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Escandell-Rico FM, Pérez-Fernández L. [Evaluation of healthcare for patients with diabetes in primary care: A systematic review]. Semergen 2024; 50:102214. [PMID: 38554679 DOI: 10.1016/j.semerg.2024.102214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/16/2024] [Accepted: 02/04/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE Have the most current evidence in relation to the evaluation of medical healthcare for patients with diabetes in primary care. METHOD During the review process, we followed the recommendations to improve the publication of systematic reviews and meta-analyses and the preferred reporting points for PRISMA systematic reviews. The bibliographic search was carried out in Cumulative Index to Nursing and Allied Health Literature (CINAHL), SCOPUS, Scielo, MedLine/ PubMed, Cochrane databases and in the Google Scholar search engine, with free and controlled language, using the MeSh search terms: «Physicians, Primary Care», «Diabetes Mellitus, Type2». Eight selected articles were analyzed. The articles were selected based on their relevance, published in peer-reviewed academic journals and published between 2019 and 2023. RESULTS The main study tool represents interventions in knowledge and practice about the care of patients with diabetes among primary care physicians. The most important discussion topics extracted in the analyzed articles refer to knowledge, clinical inertia, patients' housing challenges, adherence intervention programs, and a self-care application for patients with diabetes. CONCLUSIONS The findings of this study indicate the need to improve medical health care through knowledge, attitudes and practices in primary care regarding patients with diabetes. In this way, it could be considered a useful tool to promote medical healthcare in primary care.
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Affiliation(s)
- F M Escandell-Rico
- Profesor de enfermería, Departamento de Enfermería, Universidad de Alicante, Alicante, España.
| | - L Pérez-Fernández
- Coordinadora de enfermería, Centro de Salud Almoradí, Departamento de Salud de Orihuela, Almoradí, Alicante, España
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2
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Lindemann CH, Burst V, Völker LA, Brähler S, Simic D, Becker I, Hellmich M, Kurscheid C, Scholten N, Krauspe R, Leibel K, Stock S, Brinkkoetter PT. Personalized, interdisciplinary patient pathway for cross-sector care of multimorbid patients (eliPfad trial): study protocol for a randomized controlled trial. Trials 2024; 25:177. [PMID: 38468319 PMCID: PMC10926660 DOI: 10.1186/s13063-024-08026-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/28/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Multimorbid and frail elderly patients often carry a high burden of treatment. Hospitalization due to the onset of an acute illness can disrupt the fragile balance, resulting in further readmissions after hospital discharge. Current models of care in Germany do not meet the needs of this patient group. Rather lack of coordination and integration of care combined with a lack of interdisciplinary approaches result in fragmented and inadequate care and increase the burden of treatment even more. METHODS eliPfad is a randomized controlled trial conducted in 6 hospitals in Germany. Multimorbid elderly patients aged 55 or older are randomly assigned to the intervention or control group. Patients in the intervention group receive the eliPfad intervention additional to standard care. The core components of eliPfad are: Early assessment of patients' individual treatment burden and support through a specially trained case manager Involvement of the patient's general practitioner (GP) right from the beginning of the hospital stay Preparation of an individual, cross-sectoral treatment plan through the interdisciplinary hospital team with the involvement of the patient's GP Establishment of a cross-sectoral electronic patient record (e-ePA) for documentation and cross-sectoral exchange Support/Promote patient adherence Tailored early rehabilitation during the hospital stay, which is continued at home Close-tele-monitoring of medically meaningful vital parameters through the use of tablets, digital devices, and personal contacts in the home environment The intervention period begins in the hospital and continues 6 weeks after discharge. Patients in the control group will be treated according to standard clinical care and discharged according to current discharge management. The primary aim is the prevention/reduction of readmissions in the first 6 months after discharge. In addition, the impact on health-related quality of life, the burden of treatment, survival, self-management, medication prescription, health literacy, patient-centered care, cost-effectiveness, and process evaluation will be examined. Nine hundred forty-eight patients will be randomized 1:1 to intervention and control group. DISCUSSION If eliPfad leads to fewer readmissions, proves (cost-)effective, and lowers the treatment burden, it should be introduced as a new standard of care in the German healthcare system. TRIAL REGISTRATION The trial was registered in the German Clinical Trials Registry (Deutsches Register Klinischer Studien (DRKS)) on 08/14/2023 under the ID DRKS00031500 .
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Affiliation(s)
- Christoph Heinrich Lindemann
- Department II of Internal Medicine and Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Volker Burst
- Department II of Internal Medicine and Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Linus Alexander Völker
- Department II of Internal Medicine and Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Sebastian Brähler
- Department II of Internal Medicine and Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Dusan Simic
- Cologne Institute for Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ingrid Becker
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Clarissa Kurscheid
- Research Institute for Health and System Development, EUFH University of Applied Sciences, Cologne, Germany
| | - Nadine Scholten
- Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair for Health Services Research, University of Cologne, Cologne, Germany
| | - Ruben Krauspe
- Cologne Institute for Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Kerstin Leibel
- Cologne Institute for Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Stephanie Stock
- Cologne Institute for Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Paul Thomas Brinkkoetter
- Department II of Internal Medicine and Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany.
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Williams H, Steinberg S, Leon K, Vingum R, Hu M, Berzin R, Hagg H, Hanaway P. Predictive Criterion Validity of the Parsley Symptom Index Against the Patient-Reported Outcomes Measurement Information System-10 in a Chronic Disease Cohort: Retrospective Cohort Study. JMIR Form Res 2024; 8:e53316. [PMID: 38363587 PMCID: PMC10907938 DOI: 10.2196/53316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/11/2024] [Accepted: 01/14/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Approximately 60% of US adults live with chronic disease, imposing a significant burden on patients and the health care system. With the rise of telehealth, patient-reported outcomes measures (PROMs) have emerged as pivotal tools for managing chronic disease. While numerous PROMs exist, few have been designed explicitly for telehealth settings. The Parsley Symptom Index (PSI) is an electronic patient-reported outcome measure (ePROM) developed specifically for telehealth environments. OBJECTIVE Our aim is to determine whether the PSI predicts changes in the established Patient-Reported Outcomes Measurement Information System-10 (PROMIS-10) Global Health, a 10-question short form. METHODS We conducted a retrospective cohort study using data from 367 unique patients, amassing 1170 observations between August 30, 2017, and January 30, 2023. Patients completed the PSI and the PROMIS-10 multiple times throughout the study period. Using univariate regression models, we assess the predictive criterion validity of the PSI against PROMIS-10 scores. RESULTS This study revealed significant relationships between the PSI and PROMIS-10 physical and mental health scores through comprehensive univariate analyses, thus establishing support for the criterion validity of the PSI. These analyses highlighted the PSI's potential as an insightful tool for understanding and predicting both mental and physical health dimensions. CONCLUSIONS Our findings emphasize the importance of the PSI in capturing the nuanced interactions between symptomatology and health outcomes. These insights reinforce the value of the PSI in clinical contexts and support its potential as a versatile tool in both research and practice.
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Affiliation(s)
- Hants Williams
- Applied Health Informatics, School of Health Professions, Stony Brook University, Stony Brook, NY, United States
| | | | | | - Ryan Vingum
- Untold Content, Cincinnati, OH, United States
| | - Mengyao Hu
- Applied Health Informatics, School of Health Professions, Stony Brook University, Stony Brook, NY, United States
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4
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Kroenke K, Corrigan JD, Ralston RK, Zafonte R, Brunner RC, Giacino JT, Hoffman JM, Esterov D, Cifu DX, Mellick DC, Bell K, Scott SG, Sander AM, Hammond FM. Effectiveness of care models for chronic disease management: A scoping review of systematic reviews. PM R 2024; 16:174-189. [PMID: 37329557 DOI: 10.1002/pmrj.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/14/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To conduct a scoping review of models of care for chronic disease management to identify potentially effective components for management of chronic traumatic brain injury (TBI). METHODS Information sources: Systematic searches of three databases (Ovid MEDLINE, Embase, and Cochrane Database of Systematic Reviews) from January 2010 to May 2021. ELIGIBILITY CRITERIA Systematic reviews and meta-analyses reporting on the effectiveness of the Chronic Care Model (CCM), collaborative/integrated care, and other chronic disease management models. DATA Target diseases, model components used (n = 11), and six outcomes (disease-specific, generic health-related quality of life and functioning, adherence, health knowledge, patient satisfaction, and cost/health care use). SYNTHESIS Narrative synthesis, including proportion of reviews documenting outcome benefits. RESULTS More than half (55%) of the 186 eligible reviews focused on collaborative/integrated care models, with 25% focusing on CCM and 20% focusing on other chronic disease management models. The most common health conditions were diabetes (n = 22), depression (n = 16), heart disease (n = 12), aging (n = 11), and kidney disease (n = 8). Other single medical conditions were the focus of 22 reviews, multiple medical conditions of 59 reviews, and other or mixed mental health/behavioral conditions of 20 reviews. Some type of quality rating for individual studies was conducted in 126 (68%) of the reviews. Of reviews that assessed particular outcomes, 80% reported disease-specific benefits, and 57% to 72% reported benefits for the other five types of outcomes. Outcomes did not differ by the model category, number or type of components, or target disease. CONCLUSIONS Although there is a paucity of evidence for TBI per se, care model components proven effective for other chronic diseases may be adaptable for chronic TBI care.
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Affiliation(s)
- Kurt Kroenke
- Department of Medicine, Indiana School of Medicine and Regenstrief Institute, Indianapolis, Indiana, USA
| | - John D Corrigan
- Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus, Ohio, USA
| | - Rick K Ralston
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Robert C Brunner
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Dmitry Esterov
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | | | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, Texas, USA
| | - Steven G Scott
- Center of Innovation on Disability & Rehab Research (CINDRR), James A Haley Veterans' Hospital, Tampa, Florida, USA
| | - Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, and Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas, USA
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
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5
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Harvey PC, Willis EPE, Brown DJ, Byrne AL, Baldwin APA, Heard D, Augutis W. Navigating the care of families with a child or children with autistic spectrum disorder. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:912-926. [PMID: 35658565 DOI: 10.1177/17446295221106001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of this project was to better understand nurse navigators work with children and families who are living with severe autism spectrum disorder to achieve improved health and wellbeing outcomes. Nurse navigators were introduced into the public health sector in Queensland in 2016, with 400 navigators currently working across 16 health services in diverse geographic and demographic settings. Narrative inquiry was used to explore one nurse navigator's journey working with children and families living with severe Autism. The challenges of rigid health systems to adapt to the requirements of children with special needs, particularly in relation to care in the emergency department and where interventional procedures are necessary were apparent. Nurse navigators can effectively co-ordinate the care of an extremely vulnerable patient cohort and provide essential advocacy in a health system that is rigid and lacking the flexibility to deal with individual needs.
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Affiliation(s)
| | | | - Dr Janie Brown
- Curtin University, Australia; St John of God Midland Public and Private Hospital, Western Australia; Central Queensland University, Australia
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Koopman WJ, LaDonna KA, Kinsella EA, Venance SL, Watling CJ. Archetypes of incomplete stories in chronic illness medical encounters. PATIENT EDUCATION AND COUNSELING 2023; 117:107973. [PMID: 37734249 DOI: 10.1016/j.pec.2023.107973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE During encounters, patients and practitioners engage in conversations to address health concerns. Because these interactions are time-pressured events, it may be inevitable that any story exchanged during these encounters will be incomplete in some way, potentially jeopardizing how quality and safety of care is delivered. In this study, we explored how and why incomplete stories might arise in health interactions. METHODS Constructivist grounded theory methodology was used to explore how patients and practitioners approach their interactions during encounters. In this two-phase study, we interviewed patients (n = 21) then practitioners (n = 12). RESULTS We identified three distinct archetypes of incomplete storytelling - the hidden story, the interpreted story, and the tailored story. Measured information sharing, triadic encounters and pre-planned agendas influenced these storylines, respectively. CONCLUSION Both patient and practitioner participants focused on what each considered important, appropriate, and useful for productive encounters. While incomplete stories may be a reality, educating practitioners about how incomplete stories come about from both sides of the conversation creates new opportunities to optimize interactions at medical encounters for in-depth patient practitioner storytelling.
