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OBJECTIVE: The HIV/AIDS epidemic disproportionately involves socially vulnerable populations. Since 2001, the proportion of foreign-born patients served by the Northern Alberta HIV Program has increased. Our study aimed to evaluate antiretroviral therapy (ART) outcomes among HIV-infected foreign-born patients in northern Alberta, Canada, prescribed once-daily ART. METHODS: We utilized a two-part retrospective cohort study to compare ART outcomes of foreign-born and Canadian-born Aboriginal patients compared to Canadian-born non-Aboriginal patients. Part 1 utilized logistic regression to compare the odds of experiencing initial virological suppression of foreign-born (40%) and Canadian-born Aboriginal patients (27%) compared with Canadian-born non-Aboriginal patients (33%). Part 2 used survival analysis to compare the rate of ART failure by country of origin among patients who achieved initial virological suppression in Part 1. RESULTS: Our study sample included 322 treatment-naive patients (122 foreign-born). For Part 1, 261 patients achieved initial virological suppression within six months of initiating ART. After controlling for age, treatment regimen, HIV risk exposure, and calendar year compared to Canadian-born non-Aboriginal patients, the odds of achieving initial virological suppression were significantly lower for Canadian-born Aboriginal patients (OR=0.44, 95% CI: 0.20-0.96); and similar for foreign-born patients (OR=0.76, 95% CI: 0.33-1.73). Part 2 included 261 patients who were followed for 635.1 person-years. Adjusting for age, sex, baseline CD4 cell count, and drug regimen, compared to Canadian-born non-Aboriginal patients, Canadian-born Aboriginal and foreign-born patients had similar rates of virological failure after achieving initial virological suppression (HR=1.54, 95% CI: 0.38-6.18; HR=0.49, 95% CI: 0.11-2.20, respectively). CONCLUSIONS: Our study indicated that ART outcomes among Alberta-based foreign-born patients are similar to those among Canadian-born non-Aboriginal patients. Our results, however, suggested that Canadian-born Aboriginal patients had poorer treatment outcomes compared to Canadian-born non-Aboriginal patients. It is imperative, therefore, that clinicians, researchers and community members better understand reasons for poor ART outcomes among Canadian-born Aboriginal patients in northern Alberta. KEY WORDS: Antiretroviral therapy; emigrants and immigrants; HIV-1; treatment outcomes; Canada OBJECTIF: L'epidemie de VIH et de sida frappe demesurement les populations socialement vulnerables. Depuis 2001, la proportion de patients nes a l'etranger servis par le programme de lutte contre le VIH du nord de l'Alberta a augmente. Notre etude visait a evaluer les effets de la therapie antiretrovirale (TAR) dans le nord de l'Alberta, au Canada, chez des patients infectes par le VIH nes a l'etranger auxquels on avait prescrit une dose quotidienne d'antiretroviraux. METHODE: Nous avons utilise une etude de cohorte retrospective en deux volets pour comparer les effets de la TAR chez les patients nes a l'etranger et les patients autochtones nes au Canada et chez les patients non autochtones nes au Canada. Le 1er volet a fait appel a la regression logistique pour comparer la probabilite d'une suppression virale initiale chez les patients nes a l'etranger (40%) et les patients autochtones nes au Canada (27%) et chez les patients non autochtones nes au Canada (33%). Le 2e volet a fait appel a l'analyse de survie pour comparer le taux d'echec de la TAR selon le pays d'origine des patients ayant obtenu une suppression virale initiale durant le 1er volet. RESULTATS: Notre echantillon d'etude comportait 322 patients naifs de traitement (dont 122 nes a l'etranger). Pour le 1er volet, 261 patients ont obtenu une suppression virale initiale moins de six mois apres le debut de la TAR. Compte tenu de l'age, du schema therapeutique, du risque d'exposition au VIH et de l'annee civile, comparativement aux patients non autochtones nes au Canada, la probabilite d'obtenir une suppression virale initiale etait significativement plus faible chez les patients autochtones nes au Canada (RC=0,44, IC de 95%: 0,20-0,96); et similaire a celle des patients nes a l'etranger (RC=0,76, IC de 95%: 0,33-1,73). Le 2e volet incluait 261 patients, suivis sur 635,1 annees-personne. Compte tenu de l'age, du sexe, de la numeration des lymphocytes CD4 au depart et du regime posologique, comparativement aux patients non autochtones nes au Canada, les patients autochtones nes au Canada et les patients nes a l'etranger avaient des taux d'echec virologique similaires apres la suppression virale initiale (indice de risque (IR)=1,54, IC de 95%: 0,38-6,18; IR=0,49, IC de 95%: 0,11-2,20, respectivement). CONCLUSIONS: Notre etude indique que les effets de la TAR chez les patients de l'Alberta nes a l'etranger sont semblables a ceux observes chez les patients non autochtones nes au Canada. Par contre, nos resultats donnent a penser que chez les patients autochtones nes au Canada, les effets du traitement sont moins bons que chez les patients non autochtones nes au Canada. Il est donc imperatif que les cliniciens, les chercheurs et le public comprennent mieux les raisons de l'inefficacite relative de la TAR chez les patients autochtones du nord de l'Alberta nes au Canada. MOTS CLES: therapie antiretrovirale; emigrants et immigrants; VIH-1; effets physiologiques des medicaments; Canada, The HIV/AIDS epidemic disproportionately impacts vulnerable populations. In 2012, persons born in HIV-endemic countries comprised approximately 2.2% of the Canadian population but accounted for 13% of newly diagnosed HIV cases. [...]

