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BackgroundThe COVID-19 pandemic has had a disproportionate impact on vulnerable populations, including individuals with chronic pain. We examined associations between geographical variations in COVID-19 infection rates, stress and pain severity, and investigated factors associated with changes in pain status and psychological distress among individuals living with chronic pain during the pandemic. MethodsThis investigation is part of a larger initiative, the Chronic Pain & COVID-19 Pan-Canadian Study, which adopted a cross-sectional observational design. A total of 3159 individuals living with chronic pain completed a quantitative survey between 16 April and 31 May 2020. ResultsTwo-thirds (68.1%) of participants were between 40 and 69 years old, and 83.5% were women. Two-thirds (68.9%) of individuals reported worsened pain since pandemic onset. Higher levels of perceived pandemic-related risks (adjusted odds ratio: 1.27; 95% confidence interval: 1.03–1.56) and stress (1.21; 1.05–1.41), changes in pharmacological (3.17; 2.49–4.05) and physical/psychological (2.04; 1.62–2.58) pain treatments and being employed at the beginning of the pandemic (1.42; 1.09–1.86) were associated with increased likelihood of reporting worsened pain. Job loss (34.9% of individuals were employed pre-pandemic) was associated with lower likelihood (0.67; 0.48–0.94) of reporting worsened pain. Almost half (43.2%) of individuals reported moderate/severe levels of psychological distress. Negative emotions toward the pandemic (2.14; 1.78–2.57) and overall stress (1.43; 1.36–1.50) were associated with moderate/severe psychological distress. ConclusionStudy results identified psychosocial factors to consider in addition to biomedical factors in monitoring patients’ status and facilitating treatment access for chronic pain patients during a pandemic.

IntroductionLa pandémie de COVID-19 a eu un impact disproportionné sur les populations vulnérables, notamment les personnes atteintes de douleur chronique. Nous avons examiné les associations entre les variations géographiques des taux d’infection par le coronavirus, le stress et l’intensité de la douleur et nous avons étudié les facteurs associés à l’évolution de la douleur et à la détresse psychologique chez les personnes atteintes de douleur chronique pendant la pandémie. MéthodesCette analyse s’inscrit dans le cadre d’une initiative plus vaste, l’étude pancanadienne « Douleur chronique et COVID-19 », qui emploie une méthode de recherche transversale observationnelle. Au total, 3 159 personnes atteintes de douleur chronique ont répondu à une enquête quantitative entre le 16 avril et le 31 mai 2020. RésultatsLes deux tiers (68,1 %) des participants avaient entre 40 et 69 ans, et 83,5 % étaient des femmes. Les deux tiers (68,9 %) des répondants ont signalé une aggravation de leur douleur depuis le début de la pandémie. Un niveau élevé de risques perçus liés à la pandémie (rapport de cotes ajusté : 1,27 %; intervalle de confiance [IC] à 95 % : 1,03 à 1,56), un niveau élevé de stress (1,21; IC à 95 % : 1,05 à 1,41), la modification des traitements de la douleur pharmacologiques (3,17; IC à 95 % : 2,49 à 4,05) et physiques/psychologiques (2,04; IC à 95 % : 1,62 à 2,58) et enfin le fait d’occuper un emploi au début de la pandémie (1,42; IC à 95 % : 1,09 à 1,86) étaient associés à une probabilité accrue de déclarer une aggravation de la douleur. La perte d’emploi (34,9 % des personnes travaillaient avant la pandémie) a été associée à une probabilité inférieure (0,67; IC à 95 % : 0,48 à 0,94) de déclarer une aggravation de la douleur. Près de la moitié (43,2 %) des personnes ont indiqué une détresse psychologique d’intensité modérée ou grave. Les émotions négatives à l’égard de la pandémie (2,14; IC à 95 % : 1,78 à 2,57) et le stress global (1,43; IC à 95 % : 1,36 à 1,50) ont été associés à une détresse psychologique modérée ou grave. ConclusionLes résultats de l’étude ont permis de cerner, outre les facteurs biomédicaux, plusieurs facteurs psychosociaux à prendre en compte pour surveiller l’état des patients atteints de douleur chronique et faciliter leur accès aux traitements pendant une pandémie.

A number of cross-sectional studies report extensive use of psychiatric services and high healthcare costs in autistic youths. However, little is known about how the use of these services evolves from the time of diagnosis, as children grow up. Our objectives were to investigate the use, costs, and predictors of psychiatric services following autism spectrum diagnosis. We built a cohort of 1227 newly diagnosed autism spectrum individuals identified in the Quebec (Canada) "Régie de l'assurance maladie du Québec" administrative database (January 1998 to December 2010). Mean number and cost per individual of psychiatric healthcare use (hospitalizations, medical visits, psychoactive drug use) were calculated yearly for 5 years following autism spectrum diagnosis. Mean number of psychiatric visits decreased over time by more than threefold (7.5 vs 2.1 visits) from year 1 to year 5, whereas psychoactive drug use increased from 16.0 to 25.2 claims. Psychiatric hospitalizations decreased during follow-up, but still represented the greatest costs per individual (CAD9820 for year 1; CAD4628 for year 5). Antipsychotics represented over 50% of drug costs. Mixed-effect model with repeated measures showed that previous psychoactive drug use was the strongest predictor of greater psychiatric healthcare cost during follow-up (odds ratio: 9.96; 95% confidence interval: 7.58-13.10). These trends contrast with guidelines advocating cautious prescribing of antipsychotics with periodical re-assessment of their benefit.

