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Malkin J, Jessiman-Perreault G, Alberga Machado A, Teare G, Snider J, Tirmizi SF, Youngson E, Wang T, Law J, Bandara T, Rathwell M, Neudorf C, Allen Scott L. Individual and Geospatial Determinants of Health Associated With School-Based Human Papillomavirus Immunization in Alberta: Population-Based Cohort Study. JMIR Public Health Surveill 2024; 10:e45508. [PMID: 38536211 PMCID: PMC11007603 DOI: 10.2196/45508] [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: 01/05/2023] [Revised: 10/06/2023] [Accepted: 01/07/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection causes nearly all cervical cancer cases and is a cause of anogenital and oropharyngeal cancers. The incidence of HPV-associated cancers is inequitable, with an increased burden on marginalized groups in high-income countries. Understanding how immunization status varies by material and social deprivation, health system, and geospatial factors is valuable for prioritizing and planning HPV immunization interventions. OBJECTIVE The objective of this study was to describe school-based HPV immunization rates by individual and geospatial determinants of health in Alberta, Canada. METHODS Health administrative data for male and female individuals born in 2004 in Alberta were used to determine HPV immunization status based on age and the number of doses administered in schools during the 2014/2015-2018/2019 school years. Immunization status and its relationship with material and social deprivation and health system factors were assessed by a logistic regression model. Geospatial clustering was assessed using Getis-Ord Gi* hot spot analysis. Mean scores of material and social deprivation and health system factors were compared between hot and cold spots without full HPV immunization using independent samples t tests. A multidisciplinary team comprising researchers and knowledge users formed a co-design team to design the study protocol and review the study results. RESULTS The cohort consisted of 45,207 youths. In the adjusted model, the odds of those who did not see their general practitioner (GP) within 3 years before turning 10 years old and not being fully immunized were 1.965 times higher (95% CI 1.855-2.080) than those who did see their GP. The odds of health system users with health conditions and health system nonusers not being fully immunized were 1.092 (95% CI 1.006-1.185) and 1.831 (95% CI 1.678-1.998) times higher, respectively, than health system users without health conditions. The odds of those who lived in areas with the most material and social deprivation not being fully immunized were 1.287 (95% CI 1.200-1.381) and 1.099 (95% CI 1.029-1.174) times higher, respectively, than those who lived in areas with the least deprivation. The odds of those who lived in rural areas not being fully immunized were 1.428 times higher (95% CI 1.359-1.501) than those who lived in urban areas. Significant hot spot clusters of individuals without full HPV immunization exist in rural locations on the northern and eastern regions of Alberta. Hot spots had significantly worse mean material deprivation scores (P=.008) and fewer GP visits (P=.001) than cold spots. CONCLUSIONS Findings suggest that material and social deprivation, health system access, and rural residency impact HPV immunization. Such factors should be considered by public health professionals in other jurisdictions and will be used by the Alberta co-design team when tailoring programs to increase HPV vaccine uptake in priority populations and regions.
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Affiliation(s)
- Jennifer Malkin
- Cancer Prevention and Screening Innovation, Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Geneviève Jessiman-Perreault
- Cancer Prevention and Screening Innovation, Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Amanda Alberga Machado
- Cancer Prevention and Screening Innovation, Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Gary Teare
- Cancer Prevention and Screening Innovation, Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Joanne Snider
- Communicable Disease Control, Provincial Population and Public Health, Alberta Health Services, Edmonton, AB, Canada
| | - Syed Farhan Tirmizi
- Communicable Disease Control, Provincial Population and Public Health, Alberta Health Services, Edmonton, AB, Canada
| | - Erik Youngson
- Provincial Research Data Services, Alberta Health Services, Edmonton, AB, Canada
| | - Ting Wang
- Provincial Research Data Services, Alberta Health Services, Edmonton, AB, Canada
| | - Jessica Law
- Cancer Prevention and Screening Innovation, Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Thilina Bandara
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | | | | | - Lisa Allen Scott
- Cancer Prevention and Screening Innovation, Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
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Neudorf C, McLaren L, Laplante O, Masuda J. Public health systems and services research: an emerging field of research for CJPH to promote. Can J Public Health 2023; 114:1-4. [PMID: 36625998 PMCID: PMC9831369 DOI: 10.17269/s41997-022-00735-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Plante C, Sandhu N, Bandara T, Fuller D, Neudorf C. Defining the "local public health unit" for public health systems and services research in Canada. Can J Public Health 2022; 114:5-9. [PMID: 36459365 PMCID: PMC9717555 DOI: 10.17269/s41997-022-00714-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 10/19/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Charles Plante
- Saskatchewan Health Authority, Research Department, St. Andrew's College, 1121 College Drive, Saskatoon, Saskatchewan, S7N 0W3, Canada. .,Department of Community Health and Epidemiology, University of Saskatchewan, Health Science Building, 107 Wiggins Road, Saskatoon, Saskatchewan, S7N 5E5, Canada.
