The Underreporting Of Suicide In Canada, 1950--1982: An Exploration Of The Adequacy Of Official Statistics For Epidemiologic Purposes

This study addresses the issue of the underreporting of suicide in Canadian vital statistics, and specifically asks whether the degree of underreporting can be assumed to be even across levels of commonly studied sociodemographic variables, across time, and among the ten provinces.;The analysis involves a series of comparisons between cause-specific accident and suicide rates and the same rates with deaths of undetermined origin added, over time. Data pertaining to these latter deaths have been collected in Canada since 1969; research in other jurisdictions has demonstrated that most of these deaths could be considered misclassified suicides for research purposes in psychiatric epidemiology.;The results tend to confirm the findings of other researchers, specifically that suicide is probably underreported more among females and in cases of drowning and poisoning; the findings suggest as well that some provinces account for a disproportionate share of deaths of undetermined origin which may be sufficient to introduce regional differences in underreporting. The potential underreporting of suicide was found to peak in the mid to late 1970s in Canada, and was found not to vary significantly across age groups within the same sex and cause.;With the exception of age, the assumption of a constant error in the underreporting of suicide seems to be unjustified. This lack of constancy is argued to pose a negligible threat to most descriptive epidemiologic uses of official suicide statistics. Examples are given in which suicide statistics, corrected for potential underreporting, yield the same general conclusions regarding relative prevalence between groups as do the uncorrected statistics.;By contrast, the uneven underreporting is argued to represent a potential threat to some inferences derived from explanatory studies that use suicide statistics, because of the widespread testing of hypotheses using probability statistics. One simple method to strengthen some statistical inferences is presented, and its limitations are discussed

In-Home Rehabilitation Resources and Avoidable Admissions to Inpatient Rehabilitation after Stroke: An Ecological Study

Background and purpose: In Ontario (Canada’s most populous province), it has been suggested that mildly impaired stroke patients are being admitted to inpatient rehabilitation unnecessarily due to a lack of alternative options in the community. This ecological study aimed to formally test this hypothesis. Methods: Patients admitted to an inpatient rehabilitation bed in Ontario’s most highly functioning patient classification group (Rehabilitation Patient Group 1160) were retrospectively identified as potentially avoidable admissions, and the proportion of such patients was calculated for each Local Health Integration Network every year between 2006/2007 and 2010/2011. Five indicators of community-based rehabilitation availability were used to test the relationships between avoidable admissions and resource indicators. Results: Of the 25 correlations tested, 21 agreed with the hypothesized direction of effect and 4 reached statistical significance. Logistic-linear regressions on combined data from each of the 5 years demonstrated statistically significant associations between all 5 resource indicators and the proportion of potentially avoidable admissions. Conclusions: This study confirms the suggestion of variation in the proportion of mildly impaired patients admitted to inpatient rehabilitation across Ontario’s Local Health Integration Networks. It also adds evidence to support the concern that a lack of community-based rehabilitation is contributing to these potentially avoidable admissions

Joint replacement recipients' post-surgery views about health information privacy and registry participation

Patient registries have been demonstrated to improve health care, and represent an important source of data to health researchers and policy-makers. Building on our previous research that tested an explanatory model of health information privacy views with pre-operative joint replacement recipients, in the present study we explored privacy views and willingness to participate in registries among post-operative joint replacement recipients. Post-operative patients were asked to complete a self-administered mailed questionnaire. One hundred and fifty-seven of 173 (91%) eligible individuals were enrolled. Bivariate analyses were conducted using t-tests and one-way ANOVAs. Multivariable analyses were conducted using multiple linear regression. Overall, our previous findings that views about health information privacy are more predictive of potential registry participation than patient characteristics or health care experiences continue to hold true post-surgery. Certain health care experiences were found to play a role in health information privacy concerns, including hip versus knee replacement, primary versus revision surgery, and surgical complications. More variance was explained in post-surgery registry participation views than pre-surgery. In addition, gender differences in R2 values were smaller post-surgery. However, some aspects of the final models, such as gender as an effect modifier continued in the post-surgery study. Researchers and policy-makers should consider the impact of encounters with the health care system when seeking to understand patients' privacy concerns and willingness to participate in registries.

Additional file 1: of Validation of the Questionnaire to Identify Knee Symptoms (QuIKS) using Rasch analysis

Questionnaire to Identify Knee Symptoms-R (QuIKS-R). (DOCX 17 kb

Assessing the impact of a home-based stroke rehabilitation programme: a cost-effectiveness study

<p><b>Background:</b> Stroke is often a severe and debilitating event that requires ongoing rehabilitation. The Community Stroke Rehabilitation Teams (CSRTs) offer home-based stroke rehabilitation to individuals for whom further therapy is unavailable or inaccessible. The objective of this study was to evaluate the cost-effectiveness of the CSRT programme compared with a “Usual Care” cohort.</p> <p><b>Methods:</b> We collected data on CSRT clients from January 2012 to February 2013. Comparator data were derived from a study of stroke survivors with limited access to specialised stroke rehabilitation. Literature-derived values were used to inform a long-term projection. Using Markov modelling, we projected the model for 35 years in six-month cycles. One-way, two-way, and probabilistic sensitivity analyses were performed. Results were discounted at 3% per year.</p> <p><b>Results:</b> Results demonstrated that the CSRT programme has a net monetary benefit (NMB) of $43,655 over Usual Care, and is both less costly and more effective (incremental cost = −$17,255; incremental effect = 1.65 Quality Adjusted Life Years [QALYs]). Results of the probabilistic sensitivity analysis revealed that incremental cost-effectiveness of the CSRT programme is superior in 100% of iterations when compared to Usual Care.</p> <p><b>Conclusions:</b> The study shows that CSRT model of care is cost-effective, and should be considered when evaluating potential stroke rehabilitation delivery methods.Implications for Rehabilitation</p><p>Ongoing rehabilitation following stroke is imperative for optimal recovery.</p><p>Home-based specialised stroke rehabilitation may be an option for individuals for whom ongoing rehabilitation is unavailable or inaccessible.</p><p>The results of this study demonstrated that home-based rehabilitation is a cost-effective means of providing ongoing rehabilitation to individuals who have experienced a stroke.</p><p></p> <p>Ongoing rehabilitation following stroke is imperative for optimal recovery.</p> <p>Home-based specialised stroke rehabilitation may be an option for individuals for whom ongoing rehabilitation is unavailable or inaccessible.</p> <p>The results of this study demonstrated that home-based rehabilitation is a cost-effective means of providing ongoing rehabilitation to individuals who have experienced a stroke.</p