In This Issue

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

Previous Issues

ACHORD Seen & Heard

Recent Publications

Abdelmoneim AS, Welsh RC, Eurich DT, Simpson SH. Sulfonylurea use is associated with larger infarct size in patients with diabetes and ST-elevation myocardial infarction. Int J Cardiol 2016 1;(202):126-30. PMID: 26386939.

Al Sayah F, Soprovich A, Qiu W, Edwards AL, Johnson JA. Diabetic foot disease, self-care, and clinical monitoring in adults with type 2 diabetes: The ABCD cohort study. Can J Diabetes 2015 39 Suppl 3:S113-9. PMID: 26243464.

Ghotra SK, Johnson JA, Qiu W, Newton A, Rasmussen C, Yager J. Age of Stroke Onset Influences the Clinical Outcome and Health Related Quality of Life in Pediatric Ischemic Stroke Survivors. Dev Med Child Neurol 2015;57(11):1027-34. PMID: 26307431.

Lau D, Padwal RS, Majumdar SR, Pederson JL, Belga S, Kahlon S, Fradette M, Boyko D, McAlister FA. Patient-Reported Discharge Readiness and 30-Day Risk of Readmission or Death: A Prospective Cohort Study. Am J Med 2015 pii: S00002-9343(15)00824-4. PMID: 26344631

Pillay J, Armstrong MJ, Butalia S, Donovan LE, Sigal RJ, Vandermeer B, Chordiya P, Dhakal S, Hartling L, Nuspl M, Featherstone R, Dryden DM. Behavioral Programs for Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis for Effect Moderation. Ann Intern Med. 2015;163(11):848-60. PMID: 26414227

Pillay J, Armstrong MJ, Butalia S, Donovan LE, Sigal RJ, Chordiya P, Dhakal S, Vandermeer B, Hartling L, Nuspl M, Featherstone R, Dryden DM. Behavioral Programs for Type 1 Diabetes Mellitus: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;163(11):836-47. PMID: 26414020

Plotnikoff R, Karunamuni N, Lytvyak E, Penfold C, Schopflocher D, Imayama I, Johnson ST, Raine K. Osteoarthritis prevalence and modifiable factors: a population study. BMC Public Health 2015;15:1195. PMID: 26619838

Popeski N, McKeen C, Khokhar B, Edwards A, Ghali WA, Sargious P, White D, Hebert M, Rabi DM. Perceived Barriers to and Facilitators of Patient-to-Provider E-Mail in the Management of Diabetes Care. Can J Diabetes. 2015;39(6):478-83. PMID: 26409770

Recent Presentations

Xie F, Pullenayegum E, Gaebel K, Bansback N, Bryan S, Ohinmaa A, Poissant L, Johnson JA. A time trade-off-derived value set of the EQ-5D-5L for Canada. ISOQOL 22nd Annual Conference Vancouver, BC, October 21-24, 2015. [Oral Presentation]. Quality of Life Research 2015;24(Suppl 1):53 (A207.4).

Thiel D, Al Sayah F, Johnson JA. Relationship between Physical Activity and Health-Related Quality of Life in Alberta’s Type 2 Diabetes Population. ISOQOL 22nd Annual Conference, Vancouver, Canada, October 21-24, 2015. Quality of Life Research 2015:24(Suppl 1):103 (A1052).

Al Sayah F, Qiu W, Johnson JA. Health Literacy and Health-Related Quality of Life in Adults with Type 2 Diabetes: A Longitudinal Study. ISOQOL 22nd Annual Conference, Vancouver, Canada, October 21-24, 2015. Quality of Life Research 2015:24(Suppl 1):103 (A1054).

Bansback N,Trenaman L, Bryan S, Johnson JA. Using routine Patient Reported Outcome Measures to enhance patient decision making: a proof of concept study. ISOQOL 22nd Annual Conference, Vancouver, Canada, October 21-24, 2015. Quality of Life Research 2015:24(Suppl 1):109 (A1080).

Al Sayah F, Bansback N, Bryan S, Ohinmaa A, Pullenayegum E, Xie F, Johnson JA. Determinants of Health Preferences in the Canadian EQ-5D-5L Valuation Study. ISOQOL 22nd Annual Conference, Vancouver, Canada, October 21-24, 2015. [Quality of Life Research 2015:24(Suppl 1):177 (A3016).

McClure N, Al Sayah F, Xie F, Luo N, Johnson JA. Instrument-defined estimates of minimally important difference in EQ-5D-5L index score for Canadian, Chinese and Spanish scoring algorithms. ISOQOL 22nd Annual Conference, Vancouver, Canada, October 21-24, 2015. Quality of Life Research 2015:24(Suppl 1):181 (A3038).

