Decision-Making on New Non-Drug Health Technologies by Hospitals and Health Authorities in Canada.

INTRODUCTION: Unlike those for publicly funded drugs in Canada, coverage decision-making processes for non-drug health technologies (NDTs) are not well understood. OBJECTIVES: This paper aims to describe existing NDT decision-making processes in different healthcare organizations across Canada. METHODS: A self-administered survey was used to determine demographic and financial characteristics of organizations, followed by in-depth interviews with senior leadership of consenting organizations to understand the processes for making funding decisions on NDTs. RESULTS: Seventy-three and 48 organizations completed self-administered surveys and telephone interviews, respectively (with 45 participating in both ways). Fifty-five different processes were identified, the majority of which addressed capital equipment. Most involved multidisciplinary committees (with medical and non-medical representation), but the types of information used to inform deliberations varied. Across all processes, decision-making criteria included local considerations such as alignment with organizational priorities. CONCLUSIONS: NDT decision-making processes vary in complexity, depending on characteristics of the healthcare organization and context.

FRAMEWORK FOR USER INVOLVEMENT IN HEALTH TECHNOLOGY ASSESSMENT AT THE LOCAL LEVEL: VIEWS OF HEALTH MANAGERS, USER REPRESENTATIVES, AND CLINICIANS.

OBJECTIVES: The aim of this study was to explore stakeholders' points of views regarding the applicability and relevance of a framework for user involvement in health technology assessment (HTA) at the local level. We tested this framework in the context of the assessment of alternative measures to restraint and seclusion among hospitalized adults and those living in long-term-care facilities. METHODS: Twenty stakeholders (health managers, user representatives, and clinicians) from seven regions of Quebec participated in a semi-structured interview. A thematic analysis of the transcribed interviews was performed. RESULTS: The findings highlighted the relevance and applicability of the framework to this specific HTA. According to interviewees, direct participation of users in the HTA process allows them to be part of the decision-making process. User consultation makes it possible to consider the views of a wide variety of people, such as marginalized and vulnerable groups, who do not necessarily meet the requirements for participating in HTA committees. However, some user representatives emphasized that user consultation should be integrated into a more holistic and participatory perspective. The most frequent barrier associated with user involvement in HTA was the top-down health system, which takes little account of the user's perspective. CONCLUSIONS: The proposed framework was seen as a reference tool for making practitioners and health managers aware of the different mechanisms of user involvement in HTA and providing a structured way to classify and describe strategies. However, there is a need for more concrete instruments to guide practice and support decision making on specific strategies for user involvement in HTA at the local level.

Omega-3 long-chain polyunsaturated fatty acids for extremely preterm infants: a systematic review.

BACKGROUND AND OBJECTIVE: Omega-3 long chain polyunsaturated fatty acid (LCPUFA) exposure can be associated with reduced neonatal morbidities. We systematically review the evidence for the benefits of omega-3 LCPUFAs for reducing neonatal morbidities in extremely preterm infants. METHODS: Data sources were PubMed, Embase, Center for Reviews and Dissemination, and the Cochrane Register of Controlled Trials. Original studies were selected that included infants born at <29 weeks' gestation, those published until May 2013, and those that evaluated the relationship between omega-3 LCPUFA supplementation and major adverse neonatal outcomes. Data were extracted on study design and outcome. Effect estimates were pooled. RESULTS: Of the 1876 studies identified, 18 randomized controlled trials (RCTs) and 6 observational studies met the defined criteria. No RCT specifically targeted a population of extremely preterm infants. Based on RCTs, omega-3 LCPUFA was not associated with a decreased risk of bronchopulmonary dysplasia in infants overall (pooled risk ratio [RR] 0.97, 95% confidence interval [CI] 0.82-1.13], 12 studies, n = 2809 infants); however, when considering RCTs that include only infants born at ≤32 weeks' gestation, a trend toward a reduction in the risk of bronchopulmonary dysplasia (pooled RR 0.88, 95% CI 0.74-1.05, 7 studies, n = 1156 infants) and a reduction in the risk of necrotizing enterocolitis (pooled RR 0.50, 95% CI 0.23-1.10, 5 studies, n = 900 infants) was observed with LCPUFA. CONCLUSIONS: Large-scale interventional studies are required to determine the clinical benefits of omega-3 LCPUFA, specifically in extremely preterm infants, during the neonatal period.

Seasonal vitamin D intake in Quebec preschoolers.

