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Krstic G.,Fraser Health
Journal of the Air and Waste Management Association | Year: 2017

This notebook paper provides a brief overview of attribution estimates for some key lung cancer risk factors, focusing on indoor radon gas exposure in the U.S., UK, and Canada. Tobacco smoking represents the primary cause of lung cancer worldwide. Radon is regarded as the second leading lung cancer risk factor in the U.S. and Canada. It can be observed, however, that the reported estimates appear not to add up to the maximum cumulative attribution of 100%. Implications: Limitations and uncertainties associated with published epidemiological studies and the observed lack of consistency in lung cancer attribution estimates for radon and other non-smoking lung cancer risk factors should be taken into consideration by policy makers in setting population health protection priorities. © 2017 A&WMA


Alamgir H.,Texas A&M University | Ngan K.,Occupational Health and Safety Agency for Healthcare | Drebit S.,Occupational Health and Safety Agency for Healthcare | Li H.G.,Occupational Health and Safety Agency for Healthcare | Keen D.,Fraser Health
Occupational Medicine | Year: 2011

Aims: To examine the demographic and workplace risk factors of serious falls and associated economic burden in Canadian health care workers. Methods: Fall Injury data during 2005-2008 from a workplace health and safety surveillance system were linked with workers' compensation claims and payroll records. The costs for treatment and wage loss and days lost for accepted time-loss claims were calculated. Demographic and work-related factors were identified to distinguish the risk for more serious falls from less serious falls. Results: Nine hundred and thirty -eight fall injury claims were captured among 48 519 full-time equivalent workers. Workers >60 years, part time or employed in the long-term care sector sustained a higher proportion of serious falls (>70%). Over 75% of falls were serious for care aides, facility support service workers and community health workers. In the multivariate analysis, the risk of serious falls remained higher for workers in the long-term care sector [odds ratio (OR) 1.71; P < 0.05] compared with those in acute care and for care aides (OR 1.72; P < 0.05), facility support service workers (OR 2.58; P < 0.01) and community health workers (OR 3.61; P < 0.001) compared with registered nurses (RNs). The median number of days lost was higher for females, long-term care workers, licensed practical nurses and care aides. Females, long-term care workers, RNs, licensed practical nurses, care aides and maintenance workers had the most costly falls. Conclusions: Reducing work-related serious fall injuries would be expected to bring about significant benefits in terms of reduced pain and suffering, improved workplace productivity, reduced absenteeism and reduced compensation costs. © The Author 2011. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved.


Krstic G.,Fraser Health
Journal of the Air and Waste Management Association | Year: 2013

A reduction in population exposure to fine particulate matter air pollution (PM2.5) has been associated with improvements in life expectancy. This article presents a reanalysis of this relationship and comments on the results from a study on the reduction of ambient air PM2.5 concentrations versus life expectancy in metropolitan areas of the United States. The results of the reanalysis show that the statistical significance of the correlation is lost after removing one of the metropolitan areas from the regression analysis, suggesting that the results may not be suitable for a meaningful and reliable inference.The observed loss of statistical significance in the correlation between the reduction of ambient air PM2.5 concentrations and life expectancy in metropolitan areas of the United States, after removing one of the metropolitan areas from the regression analysis, may raise concern for the policymakers in decisions regarding further reductions in permitted levels of air pollution emissions. © 2013 Copyright 2013 A&WMA.


Robertson T.,Fraser Health | Carter D.,Fraser Health
Canadian journal of neuroscience nursing | Year: 2013

INTRODUCTION: The purpose of this point-of-care study was to test the efficacy of a prevention-based oral care protocol in reducing non-ventilator-associated hospital-acquired pneumonia in a neurosurgical population outside the critical care environment. The researchers hypothesized that an enhanced oral care protocol would decrease the incidence of pneumonia.METHODS: This quasi-experimental, comparative study took place on an acute neurosurgical unit at a tertiary care trauma hospital in Western Canada. Subjects were non-intubated, care-dependent adults with a primary diagnosis of neurologic injury/insult, and at high risk for pneumonia. The prospective study group comprised 34 subjects; two subjects were excluded from the study analysis. The retrospective study group comprised 51 subjects. Data were collected for both groups for a six-month period. Retrospective data were collected through chart review. The prospective group were eligible neurosurgical patients who received the enhanced oral care protocol. Data collection tools were developed and diagnostic criteria for hospital-acquired pneumonia were determined. The pneumonia rates between subjects who received standard oral care (retrospective group) and those who received an enhanced, prevention-based, oral care protocol (prospective group) were compared.RESULTS: A statistically significant decrease in the pneumonia rate occurred in the prospective group (p < 0.05).DISCUSSION: An enhanced oral care protocol was beneficial in reducing the incidence of non-ventilator-associated hospital-acquired pneumonia.IMPLICATIONS: Nurses play a vital role in preventing hospital-acquired pneumonia. Foundational nursing practices, such as regular oral hygiene, are important aspects of care in preventing nosocomial infections and related costs, optimizing health, and promoting quality care.


