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The 2003 Canadian recommendations for dyslipidemia management: revisions are needed.

https://arctichealth.org/en/permalink/ahliterature175311
Source
CMAJ. 2005 Apr 12;172(8):1027-31
Publication Type
Article
Date
Apr-12-2005
Author
Douglas G Manuel
Peter Tanuseputro
Cameron A Mustard
Susan E Schultz
Geoffrey M Anderson
Sten Ardal
David A Alter
Andreas Laupacis
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ont. doug.manuel@ices.on.ca
Source
CMAJ. 2005 Apr 12;172(8):1027-31
Date
Apr-12-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada
Cholesterol, LDL - blood
Coronary Disease - mortality - prevention & control
Cost-Benefit Analysis
Health Expenditures
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Hyperlipidemias - drug therapy
Hypolipidemic Agents - therapeutic use
Middle Aged
Practice Guidelines as Topic
Risk factors
Notes
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Comment In: CMAJ. 2005 Nov 8;173(10):1210; author reply 121016275979
Comment In: CMAJ. 2005 Nov 8;173(10):1207; author reply 121016275976
Comment In: CMAJ. 2005 Apr 12;172(8):1033-4; discussion 103715824410
Erratum In: CMAJ. 2005 Jul 19;173(2):133
PubMed ID
15824409 View in PubMed
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The 2006 Canadian dyslipidemia guidelines will prevent more deaths while treating fewer people--but should they be further modified?

https://arctichealth.org/en/permalink/ahliterature155805
Source
Can J Cardiol. 2008 Aug;24(8):617-20
Publication Type
Article
Date
Aug-2008
Author
Douglas G Manuel
Sarah Wilson
Sarah Maaten
Author Affiliation
Institute for Clinical Evaluative Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada. doug.manuel@ices.on.ca
Source
Can J Cardiol. 2008 Aug;24(8):617-20
Date
Aug-2008
Language
English
Publication Type
Article
Keywords
Aged
Canada
Coronary Artery Disease - genetics - mortality - prevention & control
Cross-Cultural Comparison
Dyslipidemias - drug therapy - genetics - mortality
Health Services Accessibility - statistics & numerical data
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Middle Aged
Practice Guidelines as Topic - standards
Risk factors
Survival Analysis
Treatment Outcome
Abstract
When clinical guidelines affect large numbers of individuals or substantial resources, it is important to understand their benefits, harms and costs from a population perspective. Many countries' dyslipidemia guidelines include these perspectives.
To compare the effectiveness and efficiency of the 2003 and 2006 Canadian dyslipidemia guidelines for statin treatment in reducing deaths from coronary artery disease (CAD) in the Canadian population.
The 2003 and 2006 Canadian dyslipidemia guidelines were applied to data from the Canadian Heart Health Survey (weighted sample of 12,300,000 people), which includes information on family history and physical measurements, including fasting lipid profiles. The number of people recommended for statin treatment, the potential number of CAD deaths avoided and the number needed to treat to avoid one CAD death with five years of statin therapy were determined for each guideline.
Compared with the 2003 guidelines, 1.4% fewer people (20 to 74 years of age) are recommended statin treatment, potentially preventing 7% more CAD deaths. The number needed to treat to prevent one CAD death over five years decreased from 172 (2003 guideline) to 147 (2006 guideline).
From a population perspective, the 2006 Canadian dyslipidemia recommendations are an improvement of earlier versions, preventing more CAD events and deaths with fewer statin prescriptions. Despite these improvements, the Canadian dyslipidemia recommendations should explicitly address issues of absolute benefit and cost-effectiveness in future revisions.
Notes
Cites: CMAJ. 2005 Apr 12;172(8):1027-3115824409
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Cites: Can J Cardiol. 2006 Sep;22(11):913-2716971976
Cites: Lancet. 2007 Jan 20;369(9557):168-917240267
Comment In: Can J Cardiol. 2008 Aug;24(8):62118697284
PubMed ID
18685741 View in PubMed
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Appropriate measures of influenza immunization program effectiveness.

