2015 researcher's mini-symposium

Postgraduate researchers from the Faculties of Science, Engineering, Medicine & Surgery and Health Sciences gathered for a forum to present their research interests. The symposium was held in the afternoon of 30 January 2015 in the Engineering Lecture Theatre. The symposium promoted multi-disciplinary networking between various university faculties. Participants were invited based on research topic diversity and gender balance.peer-reviewe

Outdoor air pollution and emergency department visits for asthma among children and adults: A case-crossover study in northern Alberta, Canada

<p>Abstract</p> <p>Background</p> <p>Recent studies have observed positive associations between outdoor air pollution and emergency department (ED) visits for asthma. However, few have examined the possible confounding influence of aeroallergens, or reported findings among very young children.</p> <p>Methods</p> <p>A time stratified case-crossover design was used to examine 57,912 ED asthma visits among individuals two years of age and older in the census metropolitan area of Edmonton, Canada between April 1, 1992 and March 31, 2002. Daily air pollution levels for the entire region were estimated from three fixed-site monitoring stations. Similarly, daily levels of aeroallergens were estimated using rotational impaction sampling methods for the period between 1996 and 2002. Odds ratios and their corresponding 95% confidence intervals were estimated using conditional logistic regression with adjustment for temperature, relative humidity and seasonal epidemics of viral related respiratory disease.</p> <p>Results</p> <p>Positive associations for asthma visits with outdoor air pollution levels were observed between April and September, but were absent during the remainder of the year. Effects were strongest among young children. Namely, an increase in the interquartile range of the 5-day average for NO₂and CO levels between April and September was associated with a 50% and 48% increase, respectively, in the number of ED visits among children 2 – 4 years of age (p < 0.05). Strong associations were also observed with these pollutants among those 75 years of age and older. Ozone and particulate matter were also associated with asthma visits. Air pollution risk estimates were largely unchanged after adjustment for aeroallergen levels.</p> <p>Conclusion</p> <p>Our findings, taken together, suggest that exposure to ambient levels of air pollution is an important determinant of ED visits for asthma, particularly among young children and the elderly.</p

Non-specific abdominal pain and air pollution: a novel association.

We studied whether short-term exposure to air pollution was associated with non-specific abdominal pain in epidemiologic and animal studies. Patients visiting the emergency department with non-specific abdominal pain were identified in Edmonton (1992 to 2002, n = 95,173) and Montreal (1997 to 2002, n = 25,852). We calculated the daily concentrations for ozone (O(3)), nitrogen dioxide (NO(2)), sulfur dioxide (SO(2)), carbon monoxide (CO), and particles <10 (PM(10)) or <2.5 (PM(2.5)) µm. A case crossover study design was used to estimate the odds ratio (OR) and 95% confidence interval (CI) associated with an increase in the interquartile range of the air pollutants. We investigated differential effects by age and sex. Mice were gavaged with urban particle extracts. In animal models, colonic motility was tested, and visceral abdominal pain was measured using a writhing test, and behavioral response to oil of mustard and neostigmine. Motility and pain was measured acutely (1.5 hours after gavage) and chronically (7-days and 21-days after gavage). Emergency department visits for non-specific abdominal pain were primarily by women between the ages of 15-24 years. Individuals aged 15 to 24 years were at increased risk of non-specific abdominal pain in Edmonton (same day CO: OR = 1.04, 95% CI = 1.02-1.06; and NO(2): OR = 1.06, 95% CI = 1.03-1.09). The risk of air pollution among 15-24 year olds in Montreal was significantly positive (same day CO: OR = 1.11, 95% CI = 1.05-1.17; NO(2): OR = 1.09, 95% CI = 1.01-1.16; SO(2): OR = 1.17, 95% CI = 1.10-1.25; PM(2.5): OR = 1.09, 95% CI = 1.04-1.15). Abdominal pain was increased by an acute gavage of pollution extract but not to chronic exposure to pollutants. Colonic transit was delayed following chronic but not acute exposure with the pollutants. Epidemiological and animal data suggest that short-term exposure to air pollution may trigger non-specific abdominal pain in young individuals

Evaluation of an Emergency Department Lean Process Improvement Program to Reduce Length of Stay

