Adverse drug events (ADEs) are common in older people and contribute significantly to emergency d... more Adverse drug events (ADEs) are common in older people and contribute significantly to emergency department (ED) visits, unplanned hospitalisations, healthcare costs, morbidity and mortality. Many ADEs are avoidable if attention is directed towards identifying and preventing inappropriate drug use and undesirable drug combinations. Tools exist to identify potentially inappropriate prescribing (PIP) in clinical settings, but they are underused. Applying PIP assessment tools to population-wide health administrative data could provide an opportunity to assess the impact of PIP on individual patients as well as on the healthcare system. This would open new possibilities for interventions to monitor and optimise medication management on a broader, population-level scale. The aim of this study is to describe the occurrence of PIP in Ontario's older population (aged 65 years and older), and to assess the health outcomes and health system costs associated with PIP-more specifically, the ...
Liver biopsy remains the gold standard for the diagnosis of liver fibrosis, but its use as a diag... more Liver biopsy remains the gold standard for the diagnosis of liver fibrosis, but its use as a diagnostic tool is limited by its invasive nature and high cost. The aim of this study was to systematically review the cost-effectiveness of transient elastography (TE) with and without controlled attenuation parameter (CAP) for the diagnosis of liver fibrosis or steatosis in patients with hepatitis B, hepatitis C, alcoholic liver disease and non-alcoholic fatty liver disease. An economic literature search was performed. Eligibility criteria included systematic reviews, health technology assessments or economic evaluations of TE compared to liver biopsy and other non-invasive tests. After abstract screening, full-text reports of potentially relevant articles were assessed in duplicate. The methodological quality of the included studies was also appraised. The database search yielded 253 records; four cost-effectiveness and four cost-utility studies were included. The methodological quality of the included studies varies. High-quality cost-effectiveness studies not only suggested that TE is less costly but also less accurate than liver biopsy. The incremental cost-effectiveness ratio (ICER) of TE improves with a greater level of diagnostic accuracy and a higher degree of liver fibrosis. High-quality cost-utility studies indicated that TE is a cost-effective alternative to biopsy with ICER between $9000 and $14 000 per QALY for patients with hepatitis C. We did not find studies that assessed the cost-effectiveness of TE with CAP for the diagnosis of liver steatosis. Transient elastography is an economically attractive alternative to liver biopsy and other non-invasive diagnostic tests especially for patients with a higher degree of liver fibrosis.
Hibiscus sabdariffa is a medicinal plant widely used in several countries for a long time. Nowada... more Hibiscus sabdariffa is a medicinal plant widely used in several countries for a long time. Nowadays, a number of effects
including antihypertensive effect, prevention and treatment of urinary tract infection, anti-oxidation, and anti-atherosclerotic effect
have been reported. However, since the results from studies were inconclusive, a conclusion on whether Hibiscus sabdariffa
possesses such beneficial effects is highly needed. This study aimed to examine the efficacy and tolerability of Hibiscus
sabdariffa compared to other interventions in randomized controlled trials by means of a systematic review. We searched
studies and relevant information from Medline (1966-2006), Cumulative Index to Nursing Allied Health Literature (CINAHL)
(1982-2006), International Pharmaceutical Abstracts (IPA) (1970 – 2006), Current Content, Cochrane Library, and Thai Index
Medicus, bibliographies of retrieved articles and experts in the field.
There were 66 clinical trials examining effects of Hibiscus sabdariffa. We found five trials studying the efficacy of Roselle
on human; however, only two were randomized controlled trials. These two studies were included in our present study. The first
trial tested antihypertensive effect of the tea of dried calyx of Hibiscus sabdariffa compared with captopril (25 mg every 12
hours) in patients with mild to moderate hypertension. The study found no difference regarding efficacy and tolerability between
Hibiscus sabdariffa tea and captopril. The second study reported that at day 12 of the treatment, sour tea (the tea made from
Hibiscus sabdariffa) significantly reduced both systolic and diastolic blood when compared with baseline (P < 0.01). The two
studies included in this systematic review had a relatively low quality (Jadad’s score of 2 for both). In conclusion, the
antihypertensive effect of Hibiscus sabdariffa is somewhat evident but well conducted randomized controlled trials are highly
needed to confirm such antihypertensive effect, and to examine also its other clinical benefits
The Canadian Immigration and Refugee Protection Act of 2001 outlines conditions under which indiv... more The Canadian Immigration and Refugee Protection Act of 2001 outlines conditions under which individuals may be granted or denied admission to Canada. The Act stipulates that applications for residence will be rejected if their health is expected to generate excessive demand on Canadian health or social services. The purpose of this paper is to derive a statistical definition of excessive demand and to apply that threshold to persons with HIV who are seeking admission to Canada. The paper demonstrates that the current threshold used by Citizenship and Immigration Canada is much lower than the thresholds that may be derived statistically.