Background: It has been proposed that vitamin D deficiency may be responsible for an increase in the prevalence of allergic diseases and asthma worldwide. Human ability to generate physiologically required quantities of vitamin D through sun exposure is decreasing with increasing geographical latitude. Objectives: Considering that vitamin D deficiency is usually due to lack of outdoor sun exposure, this study is designed to test the hypothesis that a higher prevalence of asthma should be expected at high relative to low geographical latitudes. Methods: Linear regression analyses are performed on asthma prevalence in the U.S. adult population vs. geographical latitude, insolation, air temperature, and air pollution (PM2.5) for 97 major metropolitan/micropolitan statistical areas of the continental United States of America and on general population asthma prevalence vs. geographical latitude in eight metropolitan areas of Australia. Results: A 10° change in geographical latitude from southern to northern regions of the Eastern Seaboard is associated with a 2% increase in adult asthma prevalence (p<0.001). Total insolation in winter months is almost as strong as latitude in its ability to explain the observed spatial variation in the prevalence of asthma (r2 = 0.43; p<0.001). Similar results are obtained using the Australian data (r2 = 0.73; p<0.01), suggesting a consistent association between the latitude/insolation and asthma prevalence worldwide. Conclusions: The results of this study suggest that, as a known modulator of the immune response closely linked with the geographical latitude and erythemal UV irradiation, vitamin D may play an important role in the development/exacerbation of asthma. © 2011 Goran Krstić.


Rowe H.,Fraser Health | Baker T.,Texas Tech University | Hale T.W.,Surrey Memorial Hospital
Pediatric Clinics of North America | Year: 2013

This article reviews the necessary skills required for clinicians to make informed decisions about the use of medications in women who are breastfeeding. Even without specific data on certain medications, this review of kinetic principles, mechanisms of medication entry into breast milk, and important infant factors can aid in clinical decision making. In addition, common medical conditions and suitable treatments of depression, hypertension, infections and so forth for women who are breastfeeding are also reviewed. © 2013 Elsevier Inc.


Background: Meteorological conditions and air pollution in urban environments have been associated with general population and elderly mortality, showing seasonal variation. Objectives: This study is designed to evaluate the relationship between apparent temperature (AT) and air pollution (PM 2.5) vs. mortality in elderly population of Metro Vancouver. Methods: Statistical analyses are performed on moving sum daily mortality rates vs. moving average AT and PM 2.5 in 1-, 2-, 3-, 5-, and 7-day models for all seasons, warm temperatures above 15°C, and cold temperatures below 10°C. Results: Approximately 37% of the variation in all-season mortality from circulatory and respiratory causes can be explained by the variation in 7-day moving average apparent temperature (r 2 = 0.37, p<0.001). Although the analytical results from air pollution models show increasingly better prediction ability of longer time-intervals (r 2 = 0.012, p<0.001 in a 7-day model), a very weak negative association between elderly mortality and air pollution is observed. Conclusions: Apparent temperature is associated with mortality from respiratory and circulatory causes in elderly population of Metro Vancouver. In a changing climate, one may anticipate to observe potential health impacts from the projected high- and particularly from the low-temperature extremes. © 2011 Goran Krstić.


Hon C.-Y.,University of British Columbia | Teschke K.,University of British Columbia | Chua P.,Fraser Health | Venners S.,Simon Fraser University | Nakashima L.,BC Cancer Agency
Safety and Health at Work | Year: 2011

