Alberta Population Research Articles

Whole‐Genome Evaluation of Genetic Rescue: The Case of a Curiously Isolated and Endangered Butterfly

ABSTRACTGenetic rescue, or the translocation of individuals among populations to augment gene flow, can help ameliorate inbreeding depression and loss of adaptive potential in small and isolated populations. Genetic rescue is currently under consideration for an endangered butterfly in Canada, the Half‐moon Hairstreak (Satyrium semiluna). A small, unique population persists in Waterton Lakes National Park, Alberta, isolated from other populations by more than 400 km. However, whether genetic rescue would actually be helpful has not been evaluated. Here, we generate the first chromosome‐level genome assembly and whole‐genome resequence data for the species. We find that the Alberta population maintains extremely low genetic diversity and is genetically very divergent from the nearest populations in British Columbia and Montana. Runs of homozygosity suggest this is due to a long history of inbreeding, and coalescent analyses show that the population has been small and isolated, yet stable, for up to 40k years. When a population like this maintains its viability despite inbreeding and low genetic diversity, it has likely undergone purging of deleterious recessive alleles and could be threatened by the reintroduction of such alleles via genetic rescue. Ecological niche modelling indicates that the Alberta population also exhibits environmental associations that are atypical of the species. Together, these evolutionary and ecological divergences suggest that population crosses may result in outbreeding depression. We therefore infer that genetic rescue has a relatively unique potential to be harmful rather than helpful for this population at present. However, because of its reduced adaptive potential, the Alberta population may still benefit from future genetic rescue as climate and habitat conditions change. Proactive experimental population crosses should therefore be completed to assess reproductive compatibility and progeny fitness.

Arising amitraz and pyrethroids resistance mutations in the ectoparasitic Varroa destructor mite in Canada

The ectoparasitic mite Varroa destructor remains a great threat for the beekeeping industry, for example contributing to excessive winter colony loss in Canada. For decades, beekeepers have sequentially used the registered synthetic varroacides tau-fluvalinate, coumaphos, amitraz, and flumethrin, leading to the risk of resistance evolution in the mites. In addition to the widespread resistance to coumaphos and pyrethroids, a decline in amitraz efficacy has recently been reported in numerous beekeeping regions in Canada. The goals of this study were to assess the evolution of resistance to amitraz in Canadian mite populations and to evaluate the presence and incidence of mutations previously associated with resistance to amitraz and pyrethroids in V. destructor. Our bioassay results confirmed the presence of amitraz-resistant mites in the population of Alberta. These phenotypic results were complemented by targeted genotyping of the octopamine receptor gene Octβ2R which revealed the presence of the mutation Y215H in 90% of tested apiaries with local allele frequencies ranging from 5 to 95%. The phenotypic resistance showed a significant correlation with the presence of this mutation across apiaries. In parallel, the L925I and L925M mutations in the voltage-gated sodium channel were identified in 100% of the tested apiaries with frequencies ranging from 33 to 97%, suggesting that resistance to pyrethroids remains widespread. These results support the notion that the practice of relying on a single treatment for a prolonged period can increase rates of resistance to current varroacides. Our findings suggest the need for large-scale resistance monitoring via genotyping to provide timely information to beekeepers and regulators. This will enable them to make an effective management plan, including rotation of available treatments to suppress or at least delay the evolution of resistance in V. destructor populations.

Using Patient-Reported Outcomes in Two Program Examples Measuring Health Status in Primary Care: An Observational Study.

Patient-reported outcome measures (PROMs) are increasingly used in primary care practices; however, the broad characteristics of this population pose unique challenges. Generic PROMs (e.g., EQ-5D-5L) measure general health status from the patient's perspective, contributing towards a comprehensive evaluation of health programming. This study describes the integration of the EQ-5D-5L within program evaluation in primary care in Alberta, Canada, using two program examples. A retrospective, longitudinal, observational design was used. The Edmonton O-day'min Primary Care Network (EOPCN) routinely collects the EQ-5D-5L in their exercise and active living and nutrition programs. Data collected between January 1, 2021 and March 31, 2022 was analyzed descriptively, by dimension, index, and visual analog scale (VAS) scores. Minimally important differences were used to interpret index (0.04) and VAS scores (7.0) and the Pareto Classification of Health Change was applied to the dimensions. Effect size of change in index and VAS scores and population comparisons were examined. In the exercise and active living program (n = 301), 72% were female with a mean age of 57 (±16) years, and 90.2% reported any problems (levels 2-5) in pain/discomfort. The mean index and VAS scores were 0.74 (±0.18) and 66.5 (±18.9), respectively. Among those with repeated measurement (n = 112), the greatest improvement was in usual activities (17%); the greatest deterioration was in pain/discomfort (25%). In the nutrition program (n = 573), 71% were female with a mean age of 50 (±17) years, and 75.9% reported any problems in pain/discomfort. The mean index and VAS scores were 0.77 (±0.19) and 70.1 (±15.6), respectively. Among those with repeated measurement (n = 212), the greatest improvement was in anxiety/depression (16%); the greatest deterioration was in pain/discomfort (26%). In both, health status was lower than the general Alberta population norms. No baseline characteristics were found to be statistically significant. These results inform future programming, to help patient needs.

