Canadian Journal of Public Health-revue Canadienne De Sante Publique, Dec 2, 2022
Objectives To describe the methodology and key findings of British Columbia's (BC) COVID-19 SPEAK... more Objectives To describe the methodology and key findings of British Columbia's (BC) COVID-19 SPEAK surveys, developed to understand the experiences, knowledge, and impact of the COVID-19 pandemic on British Columbians. Methods Two province-wide, cross-sectional, web-based population health surveys were conducted one year apart (May 2020 and April/May 2021). Questions were drawn from validated sources grounded within the social determinants of health to assess COVID-19 testing and prevention; mental and physical health; risk and protective factors; and healthcare, social, and economic impacts during the pandemic. Quota-based non-probability sampling by geography was applied to recruit a representative sample aged 18 years and older. Recruitment included strategic outreach and longitudinal follow-up of a subgroup of respondents from round one to round two. Post-collection weighting using Census data by age, sex, education, ethnicity, and geography was conducted. Results Participants included 394,382 and 188,561 British Columbians for the first and second surveys, respectively, including a longitudinal subgroup of 141,728. Key findings showed that societal impacts, both early in the pandemic and one year later, were inequitably distributed. Families with children, young adults, and people from lower socioeconomic backgrounds have been most impacted. Significant negative impacts on mental health and stress and a deterioration in protective resiliency factors were found. Conclusion These population health surveys consisting of two large cross-sectional samples provided valuable insight into the impacts and experiences of British Columbians early in the pandemic and one year later. Timely, actionable data informed several high-priority public health areas during BC's response to the COVID-19 pandemic. Résumé Objectifs Décrire la méthode et les principaux constats des enquêtes SPEAK de la Colombie-Britannique sur la COVID-19, élaborées pour comprendre l'expérience des Britanno-Colombiens durant la pandémie, ainsi que leurs connaissances de la pandémie et les effets qu'elle a eus sur eux. Méthode Deux enquêtes en ligne transversales sur la santé de la population ont été menées dans toute la province à un an d'intervalle (en mai 2020 et en avril-mai 2021). Les questions, qui provenaient de sources validées ancrées dans les déterminants * Jat Sandhu
Early treatment of HIV infection increases life expectancy and reduces infectivity; however, dela... more Early treatment of HIV infection increases life expectancy and reduces infectivity; however, delayed HIV diagnosis remains common. Implementation and sustainability of hospital-based routine HIV testing in Vancouver, British Columbia, was evaluated to address a local HIV epidemic by facilitating earlier diagnosis and treatment. Public health issued a recommendation in 2011 to offer HIV testing to all patients presenting to three Vancouver hospitals as part of routine care, including all patients admitted to medical/surgical units with expansion to emergency departments (ED). We evaluated acceptability, feasibility, and effectiveness from 2011 to 2014 and continued monitoring through 2016 for sustainability. Between October 2011-December 2016, 114,803 HIV tests were administered at the three hospitals; an 11-fold increase following implementation of routine testing. The rate of testing was sustained and remained high through 2018. Of those tested, 151 patients were diagnosed with HIV for a testing yield of 0.13%. Review of 12,996 charts demonstrated 4935/5876 (96•9%) of admitted patients agreed to have an HIV test when offered. People diagnosed in hospital were significantly more likely to be diagnosed with acute stage (aOR 1•96, 95% CI 1•19, 3•23) infection, particularly those diagnosed in the ED. This study provides practice-based evidence of the feasibility, acceptability, and effectiveness of implementing a recommendation for routine HIV testing among inpatient and emergency department admissions, as well as the ability to normalize and sustain this change. Routine hospital-based HIV testing can increase diagnoses of acute HIV infection and facilitate earlier initiation of antiretroviral treatment. 1. Introduction Antiretroviral therapy (ART) profoundly changed the course of HIV disease. The life expectancy of people living with HIV (PLWH) approaches that of the general population with early initiation of ART and good adherence (
Background: My Health My Community (MHMC) is a collaborative initiative, developed to fill a gap i... more Background: My Health My Community (MHMC) is a collaborative initiative, developed to fill a gap in health and well-being information for Vancouver Coastal Health (VCH) and Fraser Health (FH) regions. MHMC survey sought to capture information within the domains of socio-demographics, health status, lifestyle, access to care, built environment and community resiliency. VCH and FHA engaged their municipal governments and community partners to develop relevant content and recruit participants. Purpose: Understand the burden and determinants of chronic disease at a local level (municipal and neighborhood) that facilitates partnership with local governments and community organizations to create health-promoting environments.
