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Biomedical subjects

K Gray-Donald

Publications and source records attributed to K Gray-Donald.

At least 19 recordsLinked to original sources
PubMed1999

Prevalence of gestational diabetes mellitus among James Bay Cree women in northern Quebec.

BACKGROUND: The prevalence of gestational diabetes mellitus has been reported to vary widely in aboriginal populations. Most of the data have come from the United States. To help determine the extent of gestational diabetes in Canada's aboriginal population, the authors assessed the prevalence in a population of Cree women in northern Quebec. METHODS: A cross-sectional study was conducted using the National Diabetes Data Group (NDDG) criteria. Information was obtained from patient charts on pregnancies between January 1995 and December 1996 among women residing in 9 Cree communities in the eastern James Bay region of northern Quebec. Women who were not Cree, had pre-existing diabetes, had spontaneous abortion or were receiving glucocorticoid treatment were excluded. RESULTS: Data on 654 pregnancies that met the inclusion criteria were available. Results of the screening oral glucose challenge test were available for 579 of the pregnancies; the remaining 75 were excluded. The mean gestational age at screening was 28.3 (standard deviation 2.6) weeks. The prevalence of gestational diabetes was 12.8% (74/579) (95% confidence interval [CI] 10.1%-15.5%). The prevalence in the inland communities was twice as high as that in the coastal communities (18.0% v. 9.3%, p = 0.002). Women with gestational diabetes or impaired glucose tolerance tended to be older, have had more pregnancies, weigh more before pregnancy and have heavier babies than those with a normal glycemic status. INTERPRETATION: The prevalence of gestational diabetes among James Bay Cree women in northern Quebec is twice as high as that among women in the general North American population and the second highest reported in an aboriginal group worldwide.

Adolescent↗
PubMed1999

Nutrient intake of food bank users is related to frequency of food bank use, household size, smoking, education and country of birth.

The number of individuals and families accessing food assistance programs has continued to grow throughout the 1990s. Despite the increased health risk among low-income people, few studies have addressed nutrient intake throughout the month or at the end of the month when food and financial resources are thought to be compromised, and no study has described dietary status of a random sample of food bank users. Nutrient intakes of adult female and male food bank users in metropolitan Montreal, Quebec, Canada, were monitored week-by-week over a month by dietitian-administered 24-h recall interviews. A total of 428 participants from a stratified random sample of 57 urban area food banks completed all four interviews. Mean energy intake, as an indicator of diet quantity, was similar to other adult populations (10.2 +/- 4.8 and 7.9 +/- 3.6 MJ for men and women, respectively, age 18-49 y) and not related to sociodemographic variables except the expected biological variation of age and sex. Macronutrient intake was stable throughout the month. Overall median intakes of calcium, vitamin A, and zinc were below recommended levels for all age and sex groups. Intakes of several micronutrients were related to frequency of food bank use, household size, smoking, education, and country of birth. High nutrient intake variability characterized these adult food bank users.

Adult↗
PubMed1999

Construct and longitudinal validity of a modified Huang clinical scoring system in adult cystic fibrosis patients.

This study reports on the evaluation of a modified Huang scoring system in adult cystic fibrosis patients for construct and longitudinal validity. Two studies were performed. In the first study, the scoring system was applied to 59 adult cystic fibrosis patients prospectively followed at the Montreal Chest Institute. The total score and all the subscores distinguished between patients with the expected mild degree of disease severity seen in patients colonized with only Staphylococcus aureus, compared to the more advanced disease severity seen in patients colonized with Pseudomonas aeruginosa or multiple resistant pseudomonads. The relationship between disease severity assessed by forced expiratory volume in one second per cent predicted and the nonpulmonary function subscores was significant and linear (for the radiological subscore, r2=0.694, p<0.0001) and curvilinear (for the clinical and complications subscores, r2=0.622, p=0.0192 and r2=0.508, p=0.0009 respectively). In the second study, 20 patients retrospectively recorded were added to the prospective group. There was a good association between changes in nonpulmonary function subscores and changes in spirometry over a mean follow-up period of 779+/-204 days, at all levels of disease severity. The contribution of changes in clinical and complications subscores to the changes in total score became progressively more significant with more advanced disease severity. In conclusion, significant evidence for the construct validity of the scoring system as a discriminative instrument and for the longitudinal validity as an evaluative instrument was demonstrated. It may prove of value in assessing outcome of therapeutic interventions in clinical trials in patients with cystic fibrosis.

