Canadian Medical Association Journal

SARS-CoV-2 strained Ontarios health system, with social determinants of health (SDH) underexplored in cost analyses. We examined COVID-19 attributable healthcare resource use and costs from the Ontario health system perspective using health administrative data. We conducted a cohort study, matching 162,633 SARS-CoV-2-exposed individuals 1:1 to unexposed individuals. We calculated 10-day per-person mean attributable costs (2023 CAD) across care phases (pre-diagnosis, acute, post-acute, terminal),...

BackgroundRespiratory viruses are major contributors to population mortality, but cause-of-death coding undercounts their impact. Ecological regression models linking viral circulation to mortality fluctuations can address this limitation. AimTo estimate the population attributable fraction (PAF) of mortality associated with influenza A and B, respiratory syncytial virus (RSV), and SARS-CoV-2 in Ontario, Canada (1993-2024). MethodsWe analysed monthly all-cause mortality data with laboratory su...

BackgroundSocioeconomic disparities in COVID-19 outcomes have been widely documented, but evidence regarding inequities in SARS-CoV-2 transmission remains mixed. In Canada, infection-induced seroprevalence appeared to converge across socioeconomic strata by late 2022, raising questions about whether transmission inequities diminished during the Omicron period. AimTo assess whether apparent convergence in SARS-CoV-2 seroprevalence reflects true equity in transmission or masks persistent socioeco...

BackgroundIn 2024, the National Advisory Committee on Immunization recommended universal RSV immunization across Canada, prioritizing infants in remote communities. However, in the absence of population-based data, programs may not effectively narrow health gaps in remote communities. MethodsRetrospective cohort study of all births in British Columbia (BC) from April 2013 to March 2024, followed for 1 year, using health administrative data. Main outcomes were hospitalizations for all-cause and ...

PurposeMost spatio-temporal models identify COVID-19 sociodemographic and socioeconomic risk factors using methods that assume a single spatial dependency pattern across the city, which may not reflect reality. The purpose of this study is to apply a spatially and temporally localized Bayesian model to identify COVID-19 risk factors that account for localized context. MethodsFor this study, a spatio-temporal localized Bayesian Hierarchical Model (ST-LCAR) was used to assess the relationships be...

BackgroundIn patients with atrial fibrillation (AF) and stable coronary artery disease beyond 1 year after percutaneous coronary intervention (PCI), oral anticoagulant monotherapy is guideline-recommended; however, its efficacy and safety in patients with complex PCI remain uncertain. MethodsWe conducted a post-hoc analysis of the randomized ADAPT AF-DES trial comparing NOAC monotherapy versus NOAC plus clopidogrel in AF patients [≥]12 months after second- or third-generation drug-eluting st...

BackgroundRespiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections and hospitalizations among infants in Canada. New long-acting monoclonal antibodies (mAbs) and vaccines administered during pregnancy have expanded prevention options, yet the most cost-effective immunization program remains uncertain. MethodsWe updated a Canadian cost-utility model to evaluate seven seasonal RSV prevention strategies over one year (with a lifetime horizon for mortality impacts)...

BackgroundNeonicotinoid pesticides are systemic insecticides with neurotoxic potential and environmental persistence, raising concerns about chronic low-dose exposure in humans and impacts on ecosystems. In Japan, regulatory restrictions are generally less stringent than in the European Union, yet risk perception among young adults remains underexplored. ObjectiveTo examine factors associated with university students interest in pesticide-related issues, focusing on family discussions about env...

This study challenges the assumption that undiagnosed cognitive impairment (CI) is driven primarily by patient-level barriers like poor awareness. In a population-weighted cohort of 1,856 older Singaporeans, CI prevalence was 24.7% (95%CI 18.8-31.8); yet the undiagnosed rate was high (81.4%, 95%CI 65.6-90.9), especially for mild CI (97.9%, 95%CI 94.1-99.3). This diagnostic gap persisted despite high symptom awareness (81.3%, 95%CI 63.6-91.5) and help-seeking intent (63.3%, 95%CI 47.5-76.7), with...

Using the example of an unknown emerging disease with simple SIR (susceptible-infectious-recovered) dynamics, we show that an efficacy randomized clinical trial (RCT) for a vaccine can be misleading when it comes to the cost-effectiveness of that vaccine. An RCT is more likely to demonstrate efficacy with a high confidence level if it is carried out during the peak of the outbreak. However, in this scenario, the vaccine also has a higher chance of being approved too late to be cost-effective. A ...

