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Butalia S, Chu LM, Dover DC, Lau D, Yeung RO, Eurich DT, Senior P, Kaul P. Association Between Hemoglobin A1c and Development of Cardiovascular Disease in Canadian Men and Women Without Diabetes at Baseline: A Population-Based Study of 608 474 Adults. J Am Heart Assoc 2024; 13:e031095. [PMID: 38639364 DOI: 10.1161/jaha.123.031095] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/28/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND We examined the association between hemoglobin A1c (HbA1c) and the development of cardiovascular disease (CVD) in men and women, without diabetes or CVD at baseline. METHODS AND RESULTS This retrospective cohort study included adults aged 40 to <80 years in Alberta, Canada. Men and women were divided into categories based on a random HbA1c during a 3-year enrollment period. The primary outcome of CVD hospitalization and secondary outcome of combined CVD hospitalization/mortality were examined during a 5-year follow-up period until March 31, 2021. A total of 608 474 individuals (55.2% women) were included. Compared with HbA1c 5.0% to 5.4%, men with HbA1c of 5.5% to 5.9% had an increased risk of CVD hospitalization (adjusted hazard ratio [aHR], 1.12 [95% CI, 1.07-1.19]) whereas women did not (aHR, 1.01 [95% CI, 0.95-1.08]). Men and women with HbA1c of 6.0% to 6.4% had a 38% and 17% higher risk and men and women with HbA1c ≥6.5% had a 79% and 51% higher risk of CVD hospitalization, respectively. In addition, HbA1c of 6.0% to 6.4% and HbA1c ≥6.5% were associated with a higher risk (14% and 41%, respectively) of CVD hospitalization/death in men, but HbA1c ≥6.5% was associated with a 24% higher risk only among women. CONCLUSIONS In both men and women, HbA1c ≥6.0% was associated with an increased risk of CVD and mortality outcomes. The association between CVD and HbA1c levels of 5.5% to 5.9%, considered to be in the "normal" range, highlights the importance of optimizing cardiovascular risk profiles at all levels of glycemia, especially in men.
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Affiliation(s)
- Sonia Butalia
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine University of Calgary Calgary Alberta Canada
- Department of Medicine and Community Health Sciences, Cumming School of Medicine University of Calgary Calgary Alberta Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, Calgary University of Calgary Calgary Alberta Canada
- Libin Cardiovascular Institute, Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Luan Manh Chu
- Provincial Research Data Services Alberta Health Services Edmonton Alberta Canada
| | - Douglas C Dover
- Canadian VIGOUR Centre University of Alberta Edmonton Alberta Canada
| | - Darren Lau
- Department of Medicine, Faculty of Medicine & Dentistry University of Alberta Edmonton Alberta Canada
- Alberta Diabetes Institute, University of Alberta Edmonton Alberta Canada
| | - Roseanne O Yeung
- Department of Medicine, Faculty of Medicine & Dentistry University of Alberta Edmonton Alberta Canada
- Alberta Diabetes Institute, University of Alberta Edmonton Alberta Canada
- School of Public Health University of Alberta Edmonton Alberta Canada
| | - Dean T Eurich
- Alberta Diabetes Institute, University of Alberta Edmonton Alberta Canada
- School of Public Health University of Alberta Edmonton Alberta Canada
| | - Peter Senior
- Department of Medicine, Faculty of Medicine & Dentistry University of Alberta Edmonton Alberta Canada
- Alberta Diabetes Institute, University of Alberta Edmonton Alberta Canada
| | - Padma Kaul
- Canadian VIGOUR Centre University of Alberta Edmonton Alberta Canada
- Department of Medicine, Faculty of Medicine & Dentistry University of Alberta Edmonton Alberta Canada
- Alberta Diabetes Institute, University of Alberta Edmonton Alberta Canada
- School of Public Health University of Alberta Edmonton Alberta Canada
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Nagy DK, Bresee LC, Eurich DT, Simpson SH. Are Guideline-concordant Processes of Care Consistent Across the Rural-Urban Continuum? A Retrospective Cohort Study of Adults Newly Treated for Type 2 Diabetes. Can J Diabetes 2024:S1499-2671(24)00065-0. [PMID: 38583767 DOI: 10.1016/j.jcjd.2024.03.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/07/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES Our aim in this study was to identify the association between place of residence (metropolitan, urban, rural) and guideline-concordant processes of care in the first year of type 2 diabetes management. METHODS We conducted a retrospective cohort study of new metformin users between April 2015 and March 2020 in Alberta, Canada. Outcomes were identified as guideline-concordant processes of care through the review of clinical practice guidelines and published literature. Using multivariable logistic regression, the following outcomes were examined by place of residence: dispensation of a statin, angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB), eye examination, glycated hemoglobin (A1C), cholesterol, and kidney function testing. RESULTS Of 60,222 new metformin users, 67% resided in a metropolitan area, 10% in an urban area, and 23% in a rural area. After confounder adjustment, rural residents were less likely to have a statin dispensed (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.79 to 0.87) or undergo cholesterol testing (aOR 0.86, 95% CI 0.83 to 0.90) when compared with metropolitan residents. In contrast, rural residents were more likely to receive A1C and kidney function testing (aOR 1.14, 95% CI 1.08 to 1.21 and aOR 1.17, 95% CI 1.11 to 1.24, respectively). ACEi/ARB use and eye examinations were similar across place of residence. CONCLUSIONS Processes of care varied by place of residence. Limited cholesterol management in rural areas is concerning because this may lead to increased cardiovascular outcomes.
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Affiliation(s)
- Danielle K Nagy
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Lauren C Bresee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, Li Ka Shing Centre for Research, University of Alberta, Edmonton, Alberta, Canada
| | - Scot H Simpson
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
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Ye M, Vena JE, Shen-Tu G, Johnson JA, Eurich DT. Reduced incidence of diabetes during the COVID-19 pandemic in Alberta: A time-segmented longitudinal study of Alberta's Tomorrow Project. Diabetes Obes Metab 2024; 26:1244-1251. [PMID: 38131246 DOI: 10.1111/dom.15420] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
AIM To characterize the impact of the COVID-19 pandemic on diabetes diagnosis using data from Alberta's Tomorrow Project (ATP), a population-based cohort study of chronic diseases in Alberta, Canada. MATERIALS AND METHODS The ATP participants who were free of diabetes on 1 April 2018 were included in the study. A time-segmented regression model was used to compare incidence rates of diabetes before the COVID-19 pandemic, during the first two COVID-19 states of emergency, and in the period when the state of emergency was relaxed, after adjusting for seasonality, sociodemographic factors, socioeconomic status, and lifestyle behaviours. RESULTS Among 43 705 ATP participants free of diabetes (65.5% females, age 60.4 ± 9.5 years in 2018), the rate of diabetes was 4.75 per 1000 person-year (PY) during the COVID-19 pandemic (up to 31 March 2021), which was 32% lower (95% confidence interval [CI] 21%, 42%; p < 0.001) than pre-pandemic (6.98 per 1000 PY for the period 1 April 2018 to 16 March 2020). In multivariable regression analysis, the first COVID-19 state of emergency (first wave) was associated with an 87.3% (95% CI -98.6%, 13.9%; p = 0.07) reduction in diabetes diagnosis; this decreasing trend was sustained to the second COVID-19 state of emergency and no substantial rebound (increase) was observed when the COVID-19 state of emergency was relaxed. CONCLUSIONS The COVID-19 public health emergencies had a negative impact on diabetes diagnosis in Alberta. The reduction in diabetes diagnosis was likely due to province-wide health service disruptions during the COVID-19 pandemic. Systematic plans to close the post-COVID-19 diagnostic gap are required in diabetes to avoid substantial downstream sequelae of undiagnosed disease.
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Affiliation(s)
- Ming Ye
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer E Vena
- Alberta's Tomorrow Project, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Grace Shen-Tu
- Alberta's Tomorrow Project, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Dubois C, Fernandes H, Lin M, Martins KJB, Dyck JRB, Klarenbach SW, Richer L, Jess E, Hanlon JG, Hyshka E, Eurich DT. Benzodiazepine use in medical cannabis authorization adult patients from 2013 to 2021: Alberta, Canada. BMC Public Health 2024; 24:859. [PMID: 38504198 PMCID: PMC10953249 DOI: 10.1186/s12889-024-18356-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/14/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Benzodiazepines are a class of medications that are being frequently prescribed in Canada but carry significant risk of harm. There has been increasing clinical interest on the potential "sparing effects" of medical cannabis as one strategy to reduce benzodiazepine use. The objective of this study as to examine the association of medical cannabis authorization with benzodiazepine usage between 2013 and 2021 in Alberta, Canada. METHODS A propensity score matched cohort study with patients on regular benzodiazepine treatment authorized to use medical cannabis compared to controls who do not have authorization for medical cannabis. A total of 9690 medically authorized cannabis patients were matched to controls. To assess the effect of medical cannabis use on daily average diazepam equivalence (DDE), interrupted time series (ITS) analysis was used to assess the change in the trend of DDE in the 12 months before and 12 months after the authorization of medical cannabis. RESULTS Over the follow-up period after medical cannabis authorization, there was no overall change in the DDE use in authorized medical cannabis patients compared to matched controls (- 0.08 DDE, 95% CI: - 0.41 to 0.24). Likewise, the sensitivity analysis showed that, among patients consuming ≤5 mg baseline DDE, there was no change immediately after medical cannabis authorization compared to controls (level change, - 0.04 DDE, 95% CI: - 0.12 to 0.03) per patient as well as in the month-to-month trend change (0.002 DDE, 95% CI: - 0.009 to 0.12) per patient was noted. CONCLUSIONS This short-term study found that medical cannabis authorization had minimal effects on benzodiazepine use. Our findings may contribute ongoing evidence for clinicians regarding the potential impact of medical cannabis to reduce benzodiazepine use. HIGHLIGHTS • Medical cannabis authorization had little to no effect on benzodiazepine usage among patients prescribed regular benzodiazepine treatment in Alberta, Canada. • Further clinical research is needed to investigate the potential impact of medical cannabis as an alternative to benzodiazepine medication.
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Affiliation(s)
- Cerina Dubois
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy 11405 - 87 Ave Edmonton, AB, T6G 1C9 2E, Edmonton, AB, Canada
| | - Heidi Fernandes
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy 11405 - 87 Ave Edmonton, AB, T6G 1C9 2E, Edmonton, AB, Canada
| | - Mu Lin
- SPOR (Strategy for Patient Oriented Research) Data Platform, Alberta Health Services, Edmonton, Alberta, Canada
| | - Karen J B Martins
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Scott W Klarenbach
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Lawrence Richer
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ed Jess
- College of Physicians & Surgeons of Alberta, Edmonton, Alberta, Canada
| | - John G Hanlon
- St. Michael's Hospital Department of Anesthesia, University of Toronto, Ontario, Canada
- Department of Anaesthesiology and Pain Medicine, University of Toronto, Ontario, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy 11405 - 87 Ave Edmonton, AB, T6G 1C9 2E, Edmonton, AB, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy 11405 - 87 Ave Edmonton, AB, T6G 1C9 2E, Edmonton, AB, Canada.
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Nagy DK, Bresee LC, Eurich DT, Simpson SH. Rurality is associated with lower likelihood of dipeptidyl peptidase 4 inhibitor use for treatment intensification. Explor Res Clin Soc Pharm 2024; 13:100429. [PMID: 38495952 PMCID: PMC10940908 DOI: 10.1016/j.rcsop.2024.100429] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024] Open
Abstract
Background Antihyperglycemic drug utilization studies are conducted frequently and describe the uptake of new drug therapies across may jurisdictions. An increasingly important, yet often absent, aspect of these studies is the impact of rurality on drug utilization. Objectives The objective of this study was to explore the association between place of residence (rural, urban, metropolitan) and the use of dipeptidyl peptidase 4 inhibitors (DPP-4i) for first treatment intensification of type 2 diabetes. Methods A retrospective cohort study was conducted from April 1, 2008 to March 31, 2019 of new metformin users. A multivariable logistic regression analysis was performed to determine the association between place of residence (using postal codes) and likelihood of DPP-4i dispensing. Results After adjusting for confounders, analysis revealed that rural-dwellers are less likely to have a DPP-4i dispensed, compared with metropolitan-dwellers (aOR:0.64; 95%CI:0.61-0.67) and over-time, the uptake in rural areas was slower. Conclusions This study demonstrates that rurality can have an impact on drug therapy decisions at first treatment intensification, with respect to the utilization of new therapies.
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Affiliation(s)
- Danielle K. Nagy
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 2-35, Medical Sciences Building, 8613 – 114 St., Edmonton, Alberta T6G1C9, Canada
| | - Lauren C. Bresee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N4N1, Canada
| | - Dean T. Eurich
- School of Public Health, University of Alberta, 2-040F Li Ka Shing Centre For Research, 11203 – 87 Ave NW, Edmonton, Alberta T6G2H5, Canada
| | - Scot H. Simpson
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 2-020C, Katz Group Centre for Research, 11315 – 87 Ave NW, Edmonton, Alberta T6G2H5, Canada
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Eurich DT, Wozniak LA, Soprovich A, Lee C, Minhas-Sandhu JK, Crowshoe L, Johnson JA, Samanani S. Effectiveness of RADAR on diabetes processes of care for First Nations communities in Alberta, Canada. Prim Care Diabetes 2024; 18:104-107. [PMID: 37951724 DOI: 10.1016/j.pcd.2023.11.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/29/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
The epidemic of type-2 diabetes in First Nations communities is tragic. Culturally-appropriate approaches addressing multiple components, focusing beyond glycemic control, are urgently needed. Using an intention-to-treat framework, 13 processes of care indicators were assessed to compare proportions of patients who received care at baseline relative to 2-year follow-up. Clinical improvements were demonstrated across major process of care indicators (e.g. screening, education, and vaccination activities). We found RADAR improved reporting for most diabetes processes of care across seven FN communities and was effective in supporting diabetes care for FN communities, in Alberta Canada.