Measures of stimulant medications: A population-based study in Alberta, Canada

ObjectivesStimulants are a class of drugs approved for the treatment of attention-deficit hyperactivity disorder (ADHD) and narcolepsy. However, they are also often used “off-label” as adjunct therapies for the treatment of obesity and depression. The objective of this study is to summarize how stimulant use is globally measured in the literature and to explore rates of stimulant use in Alberta, Canada. MethodsA traditional narrative literature review was conducted to summarize global methods of stimulant assessment. Then using definitions guided by the literature and current regulatory bodies in Alberta, we conducted a series of descriptive analyses to assess how frequent stimulant use was in Alberta patients from 2019 to 2021: 1) number of dispenses by year; 2) average days of drug supply; 3) proportion of days covered (PDC); and 4) defined daily dose (DDDs). ResultsIn the literature review, the most frequently used measures of stimulant drug use were trends over time (prevalence), types of drug use, and dispensations of prescriptions. In all, there is a global trend of increased use of stimulants among both adults and children. In Alberta, 173,789 patients were prescribed stimulant medication in 2019–2021, representing approximately 4 % of the entire Alberta population. Overall, 61.1 % were between the ages of 10–34 and 46.8 % were female. The number of dispensations rose from 713,896 in 2019 to 973,930 in 2021 – with up to 43 % being lisdexamfetamine stimulant dispenses. ConclusionsAlthough stimulant use in AB was measured using similar trend estimates as the literature, there is a lack of research to support whether these measures are accurate and effective at the population-level. Future steps to standardize both medical and nonmedical use of prescription stimulants are warranted in efforts to fully quantify both benefits and risks associated with stimulant use.

Prescribing patterns and medications costs in patients on maintenance hemodialysis and peritoneal dialysis.

Polypharmacy is a significant clinical issue for patients on dialysis but has been incompletely studied. We investigated the prevalence and costs of polypharmacy in a population-based cohort of participants treated with hemodialysis (HD) or peritoneal dialysis (PD). We studied adults aged≥20 years in Alberta, Canada receiving maintenance HD or PD as of March 31, 2019. We characterized participants as users of 0-29 drug categories of interest and those aged≥65 as users/non-users of potentially inappropriate medications (PIM). We calculated the number of drug categories, daily pill burden, total annual cost, and annual cost per participant, and compared this to an age- and sex-matched cohort from the general Alberta population. Among 2248 participants (mean age 63 years; 39% female) on HD (n=1781) or PD (n=467), the median number of prescribed drug categories was 6 [interquartile range (IQR) 4, 8]; median daily pill burden was 8.0 (IQR 4.6, 12.6) pills/day, with 5% prescribed≥21.7 pills/day, and 16.5% prescribed≥15 pills/day. Twelve % were prescribed at least one drug that is contraindicated in kidney failure. The median annual per participant cost was ${\$}$3,831, totaling approximately ${\$}$11.6 million annually for all participants. When restricting to the 1063 participants aged≥65, the median number of PIM categories was 2 (IQR 1, 2), with a median PIM pill burden of 1.2 pills/day (IQR 0.5, 2.4). Compared to PD participants, HD participants had similar daily pill burden, higher use of PIM, and higher annual per participant cost. Pill burden and associated costs for participants on dialysis were more than 3-fold and 10-fold higher, respectively, compared to the matched participants from the general population. Participants on dialysis have markedly higher use of prescription medications and associated costs than the general population. Effective methods to de-prescribe in the dialysis population are needed.

