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Treating posttraumatic stress disorder in children

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2021
Abstract: 

Background: Posttraumatic stress disorder (PTSD) affects approximately 0.1% of children who have been exposed to serious adversities. We therefore set out to identify effective interventions for treating childhood PTSD.

Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating treatment interventions for children who had diagnosed with PTSD. After applying our rigorous inclusion criteria, we accepted five RCTs – evaluating three psychosocial interventions and one medication.

Results: Prolonged Exposure for Adolescents and KIDNET, both based on cognitive-behavioural therapy (CBT), showed significant benefits for children, including reduction of PTSD diagnoses, symptoms, and overall functioning compared to controls. In contrast, D-cycloserine failed to show benefit for children compared to controls. In a head-to-head trial, Eye Movement Desensitization and Reprocessing (EMDR) and CBT both reduced PTSD diagnoses and symptoms, with EMDR outperforming CBT in reducing diagnoses by parent-report at one-year follow-up.

Conclusions: Preventing childhood adversities is priority. But when a child develops PTSD, access to effective treatment is crucial. CBT was effective in reducing diagnoses and/or symptoms across four RCTs in our systematic review. 

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Radon in Schools: A Review of Radon Testing Efforts in Canadian Schools

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-05-20
Abstract: 

Radon, a known carcinogen, becomes a health risk when it accumulates inside buildings. Exposure is of particular concern for children, as their longer life expectancy increases their lifetime risk of developing cancer. In 2016, 5.5 million students were enrolled in Canadian elementary and secondary schools. With no national policy on radon testing in schools, children may be at risk from radon exposure while attending school and school-based programs. This study explored radon testing efforts in publicly funded Canadian schools and summarizes where testing programs have occurred. Radon testing in schools was identified through a systematic qualitative enquiry, surveying members from different levels of government (health and education) and other stakeholders (school boards, research experts, among others). Overall, this research found that approaches to radon testing varied considerably by province and region. Responsibility for radon testing in schools was often deferred between government, school boards, building managers and construction parties. Transparency around radon testing, including which schools had been tested and whether radon levels had been mitigated, also emerged as an issue. Radon testing of schools across Canada, including mitigation and clear communication strategies, needs to improve to ensure a healthy indoor environment for staff and students.

Document type: 
Article
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The Interplay between Social and Ecological Determinants of Mental Health for Children and Youth in the Climate Crisis

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-04-26
Abstract: 

Children and youth are showing increasing levels of mental health distress due to the climate crisis, characterized by feelings of sadness, guilt, changes in sleep and appetite, difficulty concentrating, solastalgia, and disconnection from land. To gain a deeper understanding of the relationship between climate change and children and youth’s mental health, we conducted a rapid review and a thematic analysis of the results in NVivo 12. Our findings show that children and youth experience a plethora of direct and indirect effects from climate change and this impacts their mental wellbeing in diverse and complex ways. Young people also have varied perceptions of climate change based on their social locations and many are dealing with feelings of immense worry and eco-anxiety. The mental health impacts of climate change on children/youth are tied to Social Determinants of Health (SDoH) but also need to be understood in relation to the Ecological Determinants of Health (EDoH). Through an eco-social lens, this paper explores these conceptual issues and uses them to provide a framework for understanding the interplay of social and ecological determinants of mental health for children/youth.

Document type: 
Article
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The Relationship Between Opioid Agonist Therapy Satisfaction and Fentanyl Exposure in a Canadian Setting

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-04-28
Abstract: 

Background

While patient-reported treatment dissatisfaction is considered an important factor in determining the success of substance use disorder treatment, the levels of dissatisfaction with opioid agonist therapies (OAT) and its relationship with the risk of fentanyl exposure have not been characterized in the context of the ongoing opioid overdose crisis in the US and Canada. Our primary hypothesis was that OAT dissatisfaction was associated with an increased odds of fentanyl exposure.

Methods

Our objective was to examine self-reported treatment satisfaction among OAT patients in Vancouver, Canada and the association with fentanyl exposure. Longitudinal data were derived from 804 participants on OAT enrolled in two community-recruited harmonized prospective cohort studies of people who use drugs in Vancouver between 2016 and 2018 via semi-annual interviews and urine drug screens (UDS). We employed multivariable generalized estimating equations to examine the relationship between OAT dissatisfaction and fentanyl exposure.

