Harmonization of clinical practice guidelines for primary prevention and screening: actionable recommendations and resources for primary care.

Background: Clinical practice guidelines (CPGs) synthesize high-quality information to support evidence-based clinical practice. In primary care, numerous CPGs must be integrated to address the needs of patients with multiple risks and conditions. The BETTER program aims to improve prevention and screening for cancer and chronic disease in primary care by synthesizing CPGs into integrated, actionable recommendations.

Forecasting the Incidence and Prevalence of Inflammatory Bowel Disease: A Canadian Nationwide Analysis.

Introduction: Canada has a high burden of inflammatory bowel disease (IBD). Historical trends of IBD incidence and prevalence were analyzed to forecast the Canadian burden over the next decade.

Methods: Population-based surveillance cohorts in 8 provinces derived from health administrative data assessed the national incidence (2007-2014) and prevalence (2002-2014) of IBD.

Laying the foundation for Real-world evidence studies: a case study from Newfoundland and Labrador.

The Janssen and Newfoundland and Labrador Health Innovation Partnership (JANL-HIP) was established to carry out Real-World Evidence (RWE) projects to generate evidence about disease pathways, healthcare delivery, the effects of clinical interventions. Doing so will support and influence clinical decision-making in Newfoundland and Labrador (NL). This case study describes the foundational elements necessary for a real-world evidence generation project in NL and may provide learning for the effective execution of real-world studies in other jurisdictions.

Real World Studies of Psoriasis and Mental Illness in Newfoundland and Labrador.

Background: Psoriasis is a chronic, immune-mediated inflammatory disease with an implied connection to psychiatric disorders.

Objective: This study aims to illustrate an association between psoriasis and psychiatric disorders using real world data gathered from the Newfoundland and Labrador population.

Methods: Data on 15,100 patients with psoriasis and 75,500 controls (1:5) was collected from the Newfoundland and Labrador Centre for Health Information's Electronic Health Records.

Longitudinal costs and health service utilisation associated with primary care reforms in Ontario: a retrospective cohort study protocol.

Introduction: Over the last 20 years, the Canadian province of Ontario implemented several new models of primary care focusing on changes to physician remuneration, clinics led by nurse practitioners and the introduction of interprofessional primary care teams. Health outcome and cost evaluations of these models thus far have been mostly cross-sectional and in some cases results from these studies were conflicting. The aim of this population-based study is to investigate short, medium and long-term effectiveness of these reforms over the past 15-20 years.

A Quality Improvement Emergency Department Surge Management Platform (SurgeCon): Protocol for a Stepped Wedge Cluster Randomized Trial.

Background: Despite many efforts, long wait times and overcrowding in emergency departments (EDs) have remained a significant health service issue in Canada. For several years, Canada has had one of the longest wait times among the Organisation for Economic Co-operation and Development countries. From a patient's perspective, this challenge has been described as "patients wait in pain or discomfort for hours before being seen at EDs.

Population coverage of the Canadian Chronic Disease Surveillance System: a survey of the contents of health insurance registries across Canada.

Introduction: Health insurance registries, which capture insurance coverage and demographic information for entire populations, are a critical component of population health surveillance and research when using administrative data. Lack of standardization of registry information across Canada's provinces and territories could affect the comparability of surveillance measures. We assessed the contents of health insurance registries across Canada to describe the populations covered and document registry similarities and differences.

Pediatric high users of Canadian hospitals and emergency departments.

Introduction: Few studies have examined the most frequent pediatric users of hospital services. Our objective was to determine the clinical diagnoses, demographic characteristics, and medical severity of high-use pediatric patients in Canada.

Methods: We conducted a retrospective analysis of patients <18 years of age who either were admitted to hospital or visited an emergency department (ED) using the Canadian Institute for Health Information's (CIHI) Dynamic Cohort of Complex, High System Users.

Association of chronic pain with comorbidities and health care utilization: a retrospective cohort study using health administrative data.

