British Columbia Research Articles

Repurposing prescribed hydromorphone: Alternative uses of safer supply and tablet-injectable opioid agonist treatment to meet unaddressed health needs

BackgroundIn response to the ongoing overdose crisis in Canada, a number of opioid agonist treatment and safer supply programs provide people at high overdose risk with daily-dispensed tablet hydromorphone, with some requiring witnessed ingestion and others providing take-away doses. While these programs are intended to reduce overdose events by limiting people's use of the contaminated drug supply, the experiences of people receiving hydromorphone vary. In this article we explore the ways people repurpose hydromorphone to address unmet needs. MethodsThis article draws on in-depth qualitative interviews from two studies evaluating hydromorphone tablet distribution programs in British Columbia, Canada. We used thematic analysis to identify themes related to repurposing hydromorphone. We compared themes across the two studies to identify any similarities or differences in relation to the ways study participants discussed repurposing hydromorphone tablets. We utilize vignettes – snapshots of participant experiences – to analyse and represent the data. ResultsFour vignettes demonstrate how hydromorphone tablets are often being used to address and resolve unmet needs of people who use drugs. While most participants reported reducing their use of illicit drugs, a variety of instrumental uses of tablet hydromorphone were also discussed, including reducing anxiety, addressing sleep issues, withdrawal management, and managing chronic pain. ConclusionOur findings demonstrate how people who use drugs are maximizing the benefits of tablet hydromorphone distribution to address unmet needs. Hydromorphone distribution programs represent a public health and harm reduction intervention that is usefully addressing experiences related to structural vulnerabilities (such as inadequate pain management), which are often overlooked amongst stigmatized groups.

Modulation of Deformation by Magmatic Tempo, Coast Mountains Batholith, British Columbia, Canada

AbstractThe tectonomagmatic evolution of the southern Coast Mountains batholith, British Columbia reveals the relation of magmatic tempo, deformation, and relative plate motions which inform models for growth of continental crust and convergent plate dynamics. Magmatism in the southern batholith is episodic, derived primarily from the mantle, and reflects lower‐plate dynamics (Cecil et al., 2018, https://doi.org/10.1029/2018gc007874, 2021, https://doi.org/10.1130/ges02361.1). New field, structural, geochronologic, and geobarometric results from the southern batholith document three episodes of deformation, each spatially and temporally coincident with a high magmatic flux event (HFE). Sinistral faulting (<117–103 Ma) and penetrative deformation (110–90 Ma) occurred only within two distinct areas affected by a HFE at 114–102 Ma. Following a magmatic lull, crustal shortening occurred after 90 Ma and before 72 Ma within the region affected by a second HFE (85–70 Ma). After 70 Ma and before 53 Ma, >100 km of dextral slip occurred on the Coast shear zone and minor shortening affected 64–62 Ma plutons, overlapping with the 64–61 Ma HFE. Thus, at the crustal level exposed in the southern batholith, the timing and location of deformation is linked to magmatic tempo and the style of deformation varies through time. These results suggest that magmatic HFE modulate the timing and location of deformation while relative plate motions during HFE influence the style of deformation. Periods of deformation in batholiths may thus record high‐flux magmatic events and coeval plate motion but do not necessarily signal changes in plate motions.

A dual bivalve approach for interpreting past sea surface temperatures and seasonality from shell midden sites using oxygen isotope sclerochronology

Stable oxygen isotope (δ18O) analysis of archaeological shellfish remains combined with sclerochronology can be used to precisely reconstruct past sea surface temperature (pSST), season(s) of shellfish collection, and thus the season(s) of archaeological site occupation. Our study tests if δ18Oshell and sclerochronological analyses of marine bivalve species Leukoma staminea – with previously unassessed seasonality and pSST potential – can provide additional insights not captured by the better studied species, Saxidmous gigantea in British Columbia (BC, Canada). We analyzed live-collected L. staminea and S. gigantea shells from Sechelt, BC, and compared results to archaeological shell data from Powell River, BC, in the territory of the Tla'amin First Nation (1065 to 797 cal. B.P.). The seasonality of shellfish harvest differed between species, with S. gigantea preferentially collected in the spring, whereas L. staminea collected year-round. This highlights that sole-species seasonality studies may miss important variability harvesting strategies. Additionally, comparisons between instrumental (5.7 to 20.4 °C) and reconstructed SST from modern L. staminea δ18Oshell (5.6 to 18.4 °C) showed good agreement in annual range. Our results indicate that archaeological S. gigantea record a wider range of pSST (−1.6 to 22.9 °C) than archaeological L. staminea (5.8 to 25.9 °C), suggesting that S. gigantea may be a more sensitive palaeotemperature recorder. Further, we found that using the same reconstructed δ18Owater value for both species in pSST reconstruction caused an overestimation of temperature. Accordingly, we argue that it is critical to calibrate the equation with corresponding species-specific δ18Oshell values, regardless of both having aragonite mineral structures. Our study highlights the potential of L. staminea to broaden seasonality interpretations while clarifying that its use for pSST reconstruction may not capture the lower range of temperature.

