Journal articles on the topic 'Health risk assessment – Ontario – Toronto'
To see the other types of publications on this topic, follow the link: Health risk assessment – Ontario – Toronto.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Health risk assessment – Ontario – Toronto.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Zeuli, Kimberly, Austin Nijhuis, Ronald Macfarlane, and Taryn Ridsdale. "The Impact of Climate Change on the Food System in Toronto." International Journal of Environmental Research and Public Health 15, no. 11 (October 24, 2018): 2344. http://dx.doi.org/10.3390/ijerph15112344.
Full textAbstract:
As part of its Climate Change and Health Strategy, in 2017, Toronto Public Health engaged stakeholders from across the food system to complete a high-level vulnerability assessment of the impact of climate change on the food system in Toronto. Using the Ontario Climate Change and Health Vulnerability and Adaptation Assessment Guidelines, the City of Toronto’s High-Level Risk Assessment Tool, and a strategic framework developed by the Initiative for a Competitive Inner City, Toronto Public Health identified the most significant extreme weather event risks to food processing, distribution and access in Toronto. Risks associated with three extreme weather events that are the most likely to occur in Toronto due to climate change were analyzed: significant rain and flooding, an extended heat wave, and a major winter ice storm. The analysis finds that while extreme weather events could potentially disrupt Toronto’s food supply, the current risk of an extended, widespread food supply disruption is relatively low. However, the findings highlight that a concerted effort across the food system, including electrical and fuel providers, is needed to address other key vulnerabilities that could impact food access, especially for vulnerable populations. Interruptions to electricity will have food access and food safety impacts, while interruptions to the transportation network and fuel will have food distribution and access impacts. Actions to mitigate these risks could include addressing food access vulnerabilities through ongoing city-wide strategies and integrating food access into the City’s emergency response planning. The next steps will include engaging with multiple partners across the city to understand and strengthen the “last mile” of food distribution and develop community food resilience action plans for vulnerable neighbourhoods.
2
van Dijk, Adam, Emily Dawson, Kieran Michael Moore, and Paul Belanger. "Risk Assessment During the Pan American and Parapan American Games, Toronto, 2015." Public Health Reports 132, no. 1_suppl (July 2017): 106S—110S. http://dx.doi.org/10.1177/0033354917708356.
Full textAbstract:
During the summer of 2015, the Pan American and Parapan American Games took place in the Greater Toronto area of Ontario, Canada, bringing together thousands of athletes and spectators from around the world. The Acute Care Enhanced Surveillance (ACES) system—a syndromic surveillance system that captures comprehensive hospital visit triage information from acute care hospitals across Ontario—monitored distinct syndromes throughout the games. We describe the creation and use of a risk assessment tool to evaluate alerts produced by ACES during this period. During the games, ACES generated 1420 alerts, 4 of which were considered a moderate risk and were communicated to surveillance partners for further action. The risk assessment tool was useful for public health professionals responsible for surveillance activities during the games. Next steps include integrating the tool within the ACES system.
3
Edge, T. A., S. Hill, G. Stinson, P. Seto, and J. Marsalek. "Experience with the antibiotic resistance analysis and DNA fingerprinting in tracking faecal pollution at two lake beaches." Water Science and Technology 56, no. 11 (December 1, 2007): 51–58. http://dx.doi.org/10.2166/wst.2007.757.
Full textAbstract:
Posting or closing of swimming beaches because of faecal contamination is a widespread problem reported in many locations. In a risk-based approach to this problem, the risk to swimmers' health is assessed by field monitoring of indicator bacteria and the associated risks are managed by source controls and other remedial measures. In risk assessment, great advances have been made in recent years with the introduction of microbial source tracking (MST) techniques. Two such techniques, antibiotic resistance analysis and DNA fingerprinting, were applied in a study of causes of faecal contamination at two lake beaches in Toronto, Ontario. Both methods identified bird faeces as the dominant sources of E. coli. Coping with this type of pollution presents a major environmental challenge.
4
Pink, Leah R., Andrew J. Smith, Philip WH Peng, Marilyn J. Galonski, Paul S. Tumber, David Evans, Doug L. Gourlay, et al. "Intake Assessment of Problematic Use of Medications in a Chronic Noncancer Pain Clinic." Pain Research and Management 17, no. 4 (2012): 276–80. http://dx.doi.org/10.1155/2012/489743.
Full textAbstract:
BACKGROUND: The present article outlines the process of instituting an assessment of risk of problematic use of medications with new patients in an ambulatory chronic noncancer pain (CNCP) clinic. It is hoped that the authors’ experience through this iterative process will fill the gap in the literature by setting an example of an application of the ‘universal precautions’ approach to chronic pain management.OBJECTIVES: To assess the feasibility and utility of the addition of a new risk assessment process and to provide a snapshot of the risk of problematic use of medications in new patients presenting to a tertiary ambulatory clinic treating CNCP.METHODS: Charts for the first three months following the institution of an intake assessment for risk of problematic medication use were reviewed. Health care providers at the Wasser Pain Management Centre (Toronto, Ontario) were interviewed to discuss the preliminary findings and provide feedback about barriers to completing the intake assessments, as well as to identify the items that were clinically relevant and useful to their practice.RESULTS: Data were analyzed and examined for completeness. While some measures were considered to be particularly helpful, other items were regarded as repetitive, problematic or time consuming. Feedback was then incorporated into revisions of the risk assessment tool.DISCUSSION: Overall, it is feasible and useful to assess risk for problematic use of medications in new patients presenting to CNCP clinics.CONCLUSION: To facilitate the practice of assessment, the risk assessment tool at intake must be concise, clinically relevant and feasible given practitioner time constraints.
5
Dossa, Fahima, Maria C. Cusimano, Rinku Sutradhar, Kelly Metcalfe, Tari Little, Jordan Lerner-Ellis, Andrea Eisen, Wendy S. Meschino, and Nancy N. Baxter. "Real-world health services utilisation and outcomes afterBRCA1andBRCA2testing in Ontario, Canada: the What Comes Next Cohort Study protocol." BMJ Open 8, no. 9 (September 2018): e025317. http://dx.doi.org/10.1136/bmjopen-2018-025317.
Full textAbstract:
IntroductionWomen who have pathogenic mutations in theBRCA1andBRCA2genes are at greatly increased risks for breast and ovarian cancers. Although risk-reduction strategies can be undertaken by these women, knowledge regarding the uptake of these strategies is limited. Additionally, the healthcare behaviours of women who receive inconclusive test results are not known. This study protocol describes the creation of a retrospective cohort of women who have undergone genetic testing forBRCA1andBRCA2, linking genetic test results with administrative data to quantify the uptake of risk-reduction strategies and to assess long-term cancer and non-cancer outcomes after genetic testing.Methods and analysisApproximately two-thirds ofBRCA1andBRCA2testing in Ontario, Canada is performed at North York General Hospital (NYGH) and Mount Sinai Hospital (MSH), Toronto. We will use registries at these sites to assemble a cohort of approximately 17 000 adult women who underwentBRCA1andBRCA2testing from January 2007 to April 2016. Trained chart abstractors will obtain detailed information for all women tested over this period, including demographics, personal and family cancer histories and genetic test results. We will link these data to provincial administrative databases, enabling assessment of healthcare utilisation and long-term outcomes after testing. Study outcomes will include the uptake of breast cancer screening and prophylactic breast and ovarian surgery, cancer incidence and mortality and incidence of non-cancer health outcomes, including cardiovascular, osteoporotic and neurodegenerative disease.Ethics and disseminationThis study has been approved by the Research Ethics Boards at NYGH (no 16-0035), MSH (no 13-0124) and Sunnybrook Health Sciences Centre (no 275-2016). We plan to disseminate research findings through peer-reviewed publications and presentations at national and international meetings.
6
REA, E., J. LAFLÈCHE, S. STALKER, B. K. GUARDA, H. SHAPIRO, I. JOHNSON, S. J. BONDY, R. UPSHUR, M. L. RUSSELL, and M. ELIASZIW. "Duration and distance of exposure are important predictors of transmission among community contacts of Ontario SARS cases." Epidemiology and Infection 135, no. 6 (January 12, 2007): 914–21. http://dx.doi.org/10.1017/s0950268806007771.
Full textAbstract:
SUMMARYWe report attack rates and contact-related predictors among community contacts of severe acute respiratory syndrome (SARS) cases from the 2003 Toronto-area outbreak. Community contact data was extracted from public health records for single, well-defined exposures to a SARS case. In total, 8662 community-acquired exposures resulted in 61 probable cases; a crude attack rate of 0·70% [95% confidence interval (CI) 0·54–0·90]. Persons aged 55–69 years were at higher risk of acquiring SARS (1·14%) than those either younger (0·60%) or older (0·70%). In multivariable analysis exposures for at least 30 min at a distance of ⩽1 m increased the likelihood of becoming a SARS case 20·4-fold (95% CI 11·8–35·1). Risk related to duration of illness in the source case at time of exposure was greatest for illness duration of 7–10 days (rate ratio 3·4, 95% CI 1·9–6·1). Longer and closer proximity exposures incurred the highest rate of disease. Separate measures of time and distance from source cases should be added to minimum datasets for the assessment of interventions for SARS and other emerging diseases.
7
Vallis, Katherine A., Melania Pintilie, Nelson Chong, Eric Holowaty, Pamela S. Douglas, Peter Kirkbride, and Andreas Wielgosz. "Assessment of Coronary Heart Disease Morbidity and Mortality After Radiation Therapy for Early Breast Cancer." Journal of Clinical Oncology 20, no. 4 (February 15, 2002): 1036–42. http://dx.doi.org/10.1200/jco.2002.20.4.1036.
Full textAbstract:
PURPOSE: To assess the risk of fatal and nonfatal myocardial infarction (MI) after breast-conserving surgery (BCS) and radiation therapy (RT) for left-sided breast cancer. PATIENTS AND METHODS: A hospital-based retrospective cohort linkage study of all breast cancer patients registered at the Princess Margaret Hospital (PMH), Toronto, Canada, between 1982 and 1988 who were treated with postlumpectomy RT was performed. Available identifiers for the study cohort were linked to two province-wide health files: the Canadian Institute for Health Information Hospitalization File and the Ontario Mortality Database. Admissions to hospital for MI and deaths attributable to MI were identified. The relevant original health records were abstracted to verify the diagnosis of MI according to diagnostic criteria used in the World Health Organization multinational monitoring of trends and determinants in cardiovascular disease (MONICA) project. We compared incidence of MI in the study cohort with the general population and incidence of MI after therapy for left- versus right-sided breast cancer. RESULTS: A cohort of 2,128 patients was identified. The median length of follow-up was 10.2 years. The incidence of MI in the study cohort was comparable to that in an age-matched general population of women in Ontario. There were 70 coronary events among 56 patients after breast irradiation. According to MONICA criteria, 53 and six events were characterized as definite and possible MIs, respectively. Eleven events did not satisfy MONICA criteria for MI. Twenty-six patients treated for left-sided and 23 patients treated for right-sided breast cancer experienced at least one definite or possible MI (log-rank test, P = .66). There were eight fatal MIs among the left-sided group and six among the right-sided group. There was no excess of other cardiac diseases among patients who received left-sided radiotherapy compared to the right-sided group. CONCLUSION: We have found no evidence for excess morbidity and mortality from coronary artery disease among women treated with RT to the left breast after BCS at 10.2 years of follow-up. Longer follow-up is required to confirm that excess cardiac disease has been completely avoided.
