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Mahant S, Borkhoff CM, Parkin PC, Imsirovic H, Tuna M, Macarthur C, To T, Gill PJ. Sociodemographic Factors and Trends in Bronchiolitis-Related Emergency Department Visit and Hospitalization Rates. JAMA Netw Open 2024; 7:e248976. [PMID: 38683605 PMCID: PMC11059049 DOI: 10.1001/jamanetworkopen.2024.8976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/28/2024] [Indexed: 05/01/2024] Open
Abstract
Importance Bronchiolitis is the most common and most cumulatively expensive condition in pediatric hospital care. Few population-based studies have examined health inequalities in bronchiolitis outcomes over time. Objective To examine trends in bronchiolitis-related emergency department (ED) visit and hospitalization rates by sociodemographic factors in a universally funded health care system. Design, Setting, and Participants This repeated cross-sectional cohort study was performed from April 1, 2004, to March 31, 2022, using population-based health administrative data from children younger than 2 years in Ontario, Canada. Main Outcome and Measures Bronchiolitis ED visit and hospitalization rates per 1000 person-years reported for the equity stratifiers of sex, residence location (rural vs urban), and material resources quintile. Trends in annual rates by equity stratifiers were analyzed using joinpoint regression and estimating the average annual percentage change (AAPC) with 95% CI and the absolute difference in AAPC with 95% CI from April 1, 2004, to March 31, 2020. Results Of 2 921 573 children included in the study, 1 422 088 (48.7%) were female and 2 619 139 (89.6%) lived in an urban location. Emergency department visit and hospitalization rates were highest for boys, those with rural residence, and those with least material resources. There were no significant between-group absolute differences in the AAPC in ED visits per 1000 person-years by sex (female vs male; 0.22; 95% CI, -0.92 to 1.35; P = .71), residence (rural vs urban; -0.31; 95% CI -1.70 to 1.09; P = .67), or material resources (quintile 5 vs 1; -1.17; 95% CI, -2.57 to 0.22; P = .10). Similarly, there were no significant between-group absolute differences in the AAPC in hospitalizations per 1000 person-years by sex (female vs male; 0.53; 95% CI, -1.11 to 2.17; P = .53), residence (rural vs urban; -0.62; 95% CI, -2.63 to 1.40; P = .55), or material resources (quintile 5 vs 1; -0.93; 95% CI -3.80 to 1.93; P = .52). Conclusions and Relevance In this population-based cohort study of children in a universally funded health care system, inequalities in bronchiolitis ED visit and hospitalization rates did not improve over time.
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Affiliation(s)
- Sanjay Mahant
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Pediatric Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cornelia M. Borkhoff
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia C. Parkin
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Pediatric Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Meltem Tuna
- ICES, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Colin Macarthur
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Teresa To
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Peter J. Gill
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Pediatric Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Mohanty S, Podmore B, Cuñado Moral A, Matthews I, Sarpong E, Lacetera A, Qizilbash N. Incidence of pneumococcal disease from 2003 to 2019 in children ≤17 years in England. Pneumonia (Nathan) 2023; 15:2. [PMID: 36683061 PMCID: PMC9868000 DOI: 10.1186/s41479-022-00103-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/15/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Pneumococcal disease is a leading cause of communicable disease morbidity and mortality globally. We aimed to estimate invasive pneumococcal disease (IPD), pneumococcal pneumonia (PP) and all-cause pneumonia (ACP) incidence rates (IRs) in children aged 0-17 years in England from 2003 to 2019. METHODS A retrospective study in children ≤17 years old from 2003 to 2019 using the Clinical Practice Research Datalink (CPRD) Gold and Hospital Episodes Statistics Admitted Patient Care (HES APC) databases. IPD episodes were identified in hospital records (HES APC). PP (caused by Streptococcus pneumoniae only) and ACP episodes (caused by any pathogen) were identified in primary care (CPRD) and in hospital records (HES APC). Annual IRs by age-group were calculated as the number of episodes/person-years (PY) at risk, with 95% confidence intervals (95% CI). Interrupted time series analyses were conducted to assess changes in IRs across the post-PCV7 (2007-2009), early post-PCV13 (2011-2014) and late post-PCV13 (2015-2019) periods compared to the pre-PCV7 period (2003-2005) using generalized linear models. RESULTS 170 IPD episodes, 769 PP episodes and 12,142 ACP episodes were identified in 1,500,686 children in 2003-2019. The overall IPD, PP and ACP IRs (per 100,000 PY) were 2.29 (95% CI 1.96-2.66), 10.34 (95% CI 9.62-11.10) and 163.37 (95% CI 160.47-166.30), respectively. The highest IPD, PP and ACP IRs were observed in children aged < 2 years compared to older children (2-4 and 5-17 years). IPD IRs decreased between the pre-PCV7 period and the late post-PCV13 period from 3.28 (95% CI 2.42-4.33) to 1.41 (95% CI 0.80-2.29), IRR 0.28 (95% CI 0.09-0.90), p-value 0.033. PP IRs declined between the pre-PCV7 period and the late post-PCV13 period from 14.65 (95% CI 12.77-16.72) to 3.87 (95% CI 2.81-5.20), IRR 0.19 (95% CI 0.09-0.38), p-value < 0.001. ACP IRs declined between the pre-PCV7 period and the late post-PCV13 period from 167.28 (95% CI 160.78-173.96) to 124.96 (95% CI 118.54-131.63), IRR 0.77 (95% CI 0.66-0.88), p-value < 0.001. CONCLUSIONS The clinical burden of IPD, PP and ACP declined in children in England aged 0-17 years between 2003 and 2019, especially in the late post-PCV13 period. This study highlights the importance of PCV vaccination in reducing the burden of PD and ACP in children in England.
