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The development of a new strategy for the construction of chiral cyclic sulfide-containing multiple stereogenic centers is highly desirable.

The development of efficient method to prepare poly(silyl ether)s (PSEs) is highly desirable. Herein, an environmentally sustainable copper-catalyzed dehydrocoupling polymerization was developed with good yields and high molecular weight (up to 48400 of Mn and up to 97% yield). Monomers of different types (AB type or AA and BB type) are suitable to afford PSEs. The PSEs show good thermal stability and low glass-transition temperature.

OBJECTIVES The incidence, as well as the predictors of mortality, for children receiving home mechanical ventilation (HMV) using population-based data in Canada is a current knowledge gap. Our objectives were to describe HMV incidence and mortality rates, and associations of demographic and clinical variables on mortality. METHODS Using Ontario health and demographic administrative databases, we conducted a retrospective cohort study (April 1, 2003–March 31, 2017) of children aged 0 to 17 years receiving HMV via invasive mechanical ventilation and noninvasive ventilation. We identified children with complex chronic conditions. We used data from Census Canada to calculate incidence rates and Cox proportional hazards modeling to assess for predictors of mortality. RESULTS We identified 906 children with a mean (SD) crude incidence rate of 2.4 (0.6) per 100 000 for pediatric HMV approvals that increased by 37% over the 14-year study period. Compared with children who were invasively ventilated, we found mortality was associated with noninvasive ventilation (adjusted hazard ratio [aHR], 1.9; 95% confidence interval [CI], 1.3–2.8). Mortality was highest in children from families in the lowest income quintile (aHR, 2.5; 95% CI, 1.5–4.0), those with neurologic impairment complex chronic conditions (aHR, 2.9; 95% CI, 1.4–6.4), those aged 11 to 17 years at HMV initiation (aHR, 1.5; 95% CI, 1.1–2.0), and those with higher health care costs in the 1 year before HMV initiation (aHR, 1.5; 95% CI, 1.3–1.7). CONCLUSIONS The incidence of children receiving HMV increased substantially over the 14-year period. Demographic variables associated with increased mortality were identified, suggesting areas requiring greater attention for care providers.

A palladium-catalyzed asymmetric hydrogenation of unprotected 3-substituted indoles was developed, providing a series of 3-substituted indolines in excellent yields with ≤94.4:5.6 er. The large sterically hindered bisphosphine ligand played a crucial role in the enantioselective control. In addition, the gram-scale hydrogenation experiment and product derivatizations were performed successfully.

The precise synthesis of chiral poly(silyl ether)s remains a challenge, in contrast to the well-studied preparation of poly(silyl ether)s. Herein, an unprecedented approach for the synthesis of optically active poly(silyl ether)s with main-chain chirality has been developed via CuH-catalyzed hydrosilylation polymerization of diketones and silanes. The polymerization features low catalyst loading, mild condition, and broad substrate scope, including a wide range of aromatic diketones and heteroaromatic diketones with excellent yields and enantioselectivities (up to 98% yield and 99% ee). Thermal analysis indicated chiral poly(silyl ether)s exhibit good thermal properties. These enantiomerically enriched poly(silyl ether)s with good thermal stability have a promising application in chiral separation.

Item does not contain fulltext OBJECTIVE: The objectives of this study are to compare the relative use of different postacute care settings in different countries and to compare three important outcomes as follows: total expenditure, total days of care in different care settings, and overall longevity over a 1-year period following a hip fracture. DATA SOURCES: We used administrative data from hospitals, institutional and home-based long-term care (LTC), physician visits, and medications compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) from five countries as follows: Canada, France, Germany, the Netherlands, and Sweden. DATA EXTRACTION METHODS: Data were extracted from existing administrative data systems in each participating country. STUDY DESIGN: This is a retrospective cohort study of all individuals admitted to acute care for hip fracture. Descriptive comparisons were used to examine aggregate institutional and home-based postacute care. Care trajectories were created to track sequential care settings after acute-care discharge through institutional and community-based care in three countries where detailed information allowed. Comparisons in patient characteristics, utilization, and costs were made across these trajectories and countries. PRINCIPAL FINDINGS: Across five countries with complete LTC data, we found notable variations with Germany having the highest days of home-based services with relatively low costs, while Sweden incurred the highest overall expenditures. Comparisons of trajectories found that France had the highest use of inpatient rehabilitation. Germany was most likely to discharge hip fracture patients to home. Over 365 days, France averaged the highest number of days in institution with 104, Canada followed at 94, and Germany had just 87 days of institutional care on average. CONCLUSION: In this comparison of LTC services following a hip fracture, we found international differences in total use of institutional and noninstitutional care, longevity, and total expenditures. There exist opportunities to organize postacute care differently to maximize independence and mitigate costs.

