Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.216
Filtrar
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.
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
3.
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
4.
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
5.
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
6.
BMC Health Serv Res ; 19(1): 626, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481056

RESUMO

BACKGROUND: Regional variation in medical care costs can indicate heterogeneity in clinical practice, inequities in access, or inefficiencies in service delivery. We aimed to estimate regional variation in medical costs for people living with HIV (PLHIV), adjusting for demographics and case-mix. METHODS: We conducted a retrospective cohort study using linked health administrative databases of PLHIV, from 2010 to 2014, in British Columbia (BC), Canada. Quarterly health care costs (2018 CAD) were derived from inpatient, outpatient, prescription drugs, antiretroviral therapy (ART), and HIV diagnostics. We used a two-part model with a logit link for the probability of incurring costs, and a log link and gamma distribution for observations with positive costs. We also estimated quarterly utilization rates for hospitalization-, physician billing- and prescription drug-days. Primary variables were indicators of individuals' Health Service Delivery Area (HSDA). We adjusted cost and utilization estimates for demographic characteristics, HIV-disease progression, and comorbidities. RESULTS: Our cohort included 9577 PLHIV (median age 45.5 years, 80% male). Adjusted total quarterly costs for all 16 HSDAs were within 20% of the provincial mean, 8/16 for hospitalization costs, 16/16 for physician billing costs and 10/16 for prescription drug costs. Northern Interior and Northeast HSDAs had 38 and 44% lower quarterly non-ART prescription drug costs, and 2 and 5% higher quarterly inpatient costs, respectively. CONCLUSIONS: We observed limited variation in medical care costs and utilization among PLHIV in BC. However, lower levels of outpatient care and higher levels of inpatient care indicate possible barriers to accessing care among PLHIV in the most rural regions of the province.


Assuntos
Fármacos Anti-HIV/economia , Infecções por HIV/economia , Adulto , Assistência Ambulatorial/economia , Fármacos Anti-HIV/uso terapêutico , Colúmbia Britânica/epidemiologia , Estudos de Coortes , Comorbidade , Bases de Dados Factuais , Progressão da Doença , Custos de Medicamentos , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Medicamentos sob Prescrição/uso terapêutico , Características de Residência , Estudos Retrospectivos , Saúde da População Rural
7.
Arthritis Rheumatol ; 71(11): 1835-1843, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31389178

RESUMO

OBJECTIVE: To elucidate the role of nonsteroidal antiinflammatory drugs (NSAIDs) in the increased risk of cardiovascular disease (CVD) among osteoarthritis (OA) patients. METHODS: This longitudinal study was based on linked health administrative data from British Columbia, Canada. From a population-based cohort of 720,055 British Columbians, we selected 7,743 OA patients and 23,229 age- and sex-matched non-OA controls. We used multivariable Cox proportional hazards models to estimate the risk of developing incident CVD (primary outcome) as well as ischemic heart disease, congestive heart failure, and stroke (secondary outcomes). To estimate the mediating effect of NSAIDs, defined as current use of an NSAID according to linked PharmaNet data, in the OA-CVD relationship, we implemented a marginal structural model. RESULTS: OA patients had a higher risk of developing CVD than controls without OA. After adjusting for socioeconomic status, body mass index, hypertension, diabetes, hyperlipidemia, chronic obstructive pulmonary disease, and Romano comorbidity score, the adjusted hazard ratio (HR) was 1.23 (95% confidence interval [95% CI] 1.17-1.28). The adjusted HRs for congestive heart failure, ischemic heart disease, and stroke were 1.42 (95% CI 1.33-1.51), 1.17 (95% CI 1.10-1.26), and 1.14 (95% CI 1.07-1.22), respectively. Approximately 41% of the total effect of OA on increased CVD risk was mediated through NSAIDs. For the secondary outcomes, the proportion mediated through NSAIDs was 23%, 56%, and 64% for congestive heart failure, ischemic heart disease, and stroke, respectively. CONCLUSION: The findings of this first study to evaluate the mediating role of NSAIDs in the relationship between OA and CVD suggest that NSAID use contributes substantially to the OA-CVD association.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Osteoartrite/epidemiologia , Idoso , Colúmbia Britânica/epidemiologia , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Isquemia Miocárdica/epidemiologia , Osteoartrite/tratamento farmacológico , Modelos de Riscos Proporcionais , Acidente Vascular Cerebral/epidemiologia
8.
Int J Pediatr Otorhinolaryngol ; 126: 109610, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31374385

