bluuebunny/crossref_metadata_2025_split huggingface dataset:
Economic Analysis of Rotavirus‐Associated Diarrhea in the Metropolitan Toronto and Peel Regions of Ontario
Authors: Jacobs P , Shane LG , Fassbender K , Wang EL , Moineddin R , Ford-Jones EL 
Published: March 2016

OBJECTIVE: To measure the economic cost of rotavirus‐ associated diarrhea for a selected group of families, in a nonexperimental setting, and to estimate the factors that influence these costs.DESIGN: Use and other socioeconomic data from a family survey (the Pediatric Rotavirus Epidemiology Study for Immunization) of children who tested positive for rotavirus were collected for the metropolitan Toronto and Peel regions of Ontario during the rotavirus season of 1997‐1998. Service costs were estimated from provider data. A statistical regression analysis was used to explain the variances of provincial health care costs, prescription drug costs and indirect (work‐loss) costs.SETTING: Data were collected in hospitals, emergency rooms, paediatric practices, primary care clinics and licensed daycare centres. Hospital coverage was wide, but community coverage was not.PATIENTS AND OTHER PARTICIPANTS: Children with diarrhea were tested for rotavirus. Those who tested positive and whose parents consented for their children to participate were included in the study.INTERVENTIONS: NoneMAIN OUTCOME MEASURES: The main outcomes were provincial health care costs, drug costs, nonmedical costs and thenumber of days of work missed by parents per child, as well as factors that determine these costs.RESULTS: Children in the most severe category incurred costs of $2,663/person, and those in the least severe categories incurred costs of approximately $350/person. The most important determinant to explain provincial health care costs was the number of health problems that the child had before having rotavirus. Costs due to work loss of parents were considerable for children in all severity groups and were influenced by family working conditions.CONCLUSIONS: When considering the economic implications of rotavirus, prior health status should be considered and indirect costs should be recognized for their importance.
Attitudes Toward Opioid Use for Chronic Pain: A Canadian Physician Survey
Authors: Morley-Forster Patricia K , Clark Alexander J , Speechley Mark , Moulin Dwight E 
Published: March 2016

OBJECTIVES: To measure chronic pain patient volumes seen in primary care practice; to determine what medications physicians choose for the treatment of moderate to severe chronic pain; to identify barriers to the use of opioids in the treatment of chronic pain; and to assess physicians′ attitudes toward the current management of chronic pain in Canada.DESIGN: A computer‐assisted telephone survey of 100 regionally representative Canadian physicians with a defined interest in palliative care (PC, n=30) or noncancer pain (GP, n=70).SETTING: A survey was conducted by Ipsos‐Reid in June 2001. Only physicians who met the eligibility criteria of having written 20 or more prescriptions for moderate to severe pain in the preceding four weeks or having devoted 20% of time to palliative care were eligible to participate.RESULTS: In one month, the average number of patients with moderate to severe chronic pain seen by PCs was 94.2; the average seen by GPs was 44.7. The pain experienced by 83.3% of GP patients was noncancer related. For chronic cancer pain, an opioid analgesic was the treatment of choice of 79% of physicians (48% preferred morphine, 21% codeine, 10% other). For moderate to severe chronic noncancer pain, opioids were the first‐line treatment of only 32% of physicians (16% preferred codeine, 16% major opioids) because a significant number preferred either nonsteriodal anti‐inflammatory drugs (29%) or acetaminophen (16%). Thirty‐five per cent of GPs and 23% of PCs would never use opioids for noncancer pain, even when described as severe. Chronic pain was deemed by 68% of physicians to be inadequately managed. Almost 60% thought that pain management could be enhanced by improved physician education. Identified barriers to opioid use included addiction potential (37%) and side effects (25%). Seventeen per cent of GPs and 10% of PCs thought that regulatory sanctions limited opioid prescribing.CONCLUSIONS: Even among physicians experienced in chronic pain treatment, there is a reluctance to use opioids for severe nonmalignant pain. One‐half of the survey participants believed that there was a need for improved physician education in pain management, including the use of opioids.
Methadone in the Treatment of Neuropathic Pain
Authors: Gagnon Bruno , Almahrezi Abdulaziz , Schreier Gil 
Published: March 2016

