208 results on '"Johnston JC"'
Search Results
2. Cluster model of alpha decay and Po-212
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Buck, B, Johnston, JC, Merchant, AC, and Perez, SM
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- 2016
3. Electronic Fetal Monitoring, Cerebral Palsy Litigation, and Bioethics: The Evils in Pandora’s Box
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Johnston Jc, Sartwelle Tp, and Arda B
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Hippocratic Oath ,medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Hesiod ,Alternative medicine ,Bioethics ,medicine.disease ,Paternalism ,Cerebral palsy ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Harm ,Informed consent ,Law ,medicine ,symbols ,030212 general & internal medicine ,Psychology ,Psychiatry - Abstract
Pandora opened the box releasing death and all other evils into the world. She hastened to close the lid but the whole content had escaped except for one thing at the bottom of the box - HOPE. Paraphrase of the Greek Myth in Hesiod’s Works and Days. Edward Hon opened the Electronic Fetal Monitoring (EFM) Pandora’s Box in the 1950s. Although perhaps noble in original purpose, the unintended EFM consequences over the last half century resulted in more harm than good to mothers and babies in most of the industrialized world. EFM became the standard of care not because it was scientifically efficacious, but because it was promoted by physicians with undisclosed conflicts of interests and because obstetricians desperately wanted to believe that a machine would solve the age old cerebral palsy malady and at the same time protect physicians and hospitals from the then new and costly cerebral palsy birth injury lawsuits. EFM became the standard of care at the same time that bioethics became medical reality replacing the medical profession’s Hippocratic paternalistic ethic with patient autonomy and informed consent in virtually all aspects of medical practice except for the use of EFM. The use of EFM without informed consent has continued for fifty years with no outcry from the bioethical world. This article explores this ongoing medical and ethical calamity, and discusses why even today EFM use continues disguised as a safety device when in fact its use is primarily as protection for physicians and hospitals from cerebral palsy lawsuits.
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- 2016
4. Healthy eating guidelines for a school jurisdiction: collaborative design and implementation
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Deborah A. McNeil, Bandali F, Riege T, Stephenson Ff, and Johnston Jc
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Male ,Adolescent ,education ,Medicine (miscellaneous) ,Healthy eating ,Guidelines as Topic ,Health Promotion ,Nursing ,Surveys and Questionnaires ,Medicine ,Humans ,Collaborative design ,Eating behaviour ,Child ,Students ,Medical education ,Potential impact ,Nutrition and Dietetics ,Schools ,Jurisdiction ,business.industry ,Food Services ,General Medicine ,Feeding Behavior ,Diet ,Health promotion ,General partnership ,Female ,business ,Food environment - Abstract
Purpose: Healthy eating is a determinant of optimal growth, and schools provide an ideal setting in which to influence students’ diets. The Healthy Eating Guidelines Initiative (HEGI) was a partnership among education, health, and community stakeholders to develop and implement healthy eating guidelines across a school jurisdiction. An evaluation was conducted to examine the potential impact of the HEGI on the school food environment and students’ self-reported diets. Methods: All schools in the jurisdiction were invited to participate in the evaluation. Participating schools included elementary, middle, high, and mixed grades schools. A school environment assessment and a student questionnaire were used to collect data before and after the HEGI. Results: Twenty-two (71%) of 31 schools participated in the evaluation. The guidelines were successfully implemented in 17 of these 22 schools. Overall, a greater proportion of students reported healthier eating behaviours at the conclusion of the HEGI. In particular, a greater proportion of students in schools with cafeteria-style food service showed significantly improved self-reported dietary behaviours. These changes were not seen among students at schools with limited or no on-site food service. Conclusions: The findings are consistent with those of previous studies, and indicate that guidelines for a school jurisdiction can have a positive impact on the school food environment and students’ food intake. The HEGI shows promise as a strategy to promote healthy eating among students.
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- 2014
5. Health care report cards. Validity of case definitions
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Cleves Ma, Golden We, and Johnston Jc
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Databases, Factual ,Medicare ,Clinical expertise ,Nursing ,Bias ,Predictive Value of Tests ,Sepsis ,Health care ,Outcome Assessment, Health Care ,Medicine ,Humans ,Hospital Mortality ,Clinical care ,Coronary Artery Bypass ,Medical education ,business.industry ,Mortality statistics ,Reproducibility of Results ,General Medicine ,Survival Analysis ,United States ,Original report ,Hip Prosthesis ,Construct (philosophy) ,business ,Report card - Abstract
Administrative databases are increasingly being used to construct health care report cards. We analyzed information from one of the original report cards, the Medicare Hospital Information Project. Assessment of mortality statistics for three clinical entities--coronary artery bypass surgery, hip reconstruction, and treatment of sepsis--demonstrated widespread outcome variances that reflected imperfect definitions rather than performance issues in clinical care. The use of administrative data sets to design report cards requires clinical expertise to ensure validity of the data. Designers of report card measures should share preliminary data with providers to enable feedback in methods and uncover definitional and validity concerns before widespread dissemination.
- Published
- 1995
6. An assessment of parents' decision-making regarding paediatric cochlear implants.
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Johnston JC, Durieux-Smith A, Fitzpatrick E, O'Connor A, Benzies K, and Angus D
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Parents of children with severe to profound hearing loss have to make a number of fundamental decisions for their children. These decisions include communication and amplifi cation options. In particular, the parents must decide whether and when their child will receive cochlear implants, and whether these will be implanted unilaterally or bilaterally. The objective of this study was to describe the decision-making needs of parents making the cochlear implant decision for their children. Semi-structured interviews were conducted with eight parents and eight cochlear implant team members at a Canadian cochlear implant centre to document parental and clinician recollections and opinions of the decision-making process related to a unilateral or bilateral cochlear implantation. The results demonstrated that the decision to go ahead with a cochlear implantation was consistently based on the parents' preferences for spoken communication for their children. Parents reported satisfaction with the cochlear implant decision-making process. Two of eight parents felt that additional information on unilateral cochlear implantation risks and benefi ts should have been provided. Four of eight parents described how more information on the experiences of other families would have been helpful for their decision. Parental and clinical perceptions of the bilateral implantation decision were highly variable. All parentsstated that additional information on bilateral cochlear implantation was needed. Based on the results of the interviews, it is concluded that there is a need for information and resources for bilateral cochlear implantation decision-making. [ABSTRACT FROM AUTHOR]
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- 2008
7. The spinoglenoid ligament. Anatomy, morphology, and histological findings.
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Plancher KD, Peterson RK, Johnston JC, Luke TA, Plancher, Kevin D, Peterson, Robert K, Johnston, Jack C, and Luke, Timothy A
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Background: Dysfunction of the distal branch of the suprascapular nerve has been reported in athletes involved in throwing or overhead sports. The consistent presence of a dynamic anatomic structure, the spinoglenoid ligament, overlying the nerve in the spinoglenoid notch may be a contributing factor to the dysfunction of this nerve. The purpose of this study was to report the anatomy, morphology, and histological characteristics of the spinoglenoid ligament.Methods: The spinoglenoid ligaments of fifty-eight fresh-frozen cadaver shoulders were dissected to evaluate their anatomic dimensions, histological characteristics, and relationship to the suprascapular nerve, the posterior part of the capsule, and the glenoid rim. The spinoglenoid ligament was harvested, with its insertions on the scapular spine and on the capsule and glenoid left intact, for the histological analysis.Results: Dissection revealed that a spinoglenoid ligament was present in all specimens. The ligament was found to form an irregular quadrangular shape. On gross examination, the deep fibers of the ligament extended from the lateral aspect of the scapular spine to the posterior part of the glenoid and the superficial fibers blended with the posterior aspect of the shoulder capsule. Histological sections demonstrated Sharpey fibers inserting into bone at the scapular spine and blending with the posterior aspect of the shoulder capsule to insert into the posterior surface of the glenoid, findings that confirmed the ligamentous nature of this structure.Conclusions: This study revealed the presence of the spinoglenoid ligament in all of the shoulders that were examined, with some variation in the size of the ligament. [ABSTRACT FROM AUTHOR]- Published
- 2005
8. Combined clinical and imaging information as an early stroke outcome measure.
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Johnston JC, Wagner DP, Haley EC Jr., Connors AF Jr., RANTTAS Investigators, Johnston, Karen C, Wagner, Douglas P, Haley, E Clarke Jr, Connors, Alfred F Jr, and RANTTAS Investigators.Randomized Trial of Tirilazad Mesylate in Acute Stroke
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- 2002
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9. Letters to the editor: the expert witness - no place to hide.
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Johnston JC
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- 2009
10. Letters to the editor. Neurology in Ethiopia: a model for third world countries.
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Johnston JC
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- 2009
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11. In mitigating risk, an apology goes a long way.
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Johnston JC
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- 2008
12. Will doctors or lawyers guide TPA use?
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Johnston JC
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- 2007
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13. Putting the brakes on drivers with epilepsy.
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Johnston JC
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- 2007
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14. Letter to the editor.