Pederson JL, Majumdar SR, Forhan M, Johnson JA, McAlister FA. Depression is associated with short-term readmission or mortality after discharge in older patients from general internal medical wards: a multi-site prospective cohort study. 44th Annual Scientific and Educational Meeting of the Canadian Association of Geriatrics, Calgary, AB, October 24-27, 2015.

Wozniak LA, Samanani S, Majumdar SR, Johnson JA, Eurich D. Reorganizing the Approach to Diabetes Care through the Application of Registries and Centralized Care Coordination (RADAR) in First Nations Communities: Baseline Data and Implementation Challenges. Poster presented at the North American Primary Care Research Group Conference, Cancun, Mexico, October 24-28, 2015.

Alsabbagh W, Eurich DT, Lix L, Wilson T, Blackburn David F. Does The Association Between Adherence To Statin Medications And Mortality Depend On The Measurement Approach? A Retrospective Cohort Study. American Heart Association’s Committee on Scientific Sessions Program. Orlando, Florida, United States. November 9, 2015.

Abdelmoneim AS, Welsh R, Eurich DT, Simpson SH. Sulfonylurea use is associated with larger infarct size in patients with diabetes and ST-elevation myocardial infarction. World Diabetes Conference, December 1-4, 2015, Vancouver, British Columbia

Butalia S, Kyle L, McGuire A, Dyjur D, Mercer J, and Pacaud D. Identifying how to improve engagement of youth with type 1 diabetes during their transition to adult diabetes care. Abstract # 0573-PD. International Diabetes Federation – 2015 World Diabetes Congress, Vancouver, December 1, 2015.

Featherstone T, Eurich DT, Simpson SH. Limited effectiveness of diabetes risk assessment tools in seniors facility residents. World Diabetes Conference, December 1-4, 2015, Vancouver, British Columbia

Bowker SL, Savu A, Donovan NKL, Johnson JA, Kaul P. Validation of Clinical and Administrative Case Definitions for Gestational Diabetes Mellitus against Laboratory Data. Symposium of the International Diabetes Epidemiology Group; 2015 Dec. 5-6; Vancouver, British Columbia.

Bowker SL, Lin M, Eurich DT, Johnson JA. Time-Varying Risk of Breast Cancer Following Initiation of Glucose-Lowering Therapy in Women with Type 2 Diabetes: Exploring Detection Bias. 14th Symposium of the International Diabetes Epidemiology Group, December 5-6, 2015; Vancouver, British Columbia.

Chen CB, Eskin M, Majumdar SR, Eurich DT, Johnson JA. Metformin, Ethnicity and Risk of Prostate Cancer in Type 2 Diabetes [abstract]. 14th Symposium of the International Diabetes Epidemiology Group; 2015 Dec. 5-6; Vancouver, British Columbia: IDEG; 2015. Abstract nr: 3.

Thiel DM, Al Sayah F, Johnson ST, Johnson JA. Relationship between Physical Activity & Health-Related Quality of Life in Alberta’s Type 2 Diabetes Population [abstract]. 14th Symposium of the International Diabetes Epidemiology Group (IDEG); 2015 Dec 5-6; Vancouver, British Columbia.


13th Annual ACHORD Retreat

March 9-11, 2016
The Banff Centre
Banff, Alberta, Canada



Report from the Chair

Hello everyone!  Hard to believe that another year is drawing to a close, and that I am nearing the end of my sabbatical leave. ACHORDians have been busy, as always, and here is a quick update on what we have been doing since our last newsletter.

We had a successful meeting in Canmore in October for the new unit being formed in ACHORD, the Alberta Proms EQ-5D Research Support Unit (APERSU). This new initiative is highlighted elsewhere in this newsletter.

ACHORD had great representation at recent international meetings, which fortunately happened to be held in Vancouver, including the International Society for Quality Of Life Research (ISOQOL), the International Diabetes Federation (IDF) and International Diabetes Epidemiology Group (IDEG) meetings. I served as Chair of the local organizing committee for IDEG, and was very pleased that we had such a successful satellite symposium in Vancouver, with over 100 participants from around the world. We were pleased that a number of ACHORD Trainees participated in the 1-day trainee workshop at IDEG.

In October we submitted a Partnerships for Health System Improvement (PHSI) grant to CIHR; we are hoping to get good news in June on that competition. This PHSI grant will support an extension of our previous work to look at financial incentives for family physicians to complete comprehensive annual care plans (CACP) for patients with diabetes and related comorbidities. We are now also proposing to evaluate CACP for similar patients by community pharmacists under Alberta Health’s enhanced pharmacy services framework.

