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Addressing the emergence of pediatric vaccination concerns: recommendations from a Canadian policy analysis.

https://arctichealth.org/en/permalink/ahliterature169730
Source
Can J Public Health. 2006 Mar-Apr;97(2):139-41
Publication Type
Article
Author
Kumanan Wilson
Meredith Barakat
Edward Mills
Paul Ritvo
Heather Boon
Sunita Vohra
Alejandro R Jadad
Allison McGeer
Author Affiliation
Department of Medicine, University of Toronto, Toronto, ON. Kumanan.Wilson@uhn.on.ca
Source
Can J Public Health. 2006 Mar-Apr;97(2):139-41
Language
English
Publication Type
Article
Keywords
Adverse Drug Reaction Reporting Systems
Attitude to Health
Canada
Child
Compensation and Redress
Health Policy
Humans
Immunization Programs
Liability, Legal - economics
Organizational Objectives
Pediatrics
Public Health Administration
Risk assessment
Trust
Vaccines - administration & dosage - adverse effects
Abstract
Ever since the advent of pediatric vaccination, individuals have expressed concerns about both its risks and benefits. These concerns have once again resurfaced among some segments of the population and could potentially undermine national vaccination programs. The views of the public, however, must be considered and respected in the formulation of vaccination policy. We have conducted an analysis of the pediatric vaccination "debate" in the Canadian context. We believe that there is common ground between those who support pediatric vaccination and those who are concerned about these programs. Based on our findings, we believe that the goal of public health authorities should be to maintain trust in vaccines by continuing to meet certain reciprocal responsibilities. To do so, we recommend the following: 1) increased investment in adverse event reporting systems; 2) request for proposals for consideration of a no-fault compensation program; 3) developing pre-emptive strategies to deal with potential vaccine risks; 4) further examination of mechanisms to improve communication between physicians and parents concerned about vaccination. All of these approaches would require additional investment in pediatric vaccination. However, such an investment is easy to justify given the benefits offered by pediatric vaccination and the ramifications of failing to maintain confidence in vaccination programs or missing a vaccine-related adverse event.
Notes
Comment In: Can J Public Health. 2006 Mar-Apr;97(2):86-916619991
PubMed ID
16620003 View in PubMed
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Adverse events associated with high-dose ribavirin: evidence from the Toronto outbreak of severe acute respiratory syndrome.

https://arctichealth.org/en/permalink/ahliterature164482
Source
Pharmacotherapy. 2007 Apr;27(4):494-503
Publication Type
Article
Date
Apr-2007
Author
Matthew P Muller
Linda Dresser
Janet Raboud
Allison McGeer
Elizabeth Rea
Susan E Richardson
Tony Mazzulli
Mark Loeb
Marie Louie
Author Affiliation
Department of Microbiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. mmuller@mtsinai.on.ca
Source
Pharmacotherapy. 2007 Apr;27(4):494-503
Date
Apr-2007
Language
English
Publication Type
Article
Keywords
Adrenal Cortex Hormones - adverse effects - therapeutic use
Adult
Adverse Drug Reaction Reporting Systems - statistics & numerical data
Anemia - chemically induced
Antiviral Agents - administration & dosage - adverse effects - therapeutic use
Bradycardia - chemically induced
Canada - epidemiology
Cohort Studies
Disease Outbreaks
Dose-Response Relationship, Drug
Female
Humans
Injections, Intravenous
Magnesium Deficiency - chemically induced
Male
Medical Records Systems, Computerized - statistics & numerical data
Middle Aged
Retrospective Studies
Ribavirin - administration & dosage - adverse effects - therapeutic use
Severe Acute Respiratory Syndrome - drug therapy - epidemiology
Tetany - chemically induced
Treatment Outcome
Abstract
To distinguish adverse events related to ribavirin therapy from those attributable to severe acute respiratory syndrome (SARS), and to determine the rate of potential ribavirin-related adverse events.
Retrospective cohort study.
Hospitals in Toronto, Ontario, Canada.
