bluuebunny/crossref_metadata_2025_split huggingface dataset:
Granuloma-Positive Crohn’s Disease
Authors: Freeman Hugh J 
Published: March 2016

BACKGROUND: The epithelioid granuloma is a characteristic histological feature of Crohn’s disease. In some pathological classification schemes, the criteria for a definite, probable or possible diagnosis have been listed, with the epithelioid granuloma indicating definite Crohn’s disease.METHODS: In the present evaluation, 247 prospectively evaluated Crohn’s disease patients (24.3%), from a consecutively accumulated population database of 1015 patients, were found to have an epithelioid granuloma. The recently devised Montreal classification for Crohn’s disease was then applied to this granuloma-positive cohort of Crohn’s disease patients to define age at diagnosis for men and women, disease site and disease behaviour.RESULTS: The investigation showed that patients with Crohn’s disease and granulomas were most often diagnosed early in the course of their disease, particularly women. Their disease was often extensive, with ileocolonic and upper gastrointestinal tract involvement. Finally, disease behaviour was most often complex, especially with penetrating disease complications.CONCLUSION: Using homogeneous (ie, ‘reagent-grade’) patient cohorts defined by a recently devised classification method for Crohn’s disease, the study demonstrated that an epithelioid granuloma may represent a histopathological marker for an early biological event in the etiopathogenesis of Crohn’s disease, and this may have predictive significance with respect to the location and clinical behaviour of Crohn’s disease.
Resource Use Study in COPD (RUSIC): A prospective Study to Quantify the Effects of COPD Exacerbations on Health Care Resource Use Among COPD Patients
Authors: FitzGerald J Mark , Haddon Jennifer M , Bradley-Kennedy Carole , Kuramoto Lisa , Ford Gordon T , The RUSIC Study Group  
Published: March 2016

BACKGROUND: There is increasing interest in health care resource use (HRU) in Canada, particularly in resources associated with acute exacerbations of chronic obstructive pulmonary disease (COPD).OBJECTIVE: To identify HRU due to exacerbations of COPD.METHODS: A 52‐week, multicentre, prospective, observational study of HRU due to exacerbations in patients with moderate to severe COPD was performed. Patients were recruited from primary care physicians and respirologists in urban and rural centres in Canada.RESULTS: In total, 524 subjects (59% men) completed the study. Their mean age was 68.2±9.4 years, with a forced expiratory volume in 1 s of 1.01±0.4 L. Patients had significant comorbidities. There were 691 acute exacerbations of COPD, which occurred in 53% of patients: 119 patients (23%) experienced one acute exacerbation, 70 patients (13%) had two acute exacerbations and 89 patients (17%) had three or more acute exacerbations. Seventy‐five patients were admitted to hospital, with an average length of stay of 13.2 days. Fourteen of the patients spent time in an intensive care unit (average length of stay 5.6 days). Factors associated with acute exacerbations of COPD included lower forced expiratory volume in 1 s (P<0.001), high number of respiratory medications prescribed (P=0.037), regular use of oral corticosteroids (OCSs) (P=0.008) and presence of depression (P<0.001). Of the 75 patients hospitalized, only 53 received OCSs, four received referral for rehabilitation and 15 were referred for home care.CONCLUSIONS: The present study showed a high prevalence of COPD exacerbations, which likely impacted on HRU. There was evidence of a lack of appropriate management of exacerbations, especially with respect to use of OCSs, and referral for pulmonary rehabilitation and home care.
Hospitalization-Based Major Comorbidity of Inflammatory Bowel Disease in Canada
Authors: Bernstein Charles N , Nabalamba Alice 
Published: March 2016