RESUMO

OBJECTIVE: To determine if radiologic imaging is necessary to rule out cholesteatoma in patients with congenital aural atresia. METHODS: A retrospective chart review of patients attending the BC Children's Hospital Microtia Clinic from January 1, 1990 through April 17, 2017 was undertaken. Patients with complete atresia of the external canal were included in the study. Available radiologic imaging and clinical records were examined for the presence or absence of cholesteatoma. RESULTS: Of the 125 charts reviewed, 102 met criteria for inclusion in the study and 79 had three-dimensional imaging completed. None of these 102 patients had radiologic or clinical evidence of cholesteatoma. CONCLUSION: Computed tomography and/or magnetic resonance imaging remains an essential modality in the work-up of selected patients with microtia/atresia. It may be unnecessary in the follow-up of certain patients to rule out a congenital cholesteatoma. This imaging avoidance may reduce exposure to radiation, the potential need for general anaesthesia, and unnecessary financial cost.


Assuntos
Colesteatoma/congênito , Anormalidades Congênitas/epidemiologia , Microtia Congênita/epidemiologia , Orelha/anormalidades , Tomografia Computadorizada por Raios X , Procedimentos Desnecessários , Colúmbia Britânica/epidemiologia , Criança , Pré-Escolar , Colesteatoma/diagnóstico por imagem , Feminino , Hospitais Pediátricos , Humanos , Imageamento Tridimensional , Imagem por Ressonância Magnética , Masculino , Estudos Retrospectivos
9.
Emerg Infect Dis ; 25(9): 1723-1726, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31441746

RESUMO

We compared 2 climate classification systems describing georeferenced environmental Cryptococcus gattii sensu lato isolations occurring during 1989-2016. Each system suggests the fungus was isolated in temperate climates before the 1999 outbreak on Vancouver Island, British Columbia, Canada. However, the Köppen-Geiger system is more precise and should be used to define climates where pathogens are detected.


Assuntos
Clima , Criptococose/epidemiologia , Cryptococcus gattii/isolamento & purificação , Surtos de Doenças , Colúmbia Britânica/epidemiologia , Criptococose/microbiologia , Cryptococcus gattii/classificação , Humanos , Ilhas , Microbiologia do Solo
10.
Cancer Causes Control ; 30(9): 931-941, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31280456

RESUMO

PURPOSE: Improving the understanding of co-existing chronic diseases prior to and after the diagnosis of cancer may help to facilitate therapeutic decision making in clinical practice. This study aims to examine patterns of comorbidities in Canadian women with breast cancer. METHODS: We conducted a retrospective cohort study using provincial linked administrative health datasets from British Columbia, Canada, between 2000 and 2013. Women diagnosed with breast cancer between 2005 and 2009 were identified. The index date was defined as the date of diagnosis of breast cancer. Subsets of the breast cancer cohort were identified based on the absence of individual type of comorbidity of interest within 5 years prior to breast cancer diagnosis. For each subset, cases were then individually matched by year of birth at 1:2 ratios with controls without a history of cancer and the individual type of comorbidity of interest within 5 years prior to the assigned index year, matching with the year of breast cancer diagnosis of the corresponding case. Baseline comorbidities were measured over a 1-year period prior to the index date using two comorbidity indices, Rx-Risk-V and Aggregated Diagnosis Groups (ADG). Cox regression model was used to assess the development of seven specific comorbidities after the index date between women with breast cancer and non-cancer women. RESULTS: The most prevalent baseline comorbidity in the breast cancer cohort measured using the Rx-Risk-V model was cardiovascular conditions (39.0%), followed by pain/pain-inflammation (34.8%). The most prevalent category measured using the ADG model was major signs or symptoms (71.8%), followed by stable chronic medical conditions (52.2%). The risks of developing ischemic heart disease, heart failure, depression, diabetes, osteoporosis, and hypothyroidism were higher in women with breast cancer compared to women without cancer, with the hazard ratios ranging from 1.09 (95 CI% 1.03-1.16) for ischemic heart disease to 2.10 (95% CI 1.99-2.21) for osteoporosis in the model adjusted for baseline comorbidity measured using Rx-Risk-V score. CONCLUSION: Women with breast cancer had a higher risk of developing new comorbidities than women without cancer. Development of coordinated care models to manage multiple chronic diseases among breast cancer patients is warranted.


