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New HIV infections occur every year in Canada, highlighting the need for integrated prevention programs. Pre-exposure prophylaxis (PrEP) and nonoccupational postexposure prophylaxis (nPEP) are two important strategies for preventing HIV that should be considered standard of care and implemented as components of a comprehensive response to the epidemic. Pre-exposure prophylaxis is the use of certain antiretroviral medications by HIV-uninfected persons who are at high, ongoing risk of HIV acquisition, beginning before and continuing after potential HIV exposures. Postexposure prophylaxis (PEP) involves 28 days of antiretroviral medications immediately after a specific HIV exposure, and is nonoccupational when used after sexual and injection drug use exposures, rather than accidental exposures that occur in work contexts. The large financial cost of HIV infection and the young age of those newly diagnosed underscore the economic and social importance of preventing new infections. We hope that this guideline will contribute to reducing HIV incidence in Canada by improving the quality of care, increasing access to care, reducing inappropriate variation in practice and promoting the rigorous evaluation of biomedical prevention strategies nationwide.

New HIV infections occur annually in Canada, highlighting the need for pre- and postexposure prophylaxis (PrEP and PEP). Through the Canadian Institutes of Health Research (CIHR) Pan-Canadian Network for HIV/AIDS and STBBI (sexually transmitted and blood-borne infections) Clinical Trials Research, we have updated the 2017 guideline on clinical indications and drug regimens for PrEP and PEP in Canada. Drawing on meetings with community-based organizations representing key populations affected by HIV in Canada, along with evidence from 3 systematic reviews on PrEP, PEP, and HIV risk assessment tools (searches to June 2024), our diverse panel of 19 experts formulated recommendations on PrEP and PEP. We used a formal evidence-to-decision-making framework and the Grading of Recommendations, Assessment, Development, and Evaluation system. We followed the Guidelines International Network principles for managing competing interests. Our guideline development and reporting adhere with Appraisal of Guidelines for Research and Evaluation II. This guideline contains 31 recommendations and 10 good practice statements. Although it is appropriate to prescribe PrEP to adults and adolescents who request it, clinicians are also encouraged to assess HIV risk during routine health visits to identify people who would benefit from PrEP. Clinicians should elicit information about patients’ anatomy and sexual partners in a culturally sensitive and affirming manner to determine which PrEP regimens — daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC), on-demand TDF/FTC, daily oral tenofovir alafenamide/emtricitabine, or long-acting injectable cabotegravir — are suitable options. When assessing whether PEP is needed, clinicians should consider the likelihood that the source person has transmissible HIV, as well as the biological risk of HIV transmission based on exposure type. Preferred PEP regimens are dolutegravir plus TDF/FTC, or bictegravir/tenofovir alafenamide/emtricitabine. Multiple safe, effective PrEP and PEP regimens are now available in Canada, making it increasingly possible to find suitable options for all who could benefit. Implementation of this guideline should expand access to biomedical HIV prevention interventions for those at risk and decrease the incidence of HIV in Canada.

Sleep is considered vital to human health and well-being, and is critical to physiological and cognitive functioning. Elite athletes experience high training and competition demands, and are often exposed to various factors, situations, and environments that can cause sleep impairments. Previous research has shown that athletes commonly experience sleep loss in the lead up to and following competition, which could have significant impacts on their preparation, performance, and recovery. In particular, the results from previous research show significant reductions in total sleep time (~1:40 h:min) and significant increases in sleep latency (~45 minutes) following evening competition. Napping is common in both the training and competition setting in athletes; however, research on the effect of napping on physiology and performance is limited. In contrast, research on strategies and interventions to improve sleep are increasing in the athletic population, with sleep hygiene research resulting in significant improvements in key sleep indices. This review investigates the physiological importance of sleep in athletes, current tools to monitor athletes' sleep, the role of sleep for cognitive functioning and athletic performance, the prevalence of sleep disturbances and the potential mechanisms causing sleep disturbances, the role of napping, and different intervention strategies to improve sleep.

The incidence of HIV infections in Canada has increased yearly since 2014. New cases of HIV have resulted almost exclusively from non-occupational exposures, including sexual contact and needle sharing. Appropriate HIV post-exposure prophylaxis is under-prescribed to patients who present to the emergency department after a high-risk exposure. In November of 2017, a Canadian guideline on HIV pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) was published. The guideline presents a standardized, evidence-based approach to assessing risk for HIV transmission and prescribing HIV prophylaxis. This summary highlights the key points from the guideline that are relevant to the practice of emergency medicine in Canada. L’incidence des infections à VIH au Canada croît sans cesse chaque année depuis 2014. La hausse du nombre de nouveaux cas d’infection s’explique presque exclusivement par des expositions non professionnelles au virus, attribuables par exemple à des contacts sexuels ou au partage de seringues. Toutefois, les médecins ne prescrivent pas suffisamment de mesures prophylactiques appropriées de postexposition aux patients qui consultent au service des urgences après une exposition à haut risque au VIH. Une nouvelle ligne directrice canadienne sur la prophylaxie préexposition au VIH et sur la prophylaxie postexposition non professionnelle a été publiée en novembre 2017. Elle porte sur une démarche uniforme et fondée sur des données probantes pour évaluer le risque de transmission du VIH et pour prescrire des mesures prophylactiques anti-VIH. Sera présenté dans l’article un résumé des principaux éléments de la ligne directrice, qui trouvent application dans la pratique de la médecine d’urgence au Canada.

