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1.
JAMA Netw Open ; 4(9): e2124650, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34529066

RESUMO

Importance: Every year, respiratory viruses exact a heavy burden on Canadian hospitals during winter months. Generalizable seasonal patterns of respiratory virus transmission may estimate the evolution of SARS-CoV-2 or other emerging pathogens. Objective: To describe the annual and biennial variation in respiratory virus seasonality in a northern climate. Design, Setting, and Participants: This cohort study is an epidemiological assessment using population-based surveillance of patients with medically attended respiratory tract infection from 2005 through 2017 in Alberta, Canada. Incident cases of respiratory virus infection and infant respiratory syncytial virus (RSV) hospitalizations in Alberta were extracted from the Data Integration for Alberta Laboratories platform and Alberta Health Services Discharge Abstract Database, respectively. A deterministic susceptible-infected-recovered-susceptible mathematical model with seasonal forcing function was fitted to the data for each virus. The possible future seasonal course of SARS-CoV-2 in northern latitudes was modeled on the basis of these observations. The analysis was conducted between December 15, 2020, and February 10, 2021. Exposures: Seasonal respiratory pathogens. Main Outcomes and Measures: Incidence (temporal pattern) of respiratory virus infections and RSV hospitalizations. Results: A total of 37 719 incident infections with RSV, human metapneumovirus, or human coronaviruses 229E, NL63, OC43, or HKU1 among 35 375 patients (18 069 [51.1%] male; median [interquartile range], 1.29 [0.42-12.2] years) were documented. A susceptible-infected-recovered-susceptible model mirrored the epidemiological data, including a striking biennial variation with alternating severe and mild winter peaks. Qualitative description of the model and numerical simulations showed that strong seasonal contact rate and temporary immunity lasting 6 to 12 months were sufficient to explain biennial seasonality in these various respiratory viruses. The seasonality of 10 212 hospitalizations among children younger than 5 years with RSV was also explored. The median (interquartile range) rate of hospitalizations per 1000 live births was 18.6 (17.6-19.9) and 11.0 (10.4-11.7) in alternating even (severe) and odd (less-severe) seasons, respectively (P = .001). The hazard of admission was higher for children born in severe (even) seasons compared with those born in less-severe (odd) seasons (hazard ratio, 1.68; 95% CI, 1.61-1.75; P < .001). Conclusions and Relevance: In this modeling study of respiratory viruses in Alberta, Canada, the seasonality followed a pattern estimated by simple mathematical models, which may be informative for anticipating future waves of pandemic SARS-CoV-2.


Assuntos
Infecções Respiratórias/virologia , Estações do Ano , Viroses/diagnóstico , Alberta/epidemiologia , Estudos de Coortes , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Infecções Respiratórias/epidemiologia , Estatísticas não Paramétricas , Viroses/epidemiologia
2.
Artigo em Inglês | MEDLINE | ID: mdl-34501687

RESUMO

The frequency of colorectal cancer (CRC) diagnosis has decreased due to the COVID-19 pandemic. Health system planning is needed to address the backlog of undiagnosed patients. We developed a framework for analyzing barriers to diagnosis and estimating patient volumes under different system relaunch scenarios. This retrospective study included CRC cases from the Alberta Cancer Registry for the pre-pandemic (1 January 2016-4 March 2020) and intra-pandemic (5 March 2020-1 July 2020) periods. The data on all the diagnostic milestones in the year prior to a CRC diagnosis were obtained from administrative health data. The CRC diagnostic pathways were identified, and diagnostic intervals were measured. CRC diagnoses made during hospitalization were used as a proxy for severe disease at presentation. A modified Poisson regression analysis was used to estimate the adjusted relative risk (adjRR) and a 95% confidence interval (CI) for the effect of the pandemic on the risk of hospital-based diagnoses. During the study period, 8254 Albertans were diagnosed with CRC. During the pandemic, diagnosis through asymptomatic screening decreased by 6·5%. The adjRR for hospital-based diagnoses intra-COVID-19 vs. pre-COVID-19 was 1.24 (95% CI: 1.03, 1.49). Colonoscopies were identified as the main bottleneck for CRC diagnoses. To clear the backlog before progression is expected, high-risk subgroups should be targeted to double the colonoscopy yield for CRC diagnosis, along with the need for a 140% increase in monthly colonoscopy volumes for a period of 3 months. Given the substantial health system changes required, it is unlikely that a surge in CRC cases will be diagnosed over the coming months. Administrators in Alberta are using these findings to reduce wait times for CRC diagnoses and monitor progression.


