Internationalization at Home: An Occupational Therapy Synchronous Collaboration Between Cyprus and the United States.

IMPORTANCE: Designing, implementing, and measuring the effectiveness of sustainable Internationalization at Home programs will support the development of cultural competence among occupational therapy students. OBJECTIVE: To explore potential sustainable, effective methods for enhancing cultural competence in occupational therapy students through cross-cultural online collaborations. DESIGN: Pretest-posttest, parallel mixed-methods design. SETTING: An online collaboration using video conferencing technology and classrooms at the European University Cyprus and the University of St. Augustine for Health Sciences. PARTICIPANTS: Bachelor of science and master of occupational therapy students at the European University Cyprus and the University of St. Augustine for Health Sciences, respectively. INTERVENTION: Online video conferencing collaboration between occupational therapy students in which students discussed their perspectives and experiences regarding social injustice and occupational therapy's role in working with vulnerable populations. OUTCOMES AND MEASURES: Each campus participated in focus groups, and students completed individual reflections. Themes were derived from the qualitative information gathered. Quantitative data were collected using the Cultural Awareness Scale for Occupational Therapy Students (CASOTS). RESULTS: CASOTS did not reflect changes in cultural awareness. The qualitative measures identified students' desire to participate in more frequent and culturally diverse experiences. Challenges included length of preparation and actual communication time. Inclusion of prior asynchronous sessions and methods to overcome the language barrier was suggested for future implementation. CONCLUSION: Synchronous cross-cultural collaborations may enhance occupational therapy student's cultural awareness and may be more attractive than traditional in-class teaching. Further development is necessary to overcome challenges. WHAT THIS ARTICLE ADDS: Documenting the benefits and barriers of implementing Internationalization at Home experiences will allow academic institutions to create sustainable methods for enhancing occupational therapy students' cultural competence. Recommendations to further enhance Internationalization at Home experiences provide opportunities for increased cultural collaboration.

Adverse drug events in adult patients leading to emergency department visits.

BACKGROUND: Adverse drug events (ADEs) occurring in the community and treated in emergency departments (EDs) have not been well studied. OBJECTIVE: To determine the prevalence, severity, and preventability of ADEs in patients presenting at EDs in 2 university-affiliated tertiary care hospitals in the Canadian province of Newfoundland and Labrador. METHODS: A retrospective chart review was conducted on a stratified random sample (n = 1458) of adults (> or =18 y) who presented to EDs from January 1 to December 31, 2005. Prior to the chart review, the sample frame was developed by first eliminating visits that were clearly not the result of an ADE. The ED summary of each patient was initially reviewed by 2 trained reviewers in order to identify probable ADEs. All eligible charts were subsequently reviewed by a clinical team, consisting of 2 pharmacists and 2 ED physicians, to identify ADEs and determine their severity and preventability. RESULTS: Of the 1458 patients presenting to the 2 EDs, 55 were determined to have an ADE or a possible ADE (PADE). After a sample-weight adjustment, the prevalence of ADEs/PADEs was found to be 2.4%. Prevalence increased with age (0.7%, 18-44 y; 1.9%, 45-64 y; 7.8%, > or =65 y) and the mean age for patients with ADEs was higher than for those with no ADEs (69.9 vs 63.8 y; p < 0.01). A higher number of comorbidities and medications was associated with drug-related visits. Approximately 29% of the ADEs/PADEs identified were considered to be preventable, with 42% requiring hospitalization. Cardiovascular agents (37.4%) were the most common drug class associated with ADEs/PADEs. CONCLUSIONS: Adult ADE-related ED visits are frequent in Newfoundland and Labrador, and in many cases are preventable. Further efforts are needed to reduce the occurrence of preventable ADEs leading to ED visits.

Adverse drug events among children presenting to a hospital emergency department in Newfoundland and Labrador, Canada.

