Declining trends in the rates of assisted injecting: a prospective cohort study.

BACKGROUND: Assisted injecting has been associated with increased risk of blood-borne infections, overdose, and other harms among people who inject drugs (PWID), particularly women. Given the changing availability of relevant harm reduction interventions in Vancouver, Canada, in recent years, we conducted a gender-based analysis to examine changes in rates and correlates of assisted injecting over time among active PWID. METHODS: Using data from a prospective cohort of PWID in Vancouver, we employed gender-stratified multivariable generalized estimating equations to examine trends in assisted injecting and identify the correlates during two periods: June 2006-November 2009 and December 2009-May 2014. RESULTS: Among 1119 participants, 376 (33.6 %) were females. Rates of assisted injecting declined between 2006 and 2014 among males (21.9 to 13.8%) and females (37.0 to 25.6%). In multivariable analyses, calendar year of interview also remained independently and negatively associated with assisted injecting among males (adjusted odds ratio [AOR] 0.95, 95% confidence interval [CI] 0.92-0.99) and females (AOR 0.93, 95% CI 0.89-0.97). Syringe borrowing remained independently associated with assisted injecting throughout the study period among females (AOR 1.53, 95% CI 1.10-2.11 during 2006-2009; AOR 2.15, 95% CI 1.24-3.74 during 2009-2014) and during 2009-2014 among males (AOR 1.88, 95% CI 1.02-3.48). CONCLUSIONS: Our findings demonstrate assisted injecting has significantly decreased for both males and females over the past decade. Nevertheless, rates of assisted injecting remain high, especially among women, and are associated with high-risk behavior, indicating a need to provide safer assisted injecting services to these vulnerable sub-populations of PWID.

Exposure and attitudes toward interprofessional teams: a three-year prospective study of longitudinal integrated clerkship versus rotation-based clerkship students.

This study explored exposure to, and attitudes toward, interprofessional (IP) teams between third-year longitudinal integrated clerkship (LIC) and traditional rotation-based clerkship (RBC) students at the University of Calgary medical school. Students completed a survey pre-post 32-week LIC or 6-week rural, regional or urban RBC family medicine rotations. Pre and post rotation surveys were completed by 213 (48%) students (LIC = 33/34; rural = 76/152; regional = 24/46; urban = 80/208). More LIC students (76%) reported participating on six or more IP teams than RBC students (rural = 38%; regional = 25%; urban = 21%). At pre rotation, the mean attitude to IP teams score of LIC and rural RBC students was high and did not differ. At post rotation, the mean attitude score of LIC students was significantly greater than the mean reported by rural RBC students. Only LIC students reported a significant pre-post rotation increase in attitude. Exposure to IP teams, possibly facilitated by a longer duration of rotation, appears to be an important factor in affecting attitude to IP teams.

Effect of the discipline of formal faculty advisors on medical student experience and career interest.

OBJECTIVE: To examine whether the discipline (family medicine vs other specialty) of formally assigned faculty advisors affected medical student experience and career interest. DESIGN: Survey. SETTING: University of Calgary in Alberta. PARTICIPANTS: A total of 104 medical students from the graduating class of 2011. MAIN OUTCOME MEASURES: Number of times medical students met with their advisors, topics of discussions, interest in family medicine, and overall medical school experience. For binary categorical variables, χ2 tests of significance were computed, and t tests were used for count and Likert-scale variables. RESULTS: Overall, 89 (86%) surveys were returned. Significant differences were noted when the discipline of the faculty advisor (family medicine vs Royal College specialty) was considered. Family medicine faculty advisors met with their students more often (P = .03) and were more likely to have a beneficial effect on the medical school experience (P = .005). Having a relationship with a family medicine faculty advisor significantly increased family medicine career interest (P = .01), although a faculty advisor in any other discipline did not erode family medicine interest. The discipline of the faculty advisor had no statistically significant influence on a student's intended selection of family medicine in the Canadian Resident Matching Service match. CONCLUSION: Family medicine faculty advisors appear particularly active in their role as mentors and appear beneficial to the medical student experience. Career interest in family medicine was enhanced by being paired with a family medicine advisor and not eroded by an advisor from another specialty.

Explaining aboriginal/non-aboriginal inequalities in postseparation violence against Canadian women: application of a structural violence approach.

Adopting a structural violence approach, we analyzed 2004 Canadian General Social Survey data to examine Aboriginal/non-Aboriginal inequalities in postseparation intimate partner violence (IPV) against women. Aboriginal women had 4.12 times higher odds of postseparation IPV than non-Aboriginal women (p < .001). Coercive control and age explained most of this inequality. The final model included Aboriginal status, age, a seven-item coercive control index, and stalking, which reduced the odds ratio for Aboriginal status to 1.92 (p = .085) and explained 70.5% of the Aboriginal/non-Aboriginal inequality in postseparation IPV. Research and action are needed that challenge structural violence, especially colonialism and its negative consequences.

Adoption of the chronic care model to improve HIV care: in a marginalized, largely aboriginal population.

OBJECTIVE: To measure the effectiveness of implementing the chronic care model (CCM) in improving HIV clinical outcomes. DESIGN: Multisite, prospective, interventional cohort study. SETTING: Two urban community health centres in Vancouver and Prince George, BC. PARTICIPANTS: Two hundred sixty-nine HIV-positive patients (18 years of age or older) who received primary care at either of the study sites. INTERVENTION: Systematic implementation of the CCM during an 18-month period. MAIN OUTCOME MEASURES: Documented pneumococcal vaccination, documented syphilis screening, documented tuberculosis screening, antiretroviral treatment (ART) status, ART status with undetectable viral load, CD4 cell count of less than 200 cells/mL, and CD4 cell count of less than 200 cells/mL while not taking ART compared during a 36-month period. RESULTS: Overall, 35% of participants were women and 59% were aboriginal persons. The mean age was 45 years and most participants had a history of injection drug use that was the presumed route of HIV transmission. During the study follow-up period, 39 people died, and 11 transferred to alternate care providers. Compared with their baseline clinical status, study participants showed statistically significant (P < .001 for all) increases in pneumococcal immunization (54% vs 84%), syphilis screening (56% vs 91%), tuberculosis screening (23% vs 38%), and antiretroviral uptake (47% vs 77%), as well as increased viral load suppression rates among those receiving ART (72% vs 90%). Stable housing at baseline was associated with a 4-fold increased probability of survival. Aboriginal ethnicity was not associated with better or worse outcomes at baseline or at follow-up. CONCLUSION: Application of the CCM approach to HIV care in a marginalized, largely aboriginal patient population led to improved disease screening, immunization, ART uptake, and virologic suppression rates. In addition to addressing underlying social determinants of health, a paradigm shift away from an "infectious disease" approach to a "chronic disease management" approach to HIV care for marginalized populations is strongly recommended.