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MacDonald SE, Tough S, Guo X, Kellner JD. Impact of combination MMRV vaccine on first-dose coverage for measles and varicella: a population-based study. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01379-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Abstract
Aim
Combination vaccines decrease the number of needles required, addressing a common concern of parents. However, some parents are hesitant about combination vaccines and/or want to opt out of certain vaccine components. This study assessed whether introduction of the combination MMRV vaccine influenced coverage levels for measles- and varicella-containing vaccines.
Study and methods
This was a population-based study of children born in Alberta, Canada between 2006 and 2012. We utilized administrative health data to evaluate coverage for the first dose of measles- and varicella-containing vaccines at the age of 24 months (i.e. between 2008 and 2014) before and after introduction of the combination MMRV vaccine in 2010. Among those who were vaccinated, we assessed whether any children continued to receive separate vaccines after the combination vaccine was introduced.
Results
Of 308,212 children, 272,345 (88.36%) were vaccinated with measles- and/or varicella-containing vaccines at the age of 24 months. Although coverage for measles-containing vaccines did not change overall between 2008 and 2014, coverage for varicella vaccine increased in the years following the introduction of MMRV. After the combination vaccine introduction, 96.55% of vaccinated children (n = 121,131) received MMRV vaccine.
Conclusion
Vaccine coverage for varicella increased after the introduction of the combination MMRV vaccine, and there was a narrowing in the gap between MMR and varicella coverage. Very few children received separate vaccines after the introduction of the combination MMRV vaccine. These findings suggest that combination vaccines are acceptable to most parents and increase coverage for varicella in our setting.
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Ji C, Piché-Renaud PP, Apajee J, Stephenson E, Forte M, Friedman JN, Science M, Zlotkin S, Morris SK, Tu K. Impact of the COVID-19 pandemic on routine immunization coverage in children under 2 years old in Ontario, Canada: A retrospective cohort study. Vaccine 2022; 40:1790-1798. [PMID: 35164987 PMCID: PMC8824235 DOI: 10.1016/j.vaccine.2022.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The COVID-19 pandemic has caused a disruption in childhood immunization coverage around the world. This study aimed to determine the change in immunization coverage for children under 2 years old in Ontario, Canada, comparing time periods pre-pandemic to during the first year of the pandemic. METHODS Observational retrospective open cohort study, using primary care electronic medical record data from the University of Toronto Practice-Based Research Network (UTOPIAN) database, from January 2019 to December 2020. Children under 2 years old who had at least 2 visits recorded in UTOPIAN were included. We measured up-to-date (UTD) immunization coverage rates, overall and by type of vaccine (DTaP-IPV-Hib, PCV13, Rota, Men-C-C, MMR, Var), and on-time immunization coverage rates by age milestone (2, 4, 6, 12, 15, 18 months). We compared average coverage rates over 3 periods of time: January 2019-March 2020 (T1); March-July 2020 (T2); and August-December 2020 (T3). RESULTS 12,313 children were included. Overall UTD coverage for all children was 71.0% in T1, dropped by 5.7% (95% CI: -6.2, -5.1) in T2, slightly increased in T3 but remained lower than in T1. MMR vaccine UTD coverage slightly decreased in T2 and T3 by approximately 2%. The largest decreases were seen at ages 15-month and 18-month old, with drops in on-time coverage of 14.7% (95% CI: -18.7, -10.6) and 16.4% (95% CI: -20.0, -12.8) respectively during T2. When stratified by sociodemographic characteristics, no specific subgroup of children was found to have been differentially impacted by the pandemic. CONCLUSION Childhood immunization coverage rates for children under 2 years in Ontario decreased significantly during the early period of the COVID-19 pandemic and only partially recovered during the rest of 2020. Public health and educational interventions for providers and parents are needed to ensure adequate catch-up of delayed/missed immunizations to prevent potential outbreaks of vaccine-preventable diseases.
