Reformulation of controlled-release oxycodone and pharmacy dispensing patterns near the US-Canada border.

Background: In August 2010, a tamper-resistant formulation of controlled-release oxycodone (OxyContin-OP) was introduced in the United States but not in Canada. Our objective was to determine whether introduction of OxyContin-OP in the United States influenced prescription volumes for the original controlled-release oxycodone formulation (OxyContin) at Canadian pharmacies near the international border.

Methods: We conducted a population-based, serial, cross-sectional study of prescriptions dispensed from pharmacies in the 3 cities with the highest volume of US-Canada border crossings in Ontario: Niagara Falls, Windsor and Sarnia.

CNODES: the Canadian Network for Observational Drug Effect Studies.

Although administrative health care databases have long been used to evaluate adverse drug effects, responses to drug safety signals have been slow and uncoordinated. We describe the establishment of the Canadian Network for Observational Drug Effect Studies (CNODES), a collaborating centre of the Drug Safety and Effectiveness Network (DSEN). CNODES is a distributed network of investigators and linked databases in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec and Nova Scotia.

Dietary and waterborne mercury accumulation by yellow perch: a field experiment.

It is well accepted that the majority of monomethylmercury (MMHg) in fish originates in their food; however, the additional contribution of water as a source to fish MMHg levels remains unclear. We used isotope enriched mercury (Hg) in a controlled field experiment to quantify the uptake of Hg from ingested and aqueous sources by young-of-year yellow perch (Perca flavescens). Water and zooplankton from a lake that had received (202)Hg-enriched additions (called spike Hg) for 7 y during a whole-ecosystem loading study (METAALICUS) provided natural, low-level Hg exposure.

Trends in opioid use and dosing among socio-economically disadvantaged patients.

Background: Opioid therapy for patients with chronic nonmalignant pain remains controversial, primarily because of safety concerns and the potential for abuse. The objective of this study was to examine trends in opioid utilization for nonmalignant pain among recipients of social assistance and to explore the relation between dose of analgesic and mortality.

Methods: Using a cross-sectional study design, we characterized annual trends in prescriptions for and daily dose of opioid analgesics between 2003 and 2008 for beneficiaries (aged 15 to 64 years) of Ontario's public drug plan.

Statins and intracerebral hemorrhage: a retrospective cohort study.

Background: A recent post hoc analysis of a large randomized trial in patients with cerebrovascular disease suggested that statins may increase the risk of intracerebral hemorrhage (ICH).

Objective: To examine the association between statins and ICH in patients with recent ischemic stroke in a population-based setting.

Design: Retrospective propensity-matched cohort study with accrual from July 1, 1994, to March 31, 2008.

Exploring variation in rates of polypharmacy across long term care homes.

Objective: Use of multiple, concurrent drug therapies, often referred to as polypharmacy, is a concern in the long term care (LTC) setting, where frail older adults are particularly at risk for adverse events. We quantified the scope of this practice by exploring variation in the use of nine or more drug therapies across LTC homes.

Design: Cross-sectional analysis of LTC home census data.

Assessment of mercury bioaccumulation within the pelagic food web of lakes in the western Great Lakes region.

While mercury is a health hazard to humans and wildlife, the biogeochemical processes responsible for its bioaccumulation in pelagic food webs are still being examined. Previous studies have indicated both "bottom-up" control of piscivorous fish Hg content through methylmercury.(MeHg) supply, as well as site-specific trophic factors.

Statin use associates with a lower incidence of acute kidney injury after major elective surgery.

Statins abrogate ischemic renal injury in animal studies but whether they are renoprotective in humans is unknown. We conducted a population-based retrospective cohort study that included 213,347 older patients who underwent major elective surgery in the province of Ontario, Canada from 1995 to 2008. During the first 14 postoperative days, 1.

Opioid dose and drug-related mortality in patients with nonmalignant pain.

Background: Opioids are widely prescribed for chronic nonmalignant pain, often at doses exceeding those recommended in clinical practice guidelines. However, the risk-benefit ratio of high-dose opioid therapy is not well characterized. The objective of this study was to characterize the relationship between opioid dose and opioid-related mortality.

Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP).

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.

Relationship of asthma management, socioeconomic status, and medication insurance characteristics to exacerbation frequency in children with asthma.

Background: less than 25% of asthmatic children are well controlled.

Objective: to identify factors associated with asthma exacerbation causing emergency department (ED) visits or hospitalizations related to health status, socioeconomic status (SES), and drug insurance.

Methods: in this retrospective cohort study, complete data were collected on 490 asthmatic children regarding demographics, SES, drug plan characteristics, health status, health resource use, and symptoms.

Quality care in seniors with new-onset rheumatoid arthritis: a Canadian perspective.

Objective: To estimate the percentage of seniors with rheumatoid arthritis (RA) receiving disease-modifying antirheumatic drugs (DMARDs) within the first year of diagnosis.

Methods: We assembled an incident RA cohort from Ontario physician billing data for 1997-2006. We used a standard algorithm to identify 24,942 seniors with RA based on ≥ 2 billing codes ≥ 60 days apart but within 5 years.

Provider volumes and early outcomes of primary total joint replacement in Ontario.

