Background: Self-rated health (SRH) is one of the most widely used measures of general health status in population health research and has received strong support as an independent predictor of mortality and morbidity. Knowledge is limited as to what exactly SRH measures and gaining a better understanding of its characteristics in people with chronic conditions is necessary. Objectives: In a Canadian community sample of people with type 2 diabetes, the aims were to understand the characteristics of SRH, to determine whether SRH was a predictor for the three year incidence of major depression and to study whether placing the question before or after health measures, as organized in a survey, would affect answers to the SRH question.Results: Disability and depression were both associated with SRH in men and women with type 2 diabetes. Fair or poor SRH at baseline was a significant predictor for the three year incidence of major depression and the majority of individuals did not change their ratings when the question was placed either at the beginning or following health-related assessments. Conclusion: Targeting both mental and physical functioning when treating diabetes could be more advantageous. Inserting a brief question, such as SRH, in clinical assessments could aid health-care practitioners in identifying high risk groups. Findings support research comparisons across studies examining SRH in people with diabetes through different surveys. Qualitative and quantitative studies are needed to gain insight into the processes through which characteristics of SRH are evaluated, to provide evidence for the use of SRH as a screening tool and as a predictor of various outcomes in people with other chronic conditions. / Contexte : L'auto-évaluation de la santé demande d'évaluer son propre état de santé en général et consiste en l'une des mesures les plus utilisées dans la recherche sur la santé de la population. Cette mesure a reçu de forts soutiens en tant que facteur indépendant prédicteur de mortalité et de morbidité. Nos connaissances demeurent limitées quant à notre compréhension de ce qui est exactement mesuré lorsqu'un individu évalue sa propre santé. Il est nécessaire de comprendre les caractéristiques de cette mesure chez les personnes atteintes de maladies chroniques. Objectifs : Dans un échantillon de la population Canadienne de personnes atteintes de diabète de type 2, les objectifs étaient de comprendre les caractéristiques de l'auto-évaluation de la santé, de déterminer si cette mesure pouvait prévoir l'incidence de la dépression majeure au cours de trois ans et d'évaluer le changement des réponses dépendamment de l'emplacement de la question dans un sondage.Résultats : L'auto-évaluation de la santé était associée à l'incapacité physique et à la dépression chez les hommes et les femmes atteints de diabète de type 2. Une mauvaise évaluation de la santé de base prévoyait significativement l'incidence de la dépression majeure au cours de trois ans. La majorité des individus n'ont pas changé leurs évaluations lorsque la question était placée avant ou suivant des questions objectives liées à la santé. Conclusions : Il pourrait être avantageux de cibler à la fois le fonctionnement mental et physique lors du traitement des personnes atteintes de diabète. Les professionnels de la santé pourraient incorporer une brève mesure telle que l'auto-évaluation de la santé dans les évaluations cliniques pour identifier les individus à risque de complications. Les résultats confirment la possibilité de comparer les résultats portant sur l'auto-évaluation de la santé obtenus à travers différentes enquêtes chez les personnes atteintes de diabète. Des études qualitatives et quantitatives sont nécessaires pour aider à mieux comprendre le processus d'évaluation des caractéristiques sur lesquelles l'auto-évaluation de la santé est basée, pour fournir des preuves quant à l'utilisation cette mesure comme outil de dépistage et comme facteur prédicteur de plusieurs résultats de la santé chez des personnes atteintes de différentes maladies chroniques.

Knowledge of the clinical progression and prognosis of Alzheimer's disease (AD) is important for planning the care of afflicted individuals and evaluating the potential benefits of interventions. There is little consensus, however, regarding the prognostic importance of clinical and demographic characteristics investigated to date. This thesis examined the methodology of prognostic studies of AD through: (1) a critical review of published studies (1984-1995); (2) an assessment of the concordance among different methods of estimating annual rate of change; and (3) an evaluation of the assumption that decline in AD is linear. / A review of 59 eligible studies revealed considerable methodological diversity. The studies also varied in the extent to which they may have been influenced by several sources of bias. Despite this, the findings for some potential prognostic factors were fairly consistent across studies. Illustrative re-analyses of Mini-Mental State Examination (MMSE) data from two longitudinal cohorts of probable AD patients (N = 65 and 46) indicated that annual rate of change estimates obtained from the two-point, adjusted two-point, and linear regression methods were comparable. Those of the trilinear model showed poorer concordance. Analyses of data from one cohort confirmed the presence of significant group and individual linear trends in MMSE scores over time and failed to provide evidence of a common quadratic trend. / These findings suggest that prognostic research in AD could benefit from more rigorous study design and further investigation of outcome instruments. Recommendations are made for future research.