OBJECTIVES: The aim of this study was to examine epidemiologic characteristics of Adverse Drug Events (ADEs) among children and adolescents presenting to an Emergency Department (ED) in Newfoundland and Labrador (NL), Canada. MATERIALS AND METHODS: This study was conducted in three phases and included an ED chart review of visits to the Janeway Hospital in St. John's, NL, between 27th April 2006 and 26th April 2007. The first phase narrowed the sampling frame by excluding visits highly unlikely to be drug-related. In the second phase, a random sample of ED charts was selected for review by two research nurses using a Trigger Assessment Tool that classified ED visits according to their likelihood of being drug related ('high', 'moderate', 'low', 'very low', or 'no' probability). The third phase included a full chart review of all 'high', 'moderate', 'low', and 'very low' probability ADE charts, carried out independently by two ED pediatricians and two clinical pharmacists. Each ADE was also scored for severity and preventability, and consensus was reached among all four reviewers during meetings held at the end of this phase. RESULTS: In this study, 69 patients presented to the ED either due to an ADE or a possible ADE (PADE). After a sample-weight adjustment, the prevalence of ADEs/PADEs was found to be 2.1%. The number of co-morbidities was inversely associated with medication-related visits. There was no significant difference found between patients with and without medication related visits with respect to mean age of the patient and the mean number of current medications being taken. Of the 69 confirmed ADE/PADEs, none were fatal, six (8.7%) were serious/life-threatening, and 63 (91.3%) were considered significant. Antimicrobial agents (45.0%) were the most common drug classes associated with ADEs/PADEs. Approximately 20% of the 69 ADEs/PADEs identified were considered preventable. CONCLUSIONS: In St. John's NL, emergency department visits as a result of ADEs are common among the pediatric population and in many cases preventable. Age and number of current medications do not appear to be associated with ED visits related with ADE. Antimicrobial agents were found to be to the cause of most ADEs/PADEs.

Role of social support in the relationship between sexually transmitted infection and depression among young women in Canada.

BACKGROUND: Individuals with a self-reported history of sexually transmitted infection (STI) are at high risk for depression. However, little is known about how social support affects the association between STI and depression among young women in Canada. METHODS: Data were drawn from the Canadian Community Health Survey (CCHS), conducted in 2005. A total of 2636 women aged 15-24 years who provided information on STI history were included in the analysis. Depression was measured by a depression scale based on the Composite International Diagnostic Interview Short-Form (CIDI-SF). The 19-item Medical Outcomes Study (MOS) Social Support Survey assessed functional social support. A log-binomial model was used to estimate the prevalence ratio (PR) for self-reported STI history associated with depression and to assess the impact of social support on the association. RESULTS: The adjusted PR for self-reported STI history associated with depression was 1.61 (95% CI, 1.03 to 2.37), before social support was included in the model. The association between STI history and depression was no longer significant when social support was included in the model (adjusted PR, 1.28; 95% CI, 0.83 to 1.84). The adjusted PRs for depression among those with low and intermediate levels of social support versus those with a high level of social support were 5.62 (95% CI, 3.50 to 9.56) and 2.19 (1.38 to 3.68), respectively. CONCLUSIONS: Social support is an important determinant of depression and reduces the impact of self-reported STI on depression among young women in Canada.

Unintentional injuries among children and adolescents in Aboriginal and non-Aboriginal communities, Newfoundland and Labrador, Canada.

OBJECTIVES: To compare epidemiologic characteristics of unintentional injuries among children and adolescents in Aboriginal and non-Aboriginal communities in the Province of Newfoundland and Labrador (NL), Canada. STUDY DESIGN: A comparative population-based study of unintentional injuries among individuals 0-19 years was conducted among Aboriginal and non-Aboriginal communities in NL. METHODS: The provincial hospital discharge and mortality data were analyzed for a 6-year period, April 1995 to March 2001. Rates and rate ratios related to hospital discharge and mortality due to unintentional injuries were calculated to assess variation of rates. The 2-independent sample binomial proportion test was used to compare rates between Aboriginal and non-Aboriginal communities. RESULTS: The overall hospital discharge rates of unintentional injury in Aboriginal and non-Aboriginal communities were 1,132.0 and 614.2 per 100,000 population, respectively (p(2)<0.001). For both Aboriginal and non-Aboriginal communities, the rate among males was higher than that of females (p(2)<0.001). The mortality rate was found to be higher in Aboriginal communities than non-Aboriginal communities (84.3 vs. 10.2 per 100,000 population) (p(2)<0.001). CONCLUSIONS: The rate of unintentional injury among children and adolescents in Aboriginal communities is higher than non-Aboriginal communities. Sex (male) and place of residence (Aboriginal communities) were strong predictors of unintentional injury in NL.