Evaluating the risk of cardiovascular events associated with different immunosuppression treatments for glomerular diseases.

Patients with glomerular disease are at high risk of cardiovascular disease but the contribution of immunosuppression to this risk is unclear. In this retrospective cohort study of 1912 patients (comprised of 759 with IgA nephropathy, 540 with focal segmental glomerulosclerosis, 387 with membranous nephropathy and 226 with minimal change disease) from British Columbia, Canada, we evaluated the association between exposure to specific immunosuppressive medications and a composite outcome including coronary artery, cerebrovascular and peripheral arterial events. Survival models were adjusted for baseline cardiovascular risk factors, type of glomerular disease, estimated glomerular filtration rate (eGFR) and proteinuria over time. During a median follow-up of 6.8 years, 212 patients (11.1%) experienced the primary outcome. Corticosteroid exposure was not significantly associated with the primary outcome after adjusting for cardiovascular risk factors. In fully adjusted models, cumulative calcineurin inhibitor exposure at modest (150-300 defined daily doses [DDD]) and higher (300 or more DDD) doses were associated with a 2-fold higher risk of cardiovascular events (hazard ratio 2.98, 95% confidence interval 1.27-6.95) and (2.78, 1.32-5.84), respectively. A peak daily dose of antimetabolite (azathioprine, mycophenolate mofetil and mycophenolate sodium) of 0.5 or more DDD was associated with higher risk of cardiovascular events after adjustment for baseline risk factors and type of glomerular disease, but not after adjusting for time-varying eGFR and proteinuria (1.70, 0.91-3.20). Each 10 grams of cumulative cyclophosphamide exposure was associated with a 1.5-fold higher risk of cardiovascular events in a fully adjusted model (1.46, 1.22-1.75) Thus, our findings suggest that immunosuppressive therapies used in the treatment of glomerular disease may have different cardiovascular risk profiles, which should be considered when deciding on immunosuppression for individual patients and as a safety endpoint in future clinical trials.

‘This is PEEP’ participatory qualitative study: learning from a provincial consultation and advisory group of people with lived and living experience of substance use in British Columbia, Canada

ObjectivesTo summarise PEEP’s (Professionals for Ethical Engagement of Peers—a group of consultants with lived and living experience of substance use) outputs and gain insights into PEEP’s impact and suggestions for...

Stability and reliability of regional cumulative impact mapping: A Canadian Pacific case study

Cumulative impact mapping is a commonly applied spatial representation of the impacts of human activities on the ocean. This spatial model has been applied at varying scales around the world, in part due to its ability to visually communicate complicated information in a simple way. The application of the model to decision-making processes requires an understanding of the reliability and stability of its outputs. This paper represents both an updated regional application in Pacific Canada and an evaluation of the tool over two iterations, 2015 and 2023. The regional application utilised higher model resolution and new and improved data inputs including 38 habitats and 46 activities across five sectors. High impact hotspots were found around major population centres and ports, as well as in fishing and shipping areas along the continental shelf. Commercial fishing, shipping, and climate change (sea surface temperature change) remained the major drivers of cumulative impacts in the region, and cumulative impacts per unit area continued to be highest in kelp and seagrass. Results suggest evidence of decreased impacts where improved protection for sponge reefs were implemented but show an overall increase in cumulative impacts for the region. Results showed consistency and reliability in the location of cumulative impact hotspots. Refinements in data quality and resolution of spatial data inputs contributed towards increasing the spatial precision of hot spot areas identified. Confidence in the cumulative impact mapping outputs and applications for marine spatial planning, marine protected area designation and management, research, and decision support are discussed.

