Dalla Lana School of Public Health

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The Dalla Lana School of Public Health (DLSPH), a Faculty of the University of Toronto, is a regional and global leader in public health education, research and service, with the largest concentrations of academic population and public health researchers in Canada and over $30 million in research funding per year.

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A scoping review and thematic analysis of social and behavioural research among HIV-serodiscordant couples in high-income settings
(2015-03-13) Mendelsohn, Joshua B; Calzavara, Liviana; Daftary, Amrita; Mitra, Sanjana; Pidutti, Joel; Allman, Dan; Bourne, Adam; Loutfy, Mona; Myers, Ted
Abstract Background While HIV incidence has stabilized in many settings, increases in health and wellbeing among many people living with HIV/AIDS suggest that the number of HIV-serodiscordant relationships is growing. Given the deficit of reviews addressing social and behavioural characteristics of HIV-serodiscordant couples within high-income settings, our objective was to understand the scope of the published literature, identify evidence gaps, and suggest future research needs. Methods Ten electronic databases were searched. Studies were included if they were reported in English, used primary data, were from the combination antiretroviral (cART) era (>1996), reported on social or behavioural aspects, included any fraction of primary (i.e., stable) relationships, and were conducted in high-income settings. Studies that identified their unit of analysis as either the dyad or individual member of the couple were included. Studies were coded according to a thematic framework. Results Included studies (n = 154) clustered into eight themes: risk behaviours (29%), risk management (26%), reproductive issues (12%), relationship quality (9%), serostatus disclosure (7%), adherence to antiretroviral therapy (7%), vulnerability (5%), and social support (3%). The proportion of studies conducted among heterosexual couples, same-sex male couples, and mixed cohorts were 42%, 34%, and 24%, respectively. Most studies (70%) were conducted in the United States, 70% of all studies were quantitative (including interventions), but only one-third were focused on couples (dyads) where both partners are recruited to a study. Over 25% of studies focused on sexual risk among same-sex male couples. Conclusions Future research efforts should focus on the interrelationship of risk management strategies and relationship quality, social determinants of health and wellbeing, HIV testing, vulnerable populations, reproductive issues among same-sex couples, disclosure of serodiscordant status to social networks, dyadic studies, population-based studies, and interventions to support risk management within couples. Additional population-based studies and studies among marginalized groups would be helpful for targeting research and interventions to couples that are most in need. As HIV-positive partners are typically the link to services and research, innovative ways are needed for reaching out to HIV-negative partners. Our review suggests that significantly more research is needed to understand the social and behavioural contexts of HIV-serodiscordant relationships.
Agreement between a health claims algorithm and parent-reported asthma in young children
(2019-07-22) Omand, Jessica A; Maguire, Jonathon L; O'Connor, Deborah L; Parkin, Patricia C; Birken, Catherine S; Thorpe, Kevin E; Zhu, Jingqin; To, Teresa
Introduction: Asthma prevalence is commonly measured in national surveys by questionnaire. The Ontario Asthma Surveillance Information System (OASIS) developed a validated health claims diagnosis algorithm to estimate asthma prevalence. The primary objective was to assess the agreement between two approaches of measuring asthma in young children. Secondary objectives were to identify concordant and discordant pairs, and to identify factors associated with disagreement. Study design and setting: A measurement study to evaluate the agreement between the OASIS algorithm and parent‐reported asthma (criterion standard). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Multivariable logistic regression was used to determine factors associated with disagreement. Results: Healthy children aged 1 to 5 years (n =3642) participating in the TARGet Kids! practice based research network 2008‐2013 in Toronto, Canada were included. Prevalence of asthma was 14% and 6% by the OASIS algorithm and parent‐reported asthma, respectively. The Kappa statistic was 0.43, sensitivity 81%, specificity 90%, PPV 34%, and NPV 99%. There were 3249 concordant and 393 discordant pairs. Statistically significant factors associated with asthma identified by OASIS but not parent report included: male sex, higher zBMI, and parent history of asthma. Males were less likely to have asthma identified by parent report but not OASIS. Conclusion: The OASIS algorithm identified more asthma cases in young children than parent‐reported asthma. The OASIS algorithm had high sensitivity, specificity, and NPV but low PPV relative to parent‐reported asthma. These findings need replication in other populations.
