Canadian Public Health Association

IntroductionThe Building on Existing Tools to Improve Cancer and Chronic Disease Prevention and Screening in Primary Care (BETTER) programme trains allied health professionals working in primary care settings to develop personalised chronic disease ‘prevention prescriptions’ with patients. However, maintenance of health behaviour changes is difficult without ongoing support. Sustainable options to enhance the BETTER programme and ensure accessibility to underserved populations are needed. We designed the BETTER Women programme, which uses a digital app to match patients with a trained peer health coach (PHC) who provides ongoing support for health behaviour change after receipt of a BETTER prevention prescription in primary care.Methods and analysisWe will conduct a type 1 hybrid implementation-effectiveness patient-randomised trial. Interested women aged 40–68 years will be recruited from three large, sociodemographically distinct primary care clinics (urban, suburban and rural). Patients will be randomised 1:1 to intervention or wait-list control after receipt of their BETTER prevention prescription. We will aim to recruit 204 patients per group (408 total). Effectiveness will be assessed by the primary outcome of targeted behaviours achieved for each participant at 6 months, consisting of three cancer screening tests (cervical, breast and colorectal) and four behavioural determinants of cancer and chronic disease (diet, smoking, alcohol use and physical activity). Data will be collected through patient survey and clinical chart review, measured at 3, 6 and 12 months. Implementation outcomes will be assessed through patient surveys and interviews with patients, peer health coaches and healthcare providers. An embedded economic evaluation will examine cost per quality-adjusted life-year and per additional health behavioural targets achieved.Ethics and disseminationThis study has been approved by Women’s College Hospital Research Ethics Board (REB), the Royal Victoria Regional Health Centre REB and the University of Toronto REB. All participants will provide informed consent prior to enrolment. Participation is voluntary and withdrawal will have no impact on the usual care received from their primary care provider. The results of this trial will be published in peer-reviewed journals and shared via conference presentations. Deidentified datasets will be shared on request, after publication of results.Trial registration numberNCT04746859.

Introduction. Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus (severe acute respiratory syndrome-related coronavirus 2). COVID-19 is now expected to stay with us for many years as a recurring disease. Molnupiravir and favipiravir are oral antiviral drugs with anti-RNA polymerase activity. The Russian Health Ministry has approved molnupiravir and favipiravir for the treatment of COVID-19. The study describes development and validation of high-performance liquid chromatography – tandem mass spectrometry (HPLC-MS/MS) method for the simultaneous determination of β-D-N4-Hydroxycytidine and favipiravir in human blood plasma. The method could be applied in pharmacokinetic study of molnupiravir and favipiravir.Aim. The aim of this study is to develop and validate a HPLC-MS/MS bioanalytical method for the determination of β-D-N4-Hydroxycytidine and favipiravir in human plasma.Materials and methods. The determination of β-D-N4-Hydroxycytidine and favipiravir in human plasma by HPLC-MS/MS. The samples were processed by 0.1 % formic acid in acetonitrile. Internal standard: promethazine. Mobile phase: 0.01 mol/L Ammonium formate buffer solution (Eluent A), 0.1 % formic acid and 0.08 % aqueous ammonia in water/acetonitrile 10 : 90 (Eluent B). Column: Shim-pack GWS C18, 150 × 4.6 mm, 5 μm. Analytical range: 50.00–10000.00 ng/mL for β-D-N4-Hydroxycytidine, 250.00–20000.00 ng/mL for favipiravir in human plasma. Ionization source: electrospray ionization. Detection conditions: 260.00 m/z → 82.10 m/z, 260.00 m/z → 111.00 m/z, 260.00 m/z → 127.95 m/z (β-D-N4-Hydroxycytidine); 156.15 m/z → 65.95 m/z, 156.15 m/z → 85.00 m/z, 156.15 m/z → 113.10 m/z (favipiravir); 285.05 m/z → 198.05 m/z (promethazine).Results and discussion. This method was validated by selectivity, suitability of reference standard, matrix effect, calibration curve, accuracy, precision, spike recovery, the lower limit of quantification, carry-over effect and stability.Conclusion. The HPLC-MS/MS method for quantitative determination of β-D-N4-Hydroxycytidine and favipiravir in human plasma was developed and validated. The analytical range was 50.00–10000.00 ng/mL for β-D-N4-Hydroxycytidine, 250.00–20000.00 ng/mL for favipiravir in human plasma. This method was applied to investigate the pharmacokinetics of molnupiravir and favipiravir.