Risk Based Regulation in Quality Assurance: Selection of (and Benefits Experienced by) Registrants Undertaking Regulator-mandated Peer Review

ABSTRACT: Purpose: To identify risk and protective factors associated with physician performance in practice; to use this information to create a risk assessment scale; and, to test use of the risk assessment scale with a new population of assessed physicians. Design: Physician assessments that were completed by community-based physicians between March 2016 and February 2022 (n =2708) were gathered to determine what professional characteristics and practice context factors were associated with poor peer practice assessment (PPA). The predictive capacity of the resulting model was then tested against a new sample of physician assessments completed between March 2022 and February 2023 (n =320). Results: N=2401 physicians were eligible for inclusion in a logistic regression analysis, which resulted in an empirical model containing 11 variables that was able to account for 21.6% of the variance in the likelihood of receiving a poor PPA generated by the College of Physicians and Surgeons of British Columbia. The resulting model, when tested against 320 new cases, was able to predict good versus poor PPA performance with a sensitivity of 0.79 and specificity of 0.75. Not having undertaken peer review (OR=1.47) created a risk like that arising from a full decade passing since completion of medical school (OR=1.50). Conclusion: In addition to being the largest known study of its type, this work builds on similar studies by demonstrating the capacity to use regulator-mandated peer review to empirically identify physicians who are at risk of substandard performance using factors that are safe from claims of violating Human Rights Codes; that emphasize modifiable aspects of practice; and that can be readily updated to account for change over time.

Multiple recommended health behaviors among medical students in Western Canada: a descriptive study of self-reported knowledge, adherence, barriers, and time use

BackgroundGeneral medical practitioners are responsible for promoting and prescribing lifestyle modification and serve as role models for healthy behaviors. We aimed to assess self-reported knowledge, adherence, barriers and time spent on all recommended health behaviors among medical students.MethodsA cross-sectional online survey of eight behavioral domains among undergraduate medical students in The University of British Columbia, Canada, was analysed using descriptive statistics and visual display.ResultsBetween March and April 2023, 137 medical students participated in the survey (74% female). Over 80% had knowledge of five health behavior recommendations, but lacked knowledge of specific dietary recommendations in particular. Over 60% reported meeting guideline-recommended levels for tobacco, weekly alcohol, daily alcohol (females only), and physical activity (males only). Large gaps existed between knowledge and adherence for physical activity, sleep, sedentariness, screen time, and dietary recommendations. Sex differences in knowledge and adherence to recommended health behaviors were identified. Time spent on wellness focused on sleep (47–49 h/week), diet (9.6 h/week), exercise (5.8 h/week), and hobbies (6.1 h/week). Forgetting recommendations (69% of females, 71% of males), and lack of time (72% of females, 52% of males) were principal barriers to knowledge and adherence.ConclusionMost medical students in Western Canada reported not meeting multiple recommended health behaviors. Time was the largest barrier to adherence and free time was spent on sleep. Medical education may require protected time and dedicated content for health behaviors to ensure future physicians can be role models of health promotion for patients.

Expanding access to addictions care: Implementation of a 24-hour healthcare provider support line in British Columbia, Canada