Assuntos
COVID-19 , Neoplasias Colorretais , Alberta/epidemiologia , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer , Humanos , Pandemias , Estudos Retrospectivos , SARS-CoV-2
3.
JCO Oncol Pract ; 17(9): e1354-e1361, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34351822

RESUMO

PURPOSE: This study reports on a mixed methods evaluation conducted within a provincial cancer program in Alberta, Canada. The purpose was to capture key learnings from a rapid virtual care implementation because of the COVID-19 pandemic and to understand the impact on patient and staff experiences. METHODS: Administrative data were collected for 21,362 patients who had at least one virtual or in-person visit to any provincial cancer center from April 1, 2020, to June 10, 2020. Patient surveys were conducted with 397 randomly selected patients who had received a virtual visit. Surveys were also conducted with 396 Cancer Care Alberta staff. RESULTS: 14,906 virtual visits took place in this period, and about 40% of weekly visits were virtual. Significant differences were observed in both patient-reported symptom questionnaire completion rates and referrals to supportive care services between patients seen in-person and virtually. Patients receiving active treatments reported significantly lower levels of satisfaction with virtual visits than those seen for follow-up, but overall 90% of patients indicated interest in receiving virtual care in the future. Staff thought virtual visits increased patients' access to care but less than one third (31.5%) felt confident meeting patients' emotional needs and having conversations about disease progression and/or end of life virtually. CONCLUSION: The COVID-19 pandemic has driven the rapid implementation of virtual visits for cancer care delivery in health care settings. The findings from this mixed methods evaluation provide a concrete set of considerations for organizations looking to develop a large-scale, enduring virtual care strategy.


Assuntos
COVID-19 , Neoplasias , Telemedicina , Alberta/epidemiologia , Humanos , Neoplasias/epidemiologia , Neoplasias/terapia , Pandemias , SARS-CoV-2
4.
J Can Dent Assoc ; 87: l4, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-34343067

RESUMO

OBJECTIVES: This scoping review provides a comprehensive overview of oral cavity cancer (OCC) and oropharyngeal cancer (OPC) in Alberta. METHODS: A database search was conducted up to 2018 using Web of Science, Scopus, Medline, PubMed and Embase, along with a manual search of gray literature. Data from the Alberta Cancer Foundation's dedicated fund for research, Cancer Surveillance and Reporting and Alberta Cancer Registry were also collected. RESULTS: Our review included 8 published papers and 14 other sources, including data on 3448 OCC and OPC patients from Surveillance and Reporting and Alberta Cancer Registry. Cancer registry data (2005-2017) showed that most OCC and OPC lesions were diagnosed at an advanced clinical stage, with a significantly large number of advanced OPC lesions in stage IV (OCC 45.2%, OPC 82.4%); 47.9% of these patients died. Survival rates were lowest in rural and First Nations areas. In Alberta, 35% of HPV-associated cancers were linked to OPCs, which were more prevalent in men and younger age groups. No routine public oral cancer screening program currently exists in Alberta. General practitioners and dentists refer patients to specialists, often with long waiting times. CONCLUSION: OCC and OPC patients in Alberta continue to be diagnosed in stage IV and experience high mortality rates.


Assuntos
Neoplasias Bucais , Neoplasias Orofaríngeas , Alberta/epidemiologia , Humanos , Incidência , Masculino , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/epidemiologia , Neoplasias Orofaríngeas/diagnóstico , Neoplasias Orofaríngeas/epidemiologia
5.
BMJ Open ; 11(8): e050550, 2021 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-34353807

RESUMO

OBJECTIVES: The COVID-19 pandemic changed daily routines, including physical activity, which could influence physical and mental health. In our study, we describe physical activity and sedentary behaviour patterns in relation to the pandemic and estimate associations between anxiety and physical activity and sedentary behaviour in community-dwelling adults. DESIGN: Cross-sectional study. SETTING: Calgary, Alberta, Canada. PARTICIPANTS: Between April and June 2020, a random sample of 1124 adults (≥18 years) completed an online questionnaire. PRIMARY AND SECONDARY OUTCOMES: The online questionnaire captured current walking, moderate intensity, vigorous intensity and total physical activity and sedentary behaviour (ie, sitting and leisure-based screen time), perceived relative changes in physical activity, sedentary and social behaviours since the pandemic, perceived seriousness and anxiety related to COVID-19, and sociodemographic characteristics. Differences in sociodemographic characteristics, perceived relative change in behaviour and current physical activity and sedentary behaviour were compared between adults with low and high anxiety. RESULTS: Our sample (n=1047) included more females (60.3%) and fewer older adults (19.2%). Most participants (88.4%) considered COVID-19 as extremely or very serious and one-third (32.9%) felt extremely or very anxious. We found no differences (p>0.05) in current physical activity or sedentary behaviour by anxiety level. The largest perceived change in behaviours included social distancing, driving motor vehicles, use of screen-based devices, watching television and interactions with neighbours. We found anxiety-related differences (p<0.05) in perceived changes in various behaviours. CONCLUSIONS: Changes in physical activity, sedentary behaviour and social behaviour occurred soon after the COVID-19 pandemic was declared, and some of these changes differed among those with low and high anxiety.


Assuntos
COVID-19 , Pandemias , Idoso , Alberta/epidemiologia , Ansiedade/epidemiologia , Estudos Transversais , Exercício Físico , Feminino , Humanos , Vida Independente , SARS-CoV-2
6.
Artigo em Inglês | MEDLINE | ID: mdl-34444093

RESUMO

Respiratory diseases contribute to high healthcare utilization rates among children. Although social inequalities play a major role in these conditions, little is known about the impact of geography as a determinant of health, particularly with regard to the difference between rural and urban centers. A regional geographic analysis was conducted using health repository data on singleton births between 2005 and 2010 in Alberta, Canada. Data were aggregated according to regional health sub-zones in the province and standardized prevalence ratios (SPRs) were determined for eight respiratory diseases (asthma, influenza, bronchitis, bronchiolitis, croup, pneumonia, and other upper and other lower respiratory tract infections). The results indicate that there are higher rates of healthcare utilization in northern compared to southern regions and in rural and remote regions compared to urban ones, after accounting for both material and social deprivation. Geography plays a role in discrepancies of healthcare utilization for pediatric respiratory diseases, and this can be used to inform the provision of health services and resource allocation across various regions.


