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Showing papers by "Saskatchewan Health published in 2018"


Journal ArticleDOI
TL;DR: The cluster crossover design efficiently tested clinical effectiveness of incremental antibiotics to reduce device infection and the observed difference in infection rates was not statistically significant.

131 citations


Journal ArticleDOI
TL;DR: Child-parent perceptions of HRQOL in a multiethnic population with CD are comparable to healthy reference populations, but significantly higher than in parent/child GI-CON.
Abstract: Objectives:Celiac disease (CD) is an autoimmune disease that requires lifelong adherence to a gluten-free diet (GFD). Adherence to the GFD in childhood may be poor and adversely influence health-related quality of life (HRQOL). The study purpose was to determine sociodemographic and socioeco

37 citations


Journal ArticleDOI
TL;DR: The aim of this short report is to highlight the updated version of INPAC, and introduce the implementation toolkit that was used to support practice improvements towards this standard.
Abstract: The Integrated Nutrition Pathway for Acute Care (INPAC) is an evidence and consensus based pathway developed to guide health care professionals in the prevention, detection, and treatment of malnutrition in medical and surgical patients. From 2015 to 2017, the More-2-Eat implementation project (M2E) used a participatory action research approach to determine the feasibility, and evaluate the implementation of INPAC in 5 hospital units across Canada. Based on the findings of M2E and consensus with M2E stakeholders, updates have been made to INPAC to enhance feasibility in Canadian hospitals. The learnings from M2E have been converted into an online toolkit that outlines how to implement the key steps within INPAC. The aim of this short report is to highlight the updated version of INPAC, and introduce the implementation toolkit that was used to support practice improvements towards this standard.

28 citations


Journal ArticleDOI
TL;DR: Significant health concerns for refugee children include stunting and high blood cholesterol levels, and emerging trends indicate that older immigrant children from privileged backgrounds in low-income countries may be more at risk of overweight and obesity.
Abstract: There are knowledge gaps in our understanding of the development of chronic disease risks in children, especially with regard to the risk differentials experienced by immigrants and refugees. The H...

28 citations


Journal ArticleDOI
TL;DR: The objective is to describe the process, structure, benefits, and challenges of a distributed model for chronic disease surveillance across all Canadian provinces and territories (P/Ts) using linked administrative data.
Abstract: Chronic diseases have a major impact on populations and healthcare systems worldwide. Administrative health data are an ideal resource for chronic disease surveillance because they are population-based and routinely collected. For multi-jurisdictional surveillance, a distributed model is advantageous because it does not require individual-level data to be shared across jurisdictional boundaries. Our objective is to describe the process, structure, benefits, and challenges of a distributed model for chronic disease surveillance across all Canadian provinces and territories (P/Ts) using linked administrative data. The Public Health Agency of Canada (PHAC) established the Canadian Chronic Disease Surveillance System (CCDSS) in 2009 to facilitate standardized, national estimates of chronic disease prevalence, incidence, and outcomes. The CCDSS primarily relies on linked health insurance registration files, physician billing claims, and hospital discharge abstracts. Standardized case definitions and common analytic protocols are applied to the data for each P/T; aggregate data are shared with PHAC and summarized for reports and open access data initiatives. Advantages of this distributed model include: it uses the rich data resources available in all P/Ts; it supports chronic disease surveillance capacity building in all P/Ts; and changes in surveillance methodology can be easily developed by PHAC and implemented by the P/Ts. However, there are challenges: heterogeneity in administrative databases across jurisdictions and changes in data quality over time threaten the production of standardized disease estimates; a limited set of databases are common to all P/Ts, which hinders potential CCDSS expansion; and there is a need to balance comprehensive reporting with P/T disclosure requirements to protect privacy. The CCDSS distributed model for chronic disease surveillance has been successfully implemented and sustained by PHAC and its P/T partners. Many lessons have been learned about national surveillance involving jurisdictions that are heterogeneous with respect to healthcare databases, expertise and analytical capacity, population characteristics, and priorities.

