Provincial Ministries Of Health Research Articles

Public sector health analytics capacity before and after Covid-19: A case study of manager perspectives in New Brunswick, Canada

BackgroundDemand for health data and analytics to support research, policy, and practice continues to rise, accelerated by the Covid-19 pandemic. Despite the importance of the government analytics workforce in driving academic-based data sharing and linkage platforms, little is known about how public sector managers assess capacity in health analytics. This case study describes findings from consultations among middle managers of analytics services in a Canadian provincial health ministry. MethodsData collection involved a mixed-questions survey to gauge the functional perspective of managers on organisational and human resource analytics capacity within the New Brunswick Department of Health. The repeated cross-sectional survey was implemented in two rounds, with a baseline collected before the Covid-19 global outbreak (in 2016) and a follow-up after the pandemic emergency response (in 2022). ResultsThe post-pandemic period was associated with perceptions of a growing role for public service personnel in handling analytics. Recruitment and retention of skilled analytics professionals emerged as the top priority for capacity building, including needs-based planning, competitive compensation packages to address skills shortages, professional development and promotion opportunities, and tracking key performance indicators for employee satisfaction. ConclusionsGovernment health analytics professionals play a critical role in advancing administrative data use and re-use. Enhanced knowledge sharing is needed on best practices in supply--demand monitoring for analytics professionals and planning for human resources surge capacity in the public service, lest significant innovation potential for health system improvement be left untapped.

Provincial Intra-Action Review of the COVID-19 Vaccination Programme: Opportunities to Improve Vaccine Response in North Kivu, Democratic Republic of Congo.

Low levels of COVID-19 vaccination coverage in many countries prompted the use of rapid assessments to characterize barriers to vaccination and identify corrective measures. The World Health Organization recommended the use of intra-action reviews (IARs) to identify best practices, gaps, and lessons learned to make real-time improvements to the COVID-19 vaccination response. The Democratic Republic of the Congo (DRC) implemented a national IAR in July 2021 that was poorly attended by the provincial health level, where vaccination activities are planned and implemented. To bridge this gap, we proposed sub-national IARs focused on COVID-19 vaccine program implementation at the provincial level. Using the WHO methodology, we organized a four-day provincial IAR workshop and invited national, provincial and health zone Ministry of Health (MoH) representatives and private and non-governmental organizations involved in the provincial COVID-19 vaccination response. Participants were divided into six groups based on their expertise, affiliation, and role within the health system to assess and identify lessons learned, challenges and the solutions within each of the six technical areas: (1) coordination, planning and monitoring; (2) service delivery; (3) risk communication and community engagement; (4) adverse effects following immunization (AEFI); (5) logistics; (6) and data management, monitoring and evaluation. The first provincial COVID-19 IAR was conducted in Goma, North Kivu, from January 19-22, 2022. A total of 56 participants came from provincial and health zone offices, and non-governmental organizations. Through work group discussions, they identified best practices, challenges, and lessons learned, and made recommendations to improve implementation of vaccination activities and reach coverage targets. Activities were proposed to operationalize recommendations and address challenges to improve the provincial response. This provincial IAR was a useful tool for reviewing progress and areas of improvement, while evaluating aspects of the COVID-19 vaccine rollout. It provided a means to share information with vaccination partners on areas of intervention, tailored to the local context.

HUBUNGAN PERILAKU SISWA SEKOLAH DASAR DENGAN KEJADIAN DEMAM BERDARAH DENGUE (DBD) DI KECAMATAN DOLOK BATU NANGGAR KABUPATEN SIMALUNGUN TAHUN 2023

