bluuebunny/crossref_metadata_2025_split huggingface dataset:
Legionnaires′ Disease ‐ Results of a Multicenter Canadian Study
Authors: Marrie Thomas J , de Carolis Emidio , Yu Victor L , Stout Janet , the Canadian Community-Acquired Pneumonia Investigators  
Published: March 2016

BACKGROUND: There has never been a cross‐Canada surveillance project to determine the rate of Legionella species as a cause of community‐acquired pneumonia requiring hospitalization and to determine whether there are any regional differences in the rates of Legionnaires′ disease in Canada. Anecdotally, Legionnaires′ disease is thought to be uncommon in Western Canada.METHODS: From January, 1996 through to October 31, 1997, a prospective study of the etiology of community acquired pneumonia requiring admission to 15 tertiary care hospitals in eight Canadian provinces was conducted. A urine sample from each patient was tested for Legionella pneumophila serogroup 1 antigen using a commercially available ELISA assay. A culture of sputum or other respiratory specimens for Legionellaceae was carried out at the discretion of the attending physician. Two hundred thirty‐four patients had acute and 6‐week convalescent serum samples tested for antibodies to L pneumophila serogroups 1 through 6 using an ELISA method.RESULTS: 28 of the 850 patients (3.2%) had Legionnaires′ disease; 18 of 823 (2.1%) were positive for L pneumophila serogroup 1 by urinary antigen testing. The rate of Legionnaires′ disease, based on urinary antigen, at the Halifax site was higher than that at the other sites (seven of 163 patients versus 11 of 660 [P=0.04]). Of the 28 cases of Legionnaires′ disease identified using all methods, 11 of 277 patients (3.9%) were enrolled from Western provinces versus 17 of 573 patients (2.9%) from Eastern provinces (P=nonsignificant).CONCLUSIONS: Legionnaires′ disease is just as common in Western as in Eastern Canada. L pneumophila serogroup 1 may be more common in Halifax than at the other sites studied.
Comparative Prevalence of Asthma in Different Groups of Athletes: A Survey
Authors: Langdeau Jean-Bruno , Turcotte Hélène , Thibault Guy , Boulet Louis-Philippe 
Published: March 2016

BACKGROUND: The type of air predominantly inhaled during training seems to play an important role in the development of airway hyperresponsiveness in athletes; however, this factor has not been evaluated for asthma.OBJECTIVE AND PATIENTS: To compare the prevalence of self‐reported and/or physician‐diagnosed asthma among four groups of athletes categorized according to the type of air predominantly inhaled during training: cold air (n=176), dry air (n=384), humid air (n=95), and mixed dry and humid air (n=43).METHOD: Self‐administrated questionnaires were used.RESULTS: One hundred seven (15.3%) of the 698 athletes reported having asthma; of these 107 athletes, 92 had physician‐diagnosed asthma. No significant differences were found for the prevalence of asthma: 15.9% (cold air), 15.4% (dry air), 12.6% (humid air) and 18.6% (mixed dry and humid air), respectively (P>0.05). Furthermore, no significant differences were observed among the groups for the prevalence of confirmed atopy, cold/flu or respiratory infections (all P>0.05), except for the prevalence of hay fever, which was significantly lower among athletes of the dry air group (P=0.04). Athletes having a first‐degree relative with asthma did not have a higher prevalence of asthma than those who did not (P>0.05).CONCLUSION: The prevalence of asthma was not significantly different among the four groups of athletes and it was not associated with a family history of asthma.
Chronic Noncancer Pain and the Long Term Utility of Opioids
Authors: Watson CPN , Watt-Watson JH , Chipman ML 
Published: March 2016

OBJECTIVE: To report on a long term experience in treating patients with chronic noncancer pain (CNCP).METHODS: One hundred two patients with CNCP were seen every three months and followed for one year or more (median eight years, range one to 22). Demographic data, diagnostic categories and response to therapies were recorded. The utility and safety of opioid therapy, adverse events, impact on disability and issues related to previous psychiatric or chemical dependency history were documented.RESULTS: Most patients reported a variety of neuropathic pain problems and most required chronic opioid therapy after the failure of other treatments. Although 44% reported being satisfied with pain relief despite adverse events, it is noteworthy that the remaining patients chose to continue therapy for the modest benefit of pain relief despite adverse events. Moreover, 54% were less disabled on opioid therapy.CONCLUSIONS: This is a large sample of CNCP patients, most taking opioids over a long period of time. CNCP can be treated by opioids safely and with a modest effect, with improvement in functioning in some patients who are refractory to other measures. If care is taken, opioids may even be used effectively for patients with a history of chemical dependency.
Spirometric Findings among School‐Aged First Nations Children on a Reserve: A Pilot Study
Authors: Sin Don D , Sharpe Heather M , Cowie Robert L , Man SF Paul , on behalf of the Alberta Strategy to Help Manage Asthma (AST  
Published: March 2016

