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Batista R, Hsu AT, Bouchard L, Reaume M, Rhodes E, Sucha E, Guerin E, Prud'homme D, Manuel DG, Tanuseputro P. Ascertaining the Francophone population in Ontario: validating the language variable in health data. BMC Med Res Methodol 2024; 24:98. [PMID: 38678174 DOI: 10.1186/s12874-024-02220-7] [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: 07/11/2023] [Accepted: 04/15/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Language barriers can impact health care and outcomes. Valid and reliable language data is central to studying health inequalities in linguistic minorities. In Canada, language variables are available in administrative health databases; however, the validity of these variables has not been studied. This study assessed concordance between language variables from administrative health databases and language variables from the Canadian Community Health Survey (CCHS) to identify Francophones in Ontario. METHODS An Ontario combined sample of CCHS cycles from 2000 to 2012 (from participants who consented to link their data) was individually linked to three administrative databases (home care, long-term care [LTC], and mental health admissions). In total, 27,111 respondents had at least one encounter in one of the three databases. Language spoken at home (LOSH) and first official language spoken (FOLS) from CCHS were used as reference standards to assess their concordance with the language variables in administrative health databases, using the Cohen kappa, sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV). RESULTS Language variables from home care and LTC databases had the highest agreement with LOSH (kappa = 0.76 [95%CI, 0.735-0.793] and 0.75 [95%CI, 0.70-0.80], respectively) and FOLS (kappa = 0.66 for both). Sensitivity was higher with LOSH as the reference standard (75.5% [95%CI, 71.6-79.0] and 74.2% [95%CI, 67.3-80.1] for home care and LTC, respectively). With FOLS as the reference standard, the language variables in both data sources had modest sensitivity (53.1% [95%CI, 49.8-56.4] and 54.1% [95%CI, 48.3-59.7] in home care and LTC, respectively) but very high specificity (99.8% [95%CI, 99.7-99.9] and 99.6% [95%CI, 99.4-99.8]) and predictive values. The language variable from mental health admissions had poor agreement with all language variables in the CCHS. CONCLUSIONS Language variables in home care and LTC health databases were most consistent with the language often spoken at home. Studies using language variables from administrative data can use the sensitivity and specificity reported from this study to gauge the level of mis-ascertainment error and the resulting bias.
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Affiliation(s)
- Ricardo Batista
- Institut du Savoir Montfort, Ottawa, ON, Canada.
- ICES uOttawa, Ottawa, ON, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Institut du Savoir Montfort, ICES and Ottawa Hospital Research Institute, 1053 Carling Ave Box 693, 2-006 Admin Services Building, Ottawa, ON, K1Y 4E9, Canada.
| | - Amy T Hsu
- ICES uOttawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Elizabeth Bruyère Research Institute, Ottawa, ON, Canada
| | - Louise Bouchard
- Institut du Savoir Montfort, Ottawa, ON, Canada
- School of Social and Anthropological Studies, University of Ottawa, Ottawa, ON, Canada
| | | | - Emily Rhodes
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Eva Guerin
- Institut du Savoir Montfort, Ottawa, ON, Canada
| | - Denis Prud'homme
- Institut du Savoir Montfort, Ottawa, ON, Canada
- Université de Moncton, Moncton, New Brunswick, Canada
| | - Douglas G Manuel
- ICES uOttawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Statistics Canada, Ottawa, ON, Canada
| | - Peter Tanuseputro
- ICES uOttawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Silva AR, Rochon A, Hornby L, Lotherington K, James L, Webster R, Sucha E, Sarti A, Dhanani S, Silva e Silva V. Resilience among organ donation coordinators: a Canadian mixed-methods study. Front Public Health 2024; 12:1367546. [PMID: 38560430 PMCID: PMC10978649 DOI: 10.3389/fpubh.2024.1367546] [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: 01/08/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Background Organ and Tissue Donation Coordinators (OTDCs) are key to the success of deceased organ donation processes. However, reduced resilience can leave them susceptible to the incidence of work-related issues and decrease the quality of the care provided. Therefore, this study aimed to examine the extent of resilience and influencing aspects among OTDCs in Canada. Methods Mixed-method (QUAN-qual) explanatory sequential design. Quantitative data was collected using an online cross-sectional survey approach with demographic data and the validated scales and analyzed using descriptive and inferential statistics. Qualitative data was collected using a descriptive approach with a semi-structured interview guide and analyzed using content analysis. Results One hundred twenty participants responded to the survey, and 39 participants were interviewed. Most participants from the survey were female (82%), registered nurses (97%) and on average 42 years old. The quantitative data revealed that OTDCs had a high level of perceived compassion satisfaction (ProQOL-CS = 36.3) but a resilience score (CD-RISC = 28.5) lower than other groups of healthcare professionals. OTDCs with over a year of experience in the role were more likely to have higher levels of resilience. The qualitative data identified that participants saw resilience as crucial for their work-related well-being. Although coping strategies were identified as a key factor that enhance resilience, many OTDCs reported difficulty in developing healthy coping strategies, and that the use of unhealthy mechanisms (e.g., alcohol and smoking) can result in negative physical consequences (e.g., weight gain) and reduced resilience levels. Conclusion Participants reported using a series of coping and protective strategies to help build resilience, but also difficulty in developing healthy mechanisms. The lack of healthy coping strategies were seen as contributing to negative work-related issues (e.g., burnout). Our findings are being used to develop tailored interventions to improve resilience and healthy coping strategies among organ donor coordinators in Canada.
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Affiliation(s)
- Amina R. Silva
- Department of Nursing, Brock University, St. Catharines, ON, Canada
| | - Andrea Rochon
- Department of Nursing, St. Lawrence College, Kingston, ON, Canada
| | | | | | - Lee James
- Canadian Blood Services, Ottawa, ON, Canada
| | - Richard Webster
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Ewa Sucha
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Aimee Sarti
- Department of Critical Care, The Ottawa Hospital, Ottawa, ON, Canada
| | - Sonny Dhanani
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Yeung E, Sant N, Sucha E, Belaghi R, Le Saux N. Finding significant pathogens in blood cultures in children: Should we set the timer to 36 hours? J Assoc Med Microbiol Infect Dis Can 2024; 9:11-19. [PMID: 38567366 PMCID: PMC10984315 DOI: 10.3138/jammi-2023-0009] [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: 04/18/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 04/04/2024]
Abstract
Background Knowledge of time to positivity (TTP) for blood cultures is useful to assess timing of discontinuation of empiric antimicrobials for suspected bacteremia with no focus. Methods An audit of positive blood cultures from the Children's Hospital of Eastern Ontario (CHEO) from November 1, 2019, to October 31, 2020, was performed to determine TTP, defined as the start of incubation to a positive signal from automated incubators. Results Three hundred seventy-six positive blood cultures were identified from 248 patients (average age: 6.27 [SD 6.24] years). Of these, 247 isolates were speciated; 90 (36.4%) were definitive/probable (DP) pathogens (median TTP 12.75 hours) and 157 (63.6%) possible/probable (PP) contaminants (median TTP 24.08 hours). At each time point, the adjusted rate of positive blood culture was significantly higher for DP pathogens compared to PP contaminants (hazard ratio [HR] 1.80 [95% CI 1.37, 2.36]) and for children ≤27 days old compared to the oldest age group (HR 1.94 [95% CI 1.19, 3.17]). By 36 hours, the proportion of positive cultures was significantly higher in the youngest age group (≤27 days) compared with the 3-11 years old age group (91.7% [95% CI 68.6%, 97.8%] versus 58.2% [95% CI 46.91%, 68.06%]). Conclusion Across all ages, the TTP was significantly shorter for blood cultures with DP pathogens compared to those with PP contaminants (HR 1.80 [95% CI 1.37, 2.36]). In newborns, 90% of blood cultures were positive by 36 hours supporting this re-assessment time for empiric antimicrobials. TTP was longer in children ≥12 months, possibly related to other factors such as blood culture volume.
