In This Issue

  • Report from the Chair
  • Project Update
  • ACHORD Seen & Heard
  • Recent Literature
  • Meet the Student
  • ACHORD Accolades
  • Events

Previous Issues

ACHORD Seen & Heard

Recent Publications

Abdelmoneim AS, Eurich DT, Gamble JM, Johnson JA, Seubert JM, Qiu W, Simpson SH. Risk of acute coronary events associated with glyburide compared with gliclazide use in patients with type 2 diabetes: a nested case-control study. Diabetes Obes Metab. 2014 Jan;16(1):22-9. PMID: 23802997.

Al Sayah F, Agborsangaya C, Cooke T, Lahtinen M, Johnson JA. Mental health and the relationship between health promotion counseling and health outcomes in chronic conditions: A cross-sectional population-based study. Can Fam Physician. 2014;60(2):e113-20. PMID: 24522689.

Asche CV, Hippler SE, Eurich DT. Review of models used in economic analyses of new oral treatments for type 2 diabetes mellitus. Pharmacoeconomics. 2014 Jan;32(1):15-27.  PMID: 24357160.

Bagshaw SM, Stelfox HT, McDermid RC, Rolfson DB, Tsuyuki RT, Baig N, Artiuch B, Ibrahim Q, Stollery DE, Rokosh E, Majumdar SR. Association between frailty and short- and long-term outcomes among critically ill patients: a multicenter prospective cohort study. CMAJ. 2014 Feb 4;186(2):E95-102. PMID: 24277703.

Baillot A, Pelletier C, Dunbar P, Geiss L, Johnson JA, Leiter LA, Langlois MF. Profile of adults with type 2 diabetes and uptake of clinical care best practices: Results from the 2011 Survey on Living with Chronic Diseases – Diabetes Component. Diabetes Res Clin Pract. 2014;103(1):11-9. PMID: 24369983.

Devereaux PJ, Mrkobrada M, Sessler DI, Leslie K, Alonso-Coello P, Kurz A, Villar JC, Sigamani A, Biccard BM, Meyhoff CS, Parlow JL, Guyatt G, Robinson A, Garg AX, Rodseth RN, Botto F, Lurati Buse G, Xavier D, Chan MT, Tiboni M, Cook D, Kumar PA, Forget P, Malaga G, Fleischmann E, Amir M, Eikelboom J, Mizera R, Torres D, Wang CY, VanHelder T, Paniagua P, Berwanger O, Srinathan S, Graham M, Pasin L, Le Manach Y, Gao P, Pogue J, Whitlock R, Lamy A, Kearon C, Baigent C, Chow C, Pettit S, Chrolavicius S, Yusuf S; POISE-2 Investigators. Aspirin in patients undergoing noncardiac surgery. N Engl J Med. 2014 Apr 17;370(16):1494-503. PMID: 24679062.

Devereaux PJ, Sessler DI, Leslie K, Kurz A, Mrkobrada M, Alonso-Coello P, Villar JC, Sigamani A, Biccard BM, Meyhoff CS, Parlow JL, Guyatt G, Robinson A, Garg AX, Rodseth RN, Botto F, Lurati Buse G, Xavier D, Chan MT, Tiboni M, Cook D, Kumar PA, Forget P, Malaga G, Fleischmann E, Amir M, Eikelboom J, Mizera R, Torres D, Wang CY, Vanhelder T, Paniagua P, Berwanger O, Srinathan S, Graham M, Pasin L, Le Manach Y, Gao P, Pogue J, Whitlock R, Lamy A, Kearon C, Chow C, Pettit S, Chrolavicius S, Yusuf S; POISE-2 Investigators. Clonidine in patients undergoing noncardiac surgery. N Engl J Med. 2014 Apr 17;370(16):1504-13. PMID: 24679061.

Gamble JM, Hall JJ, Marrie TJ, Sadowski CA, Majumdar SR, Eurich DT. Medication transitions and polypharmacy in older adults following acute care. Ther Clin Risk Manag. 2014 Mar 19;10:189-96. PMID: 24672243.

Gazala S, Johnson JA, Kutsogiannias JD, Bedard ELR. Effect of Surgical Complications on Quality of Life after Thoracoscopic Lobectomy for Lung Cancer. World Journal of Cardiovascular Surgery 2014 4:25-34.