Assuntos
Neoplasias da Mama/epidemiologia , Adulto , Idoso , Colúmbia Britânica/epidemiologia , Doenças Cardiovasculares/epidemiologia , Comorbidade , Depressão/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipotireoidismo/epidemiologia , Pessoa de Meia-Idade , Osteoporose/epidemiologia , Prevalência , Estudos Retrospectivos
11.
AIDS Behav ; 23(12): 3324-3330, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31327107

RESUMO

We examined factors associated with reporting sex with men among men who inject drugs in Vancouver, Canada. Data were drawn from three open prospective cohorts of people who use drugs between 2005 and 2014. Generalized estimating equations were used to identify factors associated with reporting non-transactional sex with men (MSM) in the previous 6 months. Of 1663 men who used injection drugs, 225 (13.5%) were MSM over the study period. Sex with men was independently associated with younger age [Adjusted Odds Ratio (AOR) = 0.96], childhood sexual abuse (AOR = 2.65), sex work (AOR = 3.33), crystal methamphetamine use (AOR = 1.30), borrowing used syringes (AOR = 1.39), inconsistent condom use (AOR = 1.76), and HIV seropositivity (AOR = 3.82). MSM were less likely to be Hepatitis C-positive (AOR = 0.43) and to have accessed addiction treatment in the previous 6 months (AOR = 0.83) (all p < 0.05). Findings highlight vulnerabilities and resiliencies among MSM-PWID and indicate a need for trauma-informed and affirming harm reduction and substance use treatment services for MSM-PWID.


Assuntos
Abuso Sexual na Infância/estatística & dados numéricos , Infecções por HIV/epidemiologia , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Trabalho Sexual/estatística & dados numéricos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Sexo sem Proteção/estatística & dados numéricos , Adulto , Sobreviventes Adultos de Maus-Tratos Infantis , Distribuição por Idade , Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia , Colúmbia Britânica/epidemiologia , Criança , Redução do Dano , Hepatite C/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , Metanfetamina , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Abuso de Substâncias por Via Intravenosa/terapia , Transtornos Relacionados ao Uso de Substâncias , Adulto Jovem
12.
Adv Neonatal Care ; 19(4): 275-284, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31268866

RESUMO

BACKGROUND: Children with complex medical needs (CMN) are high healthcare resource utilizers, have varying underlying diagnoses, and experience repeated hospitalizations. Outcomes on neonatal intensive care (NICU) patients with CMN are unknown. PURPOSE: The primary aim is to describe the clinical profile, resource use, prevalence, and both in-hospital and postdischarge outcomes of neonates with CMN. The secondary aim is to assess the feasibility of sustaining the use of the neonatal complex care team (NCCT). METHODS: A retrospective cohort study was conducted after implementing a new model of care for neonates with CMN in the NICU. All neonates born between January 2013 and December 2016 and who met the criteria for CMN and were cared for by the NCCT were included. RESULTS: One hundred forty-seven neonates with a mean (standard deviation) gestational age of 34 (5) weeks were included. The major underlying diagnoses were genetic/chromosomal abnormalities (48%), extreme prematurity (26%), neurological abnormality (12%), and congenital anomalies (11%). Interventions received included mechanical ventilation (69%), parenteral nutrition (68%), and technology dependency at discharge (91%). Mortality was 3% before discharge and 17% after discharge. Postdischarge hospital attendances included emergency department visits (44%) and inpatient admissions (58%), which involved pediatric intensive care unit admissions (26%). IMPLICATIONS FOR PRACTICE: Neonates with CMN have multiple comorbidities, high resource needs, significant postdischarge mortality, and rehospitalization rates. These cohorts of NICU patients can be identified early during their NICU course and serve as targets for implementing innovative care models to meet their unique needs. IMPLICATIONS FOR RESEARCH: Future studies should explore the feasibility of implementing innovative care models and their potential impact on patient outcomes and cost-effectiveness.