Negative impact of comorbidities on all-cause mortality of patients with psoriasis is partially alleviated by biologic treatment: A real-world case-control study

BackgroundCardiovascular comorbidities are believed to cause higher mortality in psoriasis patients. Conversely, systemic therapy may improve overall survival. ObjectiveTo evaluate the impact of different comorbidities and therapy on mortality risk of psoriasis patients in the entire population of Alberta, Canada (population 4.37 million). MethodsCohorts of psoriasis cases (n=18,618) and controls (ambulatory patients matched 1:3 by by age, and sex) were retrieved from Alberta Health Services Data Repository of Reporting database within the period 2012-2019. Cases were stratified according to Charlson Comorbidity Index (CCI), and the type of therapy. ResultsMortality in psoriasis cohort was significantly higher than in the controls (median age of death 72.0 years vs 74.4 years, respectively). CCI and comorbidities were strong predictors of mortality, in particular drug induced liver injury (hazard ratio [HR] 1.8, affective bipolar disease, HR 1.6, and major cardiovascular diseases. Mortality was lower in patients treated with biologics (HR 0.54). LimitationsSome factors (psoriasis type and severity, response to treatment, smoking, alcohol intake) could not be measured. ConclusionsHepatic injury, psychiatric affective disorders and cardiovascular disease were major determinants of overall survival in psoriasis. Biologic therapy was associated with a reduced mortality risk.

The use of EQ-5D-5L as a patient-reported outcome measure in evaluating community rehabilitation services in Alberta, Canada

BackgroundThe purpose of this study was to describe the characteristics and health-related quality of life (HRQL) of patients accessing community rehabilitation services in Alberta, Canada, using routinely collected EQ-5D-5L data, and explore factors associated with the impact of these services.MethodsA retrospective, longitudinal, observational design was used. Patients completed the EQ-5D-5L and demographic questions at intake and end of rehabilitation care. Change in EQ-5D-5L dimensions from intake until end of rehabilitation was examined using the Pareto Classification of Health Change. Change scores were calculated for the EQ-5D-5L index, VAS, and total sum scores. Change groups in the EQ-5D-5L index and VAS scores, were defined by minimally important differences of 0.04 and 7.0, respectively. One level change was considered important for the total sum score. Effect size of the change in index, VAS, and total sum scores was also examined. Chi-squared tests were conducted to examine whether change in EQ-5D-5L varied by age, gender, region, and having anxiety/depression at intake.ResultsThree service programs were examined; pulmonary rehabilitation (n = 542), group-based community exercise (n = 463), and physiotherapy for bone and joint care (n = 391). At intake, HRQL in all programs was lower than that of the general Alberta population norms and improved by end of rehabilitation. The mean (SD) change in index, VAS, and total sum scores were 0.02 (0.13), 6.0 (18.3), and − 0.5 (2.4) in pulmonary rehabilitation, 0.06 (0.13), 6.6 (18.7), − 1.2 (2.4) in community exercise, and 0.13 (0.16), 1.2 (0.9), and − 2.8 (2.8) in physiotherapy, respectively. Based on change of the index score, 24% deteriorated, 38% improved, and 38% had no change in pulmonary rehabilitation; 17% deteriorated, 51% improved, and 32% had no change in community exercise; 5% deteriorated, 72% improved, and 23% had no change in physiotherapy. Similar trends were seen in the VAS and total sum scores. Older age, urban region, and having anxiety/depression at intake were associated with positive change in EQ-5D-5L.ConclusionsThe results of this study are intended to inform program/service level decisions by describing the characteristics and HRQL of patients accessing community rehabilitation, as well as the predictors of change in health status, which will help direct future program growth and service changes.

Defining opioid naïve and implications for monitoring opioid use: A population-based study in Alberta, Canada.

Reducing initial exposure of "opioid naïve" patients to opioids is a public health priority. Identifying opioid naïve patients is difficult, as numerous definitions are used. The objective is to summarize current definitions and evaluate their impact on opioid naïve measures in Alberta. An exploratory data analysis of the literature was conducted over the last 10 years to identify definitions commonly used in the literature to define opioid naïve. Then, using these definitions as a guide, we descriptively report the proportion of patients in Alberta between 2017 and 2021 who would be considered as opioid naïve using these definitions and all opioid dispensing data. Three categories of definitions were broadly identified: (1) no opioid use within the previous 30 days/6 months/1 year, based on dispensation date; (2) no opioid use based on dispensation date plus days of supply; and, (3) exclusion of codeine from Definitions 1 and 2. Applying these definitions to the Alberta population showed a very wide range in the proportion who would be considered as opioid naïve. Overall, 36.4% of Albertans (n = 1 551 075) had an opioid dispensation in 2017-2021. The average age was 46.6 ± 18.8 and 52.8% were female. The proportion of opioid naïve were most affected by the "opioid free" period, with 97.4%, 83.2%, and 65.6% being classified as opioid naïve using time windows from Definition 1 (30 days, 6 months, 1 year of no prior opioid use). Definitions 2 and 3 did not materially change the results. Further extending the "opioid free" period to 2 years showed only 35% were opioid naïve. The most convenient definition for "opioid naïve" was the use of an "opioid free" period. The choice of window would depend on how the information may be used to assistant in clinical decisions with longer windows more likely to reflect true opioid naïve patients. Irrespective of definition used, a large proportion of opioid users would be considered opioid naïve in Alberta.

