Ellen L Toth - Academia.edu (original) (raw)
Papers by Ellen L Toth
The Lancet Diabetes & Endocrinology, 2019
Contraception, 1989
We thank Dr. Crook and his colleagues for the careful attention paid to our paper. In choosing th... more We thank Dr. Crook and his colleagues for the careful attention paid to our paper. In choosing the title we followed the traditional scientific method of attempting to disprove the null hypothesis. Having failed to demonstrate any statistically significant differences between carbohydrate and lipid values before and after 3 months on the oral contraceptives (OCs) we then concluded there was a lack of metabolic effects. We too would have liked to have seen greater numbers of subjects. Unfortunately in clinical studies of this kind there are always dropouts and we found this a problem despite our best efforts. We see no merit in converting our figures into percentages in order to exaggerate differences which are not significant. The method we used for calculation for the area under the curve is a well established one. As far as using the incremental area under the curve whereas we considered this we decided against it since it is also a transformation of the figures. Although we agree that the incremental area is unconfounded by the fasting blood glucose levels we wanted to leave open the possibility that indeed the fasting blood glucose was lowered by OCs. We realize that the NDDG criteria may be a crude yardstick in these situations but these are the currently accepted guidelines and may serve as a reference for the nondiabetologist reader. In practical terms moreover the failure of the glucose readings to even approach the upper limit of normal by the NDDG criteria would not prompt one to change the form of contraception. In regards to the HDL levels the c.v. was indeed higher than that of the total cholesterol (3.2%) and we apologize for not clarifying this. However rather than an assay problem we feel it is to be acknowledged that our low number of subjects could account for a Type 2 error. This again underscores the fact that we are in agreement with Drs. Crook and colleagues in pointing out the necessity of further studies. (full text)
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 15, 1994
Journal of the American Dietetic Association, 1996
To evaluate the long-term effects oat bran concentrate bread products in the diet of free-living ... more To evaluate the long-term effects oat bran concentrate bread products in the diet of free-living subjects with non-insulin-dependent diabetes (NIDDM) via dietary, clinical, and biochemical methods. A 24-week crossover study consisting of two 12-week periods. Eight men with NIDDM (mean age = 45 years) who lived in the community. Glucose and insulin profiles were conducted in a clinical investigation unit. Palatable, high-fiber, oat bran concentrate (soluble fiber [beta-glucan] content = 22.8%) bread products were developed. Four randomly chosen subjects ate oat bran concentrate breads first; the other subjects ate control white bread first. Dietary intake (four 48-hour dietary recalls per period) was assessed. Blood glucose and insulin (8-hour profiles) and lipid parameters after fasting were measured (at 0, 12, and 24 weeks). Analysis of variance and repeated-measures analysis of variance. Total energy and macronutrient intakes were similar in both periods. Mean total dietary fiber intake was 19 g/day in the white bread period and 34 g/day (9 g soluble fiber per day from oat bran concentrate) in the oat bran concentrate period. Body weight remained stable. Mean glycemic and insulin response areas (area under the curve) were lower (P < or = .05 and not significant, respectively) for the oat bran concentrate period than the white bread period. After breakfast, area under the curve for the oat bran concentrate period was lower for glucose (P < or = .01) and insulin (P < or = .05); insulin peak was reached earlier (P < or = .05) than in the white bread period. Dietary fiber intake was correlated negatively with insulin area under the curve (P < or = .05). Mean total plasma cholesterol and low-density lipoprotein cholesterol levels were lower (P < or = .01) in the oat bran concentrate period than in the white bread period. In the oat bran concentrate period, the mean ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol was reduced by 24% (P < or = .05). The well-accepted oat bran concentrate bread products improved glycemic, insulinemic, and lipidemic responses.
The Gerontologist, 1994
The purpose of this study was to determine the knowledge, attitudes, and opinions of older adults... more The purpose of this study was to determine the knowledge, attitudes, and opinions of older adults about cardiopulmonary resuscitation (CPR). Sixty hospitalized/institutionalized older adults were interviewed. Most had little or no accurate knowledge of CPR. However, many stated that they would wish to receive CPR and would want to be involved in the CPR decision-making process. The knowledge deficits and misconceptions of older adults should be addressed in order that they may become informed and active participants in the CPR decision-making process.