Introduction. Coronavirus disease (COVID-19) is an acute infectious disease caused by SARS-CoV-2 (severe acute respiratory syndrome-related coronavirus 2). Favipiravir is a synthetic prodrug with antiviral activity used for the treatment of COVID-19. There are oral and parenteral dosage forms of favipiravir. Compared with oral administration, parenteral administration has some advantages. Developing a method for the determination of favipiravir in human blood plasma is necessary for performing the analytical part of clinical studies of favipiravir for parenteral administration as an infusion, studying pharmacokinetics, and choosing the optimal dosage of the drug.Aim. The aim of this study is to develop and validate a method for quantitative determination of favipiravir in human plasma by high-performance liquid chromatography with ultraviolet detection (HPLC-UV) for pharmacokinetic studies.Materials and methods. Determination of favipiravir in human plasma by HPLC-UV. The UV detection was set at 323 ± 2 nm. The samples were processed by methanol protein precipitation. Internal standard: raltegravir. Mobile phase: 0.1 % formic acid in water with 0.08 % aqueous ammonia (eluent A), 0.1 % formic acid in acetonitrile with 0.08 % aqueous ammonia (eluent B). Column: Phenomenex Kinetex®, C18, 150 × 4.6 mm, 5 μm. Analytical range: 0.25–200.00 μg/mL.Results and discussion. This method was validated by selectivity, calibration curve, accuracy, precision, spike recovery, the lower limit of quantification, carry-over effect and stability.Conclusion. We developed and validated the method of quantitative determination of favipiravir in human plasma by HPLC-UV. The analytical range was 0.25–200.00 μg/mL in human plasma. The method could be applied in pharmacokinetics studies of favipiravir.

Introduction. Lappaconitine is an alkaloid, contained into Aconitum leucostomum Vorosh. roots and herbs. The alkaloid is indicated to arrhythmia. The lappaconitine drugs are metabolized into eight pharmacologically active substances, but N-desacetyllappaconitine is the most effective. Drugs based on a lappaconitine has narrow therapeutic range and many kinds of side effects. Pharmacokinetics of lappaconitine should be more studied for safety medical use of lappaconitine drugs.Aim. The aim of this study is to develop method for the quantitative determination of lappaconitine and its active metabolite N-desacetyllappaconitine in human plasma and blood by high performance liquid chromatography and tandem mass spectrometry (HPLC-MS/MS). Materials and methods. Determination of lappaconitine and N-desacetyllappaconitine in plasma and blood was carried out by HPLC-MS/MS. The samples were processed by acetonitrile protein precipitation.Results and discussion. This method was validated by next parameters: selectivity, matrix effect, calibration curve, accuracy, precision, spike recovery, lower limit of quantification, carry-over effect and stability.Conclusion. The method of the quantitative determination of lappaconitine and N-desacetyllappaconitine in human plasma and blood was developed and validated by HPLC-MS/MS. The analytical range of the was 0.50-50.00 ng/ml for lappaconitine and 0.50-100.00 ng/ml for N-desacetyllappaconitine in biological matrix. Method could be applied to determination of lappaconitine and N-desacetyllappaconitine for PK studies.

Background Policy decisions about childhood vaccination require consideration of multiple, sometimes conflicting, public health and ethical imperatives. Examples of these decisions are whether vaccination should be mandatory and, if so, whether to allow for non-medical exemptions. In this article we argue that these policy decisions go beyond typical public health mandates and therefore require democratic input. Methods We report on the design, implementation, and results of a deliberative public forum convened over four days in Ontario, Canada, on the topic of childhood vaccination. Results 25 participants completed all four days of deliberation and collectively developed 20 policy recommendations on issues relating to mandatory vaccinations and exemptions, communication about vaccines and vaccination, and AEFI (adverse events following immunization) compensation and reporting. Notable recommendations include unanimous support for mandatory childhood vaccination in Ontario, the need for broad educational communication about vaccination, and the development of a no-fault compensation scheme for AEFIs. There was persistent disagreement among deliberants about the form of exemptions from vaccination (conscience, religious beliefs) that should be permissible, as well as appropriate consequences if parents do not vaccinate their children. Conclusions We conclude that conducting deliberative democratic processes on topics that are polarizing and controversial is viable and should be further developed and implemented to support democratically legitimate and trustworthy policy about childhood vaccination.

Establishing a step-by-step process that provides practitioners with a blueprint for translating movement guidelines into action stands to optimize the investment in guideline development, improve guideline promotion and uptake, and ultimately enhance population health. The purpose of this paper is to describe how the Knowledge-to-Action framework and integrated knowledge translation were operationalized to systematically inform our knowledge translation (KT) efforts for the Canadian 24-Hour Movement Guidelines for Adults aged 18-64 years and Adults aged 65 years or older. In October 2018, the need for a KT Process, operating in tandem with the Guideline Development Process, led to the establishment of a KT team with a specific structure and terms of reference. The KT team collaboratively agreed on decision-making principles prior to selecting target audiences to focus their efforts. We undertook formative research to assess the local context and determinants of guideline dissemination and implementation efforts among target audiences. Plans for the subsequent steps and research are outlined. We highlight recommendations and lessons learned for applying the process in other settings. Novelty We outline a collaborative and systematic process and research program for the knowledge translation of movement guidelines. This paper provides an innovative and replicable blueprint to optimize future movement guideline knowledge translation efforts.