8
Darani, Shaheen, Kiran Patel, Laura Hayos, Tanya Connors, Faisal Islam, Anika Saiva, and Sandy Simpson. "Education for corrections officers to better meet the mental health needs of inmates." BJPsych Open 7, S1 (June 2021): S132—S133. http://dx.doi.org/10.1192/bjo.2021.379.
Full textAbstract:
AimsIn Canada, there has been an increase in the rate of incarceration of individuals with mental health diagnoses. Overrepresentation of individuals with psychiatric diagnoses in correctional settings is well-established. Front-line officers play a central role in dealing with mental health struggles of inmates. Nonetheless, the training that officers receive is often considered inadequate. To address this gap, the goal of this study was to design, implement, and evaluate a mental health training for correctional officers at the Toronto South Detention Centre (TSDC) and Vanier Centre for Women (VCW) in Ontario, Canada.MethodA needs assessment was undertaken among officers at the TSDC. In response to needs identified, a one-day course was delivered to officers (n = 57) at the TSDC and VCW (n = 41). The curriculum included mental health awareness; assessment of risk; communicating with inmates in distress; and self-care. Live simulations provided the opportunity for participants to identify signs of mental illness, assess risk, and respond strategically to de-escalate situations. Participants’ knowledge and confidence in their ability to identify and assist individuals with these problems was established using pre and post measures. Participant satisfaction was also measured via a survey. A three-month follow-up administration was used to determine maintenance of gains. Focus groups at nine months were conducted to understand participants’ needs, learning, and impact of training.ResultThe results were promising, with 92% and 88% of participants at TSDC and Vanier Centre for Women respectively expressing satisfaction and 62% and 68% at TSDC and Vanier Centre for Women respectively stating they intended to change practices. Analyses of change in knowledge and confidence scores pre to post-training showed statistically significant improvement in all areas measured. Three-month follow-up at TSDC showed 75% of respondents have applied what they learned from the training to a “moderate or great extent”. Focus group themes showed improved attitudes and ability to identify behaviours related to inmate mental health struggles and interest in further training to support officers’ mental health.ConclusionThis study shows that training informed by officer learning needs can help them better meet the mental health needs of inmates. Training can improve attitudes toward inmates presenting with mental health issues. Training that is interactive and provides skills practice can have sustained impact on practice. Further training should integrate self-care to support officers' mental health.
9
Wali, Sahr, Milena Guessi Margarido, Amika Shah, Patrick Ware, Michael McDonald, Mary O'Sullivan, Juan Duero Posada, Heather Ross, and Emily Seto. "Expanding Telemonitoring in a Virtual World: A Case Study of the Expansion of a Heart Failure Telemonitoring Program During the COVID-19 Pandemic." Journal of Medical Internet Research 23, no. 1 (January 22, 2021): e26165. http://dx.doi.org/10.2196/26165.
Full textAbstract:
Background To minimize the spread and risk of a COVID-19 outbreak, societal norms have been challenged with respect to how essential services are delivered. With pressures to reduce the number of in-person ambulatory visits, innovative models of telemonitoring have been used during the pandemic as a necessary alternative to support access to care for patients with chronic conditions. The pandemic has led health care organizations to consider the adoption of telemonitoring interventions for the first time, while others have seen existing programs rapidly expand. Objective At the Toronto General Hospital in Ontario, Canada, the rapid expansion of a telemonitoring program began on March 9, 2020, in response to COVID-19. The objective of this study was to understand the experiences related to the expanded role of a telemonitoring program under the changing conditions of the pandemic. Methods A single-case qualitative study was conducted with 3 embedded units of analysis. Semistructured interviews probed the experiences of patients, clinicians, and program staff from the Medly telemonitoring program at a heart function clinic in Toronto, Canada. Data were analyzed using inductive thematic analysis as well as Eakin and Gladstone’s value-adding approach to enhance the analytic interpretation of the study findings. Results A total of 29 participants were interviewed, including patients (n=16), clinicians (n=9), and operational staff (n=4). Four themes were identified: (1) providing care continuity through telemonitoring; (2) adapting telemonitoring operations for a more virtual health care system; (3) confronting virtual workflow challenges; and (4) fostering a meaningful patient-provider relationship. Beyond supporting virtual visits, the program’s ability to provide a more comprehensive picture of the patient’s health was valued. However, issues relating to the lack of system integration and alert-driven interactions jeopardized the perceived sustainability of the program. Conclusions With the reduction of in-person visits during the pandemic, virtual services such as telemonitoring have demonstrated significant value. Based on our study findings, we offer recommendations to proactively adapt and scale telemonitoring programs under the changing conditions of an increasingly virtual health care system. These include revisiting the scope and expectations of telemedicine interventions, streamlining virtual patient onboarding processes, and personalizing the collection of patient information to build a stronger virtual relationship and a more holistic assessment of patient well-being.
10
Shantier, Mohamed, Yanhong Li, Monika Ashwin, Olsegun Famure, and Sunita K. Singh. "Use of the Living Kidney Donor Profile Index in the Canadian Kidney Transplant Recipient Population: A Validation Study." Canadian Journal of Kidney Health and Disease 7 (January 2020): 205435812090697. http://dx.doi.org/10.1177/2054358120906976.
Full textAbstract:
Background: The Living Kidney Donor Profile Index (LKDPI) was derived in a cohort of kidney transplant recipients (KTR) from the United States to predict the risk of total graft failure. There are important differences in patient demographics, listing practices, access to transplantation, delivery of care, and posttransplant mortality in Canada as compared with the United States, and the generalizability of the LKDPI in the Canadian context is unknown. Objective: The purpose of this study was to externally validate the LKDPI in a large contemporary cohort of Canadian KTR. Design: Retrospective cohort validation study. Setting: Toronto General Hospital, University Health Network, Toronto, Ontario, Canada Patients: A total of 645 adult (≥18 years old) living donor KTR between January 1, 2006 and December 31, 2016 with follow-up until December 31, 2017 were included in the study. Measurements: The predictive performance of the LKDPI was evaluated. The outcome of interest was total graft failure, defined as the need for chronic dialysis, retransplantation, or death with graft function. Methods: The Cox proportional hazards model was used to examine the relation between the LKDPI and total graft failure. The Cox proportional hazards model was also used for external validation and performance assessment of the model. Discrimination and calibration were used to assess model performance. Discrimination was assessed using Harrell’s C statistic and calibration was assessed graphically, comparing observed versus predicted probabilities of total graft failure. Results: A total of 645 living donor KTR were included in the study. The median LKDPI score was 13 (interquartile range [IQR] = 1.1, 29.9). Higher LKDPI scores were associated with an increased risk of total graft failure (hazard ratio = 1.01; 95% confidence interval [CI] = 1.0-1.02; P = .02). Discrimination was poor (C statistic = 0.55; 95% CI = 0.48-0.61). Calibration was as good at 1-year posttransplant but suboptimal at 3- and 5-years posttransplant. Limitations: Limitations include a relatively small sample size, predicted probabilities for assessment of calibration only available for scores of 0 to 100, and some missing data handled by imputation. Conclusions: In this external validation study, the predictive ability of the LKDPI was modest in a cohort of Canadian KTR. Validation of prediction models is an important step to assess performance in external populations. Potential recalibration of the LKDPI may be useful prior to clinical use in external cohorts.
11
Saravana-Bawan, Bianka, Bourne Lewis Auguste, Alireza Zahirieh, and Karen Devon. "Ambulatory Parathyroidectomy for Secondary Hyperparathyroidism at a Large Dialysis Program in Toronto: A Program Report." Canadian Journal of Kidney Health and Disease 9 (January 2022): 205435812211279. http://dx.doi.org/10.1177/20543581221127937.
Full textAbstract:
Purpose of program: Operative wait times for non-oncology-related procedures continue to rise in Canada, and this was further exacerbated by the COVID-19 pandemic. These challenges will remain prevalent beyond the pandemic given the limited number of acute care beds and resources required to care for patients. As a result, the need for innovative approaches to optimize the utilization of health care resources while maintaining equitable and timely access is needed. In this report, we describe the development of a collaborative ambulatory parathyroidectomy program between two centers in Toronto, allowing for more expedient surgical treatment of secondary hyperparathyroidism among patients from a large dialysis program. Sources of information: The need for expanded access to surgical care for secondary hyperparathyroidism was identified through interdepartmental communication between referring nephrologists and surgeons at Sunnybrook Health Sciences Centre and Women’s College Hospital, respectively. Methods: A multidisciplinary ambulatory parathyroidectomy planning team was formed that included nephrologists, endocrine surgeons, nurses, and patient care managers to conduct a needs assessment. It was identified that patients had long wait times, and to address that gap in care, a protocol was developed to identify suitable patients requiring treatment. The teams created a plan to coordinate patient care and transfers. A clinical tool and protocol for post-operative management of hypocalcemia was developed using a Delphi model, gathering input from many members of the care team. The Delphi process to finalize the protocol included a series of virtual meetings over a period of about 4 months with various stakeholders and included input from two departmental heads (medicine and surgery), three nephrologists, a nurse practitioner, a patient care manager, and two nurse educators. Meetings involved core members of the Nephrology Quality Improvement and Patient Safety at Sunnybrook Health Sciences Centre and finalized protocol was agreed upon by members of this group at a quarterly meeting. Key findings: In this article, we describe the development, initial deployment, and planned assessment of the ambulatory parathyroidectomy program at the Women’s College Hospital and Sunnybrook Health Sciences Centre. The primary aim of the program is to increase accessibility to parathyroidectomy for secondary hyperparathyroidism. A secondary aim was to allow patients to have streamlined care with a team that is well versed with maintenance dialysis needs and optimizing treatment of post operative hypocalcemia through standardized protocols. Limitations: Ambulatory parathyroidectomy relies on effective communication, flow, and availability of acute care beds. It is anticipated that occasionally, unexpected hospital demands, and health care disruptions may occur, which can limit efficiency of the program. We will also need to examine the cost-effectiveness of this program as it may improve access but increase costs related to the procedure. As the program is implemented, useful adaptations and policies to our protocol to help mitigate these limitations will be documented and published in our outcomes report. Implications: Ontario residents with chronic kidney disease with secondary hyperparathyroidism who have failed medical management will have increased and timely access to parathyroidectomy.
12
Staley, Zachery R., Josey Grabuski, Ed Sverko, and Thomas A. Edge. "Comparison of Microbial and Chemical Source Tracking Markers To Identify Fecal Contamination Sources in the Humber River (Toronto, Ontario, Canada) and Associated Storm Water Outfalls." Applied and Environmental Microbiology 82, no. 21 (August 19, 2016): 6357–66. http://dx.doi.org/10.1128/aem.01675-16.
