bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association between Endotoxin and Lung Function among Children and Adolescents Living in a Rural Area
Authors: Lawson Joshua A , Dosman James A , Rennie Donna C , Beach Jeremy , Newman Stephen C , Senthilselvan Ambikaipakan 
Published: March 2016

Increased levels of endotoxin found in rural and agricultural areas are an environmental exposure believed to cause a paradoxical proinflammatory effect on respiratory health that can exacerbate asthma. Previous studies involving adults have demonstrated an association between high endotoxin levels and lower lung function. Apart from occupational settings, however, few studies have investigated the relationship between lung function and endotoxin exposure, such as environmental tobacco smoke, especially in children. This study examined the modifying effects of sex, pre‐existing asthma and other environmental exposures, including tobacco smoke, in children living in rural communities in Saskatchewan.BACKGROUND/OBJECTIVES: Knowledge of the effects of domestic endotoxin on children’s lung function is limited. The association between domestic endotoxin and asthma or wheeze and lung function among school‐age children (six to 18 years of age) was examined. The interaction between endotoxin and other personal and environmental characteristics and lung function was also assessed.METHODS: A case‐control study was conducted in and around the rural community of Humboldt, Saskatchewan, between 2005 and 2007. Parents of cases reported either doctor‐diagnosed asthma or wheeze in the previous year. Controls were randomly selected from those not reporting these conditions. Data were collected by questionnaire to ascertain symptoms and conditions, while spirometry was used to measure lung function including forced vital capacity and forced expiratory volume in 1 s. Dust collected from the child’s play area floor and the child’s mattress was used to quantify endotoxin, and saliva was collected to quantify cotinine levels and assess tobacco smoke exposure.RESULTS: There were 102 cases and 207 controls included in the present study. Lower forced expiratory volume in 1 s was associated with higher mattress endotoxin load among female cases (beta=−0.25, SE=0.07 [P<0.01]). There was a trend toward lower forced vital capacity, which was associated with higher play area endotoxin load among cases with high tobacco smoke exposure (beta=−0.17, SE=0.09 [P<0.10]).CONCLUSIONS: Findings indicated that high endotoxin levels present in common household areas of rural children with asthma or wheeze may also affect their lung function. These associations may be potentiated by tobacco smoke exposure and female sex.
Fear‐Avoidance Beliefs and Parental Responses to Pain in Adolescents with Chronic Pain
Authors: Wilson Anna C , Lewandowski Amy S , Palermo Tonya M 
Published: March 2016

BACKGROUND: The fear‐avoidance model of chronic pain posits that fear of pain is associated with fear and avoidance of activity, which can lead to deconditioning and persistence of pain and disability. Despite being well supported in adults, little is known about the role of fear‐avoidance beliefs regarding physical activity in children. Research has shown that parental protectiveness contributes to activity limitations in children; however, no studies have examined relationships between protectiveness, and fear and avoidance.OBJECTIVES: To conduct a cross‐sectional study to provide additional information regarding the reliability and validity of the Fear‐Avoidance Beliefs Questionnaire physical activity subscale among adolescents with chronic pain; examine fear‐avoidance beliefs and depressive symptoms as concurrent predictors of physical activity limitations; and test competing models using fear‐avoidance beliefs as mediators and moderators of the association between parental protectiveness and activity limitations.METHODS: Adolescents (n=42) 11 to 17 years of age with chronic pain completed questionnaires assessing pain intensity, fear‐avoidance beliefs, depressive symptoms and physical activity limitations. Their parents completed questionnaires regarding protectiveness and adolescent activity limitations.RESULTS: The Fear‐Avoidance Beliefs Questionnaire physical activity subscale was useful for assessing fear‐avoidance beliefs in the present population. In support of hypotheses, greater fear‐avoidance beliefs were associated with greater activity limitations, above pain intensity and depressive symptoms. Support was found for fear‐avoidance beliefs as mediators of the association between parental protectiveness and activity limitations. Tests of moderation were not significant.CONCLUSIONS: Fear‐avoidance beliefs may be an important target for interventions focused on decreasing activity limitations in youth with chronic pain. Future research should investigate these associations longitudinally.
The Role of the Third Acid‐Fast Bacillus Smear in Tuberculosis Screening for Infection Control Purposes: A Controversial Topic Revisited
Authors: Wilmer A. , Bryce E. , Grant J. 
Published: March 2016

