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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
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Comment In: Can J Cardiol. 2008 Aug;24(8):62118697284
PubMed ID
18685741 View in PubMed
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Access to drug and alcohol treatment among a cohort of street-involved youth.

https://arctichealth.org/en/permalink/ahliterature153685
Source
Drug Alcohol Depend. 2009 Apr 1;101(1-2):1-7
Publication Type
Article
Date
Apr-1-2009
Author
Scott E Hadland
Thomas Kerr
Kathy Li
Julio S Montaner
Evan Wood
Author Affiliation
Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
Source
Drug Alcohol Depend. 2009 Apr 1;101(1-2):1-7
Date
Apr-1-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Alcoholism - rehabilitation
British Columbia
Cohort Studies
Female
Health Behavior
Health Services Accessibility - statistics & numerical data
Homeless Youth - statistics & numerical data
Humans
Logistic Models
Male
Models, Statistical
Risk factors
Socioeconomic Factors
Substance-Related Disorders - rehabilitation
Treatment Outcome
Waiting Lists
Young Adult
Abstract
A number of options for treatment are available to young drug users, but little is known about the youth who actually attempt to access such services. Here we identify characteristics of a cohort of street-involved youth and highlight commonly encountered barriers.
From September 2005 to July 2007, data were collected from the At-Risk Youth Study (ARYS), a prospective cohort of 529 drug users aged 14-26 living in Vancouver, Canada. Participants who attempted to access any addiction services in the 6 months prior to enrollment were compared in univariate analyses and multiple logistic regression modeling of socio-demographic and drug-related factors.
Factors positively associated with attempting to access services included Aboriginal ethnicity (adjusted odds ratio [AOR]=1.66 [1.05-2.62]), high school education (AOR=1.66 [1.09-2.55]), mental illness (AOR=2.25 [1.50-3.38]), non-injection crack use (AOR=2.93 [1.76-4.89]), and spending >$50 on drugs per day (AOR=2.13 [1.41-3.22]). Among those who experienced difficulty-accessing services, the most commonly identified barrier was excessively long waiting lists. In a subgroup analysis comparing those who tried to access services but were unsuccessful to those who were successful, risk factors positively associated with failure included drug bingeing (odds ratio [OR]=2.86 [1.22-6.76]) and homelessness (OR=3.86 [1.11-13.4]).
In light of accumulating evidence that drug use among street youth is associated with risky health-related behaviors, improving access to treatment and other addiction services should remain an important public health priority.
Notes
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PubMed ID
19081203 View in PubMed
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Aspects of healthcare utilisation in self-reported obstructive lung disease.

https://arctichealth.org/en/permalink/ahliterature99066
Source
Clin Respir J. 2009 Jan;3(1):34-41
Publication Type
Article
Date
Jan-2009
Author
Rune Nielsen
Ane Johannessen
Per Sigvald Bakke
Jan Erik Askildsen
Ernst Reidar Omenaas
Amund Gulsvik
Author Affiliation
Institute of Medicine, University of Bergen, Haukeland University Hospital, Bergen, Norway. rune.nielsen@med.uib.no
Source
Clin Respir J. 2009 Jan;3(1):34-41
Date
Jan-2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Analysis of Variance
Chi-Square Distribution
Community Health Services - utilization
Female
Follow-Up Studies
Health Care Surveys
Health Knowledge, Attitudes, Practice
Health Services - utilization
Health Services Accessibility - statistics & numerical data
Humans
Logistic Models
Male
Middle Aged
Norway
Patient Acceptance of Health Care - statistics & numerical data
Probability
Pulmonary Disease, Chronic Obstructive - diagnosis - therapy
Questionnaires
Risk factors
Self Disclosure
Severity of Illness Index
Social Work - statistics & numerical data
Socioeconomic Factors
Spirometry
Statistics, nonparametric
Treatment Outcome
Abstract
INTRODUCTION: Utilisation of healthcare resources because of pulmonary diseases have previously been presented according to lung function or symptom severity. We aimed to compare the associations of symptoms and lung function to healthcare and social service utilisation in subjects with self-reported obstructive lung diseases (OLDs) (asthma, chronic obstructive pulmonary disease, chronic bronchitis, emphysema). MATERIALS AND METHODS: Of 2819 participants aged 27-82 years in the Hordaland County Respiratory Health Survey, 200 subjects (7.1%) self-reported OLD. They answered 13 questions on respiratory symptoms and 5 questions on use of healthcare and social services. Altogether, 161 participants (81%) completed post-bronchodilation spirometry. RESULTS: Use of anti-asthmatic drugs, regular physician's appointment, sick leave payment for the last 12 months, hospital admission for the last 12 months and disability pension were reported by 68%, 63%, 18%, 8% and 7% of those with self-reported OLD, respectively. Twenty per cent of subjects with self-reported OLD had not received any healthcare or social services. In adjusted multivariate logistic regression analyses, increase in the respiratory symptom score was significantly associated with more healthcare and social services. Lower forced expiratory volume in 1 s in % predicted, however, was not significantly associated with more use of healthcare and social services. CONCLUSION: The majority (80%) of subjects in a general population with self-reported OLD received healthcare services. The utilisation of healthcare and social services was strongly associated to the burden of respiratory symptoms, and, to a lesser degree, to the level and pattern of lung function.
PubMed ID
20298370 View in PubMed
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The association between market availability and adherence to antihypertensive medications: an observational study.

