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Thakali O, Mercier É, Eid W, Wellman M, Brasset-Gorny J, Overton AK, Knapp JJ, Manuel D, Charles TC, Goodridge L, Arts EJ, Poon AFY, Brown RS, Graber TE, Delatolla R, DeGroot CT. Real-time evaluation of signal accuracy in wastewater surveillance of pathogens with high rates of mutation. Sci Rep 2024; 14:3728. [PMID: 38355869 PMCID: PMC10866965 DOI: 10.1038/s41598-024-54319-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/11/2024] [Indexed: 02/16/2024] Open
Abstract
Wastewater surveillance of coronavirus disease 2019 (COVID-19) commonly applies reverse transcription-quantitative polymerase chain reaction (RT-qPCR) to quantify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA concentrations in wastewater over time. In most applications worldwide, maximal sensitivity and specificity of RT-qPCR has been achieved, in part, by monitoring two or more genomic loci of SARS-CoV-2. In Ontario, Canada, the provincial Wastewater Surveillance Initiative reports the average copies of the CDC N1 and N2 loci normalized to the fecal biomarker pepper mild mottle virus. In November 2021, the emergence of the Omicron variant of concern, harboring a C28311T mutation within the CDC N1 probe region, challenged the accuracy of the consensus between the RT-qPCR measurements of the N1 and N2 loci of SARS-CoV-2. In this study, we developed and applied a novel real-time dual loci quality assurance and control framework based on the relative difference between the loci measurements to the City of Ottawa dataset to identify a loss of sensitivity of the N1 assay in the period from July 10, 2022 to January 31, 2023. Further analysis via sequencing and allele-specific RT-qPCR revealed a high proportion of mutations C28312T and A28330G during the study period, both in the City of Ottawa and across the province. It is hypothesized that nucleotide mutations in the probe region, especially A28330G, led to inefficient annealing, resulting in reduction in sensitivity and accuracy of the N1 assay. This study highlights the importance of implementing quality assurance and control criteria to continually evaluate, in near real-time, the accuracy of the signal produced in wastewater surveillance applications that rely on detection of pathogens whose genomes undergo high rates of mutation.
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Affiliation(s)
- Ocean Thakali
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Élisabeth Mercier
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Walaa Eid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada
| | - Martin Wellman
- The Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - Julia Brasset-Gorny
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada
| | - Alyssa K Overton
- Department of Biology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Jennifer J Knapp
- Department of Biology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Douglas Manuel
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada
- Department of Family Medicine, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON, K1N 6N5, Canada
- School of Epidemiology and Public Health, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON, K1N 6N5, Canada
| | - Trevor C Charles
- Department of Biology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Lawrence Goodridge
- Department of Food Science, Canadian Research Institute for Food Safety, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Eric J Arts
- Department of Microbiology and Immunology, Western University, London, ON, N6A 3K7, Canada
| | - Art F Y Poon
- Department of Microbiology and Immunology, Western University, London, ON, N6A 3K7, Canada
| | - R Stephen Brown
- School of Environmental Studies and Department of Chemistry, Queen's University, Kingston, ON, Canada
| | - Tyson E Graber
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada
| | - Robert Delatolla
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Christopher T DeGroot
- Department of Mechanical and Materials Engineering, Western University, London, ON, N6A 5B9, Canada.
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Vargas ME, Gershon AS, Pugliese M, Gotfrit RJ, Manuel D, Sadatsafavi M, Stukel TA, To T, Kendall CE, Thavorn K, Robillard R, Kendzerska T. Pandemic Effect on Healthcare Use and Death in Adults with Epilepsy: A Population Study. Can J Neurol Sci 2023:1-11. [PMID: 38115804 DOI: 10.1017/cjn.2023.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVES We conducted a population-based study using Ontario health administrative data to describe trends in healthcare utilization and mortality in adults with epilepsy during the first pandemic year (March 2020-March 2021) compared to historical data (2016-2019). We also investigated if changes in outpatient visits and diagnostic testing during the first pandemic year were associated with increased risk for hospitalizations, emergency department (ED) visits, or death. METHODS Projected monthly visit rates (per 100,000 people) for outpatient visits, electroencephalography, magnetic resonance, computed tomography, all-cause ED visits, hospitalizations, and mortality were calculated based on historical data by fitting monthly time series autoregressive integrated moving-average models. Two-way interactions were calculated using Quasi-Poisson models. RESULTS In adults with epilepsy during the first quarter of the pandemic, we demonstrated a reduction in all-cause outpatient visits, diagnostic testing, ED visits and hospitalizations, and a temporary increase in mortality (observed rates of 355.8 vs projected 308.8, 95% CI: 276.3-345.1). By the end of the year, outpatient visits increased (85,535.4 vs 76,620.6, 95% CI: 71,546.9-82,059.4), and most of the diagnostic test rates returned to the projected. The increase in the rate of all-cause mortality during the pandemic, compared to pre-pandemic, was greater during months with the lower frequency of diagnostic tests than months with higher frequency (interaction p-values <.0001). CONCLUSION We described the impact of the pandemic on healthcare utilization and mortality in adults with epilepsy during the first year. We demonstrated that access to relevant diagnostic testing is likely important for this population while planning restrictions on non-urgent health services.
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Affiliation(s)
| | - Andrea S Gershon
- ICES, Ottawa, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Research Institute, The Hospital of Sick Children, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Pugliese
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
| | - Ryan Jason Gotfrit
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Douglas Manuel
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, Respiratory Evaluation Sciences Program, The University of British Columbia, Vancouver, BC, Canada
| | - Therese A Stukel
- ICES, Ottawa, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Teresa To
- ICES, Ottawa, Toronto, ON, Canada
- Research Institute, The Hospital of Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Claire E Kendall
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Kednapa Thavorn
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Tetyana Kendzerska
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Kendzerska T, Zhu DT, Pugliese M, Manuel D, Sadatsafavi M, Povitz M, Stukel TA, To T, Aaron SD, Mulpuru S, Chin M, Kendall CE, Thavorn K, Robillard R, Gershon AS. Trends in outpatient and inpatient visits for separate ambulatory-care-sensitive conditions during the first year of the COVID-19 pandemic: a province-based study. Front Public Health 2023; 11:1251020. [PMID: 38169852 PMCID: PMC10759216 DOI: 10.3389/fpubh.2023.1251020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Background The COVID-19 pandemic led to global disruptions in non-urgent health services, affecting health outcomes of individuals with ambulatory-care-sensitive conditions (ACSCs). Methods We conducted a province-based study using Ontario health administrative data (Canada) to determine trends in outpatient visits and hospitalization rates (per 100,000 people) in the general adult population for seven ACSCs during the first pandemic year (March 2020-March 2021) compared to previous years (2016-2019), and how disruption in outpatient visits related to acute care use. ACSCs considered were chronic obstructive pulmonary disease (COPD), asthma, angina, congestive heart failure (CHF), hypertension, diabetes, and epilepsy. We used time series auto-regressive integrated moving-average models to compare observed versus projected rates. Results Following an initial reduction (March-May 2020) in all types of visits, primary care outpatient visits (combined in-person and virtual) returned to pre-pandemic levels for asthma, angina, hypertension, and diabetes, remained below pre-pandemic levels for COPD, and rose above pre-pandemic levels for CHF (104.8 vs. 96.4, 95% CI: 89.4-104.0) and epilepsy (29.6 vs. 24.7, 95% CI: 22.1-27.5) by the end of the first pandemic year. Specialty visits returned to pre-pandemic levels for COPD, angina, CHF, hypertension, and diabetes, but remained above pre-pandemic levels for asthma (95.4 vs. 79.5, 95% CI: 70.7-89.5) and epilepsy (53.3 vs. 45.6, 95% CI: 41.2-50.5), by the end of the year. Virtual visit rates increased for all ACSCs. Among ACSCs, reductions in hospitalizations were most pronounced for COPD and asthma. CHF-related hospitalizations also decreased, albeit to a lesser extent. For angina, hypertension, diabetes, and epilepsy, hospitalization rates reduced initially, but returned to pre-pandemic levels by the end of the year. Conclusion This study demonstrated variation in outpatient visit trends for different ACSCs in the first pandemic year. No outpatient visit trends resulted in increased hospitalizations for any ACSC; however, reductions in rates of asthma, COPD, and CHF hospitalizations persisted.
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Affiliation(s)
- Tetyana Kendzerska
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
| | - David T. Zhu
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Medical Scientist Training Program, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Michael Pugliese
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
| | - Douglas Manuel
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Marcus Povitz
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Therese A. Stukel
- ICES, Ottawa, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Teresa To
- ICES, Ottawa, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Research Institute, The Hospital of Sick Children, Toronto, ON, Canada
| | - Shawn D. Aaron
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
| | - Sunita Mulpuru
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
| | - Melanie Chin
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
| | - Claire E. Kendall
- ICES, Ottawa, Toronto, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- The Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kednapa Thavorn
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Andrea S. Gershon
- ICES, Ottawa, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Research Institute, The Hospital of Sick Children, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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Scott MM, Ramzy A, Isenberg SR, Webber C, Eddeen AB, Murmann M, Mahdavi R, Howard M, Kendall CE, Klinger C, Marshall D, Sinnarajah A, Ponka D, Buchman S, Bennett C, Tanuseputro P, Dahrouge S, May K, Heer C, Cooper D, Manuel D, Thavorn K, Hsu AT. Nurse practitioner and physician end-of-life home visits and end-of-life outcomes. BMJ Support Palliat Care 2023:spcare-2023-004392. [PMID: 37979954 DOI: 10.1136/spcare-2023-004392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/13/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVES Physicians and nurse practitioners (NPs) play critical roles in supporting palliative and end-of-life care in the community. We examined healthcare outcomes among patients who received home visits from physicians and NPs in the 90 days before death. METHODS We conducted a retrospective cohort study using linked data of adult home care users in Ontario, Canada, who died between 1 January 2018 and 31 December 2019. Healthcare outcomes included medications for pain and symptom management, emergency department (ED) visits, hospitalisations and a community-based death. We compared the characteristics of and outcomes in decedents who received a home visit from an NP, physician and both to those who did not receive a home visit. RESULTS Half (56.9%) of adult decedents in Ontario did not receive a home visit from a provider in the last 90 days of life; 34.5% received at least one visit from a physician, 3.8% from an NP and 4.9% from both. Compared with those without any visits, having at least one home visit reduced the odds of hospitalisation and ED visits, and increased the odds of receiving medications for pain and symptom management and achieving a community-based death. Observed effects were larger in patients who received at least one visit from both. CONCLUSIONS Beyond home care, receiving home visits from primary care providers near the end of life may be associated with better outcomes that are aligned with patients' preferences-emphasising the importance of NPs and physicians' role in supporting people near the end of life.
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Affiliation(s)
- Mary M Scott
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Amy Ramzy
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Sarina Roslyn Isenberg
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Colleen Webber
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Anan Bader Eddeen
- ICES uOttawa, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Maya Murmann
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Roshanak Mahdavi
- ICES uOttawa, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Claire E Kendall
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher Klinger
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Denise Marshall
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Aynharan Sinnarajah
- Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Lakeridge Health, Oshawa, Ontario, Canada
| | - David Ponka
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sandy Buchman
- Division of Palliative Care, Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Carol Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Simone Dahrouge
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathryn May
- Emergency Department, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Carrie Heer
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Dana Cooper
- Nurse Practitioners' Association, Toronto, Ontario, Canada
| | - Douglas Manuel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Amy T Hsu
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Bartsota M, Jowett V, Manuel D, Mortensen K, Wolfenden J, Marek J, Carvalho JS. Double aortic arch: implications of antenatal diagnosis, differential growth of arches during pregnancy, associated abnormalities and postnatal outcome. Ultrasound Obstet Gynecol 2023; 62:69-74. [PMID: 36864493 DOI: 10.1002/uog.26186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate the prenatal characteristics of double aortic arch (DAA), assess the relative size of the arches and their growth during pregnancy, describe associated cardiac, extracardiac and chromosomal/genetic abnormalities and review postnatal presentation and clinical outcome. METHODS This was a retrospective cohort study of all fetuses with a confirmed diagnosis of DAA seen in five specialized referral centers in London, UK, between October 2012 and November 2019. Cases were identified from the hospitals' fetal databases. Fetal echocardiographic findings, intracardiac and extracardiac abnormalities, genetic defects, computed tomography (CT) findings and postnatal clinical presentation and outcome were evaluated. RESULTS A total of 79 fetuses with DAA were included. Of those assessed postnatally, 48.6% had an atretic left aortic arch (LAA), while 5.1% had an atretic LAA at the first fetal scan and were misdiagnosed antenatally with right aortic arch (RAA). The LAA was atretic in 55.8% of those who underwent CT. DAA was an isolated abnormality in 91.1% of cases; 8.9% of patients had an additional intracardiac abnormality and 2.5% had both intra- and extracardiac abnormalities. Among the 52 cases that underwent genetic testing, 11.5% had genetic abnormalities and, specifically, the 22q11 microdeletion was identified in 3.8% of patients. At a median follow-up of 993.5 days, 42.5% of patients had developed symptoms of tracheoesophageal compression (5.5% during the first month after birth) and 56.2% had undergone intervention. Statistical analysis using the χ-square test showed no significant relationship between morphology of DAA (patency of both aortic arches vs atretic LAA) and the need for intervention (P = 0.134), development of vascular ring symptoms (P = 0.350) or evidence of airway compression on CT (P = 0.193). CONCLUSIONS Most cases of DAA can be diagnosed easily at midgestation, as typically both arches are patent with a dominant RAA at this stage. However, we found that the LAA had become atretic in approximately half of the cases postnatally, supporting the theory of differential growth of the arches during pregnancy. DAA is usually an isolated abnormality; however, thorough assessment is required to exclude associated intra- and extracardiac anomalies and to determine the need for invasive prenatal genetic testing. Postnatally, early clinical assessment is needed and CT scan should be considered, irrespective of the presence of symptoms. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Bartsota
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital, London, UK
| | - V Jowett
- Great Ormond Street Hospital, London, UK
| | - D Manuel
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital, London, UK
| | | | | | - J Marek
- Great Ormond Street Hospital, London, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - J S Carvalho
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Jessri M, Hennessey D, Bader Eddeen A, Bennett C, Sanmartin C, Manuel D. Mortality and Life Expectancy Lost in Canada Attributable to Dietary Patterns: Evidence From Canadian National Nutrition Survey Linked to Routinely Collected Health Administrative Databases. Am J Epidemiol 2023; 192:377-396. [PMID: 36288797 DOI: 10.1093/aje/kwac189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 07/18/2022] [Accepted: 10/18/2022] [Indexed: 11/14/2022] Open
Abstract
Using 5 diet quality indexes, we estimated the mortality and life expectancy lost, at the national level, attributable to poor dietary patterns, which had previously been largely unknown. We used the Canadian Community Health Survey 2004, linked to vital statistics (n = 16,212 adults; representing n = 22,898,880). After a median follow-up of 7.5 years, 1,722 deaths were recorded. Population attributable fractions were calculated to estimate the mortality burden of poor dietary patterns (Dietary Guidelines for Americans Adherence Index 2015, Dietary Approaches to Stop Hypertension, Healthy Eating Index, Alternative Healthy Eating Index, and Mediterranean Style Dietary Pattern Score). Better diet quality was associated with a 32%-51% and 21%-43% reduction in all-cause mortality among adults aged 45-80 years and ≥20 years, respectively. Projected life expectancy at 45 years was longer for Canadians adhering to a healthy dietary pattern (average of 5.2-8.0 years (men) and 1.6-4.1 (women)). At the population level, 26.5%-38.9% (men) and 8.9%-22.9% (women) of deaths were attributable to poor dietary patterns. Survival benefit was greater for individuals with higher scores on all diet indexes, even with relatively small intake differences. The large attributable burden was likely from assessing overall dietary patterns instead of a limited range of foods and nutrients.
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Yousef S, Papadimitropoulos M, Faris M, Hasan H, Hossain A, Colman I, Manuel D, Wells GA. Melanin levels in relation to vitamin D among first-generation immigrants from different ethnic groups and origins: A comparative national Canadian cross-sectional study. Front Med (Lausanne) 2023; 9:992554. [PMID: 36698822 PMCID: PMC9868151 DOI: 10.3389/fmed.2022.992554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction Immigrants to Western countries tend to have darker skin than native-born populations. We examined the relationship between skin melanin and serum vitamin D (vitD) [S-25(OH)D] levels and explored whether melanin levels explained S-25(OH)D variations between immigrants and native-born Canadians. This study offers novel findings as no such study has been conducted. Methods We used a national cross-sectional population-based design with data from the Canadian Health Measures Survey (CHMS). Skin melanin levels among first-generation immigrants based on their ethnicity and origin/country of birth were compared with white and native-born populations. We assessed the association between S-25(OH)D and melanin after adjusting for independent variables related to S-25(OH)D, melanin level, and immigration status. Results Of 11,579 participants, 21.9% were immigrants aged 3-79 years (mean age 39.23 years). Compared with non-immigrants, immigrants had lower S-25(OH)D levels (mean: 51.23 vs. 62.72; 95% CI: 8.37, 14.62; P < 0.001) but higher melanin levels (mean [SE]: 17.08 [0.25] vs. 16.29 [0.29]; 95% CI: -1.29, -0.281; P = 0.004). Melanin did not differ by length of stay in Canada but was weakly positively correlated (r = 0.088, P < 0.001) with S-25(OH)D. Sex (male), age (≥18 years), summer/fall seasons, sunlight exposure, sunscreen non-use, smoking, and alcohol consumption were associated with higher melanin levels, whereas indoor tanning use was not. Conclusion Skin melanin levels were associated with sociodemographic and behavioral characteristics. Immigrants had higher melanin levels, but melanin did not differ by length of stay in Canada. The weak positive correlation between melanin and S-25(OH)D suggested confounding factors may impact the relationship between melanin levels, S-25(OH)D, and immigration status.