Assuntos
Utilização de Instalações e Serviços , Aceitação pelo Paciente de Cuidados de Saúde , Alberta/epidemiologia , Criança , Geografia , Humanos , Estudos Retrospectivos
7.
CMAJ ; 193(31): E1203-E1212, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34373268

RESUMO

BACKGROUND: The COVID-19 pandemic has exacerbated disparities in poverty and illness for people in vulnerable circumstances in ethnocultural communities. We sought to understand the evolving impacts of COVID-19 on ethnocultural communities to inform intersectoral advocacy and community action. METHODS: The Illuminate Project used participatory action research, with cultural health brokers as peer researchers, from Sept. 21 to Dec. 31, 2020, in Edmonton, Alberta. Twenty-one peer researchers collected narratives from members of ethnocultural communities and self-interpreted them as they entered the narratives into the SenseMaker platform, a mixed-method data collection tool. The entire research team analyzed real-time, aggregate, quantitative and qualitative data to identify emerging thematic domains, then visualized these domains with social network analysis. RESULTS: Brokers serving diverse communities collected 773 narratives. Identified domains illuminate the evolving and entangled impacts of COVID-19 including the following: COVID-19 prevention and management; care of acute, chronic and serious illnesses other than COVID-19; maternal care; mental health and triggers of past trauma; financial insecurity; impact on children and youth and seniors; and legal concerns. We identified that community social capital and cultural brokering are key assets that facilitate access to formal health and social system supports. INTERPRETATION: The Illuminate Project has illustrated the entangled, systemic issues that result in poor health among vulnerable members of ethnocultural communities, and the exacerbating effects of COVID-19, which also increased barriers to mitigation. Cultural brokering and community social capital are key supports for people during the COVID-19 pandemic. These findings can inform policy to reduce harm and support community resiliency.


Assuntos
COVID-19/etnologia , Serviços de Saúde Comunitária/organização & administração , Pandemias , Populações Vulneráveis/etnologia , Alberta/epidemiologia , COVID-19/prevenção & controle , COVID-19/terapia , Informação de Saúde ao Consumidor , Feminino , Estresse Financeiro , Pesquisa sobre Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Masculino , Pobreza , SARS-CoV-2 , Capital Social , Análise de Rede Social , Apoio Social
8.
JMIR Public Health Surveill ; 7(9): e26409, 2021 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-34228626

RESUMO

BACKGROUND: The development of a successful COVID-19 control strategy requires a thorough understanding of the trends in geographic and demographic distributions of disease burden. In terms of the estimation of the population prevalence, this includes the crucial process of unravelling the number of patients who remain undiagnosed. OBJECTIVE: This study estimates the period prevalence of COVID-19 between March 1, 2020, and November 30, 2020, and the proportion of the infected population that remained undiagnosed in the Canadian provinces of Quebec, Ontario, Alberta, and British Columbia. METHODS: A model-based mathematical framework based on a disease progression and transmission model was developed to estimate the historical prevalence of COVID-19 using provincial-level statistics reporting seroprevalence, diagnoses, and deaths resulting from COVID-19. The framework was applied to three different age cohorts (< 30; 30-69; and ≥70 years) in each of the provinces studied. RESULTS: The estimates of COVID-19 period prevalence between March 1, 2020, and November 30, 2020, were 4.73% (95% CI 4.42%-4.99%) for Quebec, 2.88% (95% CI 2.75%-3.02%) for Ontario, 3.27% (95% CI 2.72%-3.70%) for Alberta, and 2.95% (95% CI 2.77%-3.15%) for British Columbia. Among the cohorts considered in this study, the estimated total number of infections ranged from 2-fold the number of diagnoses (among Quebecers, aged ≥70 years: 26,476/53,549, 49.44%) to 6-fold the number of diagnoses (among British Columbians aged ≥70 years: 3108/18,147, 17.12%). CONCLUSIONS: Our estimates indicate that a high proportion of the population infected between March 1 and November 30, 2020, remained undiagnosed. Knowledge of COVID-19 period prevalence and the undiagnosed population can provide vital evidence that policy makers can consider when planning COVID-19 control interventions and vaccination programs.