Adult↗
PubMed1998

Food bank users: sociodemographic and nutritional characteristics.

BACKGROUND: The continued expansion of food assistance programs makes it important to examine the sociodemographic characteristics and nutritional profiles of people relying on this service. The authors undertook such a study in a large urban centre. METHODS: A total of 490 food bank users were randomly selected from a stratified random sample of 57 urban food banks in Montreal. A questionnaire and a dietary recall interview were given by a dietitian-interviewer to determine socioeconomic, demographic and cultural characteristics and macronutrient intake. These data were compared with national and provincial data. RESULTS: The mean age of the participants (256 men and 234 women) was 41 years; 204 (41.6%) were living alone and most (409 [83.5%]) were receiving social assistance benefits. These food bank users were well educated (190 [38.8%] had completed technical school or had a college or university education), and the sample included few elderly or disabled people. The median body mass index was greater than 24, which indicated that energy intake, although below recommended levels, was not a chronic problem. The people using the food banks had a monthly shortfall in their food budget of between $43 and $46. INTERPRETATION: Food banks are used regularly, primarily by young healthy adults. They are though of as a necessary community resource.

Adolescent↗
PubMed1998

Randomized controlled trial of a community-based psychoeducation program for the self-management of chronic pain.

Although chronic pain is a frequent cause of suffering and disability and is costly to society, there continues to be limited access to specialty pain clinic services. Hence, there is a need for cost-effective, accessible interventions that will help people find ways to better manage this difficult problem. This randomized controlled trial examined the effect of a low-cost, community-based, nurse-delivered, group psychoeducation program entitled the Chronic Pain Self-Management Program (CPSMP). It has a standard protocol that was modified from the successful Arthritis Self-Management Program (ASMP). One hundred and ten individuals with mixed idiopathic chronic pain conditions were enrolled in the study (75% female; mean age 40 years; mean chronicity 6 years) and were randomly assigned to one of two conditions: the 12-h (CPSMP) intervention group, or the 3-month wait-list control group. Self-report measures of pain-related and other quality of life variables as well as two hypothesized mediating variables were collected pre-treatment and 3 months later by assessors blind to group allocation. One hundred and two subjects completed the study. Results of intention-to-treat analysis indicated that the treatment group made significant short-term improvements in pain, dependency, vitality, aspects of role functioning, life satisfaction and in self-efficacy and resourcefulness as compared to the wait-list control group. Because it has a standard protocol, this intervention has the potential to be reliably delivered at low cost in varied urban and rural community settings and hence be more widely accessible to a greater number of people suffering from chronic pain than is currently the case with more specialized pain clinic services. Based on the results of this study, further research evaluating the long-term impact and potential cost savings to the individual and to the health care system is warranted.

Activities of Daily Living↗
PubMed1998

Prevalence and correlates of overweight among elementary schoolchildren in multiethnic, low income, inner-city neighbourhoods in Montreal, Canada.

PURPOSE: Increased understanding of the early determinants of obesity is essential because of the increasing prevalence of obesity in many industrialized countries. METHOD: As part of the evaluation of a school-based heart health promotion intervention, we measured height, weight, and triceps skinfold thickness at baseline in 2108 students aged 9-12 years (80.5% of eligible students) in 24 inner-city elementary schools located in multiethnic, low income neighbourhoods in Montreal, Canada. Data on student's socio-demographic and lifestyle characteristics were collected in classroom-administered questionnaires, and parents completed an at-home self-administered questionnaire. RESULTS: Overall, 35.2% of boys and 33.0% of girls were overweight (> or = 85th age and gender-specific percentiles from NHANES 11, for body mass index and triceps skinfold thickness); 15.1% of boys and 13.3% of girls were obese (> or = 95th age and gender-specific percentiles for body mass index and triceps skinfold thickness). Younger age, having lived all one's life in Canada, and being of European or Central American/Caribbean family origin were independent correlates of obesity in boys. Younger age, ever smoked, mother obese and father obese were independent correlates of obesity in girls. Girls of Asian family origin were protected. CONCLUSIONS: The very high prevalence of overweight students in this low income, multiethnic population suggests an important need for preventive intervention.