Clostridium difficile is a bacterium which causes gastro-intestinal infection. The association between non-steroidal anti-inflammatory drugs (NSAIDs) and Clostridium difficile-associated disease (CDAD) has not been studied. Several case reports link diclofenac, an NSAID, with CDAD. In this thesis, we conducted a case-control study, using data from the United Kingdom's General Practice Research Database (GPRD), to examine the risk of CDAD associated with NSAID use. We identified 1,360 cases and 13,072 matched controls from 1994 through 2005. Using conditional logistic regression, we found an increased risk of CDAD associated with diclofenac [adjusted rate ratio 1.35; 95% confidence interval: 1.10-1.67]. We did not observe an increased risk of CDAD with use of any other NSAID. In addition, no dose response for diclofenac was found. In conclusion, diclofenac was associated with an increased risk of CDAD. Several NSAIDs could be prescribed in place of diclofenac, reducing the risk of CDAD without additional inconveniences. / Le Clostridium difficile est une bactérie qui cause des infections gastro-intestinales. L'association entre les anti-inflammatoires non-stéroïdiens (AINS) et le C. difficile n'a jamais été étudiée. Plusieurs rapports de cas lient le diclofenac (AINS) au C. difficile. Dans cette étude cas-témoin, basée sur des données du United Kingdom's General Practice Research Database, le risque de C. difficile suite à l'utilisation d'AINS a été évalué. 1360 cas et 13072 contrôles ont été identifiés entre 1994 et 2005. À l'aide de régression logistique, nous trouvons une augmentation du risque de C. difficile chez les utilisateurs de diclofenac [Risque relatif ajusté 1.35; intervalle de confiance 95%: 1.10-1.67]. Aucun autre AINS n'est associé à une augmentation d'infection par le C. difficile. De plus, le diclofenac n'a pas d'effet de dose. En conclusion, le diclofenac est associé à un risque accru de C. difficile. Ce risque peut être éliminé en remplaçant le diclofenac par d'autres AINS.

Inuit infants throughout the Arctic experience higher mortality and poorer health than their non-Inuit counterparts, and suffer disproportionately from bacterial and viral infections. This research initially reviews the health status of these infants, with a focus on Canadian Inuit communities and reference to other circumpolar regions, as appropriate. It also discusses the wide range of inter-related factors that affect their health and their susceptibility to infection: their demographic, social, economic and physical environment, as well as personal health practices and the availability of high quality, culturally-appropriate health services within their communities. / Data were then analyzed from a cohort study of 46 healthy Inuit infants that had been previously conducted in Iqaluit, Nunavut from December 1995 to November 1997. Hospitalization and morbidity patterns were examined over their first year of life. Infants experienced an average of four respiratory tract infections (RTIs) annually, which accounted for half of the hospitalizations in the cohort. Some interesting trends were evident from assessment of risk factors for hospitalization and infections using multiple linear regression. Infants of mothers with higher educational attainment spent six fewer days in hospital per year (95% CI: -14.6, 2.9), after adjustment for confounding variables. Adoption appeared to have adverse health effects in addition to those that would be expected due to lack of breastfeeding alone; among infants who were not breast-fed, adopted infants had three more RTIs per year than non-adopted infants (95% CI: 0.5, 5.1). These results provide support for undertaking larger epidemiological studies in order to clarify the role of these risk factors, so that future preventive efforts can be informed and effective.

