The regional disparity of congenital anomalies in Saskatchewan and its impact on the utilization of health services

Congenital anomalies (CAs) are the leading cause of infant mortality and one of the leading causes of death for young children in developed countries. As significant improvements have been seen world-wide in controlling childhood infectious disease and issues related to poor nutrition, CAs are now making a proportionally bigger impact on the health of the world’s children. In addition to the impact of CA status on the individual child and one’s family, prevalence of CAs has a significant impact on the population, as children with birth defects can cost the system a great deal of money in the provision of specialized health and education services.When conducting surveillance of five selected CAs between 1990 and 1999, Saskatchewan Health found significant regional differences in the prevalence of these CAs. The purpose of this study is to ascertain whether or not there is a regional difference in all types of CAs, to assess whether or not any regional disparities also exist in the use of health care services by children with and without CAs and to determine what factors influence children’s use of health care services in the study population.This study follows a birth cohort of 17,414 children (9169 cases and 8245 controls) born between January 1, 1994 to December 31, 1998 until their 5th birthday, death or emigration out of Saskatchewan. Through graphical analysis, it was revealed that while an overall regional difference does not exist in the prevalence of CAs in Saskatchewan, there are regional differences in the prevalence of 13 of the 22 specific categories of conditions studied. One-way ANOVAs showed that children with CAs have higher numbers of physician visits (

Impact of prenatal care provider on the use of ancillary health services during pregnancy

BACKGROUND: Recent declines in the provision of prenatal care by family physicians and the integration of midwives into the Canadian health care system have led to a shift in the pattern of prenatal care provision; however it is unknown if this also impacts use of other health services during pregnancy. This study aimed to assess the impact of the type of prenatal care provider on the self-reported use of ancillary services during pregnancy. METHODS: Data for this study was obtained from the All Our Babies study, a community-based prospective cohort study of women’s experiences during pregnancy and the post-partum period. Chi-square tests and logistic regression were used to assess the association between type of prenatal care provider and use of ancillary health services in pregnancy. RESULTS: During pregnancy, 85.8% of women reported accessing ancillary health services. Compared to women who received prenatal care from a family physician, women who saw a midwife were less likely to call a nurse telephone advice line (OR = 0.30, 95% CI: 0.18-0.50) and visit the emergency department (OR = 0.47, 95% CI: 0.24-0.89), but were more likely receive chiropractic care (OR = 4.07, 95% CI: 2.49-6.67). Women who received their prenatal care from an obstetrician were more likely to visit a walk-in clinic (OR = 1.51, 95% CI: 1.11-2.05) than those who were cared for by a family physician. CONCLUSIONS: Prenatal care is a complex entity and referral pathways between care providers and services are not always clear. This can lead to the provision of fragmented care and create opportunities for errors and loss of information. All types of care providers have a role in addressing the full range of health needs that pregnant women experience

Proportion of neonatal readmission attributed to length of stay for childbirth: a population-based cohort study

Objective: Most literature on length of stay (LOS) for childbirth focuses on ‘early’ discharge as opposed to ‘optimal’ time of discharge and has conflicting results due to heterogeneous definitions of ‘early’ discharge and differing eligibility criteria for these programmes. We aimed to determine the LOS associated with the lowest neonatal readmission rate following childbirth by examining the incidence pattern of neonatal readmission for different LOS using the Kitagawa decomposition. Design: Retrospective cohort study using administrative hospitalisation data. Setting: Canada (excluding Quebec) from 2003 to 2010. Patients: Term, singleton live births without congenital anomalies. Interventions: LOS for childbirth. Main outcome measure: Neonatal readmissions within 30 days of birth. Results: 1 875 322 live births were included. Neonatal LOS peaked at day 1 (47.3%) after vaginal birth and day 3 (49.3%) following caesarean section; 4.2% of infants were readmitted following vaginal birth and 2.2% after caesarean section. In 2008–2010, most readmissions occurred among infants discharged in the first 2 days (83.8%) following a vaginal birth and among infants discharged in the first 3 days (81.7%) following a caesarean birth. Readmissions increased from 4.1% in 2003–2005 to 4.6% in 2008–2010 among vaginal births and from 2.0% to 2.4% among caesarean births and occurred mostly due to changes in the day-specific readmission rates and not due to reductions in LOS. Conclusions: Patterns of readmission suggest that readmission rates are lowest following a 1–2-day stay following a vaginal birth and a 2–4-day stay following a caesarean birth given the outpatient support in the community