The Beijing lineage of Mycobacterium tuberculosis (also referred to as the East Asian lineage or lineage 2) is an emerging public health threat (1,2). The Beijing lineage accounts for 13% [...]

OBJECTIVE: We compared the health-related quality of life (HRQL) of Aboriginal and non-Aboriginal HIV patients after they started highly active antiretroviral therapy (HAART) in Edmonton, Alberta and investigated whether clinical status (CD4 cell count and viral load) might explain any observed differences. METHODS: In 2006-2007, eligible patients who started HAART in 1997-2005 completed the MOS-HIV to measure HRQL. Using multiple linear regression models, we compared physical (PHS) and mental (MHS) health summary scores across four groups: Aboriginals infected with HIV via injection drug use (AB/IDUs); Aboriginal non-IDUs (AB/non-IDUs); non- Aboriginal IDUs (non-AB/IDUs); and non-Aboriginal non-IDUs (non-AB/non-IDUs). To assess whether clinical status could explain any observed group differences, we fitted a model adjusting for socio-demographics (age and sex) and years since starting HAART only and then additionally adjusted for current clinical status. RESULTS: Ninety-six patients were eligible (35% Aboriginal, 42% IDU). Adjusting for socio-demographics and years since starting HAART, AB/IDUs (p=0.008), AB/non-IDUs (p=0.002), and non-AB/IDUs (p=0.002) had lower PHS scores than non- AB/non-IDUs. After additionally adjusting for clinical status, these relationships remained significant for AB/non-IDUs (p=0.027) and non-AB/IDUs (p=0.048) but not for AB/IDUs (p=0.12). AB/IDUs and non AB/IDUs tended to have worse MHS scores than non-AB/non-IDUs, but these relationships were not statistically significant and weakened after adjusting for current clinical status. CONCLUSIONS: AB/IDU, AB/non-IDUs, and non-AB/IDUs had significantly poorer physical HRQL than non-AB/non-IDUs. These differences appear to be partially explained by poorer clinical status, especially for AB/IDUs, which suggests that observed inequalities in physical HRQL may be diminished by improving patients' clinical status; for example, through improved adherence to HAART. KEY WORDS: Aboriginal populations; antiretroviral therapy, highly active; intravenous drug users; treatment outcomes; health-related quality of life OBJECTIF : Nous avons compare la qualite de vie liee a la sante (QVLS) de patients autochtones et non autochtones atteints du VIH apres le debut d'une therapie antiretrovirale hautement active (TAHA) a Edmonton (Alberta) et cherche a savoir si leur etat clinique (numeration des lymphocytes CD4 et charge virale) pouvait expliquer les differences observees. METHODE : En 2006-2007, des patients admissibles ayant entame une TAHA en 1997-2005 ont rempli le questionnaire MOS-HIV, qui mesure la QVLS. A l'aide de modeles de regression lineaire multiple, nous avons compare les cotes sommaires de sante physique (CSP) et de sante mentale (CSM) de quatre groupes : les Autochtones infectes par le VIH via l'utilisation de drogues par injection (Aut./UDI); les Autochtones non-UDI (Aut./non-UDI); les non-Autochtones UDI (non-Aut./UDI); et les non-Autochtones non-UDI (non-Aut./non-UDI). Pour determiner si l'etat clinique pouvait expliquer les differences observees entre ces groupes, nous avons adapte un modele en tenant compte des caracteristiques sociodemographiques (age et sexe) et du nombre d'annees depuis le debut de la TAHA seulement, puis en tenant compte, en plus, de l'etat clinique actuel. RESULTATS : Quatre-vingt-seize patients etaient admissibles (35 % d'Autochtones, 42 % d'UDI). Compte tenu des caracteristiques sociodemographiques et du nombre d'annees depuis le debut de la TAHA, les Aut./UDI (p=0,008), les Aut./non-UDI (p=0,002) et les non-Aut./UDI (p=0,002) avaient des cotes CSP inferieures a celles des non-Aut./non-UDI. En tenant aussi compte de l'etat clinique, ces relations demeuraient significatives pour les Aut./non-UDI (p=0,027) et les non-Aut./UDI (p=0,048), mais pas pour les Aut./UDI (p=0,12). Les Aut./UDI et les non-Aut./UDI avaient tendance a presenter des CSM inferieures a celles des non-Aut./non-UDI, mais ces relations n'etaient pas significatives, et elles s'affaiblissaient apres la prise en consideration de l'etat clinique actuel. CONCLUSION : La QVLS physique des Aut./UDI, des Aut./non-UDI et des non-Aut./UDI etait significativement inferieure a celle des non-Aut./non-UDI. Ces differences semblent s'expliquer en partie par un moins bon etat clinique, surtout pour les Aut./UDI, ce qui laisse entendre que les inegalites observees dans la QVLS physique peuvent etre reduites si l'on ameliore l'etat clinique des patients, par exemple en ameliorant l'observance de la TAHA. MOTS CLES : populations autochtones; therapie antiretrovirale hautement active; toxicomanie intraveineuse; resultat therapeutique; qualite de vie liee a la sante, In Canada, Aboriginals and non-Aboriginals infected with HIV do not appear to receive equal benefit from highly active antiretroviral therapy (HAART). After starting HAART, Aboriginals have been shown to experience [...]