BackgroundMorbidity and mortality related to substance use have risen to catastrophic levels in North America, and treatment services are often difficult to access. In response, the province of British Columbia (BC), Canada, launched a province-wide addiction medicine support phone line that offers clinicians immediate access to phone consultation with an addictions medicine expert. The service operates 24/7 is accessible to any clinician in the province seeking assistance with an addiction-related question. We describe an evaluation of the reach and perceived impact of the service over its first two years.MethodsThe 24/7 Addiction Medicine Clinician Support Line was evaluated prospectively from June 2020 to April 2022. All provider-to-provider encounters were included. Data was collected from two primary sources: health provider demographic information collected at the time of consultation, and optional clinician surveys conducted after the consultation was complete. Descriptive data are presented as numerical values and percentages.ResultsOver the 22-month evaluation period, 1,279 consultations were requested by 631 distinct care providers across British Columbia. The service averaged 15 calls per week across the province, and 51.5% of calls were made outside of business hours. Physicians made the majority of calls to the service (n = 865, 67.6%), followed by nurse practitioners (n = 162, 12.7%). Among those who completed a follow-up survey (n = 258 calls, 20.2% total calls), 81.8% (n = 211) were “very” or “extremely” satisfied with the consultation. Of these respondents, 65.5% (n = 169) reported that the consultation led to the provision of better care for their patient, with 58.1% (n = 150) initiating a new prescription and 22.1% (n = 57) reporting expedited treatment for their patient. The consultation area of focus was most commonly opioid use (n = 417; 59.6%), followed by polysubstance use (n = 98; 14.0%).ConclusionsThe impact of the 24/7 Addiction Clinician Support Line was widespread, and the service increased accessibility to evidence-based addictions treatment across a range of care settings. Clinicians expressed a high degree of satisfaction with the service. To our knowledge, this province-wide program is the first of its kind in North America, offering a scalable and adaptable model to support access to evidence-based addictions care in under-resourced settings.

Exposure to air pollutants and subclinical carotid atherosclerosis measured by magnetic resonance imaging: A cross-sectional analysis.

Long-term exposure to air pollution has been associated with higher risk of cardiovascular mortality. Less is known about the association of air pollution with initial development of cardiovascular disease. Herein, the association between low-level exposure to air pollutants and subclinical carotid atherosclerosis in adults without known clinical cardiovascular disease was investigated. Cross-sectional analysis within a prospective cohort study. The Canadian Alliance for Healthy Hearts and Minds Cohort Study; a pan-Canadian cohort of cohorts. Canadian adults (n = 6645) recruited between 2014-2018 from the provinces of British Columbia, Alberta, Ontario, Quebec, and Nova Scotia, were studied, for whom averages of exposures to nitrogen dioxide (NO2), ozone (O3), and fine particulate matter (PM2.5) were estimated for the years 2008-2012. Carotid vessel wall volume (CWV) measured by magnetic resonance imaging (MRI). In adjusted linear mixed models, PM2.5 was not consistently associated with CWV (per 5 μg/m3 PM2.5; adjusted estimate = -8.4 mm3; 95% Confidence Intervals (CI) -23.3 to 6.48; p = 0.27). A 5 ppb higher NO2 concentration was associated with 11.8 mm3 lower CWV (95% CI -16.2 to -7.31; p<0.0001). A 3 ppb increase in O3 was associated with 9.34 mm3 higher CWV (95% CI 4.75 to 13.92; p<0.0001). However, the coarse/insufficient O3 resolution (10 km) is a limitation. In a cohort of healthy Canadian adults there was no consistent association between PM2.5 or NO2 and increased CWV as a measure of subclinical atherosclerosis by MRI. The reasons for these inconsistent associations warrant further study.

Cancer chemotherapy in pregnancy and adverse pediatric outcomes: a population-based cohort study.

Administration of chemotherapy during pregnancy is often delayed, while preterm delivery is common. If in utero exposure to chemotherapy is associated with adverse pediatric outcomes, it is unknown whether that relationship is directly attributable to the chemotherapy or is mediated by preterm birth. Cases were identified from Canadian cancer registries and administrative data in Alberta, British Columbia, and Ontario, 2003-2017, with follow-up until 2018. The primary exposure was receipt of chemotherapy during pregnancy. Severe neonatal morbidity and mortality (SNM-M), neurodevelopmental disorders and disabilities (NDDs) and pediatric complex chronic conditions (PCCC) reflected short- and long-term pediatric outcomes. Modified Poisson and Cox proportional hazard regression models generated adjusted risk ratios (RR) and hazard ratios (HR), respectively. The influence of preterm birth on the association between exposure to chemotherapy in pregnancy and each study outcome was explored using mediation analysis. Of the 1150 incident cases of cancer during pregnancy, 142 (12.3%) received chemotherapy during pregnancy. Exposure to chemotherapy in pregnancy was associated with a higher risk of SNM-M (RR 1.67, 95% CI: 1.13-2.46), but not NDD (HR 0.93, 95% CI: 0.71-1.22) or PCCC (HR 0.96, 95% CI: 0.80-1.16). Preterm birth <34 and <37 weeks mediated 75.8% and 100% of the observed association between chemotherapy and SNM-M, respectively. Most children born to people with cancer during pregnancy appear to have favourable long-term outcomes, even following exposure to chemotherapy in pregnancy. However, preterm birth is quite common, and may contribute to increased rates of adverse neonatal outcomes.