An analysis of the implementation of PEPFAR's anti-prostitution pledge and its implications for successful HIV prevention among organizations working with sex workers
(2013-03-28) Ditmore, Melissa Hope; Allman, Dan
Introduction: Since 2003, US government funding to address the HIV and AIDS pandemic has been subject to an anti-prostitution clause. Simultaneously, the efficacy of some HIV prevention efforts for sex work in areas receiving US government funding has diminished. This article seeks to explain why. Methods: This analysis utilizes a case story approach to build a narrative of defining features of organizations in receipt of funding from the President’s Emergency Plan for AIDS Relief (PEPFAR) and other US funding sources. For this analysis, multiple cases were compiled within a single narrative. This helps show restrictions imposed by the anti-prostitution clause, any lack of clarity of guidelines for implementation and ways some agencies, decision-making personnel, and staff on the ground contend with these restrictions. Results: Responses to PEPFAR’s anti-prostitution clause vary widely and have varied over time. Organizational responses have included ending services for sex workers, gradual phase-out of services, cessation of seeking US government HIV funds and increasing isolation of sex workers. Guidance issued in 2010 did not clarify what was permitted. Implementation and enforcement has been dependent in part on the interpretations of this policy by individuals, including US government representatives and organizational staff. Conclusions: Different interpretations of the anti-prostitution clause have led to variations in programming, affecting the effectiveness of work with sex workers. The case story approach proved ideal for working with information like this that is highly sensitive and vulnerable to breach of anonymity because the method limits the potential to betray confidences and sources, and limits the potential to jeopardize funding and thereby jeopardize programming. This method enabled us to use specific examples without jeopardizing the organizations and individuals involved while demonstrating unintended consequences of PEPFAR’s anti-prostitution pledge in its provision of services to sex workers and clients.
Anthropometric measurements in Canadian children: A scoping review.
(Canadian Public Health Association, 2013) Patton, I ; McPherson, AC
Objective The objective of the current study was identifying what forms of anthropometric measurement are currently being utilized with Canadian children and youth and what are the gaps in the literature on this topic. Method The current study utilized a scoping review methodology in order to achieve the study objectives. Online databases Medline and PubMed and CINAHLwere used to search articles from the last decade (2002-2012) that addressed Canadian children aged 2 years-18 years. Synthesis 50 studies were included in this review. A variety of anthropometric measurements were identified including body mass index, waist circumference, hip-to-waist ratio among others. Six of the included studies (12%) utilized nationally representative data from large scale studies. BMI was the most reported form of measurement with 88% of studies colleting it. Waist circumference was a distant second with 20% of studies reporting it. Several gaps in the literature exist, with regards to First Nations (FN) research, many of the measurement methods were not used. Additionally FN accounted for only 2.5% of the study’s sample. The majority of studies took place in Quebec (29%) and Ontario (27%). Conclusion Body mass index is the most reported method of anthropometric measurement used for children. Efforts should be taken by health care practitioners and researchers to collect other forms of measurement in order to assist in understanding the validity of other measures and their value when used with children. Furthermore, attention needs to be put into utilizing and studying various forms of anthropometric measurement across all Canadian regions and populations.
Antineoplastic drug contamination in the urine of Canadian healthcare workers
(Springer Verlag, 2015-10) Hon, Chun-Yip; Teschke, Kay; Shen, Hui; Demers, Paul A.; Venners, Scott
Purpose: The purpose of this study was to quantify the urine concentration of non-metabolized cyclophosphamide (CP), a commonly administered antineoplastic drug, among potentially exposed Canadian healthcare workers and to identify factors associated with the drug concentration levels. Methods: Participants were asked to provide two sets of 24-h urine samples (at two different sampling events), and the level of CP was quantified using high-performance liquid chromatography–tandem mass spectrometry. In addition to demographic information, participants were surveyed regarding their frequency of handling of antineoplastic drugs, safe drug handling training, and known contact with CP on their work shift. Descriptive and inferential statistical analyses were performed. A backward stepwise linear mixed effect model was conducted to identify the factors associated with urine concentration levels. Results: We collected 201 urine samples, and 55 % (n = 111) had levels greater than the LOD of 0.05 ng/mL. The mean urinary CP concentration was 0.156 ng/mL, the geometric mean was 0.067 ng/mL, the geometric standard deviation was 3.18, the 75th percentile was 0.129 ng/mL, and the range was
Antineoplastic drug contamination on the hands of employees working throughout the hospital medication system
(Oxford University Press, 2014-07) Hon, Chun-Yip; Teschke, Kay; Demers, Paul A.; Venners, Scott
