Plasma-derived product recipients' views on the acceptability of implementing a programme of plasma donation for fractionation from men who have sex with men.

BACKGROUND AND OBJECTIVES: Over the past few years in Québec, Canada, exclusion criteria for blood donation and plasma donation for fractionation have been modified. Héma-Québec, the institution responsible for blood products, has made changes to allow more inclusive access to blood and plasma donation, in accordance with evolving scientific data concerning donation safety. The study, conducted before those changes were implemented, aimed to assess acceptability of recipients and parents of recipients of plasma-derived products for men who have sex with men (MSM) to become eligible to donate plasma for fractionation. MATERIALS AND METHODS: Eight qualitative interviews (4 focus groups, 4 individual) were conducted with a total of 17 plasma product recipients and parents of children needing plasma-derived products. Data were analysed using thematic analysis. RESULTS: Participants were rather favourable regarding acceptability of MSM as potential donors. Participants viewed this change as necessary and beneficial. They also felt they must rely on trust in Héma-Québec, conferred automatically or by default. However, some participants raised concerns about donation safety and reported feeling helpless regarding inclusion of MSM. The importance of being informed and that recipients' safety be prioritized first and foremost were also mentioned. CONCLUSION: Despite their nuanced attitudes, recipients showed high levels of acceptability of including MSM in plasma donation for fractionation. Actions can be taken to reduce concerns regarding the safety of products received.

Donor screening question alternatives to men who have sex with men time deferral: Potential impact on donor deferral and discomfort.

BACKGROUND: Alternative screening questions could permit low-risk men who have sex with men (MSM) to donate blood without a time deferral. We performed a study to determine the proportion of current donors who may be deferred by various questions and their comfort with them. STUDY DESIGN AND METHODS: Donors attending collection sites in Canada in January and February 2018 were offered one of two questionnaires but not both. Questionnaire 1 asked about risk behaviors; Questionnaire 2 rated comfort with the questions. Volunteers uncomfortable with questions participated in short qualitative telephone interviews to understand reasons. Quantitative data were analyzed using χ2 statistics. RESULTS: Of 36 241 donors attending, 31 904 (88%, Period 1) completed Questionnaire 1; of 34 947, a total of 30 278 (87%, Period 2) completed Questionnaire 2; 294 completed an interview. In the past 3 months 3.1% (95% confidence interval [CI], 3.1%-3.6%) had more than one partner; 6.0% (95% CI, 5.7%-6.2%) had a new partner; 6.7% (95% CI, 6.4%-6.9%) were in a nonexclusive relationship; 11.2% (95% CI, 10.9%-11.6%) had at least one of these; 3.7% (95% CI, 3.4%-3.9%) had anal sex; and 62.8% (95% CI, 62.2%-63.3%) had condomless sex. More than 6% were uncomfortable with each question, but more (17.2%; 95% CI, 16.8%-17.7%) were uncomfortable with anal sex. Key reasons for discomfort were questions being too personal and unclear safety benefit. CONCLUSION: Most donors are comfortable answering alternative questions (except very personal ones) but question the benefit. Implementing alternative questions would result in substantive deferrals. Other policies such as using an MSM capture question to ask additional questions only to MSM should be considered.

Determinants of the intention to participate in a programme of plasma donation for fractionation among men who have sex with men.

