bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Asthma Control by Physicians and Patients: Comparison with Current Guidelines
Authors: Boulet Louis-Philippe , Phillips Robert , O’Byrne Paul , Becker Allan 
Published: March 2016

BACKGROUND:Current asthma consensus guidelines recommend a series of criteria for determining whether asthma is controlled. It is not known whether physicians are using these criteria to assess treatment needs and how effective such assessments are compared with patient assessment of asthma control.OBJECTIVE: To compare the parameters used by physicians and patients with asthma to determine whether asthma control is acceptable, according to the current Canadian asthma consensus guidelines.DATA AND METHODS: A total of 183 Canadian physicians, mostly general practitioners, evaluated 856 patients with mildly to moderately uncontrolled asthma who were not using anti‐inflammatory medications at the time of entry in the study. Physician characteristics and patient demographics were obtained. The physicians completed two questionnaires, one assessing the level of asthma control of the patient on an ordinal scale from 1 (very poor) to 5 (very good) and another indicating the parameters that were used to evaluate this level of control. Patients answered an asthma control questionnaire identical to the one completed by the physician and completed a six‐question asthma control questionnaire, with each question scored on a 0‐ to 6‐point scale.RESULTS: Although according to current asthma guidelines all patients surveyed had uncontrolled asthma, 66.2% of patients and 43.3% of physicians rated control of asthma symptoms as adequate to very good. The average scores for patient‐ and physician‐rated asthma control were 3.0±0.2 and 2.6±0.2, respectively. The average patient score on the Juniper asthma questionnaire was 12.2±6.3. Physicians used a mean of seven parameters to assess the patient’s level of asthma control, mostly beta2‐agonist need, followed by cough, wheezing, shortness of breath, limitation of physical activities and night‐time awakenings. Pediatricians used cough more frequently as an evaluation parameter, and respirologists measured pulmonary function more often than other physcians. Some parameters not usually included in guideline criteria for control, such as fatigue, need to clear throat, colored sputum, headache and dizziness, were sometimes used by physicians. Only 10% and 18% of physicians used measurements of forced expiratory volume in 1 s and peak expiratory flow, respectively, in asthma control assessments.CONCLUSIONS: The present study shows that the selection of asthma control criteria among physicians varies and is not always in keeping with current asthma guidelines. Both patients and physicians often consider asthma to be controlled, when according to current guidelines, it is not, and patients consider their asthma better controlled than do physicians. Objective measures of airflow obstruction are rarely used to assess asthma control. The present study stresses the need for improved dissemination ‐ to both patients and physicians ‐ of current recommendations on how asthma control should be determined.
Outbreak of Escherichia coli O157:H7 Related to Animal Contact at a Petting Zoo
Authors: Warshawsky Bryna , Gutmanis Iris , Henry Bonnie , Dow Joanne , Reffle Jim , Pollett Graham , Ahmed Rafiq , Aldom John , Alves David , Chagla Abdul , Ciebin Bruce , Kolbe Faron , Jamieson Frances , Rodgers Frank 
Published: March 2016

OBJECTIVE: To determine the cause of an outbreak of Escherichia coli 0157:H7 related to animal exposures so that further transmission could be prevented.DESIGN: Description of laboratory investigations and a case control study.SETTING: Agricultural pavilion at an annual fair in Ontario.POPULATION: People with laboratory evidence of E coli 0157:H7 (seven people) and others with diarrhea (155 people) who called the health unit following a media release were interviewed. Animals that were accessed most frequently by the public in the agriculture pavilion were tested for E coli 0157:H7. In the case control study, a case was defined as someone with laboratory‐confirmed E coli 0157:H7, or someone who developed severe or bloody diarrhea two to eight days after attending the agricultural pavilion at the fair (61 people). A convenience sample of people who attended the agricultural pavilion but did not develop diarrhea was selected as the control group (89 people).INTERVENTIONS: Human and animal E coli 0157:H7 specimens were subtyped. Cases and controls were interviewed using a standardized questionnaire.RESULTS: Subtyping of the seven human isolates of E coli 0157:H7 revealed five that were of an extremely uncommon phage type. Three samples from goats and one from sheep at the petting zoo in the agricultural pavilion were of this same phage type. The case control study also implicated goats (odds ratio [OR] 3.65; 95% CI 1.63 to 8.52) and sheep (OR 2.94; 95% CI 1.33 to 6.57) from the petting zoo.CONCLUSIONS: Results of this investigation suggest strongly that the goats and sheep from the petting zoo were the source of this outbreak of E coli 0157:H7.
Three‐Year Follow‐Up of protection Rates in Children Given Varicella Vaccine
Authors: Scheifele David W , Halperin Scott A , Diaz-Mitoma Francisco 
Published: March 2016

