Investigating the unique service and treatment needs of women with alcohol use disorder: Literature review and key informant perspectives in British Columbia.

Alcohol Use Disorder (AUD) is a medical condition uniquely affecting the female population, requiring widespread restructuring of current services to increase treatment utilization and efficacy. This review synthesizes the literature on the service and treatment needs of women with AUD. A literature search and review were conducted following PRISMA guidelines. Key informant information was collected during interviews with health leaders. Data from literature searches and interviews were analyzed to identify common themes. Results found women face more barriers when accessing and receiving AUD treatment. Major barriers include stigma, location, transportation, and childcare, which contribute to the AUD treatment gap among women. Recommendations to reduce barriers include (1) implementing universal screening, (2) improving care provider education and awareness, (3) providing childcare services, (4) establishing a strong client-clinician relationship, (5) building a community approach for Indigenous clients, (6) improving Managed Alcohol Programs, and (7) expanding virtual substance use prescribing practices.

How prescribing available pharmacotherapies for alcohol use disorder can impact the healthcare system: A retrospective quality improvement study.

Alcohol use disorder is a multifactorial undertreated chronic disorder influenced by genetic, psychological, and environmental factors. Numerous pharmacotherapies are available and effective but are underutilized in healthcare. The purpose of this retrospective quality improvement study is to determine the impact of education sessions on the availability and efficacy of medications (focusing on Naltrexone) to treat alcohol use disorder in the healthcare system. Control charts were implemented to monitor the system change in two comparable urban areas. Dispensing rates increased at three points after a series of presentations. The first increase from baseline was 2.47 times, the second 3.7, and the third 4.81. Coinciding with these, weekly visits to the emergency department also decreased by 35% and stabilized at a 15% reduction. It was also observed that alcohol use disorder hospital admission rates decreased by 21%, but bounced back once the education sessions ended. Combined with counselling, pharmacotherapies can be effective in combating alcohol use disorder, while potentially reducing demands on the healthcare system.

Evidence-based support for community outreach worker programme in Rural British Columbia, Canada.

INTRODUCTION: Community outreach workers (CWs) provide critical services to their community by connecting marginalised people to community and primary care services. The importance of CWs is overlooked in the current provincial primary health-care transformation due to perceived lack of evidence. This evaluation describes the efficacy of the CW programme in a rural British Columbian community. METHODS: Capacity of the programme was determined by reviewing service and financial reports. Outcomes of the programme were analyzed from the electronic medical records and health systems data. Group discussions were conducted with providers, care team members and CWs for a deeper understanding of programme efficacy and impact. RESULTS: For 64 h per month, CWs supported 15 clients, provided 28 visits and executed 10 referrals to community resources. The typical client was an adult of low socioeconomic status, unable to effectively organise themselves and navigate the health-care system and/or community resources, often as a result of undiagnosed low mental or cognitive functioning. The programme positively impacted the health-care system by facilitating 142 attachments to providers, reducing client emergency department use by 41%, while marginally increasing primary care services (6%), and supporting more appropriate emergency department visits. CONCLUSION: Clients enrolled in the programme did not fit into already defined services offered by the health authority. However, they required support to effectively function in their community. With the current health-care system transformation in British Columbia, it is imperative that the CW programme is recognised for its value to attract and maintain stable funding.

Résumé Introduction: Les travailleurs communautaires assurent des services essentiels à leur communauté en rapprochant les personnes marginalisées et les services communautaires et médicaux de première ligne. La transformation actuelle des soins provinciaux de première ligne ne reconnaît pas l'importance des travailleurs communautaires en raison de l'absence perçue de données probantes. Cette évaluation décrit l'efficacité du programme de travailleurs communautaires dans une communauté rurale de la Colombie-Britannique. Méthodologie: La capacité du programme a été déterminée par l'étude des services et des rapports financiers. Les résultats du programme ont été analysés à partir des dossiers médicaux électroniques (DMÉ) et des données du système de santé. Des discussions en groupe ont eu lieu avec les fournisseurs de soins, les membres des équipes de soins et les travailleurs communautaires afin de mieux comprendre l'efficacité et l'impact du programme. Résultats: Pendant 64 heures par mois, les travailleurs communautaires ont aidé 15 clients, effectué 28 visites et exécuté 10 recommandations à des ressources communautaires. Le client typique était un adulte à faible statut socio-économique, incapable de s'organiser efficacement et de naviguer dans le système de santé et/ou les ressources communautaires, souvent en raison d'un déficit mental ou cognitif non diagnostiqué. Le programme a eu un impact positif sur le système de santé en permettant 142 contacts avec des fournisseurs de soins, en réduisant de 41% les visites à l'urgence, tout en augmentant marginalement les services de soins de première ligne (6%), et en favorisant plus de visites appropriées à l'urgence. Conclusion: Les clients inscrits au programme n'arrivaient pas à s'intégrer aux services préalablement définis offerts par les autorités de santé. Mais ils avaient quand même besoin d'aide pour fonctionner efficacement dans leur communauté. Avec la transformation actuelle du système de santé en Colombie-Britannique, il est impératif que le programme de travailleurs communautaires soit reconnu pour sa qualité réelle et qu'il reçoive et maintienne un financement stable. Mots-clés: Travailleurs communautaires, travailleurs d'approche communautaire, soins en équipe.