Post-Operative Voiding Function after Total Laparoscopic Hysterectomy with Transvaginal Versus Transabdominal Morcellation

<h3>Study Objective</h3> To determine the rates of post-operative urinary retention (POUR) in patients who have undergone transvaginal and transabdominal morcellation for large multifibroid and adenomyotic uteri during a total laparoscopic hysterectomy. <h3>Design</h3> Retrospective, multi-centre, cohort study. <h3>Setting</h3> Multi-centre healthcare system serving Calgary and Southern Alberta population. <h3>Patients or Participants</h3> The patients of four high-volume minimally invasive gynecologists were included in this study. Women 18 years and older who underwent a total laparoscopic hysterectomy requiring morcellation between January 2015 to April 2021 were included. Those with pre-existing urinary retention were excluded. <h3>Interventions</h3> Retrospective observational cohort study. <h3>Measurements and Main Results</h3> POUR was defined as urinary retention requiring an indwelling or in-and-out catheter post-operatively prior to discharge. No difference in POUR was found between transvaginal (29/139, 20.9%) and transabdominal (12/56, 21.4%) morcellation. There were also no differences in time to first post-operative void (5.5±4.5h vs 5.75±3.25h), length of stay (23±5h vs 22±6h), post-operative UTI (5.1% vs 3.6%) or presentation to the emergency department for POUR post-discharge (1.4% vs 1.8%) for transvaginal and transabdominal morcellation, respectively. A trend towards increased complication rate at the time of morcellation (7% vs 0%) and urinary complaints at post-operative follow-up appointments (9.4% vs 0%) were noted in the vaginal morcellation group. <h3>Conclusion</h3> With respect to route of uterine morcellation, patients who undergo transvaginal and transabdominal approaches have similar rates of POUR. It is reasonable for surgeon preference to guide the decision about route of morcellation. Larger prospective trials are needed to further assess POUR and the potential increased complication rate and post-operative urinary complaints with transvaginal morcellation.

Cannabinoid hyperemesis syndrome in North America: evaluation of health burden and treatment prevalence.

Cannabinoid hyperemesis syndrome (CHS) is a poorly understood vomiting disorder associated with chronic cannabis use. To characterise patients experiencing CHS in North America and to obtain a population-based estimate of CHS treatment prevalence in Canada before and during the Covid-19 pandemic METHODS: Internet survey of 157 CHS sufferers in Canada and the United States. Administrative health databases for the province of Alberta (population 5 million) were accessed to measure emergency department (ED) visits for vomiting, with a concurrent diagnostic code for cannabis use. Three time periods of 1year were assessed: prior to recreational cannabis legalisation (2017-2018), after recreational legalisation (2018-2019) and during the first year of the Covid-19 pandemic (2020-2021). Problematic cannabis use (defined as a CUDIT-R score ≥8) was universal among the survey cohort, and 59% and 68% screening for moderate or worse anxiety or depression, respectively. The overall treatment prevalence of CHS across all ages increased from 15 ED visits per 100,000 population (95% CI, 14-17) prior to legalisation, to 21 (95% CI, 20-23) after legalisation, to 32 (95% CI, 31-35) during the beginning of the Covid-19 pandemic (p< 0.001). Treatment prevalence among chronic cannabis users was as high as 6 per 1000 in the 16-24 age group. Survey data suggest patients with CHS almost universally suffer from a cannabis use disorder, which has significant treatment implications. Treatment prevalence in the ED has increased substantially over a very short time period, with the highest rates seen during the Covid-19 pandemic.

