Abstract Introduction Severe acute renal failure (sARF) is associated with considerable morbidity, mortality and use of healthcare resources; however, its precise epidemiology and long-term outcomes have not been well described in a non-specified population. Methods Population-based surveillance was conducted among all adult residents of the Calgary Health Region (population 1 million) admitted to multidisciplinary and cardiovascular surgical intensive care units between May 1 1999 and April 30 2002. Clinical records were reviewed and outcome at 1 year was assessed. Results sARF occurred in 240 patients (11.0 per 100,000 population/year). Rates were highest in males and older patients (≥65 years of age). Risk factors for development of sARF included previous heart disease, stroke, pulmonary disease, diabetes mellitus, cancer, connective tissue disease, chronic renal dysfunction, and alcoholism. The annual mortality rate was 7.3 per 100,000 population with rates highest in males and those ≥65 years. The 28-day, 90-day, and 1-year case-fatality rates were 51%, 60%, and 64%, respectively. Increased Charlson co-morbidity index, presence of liver disease, higher APACHE II score, septic shock, and need for continuous renal replacement therapy were independently associated with death at 1 year. Renal recovery occurred in 78% (68/87) of survivors at 1 year. Conclusion sARF is common and males, older patients, and those with underlying medical conditions are at greatest risk. Although the majority of patients with sARF will die, most survivors will become independent from renal replacement therapy within a year.
SUMMARY Using multivariable models, we compared whether there were significant differences between reported outbreak and sporadic cases in terms of their sex, age, and mode and site of disease transmission. We also determined the potential role of administrative, temporal, and spatial factors within these models. We compared a variety of approaches to account for clustering of cases in outbreaks including weighted logistic regression, random effects models, general estimating equations, robust variance estimates, and the random selection of one case from each outbreak. Age and mode of transmission were the only epidemiologically and statistically significant covariates in our final models using the above approaches. Weighing observations in a logistic regression model by the inverse of their outbreak size appeared to be a relatively robust and valid means for modelling these data. Some analytical techniques, designed to account for clustering, had difficulty converging or producing realistic measures of association.
A sample of 457 (177 men, 280 women) undergraduate students were surveyed regarding perceived level of stress. Women were more likely than men to report an unacceptable stress level. To reduce stress, women were more likely to indicate a need to limit commitments, exercise, and worry less. Reasons for not reducing stress were lack of time and lack of self-discipline, both of which were reported significantly more often by women. The present data suggest health education interventions are needed to assist students in coping with the stress they experience.
Background: Relatively little is known about the use of disease-modifying drugs (DMDs) for multiple sclerosis (MS) in the population-based universal healthcare setting. This study aimed to describe the characteristics of a population-based cohort with MS and their DMD exposure in four Canadian provinces. Methods: We identified all adults (aged ≥18 years) with MS using linked population-based health administrative data. Individuals were followed from the most recent of their first MS or demyelinating event or 1 January 1996(study entry), to the earliest of death, emigration, or 31 March 2018(study end). Cohort characteristics examined included sex, age, socioeconomic status, and comorbidity burden. Results: Overall, 10,418/35,894 (29%) of MS cases filled a DMD prescription during the 22-year study period. Most were women (n = 7,683/10,418;74%), and 17% (n = 1,745/10,418) had some comorbidity (Charlson Comorbidity Index≥1) at study entry. Nearly 20% (n = 1,745/10,418) were aged ≥50 when filling their first DMD; the mean age was 39.6 years. Conclusions: Almost 1 in 6 people with MS had at least some comorbidity, and nearly 1 in 6 were ≥50 years old at the time of their first DMD. As these individuals are typically excluded from clinical trials, findings illustrate the need to understand the harms and benefits of DMD use in these understudied groups.