BACKGROUND: There is no reliable estimate of costs incurred by motorcycle crashes. Our objective was to calculate the direct costs of all publicly funded medical care provided to individuals after motorcycle crashes compared with automobile crashes. METHODS: We conducted a population-based, matched cohort study of adults in Ontario who presented to hospital because of a motorcycle or automobile crash from 2007 through 2013. For each case, we identified 1 control absent a motor vehicle crash during the study period. Direct costs for each case and control were estimated in 2013 Canadian dollars from the payer perspective using methodology that links health care use to individuals over time. We calculated costs attributable to motorcycle and automobile crashes within 2 years using a difference-in-differences approach. RESULTS: We identified 26 831 patients injured in motorcycle crashes and 281 826 injured in automobile crashes. Mean costs attributable to motorcycle and automobile crashes were $5825 and $2995, respectively (p INTERPRETATION: Considering both the attributable cost and higher rate of injury, we found that each registered motorcycle in Ontario costs the public health care system 6 times the amount of each registered automobile. Medical costs may provide an additional incentive to improve motorcycle safety.

Objectives To evaluate the impact of comorbidity on diabetes care quality and diabetes-related hospitalizations and to examine whether associations between the likelihood of diabetes-related hospitalizations and compliance with diabetes testing are modified by type of comorbidity. Methods A population-based cohort study of 861 354 adults with diabetes was conducted in Ontario, Canada. The diabetes cohort was categorized into 4 groups defined by their comorbidity statuses: no comorbidity, diabetes-concordant only, diabetes-discordant only, and both concordant and discordant. Outcome variables were defined as having had at least 1 hospitalization for diabetes-related short- or long-term complications between 2009 and 2011. Diabetes-care quality measures included testing for glycated hemoglobin (A1C) and low-density lipoprotein-cholesterol levels and eye examinations between 2007 and 2009. Multivariable logistic regression models were performed to examine the associations between diabetes testing and diabetes-related hospitalizations and the modifying role of comorbidity type. Results Compliance with all 3 monitoring tests by patients with diabetes had a strong positive impact on reducing hospitalizations for diabetes-related long-term complications, especially in patients with diabetes-concordant conditions. The highest levels of adherence to all 3 diabetes monitoring tests were observed in patients with diabetes-concordant conditions only and in patients with diabetes-discordant conditions. The highest odds of hospitalizations for diabetes-related short-term complications were observed in patients having both discordant and concordant conditions. Conclusions Meeting diabetes testing goals has the potential to reduce hospitalizations for diabetes-related complications; however, this depends on types of coexisting chronic conditions and diabetes-related complications in patients with diabetes.

Background We report on the impact of two system-level policy interventions (the Long-Term Care Homes Act [LTCHA] and Public Reporting) on publicly reported physical restraint use and non-publicly reported potentially inappropriate use of antipsychotics in Ontario, Canada. Methods We used interrupted time series analysis to model changes in the risk-adjusted use of restraints and antipsychotics before and after implementation of the interventions. Separate analyses were completed for early ([a] volunteered 2010/2011) and late ([b] volunteered March 2012; [c] mandated September 2012) adopting groups of Public Reporting. Outcomes were measured using Resident Assessment Instrument Minimum Data Set (RAI-MDS) data from January 1, 2008 to December 31, 2014. Results For early adopters, enactment of the LTCHA in 2010 was not associated with changes in physical restraint use, while Public Reporting was associated with an increase in the rate (slope) of decline in physical restraint use. By contrast, for the late-adopters of Public Reporting, the LTCHA was associated with significant decreases in physical restraint use over time, but there was no significant increase in the rate of decline associated with Public Reporting. As the LTCHA was enacted, potentially inappropriate use of antipsychotics underwent a rapid short-term increase in the early volunteer group, but, over the longer term, their use decreased for all three groups of homes. Conclusions Public Reporting had the largest impact on voluntary early adopters while legislation and regulations had a more substantive positive effect upon homes that delayed public reporting.