Background. It is largely unknown whether functional recovery following hip fracture differs between long-term care (LTC) and community-dwelling residents. Our primary purpose was to compare recovery between these patients 6 months following hip fracture, controlling for known prognostic factors. Secondarily, we examined the contribution of residential status, in addition to patient characteristics, to functional recovery. Methods. We studied a population-based inception cohort of 451 hip fracture patients [greater than or equal to] 65 years old admitted to one Canadian health region hospital between July 1999 and September 2000. Participants completed the Modified Barthel Functional Index (MBI) in hospital and again via telephone interviews 6 mont lected on surgery and rehabilitation timing, length of hospital stay (LOS). and discharge destination. Relative change from prefracture function adjusting for known prognostic factors, and the proportion of participants ret were compared between the LTC and community-dwelling residents. Results. LTC residents (n = 115) were older, with lower function prefracture, more comorbidities, and increased dementia than community-dwelling residents (n = 336). Six months postfracture, 17 (22%) LTC and 180 (71%) community-dwelling residents had regained prefracture function (p < .001). LTC residents had 33% lower (-40.6, -27.2) and community-dwelling residents 11.6% lower (-14.8, 8.4) 6-month MBI scores relative to prefracture scores alter risk adjustment. Residential status was significantly associated with risk-adjusted functional recovery (p < .001). Median LOS was 4 days less for LTC than for community-dwelling residents (p < .001). Twelve (10%) LTC and 266 (79%) community-dwelling residents were discharged to inpatient rehabilitation (p < .001). Conclusion. Following hip fracture, most LTC residents do not regain prefracture function irrespective of known prognostic factors. Further investigation is needed as to the extent to which personal and environmental characteristics contribute to outcome after hip fracture.

The trends in the attitudes and behaviors of youth in western Uganda are monitored with respect to prevention of HIV/AIDS. The results have shown positive changes in the sexual behavior of secondary school students in western Uganda, thereby declining the HIV prevalence rates among young people from this region.