Teaching, research and the Canadian professoriate : findings from the 2018 APIKS survey

This paper presents the Canadian findings from the 2018 APIKS study focusing on the teaching-research nexus. The online, bilingual survey was administered to full-time professors at 64 provincially-funded universities in Canada between October 2017 and June 2018 (n=2968). Findings suggest the majority of full-time, tenure-steam professors prefer both teaching and research and are engaged in both throughout the academic year. These findings are considered in light of broader changes in Canadian higher education including enrolment expansion, the increasing valorization of research, the development of new categories of academic labour, and the growth in precarious contract employment

Dependent infrastructure system modeling: A case study of the St. Kitts power and water distribution systems

Critical infrastructure systems underlie the economy, national security, and health of modern society. These infrastructures have become increasingly dependent on each other, which poses challenges when modeling these systems. Although a number of methods have been developed for this problem, few case studies that model real-world dependent infrastructures have been conducted. In this paper, we aim to provide another example of such a case study by modeling a real-world water distribution system dependent on a power system. Unlike in the limited previous case studies, our case study is in a developing nation context. This makes the availability of data about the infrastructure systems in this case study very limited, which is a common characteristic of real-world studies in many settings. Thus, a main contribution of the paper is to show how one can still develop representative, useful models for systems in the context of limited data. To demonstrate the utility of these types of models, two examples of different analyses are performed, where the results provide information about the most vulnerable parts of the infrastructures and critical linkages between the power and water distribution systems.publishedVersio

Neurolinguistic programming: a systematic review of the effects on health outcomes

BACKGROUND: Neurolinguistic programming (NLP) in health care has captured the interest of doctors, healthcare professionals, and managers. AIM: To evaluate the effects of NLP on health-related outcomes. DESIGN AND SETTING: Systematic review of experimental studies. METHOD: The following data sources were searched: MEDLINE, PsycINFO, ASSIA, AMED, CINAHL, Web of Knowledge, CENTRAL, NLP specialist databases, reference lists, review articles, and NLP professional associations, training providers, and research groups. RESULTS: Searches revealed 1459 titles from which 10 experimental studies were included. Five studies were randomised controlled trials (RCTs) and five were pre-post studies. Targeted health conditions were anxiety disorders, weight maintenance, morning sickness, substance misuse, and claustrophobia during MRI scanning. NLP interventions were mainly delivered across 4-20 sessions although three were single session. Eighteen outcomes were reported and the RCT sample sizes ranged from 22 to 106. Four RCTs reported no significant between group differences with the fifth finding in favour of the NLP arm (F = 8.114, P<0.001). Three RCTs and five pre-post studies reported within group improvements. Risk of bias across all studies was high or uncertain. CONCLUSION: There is little evidence that NLP interventions improve health-related outcomes. This conclusion reflects the limited quantity and quality of NLP research, rather than robust evidence of no effect. There is currently insufficient evidence to support the allocation of NHS resources to NLP activities outside of research purposes

The Academic Profession in Canada: Perceptions of Canadian University Faculty about Research and Teaching

Previous scholarly attention to the experiences of faculty members has emphasized the contexts of US institutions, with minimal attention to the experiences of faculty members at Canadian universities.&nbsp; This paper presents the findings of the Canadian component of an international survey that was administered in 19 different jurisdictions to understand the perceptions of faculty members about the nature and scope of changes to academic work. As such, the paper explores the perceptions on research and teaching of full-time faculty members affiliated with Canadian universities. Overall, faculty members revealed that Canadian universities have strong, engaging, and vibrant research and teaching environments, yet there are also areas for improvement. Specifically, findings showed that faculty members perceived considerable autonomy with respect to research activities, despite the increasing need to secure external funding for research. Also, faculty expressed substantial commitment to teaching undergraduate students but a lack of clarity about some issues related to graduate teaching. The survey results provide an important baseline for future studies of Canadian universities and the working conditions of the professoriate in a time of rapid institutional and professional change. &nbsp;Jusqu’à présent, les études scientifiques sur l’expérience du corps professoral ont surtout porté sur le contexte étatsunien, accordant très peu d’attention à l’expérience vécue dans les universités canadiennes. Cet article présente les résultats de la partie canadienne d’un sondage international effectué dans 19 juridictions, et dont le but était de comprendre la perception du corps professoral envers la nature et la portée de changements modifiant le travail académique. Dans l’ensemble, les membres du corps professoral ont confié que le milieu de la recherche et de l’enseignement est solide, stimulant et dynamique, bien que des points restent à améliorer. Plus précisément, notre recherche révèle que les membres du corps professoral perçoivent une autonomie considérable sur le plan des activités de recherche, malgré le besoin grandissant d’obtenir du financement externe pour la recherche. De plus, les membres du corps professoral ont exprimé leur engagement capital envers l’enseignement au premier cycle, mais aussi un manque de clarté quant à certains problèmes liés à l’enseignement aux cycles supérieurs. Dans un contexte de changements institutionnels et professionnels rapides, les résultats du sondage fournissent un important point de départ pour de futures études sur les universités canadiennes et les conditions de travail du corps professoral