| | - Navdeep Sandhu
- Urban Public Health Network, 655 Whiteswan Drive, Saskatoon, Saskatchewan S7K 8A2 Canada
| | - Thilina Bandara
- Department of Community Health and Epidemiology, University of Saskatchewan, Health Science Building, 107 Wiggins Road, Saskatoon, Saskatchewan S7N 5E5 Canada ,Urban Public Health Network, 655 Whiteswan Drive, Saskatoon, Saskatchewan S7K 8A2 Canada ,School of Public Health, University of Saskatchewan, 104 Clinic Place, S7N 2Z4 Saskatoon, SK Canada
| | - Daniel Fuller
- Department of Community Health and Epidemiology, University of Saskatchewan, Health Science Building, 107 Wiggins Road, Saskatoon, Saskatchewan S7N 5E5 Canada
| | - Cordell Neudorf
- Department of Community Health and Epidemiology, University of Saskatchewan, Health Science Building, 107 Wiggins Road, Saskatoon, Saskatchewan S7N 5E5 Canada ,Urban Public Health Network, 655 Whiteswan Drive, Saskatoon, Saskatchewan S7K 8A2 Canada
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Malkin J, Allen Scott L, Alberga Machado A, Teare G, Snider J, Ali Tirmizi SF, Bandara T, Rathwell M, Neudorf C. Factors influencing human papillomavirus school-based immunization in Alberta: A mixed-methods study protocol. PLoS One 2022; 17:e0278472. [PMID: 36454791 PMCID: PMC9714709 DOI: 10.1371/journal.pone.0278472] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/24/2022] [Indexed: 12/03/2022] Open
Abstract
More than 1,300 Canadians are diagnosed with cervical cancer annually, which is nearly preventable through human papillomavirus (HPV) immunization. Across Canada, coverage rates remain below the 90% target set out by the Action Plan for the Elimination of Cervical Cancer in Canada (2020-2030). To support this Plan, the Canadian Partnership Against Cancer has commissioned the Urban Public Health Network (UPHN) to coordinate a quality improvement project with Canada's school-based HPV immunization programs. In Alberta, the UPHN partnered with Alberta Health Services (AHS) for this work. This study has one overarching research question: what are parent/guardian and program stakeholder perceived barriers, enablers and opportunities to immunization for youth as part of the school-based HPV immunization program in Alberta? This study uses a mixed-methods sequential explanatory design. A survey will be emailed to a sample of Albertans with children aged 11-17 years. Questions will be based on a Conceptual Framework of Access to Health Care. Subsequent qualitative work will explore the survey's findings. Parents/guardians identifying as vaccine hesitant in the survey will be invited to participate in virtual, semi-structured, in-depth interviews. Stakeholders of the school-based immunization program will be purposively sampled from AHS' five health zones for virtual focus groups. Quantitative data will be analyzed using SAS Studio 3.6 to carry out descriptive statistics and, using logistic regression, investigate if Framework constructs are associated with parents'/guardians' decision to immunize their children. Qualitative data will be analyzed using NVivo 12 to conduct template thematic analysis guided by the Framework. Study results will provide insights for Alberta's public health practitioners to make evidence-informed decisions when tailoring the school-based HPV immunization program to increase uptake in vaccine hesitant populations. Findings will contribute to the national study, which will culminate in recommendations to increase HPV immunization uptake nationally and progress towards the 90% coverage target.