BACKGROUND Diabetes is among the most prevalent non-communicable diseases causing significant mor... more BACKGROUND Diabetes is among the most prevalent non-communicable diseases causing significant morbidity and mortality globally. The aetiology and disease development of diabetes are influenced by genetic, lifestyle, and environmental factors. Due to an increasing number of cases each year, it is imperative to improve the understanding of modifiable environmental risk and protective factors. In this study we aimed to analyse associations between built and natural environment features and diabetes prevalence; and two major risk factors: physical activity and obesity and their mediation effects. METHODS We analysed relationships between walkability and park availability with physical activity, obesity, and diabetes, using self-reported data from a large cross-sectional survey in British Columbia, Canada (n = 22,418). We validated results with an independent cohort (n = 11,972) in a subset of the analyses. The outcome measures included walking, moderate to vigorous physical activity (MVPA), body mass index (BMI), and diabetes. Built and natural environment features within a 1 km road network buffer around residential postal code centroids were assessed using validated indicators of walkability and park availability. We used general linear multivariable models (GLM) to examine the direct relationship between environmental features, physical activity, obesity, and diabetes respectively. Path models were developed to analyse mediation effects of physical activity and obesity on the association between environmental indicators and diabetes. The relative contribution of direct versus indirect effects was assessed. All models were adjusted for age, gender, income. ethnicity, years lived in neighbourhood and regional accessibility. RESULTS Walkable neighbourhoods and areas with greater park availability were associated with lower rates of diabetes. There was a direct association of walkability and park availability on physical activity (highest vs. lowest quintile OR = 1.15; 95% CI: 1.00, 1.33 and OR = 1.28, 95% CI: 1.13, 1.45 respectively), obesity (highest vs. lowest quintile OR = 0.58, 95% CI: 0.49, 0.70 and OR = 0.57, 95% CI: 0.48, 0.68 respectively) and diabetes (highest vs. lowest quintile OR = 0.62, 95% CI: 0.45, 0.85, and OR = 0.63, 95% CI: 0.47, 0.84 respectively). Results were similar in the independent cohort. The associations between diabetes and walkability and park availability respectively were partly mediated by obesity (41% of total association for walkability and 53% of total association for park availability). The mediating effect of physical activity was negligible. CONCLUSION Results support investments in walkability through active transportation and transit infrastructure. Changes in zoning and subdivision regulations governing land use actions are required to enable compact mixed-use environments with access to parks and high quality transit service. Future studies including cost-benefit analyses of health-related economic impacts of such investments can contribute to evidence-based decisions for healthier cities.
International Journal of Hygiene and Environmental Health, 2021
BACKGROUND There is an increased literature focusing on the role of the built and natural environ... more BACKGROUND There is an increased literature focusing on the role of the built and natural environments in preventing hypertension. However, very few studies have quantitively analyzed specific pathways through which urban form affects blood pressure levels. OBJECTIVES To examine how features of the built and natural environments relate to hypertension and the mediating role of transportation and leisure walking and body mass index in this relationship. METHODS We examined the association between neighbourhood walkability and park availability with hypertension through generalized linear models in two independent population cohorts. One Cohort was 22,418 adults (My Health My Community) and the other cohort was 11,972 adults (BC Generations Project). We employed a path analysis modelling approach to explore the presence and significance of mediating factors that may contribute to any association between walkability or park availability and hypertension. This study intentionally employed walkability measures enforced through municipal zoning and subdivision regulations legally underpinned by health, safety, and welfare. All models were adjusted for socioeconomic and other characteristics where data were available. RESULTS Our analysis of two population-based Canadian cohorts consistently found that higher levels of walkability and park accessibility were both associated with significantly lower odds of self-reported hypertension, especially for lower income individuals. Mediation analysis showed that obesity accounted for 50% and 52.9% of the total effect of walkability and park accessibility on hypertension, respectively. DISCUSSION We suggest an integrated population health approach that considers multimorbidity as a result of exposure to car-dependent areas and the lack of green spaces. Longitudinal research is needed to document causal effects of built and natural environments on hypertension.