Results

Out of 804 participants (57.0% male), 222 (27.6%) reported being dissatisfied with OAT at baseline and 1070 out of 1930 observations (55.4%) had fentanyl exposure. The distribution of OAT reported in the sample was methadone (n = 692, 77.7%), buprenorphine-naloxone (n = 82, 9.2%), injectable OAT (i.e., diacetylmorphine or hydromorphone; (n = 65, 7.3%), slow-release oral morphine (n = 44, 4.9%) and other/study medication (n = 8, 1.0%). In the multivariable analysis, OAT dissatisfaction was positively associated with fentanyl exposure (AOR = 1.34; 95% CI: 1.08–1.66).

Conclusions

A substantial proportion of OAT patients in our sample reported dissatisfaction with their OAT, and more than half were exposed to fentanyl. We also found that those who were dissatisfied with their OAT were more likely to be exposed to fentanyl. These findings demonstrate the importance of optimizing OAT satisfaction in the context of the ongoing opioid overdose crisis.

Document type: 
Article
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The Association Between Experiencing Homelessness in Childhood or Youth and Adult Housing Stability in Housing First

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-03-08
Abstract: 

Background

Researchers have pointed out the paucity of research investigating long-term consequences of experiencing homelessness in childhood or youth. Limited research has indicated that the experience of homelessness in childhood or youth is associated with adverse adjustment-related consequences in adulthood. Housing First (HF) has acknowledged effectiveness in improving housing outcomes among adults experiencing homelessness and living with serious mental illness, although some HF clients struggle with maintaining housing. The current study was conducted to examine whether the experience of homelessness in childhood or youth increases the odds of poorer housing stability following entry into high-fidelity HF among adults experiencing serious mental illness and who were formerly homeless.

Methods

Data were drawn from the active intervention arms of a HF randomized controlled trial in Metro Vancouver, Canada. Participants (n = 297) were referred to the study from service agencies serving adults experiencing homelessness and mental illness between October 2009 and June 2011. The Residential Time-Line Follow-Back Inventory was used to measure housing stability. Least absolute shrinkage and selection operator was used to estimate the association between first experiencing homelessness in childhood or youth and later housing stability as an adult in HF.

Results

Analyses indicated that homelessness in childhood or youth was negatively associated with experiencing housing stability as an adult in HF (aOR = 0.53; 95% CI = 0.31–0.90).

Conclusions

Further supports are needed within HF to increase housing stability among adult clients who have experienced homelessness in childhood or youth. Asking clients about the age they first experienced homelessness may be of clinical utility upon enrollment in HF and may help identify support needs related to developmental experiences. Results further emphasize the importance of intervening earlier in life in childhood and youth before experiencing homelessness or before it becomes chronic. Findings also contribute to a limited knowledge base regarding the adverse long-term consequences of childhood and youth homelessness.

Document type: 
Article
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A Qualitative Study of Clinicians’ Perspectives on Independent Rights Advice for Involuntary Psychiatric Patients in British Columbia, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-03-18
Abstract: 

Background

In British Columbia (BC), Canada, clinicians are responsible for giving involuntary psychiatric patients rights information upon admission. Yet an investigation by the BC Office of the Ombudsperson found that clinicians are not always fulfilling this responsibility. The Ombudsperson recommended that the provincial government fund an independent body to give rights advice to patients.

Methods

To understand how clinicians feel about this recommendation, focus groups of clinicians who may give psychiatric patients rights information (n = 81) were conducted in Vancouver, BC, to probe their attitudes toward independent rights advisors. The focus group transcripts were thematically analyzed.

Results

Most clinicians believe that giving rights information is within their scope of practice, although some acknowledge that it poses a conflict of interest when the patient wishes to challenge the treatment team’s decisions. Participants’ chief concerns about an independent rights-advice service were that (a) patients may experience a delay in receiving their rights information, (b) integrating rights advisors into the workflow would complicate an already chaotic admission process, and (c) more patients would be counselled to challenge their hospitalization, leading to an increased administrative workload for clinical staff. However, many participants believed that independent rights advisors would be a positive addition to the admission process, both allowing clinicians to focus on treatment and serving as a source of rights-related information.