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Affiliation(s)
- Salini Mohanty
- grid.417993.10000 0001 2260 0793Merck & Co., Inc, Center for Observational and Real-World Evidence (CORE), Rahway, NJ USA
| | - Bélène Podmore
- OXON Epidemiology Ltd, Epidemiology & Statistics, Madrid, Spain
| | | | - Ian Matthews
- grid.419737.f0000 0004 6047 9949MSD (UK) Ltd, Value, Access and Devolved nations (VAD), London, UK
| | - Eric Sarpong
- grid.417993.10000 0001 2260 0793Merck & Co., Inc., Real-world Data Analytics and Innovation (RDAI), Rahway, NJ USA
| | | | - Nawab Qizilbash
- OXON Epidemiology Ltd, Epidemiology & Statistics, Madrid, Spain
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Wilk P, Maltby A, Lau T, Gunz AC, Osornio-Vargas A, Yamamoto SS, Ali S, Lavigne É. Geographic inequalities in paediatric emergency department visits in Ontario and Alberta: a multilevel analysis of 2.5 million visits. BMC Pediatr 2022; 22:432. [PMID: 35858855 PMCID: PMC9297543 DOI: 10.1186/s12887-022-03485-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Research on intra- and inter-regional variations in emergency department (ED) visits among children can provide a better understanding of the patterns of ED utilization and further insight into how contextual features of the urban environment may be associated with these health events. Our objectives were to assess intra-urban and inter-urban variation in paediatric emergency department (PED) visits in census metropolitan areas (CMAs) in Ontario and Alberta, Canada and explore if contextual factors related to material and social deprivation, proximity to healthcare facilities, and supply of family physicians explain this variation. Methods A retrospective, population-based analysis of data on PED visits recorded between April 1, 2015 and March 31, 2017 was conducted. Random intercept multilevel regression models were constructed to quantify the intra- (between forward sortation areas [FSAs]) and inter- (between CMAs) variations in the rates of PED visits. Results In total, 2,537,442 PED visits were included in the study. The overall crude FSA-level rate of PED visits was 415.4 per 1,000 children population. Across CMAs, the crude rate of PED visits was highest in Thunder Bay, Ontario (771.6) and lowest in Windsor, Ontario (237.2). There was evidence of substantial intra- and inter-urban variation in the rates of PED visits. More socially deprived FSAs, FSAs with decreased proximity to healthcare facilities, and CMAs with a higher rate of family physicians per 1,000 children population had higher rates of PED visits. Conclusions The variation in rates of PED visits across CMAs and FSAs cannot be fully accounted for by age and sex distributions, material and social deprivation, proximity to healthcare facilities, or supply of family physicians. There is a need to explore additional contextual factors to better understand why some metropolitan areas have higher rates of PED visits.
