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Adverse pregnancy outcomes among foreign-born Canadians.

https://arctichealth.org/en/permalink/ahliterature135715
Source
J Obstet Gynaecol Can. 2011 Mar;33(3):207-15
Publication Type
Article
Date
Mar-2011
Author
Rajiv R Shah
Joel G Ray
Nathan Taback
Filomena Meffe
Richard H Glazier
Author Affiliation
Department of Obstetrics and Gynaecology, St. Michael's Hospital, University of Toronto, Toronto, ON.
Source
J Obstet Gynaecol Can. 2011 Mar;33(3):207-15
Date
Mar-2011
Language
English
Publication Type
Article
Keywords
Adult
Canada - epidemiology
Cesarean Section
Emigrants and Immigrants
Female
Humans
Infant, Low Birth Weight
Infant, Newborn
Pregnancy
Premature Birth - ethnology
Retrospective Studies
Young Adult
Abstract
Numerous non-Canadian studies have shown that immigrant women experience higher rates of adverse maternal and perinatal events than the general non-immigrant population. Limited information about the pregnancy outcomes of immigrant Canadian women is available.
We conducted a retrospective cohort study at St. Michael's Hospital between October 2002 and June 2006 to estimate the risk of adverse obstetrical and perinatal outcomes among foreign-born women residing in Toronto. The main study outcomes were the incidences of preterm delivery between 32 and 36 completed weeks' gestation, low infant birth weight, and delivery by Caesarean section.
Compared with Canadian-born women, those who were foreign-born had an associated adjusted odds ratio of 0.85 (95% CI 0.64 to 1.14) for preterm delivery, 1.92 (95% CI 1.29 to 2.85) for low infant birth weight, and 1.16 (95% CI 1.01 to 1.34) for delivery by Caesarean section.
In this study, foreign-born women had a non-significantly lower risk of preterm birth, but a significantly higher risk of low birth weight infants and Caesarean section than Canadian-born women. In this urban setting, recent immigrant women have worse pregnancy outcomes, warranting increased attention to this group during antenatal and intrapartum care.
PubMed ID
21453560 View in PubMed
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Age- and sex-related prevalence of diabetes mellitus among immigrants to Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature144119
Source
CMAJ. 2010 May 18;182(8):781-9
Publication Type
Article
Date
May-18-2010
Author
Maria Isabella Creatore
Rahim Moineddin
Gillian Booth
Doug H Manuel
Marie DesMeules
Sarah McDermott
Richard H Glazier
Author Affiliation
Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Universityof Toronto, Toronto, Ont.
Source
CMAJ. 2010 May 18;182(8):781-9
Date
May-18-2010
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Diabetes Mellitus - epidemiology
Educational Status
Emigrants and Immigrants - statistics & numerical data
Female
Humans
Logistic Models
Male
Middle Aged
Ontario - epidemiology
Population Surveillance
Prevalence
Risk assessment
Risk factors
Sex Distribution
Social Class
Abstract
The majority of immigrants to Canada originate from the developing world, where the most rapid increase in prevalence of diabetes mellitus is occurring. We undertook a population-based study involving immigrants to Ontario, Canada, to evaluate the distribution of risk for diabetes in this population.
We used linked administrative health and immigration records to calculate age-specific and age-adjusted prevalence rates among men and women aged 20 years or older in 2005. We compared rates among 1,122,771 immigrants to Ontario by country and region of birth to rates among long-term residents of the province. We used logistic regression to identify and quantify risk factors for diabetes in the immigrant population.
After controlling for age, immigration category, level of education, level of income and time since arrival, we found that, as compared with immigrants from western Europe and North America, risk for diabetes was elevated among immigrants from South Asia (odds ratio [OR] for men 4.01, 95% CI 3.82-4.21; OR for women 3.22, 95% CI 3.07-3.37), Latin America and the Caribbean (OR for men 2.18, 95% CI 2.08-2.30; OR for women 2.40, 95% CI: 2.29-2.52), and sub-Saharan Africa (OR for men 2.31, 95% CI 2.17-2.45; OR for women 1.83, 95% CI 1.72-1.95). Increased risk became evident at an early age (35-49 years) and was equally high or higher among women as compared with men. Lower socio-economic status and greater time living in Canada were also associated with increased risk for diabetes.
Recent immigrants, particularly women and immigrants of South Asian and African origin, are at high risk for diabetes compared with long-term residents of Ontario. This risk becomes evident at an early age, suggesting that effective programs for prevention of diabetes should be developed and targeted to immigrants in all age groups.
Notes
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PubMed ID
20403889 View in PubMed
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Age- and sex-specific income gradients in alcohol-related hospitalization rates in an urban area.