BACKGROUND: There is a lack of data in Canada on the longitudinal effects of adverse events that occur in hospital, specifically in the period after discharge. Our objective was to quantify the impact of adverse events on hospital length of stay, length of person-centred episodes of care (PCEs) and costs of PCEs, as well as their impact on the total health system. METHODS: We conducted a population-based, retrospective cohort study using linked health administrative databases. We included adults in Ontario who had an acute hospital admission between Apr. 1, 2015, and Mar. 31, 2016. We grouped hospital admissions into 1 of 9 episode types and used the Canadian Institute for Health Information methodology for hospital harm to measure adverse events. We specified generalized linear models to estimate the impact of hospital harm on the following: incremental length of index acute hospital admission, incremental length of the PCE, and incremental costs of the PCE. RESULTS: Out of 610 979 hospital admissions, 36 004 (5.9%) involved an occurrence of harm. The impact of harm on the incremental length of hospital stay ranged from 0.4 to 24.2 days (p INTERPRETATION: We found that experiencing harm in hospital significantly affects both in-hospital and post-discharge use of health services and costs of care, and constitutes an enormous expense to Ontario’s publicly funded health system.

Background Population trends of disease prevalence and incidence over time measure burden of disease and inform healthcare planning. Neuromuscular disorders (NMD) affect muscle and nerve function with varying degrees of severity and disease progression. Objective Using health administrative databases we described trends in incidence, prevalence, and mortality of adults and children with NMD. We also explored place of death and use of palliative care. Methods Population-based (Ontario, Canada) cohort study (2003 to 2014) of adults and children with NMD identified using International Classification of Disease and health insurance billing codes within administrative health databases. Results Adult disease prevalence increased on average per year by 8% (95% confidence interval (CI) 6% to 10%, P

Our objective was to quantify health service utilisation including monitoring and treatment of respiratory complications for adults with neuromuscular disease (NMD), identifying practice variation and adherence to guideline recommendations at a population level.We conducted a population-based longitudinal cohort study (2003–2015) of adults with NMD using hospital diagnostic and health insurance billing codes within administrative health databases.We identified 185 586 adults with NMD. Mean age 52 years, 59% female. 41 173 (22%) went to an emergency department for respiratory complications on average 1.6 times every 3 years; 14 947 (8%) individuals were admitted to hospital 1.4 times every 3 years. Outpatient respiratory specialist visits occurred for 64 084 (35%) with four visits every 3 years, although substantial variation in visit frequency was found. 157 285 (85%) went to the emergency department (all-cause) almost 4 times every 3 years, 100 052 (54%) were admitted to hospital. Individuals with amyotrophic lateral sclerosis/motor neurone disease (ALS/MND) had more emergency department visits compared with other types of NMD (pOne-third of adults with NMD received respiratory specialist care at a frequency recommended by professional guidelines, although substantial variation exists. Emergent healthcare utilisation was substantial, emphasising the burden of NMD on the healthcare system and urgent need to improve community and social supports, particularly for ALS/MND patients.

Background: QUALICOPC is an international survey of primary care performance. QUALICOPC data have been used in several studies, yet the representativeness of the Canadian QUALICOPC survey is unknown, potentially limiting the generalizability of findings. This study examined the representativeness of QUALICOPC physician and patient respondents in Ontario using health administrative data. Methods: This representativeness study linked QUALICOPC physician and patient respondents in Ontario to health administrative databases at the Institute for Clinical Evaluative Sciences. Physician respondents were compared to other physicians in their practice group and all Ontario primary care physicians on demographic and practice characteristics. Patient respondents were compared to other patients rostered to their primary care physicians, patients rostered to their physicians’ practice groups, and a random sample of Ontario residents on sociodemographic characteristics, morbidity, and health care utilization. Standardized differences were calculated to compare the distribution of characteristics across cohorts. Results: QUALICOPC physician respondents included a higher proportion of younger, female physicians and Canadian medical graduates compared to other Ontario primary care physicians. A higher proportion of physician respondents practiced in Family Health Team models, compared to the provincial proportion for primary care physicians. QUALICOPC patient respondents were more likely to be older and female, with significantly higher levels of morbidity and health care utilization, compared with the other patient groups examined. However, when looking at the QUALICOPC physicians’ whole rosters, rather than just the patient survey respondents, the practice profiles were similar to those of the other physicians in their practice groups and Ontario patients in general. Conclusions: Comparisons revealed some differences in responding physicians’ demographic and practice characteristics, as well as differences in responding patients’ characteristics compared to the other patient groups tested, which may have resulted from the visit-based sampling strategy. Ontario QUALICOPC physicians had similar practice profiles as compared to non-participating physicians, providing some evidence that the participating practices are representative of other non-participating practices, and patients selected by visit-based sampling may also be representative of visiting patients in other practices. Those using QUALICOPC data should understand this limited representativeness when generalizing results, and consider the potential for bias in their analyses.

