<p> Public health reporting is an important source of information for public health investigation and surveillance, which are necessary for the prevention and control of disease. There are two important problems with the current public health reporting process in the United States: (a) the reporting specifications are unstructured and are communicated with reporting facilities using nonstandard public health department Web sites and (b) most reporting facilities transmit reports to public health entities using manual and paper-based processes. Our research focuses on the development and evaluation of new strategies to improve the public health reporting process by addressing these problems. </p><p> To improve the communication of public health reporting specifications by public health authorities, we: (a) examined the business process of a laboratory complying with the reporting requirements, (b) evaluated public health department Websites to understand the problems faced by reporting facilities while accessing the reporting specifications, (c) identified the content requirements of a knowledge management system for public health reporting specifications, (d) designed the representation of the public health reporting specifications, and (e) evaluated the content and design using a prototype web-based query system for public health reporting specifications. </p><p> To improve the transmission of case reports from healthcare facilities to public health entities, we: (a) described public health workflow associated with the management of case reports, (b) identified the content of a case report to meet the needs of public health authorities, (c) modeled the case report using Health Level Seven (HL7) v2.5.1, and (d) evaluated the electronic case reports by comparing the timeliness, completeness of information content, and the completeness of the electronic reporting process with the paper-based reporting processes.</p><p> We demonstrated a model for public health reporting specifications using a prototype web-based query system. The evaluation conducted with users from laboratories, healthcare facilities, and public health entities showed that the proposed model met most of the users' needs and requirements. We also identified variation in the reporting specifications, some of which could be standardized to improve reporting compliance.</p><p> We implemented HL7 v2.5.1 case reports from Intermountain Healthcare hospitals to the Utah Department of Health. The electronic reports transmitted from the Intermountain hospitals were more timely (median delay: 2 days) than the paper reports sent from other clinical facilities (median delay: 3.5 days) but less timely than the paper reports from Intermountain laboratories (median: 1 day). However, the evaluation of the completeness of data elements needed for public health triage prior to investigation showed that electronic case reports from Intermountain hospitals included more complete information than paper reports from Intermountain laboratories. Even though the paper reports from Intermountain laboratories were more timely, the incomplete reports may delay investigation. There are informatics opportunities and public health needs to improve both electronic laboratory reporting and electronic case reporting.</p>

<p> BACKGROUD: Non-alcoholic fatty liver is the most frequent liver abnormality observed in obese children and adolescents. It is has yet to be determined whether sex and race plays a role in the effect of regular exercise without calorie restriction on intrahepatic lipid and regional adiposity in obese adolescent males and females. </p><p> OBJECTIVE: To examine the effect of sex and race after a 3-month regular exercise regimen alone without calorie restriction on intrahepatic lipid (IHL) and regional adiposity in overweight adolescent males and females. More specifically, we examined the influences of sex and race on the changes in total (TAT) and visceral fat (VAT) and IHL in response to aerobic (AE) versus resistance (RE) exercise in obese adolescents using data published previously. </p><p> STUDY DESIGN &amp; METHODS: Thirty-one adolescent boys and twenty-eight overweight adolescent females (BMI &ge; 95th percentile, 12-18 years, Tanner stage III-V) were randomly assigned to either: AE (n = 29, 60 min/session, 3 days/week) or RE (n = 30, 60 min/session, 3 days/week). Outcome measurements included IHL by proton magnetic resonance spectroscopy and TAT and VAT assessed by MRI. Cardiorespiratory fitness (CRF) and muscular strength was also assessed. </p><p> RESULTS: No significant sex differences were seen between obese adolescent males and females for IHL, TAT and VAT after 3 months of exercise regardless of modality. There were no significant race differences between obese black and white adolescents for TAT. White adolescents (&Delta; -1.46 &plusmn; 0.2%) lost significantly more IHL than black adolescents (&Delta; -0.22 &plusmn; 0.1%) after 3 months of exercise regardless of modality. Improvement in CRF was not significantly different in the AE group compared to the RE group. Muscle strength index score significantly increased in the RE (&Delta; 0.33 &plusmn; 0.02) group compared to the AE group (&Delta; 0.04 &plusmn; 0.02). </p><p> CONCLUSIONS: Our results demonstrate that 3 months of AE versus RE exercise will improve body composition and fitness measurements consistently, with no influence of sex, between obese black and white adolescent males and females. Our observations suggest that regular exercise alone is an effective treatment strategy for the treatment of obesity in overweight black and white adolescents. </p>