A systematic review of the risks factors associated with the onset and natural progression of spina bifida.

The purpose of this study was to systematically assess and synthesize the world literature on risk factors for the onset and natural progression of spina bifida, thereby providing a basis for policy makers to identify appropriate risk management measures to mitigate the burden of disease in Canada. Searches of several health literature databases from inception to February 2013 were conducted by a health sciences librarian. A total of three meta-analyses that studied a risk factor for the onset of spina bifida were included. Pooled results showed that paternal exposure to Agent Orange (RR=2.02; 95% CI 1.48-2.74) and maternal obesity prior to pregnancy (OR=2.24; 95% CI 1.86-2.74) each increased the risk of having a child with spina bifida. Paternal exposure to organic solvents was also close to the limit of significance (OR=1.59; 95% CI 0.99-2.56). A total of 63 observational studies, encompassing hundreds of potential risk factors, were included for risk factors for the onset of disease. One meta-analysis and four observational studies examined the impact of genetic risk factors. Only specified mutations in the 5,10-methylenetetrahydrofolate reductase (MTHFR) and dihydrofolate reductase (DHFR) genes were found to be linked to disease onset. One observational study evaluated a risk factor for the natural progression of disease. An extensive number of potential risk factors for the onset of spina bifida have been studied, though most lack sufficient evidence to confirm an association. Currently, strong evidence exists to suggest a causal association for maternal obesity prior to pregnancy, and paternal exposure to Agent Orange.

Using Electronic Medical Record to Identify Patients With Dyslipidemia in Primary Care Settings: International Classification of Disease Code Matters From One Region to a National Database.

OBJECTIVE: To assess the validity of the International Classification of Disease (ICD) codes for identifying patients with dyslipidemia in electronic medical record (EMR) data. METHODS: The EMRs of patients receiving primary care in St. John's, Newfoundland and Labrador (NL), Canada, were retrieved from the Canadian Primary Care Sentinel Surveillance Network database. International Classification of Disease codes were first compared with laboratory lipid data as an independent criterion standard, and next with a "comprehensive criterion standard," defined as any existence of abnormal lipid test, lipid-lowering medication record, or dyslipidemia ICD codes. The ability of ICD coding alone or combined with other components was evaluated against the two criterion standards using receiver operating characteristic (ROC) analysis, sensitivity, specificity, negative predictive value (NPV) and Kappa agreement. (No specificity was reported for the comparison of ICD codes against the comprehensive criterion standard as this naturally leads to 100% specificity.). RESULTS: The ICD codes led to a poor outcome when compared with the serum lipid levels (sensitivity, 27%; specificity, 76%; PPV, 71%; NPV, 33%; Kappa, 0.02; area under the receiver operating characteristic curve (AUC), 0.51) or with the comprehensive criterion standard (sensitivity, 32%; NPV, 25%; Kappa, 0.15; AUC, 66%). International Classification of Disease codes combined with lipid-lowering medication data also resulted in low sensitivity (51.2%), NPV (32%), Kappa (0.28), and AUC (75%). The addition of laboratory lipid levels to ICD coding marginally improved the algorithm (sensitivity, 94%; NPV, 79%; Kappa, 0.85; AUC, 97%). CONCLUSIONS: The use of ICD coding, either alone or in combination with laboratory data or lipid-lowering medication records, was not an accurate indicator in identifying dyslipidemia.

A systematic review of the risks factors associated with the onset and natural progression of hydrocephalus.

