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1.
BMJ ; 368: m772, 2020 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-32234712

RESUMO

OBJECTIVE: To compare the risk of mortality among people with opioid use disorder on and off opioid agonist treatment (OAT) in a setting with a high prevalence of illicitly manufactured fentanyl and other potent synthetic opioids in the illicit drug supply. DESIGN: Population based retrospective cohort study. SETTING: Individual level linkage of five health administrative datasets capturing drug dispensations, hospital admissions, physician billing records, ambulatory care reports, and deaths in British Columbia, Canada. PARTICIPANTS: 55 347 people with opioid use disorder who received OAT between 1 January 1996 and 30 September 2018. MAIN OUTCOME MEASURES: All cause and cause specific crude mortality rates (per 1000 person years) to determine absolute risk of mortality and all cause age and sex standardised mortality ratios to determine relative risk of mortality compared with the general population. Mortality risk was calculated according to treatment status (on OAT, off OAT), time since starting and stopping treatment (1, 2, 3-4, 5-12, >12 weeks), and medication type (methadone, buprenorphine/naloxone). Adjusted risk ratios compared the relative risk of mortality on and off OAT over time as fentanyl became more prevalent in the illicit drug supply. RESULTS: 7030 (12.7%) of 55 347 OAT recipients died during follow-up. The all cause standardised mortality ratio was substantially lower on OAT (4.6, 95% confidence interval 4.4 to 4.8) than off OAT (9.7, 9.5 to 10.0). In a period of increasing prevalence of fentanyl, the relative risk of mortality off OAT was 2.1 (95% confidence interval 1.8 to 2.4) times higher than on OAT before the introduction of fentanyl, increasing to 3.4 (2.8 to 4.3) at the end of the study period (65% increase in relative risk). CONCLUSIONS: Retention on OAT is associated with substantial reductions in the risk of mortality for people with opioid use disorder. The protective effect of OAT on mortality increased as fentanyl and other synthetic opioids became common in the illicit drug supply, whereas the risk of mortality remained high off OAT. As fentanyl becomes more widespread globally, these findings highlight the importance of interventions that improve retention on opioid agonist treatment and prevent recipients from stopping treatment.


Assuntos
Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/mortalidade , Adolescente , Adulto , Colúmbia Britânica/epidemiologia , Buprenorfina/uso terapêutico , Causas de Morte , Estudos de Coortes , Emergências , Feminino , Fentanila , Humanos , Drogas Ilícitas , Masculino , Metadona/uso terapêutico , Pessoa de Meia-Idade , Mortalidade/tendências , Naloxona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/terapia , Saúde Pública , Estudos Retrospectivos , Medição de Risco , Adulto Jovem
2.
Am J Crit Care ; 29(2): 130-131, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32114626
3.
Accid Anal Prev ; 137: 105439, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32004862

RESUMO

Zonal characteristics (e.g. built environment, network configuration, socio-demographics, and land use) have been shown to affect biking attractiveness and safety. However, previously developed bikeability indices do not account for cyclist-vehicle crash risk. This study aims to develop a comprehensive zone-based index to represent both biking attractiveness and cyclist crash risk. The developed Bike Composite Index (BCI) consists of two sub-indices representing bike attractiveness and bike safety, which are estimated using Bike Kilometers Travelled (BKT) and cyclist-vehicle crash data from 134 traffic analysis zones (TAZ) in the City of Vancouver, Canada. The Bike Attractiveness Index is calculated from five factors: bike network density, centrality, and weighted slope as well as land use mix and recreational density. The Bike Safety Index is calculated from bike network coverage, continuity, and complexity as well as signal density and recreational density. The correlation between the Bike Attractiveness Index and the Bike Safety Index in Vancouver is low (r = 0.11), supporting the need to account for both biking attractiveness and safety in the composite index.


Assuntos
Acidentes de Trânsito/prevenção & controle , Ciclismo , Ambiente Construído/normas , Colúmbia Britânica , Cidades , Humanos , Medição de Risco , Segurança , Viagem
4.
Can Assoc Radiol J ; 71(1): 83-91, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32062993