Dengue hemorrhagic fever is an infectious disease that can cause extraordinary events (KLB). Dengue Hemorrhagic Fever spreads in Southeast Asia. Western Pacific & Caribbean. Indonesia is an endemic region that has spread to all corners of the country. According to the North Sumatra Provincial Health Ministry, the number of dengue hemorrhagic fever (DHF) sufferers in the region between January and September 2022 was 5,270 cases. According to the Simalungun District Health Office, in December 2022 there were 999 cases of dengue fever and 13 deaths in Simalungun. The results of the initial study of student behavior are still not enough to eradicate mosquito nests (PSN). This type of research is a quantitative study with an analytic observation study design using cross-sectional methods. This research was conducted in the elementary school area 091690 Serbelawan. The population in this study were elementary school students in Dolok Batu Nanggar Elementary School. In this study the analysis used the chi-square or chi-square formula (x2). . The results showed that there was a relationship between the behavior of throwing garbage and the incidence of DHF at the level of p = 0.045, namely <α = 0.05. There is a relationship between the behavior of draining the bathtub and the incidence of DHF at the level of p = 0.020, namely <α = 0.05. There is no relationship between the use of anti-mosquito lotion and the incidence of DHF at the level of p=0.684, namely <α = 0.05. It is suggested to the head of the Puskesmas to develop health education about the dangers of dengue fever mosquitoes.

Assessing Canadian regulation of muscle-building supplements: Identifying gaps and recommendations for improvement to protect the health and well-being of young people

Muscle-building supplements are a vast group of dietary products purported to aid with muscle-building and performance enhancement. Legal muscle-building supplements, such as whey protein and creatine monohydrate, are commonly used among young people (i.e., adolescents and young adults ages 10–29 years), particularly boys and young men, and are correlated with many adverse health effects. In Canada, these products are regulated by the Natural Health Products Regulations. This policy analysis aimed to investigate current Canadian policy related to muscle-building supplements to identify key gaps that expose Canadians, particularly young people, to potential risks. Several gaps were identified, including an over-reliance on industry to provide accurate product and manufacturing site testing, no age restrictions on product purchasing and use, no warning labels on products related to known risks, and lack of regulatory control from individual provincial health ministries. Given the gaps, specific policy recommendations are provided to strengthen the current policy, reduce use, and minimize negative effects of use. There is an urgent need to strengthen Canadian regulations of muscle-building supplements to protect the health and well-being of young people.

Cost modelling incorporating procalcitonin for the risk stratification of febrile infants ≤60 days old.

Procalcitonin testing is recommended to discriminate febrile young infants at risk of serious bacterial infections (SBI). However, this test is not available in many clinical settings, limited largely by cost. This study sought to evaluate contemporary real-world costs associated with the usual care of febrile young infants, and estimate impact on clinical trajectory and costs when incorporating procalcitonin testing. We assessed hospital-level door-to-discharge costs of all well-appearing febrile infants aged ≤60 days, evaluated at a tertiary paediatric hospital between April/2016 and March/2019. Emergency Department and inpatient expense data for usual care were obtained from the institutional general ledger, validated by the provincial Ministry of Health. These costs were then incorporated into a probabilistic model of risk stratification for an equivalent simulated cohort, with the addition of procalcitonin. During the 3-year study period, 1168 index visits were included for analysis. Real-world median costs-per-infant were the following: $3266 (IQR $2468 to $4317, n=93) for hospitalized infants with SBIs; $2476 (IQR $1974 to $3236, n=530) for hospitalized infants without SBIs; $323 (IQR $286 to $393, n=538) for discharged infants without SBIs; and, $3879 (IQR $3263 to $5297, n=7) for discharged infants subsequently hospitalized for missed SBIs. Overall median cost-per-infant of usual care was $1555 (IQR $1244 to $2025), compared to a modelled cost of $1389 (IQR $1118 to $1797) with the addition of procalcitonin (10.7% overall cost savings; $1,816,733 versus $1,622,483). Under pessimistic and optimistic model assumptions, savings were 5.9% and 14.9%, respectively. Usual care of febrile young infants is variable and resource intensive. Increased access to procalcitonin testing could improve risk stratification at lower overall costs.

