Functional difficulties in children and youth with autism spectrum disorder: analysis of the 2019 Canadian Health Survey on Children and Youth. / Difficultés fonctionnelles chez les enfants et les jeunes atteints d'un trouble du spectre de l'autisme : une analyse de l'Enquête canadienne sur la santé des enfants et des jeunes de 2019.

INTRODUCTION: This study examined the prevalence of functional difficulties and associated factors in Canadian children/youth aged 5 to 17 years diagnosed with autism spectrum disorder (ASD). METHODS: We analyzed data from the 2019 Canadian Health Survey on Children and Youth (CHSCY), a nationally representative survey of Canadian children/youth that used the Washington Group Short Set on Functioning (WG-SS) to evaluate functioning in six daily tasks. For each functional domain, binary outcomes were derived (no/some difficulty, a lot of difficulty/no ability). We used logistic regression to identify associations between demographic characteristics, educational experiences, and perceived mental and general health and the most common functional difficulties, namely those related to remembering/concentrating, communication and self-care. All estimates were weighted to be representative of the target population. The bootstrap method was used to calculate variance estimates. RESULTS: Analysis of the records of 660 children/youth with ASD revealed that the most common functional difficulties were remembering/concentrating (22%; 95% CI: 18-27), communicating (19%; 95% CI: 15-23) and self-care (13%; 95% CI: 10-17). Lower perceived mental health was associated with increased functional difficulties with remembering/concentrating. ASD diagnosis at a lower age and lower perceived general health were associated with increased functional difficulty with communication. Parental expectations for postsecondary education were associated with decreased functional difficulty for self-care. CONCLUSION: One or more functional difficulties from the WG-SS was present in 39% of Canadian children/youth aged 5 to 17 years with ASD. Functional difficulties with remembering/concentrating, communication and self-care were most common.

Paediatric inflammatory multisystem syndrome in Canada: population-based surveillance and role of SARS-CoV-2 linkage.

BACKGROUND: Paediatric inflammatory multisystem syndrome (PIMS) is a rare condition temporally associated with SARS-CoV-2 infection. Using national surveillance data, we compare presenting features and outcomes among children hospitalized with PIMS by SARS-CoV-2 linkage, and identify risk factors for intensive care (ICU). METHODS: Cases were reported to the Canadian Paediatric Surveillance Program by a network of >2800 pediatricians between March 2020 and May 2021. Patients with positive versus negative SARS-CoV-2 linkages were compared, with positive linkage defined as any positive molecular or serologic test or close contact with confirmed COVID-19. ICU risk factors were identified with multivariable modified Poisson regression. RESULTS: We identified 406 children hospitalized with PIMS, including 49.8% with positive SARS-CoV-2 linkages, 26.1% with negative linkages, and 24.1% with unknown linkages. The median age was 5.4 years (IQR 2.5-9.8), 60% were male, and 83% had no comorbidities. Compared to cases with negative linkages, children with positive linkages experienced more cardiac involvement (58.8% vs. 37.4%; p < 0.001), gastrointestinal symptoms (88.6% vs. 63.2%; p < 0.001), and shock (60.9% vs. 16.0%; p < 0.001). Children aged ≥6 years and those with positive linkages were more likely to require ICU. CONCLUSIONS: Although rare, 30% of PIMS hospitalizations required ICU or respiratory/hemodynamic support, particularly those with positive SARS-CoV-2 linkages. IMPACT: We describe 406 children hospitalized with paediatric inflammatory multisystem syndrome (PIMS) using nationwide surveillance data, the largest study of PIMS in Canada to date. Our surveillance case definition of PIMS did not require a history of SARS-CoV-2 exposure, and we therefore describe associations of SARS-CoV-2 linkages on clinical features and outcomes of children with PIMS. Children with positive SARS-CoV-2 linkages were older, had more gastrointestinal and cardiac involvement, and hyperinflammatory laboratory picture. Although PIMS is rare, one-third required admission to intensive care, with the greatest risk amongst those aged ≥6 years and those with a SARS-CoV-2 linkage.

