British Columbia Population Research Articles

Syndemic association of COVID-19 diagnosis with diabetes across socio-demographic disparities in British Columbia (BC) population, 2020–2021

Syndemic association of COVID-19 diagnosis with diabetes across socio-demographic disparities in British Columbia (BC) population, 2020–2021

Using novel methodology to estimate the prevalence of mental disorders in British Columbia, Canada.

A needs-based model of health systems planning uses a systematic estimate of service needs for a given population. Our objective was to derive annual prevalence estimates of specific mental disorders in the adult population of British Columbia, Canada and use a novel triangulation approach encompassing multiple data sources and stratifying these estimates by age, sex, and severity to inform Ministry partners, who commissioned this work. We performed systematic literature reviews and subsequent meta-analyses to derive an annual prevalence estimate for each mental disorder. We then generated age- and sex-specific estimates by triangulating published epidemiological studies, routinely collected province-wide health administrative data, and nationally representative health survey data sources. The age- and sex-specific estimates were further stratified by severity using the Global Burden of Disease severity distributions and published literature. Anxiety disorders had the highest annual prevalence estimates (6.93%), followed by depressive disorders (6.42%). All other mental disorders had an annual prevalence of less than 1%. Prevalence estimates were consistently higher in younger age groups. Depressive disorders, anxiety disorders, and eating disorders were higher in women, while estimates for bipolar disorders, schizophrenia, and ADHD were slightly higher in men in younger age groups. We generated robust annual prevalence estimates stratified by age, sex, and severity using a triangulation approach. Variation by age, sex, and severity implies that these factors need to be considered when planning for mental health services. Our approach is replicable and can be used as a model for needs-based planning in other jurisdictions.

Trapping mortality accelerates the decline of the fisher, an endangered mesocarnivore, in British Columbia, Canada

Understanding the environmental, demographic, and anthropogenic factors driving the population dynamics of endangered species is critical to effective conservation. Habitat loss, fragmentation, and trapping all have been linked to declines in the endangered population of fishersPekania pennantiin central British Columbia (BC), Canada, hereafter referred to as the Columbian population. Although the commercial trapping season for fishers has recently been closed in central BC, the animals are still taken in traps legally set for other furbearer species, and with this continuing source of mortality, the sustainability of this vulnerable population remains unclear. We constructed population viability models in the program Vortex to evaluate the specific impacts that trapping mortality would have on Columbian fisher population persistence under different trapping scenarios. Our modeling predicted that current mortality sources, including deaths in traps set for other species, will cause the population to disappear within 11 yr. When fur harvest mortality was removed from our modeling, the Columbian population appeared unlikely to persist beyond 37 yr. Our analysis provides evidence that along with the continued trapping closure for fishers in central BC, it is likely necessary to modify trapping regulations and methods (including restricting the use of kill traps) for other furbearers within Columbian fisher range to sufficiently reduce mortality from bycatch and help to avoid extirpation of the population in the near future. Additionally, identifying areas where fishers are actively breeding and protecting these habitats from further disturbances will be needed to increase survival and reproductive rates to levels high enough to reverse population declines over the longer term.

