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ABSTRACT: The purpose of this study was to assess adherence to vascular protection drugs in diabetic patients using a cohort of diabetic patients aged >or=30 years, covered by the public drug insurance in the province of Quebec, excluding gestational diabetes and patients who were hopitalized or died during the 1-year follow-up. Drug adherence was measured using the medication possession ratio. Multivariate analyses, including logit and multinomial logit were used. Of the 170,381 diabetics (mean age: 62 +/- 14 years), 18% and 32% were regular users of ASA and ACEIs/ARBs, respectively. Regular use increased with age (p<0.0001) and comorbidities (p<0.0001). Rural inhabitants were more likely to use ACEIs/ARBs (OR: 1.29; 95% CI: 1.26-1.32) and to be regular users (OR: 1.36; 95% CI: 1.32-1.39). Similar results were found for ASA. In conclusion, despite the high cardiovascular risks associated with diabetes, less than one-third of diabetic adults took vascular-protection drugs regularly. This important issue needs proper attention.
Diabetes & Vascular Disease Research 04/2010; 7(2):167-71. · 2.12 Impact Factor
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ABSTRACT: The aim of this paper is to report a study to describe how cardiac patients experience the first 3 months following a cardiac event requiring hospitalization, identify differences between the needs expressed by patients and the support they received during their recuperation and produce a preliminary model for the development of cardiac rehabilitation programmes, taking into account the patient perspective.
Although cardiac rehabilitation should be standard care for patients with cardiovascular disease, less than 20% begin and maintain a rehabilitation programme. Cited barriers include inadequate rehabilitation services, sub-optimal referral, low participation rates of women and older adults and travel considerations. The literature suggests that programmes better adjusted to patient needs could increase attendance, but little research has considered this perspective.
Focus groups were conducted with a purposefully selected sample of 20 men and women who had been hospitalized for myocardial infarction, angina or percutaneous angioplasty. Data were analysed using qualitative content analysis.
A gap exists between what traditional rehabilitation programmes offer and patients' expressed needs during the recuperating process after hospitalization for a cardiac event. In our study, participants focused on stress management rather than on modifying health habits. Support groups were viewed as beneficial and, according to patients, accepting their condition, knowing their limits and better continuity of care would also help reduce stress. Based on the findings, we devised a model as the basis for developing cardiac rehabilitation programmes.
Cardiac rehabilitation programmes need to shift their focus of attention from promoting healthier behaviours to responding to participants' perceived needs, alongside risk factor reduction.
Journal of Advanced Nursing 10/2005; 51(6):567-76. · 1.48 Impact Factor
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ABSTRACT: In Canada, provincial and territorial laws address circumstances in which a substitute decision-maker may be appointed for an adult deemed legally incapable of making decisions in one or more areas of life. We searched for provincial and territorial laws that explicitly address substitute decision-making about research participation, and found significant differences among Canadian jurisdictions. In some provinces and territories there is no direct statutory guidance on the issue. Differences among jurisdictions that address substitute decision-making about research in legislation include whether judicial intervention is required to authorize the substitute decision-maker, whether any advance directive in place must explicitly authorize the decision about research in order for a proxy to consent, and how risk and benefit thresholds beyond which substitute consent to research is prohibited are articulated. It is imperative that government, researchers, and the Canadian public revisit the principles underpinning substitute decision-making about research in light of national and international norms, in order to lend clarity and consistency to this area of law and research practice.