Multivariate analyses of risk factors associated with laboratory exposure incidents.

Background: Laboratories involved in the study of pathogenic biological agents pose an inherent risk of exposure to the laboratory workforce and the community. Laboratory biosafety and biosecurity activities are fundamental in minimizing the likelihood of unintentional exposure incidents. The objective of this study is to describe the factors that are associated with the occurrence of exposure incidents in a laboratory setting through a predictive model. Methods: The Laboratory Incident Notification Canada is a nationally mandated surveillance system that gathers real-time data from submitted reports of laboratory incidents involving human pathogens and toxins. Data on laboratory exposure incidents were extracted from the system between 2016 and 2020. The occurrence of exposure incidents per month was modelled using a Poisson regression with several potential risk factors, including seasonality, sector, occurrence type, root causes, role and education of people exposed and years of laboratory experience. A stepwise selection method was used to develop a parsimonious model with consideration of the significant risk factors identified in the literature. Results: After controlling for other variables in the model, it was found that 1) for each human interaction related root cause, the monthly number of exposure incidents was expected to be 1.11 times higher compared to the number of incidents without human interaction (p=0.0017) as a root cause and 2) for each standard operating procedure-related root cause, the monthly number of exposure incidents was expected to be 1.13 times higher compared to the number of incidents without a standard operating procedure related root cause (p=0.0010). Conclusion: Laboratory biosafety and biosecurity activities should target these risk factors to reduce the occurrence of exposure incidents. Qualitative studies are needed to provide better reasoning for the association of these risk factors with the occurrence of exposure incidents.

Laboratory-acquired infections in Canada from 2016 to 2021.

incidents that result in an exposure to human pathogens and toxins can lead to laboratory-acquired infections or intoxications (LAIs). These infections can pose a risk to the public as well, should person-to-person transmission occur outside the laboratory after an LAI. Understanding factors that contribute to exposure incidents involving LAIs may contribute to ways to mitigate future occurrences to ensure the safety of laboratory workers and the communities in which they work. This paper describes nine exposure incidents resulting in LAIs that occurred in Canada from 2016 to 2021. Of the nine cases, most affected people had both high level of education and years of experience working with pathogens. There were varying laboratory types and activities where Salmonella spp. and Escherichia coli accounted for six out of the nine cases. Procedural issues, personal protective equipment issues and sharp-related incidents were the most cited root causes. From this information, it is clear that regular training (even of experienced staff), clear and accurate standard operating procedures, proper hygiene (especially with Salmonella spp. and E. coli) and recognition of exposure incidents at the time of occurrence are important in preventing future LAIs. Only regulated laboratories working with risk group 2 or higher organisms are required to report exposures and LAIs to the Laboratory Incident Notification Canada surveillance system. Because of the small sample size, results and inferences are based on descriptive analyses only.

Surveillance of laboratory exposures to human pathogens and toxins, Canada, 2021.