Health administrative data provide a potentially robust information source regarding the substantial burden chronic pain exerts on individuals and the health care system. This study aimed to use health administrative data to estimate comorbidity prevalence and annual health care utilization associated with chronic pain in Newfoundland and Labrador, Canada. Applying the validated Chronic Pain Algorithm to provincial Fee-for-Service Physician Claims File data (1999-2009) established the Chronic Pain (n = 184,580) and No Chronic Pain (n = 320,113) comparator groups.

Adults with diabetes mellitus in Newfoundland and Labrador: a population-based, cross-sectional analysis.

Background: Although the province of Newfoundland and Labrador has the highest rates of chronic disease in Canada, the current state of many chronic diseases in the province, including diabetes mellitus, has not been well explored. We profiled the demographic characteristics associated with, and the management of, diabetes in Newfoundland and Labrador, including any rural-urban differences.

Methods: We performed a population-based, cross-sectional analysis using data from the provincial Chronic Disease Registry for fiscal year 2015/16.

Public engagement with genomic medicine: a summary of town hall discussions.

Engaging with the public for their input about genomic medicine is critical before it is implemented into routine healthcare practice. In order to inform discussion and planning for the introduction of genome sequencing into clinical care in an Eastern Canadian province, we implemented a program of public engagement activities. Here, we report a qualitative summary of two town hall discussions utilizing a hybrid information-consultation approach with 20 residents of the province of Newfoundland and Labrador, Canada.

Infant feeding mode predicts the costs of healthcare services in one region of Canada: a data linkage pilot study.

Objective: The aim is to perform a pilot study evaluating the differences in healthcare service use and its associated costs by infant feeding mode in an infant's first year of life. Data from a prospective cohort study and administrative databases were linked to examine healthcare use in healthy full term infants (N = 160). Exposure was categorized as exclusively breastfed, mixed fed and exclusively formula fed.

Effect of primary health care reforms in the province of Newfoundland and Labrador: Interrupted time-series analysis.

Objective: To examine the effects of primary health care (PHC) reforms in the Canadian province of Newfoundland and Labrador on ambulatory care-sensitive (ACS) hospitalization rates and mortality.

Design: Interrupted time-series analysis of administrative data.

Setting: All communities in the province of Newfoundland and Labrador were divided into 3 groups: rural reform (n = 69 143), rural nonreform (n = 228 914), and urban nonreform (n = 197 012).

Primary health care services for patients with chronic disease in Newfoundland and Labrador: a descriptive analysis.

Background: Newfoundland and Labrador has a rapidly aging population, much of which is rural, with poor health behaviours and high rates of chronic disease. These factors contribute to a unique challenge in health care delivery. Our aim was to describe the availability of publicly funded primary health care programs and services delivered by regional health authorities across the province.

Health and health service use of very elderly Newfoundlanders.

Objective: To develop a better understanding of the current health status and health care use of the population of very elderly Newfoundlanders to inform policy makers, decision makers, and health care providers about aspects of the health care system that might be in higher demand in the near future.

Design: Descriptive analysis using data from the Newfoundland and Labrador component of the Canadian Primary Care Sentinel Surveillance Network database for the 2013 calendar year.

Setting: Newfoundland.

An Investigation of Comorbid Disease and Health Service Utilization Among Patients With Moderate to Severe Psoriasis in Newfoundland and Labrador.

Psoriasis is an inflammatory skin condition affecting 2% to 3% of the population and is associated with several comorbidities, including cardiovascular disease, depression, inflammatory bowel disease, metabolic syndrome, mood disorder, psoriatic arthritis, and weight gain. Psoriasis is treated with a number of topical and systemic therapies, including biologic drugs that directly target proinflammatory cytokines. This cross-sectional retrospective study investigated comorbid conditions reported in the Newfoundland and Labrador psoriasis population, outcomes associated with therapeutic treatment, and use of health care resources.

Determining Clinically Relevant Cutoff Scores for the Iowa Infant Feeding Attitude Scales Among Prenatal Women in Canada.