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Affiliation(s)
- Dean T Eurich
- School of Public Health, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta T6G 2E1, Canada; Alliance for Canadian Health Outcomes Research in Diabetes, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta T6G 2E1, Canada.
| | - Lisa A Wozniak
- School of Public Health, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta T6G 2E1, Canada; Alliance for Canadian Health Outcomes Research in Diabetes, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - Allison Soprovich
- School of Public Health, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta T6G 2E1, Canada; Alliance for Canadian Health Outcomes Research in Diabetes, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - Cerina Lee
- School of Public Health, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta T6G 2E1, Canada; Alliance for Canadian Health Outcomes Research in Diabetes, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - Jasjeet K Minhas-Sandhu
- School of Public Health, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta T6G 2E1, Canada; Alliance for Canadian Health Outcomes Research in Diabetes, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - Lynden Crowshoe
- Cumming School of Medicine & Indigenous, Local and Global Health Office, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Jeffrey A Johnson
- School of Public Health, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta T6G 2E1, Canada; Alliance for Canadian Health Outcomes Research in Diabetes, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - Salim Samanani
- OKAKI Health Intelligence Inc., P.O. Box 84210 Market Mall, Calgary, Alberta T3A 5C4, Canada
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Maayah ZH, Ferdaoussi M, Alam A, Takahara S, Silver H, Soni S, Martens MD, Eurich DT, Dyck JRB. Cannabidiol Suppresses Cytokine Storm and Protects Against Cardiac and Renal Injury Associated with Sepsis. Cannabis Cannabinoid Res 2024; 9:160-173. [PMID: 36594988 DOI: 10.1089/can.2022.0170] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: Cytokine release syndrome, also termed "cytokine storm," is the leading cause of morbidity and mortality among patients with various conditions such as sepsis. While cytokine storm is associated with multiple organ damage, acute cardiac and renal injury represents a hallmark of cytokine storm. Since recent reports have suggested that cannabidiol (CBD) may assist in the treatment of inflammatory diseases, our objective was to examine the effect of CBD on cytokine storm-induced cardiac and renal injury using the lipopolysaccharide (LPS)-induced sepsis mouse model. Materials and Methods: At 8 weeks of age, mice were randomly assigned to receive CBD (15 mg/kg) or vehicle one hour before a single injection of either phosphate-buffered saline or LPS (10 mg/kg) for an additional 24 h. Results: Our results show that CBD improves cardiac function and reduces renal injury in a mouse model of cytokine storm. Moreover, our data indicate that CBD significantly reduces systemic and renal inflammation to contribute to the improvements observed in a cytokine storm-model of cardiac and renal injury. Conclusions: Overall, the findings of this study suggest that CBD could be repurposed to reduce morbidity in patients with cytokine storm particularly in severe infections such as sepsis.
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Affiliation(s)
- Zaid H Maayah
- Department of Pharmaceutical Sciences, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Mourad Ferdaoussi
- Cardiovascular Research Centre, Departments of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Abrar Alam
- Cardiovascular Research Centre, Departments of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Shingo Takahara
- Cardiovascular Research Centre, Departments of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Heidi Silver
- Cardiovascular Research Centre, Departments of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Shubham Soni
- Cardiovascular Research Centre, Departments of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew D Martens
- Cardiovascular Research Centre, Departments of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, Departments of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Dubois C, Lunghi C, Eurich DT, Dyck JRB, Hyshka E, Hanlon JG, Zongo A. Medical cannabis authorization and risk of emergency department visits and hospitalization due to psychotic disorders: A propensity score-matched cohort study. Schizophr Res 2024; 264:534-542. [PMID: 38330686 DOI: 10.1016/j.schres.2024.01.029] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 02/10/2024]
Abstract
Despite evidence showing that recreational cannabis use is associated with a higher risk of psychotic disorders, this risk has not been well characterized for patients using medical cannabis. Therefore, this study assessed the risk of emergency department (ED) visits and hospitalization for psychotic disorders (the study outcome) among adult patients authorized to use medical cannabis. We performed a retrospective cohort study on patients authorized to use medical cannabis in a group of Ontario cannabis clinics between 2014 and 2019. Using clinical and health administrative data, each patient was matched by propensity scores to up to 3 population-based controls. Conditional Cox proportional hazards regressions were used to assess the risk. Among 54,006 cannabis patients matched to 161,265 controls, 39 % were aged ≤50 years, and 54 % were female. Incidence rates for psychotic disorders were 3.00/1000 person-years (95%CI: 2.72-3.32) in the cannabis group and 1.88/1000 person-years (1.75-2.03) in the control group. A significant association was observed, with an adjusted hazard ratio of 1.38 (95%CI: 1.19-1.60) in the total sample and 1.63 (1.40-1.91) in patients without previous psychotic disorders. The results suggest that cannabis authorization should include a benefit-risk assessment of psychotic disorders to minimize the risk of events requiring emergency attention.
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Affiliation(s)
- Cerina Dubois
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Carlotta Lunghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Department of Health Sciences, Université du Québec à Rimouski, Lévis, Quebec, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec, Université Laval Research Centre, Quebec City, Quebec, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - John G Hanlon
- St. Michael's Hospital Department of Anesthesia, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Ontario, Canada
| | - Arsene Zongo
- Population Health and Optimal Health Practices Research Unit, CHU de Québec, Université Laval Research Centre, Quebec City, Quebec, Canada; Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada.
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Lee C, Ye M, Weaver O, Jess E, Gilani F, Samanani S, Eurich DT. Defining opioid naïve and implications for monitoring opioid use: A population-based study in Alberta, Canada. Pharmacoepidemiol Drug Saf 2024; 33:e5693. [PMID: 37679887 DOI: 10.1002/pds.5693] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/17/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE Reducing initial exposure of "opioid naïve" patients to opioids is a public health priority. Identifying opioid naïve patients is difficult, as numerous definitions are used. The objective is to summarize current definitions and evaluate their impact on opioid naïve measures in Alberta. METHODS An exploratory data analysis of the literature was conducted over the last 10 years to identify definitions commonly used in the literature to define opioid naïve. Then, using these definitions as a guide, we descriptively report the proportion of patients in Alberta between 2017 and 2021 who would be considered as opioid naïve using these definitions and all opioid dispensing data. RESULTS Three categories of definitions were broadly identified: (1) no opioid use within the previous 30 days/6 months/1 year, based on dispensation date; (2) no opioid use based on dispensation date plus days of supply; and, (3) exclusion of codeine from Definitions 1 and 2. Applying these definitions to the Alberta population showed a very wide range in the proportion who would be considered as opioid naïve. Overall, 36.4% of Albertans (n = 1 551 075) had an opioid dispensation in 2017-2021. The average age was 46.6 ± 18.8 and 52.8% were female. The proportion of opioid naïve were most affected by the "opioid free" period, with 97.4%, 83.2%, and 65.6% being classified as opioid naïve using time windows from Definition 1 (30 days, 6 months, 1 year of no prior opioid use). Definitions 2 and 3 did not materially change the results. Further extending the "opioid free" period to 2 years showed only 35% were opioid naïve. CONCLUSIONS The most convenient definition for "opioid naïve" was the use of an "opioid free" period. The choice of window would depend on how the information may be used to assistant in clinical decisions with longer windows more likely to reflect true opioid naïve patients. Irrespective of definition used, a large proportion of opioid users would be considered opioid naïve in Alberta.
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Affiliation(s)
- Cerina Lee
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Ming Ye
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Olivia Weaver
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Ed Jess
- College of Physicians and Surgeons of Alberta, Edmonton, Alberta, Canada
| | - Fizza Gilani
- College of Physicians and Surgeons of Alberta, Edmonton, Alberta, Canada
| | - Salim Samanani
- OKAKI Health Intelligence Inc., Calgary, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Lee C, Danielson EC, Beestrum M, Eurich DT, Knapp A, Jordan N. Medical Cannabis and Its Efficacy/Effectiveness for the Treatment of Low-Back Pain: a Systematic Review. Curr Pain Headache Rep 2023; 27:821-835. [PMID: 38041708 PMCID: PMC11095816 DOI: 10.1007/s11916-023-01189-0] [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] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE OF REVIEW This systematic review aims to inform the current state of evidence about the efficacy and effectiveness of medical cannabis use for the treatment of LBP, specifically on pain levels and overall opioid use for LBP. Searches were conducted in MEDLINE (PubMed), Embase, and CINAHL. The search was limited to the past 10 years (2011-2021). Study inclusion was determined by the critical appraisal process using the Joanna Briggs Institute framework. Only English language articles were included. Participant demographics included all adult individuals with LBP who were prescribed medical cannabis for LBP and may be concurrently using opioids for their LBP. Study quality and the risk of bias were both evaluated. A narrative synthesis approach was used. RECENT FINDINGS A total of twelve studies were included in the synthesis: one randomized controlled trial (RCT), six observational studies (one prospective, four retrospective, and one cross-over), and five case studies. All study results, except for the RCT, indicated a decrease in LBP levels or opioid use over time after medical cannabis use. The RCT reported no statistically significant difference in LBP between cannabis and placebo groups. Low back pain (LBP) affects 568 million people worldwide. In the United States, LBP treatment represents more than half of regular opioid users. With the opioid epidemic, alternative methods, particularly medical cannabis, is now increasingly sought by practicing physicians and patients. Due to its infancy, there is minimal high-quality evidence to support medical cannabis use as a first line treatment for LBP.
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Affiliation(s)
- Cerina Lee
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - Elizabeth C Danielson
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Molly Beestrum
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Ashley Knapp
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Neil Jordan
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
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11
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Alkabbani W, Shah BR, Zongo A, Eurich DT, Alsabbagh MW, Gamble JM. Post-initiation predictors of discontinuation of the sodium-glucose cotransporter-2 inhibitors: A comparative cohort study from the United Kingdom. Diabetes Obes Metab 2023; 25:3490-3500. [PMID: 37563767 DOI: 10.1111/dom.15241] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
AIMS To assess post-initiation predictors of discontinuation of sodium-glucose cotransporter-2 (SGLT2) inhibitors compared to dipeptidyl-peptidase-4 (DPP-4) inhibitors in the United Kingdom. MATERIALS AND METHODS We conducted a comparative population-based retrospective cohort study using primary care data from the UK Clinical Practice Research Datalink (CPRD) with linked data to hospital and death records. We included new metformin users who initiated either SGLT2 inhibitors or DPP-4 inhibitors between January 2013 and October 2019. The main outcome was treatment discontinuation, defined as the first 90-day gap after the estimated treatment end date. We used a series of extended Cox models to assess which time-dependent predictors were associated with treatment discontinuation. To test if the hazard ratio of discontinuation for each predictor was statistically different between SGLT2 and DPP-4 inhibitors, an exposure-predictor interaction term was added to each model. RESULTS There were 2550 new users of SGLT2 inhibitors and 8195 new users of DPP-4 inhibitors. Approximately 69% of SGLT2 inhibitor and 74% of DPP-4 inhibitor users had discontinued treatment by the end of follow-up. Occurrence of fractures after treatment initiation was a significant predictor of discontinuation of SGLT2 inhibitors (hazard ratio [HR] 4.13, 95% confidence interval [CI] 2.12-8.06) but not DPP-4 inhibitors (HR 0.93, 95% CI 0.79-1.11). The rate of treatment discontinuation was significantly higher for those with low estimated glomerular filtration rate and minimal contact with the healthcare system. Efficacy endpoints, such as heart failure and glycated haemoglobin level, were not associated with treatment discontinuation. CONCLUSIONS Our findings reflect some discrepancy between the available evidence and prescribing behaviour for SGLT2 inhibitors.
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Affiliation(s)
- Wajd Alkabbani
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Arsène Zongo
- Faculty of Pharmacy and CHU de Quebec Research Center-Université Laval, Quebec City, Quebec, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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12
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Weaver OR, Ye M, Vena JE, Eurich DT, Proctor SD. Non-fasting lipids and cardiovascular disease in those with and without diabetes in Alberta's Tomorrow Project: A prospective cohort study. Diabet Med 2023; 40:e15133. [PMID: 37171453 DOI: 10.1111/dme.15133] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 05/13/2023]
Abstract
AIMS Non-fasting remnant cholesterol (RC) is a novel marker of cardiovascular disease (CVD) risk, however, data on this relationship in Canadians with diabetes (at high risk of CVD) is lacking. The objective of this analysis was to determine the relationship of RC with CVD in individuals with and without diabetes in the Alberta's Tomorrow Project (ATP) cohort. METHODS Non-fasting lipid data collected as part of the ATP was linked to administrative health records (October 2000-March 2015) to ascertain incident CVD and prevalent diabetes. Participants without prevalent CVD or incident diabetes and who had complete, non-negative non-fasting lipid data collected with triglycerides <4.5 mmol/L were included (n = 13,631). The relationship between non-fasting RC and incident CVD diagnoses was assessed by Cox proportional hazards regression, after stratification by diabetes status. RESULTS Participants were 69.8% women with a mean age of 61.6 ± 9.7 years, and 6.5% had prevalent diabetes. Non-fasting RC was higher in participants with diabetes compared to those without (mean 0.94 ± 0.41 mmol/L vs. 0.77 ± 0.38 mmol/L, p < 0.0001) and was associated with increased risk of incident CVD among those without diabetes (adjusted hazard ratio (aHR) 1.22, 95% CI 1.03-1.43, p = 0.02). Although a similar trend was observed in participants with diabetes it did not reach statistical significance (aHR 1.31, 95% CI 0.84-2.05, p = 0.23). CONCLUSIONS Elevated non-fasting RC predicted increased CVD risk in middle and older-aged adults without diabetes; similar trends were observed in participants with diabetes and require further testing in a larger sample.
