Successes and challenges of best practice alerts to identify and engage individuals living with hepatitis C virus.

Introduction: Many individuals living with hepatitis C virus (HCV) are unaware of their diagnosis and/or have not been linked to programs providing HCV care. The use of electronic medical record (EMR) systems may assist with HCV infection identification and linkage to care. Methods: In October 2021, we implemented HCV serology-focused best practice alerts (BPAs) at The Ottawa Hospital (TOH) via our EMR (EPIC). Our BPAs were programmed to identify previously tested HCV seropositive individuals. Physicians were prompted to conduct HCV RNA testing and submit consultation requests to the TOH Viral Hepatitis Program. We evaluated data post-BPA implementation to assess the design and related outcomes. Results: From 1 September 2022 to 15 December 2022, a total of 2,029 BPAs were triggered for 139 individuals. As a consequence of the BPA prompts, nine HCV seropositive and nine HCV RNA-positive individuals were linked to care. The proportion of total consultations coming from TOH physicians increased post-BPA implementation. The BPA alerts were frequently declined, and physician engagement with our BPAs varied across specialty groups. Programming issues led to unnecessary BPA prompts (e.g., no hard stop to the prompts even though the individual was treated and cured and individuals linked to care without first undergoing HCV RNA testing). A fixed 6-month lookback period for test results limited our ability to identify many individuals. Conclusion: An EMR-based BPA can assist with the identification and engagement of HCV-infected individuals in care. However, challenges including issues with programming, time commitment toward BPA configuration, productive communication between healthcare providers and the programming team, and physician responsiveness to the BPAs require attention to optimize the impact of BPAs.

Loneliness during COVID-19 and its association with eating habits and 24-hour movement behaviours in a sample of Canadian adolescents.

Loneliness, a feeling of distress, has aggravated due to the COVID-19 pandemic lockdowns and reduced social interactions. The objective of this study was to explore whether increased loneliness due to the COVID-19 pandemic was associated with various health behaviours in adolescence, a critical period for the development of lasting lifestyle habits. We used self-reported data from 40,521 Canadian adolescents aged 12-19 years (collected between November 2020 and June 2021) for this cross-sectional study. Logistic regression was used to predict the odds of skipping breakfast and not meeting movement behaviour guidelines [moderate-to-vigorous physical activity (≥60 min/day), recreational screen time (≤2 h/day), sleep duration (≥8 h/day)] among adolescents with increased loneliness due to the COVID-19 pandemic. We found higher odds of skipping breakfast [boys: OR 1.40 (95% CI: 1.32, 1.49), girls: OR 1.62 (95% CI: 1.53, 1.71)], exceeding screen time guidelines [boys: OR 1.43 (95% CI: 1.24, 1.66), girls: OR 1.72 (95% CI: 1.54, 1.92)], and insufficient sleep duration [boys: OR 1.38 (95% CI: 1.28, 1.48), girls: OR 1.36 (95% CI: 1.27, 1.45)] in adolescents with increased loneliness (versus decreased/stayed the same loneliness group). However, we found clinically insignificant results with moderate-to-vigorous physical activity. Future longitudinal studies in adolescents are needed to confirm the directionality of these associations. Recovery efforts are needed to support adolescent social health and establish healthy behavioural habits across the lifespan.

Association of Ambient Air Pollution with Blood Pressure in Adolescence: A Systematic-review and Meta-analysis.

We systematically reviewed the association of ambient air pollution with blood pressure (BP) as a primary outcome in adolescents (10-19 years). Five databases (Ovid Medline, Ovid Embase, Web of Science, The Cochrane Library, and LILACS) were searched for relevant articles published up to August 2022. Meta-analyses were conducted using STATA v17 (Protocol - OSF Registries https://doi.org/10.17605/OSF.IO/96G5Q). Eight studies (5 cohort, 3 cross-sectional) with approximately 15,000 adolescents were included. Data from 6 studies were suitable for inclusion in the meta-analyses. In sub-group analyses, non-significant positive associations were observed for cohort studies assessing long-term exposure to PM10, PM2.5, and NO2 on systolic and diastolic BP. At age 12 years old (3702 adolescents), we found significant positive associations for long-term exposure to PM2.5(ß=5.33 (1.56, 9.09) mmHg) and PM10 (ß=2.47 (0.10, 4.85) mmHg) on diastolic BP. Significant positive associations were observed (3,592 adolescents) for long-term exposure to PM10(ß=0.34 (0.19, 0.50) mmHg) and NO2 on diastolic BP (ß=0.40 (0.09, 0.71) mmHg), and PM10 on systolic BP (ß=0.48 (0.19, 0.77) mmHg). The overall quality of evidence analysed was graded as "low/very low." Insufficient data for short-term exposures to PM2.5, PM10, NO2, CO on BP led to their exclusion from the meta-analysis. Inconsistent associations were reported for gender-stratified results. The evidence, though of low-quality and limited, indicated that ambient air pollution was positively associated with adolescent BP. Future studies need improved measures of air pollutant exposures, consideration of gender and socio-economic circumstances on the observed pollution effects, as well as adjustment for other potential confounding factors.

The impact of pharmacological and lifestyle interventions on body weight in people with type 1 diabetes: A systematic review and meta-analysis.

AIM: To systematically review the effects of pharmacological and lifestyle interventions on body weight as a secondary outcome in people with type 1 diabetes. METHODS: The Ovid Medline, Embase and Cochrane Library databases were searched for relevant pharmacological (glucagon-like peptide-1 [GLP-1] receptor agonist, sodium-glucose co-transporter-2 [SGLT-2] inhibitor, dipeptidyl peptidase-4 [DPP-4] inhibitor and metformin) and lifestyle intervention studies (diet and exercise) for adults with type 1 diabetes reporting body weight change and HbA1c published from January 2000 to May 2020. Meta-analyses were performed for 16 randomized controlled trials (RCTs). RESULTS: Thirty-three RCTs (n = 9344 participants), 26 pharmacological (on average 43.9 years, 83.1 kg, HbA1c 8.1%; 55.8% male) and seven lifestyle-based interventions (on average 37.0 years, 85.0 kg, HbA1c 8.1%; 84.6% male), were analysed. The GLP-1 receptor agonist liraglutide 0.6 mg (mean difference [MD]: -2.22 kg [95% CI: -2.55 to -1.90]), 1.2 mg (MD: -3.74 kg [95% CI: -4.16 to -3.33]) and 1.8 mg (MD: -4.85 kg [95% CI: -5.29 to -4.41]), and the SGLT-2 inhibitors empagliflozin 2.5 mg (MD: -1.47 kg [95% CI: -2.23 to -0.71]), 10 mg (MD: -2.77 kg [95% CI: -3.24 to -2.31]) and 25 mg (MD: -3.06 kg [95% CI: -3.57 to -2.55]) and sotagliflozin 200 mg (MD: -2.40 kg [95% CI: -2.87 to -1.94]) and 400 mg (MD: -3.23 [95% CI: -3.73 to -2.72]) were associated with significant reductions in body weight. No significant effect on body weight was found for DPP-4 inhibitors, other GLP-1-receptor agonists, metformin, or for lifestyle interventions (i.e. exercise and diet). CONCLUSIONS: In people with type 1 diabetes, several adjuvant pharmacological interventions showed weight reduction as a secondary outcome. Future studies in overweight people with type 1 diabetes are needed to establish whether the lifestyle and pharmacological interventions reviewed here have potential as components of complex interventions aimed at body weight reduction as a primary outcome.