BACKGROUND: Asthma and chronic obstructive pulmonary disease (COPD) are increasing concerns for First Nations peoples in Canada. Although hospital utilization for asthma and COPD among First Nations peoples has been increasing, the prevalence of asthma or wheezing is comparable to national averages.OBJECTIVES: A pilot study was conducted to determine the prevalence of impaired lung function in school‐aged First Nations children.PATIENTS AND METHODS: A First Nations community in northern Alberta was selected to participate. Consent forms and a school health survey were completed by parents or guardians. Children with consent completed spirometry at school, and results were compared with predicted values.RESULTS: A total of 36 children participated (response rate 70.6%). Of these, 19.4% of parents reported that their child had received a physician diagnosis of asthma at some point in their life; only 28.6% had a parental report of still having asthma. Parents smoked in 73.1% of the children′s homes. The mean (± SD) percentage of forced expiratory volume in 1 s (FEV1) over forced vital capacity (FVC) was 82.6%±6.9% (94.4%±0.08% of predicted). Evidence of airflow obstruction was found in 25% of the children. Parental report of the child ever having asthma was associated with impaired lung function (OR 3.20; P=0.033). Children in a home with reported mold exposure were less likely to have impaired lung function (OR 0.68; P=0.030).CONCLUSIONS: Many children in this study already have established airflow obstruction and may be at increased risk for asthma or COPD. Exposure to mold appeared to be protective. Further research is needed to evaluate the lung health concerns of this population.
Serological Studies of West Nile Virus in a Liver Transplant Population
Authors: Nicolle LE , Gutkin A , Smart G , Dawood M , Drebot M , Van Caeseele P , Giulivi A , Minuk GY 
Published: March 2016

BACKGROUND: Solid organ transplant populations are at increased risk for serious clinical manifestations of West Nile virus (WNV) infection.OBJECTIVE: To monitor liver transplant recipients during the 2003 WNV season in Manitoba and to identify incidence, clinical presentation and serology.METHODS: Serial blood specimens were obtained from adult patients followed at the liver transplant outpatient clinic between May 2003 and October 2003. Studies for WNV infection included immunoglobulin (Ig) G and IgM enzyme immunoassay (EIA), hemagglutination inhibition (HI), plaque reduction neutralization test and reverse transcriptase‐polymerase chain reaction.RESULTS: None of the 79 patients had clinical presentations suggestive of WNV infection. On testing of the final serum specimen obtained, 14 patients (18%) had positive IgG anti‐WNV by EIA and six patients (7%) had indeterminate IgG anti‐WNV by EIA, although all were negative by IgM EIA. Four (20%) of the EIA‐positive samples were reactive by HI, but all of these were negative by WNV plaque reduction neutralization test; this is consistent with the presence of non‐West Nile flavivirus antibody in these sera. Blood specimens obtained throughout the season from EIA‐ and HI‐positive individuals were uniformly negative for WNV‐RNA by reverse transcriptase‐ polymerase chain reaction. Age, sex, hematology and biochemistry findings, hepatitis B or C virus status, immunosuppressive regimen (cyclosporin or tacrolimus) and pretransplant diagnosis of liver disease were similar for EIA‐positive and EIA‐negative patients. For the 10 patients with a positive IgG EIA maintained on cyclosporin, the cyclosporin level was 129.1±28.6 µg/L compared with 85.6±36.7 µg/L in 26 patients who were EIA‐negative (P=0.002).CONCLUSIONS: False‐positive IgG EIA serology for WNV was common in this cohort of liver transplant recipients, and was associated with elevated serum cyclosporin levels.
Cartography of Emergency Department Visits for Asthma – Targeting High‐Morbidity Populations
Authors: Lajoie Pierre , Laberge Andrée , Lebel Germain , Boulet Louis-Philippe , Demers Marie , Mercier Pierre , Gagnon Marie-France 
Published: March 2016

