PUBLICATIONS
Chhabra, M., Lewis, E. C., Balshaw, R., Stewart, B., Zaslawski, Z., Lowthian, T., Alidina, Z., Chesick-Gordis, M., Drogemoller, B.I., Wright, G.E.B., Birnie, K.A., Boerner, K.E., Tsang, V.W.L., Irwin, S.L., Pohl, D., Weil, A.G., Sell, E., Penz, E., Robson-MacKay, A., Mbabaali, S., Blackman, S., Gordon, S., Alcorn, J., Huntsman, R.J., Oberlander, T.F., Finley, G.A., Kelly, L.E. Multi-centre, tolerability study of a cannabidiol-enriched CANnabis herbal extract for Chronic Headaches in Adolescents: the CAN-CHA trial protocol. PLOS ONE. (Accepted July 4 2024).
Introduction Cannabis products have been used in the management of headaches in adults and may play a role in pediatric chronic pain. Canadian pediatricians report increasing use of cannabis for the management of chronic headaches, despite no well-controlled studies to inform its dosing, safety, and effectiveness. The aim of our clinical trial is to determine the dosing and safety of a Cannabidiol (CBD)-enriched Cannabis Herbal Extract (CHE) for the treatment of chronic headaches in adolescents.
Methods and analysis Youth, parents and an expert steering committee co-designed this tolerability study. Twenty adolescents (aged 14 to 17 years), with a chronic migraine diagnosis for more than 6 months that has not responded to other therapies, will be enrolled into an open label, dose escalation study across three Canadian sites. Study participants will receive escalating doses of a CBD-enriched CHE (MPL-001 with a THC:CBD of 1:25), starting at 0.2-0.4 mg/kg of CBD per day escalating monthly up to 0.8-1.0 mg/kg of CBD per day. The primary objective of this study is to determine the safety and tolerability of CBD-enriched CHE in adolescents with chronic migraine. Secondary objectives of this study will inform the development of subsequent randomized controlled trials and include investigating the relationship between the dose escalation and change in the frequency of headache, impact and intensity of pain, changes in sleep, mood, function, and quality of life. Exploratory outcomes include investigating steady-state trough plasma levels of bioactive cannabinoids and investigating how pharmacogenetic profiles affect cannabinoid metabolism among adolescents receiving CBD-enriched CHE.
Discussion This protocol was co-designed with youth and describes a tolerability clinical trial of CBD-enriched CHE in adolescents with chronic headaches that have not responded to conventional therapies. This study is the first clinical trial on cannabis products in adolescents with chronic headaches and will inform the development of future comparative effectiveness clinical trials.
Dames, S., Watler, C., Kryskow, P., Allard, P., Gagnon, M., Tsang, V. W. L. April 30, 2024. Psychedelic-assisted therapy training: Firsthand experience of non-ordinary states of consciousness in the development of competence. Psychedelic. DOI: https://doi.org/10.1089/psymed.2023.0004.
Introduction: This perspective on experiential training delves into the potential benefits and counterarguments related to integrating firsthand experience of psychedelic-assisted therapy (PaT) to enhance the competency of trainees.
The Case for Experiential Training as a Core PaT Competency: Experiential training serves a dual purpose: promoting therapists' mental wellness and refining their skills in facilitating healing in nonordinary states of consciousness. With a rising demand for PaT amid a growing mental health crisis, therapists are increasingly seeking PaT training, including experiential training from underground sources. Educators actively strive to establish formal PaT competencies and training standards, recognizing the need to consider both perspectives in this discourse.
Counter Arguments: The emergence of differing opinions on the therapeutic value of firsthand exposure to PaT and concerns about potential bias underscores the necessity for further research to substantiate claims on both sides.
Access: Whether or not consensus is achieved, the persistent demand for experiential training remains. Offering this form of training in regulated settings has the potential to reduce reliance on illicit sources for this sought-after form of training, ensuring a more controlled and ethical approach.
Tsang, V. W. L., Simkin, G., Stevens, K. 2023. Standardizing training for young people’s research advisory groups. The Lancet Child and Adolescent Health. DOI: https://doi.org/10/1016/S2352-4642(23)00234-1
Participatory research approaches emerged globally in the 1970s and 1980s in the context of anti-colonial movements. The adoption of the UN Convention on the Rights of the Child in 1989 then focused attention on youth participation in relation to all major decisions affecting their lives, including health-based decisions through research. Since then, patient-oriented research in health care has spawned an increase in patients-as-partners programmes, including the additional interest and focus on young people participating in research advisory groups.
Tao, B., Mah, K., Tsang, V. W. L., Varnals, T., Naveed, S., Khosa, F. Oct 31, 2023. Gender disparity among psychiatry departments awarded Canadian Institues of Health Research grants: a retrospective study. BMJ Leader, 7 (Issue Suppl 2). DOI: https://doi.org/10.1136/leader-2023-000761
Objective Although medical institutions aim to promote equity within the workplace, gender disparities persist in academic psychiatry. Previous evidence indicates that women in psychiatry encounter gender-based barriers to career advancement, resulting in slower rates of promotion, lower research productivity and less grant funding than men. Here, we investigate gender disparity in Canadian Institutes of Health Research (CIHR) grant funding decisions for researchers from Canadian Departments of Psychiatry. Method Data since inception from the CIHR funding decision database were searched for awards to applicants affiliated with Canadian psychiatry departments. For each grant, we collected the principal investigator’s (PI) name, conferral year, duration and total funding contribution. PI gender was extracted from an agreement between self-reported gender identity on provincial or territorial physician directories, from an official institutional website biography, and a validated gender application programming interface. Primary analysis was conducted for all recipients from Canadian psychiatry departments (including physician and non-physician scientists), and secondarily within a subgroup of physician scientists alone. Results Women (both physician and non-physician scientists) consistently received fewer grants (40.75%) and were less likely to obtain multiple awards in a year than men. Most strikingly, women received a total of US$110 658 191 while men received over double this amount, totalling US$253 339 865. Women (both physician and non-physician scientists) also received shorter award durations (p=2.312e-06, rg=0.179), fewer awards per year (p=0.002128, rg=0.662) and less money per grant (p=1.583e-07, rg=0.205). Within the subgroup of physician scientists, women were awarded a total of US$22 901 569 altogether, while men received a total of US$144 451 178. Women also received significantly fewer grants per year than men (p=3.565e-05, rg=0.889). Conclusions Gender disparity in CIHR funding decisions may pose another barrier to career progression for psychiatrists who are women. Further work is recommended to reduce gender funding gap in medical academia.
