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Volume 20, Issue 1, Spring/Summer 2020
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Jeff

Report from the Chair

Hello All! Here is a quick update on what has been happening in the ACHORD Group since our last newsletter. Like all of you, we are working through some very unusual times!

All faculty, staff and students in ACHORD have been working from home since mid-March due to the COVID-19 shutdown in Alberta. Some of us are feeling cooped up, some are enjoying the home base, but all are managing to stay safe, which is the most important! New patterns of work and meetings have become a way of life. In fact, we may want to adopt some of these for the future post-pandemic!

We did not host the ACHORD Retreat this year. This was the first time in 17 years since we started holding that annual get together. And so, while April and May are typically busy months for attending conferences and presenting posters, this was not the case this year as all were cancelled due to gathering restrictions implemented worldwide.

The Alberta’s PROMs and EQ-5D Research and Support Unit (APERSU) also continues to work remotely. Many APERSU Members attended the EuroQol Academy Meeting in Prague, Czech Republic at the beginning of March, just before the worldwide shut down took place. The EuroQol Annual Meeting usually held in September will be delivered in some type of virtual platform, rather than face to face. We are looking at alternatives for our APERSU annual meeting, held in October, as we will not be going forward with a face to face meeting this year.

We will be saying goodbye to Xuejing (Jennifer) Jin in June. Jennifer has decided to move back to her home country, where she has accepted a faculty position in the Centre of Evidence-based Medicine, School of Medicine, Beijing University of Chinese Medicine in Beijing. Jennifer started with us as a post-doctoral fellow in July 2017 and recently transitioned to a Research Associate, supporting our research in APERSU. We are sad to see Jennifer go but wish her all the very best with her move and her new position. We do anticipate ongoing collaborations with Jennifer in her new position in Beijing.

The Diabetes Infrastructure for Surveillance Evaluation and Research (DISER) project has reached the point of testing its capacity for cohort generation. The aim of generating a cohort is to ensure responsiveness of AHS and the DON SCN to the needs of people living with diabetes in Alberta. This step will support the distribution of DISER surveys. The aim of the DISER surveys is to ask questions related to diabetes care that will enhance surveillance of diabetes self-care activities and help AHS and the DON SCN improve its delivery of care. The intention is to identify a cohort of people who are willing to respond to occasional online surveys via email or volunteering as family or patient advisors. Respondents will be asked to join one of two groups, the first known as the "survey team" where they can provide their input on the DON SCN’s work. The second group will be known as the "volunteer team" who agree to be contacted about volunteering opportunities. The first of the DISER surveys is intended to focus on foot care, to help support DON SCN in developing their Foot Care Pathway.

Evaluation of routinely Measured PATient reported outcomes in HemodialYsis care (EMPATHY) project was implemented in Alberta Kidney Care – North (AKC-N) in September 2018 with the 1-year trial period completed in October 2019. Following the completion of the EMPATHY trial period, AKC-N re-implemented a Supportive Care program in all hemodialysis units, such that ESAS-r:Renal surveys are collected from patients at 2-month intervals, the report cards through the information system would continue to be available, as would the treatment aids for providers and patients that were developed for the study. This new supportive care model is essentially the same as study arm 1 of the EMPATHY trial. With all units implementing the same intervention, the research team is conducting a “post-trial assessment” to capture the post-EMPATHY study effect across all the units, notably in the units in the control arm, and examine if the previously assessed outcome and experience measures are stable post-study. Additionally, the AKC-N research team completed data collection for the qualitative sub-study. The team is currently working on a mixed methods secondary analysis of the burden of mental health symptoms and perceptions of their management in hemodialysis care. EMPATHY is still being implemented in Alberta Kidney Care – South (AKC-S) and the Ontario Renal Network (ORN). These renal programs were intending to continue data collection later this year, but will depend on the duration of the pandemic situation across the country.

I hope the information in our newsletter is informative, and if you have any questions about our activities, please do not hesitate to contact us. I look forward to updating you in late fall/early winter on ACHORD’s activities.
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Project Update

Food availability, accessibility and dietary practices during the Coronavirus disease pandemic (COVID-19): an international online survey.

The World Health Organization (WHO) declared the corona virus and COVID-19 outbreak a global pandemic. To date over four million people have been affected with over two hundred thousand deaths reported. Globally, countries have instituted varying levels of social and physical distancing, isolation and quarantine protocols – which is limiting face-to-face contact between individuals - as a preventative measure to curb the spread of COVID-19. Governments have responded with nationwide lockdowns restricting the movement of people and goods.