BACKGROUND: Asthma education should be offered with priority to populations with the highest asthma‐related morbidity. In the present study, the aim was to identify populations with high‐morbidity for asthma from the Quebec Health Insurance Board Registry, a large administrative database, to help the Quebec Asthma and Chronic Obstructive Pulmonary Disease Network target its interventions.METHODS: All emergency department (ED) visits for asthma were analyzed over a one‐year period, considering individual and medical variables. Age‐ and sex‐adjusted rates, as well as standardized rate ratios related to the overall Quebec rate, among persons zero to four years of age and five to 44 years of age were determined for 15 regions and 163 areas served by Centres Locaux de Services Communautaires (CLSC). The areas with rates 50% to 300% higher (P<0.01) than the provincial rate were defined as high‐morbidity areas. Maps of all CLSC areas were generated for the above parameters.RESULTS: There were 102,551 ED visits recorded for asthma, of which more than 40% were revisits. Twenty‐one CLSCs and 32 CLSCs were high‐morbidity areas for the zero to four years age group and five to 44 years age group, respectively. For the most part, the high‐morbidity areas were located in the south‐central region of Quebec. Only 47% of asthmatic patients seen in ED had also seen a physician in ambulatory care.CONCLUSION: The data suggest that a significant portion of the population seeking care at the ED is undiagnosed and undertreated. A map of high‐morbidity areas that could help target interventions to improve asthma care and outcomes is proposed.
Symptom Resolution in Patients with Mycoplasma pneumoniae Pneumonia
Authors: Marrie Thomas J , Beecroft Michael , Herman-Gnjidic Zeljka , Poulin-Costello Melanie 
Published: March 2016

BACKGROUND: Mycoplasma pneumoniae generally causes pneumonia of mild to moderate severity in adults. However, little is known about the time course of the resolution of symptoms in this illness.OBJECTIVES: To determine the time course of the resolution of symptoms in M pneumoniae pneumonia.METHODS: The severity of fatigue, cough, dyspnea, sputum and pleuritic chest pain were self‐scored and recorded daily for 14 days and on days 30 and 42. Each symptom was scored on a scale of 0 to 5. The sum of the five symptom scores had a range of 0 to 25 and was transformed into a value from zero to 100 by multiplying by four.RESULTS: The mean composite symptom score for 76 patients was 59 (out of 100) at presentation, which declined to a score of 17 on day 14. Patients with a score of greater than 20 on day 14 had significantly higher scores throughout the course of the illness. Thirty‐four per cent of those who were employed did not take time off work.CONCLUSIONS: Most patients with M pneumoniae pneumonia had resolution of their symptoms within two weeks; however, 12.6% were still symptomatic at 42 days.
Asthma and Allergic Rhinitis in Quebec Children
Authors: Lévesque Benoît , Rhainds Marc , Ernst Pierre , Grenier Anne-Marie , Kosatsky Tom , Audet Nathalie , Lajoie Pierre 
Published: March 2016

BACKGROUND: The Health and Social Survey of Quebec Children and Youth, conducted on representative samples of children nine, 13 and 16 years of age, provided data on the prevalence and determinants of asthma and allergic rhinitis in Quebec.OBJECTIVES: To determine the prevalence of asthma and allergic rhinitis among children in the province of Quebec and to identify the determinants of these pathologies.METHODS: Three groups of more than 1100 children aged nine, 13 and 16 years were recruited. Respiratory symptoms were documented using the International Study of Asthma and Allergies in Childhood questionnaire. Questions enquiring about family income, smoking, degree of urbanization of the child′s school′s location and various variables related to indoor air were also included. The comparisons of proportions were done using the X2 test.RESULTS: The prevalence rates for reported history of asthma varied from 14% to 15% depending on the age group. The prevalence of wheezing in the past year was 7% to 8%. Asthma was the primary cause of the limitation of activities due to a health problem in nine‐ and 13‐year‐old Quebecers, and the second most common cause in 16‐year‐old Quebecers. The prevalence of rhinitis, rhinoconjunctivitis and reported history of hay fever increased with age, reaching 28.0%, 15.9% and 21.1%, respectively, in the 16‐year‐old group. The prevalence of asthma and wheezing was associated with family history and allergies, and inversely related to family income.CONCLUSIONS: The prevalence of childhood asthma is high in the province of Quebec. It is a major cause of the limitation of activities due to a health problem for young Quebecers. A family history of asthma and an atopic predisposition are important determinants in the development of asthma in Quebec.
A Survey of Cancer Pain Management Knowledge and Attitudes of British Columbian Physicians
Authors: Gallagher R , Hawley P , Yeomans W 
Published: March 2016