Detection of skewed X-chromosome inactivation in Fragile X syndrome and X chromosome aneuploidy using quantitative melt analysis.

Methylation of the fragile X mental retardation 1 (FMR1) exon 1/intron 1 boundary positioned fragile X related epigenetic element 2 (FREE2), reveals skewed X-chromosome inactivation (XCI) in fragile X syndrome full mutation (FM: CGG &gt; 200) females. XCI skewing has been also linked to abnormal X-linked gene expression with the broader clinical impact for sex chromosome aneuploidies (SCAs). In this study, 10 FREE2 CpG sites were targeted using methylation specific quantitative melt analysis (MS-QMA), including 3 sites that could not be analysed with previously used EpiTYPER system. The method was applied for detection of skewed XCI in FM females and in different types of SCA. We tested venous blood and saliva DNA collected from 107 controls (CGG &lt; 40), and 148 FM and 90 SCA individuals. MS-QMA identified: (i) most SCAs if combined with a Y chromosome test; (ii) locus-specific XCI skewing towards the hypomethylated state in FM females; and (iii) skewed XCI towards the hypermethylated state in SCA with 3 or more X chromosomes, and in 5% of the 47,XXY individuals. MS-QMA output also showed significant correlation with the EpiTYPER reference method in FM males and females (P &lt; 0.0001) and SCAs (P &lt; 0.05). In conclusion, we demonstrate use of MS-QMA to quantify skewed XCI in two applications with diagnostic utility

Adherence And Persistence To Antidepressant Medication During Pregnancy: Does It Differ By The Class Of Antidepressant Medication Prescribed?

Introduction Pregnant women are often concerned about the impact of antidepressant medication use on their pregnancy, such as congenital abnormalities. This concern may vary in a way that depends on the class of antidepressant medication prescribed. Objectives and Approach This study examined the rate of adherence and persistence to antidepressants based on the class of antidepressants prescribed during pregnancy This is a retrospective cohort study using population-based administrative data in Alberta– linking delivery record, hospitalization data, physician claims data, emergency department data, and prescription medication data. The eligible study population included women with depression who gave birth between 2012-2015, and were adherent (medication possession ratio ≥80%) to ≥ 2 consecutive antidepressant prescriptions during the preconception year (n=1,865). The rates of adherence and persistence (prescription refill gap ≤30 days) were calculated by medication class and were compared using chi-square tests. Results During pregnancy, 834 (44.7%) women completely stopped taking antidepressants. Among those taking antidepressants, the overall rate of adherence was 62.6% (95% CI: 59.4%, 65.7%). The rate differed significantly by medication class (p<0.0001), with rate of 75.1% (95% CI: 68.3%, 80.9%) for serotonin-norepinephrine inhibitors, 60.9% (95% CI: 57.2%, 64.5%) for selective serotonin reuptake inhibitors, 42.9% (95% CI: 19.9%, 69.2%) for non-selective monoamine reuptake inhibitors, and 37.5% (95% CI: 22.4%, 55.4%) for the atypical antidepressants. Similarly, 40.7%, (95% CI: 37.5, 44.0) of women were persistent to antidepressants up to the full pregnancy period – similar to the adherence pattern, the rate differed significantly by medication class. Conclusion/Implications Adherence to and persistence in using antidepressants is low during pregnancy and it varies by medication class, possessing to the worsening of depression symptoms. This could be improved by conducting more research on drug safety during pregnancy and translating research evidence into treatment decision and correcting mothers’ misperceptions towards antidepressants