BACKGROUND: Methadone, being an N‐Methyl‐D‐Aspartate receptor antagonist, may have a potential role in the treatment of neuropathic pain.OBJECTIVES: To evaluate the effect of methadone in the treatment of neuropathic pain and to estimate the possible dose ranges needed for pain control.METHODS: Methadone was offered as a treatment option to consecutive cancer and noncancer patients with neuropathic pain. Pain intensity was measured by the visual analogue scale (VAS) (0‐10 cm where 0 = no pain and 10 = worst possible pain). Mechanical allodynia and paroxysmal (shooting) pain were assessed clinically. All assessments were collected prospectively before treatment and once a stable dose of methadone was reached.RESULTS: A total number of 18 patients met our inclusion criteria. The mean pretreatment VAS ± SD was 7.7±1.5 cm and this dropped significantly to 1.4±1.7 cm on a stable dose of methadone (P<0.0001). Nine of 13 patients (70 %) had a complete resolution of mechanical allodynia and all eight patients (100%) with shooting pain reported a complete response. The median stable dose of methadone was 15 mg per day.CONCLUSION: Methadone at relatively low doses seems to be useful in the treatment of neuropathic pain.
Hospitalization for Community-Acquired Pneumonia in Alberta Patients with Human Immunodeficiency Virus Infection: A Case Control Study
Authors: Johnson David H , Carriere Keumhee C , Houston Stan , Jin Yan , Predy Gerry , Gill John , Shafran Stephen , Marrie Thomas J 
Published: March 2016

BACKGROUND: To determine whether outcomes of pneumonia among human immunodeficiency virus (HIV)-positive persons differed from those among HIV-negative persons.METHODS: Alberta hospital patient abstracts for HIV-positive persons requiring hospitalization for pneumonia from April 1, 1994, until March 31, 1999, were matched by age and sex with four HIV-negative counterparts.RESULTS: Hospitalizations for community-acquired pneumonia decreased for those with HIV (acquired immunodeficiency syndrome [AIDS]) and increased for those with HIV (non-AIDS) during the study period. HIV (AIDS) patients admitted for community-acquired pneumonia (n=130) manifested three times higher odds for a longer length of hospital stay and had three and 10 times higher odds for excess in-hospital and one-year mortality, respectively, than their matched controls. Similarly, HIV (non-AIDS) patients admitted for community-acquired pneumonia (n=46) manifested two times higher odds for a longer length of hospital stay and had four times higher odds for excess one-year mortality than their matched controls. The in-hospital and one-year mortality rates for the HIV (AIDS) patients were 21.2% and 64.3%, respectively, during the first three years, and decreased to 8.7% and 40.7%, respectively, in the last two years of the study.CONCLUSIONS: The outcomes for community-acquired pneumonia were worse for those with HIV (non-AIDS) and HIV (AIDS) compared with non-HIV hospitalized patients matched for age and sex, and controlling for severity of illness and comorbidity. In-hospital and one-year mortality rates for patients with HIV (AIDS) showed a marked decline over the study period.
Comparing Two Observational Systems in the Assessment of Knee Pain
Authors: Fuchs-Lacelle Shannon , Hadjistavropoulos Thomas , Sharpe Donald , Williams Jaime , Martin Ronald , LaChapelle Diane 
Published: March 2016

OBJECTIVE: Research has demonstrated the utility of the Pain Behavior Measurement (PBM) system as a pain index. PBM involves the recording of sighing, rubbing, grimacing, guarding and bracing. A modification of this system has been proposed, focusing on the occurrence of joint flexing, rubbing, unloading the joint, guarding and rigidity, specifically for patients with knee pain. The aim of the present study was to compare the original PBM to the modified version in a sample of knee replacement patients to assess the utility of the more specialized approach. It was expected that the more discomforting physiotherapy activities (knee bending and quadriceps exercises) would result in more pain behaviours than intermediate activities (walking and standing), which, in turn, would result in more pain behaviours than reclining. The extent to which each system reflected this expected pattern was examined.METHODS: Ninety‐three seniors were observed while completing a series of structured post‐knee surgery physiotherapy activities (knee bending, standing, walking, reclining and a quadriceps exercise).RESULTS: Analyses of self‐reported levels of pain were consistent with the expected pattern of pain levels in relation to the physiotherapy activities. Specific pain behaviours within each system (eg, grimacing, rigidity) occurred in a manner consistent with the expected pattern, while other behaviours (eg, rubbing the affected area) did not.CONCLUSIONS: Although there was no clear advantage for the modified system over the PBM, an optimal approach may involve combining specific behaviours from each system.
The Impact of Sampling and Measurement on the Prevalence of Self‐Reported Pain in Canada
Authors: Van Den Kerkhof Elizabeth G , Hopman Wilma M , Towheed Tanveer E , Anastassiades Tassos P , Goldstein David H 
Published: March 2016

