Direct and indirect pathways between low income status and becoming a high-cost health care user in Ontario, Canada: a mediation analysis of health risk behaviors.

Purpose: We investigated natural direct and indirect pathways between low-income status and high-cost user (HCU) transitions considering health risk behaviors as potential mediators.

Methods: We analyzed data from respondents (aged 18+) from four pooled cycles of the Canadian Community Health Survey (2005-2010/2011) linked to administrative data in Ontario, Canada. HCUs were defined as the top 5% of the population, ranked by cost consumption in any of the five years after survey interview.

Association between the regional variation in premature mortality and immigration in Ontario, Canada.

Objectives: Health region differences in immigration patterns and premature mortality rates exist in Ontario, Canada. This study used linked population-based databases to describe the regional proportion of immigrants in the context of provincial health region variation in premature mortality.

Methods: We analyzed all adult premature deaths in Ontario from 1992 to 2012 using linked population files, Canadian census, and death registry databases.

Population-Based Estimates of Health Care Utilization and Expenditures by Adults During the Last 2 Years of Life in Canada's Single-Payer Health System.

Importance: Measuring health care utilization and costs before death has the potential to initiate health care improvement.

Objective: To examine population-level trends in health care utilization and expenditures in the 2 years before death in Canada's single-payer health system.

Design, Setting, And Participants: This population-based cohort included 966 436 deaths among adult residents of Ontario, Canada, from January 2005 to December 2015, linked to health administrative and census data.

Regional variation of premature mortality in Ontario, Canada: a spatial analysis.

Background: Premature mortality is a meaningful indicator of both population health and health system performance, which varies by geography in Ontario. We used the Local Health Integration Network (LHIN) sub-regions to conduct a spatial analysis of premature mortality, adjusting for key population-level demographic and behavioural characteristics.

Methods: We used linked vital statistics data to identify 163,920 adult premature deaths (deaths between ages 18 and 74) registered in Ontario between 2011 and 2015.

Population risk and burden of health behavioral-related all-cause, premature, and amenable deaths in Ontario, Canada: Canadian Community Health Survey-linked mortality files.

Purpose: To examine the association of all-cause and premature mortality with four modifiable lifestyle behaviors and quantify the burden of behavioral-related premature death in Ontario, Canada.

Methods: We analyzed a cohort of 149,262 adults in the 2000-2010 Canadian Community Health Surveys, linked to vital statistics data to ascertain deaths until December 31, 2015. The strength of the association between behaviors (smoking, body mass index, physical inactivity, and alcohol consumption) and all-cause and premature mortality was estimated using sex-specific Cox proportional hazards models.

Effects of behavioural risk factors on high-cost users of healthcare: a population-based study.

Objectives: High-cost users (HCUs) are known to disproportionally incur the majority of healthcare utilization costs relative to their counterparts. A number of studies have highlighted the detrimental effects of risky health behaviours; however, only a few have demonstrated the link to HCUs, a meaningful endpoint for program and policy decision-makers. We investigated the association between health behaviour risks and downstream high-cost healthcare utilization.

Accumulation Of Chronic Conditions At The Time Of Death Increased In Ontario From 1994 To 2013.

With falling mortality rates for several diseases, patients are living longer with complex multimorbidities. We explored the burden of multimorbidity at the time of death, how it varies by socioeconomic status, and trends over time in Ontario, Canada. We calculated the proportions of decedents with varying degrees of multimorbidity and types of conditions at death, and we analyzed the trend from 1994 to 2013 in the number of conditions at the time of death.

Predicting High Health Care Resource Utilization in a Single-payer Public Health Care System: Development and Validation of the High Resource User Population Risk Tool.

Background: A large proportion of health care spending is incurred by a small proportion of the population. Population-based health planning tools that consider both the clinical and upstream determinants of high resource users (HRU) of the health system are lacking.

Objective: To develop and validate the High Resource User Population Risk Tool (HRUPoRT), a predictive model of adults that will become the top 5% of health care users over a 5-year period, based on self-reported clinical, sociodemographic, and health behavioral predictors in population survey data.

A population-based study of homicide deaths in Ontario, Canada using linked death records.

Background: Homicide - a lethal expression of violence - has garnered little attention from public health researchers and health policy makers, despite the fact that homicides are a cause of preventable and premature death. Identifying populations at risk and the upstream determinants of homicide are important for addressing inequalities that hinder population health. This population-based study investigates the public health significance of homicides in Ontario, Canada, over the period of 1999-2012.

Socioeconomic gradients in all-cause, premature and avoidable mortality among immigrants and long-term residents using linked death records in Ontario, Canada.

Background: Immigrants have been shown to possess a health advantage, yet are also more likely to reside in arduous economic conditions. Little is known about if and how the socioeconomic gradient for all-cause, premature and avoidable mortality differs according to immigration status.