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Johnston JC
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- 2006
15. Liability of the expert neurologist.
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Johnston JC
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- 2005
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16. To use tPA or not? The legal implications.
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Johnston JC
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- 2005
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17. Genomic Analysis Identifies Targets of Convergent Positive Selection in Drug Resistant Mycobacterium tuberculosis
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Sebastien Gagneux, Bruce W. Birren, Bhavana Muddukrishna, Robin M. Warren, Jennifer L. Gardy, B. Jesse Shapiro, Eric J. Rubin, Devinder Kaur, Midori Kato-Maeda, Megan Murray, Jamie E. Posey, Natalia Kurepina, Maha R. Farhat, Alistair Calver, Pardis C. Sabeti, Patrick Tang, Bonnie B. Plikaytis, Eric S. Lander, Alexander Sloutsky, Razvan Sultana, Mark L. Borowsky, Elizabeth M. Streicher, Thomas C. Victor, Karen R. Jacobson, Mabel Rodrigues, James C. Johnston, Karen J. Kieser, James E. Galagan, Barry N. Kreiswirth, Marco R. Oggioni, Massachusetts Institute of Technology. Department of Biology, Lander, Eric S., Farhat MR, Shapiro BJ, Kieser KJ, Sultana R, Jacobson KR, Victor TC, Warren RM, Streicher EM, Calver A, Sloutsky A, Kaur D, Posey JE, Plikaytis B, Oggioni MR, Gardy JL, Johnston JC, Rodrigues M, Tang PK, Kato-Maeda M, Borowsky ML, Muddukrishna B, Kreiswirth BN, Kurepina N, Galagan J, Gagneux S, Birren B, Rubin EJ, Lander ES, Sabeti PC, and Murray M
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Tuberculosis ,DNA Repair ,Drug resistance ,medicine.disease_cause ,Genetic analysis ,Genome ,Article ,Mycobacterium tuberculosis ,03 medical and health sciences ,Antibiotic resistance ,Genetics ,medicine ,Selection, Genetic ,Gene ,030304 developmental biology ,0303 health sciences ,Mutation ,genomics, tuberculosis, mutations, compensatory mutations, resistance, drug resistance ,biology ,030306 microbiology ,Drug Resistance, Microbial ,biology.organism_classification ,medicine.disease ,3. Good health - Abstract
M. tuberculosis is evolving antibiotic resistance, threatening attempts at tuberculosis epidemic control. Mechanisms of resistance, including genetic changes favored by selection in resistant isolates, are incompletely understood. Using 116 newly sequenced and 7 previously sequenced M. tuberculosis whole genomes, we identified genome-wide signatures of positive selection specific to the 47 drug-resistant strains. By searching for convergent evolution--the independent fixation of mutations in the same nucleotide position or gene--we recovered 100% of a set of known resistance markers. We also found evidence of positive selection in an additional 39 genomic regions in resistant isolates. These regions encode components in cell wall biosynthesis, transcriptional regulation and DNA repair pathways. Mutations in these regions could directly confer resistance or compensate for fitness costs associated with resistance. Functional genetic analysis of mutations in one gene, ponA1, demonstrated an in vitro growth advantage in the presence of the drug rifampicin.
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- 2013
18. Predicting risk of tuberculosis disease in people migrating to a low-TB incidence country: development and validation of a multivariable dynamic risk prediction model using health administrative data.
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Puyat JH, Brode SK, Shulha H, Romanowski K, Menzies D, Benedetti A, Duchen R, Huang A, Fang J, Macdonald L, Marras TK, Rea E, Kwong JC, Campitelli MA, Campbell JR, Schwartzman K, Cook VJ, and Johnston JC
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Background: Tuberculosis (TB) incidence remains disproportionately high in people migrating to Canada and other low TB incidence countries, but systematic TB screening and prevention in migrants is often cost-prohibitive for TB programs. We aimed to develop and validate a TB risk prediction model to inform TB screening decisions in foreign-born permanent residents of Canada., Methods: We developed and validated a proportional baselines landmark supermodel for TB risk prediction using health administrative data from British Columbia and Ontario, two distinct provincial healthcare systems in Canada. Demographic (age, sex, refugee status, year of entry, TB incidence in country of origin), TB exposure, and medical (HIV, kidney disease, diabetes, solid organ transplantation, cancer) covariates were used to derive and test models in British Columbia; one model was chosen for external validation in the Ontario cohort. The model's ability to predict 2- and 5-year TB risk in the Ontario cohort was assessed using discrimination and calibration statistics., Results: The study included 715,423 individuals (including 1,407 people with TB disease) in the British Columbia derivation cohort, and 958,131 individuals (including 1,361 people with TB disease) in the Ontario validation cohort. The 2- and 5-year concordance statistic in the validation cohort was 0.77 (95%CI: 0.75-0.78) and 0.77 (95%CI: 0.76-0.78), respectively. Calibration-in-the-large values were 0.14 (95% CI: 0.08-0.21) and -0.05 (95% CI: -0.12-0.02) in 2- and 5-year prediction windows., Conclusions: This prediction model, available online at https://tb-migrate.com, may improve TB risk stratification in people migrating to low incidence countries and may help inform TB screening policy and guidelines., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
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- 2024
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19. Early prediction of Mycobacterium tuberculosis transmission clusters using supervised learning models.
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Gharamaleki OG, Colijn C, Sekirov I, Johnston JC, and Sobkowiak B
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- Humans, Supervised Machine Learning, Cluster Analysis, Male, Female, Adult, Middle Aged, Mycobacterium tuberculosis isolation & purification, Tuberculosis transmission, Tuberculosis microbiology, Tuberculosis epidemiology
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Identifying individuals with tuberculosis (TB) with a high risk of onward transmission can guide disease prevention and public health strategies. Here, we train classification models to predict the first sampled isolates in Mycobacterium tuberculosis transmission clusters from demographic and disease data. We find that supervised learning, in particular balanced random forests, can be used to develop predictive models to identify people with TB that are more likely associated with TB cluster growth, with good model performance and AUCs of ≥ 0.75. We also identified the most important patient and disease characteristics in the best performing classification model, including host demographics, site of infection, TB lineage, and age at diagnosis. This framework can be used to develop predictive tools for the early assessment of potential cluster growth to prioritise individuals for enhanced follow-up with the aim of reducing transmission chains., Competing Interests: Competing interests The authors declare no competing interests. Ethics declarations Ethics were obtained from the University of British Columbia (certificate H12-00910) and informed consent for participation in the study was not required, as determined by institutional REB review., (© 2024. The Author(s).)
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- 2024
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20. Tuberculosis-Associated Respiratory Disability in Children, Adolescents, and Adults: Protocol for a Systematic Review and Individual Participant Data Meta-Analysis.
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Chiang SS, Romanowski K, Johnston JC, Petiquan A, Bastos M, Menzies D, Land S, Benedetti A, Ahmad Khan F, van der Zalm MM, and Campbell JR
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Background: Approximately 2% of the global population has survived tuberculosis (TB). Increasing evidence indicates that a significant proportion of pulmonary TB survivors develop TB-associated respiratory disability, commonly referred to as post-TB lung disease (PLTD) and marked by impaired respiratory function, persistent symptoms, and activity limitations. However, the prevalence, risk factors, and progression of TB-associated respiratory disability throughout the life course are not well understood. To address these gaps, we will undertake a systematic review and individual participant-level data meta-analysis (IPD-MA) focusing on TB-associated respiratory disability in children, adolescents, and adults successfully treated for pulmonary TB., Methods and Analysis: We will systematically search MEDLINE, Embase, CENTRAL, Global Index Medicus, and medRxiv for original studies investigating TB-associated respiratory disability in people of all ages who have completed treatment for microbiologically confirmed or clinically diagnosed pulmonary TB. Authors of eligible studies will be invited to contribute de-identified data and form a collaborative group. Primary outcomes will be (1) abnormal lung function based on spirometry parameters and (2) chronic respiratory symptoms. We will estimate the overall and subgroup-specific prevalence of each outcome through IPD meta-analysis. Next, we will develop clinical prediction tools assessing the risk of future TB-associated respiratory disability at (i) the start of TB treatment and (ii) end of TB treatment for those without existing signs of disability. Finally, we will use stepwise hierarchical modelling to identify epidemiological determinants of respiratory disability., Ethics and Dissemination: This study has been approved by the ethics review boards at the Rhode Island Hospital (2138217-2) and the Research Institute of the McGill University Health Centre (2024-10345). Individual study authors will be required to obtain institutional approval prior to sharing data. Results will be disseminated through open-access, peer-reviewed publications and conference presentations., Prospero Registration Number: CRD42024529906., Competing Interests: Competing interests: The authors declare no conflicts of interest.
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- 2024
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21. Perspectives from the 2 nd International Post-Tuberculosis Symposium: mobilising advocacy and research for improved outcomes.
