bluuebunny/crossref_metadata_2025_split huggingface dataset:
Seasonal Changes in Lung Function in a Farming Population
Authors: Senthilselvan Ambikaipakan , Dosman James A , Semchuk Karen M , McDuffie Helen H , Cessna Allan J , Irviine Donald G , Crossley Margaret FO , Rosenberg Alan 
Published: March 2016

OBJECTIVE: To assess the changes in respiratory health from winter to summer seasons in a rural population.DESIGN: A longitudinal design was used in the study.SETTING: A population‐based study was conducted as part of the Environmental Pesticide Exposure and Human Health component of the Prairie Ecosystem Study (PECOS) in southwestern Saskatchewan.PATIENTS: In the winter season, 358 patients participated in the study. Of these patients, 234 returned for the second assessment during the summer season. After excluding 34 children aged 17 years and under, 200 adult patients were available for analysis.MEASUREMENTS: Questionnaires were used to obtain information on demographic factors, smoking habits, occupational and environmental exposures, and respiratory conditions. Pulmonary function measurements were obtained using a volume displacement spirometer.RESULTS: Mean ages (± SD) of the 106 men and 94 women participating in the study were 50.1±13.3 and 49.0±13.1 years, respectively. Mean percentage changes in maximal midexpiratory flow rate from winter to summer assessments indicated an improvement for town residents and a decline for farm residents. Mean percentage changes in the ratio of forced expiratory volume in 1 s to forced vital capacity indicated an improvement for town residents who were not engaged in farming, and increasing declines for town residents engaged in farming, farm residents not engaged in farming and farm residents engaged in farming.CONCLUSIONS: Seasonal changes occurred in measurements of pulmonary function between winter and summer seasons; these changes may be related to the environmental or occupational exposures experienced by the participants during the study.
An Outbreak of Cyclosporiasis in 1996 Associated with Consumption of Fresh Berries ‐ Ontario
Authors: Manuel DG , Neamatullah S , Shahin R , Reymond D , Keystone J , Carlson J , Ber C Le , Herwaldt BL , Werker DH 
Published: March 2016

BACKGROUND: A large foodborne outbreak of cyclosporiasis occurred in North America in 1996. An index cluster of cases associated with a catered event on May 11, 1996, in Ontario sparked the recognition of this outbreak in Canada.OBJECTIVES: To describe the Ontario experience with the North American outbreak of cyclosporiasis in 1996.PATIENTS AND METHODS: Public health units investigated the index and subsequent event‐associated clusters. Investigations included retrospective cohort studies of clusters, traceback of suspect foods and a case‐control study of sporadic cases. These activities, coordinated with those in the United States, were part of an international investigation.RESULTS: In Ontario, 232 cases of cyclosporiasis (20 laboratory‐confirmed and 72 clinically defined cases associated with seven events plus 140 additional laboratory‐confirmed sporadic cases) were identified between May 1 and July 30, 1996. For the index cluster, a strawberry flan with raspberries and blueberries was the only significant exposure (relative risk 2.16, P=0.02). Fresh berries were served at all seven events associated with clusters of cases. Raspberries were definitely served at three events, possibly served at three events, and not served at one event. Only imported berries were available in Ontario in May 1996, when initial clusters and sporadic cases were identified. The raspberries served at the two events with well documented traceback data came from Guatemala. Univariate analyses of the matched case‐control study demonstrated that illness was associated with consumption of raspberries (matched odds ratio 21.0, 95% CI 3.48 to 448) and strawberries (matched odds ratio 28.5, 95% CI 4.02 to 478). Further evidence amassed by the international investigation compellingly implicated Guatemalan raspberries as the vehicle of the outbreak.CONCLUSION: Cyclosporiasis may be acquired domestically from the consumption of contaminated produce. The scope and vehicle of this international foodborne outbreak were recognized through a coordinated public health response.
Gastroesophageal Reflux and Asthma: Can the Paradox Be Explained?
Authors: Field Stephen K 
Published: March 2016