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Affiliation(s)
- Eugene Yeung
- Department of Microbiology, Eastern Ontario Regional Laboratory Association (EORLA), The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Nadia Sant
- Department of Microbiology, Eastern Ontario Regional Laboratory Association (EORLA), The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ewa Sucha
- Children’s Hospital of Eastern Ontario Research Institute, Clinical Research Unit, Ottawa, Ontario, Canada
| | - Reza Belaghi
- Children’s Hospital of Eastern Ontario Research Institute, Clinical Research Unit, Ottawa, Ontario, Canada
| | - Nicole Le Saux
- Division of Infectious Diseases, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Clinical Research Unit, Ottawa, Ontario, Canada
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AlSaeed H, Sucha E, Bhatt M, Mitsakakis N, Bresee N, Bechard M. Rates of pediatric emergency department visits vary according to neighborhood marginalization in Ottawa, Canada. CAN J EMERG MED 2024; 26:119-127. [PMID: 38117415 DOI: 10.1007/s43678-023-00625-9] [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: 06/30/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES To determine the association between neighborhood marginalization and rates of pediatric ED visits in Ottawa, Ontario. Secondary objectives investigated if the association between neighborhood marginalization and rates varied by year, acuity, and distance to hospital. METHODS We calculated rates of pediatric ED visits per 1000 person-years for census dissemination areas within 100 km of the Children's Hospital of Eastern Ontario for patients < 18 years old from January 2018 through December 2020. The 2016 Ontario Marginalization Index categorized neighborhoods along quintiles of residential instability, material deprivation, ethnic concentration, and dependency. Generalized mixed-effects models determined the incidence rate ratios of pediatric ED visits for each quintile of marginalization; multivariate models were used to control for year of presentation and distance to hospital. Analysis was repeated for low versus high acuity ED visits. RESULTS There were 154,146 ED visits from patients in 2055 census dissemination areas within 100 km of CHEO from 2018 to 2020. After controlling for year and distance from hospital in multivariate analyses, there were higher rates of pediatric ED visits for dissemination areas with high residential instability, high material deprivation, and low ethnic concentration. These findings did not change according to visit acuity. CONCLUSIONS Neighborhood residential instability and material deprivation should be considered when locating alternatives to emergency care.
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Affiliation(s)
- Habeeb AlSaeed
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - Ewa Sucha
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
| | - Maala Bhatt
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - Nicholas Mitsakakis
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
| | - Natalie Bresee
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - Melanie Bechard
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada.
- University of Ottawa, Ottawa, ON, Canada.
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Batista R, Reaume M, Roberts R, Seale E, Rhodes E, Sucha E, Pugliese M, Kendall CE, Bjerre LM, Bouchard L, Prud'homme D, Manuel DG, Tanuseputro P. Prevalence and patterns of multimorbidity among linguistic groups of patients receiving home care in Ontario: a retrospective cohort study. BMC Geriatr 2023; 23:725. [PMID: 37946126 PMCID: PMC10634019 DOI: 10.1186/s12877-023-04267-5] [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: 02/26/2023] [Accepted: 08/30/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Prior studies have demonstrated the negative impact of language barriers on access, quality, and safety of healthcare, which can lead to health disparities in linguistic minorities. As the population ages, those with multiple chronic diseases will require increasing levels of home care and long-term services. This study described the levels of multimorbidity among recipients of home care in Ontario, Canada by linguistic group. METHODS Population-based retrospective cohort of 510,685 adults receiving home care between April 1, 2010, to March 31, 2018, in Ontario, Canada. We estimated and compared prevalence and characteristics of multimorbidity (2 or more chronic diseases) across linguistic groups (Francophones, Anglophones, Allophones). The most common combinations and clustering of chronic diseases were examined. Logistic regression models were used to explore the main predictors of 'severe' multimorbidity (defined as the presence of five or more chronic diseases). RESULTS The proportion of home care recipients with multimorbidity and severe multimorbidity was 92% and 44%, respectively. The prevalence of multimorbidity was slightly higher among Allophones (93.6%) than among Anglophones (91.8%) and Francophones (92.4%). However, Francophones had higher rates of cardiovascular and respiratory disease (64.9%) when compared to Anglophones (60.2%) and Allophones (61.5%), while Anglophones had higher rates of cancer (34.2%) when compared to Francophones (25.2%) and Allophones (24.3%). Relative to Anglophones, Allophones were more likely to have severe multimorbidity (adjusted OR = 1.04, [95% CI: 1.02-1.06]). CONCLUSIONS The prevalence of multimorbidity among Ontarians receiving home care services is high; especially for whose primary language is a language other than English or French (i.e., Allophones). Understanding differences in the prevalence and characteristics of multimorbidity across linguistic groups will help tailor healthcare services to the unique needs of patients living in minority linguistic situations.
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Affiliation(s)
- Ricardo Batista
- Institut du Savoir Montfort, Hôpital Montfort, 202-745A Ch. Montréal Road, Ottawa, ON, K1K 0T1, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Michael Reaume
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | | | - Emily Seale
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Emily Rhodes
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | | | - Claire E Kendall
- Institut du Savoir Montfort, Hôpital Montfort, 202-745A Ch. Montréal Road, Ottawa, ON, K1K 0T1, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lise M Bjerre
- Institut du Savoir Montfort, Hôpital Montfort, 202-745A Ch. Montréal Road, Ottawa, ON, K1K 0T1, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Louise Bouchard
- Institut du Savoir Montfort, Hôpital Montfort, 202-745A Ch. Montréal Road, Ottawa, ON, K1K 0T1, Canada
- School of Social and Anthropological Studies, University of Ottawa, Ottawa, ON, Canada
| | - Denis Prud'homme
- Institut du Savoir Montfort, Hôpital Montfort, 202-745A Ch. Montréal Road, Ottawa, ON, K1K 0T1, Canada
- Université de Moncton, Nouveau-Brunswick, Canada
| | - Douglas G Manuel
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- ICES uOttawa, Ottawa, ON, Canada.
- Bruyère Research Institute, Ottawa, ON, Canada.
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
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Shemie J, Scales NB, Sucha E, Barrowman N, Hornby L, van Beinum A, Dhanani S. Variability in criteria for death determination in the intensive care unit. Can J Anaesth 2023; 70:628-636. [PMID: 37131026 PMCID: PMC10202993 DOI: 10.1007/s12630-023-02412-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/23/2022] [Accepted: 10/17/2022] [Indexed: 05/04/2023] Open
Abstract
PURPOSE Variability in practice exists in death determination by circulatory criteria in the context of organ donation. We sought to describe the practices of intensive care health care professionals for death determination by circulatory criteria with and without organ donation. METHODS This study is a retrospective analysis of prospectively collected data. We included patients with death determination by circulatory criteria in intensive care units at 16 hospitals in Canada, three in the Czech Republic, and one in the Netherlands. Results were recorded using a checklist for the determination of death questionnaire. RESULTS A total of 583 patients had their death determination checklist reviewed for statistical analysis. The mean (standard deviation) age in years was 64 (15). Three hundred and fourteen (54.0%) patients were from Canada, 230 (39.5%) were from the Czech Republic, and 38 (6.5%) were from the Netherlands. Fifty-two (8.9%) patients proceeded with donation after death determination by circulatory criteria (DCD). The most common diagnostic tests reported for the whole group were absent heart sounds by auscultation (81.8%), flat continuous arterial blood pressure (ABP) tracing (77.0%), and flat electrocardiogram tracing (73.2%). In patients who successfully underwent DCD (N = 52), death was determined most frequently using a flat continuous ABP tracing (94%), absent pulse oximetry (85%), and absent palpable pulse (77%). CONCLUSION In this study, we have described practices for death determination by circulatory criteria both within and between countries. Though some variability exists, we are reassured that appropriate criteria are almost always used in the context of organ donation. In particular, the use of continuous ABP monitoring in DCD was consistent. It highlights the need for standardization of practice and up to date guidelines, especially within the context of DCD where there is both an ethical and a legal requirement to adhere to the dead donor rule, while minimizing time between death determination and organ procurement.
