Sharma S.,University of Alberta |
Barr A.B.,University of North Carolina at Chapel Hill |
Macdonald H.M.,University of Aberdeen |
Sheehy T.,University College Cork |
And 2 more authors.
Nutrition Reviews | Year: 2011
Aboriginal populations living above the Arctic Circle are at particularly high risk of vitamin D deficiency due to limited ultraviolet B exposure (related to geographic latitude) and inadequate dietary intake (recently related to decreased traditional food consumption). Major changes in diet and lifestyle over the past 50 years in these populations have coincided with increased prevalence rates of rickets, cancer, diabetes, and obesity, each of which may be associated with vitamin D inadequacy. This review examines the risk factors for vitamin D inadequacy, the associations between vitamin D and disease risk at high geographic latitudes, and the recommendations for improving vitamin D status particularly among aboriginal Arctic populations. Traditional foods, such as fatty fish and marine mammals, are rich sources of vitamin D and should continue to be promoted to improve dietary vitamin D intake. Supplementation protocols may also be necessary to ensure adequate vitamin D status in the Arctic. © 2011 International Life Sciences Institute.
Khan N.A.,University of British Columbia |
Wang H.,Health Outcomes Sciences |
Anand S.,McMaster University |
Jin Y.,Alberta Health and Wellness |
And 3 more authors.
Diabetes Care | Year: 2011
OBJECTIVE - Diabetes guidelines recommend aggressive screening for type 2 diabetes in Asian patients because they are considered to have a higher risk of developing diabetes and potentially worse prognosis. We determined incidence of diabetes and risk of death or macrovascular complications by sex among major Asian subgroups, South Asian and Chinese, and white patients with newly diagnosed diabetes. RESEARCH DESIGN AND METHODS - Using population-based administrative data from British Columbia and Alberta, Canada (1997-1998 to 2006-2007), we identified patients with newly diagnosed diabetes aged ≥35 years and followed them for up to 10 years for death, acute myocardial infarction, stroke, or hospitalization for heart failure. Ethnicity was determined using validated surname algorithms. RESULTS - There were 15,066 South Asian, 17,754 Chinese, and 244,017 white patients with newly diagnosed diabetes. Chinese women and men had the lowest incidence of diabetes relative to that of white or South Asian patients, who had the highest incidence. Mortality in those with newly diagnosed diabetes was lower in South Asian (hazard ratio 0.69 [95% CI 0.62- 0.76], P < 0.001) and Chinese patients (0.69 [0.63- 0.74], P < 0.001) then in white patients. Risk of acute myocardial infarction, stroke, or heart failure was similar or lower in the ethnic groups relative to that of white patients and varied by sex. CONCLUSIONS - The incidence of diagnosed diabetes varies significantly among ethnic groups. Mortality was substantially lower in South Asian and Chinese patients with newly diagnosed diabetes than in white patients. © 2011 by the American Diabetes Association.
Rittmueller S.E.,University of Alberta |
Corriveau A.,Alberta Health and Wellness |
Sharma S.,University of Alberta
International Journal of Circumpolar Health | Year: 2012
Objectives: The present study aimed to assess dietary adequacy and quality among Inuvialuit alcohol consumers and non-consumers in the Northwest Territories (NWT), Canada. Study design: Cross-sectional study. Methods: Avalidated quantitative food frequency questionnaire was administered to individuals (n-216) of randomly selected households in 3 NWT communities to capture dietary intake and alcohol consumption over a 30-day recall period. The daily energy and nutrient intake, dietary adequacy and the top food sources of energy and selected nutrients were determined by alcohol consumption status. Results: Energy intake was higher among all alcohol consumers regardless of gender. Male alcohol consumers had lower nutrient intake density (per 4,184 kJ) of protein, cholesterol and several micronutrients (p ≤ 0.05), and female alcohol consumers had lower intake density of saturated fat (p ≤ 0.01), thiamine, folate and sodium (p ≤ 0.05). Among all men and women, 70-100% had inadequate intakes of dietary fibre, vitamin E and potassium. Non-nutrient-dense foods contributed similar amounts and traditional foods (TF) contributed 3% less to energy comparing alcohol consumers to non-consumers. Conclusion: Nutrient inadequacies are prevalent among Aboriginal populations in the Canadian Arctic and may be exacerbated by alcohol consumption due to alcohol's effects on dietary intake, nutrient transport and metabolism. Adult Inuvialuit who consumed alcohol had increased caloric intake and consumed similar amounts of non-nutrient-dense foods and less nutrient-dense TF. Fewer dietary inadequacies were observed among alcohol consumers than non-consumers, which might be due to the increase in overall food intake among alcohol consumers; however, further exploration of volume and pattern of drinking might help explain this result. © 2012 Stacey E. Rittmueller et al.
