Fifty-five adolescents with Type 1 diabetes, who were receiving secondary care services from diabetes clinics and pediatricians, were followed for three months in this exploratory community study. Measures of parental depression, marital distress, general family functioning, and diabetes-specific family functioning were obtained during an assessment of both parents and adolescent. The 24-hour recall adherence interviews were conducted separately with both the parent and adolescent on six occasions over the three months, and metabolic control was measured by HbA1c levels at the onset and end of the study. Multiple regression analyses showed that adherence was not associated with control. Adolescents who had been diagnosed longer were in worse metabolic control. Family relations were not linked with glycemic control and their influence varied on the five dimensions of adherence. The family relations variables, as a model, was significant in predicting diet amount adherence, accounting for 32.8% of the variance, with parental depression and general family conflict accounting for most of it. The family relations model was significant in predicting exercise adherence, with diabetes-specific guidance-control, accounting for 37.2% of the variance. Controlling for chronological age and gender, adolescent depression, as a measure of child adaptation, was not a significant predictor of glycemic control or adherence. However, both gender and chronological age accounted for 39.2% of exercise adherence. Glycemic control was consistent, with 75% of the adolescents displaying stable controlled and non-controlled metabolic control throughout the study. Metabolic control, treatment adherence and frequency of insulin omissions were similar for those receiving treatment from a diabetes clinic versus a pediatrician, Using an insulin sliding scale improved metabolic control, whereas adherence was similar for the groups. Males and females omitted insulin injections equally across the three adolescent age groupings and metabolic control was worse for those who missed insulin injections. Neither adherence nor family relations differentiated between the adolescents who missed or did not miss insulin injections. Parental involvement in the diabetes regime differed by gender, with parents remaining involved with females for longer. Results were discussed in the context of adolescent development and the systems social/ecological model of adaptation and coping developed by Kazak (1989).

Objectives. The primary objective of this study is to identify predictors of leisure time physical activity (defined as the reported level of energy expenditure in non-work activities) in the adult population of Ontario. The secondary objective of this study is to compare the predictors in different subgroups of the Ontario population. Subgroups divided by age group, gender and whether the subject lived in a rural or an urban area will be examined specifically. Methods. Two different software packages were used for this thesis. Statistical Analysis Software (SAS) was used for preliminary analyses. Final models were tested using Statistical Analysis for Correlated Data (SUDAAN) software which is designed to adjust for the multi-stage sampling design. Subjects were included in this study if they were over the age of 18. Energy expenditure (NEW), the outcome variable, was calculated by summing the 20 different activity specific scores. Twenty-nine independent variables were considered as potential predictors. Three variables were excluded because they were found to be collinear with other potential predictors. The main statistical method used was multiple linear regression. (Abstract shortened by UMI.)

This research examines the two-year period prevalences and gender-specific correlates for self-reported gonorrhea, chlamydia, genital herpes, and genital warts among 43,192 sexually experienced Canadians aged 15 to 59 years in the 1996--97 National Population Health Survey. Reporting multiple partners in the past year was consistently related to higher prevalences of STD. Regular alcohol consumption was a potential indicator of a higher risk lifestyle that places men and women at increased risk for chlamydia and genital herpes. Canadian-born respondents were significantly more likely to report STD, which may be a result of respondent error. Gender, age, and age at first intercourse were also important correlates, acting as both direct risk factors influencing susceptibility and as markers of higher risk sexual activity. Although the survey relies on self-reports of STD experience, in combination with clinic-based studies and surveillance it can be a useful tool for targeting prevention strategies for the general population.

Since research has implicated a role for serotonin function in smoking abstinence and in smoking behavior, the present study examined the effects of a tryptophan-depleting amino acid mixture and the subsequent smoking of a single cigarette on the nicotine withdrawal syndrome, mood and quantitative electroencephalography (EEG) in chronic smokers acutely deprived of smoking. In a double-blind, placebo-controlled, repeated measures design, eighteen male smokers were tested on two separate occasions, three days apart. On each occasion they: (a) ingested a nutritionally balanced amino acid mixture containing tryptophan or ingested a similar mixture devoid of tryptophan, and (b) sham smoked and smoked a single cigarette. Nicotine withdrawal symptoms, mood states, EEG and expired-breath carbon monoxide (CO) concentrations were measured four times: (a) immediately before smoking deprivation and ingestion of the amino acid mixtures (baseline); (b) 5 hr after smoking abstinence and ingestion of the amino acid mixtures; (c) immediately after sham smoking, and (d) after cigarette smoking. Total plasma tryptophan levels were measured two times: before and 5 hr after amino acid mixture ingestion. A significant reduction of plasma tryptophan (71%) was achieved by the tryptophan-depletion mixture. Smoking deprivation led to clear time-dependent increases in negative mood state and nicotine withdrawal ratings and reduced EEG activation. While acute tryptophan depletion did not exacerbate this withdrawal in abstinent smokers as evidenced by the absence of change in mood and withdrawal ratings, it was associated with altered brain state arousal as indicated by the reduction in alpha2 amplitude. While the smoking of a cigarette reduced and reversed to baseline some of the smoking abstinence-induced effects, these effects were not influenced by the tryptophan depletion mixture. Localized and lateralized EEG effects in abstinent smokers and following tryptophan depletion were also not observed. These findings suggest that in chronic male smokers reduced serotonin neurotransmission is not an important characteristic of acute smoking withdrawal effects. These results do not support previous research that has implicated altered serotonin function in tobacco withdrawal and in smoking behavior.

