Facilitating barriers: Contextual factors and self-management of type 2 diabetes in urban settings.

Urban environments create unique challenges for the management of type 2 diabetes (T2D). City living is associated with unhealthy occupational, nutritional, and physical activity patterns. However, it has also been linked to behaviours that promote health, such as walking and cycling for transportation.

The influence of measurement error on calibration, discrimination, and overall estimation of a risk prediction model.

Background: Self-reported height and weight are commonly collected at the population level; however, they can be subject to measurement error. The impact of this error on predicted risk, discrimination, and calibration of a model that uses body mass index (BMI) to predict risk of diabetes incidence is not known. The objective of this study is to use simulation to quantify and describe the effect of random and systematic error in self-reported height and weight on the performance of a model for predicting diabetes.

Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework.

Background: The Theoretical Domains Framework (TDF) was developed to investigate determinants of specific clinical behaviors and inform the design of interventions to change professional behavior. This framework was used to explore the beliefs of chiropractors in an American Provider Network and two Canadian provinces about their adherence to evidence-based recommendations for spine radiography for uncomplicated back pain. The primary objective of the study was to identify chiropractors' beliefs about managing uncomplicated back pain without x-rays and to explore barriers and facilitators to implementing evidence-based recommendations on lumbar spine x-rays.

The role of ethnicity in predicting diabetes risk at the population level.

Background: The current form of the diabetes population risk tool (DPoRT) includes a non-specific category of ethnicity in concordance with publicly data available. Given the importance of ethnicity in influencing diabetes risk and its significance in a multi-ethnic population, it is prudent to determine its influence on a population-based risk prediction tool.

Objective: To apply and compare the DPoRT with a modified version that includes detailed ethnic information in Canada's largest and most ethnically diverse province.

Validation of a health administrative data algorithm for assessing the epidemiology of diabetes in Canadian children.

Objective: To validate a case definition of pediatric diabetes using administrative health data and describe trends in incidence and prevalence over time in Ontario, Canada.

Methods: We sampled hospital records of 700 children from 1994 to 2003 with a prior history of at least one outpatient or hospital record for diabetes mellitus and 300 randomly selected children with no diabetes records. We defined patients as having diabetes based on diagnoses and drug utilization from chart abstraction and compared sensitivity and specificity of a number of combinations of overall health care use using administrative data to develop a highly specific definition.

Looking inside the black box: a theory-based process evaluation alongside a randomised controlled trial of printed educational materials (the Ontario printed educational message, OPEM) to improve referral and prescribing practices in primary care in Ontario, Canada.

Background: Randomised controlled trials of implementation strategies tell us whether (or not) an intervention results in changes in professional behaviour but little about the causal mechanisms that produce any change. Theory-based process evaluations collect data on theoretical constructs alongside randomised trials to explore possible causal mechanisms and effect modifiers. This is similar to measuring intermediate endpoints in clinical trials to further understand the biological basis of any observed effects (for example, measuring lipid profiles alongside trials of lipid lowering drugs where the primary endpoint could be reduction in vascular related deaths).

Trends in deliveries, prenatal care, and obstetrical complications in women with pregestational diabetes: a population-based study in Ontario, Canada, 1996-2001.

Objective: To describe recent trends in the proportion of deliveries in women with pregestational diabetes (PGD), their use of services, and diabetes-related obstetrical complications.

Research Design And Methods: In this population-based retrospective cohort study, comprehensive administrative data were used to identify all women (with and without PGD) who gave birth in an Ontario, Canada, hospital from 1996 to 2001. Data on maternal complications and interventions were obtained from hospital discharge records; data on use of prenatal services were obtained from fee-for-service claims.

Serum lipids and outcome of early-stage breast cancer: results of a prospective cohort study.

Purpose: The prognosis of women with early-stage breast cancer is influenced by insulin and body mass index (BMI). High levels of serum insulin and obesity often coexist with dyslipidemia in the insulin resistance syndrome (IRS), but the contribution of lipids to breast cancer outcome is unclear. Here, we examine whether serum levels of total cholesterol (TC) and triglycerides (TG) influence breast cancer outcome.

Antihypertensive therapy and incidence of type 2 diabetes in an elderly cohort.

Objective: The aim of this study was to determine whether the incidence of type 2 diabetes differed among elderly users of four major antihypertensive drug classes.

Research Design And Methods: This was a retrospective, observational cohort study of previously untreated elderly patients (aged > or = 66 years) identified as new users of an antihypertensive drug class between April 1995 and March 2000. Using a Cox proportional hazards model, the primary analysis compared diabetes incidence in users of ACE inhibitors, beta-blockers, and calcium channel blockers (CCBs), with thiazide diuretics allowed as second-line therapy.