BACKGROUND: Pain is an important public health problem in Canada. International estimates of general population pain prevalence range from 2% to 46%.OBJECTIVES: The purpose of this paper is to critically examine the potentially misleading use of overall prevalence estimates in the pain literature and to use two Canadian population‐based surveys to assess the impact of sampling and measurement on prevalence.METHODS: Two of the secondary data sets used were the 1996/97 National Population and Health Survey (NPHS) and the Canadian Multicentre Osteoporosis Study (CaMos). This paper is based on the assessment of chronic pain in the NPHS, and the assessment of short term pain using the Medical Outcomes Trust′s 36‐item health survey and the Health Utilities Index, both collected by CaMos. Data are presented as frequencies and percentages overall and stratified by age and sex. CaMos prevalence estimates were age and sex‐standardized to the NPHS population.RESULTS: The overall prevalence of pain was 39% for one‐week pain, 66% for four‐week pain and 15% for chronic pain. Women were more likely to report pain than men and the prevalence of pain increased with age.CONCLUSIONS: This study yields useful information about the self‐reported responses to a variety of questions assessing pain in the general population. Responses to the different questions likely represent different categories of pain, such as short term versus chronic pain, which in turn may have different epidemiological risk factors and profiles. Longitudinal studies of the epidemiology, predictors and natural history of chronic pain are urgently needed in the Canadian population.
Choice of Antibiotics in Late Neonatal Sepsis in the Extremely Low Birth Weight Infant
Authors: Allen Tara R , da Silva Orlando P 
Published: March 2016

OBJECTIVE: To review the choice of antibiotics in treating suspected late neonatal sepsis in infants weighing 1000 g or less in a neonatal intensive care unit.METHODS: Retrospective review of medical records.RESULTS: Ninety‐six infants weighing 1000 g or less were admitted to the neonatal intensive care unit during the study period. Sixty‐two infants survived beyond four days of life and had at least one sepsis workup done to exclude late neonatal infection. Of the 62 study patients, 42 (68%) were started on ampicillin and netilmicin (A/N) and 20 (32%) were started on vancomycin and ceftizoxime (V/C) as the antibiotics of choice, pending culture results. Of the patients started on A/N, 17 of 42 had a positive blood culture compared with 11 of 20 on V/C (40% versus 55%, P=0.40). The mean (±SD) birth weight of infants started on A/N was 793±133 g compared with a mean of 728±153 g in the group that received V/C (P=0.09). Seven patients died in the A/N group compared with three in the V/C group (16.7% versus 15%, P=0.84). In addition to the sepsis episode studied, before they were discharged from hospital, 21 of 42 (50%) infants in the A/N group had further workups for suspected sepsis, compared with 16 of 20 (80%) (P=0.048) infants initially given V/C.CONCLUSIONS: Ampicillin and netilmicin is a safe antibiotic combination for neonates suspected of late sepsis. This, in turn, may be important in reducing vancomycin overuse and the potential for bacterial resistance to this antimicrobial agent.
A Cross‐Sectional Study of Intestinal Parasitic Infections in a Rural District of West China
Authors: Tang Ning , Luo Nian Ji 
Published: March 2016

