bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infectious Diseases Training in Canada: One Size Does Not Fit All
Authors: Lee B Craig 
Published: March 2016

PURPOSE: To evaluate training in infectious diseases, determining which components of the training program best prepare residents for their career choices and where improvements are needed.METHOD: A cross‐sectional survey was mailed to all 14 physicians who had graduated from both the Adult and Paediatric Infectious Diseases Training Program at the University of Calgary from 1985 to 1998. Responses about the adequacy of training were measured using a Likert‐type scale and a qualitative questionnaire.RESULTS: Of 14 mailed questionnaires, nine responses were received (64%). Two‐thirds of respondents were in an academic setting, and seven (78%) graduates obtained postfellowship training. The specialists in academic settings were all engaged in multiple nonclinical activities. The clinical and diagnostic microbiological components of training received the highest scores in terms of adequacy of training.CONCLUSION: Graduates of the University of Calgary training program indicated an overall satisfaction with their training. However, improvements are needed in career counselling, health administration, antibiotic utilization, infection prevention and specialized outpatient clinics. Potential strategies for addressing these issues include didactic lectures, enhanced exposure to clinical outpatient settings and provision of designated faculty mentors.
The Epidemiology of Childhood Asthma in Red Deer and Medicine Hat, Alberta
Authors: Hessel Patrick A , Klaver Justine , Michaelchuk Dennis , McGhan Shawna , Carson Mary M , Melvin Darrel 
Published: March 2016

OBJECTIVES: To document the prevalence of asthma among school-aged children in two Alberta communities, to understand host and indoor environmental factors associated with asthma, and to compare these factors between the two communities.DESIGN: A cross-sectional study with a nested, case-control follow-up.SETTING: Red Deer and Medicine Hat, Alberta.PATIENTS AND METHODS: Questionnaires were sent to families of children aged five to 19 years in Red Deer (n=5292) and Medicine Hat (n=5372) to identify children with current asthma. A random sample of 592 children with current asthma and 443 with no history of asthma constituted a case-control population; they were followed up by telephone to obtain responses to the European Respiratory Health Survey and, in children with current asthma, the Pediatric Quality of Life Questionnaire.RESULTS: Cross-sectional response rates were 84% and 73% for Red Deer and Medicine Hat, respectively. The prevalence of asthma was higher in Medicine Hat (17.0%) than in Red Deer (12.8%). In the follow-up study, factors associated with the presence of asthma were parental asthma or allergies, number of siblings, presence of cats, serious respiratory illnesses before five years of age, sex, age, presence of mould and/or mildew and use of a gas cooking stove. The presence of mould and/or mildew was a significant risk factor in Red Deer but not in Medicine Hat.CONCLUSIONS: Asthma prevalence among school children in Red Deer was consistent with recently published Canadian data; the prevalence in Medicine Hat was higher than expected, especially given the low relative humidity. Risk factor data are consistent with other studies in that parental asthma, especially maternal asthma, was a significant predictor of childhood asthma. Cats in the house (both communities) and environmental tobacco smoke (Medicine Hat only) were significantly less common among children with asthma, suggesting that preventive actions may have been taken in the homes of some children with asthma.
Incidence of Pulmonary Disease Caused by Mycobacteria other than Tuberculosis in British Columbia
Authors: Elwood R Kevin , Opazo Saez Anabelle M , Lentini Vittorio , Shadmani Ramak 
Published: March 2016

