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Psychosis: Is prevention possible?

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2020
Abstract: 

Background: Controversy persists about whether or not it is possible to prevent psychotic disorders. We set out to identify if there were any effective interventions that prevent psychosis among youth.

Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating prevention interventions. After applying our rigorous inclusion criteria, we accepted three RCTs –  evaluating one supplement and two psychosocial interventions with youth found to be at high-risk for psychosis.

Results: Omega-3 polyunsaturated fatty acid (PUFA) supplements reduced psychosis diagnoses and symptoms use and improved overall functioning over six years follow-up. Two other interventions – Auditory Cognitive Training and Family-Focused Treatment – did not produce significant benefits post-intervention.

Conclusions: More studies are needed to replicate results for PUFAs. As well, additional research is needed to develop psychosocial interventions that may help high-risk youth. Given the high burdens and costs associated with psychosis, prevention remains an important goal for youth and families.

Some Notes on the Use, Concept and Socio-political Framing of ‘stigma’ Focusing on an Opioid-related Public Health Crisis

Author: 
Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2020-08-03
Abstract: 

Canada has been home to a longstanding public health crisis related to opioids, including an extensive mortality and morbidity toll in the face of substantive intervention gaps. Recently (2019), two extensive reports from preeminent federal authorities – the Chief Public Health Officer and the Mental Health Commission of Canada – have been tabled with detailed, core focus on the phenomenon of ‘stigma’ and its impacts on substance/opioid use and harms. The reports present extensive descriptions of the nature and effects, as well as a multitude of prescriptions for remedial measures and actions to “stop the cycle of stigma”. Closer reading of the documents, however, suggests substantial conceptual and empirical limitations in the characterization of the – multi-faceted and challenging – nature and workings of ‘stigma’ as a socio-political, structural or individual process or force, specifically as it applies to and negatively affects substance use and related outcomes, primarily the wellbeing of substance users. Concretely, it is unclear how the remedial actions proposed will materially alleviate stigma process and impacts, especially given apparent gaps in the issues examined, including essential strategies – for example, reform of drug user criminalization as a fundamental element and driver of structural stigma - for action that directly relate to the jurisdictions and privileged mandates of the report sources themselves as health and policy leaders. The commentary provides some concrete while subjective notes and observations on the dynamics of stigma as applies to and framed for substance/opioid use, as well as strategies and measures necessary to both tangibly address the material health and wellbeing of substance users, and related forces of stigma, in the distinct context of the opioid crisis in Canada.

Document type: 
Article
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Examining Correlations Between Opioid Dispensing and Opioid-related Hospitalizations in Canada, 2007–2016

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2020-07-22
Abstract: 

Background

High levels of opioid-related mortality, as well as morbidity, contribute to the excessive opioid-related disease burden in North America, induced by high availability of opioids. While correlations between opioid dispensing levels and mortality outcomes are well-established, fewer evidence exists on correlations with morbidity (e.g., hospitalizations).

Methods

We examined possible overtime correlations between medical opioid dispensing and opioid-related hospitalizations in Canada, by province, 2007–2016. For dispensing, we examined annual volumes of medical opioid dispensing derived from a representative, stratified sample of retail pharmacies across Canada. Raw dispensing information for ‘strong opioids’ was converted into Defined Daily Doses per 1000 population per day (DDD/1000/day). Opioid-related hospitalization rates referred to opioid poisoning-related admissions by province, for fiscal years 2007–08 to 2016–17, drawn from the national Hospital Morbidity Database. We assessed possible correlations between opioid dispensing and hospitalizations by province using the Pearson product moment correlation; correlation values (r) and confidence intervals were reported.

Results

Significant correlations for overtime correlations between population-levels of opioid dispensing and opioid-related hospitalizations were observed for three provinces: Quebec (r = 0.87, CI: 0.49–0.97; p = 0.002); New Brunswick (r = 0.85;CI: 0.43–0.97; p = 0.004) and Nova Scotia (r = 0.78; CI:0.25–0.95; p = 0.012), with an additional province, Saskatchewan, (r = 0.073; CI:-0.07–0.91;p = 0.073) featuring borderline significance.

