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Biomedical subjects

C P Shah

Publications and source records attributed to C P Shah.

At least 19 recordsLinked to original sources
PubMed1995

The impact of unemployment on health: a review of the evidence.

OBJECTIVE: To review the scientific evidence supporting an association between unemployment and adverse health outcomes and to assess the evidence on the basis of the epidemiologic criteria for causation. DATA SOURCES: MEDLINE was searched for all relevant articles with the use of the MeSH terms "unemployment," "employment," "job loss," "economy" and a range of mortality and morbidity outcomes. A secondary search was conducted for references from the primary search articles, review articles or published commentaries. Data and definitions of unemployment were drawn from Statistics Canada publications. STUDY SELECTION: Selection focused on articles published in the 1980s and 1990s. English-language reports of aggregate-level research (involving an entire population), such as time-series analyses, and studies of individual subjects, such as cross-sectional, case-control or cohort studies, were reviewed. In total, the authors reviewed 46 articles that described original studies. DATA EXTRACTION: Information was sought on the association (if any) between unemployment and health outcomes such as mortality rates, specific causes of death, incidence of physical and mental disorders and the use of health care services. Information was extracted on the nature of the association (positive or negative), measures of association (relative risk, odds ratio or standardized mortality ratio), and the direction of causation (whether unemployment caused ill health or vice versa). DATA SYNTHESIS: Most aggregate-level studies reported a positive association between national unemployment rates and rates of overall mortality and mortality due to cardiovascular disease and suicide. However, the relation between unemployment rates and motor-vehicle fatality rates may be inverse. Large, census-based cohort studies showed higher rates of overall mortality, death due to cardiovascular disease and suicide among unemployed men and women than among either employed people or the general population. Workers laid off because of factory closure have reported more symptoms and illnesses than employed people; some of these reports have been validated objectively. Unemployed people may be more likely than employed people to visit physicians, take medications or be admitted to general hospitals. A possible association between unemployment and rates of admission to psychiatric hospitals is complicated by other institutional and environmental factors. CONCLUSIONS: Evaluated on an epidemiologic basis, the evidence suggests a strong, positive association between unemployment and many adverse health outcomes. Whether unemployment causes these adverse outcomes is less straightforward, however, because there are likely many mediating and confounding factors, which may be social, economic or clinical. Many authors have suggested mechanisms of causation, but further research is needed to test these hypotheses.

Accidents, Traffic↗
PubMed1989

Fatal pontine metastasis: clinical, CT, MRI and pathological correlates.

Progressive brainstem and cerebellar signs developed in a previously healthy 70-year-old man over a course of seven days. A pontine mass characterized by CT and MRI suggested an infiltrating primary pontine glioma. Gross postmortem examination showed a medullary-pontine hemorrhage. Microscopic analysis disclosed an undifferentiated large cell carcinoma which was found to originate from the lung. Differential diagnoses in cases of suspected brainstem lesions are given, including metastatic tumors which are rare when presenting as a solitary brainstem mass. Optimal patient management should be formulated on the basis of histopathological diagnosis rather than imprecise imaging data. Exact tissue diagnosis will also avoid an extensive and expensive search for an occult systemic cancer. The roles of radiation, chemotherapy and surgery are also discussed.

Aged↗
PubMed1987

The health of children of low-income families.

Childhood poverty is common in Canada: 1,114,000 children under 16 years of age live below the poverty line. The incidence is highest among children of single mothers, unemployed parents, Canadian native peoples and recent immigrants, particularly refugees. Compared with the national average, the infant mortality rate is twice as high, deaths from infectious diseases are 2.5 times more common and accidental deaths are twice as common among children of low-income families. Other problems associated with poverty are iron deficiency anemia, dental caries, chronic ear infections, mental retardation, learning disabilities, poor school performance and increased suicide rates. Health care professionals can help address the poor physical and mental health associated with poverty in children by promoting a broad range of public policies.

Adolescent↗
PubMed1987

Pulsed Doppler frequency and carotid stenosis.

