British Columbia Research Articles

Implications of Public Disclosure of Personal Information in a Mobile Alert App for People Living With Dementia Who Go Missing: Qualitative Descriptive Study.

People living with dementia are at risk of getting lost and going missing due to memory loss, confusion, and disorientation. Missing person incidents involving people living with dementia are increasing. Alert systems such as Community ASAP can promote community engagement in locating missing persons with dementia and aid in search and rescue efforts. However, the implications of public disclosure of personal information such as name, age, sex, and physical description within such alert systems have yet to be explored. This study aimed to identify and discuss the implications of public disclosure of personal information in Community ASAP for people living with dementia at risk of going missing. This study used a qualitative descriptive research design drawing from naturalistic inquiry. A total of 19 participants including people living with dementia, care partners, first responders, and service providers were recruited from Ontario, Alberta, and British Columbia, Canada. Semistructured interviews were used to explore participants' perspectives on the perceived implications of the release of personal information when using Community ASAP. NVivo (version 12) was used to manage data, and conventional content analysis was conducted to identify key themes of the implications of public disclosure of personal information in Community ASAP. In total, 10/19 (53%) of the participants were women and 9/19 (47%) were men. Of the 19 participants, 3 (16%) were people living with dementia, 5 (26%) were care partners, 4 (21%) were first responders, and 7 (37%) were service providers. In total, 4 key themes were identified as implications of public disclosure of personal information in Community ASAP: right to autonomy, safety versus privacy, informed and knowledgeable consent, and stigmatization. Participants discussed how the public disclosure of personal information in Community ASAP could undermine a person's choice not to be found and contribute to stigmatization. Participants emphasized a need to balance safety and privacy concerns. Informed and knowledgeable consent is important when using an alert system to locate missing persons with dementia. Community ASAP can promote community engagement in locating missing persons with dementia. However, the public disclosure of personal information in alert systems has implications. Users' right to autonomy, a balance between safety and privacy, informed and knowledgeable consent, and risks of stigmatization are perceived impacts of disclosure of personal information in alert systems.

Health-related adverse work outcomes associated with post COVID-19 condition: a cross-sectional study

IntroductionSymptoms from post COVID-19 condition (PCC) can impair functioning in working-age adults. However, there is uncertainty about the relationship between PCC and work outcomes. This study aimed to assess health-related...

Using a Trauma-Informed Care Approach to Understand Family Caregivers' Experiences of Accessing Formal Supports in Dementia Care.

Family caregivers provide essential care and support for individuals living with dementia, yet their contributions and needs are often unrecognized within formal health care systems. Over time, this marginalization can contribute to long-term trauma. Guided by a trauma-informed care (TIC) framework, we explored the experiences of 15 family caregivers in a longitudinal, qualitative study. Set in British Columbia, Canada, data were collected through semi-structured interviews and reflective diaries. Data were analyzed using inductive-deductive thematic analysis. Deductive analyses demonstrated that participants' experiences aligned with existing TIC principles. Inductive analysis identified "Uncertainty" as a novel principle, reflecting the ongoing challenges caregivers face from diagnosis to the inadequacy of in-home supports. Our study highlights the importance of recognizing trauma induced by interactions with formal health care services and the value of using a TIC approach with family caregivers of people living with dementia.

Inequity of Exposure to Unconventional Natural Gas Development in Northeastern British Columbia, Canada─An Environmental Justice Analysis.

In the past two decades, northeastern British Columbia, Canada, has experienced rapid growth in unconventional natural gas production and is home to Indigenous and rural communities. Living near oil and gas production can lead to deteriorated air quality that negatively impacts human health. This study explores whether three oil- and gas-related exposure metrics: modeled concentrations of 12 gases and particles; oil and gas facility-reported emissions; and active wells are disproportionately distributed in areas with higher concentrations of Indigenous people and community socioeconomic vulnerability. We calculated exposure metrics from 2018 to 2020 in geographic dissemination areas (DAs). We used a rural deprivation index that included income, education, employment, and access to amenities to identify areas of high socioeconomic vulnerability. We estimated that DAs with greater than 90% Indigenous population experience 1.2-1.8 times higher median air pollution concentrations than DAs with less than 10% Indigenous population. We estimated that DAs with high community vulnerability experience higher modeled air pollution and higher odds of exposure to facility emissions, with the most vulnerable areas experiencing 11-96 times higher median air pollution concentrations. Overall, these results suggest the presence of environmental injustice in an area that is expected to continue producing a large portion of Canadian natural gas.