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Affiliation(s)
- Jonah Shemie
- School of Medicine, University College Cork, Cork, Munster, Ireland
| | | | - Ewa Sucha
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Laura Hornby
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- System Development, Canadian Blood Services, Ottawa, ON, Canada
| | - Amanda van Beinum
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Carleton University, Ottawa, ON, Canada
| | - Sonny Dhanani
- Division of Critical Care, Department of Pediatrics, The Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
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Leigh J, Qureshi D, Sucha E, Mahdavi R, Kushnir I, Lavallée LT, Bosse D, Webber C, Tanuseputro P, Ong M. A population-based study of factors associated with systemic treatment in advanced prostate cancer decedents. Cancer Med 2023; 12:5569-5579. [PMID: 36397730 PMCID: PMC10028120 DOI: 10.1002/cam4.5401] [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: 08/23/2022] [Revised: 10/13/2022] [Accepted: 10/23/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Life-prolonging therapies (LPTs) are rapidly evolving for the treatment of advanced prostate cancer, although factors associated with real-world uptake are not well characterized. METHODS In this cohort of prostate-cancer decedents, we analyzed factors associated with LPT access. Population-level databases from Ontario, Canada identified patients 65 years or older with prostate cancer receiving androgen deprivation therapy and who died of prostate cancer between 2013 and 2017. Univariate and multivariable analyses assessed the association between baseline characteristics and receipt of LPT in the 2 years prior to death. RESULTS Of 3575 patients who died of prostate cancer, 40.4% (n = 1443) received LPT, which comprised abiraterone (66.3%), docetaxel (50.3%), enzalutamide (17.2%), radium-223 (10.0%), and/or cabazitaxel (3.5%). Use of LPT increased by year of death (2013: 22.7%, 2014: 31.8%, 2015: 41.8%, 2016: 49.1%, and 2017: 57.9%, p < 0.0001), driven by uptake of all agents except docetaxel. Adjusted odds of use were higher for patients seen at Regional Cancer Centers (OR: 1.8, 95% CI: 1.5-2.1) and who received prior prostate-directed therapy (OR: 1.3, 95% CI: 1.0-1.5), but lower with advanced age (≥85: OR: 0.54, 95% CI:0.39-0.75), increased chronic conditions (≥6: OR: 0.62, 95% CI: 0.43-0.92), and long-term care residency (OR: 0.38, 95% CI: 0.17-0.89). Income, stage at presentation, and distance to the cancer center were not associated with LPT uptake. CONCLUSION In this cohort of prostate cancer-decedents, real-world uptake of novel prostate cancer therapies occurred at substantially higher rates for patients receiving care at Regional Cancer Centers, reinforcing the potential benefits for treatment access for patients referred to specialist centers.
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Affiliation(s)
- Jennifer Leigh
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Danial Qureshi
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Nuffield Department of Population Health, University of Oxford, England, UK
| | - Ewa Sucha
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Roshanak Mahdavi
- ICES University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Igal Kushnir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Luke T Lavallée
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Urology, Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Dominick Bosse
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Colleen Webber
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Michael Ong
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
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Alqurashi W, Le Saux N, Vyles D, Byrne A, Ben-Shoshan M, Sucha E, Barrowman N, McGahern C, Dawson L, Plint A. De-Labelling Penicillin Allergy in the Emergency Department. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.208] [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: 02/05/2023]
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Leon SJ, Whitlock R, Rigatto C, Komenda P, Bohm C, Sucha E, Bota SE, Tuna M, Collister D, Sood M, Tangri N. Hyperkalemia-Related Discontinuation of Renin-Angiotensin-Aldosterone System Inhibitors and Clinical Outcomes in CKD: A Population-Based Cohort Study. Am J Kidney Dis 2022; 80:164-173.e1. [PMID: 35085685 DOI: 10.1053/j.ajkd.2022.01.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [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: 09/13/2021] [Accepted: 01/03/2022] [Indexed: 02/06/2023]
Abstract
RATIONALE & OBJECTIVE Renin-angiotensin-aldosterone system (RAAS) inhibitors are evidence-based therapies that slow the progression of chronic kidney disease (CKD) but can cause hyperkalemia. We aimed to evaluate the association of discontinuing RAAS inhibitors after an episode of hyperkalemia and clinical outcomes in patients with CKD. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Adults in Manitoba (7,200) and Ontario (n = 71,290), Canada, with an episode of de novo RAAS inhibitor-related hyperkalemia (serum potassium ≥ 5.5 mmol/L) and CKD. EXPOSURE RAAS inhibitor prescription. OUTCOME The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular (CV) mortality, fatal and nonfatal CV events, dialysis initiation, and a negative control outcome (cataract surgery). ANALYTICAL APPROACH Cox proportional hazards models examined the association of RAAS inhibitor continuation (vs discontinuation) and outcomes using intention to treat approach. Sensitivity analyses included time-dependent, dose-dependent, and propensity-matched analyses. RESULTS The mean potassium and mean estimated glomerular filtration rate were 5.8 mEq/L and 41 mL/min/1.73 m2, respectively, in Manitoba; and 5.7 mEq/L and 41 mL/min/1.73 m2, respectively, in Ontario. RAAS inhibitor discontinuation was associated with a higher risk of all-cause mortality (Manitoba: HR, 1.32 [95% CI, 1.22-1.41]; Ontario: HR, 1.47 [95% CI, 1.41-1.52]) and CV mortality (Manitoba: HR, 1.28 [95% CI, 1.13-1.44]; and Ontario: HR, 1.32 [95% CI, 1.25-1.39]). RAAS inhibitor discontinuation was associated with an increased risk of dialysis initiation in both cohorts (Manitoba: HR, 1.65 [95% CI, 1.41-1.85]; Ontario: HR, 1.11 [95% CI, 1.08-1.16]). LIMITATIONS Retrospective study and residual confounding. CONCLUSIONS RAAS inhibitor discontinuation is associated with higher mortality and CV events compared with continuation among patients with hyperkalemia and CKD. Strategies to maintain RAAS inhibitor treatment after an episode of hyperkalemia may improve clinical outcomes in the CKD population.
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Affiliation(s)
- Silvia J Leon
- Department of Community Health Sciences, Faculty of Science, Winnipeg, Manitoba, Canada; Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Reid Whitlock
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Claudio Rigatto
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Paul Komenda
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Clara Bohm
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | | | | | | | - David Collister
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Manish Sood
- Division of Nephrology, Department of Medicine, Ottawa Hospital and University of Ottawa, Ottawa, Canada; ICES, Ontario, Canada
| | - Navdeep Tangri
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada.