Driving ability may be adversely affected by many medical conditions and many jurisdictions therefore allow for a restricted license that permits driving under specified conditions. The objective of this retrospective cohort study was to evaluate restricted licensing by comparing "at-fault" crash and traffic violation rates for drivers with a restricted license to the general driving population and also to compare driving pre and post restriction. Following multivariate Poisson regression, the adjusted IRR for "at-fault" crashes and traffic violations for restricted versus non-restricted drivers were 0.92 (95% CI, 0.89 to 0.95) and 0.87 (95% CI, 0.85 to 0.90) respectively. Interventional time series analysis demonstrated a significant decrease in "at-fault" crash and traffic violation rates post imposition of restrictions. Restricted licensing programs are effective and allow persons with decreased driving ability due to medical conditions to continue driving under specific conditions.

Introduction. Statins may be under-prescribed in clinical settings. This study was undertaken to determine if the same is true in the military. The cost-effectiveness of statin therapy in patients identified by current Canadian cholesterol guidelines was also explored. Methods. Charts of 1424 Canadian military personnel (age ≥ 45) were reviewed at eleven Canadian bases. Risk factors and cholesterol values were used to identify drug therapy candidates and patients not being treated to target values. Cost-effectiveness ratios were estimated based on a systematic review of the literature. Results. 53/111 patients on therapy were not being treated to target cholesterol levels, while 172/1313 not on therapy were drug therapy candidates. An average of 2.89 years of life saved (YOLS) in drug therapy candidates was forecasted, costing less than $10,000/YOLS. Conclusion. The health benefits of statin therapy in this population are substantial and the cost-effectiveness is acceptable. Statin therapy warrants greater attention as a preventive strategy.

The combination of ethnicity and birthplace was used to identify first and second generation Chinese immigrants and US born white Americans. Cancer incident cases for three comparison groups were obtained. Population counts for each study group were extracted from The Integrated Public Use Microdata Series (IPUMS-98). Direct Age-standardized incidence rates (ASIRs) were calculated using the "world population" as a standard. ASIRs were compared among first, second generation Chinese immigrants and US born white Americans for nasopharyngeal, esophageal, stomach, liver, colon, rectum, lung, female breast and prostate cancers. Observed, relative and cause-specific survival rates were calculated for the three study groups. The advantages and disadvantages of the three survival rates were compared. Cause-specific survival rates for female breast, prostate, colorectal, and lung cancer were compared among first and second generation Chinese immigrants and US born white Americans. Multivariate survival analysis was conducted using Cox proportional hazard model. Other prognostic factors, such as stage at diagnosis, age, gender, and had or did not have directed surgery during first therapy, SEER registry, and marital status, were examined. (Abstract shortened by UMI.)

This thesis study employed epidemiologic methods to investigate snowboarding injuries and, where appropriate, included alpine skiing injuries. There were two components: a descriptive component and an etiologic component. The injuries were described as proportions of the total number of respective sports injuries. Crude, specific and standardized injury rates were calculated. A variant of the case-control design was then used to identify potential risk factors for the more severe snowboarding injuries. This project built upon previous studies and contributes to the growing body of knowledge regarding snowboarding injuries. The large sample size provided statistical power often lacking in other studies. This project investigated 2,501 snowboarding injuries experienced at 71 ski centres across the province of Quebec during the 1996/97 ski season. The descriptions of snowboarding injuries in this project reinforce what has been published. However, the additional information provided by the participation data permits assessment of age and sex distributions in the injured sports enthusiasts. (Abstract shortened by UMI.)

This thesis evaluated the surveillance of communicable diseases on the island of Montserrat, and the island's preparedness to monitor emerging communicable diseases. The evaluation consisted of a review and assessment of the activities that make up the communicable disease surveillance system, and a survey of staff within the Ministry of Health designed to determine their level of satisfaction with surveillance and their suggestions for improvement. A survey of clinical staff was also conducted to determine their awareness of the presentations and management of two emerging diseases. The system was found to be simple, acceptable, flexible and useful. Staff reported being satisfied with most surveillance tasks. The local laboratory was found to be inadequate and the Ministry unprepared for monitoring emerging diseases. Recommendations include continuation of the existing system, development of guidelines for contact tracing and re-assessment of the role of the laboratory. Continuing education is needed for staff and patients.

A ce stade de notre travail, sans revenir en profondeur sur ce qui a deja ete dit, un bref rappel de notre cheminement merite d'etre fait. A l'aide de notre cadre conceptuel nous avons interroge le processus de creation et de modification des arretes municipaux de la ville d'Ottawa portant restriction sur l'usage du tabac dans le lieu de travail et les lieux publics. La question fondamentale qui traverse l'ensemble de ce travail etait de comprendre comment les acteurs sociaux particuliers s'y sont pris pour elaborer les deux By-laws. Nous avons ainsi pu mettre en lumiere la maniere dont le probleme du tabagisme avait ete defini en terme de sante publique, de morale et de facon plus globale en terme d'externalite negative. Dans la solution au probleme, nous nous sommes enquis de savoir comment l'autorite, a partir de la question du non-fumeur, en est venue a legitimer l'appropriation de la gestion du tabagisme par l'Etat. L'analyse du processus decisionnel des appelants a la cause a permis de montrer que la rationalite politique n'avait pas ete absolue mais qu'elle s'etait dotee d'emblee de solutions privilegiees empruntees dans son entourage institutionnel. (Abstract shortened by UMI.)