David Cawthorpe | University of Calgary (original) (raw)

Papers by David Cawthorpe

Journal of Hospital Administration, Jan 23, 2014

Background: Annual rates of cancer diagnosis and costs are reported for specific cancers and age ... more Background: Annual rates of cancer diagnosis and costs are reported for specific cancers and age groups over 16 years using health utilization data in addition to the odds ratios for broad International Classification of Disease (ICD) categories of associated disorders. Methods: Using physician assigned ICD diagnosis, annual cancer diagnosis rates of six cancers (colorectal, breast, prostate, lung, mesothelioma, and pancreatic) were measured for the period of 1994-2009 in the Calgary, Alberta catchment area. As well, the patient cohort diagnosed with any neoplasm (n = 261,896) was analyzed by year for three age groups: youth (< 25 years), adult (26 years-69 years), and geriatric (≥ 70 years). Total direct cancer diagnosis costs and associated disorders costs were calculated by year and mean total costs compared by type of cancer. Odds ratio were calculated for each broad category of ICD diagnosis given the presence or absence of specified cancer types. Results: Annual rates of diagnosis increased for all six cancers and all three age groups. All six cancers showed their annual rates of diagnosis to be at least 2.1 times greater in 2009 compared to 1994. Colorectal cancer maintained the highest annual cancer rate of diagnosis, the geriatric group had the highest annual rates of cancer diagnosis out of the three age groups, and the youth group annual rates of cancer diagnosis increased by a factor of 2.6. Breast cancer had the highest associated per patient costs whereas prostate cancer had the lowest. In addition to other neoplasms, odds ratios indicated that most cancer types were associated with disorders of the blood and blood producing organs. Conclusion: Prevalence has been steadily increasing in the Calgary, AB catchment over the study period. Trends in annual rates of diagnosis have implications for future burden on healthcare systems and provide a basis for comparison of local rates and expenditures with other healthcare principalities.

European Psychiatry, Apr 1, 2008

European Psychiatry, Mar 1, 2015

European Psychiatry, 2010

Objectives: Using baseline and outcome data collected in the Calgary Region Children and Adolesce... more Objectives: Using baseline and outcome data collected in the Calgary Region Children and Adolescent Mental Health Program (CAMHP) over the last six years, a profile was developed for those who are at risk for poor treatment outcomes. Methods: Based on the data collected in CAMHP, 6229 completed measurable treatment plans (MTP) were analyzed for consistency (by year) and theoretical meaningfulness (by clinical level). A table was developed to describe by quartiles those who improved and those who got worse in terms of problem severity and function. A multi-variable linear regression model was developed for function with linked data that predicted the profile of those at risk for poor treatment outcomes. Results: MTP scores reflecting problem severity and function were consistent over time. Further, MTP scores were theoretically meaningful (e.g., inpatients were more severe on admission than those receiving community or day hospital-based treatment). In total, 659 MTPs indicated no improvement for a negative state and an additional 830 changed negatively in problem severity and Children's Global Assessment Scale (C-GAS) scores. The multivariable model based on admission data provided a risk profile for this group that accounted for 52% of the variance for discharge function.

PubMed, Nov 1, 2003

Objective: The objective of this study was to examine the occurrence of behavioral contagion amon... more Objective: The objective of this study was to examine the occurrence of behavioral contagion among inpatient adolescent psychiatric patients in terms of past self-harm related behaviors. Our goal was to isolate persistent self-harm behavior from self-harm behavior that could be considered truly contagious. Method: We employed 5 years retrospective cohort study design in order to compare the occurrence of self-harm as inpatients among those with and without histories of self-harm behavior. Results: Our results indicate that the spontaneous occurrence of self-harm among inpatients without a history of self-harm is very low. While there appears to be a group that exhibits self-harm as inpatients, the tendency in this group is more towards a reduction of the intensity or a cessation of self-harming behavior. Conclusions: Contagious self-harm does not appear to be a problem among inpatients with long stays on psychiatric treatment units. The overall tendency among inpatient adolescent psychiatric patients, especially those among those with histories of self-harm behavior is away from self-harming behavior.