CONTEXT: The incidence of pulmonary disease due to mycobacteria other than tuberculosis (TB) in Canada has not been documented.OBJECTIVE: To determine the incidence of pulmonary disease due to mycobacteria in the nonimmunocompromised population of British Columbia.DESIGN: A retrospective cohort study of 110 cases of mycobacteria infection other than TB identified from 1991 to 1995.SETTING: British Columbia Centre for Disease Control, Division of TB Control.RESULTS: The overall incidence rate of infection with mycobacteria other than TB was 0.63×10-5/year. This incidence rate was significantly higher among women (relative risk [RR]=2, P=0.0006) and in those aged 55 years or older (RR=8, P<0.00001). In contrast with TB, patients were more frequently born in Canada (P<0.00001) or in industrialized countries other than Canada (P<0.00001), and were less likely to be Aboriginal (P=0.0007) or foreign born from Asia (P<0.0001). The most common organism isolated in British Columbia was Mycobacterium avium‐intracellulare (82.7%). Overall, 78 (71%) cases had underlying lung disease. Drug intolerance was very common (42%). After treatment, 55% and 41% of the patients were rendered smear negative or culture negative, respectively. Radiological improvement was noted in 55% of patients, and 60% of patients responded symptomatically to treatment.CONCLUSIONS: The overall incidence of pulmonary disease is low. It is a disease predominantly of women 55 years and older, and targets completely different ethnic groups than TB, suggesting a protective effect of infection with Mycobacterium tuberculosis. M avium‐intracellulare was the most common pathogen isolated. Further investigation is required into the natural history of so‐called ′colonizers′. Considerable morbidity may be prevented with earlier intervention.
Epidemiology and Clinical Features of Methicillin‐Resistant Staphylococcus aureus in the University Hospital, Jeddah, Saudi Arabia
Authors: Madani Tariq A 
Published: March 2016

OBJECTIVE: To describe the prevalence, demography and clinical characteristics of patients who were colonized or infected with methicillin‐resistant Staphylococcus aureus (MRSA) in 1998 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.PATIENTS AND METHODS: Results of MRSA‐positive cultures of clinical specimens obtained as part of investigations for suspected infections were retrieved from the King Abdulaziz University Hospital Infection Control Department′s records. Charts of patients were reviewed.RESULTS: Of 292 S aureus isolates identified, 111 (38%) were MRSA, or 6.0 MRSA isolates/1000 admissions, which represented a marked increase over MRSA prevalence in 1988 (less than 2%). Nosocomial acquisition occurred in 74.8% of isolates. All age groups were affected, but 45.9% of patients were in the ′extremes of age′ group (younger than one or older than 60 years of age). The prevalence was highest in the medical ward (27%), followed by the paediatrics combined medical and surgical ward (20.7%), the outpatient department (18%), the adult surgical ward (17.1%) and the intensive care units (17.1%). Two‐thirds (66.7%) of cases represented infection and the remainder represented colonization. Surgical wounds (31.1%), the chest (27%) and endovascular catheters (20.3%) were the most common sites of infection. Bacteremia occurred in 27% of patients. Local signs (68.9%) and fever (60.8%) were the most common clinical manifestations. Respiratory distress and septic shock occurred in 28.4% and 6.8% of cases, respectively. Of 74 patients with MRSA infection and 37 patients with MRSA colonization, 91.9% and 56.8% received antibiotics in the preceding six weeks, respectively (P<0.0001). The total mortality of patients with MRSA infection was 60.8%; 37.8% of deaths were the result of MRSA infection and 23% were the result of other diseases.CONCLUSIONS: The prevalence of MRSA is high and rapidly increasing at King Abdulaziz University Hospital, as it is worldwide. Control measures to prevent the spread of MRSA in hospitals should continue with reinforcement of hygienic precautions and development of policies to restrict the use of antibiotics.
The Buccale Puzzle: The Symbiotic Nature of Endogenous Infections of the Oral Cavity
Authors: Ruby John , Barbeau Jean 
Published: March 2016

The indigenous, ′normal′ microflora cause the majority of localized infectious diseases of the oral cavity (eg, dental caries, alveolar abscesses, periodontal diseases and candidiasis). The same microflora also protect the host from exogenous pathogens by stimulating a vigorous immune response and providing colonization resistance. How can a microflora that support health also cause endogenous oral disease? This paradoxical host‐symbiont relationship will be discussed within the dynamic of symbiosis.Symbiosis means ′life together′ ‐ it is capable of continuous change as determined by selective pressures of the oral milieu. Mutualistic symbiosis, where both the host and the indigenous microflora benefit from the association, may shift to a parasitic symbiosis, where the host is damaged and the indigenous microflora benefit. Importantly, these are reversible relationships. This microbial dynamism, called amphibiosis, is the essential adaptive process that determines the causation of endogenous oral disease by a parasitic microflora or the maintenance of oral health by a mutualistic microflora.Complex microbial consortiums, existing as a biofilm, usually provide the interfaces that initiate and perpetuate the infectious assault on host tissue. The ecology of the various oral microhabitats is critical for the development of the appropriate selecting milieux for pathogens. The microbiota associated with dental caries progression are primarily influenced by the prevailing pH, whereas periodontal diseases and pulpal infection appear to be more dependent on redox potential. Candidiasis results from host factors that favour yeast overgrowth or bacterial suppression caused by antibiotics. Oral health or disease is an adventitious event that results from microbial adaptation to prevailing conditions; prevention of endogenous oral disease can occur only when we realize that ecology is the heart of these host‐symbiont relationships.
Perceived Cognitive Deficits, Emotional Distress and Disability following Whiplash Injury
Authors: Sullivan Michael JL , Hall Erin , Bartolacci Rosita , Sullivan Maureen E , Adams Heather 
Published: March 2016