Assuntos
COVID-19/epidemiologia , Doenças não Diagnosticadas/epidemiologia , Adulto , Idoso , Alberta/epidemiologia , Colúmbia Britânica/epidemiologia , COVID-19/diagnóstico , Estudos de Coortes , Humanos , Pessoa de Meia-Idade , Modelos Teóricos , Ontário/epidemiologia , Prevalência , Quebeque/epidemiologia , Estudos Soroepidemiológicos
9.
Ann Emerg Med ; 78(2): 242-252, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34325859

RESUMO

STUDY OBJECTIVE: To define the association between atrial fibrillation case volume in the emergency department and death or all-cause hospitalization at 30 days and 1 year in patients with new atrial fibrillation. Secondary objectives examined repeat ED visits and the management of atrial fibrillation within 90 days. METHODS: We identified all adults presenting to an ED in Alberta, Canada, with a new primary diagnosis of atrial fibrillation/flutter between 2009 and 2015 using International Classification of Diseases, 10th Revision code I48. Volume was classified in tertiles weighted by annual ED number of atrial fibrillation cases. The association between volume and outcomes was evaluated using generalized linear mixed models, adjusting for prognostically important covariates as fixed effects and ED as a random effect to account for potential clustering within EDs. RESULTS: The tertiles consisted of 4 high, 9 medium, and 68 low atrial fibrillation volume EDs, with 4,217, 4,193, and 4,112 patients, respectively. Volume was not independently associated with the primary outcome or individual components. However, medium- and high-volume EDs had fewer repeat ED visits at 30 days (respective adjusted odds ratio [aOR] 0.75 [95% confidence interval {CI} 0.66 to 0.87] and 0.64 [0.52 to 0.79]) and 1 year (respective aOR 0.77 [95% CI 0.67 to 0.90] and 0.71 [0.56 to 0.90]). Fewer patients were admitted from medium- (37.1%) and high- (32.0%) compared with low-volume (39.5%) EDs. Patients attending medium- and high-volume EDs were more likely to be cardioverted (aOR 3.28 [95% CI 1.94 to 5.53] and 3.81 [1.39 to 10.48] for medium- and high-volume EDs, respectively). CONCLUSION: Treatment in higher volume EDs was associated with significantly lower admission rates and repeat ED visits but no difference in survival.


Assuntos
Fibrilação Atrial/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Idoso , Alberta/epidemiologia , Fibrilação Atrial/terapia , Feminino , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Humanos , Masculino , Estudos Retrospectivos , Medição de Risco
10.
CMAJ Open ; 9(3): E788-E794, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34285058

RESUMO

BACKGROUND: Despite well-documented challenges in recruiting physicians to rural practice, few Canadian studies have described the role physician payment models may play in attracting and retaining physicians to rural practice. This study examined the perspectives of rural primary care physicians on the factors that attract and retain physicians in rural locations, including the role that alternative payment models (APMs) might play. METHODS: This was a qualitative study involving in-depth, open-ended interviews with rural primary care physicians practising under fee-for-service (FFS) models and APMs in Alberta, Canada. Participants were recruited from the Rural Health Professions Action Plan member list (consisting of physicians practising in rural or remote locations in Alberta) and the College of Physicians and Surgeons of Alberta online database. Interviews were conducted April to June 2020, and data were analyzed using a thematic framework approach. RESULTS: Fourteen physicians were interviewed. There were 5 themes identified: factors that attract physicians to rural practice, barriers and challenges associated with rural practice, the potential role of APMs in recruitment and retention, factors that physicians consider in deciding to change payment models, and physician perceptions of APMs compared with FFS models. Participants expressed that APMs may have some role to play in retaining rural physicians but identified professional challenges, and family-related and personal factors as key determinants. Most FFS physicians indicated that they were interested in exploring APMs provided specific concerns were addressed (e.g., clear and adequately compensated APM contracts, and physician involvement in the development of APMs). INTERPRETATION: Primary care physicians practising in rural regions in Alberta view payment models as one consideration among many in their decision to pursue rural practice. Alternative payment model contracts designed with the input of physicians may have a role to play in attracting and retaining physicians to rural practice.


Assuntos
Atitude do Pessoal de Saúde , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Papel do Médico , Médicos de Atenção Primária/psicologia , Mecanismo de Reembolso/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Alberta/epidemiologia , Tomada de Decisões , Análise Fatorial , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Fatores de Risco
11.
CMAJ Open ; 9(3): E777-E787, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34285057

