Helen Coo

Factors associated with health-related quality of life in multiple sclerosis.

BACKGROUND Much research has gone into the assessment of function and health-related quality of life (HRQOL) in those with multiple sclerosis (MS). The Medical Outcomes Study 36-item short form (SF-36) has been widely used in this population but current recommendations are that it be supplemented with condition-specific measures such as the MS Quality of Life Inventory (MSQLI) and the MS Functional Composite (MSFC). The goal of the baseline component of this study was the measurement of generic and condition-specific HRQOL, and the identification of factors associated with these outcomes. METHODS HRQOL was assessed at the baseline phase of a longitudinal study. Participants completed the assessment during their regularly scheduled clinic visit. RESULTS 300 of 387 eligible patients agreed to participate, for a response rate of 77.5%. Age ranged from 22 to 77 years, while duration of MS ranged from 1 to 47 years. Mean SF-36 scores were well below age- and sex-adjusted normative data. Only 240 completed the MSFC component. Higher EDSS, use of support services, pain medications, clinical depression and antidepressant use were associated with poorer HRQOL, while higher income and education were associated with better HRQOL. CONCLUSIONS There is a substantial burden of illness associated with MS when compared to normative HRQOL data. This was more pronounced in physically- than in mentally-oriented domains. Assessment of HRQOL provides a valuable complement to the EDSS by providing information about the patient perception of function and HRQOL beyond that which can be obtained by physical assessment alone.

Multiple sclerosis: change in health-related quality of life over two years.

BACKGROUND Cross-sectional research has demonstrated poorer function and health-related quality of life (HRQOL) in those with multiple sclerosis (MS) but less is known about change over time. The goals of this study were to measure change in HRQOL and identify factors associated with change. METHODS HRQOL was assessed at baseline and annually over two subsequent years using the Multiple Sclerosis Quality of Life Inventory. Function was assessed using the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Functional Composite. Annualized rate of change was calculated for all twenty outcomes. Mixed effects modeling (univariate followed by multivariate) was used to examine the associations among patient characteristics and the age- and sex-adjusted Physical Component Summary (PCS) and Mental Component Summary (MCS) at study initiation and over the two years of follow-up. RESULTS Of 300 participants, 288 (96%) provided at least one assessment and are included in this analysis. Although 14 of the 20 outcomes showed a mean decline, only two (SF-36 physical function, p=0.018 and the EDSS, p<0.001) were statistically significant. The SF-36 social function showed a significant improvement (p=0.031). Only two variables were significantly associated with a decreased rate of decline or improvement over two years, including being female (PCS, p=0.001) and use of visiting nurse services (MCS, p<0.001). CONCLUSIONS HRQOL is relatively stable over two years of follow-up, particularly for mentally-oriented outcomes. Further research with a longer period of follow-up is needed to provide additional insight into factors associated with change in HRQOL in patients with MS.

Rooming-in for Infants at Risk of Neonatal Abstinence Syndrome.

OBJECTIVE To examine the impact of a rooming-in program for infants at risk of neonatal abstinence syndrome (NAS) on the need for pharmacologic treatment and length of hospitalization. STUDY DESIGN Our hospital implemented a rooming-in program for newborns at risk of NAS in June 2013. Previously, standard care was to admit these infants to the neonatal intensive care unit. Charts were reviewed to abstract data on at-risk infants born in the 13-month periods prior and subsequent to implementation of rooming-in (n = 24 and n = 20, respectively) and the groups were compared with the outcomes of interest. RESULT Rooming-in was associated with a reduced need for pharmacologic treatment and shorter length of stay. CONCLUSION These findings add to an emerging body of evidence on the health care resource utilization benefits associated with rooming-in for infants at risk of NAS. Future studies should evaluate a broader range of outcomes for this model of care.