Full textAbstract:
ABSTRACTStorm water runoff is a major source of pollution, and understanding the components of storm water discharge is essential to remediation efforts and proper assessment of risks to human and ecosystem health. In this study, culturableEscherichia coliand ampicillin-resistantE. colilevels were quantified and microbial source tracking (MST) markers (including markers for generalBacteroidalesspp., human, ruminant/cow, gull, and dog) were detected in storm water outfalls and sites along the Humber River in Toronto, Ontario, Canada, and enumerated via endpoint PCR and quantitative PCR (qPCR). Additionally, chemical source tracking (CST) markers specific for human wastewater (caffeine, carbamazepine, codeine, cotinine, acetaminophen, and acesulfame) were quantified. Human and gull fecal sources were detected at all sites, although concentrations of the human fecal marker were higher, particularly in outfalls (mean outfall concentrations of 4.22 log10copies, expressed as copy numbers [CN]/100 milliliters for human and 0.46 log10CN/100 milliliters for gull). Higher concentrations of caffeine, acetaminophen, acesulfame,E. coli, and the human fecal marker were indicative of greater raw sewage contamination at several sites (maximum concentrations of 34,800 ng/liter, 5,120 ng/liter, 9,720 ng/liter, 5.26 log10CFU/100 ml, and 7.65 log10CN/100 ml, respectively). These results indicate pervasive sewage contamination at storm water outfalls and throughout the Humber River, with multiple lines of evidence identifying Black Creek and two storm water outfalls with prominent sewage cross-connection problems requiring remediation. Limited data are available on specific sources of pollution in storm water, though our results indicate the value of using both MST and CST methodologies to more reliably assess sewage contamination in impacted watersheds.IMPORTANCEStorm water runoff is one of the most prominent non-point sources of biological and chemical contaminants which can potentially degrade water quality and pose risks to human and ecosystem health. Therefore, identifying fecal contamination in storm water runoff and outfalls is essential for remediation efforts to reduce risks to public health. This study employed multiple methods of identifying levels and sources of fecal contamination in both river and storm water outfall sites, evaluating the efficacy of using culture-based enumeration ofE. coli, molecular methods of determining the source(s) of contamination, and CST markers as indicators of fecal contamination. The results identified pervasive human sewage contamination in storm water outfalls and throughout an urban watershed and highlight the utility of using both MST and CST to identify raw sewage contamination.
13
Forner, David, Paul Hong, Martin Corsten, Valeria E. Rac, Rosemary Martino, Andrew G. Shuman, Douglas B. Chepeha, et al. "Needs assessment for a decision support tool in oral cancer requiring major resection and reconstruction: a mixed-methods study protocol." BMJ Open 10, no. 11 (November 2020): e036969. http://dx.doi.org/10.1136/bmjopen-2020-036969.
Full textAbstract:
IntroductionAdvanced oral cancer and its ensuing treatment engenders significant morbidity and mortality. Patients are often elderly with significant comorbidities. Toxicities associated with surgical resection can be devastating and they are often highlighted by patients as impactful. Given the potential for suboptimal oncological and functional outcomes in this vulnerable patient population, promotion and performance of shared decision making (SDM) is crucial.Decision aids (DAs) are useful instruments for facilitating the SDM process by presenting patients with up-to-date evidence regarding risks, benefits and the possible postoperative course. Importantly, DAs also help elicit and clarify patient values and preferences. The use of DAs in cancer treatment has been shown to reduce decisional conflict and increase SDM. No DAs for oral cavity cancer have yet been developed.This study endeavours to answer the question: Is there a patient or surgeon driven need for development and implementation of a DA for adult patients considering major surgery for oral cancer?Methods and analysisThis study is the first step in a multiphase investigation of SDM during major head and neck surgery. It is a multi-institutional convergent parallel mixed-methods needs assessment study. Patients and surgeon dyads will be recruited to complete questionnaires related to their perception of the SDM process (nine-item Shared Decision-Making Questionnaire, SDM-Q-9 and SDM-Q-Doc) and to take part in semistructured interviews. Patients will also complete questionnaires examining decisional self-efficacy (Ottawa Decision Self-Efficacy Scale) and decisional conflict (Decisional Conflict Scale). Questionnaires will be completed at time of recruitment and will be used to assess the current level of SDM, self-efficacy and conflict in this setting. Thematic analysis will be used to analyse transcripts of interviews. Quantitative and qualitative components of the study will be integrated through triangulation, with matrix developed to promote visualisation of the data.Ethics and DisseminationThis study has been approved by the research ethics boards of the Nova Scotia Health Authority (Halifax, Nova Scotia) and the University Health Network (Toronto, Ontario). Dissemination to clinicians will be through traditional approaches and creation of a head and neck cancer SDM website. Dissemination to patients will include a section within the website, patient advocacy groups and postings within clinical environments.
14
Gomaa, Noha, Chaini Konwar, Nicole Gladish, Stephanie H. Au-Young, Ting Guo, Min Sheng, Sarah M. Merrill, et al. "Association of Pediatric Buccal Epigenetic Age Acceleration With Adverse Neonatal Brain Growth and Neurodevelopmental Outcomes Among Children Born Very Preterm With a Neonatal Infection." JAMA Network Open 5, no. 11 (November 2, 2022): e2239796. http://dx.doi.org/10.1001/jamanetworkopen.2022.39796.
Full textAbstract:
ImportanceVery preterm neonates (24-32 weeks’ gestation) remain at a higher risk of morbidity and neurodevelopmental adversity throughout their lifespan. Because the extent of prematurity alone does not fully explain the risk of adverse neonatal brain growth or neurodevelopmental outcomes, there is a need for neonatal biomarkers to help estimate these risks in this population.ObjectivesTo characterize the pediatric buccal epigenetic (PedBE) clock—a recently developed tool to measure biological aging—among very preterm neonates and to assess its association with the extent of prematurity, neonatal comorbidities, neonatal brain growth, and neurodevelopmental outcomes at 18 months of age.Design, Setting, and ParticipantsThis prospective cohort study was conducted in 2 neonatal intensive care units of 2 hospitals in Toronto, Ontario, Canada. A total of 35 very preterm neonates (24-32 weeks’ gestation) were recruited in 2017 and 2018, and neuroimaging was performed and buccal swab samples were acquired at 2 time points: the first in early life (median postmenstrual age, 32.9 weeks [IQR, 32.0-35.0 weeks]) and the second at term-equivalent age (TEA) at a median postmenstrual age of 43.0 weeks (IQR, 41.0-46.0 weeks). Follow-ups for neurodevelopmental assessments were completed in 2019 and 2020. All neonates in this cohort had at least 1 infection because they were originally enrolled to assess the association of neonatal infection with neurodevelopment. Neonates with congenital malformations, genetic syndromes, or congenital TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes and other agents) infection were excluded.ExposuresThe extent of prematurity was measured by gestational age at birth and PedBE age difference. PedBE age was computed using DNA methylation obtained from 94 age-informative CpG (cytosine-phosphate-guanosine) sites. PedBE age difference (weeks) was calculated by subtracting PedBE age at each time point from the corresponding postmenstrual age.Main Outcomes and MeasuresTotal cerebral volumes and cerebral growth during the neonatal intensive care unit period were obtained from magnetic resonance imaging scans at 2 time points: approximately the first 2 weeks of life and at TEA. Bayley Scales of Infant and Toddler Development, Third Edition, were used to assess neurodevelopmental outcomes at 18 months.ResultsAmong 35 very preterm neonates (21 boys [60.0%]; median gestational age, 27.0 weeks [IQR, 25.9-29.9 weeks]; 23 [65.7%] born extremely preterm [<28 weeks’ gestation]), extremely preterm neonates had an accelerated PedBE age compared with neonates born at a later gestational age (β = 9.0; 95% CI, 2.7-15.3; P = .01). An accelerated PedBE age was also associated with smaller cerebral volumes (β = –5356.8; 95% CI, −6899.3 to −2961.7; P = .01) and slower cerebral growth (β = –2651.5; 95% CI, −5301.2 to −1164.1; P = .04); these associations remained significant after adjusting for clinical neonatal factors. These findings were significant at TEA but not earlier in life. Similarly, an accelerated PedBE age at TEA was associated with lower cognitive (β = –0.4; 95% CI, −0.8 to −0.03; P = .04) and language (β = –0.6; 95% CI, −1.1 to −0.06; P = .02) scores at 18 months.Conclusions and RelevanceThis cohort study of very preterm neonates suggests that biological aging may be associated with impaired brain growth and neurodevelopmental outcomes. The associations between epigenetic aging and adverse neonatal brain health warrant further attention.
15
Hosang, Stephanie, Natasha Kithulegoda, and Noah Ivers. "Documentation of Behavioral Health Risk Factors in a Large Academic Primary Care Clinic." Journal of Primary Care & Community Health 13 (January 2022): 215013192210744. http://dx.doi.org/10.1177/21501319221074466.
Full textAbstract:
Objective: To determine the prevalence of alcohol, smoking, and physical activity status documentation at a family health team in Toronto, Ontario, and to explore the patient characteristics that predict documentation of these lifestyle risk factor statuses. Design: Manual retrospective review of electronic medical records (EMRs). Setting: Large, urban, academic family health team in Toronto, Ontario. Participants: Patients over the age of 18 that had attended a routine clinical appointment in March, 2018. Main Outcome Measures: Prevalence and content of risk factor status in electronic medical records for alcohol, smoking, and physical activity. Results: The prevalence of alcohol, smoking, and physical activity documentation was 86.4%, 90.4%, and 66.1%, respectively. These lifestyle risk factor statuses were most often documented in the “risk factors” section of the EMR (83.7% for alcohol, 88.1% for smoking, and 47.9% for physical activity). Completion of a periodic health review within 1 year was most strongly associated with documentation (alcohol odds ratio [OR] 9.79, 95% Confidence Interval [CI] 2.12, 45.15; smoking OR 1.77 95% CI 0.51, 6.20; physical activity OR 3.52 95% CI 1.67, 7.40). Conclusion: Documentation of lifestyle risk factor statuses is strongly associated with having a recent periodic health review. If “annual physicals” continue to decline, primary care providers should final additional opportunities to address these key determinants of health.
16
Kuster, Stefan P., Brenda L. Coleman, Janet Raboud, Shelly McNeil, Gaston De Serres, Jonathan Gubbay, Todd Hatchette, et al. "Risk Factors for Influenza among Health Care Workers during 2009 Pandemic, Toronto, Ontario, Canada." Emerging Infectious Diseases 19, no. 4 (April 2013): 606–15. http://dx.doi.org/10.3201/eid1904.111812.
Full text
17
Hanselman, Beth A., Steven A. Kruth, Joyce Rousseau, and J. Scott Weese. "Methicillin-ResistantStaphylococcus aureusColonization in Schoolteachers in Ontario." Canadian Journal of Infectious Diseases and Medical Microbiology 19, no. 6 (2008): 405–8. http://dx.doi.org/10.1155/2008/284239.
Full textAbstract:
A prospective study of methicillin-resistantStaphylococcus aureus (MRSA) colonization was performed involving teachers at a science teachers’ conference in Toronto, Ontario. Nasal swabs and questionnaire data were collected from consenting individuals. MRSAcolonization was identified in seven of 220 (3.2%) participants. No colonized individuals reported recent contact with the health care system, antimicrobial therapy, residence with health care workers or previous MRSA infections. Methicillin-susceptibleS aureuscolonization was identified in 72 of 220 (33%) individuals. The prevalence of MRSA colonization was higher than expected for a purportedly low-risk population.
18
Jamal, Alainna, Brenda Coleman, Jennie Johnstone, Kevin Katz, Matthew P. Muller, Samir Patel, Roberto Melano, et al. "512. Healthcare-Acquired (HA) Carbapenemase-Producing Enterobacteriales (CPE) in Southern Ontario, Canada: To Whom Are We Transmitting CPE?" Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S247—S248. http://dx.doi.org/10.1093/ofid/ofz360.581.
