Reasons for self-reported unmet healthcare needs in Canada: a population-based provincial comparison.

In this study, we compare self-perceived unmet need across Canadian provinces and assess how the reasons for unmet need - problems with availability, accessibility and acceptability - vary. This cross-sectional study uses data from the Canadian Community Health Survey (2.1) conducted in 2003.

Trimethoprim-sulfamethoxazole-induced hyperkalemia in patients receiving inhibitors of the renin-angiotensin system: a population-based study.

Background: Trimethoprim therapy can cause hyperkalemia and is often coprescribed with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). The objective of this study was to characterize the risk of hyperkalemia-associated hospitalization in elderly patients who were being treated with trimethoprim-sulfamethoxazole along with either an ACEI or an ARB.

Methods: We conducted a population-based, nested case-control study of a cohort of elderly patients 66 years or older who were residents of Ontario, Canada, and who were receiving continuous therapy with either an ACEI or an ARB.

Variability in physician opinions about the indications for knee arthroplasty.

To determine how much of variability in physician opinion about the indications for knee arthroplasty is due to inconsistency in individual physicians' opinions. We surveyed 201 orthopedic surgeons, 141 rheumatologists, and 455 family physicians. Physicians were asked how 34 patient characteristics affected their decision to perform or refer for knee arthroplasty.

Low rates of cervical cancer screening among urban immigrants: a population-based study in Ontario, Canada.

Objective: Women who are immigrants or socioeconomically disadvantaged have been found to have significantly lower cervical cancer screening rates than their peers in Toronto, Ontario, Canada. The objective of this study was to examine rates of appropriate cervical cancer screening among women living in Ontario, Canada, using recent registration with Ontario's universal health insurance plan as an indicator of immigrant status.

Methods: This retrospective cohort study included 2,273,995 screening-eligible women aged 25 to 69 years, who resided in Ontario's metropolitan areas during the calendar years 2003, 2004, and 2005.

The gatekeeper system and disparities in use of psychiatric care by neighbourhood education level: results of a nine-year cohort study in toronto.

Background: In Ontario, psychiatric care is fully covered by provincial health insurance without co-payments or deductibles. The provincial fee schedule supports a "gatekeeper" system for psychiatric care by paying psychiatrists more for consultations with patients who have a physician referral. In this context, we sought to explore socio-economic differences in patterns of mental health service delivery.

Association of anti-smoking legislation with rates of hospital admission for cardiovascular and respiratory conditions.

Background: Few studies have examined the impact of anti-smoking legislation on respiratory or cardiovascular conditions other than acute myocardial infarction. We studied rates of hospital admission attributable to three cardiovascular conditions (acute myocardial infarction, angina, and stroke) and three respiratory conditions (asthma, chronic obstructive pulmonary disease, and pneumonia or bronchitis) after the implementation of smoking bans.

Methods: We calculated crude rates of admission to hospital in Toronto, Ontario, from January 1996 (three years before the first phase of a smoking ban was implemented) to March 2006 (two years after the last phase was implemented.

Immigrants' duration of residence and adverse birth outcomes: a population-based study.

Objective: This study aimed to examine preterm and small-for-gestational-age (SGA) births among immigrants, by duration of residence, and to compare them with the Canadian-born population.

Design: Population-based cross-sectional study with retrospective assessment of immigration.

Setting: Metropolitan areas of Ontario, Canada.

Risk adjustment using administrative data-based and survey-derived methods for explaining physician utilization.

Objectives: The objective of this study was to evaluate an administrative data-based risk adjustment method for predicting physician utilization and the contribution of survey-derived indicators of health status. The results of this study will support the use of administrative data for planning, reimbursement, and assessing equity of physician utilization.

Methods: The Ontario portion of the 2000-2001 Canadian Community Health Survey was linked with administrative physician claims data from 2002-2003 and 2003-2004.

The predictors of self-rated health and the relationship between self-rated health and health service needs are similar across socioeconomic groups in Canada.

Objective: To examine if there are systematic differences in the predictors of self-rated health (SRH) and to examine the relationship between SRH and health care utilization across socioeconomic groups.

Study Design And Setting: We used cross-sectional data from the Canadian Community Health Survey linked to the Ontario Health Insurance Plan (N=17,109). We examined relative differences in the factors associated with different levels of SRH across socioeconomic groups (as assessed by education and household income) using probit models separately for men and women.