Tsang, V. W. L., Wong, J. S. H., Westenberg, J. N., Ramadhan, N. H., Fadakar, H., Nikoo, M., Li, V., Mathew, N., Azar, P., Jang, K. L., Krausz, R. M. Feb 13, 2024. Systematic Review on Intentional Non-Medical Fentanyl Use Among People Who Use Drugs. Frontiers in Psychiatry. DOI: 10.3389/fpsyt.2024.1347678
Objectives: Fentanyl is a highly potent opioid and has, until recently, been considered an unwanted contaminant in the street drug supply among people who use drugs (PWUD). However, it has become a drug of choice for an increasing number of individuals. This systematic review evaluated intentional non-medical fentanyl use among PWUD, specifically by summarizing demographic variance, reasons for use, and resulting patterns of use.
Methods: The search strategy was developed with a combination of free text keywords and MeSH and non-MeSH keywords, and adapted with database-specific filters to Ovid MEDLINE, Embase, Web of Science, and PsychINFO. Studies included were human studies with intentional use of non-medical fentanyl or analogues in individuals older than 13. Only peer-reviewed original articles available in English were included.
Results: The search resulted in 4437 studies after de-duplication, of which 132 were selected for full-text review. Out of 41 papers included, it was found that individuals who use fentanyl intentionally were more likely to be young, male, and White. They were also more likely to have experienced overdoses, and report injection drug use. There is evidence that fentanyl seeking behaviours are motivated by greater potency, delay of withdrawal, lower cost, and greater availability.
Conclusions: Among PWUD, individuals who intentionally use fentanyl have severe substance use patterns, precarious living situations, and extensive overdose history. In response to the increasing number of individuals who use fentanyl, alternative treatment approaches need to be developed for more effective management of withdrawal and opioid use disorder.
Dames, S., Watler, C., Miller, K., Laurie, R.W.E., Tsang, V. W. L., Olthuis, R., Allard, P., Argento, E., Kryskow, P. Oct 2023. Adapting the safe consumption site model for patient procured MDMA. Canadian Health Policy Journal. DOI: https://doi.org/10.54194/MMCN2584
Increasing demand for access to psychedelic therapy within Western medicine has given rise to a concerning trend in Canada, where individuals are increasingly resorting to self-medication with psychedelic substances or turning to unregulated psychedelic-assisted therapy. Concurrently, there is growing interest in honoring Indigenous ways of knowing and healing, including the traditional use of psychoactive substances. This article highlights the challenges facing those seeking alternative treatments, particularly persons with treatment-resistant conditions. The risks associated with unregulated practices are defined, including the prevalence of tainted drug supplies and the lack of protective measures, which pose significant threats to vulnerable populations. In a landscape where regulated care remains out of reach for many, the criminalized market catering to treatment-resistant individuals continues to expand. Healthcare providers, motivated by an ethical commitment to culturally inclusive care and enhancing access to promising therapeutic solutions, increasingly find themselves navigating the underground terrain. Informed by established safe consumption sites designed to mitigate overdose risks, this article presents an adapted harm reduction approach tailored for psychedelics, with a focus on supporting safe MDMA consumption. This innovative approach offers support to persons who have self-procured psychedelic substances for mental health indications, or for those who feel these medicines might offer benefits beyond the treatment of a defined mental disorder. This model incorporates the essential safety standards for those exploring alternative mental health treatments, laying the scientific and legal groundwork for a comprehensive harm reduction and wellness strategy.
Tsang, V. W. L., Lee, H. J., Chai, B. S., Lin, M. C. Q., Howard, A., Uy, C., Elefante, J. O. July 2023. Psilocybin’s potential mechanisms in the treatment of depression: A systematic review. Journal of Psychoactive Drugs, DOI: https://doi.org/10.1080/02791072.2023.2223195
Tsang, V. W. L., Ragazan, C., Dames, S., Kryskow, P., Walsh, Z. Sept 2023. A pilot study comparing a community of practice program with and without concurrent ketamine-assisted therapy. Journal of Psychoactive Drugs. DOI: https://doi.org/10.1080/02791072.2023.2253798
The prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) has increased among healthcare providers, while the effectiveness of conventional treatments remains limited. Ketamine-assisted therapy offers a promising alternative; however, few have integrated ketamine with a group-based therapeutic modality. We report a retrospective, secondary analysis of a 12-week pilot of a Community of Practice (CoP) oriented group therapy program with optional, adjunct ketamine for depression, anxiety, and PTSD in a sample of 57 healthcare providers. All participants moved through the treatment as one group, with 38 electing to also receive three adjunct ketamine sessions in addition to the weekly CoP. Symptoms were assessed at baseline and pilot completion with the PHQ-9 for depression, GAD-7 for anxiety, and PCL-5 for PTSD. We observed significant reductions in the mean change among all participants, suggesting that benefit was derived from the CoP component, with or without ketamine as an adjunct. PHQ-9 scores decreased by 6.79 (95% CI: 5.09-8.49, p < .001), GAD-7 scores decreased by 5.57 (CI: 4.12-7.00, p < .001), and PCL-5 scores decreased by 14.83 (CI: 10.27-19.38, p < .001). Reductions were larger, but statistically nonsignificant, among those receiving ketamine. Further research is required to assess the impact of ketamine as an adjunct in group-based therapies.
Evidence suggests that psilocybin has therapeutic benefit for treating depression. However, there is little consensus regarding the mechanism by which psilocybin elicits antidepressant effects. This systematic review summarizes existing evidence. Ovid MEDLINE, EMBASE, psychINFO, and Web of Science were searched, for both human and animal studies, using a combination of MeSH Terms and free-text keywords in September 2021. No other mood disorders or psychiatric diagnoses were included. Original papers in English were included. The PRISMA framework was followed for the screening of papers. Two researchers screened the retrieved articles from the literature search, and a third researcher resolved any conflicts. Of 2,193 papers identified, 49 were selected for full-text review. 14 articles were included in the qualitative synthesis. Six supported psilocybin’s mechanism of antidepressant action via changes to serotonin or glutamate receptor activity and three papers found an increase in synaptogenesis. Thirteen papers investigated changes in non-receptor or pathway-specific brain activity. Five papers found changes in functional connectivity or neurotransmission, most commonly in the hippocampus or prefrontal cortex. Several neuroreceptors, neurotransmitters, and brain areas are thought to be involved in psilocybin’s ability to mitigate depressive symptoms. Psilocybin appears to alter cerebral blood flow to the amygdala and prefrontal cortex, but the evidence on changes in functional connectivity and specific receptor activity remains sparse. The lack of consensus between studies suggests that psilocybin’s mechanism of action may involve a variety of pathways, demonstrating the need for more studies on psilocybin’s mechanism of action as an antidepressant.
