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Accounting for vulnerability to illness and social disadvantage in pandemic critical care triage.

https://arctichealth.org/en/permalink/ahliterature96997
Source
J Clin Ethics. 2010;21(1):23-9
Publication Type
Article
Date
2010
Author
Chris Kaposy
Author Affiliation
Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada. christopher.kaposy@med.mun.ca
Source
J Clin Ethics. 2010;21(1):23-9
Date
2010
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Critical Care
Cultural Characteristics
Disaster Planning - trends
Disease Outbreaks
Health Care Rationing - ethics
Health Policy - trends
Humans
Indians, North American - statistics & numerical data
Influenza A Virus, H1N1 Subtype - isolation & purification
Influenza, Human - ethnology - mortality - virology
Intensive Care Units - organization & administration - standards
Inuits - statistics & numerical data
Newfoundland and Labrador - epidemiology
Patient Selection - ethics
Prognosis
Risk assessment
Social Class
Triage - methods - organization & administration - standards - trends
Vulnerable Populations
Abstract
In a pandemic situation, resources in intensive care units may be stretched to the breaking point, and critical care triage may become necessary. In such a situation, I argue that a patient's combined vulnerability to illness and social disadvantage should be a justification for giving that patient some priority for critical care. In this article I present an example of a critical care triage protocol that recognizes the moral relevance of vulnerability to illness and social disadvantage, from the Canadian province of Newfoundland and Labrador.
PubMed ID
20465071 View in PubMed
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Acute diabetes complications across transition from pediatric to adult care in Ontario and Newfoundland and Labrador: a population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature306966
Source
CMAJ Open. 2020 Jan-Mar; 8(1):E69-E74
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Author
Rayzel Shulman
Longdi Fu
John C Knight
Astrid Guttmann
Roger Chafe
Author Affiliation
Department of Pediatrics (Shulman, Guttmann), The Hospital for Sick Children, University of Toronto; ICES (Shulman, Fu, Guttmann); Institute for Health Policy, Management and Evaluation (Shulman, Guttmann), University of Toronto, Toronto, Ont.; Faculty of Medicine (Knight, Chafe), Memorial University of Newfoundland, St. John's, Nfld. rayzel.shulman@sickkids.ca.
Source
CMAJ Open. 2020 Jan-Mar; 8(1):E69-E74
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Age Factors
Cohort Studies
Diabetes Complications - epidemiology
Diabetes Mellitus - epidemiology
Female
Humans
Male
Newfoundland and Labrador - epidemiology
Ontario - epidemiology
Population Surveillance
Transition to Adult Care - statistics & numerical data
Young Adult
Abstract
Transition to adult diabetes care is a high-risk period for acute complications, yet the optimal transition care model is unknown. To gain insight into the impact on health outcomes of system-level transition processes that reflect resourcing differences, we examined acute complications in youth with diabetes across transition in 2 Canadian provinces with different transition care models.
We used linked provincial health administrative data for Ontario and Newfoundland and Labrador to create 2 parallel cohorts of youth with diabetes diagnosed before age 15 years who turned 17 between 2006 and 2011. Participants were followed until 2015 (maximum age 21 yr). We described rates of and proportion of participants with at least 1 diabetes-related hospital admission at age 15-17 years and 18-20 years, standardized according to material deprivation based on the 2006 Canadian Marginalization Index. We compared diabetes-related admissions at age 15-17 years and 18-20 years in the Ontario cohort.
The cohorts consisted of 2525 youth in Ontario and 93 in Newfoundland and Labrador. In Newfoundland and Labrador, 39 participants (42.0%) were in the lowest socioeconomic quintile, versus 326 (12.9%) in Ontario. The standardized rate of diabetes-related hospital admissions per 100 person-years was 13.5 (95% confidence interval [CI] 12.6-14.4) at age 15-17 years and 14.4 (95% CI 13.5-15.3) at age 18-20 years in Ontario, and 11.4 (95% CI 7.0-15.8) at age 15-17 years and 10.5 (95% CI 6.4-14.6) at age 18-20 years in Newfoundland and Labrador. In Ontario, there was no association between the rate (adjusted rate ratio 1.10, 95% CI 0.94-1.28) or occurrence (adjusted odds ratio 1.03, 95% CI 0.91-1.17) of diabetes-related admissions across transition.