A 20-Year Review of the Ontario Radiation Therapy Access to Care Crisis: Lessons Applied to the COVID-19 Pandemic

Purpose/Objective(s)Cancer systems across Canada are struggling with an acute access to care crisis resulting from the COVID-19 pandemic. Policies are being considered and applied across the country to address the backlog of patients needing access to cancer services, including radiation therapy (RT). The purpose of this research was to assess the impact of central (provincial health ministry and cancer agency) and regional (cancer center) policies on access to RT in Ontario between 1997 and 2017, and consider their relevance to today's challenges.Materials/MethodsThe research design was a case study with multiple embedded units. The case was Cancer Care Ontario. The embedded units were four diverse regional cancer centers representing the 14 different Ontario cancer centers. Methods included a document review, longitudinal quantitative data collection, and 43 key informant interviews. The theoretical underpinning was an extension of Kingdon's Multiple Streams Framework, to examine the ‘problem’, ‘policy’ solutions and ‘politics’ surrounding the crisis.ResultsThe access to RT problem started as a wait time issue in the 1990s caused by inadequate RT facility capacity and a shortage of RT specialized staff, and evolved into a shortfall in RT utilization. Thirty-seven policies were identified and categorized as: improving existing RT capacity (n=5), system planning (n=7), performance management (n=6), human resources (HR, n=12), and building new RT capacities (n=7). Ten of the HR policies implemented to address recruitment and retention had mixed success because of implementation and political context issues. Many of these same policies are now being applied across Canada to address access to cancer services during the COVID-19 pandemic.ConclusionA 20-year case study of the Ontario RT access crisis in the 1990s, and the post-crisis periods, offer many useful learnings that can be applied to current policy challenges in access to care due to the ongoing pandemic.

Reaffirmed Guideline No. 343: Routine Non-Invasive Prenatal Prediction of Fetal RHD Genotype

<h2>ABSTRACT</h2><h3>Summary Statements</h3> <ul><li>1.Non-invasive antenatal determination of fetal RHD genotype by cellfree DNA is highly accurate with sensitivities above 99% and very few false-negative results (II-2).</li><li>2.While the risks of Rh immune globulin exposure are exceptionally low, it is no longer considered appropriate to treat all D-negative pregnant women with human plasma derivatives when there are no benefits to her or to the fetus in a substantial percentage of cases (II-2).</li><li>3.Implementation of non-invasive fetal RHD genotyping with targeted routine antenatal anti-D prophylaxis would enable up to 40% of D-negative women to avoid use of Rh immune globulin (II-2).</li><li>4.Fetal RHD genotyping is feasible as early as 10 weeks' gestation and earlier testing is preferable as it allows for targeted prophylaxis for women with sensitizing events prior to 28 weeks' gestation (II-2).</li><li>5.Implementation of non-invasive fetal RHD genotyping with selective prophylaxis requires interdisciplinary collaboration (clinical and laboratory) as well as the endorsement of provincial ministries of health (III).</li></ul> <h3>Recommendations</h3> <ul><li>1.The current optimal management of the D-negative pregnant woman is based on the prediction of the fetal D-blood group by cell-free DNA in maternal plasma with targeted antenatal anti-D prophylaxis. This approach should be adopted in Canada (II-2A).</li><li>2.While various algorithms of implementation of fetal RHD genotyping have been described, a model positioned in the first trimester appears to be most in alignment with the existing Canadian antenatal anti-D prophylaxis program and should be endorsed (II-2A).</li><li>3.While the risk of a false-negative result with RHD genotyping is very small and the benefits of knowing the fetal RHD status in terms of compliance with prophylaxis seem to outweigh the risks, the chance of immunization is not zero. Quality control at a laboratory and clinical level should be of utmost priority in program planning (II-3A).</li></ul>

Estimating surge in COVID-19 cases, hospital resources and PPE demand with the interactive and locally-informed COVID-19 Health System Capacity Planning Tool.