Evaluating web-based static, animated and interactive maps for injury prevention.

Public health planning can benefit from visual exploration and analysis of geospatial data. Maps and geovisualization tools must be developed with the user-group in mind. User-needs assessment and usability testing are crucial elements in the iterative process of map design and implementation.

Neighbourhood chronic stress and gender inequalities in hypertension among Canadian adults: a multilevel analysis.

Background: A growing body of literature regarding the contextual influences of 'place' effects on health increasingly demonstrates that living in neighbourhoods with high levels of deprivation is associated with worse cardiovascular outcomes; however, little research has explored whether neighbourhood deprivation has a differential impact on the cardiovascular health of men and women. The purpose of this study was to explore gender differences in the association between neighbourhood deprivation and the prevalence of hypertension among non-institutionalised Canadian adults.

Methods: Individual-level data from the Canadian Community Health Survey (2000-2005) were combined with area-level data from the 2001 Canada Census to assess the relationship between gender, neighbourhood deprivation and hypertension using multilevel regression.

Universal health insurance and equity in primary care and specialist office visits: a population-based study.

Purpose: Universal coverage of physician services should serve to reduce socioeconomic disparities in care, but the degree to which a reduction occurs is unclear. We examined equity in use of physician services in Ontario, Canada, after controlling for health status using both self-reported and diagnosis-based measures.

Methods: Ontario respondents to the 2000-2001 Canadian Community Health Survey (CCHS) were linked with physician claim files in 2002-2003 and 2003-2004.

International migration and adverse birth outcomes: role of ethnicity, region of origin and destination.

Background: The literature on international migration and birth outcomes shows mixed results. This study examined whether low birth weight (LBW) and preterm birth differed between non-migrants and migrant subgroups, defined by race/ethnicity and world region of origin and destination.

Methods: A systematic review and meta-regression analyses were conducted using three-level logistic models to account for the heterogeneity between studies and between subgroups within studies.

Migration to western industrialised countries and perinatal health: a systematic review.

Influxes of migrant women of childbearing age to receiving countries have made their perinatal health status a key priority for many governments. The international research collaboration Reproductive Outcomes And Migration (ROAM) reviewed published studies to assess whether migrants in western industrialised countries have consistently poorer perinatal health than receiving-country women. A systematic review of literature from Medline, Health Star, Embase and PsychInfo from 1995 to 2008 included studies of migrant women/infants related to pregnancy or birth.

A population-based nested case-control study of the costs of hip and knee replacement surgery.

Background: Studies of total joint arthroplasty (TJA) have not evaluated the costs and outcomes in the context of expected arthritis worsening.

Objectives: Using a cost-consequence approach, to examine changes in direct health care costs and arthritis severity after TJA for hip/knee arthritis compared with contemporaneous changes in matched controls.

Research Design: Case control study nested in a population-based prospective cohort.

Computer-assisted screening for intimate partner violence and control: a randomized trial.

Background: Intimate partner violence and control (IPVC) is prevalent and can be a serious health risk to women.

Objective: To assess whether computer-assisted screening can improve detection of women at risk for IPVC in a family practice setting.

Design: Randomized trial.

Capitation and enhanced fee-for-service models for primary care reform: a population-based evaluation.

Background: Primary care reform in Ontario, Canada, included the initiation of a blended capitation model in 2001-2002 and an enhanced fee-for-service model in 2003. Both models involve patient rostering, incentives for preventive care and requirements for after-hours care. We evaluated practice characteristics and patterns of care under both models.

Social disadvantage, air pollution, and asthma physician visits in Toronto, Canada.

Background: Previous research demonstrates that ambient air pollution exacerbates asthma. Asthma morbidity also varies with socioeconomic position (SEP). Few studies have examined if ambient air pollution has a differential impact on income subgroups of the population.

Patients' gender affected physicians' clinical decisions when presented with standardized patients but not for matching paper patients.

Objective: To compare physicians' treatment and referral decisions for total knee arthroplasty (TKA) for standardized patients with matching paper patients.

Study Design And Setting: Sixty-seven physicians (38 family physicians and 29 orthopedic surgeons) performed blinded assessments of two standardized patients (one man and one woman) with moderate knee osteoarthritis and otherwise identical clinical scenarios differing only in gender, and consented to including their data. Standardized patients recorded physicians' recommendations (yes/no) to refer for, or perform, TKA.