Creating Clinical Cohorts: Challenges Encountered in Two Canadian Provinces.

In 2013, the Living with HIV (LHIV) Innovation team established clinical cohorts of people living with HIV in Manitoba and Newfoundland and Labrador, and they linked the data to provincial health administrative databases. Access to these data enabled researchers to conduct studies across provincial borders; contribute to a national dialogue on HIV health system performance; and give recommendations for evidence-based healthcare, health policy and public health. However, research funding is episodic; maintaining cohorts requires stable funding. We support the establishment of a cross-jurisdictional approach to facilitate streamlined data collection and linkage without interruption and to allow for meaningful analysis in order to inform national policies.

Health and health service use of very elderly Newfoundlanders.

OBJECTIVE: To develop a better understanding of the current health status and health care use of the population of very elderly Newfoundlanders to inform policy makers, decision makers, and health care providers about aspects of the health care system that might be in higher demand in the near future. DESIGN: Descriptive analysis using data from the Newfoundland and Labrador component of the Canadian Primary Care Sentinel Surveillance Network database for the 2013 calendar year. SETTING: Newfoundland. PARTICIPANTS: A total of 1204 Newfoundlanders aged 80 years and older. MAIN OUTCOME MEASURES: Encounters with family physicians, medications used, hospitalizations, emergency department (ED) visits, laboratory tests, and mortality were described and compared by sex, age, and location (rural vs urban). RESULTS: Compared with men, women were prescribed more medications (P = .01), were less likely to be hospitalized (P = .007), were more likely to visit an ED (P = .049), and died less frequently (P = .001). Compared with those aged 90 and older, those aged 80 to 89 made more visits to their family doctors (P = .001) and were prescribed more medications (P = .001). Predictably, those aged 90 and older died more frequently than their younger counterparts did (P = .001). Compared with those in rural communities, urban dwellers were prescribed more medications (P = .031), were hospitalized more often (P = .001), were more likely to visit the ED (P = .002), were more likely to have laboratory tests ordered (P = .001), died more frequently (P = .023), and visited their family physicians more frequently (P = .001). CONCLUSION: Octogenarian women living in urban areas are the subcohort using the most resources. This might be owing to movement of the elderly to urban locations as they age.

Challenges with access to healthcare from the perspective of patients living with HIV: a scoping review & framework synthesis.

Accessing healthcare can be difficult but the barriers multiply for people living with HIV (PLHIV). To improve access and the health of PLHIV, we must consider their perspectives and use them to inform standard practice. A better understanding of the current literature related to healthcare access from the perspective of PLHIV, can help to identify evidence gaps and highlight research priorities and opportunities. To identify relevant peer-reviewed publications, search strategies were employed. Electronic and grey literature databases were explored. Articles were screened based on their title and abstract and those that met the screening criteria, were reviewed in full. Data analysis was conducted using a collaborative approach that included knowledge user consultation. Initial concepts were extracted, summarized and through framework synthesis, developed into emerging and final themes. From 20,678 articles, 326 articles met the initial screening criteria and 64 were reviewed in full. The final themes identified, in order of most to least frequent were: Acceptability, Availability, Accessibility, Affordability, Other Barriers, Communication, Satisfaction, Accommodation, Preferences and Equity in Access. The most frequently discussed concepts related to negative interactions with staff, followed by long wait times, limited household resources or inability to pay fees, and fear of one's serostatus being disclosed. Knowledge users were in agreement with the categorization of initial concepts and final themes; however, some gaps in the literature were identified. Specific changes are critical to improving access to healthcare for PLHIV. These include improving availability by ensuring staff and healthcare professionals have proper training, cultivating acceptability and reducing stigma through improving HIV awareness, increasing accessibility through increased HIV information for PLHIV and improved dissemination of this information to increase patient knowledge and health awareness. Finally, ensuring proper protocols are implemented and followed to guarantee patient confidentiality and overall satisfaction with healthcare services are recommended.

Spatial analysis of Leptospira infection in muskrats in Lower Saxony, Germany, and the association with human leptospirosis.

Leptospirosis has been reported as an emerging zoonosis and the most widespread zoonotic disease in the world. Muskrats (Ondatra zibethicus) have been known to carry Leptospira serovars, which have been linked to Weil's disease - a serious and life threatening disease in humans. In this study, muskrats were sampled across 43 regions of Lower Saxony, Germany, during 2007 to 2009 and were tested for leptospirosis using Polymerase Chain Reaction (PCR). Circular and flexibly shaped spatial scan tests were applied and detected two leptospirosis clusters in Lower Saxony, Germany. Several predictor variables were investigated using spatial Poisson rate regression analysis; however, only maximum regional temperature was associated with the incidence rate of leptospirosis in muskrats. For every 5°C increase in temperature, the incidence rate of leptospirosis in muskrats decreased 0.97 times. The association between the smoothed muskrat leptospirosis prevalence and the rate of human leptospirosis was also investigated using a Poisson rate regression model and revealed no relationship. Although no relationship was found at the level investigated in this study, recent human leptospirosis outbreaks have been linked to muskrats, so muskrats as a risk factor for human leptospirosis should not be ruled out. Overall, leptospirosis clusters were found within the muskrat population in Lower Saxony, Germany and temperature was confirmed as a risk factor.