Two hundred and forty-two internal carotid arteries (ICA) were evaluated by independently interpreted arteriography and pulsed Doppler spectrum analysis using ultrasonic arteriography to evaluate the ability of peak systolic frequency (PSF) to predict the degree of internal carotid stenosis. Mean PSF in the 129 (53.3%) high grade ICA stenoses of greater than 50% diameter reduction was 6.55 +/- 0.14 (SEM) khz, while mean PSF in the 113 (46.7%) low grade (less than 50% diameter reduction) stenoses was 3.38 +/- 0.12 (SEM) kHz (P less than 0.0001). Receiver-operator characteristic (ROC) analysis revealed that PSFs of 4.5 kHz (sensitivity 87%, specificity 88%) and 5.0 kHz (sensitivity 83%, specificity 93%) were best for identifying a 50% diameter stenosis. Positive predictive value of 5.0 kHz was 93% (107/115) and negative predictive value was 82.7% (105/127). Linear regression analysis of PSF in kHz versus percentage diameter reduction yielded the equation: % stenosis = 10.7 (PSF) - 4.1 (r = 0.76). A nonlinear equation was also derived: % stenosis = 61.9 - 33.5 (PSF) + 8.7 (PSF)2 - 0.5 (PSF)3 (r = 0.77). Based on this analysis peak systolic frequency criteria measured by pulsed Doppler spectrum analysis appear to be useful for distinguishing high grade from low grade stenoses. Both the linear and nonlinear equations further suggest that PSF can more precisely quantitate the degree of ICA luminal narrowing.

Carotid Artery Diseases↗
PubMed1986

Prevalence of hypertension, obesity and smoking in three Indian communities in northwestern Ontario.

Hypertension is perceived to be an important problem among native people in Canada, but specific prevalence data have not been accumulated. A study was carried out to determine community levels of blood pressure and to document the prevalence of hypertension, obesity and cigarette smoking in nonurban Indians in three communities in northwestern Ontario. Of the 678 people present in the communities at the time of the survey 668 (98.5%) participated. Age- and sex-specific mean diastolic and systolic blood pressure readings are presented. The overall prevalence rate of hypertension was 13%; in 9.6% of those with hypertension the condition had previously been diagnosed. Blood pressure generally rose with increasing age, but diastolic pressure declined after age 50 in both sexes. The rate of obesity increased with increasing age; 70% of women aged 35 to 64 years and 50% of men aged 35 to 44 years were obese. Over half (56.4%) of the study population smoked, and most smokers were less than 35 years old.

Adolescent↗
PubMed1985

The health of Indians in Canadian cities: a challenge to the health care system.

It is well known that Canadian native people living on reserves have high morbidity and mortality rates, but less is known about the health of those who migrated to urban centres. Several studies have shown that these people have high rates of mental health problems, specific diseases, injuries, infant death and hospital admission. In addition, there is evidence that cultural differences create barriers to their use of health care facilities. The low socioeconomic status, cultural differences and discrimination that they find in cities are identified as the primary blocks to good health and adequate health care. More epidemiologic studies need to be done to identify health problems, needs and barriers to health care. Federal, provincial and civic governments along with the appropriate departments of faculties of medicine should begin working with native organizations to improve the health of native people living in Canada's cities.

Adult↗
PubMed1984

Birth weight, length, head circumference and bilirubin level in Indian newborns in the Sioux Lookout Zone, northwestern Ontario.

The norms for birth weight, length, head circumference and bilirubin level for native newborns have not been available. To develop appropriate norms, data were obtained from the charts on all live births in the Sioux Lookout Zone, northwestern Ontario, in 1968-69 and 1974-77. These data were correlated to maternal age and parity as well as sex of the infant. Despite impoverished living conditions, the birth weights of the study population were significantly higher than the Canadian norms; length and head circumference, however, were not significantly different. Over one third of the infants had serum bilirubin levels greater than 12 mg/dL (205 mumol/L). Increased maternal age was associated with increased birth weight and length and a lower bilirubin level.

Adult↗
PubMed1984

Correlation of hemodynamically significant internal carotid stenosis with pulsed Doppler frequency analysis.