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Affiliation(s)
- Said Yousef
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada,Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada,*Correspondence: Said Yousef,
| | - Manny Papadimitropoulos
- Eli Lilly Canada Inc., Toronto, ON, Canada,Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - MoezAlIslam Faris
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Hayder Hasan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Alomgir Hossain
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Douglas Manuel
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada,Ottawa Hospital Research Institute, Ottawa, ON, Canada,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - George A. Wells
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada,Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Li J, Mestre TA, Mollenhauer B, Frasier M, Tomlinson JJ, Trenkwalder C, Ramsay T, Manuel D, Schlossmacher MG. Evaluation of the PREDIGT score’s performance in identifying newly diagnosed Parkinson’s patients without motor examination. NPJ Parkinsons Dis 2022; 8:94. [PMID: 35906250 PMCID: PMC9338052 DOI: 10.1038/s41531-022-00360-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022] Open
Abstract
Several recent publications described algorithms to identify subjects with Parkinson’s disease (PD). In creating the “PREDIGT Score”, we previously developed a hypothesis-driven, simple-to-use formula to potentially calculate the incidence of PD. Here, we tested its performance in the ‘De Novo Parkinson Study’ (DeNoPa) and ‘Parkinson’s Progression Marker Initiative’ (PPMI); the latter included participants from the ‘FOllow Up persons with Neurologic Disease’ (FOUND) cohort. Baseline data from 563 newly diagnosed PD patients and 306 healthy control subjects were evaluated. Based on 13 variables, the original PREDIGT Score identified recently diagnosed PD patients in the DeNoPa, PPMI + FOUND and the pooled cohorts with area-under-the-curve (AUC) values of 0.88 (95% CI 0.83–0.92), 0.79 (95% CI 0.72–0.85), and 0.84 (95% CI 0.8–0.88), respectively. A simplified version (8 variables) generated AUC values of 0.92 (95% CI 0.89–0.95), 0.84 (95% CI 0.81–0.87), and 0.87 (0.84–0.89) in the DeNoPa, PPMI, and the pooled cohorts, respectively. In a two-step, screening-type approach, self-reported answers to a questionnaire (step 1) distinguished PD patients from controls with an AUC of 0.81 (95% CI 0.75–0.86). Adding a single, objective test (Step 2) further improved classification. Among seven biological markers explored, hyposmia was the most informative. The composite AUC value measured 0.9 (95% CI 0.88–0.91) in DeNoPa and 0.89 (95% CI 0.84–0.94) in PPMI. These results reveal a robust performance of the original PREDIGT Score to distinguish newly diagnosed PD patients from controls in two established cohorts. We also demonstrate the formula’s potential applicability to enriching for PD subjects in a population screening-type approach.
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Selim Y, Di Lena É, Abu-Omar N, Baig Z, Verhoeff K, La J, Purich K, Albacete S, Valji R, Purich K, Safar A, Schellenberg M, Schellenberg M, Schellenberg M, Schellenberg M, Schellenberg M, Schellenberg M, Daza J, Glass LT, Verhoeff K, Johnson G, Guidolin K, Glass LT, Balvardi S, Gawad N, McKechnie T, McKechnie T, Purich K, Henley J, Imbert E, Li C, Skinner S, Lenet T, Lenet T, Metz J, Ahn H(S, Do U, Rouhi A, Greenberg B, Muaddi H, Park L, Vogt K, Bradley N, Deng SX, Murphy P, Alhabboubi M, Lie J, Laplante S, Lie J, Drung J, Nixon T, Allard-Coutu A, Mansouri S, Lee A, Tweedy J, D’Elia MA, Hopkins B, Srivastava A, Alibhai K, Lee C, Moon J(J, How N, Spoyalo K, Lalande A, Baig Z, Schweitzer C, Keogh J, Huo B, Patel YS, Patel YS, Jogiat U, McGuire AL, Jogiat U, Lee Y, Barber E, Akhtar-Danesh GG, Bondzi-Simpson A, Bowker R, Ahmadi N, Abdul SA, Patel P, Harrison L, Shi G, Shi G, Alaichi JA, Kidane B, Qu LC, Alaichi J, Mackay E, Lee J, Purich K, Castelo M, Caycedo-Marulanda A, Caycedo-Marulanda 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Claasen M, Ivanics T, Gilbert R, Englesakis M, Gallinger S, Hansen B, Sapisochin G, Ivanics T, Claasen M, Gallinger S, Hansen B, Sapisochin G, Lenet T, Morin G, Abou-Khalil J, Balaa F, Martel G, Brind’Amour A, Bertens K, Balaa F, Bertens K, Martel G, Abou-Khalil J, Collin Y, Auer RC, Ivanics T, Toso C, Adam R, Ijzermans J, Sapisochin G, Polak W, Léveillé M, Lawson C, Collin Y, Tai LH, Phang T, Greene B, Jayaraman S, Tsang M, Al-Arnawoot A, Rajendran L, Lamb T, Turner A, Reid M, Rekman J, Mimeault R, Hopkins J, Abou-Khalil J, Bertens K, Martel G, Balaa F, Zhang C, Lemke M, Glinka J, Leslie K, Skaro A, Tang E, Hopkins J, Greene B, Tsang M, Jayaraman S, Bubis L, Jayaraman S, Tsang ME, Ganescu O, Vanounou T, Pelletier JS, Greene B, Levin Y, Tsang M, Jayaraman S, Ganescu O, Pelletier JS, Vanounou T, Choi WJ, Muaddi H, Ivanics T, Classen MP, Sapisochin G, Alam A, Caminsky N, Mansouri S, Lagace P, Lagace P, El-Kefraoui C, Mainprize M, Melland-Smith M, Verhoeff K, Verhoeff K, Nasser K, Mailloux O, Purich K, Whyte M, Li T, Ahmad MS, Sun W, Ahn H(S, Lee Y, Roach E, Chow A, Trac J, He W, Ramji K, Kouzmina E, Koziak C, Hossain I, Mocanu V, Hanna N, Castelo M, Pook M, Zuckerman J, Choi WJ, Watanabe A, Saravana-Bawan B, Cyr D, Brackstone M, Ivankovic V, Nair AG, Hirpara D, Stockley C, Ng D, Luu S, Meloche-Dumas L, D’Elia MA, Eom A, Tang K, Khan S, Schmitz E, Chen KT, Newman-Bremang J, Verhoeff K, Jette N, Mir Z, Griffiths C, Rajendran L, Zuckerman J, Choi WJ, Choi WJ, Gilbert R, Lenet T, Amhis N, Claasen M, Mansouri S, Workewych A, Lee A, Waugh E, Zhu A, Nabavian H, Roldan J, Lagrotteria A, Roldan J, Rajendran L, Safa N, Rahman S, Kaneva P, Feldman L, Baig Z, Ginther N, Gill D, Sarwar Z, Verdiales C, Moser M, Mocanu V, Fang B, Dang J, Sun W, Switzer N, Birch D, Karmali S, Alqaydi A, Wei X, Digby G, Brogly S, Merchant S, Verhoeff K, Miles A, Kung JY, Shapiro AJ, Bigam DL, Matkin A, Dumestre D, Peiris L, Turner S, Verhoeff K, Mador B, McLennan S, Jastaniah A, Owattanapanich N, Grigorian A, Lam L, Nahmias J, Inaba K, Liasidis P, Inaba K, Demetriades D, Benjamin ER, Cowan S, Owattanapanich N, Wong MD, Inaba K, Demetriades D, Owattanapanich N, Emigh B, Karavites L, Clark DH, Lam L, Inaba K, Benjamin ER, Owattanapanich N, Inaba K, Demetriades D, Anderson GA, Owattanapanich N, Cheng V, Lam L, Inaba K, Myers L, Cuthbertson B, Myles P, Shulman M, Wijeysundera D, Murphy PB, Allen L, Minkhorst K, Bowker D, Tang ES, Leslie K, Hawel JE, Ma O, Purich K, Skinner S, Dhaliwal R, Strickland M, Park J, Vergis A, Gillman L, Rivard J, Lin J, Zorigtbaatar A, Nadeem M, Ibrahim T, Neilson Z, Kim KY(P, Rajendran L, Chadi S, Quereshy F, Davidson M, Friedrich E, Champion C, Semsar-Kazerooni K, Kaneva P, Mueller C, Vassiliou M, Al Mahroos M, Fiore J, Schwartzman K, Feldman L, Purich K, Verhoeff K, Anderson B, Daniel R, Kruse C, Levin M, Lee Y, Doumouras A, Hong D, Eskicioglu C, Povolo C, Lee J, Lee Y, Park L, Doumouras A, Hong D, Bhandari M, Eskicioglu C, Lee E, Verhoeff K, Sydora D, Turner S, Strickland M, Boone D, Roberts S, McGrouther D, Manuel P, Dykstra M, Wang H, Snelgrove R, Verhoeff K, Purich K, Perry T, Strickland M, Dhaliwal R, Skanes S, Tropiano J, McIsaac D, Tinmouth A, Hallet J, Nicholls S, Fergusson D, Martel G, Tropiano J, Skanes S, Ivankovic V, McIsaac D, Tinmouth A, Patey A, Fergusson D, Martel G, Naqvi R, Noppens R, Hawel J, Elnahas A, Schlachta C, Alkhamesi N, Lenet T, Gilbert R, Mallick R, Shaw J, McIsaac D, Martel G, Pook M, Najafi T, Rajabiyazdi F, El-Kefraoui C, Balvardi S, Barone N, Elhaj H, Nguyen-Powanda P, Lee L, Baldini G, Feldman L, Fiore J, Purich K, Jogiat U, Mapiour D, Kim M, Nadler A, Stukel T, De Mestral C, Nathens A, Pautler S, Shayegan B, Hanna W, Schlachta C, Breau R, Hopkins L, Jackson T, Karanicolas P, Griffiths C, Ali S, Archer V, Cloutier Z, Choi D, McKechnie T, Serrano P, McClure JA, Jones P, Mrkobrada M, Flier S, Welk B, Dubois L, Khwaja K, Allen L, Tung L, Hameed M, Spoyalo K, Lampron J, Garcia-Ochoa C, Jastaniah A, Engels P, Talwar G, Cloutier Z, Minor S, Moffat B, Parry N, Vogt K, Ebeye T, Sharma BT, Samman A, Zulfiqar A, Purzner RH, Greene B, Tsang M, Jayaraman S, Allen L, Ball CG, Hameed M, Engels P, Nenshi R, Widder S, Minor S, Parry N, Bradley N, Moffat B, Vogt K, Liberman S, Wong E, Chughtai T, Turner J, Wiseman S, Li J, Mak N, Namazi B, Kiani P, Hashimoto D, Alseidi A, Pasten M, Brunt LM, Gill S, Davis B, Bloom M, Pernar L, Okrainec A, Madani A, Hamilton T, Nabata K, Zhang JW, Zhao D, Dawe P, Hameed M, Allen L, Leslie K, Drung J, Purich K, Verhoeff K, Skinner S, Dhaliwal R, Strickland M, Heller B, Wright V, Cho W, Wong M, Singh K, Comeau É, Collin Y, Oviedo SC, Rajendran L, Lamb T, Reid M, Turner A, Bertens K, Rekman J, Balaa F, Neumann K, Porter G, Teo I, Forse CL, Musselman R, Grozman L, Alshawan N, Fraser S, Bergman S, Pelletier JS, Vanounou T, Wong EG, Nolan B, Qiao L, Jung J, Raîche I, McDonald H, Gawad N, Cheifetz R, Hawley P, Rehany Z, Bakhshi M, Razek T, Grushka J, Boulanger N, 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S, Caycedo-Marulanda A, Booth C, Bankhead C, Heneghan C, Zhang L, Flemming J, Djerboua M, Nanji S, Caycedo-Marulanda A, Merchant S, Patel S, Demian M, Sabboobeh S, Moon J, Hulme-Moir M, Liberman AS, Feinberg S, Hayden DM, Chadi SA, Demyttenaere S, Samuel L, Hotakorzian N, Quintin L, Morin N, Ghitulescu G, Faria J, Vasilevsky CA, Boutros M, Mckechnie T, Khamar J, Ichhpuniani S, Eskicioglu C, Patel S, Merchant S, Caycedo-Marulanda A, Bankhead C, Heneghan C, Govind S, Lee J, Lee Y, Hong D, Eskicioglu C, Lu J, Khamar J, Lee Y, Amin N, Hong D, Eskicioglu C, Cardenas L, Schep D, Doumouras A, Hong D, Wong R, Levine O, Eskicioglu C, Mueller C, Stein B, Charlebois P, Liberman S, Fried G, Feldman L, Wang A, Liberman S, Charlebois P, Stein B, Fiore JF, Feldman L, Lee L, Wang A, Liberman S, Charlebois P, Stein B, Fiore JF, Feldman L, Lee L, Barkun A, Levy J, Bogdan R, Hawel J, Elnahas A, Alkhamesi NA, Schlachta CM, Caycedo-Marulanda A, Iaboni N, Hurlbut D, Kaufmann M, Ren KYM, Jamzad A, Mousavi P, Fichtinger G, Nicol CJ, Rudan JF, Brennan K, Caycedo-Marulanda A, Merchant S, McClintock C, Patel SV, McClintock C, Bankhead C, Merchant S, Caycedo-Marulanda A, Booth C, Heneghan C, Zhang L, Huo B, Donaldson A, Flemming J, Nanji S, Caycedo-Marulanda A, Merchant S, Brogly S, Patel S, Lenet T, Park L, Murthy S, Musselman R, McKechnie T, Lee J, Biro J, Lee Y, Park L, Doumouras A, Hong D, Eskicioglu C, Singh H, Helewa R, Reynolds K, Sibley K, Doupe M, Brennan K, Flemming J, Nanji S, Merchant S, Djerboua M, Caycedo-Marulanda A, Patel S, Johnson G, Hochman D, Helewa R, Garfinkle R, Dell’Aniello S, Zelkowitz P, Vasilevsky CA, Brassard P, Boutros M, Zoughlami A, Abibula W, Amar A, Ghitulescu G, Vasilevsky CA, Brassard P, Boutros M, Araji T, Pang A, Vasilevsky CA, Boutros M, Ehlebracht A, Faria J, Ghitulescu G, Morin N, Pang A, Vasilevsky CA, Boutros M, Robitaille S, Oliver M, Charlebois P, Stein B, Liberman S, Feldman LS, Lee L, Kennedy E, Victor C, Govindarajan A, Zhang L, Brennan K, Djerboua M, Nanji S, Merchant SJ, Caycedo-Marulanda A, Flemming J, Robitaille S, Penta R, Pook M, Fiore JF, Feldman L, Lee L, Wong-Chong N, Marinescu D, Bhatnagar S, Morin N, Ghitulescu G, Vasilevsky CA, Faria J, Boutros M, Arif A, Ladua G, Bhang E, Brown C, Donellan F, Stuart H, Loree J, Patel S, Zhang L, MacDonald PH, Merchant S, Barnett KW, Caycedo-Marulanda A, Brown C, Karimuddin A, Stuart H, Ghuman A, Phang T, Raval M, Yoon HM, Fragoso G, Oliero M, Calvé A, Rendos HV, Gonzalez E, Brereton NJ, Cuisiniere T, Gerkins C, Djediai S, Annabi B, Diop K, Routy B, Laplante P, Cailhier JF, Taleb N, Alratrout H, Dagbert F, Loungnarath R, Sebajang H, Schwenter F, Wassef R, Ratelle R, Debroux E, Richard C, Santos MM, Hamad D, Alsulaim H, Monton O, Marinescu D, Pang A, Vasilevsky CA, Boutros M, Marinescu D, Alqahtani M, Pang A, Ghitulescu G, Vasilevsky CA, Boutros M, Marinescu D, Garfinkle R, Boutros M, Zwiep T, Greenberg J, Lenet T, Musselman R, Williams L, Raiche I, McIsaac D, Thavorn K, Fergusson D, Moloo H, Charbonneau J, Paré X, Frigault J, Letarte F, Ott M, Karanicolas P, Brackstone M, Ashmalla S, Weaver J, Tagalakis V, Boutros M, Stotland P, Caycedo-Marulanda A, Moloo H, Jayaraman S. 2022 Canadian Surgery Forum Sept. 15–17, 202201. 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The impact of the COVID-19 pandemic on general surgery residency: an analysis of operative volumes by residents at a Canadian general surgery residency program40. Postoperative care protocols for elderly emergency surgical patients: a quality improvement initiative42. Adverse events following robotic compared to laparoscopic and open surgery: a population-based analysis43. Is accrual higher for patients randomized to pragmatic v. exploratory randomized clinical trials? A systematic review and meta-analysis44. Effect of preoperative proton-pump inhibitor use on postoperative infectious and renal complications after elective general surgery45. The early burden of COVID-19 in emergency general surgery care across Canada46. Laparoscopic subtotal cholecystectomy for the difficult gallbladder: evolution of technique at a single teaching hospital and retrospective review47. The demand for emergency general surgery in Canada: a public health crisis48. Attitudes of Canadian general surgery staff and residents toward point-of-care ultrasound49. Psychological impact of COVID-19 on Canadian surgical residents50. Validation of an artificial intelligence platform for the guidance of safe laparoscopic cholecystectomy51. Predictors of recurrent appendicitis after nonoperative management: a prospective cohort study52. The effect of the first wave of the COVID-19 pandemic on colorectal and hepatobiliary oncologic outcomes at a tertiary care centre53. Trends in training and workforce representation for Canadian general surgeons working in critical care: a descriptive study54. White presentation: teaching safe opioid prescription and opioid use disorder management in Canadian universities56. How bad is really bad, eh? Impact of the first wave of the COVID-19 pandemic on residents’ operative volume: the experience of a Canadian general surgery program57. Surgeon-specific encounters within a multidisciplinary care pathway: Is there a role for shared care models in surgery?59. A pan-Canadian analysis of approach to treatment for acute appendicitis60. Appendix neoplasm stratified by age: understanding the best treatment for appendicitis61. Predicting acute cholecystitis on final pathology to prioritize surgical urgency: an evaluation of the Tokyo criteria and development of a novel predictive score62. Obesity is an independent predictor of acute renal failure after surgery64. Validation of a clinical decision-making assessment tool in general surgery65. Moral distress in the provision of palliative care delivery for surgical patients in British Columbia: lessons learned from the perspectives of general surgeons66. Delays in presentation and severity of illness predict adverse surgical outcomes among patients transferred from rural Indigenous communities for acute care surgery67. Remote video-based suturing education with smartphones (REVISE): a randomized controlled trial68. Modified Delphi consensus on appropriate use of laboratory investigations in acute care surgery patients72. Impacts of inpatient food at a tertiary care centre on patient satisfaction, nutrition and planetary health73. Racial disparities in health outcomes for oncological surgery in Canada75. Risk of recurrent laryngeal nerve injury from thyroidectomy is lower when intraoperative nerve monitoring (IONM) is used: an analysis of 17 688 patients from the NSQIP database01. The impact of the COVID-19 pandemic on non-smallcell lung cancer pathologic stage and presentation02. Screening criteria evaluation for expansion in pulmonary neoplasias (screen)03. Robotic-assisted lobectomy for early-stage lung cancer provides better patient-reported quality of life than video-assisted lobectomy: early results of the RAVAL trial04. Breathe Anew: designing and testing the feasibility of a novel intervention for lung cancer survivorship05. Learning objectives for thoracic surgery: developing a national standard for undergraduate medical education06. Plasma cell-free DNA as a point-of-care well-being biomarker for early-stage non-small-cell lung cancer patients07. Sarcopenia determined by skeletal muscle index predicts overall survival, disease-free survival and postoperative complications in resectable esophageal cancer: a systematic review and meta-analysis08. The short- and long-term effects of open v. minimally invasive thymectomy in myasthenia gravis patients: a systematic review and meta-analysis09. Optimizing opioid prescribing practices following minimally invasive lung resections through a structured quality improvement process10. Effects of virtual postoperative postdischarge care in patients undergoing lung resection during the COVID-19 pandemic11. Initiating Ethiopia’s first minimally invasive surgery program: a novel approach for collaborations in global surgical education12. Patient outcomes following salvage lung cancer surgery after definitive chemotherapy or radiation13. Replacing chest X-rays after chest tube removal with clinical assessment in postoperative thoracic surgery patients14. Updating the practice of thoracic surgery in Canada: a survey of the Canadian Association of Thoracic Surgeons15. The impact of COVID-19 on the diagnosis and treatment of lung cancer16. Development of a prediction model for survival time in esophageal cancer patients treated with resection17. The development and validation of a mixed reality thoracic surgical anatomy atlas18. Routine placement of feeding tubes should be avoided in esophageal cancer patients undergoing surgery19. Nodal count is no different during robotic segmentectomy compared with robotic lobectomy20. Point-of-care ultrasound-guided percutaneous biopsy of solid masses in the thoracic outpatient clinic: a safe, high-yield procedure to accelerate tissue diagnosis for patients with advanced thoracic malignancy21. Sarcopenia and modified frailty index are not associated with adverse outcomes after esophagectomy for esophageal cancer: a retrospective cohort study22. Near-infrared-guided segmental resection for lung cancer: an analysis of the learning curve23. Routine use of feeding jejunostomy tubes in patients undergoing esophagectomy for esophageal malignancy is safe and associated with low complication rates01. Ghost ileostomy versus loop ileostomy following total mesorectal excision for rectal cancer: a systematic review and meta-analysis02. Analysis of 100 consecutive colorectal cancers presenting at a Canadian tertiary care centre: delayed diagnosis and advanced disease03. Clinical delays and comparative outcomes in younger and older adults with colorectal cancer: a systematic review04. Recurrence rates of rectal cancer after transanal total mesorectal