27 citations


Journal ArticleDOI
TL;DR: This study will provide the first high quality analysis of safety of CBD-enriched Cannabis herbal extract in pediatric patients in relation to dosage and pharmacokinetics of the active cannabinoids.
Abstract: Initial studies suggest pharmaceutical grade cannabidiol (CBD) can reduce the frequency of convulsive seizures and lead to improvements in quality of life in children affected by epileptic encephalopathies. With limited access to pharmaceutical CBD, Cannabis extracts in oil are becoming increasingly available. Physicians show reluctance to recommend Cannabis extracts given the lack of high quality safety data especially regarding the potential for harm caused by other cannabinoids, such as Δ9-tetrahydrocannabinol (Δ9-THC). The primary aims of the study presented in this protocol are (i) To determine whether CBD enriched Cannabis extract is safe and well-tolerated for pediatric patients with refractory epilepsy, (ii) To monitor the effects of CBD-enriched Cannabis extract on the frequency and duration of seizure types and on quality of life. Twenty-eight children with treatment resistant epileptic encephalopathy ranging in age from 1 to 10 years will be recruited in four Canadian cities into an open-label, dose-escalation phase 1 trial. The primary objectives for the study are (i) To determine if the CBD-enriched Cannabis herbal extract is safe and well-tolerated for pediatric patients with treatment resistant epileptic encephalopathy and (ii) To determine the effect of CBD-enriched Cannabis herbal extract on the frequency and duration of seizures. Secondary objectives include (i) To determine if CBD-enriched Cannabis herbal extracts alter steady-state levels of co-administered anticonvulsant medications. (ii) To assess the relation between dose escalation and quality of life measures, (iii) To determine the relation between dose escalation and steady state trough levels of bioactive cannabinoids. (iv) To determine the relation between dose escalation and incidence of adverse effects. This paper describes the study design of a phase 1 trial of CBD-enriched Cannabis herbal extract in children with treatment-resistant epileptic encephalopathy. This study will provide the first high quality analysis of safety of CBD-enriched Cannabis herbal extract in pediatric patients in relation to dosage and pharmacokinetics of the active cannabinoids. http://clinicaltrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2016 Dec 16. Identifier NCT03024827, Cannabidiol in Children with Refractory Epileptic Encephalopathy: CARE-E; 2017 Jan 19 [cited 2017 Oct]; Available from: http://clinicaltrials.gov/ct2/show/NCT03024827

26 citations


Journal ArticleDOI
01 Dec 2018
TL;DR: An educational intervention was associated with a statistically significant decrease in inappropriate antibiotic treatment of LTC residents with ASB.
Abstract: Objective To determine if an educational intervention can decrease the inappropriate antibiotic treatment of long-term care (LTC) residents with asymptomatic bacteriuria (ASB). Design Prospective chart audit between May and July 2017. Setting Seven LTC facilities in Regina, Saskatchewan, Canada. Participants Chart audits were performed on all LTC residents over 18 years of age with a positive urine culture. Educational sessions and tools were available to all clinical staff at participating LTC facilities. Intervention Fifteen-minute educational sessions were provided to LTC facility staff outlining the harms of unnecessary antibiotic use, antibiotic resistance and the diagnostic criteria of a urinary tract infection (UTI). Educational sessions were complimented with posters and pocket cards that summarised UTI diagnostic criteria. Main outcome measure The primary outcome measure was the number of residents who received inappropriate antibiotic treatment for ASB. Secondary outcome measures included the appropriateness of urine culture tests, number of tests and cost associated with inappropriate treatments. Results In the preintervention period, 172 urine culture and sensitivity (UC&S) tests were performed, 62 (36.0%) were positive and 50/62 (80.6%) residents had ASB based on chart review. In the postintervention period, 151 UC&S tests were performed, 50 (33.1%) were positive and 35/50 (70.0%) residents had ASB. There was a statistically significant decrease in the number of residents treated with antibiotics for ASB, from 45/50 (90%) preintervention to 22/35 (62.9%) postintervention (χ2=9.087, p=0.003). Conclusions An educational intervention was associated with a statistically significant decrease in inappropriate antibiotic treatment of LTC residents with ASB.