Objectives: Studies examining healthcare workers' exposure to antineoplastic drugs have focused on the drug preparation or drug administration areas. However, such an approach has probably underestimated the overall exposure risk as the drugs need to be delivered to the facility, transported internally and then disposed. The objective of this study is to determine whether drug contamination occurs throughout a facility and, simultaneously, to identify those job categories that are potentially exposed. Methods: This was a multi-site study based in Vancouver, British Columbia. Interviews were conducted to determine the departments where the drugs travel. Subsequent site observations were performed to ascertain those surfaces which frequently came into contact with antineoplastic drugs and to determine the job categories which are likely to contact these surfaces. Wipe samples were collected to quantify surface contamination. Results: Surface contamination was found in all six stages of the hospital medication system. Job categories consistently found to be at risk of exposure were nurses, pharmacists, pharmacy technicians, and pharmacy receivers. Up to 11 job categories per site may be at risk of exposure at some point during the hospital medication system. Conclusion: We found drug contamination on select surfaces at every stage of the medication system, which indicates the existence of an exposure potential throughout the facility. Our results suggest that a broader range of workers are potentially exposed than has been previously examined. These results will allow us to develop a more inclusive exposure assessment encompassing all healthcare workers that are at risk throughout the hospital medication system. Copyright © 2011 by Safety and Health at Work (SH@W).


Schwenger E.,University of British Columbia | Dumontet J.,University of British Columbia | Dumontet J.,Fraser Health | Ensom M.H.H.,University of British Columbia | Ensom M.H.H.,Oak Street Health
Clinical Pharmacokinetics | Year: 2011

Olanzapine, a second-generation antipsychotic, is a first-line agent in the treatment of schizophrenia. The objective of this review was to determine whether olanzapine warrants clinical pharmacokinetic monitoring in patients with schizophrenia, using a previously published decision-making algorithm. Although olanzapine is an appropriate therapy for patients with schizophrenia and is readily measurable in biological fluids, significant interindividual variation exists in its pharmacokinetics. While the duration of therapy is expected to be long term, the correlation of olanzapine concentrations with efficacy and toxicity has not been well defined in the literature. There are multiple tools readily available for the assessment of efficacy in schizophrenia, and clinical signs and symptoms can be used to monitor both for efficacy and for adverse effects. Therefore, routine monitoring of olanzapine concentrations does not appear warranted in the general schizophrenic population. However, patients in whom a change in olanzapine pharmacokinetics is expected such as during addition or removal of an enzyme-inducing or -inhibiting drug, or during initiation or cessation of smoking may benefit from clinical pharmacokinetic monitoring, as would patients in whom non-compliance is suspected. Patients who fail to respond to maximum recommended doses and those who experience adverse effects from therapeutic doses may also benefit from therapeutic drug monitoring, as they may have inherent variations in hepatic enzyme activity. However, in the population at large who suffer from schizophrenia, monitoring of olanzapine concentrations is not expected to offer additional benefit beyond appropriate clinical monitoring alone. © 2011 Adis Data Information BV. All rights reserved.


Seto K.,University of British Columbia | Dumontet J.,University of British Columbia | Dumontet J.,Fraser Health | Ensom M.H.H.,University of British Columbia | Ensom M.H.H.,Oak Street Health
Therapeutic Drug Monitoring | Year: 2011

Background: Although risperidone is commonly used in the acute and maintenance treatment of schizophrenia, the role of therapeutic drug monitoring has yet to be elucidated. The purpose of this review was to determine whether risperidone warrants therapeutic drug monitoring in patients with schizophrenia. Methods: Using a previously published nine-step decision-making algorithm, the available evidence was examined to determine whether therapeutic drug monitoring of risperidone is warranted in adult schizophrenic patients. Results: Analytical methods used to quantify risperidone, 9-hydroxyrisperidone, and the combined active moiety are specific, sensitive, accurate, and precise; however, the therapeutic range for risperidone has not yet been established. Relationships between risperidone dose and plasma concentrations of risperidone, 9-hydroxyrisperidone, or the active moiety have not yet been demonstrated. A clear correlation between plasma risperidone concentrations and therapeutic response has also not been shown. Intrinsic interpatient variability, genetically based differences in drug metabolism, and metabolic drug interactions may all influence the variability in plasma concentrations. Patients with schizophrenia on risperidone for prevention of relapse take the medication for a sufficient duration of therapy to benefit from therapeutic drug monitoring; however, the routine use of risperidone concentrations in all patients with schizophrenia is not likely to have a significant impact on the clinical decision-making process or provide more information than clinical judgment alone. Conclusions: The routine use of risperidone levels does not seem warranted in all patients with schizophrenia. Clinical end points (ie, response and toxicity) should be monitored by assessing changes in symptoms and emergence of adverse effects, especially extrapyramidal symptoms. Therapeutic drug monitoring of risperidone may be beneficial in certain circumstances, including assessing potential noncompliance and supporting compliance, ruling out therapeutic failure as a result of low drug concentrations, and identifying and managing drug interactions, adverse effects, and use in special populations. Copyright © 2011 by Lippincott Williams & Wilkins.

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