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Affiliation(s)
- Olivia R Weaver
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Ming Ye
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer E Vena
- Alberta's Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Spencer D Proctor
- Metabolic and Cardiovascular Diseases Laboratory, University of Alberta, Edmonton, Alberta, Canada
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Sharma V, Kulkarni V, Joon T, Eurich DT, Simpson SH, Voaklander D, Wright B, Samanani S. Predicting falls-related admissions in older adults in Alberta, Canada: a machine-learning falls prevention tool developed using population administrative health data. BMJ Open 2023; 13:e071321. [PMID: 37607796 PMCID: PMC10445355 DOI: 10.1136/bmjopen-2022-071321] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/26/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE To construct a machine-learning (ML) model for health systems with organised falls prevention programmes to identify older adults at risk for fall-related admissions. DESIGN This prognostic study used population-level administrative health data to develop an ML prediction model. SETTING This study took place in Alberta, Canada during 2018-2019. PARTICIPANTS Albertans aged 65 and older with at least one prior admission. Those with palliative conditions or emigrated out of Alberta were excluded. EXPOSURE Unit of analysis was the individual person. MAIN OUTCOMES/MEASURES We identified fall-related admissions. A CatBoost model was developed on 2018 data to predict risk of fall-related emergency department visits or hospitalisations. Temporal validation was done using 2019 data to evaluate model performance. We reported discrimination, calibration and other relevant metrics measured at the end of 2019 on both ranked predictions and predicted probability thresholds. A cost-savings simulation was performed using 2019 data. RESULTS Final number of study participants was 224 445. The validation set had 203 584 participants with 19 389 fall-related events (9.5% pretest probability) and an ML model c-statistic of 0.70. The highest ranked predictions had post-test probabilities ranging from 40% to 50%. Net benefit analysis presented mixed results with some net benefit using the ML model in the 6%-30% range. The top 50 percentile of predicted risks represented nearly $C60 million in health system costs related to falls. Intervening on the top 25 or 50 percentiles of predicted risk could realise substantial (up to $C16 million) savings. CONCLUSION ML prediction models based on population-level administrative data can assist health systems with fall prevention programmes identify older adults at risk of fall-related admissions and reduce costs. ML predictions based on ranked predictions or probability thresholds could guide subsequent interventions to mitigate fall risks. Increased access to diverse forms of data could improve ML performance and further reduce costs.
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Affiliation(s)
- Vishal Sharma
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Scot H Simpson
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Don Voaklander
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Bruce Wright
- Island Medical Program, University of Victoria, Victoria, British Columbia, Canada
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Sevcik B, Lobay K, Luu H, Martins KJB, Vu K, Nguyen PU, Bohlouli S, Eurich DT, Lester ELW, Williamson T, Richer L, Klarenbach SW. Analgesic Use Among Adults with a Trauma-Related Emergency Department Visit: A Retrospective Cohort Study from Alberta, Canada. Pain Ther 2023; 12:1039-1053. [PMID: 37269501 PMCID: PMC10289951 DOI: 10.1007/s40122-023-00521-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/25/2023] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION A better understanding of current acute pain-driven analgesic practices within the emergency department (ED) and upon discharge will provide foundational information in this area, as few studies have been conducted in Canada. METHODS Administrative data were used to identify adults with a trauma-related ED visit in the Edmonton area in 2017/2018. Characteristics of the ED visit included time from initial contact to analgesic administration, type of analgesics dispensed during and upon being discharged home directly from the ED (≤ 7 days after), and patient characteristics. RESULTS A total of 50,950 ED visits by 40,505 adults with trauma were included. Analgesics were administered in 24.2% of visits, of which non-opioids were dispensed in 77.0% and opioids were dispensed in 49.0%. Time to analgesic initiation occurred more than 2 h after first contact. Upon discharge, 11.5% received a non-opioid and 15.2% received an opioid analgesic, among whom 18.5% received a daily dose ≥ 50 morphine milligram equivalents (MME) and 30.2% received > 7 days of supply. Three hundred and seventeen adults newly met criteria for chronic opioid use after the ED visit, among whom 43.5% received an opioid dispensation upon discharge; of these individuals, 26.8% had a daily dose ≥ 50 MME and 65.9% received > 7 days of supply. CONCLUSIONS Findings can be used to inform optimization of analgesic pharmacotherapy practices for the treatment of acute pain, which may include reducing the time to initiation of analgesics in the ED, as well as close consideration of recommendations for acute pain management upon discharge to provide ideal patient-centered, evidence-informed care.
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Affiliation(s)
- Bill Sevcik
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kevin Lobay
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Huong Luu
- Real World Evidence Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Karen J B Martins
- Real World Evidence Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Khanh Vu
- Real World Evidence Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Phuong Uyen Nguyen
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Solmaz Bohlouli
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Erica L W Lester
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lawrence Richer
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Scott W Klarenbach
- Department of Medicine and Real World Evidence Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
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Yuzbashian E, Fernando DN, Pakseresht M, Eurich DT, Chan CB. Dairy product consumption and risk of non-alcoholic fatty liver disease: A systematic review and meta-analysis of observational studies. Nutr Metab Cardiovasc Dis 2023; 33:1461-1471. [PMID: 37244850 DOI: 10.1016/j.numecd.2023.04.018] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND AND AIMS It is unclear whether regular consumption of dairy products is associated with the risk of developing non-alcoholic fatty liver disease (NAFLD). Thus, we conducted a systematic review followed by a meta-analysis of studies reporting on the association of dairy consumption with NAFLD risk. METHODS AND RESULTS We comprehensively searched PubMed, Web of Science, and Scopus for observational studies that evaluated the association between dairy intake and NAFLD likelihood that were published before September 1, 2022. The reported odds ratios (ORs) of fully adjusted models and their 95% confidence intervals (CIs) were pooled using a random-effects model for the meta-analysis. Out of 1206 articles retrieved, 11 observational studies, including 43,649 participants and 11,020 cases, were included. Pooled OR indicated a significant association between dairy intake and NAFLD (OR = 0.90; 95% CI: 0.83, 0.98; I2 = 67.8%, n = 11). Pooled ORs revealed that milk (OR: 0.86; 95% CI: 0.78, 0.95; I2 = 65.7%, n = 6), yogurt (OR: 0.88; 95% CI: 0.82; I2 = 0.0%, n = 4), and high-fat dairy (OR: 0.38; 95% CI: 0.19, 0.75; I2 = 0.0%, n = 5) consumption was inversely associated with NAFLD while cheese was not linked to NAFLD risk. CONCLUSION We observed that consumption of dairy products is linked to a reduced risk of developing NAFLD. Overall, the data in the source articles is of low to moderate quality; therefore, further observational studies are required to support the current findings (PROSPERO Reg. number: CRD42022319028).
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Affiliation(s)
- Emad Yuzbashian
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Dineli N Fernando
- Department of Cell Biology, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammadreza Pakseresht
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada; Alberta Health Services, Edmonton, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine B Chan
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada; Department of Physiology, University of Alberta, Edmonton, Alberta, Canada.
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16
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Weaver OR, Krysa JA, Ye M, Vena JE, Eurich DT, Proctor SD. Nonfasting remnant cholesterol and cardiovascular disease risk prediction in Albertans: a prospective cohort study. CMAJ Open 2023; 11:E645-E653. [PMID: 37491049 PMCID: PMC10374248 DOI: 10.9778/cmajo.20210318] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND European studies have shown that nonfasting remnant cholesterol can be a strong predictor of cardiovascular disease risk and may contribute to identifying residual risk; however, Canadian data are lacking on nonfasting remnant cholesterol. In this study, we aimed to determine the relation between nonfasting remnant cholesterol, low-density lipoprotein (LDL) cholesterol and cardiovascular disease among people in Alberta. METHODS In this retrospective analysis, we used data from Alberta's Tomorrow Project, a large prospective cohort that enrolled Albertans aged 35-69 years (2000-2015). Participants with consent to data linkage, with complete nonfasting lipid data and without existing cardiovascular disease were included. The nonfasting remnant cholesterol and LDL cholesterol relation with a composite cardiovascular disease outcome of major incident cardiovascular diagnoses, ascertained by linking to Alberta Health databases, was determined by multivariable logistic regression, adjusting for age, sex, statin use, comorbidities, and LDL cholesterol or remnant cholesterol. RESULTS The final sample of 13 988 participants was 69.4% female, and the mean age was 61.8 (standard deviation [SD] 9.7) years. Follow-up time was approximately 15 years. Mean remnant cholesterol was significantly higher among individuals with versus without cardiovascular disease (0.87 [SD 0.40] mmol/L v. 0.78 [SD 0.38] mmol/L, standardized mean difference [SMD] -0.24), and mean LDL cholesterol was significantly lower (2.69 [SD 0.93] mmol/L v. 2.88 [SD 0.84] mmol/L, SMD 0.21). The odds of incident composite cardiovascular disease were significantly increased per mmol/L increase in remnant cholesterol (adjusted odds ratio [OR] 1.48, 95% confidence interval [CI] 1.27-1.73) but significantly decreased per mmol/L increase in LDL cholesterol (adjusted OR 0.73, 95% CI 0.68-0.79). INTERPRETATION In this large Albertan cohort of predominantly older females, nonfasting remnant cholesterol had a positive relation with cardiovascular disease incidence, whereas LDL cholesterol did not. These findings support the clinical utility of measuring non-fasting remnant cholesterol to detect cardiovascular disease risk.
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Affiliation(s)
- Olivia R Weaver
- School of Public Health (Weaver, Ye, Eurich) and Metabolic and Cardiovascular Diseases Laboratory (Krysa, Proctor), University of Alberta, Edmonton, Alta.; Alberta's Tomorrow Project (Vena), Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alta
| | - Jacqueline A Krysa
- School of Public Health (Weaver, Ye, Eurich) and Metabolic and Cardiovascular Diseases Laboratory (Krysa, Proctor), University of Alberta, Edmonton, Alta.; Alberta's Tomorrow Project (Vena), Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alta
| | - Ming Ye
- School of Public Health (Weaver, Ye, Eurich) and Metabolic and Cardiovascular Diseases Laboratory (Krysa, Proctor), University of Alberta, Edmonton, Alta.; Alberta's Tomorrow Project (Vena), Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alta
| | - Jennifer E Vena
- School of Public Health (Weaver, Ye, Eurich) and Metabolic and Cardiovascular Diseases Laboratory (Krysa, Proctor), University of Alberta, Edmonton, Alta.; Alberta's Tomorrow Project (Vena), Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alta
| | - Dean T Eurich
- School of Public Health (Weaver, Ye, Eurich) and Metabolic and Cardiovascular Diseases Laboratory (Krysa, Proctor), University of Alberta, Edmonton, Alta.; Alberta's Tomorrow Project (Vena), Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alta
| | - Spencer D Proctor
- School of Public Health (Weaver, Ye, Eurich) and Metabolic and Cardiovascular Diseases Laboratory (Krysa, Proctor), University of Alberta, Edmonton, Alta.; Alberta's Tomorrow Project (Vena), Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alta.
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Makhinova T, Johnson JA, Minhas-Sandhu JK, Necyk C, Bhutani M, Eurich DT. Pharmacists' chronic disease management in chronic obstructive pulmonary disease: Effect on health services utilization. J Manag Care Spec Pharm 2023; 29:671-679. [PMID: 37276041 PMCID: PMC10388007 DOI: 10.18553/jmcp.2023.29.6.671] [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: 06/07/2023]
Abstract
BACKGROUND: There is limited real-world evidence on evaluation of chronic disease management initiatives provided by pharmacists to patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE: To evaluate changes in COPD-related health care resource utilization between patients with COPD who had pharmacist-provided chronic disease management (comprehensive annual care plan [CACP]) vs those who did not have CACP. METHODS: Patients with COPD who received a CACP in Alberta between 2012 and 2015 were identified within the Alberta Health administrative data. Each of these patients were matched with 2 control patients with COPD based on age, sex, provider, date of service, and qualifying comorbidities. Controlled interrupted time series analysis was used to evaluate changes in COPD-specific hospitalizations, emergency department (ED) visits, physician visits, and claims for pulmonary function test. Immediate and temporal changes were calculated for the difference in outcomes 1 year before and 1 year after receiving the CACP for the intervention group and matched controls. RESULTS: Eligible patients (N = 74,365), of whom 28,795 (38.7%) had received CACPs, were matched to a total of 45,570 controls. In 1 year after the CACPs implementation, the number of COPD-related hospitalization visits decreased by 174 (95% CI = -270.8 to -76.5) per 10,000 patients per month, COPD-related ED visits decreased by 123 (95% CI = -294.9 to 49.6) per 10,000 per month, general practitioner visits decreased by 153.9 per 10,000 per month (95% CI = -293.3 to -14.5), and pulmonary function test claims decreased by 19.5 per 10,000 per month (95% CI = -70.1 to 31.2) when compared with the matched controls. However, significant difference between the 2 groups was found for COPD-related hospitalizations only, which was not confirmed by the sensitivity analysis. CONCLUSIONS: In patients with COPD who were provided with care plans by their community pharmacists, there was no significant decrease in COPD-related hospitalizations or ED visits over 1 year compared with the matched controls who did not have a pharmacist-provided care plan. Physician visits and pulmonary function tests did not change significantly for those who had CACP compared with those who did not. There is a need to further understand how care plans can better impact other outcomes that are important in COPD management. DISCLOSURES: This study was supported by a grant from the M.S.I. Foundation (Grant#895) based in Alberta, Canada. Dr Bhutani has consulted for Astra Zeneca, GlaxoSmithKline, Boehringer Ingelheim, Valeo, Covis, and Sanofi. The authors declare no other relevant conflicts of interest or financial relationships. This study is based on data provided by Alberta Health. The interpretation and conclusions of the results are those of the researchers and do not necessarily represent the views of the government of Alberta nor the funder (M.S.I. Foundation). All authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors.
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Affiliation(s)
| | | | | | | | - Mohit Bhutani
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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18
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Mosquera L, El Emam K, Ding L, Sharma V, Zhang XH, Kababji SE, Carvalho C, Hamilton B, Palfrey D, Kong L, Jiang B, Eurich DT. A method for generating synthetic longitudinal health data. BMC Med Res Methodol 2023; 23:67. [PMID: 36959532 PMCID: PMC10034254 DOI: 10.1186/s12874-023-01869-w] [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: 04/18/2022] [Accepted: 02/19/2023] [Indexed: 03/25/2023] Open
Abstract
Getting access to administrative health data for research purposes is a difficult and time-consuming process due to increasingly demanding privacy regulations. An alternative method for sharing administrative health data would be to share synthetic datasets where the records do not correspond to real individuals, but the patterns and relationships seen in the data are reproduced. This paper assesses the feasibility of generating synthetic administrative health data using a recurrent deep learning model. Our data comes from 120,000 individuals from Alberta Health's administrative health database. We assess how similar our synthetic data is to the real data using utility assessments that assess the structure and general patterns in the data as well as by recreating a specific analysis in the real data commonly applied to this type of administrative health data. We also assess the privacy risks associated with the use of this synthetic dataset. Generic utility assessments that used Hellinger distance to quantify the difference in distributions between real and synthetic datasets for event types (0.027), attributes (mean 0.0417), Markov transition matrices (order 1 mean absolute difference: 0.0896, sd: 0.159; order 2: mean Hellinger distance 0.2195, sd: 0.2724), the Hellinger distance between the joint distributions was 0.352, and the similarity of random cohorts generated from real and synthetic data had a mean Hellinger distance of 0.3 and mean Euclidean distance of 0.064, indicating small differences between the distributions in the real data and the synthetic data. By applying a realistic analysis to both real and synthetic datasets, Cox regression hazard ratios achieved a mean confidence interval overlap of 68% for adjusted hazard ratios among 5 key outcomes of interest, indicating synthetic data produces similar analytic results to real data. The privacy assessment concluded that the attribution disclosure risk associated with this synthetic dataset was substantially less than the typical 0.09 acceptable risk threshold. Based on these metrics our results show that our synthetic data is suitably similar to the real data and could be shared for research purposes thereby alleviating concerns associated with the sharing of real data in some circumstances.