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10
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Osborne B, Oltean I, Sucha E, Mitsakakis N, Barrowman N, Bainbridge S, El Demellawy D. Association of distinct features of villitis of unknown etiology histopathology and fetal growth restriction diagnosis in a retrospective cohort from Eastern Ontario. Placenta 2022; 128:83-90. [DOI: 10.1016/j.placenta.2022.08.012] [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: 01/25/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
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11
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Nguyen L, Mitsakakis N, Sucha E, Lemyre B, Lawrence SL. Factors associated with hypothermia within the first 6 hours of life in infants born at ≥34 0 weeks' gestation: a multivariable analysis. BMC Pediatr 2022; 22:447. [PMID: 35879708 PMCID: PMC9316355 DOI: 10.1186/s12887-022-03512-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lack of appropriate temperature management has been associated with significant adverse outcomes in preterm and low birthweight neonates. There is a lack of similar investigations in the late preterm (340-366) and term (≥370) neonate population. Our aim was to identify key risk factors as well as clinical outcomes associated with hypothermia in this population. METHODS A retrospective chart review was conducted at the Ottawa Hospital including all eligible infants ≥340 weeks' gestation over a one-month period in November 2020. Infant, maternal, and delivery room variables were collected, including prematurity, maternal temperature, delivery mode, birthweight, and premature rupture of membranes, as well as clinical outcomes such as NICU/SCN admission and length of stay. Regression models were generated, adjusted for covariates, and stepwise regression was performed. RESULTS Four hundred forty infants were included in the analysis; 26.8% (118/440) were hypothermic within 6 hours of delivery. In the multivariable analysis, prematurity, low 5 minute Apgar score (< 7) or need for resuscitation, maternal hypertension, and absence of premature rupture of membranes > 18 hours or suspected maternal infection were significantly associated with hypothermia within 6 hours of delivery (p < 0.05). Multivariable analysis of clinical outcomes demonstrated a significant association between hypothermia within 6 hours of delivery and NICU/SCN admission (OR = 2.87; 95% CI 1.36, 6.04), need for respiratory support or diagnosis of respiratory distress syndrome (OR = 3.94; 95% CI 1.55, 10.50), and length of stay (exp(β) = 1.20; 95% bootstrap CI 1.04, 1.37). CONCLUSIONS Our results suggest there are similar factors associated with hypothermia in our study population of infants born at ≥340 weeks' gestation compared to prior studies in preterm and low-birthweight infants. Furthermore, hypothermia is associated with higher risk of adverse outcomes, which highlights the need to prevent hypothermia in all newborns.
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Affiliation(s)
- Laura Nguyen
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, Canada
| | - Nicholas Mitsakakis
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario, Canada
| | - Ewa Sucha
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario, Canada
| | - Brigitte Lemyre
- The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, Ontario, Canada.,Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada
| | - Sarah Linda Lawrence
- The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, Ontario, Canada. .,Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada.
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12
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Redpath S, Moore H, Sucha E, Agarwal A, Barrowman N, Lemyre B, St. Germain L. Therapeutic Hypothermia on Transport: The Quest for Efficiency: Results of a Quality Improvement Project. Pediatr Qual Saf 2022; 7:e556. [PMID: 35720863 PMCID: PMC9197372 DOI: 10.1097/pq9.0000000000000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 03/10/2022] [Indexed: 11/25/2022] Open
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13
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Wilson M, Sampson M, Barrowman N, Sucha E, Doja A. A Bibliometric Analysis of Publication Patterns in Pediatric Neurology. Front Pediatr 2022; 10:753554. [PMID: 35783308 PMCID: PMC9243535 DOI: 10.3389/fped.2022.753554] [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: 08/05/2021] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To examine the publication patterns of pediatric neurology articles in general pediatric, general neurology, and neurology subspecialty journals using a bibliometric approach. METHODS The top 5 journals in general pediatrics, general neurology and neurology subspecialties were identified using the 2017 Journal Citations Report (JCR). For general pediatric journals, we selected 4 pediatric subspecialties for comparison of publication patterns with neurology: immunology, endocrinology, gastroenterology, and respirology. For general neurology and neurology subspecialty journals, we searched both the top 5 neurology and neurology subspecialty journals for pediatric articles. Using Ovid Medline, we identified articles published between 2009-2017. RESULTS With regards to child neurology-based articles, 1501 were published in general pediatrics journals, 643 in general neurology journals and 685 in neurology subspecialty journals. Examination of the top pediatric journals revealed that Pediatrics published the most neurology-based articles. Neurology-based studies were published more frequently than other pediatric subspecialty studies. Of the top general neurology Neurology published the most child neurology-based articles, while Epilepsia published the most child neurology-based articles out of neurology subspecialty journals. Cohort studies were the most frequent study type across all journals. CONCLUSION Our study revealed that child neurology articles are published more often in pediatric journals as opposed to general neurology and neurology subspecialty journals. We also found that in general pediatric journals, neurology-based articles are published more frequently compared to other specialties. Our results provide guidance to authors when considering submission of their pediatric neurology research.
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Affiliation(s)
- Mitch Wilson
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Margaret Sampson
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Ewa Sucha
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Asif Doja
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
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14
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Hill K, Sucha E, Rhodes E, Bota S, Hundemer GL, Clark EG, Canney M, Harel Z, Wang TF, Carrier M, Wijeysundera HC, Knoll G, Sood MM. Amiodarone, verapamil, or diltiazem use with direct oral anticoagulants and the risk of hemorrhage in older adults. CJC Open 2021; 4:315-323. [PMID: 35386137 PMCID: PMC8978070 DOI: 10.1016/j.cjco.2021.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/03/2021] [Indexed: 12/26/2022] Open
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15
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Premji K, Sucha E, Glazier RH, Green ME, Wodchis WP, Hogg WE, Kiran T, Frymire E, Freeman TR, Ryan BL. Primary care bonus payments and patient-reported access in urban Ontario: a cross-sectional study. CMAJ Open 2021; 9:E1080-E1096. [PMID: 34848549 PMCID: PMC8648352 DOI: 10.9778/cmajo.20200235] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Rurality strongly correlates with higher pay-for-performance access bonuses, despite higher emergency department use and fewer primary care services than in urban settings. We sought to evaluate the relation between patient-reported access to primary care and access bonus payments in urban settings. METHODS We conducted a cross-sectional, secondary data analysis using Ontario survey and health administrative data from 2013 to 2017. We used administrative data to calculate annual access bonuses for eligible urban family physicians. We linked this payment data to adult (≥ 16 yr) patient data from the Health Care Experiences Survey to examine the relation between access bonus achievement (in quintiles of the proportion of bonus achieved, from lowest [Q1, reference category] to highest [Q5]) and 4 patient-reported access outcomes. The average survey response rate to the patient survey during the study period was 51%. We stratified urban geography into large, medium and small settings. In a multilevel regression model, we adjusted for patient-, physician- and practice-level covariates. We tested linear trends, adjusted for clustering, for each outcome. RESULTS We linked 18 893 respondents to 3940 physicians in 414 bonus-eligible practices. Physicians in small urban settings earned the highest proportion of their maximum potential access bonuses. Access bonus achievement was positively associated with telephone access (Q2 odds ratio [OR] 1.18, 95% confidence interval [CI] 0.98-1.42; Q3 OR 1.34, 95% CI 1.10-1.63; Q4 OR 1.46, 95% CI 1.19-1.79; Q5 OR 1.87, 95% CI 1.50-2.33), after hours access (Q2 OR 1.26, 95% CI 1.09-1.47; Q3 OR 1.46, 95% CI 1.23-1.74; Q4 OR 1.77, 95% CI 1.46-2.15; Q5 OR 1.88, 95% CI 1.52-2.32), wait time for care (Q2 OR 1.01, 95% CI 0.85-1.20; Q3 OR 1.17, 95% CI 0.97-1.41; Q4 OR 1.27, 95% CI 1.05-1.55; Q5 OR 1.63, 95% CI 1.32-2.00) and timeliness (Q2 OR 1.29, 95% CI 0.98-1.69; Q3 OR 1.29, 95% CI 0.94-1.77; Q4 OR 1.58, 95% CI 1.16-2.13; Q5 OR 1.98, 95% CI 1.38-2.82). When stratified by geography, we observed several of these associations in large urban settings, but not in small urban settings. Trend tests were statistically significant for all 4 outcomes. INTERPRETATION Although the access bonus correlated with access in larger urban settings, it did not in smaller settings, aligning with previous research questioning its utility in smaller geographies. The access bonus may benefit from a redesign that considers geography and patient experience.
