Introduction The aim of this study is to assess population health and to conduct a cross-country comparison across 15 countries using EQ-5D-5L outcomes in relation to macro-level indicators. Methods With data arising from the EQ-DAPHNIE project, descriptive EQ-5D-5L outcomes were calculated by country for the total population, sex and seven age groups. Population health is presented and compared across countries measured by the five EQ-5D-5L dimension scores, EQ VAS scores and EQ-5D-5L values. Cross-country comparison of EQ-5D-5L outcomes with macro-level indicators was assessed for economic, socioeconomic and health systems indicators. Results Data were collected for representative samples in 15 countries (N = 67,178). Mobility, usual activities and pain/discomfort showed increasing problems with age, while problems with anxiety/depression decreased with age. Mean EQ VAS scores ranged from 70.0 in the United Kingdom (UK) to 80.1 in China, while mean EQ-5D-5L values ranged from 0.76 in the UK to 0.92 in China. Female participants consistently reported lower self-reported health. Spearman correlations revealed significant associations between GDP per capita, median income, Gini index and health expenditure per capita and all EQ-5D-5L outcomes except anxiety/depression, indicating that populations in wealthier, higher-spending and more equal countries reported worse self-reported health. Discussion Similarities and differences between the 15 countries demonstrate the relevance of assessing and interpreting population health across countries. Non-traditional age and socioeconomic gradients were observed, which may be interpreted within the context of the global epidemiological transition, characterized by increasing mental problems, especially in younger populations, and rising rates of non-communicable diseases in wealthier countries.

Background:We aimed to compare health-related quality of life (HRQL) using a disease-specific and a generic instrument in children after complex cardiac surgery in early infancy. Methods:A prospectively followed inception cohort of children having complex cardiac surgery at age ≤6 weeks had HRQL assessed at age 4-5 years using Pediatric Quality of Life Inventory (PedsQL) 3.0 Cardiac Module. Scores were compared with the PedsQL Generic Core Scales in the same population. Predictors of Cardiac Module dimensions were determined by univariate and multivariate linear regression, with P ≤ 0.05 considered statistically significant. Results:Among 425 patients who had the PedsQL 3.0 Cardiac Module, the HRQL mean (standard deviation) scale scores were as follows: Heart Problems and Treatment, 78.7 (19.0); Treatment II, 94.5 (15.2); Perceived Physical Appearance, 93.6 (13.9); Treatment Anxiety, 71.1 (29.5); Cognitive Problems, 67.3 (22.7); and Communication, 67.5 (31.2). Correlations between Cardiac Module and Generic Core Scales were as follows: Heart Problems and Treatment × Physical Functioning 0.57; Perceived Physical Appearance × Psychosocial Summary 0.21; Cognitive Problems × School Functioning 0.48; Treatment Anxiety × Physical Functioning 0.38; and Communication × School Functioning 0.30. Thirteen predictor variables were independently associated with at least 1 dimension of the Cardiac Module, and these only partially overlapped with independent predictors of Generic Core Scale summary scores. Conclusions:The Cardiac Module measured a different HRQL construct than the Generic Core Scales, reflected by low correlations among scores and different independent predictors in the same population of children. Future studies should determine the relation of these scores with longer-term outcomes including school achievement, mental health, and well-being.

Generic patient-reported outcome measures (PROMs) are increasingly being implemented in health systems for routine outcome measurement. Their ability to screen for anxiety and depression could serve as an added benefit. This study aims to assess the screening ability of selected EQ-5D-5L, EQ-HWB, and PROMIS-10 items for anxiety and depression, using self-reported diagnostic history of these conditions, relative to established PHQ-2 and GAD-2 screeners, in general adult populations across 15 countries. Cross-sectional data from “EuroQol Data for Assessment of Population Health Needs and Instrument Evaluation (EQ-DAPHNIE)” project was used. The following countries were included in the analysis: Argentina, Australia, Brazil, Canada, Chile, China, France, Germany, Japan, Mexico, Netherlands, New Zealand, Spain, the United Kingdom (UK), and the United States (US). A sample size of 4500 was planned per country. Sample quotas for age, sex, income, and urban/rural area were based on census or national data in each country. The performance of specific mental health items of the EQ-5D-5L, EQ-Health and Wellbeing (EQ-HWB), Patient-Reported Outcomes Measurement Information System Scale v1.2 – Global Health (PROMIS-10), Generalized Anxiety Disorder 2-item questionnaire (GAD-2), and Patient Health Questionnaire 2-item version (PHQ-2) were compared to self-reported diagnostic history of anxiety or depression. Performance of EQ-5D-5L, EQ-HWB, PROMIS-10, GAD-2, and PHQ-2 in screening for anxiety and depression was evaluated using area under receiver operating curve (AUROC) analysis A total of 68,419 respondents from 15 countries completed surveys. Brazil had the highest percentage of self-reported anxiety diagnoses (29.6

