Feeling safer: effectiveness, feasibility, and acceptability of continuous pulse oximetry for people who smoke opioids at overdose prevention services in British Columbia, Canada.

BACKGROUND: Smoking is the most common mode of unregulated opioid consumption overall and implicated in fatal overdoses in British Columbia (BC). In part, perception of decreased risk (e.g., fewer who smoke carry naloxone kits) and limited smoking-specific harm reduction services contribute to overdose deaths. Overdose prevention services (OPS) offer supervised settings for drug use. Continuous pulse oximetry, common in acute care, allows real-time, remote oxygen monitoring. We evaluated the effectiveness of a novel continuous pulse oximetry protocol aimed at allowing physical distancing (as required by COVID-19, secluded spaces, and to avoid staff exposure to vaporized opioids), its feasibility, and acceptability at OPS for people who smoke opioids. METHODS: This was a mixed methods survey study. We developed a continuous pulse oximetry protocol in collaboration with clinical experts and people with lived/living experience of substance use. We implemented our protocol from March to August 2021 at four OPS in BC permitting smoking. We included adults (≥ 18 years) presenting to OPS to smoke opioids. Peer researchers collected demographic, health, and substance use information, and conducted structured observations. OPS clients participating in our study, OPS staff, and peer researchers completed post-monitoring surveys. We analyzed responses using a thematic inductive approach and validated themes with peer researchers. RESULTS: We included 599 smoking events. OPS clients participating in our study had a mean age of 38.5 years; 73% were male. Most (98%) reported using "down", heroin, or fentanyl; 48% concurrently used other substances (32% of whom reported stimulants); 76% reported smoking alone in the last 3 days; and 36% reported an overdose while smoking. Respondents reported that the protocol facilitated physical distancing, was easy to use, high satisfaction, improved confidence, improved sense of safety, and that they would use it again. CONCLUSIONS: Continuous pulse oximetry allowed safe physical distancing, was feasible, and acceptable in monitoring people who smoke opioids at OPS.

"Shared experience makes this all possible": documenting the guiding principles of peer-led services for people released from prison.

BACKGROUND: There is a growing body of evidence demonstrating the effectiveness of peer-led services in supporting community reintegration for people released from prison. This study aims to document the guiding principle of a peer-led service for people released from prison, from the perspective of peer mentors. METHODS: Data were collected using focus groups (N = 10; 2 groups with 5 participants each) and one-on-one interviews (N = 5) including a total of 13 people, representing all UTGSS staff at the time of the study. An inductive thematic analysis was used to identify patterns in the data. Initial coding was done by using "in-vivo" codes (i.e. applying codes to terms used by participants). This informed the direction of the next stage of analysis, which focused on identifying categories that synthesized the codes and data across transcripts. In this stage, broad themes and sub-themes were developed. FINDINGS: Six themes were constructed to reflect the guiding principles of UTGSS staff. This includes four central themes: 1) Offering hope; 2) Building respectful relationships; 3) Providing consistent support; 4) Meeting people where they are at. Two connected themes are also reported: 1) Relying on shared experience, which participants reported serves as the foundation for practicing these guiding principles and 2) Bridging connections to services, which reflects the outcome of practicing these guiding principles. CONCLUSION: The principles identified in this study can be used by UTGSS staff as a guide for checking-in on progress with clients and may be considered as a model for reflection on practice by staff providing similar peer-led services. These principles should not be applied in a prescriptive way, as relationship building is at the centre of peer support, and different applications will be required depending on clients' goals and the range of supports available within their community.

A Mixed Methods Study to Implement the Synergy Tool and Evaluate Its Impact on Long-Term Care Residents.

