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1.
Bone Joint J ; 103-B(2): 271-278, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33517719

RESUMEN

AIMS: Echocardiography is commonly used in hip fracture patients to evaluate perioperative cardiac risk. However, echocardiography that delays surgical repair may be harmful. The objective of this study was to compare surgical wait times, mortality, length of stay (LOS), and healthcare costs for similar hip fracture patients evaluated with and without preoperative echocardiograms. METHODS: A population-based, matched cohort study of all hip fracture patients (aged over 45 years) in Ontario, Canada between 2009 and 2014 was conducted. The primary exposure was preoperative echocardiography (occurring between hospital admission and surgery). Mortality rates, surgical wait times, postoperative LOS, and medical costs (expressed as 2013$ CAN) up to one year postoperatively were assessed after propensity-score matching. RESULTS: A total of 2,354 of 42,230 (5.6%) eligible hip fracture patients received a preoperative echocardiogram during the study period. Echocardiography ordering practices varied among hospitals, ranging from 0% to 23.0% of hip fracture patients at different hospital sites. After successfully matching 2,298 (97.6%) patients, echocardiography was associated with significantly increased risks of mortality at 90 days (20.1% vs 16.8%; p = 0.004) and one year (32.9% vs 27.8%; p < 0.001), but not at 30 days (11.4% vs 9.8%; p = 0.084). Patients with echocardiography also had a mean increased delay from presentation to surgery (68.80 hours (SD 44.23) vs 39.69 hours (SD 27.09); p < 0.001), total LOS (19.49 days (SD 25.39) vs 15.94 days (SD 22.48); p < 0.001), and total healthcare costs at one year ($51,714.69 (SD 54,675.28) vs $41,861.47 (SD 50,854.12); p < 0.001). CONCLUSION: Preoperative echocardiography for hip fracture patients is associated with increased postoperative mortality at 90 days and one year but not at 30 days. Preoperative echocardiography is also associated with increased surgical delay, postoperative LOS, and total healthcare costs at one year. Echocardiography should be considered an urgent test when ordered to prevent additional surgical delay. Cite this article: Bone Joint J 2021;103-B(2):271-278.


Asunto(s)
Ecocardiografía , Fijación de Fractura , Cardiopatías/diagnóstico por imagen , Fracturas de Cadera/cirugía , Cuidados Preoperatorios/métodos , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Ecocardiografía/economía , Femenino , Estudios de Seguimiento , Fijación de Fractura/economía , Cardiopatías/complicaciones , Fracturas de Cadera/complicaciones , Fracturas de Cadera/economía , Fracturas de Cadera/mortalidad , Costos de Hospital/estadística & datos numéricos , Humanos , Tiempo de Internación/economía , Modelos Logísticos , Masculino , Persona de Mediana Edad , Ontario , Cuidados Preoperatorios/economía , Puntaje de Propensión , Medición de Riesgo , Tiempo de Tratamiento
2.
BMC Med ; 19(1): 20, 2021 02 05.
Artículo en Inglés | MEDLINE | ID: mdl-33541357

RESUMEN

BACKGROUND: There is little information on care-seeking patterns for sexual assault and domestic violence during the COVID-19 pandemic. The objective of this study was to examine the changes in emergency department (ED) admissions for sexual assault and domestic violence since the COVID-19 pandemic was declared. METHODS: Observational ED admissions data from The Ottawa Hospital were analyzed from March 4 to May 5 (62 days) in 2020 (COVID-19 period) and compared to the same period in 2018 (pre-COVID-19). Total and mean weekly admissions were calculated for all-cause ED admissions and for sexual and domestic violence cases. A Poisson regression (without offset term) was used to calculate the weekly case count ratio and 95% confidence intervals (CI) between the two time periods. Case characteristics were compared using chi-square tests, and percent differences were calculated. RESULTS: Compared to pre-COVID-19, total ED admissions dropped by 1111.22 cases per week (32.9% reduction), and the Sexual Assault and Domestic Violence Program cases dropped 4.66 cases per week. The weekly case count ratio for sexual assault cases was 0.47 (95% CI 0.79-0.27), equivalent of 53.49% reduction in cases, and 0.52 (95% CI 0.93-0.29), equivalent to a 48.45% reduction in physical assault cases. The characteristics of presenting cases were similar by age (median 25 years), sex (88.57% female), assault type (57.14% sexual assault, 48.57% physical assault), and location (31.43% patient's home, 40.00% assailant's home). There was a significant increase in psychological abuse (11.69% vs 28.57%) and assaults occurring outdoors (5.19% vs 22.86%). CONCLUSION: This study found a decrease in ED admissions for sexual assault and domestic violence during COVID-19, despite societal conditions that elevate risk of violence. Trends in care-seeking and assault patterns will require ongoing monitoring to inform the provision of optimal support for individuals experiencing violence, particularly as countries begin to re-open or lock-down again.