Patient and public involvement and engagement (PPIE) is crucial for developing patient-centered healthcare research and improving health outcomes. While patient-reported outcome measures (PROMs) capture patients’ perspectives, meaningfully engaging patients in PROMs initiatives remains a challenge. This short report details the establishment and evolution of the Alberta PROMs and EQ-5D Research and Support Unit Patient Engagement Network (APERSU-PEN), a unique model designed to embed patient expertise and share practices throughout patient communities. Unlike many patient engagement groups focused on specific conditions, APERSU-PEN broadly integrates patient perspectives across the healthcare system. The network intentionally recruited experienced patient partners with advocacy and research backgrounds from targeted health and patient organizations. This approach enabled diverse representation and facilitated broad dissemination of PROMs awareness to various patient communities. This broad integration has most recently supported PROMs use in primary care. Key activities include the co-development of patient-friendly PROMs educational materials and active contributions sharing PROMs stories and experiences at various forums, supporting patient understanding and aiming to improve completion rates. The paper highlights challenges and their solutions, such as the broad scope of APERSU’s work, which was addressed by building this network. A critical success factor has been dedicated funding for the involvement of patients as partners, ensuring sustainable engagement and participation in external events. Flexible meeting options and cloud-based document sharing also accommodate busy schedules and geographical dispersion. APERSU-PEN exemplifies a transformative shift in healthcare culture and practice, where patients are recognized as “true end-users” of PROMs. This environment of mutual learning and respect between patients and researchers enhances the relevance and impact of PROMs. The model offers transferable guidance for other initiatives seeking to integrate PPIE meaningfully, ultimately increasing awareness of PROMs throughout patient communities. Future directions include evaluating member experiences and expanding diversity within the network to further strengthen patient engagement in PROMs and APERSU’s support services.

Objectives The roles of pharmacy staff have expanded to include public health functions, such as delivering harm reduction services for people who use drugs (PWUD), particularly unregulated substances and non-medical drug use, in response to an ongoing drug overdose crisis. Nonetheless, their involvement across the full spectrum of harm reduction services remains underexplored. This study mapped existing research describing or evaluating the implementation of harm reduction services for PWUD provided by pharmacy staff.Design Scoping review.Data sources MEDLINE, EMBASE, CINAHL, Web of Science, Scopus and Cochrane Library (inception to July 2025).Study selection Studies reporting on the description or evaluation of harm reduction services for PWUD provided by pharmacy staff.Data extraction Two team members screened studies for eligibility and extracted the data. The data were analysed primarily to describe harm reduction services and the role of pharmacy staff.Results 43 articles were included. The most frequently reported harm reduction services were sexually transmitted and blood-borne infection care (33%), needle and syringe programmes (21%), naloxone distribution (19%) and medication treatment for opioid use disorder (19%). Pharmacy staff were integrated into multidisciplinary teams (79%), with their roles varying from education to medication prescribing. Included studies reported harm reduction services for PWUD delivered by pharmacy staff as effective, feasible and safe. However, implementations were not tailored to equity-deserving populations. Services primarily addressed opioid-related harms, while strategies focusing on the use of non-opioid substances were limited.Conclusion This scoping review highlights the diverse roles pharmacy staff play in delivering harm reduction services for PWUD. Positioned at the intersection of accessibility and healthcare delivery, pharmacy staff are ideally situated to expand access to equitable care. To fully harness this potential, future research and practice should embed harm reduction as a core philosophy, extending beyond individual interventions to support the creation of person-centred, non-judgmental and low-barrier services.

