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Respiratory viral testing in hospitalized patients is thought to improve quality of care by reducing the use of diagnostic tests, guiding infection control precautions, and rationalizing antimicrobial therapies. Few small published studies have tested these assumptions, and have demonstrated conflicting results. We conducted a retrospective cohort study of 24,567 hospitalizations using administrative data to determine the associations between viral testing, patient outcomes, and process of care. Viral testing was not associated with improved mortality or length of stay in hospital, and resulted in more resource utilization. The test result did not influence the duration of isolation precautions. This implies that health care providers may not use the results of testing in making management decisions, or in guiding the use of isolation precautions. This study provides the foundation for further scientific evaluation and reform of our current respiratory infection control policy.

The incidence of Chronic Obstructive Pulmonary Disease (COPD) is expected to rise in the coming years. Presently, in health care there has been a shift of the provision of care to the home therefore, the major burden of care falls on informal caregivers. The challenges that these caregivers face may be compounded by residing in a rural area where the provision of health care services has been increasingly compromised. In the literature, there has been an abundance of information looking at the experiences of caregivers of people with other chronic illnesses. However, the information on the lived experience of caregivers of people with severe COPD has been minimal. The purpose of this study was to explore the lived experience and meaning of that experience for spousal caregivers providing care to a person with severe COPD living in rural Saskatchewan. Face-to-face, conversational interviews, along with observations of the caregivers and their spouses interactions and environment, were utilized to collect information from five women caring for their husbands with severe COPD living in rural Saskatchewan. Hermeneutic phenomenological reflection, as guided by the works of van Manen, utilized writing, collaborative discussion, life world existentials, and imaginative variation to illuminate themes and the overall essence of this experience. Five overlapping themes identified stemmed from the essence of unrelenting responsibility: 1) Assuming additional roles; 2) Ongoing vigilance; 3) Unfulfilled expectations; 4) Emotional burden; 5) Intermittent reprieve. This study assists in understanding the challenges faced by COPD caregivers and further aids in our understanding of how COPD patients manage their condition. In addition, it will facilitate the identification of strategies and actions to meet the needs sensitive to this population.

The incidence of Chronic Obstructive Pulmonary Disease (COPD) is expected to rise in the coming years. Presently, in health care there has been a shift of the provision of care to the home therefore, the major burden of care falls on informal caregivers. The challenges that these caregivers face may be compounded by residing in a rural area where the provision of health care services has been increasingly compromised. In the literature, there has been an abundance of information looking at the experiences of caregivers of people with other chronic illnesses. However, the information on the lived experience of caregivers of people with severe COPD has been minimal. The purpose of this study was to explore the lived experience and meaning of that experience for spousal caregivers providing care to a person with severe COPD living in rural Saskatchewan. Face-to-face, conversational interviews, along with observations of the caregivers and their spouses interactions and environment, were utilized to collect information from five women caring for their husbands with severe COPD living in rural Saskatchewan. Hermeneutic phenomenological reflection, as guided by the works of van Manen, utilized writing, collaborative discussion, life world existentials, and imaginative variation to illuminate themes and the overall essence of this experience. Five overlapping themes identified stemmed from the essence of unrelenting responsibility: 1) Assuming additional roles; 2) Ongoing vigilance; 3) Unfulfilled expectations; 4) Emotional burden; 5) Intermittent reprieve. This study assists in understanding the challenges faced by COPD caregivers and further aids in our understanding of how COPD patients manage their condition. In addition, it will facilitate the identification of strategies and actions to meet the needs sensitive to this population.

Background: Lower respiratory illnesses (LRIs) and asthma are common diseases in children < 5 years of age. Few studies have investigated the relationships between multiple, home-based social and environmental risk factors and asthma and LRIs in children. Of those that have, none have focused exclusively on children < 5 years of age, who are more physiologically vulnerable and spend more time at home compared to older children. Further, no studies have done so at the community level. Methods: We modeled relationships between emergency department visits and hospitalization rates for asthma and LRIs for children < 5 years and geographic risk factors, including socio-economic and housing characteristics, ambient air pollution levels, and population density in Maricopa and Pima Counties, Arizona, from 2005 to 2009. We used a generalized linear model with a negative binomial observation distribution and an offset for the population of very young children in each tract. To reduce multicollinearity among predictors, socio-economic characteristics, and ambient air pollutant levels were combined into unit-less indices using the principal components analysis (PCA). Housing characteristics variables did not exhibit moderate-to-high correlations and thus were not included in PCA. Spatial autocorrelation among regression model residuals was assessed with the Global Moran's I test. Results: Following the regression analyses, almost all predictors were significantly related to at least one disease outcome. Lower socio-economic status (SES) and reduced population density were associated with asthma hospitalization rates and both LRI outcomes (p values < 0.001). After adjusting for differences between counties, Pima County residence was associated with lower asthma and LRI hospitalization rates. No spatial autocorrelation was found among multiple regression model residuals (p values > 0.05). Conclusions: Our study revealed complex, multi-factorial associations between predictors and outcomes. Findings indicate that many rural areas with lower SES have distinct factors for childhood respiratory diseases that require further investigation. County-wide differences in maternal characteristics or agricultural land uses (not tested here) may also play a role in Pima County residence protecting against hospitalizations, when compared to Maricopa County. By better understanding this and other relationships, more focused public health interventions at the community level could be developed to reduce and better control these diseases in children < 5 years, who are more physiologically vulnerable.