RESUMO

PURPOSE: Magnetic resonance imaging (MRI) is not beneficial in patients with joint pain and concomitant osteoarthritis (OA). We attempt to determine whether evaluation of OA via X-rays can reduce inappropriate MRI and computed tomography (CT) arthrogram use. In our jurisdiction, CT arthrograms are used as surrogate tests because of MRI wait times. MATERIALS AND METHODS: Our intervention required patients ≥55 years of age scheduled for outpatient MRI of the knee/hip/shoulder at an urban hospital to have X-rays (weight bearing when appropriate) from within 1 year. Red flags (ie, neoplasm, infection) were identified for which MRI would be indicated regardless. Through review of radiographs on picture archiving and communication system/digital media and use of the validated Kellgren-Lawrence (KL) OA scale, radiologists assessed the presence and degree of OA. A finding of significant OA (KL > 2) without red flags would preclude MRI. Monthly averages of MRI and CT arthrogram examinations were measured 33 months before and 23 months following introduction of the intervention. RESULTS: The proportion of protocoled MRI requisitions that were avoided was 21%. If extrapolated to the province of British Columbia, 2419 of 11 700 examinations could have been prevented in the past year. The average monthly number of knee/hip/shoulder MRI examinations as a percentage of total MRI examinations decreased from 4.9% to 4.3% (P < .02) following the intervention. The average monthly number of knee/hip/shoulder CT arthrogram examinations decreased from 20.6 to 12.1 (P < .0001). CONCLUSION: We were able to decrease the number of MRI and CT arthrogram examinations in patients ≥55 years of age with joint pain by implementing an evaluation for OA via recent X-ray imaging.


Assuntos
Artralgia/diagnóstico por imagem , Imagem por Ressonância Magnética/estatística & dados numéricos , Osteoartrite/diagnóstico por imagem , Idoso , Artrografia , Colúmbia Britânica , Tomada de Decisões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Listas de Espera
5.
Can Assoc Radiol J ; 71(1): 110-116, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32063000

RESUMO

AIM: To decrease the number of mobile chest radiograph requests for inpatients in British Columbia who are medically able to tolerate transport to the main department by introducing and implementing request criteria. METHOD: Concerns regarding inappropriate mobile exam requests in patients receiving chest radiography were surveyed at 28 medical imaging sites. In response, a multidisciplinary team composed a set of mobile radiography request guidelines incorporating feedback from all sites. These were successfully implemented along with in-person education to 21 sites. The number of adult annual mobile chest radiographs was tracked from 2014 to 2018, and informal feedback was obtained from participating sites. RESULTS: The percentage of mobile chest radiographs of all chest radiographs performed between 2014 and 2018 decreased by 3.2%, while the total number of all chest radiographs performed during this time, including both departmental and mobile, increased by 1.9%. Sites reported positive engagement with the initiative and expressed need for ongoing education to optimize its effect. CONCLUSION: Implementation of request guidelines with in-person education helped to reduce inappropriate mobile exams in patients receiving chest radiographs in British Columbia between 2014 and 2018. These guidelines promote patient safety through reduced radiation exposure, empower radiographers to mitigate inappropriate requests, and help to optimize use of limited hospital resources by reducing inappropriate mobile exams where routine departmental exams are more suitable.


Assuntos
Unidades Móveis de Saúde/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Radiografia Torácica/estatística & dados numéricos , Adulto , Colúmbia Britânica , Humanos , Procedimentos Desnecessários
6.
Aquat Toxicol ; 220: 105383, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31924587

RESUMO

Current and proposed transcontinental pipelines for the transport of diluted bitumen (dilbit) from the Canadian oil sands traverse the coastal watersheds of British Columbia, habitat essential to Pacific salmonids. To determine the potential risks posed to these keystone species, juvenile sockeye (Oncorhynchus nerka; 1+ parr) were acutely (24-96 h) or subchronically (21-42 d) exposed to 4 concentrations of the water-soluble fraction (WSF) of unweathered Cold Lake Blend dilbit (initial total PAC concentrations: 0, 13.7, 34.7 and 124.5 µg/L) in a flow-through system. Dilbit effects on iono-osmoregulation, the physiological stress response, and the immune system were assessed by both biochemical and functional assays. Hydrocarbon bioavailability was evidenced by a significant induction of liver ethoxyresorufin-O-deethylase (EROD) activity in exposed fish. Acute and subchronic exposure significantly reduced gill Na+-K+-ATPase activity and resulted in lower plasma osmolality, Cl-, and Na+ concentrations. Acute exposure to dilbit resulted in a classic physiological stress response, however at 21 d of exposure, plasma cortisol remained elevated while other measured parameters had returned to baseline values. A compromised immune system was demonstrated by a 29.5 % higher mortality in fish challenged with Vibrio (Listonella) anguillarum following dilbit exposure compared to unexposed controls. Exposure of juvenile salmonids to the WSF of dilbit (at TPAC concentrations at the ppb level) resulted in sublethal effects that included a classic physiological stress response, and alterations in iono-osmoregulatory homeostasis and immunological performance.


