British Columbia Research Articles

Association of hepatitis B virus treatment with all-cause and liver-related mortality among individuals with HBV and cirrhosis: a population-based cohort study

We evaluated the association of hepatitis B virus (HBV) treatment with all-cause, and liver-related mortality among individuals with HBV and cirrhosis in British Columbia (BC), Canada. This analysis included people diagnosed with HBV and had cirrhosis in the BC Hepatitis Testers Cohort, including data on all individuals diagnosed with HBV from 1990 to 2015 in BC and integrated with healthcare administrative data. We followed people with cirrhosis from the first cirrhosis diagnosis date until death or December 31, 2020. We compared all-cause and liver related mortality between those who received treatment and those who did not. HBV treatment was considered a time-varying variable. We performed multivariable Cox proportional hazards model and competing risk regression models to assess the association of HBV treatment with all causes, and liver-related mortality respectively using inverse probability of treatment weighted population. Among 4962 individuals with HBV and cirrhosis, 48.1% received HBV treatment. Treated individuals had a median follow-up of 2.97 years, compared to 2.87 years for untreated individuals. The treated group was older (median age 57 vs 54 years), had higher proportion of treated of males [1802 (75.50%) vs 1766 (68.8%)], from urban area [2318 (97.2%) vs 2355 (91.8%)], and from East and South Asian ethnicity [1506 (63.1%) vs 709 (27.5%)] compared to untreated group. Untreated people experienced higher all-cause mortality (115.47 vs. 35.72 per 1000 person-years) and liver-related mortality (49.86 vs. 11.39 per 1000 person-years). Multivariable models showed that HBV treatment significantly lowered the risk of all-cause mortality (adjusted hazard ratio (aHR) 0.74; 95% CI: 0.65, 0.84) and liver-related mortality (adjusted subdistribution hazard ratio (asHR) 0.72; 95% CI: 0.58, 0.89) compared to untreated individuals. Among untreated individuals with HBV, those with HCV coinfection had a higher risk of both all-cause and liver-related mortality (aHR 1.57; 95% CI: 1.22, 2.04, and asHR 1.60; 95% CI: 1.25, 2.05, respectively). HBV treatment was associated with a significant reduction in all-cause and liver-related mortality among individuals with cirrhosis. The findings highlight the need for treatment among individuals with HBV related cirrhosis especially those with coinfection with hepatitis C virus. This work was supported by the BC Centre for Disease Control and the Canadian Institutes of Health Research (CIHR) [Grant # NHC-142832, PJT-156066, and SC1 -178736]. JDM has received doctoral fellowship from the Canadian Network on Hepatitis C (CanHepC). DJ has received Doctoral Research Award (#201910DF1-435705-64343) from the Canadian Institutes of Health Research (CIHR) and doctoral fellowship from the CanHepC. CanHepC is funded by a joint initiative of the Canadian Institutes of Health Research (CIHR) (NHC-142832) and the Public Health Agency of Canada (PHAC).

Promise and Perils of Primary HPV Testing.

Cervical cancer screening has reduced morbidity and mortality in many countries, but efforts to optimize screening modalities and schedules are ongoing. Using data from a randomized trial conducted in British Columbia, Canada, in conjunction with a provincial screening registry, Gottschlich and colleagues demonstrated that the estimated risk for precancerous disease (cervical intraepithelial neoplasia grades 2 or worse) at 8 years following a negative human papillomavirus (HPV) test was similar to the current standard of care (Pap testing after 3 years). The study supports extending screening intervals for those with a negative HPV test beyond currently recommended 5-year intervals. In an ideal world, the resources saved through less frequent routine cervical screening could be redirected to increasing screening uptake and follow-up of abnormalities to improve equity in cervical cancer prevention. However, implementation of extending screening intervals remains less than straightforward in settings with fragmented healthcare systems that lack information systems to support patient call/recall, such as the United States. To achieve the full promise of primary HPV testing, stakeholders at every level must commit to identifying and addressing the diverse spectrum of barriers that undergird existing inequities in care access, appropriately resource implementation strategies, and improve health information systems. See related article by Gottschlich et al., p. 904.

