bluuebunny/crossref_metadata_2025_split huggingface dataset:
Seroprevalence of Cytomegalovirus, Toxoplasma gondii, Syphilis, and Hepatitis B and C Virus Infections in a Regional Population Seropositive for HIV Infection
Authors: Johns Daniel G , Gill M John 
Published: March 2016

OBJECTIVE: To determine the prevalence of exposure to cytomegalovirus (CMV), Toxoplasma gondii, syphilis, hepatitis B virus (HBV) and hepatitis C virus (HCV) in a large, well characterized, regional population presenting for human immunodeficency virus (HIV) care.DESIGN: Demographic and serological data compiled prospectively in a relational database used for routine patient care. Results were analyzed for statistically significant trends within demographic subpopulations known to be at risk of such infections.PATIENTS AND SETTING: A total of 1274 persons with documented HIV infection in southern Alberta have sought medical care since 1985. Serological status to CMV, T gondii, syphilis, HBV and HCV infections were routinely requested as part of the initial assessment. All patients with serological results available were included in the analysis.RESULTS: CMV infection was found in 84.1% of patients. A lower prevalence of CMV infection in those under 30 yeasr old (P<0.001), intravenous drug users (IVDUs) (P=0.001) and in patients with transfusion‐acquired HIV (P<0.001) was seen. T gondii seropositivity was found in 10.6% of patients, with an increased risk of seropositivity in those born outside of Canada (P<0.001). Syphilis seropositivity was present in 5.1% of patients, with a higher prevalence in gay males (P=0.1). HBV carrier status was noted in 8.0% of patients, with males having an increased risk (P=0.025). Since 1990, there has been a 17.6% prevalence of HCV, predominantly in IVDUs (P<0.001).CONCLUSION: Seroprevalence to common pathogens in HIV disease varies significantly among subpopulations, necessitating individual testing.
Prevalence of Sleep Disordered Breathing in a Population of Canadian Grainworkers
Authors: Keenan Sean P , Ferguson Kathleen A , Chan-Yeung Moira , Fleetham John A 
Published: March 2016

OBJECTIVES: To determine the prevalence of sleep disordered breathing (SDB) in a Canadian population of industrial workers (grainworkers). To determine the clinical features that are predictive of SDB and the validity of self‐reported snoring.DESIGN: Cross‐sectional, interviewer‐administered questionnaire with selective recruitment of subjects for home sleep monitoring.SETTING: Community setting, Vancouver, British Columbia.PARTICIPANTS: All male grainworkers at grain elevators in Vancouver were approached for completion of a questionnaire. Eighty‐three per cent of 524 subjects completed the questionnaire and were divided by presumed risk for SDB into four groups. All subjects in the highest risk group (group 1‐ frequent snoring and witnessed apneas) and a random sample of 40 subjects in the other three groups (group 2 ‐ frequent snoring without witnessed apneas; group 3 ‐ infrequent snoring rare; group 4 ‐ nonsnoring) were approached for home sleep monitoring and 42% consented.INTERVENTIONS: Interviewer‐administered questionnaire and home sleep monitoring.RESULTS: The overall prevalence of SDB in this relatively overweight group was estimated to be 25%, with a stepwise increase from group 4 to group 1 (7%, 29%, 40%, 60%). Presence of snoring and witnessed apneas, a greater body‐mass index and a larger neck circumference were associated with SDB. Self‐reported snoring was not found to be predictive.CONCLUSIONS: This first study of the prevalence of SDB in Canada suggests that SDB is at least as prevalent in Canada as in other industrialized nations and may actually be more common than previously thought. Further studies are required to determine the morbidity, mortality and economic loss associated with SDB in industrial workers.
Cognitive Functioning and Pain Reactions in Hospitalized Elders
Authors: Hadjistvropoulos Thomas , LaChapelle Diane , MacLeod Farley , Hale Carla , O’Rourke Norm , Craig Kenneth D 
Published: March 2016