Tsang, V. W. L., Bhanot, S., Jia, L. Jan 2023. Varenicline Induced Auditory Hallucinations in a Young Female with Bipolar Disorder: A Case Report. BMC Psychiatry, 23(4): 1-8. DOI: https://doi.org/10.1186/s12888-022-04348-6
Creating appropriate and sustainable treatment plans for patients with concurrent disorders presents a challenge to psychiatrists and addiction medicine specialists alike. Although varenicline has been found to be the most effective medication for smoking cessation and abstinence when compared to results from placebo medications, nicotine patches and bupropion, caution is needed when starting patients on this medication. With the high prevalence of concurrent mental health and substance use disorders in vulnerably-housed populations in Canada, it becomes increasingly important to advocate for increased guidance and research into treating concurrent disorders.
Tao, B., Bhanot, S., Tsang, V.W.L. 2023. Unspecified psychosis and stimulant drugs: A commentary on current trends. BCMJ.
This commentary explores the association between unspecified psychosis and the use of stimulant drugs, focusing on current trends to raise awareness about stimulant-induced psychosis, in BC. It discusses the challenges in diagnosing and treating psychosis related to stimulant use, highlighting the need for a comprehensive understanding of the interplay between substance use and mental health. The commentary emphasizes the increasing prevalence of stimulant-related psychosis and underscores the importance of tailored interventions and treatment strategies. Approximately 1.5% to 3.5% of the general population is estimated to meet the diagnostic criteria for psychosis within their lifetime, however psychosis among people who use drugs is far more common as more than 33% of methamphetamine users have reported psychosis. The article suggests that addressing stimulant-related psychosis requires a multidimensional approach that considers both the substance use and mental health aspects, with a focus on individualized care. Additionally, it discusses potential gaps in current diagnostic criteria and treatment protocols, calling for further research to inform more effective clinical practices in managing cases of unspecified psychosis linked to stimulant drugs.
Tsang, V.W.L., Alqutub, D., Wenger, M., Mathias, M., Barbic, S. 2023. The Foundry Work and Education Program: A vocational rehabilitation program. BCMJ.
Foundry Work and Education Program (FWEP) is a vocational rehabilitation program aimed at supporting individuals with mental health challenges in gaining employment skills. Developed by the Canadian Mental Health Association, the program integrates education, job training, and mental health support to enhance participants' employability and well-being. FWEP incorporates a holistic approach, addressing both vocational and mental health needs. The article highlights the success of the program in improving participants' self-esteem, work-related skills, and overall mental health. It emphasizes the importance of collaboration between mental health professionals, educators, and employers in creating effective vocational rehabilitation initiatives for individuals facing mental health challenges.
Tsang, V. W. L., Tao, B., Dames, S., Walsh, Z., & Kryskow, P. 2023. Safety and tolerability of intramuscular and sublingual ketamine for psychiatric treatment in the roots to thrive ketamine-assisted therapy program: A Retrospective Chart Review. Therapeutic Advances in Psychopharmacology.
This study examines the safety and tolerability of ketamine-assisted therapy (RTT-KaT) in a community group psychotherapy setting. The 12-week program, involving group sessions and ketamine medicine sessions, was assessed through a retrospective chart review of 128 participants across four cohorts. The results indicate good tolerability, with no dropouts, and the majority of sessions showing elevated blood pressures as the most common side effect. Other adverse effects, such as nausea, vomiting, headache, and dizziness, were relatively low and generally resolved with rest or medications. The study suggests that RTT-KaT is a safe and promising approach for individuals seeking mental health treatment in a community setting.
Zaslawski, Z., Dib, K., Tsang, V. W., Orr, S. L., Birnie, K. A., Lowthian, T., Alidina, Z., Chesick‐Gordis, M., & Kelly, L. E. 2023. Co‐designing clinical trials alongside youth with chronic pain. Paediatric and Neonatal Pain.
Engaging youth in research is critical. This study emphasizes the importance of engaging youth in the design of clinical trials related to chronic pain, aiming to improve enrollment, retention, and overall research outcomes. Two recruitment strategies were employed to involve 16 youth aged 15-18 from existing and new youth groups, conducting virtual discussion groups between April and December 2020. The participants provided valuable insights on recruitment preferences, potential barriers, and study design optimization, expressing a preference for direct physician contact and emphasizing the importance of developing rapport with study staff. Feedback covered clinical trial design elements, outcome measurement tools, data collection, and engagement methods. The study also addresses the challenges of engaging adolescents in research, such as parental consent, scheduling constraints, and evolving youth advisory roles. Despite a gender imbalance, participants found the virtual format inclusive and believed their engagement would make a difference in designing the trials. The study offers a framework for researchers to involve youth in clinical trial co-design through online engagement sessions, promoting patient-oriented research practices.
Narayan, S. K., Tsang, V. W., & Qian, Y. 2022. Reflecting on earlier affected areas that shaped COVID-19 mental health efforts. Discover Mental Health.
This commentary addresses the mental health challenges posed by the COVID-19 pandemic, drawing insights from earlier epicenters to propose effective practices for North America. Emphasizing the need for tailored mental health services, the commentary discusses interventions for high-risk populations, including healthcare workers, COVID-19 patients, and vulnerable groups. COVID-19 patients in self-isolation may benefit from psychological support considering issues like anxiety, stress, and post-traumatic stress symptoms. Vulnerable populations, including marginalized individuals, those with existing health conditions, and older adults, require focused interventions due to difficulties accessing care and exacerbated mental health conditions. Healthcare workers face significant psychological distress, necessitating tailored strategies such as shift systems, online platforms for advice, and psychological intervention teams. The commentary underscores the importance of identifying high-risk groups, addressing immediate psychological needs, providing accurate health information, tailoring interventions, and adopting precautionary measures.