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Affiliation(s)
- Kamila Premji
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont.
| | - Ewa Sucha
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Richard H Glazier
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Michael E Green
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Walter P Wodchis
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - William E Hogg
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Tara Kiran
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Eliot Frymire
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Thomas R Freeman
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Bridget L Ryan
- Department of Family Medicine, Schulich School of Medicine & Dentistry (Premji, Freeman, Ryan), Western University, London, Ont.; Department of Family Medicine (Premji), University of Ottawa; ICES uOttawa (Sucha, Hogg), Ottawa Hospital Research Institute, Ottawa, Ont.; ICES Toronto (Glazier, Kiran); Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Glazier, Kiran), St. Michael's Hospital, University of Toronto, Toronto, Ont.; ICES Queen's (Green); Department of Family Medicine (Green); Health Services and Policy Research Institute (Green, Frymire), Queen's University, Kingston, Ont.; Institute of Health Policy Management and Evaluation (Wodchis), University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.; Institut du Savoir Montfort (Hogg), Ottawa, Ont.; Centre for Studies in Family Medicine (Freeman), Department of Family Medicine; Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont
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Laverty M, Crowcroft N, Bolotin S, Hawken S, Wilson K, Amirthalingam G, Biringer A, Cook J, Dubey V, Fakhraei R, Halperin SA, Jamieson F, Kwong JC, Sadarangani M, Sucha E, Walker MC, Fell DB. Health Outcomes in Young Children Following Pertussis Vaccination During Pregnancy. Pediatrics 2021; 147:peds.2020-042507. [PMID: 33875535 DOI: 10.1542/peds.2020-042507] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Maternal immunization with tetanus, diphtheria, and acellular pertussis vaccine (Tdap) is routinely recommended in many countries as a strategy to protect young infants against severe pertussis infection; few studies have assessed whether prenatal exposure to the vaccine is associated with any longer-term adverse health effects in children. We evaluated the long-term safety of exposure to Tdap vaccination during pregnancy. METHODS Population-based retrospective cohort study conducted in Ontario, Canada using multiple linked province-wide health administrative databases. All live births between April 2012 and March 2017 were included, and children were followed for up to 6 years to ascertain study outcomes. Children exposed to prenatal Tdap were propensity score matched to unexposed children at a 1:5 ratio. Tdap vaccination during pregnancy was ascertained by using vaccine-specific fee codes. Immune-related (infectious diseases, asthma) and nonimmune-related (neoplasm, sensory disorders) outcomes and a nonspecific morbidity outcome (urgent or inpatient health service use) were evaluated from birth to end of follow-up. RESULTS Of 625 643 live births, 12 045 (1.9%) were exposed to Tdap in utero. There were no significant increased risks of adverse childhood outcomes and prenatal Tdap exposure; however, we observed inverse associations (adjusted incidence rate ratio [95% confidence interval]) with upper respiratory infections (0.94 [0.90-0.99]), gastrointestinal infections (0.85 [0.79-0.91]), and urgent and inpatient health service use (0.93 [0.91-0.96]). CONCLUSIONS Exposure to Tdap vaccination in pregnancy was not associated with any increased risk of adverse health outcomes in early childhood, supporting the long-term safety of Tdap administration in pregnancy.
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Affiliation(s)
| | - Natasha Crowcroft
- ICES, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Shelly Bolotin
- University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Steven Hawken
- University of Ottawa, Ottawa, Ontario, Canada.,ICES, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- University of Ottawa, Ottawa, Ontario, Canada.,ICES, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Anne Biringer
- University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jocelynn Cook
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario, Canada
| | - Vinita Dubey
- University of Toronto, Toronto, Ontario, Canada.,Toronto Public Health, Ottawa, Ontario, Canada
| | - Romina Fakhraei
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Frances Jamieson
- University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- ICES, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; and
| | | | - Mark C Walker
- University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Deshayne B Fell
- University of Ottawa, Ottawa, Ontario, Canada; .,ICES, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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17
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Wiens K, Nisenbaum R, Sucha E, Aubry T, Farrell S, Palepu A, Duhoux A, Gadermann A, Hwang SW. Does Housing Improve Health Care Utilization and Costs? A Longitudinal Analysis of Health Administrative Data Linked to a Cohort of Individuals With a History of Homelessness. Med Care 2021; 59:S110-S116. [PMID: 33710082 DOI: 10.1097/mlr.0000000000001379] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Individuals who are homeless have complex health care needs, which contribute to the frequent use of health services. In this study, we investigated the relationship between housing and health care utilization among adults with a history of homelessness in Ontario. METHODS Survey data from a 4-year prospective cohort study were linked with administrative health records in Ontario. Annual rates of health encounters and mean costs were compared across housing categories (homeless, inconsistently housed, housed), which were based on the percentage of time an individual was housed. Generalized estimating equations were applied to estimate the average annual effect of housing status on health care utilization and costs. RESULTS Over the study period, the proportion of individuals who were housed increased from 37% to 69%. The unadjusted rates of ambulatory care visits, prescription medications, and laboratory tests were highest during person-years spent housed or inconsistently housed and the rate of emergency department visits was lowest during person-years spent housed. Following adjustment, the rate of prescription claims remained higher during person-years spent housed or inconsistently housed compared with the homeless. Rate ratios for other health care encounters were not significant (P>0.05). An interaction between time and housing status was observed for total health care costs; as the percentage of days housed increased, the average costs increased in year 1 and decreased in years 2-4. CONCLUSIONS These findings highlight the effects of housing on health care encounters and costs over a 4-year study period. The rate of prescription medications was higher during person-years spent housed or inconsistently housed compared with the homeless. The cost analysis suggests that housing may reduce health care costs over time; however, future work is needed to confirm the reason for the reduction in total costs observed in later years.
