Biomedical subjects

Anita L Kozyrskyj

Publications and source records attributed to Anita L Kozyrskyj.

13 recordsLinked to original sources

PubMed2006

Disease, temporal and sociodemographic influences on initial treatment of community-acquired pneumonia in Manitoba, Canada.

Reimbursement restrictions on newer antibiotics, common to many drug plans, may result in unnecessary hospitalisation when patients are unable to pay 'out of pocket' for recommended antibiotics. We examined the effect of income, among other subject characteristics, on the likelihood of hospitalisation or receipt of restricted antibiotics for initial treatment of community-acquired pneumonia (CAP). A retrospective cross-sectional review of healthcare claims from the province of Manitoba, Canada, from 1 May 1996 to 1 March 2002 was conducted. Of 36969 subjects with a diagnosis of CAP, 13.6% were initially hospitalised and 86.4% were treated as outpatients. Independent predictors of initial hospitalisation included: age (for every 10-year increase) (odds ratio (OR)=1.42); male gender (OR=1.22); urban residence (OR=0.52); presentation to the emergency department (OR=5.14); and level of co-morbidity (high versus low) (OR=1.66). The effect of income level on hospitalisation was modified by co-morbidity status. Among subjects lacking CAP-specific co-morbidities, the probability of initial hospitalisation was greater in the lowest versus the highest income quintile (OR=1.87). Among outpatients, restricted antibiotics were widely received and differences in use by income were modest.

Adolescent↗

PubMed2006

Outpatient treatment of community-acquired pneumonia: evolving trends and a focus on fluoroquinolones.

BACKGROUND: Increasing use of broad-spectrum antibiotics in the community, including fluoroquinolones, has been reported, despite concerns for developing antibiotic resistant organisms. Community-acquired pneumonia (CAP) is commonly treated on an outpatient basis, and recent treatment guidelines suggest only a limited role for fluoroquinolones. OBJECTIVES: To identify evolving trends in the outpatient treatment of CAP in adults, and to identify factors associated with receipt of a fluoroquinolone. METHODS: Retrospective observational design using population-based administrative data. Initial outpatient treatment for subjects diagnosed with CAP between May 1996 and March 2002 was examined. Logistic regression was used to examine the influence of patient characteristics on the receipt of a fluoroquinolone. RESULTS: A total of 31,940 outpatients with CAP were identified. The proportion of patients receiving fluoroquinolones increased from 6.6% in 1996/97 to 25.2% in 2001/02. Over the course of the study, 158 (25.9%) of the 610 patients meeting the eligibility criteria for treatment with fluoroquinolones, according to treatment guidelines, received these agents. Of the 31,330 subjects who did not meet the eligibility criterion, 3,886 (12.4%) received a fluoroquinolone. Other variables that influenced the receipt of a fluoroquinolone included: age (for every 10-year increase) [OR=1.16 (1.14-1.19)], urban residence [OR=1.40 (1.30-1.51)], presentation to an emergency department [OR=0.80 (0.70-0.90)], high-level drug use (six or more different drugs in the previous year) [OR=1.50 (1.41-1.59)], and income-level (highest to lowest) [OR=1.20 (1.08-1.35)]. CONCLUSION: The use of fluoroquinolones for the treatment of CAP is increasing. However less than 4% of the subjects receiving fluoroquinolones met eligibility requirements according to treatment guidelines. Initiatives to increase the uptake of treatment guidelines appear warranted.

Adolescent↗

PubMed2006

Antibiotic treatment of wheezing in children with asthma: what is the practice?