IntroductionThe COVID-19 pandemic revealed an urgent need for analytic tools to help health system leaders plan for surges in hospital capacity. Our objective was to develop a practical and locally informed Tool to help explore the effects of public health interventions on SARS-CoV-2 transmission and create scenarios to project potential surges in hospital admissions and resource demand.MethodsOur Excel-based Tool uses a modified S(usceptible)-E(xposed)-I(nfected)-R(emoved) model with vaccination to simulate the potential spread of COVID-19 cases in the community and subsequent demand for hospitalizations, intensive care unit beds, ventilators, health care workers, and personal protective equipment. With over 40+ customizable parameters, planners can adapt the Tool to their jurisdiction and changes in the pandemic.ResultsWe showcase the Tool using data for Ontario, Canada. Using healthcare utilization data to fit hospitalizations and ICU cases, we illustrate how public health interventions influenced the COVID-19 reproduction number and case counts. We also demonstrate the Tool’s ability to project a potential epidemic trajectory and subsequent demand for hospital resources. Using local data, we built three planning scenarios for Ontario for a 3-month period. Our worst-case scenario accurately projected the surge in critical care demand that overwhelmed hospital capacity in Ontario during Spring 2021.ConclusionsOur Tool can help different levels of health authorities plan their response to the pandemic. The main differentiators between this Tool and other existing tools include its ease of use, ability to build scenarios, and that it provides immediate outcomes that are ready to share with executive decision makers. The Tool is used by provincial health ministries, public health departments, and hospitals to make operational decisions and communicate possible scenarios to the public. The Tool provides educational value for the healthcare community and can be adapted for existing and emerging diseases.

Diversity among health care leaders in Canada: a cross-sectional study of perceived gender and race.

Background:Diverse health care leadership teams may improve health care experiences and outcomes for patients. We sought to explore the race and gender of hospital and health ministry executives in Canada and compare their diversity with that of the populations they serve.Methods:This cross-sectional study included leaders of Canada’s largest hospitals and all provincial and territorial health ministries. We included individuals listed on institutional websites as part of the leadership team if a name and photo were available. Six reviewers coded and analyzed the perceived race and gender of leaders, in duplicate. We compared the proportion of racialized health care leaders with the race demographics of the general population from the 2016 Canadian Census.Results:We included 3056 leaders from 135 institutions, with reviewer concordance on gender for 3022 leaders and on race for 2946 leaders. Reviewers perceived 37 (47.4%) of 78 health ministry leaders as women, and fewer than 5 (< 7%) of 80 as racialized. In Alberta, Saskatchewan, Prince Edward Island and Nova Scotia, provinces with a centralized hospital executive team, reviewers coded 36 (50.0%) of 72 leaders as women and 5 (7.1%) of 70 as racialized. In British Columbia, New Brunswick and Newfoundland and Labrador, provinces with hospital leadership by region, reviewers perceived 120 (56.1%) of 214 leaders as women and 24 (11.5%) of 209 as racialized. In Manitoba, Ontario and Quebec, where leadership teams exist at each hospital, reviewers perceived 1326 (49.9%) of 2658 leaders as women and 243 (9.2%) of 2633 as racialized. We calculated the representation gap between racialized executives and the racialized population as 14.5% for British Columbia, 27.5% for Manitoba, 20.7% for Ontario, 12.4% for Quebec, 7.6% for New Brunswick, 7.3% for Prince Edward Island and 11.6% for Newfoundland and Labrador.Interpretation:In a study of more than 3000 health care leaders in Canada, gender parity was present, but racialized executives were substantially under-represented. This work should prompt health care institutions to increase racial diversity in leadership.

Genetic testing for amyotrophic lateral sclerosis in Canada – an assessment of current practices

Objective: To understand current genetic testing practices at Canadian ALS clinics. Methods: An online survey and phone interviews, with clinicians practicing in 27 ALS clinics in Canada, were employed to collect data. Quantitative and qualitative analyses were conducted. Results: Ninety-three percent (25/27) of ALS clinics in Canada are routinely ordering genetic testing for familial ALS, while 33% (9/27) of clinics are routinely ordering genetic testing for sporadic ALS. Barriers to genetic testing include a perceived lack of an impact on treatment plan, difficulty in obtaining approvals, primarily from provincial Ministries of Health, and limited access to genetic counseling. Predictive testing practices were found to be the most variable across the country. The average wait time for a symptomatic patient living with ALS to see a genetic counselor in Canada is 10 months (range 0–36 months). Conclusions: Access to genetic testing, and testing practices, vary greatly across Canadian ALS clinics. There may be patients with a monogenetic etiology to their ALS who are not being identified given that genetic testing for patients diagnosed with ALS is not routinely performed at all clinics. This study highlights potential inequities for patients with ALS that can arise from variability in health care delivery across jurisdictions, in a federally-funded, but provincially-regulated, health care system. Clinical trials for both symptomatic ALS patients and pre-symptomatic ALS gene carriers are ongoing, and ALS clinicians in Canada are motivated to improve access to genetic testing for ALS.