Heat-related illness among workers in British Columbia, Canada: Extreme hot weather in 2021 compared to 2001-2020.

British Columbia (BC), Canada, experienced an unprecedented summer with record-breaking high temperatures in 2021. Yet the health impact has not been examined in occupational settings. This study aimed to characterize occupational heat-related illness (HRI) among BC workers estimated by incidence rates and associations between heatwaves and HRI, compare risks from 2021 and prior summers of 2001-2020, and assess differential impacts on worker groups by demographics and occupations. We identified HRI from workers' compensation claims that occurred between June and August from 2001-2021 in BC. Incidence rates were calculated using working population estimates from Statistics Canada's Labour Force Survey. A time-stratified case-crossover design with conditional Poisson regression was used to examine the impact of heatwaves on occupational HRI. All analyses were stratified by year (2021 versus 2001-2020), age, sex, and occupation. Of the 521 claims identified, 107 (21%) occurred in 2021. Incidence rates for 2021 and prior summers were 3.97 [95% confidence interval (CI) 3.26-4.80] and 0.93 (95% CI 0.85-1.03) claims per 100 000 workers, respectively. This difference represents a 327% increase. Rates were higher in health occupations in 2021 versus 2001-2020. During 2001-2021, the risk of HRI during heatwave days was 4.33 (95% CI 2.98-6.27) times that during non-heatwave days, and the risk was higher among middle-aged workers and workers in trades, transport, and equipment operations. The 2021 heatwaves had greater impact on younger and female workers than those from prior summers. Heat is a crucial workplace hazard. Prevention strategies should prioritize at-risk workers and not be limited to heatwaves.

The right to housing in a neoliberal and colonial context

ABSTRACT In Canada, emerging discussions about colonialism and ongoing retrenchment from the welfare state, including social housing, accentuate the urgency of addressing housing need in ways that uphold both human and Indigenous rights. Through questionnaires and interviews with 28 non-profit housing providers in British Columbia, Manitoba, and New Brunswick, this paper examines the intersection of human and Indigenous rights with the provision of low-rent non-market housing. It identifies barriers and strategies to advancing the right to housing in Canada’s settler-colonial capitalist context and, in doing so, articulates possibilities for new policies upholding housing as a human and Indigenous right.

Anatomy of a fossil liana from the Upper Cretaceous of British Columbia, Canada

Anatomy of a fossil liana from the Upper Cretaceous of British Columbia, Canada

Schizophrenia, antipsychotic treatment adherence and driver responsibility for motor vehicle crash: a population-based retrospective study in British Columbia, Canada

ObjectiveTo examine the relationship between schizophrenia, antipsychotic medication adherence and driver responsibility for motor vehicle crash.DesignRetrospective observational cohort study using 20 years of population-based administrative health and driving data.SettingBritish Columbia,...

Landslide life-loss risk quantification based on historical fatalities

Life-loss risk estimates inform decisions that have dramatic impacts on individuals and communities in landslide hazard zones. Literature provides methods for making these estimates through multiplication of site-specific parameters. However, there is no method in the literature for calibrating those estimates, and regional context is needed to make efficient, fair, and affordable decisions. Therefore, we developed methods to quantify risk to individuals and groups based on regional historical fatality and hazard zone population data. The methods can be used to evaluate the accuracy of large sets of site-specific risk estimates, to assign quantitative risk values to buildings and hazard zones at a regional scale, to develop a long-term regional budget for landslide risk management, or to inform selection of a risk tolerance threshold that can inform where limited resources are invested in landslide mitigation. An example of the methods is provided for a case study of residential landslide risk in British Columbia, Canada. It estimates that there are between a few hundred and a few thousand people living with individual risk exceeding 100 micromorts (1 in 10,000) per year, and between 70 and 370 landslide hazard zones with annual probable life loss greater than 1E-3 (1 death in 1,000 years), based on a historical fatality rate of 0.4 to 1.4 deaths per year across the entire province.