he Canadian Immigration and Refugee Protection Act (IRPA) of 2001 outlines the conditions under w... more he Canadian Immigration and Refugee Protection Act (IRPA) of 2001 outlines the conditions under which individuals may be granted or denied admission to Canada. The Act stipulates that applications for residence will be rejected if an applicant's health is likely to generate excessive demand on Canadian health or social services. The purpose of this paper is to assess the thresholds used to define excessive demand and to apply these thresholds to persons with HIV/AIDS. Three findings are reported: firstly, the current threshold for excessive demand is too low and a statistically more appropriate threshold is three-fold greater; secondly, there is an inverse relationship between HIV/AIDS disease progression and healthcare costs and finally, comparison of disease cost estimates to new thresholds for inadmissibility allows classification to depend on individual characteristics, including age, sex and health status, and the time horizon over which each applicant's projected demand is assessed.
International Journal of Culture and Mental Health, May 15, 2012
This study presents preliminary results on the level of mental health problems in a small communi... more This study presents preliminary results on the level of mental health problems in a small community of immigrants from Thailand. Data for the study were derived from a pilot survey of adult Thai immigrants living in the Greater Toronto Area in Canada. Survey data were collected from a non-probability sample of 145 adults between January and May 2009. Using a threshold of 5/6 for GHQ-28, about 14% of the sample was considered at risk for psychiatric disorder or mental health problems. Acculturative stress significantly increased risk of psychiatric disorder, whereas social support and mastery significantly lowered risk of psychiatric disorder. Participants working multiple jobs and renting an accommodation also had an increased risk of psychiatric disorder. Community-based intervention programmes that focus on developing social support and personal mastery among Thai immigrants are recommended.
Adverse drug events (ADEs) are common in older people and contribute significantly to emergency d... more Adverse drug events (ADEs) are common in older people and contribute significantly to emergency department (ED) visits, unplanned hospitalisations, healthcare costs, morbidity and mortality. Many ADEs are avoidable if attention is directed towards identifying and preventing inappropriate drug use and undesirable drug combinations. Tools exist to identify potentially inappropriate prescribing (PIP) in clinical settings, but they are underused. Applying PIP assessment tools to population-wide health administrative data could provide an opportunity to assess the impact of PIP on individual patients as well as on the healthcare system. This would open new possibilities for interventions to monitor and optimise medication management on a broader, population-level scale. The aim of this study is to describe the occurrence of PIP in Ontario's older population (aged 65 years and older), and to assess the health outcomes and health system costs associated with PIP-more specifically, the ...
Liver biopsy remains the gold standard for the diagnosis of liver fibrosis, but its use as a diag... more Liver biopsy remains the gold standard for the diagnosis of liver fibrosis, but its use as a diagnostic tool is limited by its invasive nature and high cost. The aim of this study was to systematically review the cost-effectiveness of transient elastography (TE) with and without controlled attenuation parameter (CAP) for the diagnosis of liver fibrosis or steatosis in patients with hepatitis B, hepatitis C, alcoholic liver disease and non-alcoholic fatty liver disease. An economic literature search was performed. Eligibility criteria included systematic reviews, health technology assessments or economic evaluations of TE compared to liver biopsy and other non-invasive tests. After abstract screening, full-text reports of potentially relevant articles were assessed in duplicate. The methodological quality of the included studies was also appraised. The database search yielded 253 records; four cost-effectiveness and four cost-utility studies were included. The methodological quality of the included studies varies. High-quality cost-effectiveness studies not only suggested that TE is less costly but also less accurate than liver biopsy. The incremental cost-effectiveness ratio (ICER) of TE improves with a greater level of diagnostic accuracy and a higher degree of liver fibrosis. High-quality cost-utility studies indicated that TE is a cost-effective alternative to biopsy with ICER between $9000 and $14 000 per QALY for patients with hepatitis C. We did not find studies that assessed the cost-effectiveness of TE with CAP for the diagnosis of liver steatosis. Transient elastography is an economically attractive alternative to liver biopsy and other non-invasive diagnostic tests especially for patients with a higher degree of liver fibrosis.