24 citations


Journal ArticleDOI
TL;DR: This study gathered expert opinions from parents and formal care providers about the four subproceses essential to parental hope to increase understanding of parental caregivers current support needs and offered direction in the development of a theory-based hope intervention.
Abstract: BACKGROUND The impact of a child s life-limiting or life-threatening illness is significant on parents who experience a great deal of emotional, physical, and spiritual upheaval. Hope has been identified as an important inner resource for parental caregivers. Specifically, parental hope has been described as having four subproceses including Accepting Reality, Establishing Control, Restructuring Hope, and Purposive Positive Thinking. PURPOSE The purpose of this Delphi study was to gather expert opinions from parents and formal care providers about the four subproceses essential to parental hope, to increase understanding of parental caregivers current support needs. As Phase one of a three-phase study, the findings provided direction in the development of a theory-based hope intervention. DESIGN AND METHODS A Delphi study consisting of three rounds of survey questions and controlled feedback to experts was employed. Experts suggested strategies for each subprocess and ranked them in order of highest to lowest according to feasibility and effectiveness. RESULTS Sixty-eight experts consisting of parental caregivers of children diagnosed with life-limiting or life-threatening illnesses and those who care for them (community members, nurses, social workers, and physicians) were recruited to participate. Through three rounds of survey questions, response rates ranged from 92-97%. A consensus revealed eight major themes that support parental hope: Organize Basic Needs; Connect with Others; Prioritize Self-care; Obtain Meaningful Information; Take Things Day by Day; Advocate for Parental Participation; Manifest Positivity; and Celebrate Milestones. PRACTICE IMPLICATIONS This study identified a wide variety of psychosocial needs for parental caregivers. Results also offered direction for a theory-based hope intervention while highlighting the need for additional research in this area. These results will provide the foundation for a booklet parents can work through in their journey of caring for a child with a life-limiting or life-threatening illness.

21 citations


Journal ArticleDOI
TL;DR: A better understanding of the correlates of in-hospital low food intake is offered and some avenues for improving food intake in the clinical setting are discussed, such as better mealtime monitoring and a reduction in barriers to food intake.
Abstract: In-hospital malnutrition and inadequate food intake have been associated with negative outcomes (e.g., prolonged length of stay, readmission, mortality, and increased hospital costs). Studies exami...

20 citations


Journal ArticleDOI
04 Jan 2018
TL;DR: This is the final edition of the interim recommendations, which were modified after one year of broad consultative review and represents a consensus of peer-reviewed information.
Abstract: The goal of this document was to provide Canadian laboratories with a framework for consistent reporting and monitoring of multidrug resistant organisms (MDRO) and extensively drug resistant organisms (XDRO) for common gram-negative pathogens. This is the final edition of the interim recommendations, which were modified after one year of broad consultative review. This edition represents a consensus of peer-reviewed information and was co-authored by the Canadian Public Health Laboratory Network and the Canadian Association of Clinical Microbiology and Infectious Diseases. There are two main recommendations. The first recommendation provides standardized definitions for MDRO and XDRO for gram-negative organisms in clinical specimens. These definitions were limited to antibiotics that are commonly tested clinically and, to reduce ambiguity, resistance (rather than non-susceptibility) was used to calculate drug resistance status. The second recommendation identifies the use of standardized laboratory reporting of organisms identified as MDRO or XDRO. Through the broad consultation, which included public health and infection prevention and control colleagues, these definitions are ready to be applied for policy development. Both authoring organizations intend to review these recommendations regularly as antibiotic resistance testing evolves in Canada.

