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Addressing myths about end-of-life care: research into the use of acute care hospitals over the last five years of life.

https://arctichealth.org/en/permalink/ahliterature190268
Source
J Palliat Care. 2002;18(1):29-38
Publication Type
Article
Date
2002
Author
Donna M Wilson
Corrine D Truman
Author Affiliation
Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
Source
J Palliat Care. 2002;18(1):29-38
Date
2002
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Age Factors
Aged
Aged, 80 and over
Alberta
Attitude to Death
Attitude to Health
Female
Health Services Research
Hospital Bed Capacity - statistics & numerical data
Hospital Costs - statistics & numerical data - trends
Hospitalization - statistics & numerical data - trends
Humans
Length of Stay - statistics & numerical data - trends
Male
Middle Aged
Residence Characteristics - statistics & numerical data
Sex Distribution
Socioeconomic Factors
Terminal Care - statistics & numerical data - trends - utilization
Abstract
Despite very little confirming evidence, one of the most pervasive beliefs about dying is that terminally ill people receive a great deal of health care in the last few days, weeks, or months of life. A secondary analysis of 1992/93 through 1996/97 Alberta inpatient hospital abstracts data was undertaken to explore and describe hospital use over the five years before death by all Albertans who died in acute care hospital beds during the 1996/97 year (n = 7,429). There were four key findings: (1) hospital use varied, but was most often low, (2) the last hospital stay was infrequently resource intensive, (3) age, gender, and illness did not distinguish use, and (4) most ultra-high users were rural residents, with the majority of care episodes taking place in small, rural hospitals.
PubMed ID
12001400 View in PubMed
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The adequacy of pharmaceutical treatment of schizophrenia in Quebec varies with age, but is not influenced by sex or neighbourhood deprivation.

https://arctichealth.org/en/permalink/ahliterature107816
Source
Can J Psychiatry. 2013 Aug;58(8):456-65
Publication Type
Article
Date
Aug-2013
Author
Frederieke M Brouwers
Josiane Courteau
Jean-Pierre Grégoire
Jocelyne Moisan
Sophie Lauzier
Alain Lesage
Marie-Josée Fleury
Alain Vanasse
Author Affiliation
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec.
Source
Can J Psychiatry. 2013 Aug;58(8):456-65
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Antipsychotic Agents - therapeutic use
Cohort Studies
Drug Prescriptions - statistics & numerical data
Female
Humans
Male
Middle Aged
Quebec - epidemiology
Residence Characteristics - statistics & numerical data
Schizophrenia - drug therapy - epidemiology
Sex Factors
Socioeconomic Factors
Young Adult
Abstract
Though high discontinuation rates for antipsychotics (APs) by patients with schizophrenia are frequently reported, the percentage of patients receiving pharmaceutical treatment for schizophrenia in routine practice in accordance with international clinical guidelines is unknown. Further, it is unknown if these rates are influenced by levels of neighbourhood deprivation or by a patient's age or sex. Our study aims to investigate if inequalities in AP treatment could be observed between patients living in neighbourhoods with the highest levels of material and social deprivation and those with the lowest deprivation levels, between patients from different age groups, or between men and women.
We conducted a secondary analysis of medical-administrative data of a cohort of adult patients in the province of Quebec with a medical contact for schizophrenia in a 2-year period (2004-2005). We assessed the proportion of patients that filled at least 1 prescription for an AP and received adequate pharmaceutical treatment, defined as being in possession of APs at least 80% of the time as outpatients during a 2-year follow-up period.
Among the 30 544 study patients, 88.5% filled at least 1 prescription for an AP, and 67.5% of the treated patients received adequate treatment. Though no clinically significant differences were observed by deprivation or sex, younger age was associated with lower proportions of patients receiving adequate treatment (46% of treated patients aged between 18 and 29 years, compared with 72% aged between 30 and 64 years, and 77% aged 65 years and over).
In Quebec's routine practice, over 70% of treated patients aged 30 and over received adequate pharmacological treatment, regardless of sex or neighbourhood socioeconomic status. In contrast, in patients aged between 18 and 29 years this percentage was 47%. This is a discouraging finding, especially because optimal treatment in the early phase of disease is reported to result in the best long-term outcomes.
PubMed ID
23972107 View in PubMed
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Adults' use of health services in the year before death by suicide in Alberta.