Canadian journal on aging = La revue canadienne du vieillissement 02/2005; 24(3):237-50. · 0.92 Impact Factor
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ABSTRACT: In Canada, provincial and territorial laws address circumstances in which a substitute decision-maker may be appointed for an adult deemed legally incapable of making decisions in one or more areas of life. We searched for provincial and territorial laws that explicitly address substitute decision-making about research participation, and found significant differences among Canadian jurisdictions. In some provinces and territories there is no direct statutory guidance on the issue. Differences among jurisdictions that address substitute decision-making about research in legislation include whether judicial intervention is required to authorize the substitute decision-maker, whether any advance directive in place must explicitly authorize the decision about research in order for a proxy to consent, and how risk and benefit thresholds beyond which substitute consent to research is prohibited are articulated. It is imperative that government, researchers, and the Canadian public revisit the principles underpinning substitute decision-making about research in light of national and international norms, in order to lend clarity and consistency to this area of law and research practice.RÉSUMÉAu Canada, les lois provinciales et territoriales indiquent les circonstances dans lesquelles un subrogé peut être nommé pour représenter un adulte jugé légalement incapable de prendre des décisions pour un ou plusieurs aspects de sa vie. Nous avons cherché des lois provinciales et territoriales qui portaient explicitement sur la prise de décisions par le subrogé à l'égard de la participation à des recherches et avons découvert des différences considérables entre les sphères de compétence canadiennes. Dans certaines provinces/certains territoires, il n'existe aucune directive légale directe à ce sujet. Parmi les différences législatives, entre les sphères de compétence, à l'égard de la subrogation en matière de recherches, on compte : la question de savoir si une intervention judiciaire est nécessaire pour autoriser le subrogé, la question de savoir si la décision relative à la recherche doit être explicitement autorisée de façon préalable pour qu'un mandataire puisse donner son consentement, ainsi que la question de savoir comment s'articulent les seuils de risques et d'avantages au-delà desquels le subrogé ne peut émettre de consentement à l'égard de la recherche. Il est impératif que le gouvernement, les chercheurs et le public canadien révisent les principes qui sous-tendent la prise de décision par des subrogés en matière de recherche, à la lumière de normes nationales et internationales, de manière à rendre cet aspect de la loi et les pratiques de recherche plus clairs et plus cohérents.
Canadian Journal on Aging / La Revue canadienne du vieillissement 12/2004; 24(03):237 - 249.
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ABSTRACT: Patients suffering from Alzheimer disease and other types of dementia gradually lose their decision-making capacity. Advance directives have been widely promoted as a means to maintain some control over one's life in the event of decisional incompetence. This study used data from a recent postal survey conducted in Quebec, Canada to: 1) estimate the prevalence of formal and informal advance directives for health care and research among community-dwelling older adults presumed free of cognitive deficits; and 2) characterize those who have communicated their preferences regarding health care and research participation. Prevalence rates vary from 7.4% (formal advance directives for research) to 42.3% (informal advance directives for health care). Following multivariate logistic regressions, individuals who have communicated their wishes regarding future health care were found to be older, predominantly women, and to more often know someone with cognitive impairment. Those who have expressed their wishes regarding future research involvement were more inclined to participate in research. They were also more likely to have discussed or written advance directives for health care. The finding that only a small proportion of older adults have discussed future research participation with their families points to the need to find effective ways to promote advance directives for research in this population.
Alzheimer Disease and Associated Disorders 17(4):215-22. · 2.81 Impact Factor
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ABSTRACT: To evaluate vasoprotective pharmacological treatment of patients with peripheral arterial disease (PAD) according to: 1) year, 2) age and 3) gender.
An observational retrospective study was conducted to evaluate the systemic vascular treatment of a population-based cohort of patients with PAD > or = 50 years old, discharged from a tertiary-care teaching hospital between January 1, 1997 and December 11, 2006. Data were obtained from the Régie de l'assurance maladie du Québec. Drugs evaluated included antiplatelet agents (APs), statins (STs) and angiotensin converting enzyme inhibitors (ACEIs), and a combination of all three. Proportions of patients treated were compared according to year, age and gender using Chi-square.
The mean age of the study population (5962 individuals) was 73.2 +/- 9.1 years; 43.8% were women. After hospital discharge, 71.6%, 47.6%, 42.2% and 20.6% were taking respectively, an AP, statin, ACEI or all three. Protective treatment improved significantly from 1997 to 2006. Significantly more subjects 50-64 years used a statin or all three agents, compared to subjects > or = 65 years (statins: 56.6% vs. 45.8%, all three: 26.2% vs. 19.5%; p < 0.001). Significantly more men than women used statins (49.1% vs. 45.6%; p < 0.001) and ACEIs (44.5% vs. 39.3%; p < 0.001). Similarily, use of all three agents was 22.4% for men and 18.2% for women (p < 0.001).
Although systemic vascular treatment received by patients with PAD has increased in the past years, it remains suboptimal, particularly for older patients and women. Strategies to improve adherence to treatment guidelines should be developed for these high-risk populations.
Canadian journal of public health. Revue canadienne de santé publique 101(1):96-100. · 1.02 Impact Factor
