Public Health Policy Strategies to Address the Opioid Epidemic.

Public health policy responses to the opioid epidemic require addressing both opioid supply and opioid demand. The growth in prescriptions of opioid analgesics, for example, is associated with escalating opioid overdose fatalities. Enhanced access to opioid agonist treatment, conversely, is required to curb demands driven by opioid use disorders.

Acute dental infections managed in an outpatient parenteral antibiotic program setting: prospective analysis and public health implications.

Background: The number of Acute Dental Infections (ADI) presenting for emergency department (ED) care are steadily increasing. Outpatient Parenteral Antibiotic Therapy (OPAT) programs are increasingly utilized as an alternative cost-effective approach to the management of serious infectious diseases but their role in the management of severe ADI is not established. This study aims to address this knowledge gap through evaluation of ADI referrals to a regional OPAT program in a large Canadian center.

Hospital ward design and prevention of hospital-acquired infections: A prospective clinical trial.

Background: Renovation of a general medical ward provided an opportunity to study health care facility design as a factor for preventing hospital-acquired infections.

Objective: To determine whether a hospital ward designed with predominantly single rooms was associated with lower event rates of hospital-acquired infection and colonization.

Methods: A prospective controlled trial with patient allocation incorporating randomness was designed with outcomes on multiple 'historic design' wards (mainly four-bed rooms with shared bathrooms) compared with outcomes on a newly renovated 'new design' ward (predominantly single rooms with private bathrooms).

Central venous catheter-associated bloodstream infections occurring in Canadian intensive care units: A six-month cohort study.

Objective: To determine the rate and risk factors associated with central venous catheter (CVC)-associated bloodstream infections (BSIs) in Canadian intensive care units (ICUs).

Design: A prospective, active six-month cohort with a nested case-control study.

Setting: Forty-one ICUs located in 19 Canadian hospitals.

Undertreatment of patients with Alzheimer's disease in an elderly United States population.

Background: The aim of this study was to assess the undertreatment of elderly mild to moderate Alzheimer's disease (AD) patients in the United States utilizing baseline data from a community-based trial that has established comparability to national survey samples on demographic characteristics.

Methods: Baseline data were used from an open-label, 12-week, postapproval study of compliance with galantamine, an AChEI and nicotinic receptor modulator, and vitamin E. A total of 2,114 patients from 406 community-based US practices in which physicians had previously treated patients with acetylcholinesterase inhibitors (AChEIs) were included in the study.

Change in cutaneous perfusion following 10 weeks of aerobic training in Type 2 diabetes.

A small, but positive, association between aerobic training status or prior maximal exercise and enhanced dorsal foot skin perfusion in active individuals with Type 2 diabetes has been shown. This study, therefore, was designed to examine whether an aerobic training intervention would positively affect cutaneous perfusion in sedentary Type 2 diabetic individuals as well. Nine sedentary participants with Type 2 diabetes (DS) and 10 obese nondiabetic controls (CS) were studied.

Incidence of bloodstream infection in multicenter inception cohorts of hemodialysis patients.

Objective: To assess incidence of and identify risk factors for bloodstream infection in patients starting hemodialysis or starting a new means of vascular access for hemodialysis.

Method: Two cohorts of patients, 1 initiating hemodialysis (new patients) and a 1:1 matching group of patients continuing hemodialysis but starting a new vascular access (continuing patients), were enrolled from 9 Canadian hemodialysis units and followed for 6 months. Bloodstream infection was defined using established criteria.

The effect of an aerobic exercise training program on quality of life in type 2 diabetes.

Purpose: The purpose of this study was to determine the effect of 10 weeks of moderate aerobic exercise training on quality of life (QOL) and selected physiological parameters in previously sedentary persons with diabetes.

Methods: A quality-of-life survey (SF36v2 health survey) and measurement of physiological parameters were completed before and after 10 weeks of supervised aerobic exercise training 3 days a week for 20 to 45 minutes by subjects with diabetes (n = 9) and control subjects (n = 10). Nontraining subjects with diabetes (n = 12) and control subjects (n = 10) also completed the QOL survey at equivalent times.

Cutaneous blood flow in type 2 diabetic individuals after an acute bout of maximal exercise.

Objective: We previously demonstrated a positive association between chronic aerobic exercise and dorsal foot skin blood flow during local heating in type 2 diabetic individuals. Thus, we hypothesized that a prior acute bout of maximal exercise would also have positive effects on postexercise blood flow.

Research Design And Methods: Subjects consisted of 32 individuals with type 2 diabetes and 26 nondiabetic control subjects further subdivided based on their physical activity status: diabetic exerciser (DE), diabetic sedentary (DS), control exerciser (CE), or control sedentary.

Prospective surveillance for primary bloodstream infections occurring in Canadian hemodialysis units.

Objective: Bloodstream infections are a major cause of morbidity and mortality in patients receiving long-term hemodialysis. We wanted to determine the incidence of hemodialysis-related bloodstream infections in Canadian centers participating in the Canadian Nosocomial Infection Surveillance Program.

Methods: Prospective surveillance for hemodialysis-related bloodstream infections was performed in 11 centers during a 6-month period.

Tool use and the effect of action on the imagination.