Harrigan, S. P., Tsang, V. W., Yassi, A., Zungu, M., & Spiegel, J. M. 2022. Impacts of economic inequality on healthcare worker safety at the onset of the COVID-19 pandemic: Cross-sectional analysis of a global survey. BMJ Open.
The study investigates the association between protection of healthcare workers (HCWs) during the COVID-19 pandemic and economic inequality across countries. Analyzing responses from 4,977 HCWs and stakeholders in 161 countries, the research indicates that, despite universally deemed unacceptable risks, participants from countries with lower income inequality were less likely to report unacceptable risks regarding workplace environment and organizational factors for HCWs. However, considerable variation existed in perceived adequacy of mitigation measures. Respondents from lower middle-income and low-income countries were significantly more likely to assess occupational health and safety and infection prevention and control measures as inadequate, despite higher COVID-19 rates in wealthier countries. The study suggests that economic inequality within and between countries affects the resilience of health systems, emphasizing the need for improved occupational health and safety for HCWs globally. Addressing these issues is crucial for better pandemic preparedness and protecting the well-being of HCWs, particularly in resource-poor settings.
Fletcher, S. Tsang, V. W. L., 2021. The era of virtual care: Perspectives of youth on virtual appointments in COVID-19 and beyond. Paediatrics & Child Health.
Since the COVID-19 pandemic, virtual care and physician appointments have dominated over in-person care to better protect the health and safety of patients and providers. This study asked youth from KidsCan, a pan-Canadian initiative of youth with different health conditions, to share their perspectives on virtual care. It is found that benefits of virtual care include easier access and time saved in travelling to clinics. It also helps ease anxiety for youth with fears of going to hospitals or other healthcare offices. However, drawbacks include tests that are not possible virtually, as well as access to a private space to have the virtual consultations. Forming virtual new connections with doctors might also be hard, and friends who used to offer in-person support during clinic waiting times cannot do so if appointments are virtual. Youth that may not have stable internet or technology would also struggle with virtual appointments. As long as virtual care providers try their best to ensure the quality of time spent with patients such as offering video appointments and asking caregivers to give youth a private space, youth patients are open to and prefer virtual care in light of the pandemic.
Blodgett, J. M., Lachance, C. C., Stubbs, B., Co, M., Veronese, N., Wu, Y. T., Prina, M., Tsang, V. W. L., Cosco, T. D. 2020. Latent structure of the Centre for Epidemiological Studies Depression Scale (CES-D) in adolescents: a systematic review. BMC Psychiatry.
Depression is a global mental health problem that has been increasingly common in adolescents and adults. However, adolescent depression is often underdiagnosed and undertreated. The Centre for Epidemiologic Studies Depression Scale (CES-D) was created in order to more accurately measure the disorder. It is a self-reported scale that has a factor structure, and has four factors that can identify the frequency and severity of symptoms. CES-D was first introduced in a sample of American adults, so this study systematically reviews other research analyzing the latent structure of CES-D in adolescents to see if this scale can be used in the diagnosis of a younger population. Studies included in this systematic review are peer-reviewed, original analysis of the factor structure, included a full 20-item CES-D, and used samples of people less than or equal to 18 years old (adolescent population). This study found that the four-factor structure of CES-D can be used in adolescent diagnosis, but two and three-factor variations can be used as well. There are also differences in ethnic and cultural background of patients, as different people may experience depression symptoms differently. It is concluded that the CES-D or a similar factor structure scale can be used in depression diagnosis of Western-based samples.
Tsang, V. W. L., Fletcher, S., Jassemi, S., Smith, S. 2021. Transition from pediatric to adult care for youth with chronic diseases: Perceptions of youth, caregivers, and providers. Journal of Behavioral and Developmental Pediatrics.
Ehrlich, R., Barker, S., Tsang, V. W. L., Kistnasamy, B., Yassi, A. 2021. Access to migrant gold miners to compensation for occupational lung disease: Quantifying a legacy of injustice. Journal of Migration and Health. 4.
Gold mine industry in South Africa has heavily relied on rural African men labour. Constant exposure to mine conditions including intense silica dust have increased their susceptibility to silicosis and tuberculosis. These diseases spread fast among workers and are amplified by migrancy from rural areas, affecting the workers’ communities and escalating the annual tuberculosis incidence rate. There have also been many barriers in access to compensation benefits for occupational lung disease due to discriminatory elements of the compensation legislation. This study measures the extent of barriers to compensation benefits among various groups of migrant gold miners. Using a large mining company’s database, the study compared mineworkers of different countries of origin and their compensation files. It is found that while silicosis and tuberculosis are compensable upon diagnosis, there is a long delay from processing filed claims to dispensing payment, and many claims remain unfiled. Cases where workers are diagnosed after they leave employment are common, since the disease can appear through chest radiology after exposure has ended. Former workers face more barriers and delays in filing for compensation after they ended employment. Currently, programs are increasing efforts to examine former mineworkers and secure compensation for their occupational lung disease and overturn this legacy of neglect for over a century.
As children and youth with chronic disorders age, a smooth transition from pediatric to adult care is crucial to ensure that patients are adequately supported as they step into adulthood. This study takes into account the voices of patients, caregivers, and physicians who manage this transition process. Youth was directly involved as coresearchers and partners so they can actively participate in this research that can benefit all youth that are starting to gain autonomy to manage their own disorders. Any discrepancy among the different perspectives offer insights into what can be improved, and what systems can be put in place. The study is done in three phases, with phase 1 and 2 consisting of surveys for providers, and phase 3 consisting of surveys for youth and caregivers. Major concerns found include lack of physicians to take on youth transition, lack of communication and collaboration between pediatric and adult clinicians, and lack of involvement of caregivers and patients in this process. Pre- and post-transition experience ratings by patients themselves are lower compared to ratings of the caregivers. Therefore, improvements in physician training in this transition and a better transition system would be beneficial to ensure that no patients are lost in the process, and are fully supported at all times.
Tsang, V. W. L. and Buxton, J.A. 2021. Overview of the British Columbia Take Home Naloxone program: From inception to expansion. BCMJ. 63(3): 122-125.