ObjectiveTo describe the use of multiple data sources to monitor overdoses in near real-time in o... more ObjectiveTo describe the use of multiple data sources to monitor overdoses in near real-time in order to evaluate response to the provincial overdose emergencyIntroductionOn April 14, 2016, British Columbia (BC)’s Provincial Health Officer declared a public health emergency due to a significant increase in drug-related overdoses and deaths in the Province. Despite the declaration, 161 suspected drug overdose deaths were reported across the Province in December 2016, a 137% increase over the number of deaths occurring in the same month of 2015 [1]. In response to the surge overdoses, Vancouver Coastal Health Authority (VCH), one of 5 health regions within BC, rapidly implemented a number of novel harm reduction initiatives. Overdose Prevention Sites (OPS) were opened on December 8, 2016. At these sites, people using illicit drugs are supervised by peers who can provide rapid intervention if an overdose occurs. The Mobile Medical Unit (MMU), a temporary state-of-art medical facility, ...
Increased rates of screening, advances in molecular diagnostics, the opportunity for patients to ... more Increased rates of screening, advances in molecular diagnostics, the opportunity for patients to give non-invasive urine specimens, and higher numbers of re-infection may account for some of these increases. Improved detection may not account for all of the increase, however, as the 2009 Canadian Chlamydia rate and the 2010 rate continued to rise (259 per 100,000 and 277.6 per 100,000 in 2009 and 2010, respectively). 2 In women, Chlamydia infection can cause a spectrum of disease, ranging from asymptomatic infection to pelvic inflammatory disease. 3 In particular, infertility may result from untreated infection. Because Chlamydia infections can cause significant morbidity and are largely preventable, this is an infection of public health concern. Case finding has two immediate goals: 1) to prevent complications in the case and 2) by treating the case and sexual partners, to prevent further spread of the disease. Not much is known about Chlamydia infection rates among people of Chinese ethnicity in Canada. Vancouver and Richmond, British Columbia, are adjacent municipalities with a high proportion of visible minorities. The 2006 Canadian Census found that approximately 50.5% and 65% of Vancouver and Richmond residents, respectively, self-identified as belonging to a visible minority; people of Chinese ethnicity predominated. 4 In the United States, Chlamydia rates vary significantly by race, from a high of 2,056.9 per 100,000 population in African Americans to a low of 225.9 per 100,000 among Asians/Pacific Islanders in 2008. 5 Thus it is conceivable that Chlamydia infections may also vary significantly among different ethnic groups in Canada. While US data suggest that Chlamydia incidence may be comparatively low among ethnic Chinese in Vancouver and Richmond, local ethnicity-specific data on Chlamydia rates are lacking. Understanding the local epidemiology of Chlamydia will allow public health practitioners to tailor STI prevention programs in Vancouver and Richmond to the local disease burden and cultural context. Current Canadian guidelines suggest screening for STIs in women with known risk factors. 6 These guidelines do not recommend screening for women over the age of 25 in stable, monogamous relationships. For immigrants and refugees, the guidelines suggest a "non-judgmental and culturally sensitive STI risk assessment." There are no separate recommendations about
Outbreaks of shigellosis have been documented in men who have sex with men (MSM), associated with... more Outbreaks of shigellosis have been documented in men who have sex with men (MSM), associated with interpersonal transmission and underlying HIV infection. We observed a rise in Shigella flexneri isolates identified in a downtown tertiary-care hospital laboratory located within the city centre community health area (CHA-1) of Vancouver, Canada. The objectives of this study were to evaluate clinical outcomes of shigellosis cases among MSM admitted to hospital and to evaluate trends in Shigella cases within Vancouver, Canada. Adult rates of shigellosis were analysed by gender and health region, from 2005 to 2011, followed by retrospective chart review of all hospital laboratory-identified S. flexneri cases from 2008 to 2012. Serotyping and pulsed-field gel electrophoresis (PFGE) were performed on these isolates. Although shigellosis rates in men within CHA-1 did not change from 2005 to 2011 (range 33.4-68.5 per 100 000; P = 0.74), they were significantly higher than in other regions wi...
It is unclear whether early life body mass index (BMI; in kg/m(2)) is associated with adult cardi... more It is unclear whether early life body mass index (BMI; in kg/m(2)) is associated with adult cardiovascular disease. The objective was to assess the association of early life BMI with the risk of ischemic heart disease (IHD) and stroke. The association between early life BMI and risk of adult mortality from IHD and stroke was assessed in 3 historical cohort studies in which height and weight had been assessed by using standard procedures. Participants were traced and linked to national mortality data. Participants in the 3 cohorts were born between 1922 and 1937, 1927 and 1956, and 1928 and 1950 and were aged 2-15, 9-18, and 16-22 y, respectively, at the time of assessment of their height and weight. Participants in all 3 cohorts had mean BMIs similar to those reported for contemporary children and young adults, but fewer of the cohort participants were overweight or obese. BMI was not associated with future risk of IHD or stroke in any cohort. The pooled (all 3 cohorts) adjusted haz...