In many areas of health care, randomized controlled trials (the best evidence regarding the effectiveness of health care interventions) are lacking and decision-makers have to rely on evidence from nonrandomized studies (NRS). We conducted a Medline search to identify English-language articles describing instruments for assessing the quality of NRS of health care interventions. These instruments varied greatly in scope, in the number and types of items and in developmental rigor. Items commonly included were those related to specification of study questions, allocation method, comparability of groups, and blinding of outcome assessment. We do not support the development of a generic scale to evaluate the methodological quality of nonrandomized intervention studies. Instead, further study should be directed to investigate the degree to which, and the circumstances under which, different methodological characteristics are associated with bias. This information will assist researchers in identifying apriori which methodological characteristics need careful evaluation in particular studies. Keywords: systematic reviews, nonrandomized studies, validity

Objectives. The purpose of this study was to compare hip fracture hospitalization rates between a fluoridated and a non-fluoridated community in Alberta, Canada: Edmonton, which has had fluoridated drinking water since 1967, and Calgary, which considered fluoridation in 1991 but is currently revising this decision. Methods. Case subjects were all individuals aged 45 years or older residing in Edmonton or Calgary who were admitted to hospitals in Alberta between January 1, 1981, and December 31, 1987, and who had a discharge diagnosis of hip fracture. Edmonton rates were compared with Calgary rates, with adjustment for age and sex using the Edmonton population as a standard. Results. The hip fracture hospitalization rate for Edmonton from 1981 through 1987 was 2.77 per 1000 person-years. The age-sex standardized rate for Calgary was 2.78 per 1000 person-years. No statistically significant difference was observed in the overall rate, and only minor differences were observed within age and sex subgroups, with the Edmonton rates being higher in males. Conclusions. These findings suggest that fluoridation of drinking water has no impact, neither beneficial nor deleterious, on the risk of hip fracture. (Am J Public Health. 1993;83:689-693), Use of fluoridated drinking water was found to have no effect on the risk of developing hip fractures in a comparison of two Canadian cities. Hospital admissions from 1981 to 1987 with the diagnosis of hip fracture were compared for patients 45 years old or older in Edmonton and Calgary in Alberta. Edmonton's drinking water had been fluoridated since 1967. Calgary did not have fluoridated water. In this comparison, no significant differences were found in the rates of hospitalization for hip fractures between residents of cities with fluoridated draining water and residents of cities without fluoridation. Fluoridation was begun as a means of preventing cavities in children. Later research suggested that fluoride might help prevent osteoporosis. The use of sodium fluoride to treat osteoporosis is an accepted practice but some studies have linked fluoride treatment to an increase in fractures.

Background and Objectives: The need to centralize patients for specialty care in the setting of regionalization may delay access to specialist services and compromise outcomes, particularly in a large geographic area. The aim of this study was to explore the effects of interhospital transferring of children requiring intensive care in a Canadian regionalization model. Methods: A retrospective cohort design with a matched pair analysis was adopted to compare the outcomes in children younger than 17 years admitted to a pediatric intensive care unit (PICU) of a Canadian children's hospital by a specialized transport team (pediatric critical care transported [PCCT] group) and those children admitted directly to PICU from its pediatric emergency department (PED group). The outcomes of interest included mortality 72 hours from initial contact with the critical care team (ie, either PICU transport team or intrahospital PICU team). Results: In total, 680 (27%) transports met our inclusion criteria, whereas 866 (7%) cases of 11 570 total PICU admissions were admitted directly from the emergency department. A total of 493 pairs were formed for the matched analyses. Odds of mortality within 72 hours in the PCCT group were significantly higher than in the PED group (odds ratio [OR]: 2.18, 95% confidence interval [CI]: 1.07-4.45; P = .032). When excluding cases who had at least one episode of cardiac arrest before involvement of the pediatric critical care (PCC) transport team, the OR dropped to 1.66 (95% CI: 0.77-3.46). Conclusions: Children transported from nonpediatric hospitals had a higher 72-hour mortality when compared to those children admitted directly to a children's hospital PICU from its own PED in a Canadian regionalized healthcare model. [ABSTRACT FROM AUTHOR]

Community health workers (CHWs) can help to redress the shortages of health human resources needed to scale up antiretroviral treatment (ART). However, the selection of CHWs could influence the effectiveness of a CHW programme. The purpose of this observational study was to assess whether sociodemographic characteristics and geographic proximity to patients of volunteer CHWs were predictors of clinical outcomes in a community-based ART (CBART) programme in Kabarole, Uganda. Data from CHW surveys for 41 CHWs and clinic charts for 185 patients in the CBART programme were analysed using multivariable logistic and Cox regression models. Time to travel to patients was the only statistically significant characteristic of CHWs associated with ART outcomes. Patients whose CHWs had to travel one or more hours had a 71% lower odds of virologic suppression (adjusted OR = 0.29, 95% CI = 0.13–0.65,p = .002) and a 4.52 times higher mortality hazard rate (adjusted HR = 4.52, 95% CI = 1.20–17.09,p = .026) compared to patients whose CHWs had to travel less than one hour. The findings show that the sociodemographic characteristics of CHWs were not as important as the geographic distance they had to travel to patients. [ABSTRACT FROM PUBLISHER]