Anthropometry↗
PubMed1998

Muscle strength and functional mobility in relation to lean body mass in free-living frail elderly women.

OBJECTIVES: (1) To describe body composition of the frail elderly, (2) To relate lean body mass to muscle strength and functional ability, and (3) To assess temporal stability of strength measures and index of functional ability. DESIGN: Cross-sectional study. SETTING: Community-dwelling. SUBJECTS: Thirty frail elderly women (81.5 +/- 7 y) recruited from residences or out-patient facilities. METHODS: Total body fat and fat-free mass (FFM) were determined using multi-frequency bioelectrical impedance analysis and predicted from anthropometry. Handgrip strength, biceps and quadriceps strength, functional capacities (Timed 'Up & Go') as well as self-perceived health and functional status were measured. Reliability was assessed using two separate observations made one week apart by the same examiner. RESULTS: Mean height, weight and body mass index were 1.52 +/- 0.04 m, 60.4 +/- 10.7 kg and 26.0 +/- 4.8 kg/m2 respectively. FFM (34.1 +/- 4.6 kg) was lower than previous reports for autonomous elderly females and associated with all measures of muscle strength (Pearson's r = 0.42-0.62, P < or = 0.02), but not with performance on the Timed 'Up & Go' or self-perceived health and functional status. Strength measures correlated significantly with different subscales of self-perceived functional capacities and were significantly lower among women with a low %FFM (n = 19) and those reporting pain (n = 11) as compared to other women. Excellent temporal stability for muscle and functional measures was observed (ICC = 0.80-0.90). CONCLUSIONS: Muscle strength was strongly related to FFM in free-living frail elderly women especially in the absence of pain.

Adipose Tissue↗
PubMed1998

Postprandial dyspnea and malnutrition in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To compare ventilatory response, oxygen uptake and sense of dyspnea of underweight versus normal-weight patients with chronic obstructive pulmonary disease (COPD) after a standard meal, in order to investigate whether an increase in dyspnea due to diet-induced thermogenesis might lead to altered eating habits. Weight loss in patients with COPD leads to adverse health effects, but the reasons for this loss are not well understood. DESIGN: Prospective study. PARTICIPANTS: A total of 18 patients (14 men, 4 women) aged 46 to 83 with severe, stable COPD. OUTCOME MEASURES: Minute ventilation (VE), tidal volume (VT), frequency of breathing, oxygen uptake (VO2), carbon dioxide excretion (VCO2) and sense of dyspnea (using the Borg scale) were measured 15 minutes before a 2.5-MJ (600-kcal) balanced liquid meal and at four 15-minute intervals after the meal. RESULTS: Increases in VE, VT, VO2 and VCO2 were observed for all subjects. Corrected for body surface area, the maximum postprandial changes in these indicators did not differ between the underweight and the normal-weight subjects with COPD. Work of breathing (measured in 11 subjects) did not differ between the 2 groups, nor did the number of subjects reporting increased dyspnea. CONCLUSIONS: Since the increases in VE, VO2, VCO2 and perceived dyspnea did not differ between the normal-weight and underweight patients, this indicates that dyspnea at mealtimes is not likely to lead to decreased food intake.

Aged↗
PubMed1997

High prevalence of obesity in low income and multiethnic schoolchildren: a diet and physical activity assessment.