Background: A relation between provider volume and outcome of total joint replacement (TJR) has not been demonstrated in Canada. Given the recent increase in TJR, changing patient characteristics and small sizes of previous Ontario studies, we reassessed whether adverse outcomes of TJR are related to hospital and surgeon procedure volumes.

Methods: We included all Ontarians aged 20 years and older who underwent a unilateral elective primary total hip replacement (THR) or total knee replacement (TKR) between April 2000 and March 2004.

Forecasting the need for dialysis services in ontario, Canada to 2011.

Careful projections of the demand for dialysis services are important to assist healthcare planners in forecasting the need for equipment, facilities and personnel. We used time series techniques to model the historical incidence and prevalence counts and to forecast the predicted number of patients requiring dialysis in the province of Ontario to 2011. We showed that the incidence and prevalence of dialysis patients continues to grow rapidly.

A fluorescence lifetime-based assay for serine and threonine kinases that is suitable for high-throughput screening.

We describe the development of a novel method for the assay of serine/threonine protein kinases based on fluorescence lifetime. The assay consists of three generic peptides (which have been used by others in the assay of >140 protein kinases in various assay formats) labeled with a long lifetime fluorescent dye (14 or 17 ns) that act as substrates for protein kinases and an iron(III) chelate that modulates the fluorescence lifetime of the peptide only when it is phosphorylated. The decrease in average fluorescence lifetime as measured in a recently developed fluorescence lifetime plate reader (Edinburgh Instruments) is a measure of the degree of phosphorylation of the peptide.

Rapid expansion of intravitreal drug injection procedures, 2000 to 2008: a population-based analysis.

Objective: To evaluate patterns of care for age-related macular degeneration following the introduction of vascular endothelial growth factor inhibitors.

Methods: Using a population-based retrospective design, we studied monthly fee claims for intravitreal injections submitted to the Ontario Health Insurance Plan between January 1, 2000, and March 30, 2008, and linked procedures to the physicians who performed them. This database records physician services provided as part of universal health care insurance coverage in Ontario, Canada.

Socioeconomic factors and home allergen exposure in children with asthma.

Introduction: The objective of this study was to determine the association between sociodemographic factors and the elimination of allergen sources from homes of asthmatic children.

Method: In a cross-sectional analysis of data from 845 asthmatic children, multiple linear regression investigated the association between socioeconomic factors and failure to reduce allergen sources (i.e.

Environmental stability and lake zooplankton diversity - contrasting effects of chemical and thermal variability.

Environmental variability in space and time is a primary mechanism allowing species that share resources to coexist. Fluctuating conditions are a double edged sword for diversity, either promoting coexistence through temporal niche partitioning or excluding species by stochastic extinctions. The net effect of environmental variation on diversity is largely unknown.

Blood glucose test strips: options to reduce usage.

Background: Recent evidence suggests that, despite widespread use, self-monitoring of blood glucose levels has little clinical benefit in many patients with diabetes. The impact of more focused public-payer policies for the use of blood glucose test strips may be substantial.

Methods: We conducted a cross-sectional analysis of annual prescription claims for test strips between 1997 and 2008 for patients in Ontario aged 65 and older with diabetes.

Communities contain closely related species during ecosystem disturbance.

Predicting community and species responses to disturbance is complicated by incomplete knowledge about species traits. A phylogenetic framework should partially solve this problem, as trait similarity is generally correlated with species relatedness, closely related species should have similar sensitivities to disturbance. Disturbance should thus result in community assemblages of closely related species.

Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery.

Context: Both benign prostatic hyperplasia (BPH) and cataract formation are common in older men. The alpha-adrenergic receptor blocker tamsulosin is frequently prescribed to treat BPH, and research suggests this drug may increase the intraoperative difficulty of cataract surgery. No studies have documented whether use of tamsulosin or other alpha-blocker drug therapies affect the risk of serious postoperative adverse events.

Improving Drug Benefits for Children with Asthma: Results of a Multi-stakeholder Workshop to Build a Research Agenda.

Asthma is the most common chronic childhood disease, and evidence suggests that children underutilize inhaled corticosteroid ("controller") medications. Drug plans that provide benefits to children vary widely across Canada, and families may face high out-of-pocket costs. As an initial step in a knowledge exchange process aimed at motivating relevant research, a workshop was convened in March 2007 with diverse stakeholders to explore potential research topics within the theme of improving drug benefits for Canadian children with asthma.

Cessation of deliberate self harm following eye movement desensitisation and reprocessing: A case report.

We present a case report of an eighteen year old female patient presenting with a psychological trauma related complaint. Part of the manifestation of the complaint included acts of self cutting over a number of years. Following two sessions of Eye Movement Desensitization & Reprocessing with one of the authors (DM) her self cutting ceased.

Cardiovascular Health Awareness Program (CHAP): a community cluster-randomised trial among elderly Canadians.

Objective: High blood pressure is an important and modifiable cardiovascular disease risk factor that remains under-detected and under-treated. Community-level interventions that address high blood pressure and other modifiable risk factors are a promising strategy to improve cardiovascular health in populations. The present study is a community cluster-randomised trial testing the effectiveness of CHAP (Cardiovascular Health Awareness Program) on the cardiovascular health of older adults.