Asunto(s)
/epidemiología , Violencia Doméstica/tendencias , Servicio de Urgencia en Hospital/tendencias , Pandemias , Aceptación de la Atención de Salud , Delitos Sexuales/tendencias , Adulto , Control de Enfermedades Transmisibles/tendencias , Violencia Doméstica/psicología , Femenino , Humanos , Masculino , Ontario/epidemiología , Aceptación de la Atención de Salud/psicología , Delitos Sexuales/psicología , Adulto Joven
3.
Equine Vet J ; 53(2): 331-338, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33566387

RESUMEN

BACKGROUND: Recently, the blacklegged tick (Ixodes scapularis), which is the vector of Borrelia burgdorferi, has undergone a range expansion from the northeastern and mid-west United States to areas of southeastern Canada, including parts of Ontario. Understanding the seroprevalence of antibodies against B. burgdorferi in horses and risk factors for exposure is important for monitoring and preventing this emerging disease. STUDY DESIGN: Cross-sectional study of 551 horses in southern, central, and eastern Ontario, Canada. OBJECTIVES: To assess the seroprevalence of B. burgdorferi in horses in Ontario, Canada; to evaluate risk factors associated with seropositivity; and, to compare the performance of two diagnostic tests. METHODS: Serum samples were obtained from clinically healthy horses in Ontario, Canada, along with completed questionnaires that were used for the risk factor analysis. Sera were tested with a Multiplex ELISA (Animal Health Diagnostic Center, Cornell University) and C6 ELISA (IDEXX SNAP® 4Dx® Plus test, IDEXX Laboratories). RESULTS: The seroprevalence of B. burgdorferi on at least one test was 17% (91/551), though only 15 (16%) horses tested positive with both tests. A spatial cluster of cases was detected in Eastern Ontario. The odds of being seropositive for B. burgdorferi on the C6 ELISA were significantly increased when oak trees were present by pastures (OR = 7.3 (1.8-29.2), P = .005), while the odds were significantly decreased when regular tick checks were performed (OR = 0.1 (0.01-0.7), P = 0.02). MAIN LIMITATIONS: Recruitment focused on known areas with blacklegged ticks as well as areas of higher horse density, which may have led to selection bias. CONCLUSIONS: The expansion of blacklegged tick populations poses an ongoing risk for horses. Assessment of diagnostic testing options and risk factors is important for diagnosis and prevention, and with further investigation this information may be used to propose changes in management.


Asunto(s)
Anaplasma phagocytophilum , Borrelia burgdorferi , Enfermedades de los Caballos , Enfermedad de Lyme , Animales , Estudios Transversales , Enfermedades de los Caballos/epidemiología , Caballos , Enfermedad de Lyme/epidemiología , Enfermedad de Lyme/veterinaria , Ontario/epidemiología , Factores de Riesgo , Estudios Seroepidemiológicos
4.
BMC Fam Pract ; 22(1): 31, 2021 02 03.
Artículo en Inglés | MEDLINE | ID: mdl-33535973

RESUMEN

BACKGROUND: Interprofessional primary care (IPC) teams provide comprehensive and coordinated care and are ideally equipped to support those populations most at risk of adverse health outcomes during the COVID-19 pandemic, including older adults, and patients with chronic physical and mental health conditions. There has been little focus on the experiences of healthcare teams and no studies have examined IPC practice during the early phase of the COVID-19 pandemic. The objective of the study was to describe the state of interprofessional health provider practice within IPC teams during the COVID-19 pandemic. METHODS: Observational cross-sectional design. A web-based survey was deployed to IPC providers working in team-based primary care clinics in the province of Ontario, Canada. The survey included 26 close-ended and six open-ended questions. Close-ended questions were analyzed using descriptive statistics. Content analysis was used to analyze the open-ended questions. RESULTS: 445 surveys were included in the final analysis. Service delivery shifted from in-person care (77% pre-COVID-19) to telephone (76.5% during the COVID-19 pandemic). Less than half of the respondents (40%) reported receiving any training for virtual delivery. Wait times to access team members were reported to have decreased. There has also been a shift in what IPC providers report as the most commonly seen conditions, with increases in visits related to mental health concerns, acute infections (including COVID-19), social isolation, and resource navigation. Respondents also reported a reduction in healthcare provision for multiple chronic conditions including diabetes, cardiovascular disease, and chronic pain. CONCLUSIONS: IPC teams are rapidly shifting their practice to supporting their patients during the pandemic. A surge in mental health issues has been seen and is expected to continue to increase in response to COVID-19. Understanding early experiences can help plan for future pandemic waves.


