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The Evidence Speaks (September 2020)

The Evidence Speaks Series is a recurring feature highlighting the latest in CHÉOS research. This series features summaries of select publications as well as in-depth features on the latest work from our investigators. The Series is designed to keep media and the research community up-to-date with CHÉOS’ current research results in the health outcomes field.


 

Grunau B, Kime N, Leroux B, Rea T, Belle GV, Menegazzi JJ, Kudenchuk PJ, Vaillancourt C, Morrison LJ, Elmer J, Zive DM, Le NM, Austin M, Richmond NJ, Herren H, Christenson J. Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest. JAMA. 2020 Sep;324(11):1058-67.

There are established guidelines for the treatment of out-of-hospital cardiac arrest (OHCA) by emergency medical services (EMS); however, transport to hospital during OHCA resuscitative efforts varies by agency and region. In this cohort study, a team led by CHÉOS Scientist Dr. Brian Grunau and including CHÉOS Scientist Dr. Jim Christenson investigated whether transport to hospital during cardiac arrest (intra-arrest transport) is associated with survival to hospital discharge, compared with continued on-scene resuscitation. The researchers analyzed data from the Resuscitation Outcomes Consortium Cardiac Epidemiologic Registry of ten North American study sites. They included 27,705 consecutive EMS-treated patients with nontraumatic OHCA between April 2011 and June 2015. Using a methodology that accounts for initial resuscitative efforts and matches patients based on the time of their arrest, the researchers found that four per cent of patients who underwent intra-arrest transport survived to hospital discharge compared with 8.5 per cent of patients who received on-scene resuscitation. The results demonstrate that intra-arrest transport to the hospital was significantly associated with a lower probability of survival to hospital discharge, and lower probability of surviving with good neurological outcomes, compared with continued on-scene treatment. While there are some limitations to the study due to its observational design, it highlights the need for further investigation using randomized controlled trials.

Munro S, Guilbert E, Wagner M-S, Wilcox ES, Devane C, Dunn S, Brooks M, Soon JA, Mills M, Leduc-Robert G, Wahl K, Zannier E, Norman WV. Perspectives Among Canadian Physicians on Factors Influencing Implementation of Mifepristone Medical Abortion: A National Qualitative Study. Ann Fam Med. 2020 Sep;18(5):413-21.

It is estimated that a third of Canadian women will have at least one abortion in their lifetime. Prior to 2017, abortion services in Canada were provided surgically and were often difficult to access for patients who lived outside of large cities. In July 2015, mifepristone medical abortion was approved by Health Canada and, in January 2017, it became available for prescription by physicians. Mifepristone, an oral medication, is considered a ‘gold standard’ for medical abortion. CHÉOS Scientist Dr. Sarah Munro is lead author of a study that explores the factors that influence the implementation of mifepristone medical abortion in Canadian health systems. The research team conducted one-on-one interviews with 90 participants — 55 abortion-providing and non-providing health care professionals and 35 health system stakeholders involved in the planning and provision of abortion services in Canada. The results indicate that uptake was challenging at first due to restrictions in the federal approval of mifepristone; however, these restrictions were removed in the first year of availability and the drug could then be prescribed in primary care settings and dispensed in pharmacies. Once deregulated, remaining factors were primarily related to local and regional implementation processes, like provincial variation in patient subsidies and physician billing codes. Overall, Health Canada’s easing of restrictions successfully improved access to abortion care across the country.

Tang TS, Halani K, Sohal P, Bains P, Khan N. Do Cultural and Psychosocial Factors Contribute to Type 2 Diabetes Risk? A Look Into Vancouver’s South Asian Community. Can J Diabetes. 2020 May;44(1):14-21.

In Canada, South Asian immigrants are at higher risk of type 2 diabetes than other ethnic groups. Furthermore, they are typically diagnosed at a younger age and lower body mass index (BMI), and progress more rapidly from prediabetes to diabetes, than Caucasians. This study, conducted by a team of researchers from British Columbia including CHÉOS Scientist Dr. Nadia Khan, sought to explore the role of cultural and psychosocial risk factors beyond traditional risk factors in the development of diabetes among South Asian immigrants living in Metro Vancouver. The participants were asked to complete questionnaires covering medical, social, and cultural factors such as dinnertime, religion, depressive symptoms, and acculturation (defined as the number of years living in Canada, with longer stay corresponding to a higher degree of acculturation). They also measured traditional risk factors such as glycated haemoglobin, blood pressure, weight, and BMI. Of the 425 participants, 11 per cent had undiagnosed type 2 diabetes, while 51 per cent had prediabetes. Unsurprisingly, BMI was one of the most important risk factors identified in this study. Acculturation and fruit, vegetable, and fibre intake also emerged as important risk factors; diabetes risk was positively correlated with acculturation, but negatively correlated with fruit, vegetable, and fibre intake. Delayed dinnertime was another culturally associated risk factor for diabetes; typically, South Asian immigrants ate their evening meal two to three hours later than their Caucasian counterparts, which may be associated with weight gain and higher insulin levels. With the rapidly increasing rate of type 2 diabetes among Canada’s South Asian population after immigration, the authors suggest that non-traditional factors, such as cultural practices, should be considered as important predictors of diabetes risk and taken into account when developing diabetes prevention programs.

Health research in the heart of Vancouver