UHN Toronto Rehabilitation Institute

Toronto, Canada

UHN Toronto Rehabilitation Institute

Toronto, Canada
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Richard C.,University of Alberta | Cristall L.,University of Alberta | Fleming E.,University of Alberta | Lewis E.D.,University of Alberta | And 3 more authors.
Canadian Journal of Diabetes | Year: 2016

Observational studies have reported inconclusive results regarding the relationship between egg consumption (and dietary cholesterol) and the risk for cardiovascular diseases (CVDs) in individuals with type 2 diabetes, which has led to inconsistent recommendations to patients. We reviewed the evidence of egg consumption on major CVD risk factors in individuals with or at risk for type 2 diabetes (prediabetes, insulin resistance or metabolic syndrome). We performed a systematic search in the databases PubMed, MEDLINE, EMBASE and Web of Science in January 2016. Inclusion criteria included randomized controlled trials in which the amount of egg consumed was manipulated and compared to a control group that received no-egg or low-egg diets (<2 eggs/week). We found 10 articles (6 original trials) that met our inclusion criteria. The majority of studies found that egg consumption did not affect major CVD risk factors. Consumption of 6 to 12 eggs per week had no impact on plasma concentrations of total cholesterol, low-density lipoprotein-cholesterol, triglycerides, fasting glucose, insulin or C-reactive protein in all studies that reported these outcomes in comparison with control groups. An increase in high-density lipoprotein-cholesterol with egg consumption was observed in 4 of 6 studies. Results from randomized controlled trials suggest that consumption of 6 to 12 eggs per week, in the context of a diet that is consistent with guidelines on cardiovascular health promotion, has no adverse effect on major CVD risk factors in individuals at risk for developing diabetes or with type 2 diabetes. However, heterogeneities in study design, population included and interventions prevent firm conclusions from being drawn. © 2016 Canadian Diabetes Association.


PubMed | UHN Toronto Rehabilitation Institute, U of Toronto., McMaster University, University of Toronto and 2 more.
Type: | Journal: Journal of applied physiology (Bethesda, Md. : 1985) | Year: 2017

In asthma, supine posture and sleep increase intrathoracic airway narrowing. When supine, due to gravity, fluid moves out of the legs and accumulates in the thorax. We hypothesized that fluid shift out of the legs into the thorax contributes to the intrathoracic airway narrowing in asthma.Healthy and asthmatic subjects sat for 30min and then lay supine for 30min. To simulate overnight fluid shift, supine subjects were randomized to receive increased fluid shift out of the legs using lower body positive pressure (LBPP, 10 to 30min) or none (control), and crossed over. Using forced oscillation at 5Hz, respiratory resistance (R5) and reactance (X5, reflecting respiratory stiffness), and using bioelectrical impedance, leg and thoracic fluid volumes (LFV, TFV) were measured while seated and supine (0min, 30min).In 17 healthy subjects (age:51.810.9 years, FEV1/FVC Z-score: -0.41.1), changes in R5 and X5 were similar in both study arms (p>0.05). In 15 asthmatics (58.59.8 years, -2.11.3), R5 and X5 increased in both arms (R5:0.60.9 vs. 1.40.8 cmHIn asthmatics, fluid shift from the legs to the thorax while supine contributed to increases in the respiratory resistance and stiffness.


Mazereeuw G.,Sunnybrook Research Institute | Mazereeuw G.,University of Toronto | Mazereeuw G.,Canadian Institutes of Health Research | Herrmann N.,Sunnybrook Research Institute | And 12 more authors.
Journal of Neuroinflammation | Year: 2014

