VER THE PAST DECADE, SEVeral studies have suggested that blood transfusions depress immune function in recipients. 1,2 Evidence of transfusion-associated immune suppression emerged following observations that blood transfusions improved renal allograft survival 3 and accelerated 4 and increased postoperative infections. 5 A recent randomized controlled trial undertaken to examine infections in cardiovascular surgical patients found an approximately 4.2% absolute decrease in mortality but no decrease in

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Epidemiologists should consider using multiple imputation more often than is current practice.

Purpose: Hereditary long QT syndrome is named for a prolonged QT interval reflecting predisposition to ventricular arrhythmias and sudden death. A high rate in a remote, northern Canadian First Nations community was brought to attention. Methods: Two severely affected index cases and 122 relatives were ascertained using communitybased participatory research principles. Genetic sequencing of five known genes responsible for long QT syndrome was carried out on the index cases, leading to the identification of a novel missense mutation. Functional properties of the identified mutation were studied in transfected mouse ltk-cells using whole cell patch clamp techniques. Corrected QT interval measurements were obtained from participants and subsequent genotyping of relatives was carried out. Results: In the two index cases, a novel missense mutation (V205M) was identified in the S3 transmembrane helix of KvLQT1, the pore forming domain of the I Ks channel complex. In transfected mouse ltk-cells the V205M mutation suppressed I Ks by causing a dramatic depolarizing shift in activation voltage coupled with acceleration of channel deactivation. Twenty-two mutation carriers had a significantly higher mean corrected QT interval than noncarriers (465 Ϯ 28 milliseconds vs. 434 Ϯ 26 milliseconds, P Ͻ 0.0001); however, 30% of carriers had a corrected QT interval below 440 milliseconds. Conclusion: A novel KCNQ1 mutation in this founder population likely confers increased susceptibility to arrhythmias because of decreased I Ks current. Even with a common mutation within a relatively homogenous population, clinical expression remains variable, exemplifying the multifactorial nature of long QT syndrome, and supporting the difficulty of definitive diagnosis without genetic testing. A community participatory approach enabled a comprehensive evaluation of the impact. Genet Med 2008:10(7):545-550.

Recently developed disease mapping and ecological regression methods have become important techniques in studies of disease epidemiology and in health services research. This increase in importance is partially a result of the development of Bayesian statistical methodologies that make it possible to study associations between health problems and risk factors at an aggregate (i.e. areal) level while taking into account such matters as unmeasured confounding and spatial relationships. In this paper we present a demonstration of the joint use of empirical Bayes (EB) and full Bayesian inferential techniques in a small area study of adverse medical events (also known as 'iatrogenic injury') in British Columbia, Canada. In particular, we illustrate a unified Bayesian hierarchical spatial modelling framework that enables simultaneous examinations of potential associations between adverse medical event occurrence and regional characteristics, age effects, residual variation and spatial autocorrelation. We propose an analytic strategy for complementary use of EB and FB inferential techniques for risk assessment and model selection, presenting an EB-FB combined approach that draws on the strengths of each method while minimizing inherent weaknesses. The work was motivated by the need to explore relatively efficient ways to analyse regional variations of health services outcomes and resource utilization when a considerable amount of statistical modelling and inference are required.

he current research demonstrates that Aboriginal peoples in Canada (First Nations, Inuit, and Métis) face unique health challenges. Compared with the general population, they experience higher rates of chronic diseases, higher infant mortality rates, lower life expectancy, and higher incidences of suicide. 1 While research is needed to continue to document and describe the health of Aboriginal peoples as well as test new programs, efforts must be made to translate the knowledge gained from research into improved health and well-being. Knowledge translation (KT) is the study of ways to bridge the gaps between knowledge and action. While a number of different terms are used interchangeably, including knowledge transfer, research utilization, knowledge exchange, and knowledge mobilization, 2 the Canadian Institutes of Health Research's (CIHR) mandate for KT and its definitional development of the term has placed great emphasis on this particular term and popularized its use nationally and internationally. 3-5 In addition, academic and nonacademic discussions about the importance of KT in the health disciplines have stimulated a growing KT discourse.

Research on alcohol and substance use in First Nations populations frequently describes the nature of the problem, and the severity of the risk factors, but seldom addresses possible interventions and the effectiveness of the treatments that clients do engage in. This paper reviews a participatory evaluation of the 6-week residential 'Namgis Treatment Centre (NTC) program in Alert Bay, British Columbia. Intake files (n= 218) were reviewed for clients who participated in 17 different 6-week sessions over a period of two and a half years. The assessment included a telephone follow-up survey, developed in conjunction with all of the NTC staff, for clients who had been out of treatment for 3-37 months (n= 91, 52.7% male and 47.3% female participants). In total, 24 clients (26.37%) were abstinent at the time of the interview, and 67 clients (73.6%) had had a relapse on average 155.29 (SD=167.77) days after completing treatment. Cox regression univariate and bivariate analysis revealed that pre-treatment variables were not associated with time to relapse or what happened after relapse (abstinence again, harm reduction or resuming pre-treatment consumption levels). However, the greater number of supports the client had, the more likely they were to be completely abstinent, and the less supports the client had, the more likely they were to completely relapse. NTC staff and community members were consulted on the implications of the data, and recommendations were shared with NTC policy makers. Based on the findings of this project, it is apparent, that in this context, follow-up and aftercare are critical for effective treatment.

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