BACKGROUND: Objectively coded facial activity provides a useful index of pain among elders who have difficulty in reporting pain because of cognitive impairments. However, limitations of previous research include no direct assessment of participants′ level of cognitive impairment; no comparison of the reactions of elders with cognitive impairments with those of nonimpaired elders; observers′ expectations about pain levels could have influenced judgements about the severity of pain experienced when global rather than objectively coded measures were used because the painful medical procedure was visible on film.OBJECTIVE: To extend previous findings by incorporating improvements in design and methodology in response to the aforementioned limitations.PARTICIPANTS: Fifty‐nine in‐patients with a mean age of 73 years.METHODS: Facial reactions were filmed during routine blood tests and coded objectively using the Facial Action Coding System (FACS). Observer ratings of pain were also obtained.RESULTS: FACS indexes revealed substantial changes from baseline to venepuncture indiscriminate of whether elders were cognitively impaired. Furthermore, these changes were apparent to both nurse and student observers although the nurses rated the pain displayed by the patients as being lower.CONCLUSION: After addressing limitations of previous work in this area, the validity of nonverbal indexes of pain in the assessment of elders with cognitive impairments was demonstrated. Such indexes are uniquely suited as outcome measures within the context of clinical trial methodology.
Development of the Pain Appraisal Inventory: Psychometric Properties
Authors: Unruh Anita M , Ritchie Judith A 
Published: March 2016

OBJECTIVE: To discuss the development, content validity, internal consistency and factor structure of a Pain Appraisal Inventory (PAI).DESIGN: A PAI was constructed with a threat appraisal scale and a challenge appraisal scale. Content validity was demonstrated with a panel of health experts. A sample of 309 individuals participated in a random community survey about troublesome pain in the two weeks preceding the telephone interview.RESULTS: Confirmatory factor analysis produced a two‐factor structure comprising threat appraisal and challenge appraisal. Cronbach′s alphas were 0.86 for the threat scale and 0.81 for the challenge scale. Threat appraisal was correlated with respondents′ scores on the McGill Pain Questionnaire, the Pain Disability Index, and measures of pain intensity and emotional upset due to pain. Challenge appraisal was reported by only 14% of the sample and limited the usefulness of statistical analyses for this variable.CONCLUSIONS: Appraisal of pain may be key to the underlying overall adjustment of an individual to pain. The PAI distinguishes between threat and challenge appraisal of pain, and may have considerable utility for the measurement of appraisal in experimental, epidemiological and clinical pain research.
Clinical, Physiological and Radiological Features in Asthma with Incomplete Reversibility of Airflow Obstruction Compared with Those of COPD
Authors: Boulet Louis-Philippe , Turcotte Hélène , Hudon Catherine , Carrier Guy , Maltais François 
Published: March 2016

OBJECTIVES: To compare clinical features, pulmonary function and high-resolution computed chest tomography (HRCT) findings of asthmatic patients with a component of incomplete reversibility of airflow obstruction (AIRAO) with those of patients with smoking-induced chronic obstructive pulmonary disease (COPD).METHODS: Thirteen patients with COPD (six males and seven females, mean age 59 years, mean smoking 50.5 pack-years) and 14 patients with AIRAO (six males and eight females, mean age 52 years) despite optimal treatment, with no significant smoking history (mean 1.5 pack-years) and no significant environmental exposure or any other respiratory disease, were studied. Patients had respiratory questionnaires, pulmonary function tests, allergy skin-prick tests and an HRCT to evaluate possible parenchymal or bronchial abnormalities. Eight patients in each group also had exercise tests. All patients were stable at the time of the study.RESULTS: As expected, atopy was more prevalent in AIRAO (n=13) than in COPD (n=1) patients. Mean forced expiratory volume in 1 s (FEV1) and forced vital capacity (percentage of predicted value) were 39% and 61%, respectively, in COPD patients and 49% and 71%, respectively, in AIRAO patients; FEV1improved by 18% in COPD patients and and by 22% in AIRAO patients after use of inhaled salbutamol. Mean functional residual capacity was greater in COPD patients than in AIRAO patients (178% versus 144% of the predicted value), while the mean carbon monoxide diffusing capacity of the lungs (DLCO) was lower in COPD patients than in AIRAO patients (62% versus 89% of the predicted value). Exercise tolerance was similar in both groups, as were postexercise changes in arterial oxygen pressure (PaO2). Emphysematous changes were observed in COPD patients and AIRAO patients who had evaluable HRCTs (10 versus two patients, although very mild in asthma), bronchial dilations (zero versus six patients), bronchial wall thickening (two versus eight patients) and an acinar pattern (one versus five patients). Mean thickness of the large airway wall to outer diameter (intermediary bronchus) ratio was 0.176 in COPD and 0.183 in AIRAO (P>0.05).CONCLUSIONS: Asthma may lead to physiological features similar to COPD but may be distinguished by demonstrating a preserved DLCO and a higher ratio of airway to parenchymal abnormalities on HRCT scan.
Predictors of Longitudinal Changes in Pulmonary Function among Swine Confinement Workers
Authors: Kirychuk Shelley P , Senthilselvan Ambikaipakan , Dosman James A , Zhou Chen , Barber Ernie M , Rhodes Chuck S , Hurst Tom S 
Published: March 2016