Background: Patients with coronary artery disease (CAD) are at risk of accelerated cognitive decline, particularly those with major depression. Mechanisms for cognitive deficits associated with CAD, and the effects of depression, remain poorly understood. However, CAD is associated with inflammatory processes that have been linked to neurodegeneration, may contribute to cognitive decline, and are elevated in depression. Platelet-activating factors (PAFs) are emerging as key lipid mediators that may be central to those processes and highly relevant to cognitive decline in CAD.Methods: This cross-sectional study investigated relationships between various PAFs and cognitive performance in 24 patients with CAD (age, 60.3 ± 9.4; 70.8% male). Analyses were repeated in a subgroup of 15 patients with CAD with major depression (DSM-IV). Cognitive performance was assessed using a standardized battery and summary z scores were calculated based on age, sex, and education norms. Global cognitive performance was the average of domain-specific z scores. Plasma PAF analyses were performed using electrospray ionization mass spectrometry (precursor ion scan).Results: A greater abundance of PAF PC(O-18:0/2:0) was associated with poorer global cognitive performance in patients with CAD (r = -0.45, P = 0.03). In the major depressed subgroup, PAF PC(O-18:0/2:0) (r = -0.59, P = 0.02) as well as PC(O-16:0/2:0) (r = -0.52, P = 0.04), and lyso-PAF PC(O-16:0/0:0) (r = -0.53, P = 0.04) were associated with poorer global cognitive performance. A greater abundance of PAF PC(O-19:5/2:0) was associated with better global cognitive performance (r = 0.55, P = 0.03), suggesting a possible compensatory species.Conclusions: This study suggests that certain PAFs might be associated with global cognitive performance in patients with CAD, with stronger relationships observed in those with major depression. Confirmation of these preliminary findings is warranted. © 2014 Mazereeuw et al.; licensee BioMed Central Ltd.


Cameron J.I.,University of Toronto | Cameron J.I.,UHN Toronto Rehabilitation Institute | Naglie G.,Rotman Research Institute | Green T.L.,University of Calgary | And 6 more authors.
Clinical Rehabilitation | Year: 2015

Objective: Examine feasibility of conducting a randomized controlled trial of the Timing it Right Stroke Family Support Program (TIRSFSP) and collect pilot data. Design: Multi-site mixed method randomized controlled trial. Setting: Acute and community care in three Canadian cities. Subjects: Caregivers were family members or friends providing care to individuals who experienced their first stroke. Intervention: The TIRSFSP offered in two formats, self-directed by the caregiver or stroke support person-directed over time, were compared to standard care. Main measures: Caregivers completed baseline and follow-up measures 1, 3 and 6 months post-stroke including Centre for Epidemiological Studies Depression, Positive Affect, Social Support, and Mastery Scales. We completed in-depth qualitative interviews with caregivers and maintained intervention records describing support provided to each caregiver. Results: Thirty-one caregivers received standard care (n=10), self-directed (n=10), or stroke support person-directed (n=11) interventions. We retained 77% of the sample through 6-months. Key areas of support derived from intervention records (n=11) related to caregiver wellbeing, caregiving strategies, patient wellbeing, community re-integration, and service delivery. Compared to standard care, caregivers receiving the stroke support person-directed intervention reported improvements in perceived support (estimate 3.1, P=.04) and mastery (estimate.35, P=.06). Qualitative caregiver interviews (n=19) reflected the complex interaction between caregiver needs, preferences and available options when reporting on level of satisfaction. Conclusions: Preliminary findings suggest the research design is feasible, caregivers' needs are complex, and the support intervention may enhance caregivers' perceived support and mastery. The intervention will be tested further in a large scale trial. © SAGE Publications.


Giangregorio L.,University of Waterloo | Giangregorio L.,UHN Toronto Rehabilitation Institute | Giangregorio L.,McMaster University | Lala D.,University of Waterloo | And 4 more authors.
Journal of Clinical Densitometry | Year: 2013

The objective of the study was to investigate the precision of standard outcomes obtained using peripheral quantitative computed tomography as well as apparent trabecular structure measures in adults with and without spinal cord injury (SCI). Twelve individuals with SCI, mean (standard deviation [SD]) 20 (13)yrs postinjury and mean (SD) age 44 (9)yrs, and 21 individuals without SCI (mean [SD] age: 27 [5]yrs) participated. Repeat scans of tibia epiphysis (4%) and shaft (66%) were performed using a Stratec XCT-2000 (Stratec Medizintechnik, Pforzheim, Germany). Bone mineral density and geometry variables (e.g., cortical thickness, bone area, polar moment of inertia) were derived with manufacturer's software. The following apparent trabecular structure variables were determined using custom software: average trabecular thickness (TrTh) (mm), trabecular spacing (TrSp) (mm), and trabecular number (TrN) (1/mm); average hole size (HA) and maximum hole size (HM) (mm2); connectivity index (CI); cortical thickness (CTh) (mm); bone volume to total volume (BVTV) ratio. Root mean square standard deviation and root mean square coefficient of variation (RMSCV; root mean square coefficient of variation percent [RMSCV%]) were calculated. The RMSCV% for all standard bone mineral density and geometry variables was ≤2% except for total area (4% site), where precision was 3.8%. RMSCV% for bone structure variables were as follows: CTh 5.1, TrTh 1.7, TrN 1.9, TrSp 2.6, HA 9.5, HM 20.1, CI 5.1, and BVTV 1.4. Precision for bone density and geometry was excellent across a range of bone mineral densities. RMSCVs for some apparent trabecular structure variables were comparable to that of standard variables. The RMSCV for others may necessitate larger studies to detect between-group differences. © 2013.