BACKGROUND: There are ongoing workforce challenges with the delivery of long-term care (LTC), such as staffing decisions based on arbitrary standards. The Synergy tool, a resident-centered approach to staffing, provides objective, real-time acuity and dependency scores (Synergy scores) for residents. The purpose of this study was to implement and evaluate the impact of the Synergy tool on LTC delivery. METHODS: A longitudinal mixed methods study took place within two publicly funded LTC homes in British Columbia, Canada. Quantitative data included weekly Synergy scores for residents (24 weeks), monthly aggregated resident falls data (18 months) and a six-month economic evaluation. Qualitative data were gathered from family caregivers and thematically analyzed. RESULTS: Quantitative findings from Synergy scores revealed considerable variability for resident acuity/dependency needs within and across units; and falls decreased during implementation. The six-month economic evaluation demonstrated some cost savings by comparing Synergy tool training and implementation costs with savings from resident fall rate reductions. Qualitative analyses yielded three positive impact themes (improved care delivery, better communication, and improved resident-family-staff relationships), and two negative structural themes (language barrier and staff shortages). CONCLUSIONS: The Synergy tool provides useful data for enhancing a 'fit' between resident needs and available staff.

Differential uptake and effects of digital sexually transmitted and bloodborne infection testing interventions among equity-seeking groups: a scoping review.

BACKGROUND: Digital sexually transmitted and bloodborne infection (STBBI) testing interventions have gained popularity. However, evidence of their health equity effects remains sparse. We conducted a review of the health equity effects of these interventions on uptake of STBBI testing and explored design and implementation factors contributing to reported effects. METHODS: We followed Arksey and O'Malley's framework for scoping reviews (2005) integrating adaptations by Levac et al (2010). We searched OVID Medline, Embase, CINAHL, Scopus, Web of Science, Google Scholar and health agency websites for peer-reviewed articles and grey literature comparing uptake of digital STBBI testing with in-person models and/or comparing uptake of digital STBBI testing among sociodemographic strata, published in English between 2010 and 2022. We extracted data using the Place of residence, Race, Occupation, Gender/Sex, Religion, Education, Socioeconomic status (SES), Social capital and other disadvantaged characteristics (PROGRESS-Plus) framework, reporting differences in uptake of digital STBBI testing by these characteristics. RESULTS: We included 27 articles from 7914 titles and abstracts. Among these, 20 of 27 (74.1%) were observational studies, 23 of 27 (85.2%) described web-based interventions and 18 of 27 (66.7%) involved postal-based self-sample collection. Only three articles compared uptake of digital STBBI testing with in-person models stratified by PROGRESS-Plus factors. While most studies demonstrated increased uptake of digital STBBI testing across sociodemographic strata, uptake was higher among women, white people with higher SES, urban residents and heterosexual people. Co-design, representative user recruitment, and emphasis on privacy and security were highlighted as factors contributing to health equity in these interventions. CONCLUSION: Evidence of health equity effects of digital STBBI testing remains limited. While digital STBBI testing interventions increase testing across sociodemographic strata, increases are lower among historically disadvantaged populations with higher prevalence of STBBIs. Findings challenge assumptions about the inherent equity of digital STBBI testing interventions, emphasising the need to prioritise health equity in their design and evaluation.

Evaluating the Impact of the COVID-19-Related Public Health Restrictions on Access to Digital Sexually Transmitted and Blood-Borne Infection Testing in British Columbia, Canada: An Interrupted Time Series Analysis.

BACKGROUND: Evidence of long-term impacts of COVID-19-related public health restrictions on digital sexually transmitted and blood-borne infection (STBBI) testing utilization is limited. We assessed these impacts on GetCheckedOnline (a digital testing resource for STBBIs) relative to all STBBI tests in British Columbia (BC). METHODS: Interrupted time series analyses were conducted using GetCheckedOnline program data comparing monthly test episodes (STBBI tests per requisition) among BC residents, stratified by BC region, and testers' sociodemographic and sexual risk profiles, for the prepandemic (March 2018-February 2020) and pandemic periods (March 2020-October 2021). Trends in GetCheckedOnline testing per 100 STBBI tests in BC regions with GetCheckedOnline were analyzed. Each outcome was modeled using segmented generalized least squared regression. RESULTS: Overall, 17,215 and 22,646 test episodes were conducted in the prepandemic and pandemic periods. Monthly GetCheckedOnline test episodes reduced immediately after restrictions. By October 2021 (end of the pandemic period), monthly GetCheckedOnline testing increased by 21.24 test episodes per million BC residents (95% confidence interval, -11.88 to 54.84), and GetCheckedOnline tests per 100 tests in corresponding BC regions increased by 1.10 (95% confidence interval, 0.02 to 2.17) above baseline trends. After initial increases among users at higher STBBI risk (symptomatic testers/testers reporting sexual contacts with STBBIs), testing decreased below baseline trends later in the pandemic, whereas monthly GetCheckedOnline testing increased among people 40 years or older, men who have sex with men, racialized minorities, and first-time testers via GetCheckedOnline. CONCLUSIONS: Sustained increases in utilization of digital STBBI testing during the pandemic suggest fundamental changes in STBBI testing in BC, highlighting the need for accessible and appropriate digital testing, especially for those most affected by STBBIs.