INTRODUCTION: Recent studies have suggested that two negative acid‐fast bacillus (AFB) smears may be as effective as three when screening patients with suspected Mycobacterium tuberculosis for respiratory isolation purposes. However, current recommendations in Canada, the United States and Europe still support a three‐smear approach.METHODS: The microbiology database of a tertiary care hospital was searched for sputum, tracheal aspirates and bronchoalveolar lavage samples from 2003 to 2007 that had been sent for mycobacterial testing. The first patient specimen to become AFB smear positive was noted. As well, the time required to collect the third specimen in hospitalized patients who remained smear negative was used to estimate the savings in isolation costs associated with a two‐smear approach.RESULTS: There were 8347 respiratory specimens from 5168 patients in the five‐year period. Of these patients, 2.2% (116 of 5168) were AFB smear positive, of whom 55.2% (64 of 116) were culture positive for Mycobacterium tuberculosis. Overall 89% (57 of 64) of patients were identified as being AFB smear positive by the first smear, 7.8% (five of 64) were identified by the second smear and 3.2% (two of 64) were identified by further smears. Smear‐negative patients spent a combined 710 days in isolation awaiting collection of the third sample at a cost of approximately $142,000 over five years.CONCLUSION: A two‐smear approach for discontinuation of respiratory isolation precautions is safe and has the potential to reduce hospital expenditures.
The Model for End-Stage Liver Disease Accurately Predicts 90-Day Liver Transplant Wait-List Mortality in Atlantic Canada
Authors: Renfrew Paul Douglas , Quan Hude , Doig Christopher James , Dixon Elijah , Molinari Michele 
Published: March 2016

OBJECTIVE: To determine the generalizability of the predictions for 90-day mortality generated by Model for End-stage Liver Disease (MELD) and the serum sodium augmented MELD (MELDNa) to Atlantic Canadian adults with end-stage liver disease awaiting liver transplantation (LT).METHODS: The predictive accuracy of the MELD and the MELDNa was evaluated by measurement of the discrimination and calibration of the respective models’ estimates for the occurrence of 90-day mortality in a consecutive cohort of LT candidates accrued over a five-year period. Accuracy of discrimination was measured by the area under the ROC curves. Calibration accuracy was evaluated by comparing the observed and model-estimated incidences of 90-day wait-list failure for the total cohort and within quantiles of risk.RESULTS: The area under the ROC curve for the MELD was 0.887 (95% CI 0.705 to 0.978) – consistent with very good accuracy of discrimination. The area under the ROC curve for the MELDNa was 0.848 (95% CI 0.681 to 0.965). The observed incidence of 90-day wait-list mortality in the validation cohort was 7.9%, which was not significantly different from the MELD estimate of 6.6% (95% CI 4.9% to 8.4%; P=0.177) or the MELDNa estimate of 5.8% (95% CI 3.5% to 8.0%; P=0.065). Global goodness-of-fit testing found no evidence of significant lack of fit for either model (Hosmer-Lemeshow χ2 [df=3] for MELD 2.941, P=0.401; for MELDNa 2.895, P=0.414).CONCLUSION: Both the MELD and the MELDNa accurately predicted the occurrence of 90-day wait-list mortality in the study cohort and, therefore, are generalizable to Atlantic Canadians with end-stage liver disease awaiting LT.
Nonpharmacological Management of Procedural Pain in Infants and Young Children: An Abridged Cochrane Review
Authors: Riddell Rebecca Pillai , Racine Nicole , Turcotte Kara , Uman Lindsay S , Horton Rachel , Osmun Laila Din , Kohut Sara Ahola , Stuart Jessica Hillgrove , Stevens Bonnie , Lisi Diana 
Published: March 2016

