Browsing by Author "Turin, Tanvir Chowdhury"
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Item Open Access Acute Care Surgery Outcomes(2019-05-15) Al-Busaidi, Omar Mohammed; Kortbeek, John Barry; Ball, Chad Geoffrey G.; Stelfox, Henry Thomas; Austen, Lea; Turin, Tanvir ChowdhuryIntroduction: The acute care surgery (ACS) model was initiated two decades ago to address issues of availability, timeliness and quality in emergency general surgery care. Previous publications were retrospective, single centred and lacked specific information about morbidity and mortality rates of common ACS procedures. Given that ACS is an evolving model and that the full impact of its implementation is not yet fully understood, we studied the effect of ACS implementation on morbidity and mortality. Methods: Part I, a systematic review and meta-analysis of outcome studies of appendectomies and cholecystectomies before and after the implementation of ACS. Part II, a prospective analysis of ACS post-operative morbidities and mortality in 8 high-volume centres (excluding trauma) was performed. The evaluation was conducted over a 30-day period. Results: In part I, of 1704 studies, 27 studies were selected for analysis. Following ACS introduction, the overall complication rate was significantly reduced in both appendectomy and cholecystectomy (Risk ratios = 0.7; 95% CI 0.57 to 0.85 and RR=0.6; 95% CI 0.40 to 0.94) respectively. Length of stay and time to operate were significantly reduced in both groups. In part II, there were a total of 601 post-operative patients who were followed for up to a period of 30 days. Of those, 66% of the procedures were laparoscopic. The overall complication rate was 34% and mortality was 2%. In open procedures, the morbidity rate was 73%. Conclusions: The implementation of the ACS model was associated with a significant reduction in morbidity and mortality in patients’ with appendicitis and cholecystitis. ACS patients continue to represent a high-risk population. Appropriate hospital and system resources are essential for successful implementation of the ACS model. Keywords: Acute care surgery, ACS, appendectomy, cholecystectomy. MorbidityItem Open Access Associations between Neighbourhood Built Environment and Leisure and Transportation Physical Activity among Canadian-Born Residents and Recent and Established Immigrants in Canada(2024-10-22) Masihay Akbar, Hasti; McCormack, Gavin Robert; Turin, Tanvir Chowdhury; Olstad, Dana LeeDespite well-established health benefits, nearly half of adults in Canada do not engage in enough physical activity for optimal health benefits. In Canada there are differences in physical activity levels among immigrants and non-immigrants. The built environment has the potential to reduce or widen inequalities if its effects on physical activity differ among population subgroups. While evidence has highlighted potential differences in how the built environment is associated with physical activity across various population subgroups, some equity-seeking groups, such as immigrants, have received little research attention. Globally, most studies examining this association among immigrants have been conducted in the U.S., with inconsistent findings. The study presented in this thesis addresses these knowledge gaps, guided by two relevant theoretical perspectives, including the socioecological model and acculturation theory. The aim of this research was to generate novel evidence regarding the associations between the neighbourhood built environment, specifically objectively-measured walkability, and physical activity according to residency status (Canadian-born, recent immigrants, and established immigrants). Our objectives were 1) to estimate and compare TPA and LPA participation and duration between Canadian-born, recent and established immigrant adults and determine whether neighbourhood walkability accounts for any observed residency group differences, and 2) to estimate and compare the direction and magnitude of associations between neighbourhood walkability and TPA and LPA participation and duration between these groups. The study included cross-sectional analysis of nationally representative data from Canadian Community Health survey (CCHS 2017-2018) linked with 2016 Can-ALE data. We found that recent and established immigrants were more likely than Canadian-born to participate in TPA, but these differences attenuated after controlling for walkability. Moreover, recent and established immigrants were less likely to participate in LPA and undertook fewer LPA minutes, compared to Canadian-born individuals. However, the differences in LPA minutes attenuated after controlling for walkability. Walkability was positively associated with TPA participation and duration in all residency status groups, but the magnitude of these associations differed between these groups. Findings from this thesis suggest that improving neighbourhood walkability could have broad public health benefits, but tailored strategies are essential to address the needs of immigrant populations.Item Open Access Development of a Clinical Risk Prediction Tool for Early Mortality After Dialysis Initiation Among Older Adults(2015-11-12) Wick, James; Hemmelgarn, Brenda; Turin, Tanvir ChowdhuryBackground: Early mortality after dialysis initiation is common among older adults. Information on an individual’s risk of death may influence the decision to initiate dialysis. Objective: To develop a clinical risk prediction tool for mortality within six and twelve months of dialysis initiation, for older adults. Methods: Eligible individuals were adults age ≥65 who initiated chronic dialysis between May 1, 2003 and March 31, 2012. Measures of demographics, laboratory values, health-usage and comorbidity were potential predictors of early mortality. We used logistic regression to predict mortality, and created a point score system. Results: The six- and twelve-month tools included age, glomerular filtration rate, atrial fibrillation, lymphoma, chronic heart failure, prior hospitalization and metastatic cancer. Cirrhosis and late referral to nephrologist were also in the twelve-month score. Model discrimination was 0.72 for each outcome. Conclusion: These tools may aide decision making for older adults considering dialysis.Item Open Access Polymorphisms in PPAR Genes (PPARD, PPARG, and PPARGC1A) and the Risk of Chronic Kidney Disease in Japanese: Cross-Sectional Data from the J-MICC Study(2013-10-27) Hishida, Asahi; Wakai, Kenji; Naito, Mariko; Tamura, Takashi; Kawai, Sayo; Hamajima, Nobuyuki; Oze, Isao; Imaizumi, Takeshi; Turin, Tanvir Chowdhury; Suzuki, Sadao; Kheradmand, Motahare; Mikami, Haruo; Ohnaka, Keizo; Watanabe, Yoshiyuki; Arisawa, Kokichi; Kubo, Michiaki; Tanaka, HideoChronic kidney disease (CKD) is well known as a strong risk factor for both end stage renal disease and cardiovascular disease. To clarify the association of polymorphisms in the PPAR genes (PPARD, PPARG, and PPARGC1A) with the risk of CKD in Japanese, we examined this association among the Japanese subjects using the cross-sectional data of J-MICC (Japan Multi-Institutional Collaborative Cohort) Study. The subjects for this analysis were 3,285 men and women, aged 35–69 years, selected from J-MICC Study participants; genotyping was conducted by multiplex polymerase chain reaction-based Invader assay. The prevalence of CKD was determined for CKD stages 3–5 (defined as eGFR ud_less_than 60 ml/min/1.73 m2). Participants with CKD accounted for 17.3% of the study population. When those with PPARD T-842C T/T were defined as reference, those with PPARD T-842C T/C and C/C demonstrated the OR for CKD of 1.26 (95%CI 1.04–1.53) and 1.31 (95%CI 0.83–2.06), respectively. There were no significant associations between the polymorphisms in other PPAR genes and the risk of CKD. The present study found a significantly increased risk of CKD in those with the C allele of PPARD T-842C, which may suggest the possibility of personalized risk estimation of this life-limiting disease in the near future.