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Affiliation(s)
- Wilma J Koopman
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario N6A 3K7, Canada; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada; Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada.
| | - K A LaDonna
- Department of Innovation in Medical Education and Department of Medicine, University of Ottawa, Ottawa, Ontario K1G 5Z3, Canada
| | - E A Kinsella
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec H3A 1A3, Canada
| | - S L Venance
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada
| | - C J Watling
- Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada
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7
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Hempel S, Bolshakova M, Hochman M, Jimenez E, Thompson G, Motala A, Ganz DA, Gabrielian S, Edwards S, Zenner J, Dennis B, Chang E. Caring for high-need patients. BMC Health Serv Res 2023; 23:1289. [PMID: 37996845 PMCID: PMC10668484 DOI: 10.1186/s12913-023-10236-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/28/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE We aimed to explore the construct of "high need" and identify common need domains among high-need patients, their care professionals, and healthcare organizations; and to describe the interventions that health care systems use to address these needs, including exploring the potential unintended consequences of interventions. METHODS We conducted a modified Delphi panel informed by an environmental scan. Expert stakeholders included patients, interdisciplinary healthcare practitioners (physicians, social workers, peer navigators), implementation scientists, and policy makers. The environmental scan used a rapid literature review and semi-structured interviews with key informants who provide healthcare for high-need patients. We convened a day-long virtual panel meeting, preceded and followed by online surveys to establish consensus. RESULTS The environmental scan identified 46 systematic reviews on high-need patients, 19 empirical studies documenting needs, 14 intervention taxonomies, and 9 studies providing construct validity for the concept "high need." Panelists explored the construct and terminology and established that individual patients' needs are unique, but areas of commonality exist across all high-need patients. Panelists agreed on 11 domains describing patient (e.g., social circumstances), 5 care professional (e.g., communication), and 8 organizational (e.g., staffing arrangements) needs. Panelists developed a taxonomy of interventions with 15 categories (e.g., care navigation, care coordination, identification and monitoring) directed at patients, care professionals, or the organization. The project identified potentially unintended consequences of interventions for high-need patients, including high costs incurred for patients, increased time and effort for care professionals, and identification of needs without resources to respond appropriately. CONCLUSIONS Care for high-need patients requires a thoughtful approach; differentiating need domains provides multiple entry points for interventions directed at patients, care professionals, and organizations. Implementation efforts should consider outlined intended and unintended downstream effects on patients, care professionals, and organizations.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA.
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - Michael Hochman
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, USA
| | - Elvira Jimenez
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Gina Thompson
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - David A Ganz
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | | | | | - James Zenner
- Los Angeles County Department of Mental Health, Los Angeles, CA, USA
| | - Ben Dennis
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - Evelyn Chang
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Grudniewicz A, Gray CS, Boeckxstaens P, De Maeseneer J, Mold J. Operationalizing the Chronic Care Model with Goal-Oriented Care. THE PATIENT 2023; 16:569-578. [PMID: 37642918 PMCID: PMC10570240 DOI: 10.1007/s40271-023-00645-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
The Chronic Care Model has guided quality improvement in health care for almost 20 years, using a patient-centered, disease management approach to systems and care teams. To further advance efforts in person-centered care, we propose strengthening the Chronic Care Model with the goal-oriented care approach. Goal-oriented care is person-centered in that it places the focus on what matters most to each person over the course of their life. The person's goals inform care decisions, which are arrived at collaboratively between clinicians and the person. In this paper, we build on each of the elements of the Chronic Care Model with person-centered, goal-oriented care and provide clinical examples on how to operationalize this approach. We discuss how this adapted approach can support our health care systems, in particular in the context of growing multi-morbidity.
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Affiliation(s)
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | | | - Jan De Maeseneer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - James Mold
- George Lynn Cross Emeritus Professor, Family and Preventive Medicine, University of Oklahoma, Oklahoma City, USA
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Nagykaldi Z, Littenberg B, Bonnell L, Breshears R, Clifton J, Crocker A, Hitt J, Kessler R, Mollis B, Miyamoto RES, van Eeghen C. Econometric evaluation of implementing a behavioral health integration intervention in primary care settings. Transl Behav Med 2023; 13:571-580. [PMID: 37000706 PMCID: PMC10415735 DOI: 10.1093/tbm/ibad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Integrated behavioral health (IBH) is an approach to patient care that brings medical and behavioral health providers (BHPs) together to address both behavioral and medical needs within primary care settings. A large, pragmatic, national study aimed to test the effectiveness and measure the implementation costs of an intervention to improve IBH integration within primary care practices (IBH-PC). Assess the time and cost to practices of implementing a comprehensive practice-level intervention designed from the perspective of clinic owners to move behavioral service integration from co-location toward full integration as part of the IBH-PC study. IBH-PC program implementation costs were estimated in a representative sample of 8 practices using standard micro-econometric evaluation of activities outlined in the implementation workbook, including program implementation tasks, remote quality improvement coaching services, educational curricula, and learning community activities, over a 24-month period. The total median cost of implementing the IBH-PC program across all stages was $20,726 (range: $12,381 - $60,427). The median cost of the Planning Stage was $10,258 (range: $4,625 - $14,840), while the median cost of the Implementation Stage was $9,208 (range: $6,017 - 49,993). There were no statistically significant differences in practice or patient characteristics between the 8 selected practices and the larger IBH-PC practice sample (N=34). This study aimed to quantify the relative costs associated with integrating behavioral health into primary care. Although the cost assessment approach did not include all costs (fixed, variable, operational, and opportunity costs), the study aimed to develop a replicable and pragmatic measurement process with flexibility to adapt to emerging developments in each practice environment, providing a reasonable ballpark estimate of costs associated with implementation to help guide future executive decisions.
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Affiliation(s)
- Zsolt Nagykaldi
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Levi Bonnell
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | - Ryan Breshears
- Psychological Services, Wellstar Health System, Marietta, GA, USA
| | | | - Abigail Crocker
- Department of Mathematics and Statistics, University of Vermont, Burlington, VT, USA
| | - Juvena Hitt
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | - Rodger Kessler
- Integrated Behavioral Health, Arizona State University, Phoenix, AZ, USA
| | - Brenda Mollis
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Robin E S Miyamoto
- Departments of Native Hawaiian Health and Family Medicine and Community Health, University of Hawai’i, Honolulu, HI, USA
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10
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Chang SH, Chang YY, Jeng WJ, Wai JPM. Efficacy of a multidimensional self-management intervention on low-education women with metabolic syndrome: a cluster randomized controlled trial. Sci Rep 2023; 13:10358. [PMID: 37365208 DOI: 10.1038/s41598-023-36971-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Low-education women, a substantially older population, are subject to increased risks of metabolic syndrome and consequent cardiometabolic diseases; early detection and effective management were urgently needed. Ninety-nine women with metabolic syndrome, age 61 and education ≤ 6 years, from four community units were randomly assigned to either a self-management intervention (n = 51) or a control arm (n = 48). The intervention consisted of five dimensions, physical activity and diet modifications (daily exercise classes and two nutrition courses), goal setting, coaching and peer support, problem-solving, and self-monitoring. The control arm received an education leaflet. Assessments were performed at baseline, six months, and 18 months. Compared with the control, the intervention participants improved the overall rate of meeting the recommended servings for six health foods, including vegetables, dairy products, and nuts (except whole grains, fruits, and protein); the rate of meeting regular leisure-time physical activity; and criteria biomarkers-waist circumference, fasting blood glucose, high-density lipoprotein cholesterol (except blood pressure and triglycerides); as well as body weight and body mass index; consequently decreased the number of risk factors and rate of metabolic syndrome. In conclusion, the multidimensional self-management intervention improved physical activity, healthy eating, and metabolic syndrome risks among low-education women with metabolic syndrome.
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Affiliation(s)
- Shu-Hung Chang
- Graduate Institute of Gerontology and Health Care Management, Geriatric and Long-Term Care Research Center, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Department of Gastroenterology and Hepatology, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Ya Chang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jackson Pui Man Wai
- Department of Nutrition Science, Fu Jen Catholic University, New Taipei City, Taiwan.
- Graduate Institute of Sport Science, National Taiwan Sport University, Taoyuan, Taiwan.
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May CR, Chew-Graham CA, Gallacher KI, Gravenhorst KC, Mair FS, Nolte E, Richardson A. EXPERTS II - How are patient and caregiver participation in health and social care shaped by experienced burden of treatment and social inequalities? Protocol for a qualitative synthesis. NIHR OPEN RESEARCH 2023; 3:31. [PMID: 37881470 PMCID: PMC10593344 DOI: 10.3310/nihropenres.13411.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 10/27/2023]
Abstract
Background The workload health and social care service users and caregivers take on, and their capacity to do this work is important. It may play a key part in shaping the implementation of innovations in health service delivery and organisation; the utilisation and satisfaction with services; and the outcomes of care. Previous research has often focused on experiences of a narrow range of long-term conditions, and on factors that shape adherence to self-care regimes. Aims With the aim of deriving policy and practice implications for service redesign, this evidence synthesis will extend our understanding of service user and caregiver workload and capacity by comparing how they are revealed in qualitative studies of lived experience of three kinds of illness trajectories: long-term conditions associated with significant disability (Parkinson's disease, schizophrenia); serious relapsing remitting disease (Inflammatory Bowel Disease, bipolar disorder); and rapidly progressing acute disease (brain cancer, early onset dementia). Methods We will review and synthesise qualitative studies of lived experience of participation in health and social care that are shaped by interactions between experienced treatment burdens, social inequalities and illness trajectories. The review will involve: 1. Construction of a theory-informed coding manual; systematic search of bibliographic databases to identify, screen and quality assess full-text papers. 2. Analysis of papers using manual coding techniques, and text mining software; construction of taxonomies of service user and caregiver work and capacity. 3. Designing a model of core components and identifying common factors across conditions, trajectories, and contexts. 4. Work with practitioners, and a Patient and Public Involvement (PPI) group, to explore the validity of the models produced; to develop workload reduction strategies; and to consider person-centred service design. Dissemination We will promote workload reduction models to support service users and caregivers and produce policy briefs and peer-reviewed publications for practitioners, policy-makers, and researchers.
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Affiliation(s)
- Carl R May
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- NIHR ARC North Thames, London, UK
| | | | | | - Katja C Gravenhorst
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- NIHR ARC North Thames, London, UK
| | - Frances S Mair
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ellen Nolte
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- NIHR ARC North Thames, London, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR ARC Wessex, Southampton, UK
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Eyowas FA, Schneider M, Alemu S, Getahun FA. Multimorbidity and adverse longitudinal outcomes among patients attending chronic outpatient medical care in Bahir Dar, Northwest Ethiopia. Front Med (Lausanne) 2023; 10:1085888. [PMID: 37250625 PMCID: PMC10213652 DOI: 10.3389/fmed.2023.1085888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Background Multimorbidity is becoming more prevalent in low-and middle-income countries (LMICs). However, the evidence base on the burden and its longitudinal outcomes are limited. This study aimed to determine the longitudinal outcomes of patients with multimorbidity among a sample of individuals attending chronic outpatient non communicable diseases (NCDs) care in Bahir Dar, northwest Ethiopia. Methods A facility-based longitudinal study was conducted among 1,123 participants aged 40+ attending care for single NCD (n = 491) or multimorbidity (n = 633). Data were collected both at baseline and after 1 year through standardized interviews and record reviews. Data were analyzed using Stata V.16. Descriptive statistics and longitudinal panel data analyzes were run to describe independent variables and identify factors predicting outcomes. Statistical significance was considered at p-value <0.05. Results The magnitude of multimorbidity has increased from 54.8% at baseline to 56.8% at 1 year. Four percent (n = 44) of patients were diagnosed with one or more NCDs and those having multimorbidity at baseline were more likely than those without multimorbidity to develop new NCDs. In addition, 106 (9.4%) and 22 (2%) individuals, respectively were hospitalized and died during the follow up period. In this study, about one-third of the participants had higher quality of life (QoL), and those having higher high activation status were more likely to be in the higher versus the combined moderate and lower QoL [AOR1 = 2.35, 95%CI: (1.93, 2.87)] and in the combined higher and moderate versus lower level of QoL [AOR2 = 1.53, 95%CI: (1.25, 1.88)]. Conclusion Developing new NCDs is a frequent occurrence and the prevalence of multimorbidity is high. Living with multimorbidity was associated with poor progress, hospitalization and mortality. Patients having a higher activation level were more likely than those with low activation to have better QoL. If health systems are to meet the needs of the people with chronic conditions and multimorbidity, it is essential to understand diseases trajectories and of impact of multimorbidity on QoL, and determinants and individual capacities, and to increase their activation levels for better health improve outcomes through education and activation.
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Affiliation(s)
- Fantu Abebe Eyowas
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Marguerite Schneider
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Shitaye Alemu
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fentie Ambaw Getahun
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Lucenteforte E, Finocchietti M, Addis A, Tettamanti M, Varano M, Parravano M, Virgili G. Polytherapy and Multimorbidity Pattern of Users of Anti-VEGF Drugs and Dexamethasone for the Treatment of Age-Related Macular Degeneration and other Vascular Retinopathies in Clinical Practice. Pharmaceuticals (Basel) 2023; 16:ph16050646. [PMID: 37242429 DOI: 10.3390/ph16050646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023] Open
Abstract
Introduction: Our aim was to describe the polytherapy and multimorbidity pattern of users of anti-VEGF and dexamethasone drugs for the treatment of these conditions, and to investigate their polytherapy and multimorbidity profiles, together with adherence and the burden of care. Methods: Descriptive, population-based, pharmacoepidemiology study on the users of anti-VEGF drugs, and secondarily intravitreal dexamethasone, for the treatment of age-related macular degeneration and other vascular retinopathies in clinical practice, using administrative databases of Lazio region, Italy. We used a cohort of 50,000 residents in Lazio in 2019 with same age as comparison. Polytherapy was assessed using databases of prescribed drugs intended for outpatient use. Multimorbidity was investigated with additional sources, such as hospital discharge records, outpatient care records, and disease-specific exemptions from co-payment. Each patient was followed for 1 to 3 years from the first intravitreal injection received. Results: 16,266 residents in Lazio who received the first IVI from 1 January 2011 to 31 December 2019, with at least 1 year of observation before index date, were included. The proportion of patients with at least one comorbidity was 54.0%. Patients used an average 8.6 (SD 5.3) concomitant drugs other than anti-VEGF used for injections. A large percentage of patients (39.0%) used 10 or more concomitant drugs, including antibacterials (62.9%), drugs for peptic ulcers (56.8%), anti-thrombotics (52.3%), NSAIDs (44.0%), and anti-dyslipidaemics (42.3%). The same proportions were found across patients of all ages, probably due to high prevalence of diabetes (34.3%), especially in younger age groups. When stratified by diabetes, a comparison of multimorbidity and polytherapy with a sample of 50,000 residents of the same age found that patients receiving IVIs used more drugs and had more comorbidities, particularly in non-diabetics. Lapses of care, whether short (absence of any type of contact for at least 60 days in the first year of follow-up and 90 in the second year) or long (90 days in the first and 180 days in the second year) were common: 66% and 51.7%, respectively. Conclusions: Patients receiving intravitreal drugs for retinal conditions have high multimorbidity and polytherapy rates. Their burden of care is aggravated by the large number of contacts with the eye care system for examinations and injections. Pursuing Minimally Disruptive Medicine to optimise patient care is a difficult goal for health systems, and more research on clinical pathways and their implementation is warranted.