Contraception, 1988
The glucose and insulin responses to oral glucose tolerance tests and lipid values in normal wome... more The glucose and insulin responses to oral glucose tolerance tests and lipid values in normal women taking a triphasic pill containing norethindrone (Ortho 7/7/7) were performed. After three months, no significant changes in these metabolic indices were found. These results confirm and expand the knowledge regarding the metabolic safety of norethindrone-containing triphasic formulations.
BMJ Open Quality
BackgroundAmong Indigenous peoples in Canada, access to high-quality healthcare remains an import... more BackgroundAmong Indigenous peoples in Canada, access to high-quality healthcare remains an important determinant of health. The shift to virtual and remote-based approaches, expedited during the COVID-19 pandemic, influenced the ways in which individuals accessed care and the quality of care received. This study sought to determine which elements are required for effective and sustainable virtual care approaches for delivery of primary care to Indigenous patients and develop quality indicators grounded in Indigenous community and experience. We share a conceptual framework to understand how Indigenous patients access and define high-quality virtual care, grounded in Indigenous patient experiences and worldviews.MethodsUsing principles of patient-oriented research, we grounded this work in social justice and participatory action research. We sought to gain an in-depth understanding of the Indigenous experiences of virtual care and specifically of primary care. This was developed thro...
RESEARCH DESIGN AND METHODS — We previously reported 6-month results of a controlled study of an ... more RESEARCH DESIGN AND METHODS — We previously reported 6-month results of a controlled study of an intervention that improved cardiovascular risk factors for rural patients with type 2 diabetes. We subsequently provided the identical intervention to the control region after the main study was completed. The primary outcome was 10% improvement in systolic blood pressure, total cholesterol, or HbA1c. We compared the previously reported 6-month effect of the original intervention with the effect of the crossed-over intervention to the former control region and remeasured outcomes in the original intervention region 12 months later. RESULTS — Our analysis included 200 original intervention and 181 crossed-over intervention subjects. The age of the population was 62.4 12.4 years (mean SD), and 54.3% were women. A similar proportion of patients in the crossed-over intervention group achieved improvement in the primary composite outcome compared with the original intervention group (38 vs. 4...
Canadian Medical Association Journal, 2020
• L'obésité est une maladie chronique complexe, évolutive et récidivante fort répandue qui se car... more • L'obésité est une maladie chronique complexe, évolutive et récidivante fort répandue qui se caractérise par une accumulation anormale ou excessive de graisses corporelles (adiposité) nuisible à la santé. • Les personnes vivant avec l'obésité font l'objet de préjugés et sont passablement stigmatisées, ce qui contribue à accroître la morbidité et la mortalité qui y sont associées, indépendamment du poids ou de l'indice de masse corporelle. exécutif sur les choix alimentaires et la décision de s'alimenter. L'interconnectivité de ces réseaux neuronaux est à l'origine du comportement alimentaire et serait altérée par l'obésité.
Progress in Community Health Partnerships: Research, Education, and Action, 2021
BACKGROUND Responding to concerns about perinatal health risks and adverse outcomes, we establish... more BACKGROUND Responding to concerns about perinatal health risks and adverse outcomes, we established a community-based participatory research (CBPR) partnership between a Nêhiyawi (Cree) community and university-based researchers. We designed and implemented a community-derived Elders Mentoring Program (EMP) to provide additional support for pregnant women and their partners. Our objective was to understand the collective experiences of those involved in the Program. METHODS We conducted a qualitative description with the principles of CBPR as an overarching framework. We carried out 14 qualitative interviews with parents, perinatal clinic staff, and mentor Elders involved in the Program. We also used detailed notes from Community Advisory Committee (CAC) meetings as data. All qualitative data were analyzed with content analysis. RESULTS The Program helped pregnant women and their partners by fostering enhanced and multi-generational support networks. It also improved cultural security within the clinical environment and learning among health care staff. A sense of intergenerational fulfillment and enjoyment among those involved was common and was underpinned by genuine, collaborative relationships. CONCLUSIONS A community-derived prenatal EMP, designed in partnership with those who have intimate knowledge of the community, is a major step toward ensuring multi-generational and culturally secure care in pregnancy for women and families.