https://arctichealth.org/en/permalink/ahliterature129450
Source
Health Rep. 2011 Sep;22(3):15-22
Publication Type
Article
Date
Sep-2011
Author
Kenneth B Morrison
Lory Laing
Author Affiliation
Alberta Children and Youth Services, Edmonton, Alberta, T5K 2N2. ken.morrison@gov.ab.ca
Source
Health Rep. 2011 Sep;22(3):15-22
Date
Sep-2011
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Alberta - epidemiology
Case-Control Studies
Female
Health Services - utilization
Humans
Insurance Claim Review - statistics & numerical data
Male
Mental Disorders - complications - diagnosis
Middle Aged
Residence Characteristics - statistics & numerical data
Risk factors
Sex Factors
Socioeconomic Factors
Suicide - statistics & numerical data
Abstract
The suicide rate in Alberta is consistently above the Canadian average. Health care use profiles of those who die by suicide in Alberta are currently unknown.
Death records were selected for people aged 25 to 64 with suicide coded as the underlying cause of death from April 1, 2003 to March 31, 2006. The death records were linked to administrative records pertaining to physician visits, emergency department visits, inpatient hospital separations, and community mental health visits. The control group was the Alberta population aged 25 to 64 who did not die by suicide. Frequency estimates were produced to determine the characteristics of the study population. Odds ratios relating to demographics, exposure to health care services, and case-control status were estimated with logistic regression.
Almost 90% of suicides had a health service in the year before their death. Suicides averaged 16.6 visits per person, compared with 7.7 visits for non-suicides. Much of the health service use among people who died by suicide appears to have been driven by mental disorders.
Information about health service delivery to those who die by suicide can guide prevention and intervention efforts.
PubMed ID
22106785 View in PubMed
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Alcohol misuse, gender and depressive symptoms in community-dwelling seniors.

https://arctichealth.org/en/permalink/ahliterature154879
Source
Int J Geriatr Psychiatry. 2009 Apr;24(4):369-75
Publication Type
Article
Date
Apr-2009
Author
Philip D St John
Patrick R Montgomery
Suzanne L Tyas
Author Affiliation
Section of Geriatric Medicine, Department of Medicine, Centre on Aging, University of Manitoba, Winnipeg, Canada. pstjohn@hsc.mb.ca
Source
Int J Geriatr Psychiatry. 2009 Apr;24(4):369-75
Date
Apr-2009
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alcoholism - epidemiology - psychology
Cross-Sectional Studies
Depressive Disorder - epidemiology - psychology
Female
Geriatric Assessment
Humans
Male
Manitoba - epidemiology
Questionnaires
Residence Characteristics - statistics & numerical data
Risk factors
Sex Factors
Social Support
Socioeconomic Factors
Abstract
Alcohol misuse in seniors has been studied in clinical samples and in small communities, but relatively few studies are population-based. Objectives are: (1) to describe the characteristics of seniors who score 1 or more on the CAGE (Cut down; Annoyed; Guilty; Eye-opener) questionnaire of alcohol problems; (2) to determine if depressive symptoms are associated with alcohol misuse after accounting for other factors.
Cross-sectional study of community-dwelling older people (65+ years) sampled from a representative population registry in Manitoba, Canada. Participants were initially interviewed in 1991-1992 and reinterviewed in 1996-1997. Data from Time 2 were used; 1,028 persons were included in the analyses. Sociodemographic characteristics, the CAGE questionnaire, Activities of Daily Living (ADLs) and instrumental ADLs (IADLs), the Center for Epidemiologic Studies-Depression (CES-D) scale and the Mini-Mental State Examination (MMSE) were assessed by trained interviewers.
Males were more likely to score positive on the CAGE questionnaire. After adjusting for gender, age, and education, there was a strong association between depressive symptoms and alcohol misuse. Poor self-rated health and impairments in IADLs were also associated with alcohol misuse.
Male gender, depressive symptoms, and poor functional status were associated with alcohol misuse in this population-based study. Attention to depressive symptoms and functional status may be important in the care of seniors with alcohol misuse. Alternatively, physicians should enquire about alcohol use in seniors with functional impairment or depressive symptoms.
Notes
Comment In: Int J Geriatr Psychiatry. 2009 Apr;24(4):434-5; author reply 433-419301300
PubMed ID
18837057 View in PubMed
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Analgesic use among community-dwelling people aged 75 years and older: A population-based interview study.