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Affiliation(s)
- Kathryn Wiens
- Dalla Lana School of Public Health, University of Toronto
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto
| | - Rosane Nisenbaum
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto
| | - Ewa Sucha
- Institute for Clinical Evaluative Sciences
| | - Tim Aubry
- School of Psychology
- Centre for Research on Educational and Community Services, University of Ottawa
| | | | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital
- Division of General Internal Medicine, University of British Colombia, Vancouver, BC
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montréal, QC
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital
- School of Population and Public Health, University of British Colombia, Vancouver, BC
| | - Stephen W Hwang
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto
- Division of General Internal Medicine, University of Toronto, Toronto, ON, Canada
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18
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Fakhraei R, Crowcroft N, Bolotin S, Sucha E, Hawken S, Wilson K, Gaudet L, Amirthalingam G, Biringer A, Cook J, Dubey V, Halperin SA, Jamieson F, Kwong JC, Sadarangani M, Walker MC, Laverty M, Fell DB. Obstetric and perinatal health outcomes after pertussis vaccination during pregnancy in Ontario, Canada: a retrospective cohort study. CMAJ Open 2021; 9:E349. [PMID: 33849984 PMCID: PMC8084546 DOI: 10.9778/cmajo.20200239] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In February 2018, Canada's National Advisory Committee on Immunization recommended maternal vaccination with tetanus-diphtheria-acellular pertussis (Tdap) vaccine during pregnancy to prevent severe pertussis infection in young infants. This study assessed the relation between maternal Tdap vaccination and obstetric and perinatal outcomes in Ontario. METHODS We performed a population-based cohort study of all births from April 2012 to March 2017 using multiple linked health administrative databases. We used Cox regression with a time-dependent exposure variable to estimate adjusted hazard ratios (HRs) for preterm birth (< 37 wk), very preterm birth (< 32 wk) and stillbirth. We assessed remaining outcomes (gestational hypertension, chorioamnionitis, postpartum hemorrhage, severe postpartum hemorrhage, being small for gestational age, neonatal intensive care unit stay > 24 h, composite neonatal morbidity) using log-binomial regression to generate adjusted risk ratios (RRs). We adjusted estimates for potential confounding using propensity score weighting. RESULTS Of 615 213 infants (live births and stillbirths), 11 519 were exposed to Tdap vaccination in utero. There was no increased risk for preterm birth (adjusted HR 0.98, 95% confidence interval [CI] 0.91-1.06), very preterm birth (adjusted HR 1.10, 95% CI 0.86-1.41), stillbirth (adjusted HR 1.15, 95% CI 0.82-1.60) or being small for gestational age (adjusted RR 0.96, 95% CI 0.90-1.02). The risks of a neonatal intensive care unit stay exceeding 24 hours (adjusted RR 0.82, 95% CI 0.76-0.88) and neonatal morbidity (adjusted RR 0.81, 95% CI 0.75-0.87) were decreased. There was no association with chorioamnionitis (adjusted RR 1.17, 95% CI 0.99-1.39), postpartum hemorrhage (adjusted RR 1.01, 95% CI 0.91-1.13) or severe postpartum hemorrhage (adjusted RR 0.79, 95% CI 0.55-1.13), but we observed a reduced risk of gestational hypertension (adjusted RR 0.87, 95% CI 0.78-0.96). INTERPRETATION Our results complement evidence that maternal Tdap vaccination is not associated with adverse outcomes in mothers or infants. Ongoing evaluation in Canada is needed as maternal Tdap vaccination coverage increases in coming years.
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Affiliation(s)
- Romina Fakhraei
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Natasha Crowcroft
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Shelly Bolotin
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Ewa Sucha
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Steven Hawken
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Kumanan Wilson
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Laura Gaudet
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Gayatri Amirthalingam
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Anne Biringer
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Jocelynn Cook
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Vinita Dubey
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Scott A Halperin
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Frances Jamieson
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Jeffrey C Kwong
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Manish Sadarangani
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Mark C Walker
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Meghan Laverty
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Deshayne B Fell
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
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McIsaac DI, Fottinger A, Sucha E, McDonald B. Association of frailty with days alive at home after cardiac surgery: a population-based cohort study. Br J Anaesth 2021; 126:1103-1110. [PMID: 33743980 DOI: 10.1016/j.bja.2021.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/01/2021] [Accepted: 02/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Frailty is a geriatric syndrome that leaves people vulnerable to adverse outcomes. In cardiac surgery, minimal data describe associations between frailty and patient-centred outcomes. Our objective was to estimate the association between frailty and days alive at home after cardiac surgery. METHODS We conducted a population-based cohort study using linked health administrative data in the Canadian province of Ontario. All individuals >65 yr at the time of cardiac surgery were assigned a frailty score using a validated frailty index. Days alive and at home in the 30 and 365 days after surgery were calculated. The unadjusted and adjusted associations between frailty and days alive at home were calculated. RESULTS We identified 61 389 patients from 2009 to 2015. Frailty was associated with reduced days at home within 30 days (adjusted ratio of means for every 10% increase in frailty=0.79; 95% confidence interval [CI], 0.78-0.81; P<0.0001) and 365 days (adjusted ratio of means for every 10% increase in frailty=0.92; 95% CI, 0.91-0.93; P<0.0001) of surgery. Results were consistent in sensitivity analyses (5.0 fewer days alive at home [95% CI, 4.8-5.2] within 30 days and 9.0 fewer days alive at home [95% CI, 8.7-9.2] within 365 days after surgery). CONCLUSION Frailty is associated with a reduction in days alive at home after major cardiac surgery. This information should be considered in prognostic discussions before surgery and in care planning for vulnerable older patient groups. Days alive at home may be a useful outcome for routine measurement in quality, reporting, and studies using routinely collected data.
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Affiliation(s)
- Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
| | - Alexandra Fottinger
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ewa Sucha
- Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada
| | - Bernard McDonald
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Kingsbury M, Sucha E, Manion I, Gilman SE, Colman I. Pathways from parenting practices to adolescent suicidality: Evidence on the role of emotional and behavioral symptoms from a prospective cohort of Canadian children. Suicide Life Threat Behav 2020; 50:1149-1157. [PMID: 32720746 PMCID: PMC8366387 DOI: 10.1111/sltb.12672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 03/27/2020] [Accepted: 04/24/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate longitudinal relationships between parenting practices in childhood and adolescent suicidality, and assess the mediating role of emotional and behavioral symptoms. METHODS Data were drawn from the National Longitudinal Survey of Children and Youth, a Canadian population-based longitudinal cohort study. The sample included 9,490 children aged 10-11 who were followed up biennially to ages 14-15. Parents reported their positive and punitive parenting practices when children were 10-11. Adolescents self-reported symptoms of depression/anxiety, hyperactivity, conduct disorder, and social aggression at 12-13, and past-year suicidal ideation and suicide attempts at 14-15. RESULTS The inverse associations between positive parenting at 10-11 and suicidal behaviors at 14-15 were significantly mediated by symptoms of hyperactivity, conduct disorder, and social aggression at 12-13. Direct relationships between punitive parenting and suicidal behaviors were observed. These associations were significantly mediated by hyperactivity and, among boys only, by conduct disorder and social aggression. The association between punitive parenting and suicide attempt was additionally mediated by depression/anxiety. CONCLUSIONS Parenting in childhood may be associated with adolescent suicidality both directly and indirectly through emotional and behavioral symptoms. Interventions aimed at reducing the use of harsh disciplinary strategies and promoting positive parent-child interactions may reduce the burden of adolescent suicidality.