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Affiliation(s)
- Jennifer Malkin
- Public Health Evidence and Innovation Division, Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
- * E-mail:
| | - Lisa Allen Scott
- Public Health Evidence and Innovation Division, Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amanda Alberga Machado
- Public Health Evidence and Innovation Division, Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Gary Teare
- Public Health Evidence and Innovation Division, Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joanne Snider
- Communicable Disease Control Division, Provincial Population and Public Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Syed Farhan Ali Tirmizi
- Communicable Disease Control Division, Provincial Population and Public Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Thilina Bandara
- Urban Public Health Network, Saskatoon, Saskatchewan, Canada
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mika Rathwell
- Urban Public Health Network, Saskatoon, Saskatchewan, Canada
| | - Cordell Neudorf
- Urban Public Health Network, Saskatoon, Saskatchewan, Canada
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Ilesanmi MM, Abonyi S, Pahwa P, Gerdts V, Scwandt M, Neudorf C. Trends, barriers and enablers to measles immunisation coverage in Saskatchewan, Canada: A mixed methods study. PLoS One 2022; 17:e0277876. [PMID: 36417461 PMCID: PMC9683619 DOI: 10.1371/journal.pone.0277876] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
Many social, cultural, and systemic challenges affect the uptake of measles immunisation services. Prior studies have looked at the caregivers' perspectives, but little is known about the perspectives of the health care providers on the barriers of measles immunisation services in Canada. This study examined measles immunisation coverage trends across the regional health authorities in Saskatchewan and explored the barriers and enablers to measles immunisation coverage from providers' perspectives. The study adopted an explanatory sequential mixed method. We utilized the entire population of 16,582 children under two years of age available in the Saskatchewan Immunisation Management System (SIMS) registry for 2002 and 2013 in aggregate format and interviewed 18 key informants in pre-determined two-stages in 2016 and 2017. The quantitative analysis was done with Joinpoint regression modelling, while the qualitative interview data was analyzed using hybrid inductive and deductive thematic approaches. There was a 16.89%-point increase in measles immunisation coverage in the province from 56.32% to 73.21% between 2002 and 2013. There was also a persistently higher coverage among the affluent (66.95% - 82.37%) than the most deprived individuals (45.79% - 62.60%) in the study period. The annual rate of coverage change was marginally higher among the most deprived (16.81%; and average annual percentage change (AAPC) 2.0, 95% CI 1.7-2.2) than among the affluent group (15.42% and AAPC 3.0; 95% CI 2.0-4.0). While access-related issues, caregivers' fears, hesitancy, anti-vaccination challenges, and resource limitations were barriers to immunisation, improving community engagement, service delivery flexibility, targeted social responses and increasing media role were found useful to address the uptake of measles and other vaccine-preventable diseases immunisation. There is low coverage and inequity in measles immunisation uptake in Saskatchewan from social and institutional barriers. Even though there is evidence of disparity reduction among the different groups, the barriers to increasing measles immunisation coverage have implications for the health of the socio-economically deprived groups, the healthcare system and other vaccination programs. There is a need to improve policy framework for community engagement, targeted programs, and public health discourse.
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Affiliation(s)
- Marcus M. Ilesanmi
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- * E-mail:
| | - Sylvia Abonyi
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Saskatchewan Population Health and Evaluation Research Unit (SPHERU), University of Saskatchewan, Saskatoon, SK, Canada
| | - Punam Pahwa
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | - Volker Gerdts
- Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac), University of Saskatchewan, Saskatoon, SK, Canada
- Department of Veterinary Microbiology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Michael Scwandt
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health, Office of the Chief Medical Health Officer, Vancouver, BC, Canada
| | - Cordell Neudorf
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Health Surveillance & Reporting, Saskatchewan Health Authority (SHA), Saskatoon, SK, Canada
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Alhassan JAK, Abonyi S, Neudorf C, Hanson L. "It feels like somebody cut my legs off": Austerity, transportation and the 'web of dispossession' in Saskatchewan, Canada. Soc Sci Med 2021; 282:114147. [PMID: 34166968 DOI: 10.1016/j.socscimed.2021.114147] [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: 02/28/2021] [Revised: 06/09/2021] [Accepted: 06/13/2021] [Indexed: 11/29/2022]
Abstract
Mounting global evidence reveals a rise in austerity driven by neoliberalisation. We explored the health impacts of an austerity decision to shut down the Saskatchewan Transportation Company (STC) in Saskatchewan, Canada. We conducted 100 semi-structured interviews and 4 focus group discussions with former bus riders and stakeholders in health and social services followed by a member checking exercise. The STC closure has negatively affected health through a web of dispossession where the absence of the bus affects individual former users (through healthcare access, psychosocial and financial impacts), family members (through broken relationships and other burdens), communities (through shrinking commons), and entire systems (such as health services through health worker stress and inefficiencies). Analyses of the health impacts of austerity decisions need to move beyond aggregates of individual users of public services to understand the complex ways in which various communities and systems might be caught up in a web of dispossession through austerity.
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Affiliation(s)
- Jacob Albin Korem Alhassan
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Canada; Saskatchewan Population Health and Evaluation Research Unit, Canada.
| | - Sylvia Abonyi
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Canada; Saskatchewan Population Health and Evaluation Research Unit, Canada.
| | - Cordell Neudorf
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Canada; Saskatchewan Population Health and Evaluation Research Unit, Canada.
| | - Lori Hanson
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Canada.