Hibiscus sabdariffa is a medicinal plant widely used in several countries for a long time. Nowada... more Hibiscus sabdariffa is a medicinal plant widely used in several countries for a long time. Nowadays, a number of effects
including antihypertensive effect, prevention and treatment of urinary tract infection, anti-oxidation, and anti-atherosclerotic effect
have been reported. However, since the results from studies were inconclusive, a conclusion on whether Hibiscus sabdariffa
possesses such beneficial effects is highly needed. This study aimed to examine the efficacy and tolerability of Hibiscus
sabdariffa compared to other interventions in randomized controlled trials by means of a systematic review. We searched
studies and relevant information from Medline (1966-2006), Cumulative Index to Nursing Allied Health Literature (CINAHL)
(1982-2006), International Pharmaceutical Abstracts (IPA) (1970 – 2006), Current Content, Cochrane Library, and Thai Index
Medicus, bibliographies of retrieved articles and experts in the field.
There were 66 clinical trials examining effects of Hibiscus sabdariffa. We found five trials studying the efficacy of Roselle
on human; however, only two were randomized controlled trials. These two studies were included in our present study. The first
trial tested antihypertensive effect of the tea of dried calyx of Hibiscus sabdariffa compared with captopril (25 mg every 12
hours) in patients with mild to moderate hypertension. The study found no difference regarding efficacy and tolerability between
Hibiscus sabdariffa tea and captopril. The second study reported that at day 12 of the treatment, sour tea (the tea made from
Hibiscus sabdariffa) significantly reduced both systolic and diastolic blood when compared with baseline (P < 0.01). The two
studies included in this systematic review had a relatively low quality (Jadad’s score of 2 for both). In conclusion, the
antihypertensive effect of Hibiscus sabdariffa is somewhat evident but well conducted randomized controlled trials are highly
needed to confirm such antihypertensive effect, and to examine also its other clinical benefits
The Canadian Immigration and Refugee Protection Act of 2001 outlines conditions under which indiv... more The Canadian Immigration and Refugee Protection Act of 2001 outlines conditions under which individuals may be granted or denied admission to Canada. The Act stipulates that applications for residence will be rejected if their health is expected to generate excessive demand on Canadian health or social services. The purpose of this paper is to derive a statistical definition of excessive demand and to apply that threshold to persons with HIV who are seeking admission to Canada. The paper demonstrates that the current threshold used by Citizenship and Immigration Canada is much lower than the thresholds that may be derived statistically.
he Canadian Immigration and Refugee Protection Act (IRPA) of 2001 outlines the conditions under w... more he Canadian Immigration and Refugee Protection Act (IRPA) of 2001 outlines the conditions under which individuals may be granted or denied admission to Canada. The Act stipulates that applications for residence will be rejected if an applicant's health is likely to generate excessive demand on Canadian health or social services. The purpose of this paper is to assess the thresholds used to define excessive demand and to apply these thresholds to persons with HIV/AIDS. Three findings are reported: firstly, the current threshold for excessive demand is too low and a statistically more appropriate threshold is three-fold greater; secondly, there is an inverse relationship between HIV/AIDS disease progression and healthcare costs and finally, comparison of disease cost estimates to new thresholds for inadmissibility allows classification to depend on individual characteristics, including age, sex and health status, and the time horizon over which each applicant's projected demand is assessed.