OBJECTIVE: To determine predictors of longitudinal changes in pulmonary function in swine confinement workers.DESIGN: Longitudinal study conducted from November 1989 to June 1991 and January 1994 to May 1995.SETTING: Swine confinement workers in Saskatchewan.PARTICIPANTS: Forty‐two swine confinement workers who were studied in 1989/90 and studied again in 1994/95.RESULTS: Of 98 male swine confinement workers (mean age ± SD 36.3±11.1 years) studied at baseline, 42 were studied again five years following. Complete information on baseline across‐shift pulmonary function (preshift forced expiratory volume in 1 s [FEV1], forced vital capacity [FVC], and every 2 h FEV1 and FVC during the shift), and five‐year follow‐up pulmonary function (with FEV1 and FVC) were available on all 42 subjects. Mean across‐shift changes (preshift measurement to last measurement of the day) at baseline were ‐159.8±61.7 mL in FEV1 and ‐35.3±65.6 mL in FVC. Mean annual rate change between baseline and follow‐up for FEV1 was ‐53.9±61.7 mL/year and for FVC ‐48.9±71.6 mL/year. After adjusting for age, height, smoking and hours spent in the barn, the baseline across‐shift change in FEV1 and FVC was a significant predictor of annual rate change in FEV1 (P=0.01) and FVC (P=0.02), respectively. To determine the effects of indoor air quality on longitudinal lung function decline, indoor air environmental measurements were analysed. Complete information on respiratory health and indoor air quality was available on 34 of the 42 subjects. Assessment of indoor environment of swine barns included a summer and winter measurement for airborne dust, gases and endotoxin levels. After adjusting for age, height, smoking, ammonia and hours spent in the barn, the endotoxin level (Eu/mg)was a significant predictor of annual rate change for FEV1 but not FVC.CONCLUSIONS: These results suggest that shift change is an important predictor of longitudinal changes in lung function in swine confinement workers and that endotoxin exposures may mediate annual decline in FEV1 in these workers.
Utility of Bronchoscopy with Bronchoalveolar Lavage in Diagnosing Pulmonary Infection in Hospitalized Patients with Underlying Malignancy
Authors: Chow CW , McGeer A , Kasupski G , Senathiragah N , Gallant P , Chan CK 
Published: March 2016

Objectives: To evaluate the clinical utility of bronchoscopy with bronchoalveolar lavage (BAL) for diagnosing pulmonary infection in patients with underlying malignancy and to evaluate the impact of positive microbiology results on antimicrobial therapy.Design: Retrospective chart review.Setting: University‐affiliated downtown teaching hospital in Toronto.Patient population: All patients who underwent bronchoscopy with BAL from November 1990 to September 1992.Results: One hundred and thirty‐nine BALs were performed, of which 82 (59%) were positive for microorganisms. These 82 charts were reviewed. The main underlying diagnosis was hemotogenous malignancy (70 of 82). Primary indiction for bronchoscopy was the presence of pulmonary symptoms with or without radiographic abnormality. Common organisms identified were fungi (n=50), primarily Candida albicans and cytomegalovirus (CMV) (27), and 16 ‘usual’ pathogens. Less common were herpes simplex virus (six), Pneumoncystis carinii pneumonia (PCP) (four), Legionella pneumoniae and Mycoplasma pneumoniae (one each). Eighty‐seven per cent of patients were on broad spectrum antibiotics at the time of bronchoscopy. Although antiibiotic therapy was altered postbronchoscopy in 47 of the 82 cases, only 26 instances could be directly attributed to the results of BAL. Pathogens that commonly initiated specific therapy were CMV (16 of 27) and PCP (three of four). Diagnostic yield was highest in allogenic bone marrow transplant recipients (BMT). They comprised only 49% (40 of 82) of the cases but accounted for 85% (22 of 26) of those whose therapy was directly altered by the results of BAL. Of these 22 cases, 20 were attributed to the isolation of CMV.Conclusions: The overall raw diagnostic yield from bronchoscopy with BAL was high at 59%. Of those with positive BAL cultures, a change in antimicrobial management occurred in 32% of cases. In a patient poulation with underlying hematogenous malignancy, particularly BMT recipients, bronchoscopy with BAL is useful for a specfic diagnosis of pulmonary infection.
Cost Effectiveness of Transbronchial Needle Aspiration
Authors: Crocket Jennifer A , Wong Eric YL , Lien Dale C , Nguyen Khanh Gia , Chaput Michelle R , McNamee Ciaran 
Published: March 2016

