Larry Svenson | Univeristy of Alberta (original) (raw)
Papers by Larry Svenson
Canadian family physician Médecin de famille canadien, 2004
Research ore than 80% of all physician-patient encounters occur in private offi ces, 1 but most c... more Research ore than 80% of all physician-patient encounters occur in private offi ces, 1 but most clinical studies take place in tertiary care hospitals. Owing to the differences between community and academic practices, research fi ndings in tertiary care hospitals might not be generalizable to community-based practices. 2,3 Some have advocated for practice-based research in order to address the growing gap between ideal and actual care. One barrier to practice-based research is the difficulty of recruiting primary care physicians as participants. 5 Reasons for poor participation rates include insuffi cient time, lack of interest, and inadequate resources for research. 5-7 Primary care networks were developed partially in response to these challenges. 3 Unfortunately, little has been published on how well these networks work. It is unclear whether members of networks are more likely to participate in research than nonmembers. This paper describes the experiences of the Alberta Strategy to Help Manage Asthma (ASTHMA) in recruiting primary care physicians for community-based research aimed at identifying gaps in asthma care.
Canadian family physician Médecin de famille canadien
Research ore than 80% of all physician-patient encounters occur in private offi ces, 1 but most c... more Research ore than 80% of all physician-patient encounters occur in private offi ces, 1 but most clinical studies take place in tertiary care hospitals. Owing to the differences between community and academic practices, research fi ndings in tertiary care hospitals might not be generalizable to community-based practices. 2,3 Some have advocated for practice-based research in order to address the growing gap between ideal and actual care. One barrier to practice-based research is the difficulty of recruiting primary care physicians as participants. 5 Reasons for poor participation rates include insuffi cient time, lack of interest, and inadequate resources for research. 5-7 Primary care networks were developed partially in response to these challenges. 3 Unfortunately, little has been published on how well these networks work. It is unclear whether members of networks are more likely to participate in research than nonmembers. This paper describes the experiences of the Alberta Strategy to Help Manage Asthma (ASTHMA) in recruiting primary care physicians for community-based research aimed at identifying gaps in asthma care.
Canadian Medical Association Journal, 2011
![Research paper thumbnail of A cluster randomized controlled trial comparing three methods of disseminating practice guidelines for children with croup [ISRCTN73394937]](https://attachments.academia-assets.com/44891205/thumbnails/1.jpg)
](Implementation Science, 2006
The optimal management of croup -a common respiratory illness in young children -is well establis... more The optimal management of croup -a common respiratory illness in young children -is well established. In particular, treatment with corticosteroids has been shown to significantly reduce the rate and duration of intubation, hospitalization, and return to care for on-going croup symptoms. Furthermore treatment with a single dose of corticosteroids does not appear to result in any significant adverse outcomes, and yields overall cost-savings for both families and the health care system. However, as has been shown with many other diseases, there is a significant gap between what we know and what we do. The overall aim of this study is to identify, from a societal perspective, the costs and associated benefits of three strategies for implementing a practice guideline that addresses the management of croup.
The Journal of Rheumatology, 2014
To estimate systemic autoimmune rheumatic disease (SARD) prevalence across 7 Canadian provinces u... more To estimate systemic autoimmune rheumatic disease (SARD) prevalence across 7 Canadian provinces using population-based administrative data evaluating both regional variations and the effects of age and sex. Methods. Using provincial physician billing and hospitalization data, cases of SARD (systemic lupus erythematosus, scleroderma, primary Sjögren syndrome, polymyositis/dermatomyositis) were ascertained. Three case definitions (rheumatology billing, 2-code physician billing, and hospital diagnosis) were combined to derive a SARD prevalence estimate for each province, categorized by age, sex, and rural/urban status. A hierarchical Bayesian latent class regression model was fit to account for the imperfect sensitivity and specificity of each case definition. The model also provided sensitivity estimates of different case definition approaches. Results. Prevalence estimates for overall SARD ranged between 2 and 5 cases per 1000 residents across provinces. Similar demographic trends were evident across provinces, with greater prevalence in women and in persons over 45 years old. SARD prevalence in women over 45 was close to 1%. Overall sensitivity was poor, but estimates for each of the 3 case definitions improved within older populations and were slightly higher for men compared to women.