OBJECTIVE: To define the patterns of hospitalization for known major comorbidities associated with inflammatory bowel disease (IBD) in Canada.METHODS: The data source was the Statistics Canada Health Person Oriented Information hospital database (1994/1995 to 2003/2004). The number of stays for a diagnosis of Crohn’s disease or ulcerative colitis by theInternational Classification of Diseases, ninth edition, codes 555 or 556, or theInternational Classification of Diseases, 10th edition, Canadian Enhancement, codes K50 or K51, was extracted. Age- and sex-specific and age-adjusted rates of hospitalization for selected IBD-related comorbidities were assessed.RESULTS: Rates of Hodgkin’s disease and non-Hodgkin’s lymphoma were low in the hospitalized IBD population. Rates for colon cancer, rectal cancer, pulmonary emboli and deep venous thromboembolism were generally higher among IBD patients younger than 50 years of age compared with the non-IBD hospitalized population.CONCLUSIONS: IBD was associated with life-threatening comorbidities such as venous thromboembolic disease and colon cancer among persons younger than 50 years of age to a greater extent than the general hospitalized population. Recent secular trends in rates of non-Hodgkin’s lymphomas will need to be followed to determine whether the whole population, including IBD patients who receive immunomodulating therapies, are at increased risk.
Practice Patterns in the Management of Chronic Obstructive Pulmonary Disease in Primary Practice: The Cage Study
Authors: Bourbeau Jean , Sebaldt Rolf J , Day Anna , Bouchard Jacques , Kaplan Alan , Hernandez Paul , Rouleau Michel , Petrie Annie , Foster Gary , Thabane Lehana , Haddon Jennifer , Scalera Alissa 
Published: March 2016

BACKGROUND: The information on usual care for patients with chronic obstructive pulmonary disease (COPD) in primary care is limited in Canada.OBJECTIVE: To evaluate primary care practice in patients with COPD in Quebec and Ontario compared with recommended care.METHODS: The COPD Care Gap Evaluation (CAGE) was a prospective, cross‐sectional study. Physicians’ self‐reported data of enrolled COPD patients were compared with the recommended care for the level of disease severity (using the Canadian Thoracic Society classification by symptoms) and stability, derived from Canadian Thoracic Society COPD guidelines. Pharmacological treatment, spirometric confirmation of diagnosis and nonpharmacological management, including smoking cessation counselling, influenza immunization and referral for pulmonary rehabilitation, were assessed.RESULTS: Participating physicians (n=161; 44 in Quebec, 117 in Ontario) recruited 1090 patients (320 in Quebec, 770 in Ontario). The mean (± SD) age of the patients was 69.9±10.4 years; 60% were male and 40% were currently smoking. Pharmacological treatment that matched guideline recommendations was identified in 34% of patients. Discrepancies between reported and recommended treatment stemmed from nonprescription of long‐acting bronchodilators (LABDs) for patients with moderate (27%) and severe (21%) COPD, nonprescription of two long‐acting beta agonists (a beta2‐agonist and an anticholinergic) for patients with severe COPD (51%), and prescription of inhaled corticosteroids (63%) and LABDs (47%) for patients with mild COPD for which the treatment is not recommended. Spirometric confirmation of diagnosis, as recommended by the guidelines, was reported in 56% of patients. For non‐pharmacological management, smoking cessation counselling (95%) and influenza immunization (80%) were near optimal. Referral for pulmonary rehabilitation (9%) was not common. Differences between provinces were seen mainly in the prescription of short‐acting bronchodilators (89% in Quebec, 76% in Ontario) and LABDs (60% in Quebec, 80% in Ontario).CONCLUSIONS: Substantial gaps between recommended and current care exist in the management of COPD patients in primary care practice. Undertreatment of patients with severe COPD has potential clinical implications, including loss of autonomy and hospitalization.
A Pilot Study to Compare Tobramycin 80 mg Injectable Preparation wth 300 mg Solution for Inhalation in Cystic Fibrosis Patients
Authors: Nikolaizik Wilfried H , Vietzke Delia , Ratjen Felix 
Published: March 2016

