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Emergency dispatch centres receive emergency calls and assign resources. Out-of-hospital cardiac arrests (OHCA) can be classified as appropriate (requiring emergent response) or inappropriate (requiring non-emergent response) for resuscitation. We sought to determine system accuracy in emergency medical services (EMS) OHCA response allocation.We analyzed EMS-assessed non-traumatic OHCA records from the British Columbia (BC) Cardiac Arrest registry (January 1, 2019-June 1, 2021), excluding EMS-witnessed cases. In BC the "Medical Priority Dispatch System" is used. We classified EMS dispatch as "emergent" or "non-emergent" and compared to the gold standard of whether EMS personnel decided treatment was appropriate upon scene arrival. We calculated sensitivity, specificity, and positive and negative predictive values (PPV, NPV), with 95% CI's.Of 15,371 non-traumatic OHCAs, the median age was 65 (inter quartile range 51-78), and 4834 (31%) were women; 7152 (47%) were EMS-treated, of whom 651 (9.1%) survived). Among EMS-treated cases 6923/7152 had an emergent response (sensitivity = 97%, 95% CI 96-97) and among EMS-untreated cases 3951/8219 had a non-emergent response (specificity = 48%, 95% CI, 47 to 49). Among cases with emergent dispatch, 6923/11191 were EMS-treated (PPV = 62%, 95% CI 61-62), and among those with non-emergent dispatch, 3951/4180 were EMS-untreated (NPV = 95%, 95% CI 94-95); 229/4180 (5.5%) with a non-emergent dispatch were treated by EMS.The dispatch system in BC has a high sensitivity and moderate specificity in sending the appropriate responses for OHCAs deemed appropriate for treatment by paramedics. Future research may address strategies to increase system specificity, and decrease the incidence of non-emergent dispatch to EMS-treated cases.

Background Limited studies have systematically reviewed the literature to identify and compare the various database methods and optimal thresholds for measuring medication adherence specific to adolescents and adults with asthma. In the present study, we aim to identify the methods and optimal thresholds for measuring medication adherence in population-based pharmacy databases. Methods We searched PubMed, Embase, International Pharmaceutical Abstracts (IPA), Web of Science, Google Scholar, and grey literature from January 1, 1998, to March 16, 2021. Two independent reviewers screened the studies, extracted the data, and assessed the quality of the studies. A quantitative knowledge synthesis was employed. Results Thirty-eight (38) retrospective cohort studies were eligible. This review identified 20 methods for measuring medication adherence in adolescent and adult asthma administrative health records. Two measures namely the medication possession ratio (MPR) and proportion of days covered (PDC) were commonly reported in 87% of the literature included in this study. From the meta-analysis, asthma patients who achieved adherence threshold of "0.75-1.00" [OR: 0.56, 95% CI: 0.41 to 0.77] and ">0.5" [OR: 0.71, 95% CI: 0.54 to 0.94] were less likely to experience asthma exacerbation. Conclusion Despite their limitations, the PDC and the MPR still remain the most common measures for assessing adherence in asthma pharmacy claim databases. The evidence synthesis showed that an adherence threshold of at least 0.75 is optimal for classifying adherent and non-adherent asthma patients.

The relationship between antibodies to wild-type severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigens and the risk of breakthrough infections is unclear, especially during circulation of the Omicron strain. We investigated the association of anti-spike and anti-receptor binding domain antibody levels and the risk of subsequent breakthrough coronavirus disease 2019 (COVID-19). We included adult paramedics from an observational cohort study who received ≥ 2 mRNA vaccines but did not have COVID-19 before the blood collection. Higher postvaccination antibody levels to wild-type SARS-CoV-2 antigens were associated with a reduced risk of COVID-19. Further research into clinical utility of antibody levels, to inform a threshold for protection and timing of boosters, should be prioritized.

Nucleocapsid serological assay sensitivity to identify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections among vaccinees and for Omicron cases is unclear. In this prospective study, the Elecsys nucleocapsid assay was 89% sensitive in identifying SARS-CoV-2 infections 14–607 days pre–blood collection. Sensitivity was similar when comparing by vaccination status, and in Omicron (vs pre-Omicron) cases.