Canadian Medical Association Journal, Oct 8, 2018

is a shareholder of International Graduate Medical Education Inc. and a consultant to Canadian Re... more is a shareholder of International Graduate Medical Education Inc. and a consultant to Canadian Research and Education for the Advancement of Child Health Trust. This article was solicited and has not been peer reviewed.

Community Mental Health Journal, Mar 30, 2014

The emotional, financial and social impact on caregivers of those with pediatric psychiatric, emo... more The emotional, financial and social impact on caregivers of those with pediatric psychiatric, emotional and behavioral disorders has been poorly documented. This study sought to begin to remedy this by determining the utility of the Burden Assessment Scale (BAS) with this population. 300 parents seeking services within a major Canadian city were interviewed using the BAS and a follow up questionnaire on the clarity, comprehensiveness and acceptability of the BAS. The BAS was clear, acceptable and comprehensive for [80 % of participants. Factor analysis revealed four factors compared to the original five factors found with adults. The BAS had a utility with this population and would be a valuable addition to standard information gathered but use of the total score only is recommended.

PubMed, Nov 1, 2005

Introduction: There have been various strategies employed to improve the ability of primary care ... more Introduction: There have been various strategies employed to improve the ability of primary care physicians to identify and intervene in the mental health concerns of young children. In this study we assessed community physician needs and ability to identify mental health problems in children less than 6 years of age. Methods: Two surveys were conducted. The purpose of the surveys was to identify the learning needs among primary care physicians and their capacity to serve very young children. Results: Most physicians reported that they did not have enough knowledge and support to detect and manage mental health problems in young children and that they received minimal undergraduate training. Conclusions: Community physicians require primary mental health care support to serve the mental health concerns of young children age 0-6.

Neuroscience Letters, Jun 1, 1990

Isolated gill muscle-fiber; Neuropeptide The peripheral nervous system (PNS) in the gill of Aplys... more Isolated gill muscle-fiber; Neuropeptide The peripheral nervous system (PNS) in the gill of Aplysia plays an important role in the mediation of adaptive gill withdrawal reflex (GWR) behaviors. It has proven difficult to determine whether or not neuronally active agents work directly on PNS neurons, the muscle or both. We have now been able to isolate individual gill muscle fibers in culture and thus begin an analysis of how endogenous neurotransmitters and/or neuromodulators act. We report here that both dopamine and FMRF-amide act directly on gill muscle fibers to cause contractions.

The Permanente Journal, Mar 1, 2017

Context: Few published studies of autism spectrum disorder (ASD) and comorbidity are population b... more Context: Few published studies of autism spectrum disorder (ASD) and comorbidity are population based. Objective: To describe the comorbidity of ASD and disorders listed in the main classes of the International Classification of Diseases, Ninth Revision (ICD-9) in a general population. Design: Direct physician billing data for the city of Calgary, Alberta, Canada, for the treatment of any presenting concern in the Calgary Health Zone (n = 763,449) from 1994 to 2009 were extracted. Diagnosed ICD-9 disorders (independent variable) were grouped into 17 categories using ICD-9 diagnosis codes. ASD (dependent variable) was classified under ICD-9 Code 299. Individuals with and without independent disorder classes were counted by the presence or absence of any ASD. Odds ratios (ORs) and 95% confidence intervals of the association were calculated. Main Outcome Measures: ORs of ASD comorbidities. Results: Annual rates of ASD increased 3.9-fold for males and 1.4-fold for females. Diagnosed disorders ranked by OR in the independent ICD-9 categories indicated that males with ASD had overall higher ORs (> 1.0) in 11 main ICD-9 classes, and females with ASD had higher ORs (> 1.0) in 12 main ICD-9 classes. Males with ASD had lower ORs in 4 main ICD-9 disease classes; females with ASD had lower ORs related only to the main class "complications of pregnancy and childbirth." Five main ICD-9 classes were not significant for males or females. Conclusions: Patients with ASD have significant comorbidity of physical disorders. This finding may inform other areas of research and assessment in clinical management.