Assuntos
Anormalidades Congênitas , Lactente Extremamente Prematuro , Terapia Intensiva Neonatal , Malformações do Sistema Nervoso , Alta do Paciente/estatística & dados numéricos , Colúmbia Britânica/epidemiologia , Estudos de Coortes , Comorbidade , Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/genética , Anormalidades Congênitas/mortalidade , Anormalidades Congênitas/terapia , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Recém-Nascido , Terapia Intensiva Neonatal/métodos , Terapia Intensiva Neonatal/estatística & dados numéricos , Malformações do Sistema Nervoso/epidemiologia , Malformações do Sistema Nervoso/mortalidade , Malformações do Sistema Nervoso/terapia , Estudos Retrospectivos , Resultado do Tratamento
13.
AIDS Behav ; 23(12): 3331-3339, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31286318

RESUMO

People living with HIV (PLHIV) often experience pain for which opioid medications may be prescribed. Thus, these individuals are particularly vulnerable to opioid-related harms, including overdose, misuse, and addiction, particularly when prescribed at high doses. We used a comprehensive linked population-level database of PLHIV in British Columbia (BC) to identify demographic and clinical characteristics associated with being prescribed any high-dose opioid analgesic, defined as > 90 daily morphine milligram equivalents (MME/day). Among PLHIV who were prescribed opioids between 1996 and 2015 (n = 10,780), 28.2% received prescriptions of > 90 MME/day at least once during the study period. Factors positively associated with being prescribed high-dose opioid analgesics included: co-prescription of benzodiazepines (adjusted odds ratio [AOR] = 1.14; 95% confidence interval 1.11-1.17); presence of an AIDS-defining illness (ADI; AOR = 1.78; 95% CI 1.57-2.02); seen by an HIV specialist (AOR = 1.24; 95% CI 1.20-1.29); substance use disorder (AOR = 1.46; 95% CI 1.25-1.71); and more recent calendar year (AOR = 1.05; 95% CI 1.04-1.06). Given the known risks associated with high-dose opioid prescribing, future research efforts should focus on the clinical indication and outcomes associated with these prescribing practices.


Assuntos
Analgésicos Opioides/administração & dosagem , Dor Crônica/tratamento farmacológico , Infecções por HIV/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Analgésicos Opioides/uso terapêutico , Benzodiazepinas/uso terapêutico , Colúmbia Britânica/epidemiologia , Dor Crônica/epidemiologia , Comorbidade , Overdose de Drogas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Padrões de Prática Médica , Risco
14.
Matern Child Health J ; 23(9): 1232-1239, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31222596