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Affiliation(s)
- Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Marco Finocchietti
- Department of Epidemiology, Lazio Regional Health Service, 00154 Rome, Italy
| | - Antonio Addis
- Department of Epidemiology, Lazio Regional Health Service, 00154 Rome, Italy
| | - Mauro Tettamanti
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | | | | | - Gianni Virgili
- Department of NEUROFARBA, Eye Clinic, Careggi University Hospital, University of Florence, 50134 Florence, Italy
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Dowou RK, Amu H, Saah FI, Arthur LE, Dotse PAN, Bain LE. Management of chronic non-communicable diseases in Ghana: a qualitative study of patients' coping strategies and the role of caregivers. BMC Health Serv Res 2023; 23:371. [PMID: 37072851 PMCID: PMC10111065 DOI: 10.1186/s12913-023-09398-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/13/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Chronic Non-Communicable Diseases (CNCDs) has become a major cause of mortality and disability globally. We explored the coping strategies adopted by CNCD patients and the roles of caregivers in the management of CNCDs in Ghana. METHODS This was a qualitative study that adopted an exploratory design. The study was carried out at the Volta Regional Hospital. Purposive convenience sampling procedures were used to sample patients and caregivers. Data for the study were collected using in-depth interview guides. Data were collected among 25 CNCDs patients and 8 caregivers and analysed thematically using ATLAS.ti. RESULTS Patients adopted a variety of strategies to cope with their condition. These strategies were emotion-oriented coping, task-oriented coping, and avoidance-oriented coping. Family members were the main caregivers, who provided social and financial support for patients. Financial challenges, inadequate family support, poor attitudes of health workers, delays at the health facility, unavailability of drugs at the facility, and patients' non-adherence to the medical advice were major challenges that militated against caregivers' efforts in supporting patients in the management of their CNCDs. CONCLUSION We found that patients adopted various strategies to cope with their conditions. The roles of the caregivers in supporting patients in the management practices were identified as very important as they contribute immensely to the financial and social support for the patients in their management of CNCDs. It is crucial that health professionals actively involve caregivers in every aspect of the day-to-day management of CNCDs as these caregivers spend more time with these patients and understand them better.
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Affiliation(s)
- Robert Kokou Dowou
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Science, Hohoe, Ghana.
| | - Hubert Amu
- Department of Population and Behavioural Sciences, Fred N. Binka School of Public Health, University of Health and Allied Science, Hohoe, Ghana
| | - Farrukh Ishaque Saah
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Science, Hohoe, Ghana
| | - Lordina Ewurabena Arthur
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Science, Hohoe, Ghana
| | - Priscilla Aku Nuna Dotse
- Department of Population and Behavioural Sciences, Fred N. Binka School of Public Health, University of Health and Allied Science, Hohoe, Ghana
| | - Luchuo Engelbert Bain
- Department of Psychology, Faculty of Humanities, University of Johannesburg, Auckland Park, Johannesburg, South Africa
- International Development Research Centre, IDRC, Ottawa, Canada
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Scott CK, Dennis ML, Grella CE, Watson DP, Davis JP, Hart MK. Using recovery management checkups for primary care to improve linkage to alcohol and other drug use treatment: a randomized controlled trial three month findings. Addiction 2023; 118:520-532. [PMID: 36208061 PMCID: PMC10015976 DOI: 10.1111/add.16064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/16/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Recovery management checkups (RMC) have established efficacy for linking patients to substance use disorder (SUD) treatment. This study tested whether using RMC in combination with screening, brief intervention, and referral to treatment (SBIRT), versus SBIRT alone, can improve linkage of primary care patients referred to SUD treatment. DESIGN A randomized controlled trial of SBIRT as usual (n = 132) versus SBIRT plus recovery management checkups for primary care (RMC-PC) (n = 134) with follow-up assessments at 3 months post-baseline. SETTING Four federally qualified health centers in the United States serving low-income populations. PARTICIPANTS Primary care patients (n = 266, 64% male, 80% Black, mean age, 48.3 [range, 19-53]) who were referred to SUD treatment after SBIRT. INTERVENTIONS SBIRT alone (control condition) compared with SBIRT + RMC-PC (experimental condition). MEASUREMENT The primary outcome was any days of SUD treatment in the past 3 months. Key secondary outcomes were days of SUD treatment overall and by level of care, days of alcohol and other drug (AOD) abstinence, and days of using specific substances, all based on self-report. FINDINGS At 3-month follow-up, those assigned to SBIRT + RMC-PC (n = 134) had higher odds of receiving any SUD treatment (46% vs 20%; adjusted odds ratio = 4.50 [2.49, 8.48]) compared with SBIRT only, including higher rates of entering residential and intensive outpatient treatment. They also reported more days of treatment (14.45, vs 7.13; d = +0.26), more days abstinent (41.3 vs 31.9; d = +0.22), and fewer days of using alcohol (27.14, vs 36.31; d = -0.25) and cannabis (19.49, vs 28.6; d = -0.20). CONCLUSIONS Recovery management checkups in combination with screening, brief intervention, and referral to treatment are an effective strategy for improving linkage of primary care patients in need to substance use disorder treatment over 3 months.
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Affiliation(s)
| | | | | | | | - Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, USC Center for Artificial Intelligence in Society, USC Center for Mindfulness Science, University of Southern California, Los Angeles, CA, USA
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Raaijmakers LHA, Schermer TR, Wijnen M, van Bommel HE, Michielsen L, Boone F, Vercoulen JH, Bischoff EWMA. Development of a Person-Centred Integrated Care Approach for Chronic Disease Management in Dutch Primary Care: A Mixed-Method Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3824. [PMID: 36900842 PMCID: PMC10001916 DOI: 10.3390/ijerph20053824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
To reduce the burden of chronic diseases on society and individuals, European countries implemented chronic Disease Management Programs (DMPs) that focus on the management of a single chronic disease. However, due to the fact that the scientific evidence that DMPs reduce the burden of chronic diseases is not convincing, patients with multimorbidity may receive overlapping or conflicting treatment advice, and a single disease approach may be conflicting with the core competencies of primary care. In addition, in the Netherlands, care is shifting from DMPs to person-centred integrated care (PC-IC) approaches. This paper describes a mixed-method development of a PC-IC approach for the management of patients with one or more chronic diseases in Dutch primary care, executed from March 2019 to July 2020. In Phase 1, we conducted a scoping review and document analysis to identify key elements to construct a conceptual model for delivering PC-IC care. In Phase 2, national experts on Diabetes Mellitus type 2, cardiovascular diseases, and chronic obstructive pulmonary disease and local healthcare providers (HCP) commented on the conceptual model using online qualitative surveys. In Phase 3, patients with chronic conditions commented on the conceptual model in individual interviews, and in Phase 4 the conceptual model was presented to the local primary care cooperatives and finalized after processing their comments. Based on the scientific literature, current practice guidelines, and input from a variety of stakeholders, we developed a holistic, person-centred, integrated approach for the management of patients with (multiple) chronic diseases in primary care. Future evaluation of the PC-IC approach will show if this approach leads to more favourable outcomes and should replace the current single-disease approach in the management of chronic conditions and multimorbidity in Dutch primary care.
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Affiliation(s)
- Lena H. A. Raaijmakers
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Tjard R. Schermer
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Science Support Office, Gelre Hospitals, P.O. Box 9014, 7300 DS Apeldoorn, The Netherlands
| | - Mandy Wijnen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Hester E. van Bommel
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Pharos, Dutch Centre of Expertise on Health Disparities, P.O. Box 13318, 3507 LH Utrecht, The Netherlands
| | - Leslie Michielsen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Research Group Innovation of Care and Services, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands
| | - Floris Boone
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Jan H. Vercoulen
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Erik W. M. A. Bischoff
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Wilder CA. Palliative Care for Patients With Multiple Sclerosis: Recommendations Emerging From a Case Study. J Hosp Palliat Nurs 2023; 25:12-17. [PMID: 36162091 DOI: 10.1097/njh.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Multiple sclerosis (MS) affects more than 2.8 million people worldwide and is an incurable, heterogeneous, chronic, degenerative, demyelinating, immune-mediated neurological disease of the central nervous system. It affects the physical, mental, psychosocial, financial, and spiritual dimensions of patients and their families. Given this illness trajectory and the multiple complex symptoms associated with MS, palliative care services would improve the quality of life for MS patients. Palliative care is a human right for all patients with a life-limiting, progressive disease. The goal of palliative care is the prevention and relief of suffering by means of assessment and treatment that holistically addresses symptoms and suffering. Thus, this article argues for the early integration of palliative care for persons given a diagnosis of MS. This argument is underscored by the analysis of a case study of a typical patient with MS who would have benefited from conjunctive palliative care.
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Affiliation(s)
- Carolyn Ann Wilder
- Carolyn Ann Wilder, BSN, RN , is registered nurse, Neurosciences Division, University of California San Diego; and PhD student, Loma Linda University School of Nursing, CA
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Jain R, Stone JA, Agarwal G, Andrade JG, Bacon SL, Bajaj HS, Baker B, Cheng G, Dannenbaum D, Gelfer M, Habert J, Hickey J, Keshavjee K, Kitty D, Lindsay P, L'Abbé MR, Lau DCW, Macle L, McDonald M, Nerenberg K, Pearson GJ, Pham T, Poppe AY, Rabi DM, Sherifali D, Selby P, Smith E, Stern S, Thanassoulis G, Terenzi K, Tu K, Udell J, Virani SA, Ward RA, Warburton DER, Wharton S, Zymantas J, Hua-Stewart D, Liu PP, Tobe SW. Ligne directrice C-CHANGE pour l’harmonisation des lignes directrices nationales de prévention et de prise en charge des maladies cardiovasculaires en contexte de soins primaires au Canada: mise à jour 2022. CMAJ 2023; 195:E21-E42. [PMID: 36623864 PMCID: PMC9829070 DOI: 10.1503/cmaj.220138-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Rahul Jain
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - James A Stone
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Gina Agarwal
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Jason G Andrade
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Simon L Bacon
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Harpreet S Bajaj
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Brian Baker
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Gemma Cheng
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - David Dannenbaum
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Mark Gelfer
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Jeffrey Habert
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - John Hickey
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Karim Keshavjee
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Darlene Kitty
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Patrice Lindsay
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Mary R L'Abbé
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - David C W Lau
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Laurent Macle
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Michael McDonald
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Kara Nerenberg
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Glen J Pearson
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Thuy Pham
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Alexandre Y Poppe
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Doreen M Rabi
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Diana Sherifali
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Peter Selby
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Eric Smith
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Sol Stern
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - George Thanassoulis
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Kristin Terenzi
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Karen Tu
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Jacob Udell
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Sean A Virani
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Richard A Ward
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Darren E R Warburton
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Sean Wharton
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Jennifer Zymantas
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Diane Hua-Stewart
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Peter P Liu
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont.
| | - Sheldon W Tobe
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
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Beaulieu M, Tremblay J, Bertrand K. Adjustments to Service Organization in Specialized Addiction Services and Clinical Strategies for Better Meeting the Needs of People with a Persistent Substance Use Disorder. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00982-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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20
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Müller R, Aghdassi AA, Kruse J, Lerch MM, Rach C, Simon P, Salloch S. Lived Experience of Hereditary Chronic Pancreatitis - A Qualitative Interview Study. Chronic Illn 2022; 18:818-833. [PMID: 34559012 PMCID: PMC9643816 DOI: 10.1177/17423953211039774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Hereditary chronic pancreatitis is a rare condition characterized by intermittent acute episodes of pancreatitis and long-term impairment of pancreatic functions. However, the subjective perspective of individuals affected by hereditary chronic pancreatitis has been little studied. This qualitative study investigates the experience of hereditary chronic pancreatitis patients and their relatives because the awareness of the needs of those affected is an essential component of a patient-centered management of chronic conditions. METHODS Semi-structured qualitative interviews were conducted with hereditary chronic pancreatitis patients and their relatives. Data were analysed using qualitative content analysis. The concepts of 'biographical contingency,' 'biographical disruption' and the 'shifting perspectives model' served as theoretical frameworks. RESULTS A total of 24 participants (17 patients, 7 relatives) were interviewed individually. Four main themes were identified: (1) The unpredictable clinical course of hereditary chronic pancreatitis; (2) hereditary chronic pancreatitis as a devastating experience; (3) hereditary chronic pancreatitis as part of a normal life; and (4) being reduced to hereditary chronic pancreatitis. DISCUSSION The 'shifting perspectives model' of chronic illness covers the four dimensions adequately and can serve as a theoretical model to explain hereditary chronic pancreatitis patients' experience. A better understanding of the patients and their families' experience and the shifting character of hereditary chronic pancreatitis can help healthcare professionals to tailor the care to meet the needs of those affected.
