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New approach to approving natural health products inadequate, says British Columbia Medical Association.

https://arctichealth.org/en/permalink/ahliterature116198
Source
CMAJ. 2013 Mar 19;185(5):379
Publication Type
Article
Date
Mar-19-2013

Rates of stillbirth by gestational age and cause in Inuit and First Nations populations in Quebec.

https://arctichealth.org/en/permalink/ahliterature116199
Source
CMAJ. 2013 Apr 2;185(6):E256-62
Publication Type
Article
Date
Apr-2-2013
Author
Nathalie Auger
Alison L Park
Hamado Zoungrana
Nancy Gros-Louis McHugh
Zhong-Cheng Luo
Author Affiliation
Institut national de santé publique du Québec, Montréal, Que. nathalie.auger@inspq.qc.ca
Source
CMAJ. 2013 Apr 2;185(6):E256-62
Date
Apr-2-2013
Language
English
Publication Type
Article
Keywords
Adult
Cause of Death
Female
Gestational Age
Humans
Indians, North American - statistics & numerical data
Inuits - statistics & numerical data
Odds Ratio
Pregnancy
Pregnancy Complications - ethnology
Quebec - epidemiology
Retrospective Studies
Stillbirth - ethnology
Young Adult
Abstract
Inuit and First Nations populations have higher rates of stillbirth than non-Aboriginal populations in Canada do, but little is known about the timing and cause of stillbirth in Aboriginal populations. We compared gestational age- and cause-specific stillbirth rates in Inuit and First Nations populations with the rates in the non-Aboriginal population in Quebec.
Data included singleton stillbirths and live births at 24 or more gestational weeks among Quebec residents from 1981 to 2009. We calculated odds ratios (ORs), rate differences and 95% confidence intervals (CIs) for the retrospective cohort of Inuit and First Nations births relative to non-Aboriginal births using fetuses at risk (i.e., ongoing pregnancies) as denominators and adjusting for maternal characteristics. The main outcomes were stillbirth by gestational age (24-27, 28-36, = 37 wk) and cause of death.
Rates of stillbirth per 1000 births were greater among Inuit (6.8) and First Nations (5.7) than among non-Aboriginal (3.6) residents. Relative to the non-Aboriginal population, the risk of stillbirth was greater at term (= 37 wk) than before term for both Inuit (OR 3.1, 95% CI 1.9 to 4.8) and First Nations (OR 2.6, 95% CI 2.1 to 3.3) populations. Causes most strongly associated with stillbirth were poor fetal growth, placental disorders and congenital anomalies among the Inuit, and hypertension and diabetes among the First Nations residents.
Stillbirth rates in Aboriginal populations were particularly high at term gestation. Poor fetal growth, placental disorders and congenital anomalies were important causes of stillbirth among the Inuit, and diabetic and hypertensive complications were important causes in the First Nations population. Prevention may require improvements in pregnancy and obstetric care.
Notes
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PubMed ID
23422443 View in PubMed
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Amphetamine abuse in Sweden: subject demographics, changes in blood concentrations over time, and the types of coingested substances.

https://arctichealth.org/en/permalink/ahliterature116200
Source
J Clin Psychopharmacol. 2013 Apr;33(2):248-52
Publication Type
Article
Date
Apr-2013
Author
Alan Wayne Jones
Anita Holmgren
Author Affiliation
Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden. wayne.jones@LIU.se
Source
J Clin Psychopharmacol. 2013 Apr;33(2):248-52
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Adult
Amphetamine - administration & dosage - adverse effects - blood
Amphetamine-Related Disorders - epidemiology
Automobile Driving
Cause of Death
Databases, Factual
Drug Interactions
Female
Forensic Toxicology
Humans
Male
Middle Aged
Sex Factors
Substance-Related Disorders - epidemiology
Sweden - epidemiology
Time Factors
Young Adult
Abstract
Amphetamine is a major drug of abuse in Sweden and in the other Nordic countries. The demographics of amphetamine abusers in Sweden and the concentrations of this stimulant in blood are reported for 10 years of forensic blood samples (2001-2010). Using a forensic toxicology database (TOXBASE), we studied 1183 amphetamine-related deaths, 20,452 users of illicit drugs, and 47,366 people arrested for driving under the influence of drugs (DUID). Most amphetamine abusers were male (82%-87%), and their average age was 33 to 39 years with males being 2 to 3 years older than females (P
PubMed ID
23422398 View in PubMed
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Reducing delay of carotid endarterectomy in acute ischemic stroke patients: a nationwide initiative.