BACKGROUND Health Links are a new model of providing care coordination for high-cost, high-needs patients in Ontario. We evaluated use of hospital-related health care services among Health Links patients in the Central Local Health Integration Network (LHIN) of Ontario in the year before versus after program enrolment and compared rates of use with those among similar patients with complex needs not enrolled in the program (comparator group). METHODS We identified all patients who received a Health Links coordinated care plan before Jan. 1, 2015, using linked registry and health administrative data. We used propensity scores to match (1:1) enrollees (registry) with comparator patients (administrative data). Using a difference-in-differences approach with generalized estimating equations, we evaluated 5 measures of Health Link performance: rates of hospital admission, emergency department visits, days in acute care, 30-day readmissions and 7-day postdischarge primary care follow-up. RESULTS Of the 344 enrollees in the registry, we matched 313 [91.0%] to comparator patients. All measured sociodemographic, comorbidity and health care use characteristics were balanced between the 2 groups (all standardized differences < 0.10). For enrollees, the rate of days in acute care per person-year increased by 35% (incidence rate ratio 1.35 [confidence interval 1.11-1.65]) after versus before the index date, but differences were nonsignificant for all other measures. Difference-in-differences analyses revealed greater reductions in hospital admissions, emergency department visits and acute care days after the index date in the comparator group than among enrollees. INTERPRETATION Initial implementation of the Health Link program in the Central LHIN did not reduce selected indicators of Health Link performance among enrollees. As the Health Link program evolves and standardization is implemented, future research may reveal effects from the initiative in other outcomes or with longer follow-up.

Introduction: Little data describes the epidemiology and healthcare utilization of kids with neuromuscular disease (NMD) at a population level. Aim We sought to describe incidence, prevalence and demographic characteristics of kids with NMD and to quantify health service utilization including assessment, monitoring and treatment of respiratory complications. Methods: Population-based cohort study (cohort 2003-2008; follow-up to 2014) of kids with NMD using International Classification of Disease and health insurance billing codes in administrative health databases. Results: We identified 18163 kids with NMD (2003-2008). Mean age was 8 with 40% ≤ 5 years; 45% were female. Most common NMD diagnoses were cerebral palsy (50%) and spina bifida (16%); 8% had muscular dystrophy. Asthma (26%) was a fairly common comorbidity. NMD prevalence (2013) was 870/100,000 kids; incidence (2013) 52/100,000. From 2003-2014, 15578 (86%) kids went to an emergency department (ED) (mean 3.5 visits every 3 years) (6556 [36%] for respiratory reasons), 8761 (48%) were admitted to hospital (2183 [12%] respiratory reasons) and 2446 (13%) required intensive care. Respiratory specialist visits in an outpatient clinic occurred for 2186 (12%) patients; 710 (4%) had in-hospital respiratory specialist consultation. Pulmonary function testing was conducted in 3198 (18%) patients; sleep studies in 1387 (8%). Mortality was 6% with 50% receiving palliative care. Conclusion Among children with NMD in Ontario, ED presentation was common; approximately 1/3 for respiratory reasons. Referral to a respiratory specialist, in hospital or out-patient setting, occurred for only a subset.

In order to prepare carboxyl-terminated hyperbranched polyester (HBP-COOH), succinic anhydride was used to modify hydroxyl-terminated hyperbranched polyester (HBP-OH), and the influences of the solvents, catalysts and time on the product’s structure were investigated. When THF is used as the solvent, sodium acetate as the catalyst, the molar ratio of succinic anhydride and hydroxyl groups is 3:1, and the reaction time is 6 h at 65°C, the modification extent of the hydroxyl groups is about 99% with about 95% yield. HBP-COOH has much lower glass transition temperature than that of HBP-OH due to its long and flexible end-groups.