Assuntos
Citocromo P-450 CYP1A1/metabolismo , Hidrocarbonetos/toxicidade , Fígado/efeitos dos fármacos , Campos de Petróleo e Gás , Salmão/metabolismo , Poluentes Químicos da Água/toxicidade , Animais , Colúmbia Britânica , Relação Dose-Resposta a Droga , Ecossistema , Hidrocarbonetos/química , Fígado/enzimologia , Salmão/crescimento & desenvolvimento , Solubilidade , Poluentes Químicos da Água/química
7.
Environ Pollut ; 259: 113842, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31926389

RESUMO

Assessing the fate of both legacy and newer persistent organic pollutants (POPs) is an ongoing challenge. Top predators, including seabirds, are effective monitors of POPs because they forage over a range of marine habitats, integrating signals over space and time. However, migration patterns can make unravelling contaminant sources, and potentially assessments of the effectiveness of regulations, challenging if chemicals are acquired at distant sites. In 2014, we fitted geolocators on ancient murrelets (Synthliboramphus antiqueus) at four colonies on the Pacific Coast of Canada to obtain movement data throughout an annual cycle. All birds underwent a post-breeding moult in the Bering Sea. Around one-third then returned to overwinter on the British Columbia (BC) coast while the rest migrated to overwinter in waters along the north Asian coast. Such a stark difference in migration destination provided an opportunity to examine the influence of wintering location on contaminant signals. In summer 2015, we collected blood samples from returned geo-tagged birds and analyzed them for a suite of contaminants, including polybrominated diphenyl ethers (PBDEs), non-PBDE halogenated flame retardants, perfluoroalkyl substances (PFASs), organochlorines, and mercury. Feathers were also collected and analyzed for stable isotopes (δ13C, δ15N, and δ34S). We found no significant differences in blood concentrations of any contaminant between murrelets from the two different overwinter areas, a result that indicates relatively rapid clearance of POPs accumulated during winter. Spatial variation in diet (i.e., δ13C) was associated with both BDE-47 and -99 concentrations. However, individual variation in trophic level had little influence on concentrations of any other examined contaminants. Thus, blood from these murrelets is a good indicator of recent, local contaminants, as most signals appear independent of overwintering location.


Assuntos
Distribuição Animal , Exposição Ambiental , Poluentes Ambientais , Animais , Aves , Cruzamento , Colúmbia Britânica , Monitoramento Ambiental , Poluentes Ambientais/sangue , Poluentes Ambientais/metabolismo , Oceano Pacífico , Estações do Ano
9.
Dis Aquat Organ ; 137(2): 159-165, 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31942861

RESUMO

Tracking and understanding variation in pathogens such as Batrachochytrium dendrobatidis (Bd), the agent of amphibian chytridiomycosis which has caused population declines globally, is a priority for many land managers. However, relatively little sampling of amphibian communities has occurred at high latitudes. We used skin swabs collected during 2005-2017 from boreal toads Anaxyrus boreas (n = 248), in southeast Alaska (USA; primarily in and near Klondike Gold Rush National Historical Park [KLGO]) and northwest British Columbia (Canada) to determine how Bd prevalence varied across life stages, habitat characteristics, local species richness, and time. Across all years, Bd prevalence peaked in June and was >3 times greater for adult toads (37.5%) vs. juveniles and metamorphs (11.2%). Bd prevalence for toads in the KLGO area, where other amphibian species are rare or absent, was highest from river habitats (55.0%), followed by human-modified upland wetlands (32.3%) and natural upland wetlands (12.7%)-the same rank-order these habitats are used for toad breeding. None of the 12 Columbia spotted frogs Rana luteiventris or 2 wood frogs R. sylvatica from the study area tested Bd-positive, although all were from an area of low host density where Bd has not been detected. Prevalence of Bd on toads in the KLGO area decreased during 2005-2015. This trend from a largely single-species system may be encouraging or concerning, depending on how Bd is affecting vital rates, and emphasizes the need to understand effects of pathogens before translating disease prevalence into management actions.