Optimizing the integration of family physicians into cancer survivorship care in the BC Interior: a mixed methods study of physicians' opinions and experiences.

With cancer diagnoses increasing worldwide and the number of cancer survivors rising, family physicians are being increasingly relied upon to provide post-cancer treatment care and/or survivorship care. This mixed-method study explores and evaluates barriers and facilitators to optimizing family physician-led survivorship care in the largely rural Interior of British Columbia (BC), Canada. A mixed-method approach consisting of quantitative surveys and qualitative interviews was utilized to explore family physician and oncologist perspectives on the current state of survivorship care for breast, lung, prostate, and colorectal cancers within the BC Interior. Concerns about family physician knowledge in some aspects of survivorship care were identified by both groups, with mixed responses regarding geographical factors, resources, and communication networks. Success was dependent on information from oncologists with more common cancer sites fitting the model better. There was significant concern for individuals with no family physician. Five frequently discussed facilitators were identified: (1) providing accessible survivorship guidelines, (2) standardized discharge summaries (i.e., survivorship care plans), (3) clear points-of-contact at cancer care centers, (4) more educational opportunities, and (5) compatible electronic supports between care providers. Overall, the model of family physician-led survivorship care was supported by family physicians and oncologists within the BC Interior, although success was dependent on several factors. Identifying the perspectives of physicians directly involved in the survivorship care pathway will be instrumental in developing and implementing solutions that will succeed within the BC Interior and similar regions.Implication toforCancer SurvivorsWe hope that the improvements to interprofessional cooperation driven by our research mayimprove the quality and continuity of care received by cancer survivors in British Columbia and beyond. IMPLICATION TO CANCER SURVIVORS: We hope that the improvements to interprofessional cooperation driven by our research may improve the qualityand continuity of care received by cancer survivors in British Columbia and beyond.

Enhancing Integrated Treatment Programs for Severe Concurrent Substance Use and Mental Disorders: Insights on Overdose from the ROAR CANADA Project: Améliorer les programmes de traitement intégré pour les troubles mentaux et les troubles liés à l'usage de substances psychoactives graves et concomitants : aperçu de la problématique des surdoses dans le cadre du projet ROAR CANADA.

This paper summarizes methods and initial overdose-related results from the Reducing Overdose and Relapse: Concurrent Attention to Neuropsychiatric Ailments and Drug Addiction (ROAR CANADA) project. ROAR CANADA is a longitudinal observational study of individuals with severe concurrent substance use and mental disorders (also called dual disorders or dual diagnosis). The study sampled patients treated at two tertiary treatment centres in British Columbia, Red Fish Healing Centre and Heartwood Centre, along with a concurrent treatment unit at St. Joseph's in Ontario. These facilities have implemented evidence-based integrated treatment programs. Our first analysis explores selected baseline characteristics as potential risk factors for drug overdose in this population. Sociodemographic factors, trauma history, and impulsivity were part of a more comprehensive longitudinal assessment. In this first investigation, we use bivariate analysis and logistic and linear regression modelling to examine these variables in relation to overdose history. Overall, 291 of 450 participants (64.7%) reported a history of ≥1 overdose. Across the three centres, patients had a lifetime average of 7.6 (SD = 12.9) overdoses. The prevalence and mean number of overdoses were somewhat higher among Red Fish patients (74.5% and 8.5, respectively). Adverse childhood events, lifetime trauma history, and impulsivity were all high, but only lifetime trauma history emerged as significantly associated with overdose across all treatment centres. Impulsivity indicators were selectively associated with overdose by site, but not consistently within the overall sample. These results highlight the importance of prioritizing trauma-informed care in the treatment of individuals with severe concurrent substance use and mental disorders, who are at high risk of overdose. The integration of trauma treatment into existing programs may enhance patient outcomes and contribute to the ongoing evolution of effective care strategies for this complex population. These findings are particularly relevant in light of the overdose crisis.