International Journal of Culture and Mental Health, May 15, 2012
This study presents preliminary results on the level of mental health problems in a small communi... more This study presents preliminary results on the level of mental health problems in a small community of immigrants from Thailand. Data for the study were derived from a pilot survey of adult Thai immigrants living in the Greater Toronto Area in Canada. Survey data were collected from a non-probability sample of 145 adults between January and May 2009. Using a threshold of 5/6 for GHQ-28, about 14% of the sample was considered at risk for psychiatric disorder or mental health problems. Acculturative stress significantly increased risk of psychiatric disorder, whereas social support and mastery significantly lowered risk of psychiatric disorder. Participants working multiple jobs and renting an accommodation also had an increased risk of psychiatric disorder. Community-based intervention programmes that focus on developing social support and personal mastery among Thai immigrants are recommended.
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including antihypertensive effect, prevention and treatment of urinary tract infection, anti-oxidation, and anti-atherosclerotic effect
have been reported. However, since the results from studies were inconclusive, a conclusion on whether Hibiscus sabdariffa
possesses such beneficial effects is highly needed. This study aimed to examine the efficacy and tolerability of Hibiscus
sabdariffa compared to other interventions in randomized controlled trials by means of a systematic review. We searched
studies and relevant information from Medline (1966-2006), Cumulative Index to Nursing Allied Health Literature (CINAHL)
(1982-2006), International Pharmaceutical Abstracts (IPA) (1970 – 2006), Current Content, Cochrane Library, and Thai Index
Medicus, bibliographies of retrieved articles and experts in the field.
There were 66 clinical trials examining effects of Hibiscus sabdariffa. We found five trials studying the efficacy of Roselle
on human; however, only two were randomized controlled trials. These two studies were included in our present study. The first
trial tested antihypertensive effect of the tea of dried calyx of Hibiscus sabdariffa compared with captopril (25 mg every 12
hours) in patients with mild to moderate hypertension. The study found no difference regarding efficacy and tolerability between
Hibiscus sabdariffa tea and captopril. The second study reported that at day 12 of the treatment, sour tea (the tea made from
Hibiscus sabdariffa) significantly reduced both systolic and diastolic blood when compared with baseline (P < 0.01). The two
studies included in this systematic review had a relatively low quality (Jadad’s score of 2 for both). In conclusion, the
antihypertensive effect of Hibiscus sabdariffa is somewhat evident but well conducted randomized controlled trials are highly
needed to confirm such antihypertensive effect, and to examine also its other clinical benefits
including antihypertensive effect, prevention and treatment of urinary tract infection, anti-oxidation, and anti-atherosclerotic effect
have been reported. However, since the results from studies were inconclusive, a conclusion on whether Hibiscus sabdariffa
possesses such beneficial effects is highly needed. This study aimed to examine the efficacy and tolerability of Hibiscus
sabdariffa compared to other interventions in randomized controlled trials by means of a systematic review. We searched
studies and relevant information from Medline (1966-2006), Cumulative Index to Nursing Allied Health Literature (CINAHL)
(1982-2006), International Pharmaceutical Abstracts (IPA) (1970 – 2006), Current Content, Cochrane Library, and Thai Index
Medicus, bibliographies of retrieved articles and experts in the field.
There were 66 clinical trials examining effects of Hibiscus sabdariffa. We found five trials studying the efficacy of Roselle
on human; however, only two were randomized controlled trials. These two studies were included in our present study. The first
trial tested antihypertensive effect of the tea of dried calyx of Hibiscus sabdariffa compared with captopril (25 mg every 12
hours) in patients with mild to moderate hypertension. The study found no difference regarding efficacy and tolerability between
Hibiscus sabdariffa tea and captopril. The second study reported that at day 12 of the treatment, sour tea (the tea made from
Hibiscus sabdariffa) significantly reduced both systolic and diastolic blood when compared with baseline (P < 0.01). The two
studies included in this systematic review had a relatively low quality (Jadad’s score of 2 for both). In conclusion, the
antihypertensive effect of Hibiscus sabdariffa is somewhat evident but well conducted randomized controlled trials are highly
needed to confirm such antihypertensive effect, and to examine also its other clinical benefits