Michael Asamoah-Boaheng,1 Jamie Farrell,1 Kwadwo Osei Bonsu,2 Alwell Oyet,3 William K Midodzi1 1Faculty of Medicine, Memorial University of Newfoundland, St John’s, NL, Canada; 2School of Pharmacy, Memorial University of Newfoundland, St John’s, NL, Canada; 3Department of Mathematics and Statistics, Memorial University of Newfoundland, St John’s, NL, CanadaCorrespondence: William K Midodzi, Faculty of Medicine, Memorial University of Newfoundland, St John’s, NL, Canada, Email william.midodzi@med.mun.caBackground: Poor adherence to prescribed asthma medications and risk of severe asthma exacerbations have been well established. However, the effects of changes in asthma medication compliance levels and subsequent risk of COPD is unknown and yet to be investigated. This study investigated the independent effect of medication adherence (MA) and asthma severity levels on the risk of COPD.Methods: We used four linked administrative health databases from the Population data BC to identify asthma patients aged 18 years and older between January 1, 1998 and December 31, 1999 without diagnosis of COPD. The primary event was time-to-COPD diagnosis during the follow-up period (January 1, 2000 to December 31, 2018). The proportion of days covered (PDC) – was used as a surrogate measure for medication adherence (MA) assessed at optimal-level (≥ 0.80), Intermediate-level (0.50– 0.79), and low-level (< 0.5) of adherence. A propensity adjusted analysis with Marginal Structural Cox (MSC) model was employed to estimate the adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) for the effect of medication adherence and asthma severity over time.Results: At cohort entry, the sample included 68,211 asthma patients with an overall mean age of 48.2 years. The 18-year incidence of COPD in asthma patients was 9.8 per 1000-persons year. In an inverse weighted propensity adjusted analysis of the MSC model, higher MA levels were significantly associated with decreased risk of COPD as follows: optimal-level (aHR: 0.19, 95% CI: 0.17– 0.24); Intermediate-level (aHR: 0.20, 95% CI: 0.18, 0.23) compared to the low-level adherence group. A significant increase in COPD risk was observed in severe asthma patients with low medication adherence (aHR: 1.72, 95% CI: 1.52– 1.93), independent of other patient factors.Conclusion: Optimal (≥ 0.80) and intermediate adherence (0.5 to 0.79) levels were associated with reduced risk of COPD incidence over time. Interventions aimed at improving adherence to prescribed medications in adult asthma patients should be intensified to reduce their risk of COPD.Keywords: asthma, COPD, medication adherence, severe asthma, propensity analysis

ObjectiveEmerging evidence indicates that longer SARS-CoV-2 vaccine dosing intervals results in an enhanced immune response. However, the optimal vaccine dosing interval for achieving maximum immunogenicity is unclear.MethodsThis study included samples from adult paramedics in Canada who received two doses of either BNT162b2 or mRNA-1273 vaccines and provided blood samples 6 months (170 to 190 days) after the first vaccine dose. The main exposure variable was vaccine dosing interval (days), categorized as “short” (first quartile), “moderate” (second quartile), “long” (third quartile), and “longest” interval (fourth quartile). The primary outcome was total spike antibody concentrations, measured using the Elecsys SARS-CoV-2 total antibody assay. Secondary outcomes included: spike and RBD IgG antibody concentrations, and inhibition of angiotensin-converting enzyme 2 (ACE-2) binding to wild-type spike protein and several different Delta variant spike proteins. We fit a multiple log-linear regression model to investigate the association between vaccine dosing intervals and the antibody concentrations.ResultsA total of 564 adult paramedics (mean age 40 years, SD=10) were included. Compared to “short interval” (≤30 days), higher dosing interval quartiles (moderate: 31-38 days; long: 39-73 days and longest: ≥74 days) were all associated with increased Elescys spike total antibody concentration. Compared to the short interval, “long” and “longest” interval quartiles were associated with higher spike and RBD IgG antibody concentrations. Similarly, increasing dosing intervals increased inhibition of ACE-2 binding to viral spike protein, regardless of the vaccine type.ConclusionIncreased mRNA vaccine dosing intervals longer than 30 days result in higher levels of circulating antibodies and viral neutralization when assessed at 6 months.

Asthma patients may have an increased risk for diagnosis of chronic obstructive pulmonary disease (COPD). However, risk factors accelerating time-to-COPD diagnosis are unclear. This study aims to estimate risk factors associated with the incidence of COPD diagnosis in asthma patients. Canada's Population Data BC (PopData BC) was used to identify asthma patients without prior COPD diagnosis between January 1, 1998, to December 31, 1999. Patients were assessed for time-to-incidence of COPD diagnosis from January 1, 2000, to December 31, 2018. The study estimated the effects of several risk factors in predicting the incidence of COPD in asthma patients during the 18-year follow-up period. Patient factors such as Medication Adherence (MA) were assessed by the proportion of days covered (PDC) and the medication possession ratio (MPR). The log-logistic mixed-effects accelerated failure time model was used to estimate the adjusted