Canadian Medical Association Journal, 2020
O besity is a complex chronic disease in which abnormal or excess body fat (adiposity) impairs he... more O besity is a complex chronic disease in which abnormal or excess body fat (adiposity) impairs health, increases the risk of long-term medical complications and reduces lifespan. 1 Epidemiologic studies define obesity using the body mass index (BMI; weight/height 2), which can stratify obesity-related health risks at the population level. Obesity is operationally defined as a BMI exceeding 30 kg/m 2 and is subclassified into class 1 (30-34.9), class 2 (35-39.9) and class 3 (≥ 40). At the population level, health complications from excess body fat increase as BMI increases. 2 At the individual level, complications occur because of excess adiposity, location and distribution of adiposity and many other factors, including environmental, genetic, biologic and socioeconomic factors (Box 1). 11 Over the past 3 decades, the prevalence of obesity has steadily increased throughout the world, 12 and in Canada, it has increased threefold since 1985. 13 Importantly, severe obesity has increased more than fourfold and, in 2016, affected an estimated 1.9 million Canadian adults. 13 Obesity has become a major public health issue that increases health care costs 14,15 and negatively affects physical and psychological health. 16 People with obesity experience pervasive weight bias and stigma, which contributes (independent of weight or BMI) to increased morbidity and mortality. 17 Obesity is caused by the complex interplay of multiple genetic, metabolic, behavioural and environmental factors, with the latter thought to be the proximate cause of the substantial
Canadian Journal of Diabetes, 2016
Background: Depression has been correlated with suboptimal adherence to antidiabetic drug (AD) tr... more Background: Depression has been correlated with suboptimal adherence to antidiabetic drug (AD) treatment in many studies. However, most of them were cross-sectional and the association and directionality of this relationship has not yet been established. Purpose: To measure the association between depression and nonadherence to AD treatment. Methods: We performed a population-based cohort study using the administrative data from the Quebec health insurance board (RAMQ) among adults newly using ADs. Depression was determined using a validated algorithm. To avoid immortal time bias, we carried out a depression diagnosis-time distribution matching by assigning a random fictive date of depression to individuals without depression. Non-adherence to AD treatment (i.e. <90% of days covered by at least 1 AD) in the 1-year period following depression diagnosis (real or fictive) was the main outcome. To estimate the effect of depression on AD treatment non-adherence, we conducted a multivariate logistic regression analysis, adjusting for baseline adherence and other potential confounders. Results: Between 2000 and 2006 we identified 3106 patients with a diagnosis of depression matched to 70,633 patients without depression. Among patients with depression, 52.0% were subsequently non-adherent with their AD treatment vs. 49% of patients without depression. Patients with depression were 24% more likely to be non-adherent to their AD treatment (adjusted odds ratio=1.24, 95% confidence interval: 1.13 to 1.37). Conclusions: Results suggest that depression is an independent risk factor of non-adherence to AD treatment. Patients with type 2 diabetes might benefit from regular detection for depression and adherence-enhancing interventions.
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2016
We wished to identify the prevalence, longitudinal trends, and associated risk factors for variou... more We wished to identify the prevalence, longitudinal trends, and associated risk factors for various birth weight categories by First Nations ethnicity in the province of Alberta. We performed a retrospective analysis of administrative data for the years 2000 to 2009 inclusive. Age-adjusted prevalence trends for high birth weight (HBW; > 4000g), very HBW (> 4500g), low birth weight (LBW; < 2500g), and very LBW (< 1500g) were compared via average annual percent change analyses. Logistic regression analysis was used to determine risk factors. First Nations ethnicity was a significant independent predictor of HBW (OR 1.82 [95% CI 1.75, 1.89]), very HBW (OR 2.35 [95% CI 2.18, 2.52]), and very LBW (OR 1.35 [95% CI 1.23, 1.48]), but not of LBW (OR 0.98 [95% CI 0.93, 1.03]). However, HBW prevalence decreased and other birth weight categories remained stable over time in First Nations populations. Gestational diabetes and maternal weight ≥ 91 kg were potentially manageable risk fa...
