Evaluation of 6 remote First Nations community-based buprenorphine programs in northwestern Ontario: Retrospective study.

OBJECTIVE: To evaluate established opioid addiction treatment programs that use traditional healing in combination with buprenorphine-naloxone maintenance treatment in 6 First Nations communities in the Sioux Lookout region of northwestern Ontario. DESIGN: Retrospective cohort study. SETTING: Six First Nations communities in northwestern Ontario. PARTICIPANTS: A total of 526 First Nations participants in opioid-dependence treatment programs. INTERVENTION: Buprenorphine-naloxone substitution therapy and First Nations healing programming. MAIN OUTCOME MEASURES: Retention rates and urine drug screening (UDS) results. RESULTS: Treatment retention rates at 6, 12, and 18 months were 84%, 78%, and 72%, respectively. We estimate that the rate at 24 months will also be more than 70%. The UDS programming varied and was implemented in only 1 community. Initially urine testing was voluntary and it then became mandatory. Screening with either method found the proportion of urine samples with negative results for illicit opioids ranged between 84% and 95%. CONCLUSION: The program's treatment retention rates and negative UDS results were higher than those reported for most methadone and buprenorphine-naloxone programs, despite a patient population where severe posttraumatic stress disorder is endemic, and despite the programs' lack of resources and addiction expertise. Community-based programs like these overcome the initial challenge of cultural competence. First Nations communities in other provinces should establish their own buprenorphinenaloxone programs, using local primary care physicians as prescribers. Sustainable core funding is needed for programming, long-term aftercare, and trauma recovery for such initiatives.

Prefrontal Electrical Stimulation in Non-depressed Reduces Levels of Reported Negative Affects from Daily Stressors.

Negative emotional responses to the daily life stresses have cumulative effects which, in turn, impose wide-ranging negative constraints on emotional well being and neurocognitive performance (Kalueff and Nutt, 2007; Nadler et al., 2010; Charles et al., 2013). Crucial cognitive functions such as memory and problem solving, as well more short term emotional responses (e.g., anticipation of- and response to- monetary rewards or losses) are influenced by mood. The negative impact of these behavioral responses is felt at the individual level, but it also imposes major economic burden on modern healthcare systems. Although much research has been undertaken to understand the underlying mechanisms of depressed mood and design efficient treatment pathways, comparatively little was done to characterize mood modulations that remain within the boundaries of a healthy mental functioning. In one placebo-controlled experiment, we applied daily prefrontal transcranial Direct Current Stimulation (tDCS) at five points in time, and found reliable improvements on self-reported mood evaluation. Using a new team of experimenters, we replicated this finding in an independent double-blinded placebo-controlled experiment and showed that stimulation over a shorter period of time (3 days) is sufficient to create detectable mood improvements. Taken together, our data show that repeated bilateral prefrontal tDCS can reduce psychological distress in non-depressed individuals.

Community-wide measures of wellness in a remote First Nations community experiencing opioid dependence: evaluating outpatient buprenorphine-naloxone substitution therapy in the context of a First Nations healing program.

OBJECTIVE: To document the development of unique opioid-dependence treatment in remote communities that combines First Nations healing strategies and substitution therapy with buprenorphine-naloxone. DESIGN: Quantitative measurements of community wellness and response to community-based opioid-dependence treatment. SETTING: Remote First Nations community in northwestern Ontario. PARTICIPANTS: A total of 140 self-referred opioid-dependent community members. INTERVENTION: Community-developed program of First Nations healing, addiction treatment, and substitution therapy. MAIN OUTCOME MEASURES: Community-wide measures of wellness: number of criminal charges, addiction-related medical evacuations, child protection agency cases, school attendance, and attendance at community events. RESULTS: The age-adjusted adult rate of opioid-dependence treatment was 41%. One year after the development of the in-community healing and substitution therapy program for opioid dependence, police criminal charges had fallen by 61.1%, child protection cases had fallen by 58.3%, school attendance had increased by 33.3%, and seasonal influenza immunizations had dramatically gone up by 350.0%. Attendance at community events is now robust, and sales at the local general store have gone up almost 20%. CONCLUSION: Community-wide wellness measures have undergone dramatic public health changes since the development of a First Nations healing program involving opioid substitution therapy with buprenorphine-naloxone. Funding for such programs is ad hoc and temporary, and this threatens the survival of the described program and other such programs developing in this region, which has been strongly affected by an opioid-dependence epidemic.