Aim This study evaluated the impact of the late career nurse initiative on nurse perceptions of their work environment, workplace burnout, job satisfaction, organisational commitment and intention to remain. Background The Ontario Ministry of Health and Long-Term Care introduced the late career nurse initiative with the goal of improving the retention of front-line nurses aged 55 and over by implementing a 0.20 full-time equivalent reduction of physically or psychologically demanding duties, enabling nurses to engage in special projects for the improvement of their organisations and patient care. Methods A sample of 902 nurses aged 55 and over from acute and long-term care facilities were surveyed using valid and reliable questionnaires. Results Nurses who had participated in the initiative did not differ significantly from those who had not in terms of workplace burnout, job satisfaction, length of service or intention to remain within their current organisation. The late career nurse initiative participants reported significantly higher perceptions of managers' ability, leadership and support and their level of participation in hospital affairs. Conclusion The late career nurse initiative was associated with perceived differences in nurses' work environment but not outcomes. Implications for nursing management Leaders need to pay attention to how late career nurses are selected and matched to organisational projects.

Background: Little population-level information exists about the delivery of palliative care across multiple health sectors, important in providing a complete picture of current care and gaps in care. Aim: Provide a population perspective on end-of-life palliative care delivery across health sectors. Design: Retrospective population-level cohort study, describing palliative care in the last year of life using linked health administrative databases. Setting/participants: All decedents in Ontario, Canada, from 1 April 2010 to 31 March 2012 ( n = 177,817). Results: Across all health sectors, about half (51.9%) of all decedents received at least one record of palliative care in the last year of life. Being female, middle-aged, living in wealthier and urban neighborhoods, having cancer, and less multi-morbidity were all associated with higher odds of palliative care receipt. Among 92,276 decedents receiving palliative care, 84.9% received care in acute care hospitals. Among recipients, 35 mean days of palliative care were delivered. About half (49.1%) of all palliative care days were delivered in the last 2 months of life, and half (50.1%) had palliative care initiated in this period. Only about one-fifth of all decedents (19.3%) received end-of-life care through publicly funded home care. Less than 10% of decedents had a record of a palliative care home visit from a physician. Conclusion: We describe methods to capture palliative care using administrative data. Despite an estimate of overall reach (51.9%) that is higher than previous estimates, we have shown that palliative care is infrequently delivered particularly in community settings and to non-cancer patients and occurs close to death.

Background Multimorbidity poses a significant clinical challenge and has been linked to greater health services use, including hospitalization; however, we have little knowledge about the influence of contextual factors on outcomes in this population. Objectives: To describe the extent to which the association between multimorbidity and hospitalization is modified by age, gender, primary care practice model, or continuity of care (COC) among adults with at least one chronic condition. Methods A retrospective cohort study with linked population-based administrative data. Setting: Ontario, Canada. Cohort: All individuals 18 and older with at least one of 16 priority chronic conditions as of April 1, 2009 (baseline). Main Outcome Measures: Any hospitalization, 3 or more hospitalizations, non-medical discharge delay, and 30-day readmission within the 1 year following baseline. Results Of 5,958,514 individuals, 484,872 (8.1 %) experienced 646,347 hospitalizations. There was a monotonic increase in the likelihood of hospitalization and related outcomes with increasing multimorbidity which was modified by age, gender, and COC but not primary care practice model. The effect of increasing multimorbidity was greater in younger adults than older adults and in those with lower COC than with higher COC. The effect of increasing multimorbidity on hospitalization was greater in men than women but reversed for the other outcomes. Conclusions The effect of multimorbidity on hospitalization is influenced by age and gender, important considerations in the development of person-centred care models. Greater continuity of physician care lessened the effect of multimorbidity on hospitalization, further demonstrating the need for care continuity across providers for people with chronic conditions. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1415-5) contains supplementary material, which is available to authorized users.

Conventional methods with measuring information propagation in static networks mainly rely on paths or the shortest path connecting nodes, whereas in opportunistic mobile social networks the existence of a path or the shortest path between nodes cannot be assumed due to the dynamic topological partition nature of the networks. This paper extends the concept of walk to dynamic settings and combines it with the Green's function that originates from statistical physics to quantify how much information flows through each node in the networks changing over time. By means of the time-evolving graph model and the calculation of weighted combinatorial dynamic walks on the graph, a concise theoretic result is derived to account for the relative information propagation capability of each mobile node based on the historical contacts. In addition, the iteration-form result can be conveniently computed at any time point and therefore can be used for predicting the future network behavior when the time interval is appropriately chosen in specific scenarios. Extensive experiments are conducted based on four real trace datasets and the results show that, the formula derived in this paper is very effective at quantifying the information that flows through each mobile node.