Cutaneous Melanoma Mortality-to-Incidence Ratio and Its Association With Socioeconomic and Healthcare Factors in Canada: A National Ecological Study.

The mortality-to-incidence ratio (MIR) can be used to approximate healthcare inequities and is helpful to understand/compare cancer survival between geographic regions/jurisdictions. We investigated cutaneous melanoma (CM) outcomes through MIR analysis in Canadian jurisdictions and census divisions (CDs) between 1992 and 2016. Data were obtained from the national databases from 1992 to 2016 for all Canadian jurisdictions, except Quebec. Age-standardized overall and median MIRs were calculated per province per year, while crude MIRs were calculated for CDs. Generalized linear regression models were conducted to study the effect of province and year on MIR, while a mixed effect regression model was used to determine how healthcare and socioeconomic factors affect MIR, while accounting for possible clustering effects (eg, year and province). We identified 106,015 CM cases and 20,570 CM deaths between 1992 and 2016. National MIR from 1992 to 2016 demonstrated a significant linear decrease (P value < .0001). The national median MIR was 15.4 (ie, 0.154 × 100), whereby Manitoba (19.9), Ontario (19.5), Saskatchewan (18.5), British Columbia (16.1), and Newfoundland and Labrador (15.9) demonstrated higher MIRs than the Canadian average. CDs with the highest MIRs were commonly identified in the southern regions of provinces. No healthcare or socioeconomic factors were found to be significantly associated with higher MIR at the provincial level. MIRs have decreased at the national and provincial levels in recent decades, which is reassuring. Higher MIRs were noted in select rural CDs and in the Canadian territories, reinforcing the importance of proper dermatological care in all parts of the country.

Directly Observed Therapy in Correctional Settings

What Is the Issue? Directly observed therapy ensures patient adherence to a prescribed treatment regimen by having a health care worker watch the patient take the drug (s). However, it can result in patients needing to wait to see an available health care provider, and long waits can lead to patients being late for or missing out on work, school, or other therapy. What Did We Do? We conducted a literature search to identify, gather, synthesize, and summarize relevant evidence to inform our understanding of how directly observed therapy is used and what drugs are administered via directly observed therapy in correctional settings in Canada and internationally. What Did We Find? We identified practice manuals and guidelines from Canada, British Columbia, Manitoba, Nova Scotia, Ontario, and Saskatchewan, as well as Australia and the UK, related to using directly observed therapy in correctional settings. Drugs recommended to be provided via directly observed therapy included methadone, other drugs for opioid use disorder, and drugs at high risk of misuse or diversion (e.g., benzodiazepines, opioids). Most documents noted the high risk of misuse and/or diversion, suggesting these are the main justifications for providing drugs via directly observed therapy. Some strategies that may help reduce administration or wait times include an in-possession policy (where patients keep their drugs and self-administer if possible) and long-acting injectable forms of drugs (e.g., buprenorphine, antipsychotics). In-possession is typically not recommended for drugs at high risk of misuse and diversion. Still, it may be allowed for specific drugs or on a case-by-case basis, considering factors like the particular drug, available local resources, and patient characteristics. What Does This Mean? When considering alternatives to directly observed therapy, it may be helpful to assess risks, which may be influenced by the facility, the drug being provided, and individual patients. It may also be beneficial to implement methods of monitoring drug adherence and checking for potential misuse or diversion, such as by reviewing drug administration or supply records. While some alternatives to directly observed therapy may help to reduce time spent administering drug, some potential risks include increased risk of misuse and/or diversion and higher cost of drugs. Additional time may be required initially to allow staff to learn and adapt to the new process. It may be helpful to consider alternatives to directly observed therapy as additional options for patients, allowing patients to have input into what drug they will take based on their needs and concerns.

Exploring the cross-sectional association between the strength of school vaping policies and student vaping behaviours using data from the 2021-2022 COMPASS Study.