Vaccine
Purpose: A universal publicly funded chickenpox vaccination program was implemented in Alberta in... more Purpose: A universal publicly funded chickenpox vaccination program was implemented in Alberta in 2002. We examine the epidemiology of medically attended shingles in Alberta from 1994 to 2010. Methods: Incident shingles cases (earliest health service utilizations for ICD-9 053 or ICD-10-CA B02) and their co-morbid conditions for the 12 months prior to shingles diagnosis were identified from the records of Alberta's universal, publicly funded health-care insurance system for 1994-2010. Shingles diagnostic codes at least 180 days after the first were classified as recurrent episodes. Denominators for rates were estimated using mid-year population estimates from the Alberta Health Care Insurance Plan Registry. Annual age- and sex-specific rates were estimated. We estimated the proportion of all cases that were hospitalized. We explored the pattern of rates for sex, age-group co-morbidity and year effects and their interactions. Results: Crude rates of shingles increased over the in...
Canadian Medical Association Journal
Background: The combination measles-mumps-rubella-varicella (MMRV) vaccine currently used in Cana... more Background: The combination measles-mumps-rubella-varicella (MMRV) vaccine currently used in Canada (Priorix-Tetra) may increase the risk of febrile seizures relative to the separate vaccines (MMR and varicella) previously administered. We determined the risk of febrile seizure after the first dose of MMRV, as well as any additional risk for children at high risk for seizures because of pre-existing medical conditions. Methods: In this retrospective, population-based cohort study, we compared the risk of seizures after the first dose of MMRV with the risk after same-day administration of separate MMR and varicella vaccines (MMR+V) in children 12 to 23 months of age in the province of Alberta. We deterministically linked vaccination data to health service utilization data for seizures. We used Poisson regression, with adjustment for age and calendar year, to determine the risk for the full cohort and for high-risk children. Results: The risk of seizures 7 to 10 days after vaccination...
Environmental Research, 2015
To estimate the association between fine particulate (PM2.5) and nitrogen dioxide (NO2) pollution... more To estimate the association between fine particulate (PM2.5) and nitrogen dioxide (NO2) pollution and systemic autoimmune rheumatic diseases (SARDs). Associations between ambient air pollution (PM2.5 and NO2) and SARDs were assessed using land-use regression models for Calgary, Alberta and administrative health data (1993-2007). SARD case definitions were based on ≥2 physician claims, or ≥1 rheumatology billing code; or ≥1 hospitalization code (for systemic lupus, Sjogren's Syndrome, scleroderma, polymyositis, dermatomyositis, or undifferentiated connective tissue disease). Bayesian hierarchical latent class regression models estimated the probability that each resident was a SARD case, based on these case definitions. The sum of individual level probabilities provided the estimated number of cases in each area. The latent class model included terms for age, sex, and an interaction term between age and sex. Bayesian logistic regression models were used to generate adjusted odds ratios (OR) for NO2 and PM2.5. pollutant models, adjusting for neighbourhood income, age, sex, and an interaction between age and sex. We also examined models stratified for First-Nations (FN) and non-FN subgroups. Residents that were female and/or aged >45 had a greater probability of being a SARD case, with the highest OR estimates for older females. Independently, the odds of being a SARDs case increased with PM2.5 levels, but the results were inconclusive for NO2. The results stratified by FN and non-FN groups were not distinctly different. In this urban Canadian sample, adjusting for demographics, exposure to PM2.5 was associated with an increased risk of SARDs. The results for NO2 were inconclusive.
