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The tuberculin skin test is unreliable in school children BCG-vaccinated in infancy and at low risk of tuberculosis infection.

https://arctichealth.org/en/permalink/ahliterature294033
Source
Pediatric Infectious Disease Journal. 2011 Sep;30(9):754-8. doi: 10.1097/INF.0b013e31821b8f54.
Publication Type
Article
Date
2011
Author
Jacobs S
Warman A
Richardson R
Yacoub W
Lau A
Whittaker D
Cockburn S
Verma G
Boffa J
Tyrrell G
Kunimoto D
Manfreda J
Langlois-Klassen D
Long R
Source
Pediatric Infectious Disease Journal. 2011 Sep;30(9):754-8. doi: 10.1097/INF.0b013e31821b8f54.
Date
2011
Language
English
Geographic Location
Canada
Publication Type
Article
Keywords
Adolescent
BCG Vaccine
Immunology
Child
Child, Preschool
Female
Humans
Latent Tuberculosis
Tuberculosis
Prevention & control
Male
Mycobacterium tuberculosis
Reproducibility of Results
Sensitivity and specificity
Tuberculin Test
Vaccination
Abstract
BACKGROUND: The tuberculin skin test (TST) is often used to screen for latent tuberculosis infection (LTBI) in school children, many of whom were bacille Calmette-Guérin (BCG)-vaccinated in infancy. The reliability of the TST in such children is unknown. METHODS: TSTs performed in low-risk BCG-vaccinated and -nonvaccinated grade 1 and grade 6 First Nations (North American Indian) school children in the province of Alberta, Canada, were evaluated retrospectively. To further assess the specificity of the TST, BCG-vaccinated children with a positive TST (=10 mm of induration) and no treatment of LTBI were administered a QuantiFERON-TB Gold In-Tube test (QFT-GIT, Cellestis International). RESULTS: A total of 3996 children, 2063 (51.6%) BCG-vaccinated and 1933 (48.4%) BCG-nonvaccinated, were screened for LTBI. Vaccinated children were more likely than nonvaccinated children to be TST positive (5.7% vs. 0.2%, P
PubMed ID
21487326 View in PubMed
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Performance of the ACG case-mix system in two Canadian provinces.

https://arctichealth.org/en/permalink/ahliterature195999
Source
Med Care. 2001 Jan;39(1):86-99
Publication Type
Article
Date
Jan-2001
Author
R J Reid
L. MacWilliam
L. Verhulst
N. Roos
M. Atkinson
Author Affiliation
Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada.
Source
Med Care. 2001 Jan;39(1):86-99
Date
Jan-2001
Language
English
Geographic Location
Canada
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
British Columbia - epidemiology
Child
Child, Preschool
Diagnosis-Related Groups - classification
Fees, Medical
Female
Health Expenditures
Hospital Charges
Humans
Infant
Infant, Newborn
Linear Models
Male
Manitoba - epidemiology
Middle Aged
Models, Econometric
Multivariate Analysis
Pregnancy
Reproducibility of Results
Risk Adjustment - methods
Single-Payer System
Abstract
While the adjusted clinical group (ACG) system has been extensively validated in the United States, its use in other developed nations has been limited. This article examines the performance of the system in 2 Canadian provinces and assesses the extent to which ACGs can account for same-year and next-year health care expenditures.
The study population included all residents of Manitoba and British Columbia who were continuously enrolled in the provincial health plans from April 1, 1995, to March 31, 1997. ACGs were assigned through diagnoses from fee-for-service physician claims and hospital separation records. "Physician" costs were calculated from the fee-for-service tariffs, and for Manitobans, "total" costs were also computed by combining physician and hospital costs. Linear regression was used to examine the ability of the ACG system to explain variation in individual costs (truncated at the 99th percentile).
The British Columbia and Manitoba data were generally acceptable, with fewer than 2% rejected diagnoses. Higher costs were associated with both the accumulation of morbidities and their relative severity. For physician costs, the ACG system explained approximately 50% and approximately 25% of the variation in same-year and next-year truncated costs, respectively. For total costs, the system explained approximately 40% and approximately 14% of these respective costs.
The application of ACGs in Canada is feasible using existing data. The ability of the ACG system to explain variation in costs is similar to that found in US health systems. While application of ACGs in Canada shows promise, further research is required to examine how closely they reflect population morbidity burdens and health care needs.
PubMed ID
11176546 View in PubMed
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