bluuebunny/crossref_metadata_2025_split huggingface dataset:
In Sickness and In Health: Effects of Cardiovascular Health Shocks on Spouses’ Work and Earnings
Authors: Fransoo Randy 
Published: September 2018

IntroductionA severe health shock can threaten a patient’s life and alter the lives of their family. Spouses often provide care, and may change their work situation, affecting family income. This could mean less work to allow for more caregiving, or more work to make up for the patient’s lower income.
Objectives and ApproachWe used the Canadian Hospital and Taxation Database to quantify the impact on workforce participation and changes in earnings among spouses of working-age Canadians who survived a heart attack, cardiac arrest, or stroke. All 40-61 year-olds who experienced a health shock between 2005 and 2010, and survived for at least 3 years, were included, along with their spouses. We use 15 variables to match case spouses with up to 5 (weighted) potential control spouses. The main outcome was Total earnings, which included the sum of wages and salaries, net self-employment income and other employment income, normalized to 2012 Cdn dollars.
ResultsOur analysis included 11,208 spouses of heart attack patients, 622 spouses of cardiac arrest patients, and 2,228 spouses of stroke patients, matched with spouses in the control group. For all three health shocks, we found no significant difference in the distribution of changes in earnings between cases and matched controls (p=0.30 for heart attack; p=0.72 for cardiac arrest and p=0.27 for stroke). We also found no difference in levels of working status (ie being employed). We found mixed impacts by spouses’ sex, age, and pre-event earnings for heart attack and stroke patients. These results are consistent with previous findings, but drill deeper by analyzing the distributions of changes in earnings among spouses of patients experiencing health shocks.
Conclusion/ImplicationsDespite known decreases in work and earnings among patients experiencing heart attack, cardiac arrest, or stroke, the proportion of spouses whose work and earnings were increased, decreased, or unchanged was the same as for control spouses. This combination implies a significant reduction in family income after serious health events.
ICD coding training worldwide
Authors: Varela Lucia Otero , Eastwood Catherine , Mathur Pallavi , Quan Hude 
Published: September 2018

IntroductionThe International Classification of Diseases (ICD) is globally used for coding morbidity statistics, however, its use, as well as the training provided to individuals assigning codes, varies greatly across countries.
Objectives and ApproachThe goal is to understand the quality of coder training worldwide. After an in-depth grey and academic literature review, an online survey was created to poll the 194 World Health Organization (WHO) member countries. Questions focused on hospital data collection systems and the training provided to the coding professionals. The survey was distributed to potential participants that meet the specific criteria, as well as to organizations specialized in the topic, such as WHO-CC (WHO Collaborating Centers) and IFHIMA (International Federation of Health Information Management Association), to be forwarded to their representatives. Answers will be analyzed using descriptive statistics.
ResultsThis ongoing project aims to capture responses from as many countries as possible, and thus far, data from 45 respondents from 20 different countries has been collected. Initial results reveal worldwide use of ICD, with variations in the maximum allowable coding fields for diagnoses and interventions. Coding specialists are the main personnel assigning codes, followed by physicians, and although minimum training is not mandatory in all countries (Sweden, Italy, Germany and Thailand), in those where it is, college/university degree is the most common requirement. Coding certificates most frequently entail passing a certification exam. Continuing education for coders is offered in all countries except one (Nigeria). Once more information is available, countries will be ranked and those depicting a better performance will be highlighted.
Conclusion/ImplicationsThese survey data will establish the current state of ICD use and coding training internationally, which will ultimately be valuable to the WHO for the promotion of ICD and the rollout of ICD-11, for better international comparisons of health data, and for further research on how to improve ICD coding.
Multimorbidity and access to social Care: exploiting emerging administrative data sources in Scotland.
Authors: Henderson David , Bailey Nick , McCowan Colin , Mercer Stewart 
Published: September 2018