Gill RS, Majumdar SR, Wang X, Tuepah R, Klarenbach SW, Birch DW, Karmali S, Sharma AM, Padwal RS. Prioritzation and willingness to pay for bariatric surgery: the patient perspective. Can J Surg. 2014 Feb;57(1):33-9. PMID: 24461224.

Johnson ST, Eurich DT, Vallance JK. Physical activity information sources and achieving public health guidelines among older adult males. Public Health. 2014 Jan;128(1):110-3. PMID: 24359762.

Lau D, Eurich DT, Majumdar SR, Katz A, Johnson JA. Working age adults with diabetes experience greater susceptibility to seasonal influenza: A population-based cohort study. Diabetologia 2014 2014 Apr;57(4):690-8. PMID: 24496923.

Leslie WD, Lix LM, Yogendran MS, Morin SN, Metge CJ, Majumdar SR. Temporal trends in obesity, osteoporosis treatment, bone mineral density, and fracture rates: a population-based historical cohort study. J Bone Miner Res. 2014 Apr;29(4):952-9. PMID: 24115100.

Makowsky MJ, Cave AJ, Simpson SH. Feasibility of a self-administered survey to identify primary care patients at risk of medication-related problems. J Multidiscip Healthc. 2014 Feb 22;7:123-7. PMID: 24591839.

Padwal RS, Klarenbach SW, Wang X, Sharma AM, Karmali S, Birch DW, Majumdar SR. A simple prediction rule for all-cause mortality in a cohort eligible for bariatric surgery. JAMA Surg. 2013 Dec;148(12):1109-15. PMID: 24132685.

Padwal R, Lin M, Etminan M, Eurich DT. Comparative effectiveness of olmesartan and other Angiotensin receptor blockers in diabetes mellitus: retrospective cohort study. Hypertension. 2014 May;63(5):977-83. PMID: 24535009.

Padwal RS, Rueda-Clausen CF, Sharma AM, Agborsangaya CB, Klarenbach S, Birch DW, Karmali S, McCargar L, Majumdar SR. Weight loss and outcomes in wait-listed, medically managed, and surgically treated patients enrolled in a population-based Bariatric program: prospective cohort study. Med Care. 2014 Mar;52(3):208-15. PMID: 24374423.

Pelletier R, Humphries KH, Shimony A, Bacon SL, Lavoie KL, Rabi D, Karp I, Tsadok MA, Pilote L; GENESIS-PRAXY Investigators. Sex-related differences in access to care among patients with premature acute coronary syndrome. CMAJ. 2014 Apr 15;186(7):497-504. PMID: 24638026.

Pelletier R, Lavoie KL, Bacon SL, Thanassoulis G, Khan NA, Pilote L; GENESIS-PRAXY Investigators. Depression and disease severity in patients with premature acute coronary syndrome. Am J Med. 2014 Jan;127(1):87-93.e1-2. PMID: 24384103.

Simpson SH, Abdelmoneim AS, Omran D, Featherstone TR. Prevalence of high on-treatment platelet reactivity in diabetic patients treated with aspirin. Am J Med. 2014 Jan;127(1):95.e1-9. PMID: 24384107.

Sligl WI, Hoang H, Eurich DT, Malhotra A, Marrie TJ, Majumdar SR. Macrolide use in the treatment of critically ill patients with pneumonia: Incidence, correlates, timing and outcomes. Can J Infect Dis Med Microbiol. 2013 Winter;24(4):e107-12. PMID: 24489569.

Sligl WI, Asadi L, Eurich DT, Tjosvold L, Marrie TJ, Majumdar SR. Macrolides and mortality in critically ill patients with community-acquired pneumonia: a systematic review and meta-analysis. Crit Care Med. 2014 Feb;42(2):420-32. PMID: 24158175.

Warkentin LM, Das D, Majumdar SR, Johnson JA, Padwal RS. The effect of weight loss on health related quality of life: systematic review and meta-analysis of randomized trials. Obes Rev. 2014 15:169-182. PMID: 24118750.

Wu X, Ohinmaa A, Johnson JA, Veugelers P. Assessment of Children’s own Health Status Using Visual Analogue Scale and Descriptive System of the EQ-5D-Y: Linkage Between Two Systems. Qual Life Res 2014;23(2):393-402. PMID: 23893344.

Recent Presentations

Johnson JA. Contributions and challenges of observational studies of metformin and cancer. In session titled: Repurposing aspirin and metformin for cancer prevention and treatment. American Association for Cancer Research 2014 Annual Meeting, San Diego, California, April 6, 2014.