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Affiliation(s)
- Regina Müller
- Institute of Ethics and History of Medicine, University of Tuebingen, Tübingen, Germany.,Institute of Ethics and History of Medicine, 60634University Medicine Greifswald, Greifswald, Germany
| | - Ali A Aghdassi
- Department of Medicine A, 221223University Medicine Greifswald, Greifswald, Germany
| | - Judith Kruse
- Institute of Ethics and History of Medicine, 60634University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, 221223University Medicine Greifswald, Greifswald, Germany
| | - Christoph Rach
- Department of Psychiatry, Psychotherapy and Psychosomatics, 84491Agaplesion Markus Hospital, Frankfurt am Main, Germany
| | - Peter Simon
- Department of Medicine A, 221223University Medicine Greifswald, Greifswald, Germany
| | - Sabine Salloch
- Institute of Ethics, 88782History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
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21
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Jain R, Stone JA, Agarwal G, Andrade JG, Bacon SL, Bajaj HS, Baker B, Cheng G, Dannenbaum D, Gelfer M, Habert J, Hickey J, Keshavjee K, Kitty D, Lindsay P, L'Abbé MR, Lau DCW, Macle L, McDonald M, Nerenberg K, Pearson GJ, Pham T, Poppe AY, Rabi DM, Sherifali D, Selby P, Smith E, Stern S, Thanassoulis G, Terenzi K, Tu K, Udell J, Virani SA, Ward RA, Warburton DER, Wharton S, Zymantas J, Hua-Stewart D, Liu PP, Tobe SW. Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE) guideline for the prevention and management of cardiovascular disease in primary care: 2022 update. CMAJ 2022; 194:E1460-E1480. [PMID: 36343954 PMCID: PMC9828999 DOI: 10.1503/cmaj.220138] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Rahul Jain
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - James A Stone
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Gina Agarwal
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Jason G Andrade
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Simon L Bacon
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Harpreet S Bajaj
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Brian Baker
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Gemma Cheng
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - David Dannenbaum
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Mark Gelfer
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Jeffrey Habert
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - John Hickey
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Karim Keshavjee
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Darlene Kitty
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Patrice Lindsay
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Mary R L'Abbé
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - David C W Lau
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Laurent Macle
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Michael McDonald
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Kara Nerenberg
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Glen J Pearson
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Thuy Pham
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Alexandre Y Poppe
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Doreen M Rabi
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Diana Sherifali
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Peter Selby
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.
| | - Eric Smith
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Sol Stern
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - George Thanassoulis
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Kristin Terenzi
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Karen Tu
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Jacob Udell
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Sean A Virani
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Richard A Ward
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Darren E R Warburton
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Sean Wharton
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Jennifer Zymantas
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Diane Hua-Stewart
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Peter P Liu
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Sheldon W Tobe
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
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22
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Choi Y, Jacobs DR, Shroff GR, Kramer H, Chang AR, Duprez DA. Progression of Chronic Kidney Disease Risk Categories and Risk of Cardiovascular Disease and Total Mortality: Coronary Artery Risk Development in Young Adults Cohort. J Am Heart Assoc 2022; 11:e026685. [PMID: 36314497 PMCID: PMC9673645 DOI: 10.1161/jaha.122.026685] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Previous studies of worsening chronic kidney disease (CKD) based on declining estimated glomerular filtration rate (eGFR) or increasing urine albumin-creatinine ratio (UACR) are limited to later middle-age and older adults. We examined associations of CKD progression and incident cardiovascular disease (CVD) and mortality in younger adults. Methods and Results We studied 4382 adults in CARDIA (Coronary Artery Risk Development in Young Adults) initially aged 27 to 41 years and prospectively over 20 years. Five-year transition probabilities across CKD risk categories were based on eGFR and UACR measured at each exam. Proportional hazards models predicted incident CVD and all-cause mortality by time-varying CKD risk category, adjusting for demographics and CVD risk factors. Progression of CKD risk categories over 20 years occurred in 28.7% (1256/4382) of participants, driven by increases in UACR, but including 5.8% (n=255) with eGFR<60 mL/min per 1.73 m2 or UACR ≥300 mg/g. Compared with eGFR ≥60 and UACR <10, demographic and smoking-adjusted hazard ratios for CVD were 1.62 (95% CI, 1.21-2.18) for low CKD risk (eGFR ≥60 with UACR 10-29) and 13.65 (95% CI, 7.52-24.79) for very high CKD risk (eGFR <30 or eGFR 30-44 with UACR 30-299; or eGFR 30-59 with UACR ≥300). Corresponding hazard ratios for all-cause mortality were 1.42 (95% CI, 1.08-1.88) and 14.75 (95% CI, 9.97-21.82). Although CVD associations were attenuated after adjustment for mediating CVD risk factors, all-cause mortality associations remained statistically significant. Conclusions Among young to middle-aged adults, progression to higher CKD risk category was common. Routine monitoring eGFR and UACR holds promise for prevention of CVD and total mortality.
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Affiliation(s)
- Yuni Choi
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - David R. Jacobs
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Gautam R. Shroff
- Division of Cardiology and Department of Medicine, Hennepin HealthcareUniversity of Minnesota Medical SchoolMinneapolisMN
| | - Holly Kramer
- Departments of Public Health Sciences and MedicineLoyola University ChicagoMaywoodIL
| | - Alexander R. Chang
- Division of Nephrology, Geisinger Health ClinicKidney Health Research InstituteDanvillePA
| | - Daniel A. Duprez
- Cardiovascular Division, Department of MedicineUniversity of MinnesotaMinneapolisMN
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23
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Kromme NMH, Ahaus KTB, Gans ROB, van de Wiel HBM. Internists’ ambivalence toward their role in health counseling and promotion: A qualitative study on the internists’ beliefs and attitudes. PLoS One 2022; 17:e0273848. [PMID: 36048849 PMCID: PMC9436108 DOI: 10.1371/journal.pone.0273848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
Crucial to its success is that physicians enhance their competence in Lifestyle Medicine and take on their role as Health Advocates in Health Counseling and Promotion (HC&P). However, studies on patients’ views of lifestyle counseling in clinical practice demonstrate that many patients neither perceived a need to adopt a healthy lifestyle nor having had any discussion with their physician about their lifestyle. This study is part of a participatory action research project focusing on identifying areas of improvement for health promotion in the practice of internists. Within this project, we interviewed 28 internists from six different subspecialties of an academic medical center in the Netherlands. This study aims to gain insight into how internists understand their role in HC&P by a qualitative analysis of their beliefs and attitudes in the interview data. Participants claimed that promoting a healthy lifestyle is important. However, they also reflected a whole system of beliefs that led to an ambivalent attitude toward their role in HC&P. We demonstrate that little belief in the success of HC&P nurtured ambivalence about the internists’ role and their tasks and responsibilities. Ambivalence appeared to be reinforced by beliefs about the ability and motivation of patients, the internists’ motivational skills, and the patient-doctor relationship, and by barriers such as lack of time and collaboration with General Practitioners. When participants viewed HC&P as a part of their treatment and believed patients were motivated, they were less ambivalent about their role in HC&P. Based on our data we developed a conceptual framework that may inform the development of the competences of the Health Advocate role of internists in education and practice.
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Affiliation(s)
- Nicolien M. H. Kromme
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Kees T. B. Ahaus
- Erasmus School of Health Policy & Management Health Services Management & Organization (HSMO), Rotterdam, The Netherlands
| | - Reinold O. B. Gans
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harry B. M. van de Wiel
- Wenckebach Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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24
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Aramrat C, Choksomngam Y, Jiraporncharoen W, Wiwatkunupakarn N, Pinyopornpanish K, Mallinson PAC, Kinra S, Angkurawaranon C. Advancing multimorbidity management in primary care: a narrative review. Prim Health Care Res Dev 2022; 23:e36. [PMID: 35775363 PMCID: PMC9309754 DOI: 10.1017/s1463423622000238] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Multimorbidity, defined as the coexistence of two or more chronic conditions in the same individual, is becoming a crucial health issue in primary care. Patients with multimorbidity utilize health care at a higher rate and have higher mortality rates and poorer quality of life compared to patients with single diseases. AIMS To explore evidence on how to advance multimorbidity management, with a focus on primary care. Primary care is where a large number of patients with multimorbidity are managed and is considered to be a gatekeeper in many health systems. METHODS A narrative review was conducted using four major electronic databases consisting of PubMed, Cochrane, World Health Organization database, and Google scholar. In the first round of reviews, priority was given to review papers summarizing the current issues and challenges in the management of multimorbidity. Thematic analysis using an inductive approach was used to build a framework on how to advance management. The second round of review focused on original articles providing evidence within the primary care context. RESULTS The review found that advancing multimorbidity management in primary care requires a health system approach and a patient-centered approach. The health systems approach includes three major areas: (i) improves access to care, (ii) promotes generalism, and (iii) provides a decision support system. For the patient-centered approach, four key aspects are essential for multimorbidity management: (i) promoting doctor-patient relationship, (ii) prioritizing health problems and sharing decision-making, (iii) supporting self-management, and (iv) integrating care.Advancement of multimorbidity management in primary care requires integrating concepts of multimorbidity management guidelines with concepts of patient-centered and chronic care models. This simple integration provides an overarching framework for advancing the health care system, connecting the processes of individualized care plans, and integrating care with other providers, family members, and the community.
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Affiliation(s)
- Chanchanok Aramrat
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yanee Choksomngam
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nutchar Wiwatkunupakarn
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Poppy Alice Carson Mallinson
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang MaiThailand
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25
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Han S, Mo G, Gao T, Sun Q, Liu H, Zhang M. Age, sex, residence, and region-specific differences in prevalence and patterns of multimorbidity among older Chinese: evidence from Chinese Longitudinal Healthy Longevity Survey. BMC Public Health 2022; 22:1116. [PMID: 35658851 PMCID: PMC9166487 DOI: 10.1186/s12889-022-13506-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multimorbidity among older adults, which is associated with added functional decline and higher health care utilization and mortality, has become increasingly common with the dramatic acceleration of ageing in China. The purpose of this study was to reveal age, sex, residence, and region- specific prevalence and patterns of multimorbidity among older adults in China. METHODS This study is based on the 2018 Chinese Longitudinal Health Longevity Survey (CLHLS), the most recent edition of this national survey, and involved analysis of 15,275 participants aged 65 years and older. Multimorbidity was defined as an individual who has two or more chronic diseases or conditions and was divided into two types for analysis: ≥2 (MM2+) and ≥ 3 (MM3+). Fourteen chronic diseases or conditions surveyed were used to assess patterns of multimorbidity through association rule mining. RESULTS Among the 15,275 participants, the largest proportion (39.9%) was 90 years old and over, while the distribution of sex and residence is roughly the same. Overall, the prevalence of multimorbidity was 44.1% for MM2+ and 22.9% for MM3+. The most frequently occurring patterns were two or three combinations between hypertension, cardiovascular diseases and affective disorders. Cardiovascular diseases combined with diabetes or dyslipidemia showed the most predominant association in different age groups. Moreover, the prevalence of the hypertension +diabetes pattern decreased with age. The strongest associations were found for the clustering of hypertension + cardiovascular diseases + respiratory diseases in males, however, among females it was the cardiovascular diseases + diabetes cluster. Cardiovascular diseases + rheumatoid arthritis + visual impairment was observed in urban areas and hypertension + cardiovascular diseases + affective disorders in rural areas. The most distinctive association rule in Northern China was {cardiovascular diseases, hypertension, visual impairment} = > {diabetes}. Respiratory disease was more prevalent in combination with other systemic disorders in Western China, and affective disorders in Southern China. CONCLUSIONS The prevalence of multimorbidity among older Chinese was substantial, and patterns of multimorbidity varied by age, sex, residence, and region. Future efforts are needed to identify possible prevention strategies and guidelines that consider differences in demographic characteristics of multimorbid patients to promote health in older adults.
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Affiliation(s)
- Siyue Han
- School of Public Health, Bengbu Medical College, Bengbu, 233030, Anhui, China
| | - Guangju Mo
- School of Public Health, Bengbu Medical College, Bengbu, 233030, Anhui, China
| | - Tianjing Gao
- School of Public Health, Bengbu Medical College, Bengbu, 233030, Anhui, China
| | - Qing Sun
- School of Public Health, Bengbu Medical College, Bengbu, 233030, Anhui, China
| | - Huaqing Liu
- School of Public Health, Bengbu Medical College, Bengbu, 233030, Anhui, China.
| | - Min Zhang
- School of Health Management, Bengbu Medical College, Bengbu, 233030, Anhui, China.
