The health-related quality of life of children with multiple sclerosis is mediated by the health-related quality of life of their parents.

Background: We previously found that children with the chronic disease multiple sclerosis (MS) reported lower health-related quality of life (HRQoL) when compared to children who experienced the transient illness termed monophasic acquired demyelinating syndromes (monoADS). Parents of children with MS also reported lower HRQoL.

Objectives: We evaluated whether parental HRQoL mediated the relationship between the diagnosis of MS and the HRQoL of affected children.

Disparities in Physician Compensation by Gender in Ontario, Canada.

Importance: Men and women should earn equal pay for equal work. An examination of the magnitude of pay disparities could inform strategies for remediation.

Objective: To examine gender-based differences in pay within a large, comprehensive physician population practicing within a variety of payment systems.

Personal Support Homes: An Innovative Approach to Reduce the Alternative Level of Care Population in Ontario Hospitals.

Objective: This study investigates the viability of personal support homes - a policy concept that reduces alternative level of care (ALC) days in Ontario hospitals. It allows people to leverage their empty bedrooms to temporarily house patients awaiting hospital discharge.

Method: Data from the Municipal Property Assessment Corporation are used to map geographic supply of empty bedrooms, and Ontario Ministry of Health administrative data are used to assess potential demand.

Comparing primary care Interprofessional and non-interprofessional teams on access to care and health services utilization in Ontario, Canada: a retrospective cohort study.

Background: Many countries, including Canada, have introduced primary care reforms to improve health system functioning and value. The purpose of this study was to examine the association between receiving care from interprofessional primary care teams and after-hours access to care, patient-reported walk-in clinic visits and emergency department use.

Methods: We conducted a retrospective cohort study linking population-based administrative databases to Ontario's Health Care Experience Survey (HCES) between 2012 and 2018.

When boundaries blur - exploring healthcare providers' views of chiropractic interprofessional care and the Canadian Forces Health Services.

Introduction: Musculoskeletal (MSK) conditions are primary reasons prohibiting Canadian Armed Forces (CAF) personnel from being deployed, with back pain the second most common activity-limiting condition. CAF provides a spectrum of services, including chiropractic care. There is a paucity of data related to chiropractic interprofessional care (IPC) within CAF healthcare settings.

Trends in prevalence of chronic disease and multimorbidity in Ontario, Canada.

Background: New case-mix tools from the Canadian Institute for Health Information offer a novel way of exploring the prevalence of chronic disease and multimorbidity using diagnostic data. We took a comprehensive approach to determine whether the prevalence of chronic disease and multimorbidity has been rising in Ontario, Canada.

Methods: In this observational study, we applied case-mix methodology to a population-based cohort.

The effect of mental health on social capital: An instrumental variable analysis.

Although a large body of literature has examined the effect of social capital on health and theoretical models suggest a reciprocal relationship between the two variables, there are relatively few studies that have investigated the effect of mental health on social capital. This paper evaluates the impact of mental health on the stock of social capital using data from the cross-sectional 2012 (N = 21,844) and 2002 (N = 31,089) Canadian Community Health Survey - Mental Health editions. Mental health was measured retrospectively as self-rated mental health, past year mental health conditions, and past 30-day psychological distress.

Smoking patterns based on birth-cohort-specific histories from 1965 to 2013, with projections to 2041.

Background: Characterizing smoking patterns over time is essential for evaluating the impact of tobacco control interventions and predicting smoking-related mortality. Beginning with a 1920s birth cohort, smoking histories (i.e.

Evaluation of a Heart Failure Telemonitoring Program Through a Microsimulation Model: Cost-Utility Analysis.

Background: Heart failure (HF) is a major public health issue in Canada that is associated with high prevalence, morbidity, and mortality rates and high financial and social burdens. Telemonitoring (TM) has been shown to improve all-cause mortality and hospitalization rates in patients with HF. The Medly program is a TM intervention integrated as standard of care at a large Canadian academic hospital for ambulatory patients with HF that has been found to improve patient outcomes.

Role of Interprofessional primary care teams in preventing avoidable hospitalizations and hospital readmissions in Ontario, Canada: a retrospective cohort study.

Background: Improving health system value and efficiency are considered major policy priorities internationally. Ontario has undergone a primary care reform that included introduction of interprofessional teams. The purpose of this study was to investigate the relationship between receiving care from interprofessional versus non-interprofessional primary care teams and ambulatory care sensitive condition (ACSC) hospitalizations and hospital readmissions.

Healthcare utilization and costs of pediatric home mechanical ventilation in Canada.

Background: Children using home mechanical ventilation (HMV) live at home with better quality of life, despite financial burden for their family. Previous studies of healthcare utilization and costs have not considered public and private expenditures, including family caregiver time. Our objective was to examine public and private healthcare utilization and costs for children using HMV, and variables associated with highest costs.

Physician group, physician and patient characteristics associated with joining interprofessional team-based primary care in Ontario, Canada.

Purpose: Countries throughout the world have been experimenting with new models to deliver primary care. We investigated physician group, physician and patient characteristics associated with voluntarily joining team-based primary care in Ontario.

Methods: This cross-sectional study linked provincial administrative datasets to form data extractions of interest over time with the earliest in 2005 and the latest in 2013.

Impacts of Absolute and Relative Income on Self-Rated Health in Urban and Rural China.

This study aims to assess the impacts of absolute and relative income on self-rated health (SRH) of residents in rural and urban China. Data were derived from the China Health and Nutrition Survey. Three distinct measures of relative income were considered (Gini coefficient, Yitzhaki index, and Deaton index) and computed for 3 geographic units (nation, province, and community).

Cost-effectiveness of Deceased-donor Renal Transplant Versus Dialysis to Treat End-stage Renal Disease: A Systematic Review.