Analysis of EA as an instrument for wetland protection: insights from the mining sector in western and northern Canada

ABSTRACT Environmental assessment (EA) is a primary tool for identifying and managing the impacts of development on wetlands. Despite the global presence of EA and wetland policies, wetlands continue to be lost. This paper examines how EA is being deployed to identify, assess, and mitigate impacts on wetlands. The focus is on the mining sector in western and northern Canada. A sample of 36 EAs for mining projects in British Columbia and Yukon, filed between 2010 and 2021, was analyzed to examine how wetlands were considered in the project description, baseline, impact analysis, mitigation, and management plans. Results indicate a narrow focus on the wetland area as a proxy for impacts and a dominant focus on direct impacts, indicating that the full extent of potential impacts on wetland functions is not captured; a tendency to prioritize mitigation of impacts on habitat with less attention to other wetland functions; a reliance on secondary sources versus field-based studies to identify impacts; and weak linkages between mitigations and impact predictions. Lessons emerging emphasize the need for improvements to foundational EA practices for wetland assessment and mitigation. Better practice is urgent considering the declining state of wetlands globally, coupled with an expanding mining sector.

Mortality and hospitalizations fully attributable to alcohol use before versus during the COVID-19 pandemic in Canada.

The COVID-19 pandemic period was associated with increased alcohol consumption. We sought to estimate excess mortality and hospitalizations attributable to alcohol use in Canada between April 2020 and December 2022. Using data from the Canadian Vital Statistics Database and hospital Discharge Abstract Database (Jan. 2016 to Dec. 2022), we analyzed monthly mortality and hospitalization rates for conditions fully attributable to alcohol use in people in Canada aged 15 years and older. We estimated excess rates during the study period of April 2020 to December 2022 by comparing observed rates to expected rates, modelled using the autoregressive integrated moving average method, accounting for trends, seasonality, autocorrelation, and pandemic waves. Between April 2020 and December 2022, mortality fully attributable to alcohol in Canada increased by 17.6% (1600 excess deaths), and hospitalizations fully attributable to alcohol rose by 8.1% (7142 excess hospitalizations). Most increases occurred in the first 2 years, with deaths up about 24% and hospitalizations about 14%. Mortality rose by 55.4% in adults aged 25-44 years, 19.1% in those aged 45-64 years, and 2.6% in those aged 65 years and older, with similar increases among males (17.0%) and females (17.8%). Deaths rose by 11.7% in the highest income quintile, as compared with 17.0%-21.5% in the other quintiles. Excess hospitalizations were highest among people aged 15-24 years (20.3%) and 25-44 years (13.1%) and increased more for females (15.6%) than for males (5.7%). Regionally, mortality increased most in the Prairie provinces (Manitoba, Saskatchewan, and Alberta; 28.1%) and British Columbia (24.2%), whereas hospitalizations increased the most in the territories (Northwest Territories, Nunavut, and Yukon; 27.3%) and the Prairie provinces (14.6%). Alcoholic liver disease was the leading cause of excess mortality and hospitalizations, which increased by 22% and 23%, respectively. Mortality and hospitalizations fully attributable to alcohol increased substantially across different demographics and regions in Canada during the April 2020 to December 2022 period of the COVID-19 pandemic. A comprehensive approach to preventing and managing high-risk drinking, alcohol use disorder, and alcoholic liver disease in the aftermath of the pandemic should comprise both public health and clinical management interventions.

Real-world analysis of the impact of timing of biomarker testing on first-line treatment choice in patients with metastatic colorectal cancer in British Columbia.

