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The Alberta Pregnancy Outcomes and Nutrition (APrON) study is an ongoing prospective cohort study that recruits pregnant women early in pregnancy and, as of 2012, is following up their infants to 3 years of age. It has currently enrolled approximately 5000 Canadians (2000 pregnant women, their offspring and many of their partners). The primary aims of the APrON study were to determine the relationships between maternal nutrient intake and status, before, during and after gestation, and (1) maternal mood; (2) birth and obstetric outcomes; and (3) infant neurodevelopment. We have collected comprehensive maternal nutrition, anthropometric, biological and mental health data at multiple points in the pregnancy and the post-partum period, as well as obstetrical, birth, health and neurodevelopmental outcomes of these pregnancies. The study continues to follow the infants through to 36 months of age. The current report describes the study design and methods, and findings of some pilot work. The APrON study is a significant resource with opportunities for collaboration., (© 2012 John Wiley & Sons Ltd.)

Background: Pregnant women were recruited into the Alberta Pregnancy Outcomes and Nutrition (APrON) study in two cities in Alberta, Calgary and Edmonton. In Calgary, a larger proportion of women obtain obstetrical care from family physicians than from obstetricians; otherwise the cities have similar characteristics. Despite similarities of the cities, the recruitment success was very different. The purpose of this paper is to describe recruitment strategies, determine which were most successful and discuss reasons for the different success rates between the two cities., Methods: Recruitment methods in both cities involved approaching pregnant women (< 27 weeks gestation) through the waiting rooms of physician offices, distributing posters and pamphlets, word of mouth, media, and the Internet., Results: Between May 2009 and November 2010, 1,200 participants were recruited, 86% (1,028/1,200) from Calgary and 14% (172/1,200) from Edmonton, two cities with similar demographics. The most effective strategy overall involved face-to-face recruitment through clinics in physician and ultrasound offices with access to a large volume of women in early pregnancy. This method was most economical when clinic staff received an honorarium to discuss the study with patients and forward contact information to the research team., Conclusion: Recruiting a pregnancy cohort face-to-face through physician offices was the most effective method in both cities and a new critically important finding is that employing this method is only feasible in large volume maternity clinics. The proportion of family physicians providing antenatal and post-natal care may impact recruitment success and should be studied further.

Low serum albumin may have prognostic value for morbidity and mortality in patients with hip fracture. The primary aim of the study was to evaluate the independent association between low serum albumin (<35 g/l) at hospital admission and short-term (in-hospital) mortality and post-operative complications of patients with hip fracture. We reviewed a prospective population-based cohort of 583 hip fracture patients who had pre-operative albumin values measured at hospital admission in one of the 3 tertiary hospitals in Northern Alberta, Canada. Patients with a primary diagnosis of hip fracture and 65 years or older were included. The primary outcomes were in-hospital mortality and any pre-specified post-operative complication. Mean serum albumin level was 33.8±4.5 g/l (±S.D.), and overall 55% (n=318) of patients had a low albumin. The in-hospital mortality was 8% (n=46) and rate of any non-fatal post-operative complication rate was 31/100. Mortality was 11% (n=35) among those with low albumin levels and 4% (n=11) for those with normal values (unadjusted odds ratio (OR) 2.86, 95% CI=1.42-5.74). After multivariate adjustment, the association between low serum albumin and mortality remained large and statistically significant (adjusted OR=2.44, 95% confidence interval (CI)=1.17-5.12). Low albumin levels were also significantly associated with post-operative medical complications (adjusted OR=1.96, 95% CI=1.36-2.83). We conclude that routine measurement of serum albumin provides valuable prognostic information for treating this frail population., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Background: Parental knowledge of child development has been associated with more effective parenting strategies and better child outcomes. However, little is known about what adults who interact with children under the age of 14 years know about child development., Methods: Between September 2007 and March 2008, computer assisted telephone interviews were completed with 1443 randomly selected adults. Adults were eligible if they had interacted with a child less than 14 years of age in the past six months and lived in Alberta, Canada., Results: Sixty three percent of respondents answered two (or more) out of four questions on physical development correctly. Fifteen percent of respondents answered two (or more) out of three questions on cognitive development correctly. Seven percent of respondents answered three (or more) out of five questions on social development correctly. Two percent of respondents answered three (or more) out of five questions on emotional development correctly. Parents and females were better able to identify physical developmental milestones compared to non-parents and males. 81% of adults correctly responded that a child's experience in the first year of life has an important impact on later school performance, 70% correctly responded that a child's ability to learn is not set from birth, 50% of adults correctly responded that children learn more from hearing someone speak than from television, and 45% recognized that parents' emotional closeness with a baby influences later achievement. Parents were most likely to use doctors/paediatricians, books, and nurses as resources. Among parents, there was no relationship between knowledge and parenting morale., Conclusions: The majority of adults were unable to correctly answer questions related to when children under six years of age typically achieve developmental milestones. Knowledge of physical development exceeded knowledge about cognitive, emotional and social development. Adults were aware of the importance of positive experiences in influencing children's development. Strategies to improve awareness of developmental milestones combined with information on how to support optimal development may improve child development outcomes. Given that parents seek information about child development from health care providers there is an opportunity to ensure that providers are well informed about child development.