18 citations


Journal ArticleDOI
TL;DR: Findings provide insight into the clinical characteristics of the MS prodrome using data mining analytics in the healthcare setting and Adjusted odds ratios and Area under the Curve metrics for the models' predictive performance were reported.
Abstract: Background Previous studies suggest the existence of a prodromal period in multiple sclerosis, but little is known about the phenotypic characteristics. This study aims to characterize the multiple sclerosis (MS) prodrome using data mining analytics in the healthcare setting. Methods We identified people with MS and matched general population controls using health administrative data in two Canadian provinces (British Columbia and Saskatchewan). Using a training dataset (66.6% of British Columbia's cohort), L1 penalized logistic regression models were fitted to predict MS from physician and hospital encounters (via International Classification of Diseases [ICD] codes) and prescriptions filled (as drug classes) during the five years before the MS case's first demyelinating event. Internal and external validation of identified predictors was performed using logistic regression on the remaining British Columbia (33.4%) and Saskatchewan data. Adjusted odds ratios (aORs) and Area under the Curve (AUC) metrics for the models’ predictive performance were reported. Results We identified 8,669 MS cases and 40,867 controls. Good predictive performance was observed for physician data (internal/external validation AUC = 0.81/0.79). Physician-generated ICD codes that were associated with MS and validated in both provinces included disorders of the central and peripheral nervous system, disorders of the eye, and cerebrovascular disease (aOR = 1.3–7.0). Overall, hospital and prescription data showed very poor and poor predictive performance (internal/external validation AUCs = 0.54/0.55 and 0.66/0.61, respectively). However, hospitalizations related to the urinary system or spinal cord diseases, or prescriptions for urinary antispasmodics or anti-vertigo preparations, were associated with 2 to 3-fold higher odds of MS (aOR = 2.3–3.3). Conclusions Findings provide insight into the clinical characteristics of the MS prodrome. Diagnostic codes from physician encounters were capable of differentiating between MS cases and controls.

Journal ArticleDOI
TL;DR: Efforts to reduce high-cost use should focus on reduction of multimorbidity, connection to a primary care provider (particularly for those with more than one MHA), young patients with schizophrenia, and adequately addressing housing stability.
Abstract: A small proportion of the population accounts for the majority of healthcare costs. Mental health and addiction (MHA) patients are consistently high-cost. We aimed to delineate factors amenable to public health action that may reduce high-cost use among a cohort of MHA clients in Saskatoon, Saskatchewan. We conducted a population-based retrospective cohort study. Administrative health data from fiscal years (FY) 2009–2015, linked at the individual level, were analyzed (n = 129,932). The outcome of interest was ≥ 90th percentile of costs for each year under study (‘persistent high-cost use’). Descriptive analyses were followed by logistic regression modelling; the latter excluded long-term care residents. The average healthcare cost among study cohort members in FY 2009 was ~ $2300; for high-cost users it was ~ $19,000. Individuals with unstable housing and hospitalization(s) had increased risk of persistent high-cost use; both of these effects were more pronounced as comorbidities increased. Patients with schizophrenia, particularly those under 50 years old, had increased probability of persistent high-cost use. The probability of persistent high-cost use decreased with good connection to a primary care provider; this effect was more pronounced as the number of mental health conditions increased. Despite constituting only 5% of the study cohort, persistent high-cost MHA clients (n = 6455) accounted for ~ 35% of total costs. Efforts to reduce high-cost use should focus on reduction of multimorbidity, connection to a primary care provider (particularly for those with more than one MHA), young patients with schizophrenia, and adequately addressing housing stability.

Journal ArticleDOI
TL;DR: Study results showed that males were twice as likely to undergo fistula maturation as females, while patients with no evidence of peripheral vascular disease (PVD) were three times more likely to mature their fistula and a preoperative vein diameter > 2.5 mm resulted in a fivefold increase in fistulas maturation.
Abstract: Background The objevctive of the present study was to explore the potential influence of blood markers and patient factors such as risk factors, kidney function profile, coagulation profile, lipid profile, body mass index, blood pressure, and vein diameter on the maturation of arteriovenous fistula (AVF) in patients with end-stage renal disease. Methods Retrospective data from 300 patients who had undergone AVF creation at the Royal Infirmary of Edinburgh were examined. A predictive logistic regression model was developed using a backward stepwise procedure. Model performance, discrimination, and calibration were assessed using the receiver operating characteristic (ROC) curve and Hosmer-Lemeshow goodness-of-fit test. The final model was externally validated by 100 prospective patients who received a new fistula at the Royal Infirmary of Edinburgh. Results A total of 400 (300 retrospective and 100 prospective) patients were recruited for this study, with a mean age of 60.14 ± 15.9 years (development set) and 58 ± 15 years (validation set), respectively (P = 0.208). Study results showed that males were twice as likely to undergo fistula maturation as females, while patients with no evidence of peripheral vascular disease (PVD) were three times more likely to mature their fistula and a preoperative vein diameter > 2.5 mm resulted in a fivefold increase in fistula maturation as compared with a vein size of less than 2.5 mm. The model for fistula maturation had fair discrimination, as indicated by the area under the ROC curve (0.68), but good calibration as indicated by the Hosmer-Lemeshow test (P = 0.79). The area under the receiver operating curve for the validation model in the validation set was 0.59. Similarly, in the validation set, the Hosmer-Lemeshow statistic indicated an agreement between the observed and predicted probabilities of maturation (P > 0.05). Conclusion Gender, PVD, and vein size are independent predictors of AVF maturation. The clinical utility of these risk categories in the maturation of AVF requires further evaluation in longer follow-up.