The purpose of this study was to systematically assess and synthesize the world literature on risk factors for the onset and natural progression of hydrocephalus, thereby providing a basis for policy makers to identify appropriate risk management measures to mitigate the burden of disease in Canada. Evidence for risk factors was limited for both onset and progression. Two meta-analyses that examined a risk factor for onset met the inclusion criteria. One found a significant protective effect of prenatal vitamins among case control studies, but not cohort/randomized controlled trials (RCTs). The second found maternal obesity to be a significant risk factor for congenital hydrocephalus. Significant risk factors among 25 observational studies included: biological (multiple births, maternal parity, common cold with fever, maternal thyroid disease, family history, preterm birth, hypertension, ischemic heart disease, ischemic ECG changes, higher cerebrospinal fluid protein concentration following vestibular schwannoma); lifestyle (maternal obesity, high-density lipoprotein (HDL) cholesterol, maternal diabetes, maternal age), healthcare-related (caesarean section, interhospital transfer, drainage duration following subarachnoid hemorrhage, proximity to midline for craniectomy following traumatic brain injury); pharmaceutical (prenatal exposure to: tribenoside, metronidazole, anesthesia, opioids); and environmental (altitude, paternal occupation). Three studies reported on genetic risk factors: no significant associations were found. There are major gaps in the literature with respect to risk factors for the natural progression of hydrocephalus. Only two observational studies were included and three factors reported. Many risk factors for the onset of hydrocephalus have been studied; for most, evidence remains limited or inconclusive. More work is needed to confirm any causal associations and better inform policy.

A systematic review of the risks factors associated with the onset and natural progression of epilepsy.

Epilepsy is a neurological condition that affects more than 50 million individuals worldwide. It presents as unpredictable, temporary and recurrent seizures often having negative physical, psychological and social consequences. To inform disease prevention and management strategies, a comprehensive systematic review of the literature on risk factors for the onset and natural progression of epilepsy was conducted. Computerized bibliographic databases for systematic reviews, meta-analyses, observational studies and genetic association studies published between 1990 and 2013 describing etiological risk factors for epilepsy was searched. The quality of systematic reviews was validated using the AMSTAR tool and articles were reviewed by two referees. A total of 16,958 articles went through stage one review of abstracts and titles. A total of 76 articles on genetic and non-genetic risk factors for the onset and progression of epilepsy met the eligibility criteria for data extraction. Dozens of risk factors were significantly associated with onset of epilepsy. Inconsistent levels of evidence for risk of onset included family history of epilepsy, history of febrile seizures, alcohol consumption, CNS and other infections, brain trauma, head injury, perinatal stroke, preterm birth and three genetic markers. Limited evidence showed that symptomatic epilepsy, focal seizures/syndromes, slow waves on EEG, higher seizure frequency, high stress or anxiety, and lack of sleep decreased the odds of seizure remission. High quality studies were rare and while a large body of work exists, relatively few systematic reviews were found.

Factors associated with the onset and progression of neurotrauma: A systematic review of systematic reviews and meta-analyses.

Neurotrauma, including traumatic brain injury (TBI) and spinal cord injury (SCI), is a preventable condition that imposes an important burden on the Canadian society. In this study, the current evidence on risk factors for the onset and progression of neurotrauma is systematically reviewed and synthesized. Searches of the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Medline and Medline in Process (via OVID), EMBASE and PsycINFO from inception to February 2013 were conducted to identify relevant systematic reviews and meta-analyses published in English or French. Two referees screened and assessed the quality of the studies using the AMSTAR tool. Thirty-two studies examined at least one risk factor for the onset of neurotrauma. Thirteen studies passed the quality assessment and the majority evaluated the impact of protective equipment in sports. Helmets effectively reduce TBI from bicycling, skiing, snowboarding, ice hockey and motorcycling. There was no evidence of a protective effect of helmets for SCI. No studies contributed evidence on risk factors for the onset of SCI. Of two studies examining risk factors for the progression of neurotrauma, only injury severity was found to be associated with poorer post-injury outcomes. Substantial evidence supports the use of helmets for the prevention of TBI in sports and motorcycling and face shields in ice hockey. Addressing bicycle helmet legislation across Canada may be an effective option for reducing TBI caused by bicycle accidents. Limited evidence on relevant risk factors for spinal cord injuries and neurotrauma progression was available.

Determinants of neurological disease: Synthesis of systematic reviews.