Dental oral biology and craniofacial research, Dec 30, 2021

The study objective was to examine the relationship between dental caries diagnosed before the ag... more The study objective was to examine the relationship between dental caries diagnosed before the age of four and ICD diseases over a 16-year period. Methods: The sample of approximately 33,531 (48% female) individuals having a total of 2,864,790 physician diagnoses over 16 years comprised a the cohort two groups, one with (2.7% of the sample) and one without dental caries (dependent variable) that were under the age of four years in the first two years of the sample data. Categories of dental caries and associated gingivitis and periodontal disease were based on the International Classification of Disease (ICD Version 9) diagnostic codes 521-523. The sample was described. Odds ratios comparing those with and without dental caries and the main ICD classes were calculated. Additionally, the ratio of each ICD diagnosis frequency comparing the cohort groups were calculated and represented the diagnoses assigned over the first 15 physician visits. Results: Males had proportionally more dental caries diagnosed. Diagnoses were made predominantly by general practitioners. Within the dental caries cohort group, associated ICD diagnoses were overrepresented in both odds ratios and within individual ICD diagnoses on the first diagnosis and over the first 15 diagnoses in time. Conclusion: Dental caries diagnosed in very young children before the age of four are associated with multi-morbidity over subsequent years. Sex differences and patterns of associated morbidity may contribute to a better understanding of early life vulnerability to dental caries and their sequelae.

Qeios, Jan 27, 2023

Background Little is known about the COVID-19 pandemic impact on child and adolescent mental heal... more Background Little is known about the COVID-19 pandemic impact on child and adolescent mental health, specifically self-harm. This paper serves to form a basis for understanding and planning an appropriate response to the present and longstanding child and adolescent mental health needs with global recommendations for integrated community support and disaster preparedness. Methods Anonymous, aggregated data from an established regional child and adolescent addictions and mental health service was employed to examine differences in the rates of self-harm as the primary reason for referral among the healthseeking population represented by quarter by year since 2010 to examine whether self-harm rates have increased since the onset of the COVID-19 pandemic. Results Female rates of self-harm referral were greater than male rates. Neither male nor female quarterly rates of total or firsttime self-harm referrals exceeded the highest quarterly rates since 2010. Discussion Since the COVID-19 pandemic, self-harm rates in one Canadian region remain stable and lower than the highest rates observed over the last decade. Given misplaced alarmist news and reports, a coherent, evidence-based, dynamic national response to mental health, social support, and disaster planning is required to fully understand how best to respond to the pandemic in general with a sustainable social support and disaster preparedness policy strategy and specifically the ongoing and pandemic-related mental health needs of the child and adolescent help-seeking population.

European Psychiatry, Mar 1, 2011

PLOS ONE, Nov 15, 2022

Background We aimed to improve mental health referral quality of young people by helping educator... more Background We aimed to improve mental health referral quality of young people by helping educators build capacity for early identification of youth at risk of mental illness and facilitate referrals between the education and health systems. Methods We applied the Go-To Educator mental health literacy training for early identification, triage and support in 208 schools in Calgary, Alberta between 2013 and 2016. Students presenting to mental health services during this time were compared on a number of clinical, system, and demographic variables, based on the training status of the school (untrained schools; before and after training schools), using retrospective cohort design. Based on clinical and system data, bivariate and multivariable logistic regression analysis were employed to compare the three school status domains. Results After training, referrals differed significantly from control and pre-training schools. Students presenting to services from these schools were younger, from single parent families; were referred more because of adjustment and learning/attention problems; had complex social/ family issues; thought disturbances, and harmful behavior/thoughts towards others. While they waited longer to be admitted they stayed longer in services; had more provisional comorbid diagnoses and demonstrated positive treatment outcomes.