253 Background: The treatment landscape for metastatic colorectal cancer (mCRC) has evolved significantly, shifting from chemotherapy alone to more personalized approaches that include immune checkpoint inhibitors and targeted therapies. Treatment decisions in mCRC are driven by molecular characteristics, and current guidelines recommend a minimum standard of biomarker testing, such as mismatch repair (MMR) status, and RAS and BRAF mutations, at the time of metastatic disease diagnosis to guide treatment selection. This study aimed to assess the real-world implementation of biomarker testing in a contemporary cohort of mCRC patients in British Columbia (BC) and its impact on treatment decisions by medical oncologists. Methods: We conducted a retrospective chart review of patients who received first-line systemic therapy for mCRC in BC between January 2022 and December 2023. Patient demographics, tumour characteristics, and treatment details were obtained from the BC Cancer provincial pharmacy database. Medical oncology documentation and pathology reports were reviewed to determine the availability of biomarkers, including MMR status, and RAS and BRAF mutations (OncoPanel), at the time of initial medical oncology consultation, and to assess how these results influenced treatment plan. Results: To date, 71 eligible patients have been identified, with data collection ongoing. Of these, 82% had proficient MMR status, 17% had deficient MMR status, and 1% had incomplete data. RAS mutations were present in 55% of cases, while BRAF mutations were found in 21% (Table). At the time of the initial medical oncology consultation, MMR status was unavailable in 14 patients (20%), two of whom were later found to have deficient MMR status. OncoPanel results were unavailable for 63 patients (88%) at the time of the initial consultation, and in 16 of these cases (25%), the systemic therapy plan was modified once the results were received. Conclusions: Even in contemporary practice with publicly funded biomarker testing, the results for RAS and BRAF mutations were not available at the time of initial medical oncology consultation for most patients. Biomarker testing is an essential tool for guiding therapeutic decisions in mCRC. This subsequently led to treatment plan changes in one-quarter of cases after results were received. These findings highlight the importance of timely biomarker testing to ensure optimal and efficient treatment decision-making for all mCRC patients. Metastatic colorectal cancer biomarker testing. Proficient/WT Deficient/Mutated Incomplete MMR 58 12 1 RAS 29 39 3 BRAF 53 15 3

Evaluating the Role of High-Dimensional Proxy Data in Confounding Adjustment in Multiple Sclerosis Research: A Case Study.

Given the historical use of limited confounders in multiple sclerosis (MS) studies utilizing administrative health data, this brief report evaluates the impact of incorporating high-dimensional proxy information on confounder adjustment in MS research. We have implemented high-dimensional propensity score (hdPS) and high-dimensional disease risk score (hdDRS) methods to assess changes in effect estimates for the association between disease-modifying drugs (DMDs) and all-cause mortality in an MS cohort from British Columbia (BC), Canada. We conducted a population-based retrospective study using linked administrative databases from BC, including health insurance registries, demographics, physician visits, hospitalizations, prescriptions, and vital statistics. The cohort comprised 19 360 individuals with MS, followed from January 1, 1996, to December 31, 2017. DMD exposure was defined as at least 180 days of use for beta-interferon or glatiramer acetate, or at least 90 days for other DMDs. The outcome was time to all-cause mortality. We compared Cox proportional hazards models adjusting for investigator-specified covariates with those incorporating additional empirical covariates using hdPS and hdDRS methods. In the unadjusted analysis, DMD exposure was associated with a 69% lower risk of mortality (HR 0.31; 95% CI: 0.27-0.36). Adjusting for investigator-specified covariates, the adjusted hazard ratio (aHR) was 0.76 (95% CI: 0.65-0.89). HdPS analyses showed a 20%-23% lower mortality risk (aHRs: 0.77 to 0.80), while hdDRS analyses indicated a 19%-21% reduction (aHRs: 0.79 to 0.81). Incorporating high-dimensional proxy information resulted in minor variations in effect estimates compared to traditional covariate adjustment. These findings suggest that the impact of residual confounding in the question under consideration may be modest. Further research should explore additional data dimensions and replicate these findings across different datasets.

Association of Recent Traumatic Brain Injury With Subsequent Nonfatal Overdose Among People who Use Drugs in Vancouver, British Columbia, 2018 – 2020

Association of Recent Traumatic Brain Injury With Subsequent Nonfatal Overdose Among People who Use Drugs in Vancouver, British Columbia, 2018 – 2020

Implementation of risk mitigation prescribing during dual public health emergencies: A qualitative study among Indigenous people who use drugs and health planners in Northern British Columbia, Canada.

