Pharmacy-based sexually transmitted infection service implementation considerations: A scoping review.

BACKGROUND: Rates of sexually transmitted infections (STIs) are rising despite significant management efforts in traditional healthcare settings. The growing number of individuals affected by STIs demonstrates a gap in care. Pharmacy-based STI clinical services are a potential solution to improve care. OBJECTIVE: To identify and summarize research about the implementation of pharmacy-based STI services, focusing on program characteristics, barriers, facilitators, and pharmacist and patient experiences. METHODS: A search of PubMed, Embase, and Cochrane Database of Systematic Reviews was conducted for papers evaluating STI expanded-scope clinical services performed by regulated pharmacists in an outpatient/community pharmacy setting. Study setting, design, data collection method, outcomes, target infection, services offered, patient population, and barriers and facilitators are reported. RESULTS: Twelve studies, 11 cross-sectional and 1 randomized control trial, were identified in this review. All studies focused on chlamydia, and two included gonorrhea and trichomoniasis or syphilis. Eleven services investigated STI screening, with four also offering treatment, and two offering partner treatment. Overall, patients reported positive experiences, found the services accessible, and trusted pharmacists. Pharmacists recognized the importance of STI services, were keen, and felt comfortable performing clinical tasks. Patients described convenience as a key facilitator, and concerns about privacy, particularly at the pharmacy counter, and the stigma and fear of judgement associated with STIs as primary barriers. For facilitators, pharmacists reported increased job satisfaction and a sense of relieving the burden on traditional STI services; for barriers, pharmacists highlighted patient recruitment, communication challenges, and lack of remuneration. CONCLUSION: Research on pharmacy-based STI services includes predominately small-scale, cross-sectional studies, and focuses on chlamydia screening. Both patients and pharmacists perceive these services to be acceptable and feasible, though strategies addressing patient privacy and recruitment, pharmacist competency, training, and remuneration must be considered to support the success of pharmacy-based STI services.

Self-reported injuries among Canadian adolescents: rates and key correlates. / Blessures autodéclarées chez les adolescents canadiens : taux et principaux corrélats.

INTRODUCTION: Injuries sustained by adolescents in Canada represent a costly public health issue. Much of the limited research in this area uses administrative data, which underestimate injury prevalence by ignoring injuries that are not treated by the health care system. Self-reported data provide population-based estimates and include contextual information that can be used to identify injury correlates and possible targets for public health interventions aimed at decreased injury burden. METHODS: The 2017 wave of the Canadian Community Health Survey was used to calculate the prevalence of self-reported total, intentional and unintentional injuries. We compared injury prevalence according to age, sex, employment status, presence of a mood disorder, presence of an anxiety disorder, smoking and binge drinking. Analyses were performed using logistic regression to identify significantly different injury prevalence estimates across key correlates. RESULTS: Overall past-12-month injury prevalence among adolescents living in Canada was 31.4% (95% CI: 29.4%-33.5%). Most injuries were unintentional. All provinces had estimates within a few percentage points, except Saskatchewan, which had substantially higher prevalence for both overall and unintentional injury. Smoking and binge drinking were significantly associated with higher injury prevalence in most jurisdictions. Remaining correlates exhibited nonsignificant or inconsistent associations with injury prevalence. CONCLUSION: The data suggest that injury prevention interventions aimed at reducing alcohol consumption, particularly binge drinking, may be effective in reducing adolescent injury across Canada. Future research is needed to determine how provincial context (such as mental health support for adolescents or programs and policies aimed at reducing substance use) impacts injury rates.

Alcohol access and purchasing behaviour during COVID-19 pandemic restrictions: An exploration of sociodemographic, health and psychosocial correlates in two Canadian provinces.