Conclusions

The correlations observed further add to evidence on opioid dispensing levels as a systemic driver of population-level harms. Notably, correlations were not identified principally in provinces with reported high contribution levels (> 50%) of illicit opioids to mortality, which are not captured by dispensing data and so may have distorted or concealed potential correlation effects due to contamination.

Document type: 
Article
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Quality of Life and Socioeconomic Indicators Associated with Survival of Myeloid Leukemias in Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2020-07-10
Abstract: 

Understanding how patient‐reported quality of life (QoL) and socioeconomic status (SES) relate to survival of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) may improve prognostic information sharing. This study explores associations among QoL, SES, and survival through administration of the Euro‐QoL 5‐Dimension, 3‐level and Functional Assessment of Cancer Therapy‐Leukemia and financial impact questionnaires to 138 adult participants with newly diagnosed AML or MDS in a longitudinal, pan‐Canadian study. Cox regression and lasso variable selection models were used to explore associations among QoL, SES, and established predictors of survival. Secondary outcomes were changes in QoL, performance of the QoL instruments, and lost income. We found that higher QoL and SES were positively associated with survival. The Lasso model selected the visual analog scale of the EQ‐5D‐3L as the most important predictor among all other variables (P = .03; 92% selection). Patients with AML report improved QoL after treatment, despite higher mean out‐of‐pocket expenditures compared with MDS (up to $599 CDN/month for AML vs $239 for MDS; P = .05), greater loss of productivity‐related income (reaching id="mce_marker"786/month for AML vs $709 for MDS; P < .05), and greater caregiver effects (65% vs 35% caregiver productivity losses for AML vs MDS; P < .05). Our results suggest that including patient‐reported QoL and socioeconomic indicators can improve the accuracy of survival models.

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Article
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Retaining Participants in Community-Based Health Research: A Case Example on Standardized Planning and Reporting

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2020-05-11
Abstract: 

Background

Effective strategies for participant retention are critical in health research to ensure validity, generalizability and efficient use of resources. Yet standardized guidelines for planning and reporting on retention efforts have been lacking. As with randomized controlled trial (RCT) and systematic review (SR) protocols, retention protocols are an opportunity to improve transparency and rigor. An RCT being conducted in British Columbia (BC), Canada provides a case example for developing a priori retention frameworks for use in protocol planning and reporting.

Methods

The BC Healthy Connections Project RCT is examining the effectiveness of a nurse home-visiting program in improving child and maternal outcomes compared with existing services. Participants (N = 739) were girls and young women preparing to parent for the first time and experiencing socioeconomic disadvantage. Quantitative data were collected upon trial entry during pregnancy and during five follow-up interviews until participants’ children reached age 2 years. A framework was developed to guide retention of this study population throughout the RCT. We reviewed relevant literature and mapped essential retention activities across the study planning, recruitment and maintenance phases. Interview completion rates were tracked.

Results

Results from 3302 follow-up interviews (in-person/telephone) conducted over 4 years indicate high completion rates: 90% (n = 667) at 34 weeks gestation; and 91% (n = 676), 85% (n = 626), 80% (n = 594) and 83% (n = 613) at 2, 10, 18 and 24 months postpartum, respectively. Almost all participants (99%, n = 732) provided ongoing consent to access administrative health data. These results provide preliminary data on the success of the framework.

Conclusions

Our retention results are encouraging given that participants were experiencing considerable socioeconomic disadvantage. Standardized retention planning and reporting may therefore be feasible for health research in general, using the framework we have developed. Use of standardized retention protocols should be encouraged in research to promote consistency across diverse studies, as now happens with RCT and SR protocols. Beyond this, successful retention approaches may help inform health policy-makers and practitioners who also need to better reach, engage and retain underserved populations.