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Affiliation(s)
- Catherine Ji
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada; Toronto Western Family Health Team, University Health Network, 440 Bathurst Street, 3rd Floor, Toronto, Ontario M5T 2S6, Canada.
| | - Pierre-Philippe Piché-Renaud
- Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8
| | - Jemisha Apajee
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada
| | - Ellen Stephenson
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada
| | - Milena Forte
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada; Mount Sinai Academic Family Health Team, 60 Murray Street, 4th Floor, Toronto, Ontario M5T 3L9, Canada
| | - Jeremy N Friedman
- Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8; Division of Paediatric Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| | - Michelle Science
- Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8
| | - Stanley Zlotkin
- Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8; Division of Paediatric Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Centre for Global Child Health and the SickKids Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, Ontario M5G 0A4, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8; Centre for Global Child Health and the SickKids Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, Ontario M5G 0A4, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada; Toronto Western Family Health Team, University Health Network, 440 Bathurst Street, 3rd Floor, Toronto, Ontario M5T 2S6, Canada; North York General Hospital, 4001 Leslie Street, Toronto, Ontario M2K 1E1, Canada
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Odone A, Gianfredi V, Sorbello S, Capraro M, Frascella B, Vigezzi GP, Signorelli C. The Use of Digital Technologies to Support Vaccination Programmes in Europe: State of the Art and Best Practices from Experts' Interviews. Vaccines (Basel) 2021; 9:1126. [PMID: 34696234 PMCID: PMC8538238 DOI: 10.3390/vaccines9101126] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/22/2022] Open
Abstract
Digitalisation offers great potential to improve vaccine uptake, supporting the need for effective life-course immunisation services. We conducted semi-structured in-depth interviews with public health experts from 10 Western European countries (Germany, Greece, Italy, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, and the United Kingdom) to assess the current level of digitalisation in immunisation programmes and retrieve data on interventions and best practices. Interviews were performed using an ad hoc questionnaire, piloted on a sample of national experts. We report a mixed level of digital technologies deployment within vaccination services across Europe: Some countries are currently developing eHealth strategies, while others have already put in place robust programmes. Institutional websites, educational videos, and electronic immunisation records are the most frequently adopted digital tools. Webinars and dashboards represent valuable resources to train and support healthcare professionals in immunisation services organisation. Text messages, email-based communication, and smartphone apps use is scattered across Europe. The main reported barrier to the implementation of digital-based programmes is the lack of resources and shared standards. Our study offers a comprehensive picture of the European context and shows the need for robust collaboration between states and international institutions to share best practices and inform the planning of digital intervention models with the aim of countering vaccine hesitancy and increasing vaccine uptake.
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Affiliation(s)
- Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Vincenza Gianfredi
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (V.G.); (M.C.); (B.F.); (G.P.V.); (C.S.)
| | - Sebastiano Sorbello
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Michele Capraro
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (V.G.); (M.C.); (B.F.); (G.P.V.); (C.S.)
| | - Beatrice Frascella
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (V.G.); (M.C.); (B.F.); (G.P.V.); (C.S.)
| | - Giacomo Pietro Vigezzi
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (V.G.); (M.C.); (B.F.); (G.P.V.); (C.S.)
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy; (V.G.); (M.C.); (B.F.); (G.P.V.); (C.S.)
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Chambers C. Using observational epidemiology to evaluate COVID-19 vaccines: integrating traditional methods with new data sources and tools. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:867-871. [PMID: 34160784 PMCID: PMC8220874 DOI: 10.17269/s41997-021-00554-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/10/2021] [Indexed: 11/24/2022]
Abstract
Although clinical trials are necessary for vaccine approval, observational epidemiology will be required to evaluate the long-term effectiveness, safety, and population impacts of newly approved COVID-19 vaccines under real-world field conditions. In this commentary, I argue that a hybrid approach that combines new data sources and tools, including COVID-19 vaccine registries, with traditional epidemiological methods will be needed to evaluate COVID-19 vaccines using observational epidemiology. Wherever possible, primary data collection, active surveillance, and linkage with existing population-based cohorts should be leveraged to supplement secondary data sources and passive surveillance systems. Evidence-informed public health decision making around provincial COVID-19 immunization programs will need to account for potential biases, incomplete or conflicting information, and heterogeneity across subpopulations.