Rittmueller S.E.,University of Alberta |
Corriveau A.,Alberta Health and Wellness |
Sharma S.,University of Alberta
Public Health | Year: 2012
Objective: To assess dietary adequacy and quality among Inuvialuit smokers compared with non-smokers in the Northwest Territories (NWT), Canada. Study design: Cross-sectional study. Methods: A validated quantitative food frequency questionnaire was administered between July 2007 and July 2008 to individuals of randomly selected households in three NWT communities to capture dietary intake and smoking habits over a 30-day recall period. Daily energy and nutrient intake, dietary adequacy, and the top food contributors to energy and selected nutrients were determined by smoking status. Results: Intakes of energy and several nutrients were higher among male and female smokers compared with non-smokers. Male smokers had similar daily nutrient density (per 1000 kcal consumed) of all nutrients. Female smokers had significantly lower intake densities of protein, fibre, folate, magnesium, vitamin D, vitamin E (. P ≤ 0.05) and thiamin (. P ≤ 0.01), and higher intake densities of sugar and vitamins C and K (. P ≤ 0.05). Among male and female smokers, more than 50% had inadequate intakes of fibre, potassium and vitamin E. Non-nutrient-dense foods contributed similar amounts to energy intake, and traditional foods contributed 3-6% less to energy and protein intakes among smokers compared with non-smokers. Conclusion: Adult Inuvialuit smokers had higher caloric intake and lower dietary quality, including less consumption of traditional foods, compared with non-smokers. Fewer dietary inadequacies were observed among smokers than non-smokers, which may be due to higher energy intake among smokers. © 2012 The Royal Society for Public Health.
Lew K.,University of Alberta |
Acker J.P.,University of Alberta |
Gabos S.,Alberta Health and Wellness |
Le X.C.,University of Alberta
Environmental Science and Technology | Year: 2010
Children may be exposed to arsenic during contact with structures treated with chromated copper arsenate (CCA). A high frequency of hand-to-mouth activity may increase their risk of ingesting arsenic. Previous work showed that arsenic concentrations in the hand-wash samples of children playing on CCA playgrounds were four times higher than those playing on non-CCA playgrounds. It is not clear whether playing on CCA playgrounds results in elevated overall exposure to arsenic. The objective of this study was to perform arsenic biomonitoring in children to determine whether playing on CCA-treated playgrounds substantially contributes to their overall exposure to arsenic. One hundred and twenty five saliva samples from 61 children and 101 urine samples from 45 children were collected after children played on 8 CCA and 8 non-CCA playgrounds. Arsenic speciation analysis was conducted using high performance liquid chromatography combined with inductively coupled plasma mass spectrometry. The arsenic species detected in the urine and saliva samples from children playing on CCA and non-CCA playgrounds were similar. Dimethylarsinic acid and arsenobetaine were the main arsenic species found in urine samples. The sum of inorganic trivalent and pentavalent arsenic, monomethylarsonic acid, and dimethylarsinic acid in urine was 15 ± 28 μg/L in the CCA group and 12 ± 23 μg/L in the non-CCA group (p = 0.60). The sum of these species in saliva was 1.1 ± 2.1 μg/L in the CCA group and 1.4 ± 1.1 μg/L in the non-CCA group (p = 0.32). These results show that there is no significant difference in the concentration or speciation of arsenic between the samples from children playing on CCA and non-CCA playgrounds. Contact with CCA playgrounds is not likely to significantly contribute to the overall arsenic exposure in children; other sources such as dietary arsenic may be a main contributor to their overall exposure. © 2010 American Chemical Society.
Ibrahim F.,University of Alberta |
Huang B.,University of Alberta |
Xing J.,University of Alberta |
Gabos S.,Alberta Health and Wellness
Water Research | Year: 2010
In this paper, a novel application of state estimation in environmental engineering is presented. The objective is to use on-line estimation techniques including moving horizon estimator (MHE) and extended Kalman filer (EKF) for an early concentration estimation of toxic agent presented in water supply. These estimation techniques (MHE and EKF) can be integrated in an early warning system of several features including the ability of early detection and quantification of the presence of toxicants in the water supply system. The estimation is based on dynamic measurements generated by a real-time cell electronic sensor (RT-CES) and on existing cytotoxicity mathematical dynamic models. © 2010 Elsevier Ltd.
Dover D.C.,Alberta Health and Wellness |
Schopflocher D.P.,University of Alberta
Population Health Metrics | Year: 2011
Background: Public health surveillance is often concerned with the analysis of health outcomes over small areas. Funnel plots have been proposed as a useful tool for assessing and visualizing surveillance data, but their full utility has not been appreciated (for example, in the incorporation and interpretation of risk factors).Methods: We investigate a way to simultaneously focus funnel plot analyses on direct policy implications while visually incorpora1/12/2012 11:51:30 AMting model fit and the effects of risk factors. Health survey data representing modifiable and nonmodifiable risk factors are used in an analysis of 2007 small area motor vehicle mortality rates in Alberta, Canada.Results: Small area variations in motor vehicle mortality in Alberta were well explained by the suite of modifiable and nonmodifiable risk factors. Funnel plots of raw rates and of risk adjusted rates lead to different conclusions; the analysis process highlights opportunities for intervention as risk factors are incorporated into the model. Maps based on funnel plot methods identify areas worthy of further investigation.Conclusions: Funnel plots provide a useful tool to explore small area data and to routinely incorporate covariate relationships in surveillance analyses. The exploratory process has at each step a direct and useful policy-related result. Dealing thoughtfully with statistical overdispersion is a cornerstone to fully understanding funnel plots. © 2011 Dover and Schopflocher; licensee BioMed Central Ltd.