I am off to Australia in December to end my sabbatical, where I will be meeting and collaborating with Dianna Magliano and Jonathon Shaw at Monash University in Melbourne. Dianna has been contributing to our international Diabetes and Cancer Research Consortium and I am looking forward to the collaboration. Related to this collaboration, we welcomed Jessica Harding, a Post Doctoral Fellow candidate, from Australia in December. Jessica gave a presentation on her PhD thesis research on diabetes and cancer, as part of the School of Public Health Guest Lecture Series, and co-sponsored by the Alberta Diabetes Institute.

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 the spring with more on ACHORD’s activities.  In the meantime, I hope everyone has a relaxing holiday season and a wonderful New Year!

Project Update

Alberta PROMs and EQ-5D Research and Support Unit (APERSU)

Established in October 2015, APERSU is an intermediary office that connects the EuroQol foundation ( with non-commercial users of EQ-5D instruments and other patient reported outcome measures (PROMs) in Alberta. This unit will secure licensing for the use of EQ-5D instruments, and support research and use of other PROMs in Alberta. APERSU is based within ACHORD offices in the School of Public Health, University of Alberta with funding from Alberta Health Services (AHS) and the Health Quality Council of Alberta (HQCA), and was developed in partnership with the EuroQol Foundation.

APERSU’s vision is “to improve decisions by end-users and stakeholders about health and health care in Alberta by promoting, coordinating, and supporting the use of EQ-5D and other PROMs for the measurement and valuation of health”. Our specific objectives include:
• Provide expertise, advice and support for the application of the various EQ-5D instruments and other PROMs by provincial end-users
• Provide oversight and coordination of various non-commercial applications of the EQ-5D instruments in Alberta
• Serve as a liaison between Alberta-based end-users and the EuroQol Foundation
• Facilitate collaborative research among EuroQol Group members with Alberta end-users working with EQ-5D data in the context of large-scale health applications
• Generate information for population health and economic modeling studies to support health policy

The APERSU Team includes Co-Directors Dr. Jeff Johnson & Dr. Arto Ohinmaa, Research Manager Dr. Fatima Al Sayah, and Research Administrator Sherry Lydynuik. The team is supported by a Board of Directors, with representatives from AHS, HQCA, University of Alberta School of Public Health and the EuroQol Foundation.  The Board provides strategic organization direction, and a Scientific Advisory Committee (SAC), with provincial, national and international representatives, provides advice and direction regarding APERSU’s research agenda and activities.

APERSU exists primarily to support EQ-5D end-users across the province. The basic support services we provide include:
• Registering and licensing the use of EQ-5D instruments
• Providing training and guidance on the use of EQ-5D and other PROMs
• Cleaning and scoring EQ-5D data, and reporting basic descriptive data analysis
• Additional support and advice for more advanced analyses such as statistical comparisons
• Economic evaluations are also available on a cost‐recovery basis, and would be the based on a separate agreement between the parties.

APERSU hosted the 1st Annual End-user and Scientific Advisory Committee meeting for EQ-5D end-users and select Canadian and international experts on Oct 20-21, 2015 in Canmore, Alberta.  The objectives of the meeting were to: 1) introduce APERSU to stakeholders and end-users of PROMs & EQ-5D instruments in Alberta; 2) explore provincial, national and international PROMs initiatives and strategies; and 3) devise a plan to establish APERSU’s research agenda based on end-user’s and key stakeholder’s research priorities and interests. The meeting proceedings will be available on APERSU’s website.

Following the End-User Conference, APERSU’s Scientific Advisory Committee (SAC) suggested these four priority areas APERSU’s research agenda:
1. Application of PROMs in clinical practice
2. Application of PROMs in health systems
3. Understanding the instrument (i.e. EQ-5D) better
4. Enhancing quality of PROMs use

For more information, please contact us at:
Phone: 780.248.1010
Website: (coming soon)

Recent Literature from the ACHORD Journal Club

(Papers discussed Tuesday, November 3, 2015; Commentary by Ming Ye)

Tucker-Seeley RD, Sorensen G, Subramanian SV. Lifecourse socioeconomic circumstances and multimorbidity among older adults. BMC Public Health 2011;(11):313. PMID: 21569558


Childhood financial hardships (CFH) can substantially influence the subsequent social economic status (SES) in their later life, which in turn affects the risk of chronic diseases. Lifecourse SES trajectory has been shown to be more strongly associated with adult health outcomes than assessing SES at a particular point in time. Many chronic diseases share common risk factors and individuals with one chronic condition are often likely to have other conditions. As such, many older adults are now facing two or more chronic conditions at the same time (i.e. multimorbidity). Although some epidemiological studies have linked low childhood SES (e.g. parental occupation, parental educational attainment) with incidence of individual chronic conditions in adults, including heart disease, stroke, diabetes, and some cancers, few have shown the impact of lifecourse SES, including both CFH and mid-life SES, on multimorbidity at the older age.