Establishing a Provincial Registry for Recurrent Prostate Cancer: Providing Access to PSMA PET/CT in Ontario, Canada.

Prostate Specific Membrane Antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is becoming established as a standard of care for the (re)staging of high-risk primary and prostate cancer recurrence after primary therapy. Despite the favorable performance of this imaging modality with high accuracy in disease detection, the availability of PSMA PET/CT varies across jurisdictions worldwide due to variability in the selection of PSMA PET/CT agent, regulatory approvals and funding. In Canada, PSMA based radiopharmaceuticals are still considered investigational new drug (IND), creating limitations in the deployment of these promising imaging agents. While regulatory approval rests with Health Canada, as a single payer health system, funding for Health Canada approved drugs and devices is decided by Provincial Health Ministries. Ontario Health (Cancer Care Ontario) (OH-CCO) is the agency of the Ministry of Health (MOH) in Ontario responsible for making recommendations to the MOH around the organization and funding of cancer services within Ontario (population of 15 million), and the PET Steering Committee of OH-CCO is responsible for providing recommendations on the introduction of new PET radiopharmaceuticals and indications. For Health Canada approved PET radiopharmaceuticals like 18F-FDG, OH-CCO (on behalf of the MOH) provides coverage based on levels of evidence and specific PET Registries are established to aid in real-world evidence collection to inform OH-CCO regarding emerging PET applications. In the case of PSMA PET/CT, adapting this model to an IND PSMA PET/CT agent, 18F-DCFPyL, necessitated the creation of a hybrid Registry-Study model to leverage the existing OH-CCO Registry structure while respecting the need for a Health Canada Clinical Trials Application (CTA) for the deployment of this agent in the province. Within the first 2 years of the registry, over 1700 men have been imaged resulting in a change in management (compared to pre-PET management plans) in over half of the men imaged. In this article, we describe the organization and deployment of the PSMA PET/CT (PREP) Registry throughout the province to provide access for men with suspected prostate cancer recurrence along with key stakeholder perspectives and preliminary results.

Third wave of Covid -19 in Pakistan: New Variants with new travelers?

Coronavirus disease (Covid-19) caused by SARS-CoV-2 first experienced in Wuhan city, China during late December 2019, has now spread in 2019 countries and territories including Pakistan. According to World Health Organization (WHO), 125,425,270 confirmed cases with 2,756,679 deaths have been reported till date with highest positive cases encountered in USA followed by Brazil and India. Pakistan, a developing country in the Asia, faces a big challenge with Covid-19. In Pakistan, the first case of the Coronavirus disease (Covid-19) was reported on February 26, 2020 by Ministry of Health, Government of Pakistan in Karachi, Sindh. The positive cases reported from Pakistan had travel history from Iran, London and Syria. The rapid rise of the positive cases of Covid 19 in first wave in Pakistan is attributed to mishandling of the pilgrims coming from Iran through Taftan, one of Pakistan’s border crossings with Iran. Also, the students in China were returning back to Pakistan especially from the Wuhan, which is the site of the origin of the Covid-19.&#x0D; With the emergence of the Covid-19, multiple variants of the virus are circulating globally especially B117 virus which is considered more contagious. It is also categorized among Variant of Concern (VOC) by SARS-CoV-2 Interagency Group (SIG) developed Center for Disease Control and Prevention (CDC). After one year, the third wave of Covid-19 has rising throughout the country with maximum positive cases of UK variant of SARS-CoV-2. The first case of the Covid-19 with UK strain reported in Pakistan on December 28, 2020 from passengers returning back to Pakistan from United Kingdom. At least three Covid-19 cases were detected among returnees from the UK, in the southern port city of Karachi, as reported by the provincial Health Ministry of Pakistan. The UK strain cases were mostly being found among people returning from abroad. The current outbreak of cases is centred around Punjab province, where the tested-positive rate was 17 % in the provincial capital Lahore and 15 % in Rawalpindi and Faisalabad, according to official data. Due to poor health infrastructure and slow vaccination administration in developing countries, there is ample need of policies re-examined especially for international travelling to find the loopholes contributing to next wave of Covid-19 in Pakistan.