Prematurity is a worldwide problem. Every year, 15 million babies are born prematurely, and 1 million of those babies die because of related complications. The surviving premature babies are struggling to hold on to their lives, and even when they do live, most of them end up having various complications to survive and get stronger. There are physical complications faced on their journey such as having underdeveloped lungs, pneumonia, obesity, sepsis, retinopathy of prematurity, respiratory distress syndrome, bronchopulmonary dysplasia, asthma, wheezing, bronchiolitis, cerebral palsy, and motor impairment. They can also develop mental and behavioral health complications such as depression, seizures developmental delay, schizophrenia, autism spectrum disorder, psychological development disorders, behavioral problems, attention problems, and ADHD later in life. The purpose of this systemic review is to understand the impact of long-term complications of premature birth on individual life and society. We hypothesized that based on data from primary research, nearly one half of the infants will have either physical and/or cognitive/developmental health complications. We hypothesized that infants born premature have more physical complications than cognitive complications and infants born prematurely have more cognitive complications than physical complications. This research was carried out by finding cohort study design studies through Medline, Academic Search Premier, and APA PsychINFO, where the studies will be compiled from 2003 – 2020.

Background: Respiratory illnesses can have a substantial impact on population health and burden hospitals in terms of patient load. Advance warnings of the spread of such illness could inform public health interventions and help hospitals manage patient services. Previous research showed that calls for respiratory complaints to Telehealth Ontario are correlated up to two weeks in advance with emergency department visits for respiratory illness at the provincial level. Objectives: This thesis examined whether Telehealth Ontario calls for respiratory complaints could be used to accurately forecast the daily and weekly number of emergency department visits for respiratory illness at the health unit level for each of the 36 health units in Ontario up to 14 days in advance in the context of a real-time syndromic surveillance system. The forecasting abilities of three different time series modeling techniques were compared. Methods: The thesis used hospital emergency department visit data from the National Ambulatory Care Reporting System database and Telehealth Ontario call data and from June 1, 2004 to March 31, 2006. Parallel Cascade Identification (PCI), Fast Orthogonal Search (FOS), and Numerical Methods for Subspace State Space System Identification (N4SID) algorithms were used to create prediction models for the daily number of emergency department visits using Telehealth call counts and holiday/weekends as predictors. Prediction models were constructed using the first year of the study data and their accuracy was measured over the second year of data. Factors associated with prediction accuracy were examined. Results: Forecast error varied widely across health units. Prediction error increased with lead time and lower call-to-visits ratio. Compared with N4SID, PCI and FOS had significantly lower forecast error. Forecasts of the weekly aggregate number of visits showed little evidence of ability to accurately flag corresponding actual increases. However, when visits were aggregated over a four day period, increases could be flagged more accurately than chance in six of the 36 health units accounting for approximately half of the Ontario population. Conclusions: This thesis suggests that Telehealth Ontario data collected by a real-time syndromic surveillance system could play a role in forecasting health services demand for respiratory illness. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2009-08-11 16:20:44.553

Population-based administrative data (2009-2012) from several sources were used to compare the health status and access to health services between a cohort of children in care with developmental disabilities (DD) (n=1,212) and a matched comparison group of children in care without DD (n=2,424). The two study groups were compared on a number of measures, including total respiratory morbidity, prevalence of diabetes, mood and anxiety disorders, continuity of care, injury-related hospitalizations, hospital-based dental care, and total number of ambulatory physician visits. Children in care with DD were significantly more likely to have a history of mood and anxiety disorders, respiratory illnesses, diabetes, hospital-based dental care, and injury-related hospitalizations compared to the matched comparison group. Children in care with DD also had significantly higher number of physician visits than children in the matched comparison group. No significant difference between the two study groups was found for continuity of care. / October 2015