Youth vaping is a concern in Canada. While school-level policies influence student behaviours, few studies have investigated the association between school vaping policies and student vaping. This study reviewed and scored the comprehensiveness of school vaping policies and investigated the association between school vaping policy scores and student vaping. Online policy documents from n = 39 schools in Ontario, Alberta, and British Columbia, Canada, participating in the 2021-2022 wave of the COMPASS study were collected, reviewed, and scored for comprehensiveness (/39) using the School Tobacco Policy Index (STPI) rating form. The mean and range of scores for each domain of the STPI were calculated. School policy scores were linked to student vaping data from the COMPASS study. Multilevel logistic regression analyses identified the association between school vaping policy score and student lifetime and current (past 30-day) vaping. The mean total policy score was 10.2/39 (range 0‒24), and 28% of schools scored 0/39. The majority of school policies did not identify enforcement approaches or available preventive or cessation resources. Increasing STPI score was not associated with the odds of student lifetime or current vaping in multilevel logistic regression analyses. The STPI quickly identified components of school vaping policies that were missing. The overall score of most school vaping policies in our sample was low and most school vaping policies lacked many important components. Future studies should explore factors associated with adolescent vaping and identify effective prevention measures.

Effect of a dense inflow on the stratification of a steep‐sided lake

AbstractWe detail the effect of a small stream of dense inflow that significantly altered the stratification and water quality in a constructed water body in northern British Columbia, Canada. As the dense inflow passed through the epilimnion of the steep‐sided lake, it entrained relatively large quantities of water. The resulting mixture of dense inflow and entrained epilimnetic water sank to the bottom of the lake. The removal of water from the epilimnion due to entrainment reduced the epilimnetic thickness. This opposes the normal process of epilimnetic deepening due to wind and convective cooling. The flux of fluid entrained into the dense inflow was calculated to be between 4 and 14 times the inflow, depending primarily on the thickness of the epilimnion. The entrainment had four major effects: (1) it reduced the residence time of the epilimnion from half a year to less than a month; (2) it removed the freshwater cap that resulted from spring ice melt; (3) it enabled fall turnover, which further enhanced deep oxygen content and helped to prevent meromixis from developing in the lake; and (4) it produced a rapid decline in contaminant (i.e., zinc) concentrations in the epilimnion, which received dissolved metals inputs from oxidized sulfide minerals exposed in the subaerial walls of the lake. Given the wide variety of inflows to inland water bodies, some of which are at least seasonally dense, an understanding of the mechanisms detailed here can inform lake management in general, and more specifically, management of water quality in mine‐impacted water bodies.

Assay-guided treatment sequencing in chronic lymphocytic leukemia (CLL): a cost-effectiveness analysis

Costly targeted cancer treatments challenge publicly-funded healthcare systems seeking to align expected benefit with value for money. In 2021, The Canadian Agency for Drugs and Technologies in Health (CADTH) published a provisional funding algorithm for risk-based treatment of chronic lymphocytic leukemia (CLL). We estimate the cost-effectiveness of this algorithm against current standard of care. We constructed a probabilistic Markov model comparing next generation sequencing (NGS) assay-guided front-line treatment of acalabrutinib versus venetoclax with obinutuzumab to a comparator wherein patients initiate acalabrutinib. The primary outcome was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained. Analyses were conducted from the British Columbia healthcare system perspective, with outcomes discounted at 1.5%. Assay informed treatment for patients with CLL resulted in an incremental cost effectiveness ratio of $18,040 (95% CI $16,491–$19,501) per quality adjusted life-year (QALY) gained. The probability of the NGS guided treatment algorithm being cost effective was 80% at a willingness to pay threshold of $50,000 and a corresponding ICER of $18,040. Assay-guided treatment sequencing adds additional costs to healthcare but may be a cost-effective intervention for adult patients with CLL. Integration of real-world evidence would improve the validity and reliability of model estimated for decision-makers.