https://arctichealth.org/en/permalink/ahliterature166958
Source
Vaccine. 2007 Jan 22;25(6):967-9
Publication Type
Article
Date
Jan-22-2007
Author
Jeffrey C Kwong
Thérèse A Stukel
Allison J McGeer
Douglas G Manuel
Source
Vaccine. 2007 Jan 22;25(6):967-9
Date
Jan-22-2007
Language
English
Publication Type
Article
Keywords
Humans
Immunization Programs - standards
Influenza A virus - isolation & purification
Influenza B virus - isolation & purification
Influenza Vaccines - therapeutic use
Influenza, Human - diagnosis - epidemiology - prevention & control
Ontario - epidemiology
Public Health
Treatment Outcome
Abstract
Groll and Thomson's evaluation of the effectiveness of Ontario's Universal Influenza Immunization Campaign used per capita cases of laboratory-confirmed influenza. We argue that these data are susceptible to various biases and should not be used as an outcome measure. Laboratory data are traditionally used to identify the presence of influenza activity rather than to identify levels of influenza activity. A better measure of viral activity is the proportion of influenza tests positive; whereas the weekly proportion of tests positive was relatively consistent, a marked increase over time in the numbers of laboratory-confirmed cases paralleled an increase in the number of tests performed. Regardless, for evaluating universal influenza immunization program effectiveness, other established and available measures employed in previous studies describing the epidemiology of influenza should be used instead of laboratory data.
Notes
Comment On: Vaccine. 2006 Jun 12;24(24):5245-5016624458
PubMed ID
17052813 View in PubMed
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Ascertainment of chronic diseases using population health data: a comparison of health administrative data and patient self-report.

https://arctichealth.org/en/permalink/ahliterature117385
Source
BMC Public Health. 2013;13:16
Publication Type
Article
Date
2013
Author
Elizabeth Muggah
Erin Graves
Carol Bennett
Douglas G Manuel
Author Affiliation
C.T. Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, Ottawa, Ontario, Canada. emuggah@bruyere.org
Source
BMC Public Health. 2013;13:16
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
Asthma - epidemiology
Chronic Disease - epidemiology
Diabetes Mellitus - epidemiology
Heart Failure - epidemiology
Humans
Hypertension - epidemiology
Medical Records
Myocardial Infarction - epidemiology
Ontario - epidemiology
Population Surveillance - methods
Pulmonary Disease, Chronic Obstructive - epidemiology
Reproducibility of Results
Self Report
Stroke - epidemiology
Abstract
Health administrative data is increasingly being used for chronic disease surveillance. This study explored agreement between administrative and survey data for ascertainment of seven key chronic diseases, using individually linked data from a large population of individuals in Ontario, Canada.
All adults who completed any one of three cycles of the Canadian Community Health Survey (2001, 2003 or 2005) and agreed to have their responses linked to provincial health administrative data were included. The sample population included 85,549 persons. Previously validated case definitions for myocardial infarction, asthma, diabetes, chronic lung disease, stroke, hypertension and congestive heart failure based on hospital and physician billing codes were used to identify cases in health administrative data and these were compared with self-report of each disease from the survey. Concordance was measured using the Kappa statistic, percent positive and negative agreement and prevalence estimates.
Agreement using the Kappa statistic was good or very good (kappa range: 0.66-0.80) for diabetes and hypertension, moderate for myocardial infarction and asthma and poor or fair (kappa range: 0.29-0.36) for stroke, congestive heart failure and COPD. Prevalence was higher in health administrative data for all diseases except stroke and myocardial infarction. Health Utilities Index scores were higher for cases identified by health administrative data compared with self-reported data for some chronic diseases (acute myocardial infarction, stroke, heart failure), suggesting that administrative data may pick up less severe cases.
In the general population, discordance between self-report and administrative data was large for many chronic diseases, particularly disease with low prevalence, and differences were not easily explained by individual and disease characteristics.
Notes
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PubMed ID
23302258 View in PubMed
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Association between birth order and emergency room visits and acute hospital admissions following pediatric vaccination: a self-controlled study.