Background: The original 17-item Iowa Infant Feeding Attitude Scale (IIFAS) has been validated and widely used to assess attitudes toward breastfeeding. A reduced 13-item version of the IIFAS was recently validated in a Canadian setting. However, cutoff scores for categorization of infant feeding attitudes on both scales have not yet been established.

Psychometric Assessment and Precision Remodeling of the Iowa Infant Feeding Attitude Scale to Improve Clinical Use and Efficacy Among Prenatal Women in Canada.

Background: The 17-item Iowa Infant Feeding Attitude Scale (IIFAS) has been widely used to assess maternal attitudes toward infant feeding and to predict breastfeeding intention. The IIFAS has been validated among prenatal women located in Newfoundland and Labrador in Canada, although its length may prove challenging to complete in a clinical setting. Research aim: The authors aimed to reduce the number of items from the original 17-item IIFAS scale while maintaining reliability and validity.

Relation between family physician retention and avoidable hospital admission in Newfoundland and Labrador: a population-based cross-sectional study.

Background: Physician turnover, involving physicians' leaving clinical practice in a specific area, may disrupt continuity of care, leading to poorer health outcomes and greater use of health care services. The purpose of this study was to investigate the relation between family physician retention and avoidable hospital admission for ambulatory-care-sensitive conditions.

Methods: We conducted a population-based cross-sectional study using provincial health administrative data for residents of Newfoundland and Labrador who held a provincial health card between 2001 and 2009.

Poverty and Breastfeeding: Comparing Determinants of Early Breastfeeding Cessation Incidence in Socioeconomically Marginalized and Privileged Populations in the FiNaL Study.

Infant feeding differences are strongly tied to socioeconomic status. The goal of this study is to compare determinants of early breastfeeding cessation incidence in socioeconomically marginalized (SEM) and socioeconomically privileged (SEP) populations, focusing on birthing parents who intended to breastfeed. This cohort study includes data from 451 birthing parents in the Canadian province of Newfoundland and Labrador who reported intention to breastfeed in the baseline prenatal survey.

Using Electronic Medical Record to Identify Patients With Dyslipidemia in Primary Care Settings: International Classification of Disease Code Matters From One Region to a National Database.

Objective: To assess the validity of the International Classification of Disease (ICD) codes for identifying patients with dyslipidemia in electronic medical record (EMR) data.

Methods: The EMRs of patients receiving primary care in St. John's, Newfoundland and Labrador (NL), Canada, were retrieved from the Canadian Primary Care Sentinel Surveillance Network database.

Determinants of Nonmedically Indicated In-Hospital Supplementation of Infants Whose Birthing Parents Intended to Exclusively Breastfeed.

Background: Despite high rates of intention to exclusively breastfeed, rates of exclusive breastfeeding in Canada are low. Supplementation may begin in hospital and is associated with reduced breastfeeding duration. Research aim: The aim of this investigation was to explore determinants of in-hospital nonmedically indicated supplementation of infants whose birthing parents intended to exclusively breastfeed.

Determinants of neurological disease: Synthesis of systematic reviews.

Systematic reviews were conducted to identify risk factors associated with the onset and progression of 14 neurological conditions, prioritized as a component of the National Population Health Study of Neurological Conditions. These systematic reviews provided a basis for evaluating the weight of evidence of evidence for risk factors for the onset and progression of the 14 individual neurological conditions considered. A number of risk factors associated with an increased risk of onset for more than one condition, including exposure to pesticides (associated with an increased risk of AD, amyotrophic lateral sclerosis, brain tumours, and PD; smoking (AD, MS); and infection (MS, Tourette syndrome).

Association of insulin dosage with mortality or major adverse cardiovascular events: a retrospective cohort study.

Background: Existing studies have shown conflicting evidence regarding the safety of exogenous insulin therapy in patients with type 2 diabetes. In particular, observational studies have reported an increased risk of death and cardiovascular disease among users of higher versus lower doses of insulin. We aimed to quantify the association between increasing dosage of insulin exposure and death and cardiovascular events, while taking into account time-dependent confounding and mediation that might have biased previous studies.