INTRODUCTION: There are many potential barriers to adequate cancer pain management, including lack of physician education and prescription monitoring programs. The authors surveyed physicians about their specific knowledge of pain management and the effects of the regulation of opioids on their prescribing practices.METHODS: A questionnaire was mailed out to British Columbia physicians who were likely to encounter cancer patients. The survey asked for physicians′ opinions about College of Physicians and Surgeons of British Columbia regulation and other issues related to their prescribing practices, and assessed basic knowledge of cancer pain management.RESULTS: There was a 69% return rate with a total of 4618 evaluable responses. There was a significant difference among medical disciplines, years in practice, number of chronic pain patients seen and size of community of practice. The highest knowledge scores were achieved by oncologists and the lowest scores were from surgeons. Those who practiced in smaller communities had a higher average knowledge score. Those who felt their knowledge about cancer pain was inadequate scored lower than those who felt their knowledge was adequate. The questions most frequently answered incorrectly (or by ′don′t know′) were those about equianalgesic dosing (68%) and adequate breakthrough dosing (45%), revealing knowledge deficiencies that would significantly impair a physician′s ability to manage cancer pain.CONCLUSIONS: The details of opioid prescribing are crucial areas to target education for cancer pain management. The surveyed physicians accepted the need for regulation of opioid prescribing with very few being fearful of scrutiny from the College of Physicians and Surgeons of British Columbia. However, the inconvenience of the triplicate prescription pad was more of a barrier to prescribing, it being of concern to 20% of respondents, particularly surgeons and medical specialists.
A Randomized Trial to Evaluate the Sustained Efficacy of a Mucus Clearance Device in Ambulatory Patients with Chronic Obstructive Pulmonary Disease
Authors: Wolkove Norman , Baltzan Marc A , Kamel Hany , Rotaple Michael 
Published: March 2016

OBJECTIVE: To determine whether a mucus clearance device (MCD) (Flutter; Axcan Scandipharm, USA) could consistently improve the bronchodilator response and exercise performance in patients with chronic obstructive pulmonary disease (COPD) when used in an ambulatory setting over a one‐week period.SUBJECTS: Fifteen patients with severe COPD (mean age 71±10 years) were studied.METHODS: A randomized crossover design compared an MCD with a sham MCD (SMCD), in which each were tested for one week. At the beginning and end of each study week, forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured before and after MCD or SMCD. A bronchodilator aerosol (ipratropium bromide and salbutamol sulphate) was then given, and FEV1 and FVC were remeasured 30 min, 60 min and 120 min later. A 6 min walk test (6MWT) was also performed.RESULTS: FEV1 improved significantly (P<0.05) after bronchodilator administration with both the SMCD and MCD. The improvement was always greater with MCD use than with SMCD. At the baseline measure, 120 min postbronchodilator administration, the mean FEV1 improved by 24±24% with SMCD use and 60±28% with MCD use (P<0.05). After one week of use, the corresponding values at 120 min were 19±24% and 43±26% (P<0.05). Similar findings were obtained for FVC. 6MWT distances increased by 29±12 m (P<0.05) after one week of MCD use, whereas it decreased slightly (by 16±18 m) after SMCD. The decline in saturation with the 6MWT was smaller with MCD use than with SMCD use. After one week, the decline in saturation with MCD use was similar to baseline levels, although patients were walking farther. After one week, dyspnea was lower on walking with MCD use than with SMCD use.CONCLUSION: Patients with COPD had an increased response to bronchodilator therapy after use of the MCD compared with SMCD use. The increase persisted after one week of use, and was associated with improved exercise performance as measured by the 6MWT.
The Costs of Implementing the 1999 Canadian Asthma Consensus Guidelines Recommendation of Asthma Education and Spirometry for the Family Physician
Authors: Corrigan Susan P , Cecillon David L , Sin Don D , Sharpe Heather M , Andrews Elaine M , Cowie Robert L , Man SF Paul 
Published: March 2016