We previously reported that antineoplastic drug contamination is found on various work surfaces situated throughout the hospital medication system (process flow of drug within a facility from initial delivery to waste disposal). The presence of drug residual on surfaces suggests that healthcare workers involved in some capacity with the system may be exposed through dermal contact. The purpose of this paper was to determine the dermal contamination levels of healthcare employees working throughout a hospital and to identify factors that may influence dermal contamination. We selected participants from six hospitals and wiped the front and back of workers' hands. Wipe samples were analyzed for cyclophosphamide (CP), a commonly used antineoplastic drug, using high-performance liquid chromatography-tandem mass spectrometry. Participants were asked about their frequency of handling antineoplastic drugs, known contact with CP on their work shift, gender, job title, and safe drug handling training. In addition, participants were surveyed regarding their glove usage and hand washing practices prior to wipe sample collection. We collected a total of 225 wipe samples. Only 20% (N = 44) were above the limit of detection (LOD) of 0.36ng per wipe. The average concentration was 0.36ng per wipe, the geometric mean < LOD, the geometric standard deviation 1.98, and the range < LOD to 22.8ng per wipe. Hospital employees were classified into eight different job categories and all categories had some dermal contamination levels in excess of the LOD. The job category with the highest proportion of samples greater than the LOD were those workers in the drug administration unit who were not responsible for drug administration (volunteer, oncologist, ward aide, dietician). Of note, the highest recorded concentration was from a worker who had no known contact with CP on their work shift. Our results suggest that a broader range of healthcare workers than previously believed, including those that do not directly handle or administer the drugs (e.g. unit clerks, ward aides, dieticians, and shipper/receivers), are at risk of exposure to antineoplastic drugs. A review of control measures to minimize antineoplastic drug exposure that encompasses a wide array of healthcare workers involved with the hospital medication system is recommended.
Applying activity based costing in long term care
(Canadian College of Health Service Executives, 1998-11) Wodchis, Walter P
As greater numbers of elderly use health services and health care costs climb, effective financial tracking is an essential activity. Cost management in health care can benefit if costs are linked to the care activities where they are incurred. Activity based costing (ABC) provides a useful approach. The framework aligns costs (inputs) through activities (process) to outputs and outcomes. It allocates costs based on client care needs rather than management structure. The ABC framework was tested in a residential care facility and in supportive housing apartments. The results demonstrate the feasibility and advantages of ABC for long term care agencies, including community based care.
The art and science of knowledge synthesis
(Elsevier, 2010-03-01) Tricco, Andrea C; Tetzlaff, Jennifer; Moher, David
Objectives: To review methods for completing knowledge synthesis. Study Design and Setting: We discuss how to complete a broad range of knowledge syntheses. Our article is intended as an introductory guide. Results: Many groups worldwide conduct knowledge syntheses, and some methods are applicable to most reviews. However, variations of these methods are apparent for different types of reviews, such as realist reviews and mixed-model reviews. Review validity is dependent on the validity of the included primary studies and the review process itself. Steps should be taken to avoid bias in the conduct of knowledge synthesis. Transparency in reporting will help readers assess review validity and applicability, increasing its utility. Conclusion: Given the magnitude of the literature, the increasing demands on knowledge syntheses teams, and the diversity of approaches, continuing efforts will be important to increase the efficiency, validity, and applicability of systematic reviews. Future research should focus on increasing the uptake of knowledge synthesis, how best to update reviews, the comparability between different types of reviews (eg, rapid vs. comprehensive reviews), and how to prioritize knowledge synthesis topics.
Articulating connections between the harm-reduction paradigm and the marginalisation of people who use illicit drugs
(2016-07) Souleymanov, Rusty; Allman, Dan
In this paper, we argue for the importance of unsettling dominant narratives in the current terrain of harm-reduction policy, practice and research. To accomplish this, we trace the historical developments regarding the Human Immunodeficiency Virus (HIV), the Hepatitis C Virus (HCV) and harm-reduction policies and practice. We argue that multiple historical junctures rather than single causes of social exclusion engender the processes of marginalisation, propelled by social movements, institutional interests, state legislation, community practices, neo-liberalism and governmentality techniques. We analyse interests (activist, lay expert, institutional and state) in the harm-reduction field, and consider conceptualisations of risk, pleasure, stigma, social control and exclusionary moral identities. Based on our review of the literature, this paper provides recommendations for social workers and others delivering health and social care interested in the fields of substance use, HIV prevention and harm reduction.
