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IntroductionXylitol (or 'birch sugar') is a naturally occurring sugar with antibacterial properties that has been used as a natural non-sugar sweetener in chewing gums, confectionery, toothpaste and medicines. In this preventative randomised trial, xylitol will be tested for the prevention of acute otitis media (AOM), a common and costly condition in young children. The primary outcome will be the incidence of AOM. Secondary outcomes will include upper respiratory tract infections (URTIs) and dental caries.Methods and analysisThis study will be a pragmatic, blinded (participant and parents, practitioners and analyst), two-armed superiority, placebo-controlled randomised trial with 1:1 allocation, stratified by clinical site. The trial will be conducted in the 11 primary care group practices participating in the TARGet Kids! research network in Canada. Eligible participants between the ages of 2-4 years will be randomly assigned to the intervention arm of regular xylitol syrup use or the control arm of regular sorbitol use for 6 months. We expect to recruit 236 participants, per treatment arm, to detect a 20% relative risk reduction in AOM episodes. AOM will be identified through chart review. The secondary outcomes of URTIs and dental caries will be identified through monthly phone calls with specified questions.Ethics and disseminationEthics approval from the Research Ethics Boards at the Hospital for Sick Children and St. Michael's Hospital has been obtained for this study and also for the TARGet Kids! research network. Results will be submitted for publication to a peer-reviewed journal and will be discussed with decision makers.Trial registration numberNCT03055091; Pre-results.

OBJECTIVES: Several strategies have been proposed to manage the utilization of blood glucose test strips (BGTS) in Canada; however their potential impacts on utilization and costs of publically funded test strips are unknown. METHODS: We investigated the impact of three potential policies that would restrict the number of test strips reimbursed by the public drug plans in Ontario and British Columbia (BC), and incorporated negotiated price reductions. These policies were based on recommendations from the Canadian Agency for Drugs and Technologies in Health, a briefing document by the Canadian Diabetes Association, and a new policy introduced by the Ontario Ministry of Health and Long- Term Care. BGTS utilization rates were assessed in two cross-sectional analyses among adults aged 18 years or older in BC and 65 or older in Ontario who received publicly-funded BGTS between January 2004 and December 2012. We modeled the 5-year utilization and cost implications of the three policies using time-series analysis. RESULTS: In 2012, there were 317,130 test strip recipients in Ontario and 136,659 recipients in BC, at a cost of $104.4 million and $22.6 million respectively. Under the scenarios of reduced BGTS quantities, 5-year cost savings ranged between $98.8 million (18.2% reduction) and $224.1 million (41.4% reduction) in Ontario and between $23.1 million (19.2% reduction) and $51.1 million (42.4% reduction) in BC. Price reductions of 15% resulted in annual savings of $14.4 million (13.7% reduction) in Ontario and $3.4 million (14.1% reduction) in BC. CONCLUSIONS: Policies that align with evidence and expert guidance could impart substantial cost savings in multiple jurisdictions despite different public drug plans. KEY WORDS: Self-monitoring; self-testing; blood glucose; diabetes; utilization OBJECTIFS : Plusieurs strategies ont ete proposees pour gerer l'utilisation des bandelettes de test glycemique (BTG) au Canada, mais on ignore leurs effets potentiels sur l'utilisation et le cout des bandelettes de test glycemique financees par les deniers publics. METHODES : Nous avons etudie l'effet de trois politiques possibles qui limiteraient le nombre de bandelettes de test remboursees par les regimes d'assurance medicament en Ontario et en Colombie-Britannique (C.-B.), et avons incorpore des reductions de prix negociees. Ces politiques etaient fondees sur des recommandations de l'Agence canadienne des medicaments et des technologies de la sante, sur un document preparatoire de l'Association canadienne du diabete et sur une nouvelle politique introduite par le ministere de la Sante et des Soins de longue duree de l'Ontario. On a evalue le taux d'utilisation des BTG dans deux analyses croisees chez des adultes ages de 18 ans et plus en C.