https://arctichealth.org/en/permalink/ahliterature142226
Source
Am J Geriatr Pharmacother. 2010 Jun;8(3):233-44
Publication Type
Article
Date
Jun-2010
Author
Niina Pokela
J Simon Bell
Katri Lihavainen
Raimo Sulkava
Sirpa Hartikainen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
Source
Am J Geriatr Pharmacother. 2010 Jun;8(3):233-44
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Analgesics - therapeutic use
Analgesics, Opioid - therapeutic use
Cross-Sectional Studies
Data Collection
Depression - complications
Female
Finland
Health status
Humans
Male
Multivariate Analysis
Pain - drug therapy
Polypharmacy
Residence Characteristics - statistics & numerical data
Sex Factors
Abstract
Pain is often underrecognized and undertreated among older people. However, older people may be particularly susceptible to adverse drug reactions linked to prescription and nonprescription analgesics.
The aims of this study were to assess the prevalence of analgesic use among a random sample of community-dwelling people aged >or=75 years, and to investigate factors associated with daily and as-needed analgesic use.
A random sample of people aged >or=75 years was drawn from the population register in Kuopio, Finland, in November 2003. Data on prescription and nonprescription analgesic use were elicited during nurse interviews conducted once for each participant in 2004. Self-reported drug utilization data were verified against medical records. The interview included items pertaining to sociodemographic factors, living conditions, social contacts, health behavior, and state of health. Physical function was assessed using the Instrumental Activities of Daily Living Scale, and the 10-item Barthel Index. Self-rated mobility was assessed by asking whether respondents could walk 400 meters (yes, yes with difficulty but without help, not without help, or no). Cognitive function was assessed using the Mini-Mental State Examination. The presence of depressive symptoms was assessed using the 15-item Geriatric Depression Scale. Respondents' self-rated health was determined using a 5-point scale (very poor, poor, moderate, good, or very good).
Of the initial random sample of participants (N = 1000), 700 provided consent to participate and were community dwelling. Among the participants, 318 (45.4%) were users of >or=1 analgesic on a daily or as-needed basis. Only 23.3% of analgesic users took an analgesic on a daily basis. Factors associated with any analgesic use included female sex (odds ratio [OR], 1.78 [95 degrees % CI, 1.17-2.71]), living alone (OR, 1.46 [95 degrees % CI, 1.02-2.11]), poor self-rated health (OR, 2.6 [95% CI, 1.22-3.84]), and use of >or=10 nonanalgesic drugs (OR, 2.21 [95% CI, 1.26-3.87]). Among users of >or=1 oral analgesic, factors associated with opioid use included moderate (OR, 2.46 [95% CI, 1.175.14]) and poor (OR, 2.57 [95% CI, 1.03-6.42]) self-rated health. Opioid use (OR, 0.19 [95% CI, 0.04-0.86]) and daily analgesic use (OR, 0.16 [95% CI, 0.34-0.74]) were inversely associated with depressive symptoms. Pain in the previous month was reported by 71.4% of analgesic users and 26.4% of nonusers of analgesics.
Analgesics were used by approximately 50% of community-dwelling people aged >or=75 years. However, age was not significantly associated with increased use of analgesics in multivariate analysis. The majority of analgesic drugs were used on an as-needed rather than a daily basis (76.7% vs 23.3%, respectively). Factors most significantly associated with analgesic use were female sex, living alone, poor self-rated health, and use of >or=10 nonanalgesic drugs.
PubMed ID
20624613 View in PubMed
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Antenatal seroprevalence of herpes simplex virus type 2 (HSV-2) in Canadian women: HSV-2 prevalence increases throughout the reproductive years.

