Evaluation of the ability of standardized supports to improve public health response to syndromic surveillance for respiratory diseases in Canada.

Background: Despite widespread implementation of syndromic surveillance systems within public health agencies, previous studies of the implementation and use of these systems have indicated that the functions and responses taken in response to syndromic surveillance data vary widely according to local context and preferences. The objective of the Syndromic Surveillance Evaluation Study was to develop and implement standardized supports in local public health agencies in Ontario, Canada, and evaluate the ability of these supports to affect actions taken as part of public health communicable disease control programs.

Methods: Local public health agencies (LPHA) in Ontario, which used syndromic surveillance based on emergency department visits for respiratory disease, were recruited and randomly allocated to the study intervention or control group.

Narrowing mortality gap between men and women over two decades: a registry-based study in Ontario, Canada.

Background: Historically, women have lower all-cause mortality than men. It is less understood that sex differences have been converging, particularly among certain subgroups and causes. This has implications for public health and health system planning.

The association between undiagnosed glycaemic abnormalities and cardiometabolic risk factors with periodontitis: results from 2007-2009 Canadian Health Measures Survey.

Aim: The aim was to investigate the association between undiagnosed glycaemic abnormalities and cardiometabolic risk factors with periodontitis.

Methods: Using Cycle 1 (2007-2009) of Canadian Health Measures Survey, survey-sampling weights were applied to a restricted sample of fasting, non-pregnant adults between 19 and 79 years of age without diagnosed or treated type 2 diabetes. We estimated the prevalence of periodontitis and various cardiometabolic risk factors according to the clinical diagnostic definition for metabolic syndrome (MetS), recognized by the American Heart Association and National Heart, Lung, and Blood Institute.

Residents of highly walkable neighbourhoods in Canadian urban areas do substantially more physical activity: a cross-sectional analysis.

Background: Research has shown that neighbourhood walkability is associated with small differences in physical activity; however, the health impacts of these small differences have been questioned. We examined the size of the association of walkability with accelerometer-measured physical activity in a large, national-level Canadian population, and compared results to physical activity levels recommended in international guidelines. Our primary objective was to investigate the direction and size of the differences in physical activity that were related to walkability, and whether these differences depended on age.

Assessing the risk of intussusception and rotavirus vaccine safety in Canada.

Background: Intussusception has been identified as a rare adverse event following rotavirus immunization. We sought to determine the incidence of intussusception among infants in Canada both before and after introduction of rotavirus immunization programs.

Methods: We used Canadian Institute for Health Information (CIHI) Discharge Abstract Database (DAD) to identify infants under 1 y of age who were admitted to a Canadian hospital, which the exception of Quebec, which does not submit data to CIHI, with a diagnosis of intussusception (ICD-10 code K56.

Effectiveness of pertussis vaccination and duration of immunity.

Background: A resurgence of pertussis cases among both vaccinated and unvaccinated people raises questions about vaccine effectiveness over time. Our objective was to study the effectiveness of the pertussis vaccine and characterize the effect of waning immunity and whole-cell vaccine priming.

Methods: We used the test-negative design, a nested case-control study with test-negative individuals as controls.

Measuring Burden of Unhealthy Behaviours Using a Multivariable Predictive Approach: Life Expectancy Lost in Canada Attributable to Smoking, Alcohol, Physical Inactivity, and Diet.

Background: Behaviours such as smoking, poor diet, physical inactivity, and unhealthy alcohol consumption are leading risk factors for death. We assessed the Canadian burden attributable to these behaviours by developing, validating, and applying a multivariable predictive model for risk of all-cause death.

Methods: A predictive algorithm for 5 y risk of death-the Mortality Population Risk Tool (MPoRT)-was developed and validated using the 2001 to 2008 Canadian Community Health Surveys.

Early impact of Ontario's human papillomavirus (HPV) vaccination program on anogenital warts (AGWs): A population-based assessment.

Introduction: This study aimed to evaluate the early population impact of Ontario's school-based human papillomavirus (HPV) vaccination program, implemented in September 2007 for grade 8 females, by comparing anogenital wart (AGW) health care utilization before and after vaccine program implementation, in program-eligible and program-ineligible cohorts, focusing on 15-26year olds.

Methods: Using a retrospective longitudinal population-based study design, health administrative data were used to identify incident AGWs and total health service utilization (HSU) for AGWs for Ontario residents 15years and older between April 1 2004 and March 31 2014. The study period was divided into two eras: the pre-vaccine program era and the vaccine program era.