The primary objective of this study was to assess the effectiveness of a hygiene programme in reducing the incidence of respiratory and diarrheal diseases in toddlers attending day care centres (DCCs). A randomized field trial was conducted in 52 DCCs in Quebec. One or two toddler groups in each DCC were followed between September 1st, 1996 and November 30, 1997. Absences for any reasons and the daily occurrence of colds and/or diarrhea in toddlers were recorded on calendars by the DCC educators. Questionnaires to the DCC director and on-site visits were used to measure potential confounding variables. The number of fecal coliforms (FC) on children's hands, on educators' hands, in the sandbox and in the playarea of each DCC was measured during three unannounced visits. Participating parents were asked to record on a 15-month calendar the occurrence of colds and diarrhea in the child and the actions taken when s/he was ill. Overall, 1,729 children were followed in 47 DCCs for a total of 153,643 child-days. The incidence rate of diarrhea was significantly reduced by the effect of monitoring alone (IRR = 0.73, 95% BCI = 0.54, 0.97) but not significantly reduced by the intervention whereas the intervention had an effect in reducing the IR of upper respiratory tract infections (URTI) (IRR = 0.80, 95% BCI = 0.68, 0.93) but the monitoring did not. Monitoring also had a significant effect in reducing the level of bacterial contamination on children's and educators' hands. Overall estimates of the IRs of respiratory and diarrheal infections based on parents' data were higher than those based on educators' data (difference of 0.81 episode of diarrhea and 2.2 episodes of URTI per child-DCC year-at-risk). During the 6-month pre-intervention period, the average direct, indirect and total costs per child due to the study illnesses were $132.06, $235.58 and $367.64, respectively. These results indicate that both a hygiene intervention program and monitoring alone play a signifi

To determine the effects of exposure to nonsteroidal antiinflammatory drugs (NSAIDs) on the risk of invasive female breast cancer we carried out a nested case-control study, using the beneficiaries of the Saskatchewan Prescription Drug Plan (SPDP) from 1981 to 1995 with no history of cancer since 1970 as the source population. Four age-matched controls were randomly selected for each case using incidence density sampling. Dispensing rates, calculated over successive time periods, characterized NSAID exposure according to dosage and the timing of exposure. / We accrued 5,882 cases and 23,517 controls. Increasing NSAID exposure during the period 7--12 months preceding diagnosis was associated with a trend towards an increasing rate ratio (RR) for the diagnosis of breast cancer (p trend = 0.003), which was attributed to detection bias because it was markedly reduced by eliminating from the analysis the cases with tumours most likely to have been detected by screening (≤ 2 cm diameter). Increasing NSAID exposure 2--5 years preceding diagnosis was associated with a trend towards a decreasing RR (p-trend = 0.003); for the highest exposure level RR = 0.76, 95% CI: 0.63--0.92. This protective effect could not be attributed to confounding by other risk factors. Confounding by risk factors not in the SPDP database was studied in analyses adjusted with data obtained by interviewing samples of subjects accrued from mid1991 to mid-1995, selected according to both disease and exposure status. / Increasing NSAID exposure 2--5 years and 6--10 years before diagnosis was associated with trends towards decreasing RRs for having a primary tumour >5 cm diameter at diagnosis (p-trend = 0.06 and 0.02, respectively). NSAID exposure did not alter the risk of regional lymph node metastasis. However, increasing NSAID exposure 2--5 years and 6--10 years before diagnosis was associated with trends towards decreasing RRs for having distant metastases at diagnosis (p-trend = 0.0003 and 0.03, respectively). / The use of NSAIDs may retard the growth of established, undiagnosed breast cancers and may decrease the risk of distant metastasis.

The province of Quebec screens for autosomal recessive phenylketonuria (PKU) and other forms of hyperphenylalaninemia due to phenylalanine hydroxylase deficiency and tetrahydrobiopterin variants in newborns. A review of the annual reports of the Quebec Newborn Screening Program and of the clinical files of individuals with hyperphenylalaninemia born in Quebec since 1970 was undertaken. The Newborn Screening Program was evaluated for its ability to detect and identify individuals with hyperphenylalaninemia, to characterize their phenotype, and to continue surveillance. Less than universal participation in the screening (98.6%) and loss to follow-up of individuals not on treatment are causes for concern in the context of maternal hyperphenylalaninemia. Characteristics of individuals with PKU or non-PKU HPA including ethnicity, age at screening test, administrative region of birth, and month of birth were analyzed.