RESUMO

BACKGROUND: The identification of frailty before complex and invasive procedures may have relevance for prognostic and recovery purposes, to optimally inform patients, caregivers and clinicians about perioperative risk and postoperative care needs. The aim of this study was to estimate the prevalence of frailty and describe the associated clinical course and outcomes of patients referred for nonemergent cardiac surgery. METHODS: A prospective cohort of patients aged 50 years and older referred for nonemergent cardiac surgery in Alberta, Canada, from November 2011 to March 2014 were screened preoperatively for frailty, defined as a Clinical Frailty Scale (CFS) score of 5 or greater. Postoperatively, patients were followed by telephone to assess CFS score, health services use and vital status. The primary outcome was all-cause hospital mortality. Secondary outcomes included health services use, hospital discharge disposition, 1-year health-related quality of life and all-cause 5-year mortality. RESULTS: The cohort (n = 529) had a mean age of 67 (standard deviation [SD] 9) years; 25.9% were female, and the prevalence of frailty was 9.6% (n = 51; 95% confidence interval [CI] 7.3%-12.5%). Frail patients were older (median age 75, interquartile range [IQR] 65-80 v. 67, IQR 60-73, yr; p < 0.001), were more likely to be female (51.0% v. 23.2%; p < 0.001), had a higher mean EuroSCORE II (8, SD 3 v. 5, SD 3; p < 0.001) and received combined coronary artery bypass grafting and valve procedures more frequently (29.4% v. 15.9%; p = 0.02) than nonfrail patients. Postoperatively, frail patients had a longer median duration of stay in the cardiovascular intensive care unit (median difference 2.2, 95% CI 1.60-2.79) and hospital (median difference 9.3, 95% CI 8.2-10.3). Hospital mortality was 9.8% among frail patients and 1.0% among nonfrail patients (adjusted hazard ratio 3.84, 95% CI 0.90-16.34). INTERPRETATION: Preoperative frailty was present in 10% of patients and was associated with a higher risk of morbidity and greater health services use. Preoperative frailty has important implications for the postoperative clinical course and resource utilization of patients undergoing cardiac surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Fragilidade/epidemiologia , Cardiopatias/epidemiologia , Cardiopatias/cirurgia , Período Pré-Operatório , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Alberta/epidemiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Eletivos , Feminino , Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica , Cardiopatias/etiologia , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Prevalência , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
12.
BMC Health Serv Res ; 21(1): 683, 2021 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-34246276

RESUMO

BACKGROUND: Patients in Alberta, Canada are referred to the United States (US) for proton treatment. The Alberta Ministry of Health pays for the proton treatment and the cost of flights to and from the United States. This study aimed to determine the out-of-pocket expenses incurred by patients or patients' families. METHODS: An electronic survey was sent to 59 patients treated with proton therapy between January 2008 and September 2019. Survey questions asked about expenses related to travel to the US and those incurred while staying in the US, reimbursement of expenses, and whether any time away from work was paid or unpaid leave. RESULTS: Seventeen respondents (response rate, 29%) reported expenses of flights for family members (mean, CAD 1886; range CAD 0-5627), passports/visas and other travel costs (mean, CAD 124; range CAD 0-546), accommodation during travel to the US (mean, CAD 50; range CAD 0-563), food during travel to the US (mean, CAD 89; range CAD 0-338), accommodation in the US (rented home/apartment mean, CAD 7394; range CAD 3075-13,305; hotel mean, CAD 4730; range CAD 3564-5895; other accommodation mean CAD 2660; range CAD 0-13,842), transportation in the US (car mean, CAD 2760; range CAD 0-7649; bus/subway mean, CAD 413; range CAD 246-580), and food in the US (mean, CAD 2443; range 0-6921). Expenses were partially reimbursed or covered by not-for-profit organizations or government agencies for some patients (35%). Patients missed a mean of 59 days of work; accompanying family members missed an average of 34 days. For 29% this time away from work was paid, but unpaid for 71% of respondents. CONCLUSIONS: Multiple factors contributed to the expenses incurred including age of the patient, number of accompanying individuals, available accommodation, mode of transportation within the US, and whether the patient qualified for financial support. Added to this burden is the potential loss of wages for time away from work. The study showed a large variation in indirect costs for each family and supports actively seeking more opportunities for financial support for families with children with cancer.


Assuntos
Terapia com Prótons , Adulto , Alberta/epidemiologia , Criança , Efeitos Psicossociais da Doença , Gastos em Saúde , Humanos , Encaminhamento e Consulta , Inquéritos e Questionários , Estados Unidos
13.
CMAJ Open ; 9(2): E673-E679, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34145050

RESUMO

BACKGROUND: Severe obesity is associated with adverse health outcomes and increased risk of death. This study evaluates the real-world cost-utility of therapy for severe obesity, from the publicly funded health care system and societal perspectives. METHODS: We conducted a cost-utility analysis using primary data from a prospective observational cohort of adults living with severe obesity (BMI ≥ 35 kg/m2 and a major medical comorbidity or BMI ≥ 40 kg/m2) who were enrolled in a regional obesity program over 2 years. We extrapolated 10-year and lifetime Markov models, validated and supplemented with literature sources, to compare medical, surgical and standard care therapies. We performed deterministic and probabilistic sensitivity analyses. RESULTS: The cohort included 500 adults living with severe obesity, 150 of whom received laparoscopic surgical therapy. From a publicly funded health system perspective, at 2 years, surgical therapy had an incremental cost-effectiveness ratio (ICER) of $54 456 per quality-adjusted life-year (QALY) compared with standard care therapy. Over a lifetime, it had an ICER of $14 056 per QALY. From the societal perspective, at 2 years, surgical therapy had an ICER of $340 per QALY; over a lifetime, it was the dominant option. The results were robust to sensitivity analysis. INTERPRETATION: From a public health care perspective, surgery for severe obesity is cost effective, and when approached from a societal perspective, it becomes cost saving. Real-world data support using surgical therapy for severe obesity, and our results contribute to the health economic and clinical literature with regard to a robust analysis from a societal perspective.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Saúde Pública , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Alberta/epidemiologia , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/economia , Cirurgia Bariátrica/métodos , Análise Custo-Benefício , Feminino , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Obesidade Mórbida/economia , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/psicologia , Obesidade Mórbida/cirurgia , Saúde Pública/economia , Saúde Pública/estatística & dados numéricos , Validade Social em Pesquisa/métodos , Validade Social em Pesquisa/estatística & dados numéricos
14.
CMAJ Open ; 9(2): E711-E717, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34162663