BACKGROUND: Acute pain and distress during medical procedures are commonplace for young children.OBJECTIVE: To assess the efficacy of nonpharmacological interventions for acute procedural pain in children up to three years of age.METHODS: Study inclusion criteria were: participants <3 years of age, involved in a randomized controlled or crossover trial, and use of a ‘no‐treatment’ control group (51 studies; n=3396). Additional studies meeting all criteria except for study design (eg, use of active control group) were qualitatively described (n=20).RESULTS: For every intervention, data were analyzed separately according to age group (preterm‐born, term‐born neonate and older infant/young child) and type of pain response (pain reactivity, immediate pain‐related regulation). The largest standardized mean differences (SMD) for pain reactivity were as follows: sucking‐related interventions (preterm: −0.42 [95% CI −0.68 to −0.15]; neonate −1.45 [CI −2.34 to −0.57]), kangaroo care (preterm −1.12 [95% CI −2.04 to −0.21]), and swaddling/facilitated tucking (preterm −0.97 [95% CI −1.63 to −0.31]). For immediate pain‐related regulation, the largest SMDs were: sucking‐related interventions (preterm −0.38 [95% CI −0.59 to −0.17]; neonate −0.90 [CI −1.54 to −0.25]), kangaroo care 0.77 (95% CI −1.50 to −0.03]), swaddling/facilitated tucking (preterm −0.75 [95% CI −1.14 to −0.36]), and rocking/holding (neonate −0.75 [95% CI −1.20 to −0.30]). The presence of significant heterogeneity limited confidence in nonsignificant findings for certain other analyses.CONCLUSIONS: Although a number of nonpharmacological treatments have sufficient evidence supporting their efficacy with preterm infants and healthy neonates, no treatments had sufficient evidence to support efficacy with healthy older infants/young children.
A Decade of Respiratory Syncytial Virus Epidemiology and Prophylaxis: Translating Evidence into Everyday Clinical Practice
Authors: Paes Bosco A , Mitchell Ian , Banerji Anna , Lanctôt Krista L , Langley Joanne M 
Published: March 2016

Respiratory syncytial virus (RSV) is a common infection in infancy, with nearly all children affected by two years of age. Approximately 0.5% to 2.0% of all children are hospitalized with lower respiratory tract disease, of which 50% to 90% have bronchiolitis and 5% to 40% have pneumonia. Morbidity and mortality are highest in children with nosocomial infection and in those with underlying medical illnesses such as cardiac and chronic lung disease. Aboriginal children residing in remote northern regions are specifically considered to be at high risk for hospitalization due to RSV infection. Thorough hand washing and health education are the principal strategies in primary prevention. In the absence of a vaccine, palivizumab prophylaxis is currently the best intervention to reduce the burden of illness and RSV-related hospitalization in high-risk children. Health care professionals should provide palivizumab prophylaxis cost effectively in accordance with recommendations issued by pediatric societies and national advisory bodies.The present article reviews the epidemiology of RSV infection and the short- and long-term impact of disease in high-risk infants and special populations. Prevention strategies and treatment are discussed based on the existing scientific evidence, and future challenges in the management of RSV infection are addressed.
Persistent Pain in a Community‐Based Sample of Children and Adolescents: Sex Differences in Psychological Constructs
Authors: Fuss Samantha , Pagé M Gabrielle , Katz Joel 
Published: March 2016

BACKGROUND: Very few studies have investigated the psychological factors associated with the pain experiences of children and adolescents in community samples.OBJECTIVES: To examine the lifetime prevalence of, and psychological variables associated with, persistent pain in a community sample of children and adolescents, and to explore differences according to sex, age and pain history.METHODS: Participants completed the Childhood Anxiety Sensitivity Index (CASI), the Child Pain Anxiety Symptoms Scale (CPASS), the Multidimensional Anxiety Scale for Children‐10 (MASC‐10), the Pain Catastrophizing Scale for Children (PCS‐C) and a pain history questionnaire that assessed chronicity and pain frequency. After research ethics board approval, informed consent/assent was obtained from 1022 individuals recruited to participate in a study conducted at the Ontario Science Centre (Toronto, Ontario).RESULTS: Of the 1006 participants (54% female, mean [± SD] age 11.6±2.7 years) who provided complete data, 27% reported having experienced pain that lasted for three months or longer. A 2×2×2 (pain history, age and sex) multivariate ANOVA was conducted, with the total scores on the CASI, the CPASS, the MASC‐10 and the PCS‐C as dependent variables. Girls with a history of persistent pain expressed higher levels of anxiety sensitivity (P<0.001) and pain catastrophizing (P<0.001) than both girls without a pain history and boys regardless of pain history. This same pattern of results was found for anxiety and pain anxiety in the older, but not the younger, age group.CONCLUSIONS: Boys and girls appear to differ in terms of how age and pain history relate to the expression of pain‐related psychological variables. Given the prevalence of persistent pain found in the study, more research is needed regarding the developmental implications of persistent pain in childhood and adolescence.
Canadian Prediction Equations of Spirometric Lung Function for Caucasian Adults 20 to 90 Years of Age: Results from the Canadian Obstructive Lung Disease (COLD) Study and the Lung Health Canadian Environment (LHCE) Study
Authors: Tan WC , Bourbeau J , Hernandez P , Chapman K , Cowie R , FitzGerald MJ , Aaron S , Marciniuk DD , Maltais F , O’Donnell DE , Goldstein R , Sin D , Chan-Yeung M , Manfreda J , Anthonisen NR , Tate RB , Sears MR , Siersted HC , Becklake MR , Ernst P , Bowie DM , Sweet L , Van Til L 
Published: March 2016