The objective of the study was to assess the prevalence of obesity and/or undernutrition and evaluate diet and activity patterns among schoolchildren from an ethnically diverse low income urban population. A cross-sectional survey of 498 children aged 9-12 y from 24 schools in low income multiethnic neighborhoods in Montreal, Canada was undertaken. Height, weight, dietary intake, physical activity record, and lifestyle and demographic characteristics were measured. There was no evidence of undernutrition because linear growth was appropriate for age, but 39.4% of children were overweight (>85th percentile NHANES II). Dietary fat intake was higher in children from single-parent families (P < 0.001) and those with mothers born in Canada. Intake of vitamins A, C, iron and folate was directly related to income sufficiency. Children who did more physical activity had significantly higher intakes of energy, calcium, iron, zinc and fiber but were not heavier. Dietary intake was systematically underreported among overweight children, i.e., their reported intakes did not meet calculated energy needs. This underreporting makes it difficult to attribute the accumulated energy imbalance to either energy intake or expenditure.

Anthropometry↗
PubMed1997

Relationship of childhood protein-energy malnutrition and parasite infections in an urban African setting.

A clear understanding of protein-energy malnutrition (PEM), parasite infection and their interactions is essential in formulating health and development policies. We studied the prevalence of PEM indicators and the prevalence and/or intensity of infection in 558 Zairian children aged 4 months to 10 years. Multivariate analyses were used to estimate relationships between PEM indicators and parasitic infection. Stunting was found in 40.3% of children, wasting in 4.9% and kwashiorkor in 5.1%. The risk of stunting was significantly higher in children with Ascaris lumbricoides. The risk of wasting was higher in children with A. lumbricoides or Trichuris trichiura, whereas the risk of kwashiorkor was high with T. trichiura but very reduced in those with A. lumbricoides. Plasmodium infection was not related to nutritional indicators. These relationships highlight important interactions, both synergistic and antagonistic, between nutrition and parasites in central Africa.

Ascariasis↗
PubMed1997

Validation of a short telephone administered questionnaire to evaluate dietary interventions in low income communities in Montreal, Canada.

OBJECTIVE: To validate an adaptation of a short questionnaire measuring behaviour related to selecting low fat diets. The questionnaire was adapted for telephone use in a low income, low education population. DESIGN: The factorial structure of the 38 item adaptation was studied in a population based random sample of 1432 adults. Seven day test-retest reliability was measured in a convenience sample of 93 adults, and criterion related validity in measuring fat was assessed against a dietitian administered diet history in another convenience sample of 81 adults. SETTING: Adults aged 18-65 years living in low income, inner city neighbourhoods in Montreal, Canada. RESULTS: Principal components analysis identified five food factors: avoid fat, junk food, high fat traditional foods, low fat substitutes for high fat foods, and modification of meat to reduce fat. Two factors were similar to those of the original version. Internal consistency of the subscales ranged from 0.49-0.72. Test-retest reliability ranged from 0.72-0.90. Validation of the subscales against usual dietary intake indicated that the "junk food" factor, arising from questions added to the original questionnaire to reflect local dietary habits, was most closely related to fat intake (r = 0.48; p < 0.001). CONCLUSION: This telephone adaptation provides an inexpensive and valid method of measuring fat intake. However, these results suggest that adaptations of existing dietary instruments should be validated in the populations for which they are intended before they are used.

Adult↗
PubMed1997

Impact of nutritional support on functional status during an acute exacerbation of chronic obstructive pulmonary disease.

The impact of oral nutritional supplementation during an acute exacerbation of COPD on functional status was assessed through measuring change in lung function, strength testing, and general well-being. Subjects hospitalized for an acute exacerbation of COPD (n = 33) were randomized to extra nutritional support or the regular hospital care. They consumed an additional 10 kcal/kg/d. Outcome measures were measured at 2 wk as change scores. Forced vital capacity (% predicted) improved in the treatment group as compared with the control group (+8.7% versus -3.5%, p = 0.015), and change in FEV1 was in the same direction but not significantly different (p = 0.099). There were no changes in handgrip strength or respiratory muscle strength, but there was a trend towards more improvement in the general well-being score (+11.96 versus -10.25, p = 0.066). Almost all subjects were in negative nitrogen balance, indicating muscle wasting. The degree of muscle wasting was strongly correlated with the dose of corticosteroids (r = 0.73, p < 0.005). In conclusion, it is difficult to prevent important muscle wasting in patients with COPD treated with corticosteroids, but some small gains were observed with increased dietary intake.