Background To explore inequalities in the provision of hip/knee replacement surgery and produce s... more Background To explore inequalities in the provision of hip/knee replacement surgery and produce small-area estimates of provision to inform local health planning. Methods Hospital Episode Statistics were used to explore inequalities in the provision of primary hip/knee operations in English NHS hospitals in 2002. Multilevel Poisson regression modelling was used to estimate rates of surgical provision by socio-demographic, hospital and distance variables. GIS software was used to estimate road travel times and create hospital catchment areas. Results Rates of joint replacement increased with age before falling in those aged 80þ. Women received more operations than men. People living in the most deprived areas obtained fewer hip, but more knee operations. Those in urban areas received less hip surgery, but there was no association for knee replacement. Controlling for hospital and distance measures did not attenuate the effects. Geographical variation across districts was observed with some districts showing inequality in socio-demographic factors, whereas others showed none at all. Conclusions This study found evidence of inequalities in the provision of joint replacement surgery. However, before we can conclude that there is inequity in receipts of healthcare, future research must consider whether these patterns are explained by variations in need across sociodemographic groups.
Social media is a powerful, rapid, and popular way of communication amongst people around the wor... more Social media is a powerful, rapid, and popular way of communication amongst people around the world. How can health professionals and patients use this strategy to achieve optimal disease management and prevention and attainment of wellness? An interdisciplinary group at University of British Columbia, supported by a grant from UBC Peter Wall Institute of Advanced Studies, conducted a research workshop in February 2013 to explore what is known and yet to be researched in using social media for nurturing the growth of virtual communities of people for health and wellness. This two and a half day workshop brought together a group of 30 multidisciplinary experts in closed discussions to reflect on five research themes in detail: (1) individual information acquisition and application, (2) community genesis and sustainability, (3) technological design issues, (4) knowledge management, dissemination, and renewal, and (5) research designs. In addition, a public forum for the general public, which attracted over 195 live participants, over 100 participants via Web casting, 1004 tweets, and 1,124,886 impressions following the #HCSMForum hash tag on Twitter, demonstrated the keen interest of the general public in this topic. Key concepts were captured in JMIR publications in this issue, and future directions, including research, knowledge translation approaches, and strategic partnerships of interdisciplinary researchers with policy makers and industries emerged from the workshop proceedings.
The Journal of Clinical Endocrinology & Metabolism, 2006
Context: IGFs may play an important role in disease etiology, especially cancer. Changes in diet ... more Context: IGFs may play an important role in disease etiology, especially cancer. Changes in diet can alter acute levels, but little is known about life course influences on IGF levels. Objective: The objective of the study was to examine the association between timing of puberty and adulthood serum IGFs (IGF-I and IGF binding protein-3). Design: This was a retrospective cohort study. Setting: Male pupils who attended a single school in Southern England were part of the study. Participants: Participants in the study were a cohort of 1028 men born between 1927 and 1956 with anthropometric measures between 9 and 18 yr and adulthood serum IGF levels. Main Outcome Measure: The study measured serum IGF-I and IGF binding protein-3 at mean age 63 yr. Results: Age at peak height velocity (APHV) was inversely associated with adult IGF-I levels. IGF-I decreased by 3.7 ng/ml (95% confidence interval 1.0–6.4, P = 0.007) for each sd increase in APHV. Prepubertal childhood height and body mass ind...
SUMMARYOne of the largest reported campylobacteriosis outbreaks in Canada occurred in June 2007 i... more SUMMARYOne of the largest reported campylobacteriosis outbreaks in Canada occurred in June 2007 in British Columbia, associated with a mountain bike race that took place in muddy conditions. A retrospective cohort study was conducted and environmental samples were collected and tested. There were 537 racers included in the study and 225 racers (42%) reported diarrhoeal illness after the race.C. jejuniclinical isolates (n=14) were found to be identical by multi-locus sequence typing. Although univariate analysis suggested water consumption and mud exposure as significant risk factors, multivariate analysis revealed that on direct ingestion mud was significantly associated with illness (OR 4·08, 95% CI 2·03–8·21). Contaminated mud was thus the most likely source ofCampylobacterinfection. We identified other unpublished reports of outbreaks associated with bike races in rainy or muddy conditions; these underscore the importance of educating racers and raising public awareness of the ri...