Background: The Laboratory Incident Notification Canada surveillance system monitors laboratory incidents that are mandated to be reported under the Human Pathogens and Toxins Act and the Human Pathogens and Toxins Regulations. This article describes laboratory exposure incidents that occurred in Canada in 2021 and individuals affected in these incidents. Methods: We extracted all laboratory incidents occurring in licensed Canadian laboratories in 2021 from the Laboratory Incident Notification Canada system and analyzed them using the software R. We calculated the rate of exposure incidents and performed descriptive statistics by sector, root cause, activity, occurrence type and type of pathogen/toxin. Analysis of the education level, route of exposure, sector, role and laboratory experience of the affected persons was also conducted. We conducted seasonality analysis to compare the median monthly occurrence of exposure incidents between 2016 and 2020 to monthly incidents in 2021. Results: Forty-three exposure incidents involving 72 individuals were reported to Laboratory Incident Notification Canada in 2021. There were two confirmed laboratory-acquired infections and one suspected infection. The annual incident exposure rate was 4.2 incidents per 100 active licenses. Most exposure incidents involved non-Security Sensitive Biological Agents (n=38; 86.4%) and human risk group 2 (RG2) pathogens (n=27; 61.4%), with bacteria (n=20; 45.5%) and viruses (n=16; 36.4%) as the most implicated agent types. Microbiology was the most common activity associated with these incidents (n=18; 41.9%) and most incidents were reported by the academic sector (n=20; 46.5%). Sharps-related (n=12; 22.2%) incidents were the most common, while human interaction (e.g. workload constraints/pressures/demands, human error) (n=29, 28.2%) was the most common root cause. Most affected individuals were exposed through inhalation (n=38; 52.8%) and worked as technicians or technologists (n=51; 70.8%). Seasonality analyses revealed that the number of exposure incidents reported in 2021 were highest in September and May. Conclusion: The rate of laboratory incidents was slightly lower in 2021 than in 2020. The most common occurrence type was sharps-related while issues with human interaction was the most cited root cause.

Rapid review of multisystem inflammatory syndrome in paediatrics: What we know one year later.

BACKGROUND: : Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) is an emerging condition that was first identified in paediatrics at the onset of the COVID-19 pandemic. The condition is also known as pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS or PIMS), and multiple definitions have been established for this condition that share overlapping features with Kawasaki Disease and toxic shock syndrome. METHODS: : A review was conducted to identify literature describing the epidemiology of MIS-C, published up until March 9, 2021. A database established at the Public Health Agency of Canada with COVID-19 literature was searched for articles referencing MIS-C, PIMS or Kawasaki Disease in relation to COVID-19. RESULTS: : A total of 195 out of 988 articles were included in the review. The median age of MIS-C patients was between seven and 10 years of age, although children of all ages (and adults) can be affected. Multisystem inflammatory syndrome in children disproportionately affected males (58% patients), and Black and Hispanic children seem to be at an elevated risk for developing MIS-C. Roughly 62% of MIS-C patients required admission to an intensive care unit, with one in five patients requiring mechanical ventilation. Between 0% and 2% of MIS-C patients died, depending on the population and available interventions. CONCLUSION: : Multisystem inflammatory syndrome in children can affect children of all ages. A significant proportion of patients required intensive care unit and mechanical ventilation and 0%-2% of cases resulted in fatalities. More evidence is needed on the role of race, ethnicity and comorbidities in the development of MIS-C.

Surveillance of laboratory exposures to human pathogens and toxins, Canada 2020.

BACKGROUND: The Laboratory Incident Notification Canada surveillance system monitors laboratory incidents reported under the Human Pathogens and Toxins Act and the Human Pathogens and Toxins Regulations. The objective of this report is to describe laboratory exposures that were reported in Canada in 2020 and the individuals who were affected. METHODS: Laboratory incident exposures occurring in licensed Canadian laboratories in 2020 were analyzed. The exposure incident rate was calculated and the descriptive statistics were performed. Exposure incidents were analyzed by sector, activity type, occurrence type, root cause and pathogen/toxin. Affected persons were analyzed by education, route of exposure sector, role and laboratory experience. The time between the incident and the reporting date was also analyzed. RESULTS: Forty-two incidents involving 57 individuals were reported to Laboratory Incident Notification Canada in 2020. There were no suspected or confirmed laboratory acquired infections. The annual incident exposure rate was 4.2 incidents per 100 active licenses. Most exposure incidents occurred during microbiology activities (n=22, 52.4%) and/or were reported by the hospital sector (n=19, 45.2%). Procedural issues (n=16, 27.1%) and sharps-related incidents (n=13, 22.0%) were the most common occurrences. Most affected individuals were exposed via inhalation (n=28, 49.1%) and worked as technicians or technologists (n=36, 63.2%). Issues with standard operating procedures was the most common root cause (n=24, 27.0%), followed by human interactions (n=21, 23.6%). The median number of days between the incident and the reporting date was six days. CONCLUSION: The rate of laboratory incidents were lower in 2020 than 2019, although the ongoing pandemic may have contributed to this decrease because of the closure of non-essential workplaces, including laboratories, for a portion of the year. The most common occurrence type was procedural while issues with not complying to standard operating procedures and human interactions as the most cited root causes.