A cohort of 306 patients with confirmed or probable SARS, 183 of whom received ribavirin and 123 of whom did not, between February 23, 2003, and July 1, 2003. Of the 183 treated patients, 155 (85%) received very high-dose ribavirin; the other 28 treated patients received lower-dose regimens.
Data on all patients with SARS admitted to hospitals in Toronto were abstracted from charts and electronic databases onto a standardized form by trained research nurses. Logistic regression was used to evaluate the association between ribavirin use and each adverse event (progressive anemia, hypomagnesemia, hypocalcemia, bradycardia, transaminitis, and hyperamylasemia) after adjusting for SARS-related prognostic factors and corticosteroid use. In the primary logistic regression analysis, ribavirin use was strongly associated with anemia (odds ratio [OR] 3.0, 99% confidence interval [CI] 1.5-6.1, p
PubMed ID
17381375 View in PubMed
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Alternative methods of estimating an incubation distribution: examples from severe acute respiratory syndrome.

https://arctichealth.org/en/permalink/ahliterature165570
Source
Epidemiology. 2007 Mar;18(2):253-9
Publication Type
Article
Date
Mar-2007
Author
Benjamin J Cowling
Matthew P Muller
Irene O L Wong
Lai-Ming Ho
Marie Louie
Allison McGeer
Gabriel M Leung
Author Affiliation
Department of Community Medicine, School of Public Health, University of Hong Kong, Pokfulam, Hong Kong. bcowling@hku.hk
Source
Epidemiology. 2007 Mar;18(2):253-9
Date
Mar-2007
Language
English
Publication Type
Article
Keywords
Communicable Disease Control - methods
Communicable Diseases, Emerging - epidemiology
Contact Tracing - methods
Disease Outbreaks
Hong Kong - epidemiology
Humans
Models, Biological
Ontario - epidemiology
Quarantine
Regression Analysis
Severe Acute Respiratory Syndrome - epidemiology - transmission
Time Factors
Abstract
Accurate and precise estimates of the incubation distribution of novel, emerging infectious diseases are vital to inform public health policy and to parameterize mathematical models.
We discuss and compare different methods of estimating the incubation distribution allowing for interval censoring of exposures, using data from the severe acute respiratory syndrome (SARS) epidemic in 2003 as an example.
Combining data on unselected samples of 149 and 168 patients with defined exposure intervals from Toronto and Hong Kong, respectively, we estimated the mean and variance of the incubation period to be 5.1 day and 18.3 days and the 95th percentile to be 12.9 days. We conducted multiple linear regression on the log incubation times and found that incubation was significantly longer in Toronto than in Hong Kong and in older compared with younger patients, while it was significantly shorter in healthcare workers than in other patients.
Our findings suggest subtle but important heterogeneities in the incubation period of SARS among different strata of patients. Robust estimation of the incubation period should be independently carried out in different settings and subgroups for novel human pathogens using valid statistical methods.
PubMed ID
17235210 View in PubMed
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Another look at the human papillomavirus vaccine experience in Canada.

https://arctichealth.org/en/permalink/ahliterature132021
Source
Am J Public Health. 2011 Oct;101(10):1850-7
Publication Type
Article
Date
Oct-2011
Author
Catherine L Mah
Raisa B Deber
Astrid Guttmann
Allison McGeer
Murray Krahn
Author Affiliation
Department of Health Policy, Management and Evaluation at the University of Toronto, Toronto, Ontario, Canada. catherine.mah@utoronto.ca
Source
Am J Public Health. 2011 Oct;101(10):1850-7
Date
Oct-2011
Language
English
Publication Type
Article
Keywords
Canada
Cancer Vaccines - therapeutic use
Health Policy
Humans
Immunization Programs - organization & administration
Mandatory Programs
Papillomavirus Infections - prevention & control
Papillomavirus Vaccines - therapeutic use
Policy Making
Politics
Public Health
United States
Women's health
Abstract
Policy debates about immunization frequently focus on classic trade-offs between individual versus collective well-being. Publicly funded immunization programs are usually justified on the basis of widespread public benefit with minimal individual risk. We discuss the example of the policy process surrounding the adoption of the human papillomavirus (HPV) vaccine in Canada to consider whether public good arguments continue to dominate immunization policymaking. Specifically, we show how a range of stakeholders framed HPV vaccination as a personal-rather than a public-matter, despite the absence of a controversy over mandatory immunization as was the case in the United States. Our findings suggest an erosion of the persuasiveness of public good arguments around collective immunization programs in the policy discourse.
