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Cardiovascular disease mortality in Canada.

https://arctichealth.org/en/permalink/ahliterature244041
Source
Can Med Assoc J. 1981 Nov 1;125(9):981-92
Publication Type
Article
Date
Nov-1-1981
Author
E S Nicholls
J. Jung
J W Davies
Source
Can Med Assoc J. 1981 Nov 1;125(9):981-92
Date
Nov-1-1981
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada
Cardiovascular Diseases - epidemiology - mortality
Cerebrovascular Disorders - mortality
Coronary Disease - mortality
Female
Humans
Hypertension - prevention & control
Male
Middle Aged
Nutritional Physiological Phenomena
Physical Exertion
Smoking
Abstract
During the past two decades approximately one half of all deaths in Canada were due to cardiovascular diseases. Ischemic heart disease and cerebrovascular disease caused more than 60% and 20% of those deaths respectively. The mortality rates for ischemic heart disease in males increased slightly until 1965 and then dropped substantially, whereas the rates for females, which were declining at least since the early 1960s, accelerated in their decline. As a consequence, the rates for males remain almost twice as high as those for females. The reductions were initially observed in males 25 to 34 years old and in all age groups of females, but became apparent in a wider range of ages in the second period reviewed (1969 through 1977). The mortality of cerebrovascular disease has gradually diminished for both sexes since the 1950s, but the decline has been more pronounced among females, who originally had the higher rate. Marked geographic differences in mortality rates still exist in Canada despite the decline in death rates for both ischemic heart disease and cerebrovascular disease in all regions of the country. Surprising regional differences in times of onset of these declines have been demonstrated. For ischemic heart disease Ontario maintains the highest and the Prairies the lowest mortality rates. Quebec, despite a sustained decline, still ranks third, while the Pacific region shows the second-lowest rates in the country. The Atlantic region showed the lowest rates of decline in the period reviewed. The reduction in the mortality of ischemic heart disease in Canada (16.4% between 1969 and 1977) must be considered real for a variety of reasons. Direct evidence is not available to elucidate whether the reduction is the consequence of reduced incidence, increased survival or a combination of the two factors. The potential role of various factors that may have contributed to this decline is briefly discussed in this article.
Notes
Cites: Prev Med. 1975 Jun;4(2):115-251153392
Cites: Can Med Assoc J. 1977 Dec 17;117(12):1383-6589537
Cites: Br J Prev Soc Med. 1977 Dec;31(4):245-50597678
Cites: Circulation. 1978 Mar;57(3):405-31342136
Cites: Br Med J. 1978 Mar 11;1(6113):635-7630266
Cites: Can Med Assoc J. 1976 Feb 7;114(3):185-61032345
Cites: Int J Epidemiol. 1978 Jun;7(2):145-51150409
Cites: JAMA. 1978 Sep 22;240(13):1353-4355674
Cites: Br Med J. 1978 Oct 21;2(6145):1109-12709255
Cites: J Chronic Dis. 1978;31(12):709-20748367
Cites: Am J Epidemiol. 1979 Jun;109(6):709-18453189
Cites: Ann Intern Med. 1979 Oct;91(4):630-40484967
Cites: Am J Epidemiol. 1980 Mar;111(3):315-287361756
Cites: Can J Public Health. 1979 Sep-Oct;70(5):321-8546507
PubMed ID
7332895 View in PubMed
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Emergency medicine resident attitudes and perceptions of HIV testing before and after a focused training program and testing implementation.