The COVID-19 pandemic lockdowns have disrupted food systems and compromised accessibility and availability of food. The disruption to food systems may adversely affect the health and nutritional status of people across the world through increased food insecurity. To assess the effects of COVID-19 pandemic lockdown measures on availability and accessibility of food, researchers at ACHORD joined a global team of researchers to conduct an international online survey. Respondents from Canada, France and several African nations are invited to complete an on-line survey to gain insight into food availability and accessibility during the COVID-19 pandemic.

The survey seeks to
1) Identify changes in food availability, accessibility and dietary practises during the COVID-19 outbreak
2) Investigate perceptions of the impact of COVID-19 on food security
3) Understand the coping mechanisms employed to curb hunger during COVID-19.

The University of Alberta Health Research Ethics Board approved the study. Please consider completing the survey; It takes about 7 minutes and can be found at this link or by copying and pasting this url into your browser: https://forms.gle/r1ufWGe2ZtMLafJ27

For other information about the survey, or to contact the survey team please visit the Food accessibility during COVID-19 Facebook page https://www.facebook.com/foodcovid19/
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Recent Literature from the ACHORD Journal Club

(Paper discussed Tuesday, April 7, 2020; Commentary by Siyuan Liu)

Cobiac LJ, Tam K, Veerman L, Blakely T. Taxes and subsidies for improving diet and population health in Australia: a cost-effectiveness modelling study. PLoS Med. 2017;14(2):e1002232. PMID: 28196089.

Article Summary:
Non-communicable diseases are a leading cause of death and disease burden in the world. The relationship between non-communicable diseases and consumption of unhealthy foods and drinks is well known. With increasing concerns about the health consequences of unhealthy diet, many countries have implemented taxes on unhealthy foods and drinks to address the growing burden of dietary-related disease. However, the cost-effectiveness of combining taxes on unhealthy foods and subsidies on healthy foods is not well understood. Therefore, this study used an Australian cost-effectiveness model to evaluate a range of food and drink taxes and subsidies, implemented individually and in all combinations, to determine an optimally cost-effective package of tax and subsidy options.

This study evaluated five interventions: (1) taxing saturated fat, (2) taxing excess salt in processed foods, (3) taxing sugar-sweetened beverages, (4) subsidising fruits and vegetables, and (5) taxing processed foods high in sugar. After implementing these interventions, the retail price of the foods and beverages would change. The consumer is expected to change their consumption patterns. This is assumed to change three disease risk factors: fruit and vegetable intake, systolic blood pressure, and BMI. These changes in disease-specific incidence are modelled by using the population fraction equation. The effect of changing incidence of diseases on the future health of population, health care costs and implementation costs were modelled using proportional multi-state lifetable modelling. From the health sector perspectives, this study also evaluated the cost-effectiveness of the interventions based on maximising net monetary benefit at a threshold of AU$50,000 per disability-adjusted life year (DALY).

Results showed that a combination of taxes and subsidy might avert as many as 470,000 DALYs in the Australian population of 22 million, with a net cost saving of AU$3.4 billion to the health sector. Of the taxes evaluated, the sugar tax produced the biggest estimates of health gain (270,000 DALYs averted), followed by the salt tax (130,000 DALYs), the saturated fat tax (97,000 DALYs), and the sugar-sweetened beverage tax (12,000 DALYs). The fruit and vegetable subsidy (−13,000 DALYs) was a cost-effective addition to the package of taxes. The study suggests that taxes and subsidies on foods and beverages can be combined to substantially improve population health and cost savings to the health sector.

Discussion Within Journal Club:
We first discussed the pros and cons of cost-effectiveness analysis. The populational multi-state lifetable modelling used in this study provides a chance to estimate the long-term effects of different dietary taxes and subsidies. The cost-effectiveness analysis of theses interventions individually and in all combinations helps determine the optimal combination, which provides useful information for policymakers. However, the modelling analysis is sensitive to the parameters used in the model, such as price elasticities. More analysis based on real data is needed in the future. We also discussed the optimal intervention package suggested in this study. This study is the first to do cost-effectiveness of tax and subsidy combinations. It clearly shows the cost-effectiveness of different policy choices. The figure, like Fig. 1, is an excellent example of showing the whole story in one picture. Readers could easily understand the critical points of this study from this picture. Lastly, we discussed whether similar policies could be implemented in Canada or not. Health Canada has published many dietary recommendations for Canadians. More evidence regarding the cost-effectiveness of different policy options aiming to improve diet is needed in the future to inform policy decision makers.
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ACHORD Seen and Heard

Recent Publications

Mansell K, Bhimji H, Eurich DT, Mansell H. Potential cost-savings from the use of the biosimilars filgrastim, infliximab and insulin glargine in Canada: a retrospective analysis. BMC Health Serv Res. 2019 Dec 18;19(1):972. PMID: 31849317.