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Allwood BW, Nightingale R, Agbota G, Auld S, Bisson GP, Byrne A, Dunn R, Evans D, Hoddinott G, Günther G, Islam Z, Johnston JC, Kalyatanda G, Khosa C, Marais S, Makanda G, Mashedi OM, Meghji J, Mitnick C, Mulder C, Nkereuwem E, Nkereuwem O, Ozoh OB, Rachow A, Romanowski K, Seddon JA, Schoeman I, Thienemann F, Walker NF, Wademan DT, Wallis R, and van der Zalm MM
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In 2020, it was estimated that there were 155 million survivors of TB alive, all at risk of possible post TB disability. The 2
nd International Post-Tuberculosis Symposium (Stellenbosch, South Africa) was held to increase global awareness and empower TB-affected communities to play an active role in driving the agenda. We aimed to update knowledge on post-TB life and illness, identify research priorities, build research collaborations and highlight the need to embed lung health outcomes in clinical TB trials and programmatic TB care services. The symposium was a multidisciplinary meeting that included clinicians, researchers, TB survivors, funders and policy makers. Ten academic working groups set their own goals and covered the following thematic areas: 1) patient engagement and perspectives; 2) epidemiology and modelling; 3) pathogenesis of post-TB sequelae; 4) post-TB lung disease; 5) cardiovascular and pulmonary vascular complications; 6) neuromuscular & skeletal complications; 7) paediatric complications; 8) economic-social and psychological (ESP) consequences; 9) prevention, treatment and management; 10) advocacy, policy and stakeholder engagement. The working groups provided important updates for their respective fields, highlighted research priorities, and made progress towards the standardisation and alignment of post-TB outcomes and definitions., (© 2024 The Authors.)- Published
- 2024
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22. The prevalence of tuberculosis infection among foreign-born Canadians: a modelling study.
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Jordan AE, Nsengiyumva NP, Houben RMGJ, Dodd PJ, Dale KD, Trauer JM, Denholm JT, Johnston JC, Khan FA, Campbell JR, and Schwartzman K
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- Humans, Incidence, Prevalence, Canada epidemiology, Latent Tuberculosis epidemiology, Tuberculosis epidemiology, Emigrants and Immigrants
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Background: The prevalence of tuberculosis infection is critical to the design of tuberculosis prevention strategies, yet is unknown in Canada. We estimated the prevalence of tuberculosis infection among Canadian residents born abroad., Methods: We estimated the prevalence of tuberculosis infection by age and year of migration to Canada for people from each of 168 countries by constructing country-specific and calendar year-specific trends for annual risk of infection using a previously developed model. We combined country-specific prevalence estimates with Canadian Census data from 2001, 2006, 2011, 2016 and 2021 to estimate the overall prevalence of tuberculosis infection among foreign-born Canadian residents., Results: The estimated overall prevalence of tuberculosis infection among foreign-born people in Canada was 25% (95% uncertainty interval [UI] 20%-35%) for census year 2001, 24% (95% UI 20%-33%) for 2006, 23% (95% UI 19%-30%) for 2011, 22% (95% UI 19%-28%) for 2016 and 22% (95% UI 19%-27%) for 2021. The prevalence increased with age at migration and incidence of tuberculosis in the country of origin. In 2021, the estimated prevalence of infection among foreign-born residents was lowest in Quebec (19%, 95% UI 16%-24%) and highest in Alberta (24%, 95% UI 21%-28%) and British Columbia (24%, 95% UI 20%-30%). Among all foreign-born Canadian residents with tuberculosis infection in 2021, we estimated that only 1 in 488 (95% UI 185-1039) had become infected within the 2 preceding years., Interpretation: About 1 in 4 foreign-born Canadian residents has tuberculosis infection, but very few were infected within the 2 preceding years (the highest risk period for progression to tuberculosis disease). These data may inform future tuberculosis infection screening policies., Competing Interests: Competing interests: James Johnston reports support from the Michael Smith Foundation for Health Research BC. Faiz Ahmad Khan reports support from the Canadian Institutes of Health Research, the National Research Council of Canada, Fonds de Recherche du Québec – Santé, Fonds de Recherche du Québec – Nature et technologies, Fonds de recherche du Québec – Société et culture, and Institut nordique du Québec. Delft and qure.ai have provided Faiz Ahmad Khan’s laboratory with use of their software for chest radiography analysis at academic-use pricing. Contractual agreements are in place to ensure the companies do not have input in any aspect of research design, conduct or reporting. Kevin Schwartzman reports support from the Bill and Melinda Gates Foundation and participation on a data safety monitoring board for Laurent Pharmaceuticals. He is a volunteer board member and executive committee member with the International Union Against Tuberculosis and Lung Disease. No other competing interests were declared., (© 2023 CMA Impact Inc. or its licensors.)
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- 2023
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23. Incidence of and Risk Factors for Active Tuberculosis Disease in Individuals With Glomerular Disease: A Canadian Cohort Study.
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Canney M, Gunning HM, Johnston JC, Induruwage D, Zheng Y, and Barbour SJ
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- Adult, Humans, Cohort Studies, Prospective Studies, Incidence, Risk Factors, British Columbia epidemiology, Proteinuria, Tuberculosis epidemiology, Glomerulonephritis, IGA pathology, Lupus Nephritis, Renal Insufficiency
- Abstract
Rationale & Objective: Kidney failure is an established risk factor for active tuberculosis (TB) but the risk of TB has not been reported in specific kidney diseases. We sought to determine the incidence of and risk factors for active TB in patients with glomerular disease., Study Design: Observational cohort study., Setting & Participants: A provincial kidney pathology registry (2000-2012) was used to identify 3,079 adult patients with IgA nephropathy, focal segmental glomerulosclerosis (FSGS), antineutrophil cytoplasmic antibody (ANCA)-related glomerulonephritis, lupus nephritis, membranous nephropathy, minimal change disease, or "other" glomerular diseases in British Columbia, Canada., Exposure: Predictors included demographics, immigration status, comorbidities, immunosuppression use, estimated glomerular filtration rate (eGFR), and proteinuria., Outcome: A diagnosis of active TB was ascertained using administrative data linkages and defined based on (1) the dispensation of 1 or more unique combinations of medications used to treat active TB, or (2) physician or hospital visits for active TB., Analytical Approach: The definition of TB was validated in an external cohort linked to the Provincial TB registry at the BC Centre for Disease Control (BCCDC). Standardized incidence ratios were calculated using the age-matched general population. Risk factors for active TB were identified using Cox proportional hazards regression analysis., Results: The sensitivity and specificity of the outcome definition of active TB were 87.6% and 99.5%, respectively. During a median follow-up of 6.2 years, 41 patients developed active TB with an incidence of 197 of 100,000 person-years, approximately 23 times as high as the general population and>6 times higher than the threshold of 30 per 100,000 used to define high TB incidence. A high incidence was observed in all glomerular diseases (range, 110-403 per 100,000), in both Canadian- and foreign-born patients (range, 124-424 per 100,000), and in patients exposed or not to immunosuppression (282 vs 147 per 100,000). Factors associated with higher TB risk included immigration from a high-incidence country (HR, 3.90 [95% CI, 1.75-8.68]), diminished eGFR (HR, 2.81 [95% CI, 1.18-6.69]), higher levels of proteinuria (HR, 1.15 [95% CI, 1.04-1.27]), lupus nephritis (HR, 2.79 [95% CI, 1.37-5.68]), and immunosuppression use (HR, 2.13 [95% CI, 1.13-4.03])., Limitations: A relatively low number of events contributed to uncertainty in risk estimates., Conclusions: Patients with glomerular disease have a high incidence of active TB irrespective of disease type, demographics, or use of immunosuppression. Prospective studies are needed to evaluate the utility of screening for latent TB infection in this population., Plain-Language Summary: Patients with kidney failure are at high risk of developing tuberculosis (TB), a major infection that can be prevented by identifying and treating patients who have had prior exposure to TB. The risk of TB in specific kidney diseases is unknown. In this Canadian study of 3,079 patients with glomerular disease, a group of autoimmune kidney conditions, the rate of TB was 23 times higher than in the general population. The rate was high irrespective of the use of immunosuppressive drugs or whether patients had immigrated to Canada from another country. These findings suggest that screening patients with glomerular disease for prior TB exposure may be beneficial; however, this needs to be evaluated in a prospective study., (Copyright © 2023 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)
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- 2023
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24. Risk of Tuberculosis Disease in People With Chronic Kidney Disease Without Kidney Failure: A Systematic Review and Meta-analysis.