Background Acute kidney Injury (AKI) in children undergoing cardiac surgery (CS) is strongly associated with hospital morbidity. Post-discharge CS AKI outcomes are less clear. We evaluated associations between AKI and post-discharge (a) healthcare utilization, (b) chronic kidney disease (CKD) or hypertension and (c) mortality. Methods This is a retrospective two-centre cohort study of children surviving to hospital discharge after CS. Primary exposures were post-operative [greater than or equal to]Stage 1 AKI and [greater than or equal to]Stage 2 AKI defined by Kidney Disease Impoving Global Outcomes. Association of AKI with time to outcomes was determined using multivariable Cox-Proportional Hazards analysis. Results Of 350 participants included (age 3.1 (4.5) years), 180 [51.4%] developed AKI and 60 [17.1%] developed [greater than or equal to]Stage 2 AKI. Twenty-eight (9%) participants developed CKD or hypertension (composite outcome), and 17 (5%) died within 5 years of discharge. Post-operative [greater than or equal to]Stage 1 and [greater than or equal to]Stage 2 AKI were not associated with post-discharge hospitalizations, emergency room (ER) visits, physician visits or CKD or hypertension in adjusted analyses. A trend was observed between [greater than or equal to]Stage 2 AKI and mortality but was not statistically significant. In unadjusted stratified analyses, AKI was associated with post-discharge hospitalizations in children with RACHS-1 score [greater than or equal to]3, complex chronic disease classification and children living in urban areas. Conclusions Post-CS AKI is not associated with post-discharge healthcare utilization, death and CKD or hypertension, though it may be associated with healthcare utilization in more complex paediatric CS children. Studies should aim to better understand post-CS healthcare utilization patterns and non-AKI risk factors for CKD, hypertension and mortality, to reduce adverse long-term outcomes after CS., Author(s): Sophia Nunes [sup.1] , Erin Hessey [sup.1] [sup.2] , Marc Dorais [sup.3] , Sylvie Perreault [sup.4] , Philippe Jouvet [sup.5] , Véronique Phan [sup.6] , Jacques Lacroix [sup.5] , [...]

Background: Wait time information and compliance with national guidelines are limited to a few adult conditions in the province of Quebec. We aimed to assess compliance with Paediatric Canadian Access Targets for Surgery (P-CATS) guidelines and determine the burden incurred due to waiting for 3 common elective surgical conditions (inguinal hernia, cryptorchidism and hypospadias) in a pediatric population. Methods: We carried out a population-based retrospective cohort study of randomly selected children residing in Quebec without complex chronic medical conditions, using administrative databases belonging to the Regie de l'assurance maladie du Quebec for the period 2010-2013. Disability-adjusted life years (DALYs) were calculated to measure the burden due to waiting. Multivariate forward regression identified risk factors for compliance with national guidelines. Results: Surgical wait time information was assessed for 1515 patients, and specialist referral wait time was assessed for 1389 patients. Compliance with P-CATS benchmarks was 76.6% for seeing a specialist and 60.7% for receiving surgery. Regression analysis identified older age (p < 0.0001) and referring physician specialty (p = 0.001) as risk factors affecting specialist referral wait time target compliance, whereas older age (p = 0.040), referring physician specialty (p = 0.043) and surgeon specialty (p = 0.002) were significant determinants in surgical wait time compliance. The total burden accrued due to waiting beyond benchmarks was 35 DALYs. Conclusion: Our results show that provincial compliance rates with wait time benchmarks are still inadequate and need improvement. Patient age and physician specialty were both found to have significant effects on wait time target compliance. Contexte : L'information sur les temps d'attente et le respect des lignes directrices nationales au Québec est limitée à quelques affections chez les adultes. Nous avons voulu évaluer le respect des objectifs canadiens en matière d'accès aux chirurgies pédiatriques (P-CATS) et déterminer le fardeau associé à l'attente pour 3 affections courantes nécessitant une intervention chirurgicale non urgente (hernie inguinale, cryptorchidie et hypospadias) chez une population pédiatrique. Méthodes : Pour ce faire, nous avons mené une étude de cohorte populationnelle rétrospective portant sur des enfants vivant au Québec et n'ayant pas de problèmes de santé chroniques complexes. Leur sélection aléatoire a été faite à partir de bases de données administratives appartenant à la Régie de l'assurance maladie du Québec pour la période de 2010 à 2013. Nous avons calculé les années de vie ajustées en fonction de l'incapacité (AVAI) pour mesurer le fardeau associé à l'attente. Une régression ascendante multivariée a permis de relever les facteurs de risque relatifs au respect des lignes directrices nationales. Résultats : Nous avons évalué les données sur le temps d'attente pour une intervention chirurgicale chez 1515 patients, et sur le temps d'attente pour la consultation d'un spécialiste chez 1389 patients. Les valeurs de référence pour le respect des P-CATS étaient de 76,6% pour la consultation d'un spécialiste et de 60,7% pour la réalisation d'une intervention. L'analyse de régression a montré que 1'âge plus avancé (p < 0,0001) et la spécialité du médecin traitant (p = 0,001) étaient des facteurs de risque pour la consultation d'un spécialiste, tandis que 1'âge plus avancé (p = 0,040), la spécialité du médecin traitant (p = 0,043) et la spécialité du chirurgien (p = 0,002) étaient des déterminants significatifs du respect des objectifs d'attente pour une intervention. Le fardeau total causé par l'attente au-delà des valeurs de référence était de 35 AVAI. Conclusion : Nos résultats montrent que le taux provincial de respect des lignes directrices d'attente demeure inadéquat et doit être amélioré. L'age des patients et la spécialité des médecins ont tous deux un effet significatif sur le respect des objectifs d'attente., Receiving a diagnosis requiring surgical intervention is a stressful moment for many patients and their families, (1,2) one that can be aggravated by a long wait time for treatment. (3,4) [...]