Asunto(s)
/epidemiología , Relaciones Interprofesionales , Atención Primaria de Salud/métodos , Estudios Transversales , Humanos , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Ontario/epidemiología , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Encuestas y Cuestionarios
5.
CMAJ ; 193(6): E200-E210, 2021 02 08.
Artículo en Inglés | MEDLINE | ID: mdl-33558406

RESUMEN

BACKGROUND: Globally, primary care changed dramatically as a result of the coronavirus disease 2019 (COVID-19) pandemic. We aimed to understand the degree to which office and virtual primary care changed, and for which patients and physicians, during the initial months of the pandemic in Ontario, Canada. METHODS: This population-based study compared comprehensive, linked primary care physician billing data from Jan. 1 to July 28, 2020, with the same period in 2019. We identified Ontario residents with at least 1 office or virtual (telephone or video) visit during the study period. We compared trends in total physician visits, office visits and virtual visits before COVID-19 with trends after pandemic-related public health measures changed the delivery of care, according to various patient and physician characteristics. We used interrupted time series analysis to compare trends in the early and later halves of the COVID-19 period. RESULTS: Compared with 2019, total primary care visits between March and July 2020 decreased by 28.0%, from 7.66 to 5.51 per 1000 people/day. The smallest declines were among patients with the highest expected health care use (8.3%), those who could not be attributed to a primary care physician (10.2%), and older adults (19.1%). In contrast, total visits in rural areas increased by 6.4%. Office visits declined by 79.1% and virtual care increased 56-fold, comprising 71.1% of primary care physician visits. The lowest uptake of virtual care was among children (57.6%), rural residents (60.6%) and physicians with panels of ≥ 2500 patients (66.0%). INTERPRETATION: Primary care in Ontario saw large shifts from office to virtual care over the first 4 months of the COVID-19 pandemic. Total visits declined least among those with higher health care needs. The determinants and consequences of these major shifts in care require further study.


Asunto(s)
Visita a Consultorio Médico/estadística & datos numéricos , Atención Primaria de Salud/métodos , Atención Primaria de Salud/estadística & datos numéricos , Consulta Remota/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Pandemias , Atención Primaria de Salud/tendencias , Estudios Retrospectivos , Adulto Joven
6.
BMC Public Health ; 21(1): 125, 2021 01 12.
Artículo en Inglés | MEDLINE | ID: mdl-33430832

RESUMEN

BACKGROUND: School testing for SARS-CoV-2 infection has become an important policy and planning issue as schools were reopened after the summer season and as the COVID-19 pandemic continues. Decisions to test or not to test and, if testing, how many tests, how often and for how long, are complex decisions that need to be taken under uncertainty and conflicting pressures from various stakeholders. METHOD: We have developed an agent-based model and simulation tool that can be used to analyze the outcomes and effectiveness of different testing strategies and scenarios in schools with various number of classrooms and class sizes. We have applied a modified version of a standard SEIR disease transmission model that includes symptomatic and asymptomatic infectious populations, and that incorporates feasible public health measures. We also incorporated a pre-symptomatic phase for symptomatic cases. Every day, a random number of students in each class are tested. If they tested positive, they are placed in self-isolation at home when the test results are provided. Last but not least, we have included options to allow for full testing or complete self-isolation of a classroom with a positive case. RESULTS: We present sample simulation results for parameter values based on schools and disease related information, in the Province of Ontario, Canada. The findings show that testing can be an effective method in controlling the SARS-CoV-2 infection in schools if taken frequently, with expedited test results and self-isolation of infected students at home. CONCLUSIONS: Our findings show that while testing cannot eliminate the risk and has its own challenges, it can significantly control outbreaks when combined with other measures, such as masks and other protective measures.


Asunto(s)
/prevención & control , Brotes de Enfermedades/prevención & control , Políticas , Instituciones Académicas , /epidemiología , Simulación por Computador , Humanos , Ontario/epidemiología
7.
J Am Med Dir Assoc ; 22(2): 253-255.e1, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33406385

RESUMEN

Long-term care facilities (LTCFs), retirement homes (RHs), and other congregate care settings in Canada and worldwide have experienced significant COVID-19 outbreaks. As a health system response, our acute care hospital in Toronto, Ontario, Canada, developed and mobilized an onsite Infection Prevention and Control (IPAC) SWAT team (IPAC-SWAT) to regional settings on outbreak and implemented a strategy of support through education, training, and engagement. Between April 28, 2020, and June 30, 2020, IPAC-SWAT assessed 7 LTCFs and 10 RHs for IPAC preparedness and actively managed 10 of 13 COVID-19 outbreaks (LTCF n=5; RH n=5). IPAC-SWAT strategies were multi-interventional and intended to mitigate further viral transmission or prevent outbreaks. Dedicated training of local "IPAC champions" was facilitated at 7 sites (LTCF = 5; RH = 2) using a "train-the-trainer" approach to promote local knowledge, autonomy, and site-led audits and feedback.