Item Has Been Withdrawn

ObjectivesApproximately 70% of people in British Columbia’s provincial prisons have mental health and/or substance use disorders. Many serve short sentences, and cycle frequently between corrections and community. This study examines mental health (MH) services access and reincarceration among people with a mental illness released from British Columbia’s provincial prisons.
 ApproachA 20% random sample of the general population of British Columbia (BC) (N=1,089,682) contained within BC’s Provincial Overdose Cohort was used. People who had a record of release from a provincial correctional centre between January 1 2015- December 31st 2018, and a mental illness diagnosis in the year prior to release were eligible for inclusion (N=3,907). MH services access was determined using primary care, hospitalization and emergency department records, and reincarceration and additional covariates were retrieved from linked provincial health and corrections records. Hazards of MH services access and reincarceration were calculated using state arrival extended cox proportional hazards models.
 ResultsOf the 3907 releases, 45.9% (N=1795) had MH services access following release, while 40.5% (N=1584) ended in reincarceration without MH services access. The remaining releases were censored prior to observing either outcome. Of those with MH services access, 59.4% (N=1067) ended in subsequent reincarceration. The hazard of reincarceration was elevated for people with concurrent substance use disorder, among both people who did (HR: 1.33 (95%CI: 1.13-1.57) and did not (HR: 1.55(95%CI: 1.22-1.81)) access MH services prior to reincarceration. MH services access had a protective effect on reincarceration (HR: 0.64 (95%CI:0.42-0.99)). Timeliness of MH services access was protective, such that each additional month that passed between release and subsequent MH services access was associated with a 5% increase in the hazard of reincarceration (HR: 1.05(95%CI: 1.02-1.08)).
 ConclusionMental health services access upon release from prison reduces risk of reincarceration. The timeliness of services access plays a critical role in reducing return to reincarceration. Efforts targeted at increasing accessibility of timely mental health services for this population can support increase individual well-being an reduce reincarceration.

A large linked data platform to inform the COVID-19 response in British Columbia: The BC COVID-19 Cohort.

ObjectivesThe COVID-19 pandemic has necessitated access to large health system datasets to inform the public health response. To meet this need, the Provincial Health Services Authority and the British Columbia (BC) Ministry of Health collaborated to create a population-based platform that integrates COVID-19 datasets with sociodemographic and administrative health data.
 ApproachA BC COVID Data Library proof-of-concept was created as a cloud-based, dynamic platform composed of de-identified datasets. The BC COVID-19 Cohort (BCC19C) represents a subset composed of people accessing COVID-19 health services (e.g., testing, vaccination) and linked health histories. Provincial COVID-19 datasets are updated daily and include COVID-19 lab tests, case surveillance, vaccinations and hospitalizations/deaths. These can be linked to administrative data holdings for the BC population, which are updated weekly/monthly and include vital statistics, medications, hospital admissions, medical visits, among others. A patient matching algorithm creates unique patient keys that allows the same individual to be linked across datasets.
 ResultsThe BCC19C has been used provincially to 1) support ongoing surveillance, reporting, and modelling of COVID-19; 2) describe and characterize the epidemiology of COVID-19; and 3) inform acute care planning, public health interventions and health care services in BC. Ongoing and completed BCC19C analyses include assessment of vaccine safety, vaccine effectiveness, and characteristics associated with infection and severe outcomes; use of medical visit data for syndromic surveillance and monitoring of unintended outcomes of the pandemic (e.g., mental health visits); and characterization of long-COVID. Availability of linked administrative data holdings has been crucial for identifying non-COVID control groups, measuring sociodemographics and co-morbidities, and complementing COVID-19 datasets for more complete capture of health outcomes (e.g., deaths, hospitalizations).
 ConclusionsThe large scope/breadth and timeliness of the linkable datasets integrated within the COVID Data Library and the BCC19C has supported the public health response in BC. Additional linkage to other data sources will further strengthen this data platform.

Characterizing intentions to receive the COVID-19 vaccine among the general population in British Columbia based on their future intentions towards the seasonal influenza vaccine

IntroductionThis study assessed the relationship between intention to receive a COVID-19 vaccine and intention to receive a seasonal influenza vaccine, as well as how intention to receive a COVID-19 vaccine has changed during the pandemic. MethodsResidents of British Columbia aged 25–69 years were invited to complete an online cross-sectional survey from August 2020 - March 2021. Mixed-effects logistic regression models assessed the relationship between intention to receive a COVID-19 vaccine and intention to receive the seasonal influenza vaccine. A generalized additive mixed model was used to investigate changes in COVID-19 vaccine intention during the pandemic (August 2020–March 2021). The relationship between intention to receive a COVID-19 vaccine and retrospective overall perceived value of vaccines prior to and during the pandemic was also considered. ResultsOf 6,333 participants, 80.2 % of participants were ‘somewhat or very likely’ to receive a COVID-19 vaccine and 69 % of participants reported intending to receive a seasonal influenza vaccine. In multivariable modeling, intention to receive a COVID-19 vaccine was strongly associated with intention to receive a seasonal influenza vaccine (aOR = 4.25, 95 %CI 3.33–5.43). Intention to receive a COVID-19 vaccine increased over the study period (p < 0.0001), with the largest increase coinciding with the announcement of forthcoming approvals of COVID-19 vaccines in November 2020 (aOR = 1.45, 95 %CI 1.11–1.91). ConclusionIntention to receive the COVID-19 vaccine was associated seasonal influenza vaccine intention, which is an important relationship to measure for implementation and future planning of COVID-19 booster doses. We found an increase in the intention to receive a COVID-19 vaccine after public announcements of forthcoming vaccine approval, which highlights the importance of ongoing monitoring and reporting of vaccine uptake, and the potential impact of emerging vaccine safety and efficacy information may have on vaccine acceptance.