BACKGROUND AND OBJECTIVE: The reported effects of asthma on gastroesophageal reflux (GER), effects of GER on asthma and the effects of antireflux therapy on asthma are conflicting. The purpose of this paper is to review the evidence for a relationship between the two conditions.DESIGN: A search of the MEDLINE 1966 to 1999 database, combining the terms GER and asthma, was used to identify studies of the effects of acid perfusion of the esophagus, the physiological equivalent of GER and the effects of both medical and surgical antireflux therapy on asthma. Bibliographies of the identified papers were also reviewed.MAIN RESULTS: The collected evidence suggests that GER causes asthma symptoms but has minimal effects on pulmonary function. Both medical and surgical antireflux therapy can improve asthma symptoms and asthma medication requirements without improving pulmonary function. The paradox of GER causing symptoms without affecting pulmonary function may be because of the retrosternal discomfort that accompanies GER increases minute ventilation and respiratory sensation.CONCLUSIONS: Despite an extensive body of literature, many questions remain about the relationship between GER and asthma. A review of the data suggests a strong association between the two conditions, and that GER worsens asthma symptoms without affecting pulmonary function. Asymptomatic GER does not worsen asthma. Antireflux therapy may have a role in asthma patients with symptomatic GER, possibly being most beneficial for those with reflux‐associated respiratory symptoms. Unfortunately, many studies contain flaws such as a lack of controls and small sample sizes. Further properly designed controlled trials, including ones that measure the effects of GER and antireflux therapy on quality of life, are needed to understand better the role of GER in asthma.
Reactogenicity to a Live Attenuated Varicella Vaccine in Canadian Children
Authors: Diaz-Mitoma Francisco , Halperin Scott A , Scheifele David 
Published: March 2016

OBJECTIVE: To assess the reactogenicity and safety of a thermostable, high titre, varicella vaccine in healthy infants and children.DESIGN: Open study of 505 children monitored for 42 days after vaccination.SETTING: Three urban Canadian centres (Halifax, Ottawa and Vancouver).PARTICIPANTS: 505 healthy children one to 12 years of age were enrolled and 504 completed the study. All were susceptible to varicella by history.INTERVENTIONS: All participants received one dose of live attenuated varicella vaccine (1×104.5 plaque forming units/dose) subcutaneously.MAIN OUTCOME MEASURES: The children were monitored from the day of vaccine administration (day 0) until day 42. All local and general symptoms and signs were recorded on diary cards by the patients? parents, who were encouraged to fill in the cards on days 2 to 3 and 18 to 24 via telephone calls from study personnel.RESULTS: Most of the symptoms noted after vaccine administration were mild and transient, and all resolved within the respective follow‐up periods. Injection site symptoms included pain (17.5%, 13.9% and 30.4% in centres 1, 2 and 3 respectively), redness (21.1%, 32.1% and 48.8%) and swelling (7%, 10.3% and 29.2%). The general symptoms reported were fever 37.5°Cor higher (3.5%, 4.8% and 3.0%) and varicella‐like rashes (6.4%, 2.4% and 0%). Two subjects had severe symptoms (one with cervical lymphadenopathy, and one with a fever higher than 39°C) probably related to vaccine administration. No serious adverse events were reported during the entire study.CONCLUSION: The vaccine was well tolerated.
A Descriptive Study of 100 Patients Undergoing Palliative Nerve Blocks for Chronic Intractable Headache and Neck Ache
Authors: Rothbart Peter , Fiedler Katherine , Gale George D , Nussbaum David , Hendlerb Nelson 
Published: March 2016

OBJECTIVE: To ascertain whether repeated (palliative) nerve blocks over a long period of time provide benefit to patients with chronic intractable headache and neck ache.SUBJECTS AND METHODS: One hundred patients who were receiving repeated nerve blocks as part of their pain management regimen completed a structured interview questionnaire. The patients had all been investigated and received a diagnosis of cervicogenic headache. Changes in pain rating, depression rating, anxiety rating, activities of daily living and quality of life were measured.RESULTS: After each nerve block session, the subjects reported significant improvement in their levels of pain, depression and anxiety. They also reported improvements in their quality of life and in their ability to participate in activities of daily living.CONCLUSIONS: Repeated (palliative) nerve blocks appear to be a useful modality in the armamentarium of pain control techniques for patients with chronic intractable headache and neck ache of cervical origin.
Neurogenic Tumors of the Mediastinum: A Report of 60 Cases
Authors: Topçu Salih , Alper Aysin , Gülhan Erkmen , Koçyigit Osman , Tastepe Irfan , Çetin Güven 
Published: March 2016