In recent years, lean principles have been applied to improve wait times in the emergency department (ED). In 2009, an ED process improvement program based on lean methods was introduced in Ontario as part of a broad strategy to reduce ED length of stay and improve patient flow. This study seeks to determine the effect of this program on ED wait times and quality of care. We conducted a retrospective cohort study of all ED visits at program and control sites during 3 program waves from April 1, 2007, to June 30, 2011, in Ontario, Canada. Time series analyses of outcomes before and after the program and difference-in-differences analyses comparing changes in program sites with control sites were conducted

Air Pollution and Emergency Department Visits for Suicide Attempts in Vancouver, Canada

Background Comorbidity of depression, heart disease, and migraine has been observed in clinical practice, while ambient air pollution has been identified among different risk factors for these health conditions. Suicide attempts and ideations as the result of depression may be linked to air pollution exposure. Therefore the effects of ambient air pollution on emergency department (ED) visits for suicide attempts were investigated. Methods Emergency visit data were collected in a hospital in Vancouver, Canada. The generalized linear mixed models technique was applied in the analysis of these data. A natural hierarchical structure of the data was used to define the clusters, with days nested in a 3-level structure (day of week, month, year). Poisson models were fitted to the clustered counts of ED visits with a single air pollutant, temperature and relative humidity. In addition, the case-crossover methodology was used with the same data for comparison. The analysis was performed by gender (all, males, females) and month (all: January-December, warm: April-September, cold: October-March). Results Both hierarchical and case-crossover methods confirmed positive and statistically significant associations among carbon monoxide (CO), nitrogen dioxide (NO 2 ), sulphur dioxide (SO 2 ), and particulate matter (PM 10 ) for all suicide attempts in the cold period. The largest increase was observed for males in the cold period for a 1-day lagged exposure to NO 2 , with an excess risk of 23.9% (95% CI: 7.8, 42.4) and odds ratio of 1.21 (95% CI: 1.03, 1.41). In warm months the associations were not statistically significant, and the highest positive value was obtained for ozone lagged by 1 day. Conclusion The results indicate a potential association between air pollution and emergency department visits for suicide attempts

Stroke mimics transported by emergency medical services to a comprehensive stroke center : the magnitude of the problem

Background: Despite the use of validated prehospital stroke screens, stroke mimics are frequent among patients transported by Emergency Medical Services to the Emergency Department. We aimed to describe the frequency and characteristics of neurological and non-neurological mimics transported to a comprehensive stroke center for acute stroke evaluation. Methods: This was a retrospective analysis of a database consisting of all consecutive patients with suspected stroke transported to the Emergency Department of a comprehensive stroke center during an 18-month period. Hospital charts and neuroimaging were utilized to adjudicate the final diagnosis (acute stroke, stroke mimic, and specific underlying diagnoses). Results: 950 patients were transported with suspected stroke, among whom 405 (42.6%) were stroke mimics (age 66.9±17.1 years; 54% male). Neurological mimics were diagnosed in 223 (55.1%) patients and mimics were non-neurological in 182. The most common neurological diagnoses were seizures (19.7%), migraines (18.8%) and peripheral neuropathies (11.2%). Cardiovascular (14.6%) and psychiatric (11.9%) diagnoses were common non-neurological mimics. Patients with neurological mimic were younger (64.1±17.3 years vs. 70.5±16.1 years, p<0.001) and had less vascular risk factors than non-neurological mimics. The proportion of non-neurological mimics remained high (38%) despite the use of a prehospital identification scale. Conclusion: Stroke mimics are common among patients transported by Emergency Medical Services to a comprehensive stroke center for suspected stroke, with a considerable proportion being non-neurological in origin. Studies refining triage and transport of suspected acute stroke may be warranted to minimize the number of mimics transported by to a comprehensive stroke center for acute stroke evaluation

Incidence and Prevalence of Chronic Obstructive Pulmonary Disease among Aboriginal Peoples in Alberta, Canada