https://arctichealth.org/en/permalink/ahliterature177156
Source
Ann Epidemiol. 2005 Jan;15(1):56-63
Publication Type
Article
Date
Jan-2005
Author
Stephen W Hwang
Mohammad M Agha
Maria I Creatore
Richard H Glazier
Author Affiliation
Inner City Health Research Unit, St. Michael's Hospital, Toronto, Ontario, Canada. hwangs@smh.toronto.on.ca
Source
Ann Epidemiol. 2005 Jan;15(1):56-63
Date
Jan-2005
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Alcohol-Related Disorders - economics - epidemiology
Female
Hospitalization - statistics & numerical data
Humans
Income
Male
Middle Aged
Ontario - epidemiology
Residence Characteristics
Social Class
Urban Health - statistics & numerical data
Abstract
This study examines the effects of age and sex on the relationship between neighborhood income and alcohol-related hospitalization rates in a large urban area.
Adults in Toronto, Canada, who were hospitalized with an alcohol-related condition between 1995 and 1998 were identified using discharge diagnoses. Income quintiles were determined based on area of residence. Annual rates of hospitalization for alcohol-related conditions per 10,000 individuals were calculated.
Rates of hospitalization with a primary diagnosis of an alcohol-related condition were similar among men age 20 to 39 in all incomes quintiles, but were inversely associated with income among men age 40 to 64 (28.8 and 13.3 per 10,000 in the lowest and highest income quintiles). Among women age 40 to 64, the lowest income quintile had the highest hospitalization rate (12.1 per 10,000), but women in all other income quintiles had relatively low hospitalization rates (5.9 to 7.7 per 10,000). As age increased above 65 years, rates of hospitalization with a primary diagnosis of an alcohol-related condition decreased or stabilized in both men and women.
The inverse association between income level and alcohol-related hospitalization rates becomes apparent after age 40. A gradient in hospitalization rates is seen in men across all income levels, but in women a prominent effect is seen only in those with the lowest income.
PubMed ID
15571994 View in PubMed
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Assessing methods for measurement of clinical outcomes and quality of care in primary care practices.