Assuntos
Quitridiomicetos , Alaska , Animais , Colúmbia Britânica , Ecossistema , Prevalência
10.
PLoS One ; 15(1): e0227216, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31914156

RESUMO

OBJECTIVES: Mifepristone was approved for use in medical abortion by Health Canada in 2015. Approval was accompanied by regulations that prohibited pharmacist dispensing of the medication. Reproductive health advocates in Canada recognized this regulation would limit access to medical abortion and successfully worked to have this regulation removed in 2017. The purpose of this study was to assess the leadership involved in changing these regulations so that the success may be replicated by other groups advocating for health policy change. METHODS: This study involved a mixed methods instrumental design in the context of British Columbia, Canada. Our data collection included: a) interviews with seven key individuals, representing the organizations that worked in concert for change to Canadian mifepristone regulations, and b) document analysis of press articles, correspondence, briefing notes, and meeting minutes. We conducted a thematic analysis of transcripts of audio-recorded interviews. We identified strengths and weaknesses of the team dynamic using the Develop Coalitions, Achieve Results and Systems Transformation domains of the LEADS Framework. RESULTS: Our analysis of participant interviews indicates that autonomy, shared values, and clarity in communication were integral to the success of the group's work. Analysis using the LEADS Framework showed that individuals possessed many of the capabilities identified as being necessary for successful health policy leadership. A lack of post-project assessment was identified as a possible limitation and could be incorporated in future work to strengthen dynamics especially when a desired outcome is not achieved. Document analysis provided a clear time-line of the work completed and suggested that strong communication between team members was another key to success. CONCLUSIONS: The results of our analysis of the interviews and documents provide valuable insight into the workings of a successful group committed to a common goal. The existing collegial and trusting relationships between key stakeholders allowed for interdisciplinary collaboration, rapid mobilization, and identification of issues that facilitated successful Canadian global-first deregulation of mifepristone dispensing.


Assuntos
Abortivos Esteroides , Aborto Induzido , Mifepristona , Abortivos Esteroides/provisão & distribução , Aborto Induzido/legislação & jurisprudência , Colúmbia Britânica , Aprovação de Drogas/legislação & jurisprudência , Feminino , Política de Saúde , Humanos , Liderança , Mifepristona/provisão & distribução , Gravidez , Saúde Reprodutiva/legislação & jurisprudência
11.
PLoS One ; 15(1): e0227502, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31999705

RESUMO

Effective management of marine systems requires quantitative tools that can assess the state of the marine social-ecological system and are responsive to management actions and pressures. We applied the Ocean Health Index (OHI) framework to retrospectively assess ocean health in British Columbia annually from 2001 to 2016 for eight goals that represent the values of British Columbia's coastal communities. We found overall ocean health improved over the study period, from 75 (out of 100) in 2001 to 83 in 2016, with scores for inhabited regions ranging from 68 (North Coast, 2002) to 87 (West Vancouver Island, 2011). Highest-scoring goals were Tourism & Recreation (average 94 over the period) and Habitat Services (100); lowest-scoring goals were Sense of Place (61) and Food Provision (64). Significant increases in scores over the time period occurred for Food Provision (+1.7 per year), Sense of Place (+1.4 per year), and Coastal Livelihoods (+0.6 per year), while Habitat Services (-0.01 per year) and Biodiversity (-0.09 per year) showed modest but statistically significant declines. From the results of our time-series analysis, we used the OHI framework to evaluate impacts of a range of management actions. Despite challenges in data availability, we found evidence for the ability of management to reduce pressures on several goals, suggesting the potential of OHI as a tool for assessing the effectiveness of marine resource management to improve ocean health. Our OHI assessment provides an important comprehensive evaluation of ocean health in British Columbia, and our open and transparent process highlights opportunities for improving accessibility of social and ecological data to inform future assessment and management of ocean health.


Assuntos
Monitoramento Ambiental/estatística & dados numéricos , Oceanos e Mares , Colúmbia Britânica , Conservação dos Recursos Naturais
12.
Int J Cancer ; 146(7): 1810-1818, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31245842

