Search

Objectives: To evaluate the sensitivity and positive predictive value (PPV) of administrative health and education data for identifying cases of autism spectrum disorder (ASD) in Manitoba, and to recommend a surveillance case definition., Methods: Four service providers abstracted information on children who had been clinically diagnosed with ASD ("sensitivity cohort"). That information was linked to Manitoba's administrative health and education data and records were extracted into the study dataset. Records were also included for children who had an administrative diagnosis of ASD but who were not part of the sensitivity cohort. Study packages were mailed to the parents of the latter group in order to verify their diagnostic status. The sensitivity and PPV of various case definitions were calculated., Results: Among the 1728 service provider-reported cases, 1532 had an administrative diagnosis of ASD. A total of 2414 children had an administrative diagnosis, of whom 882 were not part of the sensitivity cohort. The response to the mail-out was very poor (<3%). Accordingly, we calculated minimum PPVs. Our recommended surveillance case definitions are ≥1 physician claim (ICD-9-CM 299) or ≥1 "ASD" special education record (2-5 years of age), and ≥2 physician claims or ≥1 "ASD" special education record (6-14 years of age). The sensitivity ranged from 80% (95% CI: 77-83) to 88% (95% CI: 83-91) and the minimum PPV from 70% (95% CI: 67-73) to 78% (95% CI: 75-81) for these definitions., Conclusion: This work advances the goal of establishing a cost-effective national surveillance system for ASD.

Background: Little information exists on health of children with developmental disabilities (DDs) in the Canadian province of Manitoba., Method: The present authors linked 12 years of administrative data and compared health status, changes in health and access to health and social services between children with (n = 1877) and without (n = 5661) DDs living in the province, matched by age, sex and region of residence., Results: Children with DDs were significantly more likely than children in the matched comparison group to die before the age of 17 and have a history of respiratory illness, diabetes and injury-related hospitalizations. Children with DD also had significantly higher average number of ambulatory physician visits and higher rate of continuity of care., Conclusions: Children with DDs had poorer health status than the matched comparison group. The health disparities experienced by children with DDs persisted over time. Further population-based longitudinal research is needed in this area., (© 2016 John Wiley & Sons Ltd.)

Background: No standardized tool is used in Canada for comprehensive health assessments of adults with intellectual disabilities. This study was conducted to determine the feasibility of implementing the Comprehensive Health Assessment Program (CHAP) in Manitoba, Canada., Method: This was a qualitative study using a purposive sample of physicians, nurse practitioners, support workers and families. Data were collected through individual interviews and focus groups and were analysed using content analysis., Results: Use of the CHAP was perceived as beneficial for persons with intellectual disabilities. Improved continuity of care was of the reported benefits. Six barriers for the future implementation of the CHAP were identified including the time required to complete the CHAP, and the perceived lack of physicians' willingness to do comprehensive assessments., Conclusion: The future implementation of the CHAP was strongly supported. For its successful implementation, training of healthcare professionals and support staff and change in regulations and policies were recommended., (© 2016 John Wiley & Sons Ltd.)

Hospital Incident Command System (HICS) has been established with the mission of prevention, response, and recovery in hazards. Regarding the key role of hospitals in medical management of events, the present study is aimed at investigating benefits, barriers, and limitations of applying HICS in hospital. Employing a review study, articles related to the aforementioned subject published from 1995 to 2016 were extracted from accredited websites and databases such as PubMed, Google Scholar, Elsevier, and SID by searching keywords such as HICS, benefits, barriers, and limitations. Then, those articles were summarized and reported. Using of HICS can cause creating preparedness in facing disasters, constructive management in strategies of controlling events, and disasters. Therefore, experiences indicate that there are some limitations in the system such as failure to assess the strength and severity of vulnerabilities of hospital, no observation of standards for disaster management in the design, constructing and equipping hospitals, and the absence of a model for evaluating the system. Accordingly, the conducted studies were investigated for probing the performance HICS. With regard to the role of health in disaster management, it requires advanced international methods in facing disasters. Using accurate models for assessing, the investigation of preparedness of hospitals in precrisis conditions based on components such as command, communications, security, safety, development of action plans, changes in staff's attitudes through effective operational training and exercises and creation of required maneuvers seems necessary., Competing Interests: The authors have no conflicts of interest.