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Affiliation(s)
- Lucy Mosquera
- Replica Analytics Ltd, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1J 8L1, Canada
| | - Khaled El Emam
- Replica Analytics Ltd, Ottawa, ON, Canada.
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1J 8L1, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
| | - Lei Ding
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Vishal Sharma
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | | | - Samer El Kababji
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1J 8L1, Canada
| | | | | | - Dan Palfrey
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Linglong Kong
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Bei Jiang
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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Nagy DK, Bresee LC, Eurich DT, Simpson SH. Rural Residence Is Associated With a Delayed Trend Away From Sulfonylurea Use for Treatment Intensification of Type 2 Diabetes. Diabetes Care 2023; 46:613-619. [PMID: 36637880 DOI: 10.2337/dc22-1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/17/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To examine the intersection between location of residence along the rural-urban continuum (metropolitan, urban, and rural) and sulfonylurea dispensation records for the management of type 2 diabetes. RESEARCH DESIGN AND METHODS This retrospective cohort study used administrative health records of adult new metformin users between April 2008 and March 2019 in Alberta, Canada. Multivariable logistic regression was performed to examine the association between sulfonylurea-based treatment intensification and location of residence. RESULTS Treatment was intensified in 66,084 (38%) of 171,759 new metformin users after a mean of 1.5 years. At treatment intensification, mean age was 55 years, 62% of users were male, and 27% were rural residents. The most common antihyperglycemic drug, given to 30,297 people (46%) for treatment intensification, was a sulfonylurea. At the beginning of our observation period, the proportion of people dispensed a sulfonylurea at first treatment intensification was highest in rural (57%), compared with urban (54%) and metropolitan (52%) areas (P = 0.009). Although proportions decreased over time across the province, rural residents continued to constitute the highest proportion of sulfonylurea users (45%), compared with urban (35%) and metropolitan (37%) residents (P < 0.001), and the trend away from sulfonylurea use was delayed by ∼4 years for rural residents. Adjusting for potential sources of confounding, rural residence was associated with a significantly higher likelihood of using a sulfonylurea compared with metropolitan residence (adjusted odds ratio 1.34; 95% CI 1.29-1.39). CONCLUSIONS Variation in sulfonylurea dispensation across the rural-urban continuum provides a basis for continued research in the differences in process of care by location.
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Affiliation(s)
- Danielle K Nagy
- 1Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Lauren C Bresee
- 2Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dean T Eurich
- 3School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Scot H Simpson
- 1Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
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Ye M, Vena JE, Johnson JA, Shen-Tu G, Eurich DT. Impact of Co-morbidity on Hospitalization and Emergency Room Visits in People with Diabetes: A Longitudinal Study of Alberta’s Tomorrow Project. Can J Diabetes 2023:S1499-2671(23)00039-4. [PMID: 37178108 DOI: 10.1016/j.jcjd.2023.02.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/17/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Our aim in this study was to characterize the impact of comorbidities, including number and types, on hospitalization and emergency room (ER) visits in people with diabetes. METHODS Incident cases of diabetes from Alberta's Tomorrow Project with >24 months of follow-up were included. Comorbidities, classified by Elixhauser conditions, were updated every 12 months after diagnosis. A generalized estimating equation model was used to examine the association (by incidence rate ratio [IRR]) between time-varying comorbidity profile and hospitalization and ER visits per year of follow-up after adjusting for sociodemographic factors, lifestyle behaviours, and historic health-care utilization in the previous 5 years. RESULTS Among 2,110 incident cases of diabetes (51.0% females; median age at diagnosis: 59.5 years; median follow-up: 7.19 years), the average number of Elixhauser comorbidities was 1.9±1.6 in the first year of diagnosis and 3.3±2.0 in year 15 after diagnosis. The number of comorbidities in the previous year was positively associated with risk of hospitalization (IRR=1.33 [95% confidence interval {CI}: 1.04 to 1.70] and 2.14 [95% CI: 1.67 to 2.74] for 1 or 2 and ≥2 comorbidities, respectively) and ER visits (IRR=1.31 [95% CI: 1.15 to 1.50] and 1.62 [95% CI: 1.41 to 1.87] for 1 or 2 and ≥2 comorbidities, respectively) in the subsequent year. Cardiovascular diseases, peripheral vascular diseases, cancer, liver disease, fluid and electrolyte disorders, and depression were the conditions most typically associated with increased health-care utilization. CONCLUSIONS The number of comorbidities was a major risk factor of health-care utilization for people with diabetes. Vascular diseases, cancer, and conditions closely related to diabetic frailty (e.g. fluid and electrolyte disorders and depression) were the main drivers of hospital care and ER visits.
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Ta D, Ishaque AH, Elamy A, Anand T, Wu A, Eurich DT, Luk C, Yang YH, Kalra S. Severity of in vivo corticospinal tract degeneration is associated with survival in amyotrophic lateral sclerosis: a longitudinal, multicohort study. Eur J Neurol 2023; 30:1220-1231. [PMID: 36692202 DOI: 10.1111/ene.15686] [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: 11/24/2022] [Accepted: 12/18/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE This study sought to evaluate the relationship of progressive corticospinal tract (CST) degeneration with survival in patients with amyotrophic lateral sclerosis (ALS). METHODS Forty-one ALS patients and 42 healthy controls were prospectively recruited from the Canadian ALS Neuroimaging Consortium. Magnetic resonance imaging scanning and clinical evaluations were performed on participants at three serial visits with 4-month intervals. Texture analysis was performed on T1-weighted magnetic resonance imaging scans and the texture feature 'autocorrelation' was quantified. Whole-brain group-level comparisons were performed between patient subgroups. Linear mixed models were used to evaluate longitudinal progression. Region-of-interest and 3D voxel-wise Cox proportional-hazards regression models were constructed for survival prediction. For all survival analyses, a second independent cohort was used for model validation. RESULTS Autocorrelation of the bilateral CST was increased at baseline and progressively increased over time at a faster rate in ALS short survivors. Cox proportional-hazards regression analyses revealed autocorrelation of the CST as a significant predictor of survival at 5 years follow-up (hazard ratio 1.28, p = 0.005). Similarly, voxel-wise whole-brain survival analyses revealed that increased autocorrelation of the CST was associated with shorter survival. ALS patients stratified by median autocorrelation in the CST had significantly different survival times using the Kaplan-Meier curve and log-rank tests (χ2 = 7.402, p = 0.007). CONCLUSIONS Severity of cerebral degeneration is associated with survival in ALS. CST degeneration progresses faster in subgroups of patients with shorter survival. Neuroimaging holds promise as a tool to improve patient management and facilitation of clinical trials.
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Affiliation(s)
- Daniel Ta
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Abdullah H Ishaque
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Adam Elamy
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Tanushka Anand
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew Wu
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Collin Luk
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Yee Hong Yang
- Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada
| | - Sanjay Kalra
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.,Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Jogiat UM, Bédard ELR, Sasewich H, Turner SR, Eurich DT, Filafilo H, Baracos V. Sarcopenia reduces overall survival in unresectable oesophageal cancer: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2022; 13:2630-2636. [PMID: 36151845 PMCID: PMC9745498 DOI: 10.1002/jcsm.13082] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/02/2022] [Accepted: 08/18/2022] [Indexed: 12/24/2022] Open
Abstract
Sarcopenia measured through body composition analysis is emerging as an important prognosticator among various malignancies, including oesophageal cancer. Skeletal muscle index (SMI) as determined by the third lumbar vertebrae on cross-sectional CT images has been demonstrated as a predictor of overall survival in oesophageal cancer, using pre-defined cut off values for sarcopenia. However, this is largely within the setting of resectable disease. The primary objective of this systematic review and meta-analysis was to determine the effect of sarcopenia defined by SMI on overall-survival in patients with unresectable oesophageal cancer. On 30 January 2021, a systematic search of the literature was conducted to identify the role of SMI among patients with unresectable oesophageal cancer, with overall survival as the primary outcome. Databases included MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library. Inclusion criteria included age >18, diagnosis of oesophageal cancer, and non-operative management. A meta-analysis was conducted using RevMan 5.4.1 using an inverse variance, random effects model. After the removal of duplicates, 2755 unique search results were obtained. Manual screening of titles and abstracts resulted in 287 full text articles that were reviewed. Of these, five studies met the inclusion criteria with data evaluating the effect of sarcopenia defined by SMI on overall survival. A total of 783 patients, the majority of which were male (n = 638, 81%), with a mean age of 68 ± 2.3 years were included. 641 (82%) patients were diagnosed with squamous cell carcinoma. Sarcopenia, as determined by SMI using pre-defined cut-off values, was reported in 517 patients (66%). Meta-analysis demonstrated decreased overall survival in the sarcopenia group compared with the non-sarcopenia group (HR = 1.51; 95% CI 1.21-1.89; P = 0.0003; I2 = 0%; Figure 1). No significant publication bias was noted on assessment of funnel plot and Egger's test (P = 0.295). Sarcopenia as defined by SMI is predictive of overall survival among patients with nonoperative oesophageal cancer. Further analysis on the effect of sarcopenia on treatment related adverse effects and complications, particularly related to chemotherapy, radiotherapy, and oesophageal stenting, is needed to identify the degree of prognostication offered by body composition analysis. Studies on the modifiability of sarcopenia will help determine the utility of nutritional interventions.
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Affiliation(s)
- Uzair M Jogiat
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Eric L R Bédard
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Hannah Sasewich
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Simon R Turner
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Heather Filafilo
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Vickie Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
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Kaul P, Manh Chu L, Dover DC, Eurich DT, Yeung RO, Senior P, Butalia S. Cardiovascular disease risk in males and females with new onset diabetes: a population-based study in universal health care setting. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1272] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The evidence on whether long-term cardiovascular disease (CVD) outcomes differ among males and females with incident diabetes remains equivocal.
Objective
To examine sex-differences in the association between incident diabetes and 5-year risk of CVD and mortality at the population-level.
Methods
The study population consisted of an inception cohort of individuals between 40 and 80 years without diabetes or CVD on April 1, 2013 in the province of Alberta, Canada (N=1,315,885). Incident diabetes during a 3-year period was used to categorize males and females by diabetes status as of March 31, 2016. Primary outcome of interest was a combination of CVD hospitalization (defined as a hospitalization with a primary diagnosis of heart failure, acute coronary syndromes, cerebrovascular disorders, atrial fibrillation and flutter, ventricular arrhythmia, or sudden cardiac death) or all-cause mortality over a 5-year period until March 31, 2021. Inverse probability of treatment weighting (IPTW) was used to reduce the impact of confounders between individuals with and without diabetes. Kaplan-Meier curves were used to examine unadjusted outcomes and Cox-proportional hazards models were used to examine the impact of diabetes on outcomes in males and females after adjusting for the following: age, hypertension, material deprivation, urban/rural residence, and comorbidity burden.
Results
Among 672,881 females and 643,004 males, 27,082 (4.0%) and 33,054 (5.1%) developed incident diabetes, respectively. Regardless of sex, individuals with diabetes were older and had higher rates of hypertension and other comorbidities. Overall, CVD hospitalization/mortality rates per 1000 person years were 7.5% (95% confidence interval (CI): 7.4–7.6) among females compared to 11.7% (95% CI: 11.6–11.8) among males. When stratified by diabetes status, the rates of the combined endpoint were 7.2% (95% CI: 7.1–7.3) among females with no diabetes (F w/o DM), 11.2% (95% CI: 11.1–11.3) among males with no diabetes (M w/o DM), 14.7% (95% CI: 14.0–15.3) among females with diabetes (F with DM) and 20.9% (95% CI: 20.1–21.6) among males with diabetes (M with DM, Figure 1). The adjusted hazard ratio (aHR) associated with diabetes on outcomes was similar among males (aHR 1.38 95% confidence interval (CI): 1.36–1.41) and females (aHR 1.39 95% CI: 1.36–1.42).