OBJECTIVE: To determine the rate and severity of subsequent varicella and zoster among children given a varicella vaccine.DESIGN: Retrospective survey conducted three years after vaccination, using standardized telephone interviews.SETTING: Three urban Canadian centres (Halifax, Ottawa and Vancouver).pARTICIpANTS: Of 475 eligible children, 431 aged three to 15 years participated.INTERVENTION: participants had received one dose of a live, attenuated varicella vaccine (Oka/GSK) an average of 36 months earlier.MAIN OUTCOME MEASURES: Interviewers asked about known varicella exposures and obtained descriptions of any illnesses reported as varicella or zoster. Reported varicella was classified as definite (vesicles present, physician confirmation), probable (vesicles reported), suspected (nonvesicular rash, recent contact with varicella) or unlikely (nonvesicular rash, no known contact).RESULTS: parents reported 257 within‐home exposures to varicella and alleged that 80 subjects had had varicella rash after exposure. Of these, 40 cases were classified as definite or probable (vesicles present; rate 9.3% or 3.1% per year on average), 31 as suspected (no vesicles; rate 2.4% per year) and nine as unlikely. All rash illnesses were mild: among children with vesicles, 75% were said to have up to 10 and none had more than 100. The outcome of 76 exposures to household members with varicella was evaluable: 25 (32.9%) resulted in a rash, and 13 (17.1%) of those involved vesicles (maximum 40 lesions). parents alleged that three subjects had zoster, but only one illness was definite (six vesicles, physician confirmed).CONCLUSIONS: Varicella vaccination completely prevented the development of typical chickenpox during the three years of observation. Breakthrough infections were infrequent (about 5% per year) and mild. Zoster was rare.
Food Safety and Foodborne Disease in the 21st Century
Authors: Scott Elizabeth 
Published: March 2016

Over the past decade there has been a growing recognition of the involvement of the home in several public health and hygiene issues. Perhaps the best understood of these issues is the role of the home in the transmission and acquisition of foodborne disease. The incidence of foodborne disease is increasing globally. Although foodborne disease data collection systems often miss the mass of home‐based outbreaks of sporadic infection, it is now accepted that many cases of foodborne illness occur as a result of improper food handling and preparation by consumers in their own kitchens. Some of the most compelling evidence has come from the international data on Salmonella species and Campylobacter species infections.By its very nature, the home is a multifunctional setting and this directly impacts upon the need for better food safety in the home. In particular, the growing population of elderly and other immnocompromised individuals living at home who are likely to be more vulnerable to the impact of foodborne disease is an important aspect to consider. In addition, some developed nations are currently undergoing a dramatic shift in healthcare delivery, resulting in millions of patients nursed at home. Other aspects of the home that are unique in terms of food safety are the use of the home as a daycare centre for preschool age children, the presence of domestic animals in the home and the use of the domestic kitchen for small‐scale commercial catering operations. At the global level, domestic food safety issues for the 21st century include the continued globalization of the food supply, the impact of international travel and tourism, and the impact of foodborne disease on developing nations.A number of countries have launched national campaigns to reduce the burden of foodborne disease, including alerting consumers to the need to practice food safety at home. Home hygiene practice and consumer hygiene products are being refined and targeted to areas of risk, including preventing the onward transmission of foodborne illness via the inanimate environment. It has been said that food safety in the home is the last line of defense against foodborne disease, and it is likely that this will remain true for the global population in the foreseeable future.
Evaluation of Dosing Guidelines for Use of Controlled‐Release Codeine in Chronic Noncancer Plan
Authors: Russell Alan , Watson C Peter , Clark Alexander J , Arkinstall William , Moulin Dwight , Hays Helen , Eisenhoffer John , Quigley Patricia , Harsanyi Zoltan , Darke Andrew 
Published: March 2016