Situation analysis for delivering integrated comprehensive sexual and reproductive health services for displaced population of Kasaï, Democratic Republic of Congo: Protocol for a mixed method study.

Delivering integrated sexual and reproductive health services (SRHS) in emergencies is important in order to save lives of the most vulnerable as well as to combat poverty, reduce inequities and social injustice. More than 60% of preventable maternal deaths occur in conflict areas and especially among the internally displaced persons (IDP). Between 2016 and 2018, unprecedented violence erupted in the Kasaï's region, in the Democratic Republic of Congo (DRC), called the Kamuina Nsapu Insurgency. During that period, an estimated three million of adolescent girls and women were forced to flee; and have faced growing threat to their health, safety, security, and well-being including significant sexual and reproductive health challenges. Between August 2016 and May 2017, the "Sous-Cluster sur les violences basées sur le genre (SC-VBG)" in DRC (2017) reported 1,429 Gender Based Violence (GBV) incidents in the 49 service delivery points in the provinces of Kasaï, Kasaï Central and Kasaï Oriental. Rape cases represented 79% of reported incidents whereas sexual assault and forced marriage accounted for respectively 11% and 4% of Gender Based Violence (GBV) among women and adolescent girls. This study aims to assess the availability of SRHS in the displaced camps in Kasaï; to evaluate the SRHS needs of young girls and women in the reproductive age (12-49). Studies of sexual and reproductive health (SRH) in the Democratic Republic of Congo (DRC) have often included adolescent girls under the age of 15 because of high prevalence of child marriage and early onset of childbearing, especially in the humanitarian context. According to the 2013 Demographic and Health Survey (DHS), about 16% of surveyed women got married by age 14 while the prevalence of early child marriage (marriage by 15) was estimated at 30%; to assess the use of SRHS services and identify barriers as well as challenges for SRH service delivery and use. Findings from this study will help provide evidence to inform towards more needs-based and responsive SRH service delivery. This is hoped for ultimately improve the quality and effectiveness of services, when considering service delivery and response in humanitarian settings. We will conduct a mixed-methods study design, which will combine quantitative and qualitative approaches. Based on the estimation of the sample size, quantitative data will be drawn from the community-based survey (500 women of reproductive age per site) and health facility assessments will include assessments of 45 health facilities and 135 health providers' interviews. Qualitative data will comprise materials from 30 Key Informant Interviews (KII) and 24 Focus Group Discussions (FGDs), which are believed to achieve the needed saturation levels. Data analysis will include thematic and content analysis for the KIIs and FGDs using ATLAS.ti software for the qualitative arm. For the quantitative arm, data analysis will combine frequency and bivariate chi-square analysis, coupled with multi-level regression models, using Stata 15 software. Statistic differences will be established at the significance level of 0.05. We submitted this protocol to the national ethical committee of the ministry of health in September 2019 and it was approved in January 2020. It needs further approval from the Scientific Oversee Committee (SOC) and the Provincial Ministry of Health. Prior to data collection, informed consents will be obtained from all respondents.

Sequential Use of Carfilzomib and Pomalidomide in Relapsed Multiple Myeloma: A Multi-Institutional Report from the Canadian Myeloma Research Group (CMRG) Database

Sequential Use of Carfilzomib and Pomalidomide in Relapsed Multiple Myeloma: A Multi-Institutional Report from the Canadian Myeloma Research Group (CMRG) Database

Wait-time reporting systems for elective surgery in Canada: a content analysis of provincial and territorial initiatives

In Canada, a substantial barrier to the accessibility of surgical procedures is wait times. The objective of this study was to develop and describe an inventory of wait-time reporting systems for elective surgical procedures. Between June and August 2019, we searched all Canadian provincial and territorial ministry of health websites to identify the wait-time reporting systems in place. We conducted content analysis and used a qualitative descriptive approach to compare the variables of interest across the provinces and territories. There were websites available for assessment in all 13 provinces and territories. Seven provinces have comprehensive, centralized wait-time reporting systems. The rest of the provinces have highly decentralized wait-time reporting, and the territories do not have wait-time reporting systems in place. There is substantial variation in the comprehensiveness, purpose, data sources and data collection methods among the wait-time reporting systems across the provinces and territories. Wait-time reporting for elective surgery in Canada is diverse, and it varies in comprehensiveness across the provinces and territories. The present findings can help direct future investigations of Canadian reporting systems, which would provide useful information for policy-makers and those interested in reducing wait times in Canada.

