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Biomedical subjects

D R MacLean

Publications and source records attributed to D R MacLean.

30 records · Page 2Linked to original sources
PubMed1995

Prescribing patterns of antilipemic drugs and prevalence of hypercholesterolemia in the Nova Scotia population more than 65 years old.

OBJECTIVE: To examine the prevalence of antilipemic drug use, demographic characteristics of patients using these drugs, and the prevalence of hypercholesterolemia in the Nova Scotia population over 65 years of age. DESIGN: Information was collected on the prescribing of antilipemic drugs using Nova Scotia Medical Services Insurance Pharmacare program data from October 1991 through March 1992. Pharmacare data were compared with prevalence data on increased low-density lipoprotein (LDL) cholesterol concentrations obtained from the Nova Scotia Heart Health Survey (NSHHS). SETTING: Pharmacare is a centrally administered drug insurance system maintained in computerized claims files since 1974. It provides prescription drugs to all residents of Nova Scotia who are at least 65 years old and who are insured under the provincial Medicare program. PARTICIPANTS: In the 1991-1992 fiscal year, 47,000 men and 65,700 women were eligible for Pharmacare. The NSHHS was administered to a probability sample of 2,108 individuals, representative of the 1986 population aged 18-74 years. MAIN OUTCOME MEASURES: Prescriptions for antilipemic agents. RESULTS: The NSHHS data indicated that 3.7% of women and 2.3% of men at least 65 years old and 4.8% of women and 2.8% of men 65-74 years old received a prescription for antilipemic drugs.

Aged↗
PubMed1995

Epidemiology of diabetes mellitus in Canada.

We present data on 5 aspects of the epidemiology of diabetes mellitus in Canada: (a) the incidence of insulin-dependent diabetes mellitus in those under 15 years of age. The 2 Canadian centres that participated in the Diabetes Epidemiology Research International study had different incidence rates in IDDM:25.5/100,000 in Prince Edward Island (PEI) and 9.2/100,000 in Montreal. The reasons for this difference are not yet established. Studies on incidence of IDDM over a decade in PEI showed an apparent epidemic of the disease; (b) the prevalence of self-reported diabetes mellitus in Canadian adults. The overall prevalence of self-reported diabetes in Canadian adults (18-74 y) was 5.1% in the Canadian Heart Health Survey. There were no significant regional differences in prevalence of diabetes across Canada. The prevalence rates increased with age; (c) mortality data in people with diabetes mellitus. In PEI, 321 persons with diabetes died between January 1, 1982 and December 31, 1984, accounting for about 2% of all deaths. Diabetes was listed as the underlying cause in 16.8% of the deaths, as a contributing cause of death in 41.7%, and not mentioned at all in 41.1% of the deaths. Irrespective of whether diabetes was mentioned or not, myocardial infarction and cerebral vascular disease were the 2 major causes of deaths in these 321 persons with diabetes; (d) the prevalence of cardiovascular risk factors in Canadian adults with diabetes mellitus. In the Canadian Heart Health Survey, the prevalence rates of obesity, hypertension, sedentary lifestyle, and hypercholesterolemia were higher in the diabetic group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Theoretical rationale of community intervention for the prevention and control of cardiovascular disease.

Cardiovascular disease is the leading cause of death and disability in the developed world, accounting for slightly more than 40% of all mortality. Along with the resultant disability of those who survive with the disease it costs the health care system in Canada approximately $17 billion on an annual basis. The known risk factors for cardiovascular disease are widespread within the population; in Canada, approximately 70% of individuals have one or more of the major risk factors. Research over the past 25 years has disclosed that a significant proportion of the cause of heart disease and its risk factors are rooted in the unhealthy habits of average living in conjunction with unfavorable physical, economic and psychosocial environments. The primary prevention of cardiovascular disease has focused on individual risk factor change combined with approaches to community organization in an effort to produce a more conducive environment for behavior change to be carried out. First-generation community programs for cardiovascular disease prevention, as illustrated by the North Karelia Project, Stanford Five City Project and others in the United States, have relied heavily on social learning theory as advanced by Bandura, from Stanford University. Second-generation prevention programs, such as the Nova Scotia Heart Health Program, have relied on these theories as well as theories of participation and community development in the prevention of major noncommunicable diseases. This paper gives an overview of the theoretical basis of community intervention programs for cardiovascular disease. Included will be a discussion of some of the various theoretical approaches used in Canada and the United States and elsewhere over the past 25 years.

