CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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Indigenous peoples in Canada have high rates of psychological distress and suicide. We sought to assess the socioeconomic inequalities in psychological distress and suicidal behaviours, and the factors that explain them within Indigenous peoples living off-reserve. ⋯ Substantial income-related inequalities in psychological distress and suicidal behaviours exist among Indigenous peoples living off-reserve in Canada. Policies designed to address major contributing factors such as food insecurity and income may help reduce these inequalities.
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Randomized Controlled Trial
Effect of methylprednisolone on acute kidney injury in patients undergoing cardiac surgery with a cardiopulmonary bypass pump: a randomized controlled trial.
Perioperative corticosteroid use may reduce acute kidney injury. We sought to test whether methylprednisolone reduces the risk of acute kidney injury after cardiac surgery. ⋯ Intraoperative corticosteroid use did not reduce the risk of acute kidney injury in patients with a moderate-to-high risk of perioperative death who had cardiac surgery with cardiopulmonary bypass. Our results do not support the prophylactic use of steroids during cardiopulmonary bypass surgery. Trial registration: ClinicalTrials.gov, no. NCT00427388.
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Guidelines recommend nephrology referral for people with advanced non-dialysis-dependent chronic kidney disease, based mostly on survival benefits seen in retrospective studies of dialysis patients, which may not be generalizable to the broader population with chronic kidney disease. We aimed to examine the association between outpatient nephrology consultation and survival in adults with stage 4 chronic kidney disease. ⋯ The survival benefit of nephrology consultation in adults with stage 4 chronic kidney disease may be smaller than expected and appears to attenuate with increasing age. These findings should inform recommendations for nephrology referral considering the advanced age of the patient population meeting current referral criteria.
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Comparative Study
A disease-specific comorbidity index for predicting mortality in patients admitted to hospital with a cardiac condition.
Comorbidity indexes derived from administrative databases are essential tools of research in global health. We sought to develop and validate a novel cardiac-specific comorbidity index, and to compare its accuracy with the generic Charlson-Deyo and Elixhauser comorbidity indexes. ⋯ The cardiac-specific comorbidity index predicted in-hospital and 1-year death and length of stay in cardiovascular populations better than existing generic models. This novel index may be useful for research of cardiology outcomes performed with large administrative databases.