The novel Coronavirus Disease 2019 (COVID-19) can have lasting physical and psychological outcomes, though little is known about the long-term impact of COVID-19 on the health-related quality of life (HRQoL) of Canadians. The aim of this study is to estimate the impacts of testing positive for COVID-19 using the EQ-5D-5 L instrument. Our study is a secondary analysis of data collected in the Alberta POST-COVID-19 Follow-up Study, linking survey responses to administrative health data. The data included 11,705 individuals tested for COVID-19 in Alberta from October 2021 to September 2023. Survey data included test results, age, sex, and EQ-5D-5 L response. Linked administrative data included socioeconomic status, comorbidities, hospital, and intensive care unit admissions. We used linear regression to estimate differences in HRQoL pre- and post-COVID-19 testing and ordinal logistic regression to estimate the odds of worsening HRQoL in each of the EQ-5D domains. COVID-19-positive individuals were younger (mean 48.5 vs. 53.4 years), more often female (64.4

BACKGROUND:The RADAR (Reorganizing the Approach to Diabetes through the Application of Registries) project was launched to enhance type 2 diabetes (T2D) care and outcomes in on-reserve First Nations communities in Alberta, Canada. The objective of this study is to determine whether previously observed improvements in diabetes care outcomes were sustained over time in the communities that continued the program (continued communities) and whether these improvements were reproducible in new communities. METHODS:RADAR involved an innovative, culturally contextually grounded care model designed for First Nations people, which was deployed in a stepped-wedge design to communities. The primary outcome was a 10% improvement or persistence at target in A1C, systolic blood pressure (SBP), and/or LDL, using the intention-to-treat (ITT) framework. Outcomes were assessed in 3 continued communities at 3-, 4-, and 6- years post-implementation of the RADAR program. We provided the same intervention to 2 new communities and assessed outcomes at 1 year post-implementation (repeatability assessment). RESULTS:In 2024, 256 T2D patients were registered in RADAR, ranging from 28 to 86 individuals per community. The average age was 61 years (SD=11.7) with 57% females (N = 145). ITT analysis showed all 3 continued communities maintained high rates of primary endpoint achievement, with 94%, 100% and 92% of participants in each community achieving the primary endpoint (n = 174), respectively, relative to baseline (p < 0.001). After 1 year of RADAR in the 2 new communities (n = 28 and n = 54), the ITT combined endpoint was achieved in 82% and 91% of participants, respectively (p < 0.001). CONCLUSION:RADAR continues to be associated with high levels of achievement of the primary combined endpoint across communities and over time. This study shows promise that future RADAR implementation could be adapted, in collaboration with First Nation Health Managers, to other First Nations community settings.

Methods for collecting self-reported health status measures in population health surveys vary significantly across countries, presenting challenges to comparability. The EuroQol Data for Assessment of Population Health Needs and Instrument Evaluation (EQ-DAPHNIE) project aims to address this issue by developing infrastructure to generate representative datasets across multiple countries. This initiative aims to standardize data collection methodologies and to evaluate the performance of various health status measures, providing a foundation for reliable population health assessments. This paper describes the rationale, design and data collection methods for the EQ-DAPHNIE project. EQ-DAPHNIE employs a cross-sectional online survey design targeting the general adult population across various countries. Participants were recruited through an online panel provider. Each country had a target sample of 4500 responses, with quota sampling to ensure representativeness based on age, sex, income, region, and language. The survey collected comprehensive data on social determinants of health at both individual and neighbourhood levels. Participation was voluntary, and measures were taken to maintain data anonymity and ensure data quality through pre-testing and various quality assurance approaches. The EQ-DAPHNIE project represents a significant advancement in generating large, representative, and comparable population health datasets across multiple countries. By employing precise sampling strategies, robust recruitment and data collection methods, and rigorous quality control measures, the project aims to provide a valuable resource for assessing and understanding population health and evaluating various health-related quality of life (HRQoL) and wellbeing instruments.