https://arctichealth.org/en/permalink/ahliterature194007
Source
Sex Transm Dis. 2001 Jul;28(7):424-8
Publication Type
Article
Date
Jul-2001
Author
D M Patrick
M. Dawar
D A Cook
M. Krajden
H C Ng
M L Rekart
Author Affiliation
University of British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada. david.patrick@bccdc.hnet.bc.ca
Source
Sex Transm Dis. 2001 Jul;28(7):424-8
Date
Jul-2001
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
British Columbia - epidemiology
Confidentiality
Female
Herpes Genitalis - epidemiology - transmission
Humans
Population Surveillance
Pregnancy
Pregnancy Complications, Infectious - epidemiology
Prenatal Care
Residence Characteristics - statistics & numerical data
Sampling Studies
Seroepidemiologic Studies
Abstract
This study sought to provide the first population estimates of herpes simplex type 2 (HSV-2) seroprevalence in Canada.
To measure the antenatal seroprevalence of HSV-2 antibodies in reproductive age women.
An anonymous unlinked seroprevalence study used stored sera collected from pregnant women in British Columbia during 1999. Randomized sampling within age strata selected a total of 1215 subjects, ages 15 to 44 years. Serologic testing used the Gull Meridian Test. Overall prevalence was directly standardized to the 1999 Canadian female population.
The age-adjusted prevalence for HSV-2 was 17.3% (95% CI, 15.2-19.4). Prevalence ranged from 7.1% (ages, 15-19 years) to 28.1% (ages, 40-44 years), with the largest increases after the age of 24 years.
The HSV-2 seroprevalence among pregnant women in British Columbia is similar to that in the United States and other countries. Seroprevalence continues to rise through the later reproductive years. This observation may relate to continued transmission, an age cohort effect, or both.
PubMed ID
11460028 View in PubMed
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Association between neighbourhood marginalization and pedestrian and cyclist collisions in Toronto intersections.

https://arctichealth.org/en/permalink/ahliterature106374
Source
Can J Public Health. 2013 Sep-Oct;104(5):e405-9
Publication Type
Article
Author
Jordan D Silverman
Michael G Hutchison
Michael D Cusimano
Author Affiliation
Division of Neurosurgery, Injury Prevention Research Office, Keenan Research Centre, St. Michael's Hospital. CUSIMANOM@smh.ca.
Source
Can J Public Health. 2013 Sep-Oct;104(5):e405-9
Language
English
Publication Type
Article
Keywords
Accidents, Traffic - statistics & numerical data
Adolescent
Adult
Age Factors
Aged
Bicycling - injuries
Child
Environment Design - statistics & numerical data
Ethnic Groups - statistics & numerical data
Female
Humans
Male
Middle Aged
Ontario
Residence Characteristics - statistics & numerical data
Risk factors
Sex Factors
Social Marginalization
Socioeconomic Factors
Urban Population - statistics & numerical data
Walking - injuries
Young Adult
Abstract
Pedestrian and cyclist collisions comprise a significant proportion of preventable injury. In urban settings, collision rates have been linked to various socio-demographic factors. We sought to determine whether neighbourhood marginalization affects pedestrian and cyclist collisions in the Greater Toronto Area.
For 114 intersections, pedestrian and cyclist collisions were extracted from the Toronto Traffic Data Centre database. We used a geographic information system approach to determine census Dissemination Areas and an associated Ontario Marginalization Index (ON-Marg) for each intersection. We performed a logistic regression to examine the associations between the four ON-Marg dimensions (residential instability, material deprivation, dependency, ethnic concentration) and pedestrian and cyclist collisions.
The odds of sustaining a collision were independently associated with residential instability for both pedestrians (OR 1.84, 95% CI 1.21-2.84, p=0.006) and cyclists (OR 2.04, 95% CI 1.34-3.16, p=0.001). Higher overall collision rates (both pedestrian and cyclist) were associated with both ethnic concentration (OR 1.56, 95% CI 1.05-2.37, p=0.033) and residential instability (OR 2.16, 95% CI 1.43-3.38, p=0.001). Material deprivation and dependency were not significant risk factors for intersection collisions in this model.
Collisions involving pedestrians and cyclists are more common in areas of increased residential instability and ethnic concentration in Toronto. Intersections in neighbourhoods with these characteristics could be targeted for strategies to reduce pedestrian and cyclist injury risk in urban settings.
PubMed ID
24183182 View in PubMed
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Asthma and bronchiolitis hospitalizations among American Indian children.