Zongo A, Simpson S, Johnson JA, Eurich DT. Change in Trajectories of Adherence to Lipid-Lowering Drugs Following Non-Fatal Acute Coronary Syndrome or Stroke. J Am Heart Assoc. 2019 Dec 3;8(23):e013857. PMID: 31771443.

Eurich D, Lee C, Zongo A, Minhas-Sandhu JK, Hanlon JG, Hyshka E, Dyck J. Cohort study of medical cannabis authorisation and healthcare utilisation in 2014-2017 in Ontario, Canada. J Epidemiol Community Health. 2020;74:299–304. PMID: 31831619.

Voaklander B, Rowe S, Sanni O, Campbell S, Eurich DT, Ospina MB. Prevalence of diabetes in pregnancy among Indigenous women in Australia, Canada, New Zealand, and the USA: a systematic review and meta-analysis. The Lancet Global Health. 2020;8(5):e681-8. PMID: 32353316.

Wozniak LA, Johnson JA, and Eurich DT. Working towards a better understanding of type 2 diabetes care organization with First Nations communities: A qualitative assessment. Archives of Public Health 2020;78(7). PMID: 32025300.

Gilani F, Majumdar SR, Johnson JA, Simpson SH. Factors Associated with Pneumococcal Vaccination in 2040 People with Type 2 Diabetes: A Cross-sectional Study. Diabetes and Metabolism 2020:46(2):137-143. PMID: 31255692.

Zhao H, McClure NS, Johnson JA, Soprovich A, Al Sayah F, Eurich DT. A longitudinal study on the association between diabetic foot disease and health related quality of life in people with type 2 diabetes. Can J Diabet 2020:44(3);280-286. PMID: 31669187.

Seaton CL, Bottorff JL, Caperchione CM, Johnson ST, Oliffe JL. The Association Between Men's Heath Behaviors and Interest in Workplace Health Promotion. Workplace Health Saf. 2020 May;68(5):226-235. PMID: 31718492.

Vallance JK, Johnson ST, Thompson S, Wen K, Lam NN, Boyle T, Juárez I, Shojai S. Prevalence and Correlates of Accelerometer-Based Physical Activity and Sedentary Time Among Kidney Transplant Recipients. Can J Kidney Health Dis. 2019 Oct 29;6:2054358119882658. eCollection 2019. PMID: 31695921.

Mendez A, Seikaly H, Eurich DT, Dzioba A, Aalto D, Osswald M, Harris JR, O'Connell DA, Lazarus C, Urken M, Likhterov I, Chai RL, Rauscher E, Buchbinder D, Okay D, Happonen RP, Kinnunen I, Irjala H, Soukka T, Laine J; Head and Neck Research Network. Development of a Patient-Centered Functional Outcomes Questionnaire in Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg. 2020;146(5):1-7. PMID: 32271362.

Wozniak LA, Beaupre LA, Juby A, Kivi P, Majumdar SR, Hanson HM. Successful implementation of a Fracture Liaison Service through effect change management: a qualitative study. Arch Osteoporos. 2020. 15(1): 44. PMID: 32166431

Meeting Presentations and Invited Talks

Wen J, Jin X, Al Sayah F, Short H, Ohinmaa A, Johnson JA. Mapping the Modified Edmonton Symptom Assessment System - Renal onto EQ-5D-5L in patients with chronic kidney disease. 1st EuroQol Early Career Researchers Meeting 2020, Prague, Czech Republic. Mar 1, 2020.

Jin X, Al Sayah F, Ohinmaa A, Johnson JA. Estimating minimally important difference of the EQ-5D-3L and -5L in patients following total hip or knee replacement: An exploratory analysis of a novel approach using the ‘misery’ index. 1st EuroQol Early Career Researchers Meeting 2020, Prague, Czech Republic. Mar 1, 2020.

Jin X, McClure NS, Al Sayah F, Ohinmaa A, Johnson JA. Minimally Important Differences for EQ-5D instruments: A Systematic Review of Estimates in Published Literature. 4th EuroQol Academy Meeting 2020, Prague, Czech Republic. Mar 2-4, 2020.

McClure NS, Xie F, Johnson JA. Unpacking small differences in EQ-5D-5L health utility scores: Are you better, worse or the same? 4th EuroQol Academy Meeting 2020, Prague, Czech Republic. Mar 2-4, 2020.
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ACHORD
University of Alberta
2-040 Li Ka Shing CHRI
Edmonton, AB T6G 2E1
email: achord@ualberta.ca
Phone: 780-248-1010
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