https://arctichealth.org/en/permalink/ahliterature105745
Source
PLoS One. 2013;8(12):e81070
Publication Type
Article
Date
2013
Author
Steven Hawken
Jeffrey C Kwong
Shelley L Deeks
Natasha S Crowcroft
Robin Ducharme
Douglas G Manuel
Kumanan Wilson
Author Affiliation
ICES uOttawa, Ottawa, Ontario, Canada ; Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada ; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Source
PLoS One. 2013;8(12):e81070
Date
2013
Language
English
Publication Type
Article
Keywords
Birth Order
Child
Child, Preschool
Diphtheria-Tetanus-Pertussis Vaccine - adverse effects
Emergency Service, Hospital - statistics & numerical data
Female
Haemophilus Vaccines - adverse effects
Hospitalization - statistics & numerical data
Humans
Incidence
Infant
Male
Ontario - epidemiology
Poliovirus Vaccine, Inactivated - adverse effects
Vaccination
Vaccines, Conjugate - adverse effects
Abstract
We investigated the association between a child's birth order and emergency room (ER) visits and hospital admissions following 2-,4-,6- and 12-month pediatric vaccinations.
We included all children born in Ontario between April 1(st), 2006 and March 31(st), 2009 who received a qualifying vaccination. We identified vaccinations, ER visits and admissions using health administrative data housed at the Institute for Clinical Evaluative Sciences. We used the self-controlled case series design to compare the relative incidence (RI) of events among 1(st)-born and later-born children using relative incidence ratios (RIR).
For the 2-month vaccination, the RIR for 1(st)-borns versus later-born children was 1.37 (95% CI: 1.19-1.57), which translates to 112 additional events/100,000 vaccinated. For the 4-month vaccination, the RIR for 1(st)-borns vs. later-borns was 1.70 (95% CI: 1.45-1.99), representing 157 additional events/100,000 vaccinated. At 6 months, the RIR for 1(st) vs. later-borns was 1.27 (95% CI: 1.09-1.48), or 77 excess events/100,000 vaccinated. At the 12-month vaccination, the RIR was 1.11 (95% CI: 1.02-1.21), or 249 excess events/100,000 vaccinated.
Birth order is associated with increased incidence of ER visits and hospitalizations following vaccination in infancy. 1(st)-born children had significantly higher relative incidence of events compared to later-born children.
Notes
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Cites: Am J Epidemiol. 2002 Nov 1;156(9):882; author reply 883-412397008
PubMed ID
24324662 View in PubMed
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Avoidable mortality by neighbourhood income in Canada: 25 years after the establishment of universal health insurance.

https://arctichealth.org/en/permalink/ahliterature164564
Source
J Epidemiol Community Health. 2007 Apr;61(4):287-96
Publication Type
Article
Date
Apr-2007
Author
Paul D James
Russell Wilkins
Allan S Detsky
Peter Tugwell
Douglas G Manuel
Author Affiliation
Institute for Clinical Evaluative Sciences, G-119, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
Source
J Epidemiol Community Health. 2007 Apr;61(4):287-96
Date
Apr-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Canada
Cause of Death
Child
Child, Preschool
Delivery of Health Care
Female
Humans
Income
Infant
Infant, Newborn
Life expectancy
Male
Middle Aged
Mortality - trends
Myocardial Ischemia - mortality
Sex Distribution
Socioeconomic Factors
Universal Coverage
Abstract
To examine neighbourhood income differences in deaths amenable to medical care and public health over a 25-year period after the establishment of universal insurance for doctors and hospital services in Canada.
Data for census metropolitan areas were obtained from the Canadian Mortality Database and population censuses for the years 1971, 1986, 1991 and 1996. Deaths amenable to medical care, amenable to public health, from ischaemic heart disease and from other causes were considered. Data on deaths were grouped into neighbourhood income quintiles on the basis of the census tract percentage of population below Canada's low-income cut-offs.
From 1971 to 1996, differences between the richest and poorest quintiles in age-standardised expected years of life lost amenable to medical care decreased 60% (p
Notes
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PubMed ID
17372287 View in PubMed
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Avoidable mortality in the United States and Canada, 1980-1996.