BACKGROUND: Parasitic infections are widespread in rural areas of West China. The remote and humid environment, traditional ways of life, contaminated potable water and limited health services all contribute to the transmission and persistence of fecal parasites.OBJECTIVE: To describe the prevalence of intestinal parasitic infections in an area of West China, including its associations with demographic variables.METHODS: Single fecal specimens were collected using a previously validated kit. Parasites were detected microscopically by iodine‐stained smear, modified Kato‐Katz thick smear, simple saline smear, test tube filter paper culture and adhesive cellophane tape anal swab.RESULTS: The prevalence of enteric parasites in the population was 51.7%. The proportion of individuals infected with one parasite was 36.5%, two parasites 12.7%, three parasites 3.0% and four parasites 0.08%. Parasites identified included Ascaris lumbricoides in 41.4% of all individuals tested, Ancylostoma duodenale in 17.7%, Trichurias trichuria in 8.25%, Enterobius vermicularis in 0.43%, Blastocystis hominis in 1.37%, Entamoeba coli in 0.47%, Entamoeba histolytica in 0.16%, Giardia lamblia in 0.04%, Strongyloides stercoralis in 0.04% and Clonorchis sinensis in 0.04%. The prevalence was significantly increased in women, people aged 15 to 19 years and over 80 years, the rural farm population, farmers, preschool and primary school groups, residents of a hilly rather than mountainous or plains terrain, and in intermediate income groups. The prevalence was significantly negatively associated with educational level, but not with age or income.CONCLUSIONS: This study supports the use of simple fecal examinations to monitor the parasite burden in rural areas of developing countries. Enteric parasites remain common in this population in rural China.
Noninvasive Investigations for the Early Detection of Chronic Airways Dysfunction Following Lung Transplantation
Authors: Cook Richard C , Fradet Guy , Muller Nestor L , Worsley Daniel F , Ostrow David , Levy Robert D 
Published: March 2016

BACKGROUND: The diagnosis of chronic rejection after lung transplantation is limited by the lack of a reliable test to detect airways disease early.OBJECTIVES: To determine whether maximum midexpiratory flow (MMEF), or changes on high resolution computed tomography (HRCT) or ventilation/perfusion lung (V/Q) scans are sensitive and specific for early detection of bronchiolitis obliterans syndrome (BOS; forced expiratory volume in 1 s [FEV1] less than 80% post‐transplant baseline) by evaluating long term survivors of lung transplantation at two sequential time points.METHODS: Twenty‐two stable lung transplant recipients underwent spirometry, HRCT scanning and V/Q scanning 1.6±0.9 years and 3.1±1.1 years post‐transplant (time points 1 and 2, respectively; mean ± SD).RESULTS: Although HRCT was sensitive for the detection of BOS, it lacked specificity, and hence, there were no significant relationships between the presence of BOS and any of the HRCT parameters evaluated at time 1 or time 2. Of the V/Q parameters studied, the presence of heterogeneous perfusion (P=0.04, sensitivity 100%, specificity 33%) and segmental perfusion defects (P=0.04, sensitivity 60%, specificity 83%) were significantly related to BOS, but only at time 2. MMEF less than or equal to 75% post‐transplant baseline was significantly related to the presence BOS at time 1 only (P=0.05, sensitivity 100%, specificity 47%). MMEF less than or equal to 75% post‐transplant baseline at time 1 was sensitive for the development of BOS at time 2, but was limited by low specificity.CONCLUSIONS: In this group of lung transplant recipients, HRCT and V/Q scanning, as well as analysis of MMEF, did not add information that was clinically more useful than FEV1 for the early identification of chronic rejection.
Response to a Protease‐Inhibitor (Ritonavir)‐Containing Combination Antiretroviral Regimen in HIV‐Infected Children
Authors: Allen Upton D , Lapointe Normand , Read Stanley E , Forbes Jack C , King Susan M , Wasfy Samia , the Canadian Pediatric AIDS Research Group  
Published: March 2016

INTRODUCTION: The number of antiretroviral agents available for children who are failing existing therapy is limited. Data are lacking on the use of various combination regimens and the resulting viral load dynamics in such children.METHODS: Between March 1998 and March 2000, HIV‐infected children younger than 18 years of age were studied in an open trial. The study regimen included ritonavir, with at least two drugs to which the virus was known or presumed to be sensitive. subjects were ritonavir‐naive and were included if they had high viral loads while receiving antiretroviral therapy. Patients had clinical assessments, CD4 counts and viral load monitoring.RESULTS: Fifteen antiretroviral‐experienced HIV‐infected children were enrolled. Approximately 87% (13 of 15) had perinatally‐acquired HIV; median age was 7.9 years (range 1.6 to 14.8). At enrolment, the median CD4 count was 557 cells/mm3 (range 57 to 1702) and the median viral load was 72,600 copies/mL (range 3626 to 796,440). The majority of children (73.3%) had increases in CD4 counts within 12 weeks. During this period, the median increase in CD4 counts over baseline was 30.0%. Approximately 73% (eight of 11) of subjects with initial improvements in CD4 counts had sustained increases at 32 to 48 weeks. Over the first 12 weeks, 60% (nine of 15) had greater than 0.5 log10 decreases in viral load. The improvement was sustained in 88.9% (eight of nine) of these patients at 32 to 48 weeks. Three patients discontinued therapy due to taste aversion.CONCLUSIONS: Among pediatric patients with high viral loads while on existing therapy, the ritonavir‐containing regimen was generally well tolerated. In a significant proportion of patients, modification of therapy was associated with sustained improvements in viral loads and CD4 counts over 32 to 48 weeks.
Longitudinal Decline in Lung Function Measurements among Saskatchewan Grain Workers
Authors: Pahwa Punam , Senthilselvan Ambikaipakan , McDuffie Helen H , Dosman James A 
Published: March 2016