Canadian Journal of Public Health-revue Canadienne De Sante Publique, Dec 2, 2022
Objectives To describe the methodology and key findings of British Columbia's (BC) COVID-19 SPEAK... more Objectives To describe the methodology and key findings of British Columbia's (BC) COVID-19 SPEAK surveys, developed to understand the experiences, knowledge, and impact of the COVID-19 pandemic on British Columbians. Methods Two province-wide, cross-sectional, web-based population health surveys were conducted one year apart (May 2020 and April/May 2021). Questions were drawn from validated sources grounded within the social determinants of health to assess COVID-19 testing and prevention; mental and physical health; risk and protective factors; and healthcare, social, and economic impacts during the pandemic. Quota-based non-probability sampling by geography was applied to recruit a representative sample aged 18 years and older. Recruitment included strategic outreach and longitudinal follow-up of a subgroup of respondents from round one to round two. Post-collection weighting using Census data by age, sex, education, ethnicity, and geography was conducted. Results Participants included 394,382 and 188,561 British Columbians for the first and second surveys, respectively, including a longitudinal subgroup of 141,728. Key findings showed that societal impacts, both early in the pandemic and one year later, were inequitably distributed. Families with children, young adults, and people from lower socioeconomic backgrounds have been most impacted. Significant negative impacts on mental health and stress and a deterioration in protective resiliency factors were found. Conclusion These population health surveys consisting of two large cross-sectional samples provided valuable insight into the impacts and experiences of British Columbians early in the pandemic and one year later. Timely, actionable data informed several high-priority public health areas during BC's response to the COVID-19 pandemic. Résumé Objectifs Décrire la méthode et les principaux constats des enquêtes SPEAK de la Colombie-Britannique sur la COVID-19, élaborées pour comprendre l'expérience des Britanno-Colombiens durant la pandémie, ainsi que leurs connaissances de la pandémie et les effets qu'elle a eus sur eux. Méthode Deux enquêtes en ligne transversales sur la santé de la population ont été menées dans toute la province à un an d'intervalle (en mai 2020 et en avril-mai 2021). Les questions, qui provenaient de sources validées ancrées dans les déterminants * Jat Sandhu
Early treatment of HIV infection increases life expectancy and reduces infectivity; however, dela... more Early treatment of HIV infection increases life expectancy and reduces infectivity; however, delayed HIV diagnosis remains common. Implementation and sustainability of hospital-based routine HIV testing in Vancouver, British Columbia, was evaluated to address a local HIV epidemic by facilitating earlier diagnosis and treatment. Public health issued a recommendation in 2011 to offer HIV testing to all patients presenting to three Vancouver hospitals as part of routine care, including all patients admitted to medical/surgical units with expansion to emergency departments (ED). We evaluated acceptability, feasibility, and effectiveness from 2011 to 2014 and continued monitoring through 2016 for sustainability. Between October 2011-December 2016, 114,803 HIV tests were administered at the three hospitals; an 11-fold increase following implementation of routine testing. The rate of testing was sustained and remained high through 2018. Of those tested, 151 patients were diagnosed with HIV for a testing yield of 0.13%. Review of 12,996 charts demonstrated 4935/5876 (96•9%) of admitted patients agreed to have an HIV test when offered. People diagnosed in hospital were significantly more likely to be diagnosed with acute stage (aOR 1•96, 95% CI 1•19, 3•23) infection, particularly those diagnosed in the ED. This study provides practice-based evidence of the feasibility, acceptability, and effectiveness of implementing a recommendation for routine HIV testing among inpatient and emergency department admissions, as well as the ability to normalize and sustain this change. Routine hospital-based HIV testing can increase diagnoses of acute HIV infection and facilitate earlier initiation of antiretroviral treatment. 1. Introduction Antiretroviral therapy (ART) profoundly changed the course of HIV disease. The life expectancy of people living with HIV (PLWH) approaches that of the general population with early initiation of ART and good adherence (
Background: My Health My Community (MHMC) is a collaborative initiative, developed to fill a gap i... more Background: My Health My Community (MHMC) is a collaborative initiative, developed to fill a gap in health and well-being information for Vancouver Coastal Health (VCH) and Fraser Health (FH) regions. MHMC survey sought to capture information within the domains of socio-demographics, health status, lifestyle, access to care, built environment and community resiliency. VCH and FHA engaged their municipal governments and community partners to develop relevant content and recruit participants. Purpose: Understand the burden and determinants of chronic disease at a local level (municipal and neighborhood) that facilitates partnership with local governments and community organizations to create health-promoting environments.