COVID-19: A case for the collection of race data in Canada and abroad.

Racialized populations have consistently been shown to have poorer health outcomes worldwide. This pattern has become even more prominent in the wake of the coronavirus disease 2019 (COVID-19) pandemic. In countries where race disaggregated data are routinely collected, such as the United States and the United Kingdom, preliminary reports have identified that racialized populations are at a heightened risk of COVID-19 infection and mortality. Similar patterns are emerging in Canada but rely on proxy measures such as neighbourhood diversity to account for race, in the absence of person-level data. It follows that the collection of race disaggregated data in Canada is a crucial element in identifying individuals at risk of poorer COVID-19 outcomes and developing targeted public health interventions to mitigate risk among Canada's racialized populations. Given this continuing gap, advocating for timely access to this data is of great importance owing to the challenges that the COVID-19 pandemic has highlighted amongst racialized populations in Canada and worldwide.

Epidemiologic and clinical characteristics of multisystem inflammatory syndrome in adults: a rapid review.

Multisystem inflammatory disease in children (MIS-C) is one of the severe presentations of the coronavirus disease 2019 (COVID-19) that has been described in the literature since the beginning of the pandemic. Although MIS-C refers to children, cases with similar clinical characteristics have been recently described in adults. A description of the epidemiologic and clinical characteristics of multisystem inflammatory disease in adults (MIS-A) is a starting point for better knowledge and understanding of this emerging disease. We identified nine case reports of MIS-A in the literature, five from the United States, two from France and two from the United Kingdom. The case descriptions revealed similarities in clinical features, including occurrence during post-acute disease phase, fever, digestive symptoms, cardiac involvement and elevated inflammatory markers. All the patients were hospitalized, three required admission to the intensive care unit and one died. The most common treatments were intravenous immunoglobulin, prednisolone and aspirin. These findings suggest that MIS-A is a severe complication of COVID-19 disease that can lead to death. Further studies to improve our understanding of the pathogenesis of MIS-A, which will help improve treatment decisions and prevent sequelae or death.

Serum antibody response in COVID-19-recovered patients who retested positive.

BACKGROUND: Research studies comparing antibody response from coronavirus disease 2019 (COVID-19) cases that retested positive (RP) using reverse transcription polymerase chain reaction (RT-PCR) and those who did not retest positive (NRP) were used to investigate a possible relationship between antibody response and retesting status. METHODS: Seven data bases were searched. Research criteria included cohort and case-control studies, carried out worldwide and published before September 9, 2020, that compared the serum antibody levels of hospitalized COVID-19 cases that RP after discharge to those that did NRP. RESULTS: There is some evidence that immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody levels in RP cases were lower compared with NRP cases. The hypothesis of incomplete clearance aligns with these findings. The possibility of false negative reverse transcription polymerase chain reaction (RT-PCR test results during viral clearance is also plausible, as concentration of the viral ribonucleic acid (RNA) in nasopharyngeal and fecal swabs fluctuate below the limits of RT-PCR detection during virus clearance. The probability of reinfection was less likely to be the cause of retesting positive because of the low risk of exposure where cases observed a 14 day-quarantine after discharge. CONCLUSION: More studies are needed to better explain the immune response of recovered COVID-19 cases retesting positive after discharge.

Impact of school closures and re-openings on COVID-19 transmission.