Quality of Life Research, 2005
Background: Diabetes is a chronic medical condition accompanied by a considerable healthrelated q... more Background: Diabetes is a chronic medical condition accompanied by a considerable healthrelated quality of life (HRQL) burden. The purpose of this analysis was to use generic measures of HRQL to describe HRQL deficits associated with varying degrees of severity of type 2 diabetes. Methods: The RAND-12 physical and mental health composites (PHC and MHC, respectively) and Health Utilities Index Mark 3 (HUI3) were self-completed by 372 subjects enrolled in a prospective, controlled study of an intervention to improve care for individuals with type 2 diabetes in rural communities. Analysis of covariance was used to assess differences in HRQL according to disease severity and control of blood glucose. Disease severity was defined in terms of treatment intensity, emergency room visits and absenteeism from work specifically attributable to diabetes. To control for potential confounding, the analysis was adjusted for important sociodemographic and clinical characteristics. Results: The PHC and MHC were significantly lower for individuals treated with insulin as compared to diet alone (PHC: 41.01 vs 45.11, MHC: 43.23 vs 47.00, p < 0.05). Individuals treated with insulin had lower scores on the vision, emotion and pain attributes of the HUI3 than individuals managed with oral medication or diet. The PHC, MHC, pain attribute and overall score on the HUI3 captured substantial decrements in HRQL associated with absenteeism from work due to diabetes, while the burden associated with emergency room utilization for diabetes was seen in the PHC and HUI3 pain attribute. Conclusions: We concluded that generic measures of HRQL captured deficits associated with more severe disease in type 2 diabetes. Background Severity of diabetes has been associated with increased burden and impairment on many dimensions of health-related quality of life (HRQL), including social functioning, cognition, role functioning, physical functioning, emotional well-being, general perceptions of health and
Diabetes Care, 2004
OBJECTIVE—The aim of this study was to examine patient-reported outcomes in a controlled trial of... more OBJECTIVE—The aim of this study was to examine patient-reported outcomes in a controlled trial of a multifaceted provider-level intervention to improve quality of care for rural patients with type 2 diabetes. RESEARCH DESIGN AND METHODS—We conducted a before/after intervention study with concurrent controls in two rural regions in Alberta, Canada. The intervention consisted of six monthly visits by a multidisciplinary health care team and was primarily directed at primary care providers. Clinical and patient-reported outcomes were assessed after 6 months. Patient-reported outcomes included changes in health-related quality of life (Health Utilities Index Mark 3 [HUI3]), satisfaction with care, lifestyle (Diabetes Lifestyle Form), and adherence to self-care activities. Analysis of covariance was used to assess differences over time between the control and intervention regions. RESULTS—A total of 200 intervention and 172 control subjects were included in this analysis. After adjusting...
Canadian Medical Association Journal, 2011
Canadian Journal of Diabetes, 2009
Canadian Medical Association journal, Jan 15, 1984
A large Canadian kindred of Irish extraction extending from Quebec to British Columbia with autos... more A large Canadian kindred of Irish extraction extending from Quebec to British Columbia with autosomal dominant diabetes insipidus responsive to exogenous antidiuretic hormone (ADH) is described. Out of 121 individuals 34 have been identified as affected in seven generations. The disorder is characterized by variability in age at onset and in severity, and by apparently spontaneous abatement in old age. The affected subjects do not appear to manifest hypertension or its sequelae. In three individuals tested the plasma ADH level was very low in spite of adequate osmotic stimulation. However, the level rose in two of them when they were given furosemide, which suggests an osmoreceptor defect and a normal ADH response to volume change.