Objectives:Osteoarthritis (OA) is a leading cause of total knee arthroplasty (TKA), affecting over 15 % of Canadians. With an aging population and suboptimal use of non-surgical options, TKA rates and wait times are rising. Although TKA is effective, 30 % of patients are dissatisfied due to unmet expectations, suggesting some surgeries may be inappropriate. Patient decision aids can set realistic expectations, improve decision quality, and enhance satisfaction. We developed an individualized online patient decision aid allowing patients to compare treatment outcomes based on similar characteristics (age, sex and body mass index) and evaluated its usability before clinical implementation. Methods:Participants were recruited from a high-volume urban hip and knee clinic. Eligible adults diagnosed with knee OA completed the decision aid online and subsequently filled out demographics and survey forms, including the Preparation for Decision Making Scale (PDMS), System Usability Scale (SUS), and Acceptability Scale. Data were analyzed using descriptive statistics and content analysis of open-ended responses. Results:There were 20 participants (mean age 68 years, 65 % female). The average PDMS score was 66.4, indicating above-average preparedness for decision-making. The SUS score averaged 63.4, suggesting marginal usability. Females and participants under 70 years reported higher PDMS and SUS scores. Most participants rated the information presentation as "good" or "excellent," with 75 % finding the decision aid's length appropriate and information balanced. Feedback highlighted the need to simplify content, reduce variables, and offer the aid earlier in treatment. Conclusions:The decision aid demonstrated reasonable usability, acceptability, and usefulness for routine practice. Future research should explore its impact on long-term patient outcomes and satisfaction, including among non-surgical populations. Practice implications:Incorporating this decision aid into routine practice can help patients set realistic expectations and make informed decisions, reducing dissatisfaction. Offering it earlier in the patient journey may enhance its impact, especially for non-surgical options.

Background Health-Related Quality of Life (HRQL) is an important outcome measure in pediatrics. We aimed to determine HRQL of children who underwent complex cardiac surgery at age ≤6 weeks with follow-up at age 4-5-years. Methods We prospectively followed an inception-cohort of children after complex cardiac surgery (CCS) performed at age ≤6 weeks at Stollery Children’s Hospital between 2000-2014. At the 4-5-year follow-up visit, parents completed the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL). Scores were compared to a normative healthy population and to children with chronic illness of a similar age. Predictors of PedsQL scores were determined using univariate and multiple linear regressions, with p≤0.05 considered statistically significant. Results Of 712 children having CCS at ≤6 weeks of life, 119 (16.7%) died and 140 did not complete the HRQL questionnaire (for multiple reasons), leaving 453/593 (76.4%) of survivors included. At 4-5-year follow-up PedsQL total score (mean 79.5, SD 16.3) was significantly lower than the healthy normative population (mean 87.4, SD 12.7), and similar to children with chronic illness (mean 76.0, SD 19.3). Patients after single ventricle palliation had significantly lower PedsQL total score (mean 72.8, SD 17.1) than those after biventricular repairs (mean 82.4, SD 15.1). Independent risk factors for lower PedsQL scores consistently included single ventricle palliation, chromosomal abnormality, extracorporeal membrane oxygenation, and the number of non-cardiac hospitalizations. Conclusion The HRQL of children who had CCS in early infancy is lower than that of healthy children, but similar to children with other chronic illnesses.

Introduction:Unhealthy diet and dyslipidemia are major risk factors for cardiovascular disease (CVD). Studies have shown an inverse association between greater n-3 fatty acid (FA) intake and reduced dyslipidemia and CVD risk. We aimed to assess the association of the healthy eating index (HEI) score and n-3 FA intake with CVD incidence and non-fasting RC in the Alberta's Tomorrow Project (ATP) cohort. Methods:This is a prospective study on a subset of ATP study participants (n = 23,248), with the mean age of 50.2 (35-69) years, 36% male and 64% female, and no history of cancer or CVD in Alberta, Canada. Dietary intake was assessed using the Canadian Diet History Questionnaire (CDHQ), from which the Canadian HEI-2005 score and total n-3 FA intake were calculated. Lipid panel markers were measured from non-fasting blood samples, and CVD was defined using the International Statistical Classification of Diseases and Related Health Problems from linked administrative health records. The Cox proportional hazard model, linear regression, and logistic regression were used to assess the association of dietary intakes with CVD incidence, and lipid biomarkers. Results:The mean follow-up was 13.9 years. For every 1 unit increase in the HEI score, the adjusted Hazard Ratio (HR) of developing CVD decreased [HR: 0.98 (95% confidence interval (CI) 0.97-0.98), 0.99 (95%CI 0.98-0.99), and 0.97 (95%CI 0.97-0.98) in females, males, and total cohort, respectively (p < 0.05)]. No significant association was found between absolute n-3 FA intake (g/d) with CVD incidence. However, higher relative intake (i.e., n-3 FA as proportion of energy) increased the risk of developing CVD [HR = 1.42 (95%CI 1.1-1.84), p = 0.006] in males. Adjusted multivariate regression in a subset (n = 8,458) showed no association between n-3 FA (g/d) intake and lipid biomarkers but a significant inverse association between HEI score and non-fasting RC [coefficient: -0.006 (95%CI -0.009--0.003) for females and -0.01 (95%CI -0.018--0.005) for males], and TG levels [-0.01 (95%CI -0.015--0.006) for females and -0.01 (95%CI -0.02--0.006) for males]. Discussion:Higher overall diet quality but not n-3 FA intake was associated with a lower risk of CVD incidence and non-fasting RC.