OBJECTIVES: To analyze retrospectively 60 patients (13 infants and children, 47 adults ‐ 21 men and 39 women) with mediastinal neurogenic tumours admitted to Atatürk Centre for Chest Disease and Chest Surgery, Ankara, Turkey between 1988 and 1999. This comprised 21.2% of 283 patients who had surgical operations for all mediastinal masses during the same period.PATIENTS AND METHODS: The patients ranged from four to 67 years of age. Thirteen patients were younger than 15 years and 47 were 15 years of age or older. Medical records were reviewed for demographic data, clinical presentation, diagnostic investigations, operative procedures, and tumour location and invasion. Postoperative morbidity and mortality were noted as well as long term follow‐up. The clinical investigations included chest x‐ray and computed tomography of the thorax in all patients, and spinal magnetic resonance imaging and bronchoscopical examination in some. Clinical variables were compared.RESULTS: The tumours had the following characteristics: 42 (70%) were nerve sheath tumours; 15 (25%) were autonomic ganglion tumours; two (3.6%) were paragangliomas; and one (1.4%) was a malignant peripheral neuroectodermal tumour (Askin′s tumour). Nerve cell tumours comprised the majority of tumours in infants and children (nine of 13, 69%), whereas the nerve sheath tumours were most frequent in adults (39 of 47, 83%). There were 48 benign and 12 (20%) malignant tumours when all age groups were considered; the malignancy rate was 61.5% (eight of 13) in children and 8.5% (four of 47, P<0.05) in adults. All patients were operated via a posterolateral thoracotomy. Surgical resection of the tumour was complete in 56 of 60 patients (93.3%). Resection of malignant tumours was grossly incomplete in four cases (four of 12, 33.3%). All benign tumours were totally excised. There were two major complications (respiratory failure and pulmonary emboli) and 14 minor complications in the perioperative period. The mean follow‐up period was five years and seven months. Tumours recurred in 5.3% (three of 56) of patients who had a complete resection initially. There were no late deaths related to benign tumours.CONCLUSIONS: Complete resection of tumours can be performed safely by a thoracotomy approach and is important for achieving satisfactory long term survival in most mediastinal neurogenic tumours.
A 5‐HT Antagonist (UP 26‐91) versus Codeine and Placebo in a Human Experimental Pain Study
Authors: Arendt-Nielsen Lars , Pedersen Poul , Poulsen Lars , Andersen Ole Kæseler , Bjerring Peter , Coste Isabelle , Insuasty Jorge , Sindrup Søren , Drewes Asbjørn Mohr 
Published: March 2016

BACKGROUND: This double‐blind, randomized, crossover study compared the potential analgesic effect of the serotonin receptor antagonist UP 26‐91 (50 mg, 150 mg and 300 mg) with that of codeine (100 mg) and placebo by use of different human experimental pain models.SUBJECTS AND METHODS: In experiment 1, pain detection and tolerance thresholds to heat, pressure and pain ratings during the cold pressor test were measured. In experiment 2, the pain threshold to single and repetitive (temporal summation) electrical sural nerve stimulation, and the pain intensity on a visual analogue scale to supra pain threshold electrical stimulation (stimulus‐response‐function) were measured. Tests were performed before, and 1, 2 and 6 h after drug administration.RESULTS: UP 26‐91 did not show a marked effect on the experimental pain tests. Most of the variables tended to show a better effect from codeine than from placebo, but statistical significance for peak pain was only reached during the cold pressor test (P=0.011).CONCLUSIONS: In the present doses, the serotonin antagonist UP 26‐91 had no effect on the experimental pain models applied.
The Impact of Health Care Restructuring on Nosocomially Acquired Blood Stream Infections
Authors: Taylor Geoffrey D , McKenzie Margare , Kirkland Teresa , Buchanan-Chell Maureen , Wiens Rhoda 
Published: March 2016