Culture Change in Long-Term Care-Post COVID-19: Adapting to a New Reality Using Established Ideas and Systems.

The response to the COVID-19 pandemic in long-term care (LTC) has threatened to undo efforts to transform the culture of care from institutionalized to de-institutionalized models characterized by an orientation towards person- and relationship-centred care. Given the pandemic's persistence, the sustainability of culture-change efforts has come under scrutiny. Drawing on seven culture-change models implemented in Canada, we identify organizational prerequisites, facilitatory mechanisms, and frontline changes relevant to culture change that can strengthen the COVID-19 pandemic response in LTC homes. We contend that a reversal to institutionalized care models to achieve public health goals of limiting COVID-19 and other infectious disease outbreaks is detrimental to LTC residents, their families, and staff. Culture change and infection control need not be antithetical. Both strategies share common goals and approaches that can be integrated as LTC practitioners consider ongoing interventions to improve residents' quality of life, while ensuring the well-being of staff and residents' families.

Developmental evaluation during the COVID-19 pandemic: Practice-based learnings from projects in British Columbia, Canada.

In this article, we explore experiences and learnings from adapting to challenges encountered in implementing three Developmental Evaluations (DE) in British Columbia, Canada within the evolving context of the COVID-19 pandemic. We situate our DE projects within our approach to the DE life cycle and describe challenges encountered and required adaptations in each phase of the life cycle. Regarding foundational aspects of DEs, we experienced challenges with relationship building, assessing and responding to the context, and ensuring continuous learning. These challenges were related to suboptimal embeddedness of the evaluators within the evaluated projects. We adapted by leveraging online channels to maintain communications and securing stakeholder engagement by assuming non-traditional DE roles based on our knowledge of the context to support project goals. Additional challenges experienced with mapping the rationale and goals of the projects, identifying domains for assessment, collecting data, making sense of the data and intervening were adapted to by facilitating online workshops, collecting data online and through proxy evaluators, while sharing methodological insights within the evaluation team. During evolving crises, like the COVID-19 pandemic, evaluators must embrace flexibility, leverage, and apply their knowledge of the evaluation context, lean on their strengths, purposefully reflect and share knowledge to optimise their DEs.

The Overdose Crisis and Using Alone: Perspectives of People Who Use Drugs in Rural and Semi-Urban Areas of British Columbia.

Background: A significant rise in the rate of overdose deaths in British Columbia (BC), driven by fentanyl contamination of the illicit drug supply, led to the declaration of a public health emergency in 2016. Those at greatest risk of death are people who use alone. This community-based participatory action research study based in the Fraser East region of BC study aimed to overview underlying factors that contribute to unwitnessed overdoses in semi-urban and rural settings. Methods: This descriptive study used a community-based participatory action research model with peer research associates (PRAs) involved at various research stages. In total, 22 interviews were conducted with participants aged 19 and over who used illicit drugs in the Fraser East since the start of the public health emergency in 2016. A collaborative data analysis approach was taken for data interpretation, and content analysis was performed to explore themes surrounding using alone. Results: Among people who use drugs (PWUD), using alone was found to be influenced by (a) the availability of drugs and personal funds, (b) personal safety, (c) stigma and shame, (d) protecting privacy, (e) mental health conditions and addiction, and (f) the lack of engagement with harm reduction services. At times, using alone was due to unforeseen, episode-specific situations. Conclusion: A multi-dimentional and context-specific approach is needed in overdose prevention and response for people who use drugs alone. There is need for enhanced approaches that address or include support services for families to reduce stigma and isolation of those at risk of an overdose.