Johnson ST, Mundt C, Qiu W, Plotnikoff RC, Al Sayah F, Johnson JA. Physical Activity and Depression Among Adults with Type 2 Diabetes. 5th International Congress on Physical Activity and Public Health. Rio de Janeiro, Brazil. April 8-11, 2014.



12th Annual ACHORD Retreat

March 19-20, 2015
The Banff Centre
Banff, Alberta, Canada










11th Annual ACHORD Retreat

The 11th Annual ACHORD Retreat was held on March 6-7, 2014 at the Banff Center. As in past years, this informal meeting provided an opportunity for ACHORD investigators, collaborators and trainees to share research activities, and plan for continued growth of the ACHORD group.

Thank you to all who presented at the Retreat (also available on our website,
Padma Kaul, Lois Donovan, and Steve Johnson on planned and ongoing research in the area of gestational diabetes mellitus (GDM)
– Trainee presentations from Ahmed Abdelmoneim, Lindsey Warkentin, Marni Armstrong, Travis Featherstone and Nonsikelelo Mathe
Dean Eurich on accolades celebrating ACHORD successes for both students and faculty in the past year
– Ashley Stacewicz, Jeff Johnson and Logan McLeod on evaluation update of the Complex Annual Care Plan and 03.04J Health Service Code for Alberta Health
– Fatima Al Sayah on the ABCD Cohort study, summarizing the available data, and encouraging everyone in the ACHORD group to consider possible collaborations with the cohort.

We had a great turnout for our organized physical activity this year – Yoga! It was enjoyed by all that attended.

Thank you to everyone who attended the 11th Annual Retreat. As is the case every year, this event is a success because of those of you that attend. Thank you to Jeff Johnson and Sherry Lydynuik for planning the event and thank you to Daniala Weir and Allison Soprovich for creating the icebreaker that was enjoyed at our reception prior to dinner on Thursday evening.


Report from the Chair

Hello everyone!  Spring is here, and ACHORD has not slowed down any through the winter months! Here is a quick update on what we have been doing since our last newsletter.

As mentioned above, we held our 11th Annual ACHORD Retreat at the Banff Centre in March. As always, we had some great talks and equally great feedback from everyone in attendance.

ACHORD members have been busy submitting abstracts to various conferences. Some of the upcoming meetings that will be attended by ACHORD members are: International Congress on Physical Activity and Public Health (ICPAPH), Canadian Association for Health Services and Policy Research (CAHSPR), and American Diabetes Association (ADA) annual meetings. I have been traveling alot so far this year, including two trips to Amsterdam for the Diabetes and Cancer Research Consortium (DCRC) and for a strategic planning session for the EuroQol Group. I also presented on epidemiologic research on metformin and cancer risk at the American Association for Cancer Research (AACR) in San Diego in April.

My work with the ODN Strategic Clinical Network continues with focused discussions to highlight priorities for our respective SCN. We were successful on our 2013 PRIHS application on the care and rehabilitation of severely obese patients in tertiary care centers in Alberta (co-lead with Mary Forhan and Arya Sharma). The 2014 PRIHS opportunity is currently underway.

We are welcoming two new visitors to ACHORD this summer. Marjolein Zanders, who is working on her PhD at the Eindhoven Cancer Registry in the Netherlands, will be with us for three months as part of our international DCRC collaboration. We will also welcome Stephanie Bearman, an AIHS-funded summer student who will be working with Nonsi Mathe, ACHORD post-doctoral fellow, on the role of dietary and physical activity in type 2 diabetes, based on data from the ABCD cohort study.

We remain busy with the Alberta’s Caring for Diabetes (ABCD) Project. Evaluations of the TeamCare and HEALD interventions are wrapping up with reporting the Implementation and Effectiveness pieces of RE-AIM. Both interventions proved effective and were implemented with fidelity; however, some deviations existed in the TeamCare intervention around the degree of collaborative care practiced. We are in the midst of economic evaluations for both of these interventions as well, and will complete these in the coming year.

We finished recruitment for the ABCD Diabetes Complications study in December, with a total of 2,080 participants. We will be able to undertake a number of sub-studies and student projects with the ABCD Diabetes Complications data. For example, we have started recruitment for the Accelerometer sub-study, recruiting respondents from the ABCD cohort study. Participants are asked to record all foods and beverages consumed over a 3-day period, as well as to wear an accelerometer (motion sensor) to measure their level of activity and sleep over a 24-hour period for 7 days. We hope to gather more information about diet, physical activity and sleep behaviours among people with type-2 diabetes, aiming to identify any dietary or physical activity factors that may influence the progression of diabetes and the development of complications.