OBJECTIVE: To assess the impact of the health care restructuring, which occurred in Alberta in 1995, on the occurrence of nosocomial blood stream infection and risk factors for these infections at the University of Alberta Hospital.PATIENTS AND METHODS: Changes in patient population, hospital bed numbers, admissions and hospital days for 1993 and 1994 (1993/94) were compared with those for 1996 and 1997(1996/97). Central venous catheter (CVC) use in intensive care units (ICU), days of total parenteral nutrition (TPN) and hemodialysis were compared for the two time periods. Prospectively collected data obtained by monitoring blood culture results on nosocomial blood stream infections in 1993/94 were compared with those obtained in 1996/97.RESULTS: Hospital bed number fell by 10% between 1993/94 and 1996/97. Annual admissions fell by 19% and patient days by 17%. Some services markedly increased patient days (neurosurgery 49%, nephrology 30%, orthopedic surgery 24%), and others markedly reduced patient days (obstetrics and gynecology 99%, ophthalmology 100%, adult medicine 41%, general paediatrics 38%). ICU use of CVCs increased by 41%, TPN days increased by 25% and hemodialysis runs increased by 9%. Annual nosocomial blood stream infections increased by 31% and the annual rate per 10,000 patient days increased by 60%. TPN‐related blood stream infection rates and ICU CVC infection rates did not change from 1993/94 to 1996/97.CONCLUSIONS: Hospital restructuring has been associated with a 31% increase in nosocomial blood stream infection number and a 60% increase in rate. The increase has been associated with a change in patient populations and increases in risk factors for blood stream infection.
Asthma Education and Management Programs in Canada
Authors: Cowie Robert L , Cicutto Lisa , Boulet Louis-Philippe , the Patient Education Program Committee, Canadian Network Fo  
Published: March 2016

OBJECTIVE: To establish the number and type of asthma patient education programs throughout Canada.DESIGN: National survey.SETTING: Canada.METHODS: Over a three‐year period, contact was made with individuals and groups offering educational services for patients with asthma. Education given as part of a physician′s consultation or a pharmacist′s dispensing of medications for asthma was not considered a patient education program for the purposes of the survey. Contact was initially established by asking staff from well known asthma programs to provide lists of other such programs in their provinces or regions. Asthma programs were also identified from notices presented at Canada′s Third and Fourth National Conferences on Asthma and Education. Lung associations, lay organizations and industry representatives affiliated with the Canadian Network for Asthma Care helped to supplement the list. Once identified, each patient education program was contacted by telephone and by mail to complete a 26‐item questionnaire about their program. The province of Quebec was not included in the survey because it already had a province‐wide, structured asthma education program and register.RESULTS: Seventy‐four asthma education and management programs were identified outside Quebec. Staff in these programs were registered nurses (n=46), respiratory therapists (n=48) and other health professionals (n=21). Forty‐one programs stated that at least one member of their staff had been trained as an asthma educator. In 71 programs, the initial patient encounter was of at least one hour′s duration. Physician referral was required by 41 programs. The province of Quebec has a joint asthma education program provided by 114 asthma education centres throughout the province under the umbrella of the Quebec Asthma Education Network (QAEN). This comprehensive program is provided in hospitals and community centres by specialized educators ‐ nurses, pharmacists or respiratory therapists ‐ to patients referred by their physicians.CONCLUSIONS: A three‐year search for asthma education programs in Canada identified 74 patient education programs (outside Quebec) for an asthma population estimated to exceed 1.2 million. For the province of Quebec, an integrated asthma education program is provided through a network of 114 education centres ‐ the QAEN. The present survey shows that there has been progress in establishing asthma education programs in Canada, although there are significant regional differences in the availability of such programs.
Comparing Pressures Required to Abolish Snoring and Sleep Apnea
Authors: Hoffstein V , Oliver Z 
Published: March 2016