Although posttransition care is delivered differently in the 2 provinces, rates of adverse events across transition were stable in both. Coordinated support during transition is needed to help mitigate adverse events for young adults in both provinces. Delivery of other health care and social services, including primary care, may be influencing the risk of adverse events after transition to adult care.
PubMed ID
32046971 View in PubMed
Less detail
Source
Can Fam Physician. 2007 Nov;53(11):1961-2
Publication Type
Article
Date
Nov-2007
Author
Graham J Worrall
Author Affiliation
Dr William H. Newhook Memorial Health Centre, Whitbourne, NL. gworrall@mun.ca
Source
Can Fam Physician. 2007 Nov;53(11):1961-2
Date
Nov-2007
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adult
Age Distribution
Anti-Bacterial Agents - therapeutic use
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Child
Child, Preschool
Family Practice - methods
Female
Humans
Incidence
Male
Newfoundland and Labrador - epidemiology
Pharyngitis - drug therapy - epidemiology - microbiology
Risk assessment
Sex Distribution
Streptococcal Infections - diagnosis - drug therapy - epidemiology
Streptococcus agalactiae - drug effects - isolation & purification
Treatment Outcome
Notes
Cites: Ann Intern Med. 2001 Mar 20;134(6):506-811255529
Cites: Cochrane Database Syst Rev. 2006;(4):CD00002317054126
Cites: CMAJ. 1998 Jan 13;158(1):75-839475915
Cites: Clin Infect Dis. 2002 Jul 15;35(2):113-2512087516
PubMed ID
18000276 View in PubMed
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Adapting the Hamilton Health Sciences critical care pandemic triage protocol.

https://arctichealth.org/en/permalink/ahliterature144550
Source
Healthc Q. 2010;13(2):60-3
Publication Type
Article
Date
2010
Author
Chris Kaposy
Natalie Bandrauk
Daryl Pullman
Rick Singleton
Fern Brunger
Author Affiliation
Faculty of Medicine, Division of Community Health and Humanities, at Memorial University of Newfoundland, St. John's, Newfoundland. christopher.kaposy@med.mun.ca
Source
Healthc Q. 2010;13(2):60-3
Date
2010
Language
English
Publication Type
Article
Keywords
Decision Making
Disease Outbreaks
Emergency Service, Hospital
Humans
Influenza A Virus, H1N1 Subtype
Influenza, Human - epidemiology - therapy
Newfoundland and Labrador - epidemiology
Organizational Case Studies
Triage - methods - organization & administration
PubMed ID
20357547 View in PubMed
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Adolescent and pre-adolescent suicide in Newfoundland and Labrador.

https://arctichealth.org/en/permalink/ahliterature225937
Source
Can J Psychiatry. 1991 Aug;36(6):432-6
Publication Type
Article
Date
Aug-1991
Author
D. Aldridge
K. St John
Author Affiliation
Lakehead Regional Family Centre, Thunder Bay, Ontario.