Technology to support relational care for people who use drugs at home: Literature review and key informant content.

Canada's opioid crisis is a public health emergency that disproportionately affects people who use drugs alone at home, requiring the mobilization of health systems to implement timely, effective, and innovative programs. The purpose of this review is to provide a synthesis of recent literature relating to technology-enabled harm reduction strategies. The results of the literature review are corroborated with key informants, including family members of people who use drugs and policy-makers in the area of opioid use. Based on this, it is recommended that technology-enabled support programs for people who use drugs at home must deliver support at whatever point the person is along their drug use continuum, must transfer frontline relational skills, must be co-developed with community members and service providers, and must deliver predictable and reliable services that are safe from stigma.

Native reading direction influences lateral biases in the perception of shape from shading.

Although neurologically normal individuals often exhibit leftward biases of perception and attention, known as pseudoneglect, factors such as lighting, spatial location and native reading direction have been found to modulate these biases. To investigate lighting and spatial biases in left-to-right and right-to-left readers search times were measured in a target finding task where lighting and target locations were manipulated. Target search times under upper-left lighting were significantly shorter than lower-left, upper-right and lower-right lighting among left-to-right readers. Right-to-left readers did not display the same leftward bias, even displaying significantly shorter search times under upper-right lighting than those of left-to-right readers. Significantly shorter search times for targets located in the upper-left quadrant (compared to other quadrants) were observed for left-to-right readers, while search times for upper-right located targets were significantly shorter for right-to-left readers compared to those of left-to-right readers. Participant scan times of stimuli divided into equal quadrants were monitored by an eye-tracking camera. Both groups displayed greater scan times in upper quadrants. These findings suggest that native reading direction modulates spatial and light perception biases resulting in weaker leftward, or a lack of lateral biases among right-to-left readers.

Lower-right and upper-left biases within upper and lower visual fields in a circular array task.

Visuospatial performance varies along the horizontal and vertical dimensions, resulting in behavioral biases such as pseudoneglect. The interaction between the horizontal and vertical attentional biases was investigated using a novel circular array task capable of conveying relative brightness information across vertical and horizontal dimensions simultaneously. In a novel circular array task comprised of six discs, the grayscale gradient was disrupted by switching two grayscale values within the array. Leftward biases were observed in the lower visual fields and rightward biases in the upper visual fields. More importantly, the magnitude of bias within the upper/lower horizontal dimension altered depending on the relative position of the stimuli along horizontal and vertical axes within each dimension. Manipulating the upper-most and leftward discs yield stronger biases than manipulating rightward discs. Furthermore, stronger biases were observed during bottom and rightward disc manipulation. The upper-left and lower-right biases within the horizontal dimension indicate that the interactions between the horizontal and vertical biases may not rely simply on the dichotomy within the horizontal and vertical dimensions, but also on the relative spatial distribution of stimuli within these dimensions.

Does environmental enrichment reduce stress? An integrated measure of corticosterone from feathers provides a novel perspective.