RESUMO

BACKGROUND: In Canada, decisions regarding osteoporosis pharmacotherapy are based on estimated 10-year risk of osteoporotic fracture. We aimed to determine how frequently 2 common approaches (Canadian Association of Radiologists and Osteoporosis Canada [CAROC] tool and Fracture Risk Assessment Tool [FRAX]) produced different estimates and to seek possible explanations for differences. METHODS: We conducted a cross-sectional chart review at a tertiary osteoporosis centre (Dr. David Hanley Osteoporosis Centre in Calgary). Included patients were women referred for consideration of osteoporosis pharmacotherapy who attended a consultation between 2016 and 2019 and whose charts contained 10-year osteoporotic fracture risk estimates using both the CAROC tool (based on bone mineral density [BMD] results) and FRAX (based on BMD results and clinically assessed fracture risk factors). Risk estimates provided on BMD reports (calculated with CAROC) and generated through osteoporosis clinic consultation (calculated with FRAX, including BMD) were categorized as low (< 10.0%), moderate (10.0%-19.9%) or high (≥ 20.0%). Estimates were considered discordant when they placed the patient in different risk categories. RESULTS: Of 190 patients evaluated, 99 (52.1%) had discordant risk estimates. Although a similar proportion were considered high risk by BMD reports using the CAROC tool (17.9%) and clinic charts using FRAX (19.5%), the 2 methods identified different patients as being high risk. Around the crucial high-risk (20.0%) treatment threshold, discordance was present in 37 patients (19.5%, 95% confidence interval [CI] 14.5%-25.7%); discordance around the moderate-risk (10.0%) threshold was present in 69 (36.3%, 95% CI 29.5%-43.2%) patients. Disagreement regarding fracture history between BMD reports and clinic charts was observed in 19.8% of patients. INTERPRETATION: Fracture risk estimates on BMD reports (using the CAROC tool) and those calculated in the clinical setting (using FRAX) frequently result in different risk classification. Osteoporosis treatment decisions may differ in up to half of patients depending on which estimate is used, highlighting the need for a consistent and accurate assessment process for fracture risk.


Assuntos
Osteoporose , Fraturas por Osteoporose , Sistemas de Informação em Radiologia/estatística & dados numéricos , Medição de Risco , Alberta/epidemiologia , Densidade Óssea , Tomada de Decisão Clínica , Estudos Transversais , Tratamento Farmacológico/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Osteoporose/epidemiologia , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Medição de Risco/métodos , Medição de Risco/normas , Medição de Risco/estatística & dados numéricos
15.
BMC Public Health ; 21(1): 1047, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078341

RESUMO

BACKGROUND: Beliefs about causes and responsibility for chronic diseases can affect personal behaviour and support for healthy policies. In this research we examined relationships between socio-demographics (sex, age, education, employment, political alignment, perceived health, household income, household size) and perceptions of causes and responsibility for health behaviour, chronic disease correlates, and attitudes about cancer prevention and causes. METHODS: Using data from the 2016 Chronic Disease Prevention survey in which participants (N = 1200) from Alberta, Canada responded to items regarding how much they believed personal health behaviours, prevention beliefs, and environmental factors (i.e., healthy eating, physical activity, alcohol, smoking, and where a person lives or works) are linked to getting cancer. Participants also responded to questions about causes and responsibility for obesity, alcohol, and tobacco (i.e., individual or societal). Relationships were examined using multinomial logistic regression on socio-demographics and survey items of interest. RESULTS: Men (compared to women) were less likely to link regular exercise, or drinking excessive alcohol, to reducing or increasing cancer risk. Similarly, men were less likely to link environmental factors to cancer risk, and more likely to agree that cancer was not preventable, and that treatment is more important than prevention. Finally, men were more likely to believe that alcohol problems are an individual's fault. Left and central voters were more likely to believe that society was responsible for addressing alcohol, tobacco, and obesity problems compared to right voters. Those with less than post-secondary education were less likely to believe that regular exercise, maintaining a healthy body weight, or eating sufficient fruits and vegetables were linked to cancer - or that society should address obesity - compared to those with more education. Households making above the median income (versus below) were more likely to link a balanced diet with cancer and were less likely to think that tobacco problems were caused by external circumstances. CONCLUSIONS: These results provide insight into the importance of health literacy, message framing, and how socio-demographic factors may impact healthy policy. Men, those with less education, and those with less income are important target groups when promoting health literacy and chronic disease prevention initiatives.