RESUMO

HPV FOCAL is a randomized control trial of cervical cancer screening. The intervention arm received baseline screening for high-risk human papillomavirus (HPV) and the control arm received liquid-based cytology (LBC) at baseline and 24 months. Both arms received 48-month exit HPV and LBC cotesting. Exit results are presented for per-protocol eligible (PPE) screened women. Participants were PPE at exit if they had completed all screening and recommended follow-up and had not been diagnosed with cervical intraepithelial neoplasia Grade 2 or worse (CIN2+) earlier in the trial. Subgroups were identified based upon results at earlier trial screening. There were 9,457 and 9,552 and women aged 25-65 randomized to control and intervention and 7,448 (77.8%) and 8,281 (86.7%), respectively, were PPE and screened. Exit cotest results were similar (p = 0.11) by arm for PPE and the relative rate (RR) of CIN2+ for intervention vs. control was RR = 0.83 (95% CI: 0.56-1.23). The RR for CIN2+ comparing intervention women baseline HPV negative to control women with negative cytology at baseline and at 24 months, was 0.68 (95% CI: 0.43-1.06). PPE women who had a negative or CIN1 colposcopy in earlier rounds had elevated rates (per 1,000) of CIN2+ at exit, control 31 (95% CI: 14-65) and intervention 43 (95% CI: 25-73). Among PPE women HPV negative at exit LBC cotesting identified little CIN2+, Rate = 0.3 (95% CI: 0.1-0.7). This per-protocol analysis found that screening with HPV using a 4-year interval is as safe as LBC with a 2-year screening interval. LBC screening in HPV negative women at exit identified few additional lesions.


Assuntos
Papillomaviridae , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/virologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/etiologia , Adulto , Idoso , Colúmbia Britânica/epidemiologia , Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/etiologia , DNA Viral , Feminino , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Infecções por Papillomavirus/diagnóstico , Vigilância em Saúde Pública , Neoplasias do Colo do Útero/diagnóstico
13.
J Dairy Sci ; 103(1): 702-713, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31629510

RESUMO

Little is known about the combination of factors that motivate changes in calf management on dairy farms. Providing information to farmers may help promote change, but it is unclear how this approach affects and is affected by the farmer's relationship with the advisors such as the herd veterinarian. The goal of this study was to understand how benchmarking measures related to calf immune development and growth affected farmer and veterinarian cooperation and influenced the farmer's view of the veterinarian as an advisor for calf management. Veterinarians provided their clients (n = 18 dairy farms in the lower Fraser Valley of British Columbia) with 2 benchmark reports providing information on transfer of passive immunity and calf growth. Farmers were interviewed before and after receiving these reports to understand how they perceived their veterinarian as a calf advisor. Qualitative analysis identified 2 major themes indicating that benchmarking (1) improved farmer perception of their veterinarian's capacities to advise on calves and (2) strengthened the social influence of the veterinarian. We conclude that benchmarking can help promote stronger relationships between farmers and veterinarians.


Assuntos
Bem-Estar do Animal , Benchmarking , Bovinos/fisiologia , Indústria de Laticínios/métodos , Fazendeiros , Médicos Veterinários , Criação de Animais Domésticos/métodos , Criação de Animais Domésticos/normas , Animais , Colúmbia Britânica , Feminino , Humanos
14.
J Dairy Sci ; 103(1): 638-648, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31677832

RESUMO

The reliability of locomotion scoring is often low, making it unclear how a single gait score should be interpreted. In addition, differences in assessment frequency between longitudinal studies makes it hard to compare results. Our aims were to evaluate how lameness definition and assessment frequency affect measures of lameness incidence. Six dairy farms in British Columbia, Canada, were enrolled, and 262 cows that were sound at dry-off had their locomotion score (LS) assessed weekly from dry-off to calving, using a 1 to 5 scale. Cows were categorized as remaining sound or becoming lame using 3 different case definitions (LAME1: ≥LS3 at least once; LAME2: ≥2 consecutive scores of LS3, or ≥LS4 at least once; and LAME3: ≥3 consecutive scores of LS3, or ≥LS4 at least once). We analyzed the correspondence between the 3 definitions with percent agreement and weighted κ (linear and quadratic weighting). Comparing LAME1 to LAME3 resulted in lower percent agreement (53%) and κ values (linear κw = 0.50; quadratic κw = 0.64) than comparing LAME2 and LAME3 (85%; linear κw = 0.83; quadratic κw = 0.89), indicating that cows scored LS3 twice were likely to be scored LS3 a third time. We also compared the 3 case definitions against trim records from trimmings occurring 90 d or less before calving (n = 117), and used logistic regression models to determine sensitivity, specificity, and positive and negative predictive value. Using the LAME1 criterion resulted in high sensitivity (horn lesions = 0.90; infectious lesions = 0.92) and low specificity (horn = 0.21; infectious = 0.24). We observed higher specificity for LAME2 (horn = 0.62; infectious = 0.66) and LAME3 (horn = 0.71; infectious = 0.77), but LAME2 had higher sensitivity than LAME3 (horn = 0.89 vs. 0.64; infectious = 0.69 vs. 0.64). When evaluating the effects of assessment frequency, we obtained 3 data sets by keeping every, every other, and every third locomotion assessment, and using LAME2 as a case definition. More cows were categorized as lame when assessment frequency increased. Of the cows that were classified as lame when assessed weekly, 72% of the mildly lame, and 33% of the severely lame were classified as sound when assessed every third week. Our results suggest that a single LS3 score should not be used as a criterion for lameness in longitudinal studies. To correctly identify new cases of lameness, dairy cows should be assessed at least every 2 wk.