Notes
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PubMed ID
21852642 View in PubMed
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Antimicrobial susceptibilities of health care-associated and community-associated strains of methicillin-resistant Staphylococcus aureus from hospitalized patients in Canada, 1995 to 2008.

https://arctichealth.org/en/permalink/ahliterature144854
Source
Antimicrob Agents Chemother. 2010 May;54(5):2265-8
Publication Type
Article
Date
May-2010
Author
Andrew E Simor
Lisa Louie
Christine Watt
Denise Gravel
Michael R Mulvey
Jennifer Campbell
Allison McGeer
Elizabeth Bryce
Mark Loeb
Anne Matlow
Author Affiliation
Department of Microbiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. andrew.simor@sunnybrook.ca
Source
Antimicrob Agents Chemother. 2010 May;54(5):2265-8
Date
May-2010
Language
English
Publication Type
Article
Keywords
Anti-Bacterial Agents - therapeutic use
Canada - epidemiology
Community-Acquired Infections - drug therapy - epidemiology
Cross Infection - drug therapy - epidemiology
Hospitalization - statistics & numerical data
Humans
Incidence
Methicillin Resistance
Methicillin-Resistant Staphylococcus aureus - drug effects
Public Health - statistics & numerical data
Staphylococcal Infections - drug therapy - epidemiology
Abstract
We determined the in vitro antimicrobial susceptibilities of 7,942 methicillin-resistant Staphylococcus aureus (MRSA) isolates obtained from patients hospitalized in 48 Canadian hospitals from 1995 to 2008. Regional variations in susceptibilities were identified. The dissemination of community-associated strains in Canada appears to have contributed to increased susceptibility of MRSA to several non-beta-lactam antimicrobial agents in the past decade. Reduced susceptibility to glycopeptides was not identified.
Notes
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PubMed ID
20231402 View in PubMed
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Antiviral therapy and outcomes of influenza requiring hospitalization in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature159386
Source
Clin Infect Dis. 2007 Dec 15;45(12):1568-75
Publication Type
Article
Date
Dec-15-2007
Author
Allison McGeer
Karen A Green
Agron Plevneshi
Altynay Shigayeva
Nilofar Siddiqi
Janet Raboud
Donald E Low
Author Affiliation
Toronto Medical Laboratories and Mount Sinai Hospital, Toronto, ON M5G 1X5 Canada. amcgeer@mtsinai.on.ca
Source
Clin Infect Dis. 2007 Dec 15;45(12):1568-75
Date
Dec-15-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Antiviral agents - therapeutic use
Child
Cohort Studies
Female
Hospitalization
Humans
Influenza, Human - drug therapy - mortality
Male
Middle Aged
Ontario
Population Surveillance
Prospective Studies
Treatment Outcome
Abstract
We conducted a prospective cohort study to assess the impact of antiviral therapy on outcomes of patients hospitalized with influenza in southern Ontario, Canada.
Patients admitted to Toronto Invasive Bacterial Diseases Network hospitals with laboratory-confirmed influenza from 1 January 2005 through 31 May 2006 were enrolled in the study. Demographic and medical data were collected by patient and physician interview and chart review. The main outcome evaluated was death within 15 days after symptom onset.
Data were available for 512 of 541 eligible patients. There were 185 children (
Notes
Comment In: Clin Infect Dis. 2008 May 15;46(10):1628-9; author reply 1629-3018419504
Comment In: Clin Infect Dis. 2008 Apr 15;46(8):1323-418444878
PubMed ID
18190317 View in PubMed
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Behind the mask: Determinants of nurse's adherence to facial protective equipment.

