Search

Background: Cervical cancer can be largely prevented through vaccination against the human papillomavirus (HPV). In Canada, HPV vaccination of school-aged girls started in 2008 and has reached an average rate of 67% across the country. However, this rate is below a current national target of 90%. Aim: We project the difference in lifetime clinical outcomes and health system costs of achieving a 90% HPV vaccination rate versus a 67% rate for girls vaccinated in 2015 using the OncoSim-Cervical model. Methods: The OncoSim-Cervical model (version 2.5) is a microsimulation model led by the Canadian Partnership Against Cancer, with model development by Statistics Canada, to evaluate the impacts of cervical cancer interventions in Canada. It has two parts, the first, the HPV Microsimulation Model, simulates the transmission of HPV between males and females including possible modulation by vaccination and herd immunity, and provides projections of HPV infection and prevalence for input to the cervical cancer natural history component in the second part. We simulated two cohorts of 5-10 year old girls in 2015; one receiving HPV vaccination at the rate of 67% and another at 90%. Their relative lifetime cervical cancer outcomes and costs were compared. Assumptions included: 100% efficacy of the HPV vaccine; triennial cytology screening between ages 21 and 65; 90% screening recruitment of age-eligible women with 80% rescreening; and a $500 cost for a 3-dose quadrivalent HPV vaccine regimen. Projected costs were undiscounted and are in 2016 CAD. Results: Compared with the 67%-vaccinated cohort, in the 90%-vaccinated cohort there was a lifetime reduction of 23% in cervical cancer incident cases and 21% in cervical cancer deaths. Lifetime cancer treatment costs decreased by $26 million (23%), and wart treatment costs and precervical cancer costs decreased by $3.2 million (15%) and $45 million (16%) respectively. Lifetime screening costs decreased by $47 million (2%). Conclusion: Achieving a nationally-set target of 90% HPV vaccination in Canadian girls would not only save more lives but would free up funds that could be redirected to other health system needs. Planners could aim for relatively high nation-wide rates of HPV vaccination coverage to enhance their cervical cancer control strategy. [ABSTRACT FROM AUTHOR]

Background: Smoking is responsible for nearly 85% of lung cancer cases and 30% of all cancer-related deaths. Canada has set an ambitious target to reduce tobacco use to 5% by 2035 in alignment with a world-wide tobacco endgame initiative. Aim: We project the impact of achieving a national 5% smoking prevalence rate by 2035 on population-level lung cancer outcomes and costs. Methods: OncoSim-Lung (version 2.5), led by the Canadian Partnership Against Cancer with model development by Statistics Canada, is a microsimulation model that incorporates Canadian demographics, risk factors, registry data, resource utilization and other data to project clinical and economic impacts of cancer control measures. Smoking cessation parameters were modified to reduce the current average national smoking prevalence rate of 18% over time to 5% in 2035. Impacts were compared with those in a reference scenario, which maintained the current prevalence rate. Outputs of interest included lung cancer incidence, mortality, treatment costs, and quality-adjusted life-years (QALYs). Costs and QALYs are undiscounted and reported in 2016 CAD. Results: Achieving a 5% smoking rate by 2035 would result in a 2017-2035 cumulative total of 31,000 fewer lung cancer cases, 21,000 fewer lung cancer-related deaths, and 457,000 additional QALYs compared with projections based on a constant smoking prevalence rate of ∼20%. When stratified by sex, there would be 15,600 and 15,700 fewer lung cancer diagnoses and 11,000 and 10,000 fewer lung cancer-related deaths for males and females respectively. Furthermore, treatment-related costs would be reduced by $680 million dollars. On average there would be 4,500 fewer lung cancer cases, 3,500 fewer deaths, and $35 million in cost savings annually. If a 5% smoking rate is sustained until 2050, then there would be a 15% reduction in lung cancer cases and a 13% reduction in deaths from 2017-2050. Conclusion: Reducing Canada's smoking prevalence to 5% by 2035 could result in a significant reduction in lung cancer cases, deaths and treatment costs. Like Canada, other countries with relatively high smoking prevalence could use averted treatment costs to offset costs of aggressive smoking prevention and cessation programs or redirect them to other healthcare services. [ABSTRACT FROM AUTHOR]