Pain and fear during immunizations can affect children and their future behaviour toward immunization. These negative experiences can be amplified when children receive vaccines as part of school-based immunization programs, where parental or tutor supports are missing. In 2015, HELPinKIDS&ADULTS, a Canadian network of experts, published a clinical practice guideline (CPG) on the management of pain and fear during immunization. This guideline has been endorsed by international, national and provincial organizations. However, the level of integration and implementation of the CPG into local and community immunization programs such as school-based immunization clinics is unclear. An investigation whether public health units in Ontario integrated and implemented the pain and fear interventions recommended by the CPG into school-based immunization policies and practices was concluded. The study shows that the majority of public health units do have pain and fear policies and procedures in place, but interventions are not integrated in a consistent and formal manner, leading to suboptimal uptake of interventions during immunizations at school. For pain interventions to be applied with sufficient fidelity and in enough individuals to have a meaningful effect, organizational leaders need to create directives and procedures that support implementation in a systematic and accountable manner.

In Canada, over 80% of parents choose to vaccinate their children. Although this may appear positive, it is one of the lowest vaccination rates in the western world, and does not meet the 95% coverage rate needed to prevent outbreaks of vaccine-preventable diseases such as measles. A recent national immunization survey showed approximately 50% of parents are concerned about potential side-effects from vaccines, 25% believe that a vaccine can cause the disease it was meant to prevent, and 13% think alternative practices could eliminate the need for vaccines. In addition, vaccine hesitancy-defined by its determinants: confidence, complacency and convenience-is on rise. To address the complacency and trust (confidence) components of vaccine hesitancy, four best practices to optimize trust in vaccines and promote vaccine acceptance are presented. The first best practice is to understand the concerns; this is done at a population level via research and at individual level via motivational interviewing. The second best practice is to address these concerns by effectively presenting science-based information. This is done at a population level by communicating research and at an individual level by applying this research to the specific concerns, values and norms of the individual. Third, present immunization as a social norm, both in educational materials and in conversations. Finally, resilience is fostered by planning ahead (both at a population level and for individual practitioners) to manage events that can undermine trust and drive negative vaccine concerns, such as a new vaccine being added to the routine schedule or the emergence of an unexpected adverse event. Building and maintaining public trust in immunization takes time. Healthcare practitioners must keep in mind that while trust is a key element in vaccine acceptance, it is not the only element; convenience and access can also impact vaccine uptake. Nurturing trust is but one part of increasing vaccine acceptance and this brief will focus on strategies to build and nurture trust.

Stigma is widely recognized as a significant barrier to the prevention, management and treatment of sexually transmitted and blood-borne infections (STBBIs) in Canada. Despite major advances in STBBI prevention and treatment, and global efforts to reduce stigma, people living with or affected by STBBIs continue to experience stigma within health and social service settings in Canada. To describe the development, content and evaluation of knowledge translation resources and training workshops designed to equip health and social service professionals with the knowledge and skills needed to provide more respectful and inclusive sexual health, harm reduction and STBBI services. After conducting a literature review, environmental scan and key informant interviews, and developing a conceptual framework, the Canadian Public Health Association (CPHA) developed four knowledge translation resources and three training workshops in partnership with a number of community-based organizations and experts. The resources were drafted and reviewed by both service providers and individuals affected by STBBIs. The workshops were developed, piloted and then evaluated using post-workshop questionnaires. The four resources developed were a self-assessment tool related to STBBIs and stigma; a service provider discussion guide to facilitate respectful and inclusive discussions on issues related to sexuality, substance use and STBBIs; a toolkit focused on stigma reduction, privacy, confidentiality and the criminalization of HIV non-disclosure; and an organizational assessment tool related to STBBIs and stigma for health and social service settings. These knowledge translation resources were subsequently integrated into the content of three face-to-face trainings that were piloted and evaluated across the country. Post-workshop evaluation had an overall 85% response rate; 88% of participants noted increased awareness of various forms of stigma, 87% noted increased comfort discussing sexuality, substance use and harm reduction with their clients/patients, 90% reported increased awareness of organizational strategies to reduce stigma, and 93% reported being able to integrate workshop learnings into practice. In addition, there was strong support for professional development on issues related to STBBI stigma reduction. These knowledge translation resources and training workshops represent a comprehensive set of tools developed in Canada that service providers can use to help reduce stigma when caring for clients/patients with STBBIs and related conditions. Evaluation indicates there is a strong willingness among health and social service providers to engage in educational opportunities in this area and that participation in the training workshops led to increased awareness and a willingness to adopt best practices.