Conclusions

Participants were generally amenable to an independent rights-advice service, suggesting that the introduction of rights advisors need not result in an adversarial relationship between treatment team and patient, as opponents of the proposal fear. Clearly distinguishing between basic rights information and in-depth rights advice could address several of the clinicians’ concerns about the role that independent rights advisors would play in the involuntary admission process. Clinicians’ and other stakeholders’ concerns should be considered as the province develops its rights-advice service.

Document type: 
Article
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Intimate Partner Violence, Depression, and Anxiety Are Associated With Higher Perceived Stress Among Both Young Men and Women in Soweto and Durban, South Africa

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-03-24
Abstract: 

Objectives: Psychological stress is an important determinant of health, including for mental well-being and sexual health. However, little is known about the prevalence and psychosocial and sexual health correlates of perceived stress among young people in South Africa, where elevated life-stressors are an important driver of health inequities. This study examines the association between intimate partner violence (IPV), psychosocial and sexual health, and perceived stress, by gender, among South African adolescents and young adults.

Methods: Using baseline survey data from AYAZAZI, a cohort study enrolling youth (16–24 years) from Durban and Soweto, we used the 10-item Perceived Stress Scale (PSS-10) to measure the degree to which an individual perceives their life situations as unpredictable, uncontrollable, and overloaded. Possible scores range between 0 and 40; higher scores indicating higher perceived stress. Crude and adjusted gender-stratified linear regression models examined associations between sexual health factors, experiences (young women) and perpetration (young men) of IPV, anxiety (APA 3-item Scale, ≥2 = probable anxiety), and depression (10-item CES-D Scale, ≥10 = probable depression) and perceived stress. Multivariable models adjusted for age, income, sexual orientation, and financial dependents.

Results: Of the 425 AYAZAZI participants, 60% were young women. At baseline, 71.5% were students//learners and 77.2% earned ≤ ZAR1600 per month (~id="mce_marker"00 USD). The PSS-10 had moderate reliability (α = 0.70 for young women, 0.64 for young men). Young women reported significantly higher mean PSS scores than young men [18.3 (6.3) vs. 16.4 (6.0)]. In adjusted linear regression models, among young women experiences of IPV (β = 4.33; 95% CI: 1.9, 6.8), probable depression (β = 6.63; 95% CI: 5.2, 8.1), and probable anxiety (β = 5.2; 95% CI: 3.6, 6.8) were significantly associated with higher PSS scores. Among young men, ever perpetrating IPV (β = 2.95; 95% CI: 0.3, 5.6), probable depression (β = 6; 95% CI: 4.3, 7.6), and probable anxiety (β = 3.9; 95% CI: 2.1, 5.8) were significantly associated with higher perceived stress.

Conclusion: We found that probable depression, anxiety, perpetration of IPV among young men, and experiences of IPV among young women, were associated with higher perceived stress. Critical efforts are needed to address the gendered stressors of young men and women and implement services to address mental health within violence prevention efforts.

Document type: 
Article
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Not Quite a Block Party: COVID-19 Street Reallocation Programs in Seattle, WA and Vancouver, BC

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-03-10
Abstract: 

The COVID-19 pandemic has exposed mobility inequities within cities. In response, cities are rapidly implementing street reallocation initiatives. These interventions provide space for walking and cycling, however, other mobility needs (e.g., essential workers, deliveries) may be impeded by these reallocation decisions. Informed by mobility justice frameworks, we examined socio-spatial differences in access to street reallocations in Seattle, Washington and Vancouver, British Columbia. In both cities, more interventions occurred in areas where people of color, particularly Black and Indigenous people, lived. In Seattle, more interventions occurred in areas where people with disabilities, on food stamps, and children lived. In Vancouver, more interventions occurred in areas where recent immigrants lived, or where people used public transit or cycled to work. Street reallocations could be opportunities for cities to redress inequities in mobility and access to public spaces. Going forward, it is imperative to monitor how cities use data and welcome communities to redesign these temporary spaces to be corridors for their own mobility.

