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Despite introduction and recommendation of the capsular polysaccharide pneumococcal vaccine in Canada during 1989 to persons >65 years of age, Streptococcus pneumoniae is still a cause of major illness and [...]

Objective: The state of Illinois' Opioid Alternative Pilot Program (OAPP) is the first and only official harm-reduction program in the US to address the opioid crisis via facilitation of safe and legal access to medical cannabis. This study evaluates the association of medical cannabis use with pain level and frequency of opioid use in the first cohort of OAPP participants in 2019. Methods: A survey was sent OAPP enrollees between February and July 2019. Cannabis users (n = 626) were compared to non-users (n = 234) to determine whether there was an association between cannabis use and self-reported (a) pain level and (b) frequency of opioid use. Backward stepwise regression models were used. Results: A total of 860 participants was included in the analysis. Overall, 75% of the study sample reported pain as their primary medical symptom, and 67% of cannabis users reported having a disability. The mean difference in pain level between cannabis users and non-users was 4.5 units (on a 100-point scale) higher among cannabis users than non-users (p = 0.03); and cannabis use was statistically associated with pain level. High-frequency opioid users had lower odds of reporting cannabis use within the past year than low/no opioid users. Conclusions: Although there was a statistical association between cannabis use and pain, the difference of 4.5 points in pain level between users and non-users was too small to reflect a clinically meaningful relative difference. This study may provide useful information to providers and clinicians about how the OAPP and similar programs may reduce opioid use and improve health outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To measure the impact of beliefs, expectations, side effects, and their combined effects on the risk for medication nonpersistence. Patients and methods: Using a cross-sectional design, individuals from Saskatchewan, Canada who started a new antihypertensive, cholesterol-lowering, or antihyperglycemic medication were surveyed about risk factors for nonpersistence including: (a) beliefs measured by a composite score of three questions asking about the threat of the condition, importance of the drug, and harm of the drug; (b) incident side effects attributed to treatment; and (c) expectations for side effects before starting treatment. Descriptive statistics and logistic regression models were used to quantify the influence of these risk factors on the outcome of nonpersistence. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Results: Among 3,029 respondents, 5.8% (n=177) reported nonpersistence within four months after starting the new drug. After adjustment for numerous covariates representing sociodemographics, health-care providers, medication experiences and beliefs, both negative beliefs (OR: 7.26, 95%CI: 4.98– 10.59) and incident side effects (OR: 8.00, 95%CI: 5.49– 11.68) were associated with the highest odds of nonpersistence with no evidence of interaction. In contrast, expectations for side effects before starting treatment exhibited an important interaction with incident side effects following treatment initiation. Among respondents with incident side effects (n=741, 24.5%), the risk for early nonpersistence was 11.5% if they indicated an expectation for side effects before starting the medication compared to 23.6% if they did not (adjusted OR: 0.38, 95%CI: 0.25– 0.60). Conclusion: Expectations for side effects may be a previously unrecognized but important marker of the probability to persist with treatment. A high percentage of new medication users appeared unprepared for the possibility of side effects from their new medication making them less resilient if side effects occur. [ABSTRACT FROM AUTHOR]

Aim: To characterize the impact of the COVID‐19 pandemic on diabetes diagnosis using data from Alberta's Tomorrow Project (ATP), a population‐based cohort study of chronic diseases in Alberta, Canada. Materials and Methods: The ATP participants who were free of diabetes on 1 April 2018 were included in the study. A time‐segmented regression model was used to compare incidence rates of diabetes before the COVID‐19 pandemic, during the first two COVID‐19 states of emergency, and in the period when the state of emergency was relaxed, after adjusting for seasonality, sociodemographic factors, socioeconomic status, and lifestyle behaviours. Results: Among 43 705 ATP participants free of diabetes (65.5% females, age 60.4 ± 9.5 years in 2018), the rate of diabetes was 4.75 per 1000 person‐year (PY) during the COVID‐19 pandemic (up to 31 March 2021), which was 32% lower (95% confidence interval [CI] 21%, 42%; p < 0.001) than pre‐pandemic (6.98 per 1000 PY for the period 1 April 2018 to 16 March 2020). In multivariable regression analysis, the first COVID‐19 state of emergency (first wave) was associated with an 87.3% (95% CI −98.6%, 13.9%; p = 0.07) reduction in diabetes diagnosis; this decreasing trend was sustained to the second COVID‐19 state of emergency and no substantial rebound (increase) was observed when the COVID‐19 state of emergency was relaxed. Conclusions: The COVID‐19 public health emergencies had a negative impact on diabetes diagnosis in Alberta. The reduction in diabetes diagnosis was likely due to province‐wide health service disruptions during the COVID‐19 pandemic. Systematic plans to close the post‐COVID‐19 diagnostic gap are required in diabetes to avoid substantial downstream sequelae of undiagnosed disease. [ABSTRACT FROM AUTHOR]

Young adults are disproportionally affected by mental illnesses (MIs) and often encounter numerous obstacles to accessing healthcare. Untreated MIs have high chronicity and recurrence and are associated with worse health and life outcomes. The aim of the study described in this protocol is to characterize and better understand the barriers and facilitators to accessing mental healthcare for young adults with mental health-related disabilities (YMHDs), focusing on the impact of functional impairment, determinants of health, and unmet healthcare needs. The study protocol, guided by critical realism, uses a patient-oriented sequential mixed-methods design and involves patient research partners (PRPs) to ensure the voices and perspectives of those directly impacted are central to the research process. This study includes a quantitative analysis of secondary data from the Canadian Community Health Survey and a qualitative analysis of semi-structured interviews with YMHDs. The data will be integrated by themes-by-statistics joint display. The study protocol follows the Tri-Agency Statement of Principles for data collection, storage, retention, sharing, and analysis, adheres to ethical guidelines to ensure participant confidentiality and informed consent, and has received institutional ethics approvals. This study will provide valuable insights into factors that act as barriers or facilitators to accessing care and inform the development of targeted interventions to improve access and support for YMHDs. This study has several strengths, including a participatory research approach that involves PRPs and other relevant stakeholders in the research process, a targeted focus on a specific age group, and the use of mixed-methods research and critical realism. This protocol describes a study that will inform policy, service delivery, and treatment options. This study has the potential to drive systemic change and significantly improve the lives and health of young people with mental health needs. [ABSTRACT FROM AUTHOR]