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People who smoke crack cocaine are described as chaotic and more likely to engage in risky sex, polysubstance use and contract infectious diseases. However, little is known about how individuals perceive smoking crack as compared to other forms of cocaine use, especially injection. We explored the lived experience of people who smoke crack cocaine. Six gender-specific focus groups (n=31) of individuals who currently smoke crack in Vancouver, Canada, were conducted using a semi-structured interview guide. Focus groups were transcribed and analyzed by constant comparative methodology. We applied Rhodes’ risk environment to the phenomenological understanding that individuals have regarding how crack has affected their lives. Subjects reported that smoking rather than injecting cocaine allows them to begin “controlling chaos” in their lives. Controlling chaos was self-defined using nontraditional measures such as the ability to maintain day-to-day commitments and housing stability. The phenomenological lens of smoking crack instead of injecting cocaine “to control chaos” contributes a novel perspective to our understanding of the crack-smoking population. This study examines narratives which add to prior reports of the association of crack smoking and increased chaos and suggests that, for some, inhaled crack may represent efforts towards self-directed harm reduction.

There are no national guidelines specific for handling prion-associated specimens in Canadian medical laboratories. Medical laboratory workers may perceive themselves at risk of prion transmission and, on occasion, decline to process such specimens.To examine the knowledge, attitudes and reported behaviours of medical laboratory workers in relation to prion disease to understand their risk perception and the need for national laboratory guidelines on prion infection control.Survey development and cross-sectional web-based administration.The survey was developed through key informant interviews and a modified Delphi process. Medical laboratory workers across Canada were invited by laboratory managers and national organizations to complete the web-based survey.Twelve key informant interviews were performed. Consensus for questionnaire content was reached through two rounds of the Delphi process. Responses were received from 426 Canadian medical laboratory workers; 37% of medical laboratory staff reported processing prion-associated specimens. Different protocols for specimen processing were followed, and 18% believed they were at risk when processing these specimens. Less than one-third of those receiving specimens believed they were adequately trained. The mean (±SD) knowledge score was 9.25±4.5/24; individuals who had received training scored significantly higher than those who were untrained (P0.01). Eighty-one per cent of respondents would be more comfortable processing specimens if national guidelines existed and were used in their laboratory.There is a high perception of risk and few perceived benefits of processing prion-associated specimens. National guidelines for prion infection control in medical laboratories and adequate training would enable medical laboratory workers to process these specimens efficiently and confidently.Il n’existe pas de lignes directrices nationales propres à la manipulation d’échantillons associés aux infections à prion dans les laboratoires médicaux canadiens. Les travailleurs de ces laboratoires peuvent se percevoir comme vulnérables à la transmission d’une infection à prion et parfois refuser de traiter ces échantillons.Examiner les connaissances, les attitudes et les comportements déclarés des travailleurs de laboratoire pour comprendre leur perception du risque et la nécessité de préparer des lignes directrices nationales de laboratoire sur le contrôle des infections à prion.Élaboration de l’administration transversale d’un sondage par voie électronique.Les chercheurs ont préparé le sondage par suite d’entrevues avec des informateurs clés et d’une méthode Delphi modifiée. Des directeurs de laboratoire et des organisations nationales ont invité les travailleurs de laboratoire du Canada à répondre au sondage par voie électronique.Les chercheurs ont effectué 12 entrevues auprès d’informateurs clés. Ils sont parvenus à un consensus quant au contenu du questionnaire après deux rondes de la méthode Delphi. Ils ont reçu la réponse de 426 travailleurs de laboratoire canadiens, dont 37 % déclaraient traiter des échantillons liés à des infections à prion. Divers protocoles de traitement des échantillons étaient respectés, et 18 % des travailleurs se sentaient vulnérables dans le cadre de ce traitement. Moins du tiers des travailleurs qui recevaient ces échantillons se sentaient bien formés pour le faire. L’indice de connaissance moyen s’élevait à 9,25/24 (ÉT±4,5). Les personnes qui avaient reçu une formation obtenaient un indice considérablement plus élevé que celles qui n’en avaient pas reçu (P0,01). Quatre-vingt-un pour cent des répondants seraient plus à l’aise de traiter les échantillons s’il existait des lignes directrices nationales mises en œuvre dans leur laboratoire.La perception du risque est élevée et celle des avantages du traitement des échantillons liés à des infections à prion est faible. Des lignes directrices nationales sur le contrôle des infections à prion dans les laboratoires médicaux et une formation convenable permettraient aux travailleurs de laboratoire de traiter ces échantillons avec efficacité et en toute confiance.

BACKGROUND: A possible breach of the transducer protector in specific dialysis machines was reported in June 2004 in British Columbia (BC), which led to testing of hemodialysis patients for hepatitis C virus (HCV), hepatitis B virus (HBV) and HIV. This testing provided an opportunity to examine HCV incidence, prevalence and coinfection with HBV and HIV, and to compare anti-HCV and HCV polymerase chain reaction (PCR).METHODS: The results of hemodialysis patients who were dialyzed on the implicated machines (65% of BC dialysis patients), and tested for HCV, HBV and HIV, between June 1, 2004, and December 31, 2004, were reviewed and compared with available previous results.RESULTS: Of 1286 hemodialysis patients with anti-HCV and/or HCV-PCR testing, 69 (5.4%) tested positive. Two HCV genotype 4 seroconversions were identified. HCV incidence rate on dialysis was 78.8 cases per 100,000 person-years. Younger age, history of renal transplant and past HBV infection were associated with HCV infection. No occult infection was identified using HCV-PCR.INTERPRETATION: Hemodialysis patients had three times the HCV prevalence rate of the general BC population, and more than 20 times the incident rate of the general Canadian population. One of the two seroconversions occurred before the testing campaign; the patient was likely infected during hemodialysis in South Asia. The other was plausibly a late seroconversion following renal transplant in South Asia. Nosocomial transmission cannot be ruled out because both patients were dialyzed in the same centre. Baseline and annual anti-HCV testing is recommended. HCV-PCR should be considered at baseline for persons with HCV risk factors, and for returning travellers who received dialysis in HCV-endemic countries to identify HCV infection occurring outside the hemodialysis unit.