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Missiuna S, Plante C, Pahwa P, Muhajarine N, Neudorf C. Trends in mental health inequalities in urban Canada. Can J Public Health 2021; 112:629-637. [PMID: 33877585 DOI: 10.17269/s41997-021-00498-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/09/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Canadians do not all enjoy equal levels of health. The presence of income-related health inequalities has been well established in Canada, but there is a lack of consistent reporting of mental health inequalities in Canada's largest cities. This study reports the prevalence and inequalities in mental health outcomes at the city, provincial, and national levels over time. METHODS Self-reported poor mental health, life stress, and physician-diagnosed self-reported mood and anxiety disorder from the Canadian Community Health Survey were pooled over five-year intervals and combined with neighbourhood income information from the Canadian Census. First, prevalence rates were calculated for each interval at the neighbourhood level for urban communities. Second, the distributions of these neighbourhood rates were summarized at the city level and for Canada as a whole using overall prevalence rates and concentration indices of inequality. Finally, trends in these city- and country-level outcomes were also explored. RESULTS At the national level, starting from 2001 to 2005, the prevalence of poor mental health (27.9%), mood disorder (7.3%), and anxiety disorder (6.8%) had significantly increased by 2011-2015. Inequalities were present in 2001-2005 and worsened over time. The prevalence rate at the national level of life stress was 66.6% in 2001-2005 and decreased over time. CONCLUSION The large and increasing values of inequalities and the difference in prevalence rates and inequalities in cities highlight the necessity for mental disorder-specific data and for city-level analysis of inequalities. The next steps in reducing inequalities involve deconstructing the health inequalities, and continued monitoring.
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Affiliation(s)
- Sharalynn Missiuna
- Department of Community Health and Epidemiology, University of Saskatchewan, Health Science Building 107 Wiggins Road, Saskatoon, Saskatchewan, S7N 5E5, Canada.
| | - Charles Plante
- Johnson Shoyama Graduate School of Public Policy, University of Saskatchewan, Diefenbaker Building 141-101 Diefenbaker Place, Saskatoon, Saskatchewan, S7N 5B8, Canada
| | - Punam Pahwa
- Department of Community Health and Epidemiology, University of Saskatchewan, Health Science Building 107 Wiggins Road, Saskatoon, Saskatchewan, S7N 5E5, Canada
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, University of Saskatchewan, Health Science Building 107 Wiggins Road, Saskatoon, Saskatchewan, S7N 5E5, Canada
| | - Cordell Neudorf
- Department of Community Health and Epidemiology, University of Saskatchewan, Health Science Building 107 Wiggins Road, Saskatoon, Saskatchewan, S7N 5E5, Canada
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Keir M, Penner M, Dehghani P, Neudorf C, Lim HJ, Bradley TJ, Bree T, Kakadekar A. Barriers to Care in ACHD: A Study of Young Adults in Saskatchewan. CJC Open 2020; 2:439-446. [PMID: 33305202 PMCID: PMC7710945 DOI: 10.1016/j.cjco.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/23/2020] [Indexed: 11/05/2022] Open
Abstract
Background Adults with congenital heart disease (CHD) are living longer with more complex disease. Maintaining lifelong care prevents morbidity and mortality, but many patients remain lost to follow-up or experience care gaps. We sought to assess barriers to care for patients with adult CHD (ACHD) in Saskatchewan, a Canadian province with no local congenital cardiac surgical support and no clear framework for ACHD care. Methods We performed a telephone survey of patients with CHD transferred from pediatric to adult cardiology from 2007 to 2014. Our primary outcome was loss to follow-up > 2 years from last recommended cardiology appointment and/or multiple missed cardiology appointments. Secondary outcomes were guideline-based care (specialist training, adherence to appropriate endocarditis prophylaxis, pre-pregnancy counselling for women), presence or absence of previously described barriers to care in ACHD, and health care autonomy using the Krantz Health Opinion Survey. Results We interviewed 32 patients (30% response rate). One-quarter met the primary outcome: lost to follow-up > 2 years from last recommended cardiology appointment and/or self-report of missed cardiology appointments. Only 69% of young adults in Saskatchewan were receiving guideline-based care for their CHD (appropriate level of specialist expertise and frequency of follow-up). Only 72% of patients were adhering to endocarditis prophylaxis recommendations and 61% of women surveyed received counselling regarding pregnancy. Patients indicated a low preference for participating in decision making regarding their care on the Krantz Health Opinion Survey. Conclusions With our survey, we have created a novel snapshot of CHD care in Saskatchewan and have identified significant deficits.
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Affiliation(s)
- Michelle Keir
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Marie Penner
- Division of Pediatric Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Payam Dehghani
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Cordell Neudorf
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Hyun J Lim
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Timothy J Bradley
- Division of Pediatric Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Terry Bree
- Division of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ashok Kakadekar
- Division of Pediatric Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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Bandara T, Musto R, Kancir J, Neudorf C. Public health physician perspectives on developing and deploying clinical practice guidelines during the 2009 H1N1 pandemic. Healthc Manage Forum 2020; 33:178-181. [PMID: 32250656 DOI: 10.1177/0840470420917412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
During the H1N1 outbreak of 2009, local public health units engaged in consultations with various levels of government to develop clinical practice guidelines. These guidelines provide specific clinical considerations around prevention, management, and treatment associated with the particular pathogen involved and are used by frontline healthcare professionals across many healthcare settings. In this article, we report on the lessons learned by Medical Officers of Health from across Canada on the guideline development and deployment processes and provide suggestions to improve guidelines development and deployment during future pandemic situations.