SARS-CoV-2 represents an occupational risk to paramedics, who work in uncontrolled environments. We sought to identify the occupation-specific risk to paramedics by comparing their seroprevalence of SARS-CoV-2 infection-specific antibodies to that of blood donors in Canada.In this prospective cohort study, we performed serology testing (Elecsys Anti-SARS-CoV-2 nucleocapsid assay) on samples from paramedics and blood donors (January to July 2021) in Canada. Paramedic samples were compared to blood donor samples through 1:1-matched (based on age, sex, location, date of blood collection, and vaccination status) and raking weighted comparisons. We compared the seroprevalence with a risk difference (and 95% confidence interval [CI]) and performed secondary analyses within subgroups defined by vaccination status.The 1:1 match included 1,627 cases per group; in both groups, 723 (44%) were women, with a median age of 38. The raking weighted comparison included 1,713 paramedic samples and 19,515 blood donor samples, with similar characteristics. In the 1:1 match, the seroprevalence was similar (difference 1.2; 95% CI -0.20 to 2.7) between paramedics (5.2%) and blood donors (3.9%). The raking weighted comparison was consistent (difference 0.97; 95% CI -0.10 to 2.0). The unvaccinated paramedic samples, in comparison to the blood donor samples, demonstrated a higher seroprevalence in the 1:1 (difference 5.9; 95% CI 1.8 to 10) and weighted (difference 6.5; 95% CI 1.8 to 10) comparisons. Among vaccinated cases, the between-group seroprevalence was similar.Overall, paramedics demonstrated similar evidence of prior SARS-CoV-2 infection to that of blood donors. However, among unvaccinated individuals, evidence of prior infection was higher among paramedics compared to blood donors.

Objectives: To systematically analyze and summarize the literature on intimate partner violence (IPV) against HIV-positive women in sub-Saharan Africa (SSA) and to identify their risk factors for IPV. Method: A comprehensive review of the literature using the Preferred Reporting Item for Systematic Review and Meta-Analysis (PRISMA) and Meta-Analyses of Observational Studies in Epidemiology (MOOSE) yielded 1,879 articles (PubMed = 1,251, Embase = 491, Web of Science = 132, and identified additional records = 5). Twenty were selected for quantitative and qualitative assessment and synthesis. We employed a random effects model with generic inverse variance method and estimated the odds ratios. Findings: Results indicated a high prevalence of physical, sexual, and emotional violence against women living with HIV/AIDS in SSA. Educational background, alcohol use, marital status, previous experiences with IPV, and employment status were identified as significant risk factors. We also assessed the methodological quality of the articles by examining publication bias and some heterogeneity statistics. Conclusion: There is limited research on IPV against HIV-positive women in SSA. However, the few existing studies agree on the importance of targeting HIV-positive women with specific interventions given their vulnerability to IPV and to address factors exacerbating these risks and vulnerabilities.

Objective This review quantified prescriber adherence to opioid prescribing guidelines for chronic noncancer pain (CNCP). Method We searched CINAHL, Embase, MEDLINE, PsycINFO, the Cochrane Library, and the Joanna Briggs Institute EBP Database from inception until June 3, 2019. Studies that focused on provider adherence to opioids guidelines for CNCP in North America were eligible. Four reviewers screened studies, extracted data, and assessed study quality. Results Thirty-eight studies were eligible, comprising 17 cross-sectional studies (n = 11,835 providers) and 22 chart reviews (n = 22,512 patients). Survey data indicated that adherence was 49% (95% CI [40, 59]) for treatment agreements, 33% (95% CI [19%, 47%]) for urine drug testing, 48% (95% CI [26%, 71%]) for consultation with drug monitoring program, 57% (95% CI [35%, 79%]) for assessing risk of aberrant medication-taking behavior, and 61% (95% CI [35%, 87%]) for mental health screening. Chart review data indicated that the proportion of patients with documentation was 40% (95% CI [29, 51]) for treatment agreements, 41% (95% CI [32%, 50%]) for urine drug testing, 40% (95% CI [2%, 78%]) for consultation with drug monitoring program, 41% (95% CI [20%, 64%]) for assessing risk of aberrant medication-taking behavior, and 22% (95% CI [9%, 33%]) for mental health screening. Year of publication, practice guideline referenced, and risk of bias explained significant heterogeneity. No study evaluated whether nonadherence to recommendations reflected well-justified deviations to care. Conclusions Adherence to guideline recommendations for opioids for CNCP is low. It is unclear whether nonadherence reflects thoughtful deviations in care. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