Conclusions
The presence of diabetes weakens the possible cardio-protection of female sex with respect to CVD outcomes. Future work aims to assess CVD prevention, management and treatment among males with females with incident diabetes.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research (CIHR) Sex and Gender Science Chair
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Affiliation(s)
- P Kaul
- University of Alberta , Edmonton , Canada
| | - L Manh Chu
- Alberta Health Services, Alberta SPOR Support Unit , Edmonton , Canada
| | - D C Dover
- Canadian Vigour Center , Edmonton , Canada
| | - D T Eurich
- University of Alberta , Edmonton , Canada
| | - R O Yeung
- University of Alberta , Edmonton , Canada
| | - P Senior
- University of Alberta , Edmonton , Canada
| | - S Butalia
- University of Calgary , Calgary , Canada
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Versluys KA, Eurich DT, Marrie TJ, Forgie S, Tyrrell GJ. Invasive pneumococcal disease and long-term outcomes in children: A 20-year population cohort study. Lancet Reg Health Am 2022; 14:100341. [PMID: 36777393 PMCID: PMC9903925 DOI: 10.1016/j.lana.2022.100341] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Although vaccination against Streptococcus pneumoniae infections (such as invasive pneumococcal disease (IPD)) are available, challenges remain in prevention efforts. Moreover, downstream sequelae in children is relatively unknown. Thus, we aimed to evaluate short and long-term health outcomes among children with IPD. METHODS Analysis of Streptococcus pneumoniae positive isolates from sterile body sites in children (0-17 years) in Alberta (Canada) from 1999 to 2019 was performed retrospectively (n=888). Cases were age and sex-matched to hospitalized population controls. Linkage to administrative health datasets was done to determine comorbidities and healthcare related outcomes. Cox proportional hazards were used to assess differences in time to mortality and hospitalisation between cases and controls in short (<30-day), intermediate (30-90 day), long-term (>90-day) follow-up. FINDINGS Proportionally more deaths occurred in cases (4.8 deaths/1000 person-years (PY)) than controls (2.7 deaths/1000 PY), leading to a significant adjusted hazard ratio (aHR) of 1.80 (95% CI 1.22-2.64). This increased risk of death was influenced primarily by short-term mortality (319 vs 36 deaths/1000 PY in cases vs controls respectively, aHR 8.78 [95% CI 3.33-23.18]), as no differences were seen in intermediate (14 vs 7 deaths/1000 PY; aHR 2.03, 95% CI 0.41-10.04) or long-term time intervals (2.4 vs 2.3 deaths/1000 PY, aHR 1.03, 95% CI 0.63-1.69). INTERPRETATION IPD continues to negatively impact survival in children despite vaccination. Although long-term impact on mortality and hospitalisations may not be substantial, the immediate effects of IPD are significant. FUNDING This work was supported by grants-in-aid from Pfizer Canada and Wyeth Canada Inc all to GJT.
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Affiliation(s)
- Kristen A. Versluys
- School of Public Health, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9, Canada
| | - Dean T. Eurich
- School of Public Health, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9, Canada
| | - Thomas J. Marrie
- Faculty of Medicine, Dalhousie University, 1459 Oxford Street, Halifax, NS B3H 4R2, Canada
| | - Sarah Forgie
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Alberta, 3-509 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9, Canada
| | - Gregory J. Tyrrell
- The Department of Laboratory Medicine and Pathology, Division of Diagnostic and Applied Microbiology, University of Alberta, Walter C. Mackenzie Health Sciences Centre, Edmonton, AB T6G 2H2, Canada
- The Provincial Laboratory for Public Health, 8440 112 Street NW, Edmonton, AB T6G 2J2, Canada
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Kaul P, Chu LM, Dover D, Yeung RO, Eurich DT, Butalia S. Disparities in adherence to diabetes screening guidelines among males and females in a universal care setting: A population-based study of 1,389,697 adults. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1938] [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: 10/14/2022] Open
Abstract
ObjectivesNational guidelines recommend that all adults over the age of 40 years undergo screening for diabetes at least once every 3-years. We examined the association between sex and adherence to diabetes screening after accounting for age, urban/rural residence and material deprivation. We also examined the subsequent incidence of prediabetes and diabetes in adherent and non-adherent individuals.
ApproachOur study is based on a retrospective population-level inception cohort of adults aged 40 - 79 years without pre-existing diabetes or cardiovascular disease on April 1, 2013. Data on hospitalizations, emergency department visits, ambulatory clinic visits, physician billing claims, pharmaceutical claims, centralized laboratory data, vital statistics death registry, and census data at the neighbourhood level were linked at the patient level for years 2013 to 2020. Adherence during a 3-year screening period (2013 – 2016) and prediabetes and diabetes during a 4-year follow-up period were examined. Multivariate logistic regression was used to examine the adjusted association between sex and adherence.
ResultsAmong 1,389,697 individuals (49.2% male, 50.8% female) adherence rates were 69.9% in males and 79.8% in females. Sex-differences in adherence were largest in younger individuals (58.0% and 72.6% and in males and females aged 40-44 years, respectively) and consistent across rural/urban residence and material deprivation categories. Females were more adherent (adjusted odds ratio 1.93; 95% confidence interval 1.90 to 1.97) than males. Among adherent males and females, 65.3% and 64.8% had at least one Haemoglobin A1C, respectively during the screening period. During the follow-up period, prediabetes and diabetes rates among males who were adherent were 25.9% and 5.2%, compared to 8.8% and 2.1% among non-adherent males; and 20.2% and 2.9% among adherent and 7.3% and 1.3% among non-adherent females.
ConclusionsDespite lower rates of adherence to screening, males have higher rates of prediabetes and diabetes compared to females. Our study highlights the need to develop education campaigns and targeted interventions at the local and population level to raise awareness and improve diabetes screening rates in young people, especially males.
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Alkabbani W, Zongo A, Minhas‐Sandhu JK, Eurich DT, Shah BR, Alsabbagh MW, Gamble J. Five comparative cohorts to assess the risk of genital tract infections associated with sodium-glucose cotransporter-2 inhibitors initiation in type 2 diabetes mellitus. Diabet Med 2022; 39:e14858. [PMID: 35460294 PMCID: PMC9546240 DOI: 10.1111/dme.14858] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/22/2022] [Indexed: 12/01/2022]
Abstract
AIM To assess the association between SGLT-2 inhibitors initiation and genital tract infections (GTIs) among patients with type 2 diabetes. METHODS A population-based cohort study using administrative healthcare data from Alberta, Canada, and primary care data from the UK's Clinical Practice Research Datalink (CPRD). Among new metformin users, we identified new users of SGLT-2 inhibitors and five active comparator cohorts (new users of dipeptidyl peptidase-4 (DPP-4) inhibitors, sulfonylureas (SU), glucagon-like peptide-1 receptor agonists (GLP-1 RA), thiazolidinediones (TZD) and insulin). The outcome of interest was a composite GTI outcome. In each cohort, we used high-dimensional propensity score matching to adjust for confounding and conditional Cox proportional hazards regression to estimate the hazard ratios (HR). We used random-effects meta-analysis to combine aggregate data across databases. RESULTS The risk of GTI was higher for SGLT-2 inhibitors users compared with DPP4inhibitor users (pooled HR 2.68, 95% CI 2.19 3.28), SU users (3.29, 2.62-4.13), GLP1-RA users (2.51, 1.90-3.31), TZD users (4.17, 2.46-7.08) and insulin users (1.86, 1.27-2.73). CONCLUSION In five comparative cohorts, SGLT-2 inhibitors initiation is associated with a higher risk of GTIs. These findings from real-world data are consistent with placebo-controlled randomized controlled trials.
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Affiliation(s)
- Wajd Alkabbani
- School of PharmacyUniversity of WaterlooWaterlooOntarioCanada
| | - Arsène Zongo
- Faculty of PharmacyUniversité LavalQuebecQCCanada
- CHU de Quebec‐Université Laval Research CenterQuebecQCCanada
| | - Jasjeet K. Minhas‐Sandhu
- School of PharmacyUniversity of WaterlooWaterlooOntarioCanada
- School of Public HealthUniversity of AlbertaEdmontonABCanada
| | - Dean T. Eurich
- School of Public HealthUniversity of AlbertaEdmontonABCanada
| | - Baiju R. Shah
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
- Division of EndocrinologySunnybrook Health Sciences CentreTorontoOntarioCanada
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Versluys KA, Eurich DT, Marrie TJ, Tyrrell GJ. Invasive Pneumococcal Disease and Long-Term Mortality Rates in Adults, Alberta, Canada. Emerg Infect Dis 2022; 28:1615-1623. [PMID: 35876489 PMCID: PMC9328901 DOI: 10.3201/eid2808.212469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The relationship between increased short-term mortality rates after invasive pneumococcal disease (IPD) has been frequently studied. However, the relationship between IPD and long-term mortality rates is unknown. IPD patients in Alberta, Canada, had clinical data collected that were linked to administrative databases. We used Cox proportional hazards modeling, and the primary outcome was time to all-cause deaths. First IPD events were identified in 4,522 patients, who had a median follow-up of 3.2 years (interquartile range 0.8‒9.1 years). Overall all-cause mortality rates were consistently higher among cases than controls at 30 days (adjusted hazard ratio [aHR] 3.75, 95% CI 3.29–4.28), 30‒90 days (aHR 1.56, 95% CI 1.27‒1.93), and >90 days (aHR 1.43, 95% CI 1.33–1.54). IPD increases risk for short, intermediate, and long-term mortality rates regardless of age, sex, or concurrent conditions. These findings can help clinicians focus on postdischarge patient plans to limit long-term effects after acute IPD infection.
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Abu Fadaleh SM, Charrois TL, Makhinova T, Eurich DT, Rahman S, Sadowski CA. The effect of home medication review in community-dwelling older adults: a systematic review. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01447-0] [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: 11/29/2022] Open
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Zongo A, Lee C, El-Mourad J, Dyck JRB, Hyshka E, Hanlon JG, Eurich DT. Substance Use Disorders and Psychoactive Drug Poisoning in Medically Authorized Cannabis Patients: Longitudinal Cohort Study. Can J Psychiatry 2022; 67:544-552. [PMID: 34806435 PMCID: PMC9234898 DOI: 10.1177/07067437211060597] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Poisoning from psychoactive drugs and substance use disorders (SUD) have been reported among non-medical cannabis users. However, little is known about medical cannabis users and their risk for poisoning and/or development of SUD. This study assessed the risk of emergency department (ED) visits or hospitalization for 1) poisoning by psychoactive drugs and 2) mental/behavioural disorders due to the use of psychoactive drugs and other substances, in medically authorized cannabis patients in Ontario, Canada from 2014-2017. METHODS A cohort study of adult patients authorized for medical cannabis that were matched to population-based controls. ED visit/hospitalization were assessed with a main diagnostic code for: 1) poisoning by psychoactive drugs; 2) mental and behavioural disorder due to psychoactive drugs or other substance use. Conditional Cox proportional hazards regressions were conducted. RESULTS 18,653 cannabis patients were matched to 51,243 controls. During a median follow-up of 243 days, the incidence rate for poisoning was 4.71 per 1,000 person-years (95%CI: 3.71-5.99) for cases and 1.73 per 1,000 person-years (95% CI: 1.36-2.19) for controls. The adjusted hazard ratio (aHR) was 2.45 (95%CI: 1.56-3.84). For mental/behavioural disorders, the incident rates were 8.89 (95% CI: 7.47-10.57) and 5.01 (95% CI: 4.36-5.76) in the cannabis and the controls group. The aHR was 2.27 (95%CI: 1.66-3.11). No difference was observed between males and females (P-value for interaction > 0.05). CONCLUSIONS Our study observed a short-term increased risk of ED visit/hospitalization for poisoning or for mental/behavioural disorders (from use of psychoactive drugs and other substances)- in medically authorized cannabis patients.
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Affiliation(s)
- Arsène Zongo
- Faculty of Pharmacy, 4440Université Laval, Quebec City, Canada.,Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Quebec City, Canada
| | - Cerina Lee
- School of Public Health, 3158University of Alberta, Edmonton, Canada
| | - Jihane El-Mourad
- Faculty of Pharmacy, 4440Université Laval, Quebec City, Canada.,Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Quebec City, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, 3158University of Alberta, Edmonton, Canada
| | - Elaine Hyshka
- School of Public Health, 3158University of Alberta, Edmonton, Canada
| | - John G Hanlon
- St. Michael's Hospital Department of Anesthesia, 177410University of Toronto, Ontario, Canada.,Department of Anaesthesiology and Pain Medicine, University of Toronto, Ontario, Canada
| | - Dean T Eurich
- School of Public Health, 3158University of Alberta, Edmonton, Canada
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Barlas RS, Clark AB, Loke YK, Kwok CS, Angus DC, Uranga A, España PP, Eurich DT, Huang DT, Man SY, Rainer TH, Yealy DM, Myint PK, Mor MK, Fine MJ. Comparison of the prognostic performance of the CURB-65 and a modified version of the pneumonia severity index designed to identify high-risk patients using the International Community-Acquired Pneumonia Collaboration Cohort. Respir Med 2022; 200:106884. [PMID: 35767924 DOI: 10.1016/j.rmed.2022.106884] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although the PSI and CURB-65 represent well-validated prediction rules for pneumonia prognosis, PSI was designed to identify patients at low risk and CURB- 65 patients at high risk of mortality. We compared the prognostic performance of a modified version of the PSI designed to identify high-risk patients (i.e., PSI-HR) to CURB-65 in predicting short-term mortality. METHODS Using data from 6 pneumonia cohorts, we designed PSI-HR as a 6-class prediction rule using the original prognostic weights of all PSI variables and modifying the risk score thresholds to define risk classes. We calculated the proportion of low-risk and high-risk patients using CURB-65 and PSI-HR and 30-day mortality in these subgroups. We compared the rules' sensitivity, specificity, positive and negative predictive values for mortality at all risk class thresholds and assessed discriminatory power using areas under their receiver operating characteristic curves (AUROCs). RESULTS Among 13,874 patients with pneumonia, 1,036 (7.5%) died. For PSI-HR versus CURB-65, aggregate mortality was lower in low-risk patients (1.6% vs. 2.2%, p = 0.005) and higher in high-risk patients (36.5% vs. 32.2%, p = 0.27). PSI-HR had higher sensitivities than CURB-65 at all thresholds; PSI-HR also had higher specificities at the 3 lowest thresholds and specificities within 0.5% points of CURB-65 at the 2 highest thresholds. The AUROC was larger for PSI-HR than CURB- 65 (0.82 vs. 0.77, p < 0.0001). CONCLUSIONS PSI-HR demonstrated superior prognostic accuracy to CURB-65 at the lower end of the severity spectrum and identified high-risk patients with nonsignificant higher short-term mortality at the higher end.