BACKGROUND Diabetes is among the most prevalent non-communicable diseases causing significant mor... more BACKGROUND Diabetes is among the most prevalent non-communicable diseases causing significant morbidity and mortality globally. The aetiology and disease development of diabetes are influenced by genetic, lifestyle, and environmental factors. Due to an increasing number of cases each year, it is imperative to improve the understanding of modifiable environmental risk and protective factors. In this study we aimed to analyse associations between built and natural environment features and diabetes prevalence; and two major risk factors: physical activity and obesity and their mediation effects. METHODS We analysed relationships between walkability and park availability with physical activity, obesity, and diabetes, using self-reported data from a large cross-sectional survey in British Columbia, Canada (n = 22,418). We validated results with an independent cohort (n = 11,972) in a subset of the analyses. The outcome measures included walking, moderate to vigorous physical activity (MVPA), body mass index (BMI), and diabetes. Built and natural environment features within a 1 km road network buffer around residential postal code centroids were assessed using validated indicators of walkability and park availability. We used general linear multivariable models (GLM) to examine the direct relationship between environmental features, physical activity, obesity, and diabetes respectively. Path models were developed to analyse mediation effects of physical activity and obesity on the association between environmental indicators and diabetes. The relative contribution of direct versus indirect effects was assessed. All models were adjusted for age, gender, income. ethnicity, years lived in neighbourhood and regional accessibility. RESULTS Walkable neighbourhoods and areas with greater park availability were associated with lower rates of diabetes. There was a direct association of walkability and park availability on physical activity (highest vs. lowest quintile OR = 1.15; 95% CI: 1.00, 1.33 and OR = 1.28, 95% CI: 1.13, 1.45 respectively), obesity (highest vs. lowest quintile OR = 0.58, 95% CI: 0.49, 0.70 and OR = 0.57, 95% CI: 0.48, 0.68 respectively) and diabetes (highest vs. lowest quintile OR = 0.62, 95% CI: 0.45, 0.85, and OR = 0.63, 95% CI: 0.47, 0.84 respectively). Results were similar in the independent cohort. The associations between diabetes and walkability and park availability respectively were partly mediated by obesity (41% of total association for walkability and 53% of total association for park availability). The mediating effect of physical activity was negligible. CONCLUSION Results support investments in walkability through active transportation and transit infrastructure. Changes in zoning and subdivision regulations governing land use actions are required to enable compact mixed-use environments with access to parks and high quality transit service. Future studies including cost-benefit analyses of health-related economic impacts of such investments can contribute to evidence-based decisions for healthier cities.
International Journal of Hygiene and Environmental Health, 2021
BACKGROUND There is an increased literature focusing on the role of the built and natural environ... more BACKGROUND There is an increased literature focusing on the role of the built and natural environments in preventing hypertension. However, very few studies have quantitively analyzed specific pathways through which urban form affects blood pressure levels. OBJECTIVES To examine how features of the built and natural environments relate to hypertension and the mediating role of transportation and leisure walking and body mass index in this relationship. METHODS We examined the association between neighbourhood walkability and park availability with hypertension through generalized linear models in two independent population cohorts. One Cohort was 22,418 adults (My Health My Community) and the other cohort was 11,972 adults (BC Generations Project). We employed a path analysis modelling approach to explore the presence and significance of mediating factors that may contribute to any association between walkability or park availability and hypertension. This study intentionally employed walkability measures enforced through municipal zoning and subdivision regulations legally underpinned by health, safety, and welfare. All models were adjusted for socioeconomic and other characteristics where data were available. RESULTS Our analysis of two population-based Canadian cohorts consistently found that higher levels of walkability and park accessibility were both associated with significantly lower odds of self-reported hypertension, especially for lower income individuals. Mediation analysis showed that obesity accounted for 50% and 52.9% of the total effect of walkability and park accessibility on hypertension, respectively. DISCUSSION We suggest an integrated population health approach that considers multimorbidity as a result of exposure to car-dependent areas and the lack of green spaces. Longitudinal research is needed to document causal effects of built and natural environments on hypertension.