This study is a systematic review of interventions to improve adherence to guideline recommendations for prescribing opioids for chronic noncancer pain.Investigators searched CINAHL, Embase, MEDLINE, PsycINFO, the Cochrane Library, and Joanna Briggs Institute Evid Based Pract database from inception until June 3, 2019. Interventional studies to improve adherence to recommendations made by opioid guidelines for chronic noncancer pain in North America were eligible if outcomes included adherence to guideline recommendations or change in quantity of opioids prescribed. Data were extracted independently and in duplicate. Quantitative synthesis was performed using random effects meta-analysis. Confidence in evidence was determined using the Grades of Recommendation, Assessment, Development, and Evaluation.A total of 20 studies (8 controlled and 12 prospective cohort) involving 1,491 providers and 72 clinics met inclusion. Interventions included education, audit and feedback, interprofessional support, shared decision making, and multifaceted strategies. Multifaceted interventions improved the use of urine drug testing (n=2, or =2.31, 95% CI=1.53, 3.49, z=3.98, p0.01; high-certainty evidence), treatment agreements (n=2, or =1.96, 95% CI=1.47, 2.61, z=4.56, p0.01; moderate-certainty evidence), and mental health screening (n=2, 2.57-fold, 95% CI=1.56, 4.24, z=2.32, p=0.02; low-certainty evidence) when prescribing opioids for chronic noncancer pain. Very low-certainty evidence suggests that several interventions improved the use of treatment agreements, urine drug testing, and prescription drug monitoring programs.Mostly very low-certainty evidence supports a number of interventions for improving adherence to risk management strategies when prescribing opioids for chronic noncancer pain; however, the effect on patient important outcomes (e.g., overdose, addiction, death) is uncertain.

This study investigates the immunogenicity of extended mRNA vaccine dosing intervals.

Background Whereas most studies have reported prior history/diagnosis of asthma as an independent risk factor for chronic obstructive pulmonary disease (COPD) development in later life, no systematic review and meta-analysis has been conducted to synthesize these observational studies. The aim of this review is to investigate associations between prior history of asthma and later development of COPD. Methods We conducted a comprehensive search in PubMed, CINAHL and EMBASE for studies related to prior history of asthma and COPD diagnosis. Articles were screened for relevance by two independent reviewers. Methodological quality was independently assessed and data extracted for qualitative and quantitative review. We explored heterogeneity and performed a publication bias check. Results From the 1260 articles retrieved, 9 were included in the qualitative review and 7 in the meta-analysis. History of asthma was associated with developing COPD in later life (Inverse Variance Random-effects model, odds ratio: 7.87, 95% confidence interval: 5.40-11.45, p

Background Despite the fact that the rate of type 1 diabetes (T1D) is increasing worldwide, there exists a dearth of information on the disease in most sub-Saharan African countries. The goal of this study was to determine the enrolment trend of T1D using data compiled over 28 y from a teaching hospital in Kumasi, Ghana. Methods Information collected included sex, age at diagnosis and date of T1D diagnosis. We identified trends from 1992 to 2018, divided into 3 y intervals. Results From 1992 to 2018, 1717 individuals with T1D were enrolled in the diabetes clinic at the Komfo Anokye Teaching Hospital. The male:female ratio was 1:1.2. The number of individuals diagnosed with T1D decreased among the 10–19 y age group during the 1992–1994 period, followed by a progressive increase within the same age group during the subsequent period (from 35.4% in 1995–1997 to 63.2% in 2016–2018). There was a decline in the proportion of children 0–9 y of age diagnosed during the study period (from 5.1% in 1992–1994 to 3.6% in 2016–2018). Conclusions In our study population, a decreasing trend of T1D enrolments was observed in general while among adolescents an increasing trend was observed.

Background The prevalence and risk factors for diabetes in Ghana vary from location to location, yet no study has been conducted to quantitatively synthesize the available studies. Methods The authors conducted a comprehensive literature search in Medline (PubMed), Embase, Cinahl, Web of Science, Scopus, African journals and grey literature. Two reviewers screened the articles for relevance, identified and selected studies based on inclusion and exclusion criteria. Methodological quality was independently assessed, using two validated assessment-of-bias tools. We explored study heterogeneity and performed a publication bias check. Results This search yielded a total of 624 articles, of which 17 studies were finally selected for the qualitative review and 12 studies included in the meta-analysis. The overall prevalence of diabetes mellitus among adult Ghanaians was high at 6.46% (95% CI: 4.66-8.26%) based on the inverse-variance random-effects model. Significant risk factors associated with diabetes were a family history of diabetes (OR: 3.46, 95% CI: 2.50-4.78), physical inactivity (OR: 3.06, 95% CI: 1.66-5.64) and age ≥40 years (OR: 2.36, 95% CI: 1.77-3.16). Conclusion Studies with high methodological quality provided sufficient evidence about diabetes prevalence among adults and the associated significant risk factors in Ghana.