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Affiliation(s)
- Thilina Bandara
- O'Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Richard Musto
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jesse Kancir
- The University of British Columbia, Vancouver, British Columbia, Canada
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Anderson M, Revie CW, Stryhn H, Neudorf C, Rosehart Y, Li W, Osman M, Buckeridge DL, Rosella LC, Wodchis WP. Defining 'actionable' high- costhealth care use: results using the Canadian Institute for Health Information population grouping methodology. Int J Equity Health 2019; 18:171. [PMID: 31707981 PMCID: PMC6842471 DOI: 10.1186/s12939-019-1074-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 03/25/2019] [Accepted: 10/09/2019] [Indexed: 11/15/2022] Open
Abstract
Background A small proportion of the population consumes the majority of health care resources. High-cost health care users are a heterogeneous group. We aim to segment a provincial population into relevant homogenous sub-groups to provide actionable information on risk factors associated with high-cost health care use within sub-populations. Methods The Canadian Institute for Health Information (CIHI) Population Grouping methodology was used to define mutually exclusive and clinically relevant health profile sub-groups. High-cost users (> = 90th percentile of health care spending) were defined within each sub-group. Univariate analyses explored demographic, socio-economic status, health status and health care utilization variables associated with high-cost use. Multivariable logistic regression models were constructed for the costliest health profile groups. Results From 2015 to 2017, 1,175,147 individuals were identified for study. High-cost users consumed 41% of total health care resources. Average annual health care spending for individuals not high-cost were $642; high-cost users were $16,316. The costliest health profile groups were ‘long-term care’, ‘palliative’, ‘major acute’, ‘major chronic’, ‘major cancer’, ‘major newborn’, ‘major mental health’ and ‘moderate chronic’. Both ‘major acute’ and ‘major cancer’ health profile groups were largely explained by measures of health care utilization and multi-morbidity. In the remaining costliest health profile groups modelled, ‘major chronic’, ‘moderate chronic’, ‘major newborn’ and ‘other mental health’, a measure of socio-economic status, low neighbourhood income, was statistically significantly associated with high-cost use. Interpretation Model results point to specific, actionable information within clinically meaningful subgroups to reduce high-cost health care use. Health equity, specifically low socio-economic status, was statistically significantly associated with high-cost use in the majority of health profile sub-groups. Population segmentation methods, and more specifically, the CIHI Population Grouping Methodology, provide specificity to high-cost health care use; informing interventions aimed at reducing health care costs and improving population health.
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Affiliation(s)
- Maureen Anderson
- Department of Health Management, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada. .,Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Crawford W Revie
- Department of Health Management, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada.,Department of Computing and Information Sciences, University of Strathclyde, Glasgow, Scotland
| | - Henrik Stryhn
- Department of Health Management, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Cordell Neudorf
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Population and Public Health, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Yvonne Rosehart
- Canadian Institute for Health Information, Ottawa, Ontario, Canada
| | - Wenbin Li
- Saskatchewan Health Quality Council, Saskatoon, Saskatchewan, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Meriç Osman
- Saskatchewan Health Quality Council, Saskatoon, Saskatchewan, Canada
| | - David L Buckeridge
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Laura C Rosella
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Walter P Wodchis
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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11
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Anderson M, Revie CW, Quail JM, Wodchis W, de Oliveira C, Osman M, Baetz M, McClure J, Stryhn H, Buckeridge D, Neudorf C. The effect of socio-demographic factors on mental health and addiction high-cost use: a retrospective, population-based study in Saskatchewan. Can J Public Health 2018; 109:810-820. [PMID: 29981109 PMCID: PMC6267642 DOI: 10.17269/s41997-018-0101-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Received: 03/08/2018] [Accepted: 06/07/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE A small proportion of the population accounts for the majority of healthcare costs. Mental health and addiction (MHA) patients are consistently high-cost. We aimed to delineate factors amenable to public health action that may reduce high-cost use among a cohort of MHA clients in Saskatoon, Saskatchewan. METHODS We conducted a population-based retrospective cohort study. Administrative health data from fiscal years (FY) 2009-2015, linked at the individual level, were analyzed (n = 129,932). The outcome of interest was ≥ 90th percentile of costs for each year under study ('persistent high-cost use'). Descriptive analyses were followed by logistic regression modelling; the latter excluded long-term care residents. RESULTS The average healthcare cost among study cohort members in FY 2009 was ~ $2300; for high-cost users it was ~ $19,000. Individuals with unstable housing and hospitalization(s) had increased risk of persistent high-cost use; both of these effects were more pronounced as comorbidities increased. Patients with schizophrenia, particularly those under 50 years old, had increased probability of persistent high-cost use. The probability of persistent high-cost use decreased with good connection to a primary care provider; this effect was more pronounced as the number of mental health conditions increased. CONCLUSION Despite constituting only 5% of the study cohort, persistent high-cost MHA clients (n = 6455) accounted for ~ 35% of total costs. Efforts to reduce high-cost use should focus on reduction of multimorbidity, connection to a primary care provider (particularly for those with more than one MHA), young patients with schizophrenia, and adequately addressing housing stability.