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Luczynski P, Holmes T, Romanowski K, Arbiv OA, Cook VJ, Clark EG, and Johnston JC
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- Humans, Renal Replacement Therapy, Risk Factors, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic epidemiology, Tuberculosis complications, Tuberculosis epidemiology, Kidney Failure, Chronic complications
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Background: Kidney failure is an established risk factor for tuberculosis (TB), but little is known about TB risk in people with chronic kidney disease (CKD) who have not initiated kidney replacement therapy (CKD without kidney failure). Our primary objective was to estimate the pooled relative risk of TB disease in people with CKD stages 3-5 without kidney failure compared with people without CKD. Our secondary objectives were to estimate the pooled relative risk of TB disease for all stages of CKD without kidney failure (stages 1-5) and by each CKD stage., Methods: This review was prospectively registered (PROSPERO CRD42022342499). We systematically searched MEDLINE, Embase, and Cochrane databases for studies published between 1970 and 2022. We included original observational research estimating TB risk among people with CKD without kidney failure. Random-effects meta-analysis was performed to obtain the pooled relative risk., Results: Of the 6915 unique articles identified, data from 5 studies were included. The estimated pooled risk of TB was 57% higher in people with CKD stages 3-5 than in people without CKD (adjusted hazard ratio: 1.57; 95% CI: 1.22-2.03; I2 = 88%). When stratified by CKD stage, the pooled rate of TB was highest in stages 4-5 (incidence rate ratio: 3.63; 95% CI: 2.25-5.86; I2 = 89%)., Conclusions: People with CKD without kidney failure have an increased relative risk of TB. Further research and modeling are required to understand the risks, benefits, and CKD cutoffs for screening people for TB with CKD prior to kidney replacement therapy., Competing Interests: Potential conflicts of interest . V. J. C. reports participation on a Data and Safety Monitoring Board (DSMB) (unrelated to this manuscript) and a role as co-chair of the British Columbia Provincial TB Committee. J. C. J. reports research grants from the US Department of Health and Human Services, Canadian Institutes of Health Research, TB Vets, and the BC Lung Foundation (paid to institution) and a contract with the Michael Smith Foundation for health research (personal salary). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2023
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25. Distinct healthcare utilization profiles of high healthcare use tuberculosis survivors: A latent class analysis.
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Romanowski K, Karim ME, Gilbert M, Cook VJ, and Johnston JC
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- Humans, Aged, Adult, Latent Class Analysis, Patient Acceptance of Health Care, British Columbia epidemiology, Survivors, Tuberculosis epidemiology, Tuberculosis, Pulmonary epidemiology
- Abstract
Background: Recent data have demonstrated that healthcare use after treatment for respiratory tuberculosis (TB) remains elevated in the years following treatment completion. However, it remains unclear which TB survivors are high healthcare users and whether any variation exists within this population. Thus, the primary objective of this study was to identify distinct profiles of high healthcare-use TB survivors to help inform post-treatment support and care., Methods: Using linked health administrative data from British Columbia, Canada, we identified foreign-born individuals who completed treatment for incident respiratory TB between 1990 and 2019. We defined high healthcare-use TB survivors as those in the top 10% of annual emergency department visits, hospital admissions, or general practitioner visits among the study population during the five-year period immediately following TB treatment completion. We then used latent class analysis to categorize the identified high healthcare-use TB survivors into subgroups., Results: Of the 1,240 people who completed treatment for respiratory TB, 258 (20.8%) people were identified as high post- TB healthcare users. Latent class analysis results in a 2-class solution. Class 1 (n = 196; 76.0%) included older individuals (median age 71.0; IQR 59.8, 79.0) with a higher probability of pre-existing hypertension and diabetes (41.3% and 33.2%, respectively). Class 2 (n = 62; 24.0%) comprised of younger individuals (median age 31.0; IQR 27.0, 41.0) with a high probability (61.3%) of immigrating to Canada within five years of their TB diagnosis and a low probability (11.3%) of moderate to high continuity of primary care., Discussion: Our findings suggest that foreign-born high healthcare-use TB survivors in a high-resource setting may be categorized into distinct profiles to help guide the development of person-centred care strategies targeting the long-term health impacts TB survivors face., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Romanowski et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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26. Healthcare Utilization After Respiratory Tuberculosis: A Controlled Interrupted Time Series Analysis.
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Romanowski K, Law MR, Karim ME, Campbell JR, Hossain MB, Gilbert M, Cook VJ, and Johnston JC
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- Humans, Interrupted Time Series Analysis, Delivery of Health Care, Patient Acceptance of Health Care, British Columbia epidemiology, Tuberculosis diagnosis, Tuberculosis drug therapy, Tuberculosis epidemiology, Tuberculosis, Pulmonary
- Abstract
Background: Despite data suggesting elevated morbidity and mortality among people who have survived tuberculosis disease, the impact of respiratory tuberculosis on healthcare utilization in the years following diagnosis and treatment remains unclear., Methods: Using linked health administrative data from British Columbia, Canada, we identified foreign-born individuals treated for respiratory tuberculosis between 1990 and 2019. We matched each person with up to four people without a tuberculosis diagnosis from the same source cohort using propensity score matching. Then, using a controlled interrupted time series analysis, we measured outpatient physician encounters and inpatient hospital admissions in the 5 years following respiratory tuberculosis diagnosis and treatment., Results: We matched 1216 individuals treated for respiratory tuberculosis to 4864 non-tuberculosis controls. Immediately following the tuberculosis diagnostic and treatment period, the monthly rate of outpatient encounters in the tuberculosis group was 34.0% (95% confidence interval [CI]: 30.7%, 37.2%) higher than expected, and this trend was sustained for the duration of the post-tuberculosis period. The excess utilization represented an additional 12.2 (95% CI: 10.6, 14.9) outpatient encounters per person over the post-tuberculosis period, with respiratory morbidity a large contributor to the excess healthcare utilization. Results were similar for hospital admissions, with an additional 0.4 (95% CI: .3, .5) hospital admissions per person over the post-tuberculosis period., Conclusions: Respiratory tuberculosis appears to have long-term impacts on healthcare utilization beyond treatment. These findings underscore the need for screening, assessment, and treatment of post-tuberculosis sequelae, as it may provide an opportunity to improve health and reduce resource use., Competing Interests: Potential conflicts of interest. K. R. reports travel support from CIHR (paid to institution). M. R. L. reports grants or contracts from CIHR and BC Ministry of Health (paid to institution); consulting fees from Health Canada, iTAD Ltd, and Canadian Agency for Drugs and Technologies in Health (CADTH) (paid to author); payment for expert testimony from Federation of Post-secondary Educators and Durham Police Association (paid to author). M. E. K. reports grants or contracts from Michael Smith Health Research BC (as reported in funding) and Natural Sciences and Engineering Research Council of Canada (both paid to institution). V. J. C. reports travel support for conferences from BC Center for Disease Control (BCCDC); participation as an independent data safety monitoring committee (IDMC) member for ACT5; and an unpaid role as board member for the BC Lung Foundation. M. G. reports travel support from CIHR Canadian HIV Trials Network (research collaborative). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2023
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27. Global Neurology: The Good, the Bad, and the Ugly.
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Johnston JC, Sartwelle TP, Zebenigus M, Arda B, and Beran RG
- Subjects
- Humans, Developing Countries, Global Health, Medical Missions, Neurology
- Abstract
Global health programs engaging in isolated or short-term medical missions can and do cause harm, reinforce health care disparities, and impede medical care in the regions where it is so desperately needed. Related ethical, medical, and legal concerns are reviewed in this article. The authors recommend abandoning these ill-considered missions and focusing attention and resources on advancing neurology through ethically congruent, multisectoral, collaborative partnerships to establish sustainable, self-sufficient training programs within low- and middle-income countries., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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28. Medical Malpractice and the Neurologist: An Introduction.
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Johnston JC and Sartwelle TP
- Subjects
- Humans, Liability, Legal, Neurologists, Expert Testimony, Malpractice, Neurology
- Abstract
This article provides an overview of current malpractice trends in neurology as well as non-malpractice and forensic liability concerns. It is more important for clinicians to recognize the common patient care scenarios that are likely to precipitate lawsuits rather than memorize arcane legal principles. Therefore, this article offers an introduction to malpractice jurisprudence as well as a general overview of current litigation trends and a review of the role and duties of a neurologist serving as an expert witness. The next article highlights mitigation strategies for the most prevalent neurologic misadventures., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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29. Medical Malpractice and the Neurologist: Specific Neurological Claims.
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Johnston JC and Sartwelle TP
- Subjects
- Humans, Neurologists, Liability, Legal, Malpractice
- Abstract
This chapter highlights the most frequently encountered neurological malpractice claims. The format is designed to provide a rudimentary understanding of how lawsuits arise and thereby focus discussion on adapting practice patterns to improve patient care and minimize liability risk., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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30. Using a theory-informed approach to guide the initial development of a post-tuberculosis care package in British Columbia, Canada.