Invasive CA-MRSA in northwestern Ontario: a 2-year prospective study.

INTRODUCTION: Northwestern Ontario has a documented high rate of skin and soft-tissue infections due to community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Recently, invasive illness from this common pathogen has become a serious clinical problem in the region. We sought to better understand this trend of invasive CA-MRSA. METHODS: We prospectively studied cases of positive CA-MRSA bacteremia in 2012 and 2013. We examined genetic typing, comorbidities and outcomes. RESULTS: Twenty-three cases of CA-MRSA bacteremia were treated during the 2-year study period. Intravenous drug use accounted for only 17% of cases. One death and 2 cases of endocarditis occurred. CONCLUSION: High rates of CA-MRSA in skin and soft-tissue infections, combined with poor living conditions and poor access to potable water, may account for most of these cases of CA-MRSA bacteremia. Social determinants of health are relevant when common resistant bacterial isolates become associated with life-threatening illness.

INTRODUCTION: La région du Nord-Ouest de l'Ontario présente un taux élevé et documenté d'infections de la peau et des tissus mous causées par une souche de Staphylococcus aureus méthycillinorésistante d'origine communautaire (SARM-C). La maladie invasive causée par cet agent pathogène commun est récemment devenue un problème clinique grave dans la région. Nous avons voulu mieux comprendre cette tendance du SARM-C invasif. MÉTHODES: Nous avons étudié de manière prospective des cas de bactériémie positive à SARM C en 2012 et 2013. Nous avons analysé le typage génétique, les comorbidités et l'issue des infections. RÉSULTATS: Vingt-trois cas de bactériémie à SARM-C ont été traités au cours de la période de 2 ans. L'utilisation de drogues injectables a pu être incriminée dans seulement 17 % de cas. On a enregistré 1 décès et 2 cas d'endocardite. CONCLUSION: Des taux élevés de SARM-C dans les infections de la peau et des tissus mous alliées à de piètres conditions de vie et à un accès limité à de l'eau potable pourraient expliquer la plupart de ces cas de bactériémie à SARM-C. Il faut tenir compte des déterminants sociaux de la santé lorsque des isolats bactériens communs et résistants deviennent associés à des maladies gravissimes.

Scleroglucan-borax hydrogel: a flexible tool for redox protein immobilization.

A highly stable biological film was prepared by casting an aqueous dispersion of protein and composite hydrogel obtained from the polysaccharide Scleroglucan (Sclg) and borax as a cross-linking agent. Heme proteins, such as hemoglobin (Hb), myoglobin (Mb), and horseradish peroxidase (HRP), were chosen as model proteins to investigate the immobilized system. A pair of well-defined quasi-reversible redox peaks, characteristics of the protein heme FeII/FeIII redox couples, were obtained at the Sclg-borax/proteins films on pyrolytic graphite (PG) electrodes, as a consequence of the direct electron transfer between the protein and the PG electrode. A full characterization of the electron transfer kinetic was performed by opportunely modeling data obtained from cyclic voltammetry and square wave voltammetry experiments. The efficiency of our cross-linking approach was investigated by studying the influence of different borax groups percentage in the Sclg matrix, revealing the versatility of this hydrogel in the immobilization of redox proteins. The native conformation of the three heme proteins entrapped in the hydrogel films were proved to be unchanged, reflected by the unaltered Soret adsorption band and by the catalytic activity toward hydrogen peroxide (H2O2). The main kinetic parameters, such as the apparent Michaelis-Menten constant, for the electrocatalytic reaction were also evaluated. The peculiar characteristics of Sclg-borax matrix make it possible to find wide opportunities as proteins immobilizing agent for studies of direct electrochemistry and biosensors development.