OBJECTIVE: The clinical utility of guidelines for conversion of patients from a combination analgesic preparation of acetaminophen 300 mg plus codeine 30 mg every 4 h to 6h as needed to scheduled controlled‐release (CR) codeine every 12 h was evaluated.METHODS: Adult patients with chronic noncancer pain underwent a two‐week evaluation on acetaminophen plus codeine, followed by eight weeks of treatment with CR codeine. Patients taking four to six tablets of acetaminophen plus codeine per day were transferred to 50 mg CR codeine every 12 h; those on seven to nine tablets were transferred to 100 mg every 12 h; those on 10 to 12 tablets were transferred to 150 mg every 12 h; and those on greater than 12 tablets were transferred to 200 mg every 12 h. Subsequent dose adjustments were permitted. Acetaminophen (325 mg) was available for rescue. Pain intensity (five‐point categorical and 100 mm visual analog scale), pain related disability, adverse events and acceptability were assessed.RESULTS: Of the 140 patients enrolled, 95 completed eight weeks of treatment with CR codeine. During month 1 and month 2, the mean CR codeine daily doses were 295.7±119.1 mg and 390.3±163.4 mg, respectively. Pain scores during both CR codeine month 1 and 2 were significantly lower than on acetaminophen plus codeine (53.6±20.9 mm and 49.7±23.7 mm versus 59.6±17.5 mm; P=0.0003, P=0.0001, respectively). CR codeine treatment was rated as moderately or highly acceptable by 82% of patients compared with 50% for acetaminophen plus codeine (P=0.001). Only seven patients (5.9%) discontinued CR codeine treatment because of adverse events.CONCLUSION: The results confirm the safety, efficacy and patient acceptability of the initial conversion and maintenance dosing recommendations for CR codeine from a combination opioid/nonopioid analgesic.
Fluticasone Propionate, 100 µg bid, Using a Non‐CFC Propellant, HFA 134a, in Asthmatic Children
Authors: Lyttle Brian , Gillies John , Panov Maarja , Emeryk Andrzej , Wixon Claire 
Published: March 2016

BACKGROUND: Secondary to phasing out chlorofluorocarbons (CFCs), the fluticasone propionate (FP) pressurized metered‐dose inhaler has been formulated in a nonozone‐depleting propellant, hydrofluoralkane (HFA) 134a.OBJECTIVES: To demonstrate equivalent efficacy and safety of FP 200 µg daily propelled by HFA 134a to FP 200 µg daily propelled by CFCs 11 and 12 over a four‐week treatment period in pediatric asthmatic patients.METHODS: The study was multinational, randomized, double blind and of parallel group design. Eligible patients aged 16 years and younger were steroid naive or receiving 500 µg/day or less of beclomethasone dipropionate, budesonide or flunisolide, or 250 µg/day or less of inhaled FP. The primary efficacy variable was mean morning peak expiratory flow with equivalence determined if the 90% CIs for the treatment differences between groups were within ±15 L/min.RESULTS: Three hundred fifteen patients (mean age 9.3±2.8 years) were randomly assigned; 158 patients received FP HFA 134a and 157 patients received FP CFC. Over the four‐week treatment period, mean morning peak expiratory flow increased from baseline in both groups (14 L/min and 17 L/min, respectively), with a mean treatment difference of ‐2 L/min. Equivalence was demonstrated between the groups (90% CI ‐6 to +3 L/min; P=0.589). Both formulations were well tolerated with no serious drug‐related events.CCONCLUSIONS: FP propelled by HFA 134a has equivalent efficacy and comparable safety to FP propelled by CFC propellants at a microgram equivalent dose in pediatric asthmatic patients.
Reasons for Testing Women for Genital Chlamydia trachomatis Infection in the Calgary Region
Authors: Church Deirdre L , Zentner Ali , Semeniuk Heather , Henderson Elizabeth , Read Ron 
Published: March 2016