The Lancet Diabetes & Endocrinology, 2019
Contraception, 1989
We thank Dr. Crook and his colleagues for the careful attention paid to our paper. In choosing th... more We thank Dr. Crook and his colleagues for the careful attention paid to our paper. In choosing the title we followed the traditional scientific method of attempting to disprove the null hypothesis. Having failed to demonstrate any statistically significant differences between carbohydrate and lipid values before and after 3 months on the oral contraceptives (OCs) we then concluded there was a lack of metabolic effects. We too would have liked to have seen greater numbers of subjects. Unfortunately in clinical studies of this kind there are always dropouts and we found this a problem despite our best efforts. We see no merit in converting our figures into percentages in order to exaggerate differences which are not significant. The method we used for calculation for the area under the curve is a well established one. As far as using the incremental area under the curve whereas we considered this we decided against it since it is also a transformation of the figures. Although we agree that the incremental area is unconfounded by the fasting blood glucose levels we wanted to leave open the possibility that indeed the fasting blood glucose was lowered by OCs. We realize that the NDDG criteria may be a crude yardstick in these situations but these are the currently accepted guidelines and may serve as a reference for the nondiabetologist reader. In practical terms moreover the failure of the glucose readings to even approach the upper limit of normal by the NDDG criteria would not prompt one to change the form of contraception. In regards to the HDL levels the c.v. was indeed higher than that of the total cholesterol (3.2%) and we apologize for not clarifying this. However rather than an assay problem we feel it is to be acknowledged that our low number of subjects could account for a Type 2 error. This again underscores the fact that we are in agreement with Drs. Crook and colleagues in pointing out the necessity of further studies. (full text)
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 15, 1994
Journal of the American Dietetic Association, 1996
To evaluate the long-term effects oat bran concentrate bread products in the diet of free-living ... more To evaluate the long-term effects oat bran concentrate bread products in the diet of free-living subjects with non-insulin-dependent diabetes (NIDDM) via dietary, clinical, and biochemical methods. A 24-week crossover study consisting of two 12-week periods. Eight men with NIDDM (mean age = 45 years) who lived in the community. Glucose and insulin profiles were conducted in a clinical investigation unit. Palatable, high-fiber, oat bran concentrate (soluble fiber [beta-glucan] content = 22.8%) bread products were developed. Four randomly chosen subjects ate oat bran concentrate breads first; the other subjects ate control white bread first. Dietary intake (four 48-hour dietary recalls per period) was assessed. Blood glucose and insulin (8-hour profiles) and lipid parameters after fasting were measured (at 0, 12, and 24 weeks). Analysis of variance and repeated-measures analysis of variance. Total energy and macronutrient intakes were similar in both periods. Mean total dietary fiber intake was 19 g/day in the white bread period and 34 g/day (9 g soluble fiber per day from oat bran concentrate) in the oat bran concentrate period. Body weight remained stable. Mean glycemic and insulin response areas (area under the curve) were lower (P < or = .05 and not significant, respectively) for the oat bran concentrate period than the white bread period. After breakfast, area under the curve for the oat bran concentrate period was lower for glucose (P < or = .01) and insulin (P < or = .05); insulin peak was reached earlier (P < or = .05) than in the white bread period. Dietary fiber intake was correlated negatively with insulin area under the curve (P < or = .05). Mean total plasma cholesterol and low-density lipoprotein cholesterol levels were lower (P < or = .01) in the oat bran concentrate period than in the white bread period. In the oat bran concentrate period, the mean ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol was reduced by 24% (P < or = .05). The well-accepted oat bran concentrate bread products improved glycemic, insulinemic, and lipidemic responses.
The Gerontologist, 1994
The purpose of this study was to determine the knowledge, attitudes, and opinions of older adults... more The purpose of this study was to determine the knowledge, attitudes, and opinions of older adults about cardiopulmonary resuscitation (CPR). Sixty hospitalized/institutionalized older adults were interviewed. Most had little or no accurate knowledge of CPR. However, many stated that they would wish to receive CPR and would want to be involved in the CPR decision-making process. The knowledge deficits and misconceptions of older adults should be addressed in order that they may become informed and active participants in the CPR decision-making process.