Journal ArticleDOI
TL;DR: In Saskatchewan, First Nations’ burden of chronic kidney disease reveals higher severity, utilization of fewer home-based therapies, and longer travel distances than their non-First Nations counterparts.
Abstract: Background:Chronic kidney disease is more prevalent among First Nations people than in non-First Nations people. Emerging research suggests that First Nations people are subject to greater disease ...

Journal ArticleDOI
17 Oct 2018
TL;DR: Assessment of the experiences of Posttraumatic Stress Disorder (PTSD) and associated mental health conditions (i.e., depression, anxiety, stress) in HEMS workers revealed that five per cent of HEMS personnel experienced heightened PTSD symptoms.
Abstract: Mental health in first responders and other public safety personnel has received substantial research attention in the past decade. Emergency medical services (EMS) demonstrate a heightened prevalence of maladaptive mental health concerns compared to other first responders (e.g., police, fire fighters). Interestingly, there is an absence of research examining helicopter emergency medical services (HEMS) personnel, who respond to what are often life-threatening cases in chal­lenging circumstances. Hence, the purpose of the present study was to assess the experiences of Posttraumatic Stress Disorder (PTSD) and associated mental health conditions (i.e., depression, anxiety, stress) in HEMS workers. HEMS work­ers from a single mid-western Canadian organization (n = 100) participated in the study. The participants completed the Posttraumatic Stress Disorder Checklist (PCL-5) and the Depression, Anxiety and Stress Scale (DASS-21) as part of an online survey. The results revealed that five per cent of HEMS personnel experienced heightened PTSD symptoms. Few participants exhibited signs of mild to severe depression, anxiety, and stress (< 17%). HEMS personnel experienced fewer mental health concerns than other first responder groups as reported in the literature; indeed, these figures are similar to levels observed within the general population. These findings may be explained by organizational or personality charac­teristics. Underreporting of mental health concerns may be an alternate explanation. Future qualitative and quantitative research is needed to explain and replicate the results of the present study.

Journal ArticleDOI
TL;DR: Although system level mandates were underexplored, they may accelerate adoption and implementation of sociodemographic data collection in the presence of organizational readiness and standardized tools integrated into information systems and workflows would support adequately trained personnel.
Abstract: Despite growing awareness of the importance of social determinants of health, research remains limited about the implementation of sociodemographic data collection in Canadian health care settings. Little is known about the salient contextual factors that enable or hinder collection and use of social information to improve quality of care in clinical settings. This study examines the perceptions and experiences of managers and care providers to better understand how to support organizational efforts to collect and use sociodemographic data to provide equity-oriented care. Case studies of three diverse urban health care settings employed semi-structured individual and group interviews with managers and care providers respectively to explore their experiences with implementation. Data was analyzed separately and in context for each site as part of an individual case study. A thematic analysis of interview transcripts was performed with an inductive approach to coding of segments of the text. Constructs of the Consolidated Framework for Implementation Research (CFIR) were used as an analytical framework to structure the data to support cross case comparisons of facilitators and barriers to implementation across settings. Several perceived facilitators and barriers to implementation were identified that clustered around three CFIR domains: intervention, inner setting and characteristics of individuals. Macro level (outer setting) factors were relatively unexplored. Sites were motivated by their recognition of need for social information to improve quality of care. Organizational readiness for implementation was demonstrated by priorities that reflected concern for equity in care, leadership support and commitment to an inclusive process for stakeholder engagement. Barriers included perceived relevance of only a subset of sociodemographic questions to service delivery, staff capacity and comfort with data collection as well as adequate resources (funding and time). Although system level mandates were underexplored, they may accelerate adoption and implementation of sociodemographic data collection in the presence of organizational readiness. Standardized tools integrated into information systems and workflows would support adequately trained personnel. More research is needed to understand important factors in rural health settings and with clinical application to inform care delivery pathways.


