Objective To evaluate the effectiveness of the community based Cardiovascular Health Awareness Program (CHAP) on morbidity from cardiovascular disease. Design Community cluster randomised trial. Setting 39 mid-sized communities in Ontario, Canada, stratified by location and population size. Participants Community dwelling residents aged 65 years or over, family physicians, pharmacists, volunteers, community nurses, and local lead organisations. Intervention Communities were randomised to receive CHAP (n=20) or no intervention (n=19). In CHAP communities, residents aged 65 or over were invited to attend volunteer run cardiovascular risk assessment and education sessions held in community based pharmacies over a 10 week period; automated blood pressure readings and self reported risk factor data were collected and shared with participants and their family physicians and pharmacists. Main outcome measure Composite of hospital admissions for acute myocardial infarction, stroke, and congestive heart failure among all community residents aged 65 and over in the year before compared with the year after implementation of CHAP. Results All 20 intervention communities successfully implemented CHAP. A total of 1265 three hour long sessions were held in 129/145 (89%) pharmacies during the 10 week programme. 15 889 unique participants had a total of 27 358 cardiovascular assessments with the assistance of 577 peer volunteers. After adjustment for hospital admission rates in the year before the intervention, CHAP was associated with a 9% relative reduction in the composite end point (rate ratio 0.91, 95% confidence interval 0.86 to 0.97; P=0.002) or 3.02 fewer annual hospital admissions for cardiovascular disease per 1000 people aged 65 and over. Statistically significant reductions favouring the intervention communities were seen in hospital admissions for acute myocardial infarction (rate ratio 0.87, 0.79 to 0.97; P=0.008) and congestive heart failure (0.90, 0.81 to 0.99; P=0.029) but not for stroke (0.99, 0.88 to 1.12; P=0.89). Conclusions A collaborative, multi-pronged, community based health promotion and prevention programme targeted at older adults can reduce cardiovascular morbidity at the population level. Trial registration Current controlled trials ISRCTN50550004.

ObjectiveWe sought to validate a case-finding algorithm for human immunodeficiency virus (HIV) infection using administrative health databases in Ontario, Canada.MethodsWe constructed 48 case-finding algorithms using combinations of physician billing claims, hospital and emergency room separations and prescription drug claims. We determined the test characteristics of each algorithm over various time frames for identifying HIV infection, using data abstracted from the charts of 2,040 randomly selected patients receiving care at two medical practices in Toronto, Ontario as the reference standard.ResultsWith the exception of algorithms using only a single physician claim, the specificity of all algorithms exceeded 99%. An algorithm consisting of three physician claims over a three year period had a sensitivity and specificity of 96.2% (95% CI 95.2%–97.9%) and 99.6% (95% CI 99.1%–99.8%), respectively. Application of the algorithm to the province of Ontario identified 12,179 HIV-infected patients in care for the period spanning April 1, 2007 to March 31, 2009.ConclusionsCase-finding algorithms generated from administrative data can accurately identify adults living with HIV. A relatively simple “3 claims in 3 years” definition can be used for assembling a population-based cohort and facilitating future research examining trends in health service use and outcomes among HIV-infected adults in Ontario.

No abstract

These results support the benefit of early overdelayed cholecystectomy for patients with acute cholecystitis.

Objectives. We determined the proportion of workers meeting criteria for major depressive episodes in the past year and examined the association between psychosocial work-stress variables and these episodes.Methods. Data were derived from the Canadian Community Health Survey 1.2, a population-based survey of 24 324 employed, community-dwelling individuals conducted in 2002. We assessed depressive episodes using the Composite International Diagnostic Interview.Results. Of the original sample, 4.6% (weighted n=745948) met criteria for major depressive episodes. High job strain was significantly associated with depression among men (odds ratio [OR] = 2.38; 95% confidence interval [CI] = 1.29, 4.37), and lack of social support at work was significantly associated with depression in both genders (men, OR=2.70; 95% CI=1.55, 4.71; women, OR=2.37; 95% CI=1.71, 3.29). Women with low levels of decision authority were more likely to have depression (OR = 1.59; 95% CI = 1.06, 2.39) than were women with high levels of authority.Conclusions. A significant proportion of the workforce experienced major depressive episodes in the year preceding our study. Gender differences appear to affect work-stress factors that increase risk for depression. Prevention strategies need to be developed with employers and employee organizations to address work organization and to increase social support. (Am J Public Health. 2007;97: 208897: -209397: . doi:10.210597: /AJPH.2006 Fourth Edition (DSM-IV ) 12 and examined the relationship between psychosocial work characteristics and 12-month major depressive episodes. We hypothesized that individuals experiencing increased job strain (higher job demands and lower decision latitude) would be at higher risk for 12-month major depressive episodes.

Study Type – Health Economic (multiway sensitivity analyses)
Level of Evidence 2b OBJECTIVE To estimate the total healthcare costs and costs attributable to prostate cancer across all stages of disease, and to determine the predictors of those costs, as describing the cost of care for patients with prostate cancer is useful to understand the economic burden of illness, explore patterns of care, and provide reliable cost data for economic evaluations. METHODS We estimated direct medical costs for 42 484 men diagnosed with prostate cancer in Ontario, Canada between 1995 and 2002 using linked administrative data. The observation time was divided into five phases: (I) before diagnosis (6 months before); (II) initial care (12 months after diagnosis); (III) continuing care; (IV) pre‐terminal care (from 18 to 6 months before death); and (V) terminal care (6 months before death). Attributable costs were estimated by comparing costs in cases to matched controls. RESULTS The total direct costs per 100 days (in $Canadian, 2004) were: Phase I $1297; II $3289; III $1495; IV $5629; and V $16 020. Prostate cancer‐attributable costs accounted for 72% of total costs in the 12‐month period after diagnosis (II, $2366), but <35% of total costs in phases III to V ($398, $1977 and $3140, respectively). An advanced stage at diagnosis, being older at diagnosis, and higher comorbidity were associated with increased costs. CONCLUSION Prostate cancer is associated with increased direct healthcare costs over the natural history of the disease. Costs are highest around two events, cancer diagnosis and cancer death. Future research should evaluate costs borne by private insurers and patients, evaluate the effects of patient and system variables on lifetime costs, and explore differences in end‐of‐life healthcare costs across countries.

Automated bloodstream infection surveillance using electronic data is an accurate alternative to surveillance using manually collected data.

Therapeutic study, level IV.