Systematic reviews were conducted to identify risk factors associated with the onset and progression of 14 neurological conditions, prioritized as a component of the National Population Health Study of Neurological Conditions. These systematic reviews provided a basis for evaluating the weight of evidence of evidence for risk factors for the onset and progression of the 14 individual neurological conditions considered. A number of risk factors associated with an increased risk of onset for more than one condition, including exposure to pesticides (associated with an increased risk of AD, amyotrophic lateral sclerosis, brain tumours, and PD; smoking (AD, MS); and infection (MS, Tourette syndrome). Coffee and tea intake was associated with a decreased risk of onset of both dystonia and PD. Further understanding of the etiology of priority neurological conditions will be helpful in focusing future research initiatives and in the development of interventions to reduce the burden associated with neurological conditions in Canada and internationally.

Childhood type 1 diabetes mellitus in Newfoundland and Labrador, Canada.

The aim of this study was to calculate incidence and hospitalization rates of childhood type 1 diabetes mellitus (T1DM) in Newfoundland and Labrador, and to assess hospitalization trends and associated factors. Data for all patients aged 0-19 years with a diagnosis of T1DM was obtained from the clinical database management system (CDMS) for a 7-year period between April 1, 1995 and March 31, 2002. Incidence was calculated for the 0-7 years age group. A total of 894 T1DM hospital separations among children aged 0-19 years were identified, representing a hospitalization rate of 88.6 per 100,000 person-years (P-Y). The CDMS identified 518 incidences of hospitalization (51.2 per 100,000 P-Y). The overall hospitalization rate increased over the study period (P((2))=0.065). Hospitalization rates for males and females were 77.3 and 100.2 per 100,000 P-Y, respectively (P((2))=0.00011). Of the 894 hospitalization separations, 216 hospitalizations were for diabetic ketoacidosis (DKA) (21.4 per 100,000 P-Y). Female gender and older age were found to be predictive factors of DKA. The incidence rate of T1DM among children aged 0-7 years was 19.0 per 100,000 P-Y. Newfoundland and Labrador has one of the highest incidence rates of T1DM in the world. Hospitalization rates for DKA and non-DKA increased slightly over the study period. Age and sex patterns suggest that DKA is a particular challenge among adolescent girls. Preventive strategies are needed, particularly in areas of the province with the highest rates.

The impact of interprofessional simulation experiences in occupational and physical therapy education: a qualitative study / O impacto da experiência de simulação interprofissional na formação da terapia ocupacional e da fisioterapia: um estudo qualitativo

Abstract Interprofessional experiences are an essential part of preparing occupational and physical therapy students for clinical practice. Simulation has been used to help students achieve clinical competencies, including interprofessional competencies. The following study aimed to explore the students' perceptions of an interprofessional simulation experience, identify opportunities for the integration of interprofessional experiences across the curriculum, and document the design elements that positively influenced the outcomes of the interprofessional simulation experience. An exploratory case study design was used to examine the study aims. Focus groups were used to collect qualitative data from 85 graduate-level occupational and physical therapy students. Thematic analysis was completed on the focus group transcripts. Results from the students indicated that they perceived the interprofessional simulation experience to be beneficial to the development of affective skills and role identity. The students identified a desire for increased exposure to interprofessional education experiences throughout the curriculum. The design and implementation of the interprofessional simulation were positively received by students due to the emphasis on creating a realistic experience and despite initial student anxiety related to the experience. Interprofessional simulation is a valuable and appropriate method for engaging students in interprofessional education and developing interprofessional skills based on the results of the current study. Documenting the process of designing and implementing an interprofessional simulation may assist other programs in developing interprofessional simulation opportunities for healthcare students.