In 1798, Jenners smallpox vaccine made it possible to prevent the deadliest of childhood diseases. In Denmark the vaccine was used from 1801, and by 1810 a mandatory 1-dose childhood vaccination program was instituted, free of charge. As proof of vaccination (or natural immunity) was required for church confirmation around age 13, about 90 % of children were vaccinated and smallpox disappeared from Copenhagen after 1808. After a 16-year "honeymoon period", it returned in 1824 with a new face: a ...

IntroductionRecent evidence from randomized controlled trials and meta-analyses in the critically ill suggest small but clinically important differences in death and requirement for renal replacement therapy that favor Ringers lactate as compared to normal saline. To futher contribute to this evidence base, we will perform a secondary analysis of the FLUID trial with a focus on critically ill patients (FLUID - ICU). The FLUID trial was hospital wide cluster randomized cross-over trial that compa...

BackgroundSarcopenia is associated with increased fall risk, but its graded relationship with severity and age-specific patterns warrants further investigation in middle-aged and older adults. ObjectiveTo investigate the association between sarcopenia severity and fall risk among adults aged [≥]45 years and provide evidence for early intervention. MethodsUtilizing data from the China Health and Retirement Longitudinal Study (CHARLS) database (baseline 2011 to follow-up 2020), 9,608 particip...

Background Older adults' walking has so far been evaluated using standardised assessments of walking capacity within a clinical setting. By taking the evaluation out of the laboratory into the real world, this study provides first evidence of the ability of Digital Mobility Outcomes (DMOs) to detect changes over time and the Minimal Important Difference (MID) in patients after proximal femoral fracture (PFF). This will guide the implementation of DMOs in research and clinical care. Methods For t...

BackgroundVestibular complaints are common in older adults and are linked to imbalance and falls. Some older adults show impaired vestibular perception despite preserved peripheral-reflex ("vestibular agnosia"). Yet it remains unclear if vestibular agnosia is independently linked to imbalance and falls in otherwise healthy older adults. We therefore investigated the prevalence of vestibular agnosia in community-dwelling older adults, and examined its association to balance and prospective falls....

The risk of highly pathogenic avian influenza infection to humans is challenging to estimate because many human avian influenza virus (AIV) infections are undetected as they may be asymptomatic, symptomatic but not tested, and as contact tracing is difficult because human-to-human spread is rare. We derive equations that consider the evolutionary mechanisms that give rise to pandemics and are parameterized to be consistent with records of past pandemics. We estimate that thousands of human AIV i...

BackgroundThis study used qualitative methods to test and refine a framework for educating cognitively unimpaired individuals about their individual risk for Alzheimers disease and related dementias (ADRD) and intrapersonal health belief factors as part of the TEACH (Tailored Education for Aging and Cognitive Health) intervention. MethodWe assessed individuals ADRD risk factors and health belief concepts. Personalized data were presented individually, followed by a semi-structured phenomenograp...

BackgroundThe one-year SINEMA trial demonstrated improved blood pressure (BP) control and reduced mortality up to 72 months after the intervention. This article aims to assess between-arm differences in mean annual cumulative BP and to explore whether the associations between cumulative BP and biofunctional outcomes differed by trial arm. MethodsPost-hoc secondary analysis of the SINEMA cluster-randomized trial, which recruited 1299 adults with stroke from 50 rural villages in Hebei, China, bet...

Insomnia and anxiety are highly prevalent and often comorbid in older adults. Although cognitive-behavioural therapy is the first-line treatment for insomnia, few interventions simultaneously address both conditions. Furthermore, access remains limited by provider availability and high costs. To address these gaps, we developed an online CBT program for insomnia and anxiety (eCBT+). This randomized controlled trial aimed to assess the usability and acceptability of the eCBT+ program and evaluate...

BackgroundFalls among older adults are a leading cause of fractures, loss of independence, and need for long-term care. Community salons in Japan promote social participation and health activities among older adults. Hydrogen-rich water is widely used as a health product, but evidence in community settings remains limited. MethodsWe conducted a prospective observational study among 48 community-dwelling older adults attending community salons in Hiroshima City, Japan. Hydrogen-rich water was of...