BACKGROUND: Globally, the education of students at primary and secondary schools has been severely disrupted by the implementation of school closures to reduce the spread of coronavirus disease 2019 (COVID-19). The effectiveness of school closures in reducing transmission of COVID-19 and the impact of re-opening schools are unclear. METHODS: Research criteria for this rapid review included empirical studies, published or pre-published worldwide before January 25, 2021, that assessed the effectiveness of school closures in reducing the spread of COVID-19 and the impact of school re-openings on COVID-19 transmission. RESULTS: Twenty-four studies on the impact of school closures and re-openings on COVID-19 transmission were identified through the seven databases that were searched. Overall the evidence from these studies was mixed and varied due to several factors such as the time of implementation of public health measures, research design of included studies and variability among the levels of schooling examined. CONCLUSION: Preliminary findings suggest that school closures have limited impact on reducing COVID-19 transmission, with other non-pharmaceutical interventions considered much more effective. However, due to the limitations of the studies, further research is needed to support the use of this public health measure in response to the COVID-19 pandemic.

Assessing the progression of the COVID-19 pandemic in Canada using testing data and time-dependent reproduction numbers.

OBJECTIVES: To compare a mathematical tool and time-dependent reproduction number (Rt) estimates to assess the COVID-19 pandemic progression in a Canadian context. METHODS: Total number of reported cases were plotted against total number of tests for COVID-19 performed over time, with and without smoothing, for Canada and some Canadian provinces individually. Changes in curvature profile were identified as either convex or concave as indicators of pandemic acceleration or deceleration, respectively. Rt estimates were calculated on an exponential growth rate. RESULTS: For Canada as a whole, the testing graphs had a slightly concave profile and a coincident decrease in Rt estimates. Saskatchewan more recently had a convex profile with a gradual shift to a concave profile and also demonstrated a gradual decline in Rt estimates. Curves and Rt estimates for Alberta, British Columbia, Manitoba, Nova Scotia, Ontario and Quebec displayed a gradual shift towards concavity over time and an overall decrease in Rt estimates, which is suggestive of a positive impact of public health interventions implemented federally and provincially. CONCLUSION: The present analyses compared a mathematical tool to Rt estimates to ascertain the status of the pandemic in Canada. Caution should be taken when interpreting results due to factors such as varying testing protocols, available testing data unique to each province and limitations inherent to each method, which may generate different results using the two approaches. Analysis of testing data may complement metrics obtained from surveillance data to allow for a weight-of-evidence approach to assess the status of the COVID-19 pandemic.

RéSUMé: OBJECTIFS: Comparer un outil mathématique aux estimations du taux de reproduction en fonction du temps (Rt) pour évaluer la progression de la pandémie de la COVID-19 dans le contexte canadien. MéTHODES: Le nombre total de cas signalés a été comparé au nombre total de tests à la COVID-19 effectués au fil du temps, avec et sans lissage, pour le Canada et certaines provinces canadiennes individuellement. Les modifications du profil de courbure identifiées comme étant convexes ou concaves seraient des indicateurs respectivement d'une accélération ou d'une décélération de la pandémie. Le calcul des estimations du Rt a été réalisé en fonction du taux de croissance exponentiel. RéSULTATS: Pour l'ensemble du Canada, la légère concavité des graphiques relatifs aux tests coïncidait avec la diminution des estimations du Rt. Plus récemment, la Saskatchewan avait un profil convexe avec un passage progressif à un profil concave et a également démontré une baisse progressive des estimations du Rt. Les courbes et les estimations du Rt pour l'Alberta, la Colombie-Britannique, le Manitoba, la Nouvelle-Écosse, l'Ontario et le Québec ont montré un glissement progressif vers la concavité au fil du temps et une diminution globale des estimations du Rt, ce qui suggère un impact positif des interventions de santé publique mises en œuvre au niveau fédéral et provincial. CONCLUSION: Les présentes analyses ont comparé un outil mathématique aux estimations de Rt pour déterminer l'état de la pandémie au Canada. Les résultats doivent être interprétés avec prudence en raison de certains facteurs tels que les différences entre provinces en ce qui concerne les protocoles de réalisation des tests et la disponibilité des données relatives aux tests. De plus, une limite inhérente à la méthodologie de cette étude est la possibilité d'obtenir des résultats différents en fonction de l'approche utilisée. L'analyse des données des tests pourrait être complémentaire à celle des données de surveillance pour permettre une approche fondée sur le poids de la preuve dans le cadre de l'évaluation de l'état de la pandémie de la COVID-19.