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Affiliation(s)
- Raphae S Barlas
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Derek C Angus
- The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ane Uranga
- Servicio de Neumología, Hospital de Galdakao, Galdakao, Bizkaia, Spain
| | - Pedro P España
- Servicio de Neumología, Hospital de Galdakao, Galdakao, Bizkaia, Spain
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - David T Huang
- The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Shin Y Man
- Emergency Medicine Unit, Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Timothy H Rainer
- Emergency Medicine Unit, Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Donald M Yealy
- Department of Emergency Medicine at the University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Phyo K Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; Norwich Medical School, University of East Anglia, Norwich, UK
| | - Maria K Mor
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael J Fine
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
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Lee C, Round JM, Hanlon JG, Hyshka E, Dyck JR, Eurich DT. Generalized Anxiety Disorder 7-Item (GAD-7) Scores in Medically Authorized Cannabis Patients-Ontario and Alberta, Canada. Can J Psychiatry 2022; 67:470-480. [PMID: 34520280 PMCID: PMC9149533 DOI: 10.1177/07067437211043393] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Despite increasing rates of legalization of medical cannabis worldwide, the current evidence available on its effect on mental health outcomes including anxiety is of mixed results. This study assesses the effect of medical cannabis on generalized anxiety disorder 7-item (GAD-7) scores in adult patients between 2014 and 2019 in Ontario and Alberta, Canada. METHODS An observational cohort study of adults authorized to use medical cannabis. The GAD-7 was administered at the time of the first visit to the clinic and subsequently over the follow-up time period of up to 3.2 years. Overall changes in GAD-7 scores were computed (mean change) and categorized as: no change (<1 point); improvement; or worsening-over time. RESULTS A total of 37,303 patients had initial GAD-7 scores recorded and 5,075 (13.6%) patients had subsequent GAD-7 follow-up scores. The average age was 54.2 years (SD 15.7 years), 46.0% were male, and 45.6% noted anxiety symptoms at the baseline. Average GAD-7 scores were 9.11 (SD 6.6) at the baseline and after an average of 282 days of follow-up (SD 264) the average final GAD-7 score recorded was 9.04 (SD 6.6): mean change -0.23 (95% CI, -0.28 to -0.17, t[5,074]: -8.19, p-value <0.001). A total of 4,607 patients (90.8%) had no change in GAD-7 score from their initial to final follow-up, 188 (3.7%) had a clinically significant decrease, and 64 (1.3%) noted a clinically significant increase in their GAD-7 scores. CONCLUSIONS Overall, there was a statistically significant decrease in GAD-7 scores over time (in particular, in the 6-12-month period). However, this change did not meet the threshold to be considered clinically significant. Thus, we did not detect clinical improvements or detriment in GAD-7 scores in medically authorized cannabis patients. However, future well-controlled clinical trials are needed to fully examine risks or benefits associated with using medical cannabis to treat anxiety conditions.
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Affiliation(s)
- Cerina Lee
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jessica M. Round
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - John G. Hanlon
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Ontario, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jason R.B. Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T. Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Youn S, Eurich DT, McCall M, Walker J, Smylie M, Sawyer MB. Skeletal muscle is prognostic in resected stage III malignant melanoma. Clin Nutr 2022; 41:1066-1072. [PMID: 35397311 DOI: 10.1016/j.clnu.2022.03.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Sarcopenia (low skeletal muscle index, SMI) and myosteatosis (low skeletal muscle radiodensity, SMD) have been associated with worse survival in cancer. This study evaluated associations of body composition with survival in patients with resected stage III melanoma. METHODS A retrospective review was performed of resected stage III melanoma patients in Alberta, Canada from 2007 to 2017. Preoperative CT scans were analyzed to determine SMI and SMD. Cohort-specific SMI and SMD cut-offs that optimally predicted overall survival (OS) were identified through stratification, in addition to testing cut-offs previously established in the literature. Overall (OS), melanoma-specific (MSS), and recurrence-free survival (RFS) were determined from date of surgery and analysed using multivariable Cox regressions with age, sex, BMI, stage subgroup, ECOG PS, and tumor location as covariates. RESULTS We included 330 patients in the final analysis. Mean age was 56 years and 62.4% of patients were male. At time of censoring 150 patients (45.6%) had died. Sarcopenia based on literature cut-offs was associated with decreased OS (HR 1.55, 95% CI 1.00-2.21, p = 0.016). Using cohort-specific cut-offs, sarcopenic patients also had significantly decreased OS (HR 1.87, 95% CI 1.27-2.76, p = 0.002). Myosteatosis defined using cohort-specific cut-offs predicted worse OS (HR 2.15, 95% CI 1.42-3.25, p < 0.001), MSS (HR 2.29, 95% CI 1.40-3.75, p = 0.001) and RFS (HR 1.52, 95% CI 1.02-2.27, p = 0.041). Increased BMI ( ≥ 25) and visceral fat index were not significantly associated with survival. CONCLUSIONS Sarcopenia and myosteatosis, defined using two sets of cut-offs, are associated with decreased OS and MSS in resected stage III melanoma.
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Affiliation(s)
- Susie Youn
- Department of Surgery, University of Alberta Hospital, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada.
| | - Dean T Eurich
- University of Alberta School of Public Health, 3-300 Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, Alberta, T6G 1C9, Canada
| | - Michael McCall
- Department of Surgery, University of Alberta Hospital, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - John Walker
- Cross Cancer Institute, 11560 University Ave, Edmonton, AB, T6G 1Z2, Canada
| | - Michael Smylie
- Cross Cancer Institute, 11560 University Ave, Edmonton, AB, T6G 1Z2, Canada
| | - Michael B Sawyer
- Cross Cancer Institute, 11560 University Ave, Edmonton, AB, T6G 1Z2, Canada
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Lee C, Wozniak LA, Soprovich AL, Sharma V, Healy B, Samanani S, Eurich DT. Mental health experiences with COVID-19 public health measures in an Alberta First Nations Community. Int J Ment Health Syst 2022; 16:22. [PMID: 35488309 PMCID: PMC9051493 DOI: 10.1186/s13033-022-00532-z] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND First Nations (FN) people of Canada experience health, social, and systemic inequities due to colonization. Consequently, COVID-19 has placed further mental health stress on people related to personal finances, employment security and worry over infection, resulting in exacerbated effects of unresolved past medical and physical traumas. This study aims to understand the experiences related to mental health in an Alberta FN community during the early stages of the pandemic. METHODS In partnership with FN leadership, the study implemented an online cross-sectional survey. Adults from a large FN community in Alberta, Canada, were asked to complete a survey, including two mental health-related screening questionnaires: (1) Generalized Anxiety Disorder-2 item; and (2) Patient Health Questionnaire-2 item. In addition, respondents could provide responses to open-ended questions about their experiences. RESULTS Among 106 respondents, 95 (89.6%) finished the survey; 18% of adults screened positive for depressive symptoms (score of 3 or greater) and reported difficulty following public health advice for using hand sanitizer, maintaining social distancing, or self-isolating. 21% of adults screened positive for symptoms of anxiety (score of 3 or greater) and reported difficulty maintaining social distance, self-isolating, obtaining food and clothing, or meeting other basic living requirements. CONCLUSIONS FN communities may be disproportionately affected by COVID-19, and may experience exacerbated symptoms of anxiety, depression and overall poor mental health and well-being. Additional supports and services, including for mental health, should be considered for FN in the context of COVID-19 public health measures. HIGHLIGHTS The COVID-19 pandemic has brought upon increased stress and accompanying symptoms of anxiety and depression for a First Nations community in Alberta. Studies, such as this one, that characterize the influence of the COVID-19 pandemic on mental health among First Nations people, are urgently needed because of increasing demands on healthcare systems due to the pandemic and potential delays in the care of patients living with pre-existing mental health conditions. There is an opportunity to capitalize on First Nations people's experiences of post-traumatic growth proactively supporting/maintaining their well-being and possibly the development of community-based mental health interventions and supports.
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Affiliation(s)
- Cerina Lee
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation 11203-87 Avenue, Edmonton, AB, T6G 2E1, Canada
| | - Lisa A Wozniak
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation 11203-87 Avenue, Edmonton, AB, T6G 2E1, Canada
| | - Allison L Soprovich
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation 11203-87 Avenue, Edmonton, AB, T6G 2E1, Canada
| | - Vishal Sharma
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation 11203-87 Avenue, Edmonton, AB, T6G 2E1, Canada
| | | | | | - Dean T Eurich
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation 11203-87 Avenue, Edmonton, AB, T6G 2E1, Canada.
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Alkabbani W, Gamble JM, Eurich DT, Minhas-Sandhu JK, Shah BR, Alsabbagh MW, Zongo A. Risk of hospitalization and death associated with sodium glucose cotransporter-2 inhibitors: A comparison with five other classes of antidiabetic drugs. Diabetes Metab 2022; 48:101305. [PMID: 34808344 DOI: 10.1016/j.diabet.2021.101305] [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] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/30/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
AIM We assessed the risk of all-cause hospitalization and all-cause death associated with the use of Sodium Glucose Cotransporter-2 inhibitors (SGLT2i). METHODS Population-based propensity scores-matched cohort study of new users of metformin who subsequently initiated SGLT2i compared to those who initiated dipeptidyl peptidase-4 inhibitors (DPP4i) (primary comparison), sulfonylureas, thiazolidinediones, GLP1-Receptors agonists, and insulin, respectively. Alberta (Canada) health administrative data and United Kingdom Clinical Practice Research Datalink (CPRD) data were used to assess the study outcomes. Conditional Cox regressions were performed to assess the risk of each outcome, separately for each dataset and then results were combined using random-effects meta-analysis. RESULTS For SGLT2i versus DPP4i, 7531 and 1647 SGLT2i-DPP4i matched pairs were analyzed in Alberta and CPRD data respectively. The mean age of patients was 56 and 57 years, and 39% and 43% were females, respectively in Alberta and CPRD cohorts. Compared with DPP-4-i, SGLT2i use was associated with a significant lower risk of all-cause hospitalization (combined hazard ratio (HR): 0.84, 95% confidence interval (95%CI): 0.75-0.95), and all-cause death (0.56, 0.38-0.83). SGLT2i use was also associated with a significant lower risk of all-cause hospitalization and all-cause death when compared to sulfonylureas (HRs: 0.80, 95%CI: 0.71-0.90 and 0.56, 95%CI: 0.38-0.82, respectively) and insulin (HRs: 0.55, 95%CI: 0.41-0.74, and 0.33, 95%CI: 0.24-0.46, respectively). CONCLUSIONS SGLT2i initiation was associated with a decreased risk of all-cause hospitalization and all-cause death when compared to DPP4i, sulfonylureas, and insulin.
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Affiliation(s)
| | | | - Dean T Eurich
- School of Public Health, University of Alberta, AB, Canada
| | - Jasjeet K Minhas-Sandhu
- School of Pharmacy, University of Waterloo, ON, Canada; School of Public Health, University of Alberta, AB, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, ON, Canada; Division of Endocrinology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Arsène Zongo
- Faculty of pharmacy, Université Laval, Canada; CHU de Quebec -Université Laval Research Centre, Quebec, Canada.
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Soprovich AL, Wozniak LA, Lee C, Sharma V, Samanani S, Eurich DT. Appropriateness of COVID-19 public health guidelines for an Alberta First Nations community. Can J Public Health 2022; 113:67-80. [PMID: 34978681 PMCID: PMC8721944 DOI: 10.17269/s41997-021-00579-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 09/20/2021] [Indexed: 11/19/2022]
Abstract
Objectives The First Nations people experience significant challenges that may influence the ability to follow COVID-19 public health directives on-reserve. This study aimed to describe experiences, perceptions and circumstances of an Alberta First Nations community, related to COVID-19 public health advice. We hypothesized that many challenges ensued when following and implementing advice from public health experts. Methods With First Nations leadership and staff, an online cross-sectional survey was deployed between April 24 and June 25, 2020. It assessed the appropriateness of public health advice to curb COVID-19 within this large First Nations community. Both quantitative and qualitative data were captured and described. Results A total of 106 adults living on-reserve responded; over 80% were female. Difficulty accessing food was significant by employment status (p = 0.0004). Those people with lower income found accessing food (p = 0.0190) and getting essential medical care (p = 0.0060), clothing (p = 0.0280) and transportation (p = 0.0027) more difficult. Some respondents described lost income associated with COVID-19 experiences, as well as difficulties accessing essential supplies. Respondents found “proper handwashing” most easy (98%) and “keeping a distance of 2 m from others” most difficult (23%). Many respondents found following public health advice within their personal domain easy and put “family safety” first but experienced some difficulties when navigating social aspects and obligations, particularly when unable to control the actions of others. People stated wanting clear information, but were sometimes critical of the COVID-19 response. Conclusion First Nations people face many additional challenges within the COVID-19 response, driven in part by ongoing issues related to significant societal, economic, and systemic factors. Supplementary Information The online version contains supplementary material available at 10.17269/s41997-021-00579-4.
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Affiliation(s)
| | - Lisa A Wozniak
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Cerina Lee
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Vishal Sharma
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | | | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
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Webb AN, Lester ELW, Shapiro AMJ, Eurich DT, Bigam DL. Cost-utility analysis of normothermic machine perfusion compared to static cold storage in liver transplantation in the Canadian setting. Am J Transplant 2022; 22:541-551. [PMID: 34379887 DOI: 10.1111/ajt.16797] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 04/18/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 01/25/2023]
Abstract
To estimate the incremental cost-effectiveness of a liver transplant program that utilizes normothermic machine perfusion (NMP) alongside static cold storage (SCS) compared to SCS alone (control). A Markov model compared strategies (NMP vs. control) using 1-year cycle lengths over a 5-year time horizon from the public healthcare payer perspective. Primary micro-costing data from a single center retrospective trial were applied along with utility values from literature sources. Transition probabilities were deduced using the retrospective trial cohort, local transplant data, and supplemented with literature values. Scenario and probabilistic sensitivity analysis (PSA) were conducted. The NMP strategy was cost-effective in comparison to the control strategy, which was dominated. The mean cost for NMP was $456 455 (2021 US$) and the control was $519 222. The NMP strategy had greater incremental quality-adjusted life years (QALYs) gains over 5 years compared to the control, with 3.48 versus 3.17, respectively. The overarching results remained unchanged in scenario analysis. In PSA, NMP was cost-effective in 63% of iterations at a willingness-to-pay threshold of $40 941. The addition of NMP to a liver transplant program results in greater QALY gains and is cost-effective from the public healthcare payer perspective.