Assessing the carcinogenic potential of low-dose exposures to chemical mixtures in the environment: the challenge ahead
(Oxford University Press, 2015-06) Goodson, William H.; Lowe, Leroy; Carpenter, David O.; Gilbertson, Michael; Manaf Ali, Abdul; Lopez de Cerain Salsamendi, Adela; Lasfar, Ahmed; Carnero, Amancio; Azqueta, Amaya; Amedei, Amedeo; Charles, Amelia K.; Collins, Andrew R.; Ward, Andrew; Salzberg, Anna C.; Colacci, Annamaria; Olsen, Ann-Karin; Berg, Arthur; Barclay, Barry J.; Zhou, Binhua P.; Blanco-Aparicio, Carmen; Baglole, Carolyn J.; Dong, Chenfang; Mondello, Chiara; Hsu, Chia-Wen; Naus, Christian C.; Yedjou, Clement; Curran, Colleen S.; Laird, Dale W.; Koch, Daniel C.; Carlin, Danielle J.; Felsher, Dean W.; Roy, Debasish; Brown, Dustin G.; Ratovitski, Edward; Ryan, Elizabeth P.; Corsini, Emanuela; Rojas, Emilio; Moon, Eun-Yi; Laconi, Ezio; Marongiu, Fabio; Al-Mulla, Fahd; Chiaradonna, Ferdinando; Darroudi, Firouz; Martin, Francis L.; Van Schooten, Frederik J.; Goldberg, Gary S.; Wagemaker, Gerard; Nangami, Gladys N.; Calaf, Gloria M.; Williams, Graeme; Wolf, Gregory T.; Koppen, Gudrun; Brunborg, Gunnar; Lyerly, H. Kim; Krishnan, Harini; Ab Hamid, Hasiah; Yasaei, Hemad; Sone, Hideko; Kondoh, Hiroshi; Salem, Hosni K.; Hsu, Hsue-Yin; Park, Hyun Ho; Koturbash, Igor; Miousse, Isabelle R.; Scovassi, A. Ivana; Klaunig, James E.; Vondráček, Jan; Raju, Jayadev; Roman, Jesse; Wise, John Pierce; Whitfield, Jonathan R.; Woodrick, Jordan; Christopher, Joseph A.; Ochieng, Josiah; Martinez-Leal, Juan Fernando; Weisz, Judith; Kravchenko, Julia; Sun, Jun; Prudhomme, Kalan R.; Narayanan, Kannan Badri; Cohen-Solal, Karine A.; Moorwood, Kim; Gonzalez, Laetitia; Soucek, Laura; Jian, Le; D'Abronzo, Leandro S.; Lin, Liang-Tzung; Li, Lin; Gulliver, Linda; McCawley, Lisa J.; Memeo, Lorenzo; Vermeulen, Louis; Leyns, Luc; Zhang, Luoping; Valverde, Mahara; Khatami, Mahin; Romano, Maria Fiammetta; Chapellier, Marion; Williams, Marc A.; Wade, Mark; Manjili, Masoud H.; Lleonart, Matilde E.; Xia, Menghang; Gonzalez, Michael J.; Karamouzis, Michalis V.; Kirsch-Volders, Micheline; Vaccari, Monica; Kuemmerle, Nancy B.; Singh, Neetu; Cruickshanks, Nichola; Kleinstreuer, Nicole; van Larebeke, Nik; Ahmed, Nuzhat; Ogunkua, Olugbemiga; Krishnakumar, P. K.; Vadgama, Pankaj; Marignani, Paola A.; Ghosh, Paramita M.; Ostrosky-Wegman, Patricia; Thompson, Patricia A.; Dent, Paul; Heneberg, Petr; Darbre, Philippa; Sing Leung, Po; Nangia-Makker, Pratima; Cheng, Qiang Shawn; Robey, R Brooks; Al-Temaimi, Rabeah; Roy, Rabindra; Andrade-Vieira, Rafaela; Sinha, Ranjeet K.; Mehta, Rekha; Vento, Renza; Di Fiore, Riccardo; Ponce-Cusi, Richard; Dornetshuber-Fleiss, Rita; Nahta, Rita; Castellino, Robert C.; Palorini, Roberta; Abd Hamid, Roslida; Langie, Sabine A. S.; Eltom, Sakina E.; Brooks, Samira A.; Ryeom, Sandra; Wise, Sandra S.; Bay, Sarah N.; Harris, Shelley A.; Papagerakis, Silvana; Romano, Simona; Pavanello, Sofia; Eriksson, Staffan; Forte, Stefano; Casey, Stephanie C.; Luanpitpong, Sudjit; Lee, Tae-Jin; Otsuki, Takemi; Chen, Tao; Massfelder, Thierry; Sanderson, Thomas; Guarnieri, Tiziana; Hultman, Tove; Dormoy, Valérian; Odero-Marah, Valerie; Sabbisetti, Venkata; Maguer-Satta, Veronique; Rathmell, W Kimryn; Engström, Wilhelm; Decker, William K.; Bisson, William H.; Rojanasakul, Yon; Luqmani, Yunus; Chen, Zhenbang; Hu, Zhiwei