OBJECTIVES: To describe the pattern of perceived cognitive deficits in patients with whiplash injury, to examine the relation between perceived cognitive deficits and disability, and to examine the determinants of perceived cognitive deficits in patients with whiplash injury.PARTICIPANTS: A total of 81 individuals participated in the study. There were 29 patients (13 men, 16 women) with a diagnosis of whiplash, grade I or II. Patients with work‐related soft‐tissue injuries (n=24) and nonclinical controls (n=28) were included as comparison groups.METHODS: Participants completed measures of perceived cognitive deficits, pain severity, depression, anxiety and pain‐related disability.RESULTS: Both patient groups scored significantly higher than the nonpatient control group on the measure of perceived cognitive deficits, but did not differ significantly from each other. Perceptions of cognitive deficits were significantly correlated with pain‐related disability. A hierarchical regression examining the relative contribution of anxiety, depression and pain showed that only anxiety and depression contributed significant unique variance to the prediction of perceived cognitive deficits.DISCUSSION: The potential benefits of focusing interventions on the management of anxiety and depression in the rehabilitation of patients with whiplash injuries are discussed.
Patterns of Susceptibility in an Outbreak of Bordetella pertussis: Evidence from a Community‐Based Study
Authors: Moore David M , Mathias Richard G 
Published: March 2016

OBJECTIVE: To describe an outbreak of Bordetella pertussis and to assess which factors were associated with the development of clinical pertussis in children and adults during the outbreak.DESIGN: A case series was described to define the epidemiology of the pertussis outbreak. A school‐based survey of children was used to measure the incidence of clinical pertussis over the previous six months. Vaccination records from the local public health facility were used to look at the relationship between age and vaccination parameters, and susceptibility to clinically diagnosed pertussis. A cross‐sectional survey of teachers, parents and some hospital workers was used to assess these associations in adults.SETTING: An outbreak of pertussis in an isolated northern community in British Columbia.POPULATION STUDIED: All children in the community who attend daycare, kindergarten or school, and their parents were surveyed. In addition, some health care workers and mothers of preschool children were surveyed.MAIN RESULTS: A total of 31 suspected cases of pertussis were identified over a three‐month period. Ninety per cent of the affected children who had available vaccination records had received four or five doses of pertussis vaccine. Sixty per cent of the town′s 209 children returned completed surveys. Of these, 69% had available vaccination records. Thirty‐six children (28%) reported symptoms that fit the case definition for pertussis over the previous three months. Attack rates were highest for the group of children aged 10 to 14 years. In a multivariate logistic regression analysis, receiving prophylactic medication and an increased number of years from the last vaccine dose were found to be significant predictors for developing pertussis. Thirty‐four per cent of the estimated 291 adults in the community returned completed surveys. The attack rate of pertussis in the adults was only 9%. Being a member of the school staff and/or having a household contact with pertussis were significant predictors of developing pertussis.Conclusions: Immunity to pertussis appears to wane during childhood. Peak susceptibility appears to be during early adolescence. Adults do not seem to be at greater risk than adolescents for developing the disease, but it seems unlikely that this is due to better immunity. Rather, it is probably related to a lower risk of exposure to pertussis and a lower rate of progression to symptomatic disease when adults are infected.
Faster Onset of Bronchodilation with Formoterol than with Salmeterol in Patients with Stable, Moderate‐Severe Copd: Results of a Randomized, Double‐Blind Clinical Study
Authors: Kottakis John , Cioppa Giovanni Della , Creemers Jacques , Greefhorst Louis , Leclerc Violette , Pistelli Riccardo , Overend Tim , Till Denise , Rapatz Günter , LeGros Vincent , Bouros Demosthenes , Siafakas Nikolaos 
Published: March 2016