In this Journal Club, we discussed a research paper investigating the association between lifecourse SES and multimorbidity among elderly adults using data from the U.S. Health and Retirement Study (HRS).

Summary of the study

This study was a population-based cross-sectional study of 7,305 participants in the 2004 HRS, age 50 or older, who gave consent to link their HRS data with the Social Security Records in the United States. Childhood financial hardship (CFH) was determined by the response (Yes/No) to the question from the HRS: “While you were growing up, before age 16, did financial difficulties ever cause you or your family to move to a different place?” Lifetime earnings were measured by calculating the mean annual earnings of the participants from age 20 to 50 before they entered the HRS study. Years with zero earnings were excluded from the calculation and the average annual earnings were inflation-adjusted to 2003 US dollars using the consumer price index for urban consumers (CPI-U). Multimorbidity, the health outcome variable, was measured as the count of six chronic conditions reported in the 2004 HRS, including cancer, heart disease, lung disease, stroke, diabetes, or hypertension. Zero-inflated Poisson regression models were used to simultaneously model the likelihood of the absence of morbidity and the expected number of chronic conditions, in associations with CFH and average lifetime earnings.

Among the 2004 HRS participants, approximately 30% were in the absence of chronic morbidity. Neither CFH nor lifetime earnings was significantly associated with the presence/absence of chronic conditions. At the baseline level of lifetime earnings, CFH was associated with an 8% (95% CI: 2%-14%) higher number of chronic conditions after adjusting for age, gender, race, education and average lifetime earnings, while with the increase in lifetime earnings, the CFH associated number of chronic conditions became less, suggesting a significant interaction between childhood financial hardship and lifetime earnings on multimorbidity.


The results of this study suggest that childhood financial hardship (CFH) and lifetime earnings are associated with multimorbidity and lifetime earnings modified the association between childhood financial hardship and multimorbidity. However, the magnitude of the associations between CFH, lifetime earnings and multimorbidity was quite small (IRR_CFH=1.08, 95%: 1.02-01.14; IRR_life=0.97, 95%: 0.94-0.99) and the modification effect was also not quite significant (IRR=0.95, 95%: 0.91-0.99).

There were also potential measurement errors in measuring CFH with a single question asking about childhood moving, including recall bias and differential misclassification, which may lead to an overestimated association. Other than demographic factors and education, it would be a more valid study if the authors incorporated etiological risk factors of chronic diseases, such as smoking and physical activity, which had been measured by the HRS questionnaire, in their models, either to be controlled as potential confounders or studied for the interactive effect between SES and etiological factors on multimorbidities. We also learned and discussed how to use zero-inflated Poisson (ZIP) model and two-part model (2PM) in analyzing skewed count data and skewed continuous data with many zeros, especially in health services research and health economics studies.

Other comments and discussions included differences between “comorbidity” and “multimorbidity”, analysis of the correlation between CFH, lifetime earnings and education status, and the generalizability of the study. There were also concerns about how this paper presented the interaction/effect modification results.

Meet the Staff

Diane Aubin, PhD

Dr. Diane Aubin has joined us in the ACHORD offices, as the new Associate Director for the Career Development in Methods and Health Services Research Platform of the Alberta “Strategies for Patient Oriented Research” (SPOR) SUPPORT unit at the University of Alberta. She will be working with Dr. Dean Eurich, who is the Joint Platform Lead with Dr. Marilynne Hebert of the Department of Community Health Sciences at the University of Calgary. Diane recently completed a PhD in Educational Psychology at the University of Alberta, with a grounded theory study on the psychology of shame and its impact on health professionals when they make mistakes. She worked at the Canadian Patient Safety Institute (CPSI) while she completed her studies, and continues to have a research interest in the area of patient safety, and more specifically on mental health of our healthcare workers. Diane has two daughters whom she visits often in Ottawa (her home town) and Waterloo.

ACHORD Accolades

Congratulations to:

– Dean Eurich on receiving Instructor of the Year — Large Class Award

– Dean Eurich on success in the CIHR eHIPP Competition

– Hayford Avedzi on successful completion of his PhD Candidacy Exam

– Karly Achtymichuk on convocating with her Masters Degree in Clincal Epidemiology

– Jenelle Pederson on convocating with her Masters in Medicine

– Ahmed Abdelmoneim on convocating with his PhD in Pharmacy

– Diane Aubin on convocating with her PhD in Educational Psychology

– Chris Chen on receiving a Queen Elizabeth II Graduate Scholarship

Other ACHORD News

Congratulations to:

– Jessica Beatty on her marriage to John Schofield

– Lisa Wozniak on her engagement to Justin Larock

– Weiyu Qiu on becoming a Canadian Citizen

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