Mayo N.E.,McGill University | Anderson S.,University of Alberta | Barclay R.,University of Manitoba | Cameron J.I.,University of Toronto | And 11 more authors.
Clinical Rehabilitation | Year: 2015

Objective: To enhance participation post stroke through a structured, community-based program. Design: A controlled trial with random allocation to immediate or four-month delayed entry. Setting: Eleven community sites in seven Canadian cities. Subjects: Community dwelling persons within five years of stroke onset, cognitively intact, able to toilet independently. Interventions: Evidence-based program delivered in three 12-week sessions including exercise and project-based activities, done as individuals and in groups. Main measures: Hours spent per week in meaningful activities outside of the home and Reintegration to Normal Living Index; Stroke-Specific Geriatric Depression Scale, Apathy Scale, gait speed, EuroQuol EQ-5D, and Preference-Based Stroke Index. All measures were transformed to a scale from 0 to 100. Assessments prior to randomization, after the first session at three months, six months, 12 months, and 15 months. Results: A total of 186 persons were randomized. The between-group analysis showed no disadvantage to waiting and so groups were combined and a within-person analysis was carried out at three time points. There were statistically significant increases in all study outcomes on average over all persons. Over 45% of people met or exceeded the pre-specified target of a three hour per week increase in meaningful activity and this most often took a full year of intervention to achieve. Greatest gains were in satisfaction with community integration (mean 4.78; 95% CI: 2.01 to 7.55) and stroke-specific health-related quality of life (mean 4.14; 95% CI: 2.31 to 5.97). Conclusions: Community-based programs targeting participation are feasible and effective, but stroke survivors require time to achieve meaningful gains. © The Author(s) 2015.


Mazereeuw G.,Sunnybrook Research Institute | Mazereeuw G.,University of Toronto | Mazereeuw G.,University of Ottawa | Herrmann N.,Sunnybrook Research Institute | And 10 more authors.
Neuropsychiatric Disease and Treatment | Year: 2015

Introduction: Depression is a frequent complication of coronary artery disease (CAD) with an unknown etiology. Platelet activating factor (PAF) lipids, which are associated with CAD, have recently been linked with novel proposed etiopathological mechanisms for depression such as inflammation, oxidative/nitrosative stress, and vascular endothelial dysfunction. Methods and results: This hypothesis-generating study investigated the relationships between various PAF species and depressive symptoms in 26 CAD patients (age: 60.6±9.2 years, 69% male, mean Hamilton Depression Rating Scale [HAM-D] score: 11.8±5.2, HAM-D range: 3-20). Plasma PAF analyses were performed using high performance liquid chromatography electrospray ionization mass spectrometry in precursor ion scan. Significant associations between depressive symptom severity (HAM-D score) and a greater plasma abundance of the PAFs phosphocho-line (PC) PC(O-12:0/2:0) (r=0.49, P=0.01), PC(O-14:1/2:0) (r=0.43, P=0.03), PC(O-17:3/2:0) (r=0.44, P=0.04), and PC(O-18:3/2:0) (r=0.50, P=0.01) were observed. Associations between those PAFs and HAM-D score persisted after adjusting for age and sex. Conclusion: These preliminary findings support the exploration of the PAF lipidome for depressive symptom biomarkers in CAD patients. Patients were recruited as part of the following clinical trial: NCT00981383. © 2015, Dove Medical Press Ltd.