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Affiliation(s)
- Mila Kingsbury
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Ewa Sucha
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Ian Manion
- Royal Ottawa Hospital, Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
| | - Stephen E Gilman
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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Hill K, Sucha E, Rhodes E, Carrier M, Garg AX, Harel Z, Hundemer GL, Clark EG, Knoll G, McArthur E, Sood MM. Risk of Hospitalization With Hemorrhage Among Older Adults Taking Clarithromycin vs Azithromycin and Direct Oral Anticoagulants. JAMA Intern Med 2020; 180:1052-1060. [PMID: 32511684 PMCID: PMC7281381 DOI: 10.1001/jamainternmed.2020.1835] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 12/18/2022]
Abstract
IMPORTANCE Clarithromycin is a commonly prescribed antibiotic associated with higher levels of direct oral anticoagulants (DOACs) in the blood, with the potential to increase the risk of hemorrhage. OBJECTIVE To assess the 30-day risk of a hospital admission with hemorrhage after coprescription of clarithromycin compared with azithromycin among older adults taking a DOAC. DESIGN, SETTING, AND PARTICIPANTS This population-based, retrospective cohort study was conducted among adults of advanced age (mean [SD] age, 77.6 [7.2] years) who were newly coprescribed clarithromycin (n = 6592) vs azithromycin (n = 18 351) while taking a DOAC (dabigatran, apixaban, or rivaroxaban) in Ontario, Canada, from June 23, 2009, to December 31, 2016. Cox proportional hazards regression was used to examine the association between hemorrhage and antibiotic use (clarithromycin vs azithromycin). Statistical analysis was performed from December 23, 2019, to March 25, 2020. MAIN OUTCOMES AND MEASURES Hospital admission with major hemorrhage (upper or lower gastrointestinal tract or intracranial). Outcomes were assessed within 30 days of a coprescription. RESULTS Among the 24 943 patients (12 493 women; mean [SD] age, 77.6 [7.2] years) in the study, rivaroxaban was the most commonly prescribed DOAC (9972 patients [40.0%]), followed by apixaban (7953 [31.9%]) and dabigatran (7018 [28.1%]). Coprescribing clarithromycin vs azithromycin with a DOAC was associated with a higher risk of a hospital admission with major hemorrhage (51 of 6592 patients [0.77%] taking clarithromycin vs 79 of 18 351 patients [0.43%] taking azithromycin; adjusted hazard ratio, 1.71 [95% CI, 1.20-2.45]; absolute risk difference, 0.34%). Results were consistent in multiple additional analyses. CONCLUSIONS AND RELEVANCE This study suggests that, among adults of advanced age taking a DOAC, concurrent use of clarithromycin compared with azithromycin was associated with a small but statistically significantly greater 30-day risk of hospital admission with major hemorrhage.
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Affiliation(s)
- Kevin Hill
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ewa Sucha
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Emily Rhodes
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Marc Carrier
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amit X Garg
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of Nephrology, Department of Medicine, Health Sciences Centre, London, Ontario, Canada.,Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Ziv Harel
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of Nephrology, Department of Medicine, St Michael's Hospital, Toronto, Canada
| | - Gregory L Hundemer
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Edward G Clark
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Greg Knoll
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Manish M Sood
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
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22
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Kingsbury M, Sucha E, Manion I, Gilman SE, Colman I. Adolescent Mental Health Following Exposure to Positive and Harsh Parenting in Childhood. Can J Psychiatry 2020; 65:392-400. [PMID: 31830819 PMCID: PMC7265606 DOI: 10.1177/0706743719889551] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The purpose of the present study was to assess longitudinal associations between positive and harsh parenting in childhood and adolescent mental and behavioral difficulties. METHODS Data were drawn from Canada's population-based National Longitudinal Survey of Children and Youth (data collected from 1994 to 2009, analyzed 2018). The sample included 9,882 adolescents aged 12/13 years old. Parents self-reported positive and harsh parenting when children were 6/7, 8/9, and 10/11 years old. Symptoms of depression/anxiety, hyperactivity, physical aggression, social aggression, and suicidal ideation were self-reported by adolescents at age 12/13. Linear regression was used to examine the associations between parenting behaviors at each age and adolescent psychiatric symptoms, adjusted for children's baseline symptoms. RESULTS Harsh parenting at 10/11 was associated with elevated symptoms of early-adolescent physical aggression, social aggression, and suicidal ideation for boys only, and for all children at earlier ages. Beginning at age 8/9, harsh discipline was associated with elevated symptoms of depression/anxiety for boys only. Overall, positive parenting at age 6/7 was protective against depression/anxiety, physical aggression, and social aggression. Significant sex differences emerged beginning at age 8/9, with positive parenting associated with higher symptoms of depression/anxiety for boys only. Positive parenting at age 10/11 was associated with increased depression/anxiety, physical aggression, social aggression, and suicidal ideation among boys, but decreased symptoms of physical aggression, social aggression, and suicidal ideation among girls. CONCLUSIONS Results suggest that the impact of positive and harsh parenting may depend on age and sex, with harsh parenting being more detrimental to boys as they approach adolescence.
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Affiliation(s)
- Mila Kingsbury
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
| | - Ewa Sucha
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
| | - Ian Manion
- Royal Ottawa Hospital, Institute of Mental Health Research, University of Ottawa, Ontario, Canada
| | - Stephen E Gilman
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.,Johns Hopkins Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
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23
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Kingsbury M, Sucha E, Horton NJ, Sampasa-Kanyinga H, Murphy JM, Gilman SE, Colman I. Lifetime experience of multiple common mental disorders and 19-year mortality: results from a Canadian population-based cohort. Epidemiol Psychiatr Sci 2019; 29:e18. [PMID: 30712520 PMCID: PMC6679827 DOI: 10.1017/s2045796018000859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 01/08/2023] Open
Abstract
AIMS To examine the impact of multiple psychiatric disorders over the lifetime on risk of mortality in the general population. METHODS Data came from a random community-based sample of 1397 adults in Atlantic Canada, recruited in 1992. Major depression, dysthymia, panic disorder, generalised anxiety disorder and alcohol use disorders were assessed using the Diagnostic Interview Schedule (DIS). Vital status of participants through 2011 was determined using probabilistic linkages to the Canadian Mortality Database. Cox proportional hazard models with age at study entry as the time scale were used to investigate the relationship between DIS diagnoses and mortality, adjusted for participant education, smoking and obesity at baseline. RESULTS Results suggested that mood and anxiety disorders rarely presented in isolation - the majority of participants experienced multiple psychiatric disorders over the lifetime. Elevated risk of death was found among men with both major depression and dysthymia (HR 2.56; 95% CI 1.12-5.89), depression and alcohol use disorders (HR 2.45; 95% CI 1.18-5.10) and among men and women who experienced both panic disorder and alcohol use disorders (HR 3.80; 95% CI 1.19-12.16). CONCLUSION The experience of multiple mental disorders over the lifetime is extremely common, and associated with increased risk of mortality, most notably among men. Clinicians should be aware of the importance of considering contemporaneous symptoms of multiple psychiatric conditions.
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Affiliation(s)
- M. Kingsbury
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - E. Sucha
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - N. J. Horton
- Department of Mathematics and Statistics, Amherst College, Amherst, MA, USA
| | - H. Sampasa-Kanyinga
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - J. M. Murphy
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Psychiatry, Dalhousie University Faculty of Medicine, Halifax, NS, Canada
| | - S. E. Gilman
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - I. Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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24
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Colman I, Kingsbury M, Sucha E, Horton NJ, Murphy JM, Gilman SE. Depressive and anxious symptoms and 20-year mortality: Evidence from the Stirling County study. Depress Anxiety 2018; 35:638-647. [PMID: 29719088 PMCID: PMC6035782 DOI: 10.1002/da.22750] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/10/2018] [Accepted: 02/17/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Depression and anxiety disorders are highly comorbid, and share significant symptom overlap. Whereas depression has been consistently associated with excess mortality, the association between anxiety and mortality is less clear. Our aim was to identify constellations of anxious and depressive symptoms and examine their associations with mortality. METHOD This study considers respondents from the 1970 (n = 1203) and 1992 (n = 1402) cohorts of the Stirling County study. Symptoms of depression and anxiety were assessed using structured at-home interviews. Vital status of participants through 2011 was determined using probabilistic linkages to the Canadian Mortality Database. RESULTS Exploratory factor analysis yielded three correlated factors in each cohort. Items loading on each factor varied slightly between cohorts, but roughly corresponded to (1) depressive symptoms, (2) anxious symptoms, and (3) somatic symptoms. The depressive factor was associated with increased risk of mortality in both the 1970 (HR: 1.35, 95% CI: 1.12, 1.62) and 1992 (HR: 1.25, 95% CI: 1.05, 1.48) cohorts. Anxious symptoms were associated with a reduced risk of mortality in the 1992 sample (HR: 0.72; 95% CI: 0.53, 0.90). Somatic symptoms were associated with a reduced risk of mortality in the 1970 sample (HR: 0.83, 95% CI: 0.69, 0.99), but an elevated risk of mortality in the 1992 sample (HR: 1.29; 95% CI: 1.11, 1.51). CONCLUSIONS This study provides evidence that symptoms of depression and anxiety may have differential associations with early mortality. Somatic symptoms such as upset stomach and loss of appetite may be protective against mortality, perhaps through increased use of health care services. Conversely, symptoms such as weakness and cold sweats may be indicative of failing health.