https://arctichealth.org/en/permalink/ahliterature188792
Source
Am J Public Health. 2002 Sep;92(9):1481-4
Publication Type
Article
Date
Sep-2002
Author
Douglas G Manuel
Yang Mao
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. doug.manuel@ices.on.ca
Source
Am J Public Health. 2002 Sep;92(9):1481-4
Date
Sep-2002
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Canada - epidemiology
Cause of Death
Child
Child, Preschool
Delivery of Health Care - standards
Health Services Accessibility
Humans
Infant
Infant, Newborn
Middle Aged
Mortality - trends
Outcome Assessment (Health Care)
Quality Indicators, Health Care
Sentinel Surveillance
United States - epidemiology
Notes
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Comment In: Am J Public Health. 2003 Feb;93(2):186; author reply 186-712554564
PubMed ID
12197980 View in PubMed
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Burden of cardiovascular disease in Canada.

https://arctichealth.org/en/permalink/ahliterature184101
Source
Can J Cardiol. 2003 Aug;19(9):997-1004
Publication Type
Article
Date
Aug-2003
Author
Douglas G Manuel
Mark Leung
Kathy Nguyen
Peter Tanuseputro
Helen Johansen
Author Affiliation
Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada. doug.manuel@ices.on.ca
Source
Can J Cardiol. 2003 Aug;19(9):997-1004
Date
Aug-2003
Language
English
Publication Type
Article
Keywords
Activities of Daily Living - classification
Adult
Aged
Aged, 80 and over
Canada - epidemiology
Cardiovascular Diseases - mortality
Cause of Death
Cross-Sectional Studies
Female
Health Surveys
Humans
Life tables
Male
Middle Aged
Quality of Life
Abstract
This report updates the death estimates for cardiovascular disease (CVD) in Canada and introduces a population-based perspective on disease prevalence and health-related quality of life (HRQOL) burden.
The Canadian Mortality Database was used to estimate the mortality of men and women in different age groups for the 139 Canadian health regions from 1950 to 1999. Heart disease prevalence and its impact on HRQOL were estimated using the 2000-2001 Canadian Community Health Survey (CCHS). Life table techniques were used to estimate the impact of heart disease on life and health expectancy.
Although CVD remains the leading cause of death in Canada, between 1950 and 1999 the death rates from CVD dropped from 702 per 100,000 to 288 per 100,000 men, and from 562 per 100,000 to 175 per 100,000 women. Results from the CCHS indicated that 5.4% of men and 4.6% of women reported having heart disease as diagnosed by a medical professional. Of these individuals, 14% of men and 21% of women reported difficulty ambulating - about six times more than people without heart disease. In total, 4.5 years of life expectancy and 2.8 years of health expectancy were lost due to CVD. The study also found large differences in the burden of CVD among men and women and across the 139 Canadian health regions.
CVD is a major disease burden in terms of both mortality and HRQOL and is an important source of health inequalities between populations in Canada. Any attempt to improve the health of Canadians or to reduce health inequalities should include interventions to reduce CVD mortality and morbidity. Given the present impact of CVD on HRQOL, reducing or eliminating heart disease may potentially result in an increase in life expectancy that will be larger than the gains in health expectancy.
PubMed ID
12915926 View in PubMed
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The CANHEART health index: a tool for monitoring the cardiovascular health of the Canadian population.