https://arctichealth.org/en/permalink/ahliterature116577
Source
Am J Hypertens. 2013 Feb;26(2):180-90
Publication Type
Article
Date
Feb-2013
Author
Charity D Evans
Dean T Eurich
Xinya Lu
Alfred J Remillard
Yvonne M Shevchuk
David Blackburn
Author Affiliation
College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. charity.evans@usask.ca
Source
Am J Hypertens. 2013 Feb;26(2):180-90
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Aged
Angiotensin Receptor Antagonists - therapeutic use
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Antihypertensive Agents - therapeutic use
Cohort Studies
Female
Health Services Accessibility - trends
Humans
Hypertension - drug therapy
Male
Marketing of Health Services - trends
Medication Adherence
Middle Aged
Retrospective Studies
Saskatchewan
Treatment Outcome
Abstract
High adherence to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reported in observational studies has frequently been attributed to improved tolerability. However, these agents are also relatively new to the market compared to other antihypertensive medications. We aimed to determine if an association exists between adherence and market availability of a specific antihypertensive agent.
This retrospective cohort study used administrative data from Saskatchewan, Canada. Subjects were =40 years of age and received a new antihypertensive medication between 1994 and 2002. The primary outcome was the proportion of subjects achieving optimal adherence (=80%) at 1 year, stratified by antihypertensive medication class and the year of availability. Adherence was measured using the cumulative mean gap ratio.
A total of 36,214 subjects met the inclusion criteria. Optimal adherence was observed in 4987 of 8623 (57.8%) subjects receiving ACEIs and 1013 of 1600 (63.3%) subjects receiving ARBs, but adherence appeared inconsistent when examined within each antihypertensive class. A pattern of increasing mean adherence was observed according to availability in the ACEI subgroup (Spearman r = 0.82; P = 0.007) but not the ARB subgroup (Spearman r = 0.41; P = 0.49). However, the association between availability and optimal adherence converged when ARB and ACEI users were combined (Spearman r = 0.85, P
PubMed ID
23382402 View in PubMed
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Availability of percutaneous closure for an adult population with interatrial shunts.

https://arctichealth.org/en/permalink/ahliterature53557
Source
Cardiology. 2003;99(2):85-9
Publication Type
Article
Date
2003
Author
Magnus Johansson
Björn Söderberg
Peter Eriksson
Author Affiliation
Department of Clinical Physiology, Ostra University Hospital, Göteborg, Sweden. magnus.c.johansson@vgregion.se
Source
Cardiology. 2003;99(2):85-9
Date
2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Balloon Occlusion
Cardiac Surgical Procedures - utilization
Echocardiography, Transesophageal
Female
Follow-Up Studies
Health Services Accessibility
Heart Septal Defects, Atrial - therapy
Humans
Male
Middle Aged
Patient Selection
Postoperative Complications - etiology - ultrasonography
Research Support, Non-U.S. Gov't
Sweden
Treatment Outcome
Abstract
OBJECTIVES: To report the availability of percutaneous closure for an adult population with interatrial septal defects. METHODS: Observational study with 66 consecutive patients referred to a tertiary center for evaluation of the possibility of percutaneous closure. The patients were selected initially after review of transesophageal echocardiography (TEE) and finally after heart catheterization. RESULTS: Out of 66 patients, 50 were selected after the review of TEE and 38 of them were selected after catheterization; all of the 38 were effectively closed. CONCLUSION: Percutaneous closure is possible and can be carried out safely in a majority of the adult population with interatrial shunts.
PubMed ID
12711883 View in PubMed
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Availability of, referral to and participation in exercise-based cardiac rehabilitation after heart valve surgery: Results from the national CopenHeart survey.