Scoping review of stepped care interventions for mental health and substance use service delivery to youth and young adults.

AIMS: Many young people with mental health and/or substance use concerns do not have access to timely, appropriate, and effective services. Within this context, stepped care models (SCMs) have emerged as a guiding framework for care delivery, inspiring service innovations across the globe. However, substantial gaps remain in the evidence for SCMs as a strategy to address the current systemic challenges in delivering services for young people. This scoping review aims to identify where these gaps in evidence exist, and the next steps for addressing them. METHODS: A scoping review was conducted involving both peer-reviewed and grey literature. Eligible studies explored SCMs implemented in the various health care settings accessed by young people aged 12-24 seeking treatment for mental health and substance use challenges. After screening titles and abstracts, two reviewers examined full-text articles and extracted data to create a descriptive summary of the models. RESULTS: Of the 656 studies that were retrieved, 51 studies were included and grouped by study team for a final yield of 43 studies. Almost half of the studies were focused on the adult population (i.e., 18 and over), and most did not specify interventions for young people. Among the SCMs, substantial variability was found in almost every aspect of the models. CONCLUSIONS: Considering the current body of evidence, there is an urgent need for a consensus position on the definition, implementation, and outcome measures required for rigorously assessing the utility of SCMs for young people.

Substance use and overdose risk: documenting the perspectives of formerly incarcerated persons in the Fraser East region of BC.

BACKGROUND: The relationship between incarceration and risk of overdose has been well-documented in the literature, but few studies document the perspectives of persons at risk of overdose who were incarcerated. This sub-inquiry aimed to understand the experiences of persons with a history of substance use and incarceration in the Fraser East region of BC and how involvement with the criminal justice system affected their drug use and perceived risk of overdose. METHODS: The Fraser East Overdose Response project utilized a community-based participatory action approach that included peer researchers with lived experience in all parts of the research process. This qualitative pilot study aimed to better understand individuals at risk of an unwitnessed overdose in order to prevent deaths and identify effective local responses. A snowball sampling technique was used to recruit persons aged 19 and over who used illicit drugs over the past 3 years in the Fraser East since 2016. In total, 22 participants were interviewed. Of these, 13 participants identified a history of incarceration. Interviews were analyzed using a framework analysis approach. RESULTS: The perspectives that participants shared revealed that impacts from incarceration are influenced by policies but also highly individualized. Our inquiry found three broader themes, within which were situated differing and sometimes conflicting interpretations and experiences of systemic environments: (1) incarceration was associated with harms and was perceived to increase risk of overdose following release, (2) incarceration was perceived to have limited impact on substance use and overdose risk, and (3) incarceration was associated with a perceived reduction of substance use and overdose risk. CONCLUSIONS: Understanding the complexities of the perceptions of those with lived experience of substance use and incarceration is of importance to better inform interventions in this population. The existing knowledge base urgently requires further inquiry into the intersections between qualitative perspectives, environments and policies, and quantitative outcomes of overdose vís-a-vís correctional institution.

Building capacity for implementation-the KT Challenge.

BACKGROUND: The KT Challenge program supports health care professionals to effectively implement evidence-based practices. Unlike other knowledge translation (KT) programs, this program is grounded in capacity building, focuses on health care professionals (HCPs), and uses a multi-component intervention. This study presents the evaluation of the KT Challenge program to assess the impact on uptake, KT capacity, and practice change. METHODS: The evaluation used a mixed-methods retrospective pre-post design involving surveys and review of documents such as teams' final reports. Online surveys collecting both quantitative and qualitative data were deployed at four time points (after both workshops, 6 months into implementation, and at the end of the 2-year funded projects) to measure KT capacity (knowledge, skills, and confidence) and impact on practice change. Qualitative data was analyzed using a general inductive approach and quantitative data was analyzed using non-parametric statistics. RESULTS: Participants reported statistically significant increases in knowledge and confidence across both workshops, at the 6-month mark of their projects, and at the end of their projects. In addition, at the 6-month check-in, practitioners reported statistically significant improvements in their ability to implement practice changes. In the first cohort of the program, of the teams who were able to complete their projects, half were able to show demonstrable practice changes. CONCLUSIONS: The KT Challenge was successful in improving the capacity of HCPs to implement evidence-based practice changes and has begun to show demonstrable improvements in a number of practice areas. The program is relevant to a variety of HCPs working in diverse practice settings and is relatively inexpensive to implement. Like all practice improvement programs in health care settings, a number of challenges emerged stemming from the high turnover of staff and the limited capacity of some practitioners to take on anything beyond direct patient care. Efforts to address these challenges have been added to subsequent cohorts of the program and ongoing evaluation will examine if they are successful. The KT Challenge program has continued to garner great interest among practitioners, even in the midst of dealing with the COVID-19 pandemic, and shows promise for organizations looking for better ways to mobilize knowledge to improve patient care and empower staff. This study contributes to the implementation science literature by providing a description and evaluation of a new model for embedding KT practice skills in health care settings.

