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  INSTITUTE FOR CLINICAL EVALUATIVE SCIENCES

DECEMBER 2013

 
At a Glance
  MONTHLY HIGHLIGHTS OF ICES RESEARCH FINDINGS FOR STAKEHOLDERS  
 

Parents more likely to take first-born children to hospital after vaccine reactions

Hawken S, Kwong JC, Deeks SL, Crowcroft NS, Ducharme R, Manuel DG, Wilson K. Association between birth order and emergency room visits and acute hospital admissions following pediatric vaccination: a self-controlled study. PLoS One. 2013; 8(12):e81070.

ISSUE

Research has suggested that birth order may influence a child’s chances of developing allergies and asthma. What affect does birth order have on the incidence of emergency department (ED) visits and hospital admissions following vaccination in infancy?

STUDY

Examined records for all children born in Ontario between April 2006 and March 2009, correlating all-cause ED visits and acute hospital admissions in the days immediately following each of two-, four-, six- and 12-month vaccinations with the vaccinated child’s rank in the family birth order.

KEY FINDINGS

First-born children had a higher relative incidence of ED visits and hospitalizations compared to later-born children following all vaccinations. The strongest effects were observed following the two-month and four-month vaccinations when first-born children were 37% and 70%, respectively, more likely to be taken to hospital after vaccination than later-born children. This difference was not explained by maternal age, gestational age, family size or birth weight.

IMPLICATIONS

To help alleviate parental anxiety, physicians are encouraged to inform parents, particularly first-time parents, of expected adverse events following vaccination.
 
 

Researchers call for health care changes to help Ontario adults with developmental disabilities

Lunsky Y, Klein-Geltink JE, Yates EA, eds. Atlas on the Primary Care of Adults with Developmental Disabilities in Ontario. Toronto, ON: ICES and CAMH; 2013.

ISSUE

Adults with developmental disabilities, such as autism and Down syndrome, are at greater risk for health problems than other adults. What is the health status of adults with developmental disabilities, and how does their use of the health system compare to that of other adults?

STUDY

Identified 66,484 Ontario adults with developmental disabilities aged 18 to 64 between April 2009 and March 2010 and compared them to a cohort of adults without developmental disabilities.

KEY FINDINGS

Compared to the general population, adults with developmental disabilities had higher rates of morbidity and were more likely to be diagnosed with a range of chronic diseases. They were less likely to receive preventive care, such as screening for cancer, and they received multiple medications that were not always well monitored. While adults with developmental disabilities were as likely to see their family physician as other adults, they were more likely to visit emergency departments and be hospitalized. Although interprofessional care is recommended for this population, only 20% received care through interprofessional Family Health Teams.

IMPLICATIONS

The study’s findings support changes in three areas: improving quality of primary care based on best evidence and care standards; modifying broader health care system structures and processes; and strengthening partnerships with patients, their families and paid caregivers.
 
 

Rheumatoid arthritis patients at increased risk for complications following joint replacement

Ravi B, Croxford R, Hollands S, Paterson JM, Bogoch E, Kreder H, Hawker GA. Patients with rheumatoid arthritis are at increased risk for complications following total joint arthroplasty. Arthritis Rheum. 2013 Nov 19 [Epub ahead of print].

ISSUE

Most of the evidence regarding complications following total hip arthroplasty (THA) or total knee arthroplasty (TKA) is based on patients with osteoarthritis. Less is known about outcomes in patients with rheumatoid arthritis (RA) undergoing these procedures.

STUDY

Identified 43,997 THA recipients (3% with RA) and 71,793 TKA recipients (4% with RA) who received their first elective THA or TKA between April 2002 and March 2009 in Ontario. All patients were followed from the date of their procedure to the occurrence of venous thromboembolism or death within 90 days and infection or dislocation within two years.

KEY FINDINGS

After adjusting for potential confounders, compared to patients with osteoarthritis, those with RA were approximately twice as likely to experience a dislocation following THA, and 1.5 times as likely to experience an infection following TKA. RA patients who had a THA were only a third as likely to experience a venous thromboembolism.

IMPLICATIONS

Further research is warranted to explain the role of medication profile, implant choice, and postoperative antibiotic protocol and rehabilitation method on complications in RA patients who undergo arthroplasty. These findings will serve to inform patient management decisions, including the development of strategies to target modifiable risk factors.
 
 

First Nations residents at greater risk for hospitalization during 2009 flu outbreak

Green ME, Wong ST, Lavoie JG, Kwong J, MacWilliam L, Peterson S, Liu G, Katz A. Admission to hospital for pneumonia and influenza attributable to 2009 pandemic A/H1N1 influenza in First Nations communities in three provinces of Canada. BMC Public Health. 2013; 13:1029.

ISSUE

Reports of the 2009 influenza pandemic (pH1N1) in Canada indicate that a disproportionate burden of illness fell on First Nations communities. How do pH1N1-attributable hospitalization rates of First Nations communities compare to the general population and to each other?

STUDY

Used geocoded health claims data to identify residents of First Nations reserve communities in British Columbia, Manitoba and Ontario. Compared hospitalizations for pneumonia and influenza during pH1N1 outbreaks in 2009 to the same periods in the four previous years (the baseline period).

KEY FINDINGS

In all three provinces, there was a similar 44%–46% increase in admissions for pneumonia and influenza among First Nations communities between the baseline period and 2009. By comparison, there was little change in admission rates for the general population in BC (8%) or Manitoba (11%), but a 33% increase in Ontario. In comparison to the general population, the increase in hospitalization rates for First Nations reserve communities in 2009 was 35% higher in BC, 31% higher in Manitoba and 8% higher in Ontario.

IMPLICATIONS

There was an increased risk of pH1N1 hospitalizations for First Nations communities in all three provinces. Interprovincial differences may be explained in part by differences in age structure and socioeconomic status. Future studies should examine the influence of locally-delivered health services.
 
 

Kidney donors at no greater risk for kidney stones than nondonors

Thomas SM, Lam NN, Welk BK, Nguan C, Huang A, Nash DM, Prasad GVR, Knoll GA, Koval JJ, Lentine KL, Kim SJ, Lok CE, Garg AX; for the DONOR Network. Risk of kidney stones with surgical intervention in living kidney donors. Am J Transplant. 2013; 13(11):2935–44.

ISSUE

Knowledge of the long-term outcomes of living kidney donors is required to inform the choices of potential donors and to guide the follow-up care necessary to maintain long-term health. Compared to nondonors, are kidney donors at greater risk for kidney stones?

STUDY

Identified 2,019 individuals who donated kidneys at five Ontario transplant centres from July 1992 to March 2009. Selected nondonors from the healthiest segment of the general population and matched 10 nondonors to every donor. Followed both groups for evidence of a kidney stone with surgical intervention or an emergency department or hospital encounter for a kidney stone.

KEY FINDINGS

Median follow-up time was 8.4 years (maximum 19.7 years). There was no significant difference in the rate of kidney stones with surgical intervention in donors compared to nondonors (8.3 vs. 9.7 events per 10,000 person-years). Similarly, there was little difference in the rate of hospital encounters for kidney stones (12.1 vs. 16.1 events per 10,000 person-years).

IMPLICATIONS

These results are reassuring for the safety of living kidney donation using current eligibility criteria. However, they should not be used to justify expansion of donor eligibility to those with risk factors for stones, such as obesity or a prior history of stones.
 
 
ICES is an independent, non-profit organization that conducts research on a broad range of topical issues to enhance the effectiveness of health care for Ontarians.
 
 
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