In response to the dual public health emergencies of COVID-19 and the overdose crisis, the Government of British Columbia (BC) introduced risk mitigation prescribing, or prescribed safer supply. In the context of colonialism and racism, Indigenous people are disproportionately impacted by substance use harms and experience significant barriers to receiving care, particularly those living in rural and remote communities. As part of a larger provincial evaluation, we sought to assess the implementation of risk mitigation prescribing as experienced by Indigenous people who use drugs (IPWUD) in Northern BC. We used the Consolidated Framework for Implementation Research and the First Nations Perspective on Health and Wellness as conceptual frameworks to guide the study. In partnership with people with lived/living experience, we conducted 20 qualitative interviews with IPWUD. Data were supplemented by four interviews with health planners and analyzed thematically. Participants reported limited implementation of risk mitigation prescribing in Northern BC, with unique regional challenges and innovative facilitators to access. Analysis of supplementary health planner data was consistent with the experiences of IPWUD and together provided a comprehensive picture of implementation in Northern BC. Four themes emerged: 1) Northern socio-politico-cultural barriers to implementation (outer setting), 2) rural and remote healthcare delivery challenges (inner setting), 3) adaptability of risk mitigation prescribing on Northern wellness (intervention characteristics), and 4) Northern ingenuity, relationality and champions facilitating access (implementation process). Implementation and access to risk mitigation prescribing in Northern BC was limited, with region-specific applicability challenges and a health service delivery model that was not able to sufficiently meet the unique service needs of IPWUD. Demonstrating Northern ingenuity, peer groups, harm reduction community champions, and telehealth services were identified as stopgap measures that promoted access and reduced inequitable implementation within the region.

Microplastic distribution and composition in mudflat sediments and varnish clams (Nuttallia obscurata) at two estuaries of British Columbia, Canada: An assessment of potential anthropogenic sources

Widespread microplastic contamination affects the marine-coastal ecosystems in British Columbia, Canada. To understand the characteristics and spatial distribution of of microplastics (MPs), we compared the MPs in sediments (n = 159) and Varnish clams (Nuttallia obscurata; n = 160) collected from two estuarine ecosystems (Cowichan and K'ómoks) experiencing different anthropogenic impacts; primarily resource extraction (i.e., logging) at Cowichan and urban development at K'omoks. Our objective wasto determine the MP abundance levels in sediments and clams and infer possible sources of MPs at the two estuaries. Microplastic polymer type was confirmed through FTIR spectrometry. The average abundance of MPs in sediments were 14.37 ± 11.57 particles/kg in the Cowichan Estuary and 30.96 ± 14.58 particles/kg in the K'ómoks Estuary. Varnish clam samples contained average abundance of 3.62 ± 2.58 particles/g and 2.24 ± 1.96 particles/g in Cowichan and K'ómoks estuaries, respectively. The Cowichan Estuary's marine terminal and K'ómoks Marina were found to be hotspots for MPs, likely due to a combination of industrial and local sources. Fibers were the most common type of MPs found in both sediment (53.34 %) and clam samples (53.5 %) from Cowichan, as well as in clam samples in% K'ómoks, indicating a potential link to textile sources contributing to the widespread presence of MPs in the marine environment. There was no clear signal based on the primary use of the estuary. Polyethylene was the predominant polymer type of MPs found in sediment and clam samples at Cowichan, whereas Polyester was most common at K'ómoks. Our study revealed the ubiquitous nature of these emerging pollutants in the sensitive estuarine environments of BC, with implications for plastic waste management and the reduction of plastic pollution at the regional level.