Methods: Using several linked population-based vital and demographic databases from Ontario, we examined a cohort of all deaths in the province between 2002 and 2012.

Exploring the function and effectiveness of knowledge brokers as facilitators of knowledge translation in health-related settings: a systematic review and thematic analysis.

Background: Knowledge brokers (KBs) work collaboratively with key stakeholders to facilitate the transfer and exchange of information in a given context. Currently, there is a perceived lack of evidence about the effectiveness of knowledge brokering and the factors that influence its success as a knowledge translation (KT) mechanism. Thus, the goal of this review was to systematically gather evidence regarding the nature of knowledge brokering in health-related settings and determine if KBs effectively contributed to KT in these settings.

A risk screening tool for ethical appraisal of evidence-generating initiatives.

Background: The boundaries between health-related research and practice have become blurred as initiatives traditionally considered to be practice (e.g., quality improvement, program evaluation) increasingly use the same methodology as research.

Longitudinal variations of laryngeal overpressure and voice-related quality of life in spasmodic dysphonia.

Objectives/hypothesis: Adductor spasmodic dysphonia (AdSD) is a voice disorder characterized by variable symptom severity and voice disability. Those with the disorder experience a wide spectrum of symptom severity over time, resulting in varied degrees of perceived voice disability. This study investigated the longitudinal variability of AdSD, with a focus on auditory-perceptual judgments of a dimension termed laryngeal overpressure (LO) and patient self-assessments of voice-related quality of life (V-RQOL).

Exploring use of the ICF in health education.

Purpose: Currently, little is known regarding use of the International Classification of Functioning, Disability and Health (ICF) in health education applications. Therefore, this review sought to examine the scope of work that has been conducted regarding the application of the ICF in health education.

Methods: A review of the current literature related to use of the ICF in health education programs was conducted.

Examining the construct validity of the V-RQOL in speakers who use alaryngeal voice.

Purpose: The construct validity of the Voice-Related Quality of Life (V-RQOL; Hogikyan & Sethuraman, 1999) measure was evaluated in a sample of 109 individuals who have undergone total laryngectomy.

Method: A principal components factor analysis was performed on participant responses to the 10-question V-RQOL measure.

Results: Factor analysis of the V-RQOL in our alaryngeal sample confirmed the presence of two factors (physical and social-emotional), which is consistent with the identified domains in the current V-RQOL.

Supporting collaborative use of the Diabetes Population Risk Tool (DPoRT) in health-related practice: a multiple case study research protocol.

Background: Health policy makers have stated that diabetes prevention is a priority; however, the type, intensity, and target of interventions or policy changes that will achieve the greatest impact remains uncertain. In response to this uncertainty, the Diabetes Population Risk Tool (DPoRT) was developed and validated to estimate future diabetes risk based on routinely collected population data. To facilitate use of DPoRT, we partnered with regional and provincial health-related decision makers in Ontario and Manitoba, Canada.

Impact of nasal surgery on speech resonance.

Objectives: The nose and paranasal sinuses contribute to speech resonance and changes to these structures may alter speech nasality. This change may influence one's vocational and social functioning and quality of life. Our investigation explored objective and subjective changes in nasality following nasal surgery in a prospective and longitudinal fashion.

A critical exploration of the International Classification of Functioning, Disability, and Health (ICF) framework from the perspective of oncology: recommendations for revision.

Background: In 2001, the World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) framework in an effort to attend to the multidimensional health-related concerns of individuals. Historically, although the ICF has frequently been used in a rehabilitation-based context, the World Health Organization has positioned it as a universal framework of health and its related states. Consequently, the ICF has been utilized for a diverse array of purposes in the field of oncology, including: evaluating functioning in individuals with cancer, guiding assessment in oncology rehabilitation, assessing the comprehensiveness of outcome measures utilized in oncology research, assisting in health-related quality of life instrument selection, and comparing the primary concerns of health professionals with those of their patients.

A descriptive analysis of the relationship between quality of life and distress in individuals with head and neck cancer.

Purpose: Both short- and long-term outcomes for individuals with head and neck cancer (HNCa) may be influenced by multiple factors. Identification of distress in those with HNCa may provide a critical dimension that influences quality of life (QoL). Consequently, this investigation assessed distress and QoL in those with HNCa.

Clinical approach to monitoring variability associated with adductor spasmodic dysphonia.

Objectives: Adductor spasmodic dysphonia (ADSD) is a voice disorder characterized by considerable intra- and intersubject variability. Although objective, acoustic measures of voice may provide a metric for ADSD, such measures can be inefficient in documenting such characteristics. This project integrated a simple auditory-perceptual measure termed "laryngeal overpressure" (LO) with measures of acoustic variability.