Objective: To determine if paternal age elevates the risk of low birthweight (< 2500g, LBW), preterm birth (< 37 weeks gestation), and multiple gestation among mothers whose age does not predict an elevated risk., Design/methods: Population data on birth outcome, maternal age and paternal age was obtained from Alberta Health and Wellness for all births 1990-1996., Results: Among women aged 25 to 29, regardless of parity, there was no linear relationship between paternal age and preterm birth or LBW. However, multiple birth rates increased with increased paternal age (p < 0.01). Among singleton births, advanced paternal age (>50 years) increased the risk of LBW and preterm birth (p < 0.05)., Conclusions: Paternal age is not a risk factor for LBW or preterm delivery among low risk women. The increased risk of multiple birth with increased paternal age, regardless of parity, requires confirmation among other populations.

Introduction: There is controversy as to whether continuous passive motion (CPM) after total knee arthroplasty (TKA), which is the standard treatment, confers significant benefit with respect to outcome. The primary purpose of this study was to determine if CPM or slider-board (SB) therapy, used as adjuncts to standardized exercises (SEs) during the acute-care hospital stay, resulted in a reduced total length of hospitalization and post-discharge rehabilitation in patients who underwent primary TKA., Methods: We carried out a randomized, clinical trial on 120 patients who received a TKA at the University of Alberta Hospital, Edmonton, a tertiary care institution. The study horizon began at the point of discharge from the hospital and continued up to 6 months after operation. Postoperatively, patients (40 in each group) received CPM and SEs, SB therapy and SEs or SEs alone while in the tertiary Health service use was compared using transfer institution length of stay(LOS), post-discharge rehabilitation, readmission and complication rates and their associated costs., Results: There were no differences in health service use or costs among the 3 groups over the 6-month study. The rates of postoperative complications and readmissions also were similar among the groups. Increased health service use associated with knee flexion that was less than 60 degrees at discharge, but similar proportions of patients with poor knee range of movement (ROM) at discharge were found in each group., Conclusions: This finding suggests that adjunctive ROM therapy, as used in this study, does not reduce health service use. Further research is required to determine if adjunctive ROM therapy after discharge from the surgical hospital decreases health service utilization in those patients who have poor knee ROM at the time of discharge.

Context: No population-based data are available on the use of complementary and alternative medicine (CAM) specifically among colorectal cancer patients., Objective: To examine the prevalence and determinants of CAM use among colorectal cancer patients in Alberta, Canada., Design: Population-based questionnaire., Setting and Participants: Patients (871 of 1240 surveyed), or their close relatives or friends, who were diagnosed with colorectal cancer in 1993 or 1995 in Alberta, Canada., Main Outcome Measures: Demographics, lifestyle, health status, symptoms and coping mechanisms, and attitudes about cancer cause, conventional treatments and practitioners, and CAM and practitioners., Results: Seventy percent (871) of 1240 participants completed the questionnaire, and 49% used CAM. The most frequently used CAM therapies among users were psychological and spiritual therapies (65%), vitamins and minerals (46%), and herbs (42%). Sixty-eight percent of CAM users informed their medical doctors, and 69% used CAM after conventional care. Logistic regression suggested the strongest predictors of CAM use to be vegetarian diet, aged less than 50 years, female, having therapy options other than conventional treatment recommended by conventional doctors, experiencing changes in bowel habits orfatigue before diagnosis, and recommendation of chemotherapy. Nonsurviving patients were more likely to have used CAM than were survivors., Conclusions: Cancer patients are using CAM and communicating usage to physicians. This finding suggests that physicians should be prepared to discuss CAM with patients, and evidence-based information about CAM should be sought, including where CAM may pose risks. This study serves as a baseline for studies on the efficacy and safety of CAM.