Document type: 
Article
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Awareness of Fentanyl Exposure and the Associated Overdose Risks Among People Who Inject Drugs in a Canadian Setting

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-02-18
Abstract: 

Introduction and Aims:

Illicitly-manufactured fentanyl continues to fuel the opioidoverdose crisis throughout the United States and Canada. However, little is known about factors associated with knowingly or unknowingly using fentanyl. Therefore, we sought to identify the prevalence and correlates of suspected/known and unknown exposure to fentanyl (excluding the prescribed one) among people who inject drugs (PWID), including associated overdose risks.

 

Design and Methods:

Data were derived from three prospective cohort studies of community-recruited people who use drugs in Vancouver, Canada in 2016–2017. Multivariable logistic regression was used to identify correlates of suspected/known exposure (i.e., urine drug screen positive [UDS+] and self-reporting past three-day exposure) and unknown exposure to fentanyl (i.e., UDS+ and self-reporting no past three day exposure), respectively.

 

Results:

Among 590 PWID, 296 (50.2%) tested positive for fentanyl. Of those, 143 (48.3%) had suspected/known and 153 (51.7%) had unknown exposure to fentanyl. In multivariable analyses, using supervised injection sites and possessing naloxone were associated with both suspected/known and unknown exposure (all p<0.05). Injecting drugs alone (Adjusted Odds Ratio [AOR]: 3.26; 95% Confidence Interval [CI]: 1.72–6.16) was associated with known exposure, but not with unknown exposure.

 

Discussion and Conclusions:

We found a high prevalence of fentanyl exposure in our sample of PWID, with one half of those exposed consuming fentanyl unknowingly. While those exposed to fentanyl appeared more likely to utilize some overdose prevention services, PWID with suspected/known fentanyl exposure were more likely to inject alone, indicating a need for additional overdose prevention efforts for this group.

Document type: 
Article
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Sharpening Our Public Health Lens: Advancing Im/Migrant Health Equity During COVID-19 and Beyond

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-02-08
Abstract: 

Background:  Differential impacts of the COVID-19 pandemic have brought deeply rooted inequities to the forefront, where increasing evidence has shown that racialized immigrant and migrant (im/migrant) populations face a disproportionate burden of COVID-19. Im/migrant communities may be worst affected by lockdowns and restrictive measures, face less opportunity to physically distance or stay home sick within ‘essential’ jobs, and experience severe barriers to healthcare. Insufficient attention to experiences of racialized im/migrants in current pandemic responses globally highlights an urgent need to more fulsomely address unmet health needs through an anti-racist, equity-oriented lens. This commentary aims to highlight the need for public health and clinical training, research, and policy to thoughtfully prioritize im/migrant health equity during and beyond the COVID-19 pandemic.

Main text:  Global pandemic responses have neglected im/migrants by continuing to ignore or insufficiently address inequities, exacerbating COVID transmission, xenophobia, and occupational injustice. Deaths, illness, stress, and other negative outcomes of the overlapping epidemics of COVID-19 and structural racism disproportionately borne by racialized im/migrants suggest the urgent need for action. As evidence mounts about how im/migrants have been left behind in times of crises, we need enhanced focus on health equity within COVID-19 research and interventions, including research that examines and pursues structural interventions necessary to mitigate these impacts, and that identifies patterns and harms of xenophobic policy, structural racism, and white supremacy in shaping im/migrant health outcomes. We must also strengthen anti-racist and equity-oriented curriculum within health education, and ensure sufficient attention to the needs of im/migrant communities within public health, clinical, and research training.

Conclusion:  The COVID-19 pandemic has exacerbated and rendered more visible the deeply rooted health and social inequities faced by racialized im/migrants across diverse settings. We argue for a greater emphasis on equity-focused and anti-racist im/migrant health research, interventions, and training. Policymakers and practitioners must ensure that healthcare policies and practices do not exacerbate inequities, and instead meaningfully address unmet needs of communities, including racialized im/migrants. Ethical and respectful community engagement, commitment and collaboration with global, national, and local communities, policymakers, academics, and educators, as well as accountability across sectors, is critical.

Document type: 
Article
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