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 summer with more on ACHORD’s activities.


Project Update

Prenatal and obstetric care for women with gestational diabetes mellitus (GDM) in Alberta

By Bowker SL, Donovan L, Savu A, Yasmin F, Johnson JA, Kaul P.
Why is this research important?

In Canada, diabetes rates have increased significantly over the last decade, exceeding the predicted global rate. The prevalence and incidence of diabetes in Alberta is also on the rise, as recently reported by the Alberta Diabetes Surveillance System (ADSS). Interestingly, a study of trends in diabetes prevalence and incidence in Ontario between 1995 and 2005 found that the greatest rise in diabetes over this time period occurred in reproductive age women (a 108.2% increase).

GDM is defined as glucose intolerance first recognized during pregnancy, typically between 24-28 weeks gestation. Although it is generally a temporary condition and resolves post partum, it is an established risk factor for subsequent development of type 2 diabetes (T2DM), for both the mother and the child. In Canada, 19% of women with GDM developed T2DM by 9 years post-partum, and it is estimated that the risk of T2DM may be as high as 50 – 60% at 15 – 20 years post-partum; this is nearly ten-fold the risk of that in the general population. As such, GDM is an important marker of high-risk status for future diabetes and it’s associated serious health-related complications for both mother and child. Despite evidence that medical management reduces the risk of large for gestational age neonates, shoulder dystosia and hypertensive disorders in pregnancy, women with GDM and their infants are often treated as though such risks are unaltered by medical management. This over-cautious management of women with GDM may lead to higher rates of costly interventions that may cause harm.

Therefore, our objective is to compare utilization of fetal surveillance, labour inductions, and C-sections, for women with and without GDM, and admission of their infants to the neonatal intensive care unit (NICU) in Alberta. We hypothesize that the rates of these interventions will be higher in women with GDM, even after controlling for known risk factors and conventional indications.

What are the proposed methods for this project?

This will be a retrospective cohort study. We will link clinical data from the Alberta Perinatal Health Program (APHP) database with the provincial administrative Alberta Health (AH) database for the time period 1999-2009. The APHP is an established provincial clinical registry that collects detailed maternal, obstetrical and neonatal clinical information for all birth events in Alberta. The presence of GDM is routinely captured from case-report forms in the APHP database. The AH databases include information on hospital admissions, physician claims, and vital statistics.

We are interested in looking at the rates of fetal surveillance, labour inductions, C-sections, and NICU admissions in four different groups: 1) women with GDM, 2) women with diet-controlled pre-pregnancy diabetes (i.e. type 2 diabetes), 3) women with insulin-controlled pre-pregnancy diabetes (i.e. could be type 1 or type 2 diabetes), and 4) healthy women without any diabetes (our reference group).

What is the significance of this research?

Presuming the results support our hypothesis, that the rates of these interventions are higher among women with GDM and their infants, we will use this data to develop a broad stakeholder engagement strategy, with a view to establishing consistent standards of practice for the obstetrical management of women with GDM and neonatal care of their infants across the province of Alberta. As well, findings from this research will be informative to women with or at risk of GDM, in terms of understanding the importance of being screened and the consequences of being diagnosed with GDM.


Recent Literature from the ACHORD Journal Club

(Paper discussed Tuesday, March 4, 2014; Commentary by Jenelle Pederson)

Jani BD, Purves D, Barry S, Cavanagh J, McLean G, et al. (2013) Challenges and Implications of Routine Depression Screening for Depression in Chronic Disease and Multimorbidity: A Cross Sectional Study. PLoS ONE 8(9): e74610. doi:10.1371/journal.pone.0074610   PMID: 24058602.

Rationale for the study?

The study addresses uncertainties for practices of routine depression screening in primary care settings. The objective was to examine the impact of a program on incentivized depression screening in chronic disease for primary care in the Scotland, which began in 2006 as part of the wider chronic disease management program of ‘Local Enhanced Services” (LES).