https://arctichealth.org/en/permalink/ahliterature125485
Source
Am J Infect Control. 2013 Jan;41(1):8-13
Publication Type
Article
Date
Jan-2013
Author
Kathryn Nichol
Allison McGeer
Philip Bigelow
Linda O'Brien-Pallas
James Scott
D Linn Holness
Author Affiliation
Occupational Health Services Program, St Michael's Hospital, Toronto, ON, Canada. k.nichol@utoronto.ca
Source
Am J Infect Control. 2013 Jan;41(1):8-13
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Attitude of Health Personnel
Canada
Cross Infection - prevention & control
Cross-Sectional Studies
Female
Guideline Adherence
Humans
Male
Masks - utilization
Middle Aged
Nurses
Occupational Diseases - prevention & control
Respiratory Tract Infections - prevention & control
Young Adult
Abstract
As the predominant occupation in the health sector and as the health worker with the most patient interaction, nurses are at high risk for occupational transmission of communicable respiratory illness. The use of facial protective equipment (FPE) is an important strategy to prevent occupational transmission.
A 2-phased study was conducted to examine nurse's adherence to recommended use of FPE. Phase 1 was a cross-sectional survey of nurses in selected units of 6 acute care hospitals in Toronto, Canada. Phase 2 was a direct observational study of critical care nurses.
Of the 1,074 nurses who completed surveys (82% response rate), 44% reported adherence to recommended use of FPE. Multivariable analysis revealed 6 predictors of adherence: unit type, frequency of equipment use, equipment availability, training, organizational support, and communication. Following the survey, 100 observations in 14 intensive care units were conducted that revealed a 44% competence rate with proper use of N95 respirators and knowledge as a significant predictor of competence.
Whereas increasing knowledge should enhance competence, strategies to improve adherence to recommended use of FPE in a busy and complex health care setting should focus on ready availability of equipment, training and fit testing, organizational support for worker health and safety, and good communication practices.
PubMed ID
22475568 View in PubMed
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Beliefs and practices of Ontario midwives about influenza immunization.

https://arctichealth.org/en/permalink/ahliterature176295
Source
Vaccine. 2005 Feb 18;23(13):1574-8
Publication Type
Article
Date
Feb-18-2005
Author
Todd Lee
Refik Saskin
Margaret McArthur
Allison McGeer
Author Affiliation
Faculty of Medicine, 600 University Avenue, Room 1460, University of Toronto, Toronto, Ontario, Canada M5G 1X5.
Source
Vaccine. 2005 Feb 18;23(13):1574-8
Date
Feb-18-2005
Language
English
Publication Type
Article
Keywords
Confidence Intervals
Culture
Health Knowledge, Attitudes, Practice
Health Surveys
Humans
Immunization - psychology - statistics & numerical data - trends
Influenza Vaccines - therapeutic use
Influenza, Human - epidemiology - prevention & control
Midwifery - education - standards - statistics & numerical data
Odds Ratio
Ontario
Abstract
With an increasing number of births in Ontario being conducted by midwives, we undertook a survey of the beliefs and practices of 256 licensed Ontario midwives and student midwives about immunization, particularly against influenza. Overall, 42.9% (48/112) of midwives considered that they knew a lot about immunization; however, 36.2% (38/105) reported no education about immunization during their training. A small majority (55.9%) were in favour of vaccination in general and only 2 of 113 reported spending more than 1h discussing vaccination with their clients. Only 26.9% reported having received influenza vaccine in the previous season (compared to 60% of all health care workers in Ontario). Overall, only 37% believed that influenza vaccine is effective, and 22% believed that the vaccine was a greater risk than influenza. Graduation in 1998 or prior was associated with belief in the effectiveness in vaccine, having been vaccinated, and recommending vaccine to clients. Midwives who reported being immunized themselves were more likely to believe in the safety and efficacy of influenza vaccine, and to recommend vaccination to their clients (26% versus 3%, p=0.001). If greater attention is not focused on promoting the utility of immunization to midwives, the success of population immunization programs may be compromised.