Three studies examined the claim that hand movements can facilitate imagery for object rotations but that this facilitation depends on people's model of the situation. In Experiment 1, physically turning a block without vision reduced mental rotation times compared with imagining the same rotation without bodily movement. In Experiment 2, pulling a string from a spool facilitated participants' mental rotation of an object sitting on the spool.

Dental Students with Hepatitis B e Antigen: A Survey of Canadian Dental Schools.

BACKGROUD: Health care workers who are e-antigen-positive carriers of hepatitis B virus have become a significant focus of concern in the development of public health policy. In cases of needle-stick injury, the risk of transmission of HBV has been estimated at 60-fold greater if the carrier is positive for e antigen than if the carrier does not have the e antigen. Debate continues regarding proposed public health policies to restrict e-antigen-positive health care workers from performing "exposure-prone procedures".

Drug resistance study of Mycobacterium tuberculosis in Canada, February 1, 1993 to January 31, 1994.

Objective: To estimate the prevalence of resistance of Mycobacterium tuberculosis to first-line antituberculosis drugs in Canada.

Methods: M. tuberculosis isolates from one third of all culture-positive tuberculosis (TB) cases diagnosed between February 1, 1993 to January 31, 1994 in Canada were collected prospectively.

Onset and duration of action of levocabastine nasal spray in atopic patients under nasal challenge conditions.

Background: Although prior studies have documented the rapid onset of action of topical intranasal levocabastine (LEV), little is known about its duration of action under nasal challenge conditions.

Objectives: We sought to assess the onset and duration of action of escalating doses of LEV nasal spray by using a nasal allergen challenge (NAC) model.

Methods: Eighteen asymptomatic subjects with histories of seasonal allergic rhinitis were enrolled into a randomized, single-blind, placebo-controlled, dose-ranging crossover study.

Efficacy and safety of levocabastine nasal spray for seasonal allergic rhinitis.

This multicenter, double-blind, placebo-controlled trial evaluated the efficacy and safety of levocabastine nasal spray, a potent and selective H1-receptor antagonist, in the control of histamine-mediated symptoms of seasonal allergic rhinitis. Adults with > or = 2 year history of allergic rhinitis due to Mountain Cedar were randomized to treatment with levocabastine nasal spray (0.2 mg twice daily) or placebo for 28 days during the 1994-1995 Mountain Cedar allergy season.

A Canadian multicentre case-control study of sporadic Escherichia coli 0157:H7 infection.

Objective: To evaluate further risk factors for Escherichia coli 0157:H7 infection including consumer preferences related to the consumption of ground beef and the role of person-to-person transmission of this infection.

Patients And Methods: A case-control study of sporadic E coli 0157:H7 infection was undertaken in five Canadian cites from June to December 1991. One hundred cases of E coli 0157:H7 infection were age- and sex-matched to 200 neighbourhood controls.

Increased glucocorticoid activity in men with cardiovascular risk factors.

The association between hypertension and insulin resistance might be explained by increased activity of the principal glucocorticoid, cortisol. Recent data show that the intensity of dermal vasoconstriction after topical application of glucocorticoids is increased in patients with essential hypertension. In this report, we examine whether increased glucocorticoid sensitivity or secretion is associated with insulin resistance and is a cause or consequence of hypertension.

Comparison of tuberculosis infection control programs in Canadian hospitals categorized by size and risk of exposure to tuberculosis patients, 1989 to 1993 - Part 2.

Objective: To analyze tuberculosis (TB) programs in acute care hospitals (hospitals) categorized by size and risk of exposure to TB patients from 1989 to 1993.

Design: Retrospective survey.

Participants: Members of the Community and Hospital Infection Control Association-Canada and l'Association des professionnels pour la prévention des infections who worked in Canadian hospitals received questionnaires.

Status of tuberculosis infection control programs in Canadian acute care hospitals, 1989 to 1993 - Part 1.

Objective: To document tuberculosis (TB) prevention and control activities in Canadian acute care hospitals from 1989 to 1993.

Design: Retrospective questionnaire.

Participants: All members of the Community and Hospital Infection Control Association-Canada and l'Association des professionnels pour la prévention des infections who lived in Canada and worked in an acute care hospital received a questionnaire.

Impaired microvascular dilatation and capillary rarefaction in young adults with a predisposition to high blood pressure.

Increased vascular resistance in essential hypertension occurs mainly in microvessels with luminal diameters < 100 microm. It is not known whether abnormalities in these vessels are a cause or consequence of high blood pressure (BP). We studied 105 men (aged 23-33 yr) in whom predisposition to high blood pressure has been characterized by both their own BP and those of their parents.

Rapid progression to disease in African sex workers with human immunodeficiency virus type 1 infection.

From a cohort of female sex workers in Nairobi, Kenya, 163 women were observed to seroconvert to human immunodeficiency virus type 1 (HIV-1) and followed to study progression to HIV-1-related disease. The effect of several covariables on disease progression was studied using a Weibull proportional hazards model. The Weibull survival model was fitted to the observed incubation times.

An outbreak of diarrhea due to verotoxin-producing Escherichia coli in the Canadian Northwest Territories.

In the summer of 1991 a large outbreak of Escherichia coli O157:H7 associated diarrhea occurred in 6 Inuit communities in the Canadian Northwest Territories. The total population of these communities is 5,292. Of the 521 individuals who developed diarrhea, 152 (29%) were positive for E.