International Journal of Circumpolar Health, 2012
International Journal of Circumpolar Health, 2016
Cancer has been identified as a major cause of morbidity and mortality in Canada over the last de... more Cancer has been identified as a major cause of morbidity and mortality in Canada over the last decade. However, there is a paucity of information about cancer patterns in Aboriginal people, particularly for Métis. This study aims to explore cancer incidence and mortality burden among Métis and to compare disease estimates with non-Métis population. This population-based descriptive epidemiological study used cancer incidence and mortality data from 2007 to 2012 obtained from Alberta Health Care Insurance Plan (AHCIP) - Central Stakeholder Registry - and Alberta Cancer Registry (ACR). To identify cancer cases in Métis, the ACR was linked with the Métis Nation of Alberta (MNA) Identification Registry. In Métis and non-Métis people, age-standardized cancer incidence and mortality rates were estimated and subsequently compared between both groups. A higher incidence of bronchus/lung cancer was found among Métis men compared with their non-Métis counterparts (RR=1.69, CI 1.28-2.09; p=0.01). No other statistically significant differences in cancer incidence or mortality were found between Métis and non-Métis people living in Alberta over the course of the 6 years studied. Overall incidence and mortality associated with cancer were not higher among Métis people compared with non-Métis people. However, special efforts should be considered to decrease the higher incidence of bronchus/lung cancer in Métis men. Further development and maintenance of new and existing institutional collaborations are necessary to continue cancer research and health status surveillance in Métis population.
Canadian Medical Association Journal, 2011
Background: IMS Brogan (IMS) monitors ambulatory antibacterial (AB) consumption using the Xponent... more Background: IMS Brogan (IMS) monitors ambulatory antibacterial (AB) consumption using the Xponent®database, which samples ~60-70% of retail pharmacy dispensing records and estimates total use using a proprietary method. Many studies use IMS data for monitoring the effect of antimicrobial stewardship (AS) activities and identifying potetntial AS targets. Since 09-2007 Alberta pharmacies have submitted dispensing records to a provincial database; the Pharmacy Information Network (PIN). Our objective was to validate the IMS Brogan estimates for the province of Alberta using data from the PIN. Methods: Guidelines for reporting reliability and agreement studies (GRRAS) were followed. We obtained dispensing data from IMS and PIN for systemic AB [ATC J01] for 8 consecutive quarters from 07-2010 to 06-2012. Number of scripts were provided for all systemic ABs in 5 provincial health zones grouped by age (0-17, 18-64 and ≥65). Population estimates for each zone and each age group as of June 3...
Clinical Infectious Diseases, 2009
Citation: Kwong JC, Stukel TA, Lim J, McGeer AJ, Upshur REG, et al. (2008) The effect of universa... more Citation: Kwong JC, Stukel TA, Lim J, McGeer AJ, Upshur REG, et al. (2008) The effect of universal influenza immunization on mortality and health care use. PLoS Med 5(10): e211.
Environmental Research, 2015
To estimate the association between fine particulate (PM2.5) and nitrogen dioxide (NO2) pollution... more To estimate the association between fine particulate (PM2.5) and nitrogen dioxide (NO2) pollution and systemic autoimmune rheumatic diseases (SARDs). Associations between ambient air pollution (PM2.5 and NO2) and SARDs were assessed using land-use regression models for Calgary, Alberta and administrative health data (1993-2007). SARD case definitions were based on ≥2 physician claims, or ≥1 rheumatology billing code; or ≥1 hospitalization code (for systemic lupus, Sjogren's Syndrome, scleroderma, polymyositis, dermatomyositis, or undifferentiated connective tissue disease). Bayesian hierarchical latent class regression models estimated the probability that each resident was a SARD case, based on these case definitions. The sum of individual level probabilities provided the estimated number of cases in each area. The latent class model included terms for age, sex, and an interaction term between age and sex. Bayesian logistic regression models were used to generate adjusted odds ratios (OR) for NO2 and PM2.5. pollutant models, adjusting for neighbourhood income, age, sex, and an interaction between age and sex. We also examined models stratified for First-Nations (FN) and non-FN subgroups. Residents that were female and/or aged >45 had a greater probability of being a SARD case, with the highest OR estimates for older females. Independently, the odds of being a SARDs case increased with PM2.5 levels, but the results were inconclusive for NO2. The results stratified by FN and non-FN groups were not distinctly different. In this urban Canadian sample, adjusting for demographics, exposure to PM2.5 was associated with an increased risk of SARDs. The results for NO2 were inconclusive.