https://arctichealth.org/en/permalink/ahliterature116201
Source
Stroke. 2013 Mar;44(3):686-90
Publication Type
Article
Date
Mar-2013
Author
Agnes Hauschultz Witt
Soren Paaske Johnsen
Leif Panduro Jensen
Allan Kornmaaler Hansen
Heidi Holmager Hundborg
Grethe Andersen
Author Affiliation
Department of Neurology, Aarhus University Hospital, Aarhus, Denmark. agnes_witt@dadlnet.dk
Source
Stroke. 2013 Mar;44(3):686-90
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Aged
Carotid Arteries - ultrasonography
Cohort Studies
Denmark
Endarterectomy, Carotid
Female
Humans
Male
Registries
Retrospective Studies
Stroke - surgery
Time Factors
Treatment Outcome
Abstract
Guidelines recommend carotid endarterectomy (CEA) within 2 weeks from an ischemic event. However, previous studies have shown that only a minority of patients undergo CEA within this period. The aim of this study was to examine the effect of a multidisciplinary nationwide initiative aimed at reducing time to CEA after acute ischemic stroke.
We examined a historic population-based observational cohort based on individual patient-level records from the Danish Stroke Registry and the Danish Vascular Registry. The implementation of early ultrasound examination of the carotids (within 4 days from admission) in medical departments coupled with fast CEA after referral to a department of vascular surgery were monitored and audited systematically from 2008 and onward.
A total of 813 acute ischemic stroke patients underwent CEA during 2007-2010. The percentage of patients undergoing CEA within 2 weeks increased from 13% in 2007 to 47% in 2010 (adjusted odds ratio, 5.8 [95% CI, 3.4-10.1]). The overall median time decreased from 31 days to 16 days. The percentage of relevant acute ischemic stroke patients receiving early ultrasound examination of the carotids increased from 41% in 2008 to 72% in 2010. The time from referral to operation at a vascular department was reduced by ˜40%.
Establishing time limits of 4 days to ultrasound examination of the carotids and of 2 weeks to CEA from onset of stroke followed by a systematic multidisciplinary monitoring and auditing of processes was associated with a substantial increase in the proportion of acute ischemic stroke patients who undergo CEA within 2 weeks in Denmark.
PubMed ID
23422089 View in PubMed
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The poorer cancer survival among the unmarried in Norway: is much explained by comorbidities?

https://arctichealth.org/en/permalink/ahliterature116202
Source
Soc Sci Med. 2013 Mar;81:42-52
Publication Type
Article
Date
Mar-2013
Author
Øystein Kravdal
Author Affiliation
Norwegian Institute of Public Health, Norway. okravdal@econ.uio.no
Source
Soc Sci Med. 2013 Mar;81:42-52
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Comorbidity
Female
Humans
Male
Marital Status - statistics & numerical data
Middle Aged
Neoplasms - mortality
Norway - epidemiology
Registries
Survival Analysis
Abstract
Studies from Norway and other countries have shown that the unmarried have poorer cancer survival than the married, given age, tumor site and stage at diagnosis. The objective of this investigation was to assess the importance of comorbidities for this difference, using disease indicators derived from the Norwegian Prescription Database (NorPD) and information on cancer and sociodemographic characteristics from various other registers, all of which cover the entire Norwegian population. Discrete-time hazard models for cancer mortality up to 2007 were estimated for all 22,925 men and 21,694 women diagnosed with 13 common types of cancer in 2005-7. There were 4898 cancer deaths among men and 4187 among women. Controlling for sociodemographic factors and tumor characteristics, the odds of dying from cancer among never-married men relative to the married was 1.56 (CI 1.41-1.74). The corresponding estimates for widowed and divorced were 1.16 (CI 1.05-1.28) and 1.27 (CI 1.15-1.40). For women, the odds ratios for these three groups were 1.47 (CI 1.29-1.67), 1.10 (CI 1.01-1.20) and 1.14 (CI 1.02-1.27). Several of the 24 indicators of diseases in the year before diagnosis were associated with cancer survival, but their inclusion reduced the excess mortality of the unmarried by only 1-5 percentage points, or about 10% as an overall relative figure. Similar results were found when the four most common cancers were analyzed separately, though there were some differences between them in the role played by the comorbidities. It is possible that important comorbidities are inadequately captured by the included indicators, and perhaps especially for the unmarried. Such concerns aside, the results suggest that the marital status differences in cancer survival to little extent are due to comorbidities (and the few disease risk factors that are also captured), but rather to various other "host factors" or to treatment or care.
PubMed ID
23422059 View in PubMed
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Accumulated occupational class and self-rated health. Can information on previous experience of class further our understanding of the social gradient in health?