Frontiers in Psychiatry, Nov 29, 2018

Introduction: This chapter presents the analysis of physician-diagnosed International Classificat... more Introduction: This chapter presents the analysis of physician-diagnosed International Classification of Diseases (ICD version 9) disorders and diseases associated with autism spectrum disorders (ASD) in a 16-year pediatric cohort. Materials and Methods: The sample (n = 47,180; 62% male) consisted of children in the Alberta Health Services Calgary Health Region catchment under the age of 3 years, who received any physician-assigned ICD 9 diagnosis before the age of three between April 1993 and December 31, 1994. There were 111 females and 609 males with ASD diagnosed at any time between 1993 and 2010. The results detail the 16-year odds ratio (OR) associations of ASD diagnosis within the major classes of international classification of diseases (ICD 9) stratified by age and sex in the cohort. Further, for those suffering from ASD and any other disorder or disease, the analysis presents by sex, age, and duration, the proportions of all index physician-assigned ICD diagnoses, arising significantly before and after the index ASD diagnosis. Results: The rate of treated ASD in the cohort was 1 in 65 and the 16-year population rate of ASD was 62 per 10,000. For males with an ASD over the 16 year period, the ORs were significantly greater than the value one for 15 of the 17 main ICD classes and for 10 of the main ICD classes for females. Different age strata presented a more specific account of the main ICD class OR profiles. More specifically, 28 ICD disorders significantly preceded and 95 ICD disorders significantly followed ASD for females. Thirty-eight ICD disorders significantly preceded and 234 ICD disorders significantly followed ASD for males. Conclusions: The results largely confirm past studies focusing on more constrained sets of ASD morbidity. The age-stratified ORs gauge the order of risk in time for the cohort. The proportions of specific ICD disorders arising before and after ASD may be useful in respect to informing basic ASD research and ASD clinical management. Limitations are discussed.

Current Opinion in Psychiatry, Sep 1, 2016

Purpose of review This study outlines the rationale and provides evidence in support of including... more Purpose of review This study outlines the rationale and provides evidence in support of including psychiatric disorders in the World Health Organization's classification of preventable diseases. The methods used represent a novel approach to describe clinical pathways, highlighting the importance of considering the full range of comorbid disorders within an integrated population-based data repository. Recent findings Review of literature focused on comorbidity in relation to the four preventable diseases identified by the World Health Organization. This revealed that only 29 publications over the last 5 years focus on populations and tend only to consider one or two comorbid disorders simultaneously in regard to any main preventable disease class. Summary This article draws attention to the importance of physical and psychiatric comorbidity and illustrates the complexity related to describing clinical pathways in terms of understanding the etiological and prognostic clinical profile for patients. Developing a consistent and standardized approach to describe these features of disease has the potential to dramatically shift the format of both clinical practice and medical education when taking into account the complex relationships between and among diseases, such as psychiatric and physical disease, that, hitherto, have been largely unrelated in research.

The Permanente Journal, Dec 1, 2018

Context: Developmental psychopathology theory suggests a relationship between early childhood adv... more Context: Developmental psychopathology theory suggests a relationship between early childhood adversity and mental disorder. Objective: To examine the relationship between the specific items on the Adverse Childhood Experiences (ACE) survey and the International Classification of Diseases, Tenth Revision (ICD-10) categories of psychiatric diagnoses in a pediatric sample. Design: The sample included patients enrolled in the Child and Adolescent Addiction Mental Health and Psychiatry Program with both a completed ACE survey and at least 1 diagnosis of record (per admission). These criteria yielded 2 samples for each sex (ACE survey item frequencies and values in collapsed and multiple-admission groups). Data were analyzed employing tetrachoric correlation, hierarchical regression, and polychoric factor analysis. Results: Hierarchical regression analysis identified that ICD-10 diagnostic categories, except for substance disorders, were not consistently related to ACE total score and tended to reduce the magnitude of the ACE total score in the multiple-admission group. Tetrachoric correlation revealed very low (< 0.4) positive and negative correlations between ICD-10 categories and ACE items in both multiple-admission and collapsed sample groups. Polychoric factor analysis indicated that the ACE survey items and the ICD-10 categories for both sexes were independent, with only the diagnostic ICD-10 category substance disorders being marginally associated with the ACE items factor for females. Conclusion: The nominal relationship between ACE items and ICD-10 diagnostic categories indicates the need to include ACE assessment in advance of differential diagnosis and implementation of conventional mental health interventions for children and adolescents.