BACKGROUND: National and international asthma guidelines recommend that patients with asthma be provided with asthma education and spirometry as a component of enhanced asthma care. The cost of implementing these interventions in family physician practices is not known.OBJECTIVE: The objective of the present study was to determine the cost of providing recommended asthma care to adult patients in the family practice setting.METHODS: The present study was conducted using three scenarios of care in family practice. Small, medium and large asthmatic patient populations were used. The incremental costs of implementing enhanced asthma care based on the Canadian Asthma Consensus Guidelines, including the provision of spirometry and asthma education in both group and individual sessions, and the resources required for these interventions were calculated for each scenario.RESULTS: For a physician with 50 asthmatic patients, the cost of providing enhanced asthma care with spirometry and group education sessions was approximately $78 per patient in the first year of implementation. For individual sessions, the cost increased to $100 per patient for the first year. If the physician had 100 asthmatic patients, the per patient cost would decrease; however, the overall cost of the program would be $7,000.CONCLUSIONS: The costs of providing enhanced asthma care are significant. In most cases, physicians are inadequately reimbursed (or not reimbursed) for these interventions. In light of the evidence of the effectiveness of these interventions, health insurance plans should consider adding these services to fee schedules.
Uropathogen Antibiotic Resistance in Adult Women Presenting to Family Physicians with Acute Uncomplicated Cystitis
Authors: McIsaac Warren J , Mazzulli Tony , Moineddin Rahim , Raboud Janet , Ross Susan 
Published: March 2016

BACKGROUND: Increasing rates of trimethoprim‐sulfamethoxazole (TMP‐SMX) resistance among uropathogens have raised concerns about its continued role in empirical treatment of acute uncomplicated cystitis in adult women.OBJECTIVES: To determine current rates of antibiotic resistance among uropathogens in the community.METHOD: Urine culture reports from adult women with symptoms of cystitis attending the offices of family physicians from across Canada were examined. Antibiotic sensitivities and the total number of antibiotics an organism was resistant to was determined.RESULTS: In 446 women, 235 (61.4%) positive urine cultures were identified. Of these, 38.2% were resistant to at least one antibiotic and 21.5% were resistant to two or more antibiotics. The rate of ampicillin resistance was 34.1%. For TMP‐SMX, resistance was reported in 10.8% of samples. Antibiotic resistance was higher in British Columbia (55%) and western provinces (48%), compared with Ontario (33.3%) and the eastern provinces (26.3%, P=0.04, Fisher′s exact test). Multidrug resistance was also higher in western Canada (33.9%) than in eastern Canada (16.6%, P=0.007).CONCLUSIONS: TMP‐SMX resistance in Canada remains within current recommended guidelines, allowing for its continued use as a first line empirical treatment for acute cystitis in adult women. The reasons for higher rates of antibiotic resistance in western Canada merit further study.
Styles of Pain Coping Predict Cardiovascular Function Following a Cold Pressor Test
Authors: Edwards Robert R , Fillingim Roger B 
Published: March 2016

BACKGROUND: While many studies have examined the impact of pain‐related coping in adjustment to chronic pain, relatively few have evaluated the physiological consequences of differences in pain‐coping styles.OBJECTIVE: The association between strategies for coping with pain and cardiovascular functioning following exposure to painfully cold water was evaluated.METHODS: Impedance cardiography was used to assess cardiovascular functioning in 50 healthy subjects before and after a cold pressor test.RESULTS: The self‐reported use of active pain‐coping strategies was associated with reductions in mean arterial pressure and cardiac contractility from pre‐ to post‐cold pressor. In contrast, higher levels of pain catastrophizing were related to increases in cardiac contractility following acute cold pain. Importantly, coping variables predicted cardiovascular responses, whereas characteristics of the noxious stimulus (pain tolerance time and pain ratings) did not.CONCLUSIONS: These findings highlight the importance of coping styles in shaping physiological responses to pain and suggest that interventions targeting increases in adaptive coping and decreases in pain catastrophizing may reduce pain′s adverse impact.