Background To develop a pediatric-specific hypertension algorithm using administrative data and use it to evaluate the association between acute kidney injury (AKI) in the intensive care unit (ICU) and hypertension diagnosis 5 years post-discharge. Methods Two-center retrospective cohort study of children ([less than or equal to] 18 years old) admitted to the pediatric ICU in Montreal, Canada, between 2003 and 2005 and followed until 2010. Patients with a valid healthcare number and without end-stage renal disease were included. Patients who could not be merged with the provincial database, did not survive admission, underwent cardiac surgery, had pre-existing renal disease associated with hypertension or a prior diagnosis of hypertension were excluded. AKI defined using the Kidney Disease: Improving Global Outcomes (KDIGO) definition. Using diagnostic codes and medications from administrative data, novel pediatric-specific hypertension definitions were designed. Both the evaluation of the prevalence of hypertension diagnosis and the association between AKI and hypertension occurred. Results Nineteen hundred and seventy eight patients were included (median age at admission [interquartile range] 4.3 years [1.1-11.8], 44% female, 325 (16.4%) developed AKI). Of these patients, 130 (7%) had a hypertension diagnosis 5 years after discharge. Patients with AKI had a higher prevalence of hypertension diagnosis [non-AKI: 84/1653 (5.1%) vs. AKI: 46/325 (14.2%), p < .001]. Children with AKI had a higher adjusted risk of hypertension diagnosis (hazard ratio [95% confidence interval] 2.19 [1.47-3.26]). Conclusions Children admitted to the ICU have a high prevalence of hypertension post-discharge and children with AKI have over two times higher risk of hypertension compared to those with no AKI., Author(s): Erin Hessey [sup.1] [sup.2] , Sylvie Perreault [sup.3] , Louise Roy [sup.4] , Marc Dorais [sup.5] , Susan Samuel [sup.6] , Véronique Phan [sup.7] , Jean-Philippe Lafrance [sup.8] [sup.9] [...]

Background Baseline serum creatinine (bSCr) is required for diagnosing acute kidney injury (AKI). In children, bSCr is commonly defined as the lowest measurement within 3 months of admission. Measured values are often missing and estimating bSCr using height-based glomerular filtration rate (GFR) equations is problematic when height is unavailable. Methods This is a retrospective cohort study including 538 children admitted to the intensive care unit (ICU) between 2003 and 2005 at two centers in Canada, with measured bSCr, height, and ICU-SCr values. We evaluated the bias, accuracy, and precision of back-calculating bSCr from height-dependent and height-independent GFR equations. Agreement of AKI defined using measured and estimated bSCr was calculated. Multivariate analyses were performed to assess the impact of bSCr estimation methods on the association between AKI and ICU mortality, length of stay, and duration of mechanical ventilation. Results Both methods underestimated bSCr by 1-3%, showed good accuracy (~30% of patients with estimated bSCr within 10% of measured bSCr), but poor precision (wide 95% limits of agreement). The agreement between AKI defined by estimated versus measured bSCr was >80% ([kappa] >0.5). The height-independent method performed best in children >13 years old; however, overall, both methods performed similarly across age subgroups. AKI was associated with longer stay, prolonged mechanical ventilation, and ICU mortality using measured and estimated bSCr. Conclusions Height-dependent and height-independent bSCr estimation methods were comparable. This may have significant implications for performing pediatric AKI research using large databases, and in clinical care to define AKI when height is unknown., Author(s): Erin Hessey [sup.1] , Rami Ali [sup.2] [sup.3] , Marc Dorais [sup.4] , Geneviève Morissette [sup.5] , Michael Pizzi [sup.1] , Nikki Rink [sup.7] , Philippe Jouvet [sup.6] , [...]