Assuntos
Comportamentos Relacionados com a Saúde , Neoplasias , Alberta/epidemiologia , Doença Crônica , Exercício Físico , Feminino , Humanos , Masculino , Neoplasias/epidemiologia , Neoplasias/etiologia , Neoplasias/prevenção & controle
16.
Traffic Inj Prev ; 22(6): 437-442, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34097541

RESUMO

OBJECTIVE: Novice adolescent drivers have a higher propensity to engage in risky driving and are at higher odds of being involved in collisions. Graduated driver licensing programs have been instituted to help novice drivers gain experience while avoiding higher risk driving circumstances. This study examines modifiable risk factors contributing to novice adolescent driver fault in collisions. METHODS: Police traffic collision report data from municipalities in Alberta for the years 2010-2016, inclusive, were used. Fault in collision was assigned using an automated and previously validated tool for assigning culpability. Factors contributing to novice adolescent (16-19 years of age) fault in collision were examined using multivariable logistic regression. RESULTS: Novice adolescent drivers had higher adjusted odds ratios (aOR) of being at-fault in collision when driving from 01:00-05:00 (aOR = 1.38; 95% Confidence Interval [CI]: 1.26-1.50). Novice adolescent drivers had lower odds of fault when driving with an adult (aOR= 0.62; 95% CI: 0.57-0.68) or a single peer (aOR= 0.87; 95% CI: 0.80-0.94), but higher odds of causing a severe collision with a single peer present (aOR= 2.23; 95% CI: 1.21-4.11). Impairment of the teen driver was reported in 25% of all fatal collisions, and 40% of late-night fatal collisions. CONCLUSIONS: The findings support policies that allow driving with a single adult or peer passenger during daytime hours. Driving during late-night hours should be restricted for novice adolescent drivers.


Assuntos
Acidentes de Trânsito , Condução de Veículo , Acidentes de Trânsito/mortalidade , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Alberta/epidemiologia , Condução de Veículo/psicologia , Condução de Veículo/estatística & dados numéricos , Dirigir sob a Influência/estatística & dados numéricos , Humanos , Grupo Associado , Polícia , Registros , Fatores de Risco , Assunção de Riscos , Fatores de Tempo
17.
BMJ Open ; 11(6): e050667, 2021 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-34168036

RESUMO

OBJECTIVES: This report estimates the risk of COVID-19 importation and secondary transmission associated with a modified quarantine programme in Canada. DESIGN AND PARTICIPANTS: Prospective analysis of international asymptomatic travellers entering Alberta, Canada. INTERVENTIONS: All participants were required to receive a PCR COVID-19 test on arrival. If negative, participants could leave quarantine but were required to have a second test 6 or 7 days after arrival. If the arrival test was positive, participants were required to remain in quarantine for 14 days. MAIN OUTCOME MEASURES: Proportion and rate of participants testing positive for COVID-19; number of cases of secondary transmission. RESULTS: The analysis included 9535 international travellers entering Alberta by air (N=8398) or land (N=1137) that voluntarily enrolled in the Alberta Border Testing Pilot Programme (a subset of all travellers); most (83.1%) were Canadian citizens. Among the 9310 participants who received at least one test, 200 (21.5 per 1000, 95% CI 18.6 to 24.6) tested positive. Sixty-nine per cent (138/200) of positive tests were detected on arrival (14.8 per 1000 travellers, 95% CI 12.5 to 17.5). 62 cases (6.7 per 1000 travellers, 95% CI 5.1 to 8.5; 31.0% of positive cases) were identified among participants that had been released from quarantine following a negative test result on arrival. Of 192 participants who developed symptoms, 51 (26.6%) tested positive after arrival. Among participants with positive tests, four (2.0%) were hospitalised for COVID-19; none required critical care or died. Contact tracing among participants who tested positive identified 200 contacts; of 88 contacts tested, 22 were cases of secondary transmission (14 from those testing positive on arrival and 8 from those testing positive thereafter). SARS-CoV-2 B.1.1.7 lineage was not detected in any of the 200 positive cases. CONCLUSIONS: 21.5 per 1000 international travellers tested positive for COVID-19. Most (69%) tested positive on arrival and 31% tested positive during follow-up. These findings suggest the need for ongoing vigilance in travellers testing negative on arrival and highlight the value of follow-up testing and contact tracing to monitor and limit secondary transmission where possible.


Assuntos
COVID-19 , Viagem , Alberta/epidemiologia , COVID-19/diagnóstico , Teste para COVID-19 , Humanos , Internacionalidade , Estudos Prospectivos , SARS-CoV-2
18.
Pharmacoeconomics ; 39(9): 1059-1073, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34138458

RESUMO

OBJECTIVE: The objective of this study was to implement a model-based approach to identify the optimal allocation of a coronavirus disease 2019 (COVID-19) vaccine in the province of Alberta, Canada. METHODS: We developed an epidemiologic model to evaluate allocation strategies defined by age and risk target groups, coverage, effectiveness and cost of vaccine. The model simulated hypothetical immunisation scenarios within a dynamic context, capturing concurrent public health strategies and population behavioural changes. RESULTS: In a scenario with 80% vaccine effectiveness, 40% population coverage and prioritisation of those over the age of 60 years at high risk of poor outcomes, active cases are reduced by 17% and net monetary benefit increased by $263 million dollars, relative to no vaccine. Concurrent implementation of policies such as school closure and senior contact reductions have similar impacts on incremental net monetary benefit ($352 vs $292 million, respectively) when there is no prioritisation given to any age or risk group. When older age groups are given priority, the relative benefit of school closures is much larger ($214 vs $118 million). Results demonstrate that the rank ordering of different prioritisation options varies by prioritisation criteria, vaccine effectiveness and coverage, and concurrently implemented policies. CONCLUSIONS: Our results have three implications: (i) optimal vaccine allocation will depend on the public health policies in place at the time of allocation and the impact of those policies on population behaviour; (ii) outcomes of vaccine allocation policies can be greatly supported with interventions targeting contact reduction in critical sub-populations; and (iii) identification of the optimal strategy depends on which outcomes are prioritised.