https://arctichealth.org/en/permalink/ahliterature269925
Source
Eur J Prev Cardiol. 2015 Jun;22(6):710-8
Publication Type
Article
Date
Jun-2015
Author
Tina B Hansen
Selina K Berg
Kirstine L Sibilitz
Rikke Søgaard
Lau C Thygesen
Anne-Marie Yazbeck
Ann D Zwisler
Source
Eur J Prev Cardiol. 2015 Jun;22(6):710-8
Date
Jun-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Cardiac Surgical Procedures - adverse effects - rehabilitation
Cross-Sectional Studies
Denmark
Exercise Therapy - methods
Female
Health Care Surveys
Health Services Accessibility
Healthcare Disparities
Heart Valve Diseases - physiopathology - surgery
Heart Valves - physiopathology - surgery
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
National Health Programs
Odds Ratio
Patient compliance
Program Evaluation
Referral and Consultation
Registries
Residence Characteristics
Retrospective Studies
Surveys and Questionnaires
Treatment Outcome
Young Adult
Abstract
As with ischaemic heart disease, cardiac rehabilitation (CR) is recommended for patients undergoing heart valve surgery; recommendations are based on limited evidence. The organization of CR programmes and factors associated with uptake among patients undergoing heart valve surgery have not been studied. This study investigated CR programmes for these patients and factors associated with referral and participation.
We distributed two nationwide surveys: one to 37 hospitals and 98 municipalities and one to 742 consecutive patients undergoing heart valve surgery. Data were linked to nationwide registries. We analysed the provision and content of programmes using descriptive statistics, and factors associated with referral and participation using logistic regression analysis.
Coverage of CR programmes for these patients was high, with national programme variation. The overall uptake rate was 52%. Simultaneous CABG was associated with a higher probability of referral to CR (OR 2.02 (95%CI 1.12-3.65)); being unmarried (0.44 (0.27-0.72)) and having TAVI with a lower probability (0.26; 0.13-0.52). The referral pattern varied across administrative regions, with patients in the capital region less likely to be referred (0.22 (0.08-0.57)). Patients with TAVI were less likely to participate (0.29 (0.12-0.70)).
Despite high national programme coverage, only half the patients post heart valve surgery received CR. Both factors identified at provider- and patient-level influenced uptake and included significant regional variation in referral pattern. Further research into the effect and organization of CR post heart valve surgery is needed.
PubMed ID
24857890 View in PubMed
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Before and after, the impact of available on-demand treatment for HAE.

https://arctichealth.org/en/permalink/ahliterature268755
Source
Allergy Asthma Proc. 2015 Mar-Apr;36(2):145-50
Publication Type
Article
Author
Sandra C Christiansen
Anette Bygum
Aleena Banerji
Paula Busse
Henry Li
William Lumry
Mark Davis-Lorton
Jonathan A Bernstein
Michael M Frank
Anthony Castaldo
Janet F Long
Marc Riedl
Bruce L Zuraw
Source
Allergy Asthma Proc. 2015 Mar-Apr;36(2):145-50
Language
English
Publication Type
Article
Keywords
Activities of Daily Living - psychology
Angioedemas, Hereditary - complications - drug therapy - psychology
Child
Denmark
Disease Progression
Drug-Related Side Effects and Adverse Reactions - etiology - prevention & control - psychology
Fear - psychology
Health Services Accessibility
Humans
Perception
Quality of Life
Treatment Outcome
United States
Abstract
Availability of effective treatment for acute attacks is expected to transform the care of hereditary angioedema (HAE) patients. We felt that it would be of interest to test these assumptions by examining the perceptions of HAE patients regarding the impact that these therapies have had on their lives. Patients at a United States HAE Association summit meeting were asked to rate the burden of HAE currently and compare by recall with 2009 when these therapies were not available. Questions covered five domains: psychological/emotional status, ability to carry out daily activities, fear of suffocation, worry about their children inheriting HAE, and medication side effects. Data were analyzed using Wilcoxon signed-rank tests or analysis of variance. Responses were obtained from 134 self-identified HAE subjects: 85 type I, 21 type II, and 28 with normal C1 inhibitor (C1INH). Burden of disease showed significant improvement in all domains except worry about children inheriting HAE. With the introduction of newer therapies, subjects with the most severe burden of illness improved more than those with milder burdens. However, significant burden of illness remained. The availability of the current treatments has substantially improved the quality of life for HAE patients in the United States, similar to a survey of Danish HAE patients regarding the introduction of home treatment. Nevertheless, our study shows that a substantial burden of illness remains for HAE patients.
PubMed ID
25715243 View in PubMed
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Cannabis for therapeutic purposes: patient characteristics, access, and reasons for use.