BACKGROUND: Inhaled tobramycin has been shown to improve lung function in cystic fibrosis (CF) patients chronically infected with Pseudomonas aeruginosa. However, to date no comparative data are available for different dose regimens used in clinical practice.OBJECTIVES: To compare the clinical efficacy of the two most commonly used treatment regimens of inhaled tobramycin in patients with CF.METHODS: In an open crossover study of CF patients, subjects were randomly allocated to receive either 80 mg tobramycin twice‐daily continuous treatment or 300 mg tobramycin twice daily in cycles of 28 days on and 28 days off treatment. After three months, patients were switched to the alternative treatment regimen.RESULTS: A total of 32 patients with a mean (± SD) age of 18.5±8.6 years were included in the study. Compared with the treatment period using colistin, forced expiratory volume in 1 s decreased by −2.1±13.8% in the 80 mg tobramycin group and increased by +2.3±13.0% in the 300 mg group. Similar changes were observed in forced vital capacity (−2.5±12.9% in the 80 mg tobramycin group versus +2.5±9.6% in the 300 mg tobramycin group). Variability in responses was large but the differences were not statistically significant. Personal preference indicated that the majority of patients preferred the high‐dose cycle compared with the lower dose continuous inhalation, but this was not linked to objective data on efficacy.CONCLUSIONS: The present trial fails to provide convincing evidence for superiority in efficacy of either of the two treatment regimens of inhaled tobramycin in CF patients.
Quality of Bronchial Biopsies for Morphology Study and Cell Sampling: A Comparison of Asthmatic and Healthy Subjects
Authors: Labonté Isabelle , Laviolette Michel , Olivenstein Ron , Chakir Jamila , Boulet Louis-Philippe , Hamid Qutayba 
Published: March 2016

BACKGROUND: Bronchial biopsies are widely used for histopathological, primary cell culture and genetic studies, but very few reports have evaluated their quality.OBJECTIVES AND METHODS: The present project evaluated the quality (using a scoring system) and the general morphology of a pool of six bronchial biopsy specimens taken from three different sampling sites (the lobar, segmental and subsegmental carinae) in 27 subjects (13 asthmatic subjects and 14 healthy controls). The present study also assessed quantitative measurements of structural changes related to asthma.RESULTS: In total, 94.4% of the biopsy attempts had enough tissue to be processed. From these, 61.7% were scored with a good to excellent quality, while 76.5% presented smooth muscle bundles and 40.5% had an intact epithelium wall. The data also confirmed the structural changes observed in asthma, such as increased apparent thickening of the basement membrane, reduced amounts of smooth muscle for healthy controls and decreased percentage of intact epithelium for asthmatic subjects.CONCLUSION: A pool of six bronchial biopsy specimens can provide tissue of excellent quality in both asthmatic and healthy subjects and, consequently, a valuable sample for morphological analysis of mucosal structures.
Publicly Funded, Pegylated Interferon-Alpha Treatment in British Columbia: Disparities in Treatment Patterns for People with Hepatitis C
Authors: Hsu Priscilla C , Buxton Jane A , Tu Andrew W , Hill Warren D , Yu Amanda , Krajden Mel 
Published: March 2016

BACKGROUND: An estimated 60,000 British Columbians are chronically infected with the hepatitis C virus (HCV); 10% to 20% will develop cirrhosis after 20 years and 5% to 10% of these will develop hepatocellular carcinoma. Although treatment may prevent cirrhosis and liver cancer, and improve quality of life, availability is limited.METHODS: Individuals with HCV genotypes 1, 4, 5 and 6 who underwent baseline HCV-RNA tests between January 1, 2003 and December 31, 2005, and were eligible for publicly funded treatment through PharmaCare were linked to British Columbia’s reportable disease database. Patterns in treatment were examined, including age at treatment, sex, location, time to treatment from HCV diagnosis and seasonality of treatment.RESULTS: When corrected for HCV prevalence, men were more likely to receive treatment than women (RR 1.16, 95% CI 1.02 to 1.31). Patients aged 35 to 54 years and 55 years or older were 3.45 times (95% CI 2.80 to 4.26 times) and 4.49 times (95% CI 3.55 to 5.69 times), respectively, more likely to initiate treatment than 15- to 34-year-olds. Differences were noted between health authorities. Patients in rural health service delivery areas (HSDAs) were 1.25 times (95% CI 1.10 to 1.42 times) more likely to receive treatment than those in urban HSDAs. Patients had an average lapse of four years between HCV diagnosis and receiving treatment. The highest proportion of patients initiated therapy between January and March (36.5%), with the lowest between October and December (less than 14%).CONCLUSIONS: This data linkage enabled us to identify populations less likely to receive publicly funded treatment. Rural HSDAs have higher rates of therapy initiation; this pattern merits further research but may be a result of integrated prevention and care projects in rural areas. Policy changes to the current PharmaCare funding co-payment schedules could reduce seasonal variability of treatment initiations throughout the year.
Hyperferritinemia in the Chinese and Asian Community: A Retrospective Review of the University of British Columbia Experience
Authors: Yenson Paul R , Yoshida Eric M , Li Charles H , Chung Henry V , Tsang Peter WK 
Published: March 2016