Asunto(s)
/epidemiología , Hogares para Ancianos/organización & administración , Control de Infecciones/organización & administración , Cuidados a Largo Plazo/organización & administración , Innovación Organizacional , Neumonía Viral/virología , Anciano , Femenino , Humanos , Masculino , Ontario/epidemiología , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control
8.
BMC Health Serv Res ; 21(1): 89, 2021 Jan 26.
Artículo en Inglés | MEDLINE | ID: mdl-33499869

RESUMEN

BACKGROUND: The indication for prescribing a particular medication, or its reason for use (RFU) is a crucial piece of information for all those involved in the circle of care. Research has shown that sharing RFU information with physicians, pharmacists and patients improves patient safety and patient adherence, however RFU is rarely added on prescriptions by prescribers or on medication labels for patients to reference. METHODS: Qualitative interviews were conducted with 20 prescribers in Southern Ontario, Canada, to learn prescribers' current attitudes on the addition of RFU on prescriptions and medication labels. A trained interviewer used a semi-structured interview guide for each interview. The interviews explored how the sharing of RFU information would impact prescribers' workflows and practices. Interviews were recorded, transcribed and thematically coded. RESULTS: The analysis yielded four main themes: Current Practice, Future Practice, Changing Culture, and Collaboration. Most of the prescribers interviewed do not currently add RFU to prescriptions. Prescribers were open to sharing RFU with colleagues via a regional database but wanted the ability to provide context for the prescribed medication within the system. Many prescribers were wary of the impact of adding RFU on their workflow but felt it could save time by avoiding clarifying questions from pharmacists. Increased interprofessional collaboration, increased patient understanding of prescribed medications, avoiding guesswork when determining indications and decreased misinterpretation regarding RFU were cited by most prescribers as benefits to including RFU information. CONCLUSIONS: Prescribers were generally open to sharing RFU and clearly identified the benefits to pharmacists and patients if added. Critically, they also identified benefits to their own practices. These results can be used to guide the implementation of future initiatives to promote the sharing of RFU in healthcare teams.


Asunto(s)
Etiquetado de Medicamentos , Prescripciones de Medicamentos , Humanos , Ontario , Grupo de Atención al Paciente , Seguridad del Paciente , Medicamentos bajo Prescripción
9.
Curr Oncol ; 28(1): 278-282, 2021 01 06.
Artículo en Inglés | MEDLINE | ID: mdl-33419159

RESUMEN

Patients with cancer are more vulnerable to severe COVID-19. As a result, routine SARS-CoV-2 testing of asymptomatic patients with cancer is recommended prior to treatment. However, there is limited evidence of its clinical usefulness. The objective of this study is to evaluate the value of routine testing of asymptomatic patients with cancer. Asymptomatic patients with cancer attending Odette Cancer Centre (Toronto, ON, Canada) were tested for SARS-CoV-2 prior to and during treatment cycles. Results were compared to positivity rates of SARS-CoV-2 locally and provincially. All 890 asymptomatic patients tested negative. Positivity rates in the province were 1.5%, in hospital were 1.0%, and among OCC's symptomatic cancer patients were 0% over the study period. Given our findings and the low SARS-CoV-2 community positivity rates, we recommend a dynamic testing model of asymptomatic patients that triggers testing during increasing community positivity rates of SARS-CoV-2.


Asunto(s)
Infecciones Asintomáticas , Neoplasias/virología , Adulto , Anciano , Anciano de 80 o más Años , Instituciones Oncológicas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/tratamiento farmacológico , Ontario
10.
J Oral Maxillofac Surg ; 79(1): 18-35, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33386084

RESUMEN

PURPOSE: To investigate and compare the general public's, general dentists', and primary care physicians' level of knowledge of the scope of practice of oral and maxillofacial surgeons (OMSs). We hypothesized that there is a generalized lack of knowledge of the scope of practice of oral-maxillofacial surgery, with the general public being the least informed and the general dentists the most educated. METHODS: A cross-sectional survey study was conducted via a mail-out survey that was delivered to a random sample of the general public, general dentists, and primary care physicians in Ontario, Canada. A total of 1800 participants were selected. The survey consisted of a demographic screener along with 24 clinical scenarios in which the participants could select all the specialists they thought were capable of completing the treatment. Inferential statistics were computed using a chi-square test to compare responses between the groups and identified any significant differences between subjects for each of the 24 scenarios with P value set at 0.05. RESULTS: Total response rate of 50.1% (n = 902) was achieved. The majority of health professionals (100% dentists, 95.5% primary care physicians) have heard of oral-maxillofacial surgery, in contrast to only 73.7% of the general public (P < .001). There was a general lack of awareness of oral-maxillofacial surgery scope of practice by all groups wherein OMSs were selected less than 50% of the time in 10 (general dentists), 14 (primary care physicians), and 16 (general public) of 24 clinical scenarios. CONCLUSION: Greater than 25% of the general public are unaware of OMS. More concerning, the general public and health professionals as a whole are unfamiliar with the full scope of practice of OMSs. For enhancing access to care by qualified specialists, educational programs highlighting key aspects of oral-maxillofacial surgery should be developed and distributed to all populations.