Introduction Les registres d’assurance-maladie, qui recueillent des renseignements sur la couverture et certaines caractéristiques des individus à l’échelle de larges populations, sont précieux pour la surveillance de la santé de la population et de la recherche fondée sur l’utilisation de données administratives. Le fait que les données des registres des provinces et des territoires du Canada ne soient pas normalisées est susceptible de nuire à la comparabilité des mesures de surveillance. Nous avons évalué le contenu des registres d’assurance-maladie au Canada afin de décrire les populations couvertes et de relever les similitudes et les différences entre les registres. Méthodologie L’équipe de l’étude et des représentants de l’Agence de la santé publique du Canada ont élaboré une enquête sur les caractéristiques individuelles et les données sur la population recueillies dans les registres d’assurance-maladie. Les réponses des informateurs clés des provinces et territoires qui ont répondu à l’enquête ont été analysées de façon descriptive. Résultats Toutes les provinces ont répondu à l’enquête et les Territoires du Nord-Ouest ont fourni des réponses partielles. Certaines caractéristiques individuelles figurant dans les registres d’assurance-maladie (l’adresse principale, la date de naissance et le sexe) sont saisies dans toutes les provinces et tous les territoires. Les données disponibles sur les liens de parenté, l’origine ethnique et le statut socioéconomique sont variables selon les provinces et territoires, tout comme les dates de début et de fin de couverture et la fréquence de mise à jour du registre. L’information sur des populations particulières, comme les membres des Premières Nations, est saisie dans certaines provinces et certains territoires seulement. Conclusion Les registres d’assurance-maladie constituent une riche source d’information sur les populations assurées des provinces et des territoires. Cependant, l’hétérogénéité des données peut avoir un impact sur les personnes incluses et exclues dans les estimations de surveillance de la population produites à partir de données administratives sur la santé. L’élaboration d’un cadre de données harmonisé favoriserait l’obtention de résultats comparables et à jour en matière de recherche et de surveillance de la santé de la population dans le cadre d’études intergouvernementales.
To effectively support childhood vaccine programs for First Nations Peoples, Canada's largest population of Indigenous Peoples, it is essential to understand the context, processes, and structures organizing vaccine access and uptake. Rather than assuming that solutions lie in compliance with current regulations, our aim was to identify opportunities for innovation by exploring the work that nurses and parents must do to have children vaccinated. In partnership with a large First Nations community, we used an institutional ethnography approach that included observing vaccination clinic appointments, interviewing individuals involved in childhood vaccinations, and reviewing documented vaccination processes and regulations (texts). We found that the 'work' nurses engage in to deliver childhood vaccines is highly regulated by standardized texts that prioritize discourses of safety and efficiency. Within the setting of nursing practice in a First Nations community, these regulations do not always support the best interests of families. Nurses and parents are caught between the desire to vaccinate multiple children and the requirement to follow institutionally authorized processes. The success of the vaccination program, when measured solely by the number of children who follow the vaccine schedule, does not take into consideration the challenges nurses encounter in the clinic or the work parents do to get their children vaccinated. Exploring new ways of approaching the processes could lead to increased vaccination uptake and satisfaction for parents and nurses.
The association between injurious falls requiring a visit to the emergency department and various classes of medications was examined in a case-control study of community living persons aged 66 years and older.Administrative databases from an urban health region provided the information used. Five controls for each case were randomly selected from community dwelling older persons who had not reported an injurious fall to one of the six regional emergency departments in the study year. Two series of analyses on medication use within 30 days of the fall were conducted using logistic regression, the first controlling for age, sex, and median income, the second controlling for co-morbid diagnoses as well.During the study year there were 2,405 falls reported by 2,278 individuals to six regional emergency departments giving a crude fall rate of 31.6 per 1,000 population per year. The initial analysis identified seven medication classes that were associated with an increased risk of an injurious fall, while controlling for age, gender and income. However, with further analyses controlling for the additional effects of co-morbid disease, narcotic pain-killers (odds ratio 1.68), anti-convulsants (odds ratio 1.51) and anti-depressants (odds ratio 1.46) were significant independent predictors of sustaining an injurious fall.These results are based on a Canadian population-based study with a large community sample. The study found that taking certain medications were independent predictors of sustaining an injurious fall in our elderly population - in addition to the risk associated with their medical condition.