Full textAbstract:
Abstract Background Though CPE in Canada are mainly acquired abroad, outbreaks/transmission in Canadian hospitals have been reported. We determined the incidence of HA CPE in southern Ontario, Canada, to inform prevention and control programs. Methods Toronto Invasive Bacterial Diseases Network (TIBDN) has performed population-based surveillance for CPE in the Toronto area/Peel region of southern Ontario, Canada, since CPE were first identified in October 2007. Clinical microbiology laboratories report all CPE isolates to TIBDN; annual lab audits are performed. Incidence calculations used first isolates as numerator; denominator (patient-days/fiscal year for Toronto/Peel hospitals) was from the Ontario Ministry of Health and Long-Term Care. Results The incidence of HA CPE has risen from 0 in 2007/2008 to 0.45 and 0.28 per 100,000 patient-days for all and clinical cases, respectively, in 2017/2018 (Figure, P < 0.0001). 190/790 (24%) incident cases of CPE colonization/infection in southern Ontario from October 2007 to December 2018 were likely HA (hospitalized in Ontario with no history of hospitalization abroad/high-risk travel). Eighty (25%) were female and the median age was 73 years (IQR 57–83 years). 157 (83%) had no prior travel abroad and 33 (17%) had prior low-risk travel. 122 (64%) had their CPE identified >72 hours post-admission (of which 83 also had ≥1 other prior Ontario hospitalization); 68 (36%) had their CPE identified at admission but had recent prior Ontario hospitalization. HA cases vs. foreign acquisitions were significantly more likely K. pneumoniae (48% vs. 38%, P = 0.02) and Enterobacter spp. (20% vs. 7%, P < 0.0001) and less likely E. coli (20% vs. 48%, P < 0.0001). Genes of HA vs. foreign acquisitions were significantly more likely blaKPC (34% vs. 12%, P < 0.0001) and blaVIM (12% vs. 2%, P < 0.0001) and less likely blaNDM±OXA (38% vs. 56%, P < 0.0001) and blaOXA (13% vs. 27%, P = 0.0001). 36 (19%) HA cases had a negative CPE screen before their first positive CPE test (10/36 (28%) were on admission). The median incidence of HA CPE per 100,000 patient-days at each hospital was 0.44 (IQR 0.15–0.68) (P < 0.0001). Conclusion A quarter of CPE cases in southern Ontario were HA and the incidence of HA cases is increasing. Most cases were admitted to >1 Ontario hospital. Strategies to control transmission are critical. Disclosures All authors: No reported disclosures.
19
Mbuagbaw, Lawrence, Wangari Tharao, Winston Husbands, Laron E. Nelson, Muna Aden, Keresa Arnold, Shamara Baidoobonso, et al. "A/C study protocol: a cross-sectional study of HIV epidemiology among African, Caribbean and Black people in Ontario." BMJ Open 10, no. 7 (July 2020): e036259. http://dx.doi.org/10.1136/bmjopen-2019-036259.
Full textAbstract:
IntroductionAfrican, Caribbean and Black (ACB) communities are disproportionately infected by HIV in Ontario, Canada. They constitute only 5% of the population of Ontario yet account for 25% of new diagnoses of HIV. The aim of this study is to understand underlying factors that augment the HIV risk in ACB communities and to inform policy and practice in Ontario.Methods and analysisWe will conduct a cross-sectional study of first-generation and second-generation ACB adults aged 15–64 in Toronto (n=1000) and Ottawa (n=500) and collect data on sociodemographic information, sexual behaviours, substance use, blood donation, access and use of health services and HIV-related care. We will use dried blood spot testing to determine the incidence and prevalence of HIV infection among ACB people, and link participant data to administrative databases to investigate health service access and use. Factors associated with key outcomes (HIV infection, testing behaviours, knowledge about HIV transmission and acquisition, HIV vulnerability, access and use of health services) will be evaluated using generalised linear mixed models, adjusted for relevant covariates.Ethics and disseminationThis study has been reviewed and approved by the following Research Ethics Boards: Toronto Public Health, Ottawa Public Health, Laurentian University; the University of Ottawa and the University of Toronto. Our findings will be disseminated as community reports, fact sheets, digital stories, oral and poster presentations, peer-reviewed manuscripts and social media.
20
Bamotra, Manjinder, Wendy Pons, and Ian Young. "Evaluation of a West Nile virus risk-assessment tool used at a local health unit." Environmental Health Review 63, no. 1 (April 2020): 21–26. http://dx.doi.org/10.5864/d2020-004.
Full textAbstract:
In Ontario, public health units collect surveillance data on vector-borne diseases (VBD) to determine emerging trends and develop VBD management strategies. Risk-assessment tools that are simple and easily applied can provide public health practitioners with objective evaluations of the risk of West Nile virus (WNV) activity in their jurisdiction. This study was conducted to evaluate an existing WNV risk-assessment tool used by a public health unit in southern Ontario. The purpose of this study was to: (i) describe the trends for WNV in mosquito and human cases in the Region of Peel, Ontario, Canada, and (ii) investigate the ability of the risk-assessment tool to predict positive human cases and positive mosquito traps in the following weeks. Data were collected from 2011 to 2016 and analysed using simple descriptive statistics and Fisher’s exact tests. This study found the tool includes variables that are not significant in predicting WNV activity in the following weeks. The current tool should be revised to remove variables that are not significant in predicting risk and add additional variables that have been shown to be effective predictors in other studies, such as rainfall and human WNV cases in the previous year.
21
Saito, Gregory, Jessica Thom, Yanliang Wei, Piraveina Gnanasuntharam, Pirasanya Gnanasuntharam, Nathan Kreiswirth, Barbara Willey, et al. "Methicillin-ResistantStaphylococcus aureusColonization among Health Care Workers in a Downtown Emergency Department in Toronto, Ontario." Canadian Journal of Infectious Diseases and Medical Microbiology 24, no. 3 (2013): e57-e60. http://dx.doi.org/10.1155/2013/349891.
Full textAbstract:
BACKGROUND: Methicillin-resistantStaphylococcus aureus(MRSA) acquired in the community, otherwise known as community-acquired MRSA, has emerged rapidly in recent years. Colonization with MRSA has been associated with an increased risk of symptomatic and serious infections and, in some settings, health care workers (HCWs) exhibit a higher prevalence of MRSA colonization.OBJECTIVE: To determine MRSA colonization in emergency department (ED) HCWs in the setting of a moderate prevalence of MRSA in skin and soft tissue infections.METHODS: The present study was conducted at a downtown ED in Toronto, Ontario. ED HCWs completed a brief questionnaire and swabs were taken from one anterior nare, one axilla and any open wounds (if present). Swabs were processed using standard laboratory techniques.RESULTS: None of the 89 staff (registered nurses [n=55], physicians [n=15], other [n=19]) were MRSA positive and 25 (28.1%) were colonized with methicillin-susceptibleS aureus.CONCLUSIONS: Contrary to common belief among HCWs and previous studies documenting MRSA colonization of HCWs, MRSA colonization of this particular Canadian ED HCW cohort was very low and similar to that of the local population.
22
Park, Mike, Melissa Moos, Ian Young, Chris MacDonald, and Richard Meldrum. "Microbiological quality of Portuguese custard tarts in Toronto—a pilot study." Environmental Health Review 60, no. 3 (September 2017): 73–76. http://dx.doi.org/10.5864/d2017-019.
Full textAbstract:
Custard poses a health risk as it can support microbial growth; however, few studies have investigated custard tarts as a potential hazard. Custard tarts were sampled from 14 Toronto bakeries for microbial quality, pH, and water activity. The custard tarts displayed the ability to support microbial growth, with a pH of between 6.3 and 6.5 and a water activity of between 0.94 and 0.96. No microbiological results exceeded the Ontario limits for post-production contamination levels of Staphylococcus aureus, Escherichia coli, and coliforms. It was concluded the heat used during the baking process likely kills any pathogens present and creates a surface too dry to support microbial growth. Therefore, custard tarts may not inherently pose the same risk as non-contained custard desserts.
23
Carter, M., T. Karwalajtys, L. Chambers, J. Kaczorowski, L. Dolovich, T. Gierman, D. Cross, and S. Laryea. "Implementing a standardized community-based cardiovascular risk assessment program in 20 Ontario communities." Health Promotion International 24, no. 4 (October 9, 2009): 325–33. http://dx.doi.org/10.1093/heapro/dap030.
Full text
24
Noble, Amanda, Benjamin Owens, Naomi Thulien, and Amanda Suleiman. "“I feel like I’m in a revolving door, and COVID has made it spin a lot faster”: The impact of the COVID-19 pandemic on youth experiencing homelessness in Toronto, Canada." PLOS ONE 17, no. 8 (August 22, 2022): e0273502. http://dx.doi.org/10.1371/journal.pone.0273502.
Full textAbstract:
Purpose Research has shown that youth experiencing homelessness (YEH) face barriers to social inclusion and are at risk for poor mental health. With the COVID-19 pandemic threatening the health, wellbeing, and economic circumstances of people around the world, this study aims to assess the impacts of the pandemic on YEH in Toronto, Ontario, as well as to identify recommendations for future waves of COVID-19. Methods Semi-structured interviews were conducted with YEH (ages 16–24, n = 45) and staff who work in one of four downtown emergency shelters for youth (n = 31) in Toronto, Ontario. Results YEH experienced both structural changes and psychosocial impacts resulting from the pandemic. Structural changes included a reduction in services, barriers to employment and housing, and changes to routines. Psychosocial outcomes included isolation, worsened mental health, and increased substance use. Impacts were magnified and distinct for subpopulations of youth, including for youth that identified as Black, 2SLGBTQ+, or those new to Canada. Conclusions The COVID-19 pandemic increased distress among YEH while also limiting access to services. There is therefore a need to balance health and safety with continued access to in-person services, and to shift the response to youth homelessness to focus on prevention, housing, and equitable supports for subpopulations of youth.
25
Pamidimukkala, Anupya, Fei Dong, Jessica Ip, and Pamela Zeng. "Diving into Debt: A Study on Factors Related to Debt Risk Score in Toronto." STEM Fellowship Journal 2, no. 1 (July 1, 2016): 22–27. http://dx.doi.org/10.17975/sfj-2016-005.
Full textAbstract:
This study aimed to find the correlations between data found regarding debt risk and the 140 neighbourhoods in Toronto, Ontario. Debt risk was compared with select variables from available data, including education, health, environment, housing, economics, demographics, transportation, recreation, and safety. The purpose of this study was to help civilians and the government identify possible factors that lead to higher debt risk, as well as find solutions to reduce it. The data was retrieved from Open Data Toronto. A simple linear regression model was built to determine the factors that have a seemingly great correlation with debt risk. It was concluded that the percentage of people who receive social assistance, the percentage of people who applied for rent banks, and the number of reported sexual assaults in a neighbourhood had a positive correlation with increased debt risk. The result is that an age-adjusted rate of people who received breast cancer screening had a negative correlation with increased debt risk. Through the results, several solutions could be proposed to reduce debt risk. More education on safety and health can enable citizens to become more responsible and aware of their financial state. Giving other forms of aid that are not monetary may be beneficial in helping people get out of debt and become more financially independent.