excision (taTME): a systematic review and meta-analysis05. Transanal total mesorectal excision for abdominoperineal resection (taTME-APR) is associated with poor oncological outcomes in rectal cancer patients: a word of caution from a multicentric Canadian cohort study06. Association between survival and receipt of recommended and timely treatment in locally advanced rectal cancer: a population-based study07. Trends and the impact of incomplete preoperative staging in rectal cancer08. Postoperative outcomes after elective colorectal surgery in patients with cirrhosis09. Bowel stimulation before loop ileostomy closure to reduce postoperative ileus: a multicentre, single-blinded, randomized controlled trial10. Recurrence following perineal rectosigmoidectomy ( Altemeier) with levatorplasty: a systematic review and meta-analysis11. Nonmodifiable risk factors and receipt of surveillance investigations following treatment of rectal cancer12. Safety and effectiveness of endoscopic full-thickness resection for the management of colorectal lesions: a systematic review and meta-analysis13. Impact of preoperative carbohydrate loading before colectomy: a systematic review and meta-analysis of randomized controlled trials14. Statin therapy in patients undergoing short-course neoadjuvant radiotherapy for rectal cancer15. Feasibility of targeted lymphadenectomy during complete mesocolic excision for colon cancer using indocyanine green immunofluorescence lymphatic mapping16. Feasibility of expanding an ambulatory colectomy protocol: a retrospective analysis of early discharge following minimally invasive colectomy in an enhanced recovery pathway17. Impact of rectal cancer on bowel dysfunction before treatment and its relationship with post-treatment function18. Canadian cost–utility analysis of artificial-intelligence-assisted colonoscopy for adenoma detection in fecal immunochemical-based colorectal cancer screening19. A comparison of outcomes following intracorporeal and extracorporeal anastomotic techniques in laparoscopic right colectomies20. Assessment of metabolic signatures using desorption electrospray ionization mass spectrometry (DESI) and rapid evaporative ionization mass spectrometry (REIMS) of rectal cancer samples to assist in determining treatment response21. The association between hospital characteristics and minimally invasive rectal cancer surgery: a population-based study22. Cancer centre level designation and the impact on treatment and outcomes in those with rectal cancer: a population-based study23. Oncological outcomes after colorectal cancer in patients with liver cirrhosis: a systematic review and meta-analysis24. Optimal preoperative nutrition for penetrating Crohn disease: a systematic review and meta-analysis25. Lymph node ratio as a predictor of survival for colon cancer: a systematic review and meta-analysis26. Barriers and facilitators for use of new recommendations for optimal endoscopic localization of colorectal neoplasms according to gastroenterologists and surgeons27. Emergency colorectal surgery in patients with cirrhosis: a population-based descriptive study28. Local recurrence rates and associated risk factors after transanal endoscopic microsurgery for benign polyps and adenocarcinomas29. Bowel dysfunction impacts mental health after restorative proctectomy for rectal cancer30. Evolution of psychological morbidity following restorative proctectomy for rectal cancer: a systematic review and meta-analysis31. Frailty predicts LARS and quality of life in rectal cancer survivors after restorative proctectomy32. Low anterior resection syndrome in a reference North American population: prevalence and predictive factors33. The evolution of enhanced recovery: same day discharge after laparoscopic colectomy34. Effect of ERAS protocols on length of stay after colorectal surgery: an interrupted time series analysis35. Practice patterns and outcomes in individuals with cirrhosis and colorectal cancer: a population-based study36. Understanding the impact of bowel function on quality of life after rectal cancer surgery37. Right-sided colectomies for diverticulitis have worse outcomes compared with left-sided colectomies38. Symptom burden and time from symptom onset to cancer diagnosis in patients with early-onset colorectal cancer39. The impact of access to robotic rectal surgery at a tertiary care centre: a Canadian perspective40. Management of rectal neuroendocrine tumours by transanal endoscopic microsurgery41. The gut microbiota modulates colorectal anastomotic healing in patients undergoing surgery for colorectal cancer42. Is there added risk of complications for concomitant procedures during an ileocolic resection for Crohn disease?43. Cost of stoma-related hospital readmissions for rectal cancer patients following restorative proctectomy with a diverting loop ileostomy: a nationwide readmissions database analysis44. Older age associated with quality of rectal cancer care: an ACS-NSQIP database study45. Outcomes of patients undergoing elective bowel resection before and after implementation of an anemia screening and treatment program47. Loop ileostomy closure as a 23-hour stay procedure: a randomized controlled trial48. Extended duration perioperative thromboprophylaxis with low-molecular-weight heparin to improve disease-free survival following surgical resection of colorectal cancer: a multicentre randomized controlled trial (PERIOP-01 Trial)49. Three-stage versus modified 2-stage ileal pouch anal anastomosis: perioperative outcomes, function and quality of life50. Compliance with extended venous thromboembolism prophylaxis in rectal cancer51. Extended-duration venous thromboembolism prophylaxis after diversion in rectal cancer52. Financial and occupational impact of low anterior resection syndrome: a qualitative study53. Nonoperative management for rectal cancer: patient perspectives54. Trends in ileostomy-related emergency department visits for rectal cancer patients55. Long-term implications of treatment of fecal incontinence: a single Canadian centre’s retrospective cohort study: a 17-year follow-up56. Externally benchmarking colorectal resection outcomes in our province against the ACS NSQIP risk calculator: identifying opportunities for improvement57. Externally benchmarking our provincial colectomy outcomes against the ACS NSQIP using the Codman Score: to identify possible opportunities for improvement of outcomes58. Rural v. urban documentation of recommended practices for optimal endoscopic colorectal lesion localization01. Incidence of in-hospital opioid use and pain after inguinal hernia repair02. Ventral hernia repair following liver transplantation: outcome of repair techniques and risk factors for recurrence01. Impact of the COVID-19 pandemic on bariatric surgery in North America: a retrospective analysis of 834 647 patients02. Patient selection and 30-day outcomes of SADI-S compared to RYGB: a retrospective cohort study of 47 375 patients03. New persistent opioid use following bariatric surgery: a systematic review and pooled proportion meta-analysis04. Bariatric surgery should be offered to active-duty military personnel: a retrospective study of the Canadian Armed Forces experience05. Opioid prescribing practices and use following bariatric surgery: a systematic review and pooled summary of data06. Sacred sharing circles: urban Indigenous Manitobans’ experiences with bariatric surgery07. Gastrogastric hernia after laparoscopic gastric great curve plication: a video presentation08. Characterization of comorbidities predictive of bariatric surgery09. Efficacy of preoperative high-dose liraglutide in patients with superobesity10. The effect of linear stapled gastrojejunostomy size in Roux-en-Y gastric bypass11. Fragility of statistically significant outcomes in randomized trials comparing bariatric surgeries12. Weight loss outcomes for patients undergoing conversion to Roux-en-Y gastric bypass after sleeve gastrectomy13. Are long waiting lists for bariatric surgery detrimental to patients? A single-centre experience14. Does upper gastrointestinal swallow study after bariatric surgery lead to earlier detection of leak?15. Pharmaceutical utilization before and after bariatric surgery16. Same-day discharge Roux-en-Y gastric bypass at a Canadian bariatric centre: pathway implementation and early experiences17. Safety and efficiency of performing primary bariatric surgery at an ambulatory site of a tertiary care hospital: a 5-year experience18. Impact of psychiatric diagnosis on weight loss outcomes 3 years after bariatric surgery19. Ursodeoxycholic acid (UDCA) for prevention of gallstone disease after laparoscopic sleeve gastrectomy (LSG): an Atlantic Canada perspective20. Fecal microbial transplantation and fibre supplementation in patients with severe obesity and metabolic syndrome: a randomized double-blind, placebo-controlled phase 2 trial01. Incidence, timing and outcomes of venous thromboembolism in patients undergoing surgery for esophagogastric cancer: a population-based cohort study04. Omission of axillary staging and survival in elderly women with early-stage breast cancer: a population-based cohort study05. Patients’ experiences receiving cancer surgery during the COVID-19 pandemic: a qualitative study06. Cancer surgery outcomes are better at high-volume centres07. Attitudes of Canadian colorectal cancer care providers toward liver transplantation for colorectal liver metastases: a national survey08. Quality of narrative central and lateral neck dissection reports for thyroid cancer treatment suggests need for a national standardized synoptic operative template09. Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications and technique10. Temporal trends in lymph node assessment as a quality indicator in colorectal cancer patients treated at a high-volume Canadian centre11. Molecular landscape of early-stage breast cancer with nodal metastasis12. Beta testing of a risk-stratified patient decision aid to facilitate shared decision making for postoperative extended thromboprophylaxis in patients undergoing major abdominal surgery for cancer13. Breast reconstruction use and impact on oncologic outcomes among inflammatory breast cancer patients: a systematic review14. Association between patient-reported symptoms and health care resource utilization: a first step to develop patient-centred value measures in cancer care15. Complications after colorectal liver metastases resection in Newfoundland and Labrador16. Why do patients with nonmetastatic primary retroperitoneal sarcoma not undergo resection?17. Loss of FAM46Cexpression predicts inferior postresection survival and induces ion channelopathy in gastric adenocarcinoma18. Liver-directed therapy of neuroendocrine liver metastases19. Neoadjuvant pembrolizumab use in microsatellite instability high (MSI-H) rectal cancer: benefits of its use in lynch syndrome20. MOLLI for excision of nonpalpable breast lesions: a case series22. Patients awaiting mastectomy report increased depression, anxiety, and decreased quality of life compared with patients awaiting lumpectomy for treatment of breast cancer23. Is microscopic margin status important in retroperitoneal sarcoma (RPS) resection? A systematic review and meta-analysis24. Absence of benefit of routine surveillance in very-low-risk and low-risk gastric gastrointestinal stromal tumors25. Effect of intraoperative in-room specimen radiography on margin status in breast-conserving surgery26. Active surveillance for DCIS of the breast: qualitative interviews with patients and physicians01 Outcomes following extrahepatic and intraportal pancreatic islet transplantation: a comparative cohort study02. Cholang-funga-gitis03. Evaluating the effect of a low-calorie prehepatectomy diet on perioperative outcomes: a systematic review and meta-analysis04. Toxicity profiles of systemic therapy for advanced hepatocellular carcinoma: a systematic review to guide neoadjuvant trials05. Should cell salvage be used in liver resection and transplantation? A systematic review and meta-analysis06. The association between surgeon and hospital variation in use of laparoscopic liver resection and short-term outcomes07. Systematic review and meta-analysis of prognostic factors for early recurrence in intrahepatic cholangiocarcinoma after curative-intent resection08. Impact of neoadjuvant chemotherapy on postoperative outcomes of patients undergoing hepatectomy for intrahepatic cholangiocarcinoma: ACS-NSQIP propensity-matched analysis09. The impact of prophylactic negative pressure wound therapy on surgical site infections in pancreatic resection: a systematic review and meta-analysis10. Does hepatic pedicle clamping increase the risk of colonic anastomotic leak after combined hepatectomy and colectomy? Analysis of the ACS NSQIP database11. Development of a culture process to grow a full-liver tissue substitute12. Liver transplantation for fibrolamellar hepatocellular carcinoma: an analysis of the European Liver Transplant Registry13. Arming beneficial viruses to treat pancreatic cancer14. Hepaticoduodenostomy versus hepaticojenunostomy for biliary reconstruction: a retrospective review of a single-centre experience15. Feasibility and safety of a “shared care” model in complex hepatopancreatobiliary surgery: a 5-year analysis of pancreaticoduodenectomy16. Laparoscopic v. open pancreaticoduodenectomy: initial institutional experience and NSQIP-matched analysis17. Laparoscopic spleen-preserving distal pancreatectomy: Why not do a Warshaw?18. The impact of COVID-19 on pancreaticoduodenectomy outcomes in a high-volume hepatopancreatobiliary centre19. Transitioning from open to minimally invasive pancreaticoduodenectomy: the learning curve factor in an academic centre20. Closed-incision negative-pressure wound therapy following pancreaticoduodenectomy for prevention of surgical site infections in high-risk patients21. Robotic Appleby procedure for recurrent pancreatic cancer22. The influence of viral hepatitis status on posthepatectomy complications in patients with hepatocellular carcinoma: a NSQIP analysis. Can J Surg 2022. [DOI: 10.1503/cjs.014322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Yousef S, Hayawi L, Manuel D, Colman I, Papadimitropoulos M, Hossain A, Faris MA, Wells GA. Assessment of the quality and content of clinical practice guidelines (CPGs) for vitamin D and for immigrants using the AGREE-II instrument: a protocol for systematic review. Syst Rev 2022; 11:245. [PMID: 36397107 PMCID: PMC9673290 DOI: 10.1186/s13643-022-02129-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Worldwide, more immigrants experience vitamin D (vitD) deficiency than non-immigrants, which is attributed to ethnic variations, place or region of birth, skin pigmentation, clothing style, and resettlement-related changes in diet, physical activity, and sun exposure. Current recommendations in clinical practice guidelines (CPGs) concerning vitD are inadequate to address vitD deficiency among immigrants. CPGs may also lack guidance for physicians on vitD supplementation for immigrants. Moreover, there are concerns about the overall quality of these CPGs. OBJECTIVES This systematic review will collate and critically appraise CPGs relevant to immigrants' health and vitD. Moreover, we will evaluate whether the CPGs of vitD including recommendations for immigrants and clarify whether the CPGs of immigrants include recommendations on vitD. METHODS A systematic search of Ovid MEDLINE® ALL, EMBASE, and Turning Research Into Practice (TRIP) electronic databases, guideline repositories, and gray literature will be conducted to identify relevant CPGs. Two reviewers will independently evaluate the methodological quality of the retrieved guidelines using the Appraisal of Guidelines, Research, and Evaluation-II (AGREE-II) instrument. CPGs scoring ≥60% in at least four domains, including "rigor of development," will be considered high quality. CONCLUSION Evaluating the quality and content of relevant CPGs may support researchers in developing national and global guidelines for immigrants. Furthermore, it may support vitD testing, nutritional counseling, and supplementation for vulnerable immigrant sub-populations. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021240562.
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Affiliation(s)
- Said Yousef
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada. .,Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Room H1281, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada.
| | - Lamia Hayawi
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Douglas Manuel
- Ottawa Hospital Research Institute, Ottawa, Canada.,Institute for Clinical Evaluative Sciences, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Manny Papadimitropoulos
- Eli Lilly Canada Inc., Toronto, Canada.,Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Alomgir Hossain
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Institute for Clinical Evaluative Sciences, Ottawa, Canada
| | - Moez AlIslam Faris
- Department of Clinical Nutrition and Dietetics, College of Health Sciences/Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, UAE
| | - George A Wells
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Room H1281, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
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Jessri M, Hennessy D, Eddeen AB, Bennett C, Garriguet D, Sanmartin C, Manuel D. Linkage of the nationally representative Canadian Community Health Survey - Nutrition 2004 to routinely collected mortality records. Health Rep 2022; 33:11-20. [PMID: 36153710 DOI: 10.25318/82-003-x202200900002-eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The Canadian Community Health Survey (CCHS) - Nutrition 2004 (n=35,107; interview dates from January 2004 to January 2005) linked to the Canadian Vital Statistics - Death Database (CVSD) (2011) represents a novel linkage of a population-based, nationally representative nutrition survey with routinely collected mortality records (including date and cause of death). The linkage was done through individual tax data in Canada, and contains longitudinal records for 29,897 Canadians aged 0 years and older-1,753 of whom died-in the 10 provinces of Canada. The median follow-up time was 7.49 years, with 102,953 person-years among males and 114,876 person-years among females (unweighted), and included a special sampling survey weight (for linked data) to account for those who did not agree to share and link their information. The CCHS - Nutrition 2004 linked to CVSD has been used to evaluate associations between lifestyle and sociodemographic characteristics and mortality. Using these data, statistical methods have been developed and tested to control random and systematic measurement errors when evaluating the relationship between different dietary exposures (evaluated using repeated 24-hour dietary recalls) and health outcomes. The linked data are available through Statistics Canada's Research Data Centres.
