IMPORTANCE Clinical guidelines advise against routine electrocardiograms (ECG) in low-risk, asymptomatic patients, but the frequency and impact of such ECGs are unknown.OBJECTIVE To assess the frequency of ECGs following an annual health examination (AHE) with a primary care physician among patients with no known cardiac conditions or risk factors, to explore factors predictive of receiving an ECG in this clinical scenario, and to compare downstream cardiac testing and clinical outcomes in low-risk patients who did and did not receive an ECG after their AHE. DESIGN, SETTING, AND PARTICIPANTSA population-based retrospective cohort study using administrative health care databases from Ontario, Canada, between 2010/2011 and 2014/2015 to identify low-risk primary care patients and to assess the subsequent outcomes of interest in this time frame. All patients 18 years or older who had no prior cardiac medical history or risk factors who received an AHE.EXPOSURES Receipt of an ECG within 30 days of an AHE. MAIN OUTCOMES AND MEASURESPrimary outcome was receipt of downstream cardiac testing or consultation with a cardiologist. Secondary outcomes were death, hospitalization, and revascularization at 12 months. RESULTS A total of 3 629 859 adult patients had at least 1 AHE between fiscal years 2010/2011 and 2014/2015. Of these patients, 21.5% had an ECG within 30 days after an AHE. The proportion of patients receiving an ECG after an AHE varied from 1.8% to 76.1% among 679 primary care practices (coefficient of quartile dispersion [CQD], 0.50) and from 1.1% to 94.9% among 8036 primary care physicians (CQD, 0.54). Patients who had an ECG were significantly more likely to receive additional cardiac tests, visits, or procedures than those who did not (odds ratio [OR], 5.14; 95% CI, 5.07-5.21; P < .001). The rates of death (0.19% vs 0.16%), cardiac-related hospitalizations (0.46% vs 0.12%), and coronary revascularizations (0.20% vs 0.04%) were low in both the ECG and non-ECG cohorts.CONCLUSIONS AND RELEVANCE Despite recommendations to the contrary, ECG testing after an AHE is relatively common, with significant variation among primary care physicians. Routine ECG testing seems to increase risk for a subsequent cardiology testing and consultation cascade, even though the overall cardiac event rate in both groups was very low.
Street connectivity, defined as how well streets connect to one and other and the density of intersections, is positively associated with active transportation in adults. Our objective was to study the relation between street connectivity and physical activity in youth. Study participants consisted of 8,535 students in grades 6–10 from 180 schools across Canada who completed the 2006 Health Behaviour in School-aged Children (HBSC) survey. Street connectivity was measured in a 5 km circular buffer around these schools using established geographic information system measures. Physical activity performed outside of school hours was assessed by questionnaire, and multi-level regression analyses were used to estimate associations with street connectivity after controlling for several covariates. Compared to students living in the highest street connectivity quartile, those in the second (relative risk = 1.22, 95% confidence interval = 1.10–1.35), third (1.25, 1.13–1.37), and fourth (1.21, 1.09–1.34) quartiles were more likely to be physically active outside of school. In conclusion, youth in neighbourhoods with the most highly connected streets reported less physical activity outside of school than youth from neighbourhoods with less connected streets. Relationships between street connectivity and physical activity reported in this national study are in the opposite direction to those previously observed for active transportation in adult populations.
The design of streets, as a measure of the built environment, is related to the occurrence of youth injury. Positive effects of poorly connected street designs that are likely in terms of physical activity were offset by negative injury outcomes, although the injuries observed were mostly minor in nature.
Chronic obstructive pulmonary disease (COPD) has been associated with many types of comorbidity. We aimed to quantify the real world impact of COPD on lower respiratory tract infection, cardiovascular disease, diabetes, psychiatric disease, musculoskeletal disease and cancer, and their impact on COPD through health services.A population study using health administrative data from Ontario, Canada, in 2008-2012 was conducted. Absolute and adjusted relative rates of ambulatory care visits, emergency department visits and hospitalisations for the comorbidities of interest in people with and without COPD were determined and compared.Among 7 241 591 adults, 909 948 (12.6%) had COPD. Over half of all lung cancer, a third of all lower respiratory tract infection and cardiovascular disease, a quarter of all low trauma fracture, and a fifth of all psychiatric, musculoskeletal, non-lung cancer and diabetes ambulatory care visits, emergency department visits and hospitalisations in Ontario were used by people with COPD. Individuals with COPD used about five times more health services for lung cancer, and two times more health services for lower respiratory tract infections and cardiovascular disease than people without COPD.Individuals with COPD use a disproportionate amount of health services for comorbid disease, placing significant burden on the healthcare system. @ERSpublications COPD responsible for significant proportion of all hospitalisations, emergency department visits and ambulatory care
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