26
Rotenberg, Martin, Andrew Tuck, Kelly Anderson, and Kwame McKenzie. "S131. NEIGHBOURHOOD-LEVEL SOCIAL CAPITAL, MARGINALIZATION, AND THE INCIDENCE OF PSYCHOTIC DISORDERS IN TORONTO, CANADA: A RETROSPECTIVE POPULATION-BASED COHORT STUDY." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S85. http://dx.doi.org/10.1093/schbul/sbaa031.197.
Full textAbstract:
Abstract Background Previous studies have shown mixed results regarding the relationship between social capital and the risk of developing a psychotic disorder, and this has yet to be studied in North America. This study aims to examine the relationship between neighbourhood-level social capital, marginalization, and the incidence of psychotic disorders in Toronto, Canada. Methods A retrospective cohort of people aged 14 to 40 years residing in Toronto, Canada in 1999 (followed to 2008) was constructed from population-based health administrative data. Incident cases of schizophrenia spectrum psychotic disorders were identified using a validated algorithm. Voter participation rates in a municipal election were used as a proxy neighbourhood-level indicator of social capital. Exposure to neighbourhood-level marginalization was obtained from the Ontario Marginalization Index. Poisson regression models adjusting for age and sex were used to calculate incidence rate ratios (IRR) for each social capital quintiles and marginalization quintile. Results In the study cohort (n = 640,000) over the 10-year follow-up period, we identified 4,841 incident cases of schizophrenia spectrum psychotic disorders. We observed elevated rates of psychotic disorders in areas with the highest levels (IRR = 1.13, 95% CI 1.00–1.27) and moderate levels (IRR = 1.23, 95% CI 1.12–1.36) of social capital, when compared to areas with the lowest levels of social capital, after adjusting for neighbourhood-level indicators of marginalization. The risk associated with social capital was not present when analyzed in only the females in the cohort. All neighbourhood marginalization indicators, other than ethnic concentration, were significantly associated with risk. Discussion The risk of developing a psychotic disorder in Toronto, Canada is associated with socioenvironmental exposures. Social capital is associated with risk, however, the impact of social capital on risk differs by sex and social capital quintile. Across the entire cohort, exposure to all neighbourhood-level marginalization indicators, except ethnic concentration, impacts risk. Future research should examine how known individual-level risk factors, including immigration, ethnicity, and family history of a mental disorder may interact with these findings.
27
Harish, Vinyas, Emmalin Buajitti, Holly Burrows, Joshua Posen, Isaac Bogoch, Jonathan Gubbay, Andrea Boggild, Andrea Boggild, Laura Rosella, and Shaun Morris. "737. Geographic Clustering of Travel-acquired Infections in Ontario, Canada, 2008-2020." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S466—S467. http://dx.doi.org/10.1093/ofid/ofab466.934.
Full textAbstract:
Abstract Background As rates of international travel increase, more individuals are at risk of travel-acquired infections (TAIs). We aimed to review all microbiologically confirmed cases of malaria, dengue, chikungunya, and enteric fever (Salmonella enterica serovar Typhi/Paratyphi) in Ontario, Canada between 2008-2020 to identify high-resolution geographical clusters that could be targeted for pre-travel prevention. Methods Retrospective cohort study of over 174,000 unique tests for the four above TAIs from Public Health Ontario Laboratories. Test-level data were processed to calculate annual case counts and crude population-standardized incidence ratios (SIRs) at the forward sortation area (FSA) level. Moran’s I statistic was used to test for global spatial autocorrelation. Smoothed SIRs and 95% posterior credible intervals (CIs) were estimated using a spatial Bayesian hierarchical model, which accounts for statistical instability and uncertainty in small-area incidence. Posterior CIs were used to identify high- and low-risk areas, which were described using sociodemographic data from the 2016 Census. Finally, a second model was used to estimate the association between drivetime to the nearest travel clinic and risk of TAI within high-risk areas. Results There were 5962 cases of the four TAIs across Ontario over the study period. Smoothed FSA-level SIRs are shown in Figure 1a, with an inset for the Greater Toronto Area (GTA) in 1b. There was spatial clustering of TAIs (Moran’s I=0.61, p< 2.2e-16). Identified high- and low-risk areas are shown in panels c and d. Compared to low-risk areas, high-risk areas were significantly more likely to have higher proportions of immigrants (p< 0.0001), lower household after-tax income (p=0.04), more university education (p< 0.0001), and were less knowledgeable of English/French (p< 0.0001). In the high-risk GTA, each minute increase in drivetime to the closest travel clinic was associated with a 4% reduction in TAI risk (95% CI 2 - 6%). Bayesian hierarchical model (BHM) smoothed standardized incidence ratios (SIRs) for travel-acquired infections (TAIs) and estimated risk levels (a and c) with insets for the Greater Toronto Area (b and d). High-risk areas are defined as those with smoothed SIR 95% CIs greater than 2, and low-risk areas with smoothed SIR 95% CIs less than 0.25. Conclusion Urban neighbourhoods in the GTA had elevated risks of becoming ill with TAIs. However, geographic proximity to a travel clinic was not associated with an area-level risk reduction in TAI, suggesting other barriers to seeking and adhering to pre-travel advice. Disclosures Isaac Bogoch, MD, MSc, BlueDot (Consultant)National Hockey League Players' Association (Consultant) Andrea Boggild, MSc MD DTMH FRCPC, Nothing to disclose Shaun Morris, MD, MPH, DTM&H, FRCPC, FAAP, GSK (Speaker's Bureau)Pfizer (Advisor or Review Panel member)Pfizer (Grant/Research Support)
28
Chiarelli, A. M., V. Mai, V. Moravan, E. Halapy, V. Majpruz, and R. K. Tatla. "False-Positive Result and Reattendance in the Ontario Breast Screening Program." Journal of Medical Screening 10, no. 3 (September 2003): 129–33. http://dx.doi.org/10.1177/096914130301000306.
Full textAbstract:
Objective: To determine the association between initial screen result and returning for a second screen in an organised breast screening programme for women with a biennial screening recommendation. Setting: Women who attended the Ontario Breast Screening Program (OBSP). Methods: A retrospective cohort study was conducted of 140,723 Ontario women aged 50 years ond older who had an initial screen at the OBSP between 1 July 1990 and 31 December 1995 and were followed until 30 June 1998. Rescreening rates at 36 months and risk ratio estimates were calculated using survival methods. Age of women, year of screen, region (within Ontario) and initial screen result were compared. For initial screen results, returning for a second screen was examined by integration of screening centre with an assessment programme and by modality of referral. Results: Women with a false-positive result were less likely to return for a second screen as were women aged 70 and older and those living in regions of Ontario with fewer OBSP screening centres. However, there were minimal differences in reattendance behaviour by initial screen result for women screened at the OBSP centre with an assessment programme. Conclusions: Integration of breast screening and assessment services improved reattendance of women with false-positive screen results within an organised screening programme.
29
Aderibigbe, Oluwakemi Olanike, Shannon L. Stewart, John P. Hirdes, and Christopher Perlman. "Substance Use among Youth in Community and Residential Mental Health Care Facilities in Ontario, Canada." International Journal of Environmental Research and Public Health 19, no. 3 (February 2, 2022): 1731. http://dx.doi.org/10.3390/ijerph19031731.
Full textAbstract:
There is a need to improve the integration of substance use and mental health care for children and youth. This study examines risk and protective factors for substance use among youth with mental health conditions who received community-based or residential care services between 2012–2020 in Ontario, Canada. In this study, a cross-sectional design was used to examine patterns and factors associated with substance use among youth (12–18 years) assessed in the community (n = 47,418) and residential (n = 700) mental health care facilities in Ontario, Canada. Youth were assessed with the interRAI Child and Youth Mental Health Assessment (ChYMH). Substance use is identified by any substance use (including alcohol) 14 to 30 days prior to assessment. Logistic regression with generalized estimating equations was used to examine clinical, psychosocial, and environmental factors associated with substance use. This study shows that 22.3% of youth reported the use of substances in the community settings and 37% in residential settings. Older age group (Youth older than 16 years), being a victim of abuse, having experienced self-injurious ideation/attempt, being at risk of disrupted education, and having a parent/caregiver with addiction or substance use disorder were significantly associated with substance use. Several factors reduced the risk of substance use, including being a female, having anxiety symptoms, and having cognition problems. In conclusion, the study found that individual and parental factors increase youth’s risk of substance use, highlighting the importance of a holistic approach that includes consideration of social and biological risk factors to prevention/risk reduction, risk assessment, management, and recovery.
30
Ollson, Christopher A., Loren D. Knopper, Melissa L. Whitfield Aslund, and Ruwan Jayasinghe. "Site specific risk assessment of an energy-from-waste thermal treatment facility in Durham Region, Ontario, Canada. Part A: Human health risk assessment." Science of The Total Environment 466-467 (January 2014): 345–56. http://dx.doi.org/10.1016/j.scitotenv.2013.07.019.
Full text
31
Samokhvalov, Andriy V., Peter Selby, Susan J. Bondy, Michael Chaiton, Anca Ialomiteanu, Robert Mann, and Jürgen Rehm. "Smokers who seek help in specialized cessation clinics: How special are they compared to smokers in general population?" Journal of Smoking Cessation 9, no. 2 (August 22, 2013): 76–84. http://dx.doi.org/10.1017/jsc.2013.23.
Full textAbstract:
Introduction: Patients of specialized nicotine dependence clinics are hypothesized to form a distinct subpopulation of smokers due to the features associated with treatment seeking. The aim of the study was to describe this subpopulation of smokers and compare it to smokers in general population.Material and methods: A chart review of 796 outpatients attending a specialized nicotine dependence clinic, located in Toronto, Ontario, Canada was performed. Client smoking patterns and sociodemographic characteristics were compared to smokers in the general population using two Ontario surveys – the Ontario Tobacco Survey (n = 898) and the Centre for Addiction and Mental Health Monitor (n = 457).Results: Smokers who seek treatment tend to smoke more and be more heavily addicted. They were older, had longer history of smoking and greater number of unsuccessful quit attempts, both assisted and unassisted. They reported lower education and income, had less social support and were likely to live with other smokers.Conclusions: Smokers who seek treatment in specialized centers differ from the smokers in general population on several important characteristics. These same characteristics are associated with lower chances for successful smoking cessation and sustained abstinence and should be taken into consideration during clinical assessment and treatment planning.
32
Paszat, Lawrence, Brian O'Sullivan, Robert Bell, Vivien Bramwell, Patti Groome, William Mackillop, Emma Bartfay, and Eric Holowaty. "Processes and Outcomes of Care for Soft Tissue Sarcoma of the Extremities." Sarcoma 6, no. 1 (2002): 19–26. http://dx.doi.org/10.1080/13577140220127521.
