Laboratory-confirmed COVID-19 in children and youth in Canada, January 15-April 27, 2020.

Understanding the epidemiology of COVID-19 among children and youth in Canada will help to inform public health measures in settings where children gather. As of April 27, 2020, provinces and territories provided the Public Health Agency of Canada with detailed information on 24,079 cases, of which 3.9% (n=938) were younger than 20 years of age. The detection rate per 100,000 population was lower in this age group (11.9 per 100,000), compared with those aged 20-59 years (72.4 per 100,000) and 60 and older (113.6 per 100,000). The median age among those younger than 20 years of age was 13 years, and cases were distributed equally across male and female genders. Among provinces and territories with more than 100 cases, 1.6% to 9.8% of cases were younger than 20 years of age. Cases in this age group were more likely to be asymptomatic: 10.7% compared with 2.4% in those aged 20-59 years and 4.1% in those aged 60 and older. Children and youth experienced severe outcomes less often, but 2.2% (n=15/672) of cases within this age group were severe enough to require hospitalization. Based on available exposure information, 11.3% (n=59/520) of cases aged younger than 20 years had no known contact with a case. Canadian findings align with those of other countries.

Surgical smoke: articulating the problem.

This six-part series focuses on surgical smoke evacuation legislation and policy. It provides answers to important frequently asked questions (FAQs) about surgical smoke from policymakers and people not working in perioperative services and suggests resources and tools to help you become a strong advocate for surgical smoke evacuation. The FAQs and legislative checklists that will be shared will cover the basics of surgical smoke and its harmful effects, strategies and solutions for eradicating surgical smoke in the OR, the role of regulatory agencies, and how to lay the groundwork for successful state legislation on your own and in tandem with AORN's Government Affairs Department.

Community Primary Care Diabetes Pathway.

IN BRIEF "Quality Improvement Success Stories" are published by the American Diabetes Association in collaboration with the American College of Physicians, Inc., and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes an initiative to provide more intensive diabetes care and support in a primary care setting and thereby improve patients' glycemic, blood pressure, and lipid control, as well as BMI and psychosocial well-being.

A comparative effectiveness study of eSource used for data capture for a clinical research registry.

OBJECTIVE: This pilot study compared eSource-enabled versus traditional manual data transcription (non-eSource methods) for the collection of clinical registry information. The primary study objective was to compare the time spent completing registry forms using eSource versus non-eSource methods The secondary objectives were to compare data quality associated with these two data capture methods and the flexibility of the workflows. This study directly addressed fundamental questions relating to eSource adoption: what time-savings can be realized, and to what extent does eSource improve data quality. MATERIALS AND METHODS: The study used time and motion methods to compare eSource versus non-eSource data capture workflows for a single center OB/GYN registry. Direct observation by industrial engineers using specialized computer software captured keystrokes, mouse clicks and video recordings of the study team in their normal work environment completing real-time data collection. RESULTS: The overall average data capture time was reduced with eSource versus non-eSource methods (difference, 151s per case; eSource, 1603s; non-eSource, 1754s; p=0.051). The average data capture time for the demographic data was reduced (difference, 79s per case; eSource, 133s; non-eSource, 213s; p<0.001). This represents a 37% time reduction (95% confidence interval 27% to 47%). eSourced data field transcription errors were also reduced (eSource, 0%; non-eSource, 9%). CONCLUSION: The use of eSource versus traditional data transcription was associated with a significant reduction in data entry time and data quality errors. Further studies in other settings are needed to validate these results.

Avoidable mortality among First Nations adults in Canada: A cohort analysis.

BACKGROUND: Avoidable mortality is a measure of deaths that potentially could have been averted through effective prevention practices, public health policies, and/or provision of timely and adequate health care. This longitudinal analysis compares avoidable mortality among First Nations and non-Aboriginal adults. DATA AND METHODS: Data are from the 1991-to-2006 Canadian Census Mortality and Cancer Follow-up Study. A 15% sample of 1991 Census respondents aged 25 or older was linked to 16 years of mortality data. This study examines avoidable mortality among 61,220 First Nations and 2,510,285 non-Aboriginal people aged 25 to 74. RESULTS: During the 1991-to-2006 period, First Nations adults had more than twice the risk of dying from avoidable causes compared with non-Aboriginal adults. The age-standardized avoidable mortality rate (ASMR) per 100,000 person-years at risk for First Nations men was 679.2 versus 337.6 for non-Aboriginal men (rate ratio = 2.01). For women, ASMRs were lower, but the gap was wider. The ASMR for First Nations women was 453.2, compared with 183.5 for non-Aboriginal women (rate ratio = 2.47). Disparities were greater at younger ages. Diabetes, alcohol and drug use disorders, and unintentional injuries were the main contributors to excess avoidable deaths among First Nations adults. Education and income accounted for a substantial share of the disparities. INTERPRETATION: The results highlight the gap in avoidable mortality between First Nations and non-Aboriginal adults due to specific causes of death and the association with socioeconomic factors.

