Patterns of Primary Care Use Prior to a First Diagnosis of Nonaffective Psychotic Disorder in Ontario, Canada: Modèles d'utilisation des soins de première ligne avant un premier diagnostic de trouble psychotique non affectif en Ontario, Canada.

BACKGROUND: Many people experience early signs and symptoms before the onset of psychotic disorder, suggesting that there may be help-seeking prior to first diagnosis. The family physician has been found to play a key role in pathways to care. This study examined patterns of primary care use preceding a first diagnosis of psychotic disorder. METHODS: We used health administrative data from Ontario (Canada) to construct a population-based retrospective cohort. We investigated patterns of primary care use, including frequency and timing of contacts, in the 6 years prior to a first diagnosis of psychosis, relative to a general population comparison group matched on age, sex, geographic area, and index date. We used latent class growth modeling to identify distinct trajectories of primary care service use, and associated factors, preceding the first diagnosis. RESULTS: People with early psychosis contacted primary care over twice as frequently in the 6 years preceding first diagnosis (RR = 2.22; 95% CI, = 2.19 to 2.25), relative to the general population, with a sharp increase in contacts 10 months prior to diagnosis. They had higher contact frequency across nearly all diagnostic codes, including mental health, physical health, and preventative health. We identified 3 distinct service use trajectories: low-, medium-, and high-increasing usage. DISCUSSION: We found elevated patterns of primary care service use prior to first diagnosis of psychotic disorder, suggesting that initiatives to support family physicians in their role on the pathway to care are warranted. Earlier intervention has implications for improved social, educational, and professional development in young people with first-episode psychosis.

Differences in duration of untreated psychosis for racial and ethnic minority groups with first-episode psychosis: an updated systematic review and meta-analysis.

PURPOSE: Ethnic minority groups with early psychosis may have longer treatment delays, potentially leading to poorer outcomes. We updated a previous systematic review of the literature on racial and ethnic differences in duration of untreated psychosis (DUP) among people with first-episode psychosis. RESULTS: Six of 17 studies described significant differences across aggregated racial groups; however, the pooled estimates did not show differences across groups. Additional data from this update allowed for disaggregated analyses, finding that Black-African groups have a shorter DUP, whereas Black-Caribbean groups have longer DUP, relative to White groups. CONCLUSIONS: These findings highlight the importance of in-depth research on disaggregated ethnic groups to inform targeted early intervention strategies for minority populations.

Trends in alcohol-attributable hospitalisations and emergency department visits by age, sex, drinking group and health condition in Ontario, Canada.

INTRODUCTION: Alcohol-attributable harms are increasing in Canada. We described trends in alcohol-attributable hospitalisations and emergency department (ED) visits by age, sex, drinking group, attribution and health condition. METHODS: Hospitalisation and ED visits for partially or wholly alcohol-attributable health conditions by age and sex were obtained from population-based health administrative data for individuals aged 15+ in Ontario, Canada. Population-level alcohol exposure was estimated using per capita alcohol sales and alcohol use data. We estimated the number and rate of alcohol-attributable hospitalisations (2008-2018) and ED visits (2008-2019) using the International Model of Alcohol Harms and Policies (InterMAHP). RESULTS: Over the study period, the modelled rates of alcohol-attributable health-care encounters were higher in males, but increased faster in females. Specifically, rates of alcohol-attributable hospitalisations and ED visits increased by 300% (19-76 per 100,000) and 37% (774-1,064 per 100,000) in females, compared to 20% (322-386 per 100,000) and 2% (2563-2626 per 100,000) in males, respectively. Alcohol-attributable ED visit rates were highest among individuals aged 15-34, however, increased faster among individuals aged 65+ (females: 266%; males: 44%) than 15-34 years (females:+17%; males: -16%). High-volume drinkers had the highest rates of alcohol-attributable health-care encounters; yet, low-/medium-volume drinkers contributed substantial hospitalisations (11%) and ED visits (36%), with increasing rates of ED visits in females drinking low/medium volumes. DISCUSSION AND CONCLUSIONS: Alcohol-attributable health-care encounters increased overall, and faster among females, adults aged 65+ and low-/medium-volume drinkers. Monitoring trends across subpopulations is imperative to inform equitable interventions to mitigate alcohol-attributable harms.