Full textAbstract:
Purpose:A population-based cohort study of soft tissue sarcoma of the extremities (STSE) in Ontario, Canada was conducted using linked administrative databases.Methods and materials:Electronic administrative databases were linked from the Ontario Cancer Registry, the Canadian Institute for Health Information, and Radiation Oncology Research Unit database of radiation therapy (RT) records.Results:The definitive surgery was amputation for 6.0%, resection for 60.9%, biopsy for 7.5%; the remainder had no surgical record. Adjuvant RT was administered to 40.2% of cases. Among cases initially treated by surgical resection, 2.0% later underwent amputation and 9.5% underwent further resection during follow-up. The adjusted odds ratio (OR) for amputation as definitive surgery was 2.3 (1.19, 4.45) in eastern Ontario relative to Toronto. The likelihood of adjuvant RT among those not registered at a cancer centre within 3 months of diagnosis was decreased (OR = 0.20 (95% CI (0.13, 0.30)) relative to those registered. The adjusted relative risk of amputation at any time following diagnosis was 3.48 (95% CI (1.63, 7.46)) among cases not attending a cancer centre. The adjusted relative risk of death was 1.4; 95% CI (1.1, 1.7) among those not attending a cancer centre.Conclusions:Cases not seen at a multidisciplinary cancer centre within 3 months following diagnosis of STSE have an increased relative risk for amputation at any time, and for death due to any cause. Many hypotheses for further study are suggested by the results of this analysis.
33
Dubelt-Moroz, Alexandra, Marika Warner, Bryan Heal, Saman Khalesi, Jessica Wegener, Julia O. Totosy de Zepetnek, Jennifer J. Lee, et al. "Food Insecurity, Dietary Intakes, and Eating Behaviors in a Convenience Sample of Toronto Youth." Children 9, no. 8 (July 27, 2022): 1119. http://dx.doi.org/10.3390/children9081119.
Full textAbstract:
Background: Food insecurity has been shown to be associated with poor dietary quality and eating behaviors, which can have both short- and long-term adverse health outcomes in children. The objective was to investigate the food security status, dietary intakes, and eating behaviors in a convenience sample of youth participating in the Maple Leaf Sports Entertainment LaunchPad programming in downtown Toronto, Ontario. Methods: Youth aged 9–18 years were recruited to participate in the study. Food security status, dietary intakes, and eating behaviors were collected using parent- or self-reported questionnaires online. Results: Sixty-six youth (mean ± SD: 11.7 ± 1.9 years) participated in the study. The prevalence of household food insecurity was higher than the national average (27.7% vs. 16.2%). Dietary intake patterns were similar to the national trends with low intakes of fiber, inadequate intakes of calcium and vitamin D; and excess intakes of sodium, added sugar, and saturated fat. Despite a low prevalence of poor eating habits, distracted eating was the most frequently reported poor eating habit. Conclusions: Although youth were at high risk for experiencing household food insecurity, inadequate dietary intake patterns were similar to the national trends. Our findings can be used to develop future programming to facilitate healthy dietary behaviors appropriate for the target community.
34
Herdt, Alexandria, Robert Brown, Ian Scott-Fleming, Guofeng Cao, Melissa MacDonald, Dave Henderson, and Jennifer Vanos. "Outdoor Thermal Comfort during Anomalous Heat at the 2015 Pan American Games in Toronto, Canada." Atmosphere 9, no. 8 (August 18, 2018): 321. http://dx.doi.org/10.3390/atmos9080321.
Full textAbstract:
Mass sporting events in the summertime are influenced by underlying weather patterns, with high temperatures posing a risk for spectators and athletes alike. To better understand weather variations in the Greater Toronto Area (GTA) during the Pan American Games in 2015 (PA15 Games), Environment and Climate Change Canada deployed a mesoscale monitoring network system of 53 weather stations. Spatial maps across the GTA demonstrate large variations by heat metric (e.g., maximum temperature, humidex, and wet bulb globe temperature), identifying Hamilton, Ontario as an area of elevated heat and humidity, and hence risk for heat-related illness. A case study of the Hamilton Soccer Center examined on-site thermal comfort during a heat event and PA15 Soccer Games, demonstrating that athletes and spectators were faced with thermal discomfort and a heightened risk of heat-related illness. Results are corroborated by First Aid and emergency response data during the events, as well as insight from personal experiences and Twitter feed. Integrating these results provides new information on potential benefits to society from utilizing mesonet systems during large-scale sporting events. Results further improve our understanding of intra-urban heat variability and heat-health burden. The benefits of utilizing more comprehensive modeling approaches for human heat stress that coincide with fine-scale weather information are discussed.
35
Verma, Rahul, Yasna Mehdian, Neel Sheth, Kathy Netten, Jean Vinette, Ashley Edwards, Joanna Polyviou, Julia Orkin, and Reshma Amin. "Screening for caregiver psychosocial risk in children with medical complexity: a cross-sectional study." BMJ Paediatrics Open 4, no. 1 (July 2020): e000671. http://dx.doi.org/10.1136/bmjpo-2020-000671.
Full textAbstract:
ObjectiveTo quantify psychosocial risk in family caregivers of children with medical complexity using the Psychosocial Assessment Tool (PAT) and to investigate potential contributing sociodemographic factors.DesignCross-sectional study.SettingFamily caregivers completed questionnaires during long-term ventilation and complex care clinic visits at The Hospital for Sick Children, Toronto, Ontario, Canada.PatientsA total of 136 family caregivers of children with medical complexity completed the PAT questionnaires from 30 June 2017 through 23 August 2017.Main outcome measuresMean PAT scores in family caregivers of children with medical complexity. Caregivers were stratified as ‘Universal’ low risk, ‘Targeted’ intermediate risk or ‘Clinical’ high risk. The effect of sociodemographic variables on overall PAT scores was also examined using multiple linear regression analysis. Comparisons with previous paediatric studies were made using T-test statistics.Results136 (103 females (76%)) family caregivers completed the study. Mean PAT score was 1.17 (SD=0.74), indicative of ‘Targeted’ intermediate risk. Sixty-one (45%) caregivers were classified as Universal risk, 60 (44%) as Targeted risk and 15 (11%) as Clinical risk. Multiple linear regression analysis revealed an overall significant model (p=0.04); however, no particular sociodemographic factor was a significant predictor of total PAT scores.ConclusionFamily caregivers of children with medical complexity report PAT scores among the highest of all previously studied paediatric populations. These caregivers experience significant psychosocial risk, demonstrated by larger proportions of caregivers in the highest-risk Clinical category.
36
Bruer, Robert A., Marissa Rodway-Norman, and Matthew Large. "Closer to the Truth: Admission to Multiple Psychiatric Facilities and an Inaccurate History of Hospitalization Are Strongly Associated with Inpatient Suicide." Canadian Journal of Psychiatry 63, no. 11 (April 23, 2018): 748–56. http://dx.doi.org/10.1177/0706743718772519.
Full textAbstract:
Objective: To investigate clinical associations within Canadian psychiatric inpatient suicides. Method: We conducted a case-control study comparing 98 patients who died by suicide while in hospital and 196 similarly admitted living inpatient controls. All were admitted to an Ontario psychiatric bed between 2008 and 2015 inclusive and had data collected at admission using the Resident Assessment Instrument for Mental Health (RAI-MH). The data were analyzed with bivariate tests and logistic regression modeling. Results: The strongest associations with inpatient suicide were prior admission to any Ontario psychiatric bed within the previous 30 days (odds ratio [OR] = 6.13), self-harm assessed at prior admission to a psychiatric hospital other than the hospital of suicide (OR = 6.07), and prior admission to a psychiatric hospital other than the hospital of suicide in the previous year (OR = 5.38). A multivariate model using risk factors assessed at admission had an area under the curve (AUC) of 0.77. The model improved to (AUC) 0.81 using a retrospective search of all Ontario admissions to more accurately detect prior admissions. The risk model was optimized to (AUC) 0.83 when the model also included a “discrepancy” variable to denote records in which admission assessment data and retrospective search data did not agree regarding past month admissions. Conclusions: In addition to the well-known risks of suicide associated with previous suicide attempts and depressive conditions, our data suggest a particular risk of inpatient suicide associated with inpatient care in more than one hospital, particularly when the treating clinicians were unaware of recent previous admissions.
37
Gerth, Juliane, Astrid Rossegger, Elisabeth Bauch, and Jérôme Endrass. "Assessing the Discrimination and Calibration of the Ontario Domestic Assault Risk Assessment in Switzerland." Partner Abuse 8, no. 2 (2017): 168–89. http://dx.doi.org/10.1891/1946-6560.8.2.168.
Full textAbstract:
Intimate partner violence (IPV) is a major public health issue; worldwide, almost 1 in 3 women is affected. Police involvement in IPV cases has substantially increased because of “proarrest” and “procharging” policies and the enforcement of laws protecting victims of domestic violence. In the course of these changes, several front-line instruments have been developed to structure police risk assessment and decision-making strategies in such cases. One of those is the Ontario Domestic Assault Risk Assessment (ODARA). To investigate its validity in a Swiss police setting, a total cohort of male IPV offenders was retrospectively assessed for a fixed time at risk of 5 years. The recidivism base rate was 32% when recidivism was defined as subsequent police-registered IPV. Although ODARA scores were significantly correlated with IPV recidivism, they showed poor discrimination and calibration. Despite comparable base rates of recidivism, the Zurich sample scored significantly higher on the ODARA than the development sample. This mismatch of the expected and observed recidivism rates resulted in an overestimating of risk, especially in the two highest risk bins. Several reasons for those deviations, such as level of intervention, victim’s reporting behavior, and the dynamic nature of IPV, are discussed.
38
de Montbrun, Sandra, Marisa Louridas, and Teodor Grantcharov. "Passing a Technical Skills Examination in the First Year of Surgical Residency Can Predict Future Performance." Journal of Graduate Medical Education 9, no. 3 (June 1, 2017): 324–29. http://dx.doi.org/10.4300/jgme-d-16-00517.1.
Full textAbstract:
ABSTRACT Background The ability of an assessment to predict performance would be of major benefit to residency programs, allowing for early identification of residents at risk. Objective We sought to establish whether passing the Objective Structured Assessment of Technical Skills (OSATS) examination in postgraduate year 1 (PGY-1) predicts future performance. Methods Between 2002 and 2012, 133 PGY-1 surgery residents at the University of Toronto (Toronto, Ontario, Canada) completed an 8-station, simulated OSATS examination as a component of training. With recently set passing scores, residents were assigned a pass/fail status using 3 standards setting methods (contrasting groups, borderline group, and borderline regression). Future in-training performance was compared between residents who had passed and those who failed the OSATS, using in-training evaluation reports from resident files. A Mann-Whitney U test compared performance among groups at PGY-2 and PGY-4 levels. Results Residents who passed the OSATS examination outperformed those who failed, when compared during PGY-2 across all 3 standard setting methodologies (P < .05). During PGY-4, only the contrasting groups method showed a significant difference (P < .05). Conclusions We found that PGY-1 surgical resident pass/fail status on a technical skills examination was associated with future performance on in-training evaluation reports in later years. This provides validity evidence for the current PGY-1 pass/fail score, and suggests that this technical skills examination may be used to predict performance and to identify residents who require remediation.
39
Enzenauer, Robert W., Alex V. Levin, James E. Elder, J. Donald Morin, and Stan Calderwood. "Screening for Fungal Endophthalmitis in Children at Risk." Pediatrics 90, no. 3 (September 1, 1992): 451–57. http://dx.doi.org/10.1542/peds.90.3.451.