Lifestyle factors are responsible for a considerable portion of cancer incidence worldwide, but credible estimates from the World Health Organization and the International Agency for Research on Cancer (IARC) suggest that the fraction of cancers attributable to toxic environmental exposures is between 7% and 19%. To explore the hypothesis that low-dose exposures to mixtures of chemicals in the environment may be combining to contribute to environmental carcinogenesis, we reviewed 11 hallmark phenotypes of cancer, multiple priority target sites for disruption in each area and prototypical chemical disruptors for all targets, this included dose-response characterizations, evidence of low-dose effects and cross-hallmark effects for all targets and chemicals. In total, 85 examples of chemicals were reviewed for actions on key pathways/mechanisms related to carcinogenesis. Only 15% (13/85) were found to have evidence of a dose-response threshold, whereas 59% (50/85) exerted low-dose effects. No dose-response information was found for the remaining 26% (22/85). Our analysis suggests that the cumulative effects of individual (non-carcinogenic) chemicals acting on different pathways, and a variety of related systems, organs, tissues and cells could plausibly conspire to produce carcinogenic synergies. Additional basic research on carcinogenesis and research focused on low-dose effects of chemical mixtures needs to be rigorously pursued before the merits of this hypothesis can be further advanced. However, the structure of the World Health Organization International Programme on Chemical Safety 'Mode of Action' framework should be revisited as it has inherent weaknesses that are not fully aligned with our current understanding of cancer biology.
Assessment of a multimedia-based prospective method to support public deliberations on health technology design: participant survey findings and qualitative insights
(BioMed Central, 2016-10-26) Lehoux, P; Jimenez-Pernett, J; Miller, F A; Williams-Jones, B
Background Using a combination of videos and online short stories, we conducted four face-to-face deliberative workshops in Montreal (Quebec, Canada) with members of the public who later joined additional participants in an online forum to discuss the social and ethical implications of prospective technologies. This paper presents the participants’ appraisal of our intervention and provides novel qualitative insights into the use of videos and online tools in public deliberations. Methods We applied a mixed-method study design. A self-administered survey contained open- and close-ended items using a 5-level Likert-like scale. Absolute frequencies and proportions for the close-ended items were compiled. Qualitative data included field notes, the transcripts of the workshops and the participants’ contributions to the online forum. The qualitative data were used to flesh out the survey data describing the participants’ appraisal of: 1) the multimedia components of our intervention; 2) its deliberative face-to-face and online processes; and 3) its perceived effects. Results Thirty-eight participants contributed to the workshops and 57 to the online forum. A total of 46 participants filled-in the survey, for a response rate of 73 % (46/63). The videos helped 96 % of the participants to understand the fictional technologies and the online scenarios helped 98 % to reflect about the issues raised. Up to 81 % considered the arguments of the other participants to be well thought-out. Nearly all participants felt comfortable sharing their ideas in both the face-to-face (89 %) and online environments (93 %), but 88 % preferred the face-to-face workshop. As a result of the intervention, 85 % reflected more about the pros and cons of technology and 94 % learned more about the way technologies may transform society. Conclusions This study confirms the methodological feasibility of a deliberative intervention whose originality lies in its use of videos and online scenarios. To increase deliberative depth and foster a strong engagement by all participants, face-to-face and online components need to be well integrated. Our findings suggest that online tools should be designed by considering, one the one hand, the participants’ self-perceived ability to share written comments and, on the other hand, the ease with which other participants can respond to such contributions.