https://arctichealth.org/en/permalink/ahliterature3827
Source
Arch Pediatr Adolesc Med. 2000 Oct;154(10):991-6
Publication Type
Article
Date
Oct-2000
Author
L L Liu
J W Stout
M. Sullivan
D. Solet
D K Shay
D C Grossman
Author Affiliation
Child Health Institute, 146 N Canal St, Suite 300, Seattle, WA 98103-8652, USA.
Source
Arch Pediatr Adolesc Med. 2000 Oct;154(10):991-6
Date
Oct-2000
Language
English
Publication Type
Article
Keywords
Adolescent
Age Distribution
Asthma - epidemiology - ethnology - prevention & control
Bronchiolitis - epidemiology - ethnology - prevention & control
Child
Child, Preschool
Comparative Study
Female
Hospitalization - statistics & numerical data - trends
Humans
Indians, North American - statistics & numerical data
Infant
Inuits - statistics & numerical data
Male
Medical Record Linkage
Poverty - statistics & numerical data
Research Support, U.S. Gov't, P.H.S.
Residence Characteristics - statistics & numerical data
Retrospective Studies
United States
United States Indian Health Service
Washington - epidemiology
Abstract
OBJECTIVE: To compare asthma and bronchiolitis hospitalization rates in American Indian and Alaskan native (AI/AN) children and all children in Washington State. METHODS: A retrospective data analysis using Washington State hospitalization data for 1987 through 1996. Patients were included if asthma or bronchiolitis was the first-listed diagnosis. American Indian and Alaskan native children were identified by linking state hospitalization data with Indian Health Service enrollment data. RESULTS: Similar rates of asthma hospitalization were found for AI/AN children older than 1 year compared with all children. In AI/AN children younger than 1 year, hospitalization rates for asthma (528 per 100,000 population; 95% confidence interval [CI], 346-761) and bronchiolitis (2954 per 100,000 population; 95% CI, 2501-3456) were 2 to 3 times higher than the rates in all children (232 per 100,000 population [95% CI, 215-251] and 1190 per 100,000 population [95% CI, 1149-1232], respectively). Hospitalization rates for asthma and bronchiolitis increased 50% between 1987 and 1996 for all children younger than 1 year and almost doubled for AI/AN children younger than 1 year. CONCLUSIONS: American Indian and Alaskan native children have significantly higher rates of hospitalization for wheezing illnesses during the first year of life compared with children of other age groups and races. Furthermore, the disparities in rates have increased significantly over time. Future public health measures directed at managing asthma and bronchiolitis should target AI/AN infants.
PubMed ID
11030850 View in PubMed
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Breast cancer incidence and neighbourhood income.

https://arctichealth.org/en/permalink/ahliterature132095
Source
Health Rep. 2011 Jun;22(2):7-13
Publication Type
Article
Date
Jun-2011
Author
Marilyn J Borugian
John J Spinelli
Zenaida Abanto
Chen Lydia Xu
Russell Wilkins
Author Affiliation
British Columbia Cancer Agency, Vancouver, British Columbia V5Z 1L3. mborugian@bccrc.ca
Source
Health Rep. 2011 Jun;22(2):7-13
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Breast Neoplasms - diagnosis - epidemiology
Canada - epidemiology
Female
Humans
Incidence
Income - statistics & numerical data
Mammography - statistics & numerical data
Middle Aged
Parity
Poisson Distribution
Residence Characteristics - statistics & numerical data
Young Adult
Abstract
In developed countries, women of higher socioeconomic status often have higher breast cancer incidence rates, compared with women of lower socioeconomic status.
Data were extracted from the Canadian Cancer Registry for the 229,955 cases of adult female invasive breast cancer diagnosed from 1992 through 2004. Postal code at diagnosis was used to determine neighbourhood income quintile. Breast cancer incidence was examined by year, region, age and neighbourhood income quintile. Census data for 1991 on children ever born and British Columbia data for 2006 on first-time attendance at mammography screening were analyzed by neighbourhood income quintile.
Residence in the lowest as opposed to the highest neighbourhood income quintile was associated with a 15% lower risk of being diagnosed with breast cancer. Higher income levels were associated with lower parity in 1991 and a higher prevalence of first-time screening mammography in British Columbia in 2006.
Canadian data support an association between the diagnosis of invasive breast cancer and neighbourhood income quintile. Parity and mammography screening may account for some differences in incidence.
PubMed ID
21848127 View in PubMed
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78 records – page 1 of 8.