OBJECTIVE: Antibiotics are not recommended for the treatment of wheezing in children with asthma, but little is known about their use. This study was undertaken to evaluate trends and determinants of antibiotic use in children with wheezing during the fiscal years 1995 through 2001. METHODS: Using the population-based health care and prescription databases in Manitoba, Canada, this descriptive study examined time trends in antibiotic prescription use for wheezing episodes in a population of children with asthma. The likelihood of receiving an antibiotic prescription according to child and physician characteristics also was determined. Annual population-based rates of antibiotic prescriptions for wheezing episodes were modeled by age and antibiotic class, using general estimating equations. The odds ratio for receiving an antibiotic prescription according to child demographics and physician factors was determined from hierarchical linear modeling. RESULTS: The antibiotic prescription rate for wheezing decreased by 28% from 708 prescriptions per 1000 children with asthma in 1995 to 511 prescriptions in 2001. Fifteen-fold increases in use were observed for broader spectrum macrolides in preschool children. Twenty-three percent of physician visits for wheezing resulted in an immediate antibiotic prescription, but this percentage increased to 64% for antibiotics that were received within 7 days of the episode. General practitioners prescribed antibiotics more often than did pediatricians. Physicians who were not trained in Canada or the United States were 40% more likely to prescribe antibiotics than their counterparts. CONCLUSIONS: Antibiotic use for wheezing in children declined in the 1990s, but the increased use of broader spectrum macrolides has implications for antibiotic resistance. A link between antibiotic prescribing and physician specialty and location of training identifies opportunities for intervention.

Adolescent↗

PubMed2004

Evidence-based prescribing of antibiotics for children: role of socioeconomic status and physician characteristics.

BACKGROUND: Evidence-based guidelines for antibiotic use are well established, but nonadherence to these guidelines continues. This study was undertaken to determine child, household and physician factors predictive of nonadherence to evidence-based antibiotic prescribing in children. METHODS: The prescription and health care records of 20 000 Manitoba children were assessed for 2 criteria of nonadherence to evidence-based antibiotic prescribing during the period from fiscal year 1996 (April 1996 to March 1997) to fiscal year 2000: receipt of an antibiotic for a viral respiratory tract infection (VRTI) and initial use of a second-line agent for acute otitis media, pharyngitis, pneumonia, urinary tract infection or cellulitis. The likelihood of nonadherence to evidence-based prescribing, according to child demographic characteristics, physician factors (specialty and place of training) and household income, was determined from hierarchical linear modelling. Child visits were nested within physicians, and the most parsimonious model was selected at p < 0.05. RESULTS: During the study period, 45% of physician visits for VRTI resulted in an antibiotic prescription, and 20% of antibiotic prescriptions were for second-line antibiotics. Relative to general practitioners, the odds ratio for antibiotic prescription for a VRTI was 0.51 (95% confidence interval [CI] 0.42-0.62) for pediatricians and 1.58 (95% CI 1.03-2.42) for other specialists. The likelihood that an antibiotic would be prescribed for a VRTI was 0.99 for each successive 10,000 Canadian dollars increase in household income. Pediatricians and other specialists were more likely than general practitioners to prescribe second-line antibiotics for initial therapy. Both criteria for nonadherence to evidence-based prescribing were 40% less likely among physicians trained in Canada or the United States than among physicians trained elsewhere. INTERPRETATION: The links that we identified between nonadherence to evidence-based antibiotic prescribing in children and physician specialty and location of training suggest opportunities for intervention. The independent effect of household income indicates that parents also have an important role.

Adolescent↗

PubMed2004

Decrease in antibiotic use among children in the 1990s: not all antibiotics, not all children.

