ObjectivesTo describe the effect of in utero exposure to the buprenorphine+naloxone combination product in a rural and remote population.SettingA district hospital that services rural and remote, fly-in communities in Northwestern Ontario, Canada.ParticipantsA retrospective cohort study was conducted of 855 mother infant dyads between 1 July 2013 and 30 June 2015. Cases included all women who had exposure to buprenorphine+naloxone during pregnancy (n=62). 2 control groups were identified; the first included women with no opioid exposure in pregnancy (n=618) and the second included women with opioid exposure other than buprenorphine+naloxone (n=159). Women were excluded if they had multiple pregnancy or if they were part of a methadone programme (n=16). The majority of women came from Indigenous communities.OutcomesThe primary outcomes were birth weight, preterm delivery, congenital anomalies and stillbirth. Secondary neonatal outcomes included gestational age at delivery, Apgar scores at 1 and 5 min, NAS Score >7 and treatment for neonatal abstinence syndrome (NAS). Secondary maternal outcomes included the number of caesarean sections, postpartum haemorrhages, out of hospital deliveries and transfer of care to tertiary centres.ResultsNo difference was found in the primary outcomes or in the Apgar score and caesarean section rate between in utero buprenorphine+naloxone exposure versus no opioid exposure in pregnancy. Compared to women taking other opioids, women taking buprenorphine+naloxone had higher birthweight babies (p=0.001) and less exposure to marijuana (p<0.001) during pregnancy.ConclusionsRetrospective data suggest that there likely is no harm from taking buprenorphine+naloxone opioid agonist treatment in pregnancy. Larger, prospective studies are needed to further assess safety.

Pseudomonas aeruginosa is an opportunistic Gram-negative pathogen, which is the major cause of severe chronic lung infection in cystic fibrosis patients. It is also responsible for systemic infections in immunocompromised individuals and those presenting with significant pulmonary conditions in intensive care units. This microorganism has the capacity to initiate severe inflammation in infected lungs resulting in detrimental tissue damage. We have hypothesized that Syk protein tyrosine kinase mediates lung epithelial cellular responses to P. aeruginosa infection, and that a naturally occurring non-toxic Syk inhibitor piceatannol can protect infected human cells against the deleterious effects associated with this infection. We infected Syk-positive H292 or Syk-negative A549 human lung epithelial cell lines with P. aeruginosa and assessed the resulting cellular responses, i.e. production of proinflammatory cytokines, adhesion molecule expression, generation of reactive oxygen species, and apoptosis of infected cells, utilizing a multiplex bead-based immunoassay and flow cytometry. We also studied the internalization of P. aeruginosa using the gentamicin exclusion assay. We found that the piceatannol treatment significantly suppressed inflammation, oxidative stress and apoptosis in H292, but not in A549 cells implicating Syk participation in the regulation of the pathological processes induced by P. aeruginosa infection. Intriguingly, piceatannol was able to down-regulate the internalization of P. aeruginosa by both Syk-positive and Syk-negative cell lines, implying that the mechanisms of action of this compound extend beyond Syk inhibition. As piceatannol can interfere with several mechanisms of bacterial pathogenesis this natural compound deserves further study as a potential therapeutic option in P. aeruginosa infection.

Background: The pervasiveness of healthcare needs in the context of economic scarcity demands stewardship of healthcare resources. Despite evidence demonstrating the value of student-run clinics (SRCs), those interested in establishing or preserving SRCs are increasingly requested to conduct needs assessments. To our knowledge, no literature has described a needs assessment conducted by a developing SRC, nor how the results might inform the services offered by a SRC. This paper will explore the process, findings, and implications of a needs assessment conducted by an interprofessional team of students in Thunder Bay, Ontario, Canada.Methods: A total of 19 semi-structured interviews were conducted. Informants included: sector representatives, potential consumers, and educators. With the use of a comprehensive regional database, a local healthcare center aided with participant selection. Interviews were audio-recorded, transcribed, and qualitatively analyzed for thematic content by multiple researchers. While sector representatives and potential consumers are the subject of this paper, analysis of education interviews will be the subject of another publication.Results: The main themes encompassed existing services, primary health concerns, barriers to services, and gaps in services. The most cited health problem was drug and alcohol use. Diabetes, cardiovascular disease and mental illness were also frequently noted. Lack of basic necessities were felt to contribute to poor health. Gaps in services related to system navigation and coordination, mental health and addictions services, and preventative health services, which were felt to be more prominent for women, youth, seniors, First Nations, and LGBT populations. All participants identified opportunities for a SRC. Recommended SRC focus areas included: disease prevention, system navigation, walk-in/urgent care, counseling, safe social space, and mobile services. Some participants commented on the importance of supervision and sustainability.Conclusions: Extensive community healthcare needs were revealed which could be addressed by a SRC, while continued research exploring the effectiveness of a SRC response to a priori identified needs is warranted.