Newfoundland and Labrador Center for Health Information

St. John's, Canada

Newfoundland and Labrador Center for Health Information

St. John's, Canada
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MacDonald D.,Newfoundland and Labrador Center for Health Information
Radiology management | Year: 2011

Referring physicians in theWestern Health Authority of Newfoundland and Labrador were administered a survey before and after PACS was implemented across all acute sites in the province.The survey had 31.7% and 35.0% response rates, respectively. There was considerable support found for PACS both pre- and post-implementation in the areas of exam access and review, PACS functionality, quality of reports, efficiency, and site-to-site professional consultations.There was limited support that PACS reduced hospital length of stay. Surveys such as the one employed in this study provide an opportunity to measure the perceived benefit and challenges of PACS in a relatively cost effective manner.

Donnan J.R.,University of Toronto | Donnan J.R.,Newfoundland and Labrador Center for Health Information | Ungar W.J.,University of Toronto | Ungar W.J.,Hospital for Sick Children | And 2 more authors.
Therapeutic Drug Monitoring | Year: 2011

Background: An increased understanding of the genetic basis of disease creates a demand for personalized medicine and more accurate testing for diagnosis and treatment. Thiopurine methyltransferase (TPMT) plays an important role in the metabolism of thiopurine drugs used in pediatric leukemia, rheumatoid arthritis, and inflammatory bowel disease. The objective was to review the literature systematically to ascertain the performance characteristics of current genotype and enzymatic testing technologies for TPMT. Methods: A systematic review of the literature was conducted to describe TPMT testing technologies. Eligible studies evaluated either a TPMT genotype or TPMT phenotype technology in comparison to a reference standard and expressed results in terms of sensitivity and specificity or positive/negative predictive value. The laboratory technique was recorded, and the quality of the identified studies was assessed using a modified Critical Appraisal Skills Program tool. Results: Seventeen studies were reviewed. The sensitivity and specificity of the genotype test ranged from 55% to 100% and from 94% to 100%, respectively. The sensitivity and specificity of the phenotype test ranged from 92% to 100% and from 86% to 98%, respectively. A variety of laboratory techniques were employed. Reviewed studies were of low methodological quality. Conclusions: The systematic review of TPMT test strategies found that available technologies demonstrated high values for sensitivity and specificity, however, there was a lack of a single gold standard and most studies were of poor quality. Disregard for study sample size and confounding factors such as concurrent medications and blood transfusions were the main contributors to low quality. There were also inconsistencies in the selection of a reference standard which complicated the interpretation of the findings. © 2011 by Lippincott Williams & Wilkins.

Roche M.M.,Newfoundland and Labrador Center for Health Information | Wang P.P.,Memorial University of Newfoundland
Diabetes Care | Year: 2013

OBJECTIVE-To compare risk of all-cause mortality, cardiovascular disease (CVD)mortality, acute myocardial infarction (AMI)mortality, strokemortality, and hospitalizations formales and females with and without diabetes and those with diabetes diagnosed early and late. RESEARCH DESIGN AND METHODS-We conducted a population-based retrospective cohort study including 73,783 individuals aged 25 years or older in Newfoundland and Labrador, Canada (15,152 with diabetes; 9,517 with late diagnoses). RESULTS-Males and females with diabetes had an increased risk of all-cause mortality, CVD mortality,AMImortality, and CVD hospitalizations compared with individuals without diabetes, and the risk was stronger in females than in males. For females, risks of all-cause mortality (hazard ratio [HR] 1.85 [95% CI 1.74-1.96]) and CVD hospitalizations (2.57 [2.24-2.94]) were significantly higher compared with their male counterparts (1.59 [1.51-1.69] and 1.92 [1.72- 2.14]). Females with diabetes diagnosed late had an increased risk of CVDmortality (6.54 [4.80- 8.91]) and CVD hospitalizations (5.22 [4.31-6.33]) compared with females without diabetes, and both were significantly higher compared with their male counterparts (3.44 [2.47-4.79]) and (3.33 [2.80-3.95]). CONCLUSIONS-Females with diabetes have a greater risk of mortality than males with diabetes. CVD has a greater impact on females with diabetes than males, especially when diagnosed at a later stage. Different management strategies should be considered for males and females and those with early and late diagnoses of diabetes. © 2013 by the American Diabetes Association.

Pullman D.,Memorial University of Newfoundland | Etchegary H.,Eastern Health Care Corporation | Gallagher K.,Memorial University of Newfoundland | Hodgkinson K.,Memorial University of Newfoundland | And 3 more authors.
Genetics in Medicine | Year: 2012

Purpose: To assess the publics perception of biobank research and the relative importance they place on concerns for privacy and confidentiality, when compared with other key variables when considering participation in biobank research. Methods: Conjoint analysis of three key attributes (research focus, research beneficiary, and privacy and confidentiality) under conditions of either blanket or specific consent. Results: Although the majority of our participants described themselves as private individuals, they consistently ranked privacy and confidentiality as the least important of the variables they considered. The potential beneficiary of proposed research ranked the highest under conditions of both blanket and specific consent. When completing the conjoint task under conditions of blanket consent, participants tended to act more altruistically. Conclusion: The public tends to view biobanks as public goods designed primarily for public benefit. As such it tends to act altruistically with respect to the potential benefits that might accrue from research using biobanked samples. Participants expressed little concern about informational risks (i.e., privacy and confidentiality) should they choose to participate. The manner in which policy priorities are framed could impact participant value preferences with regard to a number of governance issues in biobanking. © American College of Medical Genetics.