As a number of seasonal factors affect cutaneous synthesis of vitamin D, especially in young children, our objective was to verify if winter and summer vitamin D intakes in Quebec preschoolers reach the adequate intake of 5 microg/day. A three-month retrospective food frequency questionnaire and a 24-hour food recall were used with parents of 98 children (mean age 56 months) in summer and of 72 of these children (mean age 65 months) in winter. To ensure completeness of data, vitamin D content of foods not covered in the Canadian Nutrient File was taken from other sources. According to the food frequency questionnaire, total vitamin D intakes were 9.7 +/- 4.3 microg/day in summer and 11.6 +/- 4.8 microg/day in winter. Only 10% of children in summer and 7% in winter had an intake below 5 microg/day. The 24-hour food recall vitamin D intake estimate was lower (summer 7.0 +/- 3.8 microg/day, winter 7.2 +/- 4.2 microg/day). This difference could be partly due to a discrepancy in the estimation of multivitamin supplement intake. However, according to both estimates, vitamin D intakes appeared generally adequate in this sample of Quebec preschoolers.

Gestational age and birth weight in relation to n-3 fatty acids among Inuit (Canada).

Seafood consumption during pregnancy carries both benefits (high n-3 FA intake) and risks (exposure to environmental contaminants) for the developing fetus. We determined the impacts of marine n-3 FA and environmental contaminants on gestational age (GA) of Nunavik women and the anthropometric characteristics of their newborns. FA and contaminant (polychlorinated biphenyls and mercury) concentrations were measured in cord plasma of Nunavik newborns (n = 454) and compared with those of a group of newborns (n = 29) from southern Québec. Data were collected from hospital records and birth certificates. In Nunavik newborns, arachidonic acid (AA) was two times lower (P < 0.0001), whereas DHA concentration, the sigman-3 / sigman-6 ratio, and the percentage of n-3 highly unsaturated FA (HUFA) (of the total HUFA) were three times higher (P < 0.0001) compared with southern Québec newborns. After controlling for confounders, GA and birth weight were higher by 5.4 d [95% confidence interval (CI): 0.7-10.1] and 77 g (95% CI: -64 to 217) in the third tertile of percentage of n-3 HUFA (of the total HUFA) as compared with the first tertile. There was no evidence that contaminants had negative effects on GA or birth weight. In this seafood-eating population, an increase in the proportion of n-3 HUFA (of the total HUFA), measured in umbilical cord plasma phospholipids, was associated with a significantly longer GA.

Vitamin A concentration in umbilical cord blood of infants from three separate regions of the province of Québec (Canada).

BACKGROUND: Inuit women from Northern Québec have been shown to consume inadequate quantities of vitamin A. This study was conducted to evaluate the prevalence of blood vitamin A deficiency in newborns from 3 distinct populations of the province of Québec. METHODS: 594 newborns were included in this study (375 Inuit newborns from northern Québec (Nunavik), 107 Caucasian and Native newborns from the Lower Northern Shore of the Saint-Lawrence River (LNS) and 112 newborns from Southern Québec where clinical vitamin A deficiency is uncommon). Mothers were recruited at delivery and vitamin A (retinol) was analyzed from umbilical cord blood samples by reversed-phase high-pressure liquid chromatography. RESULTS: Nunavik and LNS newborns had significantly lower mean vitamin A concentrations in cord blood compared to Southern Québec participants (15.7 microg/dL, 16.8 microg/dL and 20.4 microg/dL respectively). The differences observed were similar when adjusted for sex and birthweight. Results also showed that 8.5% of Nunavik newborns and 12.2% of LNS newborns were below 10.0 microg/dL, a level thought to be indicative of blood vitamin A deficiency in neonates. CONCLUSION: These data suggest that a carefully planned vitamin A supplementation program during pregnancy in Nunavik and LNS might be indicated to promote healthy infant development.

Incidence, symptoms, and intensity of damage by three coffee stem borers (Coleoptera: Cerambycidae) in South Yunan, China.

Sampling studies were conducted in coffee plantations in South Yunan to assess the incidence, symptoms, and intensity of damage by three stem borers: Xylotrechus quadripes (Chevrolat), Acalolepta cervina (Hope), and Bacchisa sp. near pallidiventris (Thomson). Of 5,690 plants sampled in eight plantations, 440 were infested with A. cervina, 63 with X. quadripes, and three with B. pallidiventris. Plants 5-7 yr old were 10 times more heavily infested with X. quadripes than 3- to 4-yr-old plants, whereas both age groups of plants had similar levels of infestation with A. cervina. Larval galleries of the three borer species markedly differ: A. cervina and B. pallidiventris larvae develop in subcortical galleries in the main stem (A. cervina) and lateral branches (B. pallidiventris), whereas larval galleries of X. quadripes intermittently punctuate and transverse the xylem of main stems or lateral branches. Significantly more plant tissue was damaged in stems infested with X. quadripes than in those infested with A. cervina or B. pallidiventris. Stems infested with A. cervina or B. pallidiventris generally had only one or a few pupation chambers, whereas stems infested with X. quadripes contained numerous chambers. Quantitative and qualitative data collected through this study provide farmers with diagnostic tools to determine which borer species infested coffee plants. Comparison of life history traits and intensity of damage for the three borer species indicates that X. quadripes is the most severe pest of coffee in Yunan, and suggests that populations of X. quadripes have the greatest potential to steadily increase with time.