Correction to: Assessment of stigma in patients with cystic fibrosis.

An amendment to this paper has been published and can be accessed via the original article.

Correlates of former smoking in patients with cerebrovascular disease: a cross-sectional study.

OBJECTIVE: To identify multilevel correlates of former smoking in patients with cerebrovascular disease. DESIGN: Secondary data analysis of the Canadian Community Health Survey. METHODS: We used data from the 2007-2008 Canadian Community Health Survey (CCHS). Smoking status (former smoking vs smoker) was described by multilevel correlates of former smoking. A multilevel approach for variable selection for this study was used to understand how multiple levels in society can have an impact on former smoking. The study sample was selected from those respondents of the CCHS that reported they suffered from stroke symptoms. Logistic regression was used to predict former smoking in patients with cerebrovascular disease while controlling for multilevel confounders. Proportions were weighted to reflect the Canadian population. RESULTS: There were 172 355 respondents who reported to suffer from stroke. From this sample, 36.5% were smokers and 63.5% were former smokers. Age groups 55-69 and 70-80 and higher education (secondary education +) were positively related to former smoking. Household and vehicle smoking restrictions significantly predicted former smoking. Counselling advice from a physician and having access to a general practitioner were correlates of former smoking. Finally, the use of buproprion was positively related to former smoking. CONCLUSIONS: There are multilevel correlates of former smoking in smokers with reported stroke symptoms. These correlates include older age groups, higher education, household and vehicle smoking restrictions, pharmacotherapy use (bupropion), access to a general practitioner and counselling advice from a physician.

Assessment of stigma in patients with cystic fibrosis.

BACKGROUND: Research that explores stigma in Cystic Fibrosis (CF) is limited. Productive cough, repeated lung infections, and periods of serious illness requiring hospitalizations are among common symptoms of CF. These symptoms may cause a negative perception by others. We developed a CF-specific Stigma Scale and tested its psychometric properties. METHODS: We conducted a focus group with 11 participants including adult patients with CF (n = 5) and their informal caregivers (n = 6). The thematic content of the focus group was analyzed to find key themes. We developed a CF-specific Stigma Scale and assessed its psychometric properties in a 3-month prospective cohort study of adult CF outpatients (n = 45). RESULTS: Stigma emerged as consistent concern for people living and caring for those with CF, affecting both patients' lives and health through the focus group. Using the newly developed CF Stigma scale, the mean baseline score was 16.6 (SD = 4.5, Range = 10-25). The CF Stigma Scale demonstrated robust psychometric properties: 1) Internal consistency: α = 0.79; 2) Mean inter-item correlation: 0.30 with good test-retest reliability; 3) Convergent validity: Positive associations with depression, severity of CF symptoms and anxiety; negative associations with validated quality of life scores were observed. CONCLUSIONS: Stigma is measurable and significantly impacts the lives of CF patients. Further research should investigate the role of stigma in patients living with CF.

The prognostic effect of cigarette smoking on stroke severity, disability, length of stay in hospital, and mortality in a cohort with cerebrovascular disease.