Background: Anxiety and mood disorders are the most common mental illnesses, peaking during adolescence and affecting approximately 25% of Canadians aged 14-17 years. If not successfully treated at this age, they often persist into adulthood, exerting a great social and economic toll. Given the long-term impact, finding ways to increase the success and cost-effectiveness of mental health care is a pressing need. Cognitive behavior therapy (CBT) is an evidence-based treatment for mood and anxiety disorders throughout the lifespan. Mental health technologies can be used to make such treatments more successful by delivering them in a format that increases utilization. Young people embrace technologies, and many want to actively manage their mental health. Mobile software apps have the potential to improve youth adherence to CBT and, in turn, improve outcomes of treatment., Objective: The purpose of this project is to improve homework adherence in CBT for youth anxiety and/or depression. The objectives are to (1) design and optimize the usability of a mobile app for delivering the homework component of CBT for youth with anxiety and/or depression, (2) assess the app's impact on homework completion, and (3) implement the app in CBT programs. We hypothesize that homework adherence will be greater in the app group than in the no-app group., Methods: Phase 1: exploratory interviews will be conducted with adolescents and therapists familiar with CBT to obtain views and perspectives on the requirements and features of a usable app and the challenges involved in implementation. The information obtained will guide the design of a prototype. The prototype will be optimized via think-aloud procedures involving an iterative process of evaluation, modification, and re-evaluation, culminating in a fully functional version of the prototype that is ready for optimization in a clinical context. Phase 2: a usability study will be conducted to optimize the prototype in the context of treatment at clinics that provide CBT treatment for youth with anxiety and/or depression. This phase will result in a usable app that is ready to be tested for its effectiveness in increasing homework adherence. Phase 3: a pragmatic clinical trial will be conducted at several clinics to evaluate the impact of the app on homework adherence. Participants in the app group are expected to show greater homework completion than those in the no-app group., Results: Phase 3 will be completed by September 2019., Conclusions: The app will be a unique adjunct to treatment for adolescents in CBT, focusing on both anxiety and depression, developed in partnership with end users at every stage from design to implementation, customizable for different cognitive profiles, and designed with depression symptom tracking measures for youth made interoperable with electronic medical records., Competing Interests: Conflicts of Interest: None declared., (©Pamela Wilansky, J Mikael Eklund, Tracy Milner, David Kreindler, Amy Cheung, Tim Kovacs, Shahin Shooshtari, Arlene Astell, Arto Ohinmaa, Joanna Henderson, John Strauss, Rosemary S L Mills. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 10.11.2016.)

Objective: Dementia is increasingly recognized as a public health priority, but little is known about persons with early-onset dementia (EOD). The objectives of this article are (a) to compare the socio-demographic and health characteristics of people with EOD and late-onset dementia (LOD) and (b) to examine the relationships between EOD and overall health and life stress., Method: Data were from the Survey on Living With Neurological Conditions in Canada (SLNCC). Logistic regression models were used to identify the characteristics associated with EOD and LOD, and to assess the impact of EOD on overall health and life stress., Results: Compared with LOD, individuals with EOD were more likely to be male, to have a mood disorder, and to have a longer illness duration. EOD was associated with high life stress, but not with negative overall health., Discussion: This study identified attributes associated with EOD that have important implications for service planning., (© The Author(s) 2015.)

Background: This paper reviews what is currently known about mortality among Canadians with intellectual and developmental disabilities and describes opportunities for ongoing monitoring., Methods: In-hospital mortality among adults with intellectual and developmental disabilities in Ontario was examined using hospital data. Mortality was compared between age-, sex- and residence area-matched groups of Manitobans with and without intellectual and developmental disabilities using linked administrative data. A retrospective cohort study of mortality among individuals with intellectual and developmental disabilities in a region of Ontario focused on measuring excess mortality and risk factors., Findings: There is evidence of excess mortality in persons with intellectual and developmental disabilities in Canada. Some of the excess is attributable to comorbidities that are more common in this population. Women may have a greater risk of death than men. Excess mortality occurs at all ages but is more pronounced in early life., Discussion: High-quality ongoing monitoring of mortality among individuals with intellectual and developmental disabilities is possible in Canada. Examination of sex differences should be a priority., (© 2015 John Wiley & Sons Ltd.)