PubMed ID
15694509 View in PubMed
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Clinical and epidemiologic features of group a streptococcal pneumonia in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature186636
Source
Arch Intern Med. 2003 Feb 24;163(4):467-72
Publication Type
Article
Date
Feb-24-2003
Author
Matthew P Muller
Donald E Low
Karen A Green
Andrew E Simor
Mark Loeb
Daniel Gregson
Allison McGeer
Author Affiliation
Department of Microbiology, Mount Sinai Hospital, 600 University Ave, Toronto, Ontario, Canada M5G 1X5.
Source
Arch Intern Med. 2003 Feb 24;163(4):467-72
Date
Feb-24-2003
Language
English
Publication Type
Article
Keywords
Chi-Square Distribution
Cross Infection - epidemiology - microbiology
Disease Outbreaks
Fasciitis, Necrotizing - epidemiology - microbiology
Hospital Mortality
Humans
Incidence
Ontario - epidemiology
Pneumonia - epidemiology - microbiology
Population Surveillance
Risk factors
Shock, Septic - epidemiology - microbiology
Streptococcal Infections - epidemiology
Streptococcus pyogenes - classification - isolation & purification
Abstract
Since the 1960s, group A streptococcus (GAS) has accounted for less than 1% of cases of community-acquired pneumonia. During the past 2 decades there has been a resurgence of invasive GAS infection, but no large study of GAS pneumonia has been performed.
To determine the clinical and epidemiologic features of GAS pneumonia, we conducted prospective, population-based surveillance of all invasive GAS infection in residents of Ontario from January 1, 1992, through December 31, 1999.
Of 2079 cases of invasive GAS infection, 222 (11%) represented GAS pneumonia. The incidence of GAS pneumonia ranged from 0.16 per 100 000 in 1992 to 0.35 per 100 000 in 1999. Most cases were community acquired (81%). Forty-four percent of nursing home-acquired cases occurred during outbreaks. The case fatality rate was 38% for GAS pneumonia, compared with 12% for the entire cohort with invasive GAS infection and 26% for patients with necrotizing fasciitis. The presence of streptococcal toxic shock syndrome (odds ratio, 19; 95% confidence interval, 8.4-42; P =.001) and increasing age (odds ratio per decade, 1.45; 95% confidence interval, 1.2-1.7; P
Notes
Comment In: Arch Intern Med. 2003 Sep 22;163(17):2101; author reply 2101-214504126
PubMed ID
12588207 View in PubMed
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Clinical and epidemiologic features of methicillin-resistant Staphylococcus aureus in elderly hospitalized patients.

https://arctichealth.org/en/permalink/ahliterature172065
Source
Infect Control Hosp Epidemiol. 2005 Oct;26(10):838-41
Publication Type
Article
Date
Oct-2005
Author
Andrew E Simor
Marianna Ofner-Agostini
Shirley Paton
Allison McGeer
Mark Loeb
Elizabeth Bryce
Michael Mulvey
Author Affiliation
Department of Microbiology, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, Canada. andrew.simor@sw.ca
Source
Infect Control Hosp Epidemiol. 2005 Oct;26(10):838-41
Date
Oct-2005
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Canada - epidemiology
Cross Infection - epidemiology
Female
Hospitals - statistics & numerical data
Humans
Logistic Models
Male
Methicillin Resistance
Middle Aged
Multivariate Analysis
Population Surveillance
Risk factors
Staphylococcal Infections - epidemiology
Abstract
We describe characteristics of elderly patients with MRSA identified in 37 Canadian hospitals between 1995 and 2002. Of these inpatients, 6,613 (66%) were older than 65 years. They were more likely than younger patients to have been colonized without infection and to have had MRSA isolated from urine or the perineum. The epidemiology and clinical features of these patients is distinct from that of younger patients.
PubMed ID
16276960 View in PubMed
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85 records – page 1 of 9.