Chaque année, au Canada, on dénombre de nouvelles infections par le virus de l’immunodéficience humaine (VIH), ce qui met en relief le besoin d’une prophylaxie préexposition (PPrE) et d’une prophylaxie postexposition (PPE). Avec l’aide du Réseau pancanadien de recherche sur les essais cliniques du VIH et des infections transmissibles sexuellement et par le sang (ITSS) des Instituts de recherche en santé du Canada (IRSC), nous avons mis à jour le guide de pratique clinique de 2017 sur les indications cliniques et les schémas thérapeutiques, relativement à la PPrE et à la PPE au Canada. En s’appuyant sur des rencontres avec des organismes communautaires représentant les principales populations touchées par le VIH au Canada, ainsi que sur des données issues de 3 revues systématiques sur la PPrE, la PPE et les outils d’évaluation du risque lié au VIH (recherches effectuées jusqu’en juin 2024), notre comité diversifié de 19 experts et expertes a formulé des recommandations sur la PPrE et la PPE. Nous avons utilisé un cadre de travail formel de prise de décision fondée sur des données probantes et le système GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Nous avons appliqué les principes du Guidelines International Network pour gérer les intérêts concurrents. Nous avons respecté les principes de l’outil AGREE II (Appraisal of Guidelines for Research and Evaluation II) quant à la conception du présent guide de pratique clinique et la rédaction de rapports. Le présent guide de pratique clinique comporte 31 recommandations et 10 énoncés de bonne pratique. Bien qu’il soit approprié de prescrire une PPrE aux adultes et aux adolescents et adolescentes qui en font la demande, nous encourageons les cliniciens et cliniciennes à effectuer une évaluation du risque d’infection par le VIH lors des visites de pratique courante afin de repérer les autres personnes qui pourraient bénéficier d’une PPrE. Les cliniciens et cliniciennes doivent obtenir de l’information sur l’anatomie du patient ou de la patiente ainsi que sur ses partenaires sexuels et sexuelles, en tenant compte des différences culturelles et de l’affirmation de genre, afin de déterminer quelles sont les options appropriées de schémas thérapeutiques de PPrE, à savoir l’association fumarate de ténofovir disoproxil/emtricitabine (TDF/FTC) à prise orale quotidienne, l’association TDF/FTC sur demande, l’association ténofovir alafénamide/emtricitabine à prise orale quotidienne ou le cabotégravir en suspension injectable à libération prolongée. Lorsque le clinicien ou la clinicienne évalue le besoin d’amorcer une PPE, il ou elle doit tenir compte de la probabilité que la personne source puisse transmettre le VIH ainsi que du risque biologique de transmission du VIH en fonction du type d’exposition. Les schémas de PPE à privilégier sont l’association dolutégravir et TDF/FTC ou l’association bictégravir/ténofovir alafénamide/emtricitabine. De nombreux schémas de PPrE et de PPE sûrs et efficaces sont maintenant offerts au Canada, ce qui augmente grandement la possibilité de trouver une option convenable pour toute personne qui pourrait en bénéficier. La mise en oeuvre du présent guide de pratique clinique devrait élargir l’accès aux interventions en matière de prévention biomédicale du VIH pour les personnes à risque et réduire l’incidence du VIH au Canada.

The development of the frontopolar cortex (FPC) through late childhood and adolescence was investigated using measures of cortical thickness. T 1-weighted structural MRIs from 35 typically developing participants aged 8–20 years were used to construct 3D models of the brain, from which cortical thickness was measured. There was a significant inverse association between age and cortical thickness, such that cortical thickness decreased as age increased between 8 and 20 years. There was no effect of laterality or gender on cortical thickness.

Previous research has found that mindfulness-based techniques are beneficial for reducing stress in heavy drinking individuals. However, the underlying neurobiology of these stress-reducing effects are unclear. Moreover, much of the research examining neurobiological correlates of mindfulness have used static functional connectivity, suggesting brain activity goes unchanged for the entire length of an MRI scan. In the current study, we used a state-based dynamic functional connectivity model to examine brain states during either a 10-minute mindfulness session or resting control that followed an individually tailored stress imagery task. Using a Hidden Semi-Markov Model (HSMM), six brain states and the associated dynamics of state traversal were estimated for the population. Participants that experienced the mindfulness session had more transitions and longer time spent in states in which the salience network was more active. Participants assigned to the control group had more transitions and increased time spent in states in which nodes of the default mode network were more active. Moreover, for control participants, increased occupancy time to SN-dominant states were associated with lower perceived stress. Using HSMM provided unique insight into network connectivity during mindful states; we believe it offers a novel approach to testing and optimizing the content of mindful-based therapies.