Enrichment is widely used as tool for managing fearfulness, undesirable behaviors, and stress in captive animals, and for studying exploration and personality. Inconsistencies in previous studies of physiological and behavioral responses to enrichment led us to hypothesize that enrichment and its removal are stressful environmental changes to which the hormone corticosterone and fearfulness, activity, and exploration behaviors ought to be sensitive. We conducted two experiments with a captive population of wild-caught Clark's nutcrackers (Nucifraga columbiana) to assess responses to short- (10-d) and long-term (3-mo) enrichment, their removal, and the influence of novelty, within the same animal. Variation in an integrated measure of corticosterone from feathers, combined with video recordings of behaviors, suggests that how individuals perceive enrichment and its removal depends on the duration of exposure. Short- and long-term enrichment elicited different physiological responses, with the former acting as a stressor and birds exhibiting acclimation to the latter. Non-novel enrichment evoked the strongest corticosterone responses of all the treatments, suggesting that the second exposure to the same objects acted as a physiological cue, and that acclimation was overridden by negative past experience. Birds showed weak behavioral responses that were not related to corticosterone. By demonstrating that an integrated measure of glucocorticoid physiology varies significantly with changes to enrichment in the absence of agonistic interactions, our study sheds light on potential mechanisms driving physiological and behavioral responses to environmental change.

Is it only humans that count from left to right?

We report that adult nutcrackers (Nucifraga columbiana) and newborn domestic chicks (Gallus gallus) show a leftward bias when required to locate an object in a series of identical ones on the basis of its ordinal position. Birds were trained to peck at either the fourth or sixth element in a series of 16 identical and aligned positions. These were placed in front of the bird, sagittally with respect to its starting position. When, at test, the series was rotated by 90 degrees lying frontoparallel to the bird's starting position, both species showed a bias for identifying selectively the correct position from the left but not from the right end. The similarity with the well-known phenomenon of the left-to-right spatially oriented number line in humans is considered.

Effects of forced-choice runway variations on rats' T-maze serial pattern learning.

Rats learned an ordered RNR/RNN serial pattern task in a T-maze where they were shifted to a different runway on Trial 3 only in the RNR series (shift-win/stay-lose group) or only in the RNN series (stay-win/shift-lose group). The shift-win/stay-lose group developed faster speeds on Trial 3 of the RNR than on Trial 3 of the RNN series more easily than the stay-win/shift-lose group. This difference occurred whether all rats were forced onto the same runway on the first two trials (Experiment 1) or onto a different runway on Trial 2 from that on Trial 1 in each series (Experiment 2). Posttraining probe tests revealed that the shift-win/stay-lose group in each experiment relied on the runway shift event in Trial 3 or on the series position to anticipate the second reward within a series. Such reward expectancies were greater when the runway shift occurred in the same series position as during training. These probe tests revealed that the stay-win/shift-lose group relied only on the series position in Experiment 2. Our findings do not support predictions based on an associative predictive validity model. Rather, they reflect rats' predisposition to spontaneously alternate choices in the T-maze, a tendency corresponding to their inherent win-shift foraging strategy. Rats in each group also reduced their speeds less on the nonrewarded Trial 2 when it preceded a rewarded rather than a nonrewarded Trial 3. This effect suggests that rats were able to determine which series contained a second rewarded trial. We discuss the theoretical implications of this Trial 2 speed effect in terms of rats' uncertainty about where this second rewarded trial might occur in the RNR series.

Effects of runway shift and stay rules on rats' serial pattern learning in the T-maze.

Rats received three-trial series on a T-maze consisting of extended visually distinct left-black and right-striped side runways. During the first phase of training, when allowed to select baited runways within these series, they predominantly alternated their choices. During the second phase, rats received forced-choice serial pattern training of series consisting of two rewarded (R) trials and one nonrewarded (N) trial in two fixed orders, RRN and RNR. In Experiment 1, the rats in the runway shift rule group always received the second R trial when forced down a runway opposite that on the preceding trial in the series and the N trial when forced down the same runway. The rats in the runway stay rule group always received the second R trial when forced down the same runway and the N trial when forced down the opposite runway. In Experiment 2, each rat was conditionally trained with both runway outcome rules as determined by the central alley lighting and the type of food in the side alleys. The rats took longer to reduce their running speed on the N trial within each sequence under the runway stay rule than under the runway shift rule. They also took longer to acquire serial pattern responding for the RNR than for the RRN series only under the runway stay rule condition. When subsequently reexposed to series of free-choice trials on the final phase, rats maintained spontaneous alternating choice patterns under the runway shift rule conditions but either seldom alternated their choices (Experiment 1) or greatly reduced choice alternations (Experiment 2) under the runway stay rule condition. We discussed these effects in terms of rats' natural foraging strategies and as a factor that interacts with other within- and between-series variables that affect serial pattern behavior.