British Columbia community pharmacy during COVID-19: Describing the patient experience via Google reviews

British Columbia community pharmacy during COVID-19: Describing the patient experience via Google reviews

Cooperative community wildfire response: Pathways to First Nations’ leadership and partnership in British Columbia, Canada

With the growing scale of wildfires, many First Nations are demanding a stronger role in wildfire response. Disproportionate impacts on Indigenous communities (including First Nations, Métis, and Inuit) in Canada are motivating these demands: although approximately 5 % of the population identifies as Indigenous, about 42 % of wildfire evacuation events occur communities that are more than half Indigenous. In what is now known as British Columbia, Canada, new pathways for cooperative wildfire response between First Nations and provincial agencies are emerging. Drawing from semi-structured interviews with 15 experts from First Nations communities and agencies, and a review of 42 documents on wildfire response, our research highlights the diverse existing capacities, priority opportunities, and processes required to enhance cooperative pathways. Within First Nations communities, existing capacities include local knowledge, firefighting experience, equipment, funding, relationships, and leadership – an overlooked but fundamental capacity. Priority opportunities include ways to build capacity within and beyond wildfire response, such as fully equipped response crews, full-time year-round wildfire management crews, Emergency Management Coordinators, First Nations Liaisons, and cross-trained wildland and structural crews. Translating existing capacities into priority opportunities requires an ongoing focus on cooperative processes, including relationship-building, respecting Rights and Title, streamlining funding, and enabling “cultural safety” to overcome racism. These cooperative pathways can help transform wildfire governance toward First Nations-led partnerships.

A holistic approach to supporting death in the home: Implementation of a home hospice program in a northern community–A study protocol

Introduction To enhance support for individuals at end of life to die at home, a new community-driven home-based hospice program was developed–Home Hospice. This wholistic hospice care program, co-designed by hospice care staff, community end-of-life care providers, researchers, and health systems decision-makers, will provide around the clock care to clients and their families. Methods and analysis This mixed methods study, guided by a process evaluation framework, will use secondary client and caregiver data collected as part of regular Home Hospice program processes, as well as primary interview data collected from caregivers at least three months post-death of the client and from hospice staff and volunteers involved in the Home Hospice program. Analysis will include descriptive statistical analysis of quantitative data and thematic analysis employing an inductive and a deductive qualitative analysis approach. Ethics Ethics approval has been received from the University of Northern British Columbia (File No: 6009117). All individuals and caregivers who enroll in the Home Hospice program will be invited to participate in this study. At three months post-death of the client, hospice staff will contact caregivers to ask if they would like to participate in a one-on-one interview with a research team member. Staff and volunteers will also be eligible to participate in one-on-one interviews with research team members. De-identified participant data will be provided by hospice staff to the research team. All participants will provide informed consent prior to participation in the study. Dissemination This study will use an integrated Knowledge Translation/Knowledge Mobilization (iKTKM) lens wherein the research team will work closely and meaningfully with knowledge users and community partners at all stages. Evidence-based and targeted iKTKM products will be created, including community event presentations and social media posts to share findings with participant and community audiences. Further, findings will be disseminated at conferences, workshops, and policy rounds with academic and decision-making audiences. Preliminary and full project findings will be published in high-quality open access journals. Strengths and limitations of this study Co-design of Home Hospice program and evaluation metrics involves researchers, hospice staff, health systems decision-makers, and community members. Evaluation metrics involve prospective collection of service utilization from client, family, hospice, and health systems perspectives. Integrated knowledge translation approach which frames the knowledge dissemination plan for the study findings focuses on a range of audiences, including local citizens, hospice and community end-of-life care providers, health systems decision-makers, and academic professionals. As a one-year pilot study, the number of clients who may be able to participate in this program will be approximately 50 persons.

Clinicians' Perspectives and an Ethical Analysis of Safer Supply Opioid Prescribing.