Summary of the study

The study is a retrospective cross-sectional analysis of routinely collected data on chronic disease patients in family medicine during 1 April 2008 to 31 May 2009. The authors evaluated the uptake and effectiveness of depression screening and the proportion of subsequent prescriptions for antidepressants. The sample included 125,143 adults aged 18 to 90 identified with at least one chronic disease (coronary heart disease (CHD), diabetes or stroke). Depression screening was done during LES annual health assessments using the Hospital and Anxiety Depression Score (HADS).  With a total score of 21, a HADS score <8 is considered not positive for depressive symptoms while positive HADS scores of 8-10 indicate moderate depressive symptoms and ≥ 11 indicate moderate to severe depression. The explanatory variables of age, gender, comorbidity, and socioeconomic status (SES) were determined by data provided by the health board.

The authors calculated incidence rates for positive results of depression screening and new antidepressant treatment. They fit a logistic regression model to examine the association between raised HADS and the explanatory variables above.


Of the population, 92% (114,473) of patients were eligible for depression screening. Only 31% (35,537) of eligible patients had recorded depression screening results. Of those, 80% (28,457) screened normal with 2% (696) newly prescribed antidepressants; 12% (4,155) screened positive for symptoms of moderate depression with 7% started on anti-depressants and 8% (2,925) showed indication of severe depression with 10% (303) started on anti-depressants. Overall, 4% (1,268) of screened patients were newly prescribed anti-depressants while 6% (4,989) of unscreened patients were started on anti-depressants. Females, younger (18-44) or multimorbid, and socioeconomically deprived patients were more likely to have a raised HADS; of these individuals, those aged 45-65 and female were most likely to be started on antidepressants.

Individuals with at least one comorbidity were found to be 1.48 times likely to have raised HADS relative to those with a single disease, when adjusting for age, gender, and socioeconomic status (OR 1.48, p<0.001). Males were 0.83 times likely to have raised HADS than females (adjusted OR 0.83, p <0.001). Younger aged individuals were more likely to have raised HADS relative to aged 76-90 with the most likely aged 45-64 (adjusted OR 1.81, p<0.001). Finally, the individuals in the most deprived SES group was 2.56 times likely to have raised HADS relative to the least deprived (adjusted OR 2.56, p<0.001).


The authors report a low uptake for routine depression screening in the UK, despite incentives to do so. First, they describe an association between positive screens of depressive symptoms and number of chronic disease. However, due to an interchangeable use and consideration for ‘comorbidity’ and ‘multimorbidity’ as well as limited access to data of only three chronic diseases, their findings for the relationship of depression screening for patients with chronic disease remains ambiguous. Second, the authors report an association of raised HADS and rates of newly prescribed antidepressants. Their findings show that patients who screened positive for symptoms of moderate to severe depression (HADS>11) had the highest rate of new prescription for antidepressants. Yet, overall, more unscreened patients received new antidepressant prescriptions than those who screened at all positive for depressive symptoms. This is perhaps due to unknown depression status for a large percentage of individuals in the unscreened group and potentially the episodic nature of depression. Also, any conclusions on treatment following depression screening were limited by data on pharmacotherapy, as they did not have information on alternative therapies, such as cognitive behavioral therapy. A novel aspect of the study is the strong representation of different socioeconomic groups relevant to depressive status and indeed, the authors presented an increasing risk of positive depression scores with lower socioeconomic statuses.


Meet the Student

Jessica Beatty, MSc

Training Program:  MSc Clinical Epidemiology, School of Public Health, University of Alberta

I grew up in St. Albert, Alberta.  I graduated from the University of Alberta in 2010 with a BSc in Immunology and Infectious Disease.  Having finished my degree I went straight into an MSc degree program in Immunology under the supervision of Dr. Hanne Ostergaard at the University of Alberta.  During my Master’s degree I became fascinated with understanding how infectious diseases develop over time between and within populations.  After completing my MSc in 2013, I decided to move away from bench science and pursue another master’s degree this time in epidemiology under the supervision of Dr. Dean Eurich.

My current area of research is focused on describing the epidemiology and clinical characteristics of all patients diagnosed with invasive pneumococcal disease in Alberta collected by the Streptococcus Pneumoniae Alberta Team (SPAT) group.

Outside of my research I enjoy volunteering at the Edmonton Humane Society. I also enjoy backcountry camping, which led me to completing the West Coast Trail in British Columbia last year.


ACHORD Accolades

Congratulations to Lindsey Warkentin on successfully completing her MSc Final Exam.


ACHORD Contact Information

Phone Numbers: General Inquiries: 780-248-1010 | Fax : 780-492-7455
University of Alberta | 2-040 Li Ka Shing Centre for Health Research Innovation | Edmonton, AB, T6G 2E1