IntroductionIntegration of health and social care services is a potential solution to improving care despite budgetary constraints and increased demand for services. Little is known about how having two-or-more long-term conditions (multimorbidity) and socioeconomic status affect social care use, or how all these factors affect unscheduled health care use.
Objectives and ApproachThe project aims to describe the demographic, geographic, and socioeconomic differences in the receipt of social care for over 65s in Scotland and how multimorbidity status influences amounts of social care received. Additional analyses will consider the influence receipt of social care has on use of unscheduled health care services and mortality.
Social Care Survey (SCS) data collected by the Scottish Government is linked to administrative health and mortality records. Linkage includes; prescribing information service and USC data which records episodes of A & E attendance, emergency admission to hospital, GP out-of-hours attendance, Scottish Ambulance Service use, and NHS24 contact
ResultsThe cohort includes 1.1million individuals over the age of 65 (54.8% Female), of which 274,011 (24.2%) people died during the study period.
The linkage rate of the SCS to records with a CHI number in the National Records of Scotland population spine was 90.5%, with one local authority removed for very low linkage rates and the remaining 31 with rates between 76.7% and 97.9%.
As of February 2018, all requested data has been transferred to the National Safe Haven and data cleaning and analysis has begun. Significant results are expected to have been produced by August 2018.
Conclusion/ImplicationsThis research will help understand if receipt of social care is equitably distributed among the population of Scotland after allowing for multimorbidity and socioeconomic status. Understanding the influence health status has on social care receipt and the influence social care has on unscheduled healthcare use has important implications for policy development.
Challenges and Facilitating Factors in Accessing Administrative Data for Research: Insights from the Children's Health Profile and Trajectory Initiative in NB and PEI
Authors: Sparks Sarah , Tranchant Carole , Malinski Patricia , Montelpare William , Bélanger Mathieu , Miedema Baukje , Bouchard Danielle , Sénéchal Martin , Jose Caroline , Barre Ed , Rossiter Misty , Bryanton Janet , Holland Margaret , McDonald Ted 
Published: September 2018

IntroductionAdministrative health data (AHD) are typically not analyzed to produce evidence on the effectiveness and limitations of primary prevention programs and strategies. The value of AHD for answering research questions is generally recognized, but the challenges in accessing and using these data for research are not always know and documented.
Objectives and ApproachTo identify and advise on the facilitating factors and challenges of accessing select AHD in New Brunswick (NB) and Prince Edward Island (PEI) for the purpose of creating an intra-provincial Child Health Profile (CHP) and population-based birth cohort database, using existing AHD not been previously linked. This research is a cross-jurisdictional collaboration between NB and PEI with an integrated knowledge translation (iKT) approach that adheres to each province’s unique data policies, data procedures, and data governance. The collaboration involves people in various roles: provincial government managers, policy-makers, data custodians, health practitioners, citizens, community organizations, in addition to academic researchers.
ResultsAccess to select AHD required considerable preparation, cross province coordination, and ongoing discussions over many months. Key facilitators were the NB Institute for Research, Data and Training, a newly established data repository that holds provincial AHD in NB, and the provincial health authority in PEI. In NB, the existence of well-documented protocols and support from designated personnel (including trained data analysts) were assets facilitating data access through the data repository. In PEI, REB approval was obtained more rapidly but challenges occurred in subsequent stages of data access directly through the health authority. This research supports the empowerment of stakeholders such as Public Health and researchers who are trying to leverage ‘big data’ resources to address research and practice questions regarding children’s health.
Conclusion/ImplicationsAccessing AHD for the project was facilitated by the existence of well-documented protocols and other specialized resources that help streamline the process of data sharing while ensuring data privacy and security. Continued relationship-building among stakeholders is needed to facilitate and maximize the use of existing AHD in NB and PEI.
Extracting primary care records for prostate cancer patients in the CHHiP multicentre randomised control trial: A healthcare data linkage study
Authors: Lemanska Agnieszka , Byford Rachel C , Cruickshank Clare , Dearnaley David P , Ferreira Filipa , Griffin Clare , Hall Emma , Hinton William , De Lusignan Simon , Sherlock Julian , Tomkinson Keeley , Van Vlymen Jeremy , Faithfull Sara 
Published: September 2018