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Affiliation(s)
- Catharine Chambers
- Department of Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
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Goyette A, Yen GP, Racovitan V, Bhangu P, Kothari S, Franco EL. Evolution of Public Health Human Papillomavirus Immunization Programs in Canada. Curr Oncol 2021; 28:991-1007. [PMID: 33617515 PMCID: PMC7985769 DOI: 10.3390/curroncol28010097] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Since 2007, all Canadian provinces and territories have had a publicly funded program for vaccination against human papillomavirus (HPV) infection. The objective of this study was to describe the evolution of these vaccination programs. Methods: This was a targeted literature review of public HPV vaccination programs and vaccination coverage rates, based on information provided by jurisdictional public health authorities. Results: HPV vaccination of schoolgirls began in school years 2007/08 to 2010/11 with three doses of the quadrivalent HPV vaccine in all provinces except Quebec, which started with two doses. By 2018/19, all jurisdictions were vaccinating with two doses of the nonavalent vaccine in both girls and boys, except Quebec, which used a mixed vaccination schedule with one dose of the nonavalent and one dose of the bivalent vaccines. Public HPV vaccination programs in most provinces include after-school catch-up vaccination. Immunocompromised or other high-risk individuals are eligible for the HPV public vaccination program in most provinces, but policies vary by jurisdiction. In 2017/18, vaccination coverage rates in provincial HPV school-based programs varied from 62% in Ontario to 86% in Prince Edward Island in girls and from 58% in Ontario to 86% in Prince Edward Island in boys. Conclusions: Since their introduction, Canadian school-based HPV public vaccination programs have evolved from a three-dose to a two-dose schedule, from a quadrivalent to a nonavalent vaccine, and from a girls-only to a gender-neutral policy. Vaccination coverage rates have varied markedly and only Prince Edward Island and Newfoundland/Labrador have maintained rates exceeding 80%.
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Affiliation(s)
| | - Glorian P. Yen
- Merck & Co., Inc., Kenilworth, NJ 07033, USA; (G.P.Y.); (S.K.)
| | - Voica Racovitan
- Merck Canada Inc., Kirkland, QC H9H 4M7, Canada; (V.R.); (P.B.)
| | - Parambir Bhangu
- Merck Canada Inc., Kirkland, QC H9H 4M7, Canada; (V.R.); (P.B.)
| | - Smita Kothari
- Merck & Co., Inc., Kenilworth, NJ 07033, USA; (G.P.Y.); (S.K.)
| | - Eduardo L. Franco
- Division of Cancer Epidemiology, McGill University, Montreal, QC H4A 3T2, Canada;
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Pulver A, Guttmann A, Ray JG, O'Campo PJ, Urquia ML. Receipt of routine preventive care among infant daughters and sons of immigrant mothers in Ontario, Canada: a retrospective cohort study. BMJ Open 2020; 10:e036127. [PMID: 32737090 PMCID: PMC7398108 DOI: 10.1136/bmjopen-2019-036127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To explore gender disparities in infant routine preventive care across maternal countries of birth (MCOB) and by mother tongue among infants of Indian-born mothers. SETTING Retrospective population-based administrative cohort in Ontario, Canada (births between 2002 and 2014). PARTICIPANTS 350 366 (inclusive) healthy term singletons belonging to families with a minimum of one opposite gender child. OUTCOME MEASURES Fixed effects conditional logistic regression generated adjusted ORs (aORs) for a daughter being underimmunised and having an inadequate number of well-child visits compared with her brother, stratified by MCOB. Moderation by maternal mother tongue was assessed among children to Indian-born mothers. RESULTS Underimmunisation and inadequate well-child visits were common among both boys and girls, ranging from 26.5% to 58.2% (underimmunisation) and 10.5% to 47.8% (inadequate well-child visits). depending on the maternal birthplace. Girls whose mothers were born in India had 1.19 times (95% CI 1.07 to 1.33) the adjusted odds of inadequate well-child visits versus their brothers. This association was only observed among the Punjabi mother tongue subgroup (aOR: 1.26, 95% CI 1.08 to 1.47). In the Hindi mother tongue subgroup, girls had lower odds of underimmunisation than their brothers (aOR: 0.73, 95% CI 0.54 to 0.98). CONCLUSIONS Gender equity in routine preventive healthcare is mostly achieved among children of immigrants. However, daughters of Indian-born mothers whose mother tongue is Punjabi, appear to be at a disadvantage for well-child visits compared with their brothers. This suggests son preference may persist beyond the family planning stage among some Indian immigrants.