The evaluation of drug effects acquires an increasing significance in psychiatric research due to the number of new compounds as well as the need for safety screening for side effects. The present study reports the results of the investigation of effects of buspirone in 57 primary chronic alcoholics, using a double blind method with a placebo control group. Buspirone was administered in doses of 20 mg/day after a two-week wash-out period during which patients in both groups received placebo capsules. After a further two weeks of the study, the buspirone dose was increased to 40 mg/day until completion of the investigation after twelve weeks. Five out of 36 subjects, who completed the study, became abstinent. Detailed characteristics of the study group were obtained, including socio-demographic data, alcohol consumption, Michigan Alcoholism Screening Test (MAST), Alcohol-Use-Inventory (AUI), Drinking Behavior Interview (DBI), and psychometric assessment: Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Scale (HAM-A) and Hopkins Symptoms Checklist 90-Revised (SCL-90-R). Statistical analysis of the results was carried out using multivariate analysis of covariance on repeated measures. The HAM-A scale results were improved significantly in patients receiving buspirone. Marked improvement was also observed in Interpersonal Sensitivity Scale (a subscale of SCL-90-R). MENTALIM subscale of AUI demonstrated a statistically significant improvement in the buspirone group, when compared to patients receiving placebo. The validity of self reports on alcohol consumption by patient was confirmed by a change in liver enzyme levels: Gamma-Glutamyl Transpeptidase (GGT), Alanine Aminotransferase (ALAT) and the results of the Edwards Hardship Scale. The scores on HAM-A and MADRS scales were higher among the drop-outs than in those who completed the study. The side effects of buspirone were minimal and a good tolerance of the drug was observed.

In this thesis, composed of two separate articles, we studied the frequency of COPD exacerbations and assessed the effectiveness of inhaled corticosteroids in preventing a first exacerbation of COPD. We used an inception cohort of COPD patients, formed from the computerised databases of Saskatchewan. / The rate of COPD exacerbations was 11.5 per 100 person-years. It increased with age and was 50% higher in men than women. Use of inhaled corticosteroids in the year prior to the index date and current use were associated with a small increase in the risk of a first exacerbation (adjusted RR = 1.27, 95% CI: 1.08--1.48 and 1.51, 95% CI: 1.22--2.87, respectively). The risk increased with increasing daily dose (adjusted RR per 1000 mug = 1.83, 95% CI: 1.47--2.28). / We did not find that the use of inhaled corticosteroids reduces the risk of a first exacerbation in patients with COPD.

In this thesis we examine the effect of hormone replacement therapy (HRT) on the risk of colorectal cancer. Also examined are the effects of oral versus transdermal estrogen replacement therapy, methods of defining estrogen exposure, selection bias, and trends in the use of HRT over the last two decades. / A nested case-control study was conducted using records from Saskatchewan Health's administrative databases. Information on covariates not available from the databases was collected during interviews, from a subgroup of subjects. Incidence density sampling was used to age match controls (four per case, N = 12,116) to each of 3,059 cases accrued in the province from 1981 to 1998. / Short and long durations of HRT use (<5 years and &ge;5 years) were associated with odds ratios (OR) of 0.86 (0.76--0.97) and 0.78 (95% CI: 0.64--0.86), respectively. Stratification according to history of having had a screening sigmoidoscopy did not eliminate the observed protective effect. Important differences were not seen between more recent HRT use (<5 and <10 years), compared with more distant past use (&ge;5 and &ge;10 years). / The use of various definitions of estrogen exposure produced ORs ranging from 0.78 to 0.99 which are similar to results from almost two dozen observational studies conducted over the past two decades indicating that this is an important source of variability that needs to be considered. / The study of independent effects of oral and transdermal estrogens revealed a protective effect of transdermal estrogen that was much greater than that of oral estrogen and which has not previously been reported. A protective effect remained when women who had used oral estrogen only were used as the reference group. / Data pertaining to lifestyle factors collected by interview appeared not to alter ORs for HRT and colorectal cancer. However, due to extremely low response rates in the interview phase of the study, 30% among cases and 18% among controls, we were unable to conclude whether or not confounding was eliminated. / An important finding of research is the strong observed protective effect of transdermal estrogen replacement therapy. This demonstrates the importance of taking into consideration the mode of estrogen delivery in studies where the associations between HRT use and health outcomes are examined.

Iron deficiency anaemia is associated with several ill-health effects. Its treatment and/or control with iron preparations in malaria endemic areas has, however, been implicated to increase host susceptibility to malaria infection. Scientific evidence accumulated to date remains equivocal about the presence of this increased susceptibility. The present work was planned to address the existing controversy by assessing the effect of oral iron supplementation on host susceptibility to malaria infection. / A randomized, double-blind, placebo-controlled field trial of oral ferrous sulphate supplementation in schoolchildren 5 to 14 years of age was carried out in northwest Ethiopia where transmission of malaria is high. A total of 500 school children, all with mild-to-moderate iron deficiency, were randomly assigned to receive either ferrous sulphate (60 mg elemental iron per day) or a look-alike placebo, over a period of 12 weeks. Follow-up continued for 24 weeks post-randomization. / Children who received iron supplementation tended to develop more clinical attacks of malaria than those children who received placebo, although the difference between the groups was not statistically significant, either during the initial 12 week supplementation period (RR = 1.59; 95% CI: 0.92-2.75) or during the 24 weeks of follow-up (RR = 1.45; 95% CI: 0.95-2.20). Similarly, a trend of increased risk of malaria infection (parasitemia) was noted in the iron-supplemented group over the 24 week follow-up period (RR = 1.22; 95% CI: 0.98-1.52). No difference in any other outcome measure (spleen rate, average enlarged spleen index, and parasite density index) was observed between the groups either during the 12 weeks of supplementation or the 24 weeks of follow-up. / This study suggests that iron supplementation, in areas where iron deficiency and malaria co-occur, may enhance host susceptibility to malaria infection. Thus, approaches to control or prevent iron deficiency anaemia in malaria endemic areas should be integrated with malaria control activities in order to minimize the unintended effects of malaria infection while providing the greatest benefit.