Self-reported health-related quality of life of the general population in Alberta, Canada during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic has impacted various aspects of people’s life and wellbeing around the world. This study aimed to examine the impact of the COVID-19 pandemic on health-related quality of life (HRQL), measured by the EQ-5D-5L, amongst the general population in the province of Alberta, Canada, and explore whether the impact varied across population subgroups based on age, gender, and dwelling.MethodsData came from two waves of a repeated cross-sectional population-based survey, the COVID-19 Experiences and Impact Survey, administered by the Health Quality Council of Alberta. The first data collection (survey 1: n = 8790) was during May/June 2020 and the second (survey 2: n = 9263) during Oct 2020. We examined the comparability of weighted survey data and their representativeness to Alberta’s general population. We then explored between-survey differences in EQ-5D-5L index, EQ-VAS and dimension responses, and differences across subgroups within each survey. We compared HRQL of the pooled sample (survey 1&2) with the Alberta population norms data from the pre-pandemic period.ResultsMean EQ-5D-5L index and EQ-VAS scores were 0.81 (0.15) and 72.54 (18.57), and 0.82 (0.14) and 71.98 (18.96) in surveys 1 and 2, respectively. The anxiety/depression dimension had the most reported problems (survey 1: 69.5%, survey 2: 70.2%). Respondents aged 16–24 or 75 and older, who identified themselves as a woman, or residing in urban areas had significantly lower EQ-5D-5L index scores compared to their counterparts in both surveys. Between-survey differences were not substantially different. Comparing the pooled sample with the pre-pandemic Alberta population norms, EQ-5D-5L index scores (0.82 vs. 0.84) and EQ-VAS scores (72.26 vs. 77.40) were significantly lower, and respondents aged 16–44, women, or urban residents were more impacted. More problems were reported in the anxiety/depression (69.9% vs. 37.2%) and usual activities dimensions (40.5% vs. 26.0%) during the pandemic period, especially for respondents aged 16–44, women, and those residing in urban areas.ConclusionsLower HRQL was reported during the COVID-19 pandemic compared to pre-pandemic HRQL in this population, with anxiety/depression and usual activities affected the most. People who were younger, women, and residing in urban areas were most impacted. The government responses to COVID-19 policies during population outbreaks should consider the needs of Albertans in these particular groups.

Tracking Emergence and Spread of SARS-CoV-2 Omicron Variant in Large and Small Communities by Wastewater Monitoring in Alberta, Canada.

Wastewater monitoring of SARS-CoV-2 enables early detection and monitoring of the COVID-19 disease burden in communities and can track specific variants of concern. We determined proportions of the Omicron and Delta variants across 30 municipalities covering >75% of the province of Alberta (population 4.5 million), Canada, during November 2021–January 2022. Larger cities Calgary and Edmonton exhibited more rapid emergence of Omicron than did smaller and more remote municipalities. Notable exceptions were Banff, a small international resort town, and Fort McMurray, a medium-sized northern community that has many workers who fly in and out regularly. The integrated wastewater signal revealed that the Omicron variant represented close to 100% of SARS-CoV-2 burden by late December, before the peak in newly diagnosed clinical cases throughout Alberta in mid-January. These findings demonstrate that wastewater monitoring offers early and reliable population-level results for establishing the extent and spread of SARS-CoV-2 variants.

Demographic, tumor and treatment factors of oral/oropharyngeal cancer in Alberta, Canada

<h3>Introduction</h3> Oral and oropharyngeal cancers have high morbidity and mortality worldwide. Distinct differ- ences exist between oropharyngeal and oral cancers; the former increasing in incidence and the later decreas- ing. The aim of this study was to determine demographic profiles, tumor characteristics and treatment factors of oral/oropharyngeal cancer in the adult population of Alberta, Canada. <h3>Methods/materials</h3> Information regarding oral/oropharyngeal cancer incidence in Alberta residents older than 18 years from 2005-2017 was extracted from the Alberta Cancer Registry database. Demographic factors included gen- der, diagnosis age, diagnosis date, age at death, vital status, death cause and geographic zone diagnosis. Tumor factors included location/site, morphology, histologic grade and clinical stage. Treatment modality was examined. Descriptive statistics was done using SPSS. <h3>Results</h3> 4069 oral/oropharyngeal cancer cases were identified. The mean (SD) age at diagnosis was 62.1 (13.3) years. 53.5% of diagnoses were made between 46-65 years of age, and 68.5% of patients were male. The number of reported oral cancer cases increased from 231 in 2005 to 398 in 2017. Most common cancer sites were tonsil (20%), tongue (19.1%), and base of tongue (15.8%). 78.6% of tumors were squamous cell carcinoma and variants and 39.1% of tumors were moderately-differentiated. 55.7% of cases were diagnosed at stage IV. Most common initial treatments were surgery (63.1%) and radiation (57.6%). As of 2017, 54.3% of patients in the study were reported alive. The main oral cancer-related deaths occurred in patients with tongue (13.9%), base of tongue (9.2%) and tonsil (9.1%) cancers. <h3>Conclusions</h3> There was a higher incidence of oral cancer in older males. Diagnoses were made at advanced stages. Higher mortality was associated with locations/sites that are difficult to examine. These findings are similar to other jurisdictions and support the need for early detection through screening examinations, increased awareness of oral/oropharyngeal cancer and earlier access to care.