Impact of pharmacist administration of influenza vaccines on uptake in Canada.

Background: Uptake of influenza vaccination in Canada remains suboptimal despite widespread public funding. To increase access, several provinces have implemented policies permitting pharmacists to administer influenza vaccines in community pharmacies. We examined the impact of such policies on the uptake of seasonal influenza vaccination in Canada.

Survival and Surgical Interventions for Children With Trisomy 13 and 18.

Importance: Trisomy 13 and 18 are genetic diagnoses with characteristic physical features, organ anomalies, and neurodevelopmental disability. Most children with these disorders die shortly after birth, although limited data suggest some children survive longer. Surgeries are controversial, and little evidence is available about outcomes.

Trajectories of objectively measured sedentary time among secondary students in Manitoba, Canada in the context of a province-wide physical education policy: A longitudinal analysis.

Objectives: Canadian adolescents' sedentary behaviour (SB) is poorly understood and greatly understudied compared to physical activity (PA). Accumulating evidence suggests that SB poses long-term health risks regardless of PA levels. To design effective interventions that target SB, it is critical to first understand adolescents' sedentary time (ST) trajectories in a Canadian context.

What predictors matter: Risk factors for late adolescent outcomes.

Objectives: A life course approach and linked Manitoba data from birth to age 18 were used to facilitate comparisons of two important outcomes: high school graduation and Attention-Deficit/Hyperactivity Disorder (ADHD). With a common set of variables, we sought to answer the following questions: Do the measures predicting high school graduation differ from those that predict ADHD? Which factors are most important? How well do the models fit each outcome?

Methods: Administrative data from the Population Health Research Data Repository at the Manitoba Centre for Health Policy were used to conduct one of the strongest observational designs: multilevel modelling of large population (n = 62,739) and sibling (n = 29,444) samples. Variables included are neighbourhood characteristics, measures of family stability, and mental and physical health conditions in childhood and adolescence.

The Economic Burden of Hospital-Acquired Clostridium difficile Infection: A Population-Based Matched Cohort Study.

BACKGROUND High-quality cost estimates for hospital-acquired Clostridium difficile infection (CDI) are vital evidence for healthcare policy and decision-making. OBJECTIVE To evaluate the costs attributable to hospital-acquired CDI from the healthcare payer perspective. METHODS We conducted a population-based propensity-score matched cohort study of incident hospitalized subjects diagnosed with CDI (those with the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada code A04.

Estimating the impact of various menu labeling formats on parents' demand for fast-food kids' meals for their children: An experimental auction.

This study experimentally tested whether parents' demand for fast-food kids' meals for their children is influenced by various menu labeling formats disclosing calorie and sodium information. The study also examined the effect of various menu labeling formats on parents' ability to identify fast-food kids' meals with higher calorie and sodium content. Online surveys were conducted among parents of children aged 3-12.

Contribution of influenza viruses to medically attended acute respiratory illnesses in children in high-income countries: a meta-analysis.

Aim: The burden of disease in children attributable to influenza viruses is difficult to quantify given the similarity of symptoms caused by infection due to influenza and other viruses. This uncertainty impacts clinical decision-making and estimates of burden. We aimed to systematically review the literature to determine the proportion of healthy children presenting for health care with an acute respiratory illness (ARI) who have laboratory-confirmed seasonal influenza (PROSPERO ID#CRD42014013896).

Underreporting of hepatitis A in non-endemic countries: a systematic review and meta-analysis.

Background: Information on reporting completeness of passive surveillance systems can improve the quality of and public health response to surveillance data and better inform public health planning. As a result, we systematically reviewed available literature on reporting completeness of hepatitis A in non-endemic countries.

Methods: We searched Medline, EMBASE and grey literature sources, restricting to studies published in English between 1997 and 21 May 2015.

Association of Neighborhood Walkability With Change in Overweight, Obesity, and Diabetes.

Importance: Rates of obesity and diabetes have increased substantially in recent decades; however, the potential role of the built environment in mitigating these trends is unclear.

Objective: To examine whether walkable urban neighborhoods are associated with a slower increase in overweight, obesity, and diabetes than less walkable ones.