Contraception, 1988
The glucose and insulin responses to oral glucose tolerance tests and lipid values in normal wome... more The glucose and insulin responses to oral glucose tolerance tests and lipid values in normal women taking a triphasic pill containing norethindrone (Ortho 7/7/7) were performed. After three months, no significant changes in these metabolic indices were found. These results confirm and expand the knowledge regarding the metabolic safety of norethindrone-containing triphasic formulations.
BMJ Open Quality
BackgroundAmong Indigenous peoples in Canada, access to high-quality healthcare remains an import... more BackgroundAmong Indigenous peoples in Canada, access to high-quality healthcare remains an important determinant of health. The shift to virtual and remote-based approaches, expedited during the COVID-19 pandemic, influenced the ways in which individuals accessed care and the quality of care received. This study sought to determine which elements are required for effective and sustainable virtual care approaches for delivery of primary care to Indigenous patients and develop quality indicators grounded in Indigenous community and experience. We share a conceptual framework to understand how Indigenous patients access and define high-quality virtual care, grounded in Indigenous patient experiences and worldviews.MethodsUsing principles of patient-oriented research, we grounded this work in social justice and participatory action research. We sought to gain an in-depth understanding of the Indigenous experiences of virtual care and specifically of primary care. This was developed thro...
RESEARCH DESIGN AND METHODS — We previously reported 6-month results of a controlled study of an ... more RESEARCH DESIGN AND METHODS — We previously reported 6-month results of a controlled study of an intervention that improved cardiovascular risk factors for rural patients with type 2 diabetes. We subsequently provided the identical intervention to the control region after the main study was completed. The primary outcome was 10% improvement in systolic blood pressure, total cholesterol, or HbA1c. We compared the previously reported 6-month effect of the original intervention with the effect of the crossed-over intervention to the former control region and remeasured outcomes in the original intervention region 12 months later. RESULTS — Our analysis included 200 original intervention and 181 crossed-over intervention subjects. The age of the population was 62.4 12.4 years (mean SD), and 54.3% were women. A similar proportion of patients in the crossed-over intervention group achieved improvement in the primary composite outcome compared with the original intervention group (38 vs. 4...
Canadian Medical Association Journal, 2020
• L'obésité est une maladie chronique complexe, évolutive et récidivante fort répandue qui se car... more • L'obésité est une maladie chronique complexe, évolutive et récidivante fort répandue qui se caractérise par une accumulation anormale ou excessive de graisses corporelles (adiposité) nuisible à la santé. • Les personnes vivant avec l'obésité font l'objet de préjugés et sont passablement stigmatisées, ce qui contribue à accroître la morbidité et la mortalité qui y sont associées, indépendamment du poids ou de l'indice de masse corporelle. exécutif sur les choix alimentaires et la décision de s'alimenter. L'interconnectivité de ces réseaux neuronaux est à l'origine du comportement alimentaire et serait altérée par l'obésité.
Progress in Community Health Partnerships: Research, Education, and Action, 2021
BACKGROUND Responding to concerns about perinatal health risks and adverse outcomes, we establish... more BACKGROUND Responding to concerns about perinatal health risks and adverse outcomes, we established a community-based participatory research (CBPR) partnership between a Nêhiyawi (Cree) community and university-based researchers. We designed and implemented a community-derived Elders Mentoring Program (EMP) to provide additional support for pregnant women and their partners. Our objective was to understand the collective experiences of those involved in the Program. METHODS We conducted a qualitative description with the principles of CBPR as an overarching framework. We carried out 14 qualitative interviews with parents, perinatal clinic staff, and mentor Elders involved in the Program. We also used detailed notes from Community Advisory Committee (CAC) meetings as data. All qualitative data were analyzed with content analysis. RESULTS The Program helped pregnant women and their partners by fostering enhanced and multi-generational support networks. It also improved cultural security within the clinical environment and learning among health care staff. A sense of intergenerational fulfillment and enjoyment among those involved was common and was underpinned by genuine, collaborative relationships. CONCLUSIONS A community-derived prenatal EMP, designed in partnership with those who have intimate knowledge of the community, is a major step toward ensuring multi-generational and culturally secure care in pregnancy for women and families.