PubMed | Sunnybrook Research Institute, UHN Toronto Rehabilitation Institute and University of Ottawa
Type: | Journal: Neuropsychiatric disease and treatment | Year: 2015

Depression is a frequent complication of coronary artery disease (CAD) with an unknown etiology. Platelet activating factor (PAF) lipids, which are associated with CAD, have recently been linked with novel proposed etiopathological mechanisms for depression such as inflammation, oxidative/nitrosative stress, and vascular endothelial dysfunction.This hypothesis-generating study investigated the relationships between various PAF species and depressive symptoms in 26 CAD patients (age: 60.69.2 years, 69% male, mean Hamilton Depression Rating Scale [HAM-D] score: 11.85.2, HAM-D range: 3-20). Plasma PAF analyses were performed using high performance liquid chromatography electrospray ionization mass spectrometry in precursor ion scan. Significant associations between depressive symptom severity (HAM-D score) and a greater plasma abundance of the PAFs phosphocholine (PC) PC(O-12:0/2:0) (r=0.49, P=0.01), PC(O-14:1/2:0) (r=0.43, P=0.03), PC(O-17:3/2:0) (r=0.44, P=0.04), and PC(O-18:3/2:0) (r=0.50, P=0.01) were observed. Associations between those PAFs and HAM-D score persisted after adjusting for age and sex.These preliminary findings support the exploration of the PAF lipidome for depressive symptom biomarkers in CAD patients. Patients were recruited as part of the following clinical trial: NCT00981383.


Oldridge N.B.,University of Wisconsin - Milwaukee | Pakosh M.T.,UHN Toronto Rehabilitation Institute | Thomas R.J.,Mayo Medical School
International Health | Year: 2015

Background: By 2030, more than 80% of cardiovascular disease-related deaths and disability-adjusted life years will occur in the 139 low- and middle-income (LMIC) countries. Cardiac rehabilitation (CR) has been demonstrated to be effective and cost-effective mainly based on data from high-income countries. The purpose of this paper was to review the literature for cost and cost-effectiveness data on CR in LMICs. Methods: MEDLINE (Ovid) and EMBASE (Ovid) electronic databases were searched for CR 'cost' and 'costeffectiveness' data in LMICs. Results: Five CR publications with cost and cost-effectiveness data frommiddle-income countries were identified with none fromlow-income countries. Studies from Brazil demonstrated mean monthly savings of US$190 for CR, with a US$48 increase in a control group with mean costs of US$503 for a 3-month CR program. Mean costs to the public health care system of US$360 and US$540 when paid out-of-pocket were reported for a 3-month CR program in seven Latin American middle-income countries. Cardiac rehabilitation is reported to be cost-effective in both Brazil and Colombia. Conclusions: Cardiac rehabilitation for patients with heart failure in Brazil and Colombiawas estimated to be costeffective. However, given the limited health care budgets in many LMICs, affordable CR models will need to be developed for LMICs, particularly for low-income countries. © The Author 2015.


PubMed | Mayo Clinic and Foundation Rochester, University of Wisconsin - Milwaukee and UHN Toronto Rehabilitation Institute
Type: Journal Article | Journal: International health | Year: 2016

By 2030, more than 80% of cardiovascular disease-related deaths and disability-adjusted life years will occur in the 139 low- and middle-income (LMIC) countries. Cardiac rehabilitation (CR) has been demonstrated to be effective and cost-effective mainly based on data from high-income countries. The purpose of this paper was to review the literature for cost and cost-effectiveness data on CR in LMICs.MEDLINE (Ovid) and EMBASE (Ovid) electronic databases were searched for CR cost and cost-effectiveness data in LMICs.Five CR publications with cost and cost-effectiveness data from middle-income countries were identified with none from low-income countries. Studies from Brazil demonstrated mean monthly savings of US$190 for CR, with a US$48 increase in a control group with mean costs of US$503 for a 3-month CR program. Mean costs to the public health care system of US$360 and US$540 when paid out-of-pocket were reported for a 3-month CR program in seven Latin American middle-income countries. Cardiac rehabilitation is reported to be cost-effective in both Brazil and Colombia.Cardiac rehabilitation for patients with heart failure in Brazil and Colombia was estimated to be cost-effective. However, given the limited health care budgets in many LMICs, affordable CR models will need to be developed for LMICs, particularly for low-income countries.

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