ObjectiveTo describe the use of multiple data sources to monitor overdoses in near real-time in o... more ObjectiveTo describe the use of multiple data sources to monitor overdoses in near real-time in order to evaluate response to the provincial overdose emergencyIntroductionOn April 14, 2016, British Columbia (BC)’s Provincial Health Officer declared a public health emergency due to a significant increase in drug-related overdoses and deaths in the Province. Despite the declaration, 161 suspected drug overdose deaths were reported across the Province in December 2016, a 137% increase over the number of deaths occurring in the same month of 2015 [1]. In response to the surge overdoses, Vancouver Coastal Health Authority (VCH), one of 5 health regions within BC, rapidly implemented a number of novel harm reduction initiatives. Overdose Prevention Sites (OPS) were opened on December 8, 2016. At these sites, people using illicit drugs are supervised by peers who can provide rapid intervention if an overdose occurs. The Mobile Medical Unit (MMU), a temporary state-of-art medical facility, ...
Increased rates of screening, advances in molecular diagnostics, the opportunity for patients to ... more Increased rates of screening, advances in molecular diagnostics, the opportunity for patients to give non-invasive urine specimens, and higher numbers of re-infection may account for some of these increases. Improved detection may not account for all of the increase, however, as the 2009 Canadian Chlamydia rate and the 2010 rate continued to rise (259 per 100,000 and 277.6 per 100,000 in 2009 and 2010, respectively). 2 In women, Chlamydia infection can cause a spectrum of disease, ranging from asymptomatic infection to pelvic inflammatory disease. 3 In particular, infertility may result from untreated infection. Because Chlamydia infections can cause significant morbidity and are largely preventable, this is an infection of public health concern. Case finding has two immediate goals: 1) to prevent complications in the case and 2) by treating the case and sexual partners, to prevent further spread of the disease. Not much is known about Chlamydia infection rates among people of Chinese ethnicity in Canada. Vancouver and Richmond, British Columbia, are adjacent municipalities with a high proportion of visible minorities. The 2006 Canadian Census found that approximately 50.5% and 65% of Vancouver and Richmond residents, respectively, self-identified as belonging to a visible minority; people of Chinese ethnicity predominated. 4 In the United States, Chlamydia rates vary significantly by race, from a high of 2,056.9 per 100,000 population in African Americans to a low of 225.9 per 100,000 among Asians/Pacific Islanders in 2008. 5 Thus it is conceivable that Chlamydia infections may also vary significantly among different ethnic groups in Canada. While US data suggest that Chlamydia incidence may be comparatively low among ethnic Chinese in Vancouver and Richmond, local ethnicity-specific data on Chlamydia rates are lacking. Understanding the local epidemiology of Chlamydia will allow public health practitioners to tailor STI prevention programs in Vancouver and Richmond to the local disease burden and cultural context. Current Canadian guidelines suggest screening for STIs in women with known risk factors. 6 These guidelines do not recommend screening for women over the age of 25 in stable, monogamous relationships. For immigrants and refugees, the guidelines suggest a "non-judgmental and culturally sensitive STI risk assessment." There are no separate recommendations about
Outbreaks of shigellosis have been documented in men who have sex with men (MSM), associated with... more Outbreaks of shigellosis have been documented in men who have sex with men (MSM), associated with interpersonal transmission and underlying HIV infection. We observed a rise in Shigella flexneri isolates identified in a downtown tertiary-care hospital laboratory located within the city centre community health area (CHA-1) of Vancouver, Canada. The objectives of this study were to evaluate clinical outcomes of shigellosis cases among MSM admitted to hospital and to evaluate trends in Shigella cases within Vancouver, Canada. Adult rates of shigellosis were analysed by gender and health region, from 2005 to 2011, followed by retrospective chart review of all hospital laboratory-identified S. flexneri cases from 2008 to 2012. Serotyping and pulsed-field gel electrophoresis (PFGE) were performed on these isolates. Although shigellosis rates in men within CHA-1 did not change from 2005 to 2011 (range 33.4-68.5 per 100 000; P = 0.74), they were significantly higher than in other regions wi...
It is unclear whether early life body mass index (BMI; in kg/m(2)) is associated with adult cardi... more It is unclear whether early life body mass index (BMI; in kg/m(2)) is associated with adult cardiovascular disease. The objective was to assess the association of early life BMI with the risk of ischemic heart disease (IHD) and stroke. The association between early life BMI and risk of adult mortality from IHD and stroke was assessed in 3 historical cohort studies in which height and weight had been assessed by using standard procedures. Participants were traced and linked to national mortality data. Participants in the 3 cohorts were born between 1922 and 1937, 1927 and 1956, and 1928 and 1950 and were aged 2-15, 9-18, and 16-22 y, respectively, at the time of assessment of their height and weight. Participants in all 3 cohorts had mean BMIs similar to those reported for contemporary children and young adults, but fewer of the cohort participants were overweight or obese. BMI was not associated with future risk of IHD or stroke in any cohort. The pooled (all 3 cohorts) adjusted haz...