IntroductionThe aim is to investigate the effect of cardiovascular and diabetes comorbidities on radiotherapy-related side-effects in prostate cancer. Previous research suggests that comorbidities increase the risk of side-effects, but some cardiovascular medications may reduce symptoms by protecting against radiation damage. The evidence is inconclusive and mechanisms are not fully understood.
ObjectiveTo explore whether routine primary care data can supplement clinical trial data in evaluating the impact of comorbidities and prescription medications on patient outcomes.
ApproachThe CHHiP radiotherapy trial (CRUK/06/16) recruited 3,216 prostate cancer patients from 71 centres in UK, Ireland, Switzerland, and New Zealand between 2002 and 2011. Baseline comorbidity and radiotherapy-related side-effects over time were recorded. This was linked to computerised medical records (CMRs) from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) database. RCGP RSC is a network of 192 English general practices with over 2 million patients (2.8% of the population).
ResultsThe English population of CHHiP patients (N=2811) was used. 120 CMRs were linked, which exceeded the estimation of 79 linked records. However, six CMRs showed no evidence of regular GP care and a further eight patients were not recruited into the CHHiP trial until after they had de-registered from an RCGP RSC practice.
Information on cardiovascular and diabetes comorbidities was extracted for 106 patients. The mean age was 69±7 years, representative of the CHHiP population. From the CMRs, 23 (22%) patients had diabetes and 47 (44%) had hypertension including 37 (35%) who took angiotensin converting enzyme (ACE) inhibitors (medications lowering blood pressure). In addition, 44 (41%) patients took aspirin, 65 (61%) statins (lowering blood lipids) and 14 (13%) took metformin (lowering blood sugar levels).
Conclusion/ImplicationsThe small sample limits statistical analysis. However, a clinical trial was successfully linked to GP data to determine comorbidities and medications of patients. This will serve as a pilot for further research. The advantage of data linkage is that it may provide a mechanism for long-term follow-up of radiotherapy-related side-effects.
Approaches to big data analysis of interface pressure measurements from continuous pressure imaging technology
Authors: Peng Mingkai , Ocampo Wrechelle , Southern Danielle , Baylis Barry , Hogan David , Conly John , Stelfox Thomas , Kaufman Jaime , Ghali William , Ho Chester 
Published: September 2018

IntroductionOver 4.5 TB of data will be collected in a randomized clinical trial assessing continuous pressure imaging technology in reducing pressure injuries. To permit efficient analysis we examined different approaches to generating a reduced representation of the data that still produced similar analytical results to the full data set.
Objectives and ApproachOur primary objective was to develop an approach for reducing the pressure data to a manageable size, without loss of information. Frame by frame analysis of excluded participant imaging data allows us to identify changes in patient position. We explored different sampling frequencies (q5, 30, 60, 120, \& 240 seconds) for analysis, coalesced frames with periods of stillness, and used correlation coefficients as a measure of similarity between adjacent frames to identify patient position changes. Heat maps and plots were used to evaluate the performance characteristics and usefulness of different sampling frequencies and correlation coefficients to compress the data.
ResultsA sampling frequency q60 seconds provided reasonable representation of changes in interface pressure over time. This translates to using only 1.7\% of the collected data in our analyses. When the threshold of correlation coefficient was set at 0.99 for coalescing the information based on position changes, then there was a maximum of 80 position changes detected. Therefore, approximately 160 frames q24 hours is sufficient to represent pressure states of participants at high risk of developing pressure injuries. In total we would require 480 frames (160*3) from 72 hours of collected data for our analyses without loss of position changes and pressure information. This represents approximately 0.185\% of the data collected.
Conclusion/ImplicationsDecreasing the sampling frequency significantly reduced our data size without compromising resolution, while the use of correlation coefficients was effective at coalescing the continuous pressure imaging data. These methods of data reduction may be applicable to pre-processing large datasets obtained from other device monitoring technologies.
Health Equity in Cancer Screening in Calgary – A Geographic Approach to Account for Population Socioeconomic Status
Authors: Liu Ning , Vigod Simone , Farrugia Michèle , Urquia Marcelo , Ray Joel 
Published: September 2018