Systolic and mean pressure gradients across internal carotid stenoses were measured at the time of carotid endarterectomy in the arteries of 90 patients, all of whom underwent angiography. Eighty-two of these patients also had pulsed Doppler ultrasonic arteriography with real-time spectrum analysis. There were 71 (79%) high grade stenoses of greater than 50% diameter reduction by angiography. Significant systolic pressure gradients (greater than or equal to 10 mmHg) were identified in 41 patients (46%), 38 (46%) of whom underwent ultrasonic evaluation. A pulsed Doppler frequency measured within the stenosis equal to or greater than 6.5 kiloHertz had a sensitivity of 94.7% (36/38) in identifying pressure reducing lesions with a specificity of 47.7% (21/44). Positive predictive value was 61% (36/59). Angiographic criteria (50% diameter reduction) exhibited a sensitivity of 97.6% (40/41), a specificity of 36.7% (18/49) and a positive predictive value of 56.3% (40/71). Negative predictive value was 94.7% for angiography and 91.3% for ultrasonic arteriography. A pulsed Doppler frequency equal to or greater than 6.5 kiloHertz appears to accurately identify lesions that are at risk to reduce distal internal carotid pressure under operative conditions with a sensitivity similar to angiography. This criterion has a positive predictive value and specificity that is slightly superior to angiography and a high negative predictive value. Pulsed Doppler spectrum analysis provides physiologic information relative to blood flow velocity that is complimentary to the anatomic data provided by angiography for assessing the potential for hemodynamic significance of internal carotid stenoses.

Blood Pressure↗
PubMed1983

Preventive health care of Indian preschoolers in the Sioux Lookout Zone, northwestern Ontario.

The provision of preventive health care to native children in the Sioux Lookout Zone of northwestern Ontario was assessed by reviewing the medical charts of 568 randomly selected preschoolers in 1980. Data were collected on the method of infant feeding; immunization status, vaccination and testing for tuberculosis; development, vision and hearing screening; monitoring of growth; and nutritional status and vitamin supplementation. Most of the children had been breast-fed and had received primary diphtheria-pertussis-tetanus-polio immunization as well as measles-mumps-rubella and bacille Calmette-Guérin vaccination. However, less than 30% had undergone developmental screening, and only 10% and 8% respectively had had their vision and hearing screened. Growth monitoring was adequate in the first year of life but not thereafter. Only about 55% of the children had ever had a hemoglobin level determined. More emphasis on health promotion is needed if native children are to receive adequate preventive health care.

Breast Feeding↗
PubMed1982

Renal artery thrombosis: a cause of reversible acute renal failure.

Acute renal failure can be produced by interruption of the arterial blood supply. We describe a case of acute renal failure that developed owing to thrombosis of the renal artery of the only functioning kidney. This thrombosis occurred in an artery that was stenosed probably by an arteriosclerotic plaque. The blood flow was re-established successfully by the passage of the catheter into the thrombosed artery and intra-balloon dilation of the stenosis.

Acute Kidney Injury↗
PubMed1982

Sexual abuse of children.

We review the characteristics of 843 cases of sexual abuse seen at the emergency department of the Hospital for Sick Children (HSC) in Toronto in 1962, 1967, and from 1970 to 1978. The children ranged in age from 23 days to 18 years, with a mean age of 9.8 years. Most (89.4%) were girls. The 174 cases seen from 1977 to 1978 were analyzed in detail. Among these, intercourse was the form of abuse in 70 (40%); molestation, in 41 (24%); and exhibitionism, in 36 (20%). Almost half (49%) of the offenses occurred in the child's or assailant's home.

Canada↗
PubMed1981

Posttraumatic pseudomeningomyelocele (enlarging fracture?) in a vertebral body. Case report.

An unusual case is reported in which a posttraumatic peudomeningomyelocele developed over many years inside the body of a fractured lumbar vertebra, eroding the pedicle and causing progressive neurological deficit. The wall of the sac was mostly formed by the scalloped bar bone, and partly by a membrane resembling the dura. The terminal part of the conus medullaris and some nerve roots of the cauda equina formed the contents and parts of the wall of the outpouching of the subarachnoid space into the vertebral body. A comparison is drawn between this lesion and formation of an "enlarging fracture" of the skull. The surgical technique used for obliteration of this pseudomeningomyelocele is described.

Adult↗
PubMed1980

Management of children with cleft lip and palate.

Cleft lip or palate or both is one of the common congenital conditions in Ontario; its incidence is 1.2 to 1.6 per 1000 live births. A review of the records of 358 patients showed that 40%, particularly those with a severe defect, had other medical problems. This condition can affect the children and their families in many ways. In early life many patients undergo surgical repair and have speech, hearing and dental problems; during adolescence they may have cosmetic, orthodontic and emotional problems. Many parents are concerned about the genetic implications of the defect. This variety of problems requires management by several health care disciplines. Many Canadian health sciences centres offer multidisciplinary team management in a cleft palate clinic. The child's primary care physician, with whom the team exchanges information, plays a significant role in helping the child and the family function optimally.

Adolescent↗