RESUMO

OBJECTIVES: Involuntary child removal via the child protection system disproportionately affects marginalized women, yet the impacts on maternal health are under-investigated. This study prospectively examined the association of child removal with self-rated health of mothers who are sex workers. Given high levels of intergenerational family separation in this population, particularly among Indigenous sex workers, we also estimated joint effects of child removal spanning two generations. METHODS: Analyses drew on 2010-2015 data from AESHA (An Evaluation of Sex Workers' Health Access), a prospective cohort of sex workers (n = 950) in Vancouver, Canada. Using logistic regression with generalized estimating equations, we modeled the association of past child removal and current self-rated health in a sample of 466 sex workers who ever had a live birth. Joint effects of child removal and history of removal from own parents were also investigated. RESULTS: Of 466 sex workers, 180 (38.6%) reported child removal at baseline and 147 (31.6%) had a history of removal from own parents. In main effects model, child removal was associated with increased odds of poorer self-rated health [odds ratio (OR) 1.50, 95% confidence interval (CI) 1.04, 2.16]. Joint effects model showed higher odds of poorer self-rated health (OR 2.04, 95% CI 1.27, 3.27) among women with intergenerational family separation. CONCLUSION FOR PRACTICE: Child removal was negatively associated with sex workers' health that was worsened when family separation spanned two generations. Findings underscore need to develop sex worker and Indigenous-led family support services, along with tailored interventions to address health needs of those separated from their children.


Assuntos
Separação da Família , Mães/psicologia , Autorrelato/estatística & dados numéricos , Adulto , Colúmbia Britânica/epidemiologia , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Masculino , Mães/estatística & dados numéricos , Razão de Chances , Estudos Prospectivos , Psicometria/instrumentação , Psicometria/métodos , Profissionais do Sexo/psicologia , Profissionais do Sexo/estatística & dados numéricos , Fatores Socioeconômicos
15.
PLoS One ; 14(4): e0216271, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31039191

RESUMO

OBJECTIVE: To examine how stratifying persons born outside Canada according to tuberculosis (TB) incidence in their birth country and other demographic factors refines our understanding of TB epidemiology and local TB transmission. BACKGROUND: Population-level TB surveillance programs and research studies in low incidence settings often report all persons born outside the country in which the study is conducted as "foreign-born"-a single label for a highly diverse population with variable TB risks. This may mask important TB epidemiologic trends and not accurately reflect local transmission patterns. METHODS: We used population-level data from two large cohorts in British Columbia (BC), Canada: an immigration cohort (n = 337,492 permanent residents to BC) and a genotyping cohort (n = 2290 culture-confirmed active TB cases). We stratified active TB case counts, incidence rates, and genotypic clustering (an indicator of TB transmission) in BC by birth country TB incidence, age at immigration, and years since arrival. RESULTS: Persons from high-incidence countries had a 12-fold higher TB incidence than those emigrating from low-incidence settings. Estimates of local transmission, as captured by genotyping, versus reactivation of latent TB infection acquired outside Canada varied when data were stratified by birthplace TB incidence, as did patient-level characteristics of individuals in each group, such as age and years between immigration and diagnosis. CONCLUSION: Categorizing persons beyond simply "foreign-born", particularly in the context of TB epidemiologic and molecular data, is needed for a more accurate understanding of TB rates and patterns of transmission.


Assuntos
Emigrantes e Imigrantes , Parto , Tuberculose/epidemiologia , Fatores Etários , Colúmbia Britânica/epidemiologia , Genótipo , Humanos , Incidência , Fatores de Tempo , Tuberculose/genética , Tuberculose/transmissão
16.
Cancer Epidemiol ; 60: 174-178, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31054466

RESUMO

INTRODUCTION: Breast cancer rates vary internationally and between immigrant and non-immigrant populations. We describe breast cancer incidence by birth region and country in British Columbia, Canada. METHODS: We linked population-based health and immigration databases for a population with >1.29 million immigrants to assess breast cancer incidence among immigrant and non-immigrant women. We report age-standardized incidence ratios (SIRs) by birth region and country using non-immigrant women as the standard. RESULTS: SIRs varied widely by both birth country and region. Low rates were found for South (SIR = 0.52, 95% CI: 0.47,0.59) and East Asian (SIR = 0.75, 95% CI: 0.72,0.79) women and a higher rate for Western Europeans (SIR = 1.15, 95% CI: 1.01,1.30). CONCLUSION: There is considerable variation in SIRs across some of British Columbia's largest immigrant populations and several demonstrate significantly different risk profiles compared to non-immigrants. These findings provide unique data to support breast cancer prevention and control.