Opioid drug overdose death has become an increasing problem in British Columbia (BC), especially since COVID-19. Naloxone is a medication that can be used to treat opioid overdose, and Canada has made naloxone and naloxone administration training more widely available over the last few years. Taken Home Naloxone (THN) kits are first put together by pharmacies and volunteers, and training sites started in an attempt to educate more people about overdose. Initially, resistance was faced due to lack of understanding and knowledge of naloxone’s importance for the community. However, expansion of the program became easier when regulations lifted restrictions to naloxone access, allowing its distribution in the community without physician prescription. Since opioid overdose was declared a public health emergency, the program quickly expanded with greater public awareness and acceptance. THN became available in all emergency sites, and more people are being trained to properly administer naloxone to individuals in the community. Increased THN possession led to increased naloxone recipients, lowering the rate of overdose death. Greater overdose incidents since COVID-19 led to a greater demand for THN kits in more nontraditional sites across BC so workers can be better equipped if an overdose emergency were to occur.
Blodgett, J. M., Lachance, C. C., Stubbs, B., Co, M., Veronese, N., Wu, Y. T., Prina, M., Tsang, V. W. L., Cosco, T. D. 2020. Latent structure of the Centre for Epidemiological Studies Depression Scale (CES-D) in adolescents: a systematic review. BMC Psychiatry.
Depression is a global mental health problem that has been increasingly common in adolescents and adults. However, adolescent depression is often underdiagnosed and undertreated. The Centre for Epidemiologic Studies Depression Scale (CES-D) was created in order to more accurately measure the disorder. It is a self-reported scale that has a factor structure, and has four factors that can identify the frequency and severity of symptoms. CES-D was first introduced in a sample of American adults, so this study systematically reviews other research analyzing the latent structure of CES-D in adolescents to see if this scale can be used in the diagnosis of a younger population. Studies included in this systematic review are peer-reviewed, original analysis of the factor structure, included a full 20-item CES-D, and used samples of people less than or equal to 18 years old (adolescent population). This study found that the four-factor structure of CES-D can be used in adolescent diagnosis, but two and three-factor variations can be used as well. There are also differences in ethnic and cultural background of patients, as different people may experience depression symptoms differently. It is concluded that the CES-D or a similar factor structure scale can be used in depression diagnosis of Western-based samples.
Fletcher, S. Tsang, V. W. L., 2021. The era of virtual care: Perspectives of youth on virtual appointments in COVID-19 and beyond. Paediatrics & Child Health.
Tsang, V. W. L. et al. 2020. Transforming disruption into innovation: Partnership between the BC COVID-19 Medical Student Response Team and the University of British Columbia MD Undergraduate Program. Academic Medicine.
The COVID-19 pandemic had a widespread impact on all aspects of society, and medical education was no exception. In response to the challenges posed by the pandemic, the BC COVID-19 Medical Student Response Team (MSRT) was formed by students and faculty from the University of British Columbia (UBC) MD Undergraduate Program (MDUP). The goal of the MSRT was to involve medical students in supporting the health care sector and community members deal with the impacts of COVID-19. This was accomplished through 68 different projects that gave medical students the opportunity to be involved in activities such as contact tracing or creating educational multimedia content to reduce misinformation. These projects were designed to adhere to public health restrictions so that students could support the health care system and advance their education while protecting themselves and the community. The success of the MRST was aided by the flexibility of the MDUP curriculum, as well as support from faculty members. As we move towards the future, the structure of the MRST projects is a valuable asset for adapting the MDUP curriculum to our new normal, as well as for preparing for future emergencies.
Tsang, V. W. L., Lam, J., Leung, A. 2021. Cutaneous lupus erythematous in children. Current Pediatric Reviews.
Since the COVID-19 pandemic, virtual care and physician appointments have dominated over in-person care to better protect the health and safety of patients and providers. This study asked youth from KidsCan, a pan-Canadian initiative of youth with different health conditions, to share their perspectives on virtual care. It is found that benefits of virtual care include easier access and time saved in travelling to clinics. It also helps ease anxiety for youth with fears of going to hospitals or other healthcare offices. However, drawbacks include tests that are not possible virtually, as well as access to a private space to have the virtual consultations. Forming virtual new connections with doctors might also be hard, and friends who used to offer in-person support during clinic waiting times cannot do so if appointments are virtual. Youth that may not have stable internet or technology would also struggle with virtual appointments. As long as virtual care providers try their best to ensure the quality of time spent with patients such as offering video appointments and asking caregivers to give youth a private space, youth patients are open to and prefer virtual care in light of the pandemic.
Cutaneous lupus erythematosus (CLE) is a skin disease that can occur when the body’s immune system targets healthy skin. Early diagnosis and intervention are vital, especially for preventing complications in children. In order to educate health care professionals about diagnosis and management, previous research regarding CLE was compiled and analyzed. Researchers used PubMed, a search engine for research articles, to identify published research regarding causes, diagnosis, investigations, related health conditions, and treatment of CLE in children. Overall, there is a wide variety of potential explanations for the development of CLE that are still being investigated. Furthermore, there are many different ways that CLE present, which is vital information for early identification of CLE. Symptoms associated with CLE that have been identified include malar rashes, which are a rash on the cheeks and bridge of the nose, and papulosquamous psoriasiform lesions, which are rashes that are generally more widespread. Most treatments involve suppression of the immune system and are typically either topical (applied directly on the skin) or oral agents (taken by mouth). These findings are important to early diagnosis and prevention of complications, as well as for informing future research into causes, early identification, and treatments for CLE.
Tsang, V. W. L., Luo, L., Kissa, P., Blair, G. 2021. Ten global surgical care statements for children: Examining our commitment to the future. Pediatric Surgery International.
Papamihali, K., Yoon, M., Graham, B., Karamouzian, M., Slaunwhite, A. K., Tsang, V., Young, S., Buxton, J. A. 2020. Convenience and comfort: Reasons reported for using drugs alone among clients of harm reduction sites in British Columbia, Canada. Harm Reduction Journal. 17(90).