Factors associated with purchasing pesticide from shops for intentional self‐poisoning in Sri Lanka

In South Asia, up to one in five individuals who ingest pesticides for self-poisoning and survive purchased them from a shop immediately prior to the event. Thus far, no research has taken place to determine whether interventions implemented through the pesticide sellers might be acceptable or effective, despite the hundreds of thousands of such risk purchases each year. We aimed to investigate factors associated with purchasing pesticides for self-poisoning in Sri Lanka. We used a case-control study. Cases (n=50) were individuals who ingested pesticides after purchasing them for the act, and controls (n=200) were customers who bought pesticides but did not use them for self-harm. Logistic regression analysis was used to assess socio-demographic and purchase-specific risk factors. Alcohol intoxication (adjusted odds ratios [AOR] 36.5, 95% confidence intervals [CI] 1.7-783.4) and being a non-farmer AOR 13.3, 95% CI 1.8-99.6 were the main distinguishing factors when purchasing pesticides for self-poisoning. The positive predictive values were 93.3% (95% CI 68.0-99.8%) and 88.2% (95% CI 72.5-96.7%), respectively. One and/or other of these factors characterised 72.0% of cases but only 2.5% controls. While results need to be interpreted cautiously, sales restrictions to prevent alcohol-intoxicated persons and non-farmers purchasing pesticides for self-poisoning may be effective.

A24 RATE OF GASTROINTESTINAL ENDOSCOPY USE AND CONCOMITTANT ANESHESIOLOGY ASSISTANCE AND PREDICTORS OF ANESTHESIOLOGY ASSISTANCE: A POPULATION-BASED ANALYSIS

Abstract Background There are limited Canadian data on time trends of gastrointestinal endoscopy (GIE) use and concomitant anesthesiology assistance. Aims To test the time trends and variations in concomitant anesthesiology assistance during GIE in the central Canadian province of Manitoba. Methods Physicians claims reimbursement data from the provincial health ministry were used to ascertain upper &amp; lower GIE procedures and anesthesiology assistance annually from 1984 to 2016. The annual provincial population was determined from health insurance registration files. Generalized linear models with generalized estimating equations were used to test the linear trend over time and differences amongst age groups, health regions and income quintiles. Logistic regression analysis with generalized estimating equations was used to assess predictors of anesthesiology use. Results 410, 685 individuals had at least one procedure in the observation period. Approximately half of the procedures were performed outside the recommended CRC screening age group of 50–74 years, with 38% among those less than 50 years. The average annual rate of increase was 4.6% (95% CI 4.4–4.8%). The rate of increase stabilized among the &amp;gt; 75 years group over the last 5 years of the study. There were marked regional variation in GIE procedures, with the smallest increase in Winnipeg region (the largest urban region):2.9% (95%CI: 2.5–3.3) vs. 5.2% (95%CI: 4.8–5.6) in Southern Health; RR: 2.2(figure 1 A). There were no differences in GIE rates by income quintile. Similar patterns were seen in analysis stratified by upper and lower GIE. Concomitant anesthesiology use ranged from 1% in Winnipeg region to 80% in the southern rural region (figure 1B). In the logistic regression analysis, independent predictors of concomitant anesthesiology use in rural regions included younger age, female sex, lower income quintile, and higher comorbidities of patients, GP endoscopist, region of physician practice, and lower volume endoscopy physician. Conclusions Marked regional variations in GIE use and concomitant anesthesiology use were observed in a universal health care system. Efforts to standardize care are needed to reduce variations. Funding Agencies Manitoba Health

Cost effectiveness of in vitro fertilisation and preimplantation genetic testing to prevent transmission of BRCA1/2 mutations.