OBJECTIVE: Snoring and obstructive sleep apnea share similar pathogenesis and similar response to treatment with continuous positive airway pressure (CPAP). The purpose of this study was to compare pressures required to abolish apneas (POSA) with pressures required to abolish snoring (PSNOR).DESIGN: Cross‐sectional, nonrandomized cohort study.SETTING: Sleep disorders clinic at St Michael′s Hospital ‐ a tertiary referral centre and a teaching hospital of the University of Toronto, Toronto, Ontario.POPULATION STUDIED: Unselected consecutive 441 patients with confirmed sleep apnea who were undergoing a CPAP titration study in the sleep laboratory.INTERVENTIONS: Nocturnal polysomnography using CPAP titration protocol, which required incremental increases in pressure until snoring and apnea were abolished or a maximum pressure of 16 cm H2O was attained. PSNOR and POSA were recorded and compared.RESULTS: Mean (± SD) pressures required to abolish snoring and apnea were: PSNOR 8.3±2.57 cm H2O and POSA 7.9±2.72 cm H2O (P<0.0001). In 75% of patients, the PSNOR was within ±1 cm H2O of the POSA; in 92%, it was within ±2 cm H2O; and in 97%, it was within ±3 cm H2O.CONCLUSIONS: Empirically increasing pressure by 2 cm H2O in patients on CPAP who continue to snore may abolish snoring and apnea without the necessity of another titration study.
The Classification of Patients with Chronic Pain: Age and Sex Differences
Authors: Cook Andrew J , Chastain Dania C 
Published: March 2016

OBJECTIVE: To further develop an empirically based classification system for chronic pain patients through the examination of age and sex differences, and incorporation of pain duration in the grouping algorithm.SUBJECTS: Three hundred seventy‐four chronic pain patients (300 aged 13 to 59 years; 74 aged 60 to 89 years) assessed at an outpatient, multidisciplinary pain management centre.METHODS: Patients completed measures of demographic and descriptive information, pain intensity (box rating scale), perceived disability (modified Pain Disability Index) and affective distress (Symptom Checklist‐90 Revised) before multidisciplinary treatment. Standardized scores from the assessment measures were entered into a series of hierarchical, multivariate cluster analyses to identify underlying patient subgroups.RESULTS: Age‐based patient groupings from prior research were partially replicated. Significant differences in clinical presentations were observed across age and sex groups. Pain duration was found to make an important contribution to the patient groupings. ′Good control′ (low pain, disability, distress) and variants of ′chronic pain syndrome′ (elevated pain, disability, distress) groupings were identified across all analyses. Two variants of a ′stoic′ profile were identified among older patients, with low levels of distress relative to pain and perceived disability. One of these profiles was associated with long pain duration and was found only among males. Several unique clinical profiles were identified for female patients.CONCLUSIONS: There are important age and sex differences in the clinical presentations of chronic pain patients. Some older patients present with unique clinical profiles that may reflect cohort differences, and/or physiological or psychological adjustment processes. There appears to be a greater number of distinct chronic pain presentations among females. Research on the classification of chronic pain patients within homogeneous diagnostic subgroups is needed.
The Emerging Epidemiology of VRE in Canada: Results of the CNISP Passive Reporting Network, 1994 to 1998
Authors: Conly John M , Ofner-Agostini Marianna , Paton Shirley , Johnston Lynn , Mulvey Michael , Kureishi Amar , Nicolle Lindsay , Matlow Anne , the Canadian Hospital Epidemiology Committee  , the Canadian Nosocomial Infection Surveillance Program  
Published: March 2016

OBJECTIVE: To provide a rapid and efficient means of collecting descriptive epidemiological data on occurrences of vancomycin‐resistant enterococcus (VRE) in Canada.DESIGN AND METHODS: Passive reporting of data on individual or cluster occurrences of VRE using a one‐page surveillance form.SETTING: The surveillance form was periodically distributed to all Canadian Hospital Epidemiology Committee members, Community and Hospital Infection Control Association members, L′Association des professionnels pour la prevention des infections members and provincial laboratories, representing 650 health care facilities across Canada.PATIENTS: Patients colonized or infected with VRE within Canadian health care facilities.RESULTS: Until the end of 1998, 263 reports of VRE were received from 113 health care facilities in 10 provinces, comprising a total of 1315 cases of VRE, with 1246 cases colonized (94.7%), 61 infected (4.6%)and eight of unknown status. (0.6%). VRE occurrences were reported in 56% of acute care teaching facilities and 38% of acute care community facilities. All facilities of more than 800 beds reported VRE occurences compared with only 10% of facilities with less than 200 beds (r2=0.86). Medical and surgical wards accounted for 51.4% of the reported VRE occurences. Sixty‐five (24.7%) reports indicated an index case was from a foreign country, with 85.2% from the United States and 14.8% from other countries. Some type of screening was conducted in 50% of the sites.CONCLUSIONS: A VRE passive reporting network provided a rapid and efficient means of providing data on the evolving epidemiology of VRE in Canada.