BACKGROUND: Decreases in antibiotic use were widely reported in the 1990s. This study was undertaken to determine trends in the use of antibiotics from fiscal year (FY) 1995 (April 1995 to March 1996) to FY 2001 in a complete population of Manitoba children. METHODS: Using Manitoba's health care databases, we determined annual population-based rates of antibiotic prescription among children by antibiotic class (narrow-spectrum and broader-spectrum antibiotics), age group, physician diagnosis (e.g., otitis media or bronchitis) and neighbourhood income in urban areas (derived from the 1996 census). Antibiotic prescription rates were generated within a generalized linear model framework with general estimating equations, and differences between FY 2001 and FY 1995 were tested. Differences in antibiotic use over time were compared across antibiotic classes, age groups, diagnoses and income neighbourhoods. RESULTS: The overall antibiotic prescription rate decreased by almost one-third, from 1.2 prescriptions per child in FY 1995 to 0.9 prescriptions in FY 2001. Total antibiotic use declined for all respiratory tract infections; decreases were greatest for the sulfonamides (decrease to less than one-third the FY 1995 rate) and narrow-spectrum macrolides (decrease to less than half the FY 1995 rate). In contrast, the FY 2001 rate for broader-spectrum macrolides was as much as 12.5 times the FY 1995 rate. Otitis media accounted for one-quarter of the use of the latter agents. Preschool children and low-income children received the greatest number of antibiotic prescriptions. Declines in antibiotic prescriptions were of a lesser magnitude for low-income children (for whom rates in FY 2001 were four-fifths the rates in FY 1995) than for higher-income children (for whom rates in FY 2001 were about two-thirds the rates in FY 1995). INTERPRETATION: Overall, antibiotic use declined over the late 1990s in this population of Canadian children, but the increasing use of broader-spectrum macrolides and higher rates of antibiotic use among preschool and low-income children may have implications for antibiotic resistance.

Adolescent↗

PubMed2004

The burden of seizures in Manitoba children: a population-based study.

BACKGROUND: Population-based studies are necessary to better understand the risk factors for developing seizure disorders and the impact of these conditions on children. We undertook an assessment of the prevalence of seizure disorders in a population of children on the basis of health care utilization records. METHODS: Using Manitoba's population-based prescription and health care data for 1998/99, the prevalence of children with seizure disorders, on the basis of at least one physician visit or hospitalization for epilepsy or a prescription for an antiepileptic drug, was determined by age, urban/rural region and socioeconomic status. The latter was measured as neighbourhoods stratified by income quintiles according to Census data. RESULTS: Age-specific prevalence rates for seizure disorders in Manitoba children, determined from health care administrative records, were similar to published data on the prevalence of epilepsy, with one exception. Prevalence rates in adolescents were higher than those reported in the literature. No statistically significant differences in prevalence rates were observed between urban and rural populations. However, a higher prevalence was found among children of all ages living in lower socioeconomic neighbourhoods in urban areas, which presented as a gradient of increased prevalence with decreased levels of income. CONCLUSIONS: Population-based health care administrative data can be used to describe the geographical distribution of seizure disorders. Our data suggest that the burden of seizure disorders is not evenly distributed among children.

Adolescent↗

PubMed2004

Identifying children with persistent asthma from health care administrative records.

BACKGROUND: Investigation into the origins of asthma is contingent on definitions of asthma, which can differentiate asthma from transient wheezing syndromes in children. OBJECTIVES: This research was undertaken to develop a definition for asthma derived from health care administrative records, which would identify children with persistent asthma. PATIENTS AND METHODS: Using population-based, health care administrative data, children with possible asthma were identified as having one or more physician visits or hospitalizations for asthma or bronchitis diagnoses from January 1995 to December 1995, or, in the absence of asthma-like diagnoses, one or more prescriptions for asthma prophylaxis drugs or ketotifen concomitant with a beta-agonist, or two or more prescriptions for beta-agonists. RESULTS: The likelihood of persistent asthma, defined as repeated health care and prescription use for asthma from 1996 to 1998, was assessed for various asthma markers and risk factors in 29,198 children with possible asthma. Children with asthma prescription drugs or asthma health care use not limited to the winter season were three to six times more likely than children without these characteristics to have persistent asthma. The likelihood of persistent asthma was elevated to a substantial degree in the presence of both of these markers. CONCLUSIONS: The inclusion of these measures in a diagnosis-based definition improves the ability to identify persistent asthma in children.