Access to essential surgeries is a challenge faced by many communities around the world, and the effects are disproportionately felt by impoverished individuals in both high-income countries (HICs) and low- and middle-income countries (LMICs). In LMICs, where up to 50-60% of the population is comprised of children, pushes for safe and accessible pediatric surgery is desperately needed. In order to address the lack of guiding principles for initiatives aimed at tackling this need, two pediatric surgeons proposed the Global Surgical Care for Children Commitment Statements. These ten statements received input from numerous global pediatric surgery organizations and have been formally recognized by several surgical organizations around the world. This article presents each of the statements along with their support and rationale as a call to action for individuals, organizations, and governments. The statements address topics such as advocacy, accessibility, global standards, administration, research, collaboration, communication, education, training, and workforce size. Furthermore, a few steps that policymakers could implement have been identified as examples of how the issues regarding pediatric surgery can be addressed. As the push for improvements to surgical care continues, the Global Surgical Care for Children Commitment Statements will serve as an important guide and resource.
Tsang, V., Bao, K., Taylor, J., 2020. Incidental findings in trauma whole-body computed tomography scans: A systematic review. Canadian Journal of Emergency Medicine. 22(S1): S69.
Whole-body computed tomography scans (WBCT) are primarily used to identify injuries, especially in cases where the patient has multiple sites of trauma. However, they can also reveal unrelated previously unknown health conditions, which are known as incidental findings (IFs). This study aimed to systematically analyze the prevalence of IFs as well as identify strategies for managing them. Research databases such as MEDLINE, PUBMED, EMBASE, and Google Scholar were used to search for research involving WBCT that reported IFs in patients. Reported patient demographics, prevalence and type of incidental finding, and follow-up management were collected from relevant studies. On average, more than half of patients had at least one IF identified by the WBCT and among studies that reported the total number of IFs, each patient had an average of 2.7 IFs. Older patients were more likely to have IFs, and men tended to have more IFs than women. Although the documentation regarding the prevalence and type of IF is strong, there is low reporting of follow-up management regarding the identified IFs. In the future, protocols regarding documentation and follow-up of IFs found during WBCTs are needed in order to address the current lack of management.
Tsang, V. W. L., Chew, S. Y, Junker, A. K. 2020. Facilitators and barriers to the training and maintenance of young persons’ advisory groups (YPAGs). International Journal of Pediatrics and Adolescent Medicine. 7(4): 166-173.
This study aims to evaluate the strengths and challenges involved with the formation of young persons’ advisory groups (YPAGs) and associated training protocols. A sample of 17 YPAG team leaders from 7 countries were surveyed to determine the nature of current training practices with further interviews conducted with 17 youth representatives and 16 team leaders. The foundation of this study was further strengthened by a series of analyses conducted by three independent reviewers. Findings of this study provide a strong foundation which can be implemented in the development processes of standardized training protocols for children and youth patient advisory groups around the world. The three main categories highlighted in the study as important considerations for YPAG maintenance and initiation with respect to research are: ethics and patient safety, core research competencies and region and topic specific training.
Within Canada, British Columbia (BC) experiences the most deaths caused by drug overdoses, many of which take place in private residences and involve individuals living alone. Resources such as harm reduction sites have been implemented in an effort to address the overdose crisis, but many factors still cause individuals to choose to use drugs alone. A Harm Reduction Client Survey was given to clients at 27 harm reduction supply distribution sites across BC. Participants were asked whether or not they had used drugs alone within the past 7 days, as well as their reasons for doing so. The survey also asked about demographic information (ie. age, gender, housing, and employment status) and substance use information. Approximately 75% of respondents reported using drugs alone within the past 7 days and using alone was associated with not having regular housing and crack/cocaine use within the past week. Participants who used alone commonly reported doing so due to convenience and comfort, although some identified stigma, having no one around, safety, and not wanting to share as other reasons for using alone. These results are especially significant for informing overdose prevention initiatives on how to mitigate the risks associated with using drugs alone.
Tsang, V. W. L., Loh, L. 2020. Using a health equity lens to evaluate short-term experiences in global health (STEGH). Annals of Global Health. 86(1): 143.
This study aims to investigate short-term experiences in global health (STEGH) using a health equity lens. Health equity can be defined as a concept in which all individuals should reach their full health potentials without disadvantages due to determinants based on their contexts. This term also has implications in the accessibility of healthcare services to individuals across the world. STEGH efforts typically involve volunteers from higher-income backgrounds traveling to lower-income settings to provide clinical or surgical care, conduct research, and/or provide community education sessions. Their growing popularity in recent years has brought forth several criticisms including more perceived benefit being provided by these experiences to the volunteer participants and organizations rather than the lower-income communities in need. While volunteers are able to provide quality healthcare to individuals in need for short periods of time, their contexts still remain after the STEGH efforts have ended. Such limitations emphasize the importance of developing ways to evaluate initiatives in global health in an effective manner. Results of this evaluation show that the extent to which health equity is advanced is an ideal metric that should be used to evaluate STEGH and other global health endeavors.
Tsang, V. W. L., Fletcher, S., Thompson, C., Smith, S. 2020. A novel way to engage youth in research: evaluation of a participatory health research project by the international children’s advisory network youth council. International Journal of Adolescence and Youth. 25(1): 676-686.
This study aims to evaluate the benefits and limitations of involving young patients as co-researchers in the creation and execution of an international participatory health research project through standardized feedback surveys and qualitative interviews. The surveys and interviews were used to gain insight into the involvement’s impact on the personal and academic growth of participants. Overall participation was determined using the percentage of youth members actively engaged along with the outcome of a completed project. This paper discusses past models of youth participation in research and describes a novel method of organization for such participation along with associated benefits and limitations. A newer approach to engage youth as partners in research was found through the iCAN Youth Council, which is a global group that advises and spearheads youth-derived research projects. It was found that the shift in roles from patient to research partner has newfound possibilities of accomplishment in a group.
Tsang, V. W. L., Lockhart, K., Spiegel, S. J., Yassi, A. 2019. Occupational health and safety programs for artisanal and small-scale gold mining: A systematic review for the WHO global plan of action for workers’ health. Annals of Global Health. 85(1): 128, 1-12.
This systematic review was conducted on the WHO Global Plan of Action for Workers’ Health for occupational health programs for artisanal and small-scale gold mining using a comprehensive search strategy consisting of four key scientific databases. Through search results, ten published studies met the criteria of having a focus on assessing the impact of interventions addressing occupational health concerns in artisanal and small-scale gold mining. It was seen that considerable attention was given to occupational hazards in the mining sector overall with some advancements made in reducing risks in those areas. However, in the search strategy, no studies identifying the occupational health and safety programs for this sector were found. Further, while major areas of intervention such as education and introduction of mercury-reducing/eliminating technology were identified, there was a lack of standardization for measuring their impact and long-term health outcomes for miners and associated communities. This was indicative of an urgent need for research on comprehensive health programs addressing hazards faced by artisanal and small-scale miners.