Assuntos
Vacinas contra COVID-19/provisão & distribuição , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinação/tendências , Idoso , Alberta/epidemiologia , COVID-19/economia , Vacinas contra COVID-19/economia , Análise Custo-Benefício , Humanos , Pessoa de Meia-Idade , Saúde Pública , SARS-CoV-2
19.
PLoS Negl Trop Dis ; 15(5): e0009428, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34038403

RESUMO

Echinococcus multilocularis (Em) is a zoonotic parasite considered a global emergent pathogen. Recent findings indicate that the parasite is expanding its range in North America and that European-type haplotypes are circulating in western Canada. However, genetic analyses are usually conducted only on a few parasites out of thousands of individuals within each definitive host, likely underestimating the prevalence of less common haplotypes. Moreover, mixed infections with several mtDNA haplotypes in the same host have been reported, but their relative abundance within the host was never estimated. We aimed to 1) estimate the frequency of co-infections of different Em haplotypes in coyotes (Canis latrans) and red foxes (Vulpes vulpes) from western Canada and their relative abundance within the definitive hosts, 2) detect less prevalent haplotypes by sampling a larger proportion of the parasite subpopulation per host, and 3) investigate differences in the distribution of Em haplotypes in these main definitive hosts; foxes and coyotes. We extracted DNA from ~10% of the worm subpopulation per host (20 foxes and 47 coyotes) and used deep amplicon sequencing (NGS technology) on four loci, targeting the most polymorphic regions from the mitochondrial genes cox1 (814 bp), nad1 (344 bp), and cob (387 bp). We detected the presence of mixed infections with multiple Em haplotypes and with different Echinococcus species including Em and E. granulosus s.l. genotypes G8/G10, low intraspecific diversity of Em, and a higher abundance of the European-type haplotypes in both hosts. Our results suggest a population expansion of the European over the North American strain in Alberta and a limited distribution of some European-type haplotypes. Our findings indicate that deep amplicon sequencing represents a valuable tool to characterize Em in multiple hosts, to assess the current distribution and possible origins of the European strain in North America. The potential use of next-generation sequencing technologies is particularly important to understand the patterns of geographic expansion of this parasite.


Assuntos
Coiotes/parasitologia , Equinococose/epidemiologia , Echinococcus multilocularis/genética , Raposas/parasitologia , Alberta/epidemiologia , Animais , DNA Mitocondrial/genética , Haplótipos , Sequenciamento de Nucleotídeos em Larga Escala , Prevalência
20.
CMAJ Open ; 9(2): E522-E528, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34021009

RESUMO

BACKGROUND: As the number of older adults continues to increase, addressing their health becomes increasingly important for both the population and the health care system. The aim of this priority setting partnership was to use direct engagement with older adults, caregivers and health care providers to identify and prioritize the most important topics on the health of older adults that should be addressed by future research. METHODS: We followed the James Lind Alliance method. We conducted an initial online and paper survey from Jan. 22 to May 2, 2018, with older adults in Alberta aged 65 years and older to identify what respondents saw as being most important for the health of older adults. We formed responses into summary questions and checked them against existing evidence. We administered a second survey (July 3 to Aug. 2, 2018) to shortlist summary questions and held an in-person workshop (Aug. 30, 2018) to rank the list through discussion and shared decision-making. RESULTS: We recruited 670 participants (32.7% older adults, 19.7% caregivers, 46.9% health and social care workers) in the initial survey to tell us what topics on the health of older adults mattered most to them. Over 3000 responses generated 101 summary questions, of which only 4 were completely answered by existing evidence. The second prioritization survey was completed by 232 participants (28.4% older adults, 24.6% care partners, 47.0% health and social care workers) to produce a shortlist of 22 high priority questions. Twenty-two attendees participated in the summary workshop to create a prioritized list of 10 questions for future research that address aspects of the health system, provision of care and living well in older adulthood. INTERPRETATION: Older adults, caregivers and clinicians collectively produced a prioritized list of questions that matter most to older adults' health in Alberta. Provincial researchers and research funders should consider these unmet knowledge needs of end-users in future endeavours.


Assuntos
Atenção à Saúde , Prioridades em Saúde , Participação do Paciente , Projetos de Pesquisa , Participação dos Interessados , Idoso , Alberta/epidemiologia , Cuidadores/estatística & dados numéricos , Atenção à Saúde/métodos , Atenção à Saúde/normas , Feminino , Pessoal de Saúde/estatística & dados numéricos , Prioridades em Saúde/organização & administração , Prioridades em Saúde/estatística & dados numéricos , Humanos , Colaboração Intersetorial , Masculino , Determinação de Necessidades de Cuidados de Saúde , Pesquisa , Assistentes Sociais/estatística & dados numéricos
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