The impact of COVID-19 pandemic on health-related quality of life of adults visiting emergency departments and primary care settings in Alberta.

ObjectivesTo examine the impact of COVID-19 pandemic on health-related quality of life (HRQL) of adults visiting emergency departments (ED) and primary care (PC) settings in Alberta, Canada, and explore whether this impact varies across demographic subgroups.MethodsData from two repeated cross-sectional surveys that measured HRQL using EQ-5D-5L were used; “pre-COVID” Sept 2019–Feb 2020 (ED, N=5927; PC, N=317), “Wave-1” Mar 2020–Aug 2020 (ED, N=4781; PC, N=375), and “Wave-2” Sept 2020–Jan 2021 (ED, N=4443; PC, N=327).ResultsIn the ED sample, there were decrements in mild–extreme problems of 3.7% in mobility and 4.1% in usual activities from pre-COVID to wave 2. There were very minor changes in mild–extreme problems in self-care (decrement=1.3%), pain/discomfort (decrement=2.6%), and anxiety/depression (decrement=0.9%). In the PC sample, there were increases of 4.8% in mild–extreme pain/discomfort and 10.7% in anxiety/depression from pre-COVID to wave 2. Despite these changes, HRQL of both samples pre-COVID and during waves 1 and 2 was worse than that of the general Alberta population. There were no significant variations in the impact of COVID-19 pandemic on HRQL across age, sex, and income subgroups in the ED survey; however, such variations were observed in the PC survey whereby younger adults, females, and those with high income had the largest HRQL deteriorations.ConclusionThe impact of COVID-19 pandemic on HRQL was minimal in adults seeking ED care, but more pronounced in those seen in PC, especially in terms of mental health. Policies around COVID-19 should take into account the needs of certain groups of the population, especially women and young people.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00606-4.

Metabolic rate and critical thermal maximum CTmax estimates for westslope cutthroat trout, Oncorhynchus clarkii lewisi.

Global warming is changing the thermal habitat of cold-water freshwater fishes, which can lead to decreased fitness and survival and cause shifts in species distributions. The Alberta population of westslope cutthroat trout (Oncorhynchus clarkii lewisi) is listed as 'Threatened' under the Canadian Species at Risk Act. The major threats to the species are the alteration in habitat and water flow, competition and hybridization with non-native trout species and climate change. Here, we conducted (i) intermittent-flow respirometry experiments with adult native westslope cutthroat trout and non-native rainbow trout (Oncorhynchus mykiss) and (ii) critical thermal maximum experiments (CTmax ) with adult westslope cutthroat trout to obtain valuable input data for species distribution models. For both species, standard metabolic rate (SMR) was lower at 10°C compared to 15°C and westslope cutthroat trout had higher SMR than rainbow trout. Although there were inter-specific differences in SMR, forced aerobic scope (using a standardized chase protocol) was different at 10°C, but no significant differences were observed at 15°C because of relative smaller differences in maximum metabolic rate between the species. CTmax of westslope cutthroat trout acclimated to 10°C was 27.0 ± 0.8°C and agitation temperature was 25.2 ± 1.0°C. The results from this study will inform and parametrize cumulative effects assessments and bioenergetics habitat modelling for the recovery planning of the species.

Abstract 10590: Trends in Major Adverse Cardiac Events During the Covid-19 Pandemic in Alberta, Canada