BACKGROUND AND METHODS: Elevated serum ferritin is a common clinical finding. The etiology of hyperferritinemia in the Asia-Pacific population is less clear due to a low prevalence of knownHFEmutations such asC282YandH63D, as well as an increased prevalence of viral hepatitis and hereditary anemia. A retrospective case review of 80 patients of Asian ethnicity referred to three subspecialists in tertiary care teaching hospitals between January 1997 and March 2005 for assessment of hyperferritinemia was performed.RESULTS: Only four patients (5%) had iron overload on liver biopsy or quantitative phlebotomy. Forty-nine patients (61%) had secondary causes for their hyperferritinemia, of which 26 had liver disease; 16 of those patients also had viral hepatitis. Thirteen patients fulfilled criteria for the insulin resistance syndrome. Other causes included hematological disorders (n=10), malignancy (n=2) and inflammatory arthritis (n=2). Twenty-seven cases (34%) of unexplained hyperferritinemia were found. Of a total of 22 patients who underwent liver biopsy, significant iron deposition was found in one patient. Fifteen patients underwentC282YandH63Dgenotyping, with two cases ofH63Dheterozygosity. Fourteen patients had first-degree relatives with hyperferritinemia. Three families were identified with more than two members affected, which is suggestive of a possible hereditary hyperferritinemia syndrome.CONCLUSION: Secondary causes of elevated ferritin in the Asian population, particularly liver disease, are common, but primary iron overload syndromes appear to be rare. In a significant proportion of patients, the etiology remains unexplained. The genetic basis for hyperferritinemia in Asians is poorly defined and requires further study.
Chronic Pain and Fatigue: Associations with Religion and Spirituality
Authors: Baetz Marilyn , Bowen Rudy 
Published: March 2016

BACKGROUND: Conditions with chronic, non‐life‐threatening pain and fatigue remain a challenge to treat, and are associated with high health care use. Understanding psychological and psychosocial contributing and coping factors, and working with patients to modify them, is one goal of management. An individual’s spirituality and/or religion may be one such factor that can influence the experience of chronic pain or fatigue.METHODS: The Canadian Community Health Survey (2002) obtained data from 37,000 individuals 15 years of age or older. From these data, four conditions with chronic pain and fatigue were analyzed together – fibromyalgia, back pain, migraine headaches and chronic fatigue syndrome. Additional data from the survey were used to determine how religion and spirituality affect psychological well‐being, as well as the use of various coping methods.RESULTS: Religious persons were less likely to have chronic pain and fatigue, while those who were spiritual but not affiliated with regular worship attendance were more likely to have those conditions. Individuals with chronic pain and fatigue were more likely to use prayer and seek spiritual support as a coping method than the general population. Furthermore, chronic pain and fatigue sufferers who were both religious and spiritual were more likely to have better psychological well‐being and use positive coping strategies.INTERPRETATION: Consideration of an individual’s spirituality and/or religion, and how it may be used in coping may be an additional component to the overall management of chronic pain and fatigue.
Dyspareunia in Postmenopausal Women: A Critical Review
Authors: Kao Alina , Binik Yitzchak M , Kapuscinski Anita , Khalifé Samir 
Published: March 2016