Source
Can J Psychiatry. 1991 Aug;36(6):432-6
Date
Aug-1991
Language
English
Publication Type
Article
Keywords
Adolescent
Age Factors
Cause of Death
Child
Cross-Sectional Studies
Female
Humans
Incidence
Indians, North American - psychology - statistics & numerical data
Male
Newfoundland and Labrador - epidemiology
Periodicity
Risk factors
Sex Factors
Suicide - prevention & control - psychology - statistics & numerical data
Abstract
This study investigated suicides by people aged ten to 19 in Newfoundland and Labrador from 1977 to 1988. It is the first study of suicide in the province to use the records of death from all eight hospital pathology departments in the province and from the office of the Chief Forensic Pathologist. Cases were selected for the study using standardized criteria, independent of the manner of death recorded on the death certificate. A suicide rate of 4.37 per 100,000 was found. This rate and the age- and sex-specific suicide rates are lower than the official figures for Canada but higher than those reported in earlier Newfoundland studies. The rate for males was nearly five times the female rate, and the rate for people aged 15 to 19 was nearly six times that of people aged ten to 14. Suicide rates for Labrador were higher than for the island portion of the province for both Native and for non Native adolescents. Extremely high rates of suicide were found only among the Native population living in Northern Labrador, while none were recorded for Native people elsewhere. Firearms accounted for 54% and hanging for 33% of all suicides. Thirty percent of suicides occurred on a Saturday. Only 36 of the 63 deaths included in this study were designated as suicide on death certificates. The higher rate of under-reporting of suicide than in other jurisdictions suggests that official rates may not be useful for comparisons. The reasons for the high rate of under-reporting are discussed.
PubMed ID
1933747 View in PubMed
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Adverse drug events in adult patients leading to emergency department visits.

https://arctichealth.org/en/permalink/ahliterature144829
Source
Ann Pharmacother. 2010 Apr;44(4):641-9
Publication Type
Article
Date
Apr-2010
Author
Khokan C Sikdar
Reza Alaghehbandan
Don MacDonald
Brendan Barrett
Kayla D Collins
Jennifer Donnan
Veeresh Gadag
Author Affiliation
Research and Evaluation Department, Newfoundland and Labrador Centre for Health Information, St. John's, NL, Canada. khokan.sikdar@nlchi.nl.ca
Source
Ann Pharmacother. 2010 Apr;44(4):641-9
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Data Collection
Drug-Related Side Effects and Adverse Reactions
Emergency Medical Services - statistics & numerical data
Female
Hospitals - statistics & numerical data
Humans
Male
Middle Aged
Newfoundland and Labrador - epidemiology
Retrospective Studies
Sex Factors
Socioeconomic Factors
Terminology as Topic
Treatment Outcome
Young Adult
Abstract
Adverse drug events (ADEs) occurring in the community and treated in emergency departments (EDs) have not been well studied.
To determine the prevalence, severity, and preventability of ADEs in patients presenting at EDs in 2 university-affiliated tertiary care hospitals in the Canadian province of Newfoundland and Labrador.
A retrospective chart review was conducted on a stratified random sample (n = 1458) of adults (> or =18 y) who presented to EDs from January 1 to December 31, 2005. Prior to the chart review, the sample frame was developed by first eliminating visits that were clearly not the result of an ADE. The ED summary of each patient was initially reviewed by 2 trained reviewers in order to identify probable ADEs. All eligible charts were subsequently reviewed by a clinical team, consisting of 2 pharmacists and 2 ED physicians, to identify ADEs and determine their severity and preventability.
Of the 1458 patients presenting to the 2 EDs, 55 were determined to have an ADE or a possible ADE (PADE). After a sample-weight adjustment, the prevalence of ADEs/PADEs was found to be 2.4%. Prevalence increased with age (0.7%, 18-44 y; 1.9%, 45-64 y; 7.8%, > or =65 y) and the mean age for patients with ADEs was higher than for those with no ADEs (69.9 vs 63.8 y; p
PubMed ID
20233911 View in PubMed
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All-terrain vehicle-related injuries and deaths in Newfoundland and Labrador between 2003 and 2013: a retrospective trauma registry review.

https://arctichealth.org/en/permalink/ahliterature303249
Source
CJEM. 2018 03; 20(2):207-215
Publication Type
Journal Article
Date
03-2018
Author
Holly Black
Desmond Whalen
Sabrina Alani
Peter Rogers
Cathy MacLean
Author Affiliation
*Faculty of Medicine,Memorial University of Newfoundland,St. John's,NL.