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has impacted cardiovascular (CV) outcomes and care globally, although to date, limited data exist on the Canadian experience. This study aimed to describe trends in major adverse cardiovascular events (MACE)/procedures during the COVID-19 pandemic in the Province of Alberta, Canada. Methods: A repeated cross-sectional study design compared MACE from inpatient and emergency department visits among Albertan adults between March 15, 2019, and September 14, 2020. The Alberta population was 4.4 million in 2020 and all residents are part of a single payer healthcare system. The percent change between each MACE reported in the control (2019) and COVID-19 restriction periods (2020) were calculated. MACE were defined individually and as a primary composite outcome (CV death, acute coronary syndrome [ACS], ischemic stroke, or coronary revascularization procedures). These preliminary data are part of an ongoing study, measuring outcomes throughout the first year of the pandemic. Results: Compared to March-June 2019, primary MACE during the initial COVID-19 restriction period (March-June 2020) decreased by 15.6% (n=739 patients), and by 7.3% (n=342 patients) during June-September 2020, when COVID-19 restrictions were eased. Most individual MACE followed similar patterns with reduced reported events/procedures during the initial restriction period and an increase towards previous rates thereafter (Figure 1): CV death (17.7% vs 10.2%), ACS (19.1% vs 8.4%), coronary revascularization (17.0% vs 9.2%). The exception was ischemic stroke, which was not notably impacted by pandemic restrictions. Conclusions: Declines in MACE/procedures during the COVID-19 pandemic are suggestive of a substantial gap in patient management and healthcare-seeking behaviour that may have negative downstream implications. Ongoing analyses will further explore reported MACE up to one year after the pandemic began.

Phenotype and pathology of the dilated cardiomyopathy with ataxia syndrome in children.

The dilated cardiomyopathy with ataxia syndrome (DCMA) is an autosomal recessive mitochondrial disease caused by mutations in the DnaJ heat shock protein family (Hsp40) member C19 (DNAJC19) gene. DCMA or 3-methylglutaconic aciduria type V is globally rare, but the largest number of patients in the world is found in the Hutterite population of southern Alberta in Canada. We provide an update on phenotypic findings, natural history, pathological findings, and our clinical experience. We analyzed all available records for 43 patients diagnosed with DCMA between 2005 and 2015 at the Alberta Children's Hospital. All patients studied were Hutterite and homozygous for the causative DNAJC19 variant (c.130-1G>C, IVS3-1G>C) and had elevated levels of 3-methyglutaconic acid. We calculated a birth prevalence of 1.54 cases per 1000 total births in the Hutterite community. Children were small for gestational age at birth and frequently required supplemental nutrition (63%) or surgical placement of a gastrostomy tube (35%). Early mortality in this cohort was high (40%) at a median age of 13 months (range 4-294 months). Congenital anomalies were common as was dilated cardiomyopathy (50%), QT interval prolongation (83%), and developmental delay (95%). Tissue pathology was analyzed in a limited number of patients and demonstrated subendocardial fibrosis in the heart, macrovesicular steatosis and fibrosis in the liver, and structural abnormalities in mitochondria. This report provides clinical details for a cohort of children with DCMA and the first presentation of tissue pathology for this disorder. Despite sharing common genetic etiology and environment, the disease is highly heterogeneous for reasons that are not understood. DCMA is a clinically heterogeneous systemic mitochondrial disease with significant morbidity and mortality that is common in the Hutterite population of southern Alberta.

COVID-19 PANDEMIC INDUCED DISRUPTIONS IN TROPONIN AND LOW-DENSITY LIPOPROTEIN CHOLESTEROL LABORATORY TEST VOLUMES ACROSS ALBERTA

BACKGROUNDAtherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality in Canada and worldwide. Laboratory tests, including troponin and low-density lipoprotein cholesterol (LDL-C), are important biomarkers of ASCVD risk. The objective of this study was to investigate patterns of testing for troponin and LDL-C test volumes among Alberta residents during the coronavirus disease 2019 (COVID-19) pandemic.METHODS AND RESULTSA repeated cross-sectional study design captured population-level laboratory test volumes between March 15, 2019 and December 14, 2020. Three-month cross-sections were derived to report laboratory test volumes by different COVID-19 restriction periods during 2020-2021 and using 2019-2020 as a preceding control period. Percent change for troponin and LDL-C test volumes were calculated for both control and COVID-19 periods among adult (≥18 years of age) Alberta residents, and stratified by age (18-49, 50-65, 66-79, and ≥80 years), sex, and geographic zones (urban, rural). This preliminary data is part of an ongoing study for which further troponin and LDL-C test volumes will be available up until March 14, 2021 (representing one year of data throughout the COVID-19 pandemic). Among the Alberta population, 292,836 troponin and 794,789 LDL-C tests were captured between March 15, 2020 and December 14, 2020 (Figure 1). Testing patterns during the COVID-19 restriction period showed marked reduction in test volumes from the previous year. The initial cross-section of the COVID-19 period (March-June 2020) was characterized by the largest overall reduction with troponin test volumes decreasing 18% and LDL-C test volumes decreasing 63%, compared to the year prior. As restrictions eased in the summer months of 2020, testing volumes rebounded to near pre-pandemic volumes for both tests. However, in the fall of 2020, troponin tests decreased again (-15%). Within these drops in utilization, slightly larger relative declines were observed for troponin test volumes in women (-20%) and patients ≥80 years-old (-25%) and for LDL-C test volumes among urban residents (-64%), women (-67%) and patients aged 18-49 (-66%) and 50-65 (-65%) years (Table 1).CONCLUSIONThis study describes declines in troponin and LDL-C test volumes in the initial and second COVID-19 lockdown periods. Women had overall smaller total troponin and LDL-C test volumes and larger relative declines during the pandemic compared to men. The decrease in these ASCVD-related laboratory test volumes during the pandemic may have been accompanied by other important changes in indicators of healthcare utilization and associated clinical outcomes. Ongoing analyses will further explore the impact of the pandemic.