Women’s knowledge of hormone therapy

The aim of this study was to assess womens knowledge of hormone therapy. Two hundred and seven women were interviewed by telephone. The median score to 24 questions concerning the benefits, risks and side effects of therapy was 54.2%. Almost three-quarters of women knew that hormone therapy may decrease the risk of osteoporosis, but half were unaware that it should be taken for at least 10 years for maximum protection against bone loss. While many women knew that hormone therapy may increase the risk of breast cancer, 13.5% believed that it would decrease their risk. Many women overestimated the potential reduction in lifetime risk of hip fracture and the potential increase in lifetime risk of breast cancer with hormone therapy. Women may have insufficient knowledge to make informed choices about hormone therapy. This has implications for physicians who wish to ensure that women are able to participate in informed decision-making.

Uptake of Colorectal Cancer Screening among Ontarians with Intellectual and Developmental Disabilities

Under-screening for cancer may contribute to a greater disease burden in individuals with intellectual and developmental disabilities (IDD) as their life expectancy increases. In 2008, the province of Ontario launched Canada’s first population-based colorectal cancer screening program. Our objectives were to compare the proportions of Ontarians with and without IDD who have undergone colorectal cancer screening and to examine factors associated with screening uptake among Ontarians with IDD. Records for Ontario residents 50–64 years of age were linked across various administrative health and social services datasets to identify individuals with IDD and to select a random sample of the age-equivalent Ontario population without IDD as a comparison group. Logistic regression models were fit to examine the odds of screening uptake among individuals with IDD while controlling for age, sex, urban or rural residence, neighbourhood income quintile, expected use of health care resources, and being enrolled with or seeing a physician in a patient enrolment model (any of several primary care practice models designed to improve patient access and quality of care in Ontario), and to examine the association between these variables and colorectal cancer screening in the IDD population. The odds of having had a fecal occult blood test in the previous two years and being up-to-date with colorectal tests were 32% and 46% lower, respectively, for Ontarians with IDD compared to those without IDD. Being older, female, having a greater expected use of health care resources, and being enrolled with or seeing a physician in a primary care patient enrolment model were all significantly associated with higher odds of having been screened for colorectal cancer in the IDD population. These findings underscore the need for targeted interventions aimed at making colorectal cancer screening more equitable.

Trends in incidence of neonatal abstinence syndrome in Canada and associated healthcare resource utilization

BACKGROUND Neonatal abstinence syndrome (NAS) is a collection of symptoms that occurs primarily due to antenatal opioid exposure. National data on incidence, hospital resource utilization, and demographic features of NAS have not been previously described for Canada. METHODS Secondary analysis was performed with data from hospitals in all Canadian provinces and territories, excluding Quebec. Infants with NAS were identified by searching for ICD-10-CA code P96.1 in the Canadian Institute for Health Informations discharge abstract database. We examined incidence, hospital beds occupied per day, length of stay (fiscal 2003-2014), hospital costs, and demographic features (due to data availability, limited to fiscal 2010-2014). RESULTS The incidence of NAS in Canada tripled between 2003 and 2014 (1.8-5.4 per 1000 live births), with an average annual increase of 0.33 cases per 1000 live births (95% CI 0.31, 0.34). Provincial incidence in 2014 ranged from 2.7 (Alberta) to 9.7 (New Brunswick) per 1000 live births. Between 2010 and 2014 total and mean per-patient costs rose from

Variations and similarities in clinical management of neonatal abstinence syndrome: Findings of a Canadian survey

15.7 to

Trends in Autism Prevalence: Diagnostic Substitution Revisited

26.9 million CAD and

The changing prevalence of autism in three regions of Canada

14,629 to

Age at Diagnosis of Autism Spectrum Disorders in Four Regions of Canada

17,367 CAD, respectively, with substantial inter-provincial variation in expenditure. Mean length of stay was 14.4 days in 2003 and 14.8 days in 2014, and beds occupied per day rose from 19.7 in 2003 to 69.4 in 2014. CONCLUSIONS The incidence of NAS is increasing in Canada with associated rise in healthcare resource utilization. Inter-provincial variability in incidence and resource utilization underscores the need to further explore best practices for cost-effective prevention and management of NAS.