“My struggles are largely sensory processing:” The sensory world of autistic people

ABSTRACT This article delved into the sensory experiences of autistic adults, drawing on ethnographic fieldwork conducted in British Columbia, Canada. Thematic analysis of qualitative data revealed how unusual perceptual sensitivities impact the emotional well-being of autistic people, complicating their social interactions and relationships and contributing to social isolation. However, autistic individuals adopt diverse sensory and social coping strategies, and constantly adapt their previous sensory and social experiences to particular social and physical environments. This enables them to deal with their sensory challenges while interacting and socializing with others and engaging in social relationships. These ongoing adaptative processes also produce distinctive sociability patterns and perceptions among autistic people, reflecting both the stress associated with social interaction and the intense desire for it. Accordingly, this study highlighted the need for greater awareness of sensory phenomena and of social and physical environments to understand the daily and life experiences of autistics individuals.

Gaining influence: Developing a Healthy Public Policy Unit at Vancouver Coastal Health.

Regional Public Health Unit (Office of the Chief MHO, Vancouver Coastal Health Authority, BC, Canada). Recognizing the need to invest resources that strategically move public health work "upstream" where policies and investments can shape the determinants of health, the Office of the Chief MHO for Vancouver Coastal Health embarked on a process in 2019 to develop a population health team designed to engage in Healthy Public Policy (HPP) and Health in All Policies (HiAP) approaches to health promotion. The mission and design of this unit was informed by internal and external research and engagement which continued even through the COVID-19 pandemic. Inthe fall of 2022, this new unit, the first of its kind in British Columbia, was launched. In 2023, it embarked on strategic planning, engaged in key public policy processes, and implemented priority areas of work to help advance healthy public policy in the region, including the development of processes, tools, and practices to support a more systematic and rigorous approach to this emerging area of public health practice. The creation of this new Healthy Public Policy Unit invites discussion within Canada's public health community on the issue of resource allocation to support upstream interventions seeking to build the capacity and effectiveness of HPP and HiAP approaches.

Client preferences for the design and delivery of injectable opioid agonist treatment services: Results from a best-worst scaling task.

Clinical trials support injectable opioid agonist treatment (iOAT) for individuals with opioid use disorder (OUD) for whom other pharmacological management approaches are not well-suited. However, despite substantial research indicating that person-centered care improves engagement, retention and health outcomes for individuals with OUD, structural requirements (e.g. drug policies) often dictate how iOAT must be delivered, regardless of client preferences. This study aimed to quantify clients' iOAT delivery preferences to improve client engagement and retention. Cross-sectional preference elicitation survey. Metro Vancouver, British Columbia, Canada. 124 current and former iOAT clients. Participants completed a demographic questionnaire package and an interviewer-led preference elicitation survey (case 2 best-worst scaling task). Latent class analysis was used to identify distinct preference groups and explore demographic differences between preference groups. Most participants (n = 100; 81%) were current iOAT clients. Latent class analysis identified two distinct groups of client preferences: (1) autonomous decision-makers (n = 73; 59%) and (2) shared decision-makers (n = 51; 41%). These groups had different preferences for how medication type and dosage were selected. Both groups prioritized access to take-home medication (i.e. carries), the ability to set their own schedule, receiving iOAT in a space they like and having other services available at iOAT clinics. Compared with shared decision-makers, fewer autonomous decision-makers identified as a cis-male/man and reported flexible preferences. Injectable opioid agonist treatment (iOAT) clients surveyed in Vancouver, Canada, appear to prefer greater autonomy than they currently have in choosing OAT medication type, dosage and treatment schedule.

Client perspectives on creating supportive sexual health environments for people with persistent anxiety: a qualitative study

ObjectivesWe sought to explore sexual health service clients’ perspectives, preferences and suggestions for how to better address or alleviate anxiety among clients of sexual health services (eg, sexually transmitted infection...

How immigration shapes health disadvantages and what healthcare organizations can do to deliver more equitable care.