https://arctichealth.org/en/permalink/ahliterature106866
Source
Int J Drug Policy. 2013 Nov;24(6):511-6
Publication Type
Article
Date
Nov-2013
Author
Zach Walsh
Robert Callaway
Lynne Belle-Isle
Rielle Capler
Robert Kay
Philippe Lucas
Susan Holtzman
Author Affiliation
University of British Columbia, 3333 University Way, Kelowna, BC V1V1V7, Canada. Electronic address: zachary.walsh@ubc.ca.
Source
Int J Drug Policy. 2013 Nov;24(6):511-6
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Canada
Crime
Cross-Sectional Studies
Drug and Narcotic Control
Female
Health Behavior
Health Knowledge, Attitudes, Practice
Health Policy
Health Services Accessibility - legislation & jurisprudence
Humans
Male
Medical Marijuana - adverse effects - supply & distribution - therapeutic use
Middle Aged
Patient satisfaction
Patients - legislation & jurisprudence - psychology
Phytotherapy
Plants, Medicinal
Treatment Outcome
Young Adult
Abstract
The authorized and unauthorized use of cannabis for therapeutic purposes (CTP) has increased dramatically in recent years, and physicians have called for further research to better clarify the parameters of effective and appropriate use. We report findings from a large cross-sectional study of the use of CTP in Canada and compare use across medical conditions and across authorized and unauthorized users.
We examined cannabis use history, medical conditions and symptoms, patterns of current use of CTP, modes of access and perceived effectiveness among 628 self-selected Canadians consumers of CTP. Participants were recruited from medical cannabis dispensaries and from organizations that assist users of CTP.
Patients reported using cannabis to treat multiple symptoms, with sleep, pain, and anxiety being the most common. Cannabis was perceived to provide effective symptoms relief across medical conditions. Patterns of use were also consistent across medical conditions. Notable differences were observed with regard to modes of access.
Across medical conditions respondents reported using cannabis to effectively address diverse symptoms. Results indicate a substantial disconnect between the therapeutic use of cannabis and research on the risks and benefits of such use; particularly with regard to the anxiolytic and sedative use of cannabis. Authorized and unauthorized users exhibited few meaningful differences with regard to medical conditions and patterns of use, but faced substantial differences regarding access.
PubMed ID
24095000 View in PubMed
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Capacity enhancement of hepatitis C virus treatment through integrated, community-based care.

https://arctichealth.org/en/permalink/ahliterature159237
Source
Can J Gastroenterol. 2008 Jan;22(1):27-32
Publication Type
Article
Date
Jan-2008
Author
Warren D Hill
Gail Butt
Maria Alvarez
Mel Krajden
Author Affiliation
British Columbia Centre for Disease Control, Vancouver, Canada.
Source
Can J Gastroenterol. 2008 Jan;22(1):27-32
Date
Jan-2008
Language
English
Publication Type
Article
Keywords
Antiviral agents - therapeutic use
British Columbia
Cohort Studies
Community Health Services - manpower - organization & administration
Counseling
Delivery of Health Care, Integrated - organization & administration
Female
Geographic Information Systems - statistics & numerical data
Health Services Accessibility - statistics & numerical data
Hepatitis C - drug therapy - prevention & control
Humans
Interferons - therapeutic use
Male
Middle Aged
Patient Education as Topic
Physician-Nurse Relations
Public health nursing
Ribavirin - therapeutic use
Treatment Outcome
Abstract
An estimated 250,000 Canadians are infected with the hepatitis C virus (HCV). The present study describes a cohort of individuals with HCV referred to community-based, integrated prevention and care projects developed in British Columbia. Treatment outcomes are reported for a subset of individuals undergoing antiviral therapy at four project sites.
Four demonstration projects based on a public health nurse and physician partnership were established in rural and small urban centres in British Columbia. Comprehensive medical assessments determined whether individuals received treatment, or counselling and education. Outcomes of the treatment group were compared with published randomized controlled trials. Client demographics were mapped using geographical information systems applications.
A total of 1795 individuals were referred to the clinics for medical assessment between September 2001 and December 2005. After assessment, 26% were eligible for therapy, while 74% received counselling and education. Wait times decreased annually, with one-half of all referrals assessed within 30 days. Combination antiviral therapy was initiated in 363 clients with interferon plus ribavirin (n=36) or pegylated interferon plus ribavirin (n=327). Treatment outcomes were available for 205 individuals. The overall rate of sustained virological response was 61% (126 of 205 individuals). The number of individuals assessed at each site represented, on average, 20% of the total cumulative reported HCV cases in the catchment areas.
The study findings illustrate how a public health nurse and physician partnership can service a population with complex medical needs while simultaneously increasing local capacity. Treatment outcomes were comparable with published clinical trials.
Notes
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PubMed ID
18209777 View in PubMed
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111 records – page 1 of 12.