OBJECTIVE: To evaluate the relationship between the long term effects of grain dust and decline in lung function among grain elevator workers in Saskatchewan, studied over a 15‐year period.METHODS: The Grain Dust Medical Surveillance Program was started by Labour Canada in 1978 and longitudinally studied the respiratory health of Canadian grain elevator workers over a 15‐year period (1978 to 1993). Data on respiratory symptoms and pulmonary function tests (forced expiratory volume in 1 s [FEV1], forced vital capacity [FVC]) were collected once every three years; each three‐year interval was called a ′cycle′. Data from Saskatchewan were analyzed for this report. A transitional model using the generalized estimating equations approach was fitted using a SAS macro to predict the annual decline in FEV1 and FVC.RESULTS: Previous lung function, as one of the covariates in the transitional model, played an important role. Significant predictors of FEV1 were previous FEV1, base height, weight, years in the grain industry, current smoking status, cycle II, cycle III and cycle V. Significant predictors of FVC were previous FVC, base height, weight, years in the grain industry, cycle II, cycle III and cycle IV.CONCLUSIONS: The estimated annual decline in FEV1 and FVC increased according to length of time in the grain industry among nonsmoking, ex‐smoking and smoking grain elevator workers. Lung function values improved after dust control, and yearly declines in FEV1 and FVC after dust control were smaller compared with yearly losses before dust control.
A Descriptive Study of Human Salmonella Serotype Typhimurium Infections Reported in Ontario from 1990 to 1997
Authors: Ford Michael W , Odoi Agricola , Majowicz Shannon E , Michel Pascal , Middleton Dean , Ciebin Bruce , Doré Kathryn , McEwen Scott A , Aramini Jeffery A , Deeks Shelley , Jamieson Frances , Ahmed Rafiq , Rodgers Frank G , Wilson Jeff B 
Published: March 2016

BACKGROUND: Salmonella infections cause gastrointestinal and systemic diseases worldwide and are the leading causes of food‐borne illnesses in North America (1‐4). Salmonella serotype typhimurium (ST), in particular, is increasingly becoming a major public health concern because of its ability to acquire multiple resistant genes (5,6).OBJECTIVE: To describe demographic, temporal and geographical distributions, and reported risk factors of nonoutbreak cases of ST reported to a surveillance system in Ontario.METHODOLOGY: Descriptive analyses were performed on data on salmonellosiscases reported in Ontario between 1990 and 1998. Direct age‐ and sex‐standardized rates were computed, and temporal trend analyses were performed using simple linear regression and a general additive model with alocally weighted regression (LOESS) smoother.RESULTS: The mean annual rates of infections with all Salmonella serotypes and with ST were 27 cases per 100,000 persons and 3.7 cases per 100,000 persons, respectively. Males and children under five years of age had significantly higher rates of both ST and ST definitive type 104 (DT104) infections. There was also evidence of temporal clustering of all strains of Salmonella, with significantly more cases being reported during the summer. Significantly higher rates of ST DT104 were observed in urban areas compared with rural areas, suggesting potential differences in the geographical distribution of risk factors.CONCLUSIONS: Information on demographic, temporal and geographical distributions, and risk factors is critical in planning disease control strategies. Further prospective analytical observation studies are needed to gain a better understanding of the epidemiology of ST and ST DT104 in Ontario, which will better guide disease control decisions.