Efficacy of calorie labelling for alcoholic and non-alcoholic beverages on restaurant menus on noticing information, calorie knowledge, and perceived and actual influence on hypothetical beverage orders: a randomized trial.

OBJECTIVES: To test the efficacy of calorie labelling for alcoholic and non-alcoholic beverages on restaurant menus on noticing calorie information, calorie knowledge, and perceived and actual influence on hypothetical beverage orders. METHODS: Participants included upper-level university students of legal drinking age residing in Ontario, Canada (n = 283). Using a between-groups experiment, participants were randomized to view one of two menus: (1) No Calorie Information (control), and (2) Calorie Information adjacent to each beverage. Participants completed a hypothetical ordering task, and measures related to noticing calorie information, calorie knowledge, and actual and perceived influence of calorie information on beverages ordered were assessed. Linear, logistic, and multinomial logistic regression models were used to examine the four outcomes. RESULTS: The odds of noticing calorie information were significantly higher in the Calorie Information (72.6%) versus No Calorie Information condition (8.0%) (OR = 43.7, 95% CI: 16.8, 113.8). Compared to those in the No Calorie Information condition, participants in the Calorie Information condition had significantly lower odds of responding 'Don't know' (OR = 0.04, 95% CI: 0.02, 0.09), underestimating (OR = 0.06, 95% CI: 0.02, 0.2), and overestimating (OR = 0.05, 95% CI: 0.02, 0.2) versus accurately estimating calories in beverages ordered. No significant differences were observed between menu labelling conditions in the calories in beverages ordered or the perceived influence of calorie information on the number of beverages ordered. CONCLUSION: Exposure to menus with calorie information increased consumers noticing the calorie information, and accurately estimating calories in alcoholic and non-alcoholic beverages ordered. These results have implications for policy-makers considering mandatory menu labelling policy inclusive of alcoholic beverages.

RéSUMé: OBJECTIFS: Évaluer l'effet de l'inscription de la valeur calorique des boissons alcoolisées et non alcoolisées sur les probabilités de remarquer cette information et la connaissance de la valeur calorique, et sur l'influence, réelle ou perçue, sur des commandes hypothétiques de boissons. MéTHODOLOGIE: Les participants étaient des étudiants universitaires avancés ayant l'âge légal pour consommer de l'alcool et vivant en Ontario, au Canada (n = 283). On les a répartis au hasard en deux groupes : 1) ceux du premier groupe ont consulté un menu sans valeurs caloriques (groupe témoin) et 2) ceux du second groupe ont consulté un menu indiquant les valeurs caloriques à côté de chaque boisson. Les participants ont ensuite fait des commandes hypothétiques et on a mesuré les données suivantes : probabilité de remarquer les valeurs caloriques, connaissance des valeurs caloriques et influence, réelle ou perçue, de cette information sur le choix des boissons. Des modèles de régression linéaire, logistique et logistique multinomiale ont été employés pour analyser les données recueillies. RéSULTATS: Les probabilités de remarquer les valeurs caloriques étaient beaucoup plus élevées dans le groupe valeurs caloriques (72,6 %) que dans le groupe sans valeurs caloriques (8,0 %) (RC = 43,7, IC à 95% : 16,8­113,8). Comparés à ceux du groupe sans valeurs caloriques, les participants du groupe valeurs caloriques avaient beaucoup moins de chances de répondre « Je ne sais pas ¼ (RC = 0,04, IC à 95% : 0,02­0,09), de donner une réponse trop basse (RC = 0,06, IC à 95% : 0,02­0,2) ou trop haute (RC = 0,05, IC à 95% : 0,02­0,2) que d'estimer précisément le nombre de calories dans les boissons commandées. Aucune différence significative n'a été observée entre les deux groupes quant au nombre de calories contenues dans les boissons commandées ni dans l'influence perçue des valeurs caloriques sur le nombre de boissons commandées. CONCLUSION: Le fait d'inscrire les valeurs caloriques sur le menu augmente les probabilités que les consommateurs remarquent les valeurs caloriques, et facilite l'estimation précise de la valeur calorique des boissons alcoolisées ou non alcoolisées commandées. Ces résultats ont une incidence pour les décideurs qui envisagent de rendre obligatoire l'inscription des valeurs caloriques sur les menus, y compris pour les boissons alcoolisées.