Occupational and environmental medicine, 2015
The study was designed to investigate whether beryllium exposure was related to illness diagnosed... more The study was designed to investigate whether beryllium exposure was related to illness diagnosed as sarcoidosis. Chronic beryllium disease (CBD) and sarcoidosis are clinically and pathologically indistinguishable, with only the presence of beryllium-specific T-lymphocytes identifying CBD. Testing for such cells is not feasible in community studies of sarcoidosis but a second characteristic of CBD, its much greater incidence in those with a glutamic acid residue at position 69 of the HLA-DPB1 gene (Glu69), provides an alternative approach to answering this question. Cases of sarcoidosis aged 18-60 years diagnosed in Alberta, Canada, from 1999 to 2005 were approached through their specialist physician, together with age-matched and sex-matched referents with other chronic lung disease. Referents were grouped into chronic obstructive pulmonary disease (COPD), asthma and other lung disease. Participants completed a telephone questionnaire, including industry-specific questionnaires. DN...
Journal of the American Society of Nephrology, 2007
Globally, it is known that the incidence of end-stage renal disease is higher among Aboriginals, ... more Globally, it is known that the incidence of end-stage renal disease is higher among Aboriginals, but it is unknown whether this is due to an increased prevalence of chronic kidney disease or other unidentified factors. We studied 658,664 people of non-First Nations and 14,989 people of First Nations and found that the age-and sex-adjusted prevalence of chronic kidney disease was significantly higher among those of non-First Nations compared to those of First Nations (67.5 versus 59.5 per 1000 population; P Ͻ 0.0001). However, severe chronic kidney disease (estimated glomerular filtration rate Ͻ30 ml/min per 1.73 m 2 ) was almost two-fold higher among people of First Nations (P Ͻ 0.0001). Cox proportional hazards models suggested that compared to people of non-First Nations, those of First Nations with chronic kidney disease had a 77% increased risk of death after adjusting for age, gender, diabetes and baseline eGFR. In conclusion, whether the higher incidence of end-stage renal disease among people of First Nations is due to suboptimal management of chronic kidney disease and its associated comorbidities, more rapid loss of kidney function, or other unidentified factors remains to be determined.
Canadian Medical Association Journal, 2008
Canadian Journal of Diabetes, 2008
Canadian family physician Médecin de famille canadien, 2004
Research ore than 80% of all physician-patient encounters occur in private offi ces, 1 but most c... more Research ore than 80% of all physician-patient encounters occur in private offi ces, 1 but most clinical studies take place in tertiary care hospitals. Owing to the differences between community and academic practices, research fi ndings in tertiary care hospitals might not be generalizable to community-based practices. 2,3 Some have advocated for practice-based research in order to address the growing gap between ideal and actual care. One barrier to practice-based research is the difficulty of recruiting primary care physicians as participants. 5 Reasons for poor participation rates include insuffi cient time, lack of interest, and inadequate resources for research. 5-7 Primary care networks were developed partially in response to these challenges. 3 Unfortunately, little has been published on how well these networks work. It is unclear whether members of networks are more likely to participate in research than nonmembers. This paper describes the experiences of the Alberta Strategy to Help Manage Asthma (ASTHMA) in recruiting primary care physicians for community-based research aimed at identifying gaps in asthma care.
Canadian family physician Médecin de famille canadien
Research ore than 80% of all physician-patient encounters occur in private offi ces, 1 but most c... more Research ore than 80% of all physician-patient encounters occur in private offi ces, 1 but most clinical studies take place in tertiary care hospitals. Owing to the differences between community and academic practices, research fi ndings in tertiary care hospitals might not be generalizable to community-based practices. 2,3 Some have advocated for practice-based research in order to address the growing gap between ideal and actual care. One barrier to practice-based research is the difficulty of recruiting primary care physicians as participants. 5 Reasons for poor participation rates include insuffi cient time, lack of interest, and inadequate resources for research. 5-7 Primary care networks were developed partially in response to these challenges. 3 Unfortunately, little has been published on how well these networks work. It is unclear whether members of networks are more likely to participate in research than nonmembers. This paper describes the experiences of the Alberta Strategy to Help Manage Asthma (ASTHMA) in recruiting primary care physicians for community-based research aimed at identifying gaps in asthma care.