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Affiliation(s)
- Ariel Pulver
- Department of Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Astrid Guttmann
- ICES, Toronto, Ontario, Canada
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Deaprtment of Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Joel G Ray
- ICES, Toronto, Ontario, Canada
- Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Patricia J O'Campo
- Department of Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Marcelo L Urquia
- Department of Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- University of Manitoba, Winnipeg, Manitoba, Canada
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Age-specific vaccination coverage estimates for influenza, human papillomavirus and measles containing vaccines from seven population-based healthcare databases from four EU countries – The ADVANCE project. Vaccine 2020; 38:3243-3254. [DOI: 10.1016/j.vaccine.2020.02.082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 02/20/2020] [Accepted: 02/28/2020] [Indexed: 11/18/2022]
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Rafferty E, Hetherington E, Tough S, Aujla S, McNeil D, Saini V, McDonald S, MacDonald SE. The impact of time since vaccination and study design on validity in parental recall of childhood vaccination status in the All Our Families cohort. Vaccine 2018; 36:2953-2959. [PMID: 29699787 DOI: 10.1016/j.vaccine.2018.04.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Parental reporting of childhood vaccination status is often used for policy and program evaluation and research purposes. Many factors can bias parental reporting of childhood vaccination status, however, to our knowledge, no analysis has assessed whether time since vaccination impacts reporting accuracy. Therefore, using the Calgary electronic vaccine registry (PHANTIM) as the gold standard, we aimed to test the accuracy of parental reporting of childhood vaccination status at three different time-points since vaccination. METHODS The All Our Families (AOF) cohort study asked parents to report their child's 2, 4, 6, 12 and 18 month vaccines (vaccination time-point) on questionnaires given when the child was 1, 2 and 3 years of age (survey time-point). We linked the AOF parental reporting of vaccination status to the PHANTIM registry and calculated the percent agreement and difference in coverage estimates between PHANTIM and AOF at each vaccination and survey time-point combination. Furthermore, we measured the sensitivity and specificity, and negative (NPV) and positive predictive values (PPV) of parental vaccine recall across time. RESULTS AOF parent reports of coverage rates were consistently higher than the PHANTIM estimates. While we saw significant differences in percent agreement for certain vaccination time-points, we saw no consistent directional difference by survey time-point, suggesting that parental accuracy did not change with time. We found a uniformly high sensitivity across all vaccination and survey time-points, and no consistent patterns in the specificity, PPV and NPV results. CONCLUSION Time since vaccination may not be the most important consideration when designing and implementing a vaccination survey. Other factors that may contribute to the bias associated with parental reporting of vaccination status include the complexity of the vaccine schedule, schedule changes over time, and the wording and structure of the questionnaires.
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Affiliation(s)
- Ellen Rafferty
- University of Alberta, Faculty of Nursing, 5-308 Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada
| | - Erin Hetherington
- University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Suzanne Tough
- University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Shyrose Aujla
- University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Deborah McNeil
- University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Strategic Clinical Networks, Alberta Health Services, Seventh Street Plaza, 14th Floor, North Tower, 10030 - 107 Street NW, Edmonton, AB T5J 3E4, Canada; University of Calgary, Faculty of Nursing, 2800 University Way N.W., Calgary, AB T2N 1N4, Canada
| | - Vineet Saini
- Population, Public and Indigenous Health, Alberta Health Services, Seventh Street Plaza, 14th Floor, North Tower, 10030 - 107 Street NW, Edmonton, AB T5J 3E4, Canada
| | - Sheila McDonald
- Population, Public and Indigenous Health, Alberta Health Services, Seventh Street Plaza, 14th Floor, North Tower, 10030 - 107 Street NW, Edmonton, AB T5J 3E4, Canada
| | - Shannon E MacDonald
- University of Alberta, Faculty of Nursing, 5-308 Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada; University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
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