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Affiliation(s)
- Alexandria N Webb
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Erica L W Lester
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - David L Bigam
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Maayah ZH, Raposo PJF, Silver H, Mandal R, Ellis L, Alam AS, Takahara S, Ferdaoussi M, Mathewson KE, Eurich DT, Fouad K, Wishart DS, Dyck JRB. Metabolomic Fingerprint of Behavioral Changes in Response to Full-Spectrum Cannabis Extracts. Front Pharmacol 2022; 13:831052. [PMID: 35145419 PMCID: PMC8822156 DOI: 10.3389/fphar.2022.831052] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022] Open
Abstract
Numerous existing full-spectrum cannabis extract products have been used in clinical trials for the treatment of various diseases. Despite their efficacy, the clinical use of some of these full-spectrum cannabis extracts is limited by behavioral side effects such as cognitive dysfunction and impaired motor skills. To better understand what constitutes cannabis-induced behavioral effects, our objective was to identify a novel panel of blood-based metabolites that are predictive, diagnostic, and/or prognostic of behavioral effects. At 8 weeks of age, male rats were randomly assigned to groups and were gavage fed with full-spectrum cannabis extract (tetrahydrocannabinol/cannabidiol (THC/CBD) along with all other cannabis compounds, 15 mg/kg), broad-spectrum cannabis extract (CBD along with all other cannabis compounds, 15 mg/kg), or vehicle oil. Four hours after being gavage fed, behavioral assessments were determined using the open field test and the elevated plus maze. Following these assessments, serum was collected from all rats and the serum metabolites were identified and quantified by LC–MS/MS and 1H NMR spectroscopy. We found that only rats treated with full-spectrum cannabis extract exhibited behavioral changes. Compared to vehicle-treated and broad-spectrum extract–treated rats, full-spectrum extract–treated rats demonstrated higher serum concentrations of the amino acid phenylalanine and long-chain acylcarnitines, as well as lower serum concentrations of butyric acid and lysophosphatidylcholines. This unique metabolomic fingerprint in response to cannabis extract administration is linked to behavioral effects and may represent a biomarker profile of cannabis-induced behavioral changes. If validated, this work may allow a metabolomics-based decision tree that would aid in the rapid diagnosis of cannabis-induced behavioral changes including cognitive impairment.
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Affiliation(s)
- Zaid H. Maayah
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Pamela J. F. Raposo
- Faculty of Rehabilitation Medicine - Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Heidi Silver
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Rupasri Mandal
- The Metabolomics Innovation Centre (TMIC), University of Alberta, Edmonton, AB, Canada
- Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
| | - Lee Ellis
- National Research Council of Canada, Halifax, NS, Canada
| | - Abrar S. Alam
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Shingo Takahara
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Mourad Ferdaoussi
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kyle E. Mathewson
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Psychology, Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Dean T. Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Karim Fouad
- Faculty of Rehabilitation Medicine - Physical Therapy, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - David S. Wishart
- The Metabolomics Innovation Centre (TMIC), University of Alberta, Edmonton, AB, Canada
- Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
| | - Jason R. B. Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- *Correspondence: Jason R. B. Dyck,
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Mendez AI, Wihlidal JGJ, Eurich DT, Nichols AC, MacNeil SD, Seikaly HR. Validity of functional patient-reported outcomes in head and neck oncology: A systematic review. Oral Oncol 2022; 125:105701. [PMID: 35021152 DOI: 10.1016/j.oraloncology.2021.105701] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/12/2021] [Accepted: 12/27/2021] [Indexed: 11/27/2022]
Abstract
Malignancy and treatment effects in head and neck oncology can be devastating to functional aspects of patient life such as swallowing, blinking, speech, salivation, and facial expression. Historically, the subjective nature of patient experience has resulted in difficulty with quantification and measurement of functional outcomes. Patient-Reported Outcomes (PROs) are questionnaires developed with patient input, forming the new gold standard for clinician assessment of subjective functional outcomes. The current review aims to identify and characterize the validation of PROs pertaining to four critical functional outcomes in head and neck oncology: swallowing, speech, dry mouth, and chewing. A literature search was conducted using MEDLINE, EMBASE, and the Cochrane databases for published, English language, peer-reviewed abstracts involving patients ≥ 18 years of age. Of 708 results, 705 were excluded at abstract or full text screening for not meeting inclusion criteria, exclusion of head and neck SCC patients in development, or absence of a functional domain measurement. The three reviewed studies-Xerostomia Questionnaire, Swallowing Outcomes After Laryngectomy, and Edmonton 33-exhibited strong reliability and construct and content validity, though two applied only to individual functional outcomes within specific patient populations receiving radiation or laryngectomy. While many PROs have been developed in head and neck oncology, very few properly employed extensive patient input in the development process. Further work must be committed to increasing head and neck cancer patient input in PRO development, particularly in the functional domains of speech and chewing.
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Affiliation(s)
- Adrian I Mendez
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 8440 112(th) Street Northwest, Edmonton, Alberta T6G 2R7, Canada; Division of Head and Neck Oncology and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada.
| | - Jacob G J Wihlidal
- Division of Head and Neck Oncology and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada.
| | - Dean T Eurich
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 8440 112(th) Street Northwest, Edmonton, Alberta T6G 2R7, Canada.
| | - Anthony C Nichols
- Division of Head and Neck Oncology and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada.
| | - S Danielle MacNeil
- Division of Head and Neck Oncology and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada.
| | - Hadi R Seikaly
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 8440 112(th) Street Northwest, Edmonton, Alberta T6G 2R7, Canada.
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Zongo A, Lee C, Dyck JRB, El-Mourad J, Hyshka E, Hanlon JG, Eurich DT. Incidence and Predictors of Cannabis-Related Poisoning and Mental and Behavioral Disorders among Patients with Medical Cannabis Authorization: A Cohort Study. Subst Use Misuse 2022; 57:1633-1641. [PMID: 35866679 DOI: 10.1080/10826084.2022.2102193] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE As medical cannabis use increases in North America, establishing its safety profile is a priority. The objective of this study was to assess rates of emergency department (ED) visits and hospitalizations due to poisoning by cannabis, and cannabis-related mental health disorders among medically authorized cannabis patients in Ontario, Canada, between 2014 and 2017. METHODS This is a retrospective cohort study of patients who received medical cannabis authorization in Ontario, Canada, using data collected in participating cannabis clinics. Outcomes included ED visit/hospitalization with a main diagnosis code for: cannabis/cannabinoid poisoning; and mental/behavioral disorders due to cannabis use. Cox proportional hazard regressions were utilized to analyze the data. RESULTS From 29,153 patients who received medical authorization, 23,091 satisfied the inclusion criteria. During a median follow-up of 240 days, 14 patients visited the ED or were hospitalized for cannabis poisoning-with an incidence rate of 8.06 per 10,000 person-years (95% CI: 4.8-13.6). A total of 26 patients visited the ED or were hospitalized for mental and behavioral disorders due to cannabis use-with an incidence rate of 15.0 per 10,000 person-years (95% CI: 10.2-22.0). Predictors of cannabis-related mental and behavioral disorders include prior substance use disorders, other mental disorders, age, diabetes, and chronic obstructive pulmonary disease. CONCLUSIONS The results suggest that the incidence of cannabis poisoning or cannabis-related mental and behavioral disorders was low among patients who were authorized to use cannabis for medical care. Identified predictors can help to target patients with potential risk of the studied outcomes.
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Affiliation(s)
- Arsene Zongo
- Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada.,Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Quebec City, Quebec, Canada
| | - Cerina Lee
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jihane El-Mourad
- Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada.,Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Quebec City, Quebec, Canada
| | - Elaine Hyshka
- Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Quebec City, Quebec, Canada
| | - John G Hanlon
- St. Michael's Hospital Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.,Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Ye M, Vena JE, Johnson JA, Shen-Tu G, Eurich DT. Anti-Hyperglycemic Medication Adherence and Health Services Utilization in People with Diabetes: A Longitudinal Study of Alberta's Tomorrow Project. Patient Prefer Adherence 2022; 16:1457-1467. [PMID: 35722195 PMCID: PMC9199902 DOI: 10.2147/ppa.s362539] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Little is known about the long-term (>2 years) relationship between the time-varying drug adherence and healthcare utilization for patients with diabetes. OBJECTIVE To characterize the relationship between time-varying anti-hyperglycemic medication adherence and healthcare utilization in patients with diabetes, using data from Alberta's Tomorrow Project, a population-based cohort study in Alberta, Canada. METHODS Incident cases of diabetes with at least 24 months of follow-up were included in the study. Anti-hyperglycemic drug adherence was measured by proportion of days covered (PDC) in the past 12 months for each year after diagnosis. The rate of healthcare utilization was assessed for the subsequent 12 months, 36 months and 60 months. A time-varying, negative binomial generalized estimating equation model was used to examine the association between medication adherence and healthcare utilization. RESULTS Among 2155 incident cases of diabetes, average age at diagnosis was 59.6±9.3, 51.0% were female and average duration of follow-up was 7.3±3.7 (range, 2.0-16.2) years. The proportion of patients taking anti-hyperglycemic medications was 47.6% during the first year of diagnosis, which increased to 77.3% by the end of follow-up. Compared to adherent patients (PDC≥0.8), non-adherent patients (PDC<0.8) had substantially higher rate of all-cause hospitalization [incident rate ratio, IRR=1.48 (1.22-1.79), ED visits [1.30 (1.15-1.47)] and GP visits [1.17 (1.08-1.27)] in the subsequent 12 months. However, these associations became weaker with longer follow-up [eg, IRR=1.18 (0.98-1.39) and 1.05 (0.94-1.18) for all-cause hospitalization in the subsequent 36 and 60 months, respectively]. CONCLUSION Poor adherence among diabetic patients was associated with substantially higher rate of healthcare utilization in the short term (eg, 12 months); however, this association weakened over a longer period (eg, 36-60 months).
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Affiliation(s)
- Ming Ye
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer E Vena
- Alberta’s Tomorrow Project, CancerCare Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Grace Shen-Tu
- Alberta’s Tomorrow Project, CancerCare Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Correspondence: Dean T Eurich, School of Public Health, University of Alberta, Canada, Email
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Ishaque A, Ta D, Khan M, Zinman L, Korngut L, Genge A, Dionne A, Briemberg H, Luk C, Yang YH, Beaulieu C, Emery D, Eurich DT, Frayne R, Graham S, Wilman A, Dupré N, Kalra S. Distinct patterns of progressive gray and white matter degeneration in amyotrophic lateral sclerosis. Hum Brain Mapp 2021; 43:1519-1534. [PMID: 34908212 PMCID: PMC8886653 DOI: 10.1002/hbm.25738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 01/17/2023] Open
Abstract
Progressive cerebral degeneration in amyotrophic lateral sclerosis (ALS) remains poorly understood. Here, three-dimensional (3D) texture analysis was used to study longitudinal gray and white matter cerebral degeneration in ALS from routine T1-weighted magnetic resonance imaging (MRI). Participants were included from the Canadian ALS Neuroimaging Consortium (CALSNIC) who underwent up to three clinical assessments and MRI at four-month intervals, up to 8 months after baseline (T0 ). Three-dimensional maps of the texture feature autocorrelation were computed from T1-weighted images. One hundred and nineteen controls and 137 ALS patients were included, with 81 controls and 84 ALS patients returning for at least one follow-up. At baseline, texture changes in ALS patients were detected in the motor cortex, corticospinal tract, insular cortex, and bilateral frontal and temporal white matter compared to controls. Longitudinal comparison of texture maps between T0 and Tmax (last follow-up visit) within ALS patients showed progressive texture alterations in the temporal white matter, insula, and internal capsule. Additionally, when compared to controls, ALS patients had greater texture changes in the frontal and temporal structures at Tmax than at T0 . In subgroup analysis, slow progressing ALS patients had greater progressive texture change in the internal capsule than the fast progressing patients. Contrastingly, fast progressing patients had greater progressive texture changes in the precentral gyrus. These findings suggest that the characteristic longitudinal gray matter pathology in ALS is the progressive involvement of frontotemporal regions rather than a worsening pathology within the motor cortex, and that phenotypic variability is associated with distinct progressive spatial pathology.
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Affiliation(s)
- Abdullah Ishaque
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Daniel Ta
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Muhammad Khan
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Lorne Zinman
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Lawrence Korngut
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Angela Genge
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, Montreal, Canada
| | - Annie Dionne
- Département des Sciences Neurologiques, Hôpital de l'Enfant-Jésus, CHU de Québec, Quebec City, Canada
| | - Hannah Briemberg
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Collin Luk
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Yee-Hong Yang
- Department of Computing Science, University of Alberta, Edmonton
| | - Christian Beaulieu
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Derek Emery
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Richard Frayne
- Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Calgary, Canada
| | - Simon Graham
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Alan Wilman
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Nicolas Dupré
- Neuroscience Axis, CHU de Québec, Université Laval, Quebec City, Canada.,Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Sanjay Kalra
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada.,Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
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Alkabbani W, Zongo A, Minhas-Sandhu JK, Eurich DT, Shah BR, Alsabbagh MW, Gamble JM. Renal effectiveness and safety of the sodium-glucose cotransporter-2 inhibitors: a population-based cohort study. BMJ Open Diabetes Res Care 2021; 9:9/2/e002496. [PMID: 34906925 PMCID: PMC8671915 DOI: 10.1136/bmjdrc-2021-002496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/20/2021] [Accepted: 11/23/2021] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION To assess the comparative effectiveness and safety of renal-related outcomes associated with sodium-glucose cotransporter-2 inhibitors (SGLT2-i) initiation among patients with type 2 diabetes using real-world data. RESEARCH DESIGN AND METHODS We conducted a population-based cohort study using administrative healthcare data from Alberta (AB), Canada and primary care data from the Clinical Practice Research Datalink (CPRD), UK. From a cohort of new metformin users, we identified initiators of a SGLT2-i or dipeptidyl peptidase-4 inhibitor (DPP4-i) between January 1, 2014 and March 30, 2018 (AB) or between January 1, 2013 and November 29, 2018 (CPRD). Initiators of an SGLT2-i or DPP4-i were followed until death, disenrolment, therapy discontinuation, or study end date. The effectiveness outcome was renal disease progression, defined as a composite of new-onset macroalbuminuria, serum creatinine doubling with estimated glomerular filtration rate of ≤45 mL/min/1.73 m2, renal replacement therapy, hospital admission or death from renal causes. The safety outcome was hospitalization due to acute kidney injury (AKI). We adjusted for confounding using high-dimensional propensity score matching and estimated HRs using Cox proportional hazards regression. Aggregate data from each database were combined by random-effects meta-analysis. RESULTS Among the 29 465 included patients (20 564 AB, 8901 CPRD), 37.5% were new SGLT2-i users in AB and 21.3% in CPRD. Compared with DPP4 initiators, SGLT2-i initiators were associated with a reduced risk of renal disease progression (pooled HR 0.79, 95% CI 0.62 to 1.00); however, there was no significant difference in the risk of AKI (pooled HR 0.89, 95% CI 0.58 to 1.36). These findings were consistent with other exposure definitions and antidiabetic comparators. CONCLUSIONS Our findings support a renoprotective effect of SGLT2-i without an increased risk of AKI, compared with clinically relevant active comparators.