Emergency Department Pediatric Visits in Alberta for Cannabis After Legalization.

Canada legalized nonmedical cannabis possession and sale in October 2018. In the United States, state legalization has been tied to an increase in cannabis-related emergency department (ED) visits; however, little research exists on provincial changes in pediatric visits after nationwide legislation. We compared pre- and postlegalization trends in pediatric cannabis-related ED visits and presentation patterns in urban Alberta EDs. Retrospective National Ambulatory Care Reporting System data were queried for urban Alberta cannabis-related ED visits among patients aged <18 years from October 1, 2013, to February 29, 2020. Population subgroups included children (aged 0-11 years), younger adolescents (12 to 14 years), and older adolescents (15 to 17 years). We calculated interrupted time series, incident rate ratios (IRRs), and relative risk (RR) ratios to identify trend change. IRRs identified changes against growth-adjusted Alberta population, while RRs measured presentation pattern changes against prelegalization ED visits. Pediatric visit volume did not change postlegalization when accounting for preexisting volume trends. Unintentional ingestions increased in children (IRR: 1.77, 95% confidence interval [CI]: 1.42 to 2.20 and RR: 1.24, 95% CI: 1.05 to 1.47, respectively) and older adolescents (IRR: 1.36, 95% CI: 1.07 to 1.71 and RR: 1.48, 95% CI: 1.21 to 1.81, respectively). Presentation patterns remained similar, although older adolescent co-ingestant use decreased (RR: 0.77, 95% CI: 0.67 to 0.88), whereas hyperemesis cases increased (RR: 1.64, 95% CI: 1.13 to 2.37). Cannabis legalization has increased child and older adolescent unintentional cannabis ingestions, increasing child cannabis-related ED visits. Changes highlight need for public health interventions targeting pediatric exposures.

The Incidence and Prevalence of Cardiac Amyloidosis in a Large Community-Based Cohort in Alberta, Canada

BackgroundDespite the improved awareness of cardiac amyloidosis among clinicians, its incidence and prevalence is not well-described in a community setting. We sought to investigate the incidence and prevalence of cardiac amyloidosis in the community. Methods and ResultsIn the adult population of Alberta, we examined 3 cohorts: (1) probable cases of cardiac amyloidosis: the presence of physician-assigned diagnosis of amyloidosis (International Classification of Diseases [ICD]-10 code E85; ICD-9 277.3) and 1 or more health care encounter for heart failure (HF) (ICD-10 I50; ICD-9 428); (2) possible cardiac amyloidosis: the presence of clinical phenotypes suggestive of amyloidosis; and (3) a comparator HF cohort without amyloidosis. Between 2004 and 2018, 982 of the 145,329 patients with HF were identified as probable cardiac amyloidosis. During the same period, the incidence rates of probable cardiac amyloidosis increased from 1.38 to 3.69 per 100,000 person-years and the prevalence rates increased from 3.42 to 14.85 per 100,000 person-years (Ptrend < .0001). Patients with probable cardiac amyloidosis were more likely to be male, have a higher comorbidity burden, greater health care use, and poorer outcomes as compared with patients with HF without amyloidosis. A much larger group of patients was identified as possible cardiac amyloidosis (n = 46,255), with similar increase in prevalence from 2004 to 2018 (from 416 to 850 per 100,000 person-years). ConclusionsThe incidence and prevalence of cardiac amyloidosis has increased over the last decade. Given the advent of new therapies for cardiac amyloidosis and considering their high cost, it is imperative to devise strategies to screen, identify, and track patients with cardiac amyloidosis from administrative databases.