That immigration is a determinant of health and that immigration systems themselves contribute to structural disadvantage remains under-addressed within healthcare in Canada. This article offers context for how immigration shapes health, and recommendations for how health systems can be better prepared to respond to the diverse needs of immigrants and migrants (together referred to as im/migrants), based on a community-based research project in British Columbia. Findings call attention to the varied and intersecting ways in which immigration status, access to health insurance, language, experiences of trauma and discrimination, lack of support for health system limits access to healthcare, and the roles community-based organizations play in supporting access. Recommendations are intended to help make sure that all health services are accessible to everyone, and move beyond a homogenizing category of "newcomers" into practical, meaningful strategies that attend to diverse and intersecting community needs.

Self-identification and workplace experience surveys for equity and inclusion in healthcare.

Data and evaluation have become integral to efforts aimed at transforming organizational cultures. This is true in Diversity, Equity, and Inclusion (DEI), where organizations are assessing their employee make-up and the impact of their programs and services on systematically marginalized communities. This article presents a case study of a self-identification and workplace experience survey that was the first of its kind at the Provincial Health Services Authority in British Columbia. With a 30.7% response rate, we share an overview of the survey, lessons learned, and recommendations for other healthcare institutions embarking on their DEI journey. Key takeaways include engaging leaders early and allowing adequate time and resources for planning and executing the survey. Confidentiality is a crucial element to ensure that everyone feels confident to take the survey. Ultimately, adequate implementation of actions from survey results will build trust among staff and advance DEI priorities in organizations.

Lyme Disease Confirmatory Western Blot Is Redundant for Screen Negative Samples in Low Endemic Areas, British Columbia, Canada.

Background: Borrelia burgdorferi sensu stricto is the causative agent of Lyme disease (LD). Possible early symptoms include flu-like symptoms and erythema migrans and later, the risk of disruption of the nervous system, joints, and heart. A two-tiered testing method is employed for serological diagnostics. The Public Health Agency of Canada guidelines recommend that samples tested negative on first-tiered test need not be confirmed by second-tiered test. Due to the challenging nature of diagnosis leading to misconceptions among physicians about false negatives, confirmatory testing is requested despite the initial negative result. Methods: Hundred screen-negative Lyme patient samples from 2007 to 2016 were tested by Western blot (WB) second-tiered confirmatory test upon physician's request in British Columbia to study the first-tiered screening test sufficiency. Results: Those negative for first-tiered enzyme-linked immunosorbent assay were also negative by WB. Conclusion: Results demonstrate that confirmatory testing is not necessary on screen-negative samples. Hence, first-tiered test is sufficient to rule out LD.

Can ChatGPT Fool the Match? Artificial Intelligence Personal Statements for Plastic Surgery Residency Applications: A Comparative Study

Introduction: Personal statements can be decisive in Canadian residency applications. With the rise in AI technology, ethical concerns regarding authenticity and originality become more pressing. This study explores the capability of ChatGPT in producing personal statements for plastic surgery residency that match the quality of statements written by successful applicants. Methods: ChatGPT was utilized to generate a cohort of personal statements for CaRMS (Canadian Residency Matching Service) to compare with previously successful Plastic Surgery applications. Each AI-generated and human-written statement was randomized and anonymized prior to assessment. Two retired members of the plastic surgery residency selection committee from the University of British Columbia, evaluated these on a 0 to 10 scale and provided a binary response judging whether each statement was AI or human written. Statistical analysis included Welch 2-sample t tests and Cohen's Kappa for agreement. Results: Twenty-two personal statements (11 AI-generated by ChatGPT and 11 human-written) were evaluated. The overall mean scores were 7.48 (SD 0.932) and 7.68 (SD 0.716), respectively, with no significant difference between AI and human groups ( P = .4129). The average accuracy in distinguishing between human and AI letters was 65.9%. The Cohen's Kappa value was 0.374. Conclusions: ChatGPT can generate personal statements for plastic surgery residency applications with quality indistinguishable from human-written counterparts, as evidenced by the lack of significant scoring difference and moderate accuracy in discrimination by experienced surgeons. These findings highlight the evolving role of AI and the need for updated evaluative criteria or guidelines in the residency application process.