<p> This study explored the attachment relationships of grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care. Research suggests that attachment is crucial in early childhood relationships and can impact relationships throughout the lifespan. Children in kinship care or nonkinship foster care are removed for abuse, neglect, dependency, and other traumatic life experiences, which can affect their ability to form positive attachment relationships. The goal was to understand attachment relationships in the grandparent kinship caregiver and nonkinship foster care milieu. Qualitative research methods were utilized. There were 8 grandparent kinship caregiver participants and 8 nonkinship foster parent participants. The themes that emerged were: 1) importance of family; 2) attachment, trauma, and traumatic grief and loss; 3) challenges; 4) roles; and 5) family relationship styles. Each theme contained subthemes. All participants reported challenges and the majority reported positive attachment relationships. This was the first qualitative study to explore attachment experiences of grandparent kinship caregivers and nonkinship foster parents with preschool-aged children in their care. The findings from this study can be used to inform mental health professionals, the child welfare system, grandparent kinship caregivers, nonkinship foster families, and serve as a guide to future research.</p>

Significant discrepancies between the various published architectonic parcellations of the ventromedial and orbital frontal cortex of the human and the macaque monkey brains present a formidable obstacle for research directed at understanding the normal cognitive function of this region in the healthy brain and its involvement in a spectrum of psychiatric diseases. The present thesis addresses this problem by describing a revised parcellation of the ventromedial and orbital frontal cortex based upon quantitative measurements of cortical architectonic features which distinguish between spatially discrete areas in the human brain and between comparable areas in the macaque monkey brain. To facilitate the communication of results within the general neuroscience community, the boundaries of the parcellated areas will be identified by stereotactic coordinates and in terms of their relation to the sulcal morphology of the cortex. Considerable emphasis is placed on describing the method of sampling the cortical architecture developed as a part of this thesis and designed specifically to measure features of the cortical architecture which can serve in cross species comparisons. / Il existe des anomalies importantes publiées entre les parcellisations architectoniques du cortex frontal ventromedial, orbital humain, et celui des singes macaques. Cela présente un défi interessant pour les chercheurs qui tentent de comprendre la fonction cognitive normale de cette région dans le cerveau sain, ainsi que son rôle dans un éventail de maladies psychiatriques. Cette thèse aborde ce problème en décrivant une parcellisation révisée du cortex frontal ventromedial et orbital. Elle se base sur des mesures quantitatives de caractéristiques architectoniques corticales, tout en distinguant entre les régions de l'espace discret du cerveau humain et les régions comparables dans le cerveau du singe macaque. Pour faciliter la divulgation des résultats, au sein de la communauté générale des neurosciences, les frontières des régions parcellés seront identifiées par leurs coordonnées stéréotactiques et leurs relations avec la morphologie sulcale du cortex. Il est à noter qu'un accent particulier est mis sur la description de la méthode d'échantillonnage de l'architecture corticale. Cette méthode, partie intégrale de la thèse, est concue spécifiquement pour mesurer les caractéristiques de l'architecture corticale et peut servir à faire des comparaisons hétérospécifiques entre espèce.

Background: Migration is known as a risk factor for schizophrenia and related disorders, but the magnitude of the risk in second-generation migrants is unclear. This study aims at determining the risk of psychosis in first- and second-generation migrants and exploring sources of variation. / Methods: A systematic review of population-based incidence studies of psychosis among first- and second-generation migrants was conducted. Descriptive and meta-analytic syntheses of identified studies were performed and sources of heterogeneity were examined. / Results: Nearly all migrant groups were at increased risk for psychotic disorders. The magnitude of the risk was similar in first- and second-generation migrants, but varied considerably according to ethno-racial status, social contexts and methodological variables. / Discussion: The risk clearly persists into the second generation, indicating that post-migration factors are more important than pre-migration factors or migration per se. The observed variability suggests that socio-environmental determinants contribute to the onset of psychotic disorders. / Contexte: L'immigration est associée à un risque accrû de troubles psychotiques, mais le doute persiste quant au risque chez les immigrants de deuxième génération demeure. Cette étude vise à évaluer le risque de psychoses des immigrants de première et deuxième génération et à en explorer la variabilité. / Méthode: Une revue systématique des études d'incidence de psychoses chez les immigrants de première et deuxième génération a été menée. Des synthèses descriptives et méta-analytiques des études ont été complétées. Les sources d'hétérogénéité ont été examinées. / Résultats : Presque tous les groupes d'immigrants ont un risque accrû de développer des troubles psychotiques. Le risque est comparable pour les deux générations, mais son ampleur varie considérablement selon le statut ethno-racial, le contexte social et la méthodologie. / Discussion : La persistance du risque dans la deuxième génération indique que les facteurs post-migratoires sont plus influents que les facteurs pré-migratoires ou la migration. La variabilité observée suggère que l'environnement social contribue au développement des troubles psychotiques.