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Affiliation(s)
- Piotr Wilk
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada. .,Department of Paediatrics, Western University, London, ON, Canada. .,Child Health Research Institute, London, ON, Canada. .,Lawson Health Research Institute, London, ON, Canada. .,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 3rd Floor, Western Centre for Public Health and Family Medicine, 1465 Richmond St, ON, N6G 2M1, London, Canada.
| | - Alana Maltby
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Tammy Lau
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Anna C Gunz
- Department of Paediatrics, Western University, London, ON, Canada.,Child Health Research Institute, London, ON, Canada.,Division of Paediatric Critical Care, Children's Hospital, London Health Sciences Center, London, ON, Canada
| | | | - Shelby S Yamamoto
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Shehzad Ali
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Éric Lavigne
- Air Health Science Division, Health Canada, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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To T, Terebessy E, Zhu J, Fong I, Liang J, Zhang K, McGihon R. Did Emergency Department Visits in Infants and Young Children Increase in the Last Decade?: An Ontario, Canada Study. Pediatr Emerg Care 2022; 38:e1173-e1178. [PMID: 34570077 DOI: 10.1097/pec.0000000000002535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of the study were to measure overall trends and to identify leading causes for pediatric emergency department (ED) visits among children aged 0 to 4 years. METHODS We conducted an 11-year population-based open cohort study using health administrative data from 2008 to 2018 in Ontario, Canada. All ED visits were extracted from the National Ambulatory Care Reporting System, along with the most responsible cause of each visit. Annual ED visit rates were calculated per 100 children in each year. Overall and disease-specific rates for all children were calculated and then stratified by sex and age groups. Relative percentage change in rates between 2008 and 2018 were calculated and compared using standardized differences (SDIFs). Statistical significance of time trends was tested using Poisson regression. RESULTS This study included an average of 911,566 children from 2008 to 2018. All-cause ED visit rates increased by 28.2% from 2008 to 2018 (43.24-55.42 per 100, SDIF >0.1). Respiratory diseases were consistently the top cause of ED visits, and contributed to 1 in 3 ED visits in 2018. These respiratory conditions include asthma, asthma-related diseases (bronchiolitis, bronchitis, influenza, and pneumonia), and other respiratory diseases. Respiratory ED visit rates increased by 32.8% from 2008 to 2018 (11.51-15.28 per 100, SDIF <0.1), driven by a 46.4% (14.58-21.35 per 100, SDIF >0.1) increase among children younger than 1 year. There was a 78.0% increase in ED visits for bronchiolitis in infants (1.45-2.58 per 100, SDIF <0.1). CONCLUSIONS Respiratory diseases like bronchiolitis among infants were the consistent leading cause for ED visits. All-cause ED visit rates among young children increased by 28.17% from 2008 to 2018.
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Affiliation(s)
| | - Emilie Terebessy
- From the Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children
| | | | - Ivy Fong
- From the Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children
| | - Jocelyn Liang
- From the Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children
| | | | - Rachel McGihon
- From the Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children
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Kassam S, Serrano-Lomelin J, Hicks A, Crawford S, Bakal JA, Ospina MB. Geography as a Determinant of Health: Health Services Utilization of Pediatric Respiratory Illness in a Canadian Province. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8347. [PMID: 34444093 PMCID: PMC8392806 DOI: 10.3390/ijerph18168347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 12/03/2022]
Abstract
Respiratory diseases contribute to high healthcare utilization rates among children. Although social inequalities play a major role in these conditions, little is known about the impact of geography as a determinant of health, particularly with regard to the difference between rural and urban centers. A regional geographic analysis was conducted using health repository data on singleton births between 2005 and 2010 in Alberta, Canada. Data were aggregated according to regional health sub-zones in the province and standardized prevalence ratios (SPRs) were determined for eight respiratory diseases (asthma, influenza, bronchitis, bronchiolitis, croup, pneumonia, and other upper and other lower respiratory tract infections). The results indicate that there are higher rates of healthcare utilization in northern compared to southern regions and in rural and remote regions compared to urban ones, after accounting for both material and social deprivation. Geography plays a role in discrepancies of healthcare utilization for pediatric respiratory diseases, and this can be used to inform the provision of health services and resource allocation across various regions.
