Exploring challenges and opportunities in detecting emerging drug trends: A socio-technical analysis of the Canadian context.

OBJECTIVES: This study aimed to apply a systems thinking approach to explore factors influencing the detection of emerging drug trends in Canada's provinces and territories to better understand how the local context can influence the design and performance of a pan-Canadian (i.e., national) substance use early warning system (EWS). This study also presents a set of actionable recommendations arising from the results. METHODOLOGY AND METHODS: Semi-structured interviews were conducted with 13 purposively recruited Medical Officers of Health and epidemiologists from across Canada working in the field of substance use. Thematic and social network analysis guided by the socio-technical systems framework were subsequently employed. RESULTS: Barriers and facilitators for detecting emerging drug trends in provinces and territories are a product of the collective linkages and interactions between social (objectives, people, culture), technical (tools, practices, infrastructure), and external environmental (financial, regulatory frameworks, stakeholders) factors. Shortcomings in several of these areas shaped the system's behaviour and together contributed to fragmented operations that lacked strategic focus, poorly designed cross-sector partnerships, and unactionable information outputs. Participants' experiences shaped perceptions of a national substance use EWS, with some voicing potential opportunities and others expressing doubts about its effectiveness. CONCLUSION: This study highlights interconnected social, technical, and external environmental considerations for the design and implementation of a national substance use EWS in Canada. It also demonstrates the value of using the socio-technical systems framework to understand a complex public health surveillance issue and how it can be used to inform a path forward.

RéSUMé: OBJECTIFS: Cette étude visait à appliquer une approche de pensée systémique pour explorer les facteurs influençant la détection des tendances émergentes en matière de drogues dans les provinces et territoires (P/T) du Canada afin de mieux comprendre comment le contexte local peut influencer la conception et le rendement d'un système pancanadien (c.-à-d. national) d'alerte précoce (SAP) en matière de consommation de substances. Cette étude présente également un ensemble de recommandations réalisables découlant des résultats. MéTHODOLOGIE ET MéTHODES: Des entrevues semi-structurées ont été menées auprès de 13 médecins hygiénistes et épidémiologistes recrutés dans tout le Canada et travaillant dans le domaine de la toxicomanie. L'analyse des réseaux thématiques et sociaux guidée par le cadre des systèmes socio-techniques (STS) a ensuite été utilisée. RéSULTATS: Les obstacles et les facilitateurs à la détection des tendances émergentes en matière de drogues dans les provinces et les territoires sont le produit des liens et des interactions collectifs entre les facteurs sociaux (objectifs, personnes, culture), techniques (outils, pratiques, infrastructure) et environnementaux externes (cadres financiers, réglementaires, intervenants). Les lacunes dans plusieurs de ces domaines ont façonné le comportement du système et, ensemble, ont contribué à des opérations fragmentées qui manquaient d'orientation stratégique, à des partenariats intersectoriels mal conçus et à de l'information inexploitable. Les expériences des participants ont façonné les perceptions d'un SAP national sur la consommation de substances, certains exprimant des opportunités potentielles et d'autres exprimant des doutes quant à son efficacité. CONCLUSION: Cette étude met en évidence les considérations sociales, techniques et environnementales externes interconnectées pour la conception et la mise en œuvre d'un SAP national sur la consommation de substances au Canada. Il démontre également la valeur de l'utilisation du cadre STS pour comprendre un problème complexe de surveillance de la santé publique et comment il peut être utilisé pour éclairer une voie à suivre.

At-a-glance - Opioid surveillance: monitoring and responding to the evolving crisis. / Aperçu - Crise des opioïdes : assurer le suivi et faire évoluer les données de surveillance.

The incidence of opioid-related overdoses is increasing at an alarming pace, largely driven by the increased use of fentanyl and its analogues. The need for sound and reliable sources of data on opioid use is crucial in order to make decisions on implementing efficient interventions, and develop appropriate policies and guidelines to mitigate the burden of opioid use. This article highlights initiatives undertaken by federal partners to address the opioid crisis in Canada. The need for novel surveillance approaches that improve the collection and harmonization of drug-related data is also discussed.

RÉSUMÉ: Le nombre de cas de surdoses liées à la consommation d'opioïdes augmente à un rythme alarmant, principalement en raison de l'usage accru du fentanyl et de ses analogues. Des sources de données fiables et solides sur l'utilisation des opioïdes sont cruciales pour la planification d'interventions efficaces, de même que pour l'élaboration de politiques et de directives appropriées en vue de réduire le fardeau des opioïdes. Cet article porte sur les mesures entreprises par les partenaires fédéraux pour s'attaquer à la crise des opioïdes au Canada. Il traite aussi de la nécessité de nouvelles méthodes de surveillance destinées à améliorer la collecte et l'harmonisation des données sur les drogues.