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Hoover CG, Coller RJ, Houtrow A, Harris D, Agrawal R, Turchi R. Understanding Caregiving and Caregivers: Supporting Children and Youth With Special Health Care Needs at Home. Acad Pediatr 2022; 22:S14-S21. [PMID: 35248243 DOI: 10.1016/j.acap.2021.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/15/2021] [Accepted: 10/22/2021] [Indexed: 02/07/2023]
Abstract
Caregiving encompasses the nurturing, tasks, resources, and services that meet the day-to-day needs of children and youth with special health care needs (CYSHCN) at home. Many gaps exist in the strategies currently offered by the health care system to meet the caregiving needs of CYSHCN. The work of family caregivers of CYSHCN is known to be extensive, but it is so poorly understood that it has been described as "invisible". This invisibility leads to poor communication and gaps in understanding between professional health care providers and family caregivers. To address these gaps, health care researchers must work with family caregivers to incorporate their expertise on caregiving and create meaningful and sustainable research partnerships. A growing body of research is attempting to remedy the problem of caregiving invisibility and lay better foundations for successful integration between health care settings, family caregiving, professional caregiving, and community supports for families of CYSHCN. We identify high-priority gaps in CYSHCN caregiving research and propose research questions that are designed to accelerate growth in evidence-based understanding of the work of family caregivers of CYSHCN and how best to support them.
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Affiliation(s)
| | - Ryan J Coller
- Department of Pediatrics (RJ Coller), School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Win
| | - Amy Houtrow
- Department of Physical Medicine and Rehabilitation (A Houtrow), School of Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Debbi Harris
- Family Voices of Minnesota (D Harris), Stillwater, Minn
| | - Rishi Agrawal
- Division of Hospital-Based Medicine (R Agrawal), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Renee Turchi
- Department of Pediatrics (R Turchi), College of Medicine, Drexel University, Philadelphia Pa
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Arini M, Sugiyo D, Permana I. Challenges, opportunities, and potential roles of the private primary care providers in tuberculosis and diabetes mellitus collaborative care and control: a qualitative study. BMC Health Serv Res 2022; 22:215. [PMID: 35177037 PMCID: PMC8851698 DOI: 10.1186/s12913-022-07612-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction The comorbidity of tuberculosis and diabetes mellitus (TB-DM) is a looming global co-epidemic problem. Despite the Indonesian Government’s ongoing effort to impose regulation for collaborative TB-DM management, the involvement of private primary care providers (PPCs) has not been considered before the COVID-19 pandemic. This study aimed to capture the PPCs’ existing practices and explore their challenges, opportunities, and potential roles in the collaborative TB-DM services and control. Methods A descriptive qualitative research design was used to collect data. Two Focus Group Discussions (FGDs) were conducted with 13 healthcare workers (HCWs) from different private clinics and eight private/solo general practitioners (GPs) from Yogyakarta City, Indonesia. We triangulated these data with data from FGDs of HCWs community health centers (CHCs) and in-depth interviews of three regional health regulators, five hospitals staff members, and a representative of national health insurance. The discussions were audio-recorded, transcribed verbatim, and subjected to thematic analysis. Results PPCs have not been initiated into the implementation of the collaborative TB-DM programme. The themes identified in this study were health system-related barriers, knowledge and perception of HCWs, lack of implementation of bi-directional screening, and needs of multisector role. The potential roles identified for PPCs include involvement in health promotion, bi-directional screening, patient referral, and data reporting according to the TB-DM programme indicators. However, more thorough improvement of PPCs’ capacity and logistic supplies are needed to provide comprehensive TB treatment. Conclusion Although PPCs’ involvement in implementing collaborative TB-DM services has yet to be considered, their potential role should not be neglected. Therefore, it is essential to increase their involvement by enhancing their capacity and improving the Public-Private Mix. PPCs’ engagement should be initiated and maintained to ensure the sustainability of the programme.
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Affiliation(s)
- Merita Arini
- Department of Family Medicine and Public Health; and Master of Hospital Administration, Universitas Muhammadiyah Yogyakarta, Jalan Brawijaya, Tamantirto, Kasihan, Bantul, 55183, Indonesia. .,Department of Public Health Nursing, School of Nursing, Faculty of Medicine and Health Sciences; and Muhammadiyah Steps, Universitas Muhammadiyah Yogyakarta, Jalan Brawijaya, Tamantirto, Kasihan, Bantul, 55183, Indonesia.
| | - Dianita Sugiyo
- Department of Public Health Nursing, School of Nursing, Faculty of Medicine and Health Sciences; and Muhammadiyah Steps, Universitas Muhammadiyah Yogyakarta, Jalan Brawijaya, Tamantirto, Kasihan, Bantul, 55183, Indonesia.,Master of Nursing; and Center of Biotechnology and Halal Studies, Universitas Muhammadiyah Yogyakarta, Jalan Brawijaya, Tamantirto, Kasihan, Bantul, 55183, Indonesia
| | - Iman Permana
- Department of Family Medicine and Public Health; and Master of Hospital Administration, Universitas Muhammadiyah Yogyakarta, Jalan Brawijaya, Tamantirto, Kasihan, Bantul, 55183, Indonesia.,Department of Public Health Nursing, School of Nursing, Faculty of Medicine and Health Sciences; and Muhammadiyah Steps, Universitas Muhammadiyah Yogyakarta, Jalan Brawijaya, Tamantirto, Kasihan, Bantul, 55183, Indonesia
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Boehmer KR, Gallacher KI, Lippiett KA, Mair FS, May CR, Montori VM. Minimally Disruptive Medicine: Progress 10 Years Later. Mayo Clin Proc 2022; 97:210-220. [PMID: 35120690 DOI: 10.1016/j.mayocp.2021.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
| | - Katie I Gallacher
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Kate A Lippiett
- Macmillan Survivorship Research Group, University of Southampton, Southampton, UK
| | - Frances S Mair
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Carl R May
- Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
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Davis J, Fischl AH, Beck J, Browning L, Carter A, Condon JE, Dennison M, Francis T, Hughes PJ, Jaime S, Lau KHK, McArthur T, McAvoy K, Magee M, Newby O, Ponder SW, Quraishi U, Rawlings K, Socke J, Stancil M, Uelmen S, Villalobos S. 2022 National Standards for Diabetes Self-Management Education and Support. Diabetes Care 2022; 45:484-494. [PMID: 35050365 DOI: 10.2337/dc21-2396] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 02/03/2023]
Affiliation(s)
| | | | - Joni Beck
- The University of Oklahoma Health Science Center, Oklahoma City, OK
| | | | | | - Jo Ellen Condon
- Anne Arundel Medical Center, Annapolis, MD
- Diabetes Alliance Network, Naples, FL
| | | | | | | | | | | | | | | | - Michelle Magee
- 15MedStar Diabetes and Research Institutes, Georgetown University School of Medicine, Washington, D.C
| | - Olivia Newby
- 16The Healthy Living Center Diabetes Education Program, Norfolk, VA
| | | | | | | | | | | | - Sacha Uelmen
- 22Association of Diabetes Care & Education Specialists, Chicago, IL
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30
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Davis J, Fischl AH, Beck J, Browning L, Carter A, Condon JE, Dennison M, Francis T, Hughes PJ, Jaime S, Lau KHK, McArthur T, McAvoy K, Magee M, Newby O, Ponder SW, Quraishi U, Rawlings K, Socke J, Stancil M, Uelmen S, Villalobos S. 2022 National Standards for Diabetes Self-Management Education and Support. Sci Diabetes Self Manag Care 2022; 48:44-59. [PMID: 35049403 DOI: 10.1177/26350106211072203] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The National Standards for Diabetes Self-Management Education and Support (DSMES) provide guidance and evidence-based, quality practice for all DSMES services. Due to the dynamic nature of health care and diabetes research, the National Standards are reviewed and revised approximately every 5 years by key stakeholders and experts within the diabetes care and education community. For each revision, the Task Force is charged with reviewing the current National Standards for appropriateness, relevance, and scientific basis and making updates based on current evidence and expert consensus. In 2021, the group was tasked with reducing administrative burden related to DSMES implementation across diverse care settings. CONCLUSION The evidence supporting the 2022 National Standards clearly identifies the need to provide person-centered services that embrace cultural differences, social determinants of health, and the ever-increasing technological engagement platforms and systems. Payers are invited to review the National Standards as a tool to inform and modernize DSMES reimbursement requirements and to align with the evolving needs of people with diabetes (PWD) and physicians/other qualified health care professionals. The American Diabetes Association and the Association of Diabetes Care & Education Specialists strongly advocate for health equity to ensure all PWD have access to this critical service proven to improve outcomes both related to and beyond diabetes. The 2022 National Standards update is meant to be a universal document that is easy to understand and can be implemented by the entire health care community. DSMES teams in collaboration with primary care have been shown to be the most effective approach to overcome therapeutic inertia.
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Affiliation(s)
| | | | - Joni Beck
- The University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | | | | | - Jo Ellen Condon
- Anne Arundel Medical Center, Annapolis, Maryland, and Diabetes Alliance Network, Naples, Florida
| | | | | | | | - Stephen Jaime
- El Centro Regional Medical Center, El Centro, California
| | | | | | - Karen McAvoy
- Yale New Haven Health System, New Haven, Connecticut
| | - Michelle Magee
- MedStar Diabetes and Research Institutes, Georgetown University School of Medicine, Washington, DC
| | - Olivia Newby
- The Healthy Living Center Diabetes Education Program, Norfolk, Virginia
| | | | | | | | | | | | - Sacha Uelmen
- Association of Diabetes Care & Education Specialists, Chicago, Illinois
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Davis J, Fischl AH, Beck J, Browning L, Carter A, Condon JE, Dennison M, Francis T, Hughes PJ, Jaime S, Lau KHK, McArthur T, McAvoy K, Magee M, Newby O, Ponder SW, Quraishi U, Rawlings K, Socke J, Stancil M, Uelmen S, Villalobos S. 2022 National Standards for Diabetes Self-Management Education and Support. Diabetes Spectr 2022; 35:137-149. [PMID: 35668879 PMCID: PMC9160547 DOI: 10.2337/ds22-ps02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Joni Beck
- The University of Oklahoma Health Science Center, Oklahoma City, OK
| | | | | | - Jo Ellen Condon
- Anne Arundel Medical Center, Annapolis, MD
- Diabetes Alliance Network, Naples, FL
| | | | | | | | | | | | | | | | - Michelle Magee
- MedStar Diabetes and Research Institutes, Georgetown University School of Medicine, Washington, DC
| | - Olivia Newby
- The Healthy Living Center Diabetes Education Program, Norfolk, VA
| | | | | | | | | | | | - Sacha Uelmen
- Association of Diabetes Care & Education Specialists, Chicago, IL
- Corresponding author: Sacha Uelmen,
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Lopes Lima M, Bordin D, Fernandes Furquim RC, Andreani Cabral LP, Muller EV, Berger Fadel C. Caminho na rede formal de cuidado em saúde de pacientes pós-alta hospitalar segundo multimorbidade. REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introdução: A gestão de informações associadas à multimorbidade na atenção hospitalar é relevante para o planejamento de estratégias de prevenção de agravos à saúde em pacientes de maior risco, a fim de oportunizar a organização de sistemas de saúde de modo eficiente. Objetivo: O presente trabalho objetivoudelinear o caminho formal percorrido por pacientes com e sem multimorbidade, considerando o uso da rede pública de saúde após a internação hospitalar. Materiais e métodos: Realizou-se um estudo quantitativo, transversal, descritivo, utilizando dados primários de 445 pacientes internados em um hospital universitário, no ano de 2018. Os dados foram coletados através de análise do prontuário médico e entrevista telefônica. Os resultados foram analisados por meio de frequência absoluta e relativa. Resultados: Desenvolveu-se um fluxograma, representando os pontos da rede de saúde utilizados pelo paciente após a alta hospitalar, segundo multimorbidade. Verificou-se uma alta prevalência de encaminhamento (com multimorbidade (CM) 93,52%; sem multimorbidade (SM) 97,71%) e comparecimento na atenção secundária à saúde (CM 86,15%; SM 89,63%), um baixo encaminhamento (CM 42,45%; SM 36,27%) e comparecimento na atenção primária à saúde (CM 61,29%; SM 64,81%), e considerando os 3 níveis de atenção juntos, houve um baixo comparecimento (CM 17,98%; SM 21,89%) para ambos os grupos investigados. Discussão: Entende-se que a semelhança de comparecimento em todos os pontos da rede por ambos os grupos é um problema, por tratar de forma igual populações desiguais e consequentemente com necessidades diversas. Conclusões: Sinaliza-se a importância de maior incentivo ao acompanhamento de pacientes com multimorbidade na rede primária de saúde, especialmente no período de pós-alta hospitalar, e a necessidade de fortalecimento da Rede de Atenção à Saúde.