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Affiliation(s)
- Maureen Anderson
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada.
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada.
| | - Crawford W Revie
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada
| | - Jacqueline M Quail
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada
- College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Walter Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada
- Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, M6J 1H4, Canada
| | - Meriç Osman
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada
| | - Marilyn Baetz
- College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
- Saskatoon Health Region, #101-310 Idylwyld Drive North, Saskatoon, SK, S7L 0Z2, Canada
| | - J McClure
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada
| | - Henrik Stryhn
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada
| | - David Buckeridge
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada
| | - Cordell Neudorf
- College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
- Saskatoon Health Region, #101-310 Idylwyld Drive North, Saskatoon, SK, S7L 0Z2, Canada
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12
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Cushon J, Waldner C, Scott C, Neudorf C. Planning Adolescent Mental Health Promotion Programming in Saskatoon. J Sch Health 2016; 86:578-584. [PMID: 27374347 DOI: 10.1111/josh.12410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 09/24/2014] [Revised: 12/29/2015] [Accepted: 01/09/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND We assessed associations between key demographic risk factors and the outcome of depressed mood in Saskatoon, Saskatchewan, to inform the planning and implementation of mental health promotion programming in schools. METHODS In the 2008/2009 school year, 3958 students from grades 5 through 8 from 76 elementary schools completed questions regarding depressed mood on the Student Health Survey administered by the Saskatoon Health Region. The demographic risk factors for depressed mood considered in this study included age, sex, cultural status, and neighborhood income, as well as the role of school and age cohorts or grades within schools. RESULTS We found Aboriginal students were significantly more likely to report moderate/severe depressed mood than other students. We also found older female adolescents were significantly more likely to report moderate/severe depressed mood. Neighborhood income explained the largest proportion (40%) of depressed mood differences between schools. CONCLUSIONS These results can inform the planning and implementation of mental health promotion programming by the health sector in Saskatoon's elementary schools, including an appropriate balance between targeted and population-based interventions that address both the distal and proximal determinants of depressed mood in adolescents.
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Affiliation(s)
- Jennifer Cushon
- Population and Public Health, Saskatoon Health Region, Royal University Hospital, Box 67, Saskatoon, Canada S7N 0W8.
| | - Cheryl Waldner
- School of Public Health and Western College of Veterinary Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, Canada S7N 2Z4.
| | - Christina Scott
- Public Health Observatory, Saskatoon Health Region, #101-310 Idylwyld Drive North, Saskatoon, Canada S7L 0Z2.
| | - Cordell Neudorf
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada.
- Saskatoon Health Region, #101-310 Idylwyld Drive North, Saskatoon, Canada S7L 0Z2.
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13
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Goddard M, Mowat D, Corbett C, Neudorf C, Raina P, Sahai V. The Impacts of Knowledge Management and Information Technology Advances on Public Health Decision-Making in 2010. Health Informatics J 2016. [DOI: 10.1177/1460458204042233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Population and public health programs in Canada in local/regional, provincial/ territorial and federal governments have been working together to adopt and to adapt modern information and communication technologies (ICTs) to improve program effectiveness. Effective public health is information intensive and the impact of emerging knowledge management and ICT solutions will be significant. To capture some of the current thinking on how knowledge management and ICT will benefit public health, a panel of Canadian public health professionals was convened to discuss opportunities for progress by 2010. Three broad areas were addressed: (1) information and knowledge management; (2) information technology; and (3) working together to improve public health with knowledge management and ICT opportunities.
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Affiliation(s)
- Michael Goddard
- Research and Technology Division, Centre for Surveillance Coordination,
Population and Public Health Branch, Health Canada, 130 Colonnade Road, 3rd
Floor, West Wing, AlL 6503C Ottawa, Ontario, Canada KMA 0K9, Tel: 1 (613)
954 0169, Fax: 1 (613) 957 6218
| | - David Mowat
- Centre for Surveillance Coordination, Population and Public Health
Branch, Health Canada
| | | | | | - Parminder Raina
- McMaster University, Evidence Based Practice Centre, Hamilton, Ontario,
Canada
| | - Vic Sahai
- Northern Health Information Partnership, Sudbury, Ontario, Canada
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14
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Abstract
It is suggested by Millar et al. that many public health leaders across Canada have been somewhat reticent to fully engage in health system transformation initiatives, including those in primary care, despite their support of the concept of collaboration. Public health leaders and staff should bring their unique population health perspective to these initiatives by applying health promotion strategies, which include methods to "reorient the health system" to better apply this perspective across the spectrum of health services and work in partnership with other sectors to support the needs of individuals and communities to lead a healthier life. Healthcare transformation efforts across the country would benefit from a more balanced approach between the Triple Aim goals: containing costs, enhancing the patient experience and improving population health.