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Affiliation(s)
- Mahsa Jessri
- Food, Nutrition and Health Program, University of British Columbia
- Centre for Health Services and Policy Research, University of British Columbia
- Health Analysis Division, Statistics Canada, Ottawa, Ontario
| | | | | | - Carol Bennett
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario
- Clinical Epidemiology Program, Ottawa Hospital Research Institute
| | | | | | - Douglas Manuel
- Health Analysis Division, Statistics Canada, Ottawa, Ontario
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario
- Clinical Epidemiology Program, Ottawa Hospital Research Institute
- Department of Family Medicine, University of Ottawa
- C.T. Lamont Primary Health Care Research Centre Program, Bruyère Research Institute, Ottawa, Ontario, Canada
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Kendzerska T, Zhu DT, Pugliese M, Manuel D, Sadatsafavi M, Povitz M, Stukel TA, To T, Aaron SD, Mulpuru S, Chin M, Kendall CE, Thavorn K, Robillard R, Gershon AS. Trends in all-cause mortality and inpatient and outpatient visits for ambulatory care sensitive conditions during the first year of the COVID-19 pandemic: A population-based study. J Hosp Med 2022; 17:726-737. [PMID: 35929531 PMCID: PMC9539068 DOI: 10.1002/jhm.12920] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The impact of the COVID-19 pandemic on the management of ambulatory care sensitive conditions (ACSCs) remains unknown. OBJECTIVES To compare observed and expected (projected based on previous years) trends in all-cause mortality and healthcare use for ACSCs in the first year of the pandemic (March 2020 to March 2021). DESIGN, SETTING AND PARTICIPANTS We conducted a population-based study using provincial health administrative data on general adul population (Ontario, Canada). OUTCOMES AND MEASURES Monthly all-cause mortality, and hospitalizations, emergency department (ED) and outpatient visit rates (per 100,000 people at-risk) for seven combined ACSCs (asthma, chronic obstructive pulmonary disease, angina, congestive heart failure, hypertension, diabetes, and epilepsy) during the first year were compared with similar periods in previous years (2016-2019) by fitting monthly time series autoregressive integrated moving-average models. RESULTS Compared to previous years, all-cause mortality rates increased at the beginning of the pandemic (observed rate in March to May 2020 of 79.98 vs. projected of 71.24 [66.35-76.50]) and then returned to expected in June 2020-except among immigrants and people with mental health conditions where they remained elevated. Hospitalization and ED visit rates for ACSCs remained lower than projected throughout the first year: observed hospitalization rate of 37.29 versus projected of 52.07 (47.84-56.68); observed ED visit rate of 92.55 versus projected of 134.72 (124.89-145.33). ACSC outpatient visit rates decreased initially (observed rate of 4299.57 vs. projected of 5060.23 [4712.64-5433.46]) and then returned to expected in June 2020.
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Affiliation(s)
- Tetyana Kendzerska
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
- ICESOntarioCanada
| | - David T. Zhu
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of Social and Behavioral SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Michael Pugliese
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- ICESOntarioCanada
| | - Douglas Manuel
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- ICESOntarioCanada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical SciencesThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Marcus Povitz
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Therese A. Stukel
- ICESOntarioCanada
- Sunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoOntarioCanada
| | - Teresa To
- ICESOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Research InstituteThe Hospital of Sick ChildrenTorontoOntarioCanada
| | - Shawn D. Aaron
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Sunita Mulpuru
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Melanie Chin
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Claire E. Kendall
- ICESOntarioCanada
- Bruyère Research InstituteOttawaOntarioCanada
- Department of Family MedicineUniversity of OttawaOttawaOntarioCanada
| | - Kednapa Thavorn
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- ICESOntarioCanada
- School of Epidemiology and Public Health, Faculty of MedicineUniversity of OttawaOntarioCanada
| | | | - Andrea S. Gershon
- ICESOntarioCanada
- Sunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Research InstituteThe Hospital of Sick ChildrenTorontoOntarioCanada
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
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Harrison L, Mahar A, Coburn N, Boyes R, Pugliese M, Compton C, Darling G, Davis L, Decker K, Gupta V, Kidane B, Manuel D, Ringash J, Turner D, Hsu A. Development of a Prediction Model for Survival Time in Esophageal Cancer Patients Treated with Resection. Int J Popul Data Sci 2022. [PMCID: PMC9645026 DOI: 10.23889/ijpds.v7i3.2097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Jessri M, Eddeen AB, Hennessy D, Bernstein J, Sanmartin C, Bennett C, Manuel D. Development and validation of a cardiovascular disease risk-prediction model using population health surveys and dietary indices: the Cardiovascular Disease Population Risk Tool – Nutrition (CVDPoRT-Nutrition). Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.2102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
ObjectivesOnly a few cardiovascular risk prediction models have been developed based on modifiable exposures and even fewer utilize complex dietary factors. Our objective was to develop and validate the Cardiovascular Disease Population Risk Tool (CVDPoRT)-Nutrition as a tool for estimating 5-year risk of incident cardiovascular disease (CVD) using lifestyle factors and dietary pattern scores.
ApproachThe CVDPoRT developed and validated using the Canadian Community Health Survey (CCHS) linked with health administrative databases was modified to remove limited measures of dietary intakes (i.e., fruit and vegetable, potato, and juice intake frequency) and instead incorporate 5 different dietary pattern scores (i.e., Dietary Guidelines for Americans Adherence Index, Dietary Approaches to Stop Hypertension, Healthy Eating Index, Alternative HEI, and Mediterranean Style Dietary Pattern Score). Outcome data (i.e., CVD events and CVD-related mortality) came from linkage with the Canadian Vital Statistics – Death Database and Discharge Abstract Database. CVDPoRT-Nutrition was tested in 61 policy-relevant subgroups.
ResultsPerformance after adding in each dietary pattern score was similar to the original CVDPoRT (Brier score=2.6%, Harrell’s c-stat=0.87(0.85-0.88) for female models; Brier score=1.6%, Harrell’s c-stat=0.82(0.81-0.84) for male models). The algorithm was calibrated in 53 (female models) and 57 (male models) of 61 policy relevant subgroups. The most important predictors of CVD and CVD-related mortality were age, sex, and smoking.
ConclusionAltering the dietary measures included in the CVDPoRT algorithm did not greatly improve the predictive capacity. The original CVDPoRT can continue to be used for predicting CVD and CVD-related mortality, while CVDPoRT-Nutrition may be used for predicting CVD incidence associated with poor dietary patterns.
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Murmann M, Manuel D, Tanuseputro P, Bennett C, Pugliese M, Roberts R, Li W, Hsu AT. Care trajectory in homes care users across mortality-risk profiles: an observational study. Int J Popul Data Sci 2022. [PMCID: PMC9644737 DOI: 10.23889/ijpds.v7i3.1847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Hsu AT, Espadero C, Tanuseputro P, Bennett C, Beach S, Roberts R, Manuel D. Using routinely collected data to develop and evaluate a clinical tool for early identification of palliative care needs in long-term care: The RESPECT Project. Int J Popul Data Sci 2022. [PMCID: PMC9644852 DOI: 10.23889/ijpds.v7i3.1858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Yousef S, Colman I, Papadimitropoulos M, Manuel D, Hossain A, Faris M, Wells GA. Vitamin D and Chronic Diseases among First-Generation Immigrants: A Large-Scale Study Using Canadian Health Measures Survey (CHMS) Data. Nutrients 2022; 14:nu14091760. [PMID: 35565728 PMCID: PMC9099619 DOI: 10.3390/nu14091760] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Nearly 22% of the Canadian population are first-generation immigrants. We investigated immigrants’ health status and health deterioration over time in terms of the prevalence of chronic diseases (CDs) and their relationship to vitD status. Methods: We used cycles three (2012–2013) and four (2014–2015) of the Canadian Health Measures Survey. These data contained unique health information and direct physical/blood measures, including serum 25-hydroxyvitamin D (S-25(OH)D). Indicators of health status and deterioration were the prevalence of CDs diagnosed by healthcare professionals, self-reported general and mental health, and CD-related biomarkers. Results: The data (n = 11,579) included immigrants from more than 153 countries. Immigrants were healthier than non-immigrants for most health status measures. The prevalence of CDs was higher among those who migrated to Canada aged ≥ 18 years. A longer time in Canada after immigration was associated with a higher risk for CDs. The mean S-25(OH)D was lower among immigrants, higher among patients with CDs, and inversely associated with glycated hemoglobin, total cholesterol/high-density lipoprotein ratio, immunoglobulin E, serum ferritin, and blood hemoglobin. After adjusting for covariates, no association was found between S-25(OH)D and the prevalence of CDs. Conclusions: Lower levels of accumulated S-25(OH)D among immigrants may impact their health profile in terms of CD-related biomarkers, which partially explains immigrants’ health deterioration over time. We recommend further longitudinal research to investigate immigrants’ vitD and health deterioration.
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Affiliation(s)
- Said Yousef
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada; (I.C.); (A.H.); (G.A.W.)
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
- Correspondence:
| | - Ian Colman
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada; (I.C.); (A.H.); (G.A.W.)
| | - Manny Papadimitropoulos
- Eli Lilly Canada Inc., Toronto, ON M5X 1B1, Canada;
- Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada
| | - Douglas Manuel
- Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada;
- Institute for Clinical Evaluative Sciences, Ottawa, ON K1Y 4E9, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Alomgir Hossain
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada; (I.C.); (A.H.); (G.A.W.)
- Institute for Clinical Evaluative Sciences, Ottawa, ON K1Y 4E9, Canada
| | - MoezAlIslam Faris
- Department of Clinical Nutrition and Dietetics, Research Institute of Medical and Health Sciences (RIMHS), College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates;
| | - George A. Wells
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada; (I.C.); (A.H.); (G.A.W.)
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
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18
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Kitano T, Brown KA, Daneman N, MacFadden DR, Langford BJ, Leung V, So M, Leung E, Burrows L, Manuel D, Bowdish DME, Maxwell CJ, Bronskill SE, Brooks JI, Schwartz KL. The Impact of COVID-19 on Outpatient Antibiotic Prescriptions in Ontario, Canada; An Interrupted Time Series Analysis. Open Forum Infect Dis 2021; 8:ofab533. [PMID: 34805442 PMCID: PMC8601042 DOI: 10.1093/ofid/ofab533] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/27/2021] [Indexed: 01/21/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has potentially impacted outpatient antibiotic prescribing. Investigating this impact may identify stewardship opportunities in the ongoing COVID-19 period and beyond. Methods We conducted an interrupted time series analysis on outpatient antibiotic prescriptions and antibiotic prescriptions/patient visits in Ontario, Canada, between January 2017 and December 2020 to evaluate the impact of the COVID-19 pandemic on population-level antibiotic prescribing by prescriber specialty, patient demographics, and conditions. Results In the evaluated COVID-19 period (March–December 2020), there was a 31.2% (95% CI, 27.0% to 35.1%) relative reduction in total antibiotic prescriptions. Total outpatient antibiotic prescriptions decreased during the COVID-19 period by 37.1% (95% CI, 32.5% to 41.3%) among family physicians, 30.7% (95% CI, 25.8% to 35.2%) among subspecialist physicians, 12.1% (95% CI, 4.4% to 19.2%) among dentists, and 25.7% (95% CI, 21.4% to 29.8%) among other prescribers. Antibiotics indicated for respiratory infections decreased by 43.7% (95% CI, 38.4% to 48.6%). Total patient visits and visits for respiratory infections decreased by 10.7% (95% CI, 5.4% to 15.6%) and 49.9% (95% CI, 43.1% to 55.9%). Total antibiotic prescriptions/1000 visits decreased by 27.5% (95% CI, 21.5% to 33.0%), while antibiotics indicated for respiratory infections/1000 visits with respiratory infections only decreased by 6.8% (95% CI, 2.7% to 10.8%). Conclusions The reduction in outpatient antibiotic prescribing during the COVID-19 pandemic was driven by less antibiotic prescribing for respiratory indications and largely explained by decreased visits for respiratory infections.
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Affiliation(s)
- Taito Kitano
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Kevin A Brown
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Nick Daneman
- Public Health Ontario, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Derek R MacFadden
- ICES, Toronto, Ontario, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Valerie Leung
- Public Health Ontario, Toronto, Ontario, Canada.,Toronto East Health Network, Michael Garron Hospital, Toronto, Ontario, Canada
| | - Miranda So
- Sinai Health System-University Health Network Antimicrobial Stewardship Program, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Leung
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Unity Health Toronto, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Lori Burrows
- Department of Biochemistry and Biomedical Sciences and the Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
| | - Douglas Manuel
- ICES, Toronto, Ontario, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Dawn M E Bowdish
- Michael DeGroote Institute for Infectious Disease Research, McMaster Immunology Research Centre, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Colleen J Maxwell
- ICES, Toronto, Ontario, Canada.,Schools of Pharmacy and Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Women's College Hospital, Toronto, Ontario, Canada
| | - James I Brooks
- Public Health Agency of Canada, Ottawa, Ontario, Canada.,Division of Infectious Diseases, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin L Schwartz
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Unity Health Network, St. Joseph Health Centre, Toronto, Ontario, Canada
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19
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Wang JL, Eccles H, Schmitz N, Patten SB, Lashewicz B, Manuel D. The impact of providing personalized depression risk information on self-help and help-seeking behaviors: Results from a mixed methods randomized controlled trial. Depress Anxiety 2021; 38:917-924. [PMID: 34196445 DOI: 10.1002/da.23192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To evaluate the impact of providing personalized depression risk information on self-help and help-seeking behaviors among individuals who are at high risk of having a major depressive episode (MDE). MATERIALS AND METHODS In a mixed methods randomized controlled trial, participants who were at high risk of having a MDE, were recruited from across Canada, and were randomized into intervention (n = 358) and control (n = 354) groups. Participants in the intervention group received their personalized depression risk estimated by sex-specific risk prediction models for MDE. All participants were assessed at baseline, 6 and 12 months. RESULTS Repeated measure mixed effects modeling showed significant between group differences in self-help scores. In the complete case analysis, the between group difference in mean self-help change score was 1.13 at 12 months (effect size = 0.16). Among participants who reported "fair" or "poor health," the between group difference in mean self-help change score was 2.78 at 12 months (effect size = 0.35). The qualitative data revealed three themes and the findings are consistent with the quantitative results. CONCLUSIONS Providing personalized depression risk information has a positive impact on self-help in high-risk individuals, particularly in those with poor health.
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Affiliation(s)
- Jian Li Wang
- Work & Mental Health Research Unit, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Heidi Eccles
- Work & Mental Health Research Unit, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Norbert Schmitz
- Department of Psychiatry, Faculty of MedicineMcG, McGill University, Montreal, Quebec, Canada.,Department of Population-Based Medicine, Institute of Health Sciences, University Hospital Tuebingen, Tuebingen, Germany
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary., Calgary, Alberta, Canada
| | - Bonnie Lashewicz
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary., Calgary, Alberta, Canada
| | - Douglas Manuel
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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20
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Yousef S, Manuel D, Colman I, Papadimitropoulos M, Hossain A, Faris M, Wells GA. Vitamin D Status among First-Generation Immigrants from Different Ethnic Groups and Origins: An Observational Study Using the Canadian Health Measures Survey. Nutrients 2021; 13:2702. [PMID: 34444863 PMCID: PMC8400966 DOI: 10.3390/nu13082702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 12/15/2022] Open
Abstract
One in five Canadians are first-generation immigrants. Evidence suggests the baseline risk for vitamin D (vitD) deficiency is increased among immigrants who move from equatorial to northern countries. We investigated the prevalence and determinants of vitD deficiency/insufficiency among first-generation immigrants compared with native-born Canadians and identified explanatory covariables. We used a cross-sectional design with data from the national Canadian Health Measures Survey (Cycles 3 and 4) (11,579 participants aged 3-79 years). We assessed serum 25-hydroxyvitamin D (S-25(OH)D) levels, sociodemographic and environmental factors, immigration status, length of time in Canada, vitD-rich food intake, ethnicity, and place of birth. Immigrants had lower mean S-25(OH)D than non-immigrants (51.23 vs. 62.72 nmol/L, p < 0.001). Those with younger age at the time of immigration (<18 years) had a high risk for low vitD, and S-25(OH)D levels increased with the length of time they had lived in Canada. The highest deficiency levels were in immigrants born in Morocco, India, and Lebanon compared with native-born Canadians. Ethnicity was the factor most strongly associated with S-25(OH)D. Compared with the white ethnic grouping, the Japanese had the highest level of vitD deficiency, followed by Arabs and Southeast Asians. Ethnic variations, dietary intake, and lifestyle factors are the main predictors of/explanatory factors for vitD status among Canadian immigrants.
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Affiliation(s)
- Said Yousef
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (I.C.); (A.H.); (G.A.W.)
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Douglas Manuel
- Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada;
- Institute for Clinical Evaluative Sciences, Ottawa, ON K1Y 4E9, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (I.C.); (A.H.); (G.A.W.)
| | - Manny Papadimitropoulos
- Eli Lilly Canada Inc., Toronto, ON M5X 1B1, Canada;
- Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada
| | - Alomgir Hossain
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (I.C.); (A.H.); (G.A.W.)
- Institute for Clinical Evaluative Sciences, Ottawa, ON K1Y 4E9, Canada
| | - MoezAlIslam Faris
- Department of Clinical Nutrition and Dietetics, College of Health Sciences/Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah 27272, United Arab Emirates; or
| | - George A. Wells
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (I.C.); (A.H.); (G.A.W.)