Assuntos
Doenças dos Bovinos/epidemiologia , Coxeadura Animal/epidemiologia , Animais , Colúmbia Britânica , Bovinos , Doenças dos Bovinos/classificação , Doenças dos Bovinos/diagnóstico , Feminino , Marcha , Incidência , Coxeadura Animal/classificação , Coxeadura Animal/diagnóstico , Modelos Logísticos , Reprodutibilidade dos Testes
15.
J Dairy Sci ; 103(1): 649-665, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31704020

RESUMO

In this longitudinal study, we tested the hypothesis that cows that are lame around dry-off are at increased risk of transition diseases (TD), including metritis, subclinical ketosis (SCK), retained fetal membranes, hypocalcemia, or displaced abomasum. We also hypothesized that the relationship between lameness and TD would be mediated through reduced feeding time. We enrolled 461 cows at 9 wk before their expected calving date on 6 commercial freestall farms in the lower Fraser Valley, British Columbia, Canada. Cows were gait-scored weekly using a scale of 1 to 5. Lameness status was classified based on consecutive gait scores as lame (2 consecutive gait scores = 3 or 1 score ≥4) or sound (2 consecutive gait scores ≤2). Lameness status was summarized as (1) lameness at dry-off (sound or lame); (2) lameness group (always sound = sound on all visits, chronically lame = lame on all visits, and other = changed from sound to lame or vice versa); and (3) proportion of weeks lame during the dry period. Body condition scores were recorded at dry-off and at calving and collectively used to calculate change in body condition for each cow. A subsample of cows (n = 159) was evaluated for feeding time once a week during the dry period. All cows were evaluated for SCK (positive = ß-hydroxybutyrate ≥1.2 mmol/L) and metritis (positive = foul smell, red/brown watery vaginal discharge) every 3 to 4 d between d 3 and 17 after calving. We retrieved data on treatment of retained fetal membranes, hypocalcemia, and displaced abomasum during the first 17 d after calving, cow parity, and milk production in the previous lactation from farm records. We created a binary variable, TD (any of SCK, metritis, retained fetal membranes, hypocalcemia, or displaced abomasum), to differentiate between healthy cows and cows that developed TD. Lameness at dry-off was associated with the occurrence of metritis and TD, but not with SCK. Cows that were chronically lame and cows that had an increased proportion of weeks lame during the dry period had higher occurrence of metritis and TD. Lameness was also associated with reduced feeding time, which in turn was associated with increased likelihood of SCK and TD, but not with metritis. Lameness was not associated with change in body condition; however, cows that lost body condition score during the dry period had increased odds of developing SCK, metritis, and TD. Change in body condition was highly associated with body condition score at dry-off. These results suggest that association between lameness and TD is partially mediated through reduced feeding time.


Assuntos
Doenças dos Bovinos/etiologia , Comportamento Alimentar , Ácido 3-Hidroxibutírico/sangue , Animais , Colúmbia Britânica , Bovinos , Doenças dos Bovinos/epidemiologia , Indústria de Laticínios , Fazendas , Feminino , Marcha , Nível de Saúde , Cetose/etiologia , Cetose/veterinária , Lactação , Estudos Longitudinais , Paridade , Placenta Retida/veterinária , Gravidez , Fatores de Risco
16.
J Fish Dis ; 43(1): 49-55, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31709554

RESUMO

The opportunistic examination of factors associated with an outbreak of piscirickettsiosis (SRS) is described in Atlantic salmon Salmo salar post-smolts held in an open netpen or in tanks supplied with raw sea water at a research aquarium in western Canada. During the outbreak, seawater temperature was significantly higher and salinity significantly lower in the netpen compared with the tanks. Mortality in the netpen began approximately 3 weeks prior to that in the tanks, and cumulative mortality in the netpen (34%) was significantly higher than in the tanks (12%). Piscirickettsia salmonis was confirmed by qPCR in tissues from moribund and dead fish and from colonies grown on enriched blood agar medium. Neither P. salmonis nor SRS were observed in salmon held concurrently in UV-irradiated sea water. The elevated mortality was curtailed by treatment with oxytetracycline. These observations further indicate warmer, less saline and periodically hypoxic seawater are risk factors for SRS. UV irradiation of sea water is shown to be a tool for SRS management in fish-holding facilities.