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Affiliation(s)
- Wajd Alkabbani
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Arsene Zongo
- Faculté de pharmacie, Université Laval, Laval, Quebec, Canada
- CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada
| | - Jasjeet K Minhas-Sandhu
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Baiju R Shah
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Alkabbani W, Zongo A, Minhas-Sandhu JK, Eurich DT, Shah BR, Alsabbagh W, Gamble JM. Sodium-glucose cotransporter-2 inhibitors and urinary tract infections: A propensity score matched population-based cohort study. Can J Diabetes 2021; 46:392-403.e13. [DOI: 10.1016/j.jcjd.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/03/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
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Ye M, Vena JE, Johnson JA, Shen-Tu G, Eurich DT. Chronic disease surveillance in Alberta's tomorrow project using administrative health data. Int J Popul Data Sci 2021; 6:1672. [PMID: 34734125 PMCID: PMC8530189 DOI: 10.23889/ijpds.v6i1.1672] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Alberta’s Tomorrow Project (ATP) is the largest population-based prospective cohort study of cancer and chronic diseases in Alberta, Canada. The ATP cohort data were primarily self-reported by participants on lifestyle behaviors and disease risk factors at the enrollment, which lacks sufficient and accurate data on chronic disease diagnosis for longer-term follow-up. Objectives To characterize the occurrence rate and trend of chronic diseases in the ATP cohort by linking with administrative healthcare data. Methods A set of validated algorithms using ICD codes were applied to Alberta Health (AH) administrative data (October 2000-March 2018) linked to the ATP cohort to determine the prevalence and incidence of common chronic diseases. Results There were 52,770 ATP participants (51.2±9.4 years old at enrollment and 63.7% females) linked to the AH data with average follow-up of 10.1±4.4 years. In the ATP cohort, hypertension (18.5%), depression (18.1%), chronic pain (12.8%), osteoarthritis (10.1%) and cardiovascular diseases (8.7%) were the most prevalent chronic conditions. The incidence rates varied across diseases, with the highest rates for hypertension (22.1 per 1000 person-year), osteoarthritis (16.2 per 1000 person-year) and ischemic heart diseases (13.0 per 1000 person-year). All chronic conditions had increased prevalence over time (p < for trend tests), while incidence rates were relatively stable. The proportion of participants with two or more of these conditions (multi-morbidity) increased from 3.9% in 2001 to 40.3% in 2017. Conclusions This study shows an increasing trend of chronic diseases in the ATP cohort, particularly related to cardiovascular diseases and multi-morbidity. Using administrative health data to monitor chronic diseases for large population-based prospective cohort studies is feasible in Alberta, and our approach could be further applied in a broader research area, including health services research, to enhance research capacity of these population-based studies in Canada.
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Affiliation(s)
- Ming Ye
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada, T6G 2E1
| | - Jennifer E Vena
- Alberta's Tomorrow Project, Cancer Care Alberta, Alberta Health Services, Alberta, Canada, T2T 5C7
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada, T6G 2E1
| | - Grace Shen-Tu
- Alberta's Tomorrow Project, Cancer Care Alberta, Alberta Health Services, Alberta, Canada, T2T 5C7
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada, T6G 2E1
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Youn S, Jogiat U, Baracos VE, McCall M, Eurich DT, Sawyer MB. CT-based assessment of body composition and skeletal muscle in melanoma: A systematic review. Clin Nutr ESPEN 2021; 45:127-133. [PMID: 34620308 DOI: 10.1016/j.clnesp.2021.06.029] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/28/2021] [Accepted: 06/29/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND/OBJECTIVES Sarcopenia (low skeletal muscle index) and myosteatosis (low skeletal radiodensity) have been associated with poor outcomes in melanoma. This systematic review was performed to summarize and critically evaluate current literature surrounding body composition in melanoma. METHODS MEDLINE and Embase databases were searched for studies of melanoma patients with computed tomography (CT) based body composition analysis from 2000 to 2020. Outcomes of interest were survival, including overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS), as well as treatment-related adverse events (AEs). RESULTS Nine studies of 914 patients were included in the final review. The majority of studies were of metastatic melanoma patients treated with immunotherapy. Studies demonstrated a variety of CT analysis techniques and cut-offs to define sarcopenia and myosteatosis. Associations of sarcopenia or myosteatosis with survival (OS, PFS, DFS) or risk of treatment-related AEs were conflicting. Multiple studies had low quality of evidence due to small sample sizes, use of non-validated CT measures, and lack of multivariable analyses. CONCLUSIONS Due to methodologic heterogeneity and low quality of evidence, impacts of CT-derived body composition parameters on outcomes in melanoma are unclear. Further research should be conducted to elucidate impacts of body composition in melanoma.
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Affiliation(s)
- Susie Youn
- Department of Surgery, University of Alberta, Edmonton, AB, Canada; School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Uzair Jogiat
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Vickie E Baracos
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Michael McCall
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Michael B Sawyer
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.
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Zongo A, Lee C, Dyck JRB, El-Mourad J, Hyshka E, Hanlon JG, Eurich DT. Medical cannabis authorization and the risk of cardiovascular events: a longitudinal cohort study. BMC Cardiovasc Disord 2021; 21:426. [PMID: 34507536 PMCID: PMC8431905 DOI: 10.1186/s12872-021-02229-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/11/2021] [Accepted: 08/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background Cannabis is increasingly used for therapeutic purpose. However, its safety profile is not well known. This study assessed the risk of cardiovascular-related emergency department (ED) visit and hospitalization in adult patients authorized to use medical cannabis in Ontario, Canada from 2014 to 2017. Methods This is a longitudinal cohort study of patients who received medical cannabis authorization and followed-up in cannabis clinics, matched to population-based controls. The primary outcome was an ED visit or hospitalization for acute coronary syndrome (ACS) or stroke; and secondary outcome was for any cardiovascular event. Conditional Cox proportional hazards regression was used to assess the association between cannabis authorization and risk. Results 18,653 cannabis patients were matched to 51,243 controls. During a median follow-up of 242 days, the incidence rates for ACS or stroke were 7.19/1000 person-years and 5.67/1000 person-years in the cannabis and controls group, respectively- adjusted hazard ratio (aHR) of 1.44 (95% CI 1.08–1.93). When stratified by sex, the association was only statistically significant among males: aHR 1.77 (1.23–2.56). For the secondary outcome (any CV events), the aHR was 1.47 (1.26–1.72). The aHR among males and females were 1.52 (1.24–1.86) and 1.41 (1.11–1.79), respectively. Tested interaction between cannabis authorization and sex was not significant (p > 0.05). Conclusions Medical cannabis authorization was associated with an increased risk of ED visits or hospitalization for CV events including stroke and ACS. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02229-6.
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Affiliation(s)
- Arsene Zongo
- Faculty of Pharmacy, Université Laval, Quebec City, QC, Canada. .,Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, 1050 Chemin Ste-Foy (office J0-08), Quebec City, QC, G1S 4L8, Canada.
| | - Cerina Lee
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jihane El-Mourad
- Faculty of Pharmacy, Université Laval, Quebec City, QC, Canada.,Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, 1050 Chemin Ste-Foy (office J0-08), Quebec City, QC, G1S 4L8, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - John G Hanlon
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.,Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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Necyk C, Johnson JA, Tsuyuki RT, Eurich DT. Exploring the impact of pharmacist comprehensive annual care plans on perceived quality of chronic illness care by patients in Alberta, Canada. Can Pharm J (Ott) 2021; 154:331-341. [PMID: 34484483 PMCID: PMC8408906 DOI: 10.1177/17151635211020340] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/17/2020] [Indexed: 11/17/2022]
Abstract
Background: In 2012, the Government of Alberta introduced a funding program to remunerate pharmacists to develop a comprehensive annual care plan (CACP) for patients with complex needs. The objective of this study is to explore patients’ perceptions of the care they received through the pharmacist CACP program in Alberta. Methods: We invited 3442 patients who received a pharmacist-billed CACP within the previous 3 months and 6888 matched controls across Alberta to complete an online questionnaire. The questionnaire consisted of the short version Patient Assessment of Chronic Illness Care (PACIC-11), with 3 additional pharmacy-specific assessment questions added. Additional questions related to health status and demographics were also included. Results: Overall, most patients indicated a low level of chronic illness care by pharmacists, with few differences noted between CACP patients and non-CACP controls. Of note, controls reported higher quality of care for 5 domains within the adapted PACIC-like tool compared with CACP patients (p < 0.05 for all). Interestingly, only 79 (44%) of CACP patients reported that they had received a CACP, whereas only 192 (66%) of control patients reported that they did not receive a care plan. In a sensitivity analysis including only these respondents, individuals who received a CACP perceived a significantly higher quality of chronic illness care across all PACIC domains. Conclusion: Overall, chronic illness care incentivized by the pharmacist CACP program in Alberta is perceived to be moderate to low. When limited to respondents who explicitly recognized receiving the service or not, the perceptions of quality of care were more positive. This suggests that better implementation of CACP by pharmacists may be associated with improved quality of care and that some redesign is needed to engage patients more. Can Pharm J (Ott) 2021;154:xx-xx.
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Affiliation(s)
- Candace Necyk
- School of Public Health, University of Alberta, Edmonton, Alberta
| | - Jeffrey A Johnson
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta
| | - Ross T Tsuyuki
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
| | - Dean T Eurich
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta
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Lau D, Eurich DT, Simpson SH. Foregone opportunities? Time-to-treatment intensification among adults with type 2 diabetes and elevated HbA1c on metformin monotherapy, 2009-2018. Can J Diabetes 2021; 46:238-243.e4. [DOI: 10.1016/j.jcjd.2021.09.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/12/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
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Ta D, Ishaque A, Srivastava O, Hanstock C, Seres P, Eurich DT, Luk C, Briemberg H, Frayne R, Genge AL, Graham SJ, Korngut L, Zinman L, Kalra S. Progressive Neurochemical Abnormalities in Cognitive and Motor Subgroups of Amyotrophic Lateral Sclerosis: A Prospective Multicenter Study. Neurology 2021; 97:e803-e813. [PMID: 34426551 PMCID: PMC8397589 DOI: 10.1212/wnl.0000000000012367] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/19/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate progressive cerebral degeneration in amyotrophic lateral sclerosis (ALS) by assessing alterations in N-acetylaspartate (NAA) ratios in the motor and prefrontal cortex within clinical subgroups of ALS. METHODS Seventy-six patients with ALS and 59 healthy controls were enrolled in a prospective, longitudinal, multicenter study in the Canadian ALS Neuroimaging Consortium. Participants underwent serial clinical evaluations and magnetic resonance spectroscopy at baseline and 4 and 8 months using a harmonized protocol across 5 centers. NAA ratios were quantified in the motor cortex and prefrontal cortex. Patients were stratified into subgroups based on disease progression rate, upper motor neuron (UMN) signs, and cognitive status. Linear mixed models were used for baseline and longitudinal comparisons of NAA metabolite ratios. RESULTS Patients with ALS had reduced NAA ratios in the motor cortex at baseline (p < 0.001). Ratios were lower in those with more rapid disease progression and greater UMN signs (p < 0.05). A longitudinal decline in NAA ratios was observed in the motor cortex in the rapidly progressing (p < 0.01) and high UMN burden (p < 0.01) cohorts. The severity of UMN signs did not change significantly over time. NAA ratios were reduced in the prefrontal cortex only in cognitively impaired patients (p < 0.05); prefrontal cortex metabolites did not change over time. CONCLUSIONS Progressive degeneration of the motor cortex in ALS is associated with more aggressive clinical presentations. These findings provide biological evidence of variable spatial and temporal cerebral degeneration linked to the disease heterogeneity of ALS. The use of standardized imaging protocols may have a role in clinical trials for patient selection or subgrouping. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that MRS NAA metabolite ratios of the motor cortex are associated with more rapid disease progression and greater UMN signs in patients with ALS. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov Identifier: NCT02405182.
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Affiliation(s)
- Daniel Ta
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada.
| | - Abdullah Ishaque
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Ojas Srivastava
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Chris Hanstock
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Peter Seres
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Dean T Eurich
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Collin Luk
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Hannah Briemberg
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Richard Frayne
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Angela L Genge
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Simon J Graham
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Lawrence Korngut
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Lorne Zinman
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada
| | - Sanjay Kalra
- From the Neuroscience and Mental Health Institute (D.T., A.I., O.S., S.K.), Department of Biomedical Engineering (C.H., P.S.), School of Public Health (D.T.E.), and Division of Neurology (C.L., S.K.), University of Alberta, Edmonton; Division of Neurology (H.B.), University of British Columbia, Vancouver; Seaman Family MR Centre (R.F.) and Hotchkiss Brain Institute (R.F., L.K.), University of Calgary, Alberta; Montreal Neurological Institute (A.L.G.), McGill University, Quebec; and Sunnybrook Health Sciences Centre (S.J.G., L.Z.), University of Toronto, Ontario, Canada.
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Lipscombe L, Butalia S, Dasgupta K, Eurich DT, MacCallum L, Shah BR, Simpson S, Senior PA. Pharmacologic Glycemic Management of Type 2 Diabetes in Adults: 2020 Update. Can J Diabetes 2021; 44:575-591. [PMID: 32972640 DOI: 10.1016/j.jcjd.2020.08.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Lorraine Lipscombe
- Division of Endocrinology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Butalia
- Division of Endocrinology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kaberi Dasgupta
- Divisions of Internal Medicine, Clinical Epidemiology, and Endocrinology and Metabolism, Department of Medicine; Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Lori MacCallum
- Banting & Best Diabetes Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine and Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Scot Simpson
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Peter A Senior
- Division of Endocrinology and Metabolism, University of Alberta, Edmonton, Alberta, Canada
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