Background: In sub-Saharan Africa, a shortage of trained health professionals and limited geographical access to health facilities present major barriers to the expansion of antiretroviral therapy (ART). We tested the utility of a health centre (HC)/ community-based approach in the provision of ART to persons living with HIV in a rural area in western Uganda. Methods: The HIV treatment outcomes of the HC/community-based ART program were evaluated and compared with those of an ART program at a best-practice regional hospital. The HC/community-based cohort comprised 185 treatmentnaïve patients enrolled in 2006. The hospital cohort comprised of 200 patients enrolled in the same time period. The HC/ community-based program involved weekly home visits to patients by community volunteers who were trained to deliver antiretroviral drugs to monitor and support adherence to treatment, and to identify and report adverse reactions and other clinical symptoms. Treatment supporters in the homes also had the responsibility to remind patients to take their drugs regularly. ART treatment outcomes were measured by HIV-1 RNA viral load (VL) after two years of treatment. Adherence was determined through weekly pill counts. Results: Successful ART treatment outcomes in the HC/community-based cohort were equivalent to those in the hospitalbased cohort after two years of treatment in on-treatment analysis (VL≤400 copies/mL, 93.0% vs. 87.3%, p=0.12), and in intention-to-treat analysis (VL≤400 copies/mL, 64.9% and 62.0%, p = 0.560). In multivariate analysis patients in the HC/ community-based cohort were more likely to have virologic suppression compared to hospital-based patients (adjusted OR = 2.47, 95% CI 1.01-6.04). Conclusion: Acceptable rates of virologic suppression were achieved using existing rural clinic and community resources in a HC/community-based ART program run by clinical officers and supported by lay volunteers and treatment supporters. The results were equivalent to those of a hospital-based ART program run primarily by doctors. [ABSTRACT FROM AUTHOR]

Introduction: Mycobacterium tuberculosis Beijing strains are frequently associated with tuberculosis outbreaks and drug resistance. However, contradictory evidence and limited study generalizability make it difficult to foresee if the emergence of Beijing strains in high-income immigrant-receiving countries poses an increased public health threat. The purpose of this study was to determine if Beijing strains are associated with high risk disease presentations relative to other strains within Canada. Methods: This was a retrospective population-based study of culture-confirmed active TB cases in a major immigrantreceiving province of Canada in 1991 through 2007. Of 1,852 eligible cases, 1,826 (99%) were successfully genotyped. Demographic, clinical, and mycobacteriologic surveillance data were combined with molecular diagnostic data. The main outcome measures were site of disease, lung cavitation, sputum smear positivity, bacillary load, and first-line antituberculosis drug resistance. Results: A total of 350 (19%) patients had Beijing strains; 298 (85%) of these were born in the Western Pacific. Compared to non-Beijing strains, Beijing strains were significantly more likely to be associated with polyresistance (aOR 1.8; 95% CI 1.0- 3.3; p = 0.046) and multidrug-resistance (aOR 3.4; 1.0-11.3; p = 0.049). Conversely, Beijing strains were no more likely than non-Beijing strains to be associated with respiratory disease (aOR 1.3; 1.0-1.8; p = 0.053), high bacillary load (aOR 1.2; 0.6- 2.7), lung cavitation (aOR 1.0; 0.7-1.5), immediately life-threatening forms of tuberculosis (aOR 0.8; 0.5-1.6), and monoresistance (aOR 0.9; 0.6-1.3). In subgroup analyses, Beijing strains only had a significant association with multidrugresistant tuberculosis (aOR 6.1; 1.2-30.4), and an association of borderline significance with polyresistant tuberculosis (aOR 1.8; 1.0-3.5; p = 0.062), among individuals born in the Western Pacific. Conclusion: Other than an increased risk of polyresistant or multidrug-resistant tuberculosis, Beijing strains appear to pose no more of a public health threat than non-Beijing strains within a high-income immigrant-receiving country. [ABSTRACT FROM AUTHOR]