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Affiliation(s)
- Cordell Neudorf
- Assistant Professor, Department of Community Health and Epidemiology, University of Saskatchewan, Chief Medical Health Officer, Saskatoon Health Region
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15
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Abstract
Most regional health authorities include "improving population health and health equity" in their mission, vision, or priority statements, yet few regional health authorities or hospitals have been shown to devote the sufficient time and resources to make significant progress toward this aim. Health system leaders want to act on this priority, but many barriers and challenges conspire to limit their effectiveness. Improving population health requires both population-based and individual-level initiatives aimed at preventing disease and improving health equity. Practical examples for integrating a population health approach into the health system are presented for healthcare leaders.
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Affiliation(s)
- Cordell Neudorf
- University of Saskatchewan College of Medicine, 107 Wiggins Road, Saskatoon, Saskatchewan S7N 5E5, Canada.
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16
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Neudorf C, di Ruggiero E, Lynkowski D, Beanlands H, Bell B, Finlay J, Fridkin A, Maxted JM, McIntyre L, Turner S. The Vienna declaration. Can J Public Health 2010; 101:271. [PMID: 21033528 PMCID: PMC6974177 DOI: 10.1007/bf03405283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Cordell Neudorf
- Canadian Public Health Association Board of Directors, Canada
| | | | - Debra Lynkowski
- Canadian Public Health Association Board of Directors, Canada
| | - Hope Beanlands
- Canadian Public Health Association Board of Directors, Canada
| | - Brian Bell
- Canadian Public Health Association Board of Directors, Canada
| | - Joel Finlay
- Canadian Public Health Association Board of Directors, Canada
| | - Alycia Fridkin
- Canadian Public Health Association Board of Directors, Canada
| | - John M. Maxted
- Canadian Public Health Association Board of Directors, Canada
| | - Lynn McIntyre
- Canadian Public Health Association Board of Directors, Canada
| | - Shannon Turner
- Canadian Public Health Association Board of Directors, Canada
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17
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Disano J, Goulet J, Muhajarine N, Neudorf C, Harvey J. Social-economic status and rates of hospital admission for chronic disease in urban Canada. Can Nurse 2010; 106:24-29. [PMID: 20175317] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Socio-economic status (SES) is recognized as an important factor that influences the utilization of health-care services. We set out to explore this association in the context of hospital admissions for the treatment of ambulatory care sensitive conditions (ACSCs)--chronic conditions normally managed on an outpatient basis. We examined rates of hospital admission for the treatment of ACSCs overall and for three specific conditions: chronic obstructive pulmonary disease (COPD), diabetes and asthma in children. Data were obtained from the Canadian Institute for Health Information, the Institut national de santé du Québec, and Statistics Canada. SES was determined using a measure known as the Deprivation Index, applied at the level of the census dissemination area (DA), the smallest geographical unit for which population statistics are available. This study accounted for 46,173 urban DAs classified into low, average and high SES groups. Statistically significant variations in rates of hospital admission were found across the three SES groups for all four ACSC categories examined. For example, hospital admission rates for COPD and diabetes in the low SES group were about 3.0 and 2.7 times higher, respectively, than those in the high SES group. Further research is needed to understand the mechanisms and underlying causes of higher rates of hospital admission for the treatment of chronic disease among people with low SES.