Canadian Medical Association Journal, 2011
Implementation Science, 2006
The optimal management of croup -a common respiratory illness in young children -is well establis... more The optimal management of croup -a common respiratory illness in young children -is well established. In particular, treatment with corticosteroids has been shown to significantly reduce the rate and duration of intubation, hospitalization, and return to care for on-going croup symptoms. Furthermore treatment with a single dose of corticosteroids does not appear to result in any significant adverse outcomes, and yields overall cost-savings for both families and the health care system. However, as has been shown with many other diseases, there is a significant gap between what we know and what we do. The overall aim of this study is to identify, from a societal perspective, the costs and associated benefits of three strategies for implementing a practice guideline that addresses the management of croup.
The Journal of Rheumatology, 2014
To estimate systemic autoimmune rheumatic disease (SARD) prevalence across 7 Canadian provinces u... more To estimate systemic autoimmune rheumatic disease (SARD) prevalence across 7 Canadian provinces using population-based administrative data evaluating both regional variations and the effects of age and sex. Methods. Using provincial physician billing and hospitalization data, cases of SARD (systemic lupus erythematosus, scleroderma, primary Sjögren syndrome, polymyositis/dermatomyositis) were ascertained. Three case definitions (rheumatology billing, 2-code physician billing, and hospital diagnosis) were combined to derive a SARD prevalence estimate for each province, categorized by age, sex, and rural/urban status. A hierarchical Bayesian latent class regression model was fit to account for the imperfect sensitivity and specificity of each case definition. The model also provided sensitivity estimates of different case definition approaches. Results. Prevalence estimates for overall SARD ranged between 2 and 5 cases per 1000 residents across provinces. Similar demographic trends were evident across provinces, with greater prevalence in women and in persons over 45 years old. SARD prevalence in women over 45 was close to 1%. Overall sensitivity was poor, but estimates for each of the 3 case definitions improved within older populations and were slightly higher for men compared to women.
Vaccine
Purpose: A universal publicly funded chickenpox vaccination program was implemented in Alberta in... more Purpose: A universal publicly funded chickenpox vaccination program was implemented in Alberta in 2002. We examine the epidemiology of medically attended shingles in Alberta from 1994 to 2010. Methods: Incident shingles cases (earliest health service utilizations for ICD-9 053 or ICD-10-CA B02) and their co-morbid conditions for the 12 months prior to shingles diagnosis were identified from the records of Alberta's universal, publicly funded health-care insurance system for 1994-2010. Shingles diagnostic codes at least 180 days after the first were classified as recurrent episodes. Denominators for rates were estimated using mid-year population estimates from the Alberta Health Care Insurance Plan Registry. Annual age- and sex-specific rates were estimated. We estimated the proportion of all cases that were hospitalized. We explored the pattern of rates for sex, age-group co-morbidity and year effects and their interactions. Results: Crude rates of shingles increased over the in...
Canadian Medical Association Journal
Background: The combination measles-mumps-rubella-varicella (MMRV) vaccine currently used in Cana... more Background: The combination measles-mumps-rubella-varicella (MMRV) vaccine currently used in Canada (Priorix-Tetra) may increase the risk of febrile seizures relative to the separate vaccines (MMR and varicella) previously administered. We determined the risk of febrile seizure after the first dose of MMRV, as well as any additional risk for children at high risk for seizures because of pre-existing medical conditions. Methods: In this retrospective, population-based cohort study, we compared the risk of seizures after the first dose of MMRV with the risk after same-day administration of separate MMR and varicella vaccines (MMR+V) in children 12 to 23 months of age in the province of Alberta. We deterministically linked vaccination data to health service utilization data for seizures. We used Poisson regression, with adjustment for age and calendar year, to determine the risk for the full cohort and for high-risk children. Results: The risk of seizures 7 to 10 days after vaccination...