OBJECTIVE: The aim of this study was to determine the prognostic influence of cigarette smoking on stroke severity, disability, length of stay (LOS) in hospital, and mortality in different stroke types. METHODS: A cohort separated by smoking status from the Registry of the Canadian Stroke Network was analyzed using logistic regression while controlling for key outcomes and clinical and demographic characteristics. RESULTS: There were 20,523 patients that were included for this study from July 2003 to March 2008. Multivariable analyses revealed that, in general, long-time smoking had a negative effect on functional outcome at discharge, mortality at 1 year, and LOS in hospital. In general, former smoking had a positive impact in reducing the risk of severe stroke, mortality risk at 30 days, and the LOS in hospital. Significant differences in clinical and demographics were found between smokers, nonsmokers, and former smokers with cerebrovascular disease. On average, smokers had an earlier initial stroke presentation of cerebrovascular disease. CONCLUSIONS: Our results provide empirical evidence regarding the prognostic influence of cigarette smoking on stroke severity, disability, and LOS in hospital and mortality, but the magnitude of the effect varied by stroke type.

The effectiveness of smoking cessation interventions in smokers with cerebrovascular disease: a systematic review.

OBJECTIVE: The main objective of this study was to determine the effectiveness of smoking cessation interventions (SCIs) for increasing cessation rates in smokers with cerebrovascular disease. DESIGN: Systematic review. Two independent reviewers searched information sources and assessed studies for inclusion/exclusion criteria. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES: Randomised control trials, conducted prior to the 22 May 2012 investigating SCIs in smokers with cerebrovascular disease, were included. No age or ethnicity limitations were applied in order to be as inclusive as possible. METHODS: We followed the PRISMA statement approach to identify relevant randomised control studies. Due to the variability of interventions used in the reported studies, a meta-analysis was not conducted. RESULTS: Of 852 identified articles, 4 articles fit the inclusion criteria describing the outcome in 354 patients. The overall cessation rate with an SCI was 23.9% (42 of 176) while without one was 20.8% (37 of 178). CONCLUSIONS: There are a limited number of reported intervention studies that explore this area of secondary stroke prevention. Furthermore, of those intervention studies that were found, only two implemented evidence-based approaches to smoking cessation. A meta-analysis was not conducted because of the variability of interventions in the reported studies. Larger studies with homogeneous interventions are needed to determine how effective SCIs are in increasing cessation in smokers with established cerebrovascular disease.

A randomised controlled pilot study of standardised counselling and cost-free pharmacotherapy for smoking cessation among stroke and TIA patients.

Background Tobacco use is a major risk factor for recurrent stroke. The provision of cost-free quit smoking medications has been shown to be efficacious in increasing smoking abstinence in the general population. Objective The objective of this pilot study was to assess the feasibility and obtain preliminary data on the effectiveness of providing cost-free quit smoking pharmacotherapy and counselling to smokers identified in a stroke prevention clinic. Trial design Cluster randomised controlled trial. Methods All patients seen at the Ottawa Hospital Stroke Prevention Clinic who smoked more five or more cigarettes per day, were ready to quit smoking in the next 30 days, and were willing to use pharmacotherapy were invited to participate in the study. All participants were advised to quit smoking and treated using a standardised protocol including counselling and pharmacotherapy. Participants were randomly assigned to either a prescription only usual care group or an experimental group who received a 4-week supply of cost-free quit smoking medications and a prescription for medication renewal. All patients received follow-up counselling. The primary outcome was biochemically validated quit rates at 26 weeks. The research coordinator conducting outcome assessment was blind to group allocation. Results Of 219 smokers screened, 73 were eligible, 28 consented and were randomised, and 25 completed the 26-week follow-up assessment. All 28 patients randomised were included in the analysis. The biochemically validated 7-day point prevalence abstinence rate in the experimental group compared to the usual care group was 26.6% vs 15.4% (adjusted OR 2.00, 95% CI 0.33 to 13.26; p=0.20). Conclusions It would be feasible to definitively evaluate this intervention in a large multi-site trial. Trial registration number http://ClinicalTrials.gov # UOHI2010-1.