Kayla D. Collins

Adverse Drug Events in Adult Patients Leading to Emergency Department Visits

Background Adverse drug events (ADEs) occurring in the community and treated in emergency departments (EDs) have not been well studied. Objective To determine the prevalence, severity, and preventability of ADEs in patients presenting at EDs in 2 university-affiliated tertiary care hospitals in the Canadian province of Newfoundland and Labrador. Methods A retrospective chart review was conducted on a stratified random sample (n = 1458) of adults (≥18 y) who presented to EDs from January 1 to December 31, 2005. Prior to the chart review, the sample frame was developed by first eliminating visits that were clearly not the result of an ADE. The ED summary of each patient was initially reviewed by 2 trained reviewers in order to identify probable ADEs. All eligible charts were subsequently reviewed by a clinical team, consisting of 2 pharmacists and 2 ED physicians, to identify ADEs and determine their severity and preventability. Results Of the 1458 patients presenting to the 2 EDs, 55 were determined to have an ADE or a possible ADE (PADE). After a sample-weight adjustment, the prevalence of ADEs/PADEs was found to be 2.4%. Prevalence increased with age (0.7%, 18–44 y; 1.9%, 45–64 y; 7.8%, ≥65 y) and the mean age for patients with ADEs was higher than for those with no ADEs (69.9 vs 63.8 y; p < 0.01). A higher number of comorbidities and medications was associated with drug-related visits. Approximately 29% of the ADEs/PADEs identified were considered to be preventable, with 42% requiring hospitalization. Cardiovascular agents (37.4%) were the most common drug class associated with ADEs/PADEs. Conclusions Adult ADE-related ED visits are frequent in Newfoundland and Labrador, and in many cases are preventable. Further efforts are needed to reduce the occurrence of preventable ADEs leading to ED visits.

A systematic review of the risks factors associated with the onset and natural progression of spina bifida.

&NA; The purpose of this study was to systematically assess and synthesize the world literature on risk factors for the onset and natural progression of spina bifida, thereby providing a basis for policy makers to identify appropriate risk management measures to mitigate the burden of disease in Canada. Searches of several health literature databases from inception to February 2013 were conducted by a health sciences librarian. A total of three meta‐analyses that studied a risk factor for the onset of spina bifida were included. Pooled results showed that paternal exposure to Agent Orange (RR = 2.02; 95% CI 1.48–2.74) and maternal obesity prior to pregnancy (OR = 2.24; 95% CI 1.86–2.74) each increased the risk of having a child with spina bifida. Paternal exposure to organic solvents was also close to the limit of significance (OR = 1.59; 95% CI 0.99–2.56). A total of 63 observational studies, encompassing hundreds of potential risk factors, were included for risk factors for the onset of disease. One meta‐analysis and four observational studies examined the impact of genetic risk factors. Only specified mutations in the 5,10‐methylenetetrahydrofolate reductase (MTHFR) and dihydrofolate reductase (DHFR) genes were found to be linked to disease onset. One observational study evaluated a risk factor for the natural progression of disease. An extensive number of potential risk factors for the onset of spina bifida have been studied, though most lack sufficient evidence to confirm an association. Currently, strong evidence exists to suggest a causal association for maternal obesity prior to pregnancy, and paternal exposure to Agent Orange. HighlightsSpina bifida (SB), a neural tube birth defect occurring within the first four weeks of pregnancy and is the most common life disabling birth defect.In this neurological condition the spinal column fails to develop properly—one or more vertebrae do not form completely leaving a gap in the spine.The aetiology of SB is unknown, but both genetic and environmental risk factors are considered important for its onset and progression.Risk factors for onset include maternal obesity, paternal Agent Orange exposure and lack of folic acid intake in the periconceptional period.All the risk factors mentioned above are modifiable hence should be targeted as preventative strategies to reduce the burden of SB.

Role of social support in the relationship between sexually transmitted infection and depression among young women in Canada.