Full textAbstract:
To evaluate the efficacy of screening ophthalmologic examinations in high-risk children, we reviewed the medical records for all patients hospitalized from 1985 through 1989 at The Hospital for Sick Children, Toronto, Ontario, who underwent ophthalmological consultation to rule out endogenous fungal endophthalmitis (n = 176). The patients were divided into groups: Group 1 (n = 47), those with deep-tissue fungal infection, and Group 2 (n = 129), those at risk for invasive fungal disease. Group 2 was subdivided further into two subgroups: Group 2a (n = 48), those with evidence of superficial fungal colonization (positive fungal culture) but no deep-tissue involvement, and Group 2b (n = 81), those with no evidence of fungal colonization (negative fungal culture). Of these 176 patients, 7 were diagnosed with endogenous fungal endophthalmitis: 6 from Group 1, 1 from Group 2a, and 0 from Group 2b. We found a significant association between the development of endogenous fungal endophthalmitis and the status of the fungal culture result (P < .005). The odds ratio indicated the risk of endogenous fungal endophthalmitis in Group 1 patients with deep-tissue infection was at least 19 times that of Group 2 at-risk patients. The risk of endogenous fungal endophthalmitis in Group 1 patients was at least 7 times that of Group 2a colonized patients and 12 times that of Group 2b patients with no positive fungal culture. Our study confirms the necessity of careful dilated ophthalmoscopic examination in patients with invasive fungal disease and suggests screening for those at-risk patients with superficial fungal colonization. Our results, however, do not document the value of routine ophthalmoscopic consultation in at-risk children without evidence of any fungal colonization.
40
Go, Stephanie Lynn, Cindy Tze-Yung Lam, Yahui Tammy Lin, Deborah Joanne Wong, Alejandro Lazo-Langner, and Ian H. Chin-Yee. "The Attitude of Canadian University Students towards a Behaviour-Based Blood Donor Health Assessment Questionnaire." Blood 116, no. 21 (November 19, 2010): 3342. http://dx.doi.org/10.1182/blood.v116.21.3342.3342.
Full textAbstract:
Abstract Abstract 3342 Background: As part of Canadian Blood Services policy (CBS), men who have sex with men (MSM) are indefinitely deferred from donating blood due to an increased risk for HIV infection. This policy has generated controversy, especially amongst student populations, due its perceived discrimination against homosexual men. Objectives: 1) To determine the acceptability of a behaviour-based donor health questionnaire amongst Canadian university students and assess its suitability as an alternative to the current MSM policy. 2) To determine the perception of blood safety associated with specific risk behaviours. Methods: We conducted a survey amongst students at the University of Western Ontario in London, Ontario, Canada. A questionnaire was designed that included questions found on the current CBS donor health survey, and behaviour-based questions derived from studies assessing high risk factors for HIV. For each question, participants were asked to rate its acceptability and its perceived effect on blood safety using 7-point Likert scales. They were also asked whether the question would deter them from future donations. Data was analyzed using non-parametric tests. Results: 741/3500 (21.2%) students participated in the study. Students rated both current and behavioural questions as equally acceptable and the majority (89-97%) would not be deterred from donating blood in the future by any question. The response scores for both sets of questions were significantly correlated. Questions on donor's sexual practices were rated less acceptable compared to those on high risk behaviours. Sexually transmitted infections, injection drug use and sex for money were considered high risk behaviours for blood safety (69-95% unsafe). In contrast, sexual practices (MSM, anal intercourse, condom use, knowledge of partner's sexual background) were rated less important for blood safety (30 to 62% unsafe). We found an inverse correlation between the perception of safety and the acceptability of questions (Table). 24.4% of students rated both questions on MSM status and a behaviour-based alternative as equally unacceptable. Discussion: A behaviour-based screening modification is unlikely to change opinions or satisfy those who object the current MSM policy. Acceptability of these questions might be related to a poor understanding of the effect of sexual practices on blood supply safety. Disclosures: No relevant conflicts of interest to declare.
41
Mustamsir, Edi, Istan Irmansyah Irsan, Thomas E. C. J. Huwae, Andhika Yudistira, Ananto Satya Pradana, Muhammad Alwy Sugiarto, Lasa Dhakka Siahaan, and Rahmad. "Study epidemiology of risk fracture in osteoporosis based on frax score, and osta score, with risk of fall using Ontario score in elderly Indonesia." Journal of Public Health Research 11, no. 3 (July 2022): 227990362211157. http://dx.doi.org/10.1177/22799036221115777.
Full textAbstract:
Background: Osteoporosis is characterized by a low bone mass of bone tissue. If osteoporosis is not treated properly, it will increase the high risk of fracture. The common causes of fracture on osteoporosis condition due to falls. This study aims to find the correlation between the risk of osteoporosis with fall risk (ONTARIO) based on osteoporosis fracture risk (FRAX) Methods: This study is an analytic study with a cross-sectional method. We collected the sample using random cluster sampling in the six primary health care in Malang on different times service since August–September 2021. Total patient 139, however only 132 patients were included in this study. After collecting data is complete, we analyze using Chi-square tests. Results: The mean age of participants was 63.9 ± 7.14. with the age group was dominated by the range of 60–64. It was found that the result of the FRAX SCORE had a low-risk category for major fracture osteoporosis and risk hip fracture. In contrast, from the OSTA score in this study, more than 68 participants (50.8%) were found medium and high-risk scores. Then, in ONTARIO score of the risk fall assessment, and high score in 57 participants (43.2%). If compared between OSTA and ONTARIO, there was a significant relationship between OSTA score and ONTARIO score ( p < 0.000) with high-risk OSTA have a significant relationship with a high risk of falling and vice versa. Conclusion: In this study, there was a relationship between the risk of high osteoporosis and the risk of falling.
42
Cusimano, Maria C., Nancy N. Baxter, Rinku Sutradhar, Joel G. Ray, Amit X. Garg, Eric McArthur, Simone Vigod, and Andrea N. Simpson. "Reproductive patterns, pregnancy outcomes and parental leave practices of women physicians in Ontario, Canada: the Dr Mom Cohort Study protocol." BMJ Open 10, no. 10 (October 2020): e041281. http://dx.doi.org/10.1136/bmjopen-2020-041281.
Full textAbstract:
IntroductionSurveys and qualitative studies suggest that women physicians may delay childbearing, be at increased risk of adverse peripartum complications when they do become pregnant, and face discrimination and lower earnings as a result of parenthood. Observational studies enrolling large, representative samples of women physicians are needed to accurately evaluate their reproductive patterns, pregnancy outcomes, parental leave practices and earnings. This protocol provides a detailed research plan for such studies.Methods and analysisThe Dr Mom Cohort Study encompasses a series of retrospective observational studies of women physicians in Ontario, Canada. All practising physicians in Ontario are registered with the College of Physicians and Surgeons of Ontario (CPSO). By linking a dataset of physicians from the CPSO to existing provincial administrative databases, which hold health data and physician billing records, we will be able to retrospectively assess the healthcare utilisation, work practices and pregnancy outcomes of women physicians at the population level. Specific outcomes of interest include: (1) rates and timing of pregnancy; (2) pregnancy-related care and complications; and (3) duration of parental leave and subsequent earnings, each of which will be evaluated with regression methods appropriate to the form of the outcome. We estimate that, at minimum, 5000 women physicians will be eligible for inclusion.Ethics and disseminationThis protocol has been approved by the Research Ethics Board at St. Michael’s Hospital in Toronto, Ontario, Canada (#18–248). We will disseminate findings through several peer-reviewed publications, presentations at national and international meetings, and engagement of physicians, residency programmes, department heads and medical societies.
43
Tremoulet, Patrice, Katie Clark, Michael McManus, and Dimitar Baronov. "IVCO2 Training Effectiveness Study." Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care 9, no. 1 (September 2020): 45–49. http://dx.doi.org/10.1177/2327857920091055.
Full textAbstract:
Etiometry’s Lead Clinical Specialist and a Human Factors Psychology Professor conducted a study to assess the effectiveness of training on how to use a new risk index, IVCO2, at The Hospital for Sick Children in Toronto, Ontario. Ten clinicians were each separately trained by the Lead Clinical Specialist and afterward the Human Factors Professor administered a ten question assessment. Immediately following the assessment, the professor interviewed each clinician, to obtain feedback about T3 which may be used to inform future enhancements user interface design changes, and/or training changes. Assessment results indicate that a majority of clinical users who are trained using existing materials will be able to interpret and use T3’s new IVCO2 Index safely and effectively. However, 30% of the study participants answered at least one assessment question wrong. This suggests that IVCO2 training should be enhanced. Meanwhile, interview data revealed that all study participants believe that Etiometry’s software provides users with relevant, clinically useful information and capabilities. However, the study’s results also suggest that users must climb a steep learning curve before they can use it effectively. It may helpful to train novice users in phases, so that they have multiple opportunities to learn about some of the features that they may not use immediately could find helpful as they start to use Etiometry’s software more.
44
Langer, Laura Kathleen, Seyed Mohammad Alavinia, David Wyndham Lawrence, Sarah Elizabeth Patricia Munce, Alice Kam, Alan Tam, Lesley Ruttan, Paul Comper, and Mark Theodore Bayley. "Prediction of risk of prolonged post-concussion symptoms: Derivation and validation of the TRICORDRR (Toronto Rehabilitation Institute Concussion Outcome Determination and Rehab Recommendations) score." PLOS Medicine 18, no. 7 (July 8, 2021): e1003652. http://dx.doi.org/10.1371/journal.pmed.1003652.
Full textAbstract:
Background Approximately 10% to 20% of people with concussion experience prolonged post-concussion symptoms (PPCS). There is limited information identifying risk factors for PPCS in adult populations. This study aimed to derive a risk score for PPCS by determining which demographic factors, premorbid health conditions, and healthcare utilization patterns are associated with need for prolonged concussion care among a large cohort of adults with concussion. Methods and findings Data from a cohort study (Ontario Concussion Cohort study, 2008 to 2016; n = 1,330,336) including all adults with a concussion diagnosis by either primary care physician (ICD-9 code 850) or in emergency department (ICD-10 code S06) and 2 years of healthcare tracking postinjury (2008 to 2014, n = 587,057) were used in a retrospective analysis. Approximately 42.4% of the cohort was female, and adults between 18 and 30 years was the largest age group (31.0%). PPCS was defined as 2 or more specialist visits for concussion-related symptoms more than 6 months after injury index date. Approximately 13% (73,122) of the cohort had PPCS. Total cohort was divided into Derivation (2009 to 2013, n = 417,335) and Validation cohorts (2009 and 2014, n = 169,722) based upon injury index year. Variables selected a priori such as psychiatric disorders, migraines, sleep disorders, demographic factors, and pre-injury healthcare patterns were entered into multivariable logistic regression and CART modeling in the Derivation Cohort to calculate PPCS estimates and forward selection logistic regression model in the Validation Cohort. Variables with the highest probability of PPCS derived in the Derivation Cohort were: Age >61 years (p^ = 0.54), bipolar disorder (p^ = 0.52), high pre-injury primary care visits per year (p^ = 0.46), personality disorders (p^ = 0.45), and anxiety and depression (p^ = 0.33). The area under the curve (AUC) was 0.79 for the derivation model, 0.79 for bootstrap internal validation of the Derivation Cohort, and 0.64 for the Validation model. A limitation of this study was ability to track healthcare usage only to healthcare providers that submit to Ontario Health Insurance Plan (OHIP); thus, some patients seeking treatment for prolonged symptoms may not be captured in this analysis. Conclusions In this study, we observed that premorbid psychiatric conditions, pre-injury health system usage, and older age were associated with increased risk of a prolonged recovery from concussion. This risk score allows clinicians to calculate an individual’s risk of requiring treatment more than 6 months post-concussion.