Is it cost-effective to use in vitro fertilisation and preimplantation genetic testing of monogenic defects (IVT/PGT-M) to prevent transmission of BRCA1/2 mutations to second-generation new births in comparison with naturally conceived births? In this cost-effectiveness analysis, we found that IVF/PGT-M is cost-effective for BRCA1 and BRCA2 mutation carriers if using a willingness to pay of $50 000 per quality-adjusted life-year (QALY). Carriers of a BRCA1 or BRCA2 mutation have a significantly increased risk of several types of cancer throughout their lifetime. The cost of risk reduction, screening and treatment of cancer in this population is high. In addition, there is a 50% chance of passing on this genetic mutation to each child. One option to avoid transmission of an inherited deleterious gene to one's offspring involves in vitro fertilisation with preimplantation genetic testing. We implemented a state transition model comparing the healthcare impact of a cohort of healthy children born after IVF/PGT-M, who have a population risk of developing cancer, to a cohort of naturally conceived live-births, half of whom are carriers of the BRCA mutation. Transition probabilities are based on published sources, a lifetime horizon and a perspective of a provincial Ministry of Health in Canada. The target population is the second-generation new births who have at least one parent with a known BRCA1 or BRCA2 mutation. At a willingness-to-pay threshold of $50 000 per QALY, IVF/PGT-M is a cost-effective intervention for carriers of either BRCA mutation. For BRCA1, the incremental cost-effectiveness ratio (ICER) for IVF/PGT-M is $14 242/QALY. For BRCA2, the ICER of intervention is $12 893/QALY. Probabilistic sensitivity analysis results show that IVF/PGT-M has a 98.4 and 97.3% chance of being cost-effective for BRCA1 and BRCA2 mutation carriers, respectively, at the $50 000/QALY threshold. Our model did not include the short-term negative effect of IVF/PGT-M on the woman's quality of life; in addition, our model did not consider any ethical issues related to post-implantation genetic testing. In countries in which the healthcare of a large segment of the population is covered by a single payer system such as the government, it would be cost-effective for that payer to cover the cost of IVF/PGT-M for couples in which one member has a BRCA mutation, in order to avoid the future costs and disutility of managing offspring with an inherited BRCA mutation. Dr Wong's research program was supported by the Canadian Institutes of Health Research (CIHR), the Natural Sciences and Engineering Research Council (NSERC), the Canadian Liver Foundation and an Ontario Ministry of Research, Innovation and Science Early Researcher Award. All authors declared no conflict of interests.

The cost of eliminating hepatitis C in Pakistan

The cost of eliminating hepatitis C in Pakistan

Global Dialysis Perspective: Canada.

Canada is a federation of ten provinces and three territories, and health care is primarily a provincial responsibility. The provinces, therefore, have substantial autonomy in health care delivery but are required to follow the basic tenets of the 1967 Canada Health Act as a condition for receiving essential health care transfer payments from the federal government. These conditions include the key requirement that all essential medical services have a single public payer, and therefore, no private insurance systems are allowed to fund such services. Therefore, neither dialysis providers nor physicians can directly charge patients for dialysis care, and conversely, patients cannot pay extra to see a particular nephrologist or attend a particular dialysis unit. This is uniquely restrictive compared with other countries (1). Health care funds come from provincial tax revenues and from federal transfer payments. Exclusively public funding does not exclude private provision of health care, and indeed, most Canadian physicians are self-employed and reimbursed “fee for service” by provincial governments. Hospital care is delivered by “not for profit” hospitals that are nominally independent, but they are funded by the provincial ministries of health (1). The delivery of maintenance dialysis services described here will be primarily on the basis of the model used in Ontario, the most populous province with 40% of the entire population. Key points of difference from other provinces will be noted however. Maintenance dialysis is almost entirely provided by Renal Programs based in “not for profit” government-funded hospitals. These range from large academic centers associated with medical schools to modest-sized community hospitals. These Renal Programs typically provide in-center hemodialysis (HD), home peritoneal dialysis (PD), and often, home hemodialysis (HHD) as well as outpatient and inpatient nephrology. Most academic Renal Programs have an associated kidney transplant unit. Many of the Renal Programs operate in …