https://arctichealth.org/en/permalink/ahliterature122368
Source
BMC Health Serv Res. 2012;12:214
Publication Type
Article
Date
2012
Author
Michael E Green
William Hogg
Colleen Savage
Sharon Johnston
Grant Russell
R Liisa Jaakkimainen
Richard H Glazier
Janet Barnsley
Richard Birtwhistle
Author Affiliation
Department of Family Medicine, Queen's University, Kingston, Ontario, Canada. michael.green@dfm.queensu.ca
Source
BMC Health Serv Res. 2012;12:214
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Chronic Disease - epidemiology - therapy
Cross-Sectional Studies
Diagnosis-Related Groups - statistics & numerical data
Female
Health Knowledge, Attitudes, Practice
Health Surveys
Humans
Male
Medical Audit - methods
Middle Aged
Ontario - epidemiology
Outcome Assessment (Health Care) - methods
Patient Acceptance of Health Care - psychology - statistics & numerical data
Patient Credit and Collection
Patients - psychology
Physicians, Family - psychology - standards
Preventive Health Services - economics - standards - statistics & numerical data
Primary Health Care - standards
Quality Indicators, Health Care
Social Class
Abstract
To evaluate the appropriateness of potential data sources for the population of performance indicators for primary care (PC) practices.
This project was a cross sectional study of 7 multidisciplinary primary care teams in Ontario, Canada. Practices were recruited and 5-7 physicians per practice agreed to participate in the study. Patients of participating physicians (20-30) were recruited sequentially as they presented to attend a visit. Data collection included patient, provider and practice surveys, chart abstraction and linkage to administrative data sets. Matched pairs analysis was used to examine the differences in the observed results for each indicator obtained using multiple data sources.
Seven teams, 41 physicians, 94 associated staff and 998 patients were recruited. The survey response rate was 81% for patients, 93% for physicians and 83% for associated staff. Chart audits were successfully completed on all but 1 patient and linkage to administrative data was successful for all subjects. There were significant differences noted between the data collection methods for many measures. No single method of data collection was best for all outcomes. For most measures of technical quality of care chart audit was the most accurate method of data collection. Patient surveys were more accurate for immunizations, chronic disease advice/information dispensed, some general health promotion items and possibly for medication use. Administrative data appears useful for indicators including chronic disease diagnosis and osteoporosis/ breast screening.
Multiple data collection methods are required for a comprehensive assessment of performance in primary care practices. The choice of which methods are best for any one particular study or quality improvement initiative requires careful consideration of the biases that each method might introduce into the results. In this study, both patients and providers were willing to participate in and consent to, the collection and linkage of information from multiple sources that would be required for such assessments.
Notes
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PubMed ID
22824551 View in PubMed
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Assessment of police calls for suicidal behavior in a concentrated urban setting.

https://arctichealth.org/en/permalink/ahliterature171591
Source
Psychiatr Serv. 2005 Dec;56(12):1606-9
Publication Type
Article
Date
Dec-2005
Author
Flora I Matheson
Maria I Creatore
Piotr Gozdyra
Rahim Moineddin
Sean B Rourke
Richard H Glazier
Author Affiliation
Centre for Research on Inner City Health, St. Michael's Hospital, and Department of Public Health Sciences, University of Toronto, Ontario, Canada. mathesonf@smh.toronto.on.ca
Source
Psychiatr Serv. 2005 Dec;56(12):1606-9
Date
Dec-2005
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Canada
Crisis Intervention
Emergency Services, Psychiatric
Female
Hotlines
Humans
Male
Middle Aged
Police
Sex Factors
Suicide - prevention & control - psychology - trends
Urban Population
Abstract
As a result of deinstitutionalization over the past half-century, police have become frontline mental health care workers. This study assessed five-year patterns of police calls for suicidal behavior in Toronto, Canada. Police responded to an average of 1,422 calls for suicidal behavior per year, 15 percent of which involved completed suicides (24 percent of male callers and 8 percent of female callers). Calls for suicidal behavior increased by 4 percent among males and 17 percent among females over the study period. The rate of completed suicides decreased by 22 percent among males and 31 percent among females. Compared with women, men were more likely to die from physical (as opposed to chemical) methods (22 percent and 43 percent, respectively). The study results highlight the importance of understanding changes in patterns and types of suicidal behavior to police training and preparedness.
PubMed ID
16339628 View in PubMed
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Association of anti-smoking legislation with rates of hospital admission for cardiovascular and respiratory conditions.