Background: Cancer control interventions exert their effects over multiple decades. To evaluate diverse and competing opportunities to reduce future cancer burden it is desirable to understand long-term effects prior to any new program implementation or significant change. Internationally, modeling is becoming an accepted source of planning information for decision-makers. Aim: We will describe the construction and use of the OncoSim microsimulation model, which was developed to evaluate cancer control strategies in Canada. Methods: OncoSim is a suite of models (cancers of the lung, colorectum, cervix and breast, plus a composite 32-cancer model) used to address key policy questions and support decision-making. It is led by the Canadian Partnership Against Cancer with model development by Statistics Canada. OncoSim incorporates risk factors, cancer natural history, screening, treatment, survival and end-of-life care. Wherever possible it is informed by Canadian data sources. Models are calibrated to reproduce a range of cancer-specific statistics, e.g., current and historical Canadian cancer-specific incidence and mortality, smoking patterns, and results of screening. The site-specific models have undergone further validation by replicating reported short-term effects of cancer prevention and screening interventions. Users may customize interventions through modifying input parameters. Outputs include incidence, mortality, costs, cost-effectiveness, and resource utilization. Users from the public sector have access at no cost to OncoSim and receive extensive support from a multidisciplinary technical team. The model is continually updated to incorporate emerging knowledge. Results: OncoSim has been used to support cancer control decision-making at the national and provincial/territorial levels. Applications include: national guidelines recommendations for colorectal and lung cancer screening; comparison of cytology vs. HPV based cervical cancer screening; and integration of smoking cessation into low-dose CT lung cancer screening. Conclusion: Validated simulation models such as OncoSim can be a versatile and efficient tool for cancer control planners to evaluate and prioritize cancer control strategies. [ABSTRACT FROM AUTHOR]

Background: Nephropathy is one of the most common microvascular impediments of diabetes mellitus. In this study, we aimed to estimate the prevalence of nephropathy in diabetic patients across the North American region., Methods: Eligible studies were screened out from 3 electronic databases, for example, PubMed, Google Scholar, and ScienceDirect using specific search keywords based on the eligibility criteria. Extracting the data from the included studies publication bias, quality assessment, outlier investigation, and meta-analysis was done followed by the subgroup analysis. A total of 11 studies met the study inclusion criteria. Meta-analysis was performed with the extracted data., Results: Pooled prevalence of 28.2% (95% confidence interval [CI]: 19.7-36.7) with a high rate of heterogeneity (I2 = 100%) was identified. The pooled prevalence of nephropathy among diabetic patients in the United States of America, Canada, and Mexico was 24.2% (95% CI: 13.8-34.5), 31.2% (95% CI: 25.8-36.5), and 31.1% (95% CI: 20.8-41.5), respectively., Conclusion: The prevalence of nephropathy among diabetic patients was found lower in the United States of America as compared to Canada and Mexico. Besides, the pooled prevalence of the North American region was found to be lower as compared to the African, European, and Asian regions. Minimizing the pathogenic factors, sufficient diagnostic, healthcare facilities, and awareness are recommended to improve the situation., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The interdependent and intersecting nature of the Sustainable Development Goals (SDGs) require collaboration across government sectors, and it is likely that departments with few past interactions will find themselves engaged in joint missions on SDG projects. Intersectoral action (IA) is becoming a common framework for different sectors to work together. Understanding the factors in the environment external to policy teams enacting IA is crucial for making progress on the SDGs., Methods: Interviews [n=17] with senior public servants leading SDG work in nine departments in the federal government of Canada were conducted to elicit information about issues affecting how departments engage in IA for the SDGs. Transcripts were coded based on a set of factors identified in a background review of 20 documents related to Canada's progress on SDGs. Iterative group thematic analysis by the authors illuminated a set of domestic and global contextual factors affecting IA processes for the SDGs., Results: The mechanisms for successful IA were identified as facilitative governance, leadership by a central coordinating office, supportive staff, flexible and clear reporting structures, adequate resources, and targeted skills development focused on collaboration and cross-sector learning. Factors that affect IA positively include alignment of the SDG agenda with domestic and global political priorities, and the co-occurrence of social issues such as Indigenous rights and gender equity that raise awareness of and support for related SDGs. Factors that affect IA negatively include competing conceptual frameworks for approaching shared priorities, lack of capacity for "big picture" thinking among bureaucratic staff, and global disruptions that shift national priorities away from the SDGs., Conclusion: IA is becoming a normal way of working on problems that cross otherwise separate government accountabilities. The success of these collaborations can be impacted by contextual factors beyond any one department's control., (© 2024 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Objective: The objective of this review is to synthesize the findings of economic evaluations of preventing or treating pressure ulcers., Introduction: Pressure ulcers are one of the most common preventable complications characterized by local tissue injury. Pressure ulcers increase mortality rates, impair quality of life, increase the length of hospital stay, and alter overall health outcomes. Published studies have found higher costs associated with treating pressure ulcers than preventing them, with treatment cost varying based on the pressure ulcer category (the greater the category, the higher the cost). We will systematically review the evidence on preventing or treating pressure ulcers from an economic perspective., Inclusion Criteria: We will include systematic reviews that investigate both the cost and outcomes associated with the prevention or treatment of pressure ulcers. Systematic reviews dealing with economic evaluation of wound care or management will be excluded if they have not provided separate information for pressure ulcers., Methods: Epistemonikos, MEDLINE, NHS Economic Evaluation Database, and the Canadian Agency for Drugs and Technologies in Health (CADTH) website will be searched for relevant systematic reviews from inception and without any language restrictions. Titles and abstracts will be screened at the initial stage, followed by full-text screening. Quality assessment will be done using the standard JBI critical appraisal instrument for systematic reviews and research syntheses. Article screening, data extraction, and quality assessment will be performed by two reviewers independently. All economic health outcomes will be considered under the primary outcomes of the study., Systematic Review Registration Number: Open Science Framework (https://osf.io/9y2a7/)., Competing Interests: MK is an associate editor for JBI Evidence Synthesis. He had no input into the editorial processes for this protocol. The other authors declare no conflict of interest., (Copyright © 2021 JBI.)