https://arctichealth.org/en/permalink/ahliterature116203
Source
Soc Sci Med. 2013 Mar;81:26-33
Publication Type
Article
Date
Mar-2013
Author
Sara Kjellsson
Author Affiliation
Swedish Institute for Social Research SOFI, Stockholm University, SE-106 91 Stockholm, Sweden. sara.kjellsson@sofi.su.se
Source
Soc Sci Med. 2013 Mar;81:26-33
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Diagnostic Self Evaluation
Female
Health Status Disparities
Humans
Longitudinal Studies
Male
Middle Aged
Occupations - classification
Sweden
Abstract
Previous research has shown a social gradient in health with better health for people in more advantaged positions in society. This research has mainly been on the relationship between current position and health, or social position in childhood and health, but less is known about the potential accumulative impact of positions held in adulthood. In this paper I use the economic activity histories from the Swedish Level of Living survey to examine the relationship between accumulated occupational class positions and health. Step-wise linear probability models are used to investigate how to best capture the potential association between class experience and self-rated health (SRH), and whether the effect of current class is modified when measures of accumulated class are included. I then further test the potentially lasting association between previous exposure to the health risk of working class by analysing only individuals currently in higher or intermediate level service class; the classes under least exposure. I find a positive association between accumulated experiences of working class and less than good SRH. Furthermore, even for employees currently in non-manual positions the risk for less than good SRH increases with each added year of previous experience within working class. This suggests that the social gradient can be both accumulative and lasting, and that more information on the mechanisms of health disparities can be found by taking detailed information on peoples' pasts into account. Although gender differences in health are not a focus in this paper, results also indicate that the influence of class experiences on health might differ between men and women.
PubMed ID
23422057 View in PubMed
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Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals.

https://arctichealth.org/en/permalink/ahliterature116204
Source
Int J Qual Health Care. 2013 Apr;25(2):110-7
Publication Type
Article
Date
Apr-2013
Author
Carl-Ardy Dubois
Danielle D'amour
Eric Tchouaket
Sean Clarke
Michèle Rivard
Régis Blais
Author Affiliation
Faculty of Nursing, University of Montreal, Montreal, Canada. carl.ardy.dubois@umontreal.ca
Source
Int J Qual Health Care. 2013 Apr;25(2):110-7
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cross-Sectional Studies
Emergency Service, Hospital
Female
Humans
Logistic Models
Male
Medical Audit
Medical Errors - trends
Middle Aged
Models, Nursing
Models, organizational
Nursing Staff, Hospital - organization & administration
Odds Ratio
Outcome Assessment (Health Care)
Patient Safety
Quebec
Retrospective Studies
Young Adult
Abstract
To examine the associations of four distinct nursing care organizational models with patient safety outcomes.
Cross-sectional correlational study. Using a standardized protocol, patients' records were screened retrospectively to detect occurrences of patient safety-related events. Binary logistic regression was used to assess the associations of those events with four nursing care organizational models.
Twenty-two medical units in 11 hospitals in Quebec, Canada, were clustered into 4 nursing care organizational models: 2 professional models and 2 functional models.
Two thousand six hundred and ninety-nine were patients hospitalized for at least 48 h on the selected units.
Composite of six safety-related events widely-considered sensitive to nursing care: medication administration errors, falls, pneumonia, urinary tract infection, unjustified restraints and pressure ulcers. Events were ultimately sorted into two categories: events 'without major' consequences for patients and events 'with' consequences.
After controlling for patient characteristics, patient risk of experiencing one or more events (of any severity) and of experiencing an event with consequences was significantly lower, by factors of 25-52%, in both professional models than in the functional models. Event rates for both functional models were statistically indistinguishable from each other.
Data suggest that nursing care organizational models characterized by contrasting staffing, work environment and innovation characteristics may be associated with differential risk for hospitalized patients. The two professional models, which draw mainly on registered nurses (RNs) to deliver nursing services and reflect stronger support for nurses' professional practice, were associated with lower risks than are the two functional models.
PubMed ID
23422039 View in PubMed
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Delineation of target volumes and organs at risk in adjuvant radiotherapy of early breast cancer: national guidelines and contouring atlas by the Danish Breast Cancer Cooperative Group.