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Affiliation(s)
- Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Mila Kingsbury
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ewa Sucha
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Jane M. Murphy
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA; Department of Psychiatry, Dalhousie University Faculty of Medicine, Halifax, NS, Canada
| | - Stephen E. Gilman
- Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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25
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Gilman SE, Sucha E, Kingsbury M, Horton NJ, Murphy JM, Colman I. Depression and mortality in a longitudinal study: 1952-2011. CMAJ 2017; 189:E1304-E1310. [PMID: 29061855 DOI: 10.1503/cmaj.170125] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Many studies have shown that depression increases mortality risk. We aimed to investigate the duration of time over which depression is associated with increased risk of mortality, secular trends in the association between depression and mortality, and sex differences in the association between depression and mortality. METHODS We conducted a cohort study of 3410 adults enrolled in 3 representative samples of a county in Atlantic Canada in 1952 (n = 1003), 1970 (n = 1203) or 1992 (n = 1402) (the Stirling County Study). Depression was measured using a diagnostic algorithm based on the presence of depressed mood and associated symptoms, duration of more than 1 month, and substantial impairment. Vital status of participants through 2011 was determined using probabilistic linkages to the Canadian Mortality Database. RESULTS Depression was associated with a heightened risk of mortality among men during the 3 time periods of the study, with hazard ratios (HRs) of 2.90 (95% confidence interval [CI] 1.69-4.98) between 1952 and 1967, 1.97 (CI 1.34-2.89) between 1968 and 1990, and 1.52 (CI 1.09-2.13) between 1991 and 2011. Elevated risk of mortality was noted among women only between 1990 and 2011 (HR = 1.51; CI = 1.11-2.05). INTERPRETATION The association between depression and mortality persists over long periods of time and has emerged among women in recent decades, despite contemporaneous improvements in the treatment of depression and reduction of stigma associated with depression. Further research is needed to better understand the mechanisms involved.
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Affiliation(s)
- Stephen E Gilman
- Health Behavior Branch, Division of Intramural Population Health Research (Gilman), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md.; Department of Mental Health (Gilman), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Department of Mathematics and Statistics (Sucha), and School of Epidemiology and Public Health (Sucha, Kingsbury), University of Ottawa, Ottawa, Ont.; Department of Mathematics and Statistics (Horton), Amherst College, Amherst, Mass.; Department of Psychiatry (Murphy), Massachusetts General Hospital and Harvard Medical School; Department of Epidemiology (Murphy), Harvard TH Chan School of Public Health, Boston, Mass.; Department of Psychiatry (Murphy), Dalhousie University Faculty of Medicine, Halifax, NS; School of Epidemiology, Public Health & Preventive Medicine (Colman), University of Ottawa, Ottawa, Ont.
| | - Ewa Sucha
- Health Behavior Branch, Division of Intramural Population Health Research (Gilman), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md.; Department of Mental Health (Gilman), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Department of Mathematics and Statistics (Sucha), and School of Epidemiology and Public Health (Sucha, Kingsbury), University of Ottawa, Ottawa, Ont.; Department of Mathematics and Statistics (Horton), Amherst College, Amherst, Mass.; Department of Psychiatry (Murphy), Massachusetts General Hospital and Harvard Medical School; Department of Epidemiology (Murphy), Harvard TH Chan School of Public Health, Boston, Mass.; Department of Psychiatry (Murphy), Dalhousie University Faculty of Medicine, Halifax, NS; School of Epidemiology, Public Health & Preventive Medicine (Colman), University of Ottawa, Ottawa, Ont
| | - Mila Kingsbury
- Health Behavior Branch, Division of Intramural Population Health Research (Gilman), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md.; Department of Mental Health (Gilman), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Department of Mathematics and Statistics (Sucha), and School of Epidemiology and Public Health (Sucha, Kingsbury), University of Ottawa, Ottawa, Ont.; Department of Mathematics and Statistics (Horton), Amherst College, Amherst, Mass.; Department of Psychiatry (Murphy), Massachusetts General Hospital and Harvard Medical School; Department of Epidemiology (Murphy), Harvard TH Chan School of Public Health, Boston, Mass.; Department of Psychiatry (Murphy), Dalhousie University Faculty of Medicine, Halifax, NS; School of Epidemiology, Public Health & Preventive Medicine (Colman), University of Ottawa, Ottawa, Ont
| | - Nicholas J Horton
- Health Behavior Branch, Division of Intramural Population Health Research (Gilman), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md.; Department of Mental Health (Gilman), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Department of Mathematics and Statistics (Sucha), and School of Epidemiology and Public Health (Sucha, Kingsbury), University of Ottawa, Ottawa, Ont.; Department of Mathematics and Statistics (Horton), Amherst College, Amherst, Mass.; Department of Psychiatry (Murphy), Massachusetts General Hospital and Harvard Medical School; Department of Epidemiology (Murphy), Harvard TH Chan School of Public Health, Boston, Mass.; Department of Psychiatry (Murphy), Dalhousie University Faculty of Medicine, Halifax, NS; School of Epidemiology, Public Health & Preventive Medicine (Colman), University of Ottawa, Ottawa, Ont
| | - Jane M Murphy
- Health Behavior Branch, Division of Intramural Population Health Research (Gilman), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md.; Department of Mental Health (Gilman), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Department of Mathematics and Statistics (Sucha), and School of Epidemiology and Public Health (Sucha, Kingsbury), University of Ottawa, Ottawa, Ont.; Department of Mathematics and Statistics (Horton), Amherst College, Amherst, Mass.; Department of Psychiatry (Murphy), Massachusetts General Hospital and Harvard Medical School; Department of Epidemiology (Murphy), Harvard TH Chan School of Public Health, Boston, Mass.; Department of Psychiatry (Murphy), Dalhousie University Faculty of Medicine, Halifax, NS; School of Epidemiology, Public Health & Preventive Medicine (Colman), University of Ottawa, Ottawa, Ont
| | - Ian Colman
- Health Behavior Branch, Division of Intramural Population Health Research (Gilman), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md.; Department of Mental Health (Gilman), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Department of Mathematics and Statistics (Sucha), and School of Epidemiology and Public Health (Sucha, Kingsbury), University of Ottawa, Ottawa, Ont.; Department of Mathematics and Statistics (Horton), Amherst College, Amherst, Mass.; Department of Psychiatry (Murphy), Massachusetts General Hospital and Harvard Medical School; Department of Epidemiology (Murphy), Harvard TH Chan School of Public Health, Boston, Mass.; Department of Psychiatry (Murphy), Dalhousie University Faculty of Medicine, Halifax, NS; School of Epidemiology, Public Health & Preventive Medicine (Colman), University of Ottawa, Ottawa, Ont
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