BACKGROUND AND OBJECTIVES: Several approaches are currently under study to contribute to efforts to allow men who have sex with men (MSM) to donate blood. One of these approaches involves implementing a programme of plasma donation for fractionation, with a quarantine period. The goal of this article is to identify the determinants of intention to participate in the plasma donation programme among MSM in Montreal, Canada. MATERIALS AND METHODS: Based on the theory of planned behaviour, a questionnaire was developed to measure MSM's intention to donate plasma and identify influencing factors. A multiple linear regression analysis was conducted to identify the determinants of intention to donate plasma. RESULTS: Respondents' (N = 933) intention to donate plasma in the next six months was moderate. The multiple linear regression model explained 55% (P < 0·001) of the variation of intention. Intention was predicted by attitudes (ß = 0·34, P < 0·001), perceived behavioural control (ß = 0·28, P < 0·001), aged under 35 years (ß = 0·26, P < 0·001), history of blood donation (ß = 0·24, P < 0·001), subjective norm (ß = 0·21, P < 0·001), income above $40,000 (ß = 0·20, P < 0·001), moral norm (ß = 0·18, P < 0·001) and higher level of involvement in various issues LGBTQ+ communities are fighting for (ß = 0·09, P < 0·001). CONCLUSION: Our analyses show that intention to donate plasma within the proposed programme is associated with personal, social and structural factors, but more strongly predicted by factors related to the theory of planned behaviour. Our results also highlight the importance of involving MSM; community acceptability of the plasma donation programme would probably be higher if MSM felt respected and party to the decisions.

'One step closer': Acceptability of a programme of plasma donation for fractionation from men who have sex with men.

BACKGROUND AND OBJECTIVES: In Canada, Héma-Québec is considering the possibility of allowing men who have sex with men (MSM) to donate plasma for fractionation combined with a mandatory quarantine period. This study aims to assess the acceptability and operational feasibility of the programme in the targeted population. MATERIALS AND METHODS: Seven focus groups with MSM (N = 47) were conducted in Montréal, regarding their beliefs underlying attitudes, subjective norms and perceived behavioural control relating to intention to participate in a programme of plasma donation for fractionation. A theoretical thematic content analysis was realized. RESULTS: Participants brought up benefits of the programme. Some are altruistic (help others, save lives, contribute as citizens), while others are linked to what it could bring to their community (progress, opportunity to include MSM in blood donation programmes, acknowledgement of MSM's contributions to the well-being of others). However, even if the programme is in accordance with their altruistic values, it clashes with their values of equality and social justice. Many disadvantages were raised (discrimination and stigmatization of MSM, the fact that their blood is presented as being not as good as the blood of others). Facilitating factors and barriers to participation were put forward in terms of programme characteristics and sites where donations would be made. CONCLUSION: The findings suggest some interest in the programme of plasma donation for fractionation, but this is significantly tempered by the fact that differential treatment for MSM would continue and that their demands regarding access to whole blood donation are still unmet.

Donor Milk Expression Habits: Can we Favor Hindmilk Banking for Extremely Preterm Infants?

Background: Extremely preterm infants often receive donor milk. Hindmilk, which is released more than 3 minutes after letdown, could be advantageous due to its elevated levels of fat and calorie density. Donor milk expression habits may influence milk composition but have not yet been investigated. This study aims to assess the practices of milk donors and the feasibility of hindmilk expression. Methods: Active milk donors in Québec were questioned using an online survey about their milk expression habits and whether hindmilk donation would be acceptable to them. Answers were analyzed using mixed methods. Results: Of 181 donors, 126 fully completed the questionnaire (70%); 57% reported expressing donated milk between breastfeeds; 15% reported simultaneously breastfeeding while expressing donated milk from the other breast; 12% reported breastfeeding their baby on each breast, then expressing donated milk (hindmilk). The majority (66%) would be willing to change their habits most or all the time to provide hindmilk for preterm infants. The main themes invoked by respondents in open-ended answers were altruism and gratitude for being able to help others. However, 15% commented on the complexity of milk expression or that adding further complexity might discourage them from donating. Conclusions: Expression practices are variable, which may lead to variability in donor milk composition. Most donors would agree to change their expression habits in favor of giving hindmilk to help the most fragile infants. More information is needed on how changing recommendations for milk expression might impact the supply and composition of donor milk.

Déjà-vu all over again: using simulation to evaluate the impact of shorter shelf life for red blood cells at Héma-Québec.

