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Biomedical subjects

S Macdonald

Publications and source records attributed to S Macdonald.

At least 37 records · Page 2Linked to original sources
PubMed1999

Demographic and substance use factors related to violent and accidental injuries: results from an emergency room study.

OBJECTIVE: The primary goal of this study was to identify demographic and substance use factors associated with violent injuries, accidental injuries, and medical conditions or illnesses (non-injured). METHOD: Data were examined from a sample of 1701 admissions to emergency rooms at two Canadian hospitals. These patients were interviewed and provided urine samples to detect the presence of drug metabolites for alcohol, THC, benzodiazepines, barbiturates, morphine, and codeine. RESULTS: Those with violent injuries were significantly (P<0.0001) more likely to be male and have lower incomes compared with both the accidental injury and non-injury groups. About 37% of violent injuries occurred at a bar or restaurant, which was significantly more than 3% for accidental injuries and 2% for non-injuries (P<0.00001). The violent injury group was significantly more likely than the other two groups to report feeling the effects of alcohol at the time of the injury and to report negative consequences of alcohol use (P<0.00001). Furthermore, about 42% of those with violent injuries had a blood alcohol level (BAL) over 80 mg% compared to only 4% with accidental injuries (P<0.00001) and 2% of non-injuries (P<0.00001). In terms of drug tests for other substances, the violent injury group was significantly more likely to test positive for benzodiazepines than the accidental injury group (P<0.01) while all between group comparisons for other drugs were not significant.

Accidents↗
PubMed1999

The relationship between alcohol consumption patterns and car, work, sports and home accidents for different age groups.

The purpose of this study was to examine the relationship between alcohol consumption patterns and car, work, sports and home accidents for different age groups. A secondary analysis of data from a randomized household survey of 10385 Canadians was conducted. Overall, alcohol consumption patterns were significantly associated with car collisions, work and sports accidents for younger age groups (i.e. 15-24 and 25-34), but this relationship was not significant for the older age groups.

Accidents, Home↗
PubMed1999

Occupational risk factors associated with alcohol and drug problems.

Ames and Janes provide a theoretical framework that explains alcohol and/or drug problems among workers. Existing studies of occupational risk factors for alcohol and drug problems across multiple occupations and industries provide mixed findings with respect to Ames and Janes' framework. In a preliminary study, the relationships between occupational characteristics and measures of alcohol and drug problems were investigated among a sample of workers from a variety of occupations and industry settings. Some support was found for all of the major elements of Ames and Janes' framework: normative regulation of drinking, quality and organization of work, workplace factors, and drinking subcultures.

Adult↗
PubMed1999

Alcohol and injury: a comparison of emergency room populations in two Canadian provinces.

The few comparative emergency room (ER) studies reported have found alcohol's role in injury occurrence to vary and suggest that regional and cultural differences in drinking patterns may account, in part, for this variation. To further this research, a probability sample of 1708 ER patients was interviewed regarding the role of alcohol in the event, usual drinking patterns, and alcohol-related problems and a urine sample was obtained to estimate blood alcohol concentration (BAC). The sample was from ERs in two Canadian provinces with distinctly different cultures: primarily English-speaking Alberta and French-speaking Quebec. While differences in demographic and drinking characteristics between injured and noninjured in both the Alberta and Quebec ERs were similar to those in other ER studies, the injured in the Alberta ER were more likely to be positive for estimated BAC; to have higher BAC levels; to report drinking prior to the event; and, among those reporting drinking, to have consumed a larger number of drinks and to report feeling drunk at the time of injury compared to those in Quebec. These differences may be associated with cultural differences in typical drinking patterns, with higher rates of abstinence reported in the Alberta ER, but also with higher rates of heavy drinking and alcohol-related problems, while those in the Quebec ER were more likely to report consuming smaller quantities with greater frequency (typical of wine-drinking cultures). Additional research is needed to explicate further alcohol's role in injury occurrence for planning effective prevention strategies that are both culturally relevant and specific.

Adolescent↗
PubMed1999

Cross-Canada spread of methicillin-resistant Staphylococcus aureus via transplant organs.