Purpose: To evaluate the epidemiology, presentation and management of hypoparathyroidism in Canada. Hypoparathyroidism is associated with significant morbidity and poor quality of life. We present baseline results from the Canadian National Hypoparathyroidism Registry, a prospective observational study evaluating hypoparathyroidism in Canada., Methods: Our study enrolled 130 patients with hypoparathyroidism. Patients were followed every 6 months with clinical and lab assessments. We present baseline data in this manuscript., Results: Seventy percent (91/130) of patients had postsurgical hypoparathyroidism, 30% (39/130) of patients had nonsurgical hypoparathyroidism due to autoimmune, genetic or idiopathic causes, and a molecular diagnosis was confirmed in 11 of these 39 patients. Pseudohypoparathyroidism was confirmed in 4/39 patients, DiGeorge syndrome in 2/39 patients, Barakat syndrome with a mutation in the GATA3 gene in 1/39, and activating mutations of the CASR gene in 3/39 patients with nonsurgical hypoparathyroidism. Renal complications with nephrocalcinosis or nephrolithiasis were present in 27% (14/52) of patients with postsurgical disease and 17% (4/24) of patients with nonsurgical hypoparathyroidism. Basal ganglia calcification was noted on imaging in 15% (n = 5/34) of patients with postsurgical hypoparathyroidism and 37% (n = 7/19) of patients with nonsurgical hypoparathyroidism., Conclusions: Hypercalciuria was more commonly seen in those with renal complications of nephrocalcinosis, nephrolithiasis or CKD, and hyperphosphatemia was more commonly seen in those with basal ganglia calcification. Hospitalization occurred in 28% of those with postsurgical hypoparathyroidism and 46% of those with nonsurgical hypoparathyroidism. Hypoparathyroidism is associated with significant morbidity. Effective strategies to reduce the short-and long-term complications of hypoparathyroidism need to be developed and evaluated.

Objective: As only sparse data are available, we aimed to investigate whether needs for activated vitamin D and calcium supplements change in women with hypoparathyroidism during pregnancy and lactation and risk of pregnancy-related complications., Design: Retrospective review of medical records., Patients: Twelve Danish and Canadian patients with chronic hypoparathyroidism who completed 17 pregnancies., Measurements: Data were extracted on plasma levels of ionized calcium (P-Ca 2+ ) and doses of active vitamin D and calcium supplements during pregnancy (N = 14) and breastfeeding (N = 10). Data on pregnancy complications were available from all 17 pregnancies., Results: Although average doses of active vitamin D (P = .91) and calcium supplements (P = .43) did not change during pregnancies, a more than 20% increase or decrease in dose of active vitamin D was needed in more than half of the pregnancies in order to maintain normocalcemia. Five women (36%) developed hypercalcaemia by the end of pregnancy or start of lactation. Median levels of P-Ca 2+ increased from 1.20 mmol/L in third trimester to 1.32 mmol/L in the post-partum period (P < .03). Accordingly, the average dose of active vitamin D was significantly reduced (P = .01) during lactation compared to 3rd trimester. One woman developed severe pre-eclampsia (6%). Further four pregnancies (24%) were complicated by polyhydramnios, dystocia and/or perinatal hypoxia. Ten pregnancies required caesarean delivery (59%) with four (24%) being performed as an emergency., Conclusion: In chronic hypoparathyroidism, close medical monitoring of the mother with frequent adjustments in the dose of calcium and active vitamin D is required during pregnancy and lactation in order to maintain normocalcemia. Patients should be offered close obstetric care to handle potential perinatal complications. We recommend evaluating the neonate immediately after birth and notifying the paediatrician of the risks of hypocalcaemia as well as hypercalcaemia in the neonate., (© 2020 John Wiley & Sons Ltd.)