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Lear SA, Norena M, Banner D, Whitehurst DGT, Gill S, Burns J, Kandola DK, Johnston S, Horvat D, Vincent K, Levin A, Kaan A, Van Spall HGC, Singer J. Assessment of an Interactive Digital Health-Based Self-management Program to Reduce Hospitalizations Among Patients With Multiple Chronic Diseases: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2140591. [PMID: 34962560 DOI: 10.1001/jamanetworkopen.2021.40591] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
IMPORTANCE Digital health programs may have the potential to prevent hospitalizations among patients with chronic diseases by supporting patient self-management, symptom monitoring, and coordinated care. OBJECTIVE To compare the effect of an internet-based self-management and symptom monitoring program targeted to patients with 2 or more chronic diseases (internet chronic disease management [CDM]) with usual care on hospitalizations over a 2-year period. DESIGN, SETTING, AND PARTICIPANTS This single-blinded randomized clinical trial included patients with multiple chronic diseases from 71 primary care clinics in small urban and rural areas throughout British Columbia, Canada. Recruitment occurred between October 1, 2011, and March 23, 2015. A volunteer sample of 456 patients was screened for eligibility. Inclusion criteria included daily internet access, age older than 19 years, fluency in English, and the presence of 2 or more of the following 5 conditions: diabetes, heart failure, ischemic heart disease, chronic kidney disease, or chronic obstructive pulmonary disease. A total of 230 patients consented to participate and were randomized to receive either the internet CDM intervention (n = 117) or usual care (n = 113). One participant in the internet CDM group withdrew from the study after randomization, resulting in 229 participants for whom data on the primary outcome were available. INTERVENTIONS Internet-based self-management program using telephone nursing supports and integration within primary care compared with usual care over a 2-year period. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause hospitalizations at 2 years. Secondary outcomes included hospital length of stay, quality of life, self-management, and social support. Additional outcomes included the number of participants with at least 1 hospitalization, the number of participants who experienced a composite outcome of all-cause hospitalization or death, the time to first hospitalization, and the number of in-hospital days. RESULTS Among 229 participants included in the analysis, the mean (SD) age was 70.5 (9.1) years, and 141 participants (61.6%) were male; data on race and ethnicity were not collected because there was no planned analysis of these variables. The internet CDM group had 25 fewer hospitalizations compared with the usual care group (56 hospitalizations vs 81 hospitalizations, respectively [30.9% reduction]; relative risk [RR], 0.68; 95% CI, 0.43-1.10; P = .12). The intervention group also had 229 fewer in-hospital days compared with the usual care group (282 days vs 511 days, respectively; RR, 0.52; 95% CI, 0.24-1.10; P = .09). Components of self-management and social support improved in the intervention group. Fewer participants in the internet CDM vs usual care group had at least 1 hospitalization (32 of 116 individuals [27.6%] vs 46 of 113 individuals [40.7%]; odds ratio [OR], 0.55; 95% CI, 0.31-0.96; P = .03) or experienced the composite outcome of all-cause hospitalization or death (37 of 116 individuals [31.9%] vs 51 of 113 individuals [45.1%]; OR, 0.57; 95% CI, 0.33-0.98; P = .04). Participants in the internet CDM group had a lower risk of time to first hospitalization (hazard ratio, 0.62; 95% CI, 0.39-0.97; P = .04) than those in the usual care group. CONCLUSIONS AND RELEVANCE In this study, an internet-based self-management program did not result in a significant reduction in hospitalization. However, fewer participants in the intervention group were admitted to the hospital or experienced the composite outcome of all-cause hospitalization or death. These findings suggest the internet CDM program has the potential to augment primary care among patients with multiple chronic diseases. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01342263.
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Affiliation(s)
- Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
- Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Monica Norena
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Davina Banner
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - David G T Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Sabrina Gill
- Division of Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jane Burns
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Damanpreet K Kandola
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Suzanne Johnston
- Department of Health Sciences, Brock University, St Catharines, Ontario, Canada
| | - Dan Horvat
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kaitey Vincent
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annemarie Kaan
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Hanlon P, Bryson I, Morrison H, Rafiq Q, Boehmer K, Gionfriddo MR, Gallacher K, May C, Montori V, Lewsey J, McAllister DA, Mair FS. Self-management interventions for Type 2 Diabetes: systematic review protocol focusing on patient workload and capacity support. Wellcome Open Res 2021; 6:257. [PMID: 35928807 PMCID: PMC9308000 DOI: 10.12688/wellcomeopenres.17238.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: People living with type 2 diabetes undertake a range of tasks to manage their condition, collectively referred to as self-management. Interventions designed to support self-management vary in their content, and efficacy. This systematic review will analyse self-management interventions for type 2 diabetes drawing on theoretical models of patient workload and capacity. Methods and analysis: Five electronic databases (Medline, Embase, CENTRAL, CINAHL and PsycINFO) will be searched from inception to 27th April 2021, supplemented by citation searching and hand-searching of reference lists. Two reviewers will independently review titles, abstracts and full texts. Inclusion criteria include Population: Adults with type 2 diabetes mellitus; Intervention: Randomised controlled trials of self-management support interventions; Comparison: Usual care; Outcomes: HbA1c (primary outcome) health-related quality of life (QOL), medication adherence, self-efficacy, treatment burden, healthcare utilization (e.g. number of appointment, hospital admissions), complications of type 2 diabetes (e.g. nephropathy, retinopathy, neuropathy, macrovascular disease) and mortality; Setting: Community. Study quality will be assessed using the Effective Practice and Organisation of Care (EPOC) risk of bias tool. Interventions will be classified according to the EPOC taxonomy and the PRISMS self-management taxonomy and grouped into similar interventions for analysis. Clinical and methodological heterogeneity will be assessed within subgroups, and random effects meta-analyses performed if appropriate. Otherwise, a narrative synthesis will be performed. Interventions will be graded on their likely impact on patient workload and support for patient capacity. The impact of these theoretical constructs on study outcomes will be explored using meta-regression. Conclusion This review will provide a broad overview of self-management interventions, analysed within the cumulative complexity model theoretical framework. Analyses will explore how the workload associated with self-management, and support for patient capacity, impact on outcomes of self-management interventions. Registration number: PROSPERO CRD42021236980.
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Affiliation(s)
- Peter Hanlon
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Iona Bryson
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Holly Morrison
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Qasim Rafiq
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kasey Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA
| | | | - Katie Gallacher
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Carl May
- London School of Hygiene and Tropical Medicine, London, UK
| | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA
| | - Jim Lewsey
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Frances S Mair
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
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Eyowas FA, Schneider M, Alemu S, Getahun FA. Multimorbidity of chronic non-communicable diseases: burden, care provision and outcomes over time among patients attending chronic outpatient medical care in Bahir Dar, Ethiopia-a mixed methods study protocol. BMJ Open 2021; 11:e051107. [PMID: 34497085 PMCID: PMC8438962 DOI: 10.1136/bmjopen-2021-051107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Multimorbidity refers to the presence of two or more chronic non-communicable diseases (NCDs) in a given individual. It is associated with premature mortality, lower quality of life (QoL) and greater use of healthcare resources. The burden of multimorbidity could be huge in the low and middle-income countries (LMICs), including Ethiopia. However, there is limited evidence on the magnitude of multimorbidity, associated risk factors and its effect on QoL and functionality. In addition, the evidence base on the way health systems are organised to manage patients with multimorbidity is sparse. The knowledge gleaned from this study could have a timely and significant impact on the prevention, management and survival of patients with NCD multimorbidity in Ethiopia and in LMICs at large. METHODS AND ANALYSIS This study has three phases: (1) a cross-sectional quantitative study to determine the magnitude of NCD multimorbidity and its effect on QoL and functionality, (2) a qualitative study to explore organisation of care for patients with multimorbidity, and (3) a longitudinal quantitative study to investigate disease progression and patient outcomes over time. A total of 1440 patients (≥40 years) on chronic care follow-up will be enrolled from different facilities for the quantitative studies. The quantitative data will be collected from multiple sources using the KoBo Toolbox software and analysed by STATA V.16. Multiple case study designs will be employed to collect the qualitative data. The qualitative data will be coded and analysed by Open Code software thematically. ETHICS AND DISSEMINATION Ethical clearance has been obtained from the College of Medicine and Health Sciences, Bahir Dar University (protocol number 003/2021). Subjects who provide written consent will be recruited in the study. Confidentiality of data will be strictly maintained. Findings will be disseminated through publications in peer-reviewed journals and conference presentations.
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Affiliation(s)
- Fantu Abebe Eyowas
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Health Systems Strengthening (HWIP), Jhpiego-Ethiopia, Bahir Dar, Ethiopia
| | | | - Shitaye Alemu
- College of Medicine and Health Sciences, School of Medicine, Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Fentie Ambaw Getahun
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Vick JB, Wolff JL. A Scoping Review of Person and Family Engagement in the context of Multiple Chronic Conditions. Health Serv Res 2021; 56 Suppl 1:990-1005. [PMID: 34363217 DOI: 10.1111/1475-6773.13857] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review definitions, concepts, and evidence regarding person and family engagement for persons with multiple chronic conditions (MCC) in order to identify opportunities to advance the field. DATA SOURCE Ovid MEDLINE STUDY DESIGN: We performed a two-step process: (1) a critical review of conceptual models of engagement to identify key concepts most pertinent to engagement among persons with MCC as a "launch pad" to our scoping review, and (2) a scoping review of reviews of engagement for persons living with MCC. DATA COLLECTION/EXTRACTION METHODS First, we critically reviewed six models of engagement. Second, our scoping review identified 1297 citations, with 67 articles meeting criteria for inclusion. Of these, we focused on reviews, of which there were nine titles/abstracts retained for full text consideration. Six full-text reviews were included in the final analysis. The purpose, review type, population, number/type of included studies, theoretical framework, and findings of each study were extracted and analyzed thematically. PRINCIPAL FINDINGS Conceptual models of engagement differ with respect to areas of emphasis (e.g., systems or clinical encounters) as well as attention to vulnerable populations; involvement of family; consideration of cost-benefit tradeoffs; and attention to outcomes that matter most. Our scoping review of reviews identified just one article explicitly focused on engagement interventions for those with MCC. Other reviews examined elements of self-management and involvement in decision-making, conceptually related to engagement without explicit use of the word. We find that existing evidence has predominantly described individual-level strategies rather than targeting organizations, systems, or policies. Barriers to engagement are not well described, nor are potential downsides to engagement. Family engagement is rarely considered. CONCLUSIONS Promising areas of future work include attention to barriers to engagement including trust, goal-based care, the design of structural changes to care delivery, tradeoffs between benefits and costs, and family engagement. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Judith B Vick
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer L Wolff
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Calvo E, Azar A, Shura R, Staudinger UM. A New Path to Address Multimorbidity? Longitudinal Analyses of Retirement Sequences and Chronic Diseases in Old Age. J Appl Gerontol 2021; 41:952-961. [PMID: 34271835 DOI: 10.1177/07334648211031038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic disease and multimorbidity are growing health challenges for aging populations, often coinciding with retirement. We examine late-life predictors of multimorbidity, focusing on the association between retirement sequences and number of chronic diseases. We modeled the number of chronic diseases as a function of six types of previously identified 10-year retirement sequences using Health and Retirement Study (HRS) data for 7,880 Americans observed between ages 60 to 61 and 70 to 71. Our results show that at baseline, the adjusted prevalence of multimorbidity was lowest in sequences characterized by late retirement from full-time work and highest in sequences characterized by early labor-force disengagement. Age increases in multimorbidity varied across retirement sequences, though overall differences in prevalence persisted at age 70 to 71. Earlier life disadvantages did not moderate these associations. Findings suggest further investigation of policies that target health limitations affecting work, promote continued beneficial employment opportunities, and ultimately leverage retirement sequences as a novel path to influence multimorbidity in old age.
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Affiliation(s)
- Esteban Calvo
- Columbia University, New York, NY, USA.,Universidad Mayor, Santiago, Chile
| | - Ariel Azar
- Universidad Mayor, Santiago, Chile.,University of Chicago, IL, USA
| | - Robin Shura
- Kent State University at Stark, North Canton, OH, USA
| | - Ursula M Staudinger
- Columbia University, New York, NY, USA.,Technical University of Dresden, Germany
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Hamiduzzaman M, Torres S, Fletcher A, Islam MR, Siddiquee NA, Greenhill J. Aging, care and dependency in multimorbidity: how do relationships affect older Bangladeshi women's use of homecare and health services? J Women Aging 2021; 34:731-744. [PMID: 34255615 DOI: 10.1080/08952841.2021.1951115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Gender issues can create major barriers to healthcare utilization for older women with multimorbidity, especially in developing countries like Bangladesh. Elderly rural women in Bangladesh, are the poorest of the poor, and the women with multimorbidity live in a regulated family atmosphere. This study explored the relationship dimensions of older women with multimorbidity in homecare and their utilization of health services. To gain a deeper understanding of these complex issues, a qualitative case study was conducted. Semi-structured, in-depth interviews were conducted with 11 health staff and 22 older women with multimorbidity, living in three residential communities of the Sylhet District, Bangladesh. Our analysis used critical thematic discourse, a technique developed from Axel Honneth's recognition-and-misrecognition theory. Seven relationship dimensions have been identified, and grouped under three major themes: intimate affairs [marital marginalization and parent-children-in law dynamics]; alienation in community relationships [patriarchal sibling relationships, neighborhood challenges, and gender inequality in interactions]; and legal disconnections [ignorance of rights and missed communication]. Our findings revealed a lack of understanding of the women's multimorbid care needs and patriarchal marginalization in family. This lack of understanding together with poor peer-supports in healthcare is perpetuated by misrecognition of needs from service providers, resulting in a lack of quality and poor utilization of homecare and health services. Understanding the high needs of multimorbidity and complexities of older women's relationships can assist in policy decisions. This study deepens our understanding of the ways gender inequality intersects with cultural devaluation to reduce the well-being of older women in developing countries.