Objective: This study quantified the impact of delayed childbearing (maternal age greater-than-or-equal to 35 years) on population rate changes in low birth weight (LBW; < 2500 g), preterm delivery (< 37 weeks), multiple births, and small for gestational age (SGA; < 10th percentile) in Alberta, Canada, between 1990 (N = 42 930) and 1996 (N = 37 710)., Methods: Data were obtained from the provincial notification of a live or stillbirth. Analyses included relative risk estimates and chi(2) tests for trend. Potential confounding attributable to in vitro fertilization was investigated., Results: The proportion of births to women greater-than-or-equal to 35 years of age was 8.4% in 1990 and 12.6% in 1996, a 51.2% increase. Among these women, LBW delivery increased 11%, and preterm delivery increased 14%. Delayed childbearing accounted for 78% of the change in LBW rate in the population and 36% of the change in preterm delivery rate in the population. Provincial multiple birth rates increased by 15% for twins and 14% for triplets. Delayed childbearing accounted for 15% of the twin increase and 69% of the triplet increase. When in vitro fertilization pregnancies were excluded, the change was 43% for preterm rates, 100% for LBW, 14% for twins, and 9% for triplets. Delayed childbearing did not contribute to changes in singleton SGA deliveries., Conclusions: The findings suggest that the recent increase in LBW and preterm delivery is partly related to the population phenomenon of delayed childbearing. Maternal age was not related to changes in SGA, suggesting that the age effect is through pregnancy complications that lead to preterm delivery and LBW. Prospective parents should be informed about the higher risk for neonatal morbidity associated with delayed childbearing. Health care providers should be aware of the impact of delayed childbearing on health care resources.

This study examined the impact of infant and maternal factors on preterm delivery and low birthweight (LBW) in Alberta between January 1, 1994 and December 31, 1996. Data on 113,994 births were collected from vital statistics registration birth data. Logistic regression models for preterm and LBW delivery suggested the key risk factors were multiple and still birth (odds ratios > 22.0). Other characteristics included female gender, birth defects, nulliparous women, maternal age 35 and greater, unmarried, history of abortion, maternal smoking, maternal street drug use, and having less than 4 prenatal visits (odds ratios 0.86-2.54). Interactions between smoking and alcohol, and smoking and parity were noted. Efforts to improve the currently low rates (8.2%) of smoking cessation during pregnancy are required. Social, economic and medical factors associated with delayed childbearing and birth outcomes should be investigated.

Objective: Between 1994/95 and 1996/7, the healthcare system in Alberta underwent a radical transformation that saw the regionalization of service delivery and a reduction in overall healthcare funding. The aim of this study is to examine trends in utilization and associated post-operative complications and readmissions for two procedures, total hip arthroplasty (THA) and total knee arthroplasty (TKA) during this period of restructuring., Methods: This is a six-year retrospective analysis using hospital separation and healthcare insurance plan registry databases. During the study period, we looked at trends in inpatient procedure volumes, average lengths of stay, post-operative complications during the index hospital stay and readmissions within one year., Results: Over a six-year period, the age-sex standardized provincial rate of THAs increased by 18% while the rate of TKAs increased by 73%. Average lengths of stay decreased for both procedures by over 50%. The rate of procedures with at least one post-operative complication within the index episode of care decreased over the study period by 19% for THA and 21% for TKA. Readmissions due to complications of surgery increased overall by 32% for THA and 2% for TKA. Regional and sex differences were observed throughout the period., Conclusions: While the overall rate of hospitalizations has decreased in Alberta, the rates of THA and TKA procedures have increased. The lengths of stay following these procedures have, at the same time, reduced dramatically. Adverse outcomes as measured by complication rates associated with these procedures have decreased, though readmissions due to complications after surgery have increased.

Magnetic resonance imaging (MRI) has excellent specificity and sensitivity for the diagnosis of internal derangement of the knee (IDK). The use of MRI to screen patients with suspected IDK could avoid unnecessary arthroscopies with a reduction in costs. The purpose of this study was to evaluate the use of arthroscopy among patients with IDK, and to estimate the potential cost-effectiveness of MRI in these patients to avoid unnecessary arthroscopies. The study was based on a retrospective cohort of all patients attending three orthopedic clinics between April and September 1993 with a new diagnosis of IDK. Charts were reviewed in 1994 to allow for a follow-up of more than 6 months. An economic evaluation was performed based on cost-effectiveness ratios (per averted arthroscopy), including direct and indirect costs. There were 241 patients with a new diagnosis of IDK (67% males, mean age 35 +/- 12 years), and 110 (46%) underwent arthroscopy. The remaining patients received conservative therapy and were not scheduled for arthroscopy within the period of observation. Using a priori established criteria, 10% of the arthroscopies could be considered diagnostic only (e.g., normal knee) and 27% were of doubtful efficacy from a therapeutic perspective (e.g., debridement alone). Many of these arthroscopies could have been avoided by performing a prior MRI. Using these findings, we conducted decision tree analyses of the use of MRI among patients requiring arthroscopy of the knee. A sensitivity analysis was performed to evaluate the various model assumptions. In general, MRI appeared to be a cost-effective diagnostic procedure for patients with IDK requiring arthroscopy of the knee, and there were cost savings associated with it in some of the models tested.