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Romanowski K, Cook VJ, Gilbert M, and Johnston JC
- Subjects
- Humans, British Columbia, Delivery of Health Care, Surveys and Questionnaires, Tuberculosis therapy, Tuberculosis prevention & control
- Abstract
Background: The importance of addressing the long-term needs of tuberculosis (TB) survivors is gaining increasing attention. One promising approach to improving post-TB care is implementing a post-TB care package. With a specific focus on the perspectives of healthcare providers in British Columbia, Canada, this study aimed to (1) determine a set of components to be included in a post-TB care package, (2) explore barriers and facilitators influencing their implementation, and (3) propose potential solutions to overcome identified challenges., Methods: Employing a multi-method approach guided by the Theoretical Domains Framework, we first conducted virtual workshops with TB care providers and utilized a modified Delphi process to establish a preliminary list of care package components. Then, we surveyed healthcare providers using closed-ended, Likert-scale questions to identify implementation barriers and enablers. Lastly, we mapped the identified barriers and enablers to establish behaviour change techniques to identify possible solutions to overcome the challenges identified., Results: Eleven participants attended virtual workshops, and 23 of 51 (45.1%) healthcare providers completed questionnaires. Identified components of the post-TB care package included: 1. Linking people with TB to a primary care provider if they do not have one. 2. Referring people with pulmonary TB for an end-of-treatment chest x-ray and pulmonary function testing. 3. Referring people with TB who smoke to a smoking cessation specialist. 4. Sharing a one-page post-TB information sheet with the patient's primary care provider, including a summary of post-TB health concerns, complications, and recommendations to prioritize age-appropriate screening for cardiovascular disease, lung cancer, and depression. Survey results indicated that domain scores for 'environment, context, and resources' were the lowest, suggesting potential implementation barriers. Care navigation services to help individuals overcome health system barriers while transitioning from TB care, information leaflets, and checklists summarizing key post-TB health concerns for patients and healthcare providers to help facilitate discussions may help overcome the identified barriers., Conclusion: Healthcare providers in British Columbia acknowledge that post-TB care is integral to comprehensive health care but are limited by time and resources. Care navigation services, a post-TB checklist, and patient information leaflets may help resolve some of these barriers., (© 2023. The Author(s).)
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- 2023
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31. The association of SARS-CoV-2 infection and tuberculosis disease with unfavorable treatment outcomes: A systematic review.
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Vadlamudi NK, Basham CA, Johnston JC, Ahmad Khan F, Battista Migliori G, Centis R, D'Ambrosio L, Jassat W, Davies MA, Schwartzman K, and Campbell JR
- Abstract
Background: Whether SARS-CoV-2 infection and its management influence tuberculosis (TB) treatment outcomes is uncertain. We synthesized evidence on the association of SARS-CoV-2 coinfection (Coinfection Review) and its management (Clinical Management Review) on treatment outcomes among people with tuberculosis (TB) disease., Methods: We systematically searched the literature from 1 January 2020 to 6 February 2022. Primary outcomes included: unfavorable (death, treatment failure, loss-to-follow-up) TB treatment outcomes (Coinfection and Clinical Management Review) and/or severe or critical COVID-19 or death (Clinical Management Review). Study quality was assessed with an adapted Newcastle Ottawa Scale. Data were heterogeneous and a narrative review was performed. An updated search was performed on April 3, 2023., Findings: From 9,529 records, we included 11 studies and 7305 unique participants. No study reported data relevant to our review in their primary publication and data had to be contributed by study authors after contact. Evidence from all studies was low quality. Eight studies of 5749 persons treated for TB (286 [5%] with SARS-CoV-2) were included in the Coinfection Review. Across five studies reporting our primary outcome, there was no significant association between SARS-CoV-2 coinfection and unfavorable TB treatment outcomes. Four studies of 1572 TB patients-of whom 291 (19%) received corticosteroids or other immunomodulating treatment-were included in the Clinical Management Review, and two addressed a primary outcome. Studies were likely confounded by indication and discordant findings existed among studies. When updating our search, we still did not identify any study reporting data relevant to this review in their primary publication., Interpretation: No study was designed to answer our research questions of interest. It remains unclear whether TB/SARS-CoV-2 and its therapeutic management are associated with unfavorable outcomes. Research is needed to improve our understanding of risk and optimal management of persons with TB and SARS-CoV-2 infection., Trial Registration: Registration: PROSPERO (CRD42022309818)., Competing Interests: The authors have read the journal’s policy and have the following competing interests: NKV reports receiving consulting fees from Broadstreet HEOR for unrelated projects outside of the submitted work. JRC reports receiving consulting fees from the COVID-19 Immunity Task Force (Canada) and The World Bank, for unrelated projects outside of the submitted work. This does not alter our adherence to PLOS policies on sharing data and materials., (Copyright: © 2023 Vadlamudi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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32. Comparing Mycobacterium tuberculosis transmission reconstruction models from whole genome sequence data.
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Sobkowiak B, Romanowski K, Sekirov I, Gardy JL, and Johnston JC
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- Humans, Genome, Bacterial, Genomics, Polymorphism, Single Nucleotide, Whole Genome Sequencing methods, Bacterial Infections, Computational Biology, Mycobacterium tuberculosis genetics, Tuberculosis microbiology, Tuberculosis transmission
- Abstract
Genomic epidemiology is routinely used worldwide to interrogate infectious disease dynamics. Multiple computational tools exist that reconstruct transmission networks by coupling genomic data with epidemiological models. Resulting inferences can improve our understanding of pathogen transmission dynamics, and yet the performance of these tools has not been evaluated for tuberculosis (TB), a disease process with complex epidemiology including variable latency and within-host heterogeneity. Here, we performed a systematic comparison of six publicly available transmission reconstruction models, evaluating their accuracy when predicting transmission events in simulated and real-world Mycobacterium tuberculosis outbreaks. We observed variability in the number of transmission links that were predicted with high probability ( P ≥ 0.5) and low accuracy of these predictions against known transmission in simulated outbreaks. We also found a low proportion of epidemiologically supported case-contact pairs were identified in our real-world TB clusters. The specificity of all models was high, and a relatively high proportion of the total transmission events predicted by some models were true links, notably with TransPhylo, Outbreaker2, and Phybreak. Our findings may inform the choice of tools in TB transmission analyses and underscore the need for caution when interpreting transmission networks produced using probabilistic approaches.
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- 2023
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33. Role of latent tuberculosis infection on elevated risk of cardiovascular disease: a population-based cohort study of immigrants in British Columbia, Canada, 1985-2019.
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Hossain MB, Johnston JC, Cook VJ, Sadatsafavi M, Wong H, Romanowski K, and Karim ME
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- Humans, British Columbia epidemiology, Cohort Studies, Incidence, Cardiovascular Diseases complications, Cardiovascular Diseases epidemiology, Emigrants and Immigrants, Latent Tuberculosis epidemiology
- Abstract
We investigated cardiovascular disease (CVD) risk associated with latent tuberculosis infection (LTBI) (Aim-1) and LTBI therapy (Aim-2) in British Columbia, a low-tuberculosis-incidence setting. 49,197 participants had valid LTBI test results. Cox proportional hazards model was fitted, adjusting for potential confounders. Compared with the participants who tested LTBI negative, LTBI positive was associated with an 8% higher CVD risk in complete case data (adjusted hazard ratio (HR): 1.08, 95% CI: 0.99-1.18), a statistically significant 11% higher risk when missing confounder values were imputed using multiple imputation (HR: 1.11, 95% CI: 1.02-1.20), and 10% higher risk when additional proxy variables supplementing known unmeasured confounders were incorporated in the highdimensional disease risk score technique to reduce residual confounding (HR: 1.10, 95% CI: 1.01-1.20). Also, compared with participants who tested negative, CVD risk was 27% higher among people who were LTBI positive but incomplete LTBI therapy (HR: 1.27, 95% CI: 1.04-1.55), whereas the risk was similar in people who completed LTBI therapy (HR: 1.04, 95% CI: 0.87-1.24). Findings were consistent in different sensitivity analyses. We concluded that LTBI is associated with an increased CVD risk in low-tuberculosis-incidence settings, with a higher risk associated with incomplete LTBI therapy and attenuated risk when therapy is completed.
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- 2023
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34. Cost analysis of COVID-19 test result notification using an automated messaging system compared to a staff caller practice in Alberta.
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Loitz CC, Johnston JC, Johansen S, Spackman E, and Devolin M
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- Humans, Alberta, Costs and Cost Analysis, Cost-Effectiveness Analysis, COVID-19 diagnosis, COVID-19 epidemiology, Text Messaging
- Abstract
Setting: In Alberta, polymerase chain reaction (PCR) COVID-19 tests were an important step in detecting and isolating contagious individuals throughout the pandemic. Initially, a staff member provided results to all PCR COVID-19 test clients by phone. As the number of tests increased, new approaches were essential for timely result notification., Intervention: An innovative automated IT system was introduced during the pandemic to reduce workloads and support timely result notification. At the time of the COVID-19 test booking and again following swabbing, clients had an option to consent to receive their test results via an automated text or voice message. Prior to implementation, a privacy impact assessment was approved, a pilot was undertaken, and changes to lab information systems were made., Outcomes: Health administration data were used in a cost analysis to compare the unique costs associated with the novel automated IT practice (e.g., administration, integration, messages, staffing costs) and a hypothetical staff caller practice (e.g., administration, staffing costs) for negative test results. The costs of sharing 2,161,605 negative test results in 2021 were assessed. The automated IT practice demonstrated a cost savings of $6,272,495 over the staff caller practice. A follow-up analysis determined the cost savings threshold of 46,463 negative tests to break even., Implications: Using an automated IT practice for consenting clients can be a cost-effective approach to reach clients in a timely manner during a pandemic or other instances warranting direct notification. This approach is being explored for test result notification of other communicable diseases in other contexts., (© 2023. The Author(s) under exclusive license to The Canadian Public Health Association.)