Environmental Research, 2015
To estimate the association between fine particulate (PM2.5) and nitrogen dioxide (NO2) pollution... more To estimate the association between fine particulate (PM2.5) and nitrogen dioxide (NO2) pollution and systemic autoimmune rheumatic diseases (SARDs). Associations between ambient air pollution (PM2.5 and NO2) and SARDs were assessed using land-use regression models for Calgary, Alberta and administrative health data (1993-2007). SARD case definitions were based on ≥2 physician claims, or ≥1 rheumatology billing code; or ≥1 hospitalization code (for systemic lupus, Sjogren's Syndrome, scleroderma, polymyositis, dermatomyositis, or undifferentiated connective tissue disease). Bayesian hierarchical latent class regression models estimated the probability that each resident was a SARD case, based on these case definitions. The sum of individual level probabilities provided the estimated number of cases in each area. The latent class model included terms for age, sex, and an interaction term between age and sex. Bayesian logistic regression models were used to generate adjusted odds ratios (OR) for NO2 and PM2.5. pollutant models, adjusting for neighbourhood income, age, sex, and an interaction between age and sex. We also examined models stratified for First-Nations (FN) and non-FN subgroups. Residents that were female and/or aged >45 had a greater probability of being a SARD case, with the highest OR estimates for older females. Independently, the odds of being a SARDs case increased with PM2.5 levels, but the results were inconclusive for NO2. The results stratified by FN and non-FN groups were not distinctly different. In this urban Canadian sample, adjusting for demographics, exposure to PM2.5 was associated with an increased risk of SARDs. The results for NO2 were inconclusive.
International Journal of Circumpolar Health, 2012
International Journal of Circumpolar Health, 2016
Cancer has been identified as a major cause of morbidity and mortality in Canada over the last de... more Cancer has been identified as a major cause of morbidity and mortality in Canada over the last decade. However, there is a paucity of information about cancer patterns in Aboriginal people, particularly for Métis. This study aims to explore cancer incidence and mortality burden among Métis and to compare disease estimates with non-Métis population. This population-based descriptive epidemiological study used cancer incidence and mortality data from 2007 to 2012 obtained from Alberta Health Care Insurance Plan (AHCIP) - Central Stakeholder Registry - and Alberta Cancer Registry (ACR). To identify cancer cases in Métis, the ACR was linked with the Métis Nation of Alberta (MNA) Identification Registry. In Métis and non-Métis people, age-standardized cancer incidence and mortality rates were estimated and subsequently compared between both groups. A higher incidence of bronchus/lung cancer was found among Métis men compared with their non-Métis counterparts (RR=1.69, CI 1.28-2.09; p=0.01). No other statistically significant differences in cancer incidence or mortality were found between Métis and non-Métis people living in Alberta over the course of the 6 years studied. Overall incidence and mortality associated with cancer were not higher among Métis people compared with non-Métis people. However, special efforts should be considered to decrease the higher incidence of bronchus/lung cancer in Métis men. Further development and maintenance of new and existing institutional collaborations are necessary to continue cancer research and health status surveillance in Métis population.
Canadian Medical Association Journal, 2011
Background: IMS Brogan (IMS) monitors ambulatory antibacterial (AB) consumption using the Xponent... more Background: IMS Brogan (IMS) monitors ambulatory antibacterial (AB) consumption using the Xponent®database, which samples ~60-70% of retail pharmacy dispensing records and estimates total use using a proprietary method. Many studies use IMS data for monitoring the effect of antimicrobial stewardship (AS) activities and identifying potetntial AS targets. Since 09-2007 Alberta pharmacies have submitted dispensing records to a provincial database; the Pharmacy Information Network (PIN). Our objective was to validate the IMS Brogan estimates for the province of Alberta using data from the PIN. Methods: Guidelines for reporting reliability and agreement studies (GRRAS) were followed. We obtained dispensing data from IMS and PIN for systemic AB [ATC J01] for 8 consecutive quarters from 07-2010 to 06-2012. Number of scripts were provided for all systemic ABs in 5 provincial health zones grouped by age (0-17, 18-64 and ≥65). Population estimates for each zone and each age group as of June 3...