BACKGROUND: Currently, no reference or normative values for spirometry based on a randomly selected Canadian population exist.OBJECTIVE: The aim of the present analysis was to construct spirometric reference values for Canadian adults 20 to 90 years of age by combining data collected from healthy lifelong nonsmokers in two population‐based studies.METHOD: Both studies similarly used random population sampling, conducted using validated epidemiological protocols in the Canadian Obstructive Lung Disease study, and the Lung Health Canadian Environment study. Spirometric lung function data were available from 3042 subjects in the COLD study, which was completed in 2009, and from 2571 subjects in the LHCE study completed in 1995. A total of 844 subjects 40 to 90 years of age, and 812 subjects 20 to 44 years of age, were identified as healthy, asymptomatic, lifelong nonsmokers, and provided normative reference values for spirometry. Multiple regression models were constructed separately for Caucasian men and women for the following spirometric parameters: forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio, with covariates of height, sex and age. Comparison with published regression equations showed that the best agreement was obtained from data derived from random populations.RESULTS: The best‐fitting regression models for healthy, never‐smoking, asymptomatic European‐Canadian men and women 20 to 90 years of age were constructed. When age‐ and height‐corrected FEV1, FVC and FEV1/FVC ratio were compared with other spirometry reference studies, mean values were similar, with the closest being derived from population‐based studies.CONCLUSION: These spirometry reference equations, derived from randomly selected population‐based cohorts with stringently monitored lung function measurements, provide data currently lacking in Canada.
An Examination of the Observed Placebo Effect Associated with the Treatment of Low Back Pain – A Systematic Review
Authors: Puhl Aaron A , Reinhart Christine J , Rok Elisabeth R , Injeyan H Stephen 
Published: March 2016

OBJECTIVE: To determine whether the nonspecific effects that occur following the use of sham interventions to treat nonspecific low back pain (LBP) are large enough to be considered clinically meaningful.DESIGN: Electronic databases were searched systematically for randomized placebo‐controlled trials of interventions for LBP that used sham ultrasound, sham laser or sham drug therapy as the placebo control. Study selection was accomplished via independent evaluation of scientific admissibility by three reviewers and final decisions of inclusion were based on consensus.RESULTS: None of the studies using sham ultrasound as the placebo control in the treatment of LBP were acceptable for inclusion. Twelve studies were included in the present evaluation of the placebo effect – eight trials that met the strict inclusion criteria for best evidence (three using sham laser placebo and five using sham medication placebo) and four sham medication studies that ‘just missed’ the inclusion criteria for best evidence. Although the evidence from studies using sham laser was inconclusive, the present review did find a clinically meaningful change in LBP scores following the use of sham oral medications.CONCLUSIONS: The present best‐evidence review found a clinically meaningful change in pain scores following the use of sham oral medications for the treatment of nonspecific LBP. This finding suggests that further clinical research is warranted to identify which patient subgroups could benefit most from such treatment and to distinguish the true contribution of the placebo effect from other nonspecific effects.
Detection of Scabies: A Systematic Review of Diagnostic Methods
Authors: Leung Victor , Miller Mark 
Published: March 2016