In British Columbia, Canada, many physicians providing care to individuals with high-risk opioid use disorder adopted safer supply (SS) opioid prescribing in the spring of 2020 with the goal of facilitating public health measures for COVID-19. This prescribing practice continued after measures were lifted. This study aimed to explore prescribers' perspectives following several years of local experience in prescribing SS opioids, primarily in the form of hydromorphone tablets, and to apply ethical concepts to explore current challenges and ongoing sources of provider distress. Addiction medicine SS prescribers participated in individual or small group semi-structured interviews. Each interview was transcribed and analysed for recurrent themes. Themes were then integrated into a narrative ethics discussion. Eleven addiction medicine physicians practicing in various settings within Vancouver participated in this study. Six themes were identified: clinical assessment, clinician distress, gaps in care, models of safer supply, research, and special populations. Ethical dilemmas in prescribing SS are identified and explored through a discussion of biomedical ethics principles and the physician role.

Cougar spatiotemporal response to human activities in a multi‐use forest landscape on southern Vancouver Island

Recreational activities have been shown to induce fear responses in carnivores, causing both spatial and temporal displacement that can have cascading effects on the wider ecological community. Cougars Puma concolor are one species that are particularly sensitive to human disturbances as they have been found to be impacted by various forms of recreational activities. This research aimed to quantify the spatial and temporal responses of cougars to human activities on southern Vancouver Island in British Columbia, Canada. Fifty camera traps were deployed in a systematic probabilistic sampling design and data from the summer season of 2022 was used for analyses. We modeled cougar weekly occurrence frequency in relation to human (hikers and bikers) occurrence frequency, vehicle occurrence frequency, and landscape features, using generalized linear mixed models. Temporal responses of cougars were investigated using activity pattern analysis to compare activity patterns within a recreation area and a restricted public access reserve. Cougars avoid occurring at sites where recreationalists frequently visited, but not sites frequented by vehicles on unpaved roads. We observed minimal influence of habitat features or prey availability on cougar occurrence frequency, as measured by information loss (AICc scores). Activity pattern analysis did not demonstrate significant differences in cougar daily activity patterns between the recreation area and no‐entry reserve, suggesting a lack of temporal response. These results suggest recreational activities on southern Vancouver Island are impacting cougar spatial – but not temporal – behavioral dynamics. Insights on how cougars respond to recreational activities can help inform landscape management and policies by providing information that can be used to mitigate negative impacts and thus ensure that recreational activities are remaining compatible with conservation efforts.

Struggles of vehicle residents in Squamish: Challenging the capitalist and colonial institution of housing

In this conversation, Thomasina Pidgeon discusses her decision to live in a vehicle in Squamish, north of Vancouver, in British Columbia, Canada. This was a choice originally driven by the lack of affordable housing, but she continued with it after falling in love with life on the road. Her story sheds light on the broader issues of housing, gentrification, and societal attitudes toward non-sedentary life choices. For Thomasina, living in a vehicle offered a sense of freedom for her and her daughter, despite occasional problems, as well as a deep connection with nature that conventional housing couldn’t provide. However, as Squamish has grown more gentrified, particularly after the 2010 Olympics, the town has increasingly cracked down on vehicle residents, categorising them as unhoused and treating them as a problem. These restrictive regulations, according to Thomasina, are part of a larger system that prioritizes property values and profits over human needs, echoing colonial practices that forced nomadic communities to settle for the benefit of those in power. Her story calls for a shift in how we think about housing, urging us to go beyond housing as a capitalist and colonial institution, and towards a deeper understanding of the systemic issues that lead to the so-called housing crisis. Despite facing stress and anxiety due to these crackdowns, Thomasina continues to advocate for the rights of vehicle residents with the organization Vehicle Residents of Squamish, and to connect different struggles from Palestinian solidarity work to struggles against an LNG terminal.

Twenty-year trends in excess costs of chronic obstructive pulmonary disease.