Document type: 
Article
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What Medical Crowdfunding Campaigns Can Tell Us About Local Health System Gaps and Deficiencies: Exploratory Analysis of British Columbia, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2020-05-22
Abstract: 

Background: There are a range of perceived gaps and shortcomings in the publicly funded Canadian health system. These include wait times for care, lack of public insurance coverage for dental care and pharmaceuticals, and difficulties accessing specialist care. Medical crowdfunding is a response to these gaps where individuals raise funds from their social networks to address health-related needs.

Objective: This study aimed to investigate the potential of crowdfunding data to better understand what health-related needs individuals are using crowdfunding for, how these needs compare with the existing commentary on health system deficiencies, and the advantages and limitations of using crowdfunding campaigns to enhance or augment our understanding of perceived health system deficiencies.

 

Methods: Crowdfunding campaigns were scraped from the GoFundMe website. These campaigns were then limited to those originating in the metropolitan Vancouver region of two health authorities during 2018. These campaigns were then further limited to those raising funds to allow the treatment of a medical problem or related to needs arising from ill health. These campaigns were then reviewed to identify the underlying health issue and motivation for pursuing crowdfunding.

 

Results: We identified 423 campaigns for health-related needs. These campaigns requested CAD $8,715,806 (US $6,088,078) in funding and were pledged CAD $3,477,384 (US $2,428,987) from 27,773 donors. The most common underlying medical condition for campaign recipients was cancer, followed by traumatic injuries from collisions and brain injury and stroke. By far, the most common factor of motivation for crowdfunding was seeking financial support for wages lost because of illness (232/684, 33.9%). Some campaigns (65/684, 9.5%) sought help with purchasing medical equipment and supplies; 8.2% (56/684) sought to fund complementary, alternative, or unproven treatments including experimental interventions; 7.2% (49/684) sought financial support to cover travel-related costs, including in-province and out-of-province (49/684, 7.2%) travel; and 6.3% (43/684) campaigns sought help to pay for medication.

 

Conclusions: This analysis demonstrates the potential of crowdfunding data to present timely and context-specific user-created insights into the perceived health-related financial needs of some Canadians. Although the literature on perceived limitations of the Canadian health system focuses on wait times for care and limited access to specialist services, among other issues, these campaigners were much more motivated by gaps in the wider social system such as costs related to unpaid time off work and travel to access care. Our findings demonstrate spatial differences in the underlying medical problems, motivations for crowdfunding, and success using crowdfunding that warrants additional attention. These differences may support established concerns that medical crowdfunding is most commonly used by individuals from relatively privileged socioeconomic backgrounds. We encourage the development of new resources to harness the power of crowdfunding data as a supplementary source of information for Canadian health system stakeholders.

Document type: 
Article
File(s): 

Mental health treatment: Reaching more kids

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2020
Abstract: 

Background: Nearly 70% of children who are in need of specialized mental health services do not access them. We set out to identify effective self-delivered interventions as a way to help bridge the gap between those in need and those being serviced.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating self-delivered treatments. After applying our rigorous inclusion criteria, we accepted five RCTs evaluating five treatment interventions.

Results: Three self-directed family interventions reduced anxiety diagnoses and symptoms for school age children. One self-directed parenting intervention reduced ADHD diagnoses for school age children. Additionally, one self-directed youth invention reduced depression symptoms for adolescents.

Conclusions: Strong research evidence supports the use of self-directed treatments to address three common childhood mental disorders. Greater use of these interventions can expand the number of children who are reached with effective treatments.

Improving Adolescent Access to Contraception in Sub-Saharan Africa: A Review of the Evidence

Author: 
Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2020-03
Abstract: 

Global commitments to and support for sexual and reproductive health (SRH) have increased over the past 10 years. Adolescent access to contraception has emerged as a crucial area of focus within this agenda, particularly in sub-Saharan Africa (SSA), where there is the greatest unmet need for contraception. Yet there is little synthesized knowledge around adolescents‘ use and knowledge of, and access to contraception in SSA. This review summarizes and analyzes literature on the subject in order to determine implications for policy and program development, and to guide future research. The majority of existing research focuses on South Africa, with numerous studies from East Africa also present. Most of this research is qualitative, with few mixed method studies, and only one randomized control trial of an intervention.  Findings from multiple countries confirm that adolescents in SSA have a significant unmet need for contraception. Most adolescents get their information about contraception from the media or peers. Persistent myths regarding effectiveness and side effects, as well as cultural and gender norms, impede access to and demand for contraception. Other determinants of access and use include education level and socio-economic status. As a result, intervention evaluations note that cultural barriers and socio-economic conditions limit SRH outcomes.