BACKGROUND: Dyspareunia, or pain during sexual intercourse, is among the problems most frequently reported by postmenopausal women. Past literature has almost unanimously attributed dyspareunic pain occurring during or after the menopausal transition to declining estrogen levels and vaginal atrophy.OBJECTIVES: To critically review the literature on the prevalence, risk factors, etiology, clinical presentation and treatment of post‐menopausal dyspareunia. The present review also examines the traditional and widely held conceptualization of postmenopausal dyspareunia as a direct symptom of hormonal decline.METHODS: Searches of medical and psychological databases were performed for relevant articles and empirical studies. The methodological quality and outcomes of the studies were systematically reviewed.RESULTS: Available empirical evidence suggests that dyspareunia is common in postmenopausal women, and that it is not highly correlated with menopausal status, estrogen levels or vaginal atrophy. Decreasing levels of endogenous estrogen contribute to the development of dyspareunia in postmenopausal women suffering from vaginal atrophy. Hormonal supplementation is beneficial in alleviating their pain. However, a substantial proportion of treated women do not report relief.CONCLUSIONS: Postmenopausal dyspareunia occurring concurrently with vaginal atrophy is strongly associated with a lack of estrogen in the genital tract. However, a significant percentage of postmenopausal women experience dyspareunic pain that is not caused by hypoestrogenism. It is likely that other types of dyspareunia that occur premenopausally are also occurring in postmenopausal women. Research is needed to adequately address this issue. A change in perspective toward a multiaxial pain‐focused approach is proposed for future research concerning dyspareunia in postmenopausal women.
Delayed Tuberculosis Treatment in Urban and Suburban Ontario
Authors: Gershon Andrea S , Wobeser Wendy , Tu Jack V 
Published: March 2016

BACKGROUND: Delay in the treatment of patients with tuberculosis (TB) increases the risk of poor clinical outcomes – including death and transmission of disease – and may be reducible.OBJECTIVE: To estimate delays in TB treatment in a Canadian, multicultural population and to examine factors associated with longer time to treatment.METHODS: Adult cases of active TB from January 1998 to December 2001 from the Ontario Reportable Disease Information System were included. Time to treatment was defined as the number of days between symptom onset and treatment.RESULTS: Data from 1753 TB patients (76% of eligible patients) were analyzed. Median time to treatment was 62 days (interquartile range 31 to 114 days). Time periods longer than the median time to treatment were independently associated with middle‐aged patients (OR 1.54, 95% CI 1.21 to 1.98), foreign‐born patients who had lived in Canada for more than 10 years (OR 1.47, 95% CI 1.02 to 2.12), patients with nonpulmonary disease (OR 1.57, 95% CI 1.28 to 1.92) and patients managed within certain health districts.CONCLUSION: A time to TB treatment of two months or more is common in Ontario, and associated with several factors. Future studies are needed to build on these findings to decrease delay and improve individual and public health outcomes.
Prevalence of Asthma and Risk Factors for Asthma‐Like Symptoms in Aboriginal and Non‐Aboriginal Children in the Northern Territories of Canada
Authors: Gao Zhiwei , Rowe Brian H , Majaesic Carina , O’Hara Cindy , Senthilselvan A 
Published: March 2016

BACKGROUND: Few studies have investigated the prevalence and risk factors of asthma in Canadian Aboriginal children.OBJECTIVE: To determine the prevalence of asthma and asthma‐like symptoms, as well as the risk factors for asthma‐like symptoms, in Aboriginal and non‐Aboriginal children living in the northern territories of Canada.METHODS: Data on 2404 children, aged between 0 and 11 years, who participated in the North component of the National Longitudinal Survey of Children and Youth were used in the present study. A child was considered to have an asthma‐like symptom if there was a report of ever having had asthma, asthma attacks or wheeze in the past 12 months.RESULTS: After excluding 59 children with missing information about race, 1399 children (59.7%) were of Aboriginal ancestry. The prevalence of asthma was significantly lower (P<0.05) in Aboriginal children (5.7%) than non‐Aboriginal children (10.0%), while the prevalence of wheeze was similar between Aboriginal (15.0%) and non‐Aboriginal (14.5%) children. In Aboriginal children, infants and toddlers had a significantly greater prevalence of asthma‐like symptoms (30.0%) than preschool‐aged children (21.5%) and school‐aged children (11.5%). Childhood allergy and a mother’s daily smoking habit were significant risk factors for asthma‐like symptoms in both Aboriginal and non‐Aboriginal children. In addition, infants and toddlers were at increased risk of asthma‐like symptoms in Aboriginal children. In analyses restricted to specific outcomes, a mother’s daily smoking habit was a significant risk factor for current wheeze in Aboriginal children and for ever having had asthma in non‐Aboriginal children.CONCLUSIONS: Asthma prevalence appears to be lower in Aboriginal children than in non‐Aboriginal children. The association between daily maternal smoking and asthma‐like symptoms, which has been mainly reported for children living in urban areas, was observed in Aboriginal and non‐Aboriginal children living in northern and remote communities in Canada.