Canada↗
PubMed1992

Canadian heart health surveys: a profile of cardiovascular risk. Survey methods and data analysis. Canadian Heart Health Surveys Research Group.

OBJECTIVE: To describe the methods used in nine provincial surveys carried out as part of the Canadian Heart Health Initiative. DESIGN: Population-based cross-sectional surveys, following a core standardized protocol, implemented by provincial departments of health in collaboration with Health and Welfare Canada. Data were obtained through a home interview and a clinic visit. A standard manual of field operations and standardized training procedures were used in all provinces. SETTING: Nine Canadian provinces during the period 1986 to 1990. PARTICIPANTS: A probability sample of 26,293 men and women aged 18 to 74 years was selected from the health insurance registries in each province. Over 30% of the participants had post-secondary education. About 50% were 18 to 34 years old. OUTCOME MEASURES: Data on sociodemographic characteristics, hypertensive and diabetic status, knowledge and awareness of the causes and consequences of cardiovascular disease and two blood pressure measurements were obtained in a home interview. During a clinic visit, data were collected on height, weight (waist and hip circumferences in four provinces), two blood pressure measures and a blood sample. Total plasma cholesterol, triglycerides and high- and low-density lipoprotein cholesterol were measured in the Lipid Research Laboratory, University of Toronto and St. Michael's Hospital. MAIN RESULTS: Of the subjects invited to participate in the survey, 78% were interviewed, 69% attended the clinic and 64% provided a fasting specimen (8 hours or more). The response rates were slightly lower for men aged 18 to 34, for women aged 65 to 74 and for those with fewer years of education. Data from the provincial surveys (Ontario will complete the survey in 1992) are being compiled in the Canadian Heart Health Database. CONCLUSION: The process followed in the implementation of the provincial heart health surveys is a model of how provincial departments of health may carry out epidemiologic investigations in support of their mandate. The approach illustrates how a country-wide database can be built through partnerships among different levels of government. The use of community health nurses was instrumental in the efficient implementation of the surveys and in the realization of the relatively high rates of response attained.

Adult↗
PubMed1992

Plasma lipids and lipoproteins and the prevalence of risk for coronary heart disease in Canadian adults. Canadian Heart Health Surveys Research Group.

OBJECTIVE: To report population reference values for blood lipids, to determine the prevalence of lipid risk factors and to assess their association with other risk factors. DESIGN: Population-based cross-sectional surveys. Survey participants were interviewed at home and provided a blood sample at a clinic. All blood lipid analyses were done in the Lipid Research Laboratory, University of Toronto. The laboratory is standardized in the National Heart, Lung Blood Institute-Centres for Disease Control Standardization Program. SETTING: Nine Canadian provinces, from 1986 to 1990. PARTICIPANTS: A probability sample of 26,293 men and women aged 18 to 74 was selected from the health insurance registers for each province. Blood samples were obtained from 16,924 participants who had fasted 8 hours or more. OUTCOME MEASURES: Concentration of total plasma cholesterol, triglycerides and high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol in blood samples from fasting participants. MAIN RESULTS: Of the study population, 46% had total plasma cholesterol levels above 5.2 mmol/L, 15% had LDL-cholesterol levels above 4.1 mmol/L, 15% had triglyceride levels above 2.3 mmol/L and 8% had HDL-cholesterol levels below 0.9 mmol/L. Total plasma cholesterol, LDL-cholesterol and triglyceride levels rose with age in men to a maximum in the 45-54 age group; in women there was little change with age up to ages 45 to 54, at which time the level of each of these lipids increased appreciably. The age-standardized prevalence of obesity was positively associated with elevation of total plasma cholesterol. CONCLUSION: The results suggest the need for a multifactorial approach in health promotion efforts to lower blood cholesterol levels and reduce other risk factors in the population. A considerable number of adults were found to be at risk at all ages in both sexes. In the short term, men aged 34 and older and women aged 45 and older might benefit most from prevention programs.

Adult↗
PubMed1988

Endemic institutional salmonellosis due to lactose-fermenting Salmonella newport in Nova Scotia.