Assessment of thiopurine S-methyltransferase activity in patients prescribed thiopurines: a systematic review
(American College of Physicians, 2011-06-21) Booth, Ronald A; Ansari, Mohammed T; Loit, Evelin; Tricco, Andrea C; Weeks, Laura; Doucette, Steve; Skidmore, Becky; Sears, Margaret; Sy, Richmond; Karsh, Jacob
Background: The evidence base for testing thiopurine methyltransferase (TPMT) enzymatic activity or genotype before thiopurine therapy is unclear. Purpose: To examine the sensitivity and specificity of TPMT genotyping with reference to TPMT enzymatic activity, thiopurine harms reduction with pretesting, and association of thiopurine toxicity with TPMT status in adults and children with chronic inflammatory diseases. Data Sources: MEDLINE, EMBASE, the Cochrane Library, and Healthstar from inception to December 2010; and BIOSIS and Genetics Abstracts to May 2009 were searched. Study Selection: Two reviewers screened records and identified relevant studies in English. Data Extraction: One author extracted, and another independently verified, data on patient characteristics, outcomes, and risks of bias. Data Synthesis: 54 observational studies and one RCT were included.Insufficient evidence addressed pre-testing effectiveness. Genotyping sensitivity to identify patients with low and intermediate TPMT enzymatic activity ranged from 70.33% to 86.15% (95% CI, lower bound 54.52% to 70.88%; upper bound 78.50% to 96.33%). There is sparse data of genotype sensitivity to identify patients with low to absent enzymatic activity. Genotyping specificity approached 100%. Compared with noncarriers, heterozygous and homozygous genotypes were associated with leukopenia (OR 4.29, 95% CI 2.67, 6.89; OR 20.84, 95% CI 3.42, 126.89, respectively). Compared with intermediate or normal activities, low TPMT enzymatic activity was significantly associated with myelotoxicity and leukopenia. Limitations: Available evidence is not rigorous and underpowered to detect a difference in outcomes. Conclusions: Insufficient evidence addresses TPMT pre-testing effectiveness in patients with chronic inflammatory diseases. Estimates of sensitivity of genotyping are imprecise. Evidence confirms known associations of leukopenia and/or myelotoxicity with reduced TPMT activity or variant genotype.
The assessment of weight status in children and young people attending a spina bifida outpatient clinic: a retrospective medical record review
(Psychology Press, Taylor & Francis Group, 2013) McPherson, AC; Swift, JA; Yung, E; Lyons, J; Church, P
Purpose Children with disabilities are 2-3 times more likely to become overweight or obese than typically developing children. Children with spina bifida (SB) are at particular risk, yet obesity prevalence and weight-management with this population are under-researched. This retrospective chart review explored how weight is assessed and discussed in a children’s SB outpatient clinic. Method Height/weight data were extracted from records of children aged 2-18 with a diagnosis of SB attending an outpatient clinic at least once between June 2009 – 2011. Body Mass Index (BMI) was calculated and classified using CDC cut-offs. Notes around weight, diet and physical/sedentary activities were transcribed verbatim and analysed using descriptive thematic analysis. Results Of 180 eligible patients identified, only 63 records had sufficient data to calculate BMI; 15 patients were overweight (23.81%) and 11 obese (17.46%). Weight and physical activity discussions typically related to function (e.g. mobility, pain). Diet discussions focused on bowel and bladder function and dietary challenges. Conclusions Anthropometrics were infrequently recorded, leaving an incomplete picture of weight status in children with SB and suggesting that weight is not prioritized. Bowel/bladder function was highlighted over other benefits of a healthy bodyweight, indicating that health promotion opportunities are being missed.
The association between loneliness and medication use in older adults
(Oxford University Press, 2020-09-14) Vyas, Manav V; Watt, Jennifer A; Yu, Amy Y X; Straus, Sharon E; Kapral, Moira K
Background: Loneliness is common in older adults, and it is associated with unhealthy behaviours, including substance use. We evaluated the association between loneliness and self-reported use of opioids and benzodiazepines in older adults. Methods: We used data from the Canadian Community Health Survey’s ‘Healthy Aging’ sub-survey and included adults 65 years or older who administered their own medications. We classified individuals as lonely if they scored 6 or more on the three -item University of California, Los Angeles’s Loneliness Scale. We used multinomial logistic regression models, adjusting for demographics and self-reported comorbidities, to describe the association between loneliness and daily or occasional use of opioids, benzodiazepines and non-opioid analgesics. We also explored the association between loneliness and polypharmacy. Results: Our cohort included 15,302 older adults, of whom 2,096 (13.7%) were classified as lonely. Daily use of opioids (4.1%) and benzodiazepines (1.7%) were less common than daily use of non-opioid analgesics (33.9%). Lonely older adults had higher daily use of opioids (odds ratio [OR] 1.61, 1.31-1.98) and benzodiazepines (OR 1.66, 1.21-2.28), but not non-opioid analgesics (OR 1.05, 0.92-1.19). Loneliness was not associated with occasional use of opioids, benzodiazepines or non-opioid analgesics in older adults, but was associated with polypharmacy (OR 1.27, 1.06-1.52). Conclusions: Loneliness in older adults is associated with increased daily use of opioids and benzodiazepines. Further research should evaluate patient- and physician-level factors that mediate this association, and develop strategies to mitigate loneliness and its attendant adverse outcomes.