https://arctichealth.org/en/permalink/ahliterature116205
Source
Acta Oncol. 2013 May;52(4):703-10
Publication Type
Conference/Meeting Material
Article
Date
May-2013
Author
Mette H Nielsen
Martin Berg
Anders N Pedersen
Karen Andersen
Vladimir Glavicic
Erik H Jakobsen
Ingelise Jensen
Mirjana Josipovic
Ebbe L Lorenzen
Hanne M Nielsen
Lars Stenbygaard
Mette S Thomsen
Susanne Vallentin
Sune Zimmermann
Birgitte V Offersen
Author Affiliation
Department of Oncology, Odense University Hospital, Odense, Denmark. mette.m.nielsen@ouh.regionsyddanmark.dk
Source
Acta Oncol. 2013 May;52(4):703-10
Date
May-2013
Language
English
Publication Type
Conference/Meeting Material
Article
Keywords
Atlases as Topic
Breast Neoplasms - pathology - radiotherapy - surgery
Denmark
Female
Humans
Mastectomy, Segmental - legislation & jurisprudence - utilization
Middle Aged
Organ Size - physiology
Organs at Risk - pathology - radiation effects
Practice Guidelines as Topic
Radiotherapy Planning, Computer-Assisted - methods - standards
Radiotherapy, Adjuvant
Radiotherapy, Conformal - methods
Abstract
During the past decade planning of adjuvant radiotherapy (RT) of early breast cancer has changed from two-dimensional (2D) to 3D conformal techniques. In the planning computerised tomography (CT) scan both the targets for RT and the organs at risk (OARs) are visualised, enabling an increased focus on target dose coverage and homogeneity with only minimal dose to the OARs. To ensure uniform RT in the national prospective trials of the Danish Breast Cancer Cooperative Group (DBCG), a national consensus for the delineation of clinical target volumes (CTVs) and OARs was required.
A CT scan of a breast cancer patient after surgical breast conservation and axillary lymph node (LN) dissection was used for delineation. During multiple dummy-runs seven experienced radiation oncologists contoured all CTVs and OARs of interest in adjuvant breast RT. Two meetings were held in the DBCG Radiotherapy Committee to discuss the contouring and to approve a final consensus. The Dice similarity coefficient (DSC) was used to evaluate the delineation agreement before and after the consensus.
The consensus delineations of CTVs and OARs are available online and a table is presented with a contouring description of the individual volumes. The consensus provides recommendations for target delineation in a standard patient both in case of breast conservation or mastectomy. Before the consensus, the average value of the DSC was modest for most volumes, but high for the breast CTV and the heart. After the consensus, the DSC increased for all volumes.
The DBCG has provided the first national guidelines and a contouring atlas of CTVs and OARs definition for RT of early breast cancer. The DSC is a useful tool in quantifying the effect of the introduction of guidelines indicating improved inter-delineator agreement. This consensus will be used by the DBCG in our prospective trials.
PubMed ID
23421926 View in PubMed
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School nutritional capacity, resources and practices are associated with availability of food/beverage items in schools.