Objective. To evaluate the clinical effectiveness of a community pharmacy based education program for asthma patients. / Design. A randomized controlled trial was conducted in 16 community pharmacies. Interventions: Patients in the intervention group (n=53) received three sessions of individualized asthma education from pharmacists. In addition, pharmacists also prepared a written action plan in consultation with patients' physicians. Patients in the control group (n=53) did not receive any asthma education during the study. / Outcome Measures. Asthma symptoms (the primary outcome), asthma knowledge, medication compliance, deep expiratory pressure percentage (DEP%), inhaler technique, quality of life (QOL), and heath resources utilization were measured. / Results. The mean score of asthma symptoms, the primary outcome, decreased more in the intervention group than in the control group (between group difference = -0.299, 95% CI, -0.71; 0.11), though this between group difference was not statistically significant (P=0.148). As to the secondary outcomes, patients in the intervention group had significant improvements in "overall mean score of QOL" (between group difference = 0.43, 95% CI, 0.023; 0.83), "symptom domain of QOL" (between group difference = 0.50, 95% CI, 0.04; 0.96), and "inhaler technique of Aerosol-dosing only" (between group difference = 1.77, 95% CI, 0.36; 3.18). Except for QOL and inhaler technique, the other four secondary outcomes did not achieve any significant differences between the two study groups. / Conclusions. Most of the study results were not statistically significant. One important reason for this was the lack of power due to the poor success in patient recruitment. The study also highlighted some of the limitations and difficulties in implementing a community pharmacy based asthma education program. Despite these difficulties, some benefits were found. Therefore, we suggest that future studies should focus on overcoming the limitations and difficulties observed in this study.

The goal of pandemic influenza planning is to minimize health and economic losses in the event of a future pandemic. One of the numerous challenges associated with this goal is the need to ration limited medical supplies such as vaccines and antivirals. This thesis seeks to formulate an ethical framework for priority access to these resources. Prioritization strategies must be consistent with the goal of pandemic planning and should reflect societal norms for equitable distribution. According to an ethics framework based on the principles of utility and equity, three groups were granted highest priority for influenza vaccine, namely health care workers, emergency service workers, and high-risk individuals predisposed to severe outcomes following influenza infection. In the case of antivirals, the expectation is that there will be competition between treatment and prophylaxis uses of these drugs. The resulting dilemma---providing primary access to the critically ill in respect of the medical profession's duty of care or prioritizing prophylaxis of health care workers in respect of their right to protection---is the major question which the framework presented in this thesis seeks to resolve.

Objectives. To estimate calcium and vitamin D intakes in Canadian men and women, to compare these intakes to Canadian guidelines, and to determine factors associated with intake of these nutrients. / Methods. We estimated intakes of calcium and vitamin D from both diet and supplements using cross-sectional data from 9,423 randomly selected subjects 25 years of age and older who completed an interviewer administered abbreviated food frequency questionnaire. The participants were recruited from July 1995 to September 1997 in nine centres across Canada. We characterized the relationships of calcium and vitamin D with socio-demographic and lifestyle variables, physical characteristics, medical diagnosis and use of osteoporosis related medications. / Results. The median daily intake for calcium was estimated to be 930 (interquartile range (IQR) = 589;1360) mg for women, and 774 (IQR = 507;1155) mg for men; for vitamin D, intakes were 3.6 (IQR = 1.1;10.0) pg and 2.7 (IQR = 0.9;7.5) pg for women and men, respectively. Age and study centre were found to be associated with calcium and vitamin D intakes in both genders. Other variables associated with calcium intake included vitamin D intake, weekly energy expenditure and femoral neck bone mineral density. Factors found to be associated with vitamin D intake in both genders included calcium intake, height and caffeine intake. / Conclusions. The only group that on average met adequate daily intake levels for calcium was women aged 51-70. For vitamin D, on average, women and men under age 51 met adequate intake levels. Further education programs may be required to encourage increased consumption of these nutrients.

We used a mailed questionnaire to investigate over-the-counter (OTC) analgesic medication use. The response rate was 77% (n= 1.339). 79% of women and 64% of men had consumed OTC analgesics in the past month, mostly on only 1-3 days, but 6% of users took them every day or almost every day. The most common reason for use was headache, followed by back and joint pain. 5% used larger doses than recommended. Women took more analgesics, but reported suffering more problems: gender differences disappeared when the number of problems was controlled. Remembered mood before and after medication indicated a substantial improvement in mood that was only partially explained by pain relief. This may explain the 81 cases who reported taking OTC analgesics for fatigue, stress, etc. Health practitioners need to determine if OTC analgesic use is appropriate and pain relief is adequate. Effects of OTC analgesics on mood need to be further investigated.