Background Type 2 diabetes affects an increasing number of Ghanaians. The timing of the onset of diabetes is linked to several other co-morbid conditions, yet no study has examined the timing of the onset of type 2 diabetes in Ghana. Methods To fill this gap in the literature, this study applied logit models to data extracted from the medical records at the Diabetes Clinic of the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Gender-specific models were also estimated. Results The results show that obesity was a significant predictor of the timing of the first onset of diabetes among both males and females. Women with high school education compared with no formal education, and female employees compared with the unemployed were more likely to experience an early onset of type 2 diabetes. Conclusion Policymakers must educate Ghanaians about behaviors that will reduce their risk of obesity and diabetes.

In this study the performance of Minimum Expected Cost of Misclassification method (MECM) and Quadratic Discriminant Function approach (QDF) were compared and evaluated for the case of equal mean discrimination under unequal misclassification cost. 30 pairs of Female liked sex twins extracted from Stocks (1933) ten (10) variate data on 832 twin children was used for evaluation. Discriminant functions were derived under each of the following misclassification cost ratios; 1: 1, 1: 2, 1: 3 and 1: 4 and their error rate estimates determined using the Cross Validation (CV) and Balanced Error Rate (BER) methods. Least Mean error rates were recorded under QDF method as compared to that of MECM. The error rate estimates showed the QDF outperforming the MECM in the provision of maximum separation between the two groups. Also the two classification rules were found to be sensitive to misclassification cost ratios exceeding 1:2.

This study investigates the asymptotic performance of the quadratic discriminant function (QDF) under skewed training samples. The main objective of this study is to evaluate the performance of the QDF under skewed distribution considering different sample size ratios, varying the group centroid separators and the number of variables. Three populations \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$(\pi _i, i=1, 2, 3)$$\end{document}(πi,i=1,2,3) with increasing group centroid separator function were considered. A multivariate normal distributed data was simulated with MatLab R2009a. There was an increase in the average error rates of the sample size ratios 1:2:2 and 1:2:3 as the total sample size increased asymptotically in the skewed distribution when the centroid separator increased from 1 to 3. The QDF under the skewed distribution performed better for the sample size ratio 1:1:1 as compared to the other sampling ratios and under centroid separator \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$(\delta =5).$$\end{document}(δ=5).

This study investigates the asymptotic performance of the Quadratic Discriminant Function (QDF) under correlated and uncorrelated normal training samples. This paper specifically examines the effect of correlation, uncorrelation considering different sample size ratios, number of variables and varying group centroid separators (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\delta$$\end{document}δ, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\delta = 1; 2; 3; 4; 5$$\end{document}δ=1;2;3;4;5) on classification accuracy of the QDF using simulated data from three populations (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\pi _{i}, i=1,2,3$$\end{document}πi,i=1,2,3). The three populations differs with respect to their mean vector and covariance matrices. The results show the correlated normal distribution exhibits high coefficient of variation as \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\delta$$\end{document}δ increased. The QDF performed better when the training samples were correlated than when they were under uncorrelated normal distribution. The QDF performed better resulting in the reduction in misclassification error rates as group centroid separator increases with non increasing sample size under correlated training samples.

In this study the characterisation and separation/discrimination of three sheep breeds (crosses, West African Dwarfs (WAD) and West African Long Legged (WALL)] based on their physical traits (morphological characterisation) was investigated extensively with the application of discriminant analysis. The study’s main objective was specifically based on developing a variable selection criterion that can discriminate best among the three sheep breeds and as well as obtain a reliable mathematical function/equation (discriminant functions) for provision of maximum separation among the three known sheep breeds. Data from College of Education, Mampong animal farms on various breeds of sheep (hybrid/crossed breed, Sahell/WALL and Djallonke/WAD) was used. Factor Analysis was employed as a variable selection criterion for selecting six sheep traits that can discriminate best among the sheep breeds. Canonical discriminant function was derived for the eight variable data set and was compared with the derived quadratic discriminant functions (QDFs) using the six extracted sheep traits. The six variable QDF distance classifier provided maximum separation after cross validation than the 8-variable canonical discriminant functions. The derived mathematical functions (QDFs) were able to provide maximum separation among the three known sheep breeds with a correct classification rate of 0.86.