Adolescent↗

PubMed2003

Childhood wheezing syndromes and healthcare data.

There is convincing evidence that several distinct wheezing syndromes exist in childhood. The purpose of this research was to assess the potential of using healthcare utilization profiles to identify wheezing syndromes in children which are distinct from asthma. Using population-based healthcare administrative data, a cohort of children, aged 5-15 years, with bronchitis diagnoses from time of birth to 1995, but no physician diagnoses of asthma, was followed over the period January 1996-March 1998. In this follow-up period, 13% had subsequent healthcare utilization for asthma, 23% had continued healthcare utilization for bronchitis, and 64% had no further healthcare utilization. The likelihood of bronchitis vs. asthma outcomes was determined for a variety of asthma risk factors. In a cohort of 11,043 children with initial healthcare contact for bronchitis but not asthma, two potentially distinct entities of bronchitis emerged from our data: 1) transient bronchitis, similar to transient wheezing of early childhood, which was associated with winter-only healthcare utilization and absence of allergy, and 2) recurrent bronchitis which differed from asthma on the basis of winter-only healthcare utilization, prematurity at birth, absence of allergy, and low socioeconomic status. Healthcare administrative records can be used to describe the natural history of wheezing in children and to identify markers which may discriminate asthma from other syndromes.

Adolescent↗

PubMed2003

Inhaled corticosteroids in childhood asthma: Income differences in use.

Asthma hospitalization rates in children increase with decreasing level of household income. This research was undertaken to determine whether use of inhaled corticosteroid drugs, which can prevent asthma hospitalizations, followed a similar socioeconomic gradient in children with asthma. We performed a cross-sectional study of association, using population-based prescription and healthcare data sources. Our subjects were 16,862 Manitoba children, aged 5-15 years, with prescriptions for asthma drugs during January 1995-March 1996. Our measures were adjusted for asthma severity, physician specialty, and proportion of children with an inhaled corticosteroid prescription by neighborhood income. Forty-five percent of children treated for asthma had at least one inhaled corticosteroid prescription during January 1995-March 1996. The proportion of children with inhaled corticosteroid prescriptions decreased with successive decreases in neighborhood income. The socioeconomic gradient in the likelihood of an inhaled corticosteroid prescription was most evident among children with mild-moderate asthma who were not in the care of an asthma specialist. In conclusion, a socioeconomic gradient in the use of inhaled corticosteroids prescriptions can be found among children with universal access to healthcare and drug insurance.

Administration, Inhalation↗

PubMed2002

Development of a drug treatment-based severity measure in childhood asthma.

Valid measures of severity are crucial in asthma pharmacoepidemiological research. This study reports the development and validation of a severity measure in childhood asthma for application to health care administrative data. A drug treatment-based asthma severity measure was developed following the stepped care approach to treatment, and this was applied to a cohort of 16,862 children who met a case definition for asthma drug prescription use between January 1995 and March 1996. Assessments were made of the measure's reliability, validity, and responsiveness to change over time. The drug treatment-based asthma severity measure classified 42% of children as having mild asthma, 37% as having moderate asthma, 19% as having moderate-severe asthma, and 2% as having severe asthma. Agreement on severity classification between two successive time periods was excellent (kappa = 0.82). Children classified as having severe asthma were significantly more likely than children with mild-moderate asthma to have previous asthma hospitalizations, to visit asthma specialists, to have high physician utilization, and to require hospital critical care. They were more likely to be reclassified as having severe asthma 2 years later. These findings show that a drug treatment-based severity measure in childhood asthma, which can be applied to prescription data, has good reliability and validity, and is responsive to changes in asthma severity over time.

Administration, Inhalation↗

PubMedDate not supplied

Assessing health status in Manitoba children: acute and chronic conditions.