IntroductionThere is substantial evidence that cancer screening rates are lower among Canadians with low socioeconomic status (SES) than they are among those with higher SES. In order to optimize cancer screening, there is a need to reduce inequities in cancer screening.
Objectives and ApproachThe purpose of this study is to understand how breast, colorectal and cervical cancer screening participation varies by socioeconomic status within local geographic areas (LGAs) in the city of Calgary. A Bayesian multilevel regression method with a spatial component was used to estimate Standardized Incidence Rates (SIR) at the LGA level. Bivariate spatial clustering analyses between screening rates at the Dissemination Area (DA) level and Pampalon material and social deprivation index was performed to better understand spatial structures of low and high screening rates compared to high and low material and social deprivation scores within LGAs.
ResultsThe effect of material (income, education and employment) and social (living alone, separated, and divorced or windowed) deprivation on lower screening rates was stronger for breast cancer screening, compared to cervical and colorectal screening. Estimated likelihood of screening significantly decreased from the least deprived to the most deprived (9% for the material component and 18% for the social component for Breast cancer; 8% for the material component and 10% for the social component for cervical cancer screening). Clusters of lower screening rates and higher social and material deprivation were identified in the northeastern and central areas of the city.
Conclusion/ImplicationsThe study allowed identifying LGAs and neighborhoods within those LGAs that have lower screening rates likely to be explained by the material and social deprivation of the population. The approach provides additional evidence for planning targeted interventions and reducing inequities for screening.
Exploring Alternative Designs using ‘Big’ Administrative Data
Authors: Roos Leslie , Wall-Wieler Elizabeth , Torabi Mahmoud 
Published: September 2018

IntroductionLarge population-based data sets present similar analytic issues across such fields as: population health, clinical epidemiology, education, justice, and children’s services. Step-wise approaches and generalized tools can bring together several pillars: big (typically administrative) data, programming, and study design/analysis. How can we improve efficiency and explore alternative designs?
Objectives and ApproachLinked data sets typically contain: 1) files presenting longitudinal histories 2) substantive files noting various events (concussions, burns, loss of a loved one, public housing entry) and several possible covariates and outcomes.
Step-wise approaches enable automating tasks by developing general tools (decreasing programmer input) and facilitating alternative designs. Macros improve upon the classic ‘one design, one data set’ perspective. Two case studies highlight tradeoffs in retrospective cohort studies (quasi-experiments) among sample size, length of follow-up, and the number of time periods.
ResultsStudy 1: Step 1 calculated the number of mothers with a child placed in care during various index years. Taking 1 year before and after placement generated 5,991 eligible mothers; selecting 5 years before/after decreased the N to 2,281. Step 2 selected appropriate in-province residents. Step 3 handled missing covariates and outcomes, while Step 4 ran alternative designs.
One example (of several) compared maternal mental health outcomes using 8 time periods (in 2 years) before/after the event with outcomes using 16 time periods (in 4 years) before/after. Besides showing increasing maternal problems, the 4-year follow-up sometimes produced different statistically significant periods than the 2-year follow-up.
Study 2. Swedish/Canadian comparisons of mothers with children placed in foster care highlighted growing differences in maternal pharmaceutical use.
Conclusion/ImplicationsPresenting design alternatives is straightforward and applicable across disciplines. Ongoing work is facilitating comparisons of ‘experimental’ and control groups. Literature-derived guidelines and simulation-based techniques should lead to better design decisions. Automated model assessment can help analyze robustness, statistical power, residuals, and bias, suggesting artificial intelligence approaches.
Making Sense of a Hot Mess: Cleaning and Validating Messy Administrative Data to study Supportive Housing in Winnipeg, Manitoba
Authors: Yogendran Marina , Doupe Malcolm , Schultz Jennifer , McDougall Chelsey 
Published: September 2018