Source
CJEM. 2018 03; 20(2):207-215
Date
03-2018
Language
English
Publication Type
Journal Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cause of Death - trends
Child
Child, Preschool
Female
Humans
Incidence
Male
Middle Aged
Newfoundland and Labrador - epidemiology
Off-Road Motor Vehicles - statistics & numerical data
Registries
Retrospective Studies
Survival Rate - trends
Wounds and Injuries - epidemiology
Young Adult
Abstract
Injury and death involving all-terrain vehicles (ATV) has been reported in a number of Canadian provinces. The objective of this study is to describe the frequency, nature, severity, population affected, immediate health costs, efficacy of related legislation, and helmet use in ATV related injuries and deaths in Newfoundland and Labrador (NL).
A retrospective review of injured or deceased ATV riders of all ages entered in the Newfoundland and Labrador Trauma Registry from 2003 to 2013 was conducted. Variables studied included demographics, injury type and severity, use of helmets, admission/discharge dates, and referring/receiving institution. Data was also obtained from the Newfoundland and Labrador Center for Health Information (NLCHI) and included all in-hospital deaths and hospitalizations due to ATVs between 1995 and 2013.
There were a total of 298 patients registered in the trauma registry, resulting in 2759 admission days, nine deaths, and a total estimated immediate healthcare system cost in excess of $1.6 million. More males (N=253, 84.9%) than females (N=45, 15.1%) were injured in ATV related incidents, t(20)=7.12, p
PubMed ID
28693640 View in PubMed
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An investigation of cancer rates in the Argentia region, Newfoundland and Labrador: an ecological study.

https://arctichealth.org/en/permalink/ahliterature274996
Source
J Environ Public Health. 2015;2015:421562
Publication Type
Article
Date
2015
Author
Pauline Duke
Marshall Godwin
Mandy Peach
Jacqueline Fortier
Stephen Bornstein
Sharon Buehler
Farah McCrate
Andrea Pike
Peizhong Peter Wang
Richard M Cullen
Source
J Environ Public Health. 2015;2015:421562
Date
2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Canada - epidemiology
Child
Child, Preschool
Environmental Pollutants - analysis
Humans
Incidence
Infant
Infant, Newborn
Middle Aged
Neoplasms - epidemiology - etiology
Newfoundland and Labrador - epidemiology
Young Adult
Abstract
The Argentia region of Newfoundland and Labrador, Canada, was home to a US naval base during a 40-year period between the 1940s and the 1990s. Activities on the base resulted in contamination of the soil and groundwater in the region with chemicals such as heavy metals and dioxins, and residents have expressed concern about higher rates of cancer in their community. This study investigated the rate of cancer diagnosis that is disproportionately high in the Argentia region.
Cases of cancer diagnosed between 1985 and 2011 were obtained for the Argentia region, two comparison communities, and the province of Newfoundland and Labrador. Crude and age-standardized incidence rates of cancer diagnosis were calculated and compared. The crude incidence rate was adjusted for differences in age demographics using census data, and age-standardized incidence rates were compared.
Although the Argentia region had a higher crude rate of cancer diagnosis, the age-standardized incidence rate did not differ significantly from the comparison communities or the provincial average. Argentia has an aging population, which may have influenced the perception of increased cancer diagnosis in the community.
We did not detect an increased burden of cancer in the Argentia region.
Notes
Cites: Am J Public Health. 2000 Aug;90(8):1300-210937014
Cites: Am J Epidemiol. 1990 Jul;132(1 Suppl):S48-522356835
Cites: Occup Environ Med. 1996 Nov;53(11):782-69038804
Cites: J Hazard Mater. 2006 Aug 25;136(3):406-1716386833
Cites: Occup Environ Med. 2007 Jun;64(6):402-817259164
Cites: JAMA. 2007 Jun 6;297(21):2360-7217545690
Cites: Int J Circumpolar Health. 2013;72. doi: 10.3402/ijch.v72i0.2118723984298
Cites: Am J Public Health. 2014 Jul;104(7):1204-824832152
Cites: J Pediatr. 2014 Dec;165(6):1216-2125241182
PubMed ID
26633979 View in PubMed
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196 records – page 1 of 20.