Field investigation with real-time virus genetic characterisation support of a cluster of Ebola virus disease cases in Dubréka, Guinea, April to June 2015.

On 11 May 2015, the Dubréka prefecture, Guinea, reported nine laboratory-confirmed cases of Ebola virus disease (EVD). None could be epidemiologically linked to cases previously reported in the prefecture. We describe the epidemiological and molecular investigations of this event. We used the Dubréka EVD registers and the Ebola treatment centre's (ETC) records to characterise chains of transmission. Real-time field Ebola virus sequencing was employed to support epidemiological results. An epidemiological cluster of 32 cases was found, of which 27 were laboratory confirmed, 24 were isolated and 20 died. Real-time viral sequencing on 12 cases demonstrated SL3 lineage viruses with sequences differing by one to three nt inside a single phylogenetic cluster. For isolated cases, the average time between symptom onset and ETC referral was 2.8 days (interquartile range (IQR): 1-4). The average time between sample collection and molecular results' availability was 3 days (IQR: 2-5). In an area with scarce resources, the genetic characterisation supported the outbreak investigations in real time, linking cases where epidemiological investigation was limited and reassuring that the responsible strain was already circulating in Guinea. We recommend coupling thorough epidemiological and genomic investigations to control EVD clusters.

Women exposure during pregnancy to haloacetaldehydes and haloacetonitriles in drinking water and risk of small-for-gestational-age neonate.

BACKGROUND: Past studies have examined the effects of maternal exposure to water chlorination disinfection by-products (DBPs), such as trihalomethanes (THMs) and haloacetic acids (HAAs) during pregnancy. However, no human-based study has yet evaluated the effect of emerging DBPs, such as haloacetaldehydes (HAs) and haloacetonitriles (HANs) on small-for-gestational-age (SGA) status in newborns. OBJECTIVE: This study aims to assess the association between maternal multiroute exposure to HAs and HANs during the third trimester of pregnancy and SGA status at birth, among neonates delivered by women residing in the Quebec City area (Province of Quebec, Canada). We also evaluated the interaction between exposure to these emerging unregulated by-products and regulated DBPs also found in drinking water (THMs and HAAs), for which a positive association with adverse reproductive outcomes has been suggested in previous studies. METHODS: We conducted a population-based case-control study in the Quebec City area. SGA newborns (n=330) were compared to 1100 controls, with matching based on calendar week of birth. HA and HAN concentrations in drinking water at participant's tap were estimated using spatio-temporal strategy based on bimonthly measurements carried out at several locations in the participant's distribution system. A computer-assisted telephone interview was completed to collect information on individual habits of water consumption and water related activities in order to determine individual multiroute exposure. This enabled us to estimate the dose of HAs and HANs absorbed daily by each participant. Associations between total HA, HAN concentrations in drinking water and SGA were analyzed. Associations between the daily-absorbed doses of these emerging DBPs and SGA were also analyzed. Odds ratios (ORs) comparing the 4th quartile of exposure to the reference group (the first three quartiles) were obtained by means of conditional logistic regression, and controlling for potential confounders. RESULTS: Globally, no evidence of increased risk of SGA was found with total HA and HAN concentrations in tap water when participants in the 4th quartile of exposure were compared to the first three quartiles (OR=1.0; 95% CI [0.7-1.5] and OR=0.8; 95% CI [0.6-1.2], respectively). Similarly, no association was found with the daily-absorbed doses of total HAs or HANs (OR=0.9; 95% CI [0.6-1.3] and OR=1.1; 95% CI [0.7-1.6], respectively). However, a small non statistically significant association was found between the dose of brominated HA and SGA (OR=1.4; 95% CI [0.9-2.1]). Also, in spite of the lack of interaction between other DBP classes, an unexpected negative interaction was observed between concentration of chloral hydrate (CH) (which represents the main HA species), and regulated DBPs (P=0.006). CONCLUSION: In this population, exposure to low levels of HAs and HANs during the third trimester of pregnancy through drinking water was not associated to SGA status in newborns. Nonetheless, more research is needed to clarify possible effect of brominated compounds and interaction between different DBPs.