We report two outbreaks of salmonellosis due to lactose-fermenting Salmonella newport in a Halifax nursing home in August 1983 and July 1986 that we believe were related. The relative rarity of this serotype and other epidemiologic evidence suggest that the organism was endemic in the institution for at least 3 years. Persistent carriers as well as ill and convalescing patients presumably were responsible for propagation of the outbreak. We recommend adequate microbiologic follow-up of infected residents and implementation of surveillance and infection control measures for nursing homes and special care institutions.

Carrier State↗
PubMed1980

Heat injuries in Canadian mass participation runs.

In two Canadian runs with a total of approximately 2900 participants 26 people collapsed with heat injury and were taken to hospital. All were relatively young (13 to 38 years old). A retrospective survey showed that all were novices to 10-km races and that many had collapsed even though they had consumed fluids before and during the run. A review of etiologic factors suggested that the extremes in the Canadian climate, which preclude heat acclimatization in the spring and early summer, may be an important influence on the incidence of heat injury.

Adolescent↗
PubMedDate not supplied

Comparison of the prevalence of cardiovascular risk factors between Quebec and other Canadian provinces: the Canadian heart health surveys.

OBJECTIVE: To compare the prevalence of different cardiovascular (CVD) risk factors between Quebec, a Canadian Province with a population of mainly French descendants, and other Canadian provinces. DESIGN: Cross-sectional surveys in the ten Canadian provinces using stratified, two-stage, replicated probability samples from health insurance registries. PARTICIPANTS: A total of 2,353 Quebec residents and 20,776 other Canadians aged 18 to 74 years were surveyed. INTERVENTION: Standardized interviews and measurement of CVD risk factors. RESULTS: Compared with other provinces, Quebec had a higher prevalence of smoking, (32% vs 25%), dyslipidemia (48% vs 43%), a similarly sedentary lifestyle (37% vs 38%), a lower prevalence of hypertension (19% vs 23%) and body mass index > or =27 (28% vs 33%). Prevalence of two of the above risk factors was greater in Quebec (29%) than in the other provinces (25%). The difference in the prevalence of dyslipidemia between Quebec and the other provinces remained after stratification by body mass index and smoking status. Combination of risk factors differed between Quebec and the other provinces. CONCLUSIONS: Different genetic backgrounds, cultural influences occurring at different times among different age groups, as well as different trends in CVD risk factors and their interaction may explain why cross-sectional surveys cannot fully explain the differences in CVD mortality between ethnic groups. Given these differences in CVD risk factors between Quebec and other provinces, the relatively high level of all risk factors in Canada justifies increased focus on the Canadian Heart Health Initiative and attention to regional and ethnic differences when addressing CVD risk factors.

Adolescent↗
PubMedDate not supplied

A dissemination research agenda to strengthen health promotion and disease prevention.

The question of how to enhance the dissemination of knowledge and the use of innovations related to disease prevention and health promotion was posed to an international group of experts at an invitational research conference held in Vancouver, British Columbia in March 1995. The Canadian Conference on Dissemination Research Strengthening Health Promotion and Disease Prevention was co-sponsored by 15 voluntary organizations, government agencies and industries. It examined advances and gaps in the study of diffusion and adoption of preventive knowledge and practices among health professionals and the public. It was the first national conference of its kind devoted to dissemination research and dissemination of research specifically in health promotion and disease prevention. This paper summarizes the major issues raised in the papers presented at this conference. Policies and strategies for strengthening dissemination research and the dissemination of health promotion knowledge and practices are suggested.

Communication↗
PubMedDate not supplied

Positioning dissemination in public health policy.

Research should play an important role in the implementation of health policy. The application of research methodologies to dissemination of knowledge and practice is being recognized more and more as a legitimate and important component of the health policy agenda. The issues and priorities concerning health are changing rapidly in many parts of the world. In Canada, the health reform process is suggesting that health policy shift from a concentration on the current mainly curative system to one which is more balanced, with an emphasis on health promotion and disease prevention, targeted not only to the individual but to whole populations. The reform process creates significant opportunities for research and emphasizes the need for dissemination of research findings. We have much to learn about how to disseminate to the appropriate people our current knowledge and the knowledge which will come from new research. A key challenges for dissemination is to narrow the gap between what is known and what is put into practice. Clearly we need to develop a much greater understanding of the dynamic of dissemination and the barriers to it.

Canada↗