Objectives: Smoking during pregnancy may cause many health problems for pregnant women and their newborns. However, there is a paucity of research that has examined the predictors of smoking during pregnancy in Canada. This study used data from the 2009-2010 Canadian Community Health Survey (CCHS) to estimate the prevalence of smoking during pregnancy and examine the demographic, socioeconomic, health-related and behavioral determinants of this behavior., Methods and Findings: The data were obtained from the 2009-2010 CCHS master data file. Weighted estimates of the prevalence were calculated. Multivariable logistic regression was used to determine demographic, socioeconomic, health related and behavioral characteristics associated with smoking behavior during pregnancy. Women living in the Northern Territories had a high rate of smoking during pregnancy (59.3%). The prevalence of smoking during pregnancy was also high among women under 25 years old, of low socioeconomic status, who reported not having a regular medical doctor, being fair to poor in self-perceived health, having at least one chronic disease, having at least one mental illness, being heavy smokers, and being regular alcohol drinkers. Results from multivariable logistic regression revealed that the odds of smoking during pregnancy were decreased with increasing age (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.91-0.99), having a regular family doctor [OR, 0.24; 95% CI, 0.11-0.52], having highest level of family income [OR, 0.09; 95% CI, 0.03-0.29]. Mothers who reported poor or fair self-perceived health [OR, 2.13; 95% CI, 0.96-4.71] and those who had at least one mental illness [OR, 1.81; 95% CI, 1.00-3.28] had greater odds of smoking during pregnancy., Conclusions: There are a number of demographic, socio-economic, health-related and behavioral characteristics that should be considered in developing and implementing effective population health promotional strategies to prevent smoking during pregnancy, promoting health and well-being of pregnant women and their newborns.

Background: The workshop that this paper reports, held in Iran in May of 2011, at the 1st Inter-national and 4th National Congress on Health Education and Promotion, had three main objec-tives: 1) to introduce participants to the knowledge translation (KT) concept, along with its mod-els and methods; 2) to enhance participants' knowledge of how KT could apply to public health education and promotion ; and 3) to learn from different participating stakeholder groups about the factors that facilitate or impede effective KT in public health education and promotion in Iran., Methods: The workshop consisted of three components: introducing the KT concept, assessing the KT capacity of participants, and facilitating a discussion of the important contextual factors that promote and impede effective KT. Of the 26 individuals from across the country participat-ing in the workshop, 17 took part in a KT capacity assessment activity. They classified them-selves into one of the following three stakeholder groups: administrators and policymakers (n=6), practitioners (n=2), and researchers (n=9)., Results: There were different capacities for KT across the three stakeholder groups. The re-ported challenges for effective KT include "lack of resources and funding"; "lack of time"; "poor quality of relationships and lack of trust between health policymakers, administrators, re-searchers, and clinicians"; "inadequate skills possessed by healthcare professionals and adminis-trators for assessment and adaptation of research findings"; and "poor involvement of commu-nity partners in the research process.", Discussion: There is a great need to develop effective strategies to overcome the reported barri-ers for effective KT.

Objective: The primary objectives of this study were to examine the likelihood of anxiety disorders among respondents with common physical health conditions and to explore the associations between this comorbidity and older adults' perceived mental and physical health., Method: The sample consisted of older adults from the Canadian Community Health Survey 1.2 (n=12,792). Trained lay interviewers assessed psychiatric disorders based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Physical health conditions were based on self-reported diagnoses by health professionals. Multiple logistic regressions examined whether suffering from a physical health condition increased the odds of any assessed anxiety disorder (panic, agoraphobia, social phobia and posttraumatic stress disorder). Multiple linear regressions examined associations between self-rated health and comorbid physical health conditions and anxiety., Results: After adjusting for confounding variables, the presence of chronically painful conditions (i.e., arthritis, back pain and migraine) and of other commonly occurring diseases (i.e., allergies, cataracts and gastrointestinal, lung and heart disease) were positively associated with anxiety. The comorbidity of anxiety with allergies, cataracts, arthritis and lung disease resulted in poorer self-rated physical and/or mental health after adjusting for confounding variables., Conclusion: Health problems in older adults are associated with increased odds of anxiety, and this comorbidity is associated with poorer self-reported health than medical problems or anxiety alone. These findings have important clinical implications for health professionals., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Study Objective. To estimate and compare the prevalence of dementia and depression among adults with and without developmental disabilities (DDs). Methods. We linked data from several provincial administrative databases to identify persons with DDs. We matched cases with DD with persons without DD as to sex, age, and place of residence. We estimated the prevalence of dementia and depression and compared the two groups using the Generalized Estimating Equations (GEEs) technique. Results. The estimated prevalence of depression and dementia among younger adults (20-54) and older adults (50+) with DD was significantly higher than the estimated rates for the matched non-DD group (Depression: younger adults: RR = 2.96 (95% CI 2.59-3.39); older adults: RR = 2.65 (95% CI 1.84-3.81)), (Dementia: younger adults: RR = 4.01 (95% CI 2.72-5.92); older adults: RR = 4.80 (95% CI 2.48-9.31)). Conclusion. Significant disparities exist in mental health between persons with and without DDs.