Journal ArticleDOI
TL;DR: Higher prevalence rates were observed for RA in Northern Health Regions than elsewhere in the province and a higher RA prevalence trend was observed in rural residents over the study period.
Abstract: To estimate and compare incidence/prevalence of rheumatoid arthritis (RA) in different geographic health regions and between urban/rural locations of residence within the province of Saskatchewan. Saskatchewan Provincial Administrative Health Databases (2001–2014) were utilized as data sources. Two RA case-definitions were employed: (1) three physician billing diagnoses, at least one of which was submitted by a specialist (rheumatologist, general internist, or orthopedic surgeon) within 2 years; (2) one hospitalization diagnosis (ICD-9-CM code-714 and ICD-10-CA codes-M05, M06). Data from these definitions were combined to estimate annual RA incidence and prevalence. Annual incidence and prevalence rates across geographic regions and between rural and urban residences were examined. An increasing RA prevalence gradient was observed in a south to north direction within the province. In the 2014–2015 Fiscal Year, the southern region of Sun Country had a 0.57% RA prevalence and the Northern Health Regions a prevalence of 1.15%. Incidence rates fluctuated over time in all regions but tended to be higher in Northern Health Regions. A higher RA prevalence trend was observed in rural residents over the study period. Higher prevalence rates were observed for RA in Northern Health Regions than elsewhere in the province. Rural prevalence rates were higher than for urban residents. Healthcare delivery strategic planning will need to ensure appropriate access for RA patients throughout the province.

Journal ArticleDOI
01 Jul 2018-BMJ Open
TL;DR: Findings indicate clinical educators are effective facilitators of research use among the care aides, but the effect is modified by organisational context.
Abstract: Objective This study explored the effect of clinical educators as facilitators of research use and how it may be modified by organisational context in the settings. Design Cross-sectional observational study. Setting A representative sample of 91 residential long-term care (LTC) facilities across Western Canada. Participants We used surveys to collect data from the frontline care aides and information about the organisational context of the care units. Outcome measure and explanatory variables We assessed research use (the outcome) with the Conceptual Research Utilization (CRU) scale. Explanatory variables in the multiple regression analysis were facilitation, organisational context and the interaction terms. Facilitation was measured by the frequency of contacts between care aides and clinical educator or person who brings new ideas about resident care. Three core organisational context variables were measured using the Alberta Context Tool. Results We included data of 3873 care aides from 294 care units in the LTC facilities. We found significant associations between CRU and facilitation, leadership, culture and evaluation. Interactions of facilitation x leadership and facilitation x culture were negative. The coefficient of the facilitation x evaluation term in the regression model was positive (0.019, 95% CI 0.012 to 0.026), suggesting synergistic effects between facilitation and a well-developed process to evaluate care quality using relevant data. Conclusions Findings indicate clinical educators are effective facilitators of research use among the care aides, but the effect is modified by organisational context. For greatest impact, managers can direct efforts of the clinical educators to care units where leadership and culture ratings are lowest, but a proficient feedback and evaluation process is in place. This understanding enables managers to deploy clinical educators (a scarce resource in LTC settings) most efficiently.

Journal ArticleDOI
TL;DR: Reports indicated that pharmacists’ most common contributions during rounds were reviewing current medications, reviewing antimicrobial therapy, adjusting medication dosing for organ dysfunction, providing therapeutic drug monitoring, and ensuring appropriate prophylaxis, which aligned with the “fundamental” and “optimal” activities for clinical pharmacists outlined by the Society of Critical Care Medicine and the American College of Clinical Pharmacy.
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Journal ArticleDOI
TL;DR: The general paediatrician is provided with a brief review of cannabinoid biology, the literature regarding their use in children with drug resistant epilepsy, the current Health Canada and Canadian Paediatric Society recommendations and also the regulations from the physician regulatory bodies for each province and territory.