Resumo As experiências interprofissionais são uma parte essencial da preparação dos alunos de fisioterapia e terapia ocupacional para a prática clínica. A simulação tem sido usada para ajudar os alunos a alcançar competências clínicas, incluindo competências interprofissionais. O estudo teve como objetivo explorar as percepções dos alunos de uma experiência de simulação interprofissional, identificar oportunidades para a integração de experiências interprofissionais em todo o currículo e documentar o processo de concepção e implementação de uma experiência de simulação interprofissional. Grupos focais foram usados ​​para coletar dados qualitativos de 85 estudantes de graduação em fisioterapia e terapia ocupacional. A análise temática foi concluída nas transcrições dos grupos focais. Os resultados indicaram que os alunos perceberam a experiência da simulação interprofissional como benéfica para o desenvolvimento de habilidades afetivas e identidade de papel profissional. Os alunos identificaram um desejo de maior exposição às experiências de educação interprofissional ao longo do currículo. O projeto e a implementação da simulação interprofissional foram recebidos positivamente pelos alunos devido à ênfase na criação de uma experiência realista, apesar da ansiedade inicial do aluno relacionada à experiência. Conclui-se que a simulação interprofissional é um método valioso e apropriado para envolver os alunos na educação interprofissional e desenvolver habilidades interprofissionais. Documentar o processo de concepção e implementação de uma simulação interprofissional pode ajudar outros programas no desenvolvimento de oportunidades de simulação interprofissional para estudantes da área de saúde.

Diabetes and sex-specific colorectal cancer risks in Newfoundland and Labrador: a population-based retrospective cohort study.

OBJECTIVE: Studies on the relationship between diabetes and colorectal cancer (CRC) are inconsistent. It is also unclear whether CRC risk elevation for individuals with diabetes is similar for males and females. Using data from Newfoundland and Labrador (NL), the province with the highest CRC incidence and diabetes prevalence in Canada, we assessed and compared the risk elevation of CRC for males and females with diabetes, overall and by anatomic subsite. METHODS: A population-based retrospective cohort study including a study sample of 122,228 individuals aged ≥30 years was conducted using administrative health databases over a 10.5-year period (October 1, 1996 to March 31, 2007). Hazard ratios were estimated using Cox proportional hazard models. RESULTS: In comparison with non-diabetes counterparts, both males and females with diabetes were at a significantly elevated risk of overall CRC, with corresponding hazard ratios of 1.38 and 1.52, respectively. For males, diabetes significantly increased the risk of proximal and distal colon cancers, but not of rectal cancer. For females, diabetes significantly increased the risk of proximal colon and rectal cancers, but not of distal colon cancer. The results suggest that there is a stronger association between diabetes and CRC for females than for males, and the association did not change after adjusting for overweight/obesity. CONCLUSIONS: Diabetes led to a greater risk of CRC in both the male and female population in NL. Risk was subsite-specific and varied by sex. Future research should examine reasons for the observed diabetes-associated CRC risk to support CRC prevention strategies among the diabetes population.

Using administrative databases in the surveillance of depressive disorders--case definitions.

The objective of this study was to assess the usefulness of provincial administrative databases in carrying out surveillance on depressive disorders. Electronic medical records (EMRs) at 3 family practice clinics in St. John's, NL, Canada, were audited; 253 depressive disorder cases and 257 patients not diagnosed with a depressive disorder were selected. The EMR served as the "gold standard," which then was compared to these same patients investigated through the use of various case definitions applied against the provincial hospital and physician administrative databases. Variables used in the development of the case definitions were depressive disorder diagnoses (either in hospital or physician claims data), date of diagnosis, and service provider type [general practitioner (GP) vs. psychiatrist]. Of the 120 case definitions investigated, 26 were found to have a kappa statistic greater than 0.6, of which 5 case definitions were considered the most appropriate for surveillance of depressive disorders. Of the 5 definitions, the following case definition, with a 77.5% sensitivity and 93% specificity, was found to be the most valid ([ ≥1 hospitalizations OR ≥1 psychiatrist visit related to depressive disorders any time] OR ≥2 GP visits related to depressive disorders within the first 2 years of diagnosis). This study found that provincial administrative databases may be useful for carrying out surveillance on depressive disorders among the adult population. The approach used in this study was simple and resulted in rather reasonable sensitivity and specificity.

Epidemiology of severe burn among children in Newfoundland and Labrador, Canada.