https://arctichealth.org/en/permalink/ahliterature105507
Source
CMAJ. 2014 Feb 18;186(3):180-7
Publication Type
Article
Date
Feb-18-2014
Author
Laura C Maclagan
Jungwee Park
Claudia Sanmartin
Karan R Mathur
Doug Roth
Douglas G Manuel
Andrea Gershon
Gillian L Booth
Sacha Bhatia
Clare L Atzema
Jack V Tu
Source
CMAJ. 2014 Feb 18;186(3):180-7
Date
Feb-18-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Canada - epidemiology
Cardiovascular diseases
Child
Diabetes Mellitus - epidemiology
Diet - statistics & numerical data
Exercise
Female
Fruit
Health Behavior
Health Status Indicators
Humans
Hypertension - epidemiology
Male
Middle Aged
Obesity - epidemiology
Overweight - epidemiology
Risk factors
Smoking - epidemiology
Vegetables
Young Adult
Abstract
To comprehensively examine the cardiovascular health of Canadians, we developed the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) health index. We analyzed trends in health behaviours and factors to monitor the cardiovascular health of the Canadian population.
We used data from the Canadian Community Health Survey (2003-2011 [excluding 2005]; response rates 70%-81%) to examine trends in the prevalence of 6 cardiovascular health factors and behaviours (smoking, physical activity, fruit and vegetable consumption, overweight/obesity, diabetes and hypertension) among Canadian adults aged 20 or older. We defined ideal criteria for each of the 6 health metrics. The number of ideal metrics was summed to create the CANHEART health index; values range from 0 (worst) to 6 (best or ideal). A separate CANHEART index was developed for youth age 12-19 years; this index included 4 health factors and behaviours (smoking, physical activity, fruit and vegetable consumption and overweight/obesity). We determined the prevalence of ideal cardiovascular health and the mean CANHEART health index score, stratified by age, sex and province.
During the study period, physical activity and fruit and vegetable consumption increased and smoking decreased among Canadian adults. The prevalence of overweight/obesity, hypertension and diabetes increased. In 2009-2010, 9.4% of Canadian adults were in ideal cardiovascular health, 53.3% were in intermediate health (4-5 healthy factors or behaviours), and 37.3% were in poor cardiovascular health (0-3 healthy factors or behaviours). Twice as many women as men were in ideal cardiovascular health (12.8% vs. 6.1%). Among youth, the prevalence of smoking decreased and the prevalence of overweight/obesity increased. In 2009-2010, 16.6% of Canadian youth were in ideal cardiovascular health, 33.7% were in intermediate health (3 healthy factors or behaviours), and 49.7% were in poor cardiovascular health (0-2 healthy factors or behaviours).
Fewer than 1 in 10 Canadian adults and 1 in 5 Canadian youth were in ideal cardiovascular health from 2003 to 2011. Intensive health promotion activities are needed to meet the Heart and Stroke Foundation of Canada's goal of improving the cardiovascular health of Canadians by 10% by 2020 as measured by the CANHEART health index.
Notes
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PubMed ID
24366893 View in PubMed
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Cardiovascular risk factor profiles of recent immigrants vs long-term residents of Ontario: a multi-ethnic study.

https://arctichealth.org/en/permalink/ahliterature132334
Source
Can J Cardiol. 2012 Jan-Feb;28(1):20-6
Publication Type
Article
Author
Maria Chiu
Peter C Austin
Douglas G Manuel
Jack V Tu
Author Affiliation
Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada. maria.chiu@ices.on.ca
Source
Can J Cardiol. 2012 Jan-Feb;28(1):20-6
Language
English
Publication Type
Article
Keywords
Adult
Cardiovascular Diseases - ethnology
Cross-Sectional Studies
Emigrants and Immigrants
Ethnic Groups - ethnology
Female
Follow-Up Studies
Health Surveys
Humans
Male
Ontario - epidemiology
Prevalence
Residence Characteristics
Retrospective Studies
Risk Assessment - methods
Risk factors
Time Factors
Abstract
There is growing evidence that cardiovascular risk profiles differ markedly across Canada's 4 major ethnic groups, namely White, South Asian, Chinese, and Black; however, the impact of long-term Canadian residency on cardiovascular risk within and across these ethnic groups is unknown.
Using pooled data from Statistics Canada's National Population and Canadian Community Health Surveys (1996-2007), we compared the age- and sex-standardized prevalence of cardiovascular risk factors and diseases between recent immigrants (
PubMed ID
21827964 View in PubMed
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