https://arctichealth.org/en/permalink/ahliterature116206
Source
Int J Behav Nutr Phys Act. 2013;10:26
Publication Type
Article
Date
2013
Author
Louise C Mâsse
Judith E de Niet
Author Affiliation
University of British Columbia, School of Population and Public Health, F508-4480 Oak Street, Vancouver, BC V6H 3V4, Canada. lmasse@cfri.ubc.ca
Source
Int J Behav Nutr Phys Act. 2013;10:26
Date
2013
Language
English
Publication Type
Article
Keywords
Adolescent
Beverages
British Columbia
Child
Climate
Diet
Environment
Food Services - standards
Food Supply
Guidelines as Topic
Health Resources
Humans
Logistic Models
Nutrition Policy
Obesity - prevention & control
Odds Ratio
Organizational Policy
Residence Characteristics
Schools
Abstract
The school food environment is important to target as less healthful food and beverages are widely available at schools. This study examined whether the availability of specific food/beverage items was associated with a number of school environmental factors.
Principals from elementary (n=369) and middle/high schools (n=118) in British Columbia (BC), Canada completed a survey measuring characteristics of the school environment. Our measurement framework integrated constructs from the Theories of Organizational Change and elements from Stillman's Tobacco Policy Framework adapted for obesity prevention. Our measurement framework included assessment of policy institutionalization of nutritional guidelines at the district and school levels, climate, nutritional capacity and resources (nutritional resources and participation in nutritional programs), nutritional practices, and school community support for enacting stricter nutritional guidelines. We used hierarchical mixed-effects logistic regression analyses to examine associations with the availability of fruit, vegetables, pizza/hamburgers/hot dogs, chocolate candy, sugar-sweetened beverages, and french fried potatoes.
In elementary schools, fruit and vegetable availability was more likely among schools that have more nutritional resources (OR=6.74 and 5.23, respectively). In addition, fruit availability in elementary schools was highest in schools that participated in the BC School Fruit and Vegetable Nutritional Program and the BC Milk program (OR=4.54 and OR=3.05, respectively). In middle/high schools, having more nutritional resources was associated with vegetable availability only (OR=5.78). Finally, middle/high schools that have healthier nutritional practices (i.e., which align with upcoming provincial/state guidelines) were less likely to have the following food/beverage items available at school: chocolate candy (OR=?.80) and sugar-sweetened beverages (OR=?.76).
School nutritional capacity, resources, and practices were associated with the availability of specific food/beverage items in BC public schools. Policies targeting the school environment are increasingly being considered as one of the strategies used to address childhood obesity, as a result it is important to further understand the factors associated with the availability of specific food/beverage items at school.
Notes
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PubMed ID
23421918 View in PubMed
Less detail

Translating and testing the Alberta context tool for use among nurses in Swedish elder care.

https://arctichealth.org/en/permalink/ahliterature116207
Source
BMC Health Serv Res. 2013;13:68
Publication Type
Article
Date
2013
Author
Ann Catrine Eldh
Anna Ehrenberg
Janet E Squires
Carole A Estabrooks
Lars Wallin
Author Affiliation
Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden. anncatrine.eldh@ki.se
Source
BMC Health Serv Res. 2013;13:68
Date
2013
Language
English
Publication Type
Article
Keywords
Aged
Alberta
Evidence-Based Medicine
Female
Geriatric Nursing
Humans
Male
Nurses
Pilot Projects
Questionnaires
Sweden
Technology Transfer
Abstract
There is emerging evidence that context is important for successful transfer of research knowledge into health care practice. The Alberta Context Tool (ACT) is a Canadian developed research-based instrument that assesses 10 modifiable concepts of organizational context considered important for health care professionals' use of evidence. Swedish and Canadian health care have similarities in terms of organisational and professional aspects, suggesting that the ACT could be used for measuring context in Sweden. This paper reports on the translation of the ACT to Swedish and a testing of preliminary aspects of its validity, acceptability and reliability in Swedish elder care.
The ACT was translated into Swedish and back-translated into English before being pilot tested in ten elder care facilities for response processes validity, acceptability and reliability (Cronbach's alpha). Subsequently, further modification was performed.
In the pilot test, the nurses found the questions easy to respond to (52%) and relevant (65%), yet the questions' clarity were mainly considered 'neither clear nor unclear' (52%). Missing data varied between 0 (0%) and 19 (12%) per item, the most common being 1 missing case per item (15 items). Internal consistency (Cronbach's Alpha?>?.70) was reached for 5 out of 8 contextual concepts. Translation and back translation identified 21 linguistic- and semantic related issues and 3 context related deviations, resolved by developers and translators.
Modifying an instrument is a detailed process, requiring time and consideration of the linguistic and semantic aspects of the instrument, and understanding of the context where the instrument was developed and where it is to be applied. A team, including the instrument's developers, translators, and researchers is necessary to ensure a valid translation. This study suggests preliminary validity, reliability and acceptability evidence for the ACT when used with nurses in Swedish elder care.
Notes
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PubMed ID
23421736 View in PubMed
Less detail

298609 records – page 1 of 29861.