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Affiliation(s)
- Mohammad Hamiduzzaman
- College of Health, Medicine & Wellbeing, The University of Newcastle, New South Wales, Australia
| | - Stacy Torres
- Department of Social and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Amber Fletcher
- Department of Sociology & Social Studies, University of Regina, Saskatchewan, Canada
| | - M Rezaul Islam
- Institute of Social Welfare & Research, University of Dhaka, Dhaka, Bangladesh
| | - Noore Alam Siddiquee
- College of Business, Government & Law, Flinders University, South Australia, Australia
| | - Jennene Greenhill
- Faculty of Health and Medical Sciences, UWA Medical School, University of Western Australia, Perth, Australia
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Ghiyasvandian S, Shahsavari H, Matourypour P, Golestannejad MR. Integrated Care model: Transition from acute to chronic care. Rev Bras Enferm 2021; 74:e20200910. [PMID: 34105697 DOI: 10.1590/0034-7167-2020-0910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/31/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Description and discussion dimensions of Integrated Care Model. METHODS A descriptive study is done that describe a technological innovation, intervention strategies for professional performance. RESULTS Integrated Care Model (ICM) has two main categories include individual and Group-and disease-specific Model. First, is used for risky patients or with comorbidities. In second category; Chronic Care Model (CCM) is common form of Integrated Care Model to improve resultants in the patients with chronic condition, to move from acute care to integrate, regular, long-lasting, preventative and community-based nursing. FINAL CONSIDERATIONS It is important to consider patient as an active member of the treatment team. It seems to be essential to monitor performance of care system. On the other hand, offer multidisciplinary care leads to present desirable care, tailored to the specific needs of patients regarding safety, patient-centered care and their culture.
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Affiliation(s)
| | - Hooman Shahsavari
- Tehran University of Medical Sciences, School of Nursing and Midwifery. Tehran, Iran
| | - Pegah Matourypour
- Tehran University of Medical Sciences, School of Nursing and Midwifery. Tehran, Iran
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40
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Bhalla IP, Deegan D, Stefanovics EA, Rosenheck RA. Psychiatric Multimorbidity in a Specialized Program for Severely Mentally Ill Veterans. Psychiatr Q 2021; 92:489-499. [PMID: 32812141 DOI: 10.1007/s11126-020-09826-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
It has been suggested that psychiatric multimorbidity may better characterize severely impaired psychiatric patients than individual severe mental illness (SMI) diagnoses, and that these patients may be better served by centers offering integrated co-located, psychiatric and social services than in conventional clinics providing one-to-one care. We tested the hypothesis that multimorbidity is a critical characteristic of Veterans treated at a co-located multi-service Veteran's Health Administration (VHA) program originally established to treat Veterans living with SMI. Administrative data from the VA Connecticut Health Care System from fiscal year 2012 were used to compare veterans using diverse mental health and social services at the Errera Community Care Center (ECCC), an integrated "one-stop shop" for SMI veterans, and those seen exclusively at standard outpatient mental health clinics. Bivariate and multiple logistic regression analyses were used to compare groups on demographic characteristics, psychiatric and medical diagnoses, service utilization, and psychotropic medication fills. Results: Of the 11,092 veterans included in the study, 2281 (20.6%) had been treated at the ECCC and 8811 (79.4%) had not. Multivariable analysis highlighted the association of treatment in the ECCC and younger age, lower income, homelessness, and especially multimorbidity including both multiple substance use and multiple psychiatric diagnoses. Programs originally designed to address the diverse needs of patients living with SMI and homelessness may be usefully characterized as treating patients with psychiatric multimorbidity, a term of greater clinical relevance. Effectiveness research is needed to evaluate the one-stop shop approach to their treatment.
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Affiliation(s)
- Ish P Bhalla
- National Clinician Scholars Program, University of California Los Angeles, Los Angeles, CA, USA. .,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Debbie Deegan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Veterans Affairs Connecticut Errera Community Care Center, West Haven, CT, USA
| | - Elina A Stefanovics
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, USA
| | - Robert A Rosenheck
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, USA.,Yale University School of Public Health, New Haven, CT, USA
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41
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Lee J, Kim KH, Ahn JC, Kim JA, Lee G, Son JS, Choi SJ, Oh YH, Park SM. Prevalence, awareness, treatment, and control of diabetes mellitus by depressive symptom severity: a cross-sectional analysis of NHANES 2011-2016. BMJ Open Diabetes Res Care 2021; 9:e002268. [PMID: 34099441 PMCID: PMC8186749 DOI: 10.1136/bmjdrc-2021-002268] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/11/2021] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Despite extensive studies on the relationship between diabetes mellitus (DM) and depression, the associations of depressive symptom severity with prevalence, awareness, treatment, and control of diabetes remain unclear. We aimed to investigate changes in these outcomes of diabetes as depressive symptoms aggravate. RESEARCH DESIGN AND METHODS We conducted a cross-sectional analysis of 14 328 participants in the 2011-2016 National Health and Nutrition Examination Survey. Participants were classified into depressive symptom groups of none, mild, moderate, moderately severe, and severe depending on their Patient Health Questionnaire-9 scores. Multivariate logistic regression analyses were conducted in three models adjusted for expanding confounders to evaluate the associations between severity of depressive symptoms and prevalence, awareness, treatment, and control of DM. RESULTS As depressive symptom severity worsened, both prevalence and awareness of DM increased regardless of models (p value for trend <0.01 in all models for prevalence and awareness; adjusted OR (aOR) 2.14, 95% CI 1.29 to 3.56 for prevalence in the severe group, model 1; aOR 2.43, 95% CI 1.27 to 4.64 for awareness in the moderately severe group, model 1). Notwithstanding higher awareness of diabetes in the moderately severe and severe groups (84.5% and 86.2%, respectively, vs 71.3% in the none group), these groups were treated less (aOR 0.25, 95% CI 0.11 to 0.55 in the severe group, model 3) or inadequately controlled (aOR 0.51, 95% CI 0.27 to 0.98 in the moderately severe group, model 3). CONCLUSIONS The gap between patients' higher awareness and lower treatment rate or control of diabetes among individuals with severe depressive symptoms highlights the unmet needs for postdiagnostic multidisciplinary care for patients with comorbid depression and DM.
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Affiliation(s)
- Jaewon Lee
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Kyae Hyung Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Joseph C Ahn
- Division of Gastroenterology and Hepatology, Mayo Clinic in Rochester, Rochester, Minnesota, USA
| | - Jihoon Andrew Kim
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gyeongsil Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Joung Sik Son
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea (the Republic of)
| | - Soo Jung Choi
- Department of Family Medicine, Gachon University Gil Medical Center, Incheon, Korea (the Republic of)
| | - Yun Hwan Oh
- Department of Family Medicine, Jeju National University Hospital, Jeju, Korea (the Republic of)
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul, Korea (the Republic of)
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
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42
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Profiles of Frailty among Older People Users of a Home-Based Primary Care Service in an Urban Area of Barcelona (Spain): An Observational Study and Cluster Analysis. J Clin Med 2021; 10:jcm10102106. [PMID: 34068296 PMCID: PMC8153285 DOI: 10.3390/jcm10102106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/28/2021] [Accepted: 05/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The multidimensional assessment of frailty allows stratifying it into degrees; however, there is still heterogeneity in the characteristics of people in each stratum. The aim of this study was to identify frailty profiles of older people users of a home-based primary care service. Methods: We carried out an observational study from January 2018 to January 2021. Participants were all people cared for a home-based primary care service. We performed a cluster analysis by applying a k-means clustering technique. Cluster labeling was determined with the 22 variables of the Frail-VIG index, age, and sex. We computed multiple indexes to assess the optimal number of clusters, and this was selected based on a clinical assessment of the best options. Results: Four hundred and twelve participants were clustered into six profiles. Three of these profiles corresponded to a moderate frailty degree, two to a severe frailty degree and one to a mild frailty degree. In addition, almost 75% of the participants were clustered into three profiles which corresponded to mild and moderate degree of frailty. Conclusions: Different profiles were found within the same degree of frailty. Knowledge of these profiles can be useful in developing strategies tailored to these differentiated care needs.
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Aleandri M, Scalorbi S, Pirazzini MC. Electronic nursing care plans through the use of NANDA, NOC, and NIC taxonomies in community setting: A descriptive study in northern Italy. Int J Nurs Knowl 2021; 33:72-80. [PMID: 33960713 PMCID: PMC9290471 DOI: 10.1111/2047-3095.12326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/02/2021] [Accepted: 04/10/2021] [Indexed: 11/29/2022]
Abstract
Purpose To carry on a descriptive analysis of nursing standardized language through the use of a software within outpatient facilities in northern Italy, organized according to the Chronic Care Model (CCM) and called Community Health Centers (CHC). Methods A descriptive design was adopted for the study. NANDA‐I, NOC, and NIC taxonomies have been used to analyze care plans pulled from the software. Both qualitative and quantitative data were analyzed. Findings The average of nursing diagnosis correctly identified with respect to the nursing assessment is 83.7% (SD 29.9%). Class 4 diagnoses from Domains 4 have been identified as the most prevalent (22.4%), followed by risk for unstable blood glucose level 00179 (16.4%) and risk for overweight 00234 (13%). The main nursing outcomes were vital signs 0802 (22.5%), blood glucose level 2300 (16%), and weight loss behavior 1627 (11%). The most prevalent nursing interventions are wound care 3660 (27%), medication administration: intramuscular 2313 (19%), and health education 5510 (14%). The analysis shows ability in identifying nursing diagnoses, but a larger variability with outcomes and interventions. The study highlights the nursing role within CHC and identifies the main areas of expertise in chronic disease management: prevention and health education. Conclusions Nurses’ role is fundamental for chronic disease management within CHC; NANDA‐I taxonomy helps to analyze care plans. Implications for nursing practice ‐ A taxonomy such as NANDA‐I represents a valid opportunity to make more visible how much nursing skills affect the achievement of a higher level of health in chronic patients. ‐ This study is useful in the further training of outpatient nurses who works in CHC. ‐ The study represents the starting point for future research to deepen the development of a standardized nursing language in outpatient facilities.
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Howell D, Mayer DK, Fielding R, Eicher M, Verdonck-de Leeuw IM, Johansen C, Soto-Perez-de-Celis E, Foster C, Chan R, Alfano CM, Hudson SV, Jefford M, Lam WWT, Loerzel V, Pravettoni G, Rammant E, Schapira L, Stein KD, Koczwara B. Management of Cancer and Health After the Clinic Visit: A Call to Action for Self-Management in Cancer Care. J Natl Cancer Inst 2021; 113:523-531. [PMID: 32525530 PMCID: PMC8096367 DOI: 10.1093/jnci/djaa083] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/29/2020] [Accepted: 06/04/2020] [Indexed: 12/25/2022] Open
Abstract
Individuals with cancer and their families assume responsibility for management of cancer as an acute and chronic disease. Yet, cancer lags other chronic diseases in its provision of proactive self-management support in routine, everyday care leaving this population vulnerable to worse health status, long-term disability, and poorer survival. Enabling cancer patients to manage the medical and emotional consequences and lifestyle and work changes due to cancer and treatment is essential to optimizing health and recovery across the continuum of cancer. In this paper, the Global Partners on Self-Management in Cancer puts forth six priority areas for action: Action 1: Prepare patients and survivors for active involvement in care; Action 2: Shift the care culture to support patients as partners in cocreating health and embed self-management support in everyday health-care provider practices and in care pathways; Action 3: Prepare the workforce in the knowledge and skills necessary to enable patients in effective self-management and reach consensus on core curricula; Action 4: Establish and reach consensus on a patient-reported outcome system for measuring the effects of self-management support and performance accountability; Action 5: Advance the evidence and stimulate research on self-management and self-management support in cancer populations; Action 6: Expand reach and access to self-management support programs across care sectors and tailored to diversity of need and stimulation of research to advance knowledge. It is time for a revolution to better integrate self-management support as part of high-quality, person-centered support and precision medicine in cancer care to optimize health outcomes, accelerate recovery, and possibly improve survival.
