal reflux disease, and hypersecretory conditions including Zollinger Ellison syndrome, systemic mastocytosis, and multiple endocrine adenomas.1 The most common unapproved dermatologic indications for H2 receptor antagonists are the treatment of cutaneous infections and chronic urticaria. Cimetidine and ranitidine are the agents usually prescribed by dermatologists. Actions of H2 Receptor Antagonists Cimetidine is generally well-tolerated but may cause adverse effects, including dizziness and mild somnolence (at doses of 800 to 1600 mg/day), reversible confusional state (especially in the elderly with preexisting renal or hepatic disease), gastrointestinal upset, gynecomastia (may occur if treatment period is greater than 1 month), reversible dose-related increase in serum transaminases, and dose-related elevations in plasma

(1999). Pica and Trace Metal Deficiencies in Adults with Developmental Disabilities. The British Journal of Development Disabilities: Vol. 45, No. 89, pp. 111-117.

This paper describes patterns of injecting drug use and blood borne virus (BBV)-related risk practices among Australian Aboriginal and non-Aboriginal people who inject drugs (PWID). A total of 588 participants, 120 of whom self-identified as Aboriginal completed a questionnaire. Aboriginal participants were more likely to have been in prison (37.6 vs. 16.5 %), to inject daily (72.7 vs. 55.0 %), to share ancillary equipment (64.9 vs. 44.8 %) and less likely to know about BBV transmission (72.0 vs. 87.7 %) and treatment (47.2 vs. 67.6 %). Aboriginal participants used services such as BBV testing and drug treatment at a comparable rate to non-Aboriginal participants. The findings suggest that Aboriginal PWID are at greater risk for acquiring BBV. The prison setting should be used to deliver health promotion information and risk reduction messages. More information is needed on Aboriginal people’s access and use of services to ensure beneficial services are received in the most appropriate settings.

Respondent-driven sampling (RDS) is a form of chain-referral sampling, similar to snowball sampling, which was developed to reach hidden populations such as people who inject drugs (PWID). RDS is said to reach members of a hidden population that may not be accessible through other sampling methods. However, less attention has been paid as to whether there are segments of the population that are more likely to be missed by RDS. This study examined the ability of RDS to capture people with small injecting networks. A study of PWID, using RDS, was conducted in 2009 in Sydney, Australia. The size of participants’ injecting networks was examined by recruitment chain and wave. Participants’ injecting network characteristics were compared to those of participants from a separate pharmacy-based study. A logistic regression analysis was conducted to examine the characteristics independently associated with having small injecting networks, using the combined RDS and pharmacy-based samples. In comparison with the pharmacy-recruited participants, RDS participants were almost 80% less likely to have small injecting networks, after adjusting for other variables. RDS participants were also more likely to have their injecting networks form a larger proportion of those in their social networks, and to have acquaintances as part of their injecting networks. Compared to those with larger injecting networks, individuals with small injecting networks were equally likely to engage in receptive sharing of injecting equipment, but less likely to have had contact with prevention services. These findings suggest that those with small injecting networks are an important group to recruit, and that RDS is less likely to capture these individuals.

Background Respondent-driven sampling (RDS) is a method for recruiting hidden populations, such as people who inject drugs (PWID). In RDS, participants recruit their peers into the study; who recruited who into the study is tracked, and thus information is gathered on the population's social networks. The purpose of this study was to use information collected from an RDS study of PWID to determine the size and structure of injecting networks and whether network characteristics are associated with sharing injecting equipment. Methods A study was launched in Sydney, Australia in 2009 with five seeds, who were asked to recruit three participants each into the survey. This process was repeated until the target sample size was reached. The median size of injecting networks and the homophily (a measure of in-group affiliation) of different subgroups were calculated. Participants' information was linked with that of their recruiter to form dyads, and multivariate analysis was conducted to determine whether dyad and injecting network characteristics were associated with sharing injecting equipment within the dyads. Results The injecting networks were large, the lowest median subgroup network size being 12. Homophily estimates indicated a lack of strong ties both within and across groups. In the multivariate analysis, factors significantly associated with sharing injecting equipment within dyads were feeling very close to their recruiter and having one or both members of the dyad identify as Aboriginal or Torres Strait Islander and one or both members having not been tested for hepatitis C in the previous year. Conclusion RDS provided valuable information on injecting networks in Sydney. PWID were shown to be socially connected with a large number of other injectors, and affiliations were formed without regard to demographic or drug use characteristics. Linking information from the recruits with that of their recruiter was a useful way of organizing information to gain a more complete understanding of risk behaviour.

General practitioners (GPs) identify that depression can be difficult to diagnose in populations with high rates of alcohol and other drug (AOD) use. This is a particular concern with gay men who are a population known to engage in high rates of AOD use and who are vulnerable to depression. This paper uses data from 563 gay men and their GPs to describe concordance between assessments of major depression and, in particular, whether AOD use undermines concordance. Data were collected as part of a larger study of male patients and GPs at high HIV-caseload general practices in Australia. Concordance was measured by comparing patients’ scores on the Patient Health Questionnaire-9 screening tool, which is based on the Diagnostic and Statistical Manual of Mental Disorders IV criteria, and GPs’ ratings of the likelihood of depression for each participant. We observed high concordance between GPs’ assessments of major depression and patients’ scores on the PHQ-9 (79% agreement), although our analysis also suggested that concordance was better when it related to cases in which there was no depression. The high concordance observed in our study did not appear to be undermined by gay male patients’ AOD use, with the exception of frequent use of crystal methamphetamine. Here, men who reported frequent use of methamphetamine were significantly less likely to have concordant assessments (adjusted odds ratio 0.3, 95% CI 0.1–0.8). Overall, GPs appear to identify depression among many of their gay male patients. While GPs should be aware of the potential complications presented by frequent crystal methamphetamine use, other AOD use may have less impact on the diagnosis of depression.