BACKGROUND: Since the 1970s red blood cells (RBCs) have had a rated shelf life of 42 days. Recently, studies have suggested poorer patient outcomes when older blood is transfused. However, shortening the shelf life of RBCs may increase costs and lead to greater instances of outdates and shortages. STUDY DESIGN AND METHODS: A simulation method to evaluate the impact of a shorter shelf life for RBCs on a regional blood network was developed. A network model of the production and distribution system in the province of Quebec was built and validated. RESULTS: The model suggests that a shelf life of 21 or 28 days will have modest impact on outdate and shortage rates. A shelf life of 14 days will create significant challenges for both blood suppliers and hospitals and will result in systemwide outdate rates of 6.64% and shortage rates of 2.75%. The impact of a shorter shelf life for RBCs will disproportionately affect smaller and midsize hospitals. CONCLUSION: A shelf life of 28 or 21 days is feasible without excessive increases to systemwide outdate, shortage, or emergency ordering rates. Large hospitals will see minimal impact; smaller hospitals will see larger increases and may be unable to find inventory policies that maintain both low outdate and shortage rates. Reducing the shelf life to 14 days, or lower, results in significant challenges for suppliers and hospitals of all sizes. All hospitals will see an impact on outdate and shortage rates; overall systemwide outdate rates (6% or more) will reach levels that would currently be considered unacceptably high.

Fibromyalgia and the therapeutic relationship: where uncertainty meets attitude.

BACKGROUND: Fibromyalgia remains underdiagnosed and suboptimally treated even though it affects an estimated 3.3% of Canadians. The present study examines knowledge and attitudinal challenges affecting optimal care. METHODS: A mixed-methods approach was employed. Discussion groups, semistructured interviews and a quantitative online survey (five-point scale) were conducted (June 2007 to January 2008). Participants included 189 general practitioners (GPs) and 139 specialists (anesthesiologists, neurologists, physiatrists, psychiatrists and rheumatologists) distributed across Canada. Participants included 18 patients to enrich the scope of the findings. RESULTS: GPs reported insufficient knowledge and skill in diagnosing fibromyalgia, with not all believing it to be a diagnosable condition (mean 3.74/5). Twenty-three per cent of GPs and 12% of specialists characterized fibromyalgia patients as malingerers. They further reported a lack of knowledge and skill in treating fibromyalgia (mean 2.73/5), including the pain, sleep disorders and mood disorders related to the condition (mean 3.32/5). Specialists shared these challenges, although to a lesser degree - "We are not trained to treat distress and suffering" (Specialist). Attitudinal issues centred around frustration (mean 3.91/5) and negative profiling of fibromyalgia patients (mean 3.06/5 and 1.99/5). CONCLUSIONS: Findings revealed the presence of GP attitudinal and confidence challenges in caring for fibromyalgia patients. As care of fibromyalgia patients moves to general practices, these fundamental competencies must be addressed to assure that all patients receive the quality of care necessary to manage their disease and to empower physicians to be more professionally effective. As stated by one patient, "Why are we being penalized for having this disability?"

The relative efficacy of three interventions to favour return to give blood.

BACKGROUND: The aim of the study was to test the relative efficacy of action planning and reward distribution to promote retention of whole blood donors. MATERIALS AND METHODS: A sample of 7,399 donors was randomised to one of three interventions: "action planning" (n=2,585); "reward" (n=2,397); and "thank you" (n=2,417). Participants in the action planning condition were invited to write the date of their next donation on a post-it note before taking it home at the end of the donation process. Participants in the "reward" condition were given an anti-theft credit card sleeve at the end of the donation process. The "thank you" intervention is the usual condition at the end of the process; it was considered the control condition. The dependent variable was the proportion of donors who registered to give blood at six months. RESULTS: Overall, 4,444 (60.06%) donors registered to give blood at six months. There were no differences between the three interventions in the proportions of donors who registered to give blood (d.f. 2, chi-square=3.72, p<0.15). However, gender modified the effect of the intervention (d.f. 2, chi-square=6.57, p<0.0375); more women registered in the "thank you" condition than in the other two. DISCUSSION: The results suggest that action planning and the distribution of a reward have no motivational effect on the return to give blood. Nonetheless, women appear to respond more negatively to these interventions at the end of the donation process.