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
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21
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D'Aoust PM, Graber TE, Mercier E, Montpetit D, Alexandrov I, Neault N, Baig AT, Mayne J, Zhang X, Alain T, Servos MR, Srikanthan N, MacKenzie M, Figeys D, Manuel D, Jüni P, MacKenzie AE, Delatolla R. Catching a resurgence: Increase in SARS-CoV-2 viral RNA identified in wastewater 48 h before COVID-19 clinical tests and 96 h before hospitalizations. Sci Total Environ 2021. [PMID: 33508669 DOI: 10.1016/j.scitotenv.2021.145319l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Curtailing the Spring 2020 COVID-19 surge required sweeping and stringent interventions by governments across the world. Wastewater-based COVID-19 epidemiology programs have been initiated in many countries to provide public health agencies with a complementary disease tracking metric and non-discriminating surveillance tool. However, their efficacy in prospectively capturing resurgences following a period of low prevalence is unclear. In this study, the SARS-CoV-2 viral signal was measured in primary clarified sludge harvested every two days at the City of Ottawa's water resource recovery facility during the summer of 2020, when clinical testing recorded daily percent positivity below 1%. In late July, increases of >400% in normalized SARS-CoV-2 RNA signal in wastewater were identified 48 h prior to reported >300% increases in positive cases that were retrospectively attributed to community-acquired infections. During this resurgence period, SARS-CoV-2 RNA signal in wastewater preceded the reported >160% increase in community hospitalizations by approximately 96 h. This study supports wastewater-based COVID-19 surveillance of populations in augmenting the efficacy of diagnostic testing, which can suffer from sampling biases or timely reporting as in the case of hospitalization census.
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Affiliation(s)
- Patrick M D'Aoust
- Department of Civil Engineering, University of Ottawa, Ottawa K1N 6N5, Canada
| | - Tyson E Graber
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada
| | - Elisabeth Mercier
- Department of Chemical Engineering, University of Ottawa, K1N 6N5, Canada
| | - Danika Montpetit
- Department of Chemical Engineering, University of Ottawa, K1N 6N5, Canada
| | - Ilya Alexandrov
- ActivSignal LLC., 27 Strathmore Rd., Natick, MA 01760, United States
| | - Nafisa Neault
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada
| | - Aiman Tariq Baig
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada
| | - Janice Mayne
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa K1H 8M5, Canada
| | - Xu Zhang
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa K1H 8M5, Canada
| | - Tommy Alain
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada; Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa K1H 8M5, Canada
| | - Mark R Servos
- Department of Biology, University of Waterloo, Waterloo N2L 3G1, Canada
| | | | - Malcolm MacKenzie
- ActivSignal LLC., 27 Strathmore Rd., Natick, MA 01760, United States
| | - Daniel Figeys
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa K1H 8M5, Canada; Department of Chemistry and Biomolecular Sciences, University of Ottawa, Ottawa K1N 6N5, Canada; Canadian Institute for Advanced Research, Toronto M5G 1M1, Canada
| | - Douglas Manuel
- Department of Family Medicine, University of Ottawa, Ottawa K1H 8M5, Canada
| | - Peter Jüni
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto M5T 3M6, Canada
| | - Alex E MacKenzie
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada
| | - Robert Delatolla
- Department of Civil Engineering, University of Ottawa, Ottawa K1N 6N5, Canada.
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22
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D'Aoust PM, Graber TE, Mercier E, Montpetit D, Alexandrov I, Neault N, Baig AT, Mayne J, Zhang X, Alain T, Servos MR, Srikanthan N, MacKenzie M, Figeys D, Manuel D, Jüni P, MacKenzie AE, Delatolla R. Catching a resurgence: Increase in SARS-CoV-2 viral RNA identified in wastewater 48 h before COVID-19 clinical tests and 96 h before hospitalizations. Sci Total Environ 2021; 770:145319. [PMID: 33508669 PMCID: PMC7826013 DOI: 10.1016/j.scitotenv.2021.145319] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/17/2021] [Accepted: 01/17/2021] [Indexed: 04/14/2023]
Abstract
Curtailing the Spring 2020 COVID-19 surge required sweeping and stringent interventions by governments across the world. Wastewater-based COVID-19 epidemiology programs have been initiated in many countries to provide public health agencies with a complementary disease tracking metric and non-discriminating surveillance tool. However, their efficacy in prospectively capturing resurgences following a period of low prevalence is unclear. In this study, the SARS-CoV-2 viral signal was measured in primary clarified sludge harvested every two days at the City of Ottawa's water resource recovery facility during the summer of 2020, when clinical testing recorded daily percent positivity below 1%. In late July, increases of >400% in normalized SARS-CoV-2 RNA signal in wastewater were identified 48 h prior to reported >300% increases in positive cases that were retrospectively attributed to community-acquired infections. During this resurgence period, SARS-CoV-2 RNA signal in wastewater preceded the reported >160% increase in community hospitalizations by approximately 96 h. This study supports wastewater-based COVID-19 surveillance of populations in augmenting the efficacy of diagnostic testing, which can suffer from sampling biases or timely reporting as in the case of hospitalization census.
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Affiliation(s)
- Patrick M D'Aoust
- Department of Civil Engineering, University of Ottawa, Ottawa K1N 6N5, Canada
| | - Tyson E Graber
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada
| | - Elisabeth Mercier
- Department of Chemical Engineering, University of Ottawa, K1N 6N5, Canada
| | - Danika Montpetit
- Department of Chemical Engineering, University of Ottawa, K1N 6N5, Canada
| | - Ilya Alexandrov
- ActivSignal LLC., 27 Strathmore Rd., Natick, MA 01760, United States
| | - Nafisa Neault
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada
| | - Aiman Tariq Baig
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada
| | - Janice Mayne
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa K1H 8M5, Canada
| | - Xu Zhang
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa K1H 8M5, Canada
| | - Tommy Alain
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada; Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa K1H 8M5, Canada
| | - Mark R Servos
- Department of Biology, University of Waterloo, Waterloo N2L 3G1, Canada
| | | | - Malcolm MacKenzie
- ActivSignal LLC., 27 Strathmore Rd., Natick, MA 01760, United States
| | - Daniel Figeys
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa K1H 8M5, Canada; Department of Chemistry and Biomolecular Sciences, University of Ottawa, Ottawa K1N 6N5, Canada; Canadian Institute for Advanced Research, Toronto M5G 1M1, Canada
| | - Douglas Manuel
- Department of Family Medicine, University of Ottawa, Ottawa K1H 8M5, Canada
| | - Peter Jüni
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto M5T 3M6, Canada
| | - Alex E MacKenzie
- Children's Hospital of Eastern Ontario Research Institute, Ottawa K1H 8L1, Canada
| | - Robert Delatolla
- Department of Civil Engineering, University of Ottawa, Ottawa K1N 6N5, Canada.
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23
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Funnell S, Walker J, Letendre A, Bearskin RLB, Manuel D, Scott M, Spruin S, Tanuseputro P. Places of death and places of care for Indigenous Peoples in Ontario: a retrospective cohort study. Can J Public Health 2021; 112:685-696. [PMID: 34008135 DOI: 10.17269/s41997-021-00482-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 01/25/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Most people, including Indigenous people in Ontario, wish to die in their communities. How often Indigenous people in Ontario die in their preferred settings is unknown. This study aims to describe the places of care and death for Indigenous people in Ontario who received provincially funded home care services. METHODS We conducted a retrospective cohort study using linked health administrative databases housed at ICES. We used a population-based cohort of Indigenous and non-Indigenous people in Ontario who died between April 1, 2010 and March 31, 2015 to describe characteristics of people, places of death, and places of care. RESULTS Indigenous decedents were on average 8.8 years younger, had more chronic diseases, and lived in lower income neighbourhoods compared with their non-Indigenous counterparts. Indigenous decedents spent nearly 8 more days in acute care in the last year of life and more died in acute care (56.1% versus 46.1%). When controlling for covariates, Indigenous decedents received 1.9 fewer home care nursing hours and 5 fewer personal support worker hours and showed decreased odds (OR 0.72) of receiving a palliative physician visit in the last 90 days of life. Among Indigenous decedents, a palliative physician visit lowered odds of dying in acute care by 50% and total days in acute care by 18%. CONCLUSION Our study identified a gap in end-of-life care for Indigenous Peoples in Ontario receiving provincially funded home care. Without continued efforts to address challenges that perpetuate health inequalities, we expect many Indigenous people will continue to die in acute care away from their people, families, and culturally relevant supports.
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Affiliation(s)
- Sarah Funnell
- Department of Family Medicine, Queen's University, 220 Bagot Street, Kingston, ON, K7L 3G2, Canada.
| | | | - Angeline Letendre
- Canadian Indigenous Nurses Association (CINA), Ottawa, Ontario, Canada
| | | | - Douglas Manuel
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Statistics Canada, Ottawa, Ontario, Canada.,C.T. Lamont Primary Health Care Research Centre, Ottawa, Ontario, Canada
| | | | | | - Peter Tanuseputro
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada
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24
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Batista R, Prud'homme D, Rhodes E, Hsu A, Talarico R, Reaume M, Guérin E, Bouchard L, Desaulniers J, Manuel D, Tanuseputro P. Quality and Safety in Long-Term Care in Ontario: The Impact of Language Discordance. J Am Med Dir Assoc 2021; 22:2147-2153.e3. [PMID: 33434567 DOI: 10.1016/j.jamda.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study compared quality indicators across linguistic groups and sought to determine whether disparities are influenced by resident-facility language discordance in long-term care. DESIGN Population-based retrospective cohort study using linked databases. SETTING AND PARTICIPANTS Retrospective cohort of newly admitted residents of long-term care facilities in Ontario, Canada, between 2010 and 2016 (N=47,727). Individual residents' information was obtained from the Resident Assessment Instrument Minimum Data Set (RAI-MDS) to determine resident's primary language, clinical characteristics, and health care indicators. MEASURES Main covariates of interest were primary language of the resident and predominant language of the long-term care facility, which was determined using the French designation status as defined in the French Language Services Act. Primary outcomes were a set of quality and safety indicators related to long-term care: worsening of depression, falls, moderate-severe pain, use of antipsychotic medication, and physical restraints. Multivariable logistic regression models were used to assess the impact of resident's primary language, facility language, and resident-facility language discordance on each quality indicator. RESULTS Overall, there were few differences between francophones and anglophones for quality and safety indicators. Francophones were more likely to report pain (10.9% vs 9.9%; P = .001) and be physically restrained (7.3% vs 5.2%; P < .001), whereas a greater proportion of anglophones experienced worsening of depressive symptoms (24.0% vs 22.9%; P = .001). However, quality indicators were generally worse for francophones in Non-Designated facilities, except for pain, which was more commonly reported by francophones in French-Designated facilities. Anglophones were more likely to be physically restrained in French-Designated facilities (6.7% vs 5.1%; P < .001). CONCLUSIONS AND IMPLICATIONS For francophones, quality indicators tended to be worse in the presence of resident-facility language discordance. However, these findings did not persist after adjusting for individual- and facility-level characteristics, suggesting that the disparities observed at the population level cannot be attributed to linguistic factors alone.
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Affiliation(s)
- Ricardo Batista
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; ICES, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Denis Prud'homme
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; Hôpital Montfort, Sport Medicine Clinic, Ottawa, Ontario, Canada; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Emily Rhodes
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Amy Hsu
- ICES, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Elizabeth Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Robert Talarico
- ICES, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael Reaume
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Eva Guérin
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; Hôpital Montfort, Sport Medicine Clinic, Ottawa, Ontario, Canada
| | - Louise Bouchard
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; School of Social and Anthropological Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Jacinthe Desaulniers
- Réseau des services de santé en français de l'Est de l'Ontario, Ottawa, Ontario, Canada
| | - Douglas Manuel
- ICES, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- ICES, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Elizabeth Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Selim S, Kunkel E, Wegier P, Tanuseputro P, Downar J, Isenberg SR, Li A, Kyeremanteng K, Manuel D, Kobewka DM. A systematic review of interventions aiming to improve communication of prognosis to adult patients. Patient Educ Couns 2020; 103:1467-1497. [PMID: 32284167 DOI: 10.1016/j.pec.2020.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Our objective was to describe interventions that aim to improve communication of prognosis to adult patients and to summarize the effect of interventions. METHODS We included randomized controlled trials of interventions that included prognosis delivery. We excluded studies of decision aids. Our analysis was a narrative synthesis of interventions and outcomes. RESULTS Our search identified 1151 unique records. After screening, and full text review we included 21 reports from 17 RCTs. Only 2 studies used a prediction model to generate prognostic estimates. Four studies used education, ten used patient mediated interventions, and 2 used coordination of care. In some studies education that includes prognosis improves patient reported outcomes, communication and treatment decisions, patient mediated interventions can increase the number of questions patients ask about prognosis. Coordination of care may improve satisfaction. CONCLUSIONS Education for clinicians that includes teaching about how to communicate prognosis may improve patient reported outcomes. Patient mediated interventions can increase the number of prognosis related questions asked by patients. PRACTICE IMPLICATIONS Communication skills training that includes training on delivering prognosis may improve communication and patient reported outcomes, but the evidence is uncertain. Giving patients question prompt lists can help them ask more prognosis related questions.
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Affiliation(s)
- Shehab Selim
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
| | - Elizabeth Kunkel
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
| | - Pete Wegier
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada; Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Canada; Department of Family & Community Medicine, University of Toronto, Toronto, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Peter Tanuseputro
- Department of Medicine, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada; Bruyere Research Institute, Ottawa, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - James Downar
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Sarina R Isenberg
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada; Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Canada; Department of Family & Community Medicine, University of Toronto, Toronto, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Aimee Li
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Kwadwo Kyeremanteng
- Department of Medicine, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada; Institut du Savoir Montfort, Ottawa, Canada
| | - Douglas Manuel
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Daniel M Kobewka
- Department of Medicine, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada.
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Warner E, Nannarone M, Smail-Crevier R, Manuel D, Lashewicz B, Patten S, Schmitz N, MacQueen G, Wang JL. The relationship between depression risk perception and self-help behaviours in high risk Canadians: a cross-sectional study. BMC Public Health 2020; 20:876. [PMID: 32505198 PMCID: PMC7276077 DOI: 10.1186/s12889-020-08983-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 05/24/2020] [Indexed: 12/21/2022] Open
Abstract
Background Self-help may reduce the risk of depression, and risk perception of depression may influence initiating self-help. It is unknown how risk perception is associated with self-help behaviours. The objectives of this study are to (1) describe the self-help strategies used by high-risk Canadians in relation to the accuracy of perceived depression risk, by sex, and (2) identify demographic and clinical factors associated with self-help behaviours. Methods Baseline data from a randomized controlled trial including 358 men and 356 women at high-risk of developing depression were used. Following methods used in cancer research, risk perception accuracy was determined by comparing the participant’s self-perceived and objective risk of developing depression and classifying as accurate, over-estimation and under-estimation based on a ± 10% threshold. The participant’s objective depression risk was assessed using sex-specific multivariable risk predictive algorithms. Frequency of using 14 self-help strategies was assessed. One-way ANOVA testing was used to detect if differences in risk perception accuracy groups existed, stratified by sex. Linear regression was used to investigate the clinical and demographic factors associated with self-help behaviours, also stratified. Results Compared to accurate-estimators, male over-estimators were less likely to “leave the house daily,” and “participate in activities they enjoy.” Male under-estimators were also less likely to “participate in activities they enjoy.” Both male ‘inaccurate’ perception groups were more likely to ‘create lists of strategies which have worked for feelings of depression in the past and use them’. There were no significant differences between self-help behaviours and risk perception accuracy in women. Regression modeling showed negative relationships between self-rated health and self-help scores, irrespective of sex. In women, self-help score was positively associated with age and educational attainment, and negatively associated with perceived risk. In men, a positive relationship with unemployment was also seen. Conclusions Sex differences exist in the factors associated with self-help. Risk perception accuracy, work status, and self-rated health is associated with self-help behaviours in high-risk men. In women, factors related to self-help included age, education, self-rated health status, and perceived risk. More research is needed to replicate findings. Trial registration Prospectively registered at ClinicalTrials.gov (NCT02943876) as of 10/21/16.
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Affiliation(s)
- Emily Warner
- The Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
| | - Molly Nannarone
- The Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
| | | | - Douglas Manuel
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Bonnie Lashewicz
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Norbert Schmitz
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Canada
| | - Glenda MacQueen
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jian Li Wang
- The Institute of Mental Health Research, University of Ottawa, Ottawa, Canada. .,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
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Wang J, Smail-Crevier R, Nannarone M, Manuel D, MacQueen G, Patten SB, Lashewicz B, Schmitz N. The accuracy of depression risk perception in high risk Canadians. J Affect Disord 2020; 265:410-415. [PMID: 32090767 DOI: 10.1016/j.jad.2020.01.099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/21/2019] [Accepted: 01/20/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Prevention and early detection of depression is a top public health priority. Accurate perception of depression risk may play an important role in health behavior change and prevention of depression. However, the way in which people in the community perceive their risk of developing depression is currently unknown. METHODS We analyzed the baseline data from a randomized controlled trial in 358 men and 356 women who are at high risk of having a major depressive episode (MDE). The predicted risk was assessed by sex-specific multivariable risk predictive algorithms for MDE. We compared participants' perceived risk and their predicted risk. Accurate risk perception was defined as perceived risk is in the range of predicted risk ± 10%. RESULTS In men, 29.7% perceived their risk accurately; 47.5% overestimated their risk; 22.8% underestimated their risk. In women, the proportions were 21.7%, 59.6% and 18.7%, respectively. Compared to men, women were more likely to overestimate their risk and less likely to be accurate. Regression modeling revealed that poor self-rated health and higher predicted depression risk were associated with inaccuracy of risk perception in men; a family history of MDE, higher psychological distress and lower predicted risk were associated with inaccuracy of risk perception in women. CONCLUSIONS Individuals who are at high risk of developing depression tend to overestimate their risk, especially women. Inaccurate depression risk perception is related to people's health status. Educational interventions are needed to enhance the accuracy of risk perception to encourage positive behavior change and uptake of preventive strategies.