We report our investigation of the transmission of methicillin-resistant Staphylococcus aureus (MRSA) through transplantation. The kidneys, liver, and corneas were harvested from a child who died in Nova Scotia. Several days postmortem it was learned that culture of a premortem endotracheal tube aspirate from the donor yielded MRSA. Both kidneys were transplanted into a child in Nova Scotia and the liver into a child in Alberta. Both recipients subsequently became blood culture-positive for MRSA. One corneal ring from the donor was MRSA-positive. All four MRSA isolates were mecA-positive by polymerase chain reaction (PCR). The relatedness of the MRSA isolates was examined by restriction fragment length polymorphism (RFLP) analysis, a 16S-23S ribosomal PCR typing method, and comparison of antibiograms. Results were identical for all four MRSA isolates. These findings indicate that MRSA from the donor was transferred to recipients during implantation of harvested organs in Alberta and Nova Scotia, a cross-Canada spread.

Adolescent↗
PubMed1999

Helicobacter pylori in the Canadian arctic: seroprevalence and detection in community water samples.

OBJECTIVE: Many North American arctic communities are characterized by risk markers associated with Helicobacter pylori (H. pylori) infection, including overcrowded housing and inadequate water supply and sanitation systems. Our aim was to determine the seroprevalence of H. pylori infection in two traditional Inuit communities in the central Canadian arctic and to test for the presence of H. pylori, by polymerase chain reaction (PCR), in local water supplies. METHODS: Samples of venous whole blood from adults and capillary blood from children were collected and analyzed by enzyme immunoassay and Helisal Rapid Test, respectively, for IgG antibody to H. pylori. Antibodies to CagA were detected by enzyme immunoassay, and ABO and Lewis antigens were also determined. Demographic and clinical information were collected by questionnaire. Water samples from each community were tested for H. pylori by PCR. RESULTS: One hundred-thirty (50.8%) of 256 subjects from the two communities were positive for H. pylori IgG antibodies. Seropositive subjects were more likely to be male, compared with seronegative individuals (p = 0.01). Antibody status did not differ with respect to age, community, alcohol or cigarette use, number of persons per household, gastrointestinal complaints or previous investigations, medications, or presence of blood group O, Lewis a-b+. CagA antibodies were detected in 78 (61.9%) of 126 H. pylori-seropositive subjects tested; however, 41 (35.3%) of 116 H. pylori-seronegative subjects were also CagA positive. Water samples taken from the water delivery truck in Chesterfield Inlet and two lakes near Repulse Bay were positive for H. pylori. CONCLUSION: The seroprevalence of H. pylori in the study group was higher than rates in southern Canadian populations, but lower than the seroprevalence previously documented in a Canadian subarctic Indian (First Nations) community. The detection of H. pylori in local water supplies may indicate a natural reservoir for the organism or possible contamination from human sewage.

ABO Blood-Group System↗
PubMed1998

Comparison of lifestyle and substance use factors related to accidental injuries at work, home and recreational events.

The purpose of this study was to examine whether risk factors vary for injuries that occur at work, at home, at recreational events and at multiple settings. Three major types of factors were investigated: lifestyle factors such as sleep, stress and exercise; substance use; and demographic characteristics. Data were obtained from a household survey of 882 Ontario adults. In order to determine whether different factors were related to different kinds of accidental injuries, chi 2 tests were conducted among five injury groups: no injuries; work; home; recreational; and multiple injury episodes (i.e. at least two separate injury episodes in two different settings). The first set of comparisons were conducted between those with zero injuries and each of the aforementioned four injury groups. Those with multiple injury episodes were significantly more likely than those with no injuries to be single, under the age of 30, and have lifestyle problems (i.e. sleep problems, financial problems and a desire for counselling) and substance use/problems (i.e. cigarettes, alcohol, licit and illicit drugs). For comparisons between each of the work, home and recreational injury groups and no injury group, eight factors were significant altogether, but no single factor was significantly related to more than one injury group. Contrasts between all combinations of injury group pairs (i.e. excluding the no injury group) indicated that risk factors for those with multiple injury episodes differed significantly from those with home and recreational injuries for several characteristics. This exploratory study provides some support that risk factors may vary, depending on the injury group.

Accidents, Home↗
PubMed1998

Referral criteria for speech and language therapy assessment of dysphagia caused by idiopathic Parkinson's disease.