Atypical antipschotic drugs and risk of ischemic storke: population based retrospective cohort study
(BMJ Publishing Group Limited, 2005-01) Gill, S.S. ; Rochon, P.A. ; Herrmann, N. ; Lee, P.E. ; Sykora, K. ; Gunraj, N. ; Normand, S-L. T. ; Gurwitz, J.H. ; Marras, C. ; Wodchis, W.P ; Mamdani, M.
Objective To compare the incidence of admissions to hospital for stroke among older adults with dementia receiving atypical or typical antipsychotics. Design Population based retrospective cohort study. Setting Ontario, Canada. Patients 32 710 older adults ( ≥ 65 years) with dementia (17 845 dispensed an atypical antipsychotic and 14 865 dispensed a typical antipsychotic). Main outcome measures Admission to hospital with the most responsible diagnosis (single most important condition responsible for the patient’s admission) of ischaemic stroke. Observation of patients until they were either admitted to hospital with ischaemic stroke, stopped taking antipsychotics, died, or the study ended. Results After adjustment for potential confounders, participants receiving atypical antipsychotics showed no significant increase in risk of ischaemic stroke compared with those receiving typical antipsychotics (adjusted hazard ratio 1.01, 95% confidence interval 0.81 to 1.26). This finding was consistent in a series of subgroup analyses, including ones of individual atypical antipsychotic drugs (risperidone, olanzapine, and quetiapine) and selected subpopulations of the main cohorts. Conclusion Older adults with dementia who take atypical antipsychotics have a similar risk of ischaemic stroke to those taking typical antipsychotics.
Atypical antipsychotic drugs and risk of ischaemic stroke: population based retrospective cohort study
(BMJ publish group, 2005-02) Gill, Sudeep S ; Rochon, P.A ; Herrmann, N ; Lee, P E ; Sykora, K ; Gunraj, N ; Normand, S L ; Gurwitz, J H ; Marras, C ; Wodchis, Walter P ; Mamdani, M
Objective To compare the incidence of admissions to hospital for stroke among older adults with dementia receiving atypical or typical antipsychotics. Design Population based retrospective cohort study. Setting Ontario, Canada. Patients 32 710 older adults ( ≥ 65 years) with dementia (17 845 dispensed an atypical antipsychotic and 14 865 dispensed a typical antipsychotic). Main outcome measures Admission to hospital with the most responsible diagnosis (single most important condition responsible for the patient’s admission) of ischaemic stroke. Observation of patients until they were either admitted to hospital with ischaemic stroke, stopped taking antipsychotics, died, or the study ended. Results After adjustment for potential confounders, participants receiving atypical antipsychotics showed no significant increase in risk of ischaemic stroke compared with those receiving typical antipsychotics (adjusted hazard ratio 1.01, 95% confidence interval 0.81 to 1.26). This finding was consistent in a series of subgroup analyses, including ones of individual atypical antipsychotic drugs (risperidone, olanzapine, and quetiapine) and selected subpopulations of the main cohorts. Conclusion Older adults with dementia who take atypical antipsychotics have a similar risk of ischaemic stroke to those taking typical antipsychotics.
Bibliographic study showed improving statistical methodology of network meta-analyses published between 1999 and 2015
(Elsevier, 2016-11-15) Petropoulou, Maria; Nikolakopoulou, Adriani; Veroniki, Areti-Angeliki; Rios, Patricia; Vafaei, Afshin; Zarin, Wasifa; Giannatsi, Myrsini; Sullivan, Shannon; Tricco, Andrea C; Chaimani, Anna; Egger, Matthias; Salanti, Georgia
Objectives: To assess the characteristics and core statistical methodology specific to network meta-analyses (NMAs) in clinical research articles. Study Design and Setting: We searched MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from inception until April 14, 2015, for NMAs of randomized controlled trials including at least four different interventions. Two reviewers independently screened potential studies, whereas data abstraction was performed by a single reviewer and verified by a second. Results: A total of 456 NMAs, which included a median (interquartile range) of 21 (13–40) studies and 7 (5–9) treatment nodes, were assessed. A total of 125 NMAs (27%) were star networks; this proportion declined from 100% in 2005 to 19% in 2015 (P = 0.01 by test of trend). An increasing number of NMAs discussed transitivity or inconsistency (0% in 2005, 86% in 2015, P < 0.01) and 150 (45%) used appropriate methods to test for inconsistency (14% in 2006, 74% in 2015, P < 0.01). Heterogeneity was explored in 256 NMAs (56%), with no change over time (P = 0.10). All pairwise effects were reported in 234 NMAs (51%), with some increase over time (P = 0.02). The hierarchy of treatments was presented in 195 NMAs (43%), the probability of being best was most commonly reported (137 NMAs, 70%), but use of surface under the cumulative ranking curves increased steeply (0% in 2005, 33% in 2015, P < 0.01). Conclusion: Many NMAs published in the medical literature have significant limitations in both the conduct and reporting of the statistical analysis and numerical results. The situation has, however, improved in recent years, in particular with respect to the evaluation of the underlying assumptions, but considerable room for further improvements remains.