Cross-sectional survey on physician burnout during the COVID-19 pandemic in Vancouver, Canada: the role of gender, ethnicity and sexual orientation.

OBJECTIVE: To determine the prevalence of physician burnout during the pandemic and differences by gender, ethnicity or sexual orientation. DESIGN, SETTING AND PARTICIPANTS: We conducted a cross-sectional survey (August-October in 2020) of internal medicine physicians at two academic hospitals in Vancouver, Canada. PRIMARY AND SECONDARY OUTCOMES: Physician burnout and its components, emotional exhaustion, depersonalisation and personal accomplishment were measured using the Maslach Burnout Inventory. RESULTS: The response rate was 38% (n=302/803 respondents, 49% women,). The prevalence of burnout was 68% (emotional exhaustion 63%, depersonalisation 39%) and feeling low personal accomplishment 22%. In addition, 21% reported that they were considering quitting the profession or had quit a position. Women were more likely to report emotional exhaustion (OR 2.00, 95% CI: 1.07 to 3.73, p=0.03) and feeling low personal accomplishment (OR 2.26, 95% CI: 1.09 to 4.70, p=0.03) than men. Visible ethnic minority physicians were more likely to report feeling lower personal accomplishment than white physicians (OR 1.81, 95% CI: 1.28 to 2.55, p=0.001). There was no difference in emotional exhaustion or depersonalisation by ethnicity or sexual orientation. Physicians who reported that COVID-19 affected their burnout were more likely to report any burnout (OR: 3.74, 95% CI: 1.99 to 7.01, p<0.001) and consideration of quitting or quit (OR: 3.20, 95% CI: 1.34 to 7.66, p=0.009). CONCLUSION: Burnout affects 2 out of 3 internal medicine physicians during the pandemic. Women, ethnic minority physicians and those who feel that COVID-19 affects burnout were more likely to report components of burnout. Further understanding of factors driving feelings of low personal accomplishment in women and ethnic minority physicians is needed.

Distributive Leadership Within an Emerging Network of Integrated Youth Health Centres: A Case Study of Foundry.

BACKGROUND: Distributive leadership has been proposed as an effective means towards achieving integrated health services. This study draws from the case of Foundry, a network of integrated youth health centres in British Columbia, Canada, and explores the function and impact of distributive leadership in the context of a large-scale effort towards integrated service delivery for youth experiencing mental health and substance use challenges. METHODS: Qualitative data was obtained from a developmental evaluation of Foundry using a longitudinal, ethnographic approach. Over 150 participants involved in the development of six Foundry centres were interviewed individually or in focus groups. Purposive and theoretical sampling strategies were used to maximize the diversity of perspectives represented in the data set. RESULTS AND DISCUSSION: Distributive leadership was observed to be a facilitator for achieving service and system-level integration. Distributive leadership was effective in promoting streamlined service provision, and coordinating efforts towards optimized access to care. A new culture of leadership emerged through collaboration and relationship-building based on a common value system to prioritize youth needs. CONCLUSION: As Foundry, and other integrated youth services, continues to expand, distributive leadership shows promise in assuring diverse and coordinated input for integrating services.