OBJECTIVE: To examine the prevalence of dysphagia in idiopathic Parkinson's disease (IPD) in the outpatient setting and to determine what assessment criteria to use to select patients with dysphagia for referral to speech and language therapists. MATERIAL AND METHODS: Sixty-four patients with IPD and 80 age-matched controls were interviewed in clinic about their swallowing history and an objective swallowing test administered. All patients were assessed over the next few weeks by an experienced speech and language therapist and dysphagia rated according to a modified Rehabilitation Institute of Chicago Dysphagia Rating Scale and a novel global rating scale. The ability of various clinic criteria to predict patients with severe dysphagia were examined. RESULTS: Dysphagia for food was found in 30% of patients, significantly more than in controls. Swallowing speed and bolus volume were significantly lower in patients compared with controls and were correlated with declining Hoehn and Yahr score. Swallowing speed fell significantly on withdrawal of medication. The therapist's global rating score and Chicago score declined with Hoehn and Yahr score and duration of disease. However, only 10% of patients required dietary advice and none needed gastrostomy or tracheostomy. Discriminant analysis showed that various combinations of clinic selection criteria were no better than the presence of dysphagia for food at predicting which patients had significant dysphagia requiring advice from a therapist. CONCLUSIONS: Patients with idiopathic Parkinson's disease should be questioned about dysphagia for food on a regular basis and, if present, should be referred to a speech and language therapist for further assessment and treatment. The outcome of this protocol should be tested prospectively.

Aged↗
PubMed1998

Community case study: suicide cluster in a small Manitoba community.

OBJECTIVES: To review a cluster of suicides and suicidal ideation in a First Nations community. METHOD: The medical records and autopsy reports of the victims are reviewed. Collateral information obtained in the community is presented. A series of psychiatric assessments conducted at the local health centre in a 3-day period is outlined. The dilemma of developing appropriate treatment plans is discussed. RESULTS: In the period from February 3 to May 5, 1995, an isolated northern Manitoba First Nations community had 6 suicides in a population of less than 1500. Several other suicide attempts occurred. Community resources were strained. Alcohol was a factor in 4 of the suicides. Previous sexual assault was cited in 4 of 5 female cases presenting with suicidal ideation. CONCLUSIONS: Cluster suicide is a shared psychiatric and public health problem of major concern. Dreams of beckoning are common following a suicide. Communities should have a prepared plan to deal with a suicide. Resources should be provided quickly in an effort to prevent a cluster of suicides from occurring. High-risk individuals must be identified. Substance abuse must be addressed. Resources to assess and treat victims of sexual abuse must be available.

Adolescent↗
PubMed1997

Gross and microscopic anatomy of the human intrinsic cardiac nervous system.

BACKGROUND: The extent and locations of intrinsic cardiac ganglia on the human heart were investigated to facilitate studying their function. METHODS: The locations and number of major intrinsic cardiac ganglia were determined in six human hearts by means of microdissection following methylene blue staining. Light and electron microscopic analyses were performed on right atrial and cranial medial ventricular ganglia obtained from 12 other human hearts. RESULTS: Gross anatomy: Collections of ganglia associated with nerves, i.e., ganglionated plexuses, were observed consistently in five atrial and five ventricular regions. Occasional ganglia were located in other atrial and ventricular regions. Atrial ganglionated plexuses were identified on 1) the superior surface of the right atrium, 2) the superior surface of the left atrium, 3) the posterior surface of the right atrium, 4) the posterior medial surface of the left atrium (the latter two fuse medially where they extend anteriorly into the interatrial septum), and 5) the inferior and lateral aspect of the posterior left atrium. Ventricular ganglionated plexuses were located in fat 1) surrounding the aortic root, 2) at the origins of the right and left coronary arteries (the latter extending to the origins of the left anterior descending and circumflex coronary arteries), 3) at the origin of the posterior descending coronary artery, 4) adjacent to the origin of the right acute marginal coronary artery, and 5) at the origin of the left obtuse marginal coronary artery. Microscopic anatomy: Ganglia ranged in size from those containing a few neurons to large ganglia measuring up to 0.5 x 1 mm. The human heart is estimated to contain more than 14,000 neurons. Neuronal somata varied in size and shape. Many axon terminals in intrinsic cardiac ganglia contained large numbers of small, clear, round vesicles that formed asymmetrical axodendritic synapses, whereas a few axons contained large, dense-cored vesicles. CONCLUSIONS: The human intrinsic cardiac nervous system is distributed more extensively than was considered previously, most of its ganglia being located on the posterior surfaces of the atria and superior aspect of the ventricles. Each ganglion therein contains a variety of neurons that are associated with complex synaptology.

Adult↗
PubMed1997

Work-place alcohol and other drug testing: a review of the scientific evidence.