Assuntos
Reservatórios de Doenças , Doenças dos Peixes/epidemiologia , Piscirickettsia/isolamento & purificação , Infecções por Piscirickettsiaceae/veterinária , Salmo salar , Salmão , Animais , Animais de Zoológico , Colúmbia Britânica/epidemiologia , Doenças dos Peixes/parasitologia , Incidência , Infecções por Piscirickettsiaceae/epidemiologia , Infecções por Piscirickettsiaceae/parasitologia , Prevalência
17.
Environ Monit Assess ; 192(1): 24, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31823017

RESUMO

Information about forest change patterns from oil and gas (OG) activities could improve our understanding of the land use-land cover change nexus, aid in predicting future forest changes, and prompt the need for more mitigation measures in reducing impacts from the activities. However, little is known about forest change patterns from OG infrastructure development in northeastern British Columbia (BC). In this study, we assess forest change from the impacts of OG infrastructure development using a geospatial approach. The study finds that forest cover was reduced by 0.234% between 1975 and 2017. However, we show that forest cover change (- 0.182%) from OG infrastructure development between 1995 and 2017 was faster compared to that of the two decades before 1995. The faster change, however, coincides with the period of the OG boom in BC. Between time points and locations, we measured a larger amount of forest fragmentation in the land cover for the year and location with larger quantities of human-induced land classes. The differences in the quantity of human-induced land cover types between time points and locations could account for the differences in the amount of fragmentation. Our findings suggest that forest fragmentation is likely to reduce if land managers would make relentless effort to reduce the quantity of anthropogenic-induced land cover classes and increase forest recovery programs in the forest areas.


Assuntos
Monitoramento Ambiental , Florestas , Indústria de Petróleo e Gás , Colúmbia Britânica , Conservação dos Recursos Naturais , Indústria de Petróleo e Gás/tendências , Dinâmica Populacional
18.
Environ Monit Assess ; 192(1): 67, 2019 Dec 26.
Artigo em Inglês | MEDLINE | ID: mdl-31879802

RESUMO

Optical sensing of chlorophyll-a (chl-a), turbidity, and fluorescent dissolved organic matter (fDOM) is often used to characterize the quality of water. There are many site-specific factors and environmental conditions that can affect optically sensed readings; notwithstanding the comparative implication of different procedures used to measure these properties in the laboratory. In this study, we measured these water quality properties using standard laboratory methods, and in the field using optical sensors (sonde-based) at water quality monitoring sites located in four watersheds in Canada. The overall objective of this work was to explore the relationships among sonde-based and standard laboratory measurements of the aforementioned water properties, and evaluate associations among these eco-hydrological properties and land use, environmental, and ancillary water quality variables such as dissolved organic carbon (DOC) and total suspended solids (TSS). Differences among sonde versus laboratory relationships for chl-a suggest such relationships are impacted by laboratory methods and/or site specific conditions. Data mining analysis indicated that interactive site-specific factors predominately impacting chl-a values across sites were specific conductivity and turbidity (variables with positive global associations with chl-a). The overall linear regression predicting DOC from fDOM was relatively strong (R2 = 0.77). However, slope differences in the watershed-specific models suggest laboratory DOC versus fDOM relationships could be impacted by unknown localized water quality properties affecting fDOM readings, and/or the different standard laboratory methods used to estimate DOC. Artificial neural network analyses (ANN) indicated that higher relative chl-a concentrations were associated with low to no tree cover around sample sites and higher daily rainfall in the watersheds examined. Response surfaces derived from ANN indicated that chl-a concentrations were higher where combined agricultural and urban land uses were relatively higher.


Assuntos
Clorofila A/análise , Monitoramento Ambiental/métodos , Substâncias Húmicas/análise , Hidrodinâmica , Rios/química , Qualidade da Água/normas , Agricultura , Colúmbia Britânica , Ecologia , Fluorometria , Ontário , Urbanização
19.
BMC Infect Dis ; 19(1): 1070, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856756