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- 2023
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35. Exploring the Alberta Health Services COVID-19 provincial public health integrated outbreak prevention, preparedness, management, and response interventions to support congregate and communal living sites in Alberta.
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Loitz CC, Johansen S, Johnston JC, Strain KL, Patterson K, Chambers P, and Devolin M
- Subjects
- Humans, Public Health, Pandemics prevention & control, Alberta epidemiology, Disease Outbreaks prevention & control, Health Services, COVID-19 epidemiology, COVID-19 prevention & control
- Abstract
Setting: On March 17, 2020, a state of public health emergency was declared in Alberta under the Public Health Act in response to the COVID-19 pandemic. Congregate and communal living sites were environments with a high risk of exposure to and transmission of COVID-19. Consequently, provincial efforts to prevent and manage COVID-19 were required and prioritized., Intervention: During the first 9 months of the pandemic, vaccines were unavailable and alternate strategies were used to prevent and manage COVID-19 (e.g., physical distancing, masking, symptom screening, testing, isolating cases). Alberta Health Services worked with local, provincial, and First Nations and Inuit Health Branch stakeholders to deliver interventions to support congregate and communal living sites. Interventions included resources and site visits to support prevention and preparedness, and the creation of a coordinated response line to serve as a single point of contact to access information and services in the event of an outbreak (e.g., guidance, testing, personal protective equipment, reporting)., Outcomes: Data from an internal monitoring dashboard informed intervention uptake and use. Online survey results found high levels of awareness, acceptability, appropriateness, and use of the interventions among congregate and communal living site administrators (n = 550). Recommendations were developed from reported experiences, challenges, and facilitators, and processes were improved., Implications: Provincially coordinated prevention, preparedness, and outbreak management interventions supported congregate and communal living sites. Efforts to further develop adaptive system-level approaches for prevention and preparedness, in addition to communication and information sharing in complex rapidly changing contexts, could benefit future public health emergencies., (© 2023. The Author(s) under exclusive license to The Canadian Public Health Association.)
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- 2023
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36. Multimorbidity prevalence and chronic disease patterns among tuberculosis survivors in a high-income setting.
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Basham CA, Karim ME, and Johnston JC
- Subjects
- Humans, Comorbidity, Cohort Studies, Prevalence, Chronic Disease, Survivors, British Columbia epidemiology, Multimorbidity, Tuberculosis epidemiology
- Abstract
Objectives: Multimorbidity is the presence of two or more chronic health conditions. Tuberculosis (TB) survivors are known to have higher prevalence of multimorbidity, although prevalence estimates from high-income low-TB incidence jurisdictions are not available and potential differences in the patterns of chronic disease among TB survivors with multimorbidity are poorly understood. In this study, we aimed to (1) compare the prevalence of multimorbidity among TB survivors with matched non-TB controls in a high-income setting; (2) assess the robustness of aim 1 analyses to different modelling strategies, unmeasured confounding, and misclassification bias; and (3) among people with multimorbidity, elucidate chronic disease patterns specific to TB survivors., Methods: A population-based cohort study of people immigrating to British Columbia, Canada, 1985-2015, using health administrative data. Participants were divided into two groups: people diagnosed with TB (TB survivors) and people not diagnosed with TB (non-TB controls) in British Columbia. Coarsened exact matching (CEM) balanced demographic, immigration, and socioeconomic covariates between TB survivors and matched non-TB controls. Our primary outcome was multimorbidity, defined as ≥2 chronic diseases from the Elixhauser comorbidity index., Results: In the CEM-matched sample (n=1962 TB survivors; n=1962 non-TB controls), we estimated that 21.2% of TB survivors (n=416), compared with 12% of non-TB controls (n=236), had multimorbidity. In our primary analysis, we found a double-adjusted prevalence ratio of 1.74 (95% CI: 1.49-2.05) between TB survivors and matched non-TB controls for multimorbidity. Among people with multimorbidity, differences were observed in chronic disease frequencies between TB survivors and matched controls., Conclusion: TB survivors had a 74% higher prevalence of multimorbidity compared with CEM-matched non-TB controls. TB-specific multimorbidity patterns were observed through differences in chronic disease frequencies between the matched samples. These findings suggest a need for TB-specific multimorbidity interventions in high-income settings such as Canada. We suggest TB survivorship as a framework for developing person-centred interventions for multimorbidity among TB survivors., (© 2022. The Author(s) under exclusive license to The Canadian Public Health Association.)
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- 2023
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37. Post-COVID dyspnea: prevalence, predictors, and outcomes in a longitudinal, prospective cohort.
- Author
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Grewal JS, Carlsten C, Johnston JC, Shah AS, Wong AW, and Ryerson CJ
- Subjects
- Adult, Humans, Prospective Studies, Prevalence, SARS-CoV-2, Dyspnea etiology, Quality of Life, COVID-19 complications
- Abstract
Background: The pathophysiology, evolution, and associated outcomes of post-COVID dyspnea remain unknown. The aim of this study was to determine the prevalence, severity, and predictors of dyspnea 12 months following hospitalization for COVID-19, and to describe the respiratory, cardiac, and patient-reported outcomes in patients with post-COVID dyspnea., Methods: We enrolled a prospective cohort of all adult patients admitted to 2 academic hospitals in Vancouver, Canada with PCR-confirmed SARS-CoV-2 during the first wave of COVID between March and June 2020. Dyspnea was measured 3, 6, and 12 months after initial symptom onset using the University of California San Diego Shortness of Breath Questionnaire., Results: A total of 76 patients were included. Clinically meaningful dyspnea (baseline score > 10 points) was present in 49% of patients at 3 months and 46% at 12 months following COVID-19. Between 3 and 12 months post-COVID-19, 24% patients had a clinically meaningful worsening in their dyspnea, 49% had no meaningful change, and 28% had a clinically meaningful improvement in their dyspnea. There was worse sleep, mood, quality of life, and frailty in patients with clinically meaningful dyspnea at 12 months post-COVID infection compared to patients without dyspnea. There was no difference in PFT findings, troponin, or BNP comparing patients with and without clinically meaningful dyspnea at 12 months. Severity of dyspnea and depressive symptoms at 3 months predicted severity of dyspnea at 12 months., Conclusions: Post-COVID dyspnea is common, persistent, and negatively impacts quality of life. Mood abnormalities may play a causative role in post-COVID dyspnea in addition to potential cardiorespiratory abnormalities. Dyspnea and depression at initial follow-up predict longer-term post-COVID dyspnea, emphasizing that standardized dyspnea and mood assessment following COVID-19 may identify patients at high risk of post-COVID dyspnea and facilitating early and effective management., (© 2023. The Author(s).)
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- 2023
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38. Améliorer les soins post-tuberculose au Canada.
- Author
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Romanowski K, Amin P, and Johnston JC
- Subjects
- Humans, Canada, Delivery of Health Care, Tuberculosis therapy
- Abstract
Competing Interests: Intérêts concurrents: Aucun déclaré.
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- 2023
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39. Tuberculosis and risk of cancer: A systematic review and meta-analysis.
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Luczynski P, Poulin P, Romanowski K, and Johnston JC
- Subjects
- Humans, Incidence, Lung Neoplasms epidemiology, Risk Assessment, Observational Studies as Topic, Neoplasms epidemiology, Tuberculosis diagnosis
- Abstract
Introduction: Cancer is a major cause of death among people who experience tuberculosis (TB), but little is known about its timing and incidence following TB treatment. Our primary objectives were to estimate the pooled risk of all and site-specific malignancies in people with TB compared to the general population or suitable controls. Our secondary objective was to describe the pooled risk of cancer at different time points following TB diagnosis., Methods: This study was prospectively registered (PROSPERO: CRD42021277819). We systematically searched MEDLINE, Embase, and the Cochrane Database for studies published between 1980 and 2021. We included original observational research articles that estimated cancer risk among people with TB compared to controls. Studies were excluded if they had a study population of fewer than 50 individuals; used cross-sectional, case series, or case report designs; and had a follow-up period of less than 12 months. Random-effects meta-analysis was used to obtain the pooled risk of cancer in the TB population., Results: Of the 5,160 unique studies identified, data from 17 studies were included. When compared to controls, the pooled standardized incidence ratios (SIR) of all cancer (SIR 1.62, 95% CI 1.35-1.93, I2 = 97%) and lung cancer (SIR 3.20, 95% CI 2.21-4.63, I2 = 90%) was increased in the TB population. The pooled risk of all cancers and lung cancer was highest within the first year following TB diagnosis (SIR 4.70, 95% CI 1.80-12.27, I2 = 99%) but remained over five years of follow-up., Conclusions: People with TB have an increased risk of both pulmonary and non-pulmonary cancers. Further research on cancer following TB diagnosis is needed to develop effective screening and early detection strategies. Clinicians should have a high index of suspicion for cancer in people with TB, particularly in the first year following TB diagnosis., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Luczynski et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2022
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40. Improving post-tuberculosis care in Canada.