Several major risk factors for chronic obstructive pulmonary disease (COPD), such as population aging, smoking rates, and air pollution levels are rapidly changing, causing inevitable changes in the population burden of COPD. We determined the excess direct costs of COPD and their trend from 2001 to 2020. Using administrative health data from British Columbia, Canada, we created a retrospective matched cohort of physician-diagnosed COPD patients and non-COPD individuals. Excess direct medical costs (2020 $CAD) were estimated by analysing hospital records, outpatient services, medications, and community-care services. Comorbidity classes were assessed using the International Classification of Diseases codes. Excess COPD costs were estimated as the adjusted difference in direct medical costs between COPD and non-COPD cohorts. There were 208 554 and 404 703 individuals in the COPD and non-COPD cohorts, respectively (47.8% female; mean baseline age 69.1 and 68.2 years, respectively). Direct medical costs for COPD were $9224 per patient-year (/PY), compared to $3396/PY for non-COPD, giving rise to excess costs of $5828/PY (95% confidence interval [CI] 5759-5897). Excess costs increased by 48% over the study period. Excess costs due to comorbidities were $3588/PY (95% CI 3554-3622), with cardiovascular-related conditions alone exceeding the costs attributed to COPD ($1375/PY versus $904/PY). Despite multifaceted prevention and management initiatives, COPD-related economic burden is increasing, with the majority of costs due to comorbid conditions. Rising per-patient costs, combined with the flat or increasing prevalence of COPD in many jurisdictions, indicates a significant increase in COPD burden.

Long-term outcomes among out-of-hospital cardiac arrest survivors with reversible vs. non-reversible causes.

A reversible cause of out-of-hospital cardiac arrest (OHCA) is vaguely defined in international guidelines as an identifiable transient or potentially correctable condition. However, studies evaluating long-term outcomes of patients experiencing OHCA due to reversible and non-reversible causes are lacking. We aimed to determine differences in long-term outcomes in OHCA survivors according to different aetiology. From the British Columbia Cardiac Arrest registry, adults with non-traumatic OHCA (2009-2016) surviving to hospital discharge were identified. Patients were categorized by OHCA aetiology combining reversibility and underlying ischaemic aetiology. The primary outcome was a composite of all-cause mortality, recurrent OHCA, or re-hospitalization for sudden cardiac arrest or ventricular arrhythmias. Using the Kaplan-Meier method and multivariable Cox regression models, we compared the risk of the composite outcome according to different OHCA aetiology. Of 1325 OHCA hospital-discharge survivors (median age 62.8 years, 77.9% male), 431 (32.5%) had reversible ischaemic, 415 (31.3%), non-reversible ischaemic, 99 (7.5%), reversible non-ischaemic, and 380 (28.7%), non-reversible non-ischaemic aetiologies. At 3 years post discharge, the Kaplan-Meier event-free rate was highest in patients with a reversible ischaemic aetiology [91%, 95% confidence interval (CI) 87-94%], and lowest in those with a reversible non-ischaemic aetiology (62%, 95% CI 51-72%). In multivariate analyses, compared with non-reversible non-ischaemic cause, reversible ischaemic cause was associated with a significantly lower hazard ratio (HR; 0.52, 95% CI 0.33-0.81), reversible non-ischaemic cause with a significantly higher HR (1.53, 95% CI 1.03-2.32), and non-reversible ischaemic cause with a non-significant HR (0.92, 95% CI 0.64-1.33) for the composite outcome. Compared to other aetiologies, the presence of a reversible ischaemic cause is associated with improved long-term OHCA outcomes.

Healthcare Provider Narratives of the Impacts of the COVID-19 Pandemic on Pregnant and Parenting Youth in Canada: A Qualitative Study

The COVID-19 pandemic led to significant challenges for healthcare providers working with pregnant and parenting youth. However, the impacts of the pandemic on this population and healthcare services from the perspective of healthcare providers are not well documented in Canada. We examined the narratives and experiences of healthcare providers regarding these impacts and explored the challenges to service provision. Using a qualitative interpretative description (ID) approach, we recruited 25 health and service providers from Alberta, Ontario, and British Columbia for individual qualitative interviews. Our analysis resulted in three themes: complexities of health service provision during COVID-19, healthcare providers’ accounts of impacts on pregnant and parenting youth, and leveraging challenges into opportunities for service provision. Participants described the influence of pandemic policies and distancing measures on accessibility of health services, availability of healthcare resources and personnel, and well-being of their clients. They also reported increased mental health issues, isolation, and exacerbation of inequities within this population. Providers highlighted the role of telemedicine in ensuring some degree of continuity of care. Additionally, they commented on service adaptations to address the evolving needs of their clients. Our findings underline the need for a resilient and adaptable healthcare system that can better support the needs of vulnerable populations during crises.