Sales A.E.,University of Michigan |
Schalm C.,Alberta Health and Wellness |
Baylon M.A.,University of Alberta |
Fraser K.D.,University of Alberta
Implementation Science | Year: 2014
Background: There is considerable evidence about the effectiveness of audit coupled with feedback for provider behavior change, although few feedback interventions have been conducted in long-term care settings. The primary purpose of the Data for Improvement and Clinical Excellence-Long-Term Care (DICE-LTC) project was to assess the effects of a feedback intervention delivered to all direct care providers on resident outcomes. Our objective in this report is to assess the effect of feedback reporting on rates of pain assessment, depression screening, and falls over time. Methods: The intervention consisted of monthly feedback reports delivered to all direct care providers, facility and unit administrators, and support staff, delivered over 13 months in nine LTC units across four facilities. Data for feedback reports came from the Resident Assessment Instrument Minimum Data Set (RAI) version 2.0, a standardized instrument mandated in LTC facilities throughout Alberta. The primary evaluation used an interrupted time series design with a comparison group (units not included in the feedback intervention) and a comparison condition (pressure ulcers). We used segmented regression analysis to assess the effect of the feedback intervention. Results: The primary outcome of the study, falls, showed little change over the period of the intervention, except for a small increase in the rate of falls during the intervention period. The only outcome that improved during the intervention period was the proportion of residents with high pain scores, which decreased at the beginning of the intervention. The proportion of residents with high depression scores appeared to worsen during the intervention. Conclusions: Maintaining all nine units in the study for its 13-month duration was a positive outcome. The feedback reports, without any other intervention included, did not achieve the desired reduction in proportion of falls and elevated depression scores. The survey on intention to change pain assessment practice which was conducted shortly after most of the feedback distribution cycles may have acted as a co-intervention supporting a reduction in pain scores. The processing and delivery of feedback reports could be accomplished at relatively low cost because the data are mandated and could be added to other intervention approaches to support implementation of evidence-based practices.
Brindley P.G.,University of Alberta |
Simmonds M.R.,University of Alberta |
Needham C.J.,University of Alberta |
Simmonds K.A.,Alberta Health and Wellness
British Journal of Anaesthesia | Year: 2010
Background. The 'sniffing position' is widely promoted for teaching airway positioning before intubation, but whether this analogy results in novices placing the head and neck appropriately has not been evaluated. We compared performance following the sniffing position instructions with an alternate analogy, 'win with the chin'. We also compared performance following simple anatomic instructions and no instructions. Methods. A randomized controlled study of medical students and PGY1 registrars in Surgery and Internal Medicine was performed. Subjects independently positioned a simulator manikin head and neck based upon their understanding of four written instructions in random order: (i) the 'sniffing position'; (ii) the 'win with the chin' analogy, (iii) anatomic instructions; and (iv) no instructions (control). Digital photographs following each instruction were analysed by two airway experts for (i) adequacy of overall positioning and (ii) the three components of airway positioning. Results. Eighty-one volunteers participated. The positioning was adequate most often (43.2%) following the 'win with the chin' analogy when compared with the other instructions (37.0% anatomic instructions; 19.8% control; 14.8% 'sniffing position' analogy). Positioning following the 'sniffing position' instructions was not different from no instruction (P=0.53). The 'win with the chin' and anatomic instructions were significantly better than no instructions (P=0.002 and 0.023, respectively). Conclusions. The 'win with the chin' analogy resulted in adequate airway positioning significantly more often than the 'sniffing position' or control. It also maintained atlanto-occipital extension compared with anatomic instructions. Overall, 'win with the chin' was a superior teaching analogy and could replace the 'sniffing position' analogy. © The Author . Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.
Bedard T.,Alberta Health and Wellness
Journal of registry management | Year: 2012
The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10 CM) will be implemented on October 1, 2013 in the United States by institutions such as hospitals and insurance companies, and by surveillance programs and registries. The Alberta Congenital Anomalies Surveillance System (ACASS) experienced a transition in 2000, changing from the British Paediatric Association version of ICD-9 (ICD-9 BPA) to the Royal College of Paediatrics and Child Health adaptation of ICD-10 (ICD-10 RCPCH). Although the United States will use ICD-10 CM, the experiences discussed are applicable to birth defects programs in the United States. ACASS is funded by the Alberta Ministry of Health known as Alberta Health and Wellness (AHW) and is primarily a passive system covering approximately 50,000 annual births in the province of Alberta. Hospitals in Alberta changed from ICD-9 to an enhanced version of ICD-10 developed by the Canadian Institute for Health Information (ICD-10 CA) in 2002. Both ICD-10 RCPCH and ICD-10 CA are comparable; however, ICD-10 RCPCH offers a more detailed breakdown of some congenital anomaly categories. Although the implementation date for ICD-10 CA was to be in 2002, Alberta hospitals were aware in 1999 that the change would occur. This 3-year period allowed for preparation by ACASS prior to the required implementation.