Ugandan policy regarding infant feeding for HIV-positive mothers is replacement feeding (RF), if feasible; otherwise, exclusive breastfeeding (EBF) for 3 months is advised (or EBF for 6 months, if RF is still not feasible). HIV-negative mothers should practise EBF for 6 months. The study objective was to explore the association between maternal HIV status and breastfeeding practices in Kabarole, Uganda. Data were collected from questionnaires administered at home to 182 women (44 HIV-positive and 138 HIV-negative) 3 months post-partum and from medical charts. The HIV-negative women were matched on delivery date to HIV-positive women at a ratio of 3:1. Interviewers were blinded to HIV status. There was no statistically significant association between adherence to Ugandan national feeding guidelines and maternal HIV status in bivariate analysis [odds ratio (OR) = 1.52; confidence interval (CI): 0.76-3.04]. Multivariate analyses showed a significant association between adherence to feeding guidelines and child illness (OR = 0.40; CI: 0.21-0.79) and between adherence to feeding guidelines and rural residence in Burahya county (OR = 2.43; CI: 1.15-5.13). Many mothers do not follow the feeding guidelines for HIV infection. This region-specific information on breastfeeding practice determinants will be used to inform local Prevention of Mother-to-Child Transmission (PMTCT) programmes. The nature of the association between child illness and EBF should be further explored. [ABSTRACT FROM AUTHOR]

Objectives: Implementation of the International Statistical Classification of Disease and Related Health Problems, 10th Revision (ICD-10) coding system presents challenges for using administrative data. Recognizing this, we conducted a multistep process to develop ICD-10 coding algorithms to define Charlson and Elixhauser comorbidities in administrative data and assess the performance of the resulting algorithms.Methods: ICD-10 coding algorithms were developed by "translation" of the ICD-9-CM codes constituting Deyo's (for Charlson comorbidities) and Elixhauser's coding algorithms and by physicians' assessment of the face-validity of selected ICD-10 codes. The process of carefully developing ICD-10 algorithms also produced modified and enhanced ICD-9-CM coding algorithms for the Charlson and Elixhauser comorbidities. We then used data on in-patients aged 18 years and older in ICD-9-CM and ICD-10 administrative hospital discharge data from a Canadian health region to assess the comorbidity frequencies and mortality prediction achieved by the original ICD-9-CM algorithms, the enhanced ICD-9-CM algorithms, and the new ICD-10 coding algorithms.Results: Among 56,585 patients in the ICD-9-CM data and 58,805 patients in the ICD-10 data, frequencies of the 17 Charlson comorbidities and the 30 Elixhauser comorbidities remained generally similar across algorithms. The new ICD-10 and enhanced ICD-9-CM coding algorithms either matched or outperformed the original Deyo and Elixhauser ICD-9-CM coding algorithms in predicting in-hospital mortality. The C-statistic was 0.842 for Deyo's ICD-9-CM coding algorithm, 0.860 for the ICD-10 coding algorithm, and 0.859 for the enhanced ICD-9-CM coding algorithm, 0.868 for the original Elixhauser ICD-9-CM coding algorithm, 0.870 for the ICD-10 coding algorithm and 0.878 for the enhanced ICD-9-CM coding algorithm.Conclusions: These newly developed ICD-10 and ICD-9-CM comorbidity coding algorithms produce similar estimates of comorbidity prevalence in administrative data, and may outperform existing ICD-9-CM coding algorithms. [ABSTRACT FROM AUTHOR]

Objectives: To describe the epidemiology of depression following traumatic spinal cord injury (SCI) and identify risk factors associated with depression. Methods: This population-based cohort study followed individuals from date of SCI to 6 years after injury. Administrative data from a Canadian province with a universal publicly funded health care system and centralized databases were used. A Cox proportional hazards model was developed to identify risk factors. Results: Of 201 patients with SCI, 58 (28.9%) were treated for depression. Individuals at highest risk were those with a pre-injury history of depression [hazard rate ratio (HRR) 1.6; 95% CI: 1.1–2.3], a history of substance abuse (HRR 1.6; 95% CI: 1.2–2.3) or permanent neurological deficit (HRR 1.6; 95% CI: 1.2–2.1). Conclusion: Depression occurs commonly and early in persons who sustain an SCI. Both patient and injury factors are associated with the development of depression. These should be used to target patients for mental health assessment and services during initial hospitalization and following discharge into the community. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Determines the perceptions of health care professionals and service providers with regards to emergency department (ED) overcrowding in Canadian hospitals. Definitions of overcrowding; Characteristics of overcrowded ED; Causes of overcrowding in the ED of hospitals.