Asunto(s)
Cirujanos Oromaxilofaciales , Cirugía Bucal , Actitud del Personal de Salud , Estudios Transversales , Humanos , Ontario , Percepción , Alcance de la Práctica , Encuestas y Cuestionarios
11.
Health Policy ; 125(2): 135-140, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33390280

RESUMEN

During the COVID-19 pandemic, in some jurisdictions, police have become involved in enforcing coronavirus-related measures. Relatedly, several North American jurisdictions have established COVID-19 data sharing protocols with law enforcement. Research across a range of fields has demonstrated that involving police in matters of public health disproportionately impacts the most vulnerable and does more harm than good. This is reflected in the consensus against COVID-19 criminalization that has emerged among civil society organizations focused on HIV, human rights, and harm reduction. The European Data Protection Board has also released guidelines against re-uses of COVID-19 data for law enforcement purposes. This article offers an overview of the harms of criminalizing illnesses and strategies for health stakeholders to seek alternatives to sharing COVID-19 data with police agencies while facilitating interoperability with healthcare first responders. It also presents case studies from two North American jurisdictions - Ontario and Minnesota - that have established routine COVID-19 data sharing with police. We recommended seven alternatives, including designating COVID-19 data as sensitive and implementing segmented interoperability with first responder agencies. These guidelines can help ensure that health information technology platforms do not become vehicles for the criminalization of COVID-19, and that health data stay within the health system.


Asunto(s)
/epidemiología , Derechos Humanos , Difusión de la Información , Aplicación de la Ley , Participación de los Interesados , Socorristas , Humanos , Minnesota/epidemiología , Ontario/epidemiología , Estudios de Casos Organizacionales , Salud Pública
12.
CMAJ Open ; 9(1): E1-E9, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33436450

RESUMEN

BACKGROUND: People with a recent history of homelessness are believed to be at high risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and, when infected, complications of coronavirus disease 2019 (COVID-19). We describe and compare testing for SARS-CoV-2, test positivity and hospital admission, receipt of intensive care and mortality rates related to COVID-19 for people with a recent history of homelessness versus community-dwelling people as of July 31, 2020. METHODS: We conducted a population-based retrospective cohort study in Ontario, Canada, between Jan. 23 and July 31, 2020, using linked health administrative data among people who either had a recent history of homelessness or were dwelling in the community. People were included if they were eligible for provincial health care coverage and not living in an institutionalized facility on Jan. 23, 2020. We examined testing for SARS-CoV-2, test positivity and complication outcomes of COVID-19 (hospital admission, admission to intensive care and death) within 21 days of a positive test result. Extended multivariable Cox proportional hazard models were used to estimate adjusted hazard ratios (HRs) in 3 time periods: preshutdown (Jan. 23-Mar. 13), peak (Mar. 14-June 16) and reopening (June 17-July 31). RESULTS: People with a recent history of homelessness (n = 29 407) were more likely to be tested for SARS-CoV-2 in all 3 periods compared with community-dwelling people (n = 14 494 301) (preshutdown adjusted HR 1.61, 95% confidence interval [CI] 1.22-2.11; peak adjusted HR 2.95, 95% CI 2.88-3.03; reopening adjusted HR 1.45, 95% CI 1.39-1.51). They were also more likely to have a positive test result (peak adjusted HR 3.66, 95% CI 3.22-4.16; reopening adjusted HR 1.76, 95% CI 1.15-2.71). In the peak period, people with a recent history of homelessness were over 20 times more likely to be admitted to hospital for COVID-19 (adjusted HR 20.35, 95% CI 16.23-25.53), over 10 times more likely to require intensive care for COVID-19 (adjusted HR 10.20, 95% CI 5.81-17.93) and over 5 times more likely to die within 21 days of their first positive test result (adjusted HR 5.73, 95% CI 3.01-10.91). INTERPRETATION: In Ontario, people with a recent history of homelessness were significantly more likely to be tested for SARS-CoV-2, to have a positive test result, to be admitted to hospital for COVID-19, to receive intensive care for COVID-19 and to die of COVID-19 compared with community-dwelling people. People with a recent history of homelessness should continue to be considered particularly vulnerable to SARS-CoV-2 infection and its complications.