RESUMO

BACKGROUND: Klebsiella species are among the most common causes of bloodstream infection (BSI). However, few studies have evaluated their epidemiology in non-selected populations. The objective was to define the incidence of, risk factors for, and outcomes from Klebsiella species BSI among residents of the western interior of British Columbia, Canada. METHODS: Population-based surveillance was conducted between April 1, 2010 and March 31, 2017. RESULTS: 151 episodes were identified for an incidence of 12.1 per 100,000 population per year; the incidences of K. pneumoniae and K. oxytoca were 9.1 and 2.9 per 100,000 per year, respectively. Overall 24 (16%) were hospital-onset, 90 (60%) were healthcare-associated, and 37 (25%) were community-associated. The median patient age was 71.4 (interquartile range, 58.8-80.9) years and 88 (58%) cases were males. Episodes were uncommon among patients aged < 40 years old and no cases were observed among those aged < 10 years. A number of co-morbid medical illnesses were identified as significant risks and included (incidence rate ratio; 95% confidence interval) cerebrovascular accident (5.9; 3.3-9.9), renal disease 4.3; 2.5-7.0), cancer (3.8; 2.6-5.5), congestive heart failure (3.5; 1.6-6.6), dementia (2.9; 1.5-5.2), diabetes mellitus (2.6; 1.7-3.9), and chronic obstructive pulmonary disease (2.3; 1.5-3.5). Of the 141 (93%) patients admitted to hospital, the median hospital length stay was 8 days (interquartile range, 4-17). The in-hospital and 30-day all cause case-fatality rates were 24/141 (17%) and 27/151 (18%), respectively. CONCLUSIONS: Klebsiella species BSI is associated with a significant burden of illness particularly among those with chronic co-morbid illnesses.


Assuntos
Bacteriemia/epidemiologia , Infecções por Klebsiella/epidemiologia , Klebsiella oxytoca/isolamento & purificação , Klebsiella pneumoniae/isolamento & purificação , Vigilância da População/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/mortalidade , Colúmbia Britânica/epidemiologia , Criança , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Incidência , Infecções por Klebsiella/mortalidade , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
20.
BMC Infect Dis ; 19(1): 982, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752729

RESUMO

BACKGROUND: Hepatitis B (HBV) and Human Immunodeficiency Virus (HIV) share common risk factors for exposure. Co-infected patients have an increased liver-related mortality risk and may have accelerated HIV progression. The epidemiology and demographic characteristics of HIV-HBV co-infection in Canada remain poorly defined. We compared the demographic and clinical characteristics and factors associated with advanced hepatic fibrosis between HIV and HIV-HBV co-infected patients. METHODS: A retrospective cohort analysis was conducted using data from the Canadian Observational Cohort (CANOC) Collaboration, including eight sites from British Columbia, Quebec, and Ontario. Eligible participants were HIV-infected patients who initiated combination ARV between January 1, 2000 and December 14, 2014. Demographic and clinical characteristics were compared between HIV-HBV co-infected and HIV-infected groups using chi-square or Fisher exact tests for categorical variables, and Wilcoxon's Rank Sum test for continuous variables. Liver fibrosis was estimated by the AST to Platelet Ratio Index (APRI). RESULTS: HBV status and APRI values were available for 2419 cohort participants. 199 (8%) were HBV co-infected. Compared to HIV-infected participants, HIV-HBV co-infected participants were more likely to use injection drugs (28% vs. 21%, p = 0.03) and be HCV-positive (31%, vs. 23%, p = 0.02). HIV-HBV co-infected participants had lower baseline CD4 T cell counts (188 cells/mm3, IQR: 120-360) compared to 235 cells/mm3 in HIV-infected participants (IQR: 85-294) (p = 0.0002) and higher baseline median APRI scores (0.50 vs. 0.37, p < 0.0001). This difference in APRI was no longer clinically significant at follow-up (0.32 vs. 0.30, p = 0.03). HIV-HBV co-infected participants had a higher mortality rate compared to HIV-infected participants (11% vs. 7%, p = 0.02). CONCLUSION: The prevalence, demographic and clinical characteristics of the HIV-HBV co-infected population in Canada is described. HIV-HBV co-infected patients have higher mortality, more advanced CD4 T cell depletion, and liver fibrosis that improves in conjunction with ARV therapy. The high prevalence of unknown HBV status demonstrates a need for increased screening among HIV-infected patients in Canada.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Antivirais/administração & dosagem , Coinfecção/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Hepatite B/tratamento farmacológico , Adulto , Colúmbia Britânica/epidemiologia , Coinfecção/epidemiologia , Coinfecção/virologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Hepatite B/epidemiologia , Hepatite B/virologia , Vírus da Hepatite B/efeitos dos fármacos , Vírus da Hepatite B/genética , Vírus da Hepatite B/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Prevalência , Quebeque/epidemiologia , Estudos Retrospectivos , Fatores de Risco
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