BACKGROUND: Numerous child health status measures have been developed, ranging from assessments of physical and mental health to activity continuums. Our objective was to report the regional distribution of physical morbidity among children in Manitoba. METHODS: Using Manitoba's population-based prescription and health care data for 1998/99, the prevalence of children with lower respiratory tract infections, four chronic conditions (asthma, cardiovascular disease, Type 1 diabetes mellitus and seizure disorders) and physical disabilities, including spina bifida and cerebral palsy, was determined for 12 Regional Health Authorities and 12 Winnipeg Community Areas, ranked by a measure of population healthiness, the premature mortality rate (PMR). Prescription rates were also reported by neighbourhood income quintile, derived from census data. RESULTS: Hospitalization for lower respiratory tract infection was highest in infants (6%) and increased with successive decreases in neighbourhood income or in the population healthiness of a region. On the basis of a physician diagnosis or prescription drug for asthma, 10% of school-age children had asthma. Asthma treatment rates in northern Manitoba were substantially lower than in Winnipeg. Treatment rates for cardiovascular conditions, Type I diabetes and seizure disorders approached 1% in adolescents and there were no regional differences in the distribution of these conditions. The prevalence of physical disability was highest in northern Manitoba. CONCLUSION: A minority of Manitoba children suffer from chronic and serious acute health problems in childhood, but the burden of illness is not evenly distributed among children.

Acute Disease↗

PubMedDate not supplied

Prescription medications in Manitoba children: are there regional differences?

BACKGROUND: Population-based studies of pharmaceutical use in children provide information on disease prevalence, physician practice and adherence to treatment. We undertook an evaluation of regional differences in prescription drug use by Manitoba children. METHODS: Using Manitoba's population-based prescription data for 1998/99, the prevalence of children receiving prescriptions for antibiotics, analgesics, iron supplements, and four classes of psychotropic drugs was reported for Regional Health Authorities and Winnipeg Community Areas, ranked by a measure of population healthiness, the premature mortality rate (PMR). Prevalence rates were also reported by census-based neighbourhood income areas. RESULTS: 60% of children received at least one prescription in 1998/99. Antibiotics, antiasthmatics, analgesics, antidepressants, and psychostimulants were the most commonly dispensed drugs. Prescription use of antibiotics, iron supplements, analgesics, antidepressants, antipsychotics and anxiolytics was highest in low income, urban neighbourhoods. Few associations between a region's PMR and prescription utilization were observed, but children living in regions with the least healthy populations were more likely to use antibiotics, non-steroidal anti-inflammatory drugs and anxiolytics. Psychostimulant use was unrelated to neighbourhood income, but highest rates were documented in some of the healthiest Winnipeg neighbourhoods. CONCLUSION: We documented regional variation in prescription use which may be related to differences in health, physician practice or child use.

Adolescent↗

PubMedDate not supplied

Community resources and determinants of the future health of Manitobans.

BACKGROUND: Life history studies in health show that some of the key determinants of health inequalities lie in biological and social experiences at the earliest times of life. The objectives of this research were to describe the regional distribution of childhood determinants of adult health, such as school achievement, and the environments which contribute to their development. METHODS: Using Manitoba data from the National Population Health Survey, the National Longitudinal Survey on Children and Youth, the Department of Education, Training and Youth, the Department of Family Services and Housing, the Library Association website and the Agriculture and Food website, the regional distribution of Grade 3 standards test scores and neighbourhood resources such as child care services, libraries, sports participation and food costs were determined for 12 Regional Health Authorities and 12 Winnipeg Community Areas, ranked by a measure of population healthiness, the premature mortality rate. Findings were also reported by income level and larger geographic regions. RESULTS: Children living in neighbourhoods with less healthy populations were more likely to have poorer school performance, as indicated by Grade 3 math standards test scores. They were-also more likely to change schools, less likely to participate in sports, and had decreased access to affordable food and licenced day care. They had similar access to library books as children living in more healthy neighbourhoods, although book lending rates were not measured. CONCLUSION: We documented regional variation in the availability of resources to support healthy childhood development.

Child↗