OBJECTIVE: To determine the clinical reason(s) for screening women with varying degrees of risk for genital Chlamydia trachomatis (CT) in the Calgary region.DESIGN: Women aged 15 to 75 years were enrolled at various patient care locations. Pertinent risk factors for genital CT infection were recorded and a gynecological examination was performed. Two endocervical swabs and a first‐void urine sample were collected for CT detection using two different nucleic acid amplification test methods.SETTING: Calgary is an urban region that provides healthcare services to a population of almost one million people. Microbiology services are provided by Calgary Laboratory Services through a centralized regional laboratory service.MAIN RESULTS: 504 women with a mean age of 28.1 ± SD 8.22 years were enrolled. Two hundred ninety‐one women (57.8%) were at high risk for acquiring genital CT infection. Twenty‐eight (5.6%) tested positive for CT infection and almost all of these women (26 of 28, 93%) had risk factors for acquiring infection. Of the high‐risk women, 9.8% were CT positive versus only 1.3% of women at low risk (P=0.0001). Only two of 152 (1.3%) women older than 30 years had genital CT infections. Although most women were asymptomatic, those with laboratory‐confirmed CT infection were more likely to have genitourinary symptoms. Three hundred forty‐three of 476 (72%) women who did not have genital CT infection had no risk factors, and screening was done as part of a routine gynecological examination for other purposes (prenatal visit, Pap smear).CONCLUSION: Women without risk factors are being screened routinely for genital CT infection as part of a routine gynecological examination done for other reasons. Elimination of the routine screening of low‐risk women older than 30 years of age would decrease the current regional utilization of CT tests by as much as one‐third.
The Descriptive Epidemiology of Primary Lung Cancer in an Alberta Cohort with a Mutivariate Analysis of Survival to Two Years
Authors: Demeter Sandor J , Chmielowiec Chester , Logus Wayne , Benkovska-Angelova Pauline , Jacobs Philip , Hailey David , McEwan Alexander 
Published: March 2016

BACKGROUND: Lung cancer contributes significantly to cancer morbidity and mortality. Although case fatality rates have not changed significantly over the past few decades, there have been advances in the diagnosis, staging and management of lung cancer.OBJECTIVE: To describe the epidemiology of primary lung cancer in an Alberta cohort with an analysis of factors contributing to survival to two years.PATIENTS AND METHODS: Six hundred eleven Albertans diagnosed with primary lung cancer in 1998 were identified through the Alberta Cancer Registry. Through a chart review, demographic and clinical data were collected for a period of up to two years from the date of diagnosis.RESULTS: The mean age at diagnosis was 66.5 years. The majority of cases (92%) were smokers. Adenocarcinoma, followed by squamous cell carcinoma, were the most frequent nonsmall cell lung cancer histologies. Adenocarcinoma was more frequent in women, and squamous cell carcinoma was more frequent in men. The overall two‐ year survival rates for nonsmall cell, small cell and other lung cancers were 24%, 10% and 13%, respectively. In multivariate analysis, stage, thoracic surgery and chemotherapy were significantly associated with survival to two years in nonsmall cell carcinoma; only stage and chemotherapy were significant in small cell carcinoma.CONCLUSIONS: This study provides a Canadian epidemiological perspective, which generally concurs with the North American literature. Continued monitoring of the epidemiology of lung cancer is essential to evaluate the impact of advances in the diagnosis, staging and management of lung cancer. Further clinical and economic analysis, based on data collected on this cohort, is planned.
Effects of Positive End‐Expiratory Pressure on Oscillated Volume during High‐Frequency Chest Compression in Children with Cystic Fibrosis
Authors: Dosman Cara F , Zuberbuhler Peter C , Tabk Joan I , Jones Richard L 
Published: March 2016

OBJECTIVE: To investigate the effects of positive end‐expiratory pressure (PEEP) on end‐expiratory lung volume (EELV) and mean oscillated volume (Vosc) during high frequency chest compression (HFCC).DESIGN: A clinic‐based prospective intervention study.SETTING: Pulmonary function laboratory, University of Alberta, Edmonton, Alberta.POPULATION: Nine children with cystic fibrosis with little or no obstructive airway disease who were selected from the outpatient Cystic Fibrosis and Pediatric Pulmonary Clinics at the University of Alberta Hospital, Edmonton, Alberta.METHODS: Each child received HFCC alone (at 10 Hz with chest wall pressure of 8 cm H2O) and HFCC plus PEEP. A closed circuit spirometry system was used to measure HFCC‐ and PEEP‐induced changes in EELV, expressed as per cent baseline functional residual capacity (FRC) measured using helium dilution. An isothermic chamber permitted measurement of Vosc.RESULTS: HFCC caused a significant 9% decrease in EELV. Adding 2.0±0.3 cm H2O of PEEP increased EELV back to at least the FRC level. With HFCC alone, Vosc was significantly lower during spontaneous expiration than during spontaneous inspiration, but adding PEEP to HFCC increased Vosc, especially during spontaneous expiration.CONCLUSIONS: Adding PEEP during HFCC prevents the decrease in EELV and increases Vosc. Therefore, PEEP may improve HFCC‐induced mucus clearance in children with cystic fibrosis.
A Comparison of Bacteremic Pneumococcal Pneumonia with Nonbacteremic Community‐Acquired Pneumonia of Any Etiology — Results from a Canadian Multicenter Study
Authors: Marrie Thomas J , Low Donald E , de Carolis Emidio , the Canadian Community-Acquired Pneumonia Investigators  
Published: March 2016