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Affiliation(s)
- Doris Howell
- Department of Supportive Care, Princess Margaret Cancer Research Center and Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Deborah K Mayer
- School of Nursing, University of North Carolina & Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Richard Fielding
- University of Hong Kong Jockey Club Institute of Cancer Care, Hong Kong, China
| | - Manuela Eicher
- Department of Oncology, Lausanne University Hospital, Institute of Higher Education and Research in Health Care, Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | - Irma M Verdonck-de Leeuw
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- Department of Otolaryongoly/Head & Neck Surgery, Cancer Centre, Amsterdam, The Netherlands
| | | | | | - Claire Foster
- School of Health Sciences, University of Southampton, Surrey, UK
| | - Raymond Chan
- Princess Alexander Hospital and Queensland University of Technology, Brisbane, Australia
| | | | - Shawna V Hudson
- Department of Family Medicine and Community Health, Rutgers Cancer Institute of New Jersey and Rutgers Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Wendy W T Lam
- Division of Behavioural Sciences, School of Public Health, and Jockey Club Institute of Cancer Care, University of Hong Kong, Hong Kong, China
| | - Victoria Loerzel
- University of Central Florida College of Nursing, Orlando, FL, USA
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, Instituto Europeo di Oncologia (IEO), European Institute of Oncology, Milan, Italy
| | - Elke Rammant
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Lidia Schapira
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Kevin D Stein
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Bogda Koczwara
- Department of Medical Oncology, & Flinders University, Bedford Park, South Australia and members of the Global Partners for Self-Management in Cancer (GPS)
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Bosire EN, Norris SA, Goudge J, Mendenhall E. Pathways to Care for Patients With Type 2 Diabetes and HIV/AIDS Comorbidities in Soweto, South Africa: An Ethnographic Study. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:15-30. [PMID: 33591926 PMCID: PMC8087426 DOI: 10.9745/ghsp-d-20-00104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 01/05/2021] [Indexed: 11/26/2022]
Abstract
Patients with type 2 diabetes are referred to tertiary hospitals in Soweto although their care could be managed at primary health care clinics. Primary health care needs to be strengthened by addressing health systemic challenges to provide integrated care for comorbid type 2 diabetes and HIV/AIDS. Background: South Africa is experiencing colliding epidemics of HIV/AIDS and noncommunicable diseases. In response, the National Department of Health has implemented integrated chronic disease management aimed at strengthening primary health care (PHC) facilities to manage chronic illnesses. However, chronic care is still fragmented. This study explored how the health system functions to care for patients with comorbid type 2 diabetes (T2DM) and HIV/AIDS at a tertiary hospital in Soweto, South Africa. Methods: We employed ethnographic methods encompassing clinical observations and qualitative interviews with health care providers at the hospital (n=30). Data were transcribed verbatim and thematically analyzed using QSR NVivo 12 software. Findings: Health systemic challenges such as the lack of medication, untrained nurses, and a limited number of doctors at PHC clinics necessitated patient referrals to a tertiary hospital. At the hospital, patients with T2DM were managed first at the medical outpatient clinic before they were referred to a specialty clinic. Those with comorbidities attended different clinics at the hospital partly due to the structure of the tertiary hospital that offers specialized care. In addition, little to no collaboration occurred among health care providers due to poor communication, noncentralized patient information, and staff shortage. As a result, patients experienced disjointed care. Conclusion: PHC clinics in Soweto need to be strengthened by training nurses to diagnose and manage patients with T2DM and also by ensuring adequate medical supplies. We recommend that the medical outpatient clinic at a tertiary hospital should also be strengthened to offer integrated and collaborative care to patients with T2DM and other comorbidities. Addressing key systemic challenges such as staff shortages and noncentralized patient information will create a patient-centered as opposed to disease-specific approach to care.
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Affiliation(s)
- Edna N Bosire
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Shane A Norris
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Global Health Research Institute, School of Human Development and Health, National Institute for Health Research, Southampton Biomedical Research Centre, University of Southampton, UK
| | - Jane Goudge
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Emily Mendenhall
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Science, Technology, and International Affairs Program, Edmund A. Walsh School of Foreign Service, Georgetown University, Washington, DC, USA
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Husebø AML, Dalen I, Richardson A, Bru E, Søreide JA. Factors influencing treatment burden in colorectal cancer patients undergoing curative surgery: A cross-sectional study. Eur J Cancer Care (Engl) 2021; 30:e13437. [PMID: 33751695 DOI: 10.1111/ecc.13437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 12/22/2020] [Accepted: 02/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the severity of treatment burden in surgically treated colorectal cancer (CRC) patients and examine associations between treatment burden and demographic and clinical variables. METHODS This cross-sectional study recruited 134 patients diagnosed with Dukes' stage A-C CRC between 2016 and 2018 who underwent curative surgery. The Patient Experience with Treatment and Self-management (PETS) questionnaire assessed treatment burden domains of 'workload', 'stressors' and 'impact' between 6 weeks and 18 months after primary surgery. RESULTS Highest scores were observed for difficulty with healthcare services (median score 33.3), physical and mental fatigue (median score 30.0) and medical information (median score 26.8). Younger age, low education level or no cohabitants were significantly associated with higher workload PETS scores (p < 0.05, 0.013, p = 0.047, respectively). Higher PETS stressors scores were significantly associated with younger age (p = 0.006), lower education level (p = 0.016), and high comorbidity (p = 0.013). Higher PETS impact scores were significantly associated with the female sex (p = 0.050), younger age (p = <0.001-0.003), lower education (p = 0.003), no cohabitants (p = 0.003), high comorbidity (p = 0.003) and cancer stage Dukes A (p = 0.004). CONCLUSIONS A seamless and supportive healthcare system beyond hospitalisation targeting CRC subpopulations in danger of high treatment burden may improve patients' self-management experience.
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Affiliation(s)
- Anne M L Husebø
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Ingvild Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - Alison Richardson
- School of Health Sciences, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Edvin Bru
- Centre for Learning Environment, University of Stavanger, Stavanger, Norway
| | - Jon A Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Hardman R, Begg S, Spelten E. Healthcare professionals' perspective on treatment burden and patient capacity in low-income rural populations: challenges and opportunities. BMC FAMILY PRACTICE 2021; 22:50. [PMID: 33750306 PMCID: PMC7942213 DOI: 10.1186/s12875-021-01387-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/13/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The challenges of chronic disease self-management in multimorbidity are well-known. Shippee's Cumulative Complexity Model provides useful insights on burden and capacity factors affecting healthcare engagement and outcomes. This model reflects patient experience, but healthcare providers are reported to have a limited understanding of these concepts. Understanding burden and capacity is important for clinicians, since they can influence these factors both positively and negatively. This study aimed to explore the perspectives of healthcare providers using burden and capacity frameworks previously used only in patient studies. METHODS Participants were twelve nursing and allied health providers providing chronic disease self-management support in low-income primary care settings. We used written vignettes, constructed from interviews with multimorbid patients at the same health centres, to explore how clinicians understood burden and capacity. Interviews were recorded and transcribed verbatim. Analysis was by the framework method, using Normalisation Process Theory to explore burden and the Theory of Patient Capacity to explore capacity. RESULTS The framework analysis categories fitted the data well. All participants clearly understood capacity and were highly conscious of social (e.g. income, family demands), and psychological (e.g. cognitive, mental health) factors, in influencing engagement with healthcare. Not all clinicians recognised the term 'treatment burden', but the concept that it represented was familiar, with participants relating it both to specific treatment demands and to healthcare system deficiencies. Financial resources, health literacy and mental health were considered to have the biggest impact on capacity. Interaction between these factors and health system barriers (leading to increased burden) was a common and challenging occurrence that clinicians struggled to deal with. CONCLUSIONS The ability of health professionals to recognise burden and capacity has been questioned, but participants in this study displayed a level of understanding comparable to the patient literature. Many of the challenges identified were related to health system issues, which participants felt powerless to address. Despite their awareness of burden and capacity, health providers continued to operate within a single-disease model, likely to increase burden. These findings have implications for health system organisation, particularly the need for alternative models of care in multimorbidity.
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Affiliation(s)
- Ruth Hardman
- La Trobe University Rural Health School, 471 Benetook Avenue, Mildura, VIC, 3500, Australia. .,Sunraysia Community Health Services, 137 Thirteenth Street, Mildura, VIC, 3500, Australia.
| | - Stephen Begg
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, VIC, 3552, Australia
| | - Evelien Spelten
- La Trobe University Rural Health School, 471 Benetook Avenue, Mildura, VIC, 3500, Australia
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Byrne AL, Harvey C, Baldwin A. Nurse navigators and person-centred care; delivered but not valued? Nurs Inq 2021; 28:e12402. [PMID: 33645885 DOI: 10.1111/nin.12402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 11/27/2022]
Abstract
Positioning the individual at the centre of care (person-centred care [PCC]) is essential to improving outcomes for people living with multiple chronic conditions. However, research also suggests that this is structurally challenging because health systems continue to adopt long-standing, episodic care encounters. One strategy to provide a more cohesive, individualised approach to care is the implementation of the nurse navigator role. Current research shows that although PCC is a focus of navigation, such care may be hindered by the rigid, systematised health services providing siloed specialist care. In this paper, we utilised a case study method to investigate the experiences of a nurse navigator and patient. The nurse navigator and the patient participated in individual interviews, the transcripts of which were analysed using critical discourse analysis. Findings from a larger research project suggest that traditional measures (hospital avoidance, emergency department usage) which work as the service objectives of the nurse navigator service have the potential to stifle the delivery of PCC. The analysis from this case study supports the broader findings and further highlights the need for improved alignment between service objectives and the health and well-being of the individuals utilising the services.
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Affiliation(s)
- Amy-Louise Byrne
- School of Nursing and Midwifery and Social Science, Central Queensland University, Townsville, QLD, Australia
| | - Clare Harvey
- School of Nursing and Midwifery and Social Science, Central Queensland University, Townsville, QLD, Australia
| | - Adele Baldwin
- School of Nursing and Midwifery and Social Science, Central Queensland University, Townsville, QLD, Australia
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Kim J, Lee M, Dan H. Gender Differences in Factors Affecting Life Satisfaction of the Elderly with Multimorbidity in Korea. NURSING REPORTS 2021; 11:54-63. [PMID: 34968312 PMCID: PMC8608087 DOI: 10.3390/nursrep11010006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 12/21/2022] Open
Abstract
To enhance the life satisfaction of the elderly with multimorbidity, it is necessary to investigate the relevant factors and to examine the differences in factors according to gender. The aim of this study was to identify factors affecting life satisfaction of the elderly with multimorbidity in the community by gender in Korea. We analyzed data from 2140 participants with multimorbidity who were aged 65 or older and participated in the Korean Longitudinal Study of Ageing (KLoSA) in 2016. A multivariate linear regression analysis was conducted to examine the factors affecting life satisfaction among male and female older participants with multimorbidity. The most common pattern of multimorbidity of women was hypertension and arthritis/rheumatism, while that of men was hypertension and diabetes mellitus. Some factors, such as depression, exercise, and number of chronic diseases, affected both male and female participants, but others related to life satisfaction varied by gender. Therefore, it is necessary to consider the characteristics of multiple chronic diseases, and policy support should be provided in consideration of gender differences to improve the life satisfaction of the elderly.
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Affiliation(s)
- Jeonghyun Kim
- College of Nursing, Ewha Womans University, Seoul 03760, Korea;
| | - Minkyung Lee
- Infectious Disease Department, Weill Cornell Medicine, New York, NY 10065, USA;
| | - Hyunju Dan
- College of Nursing, Ewha Womans University, Seoul 03760, Korea;
- Correspondence:
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Abu Dabrh AM, Boehmer KR, Shippee N, Rizza SA, Perlman AI, Dick SR, Behnken EM, Montori VM. Minimally disruptive medicine (MDM) in clinical practice: a qualitative case study of the human immunodeficiency virus (HIV) clinic care model. BMC Health Serv Res 2021; 21:24. [PMID: 33407451 PMCID: PMC7788961 DOI: 10.1186/s12913-020-06010-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 12/10/2020] [Indexed: 12/30/2022] Open
Abstract
Background Recent evidence suggests the need to reframe healthcare delivery for patients with chronic conditions, with emphasis on minimizing healthcare footprint/workload on patients, caregivers, clinicians and health systems through the proposed Minimally Disruptive Medicine (MDM) care model named. HIV care models have evolved to further focus on understanding barriers and facilitators to care delivery while improving patient-centered outcomes (e.g., disease progression, adherence, access, quality of life). It is hypothesized that these models may provide an example of MDM care model in clinic practice. Therefore, this study aimed to observe and ascertain MDM-concordant and discordant elements that may exist within a tertiary-setting HIV clinic care model for patients living with HIV or AIDS (PLWHA). We also aimed to identify lessons learned from this setting to inform improving the feasibility and usefulness of MDM care model. Methods This qualitative case study occurred in multidisciplinary HIV comprehensive-care clinic within an urban tertiary-medical center. Participants included Adult PLWHA and informal caregivers (e.g. family/friends) attending the clinic for regular appointments were recruited. All clinic staff were eligible for recruitment. Measurements included; semi-guided interviews with patients, caregivers, or both; semi-guided interviews with varied clinicians (individually); and direct observations of clinical encounters (patient-clinicians), as well as staff daily operations in 2015–2017. The qualitative-data synthesis used iterative, mainly inductive thematic coding. Results Researcher interviews and observations data included 28 patients, 5 caregivers, and 14 care-team members. With few exceptions, the clinic care model elements aligned closely to the MDM model of care through supporting patient capacity/abilities (with some patients receiving minimal social support and limited assistance with reframing their biography) and minimizing workload/demands (with some patients challenged by the clinic hours of operation). Conclusions The studied HIV clinic incorporated many of the MDM tenants, contributing to its validation, and informing gaps in knowledge. While these findings may support the design and implementation of care that is both minimally disruptive and maximally supportive, the impact of MDM on patient-important outcomes and different care settings require further studying. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06010-x.
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Affiliation(s)
- Abd Moain Abu Dabrh
- Department of Family Medicine, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL, USA. .,Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA. .,Integrative Medicine and Health, Division of General Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA.
| | - Kasey R Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Nathan Shippee
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Stacey A Rizza
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Adam I Perlman
- Integrative Medicine and Health, Division of General Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Sara R Dick
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Emma M Behnken
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
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