Design, Setting, And Participants: Time-series analysis (2001-2012) using annual provincial health care (N ≈ 3 million per year) and biennial Canadian Community Health Survey (N ≈ 5500 per cycle) data for adults (30-64 years) living in Southern Ontario cities.

Neuroimaging in encephalitis: analysis of imaging findings and interobserver agreement.

Aim: To assess the role of imaging in the early management of encephalitis and the agreement on findings in a well-defined cohort of suspected encephalitis cases enrolled in the Prospective Aetiological Study of Encephalitis conducted by the Health Protection Agency (now incorporated into Public Health England).

Materials And Methods: Eighty-five CT examinations from 68 patients and 101 MRI examinations from 80 patients with suspected encephalitis were independently rated by three neuroradiologists blinded to patient and clinical details. The level of agreement on the interpretation of images was measured using the kappa statistic.

Population-Level Impact of Ontario's Infant Rotavirus Immunization Program: Evidence of Direct and Indirect Effects.

Objective: To evaluate the direct and indirect population impact of rotavirus (RV) immunization on hospitalizations and emergency department (ED) visits for acute gastroenteritis (AGE) in Ontario before and after the publicly-funded RV immunization program.

Methods: Administrative data was used to identify ED visits and hospitalizations for all Ontarians using ICD-10 codes. We used two outcome definitions: RV-specific AGE (RV-AGE) and codes representing RV-, other viral and cause unspecified AGE ("overall AGE").

Effect of Vitamin D3 Supplementation on Inflammatory Markers and Glycemic Measures among Overweight or Obese Adults: A Systematic Review of Randomized Controlled Trials.

Background: Obesity induced low-grade chronic inflammation disrupts proper immune and metabolic function. Vitamin D deficiency increases inflammation, which is associated with cardiometabolic risk. This systematic review examines the association between oral vitamin D (VD) supplementation and circulating inflammatory biomarkers and glycemic outcomes from randomized controlled trials (RCTs) of overweight and/or obese adults.

Risk of Bias in Systematic Reviews of Non-Randomized Studies of Adverse Cardiovascular Effects of Thiazolidinediones and Cyclooxygenase-2 Inhibitors: Application of a New Cochrane Risk of Bias Tool.

Background: Systematic reviews of the effects of healthcare interventions frequently include non-randomized studies. These are subject to confounding and a range of other biases that are seldom considered in detail when synthesizing and interpreting the results. Our aims were to assess the reliability and usability of a new Cochrane risk of bias (RoB) tool for non-randomized studies of interventions and to determine whether restricting analysis to studies with low or moderate RoB made a material difference to the results of the reviews.

The Impact of WHO Essential Medicines Policies on Inappropriate Use of Antibiotics.

Background: Inappropriate overuse of antibiotics contributes to antimicrobial resistance (AMR), yet policy implementation to reduce inappropriate antibiotic use is poor in low and middle-income countries.

Aims: To determine whether public sector inappropriate antibiotic use is lower in countries reporting implementation of selected essential medicines policies.

Materials And Methods: Results from independently conducted antibiotic use surveys in countries that did, and did not report implementation of policies to reduce inappropriate antibiotic prescribing, were compared.

The development and validation of a meta-tool for quality appraisal of public health evidence: Meta Quality Appraisal Tool (MetaQAT).

Objectives: Most quality appraisal tools were developed for clinical medicine and tend to be study-specific with a strong emphasis on risk of bias. In order to be more relevant to public health, an appropriate quality appraisal tool needs to be less reliant on the evidence hierarchy and consider practice applicability. Given the broad range of study designs used in public health, the objective of this study was to develop and validate a meta-tool that combines public health-focused principles of appraisal coupled with a set of design-specific companion tools.

Health service utilisation for anogenital warts in Ontario, Canada prior to the human papillomavirus (HPV) vaccine programme introduction: a retrospective longitudinal population-based study.

Objective: Trends in occurrence of anogenital warts (AGWs) can provide early evidence of human papillomavirus (HPV) vaccination programme impact on preventing HPV infection and HPV-induced lesions. The objective of this study was to provide a baseline of AGW epidemiology in Ontario prior to the introduction of the publicly-funded school-based HPV vaccination programme in September 2007.

Setting And Participants: As a retrospective longitudinal population-based study, we used health administrative data as a proxy to estimate incident AGWs and total health service utilisation (HSU) for AGWs for all Ontario residents 15 years and older with valid health cards between 1 April 2003 and 31 March 2007.