Clinical Infectious Diseases, 2009
Citation: Kwong JC, Stukel TA, Lim J, McGeer AJ, Upshur REG, et al. (2008) The effect of universa... more Citation: Kwong JC, Stukel TA, Lim J, McGeer AJ, Upshur REG, et al. (2008) The effect of universal influenza immunization on mortality and health care use. PLoS Med 5(10): e211.
Environmental Research, 2015
To estimate the association between fine particulate (PM2.5) and nitrogen dioxide (NO2) pollution... more To estimate the association between fine particulate (PM2.5) and nitrogen dioxide (NO2) pollution and systemic autoimmune rheumatic diseases (SARDs). Associations between ambient air pollution (PM2.5 and NO2) and SARDs were assessed using land-use regression models for Calgary, Alberta and administrative health data (1993-2007). SARD case definitions were based on ≥2 physician claims, or ≥1 rheumatology billing code; or ≥1 hospitalization code (for systemic lupus, Sjogren's Syndrome, scleroderma, polymyositis, dermatomyositis, or undifferentiated connective tissue disease). Bayesian hierarchical latent class regression models estimated the probability that each resident was a SARD case, based on these case definitions. The sum of individual level probabilities provided the estimated number of cases in each area. The latent class model included terms for age, sex, and an interaction term between age and sex. Bayesian logistic regression models were used to generate adjusted odds ratios (OR) for NO2 and PM2.5. pollutant models, adjusting for neighbourhood income, age, sex, and an interaction between age and sex. We also examined models stratified for First-Nations (FN) and non-FN subgroups. Residents that were female and/or aged >45 had a greater probability of being a SARD case, with the highest OR estimates for older females. Independently, the odds of being a SARDs case increased with PM2.5 levels, but the results were inconclusive for NO2. The results stratified by FN and non-FN groups were not distinctly different. In this urban Canadian sample, adjusting for demographics, exposure to PM2.5 was associated with an increased risk of SARDs. The results for NO2 were inconclusive.
Occupational and environmental medicine, 2015
The study was designed to investigate whether beryllium exposure was related to illness diagnosed... more The study was designed to investigate whether beryllium exposure was related to illness diagnosed as sarcoidosis. Chronic beryllium disease (CBD) and sarcoidosis are clinically and pathologically indistinguishable, with only the presence of beryllium-specific T-lymphocytes identifying CBD. Testing for such cells is not feasible in community studies of sarcoidosis but a second characteristic of CBD, its much greater incidence in those with a glutamic acid residue at position 69 of the HLA-DPB1 gene (Glu69), provides an alternative approach to answering this question. Cases of sarcoidosis aged 18-60 years diagnosed in Alberta, Canada, from 1999 to 2005 were approached through their specialist physician, together with age-matched and sex-matched referents with other chronic lung disease. Referents were grouped into chronic obstructive pulmonary disease (COPD), asthma and other lung disease. Participants completed a telephone questionnaire, including industry-specific questionnaires. DN...
Journal of the American Society of Nephrology, 2007
Globally, it is known that the incidence of end-stage renal disease is higher among Aboriginals, ... more Globally, it is known that the incidence of end-stage renal disease is higher among Aboriginals, but it is unknown whether this is due to an increased prevalence of chronic kidney disease or other unidentified factors. We studied 658,664 people of non-First Nations and 14,989 people of First Nations and found that the age-and sex-adjusted prevalence of chronic kidney disease was significantly higher among those of non-First Nations compared to those of First Nations (67.5 versus 59.5 per 1000 population; P Ͻ 0.0001). However, severe chronic kidney disease (estimated glomerular filtration rate Ͻ30 ml/min per 1.73 m 2 ) was almost two-fold higher among people of First Nations (P Ͻ 0.0001). Cox proportional hazards models suggested that compared to people of non-First Nations, those of First Nations with chronic kidney disease had a 77% increased risk of death after adjusting for age, gender, diabetes and baseline eGFR. In conclusion, whether the higher incidence of end-stage renal disease among people of First Nations is due to suboptimal management of chronic kidney disease and its associated comorbidities, more rapid loss of kidney function, or other unidentified factors remains to be determined.
Canadian Medical Association Journal, 2008
Canadian Journal of Diabetes, 2008