Background Individuals with a self-reported history of sexually transmitted infection (STI) are at high risk for depression. However, little is known about how social support affects the association between STI and depression among young women in Canada. Methods Data were drawn from the Canadian Community Health Survey (CCHS), conducted in 2005. A total of 2636 women aged 15–24 years who provided information on STI history were included in the analysis. Depression was measured by a depression scale based on the Composite International Diagnostic Interview Short-Form (CIDI-SF). The 19-item Medical Outcomes Study (MOS) Social Support Survey assessed functional social support. A log-binomial model was used to estimate the prevalence ratio (PR) for self-reported STI history associated with depression and to assess the impact of social support on the association. Results The adjusted PR for self-reported STI history associated with depression was 1.61 (95% CI, 1.03 to 2.37), before social support was included in the model. The association between STI history and depression was no longer significant when social support was included in the model (adjusted PR, 1.28; 95% CI, 0.83 to 1.84). The adjusted PRs for depression among those with low and intermediate levels of social support versus those with a high level of social support were 5.62 (95% CI, 3.50 to 9.56) and 2.19 (1.38 to 3.68), respectively. Conclusions Social support is an important determinant of depression and reduces the impact of self-reported STI on depression among young women in Canada.

Determinants of neurological disease: Synthesis of systematic reviews

&NA; Systematic reviews were conducted to identify risk factors associated with the onset and progression of 14 neurological conditions, prioritized as a component of the National Population Health Study of Neurological Conditions. These systematic reviews provided a basis for evaluating the weight of evidence of evidence for risk factors for the onset and progression of the 14 individual neurological conditions considered. A number of risk factors associated with an increased risk of onset for more than one condition, including exposure to pesticides (associated with an increased risk of AD, amyotrophic lateral sclerosis, brain tumours, and PD; smoking (AD, MS); and infection (MS, Tourette syndrome). Coffee and tea intake was associated with a decreased risk of onset of both dystonia and PD. Further understanding of the etiology of priority neurological conditions will be helpful in focusing future research initiatives and in the development of interventions to reduce the burden associated with neurological conditions in Canada and internationally. HighlightsWith population aging, the burden of neurological disease is increasing worldwide.Understanding the factors affecting the onset and progression of neurological disease through systematic review is essential for the development of strategies to reduce the burden of these diseases.Systematic review identified biological, demographic, environmental, genetic, lifestyle and pharmacological risk factors for specific neurological conditions.Several risk factors were associated with the onset of multiple conditions. Pesticides, for example, were associated with an increased risk of Alzheimers disease, amyotrophic lateral sclerosis, primary brain tumours, and Parkinsons disease.Helmet use was associated with a reduction in onset of neurotrauma, as well as all neurologic conditions for which head injury was a risk factor.The findings presented here should be viewed as provisional, pending a more in‐depth evaluation of the weight of evidence.Further research will also serve to fill current data gaps, particularly regarding risk factors for the progression of neurological disease.In the interim, the modifiable risk factors may be considered as potential candidates for the development of targeted interventions to reduce the burden of neurological disease in Canada and internationally.

Epidemiology of severe burn among children in Newfoundland and Labrador, Canada

PURPOSE The objective of this study was to identify the epidemiologic characteristics of childhood burns in the province of Newfoundland and Labrador. METHODS A population-based study was carried out on children aged 0-16 years who were hospitalized due to burns in Newfoundland and Labrador between April 1995 and March 2001. Hospital and mortality data were obtained from the provincial hospital admission database and Mortality System, respectively. The Newfoundland and Labrador population was considered as a whole and as two separate geographic areas. RESULTS A total of 157 hospital admissions due to burns were identified during the study period. The rate of burns requiring hospitalization in the province was 22.3 per 100,000 person-years (P-Y). The rates for males and females was 27.7 and 16.6 per 100,000 P-Y, respectively (P=0.006). Infants (0-1 year) had the highest rate of burn (88.8 per 100,000 P-Y) followed by children aged 2-4 years (26.0 per 100,000 P-Y) (P<0.0001). Labrador, a region with high Aboriginal population (51.4 per 100,000 P-Y), had a higher rate of burn compared to Newfoundland (20.3 per 100,000 P-Y) (P<0.0001). Median age of patients with burns was 2 years for the island portion of the province and 9 years in Labrador (P<0.01). Overall, scald burn (52.2%) was the most frequent type of burn followed by flame (32.5%). In the island portion of the province, scald burn was the most common type of burn (56.4%), while in Labrador flame was the most frequent type (66.7%). Overall mortality rate due to burns was 0.9 per 100,000 P-Y. CONCLUSION Age (infants) and sex (male) are factors associated with burn in Newfoundland and Labrador. Study results indicate a difference in the epidemiologic pattern of burn between the island portion of the province, Newfoundland, and mainland Labrador. It is recommended that preventive programs be directed towards high risk groups to reduce the incidence of burns.