OBJECTIVE: To evaluate the yield and cost effectiveness of transbronchial needle aspiration (TBNA) in the assessment of mediastinal and/or hilar lymphadenopathy.DESIGN: Retrospective study.SETTING: A university hospital.POPULATION STUDIED: Ninety‐six patients referred for bronchoscopy with computed tomographic evidence of significant mediastinal or hilar adenopathy.RESULTS: Ninety‐nine patient records were reviewed. Three patients had two separate bronchoscopy procedures. TBNA was positive in 42 patients (44%) and negative in 54 patients. Of the 42 patients with a positive aspirate, 40 had malignant cytology and two had cells consistent with benign disease. The positive TBNA result altered management in 22 of 40 patients with malignant disease and one of two patients with benign disease, thereby avoiding further diagnostic procedures. The cost of these subsequent procedures was estimated at $27,335. No complications related to TBNA were documented.CONCLUSIONS: TBNA is a high‐yield, safe and cost effective procedure for the diagnosis and staging of bronchogenic cancer.
Nicotine Microaerosol Inhaler
Authors: Andrus Paul G , Rhem Rod , Rosenfeld Jack , Dolovich Myrna B 
Published: March 2016

OBJECTIVE: To measure the droplet size distribution of a nicotine pressurized metered‐dose inhaler using a nicotine in ethanol solution formulation with hydrofluoroalkane as propellant.MATERIALS AND METHODS: Sizing was performed at room temperature by multistage liquid impinger and quartz crystal impactor.RESULTS: The mass median aerodynamic diameter of the nicotine aerosol produced was measured at 1.6 μm by multistage liquid impinger and 1.5 μm by quartz crystal impactor.CONCLUSIONS: The inhaler formulation used produces a microaerosol of sufficiently fine droplet size that mimics the puff‐by‐puff pulmonary arterial bolus nicotine delivery of tobacco smoke. The absence of combustion products such as heat, carcinogens and carbon monoxide permits safer nicotine delivery via the inhaler than is possible via smoked tobacco.
Infectious Diseases on a General Internal Medicine Clinical Teaching Unit
Authors: Nicolle LE , Uhanova J , Orr P , Kraut A , Van Ameyde K , Dow G 
Published: March 2016

OBJECTIVE: To describe the spectrum of infectious diseases and characteristics of patients admitted with infections on a general internal medicine clinical teaching unit.DESIGN: Retrospective review of patients admitted to one general internal medicine unit at a tertiary care teaching hospital during two three‐month periods.METHODS: Data collection through chart review.OUTCOME MEASURES: Descriptive analysis of types of infections: therapeutic interventions; consultations and outcomes, including death; hospital‐acquired infection; and length of stay.RESULTS: During the two three‐month periods, 76 of 233 (33%) and 52 of 209 (25%) admissions were associated with a primary diagnosis of infection. An additional 23 (10%) and 24 (12%) patients had infection at the time of admission, but this was not the primary admitting diagnosis. Pneumonia, urinary infection, and skin and soft tissue infection were the most frequent diagnosis at the time of admission, but these accounted for only about 50% of admissions with infection. Patients admitted with infection were characterized by a younger age, greater number of therapeutic interventions in the first 24 h, and increased medication costs, entirely attributable to antimicrobial therapy, but patients admitted with infection did not differ in comorbidity, death, nosocomial infection or length of stay compared with patients without infection.CONCLUSIONS: A wide variety of infections contribute to admissions to general internal medical clinical teaching units. Patients with infection have more interventions and an increased cost of care, but do not differ in outcome.
A Canadian Multicentre Case‐Control Study of Sporadic Escherichia coli 0157:H7 Infection
Authors: Holton Donna , Wilson Jeff , Ellis Andrea , Haldane David , April Nicole , Grimsrud Karen , Friesen Brent , Spika John 
Published: March 2016