BACKGROUND: Bacteremic pneumococcal pneumonia has not been the subject of a multicentre Canadian Study.OBJECTIVES: To compare bacteremic community‐acquired Streptococcus pneumoniae pneumonia with nonbacteremic community‐acquired pneumonia of any etiology.METHODS: A prospective cohort study was conducted at 15 centres in eight Canadian provinces from January 1996 to January 1998.RESULTS: Fifty‐six of the 450 patients (12.4%) had one or more blood cultures positive for S pneumoniae. Compared with the 394 blood culture‐negative patients, the bacteremic patients were younger (55.6 years versus 63.4 years; P=0.002). At presentation, bacteremic patients had a higher mean oral temperature (38.1±1.2°C versus 37.7±1.2°C; P=0.026), a higher pulse rate (108.4±22.1 beats/min versus 102.1±20.6 beats/min; P=0.033), a lower diastolic blood pressure reading (66.8±12.7 mmHg versus 73.8±15.8 mmHg; P=0.001) and a higher percentage of white blood cells that were band forms (22.1% versus 14.2%; P=0.0007). The time from onset of symptoms until admission to hospital was shorter among the bacteremic patients (4.6±3.7 days versus 7.0±13.9 days; P=0.005). Three capsular polysaccharide types accounted for 53.4% of the isolates: type 14, 29.2%; type 4, 12.1%; and type 22 F, 12.1%. Two of 44 isolates were resistant to penicillin.CONCLUSIONS: While some differences in patient characteristics and presentation occur when patients with bacteremic pneumococcal pneumonia are compared with nonbacteremic patients with community‐acquired pneumonia, there is considerable overlap, and clinical presentation does not allow one to distinguish the bacteremic patients from the nonbacteremic patients.
Epidemiology, Antibiotic Susceptibility and Serotype Distribution of Streptococcus pneumoniae Associated with Invasive Pneumococcal Disease in British Columbia ‐ A Call to Strengthen Public Health Pneumococcal Immunization Programs
Authors: Bigham Mark , Patrick David M , Bryce Elizabeth , Champagne Sylvie , Shaw Carol , Wu Wrency , Ng Helen , Roscoe Diane , Roy Jacques , Isaac-Renton Judy 
Published: March 2016

BACKGROUND: This study examined the epidemiology, antibiotic susceptibility and serotype distribution of Streptococcuspneumoniae associated with invasive pneumococcal disease (IPD) in British Columbia.METHODS: Six hospitals and one private laboratory network participated in a prospective, sentinel laboratory based surveillance study of IPD, between October 1999 and October 2000. At each site, S pneumoniae isolates were collected and epidemiological data were gathered using a structured questionnaire, for all cases of IPD meeting the study case definition. Isolates were serotyped and tested for antimicrobial susceptibility. Bivariate associations were analyzed and multivariate logistic regression was used to identify independent risk factors associated with hospitalization or death.RESULTS: One hundred three reports and isolates were collected. Seventy‐nine per cent of cases were community‐acquired, 64% required hospitalization and 5% died. Cases with one or more assessed risk factor for IPD and of female sex were independent variables associated with hospitalization or death. One‐third of isolates had reduced penicillin susceptibility and 96% of these represented serotypes contained in the 23‐valent pneumococcal polysaccharide vaccine (PPV‐23). Overall, 89% of serotypes identified are included in the PPV‐23 vaccine and 88% of isolates from children under five years of age are found in the 7‐valent pneumococcal conjugate vaccine (PCV‐7). Forty‐one per cent of cases qualified for publicly funded pneumococcal vaccine and 34% of eligible persons were vaccinated.CONCLUSIONS: Overall, pneumococcal serotypes associated with IPD in this study closely matched serotypes included in PPV‐23 products currently licensed in Canada. Most serotypes associated with IPD in children under five years of age are included in a recently licenced PCV‐7. One third of isolates demonstrated reduced penicillin susceptibility, most involving serotypes included in PPV‐23. Effective delivery of current public health immunization programs using PPV‐23 and extending protection to infants and young children using the PCV‐7 will prevent many cases of IPD.