Patient-reported outcome measures (PROMs) are valuable tools for evaluating outcomes of healthcare interventions and have been increasingly used in health systems around the world. While PROMs adoption has grown globally, variations exist in their use across the health system. This stakeholder engagement and consultation activity aims to understand factors impacting PROMs adoption, implementation, and utilization, and identify strategies for enhancing utilization of PROMs data within the healthcare system in Alberta, Canada. Key stakeholders from various roles were interviewed, including PROMs programs, health system improvement, data analytics, clinical practice, evaluation, health economics, and research, from diverse clinical areas, including cancer, primary care, epilepsy, rehabilitation, arthroplasty, cardiovascular surgery, and rheumatology. Interviews were recorded, transcribed and analyzed using thematic analysis. Results were synthesized using the Consolidated Framework for Implementation Research (CFIR) and Diffusion of Innovation Framework (DOI). A total of 25 interviews, lasting between 45 and 60 minutes, were completed. Factors impacting the adoption, implementation and utilization of PROMs within the Alberta healthcare system included: (1) Intervention characteristics: shared understanding of PROMs, challenges in capturing relevant patient outcomes, standardization and integration of PROMs, modalities of data collection, making PROMs actionable at the patient-clinician level, and interpreting PROMs data; (2) Inner setting: Cultural shift towards patient-centered care, change management and clinician mindset, organizational commitment and support, integration into broader measurement frameworks, access to PROMs data, potential for replication and adaptation, and importance of incentives and requirements; (3) Outer setting: Resource constraints, policy and systemic challenges, focus on value-based care, and responsible use of PROMs data; (4) Characteristics of individuals: Expertise and understanding of PROMs, and stakeholder engagement and education; and (5) Process: Balancing bottom-up and top-down approaches, workflow integration, patient engagement, and continuous evaluation and quality improvement. The study highlights factors influencing PROMs adoption in Alberta, including the need for a unified understanding, workflow integration, and electronic data use. Key strategies involve fostering patient-centered care, ensuring organizational support, addressing resource and policy issues, and providing targeted education. Engaging early adopters and offering incentives can improve PROMs integration and patient outcomes.

ABSTRACT Background and Aims Patient‐reported outcome measures (PROMs) are increasingly used in primary care practices; however, the broad characteristics of this population pose unique challenges. Generic PROMs (e.g., EQ‐5D‐5L) measure general health status from the patient's perspective, contributing towards a comprehensive evaluation of health programming. This study describes the integration of the EQ‐5D‐5L within program evaluation in primary care in Alberta, Canada, using two program examples. Methods A retrospective, longitudinal, observational design was used. The Edmonton O‐day'min Primary Care Network (EOPCN) routinely collects the EQ‐5D‐5L in their exercise and active living and nutrition programs. Data collected between January 1, 2021 and March 31, 2022 was analyzed descriptively, by dimension, index, and visual analog scale (VAS) scores. Minimally important differences were used to interpret index (0.04) and VAS scores (7.0) and the Pareto Classification of Health Change was applied to the dimensions. Effect size of change in index and VAS scores and population comparisons were examined. Results In the exercise and active living program (n = 301), 72% were female with a mean age of 57 (±16) years, and 90.2% reported any problems (levels 2–5) in pain/discomfort. The mean index and VAS scores were 0.74 (±0.18) and 66.5 (±18.9), respectively. Among those with repeated measurement (n = 112), the greatest improvement was in usual activities (17%); the greatest deterioration was in pain/discomfort (25%). In the nutrition program (n = 573), 71% were female with a mean age of 50 (±17) years, and 75.9% reported any problems in pain/discomfort. The mean index and VAS scores were 0.77 (±0.19) and 70.1 (±15.6), respectively. Among those with repeated measurement (n = 212), the greatest improvement was in anxiety/depression (16%); the greatest deterioration was in pain/discomfort (26%). In both, health status was lower than the general Alberta population norms. No baseline characteristics were found to be statistically significant. Conclusion These results inform future programming, to help patient needs.