- Author
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Romanowski K, Amin P, and Johnston JC
- Subjects
- Humans, Canada, Tuberculosis epidemiology, Tuberculosis prevention & control
- Abstract
Competing Interests: Competing interests: None declared.
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- 2022
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41. High-dose rifamycins in the treatment of TB: a systematic review and meta-analysis.
- Author
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Arbiv OA, Kim JM, Yan M, Romanowski K, Campbell JR, Trajman A, Asadi L, Fregonese F, Winters N, Menzies D, and Johnston JC
- Subjects
- Humans, Prospective Studies, Drug Administration Schedule, Rifampin adverse effects, Neoplasm Recurrence, Local
- Abstract
Background: There is growing interest in using high-dose rifamycin (HDR) regimens in TB treatment, but the safety and efficacy of HDR regimens remain uncertain. We performed a systematic review and meta-analysis comparing HDR to standard-dose rifamycin (SDR) regimens., Methods: We searched MEDLINE, Embase, CENTRAL, Cochrane Database of Systematic Reviews and clinicaltrials.gov for prospective studies comparing daily therapy with HDRs to SDRs. Rifamycins included rifampicin, rifapentine and rifabutin. Our primary outcome was the rate of severe adverse events (SAEs), with secondary outcomes of death, all adverse events, SAE by organ and efficacy outcomes of 2-month culture conversion and relapse. This study was prospectively registered in the International Prospective Register of Systematic Reviews (CRD42020142519)., Results: We identified 9057 articles and included 13 studies with 6168 participants contributing 7930 person-years (PY) of follow-up (HDR: 3535 participants, 4387 PY; SDR: 2633 participants, 3543 PY). We found no significant difference in the pooled incidence rate ratio (IRR) of SAE between HDR and SDR (IRR 1.00, 95% CI 0.82 to 1.23, I
2 =41%). There was no significant difference when analysis was limited to SAE possibly, probably or likely medication-related (IRR 1.07, 95% CI 0.82 to 1.41, I2 =0%); studies with low risk of bias (IRR 0.98, 95% CI 0.79 to 1.20, I2 =44%); or studies using rifampicin (IRR 1.00, 95% CI 0. 0.75-1.32, I2 =38%). No significant differences were noted in pooled outcomes of death, 2-month culture conversion and relapse., Conclusions: HDRs were not associated with a significant difference in SAEs, 2-month culture conversion or death. Further studies are required to identify specific groups who may benefit from HDR., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2022
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42. A scoping review of interventions to mitigate common non-communicable diseases among people with TB.
- Author
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Romanowski K, Oravec A, Billingsley M, Shearer K, Gupte A, Huaman MA, Fox GJ, Golub JE, and Johnston JC
- Subjects
- Humans, Alcohol Drinking, Comorbidity, Counseling, Noncommunicable Diseases prevention & control, Substance-Related Disorders prevention & control, Tuberculosis epidemiology
- Abstract
BACKGROUND: Recommendations have been made to integrate screening for common non-communicable diseases (NCDs) within TB programs. However, we must ensure screening is tied to evidence-based interventions before scale-up. We aimed to map the existing evidence regarding interventions that address NCDs that most commonly affect people with TB. METHODS: We systematically searched PubMed, Medline, and Embase for studies that evaluated interventions to mitigate respiratory disease, cardiovascular disease, alcohol and substance use disorder, and mental health disorders among people with TB. We excluded studies that only screened for comorbidity but resulted in no further intervention. We also excluded studies focusing on smoking cessation interventions for which evidence-based guidelines are well established. RESULTS: The search identified 20 studies that met our inclusion criteria. The most commonly evaluated intervention was referral for diabetes care (6 studies). Other interventions included pulmonary rehabilitation (5 studies), care programs for alcohol use disorder (4 studies), and psychosocial support or individual counselling (5 studies). CONCLUSION: There is limited robust evidence to support identified interventions in changing individual outcomes, and a significant knowledge gap remains on the long-term durability of the interventions´ clinical benefit, reach, and effectiveness. Implementation research demonstrating feasibility and effectiveness is needed before scaling up.
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- 2022
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43. Costs of Tuberculosis at 3 Treatment Centers, Canada, 2010-2016.
- Author
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Campbell JR, Nsengiyumva P, Chiang LY, Jamieson F, Khadawardi H, Mah HK, Oxlade O, Rasberry H, Rea E, Romanowski K, Sabur NF, Sander B, Uppal A, Johnston JC, Schwartzman K, and Brode SK
- Subjects
- Antitubercular Agents therapeutic use, Canada epidemiology, Humans, Isoniazid therapeutic use, Retrospective Studies, Latent Tuberculosis drug therapy, Mycobacterium tuberculosis, Tuberculosis drug therapy, Tuberculosis epidemiology, Tuberculosis, Multidrug-Resistant drug therapy, Tuberculosis, Multidrug-Resistant epidemiology
- Abstract
We estimated costs of managing different forms of tuberculosis (TB) across Canada by conducting a retrospective chart review and cost assessment of patients treated for TB infection, drug-susceptible TB (DS TB), isoniazid-resistant TB, or multidrug-resistant TB (MDR TB) at 3 treatment centers. We included 90 patients each with TB infection and DS TB, 71 with isoniazid-resistant TB, and 62 with MDR TB. Median per-patient costs for TB infection (in 2020 Canadian dollars) were $804 (interquartile range [IQR] $587-$1,205), for DS TB $12,148 (IQR $4,388-$24,842), for isoniazid-resistant TB $19,319 (IQR $7,117-$41,318), and for MDR TB $119,014 (IQR $80,642-$164,015). Compared with costs for managing DS TB, costs were 11.1 (95% CI 9.1-14.3) times lower for TB infection, 1.7 (95% CI 1.3-2.1) times higher for isoniazid-resistant TB, and 8.1 (95% CI 6.1-10.6) times higher for MDR TB. Broadened TB infection treatment could avert high costs associated with managing TB disease.
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- 2022
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44. Meeting case investigation and contact tracing needs during COVID-19 in Alberta: the development and implementation of the Alberta Health Services Pod Partnership Model.
- Author
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Johnston JC, Strain KL, Dribnenki C, and Devolin M
- Subjects
- Alberta, Health Services, Humans, SARS-CoV-2, COVID-19, Contact Tracing
- Abstract
Setting: In Alberta, a small team of specialized public health experts typically complete case investigation and contact tracing. High COVID-19 case counts and a shortage of trained public health professionals required a rapid and significant adaptation of staffing models to meet the population's needs., Intervention: A tiered, interdisciplinary staffing model, based on those in critical care, was developed, piloted, and implemented in the Alberta Health Services' Communicable Disease Control department in late 2020 to complete case investigation and contact tracing. The final model included novice, non-regulated professionals divided into pods of four to six investigators, led by an experienced regulated investigator. Team leads oversaw five pods. Communicable disease nurses provided an additional tier of clinical expertise. During the model development, roles and responsibilities of team members were delineated, ratios for supervision were tested, and rapid training was provided., Outcomes: The tiered staffing model began in November 2020 with staff members in two pods. At its peak in early May 2021, 72 pods of 502 non-regulated members, 134 regulated investigators, and 4 communicable disease nurses completed 780-973 case investigations daily, or 40-45% of all positive cases in Alberta. In comparison, the same number of regulated investigators working independently in the traditional staffing model without non-regulated pods completed, on average, 249 case investigations daily., Implications: A tiered staffing model can be effective at maximizing the skills of the experienced members of the case investigation team to maintain case investigation and contact tracing activities during a pandemic., (© 2021. The Author(s) under exclusive license to The Canadian Public Health Association.)
- Published
- 2022
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45. Microclimate conditions alter Ixodes scapularis (Acari: Ixodidae) overwinter survival across climate gradients in Maine, United States.