https://arctichealth.org/en/permalink/ahliterature144274
Source
CMAJ. 2010 May 18;182(8):761-7
Publication Type
Article
Date
May-18-2010
Author
Alisa Naiman
Richard H Glazier
Rahim Moineddin
Author Affiliation
Department of Family and Community Medicine, University of Toronto, Ont. a.naiman@utoronto.ca
Source
CMAJ. 2010 May 18;182(8):761-7
Date
May-18-2010
Language
English
Publication Type
Article
Keywords
Adult
Cardiovascular Diseases - epidemiology
Female
Humans
Lung Diseases - epidemiology
Male
Ontario - epidemiology
Patient Admission - statistics & numerical data - trends
Smoking - legislation & jurisprudence
Social Control, Formal
Tobacco Smoke Pollution - legislation & jurisprudence - prevention & control
Abstract
Few studies have examined the impact of anti-smoking legislation on respiratory or cardiovascular conditions other than acute myocardial infarction. We studied rates of hospital admission attributable to three cardiovascular conditions (acute myocardial infarction, angina, and stroke) and three respiratory conditions (asthma, chronic obstructive pulmonary disease, and pneumonia or bronchitis) after the implementation of smoking bans.
We calculated crude rates of admission to hospital in Toronto, Ontario, from January 1996 (three years before the first phase of a smoking ban was implemented) to March 2006 (two years after the last phase was implemented. We used an autoregressive integrated moving-average (ARIMA) model to test for a relation between smoking bans and admission rates. We compared our results with similar data from two Ontario municipalities that did not have smoking bans and with conditions (acute cholecystitis, bowel obstruction and appendicitis) that are not known to be related to second-hand smoke.
Crude rates of admission to hospital because of cardiovascular conditions decreased by 39% (95% CI 38%-40%) and admissions because of respiratory conditions decreased by 33% (95% CI 32%-34%) during the ban period affecting restaurant settings. No consistent reductions in these rates were evident after smoking bans affecting other settings. No significant reductions were observed in control cities or for control conditions.
Our results serve to expand the list of health outcomes that may be ameliorated by smoking bans. Further research is needed to establish the types of settings in which smoking bans are most effective. Our results lend legitimacy to efforts to further reduce public exposure to tobacco smoke.
Notes
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Comment In: CMAJ. 2010 May 18;182(8):747-820385733
PubMed ID
20385737 View in PubMed
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Balancing equity issues in health systems: perspectives of primary healthcare.

https://arctichealth.org/en/permalink/ahliterature165903
Source
Healthc Pap. 2007;8 Spec No:35-45
Publication Type
Article
Date
2007
Author
Richard H Glazier
Author Affiliation
Primary Care and Population Health Program, Institute for Clinical Evaluative Sciences, Toronto.
Source
Healthc Pap. 2007;8 Spec No:35-45
Date
2007
Language
English
Publication Type
Article
Keywords
Canada
Health Care Reform
Health Policy
Health Services Accessibility - economics - organization & administration - standards
Health Status Disparities
Humans
Primary Health Care - economics - organization & administration - standards
PubMed ID
19096264 View in PubMed
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Birth outcomes by neighbourhood income and recent immigration in Toronto.

https://arctichealth.org/en/permalink/ahliterature159857
Source
Health Rep. 2007 Nov;18(4):21-30
Publication Type
Article
Date
Nov-2007
Author
Marcelo L Urquia
John W Frank
Richard H Glazier
Rahim Moineddin
Author Affiliation
Department of Public Health Sciences, University of Toronto. marcelo.urquia@utoronto.ca
Source
Health Rep. 2007 Nov;18(4):21-30
Date
Nov-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cross-Sectional Studies
Emigration and Immigration
Female
Geography
Gestational Age
Humans
Income
Infant, Low Birth Weight
Infant, Newborn
Infant, Premature
Ontario
Pregnancy
Pregnancy outcome
Residence Characteristics
Socioeconomic Factors
Abstract
This article examines differences in birth outcomes by neighbourhood income and recent immigration for singleton live births in Toronto, Ontario.
The birth data were extracted from hospital discharge abstracts compiled by the Canadian Institute for Health Information.
A population-based cross-sectional study of 143,030 singleton live births to mothers residing in Toronto, Ontario from 1 April 1996 through 31 March 2001 was conducted. Neighbourhood income quintiles of births were constructed after ranking census tracts according to the proportion of their population below Statistics Canada's low-income cutoffs. Logistic regression was used to estimate odds ratios for the effects of neighbourhood income quintile and recent immigration on preterm birth, low birthweight and full-term low birthweight, adjusted for infant sex and maternal age.
Low neighbourhood income was associated with a moderately higher risk of preterm birth, low birthweight, and full-term low birthweight. The neighbourhood income gradient was less pronounced among recent immigrants compared with longer-term residents. Recent immigration was associated with a lower risk of preterm birth, but a higher risk of low birthweight and full-term low birthweight.
PubMed ID
18074994 View in PubMed
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Building the patient-centered medical home in Ontario.