Roche M.M.,Newfoundland and Labrador Center for Health Information | Wang P.P.,Memorial University of Newfoundland
Journal of Clinical and Translational Endocrinology | Year: 2014

Aims To examine the factors associated with diabetes, a late diabetes diagnosis, and whether these factors are different for males and females. Methods Cross-sectional study including 7101 individuals aged ≥25 years in Newfoundland and Labrador, Canada (466 with diabetes; 332 diagnosed late). Logistic regression analysis was used to determine the factors associated with a diabetes diagnosis and late diabetes diagnosis. Results For males, overweight/obesity (HR, 1.35; 95% CI, 1.06-1.72) was positively associated with diabetes while being a regular/occasional drinker (HR, 0.53; 95% CI, 0.32-0.88) was inversely associated with diabetes. Living in a rural area (HR, 1.47; 95% CI, 1.01-2.15), receiving social assistance (HR, 2.80; 95% CI, 1.52-5.15), having poor self perceived health (HR, 2.06; 95% CI, 1.32-3.21), and considering most days stressful (HR, 1.45; 95% CI, 1.01-2.10) were positively associated with diabetes for females. No factors were significantly associated with a late diabetes diagnosis for males. Having a low education (OR, 0.33; 95% CI, 0.11-0.99) was inversely associated with a late diabetes diagnosis for females. Conclusions Different factors are associated with diabetes for males and females. Disadvantaged females appear to be at the greatest risk. The factors associated with a late diabetes diagnosis were also different for males and females. Females with lower education levels are diagnosed with diabetes earlier than females with higher education levels. Certain risk factors appear to impact males and females differently and more research is needed on how males and females develop diabetes and when they are diagnosed. © 2014 Published by Elsevier Inc. All rights reserved.

Worrall G.,St. John's University | Knight J.,Memorial University of Newfoundland | Knight J.,Newfoundland and Labrador Center for Health Information
Canadian Family Physician | Year: 2011

Objective: To examine the relationship between continuity of family physician care and all-cause mortality and acute hospitalizations in older people with diabetes. Design: Retrospective cohort study of administrative health databases. Continuity of family physician care for elderly patients newly diagnosed with diabetes was estimated by 3 continuity indexes using physician claims data. The relationship of continuity of family physician care to mortality and acute hospitalizations was investigated. Setting: The province of Newfoundland and Labrador. Participants: A total of 305 family practice patients 65 years of age or older with diabetes. Main outcome measures: Death rate and hospitalization rate during a 3-year period. Results: Overall, continuity of family physician care was high. In the 3 years examined, the higher-continuity group had lower rates of hospitalization (53.5% vs 68.2%) and death (8.6% vs 18.5%) than the lower-continuity group. Conclusion: The findings suggest an association between higher continuity of family physician care and reductions in likelihood of death and hospitalizations in older people with diabetes.

Newhook L.A.,Memorial University of Newfoundland | Newhook L.A.,Janeway Childrens Health and Rehabilitation Center | Penney S.,Janeway Childrens Health and Rehabilitation Center | Fiander J.,Memorial University of Newfoundland | Dowden J.,Newfoundland and Labrador Center for Health Information
BMC Research Notes | Year: 2012

Background: To study and update the provincial incidence of type 1 diabetes mellitus (T1DM) in Newfoundland and Labrador (NL), a province of Canada with a very high incidence previously reported in 2006, and one of the highest incidences reported worldwide. This is a retrospective time trend study of the incidence of T1DM, in children aged 0-14 years from 1987-2010 inclusive. Findings. Over the study period 931 children aged 0-14 years were diagnosed with T1DM. The incidence of T1DM in this population over the period 1987 - 2010 inclusive was 37.7 per 100,000 per year (95% CI 35. 3, 40.2).The incidence from 2007-2010 was 49.9 per 100,000 per year (95% CI 42.2, 57.6). The incidence over this 24 year period increased by a factor of 1.03 per 100,000 per year. Conclusion: NL has one of the highest incidences of T1DM reported worldwide. Potential reasons for the very high incidence could be related to the unique genetic background of the population, northern latitude and vitamin D insufficiency, low breastfeeding rates, and high rates of cesarean section. © 2012 Newhook et al.; licensee BioMed Central Ltd.