Activities of Daily Living↗
PubMed1997

Internal consistency reliability and predictive validity of a modified N. Huang clinical scoring system in adult cystic fibrosis patients.

We described a modified N. Huang scoring system and its application as a measure of disease status and progression in a population of adult cystic fibrosis patients. We evaluated the scoring for internal consistency reliability and predictive validity. We applied the scoring system to 109 adult cystic fibrosis patients followed at the Montreal Chest Institute. Complete data were available on 36 deceased patients. The total score represented the sum of the clinical, radiological and pulmonary function subscores, minus the complications subscore. It ranged between 0 (worst health) and 100 points (best health). The total score showed a high degree of internal consistency and reliability with an estimated Cronbach coefficient alpha of 0.934. Both total score and forced expiratory volume in one second (FEV1) percentage predicted were significant predictors of survival at 36 and 24 months. However, there was a progressive decrease in the discriminating power of FEV1 percentage pred for predicting survival at 24, 18, 12 and 6 months. The total score showed a progressive and consistent pattern clearly predicting the outcome. A total score < 41, < 38, < 35 and < 30 points was associated with a poor prognosis for survival at 24, 18, 12, and 6 months, respectively. The clinical and complications subscores were the most discriminating components of the total score. The total score of the modified N. Huang scoring system offered a better discriminating scale, as compared to forced expiratory volume in one second % predicted, in the prognostic evaluation of end-stage cystic fibrosis patients. It could be of value in decisions for lung transplantation in these patients.

Adolescent↗
PubMed1996

Multiple infection with Plasmodium and helminths in communities of low and relatively high socio-economic status.

A study was conducted in the city of Lubumbashi, Zaire: (1) to survey parasitic infections and clinical conditions in the local children and their mothers; (2) to identify combinations of parasites and clinical conditions that commonly occurred together in individuals; and (3) to determine whether single- and/or multiple-species infections were risk determinants of the observed clinical conditions. Overall, 1100 children and mothers from three subdivisions, two of low socio-economic status (LSES) and one of relatively high socio-economic status (HSES), provided stool and blood samples and were clinically examined. Plasmodium prevalence was higher in the two LSES subdivisions than in the HSES subdivision. Prevalence and intensity of Ascaris lumbricoides infection were low in the HSES subdivision and one of the two LSES subdivisions. In contrast, prevalence and intensity of Trichuris trichiura and of hookworms were similar in all subdivisions. Plasmodium and A. lumbricoides were the most frequently found single-species infections. The combination of A. lumbricoides and Plasmodium was the most frequent double-species infection and that of A. lumbricoides, Plasmodium and T. trichiura was the most frequent triple-species infection. Significant positive associations between parasite species were detected in the HSES subdivision, and in one of the two LSES subdivisions. Because the relationships were not consistently detected, it is hypothesized that the associations are determined by environmental conditions rather than synergy between the parasites in the host. The most commonly observed clinical conditions were abdominal pain, diarrhoea, fever, and low packed-cell volume (PCV). The occurrence of each was significantly lower in the HSES subdivision than in at least one of the two LSES subdivisions. Abdominal pain and low PCV were most common in individuals presenting with only a single clinical condition, and the combination of this symptom and sign was the most commonly observed pair of conditions. Abdominal pain, low PCV and diarrhoea was the most common combination in individuals with three clinical conditions. Logistic regression revealed that hookworm infection, T. trichiura infection, young age and residence in an LSES subdivision were determinants of diarrhoea. Trichuris trichiura infection, young age and living in an LSES subdivision were risk factors for abdominal pain. Plasmodium infection and young age were risk factors for fever. LSES was the only predictor of low PCV. Infection with A. lumbricoides did not enter any of the models. No significant interactions were detected among parasites, indicating that there was no synergism or antagonism among parasites in the induced disease.

Adolescent↗
PubMed1996

Increased energy intake in pregnant smokers does not prevent human fetal growth retardation.