Asunto(s)
Cuidados Críticos , Personas sin Hogar/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Vida Independiente/estadística & datos numéricos , /aislamiento & purificación , /diagnóstico , /prevención & control , /estadística & datos numéricos , Cuidados Críticos/métodos , Cuidados Críticos/estadística & datos numéricos , Femenino , Humanos , Masculino , Mortalidad , Ontario/epidemiología , Medición de Riesgo , Índice de Severidad de la Enfermedad , Poblaciones Vulnerables
13.
Viruses ; 13(1)2021 Jan 18.
Artículo en Inglés | MEDLINE | ID: mdl-33477649

RESUMEN

BACKGROUND: Co-infections of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with respiratory viruses, bacteria and fungi have been reported to cause a wide range of illness. OBJECTIVES: We assess the prevalence of co-infection of SARS-CoV-2 with seasonal respiratory viruses, document the respiratory viruses detected among individuals tested for SARS-CoV-2, and describe characteristics of individuals with respiratory virus co-infection detected. METHODS: Specimens included in this study were submitted as part of routine clinical testing to Public Health Ontario Laboratory from individuals requiring testing for SARS-CoV-2 and/or seasonal respiratory viruses. RESULTS: Co-infection was detected in a smaller proportion (2.5%) of individuals with laboratory confirmed SARS-CoV-2 than those with seasonal respiratory viruses (4.3%); this difference was not significant. Individuals with any respiratory virus co-infection were more likely to be younger than 65 years of age and male than those with single infection. Those with SARS-CoV-2 co-infection manifested mostly mild respiratory symptoms. CONCLUSIONS: Findings of this study may not support routine testing for seasonal respiratory viruses among all individuals tested for SARS-CoV-2, as they were rare during the study period nor associated with severe disease. However, testing for seasonal respiratory viruses should be performed in severely ill individuals, in which detection of other viruses may assist with patient management.


Asunto(s)
/epidemiología , Coinfección/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Canadá/epidemiología , Niño , Preescolar , Coinfección/virología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Prevalencia , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/virología , Adulto Joven
14.
Medicine (Baltimore) ; 100(1): e24138, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33429788

RESUMEN

ABSTRACT: Although the importance of quadriceps femoris function was reported previously, little is known about volume-related factors and their effects on clinical outcomes after total knee arthroplasty (TKA). We sought to determine whether there was a bilateral difference in vastus medialis muscle volume measured on single-photon emission computed tomography-computed tomography (SPECT-CT) in patients who underwent unilateral TKA. We also aimed to determine whether vastus medialis volume was related to osteoarthritis (OA) severity or scintigraphic uptake degree around the knee joint on SPECT-CT. And finally, we attempted to investigate the factors, such as vastus medialis volume and scintigraphic uptake degree, associated with the functional outcomes of TKA.This retrospective study included 50 patients (41 female, 9 male) undergone unilateral TKA due to primary OA. The maximal cross-sectional area of the vastus medialis was measured on axial SPECT-CT images. Scintigraphic uptake degrees and Kellgren-Lawrence (K-L) grade at the tibiofemoral joints were assessed. We compared maximal cross-sectional area of the vastus medialis on SPECT-CT for difference of bilateral lower limbs. We also analyzed the relationship between volume of vastus medialis and scintigraphic uptake measured on SPECT-CT and the severity of OA on conventional radiographs. The clinical outcomes were evaluated using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index at baseline and at 1 and 2 years after surgery. The relationship between preoperative muscle volume and scintigraphic uptake on SPECT-CT and WOMAC index was analyzed.The amount of muscle volume measured on SPECT-CT was smaller in operated limb in patients who underwent unilateral TKA. Preoperative vastus medialis muscle volume was not related to preoperative OA severity measured on conventional radiographs and scintigraphic uptake on SPECT-CT. However, a decreased vastus medialis muscle volume was related to worse clinical outcomes after TKA (P = .045), whereas the degree of scintigraphic uptake on SPECT-CT was not associated with postoperative clinical outcomes.Muscle volume of vastus medialis was decreased in the operated knee than in the nonoperated knee, and that was correlated with worse postoperative results. Even if the preoperative volume of vastus medialis were not related to OA severity on conventional radiographs and scintigraphic uptake on SPECT-CT, preservation and improvement of the muscle mass of the knee undergoing TKA is important.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Músculo Cuádriceps/diagnóstico por imagen , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único/estadística & datos numéricos , Anciano , Artroplastia de Reemplazo de Rodilla/métodos , Femenino , Humanos , Rodilla/cirugía , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único/métodos , Pesos y Medidas/instrumentación
15.
J Med Internet Res ; 23(1): e26165, 2021 01 22.
Artículo en Inglés | MEDLINE | ID: mdl-33444153