Sikdar K.C.,Memorial University of Newfoundland | Dowden J.,Newfoundland and Labrador Center for Health Information | Alaghehbandan R.,University of Sfax | MacDonald D.,University of Sfax | And 2 more authors.
Annals of Pharmacotherapy | Year: 2012

BACKGROUND: Although research has identified some risk factors for first-time adverse drug reactions (ADRs), little is known about the risks associated with the number of ADRs. Modeling ADR counts is relatively complex because of the rarity of the events, requiring careful consideration of appropriate models that best present the observed data. OBJECTIVE: To determine the incidence of ADRs among elderly hospitalized patients, assess patient-related risk factors for the number of ADRs, and review drug classes commonly responsible for ADRs. METHODS: This retrospective cohort study used a population-based large administrative database on hospital separations from all acute care hospitals in the Canadian province of Newfoundland and Labrador. Patients aged 65 years or older with at least 1 hospital admission from April 1, 1995, to March 31, 2007, were included. Comorbidities, Charlson Comorbidity Index (CCI), and sociodemographic factors were assessed as predictors of ADR counts. A zero-inflated negative binomial regression model was used for analysis. RESULTS: The study cohort contained 64,446 patients. The incidence of ADRs was 15.2 per 1000 person-years (95% CI 14.8 to 15.7). Of those having an ADR, 15.4% had recurrent ADRs. The most common drug category implicated in ADRs was cardiovascular agents (17.7%). A dose-response relationship was found between CCI and ADR counts (rate ratio [RR] 1.67, 95% CI 1.41 to 1.98 for CCI 2-3; RR 2.38, 95% CI 1.98 to 2.87 for CCI 4-5; and RR 3.83, 95% CI 3.21-4.57 for CCI ≥6). Comorbid conditions including congestive heart failure (RR 1.58, 95% CI 1.33 to 1.89), diabetes (RR 2.42, 95% CI 1.64 to 3.56), and cancer (RR 3.12, 95% CI 2.58 to 3.76) were strong predictors. Rural areas (RR 1.22, 95% CI 1.01 to 1.46) were associated with increased risk for ADRs, whereas age and sex had no effect. CONCLUSIONS: Comorbidity from chronic diseases and severity of illness, rather than individual characteristics (advancing age and sex), increased the likelihood of ADRs. Changes in the delivery of care focusing on the monitoring of prescribed drugs in elderly patients with comorbidities could mitigate ADRs.

Edwards N.M.,Newfoundland and Labrador Center for Health Information | Audas R.P.,Memorial University of Newfoundland
Canadian Journal of Public Health | Year: 2010

Objectives: The objective of this study was to investigate whether any observed trends in birthweight are accompanied by changes in maternal socio-demographic characteristics, including age, marital status, and education. Methods: We conducted a population-based study of term singletons born in Newfoundland and Labrador, Canada, between 1992 and 2005 (N=66,638). Large-sample significance tests for two population proportions were used to test whether differences in mean birthweight, the proportion of low and high birthweight infants, and differences in maternal socio-demographic characteristics between 1992-95 and 2002-05 were statistically significant. Chi-square tests were used to test for associations between birthweight group and maternal age, education and marital status. Multivariate logistic regression was used to examine the interaction of these effects across time periods. Results: Of the 66,638 infants included in the study, 54,256 (81.4%) were born in the normal birthweight range (2500-4000 grams) while 11,305 (17.0%) were high birthweight (>4000 grams) and 1,077 (1.6%) were low birthweight (<2500 grams). The rate of low birthweight significantly decreased from 1992 to 1995 compared to the period 2002 to 2005 (1.9% to 1.3%: p<0.01). The rate of high birthweight significantly increased over the same two time periods (16.2% to 17.5%: p<0.01). Mean birthweight increased from 3529 grams to 3566 grams (p<0.01). Compared to women who had babies from 1992 to 1995, women who gave birth from 2002 to 2005 were more likely to be older, have higher levels of education, and never have been married. Birthweight outcomes were significantly associated with mother's age, education and marital status. Conclusion: Changes in maternal demographics are associated with the upward shift in birthweight in Newfoundland and Labrador. © Canadian Public Health Association, 2010. All rights reserved.

Cadigan N.G.,Northwest Atlantic Fisheries Center | Dowden J.J.,Newfoundland and Labrador Center for Health Information
Fishery Bulletin | Year: 2010

Paired-tow calibration studies provide information on changes in survey catchability that may occur because of some necessary change in protocols (e.g., change in vessel or vessel gear) in a fish stock survey. This information is important to ensure the continuity of annual time-series of survey indices of stock size that provide the basis for fish stock assessments. There are several statistical models used to analyze the paired-catch data from calibration studies. Our main contributions are results from simulation experiments designed to measure the accuracy of statistical inferences derived from some of these models. Our results show that a model commonly used to analyze calibration data can provide unreliable statistical results when there is between-tow spatial variation in the stock densities at each paired-tow site. However, a generalized linear mixed-effects model gave very reliable results over a wide range of spatial variations in densities and we recommend it for the analysis of paired-tow survey calibration data. This conclusion also applies if there is between-tow variation in catchability.

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