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Affiliation(s)
- JianLi Wang
- The Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Rachel Smail-Crevier
- The Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Molly Nannarone
- The Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Douglas Manuel
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Glenda MacQueen
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott B Patten
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Bonnie Lashewicz
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Norbert Schmitz
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Canada
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Tsampalieros A, Fergusson D, Dixon S, English SW, Manuel D, Van Walraven C, Taljaard M, Knoll GA. The Effect of Transplant Volume and Patient Case Mix on Center Variation in Kidney Transplantation Outcomes. Can J Kidney Health Dis 2019; 6:2054358119875462. [PMID: 31565233 PMCID: PMC6755637 DOI: 10.1177/2054358119875462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/26/2019] [Indexed: 01/06/2023] Open
Abstract
Background Kidney transplantation is the optimal treatment for patients with end-stage renal disease; however, long-term outcomes remain suboptimal. Objective The objectives of our study were to examine the variation in survival rates and determine whether center volume and case mix are associated with transplant outcomes and explain the variation across kidney transplant centers in Ontario, Canada. Design This was a population-based cohort study using health care administrative databases. Setting A total of 5 transplant centers across Ontario, Canada. Patients We included adults (≥18 years) undergoing primary, solitary kidney transplantation between January 1, 2000 to December 31, 2013. Measurements The co-primary outcomes were death-censored graft loss and total mortality. Methods Multivariable Cox proportional hazards regression was used to assess potential associations and describe variation, using hazard ratios (HRs) with 95% confidence intervals (CIs) for each center relative to the average across all centers. Results The study cohort included 5037 patients followed for a median of 5.3 years, interquartile range (2.7-8.6). In multivariable models, recipient age, body mass index, Charlson Index, time on dialysis, donor type, and age were found to be significantly associated with death-censored graft loss, and recipient age and sex, Charlson Index, time on dialysis, donor age, and time era of transplant were associated with total mortality. There was statistically significant variation across centers observed for death-censored graft loss (P = .04) with HRs ranging from 0.72 to 1.22. However, neither adjusting for case mix nor center volume meaningfully changed the HRs reflecting each center-specific effect. There was a tendency toward reduced risk of graft loss (HR, per additional 25 patients, 0.90 [95% CI, 0.78-1.04]) in centers with higher volumes. For total mortality, there was statistically significant variation across centers with HRs ranging from 0.82 to 1.13 (P = .04); however, neither adjusting for case mix or center volume meaningfully changed the HRs. Center volume was not significantly associated with total mortality (HR, per additional 25 patients, 1.04 [95% CI, 0.90-1.20]). Limitations This study was limited by the small number of centers included. Conclusions Outcomes differ across the 5 transplant centers in Ontario. We did not find any strong support for our hypotheses that case mix or center volume is responsible for these differences.
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Affiliation(s)
- Anne Tsampalieros
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, ON, Canada.,Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, ON, Canada
| | - Stephanie Dixon
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.,Institute for Clinical Evaluative Sciences, London, ON, Canada
| | - Shane W English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, ON, Canada.,Department of Medicine (Critical Care), University of Ottawa, ON, Canada
| | - Douglas Manuel
- Department of Family Medicine, University of Ottawa, ON, Canada
| | - Carl Van Walraven
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, ON, Canada.,Department of Medicine, University of Ottawa, ON, Canada.,Institute for Evaluative Sciences, Toronto, ON, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, ON, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, ON, Canada
| | - Greg A Knoll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, ON, Canada.,Division of Nephrology, Kidney Research Center, Department of Medicine, University of Ottawa, ON, Canada
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Wang J, MacQueen G, Patten S, Manuel D, Lashewicz B, Schmitz N. A randomized controlled trial to examine the impacts of disclosing personalized depression risk information on the outcomes of individuals who are at high risk of developing major depression: a research protocol. BMC Psychiatry 2019; 19:285. [PMID: 31533691 PMCID: PMC6749687 DOI: 10.1186/s12888-019-2270-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/03/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Major depressive disorder is one of the most prevalent and disabling forms of mental illness in the general population. One public health strategy that may reduce the disease burden is early identification and prevention - identifying people who are at high risk and intervening to prevent symptoms from progressing into a major depressive episode (MDE). Multivariable risk predictive algorithms (MVRP) have been developed to estimate personalized risk (probability) of an MDE. The purpose of this trial is to answer the questions: (1) Does disclosure of personalized depression risk information promote high-risk individuals to take preventive actions? (2) Will disclosure of personalized depression risk information negatively affect the mental health of those at high risk? METHODS We are recruiting 350 high-risk men and 350 high-risk women across the country. Individuals are eligible, if they: (1) are 18 years or older, (2) have not had a depressive episode in the past two months, (3) are at high risk of MDE based on the MVRPs (predicted risk of 6.5% + for men and of 11.2% + for women), (4) can communicate in either English or French, and (5) agree to be contacted for follow-up interviews. The MVRPs were developed and validated using longitudinal data from over 10,000 Canadians across the country. Eligible participants are randomized into (1) the control group, and (2) the group receiving personalized depression risk information. The participants are assessed at baseline, 6 and 12 months regarding accuracy of risk perception, use of self-help strategies and changes in psychological distress and functioning. Qualitative interviews are conducted in sub-samples of the intervention groups to explore how the personalized information affects risk perception, self-help behaviors and mental health. DISCUSSION MVRPs can be used for risk stratification and planning preventive actions. The personalized risk information produced by MVRPs may also empower users to actively engage in self-management. This trial will contribute to the knowledge base about the potential health benefits and psychological harms associated with the provision of personalized depression risk information that will inform future implementation and patient-physician communication in the clinical settings. TRIAL REGISTRATION NCT02943876 . Date of trial registration: October 21st, 2016.
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Affiliation(s)
- JianLi Wang
- University of Ottawa Institute of Mental Health Research, University of Ottawa, Room 5404, 1145 Carling Ave, Ottawa, Ontario, K1Z 7K4, Canada.
| | - Glenda MacQueen
- 0000 0004 1936 7697grid.22072.35Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Scott Patten
- 0000 0004 1936 7697grid.22072.35Department of Community Health Sciences, Cumming School of School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Douglas Manuel
- 0000 0001 2182 2255grid.28046.38Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario Canada
| | - Bonnie Lashewicz
- 0000 0004 1936 7697grid.22072.35Department of Community Health Sciences, Cumming School of School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Norbert Schmitz
- 0000 0004 1936 8649grid.14709.3bDouglas Mental Health Institute, Department of Psychiatry, McGill University, Montreal, Quebec Canada
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Hiremath S, Ruzicka M, Petrcich W, McCallum MK, Hundemer GL, Tanuseputro P, Manuel D, Burns K, Edwards C, Bugeja A, Magner P, McCormick B, Garg AX, Rhodes E, Sood MM. Alpha-Blocker Use and the Risk of Hypotension and Hypotension-Related Clinical Events in Women of Advanced Age. Hypertension 2019; 74:645-651. [DOI: 10.1161/hypertensionaha.119.13289] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Alpha-blockers (ABs) are commonly prescribed as part of a multidrug regimen in the management of hypertension. We set out to assess the risk of hypotension and related adverse events with AB use compared with other blood pressure (BP) lowering drugs using a population-based, retrospective cohort study of women (≥66 years) between 1995 and 2015 in Ontario, Canada. Cox proportional hazards examined the association of AB use and hypotension and related events (syncope, fall, and fracture) compared with other BP lowering drugs matched via a high dimensional propensity score. The primary outcome was a composite of hospitalizations for hypotension and related events (syncope, fractures, and falls) within 1 year. From 734 907 eligible women, 14 106 were dispensed an AB (mean age, 75.7; standard deviation 6.9 years, median follow-up 1 year) and matched to 14 106 dispensed other BP lowering agents. The crude incidence rate of hypotension and related events was 95.7 (95% CI [confidence interval], 90.4–101.1, events 1214 [8.6%]) with AB and 79.8 (95% CI, 74.9–84.7 per 1000 person-years, events 1025 [7.3%]) with other BP lowering medications (incident rate ratio, 1.20; 95% CI, 1.10–1.30). The risk was higher for hypotension (hazard ratio, 1.71; 95% CI, 1.33–2.20) and syncope (hazard ratio, 1.44; 95% CI, 1.18–1.75) with no difference in falls, fractures, adverse cardiac events, or all-cause mortality. Treatment of hypertension in women with ABs is associated with a higher risk of hypotension and hypotension-related events compared with other BP lowering agents. Our findings suggest that ABs should be used with caution, even as add on therapy for hypertension.
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Affiliation(s)
- Swapnil Hiremath
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - Marcel Ruzicka
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - William Petrcich
- The Institute of Clinical Evaluative Sciences, ON, Canada (W.P., M.K.M., P.T., D.M., A.X.G., M.M.S.)
| | - Megan K. McCallum
- The Institute of Clinical Evaluative Sciences, ON, Canada (W.P., M.K.M., P.T., D.M., A.X.G., M.M.S.)
| | - Gregory L. Hundemer
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - Peter Tanuseputro
- The Institute of Clinical Evaluative Sciences, ON, Canada (W.P., M.K.M., P.T., D.M., A.X.G., M.M.S.)
| | - Douglas Manuel
- Kidney Research Centre, Ottawa Hospital Research Institute (D.M., K.B.), University of Ottawa, Canada
- The Institute of Clinical Evaluative Sciences, ON, Canada (W.P., M.K.M., P.T., D.M., A.X.G., M.M.S.)
| | - Kevin Burns
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
- Kidney Research Centre, Ottawa Hospital Research Institute (D.M., K.B.), University of Ottawa, Canada
| | - Cedric Edwards
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - Ann Bugeja
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - Peter Magner
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
- Bruyere Research Institute, the Ottawa Hospital, Canada (P.T.)
| | - Brendan McCormick
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - Amit X. Garg
- The Institute of Clinical Evaluative Sciences, ON, Canada (W.P., M.K.M., P.T., D.M., A.X.G., M.M.S.)
- Division of Nephrology, Western University, London, Canada (A.X.G.)
| | - Emily Rhodes
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - Manish M. Sood
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
- The Institute of Clinical Evaluative Sciences, ON, Canada (W.P., M.K.M., P.T., D.M., A.X.G., M.M.S.)
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Yousef S, Elliott J, Manuel D, Colman I, Papadimitropoulos M, Hossain A, Leclair N, Wells GA. Study protocol: Worldwide comparison of vitamin D status of immigrants from different ethnic origins and native-born populations-a systematic review and meta-analysis. Syst Rev 2019; 8:211. [PMID: 31439035 PMCID: PMC6706882 DOI: 10.1186/s13643-019-1123-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 07/26/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A growing body of literature indicates that, worldwide, immigrants experience health deterioration after their arrival into their adopted country, and moreover, they have lower vitamin D compared to the native-born population. We plan to review if the levels of vitamin D are comparable between different ethnic groups in different regions of the world with those of native-born populations and to identify the possible associations between vitamin D deficiency and disease status among immigrants. METHODS/DESIGN A systematic review and meta-analysis will be conducted following the methods of the Cochrane handbook for systematic reviews. A literature search was performed to identify studies on immigrants and vitamin D. The primary outcome is vitamin D levels, and the secondary outcome is any vitamin D deficiency-related disease. Study design and participant characteristics will be extracted, including ethnicity, country of birth and/or origin, and the host country. Descriptive and meta-analytic summaries of the outcomes will be derived. Distiller-SR and RevMan will be used respectively for data management and meta-analysis. DISCUSSION This systematic review may partially help clarify vitamin D-related health deterioration in migrants; moreover, to develop a global guideline that specifies sub-populations, in which the evidence and vitamin D-related recommendations might differ from the overall immigrant population. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018086729.
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Affiliation(s)
- Said Yousef
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada.
| | - Jesse Elliott
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Douglas Manuel
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Institute for Clinical Evaluative Sciences, Ottawa and Toronto, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Canadian Institutes of Health Research, Ottawa, ON, Canada
| | - Manny Papadimitropoulos
- Eli Lilly Canada Inc, Toronto, ON, Canada
- Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Alomgir Hossain
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Institute for Clinical Evaluative Sciences, Ottawa and Toronto, ON, Canada
| | - Nathalie Leclair
- Berkman Library, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - George A Wells
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Batista R, Prud'homme D, Hsu AT, Guérin E, Bouchard L, Rhodes E, Talarico R, Desaulniers J, Manuel D, Tanuseputro P. The Health Impact of Living in a Nursing Home With a Predominantly Different Spoken Language. J Am Med Dir Assoc 2019; 20:1649-1651. [PMID: 31351860 DOI: 10.1016/j.jamda.2019.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/02/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Ricardo Batista
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; ICES, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Denis Prud'homme
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; Hôpital Montfort, Ottawa, Ontario, Canada; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Amy T Hsu
- ICES, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Eva Guérin
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Louise Bouchard
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; School of Social and Anthropological Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Emily Rhodes
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert Talarico
- ICES, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jacinthe Desaulniers
- Réseau des services de santé en français de l'Est de l'Ontario, Ottawa, Ontario, Canada
| | - Douglas Manuel
- ICES, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- ICES, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Muldoon K, Smith G, Talarico R, Heimerl M, McLean C, Sampsel K, Manuel D. A 15-Year Population-Based Investigation of Sexual Assault Cases Across the Province of Ontario, Canada, 2002-2016. Am J Public Health 2019; 109:1280-1287. [PMID: 31318596 DOI: 10.2105/ajph.2019.305179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To estimate the population-level frequencies and standardized rates of sexual assault cases in the province of Ontario, Canada.Methods. We conducted a 15-year retrospective analysis (2002-2016) of sexual assault cases by linking 5 provincial administrative health databases. We defined sexual assault by an algorithm of 23 International Classification of Diseases, 10th Revision, and physician billing codes. We calculated age- and sex-stratified standardized rates per 100 000 census population, and we used age- and sex-stratified Poisson regressions to determine annual rate ratios.Results. Between 2002 and 2016, there were 52 780 incident cases of sexual assault in Ontario at a rate of 27.38 per 100 000 population. The highest rates were found among females aged 15 to 19 years (187 per 100 000) and 20 to 24 years (127 per 100 000). Among males, the highest rates were observed among children aged 0 to 4 years (41 per 100 000) and 5 to 9 years (29 per 10 000). Among males and females, the annual rate ratio increased among those aged 15 years and older and decreased among those aged 14 years and younger.Conclusions. Sexual assault was documented across all age groups and sexes, from children to elders, with high standardized rates among adolescents and children.
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Affiliation(s)
- Katherine Muldoon
- Katherine Muldoon, Glenys Smith, Robert Talarico, and Douglas Manuel are with ICES and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Kari Sampsel and Cheynne McLean are with Faculty of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa. Melissa Heimerl is with Ottawa Victim Services and the Victimology Program at Algonquin College, Ottawa
| | - Glenys Smith
- Katherine Muldoon, Glenys Smith, Robert Talarico, and Douglas Manuel are with ICES and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Kari Sampsel and Cheynne McLean are with Faculty of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa. Melissa Heimerl is with Ottawa Victim Services and the Victimology Program at Algonquin College, Ottawa
| | - Robert Talarico
- Katherine Muldoon, Glenys Smith, Robert Talarico, and Douglas Manuel are with ICES and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Kari Sampsel and Cheynne McLean are with Faculty of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa. Melissa Heimerl is with Ottawa Victim Services and the Victimology Program at Algonquin College, Ottawa
| | - Melissa Heimerl
- Katherine Muldoon, Glenys Smith, Robert Talarico, and Douglas Manuel are with ICES and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Kari Sampsel and Cheynne McLean are with Faculty of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa. Melissa Heimerl is with Ottawa Victim Services and the Victimology Program at Algonquin College, Ottawa
| | - Cheynne McLean
- Katherine Muldoon, Glenys Smith, Robert Talarico, and Douglas Manuel are with ICES and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Kari Sampsel and Cheynne McLean are with Faculty of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa. Melissa Heimerl is with Ottawa Victim Services and the Victimology Program at Algonquin College, Ottawa
| | - Kari Sampsel
- Katherine Muldoon, Glenys Smith, Robert Talarico, and Douglas Manuel are with ICES and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Kari Sampsel and Cheynne McLean are with Faculty of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa. Melissa Heimerl is with Ottawa Victim Services and the Victimology Program at Algonquin College, Ottawa
| | - Douglas Manuel
- Katherine Muldoon, Glenys Smith, Robert Talarico, and Douglas Manuel are with ICES and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Kari Sampsel and Cheynne McLean are with Faculty of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa. Melissa Heimerl is with Ottawa Victim Services and the Victimology Program at Algonquin College, Ottawa
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Kuenzig E, Manuel D, Donelle J, Benchimol EI. A2 LIFE EXPECTANCY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE (IBD): A POPULATION-BASED MATCHED COHORT STUDY. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Kuenzig
- Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | | | - E I Benchimol
- Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
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Hersi M, Traversy G, Thombs BD, Beck A, Skidmore B, Groulx S, Lang E, Reynolds DL, Wilson B, Bernstein SL, Selby P, Johnson-Obaseki S, Manuel D, Pakhale S, Presseau J, Courage S, Hutton B, Shea BJ, Welch V, Morrow M, Little J, Stevens A. Effectiveness of stop smoking interventions among adults: protocol for an overview of systematic reviews and an updated systematic review. Syst Rev 2019; 8:28. [PMID: 30660199 PMCID: PMC6339342 DOI: 10.1186/s13643-018-0928-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/20/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Tobacco smoking is the leading cause of cancer, preventable death, and disability. Smoking cessation can increase life expectancy by nearly a decade if achieved in the third or fourth decades of life. Various stop smoking interventions are available including pharmacotherapies, electronic cigarettes, behavioural support, and alternative therapies. This protocol outlines an evidence review which will evaluate the benefits and harms of stop smoking interventions in adults. METHODS The evidence review will consist of two stages. First, an overview of systematic reviews evaluating the benefits and harms of various stop smoking interventions delivered in or referred from the primary care setting will be conducted. The second stage will involve updating a systematic review on electronic cigarettes identified in the overview; randomized controlled trials will be considered for outcomes relating to benefits while randomized controlled trials, non-randomized controlled trials, and comparative observational studies will be considered for evaluating harms. Search strategies will be developed and peer-reviewed by medical information specialists. The search strategy for the updated review on e-cigarettes will be developed using that of the candidate systematic review. The MEDLINE®, PsycINFO, Embase, and the Cochrane Library electronic databases will be searched as of 2008 for the overview of reviews and from the last search date of the selected review for the updated review. Organizational websites and trial registries will be searched for unpublished or ongoing reviews/studies. Two reviewers will independently screen the title and abstracts of citations using the liberal accelerated method. Full-text screening will be performed independently by two reviewers. Extracted data will be verified by a second reviewer. Disagreements regarding full-text screening and data extraction will be resolved by consensus or third-party adjudication. The methodological quality of systematic reviews, risk of bias of randomized and non-randomized trials, and methodological quality of cohort studies will be evaluated using AMSTAR 2, the Cochrane risk of bias tool, and a modified version of the Scottish Intercollegiate Guidelines Network critical appraisal tool, respectively. The GRADE framework will be used to assess the quality of the evidence for outcomes. DISCUSSION The evidence review will evaluate the benefits and harms of various stop smoking interventions for adults. Findings will be used to inform a national tobacco cessation guideline by the Canadian Task Force on Preventive Health Care. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42018099691, CRD42018099692).