First record of Vespa crabro Linnaeus (Hymenoptera: Vespidae) in western North America with a review of recorded species of Vespa Linnaeus in Canada.

Vespa crabro Linnaeus is newly reported as an adventive species in British Columbia, Canada which is the first record of this invasive species in western North America. The specimen of V. crabro was identified using morphological diagnostic keys and by comparison to authoritatively identified specimens. DNA barcoding provided support that the British Columbia specimen is conspecific with sequenced specimens of V. crabro. It is not possible to be certain of the origin of the specimen, but the DNA barcode was identical to sequence from specimens of V. crabro from South Korea. DNA barcoding was also performed on morphologically identified specimens of Vespa simillima and Vespa soror collected previously in British Columbia and the sequences were closest to V. simillima and V. soror Genbank sequences, respectively. There is no evidence that any of these species have established populations in the province. We provide diagnostic morphological characters to distinguish Canadian Vespa species from each other including Vespa mandarinia which has recently established populations in British Columbia and Washington State, USA. The potential detrimental impacts of each species are discussed.

Gene expression in male and female stickleback from populations with convergent and divergent throat coloration.

Understanding of genetic mechanisms underlying variation in sexual dichromatism remains limited, especially for carotenoid‐based colors. We addressed this knowledge gap in a gene expression study with threespine stickleback. We compared male and female throat tissues across five populations, including two in which female red coloration has evolved convergently. We found that the expression of individual genes, gene ontologies, and coexpression networks associated with red female color within a population differed between California and British Columbia populations, suggesting differences in underlying mechanisms. Comparing females from each of these populations to females from populations dominated by dull females, we again found extensive expression differences. For each population, genes and networks associated with female red color showed the same patterns for males only inconsistently. The functional roles of genes showing correlated expression with female color are unclear within populations, whereas genes highlighted through inter‐population comparisons include some previously suggested to function in carotenoid pathways. Among these, the most consistent patterns involved TTC39B (Tetratricopeptide Repeat Domain 39B), which is within a known red coloration QTL in stickleback and implicated in red coloration in other taxa.

Adaptation to climate change through seasonal migration revealed by climatic versus demographic niche models.

Predicting the geographic range of species and their response to climatic variation and change are entwined goals in conservation and evolutionary ecology. Species distribution models (SDMs) are foundational in this effort and used to visualize the geographic range of species as the spatial representation of its realized niche. SDMs are also used to forecast range shifts under climate change, but often in the absence of empirical evidence that climate limits population growth. We explored the influence of climate on demography, seasonal migration, and the extent of the geographic range in song sparrows (Melospiza melodia), a species thought to display marked local adaptation to regional climate. To do so, we developed SDMs to predict the demographic and climate niches of migratory and resident song sparrows across our study area in western North America from California to Alaska, using 48years of demographic data from a focal population in British Columbia and 1.2million continental-scale citizen science observations. Spatial agreement of our demographic and climate niche models in the region of our focal population was strong (76%), supporting the hypothesis that demographic performance and the occurrence of seasonal migration varied predictably with climatic conditions. In contrast, agreement at the northern (58%) and southern (40%) extents of our study area was lower, as expected if the factors limiting population growth vary regionally. Our results support the hypothesis that local climate drives spatial variation in the occurrence of seasonal migration in song sparrows by limiting the fitness of year-round residents, and suggest that climate warming has favored range expansions and facilitated an upward shift in elevational range song sparrows that forgo seasonal migration. Our work highlights the potential role of seasonal migration in climate adaptation and limits on the reliability of climate niche models not validated with demographic data.

IDF21-0131 What Is Driving Diabetes and Diabetes Complications in British Columbia (BC), Canada?

Background: British Columbia (BC) is a Western Canadian province with 5.02 million people, ethnic diversity (Aboriginal, Chinese, South Asian) & >70% rural/remote/isolated geography. For 40 years, intermittent efforts in BC & Canada to improve chronic disease & diabetes management had little positive effect. Ideally, healthcare services & planning should be driven by strong data & evidence. No integrated system exists in BC to track, study, understand, manage & improve diabetes care. No comprehensive BC diabetes environmental scan has ever been conducted before. Aim: The BC Provincial Diabetes Evaluation is a quality improvement project to identify & better understand major gaps/barriers; & practical solutions for data-driven diabetes care management redesign in BC; so that all 470,000 diabetes people receive improved, timely, appropriate, cost-effective care that is locally/culturally/ethnically-sensitive, no matter where they live in BC. Method:1.Retrospective, open quantitative multi-source data analysis2.Prospective, open qualitative data analysis3.Knowledge Translation phase including Diabetes Heat Maps with diabetes performance measures; co-morbidities (*CKD, CAD, CHF); major procedures/surgeries (*renal dialysis, cardiac PCI, lower limb amputation) Results: BC’s geographical, socio-economic & lifestyle factors are drivers of diabetes & complications (by each of BC geographical health authority): • Fraser Health Authority (FHA): with BC’s highest population density, diabetes incidence & prevalence driven by BC's 2nd highest immigrant, non-English-speaking (ESL); highest South Asian population; & unhealthy lifestyle (diet, obesity, physical inactivity)#; associated with BC’s 2nd highest diabetes complications*, hospitalization cost & premature mortality; with an overall younger FHA population. • Northern Health Authority (NHA): with BC’s 2nd highest diabetes incidence & prevalence driven by highest rurality (64% of BC’s land mass), Aboriginal, low-education population; lifestyle# & smoking; associated with BC’s 2nd highest diabetes complications* & highest premature mortality; with an overall younger NHA population. • Vancouver Coastal Health Authority (VCHA): with BC’s highest immigrant, ESL, Chinese, low-income population; 2nd highest South Asian & BC population density; offset by a younger, healthier VCH population; associated with mid-range diabetes incidence & prevalence; & BC’s highest hospitalization cost. • Vancouver Island Health Authority (VIHA): BC’s highest elderly population; mid-range rurality, Aboriginal, immigrant, low-income population; associated with 2nd lowest incidence & prevalence; & BC’s lowest hospitalization cost. • Interior Health Authority (IHA): with BC’s 2nd highest elderly, Aboriginal, low-education population living alone; 2nd highest rurality; lowest ESL population; associated with BC’s lowest diabetes incidence & prevalence. Discussion: Substantial variation exists between BC's 5 geographical health authorities for diabetes outcomes, health determinants & cost. The current state of diabetes as an ambulatory-care-sensitive-condition indicates an inadequate primary healthcare system throughout BC & Canada. Barriers to accessing diabetes resources contributed to 80% of diabetes care provided by GPs in BC & Canada. BC has a higher reliance on physicians & lower usage of allied healthcare providers for diabetes care than other provinces. Without coordinated BC provincial diabetes care planning or services, a fragmented, non-standardized, patchwork system has resulted with negative health outcomes & high impact on BC's entire healthcare system (similar across Canada). Our BC Provincial Diabetes Evaluation Knowledge Translation findings will help with diabetes care management redesign; & improve the trajectory of diabetes, outcomes & healthcare utilization in BC.

Cost-Effectiveness of Molecularly Guided Treatment in Diffuse Large B-Cell Lymphoma (DLBCL) in Patients under 60.

Simple SummaryDiffuse large B cell Lymphoma (DLBCL) can be categorized into cell of origin (COO) subtypes. Genetic tests are used to detect which subtype of DLBCL a patient has. One subtype of DLBCL, activated B-cell like (ABC), is associated with a comparatively poorer prognosis. New evidence suggests that patients under 60 with ABC-DLBCL may benefit from ibrutinib added to their standard care treatment regimen. Genetic testing and treatments like ibrutinib can be costly to publicly funded healthcare systems. Here, we report a cost-effectiveness analysis of the addition of Ibrutinib to treat patients under the age of 60 with ABC-DLBCL. Our analysis found that the use of genetic testing to diagnose ABC-DLBCL and providing ibrutinib along with standard care treatment has a low to moderate probability of being cost-effective, depending on decision maker willingness to pay and the cost of the genetic test.Background: Classifying diffuse large B-cell lymphoma (DLBCL) into cell-of-origin (COO) subtypes could allow for personalized cancer control. Evidence suggests that subtype-guided treatment may be beneficial in the activated B-cell (ABC) subtype of DLBCL, among patients under the age of 60. Methods: We estimated the cost-effectiveness of age- and subtype-specific treatment guided by gene expression profiling (GEP). A probabilistic Markov model examined costs and quality-adjusted life-years gained (QALY) accrued to patients under GEP-classified COO treatment over a 10-year time horizon. The model was calibrated to evaluate the adoption of ibrutinib as a first line treatment among patients under 60 years with ABC subtype DLBCL. The primary data source for efficacy was derived from published estimates of the PHOENIX trial. These inputs were supplemented with patient-level, real-world data from BC Cancer, which provides comprehensive cancer services to the population of British Columbia. Results: We found the cost-effectiveness of GEP-guided treatment vs. standard care was $77,806 per QALY (24.3% probability of cost-effectiveness at a willingness-to-pay (WTP) of $50,000/QALY; 53.7% probability at a WTP of $100,000/QALY) for first-line treatment. Cost-effectiveness was dependent on assumptions around decision-makers’ WTP and the cost of the assay. Conclusions: We encourage further clinical trials to reduce uncertainty around the implementation of GEP-classified COO personalized treatment in this patient population.

Implementation of the BC Congenital Anomalies Surveillance System (BCCASS).

Congenital anomalies (CAs) can cause lifelong morbidity and accounted for 23.2% of infant deaths from 2003 to 2007. In British Columbia (BC), surveillance of CAs has been irregular since the early 2000s. To enhance CAs surveillance in BC, the Public Health Agency of Canada has provided funding for the implementation of the BC Congenital Anomalies Surveillance System (BCCASS). BCCASS is a population-based surveillance system. The system leverages existing administrative data sources that capture information regarding vital events, disease status, drug prescription, and healthcare utilization. The system uses a series of algorithms to capture specific CAs diagnoses, some of which are further validated with the support of the Provincial Advisory Committee. This Advisory Committee is a multi-stakeholder coalition that includes the BC Office of the Provincial Health Officer, subject matter experts, data partners, users, and academia, and acts to provide support, expertise, and strategic guidance to BCCASS. Through BCCASS, prevalence and historical trends for 35 CAs in BC are available. Information pertaining to maternal place of residence, risk, and protective factors can be used for association studies such as links to environmental hazards and cluster analysis. BCCASS is a cost-effective and sustainable system that leverages existing data sources necessary to understand the overall burden of CAs across the BC population. This is fundamental to support data-driven decisions around policy development, program planning, and evaluation of preventive measures. Strong coalitions with stakeholders are instrumental to ensure successful implementation and expansion in the future.

Variation in age of primiparity in mountain goats (Oreamnos americanus) estimated from horn growth increments

Variation in age of primiparity is important for population dynamics and wildlife management because it can affect population growth. Using a novel technique based on the trade-off between annual horn growth and reproduction, we estimated the age of primiparity for 2274 female mountain goats (Oreamnos americanus (Blainville, 1816)) harvested across British Columbia, Canada, from 1976 to 2019. We then investigated spatio-temporal variation in the probability that harvested females were primiparous when aged 3, 4, or 5 years and older using Bayesian ordinal regressions. We found that the probability of primiparity at 3 years decreased over time in nearly all mountain ranges. In the Coastal Mountain range, however, the probability of primiparity at age 3 significantly increased. These results suggest that the large coastal populations of mountain goats could be more resilient to harvest than other populations in British Columbia, which may be experiencing environmental effects promoting later primiparity. Models predicting age of primiparity from annual growth measures are a valuable tool for wildlife management and could help conservation of many species.

COVID Vaccination Rates in Children and Adults with Sickle Cell Disease in British Columbia, Canada

Background: Persons with Sickle Cell Disease (SCD) infected with the SARS CoV-2 virus have significantly increased risks of hospitalization and death and are strongly recommended to be fully vaccinated. Vaccine hesitancy has previously been described in the SCD population and uptake of other recommended vaccines has been reported to be low in some studies. The goal of this study was to assess how vaccination rates amongst eligible pediatric and adult SCD patients in British Columbia (BC), Canada, compared to those of the general population and other “clinically extremely vulnerable” (CEV) groups.Methods: Persons age 12 and over with SCD in BC were identified as a CEV population and prioritized for immunization. A comprehensive process was undertaken to find and identify all CEV patients in BC and notify them of their priority status. Individuals diagnosed with SCD in the province were identified in the shared pediatric and adult patient registry (iCHIP), which tracks demographics, diagnoses and therapies, and added to the CEV patient list. SCD patients were notified of their priority status through standard mail from the provincial health officer, as well as emails and phone calls from the pediatric and adult SCD programs. Those aged 16+ were invited to register for immunization beginning in March 2021 while those 12-15 years were permitted to register starting in May 2021. Adult patients were eligible to receive mRNA vaccines from Pfizer and Moderna as well as the Astra-Zeneca (AZ) COVISHIELD vaccine, while those aged 12-17 were eligible only for Pfizer vaccines. The provincial immunization registry (PIR) was interrogated to confirm vaccine administration. The main outcome measure was the proportion of SCD patients who received 1st and 2nd dose COVID vaccines.Results: 138 individuals age 12+ with SCD were identified in the iCHIP database. 71.0% had Sickle Cell Anemia (SCA), 25.4% had Hemoglobin SC (Hb SC) and 3.6% had other genotypes. Participants ranged in age from 12-69 years with a median of 28 years. 67.4% were receiving disease-modifying therapy (76 were on hydroxyurea, 11 on regular red cell exchange, 1 was receiving crizanlizumab, and 5 with Hb SC were phlebotomized). None were treated with gene therapy or transplant. 7 individuals had a PCR-confirmed SARS CoV-2 infection prior, but none following immunization.As of July 30, 2021: 68.8% of persons with SCD received a 1st and 55.1% received a 2nd dose of COVID vaccine. Almost all doses were mRNA-based vaccines with the exception of a single 1st dose administration of AZ. Vaccination rates amongst different age ranges and genotypes are displayed in Table 1. Patients with SCA did not have significantly different vaccination rates compared to those with Hb SC/other genotypes: 64.3% versus 80.0% for 1st dose (p=0.0703) and 48.0% versus 62.5% (p =0.12114) for 2nd dose.Vaccination rates amongst the SCD group were compared to other age matched CEV populations as well as the general provincial population and are detailed in Tables 2 and 3. A higher proportion of persons with SCD under the age of 20 received 1st dose (70.8% versus 31.1%; p<0.00001) and 2nd dose (50.0 versus 15.3%; p <0.00001) of vaccines compared to the general population. However, a lower proportion age 20-49 and 50+ years old received a 1st dose as demonstrated in Table 2. In addition, lower proportions of persons with SCD of all age ranges were vaccinated in comparison to other CEV groups. As demonstrated in Table 3, SCD was not associated with receiving a 1st dose vaccine compared to the general BC population (OR 0.8, 0.56 to 1.16 95% CI, p=0.2481). In contrast, persons in other CEV groups were twice as likely to receive a first dose COVID immunization compared to the general BC population (p<0.0001).No severe vaccine-related complications including vaccine-induced immune thrombotic thrombocytopenia (VITT) were reported. There were 7 presentations to hospital for vaso-occlusive crises (VOC) within 21 days of immunization.Conclusion: Despite an active CEV process to find and invite persons with SCD to be vaccinated, these data demonstrate that vaccination rates amongst persons with SCD in BC are below those of other CEV age-matched groups. Vaccination rates amongst adults are also lower than the general population, however there is a high vaccination rate in persons under 20 years old. A subsequent qualitative study exploring COVID vaccine hesitancy amongst persons with SCD in BC is being explored. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

“The Strengths of Our Community and Our Culture”

While cultural continuity has been identified as an important Indigenous determinant of health, there is limited qualitative research that has sought to understand the meaning and context of cultural continuity for First Nations, Inuit, and Métis people in Canada. Specifically, despite reported disparities in mental health for the Métis population in British Columbia (BC) and elsewhere—as well as challenges that many Métis people face in maintaining cultural connectedness—cultural continuity research with Métis communities remains largely ignored. This qualitative study explores Métis people’s experiences and conceptualizations of mental health and cultural continuity through conversational interviews, analyzed to understand the overarching themes within a Métis worldview. From this analysis, three themes are presented within the scope of this paper: Métis stories of culture, identity, and mental health; the importance of community; and intergenerational knowledge transmission. This research speaks to the important role that cultural continuity plays in shaping Métis journeys with mental health. There is a need for continued support for the maintenance of Métis cultural practices, language revitalization, and Elder-youth engagement opportunities for increased cultural continuity for Métis people, families, and communities in BC.

Simulated waterborne transmission of infectious hematopoietic necrosis virus among farmed salmon populations in British Columbia, Canada following a hypothetical virus incursion

Infectious hematopoietic necrosis (IHN) virus is a rhabdovirus of significant concern to the salmon aquaculture industry in British Columbia (BC). IHN epidemic events in BC have historically resulted in high mortalities and economic losses among farmed salmon populations. A viral disease management plan (VDMP) was developed by salmon companies in BC in, 2010 and implemented during the 2012 IHN outbreak in BC with a positive outcome; however, to date the effectiveness of VDMP practices in managing IHN epidemics on a coast-wide scale has not been formally evaluated. Therefore, we developed a model to simulate the waterborne incursion and spread of IHN virus into salmon farms across the BC coast. The model was developed using the DTU-DADS-Aqua modelling framework and model processes were designed to reflect the epidemiology of IHN, along with farm management and disease mitigation protocols currently implemented in BC. The model was used to assess effectiveness of the VDMP compared with alternative mitigation approaches. Model results quantified the combined and individual effects of disease surveillance, detection efforts, depopulation measures, and vaccine efficacy in reducing IHN virus transmission. Model outputs indicated the need for use of multiple mitigation measures in combination for a highly effective reduction in spread. Furthermore, the use of an IHN vaccine with high population coverage and efficacy, and the implementation of surveillance zones and pre-emptive depopulation of all net-pens in IHN-infected farms are crucial to contain IHN epidemics. A comparison between simulated model scenarios showed that current VDMP practices were effective in both limiting the spread and mitigating IHN epidemics across the BC coast. The model can be used to inform policy decisions in aquaculture and siting of marine farms, and provides insights to limit the magnitude of IHN epidemics in farmed salmon populations.

Prevalence of joint-specific osteoarthritis and joint pain in British Columbia, Canada.

The objective is to determine the prevalence of self-reported physician-diagnosed osteoarthritis (OA) and musculoskeletal symptoms (pain, stiffness or discomfort) in specific joints among adults in British Columbia (BC), Canada. We carried out a cross-sectional mixed-mode survey in a random population sample of persons 18years of age and older. Estimates were weighted to reflect the age and sex distribution of the population of BC. We obtained responses from 2,233 individuals. Overall, 18.4% (95% CI 16.8-20.1) of the adult population reported OA. Of those, more than 40% had OA in multiple sites. Prevalence ranged from 8.8% (95% CI 7.6-10.1) in the knee to 2.7% (2.1-3.5) in the foot. One-year prevalence of symptoms ranged from 49.1% (47.0-51.2) in the lower back to 23.3% (21.5-25.1) in the hip. Females reported more symptoms and OA than males in all joints. The most common site of self-reported physician-diagnosed OA in BC is the knee, but OA in the hands, hips, and feet is also common. Having OA in one joint is a strong predictor of OA in other joints.

Migration and non-breeding ecology of the Yellow-breasted Chat Icteria virens

Detailed information spanning the full annual cycle is lacking for most songbird populations. We examined breeding, migration, and non-breeding sites for the Yellow-breasted Chat (Icteria virens, chat). We deployed archival GPS tags and light-level geolocators on breeding chats in British Columbia and light-level geolocators in California from 2013 to 2017 to determine migration routes and non-breeding sites. We examined whether chats overwintered in protected areas and characterized the percent of land cover within 1 km. We used a combination of genetics and stable hydrogen isotopes from feathers collected on non-breeding chats in Nayarit, Mexico (2017–2019) and migrating chats in Chiapas, Mexico (2018) and Veracruz, Mexico (2014–2015) to determine subspecies and infer breeding location. Endangered chats in British Columbia followed the Pacific Flyway and spent the non-breeding period in Sinaloa and Nayarit, Mexico. Two out of five chats spent the non-breeding period in protected areas, and the most common landcover type used was tropical or subtropical broadleaf deciduous forest. We found no mixing of eastern and western chats in our Mexico sites, suggesting strong migratory connectivity at the subspecies level. Western chats likely originating from multiple breeding latitudes spent the non-breeding period in Nayarit. Eastern Yellow-breasted Chats likely breeding across various latitudes migrated through Veracruz and Chiapas. Our results provide precise migration routes and non-breeding locations, and describe habitat cover types for chats, notably an endangered population in British Columbia, which may be valuable for habitat protection and conservation efforts.

Correction: Nurse home visiting and prenatal substance use in a socioeconomically disadvantaged population in British Columbia: analysis of prenatal secondary outcomes in an ongoing randomized controlled trial.

Correction: Nurse home visiting and prenatal substance use in a socioeconomically disadvantaged population in British Columbia: analysis of prenatal secondary outcomes in an ongoing randomized controlled trial.

Use of community healthcare and overdose in the 30 days following release from provincial correctional facilities in British Columbia

BackgroundInterruptions in healthcare services contribute to an elevated risk of overdose in the weeks following release from incarceration. This study examined the association of use of community healthcare with nonfatal and fatal overdose in the 30 days following release. MethodsWe conducted a retrospective cohort study using linked administrative data from a random sample of 20% of the population of British Columbia. We examined releases from provincial correctional facilities between January 1, 2015–December 1, 2018. We fit multivariate Andersen-Gill models to examine nonfatal overdoses after release from incarceration and applied Standard Cox regression for analyses of fatal overdoses. ResultsThere were a combined 16,809 releases of 6721 people in this study. At least one overdose occurred in 2.8% of releases. A community healthcare visit preceded the first nonfatal overdose in 86.4% of releases with a nonfatal overdose event. Only 48.4% of people who had a fatal overdose used community healthcare. In adjusted analysis, people who had used community healthcare had a higher hazard of healthcare-attended nonfatal overdose (aHR 2.83 95% CI 2.13, 3.78) and lower hazard of fatal overdose (aHR 0.58, 95%CI 0.28, 1.19). ConclusionsCommunity healthcare visits after release from custody may be an important opportunity to provide overdose prevention and harm reduction supports. Policies and resourcing are needed to facilitate better connection to primary healthcare during the transition to community. Providers in community should be equipped to offer care to people who have recently experienced incarceration in a way that is accessible, acceptable and trauma-informed.