Canadian Medical Association Journal, 2020
O besity is a complex chronic disease in which abnormal or excess body fat (adiposity) impairs he... more O besity is a complex chronic disease in which abnormal or excess body fat (adiposity) impairs health, increases the risk of long-term medical complications and reduces lifespan. 1 Epidemiologic studies define obesity using the body mass index (BMI; weight/height 2), which can stratify obesity-related health risks at the population level. Obesity is operationally defined as a BMI exceeding 30 kg/m 2 and is subclassified into class 1 (30-34.9), class 2 (35-39.9) and class 3 (≥ 40). At the population level, health complications from excess body fat increase as BMI increases. 2 At the individual level, complications occur because of excess adiposity, location and distribution of adiposity and many other factors, including environmental, genetic, biologic and socioeconomic factors (Box 1). 11 Over the past 3 decades, the prevalence of obesity has steadily increased throughout the world, 12 and in Canada, it has increased threefold since 1985. 13 Importantly, severe obesity has increased more than fourfold and, in 2016, affected an estimated 1.9 million Canadian adults. 13 Obesity has become a major public health issue that increases health care costs 14,15 and negatively affects physical and psychological health. 16 People with obesity experience pervasive weight bias and stigma, which contributes (independent of weight or BMI) to increased morbidity and mortality. 17 Obesity is caused by the complex interplay of multiple genetic, metabolic, behavioural and environmental factors, with the latter thought to be the proximate cause of the substantial
Canadian Journal of Diabetes, 2016
Background: Depression has been correlated with suboptimal adherence to antidiabetic drug (AD) tr... more Background: Depression has been correlated with suboptimal adherence to antidiabetic drug (AD) treatment in many studies. However, most of them were cross-sectional and the association and directionality of this relationship has not yet been established. Purpose: To measure the association between depression and nonadherence to AD treatment. Methods: We performed a population-based cohort study using the administrative data from the Quebec health insurance board (RAMQ) among adults newly using ADs. Depression was determined using a validated algorithm. To avoid immortal time bias, we carried out a depression diagnosis-time distribution matching by assigning a random fictive date of depression to individuals without depression. Non-adherence to AD treatment (i.e. <90% of days covered by at least 1 AD) in the 1-year period following depression diagnosis (real or fictive) was the main outcome. To estimate the effect of depression on AD treatment non-adherence, we conducted a multivariate logistic regression analysis, adjusting for baseline adherence and other potential confounders. Results: Between 2000 and 2006 we identified 3106 patients with a diagnosis of depression matched to 70,633 patients without depression. Among patients with depression, 52.0% were subsequently non-adherent with their AD treatment vs. 49% of patients without depression. Patients with depression were 24% more likely to be non-adherent to their AD treatment (adjusted odds ratio=1.24, 95% confidence interval: 1.13 to 1.37). Conclusions: Results suggest that depression is an independent risk factor of non-adherence to AD treatment. Patients with type 2 diabetes might benefit from regular detection for depression and adherence-enhancing interventions.
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2016
We wished to identify the prevalence, longitudinal trends, and associated risk factors for variou... more We wished to identify the prevalence, longitudinal trends, and associated risk factors for various birth weight categories by First Nations ethnicity in the province of Alberta. We performed a retrospective analysis of administrative data for the years 2000 to 2009 inclusive. Age-adjusted prevalence trends for high birth weight (HBW; > 4000g), very HBW (> 4500g), low birth weight (LBW; < 2500g), and very LBW (< 1500g) were compared via average annual percent change analyses. Logistic regression analysis was used to determine risk factors. First Nations ethnicity was a significant independent predictor of HBW (OR 1.82 [95% CI 1.75, 1.89]), very HBW (OR 2.35 [95% CI 2.18, 2.52]), and very LBW (OR 1.35 [95% CI 1.23, 1.48]), but not of LBW (OR 0.98 [95% CI 0.93, 1.03]). However, HBW prevalence decreased and other birth weight categories remained stable over time in First Nations populations. Gestational diabetes and maternal weight ≥ 91 kg were potentially manageable risk fa...