Temperature affects distal sensory & motor latencies & nerve conduction velocity but not necessarily at the same degree. Purpose of this study is to see which one is affected less and thus could be more reliable in cold conditions. A total of 32 healthy individuals with age range of 18-28 years (mean 22.25 +/- 2.2) participated in this study. Skin Temperature was recorded at wrist. Distal median motor & sensory latencies and transcarpal median NCV were recorded before and after immersion in cold water. Statistical analysis was performed using paired t-test with SPSS. All parameters were affected by cold but the effect was less dramatic in transcarpal NCV. Transcarpal median NCV is least affected parameter by cold, so it may be more reliable than sensory & motor latencies at wrist.

Objective: The purpose of this article is (a) to extend previous research on the relationship between neighborhood socioeconomic status (SES) and health by considering a wide range of health-related measures derived from administrative health care records and (b) to explore whether this relationship persists into old age., Method: The study involved a complete cohort of community-dwelling residents in Winnipeg, Canada, who were 65 years or older in 2004/2005 (N = 77,930). Health measures were derived from administrative claims data. Census data were used to derive neighborhood-level SES., Results: Multilevel logistic regressions indicated that, relative to individuals living in the most affluent areas, those in the poorest areas had significantly higher odds of having arthritis, diabetes, hypertension, congestive heart failure, ischemic heart disease, chronic obstructive pulmonary disease, depression, and stroke. Significant neighborhood income effects tended to be evident among individuals age 65 to 75 as well as those age 75+., Discussion: A wide range of health conditions among older adults are disproportionately clustered into the poorest areas. Programs and services should be designed to meet the needs of older adults of any age in such neighborhoods.

Objectives: Carpal tunnel syndrome (CTS) is the most common neuropathy that can be diagnosed with confidence by the nerve conduction study (NCS). One of the recent treatments of CTS is the application of low power laser (LPL) therapy. The present study evaluates the effects of LPL irradiation through NCS and clinical signs and symptoms., Methods: A total of 80 patients were included in this study. Diagnosis of CTS was based on both clinical examination and electromyographic (EMG) findings. Patients were randomly assigned into two groups. Test group (group A) underwent laser therapy (9-11 joules/cm2) over the carpal tunnel area. Control group (group B) received sham laser therapy. Pain, hand grip strength, median proximal sensory and motor latencies, transcarpal median sensory nerve conduction (SNCV) were recorded. After fifteen sessions of irradiation (five times per week), parameters were recorded again and clinical symptoms were measured in both groups. Pain was evaluated by Visual Analog Scale (VAS; day-night). Hand grip was measured by Jamar dynometer. Paired t-test and independent sample t-test were used for statistical analysis., Results: There was a significant improvement in clinical symptoms and hand grip in group A (p < 0.001). Proximal median sensory latency, distal median motor latency and median sensory latencies were significantly decreased (p < 0.001). Transcarpal median SNCV increased significantly after laser irradiation (p < 0.001). There were no significant changes in group B except changes in clinical symptoms (p < 0.001)., Conclusions: Laser therapy as a new conservative treatment is effective in treating CTS paresthesia and numbness and improves the subjects' power of hand grip and electrophysiological parameters.

Background: Poor dietary habits may increase risk for obesity and chronic diseases among Canadian adolescents., Objectives: The aims of the present study were to: (a) establish the patterns of fruit and vegetable intake by Canadian adolescents, and (b) identify the impact of sociodemographic factors-including age, household income, household education, ethnicity, living arrangement, and location-on the pattern of fruit and vegetable intake in this population., Design: This is a cross-sectional study using the data from the Canadian Community Health Survey, Cycle 2.1, Public Use File. The survey used questions similar to a food frequency questionnaire., Methods: Total fruit and vegetable intake of 18,524 Canadian adolescents (12 to 19 years old) was cross-tabulated between two age groups (12 to 14 years old [n=7,410] and 15 to 19 years old [n=11,114]) by sex, level of household education, total household income, ethnicity, living arrangement, and geographical location., Results: The data revealed that a 38.3% of Canadian adolescents in this study consumed fruits and vegetables five to 10 times per day; fewer older adolescents (15- to 19-year-olds) reported eating fruits and vegetables at that frequency as compared with the younger subgroup (12- to 14-year-olds) (P<0.001). Household education and income independently had a significant (P<0.001) positive impact on fruit and vegetable consumption. Females reported a significantly (P<0.05) higher frequency of intake than did males. Adolescents living in homes with only one parent reported a significantly (P<0.005) lower frequency of intake, as compared with adolescents living with two parents., Conclusions: These results may help to identify adolescent groups at risk for poor eating habits and support the implementation of programs to encourage higher fruit and vegetable intakes.