Objective: To evaluate the incremental cost-effectiveness and cost-utility ratios (ICER; ICUR) of a single-layer high compression bandage (SLHCB) compared with Unna's boot (UB) from the perspective of the Brazilian healthcare system, with a time horizon of 26 weeks. Method: A health economic evaluation of data from a prospective, randomised, open blinded endpoint study was conducted in 22 primary healthcare services in Porto Alegre city, Brazil, with patients with venous leg ulcers (VLUs) who were randomly allocated to receive SLHCB or UB. Participants were followed until VLU healing or up to 26 weeks. Nurses performed dressings weekly and blinded examiners measured the VLU size by planimetry at baseline and every two weeks. The Short Form-6 Dimensions questionnaire was applied at baseline and on the last day of follow-up to measure quality-adjusted life years (QALYs). The ICER and ICUR were estimated, and probabilistic sensitivity analyses performed. Results: A total of 61 participants were enrolled in the trial, corresponding to 110 VLUs. SLHCB incurred an average expenditure of R$1118.74 (I$442.19) per VLU, while UB incurred R$1078.74 (I$426.38) per VLU. SLHCB exhibited a mean VLU reduction of 64.82% compared with 27.56% for UB. The mean QALY for SLHCB was 0.187 and 0.164 for UB. The ICER was 1.07 (0.42) per percentage point of VLUs healed and the ICUR was 1739.13 (687.40) per QALY gained. Conclusion: In this study, SLHCB was cost-effective when compared with UB. These findings may prompt decision-makers to weigh the prospect of allocating an additional R$1.07 (I$0.42) for each percentage point reduction in VLU area or R$1739.13 (I$687.40) per QALY gained. This financial consideration holds significant implications for guiding resource allocation.

Recent clinical trials suggest benefit of anti-hyperglycemic drugs on kidney outcomes. However, there is a paucity of information available on the real-world impact.We aimed to study the real-world impact of anti-hyperglycemic drugs (metformin, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, and glucagon-like peptide-1receptor (GLP-1R) agonists) using a cohort of patients with incident diabetes derived from the Alberta Tomorrow Project (ATP) database. A retrospective cohort was created from the ATP database using administrative data from October 1, 2000, to March 31, 2021. We examined the effect of anti-hyperglycemic medications including metformin (as a control), SGLT-2 inhibitors, DPP-4 inhibitors, and GLP-1R agonists on a composite kidney outcome including chronic kidney disease, kidney failure, dialysis, kidney transplant, and kidney-related death using a Cox-regression analysis. The study included 3001 patients with an incident diagnosis of diabetes. The average follow-up was 6.7 ± 4.6 years after diagnosis, and 628 (20.9%) patients reached the composite outcome with a mean of 5.6 ± 4.2 years to the first event. A total of 1749 (58.8%) patients were on metformin, 360 (12.0%) on SGLT-2 inhibitors, 313 (10.4%) on DPP-4 inhibitors, and 188 (6.3%) on GLP-1R agonists. Only the patients prescribed SGLT-2 inhibitors had a significant reduction in the composite outcome (hazard ratio (HR) 0.23, 95% CI 0.09-0.62, P -value = .003), and a dose-related effect was observed. Our study has shown that SGLT-2 inhibitors result in significant reduction of composite kidney outcomes, including chronic kidney disease, suggesting a renally protective effect over long term.

To characterize the association between metformin use and risk of total joint replacement in patients with diabetes using data from Alberta’s Tomorrow Project (ATP), a population-based cohort study of chronic diseases in Alberta, Canada. The ATP participants with incidence of diabetes after enrollment were included and followed up to March 31, 2021. Metformin use, including daily doses, was measured by a time-varying approach during the follow-up. A multivariable Cox regression model was used to characterize the association between metformin use and risk of total joint replacement, after controlling for time-related variation in drug use, clinical status, BMI, lifestyles and concurrent medications. Among 3,001 incident cases of diabetes (52