Background Chronic obstructive pulmonary disease (COPD) is a major respiratory disorder, largely caused by smoking that has been linked with large health inequalities worldwide. There are important gaps in our knowledge about how COPD affects Aboriginal peoples. This retrospective cohort study assessed the epidemiology of COPD in a cohort of Aboriginal peoples relative to a non-Aboriginal cohort. Methods We used linkage of administrative health databases in Alberta (Canada) from April 1, 2002 to March 31, 2010 to compare the annual prevalence, and the incidence rates of COPD between Aboriginal and non-Aboriginal cohorts aged 35 years and older. Poisson regression models adjusted the analysis for important sociodemographic factors. Results Compared to a non-Aboriginal cohort, prevalence estimates of COPD from 2002 to 2010 were 2.3 to 2.4 times greater among Registered First Nations peoples, followed by the Inuit (1.86 to 2.10 times higher) and the Métis (1.59 to 1.67 times higher). All Aboriginal peoples had significantly higher COPD incidence rates than the non-Aboriginal group (incidence rate ratio [IRR]: 2.1; 95% confidence interval [CI]: 1.97, 2.27). COPD incidence rates were higher in First Nation peoples (IRR: 2.37; 95% CI: 2.19, 2.56) followed by Inuit (IRR: 1.92; 95% CI: 1.64, 2.25) and Métis (IRR: 1.49; 95% CI: 1.32, 1.69) groups. Conclusions We found a high burden of COPD among Aboriginal peoples living in Alberta; a province with the third largest Aboriginal population in Canada. Altogether, the three Aboriginal peoples groups have higher prevalence and incidence of COPD compared to a non-Aboriginal cohort. The condition affects the three Aboriginal groups differently; Registered First Nations and Inuit have the highest burden of COPD. Reasons for these differences should be further explored within a framework of social determinants of health to help designing interventions that effectively influence modifiable COPD risk factors in each of the Aboriginal groups

Development of a minimization instrument for allocation of a hospital-level performance improvement intervention to reduce waiting times in Ontario emergency departments

<p>Abstract</p> <p>Background</p> <p>Rigorous evaluation of an intervention requires that its allocation be unbiased with respect to confounders; this is especially difficult in complex, system-wide healthcare interventions. We developed a short survey instrument to identify factors for a minimization algorithm for the allocation of a hospital-level intervention to reduce emergency department (ED) waiting times in Ontario, Canada.</p> <p>Methods</p> <p>Potential confounders influencing the intervention's success were identified by literature review, and grouped by healthcare setting specific change stages. An international multi-disciplinary (clinical, administrative, decision maker, management) panel evaluated these factors in a two-stage modified-delphi and nominal group process based on four domains: change readiness, evidence base, face validity, and clarity of definition.</p> <p>Results</p> <p>An original set of 33 factors were identified from the literature. The panel reduced the list to 12 in the first round survey. In the second survey, experts scored each factor according to the four domains; summary scores and consensus discussion resulted in the final selection and measurement of four hospital-level factors to be used in the minimization algorithm: improved patient flow as a hospital's leadership priority; physicians' receptiveness to organizational change; efficiency of bed management; and physician incentives supporting the change goal.</p> <p>Conclusion</p> <p>We developed a simple tool designed to gather data from senior hospital administrators on factors likely to affect the success of a hospital patient flow improvement intervention. A minimization algorithm will ensure balanced allocation of the intervention with respect to these factors in study hospitals.</p

Feature-specific terrain park-injury rates and risk factors in snowboarders : a case–control study

Background : Snowboarding is a popular albeit risky sport and terrain park (TP) injuries are more severe than regular slope injuries. TPs contain man-made features that facilitate aerial manoeuvres. The objectives of this study were to determine overall and feature-specific injury rates and the potential risk factors for TP injuries. Methods : Case–control study with exposure estimation, conducted in an Alberta TP during two ski seasons. Cases were snowboarders injured in the TP who presented to ski patrol and/or local emergency departments. Controls were uninjured snowboarders in the same TP. κ Statistics were used to measure the reliability of reported risk factor information. Injury rates were calculated and adjusted logistic regression was used to calculate the feature-specific odds of injury. Results : Overall, 333 cases and 1261 controls were enrolled. Reliability of risk factor information was κ>0.60 for 21/24 variables. The overall injury rate was 0.75/1000 runs. Rates were highest for jumps and half-pipe (both 2.56/1000 runs) and lowest for rails (0.43/1000 runs) and quarter-pipes (0.24/1000 runs). Compared with rails, there were increased odds of injury for half-pipe (OR 9.63; 95% CI 4.80 to 19.32), jumps (OR 4.29; 95% CI 2.72 to 6.76), mushroom (OR 2.30; 95% CI 1.20 to 4.41) and kickers (OR 1.99; 95% CI 1.27 to 3.12). Conclusions : Higher feature-specific injury rates and increased odds of injury were associated with features that promote aerial manoeuvres or a large drop to the ground. Further research is required to determine ways to increase snowboarder safety in the TP