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Affiliation(s)
- Mona Hersi
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8L6 Canada
| | | | - Brett D. Thombs
- Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec Canada
- Department of Psychiatry, McGill University, Montreal, Quebec Canada
| | - Andrew Beck
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8L6 Canada
| | - Becky Skidmore
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8L6 Canada
| | - Stéphane Groulx
- Department of Community Health Sciences, University of Sherbrooke, Sherbrooke, Quebec Canada
- Centre de recherche Charles-Le Moyne – Saguenay–Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke, Quebec, Quebec Canada
| | - Eddy Lang
- University of Calgary Cumming School of Medicine, Calgary, Alberta Canada
- Alberta Health Services, Calgary, Alberta Canada
| | - Donna L. Reynolds
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Brenda Wilson
- Division of Community Health and Humanities, Memorial University of Newfoundland, St. John’s, Newfoundland Canada
| | - Steven L. Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT USA
| | - Peter Selby
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario Canada
| | - Stephanie Johnson-Obaseki
- Department of Otolaryngology, University of Ottawa, Ottawa, Ontario Canada
- The Ottawa Hospital, Ottawa, Ontario Canada
| | - Douglas Manuel
- The Ottawa Hospital, Ottawa, Ontario Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
- Bruyere Research Institute, Ottawa, Ontario Canada
| | - Smita Pakhale
- The Ottawa Hospital, Ottawa, Ontario Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Justin Presseau
- Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario Canada
| | - Susan Courage
- Public Health Agency of Canada, Ottawa, Ontario Canada
| | - Brian Hutton
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8L6 Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Beverley J. Shea
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8L6 Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Vivian Welch
- Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
- Bruyere Research Institute, Ottawa, Ontario Canada
| | - Matt Morrow
- Patient representative, Vancouver, British Columbia Canada
| | - Julian Little
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Adrienne Stevens
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8L6 Canada
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Arnason T, Tanuseputro P, Tuna M, Manuel D. Municipal transportation policy as a population health intervention: estimating the impact of the City of Ottawa Transportation Master Plan on diabetes incidence. Can J Public Health 2019; 110:285-293. [PMID: 30628043 DOI: 10.17269/s41997-018-0168-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 12/14/2018] [Indexed: 11/17/2022]
Abstract
INTERVENTION Physical inactivity is an important behavioral risk factor for chronic disease in Canada. Individual-level strategies are used in clinical medicine to target individuals for preventive intervention based on one or more risk factors. In contrast, this study examines the impact of a population-level intervention: a municipal policy outside the healthcare sector that influences the built and social environment. RESEARCH QUESTION What is the preventive effect of a municipal transportation policy to increase active transportation on a chronic disease outcome measure-diabetes incidence-when it is viewed as a population-level health intervention to increase physical activity? METHODS The impact of increases in active transportation for regular commuting to work in the city of Ottawa, Ontario was modeled to estimate number of diabetes cases prevented over 10 years. As a health-sector comparison, the reduction in incidence was equated to an individual-level approach to prevention targeting those who are inactive, meant to represent a clinical preventive intervention. RESULTS The population-level policy shift could prevent as many as 1620 incident cases of diabetes over 10 years, the largest number prevented by increases in public transit use. This population effect was equal to 17,300 inactive individuals or 12,300 inactive individuals > 45 years old undertaking a clinical preventive intervention to increase physical activity. CONCLUSION The results demonstrate why public health matters today as population-level interventions that exist as policies outside the healthcare sector, supported by public health, may have an unrecognized and therefore underappreciated impact on population health.
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Affiliation(s)
- Trevor Arnason
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada. .,Public Health Medicine Unit, Ottawa Public Health, Ottawa, Canada.
| | - Peter Tanuseputro
- Bruyère Research Institute, Ottawa, Canada.,Ottawa Hospital - Civic Campus, Ottawa Hospital Research Institute, Ottawa, Canada.,Ottawa Hospital - Civic Campus, Institute for Clinical Evaluative Sciences, Ottawa, Canada.,Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Canada
| | - Meltem Tuna
- Ottawa Hospital - Civic Campus, Ottawa Hospital Research Institute, Ottawa, Canada.,Ottawa Hospital - Civic Campus, Institute for Clinical Evaluative Sciences, Ottawa, Canada
| | - Douglas Manuel
- Bruyère Research Institute, Ottawa, Canada.,Ottawa Hospital - Civic Campus, Ottawa Hospital Research Institute, Ottawa, Canada.,Ottawa Hospital - Civic Campus, Institute for Clinical Evaluative Sciences, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
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Tanuseputro P, Arnason T, Hennessy D, Smith B, Bennett C, Kopec J, Pinto AD, Perez R, Tuna M, Manuel D. Simulation modeling to enhance population health intervention research for chronic disease prevention. Can J Public Health 2018; 110:52-57. [PMID: 30039263 DOI: 10.17269/s41997-018-0109-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/27/2018] [Indexed: 11/17/2022]
Abstract
Population Health Intervention Research (PHIR) is an expanding field that explores the health effects of population-level interventions conducted within and outside of the health sector. Simulation modeling-the use of mathematical models to predict health outcomes in populations given a set of specified inputs-is a useful, yet underutilized tool for PHIR. It can be employed at several phases of the research process: (1) planning and designing PHIR studies; (2) implementation; and (3) knowledge translation of findings across settings and populations. Using the example of community-wide, built environment interventions for the prevention of type 2 diabetes, we demonstrate how simulation models can be a powerful technique for chronic disease prevention research within PHIR. With increasingly available data on chronic disease risk factors and outcomes, the use of simulation modeling in PHIR for chronic disease prevention is anticipated to grow. There is a continued need to ensure models are appropriately validated and researchers should be cautious in their interpretation of model outputs given the uncertainties that are inherent with simulation modeling approaches. However, given the complexity of disease pathways and methodological challenges of PHIR studies, simulation models can be a valuable tool for researchers studying population interventions that hold the potential to improve health and reduce health inequities.
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Affiliation(s)
- Peter Tanuseputro
- Bruyère Research Institute, 43 Bruyère Street, Ottawa, ON, K1N 5C8, Canada. .,Ottawa Hospital Research Institute, Ottawa Hospital - Civic Campus, 1053 Carling Ave Box 693, 2-005 Admin Services Building, Ottawa, ON, K1Y 4E9, Canada. .,Institute for Clinical Evaluative Sciences, Civic Campus, Administrative Services Building, 1st Floor, 1053 Carling Avenue, Box 684, Ottawa, ON, K1Y 4E9, Canada. .,Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Canada.
| | - Trevor Arnason
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, B3H 1V7, Canada
| | - Deirdre Hennessy
- Ottawa Hospital Research Institute, Ottawa Hospital - Civic Campus, 1053 Carling Ave Box 693, 2-005 Admin Services Building, Ottawa, ON, K1Y 4E9, Canada
| | - Brendan Smith
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.,Public Health Ontario, 480 University Ave, Toronto, ON, M5G 1V2, Canada
| | - Carol Bennett
- Institute for Clinical Evaluative Sciences, Civic Campus, Administrative Services Building, 1st Floor, 1053 Carling Avenue, Box 684, Ottawa, ON, K1Y 4E9, Canada
| | - Jacek Kopec
- School of Population and Public Health, University of British Columbia, Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada
| | - Andrew D Pinto
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Richard Perez
- Institute for Clinical Evaluative Sciences, Civic Campus, Administrative Services Building, 1st Floor, 1053 Carling Avenue, Box 684, Ottawa, ON, K1Y 4E9, Canada
| | - Meltem Tuna
- Institute for Clinical Evaluative Sciences, Civic Campus, Administrative Services Building, 1st Floor, 1053 Carling Avenue, Box 684, Ottawa, ON, K1Y 4E9, Canada
| | - Douglas Manuel
- Bruyère Research Institute, 43 Bruyère Street, Ottawa, ON, K1N 5C8, Canada.,Ottawa Hospital Research Institute, Ottawa Hospital - Civic Campus, 1053 Carling Ave Box 693, 2-005 Admin Services Building, Ottawa, ON, K1Y 4E9, Canada.,Institute for Clinical Evaluative Sciences, Civic Campus, Administrative Services Building, 1st Floor, 1053 Carling Avenue, Box 684, Ottawa, ON, K1Y 4E9, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, K1H 8M5, Canada
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Tsampalieros A, Knoll GA, Dixon S, English S, Manuel D, Van Walraven C, Taljaard M, Fergusson D. Case Mix, Patterns of Care, and Inpatient Outcomes Among Ontario Kidney Transplant Centers: A Population-Based Study. Can J Kidney Health Dis 2018; 5:2054358117730053. [PMID: 30034813 PMCID: PMC6050611 DOI: 10.1177/2054358117730053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 08/04/2017] [Indexed: 12/30/2022] Open
Abstract
Background: Significant variation in both patient case mix and the structure of care in kidney transplantation has been previously described in the United States. Objective: The objective of our study was to characterize patient case mix, patterns of care, and inpatient outcomes across 5 kidney transplant centers in the province of Ontario, Canada. Design: This was a retrospective population-based cohort study using health care administrative databases. Setting: The setting is Ontario, Canada. Patients: We included adult (≥18 years) transplant recipients who received a primary, solitary kidney between January 1, 2000, and December 31, 2013 (N = 5037). Methods: Using linked administrative health care databases, we characterized kidney transplant recipient and donor factors, center characteristics, provider characteristics, and inpatient outcomes across transplant centers in Ontario. To compare case mix–adjusted differences in length of stay across centers, multivariable Cox proportional hazards regression was used to obtain hazard ratios (HRs) for each center relative to the average across all centers. Center volume and provider characteristics were added to the models to examine whether these factors explain differences in length of stay across centers. Results: We noted significant differences across transplant centers in patient race, cause of end-stage renal disease, body mass index, comorbidities, time on dialysis, and donor type. Mean annual transplant center volumes during the study period ranged between 51.5 (9.3) and 101.7 (23.9) transplants/year across centers (P < .0001). Physician specialty most responsible for in-hospital transplant care varied significantly across centers with the most common combination being nephrologist and urologist. Less than 31 deaths occurred in hospital during the index transplant admission but mortality risk did not differ significantly between centers. Overall, 25.1% of recipients required dialysis in hospital post transplantation (range across centers 18.3%-33.5%, P < .0001) and 24.7% of recipients spent time in the intensive care unit (ICU; range across centers: 5.7%-58.0%, P < .0001). The proportion of participants requiring dialysis did not change with time (P = .12), whereas the proportion staying in the ICU increased steadily over time (P < .0001). The median length of stay in hospital after transplantation ranged from 7 to 9 days across centers (P < .0001) and decreased significantly over time. After adjusting for patient case mix as well as center and provider factors, HRs for length of stay censored at the time of death ranged between 0.75 (95% confidence interval [CI]: 0.69-0.82) and 1.29 (95% CI: 1.20-1.38) across centers. Center volume and provider experience were not independently associated with length of hospital stay. Limitations: Data were missing (0.8%-18.4%) for certain covariates of interest. Conclusions: This study found significant heterogeneity across kidney transplant centers in case mix, practice patterns, and inpatient outcomes. Future studies are needed to examine the influence of length of stay and practice patterns on long-term outcomes such as patient/graft survival and quality of life.
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Affiliation(s)
- Anne Tsampalieros
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Greg A Knoll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,Division of Nephrology, Kidney Research Center, Department of Medicine, University of Ottawa, Ontario, Canada
| | - Stephanie Dixon
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Institute for Clinical Evaluative Sciences, London, Ontario, Canada
| | - Shane English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,Department of Medicine (Critical Care), University of Ottawa, Ontario, Canada
| | - Douglas Manuel
- Department of Family Medicine, University of Ottawa, Ontario, Canada
| | - Carl Van Walraven
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,Department of Medicine, University of Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada
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Jeyakumar G, Tu JV, Austin PC, Hall R, Chu A, Khan AM, Jin AY, Martin C, Manuel D, Silver FL, Swartz R, Kapral MK. Abstract WMP58: Ambulatory Care for Secondary Prevention of Stroke in Rural versus Urban Areas in Ontario, Canada. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.wmp58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Residents of rural areas may have limited access to certain health care services. However, little is known about rural-urban differences in stroke secondary prevention care, or in the risk of recurrent stroke and death. We used linked population-based administrative databases from the province of Ontario, Canada, to assess the association between rural residence and ambulatory processes of care for secondary stroke prevention, as well as the incidence of recurrent stroke.
Methods:
We studied a sub-population of the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) cohort, comprised of individuals between ages 40 to 105 years with a history of stroke prior to January 1, 2008. We defined rural communities as those with a population size of ≤ 10, 000, and compared screening and treatment for hypertension, hyperlipidemia, diabetes mellitus and smoking in rural and urban areas, as well as the incidence of recurrent stroke, adjusting for age, sex and baseline risk factors.
Results:
In our study sample of 86,811 individuals with prior stroke, the prevalence of vascular risk factors was similar in both rural and urban residents. Rural residents (n=10,988) had fewer mean annual visits to family physicians (5.2 vs. 6.7; p<0.001) and specialist physicians (2.5 vs. 3.5; p<0.001) and were less likely to be screened for hyperlipidemia (67.9% vs. 81.5%; p <0.05) compared to their urban counterparts. There were no rural-urban differences in prescription of medications for hypertension, diabetes and hyperlipidemia, and no differences in control of diabetes. The incidence of recurrent stroke was slightly higher in rural compared to urban areas (12.0 vs. 11.5 per 1000 person years, adjusted hazard ratio 1.09; 95% confidence interval 1.01 to 1.18).
Conclusions:
Rural and urban residents with prior stroke had similar prevalence and treatment of vascular risk factors, however, rural residence was associated with fewer physician visits, less screening for hyperlipidemia, and a slight increase in the risk of recurrent stroke. Ongoing efforts are needed to maintain equitable access to recommended ambulatory care services for secondary stroke prevention, and to address other social determinants of health in rural communities.
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Affiliation(s)
| | | | | | | | - Anna Chu
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Anam M Khan
- Institute for Clinical Evaluative Sciences, Toronto, Canada
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Naicker K, Manuel D, Øverland S, Skogen JC, Johnson JA, Sivertsen B, Colman I. Population attributable fractions for Type 2 diabetes: an examination of multiple risk factors including symptoms of depression and anxiety. Diabetol Metab Syndr 2018; 10:84. [PMID: 30479670 PMCID: PMC6251110 DOI: 10.1186/s13098-018-0387-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/12/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Population attributable fractions (PAFs) are frequently used to quantify the proportion of Type 2 diabetes cases due to single risk factors, an approach which may result in an overestimation of their individual contributions. This study aimed to examine Type 2 diabetes incidence associated with multiple risk factor combinations, including the metabolic syndrome, behavioural factors, and specifically, depression and anxiety. METHODS Using data from the population-based HUNT cohort, we examined incident diabetes in 36,161 Norwegian adults from 1995 to 2008. PAFs were calculated using Miettinen's case-based formula, using relative risks estimated from multivariate regression models. RESULTS Overall, the studied risk factors accounted for 50.5% of new diabetes cases (78.2% in men and 47.0% in women). Individuals exposed to both behavioural and metabolic factors were at highest risk of diabetes onset (PAF = 22.9%). Baseline anxiety and depression contributed a further 13.6% of new cases to this combination. Men appeared to be particularly vulnerable to the interaction between metabolic, behavioural and psychological risk factors. CONCLUSION This study highlights the importance of risk factor clustering in diabetes onset, and is the first that we know of to quantify the excess fraction of incident diabetes associated with psychological risk factor interactions.
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Affiliation(s)
- Kiyuri Naicker
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cres., Room 308C, Ottawa, ON K1G 5Z3 Canada
| | | | - Simon Øverland
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Jens C. Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | | | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Department Research and Innovation, Helse Fonna HF, Haugesund, Norway
- The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cres., Room 308C, Ottawa, ON K1G 5Z3 Canada
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Nelson RL, Manuel D, Gumienny C, Spencer B, Patel K, Schmitt K, Castillo D, Bravo A, Yeboah-Sampong A. A systematic review and meta-analysis of the treatment of anal fissure. Tech Coloproctol 2017; 21:605-625. [PMID: 28795245 DOI: 10.1007/s10151-017-1664-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/14/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anal fissure has a very large number of treatment options. The choice is difficult. In an effort to assist in that, choice presented here is a systematic review and meta-analysis of all published treatments for anal fissure that have been studied in randomized controlled trials. METHODS Randomized trials were sought in the Cochrane Controlled Trials Register, Medline, EMBASE and the trials registry sites clinicaltrials.gov and who/int/ictrp/search/en. Abstracts were screened, full-text studies chosen, and finally eligible studies selected and abstracted. The review was then divided into those studies that compared two or more surgical procedures and those that had at least one arm that was non-surgical. Studies were further categorized by the specific interventions and comparisons. The outcome assessed was treatment failure. Negative effects of treatment assessed were headache and anal incontinence. Risk of bias was assessed for each study, and the strength of the evidence of each comparison was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS One hundred and forty-eight eligible trials were found and assessed, 31 in the surgical group and 117 in the non-surgical group. There were 14 different operations described in the surgical group and 29 different non-surgical treatments in the non-surgical group along with partial lateral internal sphincterotomy (LIS). There were 61 different comparisons. Of these, 47 were reported in 2 or fewer studies, usually with quite small patient samples. The largest single comparison was glyceryl trinitrate (GTN) versus control with 19 studies. GTN was more effective than control in sustained cure (OR 0.68; 95% CI 0.63-0.77), but the quality of evidence was very poor because of severe heterogeneity, and risk of bias due to inadequate clinical follow-up. The only comparison to have a GRADE quality of evidence of high was a subgroup analysis of LIS versus any medical therapy (OR 0.12; CI 0.07-0.21). Most of the other studies were downgraded in GRADE due to imprecision. CONCLUSIONS LIS is superior to non-surgical therapies in achieving sustained cure of fissure. Calcium channel blockers were more effective than GTN and with less risk of headache, but with only a low quality of evidence. Anal incontinence, once thought to be a frequent risk with LIS, was found in various subgroups in this review to have a risk between 3.4 and 4.4%. Among the surgical studies, manual anal stretch performed worse than LIS in the treatment of chronic anal fissure in adults. For those patients requiring surgery for anal fissure, open LIS and closed LIS appear to be equally efficacious, with a moderate GRADE quality of evidence. All other GRADE evaluations of procedures were low to very low due mostly to imprecision.