https://arctichealth.org/en/permalink/ahliterature146257
Source
Acad Emerg Med. 2009 Nov;16(11):1165-73
Publication Type
Article
Date
Nov-2009
Author
Yu-Hsiang Hsieh
Julianna J Jung
Judy B Shahan
Daniel Moring-Parris
Gabor D Kelen
Richard E Rothman
Author Affiliation
Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. yhsieh1@jhmi.edu
Source
Acad Emerg Med. 2009 Nov;16(11):1165-73
Date
Nov-2009
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Counseling - organization & administration
Education, Medical, Continuing
Emergency Medicine - education
Emergency Service, Hospital - organization & administration
Female
HIV Infections - diagnosis
Hospitals, Urban - organization & administration
Humans
Internship and Residency
Male
Mass Screening - standards
Referral and Consultation - organization & administration
Time Factors
Abstract
The objectives were to determine attitudes and perceptions (A&P) of emergency medicine (EM) residents toward emergency department (ED) routine provider-driven rapid HIV testing services and the impact of both a focused training program (FTP) and implementation of HIV testing on A&P.
A three-phase, consecutive, anonymous, identity-unlinked survey was conducted pre-FTP, post-FTP, and 6 months postimplementation. The survey was designed to assess residents' A&P using a five-point Likert scale. A preimplementation FTP provided both the rationale for the HIV testing program and the planned operational details of the intervention. The HIV testing program used only indigenous ED staff to deliver HIV testing as part of standard-of-care in an academic ED. The impact of the FTP and implementation on A&P were analyzed by multivariate regression analysis using generalized estimating equations to control for repeated measurements in the same individuals. A "favorable" A&P was operationally defined as a mean score of >3.5, "neutral" as mean score of 2.5 to 3.5, and "unfavorable" as mean score of
Notes
Comment In: Acad Emerg Med. 2009 Nov;16(11):1044-820053220
PubMed ID
20053237 View in PubMed
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Outcomes and cost analysis of 3 operational models for rapid HIV testing services in an academic inner-city emergency department.

https://arctichealth.org/en/permalink/ahliterature133489
Source
Ann Emerg Med. 2011 Jul;58(1 Suppl 1):S133-9
Publication Type
Article
Date
Jul-2011
Author
Yu-Hsiang Hsieh
Julianna J Jung
Judy B Shahan
Harold A Pollack
Heather S Hairston
Daniel Moring-Parris
G D Kelen
Richard E Rothman
Author Affiliation
Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA. yhsieh1@jhmi.edu
Source
Ann Emerg Med. 2011 Jul;58(1 Suppl 1):S133-9
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Academic Medical Centers
Adolescent
Adult
Baltimore - epidemiology
Continuity of Patient Care
Cost-Benefit Analysis
Emergency Service, Hospital - economics
Female
HIV Infections - diagnosis - epidemiology
Hospital Costs
Hospitals, Urban
Humans
Male
Middle Aged
Models, organizational
Outcome Assessment (Health Care)
Point-of-Care Systems - economics
Prevalence
Retrospective Studies
Abstract
We compare the outcomes and costs of alternative staffing models for an emergency department (ED) rapid HIV testing program.
A rapid oral-fluid HIV testing program was instituted in an inner-city ED in 2005. Three staffing models were compared during 24.5 months: indigenous medical staff only, exogenous staff only, or exogenous staff plus medical staff (hybrid). Personnel obtained written consent and provided brief pretest counseling, obtained kits, collected specimens, returned specimens to the ED satellite laboratory, and performed posttest counseling and referral to care. Cost analysis was performed to estimate cost per patient tested and cost per patient linked to care.
Overall, 44 of 2,958 (1.5%) patients tested received confirmed positive results and 30 (68%) were linked to care. The exogenous staff only model yielded the highest number tested per month (587), and indigenous medical staff only yielded the lowest (57). Significantly higher positivity rates were found in both indigenous medical staff only (2.2%) and hybrid (2.0%) models versus the exogenous staff only model (0.6%) (prevalence rate ratio: 3.7 [95% confidence interval {CI}1.5 to 9.3] versus 3.4 [95% CI 1.5 to 7.8], respectively). All patients with confirmed positive results were linked to care in the indigenous medical staff only model but only approximately 60% were linked to care in the 2 other models (linked to care rate ratio versus exogenous staff only: 1.8 [95% CI 1.1 to 4.4]; versus hybrid: 1.7 [95% CI 1.2 to 2.5]). The indigenous medical staff only model had the highest cost ($109) per patient tested, followed by the hybrid ($87) and the exogenous staff only ($39). However, the indigenous medical staff only model had the lowest cost ($4,937) per patient linked to care, followed by the hybrid ($7,213) and exogenous staff only ($11,454).
The exogenous staff only model tested the most patients at the least cost per patient tested. The indigenous medical staff only model identified the fewest patients with unrecognized HIV infection and had the highest cost per patient tested but the lowest cost per patient linked to care.
PubMed ID
21684392 View in PubMed
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