Deceased-donor renal transplant (DDRT) is an expensive and potentially risky health intervention with the prospect of improved life and lower long-term costs compared with dialysis. Due to the increasing shortage of kidneys and the associated rise of transplantation costs, certain patient groups may not benefit from transplantation in a cost-effective manner compared with dialysis. The objective of this systematic review was to provide a comprehensive synthesis of evidence on the cost-effectiveness of DDRT relative to dialysis to treat adults with end-stage renal disease and patient-, donor-, and system-level factors that may modify the conclusion.

Management of type 2 diabetes using non-insulin glucose-lowering therapies: a critical appraisal of clinical practice guidelines with the AGREE II instrument.

Aim: Type 2 diabetes is a major global epidemic affecting over 400 million people worldwide. The objective of this systematic review was to provide an overview of recommendations from clinical practice guidelines (guidelines) addressing non-insulin based pharmacological management of among non-pregnant adults in an outpatient setting, and critically appraise their methodological development.

Methods: We systematically searched MEDLINE and Embase databases, for relevant guidelines using the Ovid interface.

User-Centered Adaptation of an Existing Heart Failure Telemonitoring Program to Ensure Sustainability and Scalability: Qualitative Study.

Background: Telemonitoring interventions for the management of heart failure have seen limited adoption in Canadian health systems, but isolated examples of telemonitoring programs do exist. An example of such a program was launched in a specialty heart failure clinic in Toronto, Canada, and a recent implementation evaluation concluded that reducing the cost of delivering the program is necessary to ensure its sustainability and scalability.

Objective: The objectives of this study were to (1) understand which components of the telemonitoring program could be modified to reduce costs and adapted to other contexts while maintaining program fidelity and (2) describe the changes made to the telemonitoring program to enable its sustainability within the initial implementation site and scalability to other health organizations.

Inequalities in the benefits of national health insurance on financial protection from out-of-pocket payments and access to health services: cross-sectional evidence from Ghana.

A central pillar of universal health coverage (UHC) is to achieve financial protection from catastrophic health expenditure. There are concerns, however, that national health insurance programmes with premiums may not benefit impoverished groups. In 2003, Ghana became the first sub-Saharan African country to introduce a National Health Insurance Scheme (NHIS) with progressively structured premium charges.

The Association between Stroke, Integrated Stroke Systems, and the Employability and Productivity of Canadian Stroke Survivors.

Background: Integrated stroke systems have been associated with reduced disability in stroke survivors, but their impact on employability and productivity (hours worked/week and hourly wages) of stroke survivors is unclear.

Methods: We used Canadian Community Health Surveys (2000-2014) to conduct a quasi-experimental study with the aim of determining the impact of stroke on employability and productivity, and whether the implementation of integrated stroke systems was associated with improvements in the employability and productivity of adult Canadian stroke survivors. Multivariable generalized Poisson regression models were used to determine the effect of stroke on employability; multivariable Heckman models were used to estimate the effect of stroke on productivity.

Impact of Predialysis Psychosocial Conditions on Kidney Transplant Recipient Survival: Evidence Using Propensity Score Matching.

Background: An increased number of end-stage renal disease patients suffer psychosocial conditions and may experience delayed access to transplantation due to listing restrictions. However, it remains to be shown whether preexisting psychosocial conditions confer an independent risk factor of poor posttransplant outcomes.

Objective: We addressed this gap in knowledge by conducting a retrospective cohort study to investigate an independent association between the risk of death after transplant and having a diagnosis of psychosocial conditions 1 year prior to starting dialysis.

Cost-effectiveness of sunflower oil fortification with vitamin A in Tanzania by scale.

In 2011, Tanzania mandated the fortification of edible oil with vitamin A to help address its vitamin A deficiency (VAD) public health problem. By 2015, only 16% of edible oil met the standards for adequate fortification. There is no evidence on the cost-effectiveness of the fortification of edible oil by small- and medium-scale (SMS) producers in preventing VAD.

An instrumental variable approach confirms that the duration of pretransplant dialysis has a negative impact on the survival of kidney transplant recipients and quantifies the risk.

Dialysis prior to kidney transplantation may have a detrimental effect on post-transplant outcomes. However, prior studies have not fully characterized the nature of this relationship and may have been subject to residual confounding. Here we investigated the association between pre-transplant dialysis duration and two post-transplant outcomes: all-cause death and death with functioning graft.

Patient Adherence to a Mobile Phone-Based Heart Failure Telemonitoring Program: A Longitudinal Mixed-Methods Study.

Background: Telemonitoring (TM) can improve heart failure (HF) outcomes by facilitating patient self-care and clinical decision support. However, these outcomes are only possible if patients consistently adhere to taking prescribed home readings.

Objective: The objectives of this study were to (1) quantify the degree to which patients adhered to taking prescribed home readings in the context of a mobile phone-based TM program and (2) explain longitudinal adherence rates based on the duration of program enrollment, patient characteristics, and patient perceptions of the TM program.

Economic evaluation of a publicly funded hepatitis A travel vaccination program in Ontario, Canada.

Background: Hepatitis A virus (HAV) causes acute liver infection and is spread through the fecal-oral route. Travel to countries in HAV-endemic regions (e.g.

Psychological Mechanisms Linking County-Level Income Inequality to Happiness in China.

In China, income levels and living standards have improved significantly, but many Chinese citizens still do not feel any happier. This phenomenon may be attributed to increased income inequality. Using data from the 2013 Chinese General Social Survey (CGSS), we employed multilevel structural equation modeling (MSEM) to investigate the impact of county-level income inequality on individual-level happiness in China and multilevel mediation analysis with structural equation modeling (MMSEM) to explore the mechanisms through which income inequality impacted happiness.