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Affiliation(s)
- Jason Disano
- Canadian Population Health Initiative, Canadian Institute for Health Information, Ottawa, Ontario
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18
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Neudorf C. Positioning public health for future success in Canada. Can J Public Health 2009; 100:325-332. [PMID: 19994730 PMCID: PMC6973670 DOI: 10.1007/bf03405260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Vickers D, Ross AG, Mainar-Jaime RC, Neudorf C, Shah S. Whole-cell and acellular pertussis vaccination programs and rates of pertussis among infants and young children. CMAJ 2006; 175:1213-7. [PMID: 17098950 PMCID: PMC1626510 DOI: 10.1503/cmaj.051637] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The transition from a whole-cell to a 5-component acellular pertussis vaccine provided a unique opportunity to compare the effect that each type of vaccine had on the incidence of pertussis, under routine conditions, among children less than 10 years of age. METHODS Analyses were based on passive surveillance data collected between 1995 and 2005. The incidence of pertussis by year and birth cohort was compiled according to age during the surveillance period. We determined the association between vaccine type (whole-cell, acellular or a combination of both) and the incidence of pertussis using Poisson regression analysis after controlling for age (< 1 year, 1-4 years and 5-9 years) and vaccination history (i.e., partial or complete). RESULTS During 7 of the 11 years surveyed, infants (< 1 year of age) had the highest incidence of pertussis. Among children born after 1997, when acellular vaccines were introduced, the rates of pertussis were highest among infants and preschool children (1-4 years of age). Poisson regression analysis revealed that, in the group given either the whole-cell vaccine or a combination of both vaccines, the incidence of pertussis was lower among infants and preschool children than among school-aged children (5-9 years). The reverse was true in the group given only an acellular vaccine, with a higher incidence among infants and preschool children than among school-aged children. INTERPRETATION These results suggest that current immunization practices may not be adequate in protecting infants and children less than 5 years of age against pertussis. Altering available acellular formulations or adopting immunization practices used in some European countries may increase the clinical effectiveness of routine pertussis vaccination programs among infants and preschool children.
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Affiliation(s)
- David Vickers
- Department of Applied Research, College of Medicine, University of Saskatchewan, Saskatoon, Sask.
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20
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Shah SM, Ross AG, Chotani R, Arif AA, Neudorf C. Tuberculin reactivity among health care workers in nonhospital settings. Am J Infect Control 2006; 34:338-42. [PMID: 16877100 DOI: 10.1016/j.ajic.2006.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/21/2005] [Revised: 02/13/2006] [Accepted: 02/13/2006] [Indexed: 12/01/2022]
Abstract
BACKGROUND We used workers' compensation data to identify health care workers at risk of tuberculosis exposure in the hospital and nonhospital environment. METHODS We identified State Fund workers' compensation claims having a documented tuberculin skin test (TST) conversion (size >or=10 mm) with a previous negative skin test between 1996 and 2000 in the State of Washington. RESULTS Health care workers experienced an overall accepted workers' compensation claim rate of 2.3 claims/10,000 full-time equivalent employees (FTEs) per year for tuberculin reactivity. Receptionists accounted for the largest number, with 18.4% tuberculin reactivity claims. The number of tuberculin reactivity claims was the highest for offices and clinics of doctors of medicine (3.7 per 10,000 FTEs), followed by medical laboratories (2.6 per 10,000 FTEs). CONCLUSION This study allowed characterization of employees in various nonhospital health services locations with higher number of tuberculin reactivity.
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Affiliation(s)
- Syed M Shah
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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21
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Neudorf C, Obayan A, Anderson C, Chomyn J. A collaborative system-wide response to influenza outbreak management in Saskatoon Health Region. Can J Public Health 2003. [PMID: 14577739 DOI: 10.1007/bf03403556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the benefits of a regional, collaborative, system-wide approach to influenza outbreak management. PARTICIPANTS Senior management representatives from affected parts of the Regional Health Authority. SETTING Saskatoon Health Region. INTERVENTION Public Health proactively engaged a broad-based, multidisciplinary planning/management group to minimize the effect of the influenza outbreak, and institute best practice in prevention and outbreak management system-wide for the future. OUTCOMES Earlier recognition and faster resolution of influenza outbreaks, fewer outbreaks, reduced pressure on acute care, greater compliance with amantadine prophylaxis, and improved immunization rates in seniors and health care workers. CONCLUSION While many of these interventions and best practices have been recommended by individual sectors, when Public Health takes a system-wide approach facilitated by regionalization, it results in optimized planning, co-ordination, evaluation and successful outcomes.
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22
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Muhajarine N, Neudorf C, Martin K. Concurrent consultations with physicians and providers of alternative care: results from a population-based study. Can J Public Health 2001. [PMID: 11200737 DOI: 10.1007/bf03404827] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We examined the factors related to consultations with both physicians and alternative practitioners, compared with visits to physicians only. METHODS A telephone survey (random-digit dialling) collected information from 818 adults living in and around Saskatoon. Respondents reported consultations with alternative practitioners and physicians in the previous 12 months. RESULTS Approximately one in five respondents had consulted both a physician and an alternative practitioner. Among respondents under 65 years of age, having one or more chronic medical conditions significantly increased the likelihood of concurrent use of care. Men, individuals suffering from back pain or migraines, those reporting an elevation level of distress, and those for whom spiritual values were important were also more likely to use both types of care. INTERPRETATION Consultations with alternative care providers occur as an adjunct to, rather than a replacement of visits to physicians. Particular types of medical conditions as well as psychosocial and spiritual factors are determinants of concurrent use of physicians and alternative practitioners.
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Affiliation(s)
- N Muhajarine
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5.
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