Yassi A, Mabhele S, Wilcox E.S., Tsang V. W. L., Lockhart K. 2019. ‘It showed us the reality of how we made people feel’: An embodied exercise to address HIV and tuberculosis related stigma of healthcare workers in Southern Africa. Journal of Applied Arts and Health,
10(1), 73-85. DOI: https://doi.org/10.1386/jaah.10.1.73_1
This article recognizes that transparency regarding Tuberculosis (TB) or Human Immunodeficiency Virus (HIV) status in patients is directly linked to ensuring timely treatment of patients with these diseases, preventing TB transmission, and consequently protecting healthcare workers. However, the authors acknowledge that stigma around contraction of HIV plays a role in impeding open discussion about the disease. The article focuses particularly on stigma around HIV and TB infection among healthcare workers. Considering that individuals working with TB patients have a significantly higher chance of being infected than the general public, it discusses the importance of addressing stigma
amongst these workers. Researchers conducted a stigma exercise with 78 healthcare workers in South Africa, Mozambique, and Zimbabwe to foster empathy for stigmatized individuals. Follow-up discussion and surveys about the participants’ feelings during the exercise revealed that they became more empathetic for stigmatized healthcare workers after experiencing negative emotions linked with stigma and fear of being stigmatized. The participants also identified connections between the exercise and stigmatizing events in the workplace. As such, researchers found that similar participatory exercises are useful for
addressing workplace issues such as stigma among healthcare workers.
Tsang, V. W. L., Papamihali, K., Crabtree, A., Buxton J. A. 2019. Acceptability of technological solutions for overdose monitoring: perspectives of people who use drugs. Substance Abuse. 1-10.
With recent increases in the number of illicit drug-related overdoses in the United states and Canada, it has become of key importance to evaluate innovative strategies that can be used for monitoring and treatment. Specifically, leveraging existing technology and mobile-based solutions is of interest. With the input of people who use drugs, this study incorporates both numerical and non-numerical data to determine cell phone usage and the acceptability of drug-use monitoring applications. The study puts forth an important framework for future alternatives to be made for a large demographic of users. Many drug users may not use consumption sites due to fear of stigmatization, lack of privacy, or personal preference and it is important that alternative overdose monitoring systems would be available to benefit such populations. While many users are aware of opioid overdose risks and employ several strategies to stay safe, clients with access to internet-enabled smartphones may benefit from technological solutions such as alerting of friends or the emergency services by phone based on non-response or biometric markers from non-contact respiratory monitoring. On the other hand, there are some barriers to mobile-based technologies in certain geographical regions. Therefore, in conjunction with increasing technological advancements, educational interventions are imperative to inform the public and communities of people who use drugs about such solutions.
Tsang, V. W. L., Hamilton, L., Wassersug, R. J. 2019. On the meaning of
masculinities and its implication to advancing men’s health. Psychology of Men and Masculinities, 20(2), 166-173. DOI: https://doi.org/10.1037/men0000175
This article discusses the importance of taking an interdisciplinary approach in exploring the topic of men’s health. It conveys that the integration of social sciences in medical research can be especially beneficial for men’s health, but the use of certain terms and language plays a role in separating disciplines. The authors analyze the concept of masculinities and show that the fluidity of this term places masculinities studies outside of the field of biomedicine. Traditional science explores clearly distinguishable ideas and without clear guidelines for differentiating one masculinity from another, it becomes difficult to undertake scientific investigations on masculinities. Due to this disconnect from biomedicine, the authors argue that use of the word masculinities can hinder research advancements. This is because masculinities studies may consider important social contributors to men’s health that are under-emphasized in biomedical research. The article also highlights the issue of men’s aging and consequent seeking of patches or gels that raise sex hormone levels. In this case, adopting the interdisciplinary approach by considering the social and scientific impacts of access to these products is important. The authors show how changing language in studies can bridge the gap between social sciences and biomedical research for men’s health.
Tsang, V. W. L., Lum N., Ohm, H., Sagorin, Z., Yu, A. 2019. The iterative development of a simulation-based group study method for preclinical students. University of British Columbia Medical Journal, 10(2), 16-18.
This article proposes a group studying method to help foster communication, medical decision-making, and routine physical checkup skills in pre-clinical students. Group studying provides students with the opportunity to apply their knowledge by practicing their clinical skills. It also allows for peer social support while practicing these skills. The group studying method discussed in the article was designed by students enrolled in the UBC MD Undergraduate Program (MDUP) and involved a “Plan-Do-Study-Act” cycle. This method involves multiple iterations of the cycle and the fourth and final iteration entails creating a patient’s disease profile, roleplaying as patients and providers, and applying content learned discussed in lectures by performing clinical duties such as physical exams. The article discusses how performing clinical skills can help students recognize their strengths and limitations as self-observation can help them recognize where they needed to pause and seek guidance from group members. Moreover, this studying technique also maximizes engagement as all group members have assigned roles and responsibilities. Overall, the group studying method in the article focuses on incorporating knowledge obtained from curriculum with clinical skills to help students efficiently and effectively learn more about a diverse range of clinical situations and use mistakes as learning opportunities.
Tsang, V. W. L., et al. 2019. Highlighting Current Needs in Addressing Youth Mental Health in British Columbia. University of British Columbia Medical Journal, 10(2), 31-33.
This article discusses improvements for British Columbia’s (BC) youth mental health system by developing mental health information programs, organizing collaborative care, making care increasingly accessible, and focusing on Indigenous Health by highlighting the Truth and Reconciliation Committee’s (TRC) Calls to Action. The article acknowledges the prominence of mental health illnesses among BC youth and consequent urgency of establishing evidence-based approaches to improve BC’s mental health care system.
Evidence suggests that many mental health illnesses stem from childhood or adolescent experiences and that school-based programs can improve youth mental health. Therefore, the article encourages exposure to programs that teach students about mental health. Moreover, communication between healthcare providers is important for regulated and standardized treatments for youth. Accessibility is another issue and evidence shows that providing access to services at places where youth spend most of their time, such as schools, can help eliminate barriers in seeking care. Furthermore, intergenerational trauma, racism, and cultural assimilation introduce additional mental health issues for Indigenous youth but following the guidelines in the TRC’s Calls to Action can help ameliorate the negative impacts of these
obstacles. The authors argue that implementation of these four ideas can help fulfill the mental health needs of BC youth.