PURPOSE: The objective of this study was to identify the epidemiologic characteristics of childhood burns in the province of Newfoundland and Labrador. METHODS: A population-based study was carried out on children aged 0-16 years who were hospitalized due to burns in Newfoundland and Labrador between April 1995 and March 2001. Hospital and mortality data were obtained from the provincial hospital admission database and Mortality System, respectively. The Newfoundland and Labrador population was considered as a whole and as two separate geographic areas. RESULTS: A total of 157 hospital admissions due to burns were identified during the study period. The rate of burns requiring hospitalization in the province was 22.3 per 100,000 person-years (P-Y). The rates for males and females was 27.7 and 16.6 per 100,000 P-Y, respectively (P=0.006). Infants (0-1 year) had the highest rate of burn (88.8 per 100,000 P-Y) followed by children aged 2-4 years (26.0 per 100,000 P-Y) (P<0.0001). Labrador, a region with high Aboriginal population (51.4 per 100,000 P-Y), had a higher rate of burn compared to Newfoundland (20.3 per 100,000 P-Y) (P<0.0001). Median age of patients with burns was 2 years for the island portion of the province and 9 years in Labrador (P<0.01). Overall, scald burn (52.2%) was the most frequent type of burn followed by flame (32.5%). In the island portion of the province, scald burn was the most common type of burn (56.4%), while in Labrador flame was the most frequent type (66.7%). Overall mortality rate due to burns was 0.9 per 100,000 P-Y. CONCLUSION: Age (infants) and sex (male) are factors associated with burn in Newfoundland and Labrador. Study results indicate a difference in the epidemiologic pattern of burn between the island portion of the province, Newfoundland, and mainland Labrador. It is recommended that preventive programs be directed towards high risk groups to reduce the incidence of burns.

Challenges and opportunities for using administrative data to explore changes in health status: a study of the closure of the Newfoundland cod fishery.

The closure of the cod fishery in Newfoundland and Labrador has had dramatic social and economic impacts on fishing communities in the province. Following a limited closure in 1992, a more extensive closure followed in 1994, which is still in force today, although income support provided to displaced fishery workers ended in 1999. A population-based study was conducted in 2004/2005 using 7 different sources of administrative and survey data to investigate a range of social, demographic, and health changes in fishing communities affected by the closure of the cod fishery from the period 1991 to 2001. Findings of this study extend our understanding of the impact of the fishing moratorium in Newfoundland. This article also presents both the challenges to and opportunities for using administrative and survey data to explore the impact of the fishery closure on the health and well-being of Newfoundland fishing communities. One of the most significant challenges to using administrative and survey databases was the inconsistencies in how communities were identified across the various databases. Although not without limitations, administrative data is a cost-effective means to explore the impact of socioeconomic change on a population's health status.

Suicide in Newfoundland and Labrador: a linkage study using medical examiner and vital statistics data.

OBJECTIVE: To examine suicide epidemiology in Newfoundland and Labrador from 1997 to 2001. METHOD: Data from the Office of the Chief Medical Examiner (CME) were linked with data derived from the Canadian Vital Statistics Death Database. Ninety-five percent confidence intervals (CI) were calculated to assess variation of rates. We used the chi-square test to compare categorical data. RESULTS: The CME recorded 225 suicide deaths, compared with 187 in the Canadian Vital Statistics Death Database. Most deaths not coded as suicide in the national database were coded as accidental. Using the CME data, the overall suicide rate was 9.5/100000, aged 10 years and older. The rate among males (15.8/100 000, 95% CI, 10.7 to 20.8) was almost 5 times that of females (3.3/100000; 95% CI, 1.0 to 5.5). Age-standardized rates decreased over the study period, from 10.9 to 8.0/100000; however, the difference was not significant. The proportionate mortality ratio for suicide deaths was highest among those aged 10 to 19 years (20.0%) and decreased with age. The suicide rate was highest among those aged 50 to 59 years. The rate for unpartnered individuals (17.0/100000, 95% CI, 10.7 to 23.0) was significantly higher, compared with partnered individuals (5.1/100000; 95%CI, 2.5 to 7.8). Males used more violent methods than females. Suicide was significantly higher in Labrador (27.7/100000, 95% CI, 18.4 to 37.0), an area with a higher Aboriginal population, compared with the island of Newfoundland (8.5/100000, 95% CI, 7.3 to 9.7). Psychiatric illness was the most common predisposing factor. CONCLUSIONS: Suicide deaths are highest among males, unpartnered individuals, and individuals with psychiatric disorders.