OBJECTIVES: To compare the onset and magnitude of bronchodilation after dry powder inhalations of formoterol fumarate (Foradil Aerolizer) versus salmeterol xinofoate (Serevent Diskus) with respect to normalized (*) forced expiratory volume in 1 s area under the curve 0 to 1 h after inhalation (FEV1 AUC*0-1 h).DESIGN: A double‐blind, double‐dummy, multicentre, randomized, placebo controlled, single‐dose, five‐period crossover study.SETTING: Five centres in four countries ‐‐ one centre each in France, Greece and Italy, and two centres in the Netherlands.PATIENTS: Forty‐seven patients aged 42 to 80 years (mean age 63.5 years) with chronic obstructive pulmonary disease (COPD) stage II and III, and mean baseline FEV1 1.17 L (range 0.56 to 1.77 L).INTERVENTIONS: Patients inhaled single doses of formoterol dry powder (12 and 24 μg), single doses of salmeterol (50 and 100 μg) and matching placebo on five separate days.MAIN RESULTS: The estimates of treatment difference in absolute terms (0.086 L) and percentage change from predose baseline (7.8%) for the primary end point, FEV1 AUC*0-1 h, showed that formoterol 12 μg was statistically significantly superior to salmeterol 50 μg (P=0.0044 and P=0.0021, respectively). In addition, both doses of formoterol were statistically superior to placebo for both absolute improvement and percentage change (P=0.0001). The analysis of secondary variables also confirmed the superiority of formoterol over salmeterol.CONCLUSIONS: Formoterol is associated with a faster onset of bronchodilation than salmeterol in patients with COPD.
Hospitalizations for Diarrhea in Quebec Children from 1985 to 1998: Estimates of Rotavirus‐Associated Diarrhea
Authors: Buigues René-Pierre , Duval Bernard , Rochette Louis , Boulianne Nicole , Douville-Fradet Monique , Déry Pierre , Serres Gaston De 
Published: March 2016

OBJECTIVE: To characterize the incidence and duration of hospitalization due to diarrhea and to assess the proportion of hospitalizations that are attributed to rotavirus‐associated diarrhea.DESIGN: Retrospective study of hospitalization data.SETTING: Hospitals located in Quebec.POPULATION STUDIED: Children from one to 59 months of age who were discharged from hospital from April 1, 1985 to March 31, 1998.MAIN RESULTS: There were 63,827 hospitalizations for diarrhea over the study period, for an average of 4910 hospitalizations/year. The epidemic curve showed a periodicity with regular alternation of high and low annual peaks. The number of hospitalizations for rotavirus‐associated diarrhea was estimated according to three different methods. The estimates varied between 1353 and 1849 hospitalizations due to rotavirus‐associated diarrhea/year over the 13‐year period, with good agreement between the results of the three methods for a one‐month to five years of age incidence of 320 hospitalizations for rotavirus‐associated diarrhea/100,000 children. The average duration of hospital stay decreased from 5.2 days in 1985 to 3.3 days in 1998.CONCLUSIONS: The present article shows the importance of diarrhea hospitalizations among children and the alternating peak‐year periodicity.
The Relationship among the Inspiratory Muscle Strength, the Perception of Dyspnea and Inhaled Beta2‐Agonists in Patients with Asthma
Authors: Weiner Paltiel , Magadle Rasmi , Beckerman Marinella , Berar-Yanay Noa 
Published: March 2016