45
Zhao, Peibo, and Chris Lee. "Analysis and Validation of Surrogate Safety Measures by Types of Lead and Following Vehicles." Transportation Research Record: Journal of the Transportation Research Board 2659, no. 1 (January 2017): 137–47. http://dx.doi.org/10.3141/2659-15.
Full textAbstract:
This study analyzed rear-end collision risk in a mixed traffic flow of cars and heavy vehicles on a freeway using two surrogate safety measures: time to collision (TTC) and postencroachment time (PET). The study estimated surrogate safety measures for types of lead and following vehicles (car or heavy vehicle) by using the individual vehicle trajectory data. The vehicle trajectory data were collected from a segment of the US-101 freeway in Los Angeles, California. It was found that the distributions of TTC and PET were significantly different between types of lead and following vehicles. Also, the mean values of TTC and PET were higher for heavy vehicles following cars than for cars following cars and for cars following heavy vehicles. The study also validated TTC by using the simulated traffic data for a few minutes before the time of crashes that occurred on a section of the Gardiner Expressway in Toronto, Ontario, Canada. It was found that TTC reflects higher collision risk in the time intervals closer to the crash time and it reflects higher collision risk for the crash case than for the noncrash case. The findings suggest that the difference in rear-end collision risk between types of vehicle pairs should be considered in safety assessment of mixed traffic flow of cars and heavy vehicles.
46
Brown, Elizabeth M., David N. Fisman, Steven J. Drews, Sharon Dolman, Prasad Rawte, Shirley Brown, and Frances Jamieson. "Epidemiology of Invasive Meningococcal Disease with Decreased Susceptibility to Penicillin in Ontario, Canada, 2000 to 2006." Antimicrobial Agents and Chemotherapy 54, no. 3 (January 19, 2010): 1016–21. http://dx.doi.org/10.1128/aac.01077-09.
Full textAbstract:
ABSTRACT Neisseria meningitidis has been relatively slow to acquire resistance to penicillin. We previously reported an increase in the incidence of invasive meningococcal disease (IMD) strains with decreased susceptibility to penicillin (DSP) in Ontario. Our objectives were to evaluate trends in IMD with DSP, to identify case-level predictors of IMD with DSP, and to evaluate the relationship among DSP, bacterial phenotype, and the likelihood of a fatal outcome. All IMD isolates received in Ontario between 2000 and 2006 were submitted to the Public Health Laboratories, Toronto, for confirmation of the species, serogroup determination, and susceptibility testing. Isolates were considered to be IMD strains with DSP if the penicillin MIC was ≥0.125 μg/ml. Temporal trends were evaluated using multivariable Poisson regression models. Correlates of diminished susceptibility and fatal outcome were evaluated with multivariable logistic regression models. The overall rate of IMD caused by strains with DSP in Ontario was approximately 1.20 cases per million population annually (95% confidence interval [95% CI], 0.99 to 1.46). Seventy-nine strains (21.7%) were IMD strains with DSP. There was no year-to-year trend in the incidence of IMD with DSP. IMD with DSP was strongly associated with strains of serogroups Y (odds ratio [OR], 6.3; 95% CI, 3.6 to 11.1) and W-135 (OR, 8.2; 95% CI, 4.0 to 16.7). Infection with serogroup B or C strains was associated with a marked increase in the risk of mortality (OR, 3.07; 95% CI, 1.39 to 6.75); however, no association between IMD with DSP and mortality was observed. In contrast to trends of the 1990s, the incidence of IMD with DSP was stable in Ontario between 2000 and 2006. In Ontario, the serogroup rather than the penicillin MIC is the microbiological parameter most predictive of mortality.
47
Ruecker, Norma J., Shannon L. Braithwaite, Edward Topp, Thomas Edge, David R. Lapen, Graham Wilkes, Will Robertson, Diane Medeiros, Christoph W. Sensen, and Norman F. Neumann. "Tracking Host Sources of Cryptosporidium spp. in Raw Water for Improved Health Risk Assessment." Applied and Environmental Microbiology 73, no. 12 (May 4, 2007): 3945–57. http://dx.doi.org/10.1128/aem.02788-06.
Full textAbstract:
ABSTRACT Recent molecular evidence suggests that different species and/or genotypes of Cryptosporidium display strong host specificity, altering our perceptions regarding the zoonotic potential of this parasite. Molecular forensic profiling of the small-subunit rRNA gene from oocysts enumerated on microscope slides by U.S. Environmental Protection Agency method 1623 was used to identify the range and prevalence of Cryptosporidium species and genotypes in the South Nation watershed in Ontario, Canada. Fourteen sites within the watershed were monitored weekly for 10 weeks to assess the occurrence, molecular composition, and host sources of Cryptosporidium parasites impacting water within the region. Cryptosporidium andersoni, Cryptosporidium muskrat genotype II, Cryptosporidium cervine genotype, C. baileyi, C. parvum, Cryptosporidium muskrat genotype I, the Cryptosporidium fox genotype, genotype W1, and genotype W12 were detected in the watershed. The molecular composition of the Cryptosporidium parasites, supported by general land use analysis, indicated that mature cattle were likely the main source of contamination of the watershed. Deer, muskrats, voles, birds, and other wildlife species, in addition to sewage (human or agricultural) may also potentially impact water quality within the study area. Source water protection studies that use land use analysis with molecular genotyping of Cryptosporidium parasites may provide a more robust source-tracking tool to characterize fecal impacts in a watershed. Moreover, the information is vital for assessing environmental and human health risks posed by water contaminated with zoonotic and/or anthroponotic forms of Cryptosporidium.
48
Sayani, Ambreen, Mandana Vahabi, Mary Ann O’Brien, Geoffrey Liu, Stephen Hwang, Peter Selby, Erika Nicholson, Meredith Giuliani, Lawson Eng, and Aisha Lofters. "Advancing health equity in cancer care: The lived experiences of poverty and access to lung cancer screening." PLOS ONE 16, no. 5 (May 6, 2021): e0251264. http://dx.doi.org/10.1371/journal.pone.0251264.
Full textAbstract:
Background Individuals living with low income are more likely to smoke, have a higher risk of lung cancer, and are less likely to participate in preventative healthcare (i.e., low-dose computed tomography (LDCT) for lung cancer screening), leading to equity concerns. To inform the delivery of an organized pilot lung cancer screening program in Ontario, we sought to contextualize the lived experiences of poverty and the choice to participate in lung cancer screening. Methods At three Toronto academic primary-care clinics, high-risk screen-eligible patients who chose or declined LDCT screening were consented; sociodemographic data was collected. Qualitative interviews were conducted. Theoretical thematic analysis was used to organize, describe and interpret the data using the morphogenetic approach as a guiding theoretical lens. Results Eight participants chose to undergo screening; ten did not. From interviews, we identified three themes: Pathways of disadvantage (social trajectories of events that influence lung-cancer risk and health-seeking behaviour), lung-cancer risk and early detection (upstream factors that shape smoking behaviour and lung-cancer screening choices), and safe spaces of care (care that is free of bias, conflict, criticism, or potentially threatening actions, ideas or conversations). We illuminate how ‘choice’ is contextual to the availability of material resources such as income and housing, and how ‘choice’ is influenced by having access to spaces of care that are free of judgement and personal bias. Conclusion Underserved populations will require multiprong interventions that work at the individual, system and structural level to reduce inequities in lung-cancer risk and access to healthcare services such as cancer screening.
49
Mazzulli, Tony, Kevin Kain, and Jagdish Butany. "Severe Acute Respiratory Syndrome: Overview With an Emphasis on the Toronto Experience." Archives of Pathology & Laboratory Medicine 128, no. 12 (December 1, 2004): 1346–50. http://dx.doi.org/10.5858/2004-128-1346-sarsow.
Full textAbstract:
Abstract Objective.—To provide an overview of the severe acute respiratory syndrome (SARS) outbreak in Toronto, Ontario, which experienced the largest outbreak outside Asia, and to review what has been learned during the past year. Data Sources.—MEDLINE search of all studies related to SARS, including review of the Centers for Disease Control and Prevention, World Health Organization (WHO), and Health Canada Web sites. Data Synthesis.—During the SARS outbreak in Toronto, 438 people had been diagnosed as having suspected or probable SARS and 44 people died. Elderly people and those with comorbid illnesses were at greatest risk of complications or death. Transmission was via direct contact with respiratory secretions. The use of gloves, gowns, N95 masks, and eye protection was effective in preventing transmission. No transmission occurred before symptom onset or after recovery. Serologic tests suggest that antibodies may not appear until 28 days after illness onset. Molecular tests give their greatest yield during the second week of illness. The value of ribavirin treatment remains questionable. The combination of interferon plus corticosteroids appears to be better than corticosteroids alone. Postmortem examination revealed pulmonary edema and evidence of diffuse alveolar damage. Very few morphological changes were noted in other organs despite the presence of viral RNA as detected by polymerase chain reaction. Conclusion.—On July 5, 2003, the WHO declared that the SARS outbreak was over. Since then, new cases of SARS have been reported in Asia. With global travel, the disease can rapidly spread throughout the world. Therefore, we must remain vigilant to prevent another pandemic.
50
Gong, Zhaowei, Sara L. Haig, Janet E. Pope, Sherry Rohekar, Gina Rohekar, Nicole G. H. LeRiche, and Andrew E. Thompson. "Health Literacy Rates in a Population of Patients with Rheumatoid Arthritis in Southwestern Ontario." Journal of Rheumatology 42, no. 9 (August 1, 2015): 1610–15. http://dx.doi.org/10.3899/jrheum.141509.
Full textAbstract:
Objective.To determine the rate of low health literacy in the rheumatoid arthritis (RA) population in southwestern Ontario.Methods.For the study, 432 patients with RA were contacted, and 311 completed the assessment. The health literacy levels of the participants were estimated using 4 assessment tools administered in the following order: the Single Item Literacy Screener (SILS), the Medical Term Recognition Test (METER), the Rapid Estimate of Adult Literacy in Medicine (REALM), and the Shortened Test of Functional Health Literacy in Adults (STOFHLA).Results.The rates of low literacy as estimated by STOFHLA, REALM, METER, and SILS were 14.5%, 14.8%, 14.1%, and 18.6%, respectively. All 4 assessment tools were statistically significantly correlated. STOFHLA, REALM, and METER were strongly correlated with each other (r = 0.59–0.79), while SILS only demonstrated moderate correlations with the other assessment tools (r = 0.33–0.45). Multiple linear regression and binary logistic regression analyses revealed that low levels of education and a lack of daily reading activity were common predictors of low health literacy. Using a non-English primary language at home was found to be a strong predictor of low health literacy in STOFHLA, REALM, and METER. Male sex was found to be a significant predictor of poor performance in REALM and METER, but not STOFHLA.Conclusion.Low health literacy is an important issue in the southwestern Ontario RA population. About 1 in 7 patients with RA may not have the necessary skills to become involved in making decisions regarding their personal health. Rheumatologists should be aware of the low health literacy levels of patients with RA and should consider identifying patients at risk of low health literacy.