RESUMEN

BACKGROUND: To minimize the spread and risk of a COVID-19 outbreak, societal norms have been challenged with respect to how essential services are delivered. With pressures to reduce the number of in-person ambulatory visits, innovative models of telemonitoring have been used during the pandemic as a necessary alternative to support access to care for patients with chronic conditions. The pandemic has led health care organizations to consider the adoption of telemonitoring interventions for the first time, while others have seen existing programs rapidly expand. OBJECTIVE: At the Toronto General Hospital in Ontario, Canada, the rapid expansion of a telemonitoring program began on March 9, 2020, in response to COVID-19. The objective of this study was to understand the experiences related to the expanded role of a telemonitoring program under the changing conditions of the pandemic. METHODS: A single-case qualitative study was conducted with 3 embedded units of analysis. Semistructured interviews probed the experiences of patients, clinicians, and program staff from the Medly telemonitoring program at a heart function clinic in Toronto, Canada. Data were analyzed using inductive thematic analysis as well as Eakin and Gladstone's value-adding approach to enhance the analytic interpretation of the study findings. RESULTS: A total of 29 participants were interviewed, including patients (n=16), clinicians (n=9), and operational staff (n=4). Four themes were identified: (1) providing care continuity through telemonitoring; (2) adapting telemonitoring operations for a more virtual health care system; (3) confronting virtual workflow challenges; and (4) fostering a meaningful patient-provider relationship. Beyond supporting virtual visits, the program's ability to provide a more comprehensive picture of the patient's health was valued. However, issues relating to the lack of system integration and alert-driven interactions jeopardized the perceived sustainability of the program. CONCLUSIONS: With the reduction of in-person visits during the pandemic, virtual services such as telemonitoring have demonstrated significant value. Based on our study findings, we offer recommendations to proactively adapt and scale telemonitoring programs under the changing conditions of an increasingly virtual health care system. These include revisiting the scope and expectations of telemedicine interventions, streamlining virtual patient onboarding processes, and personalizing the collection of patient information to build a stronger virtual relationship and a more holistic assessment of patient well-being.


Asunto(s)
/epidemiología , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/tendencias , Telemedicina/métodos , Telemedicina/tendencias , Adulto , Anciano , Continuidad de la Atención al Paciente/tendencias , Brotes de Enfermedades , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Pandemias , Adulto Joven
16.
Healthc Q ; 23(4): 6-8, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33475484

RESUMEN

Early in the first wave of the COVID-19 pandemic, many older adult Canadians who routinely spend the winter months in warmer regions (colloquially known as "snowbirds") returned to Canada. While numerous infections were attributed to travel-related exposure at that time, little is known about the impact of COVID-19 on returning snowbirds. This population-based analysis from Ontario suggests that snowbirds were not disproportionately impacted by the pandemic. However, as older adults, they remain at high risk of complications once infected. These findings underscore the need for continued caution in this older adult population.


Asunto(s)
/epidemiología , Viaje , Anciano , Femenino , Humanos , Masculino , Ontario/epidemiología , Factores de Riesgo , Estaciones del Año , Viaje/estadística & datos numéricos
17.
Arch Gerontol Geriatr ; 93: 104321, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33359957

RESUMEN

INTRODUCTION: Caregivers play an important role in providing physical, emotional and social support to individuals with hip fracture. This study sought to explore perceptions of caregiving for older adults with hip fractures by comparing experiences of caregivers, providers and decision-makers. METHODS: Semi-structured interviews were conducted both in-person and by telephone with caregivers, providers and decision-makers (n=32) from one rural and one urban hospital selected from two health regions in Ontario, Canada. Interviews were audio-recorded and transcribed verbatim. The data were coded descriptively and interpretively, and compared within and across participants types. RESULTS: Three main themes reflected tensions between caregivers and providers/decision-makers. Firstly, differing expectations of caregiver roles were identified. Several caregivers wanted more participation in the decision-making process but often felt excluded, while others expressed feeling stressed due to the expectations placed on them. Conversely, providers and decision-makers often described caregivers needing to strike a balance between providing supportive care while avoiding becoming too involved. Secondly, different expectations of what the healthcare system and providers could provide, with tensions particularly around timing of discharge were noted. Finally, there were differing perceptions of information needs. Providers spoke about the importance of providing education to caregivers and perceived themselves to be providing appropriate education. However, caregivers often described poor communication and not having a clear understanding of next steps and the care plan. CONCLUSION: Managing and tailoring expectations, improving communication (e.g., content, timing) and the consistency of information shared with caregivers from different providers could facilitate more positive caregiving experiences and interactions.