- Author
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Volk MR, Lubelczyk CB, Johnston JC, Levesque DL, and Gardner AM
- Subjects
- Animals, Maine epidemiology, Microclimate, United States, Ixodes, Ixodidae, Lyme Disease epidemiology
- Abstract
The incidence and geographic range of vector-borne diseases have been expanding in recent decades, attributed in part to global climate change. Blacklegged ticks (Ixodes scapularis), the primary vector for multiple tick-borne pathogens in North America, are spreading rapidly beyond their historic post-colonial range and are thought to be constrained mainly by winter temperature at northern latitudes. Our research explored whether winter climate currently limits the distribution of blacklegged ticks and the pathogens they transmit in Maine, U.S.A., by contributing to overwinter mortality of nymphs. We experimentally tested tick overwinter survival across large-scale temperature and snowfall gradients and assessed factors contributing to winter mortality in locations where blacklegged tick populations are currently established and locations where the blacklegged tick has not yet been detected. We also tested the hypothesis that insulation in the tick microhabitat (i.e., by leaf litter and snowpack) can facilitate winter survival of blacklegged tick nymphs despite inhospitable ambient conditions. Overwinter survival was not significantly different in coastal southern compared to coastal and inland northern Maine, most likely due to sufficient snowpack that protected against low ambient temperatures at high latitudes. Snow cover and leaf litter contributed significantly to overwinter survival at sites in both southern and northern Maine. To further assess whether the current distribution of blacklegged ticks in Maine aligns with patterns of overwinter survival, we systematically searched for and collected ticks at seven sites along latitudinal and coastal-inland climate gradients across the state. We found higher densities of blacklegged ticks in coastal southern Maine (90.2 ticks/1000 m
2 ) than inland central Maine (17.8 ticks/1000 m2 ) and no blacklegged ticks in inland northern Maine. Our results suggest that overwinter survival is not the sole constraint on the blacklegged tick distribution even under extremely cold ambient conditions and additional mechanisms may limit the continued northward expansion of ticks., (Copyright © 2021. Published by Elsevier GmbH.)- Published
- 2022
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46. Risk of tuberculosis associated with chronic kidney disease: a population-based analysis.
- Author
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Yan M, Puyat JH, Shulha HP, Clark EG, Levin A, and Johnston JC
- Subjects
- Humans, Risk Factors, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic epidemiology, Tuberculosis complications, Tuberculosis epidemiology
- Published
- 2021
- Full Text
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47. Ethical challenges in the treatment of non-refugee migrants with tuberculosis in Canada.
- Author
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Silva DS, Cook VJ, Johnston JC, and Gardy J
- Subjects
- Canada, Delivery of Health Care, Health Services Accessibility, Humans, Refugees, Transients and Migrants, Tuberculosis drug therapy
- Abstract
While attention to the ethical issues that migrants face in accessing tuberculosis care has increased in the last few years, most of the attention has focused on challenges that refugees face when emigrating. Less attention has been given to ethical challenges that arise in the context of providing tuberculosis treatment and care to non-refugee migrants in high-income countries (HIC), particularly those that do not face immediate danger or violence. In this paper, we analyze some of the ethical challenges associated with treating migrants with tuberculosis in the Canadian context. In particular, we will discuss (i) inter- and intra-jurisdictional issues that challenge quotidian public health governance structures, and (ii) the ethical imperative for the Canadian government and its provinces to clearly differentiate access to healthcare from a person's immigration status to help overcome power imbalances that may exist between public health workers and their clients. The arguments presented herein could potentially apply to other HIC with some form of universal health coverage., (© The Author(s) 2020. Published by Oxford University Press on behalf of Faculty of Public Health.)
- Published
- 2021
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48. How Well Does TSTin3D Predict Risk of Active Tuberculosis in the Canadian Immigrant Population? An External Validation Study.
- Author
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Puyat JH, Shulha HP, Balshaw R, Campbell JR, Law S, Menzies R, and Johnston JC
- Subjects
- British Columbia, Humans, Interferon-gamma Release Tests, Tuberculin Test, Emigrants and Immigrants, Latent Tuberculosis diagnosis, Latent Tuberculosis epidemiology, Tuberculosis diagnosis, Tuberculosis epidemiology
- Abstract
Background: The online Tuberculin Skin Test/Interferon Gamma Release Assay (TST/IGRA) Interpreter V3.0 (TSTin3D), a tool for estimating the risk of active tuberculosis (TB) in individuals with latent TB infection (LTBI), has been in use for more than a decade, but its predictive performance has never been evaluated., Methods: People with a positive TST or IGRA result from 1985 to 2015 were identified using a health data linkage that involved migrants to British Columbia, Canada. Comorbid conditions at the time of LTBI testing were identified from physician claims, hospitalizations, vital statistics, outpatient prescriptions, and kidney and HIV databases. The risk of developing active TB within 2 and 5 years was estimated using TSTin3D. The discrimination and calibration of these estimates were evaluated., Results: A total of 37 163 individuals met study inclusion criteria; 10.4% were tested by IGRA. Generally, the TSTin3D algorithm assigned higher risks to demographic and clinical groups known to have higher active TB risks. Concordance estimates ranged from 0.66 to 0.68 in 2- and 5-year time frames. Comparing predicted to observed counts suggests that TSTin3D overestimates active TB risks and that overestimation increases over time (with relative bias of 3% and 12% in 2- and 5-year periods, respectively). Calibration plots also suggest that overestimation increases toward the upper end of the risk spectrum., Conclusions: TSTin3D can discriminate adequately between people who developed and did not develop active TB in this linked database of migrants with predominately positive skin tests. Further work is needed to improve TSTin3D's calibration., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
- Published
- 2021
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49. Tuberculosis-associated depression: a population-based cohort study of people immigrating to British Columbia, Canada, 1985-2015.
- Author
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Basham CA, Karim ME, Cook VJ, Patrick DM, and Johnston JC
- Subjects
- Adult, British Columbia epidemiology, Cohort Studies, Female, Humans, Male, Retrospective Studies, Risk Factors, Depression epidemiology, Tuberculosis epidemiology
- Abstract
Purpose: To estimate the risk of tuberculosis (TB)-associated depression. A second aim was to estimate the extent to which any increased risk of depression among TB patients may be mediated by the length of hospital length stay (LOS) METHODS: Retrospective cohort study of linked healthcare claims and public health surveillance data. Our primary outcome, time-to-depression, was analyzed using Cox proportional hazards (PH) regressions. Causal mediation analysis was used to estimate the natural direct and indirect effect of TB mediated by hospital LOS., Results: Among 755,836 participants (52.2% female, median age=35 years, median follow-up=8.75 years), 2295 were diagnosed with TB (exposure), and 128,963 were diagnosed with depression (outcome). We observed a covariate-adjusted hazard ratio (aHR) of 1.24 (95% CI, 1.14-1.34) for depression by TB. The total effect of TB on depression was decomposed into a natural direct effect of TB of aHR=1.11 (95% CI, 1.02-1.21) and an indirect effect through hospital LOS of aHR=1.11 (95% CI, 1.10-1.12), indicating that TB's total effect was mediated by 50% (95% CI, 35-82%) through hospital LOS., Conclusions: TB patients had a 24% higher risk of developing depression. TB's effect was mediated substantially by hospital LOS, requiring further study. Depression screening among TB patients is warranted., (Copyright © 2021 Elsevier Inc. All rights reserved.)
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- 2021
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50. Changes in pulmonary function and patient-reported outcomes during COVID-19 recovery: a longitudinal, prospective cohort study.
- Author
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Shah AS, Ryu MH, Hague CJ, Murphy DT, Johnston JC, Ryerson CJ, Carlsten C, and Wong AW
- Abstract
Objectives: The aim of this study was to compare respiratory and patient-reported outcome measures (PROMs) between 3 and 6 months after symptom onset and to identify features that predict these changes., Methods: This was a consecutive prospective cohort of 73 patients who were hospitalised with coronavirus disease 2019 (COVID-19). We evaluated the changes in pulmonary function tests and PROMs between 3 and 6 months and then investigated the associations between outcomes (change in diffusing capacity of the lung for carbon monoxide ( D
LCO ), dyspnoea and quality of life (QoL)) and clinical and radiological features., Results: There was improvement in forced vital capacity, total lung capacity and DLCO between 3 and 6 months by 3.25%, 3.82% and 5.69%, respectively; however, there was no difference in PROMs. Reticulation and total computed tomography (CT) scores were associated with lower DLCO % predicted at 6 months (coefficients; -8.7 and -5.3, respectively). The association between radiological scores and DLCO were modified by time, with the degree of association between ground glass and DLCO having decreased markedly over time. There was no association between other predictors and change in dyspnoea or QoL over time., Conclusions: There is improvement in pulmonary function measurements between 3 and 6 months after COVID-19 symptom onset; however, PROMs did not improve. A higher reticulation and total CT score are negatively associated with DLCO , but this association is attenuated over time. Lastly, there is a considerable proportion of patients with unexplained dyspnoea at 6 months, motivating further research to identify the underlying mechanisms., Competing Interests: Conflict of interest: A.S. Shah has nothing to disclose. Conflict of interest: M.H. Ryu has nothing to disclose. Conflict of interest: C.J. Hague has nothing to disclose. Conflict of interest: D.T. Murphy has nothing to disclose. Conflict of interest: J.C. Johnston has nothing to disclose. Conflict of interest: C.J. Ryerson has nothing to disclose. Conflict of interest: C. Carlsten has nothing to disclose. Conflict of interest: A.W. Wong has nothing to disclose., (Copyright ©The authors 2021.)- Published
- 2021
- Full Text
- View/download PDF
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