A rapid review of home-based activities that can promote mental wellness during the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, public health measures such as isolation, quarantine, and social distancing are needed. Some of these measures can adversely affect mental health. Activities that can be performed at home may mitigate these consequences and improve overall mental well-being. In this study, home-based activities that have potential beneficial effects on mental health were examined. METHODS: A rapid review was conducted based on a search of the following databases: MEDLINE, EMBASE, CINAHL, PyscINFO, Global Health, epistemonikos.org, covid19reviews.org, and eppi.ioe.ac.uk/covid19_map_v13.html. Eligible studies include randomized controlled trials and non-randomized studies published between 1/1/2000 and 28/05/2020 and that examined the impact of various activities on mental health outcomes in low-resource settings and contexts that lead to social isolation. Studies of activities that require mental health professionals or that could not be done at home were excluded. Two review authors performed title/abstract screening. At the full-text review stage, 25% of the potentially eligible studies were reviewed in full by two review authors; the rest were reviewed by one review author. Risk of bias assessment and data extraction were performed by one review author and checked by a second review author. The main outcome assessed was change or differences in mental health as expressed in Cohen's d; analysis was conducted following the synthesis without meta-analysis guidelines (SWiM). PROSPERO registration: CRD42020186082. RESULTS: Of 1,236 unique records identified, 160 were reviewed in full, resulting in 16 included studies. The included studies reported on the beneficial effects of exercise, yoga, progressive muscle relaxation, and listening to relaxing music. One study reported on the association between solitary religious activities and post traumatic stress disorder symptoms. While most of the included studies examined activities in group settings, particularly among individuals in prisons, the activities were described as something that can be performed at home and alone. All included studies were assessed to be at risk of bias in one or more of the bias domains examined. CONCLUSIONS: There is some evidence that certain home-based activities can promote mental wellness during the COVID-19 pandemic. Guidelines are needed to help optimize benefits while minimizing potential risks when performing these activities.

Understanding the mental health and recovery needs of Canadian youth with mental health disorders: a Strategy for Patient-Oriented Research (SPOR) collaboration protocol.

BACKGROUND: While considerable progress is being made to understand the health and self-management needs of youth with mental health disorders, little attention has focused on the mental health and recovery needs that the youth themselves identify-this despite a national priority to incorporate patient-oriented research into the development and assessment of mental health services. To address this gap, estimates of the extent to which existing patient-reported outcome measures (PROMs)-originally developed for use amongst adult populations-are clinically meaningful and psychometrically fit for use among youth are needed. In tandem, a recovery profile for youth can be constructed incorporating the youth perspective of the services provided within a community mental health setting. METHODS/DESIGN: This study will utilize a mixed methods design incorporating qualitative focus group interviews and cross-sectional survey. Our process will begin with the hiring of a youth peer research partner who will provide lived experience expertise through all phases of the study. We will advertise, recruit, and conduct four focus groups with youth who receive services from the Foundry Vancouver Granville located in British Columbia, Canada. In the first two focus groups, we will recruit youth aged 15-18 years (n = 10). In the second two focus groups, we will recruit young adults aged 19-24 years (n = 10). In parallel, we will conduct a cross-sectional survey of the recovery and mental health needs of youth, informed by ten widely used and validated PROM. Thematic analysis techniques will guide the identification of predominant thematic trends in the qualitative focus group data. We will use Classical and Rasch measurement methods to test and analyze the reliability and validity of selected PROM measures for youth populations. DISCUSSION: The proposed study has the potential to produce a preliminary conceptual and measurement model for understanding the mental health and recovery needs of youth with mental health disorders. This evidence will inform how youth mental health services can grow, support, and sustain the capacity for a collaborative, interdisciplinary and innovative patient-oriented research environment. Findings will also contribute much needed evidence to improve the standard of care for youth who experience mental health disorders in Canada and beyond.

Ethical Challenges in Contemporary FASD Research and Practice.

Fetal alcohol spectrum disorder (FASD) is increasingly recognized as a growing public health issue worldwide. Although more research is needed on both the diagnosis and treatment of FASD, and a broader and more culturally diverse range of services are needed to support those who suffer from FASD and their families, both research and practice for FASD raise significant ethical issues. In response, from the point of view of both research and clinical neuroethics, we provide a framework that emphasizes the need to maximize benefits and minimize harm, promote justice, and foster respect for persons within a global context.