Journal ArticleDOI
TL;DR: Results include making new connections between local HBE and poverty reduction efforts and promoting social inclusion guidelines in consultation processes, which can be a catalyst for engaging partners in cross-sectoral action for building inclusive physical and social environments.
Abstract: Population health approaches are visible among multidisciplinary methods used in urban design and planning, but attention to health equity is not always an explicit focus. Population and Public Health—Saskatoon Health Region recognized the need for frameworks to prioritize, integrate and measure health equity within local built environments. A cross-department healthy built environment (HBE) initiative coordinated activities involving Health Promotion, Environmental Public Health, Public Health Observatory, and Medical Health Officers engaged with municipal, academic and community partners in Saskatoon, Saskatchewan. The HBE team conducted evidence reviews and consulted with partners to identify common health equity issues in built environments and best and leading practices to address them. The HBE team then prioritized and undertook projects to model a health equity approach. Projects included the following: (1) developing a Health Equity in Healthy Built Environment Framework; (2) engaging in a partner campaign highlighting built environment and health equity during a municipal election; (3) producing a Health Equity Impact Assessment (HEIA) report on the City of Saskatoon’s growth plan; and (4) developing a monitoring and evaluation framework for health equity outcomes. Other outputs include making new connections between local HBE and poverty reduction efforts and promoting social inclusion guidelines in consultation processes. Within a population health approach to HBE, an explicit focus on health equity can be a catalyst for engaging partners in cross-sectoral action for building inclusive physical and social environments.

Journal ArticleDOI
TL;DR: The vision is for the SUPPORT Unit to integrate research and quality improvement into a continuous learning health system.
Abstract: Improving health and health services requires both better knowledge (a key function of research) and better action to adapt and use what is already known (quality improvement). However, organizational and cultural divides between academic research institutions and health system organizations too often result in missed opportunities to integrate research and improvement. The Saskatchewan Health Quality Council's experience and relationships, from linking research, quality improvement and patient engagement in its leadership of the province's healthcare quality improvement journey, provided core support and leadership in the development of Saskatchewan's Strategy for Patient-Oriented Research SUPPORT Unit. The vision is for the SUPPORT Unit to integrate research and quality improvement into a continuous learning health system.

Journal ArticleDOI
TL;DR: The results suggest that the probability of employment has negative association with the body weight of women and this effect is statistically significant and has substantial impact on employment.
Abstract: This paper examines the impact of obesity on labour market participation among Canadian women by using various Canadian population health surveys. We estimate the impact of obesity on labour market participation using probit and bivariate probit regression models. To correct for a potential endogenous relationship between obesity and labour market participation, we also use instrumental variables in the bivariate probit regression context. The results suggest that the probability of employment has negative association with the body weight of women. This effect is statistically significant and has substantial impact on employment. The results show that obesity decreases employment probability by about 25 percentage points for women. In addition to well-known negative health consequences, obesity also has additional negative effect on employment. This negative impact on employment is comparable to the impacts of mental health or illicit drug use on employment. Public health policies aimed at reducing obesity would generate additional benefits to society. Our results also provide additional evidence for lawmakers to amend the labour laws in Canada in order to acknowledge and prohibit hiring practices that discriminate against individuals with high body weight.