INTRODUCTION: Alcohol access has changed in Canada during the COVID-19 pandemic. This study compares the use of two novel purchasing modes (via delivery and in excess/stockpiling) to traditional, in-person purchasing to determine if their use is associated with sociodemographic and psychosocial characteristics, perceived COVID-19 health risk or consumption frequency. METHODS: We draw on cross-sectional survey data from 2000 residents of the Canadian provinces of Nova Scotia and New Brunswick, ages 19 years and older that were administered online and by telephone. Associations between purchasing modes and sociodemographic and psychosocial characteristics, perceived COVID-19 health risk or consumption frequency were assessed using logistic regression. RESULTS: About 70% of people who drink purchased in-person, 17% used delivery and 30% purchased in excess/stockpiled. Sociodemographic and psychosocial attributes varied among those at increased odds of using each purchasing mode. Those at higher COVID-19 health risk were at higher odds of getting alcohol delivered. Increased drinking frequency was associated with alcohol delivery and purchasing in excess/stockpiling. DISCUSSION AND CONCLUSIONS: This study highlights the need for increased public health considerations regarding changes to alcohol regulations. Alcohol delivery and purchasing in excess/stockpiling is positively associated with heavier drinking. Drinkers at higher COVID-19 health risk were more likely to purchase online for delivery, which suggests novel purchasing modes may serve a partial public health function.

Changes in alcohol consumption during the COVID-19 pandemic: exploring gender differences and the role of emotional distress. / Modifications de la consommation d'alcool pendant la pandémie de COVID-19 : exploration des différences selon le genre et du rôle de la détresse émotionnelle.

INTRODUCTION: Restrictions to do with the COVID-19 pandemic have had substantial unintended consequences on Canadians' alcohol consumption patterns, including increased emotional distress and its potential impact on alcohol use. This study examines 1) changes in adults' alcohol consumption during the COVID-19 pandemic in New Brunswick and Nova Scotia; 2) whether drinking more frequently during the pandemic is associated with increased feelings of stress, loneliness and hopelessness; and 3) whether gender moderates this relationship. METHODS: Participants were drawn from a cross-sectional survey of 2000 adults. Adjusted multinomial regression models were used to assess the association between drinking frequency and increased feelings of stress, loneliness and hopelessness. Additional analyses were stratified by gender. RESULTS: About 12% of respondents reported drinking more frequently after the start of the COVID-19 pandemic, and 25%-40% reported increased emotional distress. Increased feelings of stress (odds ratio [OR] = 1.99; 95% confidence interval [CI]: 1.35-2.93), loneliness (OR = 1.79; 95% CI: 1.22-2.61) and hopelessness (OR = 1.98; 95% CI: 1.21-3.23) were all associated with drinking more frequently during the pandemic. While women respondents reported higher rates of emotional distress, significant associations with increased drinking frequency were only observed among men in gender-stratified analyses. CONCLUSION: Individuals who report increased feelings of stress, loneliness and hopelessness during the COVID-19 pandemic were more likely to report increased drinking frequency; however, these associations were only significant for men in stratified analyses. Understanding how the pandemic is associated with mental health and drinking may inform alcohol control policies and public health interventions to minimize alcohol-related harm.

Prescription medication use as a risk factor for motor vehicle collisions: a responsibility study.

INTRODUCTION: Previous studies on the effect of prescription medications on MVCs are sparse, not readily applicable to real-world driving and/or subject to strong selection bias. This study examines whether the presence of prescription medication in drivers' blood is associated with being responsible for MVC. METHODS: This modified case-control study with responsibility analysis compares MVC responsibility rates among drivers with detectable levels of six classes of prescription medications (anticonvulsants, antidepressants, antihistamines, antipsychotics, benzodiazepines, opioids) versus those without. Data were collected between January 2010 and July 2016 from emergency departments in British Columbia, Canada. Collision responsibility was assessed using a validated and automated scoring of police collision reports. Multivariable logistic regression was used to determine OR of responsibility (analysed in 2018-2019). RESULTS: Unadjusted regression models show a significant association between anticonvulsants (OR 1.92; 95% CI 1.20 to 3.09; p=0.007), antipsychotics (OR 5.00; 95% CI 1.16 to 21.63; p=0.03) and benzodiazepines (OR 2.99; 95% CI 1.56 to 5.75; p=0.001) with collision responsibility. Fully adjusted models show a significant association between benzodiazepines with collision responsibility (aOR 2.29; 95% CI 1.16 to 4.53; p=0.02) after controlling for driver characteristics, blood alcohol and Δ-9-tetrahydrocannabinol concentrations, and the presence of other prescription medications. Antidepressants, antihistamines and opioids exhibited no significant associations. CONCLUSION: There is a moderate increase in the risk of a responsible collision among drivers with detectable levels of benzodiazepines in blood. Physicians and pharmacists should consider collision risk when prescribing or dispensing benzodiazepines. Public education about benzodiazepine use and driving and change to traffic policy and enforcement measures are warranted.