Bisexuality and HIV Risk: Experiences in Canada and the United States
(Taylor and Francis Group, 1997) Doll, Lynda; Myers, Ted; Kennedy, Meaghan; Allman, Dan
The human immunodeficiency virus (HIV) epidemic has presented unparalleled challenges to sex researchers. Investigators have sought to understand a range of sexual behaviors and have scrutinized their roles in disease transmission. Opportunities have also emerged for developing and evaluating large-scale behavioral interventions to facilitate sexual risk reduction. In this article, we examine a topic of interest to sex researchers and HIV prevention programs, namely the relationship between bisexual behavior and HIV risk. We have gathered the theoretical and empirical literatures from two countries, Canada and the United States, permitting us to describe diverse experiences in countries in which variations in demographics and social norms as well as prevention programs may have consequences for the prevalence and contexts of bisexual behavior and for HIV risk. We begin our article with a review of the theories of bisexual behavior and a critique of methods used to study these populations. These sections provide a foundation for interpreting the empirical literature and for understanding the limitations of research related to HIV risk. We then provide for each country and for each gender a brief overview of data on the prevalence of bisexual behavior, HIV prevalence and AIDS cases, and the prevalence and determinants of HIV risk behaviors. We also review the emerging findings on prevention approaches for each population. Our review ends with a synthesis of the data across countries and genders and a proposed research agenda to increase our understanding of bisexual behavior and HIV risk among men and women who engage in sexual behavior with both genders.
Bisexuality and HIV/AIDS in Canada
(Taylor & Francis, 1996) Myers, Ted; Allman, Dan
This chapter explores what is known about bisexuality and HIV/AIDS in Canada. It focuses primarily on research definitions, behavioural manifestations, and the political movement and organization of bisexuals in relation to HIV/AIDS. Published research, largely epidemiological, relating to the sexual behaviour of various populations since the beginning of the AIDS epidemic are the predominant source of information. This documentation is critical because it is the only Canadian information currently available on bisexuality. While these data shed some light on the national picture as well as on regional variation, they ultimately raise more questions than answers. Scholarly reflection on sexuality in Canada and the placement of bisexuality along the continuum of human sexual relations is a discourse in its infancy. Our consideration of bisexuality in the arena of HIV/AIDS has had to take this into account.
Bladder cancer and occupational exposure to diesel and gasoline engine emissions among Canadian men
(Wiley, 2015-12) Latifovic, Lidija; Villeneuve, Paul J.; Parent, Marie-Élise; Johnson, Kenneth C.; Kachuri, Linda; Harris, Shelley A.
The International Agency for Research on Cancer has classified diesel exhaust as a carcinogen based on lung cancer evidence; however, few studies have investigated the effect of engine emissions on bladder cancer. The purpose of this study was to investigate the association between occupational exposure to diesel and gasoline emissions and bladder cancer in men using data from the Canadian National Enhanced Cancer Surveillance System; a population-based case-control study. This analysis included 658 bladder cancer cases and 1360 controls with information on lifetime occupational histories and a large number of possible cancer risk factors. A job-exposure matrix for engine emissions was supplemented by expert review to assign values for each job across three dimensions of exposure: concentration, frequency, and reliability. Odds ratios (OR) and their corresponding 95% confidence intervals were estimated using logistic regression. Relative to unexposed, men ever exposed to high concentrations of diesel emissions were at an increased risk of bladder cancer (OR = 1.64, 0.87-3.08), but this result was not significant, and those with >10 years of exposure to diesel emissions at high concentrations had a greater than twofold increase in risk (OR = 2.45, 1.04-5.74). Increased risk of bladder cancer was also observed with >30% of work time exposed to gasoline engine emissions (OR = 1.59, 1.04-2.43) relative to the unexposed, but only among men that had never been exposed to diesel emissions. Taken together, our findings support the hypothesis that exposure to high concentrations of diesel engine emissions may increase the risk of bladder cancer.

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