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Affiliation(s)
- R L Nelson
- Epidemiology/Biometry Division, University of Illinois School of Public Health, 1603 West Taylor Room 956, Chicago, IL, 60612, USA.
| | - D Manuel
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - C Gumienny
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - B Spencer
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - K Patel
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - K Schmitt
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - D Castillo
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - A Bravo
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - A Yeboah-Sampong
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
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Ng E, Sanmartin C, Manuel D. Linking hospital and immigrant landing data to understand patterns of hospital use among refugees in Canada. Int J Popul Data Sci 2017. [DOI: 10.23889/ijpds.v1i1.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
ABSTRACT
ObjectivesIn Canada, refugees represent between 10% and 15% of the total immigrant annual in-take of immigrants. Refugees are generally admitted with different selection criteria and have different settlement challenges which may lead to higher health risk, compared to other categories of immigrants. The purpose of this study is to use linked hospital and immigrant landing data to report hospitalization rates among refugees arriving to Canada between 1980 and 2006 with special focus on those from refugee-dominant source areas, namely Poland and Vietnam, and the Middle East.
ApproachData from the 2006/07-2008/09 Discharge Abstract Database (DAD) were linked to the 1980-2008 Immigrant Landing File (ILF) to identify hospitalizations among immigrants by category of admission. Age-standardized hospitalization rates (ASHR) for overall causes (excluding pregnancy), and for selected causes are derived for refugees overall and by specific source country. Rates are compared with those for the Canadian-born population and with economic class immigrants from the same source country.
ResultsOverall, refugees had substantially lower overall ASHR compared with the Canadian-born population (494 per 10,000, 95% CI, 487, 500 vs 891 per 10,000, 95% CI, 890, 892, retrospectively). Among refugees, those who landed in Canada (refugee claimants) had the highest ASHR (539, 95% CI 524,555), especially for circulatory disease. Among refugee-dominant areas, Government-assisted refugees from the Middle East tended to have higher ASHR at levels comparable with that of the Canadian born population (for circulatory disease). Refugees had higher rates of hospitalization compared with their economic class counterparts, except among those from Poland.
ConclusionRefugees, like other immigrants, generally had lower hospitalization rates compared with the Canadian born population, but the heterogeneity within groups reveals specific vulnerability for certain types of health care use.
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Naicker K, Johnson JA, Skogen JC, Manuel D, Øverland S, Sivertsen B, Colman I. Type 2 Diabetes and Comorbid Symptoms of Depression and Anxiety: Longitudinal Associations With Mortality Risk. Diabetes Care 2017; 40:352-358. [PMID: 28077458 DOI: 10.2337/dc16-2018] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/11/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Depression is strongly linked to increased mortality in individuals with type 2 diabetes. Despite high rates of co-occurring anxiety and depression, the risk of death associated with comorbid anxiety in individuals with type 2 diabetes is poorly understood. This study documented the excess mortality risk associated with symptoms of depression and/or anxiety comorbid with type 2 diabetes. RESEARCH DESIGN AND METHODS Using data for 64,177 Norwegian adults from the second wave of the Nord-Trøndelag Health Study (HUNT2), with linkage to the Norwegian Causes of Death Registry, we assessed all-cause mortality from survey participation in 1995 through to 2013. We used Cox proportional hazards models to examine mortality risk over 18 years associated with type 2 diabetes status and the presence of comorbid affective symptoms at baseline. RESULTS Three clear patterns emerged from our findings. First, mortality risk in individuals with diabetes increased in the presence of depression or anxiety, or both. Second, mortality risk was lowest for symptoms of anxiety, higher for comorbid depression-anxiety, and highest for depression. Lastly, excess mortality risk associated with depression and anxiety was observed in men with diabetes but not in women. The highest risk of death was observed in men with diabetes and symptoms of depression only (hazard ratio 3.47, 95% CI 1.96, 6.14). CONCLUSIONS This study provides evidence that symptoms of anxiety affect mortality risk in individuals with type 2 diabetes independently of symptoms of depression, in addition to attenuating the relationship between depressive symptoms and mortality in these individuals.
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Affiliation(s)
- Kiyuri Naicker
- School of Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jens C Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Douglas Manuel
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Simon Øverland
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Department of Psychosocial Science, University of Bergen, Norway
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Regional Centre for Child and Youth Mental Health and Child Welfare, University Research Health, Bergen, Norway.,Department of Psychiatry, Helse Fonna HF, Haugesund, Norway
| | - Ian Colman
- School of Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
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Schlossmacher MG, Tomlinson JJ, Santos G, Shutinoski B, Brown EG, Manuel D, Mestre T. Modelling idiopathic Parkinson disease as a complex illness can inform incidence rate in healthy adults: the P R EDIGT score. Eur J Neurosci 2017; 45:175-191. [PMID: 27859866 PMCID: PMC5324667 DOI: 10.1111/ejn.13476] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/16/2016] [Accepted: 11/07/2016] [Indexed: 12/15/2022]
Abstract
Fifty-five years after the concept of dopamine replacement therapy was introduced, Parkinson disease (PD) remains an incurable neurological disorder. To date, no disease-modifying therapeutic has been approved. The inability to predict PD incidence risk in healthy adults is seen as a limitation in drug development, because by the time of clinical diagnosis ≥ 60% of dopamine neurons have been lost. We have designed an incidence prediction model founded on the concept that the pathogenesis of PD is similar to that of many disorders observed in ageing humans, i.e. a complex, multifactorial disease. Our model considers five factors to determine cumulative incidence rates for PD in healthy adults: (i) DNA variants that alter susceptibility (D), e.g. carrying a LRRK2 or GBA risk allele; (ii) Exposure history to select environmental factors including xenobiotics (E); (iii) Gene-environment interactions that initiate pathological tissue responses (I), e.g. a rise in ROS levels, misprocessing of amyloidogenic proteins (foremost, α-synuclein) and dysregulated inflammation; (iv) sex (or gender; G); and importantly, (v) time (T) encompassing ageing-related changes, latency of illness and propagation of disease. We propose that cumulative incidence rates for PD (PR ) can be calculated in healthy adults, using the formula: PR (%) = (E + D + I) × G × T. Here, we demonstrate six case scenarios leading to young-onset parkinsonism (n = 3) and late-onset PD (n = 3). Further development and validation of this prediction model and its scoring system promise to improve subject recruitment in future intervention trials. Such efforts will be aimed at disease prevention through targeted selection of healthy individuals with a higher prediction score for developing PD in the future and at disease modification in subjects that already manifest prodromal signs.
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Affiliation(s)
- Michael G. Schlossmacher
- Neuroscience ProgramOttawa Hospital Research Institute451 Smyth RoadRGH #1414OttawaONK1H 8M5Canada
- Division of NeurologyDepartment of MedicineThe Ottawa HospitalOttawaCanada
- University of Ottawa Brain & Mind Research InstituteOttawaCanada
- Faculty of MedicineUniversity of OttawaOttawaCanada
| | - Julianna J. Tomlinson
- Neuroscience ProgramOttawa Hospital Research Institute451 Smyth RoadRGH #1414OttawaONK1H 8M5Canada
- University of Ottawa Brain & Mind Research InstituteOttawaCanada
| | | | - Bojan Shutinoski
- Neuroscience ProgramOttawa Hospital Research Institute451 Smyth RoadRGH #1414OttawaONK1H 8M5Canada
- University of Ottawa Brain & Mind Research InstituteOttawaCanada
| | - Earl G. Brown
- Neuroscience ProgramOttawa Hospital Research Institute451 Smyth RoadRGH #1414OttawaONK1H 8M5Canada
- Faculty of MedicineUniversity of OttawaOttawaCanada
- Department of Biochemistry, Microbiology and ImmunologyUniversity of OttawaOttawaCanada
| | - Douglas Manuel
- Faculty of MedicineUniversity of OttawaOttawaCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
| | - Tiago Mestre
- Neuroscience ProgramOttawa Hospital Research Institute451 Smyth RoadRGH #1414OttawaONK1H 8M5Canada
- Division of NeurologyDepartment of MedicineThe Ottawa HospitalOttawaCanada
- University of Ottawa Brain & Mind Research InstituteOttawaCanada
- Faculty of MedicineUniversity of OttawaOttawaCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
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Fatayer H, Sharma N, Manuel D, Kim B, Keding A, Perren T, Velikova G, Lansdown M, Shaaban AM, Dall B. Serial MRI scans help in assessing early response to neoadjuvant chemotherapy and tailoring breast cancer treatment. Eur J Surg Oncol 2016; 42:965-72. [PMID: 27260848 DOI: 10.1016/j.ejso.2016.03.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 03/06/2016] [Accepted: 03/14/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Tailoring neoadjuvant chemotherapy (NAC) during breast cancer treatment is performed to improve overall tumour response, with increasing evidence to support its role. This study evaluates our breast unit's experience in MRI assessment of tumour response as an aid in tailoring NAC. MATERIALS AND METHODS This is a retrospective study of patients treated with NAC for breast cancer between 2005 and 2009 who underwent MRI to assess tumour response. Response to NAC was monitored before NAC and after 2 and/or 4 cycles of anthracycline and cyclophosphamide (AC) chemotherapy. Taxane was substituted for AC if MRI response was deemed inadequate. Tumour response on last MRI was correlated with final pathology against different tumour subtypes and in inflammatory tumours. Strength of agreement was measured using Kappa analysis. Potential predictive factors for MRI response were assessed for significance. RESULTS 166 tumours were assessed with serial MRI scans. MRI showed high sensitivity rate (93.1%) in predicting response to NAC particularly for tumours showing partial (PR) or complete (CR) response on pathology (p < 0.001) with fair agreement on Kappa analysis (K = 0.31). MRI seems more accurate in triple negative, HR+/HER2+ and high-grade tumours. Early identification of non-responders on MRI resulted in early tailoring of NAC, with improved rates of tumour response seen in 74.2% following switching NAC. Logistic regression showed that PR or CR observed on MRI after 2 NAC cycles significantly predicted pCR (p < 0.001). CONCLUSION Serial MRI can be used to assess patterns of tumour response to NAC. This study shows that tailoring NAC according to pattern of response can improve overall tumour response rates.
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Affiliation(s)
- H Fatayer
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK.
| | - N Sharma
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - D Manuel
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - B Kim
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - A Keding
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - T Perren
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - G Velikova
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK; University of Leeds, Leeds Institute of Cancer and Pathology, UK
| | - M Lansdown
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - A M Shaaban
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - B Dall
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
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Tanuseputro P, Chalifoux M, Bennett C, Gruneir A, Bronskill SE, Walker P, Manuel D. Hospitalization and Mortality Rates in Long-Term Care Facilities: Does For-Profit Status Matter? J Am Med Dir Assoc 2015; 16:874-83. [DOI: 10.1016/j.jamda.2015.06.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
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Tanuseputro P, Perez R, Rosella L, Wilson K, Bennett C, Tuna M, Hennessy D, Manson H, Manuel D. Improving the estimation of the burden of risk factors: an illustrative comparison of methods to measure smoking-attributable mortality. Popul Health Metr 2015; 13:5. [PMID: 25717287 PMCID: PMC4339639 DOI: 10.1186/s12963-015-0039-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 02/05/2015] [Indexed: 02/02/2023] Open
Abstract
Background Prevention efforts are informed by the numbers of deaths or cases of disease caused by specific risk factors, but these are challenging to estimate in a population. Fortunately, an increasing number of jurisdictions have increasingly rich individual-level, population-based data linking exposures and outcomes. These linkages enable multivariable approaches to risk assessment. We demonstrate how this approach can estimate the population burden of risk factors and illustrate its advantages over often-used population-attributable fraction methods. Methods We obtained risk factor information for 78,597 individuals from a series of population-based health surveys. Each respondent was linked to death registry (568,997 person-years of follow-up, 6,399 deaths).Two methods were used to obtain population-attributable fractions. First, the mortality rate difference between the entire population and the population of non-smokers was divided by the total mortality rate. Second, often-used attributable fraction formulas were used to combine summary measures of smoking prevalence with relative risks of death for select diseases. The respective fractions were then multiplied to summary measures of mortality to obtain smoking-attributable mortality. Alternatively, for our multivariable approach, we created algorithms for risk of death, predicted by health behaviors and various covariates (age, sex, socioeconomic position, etc.). The burden of smoking was determined by comparing the predicted mortality of the current population with that of a counterfactual population where smoking is eliminated. Results Our multivariable algorithms accurately predicted an individual’s risk of death based on their health behaviors and other variables in the models. These algorithms estimated that 23.7% of all deaths can be attributed to smoking in Ontario. This is higher than the 20.0% estimated using population-attributable risk methods that considered only select diseases and lower than the 35.4% estimated from population-attributable risk methods that examine the excess burden of all deaths due to smoking. Conclusions The multivariable algorithms presented have several advantages, including: controlling for confounders, accounting for complexities in the relationship between multiple exposures and covariates, using consistent definitions of exposure, and using specific measures of risk derived internally from the study population. We propose the wider use of multivariable risk assessment approach as an alternative to population-attributable fraction methods.
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Affiliation(s)
- Peter Tanuseputro
- Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario Canada ; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario Canada ; Institute for Clinical Evaluative Sciences, Population Health and Primary Care, Ottawa, Ontario Canada
| | - Richard Perez
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario Canada ; Institute for Clinical Evaluative Sciences, Population Health and Primary Care, Ottawa, Ontario Canada
| | - Laura Rosella
- Public Health Ontario, Toronto, Ontario Canada ; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Kumanan Wilson
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario Canada ; Institute for Clinical Evaluative Sciences, Population Health and Primary Care, Ottawa, Ontario Canada ; Department of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Carol Bennett
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario Canada ; Institute for Clinical Evaluative Sciences, Population Health and Primary Care, Ottawa, Ontario Canada
| | - Meltem Tuna
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario Canada ; Institute for Clinical Evaluative Sciences, Population Health and Primary Care, Ottawa, Ontario Canada
| | - Deirdre Hennessy
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario Canada ; Health Analysis Division, Statistics Canada, Ottawa, Ontario Canada
| | | | - Douglas Manuel
- Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario Canada ; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario Canada ; Institute for Clinical Evaluative Sciences, Population Health and Primary Care, Ottawa, Ontario Canada ; Health Analysis Division, Statistics Canada, Ottawa, Ontario Canada ; Department of Family Medicine, University of Ottawa, Ottawa, Ontario Canada
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Mullen K, Manuel D, Younger J, Hawken S, Coyle D, Jones L, Wells G, Pipe A, Reid R. HEALTH, HEALTHCARE, AND ECONOMIC IMPACTS OF A HOSPITAL-INITIATED SMOKING CESSATION INTERVENTION. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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van Walraven C, Manuel D, Knoll G. In Reply to ‘Dialysis Vintage Could Confound Survival Trends in ESRD Patients’. Am J Kidney Dis 2014; 64:156. [DOI: 10.1053/j.ajkd.2014.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 04/21/2014] [Indexed: 11/11/2022]
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Mullen KA, Coyle D, Manuel D, Nguyen HV, Pham B, Pipe AL, Reid RD. Economic evaluation of a hospital-initiated intervention for smokers with chronic disease, in Ontario, Canada. Tob Control 2014; 24:489-96. [PMID: 24935442 PMCID: PMC4552906 DOI: 10.1136/tobaccocontrol-2013-051483] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 05/23/2014] [Indexed: 11/06/2022]
Abstract
Introduction Cigarette smoking causes many chronic diseases that are costly and result in frequent hospitalisation. Hospital-initiated smoking cessation interventions increase the likelihood that patients will become smoke-free. We modelled the cost-effectiveness of the Ottawa Model for Smoking Cessation (OMSC), an intervention that includes in-hospital counselling, pharmacotherapy and posthospital follow-up, compared to usual care among smokers hospitalised with acute myocardial infarction (AMI), unstable angina (UA), heart failure (HF), and chronic obstructive pulmonary disease (COPD). Methods We completed a cost-effectiveness analysis based on a decision-analytic model to assess smokers hospitalised in Ontario, Canada for AMI, UA, HF, and COPD, their risk of continuing to smoke and the effects of quitting on re-hospitalisation and mortality over a 1-year period. We calculated short-term and long-term cost-effectiveness ratios. Our primary outcome was 1-year cost per quality-adjusted life year (QALY) gained. Results From the hospital payer's perspective, delivery of the OMSC can be considered cost effective with 1-year cost per QALY gained of $C1386, and lifetime cost per QALY gained of $C68. In the first year, we calculated that provision of the OMSC to 15 326 smokers would generate 4689 quitters, and would prevent 116 rehospitalisations, 923 hospital days, and 119 deaths. Results were robust within numerous sensitivity analyses. Discussion The OMSC appears to be cost-effective from the hospital payer perspective. Important consideration is the relatively low intervention cost compared to the reduction in costs related to readmissions for illnesses associated with continued smoking.
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Affiliation(s)
- Kerri-Anne Mullen
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Douglas Coyle
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Douglas Manuel
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Hai V Nguyen
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Ba' Pham
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andrew L Pipe
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Robert D Reid
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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