Assuntos
Neoplasias da Mama/epidemiologia , Adulto , Colúmbia Britânica/epidemiologia , Emigrantes e Imigrantes , Feminino , Humanos , Incidência , Pessoa de Meia-Idade
17.
J Stroke Cerebrovasc Dis ; 28(6): 1509-1518, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30935811

RESUMO

BACKGROUND: Knowledge about stroke and stroke prevention may provide motivation to lead a healthy lifestyle to prevent stroke. The goal of this study is to quantify the knowledge of stroke and stroke prevention of patients with a recent stroke and its association with health behaviors and cardiovascular disease risk. METHODS: We conducted a prospective cross-sectional study utilizing consecutive stroke admissions at 2 hospitals in Vancouver, Canada. We included patients within 48-72 hours of admission. Stroke knowledge was measured prior to any hospital education. The Health-Promoting Lifestyle Profile II (HPLP II), a 52-item self-report scale was used to quantify health behavior for the week prior to the stroke. The cardiovascular risk score was calculated. Hierarchical multiple regression was used to assess the determinants of HPLP II and cardiovascular disease risk. RESULTS: We enrolled patients with primarily mild stroke (n = 100). The mean age of participants was 66.6 ± 13.6 years and 60% were male. The participants had poor knowledge of stroke symptoms and risk factors. In the first regression analysis, the final model explained 27% of the variance in health behavior (F (6, 93) = 5.69, p = <0.001) with only age and knowledge of risk factors as statistically significant variables. In the second regression analysis, the final model explained 15% of the variance in cardiovascular disease risk (F (7, 84) = 2.163, p = 0.046) with only physical activity remaining as a statistically significant variable. CONCLUSION: The findings would inform the development of novel programs to improve the knowledge and health behavior for prevention of stroke.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/psicologia , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Estilo de Vida Saudável , Acidente Vascular Cerebral/prevenção & controle , Acidente Vascular Cerebral/psicologia , Idoso , Colúmbia Britânica/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Admissão do Paciente , Estudos Prospectivos , Fatores de Proteção , Medição de Risco , Fatores de Risco , Autorrelato , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo
18.
PLoS One ; 14(4): e0214870, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943250

RESUMO

OBJECTIVES: Compare the molecular epidemiology of tuberculosis (TB) between two large Canadian provinces-Ontario and British Columbia (BC)-to identify genotypic clusters within and across both provinces, allowing for an improved understanding of genotype data and providing context to more accurately identify clusters representing local transmission. DESIGN: We compared 24-locus Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR) genotyping for 3,314 Ontario and 1,602 BC clinical Mycobacterium tuberculosis isolates collected from 2008 through 2014. Laboratory data for each isolate was linked to case-level records to obtain clinical and demographic data. RESULTS: The demographic characteristics of persons with TB varied between provinces, most notably in the proportion of persons born outside Canada, which was reflected in the large number of unique genotypes (n = 3,461). The proportion of clustered isolates was significantly higher in BC. Substantial clustering amongst non-Lineage 4 TB strains was observed within and across the provinces. Only two large clusters (≥10 cases/cluster) representing within province transmission had interprovincial genotype matches. CONCLUSION: We recommend expanding analysis of shared genotypes to include neighbouring jurisdictions, and implementing whole genome sequencing to improve identification of TB transmission, recognize outbreaks, and monitor changing trends in TB epidemiology.