WCN25-1928 Clustering patients with chronic kidney disease based on routinely measured laboratory biomarkers and its association with disease progression; findings from a population level feasibility study from British Columbia, Canada

WCN25-1928 Clustering patients with chronic kidney disease based on routinely measured laboratory biomarkers and its association with disease progression; findings from a population level feasibility study from British Columbia, Canada

Applying baseflow approach to the environmental flow needs of the Similkameen River Watershed in British Columbia, Canada

Applying baseflow approach to the environmental flow needs of the Similkameen River Watershed in British Columbia, Canada

Mitigation of decline with virtual exercise with lung cancer (MoVE with lung cancer) - A promising approach to enhance physiological strength, improve body composition, and build upon current evidence.

Exercise can mitigate declines in physical function for patients with cancer, but in-person exercise programs for patients with advanced lung cancer often face low recruitment and retention. This prospective study assessed the feasibility of virtual exercise for patients with advanced lung cancer. Mitigation of decline with Virtual Exercise (MoVE) with Lung Cancer was a prospective, single-arm, feasibility study. Patients with advanced lung cancer undergoing systemic therapy in British Columbia, Canada participated in a 12-week group exercise program delivered twice weekly via Zoom. Feasibility measures included accrual, recruitment rate, attendance, adherence, attrition, adverse events, and group belongingness. Efficacy was assessed via effect on physical function, cardiovascular fitness, body composition, and quality of life (QoL). Twenty-seven patients were enrolled (median age=66years). Most had adenocarcinoma (92%) and were on targeted therapy (73%). Recruitment rate was 61%, attrition 4%, attendance 87%, and adherence 96%. Significant improvements were seen in gait speed (Z=2.759, p=0.006), 30-second chair stand (Z=3.810, p<0.001), 30-second bicep curl (Z=4.209, p<0.001), 8-foot timed up and go (Z=-3.148, p=0.002), six minute walk test (Z=3.124, p=0.002), and QoL (FACT-G post hoc p=0.005). Participants' skeletal muscle index increased by 0.9cm2 (p=0.033). Participant satisfaction was high (4.6/5). A 12-week virtually supervised exercise program for patients with advanced lung cancer showed high attendance and adherence, with significant improvements in physical function and positive participant feedback. These results demonstrate that physical function can be maintained or improved during systemic treatments for advanced lung cancer.

Occupational health impacts of climate-related emergency events on health system workers in British Columbia

Occupational health impacts of climate-related emergency events on health system workers in British Columbia

Person-Days Under Emergency Order: A Research Brief on Wildfire and Flood Evacuation Mandates in British Columbia

Person-Days Under Emergency Order: A Research Brief on Wildfire and Flood Evacuation Mandates in British Columbia

Pyrite geochemistry for deposit type prediction and exploration in the Golden Triangle, northwest British Columbia, Canada

Pyrite geochemistry for deposit type prediction and exploration in the Golden Triangle, northwest British Columbia, Canada

Criminalizing public space through a decriminalization framework: The paradox of British Columbia, Canada.

This commentary explores a recent shift in British Columbia's drug policy under a novel drug "decriminalization" framework. We focus on the province's move toward "recriminalization" under this framework. In short, recriminalization was a shift in BC's drug decriminalization framework to only apply in private residences, and be removed from essentially all outdoor spaces. This policy change was completed through an agreement with the federal government amid a public health emergency. Since 2016, BC has faced a severe crisis of drug-related overdoses and poisonings, driven by a toxic and unregulated drug supply compounded by prohibitionist policies. Expert recommendations for increasing access to a regulated drug supply have repeatedly dismissed as solutions by the governing BC New Democratic Party, opting instead for measures that do not undercut the toxic drug supply. We examine the sociolegal context of the BC government decision to recriminalize drug use in 2024, including attempts to criminalize recent drug use and police suspicion of substance use. These drug law reforms, understood here as forms of biopolitical violence, reflect a broader trend of using drug policies as tools for social and spatial regulation. By analyzing the sociolegal implications of these policies, the commentary situates the BC government's actions within a framework of sanctioned biopolitical massacre, highlighting the tension between purported decriminalization efforts and the actual enforcement strategies that perpetuate harm and exclusion. This examination underscores the complex interplay between drug policy, public health crises, and state power in the context of systemic colonial and racialized control that may be adaptable to other regions considering drug law reform.