BackgroundFactors associated with HCV incidence among young Aboriginal people in Canada are still not well understood. We sought to estimate time to HCV infection and the relative hazard of risk factors associated HCV infection among young Aboriginal people who use injection drugs in two Canadian cities.MethodsThe Cedar Project is a prospective cohort study involving young Aboriginal people in Vancouver and Prince George, British Columbia, who use illicit drugs. Participants’ venous blood samples were drawn and tested for HCV antibodies. Analysis was restricted to participants who use used injection drugs at enrolment or any of follow up visit. Cox proportional hazards regression was used to identify independent predictors of time to HCV seroconversion.ResultsIn total, 45 out of 148 participants seroconverted over the study period. Incidence of HCV infection was 26.3 per 100 person-years (95% Confidence Interval [CI]: 16.3, 46.1) among participants who reported using injection drugs for two years or less, 14.4 per 100 person-years (95% CI: 7.7, 28.9) among participants who had been using injection drugs for between two and five years, and 5.1 per 100 person-years (95% CI: 2.6,10.9) among participants who had been using injection drugs for over five years. Independent associations with HCV seroconversion were involvement in sex work in the last six months (Adjusted Hazard Ratio (AHR): 1.59; 95% CI: 1.05, 2.42) compared to no involvement, having been using injection drugs for less than two years (AHR: 4.14; 95% CI: 1.91, 8.94) and for between two and five years (AHR: 2.12; 95%CI: 0.94, 4.77) compared to over five years, daily cocaine injection in the last six months (AHR: 2.47; 95% CI: 1.51, 4.05) compared to less than daily, and sharing intravenous needles in the last six months (AHR: 2.56; 95% CI: 1.47, 4.49) compared to not sharing.ConclusionsThis study contributes to the limited body of research addressing HCV infection among Aboriginal people in Canada. The HCV incidence rate among Cedar Project participants who were new initiates of injection drug use underscores an urgent need for HCV and injection prevention and safety strategies aimed at supporting young people surviving injection drug use and sex work in both cities. Young people must be afforded the opportunity to provide leadership and input in the development of prevention programming.

Full-time direct patient care occupations have greater risk of injury compared to part-time and casual workers within the health care sector.

P ediatric palliative care can be summarized as "an active and total approach to care focused on the enhancement of quality of life for the children with life-threatening conditions and support for the family".1 A life-threatening condition is a condition with no established cure, or for which available treatment has not succeeded, and survival to full adulthood is unlikely. Children requiring, but not enrolled in, a pediatric palliative care program (PPCP) access usual care often through uncoordinated acute care admissions and some episodes of home care, but potentially with some compromise to continuity of care where critical components for family support are lacking. Complex care plans and fluctuating patient needs necessitate a coordination of care within individualized support systems.Pediatric palliative care is a relatively new and evolving field. It varies from adult palliative care in important ways. From a resource utilization perspective, pediatric palliative care is usually delivered over a longer time frame. 2,3It is unclear how enrolment in a PPCP affects health care utilization and costs compared with usual care. Understanding such outcomes may improve the efficiency of health care services for children with life-threatening conditions and support evidence-based planning and resource allocation for PPCPs. We conducted a systematic review of the published literature where inpatient health care resource utilization and costs were compared between children with life-threatening conditions who accessed a PPCP and those who did not. Background: Pediatric palliative care is a relatively new and evolving field, and the cost of pediatric palliative care programs is unclear. We conducted a systematic review to compare inpatient health care utilization and costs among children with life-threatening conditions who have accessed a pediatric palliative care program and those who have not.