BACKGROUND: It is well documented that the perception of dyspnea (POD), subjectively reported by patients, is related to the activity and strength of the inspiratory muscles, and influences the use of ′as needed′ beta2‐agonists.STUDY OBJECTIVE: To investigate the relationship among the increase in inspiratory muscle strength after specific inspiratory muscle training, beta2‐agonist consumption and the POD in patients with persistent, mild to moderate asthma.METHODS: Inspiratory muscle strength, daily beta2‐agonist consumption and the POD were measured in 30 patients with mild to moderate asthma. Patients were then randomly assigned to two groups: one group received specific inspiratory muscle training until an increase of more than 20 cm H2O was reached, and one group was a control group and received sham training. Inspiratory muscle strength, the POD and daily beta2‐agonist consumption were assessed during and after the training period.RESULTS: There was no good correlation between the baseline maximal inspiratory pressure and the POD, or between the baseline maximal inspiratory pressure and the mean daily beta2‐agonist consumption. However, there was a significant correlation between the POD and the mean daily beta2‐agonist consumption. The increase in inspiratory muscle strength after the inspiratory muscle training was closely correlated with the decrease in the POD (P<0.001) and the decrease in beta2‐agonist consumption (P<0.001).CONCLUSIONS: The present study shows that, in patients with mild to moderate, persistent asthma, there is a correlation between the POD and the mean daily beta2‐agonist consumption. When the inspiratory muscles are strengthened, there is a significant decrease in the POD and in beta2‐agonist consumption.
Guidance on patient Identification and Administration of Recombinant Human Activated protein C for the Treatment of Severe Sepsis
Authors: Garber Gary , Gibney RT Noel , Light Bruce , Martin Claudio , Cunningham Kenneth , Guimond Jean-Gilles , Magder Sheldon , Russell James 
Published: March 2016

Approximately one‐third of cases of severe sepsis result in death. Endogenous activated protein C (ApC) plays a key role in the regulation of the inflammation, fibrinolysis and coagulation associated with severe sepsis. In a recently published phase III trial, protein C Worldwide Evaluation in Severe Sepsis (pROWESS), intravenous administration of recombinant human ApC (rhApC) 24 µg/kg/h for 96 h to patients with severe sepsis resulted in a 6.1% reduction in absolute mortality and a 19.4% reduction in the relative risk of death from any cause within 28 days (number needed to treat = 16). This dose is now being applied in clinical practice.rhApC is recommended for the treatment of severe sepsis (sepsis associated with acute organ dysfunction) occurring as a result of all types of infection (Gram‐negative bacterial, Gram‐positive bacterial and fungal). A panel of Canadian clinicians experienced in the treatment of severe sepsis and the management of critical care patients has developed this consensus document to assist clinicians in appropriate patient selection and management of potential challenges associated with rhApC therapy.
Respiratory Symptoms and Lung Function in Poultry Confinement Workers in Western Canada
Authors: Kirychuk Shelley P , Senthilselvan Ambikaipakan , Dosman James A , Juorio Victor , Feddes John JR , Willson Philip , Classen Henry , Reynolds Stephen J , Guenter Wilhelm , Hurst Thomas S 
Published: March 2016

OBJECTIVE: To determine whether poultry production methods impact respiratory health, and whether poultry farmers have more respiratory symptoms and lower lung function than comparison control groups.DESIGN: Cross‐sectional study.SETTING: Provinces of Saskatchewan, Alberta and Manitoba during the winters of 1997 to 1999. POPULATION: Three hundred three poultry workers, 241 grain farmers and 206 nonfarming control subjects were studied. Poultry workers were further classified according to the poultry housing type in which they worked, ie, workers who worked with poultry raised on the floor (floor‐based operations), which included broiler/roaster, broiler/breeder and turkey operations (n=181), and workers who worked with poultry raised in a caged setting (cage‐based operations), which included egg operations (n=122).INTERVENTIONS: Subjects completed a respiratory health questionnaire, which included questions on the poultry operation and work habits, and participated in lung function testing.MAIN RESULTS: Overall, this study indicated that poultry workers report greater prevalences of current and chronic respiratory symptoms than control populations, and that the type of production method (cage‐based versus floor‐based) appears to influence the prevalence of respiratory symptoms and lung function values. Workers from cage‐based operations report greater prevalences of current cough and wheeze, as well as lower mean values for forced expiratory volume in the first second (FEV1), forced expiratory flow at 25% to 75% of vital capacity (FEF25‐75) and FEV1/FVC than workers from floor‐based facilities. Workers from cage‐based facilities also reported greater prevalences of current and chronic cough and phlegm, as well as significantly lower FEF25‐75 and FEV1/FVC values than nonfarming control subjects. Furthermore, grain farmers had lower FVC and FEV1 values than nonfarmers.CONCLUSIONS: The results suggest that the type of poultry production system (ie, floor‐ versus cage‐based) appears to have an effect on the respiratory response of workers from these facilities. Further studies are required to understand the physiological mechanisms of respiratory dysfunction and the relationships concerning workplace exposure among poultry workers.