Background: Although some studies suggest that access to cardiac procedures may differ by sex, others have found no evidence of gender bias in cardiac care.Objective: To study rates of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery in men and women after cardiac catheterization.Design: Cohort study with prospective data collection.Setting: Alberta, Canada.Patients: Persons undergoing cardiac catheterization between 1 January 1995 and 31 December 1998 (n = 21 816).Measurements: The occurrence of revascularization procedures (PCI or CABG) in the year after cardiac catheterization was measured. Unadjusted revascularization rates, partially adjusted rates (adjusted for clinical variables available in most databases, including administrative databases), and fully adjusted rates (additionally adjusted for extent of coronary artery disease and ejection fraction) were also evaluated.Results: The unadjusted relative risk was 0.67 (95% CI, 0.65 to 0.71) for the end point of any revascularization in women relative to men. The relative risk increased to 0.69 (CI, 0.66 to 0.72) with partial adjustment and to 0.98 (CI, 0.94 to 1.03) with full adjustment, indicating equivalent access to revascularization for men and women. For PCI, the corresponding relative risks were 0.77 (CI, 0.73 to 0.82), 0.84 (CI, 0.80 to 0.89), and 1.02 (CI, 0.96 to 1.08). For CABG surgery, the relative risks were 0.54 (CI, 0.51 to 0.58), 0.51 (CI, 0.48 to 0.55), and 0.93 (CI, 0.87 to 1.01).Conclusions: In Alberta, Canada, clinical variables fully explain sex differences in rates of revascularization after cardiac catheterization, and misleading conclusions would arise without full adjustment for clinical differences between men and women. Extreme caution is needed in interpreting reports on access to care that use sparsely detailed clinical data sources. [ABSTRACT FROM AUTHOR]

The predominant etiologic theory of preeclampsia is that reduced uteroplacental perfusion is the unique pathogenic process in the development of preeclampsia. Decreased uteroplacental blood flow would result in lower birth weights. To date, no study has assessed the effect of preeclampsia on birth weight by gestational age. Thus, the authors conducted a retrospective cohort study based on 97,270 pregnancies that resulted in delivery between 1991and 1996 at 35 hospitals in northern and central Alberta, Canada. Differences in mean birth weight between women with preeclampsia and normotensive women ranged from −547.5 g to 239.5 g for gestational age categories ranging from ≤32 weeks to ≥42 weeks. The birth weights were statistically significantly lower among mothers with preeclampsia who delivered at ≤37 weeks, with an average difference of –352.5 g. However, the birth weights were not lower among preeclamptic mothers who delivered after 37 weeks (average difference of 49.0 g). In Alberta, 61.2% of preeclamptic patients gave birth after 37 weeks of gestation. The authors conclude that babies born to mothers with preeclampsia at term have fetal growth similar to that of babies born to normotensive mothers. This finding does not endorse the currently held theory that reduced uteroplacental perfusion is the unique pathophysiologic process in preeclampsia. [ABSTRACT FROM PUBLISHER]

Every couple of decades governments decide that they need to involve citizens more in public decision-making processes. The significant changes that have occurred over the past decade, including a growing loss of faith in the traditional institutions of government, have once again prompted political decision-makers to explore options for enhanced citizen participation. In the health care sector, reforms occurring during the 1990s were couched in terms such as "enhanced responsiveness," "improved accountability," and "increased citizen participation." In the new millennium, governments and regional health authorities have been relatively silent on this issue. As has been the case in the past, a wide range of opinions exist about what citizen participation is and how governments should proceed. Without either conceptual clarity or practical direction, governments have been slow to articulate what they hope to achieve or how they intend to get there. The purpose of this paper is to examine the concept of citizen participation within the context of a series of basic questions from which decision-makers might draw some policy relevance. Rather than taking a particular disciplinary perspective (i.e. health promotion), the authors have chosen to review a broad spectrum of existing literature to provide a better understanding of what is known about citizen participation, both good and bad. As such, the paper is meant to be a point of departure for an informed discussion of the possibilities for improved citizen participation in health (care) decision-making. [ABSTRACT FROM AUTHOR]