Journal ArticleDOI
TL;DR: Teenagers have increased risk of disease compared to younger children, likely due to waning immunity, and rural residents had a higher incidence of disease, possibly due to clusters of conscientious objectors.
Abstract: Increased numbers of pertussis cases in September 2015 led to the declaration of an outbreak in the Saskatoon Health Region (SHR). SHR (population approximately 350,000) is a geographic area in central Saskatchewan consisting of both urban and rural municipalities. The purpose of this study was to describe the epidemiology and identify possible predictors of the outbreak. Confirmed cases of pertussis in SHR from 2010 to 2015 were extracted from the integrated Public Health Information System (iPHIS) database. Univariate and bivariate analyses and a comparison of the two outbreaks were conducted. Poisson regression modelling was used to estimate incidence rate ratios (IRRs) of factors associated with pertussis infection. Two outbreaks between 2010 and 2015. Factors associated with the 2015 outbreak were residence in rural areas (IRR = 18.67, 95% CI 11.82–29.49; 11.37, 95% CI 6.40–20.21; and 6.31, 95% CI 3.43–11.62) for Humboldt, Watrous, and Rosthern areas, respectively, compared to the City of Saskatoon, and among children 11–14 years of age (IRR = 3.11, 95% CI 1.67–5.79) compared to children under 5 years of age. Unvaccinated persons had increased risk (IRR = 1.60, 95% CI 1.07–2.38). Multiple interventions, including enhanced contact tracing, supplemental immunization clinics, and cocooning, were employed in the 2015 outbreak. Pertussis is a cyclical disease with outbreaks occurring every 3 to 5 years. Teenagers have increased risk of disease compared to younger children, likely due to waning immunity. Rural residents had a higher incidence of disease, possibly due to clusters of conscientious objectors. Control efforts require recognition of waning immunity and unvaccinated susceptibles.

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TL;DR: A description of how the MAC has been integrated into an existing pharmacy curriculum is provided, which may be valuable to schools contemplating a similar addition to existing experiential learning.

Journal ArticleDOI
TL;DR: The Saskatchewan Psychiatric Occupational Therapy Driving Screen (SPOT-DS), developed as the first comprehensive clinical reasoning guide for screening drivers with psychiatric conditions, can assist in protecting clients’ driving privileges, while ensuring public safety on the roads by providing a systematic approach to screening drivers.
Abstract: IntroductionScreening driving ability is challenging in psychiatry due to the fluctuating nature of psychiatric diagnoses, psychosocial factors, and the impact of medications. An examination of bes...

Journal ArticleDOI
TL;DR: Reducing out-of-pocket medication costs for seniors was associated with small improvements in medication adherence across the population, and the SDP wasassociated with improved adherence among the subgroup of prevalent medication users.
Abstract: Background: In 2007, a drug benefit plan for Seniors (SDP) was launched in Saskatchewan, Canada SDP capped out-of-pocket costs at $15 per prescription for individuals aged 65 and older Objectives: To quantify the impact of the SDP on chronic medication adherence Methods: A retrospective cohort study was conducted for participants aged 65 or older who were eligible to the SPD, controlled by a younger group aged 40 to 64 who were ineligible Adherence was measured over 365 days using medication possession ratio (MPR) MPRs were compared between age groups, and between pre and post SDP-launch periods The odds ratio of optimal adherence (ie, MPR≥80%) was estimated using logistic regression models with generalized estimating equations (GEE) Results: Between 2005 and 2009, 353,568 adherence observations were observed from 188,109 unique patients Comparing the post-SDP period vs before, the increase in the odds of optimal medication adherence was significant (OR=108, 95% CI: 104 to 111) and was stronger after excluding patients already receiving medication benefits from other government programs (OR= 121, 95% CI: 116 to 126) The SDP was associated with improved adherence among the subgroup of prevalent medication users (OR=108, 95% CI: 104 to 112), but not incident users (OR=105, 95% CI: 098 to 113) Conclusion: Reducing out-of-pocket medication costs for seniors was associated with small improvements in medication adherence across the population

Journal ArticleDOI
TL;DR: A case of bilateral inguinal herniae and concurrent Spigelian hernia in an adult and first case report of intra-corporeal suturing of the Spigelia hernia neck is reported.

Journal ArticleDOI
TL;DR: Thrombophilia testing for patients who are going to stop anticoagulation after a deep vein thrombosis or pulmonary embolism and patients with strong thromBophilia are advised.
Abstract: Khan and colleagues[1][1] advise thrombophilia testing for patients who are going to stop anticoagulation after a deep vein thrombosis or pulmonary embolism. They also advise that patients with strong thrombophilia (antithrombin deficiency, antiphospholipid antibodies or combined thrombophilias)