OBJECTIVE: To evaluate further risk factors for Escherichia coli 0157:H7 infection including consumer preferences related to the consumption of ground beef and the role of person‐to‐person transmission of this infection.PATIENTS AND METHODS: A case‐control study of sporadic E coli 0157:H7 infection was undertaken in five Canadian cites from June to December 1991. One hundred cases of E coli 0157:H7 infection were age‐ and sex‐matched to 200 neighbourhood controls. Cases and controls were interviewed face‐to‐face to obtain information on potential risk factors for infection and health outcomes. Daycare providers of case and control children were interviewed regarding risk factors for infection at the institutional level. Contacts of cases and controls who reported diarrhea in the seven days before the case onset date were also interviewed about their symptoms and risk factors.RESULTS: All cases had diarrhea during the course of their illness and 90 (90%) reported bloody diarrhea. Four (4%) were reported to have developed hemolytic uremic syndrome; however, there were no fatalities. Sixty‐one (61%) of patients were hospitalized. Two variables were associated with infection in the final conditional logistic regression model: eating pink hamburger patties (odds ratio = 12.4, P=0.0001, population attributable fraction =40.2%) and contact with a nonhousehold member suffering from diarrhea (odds ratio = 7.0, P=0.0054, population attributable fraction = 10.3%) in the seven days before illness. Forty per cent of cases and controls who indicated that they prefer well done hamburgers said they would eat a ‘pink’ hamburger if served to them rather than ask that the hamburger be cooked longer.CONCLUSIONS: Health care workers should remain vigilant in their efforts to educate the public as to the risks associated with the consumption of ground beef that is inadequately cooked, and the importance of personal hygiene in the prevention of enteric illness.
External Quality Assessment of Transporting Infectious Substances in Canada
Authors: Tiffin Shelley M , Noble Michael A 
Published: March 2016

OBJECTIVE: To determine the degree of compliance with Transport Canada’s Transportation of Dangerous Goods Regulations for transporting infectious substances in Canada.DESIGN: A three‐phase study including observation of packages arriving at the British Columbia Centre for Disease Control (BCCDC) provincial laboratory; observation of requested samples of either an Escherichia coli culture or serum, not human immunodeficiency virus (HIV) or HbsAg positive, from laboratories; and a questionnaire concerning training and certification of packers in laboratories.RESULTS: During phase 1, 500 packages arriving at the BCCDC provincial laboratory were assessed. All arrived intact, with 384 (76.8%) in a firm outer package. Only 178 (35.6%) contained absorbent material. Six samples were known to contain human immunodefiency virus or hepatitis B; all were appropriately packaged. Of the remainder, 11 (2.2%) were considered overpackaged, 192 (38.4%) acceptably packaged and 191 (38.2%) inadequately packaged. In phase 2, 138 requested packages were assessed. All arrived intact, 132 (95.7%) in a firm outer package. Ninety‐six (69.6%) contained absorbent material. Only six (4.3%) were considered inadequately packaged. In phase 3, 171 laboratories responded to a questionnaire. Fifty‐nine were from small laboratories, 53 from intermediate laboratories and 23 from large laboratories. Most laboratories (55.4%) relied on in‐house resources to train packers. Only 26 (15.3%) facilities had no certified packers, and 60.8% noted they had a formal copy of the regulations available in the laboratory. Laboratory characteristics associated with the likelihood of overpackaging included number of technologists (χ2=5.72; P=0.058), number of samples processed by laboratories (χ2=8.46; P=0.015) and being a private laboratory as opposed to being a hospital laboratory (Fisher Exact two‐tailed 0.040).CONCLUSIONS: Canadian laboratories tend to package safely and within the acceptable range of regulation, although not within the precision of regulation. Most laboratories have trained and certified packers. The most common error is the use of outer packaging that is not firm. Larger laboratories tend to overpackage resulting in increased costs.