In this paper, scientific evidence for alcohol and other drug testing programs is compared to determine whether each approach is justifiable for improving work-place safety. Three types of studies are reviewed: laboratory, epidemiological and evaluation studies. Laboratory studies show that alcohol use decreases psycho-motor performance; however, for other drugs, some drugs deteriorate performance while others have little effect. Epidemiological studies in the work-place have not provided conclusive evidence that a strong causal link exists between either alcohol or other drug use and work-place injuries/accidents. Evaluation studies have not shown that either drug or alcohol testing significantly reduces work injuries/accidents. Other types of scientific evidence provide some justification of alcohol testing, but not for other drug testing. Alcohol use is much more common than other drug use in industrialized countries, suggesting that alcohol may be more related to industrial accidents than other drugs. As well, epidemiological studies suggest that alcohol is a major factor for traffic collisions, but research is inconclusive for other drugs. Finally, alcohol testing is more justifiable than drug testing because the results of alcohol tests closely correlate with psycho-motor performance while drug tests do not.

Journal Article↗
PubMed1997

High levels of incorrect use of car seat belts and child restraints in Fife--an important and under-recognised road safety issue.

OBJECTIVE: To pilot data collection instruments and to make a preliminary estimate of the level of incorrect use of car seat belts and child restraints in Fife, Scotland. DESIGN: Cross sectional survey of cars containing adults and children at a number of public sites across Fife in 1995 to assess use of car occupant restraints. Trained road safety officers assessed whether seat restraints were appropriate for the age of the passengers and whether restraints were used correctly. These assessments were based on standards published by the Child Accident Prevention Trust. PARTICIPANTS: The survey gathered data from 596 occupants in 180 cars: 327 adults and 269 children. Ten per cent of drivers who were approached refused to participate. Car occupant restraint was assessed in 180 drivers, 151 front seat passengers, and 265 rear seat passengers. MAIN RESULTS: Three hundred and sixty one occupants wore seat belts, 68 were restrained by a seat belt and booster cushion, 63 in toddler seats, 25 in two way seats, and 18 in rear facing infant carriers. Ninety seven per cent of drivers, 95% of front seat passengers, and 77% of rear seat passengers were restrained. However, in 98 (52%) vehicles at least one passenger was restrained by a device that was used incorrectly. Seven per cent of adults and 28% of children were secured incorrectly. The commonest errors were loose seat belts and restraint devices not adequately secured to the seat. Rates of incorrect use were highest in child seat restraints, reaching 60% with two way seats and 44% with rear facing infant seats. CONCLUSIONS: The incorrect use of car occupant restraints is an under-recognised problem, both by health professionals, and the general public. Incorrect use has been shown to reduce the effectiveness of restraints, can itself result in injury, and is likely to be an important factor in child passenger injuries. The correct use of car seat restraints merits greater attention in strategies aiming to reduce road traffic casualties. Areas of intervention that could be considered include raising public awareness of this problem, improving information and instruction given to those who purchase child restraints, and encouraging increased collaboration between manufacturers of cars and child restraints, in considering safety issues.

Accidents, Traffic↗
PubMed1997

Obtaining the views of general practitioners on the services to which they refer patients--a locality approach.

A survey, with a locality emphasis, of the opinions of Fife general practitioners (GPs) on the quality and availability of a selection of services to which the GPs refer their patients was undertaken. Far more GPs rated services as 'poor' for availability than for quality. GPs acting as locality advisers were actively involved in the planning and execution of the survey as well as the dissemination of the results. The overall response rate was disappointing considering this approach.

Attitude of Health Personnel↗
PubMed1996

Child protection in schools: an evaluation of a training course for Fife schools' co-ordinators of child protection.

The incidence of reported episodes of child abuse has risen in recent years in Scotland and the importance of multi-agency collaboration is widely recognised in achieving an effective response to this problem. We have identified that school teachers are the single largest professional group which refer children with a history of suspected abuse to child protection units in Fife. Priority was therefore given to the training of coordinators of child protection within all Fife schools. An evaluation of this training carried out approximately 12 months after the training course showed that the child protection training course for coordinators of child protection in Fife schools has been well received. Coordinators attending the training reported a number of positive outcomes both in terms of their own personal confidence in dealing with child protection issues and also on progress made with developing school policies on child protection. However, the follow-up survey suggested that the course has not generally had a major impact on teachers from the same schools who had not attended the training course. This is in turn due to the low level of effective dissemination of the course to other teachers. It is recommended that a session on how to disseminate information, knowledge and skills gained during the course be incorporated into the training course and that a further follow-up evaluation of a sample of teachers who did not attend the training course be carried out. Our experience suggests that if the training courses are based on a knowledge of the training needs of school teachers and are run by professionals from all of the various agencies involved in child protection then these courses can be successful in improving the performance of coordinators of child protection in primary and secondary schools. This can then lead to better support for classroom teachers and promote the development and implementation of school child protection policies. In addition these courses helped develop inter-agency links and facilitate a true team approach in response to episodes of disclosure of child abuse. Regional child protection committees and education departments should consider giving priority to training coordinators of child protection in schools within their region as an important element in the response to the growing problem of child protection in their region.