Background: Lower limb injuries and ankle sprain occur frequently among football players, due to the high incidence of physical contact. As a result, lower limb nerves are subject to injury. This project aims to evaluate the lower limb nerve conduction among students playing football to investigate the probable relationship between ankle sprain in football and nerve conductivity., Materials and Methods: Fifty volunteer students aged between 19 and 25 were studied. They fell into three groups; one comprising of 20 healthy football players whose football experience exceeded three years, the second group with 15 football players who had suffered ankle sprain and the last group with 15 healthy non- sports students. Initially, the surface temperature of the foot skin was recorded. Then, the latency and the conduction velocity of deep peroneal and tibial nerves were recorded, statistical data analysis was conducted using statistical tests, i.e., "Independent sampleT", and "Paired T test"., Results: In the football player group, student with Hx of ankle sprain, the deep peroneal and tibial nerves distal latencies were significantly longer than the other two groups (P < or = 0.05). In addition, the nerve conduction velocity of the deep peroneal motor and tibial nerves showed a significant decrease in comparison with the other two groups (P < or = 0.05)., Conclusion: Harming the lower limb nerves, football may increase the nerve latencies and hence decrease the conductivity in lower limbs. Therefore, in electrophysiologic tests of the football players lower limb nerves, especially those with lower limb injuries, one has to consider the fact that the decrease in the clinical neuroconductivity may be preexistent. Thus care should be taken in diagnosing neuropathy, in this group.

Background: Erythromelalgia (EM) is characterized by severe pain associated with local redness and hotness in the extremities. When the extremity is lowered, or heat is applied, the pain is intensified and when coldness is applied, or the extremity is elevated the pain is decreased., Objective: To evaluate if there is any sympathetic nervous system involvement in erythromelalgia, sympathetic skin response (SSR) test was done., Setting: This study was conducted during the years 1998-2000 in the Department of Physical medicine and Rehabilitation, Shiraz University of Medical Sciences., Methods: SSR study was done on 22 patients with erythromelalgia and 22 normal subjects were matched for age and sex for comparison., Results: There is a significant difference between the patients and controls especially in the lower extremity findings (P = 0.000). More than 72.7% of the patients had abnormal SSR., Conclusion: It is concluded that sympathetic peripheral fibers (C fibers) are involved in erythromelalgia and it is probably the pathogenesis of the disease.

Objectives: This article examines determinants of self-perceived health. Factors associated with very good/excellent rather than good health are compared with those associated with fair/poor rather than good health., Data Source: The data are from the household cross-sectional and longitudinal components of the first three cycles (1994/95, 1996/97 and 1998/99) of Statistics Canada's National Population Health Survey (NPHS)., Analytical Techniques: Cross-tabulations from the 1998/99 NPHS cross-sectional file were used to estimate the prevalence of very good/excellent and fair/poor health by sex and age group. Based on the longitudinal file, predictors of health perceptions in 1998/99 were studied in a multivariate model using generalized logistic regression., Main Results: While physical conditions were strongly related to health perceptions, some lifestyle, socio-economic and psychosocial factors were also statistically significant. Heavy smoking, irregular exercise and overweight were associated with fair/poor health ratings. Unhealthy changes in lifestyle were associated with fair/poor rather than good health. Distress, low self-esteem and low socio-economic status were negatively associated with very good/excellent health.

Thirty patients with definite multiple sclerosis along with fourteen healthy volunteers as control group were studied. Mean SSR latencies in the control group was 1,467 ms for upper extremities and 1,915 ms for lower extremities while 1,655 and 2,170 ms respectively in the patients with multiple sclerosis. Mean SSR amplitudes in the control group was 2.22 mV for upper extremities and 1.21 mV for lower extremities while 1.24 and 0.64 mV respectively in the patients with multiple sclerosis. All the differences between the patients and the control group was significant using T test (P = 0.001). Using Roc-curve, limits with highest sensitivity specificity products for SSR latency were calculated to be 1,700 ms for upper and 2,400 ms for lower extremities. For SSR amplitude they were 1.2 mV for upper and 0.5 mV for lower extremities. Considering absent SSR and/or at least 3 abnormal amplitudes or latencies as the criteria of abnormality, the specificity of the test was 100% and the sensitivity was 80% among our patients. Using the following criteria for abnormality, SSR study in the patients with multiple sclerosis is a test with high specificity and sensitivity: 1--Absent SSR, and/or 2--At least 3 abnormal out of the eight recordings (amplitudes and latencies of four extremities) with normal limits for SSR latency being defined as < or = 1,700 ms for upper and < or = 2,400 ms for lower extremities and for SSR amplitude as > or = 1.2 mV for upper and > or = 0.5 mV for lower extremities.