Adverse drug events among children presenting to a hospital emergency department in Newfoundland and Labrador, Canada

The aim of this study was to examine epidemiologic characteristics of Adverse Drug Events (ADEs) among children and adolescents presenting to an Emergency Department (ED) in Newfoundland and Labrador (NL), Canada.

A systematic review of the risks factors associated with the onset and natural progression of hydrocephalus

&NA; The purpose of this study was to systematically assess and synthesize the world literature on risk factors for the onset and natural progression of hydrocephalus, thereby providing a basis for policy makers to identify appropriate risk management measures to mitigate the burden of disease in Canada. Evidence for risk factors was limited for both onset and progression. Two meta‐analyses that examined a risk factor for onset met the inclusion criteria. One found a significant protective effect of prenatal vitamins among case control studies, but not cohort/randomized controlled trials (RCTs). The second found maternal obesity to be a significant risk factor for congenital hydrocephalus. Significant risk factors among 25 observational studies included: biological (multiple births, maternal parity, common cold with fever, maternal thyroid disease, family history, preterm birth, hypertension, ischemic heart disease, ischemic ECG changes, higher cerebrospinal fluid protein concentration following vestibular schwannoma); lifestyle (maternal obesity, high‐density lipoprotein (HDL) cholesterol, maternal diabetes, maternal age), healthcare‐related (caesarean section, interhospital transfer, drainage duration following subarachnoid hemorrhage, proximity to midline for craniectomy following traumatic brain injury); pharmaceutical (prenatal exposure to: tribenoside, metronidazole, anesthesia, opioids); and environmental (altitude, paternal occupation). Three studies reported on genetic risk factors: no significant associations were found. There are major gaps in the literature with respect to risk factors for the natural progression of hydrocephalus. Only two observational studies were included and three factors reported. Many risk factors for the onset of hydrocephalus have been studied; for most, evidence remains limited or inconclusive. More work is needed to confirm any causal associations and better inform policy. HighlightsWith hydrocephalus, excessive accumulation of cerebrospinal fluid (CSF) results in abnormal widening of cavities (ventricles) in the brain, creating potentially harmful pressure on neural tissues.Hydrocephalus can be congenital (CHC) (developed prior to birth) or acquired (AHC) (developed during or after birth) and can occur at any age. Incidence of congenital hydrocephalus is estimated at about 3 per 1,000 live births in the US.The limited evidence available suggests that both congenital and acquired hydrocephalus may be linked to modifiable risk factors, such as maternal obesity, lack of prenatal multivitamin supplement use, and high HDL cholesterol in adults.Health care policy could focus on the following risk mitigation strategies: i) providing and improving access to adequate prenatal education and care, particularly for mothers at greater risk of pre‐term delivery (e.g., teens and older primiparous mothers); ii) better counselling for women using artificial reproductive technologies such as in‐vitro fertilization and are, thus, at a greater risk of having a multiple birth; and iii) use of safety equipment across a broad range of uses, from infant car seats and seatbelts, to workplace hardhats and harnesses, to sporting and recreation gear (e.g., bicycle helmets), all of which may help to prevent hydrocephalus due to head injuries.

Challenges and opportunities for using administrative data to explore changes in health status: a study of the closure of the Newfoundland cod fishery.

The closure of the cod fishery in Newfoundland and Labrador has had dramatic social and economic impacts on fishing communities in the province. Following a limited closure in 1992, a more extensive closure followed in 1994, which is still in force today, although income support provided to displaced fishery workers ended in 1999. A population-based study was conducted in 2004/2005 using 7 different sources of administrative and survey data to investigate a range of social, demographic, and health changes in fishing communities affected by the closure of the cod fishery from the period 1991 to 2001. Findings of this study extend our understanding of the impact of the fishing moratorium in Newfoundland. This article also presents both the challenges to and opportunities for using administrative and survey data to explore the impact of the fishery closure on the health and well-being of Newfoundland fishing communities. One of the most significant challenges to using administrative and survey databases was the inconsistencies in how communities were identified across the various databases. Although not without limitations, administrative data is a cost-effective means to explore the impact of socioeconomic change on a populations health status.