Cancer patterns in Inuit Nunangat: 1998-2007.

OBJECTIVES: To compare cancer incidence patterns between residents of Inuit Nunangat and the rest of Canada. STUDY DESIGN: Cancer cases were geographically linked to either Inuit Nunangat or the rest of Canada using postal codes or other geographic information. Population estimates were derived from the 2001 and 2006 censuses. METHODS: Cancer cases were combined from 1998 to 2007 for Inuit Nunangat and the rest of Canada. Age-standardised incidence rates were calculated for all site cancers and sub-sites by sex. Standardised rate ratios between these 2 areas were calculated for all site cancers and sub-sites. RESULTS: The age-standardised incidence rate for all cancer sites (1998-2007) was 14% lower for the Inuit Nunangat male population and 29% higher for the female population by comparison to the rest of Canada. Cancers of the nasopharynx, lung and bronchus, colorectal, stomach (males), and kidney and renal pelvis (females), were elevated in the Inuit Nunangat population compared to the rest of Canada, whereas prostate and female breast cancers were lower in the Inuit Nunangat population. CONCLUSIONS: Cancers with potentially modifiable risk factors, such as buccal cavity and pharynx, nasopharynx, lung and bronchus, and colorectal cancer were elevated in the Inuit Nunangat population compared to the rest of Canada. Besides greater smoking prevalence within Inuit Nunangat by comparison to the rest of Canada, distinct socioeconomic characteristics between respective area populations including housing, and income may have contributed to incidence differentials. This study demonstrated that a geographic approach can be used in cancer surveillance when populations of interest are spatially distinguishable, and reside across distinct jurisdictions whose combined cancer registries will not completely provide information to identify the population of interest.

Potential years of life lost at ages 25 to 74 among Status Indians, 1991 to 2001.

BACKGROUND: Compared with other Canadians, First Nations peoples experience a disproportionate burden of illness and disease. Potential years of life lost (PYLL) before age 75 highlights the impact of youthful or early deaths. DATA AND METHODS: The 1991 to 2001 Canadian census mortality follow-up study tracked a 15% sample of adults aged 25 or older over more than a decade. This study examined mortality among people aged 25 to 74-55,600 Status Indians (39,200 on reserve and 16,500 off reserve) and 2,475,700 non-Aboriginal adults-all of whom were enumerated by the 1991 census long-form questionnaire. Age-standardized PYLL rates were calculated, based on the number of person-years at risk before age 75. RESULTS: Status Indian adults had 2.5 times the risk of dying before age 75, compared with non-Aboriginal adults. Results did not differ greatly by residence on or off reserve. Relative and absolute inequalities were greatest for unintentional and intentional injuries. Socio-economic factors such as income, education, housing and employment explained a substantial share of the disparities in premature death. INTERPRETATION: Status Indian adults had higher rates of premature mortality. Socio-economic factors played an important role in those disparities. Injuries were important contributors to both relative and absolute inequalities.

Impact of Medicare Part D on osteopathic physicians.

CONTEXT: Although there is a wealth of information for patients and physicians on the Medicare Prescription Drug, Improvement, and Modernization Act, little research exists related to its impact on osteopathic physicians (DOs). OBJECTIVE: To examine the impact of Medicare's prescription drug benefit-or Part D-on DOs and their practices. METHODS: Two electronic surveys regarding Medicare Part D were e-mailed to DOs randomly selected from the American Osteopathic Association database. The first survey was sent January 31, 2006 (within the first month of Part D implementation), and the second was sent June 1, 2006 (6 months after implementation). Both surveys focused primarily on the challenges experienced by DOs and their staff regarding Part D. Responses were subjected to univariate, bivariate, and Pearson product moment correlation analysis. RESULTS: Of the 10,000 DOs contacted, 603 (6%) responded and met inclusion criteria for the first survey and 343 (3.4%) for the second survey. More than 60% of respondents to the first survey reported challenges such as increased workload, difficulties understanding Part D, difficulties with the physician appeals process, and lack of information and education. These challenges were also reported in the second survey but by approximately 30% fewer respondents. One challenge-changing medications as a result of formulary restrictions-was reported by 17% more respondents to the second survey (P<.01). Respondents in primary care, solo practice, and rural areas as well as those treating large Medicare populations and those who were their patients' primary source of information about Part D reported more challenges. CONCLUSION: Considering the numerous challenges respondents faced with Part D, it is important to remember the role of physicians in successfully implementing healthcare programs, particularly as the US healthcare reform debate progresses.