This study systematically reviewed the accuracy and precision of history, physical examination and tests for diagnosing scabies. Using a structured search strategy, Medline and Embase databases were searched for English and French language articles that included a diagnosis of scabies. Studies comparing history, physical examination and/or any diagnostic tests with the reference standard of microscopic visualization of mites, eggs or fecal elements obtained from skin scrapings or biopsies were included for analysis. History and examination of pruritic dermatoses failed to accurately diagnose scabies infection. The accuracy of dermatoscopy, performed by a trained practitioner, was determined; however, the accuracy of other diagnostic tests could not be calculated from the data in the literature. In the face of such diagnostic inaccuracy, research to identify or develop accurate diagnostic tests for scabies infection is needed and justifiable.BACKGROUND: Accurate diagnosis of scabies infection is important for patient treatment and for public health control of scabies epidemics.OBJECTIVE: To systematically review the accuracy and precision of history, physical examination and tests for diagnosing scabies.METHODS: Using a structured search strategy, Medline and Embase databases were searched for English and French language articles that included a diagnosis of scabies. Studies comparing history, physical examination and/or any diagnostic tests with the reference standard of microscopic visualization of mites, eggs or fecal elements obtained from skin scrapings or biopsies were included for analysis. Data were extracted using standard criteria.RESULTS: History and examination of pruritic dermatoses failed to accurately diagnose scabies infection. Dermatoscopy by a trained practitioner has a positive likelihood ratio of 6.5 (95% CI 4.1 to 10.3) and a negative likelihood ratio of 0.1 (95% CI 0.06 to 0.2) for diagnosing scabies. The accuracy of other diagnostic tests could not be calculated from the data in the literature.CONCLUSIONS: In the face of such diagnostic inaccuracy, clinical judgment is still practical in diagnosing scabies. Two tests are used – the burrow ink test and handheld dermatoscopy. The burrow ink test is a simple, rapid, noninvasive test that can be used to screen a large number of patients. Handheld dermatoscopy is an accurate test, but requires special equipment and trained practitioners. Given the morbidity and costs of scabies infection, and that studies to date lack adequate internal and external validity, research to identify or develop accurate diagnostic tests for scabies infection is needed and justifiable.
Outcomes of Chronic Hepatitis C Therapy in Patients Treated in Community Versus Academic Centres in Canada: Final Results of APPROACH (A Prospective Study of Peginterferon alfa-2a and Ribavirin at Academic and Community Centres in Canada)
Authors: Myers Robert P , Cooper Curtis , Sherman Morris , Lalonde Richard , Witt-Sullivan Helga , Elkashab Magdy , Harris Paul , Balshaw Rob , Usaty Christopher , Marotta Paul J 
Published: March 2016

BACKGROUND: In patients chronically infected with the hepatitis C virus (HCV), it is not established whether viral outcomes or health-related quality of life (HRQoL) differ between individuals treated at academic or community centres.METHODS: In the present observational study, adults with chronic HCV were treated with peginterferon alfa-2a 180 μg/week plus ribavirin at 45 Canadian centres (16 academic, 29 community). The primary efficacy end point was sustained virological response (SVR). Other outcome measures included HRQoL (assessed using the 36-item Short-Form Health Survey), heath resource use, and workplace productivity and absences within a 60-day interval.RESULTS: In treatment-naive patients infected with HCV genotype 1, significantly higher SVR rates were achieved in those treated at academic (n=54) compared with community (n=125) centres (52% versus 32% [P=0.01]), although rates of dosage reduction and treatment discontinuation were similar across settings. SVR rates among patients infected with genotype 2/3 were similar between academic (n=59) and community (n=100) centres (64% versus 67% [P=0.73]). Following antiviral therapy, patients with genotype 1 who achieved an SVR (n=67) had significantly higher mean scores on the physical (P=0.005) and mental components of the 36-item Short-Form Health Survey (P=0.043) compared with those without an SVR (n=111). In contrast, HRQoL scores were similar in HCV genotype 2/3 patients with and without an SVR. There were no differences in workplace productivity or absences between patients with and without an SVR. The most frequently used health care resources by all patients were visits and phone calls to hepatitis nurses, and general practice or walk-in clinics.CONCLUSION: Patients infected with HCV genotype 1 achieved higher SVR rates when treated at academic rather than community centres in Canada. The reasons for this difference require additional investigation.