A retrospective cohort study of 729 smoking and 610 nonsmoking pregnant women participating in the Prince Edward Island Prenatal Nutritional Counselling Program (1979-1989) was undertaken to study whether lower energy intake results in lower maternal weight gain and/or a higher rate of small-for-gestational-age infants (SGA) among smokers. A second objective was to quantify, using etiological fractions, the independent contributions of cigarette smoking, maternal pregravid underweight and low pregnancy weight gain to the risk of SGA. Measurements of maternal pregravid weight, height, pregnancy weight gain, smoking status, physical activity, energy intake by a series of 3-d food records throughout the duration of pregnancy, and infant birth weight were collected for women with uncomplicated pregnancies resulting in full-term singleton infants. Multiple linear regression analyses were performed to predict the effect of smoking on maternal energy intake, weight gain and infant birth weight. The independent contributions of smoking, pregravid underweight and low pregnancy weight gain to the risk of SGA were determined using logistic regression analysis. Smoking was independently associated with a higher energy intake [+702 kJ/d (+168 kcal/d)] but with lower maternal weight gain (-2.16 kg) and infant birth weight (-205 g). Dietary energy intake was positively associated with only a small increment in birth weight [5.9 g per 418 kJ (100 kcal)]. The etiologic fraction for SGA attributable to smoking was 30.8%, pregravid underweight 16.7%, and low gestational weight gain 15.3%. We conclude that the important negative effect of smoking on retarding fetal growth cannot be adequately mitigated by simply increasing energy intake.

Adolescent↗
PubMed1996

Nutritional status and mortality in chronic obstructive pulmonary disease.

The role of nutritional status in the prognosis of subjects with severe chronic obstructive pulmonary disease was studied in a cohort of Canadian men and women followed for 3 to 5 yr. A total of 348 subjects who were recruited for a study of negative pressure ventilation were evaluated for lung function and body weight, and a subset who entered hospital for the study (n=184) had baseline measures of diffusing capacity, maximal inspiratory and expiratory mouth pressure (PImax and PEmax), and blood gases. Predictors of survival were analyzed using Cox regression models. In the total cohort, low body mass index (BMI) and use of home oxygen were independently associated with reduced survival. In the hospitalized group, predictors of respiratory mortality were elevated PaCO2 and low BMI, PImax, and diffusing capacity. PaO2 (measured on oxygen therapy), FEV1, PEmax, age, smoking behavior, and gender were not associated with survival. The predictors of total mortality were similar, except that BMI was no longer significant. In conclusion, low body weight, a potentially modifiable factor, was associated with respiratory mortality, but whether it has a casual effect or is a marker of declining health can only be resolved through an intervention trial.

Adult↗
PubMed1996

Timing of weight gain during pregnancy: promoting fetal growth and minimizing maternal weight retention.

OBJECTIVE: To examine the association of the extent and timing of pregnancy weight gain with infant birth weight (IBW) and postpartum weight retention (PPWR). DESIGN: Retrospective cohort study of pregnant women followed through 6 weeks postpartum. MEASUREMENTS: Birth weight and maternal weight gain before 20 weeks, 21-30 weeks, 31 weeks to term and postpartum weight retention were measured. SUBJECTS: A total of 371 healthy white nonsmoking pregnant women followed by the Prenatal Nutrition Counselling Program of the Department of Health and Social Services of the province of Prince Edward Island, Canada, between 1979 and 1989 who had uncomplicated pregnancies resulting in full term singleton infants. RESULTS: Weight gain during pregnancy (> 12 kg) was associated with PPWR (> 2.5 kg) in underweight, normal and overweight women. Pregnancy weight gain explained 65.2% of the variability in PPWR, but very little of the variability (4.7%) in IBW. Predictors of IBW (gestational age, pregravid weight and infant gender) were not related to PPWR. Early maternal weight gain (< or = 20 weeks) was a strong predictor of PPWR. Comparisons of mothers with PPWR above and below the median of the group indicated important differences in early weight gain (< or = 20 weeks) for underweight (3.3 kg), normal weight (3.3 kg), and overweight (6.2 kg) mothers. CONCLUSION: The results emphasize the importance of the timing of gestational weight gain and show an advantage in deferring a larger portion of required weight gain to late pregnancy (particularly in well-nourished overweight women) in order to promote fetal growth while reducing the risk of high weight retention and its potential adverse health consequences.

Adolescent↗