Asunto(s)
Cuidadores , Fracturas de Cadera , Anciano , Humanos , Ontario , Investigación Cualitativa , Apoyo Social
18.
Sci Total Environ ; 750: 141484, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-32829260

RESUMEN

The SARS-CoV-2 is a novel coronavirus identified as the cause of COVID-19 and, as the pandemic evolves, many have made parallels to previous epidemics such as SARS-CoV (the cause of an outbreak of severe acute respiratory syndrome [SARS]) in 2003. Many have speculated that, like SARS, the activity of SARS-CoV-2 will subside when the climate becomes warmer. We sought to determine the relationship between ambient temperature and COVID-19 incidence in Canada. We analyzed over 77,700 COVID-19 cases from four Canadian provinces (Alberta, British Columbia, Ontario, and Quebec) from January to May 2020. After adjusting for precipitation, wind gust speed, and province in multiple linear regression models, we found a positive, but not statistically significant, association between cumulative incidence and ambient temperature (14.2 per 100,000 people; 95%CI: -0.60-29.0). We also did not find a statistically significant association between total cases or effective reproductive number of COVID-19 and ambient temperature. Our findings do not support the hypothesis that higher temperatures will reduce transmission of COVID-19 and warns the public not to lose vigilance and to continue practicing safety measures such as hand washing, social distancing, and use of facial masks despite the warming climates.


Asunto(s)
Infecciones por Coronavirus , Pandemias , Neumonía Viral , Alberta , Betacoronavirus , Colombia Británica/epidemiología , Humanos , Incidencia , Ontario , Quebec , Temperatura
19.
Aquat Toxicol ; 231: 105708, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33341508

RESUMEN

The WHAM-FTOX model quantifies cation toxicity towards freshwater organisms, assuming an additive toxic response to the amounts of protons and metals accumulated by an organism. We combined a parameterization of the model, using data from multi-species laboratory toxicity tests, with a fitted field species sensitivity distribution, to simulate the species richness (nsp) of crustacean zooplankton in acid- and metal-contaminated lakes near Sudbury, Ontario over several decades, and also in reference (uncontaminated) lakes. A good description of variation in toxic response among the zooplankton species was achieved with a log-normal distribution of a new parameter, ß, which characterizes an organism's intrinsic sensitivity towards toxic cations; the greater is ß, the more sensitive is the species. The use of ß assumes that while species vary in their sensitivity, the relative toxicities of different metals are the same for each species (common relative sensitivity). Unbiased agreements between simulated and observed nsp were obtained with a high correlation (r2 = 0.81, p < 0.0001, n = 217). Variations in zooplankton species richness in the Sudbury lakes are calculated to be dominated by toxic responses to H, Al, Cu and Ni, with a small contribution from Zn, and negligible effects of Cd, Hg and Pb. According to the model, some of the Sudbury lakes were affected predominantly by acidification (H and Al), while others were most influenced by toxic heavy metals (Ni, Cu, Zn); for lakes in the latter category, the relative importance of heavy metals, compared to H and Al, has increased over time. The results suggest that, if common relative sensitivity operates, nsp can be modelled on the basis of a single set of parameters characterizing the average toxic effects of different cations, together with a species sensitivity distribution.


Asunto(s)
Ácidos/toxicidad , Biodiversidad , Laboratorios , Lagos/química , Metales Pesados/toxicidad , Modelos Teóricos , Contaminantes Químicos del Agua/toxicidad , Zooplancton/fisiología , Animales , Organismos Acuáticos/efectos de los fármacos , Crustáceos/efectos de los fármacos , Monitoreo del Ambiente , Ontario , Especificidad de la Especie , Estadística como Asunto , Factores de Tiempo , Zooplancton/efectos de los fármacos
20.
J Environ Radioact ; 228: 106512, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33341751

RESUMEN

Extensive research has been conducted investigating the effects of ionizing radiation on biological systems, including specific focus at low doses. However, at the surface of the planet, there is the ubiquitous presence of ionizing natural background radiation (NBR) from sources both terrestrial and cosmic. We are currently conducting radiobiological experiments examining the impacts of sub-NBR exposure within SNOLAB. SNOLAB is a deep underground research laboratory in Sudbury, Ontario, Canada located 2 km beneath the surface of the planet. At this depth, significant shielding of NBR components is provided by the rock overburden. Here, we describe a Specialized Tissue Culture Incubator (STCI) that was engineered to significantly reduce background ionizing radiation levels. The STCI was installed 2 km deep underground within SNOLAB. It was designed to allow precise control of experimental variables such as temperature, atmospheric gas composition and humidity. More importantly, the STCI was designed to reduce radiological contaminants present within the underground laboratory. Quantitative measurements validated the STCI is capable of maintaining an appropriate experimental environment for sub-NBR experiments. This included reduction of sub-surface radiological contaminants, most notably radon gas. The STCI presents a truly novel piece of infrastructure enabling future research into the effects of sub-NBR exposure in a highly unique laboratory setting.


Asunto(s)
Radiación de Fondo , Monitoreo de Radiación , Radiobiología , Incubadoras , Ontario , Radón/análisis
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