Background To explore inequalities in the provision of hip/knee replacement surgery and produce s... more Background To explore inequalities in the provision of hip/knee replacement surgery and produce small-area estimates of provision to inform local health planning. Methods Hospital Episode Statistics were used to explore inequalities in the provision of primary hip/knee operations in English NHS hospitals in 2002. Multilevel Poisson regression modelling was used to estimate rates of surgical provision by socio-demographic, hospital and distance variables. GIS software was used to estimate road travel times and create hospital catchment areas. Results Rates of joint replacement increased with age before falling in those aged 80þ. Women received more operations than men. People living in the most deprived areas obtained fewer hip, but more knee operations. Those in urban areas received less hip surgery, but there was no association for knee replacement. Controlling for hospital and distance measures did not attenuate the effects. Geographical variation across districts was observed with some districts showing inequality in socio-demographic factors, whereas others showed none at all. Conclusions This study found evidence of inequalities in the provision of joint replacement surgery. However, before we can conclude that there is inequity in receipts of healthcare, future research must consider whether these patterns are explained by variations in need across sociodemographic groups.
Social media is a powerful, rapid, and popular way of communication amongst people around the wor... more Social media is a powerful, rapid, and popular way of communication amongst people around the world. How can health professionals and patients use this strategy to achieve optimal disease management and prevention and attainment of wellness? An interdisciplinary group at University of British Columbia, supported by a grant from UBC Peter Wall Institute of Advanced Studies, conducted a research workshop in February 2013 to explore what is known and yet to be researched in using social media for nurturing the growth of virtual communities of people for health and wellness. This two and a half day workshop brought together a group of 30 multidisciplinary experts in closed discussions to reflect on five research themes in detail: (1) individual information acquisition and application, (2) community genesis and sustainability, (3) technological design issues, (4) knowledge management, dissemination, and renewal, and (5) research designs. In addition, a public forum for the general public, which attracted over 195 live participants, over 100 participants via Web casting, 1004 tweets, and 1,124,886 impressions following the #HCSMForum hash tag on Twitter, demonstrated the keen interest of the general public in this topic. Key concepts were captured in JMIR publications in this issue, and future directions, including research, knowledge translation approaches, and strategic partnerships of interdisciplinary researchers with policy makers and industries emerged from the workshop proceedings.
The Journal of Clinical Endocrinology & Metabolism, 2006
Context: IGFs may play an important role in disease etiology, especially cancer. Changes in diet ... more Context: IGFs may play an important role in disease etiology, especially cancer. Changes in diet can alter acute levels, but little is known about life course influences on IGF levels. Objective: The objective of the study was to examine the association between timing of puberty and adulthood serum IGFs (IGF-I and IGF binding protein-3). Design: This was a retrospective cohort study. Setting: Male pupils who attended a single school in Southern England were part of the study. Participants: Participants in the study were a cohort of 1028 men born between 1927 and 1956 with anthropometric measures between 9 and 18 yr and adulthood serum IGF levels. Main Outcome Measure: The study measured serum IGF-I and IGF binding protein-3 at mean age 63 yr. Results: Age at peak height velocity (APHV) was inversely associated with adult IGF-I levels. IGF-I decreased by 3.7 ng/ml (95% confidence interval 1.0–6.4, P = 0.007) for each sd increase in APHV. Prepubertal childhood height and body mass ind...
SUMMARYOne of the largest reported campylobacteriosis outbreaks in Canada occurred in June 2007 i... more SUMMARYOne of the largest reported campylobacteriosis outbreaks in Canada occurred in June 2007 in British Columbia, associated with a mountain bike race that took place in muddy conditions. A retrospective cohort study was conducted and environmental samples were collected and tested. There were 537 racers included in the study and 225 racers (42%) reported diarrhoeal illness after the race.C. jejuniclinical isolates (n=14) were found to be identical by multi-locus sequence typing. Although univariate analysis suggested water consumption and mud exposure as significant risk factors, multivariate analysis revealed that on direct ingestion mud was significantly associated with illness (OR 4·08, 95% CI 2·03–8·21). Contaminated mud was thus the most likely source ofCampylobacterinfection. We identified other unpublished reports of outbreaks associated with bike races in rainy or muddy conditions; these underscore the importance of educating racers and raising public awareness of the ri...
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