https://arctichealth.org/en/permalink/ahliterature143167
Source
JAMA. 2010 Jun 2;303(21):2186-7
Publication Type
Article
Date
Jun-2-2010
Author
Richard H Glazier
Donald A Redelmeier
Author Affiliation
Institute for Clinical Evaluative Sciences, Centre for Research on Inner City Health, St. Michael's Hospital, and Department of Family and Community Medicine, University of Toronto, Toronto, Canada. rick.glazier@ices.on.ca
Source
JAMA. 2010 Jun 2;303(21):2186-7
Date
Jun-2-2010
Language
English
Publication Type
Article
Keywords
Capitation Fee
Disease Management
Emergency Service, Hospital - utilization
Fee-for-Service Plans
Health Care Reform
Healthcare Disparities
Humans
Ontario
Outcome Assessment (Health Care)
Patient-Centered Care - economics - statistics & numerical data
Primary Health Care - economics - statistics & numerical data
PubMed ID
20516421 View in PubMed
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Capitation and enhanced fee-for-service models for primary care reform: a population-based evaluation.

https://arctichealth.org/en/permalink/ahliterature150774
Source
CMAJ. 2009 May 26;180(11):E72-81
Publication Type
Article
Date
May-26-2009
Author
Richard H Glazier
Julie Klein-Geltink
Alexander Kopp
Lyn M Sibley
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ont. rick.glazier@ices.on.ca
Source
CMAJ. 2009 May 26;180(11):E72-81
Date
May-26-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Capitation Fee - organization & administration
Child
Child, Preschool
Fee-for-Service Plans - organization & administration
Fees, Medical
Female
Health Care Reform - economics
Health Services Research - organization & administration
Humans
Male
Middle Aged
Models, Economic
Ontario
Population Surveillance - methods
Primary Health Care - economics
Retrospective Studies
Salaries and Fringe Benefits
Young Adult
Abstract
Primary care reform in Ontario, Canada, included the initiation of a blended capitation model in 2001-2002 and an enhanced fee-for-service model in 2003. Both models involve patient rostering, incentives for preventive care and requirements for after-hours care. We evaluated practice characteristics and patterns of care under both models.
Using administrative data, we identified physicians belonging to either the capitation or the enhanced fee-for-service group throughout the period from Sept. 1, 2005, to Aug. 31, 2006, and their enrolled patients. Practices were stratified by location (urban v. rural). We compared the groups in terms of practice characteristics and patterns of care, including comprehensiveness of care, continuity of care, after-hours care, visits to the emergency department and uptake of new patients.
Patients in the capitation and enhanced fee-for-service practices had similar demographic characteristics. Patients in capitation practices had lower morbidity and comorbidity indices. Comprehensiveness and continuity of care were similar between the 2 groups. Compared with patients in enhanced fee-for-service practices, those in capitation practices had less after-hours care (adjusted rate ratio [RR] 0.68, 95% confidence interval [CI] 0.61-0.75) and more visits to emergency departments (adjusted RR 1.20, 95% CI 1.15-1.25). Overall, physicians in the capitation group enrolled fewer new patients than did physicians in the enhanced fee-for-service group (37.0 v. 52.0 per physician); the same was true of new graduates (60.3 v. 72.1 per physician).
Physicians enrolled in the capitation model had different practice characteristics than those in the enhanced fee-for-service model. These characteristics appeared to be pre-existing and not due to enrolment in a new model. Although the capitation model provides an alternative to fee-for-service practice, its characteristics should be the focus of future policy development and research.
Notes
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Comment In: CMAJ. 2009 May 26;180(11):1091-219468110
PubMed ID
19468106 View in PubMed
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83 records – page 1 of 9.