Adolescent↗
PubMed1996

Evaluation of the woman's drop-in service in Benarty, Fife.

BACKGROUND: A survey of the health needs of women aged between 16 and 64 years of age in the Benarty area was carried out by the Department of Public Health in Fife. In response to the findings of this survey and in particular to the expressed wish for a drop-in service to be made available and for access to self-help groups and counselling sessions, a multi-agency project was established in the Benarty area of Fife. Two drop-in centres were set up, in a local community centre and in a primary care clinic, and were staffed by health visitors, social workers and staff from the community education department. The centres were each open twice a week for 2-3 hours on each occasion and crèche facilities were made available. The aims of the service were to provide counselling on a one-to-one basis, to establish self-help groups based on the expressed needs of women and to refer people on to the most appropriate services, if necessary. The service was established on a pilot basis and an essential component of the project was an evaluation of the service. METHODS: To evaluate the service a community survey was carried out involving a random sample of 370 women taken from the community health index, and a register was kept to record details of attendances. RESULTS: Two hundred and sixty-five women were successfully interviewed, a response rate of 72 per cent. The major finding of concern was that 63 per cent of women had not heard of the drop-in service, suggesting that the advertising of the centres had been ineffective. Analysis of the clinic register showed that a total of only 77 women had attended the two drop-in centres over a 12-month period. CONCLUSIONS: Owing to the low attendance rates, the service was disbanded after one year of operation. It is possible that these low rates may be explained, at least in part, by the fact that a large number of local social services had been developed in the Benarty area since the time of the needs assessment survey in 1991. The introduction of these new local services within this area may have met many of the needs of women who otherwise may have made use of the drop-in service. The results of the survey underline that the introduction of a new service needs to be underpinned by an effective communication strategy which is realistically budgeted and maintained over a period of time if there is to be successful penetration of the messages within the community. One successful aspect of the pilot project was the improved working relationships between the statutory health and social services staff who collaborated in the operation of the service.

Adolescent↗
PubMed1995

The school health service in Fife: a survey of the views of school head and guidance teachers.

A survey of a sample of primary and secondary school headteachers and guidance teachers in Fife was carried out in November 1993. It gathered information about their views on the current school health service. The findings showed that there was a high level of satisfaction with the service but there was inadequate communication between the health service staff and school staff. Teachers clearly indicated a desire to give health education matters a higher priority and issues such as smoking and drug taking by young people in Fife were specifically mentioned. Increased collaboration with health staff in delivering the health and social curriculum appeared to be welcomed. Examples of early implementation of the health-promoting school concept were given. It is important that, at this time of change in school health services, there is adequate discussion with local authority education departments. Improved communication between health services and education staff at all levels will be important to ensure a smooth evolution of school health services and to facilitate the wide introduction and development of the health-promoting school concept.

Adolescent↗
PubMed1995

Evaluation of the Fife health visitor proactive training programme.

Proactive health visiting refers to a model of health visiting practice which involves actively seeking and meeting the health needs of a defined community. In Fife a working group was established to draw up an operational definition of this concept. Training for health visitors was introduced on a patch-by-patch basis in Fife between December 1992 and May 1993 and an evaluation was subsequently carried out to assess whether or not the proactive concept was being implemented and practised throughout Fife. The survey results suggest that the proactive training has been successful in bringing about a change in health visitor practice over a relatively short time period. With an increasing amount of health visiting work taking place in clinic settings it will be important to define the relative roles of general practitioners, practice nurses and health visitors. A number of operational constraints were identified by the survey and these tended to limit the implementation of the proactive approach. However, we believe that the initiatives which have been successfully introduced should be encouraged and supported, and recommend that this approach be more widely adopted.

Community Health Nursing↗