Assuntos
Mycobacterium tuberculosis/genética , Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas de Tipagem Bacteriana , Colúmbia Britânica/epidemiologia , Criança , Pré-Escolar , Feminino , Técnicas de Genotipagem , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Ontário/epidemiologia , Tuberculose/transmissão , Sequenciamento Completo do Genoma , Adulto Jovem
19.
Virol J ; 16(1): 41, 2019 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-30940162

RESUMO

BACKGROUND: Piscine orthoreovirus (PRV) is an emergent virus in salmon aquaculture belonging to the family Reoviridae. PRV is associated with a growing list of pathological conditions including heart and skeletal inflammation (HSMI) of farmed Atlantic salmon. Despite widespread PRV infection in commercially farmed Atlantic salmon, information on PRV prevalence and on the genetic sequence variation of PRV in Atlantic salmon on the north Pacific Coast is limited. METHODS: Feral Atlantic salmon caught in Washington State and British Columbia following a large containment failure at a farm in northern Puget Sound were sampled. Fish tissues were tested for PRV by RT-qPCR assay for segment L1 and conventional RT-PCR for PRV segment S1. The PCR products were sequenced and their relationship to PRV strains in GenBank was determined using phylogenetic analysis and nucleotide and amino acid homology comparisons. RESULTS: Following the escape of 253,000 Atlantic salmon from a salmon farm in Washington State, USA, 72/73 tissue samples from 27 Atlantic salmon captured shortly after the escape tested PRV-positive. We estimate PRV-prevalence in the source farm population at 95% or greater. The PRV found in the fish was identified as PRV sub-genotype Ia and very similar to PRV from farmed Atlantic salmon in Iceland. This correlates with the source of the fish in the farm. Eggs of infected fish were positive for PRV indicating the possibility of vertical transfer and spread with fish egg transports. CONCLUSIONS: PRV prevalence was close to 100% in farmed Atlantic salmon that were caught in Washington State and British Columbia following a large containment failure at a farm in northern Puget Sound. The PRV strains present in the escaped Atlantic salmon were very similar to the PRV strain reported in farmed Atlantic salmon from the source hatchery in Iceland that was used to stock commercial aquaculture sites in Washington State. This study emphasizes the need to screen Atlantic salmon broodstock for PRV, particularly where used to supply eggs to the global Atlantic salmon farming industry thereby improving our understanding of PRV epidemiology.


Assuntos
Doenças dos Peixes/virologia , Orthoreovirus/genética , Infecções por Reoviridae/veterinária , Salmo salar/virologia , Animais , Aquicultura , Colúmbia Britânica/epidemiologia , Genótipo , Coração/virologia , Inflamação , Orthoreovirus/isolamento & purificação , Orthoreovirus/patogenicidade , Filogenia , Reação em Cadeia da Polimerase , Prevalência , Infecções por Reoviridae/epidemiologia , Washington/epidemiologia
20.
Food Environ Virol ; 11(2): 138-148, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30900141

RESUMO

Two outbreaks of norovirus and acute gastroenteritis took place in Canada between November 2016 and April 2017. Both outbreaks were linked to oysters from British Columbia (BC) coastal waters. This paper describes the multi-agency investigations to identify the source and control the outbreak. Public health officials conducted interviews to determine case exposures. Traceback was conducted by collecting oyster tags from restaurants and analyzing them to determine the most common farms. Oyster samples were collected from case homes, restaurants, and harvest sites and tested for the presence of norovirus. Potential environmental pollution sources were investigated to identify the source of the outbreak. Four hundred and 49 cases were identified as part of the two outbreak waves. The oysters were traced to various geographically dispersed farms in BC coastal waters. Twelve farms were closed as a result of the investigations. No environmental pollution sources could be identified as the cause of the outbreak. Similarities in the timeframe, genotype, and geographic distribution of identified oyster farms indicate that they may have been one continuous event. Genotype data indicate that human sewage contamination was the likely cause of the outbreak, although no pollution source was identified.


Assuntos
Infecções por Caliciviridae/virologia , Gastroenterite/virologia , Norovirus/isolamento & purificação , Ostreidae/virologia , Frutos do Mar/virologia , Animais , Colúmbia Britânica/epidemiologia , Infecções por Caliciviridae/epidemiologia , Contaminação de Alimentos/análise , Gastroenterite/epidemiologia , Genótipo , Humanos , Norovirus/classificação , Norovirus/genética , Saúde Pública , Restaurantes/estatística & dados numéricos , Esgotos/virologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA