Comorbid Depression Among Untreated Illicit Opiate Users : Results From a Multisite Canadian Study

This study aimed to describe patterns of major depression (MDD) in a cohort of untreated illicit opiate users recruited from 5 Canadian urban centres, identify sociodemographic characteristics of opiate users that predict MDD, and determine whether opiate users suffering from depression exhibit different drug use patterns than do participants without depression. Baseline data were collected from 679 untreated opiate users in Vancouver, Edmonton, Toronto, Montreal, and Quebec City. Using the Composite International Diagnostic Interview Short Form for Major Depression, we assessed sociodemographics, drug use, health status, health service use, and depression. We examined depression rates across study sites; logistic regression analyses predicted MDD from demographic information and city. Chi-square analyses were used to compare injection drug use and cocaine or crack use among participants with and without depression. Almost one-half (49.3%) of the sample met the cut-off score for MDD. Being female, white, and living outside Vancouver independently predicted MDD. Opiate users suffering from depression were more likely than users without depression to share injection equipment and paraphernalia and were also more likely to use cocaine (Ps < 0.05). Comorbid depression is common among untreated opiate users across Canada; targeted interventions are needed for this population

How Influential Are Medical School Curriculum and Other Medical School Characteristics in Students’ Selecting Pathology as a Specialty?

There has been a significant decline in the number of United States allopathic medical students matching to pathology residency programs. Data acquired from the American Association of Medical Colleges (AAMC) show sustained variation in the medical school production of students who go on to pathology residency. When divided into groups based on the medical school\u27s historical volume of graduates entering pathology, the schools in groups labeled Group 1 and Group 2 produced significantly higher and lower proportions of pathology residents, respectively. This study aimed to identify what medical school curriculum elements and other medical school characteristics might explain the differences observed in the AAMC data. The Dean or another undergraduate medical education contact from the Group 1 and Group 2 schools was invited to participate in an interview. Pathology Program Directors and Pathology Department Chairs were also included in communications. Thirty interviews were completed with equal numbers from each group. Interview questions probed pathology experiences, existence, and structure of a pathology interest group, options for post-sophomore fellowships, recent curriculum changes, and the extent of mentoring programs. Surprisingly, the curriculum does not appear to be a predictor of a medical school\u27s production of students who enter pathology residency. A significantly greater percentage of Group 1 schools are public institutions compared to Group 2 schools. Other factors that may increase the number of students who go into pathology include mentoring, active learning versus observation, and post-sophomore fellowships or other opportunities to work in the capacity of a new pathology resident

A field test of point relascope sampling of down coarse woody material in managed stands in the Acadian Forest.

Abstract We field tested a new method for sampling down coarse woody material (CWM) using an angle gauge and compared it with the more traditional line intersect sampling (LIS) method. Permanent sample locations in stands managed with different silvicultural treatments within the Penobscot Experimental Forest (Maine, USA) were used as the sampling locations. Point relascope sampling (PRS) with three different angles spanning the practical range of angles for such stands was used along with 40 m of LIS sample per sample point. Compared to LIS, the three angles resulted in similar number of pieces and volume of CWM from stands with different histories of repeated partial harvests. In terms of sampling efficiency, PRS was up to 4 times more efficient than LIS. These results, while limited to only one forest type and a relatively small sample, are the first published results available on the field performance of PRS

Field efficiency and bias of snag inventory methods.

Abstract Snags and cavity trees are important components of forests, but can be difficult to inventory precisely and are not always included in inventories because of limited resources. We tested the application of N-tree distance sampling as a time-saving snag sampling method and compared N-tree distance sampling to fixed-area sampling and modified horizontal line sampling in mixed pine-hardwood forests of southern Maine and New Hampshire. We also present a novel modification of N-tree distance sampling that limits the distance from plot center that an observer must search to find tally trees. A field test shows N-tree to be quick, but generally biased and characterized by high variability. Distance-limited N-tree sampling mitigates these problems, but not completely. We give recommendations for operational snag inventory in similar forest types

The impact of stroke public awareness campaigns differs between sociodemographic groups

Background: Prehospital delays are a major obstacle to timely reperfusion therapy in acute ischemic stroke. Stroke sign recognition, however, remains poor in the community. We present an analysis of repeated surveys to assess the impact of Face, Arm, Speech, Time (FAST) public awareness campaigns on stroke knowledge. Methods: Four cross-sectional surveys were conducted between July 2016 and January 2019 in the province of Quebec, Canada (n = 2,451). Knowledge of FAST stroke signs (face drooping, arm weakness and speech difficulties) was assessed with open-ended questions. A bilingual English/French FAST public awareness campaign preceded survey waves 1–3 and two campaigns preceded wave 4. We used multivariable ordinal regression models weighted for age and sex to assess FAST stroke sign knowledge. Results: We observed an overall significant improvement of 26% in FAST stroke sign knowledge between survey waves 1 and 4 (odds ratio [OR] = 1.26; 95% CI: 1.02, 1.55; p = 0.035). After the last campaign, however, 30.5% (95% CI: 27.5, 33.6) of people were still unable to name a single FAST sign. Factors associated with worse performance were male sex (OR = 0.68; 95% CI: 0.53, 0.86; p = 0.002) and retirement (OR = 0.54; 95% CI: 0.35, 0.83; p = 0.005). People with lower household income and education had a tendency towards worse stroke sign knowledge and were significantly less aware of the FAST campaigns. Conclusions: Knowledge of FAST stroke signs in the general population improved after multiple public awareness campaigns, although it remained low overall. Future FAST campaigns should especially target men, retired people and individuals with a lower socioeconomic status.L’impact de campagnes de sensibilisation du public à l’accident vasculaire cérébral varie par groupe sociodémographique. Les délais préhospitaliers constituent un obstacle majeur à la thérapie de reperfusion précoce en accident vasculaire cérébral (AVC) ischémique aigu. La reconnaissance des signes d’AVC demeure toutefois faible dans la population générale. Nous présentons une analyse d’enquêtes répétées visant à évaluer l’impact de campagnes successives de sensibilisation VITE (Visage [affaissé], Incapacité [à lever les bras], Trouble de la parole, Extrême urgence) sur la connaissance des signes d’AVC dans la population générale. Quatre enquêtes transversales ont été effectuées au Québec entre juillet 2016 et janvier 2019 (n = 2451). Elles visaient à évaluer par des questions ouvertes la connaissance des signes VITE de l’AVC. Les trois premières enquêtes ont été précédées d’une seule campagne VITE bilingue (français-anglais) de sensibilisation du public à l’AVC, alors que la dernière enquête a été précédée de deux campagnes. Nous avons analysé la connaissance des signes VITE par régression ordinale pondérée pour l’âge et le sexe. Nous avons observé une amélioration globale significative de 26 % pour la connaissance des signes VITE de l’AVC entre la première et la quatrième enquête (rapport de cotes [RC] : 1,26; IC à 95 % : 1,02-1,55; p = 0,035). Toutefois, après la dernière campagne, 30,5% des individus (IC à 95%: 27,5-33,6) demeuraient incapables de nommer au moins un signe VITE. Les principaux facteurs associés à une moins bonne connaissance des signes VITE étaient le sexe masculin (RC : 0,68; IC à 95 % : 0,53-0,86; p = 0,002) et la retraite (RC : 0,54; IC à 95 % : 0,35-0,83; p = 0,005). Les individus ayant un revenu de ménage et une éducation inférieurs avaient tendance à moins connaitre les signes VITE et étaient significativement moins au courant des précédentes campagnes de sensibilisation VITE. La connaissance des signes VITE s’est améliorée après une série de campagnes de sensibilisation du public à l’AVC, bien qu’elle demeure globalement faible. Les prochaines campagnes VITE devraient particulièrement cibler les hommes, les retraités ainsi que les individus à faible statut socioéconomique

Baliunas D: Illicit Opioid Use in Canada: Comparing social, health, and drug use characteristics of untreated users in five cities (OPICAN study). Journal of Urban Health: Bulletin of the New York Academy of Medicine

ABSTRACT Most of the estimated 125,000 injection drug users (IDUs

Determinants of overdose incidents among illicit opioid users in 5 Canadian cities

BACKGROUND: Drug overdose is a major cause of death and illness among illicit drug users. Previous research has indicated that most illicit drug users experience nonfatal overdoses and has suggested a variety of factors that are associated with risk of overdose. In this study, we examined the occurrence of and the factors associated with nonfatal overdoses within a Canadian sample of illicit opioid users not enrolled in treatment at the time of study recruitment. METHODS: Interviewers used a standard questionnaire to collect data on sociodemographic characteristics, drug use, health and health care, experience in the criminal justice system and treatment for drug problems; they also performed standard assessments for mental health and infectious disease. The association between overdose and sociodemographic and drug-use factors was examined with χ(2) and t test analyses; marginally significant variables were examined with logistic regression to determine independent effects. RESULTS: A total of 679 subjects were interviewed; 651 provided answers sufficient for this analysis. One hundred and twelve (17.2%) of the 651 respondents reported an overdose episode in the previous 6 months. In the logistic regression analysis (after adjustment for sociodemographic factors), homelessness, noninjection use of hydromorphone in the past 30 days and involvement in drug treatment in the past 12 months were predictors of overdose (p < 0.05). INTERPRETATION: Overdose poses a considerable health risk for illicit opioid users. We found that a diverse set of factors was associated with overdose episodes. Prevention efforts will likely be more effective if they can be directed to specific causal factors