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Affiliation(s)
- Shehzad Kassam
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Jesus Serrano-Lomelin
- Department of Obstetrics & Gynecology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada;
| | - Anne Hicks
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - Susan Crawford
- Alberta Perinatal Health Program, Alberta Health Services, Edmonton, AB T2N 2T9, Canada;
| | - Jeffrey A. Bakal
- Provincial Research Data Services, Alberta Health Services, Edmonton, AB T6G 2C8, Canada;
| | - Maria B. Ospina
- Department of Obstetrics & Gynecology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada;
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Serrano-Lomelin J, Hicks A, Kumar M, Johnson DW, Chari R, Osornio-Vargas A, Crawford S, Bakal J, Ospina MB. Patterns of respiratory health services utilization from birth to 5 years of children who experienced adverse birth outcomes. PLoS One 2021; 16:e0247527. [PMID: 33606848 PMCID: PMC7895380 DOI: 10.1371/journal.pone.0247527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/09/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction Adverse birth outcomes have important consequences for future lung health. We evaluated patterns of respiratory health services utilization in early childhood among children born preterm (PTB), small and large for gestational age at term (SGA and LGA, respectively), and appropriate-for-gestational age at term. Materials and methods We conducted a population-based retrospective cohort study using administrative health data of all singleton live births in Alberta, Canada between 2005–2010. Data on hospitalizations and emergency department (ED) visits from birth to 5 years were collected for asthma, bronchitis, bronchiolitis, croup, influenza, pneumonia, and other acute upper and lower respiratory tract infections (other URTI and other LRTI, respectively). Adjusted rate ratios were estimated for respiratory ED visits and hospitalizations for adverse birth outcomes using the appropriate-for-gestational age at term group as reference. Age-specific trajectories of total respiratory health services utilization rates for each group were estimated in Poisson models. Results A total of 293,764 episodes of respiratory care from 206,994 children were analyzed. Very PTB children had the highest rates of health services use for all respiratory conditions, particularly for asthma, pneumonia, and bronchiolitis hospitalizations. Moderate/late PTB children also had elevated ED visits and hospitalizations for all respiratory conditions. Children born SGA showed high rates of ED visits for other LRTI, and of hospitalizations for bronchitis, bronchiolitis, and other URTI. Children born LGA had high rates of croup and other URTI ED visits, and of bronchiolitis and bronchiolitis hospitalizations. Age-specific trajectories showed a decreasing trend in the rates of total respiratory health service utilization from birth to five years of age for all groups studied. Children born PTB and LGA at term significantly required more respiratory health services over time compared to the reference group. Conclusion Patterns of paediatric respiratory health services utilization vary according to gestational age and fetal growth.
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Affiliation(s)
- Jesus Serrano-Lomelin
- Faculty of Medicine & Dentistry, Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Anne Hicks
- Faculty of Medicine & Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Manoj Kumar
- Faculty of Medicine & Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - David W. Johnson
- Department of Pediatrics, Emergency Medicine, and Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Radha Chari
- Faculty of Medicine & Dentistry, Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Alvaro Osornio-Vargas
- Faculty of Medicine & Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Maria B. Ospina
- Faculty of Medicine & Dentistry, Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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Serrano-Lomelin J, Nielsen CC, Hicks A, Crawford S, Bakal JA, Ospina MB. Geographic Inequalities of Respiratory Health Services Utilization during Childhood in Edmonton and Calgary, Canada: A Tale of Two Cities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238973. [PMID: 33276583 PMCID: PMC7730300 DOI: 10.3390/ijerph17238973] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 01/10/2023]
Abstract
Young children are susceptible to respiratory diseases. Inequalities exist across socioeconomic groups for paediatric respiratory health services utilization in Alberta. However, the geographic distribution of those inequalities has not been fully explored. The aim of this study was to identify geographic inequalities in respiratory health services utilization in early childhood in Calgary and Edmonton, two major urban centres in Western Canada. We conducted a geographic analysis of data from a retrospective cohort of all singleton live births occurred between 2005 and 2010. We aggregated at area-level the total number of episodes of respiratory care (hospitalizations and emergency department visits) that occurred during the first five years of life for bronchiolitis, pneumonia, lower/upper respiratory tract infections, influenza, and asthma-wheezing. We used spatial filters to identify geographic inequalities in the prevalence of acute paediatric respiratory health services utilization in Calgary and Edmonton. The average health gap between areas with the highest and the lowest prevalence of respiratory health services utilization was 1.5-fold in Calgary and 1.4-fold in Edmonton. Geographic inequalities were not completely explained by the spatial distribution of socioeconomic status, suggesting that other unmeasured factors at the neighbourhood level may explain local variability in the use of acute respiratory health services in early childhood.
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Affiliation(s)
- Jesus Serrano-Lomelin
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada;
| | - Charlene C. Nielsen
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - Anne Hicks
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - Susan Crawford
- Alberta Perinatal Health Program, Alberta Health Services, Calgary, AB T2N 2T9, Canada;
| | - Jeffrey A. Bakal
- Provincial Research Data Services, Alberta Health Services, Edmonton, AB T6G 2C8, Canada;
| | - Maria B. Ospina
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada;
- Correspondence: ; Tel.: +1-780-492-9351
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