-B. et de 65 ans et plus en Ontario qui recevaient des BTG financees par les fonds publics entre janvier 2004 et decembre 2012. Nous avons etabli le modele d'une utilisation sur 5 ans et des consequences financieres de ces trois politiques selon une analyse des series chronologiques. RESULTATS : En 2012, il y avait 317 130 receveurs de bandelettes en Ontario et 136 659 en C.-B., pour un cout de 104,4 millions $ et de 22,6 millions $ respectivement. Selon les scenarios des quantites reduites de BTG, les economies sur 5 ans etaient entre 98,8 millions $ (reduction de 18,2 %) et 224,1 millions $ (reduction de 41,4 %) en Ontario et entre 23,1 millions $ (reduction de 19,2 %) et 51,1 millions $ (reduction de 42,4 %) en C.-B. Une reduction de prix de 15 % entrainait des economies annuelles de 14,4 millions $ (reduction de 13,7 %) en Ontario et de 3,4 millions $ (reduction de 14,1 %) en C.-B. CONCLUSIONS : Les politiques qui correspondent aux faits et aux conseils des experts pourraient permettre des economies importantes dans plusieurs competences malgre les regimes publics d'assurance medicament differents. MOTS CLES : autosurveillance; autodiagnostic; glycemie; diabete; utilisation La traduction du resume se trouve a la fin de l'article. Can j Public Health 2015;106(4):e210-e216 doi: 10.17269/CJPH.106.4788, In Canada, more than one fifth of those aged 65 years and older have diabetes, (1) Consequently, use of blood glucose test strips (BGTS) among these patients has substantial financial [...]

Background The majority of people with hypertension require more than one medication to achieve blood pressure control. Many patients are prescribed multipill antihypertensive regimens rather than single-pill fixed-dose combination (FDC) treatment. Although FDC use may improve medication adherence, the impact on patient outcomes is unclear. We compared clinical outcomes and medication adherence with FDC therapy versus multipill combination therapy in a real-world setting using linked clinical and administrative databases. Methods and findings We conducted a population-based retrospective cohort study of 13,350 individuals 66 years and older in Ontario, Canada with up to 5 years of follow-up. We included individuals who were newly initiated on one angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II-receptor blocker (ARB) plus one thiazide diuretic. High-dimensional propensity score matching was used to compare individuals receiving FDC versus multipill therapy. The primary outcome was a composite of death or hospitalization for acute myocardial infarction (AMI), heart failure, or stroke. We conducted 2 analyses to examine the association between adherence and patient outcomes. First, we performed an on-treatment analysis to determine whether outcomes differed between groups while patients were on treatment, censoring patients when they first discontinued treatment, defined as not receiving medications within 150% of the previous days' supply. Second, we conducted an intention-to-treat analysis that followed individuals allowing for breaks in treatment to quantify the difference in drug adherence between groups and assess its impact on clinical outcomes. As expected, there was no significant difference in the primary outcome between groups in the on-treatment analysis (HR 1.06, 95% CI 0.86-1.31, P = 0.60). In the intention-to-treat analysis, the proportion of total follow-up days covered with medications was significantly greater in the FDC group (70%; IQR 19-98) than in the multipill group (42%, IQR 11-91, P < 0.01), and the primary outcome was less frequent in FDC recipients (3.4 versus 3.9 events per 100 person-years; HR 0.89, 95% CI 0.81-0.97, P < 0.01). The main limitations of this study were the lack of data regarding cause of death and blood pressure measurements and the possibility of residual confounding. Conclusions Among older adults initiating combination antihypertensive treatment, FDC therapy was associated with a significantly lower risk of composite clinical outcomes, which may be related to better medication adherence., Author(s): Amol A. Verma 1,2,*, Wayne Khuu 3, Mina Tadrous 3,4, Tara Gomes 3,4,5, Muhammad M. Mamdani 3,4,5 Introduction Hypertension affects an estimated 900 million adults [1] and is the [...]