Comorbid conditions as risk factors for West Nile neuroinvasive disease in Ontario, Canada: a population-based cohort study.

West Nile neuroinvasive disease (WNND) is a severe neurological illness that can result from West Nile virus (WNV) infection, with long-term disability and death being common outcomes. Although WNV arrived in North America over two decades ago, risk factors for WNND are still being explored. The objective of this study was to identify WNND comorbid risk factors in the Ontario population using a retrospective, population-based cohort design. Incident WNV infections from laboratory records between 1 January 2002 - 31 December 2012 were individually-linked to health administrative databases to ascertain WNND outcomes and comorbid risk factors. WNND incidence was compared among individuals with and without comorbidities using risk ratios (RR) calculated with log binomial regression.Three hundred and forty-five individuals developed WNND (18.3%) out of 1884 WNV infections. West Nile encephalitis was driving most associations with comorbidities. Immunocompromised (aRR 2.61 [95% CI 1.23-4.53]) and male sex (aRR 1.32 [95% CI 1.00-1.76]) were risk factors for encephalitis, in addition to age, for which each 1-year increase was associated with a 2% (aRR 1.02 [95% CI 1.02-1.03]) relative increase in risk. Our results suggest that individuals living with comorbidities are at higher risk for WNND, in particular encephalitis, following WNV infection.

Geographic variation in FP and GP scope of practice in Ontario: Comparative provincial study.

OBJECTIVE: To describe and compare the scope of practice (SoP) of GPs and FPs between the rural northern, rural southern, urban northern, and urban southern regions of Ontario. DESIGN: Cross-sectional retrospective analysis of the 2013 College of Physicians and Surgeons of Ontario official register and annual membership renewal survey data. SETTING: Ontario. PARTICIPANTS: All independently practising GPs and FPs with a primary practice address in Ontario. MAIN OUTCOME MEASURES: For each of the 4 regions, we determined the distribution of GPs and FPs, the mean number of hours worked per week, the mean number of clinical activities reported, the proportion of GPs and FPs reporting specific clinical activities, and the proportion of time dedicated to each activity. RESULTS: The rural north has 2.4% of the province's GPs and FPs, who on average report working more hours per week (a total of 50.82 hours a week) than practitioners in all other regions do. Rural northern and rural southern GPs and FPs report participating in more types of clinical activities than their urban counterparts do. The types of clinical activities reported vary across regions. For example, 13.3% of GPs and FPs in the urban south reported that emergency medicine was an aspect of their clinical activities, compared with 57.5% in the rural north. Urban GPs and FPs engage in fewer clinical activities and thus spend proportionately more time on each clinical activity than rural GPs and FPs do, indicating that clinical practice concentration and narrower SoP is more common in urban practices. CONCLUSION: The SoP for GPs and FPs is not uniform across Ontario. Rural physicians work more hours and engage in a broader spectrum of clinical activities. Clinical activity variation was found across all practice locations, indicating that SoP is driven by patient and community needs, which vary from region to region. Our findings are relevant for rural and northern policy and program development in medical education, continuing professional development, and physician recruitment and retention.