IntroductionWhile supportive housing (SH) is an important alternate to nursing home (NH) use, these data have never been linked to administrative records in Manitoba. By conducting linkages to other administrative records, we describe a process for cleaning and validating SH data, in preparation to conduct policy-relevant research.
Objectives and ApproachSH data (N=516 units) from Winnipeg were received at the Manitoba Centre for Health Policy (MCHP) in three different files. File 1 (2004-2008; 1005 records) contained monthly client snapshots. File 2 (2008-2010; 1336 records) contained application, move-in, cancellation, and move-out dates. File 3 (2010-2011; 729 records) contained one line of text for each record showing the application, processing, and move-in/cancellation date. We used overlapping data from these files plus linkages to other data sources (Manitoba Population Registry, nursing home data, and Vital Statistics) to clean and assess the accuracy of SH data.
ResultsThe original files contained 2039 people with 3070 records. From this we excluded: i) 215 records with unusable Personal Health Identification Numbers; ii) 949 records with missing SH move-in dates; iii) 691 records that did not match to the Manitoba Health Registry; and iv) 25 records where data did not match to the NH, hospital, or Vital Statistics files. The result was 1190 people each with one record. SH move-out dates were often missing from these records. This field was imputed from other data sources (NH, Vital Statistics). Some people transferred between SH sites, and these data were retained in the same record. Aside from the first year of operation when capacity was low, most SH dwellings operated at 80-100% occupancy annually.
Conclusion/ImplicationsUsing several verification methods including linkages to other data sources, we successfully cleaned and verified the accuracy of the SH data for use at MCHP. High annual SH occupancy rates suggest that the file contains the vast majority of SH users, and can now be used in follow-up research.
Adherence to Breast Cancer Follow-up Care Guidelines for Vulnerable Populations in four Canadian provinces: a CanIMPACT study
Authors: McBride Mary , Groome Patti , Jiang Li , Whitehead Marlo , Li Dongdong , Decker Kathleen , Kendell Cynthia , Winget Marcy , Turner Donna , Urquhart Robin , Grunfeld Eva 
Published: September 2018

IntroductionBreast cancer survivors are at risk for late and ongoing problems including cancer recurrence and late effects of treatment. Vulnerable groups may not enjoy equitable access to quality follow-up care. This study examines utilization of guideline-based follow-up care among vulnerable subpopulations in four Canadian provinces.
Objectives and ApproachFor vulnerable groups of breast cancer survivors diagnosed from 2007-2010 in British Columbia (BC), 2007-2011 in Manitoba (MB), 2007-2010 in Ontario (ON), and 2007-2012 in Nova Scotia (NS), alive at 30 months post-diagnosis and followed for five years from diagnosis, we undertook a retrospective population-based cohort study linking cancer registries, clinical and health administrative databases. We calculated adherence to recommended follow-up care for surveillance of recurrent and new cancer, late effects, and general preventive care, and examined variation among provinces. Vulnerable groups were defined as those diagnosed at older ages, with lower income status, and/or who resided in rural area.
ResultsSurvivor numbers were 23,700 (ON), 9493 (BC), 2688 (MB), and 2735 (NS). In Year 2, between 9.3% (BC) and 28.1% (ON) of survivors diagnosed aged 74+ years received annual breast cancer-related PCP or oncologist follow-up visits, a lower proportion than their younger-diagnosed counterparts; rates of surveillance breast imaging (between 34.2% (BC) and 68.6% (ON) in Year 2) were also lower than those diagnosed at younger ages. Those with incomes in the lowest 40\% did not have different rates of primary care physician and oncologist visits compared to the top 60%, nor did their utilization of surveillance imaging or imaging for metastatic disease differ. Guideline-adherent surveillance breast imaging was conducted on a higher proportion of urban than rural patients in all provinces.
Conclusion/ImplicationsWhile area-level incomes do not appear to appreciably affect follow-up care, older age and rural residence resulted in differential access to care. These results suggest that there are gaps in provision of follow-up care that potentially can be addressed through system and practice-level change.