Document type: 
Article
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Trajectories of Retention in Opioid Agonist Therapy in a Canadian Setting

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2020-02-09
Abstract: 

Background: Long-term engagement in opioid agonist therapy (OAT) has been consistently associated with reduced risk for morbidity and mortality in people with opioid use disorder (OUD). However, the dynamic nature of engagement/disengagement in OUD care for over time is poorly captured by traditional metrics. We characterized long-term longitudinal trajectories of engagement in OAT in Vancouver, Canada, between 2005 and 2018.

Methods: Data were derived from two community-recruited prospective cohorts of people who use drugs. Retention in OAT was defined as self-reported enrolment in OAT for two consecutive follow-up periods (an approximately six-month retention interval). We used latent class growth analysis to identify OAT engagement trajectories during the first five years after OAT initiation and multivariable logistic regression to evaluate predictors of trajectory group membership.

Results: We identified four OAT retention trajectories among 438 OAT initiators: “consistently high” (36%), “consistently low” (23%), “increasing” (23%), and “decreasing” (15%). Employment was a significant cross-cutting predictor of membership of all sub-optimal OAT engagement patterns compared to consistently high trajectories. We also found that initiating OAT after 2014 (when regulatory changes to the provincial OAT program were introduced) was associated with the “consistently low” engagement group relative to others.

Conclusions: We identified four distinct OAT engagement trajectories in Vancouver, Canada, with employment being a common predictor of sub-optimal care trajectories, suggesting the need to explore alternative OAT models to address employment-related barriers.  Care trajectory analysis could help inform tailored interventions to specific populations of people with OUD at specific time points to improve engagement in OAT, and decrease opioid-related morbidity and mortality.

Document type: 
Article

Analyzing Big Tobacco’s Global Youth Marketing Strategies and Factors Influencing Smoking Initiation by Nigeria Youths Using the Theory of Triadic Influence

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2020-03-20
Abstract: 

Background: Major transnational tobacco companies (TTCs) have identified Nigeria, the seventh most populous country in the world, as a market with a significant revenue potential, given its high youth population and growing gross domestic product (GDP). This research analyses tobacco industry-related strategies and activities targeting youth (aged 15 to 24 years) in Nigeria involving existing, but most importantly, future tobacco users. Nigeria is the focus of this study because the tobacco industry has viewed it as a major emerging market since the 1990s. Successful marketing in Nigeria could provide the industry with a template for similar initiatives in other emerging markets in low- and middle-income countries.

Methods: The research began with a systematic review of secondary literature to determine how the tobacco industry has targeted youth globally and factors contributing to youth smoking initiation. It then used the theory of triadic influence as a heuristic framework to categorize the various factors influencing youth smoking initiation and industry strategies related to increasing tobacco use among youths. Quotations from internal tobacco industry documents were organized into the three streams of the theory of triadic influence: biology/personality, social and cultural/environmental streams. A total of 12 interviews were conducted with 6 policymakers and governmental officials, 2 civil society organization representatives, a high school principal, a journalist and 2 researchers to investigate how the tobacco industry had targeted youth in Nigeria.

Results: The findings indicate that TTCs have actively targeted youth in Nigeria since the 1990s, focusing on changing behaviour through the biology/personality, social and environmental/ cultural streams.

Conclusion: The study suggests that Nigeria implement and vigorously enforce its 2015 National Tobacco Control Bill as well as a package of other measures to prevent tobacco companies targeting youth.

Document type: 
Article
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