The purpose of this study was to evaluate the implementation of a clinical information system (CIS) in a community setting. The researchers used a mixed-method design involving interviews, focus groups, and surveys. An independent cross-sectional sample of nurses was surveyed. At time 1 a total of 118 nurses responded and at time 2 a total of 81. Respondents were moderately satisfied with features of the CIS. User satisfaction was positively associated with access to structural and electronic resources and social capital and negatively associated with nurses' age at time 1. Social capital was positively associated with user satisfaction at time 2. Younger age was associated with overall research use at both time 1 and time 2. Research use was negatively associated with evaluation and feedback but positively associated with formal interactions. This evaluation identified the importance of educational support, user-centred design, and responsiveness to successful implementation of CISs in a community setting.

To investigate the clinical characteristics of abnormal uterine bleeding (AUB) in nonpregnant hepatic cirrhosis patients and to assess the treatment and curative effects of AUB. A retrospective analysis was conducted on 72 nonpregant AUB patients treated in Ditan Hospital from October 2008 to October 2009. Data were assessed with SPSS 10.0 and the constituent ratio was examined by chi-square tests. 58 out of the 72 nonpregnant AUB patients were climacteric patients (80.56%). Approximately 42.5% and 68.8% (x2=7.189, P = 0.027) of the AUB patients were diagnosed with compensated and decompensated liver cirrhosis, respectively, which presents a statistical significance. Among the 18 cases of AUB with hypermenorrhea, 12 were with compensated cirrhosis and 6 with decompensated cirrhosis, which makes a statistical significance with a chi-square result of 7.189, P = 0.027. 41 out of the 52 cases with diagnostic curettage (75.00%) were observed with pathological changes in endomembrane. During the three months to one year follow-up,10 of 67 patients showed effective expectant treatment and 16 cases with hysterectomia complained no postoperative complications. A high frequency of AUB was observed in nonpregnant cirrhosis patients. The main bleeding pattern of the nonpregnant AUB patients with cirrhosis is hypermenorrhea.

Yu Qing Bai,1 Gary Foster,2 Wendy Sword,3,4 Paul Krueger,5 Christine Kurtz Landy,6 Susan Watt,7 Lehana Thabane2,31Department of Mathematics and Statistics, McMaster University, Hamilton, ON, Canada; 2Biostatistics Unit, St Joseph's Healthcare, Hamilton, ON, Canada; 3Department of Clinical Epidemiology and Biostatistics, 4School of Nursing, McMaster University, Hamilton, ON, Canada; 5Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; 6School of Nursing, York University, Toronto, ON, Canada; 7School of Social Work, McMaster University, Hamilton, ON, CanadaBackground: Longitudinal studies are often used to investigate the developmental trends of outcomes over time. Several modeling strategies can be applied for the analyses of longitudinal data. In this study, various statistical approaches were discussed and compared using data from The Ontario Mother and Infant Study (TOMIS) III. TOMIS III was a longitudinal cohort study that assessed the associations between the method of delivery and health outcomes and service utilizations. The primary outcome of postpartum depression was used as an example.Methods: Generalized estimating equations (GEE) assuming a serial correlation structure were used as the primary method of analysis to assess the association between the method of delivery and postpartum depression over 12 months. We performed sensitivity analyses using three other methods – namely, the (1) generalized linear mixed-effects model (GLMM), (2) hierarchical generalized linear model (HGLM), and (3) Bayesian hierarchical model (BHM), to compare the robustness of the results.Results: The results from all four models indicated that the method of delivery had no significant effect on postpartum depression. However, GEE, GLMM, and BHM identified the following seven predictors of depression: annual household income; urinary incontinence (bladder problems); English or French (Canada's official languages) spoken at home; a lower SF-12 mental component score; unmet learning needs in the hospital; lower social support; and a lower SF-12 physical component score. HGLM showed similar results to the above three models with the exception of language spoken at home, which was not significant. GEE provided the good fit statistics for the data.Conclusion: Method of delivery had no significant effect on postpartum depression, based on GEE analysis. This result remained robust under different methods of analyses. GEE demonstrated a good fit for the TOMIS III data.Keywords: longitudinal data, generalized estimating equations, hierarchical model, TOMIS