Canada has one of the highest rates of Type 1 diabetes in children. Management of their diabetes and prevention of poor health outcomes often falls on mothers who are often the primary caregiver. The caregiving demands can result in substantial responsibility and stress. Mothers report career sacrifices, sleep deprivation, stress, grief, anxiety, and low mood. While globally Canada has a high rate of type 1 diabetes, studies on the caregiving experience within a Canadian context have not been conducted. This study explored the experiences of mothers of children with type 1 diabetes in northern Alberta, Canada. Utilizing a qualitative descriptive approach, we interviewed 16 mothers (average age = 37.1 ± 6) with children with type 1 diabetes who were under the age of 18. We also drew upon a caregiver engagement in research approach to create a Community Advisory Committee of three mothers of children with diabetes. Advisory members collaborated with us and offered invaluable insight and feedback throughout the study. Using reflexive thematic analysis, six interrelated themes were identified: (a) “I am the organ”: a sense of constant vigilance, (b) accepting a new normal, (c) grief underlying a rollercoaster of emotions, (d) caregiving as an isolating experience, (e) the continuous glucose monitor is a champion, and (f) finding the positives. Mothers face constant vigilance and anxiety, often feeling like their child’s “organ” for survival. They view caregiving as an isolating experience with limited understanding and assumptions from people without children with type 1 diabetes. Grief persists several years post diagnosis, intertwined with concerns and worries for the health and future of their children. New routines revolved around caretaking duties result in the acceptance of lifestyle changes and shifts in priorities. Caring for a child with type 1 diabetes presents many stressors for mothers. Over time, mothers gain confidence about their abilities as caregivers. They find relief in online networks and access to continuous glucose monitors, which alleviate some anxiety and sleep deprivation but also present challenges. Our findings highlight the importance of improving access to affordable technology, psychological support, and respite care to improve loss of personal time and the need for constant vigilance.

This study assessed the effects of high compression bandages and Unna's boots on health-related quality of life for venous leg ulcer treatment. A randomised clinical trial was conducted with 56 patients across 22 primary healthcare services in Brazil, between 2020 and 2023. Participants were randomly assigned to receive high compression bandages (Group A) or Unna's boots (Group B). Health-related quality of life was assessed by the six-dimensional Health State Short Form questionnaire at baseline and follow-up (venous leg ulcer healing or at 26 weeks). Descriptive analyses, and t-tests were performed. The average score change was 0.093 (+/- 0.09) (p<0.001) in Group A and 0.06 (+/- 0.1) (p=0.007) for Group B, with no difference between groups (p=0.218). For healed ulcers, Group A experienced an increase of 0.109 (+/- 0.084) (p<0.001) and Group B 0.113 (+/- 0.115) (p<0.01), with no difference between groups (p=0.914). For unhealed ulcers, the increases were 0.058 (+/- 0.098) (p=0.09) in Group A and 0.028 (+/- 0.078) (p=0.182) in Group B, with no difference between groups (p=0.441). Both treatments significantly improved participants' health-related quality of life, with no significant differences between groups, suggesting that both interventions effectively enhance quality of life.

OBJECTIVES:The Reorganizing the Approach to Diabetes through the Application of Registries (RADAR) is an innovative care model incorporating a disease registry and electronic health record tailored for First Nations people in Alberta, Canada. Given its success in improving health outcomes, this study evaluates RADAR's cost-effectiveness compared with standard diabetes care in First Nations populations with type 2 diabetes. METHODS:The United Kingdom Prospective Diabetes Study Outcomes Model 2 was used to project clinical and cost outcomes over 25 years. Demographics and clinical parameters were used as input parameters. Costs (for RADAR and complications) and utility estimates were derived from the literature. Outcome measures included life-years, quality-adjusted life-years (QALY's), and total and complication costs. Base-case analysis was conducted for eligible patients with type 2 diabetes ≥ 18 years using a Canadian payer perspective with a 25-year time horizon. Future costs and effects were discounted at 3% annually. RESULTS:RADAR clients experienced higher QALYs (12.69 vs 12.47) than those receiving baseline care. The total cost for RADAR clients (n = 516) was $3971 more per client compared with baseline care. Over the modeled time horizon, the total discounted costs (client management and complications) were higher for RADAR clients than for those receiving baseline care ($16 165 vs $14 463), yielding an incremental cost-effectiveness ratio of $8105 per QALY for RADAR users relative to baseline. CONCLUSIONS:Our analyses showed that RADAR is potentially cost-effective if the willingness-to-pay threshold of $50 000 per QALY is considered as per the Canadian Agency for Drugs and Technologies in Health guidelines, supporting its value in First Nations care.