Quality of Life Research, 2005
Background: Diabetes is a chronic medical condition accompanied by a considerable healthrelated q... more Background: Diabetes is a chronic medical condition accompanied by a considerable healthrelated quality of life (HRQL) burden. The purpose of this analysis was to use generic measures of HRQL to describe HRQL deficits associated with varying degrees of severity of type 2 diabetes. Methods: The RAND-12 physical and mental health composites (PHC and MHC, respectively) and Health Utilities Index Mark 3 (HUI3) were self-completed by 372 subjects enrolled in a prospective, controlled study of an intervention to improve care for individuals with type 2 diabetes in rural communities. Analysis of covariance was used to assess differences in HRQL according to disease severity and control of blood glucose. Disease severity was defined in terms of treatment intensity, emergency room visits and absenteeism from work specifically attributable to diabetes. To control for potential confounding, the analysis was adjusted for important sociodemographic and clinical characteristics. Results: The PHC and MHC were significantly lower for individuals treated with insulin as compared to diet alone (PHC: 41.01 vs 45.11, MHC: 43.23 vs 47.00, p < 0.05). Individuals treated with insulin had lower scores on the vision, emotion and pain attributes of the HUI3 than individuals managed with oral medication or diet. The PHC, MHC, pain attribute and overall score on the HUI3 captured substantial decrements in HRQL associated with absenteeism from work due to diabetes, while the burden associated with emergency room utilization for diabetes was seen in the PHC and HUI3 pain attribute. Conclusions: We concluded that generic measures of HRQL captured deficits associated with more severe disease in type 2 diabetes. Background Severity of diabetes has been associated with increased burden and impairment on many dimensions of health-related quality of life (HRQL), including social functioning, cognition, role functioning, physical functioning, emotional well-being, general perceptions of health and
Diabetes Care, 2004
OBJECTIVE—The aim of this study was to examine patient-reported outcomes in a controlled trial of... more OBJECTIVE—The aim of this study was to examine patient-reported outcomes in a controlled trial of a multifaceted provider-level intervention to improve quality of care for rural patients with type 2 diabetes. RESEARCH DESIGN AND METHODS—We conducted a before/after intervention study with concurrent controls in two rural regions in Alberta, Canada. The intervention consisted of six monthly visits by a multidisciplinary health care team and was primarily directed at primary care providers. Clinical and patient-reported outcomes were assessed after 6 months. Patient-reported outcomes included changes in health-related quality of life (Health Utilities Index Mark 3 [HUI3]), satisfaction with care, lifestyle (Diabetes Lifestyle Form), and adherence to self-care activities. Analysis of covariance was used to assess differences over time between the control and intervention regions. RESULTS—A total of 200 intervention and 172 control subjects were included in this analysis. After adjusting...
Canadian Medical Association Journal, 2011
Canadian Journal of Diabetes, 2009
Canadian Medical Association journal, Jan 15, 1984
A large Canadian kindred of Irish extraction extending from Quebec to British Columbia with autos... more A large Canadian kindred of Irish extraction extending from Quebec to British Columbia with autosomal dominant diabetes insipidus responsive to exogenous antidiuretic hormone (ADH) is described. Out of 121 individuals 34 have been identified as affected in seven generations. The disorder is characterized by variability in age at onset and in severity, and by apparently spontaneous abatement in old age. The affected subjects do not appear to manifest hypertension or its sequelae. In three individuals tested the plasma ADH level was very low in spite of adequate osmotic stimulation. However, the level rose in two of them when they were given furosemide, which suggests an osmoreceptor defect and a normal ADH response to volume change.