Tsang, V, W. L., et al. 2019. Role of patients and parents in pediatric drug development. Therapeutic Innovation & Regulatory Science, 53(5), 601-608. DOI: https://doi.org/10.1177/2168479018820875.
This article communicates the importance of considering paediatric patients’, and their families’ concerns while developing drugs to decrease the risk of drug adverse effects. In addition, it conveys the importance of establishing clear guidelines on how to include youth
in drug development processes and explores potential practices for involving children and their parents in drug developing stages. Moreover, incorporating patient and family input will allow for clearer identification of paediatric patient needs. Currently, there are difficulties in organizing clinical trials for studies involving children and this results in smaller sample sizes which affects the applicability of study results. As such, there is decreased drug testing and increased risk of adverse effects. The article also discusses legislation and programs that are currently in place to help parents and patients hold a more significant role in the drug development stages which highlights progression towards increasingly collaborative approaches in drug development. Involvement of family physicians can encourage patient
participation in drug development, but barriers such as busy lives, logistics, current availability of medication, and patient comfortability levels hinder patient involvement. The article promotes building patient and researcher partnerships to create programs that involve youth and their families in drug development.
Tsang, V. W. L., Wassersug, R. J. 2018. Men’s health research versus andrology—Defining the division and closing the divide. Journal of Men’s Health, 14(3), 20-32, DOI: https://doi.org/10.22374/1875-6859.14.3.2.
In this study, men’s health research was explored through two different fields - research practiced by health sociologists versus andrologists. The research team identified and examined the occurrence of 30 terms related to sex and gender in the literature. Using statistical analysis, they found that of the terms that were sampled, only “penis”, “penile”, “testicles”, and “libido” did not have any significant differences in their relative occurrence within the publications of either field. Words and phrases that are linked to gender, such as masculine, masculinity, and manhood, were more common in mens health research where gender is commonly defined as a social construct. The presumption that gender is a social construct, though common within health sociology, is not inherent in andrology, thus illustrating their distinctive research methodologies and self-defined borders. As a result, many problems in men’s health have been assumed to be a result of enculturation, when they do in fact have biological basis. However, solutions to these problems are more agreeable to social solutions rather than biomedical ones. Thus, the researchers suggest that the realm of men’s health could be dramatically advanced if men’s health researchers and andrologists understood the differences between their respective disciplines and made a greater effort to fill the gap between them.
Tsang, V. W. L., Skead C., Wassersug, R. J., Palmer-Hague, J. 2019. The impact of prostate cancer treatments on men’s sense of their manhood: Implications for understanding masculinity. Psychology of Men & Masculinity, 20(2), 214-225. DOI: https://doi.org/10.1037/men0000184.
Men who are being treated for prostate cancer (PCa) often experience a decreased sense of masculinity, however, the reasoning behind this is unclear. In this study, the research team turned to the literature to look at the characteristics and terms that were most commonly used to describe the decreased masculinity in PCa patients. They identified and ranked the terms by frequency and whether each was a biological feature or a social norm. They also took into account whether the patient reports were self-produced or a result of psychological assessment methods. The researchers found that there were prominent differences between what patients perceived as a decline in masculinity when spontaneously self-reported, or when elicited through assessment. Patients most often reported changes in bodily function such as reduced erectile function, libido, and physical strength. Therefore, the results of this study suggest that the loss of masculinity experienced by PCa patients is primarily due to biological influences, as opposed to social factors. In the future, the collaboration between those in biomedicine and psychosocial fields will be essential for improving the quality of life of PCa patients.
Palmer-Hague, J., Tsang, V., Skead, C., Wassersug, R., Nasiopoulos, E., Kingstone, A. 2017. Androgen deprivation therapy alters attention to sexually provocative visual stimuli in elderly men. Sexual Medicine, 5(4), 245-254, DOI: https://doi.org/10.1016/j.esxm.2017.10.001.
Testosterone is known to regulate male sexual interest, but the way that androgens influence men’s sexual cognition is unclear. To investigate the role of androgen deprivation (AD) on visual responses to sexually suggestive stimuli in men treated with prostate cancer, three groups were shown images of male and female runway models who were fully or minimally clothed. Eye tracking was used to compare the looking behaviour among the patients with AD-treated prostate cancer, patients with prostate cancer not on AD therapy, and healthy control participants. The proportion of fixations on fully clothed versus minimally clothed models and the proportion of fixations on target areas of the body were analyzed and compared among groups. They found that men not on AD therapy exhibited more fixations on the minimally clothed images, whereas men on AD therapy did not show any differences in fixations between the two types of images, regardless of whether the image was of a male or female model. There were no significant differences in fixations of target areas between the groups. Thus, the results of this study suggest that testosterone can influence men’s visual attention to sexual stimuli and that AD can reduce the time spent fixated on sexualized targets.
Skead, C., Tsang, V., Palmer-Hague, J.L., Wassersug, R. J., Nasiopoulos, E., Kingstone, A. 2016. Using eye-tracking to quantify the impact of prostate cancer treatments on male libido: A pilot study. J Clin Oncol 34 (Suppl 3S): Abstr 231
Eye-tracking research has shown that heterosexual men with normal testosterone levels shift their gaze to features of women associated with fertility, such as breast size and waist to hip ratio. Therefore, eye-tracking data can be used as a tool to measure a man’s libido. Many treatments for prostate cancer (PCa), particularly androgen deprivation therapy (ADT), reduce sexual desires in men, but this effect is not fully understood. In this study, eye-tracking is used to specify the impact of these treatments on men’s libido. Men aged 50 years or older were put into three groups: PCa patients using ADT, PCa patients not using ADT, and healthy controls. Unaware that their eye movements were being tracked, they were all exposed to photographs of female models, either fully clothed (neutral), or minimally clothes (sexy). The number and duration of eye fixations on target areas of the models’ bodies were recorded. The researchers found that men on ADT exhibit different patterns of visual attention to sexual stimuli compared to the men in the other 2 groups. Although confirmation is required, eye-tracking technology may provide a reliable technique to measure the influence of cancer treatments on the libido of PCa patients. Moving forward this data could be used to study and reduce the impact of PCa treatments on men’s sexual interest.