Incidence and prevalence of fetal alcohol spectrum disorder by sex and age group in Alberta, Canada.

OBJECTIVES: To estimate incidence and prevalence of FASD by sex and age in Alberta, Canada. METHODS: We included all patients recorded in the Alberta provincial health databases of inpatients, outpatients, and practitioner claims from 2003 to 2012. The number of people with FASD were calculated from available data on FAS (ICD-9 code 760.71; ICD-10 codes Q86.0 and P04.3) and estimated prevalence of FASD among individuals diagnosed with 21 FASD-related conditions (identified by a literature review) for which there are ICD codes, such as learning disability, mental retardation, and nervous system defects (Table 1). Fractions of FASD-related diagnoses that can be attributed to alcohol use during pregnancy were estimated by a systematic review. The incidence was measured as the number of new cases per 1000 births. The prevalence was measured as the number of cases per 1000 population in 2012. RESULTS: Annually, 739 to 1884 people were born with FASD in Alberta establishing an incidence of 14.2 to 43.8 per 1000 births, depending on the length of follow-up. There were about 46,000 people living with FASD in Alberta 2012, including 6,000 FAS cases and 40,000 FASD-related cases. The prevalence of FASD was 11.7 (range 8.2 to 15.1) per 1000 population. The incidence and prevalence varied greatly by sex and age group. Generally, male and younger outnumbered female and older. CONCLUSION: This study suggests new incidence and prevalence of FASD, which are higher than what has been commonly used (1%), and its variations among sex and age groups.

Health profiles of clients in substance abuse treatment: a comparison of clients dependent on alcohol or cocaine with those concurrently dependent.

UNLABELLED: The purpose of this study was to assess whether, among clients receiving substance abuse treatment (n = 616), those dependent on alcohol or cocaine differed significantly from those concurrently dependent on both drugs in terms of physical, mental, social, and economic harms as well as substance use behaviors. METHODS: Clients from five substance abuse treatment agencies presenting with a primary problem of cocaine or alcohol were classified into three groups as dependent on: (1) alcohol alone, (2) cocaine alone, or (3) both cocaine and alcohol (i.e. concurrent dependence). Participants completed a self-administered questionnaire that included details of their drug and alcohol use, physical health, mental health, social health, economic health, and demographic characteristics. RESULTS: The concurrent group drank similar amounts of alcohol as those in the alcohol group and used similar amounts of cocaine as the cocaine group. The alcohol group had significantly (p < .05) poorer health profiles than the concurrent group across most variables of the four health domains. An exception was significantly more accidental injuries (p < .05) in the alcohol group. In both bivariate and multivariate analyses, the concurrent group had significantly (p < .05) more accidental injuries, violence, and overdoses than the cocaine group. As well, the concurrent group had significantly (p < .05) higher scores on the anxiety and sexual compulsion scales than the cocaine group, controlling for demographic variables. CONCLUSION: These findings can aid health care professionals to better respond to issues related to concurrent dependence of cocaine and alcohol.

Developing effective, culturally appropriate avenues to FASD diagnosis and prevention in northern Canada.

This article describes 2 research initiatives that are being undertaken by members of the Canada Northwest FASD Research Network, involving collaborations between researchers, clinicians, service providers and community members in the Canadian North. Improving both the diagnosis and prevention of FASD requires evidence-based approaches to clinical and social service delivery that are capable of accounting for the unique contours of the geographic, regional and cultural diversities in which women become pregnant and in which families live. Although FASD has been a priority for communities and governments in northern Canada, research capacity has not been available to support the development of the context-specific knowledge needed to inform policy and practice in this region. Moreover, there have not been adequate mechanisms for transferring practice-based knowledge from the Canadian North to researchers and service providers in the South, who might make use of this knowledge to inform their own practice. Herein, we highlight the ways in which reciprocal knowledge exchange involving CanFASD Northwest researchers at academic health science centres and diverse stakeholder groups is supporting multi-directional capacity building in FASD diagnosis and prevention.